Background: The risk of neonatal SARS-CoV-2 infection from the mother’s own milk (MoM) in neonates who are exposed to maternal SARS-CoV-2 during the perinatal period remains unclear. We conducted a systematic review to assess the association between MoM feeding and neonatal SARS-CoV-2 infection in neonates who were born to SARS-CoV-2-positive pregnant persons. Methods: PubMed Central and Google Scholar were searched for studies published by 14 March 2024 that reported neonatal SARS-CoV-2 infection by feeding type. This search, including Scopus, was updated on 17 December 2024. The primary outcome was neonatal SARS-CoV-2 infection. The meta-analysis was conducted using a random effects model with two planned subgroup analyses: time of maternal PCR testing (at admission vs. previous 2 weeks) and dyad handling (isolation vs. some precautions vs. variable/NA). Results: The primary outcome was available in both arms of nine studies, including 5572 neonates who received MoM and 2215 who received no MoM. The GRADE rating was low quality, because the studies were observational (cohorts). The frequency of SARS-CoV-2 infection was similar in both arms (2.7% MoM vs. 2.2% no MoM), with a common risk ratio of 0.82 (95% confidence interval 0.44, 1.53, p = 0.54). No significant differences were observed in the subgroup analyses. Limitations include observational and incomplete data, other possible infection sources, small sample sizes for subgroup analyses, and neonates with more than one feeding type. Conclusions: Feeding MoM was not associated with an increased risk of neonatal SARS-CoV-2 infection among neonates who were born to mothers with perinatal infection. These data, along with reports showing a lack of active replicating SARS-CoV-2 virus in MoM, further support women with perinatal SARS-CoV-2 infection feeding MoM. Registration: PROSPERO ID CRD42021268576.

Neonates receiving complex dosing regimens are at an increased risk of iatrogenic events. Electronic prescribing (EP) has been proposed to reduce medication errors compared with handwritten prescriptions (HP). This study aimed to determine in a specific setting whether EP with guiding clinical support was less error prone than HP with access to literature. A prospective crossover study involved 77 neonatologists in eight French neonatal intensive care units (NICUs) and two Spanish NICUs. Each neonatologist wrote two prescriptions (four drugs each) by hand and electronically. The order was randomly assigned for 63 prescribers. In two of the NICUs, no computerized system was used, so 14 prescribers wrote only HP. Prescribers were timed and allowed to consult any documentation. Prescriptions were qualitatively analyzed against established reference standards. Each prescription was required to include the dosage form, unit dose, number of administrations, and specific preparation/administration instructions, as would be done in actual practice. The median time [IQR] to write a prescription was 8.0 minutes for HP [4.9–11.7] and 3.5 minutes for EP [2.9–4.3] (p < 0.0001). Overt errors were significantly more common with HP versus EP (145/604 prescriptions versus 3/468; p < 0.0001) and 382 prescriptions were found to be unclear writing (none in EP). All types of errors were observed in HP, including calculation errors such as incorrect cross multiplication, incorrect units, conversion errors, and errors in dosage or interval. The use of a computerized system specifically designed for neonatology significantly reduced medication prescription errors. It also significantly reduced prescription time.

Chez l’enfant, la trajectoire développementale qui suit la naissance comporte des étapes de vulnérabilité qui sont autant d’opportunités d’intervention pour permettre à l’enfant d’exprimer toutes ses potentialités. Il faut savoir reconnaître les indicateurs de risque de troubles du neurodéveloppement parmi une variabilité individuelle qui peut être trompeuse. Ce repérage permettra de proposer des interventions d’autant plus efficaces qu’elles sont précoces et impliquent les parents. Toutefois, un rattrapage et une résilience sont toujours possibles, quel que soit l’âge, avec une prise en charge appropriée. Les capacités d’apprentissage des enfants sont hétérogènes et présentent des décalages transitoires variables selon les domaines étudiés. Dans une étude de cohorte régionale d’enfants nés prématurément, scolarisés avec leur classe d’âge, nous avons montré que la majorité d’entre eux présentait des difficultés dans plusieurs domaines cognitifs, différents selon les enfants, nécessitant des prises en charge spécifiques. La moitié d’entre eux présentait des troubles neurosensoriels associés, séquelles de la période périnatale. Des études montrent qu’il existe une étroite intrication entre motricité et capacités d’apprentissage. Dans un travail évaluant l’effet de la mobilité corporelle sur les fonctions attentionnelles à l’âge scolaire chez des enfants vulnérables, nés prématurément, nous avons montré qu’au contraire d’enfants nés à terme de même âge, la position debout avec la consigne de ne pas bouger dégradait significativement leurs performances, par rapport à la position assise. En autorisant une relative mobilité et en libérant ces enfants de consignes contraignantes qui impactent leurs capacités cognitives, il est possible d’améliorer leurs performances en diminuant ainsi les risques d’échec scolaire et sociétal.

