Chloride Balance in Preterm Infants during the First Week of Life

Objective. To describe the chloride balance in infants born 25–32-week gestation, analyze the association of chloride changes with hydroelectrolytic status and their relationship with perinatal conditions, morbidities, and neurological outcome. Methods. For 7 days after birth, sodium and chloride balance, plasma potassium, phosphate, and total carbon dioxide (tCO2) were prospectively determined and strong ion difference (SID) calculated. Three multivariate regression analyses were performed to identify factors associated with high plasma chloride concentration, low SID, and low tCO2. Results. 107 infants were studied. Plasma chloride concentration was significantly positively associated with plasma sodium concentration. Higher plasma chloride and lower SID were significantly associated with lower plasma tCO2. Chloride intake was the main independent factor associated with high plasma chloride, low SID, and low plasma tCO2, with lesser contribution of sodium intake and low gestational age (GA). Also, patent ductus arteriosus and birth weight loss were independent factors affecting plasma chloride and SID. Neither high chloride levels nor low SID were associated to impaired neurological outcome. Conclusions. In preterm infants, chloride balance is influenced by GA and by interrelationship between sodium and chloride intake. High chloride levels are associated with metabolic acidosis but not related to increased risk of impaired neurological outcome

Clinical Study Chloride Balance in Preterm Infants during the First Week of Life

Objective. To describe the chloride balance in infants born 25-32-week gestation, analyze the association of chloride changes with hydroelectrolytic status and their relationship with perinatal conditions, morbidities, and neurological outcome. Methods. For 7 days after birth, sodium and chloride balance, plasma potassium, phosphate, and total carbon dioxide (tCO 2 ) were prospectively determined and strong ion difference (SID) calculated. Three multivariate regression analyses were performed to identify factors associated with high plasma chloride concentration, low SID, and low tCO 2 . Results. 107 infants were studied. Plasma chloride concentration was significantly positively associated with plasma sodium concentration. Higher plasma chloride and lower SID were significantly associated with lower plasma tCO 2 . Chloride intake was the main independent factor associated with high plasma chloride, low SID, and low plasma tCO 2 , with lesser contribution of sodium intake and low gestational age (GA). Also, patent ductus arteriosus and birth weight loss were independent factors affecting plasma chloride and SID. Neither high chloride levels nor low SID were associated to impaired neurological outcome. Conclusions. In preterm infants, chloride balance is influenced by GA and by interrelationship between sodium and chloride intake. High chloride levels are associated with metabolic acidosis but not related to increased risk of impaired neurological outcome

Choc septique du nouveau-né et entérocolite ulcéro-nécrosante avec choc (devenir, facteurs pronostiques)

LYON1-BU Santé (693882101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Stress nitro-oxydant et microcirculation (caractérisation des effets biologiques des acides trans-arachidoniques, nouveaux médiateurs du stress nitro-oxydant)

Les acides trans-arachidoniques, produits in vivo par l isomérisation de l acide arachidonique des membranes cellulaires par le radical NO2·, ont été proposés comme nouveaux marqueurs du stress nitro-oxydant. Très peu de données sont disponibles concernant leur éventuelle activité biologique et leur implication en pathologie. Nous avons caractérisé pour la première fois les effets biologiques des acides trans-arachidoniques sur la microcirculation neuro-rétinienne. Nous avons montré qu à court terme les acides trans-arachidoniques ont un effet vasodilatateur endothélium-dépendant sur les artérioles cérébrales, médié par un mécanisme non conventionnel mettant en jeu la coactivation de l hème-oxygénase 2 et des canaux potassiques calcium-dépendants à grande conductance. A plus long terme, nous avons montré que, dans un modèle de rétinopathie ischémique, les acides trans-arachidoniques entraînent une dégénérescence microvasculaire rétinienne en induisant l apoptose des cellules endothéliales par l induction de la thrombospondine-1. Nous avons ainsi mis en évidence un nouveau mécanisme par lequel le stress nitro-oxydant participe à la dégénérescence microvasculaire rétinienne dans les rétinopathies ischémiques. Nos résultats montrent que les acides trans-arachidoniques ne sont pas de simples marqueurs du stress nitro-oxydant mais bien des médiateurs de ses effets sur la microcirculation neuro-rétinienne, et ouvrent de nouvelles perspectives thérapeutiques visant préserver l intégrité fonctionnelle et anatomique de la microcirculation dans les rétinopathies ischémiques et les pathologies inflammatoires ou neuro-dégénérativesTrans-arachidonic acids are major products of NO2·-mediated isomerization of arachidonic acid within the cell membrane, and have been proposed as new mediators of nitro-oxidative stress. However, their biological relevance is unknown. We characterized the influence of trans-arachidonic acids on neuro-retinal microvasculature and endothelial cell signaling. We showed that trans-arachidonic acids exert an acute endothelium-dependent vasorelaxant effect on rat brain pial microvasculature, through interactive activation of big conductance calcium-dependant potassium channels with heme-oxygenase-2, and in turn, soluble guanylyl cyclase. Long-term effects of trans-arachidonic acids on microvasculature include a selective time- and concentration-dependent apoptosis of microvascular endothelial cells in vitro, resulting in retinal microvascular degeneration ex and in vivo, in a model of ischemic retinopathy. These effects are mediated by an upregulation of the anti-angiogenic factor thrombospondin-1. Our findings provide new insight into the molecular mechanisms of nitro-oxidative stress on neurovascular tone and microvascular injury and suggest new therapeutic avenues in the management of disorders involving nitro-oxidative stress such as ischemic retinopathies and encephalopathiesPARIS-BIUP (751062107) / SudocSudocFranceF

