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BACKGROUND: Kangaroo mother care (KMC) is a cornerstone of preterm infant management. The purpose of this study was to estimate the effectiveness of daily prolonged KMC in very preterm infants and its influence on neonatal morbidity and short-term outcomes, and breastfeeding optimization. METHODS: Research included 52 very preterm infants. According to the KMC duration newborns were divided into two groups; Group1 of 22 infants (42.3%) – KMC lasted more than 3 hours/day, Group 2 of 30 infants (57.7%) – KMC lasted less than 3 hours/day. RESULTS: Nosocomial sepsis occurred less frequently in Group 1 versus Group 2 (OR = 10.50; 95% CI 1.23–89.67, p = 0.012). Incidences of BPD, NEC, IVH I–II grades, the duration of parenteral nutrition, and growth parameters have not been different between groups (p > 0.05). Breastfeeding rates at discharge prevailed in Group 1 (OR = 3.70; 95% CI 1.16–11.86, p = 0.025). The most important factors for nosocomial sepsis: combination of parenteral nutrition duration and daily prolonged KMC, as a preventing factor (p = 0.002). Combination of the neonatal intensive care unit (NICU) treatment duration, type of enteral feeding, and mother’s age add as factors that have important influence on breastfeeding prolongation (p = 0.009). CONCLUSION: Nosocomial infection prevention and breastfeeding optimization are profitable outcomes of daily prolonged KMC in very preterm infants. No significant differences in the BPD, NEC, IVH I–II grades incidences, duration of parenteral nutrition, and growth parameters were found between studied groups. Combination of long-lasting KMC and short-term parenteral nutritionis a significant factor for nosocomial sepsis prophylaxis.

Introduction Manual feeding by parents using a syringe, a widespread practice in Sweden since the 1980s, favors parents' involvement in childcare tasks. This approach is used in our neonatal unity since 2007. Objective To study the behavioral changes of preterm children during nasogastric tube feeding: manual milk administration by parents (MAP) versus electric syringe administration (ESA) over a 30-minute period. Method This is a randomized, crossover study conducted in the neonatology unit of Toulouse. Preterm children under 33 weeks of age and over 7 days of life were included. A video recording was performed to assess the children's behavioral response, using the Dsilna score. The reviewer was blinded. Results 15 preterm children with a median gestational age of 30.1 weeks and a median birth weight of 1.210 g were included from March to October 2012. The facility, environment, and state of alertness of children were similar in both groups. Signs of well-being were significantly more prevalent in the MAP group versus the ESA group (36.2 (±8.0) versus 30.7 (±9.5)), (p = 0.04), particularly “hand-to-mouth, mouth gestures, seeking suction and sucking”. Although not significant, motor withdrawal signs were more apparent and fluctuating in the ESA group. Qualitative analysis of NIDCAP observations confirms this data. Conclusion There are behavior changes of preterm children during nasogastric tube feeding. This pilot study showed previously undescribed results: MAP is associated with more common well-being signs and could be more widely used in neonatal units.

International audience; AIM: The families of hospitalised preterm infants risk depression and post-traumatic stress and the preterm infants risk re-hospitalisation. The French neonatal society's aim was to review the literature on how the transition from hospital to home could limit these risks and to produce a position paper.METHODS: A systematic literature review was performed covering 1 January 2000 to 1 January 2018, and multidisciplinary experts examined the scientific evidence.RESULTS: We identified 939 English and French papers and 169 are quoted in the position paper. Most studies stressed the importance of early, personalised and progressive involvement of the family. Healthcare staff and families should assess discharge preparations jointly. This evaluation should assess the capacities of the newborn infant, with regard to its physiological maturity. It should also assess the family's ability to supply the medical, psychological and social assistance required before and after discharge. There should be a structured follow-up process that includes effective communication, various tools, interventions, networks, health and social professionals.CONCLUSION: Discharge preparations may improve the transition from hospital to home and the outcomes for the parents and newborn preterm infant. This early family-centred approach should be structured, coordinated and based on individual needs and circumstances.

Objective To describe the morbidity and mortality and long-term neurodevelopmental outcomes in children born from a Twin-to-Twin Transfusion Syndrome (TTTS) pregnancy treated using laser fetoscopy in Toulouse. Population and method All pregnancies with TTTS treated by laser fetoscopy in our centre were included. Antenatal and postnatal morbidity and neonatal morbidity were identified in the medical records retrospectively. The neurodevelopmental outcome was studied using Ages and Stages Questionnaires (ASQ) sent to the parents, an oral interview with the parents and with the child's doctor (last objective neurological examination, rehabilitation needs, learning disabilities). Results Seventy-one pregnancies, or 144 foetuses, were included from 2008 to 2014, overall survival at 2 years was 72.9% and the survival of at least one child at 2 years was 91.5%, severe neonatal morbidity was 11.2% of the children, severe brain damage accounted for 3.6% of children admitted to the hospital unit. It was possible to study the neurodevelopmental outcome for 58 children (55.3%), with a corrected age from 24 to 95 months. Five children (8.6%) had severe neurological abnormalities and 17 (29.3%) had moderate neurological abnormalities. Discussion The mortality, neonatal morbidity and long-term neurological morbidity of our cohort are higher than those of premature infants (EPIPAGE-2 French cohort), which confirms the severity of this syndrome, and are comparable to those of the TTTS cohorts described in the literature.

Resume L’hospitalisation d’un enfant en neonatalogie peut etre pour les parents une experience traumatisante. Une reflexion sur les besoins des parents dans les unites de neonatalogie est une etape essentielle de la modification des pratiques. Jusqu’a l’âge de 3 mois, l’enfant presente des comportements d’attachement qui ne sont pas diriges vers une figure particuliere mais vers tous les adultes s’occupant de lui. L’attachement specifique se developpe entre 3 et 6 mois aboutissant a une « base de securite » favorisant l’exploration. Du cote de la mere, le bonding est une emotion vecue juste apres la naissance sous l’influence de differents facteurs neurobiologiques, et en particulier favorise par la secretion d’ocytocine, qui la pousse a s’occuper de son bebe. Ces processus d’attachement et de bonding necessitent une proximite physique et une reconnaissance des signaux comportementaux. Une separation mere/enfant en periode neonatale risque donc d’interferer avec ce processus d’attachement et de bonding et d’etre a l’origine d’attachement desorganise. Les besoins des parents en neonatalogie decoulent de cette theorie du developpement : avoir un acces non limite a leur enfant, participer aux soins, etre valorises, vivre dans un environnement securisant, beneficier d’un accompagnement et d’un soutien. La formation des professionnels est essentielle.

