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The French Society of Neonatology (SFN) conducted a national questionnaire survey on the simulation-based education neonatal curriculum for pediatric residents. The response rate was 93% for the pediatric curriculum coordinators and 97% for the neonatal intensive care unit medical directors and neonatal transport teams. The average hourly volume during the curriculum was 21 ± 17 h. Overall, 89% of regional pediatric curricula offered at least one simulation session. Each simulation program involved newborn resuscitation in the delivery room but often lacked a formalized program. Additionally, half of the neonatology departments provided simulation-based education. Simulation education is now common for training pediatric residents in neonatology in France but it is heterogeneous in the French territory.

Resume La simulation en sante se developpe rapidement en France tant en formation initiale que continue. Les auteurs detaillent les differents types de simulation (procedurale, immersive, humaine, hybride et electronique). Ils discutent les avantages et les inconvenients respectifs de la simulation en centre et dans les services de soins (in situ). Ensuite, les 5 temps d’une seance de simulation sont presentes en insistant sur la specificite du debriefing qui est la pierre angulaire de la simulation immersive et de la simulation avec des patients simules/standardises. Outre aux competences techniques, la simulation forme aux competences non techniques, comme le leadership, la communication et le travail d’equipe, particulierement importantes dans la gestion d’une situation critique. L’efficacite de la simulation sur la qualite des soins a ete demontree par de nombreux travaux et meta-analyses. Quelques considerations generales sont evoquees comme l’organisation des centres et la formation des formateurs. L’article se termine par la place grandissante de la simulation dans l’enseignement en medecine.

Résumé Les premières données épidémiologiques sur virus et asthme ont été obtenues dans les années 1970–1980 par l'isolement viral et la sérologie. Chez l'enfant, une infection virale est identifiable dans 24 à 31,9 % des cas, et dans 13,3 % des cas chez l'adulte. Les trois virus les plus fréquents sont les rhinovirus (RV), le virus respiratoire syncytial (VRS), et les virus parainfluenza (PIV), détectés dans 8,8, 6,4 et 6 % des cas. Par son pouvoir amplificateur, l'utilisation de l'outil PCR accroît la fréquence de détection virale, et semble particulièrement approprié dans l'asthme où la charge virale peut être réduite. Dans une étude sur les bronchiolites, nous avons montré que les VRS, PIV3, AdV et RV sont identifiés dans respectivement 39,3, 4,3, 1,4 et 3,9 % des cas par IF ou culture, et dans 62,4, 8,3, 10,8 et 12,6 % des cas par PCR. Deux enquêtes épidémiologiques récentes utilisent le diagnostic moléculaire dans les crises d'asthme. Chez 61 adultes, 27 (44 %) infections sont identifiées: 16 RV, 4 CV OC43, 3 VPI, 1 VRS, 1 VI, 1 Chlamydia psitacci. Chez l'enfant, une infection virale est détectée dans 226 cas (77 %): 84 RV, 38 CV, 21 VI, 21 VPI, 12 VRS. Nous avons réalisé une courte enquête rétrospective sur l'année 1997, en biologie moléculaire, sur 39 aspirations nasales d'enfants consultant pour asthme ou bronchite sifflante. La recherche des virus respiratoires par les techniques conventionnelles identifie 8 (20,5 %) infections virales: 3 à RV, 3 à VRS, 1 à VIB et 1 à VPI2. Après extraction des acides nucléiques, des techniques de PCR-hybridations ont été appliquées à ces échantillons pour détecter des séquences de VRS, AdV, RV, CV 229E, CV OC43, CP et MP. Vingt-six aspirations (54 %) sont positives par les seules techniques de biologie moléculaire: 11 VRS, 12RV, 2 enterovirus, 1 CV OC43. Au total, 34 (82 %) infections virales sont détectées chez ces enfants, et dans 6 cas une infection mixte VRS-RV est notée. Par rapport aux études de la littérature, on retrouve la prédominance des infections à RV, plus d'infections à VRS, probablement liée à l'utilisation ici de l'outil PCR, et une plus faible incidence des infections à CV.

Resume Objectif Les erreurs medicamenteuses sont une preoccupation quotidienne des services de neonatalogie. Le but de cette etude etait d’evaluer les pratiques professionnelles de preparation et d’administration des medicaments injectables en neonatalogie. Patients et methode Une evaluation des pratiques professionnelles (EPP), concernant la preparation et l’administration de differents medicaments injectables dans les differentes unites d’un service de neonatalogie a ete realisee par un interne en pharmacie a partir d’une grille d’evaluation portant sur 10 items. Apres le premier tour d’evaluation, les resultats ont ete presentes a l’ensemble de l’equipe soignante, qui a valide les mesures correctives proposees par un groupe de travail pluri-professionnel. Une seconde evaluation a ete realisee en suivant la meme methodologie. Resultats Cinquante des 76 puericultrices du service ont ete evaluees lors du premier tour de l’audit et 21 lors du deuxieme tour. Deux axes d’ameliorations ont ete identifies : la prise en compte du volume mort de medicament dans les aiguilles et l’embase des seringues, ainsi que l’identification exhaustive des seringues du medicament administre. Lors du deuxieme tour, ces deux points ont ete ameliores passant, respectivement, de 38 a 100 % et de 59 a 89 %. Conclusion Pour ameliorer la prise en charge medicamenteuse en neonatalogie et donc la securite du patient, l’EPP est un outil necessaire qui demande une collaboration etroite entre equipe paramedicale, medecins et pharmaciens. L’interet principal est la mobilisation de toute l’equipe autour de ce sujet, garante d’une meilleure appropriation et application des mesures correctives.

