Emmanuel Lopez

The SHIVA Star device is a 1313-μF, 120-kV capacitative storage device capable of storing 9.4-MJ electrical energy. The experimental operating voltage is 90 kV. An increased current delivery from the SHIVA Star capacitor band to a plasma-flow-switch-driven cylindrical foil load is reported. Modification of a plasma-flow-switch electrode produces a current delivery that is a factor of two better than the

Background Monitoring CO2 levels in preterm infants receiving mechanical ventilation is designed to avoid the harmful consequences of hypocapnia or hypercapnia. Capnography is of questionable accuracy for monitoring PCO2 in preterm infants. Objectives To determine the accuracy of sidestream capnography in ventilated preterm infants by comparing end-tidal carbon dioxide (EtCO2) values to mixed venous carbon dioxide pressure (PvCO2) and to transcutaneous carbon dioxide pressure (TcPCO2). Methods Simultaneous recordings of EtCO2, TcPCO2 and PvCO2 in 37 ventilated preterm infants. The PvCO2–EtCO2 gradient was calculated. The Bland–Altman technique and the intra-class correlation coefficient (ICC) were used to assess agreement between methods. The area under the curve (AUC) was calculated. Results Ninety-nine EtCO2/PvCO2 pairs were studied from 37 preterm infants with a mean gestational age of 27.7 ± 1.9 weeks and a mean birth weight of 1,003 ± 331 g. The mean PvCO2–EtCO2 gradient was 11.2 ± 8.0 mmHg, and the ICC was 0.28. The mean PvCO2–TcPCO2 gradient was 0 ± 7.8 mmHg, and the ICC was 0.78. AUCs for EtCO2 and TcPCO2 were similar in detecting high or low PvCO2. Conclusion Despite an insufficient correlation between EtCO2 and PvCO2, capnography was able to detect low and high CO2 warning levels with a similar efficacy to that of TcPCO2, and may therefore be of clinical interest.

Les apnées du prématuré constituent encore actuellement un problème clinique majeur, imposant des choix thérapeutiques parfois difficiles. Des apnées plus ou moins longues surviennent chez presque tous les grands prématurés, témoignant d’une instabilité de la régulation respiratoire en rapport avec l’immaturité. Au rôle causal de celle-ci peut toutefois s’ajouter celui de nombreuses pathologies néonatales, qui peuvent aussi contribuer à la survenue d’apnées et doivent être recherchées et traitées. Les apnées du prématuré de courte durée (moins de dix secondes, sans hypoxémie ou bradycardie associée) peuvent être considérées comme sans risque pour l’enfant. Les apnées plus longues entraînent une hypoxémie et un ralentissement de la fréquence cardiaque et des perturbations de l’hémodynamique et de l’oxygénation cérébrales, susceptibles d’entraîner des effets délétères pour le développement à long terme. L’évaluation de leur degré de gravité immédiate et de leurs risques à long terme demeure imprécise. Les décisions thérapeutiques ne peuvent s’appuyer que sur assez peu de données scientifiques. Le citrate de caféine est un traitement efficace des apnées du prématuré, largement utilisé depuis des décennies. Mais c’est seulement très récemment qu’une évaluation rigoureuse de ses bénéfices et de ses inconvénients a été menée. Elle a mis en évidence la faible toxicité du citrate de caféine, et des bénéfices inattendus chez les enfants traités : diminution de fréquence des dysplasies bronchopulmonaires, de la persistance du canal artériel, et, à 18 mois, diminution du taux d’infirmité motrice cérébrale. La pression expiratoire positive par voie nasale, traitement également efficace des apnées, peut être utilisée en cas d’échec ou d’insuffisance du traitement par caféine et en association avec lui.Prematurity apnea remains a major clinical problem that requires treatment choices which are sometimes difficult. Prematurity apnea occurs in most infants of gestational age at birth less than 33 weeks. It is a developmental disorder which usually reflects a “physiological” immaturity of respiratory control. However, neonatal diseases may be associated and play an additive role, resulting in an increased incidence of apnea. Careful screening should therefore be performed in order to make sure that no other factor than immaturity is involved in the occurrence of apnea. Short apnea (less than 10 s, without hypoxemia and bradycardia), due to immaturity, are not clinically relevant. More prolonged apnea, that last for more than 15 or 20 s, and / or apnea associated with bradycardia or oxygen desaturation, results in short-term disturbances of cerebral haemodynamics and oxygenation, which may negatively impact on neurodevelopmental outcome. Evaluating the immediate severity of apnea and the risks that apnea may affect long-term outcome remains a challenge. The choice of treatments is based on a few evidences. Caffeine citrate, which reduces the incidence of apnea, has been used for decades. However, a thorough evaluation of risks and benefits of this medication has been performed only recently. Caffeine citrate was found to be safe and resulted in unexpected benefits. In treated infants, compared with controls, indeed, a decreased incidence of the following complications was recorded: bronchopulmonary dysplasia at 36 weeks of conceptional age, patent ductus arteriosus, cerebral palsy at 18 months of age. Nasal CPAP can be used in association with caffeine citrate, when the latter is not effective enough.

