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International audience; Objective: 25-hydroxyvitamin D (25OHD) deficiency has been associated with sleep disorders in adults. Only three cross-sectional studies were performed in children and showed an association between 25OHD deficiency and both obstructive sleep apnea syndrome and primary snoring. No longitudinal study has been performed in children from the general population. We analyzed the association between cord-blood vitamin D level at birth and night-sleep duration trajectories for children between 2 and 5-6 years old in a non-clinical cohort.Method: We included 264 children from the French EDEN mother-child birth-cohort with both cord-blood 25OHD level determined by radio-immunoassay at birth, and night-sleep trajectories for children between 2 and 5-6 years old obtained by the group-based trajectory modeling method. Associations between 25OHD and sleep trajectories were assessed by multinomial logistic regression adjusted for maternal and child characteristics.Results: The trajectories short sleep (

International audience; Objective. Sleep duration may vary inter-individually and intra-individually over time. We aimed at both identifying night-sleep duration (NSD) trajectories among preschoolers and studying associated factors. Methods. NSD were collected within the French birth-cohort study EDEN at ages 2, 3 and 5-6 years through parental questionnaires, and were used to model NSD trajectories among 1205 children. Familial socioeconomic factors, maternal sociodemographic, health and lifestyle characteristics as well as child health, lifestyle, and sleep characteristics at birth and/or at age 2 years were investigated in association with NSD using multinomial logistic regressions. Results. Five distinct NSD trajectories were identified: short (SS

Objective The aim was to study, with a developmental approach, the longitudinal association between night-waking from age 2 to 5–6 years and behavior at age 5–6 years. Methods Within the French birth cohort study Etude sur les Determinants pre et post natals du developpement et de la sante de l'ENfant (EDEN), repeated measures of children's night-waking were collected at age 2, 3 and 5–6 through parental questionnaires and were used to model night-waking trajectories. Behavior was assessed with the “Strengths and Difficulties Questionnaire,” which provides five subscales measuring a child's conduct problems, emotional symptoms, peer relation problems, antisocial behavior, and hyperactivity/attention problems. The behavioral subscales were dichotomized at the tenth percentile. Multivariable logistic regressions, adjusted for parents' socio-economic factors, parental characteristics, and children's characteristics and sleep habits allowed us to study, in 1143 children, the association between night-waking trajectories from 2 to 5–6 years and behavior at age 5–6 years. Results The “2 to 5–6 rare night-waking” trajectory represented 78% of the included population (n = 896), and the “2 to 5–6 common night-waking” 22% (n = 247%). Children belonging to the “2 to 5–6 common night-waking trajectory” had, at age 5–6, increased risk of presenting emotional symptoms (odds ratio [OR] = 2.17, 95% CI = 1.27–3.70, p = 0.004), conduct problems (OR = 1.63, 95% CI = 1.00–2.65, p = 0.050), and hyperactivity/attention problems (OR = 1.61, 95% CI = 1.00–2.57, p = 0.049). After adjusting for baseline behavior at age two years, only the association with emotional symptoms remained significant (OR = 2.02, 95% CI = 1.15–3.55, p = 0.015). Results did not differ according to sex. Conclusion Results suggest that the persistence of night-waking difficulties in early years is positively associated with emotional symptoms, hyperactivity/inattention, and conduct problems.

Background Studies conducted on mild intellectual disability (MID) in children are infrequent and the prevalence rates vary widely. This study aimed to estimate the prevalence of MID in children in a French county (Isere), to describe the clinical signs and associated comorbidities, and to specify the aetiologies of this disability. Methods The target population was comprised of the 15 100 children born in 1997 residing in Isere County, France, in 2008. Our goal was to find the children in this group with MID diagnosed between 9 and 13 years of age. MID was defined as an overall IQ score of between 50 and 69 [International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10)]; this definition was adjusted for the study by integrating confidence intervals so that the risk of IQ measurement relativity and possible discrepancy of scores could be taken into account. Children were identified through an administrative data source designed to assist disabled persons that contains health information, and an educational data source. Parents who agreed to let their children participate responded to an in-depth questionnaire on their child's medical and academic history. A genetic investigation was proposed for those children whose MID had an unknown aetiology. Results The preliminary selection included 267 children, resulting in a prevalence rate of 18 per 1000 (CI [15.6; 19.9]), within the expected mean. Of these 267 cases, 181 families agreed to participate in the study (68%). MID more often affected boys [male gender ratio = 1.4 (CI [1.2; 1.6])], low socioeconomic groups, and families with a history of intellectual disability. The clinical signs and comorbidities associated with MID were very frequent, with 54% spoken language disorders and 10% pervasive developmental disorder. Only 9% of the children had undergone a genetic investigation before the study. The known aetiology rate for MID was 19% among all the children who had had genetic tests performed. Conclusion MID is an important public health issue based on its prevalence. The associated clinical signs and comorbidities may be warning signs of MID in case of learning difficulties. This study may help decision-makers to develop and organise screening and care for MID.

