Many international studies have demonstrated that delayed umbilical cord clamping reduces neonatal morbidity. However, in France, delayed umbilical cord clamping is still not performed in many neonatal units. The aims of this study were to evaluate the feasibility of developing a protocol of delayed umbilical cord clamping in the maternity ward of the Toulouse university hospital and to evaluate the impact of this new protocol on neonatal mortality.We conducted a prospective observational study including 123 preterm infants born before 37 weeks of gestation between June 2012 and June 2013 and hospitalized at birth. Delayed cord clamping was performed for at least 30s after birth; otherwise, it was evaluated as early cord clamping. We excluded twin-to-twin transfusion syndrome, congenital abnormalities, alloimmunization, and perinatal asphyxia. We analyzed the reasons why delayed umbilical cord clamping was not performed and then neonatal morbidity in our population.Delayed umbilical cord clamping was performed on 79 infants and 44 infants had early umbilical cord clamping. The two groups had similar baseline characteristics. Preterm infants in the delayed cord-clamping group had a higher level of hemoglobin during the first 24h of life (17.9g/dL versus 16.6g/dL, P=0.005), fewer of them required transfusion (14% versus 35%, P=0.03), and fewer presented late-onset sepsis (8% versus 26%, P=0.02) or bronchopulmonary dysplasia (9% versus 26%, P=0.03). There was no statistically significant increase of hyperbilirubinemia requiring phototherapy.Implanting a new protocol of delayed umbilical cord clamping in our maternity ward proved to be possible without difficulty. The advantages of delayed umbilical cord clamping were observed in this prospective study. Today, delayed cord clamping has become a common practice in our maternity unit.

Introduction and objectives. Many international studies have demonstrated that delayed umbilical cord clamping reduces neonatal morbidity. However, in France, delayed umbilical cord clamping is still not performed in many neonatal units. The aims of this study were to evaluate the feasibility of developing a protocol of delayed umbilical cord clamping in the maternity ward of the Toulouse university hospital and to evaluate the impact of this new protocol on neonatal mortality.Methods. We conducted a prospective observational study including 123 preterm infants born before 37 weeks of gestation between June 2012 and June 2013 and hospitalized at birth. Delayed cord clamping was performed for at least 30s after birth; otherwise, it was evaluated as early cord clamping. We excluded twin-to-twin transfusion syndrome, congenital abnormalities, alloimmunization, and perinatal asphyxia. We analyzed the reasons why delayed umbilical cord clamping was not performed and then neonatal morbidity in our population.Results. Delayed umbilical cord clamping was performed on 79 infants and 44 infants had early umbilical cord clamping. The two groups had similar baseline characteristics. Preterm infants in the delayed cord-clamping group had a higher level of hemoglobin during the first 24 h of life (17.9 g/dL versus 16.6 g/dL, P = 0.005), fewer of them required transfusion (14% versus 35%, P = 0.03), and fewer presented late-onset sepsis (8% versus 26%, P = 0.02) or bronchopulmonary dysplasia (9% versus 26%, P = 0.03). There was no statistically significant increase of hyperbilirubinemia requiring phototherapy.Discussion and conclusion. Implanting a new protocol of delayed umbilical cord clamping in our maternity ward proved to be possible without difficulty. The advantages of delayed umbilical cord clamping were observed in this prospective study. Today, delayed cord clamping has become a common practice in our maternity unit. (C) 2016 Elsevier Masson SAS. All rights reserved.

