Circumstances, causes and timing of death in extremely preterm infants admitted to NICU: The EPIPAGE-2 study.

Aim: To describe the circumstances, causes and timing of death in extremely preterm infants.

Methods: We included from the EPIPAGE-2 study infants born at 24-26 weeks in 2011 admitted to neonatal intensive care units (NICU). Vital status and circumstances of death were used to define three groups of infants: alive at discharge, death with or without withholding or withdrawing life-sustaining treatment (WWLST).

Nationwide Study of Continuous Deep Sedation Practices Among Pediatric Palliative Care Teams.

Context: Palliative sedation practices evolved in France when the Claeys-Leonetti law passed in 2016 authorized patient-requested continuous deep sedation (CDS) until death. Its implementation in the pediatric setting is less frequently encountered and can pose several clinical and ethical challenges for health care teams and families.

Objectives: Our study aimed to describe CDS requests and practices of patients receiving specialized pediatric palliative care in France since its legalization in 2016.

Prenatal parental involvement in decision for delivery room management at 22-26 weeks of gestation in France - The EPIPAGE-2 Cohort Study.

Objective: Our main objective was to examine if parental prenatal preferences predict delivery-room management of extremely preterm periviable infants. The secondary objectives were to describe parental involvement and the content of prenatal counseling given to parents for this prenatal decision.

Design: Prospective study of neonates liveborn between 22 and 26 weeks of gestation in France in 2011 among the neonates included in the EPIPAGE-2 study.

Case Report of Clitoral Hypertrophy in 2 Extremely Premature Girls With an Ovarian Cyst.

Neonatal clitoromegaly is mainly attributed to in utero androgen exposure secondary to congenital adrenal hyperplasia. We report on 2 extremely premature girls with clitoromegaly, increased androgen levels, no salt wasting syndrome, and ovarian cyst. In case 1, the cyst liquid was aspired during ovarian hernia surgery and revealed high androgen levels.

Delivery room deaths of extremely preterm babies: an observational study.

Objective: Many extremely preterm neonates die in the delivery room (DR) after decisions to withhold or withdraw life-sustaining treatments or after failed resuscitation. Specific palliative care is then recommended but sparse data exist about the actual management of these dying babies. The objective of this study was to describe the clinical course and management of neonates born between 22 and 26 weeks of gestation who died in the DR in France.

Barriers in referring neonatal patients to perinatal palliative care: a French multicenter survey.

Background: When an incurable fetal condition is detected, some women (or couples) would rather choose to continue with the pregnancy than opt for termination of pregnancy for medical reasons, which, in France, can be performed until full term. Such situations are frequently occurring and sometimes leading to the implementation of neonatal palliative care. The objectives of this study were to evaluate the practices of perinatal care french professionals in this context; to identify the potential obstacles that might interfere with the provision of an appropriate neonatal palliative care; and, from an opposite perspective, to determine the criteria that led, in some cases, to offer this type of care for prenatally diagnosed lethal abnormality.

Therapeutic guidelines for prescribing antibiotics in neonates should be evidence-based: a French national survey.

Objective: This survey aims to describe and analyse the dosage regimens of antibiotics in French neonatal intensive care units (NICUs).

Methods: Senior doctors from 56 French NICUs were contacted by telephone and/or email to provide their local guidelines for antibiotic therapy.

Results: 44 (79%) NICUs agreed to participate in this survey.

Perceptions of lethal fetal abnormality among perinatal professionals and the challenges of neonatal palliative care.

Background: After prenatal diagnosis of lethal fetal abnormality (LFA), some couples choose to continue the pregnancy rather than opt for termination of the pregnancy. This may result in the requirement for neonatal palliative care, which in France is prescribed by the Leonetti Law. These rare situations raise various questions about when and how palliative care is provided in cases of LFA.

Caesarean section at term: the relationship between neonatal respiratory morbidity and microviscosity in amniotic fluid.

