Publications

Abstract

Objectives: To describe the process for the translation and validation of the Postpartum Specific Anxiety Scale-Preterm Birth [PSAS-PTB] and the Postpartum Specific Anxiety Scale-Neonatal Intensive Care Unit [PSAS-NICU].

Methods: We outline a four-stage process for translation and validation of the 10-item PSAS-PTB and the 16-item PSAS-NICU.

Results: The protocol outlines a multi-stage translation and validation process, including (1) independent forward translation, (2) independent back translation, (3) final approval following review, and (4) validity and reliability study.

Conclusions: Culturally and contextually relevant assessment of postpartum anxiety is vital, particularly in vulnerable populations. Following standardised procedures will support broader applicability across diverse populations, providing a reliable self-report tool for both research and clinical use.

Keywords: NICU; cross‐cultural validity; postpartum anxiety; preterm birth; psychometrics; translation.

Abstract

Preterm birth is known to severely impact the neurological development of newborns with long-lasting complications and higher risks of neurological disorders. Sheep (Ovis aries) is well known as a pre-clinical model in therapeutic studies, such as extra-uterine support. The aim of our study was to investigate the relevance of the lamb as a pre-clinical model for preterm birth when cortical maturation of preterm and term lamb is addressed. Cesarean sections were performed on time-dated pregnant ewes to obtain 13 lambs at 100 days and 140 days of pregnancy each (corresponding to 24 and 36 weeks of pregnancy in humans, respectively). Brains were collected and separated in frontal lobe, temporo-parietal lobe, occipital lobe, and cerebellum. Immunohistochemistry staining was used for each brain area by targeting neurons, interneurons, synaptic vesicles, oligodendrocytes, myelin, astrocytes, and microglia. Quantifications were normalized by the surface area of analysis. Overall, 140-days late preterm lambs have significantly higher mean positivity for interneurons, synaptic vesicles, oligodendrocytes, astrocytes, and myelin than 100-days extremely preterm lambs. Similarly, significantly higher mean positivity for neurons was found in the cerebellum of 140-days term lambs. No significant difference was observed regarding microglia. Based on the cellular and structural markers used in this study, brain development in lamb seems to follow an antero-posterior direction similarly to what was reported in humans. Further studies with more specific markers and in-depth analysis will allow for a more accurate and exhaustive description of brain development in lamb.

Keywords: brain development; immunohistochemical comparison

Abstract

Aim: Eye movements have rarely been explored in preterm born children. The aim of this study was to compare horizontal eye movements in children born preterm and full term when they reached 8 years of age.

Methods: Eye movements were recorded in 24 preterm born children (18 boys) and 26 matched controls (19 boys), recruited by a French hospital, using an eye tracker. This identified different types of visually guided saccades, namely step, gap, overlap and antisaccades and pursuit eye movements. The saccades task measured the latency and the percentage of anticipatory and express saccades and errors. The pursuit task measured the gain and percentage of intrusive saccades.

Results: This study confirmed that children born at 24-28 weeks of gestation demonstrated a global deficit in inhibitory processes compared to children born full term. The saccades were less precise in the preterm group, anticipatory and express saccades were elevated and there was a high occurrence of intrusive saccades during pursuit movements.

Conclusion: These findings suggest that preterm born children have immature brain structures, particularly the parietal and frontal cortexes that are responsible for both saccade and pursuit performance. These could have been the cause of the abnormal inhibitory control measured in this study.

Abstract

In France, the rate of twin deliveries is estimated at 1.6% of all births. These recommendations address the gestational age at delivery and the mode of delivery for twin pregnancies. They were developed using the GRADE methodology, with questions formulated according to the PICO framework. Regarding gestational age at delivery, in cases of uncomplicated dichorionic diamniotic pregnancies, it is recommended to plan delivery between 37 weeks and 0 days and 38 weeks and 6 days of gestation (weak recommendation, very low-quality evidence). In cases of uncomplicated monochorionic diamniotic pregnancies, it is recommended to plan delivery between 36 weeks and 0 day and 37 weeks and 6 days of gestation (weak recommendation, very low-quality evidence). Finally, in cases of uncomplicated monochorionic monoamniotic pregnancies, it is recommended to plan delivery between 33 weeks and 0 day and 34 weeks and 6 days of gestation (weak recommendation, very low-quality evidence). Regarding the mode of delivery for diamniotic twin pregnancies, when the first twin is in cephalic presentation and the gestational age is 32 weeks or more, a planned vaginal birth is recommended (strong recommendation, high-quality evidence). When the first twin is in breech presentation and the gestational age is 32 weeks or more, it is recommended to offer either a trial of vaginal birth or a scheduled cesarean section; the expert group suggests favoring a trial of vaginal birth when all eligibility criteria are met (weak recommendation, low-quality evidence). In monoamniotic twin pregnancies, the available data are insufficient in both quantity and quality to issue a recommendation regarding a trial of vaginal birth compared with a scheduled cesarean section (no recommendation, very low-quality evidence). It is recommended to offer labor induction rather than a scheduled cesarean section when delivery is indicated at 32 weeks or more and the first twin is in cephalic presentation (weak recommendation, very low-quality evidence). Regarding the delivery of the second twin, in vaginal births at 32 weeks or more with the second twin in cephalic presentation, it is recommended to perform either internal version or resumption of pushing efforts, with artificial rupture of membranes with or without oxytocin (weak recommendation, low-quality evidence). When the second twin is in breech presentation, total breech extraction is recommended rather than resumption of pushing efforts (weak recommendation, very low-quality evidence). In diamniotic twin pregnancies with spontaneous labor before 32 weeks and with the first twin in cephalic presentation, it is recommended to offer a trial of vaginal birth rather than systematic cesarean section (weak recommendation, low-quality evidence). The available data are insufficient in both quantity and quality to issue a recommendation regarding a trial of vaginal birth compared with systematic cesarean section in cases of spontaneous labor before 32 weeks with the first twin in breech presentation (no recommendation, very low-quality evidence). It is recommended not to take growth discordance into account when choosing the mode of delivery (weak recommendation, very low-quality evidence). The available data are insufficient in both quantity and quality to issue a recommendation regarding the usefulness of pelvimetry when the first twin is in cephalic presentation (no recommendation, very low-quality evidence).

