Jacques Sizun

Parents, siblings and grandparents in the Neonatal Intensive Care Unit A survey of policies in eight European countries

Objective:  To describe policies towards family visiting in Neonatal Intensive Care Units (NICU) and compare findings with those of a survey carried out 10 years earlier.

Parental involvement and kangaroo care in European neonatal intensive care units: A policy survey in eight countries

Objective: To compare, in a large representative sample of European neonatal intensive care units, the policies and practices regarding parental involvement and holding babies in the kangaroo care position as well as differences in the tasks mothers and fathers are allowed to carry out. Design: Prospective multicenter survey. Setting: Neonatal intensive care units in eight European countries (Belgium, Denmark, France, Italy, The Netherlands, Spain, Sweden, and the United Kingdom). Patients: Patients were not involved in this study. Interventions: None. Measurements and Main Results: A structured questionnaire was mailed to 362 units (response rate 78%); only units with ≥50 very-low-birth-weight annual admissions were considered for this study. Facilities for parents such as reclining chairs near the babies’ cots, beds, and a dedicated room were common, but less so in Italy and Spain. All units in Sweden, Denmark, the United Kingdom, and Belgium reported encouraging parental participation in the care of the babies, whereas policies were more restrictive in Italy (80% of units), France (73%), and Spain (41%). Holding babies in the kangaroo care position was widespread. However, in the United Kingdom, France, Italy, and Spain, many units applied restrictions regarding its frequency (sometimes or on parents request only, rather than routinely), method (conventional rather than skin-to-skin), and clinical conditions (especially mechanical ventilation and presence of umbilical lines) that would prevent its practice. In these countries, fathers were routinely offered kangaroo care less frequently than mothers (p < .001) and less often it was skin-to-skin (p < .0001). Conclusions: This study showed that, although the majority of units in all countries reported a policy of encouraging both parents to take part in the care of their babies, the intensity and ways of involvement as well as the role played by mothers and fathers varied within and between countries.

Heel blood sampling in European neonatal intensive care units: compliance with pain management guidelines

Objective To describe the use of heel blood sampling and non-pharmacological analgesia in a large representative sample of neonatal intensive care units (NICUs) in eight European countries, and compare their self-reported practices with evidence-based recommendations. Methods Information on use of heel blood sampling and associated procedures (oral sweet solutions, non-nutritive sucking, swaddling or positioning, topical anaesthetics and heel warming) were collected through a structured mail questionnaire. 284 NICUs (78% response rate) participated, but only 175 with ≥50 very low birth weight admissions per year were included in this analysis. Results Use of heel blood sampling appeared widespread. Most units in the Netherlands, UK, Denmark, Sweden and France predominantly adopted mechanical devices, while manual lance was still in use in the other countries. The two Scandinavian countries and France were the most likely, and Belgium and Spain the least likely to employ recommended combinations of evidence-based pain management measures. Conclusions Heel puncture is a common procedure in preterm neonates, but pain appears inadequately treated in many units and countries. Better compliance with published guidelines is needed for clinical and ethical reasons.

Infected breast milk associated with late-onset and recurrent group B streptococcal infection in neonatal twins: a genetic analysis.

Asymptomatic excretion of group B streptococcus (GBS) in breast milk may be an underrecognized cause of neonatal and recurrent infection. We report the case of late-onset and recurrent infection in newborn twins resulting from ingestion of maternal breast milk infected with GBS. Genetic analysis of isolates is equally presented.

Comparison of immunofluorescence with monoclonal antibodies and RT-PCR for the detection of human coronaviruses 229E and OC43 in cell culture