Aim There are no specific recommendations for using a mother's fresh milk for her preterm infant. We reviewed the available evidence on its collection, storage and administration. Methods The working group of the French Neonatal Society on fresh human milk use in preterm infants searched the MEDLINE database and Cochrane Library up to June 2017 for papers published in English or French. They specifically analysed 282 papers providing information on prospective, retrospective and clinical studies and examined guidelines from various countries. Results The review concluded that fresh mother's own milk should be favoured in accordance with the latest recommendations. However, it must be carried out under stringent conditions so that the expected benefits are not offset by risks related to different practices. The working group has summarised the best conditions for feeding preterm infants with human milk, balancing high nutritional and immunological quality with adequate virological and bacteriological safety. Professionals must provide parents with the necessary conditions to establish breastfeeding, together with specific and strong support. Conclusion Based on their review, the working group has made specific recommendations for using fresh mother's own milk under careful conditions, so that the expected benefits are not offset by risks related to practices.

International audience; The aim of this article is to establish the extent of knowledge in neonatal palliative care in order to reflect on new professional and research possibilities. We have used literature published between 2005 and 2016 available on electronic databases (Francis, Medline, PsychInfo) in English and/or French. This revealed two main trends: studies focused on professional practice in palliative care and those centered on the parents and their experience. The emphasis in the studies representing the carers’ points of view is on the need for training and the formalization of interventions with the medical professionals. The latter relate to medical aspects of pain management in newborn babies in palliative care and also to communication and relational skills. The subject of burnout in the profession is also raised. In the studies related to the parents, two major aspects are highlighted: their role as parents in the decision of when to end life and their own personal experience. As a result of our analysis of this research at a national and international level, we have exposed material for future research and improvements in professional practice; L’objectif de cet article est d’établir un état des connaissances sur les soins palliatifs en néonatologie afin de réfléchir sur de nouvelles perspectives tant professionnelles que de recherche. Nous avons utilisé la littérature publiée de 2005 à 2016, disponible sur les bases de données électroniques (Francis, Medline, PsychInfo) en langue anglaise et/ou française. Deux pôles importants sont relevés : les études axées sur les pratiques professionnelles en soins palliatifs et celles focalisées sur les parents et leur vécu ; les études portant sur le point de vue des soignants mettent l’accent sur la nécessité d’une formation et la formalisation des interventions auprès des professionnels de santé. Ces dernières portent sur des aspects médicaux de la gestion de la douleur chez le nouveau-né en soins palliatifs mais également sur ses compétences communicatives et relationnelles. Le burnout des professionnels est également mis en avant. Deux aspects principaux sont soulignés dans les études qui portent sur les parents : leur rôle en tant que parents vis-à-vis de la prise de décision quant à la fin de vie, et, leur propre vécu. À la suite de notre analyse sur ces recherches tant nationales qu’internationales, nous avons pu dégager pour de futures recherches et l’amélioration des pratiques professionnelles.

Necrotizing enterocolitis (NEC) is a severe, often fatal gastrointestinal emergency that predominantly affects preterm infants, and there is evidence that neonatal cytomegalovirus (CMV) infection may in some cases contribute to its pathogenesis.This study aimed to evaluate the prevalence of CMV in infants with NEC.Seventy intestinal specimens from 61 infants with NEC, spontaneous intestinal perforation (SIP), or related surgical complications were collected at Karolinska University Hospital and Uppsala University Hospital, Sweden. Ten specimens from autopsied infants without bowel disease served as controls. Samples were analyzed for CMV immediate-early antigen (IEA), CMV late antigen (LA), 5-lipoxigenase (5LO) and CMV-DNA by immunohistochemistry (IHC) and in situ hybridization (ISH), respectively. In 10 index samples, CMV DNA was analyzed with Taqman PCR after laser capture microdissection (LCM) of cells positive for CMV IEA by IHC.CMV IEA was detected by IHC in 57 (81%) and CMV LA in 45 (64%) of 70 intestinal specimens from index cases; 2 (20%) of 10 control specimens were positive for both antigens. 5LO was detected in intestinal tissue section obtained from all examined index and controls. CMV DNA was detected in 4 of 10 samples (40%) after LCM. By ISH, all 13 IHC-IEA-positive samples were positive for CMV DNA; however, 3 of 5 IHC-IEA-negative samples (60%) were also positive.CMV-specific antigens and CMV DNA were highly prevalent in intestinal specimens from infants with NEC, SIP, and related surgical complications. Our findings provide further evidence that neonatal CMV infection contributes to the pathogenesis of these diseases and may affect patient outcome.

International audience; Background: The pathophysiology of necrotizing enterocolitis (NEC) remains poorly understood. Objective: We assessed the relation between feeding strategies, intestinal microbiota composition, and the development of NEC. Design: We performed a prospective nationwide population-based study, EPIPAGE 2 (Etude Epidemiologique sur les Petits Ages Ges-tationnels), including preterm infants born at,32 wk of gestation in France in 2011. From individual characteristics observed during the first week of life, we calculated a propensity score for the risk of NEC (Bell's stage 2 or 3) after day 7 of life. We analyzed the relation between neonatal intensive care unit (NICU) strategies concerning the rate of progression of enteral feeding, the direct-breastfeeding policy, and the onset of NEC using general linear mixed models to account for clustering by the NICU. An ancillary propensitymatched case-control study, EPIFLORE (Etude Epidemiologique de la flore), in 20 of the 64 NICUs, analyzed the intestinal microbiota by culture and 16S ribosomal RNA gene sequencing. Results: Among the 3161 enrolled preterm infants, 106 (3.4%; 95% CI: 2.8%, 4.0%) developed NEC. Individual characteristics were significantly associated with NEC. Slower and intermediate rates of progression of enteral feeding strategies were associated with a higher risk of NEC, with an adjusted OR of 2.3 (95% CI: 1.2, 4.5; P = 0.01) and 2.0 (95% CI: 1.1, 3.5; P = 0.02), respectively. Less favorable and intermediate direct-breastfeeding policies were associated with higher NEC risk as well, with an adjusted OR of 2.5 (95% CI: 1.1, 5.8; P = 0.03) and 2.3 (95% CI: 1.1, 4.8; P = 0.02), respectively. Microbiota analysis performed in 16 cases and 78 controls showed an association between Clostridium neonatale and Staphylococcus aureus with NEC (P = 0.001 and P = 0.002). Conclusions: A slow rate of progression of enteral feeding and a less favorable direct-breastfeeding policy are associated with an increased risk of developing NEC. For a given level of risk assessed by propensity score, colonization by C. neonatale and/or S. aureus is significantly associated with NEC. This trial (EPIFLORE study) was registered at clinicaltrials.gov as NCT01127698.

