http://hdl.handle.net/2268/111 Search this channel search http://orbi.ulg.ac.be/simple-search http://hdl.handle.net/2268/148067 Title: Measurement of ultrasensitive troponin T levels in cord blood for the early detection of myocardial cell damage after birth <br/> <br/>Author, co-author: Rouatbi, Hatem; GKIOUGKI, Evangelia; Texeira, Jelda; CHAPELLE, Jean-Paul; SEGHAYE, Marie-Christine http://hdl.handle.net/2268/148066 Title: Neonates show transient and incomplete anti-inflammatory response to cardiac surgery <br/> <br/>Author, co-author: Wiecker, Carola; Buding, Brigitte; Vazquez-Jimenez, Jaime; SEGHAYE, Marie-Christine http://hdl.handle.net/2268/147917 Title: NEONATAL INVASIVE GROUP B STREPTOCOCCAL (GBS) INFECTIONS IN EUROPE <br/> <br/>Author, co-author: MELIN, Pierrette; Berner, Reinhard; Afshar, Baharak; Baldassarri, Lucilla; Detcheva, Antoaneta; de la Rosa, Manuel; Kunze, Mirjam; Kriz, Paula; Efstratiou, Androulla; Hufnagel, Markus; Kilian, Mogens; SEIDEL, Laurence; Telford, John <br/> <br/>Abstract: Objectives: To describe clinical characteristics and capsular type of GBS isolates responsible of invasive infections in infants from Belgium, Bulgaria, Czech-Republic, Denmark, Germany, Italy, Spain and United Kingdom, representing one of the main objectives of the DEVANI (DEsign of a Vaccine Against Neonatal Infections) project. Methods: Surveillance of invasive GBS infections in infants was performed from mid-2008 through December 2010. For each case, a standardized case report form was filled. Samples from cases were processed using local procedures. GBS isolates were characterised in national central labs using standardised type-specific (Ia, Ib-IX) latex agglutination and molecular typing methods. Results: Data on 188 infants with invasive infection were analysed: 144 (60.6%) early onset diseases (EOD) and 74 (39.4%) late onset diseases (LOD). In EOD, mean/median ages at onset were 14/0 hours and the male:female ratio was 1.25. The predominant manifestation at onset was respiratory distress (42% cases); 83% cases were associated with sepsis/bacteremia, 15% with pneumonia and 6% with meningitis. Late-prenatal screening cultures were obtained from 51% of cases’ mothers and only half of these were positive for GBS. Non-elective C-section, intrapartum fever and rupture of membrane (>18h) were more frequent in EO-cases’ mothers versus healthy babies’ GBS-positive mothers. The major serotypes were III (43%), V (21%) and Ia (18%). In LOD, mean/median ages at onset were 42/34 days and the male:female ratio was 0.9. The predominant characteristic at onset was fever (62% cases); 70% cases were associated with sepsis and 30% with meningitis. Very rare manifestations were osteomyelitis and cellulitis. Serotype III was highly predominant (80.6%) followed mainly by Ia (12.5%). Death rates were 4.7/1.5% in EOD/LOD. Conclusions: Clinical presentations were associated with age at onset of infection. Serotype III predominated in neonatal infections. Prenatal screening was not universal neither sensitive. Study funded through the European Commission Seventh Framework. http://hdl.handle.net/2268/147904 Title: Group B streptococci, a European perspective with results of the DEVANI project <br/> <br/>Author, co-author: MELIN, Pierrette <br/> <br/>Abstract: In 2011, neonatal group B streptococcal (GBS) diseases remain a global public health concern. Where consensus guidelines to detect and treat intrapartum women with GBS colonization have been widely adopted, incidence of neonatal early onset disease (EOD) has dramatically declined, however despite preventive strategies cases still occur. The strategy was not expected to prevent all cases and there are challenges and limitations to this preventive approach. The best strategy for European countries is still a matter of debate and intrapartum antimicrobial prophylaxis (IAP) is not widely recommended. To adopt the best preventive strategy, we first need better data assessing more accurately the true burden of GBS diseases in the different countries. Furthermore, as the current screening-based strategy for prevention is highly effective but imperfect, given the challenges, limitations and potential complications of maternal IAP, a new approach is still needed. Maternal immunization against GBS is an attractive alternative for the prevention of not