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School-aged prematurely born children (PC) have a higher risk of academic difficulties, which may be partly explained by attention difficulties. It has been suggested that children’s attentional performance might be influenced by their body posture and spontaneous body motion. The aim of this study (ClinicalTrials.gov – NCT 03125447) was to test the influence of three body mobility conditions on the three functions of attention (alertness, orienting, and executive control) among school-aged PC vs. term-born children (TC). Notably, 21 PC and 21 TC performed the Attention Network Test for Children in three body mobility conditions, namely, sitting and standing imposed fixed postures and a free-to-move condition. The children’s median reaction times were compared between trials (1) with and without alerting cues, (2) with valid and invalid orienting cues, and (3) with and without distracting information, to calculate the performance of alertness, orienting, and executive control, respectively. Results showed that with distracting information, PC exhibited significantly slower responses in the standing-still posture than in the sitting-still posture (1,077 ± 240 vs. 1,175 ± 273 ms, p < 0.05), but not TC. No difference was observed with the free-to-move condition. PC and TC did not significantly differ in alertness or orienting, regardless of body mobility condition. These data suggest that PC must use executive resources to stand still and maintain position, which impairs their performance during executive tasks. We speculate that these results may be related to less developed postural control and motor inhibition in PC.

Resume L’administration precoce et multimodale d’antalgiques par voie orale fait partie du programme de rehabilitation postoperatoire apres chirurgie. Aussi efficiente que la voie parenterale, l’auto-administration d’antalgiques par voie orale (PCOA) facilite la deambulation precoce des parturientes dont le premier souhait est d’etre suffisamment autonome pour s’occuper de leur enfant et permet une analgesie de qualite notamment apres cesarienne. Les antalgiques administres dans ce contexte doivent etre evalues en termes d’efficacite mais aussi de securite par rapport a l’allaitement.

International audience; Objectives: To provide up-to-date evidence-based guidelines for the management of smoking cessation during pregnancy and the post-partum period.Study design: A systematic review of the international literature was undertaken between January 2003 and April 2019. MEDLINE, EMBASE databases and the Cochrane library were searched for a range of predefined key words. All relevant reports in English and French were classified according to their level of evidence ranging from 1(highest) to 4(lowest). The strength of each recommendation was classified according to the Haute Autorité de Santé (French National Authority for Health) ranging from A (highest) to C (lowest).Results: \"Counselling\", including all types of non-pharmacological interventions, has a moderate benefit on smoking cessation, birth weight and prematurity. The systematic use of measuring expired air CO concentration does not influence smoking abstinence, however, it may be useful in assessing smoked tobacco exposure prior to and after quitting. The use of self-help therapies and health education are recommended in helping pregnant smokers quit and should be advised by healthcare professionals. Nicotine replacement therapies (NRT) may be prescribed to pregnant women who have failed to stop smoking after trying non-pharmacological interventions. Different modes of delivery and dosages can be used in optimizing their efficacy. Smoking in the postpartum period is essential to consider. The same treatment options as during pregnancy can be used.Conclusion: Smoking during pregnancy concerns more than a hundred thousand women each year in France resulting in a major public health burden. Healthcare professionals should be mobilised to employ a range of methods to reduce or even eradicate it.

IntroductionPre-eclampsia (PE) and intrauterine growth restriction (IUGR) are two major pregnancy complications, related to chronic uteroplacental hypoperfusion. Nowadays, there is no screening or diagnostic test for uteroplacental vascularisation deficiency in pregnant women. Since 2004, 3 three-imensional power Doppler (3DPD) angiography has been used for the evaluation of uteroplacental vascularisation and three vascular indices are usually calculated: Vascularisation Index (VI), Flow Index (FI) and vascularisation-FI (VFI). A high intraobserver and interobserver reproducibility and a potential interest for placental function study were reported by our team and others.The main objective of our study is to determine differences in 3DPD indices at first trimester between pregnancies defined at their outcome as uncomplicated pregnancy, PE (mild and severe) and IUGR in nulliparous women.Methods and analysisThis is a national multicentre prospective cohort study conducted in four French maternity units. We expect to include 2200 women in a period of 36 months. The nulliparous pregnant women will be recruited during their first trimester consultation (11–13+6 gestation week (GW)).The 3DPD and uterine artery Doppler acquisition will be included in the current routine 11–13+6 GW ultrasound. Also, additional blood samples will be taken for biomarker analysis (PAPP-A and P1GF) and biological collection. Uteroplacental VIs (FI and VFI) will be measured. For each subgroup (uncomplicated pregnancy, PE and IUGR), mean values in 3DPD indices will be computed and compared using a pairwise t test with a Bonferroni correction p value adjustment.Ethics and disseminationThe study was approved by the French Ethics Committee, the Comité de Protection des Personnes SUD MEDITERRANEE IV on 13 February 2018 with reference number 17 12 03. The results of this study will be published in a peer-reviewed journal and will be presented at relevant conferences.Trial registration numberNCT03342014; Pre-results. PHRCN-16-0567.

International audience; Background: Despite the pandemic, data are limited regarding COVID-19 infection in pregnant women and newborns. This report aimed to bring new information about presentation that could modify precautionary measures for infants born of mothers with a remote history of COVID-19. Methods: We report two infants with possible maternofetal transmission, and four mothers without immunologic reactions. Data were collected from the patient files.Results: One mother exhibited infection signs 10 days before uncomplicated delivery, with negative RT-PCR and no antibody detection thereafter. Another mother exhibited infection 6 weeks pre-delivery, confirmed by nasopharyngeal swab testing with positive RT-PCR, and positive antibody detection (IgM and IgG). Both newborns were asymptomatic but tested positive for nasopharyngeal and stool RT-PCR at 1 and 3 days of age for the first one and at 1 day of age for stool analysis for the second one. Two additional mothers exhibited infection confirmed by positive RT-PCR testing at 28-and 31-days pre-delivery but did not present detectable antibody reaction at the time of delivery.Conclusion: These observations raise concerns regarding contamination risk by asymptomatic newborns and the efficacy of immunologic reactions in pregnant mothers, questioning the reliability of antibody testing during pregnancy.