International audience; OBJECTIVE:To determine whether extrauterine growth is associated with neurologic outcomes and if this association varies by prenatal growth profile.STUDY DESIGN:For 1493 preterms from the EPIPAGE (Étude Épidémiologique sur les Petits Âges Gestationnels [Epidemiological Study on Small Gestational Ages]) cohort, appropriate for gestational-age (AGA) was defined by birth weight >-2 SD and small for gestational-age (SGA) by birth weight ≤-2 SD. Extra-uterine growth was defined by weight gain or loss between birth and 6 months by z-score change. Growth following-the-curve (FTC) was defined as weight change -1 to +1 SD, catch-down-growth (CD) as weight loss ≥1 SD, and catch-up-growth (CU) as weight gain ≥1 SD. At 5 years, a complete medical examination (n = 1305) and cognitive evaluation with the Kauffman Assessment Battery for Children (n = 1130) were performed. Behavioral difficulties at 5 years and school performance at 8 years were assessed (n = 1095).RESULTS:Overall, 42.5% of preterms were AGA-FTC, 20.2% AGA-CD, 17.1% AGA-CU, 5.6% SGA-FTC, and 14.5% SGA-CU. Outcomes did not differ between CU and FTC preterm AGA infants. Risk of cerebral palsy was greater for AGA-CD compared with AGA-FTC (aOR 2.26 [95% CI 1.37-3.72]). As compared with children with SGA-CU, SGA-FTC children showed no significant increased risk of cognitive deficiency (aOR 1.41[0.94-2.12]) or school difficulties (aOR 1.60 [0.84-3.03]). Compared with AGA-FTC, SGA showed increased risk of cognitive deficiency (SGA-FTC aOR 2.19 [1.25-3.84]) and inattention-hyperactivity (SGA-CU aOR 1.65 [1.05-2.60]).CONCLUSION:Deficient postnatal growth was associated with poor neurologic outcome for AGA and SGA preterm infants. CU growth does not add additional benefits. Regardless of type of postnatal growth, SGA infants showed behavioral problems and cognitive deficiency.

To evaluate growth for children born very preterm with particular focus on those born small-for-gestational age (SGA) or with ex utero growth restraint (GR), and to identify risk factors for short stature at 5 years of age.Population-based study of children born at less than 33 completed weeks of gestation (Étude Epidémiologique sur les Petits Ages Gestationnels (EPIPAGE)). Short stature was defined as height-2SD on WHO growth curves. Ex utero GR was considered to have occurred in children with appropriate size for gestational age at birth and with a height and/or weight below -2SD at 2 years of corrected age. Logistic regression models were used to test associations between risk factors and short stature.The authors measured height at 5 years of age for 1,597 of 2,193 children (73%), 5.6% (95% CI 4.6 to 6.9) of whom were diagnosed as having a short stature. Height was measured at 2 and 5 years of age in 1417 children. Among these, 24% of those born SGA and 36% of those with ex utero GR (p=0.002) had a short stature at 5 years. Predictors of short stature were SGA or birth length-2SD, maternal height ≤ 160 cm, gestational age29 weeks and systemic corticosteroids. Breastfeeding at discharge decreased the risk of short stature.Short stature at 5 years of age is common in children born preterm. The highest incidence was observed in the group with ex utero GR. Systemic steroids have a long-term impact on growth and should be used with caution. Breastfeeding at discharge appeared to be protective.

