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Introduction l´insuffisance pondérale à la naissance est considérée comme l´un des plus importants indicateurs de chances de survie d´un nouveau-né et un risque majeur de morbidité, de mortalité périnatale et infantile. L´objectif de cet article est d´étudier les facteurs associés à l´insuffisance pondérale à la naissance au Centre Hospitalier de Kingasani, à Kinshasa. Méthodes une étude rétrospective de type cas-témoins a été réalisée. Les informations sur les parturientes et leurs enfants nés du 1er janvier au 31 décembre 2016 ont été collectées dans le registre de la maternité du Centre Hospitalier Kingasani. Quatre cent cinquante-huit (458) cas (moins de 2500 grammes) ont été comparés aux 458 témoins (2500-4000 grammes). L´analyse multivariée a été faite à l´aide de la régression logistique binaire pour identifier les facteurs associés au faible poids de naissance. Résultats en 2016, 3451 naissances vivantes ont été enregistrées et la prévalence de l´insuffisance pondérale a été estimée à 13,27%. Il a été trouvé, dans l´analyse bivariée, que la parité, le terme de grossesse, le type de grossesse et le sexe du nouveau-né sont des variables significativement associées à l´insuffisance pondérale à la naissance. Après ajustement sur les variables intégrées dans l´analyse multivariée, la parité, le terme de grossesse et le type de grossesse sont demeurés significativement associées à l´insuffisance pondérale à la naissance. Conclusion de ces résultats, nous suggérons la promotion des études intégrant tous les paramètres impliqués dans la survenue de l´insuffisance pondérale à la naissance pour suivre l´évolution régulière de ce problème et des facteurs associés.

Because of the postnatal redistribution of the iron store, the term infant born after an uneventful pregnancy virtually needs no iron during its first 6 months of life. On the other hand, several factors, such as duration of gestation, gender, mother's iron status, alteration of the iron placental transfer, significantly influence the iron store at birth. Because of their reduced body store at birth and their higher demand during catch-up growth, low birth weight infants should receive an iron supplement, which should be started earlier and given at a higher dose in the more premature infants. This preventive strategy can be given as enteral supplement, preterm formula, or enriched breast milk. Finally, because of its benefits on neonatal morbidity and iron status, delayed umbilical cord clamping is recommended for preterm infants.

Exposure of pregnant women to fine particulate matter2.5μm in diameter (PM

Our objective was to evaluate the relevance of the Institute of medicine (IOM) guidelines of weight gain during twin pregnancies, published in 2009.We systematically reviewed the data from Medline and the Cochrane Library databases. We only selected the articles which studied the neonatal and maternal outcomes according to maternal gestational weight gain (GWG), depending on the prepregnancy BMI (body mass index). Five clinical parameters had been mainly studied: gestational hypertensive disorders (gestational hypertension and preeclampsia), gestational diabetes mellitus (GDM), preterm births, and birth weights.We identified 8 articles, corresponding to our inclusion criteria. They all present methodological weaknesses (observational retrospective design, small population samples and there were sometimes issues to properly determine the GWG). An excessive weight gain was associated with an increasing of gestational hypertensive disorders. Regarding GDM, the results were inconsistent, suggesting a poor correlation between GWG and occurrence of GDM. Preterm births and low birth weights were more frequent when the GWG did not reach the recommendations.Although based on low scientific evidence, the IOM recommendations for GWG in twin pregnancies should be used in daily practice.

Pregnancy is a particularly risky moment for periodontal and oral healthcare. The main diseases encountered are the development or worsening of carious lesions and gestational periodontal diseases such as gingivitis, epulis or gestational periodontitis. There is a lack of knowledge from health professionals and their patients, firstly on the link between poor oral hygiene and the impact on pregnancy, and secondly on the feasibility of oral care during pregnancy. There is a link between periodontal diseases and the increase of premature delivery risk, child with low birth weight and pre-eclampsia. Periodontal care during pregnancy would lower this risk. However, no link has been highlighted to date between oral care provided during pregnancy and the reduction of premature delivery or even of pre-eclampsia. Loco-regional anaesthesia and taking x-ray images-even dental panoramic radiography-are not contraindicated for pregnant women. All periodontal and oral care can be performed during pregnancy, at all gestational ages.

