Developmental outcome of children with Robin sequence: How does the question arise?

Robin sequence (RS) is a heterogeneous congenital condition characterized by retrognathia, glossoptosis, upper airway obstruction, and very often, posterior U-shape cleft palate. Half the children with RS have an underlying syndrome, either identified (syndromic RS) or not (RS+). Long-term intellectual developmental outcome first depends on the underlying diagnosis and is often poor in syndromic cases. On the contrary, the rare studies that analysed the long-term developmental outcome of children with isolated RS who received effective treatment of their respiratory and feeding difficulties early in life, showed intellectual and academic results close to or within the normal range. Speech outcome in RS is often delayed with phonation disorders. Speech difficulties depend on intellectual level, hearing and velar function after palate repair. It affects most children with RS and deserves active monitoring and care.

Modeling of PCB trophic transfer in the Gulf of Lions; 3D coupled model application.

3D coupled modeling approach is used for the PCB dispersion assessment in the Gulf of Lion and its transfer to zooplankton via biogeochemical processes. PCB budgets and fluxes between the different species of PCB: dissolved, particulate, biosorbed on plankton, assimilated by zooplankton, which are governed by different processes: adsorption/desorption, bacteria and plankton mortality, zooplankton excretion, grazing, mineralization, volatilization have been estimated. Model outputs were compared with the available in situ data. It was found that the Rhone River outflows play an important role in the organism contamination in the coastal zone, whereas the atmospheric depositions are rather more important in the offshore zones. The transfer of the available contaminant to bacteria and phytoplankton species is mainly related to the biomass present in the water column. Absorption fluxes (grazing) to zooplankton are rather higher than the passive sorption fluxes, which are themselves also linked to the sorption coefficient.

Modelling faecal coliforms dynamics in the Seine estuary, France.

A model describing the dynamics of faecal coliforms (FC) in the Seine estuary has been developed and coupled with a three-dimensional hydrodynamic model. As input to this model three types of FC sources were considered: (1) FC transported by the Seine river flow at the estuary entrance at Poses dam; (2) FC brought in through the tributaries of the Seine estuary; and (3) the outfalls of the treated effluents of the WWTPs located along the estuary. As previous studies in the Seine estuary showed that a large proportion of FC was attached to SM, two pools of FC were considered separately in the model: free FC and FC attached to SM. Two main processes controlling the fate of FC in the estuary were considered: mortality and settling. The model calculates for a given discharge of the Seine river at Poses the longitudinal distribution of FC along the estuary. The model was validated by comparison of model calculations with experimental data in various hydrological conditions. The model also correctly reproduced the impact of the main river flow rate on the level of estuarine water's contamination. Finally, the model was used to test different scenarios of sanitation, suggesting priorities for sanitation efforts.

[Infantile rumination]. / Mérycisme infantile.

Infantile rumination can be defined as self-induced regurgitation of previously swallowed food. Because it can lead to potential somatic complications and because it implies dysfunctional mother-child bonding, both a pediatric and psychiatric approach is needed. The treatment must be somatic (nutritional) and psychological (intensive nursing, mother-baby psychotherapy). Two case studies illustrate this rare but impressive picture.

Early feeding resistance: a possible consequence of neonatal oro-oesophageal dyskinesia.

UNLABELLED: Paediatricians frequently find early feeding disorders in neonates and infants that result in poor weight gain and which sometimes have no clear organic basis. For many years, we have observed infants with unexplained poor feeding skills and excessive regurgitation, and since 1992 we have prospectively performed oesophageal manometry in infants hospitalized for retarded growth and "unexplained" feeding disorders. From the group of infants hospitalized for growth failure in the General Paediatric Unit of Necker-Enfants Malades Hospital from 1992 to 1997, we identified 16 children (3%) with abnormal feeding behaviour who had an abnormal oesophageal manometry. The manometric data of these children were compared with those of a group of 16 age-matched children who underwent oesophageal manometry for other reasons, and served as controls. The affected children had precocious feeding skills disorders: prolonged bottle-feeding (75%), bottle refusal (75%), unexplained crying (63%) and excessive regurgitation (94%). Half of them had mild anatomical facial consequences of their poor foetal sucking, and mild pharyngolaryngeal hypotonia, which could not be considered as malformations. Apart from these disorders, their clinical status was normal. At inclusion, their oesophageal manometry was abnormal, showing in 70% of cases specific anomalies: lower oesophageal sphincter hypertonia and/or partial failure to relax, and giant waves of oesophagus body. Their course was good and their feeding difficulties decreased around the end of the first year, with the acquisition of normal voluntary mastication. CONCLUSION: We suggest that the early feeding resistance of this group of children could be related to an organic and transient neonatal oro-oesophageal dyskinesia.