[Assessment by a national survey of needs for NICU and intermediate NICU in France]. / Evaluation nationale des besoins en lits de réanimation et soins intensifs néonatals.

UNLABELLED: The setting up of the so-called "decrees on perinatal safety" on October 1998 has been associated with many difficulties which were apparently related to the lack of beds for intensive care units, special care units and neonatal medicine. This led to a national survey. OBJECTIVES: The aim of the survey was : (1) to collect the number of neonates requiring hospitalization in NICU and special care units over a 1-week period in metropolitan France and overseas departments and territories; (2) to assess the needs in equipments and care-givers. METHODS: The writs to be included in the survey were previously identified. Each day of hospitalization was classified as needing an intensive care unit, a special care unit or a neonatal unit. Then it was classified as well fitted or badly fitted. RESULTS: Two hundred and forty units (90% of the French units) from 204 hospitals participated in the survey and 3678 neonates were included and accumulated 17 583 days of hospitalization (NICU: 2728; special care: 5047; neonatal medicine: 9808). One thousand and five hundred and ninety hospitalization days did not fit well either with the technical level required by the neonate or/and with the location of the parents' home (9.2%): 23.1% in overseas departments and territories; 12% in metropolitan France. The main reasons for maladjustment were: a too high technical level: (59%); an insufficient technical level: (21%) (19 neonates could not be admitted in a NICU as they needed). The survey included 158 NICU and special care units. Taking into consideration the French law: the lack in equipment was: 294 ventilators, 231 cardio-respiratory monitors, 116 pulse oxymeters and 513 blood pressure monitors; 561 additional pediatricians were needed to allow a medical night duties including seven doctors in each NICU and each special care unit; 1878 additional nurses were also needed. Making the assumption that the mean occupation rate of the neonatal beds should be 70%, the needs were calculated for 1000 live births: metropolitan France: 0.76 (0.74; 0.78) in NICU; 1.45 (1.43-1.47) in special care units; overseas departments and territories: 2 (1.8-2.5) in NICU; 3.5 (3.2-3.8) in special care units. CONCLUSION: Finally, the main deficit was not related to the number of beds but to the equipment and number of care-givers. The status of overseas departments and territories was particularly worrying.

[A cry of alarm from non-university hospital pediatric departments. What future?]. / Cri d'alarme des services de pédiatrie des hôpitaux non universitaires. Quel avenir?

A survey by questionnaire was carried out among pediatricians of the departments of pediatrics of the non university hospitals in France in order to know the activity and the conditions of work of these departments. Responses were obtained from 84 of the 140 departments of pediatrics. The results emphasized the important activity of these departments contrasting with frequent insufficiencies of the medical staff and equipment. Solutions are proposed in order to avoid an aggravation of the actual situation.

[The organisation of perinatal care in a rural area. An enquiry into the Limousin Region (author's transl)]. / Organisation des soins périnatals en zone rurale. Enquête sur la Région Limousin.

Improvement in mortality and perinatal morbidity in rural areas is the result of: The appointment of qualified obstetricians. The provision of modern methods of obstetrical monitoring. The fact that "'avoidable" mortality and morbidity persist in these same rural districts is related to: Premature deliveries and the difficulties of transporting the premature babies. The survival of "country deliveries". We propose three solutions to improve perinatal care in these regions: Transformation of rural maternity units which are under-equipped into Centres where pregnancy can be monitored properly. Avoidance of transfer of the newborn by making it easier to transport the mother to Centres that have a good obstetric and paediatric unit. Provision of a real liaison between the unit that has the obstetrician and paediatrician in it and the district rural maternity services.

PIP: The article presents the results of a survey conducted with questionnaires in all private and public maternity centers or obstetrical services in the Limousin, France. Limousin has mainly a rural population, and natality and perinatal mortality are lower than the national average. Provisions of modern methods of obstetrical monitoring and the availability of qualified physicians have undoubtedly helped to lower perinatal mortality and morbidity. However, mortality and morbidity cases which would be totally avoidable still persist, due mainly to the impossibility of transporting premature babies to a properly equipped maternity center, but also to the fact that a certain percentage of deliveries still take place at home, often under unsanitary conditions. Perinatal care in rural areas could be improved by: 1) transforming underequipped rural maternity units into centers where pregnancies can be properly monitored; 2) avoiding the transportation of a premature baby by moving the mother prior to delivery to a properly equipped center; and 3) providing for effective liaison between rural maternity services and fully equipped maternal health centers.