The paradox between the beneficial intention of care and procedural pain highlights tensions relating to professional knowledge, denial attitudes and organizational deficiencies. Recognizing and assessing this pain category is critical for healthcare quality improvement. Current knowledge offers rich and effective preventive strategies. The multimodal approach incorporates the patient/caregiver relationship, non-pharmacological methods and preemptive analgesic administration. In this context, thanks to its properties and ease of use, EMONO (Equimolar Mixture of Oxygen and Nitrous Oxide) is a product worth knowing about and worth using, alone or in combination. Lifting the taboo and preventing procedural pain with patients is part of a process that can no longer be ignored.
Premature infants have somatic vulnerabilities that warrant specific monitoring and preventive measures in the first few months after leaving the neonatal unit. Their sensory and developmental vulnerabilities require also regular monitoring, at least until they reach the age of basic school learning. For very premature infants, coordinated monitoring is generally organized within a network for monitoring vulnerable children. Children with moderate prematurity also require special attention. Follow-up care for premature infants includes specific support for parents, who are often affected by the perinatal experience. They are the primary caregivers and developers of their children.
Cancer prognosis has steadily improved over recent decades. In 2025, approximately 85% of patients with cancer were in remission. The growing complexity of oncologic treatments has led to substantial gains in progression-free survival, albeit at the cost of increased cardiotoxic risk. Cardiotoxicity most commonly manifests as heart failure or left ventricular dysfunction. Consequently, the cardiovascular mortality of individuals treated for childhood cancers, as well as of older women treated for breast cancer, now equals or even exceeds oncologic mortality.In response, the European Society of Cardiology has issued its first cardio-oncology guidelines, establishing precise thresholds for left ventricular ejection fraction, longitudinal function (as assessed by echocardiographic strain parameters), and selected cardiac biomarkers. Within this framework, it is crucial to develop robust strategies to predict, enable early detection of, and ideally prevent treatment-related adverse cardiac effects. Rigorous control of traditional cardiovascular risk factors remains the cornerstone of preventing oncology-treatment-induced cardiotoxicity.
Long-term outcomes of preterm children are one of the major challenges in neonatology. Neurodevelopmental disorders are common in these children. Severe motor, cognitive or neurosensory disorders mainly affect the most immature children. Minor difficulties are present in more than a third of children, whatever their gestational age. School integration is frequently affected, and recourse to developmental support is important. A combination of certain factors should alert caregivers to the risk of neurodevelopmental disorders. These include male gender, small for gestational age, high-grade intraventricular hemorrhage, cystic periventricular leukomalacia or bronchopulmonary dysplasia. Early identification of neurodevelopmental disorders makes it possible to provide support for children and their families and to take advantage of the cerebral plasticity of the developing brain.
Sinonasal and petrous bone fungal infections are rare and life-threatening conditions that essentialy arise in immunocompromised patients. They are mainly due to Aspergillus in patients with hematological diseases and to Mucorales in diabetic. Invasive fungal sinusitis can be acute (invasive aspergillosis, rhino-orbito-cerebral mucormycosis) but chronic invasive sinusitis can also exist (invasive chronic fungal sinusitis and granulomatous invasive fungal sinusitis). Petrous bone fungal infections are similar to bacterial necrotizing otitis externa and are most often due to Aspergillus. The diagnosis must be made as early as possible with surgical biopsies, to allow early therapeutic management. Histopathological analysis is essential to confirm the diagnosis. The treatment is multidisciplinary and combines antifungal treatments with etiological care, sometimes associated with debridement surgery especially for mucormycosis.
Preterm birth is defined as any birth occurring before 37 completed weeks of gestation (WG). It affects 9.9% of live births, representing 13.4 million births a year worldwide. In France, preterm birth rate is of 7.0%. The causes of preterm birth can be grouped into 3 main categories: infectious/inflammatory, vascular, and other. Risk factors, preventive measures, and impact on the child's health depend of these causes. Risks of death and of neonatal complications are strongly associated with gestational age at birth. Other factors are also involved, such as birth weight (fetal growth restriction) or the administration of antenatal corticosteroids. In 2020 in France, survival rates were of 47% for children born alive at 24 WG, 80% at 26 WG, 92% at 28 WG and 97% at 31 WG.
