Search

International audience; Background: Describe the 1-year hospitalization and in-hospital mortality rates, in infants born after 31 weeks ofgestational age (GA).Methods: This nation-wide population-based study used the French medico-administrative database to assess thefollowing outcomes in singleton live-born infants (32–43 weeks) without congenital anomalies (year 2011): neonatalhospitalization (day of life 1 – 28), post-neonatal hospitalization (day of life 29 – 365), and 1-year in-hospital mortalityrates. Marginal models and negative binomial regressions were used.Results: The study included 696,698 live-born babies. The neonatal hospitalization rate was 9.8%. Up to 40 weeks,the lower the GA, the higher the hospitalization rate and the greater the likelihood of requiring the highest levelof neonatal care (both p < 0.001). The relative risk adjusted for sex and pregnancy-related diseases (aRR) reached21.1 (95% confidence interval [CI]: 19.2-23.3) at 32 weeks. The post-neonatal hospitalization rate was 12.1%. Theraw rates for post-neonatal hospitalization fell significantly from 32 – 40 and increased at 43 weeks and thispersisted after adjustment (aRR = 3.6 [95% CI: 3.3–3.9] at 32 and 1.5 [95% CI: 1.1–1.9] at 43 compared to 40 weeks).The main causes of post-neonatal hospitalization were bronchiolitis (17.2%), gastroenteritis (10.4%) ENT diseases(5.4%) and accidents (6.2%). The in-hospital mortality rate was 0.85‰, with a significant decrease (p < 0.001)according to GA at birth (aRR = 3.8 [95% CI: 2.4–5.8] at 32 and 6.6 [95% CI: 2.1–20.9] at 43, compared to 40 weeks.Conclusion: There’s a continuous change in outcome in hospitalized infants born above 31 weeks. Birth at 40 weeksgestation is associated with the lowest 1-year morbidity and mortality.

La "Donna di Ostuni", the Lady from Ostuni (fortified medieval city, on the southern Italian Adriatic coast) is the skeleton of "the human most ancient mother" ever found by paleoanthropologists, grave dated of 28,000 years BP. It concerns a 20-years-old woman buried with her baby in her womb estimated at 8 months gestation. To date, the cause of the maternal-fetal deaths is qualified of unknown origin. We propose that eclampsia may be a possible explanation for these deaths (mother and baby together). Eclampsia (convulsions), the curse of human births (non-existent in other mammals), has been described since writings has existed 5000 years ago in all civilisations. This plausible description dating from Palaeolithic times, 28,000 years BP, long before the emergence of agriculture (10,000 years BP) may be an interesting milestone. Further, she was buried with a shell-made headdress, as represented in several "Venus" figurines retrieved in all the Eurasiatic area (notably the "Willemdorf Venus"). The authors propose a new hypothesis that this headdress could be a protective device for pregnant women not only for birthing, but also against the terrorising convulsions (eclampsia) which could happen in all human pregnancy, especially in the first ones (primiparae).

Background: Retrospective studies suggest that early hypoproteinemia has prognostic value for adverse outcome in preemies, but the underlying pathophysiology is unknown. We hypothesized that the prognostic relevance of hypoproteinemia could be related to its association with impaired cardiovascular function and organ perfusion during transition. Objectives: To describe the plasma protein status and the measures of cardiovascular function according to the outcome in infants Methods: One hundred and twenty-eight infants were prospectively included from birth to discharge. During the first 24 h of life, we assessed the cardiovascular function and systemic and organ blood flow by Doppler ultrasound, and monitored cerebral and renal regional oxygen saturation (cRSO2, rRSO2) using near-infrared spectroscopy. These measures were analyzed in relationship to hypoproteinemia (total plasma protein level Results: Hypoproteinemia was associated with a higher risk of a severe adverse outcome after adjustment of confounding variables (adjusted OR = 6.8; 95% CI 1.3-34). Compared to normoproteinemic infants and after adjustment for gestational age, hypoproteinemic ones had more significantly: hypotension (7 vs. 13%, p = 0.03), abnormal capillary refilling time (20 vs. 36%, p < 0.001), abnormal renal blood flow (resistive index 0.78 ± 0.11 vs. 0.85 ± 0.09, p = 0.04), lower rRSO2 (82.9 ± 9.2 vs. 73.6 ± 10.5%, p = 0.04), and lower systemic vascular resistance (0.155 ± 0.058 vs. 0.108 ± 0.037 mm Hg/L/kg; p = 0.04). The cRSO2 patterns were significantly decreased in infants with severe adverse outcome and independent from protein status. Conclusion: Hypoproteinemia is associated with impaired cardiovascular function. Further studies are required to elucidate the interplay between changes in protein levels, postnatal hemodynamics and clinical outcome.

Cefotaxime is one of the most frequently prescribed antibiotics for the treatment of Gram-negative bacterial sepsis in neonates. However, the dosing regimens routinely used in clinical practice vary considerably. The objective of the present study was to conduct a population pharmacokinetic study of cefotaxime in neonates and young infants in order to evaluate and optimize the dosing regimen. An opportunistic sampling strategy combined with population pharmacokinetic analysis using NONMEM software was performed. Cefotaxime concentrations were measured by high-performance liquid chromatography-tandem mass spectrometry. Developmental pharmacokinetics-pharmacodynamics, the microbiological pathogens, and safety aspects were taken into account to optimize the dose. The pharmacokinetic data from 100 neonates (gestational age [GA] range, 23 to 42 weeks) were modeled with an allometric two-compartment model with first-order elimination. The median values for clearance and the volume of distribution at steady state were 0.12 liter/h/kg of body weight and 0.64 liter/kg, respectively. The covariate analysis showed that current weight, GA, and postnatal age (PNA) had significant impacts on cefotaxime pharmacokinetics. Monte Carlo simulations demonstrated that the current dose recommendations underdosed older newborns. A model-based dosing regimen of 50 mg/kg twice a day to four times a day, according to GA and PNA, was established. The associated risk of overdose for the proposed dosing regimen was 0.01%. We determined the population pharmacokinetics of cefotaxime and established a model-based dosing regimen to optimize treatment for neonates and young infants.

International audience; OBJECTIVE: Evidence supports the efficacy of probiotics in reducing necrotizing enterocolitis (NEC) in very low-birth-weight infants, although concerns remain with regard to their routine use. Since 2008 in our neonatal intensive care unit, a low dose of probiotics (unique strain) is administered as standard of care in all preterm babies born at 24 to 31 weeks' gestation. This study reports outcomes in infants receiving probiotic cohort (PC) compared with the historical cohort. DESIGN: Treatment with Lactobacillus rhamnosus Lcr35 (Lcr Restituo) (2 × 108 colony-forming units/12 h) was started early after birth and intention to treat was up to 36 weeks' gestation. The main outcome was definite NEC. Secondary outcomes were mortality, late-onset sepsis (LOS), cholestasis, isolated rectal bleeding (IRB), and time to reach full enteral feeding (FEF). RESULTS: A total of 1130 patients were included. No adverse effects were observed. Infants in PC presented a reduced rate of NEC (odds ratio [OR] 0.20; 95% confidence interval [CI] 0.07 to 0.58), mortality (OR 0.46; 95% CI 0.21 to 1.00), and LOS (OR 0.60; 95% CI 0.40 to 0.89) and achieved FEF significantly earlier. IRB was significantly reduced among infants receiving the complete scheduled treatment. CONCLUSION: Administration of Lcr Restituo was well tolerated and associated with lower mortality and morbidities in this cohort. Our results provide evidence in support of the hypothesis that this probiotic may reduce IRB.

