NIDCAP and developmental care

Perinatal mortality in very low birth weight infants has dramatically decreased during the last decades. However, 15-25% of these infants will show neurodevelopmental impairment later on. The aim of implementing early developmental care (EDC), emerged as a new field in neonatology, is to create an intervention program designed to provide support for optimal neurobehavioral development during this highly vulnerable period of brain growth. The theoretical framework, which underlies the approach, is supported by research in different scientific fields, including neuroscience, psychology, medicine and nursing. EDC utilizes a range of medical and nursing interventions that aim to decrease the stress of preterm neonates in neonatal intensive care units (NICUs). The Neonatal Individualized Developmental Care Assessment Program (NIDCAP) is an integrated and holistic form of family-centered developmental care. Changing the traditional NICU towards an EDC-NICU includes training nursing and medical staff, investing in their quality and most importantly keeping parents in proximity to the infants. The new challenge of modern neonatology is to restore the mother-infant dyad applying “couplet care” starting at birth until discharge. Most of the European NICUs apply some elements of EDC, but it is more consistent in northern Europe. The development of NIDCAP training centers in Europe demonstrates the evolution of care. It is likely that future research and intervention programs will optimize our practices. Developmental care could prove to be an important recent step in improving outcome in extremely preterm neonates.   Proceedings of the 10th International Workshop on Neonatology · Cagliari (Italy) · October 22nd-25th, 2014 · The last ten years, the next ten years in Neonatology Guest Editors: Vassilios Fanos, Michele Mussap, Gavino Faa, Apostolos Papageorgio

Management of the neonate at the limits of viability

The active treatment of fetuses or neonates at the limits of viability is an ongoing debate for perinatal physicians. Although initiating intensive care at 26 weeks is generally accepted, the gray zone of gestational ages at which aggressive perinatal care should be offered is less clear and ranges from 22 to 25 weeks. The gray zone has remained rather unchanged over the last decade. Attitudes vary among different countries, centres and individuals. The benefit-burden ratio of neonatal intensive care is balanced differently according to competing moral values. Several factors underlie the difficulty in approaches to management decisions. Neonates lack the capacity to make decisions and most parents ignore the complexity of care during and after hospitalisation. Parents have to be informed about the survival rates and the risks of long term disabilities, but accuracy for each individual baby is very weak. Outcome data are published many years after the intensive care period, and results about the prevalence of severe disabilities over time are conflicting and vary widely (ranging from 10% to 60%). Information about more subtle disabilities which only become apparent around school age is scarce. Data on the impact of the longer term outcomes of new strategies like developmental care approaches (Neonatal Individual Developmental Care Assessment Programme: NIDCAP) are still insufficient but could prove to be an important recent step in improving outcome in extremely immature babies. © RCOG 2005.SCOPUS: cp.jFLWINinfo:eu-repo/semantics/publishe

Representation and computation of the visibility information for the interactive exploration of tridimensional scenes