International audience

International audience; The sudden arrival of the SARS-CoV-2 outbreak conducted healthcare departments to rapidly adapt their organizations. The White Plan has been activated in Strasbourg and Nancy the March 13, 2020 to deal with a massive influx of patients. Due to this new kind of sanitary emergency, build on Strasbourg’s experience, the University Maternity of Nancy has been reorganized in order to propose the best care conditions for women in an environment limiting the risk of contamination. In view of the high risk of viral transmission, antenatal follow-up by teleconsultations and home visits provided by independent midwives and general practitioners was promoted for low-risk pregnancies. A pre-admission triage system and a specific circuit for patients suspected or infected with SARS-CoV-2 have been created. Specific procedures of care in anesthesiology, obstetrics and pediatrics have been drawn up and regularly revised according to national recommendations and literature. The aim of the article is to describe our health care organization, to highlight operational difficulties and points of improvement identified.; L’arrivée brutale de l’épidémie sanitaire liée au SARS-CoV-2 dans la région Grand Est a conduit les services de soins de cette région à s’adapter rapidement à la situation. Le Plan blanc a été déployé dans les hôpitaux de Strasbourg et Nancy dès le 13 mars 2020 afin de faire face à un afflux massif de patients. Face à cette urgence sanitaire d’un type nouveau, la maternité de Nancy s’est réorganisée forte de l’expérience des services strasbourgeois rapidement mis en tension afin d’assurer l’accueil et de dispenser les meilleurs soins possible aux parturientes dans un environnement limitant au maximum leur risque de contamination. Du fait du haut risque de transmission virale, un suivi anténatal par téléconsultations et visites à domicile par le réseau de ville (sages-femmes libérales, généralistes) a été organisé pour les grossesses à bas risque. Sur site, un triage des admissions a rapidement été mis en place ainsi que la création d’un circuit spécifique dédié aux patientes à risque ou confirmées porteuses du SARS-CoV-2. Des procédures de prise en charge gynéco-obstétricales, anesthésiques et pédiatriques ont été rédigées et révisées par les différentes équipes au fur et à mesure de l’évolution des connaissances et des recommandations émises par les sociétés savantes. L’objectif de cet article est de détailler l’ensemble de l’organisation mise en place, de décrire les difficultés de fonctionnement rencontrées lors du pic de l’épidémie et d’analyser les points d’amélioration mis en évidence.

Resume Le risque de reveil peroperatoire avec memorisation est de l’ordre de 0,1 a 0,2 % au cours des cesariennes sous anesthesie generale. Plusieurs facteurs contribuent a ce risque comme la diminution des doses voire l’absence de certains agents anesthesiques du fait de leur impact sur le tonus uterin et l’enfant, le delai court separant l’induction de l’incision chirurgicale et les difficultes eventuelles d’abord des voies aeriennes. A l’issue du 5e Audit national britannique centre sur les reveils peroperatoires, des recommandations ont ete redigees afin de reduire le risque de reveil peroperatoire. Apres cesarienne sous anesthesie generale, il est important d’avoir comme objectif de limiter les sequelles psychologiques apres un reveil peroperatoire.

Background Inappropriate nutritional intake in premature infants may be responsible for postnatal growth restriction (PGR) and adverse long-term outcomes. Objective We evaluated the impact of an updated nutrition protocol on very premature infants’ longitudinal growth and morbidity, and secondly the compliance to this new protocol. Design All infants born between 26–32 weeks gestation (GA) were studied retrospectively during two 6-month periods before (group 1) and after (group 2) the introduction of an optimized nutrition protocol, in a longitudinal comparative analysis. Results 158 infants were included; 72 before and 86 after the introduction of the protocol (Group 1: (mean±SD) birthweight (BW) 1154±276 g, GA 29.0±1.4 weeks; Group 2: BW 1215±332 g, GA 28.9±1.7 weeks). We observed growth improvement in Group 2 more pronounced in males (weight z-score) at D42 (−1.688±0.758 vs. −1.370±0.762, p = 0.045), D49 (−1.696±0.776 vs. −1.370±0.718, p = 0.051), D56 (−1.748±0.855 vs. −1.392±0.737, p = 0.072), D63 (−1.885±0.832 vs. −1.336±0.779 p = 0.016), and D70 (−2.001±0.747 vs. −1.228±0.765 p = 0.004). There was no difference in females or in morbidities between the groups. We observed low compliance to the protocol in both groups: similar energy intake but higher lipid intake in Group 1 and higher protein intake in Group 2. Conclusion The quality of nutritional care with a strictly-defined protocol may significantly improve weight gain for very preterm infants. As compliance remained low, an educational reinforcement is needed to prevent PGR. Clinical trial registration This retrospective study was registered by ClinicalTrials.gov under number NCT03217045, and by the CNIL (Commission Nationale de l’Informatique et des Libertes) under study number R2015-1 for the Maternity of the CHRU of Nancy.

International audience; Objectives - To provide up-to-date evidence-based guidelines for the management of smoking cessation during pregnancy. Methods - Systematic review of the international literature. We identified papers published between January 2003 and April 2019 in Cochrane PubMed, and Embase databases with predefined keywords. All reports published in French and English relevant to the areas of focus were included and classified according the level of evidence ranging from 1 (highest) to 4 (lowest). The strength of the recommendations was classified according to the Haute Autorité de santé, France (ranging from A, highest to C, lowest). Results - "Counseling", involving globally all kind of non-pharmacological interventions, has a modest benefit on smoking cessation, birth weight and prematurity. Moderate physical activity did not show a significant effect on smoking cessation. The systematic use of feedback by measuring the expired air carbon monoxide concentration do not influence smoking abstinence but it may be used in establishing a therapeutic alliance. The use of self-help interventions and health education are recommended in helping pregnant smokers quit. The prescription of nicotine replacement therapies (NRT) may be offered to any pregnant woman who has failed stopping smoking without medication This prescription can be initiated by the health care professional taking care of the pregnant woman in early pregnancy. There is no scientific evidence to propose the electronic cigarette for smoking cessation to pregnant smokers; it is recommended to provide the same advice and to use methods that have already been evaluated. The use of waterpipe (shisha/narghile) during pregnancy is associated with decreased fetal growth. It is recommended not to use waterpipe during pregnancy. Breastfeeding is possible in smokers, but less often initiated by them. Although its benefit for the child's development is not demonstrated to date, breastfeeding allows the mother to reduce or stop smoking. The risk of postpartum relapse is high (up to 82% at 1 year). The main factors associated with postpartum abstinence are breastfeeding, not having a smoker at home, and having no symptoms of postpartum depression. Conclusions - Smoking during pregnancy concerns more than hundred thousand women and their children per year in France. It is a major public health burden. Health care professionals should be mobilized for reducing or even eradicating it.

