Barreras y facilitadores para las familias con bebés prematuros que se preparan para el alta de la unidad neonatal. Percepciones del personal de salud

ABSTRACT: To explore Colombian health care provider perceptions of barriers and facilitators to preparing families with premature infants for discharge home from the neonatal intensive care unit (NICU). Methodology. Using a qualitative descriptive design, in-depth semistructured interviews were conducted with fifteen neonatal health care providers (HCPs) in Colombia. Data were analyzed using qualitative content analysis. Results. Participant responses centered on three main themes: 1) establishment of the parent-infant bond, 2) acquisition of parenting skills, and 3) getting ready for the transition from hospital to home. Barreirs to preparing parents for NICU discharge included obstacles to parental visiting in the NICU, communication barriers, difficulties related to the establishment of successful breastfeeding, insufficient human resources and poor links between hospital and community-based resources. Facilitators included the availability of social aids for vulnerable families, 24-hour telephone access to the neonatal units, tailored educational materials and group sessions, continuing education for staff and the community-based Kangaroo Program available to parents post-discharge. Adolescent mothers, indigenous parent and working fathers were identified as particularly challenging to reach and engage in discharge preparation. Conclusion. Neonatal HCPs identified numerous challenges as well as helpful strategies for preparing families for hospital discharge. Additional studies are needed on the experience of neonatal discharge from the perspective of parents of premature infants in Colombia, to help inform optimal interventions for supporting families during the transition from hospital to home.RESUMEN: Explorar las percepciones del personal de salud neonatal sobre las barreras y facilitadores para las familias con bebés prematuros que se preparan para el alta de la Unidad de Cuidado Intensivo Neonatal (UCIN). Metodología. Utilizando un diseño cualitativo descriptivo, se realizaron entrevistas semi-estructuradas a profundidad a 15 profesionales de la salud neonatal en Colombia. Los datos fueron analizados mediante el análisis de contenido. Resultados. Las respuestas de los participantes se centraron en tres temas principales: 1) el establecimiento del vínculo entre padres y el niño, 2) la adquisición de habilidades parentales, y 3) preparación para la transición del hospital al hogar. Las barreras para la preparación de los padres para el egreso del niño, incluyen desde los obstáculos a los padres para la visita en la UCIN, las barreras de comunicación, las dificultades relacionadas con el establecimiento de la lactancia materna exitosa, los recursos insuficientes de personal de salud y escasos vínculos entre el hospital y la comunidad. Los facilitadores fueron la disponibilidad de ayudas sociales para las familias vulnerables, el acceso telefónico de 24 horas a las unidades neonatales, los materiales educativos adaptados, la educación continua para el personal de salud, y la disponibilidad para los padres del Programa Canguro de base comunitaria después del alta. Las madres adolescentes, los padres que trabajan y la familia indígena fueron grupos identificados como particularmente difíciles para que participaran en la preparación del alta. Conclusión. El personal de salud identificó numerosos desafíos, así como estrategias útiles para la preparación de las familias para el alta hospitalaria del prematuro. Se necesitan estudios adicionales en la experiencia del alta neonatal desde la perspectiva de los padres de bebés prematuros en Colombia, para ayudar a documentar las intervenciones óptimas para apoyar a las familias

Barriers and facilitators to preparing families with premature infants for discharge home from the neonatal unit. Perceptions of health care providers

Objective. To explore Colombian health care provider perceptions ofbarriers and facilitators to preparing families with premature infantsfor discharge home from the neonatal intensive care unit (NICU).Methodology. Using a qualitative descriptive design, in-depth semistructuredinterviews were conducted with fifteen neonatal healthcare providers (HCPs) in Colombia. Data were analyzed usingqualitative content analysis. Results. Participant responses centeredon three main themes: 1) establishment of the parent-infant bond,2) acquisition of parenting skills, and 3) getting ready for thetransition from hospital to home. Barreirs to preparing parents forNICU discharge included obstacles to parental visiting in the NICU,communication barriers, difficulties related to the establishmentof successful breastfeeding, insufficient human resources andpoor links between hospital and community-based resources.Facilitators included the availability of social aids for vulnerablefamilies, 24-hour telephone access to the neonatal units, tailorededucational materials and group sessions, continuing educationfor staff and the community-based Kangaroo Program availableto parents post-discharge. Adolescent mothers, indigenous parentand working fathers were identified as particularly challenging toreach and engage in discharge preparation. Conclusion. NeonatalHCPs identified numerous challenges as well as helpful strategiesfor preparing families for hospital discharge. Additional studiesare needed on the experience of neonatal discharge from theperspective of parents of premature infants in Colombia, to helpinform optimal interventions for supporting families during thetransition from hospital to home

