Les soins périnatals sont extrêmement variables d'un pays d'Europe à l'autre, tant dans leurs acteurs (présence ou non de sages-femmes, rôle des médecins généralistes…) que dans leur organisation (surveillance de la grossesse, diagnostic prénatal, accouchement, suivi du nouveau-né), l'ensemble étant influencé par le système de santé, la politique sociale et le niveau de vie du pays. Cette diversité des acteurs, des modes de surveillance, des résultats rend les comparaisons difficiles. Deux éléments se dégagent dans les dernières années : une volonté d'améliorer le recueil d'information et une tendance à la régionalisation des soins [4].

La mortalité néonatale est un des contingents majeurs de la mortalité infantile dans les pays en développement. Cette étude a été menée pour identifier les déterminants de la mortalité néonatale précoce dans le service de néonatalogie de la maternité Issaka-Gazobi de Niamey.Il s'agit d'une étude rétrospective, descriptive et analytique cas–témoin incluant 283 cas et 283 témoins. Nous avons exploité les dossiers des nouveau-nés du 1er janvier au 31 décembre 2013.Au cours de la période d'étude, 5331 nouveau-nés ont été admis dans le service dont 457 décès soit un taux de mortalité néonatale hospitalière de 85,72 %. Nous avons recensé 337 cas de décès néonatal précoce soit un taux de mortalité néonatale précoce hospitalière de 63,21 %. Les principales causes de décès sont l'infection, le faible poids de naissance et l'asphyxie périnatale. Nous avons recensé 46 % de décès dans les premières 24 heures. Les nouveau-nés issus de mère ménagère présentaient 3,43 fois de risque de mourir (p = 0,0000, OR = 3,43, IC [2,88 ; 4,64]). Le bas niveau d'instruction de la mère est lié à un risque relatif de 2,25 (p = 0,005, IC [1,38 ; 3,68]). Les mères qui ont fait 4 CPN et plus ont 3,72 fois moins de risque de voir leur enfant décéder (p = 0,0000 ; IC [2,41 ; 5,74]). Les nouveau-nés de faible poids de naissance semblent être 6,18 fois plus exposés au risque de décès néonatal précoce (p = 0,000, OR = 6,18 ; IC [4,12 ; 9,33]). Le risque de décès est multiplié par 16,19 si le score d'Apgar ne dépasse pas les 7 points à 5 mn. Une altération de la conscience à l'admission multiplie par plus de 100 le risque de décès néonatal précoce (p = 0,000 ; OR = 100,32 ; IC [31,79 ; 501,49]. Le risque de décès était 10 fois plus important en cas de détresse respiratoire (p = 0,0000 ; OR = 10,24 avec IC [6,72 ; 15,67]).Le taux de mortalité néonatale précoce est très élevé dans notre service. Il est important : de faire un bon suivi des grossesses, d'assister les accouchements par de personnel qualifié, de prévenir et bien prendre en charge les petits de naissance et les cas d'infection néonatale précoce.Neonatal mortality is a major contingent of infant mortality in developing countries. This study was conducted to identify the determinants of early neonatal mortality in the neonatal department of Issaka-Gazoby's maternity of Niamey.Retrospective, descriptive case–control study, including 283 cases and 283 controls. We used the records of infants from 1 January to 31 December 2013.During the study period, 5331 infants were admitted to the service. We recorded 457 deaths. Neonatal mortality rate is 85.72%. We identified 337 cases of early neonatal death giving early neonatal mortality rate of 63.21%. The main causes of death are infection, low birth weight and asphyxia. We identified 46% of deaths in the first 24 hours. Newborns from housewife mother had 3.43 times risk of death (P = 0.0000, OR = 3.43, CI [2.88; 4.64]). The low level of maternal education is associated with a relative risk of 2.25 (P = 0.005, CI [1.38; 3.68]). Mothers who were 4 antenatal visits and over have 3.72 times less likely to see their child die (P = 0.0000, CI [2.41; 5.74]). Newborns of low birth weight appear to be 6.18 times more at risk of early neonatal death (P = 0.000, OR = 6.18, CI [4.12; 9.33]). The risk of death is multiplied by 16.19 if the Apgar score does not exceed 7 points in the fifth minute. Impairment of consciousness at admission multiplies by more than 100 risk of early neonatal death (P = 0.000; OR = 100.32, CI [31.79, 501.49]. The risk of death was 10 times important in case of respiratory distress (P = 0.0000; OR = 10.24 with CI [6.72, 15.67]).The rate of early neonatal mortality is very high in our service. It is important: to do a good monitoring of pregnancies, attending births by trained personnel, to prevent and properly manage cases of low birth weight and early neonatal infection.