To determine the impact of maternal coronavirus disease 2019 (COVID-19) on prematurity, birthweight and obstetric complications.Nationwide, population-based retrospective cohort study.National Programme de Médicalisation des Systèmes d'Information database in France.All single births from March to December 2020: 510 387 deliveries, including 2927 (0.6%) with confirmed COVID-19 in the mother and/or the newborn.The group with COVID-19 was compared with the group without COVID-19 using the chi-square test or Fisher's exact test, and the Student's t test or Mann-Whitney U test. Logistic regressions were used to study the effect of COVID-19 on the risk of prematurity or macrosomia (birthweight ≥4500 g).Prematurity less than 37, less than 28, 28-31, or 32-36 weeks of gestation; birthweight; obstetric complications.In singleton pregnancies, COVID-19 was associated with obstetric complications such as hypertension (2.8% versus 2.0%, p 0.01), pre-eclampsia (3.6% versus 2.0%, p 0.01), diabetes (18.8% versus 14.4%, p 0.01) and caesarean delivery (26.8% versus 19.7%, p 0.01). Among pregnant women with COVID-19, there was more prematurity between 28 and 31 weeks of gestation (1.3% versus 0.6%, p 0.01) and between 32 and 36 weeks of gestation (7.7% versus 4.3%, p 0.01), and more macrosomia (1.0% versus 0.7%, p = 0.04), but there was no difference in small-for-gestational-age newborns (6.3% versus 8.7%, p = 0.15). Logistic regression analysis for prematurity showed an adjusted odds ratio (aOR) of 1.77 (95% CI 1.55-2.01) for COVID-19. For macrosomia, COVID-19 resulted in non-significant aOR of 1.38 (95% CI 0.95-2.00).COVID-19 is a risk factor for prematurity, even after adjustment for other risk factors.The risk of prematurity is twice as high in women with COVID-19 after adjustment for factors usually associated with prematurity.

International audience; Abstract : Objectives : To analyse published cost-of-illness studies that had assessed the cost of prematurity according to gestational age at birth. Methods : A review of the literature was carried out in March 2011 using the following databases: Medline, ScienceDirect, The Cochrane Library, Econlit and Business Source Premier, and a French Public-Health database. Key-word sequences related to ‘prematurity’ and ‘costs’ were considered. Studies that assessed costs according to the gestational age (GA) at the premature birth (

International audience; Objective: We studied potential effects of outdoor air temperatures or barometric pressure on births, preterm births and births associated with maternal hypertension.Methods: 12,269 births were retrospectively reviewed in Brussel and 25,880 in South Reunion Island. National Belgium and French weather reference centers provided outdoor air temperatures and barometric pressures from the nearest weather stations on the corresponding birthdays. Poisson regression models were used to assess if outdoor air temperatures or barometric pressure could be correlated, immediately and several days later, with the number of daily births, preterm births and births associated with hypertension.Results: Outdoor air temperature was significantly correlated to the number of daily births in Brussels. For each additional degree Celsius, overall births increased by 0.4% during the same day. Four days later, overall births increased by 1.8%, preterm births by 2.6% and births associated with hypertension by 5.7%. Similar observations on numbers of daily births were reported in South Reunion Island, without reaching statistical significance (p = .08).Conclusion: As previously demonstrated in recent studies, increased air temperature leads progressively to higher rates of births and preterm births. An even stronger delayed effect of air temperature was observed on births associated with hypertension. This would be worth further investigating.

Background Bronchiolitis is a distressing respiratory condition and the most common cause of hospitalization during the first year of life. The hospitalization of an infant is a stressful event for parents and deserves careful consideration. The objective of this work was to develop and validate a self-administered instrument that comprehensively assesses the impact on parents of the hospitalization of their infant for bronchiolitis. Methods The Impact of Bronchiolitis Hospitalization Questionnaire (IBHQ©) was developed using a literature review and pre-study interviews with both parents and clinicians. For finalization and psychometric validation, it was included in a multicenter, longitudinal, observational study conducted in France. Parents of infants under the age of 1 year and hospitalized for bronchiolitis were asked to complete the questionnaire at hospital discharge, and 3 months after. Results Seven hundred and seven questionnaires were completed by the parents of the 463 eligible infants. After finalization, based on principal component analyses, the IBHQ included 30 core items allowing the calculation of 7 dimension core scores (Worries and distress; Fear for future; Guilt; Impact on daily organization; Physical impact; Impact on behavior with hospitalized infant; Financial impact), as well as 16 optional items, allowing the calculation of 5 optional dimension scores (Disturbed breastfeeding; Physical reaction of hospitalized infant; Impact on feeding; Impact on behavior with other infants; Siblings’ reaction). Internal consistency reliability and construct validity of the IBHQ were satisfactory. The highest impact was observed for “Worries and distress”, “Fear for future” and “Impact on daily organization” scores. Conclusions The IBHQ is a reliable and valid instrument for assessing the multifaceted impact on parents of the hospitalization of their infant for bronchiolitis.

International audience; OBJECTIVE: We aimed to investigate the predictive value for severe adverse outcome of plasma protein measurements on day one of life in very preterm infants and to compare total plasma protein levels with the validated illness severity scores CRIB, CRIB-II, SNAP-II and SNAPPE-II, regarding their predictive ability for severe adverse outcome. METHODS: We analyzed a cohort of infants born at 24-31 weeks gestation, admitted to the tertiary intensive care unit of a university hospital over 10.5 years. The outcome measure was "severe adverse outcome" defined as death before discharge or severe neurological injury on cranial ultrasound. The adjusted odd ratio (aOR) and 95% confidence interval (95% CI) of severe adverse outcome for hypoproteinemia (total plasma protein level \textless40 g/L) was calculated by univariate and multivariate analyses. Calibration (Hosmer-Lemeshow goodness-of-fit) was performed and the predictive ability for severe adverse outcome was assessed for total plasma protein and compared with CRIB, CRIB-II, SNAP-II and SNAPPE-II, by calculating receiver operating characteristic (ROC) curves and their associated area under the curve (AUC). RESULTS: 761 infants were studied: 14.4% died and 4.1% survived with severe cerebral ultrasound findings. The aOR of severe adverse outcome for hypoproteinemia was 6.1 (95% CI 3.8-9.9). The rank order for variables, as assessed by AUCs and 95% CIs, in predicting outcome was: total plasma protein [0.849 (0.821-0.873)], SNAPPE-II [0.822 (0.792-0.848)], CRIB [0.821 (0.792-0.848)], SNAP-II [0.810 (0.780-0.837)] and CRIB-II [0.803 (0.772-0.830)]. Total plasma protein predicted severe adverse outcome significantly better than CRIB-II and SNAP-II (both p\textless0.05). Calibration for total plasma protein was very good. CONCLUSIONS: Early hypoproteinemia has prognostic value for severe adverse outcome in very preterm, sick infants. Total plasma protein has a predictive performance comparable with CRIB and SNAPPE-II and greater than other validated severity scores.

International audience; BACKGROUND: Obstetric hemorrhages are a frequent cause of maternal death all over the world, but are not routinely monitored. Health systems administrative databases could be used for this purpose, but data quality needs to be assessed. OBJECTIVES: Using blood transfusion data recorded in administrative databases to estimate the frequency of obstetric hemorrhages. Research design A population-based study. Subjects Validation sub-sample: all mothers who gave birth in a French region in 2006-07 (35 123 pregnancies). Main study: all mothers who gave birth in France in 2006-07 (1 629 537 pregnancies). METHOD: Linkage and comparison of administrative data on blood transfusions with data from the French blood agency ('gold standard'), and, based on this validation, the construction of a multivariable regression model to correct the number of pregnant women identified as having received a transfusion in the national administrative database. RESULTS: The blood transfusion rate observed in the gold standard was 7.12‰. The sensitivity of the administrative data was estimated at 66.3% and the positive predictive value at 91.3%. The estimated total number of pregnant women who received blood transfusions in France in 2006-07 was 10 941 (6.71‰). CONCLUSIONS: The administrative data, available in most countries, can be used to estimate the frequency of obstetric hemorrhages.

Objective To compare prediction of perinatal deaths among preterm infants based on fetal weight standards versus a new subpopulation-based birthweight standard. Design Population-based cohort study. Setting France. Population A total of 9100 preterm singletons, born between 24 and 36 weeks of gestation in 2000–09, in Burgundy (France). Methods We first classified all newborns as either small for gestational age (SGA) or not, based on alternative fetal weight or birthweight standards, including a new birthweight standard that excludes infants born to mothers with disease related to the weight of a fetus. Based on discrepancies between the different classifications, we then divided the newborns into four groups, and compared their risks of stillbirth and in-hospital death, using a generalised linear model with relative risks (RR). Main outcome measures Perinatal deaths, including, in separate analyses, stillbirths and in-hospital deaths. Results The preterm infants classified as SGA by our new subpopulation-based birthweight standard but not by the conventional birthweight standard had a significantly higher risk of both stillbirth (RR = 2.6; 95% confidence interval [95% CI] = 1.9–3.6) and in-hospital death (RR = 2.8; 95% CI = 1.8–4.5). In contrast, no risk increase was found for infants classified as SGA by the fetal standard only (RR = 1.1; 95% CI = 0.7–1.7 for stillbirths, and RR = 0.5; 95% CI = 0.3–1.3 for in-hospital deaths). Conclusions Our subpopulation-based birthweight standard identified a subgroup of preterm newborns who have significantly increased risks of perinatal death but are not classified as SGA by the conventional birthweight standard. In contrast, the subgroup classified as SGA by the fetal standards only, but not by our subpopulation-based birthweight standard, had no increased risk of mortality, compared with non-SGA infants.

