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OBJECTIVE: Prematurity and intra-uterine growth retardation are responsible for brain damage associated with various neurocognitive and behavioral disorders in more than 9 million children each year. Most pharmacological strategies aimed at preventing perinatal brain injury have not demonstrated substantial clinical benefits so far. In contrast, enrichment of the newborn's environment appears to have positive effects on brain structure and function, influences newborn hormonal responses, and has lasting neurobehavioral consequences during infancy and adulthood. Oxytocin (OT), a neuropeptide released by the hypothalamus, may represent the hormonal basis for these long-term effects. METHOD: This review of the literature summarizes the knowledge concerning the effect of OT in the newborn and the preclinical data supporting its neuroprotective effect. RESULTS: OT plays a role during the perinatal period, in parent-child attachment and in social behavior. Furthermore, preclinical studies strongly suggest that endogenous and synthetic OT is capable of regulating the inflammatory response of the central nervous system in response to situations of prematurity or more generally insults to the developing brain. The long-term effect of synthetic OT administration during labor is also discussed. CONCLUSION: All the conceptual and experimental data converge to indicate that OT would be a promising candidate for neonatal neuroprotection, in particular through the regulation of neuroinflammation.
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Fármacos Neuroprotetores , Ocitocina , Humanos , Ocitocina/uso terapêutico , Ocitocina/fisiologia , Recém-Nascido , Fármacos Neuroprotetores/uso terapêutico , Animais , Feminino , Gravidez , Recém-Nascido Prematuro , Encéfalo/efeitos dos fármacos , Comportamento Social , Lesões Encefálicas/prevenção & controle , Apego ao ObjetoRESUMO
Introduction: La détresse respiratoire du nouveau-né est une urgence néonatale source de séquelles neurologiques graves en l'absence de traitement adéquat. L'objectif de cette étude était de décrire les aspects épidémiologiques, diagnostiques et évolutifs de la détresse respiratoire du nouveau-né. Méthodes: Il s'est agi d'une étude rétrospective analytique et descriptive, réalisée dans les services de pédiatrie des CHU de Lomé, incluant les nouveau-nés pris en charge pour une détresse respiratoire sur une période d'un an allant du 1er janvier 2021 au 31 décembre 2021. Les données étaient saisies avec Epi Data 3.1 et analysées avec Epi Info 7.2.1. Résultats: Le nombre total des nouveau-nés hospitalisés pour détresse respiratoire était de 353 cas avec un sex ratio de 1,5. L'âge moyen était de 0,82 ± 3,20 jours ; la tranche d'âge de 0-6 jours représentait 92,4 % des cas. Tous les nouveau-nés avaient un trouble de la fréquence respiratoire. La dyspnée était le principal motif de consultation (100%). Les nouveau-nés avaient été réanimés à la naissance dans 46,7 % des cas. La détresse respiratoire était intense dans 64,9 % des cas. L'hyperleucocytose et la leucopénie étaient constatées chez 14,8 % des cas. L'anémie était de 15,9 % des cas. L'encéphalopathie anoxo-ischémique y était associée dans 49,1% des cas. Le taux de mortalité était de 20,4 %. Conclusion: La détresse respiratoire néonatale était fréquente dans la période néonatale précoce et sa mortalité élevée.
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Le monoxyde d'azote inhalé (NOi), un vasodilatateur pulmonaire sélectif, est utilisé pour le traitement des nouveau-nés en insuffisance respiratoire hypoxémique (IRH) associée à une hypertension pulmonaire persistante du nouveau-né. Idéalement, il doit commencer à être administré après la confirmation échocardiographique de ce type d'hypertension. L'utilisation de NOi est recommandée chez les nouveau-nés peu prématurés ou à terme chez qui survient une IRH malgré des stratégies d'oxygénation ou de ventilation optimales. Cependant, il n'est pas recommandé d'y recourir systématiquement chez les nouveau-nés prématurés sous assistance respiratoire. On peut l'envisager comme traitement de secours chez les nouveau-nés prématurés en IRH précoce associée à une rupture prolongée des membranes ou à un oligoamnios, ou en IRH tardive en cas d'hypertension pulmonaire liée à une dysplasie bronchopulmonaire et accompagnée d'une insuffisance ventriculaire droite marquée. On peut aussi l'envisager chez les nouveau-nés atteints d'une hernie diaphragmatique congénitale qui présentent une IRH persistante, malgré un recrutement pulmonaire optimal, des signes échocardiographiques d'hypertension pulmonaire suprasystémique et un fonctionnement ventriculaire gauche approprié.