only neonatal diseases but also stillbirths and maternal diseases. Vaccines against GBS may likely become the most effective and sustainable long-term preventive strategy. But the development of vaccines with global relevance has been hampered by changes in the distribution of GBS serotypes of strains causing diseases over time and in different parts of the world. A multivalent vaccine to cover against the more prevalent serotypes suitable for European populations might not be suitable for Asian or African populations. To overcome type-specificity, new developments target vaccines based on conserved surface antigenic proteins, such as Sip protein located at the cell surface of all GBS and on immunogenic proteins from GBS pili. A pilus-based GBS vaccine is appealing and could become a globally relevant reality. The DEVANI (DEsign of a Vaccine Against Neonatal Infections) programme funded through the European Commission Seventh Framework was launched on 1 January 2008 with the key objective being the assessment of European GBS epidemiology to facilitate the design of a new vaccine that will confer neonatal immunity through a durable maternal immune response. A major component was to undertake pan European surveillance of maternal colonisation, maternal GBS antibody responses and neonatal diseases in eight European countries. Through 2009 and 2010, all Belgian laboratories sending any neonatal GBS invasive isolate to the National Reference Centre for GBS were invited to bring their contribution to this project. Belgium, Bulgaria, Czech Republic, Denmark, Germany, Italy, Spain and the United Kingdom established specific GBS screening studies during 2008/10. Maternal vaginal/rectal swabs and sera were taken between 34-37 weeks gestation and processed using a standardised microbiological screening protocol. Samples from neonatal cases were processed using local procedures. For each pregnant woman and each case of GBS neonatal disease, standardized case report forms were filled. GBS isolates were characterised using standardised serological and molecular typing methods for detection of all ten GBS capsular polysaccharide types (Ia to IX). Furthermore all the collected isolates were screened by multiplex PCR and FACS analysis to evaluate respectively gene presence and surface-exposure of pili. And clonal analysis of these isolates was performed using multi-locus sequence typing (MLST). The main microbiological results of this pan European surveillance are following. Carriage rates among pregnant women in all countries ranged from 8% to 26%. The most common GBS capsular types were III (33%), Ia (25%) and V (8%). Among GBS from EOD, the major serotypes were III (43%), V (21%) and Ia (18%). In contrast among GBS isolated from neonatal late onset disease (LOD), serotype III was highly predominant (80.6%) followed mainly by Ia (12.5%). Analysis of the pattern of pili genes showed that all isolates contained at least one gene coding for pili. The most common gene patterns found were PI-2a alone, PI 1+2a and PI 1+2b, while the PI-2b gene alone was very rare. The most prominent result was that a majority of isolates from neonatal infections carried the PI-1+2b gene pattern, while the most common pattern among pregnant women was PI-1+2a. Most of analyzed strains express at least one pilus on their surface. The clonal analysis showed that 66 sequence types were found to belong to nine clonal complexes (CC). Among these nine CCs, five were prevailing and covered 92 % of GBS isolates tested. The GBS population in pregnant women was found to be more heterogeneous than the GBS isolated from neonatal infection cases. Among neonatal isolates, the most frequent CC was CC17 (43 %) known as a highly virulent clone. Among participating countries, there were no significant differences in the occurrence of clonal complexes. The analysis of the levels of specific antibodies as surrogate markers of protection is still ongoing. More detailed and additional results as the main conclusions will be presented. http://hdl.handle.net/2268/147903 Title: GBS colonization and screening in pregnancy: how does it work in Europe? <br/> <br/>Author, co-author: MELIN, Pierrette <br/> <br/>Abstract: In Europe, as in North America, GBS infections among infants are associated to high morbidity and mortality even if some differences