Should isolated fetal ventriculomegaly measured below 12 mm be viewed as a variant of the norm? Results of a 5-year experience in a prenatal referral center

Background: Fetal ventriculomegaly (VM) is defined as lateral ventricles measured above 10?mm. Some authors believe VM <12?mm are variants of the norm and need not be addressed for referral ultrasound.

Methods: A retrospective continuous cohort study of 127 confirmed fetal VM was divided into three groups after initial referral sonographic assessment: isolated VM <12?mm (group A), isolated VM ≥12?mm (group B), and VM associated with other malformations (group C). We reviewed obstetric outcome and neonate evolution after 1 month with the aim of defining a pertinent prenatal workup.

Results: We reported fetal infections in all groups (p?=?.24) and chromosomal abnormalities only in group C (p?=?.41). Fetal magnetic resonance imaging (MRI) found initially undiagnosed brain abnormalities in groups B and C (12.5 and 14.1%, p?p?Conclusions: Our results are in favor of a systematic referral ultrasound for every fetal VM, regardless of size, as soon as definition criterion is met. Additional paraclinical assessment (maternal serologic status for toxoplasmosis and cytomegalovirus, amniocentesis, fetal cerebral MRI) should be discussed depending on the situation.     

Relationship between functional residual capacity and oxygen desaturation during short central apneic events during sleep in "late preterm" infants

Apneic episodes are frequent in the preterm neonate and particularly in active sleep (AS), when functional residual capacity (FRC) can be decreased. Furthermore, FRC may be inversely correlated with the speed of blood-O(2)-desaturation. We evaluated the potential involvement of FRC in the mechanisms responsible for blood-O(2)-desaturation during short central apneic events (>3 s) in "late-preterm" infants and analyzed the specific influence of sleep state. Apneic events were scored in 29 neonates (postmenstrual age: 36.1 +/- 1.2 wk) during AS and quiet sleep (QS). FRC was measured during well-established periods of regular breathing. Apneas with blood-O(2)-desaturation (drop in SpO(2) >5% from the baseline, lowest SpO(2) during apnea: 91.4 +/- 1.8%) were more frequent in AS than in QS, whereas no difference was seen for apneas without desaturation. The magnitude of the FRC did not depend on the sleep state. In AS only, there was a negative relationship between FRC and the proportion of apneas with desaturation. Even in late preterm infants who do not experience long-lasting apnea, blood-O(2)-desaturation during short apneic events is related (in AS but not QS) to a low baseline FRC. Sleep stage differences argue for a major role of AS-related mechanisms in the occurrence of these apneas.     

Variations in incubator temperature and humidity management: a survey of current practice

Aim: To describe and assess routine procedures and practices for incubator temperature and humidity management in France in 2009. Methods: A questionnaire was sent to all the 186 neonatal care units in France. Results: The questionnaire return rate was 86%. Seventy‐five per cent of the units preferred skin servo‐control to air temperature control in routine practice. Air temperature control was mainly used for infants with a gestational age of more than 28 weeks and aged over 7 days of life. In general, thermal management decisions did not depend on the infant’s age but were based on a protocol applied specifically by each unit. All units humidified the incubator air, but there was a large difference between the lowest and highest reported humidity values (45% and 100% assumed to be a maximal value, respectively). More than 65% of the units used a fixed humidity value, rather than a variable, protocol‐derived value. Conclusion: We observed large variations in incubator temperature and humidity management approaches from one neonatal care unit to another. There is a need for more evidence to better inform practice. A task force should be formed to guide clinical practice.     

A predictive neonatal mortality score for women with premature rupture of membranes after 22–27 weeks of gestation

Objective: Premature rupture of the membranes (PROM) remains a leading cause of neonatal morbidity. The objectives of the present study were to analyze the outcomes of pregnancies complicated by PROM between 22 and 27⁺⁶ weeks of gestation (WG) and to study antepartum risk factors that might predict neonatal death.

Patients and methods: One hundred and seven pregnancies were analyzed over a 3-year period in a tertiary maternity hospital. The collected maternal and neonatal data were used to model and predict the outcome of PROM.

Results: Prevalence of PROM (for live births) was 1.08%, and the overall survival rate was 59.8%. From preselected candidate variables, gestational age (GA) at PROM (p?=?.0002), a positive vaginal culture for pathogenic bacteria (p?=?.01), primiparity (p?=?.02), and the quantity of amniotic fluid (p?=?.03) were included in a multivariable logistic regression analysis. The corresponding adjusted odds ratios [95% confidence interval] were, respectively, 0.91 [0.87–0.96], 11.08 [1.65–74.42], 0.55 [0.33–0.91], and 0.97 [0.95–0.99]. These parameters were used to build a predictive score for neonatal death.

Conclusions: The survival rate after PROM at 22–27⁺⁶ weeks of gestation was 59.8%. Our predictive model (built using multivariable logistic regression) may be of value for obstetricians and neonatologists counseling couples after PROM.     

Eosinophilic meningitis in Tahiti: clinical study of 54 patients.

Eosinophilic meningitis is due to infestation of the nervous system by the larvae of Angiostrongylus cantonensis. The infection is from infected prawns and slugs. In a study of 54 patients from Tahiti the leading symptoms were headaches, neck stiffness, limb pains and sometimes a facial palsy. The diagnosis is made by examination of the CSF when the leucocytes are usually over 100/mm3 and over half are eosinophilic cells. The blood eosinophil count is often raised, above 400/mm3. The disease is self-limiting and there is no known specific treatment.     

Shielding Parenteral Nutrition Solutions From Light

Introduction: Oxidant stress is implicated in the pathogenesis of bronchopulmonary dysplasia (BPD). Light induces peroxide generation in parenteral nutrition (PN) solutions, creating an oxidant stress. Shielding PN from light decreases its peroxide content, which has nutrition and biochemical benefits in animals and humans. This study aims at determining whether full light protection of PN decreases the rate of bronchopulmonary dysplasia and/or death in very low‐birth‐weight infants. Methods: Multicenter randomized controlled trial of photoprotection, using amber bags and tubing initiated during compounding of PN and maintained throughout infusion in the light‐protected (LP) group. The control group (light exposed [LE]) received PN exposed to ambient light. Depending on centers, lipids were infused either separately or as all‐in‐one PN. Results: In total, 590 infants born <30 weeks gestational age were included. At randomization, LE and LP groups did not differ clinically except for maximal FiO₂ before 12 hours. The rate of BPD/death was not different between groups at 28 days (77% LP vs 72% LE, P = .16) or at 36 weeks corrected age (30% LP vs 27% LE, P = .55). Multivariate analysis showed no significant effect of photoprotection on BPD and/or death. The rate of BPD/death was significantly lower (odds ratio, 0.54; 95% confidence interval, 0.32–0.93; P = .02) in infants receiving all‐in‐one PN vs those who received lipids separately. Conclusion: This study did not show significant beneficial effects of photoprotection. Since the decreased rate of BPD/death found with all‐in‐one PN relates to a center‐dependent variable, this warrants further investigation.