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The Newborn Behavioral Observations (NBO) system is a relationship-based tool that helps parents recognize their infant's competencies and learn their behavioral cues, with the goals of enhancing parental responsiveness and satisfaction in the infant-parent relationship. In our study, a pediatrician integrated the NBO into 44 pediatric health care visits of infants in rural Pakistan villages, under the remote guidance of two U.S.-based child psychiatrists. A clinician then gave the mothers a survey about their experience of the NBO and found that the mothers were highly satisfied, reporting greater appreciation of their infant's strengths, greater understanding of their infant's behavioral cues, stronger attachment to their infant, and greater self-confidence as a mother. In their consideration of these results, the authors explore cultural reasons for the mothers' responses and generate hypotheses to inform an outcome study of a similar intervention. This was a feasibility and acceptability study and was not randomized, had no control group, and did not use objective measures of outcome.
El sistema de Observaciones de Comportamiento del Recién Nacido (NBO)™ es una herramienta basada en la relación que se enfoca en ayudar a los padres a reconocer las competencias de su infante y aprender sus señales de comportamiento, con el propósito de mejorar la sensibilidad y satisfacción del progenitor en la relación infante-progenitor. En este estudio de probabilidad y aceptabilidad, un clínico pediatra integró el NBO dentro de 44 visitas de cuidado de salud pediátricas a infantes en aldeas rurales en Pakistán, bajo la guía remota de dos siquiatras infantiles con base en los Estados Unidos. Entonces, un clínico les dio a las madres una encuesta acerca de su experiencia con el NBO y se encontró que las madres estaban altamente satisfechas, reportando un mayor aprecio por los puntos fuertes de sus infantes, una mayor comprensión de las señalas de comportamiento de sus infantes, una más fuerte afectividad hacia sus infantes, así como una mayor auto confianza como madre. En sus consideraciones de estos resultados, los autores exploran razones culturales para las respuestas de las madres y generan hipótesis como información para un estudio de resultado de una intervención similar.
Le système d'observation comportementale du nouveau-né (Newborn Behavioral Observations, abrégé selon l'anglais NBO system™) est un outil basé sur la relation se concentrant sur l'aide aux parents à reconnaître les compétences de leur nourrisson et à comprendre leurs signaux de comportement, se donnant pour but de mettre en valeur la réaction parentale et la satisfaction dans la relation nourrisson-parent. Dans cette étude de faisabilité et d'acceptabilité un clinicien en pédiatrie a intégré le NBO dans 44 visites de santé pédiatrique de nourrissons dans des villages du Pakistan rural, sous l'orientation professionnelle à distance de deux psychiatres de l'enfance basés aux Etats-Unis d'Amérique. Un clinicien a ensuite donné aux mères un questionnaires sur leur expérience du NBO et a trouvé que les mères étaient très satisfaites, faisant état d'une plus grande appréciation des forces de leurs nourrissons, d'une plus grande compréhension des signaux de comportement de leur nourrisson, d'un attachement plus fort à leur nourrisson et d'une plus grande confiance en soi en tant que mère. Dans leur considération de ces résultats les auteurs explorent les raisons culturelles expliquant les réponses des mères et génèrent des hypothèses pour informer une étude d'une intervention similaire.
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Técnicas de Observação do Comportamento , Relações Mãe-Filho , Recém-Nascido , Lactente , Feminino , Humanos , Criança , Técnicas de Observação do Comportamento/métodos , Estudos de Viabilidade , Paquistão , MãesRESUMO
In addition to the experimental work devoted to the capacities of newborns - among others on the question of sensory receptivity - it is interesting to show how much this receptivity intervenes during the clinical dialogue with young infants. But also how, from birth, professionals can identify individual profiles of babies, notably thanks to the Brazelton scale, and thus adapt their care practices.
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Qualidade da Assistência à Saúde , Humanos , Lactente , Recém-NascidoRESUMO
Developmental care is defined by a personalized approach to the premature child. Observation of sensory-motor behavior is a key part of this approach and requires specific training and the use of observation tools. This study analyzes the use of an illustrated guide during the observation and evaluation of the sensory-motor behavior of the premature baby; this didactic contribution constitutes a real added value for the professionals, allowing the elaboration of a care project.
