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Introduction The anatomy and embryology of the nail are well known, and nail abnormalities are a feature of many genodermatoses. However, the physiological aspect is not well described. We aimed to analyse the physiological features of nails in healthy newborns. Methods We performed an observational, prospective study at University Hospital Center of Tours between July and October 2015. Newborns were included by a dermatologist assistant during the systematic examination on release of the mother from the hospital. The medical history of the mother and infant were recorded by using a standardized questionnaire. Finger- and toenails were systematically photographed for a second interpretation by a dermatologist with blinding to the first photograph. Results Fifty-eight patients were eligible, and 52 were included. Half of the newborns were males, and the mean age at inclusion was 3.6 ± 1.2 days. Fingernails had an oval shape (71.1%) or a flat curvature (63.5%), and half had a lunula. Toenails showed an apparent hypertrophy of the proximal nail fold (38.4%) and lateral nail fold (73.1%). The shape of the nails was triangular (50.0%) or round (21.1%). We noted koilonychia in 32.7% of infants and lunula in 7.7%. Distal parts showed onychoschizia (28.8%) and onycholysis (26.9%). Conclusion Koilonychia, onychoschizia of toenails or absence of lunula are physiological features of nails in newborns.

Bien qu'une augmentation de l'incidence et de la severite des infections invasives au streptocoque du groupe A (SGA) durant ces dernieres decades ait ete constatee par plusieurs auteurs, les meningites dues a cette bacterie restent exceptionnelles chez le nouveau ne et leur physiopathologie est encore mal connue. A travers ce travail nous allons rapporter le cas d'une meningite neonatale a SGA diagnostiquee au sein de notre formation, avec revue de la litterature s'interessant a ces meningites.

Les érythrodermies du nouveau-né sont des tableaux rares, d'évolutions chroniques et potentiellement mortelles. Leurs étiologies sont diverses et variées dominées par les ichtyoses, le déficit immunitaire primaire, ou plus exceptionnellement le psoriasis sévère, les maladies métaboliques, la dermatite atopique ou une cause infectieuse. La détermination rapide de la cause sous-jacente est cruciale pour une meilleure prise en charge. Cependant, le diagnostic constitue un défi pour le clinicien et est souvent retardé en raison de la nature non spécifique des signes cliniques et histopathologiques. L'objectif de notre travail est de rappeler aux praticiens une étiologie grave de l'érythrodermie néonatale: le déficit immunitaire ceci à travers l'observation d'un nourrisson suivi pour une érythrodermie évoluant depuis la naissance, hospitalisé pour une fièvre prolongée, et chez qui un interrogatoire minutieux, un examen clinique soigneux, ainsi que l'évolution ont pu redresser le diagnostic vers un déficit immunitaire.

Background Individuals may be homozygous (SS) or heterozygous (AS) sickle cell gene carriers or have normal adult haemoglobin (AA). Haemoglobin S could have a protective role against malaria but evidence is sparse and the operating mechanisms are poorly known. Methods We followed two cohorts of children. The first was enrolled at birth (156 newborn babies) and the second at 24‐36 months old (84 children). Both cohorts were followed for 30 months; monthly for parasitological data and half yearly for immunological data. Results In the first cohort, 22%, and in the second 13% of children were AS. Whatever their age parasite prevalence rates were similar in AA and AS individuals. Mean parasite densities increased less rapidly with age in AS than in AA children, and were significantly lower in AS than in AA children .48 months old. The AA children tended to be more often admitted to hospital than AS children (22% versus 11%, NS). Both anti-Plasmodium falciparum and anti-Pf155/RESA antibody rates increased more rapidly in AA than in AS children. Conversely, the prevalence rate of cellular responders to the Pf155/RESA antigen was similar in AA and AS children during the first 2 years of life, then it was higher in AS than in AA children. Conclusions Sickle cell trait related antimalarial protection varies with age. The role of the modifications of the specific immune response to P. falciparum in explaining the protection of AS children against malaria is discussed.

International audience; Background: Renal failure in neonates is associated with an increased risk of mortality and morbidity. But critical values are not known. Objective: To define critical values for serum creatinine levels by gestational age in preterm infants, as a predictive factor for mortality and morbidity. Study Design: This was a retrospective study of all preterm infants born before 33 weeks of gestational age, hospitalized in Nantes University Hospital NICU between 2003 and 2009, with serum creatinine levels measured between postnatal days 3 to 30. Children were retrospectively randomized into either training or validation set. Critical creatinine values were defined within the training set as the 90th percentile values of highest serum creatinine (HSCr) in infants with optimal neurodevelopmental at two years of age. The relationship between these critical creatinine values and neonatal mortality, and non-optimal neural development at two years, was then assessed in the validation set. Results and Conclusion: The analysis involved a total of 1,461 infants (gestational ages of 24-27 weeks (n=322), 28-29 weeks (n=336), and 30-32 weeks (803)), and 14,721 creatinine assessments. The critical values determined in the training set (n=485) were 1.6, 1.1 and 1.0 mg/dL for each gestational age group, respectively. In the validation set (n=976), a serum creatinine level above the critical value was significantly associated with neonatal mortality (Odds ratio: 8.55 (95% confidence interval: 4.23-17.28); p