International audience; Late and moderate preterm infants account for \textgreater80% of premature births. These newborns experience considerable mortality and morbidity in comparison with full-term born infants. The purpose of this paper is to summarise the most common morbidities of late and moderate preterm infants in the neonatal period, their incidence, severity, risk factors and need for admission to the different levels of care. The recent findings on preventive strategies and management priorities for clinical care of these vulnerable babies are also reviewed.

ObjectivesThis study compares the prevalence and perinatal mortality of congenital heart defects on La Réunion with European (EUROCAT) standards.Methods and resultsData were extracted from a EUROCAT-affiliated congenital malformations registry, covering 88,025 births during the period 2002–2007, on the whole island territory. A total of 512 congenital heart defects were registered, including 424 live births, 18 foetal deaths from 16 weeks of gestation, and 70 terminations of pregnancy. The total prevalence of congenital heart defects was 5.8 per 1000 births and live birth prevalence was 4.8 per 1000. The total prevalence of non-chromosomal congenital heart defects was 5.1 per 1000 births, of which 3% were perinatal deaths, 33.3% prenatally diagnosed, and 11.6% termination of pregnancy. Severe non-chromosomal congenital heart defects – excluding ventricular septal defects, atrial septal defects, and pulmonary valve stenosis – occurred in 2.1 per 1000 births, of which 10.3% were perinatal deaths, 59.1% prenatally diagnosed, and 24.3% termination of pregnancy. Of the severe congenital heart defects, the rates of single ventricle (0.20‰), Ebstein anomaly (0.11‰), common arterial trunk (0.25‰), and atrioventricular septal defect (0.62‰) exceeded averages found in Europe, although coarctation of the aorta was infrequent. Conversely, rates of ventricular septal defects, atrial septal defects, and pulmonary valve stenosis were inferior to European standards. Slightly less than half of the congenital heart defects of chromosomal origin were associated with Down syndrome.ConclusionIn La Réunion, the total prevalence of congenital heart defects is far inferior to that found in Europe. The difference can be attributable to lower prevalences of mild congenital heart defects.

Objective. To describe the chloride balance in infants born 25–32-week gestation, analyze the association of chloride changes with hydroelectrolytic status and their relationship with perinatal conditions, morbidities, and neurological outcome.Methods. For 7 days after birth, sodium and chloride balance, plasma potassium, phosphate, and total carbon dioxide (tCO2) were prospectively determined and strong ion difference (SID) calculated. Three multivariate regression analyses were performed to identify factors associated with high plasma chloride concentration, low SID, and low tCO2.Results. 107 infants were studied. Plasma chloride concentration was significantly positively associated with plasma sodium concentration. Higher plasma chloride and lower SID were significantly associated with lower plasma tCO2. Chloride intake was the main independent factor associated with high plasma chloride, low SID, and low plasma tCO2, with lesser contribution of sodium intake and low gestational age (GA). Also, patent ductus arteriosus and birth weight loss were independent factors affecting plasma chloride and SID. Neither high chloride levels nor low SID were associated to impaired neurological outcome.Conclusions. In preterm infants, chloride balance is influenced by GA and by interrelationship between sodium and chloride intake. High chloride levels are associated with metabolic acidosis but not related to increased risk of impaired neurological outcome.

International audience; BACKGROUND: While intrauterine insemination (IUI), a simple, inexpensive and non-invasive technique, is the most used assisted reproduction technology (ART) worldwide, the risk of major birth defects following IUI is paradoxically not well documented. METHODS: Retrospective cohort study performed in Burgundy, France, over a 9-year period which consisted of the cross analysis of two prospective databases, the Burgundy perinatal network database and the database of the assisted conception units in Burgundy. A total of 1348 ART singletons [in vitro fertilization technologies (IVFT): n= 903; IUI: n= 445] matched with 4044 infants conceived naturally, 552 ART twins (IVFT: n= 362; IUI: n= 190) matched with 1656 twins who were conceived naturally. The major birth defects were categorized according to the European Surveillance of Congenital Anomalies classification EUROCAT. RESULTS: Compared with naturally conceived singletons, singletons born after IUI and IVFT had a higher prevalence of major congenital malformations, with adjusted odd ratios (AOR) of 2.0 [95% confidence interval (CI) 1.0-3.8] and 2.0 (CI 1.3-3.1); 3.6 and 4.2% of infants born, respectively. All twins and unlike-sex twins born after IVFT but not IUI, have an increased prevalence of major birth defects compared with naturally conceived twins; AOR of 3.0 (CI 1.6-5.6) and 3.7 (CI 1.1-16.9), respectively. When comparing IUI with IVFT, no differences were observed for singletons (AOR 1.0; CI 0.4-2.2), all twins (AOR 0.4; CI 0.1-1.2) and unlike-sex twins (AOR 0.3; CI 0.1-4.5). CONCLUSIONS: The risk of major birth defects in singletons conceived through IUI was increased over naturally conceived singletons. This risk was no different from that observed after IVFT.

International audience; OBJECTIVE: We aimed to investigate the relationship between day-1 hypoproteinemia and severe adverse outcome (SAO) in very preterm infants admitted to the neonatal intensive care unit (NICU). STUDY DESIGN: Retrospective study of all patients born from 24 to 31 weeks gestation and cared for in our NICU over an 8-year period. Infants were excluded if the serum protein value on the first day of life was not available. RESULT: A total of 913 patients were included. In all, 14.6% presented with SAO (death or severe neurological injury on cranial ultrasound). Hypoproteinemia (total protein level \textless40 g l(-1)) on day 1 of life occurred in 19.5 % of all patients. The rate of SAO was 33.7% in patients with hypoproteinemia and 9.9% in those with normoproteinemia (P\textless0.0001). Logistic and multiple regression analysis confirmed that the association hypoproteinemia-SAO remained significant after adjustment for the other major predictors of outcome present at baseline (odds ratio 3.4; 95% confidence interval 2.1-5.4; P\textless0.0001). CONCLUSION: Hypoproteinemia was highly associated with SAO in this cohort of critically ill preterm infants. We are unable to explain the link between hypoproteinemia and adverse outcome in our population. This investigation serves as a hypothesis-generating report of a large preterm infants sample, and suggests the need to assess the predictive accuracy for adverse outcome of hypoproteinemia in future prospective studies.

Resume La neonatologie est la specialite ayant la plus forte prevalence d’erreurs medicamenteuses (EM) estimee a 5 % des prescriptions environ. Ces EM surviennent a toutes les etapes du circuit du medicament : prescription, transcription, dispensation, administration et surveillance. L’erreur de dose est la plus commune des EM de prescription. La prevention des EM est globale. La mise en place d’un logiciel d’aide a la prescription est efficace sur les erreurs de prescription mais ne dispense pas des autres mesures preventives.

Background and Purpose— Perinatal arterial ischemic stroke (PAIS) is a common cause of hemiplegic cerebral palsy in children. The diagnosis of PAIS is based on cerebral imaging. The objective of our study was to determine prenatal risk factors associated with PAIS. Methods— A retrospective case–control study was nested in the whole population of Burgundy, France, from January 2000 to December 2007. Case patients were confirmed by review of brain imaging and medical records. Three control subjects per case were randomly selected from the study population by sex, term, place, and year of birth. Results— PAIS was confirmed in 32 patients and its incidence was one per 4400 live births. In comparison to control subjects, clinical conditions significantly associated to cases were gestational diabetes (16.1% versus 4.2%; P =0.04), fetal heart rate abnormalities (35.5% versus 10.9%; P =0.001), and meconium-stained liquor (40% versus 12%; P P =0.08) and during pregnancy (32.1% versus 16.7%; P =0.07), cord abnormalities (29% versus 14.1%; P =0.06), and cesarean delivery (28.1% versus 14.6%; P =0.08). In the multivariate analysis, maternal smoking during pregnancy (OR, 3.1; 95% CI, 1.1–8.8; P =0.04) was the only risk factor significantly associated with PAIS. Conclusions— This study is the first to identify maternal smoking during pregnancy as an independent prenatal risk factor of PAIS. Additional prospective studies are needed to confirm this result and to investigate the role of maternal smoking in fetal and neonatal thrombogenesis.

