André-Thomas (1867-1963), Initiator of Neonatal Neurology.

After a brilliant career as a clinician and anatomopathologist, André-Thomas (1868-1963) spent the last 30 years of his life validating the components of neurological examinations of newborns and infants. This novel approach was developed through long examinations of several hundreds of normal and sick children, notably those with anencephaly. By combining his vast knowledge of physiology with the results of his experimental work, André-Thomas built the foundations of a speciality that did not exist before his time: neuropaediatrics. His Études neurologiques (neurological studies), medical in nature but also very literary, echoing his illustrious predecessors of the 19th century, made him a transmitter of knowledge, a man of transition, from the anatomoclinical method of the 19th century to the standardised investigation techniques of the 20th century.

The Effect of Maternal Race, Ethnicity, and Nativity on Macrosomia Among Infants Born in the United States.

OBJECTIVES:  This study aims to elucidate the influence of race, ethnicity, and nativity on macrosomia rates, hypothesizing that higher rates are observed among White non-Latina mothers and United States (US)-born mothers. STUDY DESIGN:  We analyzed data from 1,791,718 US births sourced from the National Center for Health Statistics of the Centers for Disease Control and Prevention. Logistic regression analyses were conducted to examine the associations between macrosomia rates and maternal race, ethnicity, and nativity. RESULTS:  After excluding non-singleton, preterm, post-term births, and those with missing data, six maternal cohorts were identified: White non-Latina US-born (1,147,096) and foreign-born (75,542), Black non-Latina US-born (174,540) and foreign-born (32,200), and Latina US-born (223,968) and foreign-born (137,515). White non-Latina US-born mothers had the highest rates of excessive gestational weight gain (58.9%). Black non-Latina US-born mothers exhibited the highest rates of pre-pregnancy diabetes (0.7%) and obesity (29.5%). Macrosomia rates were highest among White non-Latina US-born mothers (10.7%) compared to other cohorts. After adjusting for socioeconomic and health-related factors, this group maintained the highest odds of macrosomia (OR: 1.876; 95%CI 1.832-1.922, P<0.001). CONCLUSION: Our findings reveal that White non-Latina US-born mothers experience the highest macrosomia rates, which persist after adjusting for known confounders. These results have significant implications for the development of gestational surveillance tools and targeted public health interventions aimed at improving pregnancy outcomes among high-risk cohorts.

An international study on implementation and facilitators and barriers for parent-infant closeness in neonatal units.

Importance: Parent-infant closeness and active parent participation in neonatal care are important for parent and infant health. Objective: To give an overview of current neonatal settings and gain an in-depth understanding of facilitators and barriers to parent-infant closeness, zero-separation, in 19 countries. Methods: Neonatal intensive care unit (NICU) professionals, representing 45 NICUs from a range of geographic regions in Europe and Canada, were purposefully selected and interviewed June-December 2018. Thematic analysis was conducted to identify, analyze and report patterns (themes) for parent-infant closeness across the entire series of interviews. Results: Parent-infant separation during infant and/or maternity care is very common (42/45 units, 93%), despite the implementation of family integrated care (FICare) practices, including parent participation in medical rounds (17/45, 38%), structured education sessions for parents (16/45, 36%) and structured training for healthcare professionals (22/45, 49%). NICU professionals encountered four main themes with facilitators and barriers for parent-infant closeness on and between the hospital, unit, staff, and family level: Culture (jointly held characteristics, values, thinking and behaviors about parental presence and participation in the unit), Collaboration (the act of working together between and within different levels), Capacities (resources and policies), and Coaching (education to acquire and transfer knowledge and skills). Interpretation: Implementing parent-infant closeness in the NICU is still challenging for healthcare professionals. Further optimization in neonatal care towards zero-separation and parent-infant closeness can be achieved by enforcing the 'four Cs for Closeness': Culture, Collaboration, Capacities, and Coaching.

Plasma copeptin is increased and associated with smaller kidney volume in young adults born very preterm.