ABSTRACT Objective Review how specific delivery management interventions (DMI) are associated with early neonatal SARS-CoV-2 infection (ENI) and neonatal death <28 days of life (ND). Design Systematic review and meta-analysis of individual patient-specific data from articles published 1 January 2020 - 31 December 2021 from Cochrane review databases, Medline and Google Scholar. Setting International publications specifying DMI, ENI, and ND. Patients Pregnant women infected with SARS-CoV-2 and their infants Main outcome measures Article inclusion criteria: 1) mothers with SARS-CoV-2 PCR positive status within 10 days before delivery or symptomatic at delivery with a positive test within 48 hours after delivery, 2) delivery method described, 3) infant SARS-CoV-2 PCR result reported. Primary outcomes were 1) ENI confirmed by positive neonatal PCR and 2) ND. Results Among 11,075 screened publications, 117 publications containing data for 244 infants and 230 mothers were included. Maternal and infant characteristics were pooled using DerSimonian-Laird inverse variance method. Primary outcome analyses were completed using logit transformation and random effect. Heterogeneity of included studies was evaluated with I 2 statistics. No routine care was described so comparison of DMI combinations to routine care was not possible. Sample size for each combination was too small to conduct any valid comparison of different DMI combinations. Conclusion Support for specific DMI in SARS-CoV-2 infected mothers is lacking. This review highlights the need for rigorous and multinational studies on the guidelines best suited to prevent transmission from mother to neonate. KEY MESSAGES What is already known on this topic Several specific delivery management interventions (DMI) have been recommended for women with active SARS-CoV-2 to prevent early neonatal SARS-CoV-2 infection. What this study adds This systematic review shows that support for specific DMI in SARS-CoV-2 infected mothers is lacking. How this study might affect research, practice or policy This review highlights the need for rigorous and multinational studies on the guidelines best suited to prevent transmission from mother to neonate.

Objectif de l’étudeÉvaluer l’effet à long terme de l’entraînement cognitif de la mémoire de travail sur le traitement visuospatial chez les enfants âgés de 5½ à 6 ans nés grands prématurés et présentant des troubles de la mémoire de travail.Population et méthodeEssai clinique randomisé ouvert multicentrique (18 hôpitaux universitaires français) avec 2 groupes parallèles (EPIREMED) de novembre 2016 à avril 2018 avec des enfants éligibles de la cohorte Epipage 2 âgés de 5½ à 6 ans, nés entre 24 et 34 SA, et ayant un quotient intellectuel global <70 et un indice de mémoire de travail <85. Les enfants ont été randomisés 1 : 1 entre une prise en charge standard et un programme d’entraînement cognitif de la mémoire de travail (logiciel Cogmed) pendant 8 semaines (25 séances) (intervention). Le résultat principal était le score de l’indice visuospatial de l’échelle d’intelligence Wechsler pour les enfants d’âge préscolaire et primaire, 4e édition. Les résultats secondaires étaient la mémoire de travail, le fonctionnement intellectuel, les processus exécutifs et d’attention, les compétences linguistiques, le comportement, la qualité de vie et la scolarité.RésultatsCent soixante-neuf enfants ont été randomisés avec un âge moyen (SD) de 5 ans et 11 mois (2 mois), 91 (54 %) étaient des filles. Le score de l’index visuospatial après l’entraînement n’était pas différent entre les groupes à une moyenne (SD) de 3,0 (1,8) mois (différence −0,6 points, 95 % CI −4,7–3,5 points) ou 12,9 (2,6) mois (différence, 0,1 points, 95 % CI −5,4–5,1 points). Le score de l’indice de mémoire de travail dans le groupe d’intervention s’est significativement amélioré par rapport à la ligne de base au moment intermédiaire (différence, 4,7 points, 95 % CI 1,2–8,1 points), mais cette amélioration ne s’est pas maintenue lors de l’évaluation finale.ConclusionsCet essai clinique randomisé n’a révélé aucun effet durable du programme d’entraînement cognitif sur le traitement visuospatial. Les résultats suggèrent que cette formation a des avantages limités à long terme pour l’amélioration des fonctions exécutives. Les bénéfices transitoires semblent être associés à l’état de développement des fonctions exécutives.

