Identification of newborns at risk of early-onset neonatal infection: New French guidelines and practices at Nantes University Hospital.

New French guidelines in 2017 aimed to improve the identification of newborns at risk of early-onset neonatal infection (EONI). Identification is based on perinatal risk factors, management of perinatal antibiotic prophylaxis, and standardized clinical assessment. We conducted a retrospective cross-study at the University Hospital of Nantes. The main objective was to assess implementation of the French guidelines. Of 1240 births included, 40% (501) required perinatal antibiotic prophylaxis (adequate in 67.3%) and 306 (24.7%) needed a standardized clinical assessment (performed in 69.2%). Only two newborns (0.16%) included in the study received neonatal antibiotic therapy. On the basis of the assessment conducted in our maternity ward, implementation of the recommendations seems to be effective.

Father newborn skin-to-skin wheelchair transfer from delivery room to neonatal care unit: Possible change in practices.

OBJECTIVE: To evaluate the transfer of newborns from the delivery room to the neonatal care unit with their fathers on wheelchairs in terms of the safety of the procedure and paternal anxiety. METHODS: A prospective observational single-center before-and-after pilot study was conducted from February to May 2018 at the University Maternity Hospital of Nantes. Safe transfer was judged on the basis of episodes of hypothermia or hypoglycemia. Paternal anxiety was assessed with the State-Trait Anxiety Inventory (STAI) scale after newborn transfer. RESULTS: Overall, 70 preterm newborns were enrolled, 44 were carried in wheelchairs in the father's arms (target group) and 26 were transferred in an incubator (control group). After adjusting for gestational age and birthweight, there were no statistically significantly differences between the target and the control group in the rates of hypothermia (43.9% vs 30.8%, p = 0,59) and hypoglycemia (9.52% vs 19.23%, p = 0,19). The STAI scale score was not significantly different between groups after incubator transfer or wheelchair transfer, at 35 ± 8.2 and 38 ± 10.2, respectively (p = 0.07). CONCLUSION: Transferring a newborn to the neonatal care unit via wheelchair with the father is a safe alternative to incubator transfer.

Epidemiology of invasive early-onset neonatal infection in a French administrative district: A 10-year population-based study.

BACKGROUND: In light of the pending update of the French guidelines for the management of neonatal infections, knowing the current epidemiology of early-onset neonatal infection (EONI) is essential. OBJECTIVES: The aim of this study was to assess the current epidemiology of a French administrative district population of proven EONI, including umbilical cord blood procalcitonin levels. METHODS: We conducted a retrospective population-based study in the Nantes metropolitan area. We included all infants treated for proven EONI in the maternity, neonatology, and intensive care wards between 1 January 2006 and 31 December 2015 in the Nantes University Hospital. RESULTS: Among the 140,502 children born during the study period, 61 cases of EONI were documented. The overall incidence of confirmed EONI was 0.43/1000 live births, with 0.23/1000 GBS (group B streptococcus) infections and 0.08/1000 Escherichia coli infections. The majority of infected newborns were full-term or late-preterm infants (67% were≥34 weeks of gestation), 88% had symptoms of EONI in the first 24h of life, most of which were respiratory. The mortality rate was 8% (in premature infants). Available in 51% of the population, the cord blood PCT value could contribute to an earlier diagnostic screening in 10% of cases but with a very low sensitivity. CONCLUSIONS: The incidence of confirmed EONI is low in this French district. The diagnostic value of PCT umbilical blood cord should be assessed based on further studies before confirming its value. We suggest that a national registry of these rare but serious cases of EONI could contribute to monitoring the epidemiological progression as well as to optimizing our diagnostic and therapeutic strategies.