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Doenças do Prematuro , Nascimento Prematuro , Criança , Criança Hospitalizada , Família , Feminino , Humanos , Lactente , Recém-NascidoRESUMO
On constate des écarts dans les taux de prématurité et de mortalité néonatale au Canada, en partie à cause d'une formation insuffisante en réanimation et en stabilisation néonatales et de même que d'une adhésion inégale aux pratiques exemplaires. Depuis les années 1990, le Programme de réanimation néonatale est la norme dans tous les établissements qui prodiguent des soins périnatals, mais les fournisseurs et les formateurs de soins périnatals ont continué d'observer des lacunes sur le plan des connaissances et des habiletés en matière de stabilisation des nouveau-nés après la réanimation, particulièrement dans les milieux où ces soins sont rarement requis. Le Programme de soins aigus aux nouveau-nés à risque (ACoRN) a été mis sur pied pour corriger ces lacunes. Dans l'ACoRN, une évaluation primaire et des trajectoires pour soigner les divers systèmes organiques (les séquences) priorisent et orientent l'évaluation, les soins essentiels et la prise en charge des nouveau-nés à risque ou malades pendant les premières heures et les premiers jours de vie. Le présent point de pratique fait ressortir les changements aux pratiques et aux recommandations depuis 2012, année de la dernière révision du texte et du fonctionnement de l'ACoRN, qui n'était alors offert qu'en anglais. À l'instar du Programme de réanimation néonatale, l'ACoRN est géré par la Société canadienne de pédiatrie au Canada. Un manuel et un programme d'enseignement révisés, mis à jour, traduits en français et lancés en 2021 standardiseront les soins, accroîtront les compétences et la confiance chez les dispensateurs de soins périnatals et amélioreront les pronostics néonatals au Canada et ailleurs au cours des prochaines années.
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Research points to the significant impact of maternal distress on the parent-infant relationship and infant development. The Newborn Behavioral Observations (NBO) is a brief intervention supporting the infant, the parent and their relationship. This randomized controlled trial examined the effectiveness of the NBO in a population with antenatal distress and risk of postnatal depression (PND). Pregnant, first-time mothers with current anxiety or depression symptoms or past mental illness were recruited from two Australian hospitals. Participants received three NBO sessions in the first month of life plus treatment as usual (TAU), or, TAU-only. Outcomes assessed at infant age 4 months included mother-infant interaction quality; maternal anxiety and depression symptoms; and depression diagnosis. Of 111 pregnant individuals randomized, 90 remained eligible and 74 completed the trial (82.2% retention). There were intervention effects on emotional availability F(6, 67) = 2.52, p = .049, Cohen's d = .90, with higher sensitivity and non-intrusiveness in the intervention group (n = 40) than the comparison group (n = 34). There was an intervention effect approaching significance for anxiety symptoms at 4 months (p = .06), and a significant effect over time (p = .014), but not for depression symptoms. Anxiety and depression symptoms significantly reduced to sub-clinical levels within the intervention group only. There were fewer depression diagnoses (n = 6) than expected across groups, with no observed intervention effect. No adverse intervention effects were seen. Exploratory analysis of sensory processing sensitivity suggested differential susceptibility to distress and intervention benefits. The NBO was accepted and exerted meaningful effects on relationship quality and distress; and may enhance the infant's interaction experience and maternal emotional adjustment in at-risk populations.
La angustia materna tiene impacto en las relaciones progenitor-infante y el desarrollo del infante. Las Observaciones del Comportamiento del Recién Nacido (NBO) es una intervención breve para apoyar al infante, al progenitor y la relación entre ellos. Este ensayo controlado al azar examinó la eficacia de NBO en un grupo de población con angustia antenatal y riesgo de depresión postnatal. En dos hospitales australianos, se reclutaron madres embarazadas, primerizas, con síntomas presentes de ansiedad o depresión, o enfermedad mental anterior. Las participantes recibieron tres sesiones de NBO en el primer mes de vida más el tratamiento como se acostumbra (TAU), o sólo TAU. Entre los resultados evaluados a los 4 meses se incluye la calidad de la interacción madre-infante, la ansiedad materna y síntomas de depresión, así como el diagnóstico de depresión. De las 111 mujeres embarazadas seleccionadas al azar, 90 quedaron siendo elegibles y 74 completaron el ensayo (retención 82.2%). La intervención mejoró significativamente la disponibilidad de interacción emocional F(6,67) = 2.52, p = .049, puntaje Cohen d = .90, y redujo síntomas de ansiedad a lo largo del tiempo (p = .014) entre quienes completaron el grupo de intervención (n = 40) versus el grupo comparativo (n = 34). El grupo de intervención mostró significativas reducciones en ansiedad y síntomas de depresión a niveles subclínicos, tanto en el examen previo como en el posterior. En el diagnóstico de depresión, no se observaron efectos de intervención. No se dio ningún efecto adverso de intervención. El proceso sensorial de la sensibilidad diferenció entre susceptibilidad a la angustia y los beneficios de la intervención. La NBO tuvo efectos en la calidad de la relación y la angustia; y pudiera haber mejorado la experiencia de interacción del infante y el ajuste emocional materno en los grupos clínicos de población.