Resume Objectifs Evaluer les connaissances sur le tabagisme en cours de grossesse et elaborer les recommandations de prise en charge, en utilisant la litterature fondee sur les niveaux de preuve. Methodes Revue systematique de la litterature internationale. Nous avons identifie des articles publies entre janvier 2003 et avril 2019 dans les bases de donnees Cochrane, PubMed et Embase a partir des mots cles predefinis. Toutes les etudes publiees en langue francaise ou anglaise ont ete considerees et classees par leur niveau de preuve (de 1, le plus eleve a 4 le plus bas) et la force des recommandations selon la cotation proposee par la Haute Autorite de sante (HAS) (grades A a C). Resultats Le « conseil global », signifiant tout conseil ou aide comportementale confondu, apporte un benefice modeste comme aide au sevrage et un benefice modere sur le poids de naissance et la prematurite. L’activite physique moderee n’a pas montre d’effet significatif. Le retrocontrole par l’evaluation dans l’air expire de la concentration de monoxyde de carbone n’influence pas l’abstinence tabagique mais il y a l’accord professionnel pour utiliser cette mesure en vue d’etablir une alliance therapeutique. L’utilisation d’interventions d’entraide et d’education a la sante est recommandee pour favoriser l’arret du tabac pendant la grossesse. La prescription des traitements de substitution nicotinique (TSN) peut etre proposee a toute femme enceinte qui n’a pas reussi a arreter de fumer sans aide medicamenteuse. Cette prescription peut etre initiee par le professionnel de sante prenant en charge la femme enceinte en debut de grossesse. Il n’y a pas de preuve scientifique pour proposer la cigarette electronique comme aide a l’arret du tabac ; il est recommande d’utiliser des conseils et des methodes de sevrage tabagique deja evaluees. L’utilisation de chicha pendant la grossesse est associee a une diminution de la croissance fœtale, il est recommande de ne pas l’utiliser pendant la grossesse. L’allaitement maternel est possible chez les fumeuses, bien que moins souvent initie par elles. Si ses bienfaits pour le developpement de l’enfant ne sont pas demontres a ce jour, l’allaitement toutefois permet a la mere de limiter son tabagisme. Le risque de rechute du post-partum est eleve (jusqu’a 82 % a 1 an). Les principaux facteurs associes a l’abstinence du post-partum sont l’allaitement maternel, le fait de ne pas avoir de fumeur a la maison, et l’absence de symptomes de depression. Conclusion Le tabagisme pendant la grossesse concerne des centaines de milliers de femmes et leurs enfants par an en France. Il est un probleme de sante publique majeur. Les professionnels de sante doivent se mobiliser pour le reduire voire l’eradiquer.

International audience; The anthropological part of the present research project addresses the issue of risk and uncertainties relating to perinatality and disability, and draws from the discourses of professionals in a perinatal network in the French Lorraine region. From an anthropological point of view, it is necessary to determine how and to what extent the views of professionals determine the network’s management policies. The place conferred to ‘the user’ in these representations is one of several important issues to be analysed in order to gain better understanding of the management of relationships that result from it. What is the position of professionals who ‘negotiate’ and ‘organise’ the cost of the risk of disability when grasped in connection with their images of the ‘users’ (children and parents)? This qualitative study consisted of 40 semi-structured interviews conducted with 20 medical, social, and community professionals, all involved directly or indirectly with the network. The results demonstrate the importance of a network assessment as a ‘culture’ from the social and cultural relations of network professionals. These relations form the cement of a structure made of interpersonal ties and rooted in particular histories around a ‘user’ that are conveyed through individual narratives.

International audience; Objectifs.-É valuer l'issue postnatale des hydramnios isolé s à l'é chographie anté natale et dé terminer les facteurs associé s à la survenue d'une issue dé favorable. Me´thodes.-É tude ré trospective observationnelle ré alisé e dans un centre universitaire français de type III entre 2008 et 2018, incluant toutes les femmes pré sentant une grossesse singleton compliqué e d'hydramnios. Ont é té exclues les grossesses pré sentant une anomalie é chographique foetale ou placentaire. Le critè re de jugement principal é tait la survenue d'une issue dé favorable postnatale, dé finie par un critè re composite incluant le dé cè s ou la dé couverte postnatale d'une malformation ou d'une pathologie chronique. Les caracté ristiques maternelles, obsté tricales, pé diatriques et de l'hydramnios ont é té comparé es en fonction de l'issue postnatale. Re´sultats.-Quatre-vingt-onze femmes pré sentant un hydramnios ont é té inclues. L'issue é tait dé favorable dans 24,2 % des cas (22/91). Ce taux é tait de 20,3 % en cas d'hydramnios idiopathique et de 33,3 % en cas de diabè te maternel. Le taux de mortalité postnatale é tait de 5,5 % et celui d'anomalies morphologiques non dé tecté es en anté natal de 11 %. Les facteurs associé s à une issue dé favorable é taient l'obé sité (50 % vs 18,8 % ; p = 0,004), la pré cocité du diagnostic (72,7 % avant 32 SA vs 44,9 % ; p = 0,02) et la sé vé rité de l'hydramnios (22,7 % vs 4,3 % en cas d'hydramnios sé vè re ; p = 0,01). L'incidence de la pré maturité é tait plus é levé e en cas d'issue dé favorable. Conclusion.-La pré sence d'un hydramnios doit faire ré aliser une é chographie de seconde intention, y compris en cas de diabè te maternel isolé. La ré alisation d'un bilan gé né tique systé matique reste discutable.

International audience; Objectifs.-É valuer l'issue postnatale des hydramnios isolé s à l'é chographie anté natale et dé terminer les facteurs associé s à la survenue d'une issue dé favorable. Me´thodes.-É tude ré trospective observationnelle ré alisé e dans un centre universitaire français de type III entre 2008 et 2018, incluant toutes les femmes pré sentant une grossesse singleton compliqué e d'hydramnios. Ont é té exclues les grossesses pré sentant une anomalie é chographique foetale ou placentaire. Le critè re de jugement principal é tait la survenue d'une issue dé favorable postnatale, dé finie par un critè re composite incluant le dé cè s ou la dé couverte postnatale d'une malformation ou d'une pathologie chronique. Les caracté ristiques maternelles, obsté tricales, pé diatriques et de l'hydramnios ont é té comparé es en fonction de l'issue postnatale. Re´sultats.-Quatre-vingt-onze femmes pré sentant un hydramnios ont é té inclues. L'issue é tait dé favorable dans 24,2 % des cas (22/91). Ce taux é tait de 20,3 % en cas d'hydramnios idiopathique et de 33,3 % en cas de diabè te maternel. Le taux de mortalité postnatale é tait de 5,5 % et celui d'anomalies morphologiques non dé tecté es en anté natal de 11 %. Les facteurs associé s à une issue dé favorable é taient l'obé sité (50 % vs 18,8 % ; p = 0,004), la pré cocité du diagnostic (72,7 % avant 32 SA vs 44,9 % ; p = 0,02) et la sé vé rité de l'hydramnios (22,7 % vs 4,3 % en cas d'hydramnios sé vè re ; p = 0,01). L'incidence de la pré maturité é tait plus é levé e en cas d'issue dé favorable. Conclusion.-La pré sence d'un hydramnios doit faire ré aliser une é chographie de seconde intention, y compris en cas de diabè te maternel isolé. La ré alisation d'un bilan gé né tique systé matique reste discutable.

