Neurodevelopmental outcome of late-preterm infants: Literature review.

Late-preterm infants are characterized by a birth term from 340/7 to 366/7 weeks of gestation. A foetal brain at 340/7 weeks of gestation weighs only 65% of the full-term newborn brain, which suggests a particular cerebral vulnerability to injury during this 6-week period. Epidemiological studies reporting the neurological outcomes of late-preterm infants exhibit large methodological heterogeneity that inhibits clarity on this issue. However, contradictory results and odds ratio values near neutral reveal probable moderate neurodevelopmental delay in late-preterm infants. This observation reflects the variable neurological outcomes of this population according to multiple perinatal factors. Therefore, the current challenge is to define efficient screening strategies to determine infants requiring specific follow-up.

[Do we need to perform systematic supracervical hysterectomy during laparoscopic sacrocolpopexy?] / Doit-on réaliser systématiquement une hystérectomie subtotale dans le cadre d'une promontofixation cœlioscopique ?

OBJECTIVE: To evaluate the place of subtotal hysterectomy during laparoscopic sacrocolpopexy. METHODS: This retrospective observational study includes patients undergoing laparoscopic sacrocolpopexy between November 2010 and March 2015 at the Centre Hospitalier Régional de la Citadelle, Liège, Belgium. Patient characteristics, medical and surgical history were collected. Clinical data, operative and intraoperative complications were analyzed. The postoperative results were collected at 6 weeks, 4 months and then every year with a clinical and anatomical evaluation by POP-Q (Pelvic Organ Prolapse - Quantification). RESULTS: Ninety-four patients were included in the study. Sixty-four patients (68.1%) underwent sacrocolpopexy with subtotal hysterectomy, 12 patients (12.7%) had sacrocolpopexy with uterine preservation, 16 patients (17%) had a clinical history of hysterectomy and 2 patients (2.2%) have had sacrocolpopexy with total hysterectomy. The mean age of the patients was 61±20 years, parity 2±2 and BMI 25.2±7.32. The objective success rate, defined by a stage of POP-Q<2, was 93.75% in the sacrocolpopexy group with subtotal hysterectomy vs. 66.7% in the sacrocolpopexy group with uterine preservation (P=0.019). The subjective success rates were 98.4% and 83% respectively (P=0.063ns). CONCLUSION: Sacrocolpopexy offers good anatomical results, with better objective and subjective success rates when associated with a subtotal hysterectomy. The decision of hysterectomy should consider the risk/benefit balance and the patient's preferences.

Nutritional evaluation and productivity of supplemented sheep grazing in semiarid rangeland of northeastern Brazil.

Sheep production systems in Brazilian caatinga rangelands require supplementation adapted to changes in floristic and chemical composition as dry seasons progress. Meeting sheep nutritional needs in extensive semiarid systems is challenging because of sheep dietary preferences and habits. The objective of this trial was to evaluate the substitutive effect of concentrate supplementation on grazing sheep in the Brazilian caatinga rangeland and its consequences on performance in different seasons. The trial was conducted from March to August 2013 at Embrapa Goat and Sheep in Sobral, Ceará State, Brazil. Thirty-two Brazilian Somali multiparous ewes were submitted to estrus synchronization and controlled breeding. At the start of the trial, ewes averaged 30.45 + 2.60 kg body weight (BW). Ewes were divided into four groups and individually offered 0, 200, 350, or 500 g supplement head-1 day-1. Intake prediction and digestibility trials were evaluated at three periods: rainy season (April), transition rainy-dry (June), and dry season (August). Sheep weights were taken every 14 days to measure their performance from late gestation until weaning. Ewe BW and body condition score changes were determined too. Lamb BW changes were also measured every 14 days from birth through weaning. A completely randomized design with split plot arrangement using eight replications was used for intake and digestibility measurements. The differences between supplement offered (0, 200, 350, and 500 g sheep-1) and season (rainy, transition rainy-dry, and dry) were submitted to analyses of variance and multiple means were separated, where differences were detected, using the Tukey's test. During lactation up through weaning, ewes supplemented at 500 g day-1 had greater BW than ewes without supplement. Ewes supplemented with 200 g concentrate head-1 day-1 had 9.1% greater (P ≤ 0.05) BW at weaning and their lambs had 19.7% greater birth and 16.6% heavier wean BW despite lower dry matter intake compared to unsupplemented animals. Supplementation with 200 g concentrate increased carrying capacity by 28.8% during the dry season and by 20.5% during the rainy season. This study confirmed that in the dry season, when quality of rangeland forages decreases, supplementation contributes to greater DMI, improves postpartum and lactation BW recovery of ewes, and contributes to greater lamb birth and wean weights. Moreover, supplementation leads to feed substitution effects that may increase rangeland resilience by mitigating overgrazing. Supplementation with 200 g concentrate can also prevent negative energy balance for grazing animals, improving longer postnatal recovery, longer intervals between parturitions, fewer double and is necessary to ensure a better BW at birth to lambs.