Les recherches pointent vers un impact important de la détresse maternelle sur la relation parent-nourrisson et le développement du nourrisson. Les Observations Comportementale du Nouveau-né (abrégé ici OCN en français) est une intervention courte soutenant le nourrisson, le parent et leur relation. Cet essai contrôlé randomisé a examiné l'efficacité de l'OCN chez une population clinique avec une détresse anténatale et un risque de dépression postnatale. Des mères primipares enceintes avec des symptômes d'anxiété et de dépression ou de dépression passée ont été recrutées dans deux hôpitaux australiens. Les participants ont reçu trois séances OCN durant le premier mois de vie plus un traitement habituel ou seulement un traitement habituel. Les résultats ont été évalués à l'âge de quatre mois du nourrisson, y compris la qualité de l'interaction mère-nourrisson, l'anxiété maternelle, la dépression et les symptômes de stress de parentage, et le diagnostic de dépression. De 111 participantes enceintes randomisées, 90 sont demeurées éligibles et 74 ont complété l'étude (82,2% de rétention). On a trouvé des effets de l'intervention sur la disponibilité émotionnelle F(6, 67) = 2,52, p = ,049, d = ,90 de Cohen, avec une sensibilité plus élevée et un caractère non intrusif dans le groupe d'intervention (n = 40) dans le groupe de comparaison (n = 34). Il y avait des différences de groupe importantes dans les niveaux d'anxiété au fil du temps (p = ,014). L'anxiété et les symptômes de dépression ont été très largement réduits à des niveaux subcliniques au sein du groupe d'intervention. Aucun effet négatif d'intervention n'a été observé. Une analyse exploratoire de sensibilité du traitement sensoriel a révélé une susceptibilité différentielle à la détresse et aux bénéfices de l'intervention. L'OCN a été acceptée et a produit des effets significatifs sur la qualité de la relation et la détresse, et peut améliorer l'expérience d'interaction du nourrisson et l'ajustement émotionnel maternel chez les populations cliniques.
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Depressão Pós-Parto , Relações Mãe-Filho , Ansiedade/terapia , Austrália , Criança , Depressão Pós-Parto/prevenção & controle , Feminino , Humanos , Lactente , Recém-Nascido , Relações Mãe-Filho/psicologia , Mães/psicologia , GravidezRESUMO
When they turn to pediatrics, health care professionals accept to integrate into their practice the presence of parents as an essential element, preponderant in the healing of the child. If the resulting organization is to be taken into account in daily practice, it also reveals itself as a rich source of ethical reflection.
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Cuidadores , Pediatria , Criança , Família , Humanos , Pais , Relações Profissional-FamíliaRESUMO
OBJECTIVES: Parenteral nutrition (PN) offers a quality therapeutic option when enteral feeding is non-tolerated or impossible. However, it can be associated with an increased risk of medical errors, especially in sensitive populations such as newborns. This study aimed at determining the impact of the implementation of a computerized physician order entry (CPOE) system on PN medication errors in the neonatology department in the largest teaching hospital in Tunisia. MATERIEL AND METHODS: The frequency of medication errors in PN, in a teaching neonatal intensive care unit, was prospectively reviewed by a pharmacist between December 2018 and March 2019 in a two-phase interventional study (pre and post locally developed CPOE System implementation). RESULTS: Implementation of CPOE system decreased PN order errors from 379 to 147 representing a 61.1% reduction. The decreases on PN order errors per stage, i.e. prescribing and preparation, were form 207 to 22 (89.4%), and from 117 to 66 (43.6%), respectively. Mean nutrients intakes were in conformity to the recommended daily intakes during the CPOE phase of the study. CPOE is a protective tool against prescription and preparation errors. It significantly impacted all items of the ordering process. CONCLUSIONS: In addition to the rigorous application of the recommendations, the CPOE system allows to reduce the risk of PN medication errors. This improves the safety and quality of medicines in newborns.
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Sistemas de Apoio a Decisões Clínicas , Sistemas de Registro de Ordens Médicas , Recém-Nascido , Humanos , Unidades de Terapia Intensiva Neonatal , Erros de Medicação/prevenção & controle , Nutrição ParenteralRESUMO
In 2001, a clinical trial on prophylactic antibiotics in preterm prelabor rupture of membranes reported an increased risk of necrotizing enterocolitis in newborns whose mothers were given amoxicillin-clavulanic acid before delivery. This study generated concern and reluctance to use this antibiotic in late pregnancy, despite its methodological limitations and the lack of confirmation in 3 studies published between 2001 and 2008. Since then, there have been no original publications on the topic. Therefore, the results available to date do not support an increased risk of necrotizing enterocolitis with the use of amoxicillin-clavulanic acid in late pregnancy. In clinical situations where amoxicillin/clavulanic acid is required, it can be prescribed at any stage of pregnancy, including just before delivery.
