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The hospital of Versailles no longer has a dermatologist; consequently the pediatrics department suggested assess to the system put in place in 2015 based on the telemedicine software platform WebDCR developed throughout the hospital. The acceptability of this was based on its implementation as well as speed and ease of use. Methods In 2015, 47 reviews were submitted. Results No patient refusal was noted. The answer was obtained in 100 % of cases on the day the requests were made, during the week. A diagnosis was made in 36 % of cases and one or more hypotheses were formulated in the 64 % of the remaining cases. The review resulted in a further consultation in 28 % of cases, and in one case to transfer to the dermatology department. The quality of the data collected was considered good or excellent in 96 % of cases. Discussion This first teledermatology experiment seems to show its utility in terms of the services provided. Given the successful deployment of the system, it was extended to the pediatric emergency department. The response time was reduced to 1 h. Conclusion This first teledermatology experiment seems to show its real value in terms of services rendered. However, it is necessary to have more experience to confirm the contribution of this tool, and to reassess the sustainability and economic relevance of the device. [ABSTRACT FROM AUTHOR]

Résumé Les objectifs de cet article sont de faire le bilan de la stratégie de cocooning coquelucheuse, recommandée en France depuis 2004 pour protéger le nourrisson non vacciné en vaccinant son entourage proche, et de proposer des pistes d’amélioration. L’analyse de la littérature entre 2004 et 2015 montre que la couverture vaccinale coquelucheuse des nouveaux parents est inférieure à 50 % et que les actions de promotion vaccinale expérimentées sont efficaces. L’amélioration de la couverture vaccinale coquelucheuse demande la collaboration et la formation de tous les acteurs de santé pour informer et motiver les parents à se faire vacciner avant, pendant, et après la grossesse (les parents servant ensuite de relais auprès de leurs proches) ; la généralisation de la vérification systématique à la maternité des carnets de santé ; l’extension aux sages-femmes du droit de prescription et d’administration du vaccin aux conjoints ; la facilitation de la vaccination dans les maternités avec le soutien des organismes de santé. Les échanges et le partage des expériences entre les professionnels de santé sont primordiaux. La grossesse est la période idéale pour promouvoir la vaccination coquelucheuse. The goals of this article are to review the pertussis cocooning strategy, which has been recommended in France since 2004 to protect infants not yet vaccinated from becoming infected by vaccinating their immediate entourage, and to present room for improvement. The analysis of the literature between 2004 and 2015 shows that pertussis vaccine coverage in new parents is lower than 50% and that attempts that have already been implemented to increase it are effective. Pertussis vaccine coverage improvement requires all health actors to collaborate and be trained in informing and motivating parents to get vaccinated before, during and after pregnancy (the parents then will act as relays to their relatives); generalization in maternity wards of systematic checking of the vaccination card; extension to the midwives of the right to prescribe and administer pertussis vaccine to spouses; vaccination facilitation in maternity wards with the support of health organizations. Exchange and sharing of experiences between health care professionals are essential. Pregnancy is the ideal period to promote pertussis vaccination. [ABSTRACT FROM AUTHOR]

Ultrasound plays a key role in prenatal screening for fetal anomalies. Minor anomalies with a good neonatal outcome are identified in 5 to 10% of pregnancies. Even when prenatal diagnostic work up is reassuring, announcing prenatal soft markers may have a substantial psychological impact. Psychodynamic theories hypothesize that the announcement of a fetal anomaly may disrupt the construction of maternal mental representations about the baby and thus impair early interactions. Surveys based on self interviews showed that the announcement of a minor anomaly increases parental anxiety, especially when the outcome is uncertain or when the information is considered unclear by the parents. Clinical studies based on semi-structured interviews showed that the announcement also increases anxiety and depression levels, hampers maternal investment, alters representational pattern and early mother-infant interactions. These phenomena may persist up to 2 months post partum. We discuss guidelines that may reduce the impact of announcing a minor fetal anomaly: 1) training sonographers to announcement; 2) counseling based on medical evidence or expert consensus; 3) identification of families that may benefit from psychological prenatal care during pregnancy and post partum. [ABSTRACT FROM AUTHOR]

Summary: Background: The early vaccination with BCG of children with a high risk of tuberculosis straight from the maternity hospital has been recommended since October 2005. However, this recommendation has not often been followed. Practitioners feared that the suspension of the mandatory character of the BCG vaccine dating from July 2007 would result in a decrease in vaccine coverage. The goal of this study was to assess a program for early vaccination with BCG in the maternity hospital for high-risk children. Methods: Intradermal vaccination with BCG-SSI® of high-risk newborns, as defined by the Conseil Supérieur d’Hygiène Publique de France, at the maternity hospital of Versailles from May 2007 to May 2008. Results: Six hundred and sixty children (35% of births with a sex ratio of 1.13) fulfilled criteria for vaccination in the maternity hospital. Among the high-risk newborns, 596 (89%), were vaccinated. The geographic origin of one or both parents was the main indication (98.6%) for the vaccination. Three main practitioners (two pediatricians and one nurse) performed 72.6% of the BCG intradermal injections. The other BCG vaccinations were given by occasional practitioners: pediatricians, a midwife, or medical students. A papule was subsequently observed more often when the practitioner was experienced: 96.8% for the main practitioners, 83.5% for the occasional practitioners. Fifty-six (8.3%) parents refused vaccination for their eligible newborn. Conclusion: From our experience, the early vaccination of the at-risk of tuberculosis newborn is well accepted in the maternity hospital and presents very few technical problems for an experienced team. [Copyright &y& Elsevier]

Abstract: Objective: To describe the clinical and biological characteristics of children presenting with enteroviral (EV) meningitis in a French paediatric unit during summer 2005. Methods: Retrospective study of children with EV meningitis from May to September 2005, diagnosed by PCR and/or viral culture in cerebrospinal fluid (CSF), serum or throat. Results: We reported 99 cases of EV meningitis (96 confirmed and 3 probable). The sex ratio was 2/1, and the median age was 5 years. Peak incidence was reached during the second week of July. The predominant symptom was meningism. ENT (16%), digestive (10%), cutaneous (15%) or respiratory (4%) symptoms were rare. Blood leucocyte count found a predominance of neutrophils (73%), and lymphopenia in half of the children. The mean value of CRP was 25,5 mg/l. The median leukocyte count in CSF was 65 cells/mm3, with a prevalence of neutrophils in 60% of cases. Pleiocytosis was absent in 20 children. CSF protein level was increased in 20% of cases. The rate of hospitalization was 57,5%. Intravenous antibiotic treatment, initiated among 18 patients, was stopped in 66,6% of the cases on reception of PCR result. The latter result was obtained in 2,3 days on average. Conclusion: The epidemic of 2005 EV meningitis was as widespread as that of summer 2000. Characteristics of these meningitis are strong proportion of CSF without pleiocytose and high prevalence of neutrophils in blood and CSF. [Copyright &y& Elsevier]

Abstract: During April 2006, 579 physicians took part in a survey about intradermal BCG SSI® adverse events (AE) in children less than 6 years old, managed by InfoVac France. Since January 2006, 68% physicians (paediatricians: 73% and general practitioners [GP]: 60%) have vaccinated at least one child. The site of injection is mainly the extern side of the shoulder (72%), according to the recommendations. Systematic vaccination is continued by 54% GP and 26% paediatricians. Others indications are: admission in day care center (33%), admission in day care center associated with risk factors (24%), or only risks factors (8%). Half physicians observed AE and 6% of them reported them at pharmacovigilance centers or pharmaceutical company. AE were mainly inflammations or indurations over 1 cm (for 75% of physicians who observed AE), oozing (73%). Abscesses are notified by 54%, ulcers by 39%, lymphadenopathies over 1 cm by 20%, suppurative lymphadenopathies by 3% and keloid scares by 17% of them, several AE may coexist for some children. Our aim is to start a prospective follow-up of BCG-SSI® vaccination and its AE; 58% physicians who answered this investigation agreed to participate. [Copyright &y& Elsevier]

