Peri-operative red blood cell transfusion in neonates and infants: NEonate and Children audiT of Anaesthesia pRactice IN Europe: A prospective European multicentre observational study

BACKGROUND: Little is known about current clinical practice concerning peri-operative red blood cell transfusion in neonates and small infants. Guidelines suggest transfusions based on haemoglobin thresholds ranging from 8.5 to 12 g dl-1, distinguishing between children from birth to day 7 (week 1), from day 8 to day 14 (week 2) or from day 15 (≥week 3) onwards. OBJECTIVE: To observe peri-operative red blood cell transfusion practice according to guidelines in relation to patient outcome. DESIGN: A multicentre observational study. SETTING: The NEonate-Children sTudy of Anaesthesia pRactice IN Europe (NECTARINE) trial recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. PATIENTS: The data included 5609 patients undergoing 6542 procedures. Inclusion criteria was a peri-operative red blood cell transfusion. MAIN OUTCOME MEASURES: The primary endpoint was the haemoglobin level triggering a transfusion for neonates in week 1, week 2 and week 3. Secondary endpoints were transfusion volumes, 'delta haemoglobin' (preprocedure - transfusion-triggering) and 30-day and 90-day morbidity and mortality. RESULTS: Peri-operative red blood cell transfusions were recorded during 447 procedures (6.9%). The median haemoglobin levels triggering a transfusion were 9.6 [IQR 8.7 to 10.9] g dl-1 for neonates in week 1, 9.6 [7.7 to 10.4] g dl-1 in week 2 and 8.0 [7.3 to 9.0] g dl-1 in week 3. The median transfusion volume was 17.1 [11.1 to 26.4] ml kg-1 with a median delta haemoglobin of 1.8 [0.0 to 3.6] g dl-1. Thirty-day morbidity was 47.8% with an overall mortality of 11.3%. CONCLUSIONS: Results indicate lower transfusion-triggering haemoglobin thresholds in clinical practice than suggested by current guidelines. The high morbidity and mortality of this NECTARINE sub-cohort calls for investigative action and evidence-based guidelines addressing peri-operative red blood cell transfusions strategies. TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT02350348

Complications post opératoires de la chirurgie des déformations rachidiennes par voie postérieure (à propos de 80 cas)

INTRODUCTION : La chirurgie de la scoliose chez l enfant est à risque de complications. Deux types de populations sont concernés : les enfants opérés de scoliose d origine neurologique et les scolioses idiopathiques. Notre travail a consisté à repérer toutes les complications survenues en post opératoire immédiat. MATERIEL et METHODES : 80 patients opérés d une arthrodèse vertébrale par voie postérieure ont été recensés. Toutes les complications ou événements indésirables survenant dans les 48 premières heures ont été relevés. Ces événements ont été d une part comparés entre les deux types de population et d autre part comparé aux données de la littérature afin d évaluer nos pratiques. RESULTATS : 30 patients opérés l étaient pour une scoliose neurologique et 50 pour une scoliose idiopathique. 46% des patients ont présenté des complications. La mortalité s élève à 1,25%. Les complications retrouvées sont des complications liées au saignement (17,5%), à des troubles hémodynamiques (7,5%), à des troubles respiratoires (15%), à des infections (8,75%), à des atteintes neurologiques (6,25%), à des atteintes rénales (13,75%), à la douleur (10%), à la iatrogénie (7,5%). La population neurologique se complique plus que la population idiopathique (p=0,0046) et saigne plus en post opératoire (p=0,0005). DISCUSSION : Nos résultats ont été comparés aux données de la littérature, notre taux de complications est élevé mais très exhaustif, englobant deux types de population. La population neurologique est de façon générale et pour chaque type de complications plus pourvoyeuse de complications. Nos résultats et pratiques ont été confrontés pour chacun des items aux données scientifiques retrouvées. CONCLUSION : La chirurgie de la scoliose chez l enfant est source de problèmes médico-chirurgicaux dans les 48 premières heures post opératoires. Nos résultats sont comparables aux données de la littérature.OBJECTIVES: The surgery of the scoliosis in the child is risk of complications. Two standard populations are concerned: operated children of neurological scoliosis of origin and idiopathic scolioses. Our work consisted in locating all the complications which have occurred in post operational immediate. PATIENTS, METHODS: 80 operated patients of a vertebral arthrodese by posterior way were listed. All undesirable complications or events occurring in the first 48 hours were raised. These events on the one hand were compared between the two types of population and on the other hand compared to data of the literature in order to evaluate our practice. RESULTS : 30 operated patients were it for a neurological scoliosis and 50 for a idiopathic scoliosis. 46% of the patients presented complications. Mortality amounts to 1.25%.The found complications are complications related to the bleeding (17.5%), with hemodynamic disorders (7.5%), with respiratory disorders (15%), with infections (8.75%), with neurological attacks (6.25%), with renal attacks (13.75%), with pain (10%), with iatrogénie (7.5%)The neurological population becomes complicated more than the idiopathic population (p=0,0046) and bleeds more in post operational (p=0,0005). DISCUSSION: Our results were compared with the data of the literature, our rate of complications is high but very exhaustive, including two types of population. The neurological population is in a general way and for each type of complications more provider of complications. Our results and practices were confronted for each items with the found scientific data. CONCLUSIONS: The surgery of the scoliosis in the child is source of medico-surgical problems in the first 48 post operational hours. Our results are comparable with the data of the literature.AMIENS-BU Santé (800212102) / SudocSudocFranceF