International audience; BACKGROUND AND OBJECTIVE: Accurate data on the optimal chloride (Cl) intake in premature infants are scarce. The aim of the present study was to describe Cl intakes in the first 10 days of life and to assess the relations between high Cl intakes and corrected serum Cl level or markers of severe acidosis in infants \textless28 weeks' gestation. METHODS: Retrospective cohort study including all of the infants \textless28 weeks admitted to the neonatal intensive care unit during a 3-year period and cared for from birth until day 10 or more. RESULTS: Fifty-six infants were included. Cumulative total Cl intakes reached 9.6 ± 3.7 mmol/kg at day 3 and 49.2 ± 13.5 mmol/kg at day 10. Inadvertent intakes (from intravenous fluids other than parenteral nutrition) represented on average 70% of total Cl intakes in the first 3 days. Difference between Cl and sodium intakes reached 7.8 ± 4.8 mmol/kg at day 10 and mainly originated from parenteral nutrition. By multivariate analysis, cumulative Cl intake \textgreater10 mmol/kg during the first 3 days was an independent risk factor of base excess \textless-10 mmol/L. Cumulative Cl intake \textgreater45 mmol/kg during the first 10 days was an independent risk factor of corrected chloremia \textgreater115 mmol/L and of base excess \textless-10 mmol/L. CONCLUSIONS: Cumulative Cl intake \textgreater10 mmol/kg during the first 3 days (ie, 3.3 mmol · kg (-1) · day(-1) on average) and \textgreater45 mmol/kg during the first 10 days (ie, 4.5 mmol · kg (-1) · day(-1) on average) may have unwanted metabolic consequences and should be avoided. Imbalance between electrolytes provided by the parenteral nutrition solution need to be detected and corrected.

Ultrasound assessment of fetal growth is essential to reduce adverse pregnancy outcomes. Intergrowth-21st developed international standards. Currently, we use in France chart based on Hadlock's formula. This study aims to evaluate, the impact of switching from national curves to IG-21 curves or a combination of IG-21 with Hadlock.The study population consisted of 3 697 singleton pregnancies with fetal biometry measured between 22 and 38 weeks of gestation.We observed 21% of head circumference, 9% of abdominal circumference and 7% of femoral length below the 10th centile with Intergrowth-21. Concerning estimated fetal weight, IG-21 classified 13.8% fetuses as SGA, IG-21/Hadlock 10.8% and CFEF 16.1%. Between 36 and 38 weeks of gestation, IG-21 classified more fetuses as SGA than IG-21/Hadlock and CFEF, respectively 18%, 14.1% and 13.3%.The use of IG-21 or IG-21/Hadlock in the general population would lower the number of fetuses classified as SGA except for fetuses between 36 and 38 weeks. During this period, many decisions of induced early delivery or specific management are established to prevent adverse perinatal outcome. Those results must be supplemented by a comparison to newborns' weight.

International audience; Stress reactivity is a complex phenomenon associated with multiple and multimodal expressions and functions. Herein, we hypothesized that compared with healthy controls (HCs), adolescents with borderline personality disorder (BPD) would exhibit a stronger response to stressors and a deficit in self-perception of stress due to their lack of insight. Twenty adolescents with BPD and 20 matched HCs performed a socially evaluated mental arithmetic test to induce stress. We assessed self- and heteroperception using both human ratings and affective computing-based methods for the automatic extraction of 39 behavioral features (2D + 3D video recording) and 62 physiological features (Nexus-10 recording). Predictions were made using machine learning. In addition, salivary cortisol was measured. Human ratings showed that adolescents with BPD experienced more stress than HCs. Human ratings and automated machine learning indicated opposite results regarding self- and heteroperceived stress in adolescents with BPD compared to HCs. Adolescents with BPD had higher levels of heteroperceived stress than self-perceived stress. Similarly, affective computing achieved better classification for heteroperceived stress. HCs had an opposite profile; they had higher levels of self-perceived stress, and affective computing reached a better classification for self-perceived stress. We conclude that adolescents with BPD are more sensitive to stress and show a lack of self-perception (or insight). In terms of clinical implications, our affective computing measures may help distinguish hetero- vs. self-perceptions of stress in natural settings and may offer external feedback during therapeutic interaction.

Background The objective of this work was to explore the impact on parents of the bronchiolitis hospitalization of their infant using the Impact of Bronchiolitis Hospitalization Questionnaire (IBHQ©). Methods Four hundred sixty-three infants aged less than 1 year and hospitalized for bronchiolitis were included in a French observational study during the 2008–2009 season. Parents were asked to complete the IBHQ at hospital discharge and 3 months later. IBHQ scores, ranging from 0 (no impact) to 100 (highest impact), were compared according to gestational age (full-term, 33–36 wGA, ≤ 32 wGA) and the presence of congenital heart disease (CHD). The potential drivers of impact were explored using multivariate linear regressions. Results The study included 332 full-terms, 71 infants born at 33–36 wGA, and 60 at ≤ 32 wGA; 28 infants had a CHD. At hospital discharge, 9 of the 12 IBHQ mean scores were above 40, indicating a marked impact on parents. Three months later, all mean scores were lower but 5 were still greater than 40. At discharge, the length of hospitalization had a significant effect on IBHQ worries and distress, fear for future, guilt and impact on daily organization scores (p Conclusions Bronchiolitis hospitalization has conspicuous emotional, physical and organizational consequences on parents and siblings, which persist 3 months after hospital discharge. The main drivers of the impact were length of hospital stay and parents’ educational level, while infants’ gestational age or the presence of a CHD had little influence.

Introduction: Prescribing antibiotics to newborns is challenging, as excess antibiotics are a risk factor for increased morbidity and mortality. The objective of this study was to describe the evolution of antibiotic exposure over three years in a large network of level 3 neonatal wards where each center is informed yearly of its own results and the results of other centers and has full autonomy to improve its performance.Patients and Methods: This is a prospective, observational study of antibiotics prescriptions over the 2017–2019 period in a network of 23 French level 3 neonatal wards. The network relied on an internal benchmarking program based on a computerized prescription ordering system. Among others, antibiotics exposure, treatment duration, and antibiotics spectrum index were analyzed.Results: The population consisted of 39,971 neonates (51.5% preterm), 44.3% of which were treated with antibiotics. Of the treated patients, 78.5% started their first antibiotic treatment in the first three days of life. Antibiotic exposure rate significantly declined from 2017 to 2019 (from 46.8% to 42.8%, p < 0.0001); this decline was significant in groups with gestational age >26 weeks, but not in the group with extremely low gestational age Conclusion: This study showed that a strategy characterized by the collection of information via a computerized order-entry system, analysis of the results by a steering committee representative of all neonatal wards, and complete autonomy of neonatal wards in the choice of prescription modalities, is associated with a significant reduction in the use of antibiotics in newborns with gestational age greater than 26 weeks.

International audience; Objective: To assess the risk of preterm birth associated with nonsteroidal anti-inflammatory drugs (NSAIDs), focusing on early exposure in the period from conception to 22 weeks of gestation (WG). Design: National population-based retrospective cohort study. Setting: The French National Health Insurance Database that includes hospital discharge data and health claims data. Population: Singleton pregnancies (2012–2014) with a live birth occurring after 22WG from women between 15 and 45 years old and insured the year before the first day of gestation and during pregnancy were included. We excluded pregnancies for which anti-inflammatory medications were dispensed after 22WG. Methods: The association between exposure and risk of preterm birth was evaluated with GEE models, adjusting on a large number of covariables, socio-demographic variables, maternal comorbidities, prescription drugs and pregnancy complications. Main outcome measures: Prematurity, defined as a birth that occurred before 37WG. Results: Among our 1 598 330 singleton pregnancies, early exposure to non-selective NSAIDs was associated with a significantly increased risk of preterm birth, regardless of the severity of prematurity: adjusted odds ratio (aOR) = 1.76 (95% CI 1.54–2.00) for extreme prematurity (95% CI 22–27WG), 1.28 (95% CI 1.17–1.40) for moderate prematurity (28–31WG) and 1.08 (95% CI 1.05–1.11) for late prematurity (32–36WG), with non-overlapping confidence intervals. We identified five NSAIDs for which the risk of premature birth was significantly increased: ketoprofen, flurbiprofen, nabumetone, etodolac and indomethacin: for the latter, aOR = 1.92 (95% CI 1.37–2.70) with aOR = 9.33 (95% CI 3.75–23.22) for extreme prematurity. Conclusion: Overall, non-selective NSAID use (delivered outside hospitals) during the first 22WG was found to be associated with an increased risk of prematurity. However, the association differs among NSAIDs. Tweetable abstract: French study for which early exposure to non-selective NSAIDs was associated with increased risk of prematurity.