The persistent ductus arteriosus remains a common congenital pathology. Although percutaneous closure of wide channels using an Amplatzer Duct Occluder is an attractive alternative to the surgical treatment, this prosthesis is not recommended for infants weighing less than 6kg.The objective was to evaluate the efficacy and safety of this prosthesis in low-weight children.The records of children weighing less than 6kg who underwent closure with the Amplatzer Duct Occluder prosthesis between January 2010 and December 2014 were retrospectively analyzed.Fourteen patients (mean weight: 5.7kg [range: 4.8-6]; mean age: 6.5months [range: 3-12]) were included. The main circumstance for discovery was difficulty in breathing (93% of children). The average angiographic persistent ductus arteriosus diameter was 3.5mm (range: 3-6mm), correlating well with that found on ultrasound (r=0.68). The prosthesis was implanted successfully in 93% of cases. The only failure was explained by the increased risk of aortic subocclusion. The immediate angiographic occlusion rate was 71%. The average duration of the procedure was 46±12min. Three children had a channel C-type on the Krichenko classification. Two complications occurred in two patients: a case of cardiac tamponade drained during the procedure without incident and one case of partial protrusion of the Amplatzer disk into the aortic lumen. C-type (tubular) persistent ductus arteriosus and a ratio of the diameter of the persistent ductus arteriosus/weight greater than 0.95 were significantly associated with intervention failure and/or major complications during the percutaneous closure, while weight of less than 6kg was not retained as a predictor of procedure failure. No late embolization occurred after 11months of median follow-up. During this monitoring, we noted a marked clinical improvement with normalization of pulmonary pressure.This study includes the few records reported in the literature assessing the feasibility of percutaneous closure in persistent ductus arteriosus in infants weighing up to 6kg. It confirms the effectiveness of the procedure with a relatively low prevalence of complications.

Low birth weight (LBW) constitutes a major public health problem, both in developed than in developing countries, due to its extent and its strong association with childhood morbidity and mortality.to estimate prevalence of low birth weight and determine its related factors in the Prefectoral Hospital in Mohammedia.We carried out a cross sectional study from May to July 2012 which concerned 713 newborns and theirs mothers. We collected information about socioeconomic and anthropometric factors and characteristics of pregnancy. A multivariate analysis was performed.Among the 713 studied newborns, 38 had LBW; the prevalence of LBW was 5,3% (95% CI: 3,7%-6,9%). Factors significantly associated with LBW in multivariate analysis were: mother age ( OR 9,27; IC95%:2,15-39,85), prematurity (OR 9,34; IC95%:1,29-67,32), twin pregnancy (OR 195,07; IC 95%:30,38-125,39) and gender of new born (OR 5,26; IC 95%:1,61-17,18). Well-balanced diet (OR 0,12; IC 95%:0,04-0,34) and hours of sleep equal or more than 8 per day (OR 0,20; IC 95%:0,07-0,58) were protector factors.Actions of education, screening and treatment of the diseases occurred in the pregnancy are necessary. Facilitating the access of pregnant women to high quality antenatal care, promoting a healthy lifestyle as a balanced diet, fighting against the active and passive smoking and offering a psychological support to the pregnant woman is necessary to reduce the prevalence of LBW and to improve the maternal and child health.

Social insecurity is a known perinatal risk factor but beyond that, a social gradient in perinatal health is observable. This social gradient is particularly visible for the risk of neonatal mortality from congenital anomalies, premature delivery, and low birth weight. Analysis of mechanisms that would explain how the different dimensions of the social status of women interact with perinatal health indicators are not to this day fully understood. However, numbers of intermediate factors related to both the social status and perinatal risk have been identified. Among them, smoking, drug use, exposure to psychological and physical stress, genital infections, access to care, or drudgery. Finally, it was observed that the interaction of social conditions with the level of maternal education, geographic or ethnic origin, and the environment in which women live are complex and make the generalization of data obtained in a particular context sensitive.