Because of insufficient vaccine coverage, there is an outbreak of measles since 2008 in France with an increasing incidence of cases, most of them among children less than 1 year old or young adults. When measles occurs during pregnancy, maternal and fetal morbidity is increased.Particularly pregnant women are exposed to a higher risk of severe respiratory distress that might cause death.Measles virus can be detected in the placenta. Placental infection appears to be involved in some cases of fetal death. The virus is not responsible for congenital defects but can induce histologic damages inside the placenta which may lead to fetal death.Major perinatal risks are also miscarriage and prematurity.When measles occurs in late pregnancy, congenital infection is possible with variable expression and a risk of subacute sclerosing panencephalitis.Non immune pregnant women or neonates exposed to measles should receive an immunoglobulin prophylaxis within 6 days after contact in order to reduce the risk of infection and severe morbidity.In case of declared measles infection, symptomatic treatment can be proposed and tocolysis can be used if preterm labor is associated.Daily fetal monitoring during the 14 days following the beginning of the eruption can be offered when the fetus is viable.Vaccination is recommended for the people born in France after 1980 with 2 doses of vaccine against measles, rubeola and mumps. Measles vaccine, an attenuated living vaccine, should not be administered during pregnancy but must be proposed before pregnancy or during the post-partum period.En raison d’une couverture vaccinale insuffisante, la France est touchée depuis 2008 par une épidémie de rougeole avec une augmentation du nombre de cas déclarés chaque mois, en particulier chez les nourrissons de moins d’un an et les jeunes adultes.Lorsqu’elle survient en cours de grossesse, la rougeole expose la femme enceinte à des complications pour elle-même et son enfant. En particulier, le risque de pneumopathie avec syndrome de détresse respiratoire aiguë peut menacer le pronostic vital.Le virus de la rougeole peut être détecté dans le placenta. Il n’est pas responsable de malformations fœtales, mais peut entraîner un dysfonctionnement placentaire pouvant expliquer la survenue dans certains cas d’une mort fœtale in utero.Le risque majeur est celui de fausse couche ou d’accouchement prématuré.Il existe de plus, en cas de rougeole en fin de grossesse, un risque de rougeole congénitale de gravité variable, allant de simples éruptions, à des pneumopathies et des formes rapidement mortelles. De plus, les rougeoles congénitales et néonatales sont associées à un risque augmenté de panencéphalite subaiguë sclérosante.En cas de contage avec un cas de rougeole, les immunoglobulines polyvalentes intraveineuses sont recommandées chez la femme enceinte ou chez un nouveau-né de mère ayant une rougeole en fin de grossesse. Administrées dans les six jours qui suivent le contage, elles permettent de réduire le risque de rougeole et celui de complications sévères.En cas de rougeole avérée, le traitement est symptomatique.En l’absence de contre-indications, une tocolyse peut être utilisée si une menace d’accouchement prématurée est associée.La surveillance fœtale repose sur un enregistrement cardio-tocographique quotidien à partir du seuil de viabilité et pendant les 14 jours qui suivent le début de l’éruption. La déclaration de la rougeole auprès de l’Institut de veille sanitaire est obligatoire.Toutes les personnes nées après 1980 doivent avoir reçu deux doses du vaccin trivalent rougeole-oreillons-rubéole. Le vaccin est un vaccin vivant atténué qui est contre-indiqué chez la femme enceinte. Le vaccin peut être proposé en période préconceptionnelle ou dans le post-partum.

During the perinatal period, lungs undergo changes to adapt to air breathing. The genes involved in these changes are developmentally regulated by various signaling pathways, including the cyclic nucleotide cAMP. As PDE4s are critical enzymes for regulation of cAMP levels, the objective of this study was to investigate PDE4's ontogeny in developing rat lung during the perinatal period. Pulmonary PDE4 activity, PDE4A-D, PDE4B, and PDE4D variant expression levels, PDE4B and PDE4D protein levels, and PDE4D localization in distal lung were determined. PDE4 activity increased towards term, dropped at birth, and increased thereafter to reach a plateau at the end of the second week of life. PDE4B2 and PDE4D long forms demonstrated a pattern of expression that increased markedly at birth. After birth, PDE4D was expressed in alveolar epithelial and mesenchymal cells. The study, therefore, evidenced striking variations in expression patterns among the PDE4 family that differed from changes in global PDE4 activity. Developmental Dynamics 239:2470–2478, 2010. © 2010 Wiley-Liss, Inc.

