11 research outputs found
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 NĂŠvus CongĂ©nitaux gĂ©ants : Ă propos dâun cas Ă Libreville
English title: The Giant Congenital Nevi: About a Case of Libreville
Le nĂŠvus congĂ©nital gĂ©ant correspond Ă des lĂ©sions cutanĂ©es bĂ©nignes,prĂ©sentes dĂšs la naissance. Son Ă©volution est marquĂ©e par le risque de transformation maligne. La prise en charge thĂ©rapeutique doit ĂȘtre instaurĂ©e dĂšs le jeune Ăąge afin dâĂ©viter au patient et Ă son entourage des rĂ©percussions esthĂ©tiques et psychosociales importantes. Nous illustrons Ă travers cette observation le cas dâun nouveau-nĂ© qui prĂ©sente un nĂŠvus congĂ©nital gĂ©ant. Il sâagit dâun nouveau-nĂ© de sexe fĂ©minin, issu dâune grossesse menĂ©e Ă terme, qui prĂ©sente depuis sa naissance une plaque pigmentĂ©e asymptomatique dâune taille entre 12cm/10cm siĂ©geant au niveau du dos, dutronc parsemĂ©e de quelques espaces saints, associĂ© Ă des lĂ©sions similaires au niveau de la fesse. Le diagnostic retenu Ă©tait celui dâun nĂŠvus congĂ©nital gĂ©ant. Les nĂŠvus congĂ©nitaux de grande taille sont exceptionnels 1/2000 Ă 10000 naissances. La hantise est la transformation maligne en mĂ©lanome. Dâailleurs le mĂ©lanome est dans 30% des cas associĂ© Ă un nĂŠvus congĂ©nital gĂ©ant et est le plus souvent prĂ©coce (10 premiĂšres annĂ©es de vie) et son pronostic est gĂ©nĂ©ralement catastrophique. La deuxiĂšme complication est la mĂ©lanose neuromĂ©ningĂ©e qui est une manifestation rare qui associe des manifestations pigmentaires Ă la fois cutanĂ©es et mĂ©ningoencĂ©phaliques. Lâatteinte du systĂšme nerveux se manifeste par une hydrocĂ©phalie et par des signes de localisation indiquant la rĂ©alisation dâune IRM. Le traitement des nĂŠvus congĂ©nitaux est trĂšs difficile. Les excisions itĂ©ratives sont proposĂ©es associĂ©es Ă des techniques dâexpansion cutanĂ©es. Les alternatives sont la dermabrasion, le laser CO2 et le curetage en pĂ©riode nĂ©onatale. Les nĂŠvuscongĂ©nitaux gĂ©ants sont exceptionnels, de pronostic fĂącheux et sont de prise en charge thĂ©rapeutique difficile. Le nouveau-nĂ© a Ă©tĂ© dĂ©clarĂ© perdu de vue du service.
Mots clés : nÊvus congénital géant, nouveau-né, Libreville-Gabo
PSEUDOMYXOME PERITONEAL : Ă propos dâun nouveau cas et revue de la littĂ©rature
Le pseudomyxome pĂ©ritonĂ©al (PP) est une maladie rare, classiquement dĂ©pistĂ©e par la dĂ©couverte de gĂ©latine au cours dâune laparotomie. LâĂ©tiopathogĂ©nie de cette affection nâest pas univoque, toutefois de rĂ©centes analyses immuno-histochimiques et gĂ©nĂ©tiques affirment son origine appendiculaire et non ovarienne. Les auteurs rapportent une observation de pseudomyxome pĂ©ritonĂ©al associĂ© Ă des tumeurs mucineuses appendiculaire et ovarienne ; et discutent de cette association, qui pose le double problĂšme du diagnostic et de la stratĂ©gie thĂ©rapeutique en cas de dĂ©couverte fortuite.Mots-clĂ©s : pseudomyxome pĂ©ritonĂ©ale â mucocĂšle appendiculaire â chirurgie de rĂ©duction
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 >8.3Â mmol/L (150Â 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
Les avortements clandestins au Centre Hospitalier Universitaire de Libreville de 2014 Ă 2018 : Ă propos de 212 cas
Objectif : Cette Ă©tude avait pour but dâĂ©tudier les aspects Ă©pidĂ©miologiques cliniques et thĂ©rapeutiques des avortements clandestins dans le service de gynĂ©cologie interne du Centre Hospitalier Universitaire de Libreville de 2014 en 2018.
