[Neonatal screening of congenital toxoplasmosis. Prospective study]. / Depistage neonatal de la toxoplasmose congenitale: etude prospective.

BACKGROUND: While toxoplasmosis infection in women is often benign, transmission of maternal infection to the fetus can lead to severe sequelae. Because the majority of patients with acute toxoplasmosis are asymptomayic, a systematic serologic screening program will needed with monthly serologic screening of all seronegative pregnant women until delivery. The aim of this study was to identify cases of congenital toxoplasmosis among all live births of women found to be seronegative in pregnancy once at least. METHODS: During a prospective study period of 16 months (from 07/02/2003 to 30/06/2004) we conduct a neonatal screening of all live births of women found to be seronegative in pregnancy once at least. Peripheral samples were obtained from every couple mother/infant. Serological methods performed for diagnosis of toxoplasma specific IgM and IgG antibodies were Hemaglutination and Enzyme-linked immunosorbent assay (ELISA). RESULTS: Four cases of congenital toxoplasmosis were diagnosed after birth. All cases were asymptomatic and a specific treatment was started soon after diagnosis. The clinical and serologic evolution was normal in three cases. A serologic rebound at two years was reported in one case with a chorioretinitis in the examination of the ocular fundus. CONCLUSION: Neonatal as well maternal screening during pregnancy and at birth should be systematic to prevent, diagnose and treat early the affected neonates usually asymptomatic.

[Bronchopulmonary dysplasia and corticosteroid therapy]. / Dysplasie broncho-pulmonaire et corticothérapie.

Inflammation plays a major role in the pathogenesis of bronchopulmonary dysplasia of preterm infants. Having a strong anti-inflammatory effect, corticosteroids have been proposed in the management of this disease. Antenatal steroids protect the newborn against its development. Postnatal systemic administration of steroids reduces the duration of mechanical ventilation and oxygen therapy, but is associated with short term and long term adverse effects. Early administration of dexamethasone (before 7 days of life) reduces the incidence and the severity of chronic lung disease at 28 days of life and 36 weeks of post-conceptional age. Inhaled steroids are associated with less adverse effects than dexamethasone administration, but they are also less effective.

[Pharmacologic study of monohydrated caffeine in the treatment of apnoea of premature infant]. / Etude pharmacologique de la caféine monohydratée dans le traitement des apnées du prématuré

UNLABELLED: Monohydrated caffeine was the only respiratory xanthine available in our country to treat apnea of premature infant. The aim of this study was to evaluate plasma levels of this molecule at dosages of 20 mg/kg (equal to 18 mg/kg of caffeine base) as a loading dose and 5 mg(-1) kg(-1) (equal to 4.5 mg(-1) kg(-1) of caffeine base) as a maintenance dose. PATIENTS AND METHODS: The study was prospective including premature infants less than 34 weeks of gestational age born between the 1st of july 2001 and 15th december 2001 and receiving monohydrated caffeine to prevent apnea. Each premature infant has received orally a loading dose of 20 mg/kg in the first hours of life followed, 24 h after, by a maintenance dose orally once a day of 5 mg/kg until 35 weeks of post-conceptional age. Caffeinemia plasma levels were measured by high performance liquid chromatography immediately before the second dose to determine the loading residual rate and immediately before the sixth dose to determine the maintenance residual rate. RESULTS: Twenty-one premature infants were included. Their medium term was 31.4 weeks (27.4-33.3 weeks), birth weight was 1684 g (1000-2800 g) and sex-ratio M/F was 1.3. Fifteen infants (71.4%) have presented apnea with an average of 4.1 episodes per infant and per day. Tolerance of the medicament was good in all cases. The medium loading residual rate was 3.26 microg/ml (1.75-7.80) and the medium maintenance residual rate was 4.26 microg/ml (2.13-7.64). CONCLUSION: Prescribed at a dosage close to twice the recommendations of the literature, monohydrated caffeine does not provide efficient plasma rates. This is probably due to a difference in its oral bio-availability compared with caffeine citrate and further study with greater dosages is needed to appreciate its efficacy.

[Diastematomyelia: antenatal diagnosis with successful outcome, two cases]. / Diastématomyélie: à propos de deux observations anténatales et revue de la littérature.

