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Background: Acute bronchiolitis affects around 30 % of infants each winter in France. Breastfeeding (BF) is described as being protective against acute lower respiratory infections in developing countries, but this effect is more difficult to demonstrate in industrialized countries. Moreover, the effect of using a pacifier in the occurrence of bronchiolitis is not clearly established. In this context, the aim of the study was to investigate the link between BF and the use of a pacifier in the occurrence of bronchiolitis in children under 1 year of age who presented to five pediatric emergency centers in Pays de la Loire, France., Method: A questionnaire collecting data on diet, sociodemographic characteristics, and the reason for presentation was provided at the admission to pediatric emergency centers in five hospitals in Pays de Loire, France, between 2018 and 2020. Children with bronchiolitis were included in group 1, and children consulting for other reasons (except gastrointestinal infections or otitis) were included in group 2. Breastfeeding was classified as exclusive breastfeeding (EBF) and partial breastfeeding (PBF). Pacifier use was classified as frequent and during sleep or not used., Results: The study included 671 children under 1 year of age, including 174 (25.8 %) who were admitted with bronchiolitis. In univariate analysis, a significantly smaller number of children in group 1 s were breastfed (EBF and PBF) at admission compared with children in group 2:21.8 % versus 32.8 %, respectively, (OR=0.57, 95 % CI: 0.38-0.86, p = 0.006); furthermore, children in group 1 used a pacifier more often than those in group 2: 84.5 % versus 75.8 % (OR=1.74, 95 % CI: 1.10-2.76, p = 0.017). In multivariate analysis, after adjusting for age, ongoing BF or EBF beyond 9 and 12 months of age remained a protective factor; however, the protective effect of BF disappeared with the introduction of a pacifier, and pacifier use was significantly associated with bronchiolitis., Conclusion: The protective effect of BF against bronchiolitis was demonstrated independently of pacifier use. However, due to the strong association between pacifier use and bronchiolitis, the effect of BF weakened. The advice to be given to parents for BF and pacifier use is discussed., Competing Interests: Declaration of competing interest The authors have no funding or conflicts of interest to disclose., (Copyright © 2024. Published by Elsevier Masson SAS.)

Background: In pediatric intensive care units (PICUs), parents and healthcare professionals attend to children who verbally and non-verbally express their pain and suffering, fears, anxieties, desires, and wishes in complex intensive care situations. What can we learn from these experiences to improve the way we can take care of and support children?, Objectives: The main objective of this clinical ethics study was to focus on the experience stories of parents during their child's hospitalization in a PICU, to analyze their discourse, and to propose an ethical perspective., Method: The current research collects the experience reports of parents during their child's hospitalization in a PICU and those of the caregivers who treated them. A total of 17 semi-directive interviews were conducted in the PICU of the Nantes University Hospital from November 2017 to June 2019. Each interview lasted around 1 h. The main results of our study are analyzed and informed by the four ethical principles of T. Beauchamp and J. Childress: autonomy, beneficence, non-maleficence, and justice., Results: The interviews highlighted the difficulties encountered by parents during the hospitalization of their children, such as the distance between their home and the hospital, the technicality of PICU environment, and the difficulty in finding their place as parents. For medical and paramedical teams, their main concerns are undoubtedly to improve the coherence and continuity of their stand toward parents, to promote parental autonomy, and to remain fully aware of the profound existential changes that the child's illness brings about for parents: It is the caregivers' duty to take this into account and to respect the parents' rhythm as much as possible., Conclusions: The main disagreements between healthcare teams and parents, where they exist, are communication problems that are easily controlled, for the most part, by caregivers., Competing Interests: Conflict of interest None., (Copyright © 2022 French Society of Pediatrics. Published by Elsevier Masson SAS. All rights reserved.)

