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Guedj R, De Suremain N, Cavau A, Enault M, Carbajal R. Crises fébriles : mise au point pour le médecin aux urgences. Ann Fr Med Urgence 2022. [DOI: 10.3166/afmu-2022-0389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Les crises fébriles (CF), définies comme des crises d’épilepsie en contexte fébrile chez un enfant âgé entre six mois et cinq ans sans infection du système nerveux central affectent entre 2 et 5 % des enfants. Leur pronostic à long terme est excellent, n’exposant ni à un excès de mortalité ni à une diminution des compétences intellectuelles et comportementales. Poser le diagnostic de CF nécessite d’éliminer les autres causes de crises d’épilepsie en contexte fébrile, dont une méningite bactérienne et une méningoencéphalite herpétique. Cependant, le diagnostic de CF ne nécessite généralement aucun examen complémentaire sous réserve d’un interrogatoire et d’un examen clinique minutieux. L’indication des examens complémentaires pour identifier l’étiologie de la fièvre n’est pas modifiée par le fait que l’enfant ait présenté une CF. Bien qu’un tiers des enfants ayant eu une CF récidiveront au moins une fois avant l’âge de cinq ans, aucune mesure prophylactique (traitement antiépileptique, prise en charge agressive de la fièvre) n’est indiquée pour éviter ces récidives pour la quasi-totalité de ces enfants. Plusieurs facteurs de risque d’épilepsie sont à rechercher pour identifier les rares patients nécessitant un avis spécialisé sans urgence. Enfin, assister à un épisode de CF est une expérience très éprouvante pour les parents. Plusieurs messages clés doivent être délivrés aux parents avant le retour au domicile dans le but d’améliorer leur compréhension de l’épisode qui a eu lieu et de prévenir un syndrome posttraumatique ainsi que des modifications du comportement parental face à la fièvre.
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Vasse C, Faye A, Naudin J, Titomanlio L, Angoulvant A, Pham LL, Carbajal R, de Suremain N. Severe imported malaria involving hyperparasitemia (≥ 10%) in non-immune children: Assessment of French practices. Arch Pediatr 2022; 29:300-306. [DOI: 10.1016/j.arcped.2022.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 12/27/2021] [Accepted: 01/13/2022] [Indexed: 11/28/2022]
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Lecarpentier T, Guilbert J, Constant I, Louvet N, Corvol H, Lorrot M, Rivière S, Plages B, Pelle R, Carbajal R. Retour d’expérience d’un hôpital pédiatrique pendant la crise Covid-19 en Île-de-France. Ann Fr Med Urgence 2020. [DOI: 10.3166/afmu-2020-0272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
La crise sanitaire de la Covid-19 du printemps 2020 a peu touché les enfants avec peu d’hospitalisations dans les hôpitaux pédiatriques. Le défi a été d’apporter une aide aux hôpitaux adultes avec un personnel principalement formé à la pédiatrie tout en maintenant la permanence des soins urgents pour les enfants atteints ou non de la Covid-19. À l’hôpital universitaire Armand-Trousseau, nous avons créé des unités dédiées pour les enfants atteints de la Covid-19, identifié les spécificités des enfants atteints de la Covid-19 et notamment les formes de Kawasaki like ou PIMS (paediatric multisystem inflammatory syndrome), créé une unité de réanimation adulte au pic de l’épidémie pour augmenter les capacités en lits de réanimation dans notre région, mutualisé notre centre de dépistage pour le personnel d’hôpitaux adultes. Enfin, nous avons envoyé plus de 140 personnels médicaux et paramédicaux dans les hôpitaux adultes de notre groupe hospitalier. Cette aide a pu être organisée grâce aux liens étroits établis par des cellules de crises communes avec les hôpitaux adultes de notre groupe hospitalier. Nous rapportons ainsi un retour d’expérience d’un hôpital pédiatrique au cours de la crise de la Covid-19 en Île-de-France.
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de Suremain N, Ngo J, Loschi S, Haegy-Doehring I, Aroulandom J, Carbajal R. Carbon monoxide poisoning from waterpipe (narghile) smoking in a child. Arch Pediatr 2019; 26:44-47. [DOI: 10.1016/j.arcped.2018.11.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 07/21/2018] [Accepted: 11/10/2018] [Indexed: 11/28/2022]
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Picherot G, Cheymol J, Assathiany R, Barthet-Derrien MS, Bidet-Emeriau M, Blocquaux S, Carbajal R, Caron FM, Gerard O, Hinterman M, Houde O, Jollivet C, Le Heuzey MF, Mielle A, Ogrizek M, Rocher B, Samson B, Ronziere V, Foucaud P. Children and screens: Groupe de Pédiatrie Générale (Société française de pédiatrie) guidelines for pediatricians and families. Arch Pediatr 2018; 25:170-174. [PMID: 29366533 DOI: 10.1016/j.arcped.2017.12.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 11/20/2017] [Accepted: 12/10/2017] [Indexed: 11/25/2022]
Abstract
The Groupe de Pédiatrie Générale (General Pediatrics Group), a member of the Société française de pédiatrie (French Pediatrics Society), has proposed guidelines for families and doctors regarding children's use of digital screens. A number of guidelines have already been published, in particular by the French Academy of Sciences in 2013 and the American Academy of Pediatrics in 2016. These new guidelines were preceded by an investigation into the location of digital screen use by young children in France, a survey of medical concerns on the misuse of digital devices, and a review of their documented benefits. The Conseil Supérieur de l'Audiovisuel (Higher Council on Audiovisual Technology) and the Union Nationale de Associations Familiales (National Union of Family Associations) have taken part in the preparation of this document. Five simple messages are proposed: understanding without demonizing; screen use in common living areas, but not in bedrooms; preserve time with no digital devices (morning, meals, sleep, etc.); provide parental guidance for screen use; and prevent social isolation.
