[Management of newborn infants in maternity-neonatal intensive care units]. / Prise en charge des nouveau-nés en maternité par un service de réanimation néonatale.

BACKGROUND: Although in utero transfer seems actually the safest option when risk factors are identified, specialized transport teams remain important to consider for the neonatal overall management. SUBJECTS: From January 1988 through December 1992, 692 transports of 838 neonates were prospectively studied to determine effectiveness and safety of the Hospital Lenval's neonatal transport team. RESULTS: Neonatal transports were required respectively for prematurity (46.4%), acute fetal distress (13.8%), respiratory distress (10.1%), intrauterine growth retardation (7.8%), multiple pregnancies (5.2%), perinatal asphyxia (3.1%) and life-threatening congenital abnormalities (2%). Pediatric assistance was unplanned in most of the cases (80%). Assistance with a pediatrician before delivery was performed more frequently (70%) for premature babies (mean gestational age 34.1 +/- 3.1 wk) delivered by cesarean section in 66.4% of the cases; in this group, delivery room resuscitation was less aggressive. Assistance was performed after delivery less frequently (30%), approximately in one-half of the cases for neonatal distress: respiratory (33.9%) or neurologic (17.1%); in this group, delivery room resuscitation was more aggressive. In transit, ventilation support via endotracheal intubation was given to 17.9% of the babies. Neither death nor heavy complication occurred during transport. On arrival in the neonatal intensive care unit, hypothermia was noted in 9.6% of the cases, hypotension in 4.3%, hypoglycemia in 13.1% and metabolic acidosis in 10.4%. In our series, the overall mortality rate was 6%, and incidence of neurologic damage 3.3%. CONCLUSION: A skilled person in neonatal resuscitation available at every referring maternity and regional high-risk obstetric/neonatal combined centre are two recommendations which could provide improved neonatal management.

[Activity of pediatric emergency departments in 1991]. / Activité d'un service d'accueil des urgences pédiatriques en 1991.

The authors report the results of a prospective survey concerning the children examined in the pediatric emergency ward of the Lenval's hospital in Nice. The study was conducted over a period of 124 days, one month of each season, and included 3,611 children. There was a majority of boys (60.8%) and children older than 7 years (56.8%). The representation of foreign children was 11.2%. Most of the consultations were decided by the parents (86%); 6.2% were sent by a general practitioner and 1.1% by a pediatrician; 6.5% were conveyed through a professional public health service transport. Traumatology was the main surgical etiology and supplied the large majority of benign cases and 23% of the emergencies. Upper respiratory and bronchopulmonary tract infections and gastroenteritis represented 70% of medical etiologies. A complementary investigation, essentially a radiological examination, was carried out in 53.6% of cases. A wound suture was performed in 13% and a plaster immobilization in 9.2% of cases. The hospitalisation's rate was 22%. Emergencies represented 1.8% of cases. A surgical intervention with general anesthesia was performed in 4.4% of cases within 12 hours following the admission. A recent law (ministerial circular: 14.05, 1991) defines the organisation and working principles of the public emergency departments in France as requiring an uninterrupted activity, a continuous medical presence and an area for very short hospitalization. This should improve the quality of the pediatric emergency wards, providing that the financial means will be available.