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Summary: Background: The hygiene of hands stays the basic measure to reduce the incidence of the hospital-borne infections. Its importance is major in a service of neonatology. Our work aimed at estimating the knowledge and the practices on the hygiene of hands. Method: The study was realized at the level of the unit of neonatology and the intensive care of the service of infant medicine and neonatology of the north hospital of Marseille and took place from 1st till 15 August 2008. Results: We questioned 55 persons of the staff, seek attendants and observed 30 persons. Near the quarter of the staff (23.6%) think that the solutions hydro-alcoholic are less effective than the simple wash of hands and more half (the 51%) than they are less effective than the hygienic wash. In respectively 20% and 36% of the cases, the staff underestimates the duration of the procedure of wash of hands and the hydro-alcoholic friction. In 58.1% of the cases, the staff ignores that the hydro-alcoholic solutions can be used in all the situations where hands are not soiled. Attendants seems to have a good knowledge of the hydro-alcoholic solutions. They know the indication about it in 56.2% of the cases and think that they are effective in 50% of the cases. The staff seems to have a good theoretical knowledge (87.2 in 96.4%) measures of hygiene of hands to be before adopted and after the most current gestures in the unit. There is an inobservance of the hygiene of hands in 33.3% of the cases. None of the persons outside the service practised a measure of hygiene of hands. A bad quality of the wash of hands concerning the contagion at the end of procedure was found in 64.7% of the cases and it in all the observed categories. Conclusion: There is a real lack of information of the staff about the hygiene of hands. For the improvement of the quality of the care, the evaluation of the practices and the training of the staff turn out indispensable. [Copyright &y& Elsevier]

Aim of the study: Assess the potential benefits of performing an early cerebral MRI to evaluate the gravity of cerebral lesions among premature neonates at risk of neurologic sequels and establish correlations between EEG findings, abnormal neuroimaging findings and neurodevelopment.Methods: A MRI was performed in 34 premature newborn babies with abnormal neurological clinical signs, and/or with two abnormal EEG and/or with two abnormal cerebral ultrasound scans. The mean age and the adjusted age of our population were 5 weeks (range 1–11 weeks) and 35 weeks of adjusted age (range 29–40 weeks) respectively. The neuroimaging findings were correlated to the results of three EEGs (recorded before 15 days old, between 15 days and one month old, and after the first month of life) and to neurodevelopment.Results: Two statically significant correlations were found between: 1) the severity of brain injuries observed in MRI and the results of the latest EEG (sensitivity 100%, specificity 60%), 2) the severity of brain injuries observed in MRI and abnormal neurodevelopment (sensitivity 75%, specificity 80%). There was no correlation between the abnormal development and the results of EEG recordings.Conclusion: Early cerebral MRI is justified in a selected premature population. It is useful for the diagnosis, the evaluation of the severity of brain injury and for the management of these children. The correlation with EEGs traces allows the detection of the majority of prematures babies that will develop sequels. [Copyright &y& Elsevier]

Abstract Objective To evaluate the usefulness of transvaginal ultrasonography in the determination of the risk of preterm delivery and chorioamnionitis in pregnancies affected by preterm premature rupture of membranes preterm premature rupture of membranes. Design One hundred and one singleton pregnancies with preterm premature rupture of membranes were included in this prospective study over a 3-year period. Patients underwent cervical length measurement by transvaginal ultrasonography at admission and thereafter, in the absence of chorioamnionitis, were managed expectantly. Results The median time interval between admission and delivery (latency period) was 48 h. A cervical length of less than 20 mm was associated with a significant risk of early delivery (mean latency period was 59.44 ± 159.93 h vs. 240.94 ± 364.67; P < 0.05). There was no relation between cervical length and occurrence of chorioamnionitis or neonatal sepsis. Conclusions These data suggest that the use of transvaginal ultrasonography for cervical length measurement during preterm premature rupture of membranes may predict an early delivery but cannot anticipate the risk of chorioamnionitis or neonatal sepsis. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented about the case of a 25-year-old woman diagnosed with right diaphragmatic hernia and hydrops.

Investigates the pathology of epidermolysis bullosa (EB) and pyloric atresia. Accounts on the types of EB; Relationship between EB and pyloric atresia; Accounts on the hereditary characteristic of EB; Role of hemidesmosomal plaque on EB expression.

