Recommendation for hygiene and topical in neonatology from the French Neonatal Society.

We sought to establish guidelines for hygiene care in newborns based on a systematic review of the literature and grading of evidence using the Groupe de Réflexion et d'Evaluation de l'Environement des Nouveau-nés (GREEN) methodology. We examined 45 articles and 4 reports from safety agencies. These studies recommend a tub bath (rather than a sponge bath) for full-term infants and a swaddle bath for preterm newborns. They also recommend against daily cleansing of preterm infants. The literature emphasized that hygiene care must consider the clinical state of the newborn, including the level of awareness and behavioral responses. Hospitalized newborns treated with topical agents may also experience high exposure to potentially harmful excipients of interest. Caregivers should therefore be aware of the excipients present in the different products they use. In high-resource countries, the available data do not support the use of protective topical agents for preterm infants.Conclusions: We recommend individualization of hygiene care for newborns. There is increasing concern regarding the safety of excipients in topical agents that are used in neonatology. A multidisciplinary approach should be used to identify an approach that requires lower levels of excipients and alternative excipients. What is known: • Hygiene care is one of the most basic and widespread types of care received by healthy and sick newborns worldwide. • There is no current guideline on hygiene for preterm or hospitalized term newborn. What is new: • The French Group of Reflection and Evaluation of the environment of Newborns (GREEN) provided here guidelines based on the current body of evidence. • Caregivers should be aware of the many issues related to hygiene care of newborns including newborns' behavioral responses to hygiene care, exposition to excipients of interest, and the potential risk of protective topical agents in a preterm infant. provided here guidelines based on the current body of evidence. • Caregivers should be aware of the many issues related to hygiene care of newborns including newborns' possible behavioral responses to hygiene care, exposition to excipients of interest and the potential risk of protective topical agents in a preterm infant.

Dietary fibers reduce the urinary excretion of 1-hydroxypyrene following intravenous administration of pyrene.

During biological monitoring of exposure to a chemical, a possible source of interindividual variability in the measurement of a urinary metabolite that undergoes enterohepatic cycling is the presence of dietary fiber in the gastrointestinal tract. This study examined the effect of diets containing either the insoluble fiber Alphacel (nonnutritive bulk cellulose) or the soluble pectin (from citrus fruit, MW 20,000-40,000). Five groups of male Sprague-Dawley rats received one of the following diets: poor (5% w/w) or rich (15% w/w) in Alphacel, poor (5% w/w) or rich (15% w/w) in pectin, or no fiber (NF). Five micromol/kg of pyrene was administered by iv injection immediately after feeding the animals with their respective diet, and urine and feces collections started for the determination of 1-hydroxypyrene (1-OHP), a metabolite of pyrene. The type of fiber had no influence on the results. The rats receiving diets both poor and rich in fiber excreted less 1-OHP (18 +/- 8 and 15 +/- 7 pmol per g of rat, respectively) in the 24-h urine samples than the NF group (28 +/- 6 pmol/g). There was a nonstatistically significant trend towards increased fecal and total (urinary + fecal) 1-OHP excretion with increasing amount of fiber in the diet. An in vitro experiment showed an inverse correlation (r(2) = 0.98) between the amount of Alphacel in suspension in a 1-OHP aqueous solution and the recovery of 1-OHP from the soluble fraction. The reduction in urinary output of the metabolite due to fiber reaching approximately 40% may contribute to its interindividual variability observed in occupational and environmental studies.

[Contribution to the definition of high-risk groups of low birth weight infants]. / Contribution à la définition des groupes à haut risque d'enfants de faible poids de naissance.

Follow-up studies of low birth weight infants concern usually infants selected on the basis of either the birthweight--inferior or equal to 1500 g--or the gestational age: the upper limit is 31 or 32 weeks. To determine the most pertinent criterium, mortality and neurodevelopmental outcome at two years were compared in 3 groups, selected on the above criteria from a cohort of 369 infants with a birthweight below 2,000 grams admitted in 1983 in the neonatal unit of the University hospital of Lille. Under 1501 grams the rate of small for gestational age infants is high: it could be a part of the explanation for the high rate of minor sequelae. When cohorts are selected on the basis of gestational age, it appears that mortality is low at 32 weeks but the rate of major and moderate sequelae is still high: that fact must be considered when premature induced delivery comes in discussion. Because these criteria select different high risk populations, mortality and neurodevelopmental follow-up studies should include all infants with gestational age inferior or equal to 32 weeks and/or birthweight inferior or equal to 1,500 grams.

[Very preterm infant (< 32 weeks) vs very low birth weight newborns (1500 grammes): comparison of two cohorts]. / Grands prématurés infant (< 32 semaines) vs nouveau-nés de très faible poids de naissance (< 1500 grammes): comparison de deux cohortes.

UNLABELLED: Studies concerning very preterm newborns are either defined by birth weight (<1500 g) or gestational age (<32 weeks). The aim of our study was to underline limits of cohort definitions by birth weight. METHODS: Data come from the Nord Pas de Calais EPIPAGE cohort. Every birth occurring in 1997 before 32 weeks or with a birth weight less than 1500 g and transferred in a neonatal unit was included. Two cohorts were defined, one by gestational age (<32 weeks), the other by birth weight (<1500 g). Two subgroups could be defined from these to cohorts: group A (<32 weeks and > or =1500 g), from cohort (<32 weeks), group B (> or =32 weeks and <1500 g) from cohort (<1500 g). RESULTS: Five hundred nine newborns were included. Perinatal characteristics of both cohorts seemed comparable. The analysis by subgroups A and B revealed an excess of pulmonary and neurological morbidity in very preterm infant compared to very low birth weight newborn. This was linked to an excess of growth restricted newborns in this cohort with more advanced gestational ages. CONCLUSION: Cohorts of very preterm newborns should rather be defined by gestational age. If not possible, results in very low birth weight cohorts should also be given by gestational age and rate of growth restriction should be described.