BackgroundThe known relationship between the gestational age at maternal primary infection an the outcome of congenital CMV is based on small, retrospective studies conducted between 1980 and 2011. They reported that 32% and 15% of cases had sequelae following a maternal primary infection in the first and second or the third trimester, respectively. We aimed to revisit this relationship prospectively between 2011 and 2017, using accurate virological tools.MethodsWe collected data on women with a primary infection and an infected child aged at least 1 year at the time of analysis. An accurate determination of the timing of the primary infection was based upon serial measurements of immunoglobulin (Ig) M and IgG and on IgG avidity in sera collected at each trimester. The case outcome was assessed according to a structured follow-up between birth and 48 months.ResultsWe included 255 women and their 260 fetuses/neonates. The dating of the maternal infection was prospective in 86% of cases and retrospective in 14%. At a median follow-up of 24 months, the proportion of sensorineural hearing loss and/or neurologic sequelae were 32.4% (95% confidence interval [CI] 23.72–42.09) after a maternal primary infection in the first trimester, 0 (95% CI 0–6.49) after an infection in the second trimester, and 0 (95% CI 0–11.95) after an infection in the third trimester (P < .0001).ConclusionsThese results suggest that a cytomegalovirus infection can be severe only when the virus hits the fetus in the embryonic or early fetal period. Recent guidelines recommend auditory follow-ups for at least 5 years for all infected children. This raises parental anxiety and generates significant costs. We suggest that auditory and specialized neurologic follow-ups may be recommended only in cases of a maternal infection in the first trimester.

NIDCAP is theory-guided, relationship-based and system-oriented. According to Gilkerson & Als, “Changes in the larger system affect the dynamics within the smaller unit”.1 Therefore it appears important to act at a national level to support NIDCAP dissemination.

Nager syndrome belongs to a heterogeneous group of disorders involving abnormal development of the extremities, face, and jaw: acrofacial dysostosis (AFD). Fewer than 100 cases of Nager syndrome have been reported to date. Recently, mutations in the 1q21.2 region of the SF3B4 gene (splicing factor 3B subunit 4), which encodes a spliceosomal protein (SAP49) involved in the assembly of the spliceosomal complex U2SNP, have been demonstrated in patients with Nager syndrome. We report the case of a child who had a characteristic association (Pierre Robin sequence, bilateral and symmetrical malar hypoplasia, absent thumbs) clinically diagnosed as Nager syndrome. This child also presented tetralogy of Fallot. This combination is unusual; only two other cases have been described. The karyotype and the CGH-array were normal. After the description in 2012 of several mutations in the SF3B4 gene (1q21.2) in Nager syndrome, a genetic search for our patient revealed the mutation c.1229delC. In 2013, other authors showed the presence of these same mutations in the majority of their patients diagnosed as Nager syndrome. The haploinsufficiency of the SF3B4 region seems to be the major cause of Nager syndrome.

Resume Objectif Rechercher la survenue d’un effet indesirable grave imputable a l’utilisation du protocole de dilatation pupillaire utilise au CHU de Caen pour le depistage de la retinopathie du premature. Ce protocole comprend une goutte de phenylephrine 5 % et deux gouttes de tropicamide 0,5 %, instillees a 5 minutes d’intervalle. Patients et methodes Cette etude retrospective a inclus tous les nourrissons nes prematurement avec un poids de naissance inferieur ou egal a 1500 g et/ou un âge gestationnel inferieur ou egal a 32 semaines d’amenorrhee, ayant beneficie d’un ou plusieurs fonds d’yeux de depistage de la retinopathie du premature lors de leur hospitalisation en neonatologie au CHU de Caen de 2009 a 2014. Parmi cette population, les dossiers des nourrissons decedes ou ayant presente une enterocolite ulceronecrosante ont ete analyses afin de rechercher l’imputabilite des deux collyres utilises pour la dilatation pupillaire. Resultats Les dossiers de 512 enfants representant 1033 fonds d’yeux ont ete analyses. Aucun deces imputable a l’instillation des collyres n’a ete observe. Deux cas d’enterocolite ulceronecrosante imputables a l’administration de tropicamide ont ete identifies avec une imputabilite intrinseque respectivement douteuse et plausible selon les criteres d’imputabilite francais. Conclusion Le protocole de dilatation pupillaire utilise au CHU de Caen pour depister la retinopathie du premature pourrait etre implique dans 2 cas d’enterocolites ulceronecrosantes avec une imputabilite incertaine du tropicamide 0,5 %. Nous n’avons pas mis en evidence d’effet indesirable grave imputable a l’utilisation de phenylephrine 5 %.

Le Plan perinatalite 2005–2007 recommande un suivi a long terme des enfants a risque de handicap au sein de reseaux perinatals. Notre objectif etait d’evaluer le degre de satisfaction des medecins generalistes (MG) referents du reseau bas-normand. Le taux de participation etait de 91 %. Neuf MG sur dix etaient satisfaits de leur role dans le reseau, et 84 % satisfaits des formations. Cependant, certains points restent a ameliorer tels que la formation continue et les relations entre professionnels.

Clinical and radiological knowledge of language development in the former premature infant compared to the newborn allows us to argue for exploration of the sensorimotor co-factors required for proper language development. There are early representations of the maternal language in the infant's visual, auditory, and sensorimotor areas, activated or stabilized by orofacial and articulatory movements. The functional architecture of language is different for vulnerable children such as premature infants. We have already mentioned the impact of early dysfunction of the facial praxis fine motor skills in this population presenting comprehension disorders. A recent meta-analysis confirms the increasing difficulty of understanding between 3 and 12 years, questioning the quality of the initial linguistic processes. A precise analysis of language, referenced from 3 years of age, should be completed by sensorimotor tests to assess possible constraints in automating neurolinguistic foundations. The usual assessment at this age can exclude sensory disturbances and communication and offers guidance and socialization. However, a recent study shows the ineffectiveness of "language-reinforced immersion" at 2 and 3 years in a population of vulnerable children. The LAMOPRESCO study of language and motor skills in the premature infant (National PHRC 2010) has assessed language and sensorimotor skills of preterm-born (

Resume Les auteurs detaillent les methodes et les resultats des principaux programmes d’intervention precoces proposes apres l’hospitalisation pour les familles d’enfants prematures. Ces programmes presentent une grande diversite dans le type d’intervention, la frequence des seances et la duree totale de l’intervention, ainsi que dans la duree du suivi. Selon les etudes, il apparait un benefice inconstant sur le developpement cognitif et comportemental dans les 2 premieres annees et a l’âge prescolaire. Ce qui parait important a la lumiere des etudes les plus recentes, c’est que l’intervention prenne en compte la sante psychique parentale, qu’elle porte sur les interactions parents–enfant et soit suffisamment prolongee.