In the first trimester, ultrasound is crucial to screen for aneuploidies based on nuchal translucency, to diagnose major birth defects, and to establish chorionicity. Indeed prenatal diagnosis strategies as well as obstetrical management options are largely based on placental type. In the second trimester, maternal serum screening is not as effective, and ultrasound screening is more difficult in twins than in singletons. When a severe abnormality in found in one twin, selective termination of pregnancy may be considered. This technique is safe in dichorionic twins, but hazardous in monochorionic pregnancies. Selective termination in dichorionic twins is safer in the first trimester, underscoring the need for early prenatal diagnosis in twins. Monochorionic twin pregnancies carry specific risks, such as the twin-to-twin transfusion syndrome, which can be treated by endoscopic photo-coagulation of intertwin anastomoses in the severe early onset cases, or by amnioreduction in milder cases. [Copyright &y& Elsevier]

Previous studies in a mouse model of neonatal excitotoxic brain damage mimicking the brain lesions in human cerebral palsy showed microglial activation within 24 h after intracerebral injection of the glutamatergic analog ibotenate. Using this model, we studied the expression of CD-45 antigen, a marker of blood-derived cells, by these activated microglial cells labeled by Griffonia simplicifolia I isolectin B4. Immunohistochemistry performed during early development of excitotoxic lesions showed that most cells labeled with the isolectin B4 were CD-45-negative, suggesting that these early activated microglial cells were deriving chiefly from resident microglia and not from circulating monocytes. We also directly tested the hypothesis that activated resident microglia and/or blood-derived monocytes play a role in the pathophysiology of excitotoxic brain damage. Repeated i.p. administrations of chloroquine, chloroquine+colchicine, minocycline, or an anti-MAC1 antibody coupled to the toxin saporin before and/or after ibotenate injection induced a significant reduction in the density of isolectin B4-positive cells. This inhibition of resident microglial and/or blood-derived monocytes activation was accompanied by a significant reduction in the severity of ibotenate-induced brain lesions (up to 79% lesion size reduction with the highest minocycline dose) as well as of ibotenate-induced cortical caspase-3 activation (49% reduction). [Copyright &y& Elsevier]

Tianeptine is an antidepressant with proven clinical efficacy and effects on hippocampal plasticity. Hypoxia increased lactate dehydrogenase (LDH) release from cortical neuronal cultures, and tianeptine (1, 10 and 100 μM) inhibited LDH release as efficiently as the N-methyl-d-aspartate (NMDA) antagonist, MK-801. However, tianeptine did not block apoptosis in cultured cortical neurones caused by NMDA, but reduced apoptosis when interleukin-1β (IL-1β) was included with NMDA. In 5-day old mice, intracerebral injection of ibotenate induced reproducible lesions in cortex and white matter. Lesion size was markedly reduced by co-administration of MK-801 (1 mg/kg i.p.) but neither by tianeptine or its enantiomers administered acutely (1, 3 or 10 mg/kg i.p.) nor by tianeptine administered chronically (10 mg/kg i.p. for 5 days). Chronic administration of IL-1β (10 ng/kg i.p. for 5 days) prior to ibotenate injection exacerbated lesion size in cortex and white matter, and this exacerbation was prevented by chronic pre-treatment with tianeptine (10 mg/kg i.p.) or by acute administration of tianeptine (10 mg/kg i.p.) concomitantly with ibotenate. Thus tianeptine has neuroprotective effects against hypoxia in tissue culture and against the deleterious effects of cytokines in cortex and white matter, but not against NMDA receptor-mediated excitotoxicity. [Copyright &y& Elsevier]

Abstract Objectives To compare nuchal translucency and second-trimester maternal serum measurements as alternative methods of antenatal screening for Down syndrome in a low-risk population and to evaluate the consequence of combining the results in the estimation of risk. Design In a consecutive series of 4130 women aged less than 38 years with a singleton pregnancy, we examined both the detection rate of Down syndrome by nuchal translucency measurement at 10–14 weeks and maternal serum screening by human chorionic gonadotrophin and alpha-fetoprotein at 14–18 weeks. Women with a nuchal translucency measurement of ≥ 3 mm and women with a maternal serum screening-derived risk ≥ 1/250 were recommended to have amniocentesis. A second-trimester detailed ultrasound scan was also performed in all women. The outcome of all pregnancies was recorded prospectively and the detection rate and false-positive rate of different screening strategies were retrospectively analyzed. Results Out of the 4130 pregnancies that were followed (mean maternal age, 30.1 years), 12 cases of Down syndrome were observed (0.28%), all detected prenatally. Seven of 12 cases had a nuchal translucency measurement of ≥ 3 mm (58%), and six out of 10 cases with available maternal serum screening had a calculated risk of ≥ 1/250 (60%). Four of the five Down syndrome cases with a nuchal translucency measurement of < 3 mm were detected by subsequent maternal serum screening. At a threshold giving 5% of positive tests, the sensitivity of nuchal translucency, maternal serum screening and combined risk screening were 75%, 60% and 90%, respectively. Conclusions In screening for Down syndrome, an approach which combines the results from first-trimester nuchal translucency and second-trimester biochemistry is effective and increases the detection rate compared to the use of any single test. However, this strategy is likely to raise the false-positive rate and the interpretation of maternal serum screening-derived risk should be combined with the first-trimester nuchal translucency measurement. [ABSTRACT FROM AUTHOR]

We report a case of congenital dyserythropoietic anaemia, type I, with severe pre- and postnatal manifestations. Exchange transfusions were required for fetal anaemia (3·5 g/dl) at 28 and 30 weeks of gestation. Transfusions were administered at birth (Caesarean section at week 35) and at regular intervals thereafter. At 14 months, α-interferon therapy was initiated (106 units three times a week). This resulted in stabilization of the haemoglobin at or above 11 g/dl and a reduction in the percentage of erythroblasts with ultrastructurally abnormal heterochromatin. After 9 months, the dose of α-interferon was decreased to 106 units twice a week. No relapse of anaemia was noted during an additional 4 months of follow-up. [ABSTRACT FROM AUTHOR]

Résumé La conférence a parmi ses fonctions, la promotion d’une politique d’assurance de qualité des examens d’échographie obstétricale et fœtale en participant à l’élaboration d’une stratégie d’information des professionnels et du public sur l’intérêt et les limites de ces techniques et à l’élaboration de règles de bonnes pratiques. Elle a donc produit, en 2005, un rapport de recommandations de bonnes pratiques concernant la réalisation des échographies, dites de dépistage, réactualisé en 2015, et a publié en 2014 l’équivalent concernant l’échographie, dite de diagnostic. La conférence complète ces recommandations en caractérisant le troisième type d’échographie dite focalisée, outil quotidien de chaque praticien de l’obstétrique. The conference has among its functions, to promote a quality assurance policy for obstetrics and foetal ultrasound scans by participating in the development of an information strategy for the professionals and the public on the interest and limits of these techniques, and in the development of rules for good practice. Thus, the conference produced in 2005 a good practice's recommendations report concerning the screening of ultrasound scans, with an actualised version in 2015, and has published in 2014 a similar report concerning second line prenatal ultrasound. The conference complements these recommendations by characterizing the third type of ultrasound scan, the “focused ultrasound scan”, which is a daily tool for every practitioner in obstetrics. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 24-year-old woman who was diagnosed with brachytelephalangic chondrodysplasia punctata (CDP). It mentions that the patient has no history of alcohol exposure and drugs and teratogens such as warfarin and hydantoin. It was found out that CDP was associated with polyhydraminos and a normal cervical spinal canal. Hence, a fetal magnetic resonance imaging was conducted to make the cervical spinal cord normal. Other forms of CDP is also discussed.