Severe delayed autoimmune haemolytic anaemia following artesunate administration in severe malaria: a case report

International audienceBackground: Parenteral artesunate is recommended as first-line therapy for severe and complicated malaria. Although its efficacy has been proven, long-term safety profile is still under evaluation. Several cases of delayed haemolytic anaemia occurred after initial clinical improvement and resolution of parasitaemia in non-immune travellers and children living in endemic areas. Reports have generated concern that this phenomenon might be related to the treatment itself, either by direct toxicity or immune-related mechanism. This is a report of the first case of autoimmune haemolytic anaemia following treatment of severe malaria initially managed with parenteral artesunate with strong indication for drug-immune related mechanism. Case: A 17-year old Ivoirian female travelling in France presented with fever, headache and abdominal pain seven days after her arrival. Physical examination was indicative of septic shock while blood analysis showed normal haemoglobin level, but profound thrombocytopaenia and hyperlactataemia. Blood smear analysis showed Plasmodium falciparum infection with a parasitaemia of 0.8%. Severe malaria was diagnosed according to the WHO criteria. The patient was initially managed with artemether/lumefantrine combination and then parenteral artesunate for 48 hours. Empiric antibiotic course was also initiated with ceftriaxone, metronidazole, gentamycin, and then piperacillin and ciprofloxacin. At day 14, haemoglobin dropped to 4.6 g/dL with biologic features indicative of haemolysis (LDH 658 U/L, haptoglobin <0.15 g/L). At that time, parasitaemia was negative and other infections or hereditary disorders were excluded, while Coombs' direct antiglobulin test was positive for IgG and C3d. Antinuclear antibodies were absent. Further investigations evidenced drug-induced antibodies related to artesunate. It was concluded a drug-mediated autoimmune haemolytic anaemia. A corticosteroids regimen was initiated at 1 mg/kg/day. Outcome was favourable and corticosteroids were progressively tapered during two months. At present the patient's condition remains stable without recurrence of haemolytic anaemia. Conclusion: This is the first case of delayed haemolytic anaemia related to artesunate with a strong indication for drug-immune related mechanism. Further research is warranted to better characterize this plausible cause of post-treatment haemolysis following parenteral artesunate administration in severe malaria patients

Scabies incidence and association with skin and soft tissue infection in Loyalty Islands Province, New Caledonia : A 15-year retrospective observational study using electronic health records

International audienceScabies is a known public health problem in the Pacific region. This study aimed to determine the importance of scabies and associated skin infections in the Loyalty Island Province (LIP) of New Caledonia (20,000 inhabitants). The provincial electronic medical database was searched for all cases of scabies and skin infection that occurred in the LIP population between 2004 and 2018. To evaluate the impact of scabies on skin infections, we measured the decrease in the number of skin infections in children <5 years one year after scabies treatment.Over the study period, the average number of scabies cases occurring each year was 6 per 100 inhabitants. In children <1 year, this number was 18 per 100 inhabitants. We found that 80% of children aged 15 years had experienced at least one episode of scabies. We also observed a fourfold decrease in the number of skin infections in children <5 years 1 year after treatment. Scabies was more frequent (+30%) in winter

