Improving safety of preparation and administration of medicines and enteral nutrition in a neonatal care unit: Global risk analysis.

OBJECTIVE: To date, few adapted pharmaceutical forms are available for infants leading to multiple steps of preparation and medicines dilution before administration. The main purpose of this study was to assess the risks on the steps of preparation and administration of medicines in a neonatal care unit and to propose corrective actions to ensure the medicines safety. METHODS: A global risk analysis was performed, conducted by a multidisciplinary working group of 9 experts, that is 9 meetings. RESULTS: We identified 57 scenarios: 59,6% of scenarios had an initial criticality C1, 31,6% C2 and 8,8% C3. The most risky phases were phases of needs identification including the step of doses calculation and phases of preparation. The strategic management together with the human factor were the most risky dangers. Nineteen corrective actions were proposed. After implementing those actions, 82,5% of scenarios had residual criticality C1, 17,5% C2 and no scenario had residual criticality C3. Follow-up actions have been implemented to control the residual risk as in service training. CONCLUSION: Neonatal unit care is a risky service and should be a priority in the risk management policy. This analysis joins the quality policy implemented in the hospital and similar risk analysis is on process.

[Moderate preterm birth 34-37 weeks: Description of immediate neonatal causes and consequences in a level 2 maternity]. / Prématurité modérée 34-37SA : description des causes et conséquences néonatales immédiates dans une maternité de niveau 2.

OBJECTIVES: In France, 75% of annual preterm births happen between 34 and 36 weeks+6 days. This study's goal is to describe the main causes and short-term consequences. METHODS: Two hundred and ninety-seven computerized files of patients who gave birth between 34 and 36 weeks+6 days at the hospital Foch's maternity were analyzed retrospectively. Descriptive statistical analysis was done with XLSTAT 2008. RESULTS: Among the 6028 births, 4.9% happened between 34 and 36 weeks+6 days and 43.1% of these births were medically induced. The two main causes of induced late preterm birth were: pre-eclampsia (28.9%) and premature rupture of membranes (25%). In spontaneous deliveries, newborns less often require respiratory support at birth (17.2% vs 31%; P=0.02) and are significantly less likely to be hospitalized in neonatology (54% vs 72.3%; P<0.01). C-section rates (71.1% vs 17.75%; P<0.01) and post-partum hemorrhages' probability (10.2% vs 3%; P<0.01) are significantly higher than for medically induced deliveries. CONCLUSION: Better knowledge of late prematurity causes and consequences would help limit medically induced births after 34 weeks.

[Cystic adenomatoid malformation of the lung revealed in a newborn infant by an image of a lung abscess]. / Malformation kystique adénomatoïde du poumon révélée chez un nouveau-né par une image d'abcès pulmonaire.

BACKGROUND: Cystic adenomatoid malformation, a rare pulmonary malformation, usually appears as a cystic mass, radiologically. It may be infected and confusion has also arisen in distinguishing it from pneumonia with pneumatoceles. CASE REPORTS: A full-term boy suffered from severe neonatal respiratory distress. Pregnancy had been uneventful despite the fact that his mother had insulin-dependent diabetes. Prenatal ultrasonographies did not reveal any abnormality. On day 2, X-rays showed a right pulmonary mass that appeared solid. The patient was treated for E Coli sepsis. Subsequently, the pulmonary mass became lacent, cystic, fluid-filled, resembling an abscess; the CT scan confirmed these features. As the lesion increased in volume, a limited resection was performed. Histologic examination showed adenomatoid proliferation of bronchiolar elements with formation of cysts and necrosis. CONCLUSION: Infection of cystic adenomatoid malformation may supervene the first days of life resulting in a lung abscess appearance.