Parenteral nutrition for preterm infants: Issues and strategy.

Due to transient gut immaturity, most very preterm infants receive parenteral nutrition (PN) in the first few weeks of life. Yet providing enough protein and energy to sustain optimal growth in such infants remains a challenge. Extrauterine growth restriction is frequently observed in very preterm infants at the time of discharge from hospital, and has been found to be associated with later impaired neurodevelopment. A few recent randomized trials suggest that intensified PN can improve early growth; whether or not such early PN improves long-term neurological outcome is still unclear. Several other questions regarding what is optimal PN for very preterm infants remain unanswered. Amino acid mixtures designed for infants contain large amounts of branched-chain amino acids and taurine, but there is no consensus on the need for some nonessential amino acids such as glutamine, arginine, and cysteine. Whether excess growth in the first few weeks of life, at a time when very preterm infants receive PN, has an imprinting effect, increasing the risk of metabolic or vascular disease at adulthood continues to be debated. Even though uncertainty remains regarding the long-term effect of early PN, it appears reasonable to propose intensified initial PN. The aim of the current position paper is to review the evidence supporting such a strategy with regards to the early phase of nutrition, which is mainly covered by parenteral nutrition. More randomized trials are, however, needed to further support this type of approach and to demonstrate that this strategy improves short- and long-term outcome.

Review shows that using surfactant a number of times or as a vehicle for budesonide may reduce the risk of bronchopulmonary dysplasia.

AIM: Bronchopulmonary dysplasia (BPD) remains the most common respiratory morbidity in immature infants. This review describes the diagnosis of BPD has evolved and summarises the therapeutic approaches that have made it possible to limit the incidence of BPD. METHOD: We reviewed the literature from the first definition of BPD by Northway in 1967 to the surfactant treatment policies that are currently in use, drawing on more than 50 papers up to 2017. RESULTS: Our review showed that improvements in neonatal survival have been associated with an increased risk of severe BPD, significant levels of long-term morbidity and the increased use of healthcare resources. These issues have encouraged researchers to explore potential new treatments that limit the incidence of BPD. Repeated surfactant instillation and the use of surfactant as a vehicle for budesonide are promising strategies for alleviating the burden of chronic lung disease. Ongoing research on surfactant or stem cell therapy may further improve the respiratory prognosis for prematurely born children. CONCLUSION: Considerable research has been carried out into the increase in BPD, which has resulted from improvements in neonatal survival. Key areas of research include repeated surfactant administration, using surfactant as a vehicle for budesonide and stem cell therapy.

Efeito da suplementação com sulfato de zinco ou propilenoglicol em ovinos em uma pastagem nativa da Caatinga no período chuvoso: desempenho, características da carcaça e da carne / Effect of supplementation with either Zinc sulfate or propylene glycol in lambs on a native Caatinga pasture in the wet season: performance, carcass and meat characteristics