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Combinação Amoxicilina e Clavulanato de Potássio , Antibacterianos , Combinação Amoxicilina e Clavulanato de Potássio/efeitos adversos , Antibacterianos/efeitos adversos , Ensaios Clínicos como Assunto , Feminino , Humanos , Recém-Nascido , GravidezRESUMO
Every year, 30 million infants worldwide are delivered after intra-uterine growth restriction (IUGR) and 15 million are born preterm. These two conditions are the leading causes of ante-/perinatal stress and brain injury responsible for neurocognitive and behavioral disorders affecting more than 9 million children each year. Most pharmacological candidates to prevent perinatal brain damage have failed to demonstrate substantial benefits. In contrast, environment enrichment based on developmental care, skin-to-skin contact and vocal/music exposure appear to exert positive effects on brain structure and function. However, mechanisms underlying these effects remain unknown. There is strong evidence that an adverse environment during pregnancy and the neonatal period can influence hormonal responses of the newborn with long-lasting neurobehavioral consequences in infancy and adulthood. In particular, excessive cortisol release in response to perinatal stress associated with prematurity or IUGR is recognized to induce brain-programming effects and neuroinflammation, a key predictor of subsequent neurological impairments. These deleterious effects are known to be balanced by oxytocin (OT), a neuropeptide released by the hypothalamus, which plays a role during the perinatal period and in social behavior. In addition, preclinical studies suggest that OT is able to regulate the central inflammatory response to injury in the adult brain. Using a rodent model of IUGR associated with developing white matter damage, we recently reported that carbetocin, a brain permeable OT receptor (OTR) agonist, induced a significant reduction of activated microglia, the primary immune cells of the brain. Moreover, this reduced microglia reactivity was associated with long-term neuroprotection. These findings make OT a promising candidate for neonatal neuroprotection through neuroinflammation regulation. However, the mechanisms linking endogenous OT and central inflammation response to injury have not yet been established. Further studies are needed to assess the protective role of OT in the developing brain through modulation of microglial activation, a key feature of brain injury observed in infants born preterm or growth-restricted. They are expected to have several impacts in the near future not only for improving knowledge of microglial cell physiology and reactivity during brain development, but also to design clinical trials testing interventions associated with endogenous OT release as a relevant strategy to alleviate neuroinflammation in neonates.
Title: Ocytocine : une nouvelle cible de neuroprotection ? Abstract: Chaque année, dans le monde, 30 millions de nouveau-nés naissent après un retard de croissance intra-utérin (RCIU) et 15 millions naissent prématurément. Ces deux conditions sont les principales causes de stress anté-/périnatal et de lésions cérébrales responsables de troubles neurocognitifs et comportementaux chez plus de 9 millions d'enfants chaque année. La plupart des stratégies pharmacologiques visant à prévenir les lésions cérébrales périnatales n'ont pas réussi à démontrer des bénéfices cliniques substantiels. En revanche, l'enrichissement de l'environnement basé sur les soins de développement, le contact peau à peau et l'exposition vocale/musicale semblent avoir des effets positifs sur la structure et la fonctionnalité du cerveau. Toutefois, les mécanismes qui sous-tendent ces effets restent inconnus. De nombreuses évidences montrent qu'un environnement défavorable pendant la grossesse et la période néonatale peut influencer les réponses hormonales du nouveau-né et avoir des conséquences neurocomportementales durables pendant la petite enfance et à l'âge adulte. L'ocytocine (OT), un neuropeptide libéré par l'hypothalamus, joue un rôle pendant la période périnatale dans l'attachement parents-enfant et dans le comportement social. En outre, des études précliniques suggèrent que l'OT est capable de réguler la réponse inflammatoire centrale aux lésions dans le cerveau adulte. Ces données font de l'OT un candidat prometteur pour la neuroprotection néonatale par la régulation de la neuro-inflammation.