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Affiliation(s)
- G Picherot
- Pediatricians of the Groupe de pédiatrie générale (GPG), GPG CH Versailles, 1, rue Richaud, 78000 Versailles, France.
| | - J Cheymol
- Pediatricians of the Groupe de pédiatrie générale (GPG), GPG CH Versailles, 1, rue Richaud, 78000 Versailles, France
| | - R Assathiany
- Pediatricians of the Groupe de pédiatrie générale (GPG), GPG CH Versailles, 1, rue Richaud, 78000 Versailles, France; AFPA (Association française de pédiatrie ambulatoire [French Association for Outpatient Pediatrics]), AFPA, 15, rue Maurice-Berteaux, 33400 Talence, France
| | - M-S Barthet-Derrien
- PMI (Protection Maternelle et Infantile Lyon), métropole de Lyon, 20, rue du Lac, 69505 Lyon cedex 03, France
| | - M Bidet-Emeriau
- CSA (Conseil supérieur de l'audiovisuel), 39-43, quai André-Citroën, 75015 Paris, France
| | - S Blocquaux
- Sciences de l'information et de la communication (Information and communication sciences), UCO, 3, place André-Leroy, 49100 Angers, France
| | - R Carbajal
- Hôpital Trousseau, 26, rue du Dr-Arnold-Netter, 75012 Paris, France
| | - F-M Caron
- AFPA (Association française de pédiatrie ambulatoire [French Association for Outpatient Pediatrics]), AFPA, 15, rue Maurice-Berteaux, 33400 Talence, France
| | - O Gerard
- UNAF (Union nationale des associations familiales [National Union of Family Associations]), 28, place Saint-Georges, 75009 Paris, France
| | - M Hinterman
- CSA (Conseil supérieur de l'audiovisuel), 39-43, quai André-Citroën, 75015 Paris, France
| | - O Houde
- Psychology of Child Development and Education, UMR CNRS 8240, université Paris Descartes, 12, rue de l'École de Médecine, 75006 Paris, France
| | - C Jollivet
- DASES, 94-96, quai de la Rapée, 75012 Paris, France
| | - M-F Le Heuzey
- CHU Robert-Debré Paris, boulevard Sérurier, 75012 Paris, France
| | - A Mielle
- CSA (Conseil supérieur de l'audiovisuel), 39-43, quai André-Citroën, 75015 Paris, France
| | - M Ogrizek
- 26, rue de la Parchimenerie, 75005 Paris, France
| | - B Rocher
- Service d'addictologie, CHU de Nantes, CHU Espace-Barbara, 9, rue de Bouillé, 44093 Nantes, France
| | - B Samson
- Pediatricians of the Groupe de pédiatrie générale (GPG), GPG CH Versailles, 1, rue Richaud, 78000 Versailles, France
| | - V Ronziere
- PMI (Protection Maternelle et Infantile Lyon), métropole de Lyon, 20, rue du Lac, 69505 Lyon cedex 03, France
| | - P Foucaud
- Pediatricians of the Groupe de pédiatrie générale (GPG), GPG CH Versailles, 1, rue Richaud, 78000 Versailles, France
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Rambaud J, Guilbert J, Guellec I, Jean S, Durandy A, Demoulin M, Amblard A, Carbajal R, Leger PL. [Extracorporeal membrane oxygenation in critically ill neonates and children]. Arch Pediatr 2017; 24:578-586. [PMID: 28416430 DOI: 10.1016/j.arcped.2017.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 01/02/2017] [Accepted: 03/11/2017] [Indexed: 10/19/2022]
Abstract
Extracorporeal membrane oxygenation is used as a last resort during neonatal and pediatric resuscitation in case of refractory circulatory or respiratory failure under maximum conventional therapies. Different types of ECMO can be used depending on the initial failure. The main indications for ECMO are refractory respiratory failure (acute respiratory distress syndrome, status asthmaticus, severe pneumonia, meconium aspiration syndrome, pulmonary hypertension) and refractory circulatory failure (cardiogenic shock, septic shock, refractory cardiac arrest). The main contraindications are a gestational age under 34 weeks or birth weight under 2kg, severe underlying pulmonary disease, severe immune deficiency, a neurodegenerative disease and hereditary disease of hemostasis. Neurological impairment can occur during ECMO (cranial hemorrhage, seizure or stroke). Nosocomial infections and acute kidney injury are also frequent complications of ECMO. The overall survival rate of ECMO is about 60 %. This survival rate can change depending on the initial disease: from 80 % for meconium aspiration syndrome to less than 10 % for out-of-hospital refractory cardiac arrest. Recently, mobile ECMO units have been created. These units are able to perform ECMO out of a referral center for untransportable critically ill patients.
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Affiliation(s)
- J Rambaud
- Service de réanimation néonatale et pédiatrique, CHU d'Armand-Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France; Université Pierre et Marie Curie (UPMC), 75005 Paris, France.
| | - J Guilbert
- Service de réanimation néonatale et pédiatrique, CHU d'Armand-Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - I Guellec
- Service de réanimation néonatale et pédiatrique, CHU d'Armand-Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - S Jean
- Service de réanimation néonatale et pédiatrique, CHU d'Armand-Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - A Durandy
- Service de réanimation néonatale et pédiatrique, CHU d'Armand-Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France; Université Pierre et Marie Curie (UPMC), 75005 Paris, France
| | - M Demoulin
- Service de réanimation néonatale et pédiatrique, CHU d'Armand-Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France; Université Pierre et Marie Curie (UPMC), 75005 Paris, France
| | - A Amblard
- Service de réanimation néonatale et pédiatrique, CHU d'Armand-Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - R Carbajal
- Service de réanimation néonatale et pédiatrique, CHU d'Armand-Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - P-L Leger
- Service de réanimation néonatale et pédiatrique, CHU d'Armand-Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France; Unité Inserm U1141, hôpital Robert-Debré, 75019 Paris, France
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Rambaud J, Leger PL, Larroquet M, Amblard A, Lode N, Alix-Seguin L, Demoulin M, Guilbert J, Jean S, Durandy A, Guellec I, Walti H, Carbajal R. Mise en place de la première unité mobile d’assistance circulatoire et respiratoire pédiatrique et néonatale en Île-de-France. Ann Fr Med Urgence 2016. [DOI: 10.1007/s13341-016-0622-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Affiliation(s)
- R Carbajal
- Urgences pédiatriques, AP-HP, Hôpital Armand-Trousseau, 26 avenue du Dr Arnold Netter, 75012 Paris, France.
