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La pandemie « Corona Virus Disease 2019 » (COVID-19) liee au « SARS-CoV-2 » a ete declaree « crise sanitaire mondiale » par l’Organisation mondiale de la sante fin janvier 2020. Des mesures exceptionnelles de confinement ont ete prises pour contenir cette infection tres contagieuse et parfois grave, que les equipes soignantes combattent en premiere ligne. Les nouveau-nes hospitalises representent par principe de precaution un groupe de patients vulnerables juge potentiellement a risque, mais qui s’avere finalement peu infecte et pauci-symptomatique comme l’indiquent les faibles incidences et severites des cas pediatriques publies [1]. L’acces des parents a leur nouveau-ne hospitalise fait partie integrante des soins en neonatologie et en particulier des soins centres sur l’enfant et sa famille. La presence de ses parents a ses cotes est un droit fondamental pour l’enfant hospitalise [2] et repond a un besoin premier des parents d’etre aupres de leur bebe [3]. Les benefices de strategies environnementales et de soins portees par les parents sont etablis avec un haut niveau de preuve [4]. La prematurite est source de stress parental, de troubles de l’attachement et de troubles anxiodepressifs renforces par la separation de la dyade parent–enfant, qui entrave le contact physique normal et la proximite emotionnelle entre la mere (le pere) et son enfant [5], [6]. Cette separation precoce peut affecter la sante mentale des parents mais aussi avoir des effets durables sur la programmation emotionnelle et le neurodeveloppement des nouveau-nes. La pandemie COVID-19 expose toutes les personnes a un stress et une angoisse qui peuvent majorer les troubles psychologiques preexistants ou exacerber le vecu des situations emotionnellement difficiles [7]. Ceci est vrai pour les soignants mais aussi pour les parents de nouveau-nes hospitalises dans un contexte de distanciation sociale qui limite le soutien de leurs proches. Bien que cela ne soit pas encore documente, il est aussi possible que les meres COVID-19 positives soient exposees a un plus grand sentiment de culpabilite, deja tres present en cas de naissance prematuree ; et se rajoutant a une crainte pour leur propre etat de sante. Pourtant, la situation pandemique actuelle et le decret de confinement national ont pour effet collateral de restreindre l’accueil des parents en neonatologie aussi bien quand la mere est suspecte ou infectee par le COVID-19 au moment de l’accouchement, qu’en dehors de cette situation. Ces restrictions d’acces variables suivant les centres, resultent de regles institutionnelles editees avec les equipes d’hygiene hospitaliere de chaque hopital, de decisions prises au niveau des poles de pediatrie et/ou des hopitaux mere-enfant. Ces mesures qui visent initialement a proteger les nouveau-nes hospitalises et l’ensemble des adultes presents dans les services de neonatologie peuvent alterer la qualite des soins delivres a ces patients vulnerables et a leur famille. Notre reflexion vise a mettre en balance les mesures necessaires pour contenir la pandemie avec les besoins premiers des enfants hospitalises en neonatalogie et de leurs parents. Nous envisageons les avis emis sur la prise en charge d’un nouveau-ne d’une mere avec COVID-19 suspecte ou confirme, par des organisations internationales, des institutions et societes savantes. Pour finir, nous proposons des actions pour aider les professionnels de sante a soutenir la qualite des soins delivres, l’attachement et la participation des parents aux soins de leur nouveau-ne hospitalise, sans majorer le risque de propagation du virus.

Resume La famille est primordiale pour les nouveau-nes hospitalises. Elle soutient son developpement, tout en tissant des liens d’attachement solides avec lui. Les soins centres sur l’enfant et sa famille affirment que la famille fait partie de l’equipe soignante de neonatologie. Elle est integree dans le processus de decision medicale et est partenaire dans les soins a son ou ses enfants. Il semble essentiel de preciser la definition de la famille. Nous allons aborder cette definition sous un aspect juridique, sociologique ou philosophique. Le Groupe de Reflexion et d’Evaluation de l’Environnement des Nouveau-nes (GREEN) de la Societe francaise de neonatologie estime qu’il est important de clarifier la definition de la famille d’un nouveau-ne hospitalise, de decrire les difficultes lies a la separation pour l’enfant, ses parents, sa fratrie et sa famille, de faire un etat des lieux sur les pratiques, puis de proposer des recommandations et des strategies d’application.