Neonatal respiratory distress is one of the leading causes of hospitalization of preterm newborns in intensive care units. Regardless of the pathology, initial respiratory support is usually delivered nasally (non-invasive ventilation), with intubation now being much less common than in previous decades, even for the most extremely preterm babies.The most frequent respiratory pathology is respiratory distress syndrome (RDS) also termed hyaline membrane disease. It is prevented by antenatal corticosteroid therapy and very effectively treated by the administration of exogenous surfactant directly in the lungs. Apnea of prematurity can last for a long time and partly explains the need for prolonged hospitalization in intensive care units. The major risk is the progression toward bronchopulmonary dysplasia, a chronic respiratory disease of preterm babies which can have longer-term consequences. In the very long term, this pathology is likely to promote the development of adult chronic obstructive pulmonary disease.
Chronic pain predominantly affects women, yet they continue to receive suboptimal care due to scientific and social biases, leading to diagnostic delays, prolonged medical wandering, and a significant impact on quality of life. In response to this invisibilization, patient associations have mobilized to document lived experiences, support research, and contribute to the structuring of care pathways. It is within this context that the Dolora project emerged: a participatory initiative bringing together researchers, affected women, and patient associations to co-construct an assessment and support tool for chronic pain. As a pluripathological project, Dolora aims to identify common determinants of the pain experience and to integrate dimensions often absent from traditional assessment tools.
Preterm neonates present multiple challenges due to organ immaturity.Cardiovascular:Patent ductus arteriosus (PDA) is common in lower gestational ages and may cause respiratory and circulatory complications. Treatment includes medical (ibuprofen, para-cetamol), surgical, or percutaneous approaches. Bradycardia is frequent and requires continuous monitoring.Digestive/Metabolic:Early enteral nutrition with fortified breast milk is preferred; parenteral nutrition is often required. Gastroesophageal reflux is usually benign. Preventing metabolic bone disease necessitates adequate calcium and phosphate intake. Jaundice is common; cholestasis often relates to parenteral nutrition.Infectious:Immune immaturity and invasive devices increase risks of early-onset (E.coli), nosocomial (CoNS), and fungal (Candida) infections. Diagnosis relies on blood cultures; treatment is empirical then targeted.Neurological:Common lesions include periventricular leukomalacia and intraventricular hemorrhage, with potential sequelae. Monitoring includes cranial ultrasound, EEG, MRI, and routine screening for hearing loss and retinopathy of prematurity.
Individualised developmental care has gradually become an international standard in neonatology over the last two decades. It is particularly useful in the case of very premature babies, as it makes it possible to humanise and personalise the care given to each infant, as well as providing support for their families. Individualised developmental care represents a revolution in the way care is provided, the environment in which it is carried out, and parental involvement. Parents are no longer visitors, but care partners.Changing a team's practices towards individualized developmental care requires structured training and support for professionals. In particular, they need to learn how to analyse the child's behavior correctly (observation), to deduce the best time and the best way to intervene with each child according to his own abilities and needs. Professionals must provide parental guidance, from birth through discharge home.Individualized developmental care helps to reduce the impact of prematurity on the immediate postnatal health and long-term development of premature babies, as well as on the parent-child relationship and the parents' well-being. They help to reduce the complications associated with extreme prematurity and the lengthy hospitalization required to manage it.
Neuroimaging techniques have a rightful place in the field of psychiatry. They are essential for differential diagnosis, especially when the psychiatric presentation is atypical. Furthermore, they associate brain dysfunction with psychiatric disorders, but they cannot yet provide a definitive psychiatric diagnosis. However, from a therapeutic perspective, brain MRI is a very useful tool for neuronavigation techniques in combination with rTMS. From a neurobiological perspective, advances in genetics are allowing the development of genomic tests to guide antidepressant therapy and predict a diagnosis of bipolar disorder. In addition, psychedelics such as psilocybin offer promising alternatives for the treatment of depression. Similarly, ketamine, an antagonist of NMDA-type glutamatergic receptors, has shown efficacy in the management of suicidal crises and in the treatment of depressive disorders. Finally, antagonism of orexin receptors offer a new avenue for treating insomnia.