International audience; Objectives: Large studies are needed to update risk factors of bronchiolitis hospitalization. We performed a nationwide analysis of hospitalization rates for bronchiolitis over four consecutive bronchiolitis seasons to identify underlying medical disorders at risk of bronchiolitis hospitalization and assess their frequency.Methods: Data were retrieved from the French National Hospital Discharge database. Of all infants discharged alive from maternity wards from January 2008 to December 2013 in France (N = 3,884,791), we identified four consecutive cohorts at risk of bronchiolitis during the seasons of 2009–2010 to 2012–2013. The main outcome was bronchiolitis hospitalization during a season. Individual risk factors were collected.Results: Among infants, 6.0% were preterm and 2.0% had ≥1 chronic condition including 0.2% bronchopulmonary dysplasia (BPD) and 0.2% hemodynamically significant congenital heart disease (HS-CHD). Bronchiolitis hospitalization rates varied between seasons (min: 1.26% in 2010–2011; max: 1.48% in 2012–2013; p

Resume Objectif Etablir un etat des lieux des pratiques professionnelles concernant la prise en charge des grossesses prolongees dans les maternites lorraines. Materiels et methodes Il s’agissait d’une etude des pratiques professionnelles incluant les 20 maternites du Reseau Perinatal Lorrain. Les differentes maternites etaient interrogees sur les points suivants : moyens de datation de la grossesse, date de debut du suivi et frequence de ce suivi, moyens de surveillance, terme de declenchement, moyens utilises pour le declenchement et les adaptations eventuelles en cas d’uterus cicatriciel. Une comparaison etait ensuite realisee entre les reponses donnees et les recommandations du CNGOF. Resultats Sur les 20 maternites, 19 (95 %) datent la grossesse selon les recommandations et debutent le suivi des 41 SA, 13 (65 %) effectuent un suivi 2 a 3 fois par semaine, 12 (60 %) utilisent les moyens recommandes pour la surveillance des grossesses prolongees, 18 (90 %) effectuent une maturation cervicale en cas de col defavorable, et l’ensemble des maternites suivent les recommandations concernant la date de declenchement. Conclusion La prise en charge apparait tres heterogene en Lorraine et seules 12 des 20 maternites lorraines (60 %) suivent la totalite des recommandations nationales.

International audience; Transient hypothyroxinaemia of prematurity (THOP) presents as decreased free thyroxine without an increase in thyroid stimulating hormone. Thyroxine availability is important in case of premature birth, and THOP could be associated with impaired adaptation to extra-uterine life but the association of thyroxine level and clinical status has not yet been clearly defined. Aim: To defined a free thyroxine threshold likely associated with neonatal clinical impairment and outcomes at age three years. Methods: This retrospective cohort study included infants born before or at 28 weeks' gestation at the Regional Maternity in Nancy, France. We defined a free thyroxine threshold as a function of clinical impairment by Receiver Operating Curve analysis, validated by log likelihood iteration in binary logistic regression, in infants born from October 2008 to December 2012 and meeting neonatal clinical impairment criteria. This threshold was validated in a distinct cohort of infants born from January 2014 to December 2016. Clinical impairment was defined as assisted ventilation requirement at seven days of age plus four minor clinical disorders among heart rate, blood pressure, temperature, serum sodium and potassium, APGAR score at five minutes, vasopressor treatment and patent ductus arteriosus. The first cohort was assessed at age three years for neurodevelopmental outcomes. Results: We identified a ≤10 pmol/L threshold with 85.7% sensitivity and 51% specificity. From the first and second cohorts, 196 and 176 infants respectively had available data, and 85% (97/112) and 26% (20/78) with free thyroxine ≤10 pmol/L met clinical impairment criteria. For infants with values >10 pmol/L, 41% (35/84) and 3% (3/98) from the first and second cohorts met impairment criteria. Of 147 children with available data at age 3 years, 65% (58/89) with neonatal free thyroxine ≤10 pmol/L had adverse neurodevelopmental outcomes vs. 34% (20/58) with >10 pmol/L (OR 3.55; 95% confidence interval, 1.77-7.13; p < 0.001). Conclusion: A free thyroxine level ≤10 pmol/L in infants is associated with neonatal clinical impairment and poor outcome at age three years.

International audience; Seven years of age is a milestone for learning basic knowledge allowing for appropriate adaptation to primary school. As compared to term born infants, prematurely born children (EP) would be prone to interference control difficulties, illustrating inhibition developmental disorders. Furthermore, these infants often present a high level of motor activity usually linked to attentional components deficit such as inhibition. However, studies suggest that corporal mobility may not always mean learning difficulty.ObjectivesThis work aims to study the impact of corporal mobility on interference control.MethodsUsing the Eriksen flanker task adapted to children, we evaluated children's ability to filter out distracting or competing information. Children aged 6–7 years born at a mean of 27 weeks gestation were compared to term born children, all in their expecting grade without learning difficulty.ResultsPreliminary results suggest that the inhibition capability of prematurely born children is indeed different from those of term born infants: EP give a spontaneous and stereotyped answer when interference control is enabled in imposed fixed sitting or standing position. However, when the posture is freed and mobility allowed, the EP would then be able to adjust their reaction time to answer the cognitive task.ConclusionThese preliminary data suggest that attentional efforts to maintain a postural constraint as usually imposed at school could limit infants’ ability to perform requested cognitive task. Waiving this postural constraint could lead improvement of school results.; L’âge de 6–7 ans marque le début des apprentissages conditionnant les capacités des enfants à suivre une scolarité normale. Les enfants nés prématurés (EP) présenteraient une moindre résistance à la distraction que les enfants nés à terme, souvent associée à un niveau élevé d’activité motrice, mais plusieurs études suggèrent que la mobilité corporelle ne serait pas forcément source de difficultés d’apprentissage.ObjectifsCe travail propose d’étudier l’impact de la mobilité corporelle des enfants sur la résistance à la distraction.MéthodesNous avons évalué, en utilisant le principe de l’Eriksen flanker task adapté aux enfants, les capacités de résistance à la distraction d’enfants nés à terme âgés de 6–7 ans comparées à celles d’enfants nés grands prématurés, à 27 semaines de gestation en moyenne, dans des classes de même niveau scolaire, sans difficulté d’apprentissage.RésultatsLes premiers résultats, préliminaires, suggèrent que les capacités d’inhibition de l’enfant âgé de 7 ans sont différentes en cas de naissance prématurée : les EP répondent de façon immédiate et stéréotypée à la sollicitation de la fonction d’inhibition en position assise ou debout imposée. Une posture libre, en revanche, redonnerait la possibilité aux EP d’adapter leur temps de réaction à la tâche imposée et améliorerait leur taux de bonnes réponses.ConclusionCes données suggèrent que les efforts attentionnels nécessaires pour maintenir une contrainte posturale pourraient limiter la disponibilité des enfants à réaliser les tâches cognitives. Une libération de cette contrainte cognitive, liée au respect d’une posture imposée, pourrait améliorer les performances scolaires.

