Effects of nasal continuous positive airway pressure on nutritive swallowing in lambs

Current knowledge suggests that, to be successful, oral feeding in preterm infants should be initiated as soon as possible, often at an age where immature respiration still requires ventilatory support in the form of nasal continuous positive airway pressure (nCPAP). While some neonatologist teams claim great success with initiation of oral feeding in immature infants with nCPAP, others strictly wait for this ventilatory support to be no longer necessary before any attempt at oral feeding, fearing laryngeal penetration and tracheal aspiration. Therefore, the aim of the present study was to provide a first assessment of the effect of various levels of nCPAP on bottle-feeding in a neonatal ovine model, including feeding safety, feeding efficiency, and nutritive swallowing-breathing coordination. Eight lambs born at term were surgically instrumented 48 h after birth to collect recordings of electrical activity of laryngeal constrictor muscle, electrocardiography, and arterial blood gases. Two days after surgery, lambs were bottle-fed under five randomized nCPAP conditions, including without any nCPAP or nasal mask and nCPAP of 0, 4, 7, and 10 cmH(2)O. Results revealed that application of nCPAP in the full-term lamb had no deleterious effect on feeding safety and efficiency or on nutritive swallowing-breathing coordination. The present study provides a first and unique insight on the effect of nCPAP on oral feeding, demonstrating its safety in newborn lambs born at term. These results open the way for further research in preterm lambs to better mimic the problems encountered in neonatology

Privatisation, gouvernement d'entreprise et processus décisionnel:une intégration de la dynamique organisationnelle à travers le cas de France Télécom

L'objet de cette recherche est d'appliquer les éléments de la grille de lecture du gouvernement d'entreprise pour expliquer l'incidence de la privatisation sur le processus décisionnel, notamment en matière d'investissement. L'examen des mécanismes disciplinaires et de leur dynamique constitue le cadre conceptuel d'analyse support d'une recherche exploratoire portant sur le cas de France Télécom.création de valeur;gouvernement d'entreprise;privatisation; processus décisionnel;répartition de la valeur.

Privatisation, gouvernement d'entreprise et processus décisionnel:une interprétation de la dynamique organisationnelle à travers le cas France Télécom

This article tries to explain the influence of privatization on the decision making process, especially in terms of investments through the corporate governance theory. In this perspective we suggest a conceptual framework based on the analysis of disciplinary mechanisms and their dynamic as a foundation of an explanatory research applied to the France Télécom case.value creation;corporate governance;privatization; decision making process;value allocation.

Clinical, physiologic, and biologic impact of environmental and behavioral interventions in neonates during a routine nursing procedure.

International audienceThe aim of this randomized crossover study was to evaluate the impact of environmental and behavioral interventions (EBI) on behavioral, physiologic, and biologic stress response during a weighing procedure in neonates. Three groups of 15 neonates included (A) gestational age (GA), or =37 weeks. Each neonate experienced 2 weighing procedures with and without EBI. Pain was evaluated by using the Neonatal Infant Pain Scale (NIPS) and the Neonatal Pain and Discomfort Scale (EDIN). Heart rate and oxygen saturation were recorded. Salivary samples were obtained for cortisol assay. Cerebral tissue oxygenation index (TOI) was recorded with near-infrared spectroscopy. A significant decrease of NIPS and EDIN was observed with EBI versus control. Mean heart rate was lower with EBI. No difference in cortisol level changes was observed. For groups A and B, a trend of increased TOI was observed with EBI. We concluded that EBI during a nursing procedure provides a decrease in pain scores in preterm and term neonates with changes in heart rate. PERSPECTIVE: This study evaluates the impact of combined environmental and behavioral interventions on pain responses in neonates during a weighing procedure. The results indicate a decrease in behavioral pain scores and in heart rate for preterm and term neonates and a trend in increased brain oxygenation depending on gestational age