Background: Plasma copeptin, a surrogate marker for vasopressin levels, is increased in neonates born preterm, particularly in those with a more severe neonatal course, as reflected by bronchopulmonary dysplasia. Copeptin levels in adulthood are unknown. Methods: In this case-control study of 101 adults born very preterm (<30 weeks of gestation) and 105 control adults born full-term, a comprehensive clinical and biological assessment was performed, including blood pressure measurements, kidney ultrasound and determination of plasma copeptin, renin activity, angiotensin II, aldosterone, apelin, sodium and potassium, serum and morning urine osmolality. Results: The median age in the study was 23.1 years [interquartile range (IQR) 21.2-24.8] and 57% were females. In males, the median copeptin levels were 8.2 pmol/L (IQR 6.3-12.4) and 6.1 pmol/L (IQR 4.3-9.0) in the preterm and term groups, respectively (P = 0.022). In females, the median copeptin levels were 5.2 pmol/L (IQR 3.9-7.6) and 4.0 pmol/L (IQR 2.8-5.7) in the preterm and term groups, respectively (P = 0.005). Adults born preterm with a history of bronchopulmonary dysplasia had further increased copeptin levels. The kidney volume, adjusted for height, was smaller and albuminuria was higher in the preterm group, and both were associated with higher plasma copeptin levels. Conclusions: Plasma copeptin is higher in young adults born preterm and is related to a more severe neonatal course and smaller kidney volume.

[How can the process of paternity in neonatology be boosted?] / Comment dynamiser le processus de paternalité en néonatologie ?

Premature birth is a test for fatherhood's process: it may hinder the ability to feel like a father or like a good father, and the ability to make the baby be part of the family line. A clinical research did explore how care givers in neonatal services may deploy psychic functions which support and revitalize a process of fatherhood which is potentially disturbed.

Haematological profile in foals during the first year of life.

Foals' haematological values change constantly during their first year of life. The use of updated age-based reference intervals (RIs) is imperative for providing accurate diagnosis and optimum care for sick foals. The authors' objective was to provide updated RIs for 13 haematological values in 2, 7, 14, 30, 90, 180 and 365-day-old foals and to investigate the changes over time in each measured value. Venous blood was collected at those ages from clinically healthy foals. Thirteen haematological values were analysed. The 95% RIs were reported using a bootstrapping method. Differences over time were examined using Friedman test. RIs for each of the measured values were calculated. Results showed noticeable trends in changes over time in several values. Nevertheless, white blood cell counts significantly increased between day 2 and day 90 (P=0.011) while lymphocyte counts increased from day 2 up to day 180 (P=0.033). The mean corpuscular haemoglobin and mean corpuscular volume (P=0.011) significantly decreased between day 2 and day 90. Normal haematological values in foals not only differ from those in adult horses but also change throughout the first year of life; thus, it is critical that clinicians use age-based RIs when treating sick foals.

[A nursing career caring for children]. / Un parcours infirmier au service des enfants.

Céline Crouvisier always knew she wanted to work with babies and resolved to apply herself in secondary school in order to be able to go on to train as a child health nurse.

Hand measurement data from human babies at birth, from 26 to 41 weeks estimated gestational age.

This article displays measurement data from the hands of human babies, taken at birth. Measurements were made on 25 individuals born pre-term, from 26 to 36 weeks EGA (Estimated Gestational Age), and on 36 individuals born at term, from 37 to 41 weeks EGA. Data were collected in the Neonatal Unit of the CHRU Jeanne de Flandre (University Hospital) in Lille, France, between January and May 2014. Seven kinds of measures were taken with a medical caliper on the hand, palm and digits.

[Advantages and special features of hospital preparations of parenteral nutrition in neonatalogy]. / Avantages et spécificités des préparations hospitalières de nutrition parentérale en néonatalogie.

INTRODUCTION: The care of premature infants requires specific, suitable parenteral nutrition, in which the dosage must be frequently adjusted. METHOD: A comparative analysis of four industrial standard parenteral nutrition formulations NP 100®, Pediaven AP-HP Nouveau-né 1®, Pediaven AP-HP Nouveau-né 2® and Numetah G13% E® and of two hospital preparations made specifically in hospital pharmacies produced by two separate university hospitals (Nutrine® HCL and Formule standardisée début de nutrition) was conducted. The comparison between the formulations focused on electrolytic compositions and protein/energy ratio. RESULTS: Formule standardisée début de nutrition and Pediaven AP-HP Nouveau-né 1® are free from (i) sodium and potassium, (ii) potassium respectively. Almost equivalent sodium concentration (19-27 mM) and more variable potassium concentration (∼9-26 mM) characterize the other formulations. Protein/energy ratio of Numetah G13% E®, Nutrine® HCL and Formule standardisée début de nutrition is 58% higher than that of NP 100®, Pediaven AP-HP Nouveau-né 1® and Pediaven AP-HP Nouveau-né 2®. DISCUSSION: Formule standardisée début de nutrition and Pediaven AP-HP Nouveau-né 1® are in accordance with the recommendations about hydro-electrolytic supplies during transition phase. Nutrine® HCL complies best to the recommendations about hydro-electrolytic account during stabilization phase. CONCLUSION: Hydro-electrolytic composition and protein/energy ratio of standard hospital parenteral nutrition formulations comply best to nutritional needs of premature infants.

