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Long-term digestive, respiratory, and neurological morbidity is significant in children who have undergone surgery for esophageal atresia (EA), especially after staged repair for long-gap EA. Risk factors for morbidity after primary repair (non-long-gap populations) have been less documented. We investigated peri- and neonatal factors associated with unfavorable outcomes in children 2 years after primary esophageal anastomosis. This was a single-center retrospective study, based on neonatal, surgical, and pediatric records of children born between December 1, 2002, and December 31, 2018, and followed up to age 2 years. The primary endpoint was unfavorable outcome at 2 years of age, defined by death or survival with severe respiratory, digestive, or neurologic morbidity. Univariate analyses followed by logistic regression analyses were performed to identify the peri- and neonatal risk factors of unfavorable outcomes among survivors at discharge. A total of 150 neonates were included (mean birth weight 2520 ± 718 g, associated malformations 61%); at age 2, 45 (30%) had one or more severe morbidities and 11 had died during the neonatal stay and 2 after discharge (8.7% deaths). In multivariate analyses of the 139 survivors at discharge, duration of ventilatory support (invasive and non-invasive) for more than 8 days (OR 3.74; CI95% [1.68-8.60]; p = 0.001) and achievement of full oral feeding before hospital discharge (OR 0.20; CI95% [0.06-0.56]; p = 0.003) were independently associated with adverse outcome after adjustment for sex, preterm birth, associated heart defect, any surgical complication, and the occurrence of more than one nosocomial infections during the neonatal stay.Post-operative ventilation and feeding management strategies may represent an opportunity for quality-of-care improvement to positively impact long-term outcomes after primary esophageal atresia repair.• Children operated on for esophageal atresia experience long-term digestive, respiratory, and neurologic morbidity, especially after multiple-stage esophageal repair. • Exclusive oral feeding at discharge is associated with a decreased risk of medical complications in the first years of life, in studies including all types of esophageal atresia repair. Outcomes of children after primary repair (non-long gap populations) have been less documented.• In our retrospective cohort of children with one-stage esophageal atresia repair, ventilatory support for more than 8 days and inability to achieve full oral feeding before hospital discharge in the neonatal period were independently associated with adverse digestive, respiratory, and neurologic outcomes at 2 years in survivors. • Both these factors are potentially modifiable, representing an opportunity for quality-of-care improvement to positively impact long-term outcomes. These results might also help identify children at risk of unfavorable evolution, to customize a multi-disciplinary follow-up program.

Nonostante alcuni cantanti, sotto le luci della ribalta, abbiano potuto dare un effimero volto multicolore alla canzone italiana (un certo Leopoldo e, successivamente, negli anni Settanta, un duo bianco e nero: Wess e Dori Ghezzi), nell'Italia degli anni Ottanta, se ci fidiamo dei nostri ricordi, quando passava un nero ancora ci si girava per strada. Anche maggiore la curiosità destata dalle coppie cosiddette “miste”, per non parlare poi dei bambini “meticci”, parola che prima che fosse lanci...

Purpose: Long-term digestive, respiratory and neurological morbidity is significant in children who have undergone surgery for esophageal atresia (EA), especially after staged repair for long-gap EA. Risk factors for morbidity after primary repair (non-long-gap populations) have been less documented. We investigated perinatal factors associated with unfavourable outcome in children two years after a primary esophageal anastomosis. Methods: Single-center retrospective study, based on neonatal, surgical, and paediatric records of children born between December 1, 2002, and December 31, 2018, and followed up to age 2 years. The primary endpoint was unfavourable outcome at 2-years of age, defined by death or survival with severe respiratory, digestive, or neurologic morbidity. Univariate analyses followed by logistic regression analyses were performed to identify perinatal risk factors of unfavourable outcome among survivors at discharge. Results: 150 neonates were included (mean birth weight 2520±718 g, associated malformations 61%); at age two, 45 (30%) had one or more severe morbidities, 11 had died during the neonatal stay and 2 after discharge (8.7% deaths). In multivariate analyses in the 139 survivors at discharge, duration of ventilatory support (invasive and non-invasive) for more than 8 days (OR 3.74; CI95%[1.68-8.60]; p=0.001) and achievement of full oral feeding before hospital discharge (OR 0.20; CI95%[0.06-0.56]; p=0.003) were independently associated with adverse outcome after adjustment for sex, preterm birth, associated heart defect, any surgical complication and the occurrence of more than one nosocomial infections during the neonatal stay. Conclusions: Potentially modifiable neonatal factors are associated with 2-year unfavourable outcome after primary repair of EA.

