Parental presence during painful or invasive procedures in neonatology: A survey of healthcare professionals.

BACKGROUND: Newborns in neonatology are exposed to invasive and painful procedures. The absence of parents during procedures revealed significantly high pain scores. OBJECTIVE: The aim of this study was to assess practices regarding the role of parents during painful and invasive procedures. METHODS: This was a prospective, observational, multicenter study in France in which 471 caregivers participated. Professional practices regarding the role of parents during painful procedures on their child were assessed. Univariate and multivariate analyses were performed to identify factors associated with parental presence during painful procedures. RESULTS: Parental presence was most often allowed during capillary blood sampling, nasogastric tube insertions, and vein punctures, whereas it was mostly restricted during central line insertions, extubations, lumbar punctures, and intubations. However, we found discrepancies depending on the type of facility and caregiver seniority. CONCLUSION: An important variability in practices concerning the role of parents during painful and invasive procedures on their child was reported.

[Management of jaundice in the newborn≥35 GW: From screening to follow-up after discharge. Guidelines for clinical practice]. / Ictère à bilirubine non conjuguée du nouveau-né de 35 semaines et plus : du dépistage au suivi après sortie de la maternité. Recommandations pour la pratique clinique.

Jaundice due to unconjugated bilirubin is an everyday condition in the neonatal period because it results from the adaptation of bilirubin metabolism at this time of life. Hyperbilirubinemia has a potential neurotoxicity and although it most often resolves spontaneously, it can lead to acute and sometimes chronic encephalopathy. The latter condition is called kernicterus and induces severe and irreversible neurological sequelae. This rare complication is still reported in all countries throughout the world even if severe hyperbilirubinemia can be prevented and critical points points of failure in jaundice management are identified. Jaundice management are identified, jaundice is the most frequent symptom during the first days of life and after discharge from the maternity ward but also the major cause of readmission in the 15 first days of life. Therefore in the past 20 years, numerous countries have written national practical guidelines for the management of neonatal jaundice using various methodologies. Most of the time, the guidelines resulted from expert consensus more than from an evidence-based argument. The Société française de néonatologie created a working group to provide the first French clinical guidelines for the management of jaundice in the near-term newborn (35 weeks and more). They were written following a physiopathological argument and taking into account both clinical risk factors for severe hyperbilirubinemia and interindividual variability in vulnerability to bilirubin neurotoxicity. Practical tools were also developed to facilitate implementation of the guidelines and are also included.

[How to assess clinical practice guidelines with AGREE II: The example of neonatal jaundice]. / Évaluation de la qualité d'élaboration d'une recommandation pour la pratique clinique avec la grille AGREE II : exemple de l'ictère néonatal.

BACKGROUND: Neonatal jaundice is a very frequent condition that occurs in approximately 50-70% of term or near-term (>35 GA) babies in the 1st week of life. In some cases, a high bilirubin blood level can lead to kernicterus. There is no consensus for the management of neonatal jaundice and few countries have published national clinical practice guidelines for the management of neonatal jaundice. The aim of this study was to assess the quality of these guidelines. METHODS: We conducted a systematic review of the literature for national clinical practice guidelines for the management of neonatal jaundice in term or near-term babies. Four independent reviewers assessed the quality of each guideline using the AGREE II evaluation. For each of the clinical practice guidelines, the management modalities were analyzed (screening, treatment, follow-up, etc.). RESULTS: Seven national clinical practice guidelines were found (South Africa, USA AAP, UK NICE, Canada, Norway, Switzerland, and Israel). The AGREE II score showed widespread variation regarding the quality of these national guidelines. There was no major difference between the guidelines concerning the clinical management of these babies. DISCUSSION: The NICE guideline is the most valuable guideline regarding the AGREE II score. NICE showed that, despite a strong and rigorous methodology, there is no evidenced-based recommended code of practice (RCP). Comparing RCPs, we found no major differences. CONCLUSION: The NICE guideline showed the best quality. The AGREE II instrument should be used as a framework when developing clinical practice guidelines to improve the quality of the future guideline. In France, a national guideline is needed for a more standardized management of neonatal jaundice.

Computed tomographic study of the optimal safe implantation corridors in feline thoraco-lumbar vertebrae.

OBJECTIVE: To define the implantation corridors in feline thoraco-lumbar vertebrae (T10-L7) using computed tomography (CT) for optimal safe placement of the implants (screws/pins) in spinal column stabilization. STUDY DESIGN: Computed tomographic study. MATERIALS AND METHODS: Computed tomography images of feline spinal column (n = 10) were used to define the optimal safe implantation corridors (OSIC) in the transverse plane. The OSIC were defined as corridors allowing the greatest amount of bone purchase with safe margins for implantation of the bicortical implants. They were characterized by their insertion point, optimal angle (from the midsagital plane), maximum and minimum safe angles (from the same insertion points), length, and width. RESULTS: The OSIC are located within the vertebral bodies. Insertion points were situated at the level of the vertebro-costal joint or the base of the transverse process of the vertebral body for thoracic and lumbar vertebrae, respectively. The mean optimal angle of the OSIC was 90.2° with a maximum deviation angle from optimal angle of 10° dorsally and 8.8° ventrally in thoracic vertebrae, and 90.5° with a maximum deviation angle from the optimal angle of 8.4° dorsally and 7.6° ventrally in lumbar vertebrae. CONCLUSION AND CLINICAL RELEVANCE: Corridors drilled in the vertebral body perpendicular to the midsagital plane (90°) or with a small angle (≤10°) of deviation from the optimal angle provide an optimal safe placement of bicortical implants. However, perpendicular implant placement may not always be feasible due to surrounding soft tissue structures.