Personal recovery of young adults with severe anorexia nervosa during adolescence: a case series

International audiencePurpose: Despite the emergence of a growing qualitative literature about the personal recovery process in mental disorders, this topic remains little understood in anorexia nervosa (AN), especially severe AN during adolescence. This cases series is a first step that aims to understand recovery after severe AN among adolescents in France, from a first-person perspective. Methods: This cases series applied the interpretative phenomenological analysis (IPA) method to data collected in semi-structured face-to-face interviews about the recovery process of five young women who had been hospitalized with severe AN 10 years earlier during adolescence. Results: A model of recovery in four stages (corseted, vulnerable, plastic, and playful) crossing seven dimensions (struggle and path of initiation; work on oneself; self-determination and help; body; family; connectedness; and timeline) emerged from the analysis. New features of the AN personal recovery process were characterized: bodily well-being and pleasure of body; stigmatization; the role of the group; relation to time; and importance of narratives. We suggest a new shape to model the AN recovery process, one that suggests several tipping points. Recruitment must now be widened to different AN contexts. Conclusions: The personal recovery paradigm may provide a new approach to care, complementary to medical paradigm. Registration of clinical trial: No. NCT03712384. Our study was purely observational, without assignment of medical intervention. As a consequence, this clinical trial was registered retrospectively. Level of evidence: Level V, descriptive study

Group Qigong for Adolescent Inpatients with Anorexia Nervosa: Incentives and Barriers

<div><p>Background</p><p>Qigong is a mind-body intervention focusing on interoceptive awareness that appears to be a promising approach in anorexia nervosa (AN). In 2008, as part of our multidimensional treatment program for adolescent inpatients with AN, we began a weekly qigong workshop that turned out to be popular among our adolescent patients. Moreover psychiatrists perceived clinical benefits that deserved further exploration.</p><p>Methods and findings</p><p>A qualitative study therefore sought to obtain a deeper understanding of how young patients with severe AN experience qigong and to determine the incentives and barriers to adherence to qigong, to understanding its meaning, and to applying it in other contexts. Data were collected through 16 individual semi-structured face-to-face interviews and analyzed with the interpretative phenomenological analysis method. Eleven themes emerged from the analysis, categorized in 3 superordinate themes describing the incentives and barriers related to the patients themselves (individual dimension), to others (relational dimension), and to the setting (organizational dimension). Individual dimensions associated with AN (such as excessive exercise and mind-body cleavage) may curb adherence, whereas relational and organizational dimensions appear to provide incentives to join the activity in the first place but may also limit its post-discharge continuation. Once barriers are overcome, patients reported positive effects: satisfaction associated with relaxation and with the experience of mind-body integration.</p><p>Conclusions</p><p>Qigong appears to be an interesting therapeutic tool that may potentiate psychotherapy and contribute to the recovery process of patients with AN. Further analysis of the best time window for initiating qigong and of its place in overall management might help to overcome some of the barriers, limit the risks, and maximize its benefits.</p></div

Participants' characteristics.

<p>Participants' characteristics.</p

Incentives and barriers to adherence to qigong, to understanding its meaning, and to applying its techniques in other spheres.

<p>Incentives and barriers to adherence to qigong, to understanding its meaning, and to applying its techniques in other spheres.</p

Interview topic guide.

<p>Interview topic guide.</p

Epidemiology and complications of anaesthesia in the French centres that participated to NECTARINE: A secondary analysis

International audienc