Early parenteral lipids and growth velocity in extremely-low-birth-weight infants.

BACKGROUND & AIMS: Whether early parenteral lipids improve postnatal growth of preterm neonates remains unclear. We aimed to assess the effects of parenteral lipids on growth velocity in extremely-low-birth-weight infants. METHODS: This retrospective cohort study included 121 extremely-low-birth-weight infants. The associations between parenteral lipids (cumulative intakes during the first week and delays in their introduction) and growth velocities (weight, head circumference and length) up to 28 days of life and to 36 weeks of corrected age were analysed using uni- and multivariate linear regression. RESULTS: Univariate analyses showed a significant positive association between the cumulative intakes of parenteral lipids during the first week and i) weight gain up to day 28; ii) weight gain up to 36 weeks of corrected age; iii) head circumference growth up to day 28. There was a negative correlation between the delay in parenteral lipid introduction and weight gain up to day 28. In multivariate analyses, the association between the cumulative intakes of parenteral lipids and weight gain up to 28 days was independent of gestational age at birth, birth weight, sex, smallness for gestational age, and enteral intakes (regression coefficient: 0.19; 95% CI: 0.01-0.38) and, up to 36 weeks, independent of gestational age, birth weight, sex, smallness for gestational age and parenteral glucose and amino acids (0.16; 95% CI: 0.04-0.27). CONCLUSIONS: Parenteral lipids during the first week were positively associated with weight gain in extremely-low-birth-weight infants and could improve early nutritional support of preterm neonates

Les Nævus Congénitaux géants : à propos d’un cas à Libreville

English title: The Giant Congenital Nevi: About a Case of Libreville Le nævus congénital géant correspond à des lésions cutanées bénignes,présentes dès la naissance. Son évolution est marquée par le risque de  transformation maligne. La prise en charge thérapeutique doit être instaurée dès le jeune âge afin d’éviter au patient et à  son entourage des répercussions esthétiques et psychosociales importantes. Nous illustrons à travers cette observation le cas d’un nouveau-né qui présente un nævus congénital géant. Il s’agit d’un nouveau-né de sexe féminin, issu d’une grossesse menée à terme, qui présente depuis sa naissance une plaque pigmentée asymptomatique d’une taille entre 12cm/10cm siégeant au niveau du dos, dutronc parsemée de quelques espaces saints, associé à des lésions similaires au niveau de la fesse. Le diagnostic retenu était celui d’un nævus congénital géant. Les nævus congénitaux de grande taille sont exceptionnels 1/2000 à 10000 naissances. La hantise est la transformation maligne en mélanome. D’ailleurs le mélanome est dans 30% des cas associé à un nævus congénital géant et est le plus souvent précoce (10 premières années de vie) et son pronostic est généralement catastrophique. La deuxième complication est la mélanose neuroméningée qui est une manifestation rare qui associe des manifestations pigmentaires à la fois cutanées et  méningoencéphaliques. L’atteinte du système nerveux se manifeste par une hydrocéphalie et par des signes de localisation indiquant la réalisation d’une IRM. Le traitement des nævus congénitaux est très difficile. Les excisions itératives sont proposées associées à des techniques d’expansion cutanées. Les alternatives sont la dermabrasion, le laser CO2 et le curetage en période néonatale. Les nævuscongénitaux géants sont exceptionnels, de pronostic fâcheux et sont de prise en charge thérapeutique difficile. Le nouveau-né a été déclaré perdu de vue du service. Mots clés : nævus congénital géant, nouveau-né, Libreville-Gabo

PSEUDOMYXOME PERITONEAL : à propos d’un nouveau cas et revue de la littérature

Le pseudomyxome péritonéal (PP) est une maladie rare, classiquement dépistée par la découverte de gélatine au cours d’une laparotomie. L’étiopathogénie de cette affection n’est pas univoque, toutefois de récentes analyses immuno-histochimiques et génétiques affirment son origine appendiculaire et non ovarienne. Les auteurs rapportent une observation de pseudomyxome péritonéal associé à des tumeurs mucineuses appendiculaire et ovarienne ; et discutent de cette association, qui pose le double problème du diagnostic et de la stratégie thérapeutique en cas de découverte fortuite.Mots-clés : pseudomyxome péritonéale – mucocèle appendiculaire – chirurgie de réduction

Early Use of Mother's Own Raw Milk, Maternal Satisfaction, and Breastfeeding Continuation in Hospitalised Neonates: A Prospective Cohort Study.

