Conformité des pratiques de l hypothermie aux recommandations (étude multicentrique chez le nouveau-né à terme)

OBJECTIF : L objectif de l étude était de décrire les pratiques de l hypothermie (HT) en France chez les enfants nés à terme et atteints d une encéphalopathie anoxo-ischémique (EAI) et d analyser les écarts par rapport aux recommandations de la Société Française de Néonatologie. MATERIEL ET METHODES : De Mai 2010 à Mars 2012 nous avons inclus tous les cas EAI traités par HT enregistrés dans la base nationale française déclarative des EAI. La population a été divisée en deux groupes hypothermie suboptimale (HTSO) ou hypothermie optimale (HTO) selon le parfait respect ou non des recommandations. RESULTATS : Sur les 311 nouveau-nés enregistrés dans la base et ayant bénéficié d hypothermie, 65 % ont été classés dans le groupe HTO et 35 % dans le groupe HTSO. Dans le groupe HTSO, 62% (n=68) des enfants ont commencé l HT au-delà de 6h et 38% (n=27) n avaient pas tous les critères de mise en HT. Sur la totalité de la population, 46% des nouveau-nés n avaient pas eu d électroencéphalogramme avant le début de l HT. Enfin, pour le groupe HTSO : les enfants nécessitaient moins fréquemment d une réanimation à la naissance et présentaient moins souvent une acidose sévère à la naissance ou des complication de l EAI. CONCLUSION : Ce premier bilan illustre les difficultés d application des recommandations concernant l HT et doit inciter à une optimisation des soins périnataux pour l EAI.AIM : The objective of this study was to describe the French practice of hypothermia treatment (HT) in fullterm newborns with hypoxic-ischemic encephalopathy (HIE) and to analyze the deviations from the guidelines of the French Society of Neonatology. MATERIAL AND METHOD : From May 2010 to March 2012 we included all cases of HIE treated by HT entered in a declarative French national database of HIE. The population was divided into two groups, "optimal hypothermia" (OHT) and "sub-optimal hypothermia" (SOHT), according to whether the guidelines were fully followed or not. RESULTS : Of the 311 newborns registered in the database and having hypothermia treatment, 65% were classified in the OHT group and 35% in the SOHT group. In the SOHT group, 62% of newborns (n = 68) started HT at over 6h and 38 % (n = 27) had insufficient criteria for implementing HT. In the whole population, 46% of newborns had no electrophysiological examination before starting HT. Nevertheless in the SOHT group, severe acidosis, resuscitation at birth and neonatal complications of HIE were less frequent. CONCLUSION : This first report illustrates the difficulties in implementing guidelines for HT and should lead to an optimization of perinatal care for HIE.GRENOBLE1-BU Médecine pharm. (385162101) / SudocSudocFranceF

Method and system for image analysis

A computer-implemented method for analyzing a sample comprising a first material and a second material of generally different densities and having a junction therebetween. The method comprises: defining automatically a plurality of regions of interest within an image of the sample, each of said regions of interest having a width of one or more voxels or pixels; determining respective density, intensity or attenuation profiles within the regions of interest; determining a location of said junction including defining a first reference point within one of said first and second materials and employing the first reference point as current reference point, and (i) determining a closest point to said current reference point that is on said respective profile and in the other of said first and second materials to that of the current reference point; (ii) locating a greatest difference in values of the respective profile between an adjacent peak and trough in a segment of the respective profile between said current reference point and said closest point; and (iii) locating a point of inflexion in said segment

Common variants in the region around Osterix are associated with bone mineral density and growth in childhood

