Recurrence of group B streptococcal meningitis.

Group B Streptococcus is the most frequent cause of neonatal sepsis. However, recurrences are rare. We report a case of recurrent meningitis due to Streptococcus B in a 2-month-old infant. Streptococcus B identified was hypervirulent clone ST-17 serotype III, which is known for its neurotropism. We found five other cases of recurrent group B streptococcal meningitis in the literature, which we report here. Many reports have identified breastfeeding and persistent colonization as the mode of transmission in recurrent Streptococcus B infections. We also discuss different ways to prevent recurrent group B streptococcal infections. Oral antibiotic therapy against carriage does not seem to be effective and there is no consensus on management of breastfeeding.

French prenatal Vitamin D recommended supplementation: Enough or not?

OBJECTIVE: To determine the impact of current recommended vitamin D prenatal supplementation on blood cord 25(OH)D level in a French cohort and to determine population at risk of higher needs. DESIGN AND SETTING: An observational prospective study was conducted in teaching hospital including two large groups of newborns, one born after summer and another after winter period. PATIENTS AND METHODS: Three hundred and ninety-nine mother/newborns pairs were enrolled and blood cord results were available for 225 newborns in the post-summer group and 174 newborns in the post-winter group. Maternal supplementation during pregnancy was recorded from medical notes and questionnaires. RESULTS: 25(OH)D level were generally low with mean at 50.9±24.7nM. Vitamin D supplementation was prescribed in only 37.6% over all the study period. Studying general population, 25(OH)D was significantly higher in the supplemented group, but current recommended supplementation failed to cover the needs for most subgroups of newborns. After winter, 25(OH)D cord blood level was in deficiency range for 40.7% of the general population and in the pigmented mothers group the deficiency rates even rose up to 61.9%. DISCUSSION AND CONCLUSION: Vitamin D cord level is low in north of France as in other industrial countries. Despite national guidelines on vitamin D supplementation, the rates are currently insufficient. Beside, although the recommended 100,000IU single dose helps to limit deficiency in newborns, it fails to cover infant's needs for optimal status. Actually, benefit of this substitution is for children below the 10th percentile weight. A new recommendation with higher rate of vitamin D for all pregnant women after specific studies seems to be indicated.

[Fulminant pneumonia during varicella in an immunocompetent 16-month-old girl]. / Pneumopathie fulminante au cours de la varicelle chez une fillette de 16 mois immunocompétente.

Varicella is a cosmopolitan communicable disease caused by varicella-zoster virus (VZV) characterized by papulovesicular rash and fever. Management of fever and pruritus and prevention of bacterial infection are the main aspects of treatment. Severe complications and death may occur in pregnancy, in newborns, in adults, and in immunocompromised children. Contrary to immunocompetent adults in whom pneumonia occurs in 50% of cases during varicella, this complication in children is rare. We report a fatal case of pneumonia with severe hypoxemia during varicella in an immunocompetent 16-month-old child. Based on a literature review, we discuss the main aspects of diagnosis, treatment, and prognosis of varicella. Active immunization of children after 12 months of age is the primary prevention of varicella.

[Continuous medical evaluation in a gynaecological and obstetrical unit: Our experience about scheduled caesarean]. / Evaluation des pratiques professionnelles dans le cadre de la certification d'un établissement public de santé à propos des césariennes programmées.

Continuous medical evaluation (CME) is compulsory which aims to ameliorate and guarantee quality of care. This paper describes the experience of our unit during the different stages of evaluation that permit us to obtain our accreditation. Our evaluation dealt with the "amelioration of women's and newborn's care after scheduled caesarean section". A first retrospective study of files of scheduled caesareans allowed to update possible points of improvement, after application of adapted corrective actions, both at the medical and paramedical level. The second study, made after application of these actions, allowed to appreciate the results of our initiative of CME, to update new possible points of improvement, but also to notice certain limits in the achievement of the objectives.

Prenatal evaluation of a scrotal mass using a high-frequency probe in the diagnosis of inguinoscrotal hernia.

Whereas inguinal hernia is a common pediatric disease, fetal inguinal hernia is rarely diagnosed because intra-abdominal pressure usually occurs only after birth. We report a case of prenatal diagnosis of a scrotal mass at 35 weeks' gestation. The initial differential diagnosis included hydrocele, testicular teratoma and testicular torsion, but inguinoscrotal hernia was considered the most likely diagnosis when further ultrasound imaging using a high-frequency probe demonstrated bowel loop movements around the mesenteric artery. This diagnosis was confirmed postnatally.