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Myomatous erythrocytosis syndrome (MES) is a rare gynaecological condition associated with the presence of a uterine fibroid and isolated polycythaemia. The main characteristic of MES is that haemoglobin returns to a normal level after removal of the myoma. MES is poorly known and still not fully understood. This case report describes the history of a patient with MES with surprising erythrocytosis resolution after myomectomy., Learning Points: A case of myomatous erythrocytosis syndrome with a normal erythropoietin level is described, adding to the scarce literature; the mediator responsible for the erythrocytosis is not yet known.This is a rare presentation of a common condition: erythrocytosis and uterine fibroids are frequent in the general population but are only anecdotally correlated.Delayed diagnosis led to unnecessary aggressive treatment with the aim of reducing the haematocrit level to below 45%., Competing Interests: Conflicts of Interests: The Authors declare that there are no competing interests., (© EFIM 2023.)

Background: In Europe, meningococcal (Men) vaccines are available against 5 of the 6 serogroups responsible of nearly all cases of invasive meningococcal disease (IMD). Meningococcal vaccination has been introduced in the national immunization programs (NIPs) for children and adolescents of numerous European countries, but with no consistent strategy across countries., Objectives: To describe IMD epidemiology, NIPs, and vaccination coverage rates (VCRs) in children and adolescents in 8 Western European countries., Methods: Epidemiological data (from 1999 to 2019), NIPs regarding meningococcal vaccination status, and VCRs were collected from the European Centre for Disease Prevention and Control (ECDC) and/or national websites., Results: MenB was the most common serogroup. In Belgium, Spain, France, the Netherlands, the United Kingdom (UK), and Portugal, incidence was greater for MenW than MenC. In 2019, MenB risk was covered in 2 countries (Italy, UK). MenC risk was covered in all countries, via MenC only (countries: N  = 3), MenACWY only ( N  = 2), or MenC (infants/children) and MenACWY (adolescents) ( N  = 3) vaccination. VCRs were higher in children than adolescents., Conclusion: Our study confirmed the diversity of NIPs, including in neighboring European countries with similar factors like economic resources and epidemiological risk, thus indicating that other factors underlie NIPs. Convergence toward a more common immunization program including MenACWY and MenB vaccination would promote equity and safe travel regarding infectious diseases for young people, and possibly improve the understanding of vaccination by patients and healthcare professionals., Competing Interests: GPC participates or has participated in congresses and meetings, and receives or has received honoraria from GSK and Sanofi. MLC participates or has participated in meetings, and receives or has received honoraria from Sanofi. MC participates or has participated in meetings, and receives or has received honoraria from Sanofi. JG participates or has participated in meetings, studies, post-university lectures, congresses (ESPID, ICAAC, SFP), and receives or has received honoraria from AstraZeneca, GSK, Novartis, Pfizer, and Sanofi. HH participates or participated in conferences and meetings, and receives or has received honoraria from GSK, MSD, Pfizer, and Sanofi. JPL participates or has participated in meetings, and receives or has received honoraria from Sanofi. PB participates or has participated in congresses, meetings, and PG training, and receives or has received honoraria from GSK, MSD, and Sanofi. JFP participates or has participated in congresses and meetings, and receives or has received honoraria from GSK and Sanofi. AW participates or has participated in congresses and meetings, and receives or has received honoraria from MSD, GSK, Sanofi, ALK, Novartis, and GNM Healthcare. MAD participates or has participated in congresses and meetings, and receives or has received honoraria from MSD, GSK, Sanofi, and Pfizer. EP participates or has participated in congresses and meetings, and receives or has received honoraria from GSK, MSD, and Sanofi. DP participates or has participated in congresses and meetings, and receives or has received honoraria from Abbot, AstraZeneca, MSD, GSK, and Sanofi., (© 2022 Pinto Cardoso, Lagrée-Chastan, Caseris, Gaudelus, Haas, Leroy, Bakhache, Pujol, Werner, Dommergues, Pauquet and Pinquier.)