Abstract Human coronaviruses, with two known serogroups named 229E and OC43, cause up to one third of common colds and may be associated with serious diseases such as nosocomial respiratory infections, enterocolitis, pericarditis and neurological disorders. Reliable methods of detection in clinical samples are needed for a better understanding of their role in pathology. As a first step in the design of such diagnostic procedures, the sensitivities and specificities of two viral diagnostic assays were compared in an experimental cell culture model: an indirect immuno-fluorescence assay using monoclonal antibodies and reverse transcriptase-polymerase chain reaction amplification of viral RNA from infected cells. Immunofluorescence detected human coronaviruses in cells infected at a MOI as low as 10−2 (log TCID50/ml=4.25 for HCV-229E and 2.0 for HCV-OC43; log PFU/ml=4.83 for HCV-229E and 1.84 for HCV-OC43) versus 10−3 (HCV-OC43) or 10−4 (HCV-229E) for reverse transcriptase-polymerase chain reaction amplification (log TCID50/ml=1.75 for HCV-229E and 1.5 for HCV-OC43; log PFU/ml=2.3 for HCV-229E and 1.34 for HCV-OC43). There were no false positive signals with other human respiratory pathogens: influenza virus, respiratory syncytial virus and adenovirus. Moreover, each assay was coronavirus serogroup-specific. These results demonstrate the potential usefulness of immunofluorescence with monoclonal antibodies and reverse transcriptase-polymerase chain reaction RNA amplification for the rapid detection of human coronaviruses in infected cell cultures. Both methods could be applied to clinical specimens for the diagnosis of human infections.

Detection of human Coronavirus 229E in nasal specimens in large scale studies using an RT-PCR hybridization assay

Abstract A novel human Coronavirus (HCoV) was this year recognized as the etiological agent of the Severe Acute Respiratory Syndrome. Two other HCoV (HCoV-229E and HCoV-OC43) have been known for 30 years. HCoV-229E has been recently involved in nosocomial respiratory viral infections in high-risk children. However, their diagnosis is not routinely performed. Currently, reliable immunofluorescence and cell culture methodologies are not available. As part of a four-year epidemiological study in a Pediatric and Neonatal Intensive care unit, we have performed and demonstrated the reliability of a reverse transcription-PCR-hybridization assay to detect HCoV of the 229E antigenic group in 2028 clinical respiratory specimens. In hospitalized children (children and newborns) and staff members we found a high incidence of HcoV-229E infection. This reverse transcription-PCR-hybridization assay gave a high specificity and a sensitivity of 0.5 50% Tissue Culture Infective Dose per ml. This technique is reliable and its application for screening large number of clinical samples would improve the diagnosis of HCoVs respiratory infection and our knowledge of these viruses epidemiology.

Extended-spectrum β-lactamase-producing Enterobacteriaceae in a Malian orphanage.

We show high rates of extended-spectrum β-lactamase–producing Enterobacteriaceae carriage among the staff and children at an orphanage in Bamako, Mali. Enterobacteriaceae colonized in 100% and 63%, respectively, of the 38 children and 30 adults studied. Use of antimicrobial drugs appeared excessive and inappropriate; decontamination and hygiene protocols were also questioned.

Recherche clinique, soins de développement et NIDCAP: aspects méthodologiques spécifiques

Developmental care is the use of a range of medical and nursing interventions to decrease the stress of preterm neonates in neonatal intensive care units. Interventions may be integrated into an individualized approach known as the Neonatal Individualized Developmental Care and Assessment Programme (NIDCAP). In comparison with drug trials, it is more difficult to achieve a standard experimental design in this kind of study as the experiments may include several individual approaches. Randomized control trials must remain a predominant practice but use of other methodologies can help to evaluate the benefits of developmental care and offer a better understanding of the impact of this kind of care : qualitative research, benchmarking or animal studies.

Policy of feeding very preterm infants with their mother's own fresh expressed milk was associated with a reduced risk of bronchopulmonary dysplasia.

Since 2005, the French Food Safety Agency has recommended that very preterm or low‐birthweight babies should be fed with pasteurised, expressed breastmilk, and feeding policies on this vary widely in French neonatal units. We investigated the differences between using a mothers expressed milk, in fresh or pasteurised forms, for very preterm infants.

Eight principles for patient-centred and family-centred care for newborns in the neonatal intensive care unit

Despite the recent improvements in perinatal medical care leading to an increase in survival rates, adverse neurodevelopmental outcomes occur more frequently in preterm and/or high-risk infants. Medical risk factors for neurodevelopmental delays like male gender or intrauterine growth restriction and family sociocultural characteristics have been identified. Significant data have provided evidence of the detrimental impact of overhelming environmental sensory inputs, such as pain and stress, on the developing human brain and strategies aimed at preventing this impact. These strategies, such as free parental access or sleep protection, could be considered ‘principles of care’. Implementation of these principles do not require additional research due to the body of evidence. We review the scientific evidence for these principles here.