Objectives To assess understudied, alternative suicide prevention modalities in a mental health care setting. Methods This was a prospective study of patients (n = 140, 68 cases and 72 controls) who were admitted to hospital or who contacted an SOS suicide crisis line for suicidal ideation or attempts. Psychiatric diagnoses (Mini-International Neuropsychiatric Interview) and intensity of anxiety/depression/suicidality (Hamilton Anxiety Rating Scale, Montgomery–Åsberg Depression Rating Scale, and Beck Scale for Suicidal Ideation) were assessed. All intervention group subjects received a crisis card with a crisis line number, interviews with psychologists or volunteers and a telephone call on days 10 to 21, then 6 months later. These subjects also had a choice between two further 4-month interventions: body contact care or mobile intervention team visits. Results The interventions significantly reduced the number of suicide attempts and suicide (3%) at 6 months compared with the control condition (12%). There were fewer losses to follow-up in the intervention group (7.35%) than in the control group (9.72%). Conclusions The results favour the implementation of integrated care and maintaining contact in suicide prevention.

International audience; To describe the exposure to drugs used for the treatment of patent ductus arteriosus (PDA) in a large cohort of preterm infants born before 32 weeks of gestation. METHODS: A prospective observational cohort analysis was conducted during 2 years in 28 French level 3 NICU using the same computerized order-entry system. The main outcome was "a medically treated PDA," defined as exposure to ibuprofen, indomethacin, or paracetamol prescribed with the indication of PDA closure. Secondary outcomes were as follows: time of the first treatment administration; total exposure to furosemide during hospitalization; and rate of PDA refractory to pharmacological closure. RESULTS: The study cohort consisted of 2614 infants. Among them, 474 (18.1%) received a medical treatment for PDA, with a mean postnatal age at treatment of 4.3 ± 6.6 days. The drug used as a first-line treatment was ibuprofen in 89.5% and paracetamol in 10.5%. One hundred and ninety-five infants (7.4%) had a PDA refractory to pharmacological closure. At the multivariate analysis, factors associated with PDA refractory to pharmacological closure (OR; 95% CI) were as follows: gestational age (GA) (0.81; 0.72-0.90), paracetamol as the first-line treatment (0.32; 0.15-0.68), and pharmacological treatment before 48 h of life (0.63; 0.43-0.94). 24.6% of the study cohort was exposed to furosemide (cumulative dose 6.5 ± 12.6 mg/kg). Variables significantly associated with higher cumulative doses of furosemide were lower GA and ibuprofen treatment (both p

Background Q fever (Coxiella burnetii infection) has been associated with adverse perinatal outcomes. After investigating the obstetrical importance of Q fever on Reunion island and demonstrating an association between incident Q fever and miscarriage, we conducted a cross-sectional serosurvey to assess the prevalence of Coxiella burnetii infection among parturient women. Methods Between January 9 and July 24, 2014, within the level-4 maternity of Saint Pierre hospital and the level-1 maternity of Le Tampon, we proposed to screen all parturient women for Coxiella burnetii serology. Seropositivity was defined using indirect immunofluorescence for a dilution of phase 2 IgG titre ≥1:64. Further dilutions were chosen to discriminate recent or active infections from past or prevalent infections ( Results Among 1112 parturient women screened for Q fever over this 7-month period, 203 (18.3%) were seropositive. Overall weighted seroprevalence was of 20.1% (95%CI, 17.7–22.5%). Weighted seroprevalence of probable infections was 4.7% (95%CI 3.4–5.9%), while > 90% of positive serologies corresponded to past infections or false positives. Seropositivity was associated with none of the abovementioned adverse perinatal outcomes, whether in unpaired or matched analyses on propensity score. Conclusion The magnitude and the pattern of seroprevalence suggest that Q fever is endemic on Reunion island. In this context, we found no significant contribution of prevalent Coxiella burnetii infection to adverse pregnancy outcomes. Although reassuring, these data put in our endemic context, with a previously demonstrated increased risk of incident Q fever associated miscarriage, encourage us to protect pregnant women against the risk of new infection, periconceptional or early in pregnancy.

International audience; Objective: Our aim was to describe risk factors associated with 34DPT in operative and non-operative vaginal deliveries, over a five-year period. Study design: This was a retrospective cohort study including 39,227 vaginal deliveries from 2013 to 2017 in a single French University Hospital. Annual characteristics of the analyzed population were recorded. Univariate logistic regression was used to evaluate the association between these characteristics and 34DPT. Multivariate analysis was used to identify combinations of risk factors associated with instrumental delivery.Results: The rate of perineal tears was constantly rising but rate of 34DPT was stable, ranging between 0.8 and 1.4% over the study period. Cesarean section rate was stable between 18.8% and 19.6%. Rate of diabetes, preeclampsia and obesity (BMI < 40) was increasing and episiotomy rate decreasing (from 19.8% to 11.8%). Operative deliveries rate remained stable between 11 and 12.8%. Multivariate regression showed that gestational age over 39 weeks (aOR 1.18, 95% CI [1.02; 1.35]), birth weight over 3500 g (aOR 1.62, 95% CI [1.05; 2.49]) were associated with 34DPT in patients without operative vaginal deliveries but not episiotomy. Gestational age (aOR 1.71, 95% CI [1.18; 2.47]), episiotomy (aOR 0.55, 95% CI [0.38; 0.79]) and diabetes (aOR 1.73, 95% CI [1.15; 2.61]) were associated with 34DPT among patients with operative vaginal deliveries.Conclusion: In a tertiary medical center model with low cesarean section rate, factors associated with 34DPT were different among patients with or without operative vaginal delivery. The question of the protective effect of mediolateral episiotomy against 34DPT in case of operative delivery deserves further investigations.