Nipple crack are a frequent complication of breastfeeding, causing pain for the mother and feeding difficulties for the baby with the risk of early cessation of breastfeeding. The characteristics of nipple cracks have rarely been described. Treatment varies according to the period of breasfeeding and the maternity ward. Eight maternity wards in a perinatal health network in western France followed up maternal nipple cracks. The cracks were described and their treatment was noted. The variables regarding the mothers, delivery conditions, health of newborns, and their ability to breastfeed were analyzed. Each case patient was matched with a control patient who was in a room adjacent to the case patient. Case-control analysis was univariate, followed by multivariate analysis via logistic regression (SPSS 20.0) with adjusted odds ratios (aOR). In all, 101 cases of women with nipple cracks were studied. The cracks were predominantly located in the upper external quadrants as well as in the central part of the nipple. There were no lateralization effects (right or left). The most frequent treatments after breastfeeding were oils, hydrophilic gel, and maternal milk. Compared with the 101 controls without cracks, the features associated with cracks in multivariate analysis were fair skin (aOR=1.92 [1.01-3.60]; P=0.04), history of nipple cracks (aOR=11.38 [3.69-35.13]; P=0.0001), first breastfeeding (aOR=4.21 [1.27-13.86]; P=0.018), and normal weight or no obesity (aOR=0.33 [0.14-0.75]; P=0.008). Two more specific analyses were performed in primiparous and multiparous women. In conclusion, the practitioners learned to describe nipple cracks and analyze their treatments. Knowledge of the risk factors should enable practitioners to propose active prevention to mothers with fair skin, a history of cracks, or a lack of experience in breastfeeding by helping them to breastfeed during the first days of their infant's life, especially for primiparous and overweight or obese women., (Copyright © 2019 French Society of Pediatrics. Published by Elsevier Masson SAS. All rights reserved.)

Context: Early childhood caries is a chronic disease that affects a child's general state of health. The question of a link between primary tooth caries and breastfeeding has been addressed for many years, with contradictory results. The concomitant decay of primary teeth, effective establishment, or not, of oral hygiene, and alimentary diversification away from breastfeeding are all confounding factors in this topic. The aim of our study was to analyze the links between breastfeeding and the appearance of caries, as described in the scientific literature and in the recommendations of specialist societies., Methods: A review of publications written in English and French was carried out, searching for the terms early childhood caries, decay and breastfeeding, focusing on literature reviews and meta-analyses dating from the past 10 years. The PubMed database of the US National Library of Medicine National Institutes of Health (NBCI) was used. Furthermore, a review of specialist dental and pediatric societies was conducted., Results: Breastfeeding until the age of 1 year is not associated with an increased risk of dental caries, and may even provide protection compared with feeding with formula milk. By contrast, infants who are breastfed beyond the age of 12 months demonstrate an increased risk of caries. However, the results derive from heterogeneous studies that do not always take into account contradictory factors such as eating habits of the mother or infant (feeding during the night, number of meals per day, eating sweet foods etc.), dental hygiene, or the sociocultural context. Moreover, the most recent recommendations of pediatric and dental societies advise breastfeeding until the age of 2 years, suggesting that this be accompanied by toothbrushing and better nutrition by reducing the frequency and consumption of sugary foods, aimed at helping parents choose prolonged breastfeeding., Conclusion: Extended breastfeeding is a protective factor for childhood caries under 1 year of age. Beyond 1 year, it is difficult to conclude between protection and aggravation of caries because of the multiplicity of confounding factors such as dietary patterns, which vary depending on countries and families, and problems of oral hygiene. In practical terms, when breastfeeding continues beyond 1 year, consultation with a dentist is necessary for examination and preventive advice regarding dietary practices (especially sugar intake), oral hygiene, or supplementary fluoride., (Copyright © 2019 French Society of Pediatrics. Published by Elsevier Masson SAS. All rights reserved.)

