Premedication for neonatal endotracheal intubation: results from the epidemiology of procedural pain in neonates study.

Objectives: To describe the frequency and nature of premedications used prior to neonatal endotracheal intubation; to confront observed practice with current recommendations; and to identify risk factors for the absence of premedication.

Design, Setting, And Patients: Data concerning intubations were collected prospectively at the bedside as part of an observational study collecting around-the-clock data on all painful or stressful procedures performed in neonates during the first 14 days of their admission to 13 tertiary care units in the region of Paris, France, between 2005 and 2006.

Intervention: Observational study.

Identification of SPOCK2 as a susceptibility gene for bronchopulmonary dysplasia.

Rationale: Bronchopulmonary dysplasia is the most common chronic respiratory disease in premature infants. Genetic factors might contribute to bronchopulmonary dysplasia susceptibility.

Objectives: To identify genetic variants involved in bronchopulmonary dysplasia through a genome-wide association study.

Neurodevelopmental outcome at 2 years in children born preterm treated by amnioreduction or fetoscopic laser surgery for twin-to-twin transfusion syndrome: comparison with dichorionic twins.

Objective: We sought to assess long-term neurodevelopment of children born prematurely treated for twin-to-twin transfusion syndrome and dichorionic (DC) twins.

Study Design: In all, 21 and 88 children treated with amnioreduction (AR) and fetoscopic laser surgery (FLS), respectively, and 222 DC twins matched for gestational age at delivery were assessed with Ages and Stages Questionnaire and standardized examination at 2 years of age.

Results: Normal development was noted in 81% in the AR group, 88.

[Evaluation of an educational intervention on the standard of neonatal resuscitation: orotracheal versus nasotracheal intubation].

Unlabelled: Proficiency in endotracheal intubation is an essential step in the neonatal resuscitation process. This skill is difficult to acquire and its mastery requires experience. Recent changes in neonatal resuscitation guidelines (ILCOR 2006) have resulted in a decrease in the opportunities to practice intubations.

Epidemiology and treatment of painful procedures in neonates in intensive care units.

Context: Effective strategies to improve pain management in neonates require a clear understanding of the epidemiology and management of procedural pain.

Objective: To report epidemiological data on neonatal pain collected from a geographically defined region, based on direct bedside observation of neonates.

Design, Setting, And Patients: Between September 2005 and January 2006, data on all painful and stressful procedures and corresponding analgesic therapy from the first 14 days of admission were prospectively collected within a 6-week period from 430 neonates admitted to tertiary care centers in the Paris region of France (11.

EMLA cream and nitrous oxide to alleviate pain induced by palivizumab (Synagis) intramuscular injections in infants and young children.

Objective: Palivizumab (Synagis [Abbot Laboratories, Kent, United Kingdom]) is recommended for the prevention of severe lower respiratory tract infections caused by respiratory syncytial virus in infants at high risk. These injections are very painful, and currently the use of analgesics is not systematic. The objective of this study was to compare the efficacy of EMLA with premixed 50% nitrous oxide/oxygen, used alone or combined with EMLA, for pain alleviation during palivizumab injections.

[Medication errors in neonatology: a review].

Of all medical errors, medication errors are the most common as well as the most frequent cause of adverse events, the majority of them being preventable. Errors are possible at any step of the process from ordering, dispensing and administration. Neonates are reported to be at greater risk of medication error than older children and adults.

Neonatal outcome in preterm monochorionic twins with twin-to-twin transfusion syndrome after intrauterine treatment with amnioreduction or fetoscopic laser surgery: comparison with dichorionic twins.

Objective: The purpose of this study was to compare neonatal outcome in preterm neonates after twin-to-twin transfusion syndrome (TTTS) that was treated by amnioreduction or fetoscopic laser surgery (FLS) and in dichorionic neonates who were matched for gestational age at birth.

Study Design: Neonatal outcome was assessed in 137 TTTS preterm neonates who were treated primarily with either amnioreduction (n = 36) or FLS (n = 101) and compared with dichorionic twins (n = 242) who were delivered at our center at 24-34 weeks of gestation.

Results: Adverse neonatal outcome (death or severe cerebral lesions) was more frequent in the amnioreduction group than in the FLS and dichorionic groups.

Assessment of implementation of a standardized parenteral formulation for early nutritional support of very preterm infants.

Introduction: Parenteral nutrition (PN) plays an important role in the nutritional support of very preterm newborns. It has been suggested that a high proportion of PN orders could be standardized. In 2002, we implemented in our unit the preparation of three standardized formulations for PN adapted to the nutritional requirements of premature infants<32 weeks.

Foetal kidney maldevelopment in maternal use of angiotensin II type I receptor antagonists.

We report renal lesions observed in a foetus exposed throughout pregnancy to angiotensin II type I (AT 1) receptor antagonists. The mother suffered from essential hypertension and was treated with Cozaar (losartan 50 mg). Autopsy examination of the foetus revealed severe renal lesions, including tubular dysgenesis, hypertrophy of the endothelial and medial cells lining the arterial and arteriolar walls, hyperplasia of the juxtaglomerular apparatus and poorly developed vasa recta.