Background Little is known about the influence of anaesthesia for caesarean section on outcome in very preterm infants. Methods A prospective, population-based, cohort study (the EPIPAGE cohort) included all births before 33 weeks in nine French regions in 1997. Of 2360 infants live-born between 27 and 32 weeks, 1338 were delivered by caesarean section with general anaesthesia (n = 711, 53.1%), spinal anaesthesia (n = 419, 31.3%), or epidural anaesthesia (n = 208, 15.6%). Neonatal mortality was compared among these three groups using bi- (according to gestational age and to anaesthetic technique) and multivariate analyses. Results Neonatal mortality was 10.1% with general anaesthesia, 12.2% with spinal anaesthesia and 7.7% with epidural anaesthesia. After adjustment for gestational age and characteristics of pregnancy, delivery and neonate, spinal anaesthesia was associated with a higher risk of neonatal death than general anaesthesia (adjusted odds ratio, 1.7; 95% confidence interval 1.1 to 2.6). Conclusion In this population-based study, spinal anaesthesia was associated with an increased risk of neonatal mortality in very preterm infants compared to general anaesthesia (and epidural anaesthesia), independently from gestational age and characteristics of the pregnancies, deliveries and neonates. Although this multivariate analysis does not prove a causal relationship, the results suggest it could exist, particularly if maternal haemodynamics are poorly controlled. With recent significant change in the conduct of spinal anaesthesia, further studies are needed to investigate potential harmful effects of anaesthesia on very preterm infants delivered by caesarean section.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 33 - N° 6-C1 - p. 475-486

Studies conducted on mild intellectual disability (MID) in children are infrequent and the prevalence rates vary widely. This study aimed to estimate the prevalence of MID in children in a French county (Isère), to describe the clinical signs and associated comorbidities, and to specify the aetiologies of this disability.The target population was comprised of the 15 100 children born in 1997 residing in Isère County, France, in 2008. Our goal was to find the children in this group with MID diagnosed between 9 and 13 years of age. MID was defined as an overall IQ score of between 50 and 69 [International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10)]; this definition was adjusted for the study by integrating confidence intervals so that the risk of IQ measurement relativity and possible discrepancy of scores could be taken into account. Children were identified through an administrative data source designed to assist disabled persons that contains health information, and an educational data source. Parents who agreed to let their children participate responded to an in-depth questionnaire on their child's medical and academic history. A genetic investigation was proposed for those children whose MID had an unknown aetiology.The preliminary selection included 267 children, resulting in a prevalence rate of 18 per 1000 (CI [15.6; 19.9]), within the expected mean. Of these 267 cases, 181 families agreed to participate in the study (68%). MID more often affected boys [male gender ratio = 1.4 (CI [1.2; 1.6])], low socioeconomic groups, and families with a history of intellectual disability. The clinical signs and comorbidities associated with MID were very frequent, with 54% spoken language disorders and 10% pervasive developmental disorder. Only 9% of the children had undergone a genetic investigation before the study. The known aetiology rate for MID was 19% among all the children who had had genetic tests performed.MID is an important public health issue based on its prevalence. The associated clinical signs and comorbidities may be warning signs of MID in case of learning difficulties. This study may help decision-makers to develop and organise screening and care for MID.

OBJECTIVES. This study investigated the effect of moderate prenatal alcohol exposure on psychomotor development of preschool-age children in a longitudinal study. METHODS. Pregnant women were interviewed about their alcohol consumption at their first visit to the maternity hospital in Roubaix, France. Alcohol consumption before pregnancy and during the first trimester was assessed with a structured questionnaire. The psychomotor development of 155 children of these women was assessed with the McCarthy scales of children's abilities when the children were about 4 1/2 years old. RESULTS. Consumption of 1.5 oz of absolute alcohol (approximately three drinks) or more per day during pregnancy was significantly related to a decrease of 7 points in the mean score on the general cognitive index of the McCarthy scales, after gender, birth order, maternal education, score for family stimulation, family status, maternal employment, child's age at examination, and examiner were controlled for. CONCLUSIONS. This study showed that moderate to heavy alcohol consumption during pregnancy, at levels well below those associated with fetal alcohol syndrome, has effects on children's psychomotor development.