Acute gastrointestinal bleeding is a medical emergency in which early management, including pre-hospital care, is crucial for prognosis. The patient's history and clinical examination should focus on identifying signs of severity requiring immediate medical intervention. The pharmalogical treatment of upper gastrointestinal bleeding depends on the suspected cause: proton pump inhibitors for peptic ulcers, splanchnic vasoconstrictors and antibiotics in cases of portal hypertension. Risk stratification using validated scoring systems helps identify low-risk patients eligible for outpatient management. A restrictive transfusion strategy (hemoglobin < 7 g/dL) is recommended. For upper gastrointestinal bleeding, endoscopy should be performed within 24 hours (within 12 hours in patients with portal hypertension). For lower gastrointestinal bleeding, computed tomography angiography is useful for locating active bleeding, while colonoscopy remains the gold standard procedure.
Gastrointestinal bleeding (GIB) is a frequent and potentially life-threatening emergency. It is defined as any bleeding originating from the digestive tract, either overt (hematemesis, hematochezia, melena) or occult. From a nosological perspective, GIB is classified into upper GIB (proximal to the Treitz ligament), lower GIB (colonic or anorectal origin), suspected small bowel bleeding (SSBB), mid-GIB (jejunal or ileal lesions), and obscure GIB (no source identified despite complete evaluation). Over the past 20 years, the incidence of upper GIB has declined by 30-50%, mainly due to Helicobacter pylori eradication, proton pump inhibitors use, and reduced tobacco consumption. Conversely, lower GIB is increasing, and in some countries has surpassed upper GIB in frequency. Hospital mortality has decreased from about 10% to 5-7% owing to advances in diagnostics, therapeutic endoscopy, and healthcare organization. Cirrhotic patients and the elderly remain at particularly high risk.
Lower gastrointestinal bleeding (LGIB) is a common emergency, defined nowadays as bleeding of colorectal origin. It predominantly affects elderly patients in whom it is associated with increased morbidity and mortality. The main causes include diverticulosis, anorectal disorders, angiodysplasias, ischemic colitis, post-endoscopic resection complications, and tumor-related bleeding. Clinically, lower gastrointestinal bleeding (LGIB) presents with episodes of hematochezia or melena, or sometimes as occult bleeding. Initial assessment of clinico-biological severity and risk of recurrence is essential to determine the need for hospitalization and the timing of diagnostic procedures. Colonoscopy is the reference diagnostic and therapeutic procedure, ideally performed within 24 hours with CT angiography reserved for cases of hemodynamic instability. In case of failure, therapeutic escalation includes repeat endoscopy, arterial embolization, and, as a last resort, surgery. Early multidisciplinary management helps reduce morbidity, mortality, and recurrence.
The prevalence of maternal obesity is steadily increasing, affecting a significant proportion of pregnancies. Beyond well-known obstetric complications, this condition exposes the newborn to immediate risks (perinatal mortality, congenital malformations, macrosomia) and the child to long-term consequences (obesity, metabolic disorders, and neurodevelopmental issues). Since lifestyle interventions during pregnancy show limited efficacy on child outcomes, prevention strategies must focus on the preconception period and the promotion of breastfeeding. This is an underestimated public health issue that requires collective action by health authorities and practitioners.
Pediatric acute ischemic stroke is a neurological emergency with potentially severe consequences. Early recognition is essential to allow timely reperfusion treatment within the therapeutic window. The "Pediatric Stroke Alert" pathways are crucial. MRI is the gold standard to differentiate stroke from common mimics. Thrombolysis and mechanical thrombectomy are possible if performed within appropriate timeframes. Tenecteplase use in children remains experimental and further studies are needed to adapt the treatment protocols to the pediatric patients. Arteriopathies, particularly inflammatory focal cerebral arteriopathy, are the most frequent causes. Long-term neurodevelopmental follow-up is mandatory because of the damaging impact of stroke in the children lives.
