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The Apgar score provides an accepted and convenient method for reporting the status of the neonate, immediately after birth, and the response to resuscitation if needed. A low score and/or the absence of a rapid improvement leads to suspect an anoxo-ischemia, before or during birth. Cord blood pH and lactate analysis must complete the clinical score. EEG and cerebral MRI are important for prognosis and for medico-legal assessment. Poor supervision of fetal heart rate, ineffective resuscitation, Insufficient information, absence of transfer for hypothermia lead to an increasing filling of complaints. Bad or absence of traceability in medical files also increases the risk for legal complaint. [ABSTRACT FROM AUTHOR]

Résumé: Les unités de sang placentaire sont maintenant largement utilisées comme source de cellules souches hématopoïétiques en situation d'allogreffe non apparentées. En France, les unités de sang placentaire sont collectées dans un réseau de plus de 70 maternités réparties sur l'ensemble du territoire national et rattachées à 11 banques publiques affiliées au Réseau français de sang placentaire. Cette collecte est réalisée sur le principe du don anonyme, gratuit et pour autrui. L'absence de contre-indication au don est vérifiée chez la parturiente. Seules les unités de sang placentaire répondant aux critères quantitatifs du Réseau français de sang placentaire (cellules nucléées >100×107 et cellules CD34+>1,8×106) sont cryopréservées. La qualification des unités sera complétée par des tests virologiques et fonctionnels sur les unités de sang placentaire ainsi que par le recueil de l'état de santé du nouveau-né donneur six semaines après le don. Le banking de sang placentaire a été encouragé ces cinq dernières années en France permettant d'enrichir le Registre français des donneurs de moelle osseuse en termes de diversité génétique HLA afin de les mettre à disposition des patients à greffer. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: At birth, evaluation of neonatal well-being is crucial. It is though important to perform umbilical cord blood gas analysis, and then to analyze the samples. We wanted to establish the feasibility and reliability of systematic umbilical cord blood sampling in a French labour ward. Patients and methods: Study of systematic umbilical cord blood gas analysis was realized retrospectively from 1000 consecutive deliveries. We first established the feasibility of the samples. Feasibility was defined by the ratio of complete cord acid-base data on the number of deliveries from alive newborns. Afterwards, we established the reliability on the remaining cord samples. Reliability was the ratio of samples that fulfilled quality criteria defined by Westgate et al. and revised by Kro et al., on the number of complete samples from alive newborns. At last, we looked for factors that would influence these results. Results: The systematic umbilical cord blood sample feasibility reached 91.6%, and the reliability reached 80.7%. About the delivery mode, 38.6% of emergency caesarians (IC 95% [30.8–46.3]; P <0.0001) led to non-valid samples, when only 11.3% of programmed caesarians (IC 95% [4.3–18.2]; P <0.0001) led to non-valid samples. Umbilical cord blood analysis were significantly less validated during emergency caesarians. Discussion and conclusion: Realization of systematic cord blood gas analysis was followed by 8.4% of incomplete samples, and by 19.3% that were uninterpretable. Training sessions should be organized to improve the feasibility and reliability, especially during emergency caesarians. [Copyright &y& Elsevier]

Summary: The methods used to collect hematopoietic stem cells in their natural environment (bone marrow or cord blood) or in the peripheral blood after stimulation are well-defined and ruled both to ensure the donor security and perform a quality hematopoietic transplantation. Safety of the familial or non-familial donor must be ensured not only during the collection but also on a medium- or a long-term basis. The stem cells amount in a graft and its characterisation depend on the collection site of hematopoietic stem cells and on the technique used. The knowledge of conditions influencing these amounts allows optimising the hematopoietic stem cells collection while preventing conditions in which the donor safety could be decreased. The collection site also influences the collection of significant amounts of other blood cells. This knowledge conditions the preparation procedures of the graft in cell therapy units or the management of per- or post-transplantations complications in haematology units. Thus, hematopoietic transplantations concern not only hematological units but also the teams involved in various stages of donor selection, hematopoietic stem cells collection and graft preparation. In order to allow an appropriate care of both donor and recipient, a concomitant knowledge of all the stages involved in hematopoietic collection conditions, characterisation of collected cells, hematological diseases and conditioning must be brought to hematological, collection and cell therapy teams. [Copyright &y& Elsevier]