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Lesões Encefálicas , Ocitocina , Gravidez , Feminino , Humanos , Ocitocina/farmacologia , Ocitocina/uso terapêutico , Ocitocina/fisiologia , Neuroproteção , Doenças Neuroinflamatórias , EncéfaloRESUMO
AIMS: To determine the epidemiological profile of newborn dermatitis and to describe the different clinical aspects of the observed neonatal dermatitis. PROCEDURE: The study took place at the University Hospital of Cocody (Abidjan). The study was cross-sectional, descriptive and analytical, carried out on the basis of prospective recruitment. The study included newborns who were seen in outpatient or inpatient settings by 4 april 2018 to 23 August 2018 and in whom the pediatrician had observed cutaneous and/or mucosal lesions. The diagnosis was made with the collaboration of a dermatologist. RESULTS: During the study period, 116 newborns were identified. The age of the patients seen in pediatrics with dermatitis varied from 1 to 28 days, with a mean of 16.86 ± 8.4 days. The median age was 19 days. The most representative age range (32.8%) was 24-28 days. The sex ratio (M/F) was 1. In almost 2/3 of the cases, the children were born at term, 29.3% were premature and 5.2% were born after term. In almost 2/3 of the cases (63.8%), the newborns had a birth weight of more than 2500 g. Only 3.4% of newborns seen in pediatric consultations were referred for a dermatitis. The age of the lesions at the time of consultation varied from 1 to 26 days, with a mean of 06.19 days ± 5.13. In more than half (53.5%) of the cases, the lesions had evolved for less than 5 days. Transient dermatitis was more frequent (51.7%), followed by infectious dermatitis (32.8%). Transient dermatitis of the newborn was dominated by sweaty miliaria (40%). Infectious dermatitis were mainly represented by mycotic (68.4%) and bacterial (31.9%) infections. Bacterial dermatitis were composed of neonatal impetigo (83.3%) and folliculitis (16.7%). In almost half of the cases (46.1%) the mycotic dermatitis were represented by candidosis intertrigo and in 38.5% of the cases there was oral candidiasis. The other neonatal dermatitis observed were dominated by diaper rash (64.3%) (Photo 2) and congenital nevi (21.5%). More than half (57.1%) of the cases of toxic erythema neonatorum occurred between days 6 and 10 of life. Nearly half (41.6%) of the cases of sudoral miliaria occurred between birth and day 5 of life. More than half (57.1%) of the cases of sebaceous hyperplasia occurred before the 5th day of life. All cases of neonatal scaling and mongoloid spots were already present between birth and day 5 of life. The mean age of patients with transient dermatitis was 14.31 days compared with 19.41 days for those with the other dermatitis. The difference in age was statistically significant (p < 0.05). The transient dermatitis predominated in male neonates while the other dermatitis predominated in females, however the difference observed at the level of sex was not statistically significant (p > 0.05). CONCLUSION: The diagnosis of neonatal dermatitis is not always obvious, especially on black skin where few publications have been published.
OBJECTIFS: Déterminer le profil épidémiologique des dermatoses du nouveau-né et de décrire les différents aspects cliniques des dermatoses néonatales observées. MATÉRIEL ET MÉTHODES: L'étude s'est déroulée au Centre hospitalier universitaire de Cocody (Abidjan). L'étude était transversale, à visée descriptive et analytique, réalisée sur la base d'un recrutement prospectif. Ont été inclus, les nouveau-nés ayant été vus en consultation externe ou en hospitalisationdu 4 avril 2018 au 23 août 2018 chez qui le médecin pédiatre avait observé des lésions cutanées et/ou muqueuses.Ensuite,le diagnostic était posé par le dermatologue référant de l'étude. RÉSULTATS: Pendant la période d'étude, 116 nouveau-nés ont été recensés. La moyenne d'âge était 16,86 ± 8,4 jours avec un âge médian de 19 jours. Lesex ratio (H/F) était de 1. Dans plus de la moitié (53,5%) des cas, les lésions évoluaient depuis moins de 5 jours. Une dermatose transitoire était diagnostiquée dans plus de la moitié des cas (51,7%) et dans près du tiers des cas (32,6%) une dermatose infectieuse. Les dermatoses transitoires du nouveau-né étaient dominées par la miliaire sudorale (40%), l'érythème toxique (23%), la desquamation néonatale (10,7%) et l'hyperplasie néonatale (10,7%).Les taches mongoloïdes représentaient3,3% des cas. Les dermatoses infectieuses étaient essentiellement représentées par des infections mycosiques (68,4%) et bactériennes (31,6%). Les autres dermatoses néonatales observées étaient dominées par dermite du siège (64,3%) et les nÅvi congénitaux (21,5%). Plus de la moitié (57,1%) des cas d'érythème toxique néonatal survenaient entre le 6e et le 10e jour de vie. L'âge moyen des patients présentant une dermatose transitoire était de 14,31 jours contre 19,41 jours pour ceux présentant les autres dermatoses. La différence observée au niveau de l'âge était statistiquement significative (p < 0,05). CONCLUSION: Les dermatoses néonatales sont multiples et variées. Certaines sont transitoires, ne nécessitant pas toujours de prise en charge thérapeutique. Leur diagnostic n'est pas toujours évident pour le pédiatre d'où la nécessité d'une étroite collaboration entre pédiatres et dermatologues afin d'améliorer la démarche diagnostique et parfois thérapeutique.
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La paralysie néonatale du plexus brachial, qui se manifeste à la naissance, peut être débilitante et avoir des conséquences prolongées. La présentation à la naissance dépend de l'importance de la lésion nerveuse et peut varier entre une faiblesse transitoire et une parésie globale qui touche l'amplitude active des mouvements. Il est essentiel de procéder à des examens cliniques sériels après la naissance et pendant la période néonatale (jusqu'à l'âge d'un mois) pour évaluer le rétablissement et prédire le pronostic à long terme. Le présent document de principes décrit l'évaluation des facteurs de risque des nouveau-nés à la naissance, l'orientation précoce vers une équipe multidisciplinaire spécialisée et les communications entre les intervenants communautaires et les spécialistes pour optimiser le pronostic pendant l'enfance.
