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relationship between initial lung mechanics and occurrence of bronchopulmonary dysplasia (BPD). Method Preterm infants who were Results 10 premature infants were studied. Mean gestational age was 28.4 ± 1.6 (26-31) weeks and mean birth weight was 955 ± 155 (710-1250) g. Five infants received beractant and the other five received poractantalpha. The alteration of lung mechanics after surfactant administration was summarized in Table . Conclusion Surfactant therapy significantly reduced the resistance and improved the lung compliance. These effects were not directly related to the type of surfactant administered.

Rationale Congenital diaphragmatic hernia (CDH) is associated with a high incidence of respiratory problems, even after initial hospital discharge. These problems are likely to lead to re-hospitalization during infancy, although actual frequency of readmissions is unknown. Objective We aimed to determine the rate of hospitalization for wheezing in infants with CDH between the time of initial discharge and 24 months of age, and to identify factors associated with readmission. Methods Data about infants with CDH born in three French reference tertiary centers between January 2009 and March 2013 who were alive at hospital discharge, were extracted from a prospective national database. Results Ninety-two children were identified, and 86 were included in the analysis. In total, 116 wheezing episodes requiring a doctor's visit occurred in 50 infants (58%) before 24 months of age. Twenty-two children (26%) were readmitted at least once for wheezing exacerbations. RSV was present in 6 of 15 (40%) of children with available nasal samples at first readmission, and 1 of 5 (20%) at second readmission. Thoracic herniation of the liver, low gestational age, longer initial hospitalization, need for oxygen therapy at home, and eczema were all significantly associated with readmission for wheezing exacerbations. Fifty-three infants (62%) received palivizumab prophylaxis, but there was no association with the overall rate of readmission for wheezing exacerbations or RSV-related hospitalization.

Congenital diaphragmatic hernia (CDH) is a rare congenital anomaly and remains among the most challenging ICU-managed disease. Beside severe pulmonary hypertension, lung hypoplasia and major abdominal surgery, infective complications remain major determinants of outcome. However, the specific incidence of sepsis as well as associated risk factors is unknown. This prospective, 4-year observational study took place in the pediatric intensive care and neonatal medicine department of the Paris South University Hospitals (Le Kremlin-Bicêtre, France), CDH national referral center and involved 62 neonates with CDH. During their ICU stay, 28 patients (45%) developed 38 sepsis episodes. Ventilator-associated pneumonia (VAP: 23/38; 31.9 VAP per 1000 days of mechanical ventilation) and central line-associated blood stream infections (CLABSI: 5/38; 5.5 per 1000 line days) were the most frequently encountered infections. Multivariate analysis showed that gestational age at birth and intra-thorac...

Objectives: To evaluate the positive threshold of PCT for neonates of <32 weeks of gestation for the diagnosis of early-onset sepsis and to determine if the level of PCT collected within 6 h of life could be used. Design: Retrospective and bicentric study from May 2016 to April 2018. Setting: Two groups were established, neonates evaluated for PCT at birth (CordPCT) and within 6 h of life (delPCT). Patients: Two hundred and sixty neonates of <32 weeks of gestation born in Nice and South Paris (Bicêtre) University Hospitals, had been evaluated for PCT level. Main Outcomes Measures: The value of the PCT positive threshold was determined for the total population and each groups thanks ROC curves. Results: The threshold level of PCT for the total population was 0.98 ng/mL. The threshold value of cordPCT group was 1.00 vs. 0.98 ng/mL for delPCT group. The area under the Receiver Operating Characteristics curve for PCT sampled in delPCT group was significantly higher than in cordPCT...

Le processus decisionnel est un evenement particulier qui confronte les soignants a leurs doutes et a leurs incertitudes. Chaque decision comporte ineluctablement une part de doute et d’incertitude, sinon elle ne merite pas d’etre appelee « decision », car elle ne serait que le resultat de l’application d’un savoir acquis a l’avance, a une situation connue. C’est cette part d’incertitude qui est le lieu de la reflexion et qui offre a chacun la possibilite de se questionner, c’est-a-dire de se mettre dans la situation ou il faut vaincre l’indecidable pour pouvoir decider. Au cours de ce travail, j’aborde le role du medecin en tant qu’arbitre entre le certain et l’incertain en situation de fin de vie chez le nouveau-ne. Afin de cerner cette problematique, je rapporte six observations cliniques, toutes tirees de ma propre experience et qui illustrent mieux qu’un long discours les notions du certain et de l’incertain, et permettent de donner a chacune de ces notions son veritable sens p...