OC05.07: Transvaginal ultrasound probes are human papillomavirus-free following low-level disinfection: a survey of 667 observations To assess the risk of high risk human papillomavirus (hrHPV) contamination of transvaginal ultrasound (TVUS) probes following low level disinfection (LLD). Before each TVUS, and following LLD, we sampled the keyboard, the naked probe, and the sheathed probe for hrHPV DNA detection (Cobas® 4800 Roche, Alameda, CA, USA). [Extracted from the article]

La plupart des infections ostéo-articulaires (IOA) surviennent par voie hématogène, touchent les enfants de moins de 5 ans et comprennent l'ostéomyélite, l'arthrite septique, l'ostéo-athite et la spondylodiscite. Un diagnostic précoce et un traitement rapide sont nécessaires pour éviter les complications. Les enfants chez lesquels on suspecte une IOA doivent être hospitalisés dès le début du traitement. Le drainage chirurgical est indiqué chez les patients souffrant d'arthrite septique ou d'abcès périostique. Staphylococcus aureus est impliqué dans l'IOA chez les enfants de tous âges ; Kingella kingae est un agent pathogène très commun chez les enfants de 6 mois à 4 ans. Le Groupe français d'infectiologie pédiatrique recommande une antibiothérapie empirique avec une couverture appropriée contre les S. aureus sensibles à la méthicilline. S. aureus (MSSA) avec de fortes doses (150 mg/kg/j) de céfazoline intraveineuse. Chez la plupart des enfants présentant une IOA non compliquée présentant une évolution favorable (disparition de la fièvre et de la douleur), une antibiothérapie intraveineuse courte pendant 3 j peut être suivie d'un traitement oral. En l'absence d'identification bactériologique, le relais oral se fait avec l'association amoxicilline/clavulanate (80 mg/kg/j d'amoxicilline) ou la céfalexine (150 mg/kg/j). Si l'espèce bactérienne est identifiée, l'antibiothérapie sera adaptée à la sensibilité aux antibiotiques. La durée totale minimale de l'antibiothérapie doit être de 14 j pour les arthrites septiques, de 3 semaines pour les ostéomyélites et de 4 à 6 semaines pour les ostéoarthrites du bassin, les spondylodiscites et les ostéoarthrites plus sévères, ainsi que celles qui évoluent lentement sous traitement ou qui présentent une pathologie sous-jacente (nouveau-né, nourrisson de moins de 3 mois, patients immunodéprimés). Le traitement de la spondylodiscite et de l'IOA sévère nécessite un avis orthopédique systématique. Most osteoarticular infections (OAI) occur via the hematogenous route, affect children under 5 years of age old, and include osteomyelitis, septic arthritis, osteoarthritis and spondylodiscitis. Early diagnosis and prompt treatment are needed to avoid complications. Children with suspected OAI should be hospitalized at the start of therapy. Surgical drainage is indicated in patients with septic arthritis or periosteal abscess. Staphylococcus aureus is implicated in OAI in children at all ages; Kingella kingae is a very common causative pathogen in children from 6 months to 4 years old. The French Pediatric Infectious Disease Group recommends empirical antibiotic therapy with appropriate coverage against methicillin-sensitive S. aureus (MSSA) with high doses (150 mg/kg/d) of intravenous cefazolin. In most children presenting uncomplicated OAI with favorable outcome (disappearance of fever and pain), short intravenous antibiotic therapy during 3 days can be followed by oral therapy. In the absence of bacteriological identification, oral relay is carried out with the amoxicillin/clavulanate combination (80 mg/kg/d of amoxicillin) or cefalexin (150 mg/kg/d). If the bacterial species is identified, antibiotic therapy will be adapted to antibiotic susceptibility. The minimum total duration of antibiotic therapy should be 14 days for septic arthritis, 3 weeks for osteomyelitis and 4–6 weeks for OAI of the pelvis, spondylodiscitis and more severe OAI, and those evolving slowly under treatment or with an underlying medical condition (neonate, infant under 3 months of old, immunocompromised patients). Treatment of spondylodiscitis and severe OAI requires systematic orthopedic advice. [ABSTRACT FROM AUTHOR]

Summary: In 2008 and 2010, the Comité technique des vaccinations and the Haut Conseil de Santé Publique have not recommended generalized vaccination against rotavirus (RV) in France. The Groupe de Pathologie Infectieuse Pédiatrique (GPIP) and the Association Française de Pédiatrie Ambulatoire (AFPA) believes that it is time to reconsider the recommendation. Indeed, on the one hand, answers were made on the presence of circovirus in vaccines and the risk of intussusception, on the other hand, these vaccines are already implemented in vaccination programs in many developing countries or countries with income intermediate and high. Finally, independent studies have demonstrated the effectiveness in countries with widespread vaccinations (without significant genotypic changes of circulating strains). In addition, implementation would have a major impact on our health care system, changes of the epidemic curve of RV infections (delayed and shortened) to prevent the coexistence of different epidemics occurring during the fall and winter. Remains medico-economic evaluation, which is not of the competence and the responsibility of GPIP and AFPA. However, it seems surprising that developing or middle-income countries have been able to generalize this vaccination and that France can’t do it. [Copyright &y& Elsevier]

Summary: The diversity and antigenic variability of Neisseria meningitidis serogroup B strains around the world has been a major challenge to developing a vaccine with broad coverage. Outer-membrane vesicle vaccines appear to be safe and effective but are strainspecific vaccines and used in delimited areas. Also, recombinant protein vaccines such as factor H binding protein, given alone or in combination with others antigens have been developed and may be effective against the majority of group B strains. [Copyright &y& Elsevier]

An abstract of the article "Second and third trimester termination of pregnancy for fetal anomaly: impact of a previous Caesarean section on maternal morbidity," by M. Driessen and colleagues is presented.

Résumé: Les parechovirus (HPeV), comme les entérovirus (HEV), peuvent être responsables de manifestations cliniques allant d’une fièvre non spécifique à des infections du système nerveux central, les nouveau-nés étant les plus à risque d’infections graves. Pourtant, la recherche du génome des HPeV n’est pas encore réalisée de façon courante dans les laboratoires de virologie clinique. Objectifs: Préciser les caractéristiques cliniques et épidémiologiques des infections à HPeV au centre hospitalier de Versailles. Méthodes: La recherche du génome des HPeV a été réalisée rétrospectivement par reverse transcription polymerase chain reaction (RT-PCR) dans 380 liquides céphalorachidiens (LCR) de patients, dont 256 enfants, ayant présenté une suspicion d’infection neuroméningée entre le 1er janvier 2007 et le 31 août 2011. L’identification des HPeV a été réalisée par génotypage. Résultats: Le génome des HPeV a été détecté dans le LCR de 9 (2,4 %) enfants âgés de moins de 2ans (médiane=30j, extrêmes : 8 j – 18 mois). Les signes cliniques les plus fréquemment observés étaient la fièvre (100 %) et une irritabilité (8/9, 89 %). Les analyses cytologiques et biochimiques du LCR étaient normales. Il s’agissait du type 3 pour les 6 enfants pour lesquels le génotypage a été possible. Conclusion: Cette étude montre l’intérêt de la recherche du génome des HPeV dans le LCR des enfants de moins de 2ans présentant une suspicion d’infection neuroméningée. L’introduction du diagnostic rapide des infections à HPeV permet d’augmenter le champ diagnostique des causes d’infections neuroméningées chez le jeune enfant et d’améliorer ainsi leur prise en charge. [ABSTRACT FROM AUTHOR]