Kangaroo care (KC) is an effective method to care for low birth weight (LBW) newborns, particularly in developing countries. The objective of this study was to estimate the efficacy of this method and its impact on morbidity and mortality of LBW infants admitted to the KC unit of Albert-Royer National Children's Hospital Center (ARNCHC) in Dakar, Senegal.This was a retrospective, single-center study from July 2011 to July 2013. We collected sociodemographic, maternal, and obstetrical data, neonatal characteristics and information during KC (age and weight at inclusion, thermoregulation, feeding, growth, and overall progression). Data were entered and analyzed using SPSS version 9.0.We included 135 newborns, with a female predominance (sex ratio: 0.78). One-third of the mothers (35.5%) were primiparous and only 21.1% had a socioprofessional activity and the majority had a low educational level. The mean gestational age (GA) was 33.08±2.06 weeks of amenorrhea and the mean birth weight 1485±370 g. There were 20 term babies with intrauterine growth restriction (IUGR) (14.8%) and 115 (85.2%) preterm newborns, 83 (72.2%) of whom, showed IUGR. The mean duration of conventional care was 12.3 days (range: 4-27 days) and the main complications were respiratory distress (46.2%), infection (36.9%), and necrotizing enterocolitis (15.1%). At KC admission, the mean post-conceptional age was 34.2±2.46 weeks and the mean weight 1445±319 g (minimum, 700 g). The main complications in KC were infections (20.2%), hypoglycemia (18.5%), and gastro-esophageal reflux disease (16.4%). Only 56.3% of the babies were exclusively breastfed. The mean weight gain during the stay in the KC unit was 15.3±9.08 g/kg/day and the mean weight at discharge was 1761±308 g. Only three episodes of hypothermia were noted. The mean duration in the KC unit was 10.2 days (range: 3-24 days). Five babies died (3.7%): one during KC, one at home, and the three others after readmission to neonatology.Kangaroo care for LBW infants is highly effective in our context. This method should be spread to a large majority of health centers in the country.

Advances in lung transplantation allow the women of childbearing age to consider becoming mothers. When planning to become pregnant, a therapeutic drug management of immunosuppressive drugs and associated therapies is required. It must take into account teratogenic and fetotoxic drugs, as well as pharmacokinetic changes encountered during pregnancy. Increasingly data are currently available on the management of immunosuppressive drugs and associated therapies during pregnancy. We report the case management of drug therapy before and during pregnancy in two patients after a lung or heart-lung transplantation. To prevent the emergence of complications for mother and child, a literature review has been necessary to manage drug therapies of each patient.

Introduction Evaluer l'influence de l’âge maternel et de la parité sur la naissance d'un faible poids de naissance (FPN) à Lubumbashi. Méthodes Il s'agit d'une étude basée sur une analyse documentaire des dossiers médicaux des accouchées enregistrées dans les maternités des 10 hôpitaux généraux de référence (HGR) de la ville de Lubumbashi en République Démocratique du Congo entre le 1er décembre 2013 et le 31 mars 2014. Ces accouchées ont été réparties en deux groupes, en fonction du poids de naissance de leurs enfants: groupe I (femmes ayant accouché de nouveau-nés vivants dont le poids était inférieur à 2500 grammes) et groupe II (femmes ayant accouché de nouveau-nés vivants dont le poids était supérieur ou égal à 2500 grammes). Il s'agissait dans tous les cas de grossesses monofoetales âgées de 28 semaines ou plus. L’âge maternel et la parité ont été étudiés et comparés dans les deux groupes. Les données ont été analysées à l'aide des logiciels Épi info version 7.0 et SPSS version 19. Les différences étaient jugées significatives pour un seuil p < 0,05. Résultats La prévalence du FPN chez les nouveau-nés issus de ces accouchées était ainsi de 6,4% (71/1112). En analyse univariée, les femmes d’âge < 20 ans présentent un risque multiplié par 2,47 fois d'avoir un nouveau-né de FPN comparativement à celles de ≥20 ans (OR = 2,47; IC95%: 1,26-4,78) et celui pour les primipares d'avoir un enfant de FPN est 2,3 fois supérieur à celui de multipares (OR = 2,32; IC95%: 1,34-3,99). En faisant la régression logistique, nous avons observé que seule la parité est significativement corrélée au poids de naissance (OR ajusté = 2,61; IC95%: 1,43-4,74). Conclusion L’étude que nous avons menée montre que le taux de FPN diminue considérablement avec l’âge de la mère à partir de 20 ans et la multiparité.

Enteroviruses (EVs) are among the most common viruses infecting humans. One-third of EV infections affect children under 1 year of age. Neonatal EV infections lead to a wide range of clinical manifestations, from mild febrile illness to severe, potentially fatal sepsis-like conditions with multiorgan failure. EV detections by serotype are reported by the National Reference Centre for EV Infections Lyon on a monthly basis. Demographic, clinical, and biological data were also collected in neonates hospitalized in 2012 for EV infection. Two subgroups were identified according to the beginning of symptoms: until 8 days of life (D8) or strictly after D8. There were 120 neonatal EV infections. Before D8, children with severe infection were born more prematurely with a low birth weight. The EVs most commonly detected in neonates were CV-B4 and E-11. Risk factors for severe EV infections included liver (73% before D8) and hematological damage (thrombocytopenia, 82%; coagulopathy, 64% before D8). This study suggests that systematic serotyping of neonatal EV infections and biological monitoring of liver function could be useful for early identification of children at high risk of clinical severity and fatality.

