La Prématuré Infant Pain Profile (PIPP) a été étudiée et validée pour les nouveau-nés mais rarement en contexte de réanimation. Notre objectif était d'évaluer la réalisation de la PIPP (faisabilité, reproductibilité inter-évaluateur, facilité) lors d'une aspiration trachéale chez des nouveau-nés ventilés afin de l'utiliser dans le traitement par monitoring de la douleur. Etude prospective réalisée dans le service de réanimation néonatale de l'Hôpital des Enfants de Toulouse, du 5 mars au 25 avril 2013, chez 25 nouveau-nés intubés-ventilés, filmés pendant la procédure. Quatre évaluateurs indépendants ont côté la PIPP: de visu, l'infirmière de l'enfant et un interne du service, et après visionnage vidéo, un médecin certifié NIDCAP et l'interne réalisant le mémoire. 100% des PIPP ont été réalisées. L'accord inter-évaluateur global était médiocre, coefficient kappa à 0,303 (0,035–0,571). 33% des infirmières ont trouvé la PIPP difficile à réaliser. L'échelle PIPP, lors d'une aspiration trachéale d'un nouveau-né ventilé, était peu reproductible et difficile à utiliser par l'infirmière du patient. Son utilisation pour guider un protocole d'analgésie sédation nous parait difficile.

Background and aims Premature Infant Pain Profile (PIPP) has been studied and validated in intensive care units but seldom in neonates with ventilatory support. The aim of the study was to assess PIPP (feasibility, inter-rater reproductibility, easiness) while endotracheal suctionning in ventilated newborns in order to use it later for pain treatment monitoring. Methods Prospective study done in a level III neonatal intensive care unit, from 2013 march 5th to 2013 April 25th. 25 newborns with invasive mechanically ventilatory support were involved and they were filmed during the procedure. Four observators noted individually PIPPscale for each baby: the patient’s nurse and a department’s resident in the room and, an NIDCAP experienced paediatrician and the resident making the study, after viewing the video. The inter-rater agreement was assessed by the Cohen’s Kappa coefficient. Results 100% of the PIPP scales were done. The global inter-rater agreement was poor, with a kappa coefficient at 0,303 (0,035–0,571) and especially for the mimic items. 33% of the nurses found the PIPP scale difficult to use. Mean PIPP during endotracheal suctionning varied from 8.7 to 9.3. Conclusions Pain assessment by PIPP scale was poorly reproducible and hard to nurse’s use in the ventilated newborns. Neonatal pain and sedation protocol guided by PIPP scale seems us to be difficult to implement in intubated neonates.

Dermohypodermitis (cellulitis) in newborn infants and in infants aged up to 3 months is uncommon and often not typical. Because group B Streptococcus is known to induce rapid life-threatening complications; early diagnosis leading to emergency treatment is of utmost importance. We report on the case of a 14-day-old girl, initially admitted for viral bronchiolitis with suspected bacterial pulmonary infection, in the absence of any cutaneous injury. The disease actually was cellulitis of the face, caused by group B Streptococcus. The baby presented with a severe septic clinical condition. Early treatment with antibiotics (intravenous amoxicillin for 10 days) allowed a favorable course, with rapid control of the sepsis and regression of the submandibular tumefaction. (c) 2012 Elsevier Masson SAS. All rights reserved.

We focused on current nutritional and ventilation strategies of extremely preterm infants and reviewed the evidence and the practical experience in four French neonatal intensive care units. The recommendations from reviews and the local clinical guidelines were compared and were overall in agreement. We wanted then to evaluate if different ventilatory and nutritional styles existed between four French intensive neonatal units, and if these approaches had an effect on short term outcomes. 399 infants delivered at a gestational age <28 weeks between January 2005 and December 2006 were retrospectively studied (unit I = 141, unit II = 97, unit III = 85, unit IV = 76). Data were collected from birth to discharge. The study groups were similar with regard to gestational age, birth weight, gender, prenatal steroids, rate of inborn. There were significant differences in ventilatory and nutritional strategies between the units. Incidence of NEC, IVH grade 3-4 and PVL were similar between the units. Mortality rate during the hospitalization stay was 14.9 %, 35.0 %, 29.4 % and 29 % (p<0.05). A national database would be useful to analyse differences in strategies and long term outcomes.