The aim of this study was to determine the incidence of congenital toxoplasmosis (CT) and to assess the performances of prenatal and neonatal diagnoses. From 1994-2005, in Toulouse University Hospital, France, amniocentesis was performed on 352 pregnant women who were infected during pregnancy. All women were treated with spiramycin and pyrimethamine-sulfadoxine when prenatal diagnosis was positive. Among the 275 foetuses with follow-up, 66 (24%) were infected. The transmission rates of Toxoplasma gondii were 7%, 24% and 59% in the first, second and third trimesters, respectively. The sensitivity and specificity of PCR on amniotic fluid (AF) were 91% and 99.5%, respectively. One case was diagnosed by mouse inoculation with AF and six cases were diagnosed by neonatal or postnatal screening. The sensitivity and specificity of PCR on placentas were 52% and 99%, respectively. The sensitivity of tests for the detection of specific IgA and IgM in cord blood was 53% and 64%, respectively, and specificity values were 91% and 92%. In conclusion, PCR performed on AF had the highest levels of sensitivity and specificity for the diagnosis of CT. This permits an early diagnosis of most cases and should be recommended.

Suite a l’exposition chronique tout au long de la grossesse a la clomipramine prise par la mere a raison de 25 mg/j, le nouveau-ne manifeste a sa naissance un syndrome d’inadaptation neonatale avec hypotonie et hypoventilation sans aucune consequence grave. Au bout de 33 jours d’allaitement, la mere poursuivant son traitement, aucune trace de clomipramine ni de son metabolite n’a ete detectee dans le sang du nouveau-ne par une technique chromatographique liquide sensible et specifique. Par contre, il a ete retrouve dans le lait maternel une concentration de clomipramine de 55,1 μg/L. L’allaitement peut etre poursuivi et une surveillance clinique du couple mere-nourrisson est fortement conseillee.

BACKGROUND:Reference values of numerous micronutrients at different gestational ages (GA) have not been yet reported based on large series. AIMS:This study aimed to establish the reference range for zinc, copper, selenium, vitamin A, vitamin E, retinol binding protein, transthyretin, albumin, transferrin and ceruloplasmin in neonates and to give the profiles according to gestational age. STUDY DESIGN:A total of 510 infants appropriate for gestational age were included in the study. The determinations were done using the serum cord blood of 262 term and 248 preterm infants (gestational age of 37 to 42 and 26 to 36 weeks, respectively). RESULTS:All nutrients correlated significantly with birth weight and gestational age but different patterns were highlighted. Vitamin A, retinol binding protein and prealbumin showed a triphasic pattern with a cut-off at about 36 to 39 weeks. In this period, these parameters rised significantly (P<0.001). Albumin and selenium showed a biphasic pattern with a significant positive correlation (P<0.001) between weeks 26 to 38. Transferrin and ceruloplasmin associated with copper showed a continuous increase with GA (P<0.001). On the opposite, zinc and vitamin E decreased. Zinc showed a biphasic pattern with a significant negative correlation (P<0.001) between the 26th to 34th weeks. Vitamin E presented a triphasic pattern with a cut-off at about 32 to 35 weeks (P<0.001). CONCLUSION:The large number of data allow the build-up of reference ranges and charts for the evaluation of micronutrients and proteins in high-risk neonates.

Le passage des substances dans le lait maternel dépend de caractéristiques comme la liaison aux protéines plasmatiques, l'ionisation, le degré de lipophilie et le poids moléculaire…. Ces paramètres varient pour chaque médicament et les études manquent pour un nombre important de spécialités, en particulier quand leur commercialisation est récente. Ainsi, la mention « ne pas utiliser chez la femme allaitante » signifie plutôt l'absence totale d'investigations pharmacocinétiques sur l'excrétion dans le lait que l'existence d'observations cliniques. Nous présentons un résumé des données disponibles concernant des médicaments d'utilisation courante et quelques règles simples pour aider les professionnels de santé confrontés à la prescription de médicaments chez la femme allaitant son enfant.

