[Evaluation of the concordance between guidelines and transfusion practices in neonatal intensive care units]. / Évaluation de la concordance entre recommandations et pratiques transfusionnelles en unités de soins intensifs néonataux.

OBJECTIVE: To assess the concordance rate between the prescriptions of blood products and Afssaps guidelines for transfusion practices in neonatology. STUDY DESIGN: Retrospective monocentric study. PATIENTS AND METHODS: Children transfused in the neonatology intensive care units in the Universitary Hospital of Rouen were included. Concordance rates between transfusion prescriptions, delivered and transfused products and the Afssaps guidelines were assessed. Any additional costs resulting from a theoretical discordance was also assessed. RESULTS: In 2006, 380 PSL were administered to 168 newborn children (NBC). Packed red blood cells (PRBC) represented the most often transfused products (n=290, 76%). Fifty packed platelets (PP) were transfused (13% of the blood products) and 41 fresh frozen plasmas (11%). Overall concordance rate between the Afssaps guidelines and the prescriptions was 64.9%. In 35.1% of cases, the prescription was excessive, compared to the recommendations. Excessive transfusion represented a total of 27,307 euros. CONCLUSION: Global concordance's rate between the guidelines and the prescriptions is fairly well. PRBC are the most blood product transfused. Excessive transfusions related to this concordance rate are leading to important theoretical costs. New informations to the guidelines are warranted to improve transfusional practices in this institution.

[Use of platelet concentrates: a regional experience]. / Utilisation des concentrés plaquettaires : expérience d'une région.

PURPOSE OF THE STUDY: The Établissement français du sang (EFS) distributes two types of platelet concentrates: using a single donor in aphaeresis platelet concentrate (SDAP), versus pooled platelet concentrates (PPC). A retrospective study performed by the Blood Derivatives Group at Observatory for Drugs, Medical Devices and Therapeutic Innovations (OMEDIT), in collaboration with EFS and haemovigilance correspondents from eight regional health care establishments, has analyzed platelet concentrates prescriptions and the position of the prescribers concerning PPC supply. MATERIAL AND METHODS: Between the 2nd and 6th June 2008, 151 platelet concentrates were supplied by ESF. Data were collected for 144 platelet concentrates and in 83 transfused patients with an average age of 50years. During this study, 33 PPC (23%) and 111 SDAP (77%) were supplied. RESULTS: With regards to the 111 SDAP, the supply of PPC was refused in 47 cases (42%), accepted in 18 cases (16%) and unknown for 46 cases (42%). A total of 51 PPC could be supplied during this period, which represented 35% of platelet concentrates prescriptions. The rate of platelets before transfusion was known for 121 platelet concentrates, the median was 32G·L(-1) for SDAP and 44G·L(-1) for PPC. CONCLUSION: More frequent PPC use, with comparable therapeutic efficacy, could be interesting in a context of increasing platelet concentrates consumption in health care establishments. Moreover, prescribers did not seem to be against the idea. An information pamphlet on platelet concentrates was drafted and distributed to prescribers in order to promote the prescription of PPC. A second assessment is planned to measure the impact of this communication.

[Incidence of invasive meningococcal diseases in children in Northern France: usefulness and limits of the discharge code database for correcting compulsory notification data]. / Incidence des infections invasives à méningocoque de l'enfant dans le Nord-Pas-de-Calais : intérêt et limites du programme de médicalisation des systèmes d'information (PMSI) pour la correction des données des déclarations obligatoires.

UNLABELLED: Surveillance of invasive meningococcal diseases (IMD) is based on mandatory reporting. Evaluation of the exhaustivity of the surveillance with capture-recapture analysis can correct for underreporting. AIM: To evaluate IMD incidence in children in Northern France from 2 databases and to determine the usefulness of the regional hospital reporting database for correcting mandatory reported data. PATIENTS AND METHODS: Regional study of IMD incidence in children under 18 years of age, between the years 2002 and 2005, by a secondary analysis of 2 databases: the regional hospital reporting database administered by the Department of Medical Information (DIM) and the mandatory reporting health authorities database (DDASS). The corrected incidence of IMD was determined using a capture-recapture method. RESULTS: Three hundred and eleven cases of IMD were reported in at least 1 database. Of the 233 patients identified in the DIM database, 23 were not reported in the DDASS database, but 78 retrieved in the DDASS database were missed by the DIM. Database exhaustivity varied between years from 70 to 75% for the DIM and from 83 to 99% for the DDASS database. The corrected incidence of IMD varied from 6.9 to 9.4/100,000 children between 2002 and 2005. IMD incidence of children less than 1 year of age reached 44.5/100,000 in 2005. IMD attributable to serogroup B were predominant (56%). CONCLUSION: In this study, the DIM database provided a useful independent correction of mandatory reporting, although it remained insufficient. A high IMD incidence in children was identified in Northern France, especially in children less than 1 year of age.

Decline in pneumococcal meningitis after the introduction of the heptavalent-pneumococcal conjugate vaccine in northern France.

BACKGROUND: The impact of the heptavalent-pneumococcal conjugate vaccine on the incidence of pneumococcal meningitis in Europe has not yet been assessed. OBJECTIVE: To determine whether heptavalent-pneumococcal conjugate vaccine implementation in northern France has resulted in a decrease in the incidence of pneumococcal meningitis in children. DESIGN: Multicentre retrospective cohort study from 2000 through 2005. SETTINGS: All paediatric departments of the 18 hospitals in northern France. PATIENTS: Patients <18 years of age, admitted for laboratory-confirmed pneumococcal meningitis during the study period, were included. INTERVENTIONS: Data were collected from medical files and the microbiological laboratories of each hospital and compared with the regional hospital discharge codes, using a capture-recapture method. MAIN OUTCOME MEASURES: The study assessed and compared global and age-related incidence rates of pneumococcal meningitis in 2001 (pre-vaccine era) and 2005. RESULTS: 77 cases were found through the capture-recapture method. The incidence rate of pneumococcal meningitis varied from 1.65/100,000 children <18 years in 2001 to 0.80/100,000 children in 2005 (53% reduction, 95% CI 31 to 74; p = 0.08). This has so far been significant only for children <2 years of age (8.9/100,000 in 2001 to 1.8/100,000 in 2005; 82% reduction, 95% CI 52 to 95; p = 0.03). CONCLUSION: A decline in pneumococcal meningitis has been observed in infants since heptavalent-pneumococcal conjugate vaccination began in our area.