Patients et mĂ©thodes : Il sâest agi dâune Ă©tude rĂ©trospective, descriptive qui sâest dĂ©roulĂ©e du 1er janvier au 31 dĂ©cembre 2018. Elle a portĂ© sur toutes les patientes ayant pratiquĂ©es un avortement clandestin avec un Ăąge gestationnel infĂ©rieur ou supĂ©rieur Ă 12 semaines amĂ©norrhĂ©e, mariĂ©es ou cĂ©libataires, admises et/ou prise en charge dans le service de gynĂ©cologique interne du CHUL, dans la pĂ©riode de lâĂ©tude quelle que soit leur provenance. Lâapproche de collecte Ă©tait une enquĂȘte par dĂ©pouillement de dossiers mĂ©dicaux assortie Ă une Ă©tude des registres de compte rendu dâhospitalisation.
RĂ©sultats : La frĂ©quence moyenne annuelle des avortements provoquĂ©s Ă©tait de 50±3,1 avortements pour 1000 accouchements. Cette frĂ©quence a Ă©tĂ© multipliĂ©e par 5 en 2014 et 2018. LâĂąge moyen Ă©tait de 27,3± 6,6 ans avec des extrĂȘmes de 14 et 50ans. La majoritĂ©, soit 62,3% Ă©tait du niveau secondaire, 79,9% Ă©tait cĂ©libataires. LâĂąge gestationnel Ă©tait connu pour 60,4% et infĂ©rieur Ă 12 semaines dâamĂ©norrhĂ©e dans 46,7% des cas. Deux ethnies Ă©taient majoritairement reprĂ©sentĂ©es : les fangs 32,1% et les punus 25,5%. Le lieu de lâavortement Ă©tait principalement le domicile familial pour 72,6% des patientes. La mĂ©thode abortive utilisĂ©e Ă©tait principalement le comprimĂ© de misoprostol Ă 58,0%. Le motif de lâavortement Ă©tait Ă 52,8% une grossesse non dĂ©sirĂ©e plus ou moins associĂ©e Ă 22,6% Ă un manque de moyens financiers. Sur le plan clinique, le diagnostic retenu Ă©tait principalement lâavortement compliquĂ© dâune hĂ©morragie (55,6%). La prise en charge comprenait : le remplissage vasculaire (59,0%), lâAMIU (50,9%), lâantibiothĂ©rapie (88,6%) dominĂ© par le mĂ©tronidazole Ă 53,3%, la transfusion (60,8%), le fer et les acides foliques (35,4%), utĂ©rotonique (34,0%). La complication majeure Ă©tait lâanĂ©mie (71,7%). LâĂ©volution Ă©tait favorable pour 92,5% dont 75% (soit 16/212) sont dĂ©cĂ©dĂ©s en cours dâhospitalisation.
Conclusion : Lâavortement clandestin demeure un problĂšme de santĂ© publique dans notre pays, de par sa frĂ©quence croissante, et ses omplications Ă type dâhĂ©morragie pouvant engager le pronostic vital. La technique dâAspiration Manuelle Intra utĂ©rine (AMIU) a encore montrĂ© son efficacitĂ© dans la prise en charge des complications de cette pratique avant lâĂąge gestationnel de 12 semaines dâamĂ©norrhĂ©e. Sensibiliser davantage les populations sur les mĂ©thodes contraceptives et Ă©largir sur le plan juridique lâaccĂšs Ă lâavortement mĂ©dicalisĂ© au premier trimestre de grossesse, pourraient amoindrir lâincidence 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