| | - M Eriksson
- Centre for health care sciences, Örebro University Hospital, Örebro, Sweden
| | - E Courtois
- Urgences pédiatriques, AP-HP, Hôpital Armand-Trousseau, 26 avenue du Dr Arnold Netter, 75012 Paris, France
| | - K J S Anand
- Department of pediatrics Critical Care Medicine Division, University of Tennessee Health Science Center, Memphis, USA
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Avila-Alvarez A, Carbajal R. Réplica a: Analgesia no farmacológica en las unidades neonatales españolas. An Pediatr (Barc) 2016; 84:66. [DOI: 10.1016/j.anpedi.2015.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 09/16/2015] [Indexed: 11/28/2022] Open
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Rambaud J, Léger PL, Larroquet M, Amblard A, Lodé N, Guilbert J, Jean S, Guellec I, Casadevall I, Kessous K, Walti H, Carbajal R. Transportation of children on extracorporeal membrane oxygenation: one-year experience of the first neonatal and paediatric mobile ECMO team in the north of France. Intensive Care Med 2015; 42:940-941. [PMID: 26626061 DOI: 10.1007/s00134-015-4144-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2015] [Indexed: 11/30/2022]
Affiliation(s)
- J Rambaud
- Paediatric Intensive Care Unit, Armand-Trousseau Hospital, APHP, UPMC University, 26 Avenue du Dr Arnold Netter, 75012, Paris, France.
| | - P L Léger
- Paediatric Intensive Care Unit, Armand-Trousseau Hospital, APHP, UPMC University, 26 Avenue du Dr Arnold Netter, 75012, Paris, France
| | - M Larroquet
- Paediatric Surgery, Armand-Trousseau Hospital, APHP, UPMC University, Paris, France
| | - A Amblard
- Paediatric Intensive Care Unit, Armand-Trousseau Hospital, APHP, UPMC University, 26 Avenue du Dr Arnold Netter, 75012, Paris, France
| | - N Lodé
- Emergency Transport Unit, Robert Debré Hospital, Paris, France
| | - J Guilbert
- Paediatric Intensive Care Unit, Armand-Trousseau Hospital, APHP, UPMC University, 26 Avenue du Dr Arnold Netter, 75012, Paris, France
| | - S Jean
- Paediatric Intensive Care Unit, Armand-Trousseau Hospital, APHP, UPMC University, 26 Avenue du Dr Arnold Netter, 75012, Paris, France
| | - I Guellec
- Paediatric Intensive Care Unit, Armand-Trousseau Hospital, APHP, UPMC University, 26 Avenue du Dr Arnold Netter, 75012, Paris, France
| | - I Casadevall
- Emergency Transport Unit, Robert Debré Hospital, Paris, France
| | - K Kessous
- Emergency Transport Unit, Robert Debré Hospital, Paris, France
| | - H Walti
- Paediatric Intensive Care Unit, Armand-Trousseau Hospital, APHP, UPMC University, 26 Avenue du Dr Arnold Netter, 75012, Paris, France
| | - R Carbajal
- Paediatric Intensive Care Unit, Armand-Trousseau Hospital, APHP, UPMC University, 26 Avenue du Dr Arnold Netter, 75012, Paris, France
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Avila-Alvarez A, Carbajal R, Courtois E, Pertega-Diaz S, Muñiz-Garcia J, Anand KJS. [Sedation and analgesia practices among Spanish neonatal intensive care units]. An Pediatr (Barc) 2015; 83:75-84. [PMID: 25979386 DOI: 10.1016/j.anpedi.2015.03.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 03/25/2015] [Accepted: 03/27/2015] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION Pain management and sedation is a priority in neonatal intensive care units. A study was designed with the aim of determining current clinical practice as regards sedation and analgesia in neonatal intensive care units in Spain, as well as to identify factors associated with the use of sedative and analgesic drugs. METHOD A multicenter, observational, longitudinal and prospective study. RESULTS Thirty neonatal units participated and included 468 neonates. Of these, 198 (42,3%) received sedatives or analgesics. A total of 19 different drugs were used during the study period, and the most used was fentanyl. Only fentanyl, midazolam, morphine and paracetamol were used in at least 20% of the neonates who received sedatives and/or analgesics. In infusions, 14 different drug prescriptions were used, with the most frequent being fentanyl and the combination of fentanyl and midazolam. The variables associated with receiving sedation and/or analgesia were, to have required invasive ventilation (P<.001; OR=23.79), a CRIB score >3 (P=.023; OR=2.26), the existence of pain evaluation guides in the unit (P<.001; OR=3.82), and a pain leader (P=.034; OR=2.35). CONCLUSIONS Almost half of the neonates admitted to intensive care units receive sedatives or analgesics. There is significant variation between Spanish neonatal units as regards sedation and analgesia prescribing. Our results provide evidence on the "state of the art", and could serve as the basis of preparing clinical practice guidelines at a national level.
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Affiliation(s)
- A Avila-Alvarez
- Unidad de Neonatología, Servicio de Pediatría, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade de A Coruña (UDC), A Coruña, España.