Jaundice due to unconjugated bilirubin is an everyday condition in the neonatal period because it results from the adaptation of bilirubin metabolism at this time of life. Hyperbilirubinemia has a potential neurotoxicity and although it most often resolves spontaneously, it can lead to acute and sometimes chronic encephalopathy. The latter condition is called kernicterus and induces severe and irreversible neurological sequelae. This rare complication is still reported in all countries throughout the world even if severe hyperbilirubinemia can be prevented and critical points points of failure in jaundice management are identified. Jaundice management are identified, jaundice is the most frequent symptom during the first days of life and after discharge from the maternity ward but also the major cause of readmission in the 15 first days of life. Therefore in the past 20 years, numerous countries have written national practical guidelines for the management of neonatal jaundice using various methodologies. Most of the time, the guidelines resulted from expert consensus more than from an evidence-based argument. The Societe francaise de neonatologie created a working group to provide the first French clinical guidelines for the management of jaundice in the near-term newborn (35 weeks and more). They were written following a physiopathological argument and taking into account both clinical risk factors for severe hyperbilirubinemia and interindividual variability in vulnerability to bilirubin neurotoxicity. Practical tools were also developed to facilitate implementation of the guidelines and are also included.

Resume Introduction Plusieurs etudes internationales ont demontre qu’un clampage tardif (CT) du cordon ombilical chez l’enfant premature permettait de diminuer la morbidite neonatale. Nos objectifs etaient d’evaluer la faisabilite d’un protocole de CT chez les enfants prematures et d’evaluer son impact sur la morbidite neonatale. Patients et methodes Nous avons realise une etude observationnelle prospective chez des prematures nes avant 37 semaines d’amenorrhee entre juin 2012 et juin 2013 et hospitalises a la naissance. Le CT etait realise au moins 30 secondes apres la naissance, autrement il s’agissait d’un clampage precoce (CP). Les criteres d’exclusion etaient : l’asphyxie, un syndrome transfuseur-transfuse, une malformation congenitale ou une allo-immunisation. Plusieurs parametres de morbidite neonatale ont ete analyses. Resultats Cent vingt-trois enfants ont ete inclus parmi lesquels 79 ont beneficie d’un CT et 44 d’un CP, montrant une bonne adhesion a cette nouvelle pratique. Les deux groupes etaient comparables a la naissance. Les enfants ayant eu un CT ont eu un taux d’hemoglobine plus eleve a la naissance (17,9 g/dL versus 16,6 g/dL ; p = 0,005), moins de transfusions (14 % versus 35 % ; p = 0,03) et moins de sepsis tardif (8 % versus 26 % ; p = 0,02). Discussion et conclusion La mise en place du protocole de CT pour les enfants prematures s’est faite sans difficulte majeure. Les avantages du CT ont pu etre mis en evidence sur une cohorte d’observation. Cette pratique est ainsi devenue courante dans notre etablissement.

Resume Introduction En France, le streptocoque du groupe B (SGB) est le germe principal des infections neonatales precoces (INP) a terme. Leur prevention repose sur l’antibiotherapie intra partum (AIP) apres depistage du portage maternel par prelevement vaginal (PV) entre 34 et 38 semaines d’amenorrhee. Objectif et methodes Entre le 31 janvier 2012 et le 17 aout 2012, nous avons compare un depistage rapide du SGB par amplification genique (PCR) en intra partum au depistage habituel chez des parturientes a terme. Resultats Parmi les 1416 dyades mere–enfant incluses, le SGB a ete detecte chez 148 meres (10,6 %) par PV au neuvieme mois et chez 176 (12,5 %) par PCR en intra partum (p = 0,025). Aucune INP certaine et 9 INP probables a SGB ont ete diagnostiquees. La valeur pronostique des 2 tests s’est averee similaire (AUC PCR-SGB intra partum : 0,83 [0,68–0,97] vs PV du 9e mois : 0,67 [0,50–0,84]), (p = 0,057). La valeur predictive negative du test rapide etait superieure (rapport de vraisemblance [RV] negatif : 0,3 [0,1–0,9] vs 0,6 [0,4–1,1]). Apres ajustement, le test rapide offrait une meilleure valeur predictive positive en l’absence d’AIP complete et de facteur de risque d’infection associe (RV positif : 21,3 [15,4–29,5]). Conclusion Le depistage intra partum par PCR a montre une meilleure valeur predictive de l’INP a SGB, surtout en l’absence d’AIP complete et de facteur de risque d’infection surajoute, mais ceci requiert une confirmation par des etudes de grande puissance.

Les unites de neonatologie constituent un environnement hautement technique perturbant le nouveau-ne premature et son developpement cerebral. Un nouveau-ne premature est capable d’interagir avec l’environnement et ses parents. Ces derniers ont du mal a trouver leur place et de se sentir parents. C’est pourquoi les pays scandinaves ont mis en place des soins centres sur l’enfant et sa famille et des soins couples mere–enfant (couplet care), minimisant ainsi la separation. Ces modeles necessitent des amenagements de l’architecture et de l’organisation des unites et de la philosophie des soins delivres.

Une enquete anonyme accessible en ligne a ete diffusee des fevrier 2014 pour evaluer le ressenti des parents apres une hospitalisation en neonatologie. En octobre 2015, plus de 3 300 parents d’enfants hospitalises a la naissance avaient repondu. La premiere participation des parents aux soins donnait lieu a des emotions complexes. Les parents rapportaient souhaiter une participation active dans les soins. Le peau a peau etait decrit comme etant insuffisamment propose. Les equipes de soins peuvent s’appuyer sur ces premiers resultats pour mieux repondre aux attentes parentales.