Aim: Hospitalised newborn infants may be stressed due to inappropriate sensory stimuli and early separation from their families, that can negatively impact their neurodevelopment. The French Group of Reflection and Evaluation of the Environment of Newborns (GREEN) issues guidelines based on environmental neonatology and family-centred care. The first recommendation focuses on private family rooms versus large shared rooms., Methods: These guidelines are based on a systematic evaluation of the literature providing different grades of evidence. Internal and external reviews by multidisciplinary experts examined the scientific evidence of all recommendations. The literature search was performed for the period January 1, 2000 to January 1, 2016 with the keywords 'single room' or 'private room' and 'neonatal intensive care unit'., Results: A total of 25 studies were retained. Most studies reported a positive impact of private rooms on the health of newborn infants and satisfaction of families. Private rooms could lead to sensory deprivation if there is low parental involvement with limited presence and to reduced interaction among caregivers., Conclusion: We recommend that neonatal units should mostly have private rooms. With this architectural design, we recommend supporting the staff's needs for changes in the organisation and philosophy of care and to provide improved family support., (©2018 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)

Decisions regarding whether to initiate or forgo intensive care for extremely premature infants are often based on gestational age alone. However, other factors also affect the prognosis for these patients and must be taken into account. After a short review of these factors, we present the thoughts and proposals of the Risks and Pregnancy department. The proposals are to limit emergency decisions, to better take into account other factors than gestational age and prenatal predicted fetal weight in assessing the prognosis, to introduce multidisciplinary consultation in the evaluation and proposals that will be discussed with the parents, and to separate prenatal steroid therapy from decision-making regarding whether or not to administer intensive care., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

Extreme prematurity, defined as birth occurring before 27 weeks of gestation in Sweden, is managed according to the latest data of the most recent literature, with monitoring of the results through a continuous perinatal registry. National guidelines were issued in 2013. They highlight the importance of infant developmentally supportive and family-centered care focused on the child and the family, nutritional support, pain management, management of ductus arteriosus, and brain damage. However, there remain areas without national consensus including respiratory support management. The French vision of the Swedish approach highlights the proactive attitude of neonatologists, the coherent and narrow collaboration between neonatologists and obstetricians, and the active presence and involvement of parents in the care of their infants., (Copyright © 2017. Published by Elsevier SAS.)

Background: Considering the remarkable efficacy of the strategies for preventing mother-to-child transmission of HIV infection (PMTCT), failures are rare in high-resource countries and deserve further investigation. Moreover, infants have been found to be at increased risk of viral failure. We analyzed the factors related to the children's environment, including maternal psychological factors that may be associated with viral failure in children diagnosed before the age of 1 year., Patients and Methods: Retrospective study of all HIV-infected infants, born in France between July 2003 and July 2013, diagnosed before the age of 1 year, cared for in a single reference center, comparing the group of children in viral success to the group of children presenting at least one episode of viral failure, using data available in their medical, psychological and social files., Results: Out of 1061 infants included in the prospective PMTCT follow-up, eight infants were found HIV-positive and an additional six cases were referred from other centers before the age of 1 year, for a total of 14 children born to 13 mothers. Seven children presented durable optimal viral control (VL<50 c/mL) whereas seven others did not reach or maintain optimal viral control over time. The main difference between the two groups was the presence among the mothers of children with viral failure of severe psychological disorders, leading to treatment adherence problems in the mothers who were aware of their HIV status before pregnancy, and difficulties in giving their children's treatments correctly., Conclusions: Although seroconversion during pregnancy is responsible for a significant proportion of residual transmission in high-resource countries, severe psychological or psychiatric conditions in HIV-positive mothers play an important role on the risk of both MTC residual transmission and viral failure in their infants., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

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 Société française de néonatologie 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., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Background: The experience of becoming the parent of a sick or premature newborn can be particularly distressing for parents. They often encounter challenges to the development of their parenting roles. Perception of the hospital stay has never been analyzed on a large scale., Objective: To analyze parents' perception of their involvement in the care of their newborn., Methods: An internet-based survey started in France in February 2014 on the basis of a validated questionnaire composed of 222 neonatal care-related items. A quantitative and qualitative analysis was performed on the items dealing with parents' involvement until August 2014., Results: The survey was completed by 1500 parents, 98 % of whom were mothers. The infants had a mean GA of 32 weeks and a mean birth weight of 1600g. Parents rated their first care of their infant with mixed emotions (joy, stress, etc.). Parents were willing to practice new skills through guided participation, even for more complex care. Skin-to-skin care was only proposed after 7 days for 20 % of the parents; 10 % of the parents did not feel secure during this practice. The need for privacy and professional guidance was essential for meaningful skin-to-skin contact., Discussion: Parents' perception of participating actively in their infant's care was positive and they felt guided by the nursing team. Most of them would have been more active with guidance. Skin-to-skin care was appreciated and desired, but could become stressful if the conditions were not optimal., (Copyright © 2016. Published by Elsevier SAS.)

