Catherine Gire

Assessment of Normal Fetal Brain Maturation In Utero by Proton Magnetic Resonance Spectroscopy

Cerebral maturation in the normal human fetal brain was investigated by in utero localized proton MR spectroscopy (1H MRS). Fifty‐eight subjects at 22–39 weeks of gestational age (GA) were explored. A combination of anterior body phased‐array coils (four elements) and posterior spinal coils (two to three elements) was used. Four sequences were performed (point‐resolved spectroscopy (PRESS) sequence with short and long TEs (30 and 135 ms), with and without water saturation). A significant reduction in myo‐inositol (myo‐Ins) and choline (Cho) levels, and an increase in N‐acetylaspartate (NAA) and creatine (Cr) content were observed with progressing age. A new finding is the detection of NAA as early as 22 weeks of GA. This result is probably related to the fact that oligodendrocytes (whether mature or not) express NAA, as demonstrated by in vitro studies. Cho and myo‐inositol were the predominant resonances from 22 to 30 weeks and decreased gradually, probably reflecting the variations in substrate needed for membrane synthesis and myelination. The normal MRS data for the second trimester of gestation (when fetal MRI is usually performed) reported here can help determine whether brain metabolism is altered or not, especially when subtle anatomic changes are observed on conventional images. Magn Reson Med, 2006.

MR imaging of acquired fetal brain disorders

IntroductionAcquired fetal brain disorders represent the third indication of fetal brain MRI, after ventricular dilatation and malformations of the central nervous system.DiscussionMRI is an adequate imaging technique for evaluating fetal brain damage. Fetal brain response to brain injury may be acute, chronic or a combination of acute and chronic. An acute response is not as common in the fetal brain as in the postnatal period. A chronic response or the combination of chronic and acute response are the most common responses of the fetal brain to injury, whatever its origin. MRI also provides the natural history of acquired fetal brain lesions with regard to the stage of development.

Gestational diabetes: a strong independent risk factor for severe neonatal respiratory failure after 34 weeks

PurposeTo evaluate if gestational diabetes (GD) exposes neonates delivered after 34xa0weeks to an increased risk of severe neonatal respiratory failure (NRF).MethodsData from 3,237 women who delivered after 34xa0weeks with systematic screening for GD were analyzed. Diagnosis of severe NRF required the association of clinical and radiological criteria with a minimum of 24xa0h of ventilation and admission to neonatal intensive care unit.ResultsA total of 166 (5.1%) cases of GD were identified. Severe NRF was diagnosed in 7 (4.21%) cases among women with GD as compared to 13 (0.42%) in others (pxa0<xa00.001). The rate of severe NRF was also significantly higher in cases of premature delivery (pxa0<xa00.001), fetal growth retardation (pxa0<xa00.001), and cesarean section (pxa0=xa00.005). After adjustment for these variables, GD was identified as an independent risk factor for NRF (AOR 11.55, 95% CI 3.9–33.9, pxa0<xa00.001). Two other risk factors were also identified: late preterm delivery (AOR 6.13, 95% CI 1.8–21.2, pxa0=xa00.004); and hypotrophy (AOR 9.16, 95% CI 2.7–30.5, pxa0<xa00.001).ConclusionsGD is an independent risk factor for severe NRF after 34xa0weeks. Neonates from such pregnancies should be monitored carefully.

Hyperthyroïdie néonatale chez un prématuré né de mère atteinte d'une maladie de Basedow

Resume Lhyperthyroidie neonatale est le plus souvent la consequence du passage transplacentaire danticorps maternels thyreostimulants dans le cadre dune maladie de Basedow. Differents facteurs predictifs dhyperthyroidie neonatale ont ete proposes et, en particulier, le dosage de lactivite thyreostimulante des TRAb ( thyrotropin-receptor antibodies ) par bioassay . Observation Un nouveau-ne premature de mere atteinte dune maladie de Basedow a presente une hyperthyroidie neonatale prolongee bien que le dosage par bioassay de lactivite thyreostimulante des anticorps maternels ait montre un titre faible. Le carbimazole a pu etre arrete a deux mois de vie, le taux de TRAb etant devenu tres faible. Conclusion Differents facteurs predictifs dhyperthyroidie neonatale en cas de maladie de Basedow maternelle ont ete proposes mais ne semblent pas toujours satisfaisants. Le dosage des hormones thyroidiennes doit etre effectue systematiquement chez tout enfant de mere atteinte de maladie de Basedow. La prise en charge diagnostique et therapeutique de lhyperthyroidie neonatale reste encore complexe, surtout chez le premature.

Consumption of bioactive molecules protecting from necrotising enterocolitis in premature newborns receiving natural or pasteurised human milk

The aim of the present study was to investigate, in very-low-birth-weight (VLBW) premature newborns susceptible to developing anecrotising enterocolitis (NEC), the consumption of bioactive molecules (DHA, sphingomyelin (SM), acid sphingomyelinase (Smase), andCD14) over 1 month, and to compare their levels in natural motherOs milk (NM) v. pasteurised motherOs milk from a milk bank (PM).Nine VLBW premature newborn babies (< 1 kg body weight, < 32 weeks of gestational age) were followed up for 4 weeks after thecommencement of digestive stimulation using NM or PM