We sought to establish guidelines for hygiene care in newborns based on a systematic review of the literature and grading of evidence using the Groupe de Reflexion et d'Evaluation de l'Environement des Nouveau-nes (GREEN) methodology. We examined 45 articles and 4 reports from safety agencies. These studies recommend a tub bath (rather than a sponge bath) for full-term infants and a swaddle bath for preterm newborns. They also recommend against daily cleansing of preterm infants. The literature emphasized that hygiene care must consider the clinical state of the newborn, including the level of awareness and behavioral responses. Hospitalized newborns treated with topical agents may also experience high exposure to potentially harmful excipients of interest. Caregivers should therefore be aware of the excipients present in the different products they use. In high-resource countries, the available data do not support the use of protective topical agents for preterm infants. Conclusions: We recommend individualization of hygiene care for newborns. There is increasing concern regarding the safety of excipients in topical agents that are used in neonatology. A multidisciplinary approach should be used to identify an approach that requires lower levels of excipients and alternative excipients.What is known:center dot Hygiene care is one of the most basic and widespread types of care received by healthy and sick newborns worldwide.center dot There is no current guideline on hygiene for preterm or hospitalized term newborn.What is new:center dot The French Group of Reflection and Evaluation of the environment of Newborns (GREEN) provided here guidelines based on the current body of evidence.center dot Caregivers should be aware of the many issues related to hygiene care of newborns including newborns' behavioral responses to hygiene care, exposition to excipients of interest, and the potential risk of protective topical agents in a preterm infant. provided here guidelines based on the current body of evidence.center dot Caregivers should be aware of the many issues related to hygiene care of newborns including newborns' possible behavioral responses to hygiene care, exposition to excipients of interest and the potential risk of protective topical agents in a preterm infant.

NIDCAP is theory-guided, relationship-based and system-oriented. According to Gilkerson & Als, “Changes in the larger system affect the dynamics within the smaller unit”.1 Therefore it appears important to act at a national level to support NIDCAP dissemination.

Cytomegalovirus (CMV) infection acquired from breast milk can cause serious illness in extremely preterm (EPT) infants (28 weeks). Some neonatal centers freeze maternal milk (MM) to prevent CMV transmission; however, this practice is controversial. In this study, we assessed the CMV transmission rate and neonatal outcome in EPT infants after routine freezing of all MM.EPT infants (n = 140) and their mothers were randomized to the intervention group (only freeze-thawed MM) or the control group (combined fresh and freeze-thawed MM). Freeze-thawed MM was frozen at -20°C for ≥3 days before thawing. Mothers had serological tests for CMV, and MM was analyzed for CMV by polymerase chain reaction and CMV culture. Infants underwent CMV screening with urine analysis by CMV-polymerase chain reaction and CMV culture until 12 weeks of age.Congenital CMV infection was detected in 2% of screened infants. The CMV transmission rate in infants fed with CMV-DNA positive milk was 8% (3 of 37) in the intervention group and 6% (2 of 33) in controls. All infants infected by CMV were asymptomatic. The final per-protocol analysis included 56 infants in the intervention group and 65 controls. Neonatal mortality was comparable between the groups (7% vs. 6%). Neonatal morbidity was similar, except for late onset Candida sepsis, which was more frequent in the controls (12% vs. 0%).Routine freezing of all MM did not affect the rate of CMV transmission but may help to prevent fungal sepsis in EPT infants. This observation merits further investigation.

Skin-to-skin contact (SSC) is a cornerstone of neurodevelopment and family-oriented care for preterm infants. The purpose of the present study was to investigate the effectiveness of skin-to-skin contact in preterm babies depending on regularity, duration, and the period of the first contact.This retrospective study involved 26 premature infants with gestational age 24/0-28/6 weeks who were treated in the neonatal intensive care unit and neonatal department. All infants had SSC with their parents.According to the first SSC, newborns were divided into two groups: group 1 (SSC began in the 1st week of life) and group 2 (SSC began after the 1st week of life). Group A (SSC was performed regularly, i.e., everyday) and group B (SSC was irregular, i.r., once every 2 or 3 days) were based on the regularity of SSC. Depending on the duration of SSC, group І (SSC was more than 3h per day) and group II (SSC was less than 3h per day) were formed. Early SSC correlated with lower incidence of secondary infections (OR=6.75; 95% CI 1.06-42.84; P=0.051), bronchopulmonary dysplasia (OR=10.67; 95% CI 1.70-66.72; P0.015), and cholestasis (P=0.022). Regular SSC correlated with lower incidence of secondary infections (OR=15.0; 95% CI 1.50-149.70; P=0.014). Duration of SSC was correlated with lower rates of secondary infections (OR=7.00; 95% CI 1.20-40.83; P=0.043) and better rates of breastfeeding (OR=7.00; 95% CI 1.20-40.83; P=0.043).Early, regular, and prolonged SSC has a positive impact on premature infants' health. In particular, early SSC is associated with a reduced risk of BPD development, cholestasis, and nosocomial infection. Prolonged daily skin-to-skin contact is associated with a lower incidence of nosocomial infection and promotes breastfeeding.

La reanimation et les soins intensifs de neonatologie refletent les grandes avancees technologiques de ce domaine depuis quelques decennies. Cet environnement hautement technique peut etre perturbant pour le nouveau-ne premature (procedure de soins, luminosite, volume sonore). Des donnees de recherche en neurosciences ont montre l’importance de l’environnement dans le developpement d’un cerveau immature. Il existe une rupture entre les attentes sensorielles d’un nouveau-ne et les stimulations atypiques auxquelles il est expose dans son environnement nosocomial postnatal. Un nouveau-ne, meme premature, est capable d’interagir avec l’environnement et ses parents. L’architecture, le materiel de reanimation, les produits utilises, les strategies et l’organisation des soins courants peuvent l’affecter et perturber son developpement. A l’inverse, des amenagements de l’environnement, des strategies adaptees aux capacites sensorielles de l’enfant peuvent favoriser son bien-etre physiologique et comportemental et ainsi favoriser son developpement. Cette nouvelle approche est actuellement de plus en plus integree dans les pratiques cliniques afin d’optimiser l’environnement du nouveau-ne premature.