International audience; Background: The diagnosis of a fetal anomaly in perinatal medicine forces expectant parents and healthcare providers to face the difficult process of breaking bad news.Objectives: This exploratory literature review was aimed at providing a medical and psychological view of the psychological experience in expectant parents and physicians in the context of prenatal diagnosis of a fetal anomaly.Method: An exploratory search of PubMed and PsycINFO/PsycARTICLES databases performed by an interdisciplinary team composed of a physician and psychologists. Search terms were: prenatal diagnosis AND bad news; prenatal diagnosis AND psychological consequences; prenatal diagnosis AND psychological sequelae; prenatal diagnosis AND fetal abnormality. The processing of selected articles followed a standardised five-step procedure.Results: A total of 860 articles were screened of which 32 were retained for analysis. Four main themes emerged from the explanatory content analysis: (1) parents' subjective experience; (2) physicians' subjective experience; (3) encounters between expectant parents and professionals; and (4) ethical challenges in breaking bad news in prenatal medicine.Conclusion: Expectant parents go through a complex and multidimensional experience when the diagnosis of a fetal anomaly is disclosed. Simultaneously, physicians consider breaking bad news as a very stressful event and are poorly prepared in this regard. A better knowledge of factors underlying psychological adjustment of the parental dyad and on the subjective experience of physicians delivering these diagnoses could enable better adaptation for both patients and professionals.Keywords: Prenatal diagnosis; bad news disclosure; healthcare professional’s subjective experience; interdisciplinary perspective; psychological consequences.

IntroductionKnowledge about the mechanisms leading to the establishment of uteroplacental vascularisation is inadequate, and some of what has been thought to be known for decades has recently been challenged by showing that the intervillous space, the major area of maternal-fetal exchange, appears to be perfused by maternal blood at as early as 6 weeks of gestation. The vascular flow then seems relatively constant until 13 weeks when it appears to increase suddenly.ObjectivesThe principal objective is to quantify the perfusion of the intervillous space by contrast-enhanced ultrasonography (CEUS) during the first-trimester at three different gestational ages (8, 11 and 13 weeks). The secondary objectives are to: (1) describe the indicators of vascularisation of the placenta (intervillous space) and the myometrium at the three gestational ages, measured by CEUS and three-dimensional power Doppler (3DPD) angiography; (2) compare the diagnostic performance of CEUS and 3DPD for the demonstration and quantification of uteroplacental vascularisation and (3) establish a biological collection of placentas to increase knowledge about placental development and functions during pregnancy.Methods and analysisThis is a prospective, cross-sectional, multicentre and non-randomised open study. We will include 42 women with ongoing pregnancy and divided into three groups of gestational ages (ie, 14 women by per group): 8, 11 and 13 weeks of gestation. 3DPD and then CEUS will be performed and the data about the perfusion kinetics and the 3DPD indices will be calculated and then compared with each other and for each gestational age.Ethics and disseminationThe appropriate French Ethics Committee Est III approved this study and the related consent forms on 5 April 2016, and the competent authority (Agence Nationale de Sécurité du Médicament et des Produits de Santé) authorised the study on 21 June 2016. The results of this study will be published in a peer-reviewed journal and will be presented at relevant conferences.Trial registration numbersClinicalTrials.gov registry (NCT02884297); EudraCT registry (2015-005655-27).

Introduction: Mini-invasive surgery of deep endometriosis is challenging. Surgical difficulties related to the technical limitations of classical laparoscopic approach might be overcome with the use of robotic assistance. The aim of this study was to evaluate the safety and feasibility of robotic surgery for deep infiltrating endometriosis in the learning phase of our team. Methods: The 20 first cases of robotic-assisted laparoscopies for endometriosis were included over a 2-year period. Baseline characteristics of patients and surgical data were reviewed. Surgical outcomes and follow-up information of the patients were analyzed. Results: Twenty women were included. The mean age was 31.9 years (range: 25–44) and mean body mass index was 23 kg/m2 (range: 16–35). Ten patients had rectovaginal or uterosacral location only (50%) and nine women had deep infiltrating endometriosis with digestive or urinary tract lesions (45%). In addition to the gynecologic surgeon, urologic or visceral surgeons were required in 10 cases, and there were 3 cases where the three specialties were needed. The mean operative time was 183.9 min (range: 85–398) and no difference was observed between the first five cases and the last five cases. There was one laparoconversion, and only two urologic postoperative complications occurred. Conclusion: Thanks to the use of robotic surgical assistance and a multidisciplinary approach, and despite the start of the team for deep endometriosis care, no learning curve effect was observed regarding surgical procedures’ success, safety, or duration. The use of robotic assistance might improve the quality of care for women facing deep endometriosis.

Resume Objectifs L’objectif de notre etude etait de realiser une evaluation des pratiques declarees par les professionnels de la naissance de la region Lorraine a propos de la protection perineale obstetricale (toute dechirure perineale confondue). L’objectif secondaire etait d’evaluer les mesures de prevention realisees en pratique par les professionnels de la naissance en fonction du risque perineal subjectivement estime pour chaque situation obstetricale. Methodes Il s’agit d’une enquete de pratique realisee grâce a un questionnaire anonyme distribue aux professionnels de la naissance (gynecologues-obstetriciens, internes de specialite, sage-femme, etudiants sage-femme) en octobre 2016. Les themes abordes concernaient les facteurs de risque maternels, obstetricaux et fœtaux associes aux lesions perineales (du 1er au 4e degres) et les mesures de protection associees. Il a ete realise une analyse descriptive des donnees recueillies. Resultats Cent cinq professionnels ont repondu au questionnaire. Les facteurs de risque identifies etaient en accord avec ceux mis en evidence dans la litterature. D’autres facteurs, non connus comme associes a un risque perineal, etaient cites par les professionnels (tabagisme, phototype). En cas de perception, subjective, par le professionnel d’un risque perineal important, ils pratiquaient plus frequemment une episiotomie (15 % vs 0 %, p Conclusion Cette evaluation montre que les professionnels de la naissance connaissent les principaux facteurs de risque de lesion perineale. En revanche, ils utilisent facilement des manœuvres de protection perineale (episiotomie par exemple) sans reelle efficacite demontree.