Peak bone mass achieved in adolescence is a determinant of bone mass in later life. In order to identify genetic variants affecting bone mineral density (BMD), we performed a genome-wide association study of BMD and related traits in 1518 children from the Avon Longitudinal Study of Parents and Children (ALSPAC). We compared results with a scan of 134 adults with high or low hip BMD. We identified associations with BMD in an area of chromosome 12 containing the Osterix (SP7) locus, a transcription factor responsible for regulating osteoblast differentiation (ALSPAC: P = 5.8 × 10−4; Australia: P = 3.7 × 10−4). This region has previously shown evidence of association with adult hip and lumbar spine BMD in an Icelandic population, as well as nominal association in a UK population. A meta-analysis of these existing studies revealed strong association between SNPs in the Osterix region and adult lumbar spine BMD (P = 9.9 × 10−11). In light of these findings, we genotyped a further 3692 individuals from ALSPAC who had whole body BMD and confirmed the association in children as well (P = 5.4 × 10−5). Moreover, all SNPs were related to height in ALSPAC children, but not weight or body mass index, and when height was included as a covariate in the regression equation, the association with total body BMD was attenuated. We conclude that genetic variants in the region of Osterix are associated with BMD in children and adults probably through primary effects on growth

Définitions : petit poids pour l’âge gestationnel et retard de croissance intra-utérin

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Définitions du retard de croissance intra-utérin (intérêt des courbes ajustées individuelles de poids fœtal)

Le retard de croissance intra-utérin est une pathologie fréquente et complexe en médecine périnatale, mais sa définition et son dépistage ne sont pas clairement définis. De nombreuses courbes de références de poids de naissance sont utilisées dans le monde afin d identifier les enfants de faible poids. Cependant l utilisation d un seuil de poids (le plus souvent le 10ème percentile) ne tient pas compte du potentiel de croissance individuel. Des alternatives consistant à modéliser la croissance et rechercher une cassure de la courbe existent, mais sont difficiles à utiliser. En 1995, Jason Gardosi a suggéré la construction de courbes ajustées sur des facteurs individuels dont le sexe foetal, la taille et le poids maternels, la parité, et cette approche semble montrer un bénéfice dans l identification d enfants à risque. En l absence de courbes de poids satisfaisantes en France, un modèle ajusté adapté aux naissances de notre pays a ainsi été développé. Ce modèle, appliqué à un large échantillon multicentrique (N=56606), montre une amélioration du dépistage de la morbidité et mortalité périnatale liées au faible poids. La question du choix des paramètres d ajustement dans ces modèles reste à débattre. L exclusion du facteur parité ne semble pas altérer la pertinence du modèle. En France, l utilisation des courbes ajustées individuelles à l aide d un outil validé pourrait améliorer les soins en maternité et harmoniser la définition du RCIU entre cliniciens et épidémiologistes. Cependant, leur impact sur les soins et la santé périnatale nécessite d être évalué de façon prospective en pratique clinique.PARIS-BIUSJ-Thèses (751052125) / SudocPARIS-BIUSJ-Physique recherche (751052113) / SudocSudocFranceF

LyTONEPAL: long term outcome of neonatal hypoxic encephalopathy in the era of neuroprotective treatment with hypothermia: a French population-based cohort.

BACKGROUND: Hypoxic-ischemic encephalopathy (HIE) is a rare neonatal condition affecting about 1‰ births. Despite a significant improvement in the management of this condition in the last ten years, HIE remains associated with high rates of death and severe neurological disability. From September 2015 to March 2017, a French national cohort of HIE cases was conducted to estimate the extent of long-term moderate and severe neurodevelopmental disability at 3 years and its determinants. METHODS: This prospective population-based cohort includes all moderate or severe cases of HIE, occurring in newborns delivered between 34 and 42 completed weeks of gestation and admitted to a neonatal intensive care unit. Detailed data on the pregnancy, delivery, and newborn until hospital discharge was collected from the medical records in maternity and neonatology units. All clinical examinations including biomarkers, EEG, and imaging were recorded. To ensure the completeness of HIE registration, a registry of non-included eligible neonates was organized, and the exhaustiveness of the cohort is currently checked using the national hospital discharge database. Follow-up is organized by the regional perinatal network, and 3 medical visits are planned at 18, 24 and 36 months. One additional project focused on early predictors, in particular early biomarkers, involves a quarter of the cohort. DISCUSSION: This cohort study aims to improve and update our knowledge about the incidence, the prognosis and the etiology of HIE, and to assess medical care. Its final objective is to improve the definition of this condition and develop prevention and management strategies for high-risk infants