Cadre de la recherche : Plusieurs études ont montré que le vécu parental lors d’une naissance prématurée peut être de nature traumatique avec un impact sur la qualité de la relation parent-enfant (Lindberg, Axelsson et Ohrling, 2008). Cependant, force est de constater que les processus en jeu chez le père restent relativement inexplorés.Objectifs : L’objectif de cette étude exploratoire est de développer un modèle de compréhension de l’expérience paternelle de nouveau-nés prématurés. Celle-ci est appréhendée par la relation avec le nourrisson (Blomqvist et al., 2012 ; Helth et Jarden, 2013) et l’expérience du devenir père (Zaouche Gaudron et al., 2003 ; Zaouche Gaudron et al., 2005) mais également par la relation avec l’équipe soignante (Fegran et Helseth, 2009). La gravité de la prématurité est également examinée (Ibanez et al., 2006).Méthodologie : L’échantillon se compose de 48 pères de bébés prématurés. Un entretien semi-directif basé sur le Clinical Interview for Parents of High Risk Infants (Meyer et al., 1993) a été adapté et utilisé pour le recueil de données. Les axes réfèrent à la grossesse de la conjointe, à l’accouchement, à la relation avec le nourrisson et au soutien social.Résultats : Nos principaux résultats indiquent que les pères construisent un premier lien avec leur bébé par le contact du peau-à-peau et par l’accordage du regard. Ils témoignent, par ailleurs, d’un vécu traumatique lié à la prématurité décrit par des sentiments ambivalents, comme la peur, le stress mais également le bonheur. La source la plus importante de soutien social, hormis la famille, est l’équipe soignante et les autres parents dans le service.Conclusions : Les principales conclusions permettent d’amener des propositions quant aux pratiques professionnelles afin de soutenir le processus de paternalisation dans ce contexte particulier de prématurité.Contribution : Dans une approche qualitative, cette étude apporte un éclairage concernant l’expérience paternelle dans le contexte particulier qu'est la prématurité du nouveau-né., Research Framework : Several studies have shown that the parents’ experience in the advent of preterm birth can be of a traumatic nature and have an impact on the quality of the parent-child relationship (Lindberg, Axelsson and Ohrling, 2008). However, we must take note of the fact that the processes at play among fathers remain mostly unknown.Objectives : This exploratory study aims to develop a model for understanding the fathers’ experience of preterm infants. This experience is appreciated through the father’s relationship with the infant (Blomqvist et. al., 2012, Helth and Jarden, 2013) and experience of becoming a father (Zaouche Gaudron et. al., 2003 ; Zaouche Gaudron et. al., 2005) but also through the father’s relationship with the medical team (Fegran and Helseth, 2009). The extent of the child’s prematurity is also considered (Ibanez et. al., 2006). Methodology : The sample includes 48 fathers of preterm infants. We developed and used a semi-directive interview based on the Clinical interview for Parents of High Risk Infants (Meyer et. al., 1993) to collect the data. The focus is on the partner’s pregnancy, labour and delivery, the relationship with the infant and social support. Results : Our main results indicate that the fathers build an initial bond with their infant through skin-to-skin contact and eye contact. They also reflect the traumatic experience that is connected to preterm birth, with ambivalent feelings such as fear, stress, but also happiness. The main source of social support, besides the family, is the healthcare team, and the other parents in the department. Conclusions : The main conclusions allow us to make proposals concerning professional practices aimed at supporting the paternalization process in the particular context of preterm birth.Contribution : Within a qualitative perspective, this study sheds light on the father’s experience in the specific context that is the birth of a preterm infant.

International audience; AimSince 2005, the French Food Safety Agency has recommended that very preterm or low-birthweight babies should be fed with pasteurised, expressed breastmilk, and feeding policies on this vary widely in French neonatal units. We investigated the differences between using a mother's expressed milk, in fresh or pasteurised forms, for very preterm infants.MethodsThis observational multicentre study analysed data on 926 very preterm infants: 636 from neonatal units who used the mother's own fresh milk and 290 who used the mother's milk after pasteurisation. We analysed necrotising enterocolitis, bronchopulmonary dysplasia, in-hospital mortality, late-onset sepsis, weight gain, length of hospital stay, the duration of parenteral nutrition and the duration of enteral feeding with a nasogastric tube. Multivariate analyses were conducted to assess the impact of maternal milk policies.ResultsAfter adjustment, there was a reduced risk of bronchopulmonary dysplasia in the fresh milk group with an odds ratio of 0.40 and 95% confidence interval of 0.27–0.67 (p < 0.001). No other statistically significant differences were observed.ConclusionFeeding very preterm infants with their mother's expressed fresh milk was associated with a reduced risk of bronchopulmonary dysplasia, and further investigations are needed to evaluate the clinical impact of this practice.AimSince 2005, the French Food Safety Agency has recommended that very preterm or low-birthweight babies should be fed with pasteurised, expressed breastmilk, and feeding policies on this vary widely in French neonatal units. We investigated the differences between using a mother's expressed milk, in fresh or pasteurised forms, for very preterm infants.MethodsThis observational multicentre study analysed data on 926 very preterm infants: 636 from neonatal units who used the mother's own fresh milk and 290 who used the mother's milk after pasteurisation. We analysed necrotising enterocolitis, bronchopulmonary dysplasia, in-hospital mortality, late-onset sepsis, weight gain, length of hospital stay, the duration of parenteral nutrition and the duration of enteral feeding with a nasogastric tube. Multivariate analyses were conducted to assess the impact of maternal milk policies.ResultsAfter adjustment, there was a reduced risk of bronchopulmonary dysplasia in the fresh milk group with an odds ratio of 0.40 and 95% confidence interval of 0.27–0.67 (p < 0.001). No other statistically significant differences were observed.ConclusionFeeding very preterm infants with their mother's expressed fresh milk was associated with a reduced risk of bronchopulmonary dysplasia, and further investigations are needed to evaluate the clinical impact of this practice.