Diffuse correlation spectroscopy for non-invasive, micro-vascular cerebral blood flow measurement.

Diffuse correlation spectroscopy (DCS) uses the temporal fluctuations of near-infrared (NIR) light to measure cerebral blood flow (CBF) non-invasively. Here, we provide a brief history of DCS applications in the brain with an emphasis on the underlying physical ideas, common instrumentation and validation. Then we describe recent clinical research that employs DCS-measured CBF as a biomarker of patient well-being, and as an indicator of hemodynamic and metabolic responses to functional stimuli.

O ruído da unidade de terapia intensiva neonatal após a implementação de programa educativo / Noise at the neonatal intensive care unit after the implementation of an educational program / El ruido de la unidad de cuidados intensivos neonatal después de la implementación de un programa educativo

O estudo verificou os níveis de pressão sonora no interior das incubadoras e na Unidade de Terapia Intensiva Neonatal, seis meses após a implementação de um programa educativo. Estudo quantitativo descritivo, realizado na Unidade de Terapia Intensiva Neonatal e no interior das incubadoras de um hospital. Foram registrados 151 horas e 30 minutos de níveis de pressão sonora da Unidade de Terapia Intensiva Neonatal e do interior da incubadora, em janeiro de 2009 e 2010. O maior e o menor Leq médios, antes do programa educativo na Unidade de Terapia Intensiva Neonatal foram 71,0 dBA e 59,0 dBA, respectivamente. Após a intervenção, registraram-se na Unidade de Terapia Intensiva Neonatal, Leq médio entre 80,4 e 52,6 dBA. Na incubadora, valores variaram de 79,2 a 40,0 dBA para 79,1 a 45,4dBA após a intervenção, permanecendo acima dos valores recomendados. Constatou-se que não houve redução do nível de pressão sonora após a intervenção. Sugerem-se estratégias para sensibilização da equipe, elaboração de guideline, mudanças arquitetônicas, e renovação e/ou manutenção preventiva de equipamentos.

The present study verified the sound pressure levels inside incubators and at the Neonatal Intensive Care Unit, six months after the implementation of an educational program. Quantitative and descriptive study carried out at the Neonatal Intensive Care Unit and inside the incubators of a hospital. It was registered 151 hours and 30 minutes of sound pressure levels at the Neonatal Intensive Care Unit and inside the incubators, in January 2009 and 2010. The highest and lowest mean Leq before the educational program at the Neonatal Intensive Care Unit were 71.0 dBA and 59.0 dBA, respectively. After the intervention, it was registered at the Neonatal Intensive Care Unit the mean Leq between 80.4 and 52.6 dBA. Inside the incubators, values varied from 79.2 and 40.0 dBA to 79.1 and 45.4dBA post intervention, remaining above the recommended values. It was verified that there was no reduction of sound pressure level after the intervention. Some strategies are suggested to sensitize the staff, preparation of a guideline, architectural changes, renovation and/or preventive maintenance of equipments.