Nosocomial infections are very common in African hospitals, particularly in neonatal units. These infections are most often caused by bacteria such as Escherichia coli, Klebsiella spp and Staphylococcus spp. Salmonella strains are rarely involved in nosocomial infections. Here, we report the first description of S. Grumpensis in neonatal infections in Senegal. Seventeen Salmonella strains were isolated from hospitalized infants' stool samples. The following resistance phenotype was described in strains: AMXRTICRCFR FOXRCFXRCTXRCAZRIMPSATMRNARNORRCIPRTMRGMRTERSXTR. All isolates were susceptible to imipenem, 15 out of 17 produced an extended spectrum ß-lactamase (ESBL). blaOXA-1, blaSHV-1, blaTEM-1, blaCTX-M1 genes were detected in strains 8, 13, 5 and 8, respectively. blaCTX-M1 sequencing revealed the presence of blaCTX-M-109. Thirteen of the 17 Salmonella Grumpensis strains were analyzed by PFGE. These 13 isolates belonged to a single pulsotype and were genotypically identical. This is the first report of neonatal S. Grumpensis infections in Senegal, and the first report of blaCTX-M-109 in the genus Salmonella.

Unlabelled: The aim of this study was to analyze why anti-rotavirus vaccination is rarely used in France, although this infection is frequent and associated with a large number of hospitalizations., Method: A questionnaire was sent to 732 general practitioners and pediatricians in the Bordeaux area., Results: The response rate was 57% (381 GPs and 38 pediatricians). Most of them (71.8%) declared that they received information on the vaccination and more than 80% of them feel that gastroenteritis is a severe disease. However, anti-rotavirus is never prescribed by the majority of them (59.6%) and only 2.6% prescribe it systematically. The reasons are that the patient is not refunded (64.2%), the vaccination timetable is overloaded (53.6%), and there are no recommendations for this vaccination (35.1%). Physicians believe that parents feel gastroenteritis as a benign disease (52.6%) and say that they refuse the vaccination because it is not refunded (77.7%), not mandatory (45.5%), or may have side effects (44.1%). Physicians' prescription of vaccination is correlated to their information on the vaccination and their feeling about the disease's severity. They would modify their practice if the vaccination was recommended and/or refunded., Conclusion: The main obstacles against anti-rotavirus vaccination are the absence of recommendations and refunding. The recent recommendation for the vaccination and a lower price should lead to its generalization in France., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Introduction: In countries with limited health-care resources, achieving the fourth Millennium Development Goal recommended by the WHO requires the reduction of neonatal mortality. Interventions at different levels of the community and the health-care system are needed, including in district hospitals., Method: This was a descriptive study in the neonatal unit of the District Hospital of Bonassama/Douala in Cameroon that analyzed neonatal mortality and morbidity to discover possible intervention levers. The clinical, sociodemographic, and outcome data of hospitalized newborns were recorded from November 2009 to May 2012. The analysis was performed anonymously., Results: During 29 months, 813 infants were hospitalized; 71% were delivered naturally and 16% by cesarean section. Globally, 20% were premature, 55% were male, and 24% had a birth weight of less than 2500 g. At admission, 35% of the infants had hyperthermia and 29% hypothermia. The most common diagnoses were early infection (77%), late infection (22%), jaundice (17%), early adaptation disorders (18%), and hypoxic-ischemic encephalopathy (2.2%). The hospital mortality rate was 8% and the main diagnoses associated with death were: low birth weight, prematurity, hypothermia, and early adaptation disorders with and without encephalopathy. No excess mortality was found for neonates treated for infection., Conclusion: In developing sub-Saharan countries, the main causes of neonatal mortality must be taken care of by hospitals at a peripheral district level. Epidemiological knowledge of neonatal diseases at the peripheral level (district) allows for an estimation of the requirements in terms of competence and equipment. Specific needs for transfer to a superior care unit can be estimated but the high transfer risk and the limited resources of the referral center should be taken into account., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Objectives: To study the epidemiological, clinical, and bacteriological aspects as well as the outcome of neonatal bacterial meningitis and analyze the factors of poor prognosis of this condition., Patients and Methods: We report a retrospective analysis of 44 cases of neonatal bacterial meningitis hospitalized in the pediatric unit of Tahar Sfar Hospital in Mahdia, Tunisia, between January 1996 and December 2010. Inclusion criteria were infants less than 29 days of age who were hospitalized for bacterial meningitis diagnosed on either the presence of bacteria in cerebrospinal fluid or with more than 50 cells/mm(3), predominance of neutrophils, and the protein level greater than 1.2g/l. Clinical data were obtained through the analysis of patient files. Statistical analysis was based on the Chi(2) test, and P-values less than 0.05 were considered statistically significant., Results: The incidence of neonatal bacterial meningitis was 0.49 per 1000 live births. The patients were premature in 20.4 % and low birth weight in 13.6 % of cases. The clinical presentation was not specific for most cases. The main signs at admission were hyperthermia (43.2 %), refusal to nurse (20.4 %), seizures (18.2 %), and respiratory distress (13.6 %). The cerebrospinal fluid culture was positive in 36.4 % of cases. The group B streptococcus was the most frequently isolated (62.5 %) followed by Escherichia coli (12.5 %). The association of cefotaxime-ampicillin-gentamicin was used as the first treatment in all cases. Ofloxacin was associated with