Resume Le peau a peau est defini par le portage d’un enfant vetu d’une couche et d’un bonnet entre les seins de sa mere ou contre le torse du pere, peau contre peau. Les objectifs du Groupe de Reflexion et d’Evaluation de l’Environnement des Nouveau-nes etaient d’evaluer son rationnel scientifique et d’emettre des recommandations pratiques pour sa realisation en neonatologie et en salle de naissance. Une recherche bibliographique systematique, suivant la methodologie de la Haute Autorite de sante, montre l’existence de benefices sur la stabilite physiologique, le sommeil, la douleur, le developpement neurologique, l’allaitement, l’attachement et le stress parental. Il est recommande que le peau a peau soit propose a tous les bebes prematures hospitalises, le plus precocement et le plus largement possible, des stabilite clinique, avec des procedures ecrites de transfert et surveillance, et un environnement soutenant. Cette pratique semble beneficier aux nouveau-nes extremement prematures et/ou intubes, mais necessite une expertise de l’equipe. Le peau a peau precoce en salle de naissance avec la mere est benefique pour l’allaitement, le comportement, l’adaptation du nouveau-ne a terme ou proche du terme. Le peau a peau avec le pere ameliore aussi le comportement de l’enfant. L’installation immediate en peau a peau avec la mere est fortement recommandee pour le nouveau-ne d’âge ≥ 35 semaines, si son etat clinique le permet. Il est recommande a chaque equipe d’informer et soutenir les parents, d’instaurer des procedures de securite/surveillance adaptees pour soutenir la pratique du peau a peau en securite en salle de naissance.

The rate of children born prematurely has increased considerably in the last few decades, and their developmental outcome remains of great concern. The literature on the impact of prematurity has reported a wide range of cognitive and behavioral problems that may be related to deficits in executive function (EF) skills. EF refers to a series of high-level processes (selective attention, inhibition, set shifting, working memory, planning, goal setting) that develop throughout childhood and adolescence and play an important role in cognitive and social development as well as in school achievement. EF skills have been linked to the prefrontal cortex, as well as to other neural networks and brain regions including the basal ganglia and cerebellum. This paper focuses on studies related to the development of EF and social behavior in children born preterm. The preschool period is a critical time to perform neuropsychological assessment in addition to IQ testing, and to detect the child's specific needs in order to adapt effective intervention to enhance the development of executive processes in these high-risk children.

The most immature infants have critically low concentrations of all immunoglobulin G (IgG) subclasses, associated with a higher risk for pyogenic, respiratory, and meningeal infection. Selective IgG subclass deficiency is an established indication for intravenous immunoglobulin (IVIG) substitution. However, considering that therapeutic efficacy of IVIG is dependent on its pharmacokinetics, we studied peak and trough IgG subclass serum levels during the neonatal period (28 days) in a group of 34 healthy preterm babies (30.2 +/- 2 weeks gestational age (GA) and 1065 +/- 210 g birthweight (BW) treated prophylactically with three daily standard doses of two different IVIG preparations: Sandoglobulin (SG) (0.5 g/kg/day) and Pentaglobin (PG) (5 mL/kg/day). IgG subclass levels were assayed by radioimmundiffusion (RID) before treatment (day 1) and at days 3, 5, 7, 14, and 28 of life. Statistical analysis was performed by paired t test. In the first week of life only (days 3, 5, 7), for both IVIG preparations, subclass levels were higher than pretreatment values: IgG1, 4.6 +/- 1.7 versus 5.6 +/- 1.6 g/L; IgG2, 1.6 +/- 0.8 versus 2.1 +/- 0.6 g/L; IgG3, 0.2 +/- 0.7 versus 0.3 +/- 0.1 g/L; IgG4, 0.3 +/- 0.1 versus 0.9 +/- 0.1 g/L (p < 0.05). During this time (7 days) IgG2 levels were higher in the SG group and IgG4 was higher in the PG group (p < 0.05). This study shows pretreatment IgG subclass levels 14 days after treatment and different patterns, depending on the used preparation. We conclude that prospective clinical trials should include the study of target serum levels and timing of IVIG administration not only for IgG but also for IgG subclasses.

One hundred eight newborns (gestational age 36 + 1.8 weeks and birth weight 2860 +/- 240 g) had muscle type Creatine-Kinase activity (CK-MM) assayed immediately after birth (CK-I) and serially at 6-10 h (CK-II), 20-30 h (CK-III) and 40-60 h (CK-IV) of age. Using statistical Regression analysis, CK-MM levels were correlated to four perinatal parameters: gestational age, birth weight, neonatal acidosis (pH less than 7.15), mode of delivery (vaginal/cesarean section). It was observed that CK-MM activity was dependent on gestational age and correlated to the mode of delivery at time III (600 U/l) and IV (400 U/l) comparing the mean serum values of 156 + 44 U/l observed in atraumatic delivery (p less than or equal to 0.05). Our results demonstrate markedly higher levels of CK-MM following vaginal delivery especially if complicated by forceps, vacuum and breech presentation, suggesting that birth trauma may be responsible for this phenomenon.