El estudio verificó niveles de presión sonora en el interior de incubadoras en Unidad de Cuidados Intensivos Neonatal, seis meses después de la implementación de programa educativo. Estudio cuantitativo descriptivo realizado en Unidad de Cuidados Intensivos Neonatal en el interior de las incubadoras de un hospital. Fueron registradas 151 horas y 30 minutos de niveles de presión sonora en la Unidad de Cuidados Intensivos Neonatal y en el interior de incubadoras en enero de 2009 y 2010. El mayor y menor Leq medios, antes del programa educativo en unidad de cuidados intensivos neonatal fueron 71,0 y 59,0 dBA, respectivamente. Después de la intervención, se registraron en la Unidad de Cuidados Intensivos Neonatal Leq medio entre 80,4 y 52,6 dBA. Dentro de la incubadora, valores variaron de 72,9 a 40,0 dBA para 79,1 hasta 45,2 dBA después de intervención se mantuvo por encima de los valores recomendados. Se encontró que no hubo reducción del nivel de presión sonora después de la intervención. Se sugieren estrategias para la sensibilización del equipo, elaboración de guías, mudanzas arquitectónicas, renovación y/o manutención preventiva de equipamientos.

Enfermagem cuidando do recém-nascido na Unidade de Terapia Intensiva Neonatal: um olhar ético da ação profissional / Nursing care of the newborn in the Neonatal Intensive Care Unit: an ethical look at the professional action

Trata-se de um estudo do tipo qualitativo, sobre as ações experienciadas pela equipe de enfermagem no cotidiano da Unidade de Terapia Intensiva Neonatal (UTI Neonatal), tendo como objetivo apreender os aspectos éticos implícitos nas ações experienciadas pelos profissionais de enfermagem ao cuidar do recém-nascido (RN). Foram utilizados como referencial teórico-filosófico alguns autores renomados como: Mehry, Pegoraro, Pessini, entre outros. A abordagem metodológica aplicada no estudo foi a fenomenologia sociológica de Alfred Schutz, buscando, na intencionalidade das ações de enfermagem, a motivação que sustenta este cuidar. A aproximação face a face aos sujeitos do estudo deu-se solicitando o seguinte: Fale-me sobre a sua experiência ao cuidar de um RN no cotidiano da UTI. Para alcançar o objetivo proposto, utilizei as questões orientadoras da entrevista fenomenológica: O que você tem em vista ao cuidar do RN na UTI? Em relação à ética, o que você pensa ao cuidar do RN? As entrevistas foram realizadas com 16 profissionais da equipe de enfermagem da UTI de uma Maternidade Pública do Município do Rio de Janeiro, escolhidos de forma aleatória. Foram respeitados os critérios estabelecidos pela Resolução nº 196/96, garantindo a privacidade e o anonimato dos entrevistados, bem como aprovação do estudo pelo comitê de ética em pesquisa. A partir da análise das falas emergiram três categorias, que possibilitaram a apreensão dos aspectos éticos das ações de enfermagem na UTI como um típico. Esses profissionais têm em vista realizar o melhor cuidado desejando a cura e a alta do RN, apoiando-se na tecnologia para valorizar a perspectiva humana do cuidado na UTI e na possibilidade de agir com ética. Na realidade pesquisada, a tecnologia manifestou-se de maneira positiva no projeto intencional dos profissionais, mostrando uma enfermagem que acredita estar fazendo o seu melhor, envolvida com as questões éticas e humanas...

This is a qualitative study about experienced actions in the daily routine of the Neonatal Intensive Care Unit (NICU) by the nursing staff. It aims to understand implicit ethical aspects in experienced actions of nurses concerning the newborn care. Mehry. Pegoraro, Pessini and others renowned authors were used as theoretical and philosophical reference. The sociological phenomenology of Alfred Schutz was the methodological approach of the study as it seeks the motivation that confirms this care by the intention of nursing actions. The face-to-face approach to people of this study asked the following: Tell me about your experience in taking care of newborns in a NICU routine? Guiding questions of the phenomenological interview were used to achieve the proposed objective: What do you have in mind about taking care of newborns in a NICU? What do you think about when taking care of a newborn in relation to ethics? Sixteen professionals chosen at random of the nursing staff of a public hospital in the city of Rio de Janeiro carried the interviews out. The established criteria of the 196/96 resolution ensured the privacy and anonymity of the respondents and approves the study by the ethics committee on research. Three categories emerged from the analysis of the discourse and they allowed the understanding of ethical aspects of typical actions of the nursing staff in an Intensive Care Unit. These professionals aims to achieve the best care as they wants the newborn left the hospital well. So, they rely on technology in order to value the human perspective of care in the NICU and the ability to act ethically. The research proved that technology is a positive instrument in the intentional design of the nursing staff as it shows professionals who believe that ethical and human aspects help them to do their best...