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]

Non-digestible milk oligosaccharides were proposed as receptor decoys for pathogens and as nutrients for beneficial gut commensals like bifidobacteria. Bovine milk contains oligosaccharides, some of which are structurally identical or similar to those found in human milk. In a controlled, randomized double-blinded clinical trial we tested the effect of feeding a formula supplemented with a mixture of bovine milk-derived oligosaccharides ( BMOS) generated from whey permeate, containing galacto-oligosaccharides and 3'- and 6'-sialyllactose, and the probiotic B ifidobacterium animalis subsp. lactis ( B . lactis) strain CNCM I-3446. Breastfed infants served as reference group. Compared with a non-supplemented control formula, the test formula showed a similar tolerability and supported a similar growth in healthy newborns followed for 12 weeks. The control, but not the test group, differed from the breast-fed reference group by a higher faecal pH and a significantly higher diversity of the faecal microbiota. In the test group the probiotic B . lactis increased by 100-fold in the stool and was detected in all supplemented infants. BMOS stimulated a marked shift to a bifidobacterium-dominated faecal microbiota via increases in endogenous bifidobacteria ( B . longum, B . breve, B . bifidum, B . pseudocatenulatum). [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to evaluate the use of nests on general movements (GM) and posture in very preterm infants at term age. Method: Seventeen high-risk preterm infants-less than 30 weeks of gestation (GA)-underwent a video recording, lying in supine position, with or without nest. Posture, GM quality, and movements made around the child's midline, as well as abrupt movements and frozen postures-in extension or flexion of the four limbs-were analyzed. Results: Nest did not modify quality of GM. Children significantly adopted a curled-up position. The nest system was associated with an increase in movements toward or across the midline, as well as reduction of the hyperextension posture and head rotation movements. Frozen postures in flexion or extension, as well as abrupt movements of the four limbs, were reduced but not significantly. Conclusions: Nest helps very preterm infants to adopt semi-flexed posture and facilitates movements across the midline and reduces movements of spine hyperextension, without GM global quality modifications. [ABSTRACT FROM AUTHOR]

Résumé: Lorsqu’une pathologie fœtale incurable est découverte, certains couples choisissent de poursuivre la grossesse, ne pouvant se résoudre à une interruption de grossesse pour motif médical. De telles situations apparaissent, depuis quelques années, en médecine néonatale et peuvent déboucher sur une prise en charge palliative néonatale. Devant l’imprécision du diagnostic anténatal et face aux incertitudes pronostiques, l’équipe médicale se doit d’informer le couple des différentes évolutions possibles, étape après étape. La prise en charge palliative de l’enfant à naître doit alors avoir une cohérence d’intention à la fois dans la réflexion qui la porte, le discours qui est livré aux parents et les actions qui sont menées, tout en faisant participer l’ensemble des intervenants d’une équipe de santé. L’un des enjeux est d’explorer comment il est possible de contribuer à la construction de la parentalité dans le contexte d’un projet de naissance en soins palliatifs. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To describe the health-related quality of life (HRQL) of a cohort of children aged 6–10 years who were born preterm; and to determine whether sociodemographic factors, neonatal features and neurocognitive status were affecting their HRQL. Study design: All singleton infants born between 24 and 32 weeks of gestation between January 1997 and December 2001 at the study hospital, who were still alive in 2007 (age 6–10 years), and who had undergone complete clinical paediatric follow-up were included in the study. Maternal and perinatal data were obtained by chart review and regular clinical examination. The ‘Battery for Rapid Evaluation of Cognitive Functions’ (BREV) was used for cognitive evaluation when children were aged 4–8 years. HRQL data were collected in 2007 using the ‘Vécu et Santé Perçue de l’Adolescent et de l’Enfant’ (VSP-A) questionnaire (parent version). The HRQL of the preterm children was compared with that of a French reference population. Results: Of 202 children who fulfilled the inclusion criteria, 82 children participated in the study. Their mean age was 7.9 years [standard deviation (SD) 1.4], mean birth weight was 1130.0g (SD 361.4), 23 children were born before 28 weeks of gestation, 46 were female and 11 had major neurocognitive disorders. These data were not significantly different for the non-respondents (n =120). Parents of preterm children reported a significantly lower perception of HRQL of their child compared with parents of children in the reference population, as reflected by VSP-A global index scores and scores for the ‘body image’, ‘vitality’, ‘psychological well-being’ and ‘school performance’ dimensions. In multivariate analyses, three factors were found to be significantly associated with at least one dimension in the VSP-A scale in the preterm children: presence of major neurocognitive disorders, negatively correlated with ‘vitality’, ‘relationships with friends’, ‘physical well-being’ and ‘school performance’ dimensions; maternal parity, positively correlated with the ‘psychological well-being’ dimension; and socio-economic status of family, positively correlated with the ‘relationships with friends’ dimension. The maximum R 2 was 15%. Conclusion: In addition to neurocognitive disorders, other variables such as socio-economic status of the family have a significant impact on the HRQL of preterm children at 6–10 years of age. Given the low proportion of variability in HRQL explained by the models, there is a need to explore other factors (e.g. environmental). [Copyright &y& Elsevier]