exist between different European countries. During the past two decades, major initiatives have been proposed to prevent early onset GBS disease (EOD) and they are still subject of controversy. Several European countries have issued guidelines for the prevention of neonatal GBS diseases, either universal screening-based or risk-based strategy, others have no official guidelines at all. In countries having guidelines, despite considerable efforts and economic resources spent on intrapartum antimicrobial prophylaxis for GBS EOD, cases continue to occur. Among these cases there are a lot of missed opportunities to administer IAP but there are also false negative screening. Therefore in the setting of a maternal GBS-screening program and successful implementation of the strategy, efforts to improve screening for GBS status remain important. The natural reservoir for GBS is the gastrointestinal tract and is likely the source for vaginal colonization. Among pregnant women, GBS carriage rate in the vaginal and rectal flora ranges from 10% up to 30%. Critical factors that influence the accuracy of detecting GBS maternal colonization are the choice of the body sites sampled, the timing of sampling and the use of selective culture media. The evolution of the different culture options to improve the GBS-screening strategy will be reviewed. If the optimal time for performing antenatal cultures is between 35 to 37 weeks’ gestation, as GBS carriage is highly variable, the predictive values of GBS antenatal cultures are not always as good predictors of the maternal GBS status at presentation for delivery as expected. Potential alternative to antenatal GBS-screening culture is the identification of GBS colonization at presentation for delivery. Use of a reliable, sensitive, easy to use rapid test should be cost effective leading to the prevention of more EOGBS cases while reducing the number of unnecessarily IAP. Advances of polymerase chain reaction (PCR) and fluorescence labeling technologies has provided new detection tools for bacterial identification. Therefore, commercialization of rapid detection of GBS through real-time PCR offers the potential for GBS detection among women without prenatal care or those in whom no antenatal culture was collected. However questions of costs and logistics remain unanswered. Could such rapid intrapartum test replace existing screening strategies or could it be used in conjunction with them? Colonizing rates and recommended screening procedures existing through Europe will be reviewed. http://hdl.handle.net/2268/147897 Title: GBS AND THE NEONATE: PREVENTION STRATEGIES <br/> <br/>Author, co-author: MELIN, Pierrette <br/> <br/>Abstract: Streptococcus agalactiae, or group B streptococcus (GBS), remains the leading cause of neonatal sepsis and meningitis, early onset and late onset diseases (EOD, LOD). Where consensus guidelines to detect and treat intrapartum women with GBS colonization have been widely adopted, incidence of neonatal EOD has dramatically declined. In response to both successful impacts on the incidence of GBS-EOD and analyses of missed opportunities, the first American guidelines for prevention issued in the 90s have since been adapted in several stages to improve their efficacy. In some countries in Europe, nationwide guidelines, whether screening-based or risk-based, for the prevention of neonatal GBS diseases have also been issued and adopted, with the expected impact on incidence of GBS-EOD. In spite of universal screening, in spite of the great progress that has been made, GBS-EOD continues to occur and the GBS burden remains a significant public health issue. Continuous efforts to improve screening for GBS status continue to be important and may be able to take advantage of new rapid diagnostic technologies. The current screening-based strategy for prevention is highly effective but imperfect. Given the challenges, limitations and potential complications of maternal intrapartum prophylaxis, a new approach is still needed. Maternal immunization against GBS is an attractive alternative for the prevention of not only neonatal diseases but also stillbirths and maternal diseases. Vaccines against GBS may likely become the most effective and sustainable long-term preventive strategy. http://hdl.handle.net/2268/146965 Title: Carnet de