Atividades antinociceptiva e antiinflamatória do extrato etanólico de Luehea divaricata / Antinociceptive and anti-inflammatory activities of Luehea divaricate ethanol extract

RESUMO Considerando os diferentes usos etnofarmacológicos apresentados pela planta Luehea divaricata, realizou-se este estudo com o objetivo de avaliar as atividades antinociceptiva e antinflamatória do extrato etanólico de suas folhas, em modelo animal, nas dosagens de 20, 40, 80 e 160 mg/Kg, por via oral. Foram realizados os seguintes testes: contorções abdominais induzidas pelo acido acético, placa quente, formalina e edema de pata induzido por carragenina. Foram utilizados camundongos Swiss (20-25 g) para os três primeiros testes e ratos Wistar (180-250 g), para o último, divididos em seis grupos de oito animais, totalizando 48 animais em cada parâmetro de avaliação. Os resultados foram analisados estatisticamente pela análise de variância a 5% de probabilidade, para verificar quais os tratamentos que diferiram entre si, e estes foram submetidos aos testes de Kruskall-Wallis e Student-Newman-Keuls. O extrato etanólico das folhas de L. divaricata (EEtOH-Ld), nas diferentes doses estudadas, apresentou significativa atividade antinociceptiva sobre a dor induzida quimicamente por injeções intraperitoneal de acido acético e intraplantar de formalina. Na dosagem de 160 mg/Kg, esse extrato apresentou ação analgésica central, aos 120 minutos de observação, no teste de placa quente e reduziu o edema de pata induzido pela administração de carragenina, uma hora após a administração do agente inflamatório, semelhante ao efeito produzido pelo fármaco padrão.

ABSTRACT Considering the different ethnopharmacological uses submitted by the plant Luehea divaricata, this study took place in order to evaluate the antinociceptive and anti-inflammatory activities of the ethanol extract of the leaves in an animal model, the dosages of 20, 40, 80 and 160 mg/kg by oral intake. The following tests were performed: writhing induced by acetic acid, hot plate, formalin, and paw edema induced by carrageenan. Swiss mice (20-25 g) were used for the first three tests and Wistar rats (180-250 g) for the last, divided into six groups, each of eight animals, totaling 48 animals for each assessment parameter. The results were statistically analyzed by analysis of variance at 5% probability to verify which treatments differ, and these were tested by Kruskal-Wallis and Student-Newman-Keuls. The ethanol extract of L. divaricataleaves (EEtOH-Ld) at the different studied doses showed significant antinociceptive activity on chemically induced pain by intraperitoneal injections of acetic acid and intraplantar formalin. At a dosage of 160 mg/kg, this extract showed a central analgesic action after 120 minutes of observation in the hot plate test and reduced action in the paw edema induced by carrageenan one hour after the administration of the inflammatory agent, similar to the effect produced by the standard drug.

Influência da própolis sobre os perfis leucocitário e proteico de camundongos e tempo de fechamento de feridas excisionais limpas e infectadas por Staphylococcus aureus / Influence of Propolis on leukocyte and protein profiles of mice and closing time of excisional wounds clean and infected by Staphylococcus aureus

RESUMO Este estudo teve como objetivo avaliar os efeitos da própolis sobre os perfis leucocitário e protéico de camundongos e sobre o tempo de fechamento de lesões de pele confeccionadas experimentalmente, limpas e infectadas com Staphylococcus aureus. No primeiro, foram utilizados 48 animais divididos em quatro grupos, sendo um tratado com solução hidroalcóolica pura e três tratados com própolis a 10%, nas dosagens de 20 mg, 40 mg e 80 mg por animal de 25 gramas de peso, em única aplicação intraperitoneal. Foram coletadas amostras de sangue no segundo, 10º, 18º e 26º dias após o tratamento para realização de leucograma, proteinograma e fracionamento eletroforético das proteínas. Na avaliação da atividade cicatrizante, também foram utilizados 48 camundongos divididos em seis grupos, nos quais realizou-se a confecção cirúrgica de feridas na dimensão de 1cm2, após anestesia dissociativa. Dois grupos serviram como controle para feridas limpas e infectadas. Dois grupos de feridas infectadas por S. aureuse dois grupos de feridas limpas foram tratados com própolis a 5% e 10%, sendo a escolha destas concentrações baseada em um estudo piloto realizado. Os resultados mostraram que o tratamento com própolis influencia o leucograma e o proteinograma, de forma dose-dependente, sendo que a maior dose utilizada desencadeou leucocitose com linfocitose e aumento de proteínas da fração gamaglobulínica, no 10º dia após o início do tratamento. Também mostraram que a concentração da solução influenciou o tempo de cicatrização das feridas infectadas, ocorrendo em menor tempo no grupo tratado com a solução a 5%.