PURPOSE: In the last 8 years, numerous cohort studies have been conducted to estimate the rate of mother-to-child transmission (MTCT) of HIV. Many of these have faced problems in data collection and analysis, making it difficult to compare transmission rates between studies. This workshop on methodological aspects of the study of MTCT of HIV-1 was held in Ghent (Belgium) in February 1992. STUDY SELECTION AND DATA EXTRACTION: Fourteen teams of investigators participated, representing studies from Central (five) and Eastern Africa (three), Europe (two), Haiti (one) and the United States (three). A critical evaluation of the projects was carried out, under four headings: (1) enrollment and follow-up procedures, (2) diagnostic criteria and case definitions, (3) measurement and comparison of MTCT rates and (4) determinants of transmission. RESULTS OF DATA ANALYSIS: Reported transmission rates ranged from 13 to 32% in industrialized countries and from 25 to 48% in developing countries. However, no direct comparisons could be made because methods of calculation differed from study to study. Based on this review, a common methodology was developed. Agreement was reached on definitions of HIV-related signs/symptoms, paediatric AIDS and HIV-related deaths. A classification system of children born to HIV-1-infected mothers according to their probable HIV infection status during the first 15 months of life, allowed the elaboration of a direct method of computation of the transmission rate and of an indirect method for studies with a comparison group of children born to HIV-seronegative mothers. This standardized approach was subsequently applied to selected data sets. CONCLUSIONS: The methodology can now be applied to all studies with sufficient follow-up and comparisons made between transmission rates. This step is essential for assessing determinants of transmission and for the development of a common approach for the evaluation of interventions aimed at reducing or interrupting MTCT of HIV.

Human immunodeficiency virus type 1 (HIV-1) is transmitted mainly by cell-to-cell contact. We postulated that transmission of HIV-1 through breastmilk could be favoured by the presence of infected cells, by deficiency of anti-infective substances in breastmilk, or both factors. 215 HIV-1-infected women were enrolled at delivery in Kigali, Rwanda; milk samples were collected 15 days, 6 months, and 18 months post partum. HIV-1 IgG, secretory IgA, and IgM were assayed by western blot, for the latter two after removal of IgG with protein G. In the 15-day and 6-month samples, we sought viral genome in milk cells by a double polymerase chain reaction with three sets of primers (gag, pol, and env). HIV-1 infection in the offspring was defined according to serological and clinical criteria. At 15 days, 6 months, and 18 months post partum, HIV-1 specific IgG was detected in 95%, 98%, and 97% of breastmilk samples, IgA in 23%, 28%, and 41%, and IgM in 66%, 78%, and 41%. In children who survived longer than 18 months, the probability of infection was associated with lack of persistence of IgM and IgA in their mothers' milk (adjusted chi 2 for trend, p = 0.01 for IgM and p = 0.05 for IgA). The presence of HIV-1-infected cells in the milk 15 days post partum was strongly predictive of HIV-1 infection in the child, by both univariate (p0.05) and multivariate analysis (p = 0.01). The combination of HIV-1-infected cells in breastmilk and a defective IgM response was the strongest predictor of infection. HIV-1 infection in breastfed children born to infected mothers is associated with the presence of integrated viral DNA in the mothers' milk cells. IgM and IgA anti-HIV-1 in breastmilk may protect against postnatal transmission of the virus.

A case-control study for evaluating the risk factors of neonatal tetanus was conducted in a rural area of Senegal under demographic surveillance (Niakhar). Some 45 neonatal tetanus deaths that occurred in the study area between March 1983 and March 1986 were investigated. They were matched with 187 controls. Neonatal tetanus accounted for one-third of all neonatal deaths; mortality from neonatal tetanus was 16/1000 livebirths. The effect of various demographic, socioeconomic, epidemiological and behavioural factors was investigated in a multivariate analysis using linear logistic regression. There was no difference associated with socioeconomic factors between cases and controls. Factors associated with the skill and behaviour of birth attendant and mother were highly significant and were associated with high odds ratio (OR) and included whether the hands of the person cutting the cord were washed with soap (OR = 5.22; p = 0.001); whether the person who dressed the cord was skilled (OR = 4.71; p = 0.012); whether the age of the mother was less than 18 years (OR = 7.03; p = 0.027) and whether the birth attendant arrived before delivery (OR = 4.15, p = 0.023). Conversely, the type of tool used to cut the cord did not have a significant effect (p = 0.239). Data analysis suggests that a main source of Clostridium tetani may be the hands of the birth attendant and that the main mode of contamination may be the dressing of the wound stump. Results suggest that teaching mothers and birth attendants simple hygienic principles and basic techniques may have a significant impact on neonatal tetanus mortality.