Objective: In the health district of Goundi in Chad, 6.7% of children were affected by acute malnutrition in 2011. The purpose of this study was to evaluate the efficacy of a locally made ready-to-use therapeutic food (RUTF)., Methods: One hundred sixty-eight children were suffering from severe acute malnutrition (weight-for-height status less than -3 SD or mid-upper arm circumference less than 115mm). The RUTF was made in a specific laboratory. The product consisted of 49% carbohydrates, 33% lipids, 16% proteins, and 1.5% vitamins. Children received daily one packet of RUTF containing 500kcal as outpatient care., Results: At inclusion, the average age was 17.4±8.7 months, and the weight-for-height status -3.8±0.9 SD. At the end of the program, we noted recovery in 58.3% of the children, 2.4% unsuccessful treatment, 21.4% lost to follow-up, and 17.9% deaths (60% of which occurred during the first 2 weeks). At the end of the program, the weight-for-height status had increased by 2.1 SD. At recovery, children treated for tuberculosis had a higher weight-for-height status (-1.2±1.5 SD) than the children who were not infected by tuberculosis (-2±1.9 SD) (P<0.005)., Conclusion: Nutritional treatment using RUTF was effective. To improve treatment, early case detection should be improved, as should management of associated infectious diseases., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Introduction: Vulnerable children are at-risk newborns including premature infants and some children with pathologies presented by fear anomalies and deficiencies, most particularly neurological. Monitoring is based on the detection of these abnormalities and their early management. The organization of this monitoring system is based on a network of doctors, mostly pediatricians, trained regularly. The objective of this review was to assess the resources, means, and results of 10 years of follow-up., Methods: The Pays de la Loire network includes 24 maternity wards and 13 neonatal departments. Annual admissions are around 5000 newborns to approximately 45,000 annual births. Upon discharge of newborns, born prematurely at 34 weeks of gestation (WG) or less, or term infants with neurological problems, parents are asked to have their child monitored by a referring doctor. During the consultation, a reference document is filled out by the doctor and sent to the project manager for data collection and specific compensation for private practitioners. Standardized questionnaires were used such as the ASQ (Ages and Stage Questionnaire) completed by parents, the developmental quotient (DQ) with the Lézine Brunet-Revised test (BLR), the intelligence quotient (IQ) with the Wechsler Preschool and Primary Scale of Intelligence (WIPPSI III) completed by psychologists employed in the network, and a questionnaire completed by the teacher at 5 years of age., Results: The network started on 1st March 2003, and 28th February 2013, after 10 years of inclusion, 10,800 children had been included. This population accounts for 2.4% of all annual births: 1.1% were included for prematurity less than 33 weeks and 0.25% were term-born infants. The characteristics of children are presented with gestational age, birth weight, and obstetric and neonatal pathologies. The percentage of these children followed was 80% at 2 years and 63% at 5 years. At 2 years, the results are presented according to gestational age with approximately 60% of children without disabilities at 25-26 WG, 73% at 27-28 WG, 77% at 29-30 WG, and 86% at 31-32 WG. Absorptions are diverse and vary according to the age of the child with physical therapy, psychomotor skill work, speech therapy, hearing and vision consultations, and psychology/psychiatry. Assessment tools were refined by specific analyses: the ASQ 24 months (completed by parents) was deemed valid and predictive with respect to IQ (abandoned in 2012), and the grid completed by the teacher was found to predict abnormalities in 5 years., Conclusion: The Pays de la Loire monitoring network has met its initial objective, namely to detect disabilities early and provide practical help to parents in a population of vulnerable children. Benefits for professionals and other children not followed in the network were observed, with an increase in pediatricians' skills. The benefits of the evaluation results are more difficult to assess with the care than neonatal care in obstetrics. The sustainability of such a network seems assured for healthcare professionals, provided that funding is maintained by the health authorities., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Background: Because clinical symptoms and biological markers are neither sensitive nor specific, newborns are frequently suspected of having an infection. In France, 30-50% of newborns are suspected of having early-onset sepsis (EOS) and many of them undergo laboratory tests and empirical antibiotic treatments while awaiting results. The aim of this study was to evaluate the diagnostic value of various suspicion criteria for EOS as recommended by the Anaes since 2002, and the value of umbilical cord blood procalcitonin (PCT), currently assayed in our maternity ward., Material and Methods: This 4-year retrospective study in the CHU of Nantes included hospitalized newborns with suspected early neonatal infection. Infection status was established according to the Anaes definitions and clinical evolution., Results: The study included 2151 newborns. Among anamnestic criteria, only prematurity significantly increased the risk of EOS (relative risk of 3.1; 95% CI 1.4-7.0). The relative risk of infection for a symptomatic newborn was 12.2 (95% CI 4.9-30.2; P<0.0001). Laboratory test results were the most predictive criteria. The relative risk to be infected was 291.6 (95% CI 70.7-1,214.0; P<0.0001) with a blood cord PCT value>0.6 ng/L. The positive post-test probability was 28% (95% CI: 23-33) and the negative post-test probability was close to 0 (95% CI: 0-0)., Conclusion: Clinical criteria of postnatal life adaptation are more predictive of early-onset neonatal infection than anamnestic criteria are. The blood cord PCT value could be a helpful marker in the identification of infected newborns. PCT measured in umbilical cord blood could be included in a general algorithm in order to identify as soon as possible newborns with a high risk of EOS., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Introduction: The Haute autorité de santé released clinical practice guidelines in 2000 to assist in the management of bronchiolitis. These guidelines emphasized supportive care with nasal suctioning and encouraged chest physiotherapy. The aim of this study was to examine the adherence to the french guidelines for the management of bronchiolitis by general practitioners., Patients and Methods: The study included infants less than 24 months of age with bronchiolitis, consulting a general practitioner in Vendée or in Loire-Atlantique, from November 2011 to April 2012 and whose parents accepted to participate to the study. The primary endpoint was the concordance of therapeutic practice with the french guidelines (administrated treatments, refer to pediatric emergencies). Data were collected through questionaires completed by general practitioners., Results: Of the 1236 questionnaires distributed, 134 were completed and 118 therapeutic practice were analyzed. A total of 52.5% of therapeutic practice were concordant with guidelines and 57.5% in case of first bronchiolitis. 50% of infants with a hospitalization criteria according to the guidelines, have not been, which probably shows the interest of new guidelines, with highlighting of hospitalization criteria., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