Harness risk stratification of diabetic patients with dengue in a cohort study

Background: Identifying predictors of severe dengue (SD) is key for triage and management of patients as well as for advising travellers to countries where dengue is endemic. In this, meta-analyses have raised diabetes mellitus as a risk factor for SD and a prognostic factor for dengue-related mortality. The purpose of this study was to assess whether diabetic patients (DPs) are at increased risk for SD in comparison to non-diabetic patients (NDPs) in a setting of high prevalence of type 2 diabetes mellitus and increasing endemicity for dengue. Methods: In a cohort study conducted during the 2019 dengue epidemic on Reunion Island, we estimated the risk ratios (RR) of DPs for SD (WHO 2009 definition), hospitalisation, intensive care unit (ICU) admission, critical care need or death in the ICU, and scales rating severity or multiple organ dysfunction syndrome (MODS), among confirmed cases of dengue (positive RT-PCR or NS1 antigen). Results: In a Poisson regression model adjusted for age, gender and comorbidity, DPs were more likely to develop SD (adjusted RR: 1.46, 95%CI 1.10–1.95), to be hospitalised, admitted to the ICU, and need critical care or die in the ICU. Subgroup analyses identified female DPs, non-elderly DPs (< 65 years) and DPs with low Charlson score (< 3) to be at higher risk for SD, the two first subgroups trough more severe presentation (higher Simplified Acute Physiology Score-2 values; higher MODS scores, respectively). Male gender, age less than 65 years and mixed comorbidity were identified as prognostic factors for critical care need or death in the ICU, male and non-elderly DPs being more likely to develop MODS than their non-diabetic counterparts. Conclusions: Together, these data highlight the role of diabetes mellitus in the progression from dengue to SD through higher severity per se or the event of MODS

Managing pain and anxiety during transabdominal chorionic villus sampling. A noninferiority randomized trial of nitrous oxide vs local anesthesia

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Major Neutrophilia Observed in Acute Phase of Human Leptospirosis Is Not Associated with Increased Expression of Granulocyte Cell Activation Markers

International audienceIt has long been known that pathogenic Leptospira can mobilize the immune system but the specific contribution of neutrophils to control the infectious challenge remains to be clarified. We herein analyzed the phenotype of circulating neutrophils of patients with leptospi-rosis and healthy controls for the expression of toll-like receptor (TLR) type 2 (TLR2, to sense the leptospiral LPS) and several activation markers: interleukin 8 chemokine receptor CD182 (CXCR2), CD11b of the integrin/opsonin complement receptor type 3 (CR3) and CD15 (ligand of the selectin). The plasmatic level of the main CD182 ligand, interleukin 8 (CXCL8), was measured by ELISA. Hospitalized leptospirosis cases showed marked neu-trophilia, particularly in the most severe cases. Interestingly, TLR2 was significantly increased in leptospirosis but identical levels of CD182 and CD11b were detected when compared to controls. CD15 was significantly decreased on neutrophils in leptospirosis but returned to normal within 1 month. Basal levels of IL-8 were measured in control subjects and were not increased in leptospirosis cases at the initial stage of the disease. In conclusion , we observed that neutrophils failed to regulate the expression of several of the receptors involved in cell activation and recruitment. This study further emphasizes the paradigm that neutrophils may be impaired in their overall capacity to thwart bacterial infection in lep-tospirosis patients

Single Injection of High Volume of Autologous Pure PRP Provides a Significant Improvement in Knee Osteoarthritis: A Prospective Routine Care Study

Background: Evidence is growing regarding the ability of platelet-rich plasma (PRP) injections to enhance functional capacity and alleviate pain in knee osteoarthritis (OA). However, heterogeneity in common practice regarding PRP preparation and biological content makes the initiation of this activity in a hospital complex. The aim of this study was to document the efficacy of a single PRP injection to treat knee OA and validate a routine care procedure. Methods: Fifty-seven patients with symptomatic knee OA received a single injection of large volume of very pure PRP. They were assessed at baseline and after one, three and six months, by measuring Knee Injury and Osteoarthritis Score (KOOS), Observed Pain after a 50-foot walk test and Visual Analog Scale (VAS) assessments. Magnetic Resonance Imaging (MRI) analysis was performed at baseline and six months after the procedure. The objective was to recover 50% of responders three months after the procedure using OMERACT-OARSI criteria. Results: A single administration of high volume pure PRP provided significant clinical benefit for 84.2% of the responders, three months after the procedure. The KOOS total score significantly increased from 43.5 &plusmn; 14.3 to 66.4 &plusmn; 21.7 six months after the procedure (p &lt; 0.001). Pain also significantly decreased from 37.5 &plusmn; 25.1 to 12.9 &plusmn; 20.9 (p &lt; 0.001). No difference was observed on MRI parameters. Conclusion: A single injection of large volume of very pure PRP is associated with significant functional improvement and pain relief, allowing initiation of daily PRP injection within our hospital