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Résumé Les réanimations pédiatriques sont des services dont l’accessibilité pour les familles est sujette à controverse, avec des règles qui leur sont propres. Les patients hospitalisés sont dans des situations graves et instables, avec un pronostic vital souvent engagé. Dans ce contexte, la communication avec les parents et leur participation aux soins dans le service peuvent être difficiles. Ce sont pourtant des devoirs légaux, déontologiques et moraux de la part des soignants envers les parents, réaffirmés par les besoins exprimés des parents. Mais la capacité à remplir ces devoirs et à s’adapter aux besoins de chaque parent est un défi. La communication entre les soignants et les parents se fait dès l’admission de l’enfant par un entretien d’accueil, la qualité de l’information étant évaluée selon des critères érigés par la Société de réanimation de langue française (SRLF) : compréhension, satisfaction, et anxiété et dépression des parents. Il a été montré que la compréhension dépendait de multiples facteurs, liés aux parents, aux soignants ou aux conditions médicales de l’enfant. Concernant la participation des parents au sein du service et de l’équipe soignante, leur présence prend une place croissante et leur statut a évolué. Ils sont partie prenante des soins, avec un rôle de partenaire. L’intérêt supérieur de l’enfant est toujours discuté avec eux qui sont les meilleurs représentants de l’enfant. Ce partenariat leur confère une part de responsabilité qui ne se substitue pas à celle des soignants, mais est complémentaire. Summary Pediatric intensive care units (PICUs), whose accessibility to parents raises controversy, often operate under their own rules. Patients are under critical and unstable conditions, often in a life-threatening situation. In this context, the communication with the parents and their participation in the unit may be difficult. Information is a legal, deontological, and moral duty for caregivers, confirmed by the parents’ needs. But the ability to enforce them is a challenge, and there is a gap between the theory and the reality. The communication between the parents and the physicians starts at the admission of the child with a family conference. According to the Société de réanimation de langue française (SRLF), the effectiveness of the communication is based on three criteria: the patients’ comprehension, their satisfaction and their anxiety and depression. It has been shown that comprehension depends on multiple factors, related on the parents, the physicians, and the medical condition of the child. Regarding the parents’ participation in the organization of the service, the parents’ presence is becoming an important factor. In the PICU, the parents’ status has evolved. They become a member of the care team, as a partner. The best interest of the child is always discussed with the parents, as the person knowing the best their child. This partnership gives them a responsibility, which is complementary to the physician's one, but does not substitute it. [ABSTRACT FROM AUTHOR]

Résumé Le protocole donneur unique (PDU) pour la transfusion en culots globulaires consiste en l’attribution à un enfant de 4 unités pédiatriques issues d’un même don de sang. Son utilisation est recommandée pour les nouveau-nés prématurés afin de diminuer les risques infectieux et d’allo-immunisation. Cependant, il conduit à la transfusion de sang stocké, dont certaines études remettent en cause l’innocuité. À la veille des nouvelles recommandations de la Haute Autorité de santé en 2015, nous avons effectué une enquête nationale de pratique auprès des réanimations néonatales afin d’évaluer l’utilisation du PDU ainsi qu’une étude des caractéristiques des enfants transfusés au sein de notre unité afin de mieux en identifier les bénéficiaires. L’enquête de pratique a révélé que 30 % des réanimations néonatales ne l’utilisaient plus en 2014, en raison de problèmes logistiques, financiers ou d’inquiétudes face à la transfusion de sang stocké. Dans notre unité, le PDU entraînait l’utilisation de sang stocké depuis plus de 20 jours dans la moitié des cas à partir de la 3 e unité transfusée. Deux facteurs étaient prédictifs de polytransfusion : la faiblesse du terme de naissance et la hauteur du score Clinical Risk Index for Babies (CRIB). Ces variables intégrées dans un modèle statistique permettaient de prédire le risque de polytransfusion. D’après ce modèle, un seuil de 50 % de risque de polytransfusion permet de cibler au mieux les enfants devant bénéficier d’un PDU en limitant le nombre de poches utilisées. Summary In France since 2002, the single-donor transfusion protocol, using four pediatric units from the same adult donor's packed red blood cells (PRBCs) in multiply transfused newborns, is recommended in preterm neonates to reduce the risks of infection and alloimmunization. This protocol is controversial, however, because it causes the transfusion of stored blood, which could have adverse consequences. Before the new recommendations of the French Haute Autorité de santé (National authority for health) in 2015, we conducted a national practice survey in 63 neonatal intensive care units (NICU) and a retrospective study of the characteristics of 103 children transfused within our unit, to better target beneficiaries. The practice survey showed that 30 % of French NICUs no longer used the protocol in 2014, due to logistical or financial problems, or concerns about the transfusion of stored blood. The practices were heterogeneous. Few NICUs used a written protocol. In our NICU, the use of single-donor protocol involved the use of units stored for more than 20 days in half of the cases beginning with the third unit used. Six-term newborns were mainly transfused once, which does not seem to warrant the single-donor transfusion protocol. The use of this protocol caused the loss of 50 % of the manufactured units, which go unused. In multivariate analysis, two factors were predictive of multiple transfusion within our population of 95 premature neonates undergoing transfusion: low-term and a high Clinical Risk Index for Babies (CRIB) score. The risk of multiple transfusions would be reduced by about 15 % for each additional week of gestation and approximately 16 % per point within the CRIB score. These variables integrated into a statistical model predict the risk of multiplying transfusions. According to the ROC curve, a calculated risk higher than 50 % is the appropriate cut-off value to transfuse with the single-donor transfusion protocol. This would limit its indications, saving more than 130 pediatric units of blood for 100 transfused children. A prospective study in our department will allow internal validation of this test. [ABSTRACT FROM AUTHOR]

