Withholding life support for children with severe neurological impairment: Prevalence and predictive factors prior to admission in the PICU.

Background: Our study aimed to evaluate the prevalence and predictive factors of withholding life support for children suffering from severe neurological impairment before admission to the pediatric intensive care unit (PICU).

Method: Children under 18 years of age with severe neurological impairment, who were hospitalized between January 2006 and December 2016, were included in this retrospective study. They were allocated to a withholding group or a control group, depending on whether life support was withheld or not, before admission to the PICU.

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.

The role of perinatal palliative care following prenatal diagnosis of major, incurable fetal anomalies: a multicentre prospective cohort study.

Objective: To describe prenatal decision-making processes and birth plans in pregnancies amenable to planning perinatal palliative care.

Design: Multicentre prospective observational study.

Setting: Nine Multidisciplinary Centres for Prenatal Diagnosis of the Paris-Ile-de-France region.

[Clinical ethics and uncertainty: an inseparable duo for the benefit of the patient].

Clinical ethics can be conceived as thought marked by uncertainty and on uncertainty. Its difficulties must be highlighted and discussed, in order to help guide the actions of caregivers, both on a scientific and human level, for the benefit of the patient. As an intellectual and moral virtue, humility is likely to favour a high standard of reflection and action.

[Not Available].

Introduction : Despite the number and importance of French-language guidelines related to palliative sedation for adults, these texts have never been the subject of a linguistic analysis.Objectives : This study aimed to explore and analyze the terms used for sedation and their definitions in Belgian, French, Quebec, and Swiss guidelines.Methods : Current documents were subjected to textual, terminological, and conceptual analysis.

[Current status of clinical practice guidelines on palliative sedation for adults in French-speaking countries].

Introduction: Many clinical practice guidelines on palliative sedation have been developed. To date, studies on French-language guidelines are lacking, despite the specific and potentially influential end-of-life positions taken by some French-speaking countries. This study aimed to perform a systematic review of the guidelines related to palliative sedation for adults in French-speaking countries, taking a synchronic and diachronic approach (current and former guidelines).

Integrating a palliative approach into the healthcare provided by the French-African Pediatric Oncology Group's pilot units. Insights from a 3-year training program.

Working alongside local stakeholders, members of the French-African Pediatric Oncology Group developed a 3-year program to train pediatric oncology teams from 15 French-speaking countries in Africa in using analgesics and providing palliative care. This program was rolled out in three phases: initial training, in situ assessment, and advanced training in selected topics. To access this program, multidisciplinary teams had to come up with a project to improve their existing palliative care and pain management practices, and commit themselves to implementing it.

Palliative Care in SMA Type 1: A Prospective Multicenter French Study Based on Parents' Reports.

Spinal muscular atrophy type 1 (SMA-1) is a severe neurodegenerative disorder, which in the absence of curative treatment, leads to death before 1 year of age in most cases. Caring for these short-lived and severely impaired infants requires palliative management. New drugs (nusinersen) have recently been developed that may modify SMA-1 natural history and thus raise ethical concerns about the appropriate level of care for patients.

The role of the neuropediatrician in pediatric intensive care unit: Diagnosis, therapeutics and major participation in collaborative multidisciplinary deliberations about life-sustaining treatments' withdrawal.

Background: In Pediatric Intensive Care Unit (PICU) two types of population require the intervention of neuropediatricians (NP): chronic brain diseases' patients who face repetitive and prolonged hospitalizations, and patients with acute brain failure facing the risk of potential neurologic sequelae, and both conditions may result in a limitation of life-sustaining treatments (LLST) decision.

Objective: To assess NP's involvement in LLST decisions within the PICU of a tertiary hospital.

Method: Retrospective study of medical reports of patients hospitalized during 2014 in the Necker-Hospital PICU.

[Palliative care for newborn infants with congenital malformations or genetic abnormalities].

The choice of palliative care can be made today in the perinatal period, as it can be made in children and adults. Palliative care, rather than curative treatment, may be considered in three clinical situations: babies born at the limits of viability, withholding/withdrawing treatments in the NICU, and babies with severe malformations of genetic abnormalities identified during pregnancy. Only the last situation is addressed hereafter.

[Pediatric palliative care: a national survey of French pediatric residents' knowledge, education, and clinical experience].