Resume Introduction L’hospitalisation a domicile (HAD) diminue le temps d’hospitalisation conventionnelle en offrant a domicile des conditions de qualite et de securite de soins equivalentes. Ce travail avait pour but de decrire et d’evaluer le cout du sejour dans une HAD de neonatologie et de le comparer aux recettes generees par le systeme de tarification a l’activite lors de la premiere annee de fonctionnement. Methode Etude medicoeconomique de couts. Le point de vue adopte etait celui de l’hopital. Pour les enfants presents dans l’unite d’HAD entre mai 2010 et mai 2011, les caracteristiques sociodemographiques ont ete recensees, les ressources consommees valorisees et les couts constates compares au systeme de la tarification a l’activite (T2A). Resultats Plus de 75 % des enfants admis en HAD de neonatologie etaient d’anciens prematures et 67 % des sejours avaient un motif nutritionnel de prise en charge. La duree moyenne de sejour avait ete de 16,5 ± 11 jours. L’ensemble des 85 sejours avait genere une recette de 152 582 euros pour une recette mediane de 1531 euros. Le cout median du sejour avait ete de 1945 euros, entrainant une perte de 45 518 euros pour l’hopital mais le taux de remplissage n’avait pas ete maximal au cours de cette periode de montee en charge (77 %). Le plus important poste de depense avait ete le personnel (73 % du cout total) suivi par les frais de gestion generale et de structure (20 %). Conclusion Un taux d’occupation proche de 100 % permettrait quasiment d’equilibrer le bilan financier de cette HAD de neonatologie.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 37 - N° 4 - p. 415-418

Adverse drug events are a daily concern in neonatology departments. The aim of this study was to assess the professional practices of preparation and administration of injectable forms of medications in neonatology.A professional practice evaluation with regard to the preparation and administration of various injectable forms of medications in different neonatology units within a given department was conducted by a pharmacy intern based on an assessment grid comprising ten criteria. Following an initial assessment, the results were presented to the care team, which validated the corrective measures put forward by a multiprofessional work group. A second assessment was conducted following the same methodology.Fifty of the department's 76 pediatric nurses were assessed during the first round of the audit and 21 during the second round. Two improvement priorities were identified: taking account of the dead volume of medication in needles and syringe hubs, together with complete identification of syringes used to administer medication. During the second round, these two aspects were improved, progressing from 38% to 100% and from 59% to 89%, respectively.To improve drug administration in neonatology and consequently, to improve patient safety, professional practice evaluation is an essential tool that requires close collaboration between the paramedical team, physicians and pharmacists. Its main value lies in the mobilization of the entire team around the subject in question, hence generating improved understanding and application of corrective measures.

Intrapartum asphyxia is a rare yet serious complication during labor with immediate consequences and possible long-term neurological impairment. The international Cerebral Palsy Task Force established criteria that attribute a cerebral palsy to intrapartum asphyxia: metabolic acidemia measured at birth with pH7 and base deficit≥12mmol/L.To determine the risk factors of an intrapartum asphyxia occurring in term live births, to evaluate the short-term consequences.Our retrospective study included all births between 2002 and 2010 in a level 3 maternity of a university hospital center. Inclusion criteria were those of the Cerebral Palsy Task Force associated with a gestational age≥34weeks of gestation. We studied the conventional markers of intrapartum asphyxia: Apgar score at 5minutes, abnormal cardiotogographic recordings whether they occurred after a sentinel hypoxic event or not before and during labor. The duration of expulsive efforts, the amniotic fluid aspects, the delivery mode as well as the preexisting pregnancy pathologies were also evaluated. On the other hand, we studied the short-term consequences at the newborns: death, multiorgan failure and especially the occurring of a neonatal encephalopathy using Sarnat and Sarnat staging.One hundred and twenty-nine newborns (0.43%) out of 29,416 live births had a pH7 of whom only 82 (0.27%) presented a real intrapartum asphyxia and were included in this study. A preexisting pregnancy pathology was found in 22% of the women. Hypoxic events were noted in only 9/82 of the cases. Abnormal cardiotocographic recordings were present in 97.6% of the cases. The duration of expulsive efforts as well as the amniotic fluid aspects did not interfere with the occurring of a metabolic acidemia. Caesarean rate was at 46.3% and instrumental extraction rate was at 34.1%. Thity-eight newborns (46.3%) were admitted in neonatal intensive care in which we noted 3 deaths (3.65%), 2 multiorgan failures (2.4%) and 17 neonatal encephalopathy (20.7%). The pH value seemed to influence the occurring of an encephalopathy: 50% when pH6.9 vs. 13.6% when pH≥6.9 (P=0.0013), as well as for the base deficit: 50% when BD-18 vs. 15.7% when BD≥-18 (P=0.0068). Apgar score at 5minutes also seemed predictive for a neonatal encephalopathy: 100% when4, 46% between 4 and 6 and 11% when6 (P0.001).Our results showed an intrapartum asphyxia rate half the one widely recorded of 0.5% of total live births. Our study also validates the commonly used markers to evaluate a high risk of an early neonatal encephalopathy. This study should be continued with the evaluation of hypoxia long-term consequences on the psychomotor development of these kids and especially the occurring of cerebral palsy.

Nager syndrome belongs to a heterogeneous group of disorders involving abnormal development of the extremities, face, and jaw: acrofacial dysostosis (AFD). Fewer than 100 cases of Nager syndrome have been reported to date. Recently, mutations in the 1q21.2 region of the SF3B4 gene (splicing factor 3B subunit 4), which encodes a spliceosomal protein (SAP49) involved in the assembly of the spliceosomal complex U2SNP, have been demonstrated in patients with Nager syndrome. We report the case of a child who had a characteristic association (Pierre Robin sequence, bilateral and symmetrical malar hypoplasia, absent thumbs) clinically diagnosed as Nager syndrome. This child also presented tetralogy of Fallot. This combination is unusual; only two other cases have been described. The karyotype and the CGH-array were normal. After the description in 2012 of several mutations in the SF3B4 gene (1q21.2) in Nager syndrome, a genetic search for our patient revealed the mutation c.1229delC. In 2013, other authors showed the presence of these same mutations in the majority of their patients diagnosed as Nager syndrome. The haploinsufficiency of the SF3B4 region seems to be the major cause of Nager syndrome.