In France since 2002, the single-donor transfusion protocol, using four pediatric units from the same adult donor's packed red blood cells (PRBCs) in multiply transfused newborns, is recommended in preterm neonates to reduce the risks of infection and alloimmunization. This protocol is controversial, however, because it causes the transfusion of stored blood, which could have adverse consequences. Before the new recommendations of the French Haute Autorité de santé (National authority for health) in 2015, we conducted a national practice survey in 63 neonatal intensive care units (NICU) and a retrospective study of the characteristics of 103 children transfused within our unit, to better target beneficiaries. The practice survey showed that 30 % of French NICUs no longer used the protocol in 2014, due to logistical or financial problems, or concerns about the transfusion of stored blood. The practices were heterogeneous. Few NICUs used a written protocol. In our NICU, the use of single-donor protocol involved the use of units stored for more than 20 days in half of the cases beginning with the third unit used. Six-term newborns were mainly transfused once, which does not seem to warrant the single-donor transfusion protocol. The use of this protocol caused the loss of 50 % of the manufactured units, which go unused. In multivariate analysis, two factors were predictive of multiple transfusion within our population of 95 premature neonates undergoing transfusion: low-term and a high Clinical Risk Index for Babies (CRIB) score. The risk of multiple transfusions would be reduced by about 15 % for each additional week of gestation and approximately 16 % per point within the CRIB score. These variables integrated into a statistical model predict the risk of multiplying transfusions. According to the ROC curve, a calculated risk higher than 50 % is the appropriate cut-off value to transfuse with the single-donor transfusion protocol. This would limit its indications, saving more than 130 pediatric units of blood for 100 transfused children. A prospective study in our department will allow internal validation of this test., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

During Parkinson's disease static contrast sensitivity (C.S.) abnormalities are linked to an impairment of the sensitive visual function. C.S. was tested in twelve parkinsonians and 12 controls without neurological and/or ophthalmological pathology, using a Colored Stripes Electronic Generator (GEPCO). Results for parkinsons showed a general deficiency over the spectrum of spatial frequencies, which was statistically significant and particularly pronounced for intermediate frequencies. This study was repeated for three patients: it showed threshold deterioration for two of them, correlated by evolution in the disease, and an improvement for the third patient after introduction of dopatherapy. C.S. is subjected to dopaminergic control. Among parkinsonians. C.S. deterioration may result in an operating failure of both the visual cortex and retina, and is improved by dopatherapy. The Static Gepco contrast sensitivity test is easy to reproduce and can be used easily to monitor the sensory visual defect in parkinsonian patients under treatment.