[Missed opportunities of in utero transfer of very preterm births (24-32 weeks gestation) in Aquitaine, 2003-2005]. / Opportunités manquées de transfert in utero des grands prématurés (24-32 semaines d'aménorrhée) en Aquitaine, 2003-2005.

OBJECTIVE: Describe and define the factors associated with missed opportunities of an in utero transfer (IUT), defined by by an absence of IUT where there was no counter-indication for a transfer. MATERIALS AND METHODS: Multicentric and retrospective cohort study within the Aquitaine perinatal healthcare network from 1st January 2003 to 30th June 2005 on deliveries between 24 and 32 weeks gestation, depending on whether the woman initially followed care in level I or II facilities benefited from an IUT at a level III facility or not. associated with missed opportunities of IUT were analysed by a logistic regression. RESULTS: Five hundred and twelve deliveries, eligible to deliver in level III facilities, were included in the study: 273 after an IUT and 239 in a level I or II maternity hospitals out of which 18% are defined as a missed opportunity of an in utero transfer. The multivariate analysis did not show a link between missed opportunities of an in utero transfer and the characteristics of maternities: status, size, level of care and distance from a level III facility. Only the delivery term appears to be linked to a missed opportunity of an in utero transfer (p=0.01): 32 weeks gestation versus 26-29 weeks gestation (RC=6.53; IC(95%): 2.00-21.25). While managing the delivery after 31 weeks gestation is considered suitable in a level IIb facility, the delivery term is no longer statistically related to a missed opportunity. CONCLUSION: This study serves as a first analysis of the Aquitaine perinatal healthcare network. It shows that missed opportunities of IUT does not seem to be linked to characteristics of maternities but seems to be linked to deliveries after 31 weeks gestation in level IIb facilities.

[Febrile seizures]. / Convulsions hyperthermiques.

The febrile seizures (FS) of the child are frequent. Their management is essentially based on the rigorous analysis of their characteristics, the clinical evaluation of the patient like on the collection of the family antecedents. In the case of "simple" FS, the forecast, always favourable, reduce the indications of assessment or treatment, including under possible repetitions. The possibility of an infection of the central nervous system must however always be isolated. In the case of "complicated" FS, the more important risk of later epilepsy makes often necessary of complementary explorations, as well as a treatment. Genetic predispositions were highlighted. In the case of a favourable forecast, contrast always large between the benignity of the FS and the parental dramatic experience. It must be taken into account in the evaluation and the choice of the therapeutic attitude.

[Vaccinal status in children with seizures: a retrospective study conducted in the Bordeaux child hospital]. / Statut vaccinal d'enfants ayant un antécédent de convulsion ou d'épilepsie débutante: étude rétrospective comparative réalisée au CHU de Bordeaux.

UNLABELLED: Vaccination is a common act in medicine. Some serious side effects are always feared in a preventive action, mainly among high-risk patients such as epileptic children or children having already experienced a seizure. OBJECTIVES: To study consequences of such background on the vaccine medical practice. POPULATION AND METHODS: A retrospective study comparing the vaccine statute of children with or without case history of seizures was carried out by the neurologic and paediatric emergencies departments. The study compared 55 with seizures versus 109 without. RESULTS: On the whole, the 2 groups were insufficiently vaccinated. A statistically significant difference was highlighted between the 2 groups for the vaccination coverage by vaccine DTP (diphtheria-tetanus-pertussis) (P=0.017) and MMR (measles-mumps-rubella) (P=0.004). However, concerning the vaccination against hepatitis B, no difference was found. CONCLUSION: The usual contra-indications of these vaccines do not explain this difference and progress must be made to improve the vaccination coverage of epileptic children.

[Rehospitalization of very preterm infants in the first year of life. Comparison of 2 groups: 1997 and 2002]. / Réhospitalisation dans l'année suivant leur naissance des prématurés d'âge gestationnel inférieur ou égal à 32 semaines d'aménorrhée. Comparaison de 2 cohortes: 1997 et 2002.

OBJECTIVE: The aim of the study was to compare the rehospitalization rate in the first year of life between 2 groups of very preterm infants born on 1997 and 2002; then we compared the very preterm infants' rehospitalization rate between our retrospective 1997 group and literature (including French cohort Epipage). PATIENTS AND METHODS: Our retrospective study included all neonates born

[Attachment and prematurity]. / Attachement et prématurité

The path leading from the desire for a child, his or her birth to the very meeting with the newborn is pregnant with psychic experiences. Among the different experiences punctuating the way is found the process of attachment, that which is necessary to the establishing and structuring the link between the newborn, his or her mother, father and family. Prematurity, and along with it the receiving the premature babies in intensive care or neonatology units, modify the conditions of this meeting, in other word this getting to know one's baby. We will try and understand how and why the nature of the bond that is being created may then be altered. We will mention the characteristic troubles of attachment as reported in the literature. We will also discuss the possible ways of prevention or restoration to be set up. The evaluation of attachment, its follow-up, as well as the possibility of early care surrounding the mother-child bond should be encouraged nowadays for all premature babies and their parents.

[Intrapleural fibrinolytic treatment and infectious pleuresies: three pediatric cases]. / Traitement fibrinolytique intrapleural et pleurésies infectieuses: à propos de trois observations pédiatriques.