Objetivou-se avaliar os efeitos do zinco ou do propilenoglicol sobre o desempenho e nas características da carcaça e da carne de ovinos sob pastejo em pastagem nativa da Caatinga. Utilizaram-se 24 ovinos, mestiços Santa Inês, machos, não castrados, peso inicial de 19,3±2,52kg, com quatro meses de idade, oito repetições por tratamento, distribuídos em um delineamento inteiramente ao acaso. Os tratamentos foram: sem aditivo, controle (CT), adição de sulfato de zinco (ZnSO4.7H2O) (Zn) para fornecimento de 300mg de Zn dia-1 via sal mineral, e propilenoglicol (PG), 2,5mL kgPC0,75-1 animal-1 dia-1 misturado no concentrado. Os animais foram suplementados com concentrado constituído de milho (54,0%), farelo de soja (45,1%) e calcário (0,911%) em 0,7% do PC médio de cada tratamento. O ensaio foi conduzido durante quatro meses (março a junho/2014). Avaliaram-se o desempenho e, após o abate dos animais, as características de carcaça e os componentes não carcaça, os parâmetros físico-químicos e organolépticos na carne. O Zn e o propilenoglicol não afetaram o desempenho e os parâmetros da carcaça em termos absoluto e relativo, bem como os pesos dos cortes e seus rendimentos (P>0,05). Não houve efeito dos aditivos nas características organolépticas e nos aspectos físico-químicos da carne (P>0,05), exceto cinzas (P<0,05). O zinco e o propilenoglicol não melhoram o desempenho e as características da carcaça de animais terminados em pastagem nativa da Caatinga. O baixo suprimento energético devido à má qualidade do pasto entre os meses de abril a junho contribui para a ineficiência no aproveitamento dos constituintes proteicos, implicando menor consumo e consequente diminuição do desempenho.(AU)

The aim was to evaluate the effects of zinc sulfate or propylene glycol on performance and carcass and meat characteristics from sheep under grazing in native Caatinga (Brazilian savannah) pasture during the rainy season. Twenty-four intact Santa Ines crossbreed male lambs, with an initial weight of 19.3±2.52kg, and 4-mo old, were distributed in a completely randomized design with eight replications per treatment. The treatments were composed of additives, as follows: no additive - control (CT); addition of zinc sulfate (ZnSO4.7H2O) (Zn) to supply a total of 300mg Zn day−1 on mineral salt; and addition of propylene glycol (PG), 2.5mL kg LW0.75−1 animal−1 day−1 mixed directly in the concentrate. Afterwards, they were supplemented with concentrate at 0.7% of the average LW of each batch according to the treatments. The concentrate was based on corn (54.0%), soybean meal (45.1%), and limestone (0.911%). The trials were carried out during the rainy season (March to June 2014), and evaluated the performance, and before of slaughter, carcass characteristics and non-carcass components were evaluated and the physical-chemical aspects and the organoleptic attributes on the meat. The additives did not affect the performance, parameters of carcass, in terms absolute and relative, carcass morphometric measurements, weight of the commercial cuts and yields (P>0.05). The additives did not affect the organoleptic characteristics and physical-chemical aspects of the meat (P>0.05), except, ash (P<0.05). The zinc sulfate and propylene glycol did not improve on performance and in carcass characteristics in lambs finished on a native Caatinga (Brazilian savannah) pasture. The low supply energetic due to poor quality of pasture between the months of April to June, which contributed to inefficiency in the utilization of proteics constituents, implying in lower intake, and decrease in performance.(AU)

Comparação de métodos in vitro para a quantificação da digestibilidade da matéria seca e da fibra em detergente neutro de forragens e concentrados / Comparison of in vitro methods to quantify the dry matter and neutral detergent fiber digestibility of forages and concentrates

Objetivou-se comparar a digestibilidade in vitro da matéria seca (DIVMS) e da fibra em detergente neutro (DIVFDN) de forragens e concentrados obtidos por intermédio das incubadoras DaisyII e TE-150, combinadas com filter bags tipo F57 (Ankon®) ou tecido não-tecido (TNT, 100g/m²), em relação aos valores obtidos utilizando-se o método de Tilley e Terry (1963). Foram utilizadas 25 amostras de alimentos concentrados e 25 de forragens. Não houve diferenças entre filter bags (P>0,39) para a DIVMS de forragens. Maiores valores de DIVMS (P<0,01) foram verificados para a incubadora TE-150 em relação à DaisyII. As estimativas de DIVMS obtidas com incubadoras e filter bags foram superiores (P<0,01) àquelas obtidas com o método Tilley e Terry (1963). Observaram-se maiores valores de DIVFDN de forragens (P<0,01) com filter bags F57 em relação ao TNT e com a incubadora TE-150 em relação à DaisyII. Todos os valores de DIVFDN obtidos com incubadoras e filter bags foram superiores (P<0,01) aos obtidos com o método Tilley e Terry (1963). Todos os métodos apresentaram-se positiva e fortemente correlacionados (P<0,01), tanto para DIVMS como para DIVFDN. As repetibilidades e variâncias entre amostras para DIVMS e DIVFDN foram similares entre os métodos. Portanto, conclui-se que, em se tratando de avaliações comparativas entre alimentos, todos os métodos avaliados possuem capacidade similar de discriminação.(AU)

