Publications

We thank Chen et al for their thoughtful comments regarding our recent study on pregnancy-related complications in osteogenesis imperfecta. We appreciate the opportunity to clarify several points and to discuss future research directions.We thank Chen et al¹ for their thoughtful comments regarding our recent study on pregnancy-related complications in osteogenesis imperfecta.² We appreciate the opportunity to clarify several points and to discuss future research directions.

No abstract available

Abstract

Introduction: Extracorporeal membrane oxygenation (ECMO) is an advanced extracorporeal life support rarely used in neonates with severe uropathies. This study describes our experience with ECMO support in five neonates presenting with life-threatening respiratory failure associated with congenital uropathy.

Materials and methods: We conducted a retrospective review on five neonates treated with ECMO between 2015 and 2024. All had severe uropathies (four with posterior urethral valves, one with a solitary dysplastic cystic kidney) and required ECMO for refractory hypoxia. Veno-arterial jugular-carotid cannulation was used in all cases. Data collected included procedural details, renal and neurological outcomes, and follow-up.

Results: Median gestational age was 36 weeks. ECMO was initiated at a median of 1 day of life for a median duration of 6 days. No procedural mortality occurred. One circuit failure and one jugular thrombosis occurred. Three patients survived. Two had stable renal function; one developed chronic kidney disease stage 5 (CKD-5). Neurological outcomes were encouraging. At follow-up, two children had normal development, one had psychomotor delay.

Conclusion: ECMO is a reliable rescue strategy in selected neonates even with uropathies experiencing respiratory failure. Complication rates remained within reasonable limits for such critical interventions, and long-term outcomes varied, underscoring the need for individualized multidisciplinary care

Abstract

The aim of the PRECOG study was to evaluate if the use of the sFlt-1/PlGF ratio in patients hospitalized for suspected preeclampsia before 35 weeks could improve patient management and reduce the length of hospitalization. A prospective randomized multicenter interventional open-label study in a hospital population with 2 parallel groups with or without taking into account the sFlt-1/PlGF ratio for the management of patients admitted for suspected pre-eclampsia. 80 patients were included in the study. Characteristics of patients were equally distributed among randomization groups. There was no difference in the primary outcome between the two groups. Hospitalization for more than 24 h was 75% in the group reveal versus 80% in the group conceal (Relative Risk p = 0.59). Groups did not differ in hospitalization duration for different cut-off values such. When stratifying by ratio value, among those with a ratio < 38, 37% were discharged home < 24 h in the conceal group and 47% in the reveal group. There was no difference in the secondary outcomes between the two groups. In this randomized controlled trial in women hospitalized for suspected of preeclampsia, the use of the sFlt-1/PlGF ratio at was not associated with a benefit in terms of duration of hospitalization or in maternal and neonatal outcomes.

Abstract

Respiratory syncytial virus (RSV) is a common and highly contagious viral pathogen responsible for acute lower respiratory tract infection in infants. It represents an important public health and economic concern. This study, performed in a level 3 perinatal center, evaluated adherence to the first French national RSV immunization campaign with nirsevimab. This retrospective single-center study included 1361 newborns born at 34 weeks of gestation or after, from October 1, 2023, to January 10, 2024 in France. Data collected included sociodemographic and medico-economic characteristics of families (parents and newborns), and nirsevimab administration. Multivariable logistic regression was performed to determine factors associated with immunization acceptance. Overall, 87.7% of newborns received nirsevimab. The median postnatal age at administration was 2.8 days. Among parents initially refusing the administration, 17.7% of their infants (12/68) finally received the product, and among those initially reluctant to its administration, 57.4% (101/176) of their infants received it. On multivariable analysis, maternal birth in France, mother’s occupation, and adherence to recommended vaccination during pregnancy were positively associated with passive immunization acceptance; delivery in January was negatively associated.

Conlusion: The study observed a high adherence rate to the 2023-2024 RSV immunization campaign. The administration of nirsevimab free of charge and before maternity unit discharge may have contributed to these results. Socio-demographic and medico-economic factors appeared to influence immunization adherence, suggesting that the period before maternity hospital discharge could represent a key time to carry out preventive actions and reduce social and territorial health inequalities.

What is known: • Respiratory syncytial virus (RSV) is among the leading causes of acute lower respiratory-tract infection in young children with substantial economic impacts. • The first national passive immunization campaign against RSV was launched during the 2023-2024 RSV epidemics in France.

What is new: • Medical, social, and territorial factors associated with parental adherence to passive immunization for their newborns are unknown. • Despite high adherence rates, disparities in passive immunization with nirsevimab uptake underscore the need for targeted interventions to ensure equitable access to healthcare: differences in uptake, despite free access, highlight the need for targeted communication and support strategies to overcome non-financial barriers and ensure equitable preventive care.