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In this commentary, we summarize the current evidence from randomized controlled trials on enteral lactoferrin supplementation in preterm neonates. Our recently completed systematic review includes 12 randomized controlled trials performed all over the world. Our meta-analysis suggests clinical benefit in decreasing late-onset sepsis, late-onset fungal sepsis, length of stay in the hospital and urinary tract infections. There were no adverse effects. There was no statistically significant decrease in necrotizing enterocolitis, mortality or neurodevelopmental impairment in lactoferrin supplemented preterm infants. There was significant statistical heterogeneity in the effects of lactoferrin on late-onset sepsis between larger and smaller studies, which may reflect either small study biases, differences in the effectiveness, dose or duration of supplemental lactoferrin products, or differences in underlying population risk, or any or all of these.
Assuntos
Nutrição Enteral , Lactoferrina/administração & dosagem , Sepse/prevenção & controle , Infecções Urinárias/prevenção & controle , Suplementos Nutricionais , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
OBJECTIVES: Croatian Institute of Transfusion Medicine (CITM) implemented non-invasive fetal RHD genotyping as a request for targeted antenatal anti-D prophylaxis. The diagnostic performance of in-house RT-PCR method for fetal RHD genotyping and preliminary results are analyzed. MATERIALS AND METHODS: Evaluation included results of RHD genotyping for 205 RhD negative pregnant women, 12-36th week of gestation, whose samples were received in period between 2015 and 2020. QIAsymphony SP DSP Virus Midi Kit was used for cffDNA extraction on QIAsymphony SP platform (Qiagen, Germany). Fragments of RHD exons 7 and 10 and later exon 5 were RT-PCR amplified. As internal controls, amplification of SRY gene or RASSF1A fragment and ß-actin genes digested with BsTUI were used. RESULTS: We identified 70.72% (145/205) positive and 28.78% (59/205) negative fetal RHD genotypes. We had one inconclusive result (0.50%) due to the interference of maternal DNA with variant genotype RHD*09.02.00/01/*01N.01. When compared to newborns RhD phenotypes, no false negative and three false positive results (3/199, 1.50%) were observed. The test yielded 100% sensitivity and 95.08% specificity, while diagnostic accuracy was 98.48%. We were able to determine one case of fetal variant genotype RHD*04.04/*01N.01 inherited from the father. The negative and positive predictive test values were 100% and 97.86%, respectively. CONCLUSION: Automated cffDNA extraction and RT-PCR amplification of fetal RHD exons 5,7,10 and fragments of SRY, RASSF1A genes represents highly reliable system for determining fetal RHD status which enables targeted antenatal anti-D prophylaxis. To obtain high specificity of cffDNA extraction, strict and thoroughly cleaning procedures are required.
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Diagnóstico Pré-Natal , Sistema do Grupo Sanguíneo Rh-Hr , Croácia , Feminino , Feto , Genótipo , Humanos , Recém-Nascido , Gravidez , Sistema do Grupo Sanguíneo Rh-Hr/genéticaRESUMO
When a pathology is diagnosed at the birth of a child, the parents are confronted with an overwhelming life ordeal they have to face. A discussion group for these mothers and fathers of newborn babies who have needed a digestive stoma allows them to discuss their daily lives and share common concerns, to be reassured by the difficulties encountered, to gain confidence in the care provided and to project themselves into the future more serenely.
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Anormalidades do Sistema Digestório/psicologia , Pais/psicologia , Grupos de Autoajuda , Apoio Social , Pai/psicologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Recém-Nascido , Masculino , Mães/psicologiaRESUMO
OBJECTIVES: The coronavirus SARS-CoV-2 identified late 2019 in China had spread across all continents. In the majority of cases, patients have mild symptoms (fever, cough, myalgia, headache, some digestive disorders) or are asymptomatic, however it can cause serious lung diseases and lead to death. On September 2020, over 28 million people have been infected with over 920,000 deaths. METHODS: In view of the evolution of the epidemic the French National College of Obstetricians and Gynecologists has decided to update the recommendations previously issued. To do this, the same group of experts was called upon to carry out a review of the literature and take into account the opinions of the General Directorate of Health (DGS), the "Haute Autorité de Santé" (HAS) and the "Haut Conseil de santé Publique" (HCSP). RESULTS: The data on consequences during pregnancy have accumulated. The symptoms in pregnant women appear to be similar to those of the general population, but an increased risk of respiratory distress exists in pregnant women especially in the third trimester. A case of intrauterine maternal-fetal transmission has been clearly identified. Induced prematurity and cases of respiratory distress in newborns of infected mothers have been described. CONCLUSION: In light of the new data, we propose updated recommendations. These proposals may continue to evolve in view of the pandemic and of advances in studies in pregnant women.
