[Linear insertion of atrioventricular valves (Livav): echocardiographic diagnosis, reliability and prevalence in the general population]. / Insertion linéaire des valves auriculoventriculaires (Ilvav): fiabilité du diagnostic échographique et prévalence dans une population sans trisomie 21.

OBJECTIVES: Assess the reliability of prenatal diagnosis of linear insertion of atrioventricular valves (Livav) by echocardiography as well as estimate Livav's prevalence in a population without Down syndrome. PATIENTS: One hundred and twenty-three fetuses of whom 113 were explored before and after birth and 631 consecutive out-patients explored in cardiopediatric unit. METHODS: Determination of the likehood ratio (LHR+ and LHR-) of Livav prenatal diagnosis. Evaluation of the consistency between pre- and postnatal diagnoses as well as between two observers after birth (Kappa index). Prevalence study according to the presence of Down syndrome, cardiac malformation or others abnormalities. RESULTS: LHR+ value was 6.17 and LHR- value was 0.30 for echographic Livav prenatal diagnosis. Consistency was low between pre- and postnatal diagnoses (Kappa = 0.57) and higher between two observers after birth (Kappa = 0.79). Livav prevalence was 2 to 5% in a population without Down syndrome but 15% when associated with a cardiac malformation. Seventy-eight percent Down syndromes had either Livav or AVSD. CONCLUSION: Livav echographic prenatal diagnosis is difficult, for it generates many false positives. Livav is not specific of Down syndrome and can be found relatively frequently in other subjects.

[Neonatal death of a newborn twin]. / Le décès d'un jumeau en réanimation néonatale. La place que le psychiatre peut prendre.

In France, in 2001, 33,000 children were born from multiple pregnancies (4.2% of births). Lately, with the stimulated fertilization improvement, this number has strongly increased. These pregnancies are pretty often difficult and the hospitalizations of the twins (or other multiples) in a neonatal intensive care unit are more frequent than in a single pregnancy (48 vs. 5.3%). Newborn twin death leads the parents to face a tough mourning because of the surviving twin presence. The psychiatrist's function is crucial with the parents, the deceased child, the surviving child and the pediatric staff. Therefore, as much as possible, the psychiatrist (or the psychologist) has to gather and work through the confused feelings of the parents. Several splittings occur in this situation. Some of these splittings concern the medical staff, some others affect the children, the dead one and the living one, either rejected and disinvested or idealized and overprotected. The child psychiatrist is a preferred recipient for the different projections of the parents.The hospital staff as a whole has to understand their full significance and their important psychic sparing for the couple. As the deceased child, the psychiatrist may look bad and unsatisfying, for instance: "he doesn't answer as we would like", "he doesn't come up to the couple's expectations", "he doesn't talk enough", "he's leaving too soon", etc.In addition, the psychiatrist may be attacked as the representative of the pediatric staff, in order to preserve in a better way the others medical protagonists, still essential for the survival of the alive child. These parents are in mourning and the psychiatrist must help them in this process in order to improve the specific investment of the surviving child, the attachment and the communication with him.