Ultrasonographic adrenal gland measurements in healthy Yorkshire Terriers and Labrador Retrievers.

An upper threshold of 7.4 mm for maximal adrenal gland diameter is commonly used to detect pituitary-dependent hyperadrenocorticism ultrasonographically in dogs. There is a substantial overlap between adrenal gland diameter of healthy dogs and of those with pituitary-dependent hyperadrenocorticism. The aim of this study is to determine the measurements of both adrenal glands, in particular, of the height at the caudal glandular pole in a longitudinal plane, in the Labrador retriever and Yorkshire terrier, two breeds widely represented in the population suspected of hyperadrenocorticism. Seventeen Labrador retrievers and 24 Yorkshire terriers considered healthy were included in the study. Adrenal gland measurements were taken on static images and comprised in measurements of the length in a longitudinal plane (L), of the height at the cranial (CrHLG) and caudal pole (CdHLG) in a longitudinal plane and in a transverse plane (CrHTR and CdHTR, respectively), and of the width at the cranial and caudal poles in a transverse plane (CrWTR and CdWTR, respectively). This study established new upper thresholds for the left and right height at the caudal pole measured in a longitudinal plane: 7.9 mm (left) and 9.5 mm (right) for the Labrador retrievers and 5.4 mm (left) and 6.7 mm (right) for the Yorkshire terriers. All the measurements were significantly different between the two breeds. There was a significant relationship between CdHTR and CdHLG, and the age of the dogs for both breeds.

[Deadly nightshade (Atropa belladonna) intoxication in a 2-year-old child]. / Un cas d'intoxication aiguë par la belladone (Atropa belladona) chez une enfant de 2ans.

Plant intoxications account for 5% of all intoxication cases according to French anti-poison centers. We report an uncommon case of intoxication with deadly nightshade (Atropa belladonna) in a 2-year-old child. The child presented at the ER with an atropinic syndrome, both central and peripheral, after ingestion of wild berries a few hours before. The fruit and leaves brought in by the mother allowed the anti-poison center to identify belladonna, in agreement with clinical findings. The child was kept in the intensive care unit for 48 h and progression was favorable with symptomatic treatment.

[Sternal cleft: repair during the neonatal period]. / Fente sternale : intérêt d'une prise en charge chirurgicale néonatale.

Sternal cleft is a rare congenital abnormality. We report on a neonatal case of sternal cleft with median raphe with a follow-up of 3 years. We review the advantages of surgical repair in the neonatal period because the flexibility of the chest wall is maximal and compression of underlying structures is minimal.

Ilio-psoas abscess in neonates: treatment by ultrasound-guided percutaneous drainage.

Ilio-psoas abscess is rare in neonates and is usually treated by surgical drainage. We report two cases of ilio-psoas abscess in 15- and 21-day-old infants successfully treated by US-guided percutaneous drainage as a supplement to antibiotic therapy. Clinical improvement was observed within 24-48 h of drainage and subsequent imaging demonstrated resolution of the abscess cavity. The analysis of these cases and of those previously reported indicates that imaging is essential for diagnosis. In neonates, US-guided percutaneous drainage may represent the first-choice treatment of this disease in association with antibiotic therapy.

Physiological parameters evaluation following apnea in healthy premature infants.

To assess responses to central and obstructive apnea, we performed 10-hour polygraphic recordings in healthy 33-34 wGA infants. Each apnea period was paired with a control period. The presence of body movements (BM) and augmented breaths (AB), the EEG, heart rate (HR), respiratory rate, phase relationships between thoracic and abdominal respiratory movements, and changes in SaO(2) were evaluated. No apnea caused awakening. Apnea were not usually followed by motor events (no significant differences with control periods), with the exception of most obstructive apnea longer than 10 s. The mean percentage of changes following apnea, normalized to baseline values, was significant for the EEG (frequency slightly increased, mainly after obstructive apnea), HR (deceleration), and respiratory rate (increased). However, the mean values masked heterogeneity across apnea in the direction of the change in each parameter. The only significant correlation was between changes in HR and SaO(2). The increases in EEG frequency and respiratory rate seen in our study can be considered markers of CNS activation, but were small and inconsistent. The heart rate decelerations and SaO(2) changes are not activation markers. Thus, mechanisms underlying restarting of breathing efforts following apnea remain unclear in premature babies. Our investigation establishes the importance of using control data to distinguish between spontaneous and apnea-related events.