Objective: To determine the accuracy and precision of prenatal three-dimensional (3D) ultrasound in estimating fetal lung volume using the rotational multiplanar technique (VOCAL) by comparing it to postmortem volume measurements. Methods: Fetal lung volume was measured during 3D ultrasound examination using a rotational multiplanar technique in eight cases of congenital diaphragmatic hernia (CDH) (six left and two right-sided) and in 25 controls without pulmonary malformation, immediately before termination. Prenatal 3D sonographic estimates of fetal lung volume were compared with postmortem measurement of fetal lung volume achieved by water displacement. Results: The intraclass correlation coefficient of fetal lung volume estimated by 3D ultrasound and measured at postmortem examination was 0.95 in CDH cases and 0.99 in controls. Based on Bland-Altman analysis, the bias, precision and limits of agreement were, respectively, 0.35 cm(3), 1.46 cm(3) and between -2.51 and + 3.21 cm(3) in cases with CDH and 0.08 cm(3), 2.80 cm(3) and between -5.41 and + 5.57 cm(3) in controls. The mean relative error of 3D ultrasound fetal lung volume measurement was -7.19% (from -42.70% to + 18.11%) in CDH cases and -0.72% (from -30.25% to + 19.22%) in controls, while the mean absolute error of 3D ultrasound fetal lung volume measurement was 1.40 (range, 0.71-2.52) cm(3) and 2.12 (range, 0.05-4.98) cm(3), respectively. Accuracy of 3D ultrasound for measuring fetal lung volumes was 84.86 (range, 57.30-99.48)% in cases with CDH and 91.38 (range, 69.75-99.45)% in controls. The mean intraobserver variability for lung volume estimated by 3D ultrasound was 0.28 cm(3) in controls and 0.17 cm(3) in CDH cases. Conclusion: Prenatal 3D ultrasound can estimate accurately fetal lung volume using the rotational multiplanar technique for volume measurements (VOCAL), even in fetuses with very small lungs, such as cases with isolated CDH. [ABSTRACT FROM AUTHOR]

Objective: To identify risk factors for early‐ and late‐onset postpartum depression (PPD) among a wide range of variables, including sociodemographic characteristics, childhood trauma, stressful life events during pregnancy and history of personal and family psychiatric disorders, and to assess the contribution of each risk factor. Design: Nested case–control study in a prospective longitudinal cohort study. Setting: Eight maternity departments in the Paris metropolitan area, France. Sample: A cohort of 3310 women with deliveries between November 2011 and June 2016. Methods: Cases were women with early‐ or late‐onset PPD. Controls were women without depression during pregnancy or the postpartum period. Logistic regression adjusted on sociodemographic variables was performed for each outcome and a multivariable model was proposed based on a stepwise selection procedure. Main outcome measures: Early‐ and late‐onset PPD assessed at 2 months and 1 year postpartum, respectively. Results: Stressful life events during pregnancy have a dose–response relationship with both early‐ and late‐onset PPD. Conclusions: Early‐ and late‐onset PPD presented distinct patterns of determinants. These results have important consequences in terms of prevention and specific care. Early‐ and late‐onset postpartum depression are associated with stressful life events and psychiatric history. Early‐ and late‐onset postpartum depression are associated with stressful life events and psychiatric history. [ABSTRACT FROM AUTHOR]

Although it is established that bronchopulmonary sequestration complicated by fetal hydrops carries a high risk of perinatal mortality, prenatal management remains controversial. Therapeutic options include immediate delivery, medical therapy based on an inotropic regimen, alcohol ablation of the vascular pedicle, open fetal surgery, or thoracoamniotic shunting of fetal pleural effusions. We report a case of pulmonary sequestration with hydrothorax and fetal hydrops which was successfully treated by a single fetal thoracoamniotic catheter drainage. Following emergency catheter placement, hydrothorax and hydrops decreased dramatically. The sequestration gradually disappeared postnatally, and long-term outcome remained normal without any postnatal therapy. Based on this observation, the natural history of pulmonary sequestration and prenatal management options are reviewed. [ABSTRACT FROM AUTHOR]

Objectives: To assess the frequency of detection of high-risk human papillomavirus (hrHPV) on transvaginal ultrasound (TVS) probes and keyboards and evaluate operator compliance with national recommendations for prevention of cross-infection during TVS.Methods: This was a multicenter observational survey involving 46 public and private centers, in the Paris region of France, in which at least five consecutive TVS examinations were performed per day. We audited 676 TVS procedures. We recorded preventive hygiene actions undertaken by the operator at three stages: (1) during TVS; (2) during probe disinfection; and (3) during preparation of the probe for the next TVS. After probe disinfection, we collected one sample from the bare probe and one from the ultrasound keyboard; following probe preparation for the next examination, an additional sample was obtained from the covered probe. The samples were tested for presence of hrHPV DNA using the Cobas® 4800 System.Results: We did not detect hrHPV DNA in samples collected from uncovered or covered probes (0%; 95% CI, 0.00-0.55%). Keyboard samples were positive for hrHPV in two cases (0.3%; 95% CI, 0.04-1.07%). During TVS, the operator avoided touching the keyboard with a hand that had touched the patient's vulva in 86% of cases and held the probe with a gloved hand in 68%. Before probe disinfection, the operator wore new gloves, or performed hand disinfection in 8% of cases. The probe disinfection technique used was adequate in 87% of cases, not performed at all in 12% and insufficient in 1%. Before preparing the probe for the next scan, the operators disinfected their hands or used new gloves in 81% of cases. The probe cover and the coupling gel used complied with recommendations in 98% and 46% of cases, respectively. Of the seven preventive hygiene actions recommended in national guidelines, all were performed in 2%, three to six in 95% and two in 3% of observations. In four (9%) centers, disinfection was not performed in over half the observations.Conclusions: No evidence of hrHPV DNA was found on TVS probes and probe covers following low-level disinfection, despite suboptimal compliance with hygiene guidelines. Routine TVS practice could be made easier and safer with a global approach to probe disinfection and hand hygiene. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Study Question: How efficacious is transplantation of ovarian cortex previously exposed to chemotherapy?Summary Answer: Prior exposure to chemotherapy did not disrupt the function of cryopreserved ovarian tissue after transplantation.What Is Known Already: Ovarian tissue cryopreservation (OTC) followed by ovarian tissue transplantation (OTT) is an efficacious technique for restoration of female fertility. At least 130 children have been born following this procedure. To date, little is known about the efficacy of OTT in patients exposed to cancer chemotherapy prior to OTC.Study Design, Size, Duration: This study evaluates the recovery of ovarian function and fertility in 31 consecutive patients who had received OTT, between 2005 and 2015.Participants/materials, Setting, Methods: Thirty one patients, wanting children, were transplanted with autologous ovarian cortex, among which 22 patients (71%) had been exposed to chemotherapy before OTC. Recovery of ovarian function was considered total once menstruation occurred. Ovarian function recovery (OFR), ovarian graft survival, and incidence of pregnancy were related to previous chemotherapy exposure, type of chemotherapy and graft characteristics (number of grafted fragments and follicular density).Main Results and Role Of Chance: The amount of ovarian tissue collected was the only parameter to show any significant change between patients with versus without previous chemotherapy. At 1 year after OTT, the cumulative incidence of OFR was 83% (93% in patients exposed to chemotherapy and 67% in others (P = 0.14)). A low follicular density (<0.3 foll/mm2) in the transplant and a low number of grafted fragments (<16) were significantly associated with a delayed OFR. Graft survival at 2 years after OTT was 77%. It was significantly lower in patients exposed to bifunctional alkylating agents before ovarian cryopreservation and in patients with a low follicular density. The proportion of women who succeeded in having at least one live birth was 23% in the total population, 0% (0/9) in the group 'no previous chemotherapy', and 32% (7/22) in the group 'previous chemotherapy'. The cumulative incidence of pregnancy (Kaplan-Meier) at 3 years after OTT was 36% overall and 49% in case of previous chemotherapy, with no difference related to previous chemotherapy exposure. In total there were 13 pregnancies and 8 births in 7 patients.Limitations, Reasons For Caution: The pathology in the two groups of patients was not comparable. In the group of patients who had chemotherapy before OTC, there were 95% of hematological malignancies. In the group of patients who did not have chemotherapy before OTC only 1 out of 9 patients had a malignant hematological disease while 44% had some pathology affecting the ovaries. Few women are available for study and only large changes are likely to have statistical significance.Wider Implications Of the Findings: These results suggest that prior cancer chemotherapy should no longer be considered a limitation to cryopreservation of ovarian tissue and current recommendations in this regard should be revised.Study Funding/competing Interest(s): This study was supported by the Agence de la Biomédecine (France's biomedical office). There are no competing interests to report.Trial Registration Number: NCT02184806. [ABSTRACT FROM AUTHOR]

