ABSTRACT
BACKGROUND: The early vaccination with BCG of children with a high risk of tuberculosis straight from the maternity hospital has been recommended since October 2005. However, this recommendation has not often been followed. Practitioners feared that the suspension of the mandatory character of the BCG vaccine dating from July 2007 would result in a decrease in vaccine coverage. The goal of this study was to assess a program for early vaccination with BCG in the maternity hospital for high-risk children. METHODS: Intradermal vaccination with BCG-SSI of high-risk newborns, as defined by the Conseil Supérieur d'Hygiène Publique de France, at the maternity hospital of Versailles from May 2007 to May 2008. RESULTS: Six hundred and sixty children (35% of births with a sex ratio of 1.13) fulfilled criteria for vaccination in the maternity hospital. Among the high-risk newborns, 596 (89%), were vaccinated. The geographic origin of one or both parents was the main indication (98.6%) for the vaccination. Three main practitioners (two pediatricians and one nurse) performed 72.6% of the BCG intradermal injections. The other BCG vaccinations were given by occasional practitioners: pediatricians, a midwife, or medical students. A papule was subsequently observed more often when the practitioner was experienced: 96.8% for the main practitioners, 83.5% for the occasional practitioners. Fifty-six (8.3%) parents refused vaccination for their eligible newborn. CONCLUSION: From our experience, the early vaccination of the at-risk of tuberculosis newborn is well accepted in the maternity hospital and presents very few technical problems for an experienced team.
Subject(s)
BCG Vaccine/administration & dosage , Hospitals, Maternity , Tuberculosis, Pulmonary/prevention & control , Vaccination/statistics & numerical data , Female , France , Guideline Adherence , Health Policy , Humans , Immunization Programs/organization & administration , Infant, Newborn , Injections, Intradermal , Male , Practice Guidelines as Topic , Retrospective Studies , Risk , Risk Assessment , Risk Factors , Vaccination/methodsABSTRACT
During the cesarean section, the immediate proximity of the scalpel blade to the fetus exposes this latter to possible injuries. This article aims at reflecting on the measures to be developed in the prevention of fetal injuries during the cesarean section after a bibliographical analysis of the available data. Occurring in about 1% of the cesarean cases, the fetal injuries are most often minimal and localized at the scalp or the face, rarely requiring a surgical repair. Sometimes, they can have a functional, aesthetic, psychological and forensic impact. The associated risk factors substantially are the emergency cesarean, the "cutaneous incision/delivery" delay and a T- or J-shaped uterine incision. In this article we expose simple means enabling an incision of the uterine cavity, thus minimizing the fetal risk.