BACKGROUND:Reports of short- and medium-term evolution of Lung Function Tests (LFT) in infants with bronchopulmonary dysplasia (BPD) are still scarce. POPULATION AND METHODS:The results of the first (before 3 months of corrected age) and the second (between 3 and 9 months of corrected age) LFT in 22 premature infants with BPD (gestational age 31 +/- 2.5 weeks; birth weight: 1570 +/- 440 g; duration of mechanical ventilation: 46 +/- 24 days, total duration of oxygen therapy: 88 +/- 47 days) were compared to those obtained in 27 normal infants for the first LEF and 10 normal infants for the second LFT, similar to the patients for birth weight and corporeal index (CI). RESULTS:In the first LFT, major abnormalities were an increased thoracic gaz volume (TGV) (16.5 +/- 42 vs 122 +/- 24 mL; P < 0.001) and TGV CI ratio (1.25 +/- 0.31 vs 0.89 +/- 0.17 ml/kg/m2; P < 0.0001) a decreased pulmonary compliance (2.49 +/- 1.46 vs 11.60 +/- 4.50 mL/cmH2O; P < 0.0001) and specific pulmonary compliance (0.015 +/- 0.10 vs 0.100 +/- 0.042 mL/cmH2O/mL de TGV; P < 0.0001), an increased total pulmonary resistance (20.4 +/- 12.1 vs 10.5 +/- 5.3 cmH2O/L/s; P < 0.001). In the second LFT, an increased TGV (235 +/- 62 vs 166 +/- 28 mL; P < 0.01) and TGV CI ratio (1.64 +/- 0.65 vs 0.98 +/- 0.11 ml/kg/m2; P < 0.05), a decreased pulmonary compliance (2.68 +/- 2.0 vs 15.2 +/- 5.7 mL/cmH2O; P < 0.0001) and specific pulmonary compliance (0.013 +/- 0.010 vs 0.106 +/- 0.050 mL/cmH2O/mL de TGV; P < 0.0001), an increased total pulmonary resistance (17.1 +/- 9.6 vs 8.6 +/- 4.9 cmH2O/L/s; P < 0.05) were noted when compared with the control group results. Major abnormalities of the blood gases were hypoxemia (63 +/- 10 vs 85 +/- 20 mmHg; P < 0.05), hypercapnia (38.5 vs 31 +/- 4 mmHg; P < 0.0001) during the first LFT. Hypoxemia (77 +/- 14 vs 90 +/- 14 mmHg and hypercapnia (37 +/- 4 vs 29 +/- 5 mmHg) continued in the second LFT. Thoracic distention and total pulmonary resistances in infants with BPD did not improve but their pulmonary compliance (P < 0.0001) and PaO2 (P < 0.01) between the first and second LFT did it. Infants who had been ventilated for a hyaline membrane disease (HMD) were more hypoxic on the second LFT (P < 0.05) than those who had been ventilated for other causes. Statistically significant relationships were found between thoracic distention and duration of positive inspiratory pressure (P < 0.05; r = 0.43), duration of positive expiratory pressure (P < 0.05, r = 0.45) total oxygen therapy duration; between total pulmonary resistance and duration of mechanical ventilation with high frequency (P < 0.05; r = 0.52); between hypoxemia and duration of oxygen therapy with FiO2 > or = 60% (P < 0.05; r = 0.54). CONCLUSIONS:This study shows prolonged clinical and functional abnormalities of the respiratory functions requiring longer follow-up.

