IntroductionCentral venous catheters are critical in preterm neonatal care but increase the risk of central line-associated bloodstream infections (CLABSIs). The incidence of S. haemolyticus-associated CLABSIs in French neonates is increasing, but the mechanisms underlying this trend remain unclear.MethodsWe examined microorganisms in 108 central line infusion sets used in preterm infants across 12 neonatal intensive care units, and collected at the time of removal.ResultsThe infusion sets varied widely in type (28 types; 1-6 parts) and length (10-180 cm, mean 52.9 cm). Contamination was detected in 24 infusion sets (22.2%), mainly by coagulase-negative Staphylococci (50.0%) and Bacillus species (41.7%). Higher contamination rates were linked to longer infusion lines (> 50 cm; p < 0.001), usage beyond 7 days (p = 0.002), and multi-line infusion systems (p < 0.001).DiscussionOur findings are fully consistent with guidelines, which recommend simpler designs and a 4 or 7-day use of infusion sets, emphasizing the importance of adhering to these guidelines to reduce the risk of CLABSIs. Additionally, our findings raise concerns regarding the use of multi-line infusion systems. These devices, which combine extended infusion line length, manufacturer-authorized use of up to 21 days, and intermittent use of certain infusion lines, are easily contaminated during use, creating a high-risk situation for central line contamination.

The objective of this study was to evaluate the adherence to the French Health Authority's 2017 guidelines concerning early-onset sepsis (EOS) in neonates. This 6-month prospective observational study was conducted in 2020 in a tertiary hospital maternity unit. Neonates were classified according to their risk of EOS and the level of appropriate surveillance was analyzed. The risk of EOS was determined for 69.9% of the 1024 included neonates. Of the 123 neonates with a moderate or high risk of EOS, the optimal clinical surveillance was 88%. Even in a tertiary hospital, with training of caregivers, adherence to guidelines was incomplete. Some corrective measures are suggested and should be applied to enhance the adherence.

This study analyzes the bacteriological quality of breast milk samples destined to direct milk donation to preterm infants under 34 Gestational Weeks (GW) hospitalized in a neonatology and a neonatal intensive care unit of a French university hospital. All samples of breast milk destined to direct milk donation between April 2007 and December 2016 were included. A sample was defined as compliant if its total flora was less than 10(6) Colony Forming Units per milliliter (CFU/mL) and in the absence of Staphylococcus aureus and other pathogens. A total of 777 samples were taken from 629 mothers. The overall non-compliance rate for the initial sample was 21.3%; 63 samples (10.0%) had a total flora <= 10(6) CFU/mL, 63 (10.0%) were contaminated by a pathogenic bacteria and 8 (1.3%) were non-compliant because of both. An increase of the non-compliance rate was observed between 2008 and 2016 (10.2%-26.1%). The increase of the total flora non-compliance rate began in 2011, in link with the doubling of the number of samples taken, to reach a peak in 2013 then decreased in link with development of portable pump. No statistically significant difference of the presence of S. aureus in breast milk was observed. For the other pathogenic bacteria, the rate increased significantly in 2014. The increase of the non-compliance rate could be explained by a decrease of best practices in milk collection. Education of mothers should be strengthened.

Splenic rupture in the neonatal period is a rare condition that can be complicated by hemorrhagic shock. The symptoms are not very specific, rendering the diagnosis difficult and often delayed; sometimes only discovered at autopsy. We report five cases diagnosed in the Rhône-Alpes region of France. From these observations and from a review of the literature, the circumstances of the occurrence, the clinical signs, and the therapeutic possibilities are discussed. In the presence of severe anemia with pallor and abdominal distension, particularly in the context of a difficult birth, an abdominal ultrasound must be urgently performed and surgical management promptly considered.CONCLUSION:This pathology must be known to the neonatologist so that she/he can quickly evoke it, given that it can quickly become life-threatening. What is known: • Splenic rupture in the neonatal period is a rare condition that can be complicated by hemorrhagic shock and quickly lead to the death of the newborn. • The symptoms are not very specific, rendering the diagnosis difficult and often delayed. What is new: • This is the first publication bringing together as many clinical cases on the subject reporting in particular very serious cases to alert the clinician on this pathology and its diagnostic urgency. • We propose a clear therapeutic behavior to help the clinician in his daily practice.