International audience; IntroductionDoxapram is used as a third-line treatment for apnea unresponsive to caffeine and continuous positive airway pressure (CPAP) in preterm infants.ObjectivesThe objectives of this study were to compare the effects of dosing adjusted for gender and postmenstrual age (PMA) (GrA) versus infants’ weight alone (GrW) on doxapram plasma levels, clinical efficacy, and side effects.MethodsThis was a randomized, double-blind study, including premature infants for whom optimized caffeine and CPAP therapy for apnea of prematurity had failed. Failure was defined as the persistence of more than one significant apnea per hour over an 8-h period. Plasma levels of doxapram and ketodoxapram were measured with high-performance liquid chromatography (HPLC) 48 h after the onset of treatment. Dosing aimed to maintain the combined doxapram and ketodoxapram plasma level in the therapeutic range of 1.5–4 mg/l. Infants were followed-up for 4 days after the onset of treatment.ResultsA total of 85 infants were included: 46 in GrW (27.7 ± 1.9 weeks’ gestational age [GA]), 39 in GrA (27.9 ± 1.4 weeks’ GA); available plasma levels showed that 25 of 40 in the GrW group and 27 of 37 in the GrA group had levels within the therapeutic range (p = 0.344). Of note, plasma level variance was significantly higher in GrW for doxapram + ketodoxapram (1.87 vs. 0.89; p = 0.028). Clinical efficacy was better in the GrA group, with a reduction from 32 to 3 of 38 (76 %) infants with significant apnea versus 30 to 5 of 45 (56 %) in the GrW group (p < 0.001). No adverse effects were observed during the study.ConclusionsTaking gender and PMA into account for doxapram dosing did not significantly increase the number of infants with a plasma level in the therapeutic range. However, it improved plasma level stability and clinical efficacy without adverse effects.

Les benefices de l’implication des parents aupres de leur enfant hospitalise sont connus depuis le debut du siecle dernier mais les unites de neonatologie n’ont ete ouvertes aux parents que tres progressivement au cours de la deuxieme moitie du XXe siecle, en meme temps qu’etaient developpees les notions de soins de developpement et de soins centres sur la famille. Malgre tout, de nos jours, les pratiques concernant la place faite aux parents dans les unites de neonatologie restent tres variables d’un centre a l’autre et les reticences medicales sont encore nombreuses. Pourtant, les benefices que les parents retirent de leur presence et implication dans les soins de leur bebe hospitalise sont multiples : amelioration du vecu parental de l’hospitalisation, reduction du stress et du risque de depression maternelle, amelioration des interactions parents-enfant, augmentation des taux et des durees d’allaitement maternel, retour plus precoce et plus serein a domicile. Nous developpons, dans cet article, ces differentes strategies et leur impact respectif pour les parents.

La reanimation et les soins intensifs de neonatologie refletent les grandes avancees technologiques de ce domaine depuis quelques decennies. Cet environnement hautement technique peut etre perturbant pour le nouveau-ne premature (procedure de soins, luminosite, volume sonore). Des donnees de recherche en neurosciences ont montre l’importance de l’environnement humain dans le developpement d’un cerveau immature. Elles ont montre les capacites d’un nouveau-ne, meme premature, a interagir avec l’environnement et ses parents. Dans la pratique, un etat des lieux europeen, conduit en 2005, decrit un accueil tres heterogene des parents dans les unites de neonatologie, avec un gradient Nord/Sud. La presence des parents et l’environnement humain sont un axe de recherche de plus en plus etudie et avec des resultats tres prometteurs. L’integration de ces donnees dans les pratiques cliniques reste cependant difficile, mais indispensable pour l’environnement hospitalier en neonatologie en France.

Aim: To determine whether growth, feeding tolerance and infectious events of preterm infants is related to the proportion of intake of mother’s own raw milk (maternal milk) versus pooled pasteurized banked breast milk (donor milk). Methods: This is a prospective observational study of 55 premature infants born less than 32 weeks of gestational age admitted to the neonatal intensive care unit at the Children’s Hospital of Toulouse during two 6-month periods from 2003 to 2005. Enrolled infants were exclusively on enteral feeds with maternal milk ± donor milk. Results: Mean gestational age was 28.6 weeks (SD 1.5) and mean birth weight 1105 grams (SD 282). During the time of exclusively breast milk feeds, weight gain (g/kg/day) was correlated to the proportion of maternal milk consumed (p = 0.0048, r = 0.4). Necrotizing enterocolitis was inversely correlated to the amount of maternal milk. The amount of maternal milk did not impact on infectious events. Conclusion: Mother’s own raw milk improves weight gain compared with donor milk in preterm infants. Lactation strategies should be sought that helps mothers to increase their milk production.

Aim: Water channel AQP2 is the target for vasopressin (AVP) and a major determinant of urinary concentrating capacity. In mature kidneys, prostaglandins counteract the effect of AVP on AQP2 expression at functional sites. We investigated whether disturbances in water homeostasis in infants with patent ductus arteriosus (PDA) treated with prostaglandin inhibitors can be attributed to activation of AQP2. Methods: In 53 infants with symptomatic PDA (gestational age 24-33 weeks), 30 receiving ibuprofen and 23 indomethacin starting at 2-15 days of life, clinical and biochemical data were collected before treatment and after each dose of the drugs. Urinary AQP2 was determined by dot immunoblotting. Results: Urinary AQP2 level and osmolality were decreased in both groups. Urinary osmolality was overall low and correlated inversely with fluid uptake. In ibuprofen group, there was no correlation of AQP2 level with urinary osmolality. Conclusion: There was no AQP2 upregulation in the infants. The low urinary osmolality and dissociation between urinary osmolality and urinary AQP2 level indicate that the fluid retention sometimes observed in PDA infants treated with prostaglandin inhibitors is not caused by increased levels of functional AQP2. Thus, knowledge about the renal physiology of the adult cannot always be transferred to the infant kidney.

We extracted L., the newborn of a diabetic mother, for antenatal diagnostic of myocardial hypertrophy and anomaly of foetal heart rate. Post-natal echocardiography showed severe septal myocardial hypertrophy with latero-basal myocardial akinesia. We did not observe a Doppler gradient through the left ventricular outflow. Selective coronary angiography showed an occlusion of the circumflex artery. Myocardial hypertrophy is a classic complication in newborns of diabetic mothers. The mother's diabetes and neonatal infarction remain an exceptional association. We discuss a different hypothesis to explain coronary occlusion and how myocardial infarction avoided septal obstruction.

Aim: The aim of the study was to determine whether neonatal respiratory distress is related to changes in water and ion transporter expression in lung epithelium. Methods: The study included 32 neonates on mechanical ventilation: 6 patients with normal lung X-rays (control group), eight with respiratory distress syndrome (RDS), eight with transient tachypnea of the newborn (TTN), 10 with abnormal lung X-rays (mixed group). The protein abundance of water channel AQP5, epithelial sodium channel (ENaC; alpha-, beta- and gamma-ENaC) and Na+, K+-ATPase alpha 1 were examined in tracheal aspirates using semiquantitative immunoblotting. Results: beta-ENaC level was significantly lower in RDS group compared with infants with TTN and infants in the control group. AQP5 expression was significantly higher in TTN compared with the infants with RDS and all other infants with abnormal lung X-rays. Conclusion: Neonatal respiratory distress is associated with changes in beta-ENaC and AQP5 expression. The lower beta-ENaC expression may be one of the factors that predispose to the development of RDS. The higher AQP5 expression may provide the possibility for reabsorption of postnatal lung liquid, which contributes to quick recovery of infants with TTN.