initial antibiotic therapy during the first 5 days in 20.4 % of cases. The mortality rate was 15.9 % and the rate of neurological sequelae in survivors was 21.6 %. Prematurity, low birth weight, shock, respiratory distress, and pleocytosis of less than 500 cells/mm(3) were the main factors of a poor prognosis. The addition of ofloxacin to the initial antibiotic therapy was associated with a decreased rate of neurological sequelae in survivors (11 % vs. 25 %, P=0.042)., Conclusion: This study emphasizes the severity of neonatal bacterial meningitis with high rates of mortality and neurological sequelae, especially in premature and low birth weight infants. An early diagnosis and effective antibiotic therapy is needed to improve the prognosis., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Schizophrenic women can now complete a pregnancy successfully, mostly due to psychiatric stabilization obtained with neuroleptic treatment. Side effects of classic neuroleptics are largely described in adults. On the other hand, effects of atypical neuroleptics, which are indicated when there is chronic severe schizophrenia with resistance or major intolerance to classic neuroleptics, are little known in newborn infants. We report the case of a hypertrophic full-term newborn whose mother received clozapine treatment alone with decreasing posology during the course of pregnancy. On his 2nd day of life, this newborn infant presented delayed peristalsis that required hospitalization in the digestive surgery department for more than 2 weeks. We assume that the anti-cholinergic effect of this molecule associated with a substantial plasmatic concentration and a possible increased half-life elimination were involved. Neonatal delayed peristalsis associated with clozapine treatment alone during pregnancy is poorly described in the medical literature. We only found one report on plasmatic concentrations of clozapine and its metabolite in a newborn, published in 1994. Close digestive monitoring is needed in the first days of life after in-utero exposure to clozapine and we believe that the question of a delayed initiation of enteral feeding after meconium elimination and in the absence of abdominal distension is debatable., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Infantile cutaneous hemangioma is a benign vascular tumor and is very frequent in infants. The evolution is mostly favorable with spontaneous regression in 80% of cases. Clinical diagnosis is easy in its triphasic typical form with a phase of sometimes brutal postnatal growth, a phase of stabilization and a phase of slow secondary regression. We report a case of a giant facial hemangioma diagnosed at birth in full-term female newborn getting the right peri-orbital and fronto-temporal region. Initial evolution was marked by a fast increase of the tumor justifying its stake under prednisone at the age of 3 months but without improvement. At the age of 6 months, the patient was hospitalized for infection of the hemangioma with favorable evolution under oxacilline. Following evolution was marked by the total regression of the hemangioma at the age of 5 years at the price of peri-orbital cutaneous scars. We discuss here the diagnostic, therapeutic and evolutionary aspects of this pathology and review of the literature., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Neonatal resuscitation is one of the most cost-effective medical interventions, most often an emergency procedure involving a multidisciplinary team in the delivery room: doctors, nurses, midwives, obstetricians, anesthetists and other theatre staff. The success of resuscitation depends not only on individual competence but also on efficient teamwork between healthcare professionals in the delivery room; failure often results from the weakest link. Initiation of basic resuscitation procedures must be rapid and effective. Simple procedures must therefore be known by a large number of healthcare professionals, in fact all those potentially present at a delivery. Many complex neonatal diseases on the other hand are too infrequent for all to acquire sufficient personal experience. In addition, synchronization between the interventions of the different members in a perinatal team is complex. It is therefore necessary to train both individuals and teams to better manage perinatal crisis situations. The educational approach should remain multimodal, combining teaching of technical and non-techniques skills. Simulation of resuscitation scenarios can mimic emergency situations without any risk to the patient. It can be used for teaching and/or evaluation of the effectiveness of procedures and collaboration between actors. For maximum performance in complex pathologies, multidisciplinary teaching sessions are necessary. Simulation techniques adapted to neonatal resuscitation in the delivery room appear of great educational interest and proof of their efficiency gradually appears in literature., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Introduction: Congenital epulis, known as a congenital gingival granular cell tumor, is a benign tumor and very rare in newborns. Voluminous or multiple tumors can cause mechanical obstruction of the oral cavity and may result in postnatal feeding and respiratory problems., Discussion: We report the clinical case of a female full-term newborn who presented a tumor on the upper gum obtruding into the oral cavity discovered at birth. The pregnancy was followed normally with three prenatal ultrasounds, which did not show abnormalities. The mass was excised under local anesthesia on the second day of life. The outcome was good after surgery and regular feedings were started on the second postoperative day. Histological examination confirmed the diagnosis of gingival tumor with granular cells and absence of signs of malignancy., Conclusion: Prenatal diagnosis is fundamental in the therapeutic approach to this rare lesion but remains difficult because the findings are non specific and the generally late development of the tumor., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)

