[Is self-confidence a factor for successful breastfeeding?]. / Les mères confiantes en elles allaitent-elles plus longtemps leur nouveau-né ?

CONTEXT: Maternal self-confidence and self-efficacy in breastfeeding are recognized as factors positively associated with the initiation and duration of breastfeeding. OBJECTIVE: To evaluate the importance of this association using the Breast Feeding Self-Efficacy Scale (BSES). METHOD: This prospective study was conducted in 2012 in the Jeanne-de-Flandre maternity department in the Lille University Hospital (France). During their time in the maternity department, breastfeeding mothers who participated in the study completed the BSES, a brief self-assessment of their feelings of self-efficacy relating to breastfeeding. They then received follow-up telephone interviews at 1 and 3 months postpartum. RESULTS: One hundred and forty-nine mothers were included in the study. Breastfeeding rates were 86.5% at 1 month and 60% at 3 months. The BSES score of mothers who continued to breastfeed at 1 and 3 months was significantly higher than the score of mothers who had already weaned their children, with an AUROC of 0.72 at 3 months. This confirmed the reliability of the BSES for predicting adherence to breastfeeding. The BSES score of mothers who had previously breastfed was significantly higher than for those breastfeeding for the first time. The threshold score for the BSES was determined as 116/165. CONCLUSION: It is important that mothers who lack confidence in their ability to breastfeed be identified early, whether on the maternity ward or even before this point. The value of BSES-based breastfeeding support intervention needs to be evaluated through randomized trials.

[Evaluation of ambulatory prescribing for community-acquired pneumonia in children]. / Évaluation des prescriptions dans la prise en charge des pneumonies aiguës communautaires de l'enfant.

OBJECTIVE: To determine how national recommendations for the treatment of acute community-acquired pneumonia (CAP) are applied in children. METHODS: A phone survey was conducted in northern France. A standardized questionnaire was submitted to randomized general practitioners (GPs), private pediatricians, and pediatric fellows to analyze their practices for CAP in children. Diagnostic and treatment data were collected for the last child they had treated for CAP and for a factitious clinical case of CAP. Treatments, particularly prescribing antibiotics, were compared to the guidelines published in 2005 for lower respiratory tract infections, in order to determine the percentage of "good prescribers". RESULTS: A total of 101 physicians were involved: 77 senior physicians (62 GPs and 15 private pediatricians) and 24 pediatric fellows. For the last child treated for a CAP (mean age: 4.5 years±3.4), amoxicillin was prescribed in 29% of cases and associated (most of the time by GPs) with clavulanic acid in 54%. For the factitious clinical case (age: 3 years), amoxicillin alone was prescribed in 50% of cases and associated with clavulanic acid in 45%. Also considering recommended doses and length of treatment, the percentage of "good prescribers" for senior physicians for each situation was 15% and 16%, respectively, and for pediatric residents was 52% and 50%. CONCLUSION: Guidelines for CAP in children were insufficiently followed.

[Fluoroquinolones to prevent bacterial infection in children with chemotherapy induced neutropenia: is it reasonable?]. / Prophylaxie par les fluoroquinolones dans la neutropénie post-chimiothérapie de l'enfant : est-ce bien raisonnable ?

Chemotherapy-induced febrile neutropenia is a frequent event in children with cancer, with a high morbidity. Antibiotic prophylaxis has been proposed for many years to prevent infectious diseases in patients with neutropenia. Fluoroquinolone prophylaxis induced a significant reduction of mortality and infectious morbidities in these situations. Less data are available in children with neutropenia. The emergence of antimicrobial resistance involving not only quinolones, but also cephalosporins, aminoglycosides and penems, is the main long term risk. This article summarise the usefulness of the prophylactic antibiotic treatment and its perspective in children with cancer.