Background: The need for educational training of healthcare professionals in palliative care is an important issue. Training and practice of pediatric residents in the field of pediatric palliative care (PPC) has never been assessed, although the organization of the medical curriculum in France is currently being revised.

Materials And Methods: This study presents a national survey of pediatric residents, using a computerized anonymous questionnaire.

[Multicentric study of medical care and practices in spinal muscular atrophy type 1 over two 10-year periods].

Aim: Questions about care practices and the role of palliative care in pediatric neurodegenerative diseases have led the Neuromuscular Committee of the French Society of Neurology to conduct a retrospective study in spinal muscular atrophy type 1, a genetic disease most often leading to death before the age of 1 year.

Material And Methods: A retrospective multicenter study from pediatricians included in the reference centers of pediatric neuromuscular diseases was carried out on two 10-year periods (1989-1998 and 1999-2009).

Results: The 1989-1998 period included 12 centers with 106 patients, the 1999-2009 period 13 centers with 116 children.

Some general considerations of a human-based medicine's palliative approach to the vulnerability of the multiply disabled child before the end of life.

Specificities of situation of individuals with multiple disabilities and pediatric neurological pathologies call for specialized and multi-field competences that are commonly allowed and disallowed in contemporary clinical contexts. However what must be questioned in this matter is not only the meaning of the clinical, social, and human approach that is implemented, but also its spirit. The aim of medicine is double: to offer a technoscientific capacity (to cure as much as it is possible and always relieve suffering) and guarantee the meaning and value of the child's human and social capacities.

[The practices of withdrawing artificial nutrition and hydration in the neonatal intensive care unit: a preliminary study].

Introduction: Prematurity is one of the etiologies for severe neurological complications. Decisions to withdraw therapeutics, including artificial nutrition and hydration (ANH), are sometimes discussed. But can one withdraw ANH if the patient is a child suffering from severe neurological conditions, based on his best interests? The aim of this study was to further the understanding of the complexity of the withdrawal of ANH and its implementation in the neonatal intensive care unit (NICU).

Eligibility of patients withheld or withdrawn from life-sustaining treatment to organ donation after circulatory arrest death: epidemiological feasibility study in a French Intensive Care Unit.

Background: Transplantation brings sustainably improved quality of life to patients with end-stage organ failure. Persisting shortfall in available organs prompted French authorities and practitioners to focus on organ retrieval in patients withdrawn from life-sustaining treatment and awaiting cardiac arrest (Maastricht classification category III). The purpose of this study was to assess the theoretical eligibility of non-heart-beating donors dying in the intensive care unit (ICU) after a decision to withhold or withdraw life-sustaining treatment (WoWt).

[Palliative care in the neonatal period. Part one: general considerations].

In France, the law dated 22 April 2005 required that all practitioners offer palliative care to patients as an alternative to unreasonable obstinacy. The practical development of palliative care during the neonatal period is not easy, even though obstetricians and neonatologists have always been aware of the ethical necessity of comfort in the dying newborn. The decision leading to palliative care begins with the recognition of patent or potential unreasonable obstinacy, followed by withdrawing treatment and technical support, and finally a palliative care plan is drawn up with the medical team and the parents.

[Calls to the SAMU Centre 15 (Emergency Medical Service Center 15): an indicator of peak pollen concentrations].

A retrospective analysis of the calls received by the emergency services in Montluçon and the outpatient dossiers in the Adult and Pediatric Emergency Departments for June 3 to 5, 2000 evidenced an increase in the number of requests made for assistance regarding pollinosis symptoms. These symptoms and the associated requests for assistance seem to have been caused by Poaceae pollen peaks, ozone peaks and specific weather conditions. Hence, the number of calls received by the emergency services can be viewed as an unfavorable indicator for pollen-related diseases.

[Antibiotic prophylaxis in biliary surgery].

Prophylactic antibiotics in gallbladder surgery is designed to reduce the incidence of postoperative wound infections. Bacteria isolated from the biliary tract are generally the same as those found in the pus of wounds. Prospective and placebo-controlled trials have shown the efficacy of prophylactic antibiotics in high-risk patients presenting one or more of the following criteria: age over 70 years, recent episode of acute chollecystitis, emergency cholecystectomy, presence of common duct stones, jaundice or diabetes mellitus in patients with no risk factors for gallbladder surgery, prophylactic antibiotics may not be essential.