International audience; ABSTRACTBackground: The risk of neural tube defects (NTDs) is influenced by nutritional factors and genetic determinants of one-carbon metabolism. A key pathway of this metabolism is the vitamin B12– and folate-dependent remethylation of homocysteine, which depends on methionine synthase (MS, encoded by MTR), methionine synthase reductase, and methylenetetrahydrofolate reductase. Methionine, the product of this pathway, is the direct precursor of Sadenosylmethionine (SAM), the universal methyl donor needed for epigenetic mechanisms. Objectives: This study aimed to evaluate whether the availability of vitamin B-12 and folate and the expression or activity of the target enzymes of the remethylation pathway are involved in NTD risk. Methods: We studied folate and vitamin B-12 concentrations and activity, expression, and gene variants of the 3 enzymes in liver from 14 NTD and 16 non-NTD fetuses. We replicated the main findings in cord blood from pregnancies of 41 NTD fetuses compared with 21 fetuses with polymalformations (metabolic and genetic findings) and 375 control pregnancies (genetic findings).Results: The tissue concentration of vitamin B-12 (P = 0.003), but not folate, and the activity (P = 0.001), transcriptional level (P = 0.016), and protein expression (P = 0.003) of MS were decreased and the truncated inactive isoforms of MS were increased in NTD livers. SAM was significantly correlated with MS activity and vitamin B-12. A gene variant in exon 1 of GIF (Gastric Intrinsic Factor gene) was associated with a dramatic decrease of liver vitamin B-12 in 2 cases. We confirmed the decreased vitamin B-12 in cord blood from NTD pregnancies. A gene variant of GIF exon 3 was associated with NTD risk.Conclusions: The decreased vitamin B-12 in liver and cord blood and decreased expression and activity of MS in liver point out theimpaired remethylation pathway as hallmarks associated with NTD risk. We suggest evaluating vitamin B-12 in the nutritional recommendations for prevention of NTD risk beside folate fortification or supplementation. Am J Clin Nutr 2019;00:674–683.

International audience; Introduction - Turner syndrome is one of the most frequent chromosomal abnormalities in women, with a prevalence estimated to be 1 of 2500 live birth. Pregnancy in women with Turner syndrome is known to be at high risk, whether it is spontaneous or after oocyte donation, because of miscarriages and potential cardio-vascular complications which can be life-threatening. All of these patients should therefore be screened with a comprehensive cardio-vascular assessment before pregnancy, and have a close follow-up during and after pregnancy.Patients and methods - It is a retrospective study, conducted in 10 of the 27 French oocyte donation centers between 2012 and 2016, on all the patients presenting with Turner syndrome included in an oocyte donation program.Results - 151 embryo transfers were realized in 73 patients, resulting in 39 pregnancies. Among these pregnancies, 24 children were born healthy, 11 spontaneous miscarriages, 3 voluntary abortions, 1 extra-uterine pregnancy and 1 maternal death from non-cardio-vascular origin occurred. Pregnancies were complicated by gravid arterial hypertension in 28.2% of cases, preeclampsia in 10.3% of cases, and gestational diabetes in 7.7% of cases.Conclusion - This study bring out obstetrical complications of the same magnitude than the ones described in the literature. Lead over a period of 4 years, in 10 French oocyte donation centers, it doesn't reveal any cardio-vascular complications, conversely to other studies published before French and American recommendations. This study reinforces the usefulness of specific recommendations for the care of these particular patients.

International audience; Aim: This study examined the influence of different human milk fortifiers on biomarkers of gastrointestinal immaturity and inflammation in preterm infants.Methods: We report secondary outcomes from a controlled, double‐blind, randomised, parallel group study conducted from 2011 to 2014 in neonatal intensive care units at 11 metropolitan hospitals in France, Belgium, Germany, Switzerland and Italy. Preterm infants born at up to 32 weeks or weighing up to 1500 g were randomised to a new powdered human milk fortifier (n = 77) or a control fortifier (n = 76) for a minimum of 21 days. We analysed faecal markers of gut inflammation, namely alpha‐1 antitrypsin and calprotectin, and maturity, namely elastase‐1.Results: Faecal alpha‐1 antitrypsin was slightly lower in the new than control fortifier group after 21 days of full enteral feeding, with a geometric mean and standard deviation of 1.52 ± 1.32 vs 1.82 ± 1.44 mg/g stools (P = .01). There was no significant difference in faecal calprotectin (median [Q1‐Q3] of 296 [136‐565] μg/g stools in both groups combined at study day 21). Faecal elastase‐1 was lower in the new fortifier than control fortifier group (202.5 ± 1.6 vs 257.7 ± 1.5 μg/g stools, P = .016).Conclusion: Mean values for each parameter were within the ranges in healthy term infants, indicating favourable markers of gastrointestinal status in both groups. In addition, for faecal calprotectin, the relatively high concentration observed in preterm infants fed fortified human milk suggests that the threshold level for detecting necrotising enterocolitis should be revised.

The main objective was to evaluate the practices declared by birth professionals in the Lorraine region about perineal obstetric protection (any perineal tear combined). The secondary objective was to evaluate prevention measures performed in practice by birth professionals according to the perineal risk subjectively estimated for each obstetric situation.This is a practice survey conducted through an anonymous questionnaire distributed to birth professionals (gynecologists, interns, midwife and midwife student) in October 2016. Topics covered concerned maternal, obstetric and fetal risk factors associated with perineal (1st to 4th degrees) lesions and the associated protective measures. A descriptive analysis of the data collected was conducted.One hundred and five professionals answered the questionnaire. The identified risk factors were consistent with those highlighted in the literature. Other factors, not known as associated with perineal risk, were cited by professionals (smoking, phototype). If the professional perceived a significant perineal risk, they more frequently practiced an episiotomy (15% vs. 0%, P0.001) or considered that the delivery should be performed by an obstetrician (34% vs 8%, P0.001).This evaluation shows that birth professionals know the main risk factors for perineal injury. On the other hand, they easily use perineal protection maneuvers (episiotomy for example) without real demonstrated effectiveness.