Topical application of caffeine for the treatment of neonatal apnoea was considered in 57 low birth weight infants (less than 1500 g birth weight). The rationale for the study was that transdermal absorption of drugs and chemical agents has been demonstrated in neonates depending on anatomical and functional immaturity of the epidermal barrier. Considering these issues we studied the efficacy of percutaneous application of caffeine using high pressure liquid chromatography (HPLC) for evaluation of its plasma levels. 2 x 7.5 mg (babies less than 1000 g, extremely low birth weight [ELBW] or 2 x 10 mg (babies greater than 1000 g, very low birth weight [VLBW]) of caffeine were applied transcutaneously in form of a gel to the abdominal skin (Standard dose = 0.06 g of gel equivalent to 10 mg of caffeine citrate). Gestational age of our patients was 29.4 +/- 1.7 weeks, mean birth weight 1025 +/- 240 g. Mean postnatal age at beginning of treatment was 25.5 +/- 18 h. Of the treated babies, 73% had serum levels in therapeutic range about 48 h after the first dose of caffeine application. After 10 doses 97% of patients had serum levels in the therapeutic range. We conclude that percutaneous caffeine application is a safe and useful approach for treatment of apnoea in VLBW and ELBW infants.

Management of 32 consecutive cases of fetal hydrocephalus diagnosed prenatally during a five years period is presented. Thirteen cases (40%) being patients with ventriculomegaly due to isolated brain malformation are the topic of this paper. In this group, management was conservative and consisted of termination of pregnancy by elective cesarean section after prenatal fetal assessment. Agenesis of corpus callosum (6 cases) and Dandy-Walker malformation (7 cases) were the most common observed forms. Antenatal sonography improved intrauterine follow-up. Skillful perinatal management and support facilities after birth have been found a reliable approach to conservative management of fetal hydrocephalus by lacking of satisfactory techniques for in utero permanent cerebrospinal fluid shunting.

The potential of exogenous replacement therapy in surfactant-deficient states such as neonatal respiratory distress syndrome (RDS) is an area of intense clinical interest today. At present, a fundamental problem with any type of exogenous surfactant is the uncertainty about potential effects on physiological defense mechanisms, such as differentiation and mobilization of peripheral leukocytes. Considering that newborn infants with proven bacterial infections have abnormal values of segmented (neutrophil) and nonsegmented (band) polymorphonuclear leukocytes, we studied 42 placebo- versus Curosurf-treated babies with severe RDS. Differential white blood cell (WBC) count was serially performed before and after treatment during the first days of life. The statistically significant increase in the proportion of bands in surfactant-treated babies did not coincide with clinical and bacteriologic evidence of possible infection. Some molecular interaction mechanisms influencing immature to mature WBC ratio are supposed. Among a variety of influences on the leukocyte count, surfactant replacement therapy needs to be considered for proper interpretation of hematologic data in babies treated for RDS.

Intravenous administration of Immunoglobulin (IVIG) has been used for prevention or treatment of neonatal sepsis. However, therapeutic efficacy of IVIG is dependent on pharmacokinetic factors. There have been no comparative studies in neonates between licensed IgG and IgM enriched preparations. The aim of this study was to investigate serial IgG and IgM serum levels during the neonatal period in two groups of non-septic, preterm infants treated prophylactically with IVIG. Twenty-two very low birth weight (VLBW) patients (1001-1500g) (gestational age 31.8 +/- 2.0 weeks and 1265 +/- 245g birth weight) and 12 extremely low birth weight (ELBW) patients (1000g) (gestational age 28.6 +/- 2.5 weeks and 910-85g birth weight) received at random three standard doses of Sandoglobulin (SG) (0.5 g/kg/day) or IgM enriched Pentaglobin (PG) (5 ml/kg/day). IgG and IgM concentrations were assayed by rate nephelometry before treatment and at day 3, 5, 7, 14 and 28 of life. At any time IgG levels were higher in the SG-VLBW group (p0.01), no difference being observed in the ELBW group (p0.5). IgM levels were higher at day 3 and 5 in the PG-VLBW group and until day 7 in the ELBW group (p0.01). This study indicates a wide range of IgG and IgM kinetics in the healthy premature and suggests frequent monitoring of immunoglobulin serum levels during efficacy studies.

