[Pregnancy and delivery of teenagers: Is the obstetrical prognosis worst between 13-15years old?] / Grossesse et accouchement de l'adolescente : le pronostic obstétrical est-il plus défavorable entre 13 et 15 ans ?

OBJECTIVE: To assess the prognosis of pregnancy and delivery of 13-15years old patients compared to teenagers aged of 16-17. METHODS: Single-center retrospective study of a continuous series of 13-15 teenagers followed in a public maternity between 1996 and 2012 compared to a series of patients aged of 16-17 matched on the day of the delivery (two controls for a case). RESULTS: Seventy-three teens 13-15 were followed during the study period, and 146 adolescents aged 16-17 were included and matched. The two groups did not differ regarding size, weight or medical history. Younger patients were more often educated than older ones (46.6 vs 27.4%, P<0.01). The incidence of congenital malformations was high but substantially identical in the two groups (9.6 vs 11.0%, NS), as well as prematurity concerned that almost one third of patients (27.4 vs 30.1%, NS). The Caesarean section rate was low (11.0 vs 10.3%, NS). The frequency of birth weight below the 10th percentile did not differ between groups (15.1 vs 19.9%, NS). CONCLUSION: Teenage girls of 13-15years old have high perinatal risk (prematurity, congenital malformation), and frequently delivery vaginally. These risks do not seem superior to those of adolescent girls aged of 16-17years old.

[Risk of accumulation of CO2 in the oxygen chamber in "HOOD" (Experimental study on test bed)]. / Risque d'accumulation du CO2 lors de l'oxygénothérapie sous enceinte « HOOD ¼ (Étude expérimentale sur banc d'essai).

OBJECTIVES: Oxygen hood is largely used to deliver O2 to newborn infants with respiratory failure in the northern region of France. The oxygen flow is set to obtain the target arterial blood oxygen saturation. Thus, O2 flow delivers into the hood may be below the recommended gas flow of 6L/min. However, gas flow below 6L/min exposes to CO2 rebreathing. The aim of this study was to evaluate the effect of various rates of gas flows on the values of partial pressure of CO2 into the hood. MATERIAL AND METHODS: We measured CO2 and O2 partial pressure into hoods of two different volumes (4 and 10L) under two experimental bench test conditions. Protocol 1: gas flow was constant at 6L/min, while oxygen fraction varied from 0.21 to 1. Partial pressure of CO2 and O2 were recorded. Protocol 2: while O2 fraction was kept constant, oxygen flow varied from 0.5 to 7L/min (by step of 0.5L/min). Partial pressure of CO2 and O2 were recorded. RESULTS: Partial pressure of CO2 increases proportionally to the decrease in the gas flow delivered into the hood, and reached 14 mmHg at gas flow of 0.5L/min. CONCLUSION: Risk of CO2 rebreathing exists as soon as the gas is delivered into the hood at minimal flow rates below 6L/min.

[Per and post-natal medical management of congenital diaphragmatic hernia]. / Prise en charge médicale per et post-natale de la hernie congénitale du diaphragme.

Congenital diaphragmatic hernia (CDH) is a 1 out of 3500 live-born malformation with persistent 30-40% mortality rate, related to severe pulmonary hypoplasia and hypertension. Better knowledge on the mechanisms inducing failure of adaptation at birth is a prerequisite for improving CDH prognosis. CDH is also associated with longterm morbidity, including prolonged respiratory failure, failure to growth, oral aversion, and scoliosis. Early prevention starting as soon as the first hours of life are required to reduced long term morbidity. The aims of the management are not only to reduce early mortality, related to persistent pulmonary hypertension, but also to prevent late morbidity.

[Feeding practices in infants: a 6-month prospective cohort study]. / Conduite de la diversification alimentaire: enquête prospective jusqu'à l'âge de 6 mois.

UNLABELLED: The aims of this work were to assess timing of complementary feeding in infants and to precise the underlying factors that may cause inappropriate complementary feeding. PATIENTS AND METHODS: A cohort of 167 newborns, born in the same maternity ward during a 6 week-period, was prospectively analyzed. Only healthy neonates were included in the study. A phone questionnaire was filled at 4 and 6 months of age to evaluate modality of complementary feeding. Multivariate analysis (segmentation tree, analyse by multiple correspondence) was used to study factors associated with inappropriate diversification. RESULTS: Out of the 167 neonates included in the study, 132 mothers could be contacted at 4 months and 116 at 6 months of age. Sixty-seven per cent of mothers started breast feeding at birth. Among these, 33% still breastfed -at least partially- at 4 months and 17% at 6 months. Fifty-two percent of mothers started complementary feeding before 4 months, and 24% of infants received gluten at 4 months of age. Multi-gravida mothers, mothers aged more than 35 years old and mothers who gave infant or follow-up formulae before 4 months, started complementary feeding significantly earlier (P<0.05). Infants who were formula fed received more frequently complementary feeding before the age of 4 months than breast fed infants (57% vs 33%, P<0.05). CONCLUSION: Our study showed that half of infants were introduced solid food too early and allowed to identify a population at risk that could benefit from nutritional intervention programs.

Neurological assessment at five years of age in infants born preterm.

AIM: To evaluate the agreement between Touwen's neurological examination and a derived simplified one, created to be applied at the age of 5 y to infants born preterm. METHODS: 185 children born at a gestational age (GA) of <33 wk and/or with a birthweight <1501 g, free of cerebral palsy, underwent Touwen's neurological examination at a mean age of 5 y and 8 mo (5-6.5 y). One-hundred and seventy had a full examination and were included into the study. They were born at a mean GA of 30 wk (range 24-35 wk) with a mean birthweight of 1250 g (range 600-2690 g). A simplified examination, based on the clinical experience of two of the authors, was created a priori. The data were reviewed retrospectively and the concordance between the two forms was assessed. The reviewers were blinded to the original categorization from the long form. RESULTS: On the basis of the original Touwen's neurological examination, the 170 children were classified into 122 with a normal neurological examination, 41 with grade 1 minor neurological dysfunction (MND) and 7 with grade 2 MND, giving 28% of the cohort with MND. The concordance between the two forms was excellent, with an agreement in 169 out of 170 subjects. None of the infants with the most complex form of MND was misclassified. CONCLUSION: The simplicity of this examination could allow its diffusion and its use in follow-up programmes. It could improve the quality of routinely collected follow-up data of preterm neonates.

[Management of newborn life-threatening distress at birth. Study of the experience at a university maternity ward]. / Prise en charge des détresses vitales du nouveau-né à la naissance. Etude de l'expérience d'une maternité universitaire.

Care given to 1,425 consecutive new-born infants in a University Maternity Ward was screened for high-risk pregnancies. The characteristics of the new-borns retained for study resulted from this choice. Life-threatening distress, defined as the need for respiratory assistance beyond the third minute of life, was observed in 6% of cases. Distress had been predicted 30 minutes before birth in only 42% of cases. In 56.5%, the signs of distress occurred outside "normal" working hours and immediate care was given by the mid-wife in 36% of cases. Despite progress in fetal medicine, these findings would suggest that life-threatening distress at birth is often unpredicted and occurs at a non-negligible rate. This would emphasize the need of training the entire obstetrical team, especially the mid-wives in care the for new-borns.