Abstract: Despite the well-known therapeutic utility of cells derived from umbilical cord, the public health code still qualifies it as a simple operating waste what requires the adoption of an adapted legal status. This situation enabled the appearance of private commercial banks storing the blood of umbilical cord for autologous or intra-family purposes in spite of the absence of any authorization. This raises numerous questions of legal, ethical and social order. According to the French general principles in public health, only banks storing transplants for non-commercial allogeneic purposes are currently authorized in France. However, a bill would come to modify this situation by possibly allowing commercial banks. The Council of State, the Senate and the Government consider however that ethical requirements and public utility have to prevail in this domain. Recently, these principles have been resumed by a second bill. The next revision of the Bioethical law should revive the debate. [Copyright &y& Elsevier]

Abstract: Purpose: Today, haematopoietic stem cell graft from placental blood concerns more than 15 % of allogeneic grafts. An inter-laboratory study of the quality control of defrosted cord blood units has been coordinated by the French society for cell and tissue bioengineering (SFBCT), with the cord blood bank of Bourgogne Franche-Comté and controlled by the French health products safety agency (Afssaps). The aim of this study is to ensure the inter-laboratory reproducibility of the quality controls practised by the banks during defrosting. The cellular outputs were analyzed according to the defrosting techniques, according to the method used in flow cytometry: single-platform (SP) versus double-platform (DP), or the product nature, i.e. in total blood or miniaturized. Methods: Forty-two units of placental blood (USP), which were out of range were provided for defrosting to 14 participating sites. USP were defrosted and controlled according to the procedures of each bank. Once the USP is defrosted, a part of the product was controlled by the site and the other part by Afssaps. Following controls were carried out: numeration of the total nucleated cells (TNC) and of CD34+ cells (made by a SP method in Afssaps) and functional assay. Results: Concerning TNC, the defrosting sites obtained a cellular output of 94 %±28 in day 0 compared with an output of 72 %±24 in Afssaps showing a rather good stability of the USP transmitted with an average deviation of 23 %±22. The freezing process with or without reduction of volume does not affect this variation. Concerning the numeration of CD34+ cells, the average deviation between the participating sites and Afssaps was 29 %±23 compared with 21 %±16 for the sites using a SP method against 47 %±25 for those using a DP method. The CD34+ outputs are equal to 82 % ± 60 in day 0 for the participating sites against 52 %±20 for Afssaps. For the sites using a DP method, it is stressed that this output is particularly high with a rate of 126 %±90 (n =15) whereas it is 62 %±20 (n =32) for the sites using a SP method. Conclusion: These results underline a good stability of viable CD34+ cells and a greater reliability of the SP methods for the CD34+ cell numeration for these defrosted USP. Lastly, the results of the functional assay regarding the average clonogenicities (equal to 15 %) reinforce the conclusions on the quality of the defrosted products. [Copyright &y& Elsevier]

Abstract: A cord blood graft is now frequently used in the context of allogeneic hematopoietic transplantation. In 2007, 27% of unrelated allotransplantations performed in France used a cord blood graft. In comparison to other sources of hematopoietic grafts, cord blood has a number of advantages (immediate availability of the graft, possibility of a lesser HLA compatibility between donor and recipient…) and inconveniences (a limited number of stem cells, increased risk of infectious complications…). Recently, the possibility of combining two cord blood grafts has been demonstrated. In 2007, 55% of unrelated cord blood grafts transplantation were performed as such. Results of multicentric studies published as of now, as well as considerable potential associated with cord blood transplantation requires important efforts to increase both the quantity and quality of cord blood grafts made available for transplantation. [Copyright &y& Elsevier]