| | - R Carbajal
- Service d'Urgences Pédiatriques, Hôpital d'enfants Armand Trousseau, Inserm UMR 1153, Equipe de recherche en Epidémiologie Obstétricale, Périnatale et Pédiatrique (EPOPé), Université Pierre et Marie Curie, París, Francia
| | - E Courtois
- Service d'Urgences Pédiatriques, Hôpital d'enfants Armand Trousseau, Inserm UMR 1153, Equipe de recherche en Epidémiologie Obstétricale, Périnatale et Pédiatrique (EPOPé), Université Pierre et Marie Curie, París, Francia
| | - S Pertega-Diaz
- Grupo de Investigación de Epidemiología Clínica y Bioestadística, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade de A Coruña (UDC), A Coruña, España
| | - J Muñiz-Garcia
- Instituto Universitario de Ciencias de la Salud, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade de A Coruña (UDC), A Coruña, España
| | - K J S Anand
- University of Tennessee Health Science Center, Menphis, Estados Unidos
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Walter-Nicolet E, Courtois E, Durrmeyer X, Carbajal R. Poster Symposium-01 – Prémédication avant intubation en salle de naissance chez les prématurés: données en population. Arch Pediatr 2015. [DOI: 10.1016/s0929-693x(15)30717-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Guedj R, Chappuy H, Titomanlio L, Trieu T, Bisacrdi S, Nissak G, Pellegrino B, Charara O, Angoulvant F, De Villemeur TB, Levy C, Cohen R, Denis J, Carbajal R. CO-54 – Crise convulsive complexe et risque d'infection neurologique grave. Arch Pediatr 2015. [DOI: 10.1016/s0929-693x(15)30155-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Arnaud C, Sivanandamoorthy S, Loschi S, Guedj R, Tournier C, Lecarpentier T, Petit A, Carbajal R, de Suremain N. P-152 – Apport de la simulation en équipe aux urgences pédiatriques. Arch Pediatr 2015. [DOI: 10.1016/s0929-693x(15)30334-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Courtois E, Carbajal R, Galeotti C. Enquête nationale sur les méthodes de triage aux urgences pédiatriques. Ann Fr Med Urgence 2015. [DOI: 10.1007/s13341-014-0477-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Pop Jora D, de Suremain N, Arnaud C, Gréteau S, Guellec I, Renolleau S, Carbajal R. Convulsions hyponatrémiques et bronchiolite à VRS : à propos de 3 cas. Arch Pediatr 2014; 21:1359-63. [DOI: 10.1016/j.arcped.2014.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 02/05/2014] [Accepted: 09/23/2014] [Indexed: 10/24/2022]
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Carbajal R, Gréteau S, Arnaud C, Guedj R. [Pain in neonatology. Non-pharmacological treatment]. Arch Pediatr 2014; 22:217-21. [PMID: 25066701 DOI: 10.1016/j.arcped.2014.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 06/30/2014] [Accepted: 07/04/2014] [Indexed: 10/25/2022]
Abstract
Diagnostic and therapeutic skin-breaking procedures have become ubiquitous in current medical practice and neonatology does not constitute an exception. One of the main sources of neonatal pain is procedure-induced pain. It has recently become clear that pain prevention must be a health care priority. Non-pharmacological approaches constitute a first option for the analgesia of common procedures performed in neonatology. This article reviews the non-pharmacological treatments most frequently used in this context: swaddling, tucking, containment, sweet solutions, non-nutritive sucking (NNS), breastfeeding analgesia, breast milk and music. In practice, the dose of 1 to 2mL of 24% or 30% sucrose solution or 30% glucose solution immediately followed by NNS can be given for minor painful procedures in term neonates or those weighing more than 2500g. In the preterm, 0.3mL of a sweet solution (sucrose or glucose) can be given for infants weighing less than 1500g and 0.5mL for those weighing between 1500 and 2500g. The synergistic effect of sweet solutions and NNS has been clearly shown and thus their association is largely justified in practice. For breast-fed term neonates, breastfeeding can be given to sooth procedure-induced pain. All these non-pharmacological options can be effective to relieve pain from minor or moderate procedures. However, when more painful procedures are performed, stronger analgesics must be used.
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Affiliation(s)
- R Carbajal
- Service des urgences pédiatriques, hôpital Armand-Trousseau, AP-HP, 26, avenue du Dr-Netter, 75012 Paris, France.
| | - S Gréteau
- Service de pédiatrie, réanimation pédiatrique, néonatologie et urgences pédiatriques, centre hospitalier de Pau, 4, boulevard Hauterive, 64046 Pau cedex, France
| | - C Arnaud
- Service des urgences pédiatriques, hôpital Armand-Trousseau, AP-HP, 26, avenue du Dr-Netter, 75012 Paris, France
| | - R Guedj
- Service des urgences pédiatriques, hôpital Armand-Trousseau, AP-HP, 26, avenue du Dr-Netter, 75012 Paris, France
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Carbajal R, Yisfalem A, Pradhan N, Baumstein D, Chaudhari A. Case report: boldo (Peumus boldus) and tacrolimus interaction in a renal transplant patient. Transplant Proc 2014; 46:2400-2. [PMID: 24981811 DOI: 10.1016/j.transproceed.2014.01.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 12/13/2013] [Accepted: 01/15/2014] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Boldo is an extract of a Chilean tree leave (Peumus boldus mol) that have been traditionally employed in folk medicine. We have presented a case of subtherapeutic tacrolimus levels in a renal transplant patient while taking boldo. In the literature search, no interaction has been reported between boldo and tacrolimus. CASE REPORT A 78-year-old Hispanic man with history of diabetes mellitus, hypertension, and deceased donor renal transplant in 2005 presented to the renal clinic for regular follow-up on September 1, 2010. No complaints were reported and physical examination was unremarkable. Laboratory tests taken on July 26, 2010, were significant for tacrolimus level of <3 ng/mL (measured by liquid chromatography/tandem mass spectrometry) and serum creatinine of 1.2 mg/dL (106 μmol/L). Medications included tacrolimus 2 mg bid and mycophenolate 500 mg bid. On further inquiry, the patient admitted taking herbal medication, boldo 300 mg bid, for the last few weeks. There was no change in his regular medications. He was adherent to his medication. He had been taking tacrolimus from the same company and pharmacy since August 2009. The last dose of boldo was on September 1, 2010. One week after he stopped taking boldo, tacrolimus level was 6.1 ng/mL (9/8/2010) on the same tacrolimus dose of 2 mg bid. Tacrolimus dose was increased to 3 mg bid (9/9/2010), awaiting tacrolimus levels. Subsequent levels (ng/mL) were 8.6 and 9.5, which made us resume the prior tacrolimus dose (2 mg bid). CONCLUSIONS We have reported a case of an allograft renal transplant recipient who presented to the clinic with subtherapeutic levels of tacrolimus while taking the herbal remedy boldo. Tacrolimus levels rose to the intended target after discontinuation of boldo. Although it is a single case report, our observation suggests a possible herb-drug interaction.
