Archives de pédiatrie : organe officiel de la Sociéte française de pédiatrie
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Pain causes numerous physiological changes in neonates. All invasive procedures induce undesirable stress responses; theses responses can, however, be eliminated or reduced by a judicious use of analgesia. Even though a large number of analgesics and sedatives are currently available, most of them have not been studied in the neonate. ⋯ After a review of the literature regarding these drugs, some practical advices and suggestions for the treatment of procedure-induced pain, and background sedation/analgesia for ventilated neonates are given. It is also stated in this article that the best way to soothe pain in neonates is to combine non pharmacological and pharmacological strategies. At the national level, written guidelines should be prepared in order to improve pain management in the neonate.
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Case Reports
[Antenatal closure of ductus arteriosus following maternal intoxication by niflumic acid].
Antenatal closure of the ductus arteriosus is an uncommon event that has been considered as a risk factor for development of congestive heart failure and persistent pulmonary hypertension of the newborn. We report here on a case of antenatal ductus arteriosus closure due to niflumic acid maternal intoxication at 32 weeks of gestation. ⋯ The child survived after 3 days of severe persistent pulmonary hypertension. This case emphasizes the potential risk of niflumic acid during pregnancy and the need of antenatal echographic monitoring for optimal management.
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Comparative Study
[Which sedation scale should be used in the paediatric intensive care unit? A comparative prospective study].
To compare pain and sedation assessments by nurses undertaken with the Objective Pain Scale (OPS) and a Visual Analogue Scale (VAS) to the current reference scale for paediatric intensive care that is the COMFORT scale. To compare the unmodified COMFORT scale to a COMFORT "behaviour" scale which does not include physiologic items. To evaluate the ease of use of these scales. ⋯ Among the 3 scales compared to the COMFORT scale in this study, the COMFORT "behaviour" scale was the only one to show a strong correlation and it also seemed to be the easiest to use.
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Gastric volvulus is an abnormal rotation of the stomach around its axis. The acute form is a surgical emergency, which doesn't tolerate any therapeutic delay. We report on a case in a young girl, revealed by painful epigastric mass and distended gastric bubble on abdominal X-ray. ⋯ The clinical picture of gastric volvulus is characterised by the Borchardt triad of symptoms: upper abdominal pain, vomiting and difficulty to pass a nasogastric tube. The gastrointestinal barium series and CT-scan help to confirm the diagnosis. As was demonstrated in this case, the treatment is surgical by reducing the volvulus and fixing the stomach to prevent recurrence.
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Oral rehydration therapy: Guidelines for the treatment of diarrhoea endorsed the use of ORT for the treatment of mild to moderate dehydration secondary to diarrhoea. Despite these recommendations, surveys demonstrate that many physicians do not comply with them. It took nearly 20 years after the successful use of ORT in developing countries for physicians in other countries to accept and use this treatment.