LyTONEPAL: long term outcome of neonatal hypoxic encephalopathy in the era of neuroprotective treatment with hypothermia: a French population-based cohort

International audienceBACKGROUND: Hypoxic-ischemic encephalopathy (HIE) is a rare neonatal condition affecting about 1‰ births. Despite a significant improvement in the management of this condition in the last ten years, HIE remains associated with high rates of death and severe neurological disability. From September 2015 to March 2017, a French national cohort of HIE cases was conducted to estimate the extent of long-term moderate and severe neurodevelopmental disability at 3 years and its determinants. METHODS: This prospective population-based cohort includes all moderate or severe cases of HIE, occurring in newborns delivered between 34 and 42 completed weeks of gestation and admitted to a neonatal intensive care unit. Detailed data on the pregnancy, delivery, and newborn until hospital discharge was collected from the medical records in maternity and neonatology units. All clinical examinations including biomarkers, EEG, and imaging were recorded. To ensure the completeness of HIE registration, a registry of non-included eligible neonates was organized, and the exhaustiveness of the cohort is currently checked using the national hospital discharge database. Follow-up is organized by the regional perinatal network, and 3 medical visits are planned at 18, 24 and 36 months. One additional project focused on early predictors, in particular early biomarkers, involves a quarter of the cohort. DISCUSSION: This cohort study aims to improve and update our knowledge about the incidence, the prognosis and the etiology of HIE, and to assess medical care. Its final objective is to improve the definition of this condition and develop prevention and management strategies for high-risk infants

Un proyecto de escuela ambiental en el extremo norte del Perú

A Project of Environmental Education in the Northern Peru We show here that the current education system forms individuals that tend to ignore the historical relation at the regional level between nature and society. For that reason, we attempt to create a school where diverse representatives of the regional society in the extreme north of Peru can communicate with researchers from both the social and natural sciences who have specialized in that region, to create an environmental history of that area. This shared vision of the past with a projection towards the future would strengthen the awareness of a regional identity and allow the elaboration of projects for a decentralized development process that wouldake into account the great diversity of local realities.Un projet d'école environnementale dans l'extrême nord du Pérou Nous avons constaté que l’actuel système d’éducation forme des individus qui se reproduisent le dos tourné à l’histoire régionale de la relation entre la nature et la société. Nous avons donc tenté de créer une école dans laquelle divers représentants de la société régionale, avec des chercheurs en sciences naturelles et sociales, spécialistes de l’extrême nord du Pérou, tenteraient d’élaborer une histoire environnementale. Cette vision partagée du passé vers l’ avenir permettrait, en consolidant la conscience d’une identité régionale, la définition de projets de développement décentralisés qui prennent en compte les divers aspects des multiples réalités locales.Constatamos que el actual sistema de educación forma individuos que se reproducen de espaldas a la historia regional de la relación entre la naturaleza y la sociedad. Intentamos entonces crear una escuela donde diversos representantes de la sociedad regional, junto con investigadores en ciencias naturales y sociales especialistas del extremo norte del Perú, intentarían elaborar una historia ambiental. Esta visión compartida del pasado con miras al porvenir permitiría, fortaleciendo la conciencia de una identidad regional, definir proyectos de desarrollo descentralizados que tomen en cuenta los diversos aspectos de las múltiples realidades locales.Hocquenghem Anne-Marie, Dammert Ego Aguirre Manuel. Un proyecto de escuela ambiental en el extremo norte del Perú. In: Bulletin de l'Institut Français d'Études Andines, tome 28, N°3, 1999. Transformar o reflejar las realidades andinas: la educación en el siglo XX. pp. 461-466

Recommandations pour la prise en charge de l’infarctus cérébral artériel à révélation néonatale chez le nouveau-né à terme ou proche du terme

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More validation is needed before widespread adoption of INTERGROWTH-21 st fetal growth reference standards in France

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