Objective The aim of the study was to identify risk factors associated with pre-transplant fecal carriage of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae in liver transplant recipients. Patients and methods Over a 3-year period (January 2009–December 2011), 317 patients who underwent liver transplantation were screened preoperatively for fecal carriage of ESBL-producing Enterobacteriaceae. Risk factors for fecal carriage were investigated by univariate analysis and stepwise logistic regression. Results Of the 317 patients screened, 50 (15.7%) harbored an ESBL-producing isolate. Previous infection with an ESBL-producing organism had developed during the last 6 months in 20% of fecal carriers versus in none of the non-carriers. Other variables associated with fecal carriage were a model for end-stage liver disease score ≥25, pre-transplant stay in the intensive care unit ≥48 h, hospital stay ≥10 days in the last 6 months, a history of spontaneous bacterial peritonitis (SBP), exposure to a β-lactam agent in the last month, and prophylaxis with norfloxacin. Independent predictors of fecal carriage in the multivariate logistic regression model were exposure to a β-lactam agent in the month preceding transplantation (odds ratio [OR] = 7.8, confidence interval [CI] = 4–15.5, P

The teratogenic effects of alcohol have been recognized in the fetal alcohol syndrome. The syndrome is associated with very high levels of maternal consumption. Studies of the relation between much lower levels of consumption and pregnancy outcome seem to indicate consistently lower birthweight among children born to mothers drinking more than 140 g absolute alcohol per week, or about two drinks a day.

The immature brain is highly susceptible to the consequences of very preterm birth with a high rate of long-term neurodisabilities in survivors and high use of specific outpatient services to limit the functional effects of the disabilities. To assess the economic burden for the social and health care system, it is necessary to inventory the community supports and need for special education or rehabilitation used by preterm children. Such studies are few and were done only in extremely low-birthweight or extremely preterm newborns in the United States.To study the rates of specific outpatient services and special education at 5 years of age and between 5 and 8 years of age in a geographically-defined population of children born very preterm.2901 liveborn children before 33 weeks'gestation (WG) and one control group of 666 liveborn children at 39-40WG were included in nine regions of France in 1997 corresponding to more than one third of all births. At five years, these children had a medical examination and were evaluated by a psychologist at local centres organised for the study in every region. Cognitive function was assessed by the mental processing composite scale (PMC) of the Kauffmann Assessement Battery for Children test, which is considered to be equivalent to intelligence quotient and behavioral difficulties using the Strength and Difficulties questionnaire completed by the parents. Data for dependence or compensatory aids, i.e. occupational therapy or physical therapy, speech therapy, psychologist or psychiatrist visits, orthoptic therapy, wearing glasses, wearing hearing aid, specific equipment to walk (walker, wheelchair...), orthopaedic treatment or anti-epileptic treatment were collected from parents. At eight years, a postal questionnaire was sent to the parents to collect data on specific outpatient services and special treatments at home and school. Stata software was used (version 9.0). Main outcome measures. Parent Questionnaire for identifying children with chronic conditions and specific health care needs at 5 and 8 years and categorization of developmental neurodisabilities based on examination of children and psychometric evaluation at 5 years.At 5 years data were obtained for respectively 1817 and 396 children born before 33WG or at 39-40WG, which represent 80% of the very preterm children and 71% of the at term children. At 8 years we obtained data for 63% of the very preterm children and 59% of the at term children. At 5 years, care in a rehabilitation center and/or specific outpatient services were required for 41% of children born between 24 and 28WG, 32% of children born between 24 and 32WG and 15% of those born at 39-40WG. Between 5 and 8 years, these figures were respectively 61%, 50% and 36%. In the very preterm group, rates of specific outpatient services were higher than 80% if the child had a motor and/or a neurosensory deficit. In case of cognitive deficiencies (PMC85), rates of specific outpatient services were low at 37% at 5 years and increases at 63% between 5 and 8 years.Compared to the children born at term, the very preterm children have considerable educational needs, which are inversely related to gestational age at birth and to age of the children at the time of reporting. Despite economic burden, efforts to improve access to services are necessary, in particular in case of cognitive impairment.