Despite the critical importance of breast milk for preterm and sick neonates, there is no consensus regarding the use of raw mother's own milk (MOM) in neonatal units. This study aimed to describe the use of raw MOM in hospitalised neonates before day 7 (early use), and to investigate: (i) related factors, (ii) maternal satisfaction, and (iii) the association with breastfeeding continuation. This prospective cohort included 516 neonates intended to be breastfed in 2 French neonatal units. Neonates receiving raw MOM before day 7 were compared to those who did not. The association between early use of MOM and breastfeeding continuation at hospital discharge, and up to 6 months later, was measured by logistic regression. More than one-third (36.2%) of breastfed neonates did not receive any MOM during their first week, mainly due to organisational constraints and staff reluctance. Maternal satisfaction related to early raw MOM use was high (96%), and was coupled with a more frequent maternal feeling of being supported in breastfeeding (p = 0.003). There was a significant association between early use of MOM and breastfeeding continuation at discharge (OR 2.92, 95% CI 1.94-4.40, p < 0.0001), which persisted 6 months later (OR 2.70, 95% CI 1.21-6.03, p = 0.023). This association appeared independent in multivariable analyses (at discharge: aOR 2.03, 95% CI 1.27-3.25, p = 0.003; 6 months later: aOR 2.46, 95% CI 1.02-5.92, p = 0.045). While the early use of raw MOM in hospitalised neonates can be limited by multiple factors, it appears supportive for mothers, and might represent a simple opportunity to improve breastfeeding in neonatal units

Low phosphatemia in extremely low birth weight neonates: A risk factor for hyperglycemia?

Hyperglycemia occurs in more than half of the extremely low birth weight (ELBW) neonates during the first weeks of life, and is correlated with an increased risk of morbi-mortality. Hypophosphatemia is another frequent metabolic disorder in this population. Data from animal, adult studies and clinical observation suggest that hypophosphatemia could induce glucose intolerance. Our aim was to determine whether a low phosphatemia is associated with hyperglycemia in ELBW neonates. This observational study included ELBW infants admitted in a tertiary neonatal care center (2010-2011). According to the center's policy, they received parenteral nutrition from birth and human milk from day 1. Phosphatemia and glycemia were measured routinely during parenteral nutrition. Hyperglycemia was defined by two consecutives values >8.3 mmol/L (150 mg/dL). Statistical analysis used a joint model combining a mixed-effects and a survival submodels to measure the association between phosphate and hyperglycemia. The study included 148 patients. Mean gestational (Standard Deviation) age was 27.3 (1.6) weeks; mean birth weight was 803 (124) grams; 57% presented hyperglycemia. The multivariate joint model showed that the hazard of hyperglycemia at a given time was multiplied by 3 for each 0.41 mmol/L decrease of phosphate level at this time (p = 0.002) and by 3.85 for the same decreased of phosphate the day before (p = 0.0015). To our knowledge, this is the first study suggesting that low phosphatemia can be associated with hyperglycemia in ELBW neonates. Further studies will have to demonstrate whether better control of phosphatemia could help in preventing hyperglycemia

Early Use of Mother's Own Raw Milk, Maternal Satisfaction, and Breastfeeding Continuation in Hospitalised Neonates: A Prospective Cohort Study

International audienceBackground: Despite the critical importance of breast milk for preterm and sick neonates, there is no consensus regarding the use of raw mother's own milk (MOM) in neonatal units. Objectives: This study aimed to describe the use of raw MOM in hospitalised neonates before day 7 (early use), and to investigate: (i) related factors, (ii) maternal satisfaction, and (iii) the association with breastfeeding continuation. Methods: This prospective cohort included 516 neonates intended to be breastfed in 2 French neonatal units. Neonates receiving raw MOM before day 7 were compared to those who did not. The association between early use of MOM and breastfeeding continuation at hospital discharge, and up to 6 months later, was measured by logistic regression. Results: More than one-third (36.2%) of breastfed neonates did not receive any MOM during their first week, mainly due to organisational constraints and staff reluctance. Maternal satisfaction related to early raw MOM use was high (96%), and was coupled with a more frequent maternal feeling of being supported in breastfeeding (p = 0.003). There was a significant association between early use of MOM and breastfeeding continuation at discharge (OR 2.92, 95% CI 1.94-4.40, p p = 0.023). This association appeared independent in multivariable analyses (at discharge: aOR 2.03, 95% CI 1.27-3.25, p = 0.003; 6 months later: aOR 2.46, 95% CI 1.02-5.92, p = 0.045). Conclusion: While the early use of raw MOM in hospitalised neonates can be limited by multiple factors, it appears supportive for mothers, and might represent a simple opportunity to improve breastfeeding in neonatal units

Les avortements clandestins au Centre Hospitalier Universitaire de Libreville de 2014 à 2018 : à propos de 212 cas