The aim of this study was to evaluate the impact on vaccination coverage of a protocol in which promotion and administration of pertussis vaccine in the maternity ward were proposed upon discharge from a French university hospital. Pertussis is a potentially fatal bacterial respiratory infection, especially in young infants. Since 2004 the High Council of Public Health has recommended vaccinating adults who may become parents. This recommendation is not widely applied in France. The study, organized as a professional practice evaluation (EPP) was conducted by a multidisciplinary team at Caen University Hospital. Thirty couples were included for each period. The primary endpoint was the rate of vaccination coverage for both parents at hospital discharge. Before the information campaign (first period, January 2012), immunization coverage of mothers and fathers was 20% and 13%, respectively. No couple had received a prescription for vaccines. During the second period (June 2013), vaccination coverage was 77% at hospital discharge for mothers and 57% for fathers. Parental immunization coverage against pertussis was multiplied by four to five during the study, which is very encouraging, and it is important to continue this campaign at the region and national levels.

Purpose Retinopathy of prematurity screening requires pupil dilation of premature infants. While essential for reliable fundus examination, proper dilatation may sometimes be difficult to achieve in this population. The aim of our study was to compare the efficacy of two mydriatic regimens: one consisting in three drops of tropicamide 0.5% and the other one consisting in two drops of tropicamide 0.5% with one drop of phenylephrine 5%. Methods Thirty premature infants were enrolled and each infant was dilated with one regimen in one eye and the other regimen in the other eye. The side of each regimen was determined by randomization. A photograph of each eye was taken. The photographs were anonymised and randomly presented to two independant readers. The effect of the two regimens was determined by calculating the ratio of pupil diameter divided by cornea diameter. Assuming that pupil and cornea are circle-shaped, we calculated the ratio of pupil surface area relative to cornea surface area for both regimens. Results The pupil to cornea diameters ratio was 46.7% (+/-8.8) with tropicamide alone and 65.2%(+/-6.0) with tropicamide-phenylephrine combination. The ratio of pupil to cornea surface areas was 21.8% with tropicamide alone and 42.6% with tropicamide-phenylephrine combination. In other words, the pupil surface area was 1.95 fold greater with tropicamide-phenylephrine combination than with tropicamide alone. Conclusion The use of a combination of two drops of tropicamide 0.5% with one drop of phenylephrine 5% is far more efficient than tropicamide alone to achieve proper pupil in premature infants.

This study aimed at investigating serious side effects of the pupillary dilation protocol used in Caen University Hospital for the screening of retinopathy of prematurity. This protocol includes one drop of phenylephrine 5% and two drops of tropicamide 0.5% instilled at a 5-minute interval.This retrospective study included all premature infants with a birth weight less than or equal to 1500 g and/or a gestational age less than or equal to 30 gestational weeks, hospitalized in the neonatal intensive care unit of Caen University Medical Center, having ocular fundus examinations for retinopathy of prematurity screening between 2009 and 2014. The medical records of patients who died or developed necrotizing enterocolitis were reviewed to analyze the imputability of the two eye drops used for pupil dilation.Five-hundred and twelve infants were included, corresponding to 1033 ocular fundus examinations. No case of death could be ascribed to the use of eye drops. Two cases of necrotizing enterocolitis could be ascribed to the use of tropicamide with a doubtful and plausible intrinsic imputability according to French imputability criteria.The pupillary dilation protocol used in Caen University Hospital for screening of retinopathy of prematurity might be implicated in two cases of necrotizing enterocolitis with an uncertain imputability of tropicamide 0.5% eye drops. No serious side effect could be ascribed to the use of phenylephrine 5% eye drops in this study.

Alveolar capillary dysplasia with misalignment of pulmonary veins (ACD/MPV) is a rare neonatal pathology that combines refractory hypoxemia with severe pulmonary arterial hypertension, and leads to death every time. Histologic examination of lung tissue confirms the diagnosis and is characterized by a decreased number of pulmonary capillaries, immature lobular development, and abnormal proximity between pulmonary arteries and veins. This abnormal proximity is responsible for an arteriovenous shunt. We report five cases confirmed by postmortem histology, which occurred over 14 years in Lower Normandy (France). The cumulative incidence is therefore of 1.8 for 100,000 births. In these five cases, the first symptoms appeared during the first hour of life and death occurred before 24h in four of five cases. The patient with the longest survival had mild histological lesions and delayed emergence of the first symptoms. Genitourinary and gastrointestinal anomalies were associated with ACD/MPV in two cases, and bilateral pulmonary hypoplasia in three cases. Optimized invasive ventilation, pulmonary vasodilators, vasoactive drugs, and pulmonary surfactant did not improve survival. Extracorporeal membrane oxygenation (ECMO) was not used. We present a review of the literature on ACD/MPV, a clinical and histological entity little known to both clinicians and pathologists, whereas a premortem diagnosis is possible and genetic counseling in affected families can be suggested.

La sortie a domicile d’un nouveau-ne premature est classiquement conditionnee par differents criteres : stabilite thermique et cardiorespiratoire, capacites parentales a prendre en charge ce nouveau-ne fragile, autonomie alimentaire. Les hospitalisations initiales en neonatalogie sont parfois tres longues, induisant une separation prolongee de l’enfant et de sa famille [1–4]. La transition hospitalisation initiale/domicile est souvent mal vecue par les familles. Dans les pays scandinaves, les pratiques ont evolue depuis plus d’une dizaine d’annees vers une sortie plus precoce, encadree par une hospitalisation a domicile (HAD). La sortie a domicile est autorisee alors que l’autonomie alimentaire n’est pas acquise. Actuellement, les 15 unites de neonatologie suedoises fonctionnent avec une HAD en neonatologie. La sortie est possible en moyenne a 35 SA avec un poids moyen de 1 875 grammes [5].

De nombreuses etudes ont montre que les grands prematures ont plus de difficultes motrices, cognitives et comportementales que les enfants nes a terme [1–4]. Neanmoins, avec les progres des soins perinataux, la survenue de handicaps severes a type de paralysie cerebrale, de deficience mentale, de cecite ou de surdite a regresse et la majorite des enfants d’âge gestationnel (AG) inferieur a 32 SA ou de poids de naissance (PN) inferieur a 1 500 grammes presente surtout des problemes d’apprentissage, des scores de quotient intellectuel limites, des deficits de l’attention et des deficits neuropsychologiques specifiques touchant l’integration visuo-motrice et les fonctions executives [5]. Des troubles a type de depression ou d’anxiete ont egalement ete rapportes chez les anciens prematures [6]. Ces alterations neurodeveloppementales tardives correspondent dans la jeune enfance a des difficultes d’autoregulation, a type d’etat physiologique de base instable, de mauvaise qualite des mouvements, de defaut de controle postural, d’hypo ou d’hyperreactivite aux stimulations sensorielles. Ces difficultes d’autoregulation diminuent les capacites d’interaction sociale et d’exploration du nourrisson qui sont necessaires a son apprentissage et augmentent le stress et les comportements d’opposition qui alterent l’architecture de son cerveau en developpement rapide [7].

