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Because of the important changes in medical care and the social context of pregnancy, the relevance of well-established risk factors of preterm delivery (< 37 weeks) needs to be re-assessed. The objective of this study was to determine whether the associations between maternal characteristics and preterm delivery in France in 1995 were similar to those in 1981. We used two national representative samples of births, 5577 newborns in 1981 and 13318 in 1995. Univariable and multivariable analyses were applied to identify variables associated with increased risk of preterm delivery. Some risk factors were similar in 1981 and 1995, including age > 34 years and previous adverse obstetric history. Other factors that were observed in 1981 but which were not linked to preterm delivery in 1995 included the mothers being very young, single or foreign. However, parity and previous induced abortion were associated with preterm delivery in 1995, but not in 1981. These results show that the definition of high-risk groups used in prevention programmes should be brought up to date regularly. [ABSTRACT FROM AUTHOR]

Les infections sont une pathologie fréquente de la période néonatale, touchant entre 1 et 5 % des nouveau-nés. La mortalité de ces infections néonatales reste préoccupante malgré les progrès en néonatologie. Les conséquences des infections sont possibles à court terme mais aussi à long terme, avec notamment des troubles du neurodéveloppement. Les caractéristiques et les conséquences des infections néonatales varient selon leur caractère précoce (dans les 3 premiers jours de vie) ou tardif (entre le 3e et le 28e jour de vie) et selon le terrain sur lequel elles surviennent (nouveau-né à terme ou prématuré notamment). Le diagnostic des infections néonatales est difficile en raison des signes cliniques aspécifiques. L'identification d'une bactérie dans le sang ou le liquide cérébrospinal permet d'affirmer le diagnostic. Les infections néonatales bactériennes précoces sont majoritairement liées au streptocoque du groupe B et à Escherichia coli. Les infections néonatales bactériennes tardives sont à distinguer selon deux cadres nosologiques : les infections communautaires et les infections associées aux soins, fréquentes chez les nouveau-nés prématurés. [ABSTRACT FROM AUTHOR]

BACKGROUND Retinoblastoma (RB) is the most frequent eye tumour in children, with an incidence of 1 in 15–20 000 births. It accounts for 11% of all cancers in the first year of life. Except for the hereditary forms, its causes are not well-known. Studies have recently suggested an increased risk of RB among children born after IVF, but the relevant literature is sparse. We assessed the association between infertility treatment, subfertility and RB. METHODS We included all children living in France diagnosed with RB between 1 January 2000 and 31 December 2006 at the Institut Curie, the national reference centre for RB diagnosis and treatment. We used multiple logistic regression to compare them with a national sample of births in France in 1998 and 2003 (n = 28 170). RESULTS The study included 244 non-familial RB cases. The risk of RB increased with maternal age [adjusted odds ratio (adj OR) = 2.07, 95% confidence interval (CI) 1.33–3.22 at 35–39 years compared with younger than 25 years and adj OR = 2.42, 95% CI 1.22–4.81 at 40 years or older], but the associations with IVF (adj OR = 1.37, 95% CI 0.64–2.95) and ovarian stimulation or intrauterine insemination (adj OR = 1.35, 95% CI 0.77–2.38) were not statistically significant after adjustment for maternal age and tobacco use. Among women who had no infertility treatment, the risk of RB was significantly increased when time to pregnancy exceeded 24 months (adj OR = 2.02, 95% CI 1.17–3.48) compared with time to pregnancy ≤24 months. CONCLUSIONS Our study did not observe a significantly increased risk of RB associated with infertility treatment, in particular with IVF. But we did find an increased risk for women for whom time to pregnancy exceeded 24 months. [ABSTRACT FROM AUTHOR]