Abstract: One has been trying for several years to find a substitute for red blood cells (RBC). The development of chemical or natural molecules to replace hemoglobin has nevertheless proved difficult and artificial blood is still unattainable. We have described a methodology permitting the massive ex vivo production of mature human RBC having all the characteristics of native adult RBC from hematopoietic stem cells (HSC) of diverse origins: blood, bone marrow or cord blood. This protocol allows both massive expansion of the HSC/progenitors and their complete differentiation to the stage of perfectly functional mature RBC. The levels of amplification obtained (105 to 2×105) are compatible with an eventual transfusion application. We discuss here the state of the art of this new concept and evoke the obstacles to be overcome to pass from the laboratory model to clinical practice. This concept of “cultured RBC” opens up potentially considerable therapeutic perspectives in the field of blood transfusion. [Copyright &y& Elsevier]

Abstract: Purpose: The practical management of a pregnant woman with a platelet count below 150×109 per liter is very simple. Key points: A spurious thrombocytopenia must be discarded and isolated thrombocytopenia (begnin idiopathic gestational thrombocytopenia and idiopathic thrombocytopenic purpura) must be first differenciated from associated forms. It must be determined if thrombocytopenia appeared recently and therefore is directly specific of pregnancy. Severity is indicated by a very low platelet count and a high speed in lowering. Platelet count of the newborn must always be checked on ombilical cord blood at the time of the birth. Steroid therapy may be needed in some cases of idiopathic thrombocytopenic purpura, lupus or HELLP syndrome. Platelet counts must be checked, in every case, three months after delivery and in case of subsequent pregnancy. Conclusion: Low platelet count is a demonstrative example of the help the internist can afford to the obstetrician in the management of pregnancy-associated conditions. [Copyright &y& Elsevier]

Umbilical cord blood (UCB) provides an alternative source of haematopoietic stem cells for patients with haematological diseases who lack HLA-matched, related or unrelated donors. Compared to other sources of stem cells, UCB is more readily available and makes it possible to extend transplants to a larger number of patients, even patients with rare haplotypes and HLA incompatibility. The choice of the cord blood unit (CBU) is mainly based on cell dose (both the number of nucleated cells and the number of CD34 positive cells) and HLA incompatibility. There is a clear association between these two parameters and the main outcomes of UCB transplantation (UCBT): neutrophil and platelet engraftment, transplant-related mortality (TRM), acute and chronic graft-versus-host disease (GVHD), relapse and survival. Compared to bone marrow transplantation, UCBT is associated with slower neutrophil and platelet engraftment, a lower incidence of acute and chronic GVHD, despite HLA disparities, and comparable TRM, relapse and survival rates, both in children and adults. Recently, the use of two CBU grafts (double transplant) has been investigated in order to improve cell dose and, consequently, allow adult patients to receive suitable grafts. Preliminary analysis shows that double UCBT is safe and associated with faster neutrophil recovery and higher engraftment rates than single UCBT. In addition, the use of reduced-intensity conditioning provides a valuable alternative with encouraging results, especially for elderly patients and those with comorbidities. [ABSTRACT FROM AUTHOR]

Abstract: The mesenchymal stem cells are a cell population of bone marrow, which have the capacity to differentiate towards all the cells from the locomotor apparatus. They also have immunomodulatory properties and can contribute to tissue repair, thanks to the secretion of many growth factors. Such cells are also found in the cord blood. In the same way, very close stem cells exist in great quantity in fat tissue. These cells are very good candidates in regenerative medicine. Besides, several clinical trials were carried out in order to highlight their effectiveness mainly in osseous repair and also during hematopoietic stem cells graft or cardiac repair after infarction. However, these trials will be able to develop fully only with the condition that culture techniques meeting the conditions of good manufacturing practice are set-up. This presentation gives a progress report on the whole of these subjects. [Copyright &y& Elsevier]

