Umbilical vein catheterization through Wharton's jelly: A possibility for a fast and safe way to deliver treatments in the delivery room?

Fast and safe venous access can be a critical issue in the delivery room during neonatal cardiopulmonary resuscitation or before endotracheal intubation. Here, we describe a new method to inject drugs using the umbilical vein, directly punctured through Wharton's jelly, performed in ten newborns between November 2016 and May 2018. The umbilical vein was identified and punctured easily and a reflux was obtained in all patients. The treatments were efficient in all but two patients, which was imputable to the method in one patient. We describe a new route for administration of drugs that has been successfully used in neonates.

[Analgesia with saccharose during heel capillary prick. A randomized study in 37 newborns of over 33 weeks of amenorrhea]. / Analgésie au saccharose lors des prélèvements capillaires au talon. Etude randomisée chez 37 nouveau-nés de plus de 33 semaines d'aménorrhée.

BACKGROUND: To evaluate the efficiency of intraoral saccharose administration for analgesia among neonates born after at least 33 weeks of gestation. POPULATION AND METHOD: Thirty-seven neonates from two neonatal units were tested using an objective scale of infants' pain. A double blind study of the heel prick response after saccharose vs. water administration was performed. RESULTS: Prior administration of saccharose significantly reduced the pain reaction (1.24 vs. 2.24, P < 10(-5)). CONCLUSION: The analgesia obtained after an intraoral saccharose administration can be useful for repeated punctures for which common procedures of analgesia are ineffective. Beyond its use for heel prick, this procedure could be proposed for venous punctures when ELMA analgesia is not possible.

[Modification of C-reactive protein after instillation of natural exogenous surfactants]. / Modification de la protéine C réactive après instillation de surfactant exogène naturel (Curosurf).

BACKGROUND: Blood C-reactive protein levels have been frequently found to be increased after Curosurf instillation. These variations have been compared to the values after Surfexo therapy and after absence of surfactant therapy. POPULATION AND METHODS: The files of not infected premature babies, aged 25 to 36 weeks of gestational age, under mechanical ventilation for a hyaline membrane disease (HMD), admitted in our unit between January 1990 to June 1995, have been retrospectively studied. They were separated into three groups: A: 67 infants ventilated for more than 5 days for HMD without surfactant therapy; B: 23 infants treated by Surfexo; C: 60 infants treated by Curosurf. CRP was measured daily between day 0 (DO) and D5. Means and standard deviations were calculated for each day and each group. The mean values of CRP at D1 to D5 in group C were compared to DO. The daily CRP values were compared in the three groups. For group C, the results were studied daily according to the gestational age, dosage and age of the neonate at the first instillation. The statistical results have been given according to the Student t test. RESULTS: After Curosurf, the mean CRP value rose significantly from D1 to D4 compared to D0. There was no difference of CRP between groups A and B from D0 to D5, Group C had higher values in comparison to group A (between D1 to D5) and to group B (between D1 and D3). There was no significant difference of the CRP values in group C according to the number of instillations or the amount instilled, but CRP was lower in early treated infants (< H6). DISCUSSION: Curosurf instillation is followed by a significant increase in CRP, maximum at D2. This is not seen after Surfexo. This increase seems less important at D2-D3 when Curosurf is administered early. The CRP increase after Curosurf therapy could be due to an inflammatory reaction to the heterologous proteins it contains.

[Use of EMLA cream in premature and full-term newborn infants. Study of efficacy and tolerance]. / Utilisation de la crème EMLA chez le nouveau-né à terme et prématuré. Etude d'efficacité et de tolérance.

BACKGROUND: Mild methemoglobinemia is a known side-effect of one of the constituents of EMLA cream, this topical local anesthetic is used with great caution in neonates. POPULATION AND METHODS: One hundred and sixteen neonates admitted from January to July 1994 in an intensive care unit were included in the study. All required skin punctures which were performed 1 h 30-2 hours after EMLA had been applied on the skin. A reaction score (0 to 5) to skin puncture was established 157 times (120 after and 37 without local anesthesia); methemoglobin (Met Hb) concentrations were measured in 47 blood samples, 18-24 hours (40.4% of samples) or 2-3 days (36.2%) after application of EMLA. RESULTS: Ninety-four neonates were quiet before puncture (score 0-1). Among them, 57% of those who were given EMLA had a low score (2 or less) vs 18% without EMLA. A low reaction was observed in 65% when the dressings had been kept in place for at least 90 minutes vs 15% with a shorter application. A lower reaction was noted in 78.8% of cases after venopuncture (41% after arterial puncture). No Met Hb level was above 5% and 7 (15%), in five neonates, were between 3 and 5%. There was no clear relationship between methemoglobinemia and gestational age or duration of dressing. CONCLUSION: EMLA cream is effective and safe in neonates including preterms, when it is applied in a small amount once a day.

[Pre- or neonatal corticotherapy: what are the long-term consequences?]. / Corticothérapie anté- ou néonatale: quelles conséquences à long terme?

This paper is a literature overview on the potential long-term side effects of steroid therapy in the prenatal and neonatal period. Incomplete and transient suppression of adrenal function without growth impairment has been reported in prolonged treatment with steroids for bronchopulmonary dysplasia. There seems to be no secondary chronic immune dysfunction. There is evidence for deleterious effects on lung and brain development in experimental animals. In human preterm neonates, no pulmonary and cerebral secondary effects were observed after short prenatal steroid courses, but it is as yet uncertain whether this applies also to prolonged steroid therapy which requires further long-term investigations, including school performance.