Accompaniment and care for extremely premature babies at Amiens University Hospital

3rd Biennial Meeting of the National-French-Federation-of-Regional-Paediatric-Palliative-Care-Resour ce-Teams, Lille, FRANCE, OCT 10-11, 2019International audienceHow can we support the birth of very premature babies, those born before 25 weeks of gestation? Stillborn infant, born alive but who dies very quickly, viable infant or not? What clinical and ethical management would be optimal? There are no national consensus or protocol on this subject. It is clear that these cares depend on local medical teams (sensitivity, availability). Midwives, sometimes alone when facing with these situations, are then placed in a delicate position, they are not allowed to prescribe treatments for such infant. In order to answer these many questions, the Regional Pediatric Palliative Care Resource Team (ERRSPP) then set up a multiprofessional working group in 2017. Thirteen meetings were planned. During these meetings, the various aspects were discussed: medical, legal and ethical. The discussions raised many questions, particularly in the face of legal limits and ethical decisions, but allowed everyone's point of view to change and converge. The working group developed new local tools (detailed written procedures and action flowcharts) for each of the two groups of premature children that were considered: newborn infant born strictly before 24 weeks of gestation on the one hand and newborn infant born between 24 weeks and 24 weeks + 6 days on the other. These new tools reflect a desire for improvement, harmonization of practices and support for caregivers, each situation obviously remaining unique. These procedures, which are still to be perfected, have opened the way to new reflections on support. (C) 2020 Elsevier Masson SAS. All rights reserved

Effect of multi-lumen perfusion line on catheter-related bacteremia in premature infants: study protocol for a cluster-randomized crossover trial

Abstract Background Catheter-related bacteremia (CRB) is the most frequent nosocomial infection in neonatal intensive care unit (NICU) patients, especially in very low-birth-weight infants. Administration of injectable drugs in premature newborn infants has many particularities and several types of infusion incidents have been reported. The Edelvaiss® Multiline NEO device is a novel multi-lumen access infusion device adapted to the specificities of infusion in neonatology. This multicenter, randomized, controlled study was therefore designed to determine whether or not Edelvaiss® Multiline NEO reduces the risk of CRB in preterm newborn infants in an NICU. Methods/design This is a multicenter, randomized, controlled trial, using a cluster-randomized crossover design. Four investigator centers (four clusters) will participate in the study and will be randomized into two groups, corresponding to two different sequences (either the Edelvaiss® Multiline NEO or standard infusion system sequence, then vice versa). A total of 280 patients will be recruited. Infants will be enrolled in the study at the time of placing a single-lumen central venous catheter. Three visits recording specific data are planned in the study protocol. The primary outcome measure is the incidence density (ID) of CRB. For each patient, the total number of catheters and CRB incidents as well as the duration of stay in the NICU will be computed and considered for analysis. Discussion The study will provide high-quality evidence to determine whether the Multiline NEO device reduces the risk of CRB in preterm newborns in NICUs or not. Trial registration ClinicalTrials.gov, NCT02633124. Registered on 7 December 2015

Neurodevelopmental Outcomes after Premedication with Atropine/Propofol vs Atropine/Atracurium/Sufentanil for Neonatal Intubation: 2-Year Follow-Up of a Randomized Clinical Trial

International audienceThis study followed 173 newborn infants in the PREmedication Trial for Tracheal Intubation of the NEOnate multicenter, double-blind, randomized controlled trial of atropine-propofol vs atropine-atracurium-sufentanil for premedication before nonemergency intubation. At 2 years of corrected age, there was no significant difference between the groups in death or risk of neurodevelopmental delay assessed with the Ages and Stages Questionnaire

Effect of Atropine With Propofol vs Atropine With Atracurium and Sufentanil on Oxygen Desaturation in Neonates Requiring Nonemergency Intubation A Randomized Clinical Trial

International audienceIMPORTANCE Propofol or a combination of a synthetic opioid and muscle relaxant are both recommended for premedication before neonatal intubation but have yet to be compared. OBJECTIVE To compare prolonged desaturation during neonatal nasotracheal intubation after premedication with atropine-propofol vs atropine-atracurium-sufentanil treatment. DESIGN, SETTING, AND PARTICIPANTS Multicenter, double-blind, randomized clinical trial (2012-2016) in 6 NICUs in France that included 173 neonates requiring nonemergency intubation. The study was interrupted due to expired study kits and lack of funding. INTERVENTIONS Eighty-nine participants were randomly assigned to the atropine-propofol group and 82 to the atropine-atracurium-sufentanil group before nasotracheal intubation. MAIN OUTCOMES AND MEASURES The primary outcome was prolonged desaturation (SpO(2) ( 60 seconds), using intention-to-treat analysis using mixed models. Secondary outcomes assessed the characteristics of the procedure and its tolerance. RESULTS Of 173 neonates randomized (mean gestational age, 30.6 weeks; mean birth weight, 1502 g; 71 girls), 171 (99%) completed the trial. Of 89 infants, 53 (59.6%) in the atropine-propofol group vs 54 of 82 (65.9%) in the atropine-atracurium-sufentanil group achieved the primary outcome (adjusted RD, -6.4; 95% CI, -21.0 to 8.1; P = .38). The atropine-propofol group had a longer mean procedure duration than did the atropine-atracurium-sufentanil group (adjusted RD, 1.7 minutes; 95% CI, 0.1-3.3 minutes; P = .04); a less frequent excellent quality of sedation rate, 51.7%(45 of 87) vs 92.6%(75 of 81; P < .001); a shorter median time to respiratory recovery, 14 minutes (IQR, 8-34 minutes) vs 33 minutes (IQR, 15-56 minutes; P = .002), and shorter median time to limb movement recovery, 18 minutes (IQR, 10-43 minutes) vs 36 minutes (IQR, 19-65 minutes; P = .003). In the 60 minutes after inclusion, SpO(2) was preserved significantly better in the atropine-propofol group (time x treatment interaction P = .02). Of the atropine-propofol group 20.6% had head ultrasound scans that showed worsening intracranial hemorrhaging (any or increased intraventricular hemorrhage) in the 7 days after randomization vs 17.6% in the atropine-atracurium-sufentanil group (adjusted RD, 1.2; 95% CI, -13.1 to 15.5, P = .87). Severe adverse events occurred in 11% of the atropine-propofol group and in 20% of the atropine-atracurium-sufentanil group. CONCLUSIONS AND RELEVANCE Among neonates undergoing nonemergency nasotracheal intubation, the frequency of prolonged desaturation did not differ significantly between atropine used with propofol or atropine used with atracurium and sufentanil. However, the study may have been underpowered to detect a clinically important difference, and further research may be warranted