Abstract: Since 1988, allogeneic cord blood transplantations have been used in the hematology and oncology area. Cord blood banks, either public or from non-profit corporations, opened in several countries. They organized themselves into a world-wide network permitting broad and quick graft availability all over the world. Cryopreservation modalities and biological safety were strongly defined according to laboratory good practices. More recently, in the United States, Canada and some European and Asian countries, commercial companies created for-profit cord blood banks. They offer families the possibility of privately storing the cord blood of their children. Then, if a child gets sick and needs a hematopoietic stem cell transplantation, it is possible to use the cord blood for an autograft. These companies present this service, relatively expensive for the families, as a true biological insurance. Also, they capitalize on families’ hopes that scientific progress will increase cord blood autografts and other stem cell medical applications. In this work, we review available scientific data, ethical considerations and laws that can contribute to an informed reflection. [Copyright &y& Elsevier]

Abstract: Objective. – To evaluate the validity and the feasibility of fetal scalp lactate sampling during labour in the assessment of non reassuring fetal status. Patients and method. – A prospective observational study was conducted on 129 fetal scalp blood samplings. Scalp lactate measurements were compared to scalp pH (gold standard procedure), neonatal cord blood gas (pH and lactates) and Apgar score. Pathological values taken were for scalp lactates>5 mmol/l, scalp pH<7.20, cord arterial pH<7.10, cord arterial lactates>6,35 mmol/l, and Apgar score<7 at one and five minutes. All measurements were performed using the Rapid Lab™ 860 device from Bayer. Results. – Scalp lactate correlated significantly with scalp pH (R =–0.54, P =0.001), with umbilical artery pH (R =–0.46, P =0,01), with umbilical artery lactate (P =0.49, P =0.01), but with neither Apgar score at one minute (R =–0.21, ns) nor at 5 minutes (R =–0.11, ns). Scalp lactate at a cut-off value of 5 mmol/l had the same predictive values than scalp pH at 7.20 to predict neonatal acidosis. Sampling failure with scalp lactate was inferior to 1 vs 18% for scalp pH. Discussion and conclusion. – The measurement of lactate in fetal blood scalp seems correlated to the fetal scalp pH. It may be an attractive alternative to pH analysis and a useful tool for monitoring fetal asphyxia, especially with the advent of handheld devices requiring small sample volumes. [Copyright &y& Elsevier]

The first years of life are of major importance in the “allergic march”. The passage of allergens from mother to foetus during pregnancy most likely involves foods rather than other sorts of allergens. Still, immunological changes that are found in cord blood are not of long-term value. When nursing, mothers should avoid peanuts and peanut-containing foods, especially if the infant has any skin lesions. Concerning the infant, it is known that the application of creams containing peanuts on an infant’s skin can induce peanut allergy. Furthermore, especially if the baby is at risk for atopy, breast feeding or, when that is not being done, the use extensive hydrolisate formulas, as well as delayed introduction of new foods, is recommended. [Copyright &y& Elsevier]

This article describes the current techniques of foetal sampling. All of them are actually ultrasound guided, and therefore generally very safe. Nevertheless, an elaborate learning process remains indispensable, in addition to a particular attention to the quality of the physician–patient dialogue. The choice of a technique depends on the indication and on the term of the pregnancy. The most frequently used technique is amniocentesis which presents a low risk of foetal loss, estimated between 0.2 and 0.5 percent. The interest of chorionic villus sampling is the possibility to obtain results at an earlier stage of pregnancy, with a lower risk taking when compared to early amniocentesis. We prefer the transabdominal chorionic villus sampling to the transvaginal. Foetal blood sampling is still required in some cases, but the risk of complications is higher – around 1 percent. [ABSTRACT FROM AUTHOR]