Abstract: Objectives: This study was performed to understand the parental attitudes, needs and ethical issues associated with perinatal death, to assist in the development of interventions for bereaved families. Study design: We conducted a qualitative descriptive survey of parental experiences with perinatal death. We developed a questionnaire based on the Delphi method, conducted semi-directed interviews or asked subjects to return the questionnaire by post. As a secondary analysis, we examined whether certain ethical principles (i.e., the concepts of beneficence, nonmaleficence, autonomy, and justice) were encountered by the study participants. The study population consisted of families who had experienced perinatal death in the maternity department of a French university hospital, as well as members of bereaved parent support groups. Results: Six of the 12 parents who participated in the survey were members of a support group. Responses were analyzed according to precise objectives and grouped according to key themes. In particular, we studied deaths that occurred during neonatal palliative care and deaths relating to multiple pregnancies. Parents expressed opinions about the caregivers’ practices (e.g., which practices were beneficial and detrimental). Half of the parents did not feel that their feelings and decisions were respected according to ethical principles. Understanding the experience of parents allows staff to reconsider and change their practices. Conclusions: By understanding parents’ feelings toward neonatal death, caregivers can better assist with the grieving process. Our study reveals parents’ attitudes toward the ethical decision-making process and shows that it is difficult for perinatal medicine caregivers to respect parents’ autonomy. [Copyright &y& Elsevier]

Abstract: With increasing numbers of preterm infants surviving, the impact of preterm birth on later cognitive development presents a major interest. This study investigates the impact of preterm birth on later dorsal- and ventral-stream functioning. An atypical pattern of performance was found for preterm children relative to full-term controls, but in the dorsal-drawing task only. These findings suggest that the number of gestational weeks does affect dorsal-stream functioning, even after more than 6 years of favorable environmental conditions in healthy preterm children. [Copyright &y& Elsevier]

Congenital laryngeal cysts are rare and can cause upper airway obstruction if they are misdiagnosed. We describe a case of large vallecular cyst diagnosed at 33 weeks of gestation. The purpose of an early diagnosis is to establish a careful perinatal management. If the airway is compromised, a multidisciplinary medical team is necessary to perform emergency immediate tracheostomy. Elective delivery should be always carried out in a tertiary referral center. [ABSTRACT FROM AUTHOR]

To describe the pre- and post-natal management of vesico-ureteric reflux in a propective study of babies presenting with vesico-ureteric reflux suspected from pre-natal ultrasonography in a tertiary paediatric center.Patients and methods. – Between 1997 and 2001, 35 children (25 boys and 10 girls) with were vesico-ureteric reflux followed for 12 to 36 months after the pre-natal detection of urinary tract anomalies. Ultrasound examination was realized at the 5th of life, retrograde cystography at the 15th if the renal pelvic dilatation measured at least 10 mm of diameter. In 11 the reflux was bilateral and 46 refluxing units were reviewed.Results. – According to the international classification of, 7% vesico-ureteric reflux were grade I, 20.5% were grade II, 32% were grade III, 18% were grade IV, 22.5% were grade V. Fourteen patients (17 refluxing units) underwent ureteric-reimplantation. Four total and two partial nephrectomies were carried out in patients < 2 years old; in 8 patients the VUR resolved spontaneously. Of the latter, 7 patients (ten refluxing grade III–IV units) are still being followed and awaiting a decision on treatment.Conclusion. – This study confirms the predominance of boys in those with antenatally suspected vesico-ureteric reflux. The spontaneous resolution or improvement during the first 3 years of life was apparent in most cases, even in those with severe reflux (grade III–V). [Copyright &y& Elsevier]