Abstract

Plastics constitute an area of interest within the context of the placental exposome. A growing body of evidence now indicates that various micro- and nanoplastics – including notably polystyrene, polypropylene, polyethylene, and polyvinylchloride – are present in the human placenta, from the basal plate to the fetal membranes. Results from in vitro and ex vivo studies have shown that these environmental pollutants can enter the maternal bloodstream and reach the placenta, where they concentrate in the syncytiotrophoblast. These so-called « plasticenta » have been observed even in uncomplicated pregnancies, and to date, no longitudinal study has confirmed harmful long-term consequences for the newborn. However, plastics appear to alter placental functions and may therefore be associated with adverse outcomes such as miscarriage, intrauterine growth restriction and preterm birth. Findings from ex vivo human studies, in vivo murine models, and in vitro experiments with micro- and nanoplastics indicate that factors such as particle type, size, concentration, surface functionalization, route of exposure, and environmental conditions play key roles in cellular uptake and subsequent alterations in cell function and phenotype. Consequently, various impairments in placental metabolic and immune functions may contribute to abnormal development of the placenta and the fetus. Maternal exposure to these ubiquitous environmental pollutants may induce prenatal and neonatal disease states. In this review, we examine the current clinical, in vivo and in vitro data on the occurrence, distribution and impact of micro- and nanoplastics in the placenta.

Abstract

Parental presence in neonatal medicine is essential for the development of premature newborns and the parent-child relationship. Through collaborative work with the neonatal medicine teams at Louis-Mourier Hospital, a tool to support parental presence called « Mon livret des premiers jours » has been designed and developed. This booklet is made available to parents with the aim of encouraging them to be present and enabling caregivers to more easily identify their needs and vulnerabilities. Parents can fill out the booklet daily, writing or using stickers to express what they are doing or feeling. The booklet is the subject of action research that will assess its contribution to parenting support. At the end of their hospital stay, parents can take the booklet home with them as a record of their experience that they can share with their child later on.

Abstract

Background: Patent ductus arteriosus is a common complication of extreme prematurity. Prophylactic treatment with indomethacin or ibuprofen has shown efficacy on ductus closure but without reducing mortality and morbidity. Prophylactic treatment by paracetamol could be a safer alternative.

Objective: The aim was to build a pharmacokinetic-pharmacodynamic (PKPD) model describing the effect of paracetamol on the time-course of the ductus arteriosus diameter.

Methods: Extremely preterm neonates of 23-26 weeks of gestational age were recruited within 12 h after birth and were treated with prophylactic intravenous paracetamol for 5 days (two dose levels: 20 mg/kg followed by 7.5 mg/kg or 25 mg/kg followed by 10 mg/kg every 6 h). The diameter of ductus arteriosus was determined by echocardiography performed daily until day 7. The PKPD model was built using an I_max model with effect compartment and exponential disease progression model. Concentrations of paracetamol in the effect compartment were simulated with different doses over time for 500 virtual patients.

Results: A total of 29 extremely preterm neonates with median birth weight of 800 g (IQR: 670-860) were included in the study. Between-subject variability was estimated on transfer rate constant between the central compartment and the effect compartment (ke₀) and maximum drug inhibition (I_max) parameters. Two subpopulations with different I_max values were identified: 99% for a first subpopulation of 10 patients and 42% for the second subpopulation of 19 patients. A negative effect of maximum fraction of inspired oxygen (FiO₂) used during transfer to intensive care unit and a positive effect of intubation and ventilation during treatment were significant on ke₀. Simulations showed that both dose levels generally enabled patients to reach the concentration needed to achieve 95% of maximal inhibition by the end of treatment. However, the second dose level enabled more than 90% of patients to reach this inhibition threshold as early as day one.

Conclusion: The relationship between paracetamol and the time-course of ductus arteriosus diameter has been described in extremely preterm neonates. Intravenous paracetamol treatment with a loading dose of 25 mg/kg within 12 h after birth followed by 10 mg/kg every 6 h appears to be effective to accelerate time to ductus closure with limited benefit of a further dose increase.

Abstract

Background: Prospective data on pregnancies in systemic sclerosis are scarce. We aimed to examine the frequency of adverse pregnancy outcomes and maternal disease progression in systemic sclerosis, as well as the factors that predict these events.