To assess neonatal morbidity in twin pregnancy according to the planned mode of delivery. A retrospective cohort study of 758 consecutive sets of twins born after 35 weeks of gestation with a cephalic-presenting first twin was undertaken in a level III maternity unit in which active management of the second twin delivery is performed routinely. The primary outcome was a composite measure of neonatal mortality and morbidity, including pH less than 7.0, 5-minute Apgar score less than 4, neonatal intensive care unit transfer more than 4 days, pneumothorax, and fracture. Control for potential confounders was performed by excluding from the analysis women who experienced pregnancy complications and by using logistic regression models. Vaginal or cesarean delivery was planned for 657 (86.7%) and 101 (13.3%) women, respectively. Among planned vaginal deliveries, 515 (78.4%) patients delivered both twins vaginally, 139 (21.1%) had a cesarean delivery during labor, and 3 (0.5%) had cesarean delivery for the second twin. After vaginal birth of the first twin, the mean intertwin delivery interval was 4.9+/-3.2 minutes. When patients who experienced pregnancy complications were excluded (n=202), the neonatal composite morbidity for the second twin did not differ between planned cesarean and planned vaginal delivery (5.0% compared with 4.7%, adjusted odds ratio 1.5, 95% confidence interval 0.3-7.4, P=.63). Neonatal composite morbidity of first twins did not differ between groups. For twin gestations with a cephalic-presenting first twin, planned vaginal delivery after 35 weeks of gestation in selected women remains a safe option in centers used to active management of the second twin delivery.

Capnocytophaga, a genus of Gram-negative anaerobes that inhabit the oral cavity, has been reported to be an unusual cause of chorioamnionitis and neonatal infection. We report five cases of Capnocytophaga spp. infections in preterm infants (one proven infection and four probable infections) and review 14 previously reported cases. We suggest that Capnocytophaga sp. may be responsible for some occult causes of chorioamnionitis or preterm birth, and that the prevalence of this infection may be higher than previously reported.

Clin Microbiol Infect 2010; 16: 1539–1543Clin Microbiol Infect 2010; 16: 1539–1543AbstractCapnocytophaga, a genus of Gram-negative anaerobes that inhabit the oral cavity, has been reported to be an unusual cause of chorioamnionitis and neonatal infection. We report five cases of Capnocytophaga spp. infections in preterm infants (one proven infection and four probable infections) and review 14 previously reported cases. We suggest that Capnocytophaga sp. may be responsible for some occult causes of chorioamnionitis or preterm birth, and that the prevalence of this infection may be higher than previously reported.Capnocytophaga, a genus of Gram-negative anaerobes that inhabit the oral cavity, has been reported to be an unusual cause of chorioamnionitis and neonatal infection. We report five cases of Capnocytophaga spp. infections in preterm infants (one proven infection and four probable infections) and review 14 previously reported cases. We suggest that Capnocytophaga sp. may be responsible for some occult causes of chorioamnionitis or preterm birth, and that the prevalence of this infection may be higher than previously reported.

Genetic characterization of non-K1 Escherichia coli strains isolated from a mother and her neonate allowed us to provide evidence of the maternal origin of a late-onset neonatal infection. The use of ante- and peripartum antimicrobial prophylaxis with amoxicillin may have promoted the vertical transmission of this amoxicillin-resistant E. coli from mother to newborn. It allowed us to clarify the natural history of the disease.

Exposure of newborn rats to hyperoxia impairs alveolarization. Nitric oxide (NO) may prevent this evolution. Angiogenesis and factors involved in this process, but also other growth factors (GFs) involved in alveolar development, are likely potential therapeutic targets for NO. We studied the effects of the NO donor, [Z]-1-[N-(2-aminoethyl)-N-(2-ammonioethyl)aminio]diazen-1-ium-1, 2-diolate, also termed DETANONOate (D-NO), on hyperoxia-induced changes in key regulatory factors of alveolar development in neonatal rats, and its possible preventive effect on the physiologic consequences of hyperoxia. Newborn rat pups were randomized at birth to hyperoxia (> 95% O2) or room air exposure for 6 or 10 d, while receiving D-NO or its diluent. On Day 6, several GFs and their receptors were studied at pre- and/or post-translational levels. Elastin transcript determination on Day 6, and elastin deposition in tissue and morphometric analysis of the lungs on Day 10, were also performed. Hyperoxia decreased the expression of vascular endothelial growth factor (VEGF) receptor (VEGFR) 2, fibroblast growth factor (FGF)-18, and FGF receptors (FGFRs) FGFR3 and FGFR4, increased mortality, and impaired alveolarization and capillary growth. D-NO treatment of hyperoxia-exposed pups restored the expression level of FGF18 and FGFR4, induced an increase of both VEGF mRNA and protein, enhanced elastin expression, and partially restored elastin deposition in alveolar walls. Although, under the present conditions, D-NO failed to prevent the physiologic consequences of hyperoxia in terms of survival and lung alveolarization, our findings demonstrate molecular effects of NO on GFs involved in alveolar development that may have contributed to the protective effects previously reported for NO.