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Mazarin N.,Service de reanimation pediatrique | Rosenthal J.-M.,Service de Reanimation Neonatale
Archives de Pediatrie | Year: 2014

The risks related to dengue virus infection during pregnancy have been increasingly better described over the past 10. years. The possibility of maternal-fetal transmission is now recognized, but the diagnosis is still too late because of a wide range of clinical signs that the infected newborn child can present. From December 2009to October 2010, Guadeloupe Island underwent an exceptional dengue epidemic. During this epidemic, at least four cases of vertical virus transmission were biologically proved. The purpose of this article is to describe the clinical aspects of these cases, some of which have rarely been described in this pathology. Of the four cases, one showed fetal growth restriction, one neonatal cholestasia, one twin pregnancy, and what seems to be the first case of hemophagocytic syndrome associated with a newborn child infected by this virus. Although the proportion of vertical transmission proved is low, compared with the number of adults affected during an epidemic, some severe cases urge us to be increasingly watchful with this emergent arbovirus, especially because its real incidence is still unknown. © 2014 Elsevier Masson SAS. Source

Rigo J.,University of Liege | Marlowe M.L.,Baxter Healthcare | Bonnot D.,Baxter SAS | Senterre T.,University of Liege | And 8 more authors.
Journal of Pediatric Gastroenterology and Nutrition | Year: 2012

OBJECTIVES:: The aim of this study was to evaluate the efficacy, safety, flexibility, and ease of handling and use of the Ped3CB-A 300mL, the first ready-to-use multichamber parenteral nutrition (PN) system, with optional lipid bag activation, specially designed for administration to preterm infants. MATERIALS AND METHODS:: In this prospective, open-label, multicenter, noncomparative, phase III clinical trial, preterm infants were treated with Ped3CB-A for 5 to 10 consecutive days. RESULTS:: A total of 113 preterm infants were enrolled in the study and 97 (birth weight 1382±520g; gestational age 31.2±2.5 weeks; postnatal age administration 5.6±6.1 days) were included in the per protocol analysis accounting for 854 perfusion days. Double-chamber bag activation was used for 32 perfusion days. Macronutrient, electrolyte, and mineral supplements were primarily administered through a Y-line or directly in the activated bag. In all, 199 additions (mainly sodium, 95%) were made to the Ped3CB-A bags on 197 infusion days (23.1%) in 43 infants (44.3%). More than 1 of these nutrients was added to the bag on only 1 perfusion day. Mean and maximum parenteral nutrient intakes were 2.8±0.7 and 3.6±0.8g amino acids per kilogram per day, and 80±20 and 104±22kcal • kg • day. Mean weight gain represented 10.0, 21.5, and 22.6g • kg • day according to age at inclusion (0-3, 4-7, or >7 days of life). A visual analog scale was completed and produced positive results. No adverse events were attributable to the design of the Ped3CB-A system. CONCLUSIONS:: Ped3CB-A provides easy-to-use, well-balanced, and safe nutritional support. Nutritional intakes and weight gain were within the recent PN recommendations in preterm infants. © 2012 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition. Source

Following antenatal diagnosis of a lethal disorder, some parents are so overwhelmed by grief that therapeutic abortion is seen as the least traumatic option. However, the impending death and anticipated mourning create a particularly complex emotional situation. When faced with such dramatic circumstances, some parents seek to restore meaning to their parenthood by accompanying their baby through to the end of its life. Methods derived from hospice care may be appropriate in such situations, considering the unborn child as "a living being among the living", pregnancy as the first chapter of every life, and death as a natural process. This approach, which may be adopted in maternity wards and neonatal intensive care units, requires the medical team to provide consistent information to the parents and to ensure their close involvement. These new parental demands must be clearly understood if they are to be met as effectively as possible. Source

Henri H.,Service de Reanimation Neonatale
Medecine Therapeutique Pediatrie | Year: 2011

Legislative developments in France over the last decade have allowed the emergence of palliative care to newborns in delivery room. The population concerned includes babies with severe congenital malformation and extremely preterm newborns at the limits of viability. This support is focused on the child's comfort and offers parents to be involved in it. The palliative care allows to anchor the dying babies in humanity. It offers the parents to play their real parents' role. The caregivers can fulfill their mission of care with dignity and empathy. The future is also prepared with a reduced risk of pathological grief and replacement child. The palliative care support for nonviable newborns is a new practice in delivery room. It may offend some caregivers because they feel criticism of past practices as an aggression. It is nevertheless very important to get out of the illegal or unsaid practices. The ethics component of the EPIPAGE 2 study, beginning in 2011, is expected to make an inventory of actual practices relating to the management of death in the neonatal period in France. Source

Birth asphyxia occurs in 0.5% of term deliveries. Prognosis of newborns with birth asphyxia depends on clinical features of neonatal encephalopathy. The outcome of infants without encephalopathy is excellent. In contrast, neurological outcome of infants with encephalopathy is poor: 40 to 100% of neurodevelopmental disabilities according to the grade of encephalopathy. Prognosis can be more accurately assessed by EEG and MRI. Infants with encephalopathy following birth asphyxia must be referred as soon as possible in centers where neuroprotection by hypothermia is available. © 2010 Elsevier Masson SAS. Source

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