pédiatrie: propédeutique clinique et d'imagerie <br/> <br/>Author, co-author: Battisti, Oreste http://hdl.handle.net/2268/145211 Title: L'asthme ou le spectre asthmatique chez l'enfant <br/> <br/>Author, co-author: Battisti, Oreste; Zigabe Mushamuka, Serge <br/> <br/>Abstract: ce travail présente les aspects cliniques, investigationnels, thérapeutiques et éducatifs du spectre asthmatique chez l'enfant http://hdl.handle.net/2268/144742 Title: Douleur et inconfort chez l'enfant <br/> <br/>Author, co-author: Battisti, Oreste <br/> <br/>Abstract: Bases de la physiopathologie, de l'évaluation et du traitement de la douleur et de l'inconfort chez l'enfant http://hdl.handle.net/2268/144495 Title: Carnet de pédiatrie: hématologie et douleur de l'enfant <br/> <br/>Author, co-author: Battisti, Oreste; DRESSE, Marie-Françoise http://hdl.handle.net/2268/144488 Title: Neonatal seizures or convulsions <br/> <br/>Author, co-author: Battisti, Oreste; DUBRU, Jean-Marie <br/> <br/>Abstract: diaporama et video des convulsions néonatales http://hdl.handle.net/2268/143572 Title: Carnet de pédiatrie: néphrologie de l'enfant <br/> <br/>Author, co-author: Battisti, Oreste http://hdl.handle.net/2268/143162 Title: Nouvelles perspectives pour l’alimentation des prématurés et leur croissance postnatale <br/> <br/>Author, co-author: SENTERRE, Thibault; Rigo, Jacques http://hdl.handle.net/2268/142456 Title: Eating disorders throughout female adolescence. <br/> <br/>Author, co-author: Domine, F.; Dadoumont, C.; BOURGUIGNON, Jean-Pierre <br/> <br/>Abstract: Eating disorders (EDs) are conditions which are becoming more and more widespread among adolescents and they often lead them to seek the opinion of a professional health caregiver, including gynecologists and pediatricians. EDs, and particularly anorexia nervosa (AN), are usually classified as psychological or psychiatric disorders, but they may have major somatic implications and complications as osteoporosis, nutritional deficiencies, cerebral atrophy, cardiac and metabolic disorders. A key issue in the management is prevention or reduction of both the serious somatic consequences and the important mental health consequences (e.g. depression, psychosocial withdrawal, phobia and suicide), integrating different perspectives (psychological or psychiatric - individual and familial -, genetic, nutritional, pediatric, gynecological). Adolescence is a critical period for the onset of EDs though they may also involve younger children. In this case, the consequences on the development (height, weight, puberty) can also be significant. In this review, we will focus on eating disorders in adolescent girls with an emphasis on AN. We describe variations in ED characteristics and their management depending on age at occurrence. A possible ED should be considered by pediatricians consulted about delayed female growth and puberty as well as gynecologists in patients with primary or secondary amenorrhea or infertility. <br/> <br/>Commentary: Copyright (c) 2012 S. Karger AG, Basel. http://hdl.handle.net/2268/142112 Title: Carnet de pédiatrie: Physiologie rénale <br/> <br/>Author, co-author: Battisti, Oreste <br/> <br/>Abstract: physiologie rénale: module complémentaire à la néphrologie de l'enfant http://hdl.handle.net/2268/141909 Title: Contribution à l'étude de la surveillance de la mécanique ventilatoire du nouveau-né ventilé. <br/> <br/>Author, co-author: RIGO, Vincent <br/> <br/>Abstract: La ventilation artificielle, qui contribue encore grandement à l’amélioration pronostique des nouveau-nés et prématurés, ne peut se réaliser sans une surveillance attentive. Cette surveillance des nouveau-nés ventilés intègre des données diverses. Elle est classiquement centrée sur celle des gaz sanguins, de manière directe ou via l’oxymétrie de pouls et les valeurs transcutanées. Elle reprend également les données de l’examen clinique, de l’imagerie thoracique et l’évaluation des réglages du respirateur. Les paramètres de mécanique respiratoire actuellement affichés par les respirateurs néonataux restent peu utilisés, notamment à cause d’une variabilité apparente élevée. Les stratégies de ventilation, qui visent actuellement à réduire la durée de celle-ci et à limiter les lésions iatrogènes qui sont associées à cette intervention, pourraient bénéficier d’outils de surveillance