[Vitamin A in Gabonese children not receiving supplements: relation to ocular and nutritional diseases]. / Vitamine A chez les enfants gabonais non supplémentés : relation avec les pathologies oculaires et nutritionnelles.

To define vitamin A status in Gabonese children before the supplementation campaigns by UNICEF and the Gabonese Ministry of Health. We conducted an epidemiological, clinical and laboratory study at two of the main child health centers of Libreville and included 150 children aged from 0 to 156 months. We assessed their nutritional and ophthalmological status, their consumption of food rich in vitamin A and their blood levels of vitamin A (retinol). The latter was below the normal level (0.76 mmol/l) for 70% of the children. We observed the following eye diseases correlated with retinol levels: nyctalopia (16%), conjunctiva xerosis (6.7%), Bitot's spots (1.3%), corneal xerosis (3.3%), leukoma (0.7%) and blindness (1.3%). Moreover, 48.7% of the children had delayed growth, positively correlated with low retinol concentrations (0.643 mmol/l), 10% kwashiorkor and 19.9% marasmus. Among the mothers interviewed, 56% were unemployed and 69.3% knew little about vitamin A-rich food, which indeed is a rare part of the population's diet. This prospective study showed that the vitamin A deficiency is a major public health problem in Libreville. Supplementation campaigns are certainly necessary to fight it, but also and especially improved nutrition, including regular consumption of the vitamin A-rich food available in Gabonese market places.

Newborn infant pain assessment using heart rate variability analysis.

OBJECTIVES: Systems controlling cardiovascular function are closely coupled with the perception of pain. Heart rate variability (HRV) is a well-established noninvasive measure of cardiac autonomic control. We hypothesized that pain may alter HRV in the newborn infant and that HRV analysis could be used as an indicator of prolonged pain in the newborn infant. METHODS: To test the hypothesis, we measured the magnitude of the heart rate high-frequency variations using an innovative High Frequency Variability Index (HFVI) in newborn infants at risk of postoperative pain. We investigated newborn infants with a gestational age (GA) more than 34 weeks, and who were admitted after a major surgical procedure. Inclusions ranged from 2 to 72 hours after the surgery. The postoperative pain was scored using EDIN scale (neonatal pain and discomfort scale) at the end of the 2 hours recording period. The infants were separated in: (1) Group "Low EDIN," when EDIN<5; and (2) Group "High EDIN," when EDIN >=5. Predictive positive and negative values of a threshold value of HFVI in assessing pain have been studied. RESULTS: Twenty-eight newborn infants were enrolled in the study (mean GA=37.8+/-1.5 wk) at a median delay between the surgery and the recording of 5 hours. Mean EDIN were 2+/-1 and 7+/-2 in respectively the groups "Low EDIN" and "High EDIN." The 2 groups were similar for GA, basal heart and respiratory rates, SpO2, mean arterial blood pressure, and morphine infusion rate. HFVI was significantly lower in the group "High EDIN" than in the group "Low EDIN" (0.7+/-0.2 vs. 1.2+/-0.3, respectively; P<0.01). An HFVI <0.9 was able to predict an EDIN score >=5, with a sensitivity of 90%, and a specificity of 75%. DISCUSSION: The results of this study indicate that postoperative pain is associated with a decreased high-frequency HRV in full-term newborn infants. Our findings suggest that HRV could be used as an indicator to assess prolonged pain in the newborn infants.