With improving neonatal survival for very premature babies, the challenge for neonatalogists is to ameliorate outcome of surviving babies. Several pharmacological molecules have been shown to have protective effects in different types of in vitro or in vivo animal models of acquired cerebral brain damages. However translational research and conduction of therapeutic trials in human remain difficult due to failure to recognize start of deleterious cascade leading to cerebral damage and additional toxic effect of potential protective molecules. This review concentrates on best evidence emerging in recent years on prevention on brain damage by early drug administration. It has been shown in two randomised trials that prenatal low-dose of magnesium sulphate does not increase paediatric mortality in very-preterm infants and has non significant neuroprotective effects on occurrence of motor dysfunction (with a 0.62 odds ratio in the French trial Premag and 0.71 relative risk in the Australian trial ACTOMgSO4), justifying that magnesium sulphate should be discussed as a stand-alone treatment or as part of a combination treatment, at least in the context of clinical trials. Antenatal corticosteroid therapy increases the survival of very-preterm infants, including the most immature. Moreover in an observational recent study of the Epipage cohort, it has been observed a significant decrease in white matter injury in the 28-32 weeks' gestation group but no effect on long term outcome and behaviour. Conversely in the most immature of the 24-27 weeks' gestation group, no effect has been detected either in white matter injury incidence or in long term outcome rates. Caffeine has a protective effect since a decrease in cerebral palsy has been noted in the caffeine group in a randomised trial studying caffeine versus placebo. For what concern other widely used potential protective molecules during the perinatal period, there is no evidence of cerebral protection with indometacine, nitric oxide, eythropoietin, phenobarbital, and etamsylate. Due to their specific properties, a careful evaluation of aspirin, anaesthetic drugs and tocolytics should be done in the next months.

Advances in perinatal care have lead to the survival of an increasing number of children born very premature. The purpose of this review is to discuss findings in the literature regarding long term developmental outcome of infants born prematurely especially for studies with children at least 5 years old, born in the 80's or after, in a context of care with increased use of antenatal corticoids, in utero transfer, and surfactant therapy. Developmental sequelae, which are seen in children older than those presenting severe deficiencies, concerns a greater number of very premature children. They have poorer outcomes than term children or normal birth weight controls for cognitive-neuropsychological skills, school performances and behavior. Long term follow up of these children shows that consequences are still present for adolescents or young adults. There is a gradient of developmental sequelae in children that is inversely related to decreasing gestational age or birth weight. Developmental sequelae are related to neonatal medical complications and social risks factors. Research should be conducted in order to better understand etiology and neuropathological basis of sequelae, and the long term developmental implication of being born very premature and the type of care or intervention which could improve their development. An early and regular follow up by a team specialized in child development should be proposed in order to detect developmental sequelae and propose early intervention.

To compare the use of health and social services between children born before 33 weeks (very preterm), children born at 33 or 34 weeks (moderately preterm) and children born at 39 or 40 weeks (full term).All very preterm children born in 1997 in nine French regions and a representative sample of the two other groups were followed up since birth. Data on the use of services between discharge from initial neonatal hospitalisation and the 9 months after birth were obtained by mail questionnaire filled in by parents.38.2% of very preterm children, 24.3% of moderately preterm children and 10.3% of full term children were admitted to hospital at least once. Respiratory tract disorder was the main reason for rehospitalisation of very preterm children. The total number of visits, visits to specialists, and chest therapy were more frequent among very preterm children than among the two other groups.Medical care of very preterm children is intensive after discharge from initial neonatal hospitalisation. Need of services are also substantial for moderately preterm children.

Studies concerning smoking during pregnancy and cognitive development of the child were reviewed. Some studies tend to support the existence of an association between smoking during pregnancy and a less optimal cognitive development of the child. The meaning of these relationships remains obscure, since it cannot be assumed that they are due to maternal cigarette smoking: they could be due to different characteristics of smokers or non-smokers. In the older studies, potential confounding factors were not adequately taken into account and in some recent studies, the observed difference was no longer significant after taking into account the maternal educational level and the family stimulation of the child. Behavior problems are associated with smoking during pregnancy in nearly all studies but the same problem of confounding factors remains. It is thus difficult to conclude presently from these studies if there is a causal relationship between prenatal exposure to tobacco smoke and cognitive development.

To study perinatal and neonatal mortality of very preterm infants and to assess the association with birth weight and multiple births.Infants enrolled in the Epipage study born between 22 and 32 weeks gestational age in 9 French regions in 1997 were included in this study. The main outcome measure was stillbirth and death before discharge from hospital.During the study period, 4397 births and therapeutic abortions meeting the inclusion criteria were recorded (including 16% therapeutic abortions and 18% stillbirths). Survival rate for babies born between 22 and 32 weeks was 67% of all births (stillborn + liveborn) and 85% among livebirths. Survival rose with increasing gestational age: survival (livebirths) was 50% at 25 weeks gestation, 78% at 28 weeks and 97% at 32 weeks. Survival was lower for infants with a birthweight below the 10th percentile and for multiple-pregnancy infants. The different stages of the follow-up planned up to 5 years are presented together with the response rate to the postal follow-up questionnaire.This cohort provides mortality data on very premature infants during pregnancy, at birth, during hospitalization before discharge. Survival of liveborn infants was stratified by gestational age and was consistent with other geographically based studies of very preterm infants born in the 1990s.