Low birth weight and intrauterine growth retardation are well-recognized risk factors for increased mortality, morbidity and poor neurologic outcome. Risk assessment is different considering true preterm (appropriate-for-gestational-age, AGA) or growth-retarded (small-for-gestational-age, SGA) infants. Therefore, we carried out a study on the incidence of hemorrhagic (peri-intraventricular hemorrhage, PIVH) and ischemic (periventricular leukomalacia) brain lesions in two groups of AGA and SGA very-low-birth-weight (VLBW) infants. In the study period (1987-1990), 111 VLBW babies (1,500 g body weight) were serially studied at days 1, 3 and 7 and weekly until discharge by cerebral ultrasonography (ATL, MK 4, 7.5 MHz). 57 were VLBW-AGA babies (mean gestational age 28 weeks, mean body weight 1,106 g). 54 were VLBW-SGA babies (mean gestational age 31 weeks, mean body weight 990 g). PIVH was graded according to the system of Papile et al. Periventricular leukomalacia was defined as an echodensity (3 mm) adjacent to the lateral border of the ventricular body. We noted a higher incidence of PIVH in the AGA group (36.8%) than in SGA babies (18.5%; p0.01, Fisher test). The AGA subgroup1,000 g body weight had 72.2% PIVH compared to AGA babies1,000 g (20.5%; p0.01). The same relationship was observed in SGA babies (34.8% in1,000 g and 6.4% in1,000 g babies). Ischemic brain lesions (periventricular leukomalacia) were equally distributed between AGA and SGA babies (10.5 vs. 3.7%, p0.5) independently of body weight category.(ABSTRACT TRUNCATED AT 250 WORDS)

Caffeine is commonly used in the treatment of apnea of prematurity. The skin of preterm infants varies considerably in its level of maturity. To understand skin absorption in low birthweight infants (less than 1500 gm) with gestational age between 26 and 34 weeks, a group of 56 preterm babies was studied after percutaneous application of 7.5 mg twice daily of caffeine for babies with birthweight less than 1000 gm and 10 mg twice daily for babies with birthweight more than 1000 gm. The reported technique is a useful alternative method of drug administration in premature babies. This study indicates an inverse relationship between gestational age and skin absorption contributing to a better understanding of skin barrier function in the newborn.

One hundred eight newborns (gestational age 36 + 1.8 weeks and birth weight 2860 +/- 240 g) had muscle type Creatine-Kinase activity (CK-MM) assayed immediately after birth (CK-I) and serially at 6-10 h (CK-II), 20-30 h (CK-III) and 40-60 h (CK-IV) of age. Using statistical Regression analysis, CK-MM levels were correlated to four perinatal parameters: gestational age, birth weight, neonatal acidosis (pH less than 7.15), mode of delivery (vaginal/cesarean section). It was observed that CK-MM activity was dependent on gestational age and correlated to the mode of delivery at time III (600 U/l) and IV (400 U/l) comparing the mean serum values of 156 + 44 U/l observed in atraumatic delivery (p less than or equal to 0.05). Our results demonstrate markedly higher levels of CK-MM following vaginal delivery especially if complicated by forceps, vacuum and breech presentation, suggesting that birth trauma may be responsible for this phenomenon.

Cerebral infarction is rare in premature newborns and is most commonly the result of arterial embolization from the placenta. A focal echodense area was identified on prenatal cranial ultrasonography (US) in a premature infant (34 weeks of gestation). After birth, cerebral infarction was confirmed by magnetic resonance imaging (MRI). The clinical findings, imaging findings and pathogenesis are discussed. New diagnostic methods such as MRI show to be a useful approach in the neonatal period facilitating recognition of cerebrovascular accidents also in low-birth-weight infants.

Surfactant replacement therapy in patients with neonatal respiratory distress syndrome (RDS) is a new therapeutic approach. There is now convincing evidence that the incidence and severity of RDS can be reduced. Surfactant (CUROSURF) was intratracheally applied to a group of fifteen intubated preterm infants with severe RDS (29 +/- 2.1 weeks of gestation and 1204 +/- 301 g birth weight) at 9.1 +/- 2.5 hours of life. For detection of potential neurological risk we performed serial ultrasound examinations (US), serial measurements of Creatine-Kinase Isoenzyme levels (CK-BB) looking for the presence of human antibodies to different brain antigens (BSA) as markers for neonatal cerebral injury. Using these diagnostic methods, there was no evidence of any negative influence of surfactant therapy on cerebral function of treated preterm infants.

There is now convincing evidence that the severity of respiratory distress syndrome (RDS) can be reduced by treatment with lipid extracts of animal surfactant. The widespread use of IgE serum levels as a high indicative parameter for sensitization led us to determine IgE concentrations before and after surfactant (Curosurf) application [1]. The study was performed on a group of 15 preterm infants treated for severe RDS in order to study potential complications of surfactant administration due to immunogenicity. Considering the influence of gestational age on IgE concentrations [2], these results were compared with those of a similar group of healthy preterm infants without RDS.