International audience; The practice of ultrasonography by midwives is becoming widespread, including outside the framework of antenatal screening. In order to extend this technique to focused fœtal or maternal monitoring, the training of non-ultrasound specialist midwives needs to be optimised and their knowledge of the indications and limits of each examination reinforced.; La pratique de l’échographie par les sages-femmes se généralise, y compris hors du cadre du dépistage anténatal. L’extension de cette technique à la surveillance focalisée du fœtus ou de la parturiente impose d’optimiser la formation des praticiens sages-femmes non-échographistes mais aussi de renforcer leurs connaissances des indications et des limites de chaque examen.

Background: Post-natal gut maturation in infants interrelates maturation of the morphology, digestive, and immunological functions and gut microbiota development. Here, we explored both microbiota development and markers of gut barrier and maturation in healthy term infants during their early life to assess the interconnection of gut functions during different infant formulae regimes. Methods: A total of 203 infants were enrolled in this randomized double-blind controlled trial including a breastfed reference group. Infants were fed starter formulae for the first four weeks of life, supplemented with different combination of nutrients (lactoferrin, probiotics (Bifidobacterium animal subsp. Lactis) and prebiotics (Bovine Milk-derived Oligosaccharides&mdash, BMOS)) and subsequently fed the control formula up to eight weeks of life. Stool microbiota profiles and biomarkers of early gut maturation, calprotectin (primary outcome), elastase, &alpha, 1 antitrypsin (AAT) and neopterin were measured in feces at one, two, four, and eight weeks. Results: Infants fed formula containing BMOS had lower mean calprotectin levels over the first two to four weeks compared to the other formula groups. Elastase and AAT levels were closer to levels observed in breastfed infants. No differences were observed for neopterin. Global differences between the bacterial communities of all groups were assessed by constrained multivariate analysis with hypothesis testing. The canonical correspondence analysis (CCA) at genus level showed overlap between microbiota profiles at one and four weeks of age in the BMOS supplemented formula group with the breastfed reference, dominated by bifidobacteria. Microbiota profiles of all groups at four weeks were significantly associated with the calprotectin levels at 4 (CCA, p = 0.018) and eight weeks of age (CCA, p = 0.026). Conclusion: A meaningful correlation was observed between changes in microbiota composition and gut maturation marker calprotectin. The supplementation with BMOS seems to favor gut maturation closer to that of breastfed infants.

Resume Objectif L’echographie joue un role central pour la prise en charge des suspicions de grossesses arretees. En cas d’erreur diagnostique, cet examen peut amener a mettre en œuvre une prise en charge inadaptee pouvant avoir des consequences lourdes, notamment en cas de faux positif. Les criteres de realisation de cet examen sont aujourd’hui bien definis. L’objectif etait d’evaluer la faisabilite et la reproductibilite d’une note de qualite regroupant les criteres diagnostiques echographiques de grossesse arretee. Methode Trente cliches de grossesses arretees ont ete evalues en double relecture. Deux grilles de notation ont ete evaluees. La premiere permettait d’evaluer la qualite du cliche en cas de sac gestationnel sans embryon (note du sac gestationnel), la seconde permettait d’evaluer le cliche en cas d’embryon present (note de l’embryon). Resultats Les CCI (coefficient de correlation intra-classe) etaient superieurs a 0,75 pour la note du sac gestationnel et pour celle de l’embryon en intra et en inter observateur avec une faible variabilite en fonction des notes obtenues. La reproductibilite inter observateur etait plus faible en premiere lecture pour les longueurs crânio-caudales inferieures a 5 mm mais apres ajustement des modalites de notation, le CCI etait egalement > 0,75. Conclusion Le systeme de notation de la qualite des cliches d’echographies en cas de grossesse arretee propose ici presente une reproductibilite elevee en inter et intra-observateur avec une faible variabilite. Ce systeme de note pourrait donc etre utilisable en pratique courante.

Background: Prebiotics and probiotics exert beneficial effects by modulating gut microbiota and immune system. This study evaluates efficacy and safety of an infant formula containing bovine milk-derived oligosaccharides and Bifidobacterium animalis ssp lactis (B. lactis) (CNCM I-3446) on incidence of diarrhea and febrile infections during the first year of life (primary outcome). Methods: Full-term infants receiving Test or Control (without bovine milk-derived oligosaccharide and B. lactis) formulae were enrolled in a multicenter, randomized, controlled, and double-blind trial with a reference breastfeeding group. . Results: 413 infants were assigned between Test (n = 206) and Control (n = 207) formula. There was no significant difference for diarrhea and febrile infections incidence between groups at 6 (odds ratio (95% confidence interval) = 0.56 (0.26–1.15), P = 0.096) and 12 mo (odds ratio = 0.66 (0.38–1.14), P = 0.119). Test formula was well tolerated, anthropometrics parameters were not significantly different between groups and aligned with WHO growth standards up to 12 mo. Data from test group showed that gut microbiota pattern, fecal IgA and stool pH were brought to be closer to those of breastfed infants. Conclusion: An infant formula enriched with bovine milk-derived oligosaccharide and B. lactis supports normal infant growth, is well tolerated and improves intestinal health markers. No differences in diarrhea and febrile infection incidence were found in the population studied.

Introduction A normal placenta development is crucial for a successful pregnancy. In case of major obstetric complications such as intra-uterine growth restriction, the placental vascularization morphological alteration at macroscopic level is less known than that at microscopic scale. Ex vivo MRA has the potential to visualize whole fresh human placental vasculature fast and efficiently but can be hampered by contrast agent extravasation problem. This study aimed to provide an optimized ex vivo MRA protocol to acquire understanding of global human placenta vasculature morphology. Methods Six fresh normal human placentas were imaged with two contrast agents (i.e. Gd-chelate and pump oil) using different imaging parameters on a 3T clinical MR scanner (GE). The contrast to noise ratio, signal to noise ratio and enhancement efficiency were assessed in order to decide which contrast agent and imaging protocol was better. In the end, morphology indices were measured based on the 3D vasculature models reconstructed from the placentas imaged with the optimized protocol. Results With the same imaging parameters, the CNR and the enhancement efficiency of images enhanced with pump oil were superior to those using Gd-chelate. Enhanced by pump oil, an optimized ex vivo MRA protocol was determined, leading to a clear 3D visualization and reconstruction of human placenta vascularization. Discussion The proposed ex viv o MRA method is easy to manipulate, and can be used to investigate the human placental vasculature morphology. The acquired data are of good quality and can be used for characterization of placenta vascularization morphology.

