[Monitoring network for vulnerable children in the Pays de la Loire ("Grandir ensemble" - Cohort LIFT): 10 years of activity 2003-2013]. / Réseau de suivi des enfants vulnérables dans les Pays de la Loire (Grandir Ensemble - Cohorte LIFT) : dix ans d'activité de 2003 à 2013.

INTRODUCTION: Vulnerable children are at-risk newborns including premature infants and some children with pathologies presented by fear anomalies and deficiencies, most particularly neurological. Monitoring is based on the detection of these abnormalities and their early management. The organization of this monitoring system is based on a network of doctors, mostly pediatricians, trained regularly. The objective of this review was to assess the resources, means, and results of 10 years of follow-up. METHODS: The Pays de la Loire network includes 24 maternity wards and 13 neonatal departments. Annual admissions are around 5000 newborns to approximately 45,000 annual births. Upon discharge of newborns, born prematurely at 34 weeks of gestation (WG) or less, or term infants with neurological problems, parents are asked to have their child monitored by a referring doctor. During the consultation, a reference document is filled out by the doctor and sent to the project manager for data collection and specific compensation for private practitioners. Standardized questionnaires were used such as the ASQ (Ages and Stage Questionnaire) completed by parents, the developmental quotient (DQ) with the Lézine Brunet-Revised test (BLR), the intelligence quotient (IQ) with the Wechsler Preschool and Primary Scale of Intelligence (WIPPSI III) completed by psychologists employed in the network, and a questionnaire completed by the teacher at 5 years of age. RESULTS: The network started on 1st March 2003, and 28th February 2013, after 10 years of inclusion, 10,800 children had been included. This population accounts for 2.4% of all annual births: 1.1% were included for prematurity less than 33 weeks and 0.25% were term-born infants. The characteristics of children are presented with gestational age, birth weight, and obstetric and neonatal pathologies. The percentage of these children followed was 80% at 2 years and 63% at 5 years. At 2 years, the results are presented according to gestational age with approximately 60% of children without disabilities at 25-26 WG, 73% at 27-28 WG, 77% at 29-30 WG, and 86% at 31-32 WG. Absorptions are diverse and vary according to the age of the child with physical therapy, psychomotor skill work, speech therapy, hearing and vision consultations, and psychology/psychiatry. Assessment tools were refined by specific analyses: the ASQ 24 months (completed by parents) was deemed valid and predictive with respect to IQ (abandoned in 2012), and the grid completed by the teacher was found to predict abnormalities in 5 years. CONCLUSION: The Pays de la Loire monitoring network has met its initial objective, namely to detect disabilities early and provide practical help to parents in a population of vulnerable children. Benefits for professionals and other children not followed in the network were observed, with an increase in pediatricians' skills. The benefits of the evaluation results are more difficult to assess with the care than neonatal care in obstetrics. The sustainability of such a network seems assured for healthcare professionals, provided that funding is maintained by the health authorities.

[Effectiveness of an informative report on the prevention of nosocomial bloodstream infections in a neonatal intensive care unit]. / Prévention des septicémies nosocomiales sur cathéters veineux centraux dans une unité de réanimation néonatale: impact d'une procédure d'information.

OBJECTIVE: Few studies have evaluated the impact of an information and prevention process specifically aimed at neonatalogists and nurses working in a neonatal intensive care unit (NICU) towards the prophylaxis of nosocomial bloodstream infections. Our objective was first to analyze nosocomial infections within our unit, and secondly to evaluate the impact of a monthly report providing information related to the number and characteristics of such infections. PARTICIPANTS AND METHODS: A prospective study was performed in the NICU of Angers University Hospital during 2 six-month periods. All cases of nosocomial bloodstream infections and their characteristics were analyzed. We then published a nosocomial infections report every month during the second period, in order to inform the medical staff and nurses of the results. The impact of the information and prevention process was evaluated by comparing the results between the 2 periods. We also assessed the staff's interest by questionnaire. RESULTS: Two hundred and fifty-four (first period) and 240 (second period) patients were included. A decrease in the specific incidence rate and density of catheter related bloodstream infections was observed between the 2 periods, especially for preterms with a birth weight<1000 g and gestational age<28 SA (P<0.01). Coagulase negative Staphylococcus was identified in 82.3% and 62.5% of cases respectively. 54% of the members of staff expressed their concerns related to the findings and were very interested to read about the observations made during the study. CONCLUSION: This original process seems to be both effective and inexpensive, and can be easily reproduced to decrease the frequency of bloodstream infections in NICU. However, its long-term impact still needs to be evaluated.

[Antineutrophil cytoplasmic antibodies in cystic fibrosis. Frequency and significance]. / Anticorps anticytoplasme des polynucléaires neutrophiles au cours de la mucoviscidose. Fréquence et signification.

UNLABELLED: Some immune system abnormalities have been reported in cystic fibrosis, particularly the presence of antineutrophil cytoplasmic antibodies (ANCAs). The purpose of this study was to determine the frequency of these antibodies in a population of patients with cystic fibrosis and to assess their relationship with the disease progression. POPULATION AND METHODS: This retrospective study looked for the presence of these antibodies in sera from 64 patients (30 boys and 34 girls) aged one to 29 years. All patients were followed up within the Cystic Fibrosis Center of the University Hospital of Angers. The serum samples were collected in 2001 during the yearly check-up to evaluate disease status. RESULTS: Seven of the 64 patients presented the antibodies. Univariate analysis showed that these patients were significantly older and more often chronically infected with Pseudomonas aeruginosa than the other patients. They also scored significantly more poorly on pulmonary radiography and showed significantly higher IgG and CRP. Multivariate analysis revealed that the two following independent factors were associated with the presence of ANCAs: chronic P. aeruginosa infection and high IgG level. CONCLUSION: This work confirms the abnormally high frequency of antineutrophil cytoplasmic antibodies in patients with cystic fibrosis. These antibodies were observed in the sickest patients with severe infection status. They reflect the impact of inflammatory processes in the pathogenesis of the disease. Detection of these antibodies might be an indication for intensified treatment of bronchial infections.