Resume Les diarrhees aigues du nourrisson sont responsables de 10 % des hospitalisations a cet âge, avec de tres importantes variations du taux d'hospitalisation selon les centres. Objectifs. – Evaluer le traitement hospitalier des diarrhees aigues du nourrisson, et notamment l’impact de la presence permanente d’un pediatre et d’une structure d’hospitalisation de courte duree sur les modalites de rehydratation et les taux d’hospitalisation. Methodes. – L’etude prospective, multicentrique, a inclus durant deux periodes epidemiques d’infection a rotavirus 1 187 nourrissons, d’âge moyen 10 ± 6 mois, amenes a l’hopital pour une diarrhee aigue avec ou sans deshydratation. La premiere phase a concerne 12 centres hospitaliers volontaires. Dans la deuxieme phase, les modalites de rehydratation et d’hospitalisation ont ete comparees dans six centres hospitaliers (parmi les 12) ou les enfants etaient accueillis dans le service d’urgences ou de pediatrie sans la presence permanente d’un pediatre, et dans une unite d’urgences pediatriques ayant un pediatre en permanence sur place et dix lits d’hospitalisation de courte duree. Resultats. – Dans la premiere phase, 32 % des nourrissons etaient deshydrates et 6 % etaient choques a l’admission. Le taux d’hospitalisation etait de 81 %. Seuls 19 % des enfants deshydrates etaient rehydrates exclusivement par voie orale tandis que 19 % des normohydrates etaient perfuses. Dans la deuxieme phase, le taux global d’hospitalisation etait moindre dans l’unite d’urgences pediatriques : 42 % (soit 28 % d’hospitalisation de courte duree aux urgences + 14 % d’hospitalisation en pediatrie) contre 77 % dans les six centres hospitaliers. Dans l’unite d’urgences pediatriques, par comparaison aux six centres hospitaliers, le nombre de journees d’hospitalisation etait reduit de 65 %, le recours a la voie veineuse de 58 %, et le recours a des examens sanguins de 66 %. Conclusions. – Cette etude montre l’interet de la presence d’un pediatre et de lits d’hospitalisation de courte duree dans la prise en charge de cette affection frequente et couteuse.

Resume La myase ou hypodermose est une parasitose en voie de disparition. Nous en rapportons un cas survenu en Basse-Normandie. Observation Caroline, sept ans, a ete hospitalisee en novembre 1998 pour un œdeme palpebral superieur et inferieur droit, indolore, non inflammatoire, de volume variable dans le temps, responsable d'un ptosis, accompagne de nodules sous-cutanes sus-orbitaires droits, apparus dix jours auparavant. Les examens complementaires comportant en particulier la recherche d'une hypereosinophilie et les serologies de l'hypodermose et de la toxocarose etaient normaux. Caroline a presente plusieurs poussees œdemateuses, l'œdeme devenant de plus en plus ecchymotique et douloureux. Apres un mois et demi d'evolution, une hypereosinophilie est apparue et la serologie de l'hypodermose est devenue positive. Une corticotherapie breve (sept jours) par voie orale a ete decidee, compte tenu de la gene visuelle secondaire a l'importance de l'œdeme palpebral. Par la suite, Caroline n'a pas eu de nouvelle poussee œdemateuse, et les nodules sous-cutanes ont disparu. La larve ne s'est pas exteriorisee. Conclusion Dans les regions d'elevage bovin, il faut savoir garder a l'esprit le diagnostic d'hypodermose devant des signes cliniques evoquant une migration larvaire, meme en l'absence d'hypereosinophilie et de positivite initiale de la serologie. Cette affection devrait etre eradiquee en raison de l'existence de programmes regionaux de traitement systematique du cheptel bovin.

Resume L'hypothyroxinemie du premature est un phenomene decrit depuis longtemps. Souvent qualifiee d'hypothyroxinemie transitoire sans elevation de la TSH, elle est consideree comme une phase normale du developpement. Cependant, plusieurs travaux ont montre une association, a defaut d'un lien de cause a effet, entre l'hypothyroxinemie des prematures et les retards de developpement moteur et cognitif ulterieurs. Nous avons evalue le degre et la duree de l'hypothyroxinemie des prematures, et les resultats indiquent que ce phenomene, d'autant plus frequent que le terme de naissance est precoce, n'est pas pour autant systematique. Une frequence plus elevee que la normale des elevations moderees de la TSH semble indiquer qu'il y a une part d'hypothyroidie vraie chez les prematures. La duree moyenne de l'hypothyroxinemie est de 6 a 7 semaines apres la naissance. La grande variabilite inter-individus suggere qu'un essai randomise de supplementation en thyroxine devrait s'appuyer sur un suivi regulier de la thyroxinemie de chaque enfant, plutot que sur l'administration d'une dose unique de L-T4.

D'abord decouvert chez le singe, le virus respiratoire syncytial humain (VRS) a ete isole en 1957 par Chanock [11] chez un enfant atteint de pneumopathie sifflante et quelques annees apres, les epidemies hivernales de broncho-pneumopathies aigues dyspneisantes etaient rattachees au VRs. II a fallu cependant attendre une dizaine d'annees pour que le diagnostic rapide par immunofluorescence (IF) permette de mieux connaitre la clinique et l'epidemiologie de l'infection a VRS.