Acyclovir is a synthetic nucleoside analogue active against herpes viruses. Exposure during human pregnancy and during the neonatal period seems safe. We report a case of early necrotizing enterocolitis in a full term infant treated with acyclovir as a prophylactic therapy. The mother had herpes genitalis with preterm, premature ruture of membranes at 32 weeks of gestational age and was treated with acyclovir until vaginal delivery. Acyclovir treatment in utero and after birth is discussed as a possible cause of necrotizing enterocolitis in the infant. Acyclovir should be used only if its benefit outweighs the potential risk to the baby.

Neonatal osteoarticular infections remain rare, with an estimated incidence of 1 to 3 cases per 1000 admissions to Neonatal Intensive Care Units. It usually results from bacteraemia and may thus be induced by IV catheters. More rarely it is due to direct inoculation secondary to cutaneous damage, or extension of soft tissue infection. The particularity of bone vascularization in the newborn explains the frequency of abscess formation in the periosteum or in soft tissues. The main pathogen involved is S. aureus (3/4 of cases), followed by group B streptococci and enterobacteriacae. Infection consists mainly of localised and slowly progressing abscesses. However, multifocal and severe infection is possible, in particular when caused by an IV catheter. Ultrasonography is the best initial investigation, possibly leading to surgical care. Medical treatment must include 2 synergistic antistaphyloccocal antibiotics, possibly associated with cefotaxime. The outcome is generally favorable, but orthopaedic consequences may emerge if the growth plate is involved. Rare specific causes, such as syphilis or tuberculosis, should also be evoked, but the clinical context is generally helpful for the diagnosis.

Aim: To describe a group of newborns born from mothers with connective tissue diseases, to determine their perinatal characteristics and the neonatal morbidity, and to assess the possible role of drugs received by mothers on the obstetrical and neonatal morbidity., Patients and Methods: During a 34-month period, newborns born from mothers with connective tissue diseases and followed in a single center were prospectively included in the study. In all cases, maternal treatments (i.e. hydroxychloroquine and/or prednisone) were continued during pregnancy., Results: Among the 73 included infants, 18 (25%) were born before 37 weeks of gestation and 3 (4%) were small for gestational age. A neonatal lupus syndrome with facial rash and thrombopenia was observed in 1 case. No neonatal congenital heart block was observed and maternal treatment did not significantly influence the mean PR or QT intervals. Four infants had minor congenital abnormalities and 3 had feto-maternal infection., Conclusion: These data show that perinatal morbidity is lower than that previously published. We postulate that a strict follow-up during pregnancy may have played a significant positive role in these results.

Pseudomonas aeruginosa is a ubiquitous environmental organism usually considered as opportunistic pathogen in immunocompromised subjects. However it can produce disease in healthy children, mainly on moist body sites. Familial, community and nosocomial outbreaks of cutaneous infections have been reported. Ecthyma gangrenosum is possible without bacteremia. P. aeruginosa is also the most common cause of otitis externa in swimmers and osteomyelitis after puncture wound of the foot.

Perinatology is a developing medical field where decisions are particularly difficult and may be harmful in that they deal with the life of an infant and the future of the families. It deals with matters that are at cross boards of several medical specialties belonging to medicine and surgery but also relevant to psychology and ethics. Therefore, a collaborative approach is required. Interprofessional exchanges and a team organization are warranted in order to make handling consistent and allow a fruitful follow up. This holds true for the mother and the newborn throughout the pregnancy, delivery and early life. It seems important to us that the parents face with a couple obstetrician-pediatrician. This couple will be able to help them in building their parenthood and considering their newborn as a full human being and not only a sum of several medical problems.