To evaluate whether precociously treated subjects with congenital hypothyroidism (CH) are at risk of poor school performance in early adolescence, and to investigate which factors affect their school achievement.All children treated early for congenital hypothyroidism and born in France during the first 7 y (1979-1985) of the national screening program for congenital hypothyroidism were selected for the study. School performance during childhood, assessed according to age at entry into the first grade of secondary school, was evaluated as normal (usually 11 y of age) vs late entry (or = 12 y). The national register of children with congenital hypothyroidism enabled a comparison to be made with data from the national population for the same school years.School achievement was similar among the 682 patients with CH and in the national population. After an adjustment for the sex and socioprofessional category of the parents, the severity of CH as assessed by the type (athyreosis. the most severe vs other types), the initial low serum T4 levels (or = 53 nmol/L vs53 nmol/L), and the profound bone maturation delay (absence vs presence of the two knee epiphyseal ossification centres at diagnosis), initially low L-thyroxine dosage (below vsor = 7 microg/kg/day), the absence of near normalization of thyroid hormone levels after 15 d of treatment and poor adequacy of treatment throughout childhood were associated with an increased risk of school delay. School achievement was unaffected by the age at start of treatment (mean age = 22.8 +/- 6.8 d). In a multivariate logistic regression analysis, recurrent episodes of insufficiently suppressed TSH levels (or = 15 mUi/L at least four times during follow-up from the age of 6 mo onwards) were the most important variable associated with school delay.Careful follow-up of the adequacy of treatment is required throughout childhood, to reduce the risk of school delay.

A cross-sectional survey was conducted between November 1986 and January 1988 among 246 homosexual/bisexual patients by consulting physicians promoting human immunodeficiency virus (HIV) infection prevention, to determine factors correlated with HIV infection a few years after the launch of safer sex recommendations. After adjustment for numbers of sexual partners and frequency of unprotected receptive anal intercourse, seropositive subjects, compared to seronegative ones, had significantly higher frequencies of: (1) receptive anal intercourse using condoms and extraneous lubricants, (2) anorectal douching before or after intercourse, (3) past history of syphilis, and (4) nitrite inhalations. The first three factors remained significant after multivariate analysis. Eighty-three percent of the subjects practicing receptive anal intercourse with condoms plus lubricants used inappropriate lubricants. Some factors identified in our study are well established risk factors for homosexually acquired HIV infection, suggesting that safer sex recommendations still are not followed by all. Our results also elicit additional factors that independently increase the risk. Two of them, extraneous lubrication of the condom for anal receptive intercourse and anorectal douching, may result from a misunderstood notion of "safer sex," or from practices thought by mistake to protect against HIV.

The teratogenic effects of alcohol have been recognized in the fetal alcohol syndrome. The syndrome is associated with very high levels of maternal consumption. Studies of the relation between much lower levels of consumption and pregnancy outcome seem to indicate consistently lower birthweight among children born to mothers drinking more than 140 g absolute alcohol per week, or about two drinks a day.

Objectifs L’evaluation de l’inflammation dans la maladie de Crohn est un element majeur de la decision therapeutique. Le but de notre travail etait de rechercher les signes IRM associes a l’inflammation en les comparant a une classification histologique realisee sur des pieces operatoires. Materiels et methodes Entre juin 2006 et Fevrier 2009, 53 patients necessitant une resection intestinale ont ete explores par une entero-IRM par voie orale. Le delai moyen entre F IRM et la chirurgie etait de 24 jours. L’activite inflammatoire histologique etait classee en 3 grades : absence d’activite, activite moderee ou severe. Les signes IRM ont ete evalues et correles avec les grades histologiques de l’inflammation. Les associations entre les variables radiologiques et histologiques ont ete testees en utilisant le test du Chi2, le coefficient de correlation de Spearman et le test de Kruskall-Wallis. Resultats L’activite inflammatoire etait classee comme suit : grade 0 (n = 11 ; 20,7%), grade 1 (n = 15 ; 28,3%) ; grade 2 (n = 27 ; 51%). Les signes radiologiques significativement correles a l’activite etaient : epaisseur parietale (p Conclusion Cette etude a permis d’identifier plusieurs signes IRM significativement correles a la presence et a l’intensite de l’inflammation intestinale histologique au cours de la maladie de Crohn, ce qui peut avoir des consequences therapeutiques.