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Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Avaliação de Sintomas , COVID-19 , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/mortalidade , Feminino , França/epidemiologia , Humanos , Masculino , Pandemias , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/mortalidade , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Terceiro Trimestre da Gravidez , SARS-CoV-2RESUMO
OBJECTIVES: The purpose of this literature review is to make recommendations regarding the first steps and care provided to the healthy newborn. METHODS: Consultation of the Medline database, and of national and international guidelines. RESULTS: The initial assessment of the newborn should quickly determine whether resuscitation is necessary or not. Any anomaly requires the help of the pediatrician (Consensus agreement). For a newborn with no cardiorespiratory adaptation, delayed cord clamping may be considered more as a physiological modality of delivery, which may help prevent iron deficiency in the first months of life, without deleterious effects for the child or his/her mother, apart from a slightly increased risk of neonatal jaundice (gradeC). In order to avoid separating a woman and her child, it is recommended to postpone routine postnatal procedures, to allow for skin-to-skin contact between the mother and the newborn, if she wishes, according to a defined/specified surveillance protocol (grade B). Breastfeeding should be encouraged, and supported, especially the first time (Consensus agreement). In the absence of suggestive clinical signs, aspiration of the upper airways and systematic verification of the permeability of posterior nasal apertures and of the esophagus are not recommended (Consensus agreement). The prevention of hemorrhagic disease of the newborn by the oral administration of vitamin K1 to all healthy term babies begins in the delivery room, preferably in the presence of the parents and after having obtained their consent (Consensus agreement). CONCLUSION: Regarding the birth of a healthy newborn, it is strongly advised to avoid unnecessary technical actions and to favor the mother-child relationship in a safe environment.
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Ginecologia , Tocologia , Aleitamento Materno , Salas de Parto , Parto Obstétrico , Feminino , Humanos , Recém-Nascido , Masculino , GravidezRESUMO
OBJECTIVE: The objective of these guidelines is to define for women at low obstetric risk modalities that respect the physiology of delivery and guarantee the quality and safety of maternal and newborn care. METHODS: These guidelines were made by a consensus of experts based on an analysis of the scientific literature and the French and international recommendations available on the subject. RESULTS: It is recommended to conduct a complete initial examination of the woman in labor at admission (consensus agreement). The labor will be monitored using a partogram that is a useful traceability tool (consensus agreement). A transvaginal examination may be offered every two to four hours during the first stage of labor and every hour during the second stage of labor or before if the patient requests it, or in case of a warning sign. It is recommended that if anesthesia is required, epidural or spinal anesthesia should be used to prevent bronchial inhalation (grade A). The consumption of clear fluids is permitted throughout labor in patients with a low risk of general anesthesia (grade B). It is recommended to carry out a "low dose" epidural analgesia that respects the experience of delivery (grade A). It is recommended to maintain the epidural analgesia through a woman's self-administration pump (grade A). It is recommended to give the woman the choice of continuous (by cardiotocography) or discontinuous (by cardiotocography or intermittent auscultation) monitoring if the conditions of maternity organization and the permanent availability of staff allow it and, after having informed the woman of the benefits and risks of each technique (consensus agreement). In the active phase of the first stage of labor, the dilation rate is considered abnormal if it is less than 1cm/4h between 5 and 7cm or less than 1cm/2h above 7cm (level of Evidence 2). It is then recommended to propose an amniotomy if the membranes are intact or an oxytocin administration if the membranes are already ruptured, and the uterine contractions considered insufficient (consensus agreement). It is recommended not to start expulsive efforts as soon as complete dilation is identified, but to let the presentation of the fetus drop (grade A). It is recommended to inform the gynecologist-obstetrician in case of nonprogression of the fetus after two hours of complete dilation with sufficient uterine dynamics (consensus agreement). It is recommended not to use abdominal expression (grade B). It is recommended to carry out preventive administration of oxytocin at 5 or 10 IU to prevent PPH after vaginal delivery (grade A). In the case of placental retention, it is recommended to perform a manual removal of the placenta (grade A). In the absence of bleeding, it should be performed 30minutes but not more than 60minutes after delivery (consensus agreement). It is recommended to assess at birth the breathing or screaming, and tone of the newborn to quickly determine if resuscitation is required (consensus agreement). If the parameters are satisfactory (breathing present, screaming frankly, and normal tonicity), it is recommended to propose to the mother that she immediately place the newborn skin-to-skin with her mother if she wishes, with a monitoring protocol (grade B). Delayed cord clamping is recommended beyond the first 30seconds in neonates, not requiring resuscitation (grade C). It is recommended that the first oral dose (2mg) of vitamin K (consensus agreement) be given systematically within two hours of birth. CONCLUSION: These guidelines allow women at low obstetric risk to benefit from a better quality of care and optimal safety conditions while respecting the physiology of delivery.