Serum calcium normal range in 1000 term newborns.

INTRODUCTION: Serum calcium rapidly declines at birth because of the sudden interruption of the maternal-fetal calcium influx. Several factors are known to influence serum calcium in the first days of life, including circulating concentrations of maternal vitamin D. Objective was to establish the normal range variations of neonatal serum calcium according to the French current vitamin D supplementation during pregnancy, i.e. 100,000 IU of cholecalciferol during the third trimester. METHODS: We included in our prospective cohort study 1002 mother-newborn dyads from, with recruitments from April 2012 to July 2014 in France, in two recruiting centers located in Paris neighborhoods. RESULTS: Total serum calcium at 3 days of life in neonates varied from 2.06 to 2.73 mmol/L [2.5 and 97.5 percentiles], with a mean of 2.45 mmol/L. Serum calcium was similar between babies born from vitamin D supplemented mothers and those born from the non-supplemented ones. Univariate and multivariable analyses demonstrated the importance of maternal and cord blood 25(OH)D concentrations for newborn serum calcium maintenance. CONCLUSION: We established that the expected serum calcium in neonates ranges between 2.06 and 2.73 mmol/L which is significantly wider than the adult range. This finding should help physicians in the diagnosis of hypo- or hypercalcemia. In addition, our study supports the importance of vitamin D supplementation and 25(OH)D status for neonatal serum calcium maintenance.

Cytomegalovirus Specific Serological and Molecular Markers in a Series of Pregnant Women With Cytomegalovirus Non Primary Infection.

(1) Background: In a period where systematic screening of CMV during pregnancy is still debated, diagnosis of non primary infection (NPI) remains challenging and an obstacle to systematic screening. Our aim is to report kinetics of serological and molecular CMV markers of NPI. (2) Methods: We identified immunocompetent pregnant women with CMV NPI as women known to be seropositive for CMV before pregnancy who gave birth to cCMV infected infants. We performed CMV-IgG, CMV-IgM, CMV-IgG avidity and CMV PCR retrospectively on sequential serum samples collected during pregnancy. (3) Results: We collected 195 serum samples from 53 pregnant women with NPI during pregnancy. For 29/53 (55%) patients, no markers of active infection were observed (stable IgG titers, negative IgM and negative PCR). CMV PCR was positive in at least one serum for 18/53 (34%) patients and median viral load was 46 copies/mL, IQR (21-65). (4) Conclusions: For more than half of patients with confirmed CMV NPI during pregnancy, available diagnostic tools are liable to fail in detecting an active infection. These should therefore not be used and universal neonatal screening for CMV remains the only way to detect all cCMV infections.

Estimation of early life endogenous surfactant pool and CPAP failure in preterm neonates with RDS.

BACKGROUND: It is not known if the endogenous surfactant pool available early in life is associated with the RDS clinical course in preterm neonates treated with CPAP. We aim to clarify the clinical factors affecting surfactant pool in preterm neonates and study its association with CPAP failure. METHODS: Prospective, pragmatic, blind, cohort study. Gastric aspirates were obtained (within the first 6 h of life and before the first feeding) from 125 preterm neonates with RDS. Surfactant pool was measured by postnatal automated lamellar body count based on impedancemetry, without any pre-analytical treatment. A formal respiratory care protocol based on European guidelines was applied. Clinical data and perinatal risk factors influencing RDS severity or lamellar body count were real-time recorded. Investigators performing lamellar body count were blind to the clinical data and LBC was not used in clinical practice. RESULTS: Multivariate analysis showed gestational age to be the only factor significantly associated with lamellar body count (standardized ß:0.233;p = 0.023). Lamellar body count was significantly higher in neonates with CPAP success (43.500 [23.750-93.750]bodies/µL), than in those failing CPAP (20.500 [12.250-49.750] bodies/µL;p = 0.0003).LBC had a moderate reliability to detect CPAP failure (AUC: 0.703 (0.615-0.781);p < 0.0001; best cut-off: ≤30,000 bodies/µL). Upon adjustment for possible confounders, neither lamellar body count, nor its interaction factor with gestational age resulted associated with CPAP failure. CONCLUSIONS: Early postnatal lamellar body count on gastric aspirates in CPAP-treated preterm neonates with RDS is significantly influenced only by gestational age. Lamellar bodies are not associated with CPAP failure. Thus, the endogenous surfactant pool available early in life only has a moderate reliability to predict CPAP failure.