Rétinopathie du prématuré : de la prévention au traitement

International audienceLa rétinopathie du prématuré (ROP) est la principale cause évitable de cécité infantile. Son incidence augmente avec la survie de nouveau-nés extrêmement prématurés. La ROP est une pathologie multi-factorielle du développement de la rétine et du réseau vasculaire rétinien, impliquant des facteurs oxygéno-dépendants et nutritionnels. La multiplicité des facteurs participant à la survenue de la ROP plaide en faveur de stratégies préventives complémentaires et synergiques, telles que le contrôle rigoureux de l’oxygénothérapie, l’optimisation des apports nutritionnels et de la croissance post-natale, l’allaitement maternel, un apport suffisant en AGPI-ω-3 et le contrôle des épisodes hyperglycémiques liés à la prématurité. La ROP nécessite une prise en charge multidisciplinaire, qui inclut un dépistage systématique, un traitement adapté et un suivi à long terme. Les modalités actuelles de dépistage font appel à une caméra grand-champ, permettant également un dépistage par télémédecine. Le traitement de référence de la ROP demeure la photocoagulation au laser. Il peut être associé à des injections intravitréennes d’anticorps anti-VEGF, en cours d’évaluation, ou à la chirurgie pour les stades avancés

La rétinopathie du prématuré

L’exposition à des concentrations élevées d’oxygène est une cause majeure de la rétinopathie du prématuré ; elle est caractérisée par une dégénérescence des micro-vaisseaux et par une ischémie rétinienne suivie d’une angiogenèse anarchique pré-rétinienne. Cependant, des données cliniques et expérimentales suggèrent que des concentrations élevées de dioxyde de carbone joueraient un rôle important dans cette pathologie. L’hyperoxie et l’hypercapnie sont associées au déclenchement d’un stress azoté qui favorise la nitration de l’acide arachidonique qui se transforme en acide trans-arachidonique. À son tour l’acide trans-arachidonique peut lui-même causer une dégénérescence micro-vasculaire dans la rétine par suite de l’induction de l’expression du facteur anti-angiogénique thrombospondine-1. Ces effets nouvellement décrits du stress azoté menant à des dommages micro-vasculaires et impliquant l’acide trans-arachidonique ouvrent peut-être de nouvelles avenues pour le traitement des affections liées au stress azoté comme les rétinopathies (autant celles des prématurés que des diabétiques) et les encéphalopathies ischémiques

Excessive workload and insufficient night-shift remuneration are key elements of dissatisfaction at work for French neonatologists

International audienceAIM: Neonatologists are exposed to ethical issues and unplanned emergencies that require 24-h in-house coverage. These elements may affect quality of life at work, which we surveyed. METHODS: This was a self-administered, voluntary and anonymous cross-sectional survey of French neonatologists. An online questionnaire was sent to members of the French Society of Neonatology from June to October 2022. RESULTS: Of approximately 1500 possible responses, 721 were analysed, with a response rate of 48%. Respondents were mostly women (77%), aged 35-50 years (50%), and hospital practitioners (63%). Reported weekly working time was over 50 h for 80%. Among the 650 neonatologists with on-call duty, 47% worked ≥5 shifts per month. For 80% of practitioners, on-call duty was perceived to have a negative impact on personal life; 49% indicated having sleep disorders. The mean satisfaction score at work was 5.7 ± 1.7 on a scale of 0-10. The main reasons for dissatisfaction were excessive working hours and insufficient remuneration for on-call duty. CONCLUSION: This first evaluation of the quality of life at work of French neonatologists showed high workload. The working conditions and specificities of NICU activity may have significant consequences for their mental health

Data from: Posttraumatic stress reactions in parents of children esophageal atresia.