The objective was to compare in vitro digestibility of dry matter (IVDMD) and neutral detergent fiber (IVNDFD) of forages and concentrates obtained using the incubators DaisyII and TE-150, and filter bags F57 (Ankon®) or non-woven textile (NWT - 100g/m²) in comparison with the values obtained using the Tilley and Terry (1963) method. Twenty-five samples of concentrates and 25 samples of forages were used. There were no differences between filter bags (P>0.39) for IVDMD of forages. Higher IVDMD (P<0.01) were observed for TE-150 compared to DaisyII. Estimates of IVDMD obtained with incubators and filter bags were higher (P<0.01) than those obtained with the Tilley and Terry (1963) method. Higher IVNDFD (P<0.01) were obtained with filter bags F57 regarding to NWT and TE-150 when compared to DaisyII. All values of the IVNDFD obtained with incubators and filter bags were higher (P<0.01) than those obtained with the Tilley and Terry (1963) method. Both IVDMD and IVNDFD variables were greater using TE-150 incubator than using DaisyII (P<0.04). Estimates obtained using NWT filter bags were higher (P<0.01) than F57 filter bags. All methods were positively and strongly correlated (P<0.01) to each other for IVDMD and IVNDFD. The repeatability and variances among samples for IVDMD and IVNDFD were similar among methods. In conclusion, all methods were similarly able to discriminate samples.(AU)

[Neonatal arterial ischemic stroke: Which thrombotic biological risk factors to investigate and which practical consequences?] / Accident vasculaire cérébral ischémique du nouveau-né : quels facteurs biologiques de risque thrombotique rechercher et quelles conséquences en pratique ?

All biological risk factors that have been previously identified to increase the risk of thrombosis in adults, have also been studied in neonates with arterial Ischemic Stroke (NAIS), but most studies were retrospective and included relatively low numbers of affected children. We therefore could not suggest recommendations with a strong level of evidence and only expert proposals potentially useful for clinical practice will be presented in this text. Despite these limitations, the extensive analysis of published data supported that factor V Leiden (FVL) and increased levels of Lp(a) could be significant risk factors for NAIS. Importantly, these 2 risk factors cannot be considered as having provoked NAIS, and moreover, they do not influence the prognosis and the immediate treatment. However, since the FVL may have an impact for the prescription of a thromboprophylaxis when the neonate will become adult, to look for its presence in affected patients may be justified. For clinical practice, the following propositions can be applied: 1. Routine testing for thrombophilia (AT, PC PS deficiency, FV Leiden or FII20210A) or for detecting other biological risk factors such as antiphospholipid antibodies, high FVIII, homocystein or Lp(a) levels, MTHFR thermolabile variant, should not be considered in neonates with NAIS. 2. Testing for FV Leiden can be performed in case of documented family history of venous thromboembolic disease. 3. Testing neonates for the presence of antiphospholipid antibodies (APA) is mandatory in case of clinical events suggesting antiphospholipid syndrome in the mother (vascular thrombosis, and/or pregnancy morbidity). 4. Routine testing for thrombophilia is not proposed in both parents in case of early death of the neonate, apart from APA in the mother.

[Therapeutic management of neonatal arterial cerebral infarction and neuroprotection perspectives]. / Prise en charge thérapeutique des convulsions associées à l'accident vasculaire cérébral du nouveau-né et perspectives de neuroprotection à la phase aiguë.

Neonatal seizure related to stroke is a common diagnostic feature. Their treatment, although widely debated even today must be initiated in case of status epilepticus, clinical seizures of more than 5 minutes duration or short (> 30 secondes) and repeated clinical seizures (2 or more per hour). The treatment of neonatal seizures is a challenge that remains only partially solved. It should take into account the etiology of seizures, type of brain lesions and clinical/electrical response to treatment after the first line treatment. It is based on using a single anti-epileptic at its maximum dosage, and if needed, on the association with another anti-epileptic drug with a different mechanism of action. Phenobarbital remains the most commonly used drug for initial treatment of neonatal seizures and for which the most clinical experience has been accumulated. The lack of randomized controlled trials makes difficult recommendations about the optimal duration of treatment, but most experts agree that once arrested seizures, the duration of treatment should be as short as possible because of its potential risk on the developing brain. Novel neuroprotective strategies for reducing impact of neonatal stroke or promoting brain repair remain for the moment the concept stage, pre-clinical or parcel clinical data.