We evaluated associations between ecological variables and the risk of very small for gestational age (VSGA) birth in Quebec in 2000-2008.Ecological variables came from the Canadian Community Health Survey, the Canadian census and Quebec's birth registry; individual variables also came from Quebec's birth registry. Odds ratios (ORs) adjusted for mother's age, academic qualification, parity, marital status and country of birth were estimated using multilevel logistic regression (generalized estimating equations method).Births in neighbourhoods with a high proportion of people leading a sedentary lifestyle (OR: 1.07, 95% confidence interval [CI]: 1.01-1.11) and those with a high/middle proportion of residents with food insecurity (OR: 1.09, 95% CI: 1.05-1.15; OR: 1.05, 95% CI: 1.01-1.11) had higher odds of VSGA birth. Those with middle proportion of married residents had lower odds of VSGA birth (OR: 0.94, 95% CI: 0.90-0.98).Incidence des caractéristiques individuelles et des caractéristiques du contexte sur les nouveau-nés de faible poids : une étude d’observation au Québec.Nous avons analysé les liens entre certaines variables contextuelles, certaines caractéristiques des mères et le risque de donner naissance à des nouveau-nés très petits pour l’âge gestationnel (TPAG) au Québec entre 2000 et 2008.Les variables liées au contexte ont été tirées de l’Enquête sur la santé dans les collectivités canadiennes, du Recensement canadien et du Registre des naissances du Québec. Les variables individuelles provenaient aussi du Registre des naissances du Québec. Les rapports de cotes (RC), ajustés selon l’âge de la mère, la scolarité, la parité, l’état matrimonial et le pays de naissance, ont été évalués au moyen de modèles de régression logistique multiniveau (par des équations d’estimation généralisées).Les naissances survenues dans les quartiers présentant une proportion élevée de résidents sédentaires (RC : 1,07, intervalle de confiance [IC] à 95% : 1,01 à 1,11) et dans les quartiers présentant une proportion moyenne (RC : 1,09, IC à 95% : 1,05 à 1,15) ou élevée de résidents souffrant d’insécurité alimentaire (RC : 1,05, IC à 95% : 1,01 à 1,11) présentaient un risque accru d’être TPAG. Le risque de naissance de nouveau-né TPAG était plus faible dans les quartiers présentant une proportion moyenne de résidents mariés (RC : 0,94, IC à 95 % : 0,90 à 0,98).

The Neonatal Intensive Care Unit (NICU) of our hospital has a 30% survival rate among babies born premature weighing1,000g. This hospital serves about 10 million people; there was no retinopathy of prematurity (ROP) screening program in place in Nigeria.Babies born premature were recruited based on preset criteria: ≤ 35 weeks Gestation Age and birth weight ≤ 1.9 kg. The first retina examination was done at 3-4 weeks post-delivery and were documented on a proforma and analyzed with SPSS 15 Statistical Package.58 eyes of 29 babies were examined. The birth weight range was 950-1900g, 17(58.6%) babies were ≤ 1500g, and 12 (41.4%) 1500-1900g. The Gestation age range was 27-35 weeks with a mean of 30. Avascularity in retina zones 23 was found in 52(89.6%) eyes mostly among babies32 weeks gestation age and1500g. Risk factors associated with retinal avascularity are highlighted. The challenges were with co-ordination of follow-up visits and accessibility to treatment such as laser and newer treatment methods.A cost effect screening criteria for ROP in Nigeria is suggested to include birth weight ≤ 1500g and gestational age ≤ 32 weeks. Dedicated staffresources for treatment and imaging are needed for a successful program. An opportunity exists to study the effect of genetics on the development and severity of ROP among native African babies.

Intrauterine growth restriction (IUGR) is an obstetrical complication, which by definition would screen in 10% of fetuses in the general population. The challenge is to identify the subset of pregnancies affected with pathological growth restriction in order to allow intervention that would decrease morbidity and mortality.The purpose of this guideline is to provide summary statements and recommendations and to establish a framework for screening, diagnosis, and management of pregnancies affected with IUGR.Affected pregnancies are compared with pregnancies in which the fetus is at an appropriate weight for its gestational age. History, physical examination, and laboratory investigations including biochemical markers and ultrasound characteristics of IUGR are reviewed, and a management strategy is suggested.Published literature in English was retrieved through searches of PubMed or MEDLINE, CINAHL, and The Cochrane Library in January 2013 using appropriate controlled vocabulary via MeSH terms (fetal growth restriction and small for gestational age) and key words (fetal growth, restriction, growth retardation, IUGR, low birth weight, small for gestational age). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies.The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table).Implementation of the recommendations in this guideline should increase clinician recognition of IUGR and guide intervention where appropriate. Optimal long-term follow-up of neonates diagnosed as IUGR may improve their long-term health.