The "sécurité naissance - naître ensemble" network in the Pays de la Loire region of France, with 24 maternity units, conducted a survey of nursing women to determine the duration of breastfeeding and to study the factors influencing this practice. Phone calls were made to mothers at 1 month, 2 months, 3 months, and 6 months or until weaning. The statistical methods used were the Kaplan-Meier survival curve method with the calculation of the median duration of breastfeeding (exclusive or partial) in weeks, and the Cox multivariate model. The hazard ratio or relative risk (RR) was used in univariate analysis, and the adjusted odds ratio (aOR) in multivariate analysis (>1 related to short duration, and<1 related to long duration). Fifteen maternity units participated, and 239 women were followed. The median duration of breastfeeding was 15 weeks (3.5 months) with 10% discontinuing the first month and 25% continuing breastfeeding at 6 months. The final model of risk of duration contains the following variables: maternal age less than 30 years (aOR=1.54; 1.08-2.19), the time the decision was made before pregnancy (aOR=0.56; 0.38-0.83), BMI greater or equal to 30 (aOR=2.12 (1.18-3.79), and for the first month, the administration of bottle feeding or complements (aOR=2.51; 1.62-3.89), the baby's need to be stimulated to feed (aOR=5.07; 3.24-7.90), breastfeeding on demand (aOR=0.56; 0.39-0.82), and problems breastfeeding (aOR=1.45; 1.005-2.09). This survey to determine the duration of breastfeeding in western France, a region with low initiation rates, duration appears to be relatively long compared to other studies. The factors influencing breastfeeding duration were for some non-modifiable (age, time of the decision, etc.), and for others assistance by a professional (supplements, need for stimulation, difficulty sucking, breastfeeding on demand, etc.). Criteria for identifying difficulties are presented., (Copyright © 2012. Published by Elsevier SAS.)