[Vitamin K in the neonate: Recommendations update]. / Vitamine K chez le nouveau-né : mise à jour des recommandations.

Hemorrhagic disease of the newborn is not common but may be very serious, with cerebral, hepatic, or adrenal gland bleeding. Its prevention is based upon vitamin K1 administration from birth. Scientific studies to validate appropriate treatment policies are scarce, with recommendations coming from expert opinions, retrospective studies, or controversies on possible side effects. After analysis of recent literature data, we propose an oral administration of three doses of 2mg of vitamin K1 at birth, at discharge from the maternity ward, and at 1 month postnatal age for term infants. For premature infants born with a birth weight above 1500g, a weekly dose of 2mg up to term equivalent age may be recommended. For premature infants below 1500g, a weekly dose of 1mg up to 1500g body weight, then a weekly dose of 2mg up to term equivalent age seems appropriate. If oral administration is not possible, the intravenous or intramuscular route may be used with a 50% reduction in dosing.

[Blood transfusion to pre-term neonates: What is new in the French guidelines since 2002?] / Transfusion de culot globulaire chez le nouveau-né grand prématuré : ce qui a changé dans les recommandations françaises depuis 2002.

This document updates the "Guidelines for the Administration of Blood Products: Transfusion of Infants and Neonates" published in 2002 by the French National Authority for Health (HAS). In doing so, it acknowledges changes in transfusion practices during the past decade, particularly with respect to safety issues and additional published transfusion-related guidelines. The major modifications concern irregular agglutinin screening indications before 4 months of age, a limitation of blood irradiation, and a non-recommendation for systematically checking for cytomegalovirus status. More precise thresholds for transfusion and an update of blood transfusion alternatives were also provided. Delayed cord clamping (>30s after birth) is recommended unless the neonate is asphyxiated and needs to be moved immediately for resuscitation.

Validação do Nanolipe ® como método para determinar a digestibilidade aparente dos nutrientes pelos equinos / Validation of Nanolipe ® as method to assess the apparent digestibility of nutrients on horses

O NANOLIPE® é o indicador de digestibilidade LIPE® com incorporação de nano partículas que se misturam de forma mais homogênea e rápida na digesta, permitindo redução do período de adaptação e maiores taxas de recuperação daquele quando comparado com outros indicadores usados em equinos. Objetivou-se neste trabalho comparar a digestibilidade dos nutrientes de dieta em equinos obtida pelo método padrão (coleta total de fezes - CTF), estimada por dois indicadores internos (fibra em detergente ácido indigestível - FDAi; lignina Klason - LK) e por indicador externo NANOLIPE®, visando à validação deste último para uso na nutrição equina. Em delineamento de blocos ao acaso, oito éguas Mangalarga Marchador adultas (média de 380kg PV) foram usadas para avaliação dos tratamentos (CTF, FDAi, LK, NANOLIPE®). A dieta foi composta por 1,5% PV de feno de coast cross, 1,0% PV de concentrado comercial com 13% PB, dividido em dois tratos diários fornecidos às oito e às 17h, além de água e sal mineral à vontade. O experimento teve duração de 13 dias, sendo os oito iniciais para adaptação à dieta e ao manejo e os cinco finais para coleta de fezes. O NANOLIPE® foi fornecido no terceiro e quarto dias da coleta de fezes, sendo administrado uma vez por dia, por meio de cápsulas de 0,25g/animal/dia via oral. Houve diferença (P<0,05) entre os valores de produção fecal estimados pela FDAi (0,86kg MS) e LK (0,60kg MS) em comparação aos observados na CTF (2,16kg MS) e NANOLIPE® (2,17kg MS), com sub ou superestimação dos coeficientes de digestibilidade da MS, FDN, FDA, HEM, ED, MO e PB estimados pelos indicadores internos. O NANOLIPE® obteve alta taxa de recuperação (100,46%) e os coeficientes de digestibilidade de todos nutrientes foram semelhantes aos obtidos pela CTF. O indicador NANOLIPE® foi eficiente para estimativa da produção fecal e digestibilidade aparente dos nutrientes da dieta em equinos, quando fornecido por dois dias, sendo uma aplicação diária e com início da coleta de fezes, 24 horas após sua administração.(AU)

