Recommendation for hygiene and topical in neonatology from the French Neonatal Society.

We sought to establish guidelines for hygiene care in newborns based on a systematic review of the literature and grading of evidence using the Groupe de Réflexion et d'Evaluation de l'Environement des Nouveau-nés (GREEN) methodology. We examined 45 articles and 4 reports from safety agencies. These studies recommend a tub bath (rather than a sponge bath) for full-term infants and a swaddle bath for preterm newborns. They also recommend against daily cleansing of preterm infants. The literature emphasized that hygiene care must consider the clinical state of the newborn, including the level of awareness and behavioral responses. Hospitalized newborns treated with topical agents may also experience high exposure to potentially harmful excipients of interest. Caregivers should therefore be aware of the excipients present in the different products they use. In high-resource countries, the available data do not support the use of protective topical agents for preterm infants.Conclusions: We recommend individualization of hygiene care for newborns. There is increasing concern regarding the safety of excipients in topical agents that are used in neonatology. A multidisciplinary approach should be used to identify an approach that requires lower levels of excipients and alternative excipients. What is known: • Hygiene care is one of the most basic and widespread types of care received by healthy and sick newborns worldwide. • There is no current guideline on hygiene for preterm or hospitalized term newborn. What is new: • The French Group of Reflection and Evaluation of the environment of Newborns (GREEN) provided here guidelines based on the current body of evidence. • Caregivers should be aware of the many issues related to hygiene care of newborns including newborns' behavioral responses to hygiene care, exposition to excipients of interest, and the potential risk of protective topical agents in a preterm infant. provided here guidelines based on the current body of evidence. • Caregivers should be aware of the many issues related to hygiene care of newborns including newborns' possible behavioral responses to hygiene care, exposition to excipients of interest and the potential risk of protective topical agents in a preterm infant.

[Anesthesia and surveillance in intracavitary fulguration for radical treatment of ventricular tachycardia]. / Anesthésie et surveillance dans la fulguration endocavitaire pour le traitement radical des tachycardies ventriculaires.

Endocavitary fulguration, is a new technique to ablate the arrhythmogenic substrate of chronic ventricular tachycardias (VT). This method is used in patients with ventricular tachycardias of varied etiologies. 47 fulgurations in 36 patients with 40 hemodynamic and 12 myocardial metabolic studies are presented. In cardiopathies, the cardiac performance is altered with an ejection fraction of less than 50% and a ventricular function curve which is in Braunwald zone II. Ablation of the arrhythmia was obtained in 63% of cases. Severe complications were observed in 13% of cases, i.e.: low cardiac output, pulmonary oedema and myocardial ischemia. Three patients died from cardiac failure. Ventricular tachycardia was induced to localize the arrhythmogenic foci to be fulgurated. Ventricular tachycardia led to hemodynamic changes with a high pulmonary capillary wedge pressure and low cardiac output (-21%) which was further lowered under general anesthesia (-42%) due to poor response to tachycardia. Endocardial fulguration per se induced severe but transient (less than 5 minutes) hemodynamic changes and was sometimes complicated by myocardial ischemia and conduction disorders. General anesthesia is necessary to perform endocardial fulguration but cannot be induced with a poor hemodynamic state and with high rate ventricular tachy-arrhythmias. Three criteria are used concerning the anesthetic agents: 1) maintainance of cardiac contractility and baro-reflex efficiency; 2) respect of myocardial oxygen balance; 3) maintainance of excitability during mapping of arrhythmogenic foci. Hemodynamic monitoring is necessary to understand and manage complications due to this new type of therapy.

[Propofol or ketamine in anesthesia of the very old patient. Study of the hemodynamic effects during induction]. / Propofol ou kétamine pour l'anesthésie du grand vieillard. Etude des effets hémodynamiques à l'induction.

The haemodynamic changes following anaesthesia for hip surgery in 16 very old ASA II or III patients (mean age 85.8 +/- 5 years) were studied. Patients were randomly assigned to two groups: group I 1 mg X kg-1 propofol, group II 1.5 mg X kg-1 ketamine. After injection, the patients were left spontaneously breathing oxygen, and were assisted when apneic. Haemodynamic measures with a Swan-Ganz catheter and thermodilution cardiac output calculator were made before and 1, 3, 5, 10 and 15 min after anaesthetic induction. The two groups were similar in age, weight and mean arterial pressure, but statistically different for some haemodynamic parameters (Ppa, Ppw, CI). In group I, arterial pressure fell significantly (-17%) in the first minute and continued to fall (-15%) until the 15th min. Heart rate remained unchanged: right atrial and pulmonary pressures were not changed; cardiac index fell slightly and MVO2 estimated by the triple product fell (-27%) as soon as propofol was infused. There was no clinical sign of cardiac failure. In group II, arterial pressure increased significantly, and heart rate decreased; pulmonary capillary wedge pressure increased (+93% after the 3rd min) and cardiac index was unchanged. The ventricular function curve was shifted to the right, suggesting a decrease in inotropism. Systemic vascular resistances were steady. MVO2 increased twofold, mainly due to the rise in pulmonary capillary wedge pressure.(ABSTRACT TRUNCATED AT 250 WORDS)

[Circulatory assistance by aorto-ventricular shunt. A new implantation technique]. / Assistance circulatoire par dérivation ventriculo-aortique. Une nouvelle technique d'insertion.

This technique is original in that it involves a single site (the ascending aorta) easily accessible to cannulation. Following lateral clamping of the ascending aorta, a bifurcate Dacron prosthesis is anastomosed. The draining cannula is introduced through one of the branches of the prosthesis and manually guided through the aortic sigmoid leaflets down to the left ventricular ejection outlet. The perfusion cannula is introduced through the outer branch of the prosthesis. The end of this cannula is positioned at the origin of the prosthesis to avoid a possible bend in the fork. This technique is a simple and effective means of providing left ventricular support.

[Evolution of the blood levels of propofol administered by continuous perfusion during extracorporeal circulation]. / Evolution des niveaux sanguins de propofol administré en perfusion continue au cours de la circulation extracorporelle.

The pharmacokinetics of propofol administered in continuous infusion was studied in 10 patients without left ventricular insufficiency during extracorporeal circulation (ECC) with hemodilution, for aortocoronary bypass. After a dosage of 1.5 mg.kg-1 during anaesthetic induction, the blood level was 4,800 micrograms.l-1. Under continuous infusion levels remained very high: they decreased by 40% during EEC induction and rose more than 10% when artificial ventilation started again. These modifications can be explained by physiological variations induced by EEC (non pulsated flow, redistribution, vasoconstriction, hemodilution, hypothermia) and they lead to adapt dosages in this type of anaesthesia.