Intrauterine growth restriction indicates that a fetus is unable to achieve its growth potential. The individual growth potential is approximated by customization of growth charts. Neonatal growth charts rely on body weight measures at birth while fetal growth charts rely on body weight estimated from biometric measurements of the fetus. The neonatal and fetal growth charts are not equivalent and have different meanings for epidemiologists and clinicians. Fetal growth charts also assess fetal growth velocity, but individual assessment of fetal weight may be flawed by lack of precision. Neonatal charts are constructed based on data obtained in the whole population or in a subgroup without gestational diseases. The two types of neonatal charts markedly differ at low gestational ages as 30% of preterm infants present intrauterine growth restriction, usually due to maternal diseases. Even if intrauterine growth restriction is a risk factor of fetal mortality, neonatal mortality, and short- and long-term morbidity, the predictive value of the charts (whether or not they are customized) at an individual level is low and may be improved by additional investigations.

In countries with limited health-care resources, achieving the fourth Millennium Development Goal recommended by the WHO requires the reduction of neonatal mortality. Interventions at different levels of the community and the health-care system are needed, including in district hospitals.This was a descriptive study in the neonatal unit of the District Hospital of Bonassama/Douala in Cameroon that analyzed neonatal mortality and morbidity to discover possible intervention levers. The clinical, sociodemographic, and outcome data of hospitalized newborns were recorded from November 2009 to May 2012. The analysis was performed anonymously.During 29 months, 813 infants were hospitalized; 71% were delivered naturally and 16% by cesarean section. Globally, 20% were premature, 55% were male, and 24% had a birth weight of less than 2500 g. At admission, 35% of the infants had hyperthermia and 29% hypothermia. The most common diagnoses were early infection (77%), late infection (22%), jaundice (17%), early adaptation disorders (18%), and hypoxic-ischemic encephalopathy (2.2%). The hospital mortality rate was 8% and the main diagnoses associated with death were: low birth weight, prematurity, hypothermia, and early adaptation disorders with and without encephalopathy. No excess mortality was found for neonates treated for infection.In developing sub-Saharan countries, the main causes of neonatal mortality must be taken care of by hospitals at a peripheral district level. Epidemiological knowledge of neonatal diseases at the peripheral level (district) allows for an estimation of the requirements in terms of competence and equipment. Specific needs for transfer to a superior care unit can be estimated but the high transfer risk and the limited resources of the referral center should be taken into account.

Endocrine disruptors are ubiquitous chemicals contaminants in the environment, wildlife, and humans. Their adverse effects on reproduction are well-documented. There is growing evidence that they can contribute to the current emergence of chronic diseases.Our aim is to assess the relationships between endocrine disruptors and the neonatal health outcomes.Two persons have independently reviewed Medline and Toxline databases about the following pollutants: bisphenol A, phthalates, parabens, brominated flame retardants and perfluorinated compounds. Only the human epidemiological studies, in general population with an abstract available, published between 2007 January the 1st and 2011 December the 31st, were analysed. The quality of each study was assessed with the Strobe score.Twenty-five out of 680 studies were included in the analysis. All pollutants were widely detected in maternal and new borns samples. Most of the studies have shown associations between bisphenol A, brominated flame retardants and perfluorinated compounds and lower birth weight. The effects on gestational age were less documented and have shown no clear connection. Results for phthalates were more ambiguous. Only one non-instructive study was found on parabens.Due to the inherent methological bias on endocrine disruptors research, further additional studies on environmental health must be investigated. It seems necessary to adopt preventive health measures first for vulnerable population.

In neonatal intensive care units, the incidence of nosocomial infection is high. This study aimed to determine the epidemiology of a nosocomial bacterial infection in the neonatal intensive care unit of Mohamed VI university hospital. A total of 702 newborns were included in this study. Of the 702 neonates studied, 91 had developed a nosocomial infection. The incidence rate was 13% and incidence density was 21.2 per 1000 patient-days. The types of infection were: bloodstream infections (89%), pneumonia (6.6%), meningitis (3.3%), and urinary tract infections (1.1%). Nosocomial infection was particularly frequent in cases of low birth weight, prematurity, young age at admission, umbilical venous catheter, and mechanical ventilation. Multiresistant bacteria included enterobacteria producing betalactamase (76.9%), especially enterobacteria that were dominated by Klebsiella pneumoniae (39.7%). The mortality rate was 52.7% in nosocomial infections, 19 (20.87%) of whom had septic shock. The results of this study show that nosocomial infection is an intrahospital health problem that could be remedied by a prevention strategy.