Introduction L’evaluation de l’inflammation intestinale au cours de la maladie de Crohn est un element majeur dans la decision therapeutique. L’entero-IRM, technique recente d’exploration de l’intestin grele, a l’avantage par rapport au scanner de n’etre pas irradiante et de permettre la repetition des examens chez des malades souvent jeunes. Le but de notre travail etait d’evaluer la valeur diagnostique des signes utilises en entero-IRM pour decrire l’inflammation au cours de la maladie de Crohn, et de les comparer a l’histologie des pieces operatoires, consideree comme la methode de reference. Patients et Methodes Entre juin 2006 et avril 2008, tous les patients necessitant une resection intestinale pour maladie de Crohn symptomatique ont ete explores par une entero-IRM, realisee apres administration orale de mannitol. Le pathologiste classait l’activite inflammatoire des pieces de resection intestinale en 3 grades : grade 0 - absence d’activite ; grade 1- activite moderee ; grade 2 - activite severe avec fistule et/ou abces. Les anomalies parietales et extra parietales decrites en IRM ont ete repertoriees. Tous les resultats ont ete correles avec les grades histologiques. Les associations entre les variables radiologiques et histologiques ont ete testees en utilisant le test du Chi2, le coefficient de correlation de Spearman et le test de Kruskall-Wallis. Resultats Quarante patients ont ete inclus. Le delai moyen entre l’IRM et la chirurgie etait de 26 (1-90, mediane 17) jours. L’activite inflammatoire etait classee comme suit : grade 0 (n = 8 ; 20 %), grade 1 (n = 11 ; 27,5 %) ; grade 2 (n = 21 ; 52,5 %). Les aspects histologiques et radiologiques etaient correles pour la longueur (p Conclusion Cette etude a permis d’identifier plusieurs signes IRM significativement correles a la presence et a l’intensite de l’inflammation intestinale histologique au cours de la maladie de Crohn, ce qui peut avoir des consequences therapeutiques majeures immediates. Des etudes prospectives multicentriques doivent maintenant confirmer et completer ces resultats, en particulier dans le but de bâtir un score IRM fiable de l’inflammation au cours de la maladie de Crohn.

In tempered countries, higher sudden infant death rates are observed during winters, which is in favor of an infectious factor in the etiology. According to the geographic regions, the rates of SIDS are showing a downward gradient from the north of France to the south. In an attempt to assess the infectious hypothesis, we carried out a research about space-time clusters of Sudden infant deaths. The Knox's méthode was used with data of the medical causes of death registered in France from 1981-82 to 1985-86, by areas. Clusters were found in several regions, but they are moving from one year to another. The interpretation of these findings remains difficult because of the large number of tests.

International audience; BACKGROUND:Many genetic polymorphisms identified by genome-wide association studies for adult body mass index (BMI) have been suggested to regulate food intake.OBJECTIVE:The objective was to study the associations between a genetic obesity risk score, appetitive traits, and growth of children up to age 5 years, with a longitudinal design.METHODS:In 1142 children from the Etude des Déterminants pre et post natals de la santé de l'ENfant (EDEN) birth cohort, a combined obesity risk-allele score (BMI genetic risk score [GRS]) was related to appetitive traits (energy intake up to 12 mo, a single item on appetite from 4 mo to 3 y, a validated appetite score at 5 y) using Poisson regressions with robust standard errors. The potential mediation of appetitive traits on the association between BMI-GRS and growth was assessed by the Sobel test.RESULTS:Children with a high BMI-GRS were more likely to have high energy intake at 1 year and high appetite at 2 and 5 years. High energy intake in infancy and high appetite from 1 year were related to higher subsequent BMI. High 2-year appetite seemed to partially mediate the associations between BMI-GRS and BMI from 2 to 5 years (all P ≤ 0.05).CONCLUSIONS:Genetic susceptibility to childhood obesity seems to be partially explained by appetitive traits in infancy, followed by an early childhood rise in BMI.