Special Care and School Difficulties in 8-Year-Old Very Preterm Children: The Epipage Cohort Study

OBJECTIVES: To investigate school difficulties, special care and behavioral problems in 8 year-old very preterm (VPT) children. PATIENT AND METHODS: Longitudinal population-based cohort in nine regions of France of VPT children and a reference group born at 39-40 weeks of gestation (WG). The main outcome measures were information about school, special care and behavioral problems using Strengths and Difficulties Questionnaire from a questionnaire to parents. RESULTS: Among the 1439 VPT children, 5% (75/1439) were in a specialised school or class, 18% (259/1439) had repeated a grade in a mainstream class and 77% (1105/1439) were in the appropriate grade-level in mainstream class; these figures were 1% (3/327) , 5% (16/327) and 94% (308/327) , respectively, for the reference group. Also, 15% (221/1435) of VPT children in a mainstream class received support at school versus 5% (16/326) of reference group. More VPT children between the ages of five and eight years received special care (55% (794/1436)) than children born at term (38% (124/325)); more VPT children (21% (292/1387)) had behavioral difficulties than the reference group (11% (35/319)). School difficulties, support at school, special care and behavioral difficulties in VPT children without neuromotor or sensory deficits varied with gestational age, socioeconomic status, and cognitive score at the age of five. CONCLUSIONS: Most 8-year-old VPT children are in mainstream schools. However, they have a high risk of difficulty in school, with more than half requiring additional support at school and/or special care. Referral to special services has increased between the ages of 5 and 8 years, but remained insufficient for those with borderline cognitive scores

Faecal D/L lactate ratio is a metabolic signature of microbiota imbalance in patients with short bowel syndrome

Our objective was to understand the functional link between the composition of faecal microbiota and the clinical characteristics of adults with short bowel syndrome (SBS). Sixteen patients suffering from type II SBS were included in the study. They displayed a total oral intake of 2661 +/- 1005 Kcal/day with superior sugar absorption (83 +/- 12%) than protein (42 +/- 13%) or fat (39 +/- 26%). These patients displayed a marked dysbiosis in faecal microbiota, with a predominance of Lactobacillus/Leuconostoc group, while Clostridium and Bacteroides were under-represented. Each patient exhibited a diverse lactic acid bacteria composition (L. delbrueckii subsp. bulgaricus, L. crispatus, L. gasseri, L. johnsonii, L. reuteri, L. mucosae), displaying specific D and L-lactate production profiles in vitro. Of 16 patients, 9/16 (56%) accumulated lactates in their faecal samples, from 2 to 110 mM of D-lactate and from 2 to 80 mM of L-lactate. The presence of lactates in faeces (56% patients) was used to define the Lactate-accumulator group (LA), while absence of faecal lactates (44% patients) defines the Non lactate-accumulator group (NLA). The LA group had a lower plasma HCO3(-) concentration (17.1 +/- 2.8 mM) than the NLA group (22.8 +/- 4.6 mM), indicating that LA and NLA groups are clinically relevant sub-types. Two patients, belonging to the LA group and who particularly accumulated faecal D-lactate, were at risk of D-encephalopathic reactions. Furthermore, all patients of the NLA group and those accumulating preferentially L isoform in the LA group had never developed D-acidosis. The D/L faecal lactate ratio seems to be the most relevant index for a higher D-encephalopathy risk, rather than D-and L-lactate faecal concentrations per se. Testing criteria that take into account HCO3(-) value, total faecal lactate and the faecal D/L lactate ratio may become useful tools for identifying SBS patients at risk for D-encephalopathy

Multiple logistic regression model for the risk of absence of language manifestation at age 1, assessed by the midwife during clinical examination.

<p>The EDEN Mother-Child Cohort N = 1452.</p

Psychomotor and language milestones at age 1, as answered by parents to midwives questions, according to social withdrawal.

<p>The EDEN Mother-Child Cohort.</p

Psychomotor and language outcomes as observed by midwives at age 1 year, according to social withdrawal.

<p>The EDEN Mother-Child Cohort.</p

Maternal and infant characteristics according to social withdrawal at 12 months.

<p>The EDEN Mother Child Cohort.</p

Flow chart for study population.

<p>The EDEN Mother-Child Cohort.</p

Genetic determinism of dairy sheep ruminal microbiota

The microbiota of herbivorous animals plays a central role in the nutrition of its host, directly affecting his health and his ability to produce. Very few publications reported results concerning the impact of host genetics on the composition of ruminal microbiota. Thus, we proposed to study the genetic determinism of bacterial relative abundances of sheep rumen microbiota. 369 dairy Lacaune ewes raised indoor at the INRA Experimental Farm of La Fage, had a sampling of their rumen fluid done. These ewes were adult animals, fed with a 93% hay-silage based diet and belonged to 4 different lines (lines divergently selected on somatic cells count or on milk persistency). Ruminal metagenome were sequenced using 16s rRNA gene with Illumina Miseq technology. Bioinformatics analysis of the microbiota sequences were implemented with FROGS pipeline to obtain relative abundances of bacteria and R Phyloseq package to estimate biodiversity indices. Heritability estimates of the square root of relative abundances were computed in single trait using the VCE 6.0 software. FROGS pipeline allowed clustering the 4,944,307 informative sequences into 2,135 OTUs, which represented 247 bacteria taxas (140 genera, 50 families, 31 orders, 17 classes and 9 phyla). Significant differences between lines were observed: 4 bacteria generas have abundancies differences according to CCS lines (Olsenella, Prevotella 1, Prevotellaceaea Ga6a1, Syntrophococcus with always higher values for CCS+) and 4 others according to PERS lines (Coprococcus 1, Olsenella, Succonivibrionaceae U2, Syntrophococcus). At the genera scale, heritabilities estimates ranged from 0.00 to 0.49 with a standard error of 0.11 on average: 22% of genera had heritabilities higher than 0.1, which is lower than Estellé et al. on Large White (50% genera with h2>0.1). The most heritable genera (h2>0.25) were Ruminococcaceae UCG002, Lachnospira, Atopobium and Oscillospira which also were taxa with low abundances

Type of schooling, special care and behavioural problems by sex, type of pregnancy and family socioeconomic status in very preterm children.

a<p>Family socio-economic status is defined as the higher of the two parental levels..</p>b<p>p-value adjusted for family socioeconomic status and gestational age.</p