The neonatal arterial ischemic stroke is an emergency. Recurrent focal seizures, generally occurring in the first 24-72 hours after birth, are the commonest first clinical signs. When neonatal arterial ischemic stroke is suspected, optimal initial management involves careful supportive care including treatment of clinical and frequent or prolonged subclinical seizures, correction of the possible metabolic disorders and their prevention. Contrary to hypoxic ischemic encephalopathy, therapeutic hypothermia is not indicated. This newborn requires emergent transfer to a neonatal intensive care unit for the confirmation of the diagnosis by means of a specialized neonatal transport team.

La maladie de Basedow complique deux grossesses sur mille et lorsqu’elle est connue avant la grossesse, justifie une surveillance bien établie, du fœtus et du nouveau-né. Nous rapportons le cas d’une hyperthyroïdie néonatale, qui a révélé une pathologie thyroïdienne maternelle jusqu’alors méconnue. Dans cette situation, les signes néonatals peuvent être mal interprétés, retardant le diagnostic. L’hyperthyroïdie néonatale est cependant une urgence thérapeutique en raison du risque de complications cardiaques et neurologiques. Le pédiatre doit savoir évoquer cette pathologie thyroïdienne même en l’absence d’antécédent maternel identifié afin de permettre une prise en charge thérapeutique rapide.

Graves disease complicates two pregnancies out of 1000 and when it is known before pregnancy, it warrants careful monitoring of the fetus and the newborn. We report on a case of neonatal hyperthyroidism, which revealed a previously unknown maternal thyroid disease. In this situation, neonatal signs can be misinterpreted, delaying the diagnosis. Neonatal hyperthyroidism is, however, a therapeutic emergency because of the risk of cardiac and neurological complications. The neonatologist must identify thyroid disease in the absence of a maternal history in order to promptly start therapy. (C) 2017 Elsevier Masson SAS. All rights reserved.

Neonatal arterial ischemic stroke (NAIS) is a rare event that occurs in approximately one in 5000 term or close-to-term infants. Most affected infants will present with seizures. Although a well-recognized clinical entity, many questions remain regarding diagnosis, risk factors, treatment, and follow-up modalities. In the absence of a known pathophysiological mechanism and lack of evidence-based guidelines, only supportive care is currently provided. To address these issues, a French national committee set up by the French Neonatal Society (Société française de néonatologie) and the national referral center (Centre national de référence) for arterial ischemic stroke in children drew up guidelines based on an HAS (Haute Autorité de santé [HAS]; French national authority for health) methodology. The main findings and recommendations established by the study group are: (1) among the risk factors, male sex, primiparity, caesarean section, perinatal hypoxia, and fetal/neonatal infection (mainly bacterial meningitis) seem to be the most frequent. As for guidelines, the study group recommends the following: (1) the transfer of neonates with suspected NAIS to a neonatal intensive care unit with available equipment to establish a reliable diagnosis with MRI imaging and neurophysiological monitoring, preferably by continuous video EEG; (2) acute treatment of suspected infection or other life-threatening processes should be addressed immediately by the primary medical team. Persistent seizures should be treated with a loading dose of phenobarbital 20mg/kg i.v.; (3) MRI of the brain is considered optimal for the diagnosis of NAIS. Diffusion-weighted imaging with apparent diffusion coefficient is considered the most sensitive measure for identifying infarct in the neonatal brain. The location and extent of the lesions are best assessed between 2 and 4 days after the onset of stroke; (4) routine testing for thrombophilia (AT, PC PS deficiency, FV Leiden or FII20210A) or for detecting other biological risk factors such as antiphospholipid antibodies, high FVIII, homocysteinemia, the Lp(a) test, the MTHFR thermolabile variant should not be considered in neonates with NAIS. Testing for FV Leiden can be performed only in case of a documented family history of venous thromboembolic disease. Testing neonates for the presence of antiphospholipid antibodies should be considered only in case of clinical events arguing in favor of antiphospholipid syndrome in the mother; (5) unlike childhood arterial ischemic stroke, NAIS has a low 5-year recurrence rate (approximately 1 %), except in those children with congenital heart disease or multiple genetic thrombophilia. Therefore, initiation of anticoagulation or antithrombotic agents, including heparin products, is not recommended in the newborn without identifiable risk factors; (6) the study group recommends that in case of delayed motor milestones or early handedness, multidisciplinary rehabilitation is recommended as early as possible. Newborns should have physical therapy evaluation and ongoing outpatient follow-up. Given the risk of later-onset cognitive, language, and behavioral disabilities, neuropsychological testing in preschool and at school age is highly recommended.