Purpose: The primary objective was to evaluate the impact of necrotising enterocolitis (NEC) and spontaneous intestinal perforation (SIP) on mortality and neurodevelopmental outcomes at 2 years’ corrected age (CA) in infants born before 32 weeks’ gestation (WG). Methods: We studied neurodevelopment at 2 years’ CA of infants with NEC or SIP who were born before 32 WG from the EPIPAGE-2 cohort study. The primary outcome was death or the presence of moderate-to-severe motor or sensory disability defined by moderate-to-severe cerebral palsy or hearing or visual disability. The secondary outcome was developmental delay defined by a score < 2 SDs below the mean for any of the five domains of the Ages and Stages Questionnaire. Results: At 2 years’ CA, 46

AIMS:Sertraline is frequently prescribed for mental health conditions in both pregnant and breastfeeding women. According to the limited available data, only small amounts of sertraline are transferred into human milk, yet with a large amount of unexplained interindividual variability. This study aimed to develop a population pharmacokinetic (popPK) model to describe the pharmacokinetics of sertraline during the perinatal period and explain interindividual variability. METHODS:Pregnant women treated with sertraline were enrolled in the multicenter prospective cohort SSRI-Breast Milk study. A popPK model for sertraline maternal plasma and breast milk concentrations was developed and allowed estimating the milk-to-plasma ratio (MPR). An additional fetal compartment allowed cord blood concentrations to be described. Several covariates were tested for significance. Ultimately, model-based simulations allowed infant drug exposure through placenta and breast milk under various conditions to be predicted. RESULTS:Thirty-eight women treated with sertraline were included in the study and provided 89 maternal plasma, 29 cord blood and 107 breast milk samples. Sertraline clearance was reduced by 42% in CYP2C19 poor metabolizers compared to other phenotypes. Doubling milk fat content increased the MPR by 95%. Simulations suggested a median daily infant dosage of 6.9 μg kg-1 after a 50 mg maternal daily dose, representing 0.95% of the weight-adjusted maternal dose. Median cord blood concentrations could range from 3.29 to 33.23 ng mL-1 after maternal daily doses between 25 and 150 mg. CONCLUSIONS:Infant exposure to sertraline, influenced by CYP2C19 phenotype and breast milk fat content, remains low, providing reassurance regarding the use of sertraline during pregnancy and breastfeeding.

In children, the developmental trajectory following birth includes stages of vulnerability that are opportunities for intervention allowing the child to express his or her full potential. We must recognize risk indicators for neurodevelopmental disorders among individual variability that can be misleading. This identification will make it possible to propose interventions that are most effective if they are early and involve both parents. However, catch-up and resilience are always possible, whatever the age, with appropriate support. Children's learning abilities are heterogeneous and present variable transitional lags depending on the areas studied. In a regional cohort study of children born prematurely, attending school with their peer age group, we showed that most of them had difficulties in several cognitive domains depending on the child, requiring specific support. Half of the children had associated neurosensory disorders, sequelae of the perinatal period. Studies show that there is a close association between motor skills and learning abilities. In a study evaluating the effect of bodily mobility on attentional functions at school age in children born prematurely, we showed that, unlike full-term children of the same age, the standing position with a strict instruction not to move significantly impaired the performance of these children compared to sitting or free to move. By allowing relative mobility and freeing these children from restrictive instructions that impact their cognitive abilities, it is possible to improve their performance, thus reducing the risks of academic and societal failure. (c) 2024 l'Academie nationale de medecine. Published by Elsevier Masson SAS. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Neonatal mortality in France has not decreased for 20 years and the last perinatal plan ended in 2007. An unprecedented demographic crisis is affecting all perinatal profes-sions. This crisis is contributing to the acceleration of maternity unit closures, particularly in private health care establishments. The territorial coverage by type 2 and 3 establishments, with the exception of Corsica, is satisfactory, but these establishments are saturated and offer deteriorated working and reception conditions. Their attractiveness is particularly low for mid-wives and nurses, professions where there are many vacancies. The population's expectations regarding childbirth are not being met either qualitatively or in terms of access to care. The particularly worrying situation of the overseas departments and regions could not be analyzed in this report. The implementation of an appropriate perinatal policy should be based on an increased reduction in the number of maternity units. These should be merged together with type 2 and type 3 establishments in the same territory whose structural and human resource constraints must guarantee both the safety and satisfaction of users while offering acceptable and sustainable working conditions. Only these large establishments could accommodate the most complex care pathways as well as the most physiological health pathways by reinforcing human resources and at the cost of architectural adaptations allowing the cohabitation of dif-ferent levels of care. These transformations will avoid the caricature of "baby factories" that is often made of large, saturated and therefore unwelcoming structures. The second lever of this policy is the pooling of public and private provision, which should be coordinated at the level of territories defined by the length of the journey to a type 2 or 3 facility to the benefit of families. This strategy requires complementarity between health establishments and commu-nity medicine. This has changed in 25 years due to the considerable increase in the number of midwives in private practice and the variety of their missions. Perinatal communities of proxi-mity with the actors of community care should define and coordinate health and care paths. These communities should have the appropriate means of face-to-face and remote consulta-tion and expertise, but also hospitalization facilities, particularly in the postpartum period, to encourage the development of the parent-child bond within the local community, as close as possible to the home. The longer journeys between home and the place of birth imposed by such groupings will require coordination between referents in the local perinatal commu-nity and recourse to medical transport, in particular Emergency Services. The development of hotel-hospital structures should also be an important element of the access to care system. These measures seem to be the only ones capable of alleviating the reality and the feeling of a perinatal desert by families and all those involved in perinatal care.& COPY; 2023 Published by Elsevier Masson SAS on behalf of l'Academie nationale de medecine.