Abstract Lyme neuroborreliosis is a bacterial infection caused by the dissemination and proliferation of a Borrelia species in the central nervous system. Neuroborreliosis occurs after transmission of the pathogen from an infected tick to a human host during a tick bite. We report nine cases of pediatric neuroborreliosis collected by the National Observatory of Pediatric Bacterial Meningitis in France between 2001 and 2012. The nine children, aged 4–13 years, were identified in northern and eastern France and had the following clinical features: meningeal irritation alone or with facial palsy, or isolated facial palsy. All cases showed anti- Borrelia antibodies in cerebrospinal fluid or serum, or with a positive Borrelia PCR in the CSF. The outcome was favorable in all cases after a 2- to 3-week course of third-generation cephalosporin. On the basis of these nine pediatric cases, this study provides an update on the epidemiology, pathophysiology, diagnostic strategy, and treatment of neuroborreliosis, with insight into the specific features of pediatric neuroborreliosis and the difficulties encountered in the diagnosis of this infection. [ABSTRACT FROM AUTHOR]

Résumé Les crises fébriles (CF) concernent 2 à 5 % des enfants de moins de 5 ans et sont la cause la plus fréquente de crise épileptique chez l’enfant. Il s’agit donc d’une situation fréquente en pratique clinique. Les connaissances et les recommandations ont évolué aux cours des vingt dernières années. Cinq critères sont enseignés et utilisés en pratique courante pour classer les CF en CF simples et complexes. Il semble toutefois que l’ambiguïté de certains critères rende inopérante leur utilisation en pratique, en particulier pour l’indication d’une ponction lombaire. De plus, les études épidémiologiques ont montré que les critères prédictifs de récidive des CF étaient différents de ceux associés à un risque d’épilepsie, augmentant la confusion sur le rôle de chacun de ces critères. C’est dans ce contexte qu’un groupe de travail s’est mis en place pour essayer de formuler des réponses à trois questions cliniques se posant face à un enfant ayant présenté une CF : quand réaliser une ponction lombaire, faut-il prescrire un traitement antiépileptique d’urgence en cas de récidive se prolongeant, chez quel enfant demander un avis neurologique (risque d’épilepsie) ? Un travail de bibliographie a été réalisé suivi d’une journée de travail de discussion et de synthèse des données disponibles. Nous présentons dans cette étude les données de la littérature ainsi que les conclusions des experts. Febrile seizures (FS) are the most common seizures seen in the paediatric population in the out-of-hospital and emergency department settings, and they account for the majority of seizures seen in children younger than 5 years old. An FS is a seizure accompanied by fever, without central nervous system infection, occurring in children between 6 months and 5 years old. Five criteria have been used and taught to classify any FS as simple or complex FS. These factors do not bear the same significance for clinical practice, in particular, the decision to perform a lumbar puncture for cerebrospinal fluid analysis to rule out an intracranial infection. Moreover, epidemiological studies have illustrated that some factors are predictive of febrile seizure recurrence while others are predictive of epilepsy occurrence. On this basis, a workshop was organized to provide an answer to three clinical practice questions: when should a lumbar puncture be performed in a child who has experienced a seizure during a fever episode, is the prescription of a rescue drug required with a risk of a prolonged febrile seizure recurrence, when should a neurological consultation be requested (risk of later epilepsy)? Based on a review of the literature and on a 1-day workshop, we report here the conclusion of the working group. A lumbar puncture is required in any child with meningitis symptoms or septic signs or behaviour disturbance. A lumbar puncture should be discussed based on the clinical symptoms and their progression over time when a child has experienced a focal FS or repetitive FSs without signs of meningitis or sepsis or behaviour disturbance. The lumbar puncture is not necessary in case of simple FS without signs of meningitis, including in infants between 6 and 12 months old. An early clinical evaluation (at least 4 h after the first clinical assessment) could be helpful, in particular in infants younger than 12 months of age. A rescue drug might be prescribed when there is a high risk of prolonged FS (i.e., risk higher than 20%): age at FS < 12 months OR a history of a previous febrile status epilepticus OR if the first FS was a focal seizure OR abnormal development/neurological exam/MRI OR a family history of nonfebrile seizure. A neurological consultation should be requested for any child who has experienced a prolonged FS before the age of 1 year, for children who have experienced prolonged and focal FS or repetitive (within 24 h) focal FS, for children who have experienced multiple complex (focal or prolonged or repetitive) FS, for children with an abnormal neurological exam or abnormal development experiencing a FS. Although childhood febrile seizures in most cases are benign, witnessing such seizures is always a terrifying experience for the child's parents. Most parents feel that their child is dying or could have severe brain injury related to the episode. Therefore, the group also suggests a post-FS visit with the primary care physician. [ABSTRACT FROM AUTHOR]

An abstract of the article "Does underestimating nuchal translucency measurement impact sensitivity of Down's syndrome screening?" by N. Fries and others is presented.

A 3-year multicenter prospective French study revealed that the frequency of community-acquired pneumonia in children, especially that complicated by pleural effusion and pneumococcal pneumonia, has significantly decreased since the switch from 7-valent to 13-valent pneumococcal conjugate vaccine in young children.Background. Pneumococcal serotypes 1, 3, 5, 7F, and 19A were the most implicated in community-acquired pneumonia (CAP) after implementation of 7-valent pneumococcal conjugate vaccine (PCV7). In France, the switch from PCV7 to 13-valent pneumococcal conjugate vaccine (PCV13) occurred in June 2010. An active surveillance network was set up to analyze the impact of PCV13 on CAP.Methods. An observational prospective study performed in 8 pediatric emergency departments from June 2009 to May 2012 included all children between 1 month and 15 years of age with chest radiography–confirmed pneumonia. Three 1-year periods were defined: pre-PCV13, transitional, and post-PCV13.Results. During the 3-year study period, among the 953 274 pediatric emergency visits, 5645 children with CAP were included. CAP with pleural effusion and documented pneumococcal CAP were diagnosed in 365 and 136 patients, respectively. Despite an increase (4.5%) in number of pediatric emergency visits, cases of CAP decreased by 16% (2060 to 1725) between pre- and post-PCV13 periods. The decrease reached 32% in infants in the same periods (757 to 516; P < .001). Between pre- and post-PCV13 periods, the proportion of CAP patients with a C-reactive protein level >120 mg/dL decreased from 41.3% to 29.7% (P < .001), the number of pleural effusion cases decreased by 53% (167 to 79; P < .001) and the number of pneumococcal CAP cases decreased by 63% (64 to 24; P = .002). The number of additional PCV13 serotypes identified decreased by 74% (27 to 7).Conclusions. Our data suggest a strong impact of PCV13 on CAP, pleural effusion, and documented pneumococcal pneumonia, particularly cases due to PCV13 serotypes. [ABSTRACT FROM AUTHOR]

