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Resume Objectifs La delivrance d’oxygene sous enceinte « Hood » : (EH) de type PDG Systeme ® , 15 bis, rue de l’Ancienne, 28380 Saint-Remy-sur-Avre, est pratiquee dans 17 salles de naissance sur 40 maternites du Nord-Pas-de-Calais. Le debit est delivre en fonction de la saturation d’oxygene desiree pour le nouveau-ne. Il est d’usage d’utiliser un debit de gaz a 6 L/min mais le debit minimum necessaire pour le balayage des gaz expires sous le EH n’est pas connu avec precision. Materiel et methodes La mesure du CO 2 dans deux EH de taille differente (4 et 10 L) selon deux protocoles differents. Protocole 1 : le debit de gaz (air et oxygene) est fixe a 6 L/min, la fraction inspiree en oxygene varie de 21 a 100 %. Protocole 2 : la ventilation est realisee avec de l’oxygene pur avec un debit croissant de 0,5 a 7 L/min. Resultats Le taux de CO 2 etait negligeable quand le debit de gaz dans l’EH depassait 6 L/min. La FiO 2 obtenue dans l’EH etait correlee a la FiO 2 delivree quand le debit de gaz etait superieur a 6 L/min. Le taux de CO 2 augmentait des que le debit de gaz etait inferieur a 6 L/min. Conclusion Il existe un risque de reinhalation de CO 2 quand le debit de gaz dans une EH est inferieur a 6 L/min.

Congenital diaphragmatic hernia (CDH) is a 1 out of 3500 live-born malformation with persistent 30-40% mortality rate, related to severe pulmonary hypoplasia and hypertension. Better knowledge on the mechanisms inducing failure of adaptation at birth is a prerequisite for improving CDH prognosis. CDH is also associated with longterm morbidity, including prolonged respiratory failure, failure to growth, oral aversion, and scoliosis. Early prevention starting as soon as the first hours of life are required to reduced long term morbidity. The aims of the management are not only to reduce early mortality, related to persistent pulmonary hypertension, but also to prevent late morbidity.

Malgre les progres de la reanimation, la mortalite neonatale des enfants porteurs de HCD reste elevee, proche de 30–40 %, essentiellement du fait de l’hypoplasie pulmonaire et d’une hypertension arterielle pulmonaire. Les principales sequelles observees sont respiratoires (HTAP chronique, dysplasie bronchopulmonaire, susceptibilite aux infections virales), digestives (reflux gastro-oesophagien, trouble de l’oralite), nutritionnelles (denutrition d’origine multifactorielle: RGO, trouble de l’oralite, insuffisance respiratoire) et orthopediques (scoliose). La prise en charge actuelle de ces complications est tardive: elle necessite une intervention plus precoce, qui doit debuter des la periode neonatale. Les objectifs de la prise en charge medicale seront: 1) d’assurer une oxygenation tissulaire et la decarboxylation tout en minimisant le baro-volotraumatisme du poumon; 2) d’assurer une fonction circulatoire adequate en limitant les consequences de l’HTAP; 3) de prevenir la morbidite respiratoire et digestive. Elle necessite imperativement un suivi et une prise en charge multidisciplinaire specialisee, du fait de l’intrication de ces differentes complications.

The aims of this work were to assess timing of complementary feeding in infants and to precise the underlying factors that may cause inappropriate complementary feeding.A cohort of 167 newborns, born in the same maternity ward during a 6 week-period, was prospectively analyzed. Only healthy neonates were included in the study. A phone questionnaire was filled at 4 and 6 months of age to evaluate modality of complementary feeding. Multivariate analysis (segmentation tree, analyse by multiple correspondence) was used to study factors associated with inappropriate diversification.Out of the 167 neonates included in the study, 132 mothers could be contacted at 4 months and 116 at 6 months of age. Sixty-seven per cent of mothers started breast feeding at birth. Among these, 33% still breastfed -at least partially- at 4 months and 17% at 6 months. Fifty-two percent of mothers started complementary feeding before 4 months, and 24% of infants received gluten at 4 months of age. Multi-gravida mothers, mothers aged more than 35 years old and mothers who gave infant or follow-up formulae before 4 months, started complementary feeding significantly earlier (P0.05). Infants who were formula fed received more frequently complementary feeding before the age of 4 months than breast fed infants (57% vs 33%, P0.05).Our study showed that half of infants were introduced solid food too early and allowed to identify a population at risk that could benefit from nutritional intervention programs.