[Correct procedure in the presence of a fetal goiter associated with hypothyroidism. Observations from three cases].

Fetal goiter is a rare occurrence of which neonatal consequences are not always predictable. Concerning three cases of goiters associated with hypothyroidism discovered in utero, the authors describe the way to take care of in this bad codified situation. They insist upon the major role of ultrasound for goiter diagnosis and its impacts and for control of treatment efficiency.

Minimum effective dose of midazolam for sedation of mechanically ventilated neonates.

Objective: To determine the minimal effective dose (MED) of intravenous midazolam, required for appropriate sedation in 95% of patients, 1 h after drug administration.

Methods: A double-blind dose-finding study using the continual reassessment method, a Bayesian sequential design. Twenty-three newborn infants hospitalized in intensive care unit participated.

Morphine does not provide adequate analgesia for acute procedural pain among preterm neonates.

Background: Morphine alleviates prolonged pain, reduces behavioral and hormonal stress responses induced by surgery among term neonates, and improves ventilator synchrony and sedation among ventilated preterm neonates, but its analgesic effects on the acute pain caused by invasive procedures remain unclear.

Objective: To investigate the analgesic efficacy of intravenously administered morphine on heel stick-induced acute pain among preterm neonates.

Design: This study was nested within a prospective, randomized, double-blind, multicenter, placebo-controlled trial (the NEOPAIN Trial).

[Oxygen therapy in the neonatal period].

Although oxygen has been widely used in the neonatal period for many years, and although serious complications such as retinopathy of the premature infant have been directly attributed to its use, there persists a degree of uncertainty about the optimal level of oxygen which should be used or target levels to achieve. There is a great variability in current practices. Some theoretical data and recent clinical results question uncontrolled use of oxygen during the neonatal period.

Benefit of antenatal glucocorticoids according to the cause of very premature birth.

In this observational study performed in a large cohort of very preterm singletons, respiratory outcome was found to be strongly dependent on the cause of premature delivery. Although less apparent in infants born to mothers with chorioamnionitis, exposure to antenatal glucocorticoids remained significantly associated with a decrease in the incidence of respiratory distress syndrome after adjustment for the main cause of premature birth.

[Peritoneal tuberculosis in children: report of two cases].

Unlabelled: Peritoneal tuberculosis is an uncommon presentation of extra-pulmonary tuberculosis in children. It usually presents as ascites, abdominal pain, anorexia and weight loss.

Cases Report: We report two adolescent patients who presented with ascites, fever, weight loss and abdominal distension.

[Enteral nutrition: bolus versus continuous feeding].

Published evidence has not yielded clear guidelines about the best method of how to feed the preterm baby. Enteral feeding involves many potentially confounding interventions. Variations in nutritional practices are in part explained by difficulties in measuring outcome.

Prenatal diagnosis of hypoplasia of the corpus callosum in association with non-ketotic hyperglycinemia.

Abnormalities of the corpus callosum are often associated with a poor prognosis due to the anatomical defect itself and associated anomalies that include malformations and inherited metabolic disorders. We report a case of the prenatal diagnosis of hypoplasia of the corpus callosum that was associated with non-ketotic hyperglycinemia. Metabolic disorders are a known association with corpus callosum abnormalities and carry a dismal prognosis.

Crossover trial of analgesic efficacy of glucose and pacifier in very preterm neonates during subcutaneous injections.

Objective: Very preterm newborns undergo multiple invasive procedures. Nonpharmacological interventions are valuable alternatives for pain relief during minor procedures in neonates. Oral sucrose analgesia has been widely studied in term and preterm neonates during painful procedures.

[Use of a polyethylene bag: a way to improve the thermal environment of the premature newborn at the delivery room].

Background: Early interventions, such as occlusive wrapping of very low birth weight infants at delivery reduce postnatal temperature fall. This new intervention was implemented in our hospital on January 2000. The aim of this study was to investigate retrospectively the effect of polyethylene wrap, applied immediately at birth, on thermoregulation.

[Jargon of the neonatal intensive care unit].

Jargon, the specialized vocabulary and idioms, is frequently used by people of the same work or profession. The neonatal intensive care unit (NICU) makes no exception to this. As a matter of fact, NICU is one place where jargon is constantly developing in parallel with the evolution of techniques and treatments.

[Early cardiovascular effects of corticotherapy for bronchopulmonary dysplasia].

Objectives: The aim of this study was to analyze the time course of cardiovascular effects in glucocorticoid-treated premature infants with bronchopulmonary dysplasia (BPD).

Methods: In a retrospective case study, 63 ventilator-dependent very-low-birth-weight neonates (mean gestational age = 27.9 +/- 2 weeks and mean birth weight = 920 +/- 275 g) treated with dexamethasone (52%) or betamethasone (48%) were studied.

[Erythrocyte transfusion in the newborn].

The main aim of erythrocyte transfusion in the newborn infant is to improve oxygen transport to the tissues. However, clear evidence for its effectiveness in this objective is lacking. In addition, the potential complications (mainly viral infections) of transfusion have led to a limitation of its use.