Résumé: Le diagnostic des méningites à entérovirus (EV) repose actuellement sur la réaction de polymérisation en chaîne (PCR) dans le liquide céphalorachidien (LCR). L’objectif de cette étude était d’étudier la corrélation entre les PCR EV dans le sérum et le LCR. La PCR EV a été réalisée dans le LCR et le sérum, prélevés au même moment, chez tous les enfants ayant eu une ponction lombaire (PL) pour suspicion de méningite entre le 1er juin et le 31 juillet 2010. Quarante-quatre enfants ont été inclus et une infection à EV a été documentée chez 22 d’entre eux. Le génome a été détecté uniquement dans le LCR chez 10 enfants, dans le sérum chez 3 et dans les deux chez 9. Les enfants virémiques étaient significativement plus jeunes (1,6 mois versus 5,8ans, p <0,001). Cette virémie était précoce et transitoire, détectée uniquement lorsque le sérum avait été prélevé moins de 30h après le début des symptômes. Si elle avait été connue en temps réel, elle aurait pu permettre d’éviter la PL chez 5 enfants parmi les 44 suspects (11,4 %). Cette étude préliminaire souligne l’intérêt et les limites de la PCR EV dans le sérum. Positive, elle ne permettrait d’éviter qu’un nombre limité de PL sous certaines conditions : âge supérieur à 3 mois, signes cliniques et biologiques compatibles avec une infection virale, délai entre le début des symptômes et le prélèvement sanguin inférieur à 30h, absence d’antibiothérapie préalable, résultat rendu en 3h. [ABSTRACT FROM AUTHOR]

Résumé: Chaque année, la National Foundation for Infectious Diseases (NFID - Fondation américaine pour les maladies infectieuses) rassemble plus de 300 personnes pour faire le point des dernières avancées scientifiques dans le domaine des vaccins et identifier les nouvelles voies de recherche les plus prometteuses. Ces conférences figurent parmi les plus importantes réunions scientifiques entièrement dédiées à la recherche sur les vaccins, que ce soit dans le secteur de la santé humaine ou dans le secteur de la santé animale. Lors de la 15e conférence, qui s’est tenue à Baltimore en mai 2012, se sont succédé conférences plénières par des experts invités de renommée internationale, sessions parallèles, présentations de posters et rencontres entre experts et jeunes chercheurs. Différents thèmes ont été abordés, allant des fondements de la vaccination, de l’exploration de la réponse immunitaire et de la conception de nouveaux vaccins et adjuvants jusqu’à l’évaluation de l’impact sur le terrain des vaccins nouvellement introduits (rotavirus, HPV) et de la sécurité des vaccins, en passant par les stratégies de vaccination, notamment dans les pays en développement. Les nouvelles techniques de la vaccinologie systémique permettant l’étude de la réponse immunitaire dans son ensemble ouvrent de nouvelles pistes pour établir des corrélats de protection, et concevoir de nouveaux vaccins, notamment contre les maladies chroniques, comme le sida ou le paludisme, pour lesquelles l’immunité naturelle est imparfaite. [ABSTRACT FROM AUTHOR]

Summary: Children empyema pose therapeutic problems for reasons that are not clearly established. The pneumococcus is by far the bacteria most often responsible. There is no clinical study demonstrating the superiority of an antibiotic regimen over another. Even though these studies exist, they would be challenged by the evolution of bacterial resistance that may vary depending on different parameters: antibiotic pressure, vaccination etc. Therefore, it is on the microorganism suspected, the data of bacterial resistance and pharmacokineticspharmacodynamic (Pk / Pd) parameters that lead to antibiotic choice. An analysis of these elements can lead to the following proposals. For pneumococcal empyema, intraveinous 3rd generation cephalosporin at dose of 100mg/kg/day divided 4 injections IV for cefotaxime or 50mg/kg/day in once a day for ceftriaxone. These doses are likely to be doubled in case of pneumococcus resistant to penicillin. Neither fosfomycine or aminoglycosides have a sufficient activity against pneumococcus to be offered in combination. If an association seems useful, the two best candidates are vancomycin and rifampin. For group A streptococcus empyema, clindamycin in association with is certainly the best choice. The recent evolution of resistance to macrolides should lead to check the susceptibility of the bacteria implicated. If S. aureus is susceptible to meticilline (most often), a M penicillin by parenteral route associated with an aminoglycoside is proposed. Fosfomycine can be an alternative to the aminoglycoside. If S. aureus is meticilline resistant, the association vancomycin and rifampicin seems best suited. When no bacteria has been isolated, the choice against pneumococcus resistant seems most appropriate. [Copyright &y& Elsevier]

Summary: Schizophrenic women can now complete a pregnancy successfully, mostly due to psychiatric stabilization obtained with neuroleptic treatment. Side effects of classic neuroleptics are largely described in adults. On the other hand, effects of atypical neuroleptics, which are indicated when there is chronic severe schizophrenia with resistance or major intolerance to classic neuroleptics, are little known in newborn infants. We report the case of a hypertrophic full-term newborn whose mother received clozapine treatment alone with decreasing posology during the course of pregnancy. On his 2nd day of life, this newborn infant presented delayed peristalsis that required hospitalization in the digestive surgery department for more than 2 weeks. We assume that the anti-cholinergic effect of this molecule associated with a substantial plasmatic concentration and a possible increased half-life elimination were involved. Neonatal delayed peristalsis associated with clozapine treatment alone during pregnancy is poorly described in the medical literature. We only found one report on plasmatic concentrations of clozapine and its metabolite in a newborn, published in 1994. Close digestive monitoring is needed in the first days of life after in-utero exposure to clozapine and we believe that the question of a delayed initiation of enteral feeding after meconium elimination and in the absence of abdominal distension is debatable. [Copyright &y& Elsevier]

Abstract: Antiphospholipid syndrome (APS) is associated with a risk of obstetrical complications, affecting both the mother and the fetus. Obstetrical APS is defined by a history of three consecutive spontaneous miscarriages before 10 weeks of gestation (WG), an intra-uterine fetal death after 10 WG, or a premature birth before 34 WG because of severe pre-eclampsia, eclampsia or placental adverse outcomes (intrauterine growth retardation, oligohydramnios). Pregnancy in women with a diagnosis of obstetric APS is at increased risk for placental abruption, HELLP (Hemolysis, Elevated Liver enzymes, Low Platelet count) syndrome and thrombosis that may be part of a catastrophic antiphospholipid syndrome (CAPS). A previous thrombosis and the presence of a lupus anticoagulant are risk factors for pregnancy failure. A multidisciplinary approach, associating the internist, the anesthesiologist and the obstetrician, is recommended for these high-risk pregnancies. Preconception counseling is proposed to identify pregnancy contraindications, and to define and adapt the treatment prior and during the upcoming pregnancy. Heparin and low-dose aspirin are the main treatments. The choice between therapeutic or prophylactic doses of heparin will depend on the patient''s medical history. The anticoagulant therapeutic window for delivery should be as narrow as possible and adapted to maternal thrombotic risk. There is a persistent maternal risk in the postpartum period (thrombosis, HELLP syndrome, CAPS) justifying an antithrombotic coverage during this period. We suggest a monthly clinical and biological monitoring which can be more frequent towards the end of pregnancy. The persistence of notches at the Doppler-ultrasound evaluation seems to be the best predictor for a higher risk of placental vascular complications. Treatment optimization and multidisciplinary antenatal care improve the prognosis of pregnancies in women with obstetric APS, leading to a favorable outcome most of the time. [Copyright &y& Elsevier]