Summary background Comparing two surveys performed in Bolivia in 1992–1994 and 1999–2001, we reported a significant decrease in the proportions of severe and mortal forms of congenital Chagas disease. This might be due to a reduction of vectorial density (VD) in maternal residence area, raising the question of a possible causal relationship between such VD, maternal parasitaemia and prognosis of congenital infection with Trypanosoma cruzi. method Comparisons of haematological and parasitological data obtained from Bolivian mothers infected with T. cruzi, and of clinical and biological data obtained from their infected and uninfected newborns, stratified according to VD in the area of maternal residence. results i) Blood hematocrit rates or hemoglobin amounts were within the normal ranges and similar in all the maternal groups, whatever the VD in their areas of residence; ii) mothers living in high VD areas displayed a higher frequency of hemocultures positive for T. cruzi; iii) newborns congenitally infected with T. cruzi, but not uninfected babies born from infected mothers, displayed higher frequencies of very low Apgar scores, low birth weights, prematurity, respiratory distress syndrome or anasarca, as well as higher mortality rates when their mothers lived in areas of high VD. conclusion Frequent bites of blood sucking Reduvidae during pregnancy do not induce maternal anaemia, but, likely through multiple maternal re-infections with T. cruzi, increase maternal parasitemia and worsen congenital Chagas disease. Maternal dwelling in areas of high VD is associated with a serious increased risk of severe and mortal congenital Chagas disease.

Objective To compare the anthropometric characteristics of children with and without HIV-1 infection. Methods In a prospective cohort study of 218 children born to HIV-1 seropositive mothers and 218 children born to HIV-1 seronegative mothers in Kigali, Rwanda, 3 groups were compared: infected children (n = 46); uninfected children born to seropositive mothers (n = 140); and uninfected children born to seronegative mothers (n = 207). Weight, height and head circumference were measured at birth, every 3 months during the first year of life and every 6 months thereafter. The weight-for-age, height-for-age, weight-for-height and head circumference-for-age mean z scores were calculated. Results The weight-for-age, height-for-age and head circumference-for-age mean z scores were lower among HIV-infected children than among uninfected ones at each time period. The reduction in the weight-for-age mean z score was the greatest between 12 and 36 months. The reduction in the height-for-age mean z score of HIV-infected children was persistently below 2 SD after 9 months of age. On the other hand the weight-for-height mean z score was not consistently lower in HIV-infected children when compared with uninfected ones. The anthropometric characteristics of uninfected children born to seropositive mothers were similar to those of children born to seronegative mothers. Conclusions In this study HIV-infected children were more frequently stunted (low height-for-age) than uninfected ones. Wasting (low weight-for-height) was not common among HIV-infected children.

Prospective cohort studies indicate that 13-45% of human immunodeficiency virus type 1 (HIV-1)-infected pregnant women transmit the virus to their infants. Although factors that influence perinatal transmission are not well understood, drug and immunotherapy trials to interrupt transmission are underway. The identification of women most at risk is essential for prevention, counselling, and medical intervention. We assessed 70 HIV-1-infected pregnant women enrolled in a prospective study of perinatal transmission in Brazzaville, Congo. The relations between maternal health status, antibody levels to selected HIV-1 structural antigens at delivery, and infant outcome were explored. Independent of clinical stage, higher maternal antibody titres to peptides corresponding to the V3 region of gp120 and the immunodominant domain of gp41 were correlated with a higher risk of perinatal transmission. In a logistic regression model, the predicted risk of transmission for symptom-free women whose antibody titres to V3 and gp41 were lowest was 0·02, whereas it was 0·88 for symptomatic women whose antibody titres to V3 and TMSP18 were highest. These associations may give new insight into the mechanisms of perinatal transmission and they may also provide a powerful means of identifying women who would most benefit from intervention trials to halt perinatal transmission.

Rapid growth occurs during fetal and neonatal development. The duration and quality of intrauterine development affect neonate body composition. Weight is routinely used to assess and monitor the nutritional status of newborns. Any weight loss or gain in hospitalized newborn infants may reflect shifts in water balance rather than changes in body mass, and have strong implications for investigating the nutritional status of newborns. It is, however, difficult to measure the body composition of newborns. Bioelectrical impedance analysis (BIA) is a relatively new technique for estimating body composition. It is based on the fact that the conduction of an applied electrical signal is far greater in fat-free tissues (because of water and electrolyte content) than in fat. BIA has been gaining wide usage for the estimation of body composition in adults1,2, and should be a very suitable method for use in children, because of its noninvasiveness, simplicity and reliability.

