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Hubert P.,Service de reanimation et surveillance continue pediatriques
Neuropsychiatrie de l'Enfance et de l'Adolescence | Year: 2016

The author presents a panorama of the evolution of the reflections and practices at the heart of pediatric resuscitation units both with regards to limitations and stopping of treatment (LAT) and the role of parents in these decisions. Professional recommendations and legal requirements have very likely contributed, but one should not underestimate the importance of ethical reflection carried out by many caring pediatric and neonatal resuscitation teams who were able to benefit from the contribution of parents, child psychiatrists and palliative care professionals. Starting from the idea that this decision was too serious for the families alone, and the need to avoid having them be associated in order to protect them, currently one simply seeks information and collection of the consent or non-opposition of the parents of the sick child with regard to a LAT. This is an uncontested moral and legal requirement, although French legislation has ruled that an LAT decision ultimately rests with the doctor. The recommended attitude towards the parents departs from any systematic approach in order to permit a personalized one, leaving the parents free to choose their level of involvement with regard to the decision of the care team. This is also reflected in the possible presence of parents with their child, a period of reflection (on the order of 24 to 48. hours) between the time when the care team makes a collegial decision and the agreement of the parents not to pursue treatment, and the effective switch-off time. This attitude implies a greater team cohesion where nurses and doctors are together with families and children, but it also requires that teams facing such difficult decisions can be assisted. © 2016 Elsevier Masson SAS. Source


Gatti H.,Service de pediatrie generale | Dauger S.,Service de reanimation et surveillance continue pediatriques | Dauger S.,University Paris Diderot | Sommet J.,Unite DEpidemiologie Clinique | And 4 more authors.
Archives de Pediatrie | Year: 2014

In 2006, decrees relating to pediatric critical care defined the main rules of pediatric intermediate care units (PIMU). These units ensure continuous monitoring of children at risk of critical deterioration without requiring invasive support. In French Polynesia, a PIMU has been integrated into the general pediatric ward since the new hospital opened in November 2010. We conducted a prospective observational study of patients admitted to the PIMU depending on whether they were surgical patients or were secondarily transferred to the ICU or were transferred via long-distance medical air transport for specialized care. For the very first operational year, 199 children (median age, 3. years old) were admitted to the PIMU: for the most part respiratory (31.7%) and neurologic (23.6%) failures were involved. Surgical patients more often required a prosthesis or treatments associated with serious adverse effects than nonsurgical patients (respectively, 46% vs. 16%, P<. 0.01; 29% vs. 7%, P<. 0.01) and the length of the hospital stay was longer (5. days vs. 2, P<. 0.01). Patients who were secondarily transferred to the ICU had a higher admission Pediatric RISk of Mortality (PRISM) score (6 vs. 4, P<. 0.01) and required more treatments associated with serious adverse effects (50% vs. 20%, P<. 0.01) than nontransferred patients. The length of the hospital stay was longer (6. days) for patients who underwent long-distance medical transport. In addition to PIMU defining criteria, the use of treatments associated with serious adverse effects should be considered risk factors of impaired prognosis in local practical procedures. Assessment of PIMU activity should take into account that intensive surgical care and geographical isolation are closely related to increased length of hospital stay. © 2014 Elsevier Masson SAS. Source


Sachs P.,University Paris Diderot | Prot-Labarthe S.,Pole de Biologie | King L.A.,Institute of Veille Sanitaire | Blonde R.,Service de pediatrie generale | And 5 more authors.
Reanimation | Year: 2012

Botulism rarely involves young children. Food borne botulism is a direct toxin contamination that can affect infants following the ingestion of a food product contaminated by botulinum toxin. Infant botulism occurs after intestinal colonisation by Clostridium botulinium and secondary toxin production in children less than 12 months of age. Both forms lead to a presynaptic blockage of the neuromuscular junction. In its natural course, the disease ultimately resolves completely, but some patients will require ventilatory and nutritional support, thus experiencing intensive care complications. Early administration of intravenous antitoxin has been proved to accelerate recovery, which requires physicians to be aware of this rare disease. Here we report three recent cases of botulism in young children that are especially relevant, and propose guidelines to optimise diagnosis and treatment. © SRLF et Springer-Verlag France 2012. Source


Menier I.,Service de Reeducation Fonctionnelle Pediatrique | Dejonkheere C.,Service de reanimation et surveillance continue pediatriques | Baou O.,Service de reanimation et surveillance continue pediatriques | Moreno M.E.,Service de reanimation et surveillance continue pediatriques | And 3 more authors.
Reanimation | Year: 2014

In infants hospitalized in the paediatric intensive care unit (PICU), a disorder of the oral behaviour may occur soon in relation to a lack in feeding reflexes solicitation and performance of invasive oral procedures, often in association with artificial nutrition. Such disorders not only include oral aversion, but also sensory, expressive, relational, and psychomotor issues. Looking beyond the intensive care, measures to lower the incidence of such disorders should be seek to limit durations of artificial nutrition and hospitalization, avoid psychomotor retardation, enable a secure parentinfant attachment, and improve the quality of life for children and family. In 2011, Robert Debré Hospital's PICU team investigated how to prevent oral disorders in hospitalized child. A multidisciplinary group focusing on "oral behaviour" was set up and took several decisions, including the raise of the medical and paramedical staff awareness and training, the development of a preventive care protocol and a leaflet dedicated to the paramedics and children's families. This project allowed homogenizing day-to-day practice and better involving PICU children's families. However, the real impact of these protocol and actions on the future of PICU children remains difficult to estimate due to the limited number of included children and a final evaluation is still required. After a preliminary literature review, this article presents our recent activity in preventing and handling the secondary oral disorders in the PICU. © 2014 Société de réanimation de langue française (SRLF) and Springer-Verlag. Source


Blonde R.,Center Hospitalier Of Mayotte | Naudin J.,Service de reanimation et surveillance continue pediatriques | Naudin J.,University Paris Diderot | See H.,Center Hospitalier Intercommunal Andre Gregoire | And 7 more authors.
Reanimation | Year: 2013

Necrotizing soft tissue infection in children with or without necrotizing fasciitis is a rare bacterial infection. Varicella and trauma represent the most frequent predisposing factors. These infections must be early diagnosed, before the occurrence of any complication, including extension necrosis of soft tissue and septic shock. Magnetic resonance imaging and computed tomography-scan are helpful to delimit necrosis extent in deeper tissues. However, indications should be discussed according to infection localisation and imaging timing should not delay appropriate care. Group A β-hemolytic streptococcus is the most common microorganism associated with these infections, although incidence of Staphylococcus aureus is increasing. Death occurs in 5-20% of patients. Good prognosis is related to early diagnosis, antibiotic treatment and surgery. This emergent multidisciplinary approach is sometimes difficult to manage in paediatrics because of the rarity of these infections. © SRLF et Springer-Verlag France 2013. Source

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