ABSTRACT This study aimed to evaluate the propolis effects on both the leukocyte and protein profiles of mice and on the closing time of skin lesions made experimentally, clean and infected with Staphylococcus aureus. The first 48 animals were divided into four groups, one treated with pure alcohol solution and three treated with propolis 10% at dosages of 20 mg, 40 mg and 80 mg per 25 g of animal weight in an intraperitoneal single application . Blood samples in the second, and then 10º, 18º and 26º days after treatment were collected in order to perform WBC, proteins and electrophoretic fractionation of proteins. Regarding the healing activity, also 48 mice divided into six groups were used, in whom surgical wounds in the size of 1cm2 were purposely inflicted , after the dissociative anesthesia were applied . Two groups served as control ones, for clean and infected wounds. Two groups of S. aureus with infected wounds and two groups with clean sores were treated with 5% and 10 % propolis, being this concentration choice based on a pilot study previously performed. The results showed that treatment with propolis influences leukocyte and protein concentrations in a dose- dependent manner, with the highest dose triggering leukocytosis with lymphocytosis and increasing the protein fraction of gamaglobulínica, on the 10th day after the start of treatment. It also indicated that the concentration of the solution influence the time of healing of infected wounds, since the process on the group treated with 5% solution happened faster.

[Hurler syndrome: early diagnosis and treatment]. / Syndrome de Hurler : diagnostic et prise en charge précoces.

Hurler syndrome, the most severe form of mucopolysaccharidosis type I (MPS I), is a rare lysosomal storage disease. The overall incidence of MPS I is 0.99-1.99/100,000 live births. Accumulation of glycosaminoglycans causes the progressive dysfunction of multiple organs. We report the case of a 3-week-old newborn who was hospitalized in the Neonatal Intensive Care Unit for feeding problems. Coarse facial features and gingival hypertrophy, associated with axial hypotonia, upper airway obstruction, and moderate hepatomegaly, led to the early diagnosis of MPS I at 3 weeks of age and was confirmed by an abnormally elevated amount of dermatan and heparan sulphate in the urine and complete deficiency of alpha-L-iduronidase lysosomal enzyme activity. The child was homozygous for the p.W402X mutation, located on chromosome 4p16.3 of the alpha-L-iduronidase (IDUA) gene. The clinical condition gradually deteriorated until the age of 4 months, with thoracic and lumbar dysostoses, glaucoma, cerebral ventricular dilatation and cervical spinal stenosis, dilated cardiomyopathy, and umbilical hernia. Early diagnosis allowed enzyme replacement therapy (iaronidase, Aldurazyme(®), Genzyme) started at the age of 5 months, which provided stabilization of the heart disease, significant regression of rhinologic symptoms, and regression of hepatomegaly. Cord blood hematopoietic stem cell transplantation was performed at 11 months of age, allowing optimal preservation of cognitive development.

[Diagnostic value of suspicion criteria for early-onset neonatal bacterial infection: report ten years after the Anaes recommendations]. / Valeur diagnostique des critères de suspicion d'infection néonatale précoce : bilan dix ans après les recommandations de l'Anaes.

BACKGROUND: Because clinical symptoms and biological markers are neither sensitive nor specific, newborns are frequently suspected of having an infection. In France, 30-50% of newborns are suspected of having early-onset sepsis (EOS) and many of them undergo laboratory tests and empirical antibiotic treatments while awaiting results. The aim of this study was to evaluate the diagnostic value of various suspicion criteria for EOS as recommended by the Anaes since 2002, and the value of umbilical cord blood procalcitonin (PCT), currently assayed in our maternity ward. MATERIAL AND METHODS: This 4-year retrospective study in the CHU of Nantes included hospitalized newborns with suspected early neonatal infection. Infection status was established according to the Anaes definitions and clinical evolution. RESULTS: The study included 2151 newborns. Among anamnestic criteria, only prematurity significantly increased the risk of EOS (relative risk of 3.1; 95% CI 1.4-7.0). The relative risk of infection for a symptomatic newborn was 12.2 (95% CI 4.9-30.2; P<0.0001). Laboratory test results were the most predictive criteria. The relative risk to be infected was 291.6 (95% CI 70.7-1,214.0; P<0.0001) with a blood cord PCT value>0.6 ng/L. The positive post-test probability was 28% (95% CI: 23-33) and the negative post-test probability was close to 0 (95% CI: 0-0). CONCLUSION: Clinical criteria of postnatal life adaptation are more predictive of early-onset neonatal infection than anamnestic criteria are. The blood cord PCT value could be a helpful marker in the identification of infected newborns. PCT measured in umbilical cord blood could be included in a general algorithm in order to identify as soon as possible newborns with a high risk of EOS.

