[Cardiac tamponade after central venous catheterization in a newborn infant]. / Tamponnade cardiaque après cathétérisme veineux central chez un nouveau-né.

BACKGROUND: Cardiac tamponade due to an intrapericardial infusion is a serious complication of central venous catheterization. CASE REPORT: An infant born at 35 weeks of gestation age, weighing 2300 g, was operated on at H10 for a duodenal stenosis. On day 2, a polyurethane central venous catheter was inserted for parenteral nutrition via his right internal jugular vein. A frank blood return was obtained and a chest X-ray taken 2 hours later showed that the tip into the catheter was in the right ventricle. Four hours after insertion, a sudden deterioration of the infant's status led to tracheal intubation and artificial ventilation on 100% oxygen; no improvement was noted. The heart rate was 135 bpm, but the differential blood pressure was decreased at 68/56 mmHg and there was no blood return on the catheter. Cardiac tamponade was then suspected and immediately confirmed by pericardial tap that yielded 10.5 mL of the infused solution. The catheter tip was then repositioned and a good blood return was obtained. The infant's breathing and hemodynamic status improved dramatically. CONCLUSION: The use of very thin and flexible central venous catheters does not eliminate the risk of perforation of the cardiac chambers. A cardiac tamponade must always be considered in children with a central venous catheter when a sudden deterioration of hemodynamic status is noted.

[What is the choice of training in neonatal intensive care? Analysis of wishes from 106 neonatologists]. / Quels choix pédagogiques pour la formation à la réanimation du nouveau-né? Analyse des souhaits de 106 néonatologues.

BACKGROUND: Improvement of the care to the neonate relys on an increased number of pediatricians in nurseries and adequate neonatal resuscitation training. METHODS: A questionaire about the optimal modes of neonatal resuscitation training was sent to 132 pediatricians in charge of a neonatal unit or a neonatal intensive care unit. Response rate was 80.3%. RESULTS: The training program was targeted to be regional for the organization and for the evaluation. Nevertheless, 41% of answers also favored local evaluation. Duties in neonatal intensive care unit or transportation system, with differences among areas, were the proposed training choices. The pediatrician was considered to be the first person as an instructor and also as a learner in a multidisciplinary training program. Cooperation between primary and tertiary centers physicians was proposed as the best way for training. Proposed criteria for evaluating training efficacy included neonatal mortality and meconium aspiration syndrome rates. Government funding was suggested in 92% of answers. CONCLUSION: It seems necessary to perform a wide neonatal resuscitation training program. This multidisciplinary approach should be regional and follow the guidelines of the neonatal study group.