complémentaires. Pour le National Institute for Child Health and Human Development américain, la surveillance continue des fonctions pulmonaires fait partie des priorités identifiées en matière d’innovation technologique en néonatologie intensive. L’objectif de ce travail est de contribuer à la résolution de ce problème. Dans un premier temps, les données de compliance dynamique (Cdyn), résistance dynamique (Rdyn), volume courant (VT) et l’indice de surdistension C20/C fournies par le Dräger Babylog 8000®, le ventilateur néonatal le plus utilisé en Europe, sont d’abord évaluées pour juger de leur intérêt clinique. Ces paramètres présentent une variabilité importante, et manquent donc de précision. Une modification mathématique simple, le calcul de la moyenne sur quelques minutes, donne des résultats reproductibles et diminue logiquement cette variabilité. Les données continues de pression, débit et volume fournies par le respirateur permettent de reconstruire les courbes et boucles de cycles respiratoires. A partir de cycles d’apparence normale, le VT est déterminé et Cdyn et Rdyn sont calculés par la technique de Mead-Whittenberger. Ces valeurs calculées présentent des différences significatives avec les données du respirateur. En raison du manque de précision des données du ventilateur, une nouvelle approche est donc élaborée dans le cadre de ce travail. Elle base le calcul des paramètres de mécanique respiratoire exclusivement sur des cycles respiratoires sélectionnés. Un nouveau programme informatique est développé en collaboration avec la société Nomics. Ce programme permet d’individualiser automatiquement les cycles respiratoires et de reconstituer les courbes et boucles de pression, débit et volume de ces cycles. Le programme calcule pour chaque cycle les valeurs de Cdyn et Rdyn par une méthode de régression linéaire multiple, ainsi que VT et C20/C. Sur base de 10 séries de 2 enregistrements (un en mode Ventilation assistée contrôlée intermittente- VACI, et un en mode Ventilation assistée contrôlée- VAC), 11274 cycles respiratoires sont évalués pour en conserver 4847 d’apparence optimale. Ces cycles assistés par le ventilateur présentent une fuite nulle ou minimale, une hystérésis satisfaisante sur la courbe pression-volume, et des tracés de débits normaux. Les coefficients de variation obtenus à partir de cette sélection sont significativement diminués en comparaison de ceux obtenus à partir des données du ventilateur. Cette diminution est de 25-27% pour Rdyn, Cdyn et C20/C, et de 60% pour VT. Cette précision accrue s’accompagne d’une amélioration du pouvoir de discrimination entre les paramètres correspondant aux différents enregistrements et situations cliniques. L’analyse des différences observées entre les résultats du ventilateur et ceux des cycles sélectionnés est intéressante. Les VT annoncés par le premier sont plus élevés que ceux dérivés des cycles optimaux, suggérant que les valeurs rapportées par le respirateur sont à elles seules insuffisantes pour servir de base à l’ajustement des réglages de ventilation. En mode VACI, la faible corrélation entre les Cdyn obtenues par les deux méthodes interpelle quant à la pertinence des informations du ventilateur. Enfin, la dispersion marquée des résultats de C20/C, souvent en dehors des valeurs normatives reconnues, et l’absence de corrélation avec les données issues de cycles optimaux démontrent l’absence de validité des C20/C calculés par le ventilateur. Les résultats permettent également de suggérer que l’utilisation de valeurs dérivées de cycles sélectionnés pourrait servir de base à la conception d’un outil de surveillance continue des paramètres de mécanique respiratoire utile pour la conduite de la ventilation. Pour éviter la charge de travail importante liée à la sélection visuelle des cycles respiratoires, le programme décrit ci-dessus est complété pour identifier automatiquement les cycles optimaux. Cette sélection présente une valeur prédictive positive et une spécificité très élevées. Les paramètres de mécanique respiratoire obtenus à partir de cette sélection automatique concordent avec ceux de la sélection visuelle. La dernière partie de ce travail est consacrée à l’évaluation des potentialités du programme en analysant 21 enregistrements obtenus dans des conditions cliniques variées. La capacité de distinction