Abstract

Preterm neonates present multiple challenges due to organ immaturity.Cardiovascular:Patent ductus arteriosus (PDA) is common in lower gestational ages and may cause respiratory and circulatory complications. Treatment includes medical (ibuprofen, para-cetamol), surgical, or percutaneous approaches. Bradycardia is frequent and requires continuous monitoring.Digestive/Metabolic:Early enteral nutrition with fortified breast milk is preferred; parenteral nutrition is often required. Gastroesophageal reflux is usually benign. Preventing metabolic bone disease necessitates adequate calcium and phosphate intake. Jaundice is common; cholestasis often relates to parenteral nutrition.Infectious:Immune immaturity and invasive devices increase risks of early-onset (E.coli), nosocomial (CoNS), and fungal (Candida) infections. Diagnosis relies on blood cultures; treatment is empirical then targeted.Neurological:Common lesions include periventricular leukomalacia and intraventricular hemorrhage, with potential sequelae. Monitoring includes cranial ultrasound, EEG, MRI, and routine screening for hearing loss and retinopathy of prematurity.

No abstract available

Abstract

Preterm birth is defined as any birth occurring before 37 completed weeks of gestation (WG). It affects 9.9% of live births, representing 13.4 million births a year worldwide. In France, preterm birth rate is of 7.0%. The causes of preterm birth can be grouped into 3 main categories: infectious/inflammatory, vascular, and other. Risk factors, preventive measures, and impact on the child’s health depend of these causes. Risks of death and of neonatal complications are strongly associated with gestational age at birth. Other factors are also involved, such as birth weight (fetal growth restriction) or the administration of antenatal corticosteroids. In 2020 in France, survival rates were of 47% for children born alive at 24 WG, 80% at 26 WG, 92% at 28 WG and 97% at 31 WG.

Keywords: prematurity.

Abstract

Neonatal respiratory distress is one of the leading causes of hospitalization of preterm newborns in intensive care units. Regardless of the pathology, initial respiratory support is usually delivered nasally (non-invasive ventilation), with intubation now being much less common than in previous decades, even for the most extremely preterm babies.The most frequent respiratory pathology is respiratory distress syndrome (RDS) also termed hyaline membrane disease. It is prevented by antenatal corticosteroid therapy and very effectively treated by the administration of exogenous surfactant directly in the lungs. Apnea of prematurity can last for a long time and partly explains the need for prolonged hospitalization in intensive care units. The major risk is the progression toward bronchopulmonary dysplasia, a chronic respiratory disease of preterm babies which can have longer-term consequences. In the very long term, this pathology is likely to promote the development of adult chronic obstructive pulmonary disease

Abstract

Objective: To examine associations between a 5-min Apgar score < 7 and severe neonatal outcomes in very preterm (VPT) infants and how results are impacted by variations in assigning Apgar scores within an international context.

Design: Prospective observational population-based cohort study.

Setting: Eleven structurally and organisationally diverse countries across Europe.

Population: In total, 7900 liveborn VPT infants from the EPICE-SHIPS study.

Methods: Descriptive statistics, logistic regression, modified Poisson regression.

Main outcome measures: Associations between 5-min Apgar scores < 7 and adverse neonatal outcomes were estimated with adjustments for perinatal characteristics. We tested for interactions by country-level prevalence of an Apgar score < 7, grouped into low (14%-16%), medium (19%-22%) and high (28%-40%).

Results: 20.2% of infants had 5-min Apgar score < 7 with rates of 14%-40% across countries. A score < 7 increased risks of in-hospital mortality, intraventricular haemorrhage (IVH), cystic periventricular leukomalacia (cPVL), retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD) and length of hospital stay (LHS), but not necrotising enterocolitis or late-onset infection (LOI). No interactions with country group were detected for mortality, cPVL and ROP, while associations with IVH, BPD and LHS were restricted to countries with lower prevalence of scores < 7.

Conclusions: Significant differences exist in the prevalence of low Apgar scores across countries. Their interactions with adverse outcomes demand caution when using the Apgar score in prognostic models for clinical care and research without local validation. More broadly, our findings emphasise the importance of accounting for country-specific effects in clinical assessment scores.

Abstract

Long-term outcomes of preterm children are one of the major challenges in neonatology. Neurodevelopmental disorders are common in these children. Severe motor, cognitive or neurosensory disorders mainly affect the most immature children. Minor difficulties are present in more than a third of children, whatever their gestational age. School integration is frequently affected, and recourse to developmental support is important. A combination of certain factors should alert caregivers to the risk of neurodevelopmental disorders. These include male gender, small for gestational age, high-grade intraventricular hemorrhage, cystic periventricular leukomalacia or bronchopulmonary dysplasia. Early identification of neurodevelopmental disorders makes it possible to provide support for children and their families and to take advantage of the cerebral plasticity of the developing brain.

Keywords: prematurity.