[Respiratory syncytial virus infections and apnea in low birth-weight infants]. / Infections à virus respiratoire syncytial et apnées chez le nourrisson de faible poids de naissance.

Respiratory syncytial virus infection was observed in 20 infants of less than 6 months of age who had a low weight at birth, were premature and/or presented with intra-uterine growth retardation. Except for rhinitis, which was present in all cases, the symptoms were closely correlated to the gestational age: beyond 48 weeks they were those of a common lower respiratory tract infection, but below 48 weeks attacks of apnea predominated, associated or not with signs of bronchitis. The apnea was of central origin, although there was no meningo-encephalitis; it regressed completely and without sequelae within a few days. In spite of similarities (notably of terrain) with disorders of respiratory command regarded as predictive of the sudden infant death syndrome risk, such children must be considered definitely cured after the initial episode. Including them in a long-term monitoring programme does not seem to be justified.

[Piperacillin in the newborn infant. A clinical and pharmacologic study]. / Pipéracilline chez le nouveau-né. Etude clinique et pharmacologique.

The study involved 70 neonates born at 27 to 48 weeks of pregnancy (mean: 34.2 weeks) and weighing between 840 and 4350 g (mean: 1860 g). In every case piperacillin was combined with an aminoglycoside. The infants were treated for materno-foetal infection (14), post-partum infection (19), enterocolitis (18, surgical in 9 cases) and other post-operative infections (19). The antibiotic combination was given prophylactically in 2 cases. Fifty micro-organisms were isolated in 39 patients: 24 from blood (hemoculture), 2 from CSF, 24 from multiple peripheral samples. There were 13 Gram-positive organisms (Streptococcus B, D, A, Listeria spp.) and 37 Gram-negative organisms (E. coli 14, Klebsiella spp. 10, Enterobacter spp. 6). Clinical and bacteriological cure was obtained in 67 patients. Three failures were recorded, with resistance to treatment of Klebsiella pneumoniae and emergence (at hemoculture) of Klebsiella oxytoca under treatment in one patient and of Enterobacter cloacae in another patient. A pharmacokinetic study was performed in 47 neonates. Piperacillin (75 mg/kg per dose) was given twice a day until the 8th day post-partum and three times a day subsequently. The antibiotic was administered either by 30-min infusions or by intravenous or intramuscular injections; 124 serum level measurements were carried out at peak and/or residual level. In 44 infants with normal renal and hepatic function the mean residual level was 23 micrograms/ml (range: 7-100 micrograms/ml) and the mean peak level was 119 micrograms/ml (range: 47-278 micrograms/ml). No local or systemic side-effect was noted, and there was no evidence of toxicity.

[Neonatal systemic candidiasis]. / Candidoses systémiques néo-natales.

An immature cellular immunity, the prolonged use of intravascular catheters and the administration of broad-spectrum antibiotics are the principal factors responsible for systemic Candida infections in premature babies. Six infants born at less than 33 weeks and weighing 1500 grams presented with signs of non-specific septicaemia; blood cultures were positive for Candida. All were cured with a treatment consisting of 5-fluorocytosine in 5 cases; amphotericin B was required in one case. This experience authorizes us to recommend 5-fluorocytosine as first-choice treatment of systemic candidiasis in premature babies. We also believe that priority should be given to a policy of eradication of Candida in all neonatology units.

[Discharge to the family milieu of low birth weight children. Analysis of an experience with "early discharge" in a neonatology unit]. / Le retour en milieu familial des enfants de faible poids de naissance. Analyse d'une expérience de "sortie précoce" d'un service de néonatologie.

A retrospective study of 182 children with birth weights less than or equal to 2,000 gms was undertaken. Its analysis showed that heterogeneity in discharge weights (1,580 to 3,400 gms) corresponded to an homogeneous average gestational age, around 39 weeks. Low discharge weights were neither correlated with the pathology of the first days, nor with the socio-economic status of the family. The majority were children born with intra-uterine growth retardation, who mature more rapidly and who might be given to their families earlier, with lower weights. There was no correlation between discharge weight and a second hospitalization during the first year. A policy of "early" discharge did not seem to have disadvantages, while its advantages are unquestionable.

[Ultrasonic diagnosis of periventricular leukomalacia in premature infants]. / Le diagnostic échographique des leucomalacies périventriculaires du prématuré.

The ultrasonographic study through the fontanelle of 192 children below 33 weeks of age and surviving after the neonatal period led to the diagnosis of leukomalacia by identifying anechogenic cavities in the periventricular area in 7 cases. Clinical pictures were not characteristic. Important electro-encephalographic changes were constantly found, even before the occurrence of sonographic signs. Although non specific they are still suggestive when associated hemorrhage is not present. With these criteria, diagnosis seems to be correlated with severe neurologic prognosis. Its interest and chronology warrant the extension of the ultrasonographic supervision of severely immature infants up to the end of the second month.

[Pseudo-diastrophic dysplasia]. / La dysplasie pseudo-diastrophique.

A new case of pseudo-diastrophic dysplasia in a boy born to consanguineous parents is reported. The patient developed neurologic (hydrocephalus) and respiratory anomalies and died at the age of 11 months of an unknown cause. Features that distinguish this chondrodysplasia from diastrophic dysplasia include decreased height of vertebral bodies and anomalies of the pelvis with short iliac wings and a horizontal orientation of the internal spine of the acetabular roof.