This study aimed at evaluating the 7-year outcomes of 118 very preterm newborns (VPNs, gestational age = 26 ± 1.4 w) involved in a randomized controlled trial. They presented neonatal respiratory distress (RDS), requiring ventilation for 14 ± 2 days post-natal age (PNA). A repeated instillation of 200 mg/kg poractant alfa (SURF) did not improve early bronchopulmonary dysplasia, but the SURF infants needed less re-hospitalization than the controls for respiratory problems at 1- and 2-year PNA. There was no growth difference at 7.1 ± 0.3 years between 41 SURF infants and 36 controls (80% of the eligible children), and 7.9% SURF infants vs. 28.6% controls presented asthma (p = 0.021). The children underwent cognitive assessment (WISC IV) and pulmonary function testing (PFT), measuring their spirometry, lung volume, and airway resistance. The spirometry measures showed differences (p < 0.05) between the SURF infants and the controls (mean ± standard deviation (median z-score)) for FEV1 (L/s) (1.188 ± 0.690(−0.803) vs. 1.080 ± 0.243 (−1.446)); FEV1 after betamimetics (1.244 ± 0.183(−0.525) vs. 1.091 ± 0.20(−1.342)); FVC (L) (1.402 ± 0.217 (−0.406) vs. 1.265 ± 0.267 (−1.141)), and FVC after betamimetics (1.452 ± 0.237 (−0.241) vs. 1.279 ± 0.264 (−1.020)). PFT showed no differences in the volumes or airway resistance. The global IQ median (interquartile range) was 89 (82:99) vs. 89 (76:98), with 61% of the children >85 in both groups. Repeated surfactant treatment in VPNs presenting severe RDS led to the attenuation of early lung injuries, with an impact on long-term pulmonary sequelae, without differences in neurodevelopmental outcomes.

Objective. - The purpose of this review was to present the different genitourinary complications following pelvic radiotherapy as well as their assessment and treatments. Methods. - A review of literature was conducted using Medline/Pubmed database without period restriction. In order to write this article, we also use the 2016 AFSOS, SFRO and AFU recommendations.Results. - On the one hand, early side effects are common and mild. The symptomatic treatments available generally provide effective relief to patients. On the other hand, late adverse effects need long and complex care. Its side effects alter the quality of life and can be life -threatening. The effects of radiotherapy are irreversible. Except hyperbaric oxygen therapy and hyaluronic acid/chondroitin sulfate instillations, treatments remain symptomatic. Ure-throvesical fibroscopy is essential in cases of gross hematuria, and urodynamic assessment (or videourodynamic) can be used in cases of severe vesicosphincter disorders. Pharmacological treatments are less effective than in non-radiation patients, and the morbidity of surgical treatments is higher in this population.Conclusion. - Genitourinary complications after pelvic radiotherapy are frequent and mild in the early phase but rare and severe in the late phase. Their management is based on a vast diagnostic and therapeutic arsenal, but the treatments are only symptomatic, and the sequelae of radiotherapy remains, to date, irreversible.(c) 2023 Elsevier Masson SAS. All rights reserved.