Antenatal closure of the ductus arteriosus is an uncommon event that has been considered as a risk factor for development of congestive heart failure and persistent pulmonary hypertension of the newborn. We report here on a case of antenatal ductus arteriosus closure due to niflumic acid maternal intoxication at 32 weeks of gestation. Fetal extraction was performed few days later because of echographic signs of congestive heart failure. The child survived after 3 days of severe persistent pulmonary hypertension. This case emphasizes the potential risk of niflumic acid during pregnancy and the need of antenatal echographic monitoring for optimal management.

Unlabelled: A newborn hospitalized in neonatology suffers a lot of painful and fully perceived procedures. However this pain is not enough taken into consideration. There are various reasons for this failure. The objective of our study was to analyze the perception of 3 groups of participants (parents, nurses and doctors) about newborns'pain. We wanted to compare these perceptions with pain scales (EDIN and BBdol scale) and to study their connection with newborn illness severity and mortality risk scores (SNAP and CRIB)., Population and Method: We have led a prospective study involving 80 newborns. Questionnaires assessing, with the help of a visual analogic scale, the pains' perception and the efficiency of the treatment of this pain were given to the 3 groups of participants., Results: Parents assessed that their newborn feels an important pain (median: 5/10), that was not correlated with pain scales. Nurses and doctors assessed a lower level of pain (median: 2/10), greatly correlated with the pain scales. Parents assessed that the treatment of pain was better when the newborn was severely ill. The nurses, and even more the doctors, assessed the opposite effect. The nurses appeared to hold an intermediate position between parents and doctors. Nurses underlined moreover some lack of communication of the doctors about the newborns' pain. This communication problem is a major hindrance to the adequate treatment of pain.

Incidence of chlamydial infection depends on maternal colonization during pregnancy, which is different in each population. The transmission is not obligatory but when present, it occurs at birth through the genital tractus. Chlamydia trachomatis infection is the first cause of neonatal conjunctivitis, with no influence of eye lotion application at birth. C. trachomatis is also responsible for interstitial pneumonia with possible consequences on the lung function. The laboratory diagnosis relies on the identification of intracellular bacteria in patient samples by the mean of culture or PCR. Systemic antibiotherapy by macrolides is always necessary, with local application in the case of conjunctivitis. The key point is the detection of colonization of pregnant women with identified risk factors. In positive case, oral treatment of both parents is recommended.

Unlabelled: Methylxanthines and doxapram have been used to stimulate breathing and to prevent apnea in preterm infants. The use of doxapram is controversial because the therapeutic index seems to be narrow and short-term adverse effects have been described., Objective: To determine the use of doxapram in the French neonatal and intensive care units., Methods: A structured postal questionnaire was sent to all the 236 neonatology and neonatal intensive care units of level IIa, IIb and III in France. The questionnaires were analysed after four months., Results: Answers were obtained from 159 chiefs of department (67.4%), 102 used doxapram (64.1%). Doxapram was mainly used as a second step, if methylxanthines failed to reduce the frequency of apneic spells (102/159 units, 64.1%). Doxapram was usually administered intravenously (91/102 units, 89.2%). Only 57 respondents (35.8%) did not use doxapram, because they were aware of the potential adverse effects or they did not know the drug. Monitoring of drug plasma concentrations was rarely performed (11/102 services, 10.8%). Nevertheless, there was a significant interest in this monitoring., Conclusion: Doxapram is frequently used in France to reduce apnea of prematurity if methylxanthine therapy fails. Further studies are needed to determine safety of doxapram at short and long-term. A multicenter, randomised, double-blinded clinical trial would be interesting to perform, similar to the ongoing caffeine for Apnoea of Prematurity trial (CAP) . The French setting seems appropriate for this kind of study.

We report a retrospective study of nine neonatal observations of antenatal isolated pyelectasis during a period of two years. Pyelectasis associated with other congenital abnormalities and in utero died foetus were excluded. Finding interesting sex, gestational age at diagnosis, echographic aspect, antenatal management and postnatal follow-up were assigned. Foetal kidneys was noted in two cases and an oligoamnios was noted in two other cases. No foetal urinary intervention was assessed. Postnatal exploration revealed a transitional pyelectasis in four cases, an ureteropelvic junction obstruction in four cases and a congenital megauretere in one case. Postnatal renal function was decreased in two cases. Postnatal surgery was assessed in two cases and a spontaneous regression under a sequential treatment occurred in the other three cases. Isolated foetal pyelectasis can have a pathologic significance.This examination permits, in plus, to evaluate the renal prognosis. Antenatal therapeutic implications of interruption of pregnancy or urinary intervention are still not clear and those after birth depend essentially on renal function determined by scintigraphy.

