Impacts des facteurs maternels sur l’allaitement maternel en réanimation néonatale

ObjectiveAdmission at birth to a Neonatal Intensive Care Unit (NICU) complicates breastfeeding especially for preterm babies despite hospital staff trained to encourage breastfeeding. The aim of this study was to find factors related to the mother, the pregnancy or the neonate influencing breastfeeding rate on a NICU.Patients and methodsThis was a retrospective study including neonatal admissions to the NICU at Antoine-Béclère University Hospital from 1st May 2009 to 30th April 2010. Data was collected from medical notes. The breastfeeding rate (at initiation and at discharge) was analysed with regards to maternal age, method of procreation, type of pregnancy (single or multiple), parity, mode of delivery (vaginal delivery or C-section), birthweight, gestational age and intra-uterine growth restriction (IUGR).ResultsThe study was based on 460 neonates having complete documentation. The average maternal age was 32 years. Premature infants represented 74.8% of the population (median gestational age = 34 weeks) of which 57% were less than 33 weeks (42.6% of all infants, n = 196). The median birthweight was 1900 g with 17.6% of IUGR infants. Breastfeeding rate at initiation was 58.7 and 43.9% at discharge (mean admission days: 17.1 [0–180], median = 8 days). For infants born of multiple pregnancies (24.3% of the population) 51.6% were born of medically assisted pregnancies (MAP) and 17.6% of spontaneous pregnancies. Breastfeeding rate among these infants was 57.1% at initiation and 45.5% at discharge. It was higher in infants born of MAP at initiation (70.3% versus 55.8% for spontaneous pregnancies, P < 0.05) and at discharge (49.5% versus 42.5% for spontaneous pregnancies). For these infants, average maternal age was higher for breastfed infants (33.9 versus 32.1 years for the formula-fed, P < 0.05). Breastfeeding rate in infants born to primipares was higher at initiation (64.9% versus 53.6% for multipares, P < 0.05) and at discharge (48.5% versus 40.8% for multipares, P < 0.05). The rate of infants breastfed was influenced neither by maternal age alone (31.8 ± 5.6 versus 31.4 ± 5.7 years for formula-fed), nor by type of delivery (56.7% for infants born by C-section versus 62.5% for infants born by vaginal delivery), nor gestational age (33.2 ± 4.3 weeks for breastfed, versus 33.4 ± 4.2 weeks for formula-fed infants), nor birthweight (2060 ± 978 g for breastfed versus 2055 ± 909 g for formula-fed infants), nor IUGR (58% versus 58.8% for eutrophes).DiscussionOur maternal population was different as 16.7% of deliveries were accounted for by MAP, superior to the French average (< 10%). We describe for the first time MAP as a positive influencing factor on breastfeeding rates in newborns admitted to a NICU. A better breastfeeding information policy during pregnancy, higher maternal age and increased multiple pregnancies would explain a higher breastfeeding rate among the women who had MAP. An impact of increasing maternal age was found on the rate of breastfed infants born of MAP. Primiparity was also a contributing factor for breastfeeding. Professional formation for all hospital staff concerned would be essential to give out clear and consistent information to families and to encourage support and intimacy throughout hospitalisation as well as at discharge.     

Vécus de familles d’enfants autistes en période de confinement : étude exploratoire

ObjectiveThe lockdown periods associated with the Covid-19 pandemic are a particularly significant challenge for families of children with autism. Exchanges by e-mail and interviews were aimed at collecting testimonies from parents for a better understanding of their difficulties and the help provided by the mobilization of professionals.Methods and resultsEight parents of autistic children living in the Seine-Saint-Denis area agreed to testify about their experience, either in person, taking into account the barrier measures after the first lockdown, or by telephone during the second lockdown. By way of comparison, e-mails were exchanged with a mother and two fathers of autistic children from higher socio-economic backgrounds living in other parts of France or Belgium. While at the beginning of the first lockdown, some children may have felt soothed by being at home with their parents, the extension of the situation led to crises related to feelings of anxiety or boredom. Despite the closure of many medical-social facilities, professionals mobilized to continue helping families and children whose routines were disrupted.ConclusionDepending on the conditions of lockdown, the families’ experiences differed and evolved over time. The major problems encountered by some families were the worsening of their child's troubles (self-harm, tantrums, violence, and shouting). Pedagogical tools were adapted by the teachers, activity sheets were sent out, group workshops were organized, and consultations were given at a distance. The teams of the child psychiatry services and the medico-social services have mobilized themselves and have shown reactivity and inventiveness in order to ensure the care and follow-up of children and their families.     

Effets de l’exposition chronique aux écrans sur le développement cognitif de l’enfant

During the last few years, the time spent in front of various screens, including TV sets, video games, smartphones and computers, has dramatically increased. Numerous studies show, with a remarkable consistency, that this trend has a strong negative influence on the cognitive development of children and teenagers. The affected fields include, in particular, scholastic achievement, language, attention, sleep and aggression. We believe that this often disregarded - not to say denied - problem should now be considered a major public health issue. Primary care physicians should inform parents and children about this issue to support efficient prevention.