Low birth weight (LBW) increases the risk of infant death, but little is known about its rate and determinants among babies born to HIV-infected mothers in sub-Saharan Africa.This study was conducted in South Africa, Burkina Faso, Uganda and Zambia, during the recruitment process of the PROMISE-PEP (ANRS 12174) clinical trial. The study sample included 1196 subjects screened between August 2009 and December 2011, respectively 254 in South Africa, 221 in Burkina Faso, 197 in Uganda and 524 in Zambia, all ineligible for antiretroviral therapy. Data were collected during ANRS12174 clinical trial antenatal and postnatal screening visits, and during an inclusion visit for completion of an electronic case report form (eCRF).The mean (±SD) age of mothers was 27±5years and their mean CD4 count was 576±195cells/μL. Most mothers lived in a couple (78.7%), had no employment (72.3%) and had a good level of education (74% had gone to school). Male newborns predominated (51.7%). The mean birth weight was 3043g±435g, and 7.8% ([95%CI: 6.3%-9.3%]) of newborns weighed less than 2500g. In univariate analyses, being married or cohabiting, body mass index, WHO HIV disease stage II, female newborn and low gestational age were associated with risk of LBW. In multivariate regression model, low gestational age (aOR=3.74, P0.0001) and female newborn (aOR=1.63, P=0.04) were significantly associated with LBW.The risk factors for LBW found in HIV-infected women ineligible for antiretroviral therapy were the same as in the general population. There was no evidence of additional risk factors associated with HIV infection.

To study the epidemiological, clinical, and bacteriological aspects as well as the outcome of neonatal bacterial meningitis and analyze the factors of poor prognosis of this condition.We report a retrospective analysis of 44 cases of neonatal bacterial meningitis hospitalized in the pediatric unit of Tahar Sfar Hospital in Mahdia, Tunisia, between January 1996 and December 2010. Inclusion criteria were infants less than 29 days of age who were hospitalized for bacterial meningitis diagnosed on either the presence of bacteria in cerebrospinal fluid or with more than 50 cells/mm(3), predominance of neutrophils, and the protein level greater than 1.2g/l. Clinical data were obtained through the analysis of patient files. Statistical analysis was based on the Chi(2) test, and P-values less than 0.05 were considered statistically significant.The incidence of neonatal bacterial meningitis was 0.49 per 1000 live births. The patients were premature in 20.4 % and low birth weight in 13.6 % of cases. The clinical presentation was not specific for most cases. The main signs at admission were hyperthermia (43.2 %), refusal to nurse (20.4 %), seizures (18.2 %), and respiratory distress (13.6 %). The cerebrospinal fluid culture was positive in 36.4 % of cases. The group B streptococcus was the most frequently isolated (62.5 %) followed by Escherichia coli (12.5 %). The association of cefotaxime-ampicillin-gentamicin was used as the first treatment in all cases. Ofloxacin was associated with initial antibiotic therapy during the first 5 days in 20.4 % of cases. The mortality rate was 15.9 % and the rate of neurological sequelae in survivors was 21.6 %. Prematurity, low birth weight, shock, respiratory distress, and pleocytosis of less than 500 cells/mm(3) were the main factors of a poor prognosis. The addition of ofloxacin to the initial antibiotic therapy was associated with a decreased rate of neurological sequelae in survivors (11 % vs. 25 %, P=0.042).This study emphasizes the severity of neonatal bacterial meningitis with high rates of mortality and neurological sequelae, especially in premature and low birth weight infants. An early diagnosis and effective antibiotic therapy is needed to improve the prognosis.

The authors describe the methods and results of the main early intervention programs after discharge in the families of premature infants. There is great variability between the studies concerning the type, frequency, and length of interventions and the length of follow-up. Inconsistent improvement in cognitive and behavioral outcomes in the first 2years of life and at preschool age were noted. Most recent studies underscore that the intervention should take into account parental psychological status, focus on parent-infant interaction, and last a sufficiently long time.