The intestinal microbiota is known to be composed by several hundred different bacterial species and is stable over time.Antibiotics intake induces a disturbance in the composition of intestinal microbiota which impairs its protective role against infection by pathogens.The presence of a large biomass of bacteria in the digestive tract exerts physiological effects with beneficial consequences for the host.Patients with inflammatory bowel diseases, exhibit an imbalance in the composition of intestinal microbiota called dysbiosis.Le microbiote intestinal est représenté par plusieurs centaines d'espèces bactériennes différentes et est stable au cours du temps.La présence permanente d'une importante biomasse bactérienne dans le tube digestif exerce des effets physiologiques dont les répercussions pour l'hôte sont, pour la plupart, bénéfiques.L'administration d'antibiotiques à larges spectres ou à spectres étroits, entraîne une perturbation dans la composition du microbiote intestinal qui ne joue alors plus correctement son rôle de protection vis-à-vis des bactéries pathogènes.Chez les patients atteints de maladies inflammatoires chroniques de l'intestin, il a été mis en évidence la présence d'un déséquilibre dans la composition du microbiote intestinal ou dysbiose.

Neonatal herpes is a severe disease. We report a case with a fatal outcome, whose transmission was linked to mammary herpes. The lack of early diagnosis delayed appropriate therapeutic management. The purpose of this report is to alert clinicians to this potential mode of transmission.

L’hypothermie (HT) est une des premières stratégies neuroprotectrices ayant démontré son efficacité en recherche expérimentale et clinique. Elle est maintenant recommandée par les guidelines internationaux pour la prise en charge des encéphalopathies anoxo-ischémiques (EAI) du nouveau-né à terme. L’HT agirait à différents niveaux de la cascade excitotoxique afin de limiter la mort neuronale secondaire. Elle doit être mise en oeuvre dans les six heures après la naissance, après avoir démontré l’existence d’une asphyxie pernatale et argumenté une certaine gravité pour l’EAI. L’efficacité sur la réduction du taux combiné de décès ou séquelles graves à 18 mois est prouvée par plusieurs essais randomisés. Par contre, le bénéfice à plus long terme durant la petite enfance reste mal connu, incitant à suivre les enfants traités par HT au-delà de l’âge de deux ans. Une réflexion sur les extensions d’indication (prématurité tardive, enfant admis en réanimation au-delà de six heures de vie) est d’actualité et des essais cliniques sont en cours aux États-Unis sur ces sujets. Le devenir à 18 mois des EAI est certes amélioré par l’HT mais reste préoccupant pour plus de 40 % des enfants traités. D’autres stratégies neuroprotectrices comme l’érythropoïétine, la mélatonine, le xénon, le sulfate de magnésium sont en cours d’évaluation. Les résultats de ces travaux en cours mériteront une attention certaine, car ils pourraient, dans l’avenir, être proposés en complément de l’HT.