Objective: To determine survival and neurologic outcomes at 2 years after extremely preterm birth., Methods: A retrospective study including all births (live births and stillbirths) and late terminations of pregnancy at 22-26 completed weeks' gestation in the Pays de la Loire region of France in 2004-2005. We determined survival rates, factors associated with death in neonatal intensive care units (NICUs), and neurologic assessment at the corrected age of 2 years by the Loire Infant Follow-up Team (LIFT)., Results: A total of 444 births were recorded, 37% were medical terminations of pregnancy, 34% were stillbirths, and 29% were live births. Among the 129 hospitalized live births, the survival rate at discharge was 47% (13.7% of all obstetrical outcomes). Mortality decreased with gestational age (P=0.02) and cesarean section (P=0.03). Mortality was higher after extrauterine transport (OR=4.44; 95% CI [1.63-12.12]; P<0.01) and in cases of grade III or IV intraventricular hemorrhage (OR=13.7; 95% CI [4.85-38.5]; P<0.01). The NICU where infants were admitted, gender, multiple birth, and birth weight did not alter mortality. At the corrected age of 2years, 26% of survivors had a normal neurologic assessment, whereas 31% had severe abnormal neurologic outcome., Conclusion: In our study, survival and neurologic outcomes of extremely preterm infants were poor. An extended neurologic follow-up seems necessary for these children, in order to diagnose and manage any subsequent disability., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Background: The Loire Infant Follow-up Team (LIFT) is a network for caring for premature infants whose gestational age is 34 WA or less and at-risk neonates in the Pays-de-la-Loire area in France. The network aims to screen for clinical anomalies early and to propose adapted care. Trained physicians follow the included children in a standardized manner at 3, 6, 9, 12, and 18 months and 2 years, with a specific examination by psychologists at 2 years. The aim of the study was to assess the satisfaction of the parents of the children followed., Methods: To evaluate parent satisfaction, a questionnaire from the Consumer Satisfaction Survey (CSS) in its French version was sent to parents whose infants were 2 years old, stratifying on the presence of an anomaly. The questioner had 39 items, with 8 specific items on the network and 31 from the CSS. The questionnaire was mailed twice in September 2006., Results: Out of 300 questionnaires mailed, 269 were returned (rate 89.7 %). The questionnaire was assessed using principal component analysis with 2 dimensions for the 30 items common to all children, one of which covered empathy with physicians and the other with the consulting psychologists at 2 years. The validity was good (Cronbach coefficient, 0.91). The answers to overall questions such as "We are satisfied with the care in the network" scored 16.1±0.7/20, with 90 % "totally agree" or "moderately agree" responses. The "The care is perfect" scored 14.6±0.7/20 with 78 % agreeing with the statement. The total score for 30 general questions was 14.6±3.1 (median, 14.9). The total score was lower for infants with anomalies: 13.7±3.3 versus 14.9±2.9 (P<0.01). The answers with a low score (<10) were given by 22 parents (8.2 %). There was no significant relation between the total score or the satisfaction score and neonatal events., Conclusion: A postal survey is helpful to know the views of parents on the follow-up of their infants. This good level of satisfaction seems to stem from the parents feeling they belong to the network, the quality of the relationships with personnel, and the doctors' empathy, as well as the number of contacts between parents and the network coordinator., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)

Background and Objectives: - Follow-up networks for newborns with a handicap risk need to be put into place downstream of the perinatal health networks. Such a network was implemented in the Pays de la Loire region in 2003. Our objective is to evaluate the feasibility and the capacity to detect infants with an incapacitating condition at nine months corrected age and the patents'satisfaction with such a network., Material and Methods: - A common tool based on the Amiel Tison assessment was set up. Infants included since 1(st) March 2003 and who were two years old corrected age on 1(st) September 2006 were taken into consideration. A satisfaction survey was conducted with the parents of infants showing normal development at two years old corrected age or with an abnormal neuromotor examination., Results: - Amongst the 1339 infants included, 1185 (88.4 %) were seen at the age of two years: 7.3 % showed pathological development, 4.5 % infants showed suspect neuromotor examination. Cares were proposed for 11% of the infants followed, permitting cares from nine months old for 65 % of the infants considered as having a pathological development at the age of two years., Discussion/conclusion: - This follow-up network has fulfilled its initial goal: 2.2 % of newborn babies in the region were included, a low rate of lost for follow-up was observed. Moreover, this network has a relative good capacity for detection and early initiation of care. The application of the parents is important and their level of satisfaction appeared to be high. This experiment shows that regional follow-up networks can become reality, but their efficiency still needs to be improved.

Objectives: To report longitudinal assessment of pulmonary function in children with neonatal screening for cystic fibrosis and its relationships with Pseudomonas aeruginosa (PA) chronic infection, nutritional status, sex, age and genotype., Population and Methods: Children benefited systematically of 3 visits a year with pulmonary function tests (PFT) and bacteriological examination. Forty children and 744 PFTs were analysed, with 38 children during at least 4 years., Results: We reported a decrease of pulmonary function tests with chronic PA infection and the genotype DeltaF508/DeltaF508. The decline was gradual and not different between not infected and recently infected children. The PFTs of children infected for a long times were very deteriorate, probably due to the fact that they were infected with multiresistant strains of PA., Conclusion: We think that it is important to survey pulmonary function before 5 years old in these early infected children. We should determinate if the important decrease of PFT in these early infected children is due to infection by PA mucoid.