To discuss, through a review of the literature, clinical signification and antenatal and postnatal management of diastematomyelia. We present two cases highlighting the clinical presentation and discuss management options. The first case was diagnosed in a 32-year-old primagravida female physician. The conssanguinous couple had a history of primary hypofertility. Antenatal magnetic resonance imaging revealed the presence of a sagittal spinal spur separating two asymmetrical hemi cords. Pregnancy was not interrupted due to the lack of factors of poor prognosis. The infant was delivered at term and outcome has been favorable at 18 months follow-up. Ultrasonography performed at 22 weeks gestation provided the diagnosis in the second case. The mother was a 30-year-old primagravida anesthesist who had been addressed for suspected spina bifida. The consanguinous couple had a history of male hypoferility. The ultrasound scan revealed an echogenic spinal spur and integrity of the skin. Pregnancy was not interrupted due to the lack of factors of poor prognosis. The infant was delivered at term and outcome has been favorable at 18 months follow-up. Diastematomyelia is a rare malformation which can be diagnosed antenatally. Careful ultrasonography can distinguish diastematomyelia from myelomeningocele. Antenatal assessment is essential to identify forms with good prognosis because the neonatal outcome of isolated diastematomyelia is generally good, even if surgical repair is required.

[Epidemiology of maternal-fetal group B streptococcal infections]. / Épidémiologie des infections materno-fœtales à streptocoque du groupe B.

GOAL: The aim of this study was to determine the incidence, risk factors, and outcome of maternal-fetal infection due to group B streptococcus. PATIENTS AND METHODS: We identified all cases of maternal-fetal group B streptococcus infection between January 2003 and December 2007, from neonatal unit reports at the Charles Nicolle Hospital. RESULTS: Ninety cases were identified out of 17,922 live births, incidence 5 ‰ of which 2.3 ‰ of bacteremia. Twenty percent of all newborns were premature and 22.2% had a low birth weight. Peripartum maternal fever was recorded in 52.2% of cases and membrane rupture more than 12 hours before delivery occurred in 74.4%. Among the newborns, 45.6% were symptomatic at birth. Forty percent of group B streptococci were resistant to erythromycin and 3.3% with intermediate resistance to ampicillin. The global neonatal mortality after group B streptococcus infection was 3.3%. CONCLUSION: Maternal-fetal infection due to group B streptococcus is still frequent and continues to be a major cause of morbidity and mortality.

[Usefulness of serum procalcitonin in the early diagnosis of maternal-fetal bacterial infection. A prospective study]. / Apport de la procalcitonine dans le diagnostic précoce de l'infection materno-fœtale bactérienne. Étude prospective.

UNLABELLED: Early diagnosis avoiding unnecessary treatment of maternal-fetal bacterial infection remains one of the greatest challenges for obstetricians and pediatricians. To meet these objectives, many inflammatory mediators were used, including procalcitonin (PCT). The aim of our study was to determine the usefulness of PCT in early diagnosis and management of neonatal infection. SUBJECTS AND METHODS: Over a period of 8 months, all living newborns with highly suspected maternal-fetal bacterial infection who were to receive antibiotic treatment according to our neonatal unit protocol were included in this prospective study. Serum PCT concentrations were determined at birth and after 12h of life using a specific immunoluminometric assay. Two distinct populations were defined based on clinical, biological, and bacteriological criteria: group 1: infected neonates, and group 2: noninfected neonates. STATISTICAL METHODS: We compared PCT means in different groups and determined the cut-off value correlated with maternal-fetal bacterial infection by analyzing the receiver operating characteristics curve (ROC). RESULTS: A total of 130 neonates were included in the study: 38 (29%) were classified in group 1 with 29 possible infections and 9 defined infections, including 5 cases of septicemia. The average PCT at birth in group 1 was significantly higher than in group 2 (3.52 ± 8.19 ng/ml vs 0.43 ± 0.73 ng/ml; P<0.001). The PCT threshold value at birth found by the ROC curve with the highest sensitivity (71.1%) and highest specificity (62%) was 0.215 ng/ml. The negative predictive value (NPV) was 83.8%, making it possible to avoid unnecessary treatment in the majority of the cases. The PCT threshold value within 12h of birth was 3.78 ng/ml, for a sensitivity of 89.5% and 1 NPV of 94.4%. CONCLUSION: PCT is a valuable biological examination because it can be administered early, it is sensitive, and it has a NPV. These characteristics make PCT a biological argument that can be used in the initial decision on whether to administer antibiotics. Another study will be conducted to establish the cut-off value.

[Radiological signs of type I primary hyperoxaluria]. / Les signes radiologiques de l'hyperoxalurie primaire de type I.

The authors report the radiological signs observed in 14 patients between the ages of 3 months and 16 years, suffering from type I primary hyperoxaluria. Four of these patients were being treated conservatively for renal failure and ten had reached end-stage renal failure. Stones were demonstrated in 9 patients. Nephrocalcinosis was present on the plain abdominal x-ray in 6 patients before dialysis, and in all patients dialysed for more than 3 months. Bone signs characteristic of type I primary hyperoxaluria were only observed in children with end-stage renal failure. Metaphyseal dense bands were revealed in 5 patients. Metaphyseal clear bands, observed in 4 patients, occurred later and appeared to replace dense bands which moved towards the diaphysis. The other signs detected were osteosclerosis of the vertebrae and ilium (4 patients) and epiphyseal subchondral clear bands (one patient).