Resume L’arret cardiaque au cours de l’accouchement, eventualite rare, engage le pronostic vital de la mere et de l’enfant a naitre. L’âge croissant des parturientes et les comorbidites cardiovasculaires, sont des facteurs de risque. Les etiologies font intervenir les hemorragies de la delivrance, les complications de l’anesthesie, les accidents obstetricaux. Une cesarienne dite perimortem doit etre pratiquee dans le temps du massage cardiaque pour en augmenter l’efficacite en levant notamment la compression cave et preserver les chances de survie du fœtus. Une demarche etiologique doit etre entreprise en parallele. L’entrainement par la simulation fait partie des recommandations internationales.

Dès sa première œuvre, roman autobiographique d’une enfance en Afrique orientale alors colonie italienne, Erminia Dell’Oro trace le portrait d’une petite sœur morte dont l’absence continue d’irradier dans les œuvres suivantes. À travers les trois romans Asmara addio (1988), Il Fiore di Merara (1994) et La Gola del diavolo (1999), nous suggérons de traiter la représentation des disparus comme une matrice thématique qui, selon nous, détermine tout le travail de l’écrivain. Celui-ci se fait porte-parole et donne à entendre les voix des disparus mais aussi des oubliés de l’historiographie. Ainsi, la narration acquiert une nouvelle ampleur car les histoires singulières ancrées dans les mémoires familiales nous ramènent au collectif et au poids de l’Histoire. D’autres ombres affleurent, notamment celles qui étaient destinées à devenir cendre dans les décombres du siècle. La Gola del diavolo, du titre du dernier roman « africain » publié, apparaît alors comme une métaphore des topographies de l’ombre qui menace et met parfois en échec les repères des vivants. Recueillir les voix tombées dans l’oubli, restaurer le fil ténu de la mémoire, rendre la parole à ceux à qui elle a été confisquée, tels sont sans doute les enjeux de l’écriture chez Erminia Dell’Oro. Au-delà du plaisir d’écrire, l’œuvre devient alors l’instrument d’une transmission qui est aussi question de vie ou de mort. Sin dalla prima opera, autobiografia romanzata dell’infanzia in Africa orientale allora colonia italiana, Erminia Dell’Oro fa il ritratto di una sorellina scomparsa la cui mancanza irradia anche attraverso le opere successive. Attraverso i tre romanzi Asmara addio (1988), Il Fiore di Merara (1994) e La Gola del diavolo (1999), proponiamo di considerare la rappresentazione degli scomparsi in quanto matrice tematica caratteristica del laboratorio della scrittura. Lo scrittore-medium ritrova la voce degli scomparsi ma anche di quelli che la Storia ha sepolti nell’oblio. La narrazione acquista una dimensione nuova poiché le storie singolari che affondano nelle memorie familiari riconducono al collettivo e al peso della Storia. I romanzi di Erminia Dell’Oro ricordano anche altri cortei d’ombra, in particolare quelli che erano destinati a finire in cenere sotto le macerie del secolo scorso. La Gola del diavolo, dal titolo dell’ultimo romanzo « africano » pubblicato, appare quindi come la metafora delle topografie dell’ombra che minaccia e qualche volta sconfigge i riferimenti dei vivi. Raccogliere le voci cadute nella dimenticanza, restaurare il filo tenue della memoria, dar voce a quelli a cui è stata tolta, questa è la posta in gioco. Oltre al piacere della scrittura, l’opera diventa quindi lo strumento di una trasmissione che è anche questione di vita o di morte.