Objectif : Cette étude avait pour but d’étudier les aspects épidémiologiques cliniques et thérapeutiques des avortements clandestins dans le service de gynécologie interne du Centre Hospitalier Universitaire de Libreville de 2014 en 2018. Patients et méthodes : Il s’est agi d’une étude rétrospective, descriptive qui s’est déroulée du 1er janvier au 31 décembre 2018. Elle a porté sur toutes les patientes ayant pratiquées un avortement clandestin avec un âge gestationnel inférieur ou supérieur à 12 semaines aménorrhée, mariées ou célibataires, admises et/ou prise en charge dans le service de gynécologique interne du CHUL, dans la période de l’étude quelle que soit leur provenance. L’approche de collecte était une enquête par dépouillement de dossiers médicaux assortie à une étude des registres de compte rendu d’hospitalisation. Résultats : La fréquence moyenne annuelle des avortements provoqués était de 50±3,1 avortements pour 1000 accouchements. Cette fréquence a été multipliée par 5 en 2014 et 2018. L’âge moyen était de 27,3± 6,6 ans avec des extrêmes de 14 et 50ans. La majorité, soit 62,3% était du niveau secondaire, 79,9% était célibataires. L’âge gestationnel était connu pour 60,4% et inférieur à 12 semaines d’aménorrhée dans 46,7% des cas. Deux ethnies étaient majoritairement représentées : les fangs 32,1% et les punus 25,5%. Le lieu de l’avortement était principalement le domicile familial pour 72,6% des patientes. La méthode abortive utilisée était principalement le comprimé de misoprostol à 58,0%. Le motif de l’avortement était à 52,8% une grossesse non désirée plus ou moins associée à 22,6% à un manque de moyens financiers. Sur le plan clinique, le diagnostic retenu était principalement l’avortement compliqué d’une hémorragie (55,6%). La prise en charge comprenait : le  remplissage vasculaire (59,0%), l’AMIU (50,9%), l’antibiothérapie (88,6%) dominé par le métronidazole à 53,3%, la transfusion (60,8%), le fer et les acides foliques (35,4%), utérotonique (34,0%). La complication majeure était l’anémie (71,7%). L’évolution était favorable pour 92,5% dont 75% (soit 16/212) sont décédés en cours d’hospitalisation. Conclusion : L’avortement clandestin demeure un problème de santé publique dans notre pays, de par sa fréquence croissante, et ses omplications à type d’hémorragie pouvant engager le pronostic vital. La technique d’Aspiration Manuelle Intra utérine (AMIU) a encore montré son efficacité dans la prise en charge des complications de cette pratique avant l’âge gestationnel de 12 semaines d’aménorrhée. Sensibiliser davantage les populations sur les méthodes contraceptives et élargir sur le plan juridique l’accès à l’avortement médicalisé au premier trimestre de grossesse, pourraient amoindrir l’incidence et les complications de ces avortements dans notre region. Mots clés : Epidémiologie, clinique, thérapeutique, avortement clandestin, Libreville English Abstarct: Clandestine abortions at the Libreville University Hospital Center from 2014 to 2018: About 212 cases Objective: The aim of this study was to investigate the clinical and therapeutic epidemiological aspects of clandestine abortions in the internal gynecology department of the University Hospital of Libreville from 2014 to 2018. Patients and methods: This was a retrospective, descriptive study that took place from January 1 to December 31, 2018. It focused on all patients who had performed a clandestine abortion with a gestational age of less than or greater than 12 weeks of amenorrhea, married or single, admitted and/or managed in the internal gynecological service of the CHUL, in the period of the study regardless of their origin. The collection approach was a medical record survey combined with a study of hospitalization records. Results: The average annual frequency of induced abortions was 50±3.1 abortions per 1000 deliveries. This frequency increased 5-fold in 2014 and 2018. The average age was 27.3± 6.6 years extreme 14 and 50 years. The majority, 62.3% were of secondary school level, 79.9% were single. Gestational age was known for 60.4% and less than 12 weeks of amenorrhea in 46.7% of cases. Two ethnic groups were predominantly represented: the Fangs (32.1%) and the Punus (25.5%). The place of abortion was mainly the family home for 72.6% of patients. The abortion method used was mainly misoprostol tablets (58.0%). The reason for the abortion was an unwanted pregnancy in 52.8% of cases, more or less associated with a lack of financial means in 22.6%. Clinically, the diagnosis was mainly abortion complicated by hemorrhage (55.6%). Management included: vascular filling (59.0%), MVA (50.9%), antibiotic therapy (88.6%) dominated by metronidazole (53.3%), transfusion (60.8%), iron and folic acids (35.4%), uterotonic (34.0%). The major complication was anemia (71.7%). The evolution was favorable for 92.5% of which 75% (16/212) died during hospitalization. Conclusion: Clandestine abortion remains a public health problem in our country, due to its increasing frequency, and its complications such as hemorrhage that can be life threatening. The IMIU technique has again shown its effectiveness in the management of complications of this practice before the gestational age of 12 weeks of amenorrhea. Increased awareness of contraceptive methods and legal access to medical abortion in the first trimester of pregnancy could reduce the incidence and complications of these abortions in our religion. Keywords: Epidemiology, clinical, therapeutic, clandestine abortion, Libreville