Objective To assess the impact of antenatal corticosteroids (ACS) on neonatal mortality, cerebral lesions and 5-year neurodevelopmental outcome of infants born at 24–27 and 28–32 weeks of gestational age (GA). Design Observational population-based study including all births at GAs between 22 and 32 weeks in 1997 in nine regions of France. Survivors were assessed at the age of 5 years. Sample and methods The population enrolled in the follow up comprised 2323 infants; there were 23 deaths before age 5 years and outcome at 5 years was available for up to 1781 subjects. Two GA subgroups (24–27 and 28–32 weeks of GA) were analysed separately. Propensity scores were used to reduce bias in the estimation of the association between ACS treatment and outcomes. Main outcome measures Neonatal death, neonatal white matter injury, cerebral palsy, mental processing composite (MPC) of the Kaufman Assessment Battery for Children test and behavioural difficulties at 5 years. Results In the 28- to 32-week GA subgroup, there was a significant association between ACS and a decreased risk of both neonatal death (OR = 0.61 [0.41–0.91]) and white matter injury (OR = 0.60 [0.46–0.79]) but only a nonsignificant trend for improved 5-year outcome (cerebral palsy, MPC < 70). In the 24- to 27-week GA subgroup, ACS was associated with a significant decrease risk of neonatal death (OR = 0.43 [0.27–0.68]) but there was only a trend for a lower risk of white matter injury and no beneficial impact on outcome at 5 years. Limiting the analysis to only those who received complete courses of ACS did not modify the results. Conclusion The study shows that ACS therapy greatly increases the survival of very preterm infants, including the most immature, but there is little evidence that ACS affects long-term neurodevelopmental and behavioural outcome in 28- to 32-week survivors, and none in <28-week survivors. [ABSTRACT FROM AUTHOR]

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

Objective: To compare the short- and mid-term outcomes of preterm twins by chorionicity of pregnancy.Design: Prospective nationwide population-based EPIPAGE-2 cohort study.Setting: 546 maternity units in France, between March and December 2011.Population: A total of 1700 twin neonates born between 24 and 34 weeks of gestation.Methods: The association of chorionicity with outcomes was analysed using multivariate regression models.Main Outcome Measures: First, survival at 2-year corrected age with or without neurosensory impairment, and second, perinatal, short-, and mid-term outcomes (survival at discharge, survival at discharge without severe morbidity) were described and compared by chorionicity.Results: In the EPIPAGE 2 cohort, 1700 preterm births were included (850 twin pregnancies). In all, 1220 (71.8%) were from dichorionic (DC) pregnancies and 480 from monochorionic (MC) pregnancies. MC pregnancies had three times more medical terminations than DC pregnancies (1.67 versus 0.51%, P < 0.001), whereas there were three times more stillbirths in MC than in DC pregnancies (10.09 versus 3.78%, P < 0.001). Both twins were alive at birth in 86.6% of DC pregnancies compared with 80.0% among MC pregnancies (P = 0.008). No significant difference according to chorionicity was found regarding neonatal deaths and morbidities. Likewise, for children born earlier than 32 weeks, the 2-year follow-up neurodevelopmental results were not significantly different between DC and MC twins.Conclusions: This study confirms that MC pregnancies have a higher risk of adverse outcomes. However, the outcomes among preterm twins admitted to neonatal intensive care units are similar irrespective of chorionicity.Tweetable Abstract: Monochorionicity is associated with adverse perinatal outcomes, but outcomes for preterm twins are comparable irrespective of their chorionicity. [ABSTRACT FROM AUTHOR]