The funduscopic examination is essential in neonatology to screen for retinopathy in the pre-term infant. Mydriatic eyedrops, which are used for this examination, are known to induce digestive side effects. We present a case of necrotizing enterocolitis developing in a pre-term infant as a complication of mydriatics. This in was a girl born at 28 weeks gestation and 5 days, with Down's syndrome, who died on the 44th day of life, due to necrotizing enterocolitis, after instillation oft drop of atropine 0.3% in each eye. The chronology of events, the application method, and the clinical symptoms of at impregnation argue in favor of a causal relationship between at opine and neerotizing enterocolitis. The review of the literature made on the basis of this observation shows that side effects of mydriatic eyedrops are frequent in pre-term infants and raise the question of atropine hypersensitivity in pre-term infants with Down's syndrome. (c) 2011 Elsevier Masson SAS. All rights reserved.

PURPOSE:Pyridoxine-Dependent Epilepsy (PDE) is a rare autosomal recessive disease with neonatal seizures resistant to conventional anti-epileptic drugs. This metabolic disease has to be diagnosed early and treated to improve outcome. We report on two new mutations that open new prenatal prospects and suggest a new diagnostic procedure.CASE REPORT:We describe PDE in a neonate carrying two novel mutations in the ALDH7A1 gene: c.[852_856delCTTAG] + [1230C > A]; p.[(Phe410Leu)] + p.[(Leu285CysfsX26)]. This case also illustrates that diagnosis could have been made without any pyridoxine withdrawal, thanks to the measurement of biomarkers. The patient was successfully treated with pyridoxine supplementation and currently shows normal neurological development.

OBJECTIVE:To determine the prognostic value of early electroencephalograms (EEG) in full-term neonates suffering from hypoxic ischemic encephalopathy (HIE) exposed to whole-body hypothermia (cooled group), compared to neonates treated conventionally (control group). METHODS:The study included all term neonates born at Grenoble Hospital between 2000 and 2006 with symptoms of HIE. The first two EEGs were reviewed retrospectively and classified according to current electrophysiological criteria. In the cooled group, EEGs were recorded with a mean body temperature of 33°C. Neurological outcome was correlated with EEG pattern. RESULTS:An EEG inactive or paroxysmal pattern was associated with death in 60% of the controls, while all survivors had neurological sequels. In the cooled group, this EEG pattern was only predictive of death in 40% while survivors had normal examination at 1 year of age. Mild abnormalities on the first EEG correlated with a good prognosis in both groups. The second EEG had a high predictive value, particularly in the cooled group. Persistence of inactivity at 3 days after birth was always associated with death. CONCLUSIONS:After HIE, the first two EEGs are good prognostic indicators, also in the cooled group. Strong discontinuity in the EEG observed on the first hours after hypothermia induction can be associated with a good outcome. SIGNIFICANCE:Early Stage 4 EEGs recorded during the hypothermia may not always indicate a poor prognosis in HIE.

BACKGROUND:A whole-body hypothermia protocol for term infants with hypoxic-ischemic encephalopathy (HIE) was implemented in our network in May 2004. The main objective of this study was to assess the feasibility of the protocol. The impact on the outcome was also assessed. METHODS:Monocentric retrospective study of all term infants admitted for HIE after the implementation of the protocol. The feasibility of the protocol was evaluated by its observance during the first 72 h. The neurodevelopmental outcome at 12 months of age of this population was compared with a historical control group. RESULTS:Twenty-five children were included. The protocol was not correctly applied for 8 children. The target temperature (33-34°C) was not reached for 3 infants. Four infants were admitted after 6h of age. In 1 infant, HIE was not diagnosed at admission. In the 17 patients with a good protocol observance, rectal temperature fell to the target temperature on average at 6.4h of age. The long-term follow-up rate was improved after the implementation of the protocol (100 % versus 92 % before protocol implementation). Death or neurodevelopmental disability occurred in 40 % during the protocol period versus 87 % before protocol implementation (p<0.01). CONCLUSIONS:The main limiting factor for implementation of whole-body hypothermia in infants with HIE is admission delay. The follow-up and the rate of death or disability in infants with HIE improved after implementing the protocol.