Isolated atrial flutter is an extremely rare form of supraventricular tachycardia in the neonatal period. It may be initiated by central venous catheterization.Case report. – A male infant was born at 35 weeks by cesarean section for placenta praevia. He was eutrophic. Apgar score was 10 at 1 and 5 minutes. He secondary developed a respiratory distress syndrome. He was then ventilated by nasal CPAP. Immediately after an umbilical venous catheterization, a tachycardia appeared without preexistent cardiac dysfunction. An intravenous dose of adenosine (Striadyne®) showed a characteristic sawtooth pattern of P waves on inferior leads. The cardiac-US examination was normal. This atrial flutter was converted to normal sinus rhythm by transoesophageal pacing, without adjonction of antiarythmic drugs. The newborn was weaned from mechanical ventilation 48 hours later and discharged from hospital at seven days post natal age. His development and clinical examination were normal two months later.Conclusion. – The isolated atrial flutter is rare in the neonate. It may be triggered by a venous catheterization. Transoesophageal atrial pacing is safe and effective for conversion. [Copyright &y& Elsevier]

Résumé: Dans une démarche qui vise à uniformiser les procédures d’allogreffe de cellules souches hématopoïétiques, la société française de greffe de moelle et de thérapie cellulaire (SFGM-TC) a organisé les troisièmes ateliers d’harmonisation des pratiques en octobre 2012 à Lille. Le but de ces ateliers est de trouver un terrain d’entente entre les centres qui le souhaitent dans les domaines où la littérature ne fournit pas de réponses incontestables et consensuelles. Dans cet atelier nous abordons l’allogreffe de cellules souches hématopoïétiques à partir d’un sang cordon non apparenté en précisant quelle unité choisir. [ABSTRACT FROM AUTHOR]

Introduction: L’objectif de cette étude a été d’évaluer la prévalence des femmes enceintes non immunisées contre la toxoplasmose dans notre contexte. Patientes et Méthodes: En salle d’accouchement ont été réalisés des prélèvements au sang du cordon chez les femmes enceintes, à terme, qui n’ont pas eu de sérologies durant leur grossesse. Résultats: Sur les 500 femmes étudiées, la grossesse a été suivie dans 89,3 %. 14,4 % de ces femmes étaient du milieu rural et 85,6 % du milieu urbain. Leur âge moyen était de 33,6 ans avec des extrêmes de 16 et 44 ans. 57,7 % étaient non immunisées. L’analyse des résultats par milieu de résidence a montré que 55 % des femmes issues du milieu rural étaient immunisées contre seulement 38,6 % issues du milieu urbain. Lorsqu’on s’intéresse au groupe des femmes non immunisées on constate que leur âge moyen était de 26,7 ans et qu’elles étaient pour la majorité à leur deuxième grossesse. Conclusion: Ces résultats confirment la nécessité de généraliser au Maroc les sérologies de toxoplasmose en prénuptial, ou au moins en début de grossesse en vue de dépister les femmes non immunisées, de plus en plus nombreuses en milieu urbain, afin de leur fournir les conseils nécessaires pour prévenir la séroconversion en cours de grossesse. [ABSTRACT FROM AUTHOR]

Le système rénine-angiotensine est impliqué dans le développement fœtal et l’adaptation à la vie extra-utérine. Chez le nouveau-né, il est peu décrit et aucune valeur normale n’est établie pour la rénine ou l’aldostérone. Ce travail a étudié les évènements périnatals pouvant influencer ces 2 hormones. Nous avons réalisé 129 prélèvements au sang de cordon. Cette étude mono-centrique a été descriptive, puis analytique (uni et multivariée) grâce à un recueil de données maternelles et périnatales. Soixante-trois nouveau-nés à terme et 66 prématurés ont été inclus au cours des 6 mois d’étude. Concernant l’aldostérone, nous avons observé une corrélation linéaire des taux en fonction de l’âge gestationnel. Les variables « toxémie », « corticothérapie anténatale », « anomalie du rythme cardiaque fœtal » et « prématurité » influencent négativement cette hormone. Aucune variable n’influence de façon significative la rénine. Les valeurs seuils des 2 hormones révèlent des chiffres bien supérieurs à ceux de l’adulte. Nos données sont similaires aux études précédentes (souvent animales). L’effet endocrine de l’aldostérone fluctue significativement selon le contexte périnatal. L’absence de variations de la rénine tient sans doute à ses effets plus paracrines qu’endocrines chez le fœtus. [ABSTRACT FROM AUTHOR]