Archives de pédiatrie : organe officiel de la Sociéte française de pédiatrie
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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.
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Case Reports
[Weaning from invasive mechanical ventilation in pediatric patients (excluding premature neonates)].
The process of weaning from mechanical ventilation (WMV) is the same in children as in adults. In the pediatric literature, weaning failure rate ranges from 1.4 to 34%. So far, no indices of weaning success have been demonstrated to be sufficiently accurate. ⋯ It should be paired with a sedative interruption protocol. Weaning criteria, SBT criteria, and/or protocol tolerance are guides, but clinicians must individualize decisions to use these criteria. The use of noninvasive ventilation is increasing and its place in weaning protocols for children needs to be determined; it might modify the definitions of weaning failure and weaning success in the future.
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The university department of child and adolescent psychiatry of Brest Hospital (a medium size town of 200,000 inhabitants) has at disposal a 14 in-patient emergency care unit, where young people under 16, mostly in crisis (individual and/or family and/or institutional crisis) are admitted. This unit opens 24h a day throughout the year, and patients with any type of pathology are admitted for a short stay, mainly with no demand for care. After a description of this unit with its modalities of functioning, the authors will report on its activity assessed from sets of data pertinent to the last 8 years. ⋯ Finally, this rejuvenation of mental disorder(s), the occurrence of adolescent problems at an earlier age, together with their observation of the lengthening of the oedipian phase, whose elaboration seems more problematic than previously, have made them wonder about the contemporary characteristics of the phase of latency and the modalities of negotiation of this stage by their cohort of young people. These modifications have incited the authors to reconsider their offer of care and to propose alternatives to the hospitalisation through the recent development of a structure of home psychiatric-care. This new unit caused no arrest in the massive influx of the patients in complete hospitalisation, but it allowed them to optimise the care for some young people in complex situations through improvement of relationships with their various partners of the sanitary and socio-educational world (listening and support by the partners, exchanges of know-how in full awareness of complementarity, and work in the continuity during the stay at hospital [better prepared hospitalisation together with a better understanding of its interest by the child/teenager and the partners]).
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Analysis of domestic low-voltage (220-240 V) electrical injury in children admitted to a pediatric emergency department to illustrate the low risk of initial or delayed risk of arrhythmia. ⋯ After a low-voltage electrical injury, initial arrhythmia is not frequent, with often a nonspecific and transitory EKG expression; delayed arrhythmia is very rare. Children presenting to the emergency department after such an electrical accident, who are asymptomatic, without any risk factors for arrhythmia (wet skin, tetany, vertical pathway of the current, preexistent cardiological conditions, loss of consciousness) and with a normal initial EKG do not require cardiac monitoring.
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Palliative care in newborns may take place in the delivery room and then continued either in maternity wards or in the neonatal unit. For babies developing a chronic condition, going home may be advantageous. The population concerned includes babies born with a severe intractable congenital malformation and certain extremely preterm newborn babies at the limits of viability. Care procedures as well as withholding and withdrawing treatments are reviewed.