International audience; Aims: To analyse the risk factors associated with home births and “en-route” deliveries that occurred in the south of Reunion Island. Patients and methods: Since 2001, all births have been recorded in an epidemiological database from 22 weeks’ gestation, including maternal and neonatal information. This study is based on a 15-year period (1/01/2001–31/12/2015).Results: Over this period, there were 656 cases of home births recorded across a total of 81,511 of all births in South Reunion (0.8%). Compared with births in maternity units, these deliveries occurred on the whole at night (67% vs. 54%, OR: 1.74 [1.4–2.1]), by multiparous women (OR: 5 [3.7–6.2]) and and highly multiparous women (5 or more children, OR: 4.1 [3.5–4.9]), women aged over 35 years (OR: 1.4 [1.2–1.7]), in single-parent families (women who live alone, OR: 1.47 [1.3–1.7]), households from a lower socioeconomic (without work OR: 1.24 [1.2–1.3]) and educational (primary or secondary school, OR: 2.4 [2.0–2.9]) background, and who had received fewer prenatal checkups (number of visits 6.4 vs. 9.0). From a neonatal point of view, prematurity was more common (17 vs. 9.9%, OR: 1.9 [1.6–2.4]), as was severe prematurity (< 33 weeks, 5.1 vs. 2.2%, OR: 2.38 [1.7–3.4]) and transfers to a neonatal unit (12.7 vs. 8.0%, OR: 1.67 [1.3–2.1]) were more significant (P< 0.0001). There were 43 perinatal deaths (9.4%, OR: 3.2 [2.3–4.6]) and one maternal death, in a 26-year old highly multiparous woman.Conclusions: In this context, specific monitoring of multiparous women from a low socioeconomic background appears to be a priority.; Objectifs : Analyser les facteurs de risque des accouchements à domicile et « en route » survenus dans le Sud de l’île de La Réunion. Patients et méthodes : Depuis 2001, toutes les naissances sont colligées dans une base de données épidémiologique à partir de 22 semaines d’aménorrhée avec les données maternelles et néonatales. Cette étude porte sur une période de 15 ans (1er janvier 2001–31 décembre 2015). Résultats : Pendant la période d’étude, il y a eu 656 cas recensés d’accouchements à domicile sur un total de 81 511 naissances totales dans le Sud Réunion (0,8 %). Par rapport aux naissances dans les maternités, ces accouchements surviennent surtout la nuit (67 vs 54 %, OR : 1,74 [1,4–2,1]), chez des multipares (OR : 5 [3,7–6,2]) et grandes multipares (cinq enfants et plus, OR : 4,1 [3,5–4,9]), chez des femmes de plus de 35 ans (OR : 1,4 [1,2–1,7]), dans des foyers monoparentaux (femmes vivant seules, OR : 1,47 [1,3–1,7]), des foyers niveau socio économique (sans profession, OR : 1,24 [1,2–1,3]) et éducatifs (niveau primaire ou collège, OR : 2,4 [2,0–2,9]) plus faibles, et ayant plutôt un moins bon suivi prénatal (nombre de visites : 6,4 vs 9,0). Du point de vue néonatal, on retrouve plus de prématurité (17 vs 9,9 %, OR : 1,9 [1,6–2,4]), de grande prématurité (< 33 SA, 5,1 vs 2,2 %, OR : 2,38 [1,7–3,4]) et de transferts en néonatologie (12,7 vs 8,0 %, OR : 1,67 [1,3–2,1]), de manière significative (p < 0,0001). Il y a eu 43 décès périnatals (9,4 %, OR : 3,2 [2–4,6]) et une mort maternelle chez une grande multipare de 26 ans. Conclusions : Dans notre contexte, un suivi particulier chez les multipares à bas niveau socio-économique semble prioritaire.

Purpose: To investigate the association between maternal age and spontaneous breech presentation.Material and methods: Fifteen-year observational study over (2001–2015). All consecutive singleton births delivered at the Centre Hospitalier Universitaire Sud Reunion’s maternity. The only single exclusion criterion was uterine malformations (N = 123) women.Results: Of the 60,963 singleton births, there was a linear association (χ2 for linear trend, p

Background Patients undergoing gynaecological surgery are known to experience anxiety. While the use of music selected by patients based on their personal taste has hardly been evaluated, a recent study suggests that musical preferences significantly alter the anxiolytic and relaxing effects of music. Our study aims to determine whether self-selected music decreases patient anxiety prior to gynaecological surgery, as compared with predetermined music from a software programme such as MUSIC CARE®. Methods The study will consist of a clinical trial comparing the effects of self-selected music versus predetermined music on patient anxiety prior to gynaecological surgery. A minimum of 170 patients will be randomised in a 1:1 ratio. Inclusion criteria will be: women aged 18–55 years, awaiting scheduled gynaecological surgery under general/local anaesthesia or under sedation; having created a personal 20-min playlist; and not having received anxiolytic drugs prior to surgery. The primary outcome will be the difference between the preoperative anxiety score taken 15 to 20 min before the music-listening session and the preoperative anxiety score taken shortly after the session, as measured with the STAI for state anxiety. Discussion This study should help to identify more effective non-medical treatments for preoperative anxiety, as well as to adapt music therapy to the cultural context of patients. Trial registration ClinicalTrials.gov, ID: NCT03226834. Registered on 24 July 2017.

BackgroundQ fever has been associated with perinatal complications. We conducted a prospective follow-up study to assess both the incidence of adverse pregnancy outcomes (APOs) associated withCoxiella burnetiiinfection and the contribution of Q fever to APOs.MethodsBetween May 1 and October 31, 2013, within the regional perinatal health care centre of Saint Pierre, Reunion island, we investigated unexplained miscarriages, stillbirths, preterm births or small-for-gestational age children. Seropositivity forC. burnetiiantibodies was defined using indirect immunofluorescence for a phase 2 IgG titre ≥1:64. Acute Q fever was defined for a high phase 2 IgG titre ≥1:256 (compatible with recent or active infection) or the detection ofC. burnetiigenome in miscarriage products and placentas. Incidence rate ratios (IRR) for Q fever related APOs (taken as a composite outcome or individually) were assessed using Poisson regression models for dichotomous outcomes controlling major confounders.ResultsOver a 6-month period, 179 pregnant women suspected or diagnosed with an APO were investigated for Q fever, of whom 118 met the definition for an APO. Of these, 19 were seropositive and 10 presented a profile indicative of an acute infection. For three women with an acute Q fever, the chronology between the onset of infection, the APO (2 miscarriages, 1 preterm birth) and the seroconversion suggested causality in the pathogenesis. The cumulative incidence of Q fever related APOs was estimated between 2.2‰ and 5.2‰, whether causality was required or not. BothC. burnetiiexposure and acute Q fever were independently associated with APOs (IRR 1.55, 95% CI 1.31–1.84; IRR 1.47, 95% CI 1.15–1.89, respectively).ConclusionsIn the endemic context of Reunion island, acute Q fever may lead to APOs. To limit the burden of Q fever on reproduction, pregnant women should be kept away from farms and avoid direct contact with ruminants.

Background In Reunion Island, a French overseas department, the burden of preterm birth and perinatal mortality exceed those observed in mainland France, despite similar access to standard perinatal care. The purpose of the study was to compare the outcome of two cohorts of NICU-admitted very preterm infants born between 24 and 31 weeks of gestation (WG): the registry-based OGP (Observatoire de la Grande Prématurité, Reunion Island, 2008–2013) cohort, and the nationwide EPIPAGE-2 (mainland France, 2011) observational cohort. Methods The primary outcome was adverse neonatal outcomes defined as a composite indicator of in-hospital mortality or any of three following severe morbidities: bronchopulmonary dysplasia (BPD), necrotising enterocolitis, or severe neurological injury (periventricular leukomalacia or grade III-IV intraventricular haemorrhages). Logistic regression modelling adjusting for confounders was performed. Results A total of 1272 very preterm infants from the Reunionese OGP cohort and 3669 peers from the mainland EPIPAGE-2 cohort were compared. Adverse neonatal outcomes were more likely observed in the OGP cohort (32.6% versus 26.6%, p Conclusions Despite similar guidelines for standard perinatal care, very preterm infants born in Reunion Island have a higher risk for death or severe morbidity compared with those born in mainland France.

ObjectivesThe primary objective of this study is to determine the current level of patient medication exposure in Level 3 Neonatal Wards (L3NW). The secondary objective is to evaluate in the first month of life the rate of medication prescription not cited in the Summary of Product Characteristics (SmPC). A database containing all the medication prescriptions is collected as part of a prescription benchmarking program in the L3NW.Material and methodsThe research is a two-year observational cohort study (2017-2018) with retrospective analysis of medications prescribed in 29 French L3NW. Seventeen L3NW are present since the beginning of the study and 12 have been progressively included. All neonatal units used the same computerized system of prescription, and all prescription data were completely de-identified within each hospital before being stored in a common data warehouse.ResultsThe study population includes 27,382 newborns. Two hundred and sixty-one different medications (International Nonproprietary Names, INN) were prescribed. Twelve INN (including paracetamol) were prescribed for at least 10% of patients, 55 for less than 10% but at least 1% and 194 to less than 1%. The lowest gestational ages (GA) were exposed to the greatest number of medications (18.0 below 28 weeks of gestation (WG) to 4.1 above 36 WG) (pConclusionNeonates remain therapeutic orphans. The consequences of polypharmacy in L3NW should be quickly assessed, especially in the most immature infants.