Objective: This prospective study was designed to assess the relationship between variations of serum Aluminium levels and bone mineralization, which is one of its target tissues, in healthy premature (PT) and fullterm (FT) infants. Study design: Lumbar spine bone mineral density (BMD) and content (BMC) studied by dual energy X-ray absorptiometry were compared to serum aluminium (S-Al), Ca (S-Ca), P (S-P), osteocalcin, alkaline phosphatase activity (S-AP), and 25 OH Vitamin D (25 OH D) by simple and multiple regressions in healthy PT (n=44) following their hospital discharge and FT (n=82). PT (gestational age at birth (mean±1 s.d.) 32±2 weeks) and FT were 43±39 and 36±32 weeks old respectively. Results: In PT multiple stepwise regression analysis including gestational age at birth, postconceptional age and postnatal age displayed only a significant correlation between BMD or BMC and postnatal age and a negative one with S-Al. In FT correlations were found between BMD or BMC and age and S-Ca. Conclusions: In PT, variations in blood Al are associated with developmental delays. Care should be taken to lessen Al levels, even in healthy PT babies.

Resume La corticotherapie proposee dans la prevention de la dysplasie bronchopulmonaire peut etre a l'origine d'un certain nombre de complications dont une hypertrophie myocardique. Observations. - Quatre observations d'hypertrophie myocardique induite par les glucocorticoides dont l'une s'est manifestee par une defaillance cardiaque sont rapportees. Il s'agissait de prematures d'âge gestationnel de 26 semaines et de poids de naissance compris entre 780 g et 1 080 g, traites par dexamethasone et/ou betamethasone pour une dysplasie bronchopulmonaire debutante. Les signes echographiques d'hypertrophie myocardique sont apparus 4 a 15 jours apres le debut du traitement alors que les enfants avaient recu une dose cumulee de glucocorticoides de, respectivement, 1,82 - 1,87 - 3,51 et 3,86 mg/kg. Cette myocardiopathie a toujours regresse a l'arret du traitement dans un delai de 2 a 4 semaines. Conclusion. - Pour prevenir cette complication, il est propose d'utiliser une posologie initiale de corticoides relativement faible (0,3 mg/kg/j) et de realiser une surveillance echographique systematique de ces enfants dans les 15 premiers jours de traitement.

This paper has been retracted because it contained errors in the data extraction and analyses that affect the results, figures and tables. Data from a study that had been published in two different journal articles were included twice in the analyses. There was an error in the description of the measures used for neurodevelopmental testing in the reporting of the results.

Resume Le lymphangiome kystique retroperitoneal represente une tumeur benigne rare dont la presentation clinique est polymorphe. Observations. - Cas 1: une echographie fœtale a ete realisee a la 31 e semaine d'âge gestationnel; elle a montre l'existence d'une masse abdominale kystique. L'enfant, de sexe feminin, nee a terme, a presente une masse abdominale cliniquement palpable, egalement retrouvee a l'echographie. L'exploration chirurgicale au 3 e jour de vie a montre un lymphangiome kystique retroperitoneal dont l'exerese n'a pu etre que partielle. Une reintervention a l'âge de 2 mois a encore ete incomplete. Les echographies successives ont montre un kyste laterovesical persistant; l'enfant est asymptomatique a l'âge de 2 ans. Cas 2. — Une fille, nee a terme, a ete admise en periode neonatale pour ictere et pâleur. L'examen a montre l'existence d'une masse ferme du flanc gauche qui a ete confirmee par les examens radiologiques et l'echographie. Malgre la transfusion sanguine, l'anemie a persiste, necessitant une intervention chirurgicale qui a montre une masse kystique hemorragique dont le contenu a ete evacue. Une reintervention, quelques semaines plus tard, a permis une excision incomplete du kyste et l'echographie realisee a l'âge de 7 mois a montre plusieurs petites masses kystique derrie le rein gauche. Cas 3 . — Un garcon de 16 mois a ete opere pour une hernie inguinale droite. Le sac herniaire contenait du liquide et sa paroi etait epaissie. L'echographie et le scanner realises 3 jours plus tard etaient normaux. L'enfant a ete revu 28 mois plus tard pour la survenue d'une douleur abdominale; une masse importante etait palpable dans le flanc droit dont l'echographie et le scanner ont montre la nature kystique. Il s'agissait d'un lymphangiome retroperitoneal qui a pu etre completement retire. Conclusion. - Du fait d'un risque eleve de complications, le traitement chirurgical est toujours necessaire. En periode neonatal, l'ablation complete est cependant difficile, pouvant necessiter de surseoir a l'intervention pendant quelques mois.

Resume De 1990 a 1994, 105 enfants ont ete hospitalises pour coqueluche dans l'une des 22 unites de reanimation du Groupe Francophone de Reanimation Pediatrique participant a l'etude. A l'admission 78 enfants avaient moins de 3 mois, dont 9 avaient moins de 30 jours, 24 enfants etaient âges de 3 a 6 mois, 2 de 6 a 12 mois et un seul enfant avait plus de 12 mois. Quatre vingt dix huit pour cent des enfants ont presente des quintes asphyxiantes, 50 % des bradycardies, 21 % des apnees syncopales et 9 % un tableau de coqueluche maligne. Parmi les complications, il est a noter un pneumothorax dans 2 cas, une ou des atelectasies dans 17 cas, une surinfection bacterienne bronchopulmonaire dans 11 cas (bacterie a Gram negatif 8 cas), une septicemie dans 2 cas et des convulsions dans 6 cas. Les moyennes des leucocytoses et lymphocytoses maximales etaient statistiquement differentes entre le groupe coqueluche maligne et le groupe autres coqueluches avec des valeurs respectives de 99 100 versus 28 000/mm 3 et 41 200 versus 19 410/mm 3 . De meme on retrouvait une difference statistiquement significative entre ces deux groupes pour la moyenne de la valeur minimale de la natremie respectivement a 123 versus 136 mmol/l. Trente quatre enfants ont necessite la ventilation controlee pour une duree moyenne de 8,3 jours (1–21 jours), 7 enfants sont decedes (6,6 %) : il s'agissait tous de coqueluche maligne.

Resume La myosite ossifiante progressive est une maladie progressive du tissu conjonctif dont le pronostic est severe. Observation. - Une adolescente de 16 ans a presente une boiterie de la jambe droite avec tumefaction inguinale du meme cote. L'aggravation progressive de la douteur, et la progression de la tumefaction vers la loge posterieure de la cuisse a necessite un examen radiologique qui a montre une dysplasie de la hanche droite, et des calcifications periarticulaires. L'arteriographie a ete normale: un diagnostic d'hematome a ete propose apres examen tomodensitometrique de la masse et scintigraphie osseuse. Cependant, la biopsie a montre un aspect de fasciite nodulaire. La decouverte d'une malformation du gros orteil des deux pieds a conduit au diagnostic de myosite ossifiante progressive. Conclusions. - La decouverte de malformations congenitales, essentiellement des gros orteils et des pouces, est importante pour reconnaitre la myosite ossifiante progressive parmi les autres maladies musculaires.