Acute myocarditis is a rare inflammatory cardiac disease in children with potentially fatal issue. Clinical findings are very variable from nausea and vomiting to acute cardiovascular collapse. The cardiac function can be reversible with circulatory support. We report the case of a 6-year-old girl with ECG changes like myocardial infarction and diagnosis of fulminant myocarditis. She developped rapidly a cardiogenic shock and died before treatment with mechanical circulatory support. (c) 2006 Publie par Elsevier Masson SAS.

Acute myocarditis is a rare inflammatory cardiac disease in children with potentially fatal issue. Clinical findings are very variable from nausea and vomiting to acute cardiovascular collapse. The cardiac function can be reversible with circulatory support. We report the case of a 6-year-old girl with ECG changes like myocardial infarction and diagnosis of fulminant myocarditis. She developped rapidly a cardiogenic shock and died before treatment with mechanical circulatory support.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 33 - N° 4 - p. 365

Background: Homeostasis of the body osmolality is partly governed by water reabsorption through aquaporin 2 (AQP2), a vasopressin-regulated water channel of the renal collecting duct. The role of AQP2 in the development of urinary concentrating capacity during postnatal life is unknown. The aim of this study is to determine urinary excretion of AQP2 during early postnatal age at different gestational ages and during different clinical and/or biological conditions in the newborn infants. Methods: 119 premature and 6 full-term newborn infants were included in the study. Urine sample was collected at 72 hours and 3 weeks of life. Clinical and biological status was known at each sampling. No child received nephrotoxic treatment. Urinary AQP2 levels were determined by dot blot and expressed in terms of AQP/urinary creatinine. Results: 160 urine samples were analysed. Urine osmolality was low. Urinary AQP2 level increased with gestational age (p<0.05). Blood acidosis and renal impairment decreased the urinary excretion of AQP2. Prenatal glucocorticoid administration and aldosteronism (urinary Na/K ratio) increased excretion of AQP2. Conclusion: Renal concentrating capacity of the newborn is low. Nevertheless, we show that AQP2 excretion undergoes developmental changes with gestational age. In addition, different biological conditions in the neonate seems to have an impact on the level of urinary AQP2 excretion.

Objective: To assess the benefits and drawbacks of intraosseous infusion (IOI) for emergency therapy in children.Study design: Retrospective, non comparative study of IOI carried out between January 1994 and June 1998.Patients: Forty-one children requiring without delay IOI either in the emergency medical ambulance or the emergency admission and intensive therapy units.Methods: The tibia was punctured by paediatricians either with Mallarme's trocars in 1994 or Cook Critical Care trocars(R) from 1995 on.Results: Overall, 46 IOI have been carried out in 41 children with a median age of 18 months (range: 8 days-9 years). The main indications for 101 were the management of near drowning, road traffic accidents and cardiopulmonary resuscitation. Complications included one articular puncture and nine subcutaneous extravasations, requiring the puncture of the other limb in five cases.Conclusion: IOI is an easy technique for vascular access. It is indicated in emergency cases when, after a delay of five minutes, other techniques have failed. (C) 1999 Elsevier, Paris.

BACKGROUND:We studied all intraosseous infusions performed between 1994 and 1997 by the pediatric intensive care unit and by the pre-hospital emergency medical staff in the Hôpital d'Enfants, Toulouse, France.POPULATION AND METHODS:We report 32 cases of intraosseous infusions in 30 children aged 2 weeks to 9 years.RESULTS:In our population, such a technique has been used in about 60% of all cardiopulmonary arrest, drowning or traffic accident cases. Intraosseous infusion was successful in all cases, on the first attempt in more than 80% of cases. Nine children recovered without any sequelae. No major complications have been observed.CONCLUSIONS:Intraosseous infusion is safe, rapid and effective. It is an essential alternative route in pediatric resuscitation when no other venous access can be performed quickly. An effort must be made on behalf of its diffusion and teaching.