NANOLIPE® is the LIPE®digestibility indicator incorporating nano particles that blend more smoothly and quickly in digesta, allowing reduction of the induction period, and higher recovery rates that compared with other indicators used in horses. The objective of this work was to compare the digestibility of the diet of nutrients in horses obtained by standard method (total collection of feces - TCF) and estimated by two internal indicators ( Klason Lignin - KL and indigestible Acid Detergent Fiber.- iADF) ) and external indicator NANOLIPE®, aiming to validate the latter for use in equine nutrition. In a randomized block design, eight Mangalarga Marchador adult mares were used to evaluate treatments (CBC, iADF, LK, NANOLIPE®). The diet was composed of 1.5% PV hay Coast Cross, 1.0% PV of commercial concentrate, divided into two daily treatment.. The trial lasted 13 days, with 8 adaptation to the diet and the handling and 5 for the experimental procedures. In the first five days of the experimental period total feces was collected and in the 3th and 4th day the animals received NANOLIPE® administered once a day through capsules of 0.25 g / animal / day orally. Using the method of TFC as standart, the Klason Lignin and iADF proved inadequate (P<0,05) and NANOLIPE® was considered efficient (P>0,05) for estimating the digestibility of nutrients in the equine species. There were differences (P <0.05) between fecal production values estimated by iADF (0.86 kg DM) and LK (0.60 kg DM) compared to those observed in CTF (2.16 kg DM) and NANOLIPE® (2.17 kg DM) with under- or overestimation of the digestibility of DM, NDF, ADF, HEM, ED, OM and CP estimated by internal indicators. The NANOLIPE® got high recovery rate (100.46%) and the digestibility coefficients of all nutrients were similar to those obtained by the CTF. The NANOLIPE® indicator was efficient to estimate fecal output and apparent digestibility of dietary nutrients in horses when provided for two days, with a daily application and start collecting feces 24 hours after administration.(AU)

A Rare Complication of Central Venous Catheter Extravasation in a Preterm Neonate: Hemidiaphragmatic Paralysis.

We report a case of a preterm neonate born at 26 weeks' of gestation diagnosed with unilateral diaphragmatic paralysis. This paralysis was a consequence of a phrenic nerve injury due to extravasation of hyperosmolar parenteral nutrition fluid in the upper thorax. Chest X-rays and ultrasonography confirmed the diagnosis. The neonate was treated with prolonged respiratory support and did not require surgical treatment. This report describes a case of hemidiaphragmatic paralysis as a complication of central venous catheter insertion. In neonates, spontaneous recovery of diaphragmatic paralysis is possible. This study concludes that recovery of extravasation injury-induced phrenic nerve palsy in the context of conservative management is possible.

[Neonatal arterial ischemic stroke: Review of the current guidelines]. / Accidents vasculaires cérébraux ischémiques artériels néonatals : synthèse des recommandations.

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

Nail features in healthy term newborns: a single-centre observational study of 52 cases.

INTRODUCTION: The anatomy and embryology of the nail are well known, and nail abnormalities are a feature of many genodermatoses. However, the physiological aspect is not well described. We aimed to analyse the physiological features of nails in healthy newborns. METHODS: We performed an observational, prospective study at University Hospital Center of Tours between July and October 2015. Newborns were included by a dermatologist assistant during the systematic examination on release of the mother from the hospital. The medical history of the mother and infant were recorded by using a standardized questionnaire. Finger- and toenails were systematically photographed for a second interpretation by a dermatologist with blinding to the first photograph. RESULTS: Fifty-eight patients were eligible, and 52 were included. Half of the newborns were males, and the mean age at inclusion was 3.6 ± 1.2 days. Fingernails had an oval shape (71.1%) or a flat curvature (63.5%), and half had a lunula. Toenails showed an apparent hypertrophy of the proximal nail fold (38.4%) and lateral nail fold (73.1%). The shape of the nails was triangular (50.0%) or round (21.1%). We noted koilonychia in 32.7% of infants and lunula in 7.7%. Distal parts showed onychoschizia (28.8%) and onycholysis (26.9%). CONCLUSION: Koilonychia, onychoschizia of toenails or absence of lunula are physiological features of nails in newborns.

