[Emergency medical transport of children in the Ile-de-France area].


Pediatric emergency medical service is available since 1976 in France. Presently, 4 such services are available in the Paris area for neonatal and pediatric emergencies. Coordination of these services was established in 1980, to establish a close collaboration between the various medical teams by linking them in a synergic way. This resulted, in 1985, in 6,740 transports of children, 83% of which in an emergency. Neonatal pathology accounted for 70% of the transports and 53% of transported children required assisted ventilation. The importance of these pediatric emergency services, their specificity and their level of technicality suggest that they contributed to the decrease of the pediatric and neonatal morbidity and mortality recorded in the past decade.

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    ABSTRACT: Prenatal events are thought to play an important role in long-term handicap, but the specific role of perinatal factors remains controversial. Our study, conducted in the context of this debate, aimed to break down the various components of perinatal management and to assess the relationship between these components and survival without disability at the age of two years. A prospective geographically-defined study was conducted in 1985 in the Paris metropolitan area. It covered 53430 births (stillbirths and live births), including 539 that occurred between 25 and 32 weeks gestation. The relationship between perinatal management and survival without disability was studied by a multivariate analysis (logistic regression). The analysis was restricted to a group of 202 infants born at 31 or 32 week's gestation, to avoid indication bias. An inborn status (delivery in a tertiary care facility) exerted a protective effect on survival without disability at the age of two years (Adjusted Odds Ratio (OR)=7.51 [1.51; 37.4]), even though the area we studied possessed an excellent Medical Neonatal Transport Service. Multiple pregnancies also seemed to have a protective effect (Adjusted OR=2.45 [0.96; 6.27]). No statistically significant association was seen between survival without disability at two years and the presence of a hospital staff paediatrician in the delivery room. These results lead us to consider what the concept of inborn/outborn represents in the perinatal management of infants at high risk.
    European Journal of Obstetrics & Gynecology and Reproductive Biology 08/1998; 79(1):13-8. DOI:10.1016/S0301-2115(97)00243-1 · 1.70 Impact Factor
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    ABSTRACT: To determine the number and characteristics of inter-hospital transfers of newborn infants in London and the South East of England. Prospective census of neonatal transfers over a three month period. Transfers between the 53 hospitals that provide care for newborn infants within the former Thames regions. Census returns from participating neonatal units. Number, timing, and hours of staff time spent on transfers. Gestation, birth weight, and reason for transfer of the baby. Time elapsed between request and retrieving team departing and arriving with patient. A daily average of 2.7 urgent, 3.5 elective, and 0.7 short term transfers took place during the census period. The most common reason for urgent transfer was neonatal surgery. Neonatal unit staff spent an average of 21 hours a day off their units accompanying transfers each day. It took over four hours for 90% of ambulances to set off with the retrieving team and over six hours for 90% of teams to reach the baby. During the census period, services for the transport of neonates in London and the South East of England involved long delays and used appreciable amounts of staff time. It is likely that a small number of dedicated neonatal transfer teams could meet the needs identified in this census more effectively than the 53 hospitals currently involved.
    Archives of Disease in Childhood - Fetal and Neonatal Edition 12/2004; 89(6):F521-6. DOI:10.1136/adc.2003.029017 · 3.12 Impact Factor
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