OBJECTIVE:To assess the benefits and drawbacks of intraosseous infusion (IOI) for emergency therapy in children. STUDY DESIGN:Retrospective, non comparative study of IOI carried out between January 1994 and June 1998. PATIENTS:Forty-one children requiring without delay IOI either in the emergency medical ambulance or the emergency admission and intensive therapy units. METHODS:The tibia was punctured by paediatricians either with Mallarmé's trocars in 1994 or Cook Critical Care trocars from 1995 on. RESULTS:Overall, 46 IOI have been carried out in 41 children with a median age of 18 months (range: 8 days-9 years). The main indications for IOI were the management of near drowning, road traffic accidents and cardiopulmonary resuscitation. Complications included one articular puncture and nine subcutaneous extravasations, requiring the puncture of the other limb in five cases. CONCLUSION:IOI is an easy technique for vascular access. It is indicated in emergency cases when, after a delay of five minutes, other techniques have failed.

Blockchain has received global concern as a research focus in recent years. It is a decentralized and unreliably distributed database technology. Numerous countries and researchers have successively applied blockchain in various fields. CiteSpace and VOSviewer were adopted as bibliometric analysis tools in this paper to obtain a comprehensive overview of blockchain technology and grasp the current research emphasis. The Web of Science core collection database was used as the primary source for data collection. The data were collected from 3826 articles published from 2013 to 2020. Specifically, the publication trends and categories might throw light on the development trends and current domains in terms of blockchain research. The most influential and productive authors, institutions, countries, and journals were involved in this bibliometric analysis. Theoretical knowledge and hot research topics on blockchain mainly ranged over “smart contract”, “bitcoin”, “security”, “ethereum”, and “cryptography”. A cluster analysis from the keyword perspective was carried out to obtain emerging trends and frontiers of blockchain. The results showed that future research should concentrate on management, blockchain technology, energy, machine learning, and smart home. Therefore, this paper assisted scholars and practitioners in getting a comprehensive understanding of the status quo and trends of blockchain research.

Background Inhaled nitric oxide improves oxygenation in severely hypoxaemic term neonates, which lessens the need for extracorporeal-membrane oxygenation. Improvement in other relevant outcomes remains unknown, and safety of inhaled nitric oxide is uncertain In preterm neonates. We did a randomised controlled trial to assess use of inhaled nitric oxide in preterm and near-term neonates.Methods We randomly assigned 204 preterm (<33 weeks) and near-term (greater than or equal to 33 weeks) neonates with oxygenation indices from 12.5 to 30.0 and 15 to 40, respectively, 10 parts per million (ppm) inhaled nitric oxide (n=105) or control ventilation therapy without nitric oxide (n=99). The primary endpoint was the oxygenation index at 2 h. Analysis was done by intention to treat.Findings 12 neonates were excluded, leaving 97 (45 preterm) in the nitric-oxide group and 95 (40 preterm) in the control group. The decline in oxygenation index at 2 h was greater in the nitric-oxide group than in the control group (IQR 6.2 [median 8.4] vs -2.9 [12.4], p=0.005), but was significant only in near-term neonates (p=0.03). Survivors assigned nitric oxide spent fewer days on mechanical ventilation and in the neonatal intensive-care unit, but this was also significant only in near-term neonates (6 [3] vs 7 [3] days, p=0.05, and 9 [6] vs 12 [9] days, p=0.02, respectively).Interpretation Low-dose inhaled nitric oxide early in the course of neonatal respiratory failure improves oxygenation and shortens duration of mechanical ventilation and the length of stay in intensive care. Inhaled nitric oxide was not, however, significantly beneficial in preterm neonates.

Background. - We studied all intraosseous infusions performed between 1994 and 1997 by the pediatric intensive care unit and by the pre-hospital emergency medical staff in the Hopital d'enfants, Toulouse, France.Population and methods. - We report 32 cases of intraosseous infusions in 30 children aged 2 weeks to 9 years.Results. - In our population, such a technique has been used in about 60% of all cardiopulmonary arrest, drowning or traffic accident casts. Intraosseous infusion was successful in all casts, on the first attempt in more than 80% of cases. Nine children recovered without any sequelae. No major complications have been observed.Conclusions. - Intraosseous infusion is safe, rapid and effective. It is an essential alternative route in pediatric resuscitation when no other venous access can be performed quickly. Arl effort must be made on behalf of its diffusion and teaching. (C) 1999 Elsevier, Paris.