Little data are available on the management of pregnant women infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) We conducted a retrospective study of 100 pregnant women with SARS-CoV-2 infection in 4 obstetric units in the Paris metropolitan area of France during March 12-April 13, 2020 Among patients, 52 (52%) were hospitalized, 10 (10%) in intensive care units (ICUs) Women with higher body mass indexes (BMIs;median 30 7 kg/m(2)) were more likely to be hospitalized in ICUs than other women (median BMI 26 2 kg/m(2)) Women hospitalized in ICUs had lower lymphocyte count at diagnosis (median 0 77 x 10(9) cells/L) than women not hospitalized in ICUs (median lymphocyte count 1 15 x 10(9) cells/L) All women requiring oxygen >5 L/min were intubated Clinical and laboratory evaluation of SARS-CoV-2-positive pregnant women at the time of diagnosis can identify patients at risk for ICU hospitalization

Background Pregnant women are at increased risk of hypoxaemia during general anaesthesia. Our aim was to determine the incidence and the risk factors that contribute to hypoxaemia in this setting. Methods Every woman 18 yr or older who underwent a non-elective Caesarean section under general anaesthesia was eligible to participate in this multicentre observational study. The primary endpoint was the incidence of hypoxaemia defined as the SpO2 ≤95%. The secondary endpoint was the incidence of difficult intubation defined as more than two attempts or failed intubation. Results During the study period, 895 women were prospectively included in 17 maternity hospitals, accounting for 79% of women who had general anaesthesia for non-elective Caesarean section. Maternal hypoxaemia was observed in 172 women (19%; confidence interval [CI], 17–22%). Risk factors associated with hypoxaemia in the multivariate analysis were difficult or failed intubation (adjusted odds ratio [aOR]=19.1 [8.6–42.7], P 35 kg m−2 (aOR=0.53 [0.28–0.998], P=0.0495). Intubation was difficult in 40 women (4.5%; CI, 3.3–6%) and failed intubation occurred in five women (0.56%; CI, 0.1–1%). In the multivariate analysis, use of a hypnotic drug other than propofol was associated with difficult or failed intubation (aOR=25 [2–391], P=0.02). A propensity score confirmed that propofol was associated with a significant decreased risk of difficulty or failure to intubate (P Conclusions Hypoxaemia during Caesarean sections was observed in 19% of women and was significantly associated with difficult or failed intubation. The use of propofol may protect against the occurrence of difficult intubation.

Resume De plus en plus de parturientes ont recours a une analgesie peridurale pour l’accouchement. Plusieurs facteurs de realisation difficile ont ete mis en evidence : un indice de masse corporel eleve, une palpation difficile des reperes osseux anatomiques, des anomalies structurales du rachis et une incapacite a adopter une position convexe du rachis lombaire. Ces 3 derniers facteurs ont ete compiles dans un score de 0 a 4, afin d’anticiper les difficultes a venir. De plus, la consistance du ligament jaune (limite posterieure de l’espace peridural) peut etre modifiee au cours de la grossesse et de fausses pertes de resistance peuvent percues. La resonnance acoustique et la transmission de la resistance opposee par le ligament jaune par compression de fluide semblent bien identifier l’entree dans l’espace peridural. L’echographie determine de facon fiable le niveau de ponction, l’inclinaison des processus epineux ainsi que la distance entre la peau et l’espace peridural. Elle peut egalement permettre de confirmer la bonne mise en place du catheter d’analgesie. Enfin, la peri-rachianesthesie combinee ou la realisation d’une « dural puncture epidural » (ou DPE, consistant a faire une rachicenthese, avec une ponction durale seule, sans injection intrathecale) pourraient permettre de verifier, par reflux de liquide cephalo-rachidien, le caractere median de l’abord peridural.