Objectives: To know nosocomial infections (NI) rates among newborns and hospitalised children according to age and units of hospitalisation,, Methods: In 2001, the Comité technique des infections nosocomiales (CTIN) initiated a one-day prevalence survey on an arranged date. It was conducted by the 5 centres de coordination de lutte contre les infections nosocomiales (C.CLIN). Paediatric data only were analysed dividing them into 2 groups: newborns (NB) up to 28 days old, whether in maternity, neonatology or intensive care units, and children (CH) from 29 days to 18 years old with separate analysis for surgery, cancer units and intermediate care and rehabilitation centres (ICRC)., Results: The survey included 21 596 children under 18 years old: 9136 NB and 12,460 CH, i.e. 7.1% of the total hospital population on that one given day. A total of 2.6% of the patients were infected, with 1.2% of NB and 3.3% of CH. There were 1.09 infections per patient. 456 different microorganisms were responsible for 562 infections, i.e. 81.1%: 18,6% Staphylococcus aureus of which 26.7% were methicillin resistant (MRSA), 21.9% Staphylococcus epidermis, 21.9% enterobacteries, 10.3% Pseudomonas aeruginosa, 4.4% Candida albicans, and 4.2% rotavirus. NB and CH infection factors were studied separately. Selective criteria for hospitalised NB were: gender: male(P < 0.05), level of gravity (P < 0.05), surgery (P < 0.001), catheter (P < 0.01) and hospital type (P < 0.01). For EN, criteria were severity score (P < 0.01), surgery (P < 0.001), catheter (P < 0.01), and hospital type (P < 0.01). The rate for patients hospitalised in cancer units was 13.2% with no significant factors found. The rate of infected patients in intensive care units was 7.8% for NB and 16.2% for CH, with 9.6% neonatal, 30.8% heart condition, 26.3% non-specialised units and 14.2% children units. ICRC infection rate was 4.5% while surgery units had a rate of 1.9% with 2.4% orthopaedic, 0.7% children units, 2.0% non-specialised units and 8.1% neurosurgery., Discussion: The 2001 NI level showed a significant fall from 3.5% in the 1996 survey (all ages) to 2.4%. However, including newborns from private maternity units into the survey may have partly lowered this level. MRSA levels have also dropped from 46% in 1996 to 27% in 2001. It is difficult to compare international data as definitions vary. Furthermore, it should be possible to separate newborns from older children as well as specifying the type of units involved. Infected patients levels are generally lower in the French surveys, no matter the age group or units studied than in other surveys., Conclusion: This survey has enabled the monitoring of the children population in maternity units, on a given day, in France. It showed that the rate of NI in the paediatric population seems low compared to previous data or other countries'data. Efforts need to be made in order to lower it further. Incidence surveillance method is preferable to single out which risk factors can be acted upon. Standardized national protocols are offered to maternity units and should soon be available for newborns units as well as older children units.

Background: Spiruline, a microscopic algae with nutritious quality was put forward as food supplement to fight malnutrition in infant., Population and Methods: To assess its effectiveness, a survey was carried out among children with malnutrition whose Z-score was <2 for their age, in the Koudougou province, Burkina-Faso. Within five centers, three groups were defined at randomization: group 1 with usual nutritional rehabilitation program, group 2 as above + 5 g x d(-1) of spiruline, group 3 as above + spiruline + fish. 182 children, aged three months - three years, were originally involved. Six died (3.3%) and 11 hospitalised were excluded; the study was carried out on 165 children and lasted three months. Judging criteria were: length per aged, weight for length group evolution and the corresponding Z-score at 60 et 90 days., Results: At the inclusion, children were aged 14.6 months on average and weighed 6.7 kg (Z-score of -3.2 weight/age) with a length of 71.4 cm (-2.0 Z-score length/age) and weight for length of 0.093 (-2.5 Z-score). 9.4% had oedema. There were no noticeable differences between the three groups as to weight gain, length gain, weight for length gain., Conclusion: A 5 g x d(-1) spiruline dose does not bring any benefit over 90 days, compared to traditional renutrition. Furthermore, at the moment, it is costly, and the battle against infant malnutrition cannot be based on one single element, such as a wonder drug, but on a national or local policy based on training, education, economical aid, and nutritional rehabilitation centers and infection treatment.