Objective – The aim of this study was to investigate psychological stress in parents of children with esophageal atresia and to explore factors associated with the development of Posttraumatic Stress disorder (PTSD). Design - Self-report questionnaires were administered to parents of children with EA. Domains included: (1) sociodemographic data, current personal difficulties, assessment scales for the quality of life and for the global health status of the child (2) French-validated versions of the Perinatal Posttraumatic Stress disorder Questionnaire and of the State-Trait Anxiety Inventory. Associations between PTSD and severity of the neonatal course, presence of severe sequelae at 2 years of age, and quality of life and global health status of children according to their parents’ perception were studied. Setting – a Tertiary care University Hospital Results - Among 64 eligible families, 54 parents of 38 children (59%) participated to the study. PTSD was present in 32 (59%) parents; mothers were more frequently affected than fathers (69 vs 46%, p=0.03). Four mothers (8%) had severe anxiety. PTSD was neither associated with neonatal severity nor with severe sequelae at 2 years. Parents with PTSD rated their child’s quality of life and global health status significantly lower (7.5 vs 8.6; p=0.01 and 7.4 vs 8.3; p=0.02 respectively). Conclusions - PTSD is frequent in parents of children with esophageal atresia, independently of neonatal severity and presence of severe sequelae at 2 years of age. Our results highlight the need for a long-term psychological support of families

Posttraumatic Stress Reactions in Parents of Children Esophageal Atresia.

OBJECTIVE:The aim of this study was to investigate psychological stress in parents of children with esophageal atresia and to explore factors associated with the development of Posttraumatic Stress disorder (PTSD). DESIGN:Self-report questionnaires were administered to parents of children with EA. Domains included: (1) sociodemographic data, current personal difficulties, assessment scales for the quality of life and for the global health status of the child (2) French-validated versions of the Perinatal Posttraumatic Stress disorder Questionnaire and of the State-Trait Anxiety Inventory. Associations between PTSD and severity of the neonatal course, presence of severe sequelae at 2 years of age, and quality of life and global health status of children according to their parents' perception were studied. SETTING:A Tertiary care University Hospital. RESULTS:Among 64 eligible families, 54 parents of 38 children (59%) participated to the study. PTSD was present in 32 (59%) parents; mothers were more frequently affected than fathers (69 vs 46%, p = 0.03). Four mothers (8%) had severe anxiety. PTSD was neither associated with neonatal severity nor with severe sequelae at 2 years. Parents with PTSD rated their child's quality of life and global health status significantly lower (7.5 vs 8.6; p = 0.01 and 7.4 vs 8.3; p = 0.02 respectively). CONCLUSIONS:PTSD is frequent in parents of children with esophageal atresia, independently of neonatal severity and presence of severe sequelae at 2 years of age. Our results highlight the need for a long-term psychological support of families

Burden of bacterial resistance among neonatal infections in low income countries: how convincing is the epidemiological evidence?

International audienceBackground: Antibiotic resistance is a threat in developing countries (DCs) because of the high burden of bacterial disease and the presence of risk factors for its emergence and spread. This threat is of particular concern for neonates in DCs where over one-third of neonatal deaths may be attributable to severe infections and factors such as malnutrition and HIV infection may increase the risk of death. Additional, undocumented deaths due to severe infection may also occur due to the high frequency of at-home births in DCs. Methods: We conducted a systematic review of studies published after 2000 on community-acquired invasive bacterial infections and antibiotic resistance among neonates in DCs. Twenty-one articles met all inclusion criteria and were included in the final analysis. Results: Ninety percent of studies recruited participants at large or university hospitals. The majority of studies were conducted in Sub-Saharan Africa (n = 10) and the Indian subcontinent (n = 8). Neonatal infection incidence ranged from 2.9 (95% CI 1.9–4.2) to 24 (95% CI 21.8–25.7) for 1000 live births. The three most common bacterial isolates in neonatal sepsis were Staphylococcus aureus, Escherichia coli, and Klebsiella. Information on antibiotic resistance was sparse and often relied on few isolates. The majority of resistance studies were conducted prior to 2008. No conclusions could be drawn on Enterobacteriaceae resistance to third generation cephalosporins or methicillin resistance among Staphylococcus aureus. Conclusions: Available data were found insufficient to draw a true, recent, and accurate picture of antibiotic resistance in DCs among severe bacterial infection in neonates, particularly at the community level. Existing neonatal sepsis treatment guidelines may no longer be appropriate, and these data are needed as the basis for updated guidelines. Reliable microbiological and epidemiological data at the community level are needed in DCs to combat the global challenge of antibiotic resistance especially among neonates among whom the burden is greatest