Outcomes of pregnancies with preterm premature rupture of membranes occurring before 24 weeks of gestation: An 11-year observational study.

OBJECTIVE: This study describes the fetal and neonatal outcomes and their predictive factors in pregnancies with preterm premature rupture of membranes (PPROM) before 24 weeks of gestation. METHODS: A retrospective study was conducted using the patient database of a tertiary university hospital in Lyon, France. All of the medical data of women diagnosed with PPROM before 24 weeks of gestation from 2008 to 2018 were extracted. R software was used for descriptive and analytical statistics. RESULTS: The study included 78 women. Mean gestational age (GA) at PPROM was 19.6 weeks (13.1 to 23.9 weeks). Fifteen (19.2%) pregnancies were terminated, 37 (47.4%) resulted in intrauterine fetal death (IUFD), and 26 (33.3%) children were born alive at an average of 26.9 weeks of gestation. Fourteen children survived and 12 died after birth; 50% of survivors had pulmonary hypoplasia. Within 7 days after PPROM, 46% of IUFD occurred and 36% of pregnancies ended. PPROM before 20 weeks of gestation and chorioamnionitis are statistically associated with IUFD, whereas a latency period of more than 2 weeks is statistically related to live birth. CONCLUSION: PPROM before 24 weeks of gestation is associated with a high rate of IUFD, preterm birth, and postpartum mortality.

Limited resources restrict the provision of adequate neonatal respiratory care in the countries of Africa.

AIM: Over two thirds of newborn deaths occur in Africa and South Asia, and respiratory failure is a major contributor of these deaths. The exact availability of continuous positive airway pressure (CPAP) and surfactant in Africa is unknown. The aim of this study was to describe the availability of newborn respiratory care treatments in the countries of Africa. METHODS: Surveys, in English, French and Portuguese, were sent to neonatal leaders in all 48 continental countries and the two islands with populations over 1 million. RESULTS: Forty-nine (98%) countries responded. Twenty-one countries reported less than 50 paediatricians, and 12 countries had no neonatologists. Speciality neonatal nursing was recognised in 57% of countries. Most units were able to provide supplemental oxygen. CPAP was available in 63% and 67% of the most well-equipped government and private hospitals. Surfactant was available in 33% and 39% of the most well-equipped public and private hospitals, respectively. Availability of CPAP and surfactant was greatly reduced in smaller cities. Continuous oxygen saturation monitoring was only available in 33% of countries. CONCLUSION: The availability of proven life-saving interventions in Africa is inadequate. There is a need to sustainably improve availability and use of these interventions.

[Gastroesophageal reflux in premature: a case report]. / Reflux gastro œsophagiens du prématuré: à propos d'un cas.

Gastroesophageal reflux disease (GERD) is a common problem in neonatology. Various physiological protective reflex responses provide a plausible biological link between gastro-esophageal reflux and apnea and bradycardia in premature. It is uncertain whether or not there is a causal relationship between the two diseases. However there is no consensus about the clinical and paraclinical diagnosis. Further explorations and treatment offered to premature infants with symptoms are discussed. We report the case of a preterm infants admitted to neonatal intensive care and with apnea and bradycardia. Clinical examination and exploration results were normal. We retained the gastrointestinal reflux diagnosis complicated of apnea and bradycardia. Pharmacological therapy for gastro-esophageal reflux disease has not definitively been shown to be effective in improving symptoms and should be reserved especially for infants with treatment refractory apnea and bradycardia episodes suspected as being gastro-esophageal reflux in premature infants. From a case report we made a literature review to discuss at length the different aspects of the problem.

[Maternal use of non-steroidal antiinflammatory drugs and closure of the ductus arteriosus]. / Prise maternelle d'anti-inflammatoires non stéroïdiens et fermeture du canal artériel.

We report a case of intrauterine premature closure of the ductus arteriosus diagnosed in an anasarca fetus associated with major heart failure following mother's ingestion of non-steroidal anti-inflammatory drugs (NSAID). Second trimester obstetric ultrasound allowed detection of an asymmetry of the cardiac chambers. Caesarean section was perfomed at 30 weeks of pregnancy to remove anasarca fetus with major heart failure due to prenatal closure of the ductus arteriosus. Based upon this case, we conducted a literature review to highlight potential fetal and neonatal complications resulting from early closure of the ductus arteriosus secondary to NSAID use during pregnancy.