A Computer Prescribing Order Entry-Clinical Decision Support system designed for neonatal care: results of the 'preselected prescription' concept at the bedside.

WHAT IS KNOWN: The neonatal intensive care units (NICUs) are at the highest risk of drug dose error of all hospital wards. NICUs also have the most complicated prescription modalities. The computerization of the prescription process is currently recommended to decrease the risk of preventable adverse drug effects (pADEs) in NICUs. However, Computer Prescribing Order Entry-Clinical Decision Support (C.P.O.E./C.D.S.) systems have been poorly studied in NICUs, and their technical compatibility with neonatal specificities has been limited. OBJECTIVES: We set up a performance study of the preselected prescription of drugs for neonates, which limited the role of the prescriber to choosing the drugs and their indications. METHODS: A single 29 bed neonatal ward used this neonatal C.P.O.E./C.D.S. system for all prescriptions of all hospitalized newborns over an 18-month period. The preselected prescription of drugs was based on the indication, gestational age, body weight and post-natal age. The therapeutic protocols were provided by a formulary reference (330 drugs) that had been specifically designed for newborns. The preselected prescription also gave complete information about preparation and administration of drugs by nurses. The prescriber was allowed to modify the preselected prescription but alarms provided warning when the prescription was outside the recommended range. The main clinical characteristics and all items of each line of prescription were stored in a data warehouse, thus enabling this study to take place. RESULTS: Seven hundred and sixty successive newborns (from 24 to 42 weeks' gestation) were prescribed 52 392 lines of prescription corresponding to 65 drugs; About 30·4% of neonates had at least one out of licensed prescription; A prescription out of the recommended range for daily dose was recorded for 1·0% of all drug prescriptions. WHAT IS NEW?: The C.P.O.E./C.D.S. systems can currently provide a complete preselected prescription in NICUs according to dose rules, which are specific to newborns and also comply with local specificities (therapeutic protocols and formulation of drugs). The role of the prescriber is limited to the choice of drugs and their indications. The prescriber still retains the possibility of modifying each item of the prescription, with all other prescription items being calculated by the C.P.O.E. system. In these conditions, the prescribers rarely modified the preselected prescription and the rate of out of range prescription was low. A multicentric study is required to confirm and extend these observations. CONCLUSIONS: This study showed the feasibility of preselected prescription in NICUs and a low rate of out of range prescriptions. The preselected prescription could play a key role in lowering the dose error rate in NICUs.

Management of spinal infections in children with cerebral palsy.

Cerebral palsy patients who undergo posterior spinal instrumentation for scoliosis are at a greater risk of surgical site infection compared to adolescents with idiopathic scoliosis. Many infecting organisms are reported. Risk factors include patients' specific factors, nutritional status as well as surgery related factors. Although surgical management is still controversial, it is always based on irrigation and debridement followed or not by implant removal. The purpose of this paper is to review the pathophysiology of surgical site infection in this patient population and to propose a treatment algorithm, based on a thorough review of the current literature and personal experience.

[Neonatal complications related to shoulder dystocia]. / Complications néonatales de la dystocie des épaules: facteurs de risque et prise en charge.

OBJECTIVE: To describe neonatal complications related to shoulder dystocia. METHODS: This systematic evidence review is based on PubMed search, Cochrane library and experts' recommendations. RESULTS: The risks of brachial plexus birth injury, clavicle and humeral fracture, perinatal asphyxia, hypoxic-ischemic encephalopathy and perinatal mortality are increased after shoulder dystocia. The medical team should be able to provide neonatal resuscitation in the delivery room in case of perinatal asphyxia following shoulder dystocia, according to national and international guidelines. The initial clinical examination should search for complications such as brachial plexus birth injury or clavicle fracture. CONCLUSION: The risk of perinatal complications is increased in newborn after shoulder dystocia. The medical team should be able to manage these complications.