To determine the effect of chloroquine chemoprophylaxis during pregnancy on birth weights, a randomized trial was carried out in 1987 and 1988 in Banfora, Burkina Faso (West Africa). Seven hundred forty-five randomly selected women treated with chloroquine sulfate were compared to with 719 controls who received no treatment. In spite of an unquestionable effect of chloroquine in preventing placental infection (4.1% infected placentas in the treated group versus 19.0% in the controls), the mean difference in birth weights between the two groups (6 g) was not significant. The difference in the proportion of low birth weight (LBW) newborn babies in two groups (16.3% versus 16.4%) was also not significant. However, there was a strong relationship between placental infection and birth weight (the mean birth weight difference between infected and uninfected placentas was 113 g, and the proportion of LBW babies was 26.0% in infected placentas versus 14.8% in uninfected placentas). The small difference in birth weights observed between the two groups may be due to the fact that the prevalence rate of placental infection is low and that prophylaxis is effective only on a portion of the subjects in the treated group. It may also indicate that malaria is only one of several risk factors responsible for LBW. The relatively small increase in birth weight, the expected poor acceptance of mass prophylaxis, and the spreading of chloroquine-resistant Plasmodium strains should be considered before extending malaria chemoprophylaxis to all pregnant women. It might be worth considering to limit prophylaxis to primigravidae.

Based on data obtained from the 1984–1985 Guadeloupean Perinatal Audit, a pregnancy risk scoring system was developed using maternal demographic, socioeconomic, obstetric history and risk characteristics recorded at the first prenatal visit. Various combinations of risk factors were identified for four distinct pregnancy outcomes (perinatal mortality, low birth weight, preterm delivery and intra-uterine growth retardation). The findings emphasize the importance of developing risk assessments for discrete pregnancy outcomes within specific populations.

Although ivermectin is safe and well tolerated when distributed through mass treatment, pregnancy remains the major contraindication. PACQUE et al. (1990) considered that about half of the women in the first trimester of pregnancy might be treated inadvertently during community-based distribution of ivermectin, and stated that rates of miscarriage, stillbirth or major congenital malformation were not significantly different between treated and untreated women, During a mass treatment campaign for onchocerciasis in the Vina valley, North Cameroon, 2710 women from 15 to 45 vears old received ivermectin. Of 1495 women treated tre at ed

Physiological adjustments to heat upright posture and exercise interact in man. One result is that sympathetic activity increases with temperature in nonresting subjects. Comparative evidence suggests that utero-placental blood flow is affected by this reaction. This could be a major cause of fetal malnutrition in the tropics which presumably will not be overcome by improving maternal diet. Allowing a pregnant woman rest at the end of pregnancy might be a prerequisite to reducing fetal malnutrition and perinatal mortality in these areas. (authors modified)

Background Since 2001, a referral system has been operating in Kayes (Mali) to reduce maternal and perinatal deaths. Normal deliveries are managed in community health centers (CHC). Complicated cases are referred to a district health center (DHC) or the regional hospital (RH). Women with obstetric emergencies can directly access the DHC and the RH. Objective To assess, in women presenting with an obstetric complication: 1) the effects of the point of entry into the referral system on joint mother-newborn survival; and 2) the effects of the configuration of healthcare team at the CHCs on joint mother-newborn survival. Method Cross-sectional study of 7,214 women users of the referral system in the region of Kayes in 2006-2009. Bivariate probit equations were fitted to estimate joint mother-newborn survival. The marginal effects of the point of entry into the referral system and of the configuration of the healthcare team at the CHCs were evaluated with a probit bivariate regression. Results Entering the referral system at the RH was associated with the best joint mother-newborn survival; the most qualified the CHCs team was, the best was mother-newborn survival. Distance traveled interacts with the point of entry and the configuration of the CHCs team. For women coming from far (over 50 km), going directly to the RH increased the probability of joint mother-newborn survival by 11.90% (p < 0.001) as compared with entry at the CHC. Entry at the CHC while coming from a distance of less than 5 km increased the likelihood of joint survival by 8.50% (p < 0.001). Among women who go first to a CHC, physician presence increased joint mother-newborn survival, compared with having no physician and fewer than three professionals. The size of the healthcare team at the CHC is significantly associated with mother-newborn survival only when distance traveled is 5 km or less. Conclusion Mother-newborn survival in the Kayes maternal referral system is influenced by combined effects of the point of care, the skill configuration of CHC personnel and distance traveled.