Methods: In this analysis, we studied pregnant women with systemic sclerosis (American College of Rheumatology-European League Against Rheumatism 2013 classification) or with Very Early Diagnosis of Systemic Sclerosis (VEDOSS criteria) included in the GR2 French prospective study. Frequency of composite adverse pregnancy outcomes (preterm birth at 34 weeks or less, placental insufficiency complications, small for gestational age, or fetal or neonatal death) and maternal disease course were the primary objectives. The secondary objectives were to assess other complications related to pregnancy (including delivery outcomes and postpartum complications) and compare these results with outcomes for age-matched controls from the French perinatal survey (ENP) 2016 (ie, general population), and to identify predictive factors associated with composite adverse pregnancy outcomes and maternal disease course using univariate analysis.

Findings: Between May 1, 2014, and Dec 27, 2020, we included 58 pregnancies (in 52 women), with 53 (91·4%) resulting in livebirths. Of the 53 ongoing pregnancies beyond 22 weeks of gestation, 14 (26·4%) had a composite adverse pregnancy outcome, including two (3·8%) preterm deliveries at 34 weeks of gestation or less, 12 (22·6%) placental insufficiency complications (pre-eclampsia or fetal growth restriction), and six (11·3%) small for gestational age. Among the 53 pregnancies, six (11·3%) severe postpartum haemorrhage events occurred. When compared with the 2016 ENP survey results, pre-eclampsia (seven [13·2%] of 53 vs 16 [3·0%] of 530, p=0·0010, preterm birth before 37 weeks of gestation (seven [13·2%] of 53 vs 31 [5·8%] of 530, p=0·047), birthweight of less than 2500 g (11 [21·1%] of 52 vs 23 [4·3%] of 530, p<0·0001), and severe postpartum haemorrhage (six [11·3%] of 53 vs seven [1·4%] of 516, p=0·0001) were more frequent than in the general population. No factors were significantly associated with the composite adverse pregnancy outcome in univariate analysis. Systemic sclerosis or VEDOSS worsened in 23 (39·7%) of 58 pregnancies, mainly during the postpartum period. In the univariate analysis, diffuse cutaneous systemic sclerosis (odds ratio 3·7 [95% CI 1·1-12·4]) and previous cutaneous vascular involvement (3·7 [1·2-11·5]) were associated with maternal disease progression, whereas the presence of anticentromere antibodies was inversely associated with stable disease (0·2 [0·1-0·8]).

Interpretation: Despite 53 (91·4%) of 58 livebirths, systemic sclerosis pregnancies were associated with higher rates of adverse pregnancy outcomes and severe postpartum haemorrhage. Disease worsened in 23 (39·7%) of 58 pregnancies, particularly during the postpartum period, especially in women with diffuse cutaneous systemic sclerosis, previous cutaneous vascular involvement, and antibodies other than anticentromere.

Funding: Lupus France, Association des Sclérodermiques de France, Association Gougerot Sjögren, Association Francophone Contre la Polychondrite Chronique Atrophiante, AFM-Telethon, Société Nationale Française de Médecine Interne, Société Française de Rhumatologie, Cochin Hospital, French Health Ministry, Fondation for Research in Rheumatology, Association Prix Véronique Roualet, Union Chimique Belge.

Abstract

A growing body of epidemiological evidence links maternal exposure to air pollution with an increased risk of adverse pregnancy outcomes, such as preterm birth and low birth weight. Cerium dioxide nanoparticles (CeO₂ NPs or nanoceria) are emerging pollutants, used as additives in diesel fuels and cigarettes for their catalytic properties, and released into the environment. Due to their high surface-to-volume ratio and reactivity, CeO₂ NPs develop a surface coating during combustion, which may incorporate other released fuel-borne chemicals, such as benzo[a]pyrene (BaP), a known carcinogen, mutagen and reprotoxicant, raising concerns about their combined impacts on human health. To better reflect environmental reality, we produced BaP-coated CeO₂ NPs and exposed primary human trophoblasts and chorionic villi. Our findings show that BaP-coated CeO₂ NPs activate the aryl hydrocarbon receptor (AhR) pathway, enhancing trophoblast differentiation and syncytium formation, with effects distinct from those of BaP or CeO₂ NPs alone, or their unbound mixture. Additionally, exposure to CeO₂ NPs alone altered homeostasis of mitochondria, affecting their phenotype and function. While individual exposures or BaP-coated CeO₂ NPs had no detectable impact, parallel co-exposure resulted in a slight but significant reduction in basal respiration. Finally, uncoated CeO₂ NPs altered placental steroidogenesis, increasing estrone level while decreasing dehydroepiandrosterone level, with sex-specific effects. These findings suggest that CeO₂ NPs can influence the biological effects of BaP in the human placenta, including modulating trophoblast differentiation, as well as disrupting mitochondria homeostasis and steroid production, with potential implications for pregnancy outcomes in polluted environments.