Consumo, degradabilidade in situ e cinética ruminal em bovinos suplementados com diferentes proteinados / Intake, degradability in situ and ruminal kinetics in cattle supplemented with different protein supplements

Objetivou-se avaliar o efeito de combinações de diferentes fontes de nitrogênio não proteico com fontes de carboidratos como suplemento para bovinos sobre o consumo, degradabilidade in situ, taxa de passagem e cinética ruminal em bovinos. Os tratamentos consistiram nos seguintes suplementos proteinados: CSUENC = casca de soja + ureia encapsulada; CSUREIA = casca de soja + ureia; MTAMIR = milho triturado + amireia; MTURENC = milho triturado + ureia encapsulada, MTUREIA = milho triturado + ureia. Os animais foram alimentados com feno de Brachiaria brizantha cv. Marandu como fonte de volumoso. O ensaio foi conduzido em delineamento quadrado latino 5x5 (cinco suplementos, cinco animais, cinco períodos). Não houve diferenças para consumo de nutrientes (P>0,05), exceto para consumo de proteína bruta g/kgPV0,75, em que se verificou maior consumo no tratamento CSUENC. Para frações fibrosas, foram obtidas maiores ingestões de fibra em detergente neutro, fibra em detergente ácido (kg/dia; % PV; g/kgPV0,75), hemicelulose (% PV; g/kgPV0,75) quando alimentados com CSUREIA em relação àqueles com MTUREIA (P<0,05). Os tratamentos constituídos pelos diferentes proteinados não afetaram a degradabilidade in situ das frações nutricionais (P>0,05), exceto para fração potencialmente degradável da celulose. A concentração de nitrogênio amoniacal no líquido ruminal foi influenciada pela composição dos proteinados (P<0,05), sendo superior para os tratamentos MTUREIA e MTURENC em relação à CSURENC. As combinações entre diferentes fontes de nitrogênio não proteico e de carboidratos nos diferentes suplementos não modificam o consumo e a degradabilidade da forragem. Dessa forma, a escolha dos ingredientes para formulação de proteinados deve ser realizada considerando-se disponibilidade e preços desses suplementos.(AU)

The aim of this study was to evaluate the effect of combinations of different sources of non-protein nitrogen with carbohydrate sources as supplement feed to cattle on intake, in situ degradability and passage rate. Treatments consisted of the following protein supplements: CSUENC= soybean hulls + encapsulated urea; CSUREIA = soybean hulls + urea; MTAMIR = ground corn + starea; MTURENC = ground corn + encapsulated urea; MTUREIA = ground corn + urea. The animals were fed with Brachiaria brizantha cv. Marandu as roughage. The experiment was conducted in a latin square design (five supplements, five animals, five periods). The treatments did not affect the intake of nutrients (P>0.05), although a higher intake of crude protein (g/kgBW0.75) was observed by animals fed with CSUENC. A higher intake of NDF, ADF (kg/day, %BW; g/kgBW0.75) and hemicellulose (% PV; g/kgBW0.75) was observed by animals fed with CSUREIA when compared to those with MTUREIA (P<0.05). The degradability of nutritional fractions was not affected by any of the treatments (P>0.05), except for the potentially degradable cellulose. The ammoniacal nitrogen concentration in rumen fluid was influenced by the protein source (P<0.05) and was higher for MTUREIA and MTURENC treatments in relation to CSURENC. The tested combinations of different sources of non-protein nitrogen with different carbohydrates did not affect the forage intake or degradability. Therefore, the choice of the ingredients for protein supplement formulation should be made considering other factors as availability and price of these supplements.(AU)

[Malignant pertussis and exchange transfusion]. / Coqueluche maligne et exsanguino-transfusion.

CASE REPORT: Malignant pertussis is a critical clinical state associated with fatal outcome in 70% of cases. The severity criteria are a lung infection with pulmonary hypertension and hyperleukocytosis usually above 50 G/L. We report the case of a 2.5-month-old girl hospitalized with critical pertussis in a pediatric intensive care unit. She had acute respiratory distress syndrome with pulmonary hypertension complicated by a bacterial secondary infection with Enterobacter cloacae managed by high-frequency oscillatory ventilation associated with pulmonary vasodilatation therapy. In the absence of clinical improvement and before considering extracorporeal life support, exchange transfusion was performed at day 9 to reduce hyperleukocytosis at 70 G/L. Exchange transfusion was successfully performed with a reduction of leukocytes to under 40 G/L followed by steady improvement of pulmonary function. Weaning from mechanical ventilation and discharge took place at day 23 and 38, respectively. COMMENTS: Exchange transfusion should be considered in infants suffering from malignant pertussis with extreme leukocytosis before hemodynamic failure to improve the survival prognosis.