Abstract: The annual meeting of the Infectious Disease Society of America (IDSA) ; which brought together nearly 5000 participants from over 80 countries in Vancouver, Canada, October 21 to 24, 2010 ; provided a review of the influenza (H1N1) 2009 pandemic, evaluated vaccination programmes and presented new vaccines under development. With 12,500 deaths in the United States in 2009–2010, the influenza (H1N1) 2009 pandemic was actually less deadly than the seasonal flu. But it essentially hit the young, and the toll calculated in years of life lost is high. The monovalent vaccines, whether live attenuated or inactivated with or without adjuvants, were well tolerated in toddlers, children, adults and pregnant women. In order to protect infants against pertussis, family members are urged to get their booster shots. The introduction of the 13-valent Pneumococcal conjugated vaccine in the beginning of 2010 may solve – but for how long ? – the problem of serotype replacement, responsible for the re-increasing incidence of invasive Pneumococcal infections observed in countries that had introduced the 7-valent vaccine. The efficacy of a rotavirus vaccine has been confirmed, with a reduction in hospitalization in the United States and a reduction in gastroenteritis-related deaths in Mexico. In the United States, vaccination of pre-adolescents against human papillomavirus (HPV) has not resulted in any specific undesirable effects. Routine vaccination against chicken pox, recommended since 1995, has not had an impact on the evolution of the incidence of shingles. Vaccination against shingles, recommended in the United States for subjects 60 years and over, shows an effectiveness of 55 %, according to a cohort study (Kaiser Permanente, Southern California). Although some propose the development of personalized vaccines according to individual genetic characteristics, the priority remains with increasing vaccine coverage, not only in infants but also in adults and the elderly. Vaccine calendars that cover a whole lifetime should be promoted, since the vaccination of adults and seniors is a determining factor of good health at all ages. [Copyright &y& Elsevier]

Objective To compare six online evaluation methods for auditing routine second-trimester four-chamber view still images. Methods We evaluated three different scoring grids (subjective, five-item score and seven-item score), which were applied with or without access to online help, resulting in a total of six evaluation methods. For the subjective scoring grid, images were rated as excellent, good, fair, poor or very poor. For the five-item score, 1 point was allocated for visualization (vs non-visualization or non-evaluable) of each of: heart crux, atria, ventricles, apex and aorta, yielding a score of 0-5. For the seven-item score, 1 point was allocated for clear (vs unclear) visualization of each of: moderator band at the apex, interventricular septum, atrioventricular valves, non-linear insertion of atrioventricular valves (normal offset), septum primum, aorta and pulmonary vein. Each evaluation method was used via the Internet by three randomly selected reviewers, who evaluated the same set of 80 images. Reviewers were experienced in fetal ultrasound, but were not involved in the design of the study. Interrater agreement was the main outcome. Results The five-item scoring grid with online help achieved the best interrater agreement (interrater intraclass correlation coefficient = 0.7). Conclusions Evaluation of the second-trimester sonographic four-chamber view is apparently best achieved with a simple five-item scoring grid. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Abstract: The annual meeting of the Infectious Disease Society of America (IDSA); which brought together nearly 5000 participants from over 80 countries in Vancouver, Canada, October 21 to 24, 2010; provided a review of the influenza (H1N1) 2009 pandemic, evaluated vaccination programmes and presented new vaccines under development. With 12 500 deaths in the United States in 2009–2010, the influenza (H1N1) 2009 pandemic was actually less deadly than the seasonal flu. But it essentially hit the young, and the toll calculated in years of life lost is high. The monovalent vaccines, whether live attenuated or inactivated with or without adjuvants, were well tolerated in toddlers, children, adults and pregnant women. In order to protect infants against pertussis, family members are urged to get their booster shots. The introduction of the 13-valent Pneumococcal conjugated vaccine in the beginning of 2010 may solve – but for how long? – the problem of serotype replacement, responsible for the re-increasing incidence of invasive Pneumococcal infections observed in countries that had introduced the 7-valent vaccine. The efficacy of a rotavirus vaccine has been confirmed, with a reduction in hospitalization in the United States and a reduction in gastroenteritis-related deaths in Mexico. In the United States, vaccination of pre-adolescents against human papillomavirus (HPV) has not resulted in any specific undesirable effects. Routine vaccination against chicken pox, recommended since 1995, has not had an impact on the evolution of the incidence of shingles. Vaccination against shingles, recommended in the United States for subjects 60years and over, shows an effectiveness of 55%, according to a cohort study (Kaiser Permanente, Southern California). Although some propose the development of personalized vaccines according to individual genetic characteristics, the priority remains with increasing vaccine coverage, not only in infants but also in adults and the elderly. Vaccine calendars that cover a whole lifetime should be promoted, since the vaccination of adults and seniors is a determining factor of good health at all ages. [Copyright &y& Elsevier]

Abstract: Objective: To examine the effect of women''s weight on the success rate of in vitro fertilization. Patients and methods: Single centre retrospective study of a continuous series of 846 patients who underwent 1444 in vitro fertilization or ICSI cycles. The outcomes of each cycle was analysed as a function of the woman''s body mass index (BMI). Three groups were defined: (1) underweight (BMI<18kg/m2, n =68 cycles, 43 women), (2) normal BMI (18≤BMI<25, n =1045 cycles, 607 women), (3) overweight or obese women (IMC≥25, n =331 cycles, 196 women). Main outcome measurement: live birth rate per cycle. Results: In group 3, the live birth rate per cycle (10,6% [95% confidence interval: 7,3–13,9]) was significantly lower than in group 2 (16,6% [14,3–18,8]). There was a non-significant trend towards a decreased live birth rate in group I (11,8% [4,1–19,4]). In group 3, the cancellation rate (30,8% [25,8–35,8]) was significantly greater than in group 2 (19,6% [17,2–22]), the pregnancy per oocyte pick-up rate was lower (19,9% versus 24,6%) and the early miscarriage rate was increased (26,9% versus 15,7%) without reaching statistical significance. Discussion and conclusion: The live birth rate was decreased among overweight or obese women. This could be mediated by impairment of response to ovarian stimulation, oocyte quality, or implantation abnomalies. [Copyright &y& Elsevier]

Adrenal necrosis, a rare life threatening complication of antiphospholipid syndrome, is difficult to diagnose during pregnancy. We report the case of a 33-year-old woman with bilateral adrenal necrosis which started during the third trimester of her second pregnancy. Antiphospholipid syndrome had been diagnosed a few years ago, after a thrombotic event. The pregnancy was uneventful until 36 weeks plus five days, when the patient was admitted for bilateral back ache, initially considered as uterine contractions. Labour was induced because pain persisted and was associated with major thrombocytopenia. A healthy infant was delivered vaginally on the second day, adrenal failure was diagnosed based on intense asthenia, persistent severe lumbar pain, low blood sodium and cortisol. Bilateral adrenal oedema was documented by CT scan and MRI. Symptoms resolved following administration of hydrocortisone and fludrocortisone. This case illustrates the difficulty to diagnose adrenal necrosis in the third trimester of pregnancy. [Copyright &y& Elsevier]

Abstract: Pregnancy is an important stage in processes of the woman''s identity structuring. During this so particular period of her life the woman shows an important “psychic transparency”, that also signs a psychic vulnerability. The arising of a suspicion on her child''s integrity to come reaches her representation''s models and trouble her interactions with the child descended of this pregnancy and by this slant this child''s development. Objectives, population and methods: In order to put in evidence these disruptions, we followed two groups of women: a presenting a “pregnancy supervised” following a suspected scan, the other without echographic anomaly, during the last quarter of pregnancy, to the childbirth and the child''s two months. Results: We present the first results of this survey. During pregnancy, mother described a suspension of infant investment, with perturbation of foetus'' representation. At the birth, the infant-mother meeting is tense. The dyad is not well dynamic. Mother is anxious and this anxiety increase across the time. Conclusion: Nevertheless, it seems that a preventive taking in charge during of the pregnancy associated with a medical follow up of that suspected anomaly could help to avoid that “diversion” of the maternal psychic mechanism, all the more so since maternity makes women more psychically approachable. [Copyright &y& Elsevier]