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Affiliation(s)
- R Carbajal
- Metropolitan Hospital Center, Department of Nephrology, New York, New York.
| | - A Yisfalem
- Metropolitan Hospital Center, Department of Nephrology, New York, New York
| | - N Pradhan
- Metropolitan Hospital Center, Department of Nephrology, New York, New York
| | - D Baumstein
- Metropolitan Hospital Center, Department of Nephrology, New York, New York
| | - A Chaudhari
- Metropolitan Hospital Center, Department of Nephrology, New York, New York
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Carbajal R, Courtois E, Droutman S, Magny J, Merchaoui Z, Durrmeyer X, Roussel C, Biran V, Eleni S, Renolleau S, Desfrere L, Todorova D, Boimond N, Mellah D, Bolot P, Coursol A, Vottier G, Brault D, Cimerman P. SFNP-16 - Epidémiologie des gestes douloureux et stressants en réanimation néonatale, Epippain2. Arch Pediatr 2014. [DOI: 10.1016/s0929-693x(14)71889-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rotenberg Brigot D, Quinet B, Moulin F, Aurel M, Carbajal R, de Suremain N. SFP P-091 - Place des conseils préventifs et morbidité chez l’enfant voyageur. Arch Pediatr 2014. [DOI: 10.1016/s0929-693x(14)72061-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Lanneaux J, Naudin J, Pham L, Gillet Y, Bosdure E, Chéron G, Morin L, Carbajal R, Dubos F, Vialet R, Dauger S, Angoulvant F. SFP PC-80 – Critères de gravité du paludisme d’importation pédiatrique en France. Arch Pediatr 2014. [DOI: 10.1016/s0929-693x(14)72229-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Arnaud C, De Suremain N, Gatterre P, Petit A, Thouvenin G, Guedj R, Carbajal R. SFP PC-50 - Apport de la simulation dans la formation aux urgences pédiatriques. Arch Pediatr 2014. [DOI: 10.1016/s0929-693x(14)72200-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Guedj R, Billette De Villemeur T, Angoulvant F, Trieu T, Biscardi S, Titomanlio L, Nissack Obiketeki G, Pellegrino B, Oussama C, Carbajal R. SFP CO-72 - Méningite bactérienne et crise convulsive fébrile simple avant 12 mois. Arch Pediatr 2014. [DOI: 10.1016/s0929-693x(14)71910-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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de Suremain N, Marteau E, Leruste A, Tournier C, Delamar AL, Carbajal R. Parotidite aiguë néonatale suppurative : revue de la littérature à propos d’une observation. Arch Pediatr 2014; 21:223-5. [DOI: 10.1016/j.arcped.2013.09.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 09/24/2013] [Indexed: 10/26/2022]
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de Suremain N, Thevenin-Lemoine C, Tournier C, Mary P, Armengaud JB, Vialle R, Carbajal R. Traumatisme de la cheville : épidémiologie et évaluation clinique. Arch Pediatr 2012. [DOI: 10.1016/s0929-693x(12)71197-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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de Suremain N, Arnaud C, Agogue M, Tournier C, Armengaud JB, Carbajal R. [Traumatic lacerations: wound closure]. Arch Pediatr 2011; 18:344-8. [PMID: 21269815 DOI: 10.1016/j.arcped.2011.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Accepted: 01/03/2011] [Indexed: 11/27/2022]
Abstract
The suture, when possible, is the best method to close a simple wound. It must be preceded by debridement and performed with great care. A rigorous technique applied in the best possible environment is necessary but not always sufficient to achieve a good cosmetic result.
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Affiliation(s)
- N de Suremain
- Service d'accueil d'urgence, hôpital d'Enfants-Armand-Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France.
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Galeotti C, Courtois E, Carbajal R. CL183 - Enquête nationale sur la crise vasoocclusive drépanocytaire aux urgences pédiatriques. Arch Pediatr 2010. [DOI: 10.1016/s0929-693x(10)70394-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Pain causes numerous physiological changes in neonates. All invasive procedures induce undesirable stress responses; theses responses can, however, be eliminated or reduced by a judicious use of analgesia. Even though a large number of analgesics and sedatives are currently available, most of them have not been studied in the neonate. At present, a precise understanding of the pharmacological mechanisms of analgesics is difficult because many interactions still remain unknown in the term and premature neonate. This article describes the main analgesics and sedative agents used in the neonate: morphine, fentanyl, sufentanil, alfentanil, nalbuphine, ketamine, midazolam, propofol, acetaminophen, and Emla cream. After a review of the literature regarding these drugs, some practical advices and suggestions for the treatment of procedure-induced pain, and background sedation/analgesia for ventilated neonates are given. It is also stated in this article that the best way to soothe pain in neonates is to combine non pharmacological and pharmacological strategies. At the national level, written guidelines should be prepared in order to improve pain management in the neonate.
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Affiliation(s)
- R Carbajal
- Centre National de Ressources de Lutte contre la Douleur, Hôpital d'Enfants Armand-Trousseau, 26, avenue du Docteur-Arnold-Netter, 75012 Paris, France.
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Nolent P, Nanquette MC, Carbajal R, Renolleau S. [Which sedation scale should be used in the paediatric intensive care unit? A comparative prospective study]. Arch Pediatr 2005; 13:32-7. [PMID: 16297608 DOI: 10.1016/j.arcped.2005.09.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2005] [Accepted: 09/21/2005] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To compare pain and sedation assessments by nurses undertaken with the Objective Pain Scale (OPS) and a Visual Analogue Scale (VAS) to the current reference scale for paediatric intensive care that is the COMFORT scale. To compare the unmodified COMFORT scale to a COMFORT "behaviour" scale which does not include physiologic items. To evaluate the ease of use of these scales. METHODS This prospective observational comparative study was carried out in children aged 1 year or older who were admitted in an intensive care unit. At 2 to 3 time points within 24 hours, a pain sedation assessment was carried out by the nurse in charge of the child with COMFORT scale, OPS and VAS. Correlation tests were used to compare the scores of each scale. RESULTS Nurses recorded 55 assessments in 20 children. Correlation studies showed a poor correlation between OPS, VAS and the COMFORT scale (Spearman's r=0.54 and 0.53 respectively) and a strong correlation between the COMFORT scale and the COMFORT "behaviour" scale (Spearman's r=0.96). The COMFORT behaviour scale was the most frequently fully completed scale. CONCLUSION Among the 3 scales compared to the COMFORT scale in this study, the COMFORT "behaviour" scale was the only one to show a strong correlation and it also seemed to be the easiest to use.