La mortalité néonatale en France n’a pas diminué depuis 20 ans et le dernier plan de périnatalité est arrivé à terme en 2007. Une crise démographique sans précédent touche toutes les professions de la périnatalité. Cette crise contribue à l’accélération des fermetures de maternités, en particulier au sein des établissements de soins privés. La couverture territoriale par les établissements de type 2 et 3, à l’exception de la Corse, est satisfaisante, mais ces établissements sont saturés et offrent des conditions de travail et d’accueil dégradées. Leur attractivité est particulièrement faible pour les sages-femmes et les infirmières, professions où les postes vacants sont nombreux. Les attentes de la population autour de la naissance ne sont satisfaites ni qualitativement ni en termes d’accès aux soins. La situation particulièrement préoccupante des départements et régions d’outre-mer doit faire l’objet d’une analyse qui n’a pas pu être réalisée dans ce rapport. La mise en œuvre d’une politique adaptée en matière de périnatalité devrait s’appuyer sur une réduction accrue du nombre de maternités. Celles-ci devraient être regroupées avec les établissements de type 2 et de type 3 d’un même territoire, dont les contraintes structurelles et de ressources humaines doivent garantir, à la fois, la sécurité et la satisfaction des usagers, tout en offrant des conditions de travail acceptables et pérennes. Seuls ces grands établissements pourraient accueillir les parcours de soins les plus complexes comme des parcours de santé les plus physiologiques en renforçant les moyens humains et au prix d’adaptations architecturales permettant la cohabitation des différents niveaux de prise en charge. Ces transformations éviteront la caricature d’« usines à bébés » qui est souvent faite de grosses structures saturées et donc peu accueillantes. Le deuxième levier de cette politique passe par une mutualisation de l’offre publique et libérale qui devrait être coordonnée à l’échelle de territoires définis par la durée du trajet conduisant à une structure de type 2 ou 3 au bénéfice des familles. Cette stratégie nécessite une complémentarité entre les établissements de santé et la médecine de ville. Celle-ci a changé en 25 ans du fait de l’augmentation considérable du nombre de sages-femmes en exercice libéral et de l’extension de leurs missions. Les communautés périnatales de proximité avec les acteurs de la médecine de ville devraient définir et coordonner les parcours de santé et les parcours de soins. Ces communautés devraient disposer des moyens de consultation et d’expertise présentielles et à distance adaptés, mais aussi de structures d’hospitalisation, en particulier en post-partum, pour favoriser le développement du lien parents-enfants au sein de la communauté locale, au plus près du domicile. L’allongement des trajets entre le domicile et le lieu de naissance, imposé par de tels regroupements, nécessitera une coordination entre référents de la communauté périnatale de proximité et le recours aux moyens de transport médicalisé, en particulier les SAMUs. Le développement de structures hôtelières-hospitalières devrait être également un élément important du dispositif d’accès aux soins. Ces mesures paraissent seules pouvoir pallier la réalité et le ressenti de désert périnatal par les familles et tous les acteurs de la périnatalité.

IntroductionFluvoxamine is widely used to treat depression during pregnancy and lactation. However, limited data are available on its transfer to the fetus or in human milk. This case series provides additional information on the infant exposure to fluvoxamine during pregnancy and lactation.Case presentationTwo women, aged 38 and 34 years, diagnosed with depression were treated with 50 mg fluvoxamine during pregnancy and lactation. At delivery a paired maternal and cord blood sample was collected for each woman. The first mother exclusively breastfed her child for 4 months and gave one foremilk and one hindmilk sample at 2 days and 4 weeks post-partum, whereas the second mother did not breastfeed.ResultsThe cord to plasma concentration ratios were 0.62 and 0.48, respectively. At 2 weeks post-partum, relative infant doses (RID) were 0.47 and 0.57% based on fluvoxamine concentrations in foremilk and hindmilk, respectively. At 4 weeks post-partum, the RIDs were 0.35 and 0.90%, respectively. The child from the first mother was born healthy and showed a normal development at the 6th, 18th and 36th month follow-ups. One of the twins from the second woman was hospitalized for hypoglycemia that was attributed to gestational diabetes and low birth weight. The second one was born healthy.ConclusionThese results suggest a minimal exposure to fluvoxamine during lactation which is in accordance with previously published data. Larger clinical and pharmacokinetic studies assessing the long-term safety of this drug during lactation and the variability of its exposure through breastmilk are warranted.