International audience

ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition : Fluid and electrolytes

International audience; Background: Early diagnosis is essential to improve the treatment and prognosis of newborn infants with nosocomial bacterial infections. Although cytokines and procalcitonin (PCT) have been evaluated as early inflammatory markers, their diagnostic properties have rarely been compared.Objectives: This study evaluated and compared the ability of individual inflammatory markers available for clinician (PCT, semi-quantitative determination of IL-8) and of combinations of markers (CRPi plus IL-6 or quantitative or semi-quantitative determination of IL-8) to diagnose bacterial nosocomial infections in neonates.Methods: This prospective two-center study included neonates suspected of nosocomial infections from September 2008 to January 2012. Inflammatory markers were measured initially upon suspicion of nosocomial infection, and CRP was again measured 12–24 h later. Newborns were retrospectively classified into two groups: those who were infected (certainly or probably) and uninfected (certainly or probably).Results: The study included 130 infants of median gestational age 28 weeks (range, 24–41 weeks). Of these, 34 were classified as infected and 96 as uninfected. The sensitivity, specificity, positive and negative predictive values (PPV and NPV), and positive and negative likelihood ratios (LR+ and LR-) for PCT were 59.3% (95% confidence interval [CI], 38.8–77.6%), 78.5% (95% CI, 67.8–86.9%), 48.5% (95% CI, 30.8–66.5%), 84.9% (95% CI, 74.6–92.2%), 2.7 (95% CI, 1.6–4.9), and 0.5 (95% CI, 0.3–0.8), respectively. Semi-quantitative IL-8 had the highest specificity (92.19%; 95% CI, 82.70–97.41%), PPV (72.22%; 95% CI, 46.52–90.30%) and LR+ (6.17, 95% CI, 2.67–28.44), but had low specificity (48.15%; 95% CI, 28.67–68.05%). Of all markers tested, the combination of IL-6 and CRPi had the highest sensitivity (78.12%; 95% CI, 60.03–90.72%), NPV (91.3%; 95% CI, 82.38–96.32%) and LR- (0.29; 95% CI, 0.12–0.49). The combination of IL-6 and CRPi had a higher area under the curve than PCT, but with borderline significance (p = 0.055).Conclusions: The combination of IL-6 and CRPi was superior to other methods, including PCT, for the early diagnosis of nosocomial infection in neonates, but was not sufficient for sole use. The semi-quantitative determination of IL-8 had good diagnostic properties but its sensitivity was too low for use in clinical practice.

International audience; Witnessing a “Grand-mal” epileptic crisis is undoubtedly one of the most impressive events which may happen to any observer (including those who have chosen to work in the medical field). Convulsions have been described and written down since the beginning of writings 5,000 years ago in all continents. Specific to humans, eclampsia, which is a grand-mal epilepsy, happens naturally in 1% of all human births and is responsible of a very high rate of maternal deaths near or at delivery, with also often the death of the foetus or the newborn. Further, it happens preferentially during the first pregnancy, therefore in very young previously very healthy women. Mankind has then eternally lived with this apparent “curse” happening in its reproduction. The terror that inspires this spectacular feature, even nowadays, has undoubtedly shaped the human conscience and interpretations since the beginning of our species, moreover because it happens during the paramount emotional event which is a birth. The author wishes that (paleo) anthropologists and archaeologists integrate this datum in their reflections. For example, the upper Palaeolithic so-called “Venuses”, could be protective talismans for pregnant women not only for birthing, but also against the terrorizing convulsions (eclampsia) which could happen in all human pregnancy, especially in the first ones (primiparae).

International audience; IntroductionUne avancée récente dans l’approche à l’IRA néonatale repose sur l’identification de différents degrés de réduction aiguë de la fonction rénale, comprenant un continuum pathologique dont l’IRA est le stade le plus sévère et où les variations de la créatinine plasmatique (Crp) sont corrélées à la dysfonction rénale. Selon cette conception, l’exploration de paramètres précoces d’hypoperfusion rénale permet une anticipation de l’IRA et une prise en charge plus précoce et préventive de ses complications. Cette étude souhaitait caractériser le lien entre l’hémodynamique dans les premières 24 h et la fonction rénale dans la première semaine de vie dans une cohorte de grands prématurés, population très sensible aux perturbations de la fonction rénale.MéthodesAu total, 128 prématurés < 32 SA ont été inclus dès la naissance. Pendant les premières 24 h de vie, les paramètres hémodynamiques cliniques, échographiques (volémie, débit cardiaque, contractilité, résistances vasculaires, canal artériel–diamètre et shunt à 6 h de vie), la perfusion d’organe (Doppler) et l’oxygénation tissulaire par le NIRS (rSO2 cérébrale et rénale) ont été enregistrés. L’association entre ces paramètres, ainsi qu’entre les facteurs de risques connus d’IRA et la mesure de la créatinine plasmatique (Crp) dans la première semaine de vie a été analysée. L’IRA a été définie par un taux de Crp > 130 mmol/L à j2.RésultatsDouze enfants (9,4%) ont présenté une IRA. La Crp maximale (mmol/L) était de 155 ± 30 dans le groupe IRA vs 82 ± 16 dans le groupe sans IRA. Les facteurs significativement associés à l’IRA étaient : l’AG, le poids de naissance, la voie d’accouchement, la protidémie à H12, la rSO2 cérébrale, le canal artériel traité, la rSO2 rénale, l’index de résistance dans l’artère rénale. L’analyse multivariée a montré que les facteurs de risque indépendants liés à l’augmentation de la Crp étaient : le canal artériel traité (p = 0,002), l’hypoprotidémie à H12 (p = 0,01), une plus basse mesure de rSO2 rénale (p = 0,02) et un plus faible AG (p = 0,03).ConclusionsNos résultats montrent pour la première fois que l’hypoprotidémie à H12 et l’hypoxie tissulaire rénale mesurée par le NIRS sont des facteurs de risque précoces d’anomalie de la fonction rénale chez le grand prématuré.

International audience; ObjectiveTo assess the effect of prophylaxis for early adrenal insufficiency using low-dose hydrocortisone on survival without bronchopulmonary dysplasia (BPD) in very preterm infants using an individual patient data meta-analysis.Study designAll existing randomized controlled trials testing the efficacy of the prophylaxis of early adrenal insufficiency using low-dose hydrocortisone on survival without BPD were considered for inclusion when data were available. The primary outcome was the binary variable survival without BPD at 36 weeks of postmenstrual age.ResultsAmong 5 eligible studies, 4 randomized controlled trials had individual patient data available (96% of participants identified; n = 982). Early low-dose hydrocortisone treatment for 10-15 days was associated with a significant increase in survival without BPD (OR, 1.45; 95% CI, 1.11-1.90; P = .007; I2 = 0%), as well as with decreases in medical treatment for patent ductus arteriosus (OR, 0.72; 95% CI, 0.56-0.93; P = .01; I2 = 0%) and death before discharge (OR, 0.70; 95% CI, 0.51-0.97; P = .03; I2 = 0%). The therapy was associated with an increased risk of spontaneous gastrointestinal perforation (OR, 2.50; 95% CI, 1.33-4.69; P = .004; I2 = 31.9%) when hydrocortisone was given in association with indomethacin exposure. The incidence of late-onset sepsis was increased in infants exposed to hydrocortisone (OR, 1.34; 95% CI, 1.02-1.75; P = .04; I2 = 0%), but no adverse effects were reported for either death or 2-year neurodevelopmental outcomes as assessed in an aggregate meta-analysis.ConclusionsThis individual patient data meta-analysis showed that early low-dose hydrocortisone therapy is beneficial for survival without BPD in very preterm infants.

International audience; Suicidal behaviour in adolescence is a major public health issue. It is the consequence of a sum of individual, relational and environmental difficulties that weaken the subject in a period of great vulnerability. The main aspects of their care consist in developing a good therapeutic link and adapting the adolescent's environment. Prevention is the concern of everyone, especially healthcare professionals who are regularly consulted before suicidal acts.; Les conduites suicidaires à l’adolescence sont un enjeu majeur de santé publiqueElles font suite à une constellation de difficultés individuelles, relationnelles et environnementales, qui fragilisent le sujet dans une période de grande vulnérabilitéLe soin passe par le lien thérapeutique et l’adaptation de l’environnement de l’adolescentLa prévention est l’affaire de tous, et particulièrement des soignants, qui sont régulièrement sollicités avant un passage à l’acte.

The objective of this study was to evaluate laparoscopy training using pelvitrainers for gynaecological surgeons in a low-income country.The study was carried out in Madagascar from April 2016 to January 2017. The participants were gynaecological surgeons who had not previously performed laparoscopy. Each surgeon was timed to evaluate the execution times of four proposed exercises, based on the fundamentals of laparoscopic surgery (FLS) programme's skills manual, as follows: exercise 1, involving a simple object transfer; exercises 2 and 3, comprising complex object transfers; and exercise 4, a precision cutting exercise. The 8-month training and evaluation programme was divided into different stages, and the four following evaluations were compared: a pretest (T0), assessment at the end of the first training (T1) and auto-evaluation at 2 months (T2) and 8 months (T3).Eight participants were included. The median time was significantly reduced (P0.05) at each evaluation for exercises 1, 2 and 4 compared to the pretest. For exercise 3, there was no difference between T0 and T1 (P=0.07). After 8 months of training, all participants progressed in all exercises.Our study showed that it is possible and beneficial to develop a programme for teaching laparoscopic surgery in low-income countries before providing the necessary equipment.

