Subject(s)
Hospitals, Maternity , Parents/education , Patient Education as Topic , Pertussis Vaccine/administration & dosage , Vaccination , Whooping Cough/prevention & control , Directive Counseling , Female , Follow-Up Studies , Hospitals, Maternity/statistics & numerical data , Humans , Infant, Newborn , Interviews as Topic , Male , Pregnancy , Vaccination/psychology , Vaccination/statistics & numerical dataABSTRACT
INTRODUCTION: Following Nordic and Anglo-Saxon countries, France is directing towards an early discharge policy from maternity hospitals. French National Authority for Health has published recommendations focusing on the importance to highlight the dangers of such a policy so as to be able to anticipate them. AIM: To describe the complications diagnosed in the newborn infants from day 2 to the current hospital's discharge (noteworthy, if infants are discharged early, these complications may occur at home) to determine predictive factors and to validate those proposed by the French National Authority for Health. METHOD: Prospective study conducted in the maternity ward of Nancy's level III facility, from January 6th to May 6th 2005. RESULTS: Nine hundred and three newborn infants were included. Forty-two (4.6%) presented with complications diagnosed from day 2 to hospital's discharge, among which 4 required urgent neonatal care. The most frequent complication was hyperbilirubinemia: 23 newborns were treated with phototherapy between day 2 and day 10. Statistically significant risk factors of hyperbilirubinemia after day 2 in multivariate analysis were instrumental vaginal delivery (OR=2.94; CI 95% [1.04-8.34]) and jaundice before day 2 (OR=7.39; CI 95% [2.66-20.55]). According to the French National Authority for Health's policy, 33 among 42 infants presenting with a complication would have been withdrawn from an early discharge program. CONCLUSION: In our population, French National Authority for Health's recommendations were relevant to guide an early discharge project.
Subject(s)
Health Policy , Patient Discharge , Female , France/epidemiology , Humans , Infant, Newborn , Infant, Newborn, Diseases/epidemiology , Infant, Newborn, Diseases/therapy , Male , Patient Readmission/statistics & numerical data , Prospective Studies , Risk Factors , Time FactorsABSTRACT
We report the case of an 2-year-old boy presenting an essential polycythemia since birth, with details of the diagnostic procedures used and clinical course. Pediatric cases are very rare, and a secondary acquired polycythemia should be first investigated. Most causes of primary childhood polycythemia remains unknown. Erythropoietin (EPO) level may help to separate diseases with high EPO (Chuvash, or yet unclassified), or with normal/low EPO (congenital with truncation of the EPO receptor, polycythemia vera-Vaquez disease-, or currently with unknown mechanism).