Case report on early treatment with valaciclovir after maternal primary cytomegalovirus infection.

BACKGROUND: Cytomegalovirus (CMV) is the main cause of congenital viral infections. Current guidelines do not include any recommendation about antenatal treatment. Most studies that evaluate the efficacy of valaciclovir aim to treat infected symptomatic fetus but the benefit of anti-CMV therapy remains unclear. CASE PRESENTATION: We report the case of cytomegalovirus seroconversion during the second trimester of pregnancy. Early treatment with valaciclovir was introduced, associated with a close monitoring of maternal CMV viremia. The virus was no longer detected in maternal blood soon after the beginning of antiviral therapy. Valaciclovir was stopped at 24 + 5 WG after negative prenatal diagnosis but CMV viremia was still monitored in maternal blood until the end of pregnancy. CONCLUSION: The neonate was not infected and remained asymptomatic. It suggests that early treatment with valaciclovir 8 g per day could be effective in quickly reducing maternal viral load and lowering the risk of vertical CMV transmission.

Autochthonous Hepatitis E during Pregnancy, France.

Acute hepatitis E virus infections occurred during the third trimester in 2 pregnant women in France who sought treatment with nonspecific symptoms or asymptomatic elevation of liver enzymes. Infection cleared quickly in both women. We detected no hepatitis E RNA in 1 newborn's feces at 3 weeks of age.

[Creation of an observation scale for newborns in the maternity setting]. / Élaboration d'une échelle d'observation des nouveau-nés en maternité.

In clinical practice in the maternity setting, professionals are regularly confronted with situations for which a clinical observation of the newborn's condition is necessary. The Assessment for Newborn Development and Abilities (Panda) scale is a tool for evaluating the sensory-motor skills of newborns and their relationship with others, as well as raising professionals' awareness of their fine observation.

Outcomes of Preterm Neonates Transferred Between Tertiary Perinatal Centers.

OBJECTIVE: To verify if preterm neonates transferred between tertiary referral centers have worse outcomes than matched untransferred infants. DESIGN: Cohort study with a historically matched control group. SETTING: Two tertiary-level neonatal ICUs. PATIENTS: Seventy-five neonates per group. INTERVENTIONS: Transfer between tertiary-level neonatal ICUs carried out by a fully equipped transportation team. MEASUREMENTS AND MAIN RESULTS: We measured in-hospital mortality, frequency of intraventricular hemorrhage greater than 2nd grade, periventricular leukomalacia, necrotizing enterocolitis greater than or equal to grade 2, bronchopulmonary dysplasia, composite outcomes (in-hospital mortality/bronchopulmonary dysplasia, in-hospital mortality/intraventricular hemorrhage > 2nd grade, and bronchopulmonary dysplasia/periventricular leukomalacia/intraventricular hemorrhage > 2nd grade), length of neonatal ICU stay, weight at discharge, and time spent on ventilatory support. Seventy-five similar (except for antenatal steroids administration) neonates were enrolled in each cohort. Cohorts did not differ in mortality, bronchopulmonary dysplasia, intraventricular hemorrhage greater than 2nd grade, periventricular leukomalacia, necrotizing enterocolitis greater than or equal to grade 2, any composite outcomes, neonatal ICU stay, weight at discharge, and duration of respiratory support. Results were unchanged adjusting for antenatal steroids. CONCLUSIONS: Neonatal transfer between tertiary-level centers does not impact on clinical outcomes, if performed under optimal conditions.

Case of a healthy infant born following antenatal enterovirus myocarditis and hydrops.

Fetal hydrops and myocarditis were diagnosed in a woman at 32 weeks of gestation (WG). Transplacental enterovirus infection was suspected because all other causes of myocarditis and hydrops were excluded, it was during an endemic period, and there was a setting of maternal infection (fever a few days before). We opted for in utero treatment because of the risk of resuscitating a neonate with myocarditis and hydrops. We administered dexamethasone 12mg twice for pulmonary maturation and presumed it would partially improve the myocarditis. Fetal arrhythmia was noted at 35 WG and we decided to deliver the infant as postnatal treatment of the heart disorder would be more effective. RT-PCR (ARGENE(®)) showed that the neonate's throat and anal tissues and cord blood sampled on the day of birth contained enterovirus ribonucleic acid and coxsackievirus B5, as did the mother's anal sample. Laboratory tests, heart MRI and probably brain MRI indicated neonatal enterovirus infection. Findings were normal at two-year follow-up.