[Screening for the risk of allergy and prevention in French maternity units: A survey]. / Dépistage du risque d'allergie et prévention en maternité : enquête des pratiques AllerNaiss.

Allergy has been on the rise for half a century and concerns nearly 30% of children; it has now become a real public health problem. The guidelines on prevention of allergy set up by the French Society of Paediatrics (SFP) and the European Society of Paediatric Allergology and Clinical Immunology (ESPACI) are based on screening children at risk through a systematic search of the family history and recommend, for children at risk, exclusive breastfeeding whenever possible or otherwise utilization of hypoallergenic infant formula, which has demonstrated efficacy. The AllerNaiss practice survey assessed the modes of screening and prevention of allergy in French maternity units in 2012. The SFP guidelines are known by 82% of the maternity units that took part in the survey, and the ESPACI guidelines by 55% of them. A screening strategy is in place in 59% of the participating maternity wards, based on local consensus for 36% of them, 13% of the units having a written screening procedure. Screening is based on the search for a history of allergy in first-degree relatives (99%) during pregnancy (51%), in the delivery room (50%), and after delivery (89%). A mode of prevention of the risk of allergy exists in 62% of the maternity units, most often in writing (49%). A hypoallergenic infant formula is prescribed for non-breastfed children in 90% of the units. The survey shows that there is a real need for formalization of allergy risk screening and prevention of allergy in newborns in French maternity units.

Response to dobutamine and dopamine in the hypotensive very preterm infant.

A randomised double blind study was designed to evaluate haemodynamic response to dobutamine and dopamine in 20 hypotensive preterm infants of less than 32 weeks' gestation. Neonates initially received dopamine or dobutamine 5 micrograms/kg/min. If mean arterial pressure (MAP) remained below 31 mm Hg, the infusion rate was increased in increments of 5 micrograms/kg/min. If 20 micrograms/kg/min of the initial drug failed to achieve a MAP above 30 mm Hg, it was discontinued and the other drug was administered at the same infusion rate. Left ventricular output (LVO) was measured by pulsed Doppler echocardiography. Mean (SE) MAP increased significantly from 24.4 (1.0) to 32.0 (1.4) mm Hg at a median dobutamine dosage of 20 micrograms/kg/min and from 25.6 (1.2) to 37.7 (1.5) mm Hg at a median dopamine dosage of 12.5 micrograms/kg/min. The percentage LVO increase was +21 (7)% with dobutamine compared with -14 (8)% with dopamine. Dobutamine failed to increase MAP above 30 mm Hg in six infants out of 10, whereas dopamine succeeded in all 10 infants. Six switches from dobutamine to dopamine were thus performed, providing a rise in MAP (29.2 (0.5) to 41.2 (2.0) mm Hg) and drop in LVO (356 (40) to 263 (36) ml/kg/min). These data indicate that dopamine is more effective than dobutamine in raising and maintaining MAP above 30 mm Hg; however dopamine does not increase LVO.

[Posology of amikacin in newborn infants, adapted to the postconceptional age]. / Posologie de l'amikacine chez le nouveau-né, adaptée à l'âge post-conceptionnel.

Two consecutive studies of amikacin plasma levels were performed in 63 and 64 neonates whose postconceptional age (PCA) ranged from 26 to 45 weeks. The first study, using a dose of 7.5 mg/kg every 12 hours, permitted to establish a dosage related to PCA. Half-life elimination of amikacin was strongly correlated with PCA (r = -0.42, p = 0.0009). The apparent volume of distribution was correlated with none of the variables studied. The mean volume of distribution was 640 +/- 190 ml/kg. From these data, the inferred dosage was 10 mg/kg, given at intervals of time predetermined as a function of PCA. A second prospective study proved the value of this PCA adapted dosage. The maximal concentrations obtained were higher (21.6 +/- 5.9 vs 18.5 +/- 4.6 micrograms/ml, p less than 0.001), the nadir concentrations were not significantly increased (5.7 +/- 3.1 vs 5.2 +/- 3.7 micrograms/ml, NS) and the number of nadir concentrations outside the desired interval of 2-8 micrograms/ml was smaller (p less than 0.01).