Résumé Introduction L’infection néonatale bactérienne précoce (INBP) reste une des principales causes de mortalité et morbidité néonatales. La généralisation du dépistage du portage vaginal de streptocoque du groupe B (SGB) et de l’antibioprophylaxie per-partum a entraîné une diminution de l’incidence des INBP à SGB. Plus de dix ans après les dernières recommandations françaises, nous avons évalué les pratiques professionnelles concernant le dépistage, le diagnostic et le traitement des INBP en Île-de-France. Patients et méthodes Enquête observationnelle multicentrique, prospective, du 18 au 31 mars 2013, dans 14 maternités volontaires d’Île-de-France. Tous les enfants nés vivants à 35 semaines d’aménorrhée (SA) ou plus ont été inclus. Les caractéristiques maternelles, obstétricales, néonatales et les modalités de prise en charge des suspicions d’INBP ont été recueillies. Résultats La population d’étude a comporté 1194 mères et 1217 nouveau-nés. Parmi ces derniers, 54 % ont eu des prélèvements bactériologiques à la naissance, dont au moins un liquide gastrique. L’indication des prélèvements bactériologiques reposait dans 85 % des cas sur la présence de critères majeurs ou mineurs définis par l’Agence nationale d’accréditation et d’évaluation en santé (ANAES) en 2002. En outre, plus d’un nouveau-né sur 4 a eu au moins un prélèvement sanguin. Une antibiothérapie a été administrée à 4 % des enfants, comportant la céfotaxime dans près de deux tiers des cas. Conclusion Une mise à jour des recommandations concernant la prise en charge de l’INBP paraît nécessaire pour mieux cibler les nouveau-nés à risque et optimiser l’utilisation des antibiotiques. La place des prélèvements bactériologiques à la naissance dans la gestion des suspicions d’INBP est certainement à redéfinir. Summary Introduction Early-onset neonatal infection remains a major cause of morbidity and mortality in neonates. Both universal vaginal screening for group-B streptococcus (GBS) and intrapartum antibiotic prophylaxis have decreased the incidence of early-onset GBS disease. Almost 12 years after the implementation of the French recommendations, we assessed the practices around screening, diagnosis, and treatment of early-onset neonatal infection in the Île-de-France region. Patients and methods We conducted a prospective, multicenter, observational study in 14 volunteer maternity wards from 18 to 31 March 2013. All live newborn infants delivered at 35 gestational weeks or more were eligible. Maternal, obstetrical, and neonatal characteristics were collected, as well as the management of suspected early-onset neonatal infections. Results A total of 1194 mothers and 1217 neonates were included. Among the latter, 54% had bacteriological samplings at birth, with at least a gastric aspirate. Bacteriological samples were collected at birth in 85% of cases based on major or minor anamnestic infection criteria defined by the French National Authority for Health in 2002. In addition, 26% of neonates had at least one blood sample taken. Antibiotic treatment was administered in 4% of the infants with cefotaxime administered in two thirds of cases. Conclusion An update of the French guidelines for the management of early-onset neonatal infections is required in order to improve targeting of newborn infants suspected of having an infection and to optimize the antibiotics administered. Moreover, the role of bacteriological sampling at birth needs to be clarified. [ABSTRACT FROM AUTHOR]

Our aim was to assess the long-term outcomes of infants born out of a pregnancy complicated by unexplained polyhydramnios. We retrospectively analysed a cohort of 173 singleton pregnancies with polyhydramnios. There were 24 singletons with unexplained polyhydramnios, defined as polyhydramnios where prenatal testing was negative. Infants were examined by a paediatrician at a median age of 12 months (range 12–64 months). Of the 24 infants, 19 (79%) had a normal outcome. West syndrome, polyuria and pulmonary stenosis were diagnosed in three children during follow up, while there were two perinatal deaths. Paediatric follow up of children born out of pregnancies complicated by unexplained polyhydramnios should be carried out systematically. [ABSTRACT FROM AUTHOR]

The study reported here prospectively evaluated the time-to-diagnosis of imported Plasmodium falciparum malaria in children in seven French pediatric emergency departments during a 1-week period. For the 29 patients included, the mean patient, doctor and total delays were 3.1, 1.5 and 4.7 days, respectively. The late medical diagnosis for 11 patients was mainly due to the treating physician’s failure to consider malaria, despite having been informed that the child had been in an endemic area, and erroneously making a diagnosis of viral infection. The five patients who were diagnosed correctly without delay had higher mean platelet counts than the others (206,000 vs 118,541/mm3; p=0.008). The results indicate that greater awareness of the risk of malaria in returning travelers may help reduce delays in diagnosis and its consequences. [ABSTRACT FROM AUTHOR]

Introduction L’orchi-épididymite (OE) néonatale est rare. Le Streptocoque du groupe B (SGB) est le germe le plus fréquent dans les infections néonatales précoces. La généralisation de l’antibioprophylaxie per-partum a réduit l’incidence des infections précoces à SGB alors que celle des infections néonatales tardives est restée stable. Fait clinique Nous rapportons le cas d’une OE néonatale ayant révélé un sepsis tardif à SGB chez un prématuré de 33 semaines. Le prélèvement vaginal était positif, les prélèvements bactériologiques de naissance étaient stériles. Lors de l’exploration chirurgicale de la bourse inflammatoire, la pose de la rachianesthésie retrouve un liquide céphalo-rachidien trouble et permet le diagnostic d’une méningite à SGB. L’imagerie cérébrale montre une lésion de nécrose ischemique temporale gauche. Discussion Premier cas rapporté d’OE néonatale à SGB. Le mode de transmission est difficile à déterminer. Ni la transmission verticale, ni la transmission horizontale nosocomiale ou par l’allaitement maternel ne peut être exclue. L’importante morbi-mortalité liée aux infections à SGB et la présentation clinique atypique interrogent sur la réalisation systématique d’une ponction lombaire devant toute infection locale, en particulier si le site est inhabituel. [ABSTRACT FROM AUTHOR]