Umbilical cord blood procalcitonin level in early neonatal infections: a 4-year university hospital cohort study.

This article describes a study of procalcitonin (PCT) measured in cord blood as a discriminating marker of early-onset neonatal infection. This was a monocenter retrospective study with prospective collection of data including all babies born during the study period. Those presenting infection risk factors had PCT measurement. Three groups were defined: certainly infected, probably infected, and non-infected. A total of 12,485 newborns were included, 2151 had PCT measurement, and 26 were infected. Receiver operating curves of PCT determined 0.6 ng/ml as the best cut-off, with an area under the curve of 0.96 (CI 95% 0.95-0.98). Sensitivity, specificity, positive and negative predictive value and positive and negative likelihood ratios were 0.92 (range, 0.75-0.98), 0.97 (0.96-0.98), 0.28 (0.20-0.36), 0.99 (0.99-0.99), 32 (24-41) and 0.08 (0.02-0.3), respectively. Post-test probabilities were 28% (23-33) if the test was positive, and less than 0.001% (0-1.10(-5)) if the test was negative. Gestational age between 28 and 32 weeks (OR 4.4; range, 1.2-16.2) and pH at birth < 7.10 (OR 2.9; 1.1-7.4) were other independent factors of increasing PCT (p < 0.05). PCT measured in umbilical cord blood is reliable to detect early infected and non-infected newborns.

[Chorioangiomatosis: a rare etiology of nonimmune hydrops fetalis. Obstetric and pediatric implications for patient care]. / La chorioangiomatose : une cause rare d'anasarque foetoplacentaire non immune. Implications pratiques obstétrico-pédiatriques.

UNLABELLED: We report a case of chorioangiomatosis with hydrops fetalis as a complication. OBSERVATION: Hydrops fetalis associated with fetal distress led to preterm birth at 33 GW. Resuscitation was needed at birth. A systematic histologic exam showed diffuse chorioangiomatosis. There was no congenital hemangioma. COMMENTS: We describe the features of chorioangiomatosis, a rare cause of nonimmune hydrops fetalis. Prenatal diagnosis of chorioangiomatosis before early recognition of severe maternal and fetal complications during pregnancy is infrequent, thus precluding early management of the pregnancy. Reports of associated chorioangioma and infantile hemangioma are frequent, illustrated with a recent pathophysiological hypothesis involving embolism of a placental angioblast as for the cause of congenital hemangioma. Investigations for associated cutaneous or visceral infantile hemangioma should be undertaken when chorioangioma is diagnosed.

Changes in the atmospheric deposition of acidifying compounds in the UK between 1986 and 2001.

Emissions of a precursor of acidity in precipitation, sulphur dioxide (SO2), declined in the UK and the EU (15) by 71% and 72%, respectively, between 1986 and 2001, while nitrous oxide emissions declined by about 40%. Acidity in UK precipitation and the deposition of sulphate in precipitation halved during this period, but reductions were larger in the English Midlands than at the west coast and in high rainfall areas (>2000 mm). There is evidence that the smaller reductions in sulphur deposition in the west and south are due in part to shipping sources of SO2. Reductions in sulphur dry deposition (74%) are larger than in wet deposition (45%), due to changes in the canopy resistance to dry deposition. For reduced nitrogen, there has been a small (10%) reduction in emissions and deposition, while for oxidized nitrogen, a substantial reduction in emissions (40%) occurred but wet deposition of nitrate changed by less than 10%.