L'evolution des explorations fonctionnelles respiratoires (EFR) chez des enfants atteints d'une dysplasie bronchopulmonaire (DBP) a court (avant 3 mois d'âge corrige) et a moyen terme (entre 3 et 9 mois d'âge corrige) est encore imparfaitement connue. Population et methodes. - Les resultats des EFR chez 22 prematures atteints de DBP (âge gestationnel = 31 ± 2,5 semaines d'amenorrhee ; poids de naissance = 1570 ± 440 g ; duree de ventilation artificielle = 46 ± 24 jours ; duree totale d'oxygenation = 88 ± 47 jours) ont ete compares a ceux obtenus chez 27 bebes temoins pour la premiere EFR et dix bebes temoins pour la deuxieme EFR. Il n'y avait pas de difference significative au niveau du poids et de l'indice de corpulence (IC) entre les patients et les enfants temoins. Resultats. - A la premiere EFR, les principales anomalies constatees par rapport au groupe de controle etaient une augmentation du volume gazeux thoracique (VGT) (165 ± 42 vs 122 ± 24 mL ; p < 0,001) et du rapport VGT/IC (1,25 ± 0,31 vs 0,89 ± 0,17 mL/kg/m 2 ; p < 0,0001), une baisse de la compliance pulmonaire (2,49 ± 1,46 vs 11,6 ± 4,50 mL/cmH 2 O ; p < 0,0001) et de la compliance pulmonaire specifique (0,015 ± 0,010 vs 0,100 ± 0,042 mL/cmH 2 O/mL de VGT ; p < 0,0001), une augmentation des resistances pulmonaires totales (20,4 ± 12,1 vs 10,5 ± 5,3 cmH 2 O/L/s ; p < 0,001). A la deuxieme EFR, une augmentation du VGT (235 ± 62 vs 166 ± 28 mL ; p < 0,01) et du rapport VGT/IC (1,64 ± 0,65 vs 0,98 ± 0,11 mL/kg/m 2 ; p < 0,05), une baisse de la compliance pulmonaire (2,68 ± 2,0 vs 15,1 ± 5,7 mL/cmH 2 O ; p < 0,001) et de la compliance pulmonaire specifique (0,013 ± 0,010 vs 1,106 ± 0,050 mL/cmH 2 O/mL de VGT ; p < 0,0001), une augmentation des resistances pulmonaires totales (17,1 ± 9,6 vs 8,6 ± 4,9 cmH 2 O/L/s ; p < 0,05) ont ete trouvees par rapport au groupe controle. Les principales anomalies au niveau des gaz du sang etaient une hypoxie (63 ± 10 vs 85 ± 20 mmHg ; p < 0,0001) et une hypercapnie (38,5 vs 31 ± 4 mmHg ; p < 0,0001) a la premiere EFR. A la deuxieme EFR, l'hypoxie (77 ± 14 vs 90 ± 14 mmHg ; p < 0,05) et l'hypercapnie (37 ± 4 vs 29 ± 5 mmHg ; p < 0,0001) persistaient. Chez les enfants atteints de DBP, la distension thoracique et les resistances pulmonaires totales ne s'amelioraient pas d'une EFR a l'autre, alors qu'une amelioration au niveau de la compliance pulmonaire (p < 0,0001) et de la PaO 2 (p < 0,01) etait notee. Les enfants qui ont ete ventiles pour une maladie des membranes hyalines (MMH) etaient plus hypoxiques a la deuxieme EFR que ceux qui ont ete ventiles pour d'autres pathologies (p < 0,05). Il existait des relations statistiquement significatives entre la distension thoracique et la duree de l'agression barometrique par pression positive inspiratoire (p < 0,05 ; r = 0,43), par pression positive expiratoire (p < 0,05 ; r = 0,45), la duree d'oxygenotherapie (p < 0,05 ; r = 0,55) ; entre les resistances pulmonaires totales et la duree d'une ventilation artificielle a frequence elevee (p < 0,05 ; r = 0,52) ; entre l'hypoxemie et la duree de l'oxygenotherapie a FiO 2 ≥ 60 % (p < 0,05 ; r = 0,54). Conclusion. - Dans cette population de 22 prematures atteints de DBP, il existe encore des troubles respiratoires vers l'âge de 9 mois d'âge conge, associes a des perturbations prolongees des EFR.

Our knowledge on relationships between nutrition, immunity and infection has much progressed. Malnutrition affects all three defence mechanisms: unspecific immunity, cellular immunity and humoral immunity. Any kind of nutriment is concerned: nitrogen-caloric nutriments, trace elements, vitamins. Restoration and maintenance of a good nutritional status have become imperative in order to stop the vicious cercle of malnutrition-infection in infants and children.