BACKGROUND:We wished to determine the incidence of nosocomial infections in the mother and the newborn during the early postpartum period.MATERIAL AND METHODS:Over a three-month period, the same investigator collected 50 different clinical and microbiological, standardized data related to infectious diseases in parturients and their newborns.RESULTS:Data were collected on 804 deliveries. The overall rate of nosocomial infection was 2.9% (23/804). For vaginal deliveries, the rate was 1.9% (12/615) and for deliveries by Cesarean section, the rate was 5.8% (11/189). Of 745 newborns followed until discharge from hospital, 0.7% (5/745) had a nosocomial infection.CONCLUSION:These results are in line with previously published rates of nosocomial infections, which varied between 0.2% to 2.3% for vaginal deliveries, 1.6% to 18.9% for Cesarean section, and 0.2 to 4% in newborns. Regular surveys of the incidence or the prevalence of nosocomial infections are necessary to monitor the effectiveness of educational programs, aimed to reduce hospital acquired infections.

Management of neonates with congenital diaphragmatic hernia (CDH) has undergone many changes associated with increased survival of high-risk CDH. However, little is known about the long-term outcome of CDH infants.Follow-up was performed in 85 newborn infants with CDH admitted in our neonatal intensive care unit between January 1991 and December 1998. Early (< 2 months) and late mortality (≥ 2 months), and respiratory, nutritional, musculoskeletal, and neurosensory outcome at 2 years were recorded.Surgical repair was performed in 59 infants (69%) at a median postnatal age of 124 (range, 38 to 246) hours. Extracorporeal membrane oxygenation was used in 26 (30%) newborn infants. Survival at 2 years was 51 of 85 (60%) (early death, 28/85 [33%]; late death, 6/85 [7%]). Late deaths occurred because of persistent pulmonary hypertension or iatrogenic complications. Twelve of 51 (24%) newborn infants were oxygen dependant at the postnatal age of 28 days, and 1 of 51 (1.9%) was still oxygen dependant at 2 years. Growth failure was noted in 9 of 51 (18%), mainly related to severe gastro-esophageal reflux and oral aversion. Scoliosis was diagnosed in 2 infants. Neurologic examination at 2 years was normal in 45 of 51 (88%). Cerebral palsy and developmental delay were observed in 2 and 4 infants, respectively. Four infants (8%) experienced associated problems. Respiratory, nutritional, and musculoskeletal morbidity was higher in infants treated by extracorporeal membrane oxygenation (p < 0.05).CDH infants are at risk for adverse nutritional and respiratory outcome. Despite severe respiratory failure at birth, prolonged oxygen therapy above 2 years of age is uncommon. Conversely, failure to thrive related at least in part to gastroesophageal reflux and oral dysfunction remains the major problem at 2 years of age. However, both nutritional and respiratory problems tend to improve with age.

Chickenpox is rare during pregnancy (1 to 7 per 10,000). The infection can be severe for the mother and indirectly may affect the fetus. Before 20 weeks of amenorrhea, the varicella-zoster virus may be responsible for a rare embryofetopathy (incidence rate: 0.4 to 2%). After the 20th week of amenorrhea, fetal infection is not symptomatic, but it may lead to neonatal or infantile herpes zoster infection. During the perinatal period, a primary maternal infection may be responsible for severe neonatal varicella if delivery occurs prior to maternal antibody production. Practical guidelines are proposed according to the date of infection during pregnancy and prenatal diagnosis using amniocentesis and/or cordocentesis is discussed.

A Berrebi, C Assouline, JM Ayoubi, O Parant, J Icart Chickenpox is rare during pregnancy (1 to 7 per 10,000). The infection can be severe for the mother and indirectly may affect the fetus. Before 20 weeks of amenorrhea, the varicella-zoster virus may be responsible for a rare embryofetopathy (incidence rate: 0.4 to 2%). After the 20th week of amenorrhea, fetal infection is not symptomatic, but it may lead to neonatal or infantile herpes zoster infection. During the perinatal period, a primary maternal infection may be responsible for severe neonatal varicella if delivery occurs prior to maternal antibody production. Practical guidelines are proposed according to the date of infection during pregnancy and prenatal diagnosis using amniocentesis and/or cordocentesis is discussed. Arch Pediatr 1998; 5: 79-83