Resume L’« evidence » ou la medecine basee sur des preuves (ou evidencebased medecine ) est difficile a appliquer aux extremes prematures car la litterature reste peu abondante et fragmentee. Nous avons releve les protocoles dans quatre centres de niveau 3 francais afin d’evaluer si les recommandations actuelles etaient appliquees et si les pratiques d’un centre a l’autre etaient comparables. Ces quatre centres ont ete evalues sur une periode de 2 ans (2005-2006) sur la prise en charge, la mortalite et la morbidite en cours d’hospitalisation de 399 extremes prematures. Les resultats montrent que les protocoles de soins sont globalement en accord avec la litterature. Des differences de pratique persistent entre les centres, refletant la difficulte d’appliquer les strategies choisies et le manque de consensus actuel. Seule une base de donnees commune nationale permettrait une analyse globale des pratiques, une meilleure comprehension des divergences de prise en charge, ainsi qu’une evaluation du devenir a long terme des extremes prematures. L’harmonisation des pratiques permettrait de conduire des etudes multicentriques avec moins de biais lies aux divergences des pratiques.

In Sweden preterm infants born32 gestational weeks are fed maternal breastmilk or, if not available, donor breastmilk. Nutritional and immunological composition of human milk is affected by processing and storage procedures. Additionally, freezing of breastmilk may reduce cytomegalovirus transmission. The present recommendations for human milk use in Sweden are outdated. However, new guidelines to standardize routines are underway. This study was designed to document current routines pertaining to breastmilk use for preterm infants in Sweden.A questionnaire regarding breastmilk handling and routines was sent to all 36 neonatal units in Sweden in November 2006 and February 2007.Of the 36 participating neonatal units 27 had their own milk bank. Milk donors were screened for human immunodeficiency virus, human T-lymphotropic virus, and hepatitis B and C viruses by 27, 14, and 22 of the milk banks, respectively. Bacterial culture was performed on donor milk in 24 milk banks. Donor milk was pasteurized in 22 milk banks. In 11 of the 36 neonatal units maternal milk was frozen to reduce the risk of cytomegalovirus transmission. No neonatal unit performed bacterial culture or pasteurization of maternal milk. Breast milk was kept frozen for a maximum of 3-6 months before use. Nutritional analysis of donor and/or maternal milk was performed in 25 units. All neonatal units enriched donor milk and maternal milk.Routines for breastmilk handling differ among the 36 neonatal units in Sweden. New guidelines can standardize the handling of human milk, thereby improving nutrition and minimizing the risk of breastmilk-induced infection in the preterm infant.

Resume Introduction Les parents des nouveau-nes hospitalises sont soumis a une situation stressante. Il leur est difficile de s’impliquer dans les soins apportes a leur enfant. Leur ressenti apres une hospitalisation n’a jamais ete explore a grande echelle. Objectif Analyser le ressenti des parents concernant leur participation aux soins. Methodes Une enquete anonyme accessible en ligne a ete diffusee des fevrier 2014 avec analyse en aout 2014. Les 222 items etaient a choix multiples ou sous forme de questions ouvertes. L’analyse a ete quantitative et qualitative. Resultats Parmi les 1500 parents ayant repondu, 98 % etaient des meres. Les enfants etaient nes en moyenne a 32 semaines d’amenorrhee avec un poids de naissance moyen de 1600 g. La premiere participation des parents aux soins avait donne lieu a des emotions contradictoires (joie, stress, angoisse). Ils souhaitaient le plus souvent une participation active, meme pour des soins complexes (alimentation par sonde, positionnement de la continuous positive airway pressure [CPAP]…). Le peau a peau avait ete propose apres 7 jours de vie pour 20 % des parents et 10 % des parents ne s’etaient pas sentis en confiance. Le besoin d’intimite et d’un accompagnement securisant a ete mis en avant. Discussion Les parents s’etaient sentis entoures et encourages par l’equipe soignante mais ils souhaitaient souvent une participation plus active. Le peau a peau avait ete apprecie et souhaite, mais il peut etre stressant si les conditions optimales ne sont pas reunies.

INTRODUCTION:Feeding strategies are critical for healthy growth in preterm infants. Bile salt-stimulated lipase (BSSL), present in human milk, is important for fat digestion and absorption but is inactivated during pasteurization and absent in formula. This study evaluated if recombinant human BSSL (rhBSSL) improves growth in preterm infants when added to formula or pasteurized breast milk. PATIENTS AND METHODS:LAIF (Lipase Added to Infant Feeding) was a randomized, double-blind, placebo-controlled phase 3 study in infants born before 32 weeks of gestation. The primary efficacy variable was growth velocity (g/kg/day) during 4 weeks intervention. Follow-up visits were at 3 and 12 months. The study was performed at 54 centers in 10 European countries. RESULTS:In total 415 patients were randomized (rhBSSL n = 207, placebo n = 208), 410 patients were analyzed (rhBSSL n = 206, placebo n = 204) and 365 patients were followed until 12 months. Overall, there was no significantly improved growth velocity during rhBSSL treatment compared to placebo (16.77 vs. 16.56 g/kg/day, estimated difference 0.21 g/kg/day, 95% CI [-0.40; 0.83]), nor were secondary endpoints met. However, in a predefined subgroup, small for gestational age infants, there was a significant effect on growth in favor of rhBSSL during treatment. The incidence of adverse events was higher in the rhBSSL group during treatment. CONCLUSIONS:Although this study did not meet its primary endpoint, except in a subgroup of infants small for gestational age, and there was an imbalance in short-term safety, these data provide insights in nutrition, growth and development in preterm infants. TRIAL REGISTRATION:ClinicalTrials.gov NCT01413581.