Clinical and radiological knowledge of language development in the former premature infant compared to the newborn allows us to argue for exploration of the sensorimotor co-factors required for proper language development. There are early representations of the maternal language in the infant's visual, auditory, and sensorimotor areas, activated or stabilized by orofacial and articulatory movements. The functional architecture of language is different for vulnerable children such as premature infants. We have already mentioned the impact of early dysfunction of the facial praxis fine motor skills in this population presenting comprehension disorders. A recent meta-analysis confirms the increasing difficulty of understanding between 3 and 12 years, questioning the quality of the initial linguistic processes. A precise analysis of language, referenced from 3 years of age, should be completed by sensorimotor tests to assess possible constraints in automating neurolinguistic foundations. The usual assessment at this age can exclude sensory disturbances and communication and offers guidance and socialization. However, a recent study shows the ineffectiveness of "language-reinforced immersion" at 2 and 3 years in a population of vulnerable children. The LAMOPRESCO study of language and motor skills in the premature infant (National PHRC 2010) has assessed language and sensorimotor skills of preterm-born (33 weeks) 3.5-year-old children without cerebral palsy. Fragile children were randomized into 2 groups, 1 stimulated by a specific individual protocol, the other given guidance. The primary endpoint was phonology, assuming that it is composed of very early good-quality sensorimotor integration stabilized by the child's oral facial motor skills before 5 years of age. This developmental integrative dynamic validates the "motor theory of speech perception." Early and accurate assessment of language and the patient's constraints should differentiate and specify management strategies for all children, whatever their background and pathologies.

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.

Measles is one of the most contagious diseases implicated in an outbreak in Western Europe for a few years. In France, the outbreak began in 2008, especially in the southern regions. Most of the cases are mild but deleterious effects can occur in infants, during the pregnancy, or in immunosuppressive patients. Pneumonia and encephalitis are the major complications in these patients. Measles illness during pregnancy results in a higher risk of premature labor, spontaneous abortion, and low-birthweight infants. Death from measles was reported in approximately 0.3% of cases. The National Reference Center for measles and paramyxoviridae is implicated in biological confirmation of cases and epidemiologic surveillance. Virologic diagnosis consists in a direct detection of viral RNA (real time PCR), or indirect detection of the immune response (IgM and IgG) in saliva samples. The measles genotype is determined by sequencing a 450 nucleotids fragment of the N gene, as the World Health Organization (WHO) recommendation. This molecular analysis helps determine the geographic origin of the virus and the viral strains circulating in the country. In 2011, 3105 specimens were received. PCR was positive for 1990 patients (64%), with a large majority of children younger than 2 years of age and young adults. The most important cause of measles resurgence is low vaccination coverage. The role of pediatricians is important in order to achieve the goal of 95% of vaccination coverage established by the WHO.

Hospital at home (HAH) shortens hospitalization time by providing at-home hospital-level care. The aim of this study was to describe and assess the cost of the neonatal HAH stay and compare it to the incomes produced by activity-based payments during the 1st year of a neonatal HAH program.Medical and economic cost study from the hospital's point of view. For children admitted to the neonatal HAH unit between May 2010 and May 2011, sociodemographic characteristics were identified, consumed resources evaluated, and costs compared to the incomes produced by activity-based payments.Over 75% of children admitted to neonatal HAHs were former preterm infants and 67% of stays included nutritional support. The average length of stay was 16.5 days (SD, 11). The 85 stays produced 152,582 euros of income, the median income was 1531 euros. The median cost of the HAH stay was 1945 euros, resulting in a loss of 45,518 euros for the hospital, but the filling rate was not at its maximum during this period of scalability (77%). Personnel was the most costly item (73% of the total cost) followed by general management and structural costs (20%).Economic aspects must be considered to preserve the financial viability of a HAH unit, but the secondary human benefits must be highlighted. A 100% occupation rate would nearly balance the neonatal HAH budget. However, fees must be adjusted to ensure the sustainability and development of these structures.

Resume Les epidemies hivernales d'infections a virus respiratoire syncytial (VRS) sont a l'origine de frequentes atteintes des voies aeriennes inferieures chez le jeune enfant. La necessite d'identifier les formes graves de bronchiolites a VRS et de les distinguer d'autres pneumonies bacteriennes ou virales, et la perspective d'utiliser un traitement anti viral ont suscite le developpement de techniques de diagnostic rapide. Les essais d'utilisation de la serologie IgM se sont reveles decevants. La recherche directe d'antigenes du VRS dans les secretions respiratoires par immunofluorescence ou ELISA est la methode de choix. Les deux techniques ont sur la culture les avantages de facilite et de rapidite, et peuvent apparaitre plus sensibles en raison de l'inactivation rapide du VRS dans le prelevement nasal. Compares a la culture, les resultats de l'immunofluorescence sont concordants dans 90,6 % des cas (1584/1747), mais celle-ci permet aussi de detecter 6,3 % (111/1747) de prelevements infectes par le VRS qui sont negatifs en culture, alors que 2,9 % (52/1747) de prelevements, a la charge virale tres faible, sont deceles uniquement en culture. L'isolement viral en culture de cellules conserve aussi un interet pour etudier la sensibilite des souches de VRS a la ribavirine. La mesure des DI50 et DI90 (μg/ml) par la technique de reduction de plages, realisee sur 44 souches de VRS, isolees de patients non traites, montre qu'il n'existe pas de differences entre les valeurs de DI50 et de DI90 des VRS des sous-groupes A ou B ou des souches non typables, et que la valeur moyenne de la DI90 (43,7 μg/ml) est relativement proche de celle de la DI50 (22,1 μg/ml). L'identification au groupe A ou B de VRS a ete realisee chez les enfants hospitalises a Caen, au cours de 11 epidemies successives de 1982 a 1993. Les deux groupes sont habituellement egalement representes, sauf en 1978–88 ou le sous-groupe A predomine, et en 1983–84 et 1989–90 ou il s'agit du sous-groupe B. Une plus grande gravite des formes cliniques est observee avec les souches A. La recherche du genome viral par PCR apres retrotranscription est possible, mais, outre la complexite, la lenteur et le cout eleve de cette technologie, il n'existe aucune justification theorique ou pratique a son utilisation en routine pour le diagnostic de l'infection a VRS du jeune enfant.