entre résultats différents est évaluée sur une population étendue. Les possibilités de suivi de tendances sont évaluées. L’analyse des paramètres de mécanique respiratoire sur base de cycles sélectionnés automatiquement permet de démontrer des différences de 4,6-7,1% ou plus entre les paramètres de deux enregistrements de 10 minutes. Pour mettre en évidence une différence de 10%, il suffit d’établir les moyennes sur 3 à 7 minutes selon le paramètre étudié. Des moyennes établies sur dix minutes permettent ainsi de confirmer des variations de 10% chez presque tous les patients. Ces données permettront d’établir des courbes de tendances avec des données significatives sur les plans clinique et statistique. En conclusion, le programme de surveillance de la mécanique respiratoire développé et évalué lors de ce travail devrait donner des informations précises sur l’évolution dynamique des paramètres de compliance, résistance, volume courant et C20/C. La dernière version du programme permet un fonctionnement en temps réel et intègre des fonctions qui donnent des possibilités immédiates d’utilisation en recherche. L’application en clinique semble également toute proche, et pourrait compléter les informations guidant la conduite ventilatoire.; Mechanical ventilation, still a major intervention to improve prognosis in newborns, requires careful monitoring of ventilated infants. This monitoring integrates different parameters. Its classical focus is on blood gases and their proxy (pulse oxymetry, transcutaneous oxygen and carbon dioxide content), and also includes physical assessment, thoracic imaging and appraisal of ventilator settings. Use of currently available on-line respiratory mechanics (RM) as displayed by ventilators seems limited given a large apparent variability. As current respiratory support strategies aim to reduce exposure to mechanical ventilation and to decrease ventilator associated lung injuries, additional continuous monitoring tools could benefit neonatal patients. In a review of advanced biomedical devices in use in the neonatal intensive care units and areas where improvement or evaluation is necessary, the National Institute for Child Health and Human Development underlines simple tools for continuous assessment of vital pulmonary functions at the bedside. This research aims at finding solutions to that problem. In a first step, different respiratory mechanics parameters (dynamic compliance –Cdyn, dynamic resistance –Rdyn, tidal volume –VT and the overdistension parameter C20/C) are obtained from ventilatory recordings of newborns under respiratory support with the most commonly used neonatal ventilator to evaluate their clinical relevance. Those data present a high variability and therefore lack precision. It is possible to mathematically decrease this variability by using parameters averaged over a few minutes and to obtain reproducible results. Continuous pressure, flow and volume data from the ventilator allow construction of pressure-volume, pressure-flow and flow-volume loops. From those loops, Cdyn, Rdyn and VT can be computed by the Mead-Whittenberger method. Those values when derived from respiratory cycles with good appearance significantly differ from ventilator values. Given the lack of precision of ventilator derived respiratory mechanics data, a new strategy is developed to obtain those parameters only from optimal looking respiratory cycles. A new software is designed to reconstruct waves and loops from the ventilator continuous recordings. This software individualises respiratory cycles and compute Cdyn and Rdyn (least mean square method), VT and C20/C. Using 10 sets of two recordings (one in Synchronized Intermittent Mandatory Ventilation and one in Assist/Control ventilatory modes), visual evaluation of 11274 respiratory cycles selects 4847 cycles considered optimal looking. Those assisted cycles present no or minimal leak, good hysteresis of the pressure-volume loop, and no abnormalities of the flow curves. The coefficients of variation of the respiratory mechanics parameters obtained with this method are significantly decreased, by 25-27% from the ventilator values for Rdyn, Cdyn and C20/C, and by 60% for VT. This increase in parameters precision is associated with an improved capacity to discriminate different values. Analysis of discordant values