Unlabelled: Monohydrated caffeine was the only respiratory xanthine available in our country to treat apnea of premature infant. The aim of this study was to evaluate plasma levels of this molecule at dosages of 20 mg/kg (equal to 18 mg/kg of caffeine base) as a loading dose and 5 mg(-1) kg(-1) (equal to 4.5 mg(-1) kg(-1) of caffeine base) as a maintenance dose., Patients and Methods: The study was prospective including premature infants less than 34 weeks of gestational age born between the 1st of july 2001 and 15th december 2001 and receiving monohydrated caffeine to prevent apnea. Each premature infant has received orally a loading dose of 20 mg/kg in the first hours of life followed, 24 h after, by a maintenance dose orally once a day of 5 mg/kg until 35 weeks of post-conceptional age. Caffeinemia plasma levels were measured by high performance liquid chromatography immediately before the second dose to determine the loading residual rate and immediately before the sixth dose to determine the maintenance residual rate., Results: Twenty-one premature infants were included. Their medium term was 31.4 weeks (27.4-33.3 weeks), birth weight was 1684 g (1000-2800 g) and sex-ratio M/F was 1.3. Fifteen infants (71.4%) have presented apnea with an average of 4.1 episodes per infant and per day. Tolerance of the medicament was good in all cases. The medium loading residual rate was 3.26 microg/ml (1.75-7.80) and the medium maintenance residual rate was 4.26 microg/ml (2.13-7.64)., Conclusion: Prescribed at a dosage close to twice the recommendations of the literature, monohydrated caffeine does not provide efficient plasma rates. This is probably due to a difference in its oral bio-availability compared with caffeine citrate and further study with greater dosages is needed to appreciate its efficacy.

Inflammation plays a major role in the pathogenesis of bronchopulmonary dysplasia of preterm infants. Having a strong anti-inflammatory effect, corticosteroids have been proposed in the management of this disease. Antenatal steroids protect the newborn against its development. Postnatal systemic administration of steroids reduces the duration of mechanical ventilation and oxygen therapy, but is associated with short term and long term adverse effects. Early administration of dexamethasone (before 7 days of life) reduces the incidence and the severity of chronic lung disease at 28 days of life and 36 weeks of post-conceptional age. Inhaled steroids are associated with less adverse effects than dexamethasone administration, but they are also less effective.

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: Female health professionals are not more likely to contract cytomegalovirus (CMV) infection than the general population., Case Report: Generalized congenital infection was diagnosed in a neonate. His mother was a nurse working the 2 first trimesters of her pregnancy in close-contact with AIDS patients chronically infected with CMV., Conclusion: Preventive measures to avoid CMV transmission among health-care professionals are controversial. The only guideline actually receiving universal agreement consists of standard hospital measures of hygiene.

Caffeine (C) decreases apneic episodes in premature infants and is thought to stimulate breathing mainly by a central mechanism. While the methylxanthines theophylline and aminophylline are known to alter the carotid chemoreceptor activity, there are little data on C. The aim of the study was to examine the effects of C on the carotid sinus nerve discharge (CSND) in developing animals. Nine kittens 17-21 days old and six adult cats that were anesthetized and artificially ventilated were studied. They received four consecutive doses of C, each of 10 mg/kg, administered at intervals of 20 min either as intravenous bolus injection (6 kittens, 3 cats) or continuous infusion (3 kittens, 3 cats). Bolus injections of C invariably induced a prompt but transient increase in the CSND from 4.1 +/- 0.6 to 8.1 +/- 1.0 (SE) impulses/s in kittens (P = 0.01) and form 3.9 +/- 0.1 to 7.9 to 1.0 impulses/s in cats (after the first injection). This response was associated with a significant decrease in arterial blood pressure. Continuous infusion of C did not induce any early change in either CSND or blood pressure in kittens or cats. Fifteen minutes after C injection or infusion was begun, CSND values in air, 8% O2-balance N2, or 100% O2 were not significantly different from control. Haloperidol administered at the end of the experiment in four cats and four kittens significantly increased CSND and did not suppress the early response to C injection. It is concluded that caffeine administered by bolus in the kitten induces a transient stimulation of the CSND that is associated with a decrease in the arterial blood pressure and is independent of the dopaminergic mechanisms in the carotid body. The lack of sustained effect implies the main mechanism to the ventilatory stimulation by C must be central.