To compare evolution and characteristics of in utero transfers (IUT) in Basse-Normandie area, France, between 2004 and 2008, and to describe characteristics of IUT in 2008.Analysis of data from the IUT registry, collected prospectively since 2004.An average of five IUT per week was observed. The rate of IUT regularly increased (P=0.003) and reached 16.2 per 1000 pregnancies in 2008. Extra network IUT decreased steadily (P=0.04). For level 3 units, the proportion of IUT from level 2 units increased (P10(-3)). Before 32 weeks of gestational age, all IUT were done towards a level 3 unit. Median time between IUT and delivery and caesarean section rates were variable according to IUT indication (for threats of premature delivery, respectively 5 days and 23.3%). The rate of retransfer towards initial unit of towards a birth site of relevant level was 5.3%.The IUT registry gives useful information on evolution and characteristics of IUT in our area. An increased regionalisation and more frequent adequate IUT were observed. The registry must now serve as a basis for practices assessment.

Résumé En Normandie, le virus respiratoire syncytial (hRSV) est trouvé dans 64,1 % des cas de bronchiolites aiguës chez l’enfant hospitalisé, les rhinovirus dans 26,8 %, le métapneumovirus humain (hMPV) dans 7,6 % et les virus para-influenza (PIV) dans 3,4 %. Dans les bronchiolites aiguës communautaires, on a une répartition différente : hRSV : 42 %, rhinovirus : 19,5 %, coronavirus : 8 %, PIV : 3,5 %, hMPV : 2,5 %. Le hRSV infecte les nourrissons (86,9 %), dont 53,7 % ont moins de 6 mois et 48,2 % des hRSV sont détectés en novembre et décembre, et 44,5 % en janvier et février. L’épidémie débute la 1re ou 2e semaine d’octobre, mais elle varie d’une année à l’autre et d’une région à l’autre. À l’hôpital, les bronchiolites à hRSV sont passées de 261 cas par épidémies de 1999 à 2003, à 341 cas de 2004 à 2009. Les rhinovirus sont associés à des bronchiolites aiguës dans 38,4 % des cas ; 54,6 % des souches étant identifiées en septembre et octobre, et 38,5 % en mars et avril ; 34,2 % infectent des nourrissons de moins de 6 mois, 37,8 % entre 6 mois et 2 ans, et 19,5 % des enfants entre 2 et 5 ans. Les épidémies à hMPV coïncident avec celles du hRSV mais ont 6 fois moins de cas hospitalisés. Le hMPV infecte les nourrissons (74 %) mais plus âgés que ceux infectés par le hRSV. Il entraîne une bronchiolite aiguë dans 59 % des cas, une pneumonie dans 17 %. Les infections à PIV (environ 100 cas hospitalisés par an) se répartissent en PIV3 : 62,7 %, PIV1 : 25,3 % et PIV2 : 7,3 %. Les PIV1 apparaissent tous les 2 ans, à l’automne. Les infections à PIV3 sont automnales et hivernales, avec des infections au printemps les années sans PIV1. Il y a des bronchiolites aiguës dans 29,8 % des infections à PIV3 et 18,3 % à PIV1.

Palivizumab is a recombinant humanized monoclonal antibody against the F glycoprotein of respiratory syncytial virus (RSV). It has been licensed since 1999 in France for the prevention of serious lower respiratory-tract infection caused by RSV requiring hospitalization in children born at 35 weeks gestation or less and who are less than 6 months old at the onset of RSV season, or in children less than 2 years old who have received treatment for bronchopulmonary dysplasia within the last 6 months. Since 2003, it has been also licensed for children less than 2 years with hemodynamically significant heart disease. Its high cost leads french and foreign pediatric Societies to restrain its indications for children with the highest risk of severe illness.

To evaluate whether magnesium sulphate (MgSO(4)) given to women at risk of very-preterm birth would be neuroprotective in preterm newborns.In 18 French centres, women with fetuses of gestational age less than 33 weeks whose birth was expected within 24 hours were randomised from 1993 to 2003 with follow-up of infants until two years of age after discharge. They received a single injection of 0.1 mg/l de MgSO(4) (4g) or isotonic 0.9% saline over 30 minutes. This study is registered as an International Standard Randomised Controlled Trial, number 00120588. Analyses were based on intention to treat.Data from 688 infants were analysed of which 606 were followed up and 10 were lost to follow-up. Comparing infants who received MgSO(4) or placebo, respectively, has shown a decrease of all primary endpoints (total mortality, severe white matter injury and their combined outcome) and of all secondary endpoints (motor dysfunction, cerebral palsy, cognitive dysfunction and their combined outcomes at two years of age) in the MgSO(4) group. The decrease was nearly significant or significant for gross motor dysfunction (OR: 0.65 [0.41-1.02]) and combined criteria: death and cerebral palsy (OR: 0.65 [0.42-1.03]); death and gross motor dysfunction (OR: 0.62 [0.41-0.93]); death, cerebral palsy and cognitive dysfunction (OR: 0.68 [0.47-1.00]). No major maternal adverse effects were observed in the MgSO(4) group.Given its beneficial effects and safety, the use of prenatal low-dose MgSO(4) for preventing neurodisabilities of very-preterm infants should be discussed either as a stand-alone treatment or as part of a combination treatment, at least in the context of clinical trials.

Pudendal nerve block may be indicated during instrumental delivery in situations where peridural anesthesia is unavailable. We report three cases of neonatal lidocaine intoxication following maternal pudendal block during delivery. Clinical features were hypotonia, pupillary mydriasis fixed to light, apnea, cyanosis and seizures. Two neonates required mechanical ventilation. Lidocaine was found in the serum of two babies. In all three cases, recovery was complete. The pharmacokinetics of lidocaine in a highly vascularized perineum during labor increase the risk of neonatal intoxication. A possible intoxication by local anesthetics should be considered in neonates presenting an acute distress in the delivery room.