To evaluate the impact of antenatal corticosteroid therapy (ACS) on birth outcomes in term infants exposed during pregnancy. Exposed newborns were compared with non-exposed controls in a 1 to 2 design. Multivariate analysis was used to assess the effect of ACS exposure on neonatal outcomes. 408 newborns were included (136 exposed to ACS, 272 non-exposed). Mean ± SD head circumference (HC) was 33.7 ± 1.4 vs 34.3 ± 1.6 cm, p = 0.001 in exposed vs controls; birth weight was 3.1 ± 0.4 vs 3.3 ± 0.4 kg, p = 0.0001; and birth height was 47.9 ± 2.1 vs. 49.1 ± 2.0 cm, p < 0.0001. Hypocalcemia (4.4 vs 0.7%, p = 0.019) and feeding difficulties (5.1 vs 1.5%, p = 0.047) were significantly more common in exposed newborns. Multivariate analysis for HC showed a significant independent association with ACS exposure (β = −0.5, p = 0.009). Term newborns exposed to ACS have lower birth HC and higher risk of neonatal complications. NCT05640596.

Background: Necrotizing enterocolitis (NEC) is the most common life-threatening gastrointestinal emergency in prematurity. The pathophysiology is multifactorial and remains incompletely understood. Early diagnosis and treatment could reduce the risk of mortality and morbidity. We aimed to identify factors associated with NEC in preterm newborns.Method: This case-control study included all preterm newborns presenting with NEC and managed between January 1, 2009 and December 31, 2018 in the neonatal intensive care unit of Nancy. For each case, two con-trols were matched according to three criteria: gestational age (WG), date of birth, and mode of delivery. Antenatal, peripartum, and postnatal risk factors prior to NEC were analyzed.Results: A total of 292 infants were involved in the study, 113 of whom had NEC. Mean gestational age for newborns with NEC was 29 WG, and mean birth weight, 1340 g. Only early-onset infection was identified as a significant risk factor for NEC (15% vs. 6.6% for infection p<0.04, and 28.3% vs. 16.4% p<0.02 for infection and sepsis, NEC vs. controls, respectively). Late-onset feeding and initial continuous enteral feeding were significantly associated with the occurrence of more severe NEC (p<0.02 and p = 0.03, respectively).Conclusion: The results of this study are consistent with intestinal dysbiosis being a risk factor for NEC. Early-onset infection was found to be a significant risk factor. Enteral feeding practice may also be associated with NEC.(c) 2023 Published by Elsevier Masson SAS on behalf of French Society of Pediatrics.

Certaines eaux conditionnées, eaux minérales naturelles (EMN, eaux de source principalement, peuvent avoir un contenu minéral à l’origine d’effets cliniques qui méritent d’être mentionnés pour l’information des consommateurs. L’effet diurétique est lié au volume d’eau et à la vitesse d’ingestion, mais les minéraux ne sont pas susceptibles de jouer un rôle concret ; il n’y a donc pas matière à mention. Les eaux bicarbonatées (à partir de 600mg/L d’hydrogénocarbonate) facilitent la digestion en agissant sur le transit gastroduodénal et les fonctions hépatobiliaires. Les eaux sulfatées (à partir de 200mg/L chez l’adulte et 140mg/L chez l’enfant) sont susceptibles d’accélérer le transit intestinal et d’avoir un effet laxatif qui est accru si les eaux sont riches en magnésium (à partir de 50mg/L). Ces effets doivent faire l’objet de mentions. La carence en fluor entraîne des caries dentaires que la fluoration des eaux de consommation humaine dans les limites fixées par les recommandations internationales permet de prévenir sans effet délétère, dentaire ou osseux. Un apport fluoré excessif conduit à une altération de la structure et de la qualité des dents et du squelette. Un apport supplémentaire de fluor qui serait bénéfique à la santé osseuse n’est pas déterminé à ce jour. Les apports quotidiens ne doivent pas dépasser 0,05mg/kg de poids corporel par jour. Les nourrissons et jeunes enfants ne doivent pas consommer une eau dont la concentration en fluor soit supérieur à 0,3mg/L s’ils font l’objet d’une supplémentation médicale en fluor. La composition physicochimique essentielle de toutes les eaux destinées à la consommation humaine doit être communiquée aux consommateurs de manière lisible. Les boissons, préparées à partir d’eaux conditionnées et addition de nutriments d’autre nature, doivent porter une information nutritionnelle adaptée à la consommation aux divers âges de la vie. Les eaux rendues potables par traitement peuvent exposer à des carences minérales encore mal évaluées. La consommation au long cours d’une eau conditionnée, EMN en particulier, devrait t être approuvée par le médecin traitant.