Unlabelled: IS INFORMATION A TOOL FOR PREVENTIVE ACTION? The aim of this study was to evaluate maternal beliefs concerning neonatal performances, to compare them with currently accepted knowledge and to analyse parameters that could influence the maternal judgement., Population and Methods: A total of 189 mothers in the postpartum period were prospectively questioned about their beliefs concerning the developmental visual, auditive, olfactive, gustative and sensitive functions of their neonates., Results: Only 57.7% of mothers agreed with the fact that their neonates were able to see. Similarly, there were more than 80% for the olfactive and gustative function and more than 90% for the auditive function and pain discrimination. Multiparity and high level of professional activities improved the mothers' answers about the visual abilities of their neonates. Scientific information through media appeared poorly assimilated., Conclusions: The time spent by the mothers in the maternity home or word could be used to inform them.

Background: Herpes gestationis in the neonate is usually associated with an increased risk of premature birth and/or low birth weight for gestational age (GA) and sometimes skin lesions. Neurologic manifestations are nos described in these babies., Case Report: A boy was born at 35 weeks of GA from a mother who developed skin eruption typical of herpes gestationis. His weight was 2320 g and his height was 46 cm. He had transient respiratory distress syndrome and was given antibiotics due to suspected group B streptococcus infection. He developed on day 3 skin vesiculous eruption which disappeared within 3 days and neurologic manifestations: hypertonia and hyperkinesis, abnormal EEG. The CSF was normal. The manifestations spontaneously disappeared within 5 days. The herpes gestationis factor was present in both mother and infant., Conclusion: A relationship between the maternal herpes gestationis and neonatal neurologic manifestations is possible; there was no other known causes for the transient neurological disease.

Unlabelled: The mortality rate is an indicator of public health related to social, economic and sanitary conditions. In 1990, the early neonatal and infant mortality rates published by the National Institute of Statistics and Economic Studies (INSEE) for Reunion Island were surprisingly lower than those published for continental France, in spite of a less favourable socio-economic status. Therefore, we considered is useful to try to re-establish the true rates by means of a retrospective survey based first on the vitality and maturité criteria of the French Register Office, then on those of the World Health Organisation (WHO)., Population and Methods: Among all the childbirths registered in Reunion Island between January 1st and December 31st 1990, we collected the cases of stillbirths and neonatal deaths that occurred in hospital or at home. The vitality and maturity criteria were defined according to all clinical and para-clinical records available., Results: After an adjustment of the vitality criteria based on the medical files, the use of the French Register Office maturity criteria resulted in the following date: stillbirth rate 8.69% (versus 9.89), early neonatal mortality rate 3.88% (versus 2.65%), and infant mortality rate 8.12% (versus 6.7%). Then, using the WHO maturity criteria, we found the following rates: stillbirth 12.7%, early neonatal mortality 5.1%, perinatal mortality 17.74%, infant mortality 9.34%., Conclusion: The non-observance of vitality criteria leads to a decrease of early neonatal mortality rate, and consequently of infant mortality rate. On the other hand, the WHO maturity criteria are either ignored or debated. Those two facts contribute to the publication of wrong still birth, early neonatal mortality and infant mortality rates. Therefore, the fetal-infant mortality rate seems to be more reliable than the infant mortality rate.

Background: Very few people have no Kell antigens (phenotype Ko). They can develop antibodies to Kell antigens after transfusion, or the abortion of a Kell-positive fetus. This paper describes a case of immunization that may have been due to amniocentesis., Case Report: The eighth pregnancy of a woman required an amniocentesis on the 17th week for chromosomal study because she was 41 years old. She had 4 prior abortions. Her blood group was A Rh+. Her red cells were not tested for rare blood groups and antibodies to blood groups were not screened before and after amniocentesis. The newborn baby developed hemolytic anemia. On her 10th hour of life, her hemoglobin was 10.7 g% and her bilirubinemia 308 mumol/l. Her blood group was A Rh+. Indirect Coomb's test was positive in the mother, and the baby was given 3 exchange transfusions of O+, Ccee, K- blood. Further studies showed that the mother had phenotype Ko (A+, Ccce, K-, k-, Kpa-, Kpb-, Jsa-, Jsb-). The baby's phenotype was K-, k+, Kpa-, Kpb-, Jsa-, Jsb+. The mother was found to have a high titer of Ku antibodies., Conclusion: This mother belongs to one of the 3 families known in the Reunion Island to have phenotype Ko. She had never been given transfusions, and prior abortions are unlikely to have played a role since no hemolysis was seen in further newborns. While amniocentesis is probably a major factor, its role cannot be determined because no pre-amniocentesis samples were analysed immunologically.