[Medication errors: analysis of a digoxin overdose case in a neonatology unit]. / Erreur médicamenteuse : analyse d'un surdosage en digoxine dans un service de néonatalogie.

Neonatology and pediatrics are units where medication errors occur. Indeed, the complexity of nursing care, the lack of information and marketing authorization for drugs contribute to the occurrence of often underestimated iatrogenic events. Through a case of digoxin overdose in a neonatology unit, each stage of the drug circuit was analyzed. From prescription to administration to dispensation, the accumulation of individual errors put a newborn in danger. The analysis and declaration of such events can improve safety and the quality of patient care.

[Pseudomonas aeruginosa unilateral endogenous endophthalmitis in a preterm infant: a case report]. / Endophtalmie endogène unilatérale à Pseudomonas aeruginosa chez un prématuré: à propos d'un cas.

Endogenous endophthalmitis is a rare eye disease, affecting vulnerable subjects (such as preterm or older elderly subjects), with reserved visual and sometimes vital prognosis. We present a preterm boy, born at 35 weeks and 2 days gestation, who developed a right eye Pseudomonas aeruginosa endogenous endophthalmitis secondary to a left-foot peripherical catheter-infection-associated bacteremia. He had a first intravenous antibiotic therapy associating third-generation cephalosporin and fluoroquinolone, then Ceftazidime® by intravitreous injection and a subconjunctival injection of betamethasone. Because of the development of vitreoretinal retraction, phacophagia and vitrectomy were performed. We point and discuss the severity of this disease, associated with poor visual and vital prognosis, and the importance of prompt biological diagnosis so that the appropriate intravenous antibiotic therapy is chosen. Treatment is also discussed, especially the interest value of antibiotic intravitreous injection in preterm infants.

[Vaccination coverage among health care workers in the pediatric emergency and intensive care department of Edouard Herriot hospital in 2007, against influenza, pertussis, varicella, and measles]. / Couverture vaccinale du personnel hospitalier du service d'urgences et de réanimation pédiatriques de l'hôpital Edouard-Herriot de Lyon en 2007, concernant la grippe, la coqueluche, la varicelle et la rougeole.

AIM: The aim of this study was to determine the vaccination coverage among the medical and paramedical health care workers of the pediatric intensive care and emergency department of Edouard Herriot hospital in Lyon, with respect to influenza, pertussis, varicella, and measles, 4 diseases with air transmission and vaccination recommendations. METHOD: During February and March 2007, a questionnaire was given by hand to 123 health care workers by a medical student working there or available in the intensive care unit. RESULTS: The response rate to the questionnaire was 68.3%. The vaccination coverage against influenza was 42.8%; men and medical health care workers were better vaccinated. With respect to vaccination against pertussis, one third had received an injection in adulthood, adults under age 30 and medical health care workers were better vaccinated, but the difference was not statistically significant. Ten health care workers were not vaccinated and had no history of measles: only 1 had had a measles serology and none were vaccinated. Eleven had no history of varicella: 6 had had a varicella serology and none were vaccinated. CONCLUSIONS: Vaccination coverage against influenza is higher than what has been reported in the literature, possibly because of a mobile vaccination campaign against influenza made during winter 2006 in this pediatric department. Vaccination coverage against pertussis is encouraging and probably the consequence of an awareness of the gravity of the disease among infants. Individual information is necessary for health care workers on the nosocomial risk for influenza and pertussis in infants, and vaccination must be proposed. Serology against varicella and measles is compulsory for all health care workers with no history and no vaccination against these 2 diseases, to track and vaccinate the nonimmunized personnel. Occupational physicians have a very important role to play in meeting this goal.

[Air embolism on central venous access in a premature neonate, beware of the infusion device assembly! ]. / Embolie gazeuse sur cathéter central chez un nouveau-né prématuré, méfiez-vous de votre montage de perfusion !

A fatal pulmonary air embolism, confirmed by an oriented necropsy, is described in a 25-day-old premature and small-for-gestational-age neonate. The embolism was suspected after air bubbles were detected in the infusion line. The air bubbles originated from a male Luer-lock to male Luer-lock connector, which was part of a specific assembly of the perfusion line. A solution to this problem is thereby proposed. We recommend caution in using complex infusion line assemblies because such complications are probably underestimated.

[Very preterm birth: should we be interested in maternal pre-pregnancy body mass index?]. / Grande prématurité : faut-il s'intéresser à la corpulence maternelle ?

UNLABELLED: Link between maternal body mass index (BMI) and pregnancy outcome is not clear. OBJECTIVE: To appreciate the impact of prepregnancy maternal BMI on very preterm birth (22-32 gestation's weeks). SECONDARY OBJECTIVE: To assess how maternal BMI does explain the mechanism of very preterm birth among live births. METHODS: Population-based study, including each mother with a live or stillborn baby was included in a geographically defined (Poitou-Charentes and Franche-comté, France) case-control study in 2004 to 2006. Leanness (BMI<18.5kg/m(2)) and overweight and obesity (BMI> or =25kg/m(2)) were defined according to World Health Organization's standards. Statistical analysis consisted in a polynomial regression on 832 mothers of very preterm babies and 431 mothers of full-term babies, taking account for confounders as maternal age, birth country, educational level, maternal work and smoking during the pregnancy. RESULTS: Leanness is a risk factor for very preterm live birth (aOR=1.73 [1.12-2.68]), overweight is a risk factor for stillbirth. (aOR=1.71 [1.03-2.84]). Among mothers of live born babies, leanness is a risk factor for spontaneous preterm birth (aOR=2.12 [1.20-3.74]), whereas overweight is a risk factor for very preterm birth on medical decision due to gestational hypertension (aOR=2.85 [1.80-4.52]). CONCLUSION: Morbid maternal stoutness before pregnancy is a complex risk factor for very preterm delivery. Women and couples should be informed and practitioners should be aware in order to prevent and manage this pathological status.