Background - Reports of short- and medium-term evolution of Lung Function rests (LFT) in infants with bronchopulmonary dysplasia (BPD) are still scarce.Population and methods. - The results of the first (before 3 months of corrected age) and the second (between 3 and 9 months of corrected age) LFT in 22 premature infants with BPD (gestational age: 31 +/- 2.5 weeks; birth weight: 1570 +/- 440 g; duration of mechanical ventilation: 46 +/- 24 days; total duration of oxygen therapy: 88 +/- 47 days) were compared to those obtained in 27 normal infants for the first LFT and 10 normal infants for the second LFT, similar to the patients for birth weight and corporeal index (CI).Results. - In the first LFT, major abnormalities were on increased thoracic gaz volume (TGV) (165 +/- 42 vs 122 +/- 24 mL; P < 0.001) and TGV CI ratio (1.25 +/- 0.31 vs 0.89 +/- 0.17 mL/kg/m(2); P < 0.0001) a decreased pulmonary compliance (2.49 +/- 1.46 vs 11.60 +/- 4.50 mL/cmH(2)O; P < 0.0001) and specific pulmonary compliance (0015 +/- 0.10 vs 0.100 +/- 0.042 mL/cmH(2)O/mL, de TGV; P < 0.0001), an increased total pulmonary resistance (20.4 +/- 12.1 vs 10.5 +/- 5.3 cmH(2)O/L/s; P < 0.001). In the second LFT, an increased TGV (235 +/- 62 vs 166 +/- 28 mL P < 0.01) and TGV CI ratio (1.64 +/- 0.65 vs 0.98 +/- 0.11 mL/kg/m(2); P < 0.05), a decreased pulmonary compliance (2.68 +/- 2.0 vs 15.2 +/- 5.7 mL/cmH(2)O; P < 0.0001) and specific pulmonary compliance (0.013 +/- 0.010 vs 0.106 +/- 0.050 mL/cmH(2)O/mL de TGV; P < 0.0001), an increased total pulmonary resistance (17.1 +/- 9.6 vs 8.6 +/- 4.9 cmH(2)O/L/s; P < 0.05) were noted when compared with the control group results. Major abnormalities of the blood gases were hypoxemia (63 +/- 10 vs 85 +/- 20 mmHg; P < 0.05), hypercapnia (38.5 vs 31 +/- 4 mmHg; P < 0.0001) during the first LFT. Hypoxemia (77 +/- 14 vs 90 +/- 14 mmHg) and hgpercapnia (37 +/- 4 vs 29 +/- 5 mmHg) continued in the second LFT. Thoracic distention and total pulmonary resistances in infants with BPD did not improve but their pulmonary compliance (P < 0.0001) and PaO2 (P < 0.01) between the first and second LFT did it. Infants who had been ventilated for a hyaline membrane disease (HMD) were more hypoxic on the second LFT (P < 0.05) than those who had been ventilated for other causes. Statistically significant relationships were found between thoracic distention and duration of positive inspiratory pressure (P < 0.05; r = 0.43), duration of positive expiratory pressure (P < 0.05; r = 0.45), total oxygen therapy duration; between total pulmonary resistance and duration of mechanical ventilation with high frequency (P < 0.05; r = 0.52); between hypoxemi0a and duration of oxygen therapy with FiO(2) greater than or equal to 60% (P < 0.05; r = 0.54).Conclusions. - This study shows prolonged clinical and functional abnormalities of the respiratory functions requiring longer follow-up.

Our knowledge on relationships between nutrition, immunity and infection has much progressed. Malnutrition affects all three defence mechanisms: unspecific immunity, cellular immunity and humoral immunity. Any kind of nutriment is concerned: nitrogen-caloric nutriments, trace elements, vitamins. Restoration and maintenance of a good nutritional status have become imperative in order to stop the vicious cercle of malnutrition-infection in infants and children.

La confirmation d'une infection néonatale nécessite la mise en évidence du germe responsable à partir de différents prélèvements. À cet égard, la réalisation en routine d'une ponction lombaire (PL) soulève certains problèmes.