Vitamin D plays a key role in calcium-phosphorus homeostasis and bone metabolism, but it is also involved in numerous others tissues. Vitamin D deficiency among pregnant women is frequent in many populations over the world. It is associated with an increased risk of preeclampsia, gestational diabetes mellitus, and caesarean section. Consequences in newborns are low birth weight, neonatal rickets, a risk of neonatal hypocalcemia, asthma and/or type 1 diabetes. Therefore, prevention of vitamin D deficiency among pregnant women is essential. The currently recommended supplementation amount of vitamin D is not sufficient to maintain a value of 25 hydroxy vitamin D above 30 ng/ml, during pregnancy. Randomized controlled trials during pregnancy are necessary to evaluate the amount of vitamin D sufficient to avoid the consequences of vitamin D deficiency.

In Tunisia, despite the activities of national programs of maternal and child health, low birth weight (LBW) remains common. The aim of this study is to draw up the epidemiological profile of the LBW in the region of Monastir and to study the chronological trends of the associated factors during a period of 14 years (1994-2007). We conducted a population study which interest 97.630 live births (from 26 to 43 weeks) in the public maternities of the region of Monastir. The mean's age of pregnant women was 28.7 +/- 5.5 years. Among them 14.2% were aged 35 and older and 40% were primipara. Newborns were in term in 94.7% of cases. Maternal age, prenatal care, twin pregnancies and fetal complications were the factors independently associated with the occurrence of LBW in term newborns. However, only prenatal care and twin pregnancies were independently associated to LBW in preterm newborns. During the fourteenth years of the study the parturient mean age and the frequency of preterm birth increased significantly (P0.001) while the frequency of multiparty decreased significantly (P0.001). We found that the risk factors of LBW (advanced age, multiparty, etc.) are still common in our country and require targeted interventions.

In France, new care units have emerged in maternity wards for the treatment of moderate prematurity, called mother-child units (MCU). We compared the length of hospitalization between the MCUs and the neonatal units (NNUs) for premature infants born at 34 weeks of amenorrhea at Grenoble university hospital. This was a retrospective, single-center study, including 99 premature infants born from 34 of amenorrhea to 34 weeks+6 days between 2004 and 2009. Were included all premature 34-week infants hospitalized in the NNU or the MCU excluding those with respiratory distress, birth defects, and including infants whose birth weight was less than 1500g admitted to the neonatal intensive care unit or transferred secondarily to the MCU. The characteristics of both groups were similar apart from a lower birth weight in the NNU group (1892 vs. 2182g) and gestational age less than in the NNU group (34.1 vs. 34.3 SA). Our primary outcome, length of hospital stay, was significantly shorter in the MCU (15.4 vs. 20.7 days in the NNU, P0.01) as well as the duration of nasogastric tube feeding (2.8 vs. 9.1 days, P0.01). This difference remained after adjustment for birth weight and gestational age. Our retrospective study shows that the length of hospitalization of premature infants born at 34 weeks gestation and hospitalized in our center is significantly shorter when they are admitted to the MCU rather than neonatology. For this reason, this mode of hospitalization in maternity MCUs can be recommended.

The aim of this work is to determine periodontal disease's prevalence in preterm delivery (before 37 weeks of gestation) and find a significant association between preterm birth and periodontal diseases. Periodontal status was determined. Status and severity were noted and correlated to term of delivery. Fifty-two patients were included in the study. Periodontal disease's prevalence was 33% for gingivitis and 44% for periodontitis. No significant correlation was found (P=0.41). Periodontal disease's prevalence is agreed with literature review. The different opinion are largely discussed. Methodological harmonization of periodontal definitions is needed to increase study's power.

In developing countries, maternal and neonatal mortality is high. Among the causes of death during the neonatal period, low birth weight is crucial. A dose of fluoride beyond 2mg/L causes enamel damage, possibly affecting the fetus. The aim of this study was to search for an association between dental fluorosis in the mother and low birthweight of the newborn.This was a case-control study performed in an endemic area in Senegal (Diourbel). It included 108 mothers who gave birth to newborns weighing less than 2500 g (cases) and 216 mothers with newborns weighing greater or equal to 2500 g (controls). Data on socio-demographic, lifestyle, history and pregnancy variables were collected. Those related to water consumption during pregnancy and dental fluorosis (Dean's index) were measured. The data were analyzed by R software. Logistic regression was used to identify associations and the statistical significance level was set to 0.05.The proportions of mothers consuming well water were 62% among cases versus 43.5% among controls. The score 4 of Dean's Index was reported for 25.9% of cases versus 6.9% of controls. The water consumed and the modal score of Dean's Index were significantly associated with the occurrence of low birthweight adjusted for gender, consanguinity, anemia and hypertension.Low birthweight was associated with pregnant women living in endemic areas. Defluoridation programs and access for pregnant women and children to high quality water are necessary in areas of endemic fluorosis.

