Hyperbilirubinemia and neurodevelopmental outcome of very low birthweight infants: results from the LIFT cohort.

BACKGROUND: Bilirubin-related neurotoxicity is an important clinical issue in very low birthweight (VLBW) infants, and the existing literature is inconsistent. OBJECTIVE: To analyze the relationship between maximal serum unconjugated bilirubin levels (SBL) and neurodevelopmental outcome at 2-year corrected age in VLBW infants. METHODS: Phototherapy was initiated in all infants born before 33 weeks of gestation, according to Maisels' recommendations. Neurodevelopmental assessment at 2-year corrected age was performed in all infants that survived. SBLs collected during the first week of life were used to define three tertiles of max-SBL. The first tertile corresponded to infants with the lowest max-SBL. RESULTS AND CONCLUSIONS: A total of 724 infants were included in the study, and among them, 631 (87%) were evaluated at two years old. The infants of the first tertile were younger and smaller than the infants of the other two tertiles, in accordance with Maisels' recommendations for very small infants. No difference in the risk of impaired functional outcome among the three groups was observed. However, among infants weighing less than 1001 g, those in the third tertile had a poorer neurodevelopmental prognosis as compared to those in the second tertile (adjusted odds ratio = 6.8, 95% CI: 1.2-36.7, p = 0.03). Considering the results obtained, we propose 196 µmol/L (11.5 mg/dL) when birthweight varies between 1001 and 1500 g, and 170 µmol/L (9.9 mg/dL) when birthweight is less than 1001 g, as recommended max-SBLs (defined as maximal levels of 95(th) percentile curves of SBLs in infants with an optimal outcome). When Maisels' recommendations were applied, max SBLs were higher in 8% of infants weighing 1001-1500 g and in 15% of infants weighing less than 1001 g. Our data seems to validate Maisels' recommendations in the overall population of infants born before 33 weeks of gestation, but not in infants weighing less than 1001 g.

[Analgesia and sedation in premature newborns]. / Analgésie et sédation chez le nouveau-né prématuré.

Analgesics and sedatives are routinely prescribed in intensive care on intubated premature newborns, to ensure their comfort and limit pain. The results of two studies show that there is no significant link between prolonged exposure to these treatments and a more unfavourable long-term neurological outcome.

[Cobedding for premature twins]. / Le cobedding pour les jumeaux prématurés.

The cobedding of premature twins consists in lying them together in a single cocoon to maintain the closeness developed in the womb. It is associated with beneficial effects on the quality of sleep and could favour weight gain. Moreover, it does not seem to increase the incidence of infections or the frequency of the accidental removal of medical devices.

Application of denaturing high-performance liquid chromatography for intestinal microbiota analysis of newborns.

AIMS: Neonatal microbiota development seems to play a key role in the early origins of health and disease. However, the analysis of this complex ecosystem is still difficult. The aim of this work was to investigate the feasibility of a new technique, denaturing high-performance liquid chromatography (dHPLC), to analyze newborn intestinal microbiota using genomic approaches. METHODS AND RESULTS: Eleven neonates were recruited among patients admitted for intestinal surgery to the neonatal intensive care unit. Preoperative samplings were obtained in each case. Three methodologies were compared for each sample: (i) dHPLC, (ii) temporal temperature gradient gel electrophoresis (TTGE), and (iii) conventional culture techniques. RESULTS: All samples were poorly colonized. In three samples, the microbiota was detected only with the dHPLC technique. Results obtained with culture and TTGE could be found with dHPLC. CONCLUSION: The results suggest that neonatal applications of the dHPLC technique, especially for gut microbiota analysis, appear to be a sensitive and promising analytical technique.

The use of procalcitonin in the diagnosis of late-onset infection in neonatal intensive care unit patients.

We evaluated the semi-quantitative procalcitonin level for diagnosing late-onset infections in 176 neonates. Using a cut-off level of 0.5 ng/ml, the sensitivity was 84.4%+/-0.19, specificity was 93.9%+/-0.04, positive predictive value was 82.6%+/-0.1, and negative predictive value was 94.6%+/-0.04. Procalcitonin could be a useful marker of late-onset infection in neonates.

Shock revealing salt poisoning in a neonate.

BACKGROUND: We report a case of shock, revealing a severe hypernatremia caused by salt poisoning in a 17-day-old male neonate. OBJECTIVE: We consider the physiopathology of salt overload in this context and the diagnostic strategy in neonate with hypernatremia. METHODS: We used patient history, weight, plasma, and urine osmolality to establish the diagnostic strategy. RESULTS: Salt poisoning in neonates manifests as intracellular dehydration without extracellular fluid accumulation. CONCLUSIONS: This poisoning underscores the need for providing appropriate help to mothers at discharge from the maternity ward or neonatology unit.