Unlabelled: This study was carried out in Rennes's maternity hospitals (France), to determine the breastfeeding rate for newborns hospitalized after birth, as well as the factors associated with the choice to breastfeed or not in these conditions., Methods: Three hundred and twenty mothers delivered in Rennes Teaching Hospital, whose neonates were transferred in neonatal care unit, were questioned about their choice for neonate feeding., Results: Three hundred and eight of the 320 mothers concerned by the study answered our interview. Fifty one percent of them chose to breast feed, which is near the breastfeeding rate of the general population of Rennes' maternity hospitals (52%). A high sociocultural level, a mother previously breastfed herself, and a previous breast feeding (RR = 5.2; P < 10(-8)) were associated with the choice of breastfeeding. Factors concerning the information of the mothers were also associated with the choice of breastfeeding information during the preparation to birth sessions (RR = 1.7; P < 10(-5)), individual information on the breastfeeding of an ill newborn (RR = 1.5; P < 0.01), and the simple advice to breastfeed given by a health care professional (RR = 2; P < 10(-8)). Of the four qualities named, the more breast-milk qualities a mother knew, the higher breastfeeding rate was (10% for none, 27% for one, 54% for two, and 76% for three or four). Concerning the postnatal factors, gestational age below 31 weeks multiplied breast feeding by 1.5 (P < 0.05), and an early contact mother-child (first day) by 1.3 (P < 0.05)., Conclusion: This study pointed out the populations at risk of no breastfeeding. Informations on the properties of breastfeeding given to mothers by health care professionals may influence them in their choice of breast feeding or not their ill newborn.

Unlabelled: The aetiology of cavitating periventricular leukomalacia (cPVL) involves pre and perinatal factors. Early postnatal dexamethasone has been associated with an increase in cerebral palsy but its role in the development of PVL remains uncertain., Objectives: (1) Reevaluate major factors associated with cPVL, (2) Evaluate the potential effect of early postnatal dexamethasone., Method: This retrospective case-control study (matched for gestational age, birth weight, twin pregnancy and date of birth) compared 50 premature infants with cPVL diagnosed between D7 and D45 from 1995 to 2000 and 50 matched control newborns with normal serial neurosonograms. A data base with 97 selected perinatal variables was used to perform logistic regression analysis in controlling confounding variables, the results are expressed as adjusted Odds Ratio (OR) with 95% confidence interval., Results: The two populations were comparable for gestational age (median: 29.3 weeks, range: 24.4-34.7) and birth-weight (1297 g, 645-2130 g). The annual incidence of cPVL in preterm infants with a gestational age < 33 weeks varied from 1995 to 2000: 1.3%, 4.5%, 13.4%, 2.1%, 3%, 2.9%. Early postnatal dexamethasone was used in 23 of the newborns who developed cPVL (between november 1996 and march 1998). The only antenatal factor associated with cPVL was cardiac decelerations (28% vs 14%, OR = 3.4, 1.1-11.3). The postnatal risk factors were respiratory distress syndrome requiring the use of rescue surfactant (78% vs 38%, OR = 4.2, 1.4-11.9) and early postnatal dexamethasone at the time it was used (78% vs 17%, OR = 17.1, 3.9-73)., Conclusion: The use of rescue surfactant and of early postnatal dexamethasone in preterm infants with respiratory distress syndrome were independently associated with the subsequent occurrence of cPVL. Cardiac deceleration was the only antenatal factor associated with cPVL.

