Archives de pédiatrie : organe officiel de la Sociéte française de pédiatrie
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Two recent laws have significantly reformed the French Public Health Code: the law of March 4th 2002, related to the patient's rights and the quality of the health care system and the law of April 22nd 2005, related to the patient's rights and the end of life. These changes have prompted health care professionals involved in perinatal and neonatal medicine to update their considerations on the ethical aspects of the end of life in neonatal medicine. Therefore, the authors examined the clauses of the law related to the patient's rights and to the end of life, confronting them with the distinctive features of neonatal medicine. ⋯ Next, the justifications provided by the legislation to authorize these practices are analysed: prohibition of unreasonable obstinacy and respect for individual wishes. Then, the conditions required by the law to determine and to implement these acts are discussed: consultation with the healthcare staff and justified advice from a consulting physician, consideration of parental opinion, registration of the decision and its justifications into the patient's medical file, protection of the dying patient's dignity and preservation of his life quality by providing palliative care. Lastly, we report the terms of the ethical dilemma which may occur in the area of neonatal medicine in spite of genuine and persevering efforts in order to conciliate legal requirement and ethical responsibility.
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Oral rehydration solutions (ORS) have been used since 1960 and avoided millions of children deaths due to acute diarrhoeas. It is the only treatment currently able to prevent and treat acute dehydration. In France, ORS are cost free due to a health insurance refund. ⋯ In cases of bottle feeding, milk should be reintroduced after a few hours of rehydration. ORS are not well known, prescribed or used and that may explain for the most part the dehydration and deaths which occur in France. ORS are the only life-saving treatment for gastroenteritis, which has proved its efficacy for the past 50 years: it is time to use it on a routine basis.
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Editorial Historical Article
[This special issue of Archives de Pédiatrie is dedicated to neonatology].
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Case Reports
[Painful ophthalmoplegia in children: Tolosa-Hunt syndrome or ophthalmoplegic migraine?].
In children with painful ophthalmoplegia, the diagnosis of Tolosa-Hunt syndrome or of ophthalmoplegic migraine should only be considered when tumoral, infectious, inflammatory or vascular causes have been excluded by appropriate investigations. Both entities are classified as "neuralgia" by the International Headache Society, and seem to share a similar pathogenic mechanism. Both diseases have many clinical similarities with slight differences concerning pain characteristics or ocular associated symptoms. ⋯ Such treatment may decrease the risk of recurrence. It is important to follow-up these patients for a 2 years period and to repeat the etiologic assessment. We report here 2 cases of children with painful ophtalmoplegia.