Objectives: The incidence of neonatal respiratory morbidity following an elective caesarean section is 2-3 times higher than after a vaginal delivery. The microviscosity of surfactant phospholipids, as measured with fluorescence polarisation, is linked with the functional characteristics of fetal surfactant and thus fetal lung maturity, but so far this point has received little attention in newborns at term. The aim of the study is to evaluate the correlation between neonatal respiratory morbidity and amniotic microviscosity (Fluorescence Polarisation Index) in women undergoing caesarean section after 37 weeks' gestation.

Respiratory support by neurally adjusted ventilatory assist (NAVA) in severe RSV-related bronchiolitis: a case series report.

Background: Neurally adjusted ventilatory assist (NAVA) is a new mode of mechanical ventilation controlled by diaphragmatic electrical signals. The electrical signals allow synchronization of ventilation to spontaneous breathing efforts of a child, as well as permitting pressure assistance proportional to the electrical signal. NAVA provides equally fine synchronization of respiratory support and pressure assistance varying with the needs of the child.

Uncorrelated randomness of the heart rate is associated with sepsis in sick premature infants.

Background: Late-onset sepsis in the premature infant is frequently revealed by severe, unusual and recurrent bradycardias. In view of the high morbidity and mortality associated with infection, reliable markers are needed.

Objectives: It was the aim of this study to determine if heart rate (HR) behavior may help the diagnosis of infection in premature infants with such cardiac decelerations.

[Indications for use of labile blood products and the physiology of blood transfusion in medicine. The French Agency for the Health Safety of Health Products].

This article presents the French national recommendations for the use of blood products in medicine.

Congenital diaphragmatic hernia: prenatal diagnosis permits immediate intensive care with high survival rate in isolated cases. A population-based study.

Objectives: To estimate the prognosis of prenatally diagnosed isolated congenital diaphragmatic hernia (PDICDH) treated with 'immediate planned care' (IPC) between 1999 and 2003 in Eastern Brittany.

Methods: The prognosis of PDICDH was compared with the prognosis of the other live-born CDH, either prenatally undiagnosed or not having had IPC. IPC consisted in prenatal lung maturation with corticosteroids, elective caesarean section at 37 weeks, immediate intubation, surfactant, high- frequency ventilation or oscillation, nitric oxide, intravenous prostacyclin, anaesthesia and haemodynamic support.

Central neurotoxicity of cyclosporine in two children with nephrotic syndrome.

The central neurotoxicity of cyclosporin A (CsA) has been abundantly documented in pediatric and adult recipients of bone marrow or organ transplants, with variations in the rate of occurrence from 0.5% to 35%. We report two cases of central neurotoxicity ascribable to CsA in children with nephrotic syndrome due to lipoid nephrosis.

Beat-to-beat blood pressure variability and patent ductus arteriosus in ventilated, premature infants.

The aim of the present study was to test the hypothesis that a relationship exists between respiratory-induced blood pressure variability (BPV) and transductal shunting in premature infants with respiratory distress. Ten premature infants (27-32 weeks gestation) with respiratory distress ventilated in the synchronised, positive-pressure mode were examined. The interrelations between blood pressure and transthoracic impedance were described using time and frequency domain analysis.

Beat-to-beat analysis of the relation between RT and RR intervals in newborns.

Objective: To evaluate the dynamic RT (QRS apex-end of T wave) rate dependence in newborns.

Study Design: A Digital Holter ECG was acquired on day 15 in nine full-term and eight preterm infants. Ten-minute periods were recorded during wakefulness and sleep.

Perinatal management and outcome of prenatally diagnosed congenital diaphragmatic hernia: a 1995-2000 series in Rennes University Hospital.

Objectives: To assess the prognosis of prenatally diagnosed congenital diaphragmatic hernia (CDH) during the years 1995-2000 in order to improve prenatal counselling.

Methods: Retrospective study of all 31 cases of women with prenatally diagnosed CDH.

Results: Nine pregnancies (29%) were terminated and two fetuses (6%) were stillborn.