[Neonatal alloimmune neutropenias. Importance of treatment with granulocyte colony-stimulating factor (G-CSF). Report of 2 new cases]. / Neutropénies allo-immunes néonatales. Intérêt du traitement par facteur de croissance granuleux (G-CSF). Deux nouvelles observations.

UNLABELLED: Alloimmune neonatal neutropenia is a rare event. Usually asymptomatic, it may however in some cases result in a severe sepsis. Treatment with recombinant granulocyte colony-stimulating factor (G-CSF) has been recently proposed. CASE REPORT: We report two new cases in infected newborns of a successful treatment of alloimmune neonatal neutropenia with G-CSF, resulting in complete neutrophil recovery in less than 72 hours. Moreover, the treatment was well tolerated. CONCLUSION: The analysis of these two cases and of those previously reported indicates that G-CSF represents the first-choice treatment in this affection when infectious signs are present in the neonate.

[Urinary tract infection in the newborn infant]. / L'infection urinaire du nouveau-né.

Urinary tract infection in the first month of life may be revealed by isolated fever, poor weight gain or severe sepsis. It is more frequent in male infants. Escherichia coli is the most common infecting agent. A urinary tract malformation is found in approximately 30% of the cases. In most cases intravenous treatment with an association of cephalosporin and aminoside is efficient. However, because of the possible involvement of an enterococcus, amoxicillin must be added until the result of the urine culture is available. Prophylaxis with oral administration of antibiotics is recommended in case of urinary tract malformation.

[Intracranial hypertension in a newborn treated with quinolone]. / Hypertension intracrânienne chez un nouveau-né traité par quinolones.

BACKGROUND: Fluoroquinolones have not received administrative authorization for use in children, but because of multiresistant pathogens in neonatal intensive care, floroquinolones may be the only alternative. CASE REPORT: A premature infant exclusively nourished by parenteral nutrition developed enterobacteria sepsis. Ceftazidine was given initially but resistance led to the prescription of fluoroquinolone. Signs of intracranial hypertension developed 3 days after onset of fluoroquinolone treatment and regressed 48 hours after its withdrawal. DISCUSSION: The main potential adverse effects with fluoroquinone in the newborn are arthropathy, photosensitivity, discoloration of the teeth and neurological disorders. Intracranial hypertension is a known complication of nalidixic acid both in adults and children, but to our knowledge has not been previously with floroquinolone in the newborn.

[Long QT syndrome under cisapride in neonates and infants]. / Allongement de l'espace QT sous cisapride chez le nouveau-né et le nourrisson.

BACKGROUND: Cisapride is frequently used in the newborn and infant for treatment of gastroesophageal reflux. Twisting-spikes have been reported in adults due to overdosage or therapeutic interaction. We report seven cases of QT prolongation in infants treated with cisapride. PATIENTS AND METHODS: Seven children (one full-term, two mature preterms, four preterm babies), aged (mean, range) 41.8 +/- 21 days (14-79) weighing 2.1 +/- 1.1 kg (1.2-4), free from any cardiac abnormality, except one patent ductus arteriosus, have been studied by ECG and Holter monitoring. They received cisapride at a mean dose of 1.31 +/- 0.2 mg/kg/d (between 1 and 1.7 mg/kg/d). RESULTS: The corrected QT (QTc: N < 450 ms) was increased to 486 ms (450-540) with a notched T-wave pattern. No arrhythmia was detected. In five cases, cisapride was stopped and changed to metoclopramide. Cisapride dosage was reduced to 0.8 mg/kg/d in the two others. No other therapeutic modification was done. A control ECG performed 48 hours after therapeutic changes showed a QTc shortening of 74 +/- 18 ms (45-90) and the disappearance of the notches independent of any heart rate changes, leading to normal QTc values: 413 +/- 21 ms (390-440). CONCLUSION: High cisapride dosage in preterm, newborns and infants seems to favor QT prolongation which is reversible when dosage is reduced or drug is stopped. The use of cisapride in combination with other drugs known to increase QT should be done with extreme caution.

Prolongation of hospital stay and extra costs due to hospital-acquired infection in a neonatal unit.

A case-control study to evaluate the mean extra stay and corresponding cost of neonates acquiring a hospital-acquired infection (HAI) was performed on all patients admitted to a neonatology unit and discharged alive in 1994. Cases were identified from medical records. Controls were matched to cases for birthweight, gestational age, mode of admission to the unit, previous stay in an intensive care unit and presence of a central venous catheter. Costs were taken as those of the extra days attributable to HAI, i.e. the mean difference in the length of stay between cases and controls. Among a cohort of 616 neonates, 34 (5.5%) had one or more HAIs (average = 1.1). The mean extra cost per infected case was 52,192 FF (US$10,440), corresponding to 5.2 extra days in hospital.