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Affiliation(s)
- P Nolent
- Réanimation néonatale et pédiatrique, hôpital d'enfants Armand-Trousseau, Assistance publique-Hôpitaux de Paris, 26, avenue du Docteur-Netter, 75571 Paris cedex 12, France.
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Abstract
It has taken a staggering amount of time for the medical community to realize that new-borns are able to feel pain. The treatment of neonatal pain during procedures has become mandatory, not only for humanitarian reasons which could alone justify the soothing of pain in these infants but also because repeated and prolonged pain may have long-term consequences in neonates. Nonpharmacological interventions which comprise environmental and behavioral interventions have a wide applicability for neonatal pain management alone or in combination with pharmacological treatments. These interventions are not necessarily substitutes or alternatives for pharmacological interventions but are complimentary. Nonpharmacological interventions can reduce neonatal pain indirectly by reducing the total amount of noxious stimuli to which infants are exposed and directly, by blocking nociceptive transduction or transmission or activation of descending inhibitory pathways or by activating attention and arousal systems that modulate pain. This article describes prevention, environmental interventions, and behavioral strategies. Within the behavioral strategies, sweet solutions, especially sucrose and glucose, with or without non-nutritive sucking, skin to skin contact, and breastfeeding during procedures have been studied and their analgesic efficacy has been shown. A practical approach is described hereafter. Give 1-2 ml of oral sucrose or glucose 30% at 2 min before a minor painful procedures in term neonates or neonates weighing more than 2500 g. The analgesic efficacy of sucrose and glucose seems similar. For preterm neonates weighing less than 2500 g, give 0.5 ml of oral sucrose or glucose 30%, and for those weighing less than 1500 g, 0.3 ml of oral sucrose or glucose 30%. Since a synergistic effect has been shown for the association of sweet solutions and pacifiers, give a pacifier together with sweet solutions. For term neonates that are breastfed, consider breastfeeding during procedures. These nonpharmacological interventions are suitable for minor procedures. They should not constitute the sole analgesic when performing more invasive procedures.
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Affiliation(s)
- R Carbajal
- Centre national de ressources de lutte contre la douleur, hôpital d'enfants Armand-Trousseau, Paris, France.
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Blanc P, Perrin I, Barlet L, Talbotec C, Goulet O, Paupe A, Lenclen R, Carbajal R. Tuberculose péritonéale de l'enfant : à propos de deux cas. Arch Pediatr 2004; 11:822-5. [PMID: 15234379 DOI: 10.1016/j.arcped.2004.03.124] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2003] [Accepted: 03/20/2004] [Indexed: 11/16/2022]
Abstract
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. In one case, the diagnosis was late, and confirmed by ascites culture. In the second case, a laparoscopy was performed and showed whitish nodules involving the entire abdominal cavity, compatible with peritoneal tuberculosis, later confirmed bacteriologically. CONCLUSION Peritoneal tuberculosis presents with nonspecific symptoms. Because laboratory investigations may not be helpful, diagnosis may be difficult. Peritoneal-fluid adenosine deaminase (ADA) determination and coelioscopy seem to be the best way to make a rapid diagnosis.
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Affiliation(s)
- P Blanc
- Service de pédiatrie, site de Poissy, centre hospitalier Poissy-Saint-Germain-en-Laye, 10, rue du Champ-Gaillard, BP 3082, 78303 Poissy, France.
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Abstract
Pasteurella multocida is usually responsible for local infections occurring after animal bites. It can also be responsible for meningitis in infants. A three-month old infant was admitted to hospital with a diagnosis of bacterial meningitis and hip osteitis. Cultures of cerebrospinal fluid, blood and joint liquid were positive to Pasteurella multocida. Licking from the family dog was the transmission mode in this case. Despite initial neurological complications, clinical evolution was favourable after three weeks of intravenous antibiotic therapy followed by an oral administration for three months. Pasteurella multocida meningitis is rare in infants. It can be associated with arthritis, osteitis and septicaemia. Besides animal bites, licking is also a mode of contamination.
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Affiliation(s)
- I Perrin
- Service de pédiatrie, CHI Poissy-Saint-Germain, site de Poissy, 10, rue du Champ-Gaillard, 78300 Poissy, France.
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Abstract
UNLABELLED The aim of this study was to investigate pain management in neonatal intensive care units (NICUs) in France and to identify factors associated with variability across units. A questionnaire sent to 143 heads of level II or III NICUs investigated the use of pain scores, pain management organization and pharmacological treatment in five clinical situations (endotracheal intubation, prolonged mechanical ventilation, acute stage of necrotizing enterocolitis, central venous catheter insertion and cephalhaematoma). The response rate was 81%. Among the 35 (30%) units that used no pain scores, 40% ascribed this to lack of knowledge. Factors associated with failure to use pain scores were level II status, no university affiliation, no surgical patients and neonatal patients only. Among the units that scored pain, 78% used valid scores for acute pain and 73% for prolonged pain. Written guidelines were available for acute pain in 65% of units and for prolonged pain in 36%. The rate of pharmacotherapy use varied widely across the five clinical situations studied (from 16 to 77%) and across units for a given clinical situation. Also extremely variable were the regimens used in each situation and the dosages of analgesics and sedatives. Only 11% of units adjusted dosages to gestational age. CONCLUSION Pain assessment was performed in the most French NICUs, but a strong heterogeneity for pain treatment was observed. Reference to recently published pain management guidelines and new randomized trials could be useful to optimize pain treatment in NICUs.
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Affiliation(s)
- T Debillon
- Neonatal Intensive Care Unit, Mother and Child University Hospital, Nantes.