Abstract: Objectives. – To describe the different pathways of management of intussusception (IS) in infants and children in metropolitan France and to identify paediatric emergency centres that might constitute a surveillance network for IS. Material and Methods. – A questionnaire was sent to 273 paediatric emergency centres distributed across France in 2005. Modalities of diagnosis and treatment of IS had to be precised. Results. – One hundred and sixty-seven centres (61.2%) responded. The response was given by 131 paediatricians (78.4%) and 36 surgeons (21.6%) working in 38 universitary hospitals (22.7%) and 129 general hospitals (77.2%). The mean number of IS treated in each centre in 2004 was 11±13.5 (extr. 0 to 70; median 6). Diagnosis of IS required a collaboration between medical and surgical teams in 51.5% of the centres, but in 40.1% the sole medical team was in charge of the diagnosis. Ultrasonography is used for diagnosis by 98.8% of the centres. Reduction with hydrostatic enema and eventually surgery was performed in the same hospital in 44.3%. Other centres systematically or frequently transferred the patients for reduction, mostly towards universitary hospitals (90%). Conclusion. – The procedures of IS diagnosis are the same everywhere in France but the pathways of therapeutic management do vary, depending on the availability of surgeons and anaesthetists trained in paediatrics on each site. These disparities will probably change with the implementation of the new plan for sanitary organization in children and adolescents in France. Labellized paediatric emergency centres will gather more surgical patients and could eventually constitute an effective surveillance network for IS. [Copyright &y& Elsevier]

Objective To investigate the contribution of three-dimensional power Doppler ultrasound to the prenatal diagnosis of pulmonary sequestration. Methods Prenatal three-dimensional power Doppler ultrasound was used to screen loran abnormal pulmonary blood supply in eight fetuses with hyperechogenic lung lesions and to image the pulmonary blood supply in 50 normal controls. A comparison was made with postnatal findings. Results Postnatally the eight pulmonary lesions were found to be an isolated pulmonary sequestration (n = 3), a microcystic congenital adenomatoid malformation (n = 4), and a mixed (macrocystic and microcystic) congenital adenomatoid malformation (n = 1). Prenatal three-dimensional power Doppler ultrasound demonstrated an abnormal blood supply in all cases of pulmonary sequestration and in none of the other cases. Among the three cases that turned Out to be pulmonary sequestrations, conventional two-dimensional ultrasound failed to identify the feeding vessel in one case and identified it at a later stage of gestation than did three-dimensional power Doppler in the other two. Conclusion Prenatal three-dimensional power Doppler ultrasound may be useful in identifying the feeding vessel and thus establishing the diagnosis of pulmonary sequestration in the presence of a hyperechogenic pulmonary lesion, allowing its differentiation from congenital cystic adenomatoid malformation. [ABSTRACT FROM AUTHOR]

Objective: To study the feasibility of second- and third-trimester termination of pregnancy (TOP) with complete placenta previa, and the impact of performing feticide before labor induction on maternal hemorrhagic morbidity. Patients and Methods: From 1987 to 2002, the databases of two referral hospitals were reviewed. We identified 15 cases of second- or third-trimester TOP in women with complete placenta previa. Feticide was performed 2-14 days before induction in 6/15 cases. Cervical ripening was achieved in 8 cases by mifepristone alone (n = 2) or by mifepristone and dilapan (n = 6). Labor was induced by vaginal gemeprost (n = 2), intramuscular (n = 5) or intravenous (n = 4) sulprostone, vaginal misoprostol (n = 1) or a combination of misoprostol and sulprostone (n = 3). Hemorrhage was defined by the need for transfusion. The difference between the preoperative and the lowest per- or postoperative maternal hemoglobin level was also analyzed. Results: Of the 9 women who underwent labor induction without previous feticide, 4 required blood transfusions, 1 of whom had a hemostat hysterectomy. The mean hemoglobin difference was 2.5 g/dl (range: 0.5-5.3). None of the 6 patients with preinduction feticide required transfusion. The hemoglobin difference was significantly smaller in this group than in terminations without previous feticide (mean: 1.0 g/dl ; range: 0.1-2.2; p = 0.03). Conclusion: In cases with complete placenta previa, second- or third-trimester TOP is feasible. It carries a substantial risk of hemorrhage that might be decreased by preinduction feticide. [ABSTRACT FROM AUTHOR]

: ObjectiveTo study perinatal and long term outcome following prenatal diagnosis of hyperechogenic kidneys.: DesignProspective observational cohort study.: SettingThe Maternite´ Port-Royal Hoˆpital Cochin and at the Departments of Obstetrics and Paediatric Nephrology, Necker Enfants Malades in Paris, France.: PopulationForty-three fetuses with isolated bilateral hyperechogenic kidneys.: MethodsAll patients referred with isolated bilateral hyperechogenic fetal kidneys were followed up prospectively up to 34–132 months. The following prenatal items were analysed: fetal kidney size, amniotic fluid volume, gestational age at diagnosis, family history and renal ultrasound in parents. Postmortem examination was carried out in cases with perinatal death. Postnatal follow up of survivors included postnatal ultrasound, blood pressure, serum creatinine, proteinuria, need for restricted diet, weight and height and renal biopsy when available.: Main outcome measuresAetiology of hyperechogenicity, perinatal mortality and renal function in survivors.: ResultsThe aetiology could be established by family history, postmortem or postnatal data, but not by prenatal ultrasound. There were 20 autosomal recessive, 8 autosomal dominant polycystic kidney diseases, 9 other renal disorders and 6 symptom-free survivors without aetiological diagnosis. There were 19 terminations of pregnancy, 5 neonatal deaths and 19 survivors, of whom 14 had normal renal function three had mild and two had end stage renal failure. None of those with severe oligohydramnios and fetal kidneys > 4 SD survived (n = 14, 10 terminations and 4 neonatal deaths), whereas of the 17 with normal amniotic fluid volume and kidneys < 4 SD, 14 survived, of whom 9 were symptom-free.: ConclusionAetiology could not be established prenatally in the absence of familial data. Kidney size and amniotic fluid volume were the best prenatal predictors of outcome. [Copyright &y& Elsevier]

One of the major progress in fetal medicine in recent years is the increased sensitivity of sonographic screening for foetal malformations, due to technical improvement but also to a better training of professionals. Screening for chromosomal abnormalities is no longer based on maternal age alone. Second trimester maternal serum screening (MSS) is increasingly used : thus in 1997, 376 798 MSS tests were performed in France, yielding to the prenatal diagnosis of 391 cases of Down’s syndrome. First trimester sonographic nuchal translucency measurement (NTM) is an effective screening method when performed under stringent conditions. Quality control however, is more difficult to implement on a large scale for NTM than for MSS. Performing screening tests sequentially carries a danger of generating an unnecessarily high number of amniocentesis, which may be obviated by a rational calculation of an individual’s risk to carry an aneuploid baby. First trimester MSS is expected to become standard practice in the next years, probably in combination with NTM. Cytogenetics underwent substantial innovations recently, due to the ever-increasing use of molecular cytogenetics. FISH techniques allow : 1) precise analysis of unexpected structural chromosomal abnormalities diagnosed by routine amniocentesis, 2) rapid screening of the most common aneuploidies by amniocentesis when a fetal structural anomaly is detected by 3rd trimester ultrasound, 3) diagnosis of micro-deletions suspected by fetal ultrasound or post-mortem. Prenatal diagnosis by maternal blood sampling and fetal cells or DNA analysis is now part of routine clinical practice in selected cases, such as fetal sexing in families affected by an X linked disease. Thus one can select those pregnancies eligible to invasive prenatal diagnosis. Pre implantation diagnosis, which has not been legal in France until 1999 is now increasingly used as an alternative to first trimester diagnosis. As for fetal therapy, a major recent breakthrough is the prenatal management of twin to twin transfusion syndrome by either amnioreduction or laser coagulation of inter-twin vascular shunts. In addition, new pathophysiologic concepts involving the renin angiotesin system could lead to further therapeutic innovations. A European randomised trial is now being completed to establish the respective indications of drainage and Laser. All this underscores that fetal medicine is no longer solely a succession of dramatic technical breakthroughs, but is entered an era of large-scale diffusion that requires evidence based evaluation. [Copyright &y& Elsevier]