Background. - Definitive diagnosis of a neonatal infection usually requires recovery of an etiologic agent from body fluids or tissues such as spinal fluid blood and urine. Routine lumbar puncture (LP) may raise some problems in interpreting results.Population and methods. - A retrospective analysis of 1331 samples of CSF was made. LP had been performed on 1041 neonates including 569 prematures (54.6%) as a part of the evaluation for suspected bacterial infection.Results. - In 50.7% of the cases, the CSF was haemorrhagic. The frequency of traumatic taps increased with the degree of prematurity,: low birth weight, precocity of LP, association with respiratory distress and disorders of coagulating factors. In addition, haemorragic taps modified biochemical and cytologic characteristics of CSF. One hundred and six (8%) CSF samples contained organisms but the diagnosis of meningitis was certain in only 23 cases (2.2%). In the other 83 cases, CSF was thought to be contaminated, mostly by coagulase-negative staphylococci. Since both blood and CSF cultures were positive for the same bacterial organism in 18 cases, it was concluded that the LP had been useful in identifying the pathogens in only five cases. The high frequency of contaminated CSF led to overestimation of the incidence of true bacterial meningitis (0.57% in our study).Conclusions. - The low incidence of meningitis in neonates, the risk of having an haemorragic tap associated with the possibility of clinical aggravation during LP and the fact that the same pathogen is frequently (78.2% of cases) identified in blood cultures suggest that the immediate and routine LP is of less value than expected in infants suspected to be infected. LP could be postponed when the neonate presents with a respiratory distress syndrome and/or a precarious haemodynamic state.

Several cardiologic pathologies are seen in infants of diabetic mothers (IDMs). Though asymmetrical septal hypertrophy (ASH) is a frequent pathology in IDMs, it is not routinely searched for with an echocardiographic scan. We have performed an echocardiographic examination for all IDMs (56 neonates) hospitalized between January 1987 and December 1992 in our neonatology and neonatal reanimation units. Of 56 patients, the diagnosis of 17 cases of ASH 930%) was made. The group with ASH (17 neonates) had a greater corporeal index than the group without ASH (39 neonates) (p < 0.05). Four of the 17 IDMs (24%) with ASH and one of the 39 IDMs (3%) without ASH presented with a cardiac insufficiency (p < 0.05). ASH is a pathology which should be searched for routinely IDMs.

The case of an infant admitted for evaluation of severe emaciation with intermittent ocular anomalies including strabismus and nystagmus is reported. This case demonstrates the value of magnetic resonance imaging and transfontanellar ultrasonography for the diagnosis of diencephalic syndrome of infancy. The prognosis of this condition is usually grim, in particular because of the severe emaciation which is disproportionate with the tumour spread. Pathophysiologic hypotheses put forward to explain this cachexia are reviewed. Although cytokines such as TNF alpha are currently incriminated in the pathophysiology of cachexia induced by a number of conditions, they have not yet been studied in diencephalic syndrome of infancy. TNF alpha is a potent lipolytic agent. Excessive production of TNF alpha may be involved in the genesis of the emaciation characteristic of diencephalic syndrome. Inappropriate production of TNF alpha may respond to the administration of specific anti-TNF monoclonal antibodies. This approach may be considered as a means for treating emaciation in patients with diencephalic syndrome of infancy.

Some infants are cared with a home monitoring system during their first year of life. An international clinical consensus has been obtained and has proposed this technique mainly for infants who have presented an apparent life threatening event or for ex-premature with bradycardia or apnea, rather than for siblings of sudden infant death syndrome or other infants. In any case, this monitoring must be held after a complete clinical evaluation of the infant and after a real education of the parents about the use of the device. Many types of devices are used. The most efficient is the cardio-respiratory monitoring. Some of them include a processor and record the alarms. The need to see or to call the medical team to decode them allows close collaboration between the family and the clinical team. Knowledge of the alarms and the circumstances in which they have occurred help the medical team to propose the withdrawal of the home monitoring. Thus, sometimes preventive, sometimes prophylactic, this device will provide us for an optimal help.

In few infants, home monitoring is useful to prevent recurrent apparently life-threatening events. Some devices have an alarm record system. We report our experience of home monitoring with such a device in 22 infants. 43.3% of the recorded events were considered as false alarms and 56.7% as true alarms. Among the alarms relative to abnormal respiratory events (38%), more than half occurred after two min of very low impedance thoracic signal. Among the true alarms relative to cardiac abnormalities (18.7%) more than half occurred during high amplitude fluctuations of the thoracic impedance signal and were relative to obstructive apnea or hypertonic vagal reactivity. Three infants presented an apparent life threatening event during an alarm, and two of them were hospitalized. These results indicate that it is important to define precisely the significance of the alarms during the survey of home monitoring of infants at risk for sudden infant death.