UNLABELLED: Intrapleural instillation of fibrinolytic agents has been proposed for the treatment of loculated pleural effusions, or whenever the biochemical characteristics of the pleural fluid (pH, glucose level, LDH) indicate the risk of a complicated outcome due to a pleural effusion with complications and the possible development of empyema. At present, there is no consensus regarding the use of intrapleural fibrinolytic agents in children. CASE REPORTS: In this study, the successful treatment by fibrinolytic agents and standard drainage are successfully performed in three children with a pleural effusion due to an infection. CONCLUSION: The clinical utility, in terms of the reduction of the duration of hospitalization and additional surgical treatment, should be assessed in prospective studies.

[Neonatal nonbacterial thrombotic endocarditis]. / Les endocardites thrombotiques néonatales non bactériennes.

UNLABELLED: Nonbacterial thrombotic endocarditis is not widely known in neonates. CASE REPORTS: We report three new cases which illustrate some specific aspects of this pathology. Respiratory distress with severe pulmonary hypertension, systemic hypotension and disseminated intravascular coagulopathy in a full-term newborn were characteristic findings. CONCLUSION: An early echocardiography should lead to accurate diagnosis. Hypoxemia and genetic factors could be determining factors in its pathogenesis.

[Pediatric emergency department policy. Implementation and management of the resuscitation room]. / Recommandations concernant la mise en place, la gestion, l'utilisation et l'évaluation d'une salle d'accueil des urgences vitales pédiatriques.

The pediatric resuscitation room is the place where children suffering from vital distress are cared for in the emergency unit. Recommendations for its organization, functioning and evaluation have been ruled on by experts from six medical societies involved in these emergencies. They concern all the hospital's physicians, nurses and administrative directors.

[Neonatal staphylococcal epidermolysis due to maternal-fetal transmission]. / Epidermolyse staphylococcique néonatale à transmission materno-foetale.

INTRODUCTION: The staphylococcal scalded skin syndrome (SSSS) is due to exfoliative toxins A or B excreted by some strains of Staphylococcus aureus. This syndrome is exceptional in the first hours of life. We report a case of SSSS due to materno-fetal infection. CASE REPORT: At 31 weeks of pregnancy a 40-year-old mother was febrile (39 degrees C) and a premature rupture of the amniotic sac occurred the following day. SSSS was diagnosed at 6 hours of life in the newborn, a 1760 g female. Staphylococcus aureus grew on the blood and vaginal bacterial cultures of the mother, as well as, from cultures of skin, nose, throat, and umbilical catheter in the newborn. The strains of Staphylococcus aureus isolated in the mother and the child had identical characteristic antibiotype and genotype by Random-PCR. The genes for both exfoliations A and B were present. Epidermization was rapidly obtained and no septicemia or septic complication was noted. DISCUSSION: Staphylococcus aureus is usually responsible for nosocomial infections which occur in the early newborn period. In most cases, the infection is transmitted by a carrier who manipulates the child (family, visitors, nurse or medical staff). In our case, onset of SSSS early after birth suggested a perinatal transmission, due to lower genital tract infection in the mother. The presence of SSSS in the child and not in the mother may be explained by a massive perinatal infection and low elimination of the toxin in the newborn resulting in higher concentrations of exfoliative toxins in the blood.

[Respiratory emergencies in infants]. / Urgences respiratoires du nourrisson.

Respiratory distress in childhood is a frequent cause of admission to the emergency department. The initial management requires a rapid clinical evaluation in order to initiate appropriate interventions, which will improve respiratory status, and avoid cardiac arrest and hypoxic encephalopathy. There are many possible etiologies but in the vast majority of cases the following conditions are observed: nasal obstruction before 3 months and laryngitis after 6 months. Moreover, during winter acute viral bronchiolitis is the most common disease of the respiratory tract during the first year of life, and occurs in annual epidemics. The diagnostic of an inhaled foreign body must always be suspected. Prevention is based upon information given to families, as well as the medical community, which often minimises the seriousness of inhalation hazards.

Minimal effective dose of indomethacin for the treatment of patent ductus arteriosus in preterm infants.

The aim of this study was to determine if it was possible to decrease the number of boluses of indomethacin for the treatment of patent ductus arteriosus. This retrospective study included 46 preterm neonates (<34 weeks' GA) who had had an ultrasound diagnosis predictive of subsequent symptomatic patent ductus arteriosus. All patients had received a daily intravenous doses of indomethacin, 0.1 mg/kg. Mean age at initiation of treatment was 4.5 +/- 3.1 days. Patency of the ductus arteriosus was controlled echocardiographically each day and treatment was discontinued as soon as the ductus arteriosus was closed. The initial success rate was 84.7%, of which 6.5% reopened. The mean cumulative dose of indomethacin was 0.35 mg/kg. There was no correlation between gestational age or birth weight and total cumulative dose. Overall tolerance was satisfactory with only one case of transient acute renal failure. A weak correlation between the cumulative dose of indomethacin and natremia (r = -0.43) or weight gain (r = 0.35) was noted, and none with serum creatinine or blood urea nitrogen levels. We confirm that lower indomethacin treatment of patent ductus arteriosus in premature neonates are as effective as standard protocols.