Previously, we found that emergence of the X4 viral phenotype in HIV-1-infected children was related to the presence of X4 in their mothers (C.H. Casper et al., J Infect Dis 2002; 186:914-921). Here, we investigated the origin of the X4 phenotype in the child, analyzing two mother-child pairs (Ma-Ca, Mb-Cb) where the mothers carried X4 and their children developed X4 after an initial presence of R5. We used nested polymerase chain reaction of the env V3 region to generate 203 HIV-1 clones for sequencing (Ma, n = 44; Ca, n = 73; Mb, n = 61; Cb, n = 25) from DNA of peripheral blood mononuclear cell (PBMC) lysates, altogether 167 clones, or from cDNA of plasma RNA, 36 clones. PBMC and plasma isolate sequences from each time point enabled us to assign the probable phenotype to clone sequences in a phylogenetic tree. The transmission and evolution were reconstructed using the maximum likelihood method. In mother-child pair Ma-Ca, one maternal R5 isolate clustered with the child's R5 sequences, at the earliest time when R5 was isolated in the child, confirming this as a likely source of the transmitted R5 phenotype. At age 3, an X4 population was present in the child that had evolved from the child's own R5-associated population, clearly distinct from the maternal X4 sequences. The second mother-child pair (Mb-Cb) displayed a similar pattern. Amino acid substitution patterns corroborated the conclusions from the phylogenetic tree. Thus, in both children, the X4 virus developed from their own R5 population, and was not caused by transmission of X4.

Resume Le traitement pharmacologique de reference des apnees du premature fait appel aux methylxanthines (cafeine et theophylline). L'utilisation du doxapram en deuxieme intention est controversee du fait de la marge therapeutique etroite et des effets indesirables. Objectif. – Connaitre l'importance de l'utilisation du doxapram et ses modalites dans les unites de neonatalogie francaises. Methodes. – Etude nationale transversale, portant sur 236 services hospitaliers de niveau III, IIb et IIa auxquels a ete adresse un questionnaire. Les questionnaires ont ete analyses apres une duree de quatre mois. Resultats. – Cent cinquante-neuf chefs d'unite ont repondu (67,4 %), 102 unites etaient utilisatrices de doxapram (64,1 %). Le doxapram etait avant tout utilise en deuxieme intention dans le traitement des apnees du premature resistant aux methylxanthines (102/159 unites, 64,1 %). L'administration initiale se faisait essentiellement par voie parenterale (91/102 unites, 89,2 %). Les unites non utilisatrices estimaient que les effets indesirables etaient trop nombreux ou ne connaissaient pas le produit. Le monitorage des concentrations plasmatiques du doxapram etait peu realise (11/102 unites, 10,8 %), bien qu'un interet certain pour cette surveillance se degage des reponses. Conclusion. – Le doxapram est frequemment utilise en France dans le traitement des apnees du premature resistant aux methylxanthines. Les effets indesirables en cours de traitement ne semblent pas etre un obstacle a son emploi, mais les effets indesirables a moyen et long terme demandent a etre mieux evalues par une etude multicentrique, en double insu et randomisee, menee sur le modele de l'etude « Caffeine for Apnoea of Prematurity » (CAP) pour la cafeine. La France pourrait parfaitement se preter a ce type d'etude.

Cet article est une introduction a ce numero special sur les parents en neonatologie. La presence des parents n’est pas autorisee24 heures/24 de facon uniforme, ce qui est le cas plus souvent en Europe du Nord que dans le Sud, la France occupant une position intermediaire avec 50% d’unites en acces libre par les parents. Divers methodes et programmes sont passes en revue ici pour augmenter l’implication des parents dans les soins de leur enfant en neonatologie.

Coreceptor use was determined for human immunodeficiency virus type 1 (HIV-1) isolates of various subtypes from 11 women during pregnancy and their infected children. Isolates from peripheral blood mononuclear cells (n=79) and from plasma (n=59) were available. The clinical and immunological stages of HIV-1 infection were recorded. Coreceptor use was tested on human cell lines expressing CD4 and different chemokine receptors. The R5 virus predominated, and only 9 isolates from 2 mothers used CXC chemokine receptor 4. All children carried the R5 virus at the time of diagnosis of HIV-1 infection. In 2 children of mothers carrying the X4 virus, the virus switched from R5 to X4 or to R5X4 by age 18 months (child no. 9) and age 48 months (child no. 10), whereas no children followed up to a similar age whose mothers were carrying the R5 virus experienced such a switch (P=.048). This points to a link between the presence of X4 virus in the mother and the emergence of X4 virus in her child.

Recombination is an efficient mechanism of HIV-1 to generate genetic variability. Some of the recombinant forms of HIV-1 that have been described are of epidemic importance, and they are referred to as circulating recombinant forms (CRFs). In this study, we characterized four HIV-1 isolates from Cameroon that had previously been classified as subtype J in the protease gene and as subtype A in the env C2-V5 region. Analyses of the nearly complete genomes revealed that two of the samples (95CM-1816 and 96CM-4496) had the same recombinant structure as CRF11-cpx. The two remaining samples (96CM-1849 and 96CM-4164) constituted a new recombinant virus variant with genomic regions identified as subtypes A, G, J, and CRF01-AE. This mosaic virus structure was found in two individuals who had no direct epidemiological relationship, and may thus represent a new CRF. The fragments that were classified as subtype J in the new recombinant form were more related to subtype J regions of the CRF11-cpx sequences than to the reference strains of subtype J. The complex structures of CRF11-cpx and our new recombinant form, which are both the result of at least four recombination events, exemplify the coming difficulties in characterizing the internal relationships and origins of future recombinant HIV-1 strains. The new recombinant structure has been designated CRF13-cpx in the Los Alamos HIV Sequence Database.

The acquired immunodeficiency syndrome (AIDS), which is caused by the human immunodeficiency virus (HIV), was first described in the United States of America in 1981 [1]. The worldwide spread of HIV has soon been recognized and AIDS has become one of the most alarming infectious diseases of our days. Its impact has been tremendous, high morbidity and mortality has caused a reversal of socioeconomic gains previously recorded in several developing countries, especially those in Sub-Saharan Africa [2]. Epidemiological data about the HIV and AIDS pandemic are updated by the Joint United Nation Programme on HIV/AIDS, UNAIDS (http://www.unaids.org). Their latest report from December 2000 states that in year 2000 approximately 5.3 million people have become newly infected with HIV, of which 2.2 were women and 600 000 children younger than 15 years of age. The estimated number of people living with HIV/AIDS globally is 36.1 million, of which 16.4 million are women and 1.4 million are children younger than 15 year...