[Audit "Toys and incubators in neonatology"]. / Audit << Les jouets et les couveuses en néonatologie >>

Owing to an increase in nosocomial septicaemias in the Neonatalogy department, we've judged it necessary to consider the role of items not linked to the nursing procedures, and nevertheless present in the incubators, as well as the hygiene techniques applied to them. In November 2007, we've made a longitudinal prospective study consisting in an observation audit during 3 successive days, observing every single incubator with a newborn baby. In each incubator, we've checked whether there were or not items that weren't required by the nursing activities, along with their characteristics and the hygiene procedures applied to them. We've inquired as well whether the parents and the nursing staff knew and applied the required hygiene procedures. In 13 among the 17 incubators under survey, at least one item not strictly required by the nursing procedures could be found. The number of toys in each incubator varied from seven to one. Among the 33 toys surveyed, 24 (73%) of them showed a score of maximum fluffiness (4 out of 4), and only 10 wore labels giving cleansing advice from the manufacturers. Without any record about the cleaning/disinfecting of the toys brought in hospital, we have observed that the parents were given varied advice about how to clean the toys at home before putting them in the incubators (only four parents had washed the toys in their washing machines at more than 30 degrees C). From the six samples under scrutiny, all the culture results were tested positive. In particular two of the soft toys sampled were found infected by a Pseudomonas oryzihabitans. These particular toys belonged to a baby who had been diagnosed with a septicaemia characterized by hemocultures positive to a P. oryzihabitans of a different strain. Our audit has been an efficient reminder that any item put in an incubator is a potential vector and reservoir of pathogen organisms. After a general feedback towards the department staff, the medical staff then prescribed to permanently ban all the items not strictly required by the nursing activities from all the incubators of the department.

[Lidocaine intoxication in newborn following maternal pudendal anesthesia: report of three cases]. / Intoxication néonatale à la lidocaïne après analgésie par bloc des nerfs honteux: à propos de trois observations.

Pudendal nerve block may be indicated during instrumental delivery in situations where peridural anesthesia is unavailable. We report three cases of neonatal lidocaine intoxication following maternal pudendal block during delivery. Clinical features were hypotonia, pupillary mydriasis fixed to light, apnea, cyanosis and seizures. Two neonates required mechanical ventilation. Lidocaine was found in the serum of two babies. In all three cases, recovery was complete. The pharmacokinetics of lidocaine in a highly vascularized perineum during labor increase the risk of neonatal intoxication. A possible intoxication by local anesthetics should be considered in neonates presenting an acute distress in the delivery room.

[Neonatal pleuropulmonary staphylococcal infection with multiple abscesses of the liver]. / Staphylococcie pleuro-pulmonaire néonatale avec abcès hépatiques multiples.

We report the case of a neonate who developed septicemia due to a methicillin-susceptible Staphylococcus aureus strain at six days of age. At eight days of age, physical evaluation revealed a tense, tender abdomen and further enlargement of the liver, and abdominal ultrasonography demonstrated multiple liver abscesses. On the following day, pleuropulmonary lesions developed and required mechanical ventilation. Recovery was achieved using parenteral vancomycin and fosfomycin for 15 days followed by oral pristinamycin for ten days. This case is unusual in that the infection was acquired by the digestive route probably as a result of lymphangitis of the breast in the mother, and multiple liver abscesses were associated with the pleuropulmonary localization. It provides further evidence of the value of ultrasonography for the diagnosis and monitoring of liver abscesses, including multiple abscesses.

The importance of C3d estimation in the diagnosis of generalized bacterial infections in newborn infants.

We evaluated the clinical relevance of a new C3d test in generalized bacterial neonatal infections. C3d was qualitatively evaluated by using an original counterimmunoelectrophoresis technique in 171 plasma. There were 13 cases of bacteriologically proven cases of septicemia and/or meningitis, 6 cases of probable and 42 cases of possible generalized infection. One hundred and ten non-infected samples were also tested. The sensitivity, specificity, positive and negative predictive values were 73.6, 83.6, 43.7 and 94.8%, respectively. The numbers of false positive and false negative were therefore found to be close to those observed when using classical infection markers.