To study the maternal risk factors and perinatal complications of a short interpregnancy interval.Retrospective case-control study between 2007 and 2009, comparing a group with a short interpregnancy interval (less than 9 months, n=83), and a control group (interval between two pregnancies between 18 and 24 months, n=166).The main risk factor of short interpregnancy interval is to be unemployed (OR=3.2, P0.001). There is a significant link between lack of prescription contraceptives in postpartum and a short interval between pregnancies (OR=3.4, P0.001). We also found a higher rate of anemic women during pregnancy (OR=4.9, P=0.001) and postpartum (OR=2.1, P=0.02) in case of short interpregnancy interval. Short interpregnancy interval increases risk of small for gestational age (OR=2.4, P=0.05) and thermoregulation disorders (OR=3.1, P=0.02).A low socioeconomic level is a risk factor of short interpregnancy interval. Short interpregnancy interval is at risk of maternal iron deficiency and neonatal complications like low birth weight and hypothermia.

Newborns and particularly preterm infants are a population at high risk of transfusion. The implementation of strategies to prevent transfusion by reducing blood loss, use of recombinant human erythropoietin, administration of iron and vitamins and delayed umbilical cord clamping have reduced the frequency of transfusions neonatal periods. The emergence of more stringent recommendations on indications for transfusion has been involved in this development. Various transformations and qualifications for red cell concentrates, platelet concentrates and fresh frozen plasma must be known to better adapt the blood products to newborn term and preterm according to their pathologies. Preparing pediatric units from a single donor for repeated transfusions reduces the allo-immune and infectious risks.

Inflammatory bowel diseases (IBD), including Crohn's disease and ulcerative colitis, are invalidating inflammatory affections, which evolve by relapse interrupted with clinical remission. Crohn's disease commonly affects young women in their reproductive years with a peak of incidence between 20 and 30. Infertility and sexual dysfunction are equivalent to that of the general population while they are increasing in patients with active IBD or after colorectal surgery. IBD are well controlled by medical treatments and the frequency of relapse during the pregnancy is similar to that of the non-pregnant IBD patients. The data concerning the risk of congenital malformations in IBD are contradictory. The risk of preterm delivery and low birth weight is significantly increased and correlated to the disease activity. When a medical treatment insures a quiescent disease before the pregnancy, it is advisable to continue it during the pregnancy because the benefits of controlled disease outweigh the risks of medication. IBD, possible perianal lesions and colorectal surgical interventions influence the mode of delivery, but the indication of caesarean section should primarily be governed by obstetric necessity. Preconceptional counseling seems desirable because of the risks during pregnancy, according to the disease activity, the surgical histories and the therapeutic agents.

To assess the glycemia of low-weight newborns (LWNBs) during their first 24h of life as well as their mother's glycemia.This was a cross-sectional prospective study within a case-control group, conducted at Lomé University Hospital (nationwide main hospital) from January to May 2006. One hundred thirty-nine LWNBs and 150 eutrophic term newborns (ETNBs), 98 mothers of LWNBs (MLWNBs), and 145 mothers of ETNBs (METNBs) were screened and monitored on glycemia dosage.The average glycemia level of the LWNBs (0.34 ± 0.27g/l) was significantly greater than the ETNBs' glycemia level (0.30 ± 0.14 g/l); it was nearly the same for the mean glycemia level of the MLWNBs (0.82 ± 0.2g/l) and the METNBs (0.77 ± 0.1g/l). Neonatal hypoglycemia during the first 24h of life was less frequent (RR=0.8) in the LWNBs (61.15%) than in the ETNBs (80%). The positive correlation between gestational age and glycemia was higher in the ETNBs (r=0.17) than in the LWNBs (r=0.07). This positive correlation between birthweight and glycemia was lower in the LWNBs (r=0.17) compared to the ETNBs (r=0.37); this was not the case within the group of the ETNBs (r=0.02) compared to the group of the LWNBs (r=0.34) concerning the correlation between the glycemia of mothers and newborns.The early hypoglycemia was much greater in the ETNBs compared to the LWNBs. Therefore, it is necessary to systematically start breastfeeding all newborns within their first hours of life whatever their gestational age, in order to solve these metabolic disorders.