La synthèse d'images, qui consiste à développer des algorithmes pour générer des images à l'aide d'un ordinateur, est devenue incontournable dans de nombreuses disciplines. Les méthodes d'affichage interactives permettent à l'utilisateur d'explorer des environnements virtuels en réalisant l'affichage des images à une cadence suffisamment élevée pour donner une impression de continuité et d'immersion. Malgré les progrès réalisés par le matériel, de nouveaux besoins supplantent toujours les capacités de traitement, et des techniques d'accélération sont nécessaires pour parvenir à maintenir une cadence d'affichage suffisante. Ce travail s'inscrit précisemment dans ce cadre. Il est consacré à la problématique de l'élimination efficace des objets masqués, en vue d'accélérer l'affichage de scènes complexes. Nous nous sommes plus particulièrement intéressé aux méthodes de précalcul, qui effectuent les calculs coûteux de visibilité durant une phase de prétraitement et les réutilisent lors de la phase de navigation interactive. Les méthodes permettant un précalcul complet et exact sont encore hors de portée à l'heure actuelle, c'est pourquoi des techniques approchées leur sont préférée en pratique. Nous proposons trois méthodes de ce type.La première, présentée dans le chapitre 4, est un algorithme permettant de déterminer de manière exacte si deux polygones convexes sont mutuellement visibles, lorsque des écrans sont placés entre eux. Nos contributions principales ont été de simplifier cette requête, tant du point de vue théorique que du point de vue de l'implémentation, ainsi que d'accélérer son temps moyen d'exécution à l'aide d'un ensemble de techniques d'optimisation. Il en résulte un algorithme considérablement plus simple à mettre en oeuvre que les algorithmes exacts existant dans la littérature. Nous montrons qu'il est également beaucoup plus efficace que ces derniers en termes de temps de calcul.La seconde méthode, présentée dans le chapitre 5, est une approche originale pour encoder l'information de visibilité, qui consiste à stocker l'ombre que générerait chaque objet de la scène s'il était remplacé par une source lumineuse. Nous présentons une analyse des avantages et des inconvénients de cette nouvelle représentation. Finalement, nous proposons dans le chapitre 6 une méthode de calcul de visibilité adaptée aux scènes d'intérieur. Dans ce type d'environnements, les graphes cellules-portails sont très répandus pour l'élimination des objets masqués, en raison de leur faible coût mémoire et de leur grande efficacité. Nous reformulons le problème de la génération de ces graphes en termes de segmentation d'images, et adaptons un algorithme classique, appelé «watershed», pour les obtenir de manière automatique. Nous montrons que la décomposition calculée de la sorte est proche de la décomposition classique, et qu'elle peut être utilisée pour l'élimination des objets masqués.Doctorat en sciences appliquéesinfo:eu-repo/semantics/nonPublishe

Lipid infusion and intravenous access in newborn infants

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Factors affecting glycosylated hemoglobin in diabetic children

SCOPUS: le.jinfo:eu-repo/semantics/publishe

ENewborn: The Information Technology Revolution and Challenges for Neonatal Networks

Among preterm infants, 1-2% are born before 32 weeks of gestation or have a birth weight below 1,500 g. They contribute disproportionately to the burden of mortality and morbidity related to preterm birth, whether in the neonatal period or later in life. They are the target population studied in neonatal networks. Improving neonatal care and later outcome is a major issue in public health. Neonatologists, health care providers, public authorities, parents and families, industry, and all organizations dedicated to infant health must bring their efforts together and dedicate their actions in order to do so. Neonatal networks are the strongest platforms through which to achieve this goal. The progressive information technology (IT) revolution is leading to a new approach. The power of search engines and new technological devices opens extraordinary new perspectives in terms of speed, storing, sharing, and innovative approaches in providing health care. However, difficulties are expected with old applications that cannot evolve in the new IT environment. Security and privacy in data collection are future challenges to be addressed. Here, we describe the eNewborn project and its original software. The main functionalities are interactive navigation, harmonization with other formats, linkage with other databases, and strict security and privacy procedures.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Complete Polygonal Scene Voxelization

info:eu-repo/semantics/publishe

BREAST VERSUS BOTTLE: C-PEPTIDE IMMUNOREACTIVITY

SCOPUS: le.jinfo:eu-repo/semantics/publishe

Tensions éthiques émergentes: La néonatalogie et les limites de la viabilité

Births at the limit of viability are extremely complex, emblematic situations in the debate on medical futility, the "senseless obstinacy" as mentioned in the French law on end of life. The context of extreme preterm birth is highly specific, due to multiple natural, medical, psychological and socio-economical factors. It led in the past to decision-making processes based on simplistic, collective criteria, such as birth weight or gestational age thresholds, that were considered essential safeguards to avoid excess medical intervention and assist in medical decision-making. Currently available scientific information from population-based studies of patients follow-up, together with a renewed ethical reflection, aware of the biases induced by the symbolic context, are changing the views of many health care professionals and ethicists. Both lead today to the back to basics conclusion that the respect of the fundamental, individual rights of every infant, born extremely premature or not, and the patient's best interest do apply in this field like in others fields of medicine through individualized, not category-based medical decisions. Such principles should especially guide medical decisions involving antenatal interventions around the limit of viability, which constitute the most complex dilemmas.SCOPUS: sh.jinfo:eu-repo/semantics/publishe

Renal threshold for glucose in diabetic children

SCOPUS: le.jinfo:eu-repo/semantics/publishe