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Lenclen R, Mazraani M, Jugie M, Couderc S, Hoenn E, Carbajal R, Blanc P, Paupe A. [Use of a polyethylene bag: a way to improve the thermal environment of the premature newborn at the delivery room]. Arch Pediatr 2002; 9:238-44. [PMID: 11938534 DOI: 10.1016/s0929-693x(01)00759-x] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
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. PATIENTS AND METHODS Matched pair analysis was conducted for 60 infants delivered inborn at less than 33 weeks' gestation and 60 premature infants who were born during the second half of 1999 fulfilling the same criteria. The only difference in the management (medical and environmental) was wrapping with a polyethylene bag in the delivery room. Rectal temperature and other vital parameters were taken, after removal of wraps, on admission to NICU. RESULTS The perinatal characteristics of both groups were comparable. Use of wrapping resulted in a significantly higher admission rectal temperature (difference in means = 0.8 degree C, p < 0.0001), this difference was also significant in infants < 30 weeks. The incidence of hypothermia (< 35.5 degrees C) was less frequent in infants enclosed in plastic bags (8.3% vs 55%). No side effects (skin burns, infection or hyperthermia) were attributable to the intervention. The heart rate was higher in the wrapping group (163 +/- 16 vs 150 +/- 17 b/min, p < 0.01), as well as the capillary glycemia (62 +/- 26 vs 45 +/- 30 mg/dl, p < 0.01). There was no significant difference on arterial pressure. CONCLUSION Occlusive wrapping with a polyethylene bag at birth prevented low rectal temperature in premature infants in the immediate postnatal period. This method is easy, practical and effective, and does not interfere with current practice for resuscitation.
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Affiliation(s)
- R Lenclen
- Réanimation néonatale, CHI Poissy-St Germain, site de Poissy, 10, rue du Champ-Gaillard, 78300 Poissy, France.
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Affiliation(s)
- F Cantarovich
- Service de Réanimation et Transplantation, Hôpital Necker, Paris, France
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Carbajal R, Lenclen R, Paupe A, Blanc P, Hoenn E, Couderc S. [Jargon of the neonatal intensive care unit]. Arch Pediatr 2001; 8:92-100. [PMID: 11218591 DOI: 10.1016/s0929-693x(00)00173-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
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. The use of jargon within the NICU is very practical for those who work in these units. However, this jargon is frequently used by neonatologists in medical reports or other kinds of communication with unspecialized physicians. Even if part of the specialized vocabulary can be decoded by physicians not working in the NICU, they do not always know the exact place that these techniques or treatments have in the management of their patients. The aim of this article is to describe the most frequent jargon terms used in the French NICU and to give up-to-date information on the importance of the techniques or treatments that they describe.
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Affiliation(s)
- R Carbajal
- Service de pédiatrie et de médecine néonatale, centre hospitalier Poissy-Saint-Germain-en-Laye, site Poissy, 78300 Poissy, France.
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Abstract
OBJECTIVE Although the equimolecular mixture of oxygen and nitrous oxide (EMONO) seems a good choice to relieve procedure-related pain in children, it has not been accepted everywhere. In France, the rapid spread of its use has elicited suspicion and doubts regarding its safety. To assess the use and the safety of this gas mixture in the pediatric settings in France, we conducted a national survey. METHODOLOGY Centers that had accepted a nation- wide invitation to participate in the survey filled out a questionnaire after each EMONO administration during a 2-month study. Procedure and inhalation characteristics, as well as pain evaluations and side effects, were reported. RESULTS One thousand nineteen EMONO inhalations from 31 centers that agreed to participate in this 2-month survey were analyzed. Median (range) age was 6.4 (0-18) years. Four percent (46) of children were 12 months old or younger, 29% (295) were 5 years old or younger, 45% (459) were 6 to 10 years old, and 26% (265) were older than 10 years of age. The procedures performed with EMONO inhalation were: lumbar punctures (286), bone marrow aspirations (BMA; 231), laceration repairs (215), minor procedures (75), minor surgery (53), punctures (49), fractures (45), dental care (43), and pulmonary endoscopy (22). Nine percent of procedures were undertaken without the presence of a physician; the child being observed only by the attending nurse. A drug association was noted in 182 (17.9%) of procedures: midazolam (63%), acetaminophen (18%), nalbuphine (8.5%), hydroxyzine (5%), flunitrazepam (2%), chlorazepate (2%), morphine (1%), and lorazepam (.5%). EMLA cream (Astra) was applied in 98.6% of lumbar punctures, 93.7% of BMA, and 54.2% of punctures including lymph nodes, hematoma, or renal biopsies. Lidocaine infiltration was performed in 51% of minor surgery procedures, 40% of laceration repairs, and 28% of BMA. The inhalation system included a whistle, a scented mask, and a nonrebreathing respiratory valve in 48.9%, 71.2%, and 78.3% of the patients, respectively. Initial physical restraint was needed in 18. 2% of all the patients. Inhalation refusal was noted in 129 (12.7%) children; of these, 53 had an alternative method of analgesia (EMLA or lidocaine infiltration), 15 had no other analgesia, and in the remaining 61, EMONO inhalation was maintained against the child's will. Median (interquartile) inhalation length was 4 (3-5) minutes before starting the procedure and 6 (6-15) minutes for the total inhalation. Median (interquartile) procedural pain evaluations were 9 (0-30) for children on a 0 to 100 visual analog scale, 1 (0-3) for both nurses and parents on a 0 to 10 numerical scale. Median (interquartile) procedural pain as evaluated by nurses for the 3 most frequent procedures were 0 (0-2) for lumbar punctures, 2 (0-4) for bone marrow aspiration, and 2 (0-4) for laceration repair. Comparison of pain assessed by nurses in children 3 years old or younger and those older than 3 years of age showed a median (range) score of 2 (0-10) versus 1 (0-10), respectively. Pain self-assessment was completed in 647 children 6 years of age or older. Median (interquartile) children pain assessments were as follows: lumbar puncture (5; 0-20), bone marrow aspiration (12.5; 0-40), laceration repair (12; 0-40), minor procedures (18; 0-32), minor surgery (10; 0-35), punctures (0; 0-18), fracture (15; 0-30), dental care (20; 0-40), and pulmonary endoscopy (15; 0-30). Ninety-three percent of the 647 children who were able to answer the question said they would accept EMONO analgesia if a new procedure were to be performed. Behavioral reactions during procedures varied with age of the child; cry was observed in 44.1%, 24.4%, 12.9%, and 11.2% of children 3 years or younger, 4 to 6 years, 7 to 10 years, and 11 years or older, respectively. Physical restraint was necessary in 34.2%, 22%, 13.5%, and 8.4% of children aged 3 years or younger, 4 to 6 years, 7 to 10 years, and 11 years or old
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Affiliation(s)
- D Annequin
- Unité Fonctionnelle d'Analgésie Pédiatrique Hôpital d'Enfants Armand Trousseau, Paris, France.