Unlabelled: Neonatal screening for cystic fibrosis was started in Brittany in 1989 but not in the adjacent department of Loire-Atlantique. This study compares the outcome from the children of both populations nine years after the beginning of the screening. Those children were seen in different centers but with the same following guidelines., Population and Methods: All children with cystic fibrosis born between 01/01/89 and 31/12/97 in Brittany and the Loire-Atlantique, excluding the meconium ileus, were compared for their initial characteristics and their outcome after nine years of follow-up., Results: There was no significant difference between both populations for sex ratio, gestational age, birth biometry, percentage of homozygotes delta F508, and mean age of children. Age at diagnosis was lower in Brittany (37 vs 372 days, P < 10(-7)), as was the delay for starting pancreatic supplementation (1.5 vs 14.3 months, P < 10(-7)). Percentage of children hospitalized at least once was higher in Loire-Atlantique (84.4 vs 40.3%, P < 10(-4)). There was no significant difference for colonization with Pseudomonas aeruginosa. Z-scores for weight and height were better in Brittany, as were Shwachman's and Brasfield's scores., Conclusion: The homogeneity of both populations and their follow-up points out that even if the numbers of children are small and the study is retrospective, some benefits of neonatal screening appear, which are already found in other countries where it is partly practiced. This leads us recommend its general use in our populations, which should be associated with the follow-up of the screened children in cystic fibrosis centers to achieve the most of its benefits.

Aim: Evaluation of the progress in the treatment of seriously ill newborn infants under hospital care over the nine-year period from 1986 to 1995 in three departments of the Pays de la Loire region in France., Population and Methods: The category of seriously ill newborn infants included only infants born after at least 32 weeks of gestation and having a Cullen severity score higher than 2. The two groups of seriously ill newborn infants at risk in 1986 and 1995 were first compared to a control group of healthy newborn babies delivered during the same years. The two groups were then compared with each other., Results: In 1986 and 1995, the numbers of births were respectively 32,876 and 29,446, and the numbers of seriously ill newborn infants under hospital care were respectively 307 and 245. However, between 1986 and 1995 the risk factors as well as the causes of morbidity had changed. The average period of hospitalization decreased by five days. The mortality rate dropped from 0.16% to 0.09% (P < 0.05) and the number of serious complications decreased from 0.07% to 0.03% (P < 0.05)., Conclusion: The improvement in the care of seriously ill newborn infants between the two reference periods, 1986 and 1995, may be attributed not only to technical progress but also to a better organization of the perinatal care in our region.

Background: The duration of breast feeding has not yet been thoroughly described in France. A prospective survey has been performed on 150 breast feeding mothers to determine its duration. The objective of this study was to analyse predicting factors of this duration., Methods: A questionnaire including sociological, psychological and medical variables was completed by the mothers and fathers. After discharge, the mothers were contacted every month by a physician until the completion of weaning., Results: The median duration was 10 weeks. By univariate analysis, several variables were associated with a longer duration: decision to breast feed before pregnancy (12 weeks vs 9 weeks; P < 0.01), multiparity (17 weeks vs 12 weeks, P < 0.05), high paternal social level (14 weeks vs 9 weeks, P < 0.001), high maternal education level (12 weeks vs 9 weeks; P < 0.05), mother's idea of "bad" milk (9 weeks vs 30 weeks; P < 10(-6), satisfied mothers (11 weeks vs 2 weeks; P < 0.001), motivation to breast feed (P < 0.05), baby and mother in the same room during the night (13 weeks vs 10 weeks; P < 0.05), and formula supplementation (6 weeks vs 13 weeks; P < 0.01). The mother's return to work was related to a decline in the breast feeding rate at 12 weeks, yet working women generally breast fed the most frequently before returning to work, and many women breast fed and worked concomitantly. A Cox multivariate analysis took into account six significant variables: "bad" milk (lower duration), mother who had been fed, mother satisfied with breast feeding, multiparity, high maternal education, closer proximity of baby to mother (longer duration)., Discussion: The duration in our study is longer than in other studies in France. Predictive factors are sociological, linked to maternal education, and psychological, with antecedent of mother breast feeding and decision before pregnancy. The role of the mother's occupation was not very important because working women are generally at a higher social level. The role of the father was analysed, as well as the role of professional workers, family and breast feeding women's associations., Conclusion: Factors of breast feeding duration can be somewhat modified, but it is necessary to respect the plans of both the mother and the father. However, early assistance in the hospital and after discharge can help parents realize their plans for prolonged breast feeding and helps obviating the cessation of 20% of mothers during the 1st month.