Shielding Parenteral Nutrition Solutions From Light: A Randomized Controlled Trial

International audienceIntroduction: Oxidant stress is implicated in the pathogenesis of bronchopulmonary dysplasia (BPD). Light induces peroxide generation in parenteral nutrition (PN) solutions, creating an oxidant stress. Shielding PN from light decreases its peroxide content, which has nutrition and biochemical benefits in animals and humans. This study aims at determining whether full light protection of PN decreases the rate of bronchopulmonary dysplasia and/or death in very low-birth-weight infants. Methods: Multicenter randomized controlled trial of photoprotection, using amber bags and tubing initiated during compounding of PN and maintained throughout infusion in the light-protected (LP) group. The control group (light exposed [LE]) received PN exposed to ambient light. Depending on centers, lipids were infused either separately or as all-in-one PN. Results: In total, 590 infants born <30 weeks gestational age were included. At randomization, LE and LP groups did not differ clinically except for maximal FiO(2) before 12 hours. The rate of BPD/death was not different between groups at 28 days (77% LP vs 72% LE, P = .16) or at 36 weeks corrected age (30% LP vs 27% LE, P = .55). Multivariate analysis showed no significant effect of photoprotection on BPD and/or death. The rate of BPD/death was significantly lower (odds ratio, 0.54; 95% confidence interval, 0.32-0.93; P = .02) in infants receiving all-in-one PN vs those who received lipids separately. Conclusion: This study did not show significant beneficial effects of photoprotection. Since the decreased rate of BPD/death found with all-in-one PN relates to a center-dependent variable, this warrants further investigation

Le paysage

Dossier Quelles formes de médiation entre l'espace et la société peut offrir la notion de paysage ? Sans prétendre à l'exaustivité, six articles de recherche approfondissent cette question. Comment l'Etat s'est-il mobilisé pour répondre aux demandes sociales de paysage et de cadre de vie ? Après avoir suscité de nombreux courants de pensées, pourquoi la notion de paysage est non seulement au centre de projets d'esthétique environnementale mais aussi un acteur de médiation sociale dans les conflits liés au développement économique. Au Québec, la notion de paysage est non seulement au centre de projets d'esthétique environnementale mais aussi un acteur de médiation sociale dans les conflits liés au développement économique. L'écologie est une discipline du paysage. Comment analyse-t-elle l'organisation de l'espace pour la relier aux processus écologiques qui caractérisent les dynamiques des territoires ? Le paysage est une ressource économique qu'il est possible de quantifier. A titre d'illustration, dans la ceinture périurbaine de Dijon, quelle valeur peut être donnée aux attributs paysagers ? Parmi les recherches récentes sur le paysage, l'économie ne figure pas en bonne place. En rassemblant des éléments épars dans les différentes branches de l'économie, la nature économique du paysage et les politiques paysagères concernées peuvent être mieux comprises. Etat de l'art L'agriculture comparée. Comment cette nouvelle approche de l'agriculture s'est-elle peu à peu précisée, construite, consolidée, pour finalement constituer une disciplinescientifique à part entière avec ses méthodes et ses concepts propres ? Débat Le cycle de Doha : Comment aboutir à un commerce agricole équitable

Optimising homeothermy in neonates: A systematic review and clinical guidelines from the French Neonatal Society

AimThermal instability is harmful on the newborn infant. We sought to draw up practical guidelines on maintaining homeothermy alongside skin-to-skin contact.MethodsA systematic analysis of the literature identified relevant studies between 2000 and 2021 in the PubMed database. Selected publications were evaluated, and their level of evidence was graded, in order to underpin the development of clinical guidelines.ResultsWe identified 7 meta-analyses and 64 clinical studies with a focus on newborn infants homeothermy. Skin-to-skin contact is the easiest and most rapidly implementable method to prevent body heat loss. Alongside skin-to-skin contact, monitoring the newborn infant's body temperature with a target of 37.0°C is essential. For newborn infants <32 weeks of gestation, a skullcap and a polyethylene bag should be used in the delivery room or during transport. To limit water loss, inhaled gases humidification and warming is recommended, and preterm infants weighing less than 1600 g should be nursed in a closed, convective incubator. With regard to incubators, there are no clear benefits for single- versus double-wall incubators as well as for air versus skin servo control.ConclusionAlongside skin-to-skin contact, a bundle of practical guidelines could improve the maintenance of homeothermy in the newborn infant