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Romain O, David L, Carbajal R. Informations pour le praticien. Arch Pediatr 2000. [DOI: 10.1016/s0929-693x(00)88925-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Carbajal R, Chauvet X, Couderc S, Olivier-Martin M. Randomised trial of analgesic effects of sucrose, glucose, and pacifiers in term neonates. BMJ 1999; 319:1393-7. [PMID: 10574854 PMCID: PMC28282 DOI: 10.1136/bmj.319.7222.1393] [Citation(s) in RCA: 233] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess and compare the analgesic effects of orally administered glucose and sucrose and pacifiers. To determine the synergistic analgesic effect of sucrose and pacifiers. DESIGN Randomised prospective study with validated behavioural acute pain rating scale. SETTING Maternity ward. PARTICIPANTS 150 term newborns undergoing venepuncture randomly assigned to one of six treatment groups: no treatment; placebo (2 ml sterile water); 2 ml 30% glucose; 2 ml 30% sucrose; a pacifier; and 2 ml 30% sucrose followed by a pacifier. RESULTS Median (interquartile) pain scores during venepuncture were 7 (5-10) for no treatment; 7 (6-10) for placebo (sterile water); 5 (3-7) for 30% glucose; 5 (2-8) for 30% sucrose; 2 (1-4) for pacifier; and 1 (1-2) for 30% sucrose plus pacifier. Mann-Whitney U test P values for comparisons of 30% glucose, 30% sucrose, pacifier, and 30% sucrose plus pacifier versus placebo (sterile water) were 0.005, 0.01, <0.0001, and <0.0001, respectively. Differences between group median pain scores for these comparisons were 2 (95% confidence interval 1 to 4), 2 (0 to 4), 5 (4 to 7), and 6 (5 to 8), respectively. P values for comparisons of 30% glucose, 30% sucrose, and 30% sucrose plus pacifier versus pacifier were 0.0001, 0.001, and 0.06, respectively. Differences between group medians for these comparisons were 3 (2 to 5), 3 (1 to 5), and 1 (0 to 2), respectively. CONCLUSION The analgesic effects of concentrated sucrose and glucose and pacifiers are clinically apparent in newborns, pacifiers being more effective than sweet solutions. The association of sucrose and pacifier showed a trend towards lower scores compared with pacifiers alone. These simple and safe interventions should be widely used for minor procedures in neonates.
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Affiliation(s)
- R Carbajal
- Department of Paediatrics, Poissy Hospital, 78300 Poissy, France.
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Abstract
Nitrous oxide is a gas that has been used to provide analgesia to patients for more than a century. Its modern use started in the late sixties when a mixture of 50% nitrous oxide/50% oxygen was prepared. Nitrous oxide/oxygen provides analgesia within 3 minutes of inhalation and this analgesic effect disappears in less than 4 minutes after cessation. Its administration is very easy and a complete or partial pain relief is observed in 75 to 81% of patients. The gas mixture has been found to be safe with few side effects and no significant adverse reactions. Diffusion hypoxia which could lead to hypoxemia was reported in 1955, but recent work does not confirm this complication. Nitrous oxide/oxygen mixture constitutes an excellent drug to control procedure-related pain in children. This articles describes the history, the pharmacology, and the clinical uses of nitrous oxide/oxygen in children.
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Affiliation(s)
- R Carbajal
- Service de pédiatrie, Centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye, France
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Abstract
Texas Children's Hospital, a 456 bed pediatric hospital located in the Texas Medical Center, has been constructing a large-scale picture archiving and communications system (PACS), including ultrasound (US), computed tomography (CT), magnetic resonance (MR), and computed radiography (CR). Until recently, filmless radiology operations have been confined to the imaging department, the outpatient treatment center, and the emergency center. As filmless services expand to other clinical services, the PACS staff must engage each service in a dialog to determine the appropriate level of support required. The number and type of image examinations, the use of multiple modalities and comparison examinations, and the relationship between viewing and direct patient care activities have a bearing on the number and type of display stations provided. Some of the information about customer services is contained in documentation already maintained by the imaging department. For example, by a custom report from the radiology information system (RIS), we were able to determine the number and type of examinations ordered by each referring physician for the previous 6 months. By compiling these by clinical service, we were able to determine our biggest customers by examination type and volume. Another custom report was used to determine who was requesting old examinations from the film library. More information about imaging usage was gathered by means of a questionnaire. Some customers view images only where patients are also seen, while some services view images independently from the patient. Some services use their conference rooms for critical image viewing such as treatment planning. Additional information was gained from geographical surveys of where films are currently produced, delivered by the film library, and viewed. In some areas, available space dictates the type and configuration of display station that can be used. Active participation in the decision process by the clinical service is a key element to successful filmless operations.
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Affiliation(s)
- R Carbajal
- Edward B. Singleton Diagnostic Imaging Services, Texas Children's Hospital, Houston 77030, USA
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Carbajal R. [Analgesia with sugar nipples in the newborn]. Soins Pediatr Pueric 1999:22-3. [PMID: 10615145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
- R Carbajal
- Service de Pédiatrie, Centre hospitalier intercommunal de Poissy/Saint-German-en-Laye, hôpital de Poissy
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Carbajal R. Faut-II encore hospitaliser les enfants pour la détection du Mycobacterium tuberculosis par tubage gastrique? Arch Pediatr 1999. [DOI: 10.1016/s0929-693x(99)81937-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Blanc P, Desgrippes A, Carbajal R, Paupe A, Lenclen R, Olivier-Martin M. Syndrome de Kawasaki révelé par une cholestase fébrile. Med Mal Infect 1998. [DOI: 10.1016/s0399-077x(98)70005-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Carbajal R, Buffin R, Pajot C, Paupe A, Hoenn E, Blanc P, Olivier-Martin M. [Arterial puncture in the premature newborn guided with a pulse oximeter probe]. Arch Pediatr 1998; 5:464. [PMID: 9759177 DOI: 10.1016/s0929-693x(98)80046-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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50
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Carbajal R. [Pain in pediatric emergency units]. Soins Pediatr Pueric 1998:33-4. [PMID: 9574086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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