International audience; Objectives: To investigate the incidence of early − (delivery

International audience; In vitro fertilization (IVF) is nowadays a reliable and common method for couple who need medically assisted procreation. Complications are rare. We report in this paper, the case of a woman with severe endometriosis who developed ureteral obstruction complicated by a renal rupture of the fornix due to ovarian hyperstimulation during an IVF attempt. The condition was diagnosed by CT scan and resolved with insertion of double-J catheter in the left ureter.

International audience; Background: There is a peculiar phenomenon: two separate individuals (mother and foetus) have a mutually interactive dependency concerning their respective weight. Very thin mothers have a higher risk of small for gestational age (SGA) infants, and rarely give birth to a large for gestational age (LGA) infant. While morbidly obese women often give birth to LGA infants, and rarely to SGA. Normal birthweight (AGA) infants (>10 th and

International audience; Introduction – The Registry of Congenital Malformations (CM) in Reunion Island (REMACOR) oversees the surveillance of CM for public health and research purposes. This surveillance consists of the exhaustive collec- tion of cases, and temporal analysis of CM. Since 2013, REMACOR has retrospectively geolocalized the data to allow their spatial analysis and the detection of health signals the methodology of which is presented hereunder.Materials and methods – Each case is geolocated according to the mother’s address, using the reference address databases. Birth-related prevalence is then calculated by aggregating cases according to the different administrative scales. The choice of the suitable scale is determined using a Poisson test that estimates the minimum number of births required to perform the analysis in a statistically signi cant manner, and then a compromise between this representativeness of information, data completeness and spatial resolution.Results – 95% of the cases could be geolocalized. Different cluster detection methods are used to identify the most affected areas. Finally, clusters detected at different scales are nally intersected to calculate an index of belonging to 1, 2 or 3 scales.Discussion and conclusion – The spatialized database set up now allows REMACOR to consider the spatial heterogeneity of the distribution of the most frequent CM in order to inform public health stakeholders.; Introduction: Le Registre des malformations congénitales de La Réunion (Remacor) assure la surveillance de ces pathologies à des fins de santé publique et de recherche. Cette surveillance consiste en un recueil exhaustif des cas et en l'analyse temporelle de leur survenue. Afin de permettre leur analyse spatiale et la détection de signaux sanitaires, le Remacor a géocodé rétroactivement les données et mis en place une surveillance spatialisée, dont les choix méthodologiques sont présentés ici.Matériel et méthodes: Chaque cas est géolocalisé conformément à l'adresse de la mère. Les prévalences relatives aux naissances sont ensuite calculées par agrégation des cas selon les différentes échelles administratives. Le choix de l'échelle est déterminé à l'aide d'un test de Poisson qui permet d'estimer le nombre de naissances minimum nécessaire pour réaliser l'analyse de manière statistiquement significative, puis d'un compromis entre cette significativité de l'information, la complétude des données et la résolution spatiale.Résultats: Il a été possible de géolocaliser 95% des cas. Différentes méthodes de détection d'agrégats de cas ont été utilisées afin de repérer les zones les plus touchées. Enfin, les agrégats détectés à différentes échelles ont été intersectés pour calculer un indice d'appartenance à 1, 2 ou 3 échelles.Discussion et conclusion: La base de données spatialisée mise en place permet aujourd'hui au Remacor de prendre en compte l'hétérogénéité spatiale de la distribution des malformations congénitales les plus fréquentes pour informer les acteurs de la santé publique.

Background: Previous guidelines on Paediatric Parenteral Nutrition (PN) were published in 2010, by the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the European Society for Clinical Nutrition and Metabolism (ESPEN), supported by the European Society of Paediatric Research (ESPR) were published. The aim of the present paper was to provide up-to-date evidence for health professionals working with infants, children and adolescents receiving PN. Methods: The current document is a revision of the 2005 guidelines produced by the same 3 organizations (ESPEN, ESPGHAN, ESPR) together with the Chinese Society of Parenteral and Enteral Nutrition (CSPEN). Experts participating in the guideline updating process were all professionals with extensive experience in managing PN from a wide range of European countries, Israel and China. The guideline development process was coordinated by a guideline steering committee. Each chapter of the guideline was prepared by a separate author group. These author groups were responsible for screening titles and abstracts identified by a systematic literature search for inclusion, for conducting additional expert searches (including secondary sources such as other published valid guidelines), for evaluating the quality of studies included in the given chapter and assigning evidence levels to the literature. Based on the evidence level of included studies experts formulated and graded recommendations. A consensus conference was held in February 2015. All chapter manuscripts were revised following the recommendations of the consensus conference and then reviewed and edited by the project steering committee. Final consensus on each individual guideline and its individual recommendations was achieved and assessed by online voting. This process lasted until January 2018. Funding for the consensus conference (including travel expenses for participants) was provided by all participating societies. No other funding was received for the guideline updating process and participants received no payment. Support was provided by the Hungarian Cochrane organization. Results/conclusions: The present document provides guideline for the use of PN across the wide range of pediatric patients, ranging from extremely premature infants up to teenagers weighing up to and over 100 kg [1]. It covers their individual macro- and micronutrient needs [2], [3], [4], [5], [6], [7], [8], fluid requirements [9], venous access [10], organizational aspects [11], home parenteral nutrition [12], standardized vs. individualized PN [13], and last but not least a wide range of safety considerations for prevention and management of complications such central line associated bloodstream infections (CLABSI)

International audience; Background: Focusing on the current context of national and international recommendations, techniques development to evaluate and preserve fertility and patients’ claims, this study aims to make a survey about the management of patients’ breast cancer regarding oncofertility.Methods: Retrospective and analytic study of medical practices at Bergonié Institute of health professionals (medical oncologists, surgical oncologists, nurses) dedicated to the care of non-disseminated breast cancer patients younger than 37, needing medical treatment.Results: The number of participants was 230. The most interested practitioners in fertility theme are those of multidisciplinary consultation and surgeons (P < 0.001), with an increasing interest during last years (P < 0.05). The information about hypofertilizing risks of treatments are delivered most of the time by oncologists (57.7%). The motherhood project is expressed by 11 patients (4.9%) before treatment, only 4 of them receive information on the risks and 49 patients (21.7%) during follow-up. Only 24 patients (48% of the 49) are encouraged for motherhood.Conclusion: To satisfy patients’ requests, several improvements have to be made regarding the patients’ information, the health professionals’ awareness and care coordination.; Introduction: Dans le contexte actuel de revendications des patientes, développement des techniques de préservation de la fertilité, et recommandations (inter)nationales, notre étude a pour objectif de réaliser un état des lieux, concernant l’oncofertilité, chez des patientes en âge de procréer traitées pour cancer du sein.Méthodes: Étude rétrospective, unicentrique, analytique, des pratiques des intervenants de l’institut Bergonié (oncologues médicaux, chirurgiens, infirmières d’annonce), face aux patientes de moins de 37 ans, traitées pour un cancer du sein infiltrant non disséminé, nécessitant traitement médical.Résultats: Deux cents trente patientes ont été incluses, entre 2000 et 2010. Les praticiens s’intéressant le plus à la fertilité sont les chirurgiens et les comités multidisciplinaires (p < 0,001), avec une amélioration de l’intérêt des médecins ces dernières années (p < 0,05). L’information sur le caractère hypofertilisant des traitements est majoritairement donnée par l’oncologue médical (57,7 %). Un projet de maternité est exprimé par 11 patientes (4,9 %) en pré-thérapeutique dont 4 sont informées sur les risques des traitements, et par 49 patientes (21,7 %) durant le suivi. Seulement 24 patientes (48 % d’entre elles) y sont encouragées.Conclusion: Afin de répondre aux demandes des patientes, des améliorations sont à réaliser, dans l’information des patientes, la sensibilisation du personnel, et la coordination des soins.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 44 - N° 2 - p. 154-163