International audience; Transition to parenthood is considered a developmental crisis and adult attachment has been identified as a key concept for a better understanding of the psychological adjustment of individuals and couples during the transition to parenthood. In the context of transition to parenthood, prenatal diagnostic of a fetal anomaly is a very demanding situation. Regardless of the degree of the illness, this experience incorporates a traumatogenic dimension, due to the impact of the diagnosis of a fetal anomaly on the psychological functioning and well being of expectant parents. It is important to continue to study the factors of psychological adaptation to parenthood in order to guide the clinical interventions protocols focused on individual and dyadic adaptation to parenthood, mainly in pathological contexts.; La transition vers la parentalité représente une crise développementale et l’attachement adulte a été identifié en tant que concept-clé dans la compréhension de l’ajustement psychologique des personnes et des couples pendant cette période. Dans le cadre de la transition vers la parentalité, le diagnostic prénatal d’une pathologie fœtale représente une situation d’extrême exigence. À cause de l’impact de l’annonce du diagnostic sur le fonctionnement psychologique et bien-être des futurs parents, cette expérience peut avoir un caractère traumatogène, indépendamment de la sévérité de la maladie diagnostiquée. L’étude des variables qui déterminent l’adaptation à la parentalité doit se poursuivre de façon à orienter les interventions cliniques qui visent l’adaptation individuelle et dyadique pendant ce parcours développemental, surtout dans les situations pathologiques.

International audience; Objective: Few studies compared growth and neurodevelopment outcome between asymmetric (aSYM) and symmetric (SYM) small for gestational age (SGA) term infants. We aimed at evaluating their respective outcome at 9 months postnatal age.Study design: A cohort study including infants born in 2010 to 2011 with a birth weight

International audience; Background: In order to assess public health policies for the perinatal period, routinely produced indicators are needed for the whole population. In France, these indicators are used to compare the national public health policy with those of other European countries. French administrative and medical data (PMSI) are straightforward and reliable and may be a valuable source of information for research. This study aimed to measure the quality of PMSI data from three university health centers for core indicators in perinatal health. Method: PMSI data were compared with medical files in 2012 from 300 live births after 22 weeks of amenorrhea, drawn at random from University Hospitals in Dijon, Paris and Nancy. The variables were chosen based on the Europeristat Project's core and recommended indicators, as well as those of the French National Perinatal survey conducted in 2010. The information gathered blindly from the medical files was compared with the PMSI data positive predictive value (PPV) and the sensitivity was used to assess data quality. Results: Data on maternal age, parity and mode of delivery as well as the rates of premature births were superimposable for the two sources. The PPV for epidural injection was 96.2% and 94.3% for perineal tears. Overall, maternal morbidity was underdocumented in the PMSI, so the PPV was 100.0% for pre-existing diabetes, 88.9% for gestational diabetes and 100.0% for high blood pressure with a rate of 9.0% in PMSI and 6.3% in the medical files. The PPV for bleeding during labor was 89.5%. Conclusion: To conclude, PMSI data are apparently becoming more and more reliable for two reasons: on one hand, the importance of these data for budgetary promotion in hospitals; on the other, the increasing use of this information for statistical and epidemiological purposes.

L’ethique du care formulee en 1982 par C. Gilligan enonce qu’hommes et femmes n’ont pas les memes preoccupations morales. Ce travail a eu comme objectif principal de determiner quelles sont les preoccupations morales des hommes qui ont choisi la profession de « puericultrice », profession quasi-exclusivement feminine (On note en France, 1,3 % d’hommes recenses en 2010 parmi les infirmiers specialises en puericulture).Population et methode : la population a ete constituee par un echantillon non representatif de puericulteurs recrutes de proche en proche. La methode a consiste en une enquete qualitative realisee sous forme d’entretiens en face a face par une enquetrice unique.Resultats : 11 sujets ont ete interviewes entre janvier et mai 2013. L’analyse de contenu des entretiens relative a l’ethique du care a montre que, bien qu’ils repondent aux questions portant sur leurs valeurs et vertus par des elements relevant des valeurs soignantes classiques et des valeurs considerees comme masculines, les preoccupations morales qui caracterisent l’ethique du care sont presentes chez la quasi-totalite d’entre eux (10/11).Discussion : l’enquetrice ayant rencontre des professionnels de sante heureux, il est emis l’hypothese que l’explication de ce constat reside en ce que les hommes qui constituent ce groupe professionnel particulier conjuguent, de facon apparemment harmonieuse, des preoccupations morales attribuees traditionnellement aux hommes et aux femmes.

International audience; BACKGROUND: Socioeconomic deprivation is not easily measurable in hospital information systems. However, its identification is essential, as it is associated with morbidity and hospital length of stay (LOS). We aimed at studying the feasibility of using routinely recorded individual and area-based socioeconomic indicators, and assessing their relation with LOS. METHODS: In a cross-sectional study we collected area-based socioeconomic deprivation indicators from French census databases and individual ones from the 2009 medical and administrative databases of a French referral maternity hospital. The principal outcome was the LOS for delivery. Individual level socioeconomic deprivation indicators included preferential insurance scheme (health insurance allocated to poor persons). Nine area-based socioeconomic deprivation indicators were aggregated at the census tract and commune levels. The relation between socioeconomic deprivation and LOS was studied using multilevel models. The well-documented relation between socioeconomic deprivation and preterm delivery was firstly studied in these models as a validation step. RESULTS: The linkage between aggregated and individual data was possible for the 3471 women included. The median LOS was 5 days. In multivariable analysis adjusted for age (P=0.02), twinning (P=0.0001), delivery mode (P

absent

Background Usher syndrome (USH) combines sensorineural deafness with blindness. It is inherited in an autosomal recessive mode. Early diagnosis is critical for adapted educational and patient management choices, and for genetic counseling. To date, nine causative genes have been identified for the three clinical subtypes (USH1, USH2 and USH3). Current diagnostic strategies make use of a genotyping microarray that is based on the previously reported mutations. The purpose of this study was to design a more accurate molecular diagnosis tool. Methods We sequenced the 366 coding exons and flanking regions of the nine known USH genes, in 54 USH patients (27 USH1, 21 USH2 and 6 USH3). Results Biallelic mutations were detected in 39 patients (72%) and monoallelic mutations in an additional 10 patients (18.5%). In addition to biallelic mutations in one of the USH genes, presumably pathogenic mutations in another USH gene were detected in seven patients (13%), and another patient carried monoallelic mutations in three different USH genes. Notably, none of the USH3 patients carried detectable mutations in the only known USH3 gene, whereas they all carried mutations in USH2 genes. Most importantly, the currently used microarray would have detected only 30 of the 81 different mutations that we found, of which 39 (48%) were novel. Conclusions Based on these results, complete exon sequencing of the currently known USH genes stands as a definite improvement for molecular diagnosis of this disease, which is of utmost importance in the perspective of gene therapy.