between ventilator and optimal respiratory cycles is relevant. In A/C mode, the VTs from the selected respiratory cycles are lower than values reported by the ventilator, suggesting that currently available VTs give incomplete information for adjustment of ventilator settings. In SIMV mode, the weak correlation between Cdyn from both methods leads to question the relevance of ventilator informations. The important scattering of ventilator C20/Cs out of classical values, and the absence of correlation with values from selected respiratory cycles demonstrate the lack of validity of ventilator C20/Cs. Overall, the results suggest that the use of data derived from selected respiratory cycles could underlie the conception of RM monitoring tools to support ventilatory management. To avoid the heavy workload associated with visual respiratory cycles’ selection, the software is improved to automatically identify optimal cycles. The positive predictive values and specificity of this selection are high. Respiratory mechanics parameters from cycles selected automatically are very concordant with those from visually selected cycles. The last step of this work assesses the software potential with analysis of 21 recordings from various clinical situations. The discriminating power of automatically selected respiratory cycles’ parameters is tested in an extended population. Trending abilities of those parameters are evaluated. Analyses of respiratory mechanics parameters derived from automatically selected cycles are able to demonstrate differences of 4.6-7.1% and more between parameters from two 10min recordings. Averaging data over 3-7min allows to determine a 10% difference. Parameters averaged over 10min allow detection of 10% changes in most patients. Those results should allow building trend curves with clinically and statistically significant informations. In conclusion, the continuous respiratory mechanics analysis software developed and evaluated in this work should give precise informations on the dynamic evolution of RM parameters. Functions integrated in the last version of the software give immediate research opportunities, and should lead to clinical application in a very near future. Those parameters could then complete current informations integrated in ventilatory management. http://hdl.handle.net/2268/141908 Title: Insulin sensitivity modulates the growth response during the first year of high-dose growth hormone treatment in short prepubertal children born small for gestational age. <br/> <br/>Author, co-author: Gies, Inge; Thomas, Muriel; Tenoutasse, Sylvie; De Waele, Kathleen; LEBRETHON, Marie-Christine; Beckers, Dominique; Francois, Inge; Maes, Marc; Rooman, Raoul; de Beaufort, Carine; Massa, Guy; De Schepper, Jean <br/> <br/>Abstract: AIM: To study the relationship between insulin sensitivity and growth response in short children born small for gestational age (SGA) treated with growth hormone (GH). METHODS: Randomized, open-label, 24-month intervention study in 40 short prepubertal SGA children [age (mean +/- SD) 5.3 +/- 1.5 years], who either remained untreated (n = 20) or were treated with GH (66 microg/kg/day; n = 20). Changes in fasting glucose, insulin, quantitative insulin sensitivity check index (QUICKI), IGF-1 and leptin after 1 and 2 years were studied. RESULTS: Mean height SDS increased from -3.3 +/- 0.7 to -2.3 +/- 0.7 after 1 year, and to -1.9 +/- 0.7 after 2 years of treatment. QUICKI decreased significantly (p = 0.008) in the first year of GH treatment and stabilized in the second year. Baseline QUICKI was positively associated (r = 0.40; p < 0.05) with the change in height SDS in the first year. CONCLUSION: Higher insulin sensitivity at the start of GH therapy is associated with greater first-year growth response to GH, and could be a promising parameter in selecting prepubertal short SGA children for GH treatment. However, this finding needs to be confirmed in larger studies. <br/> <br/>Commentary: Copyright (c) 2012 S. Karger AG, Basel. http://hdl.handle.net/2268/141907 Title: Care delivery and outcomes among Belgian children and adolescents with type 1 diabetes. <br/> <br/>Author, co-author: Doggen, K.; Debacker, N.; Beckers, D.; Casteels, K.; Coeckelberghs, M.; Dooms, L.; Dorchy, H.; LEBRETHON, Marie-Christine; Logghe, K.; Maes, Marijke; Massa, G.; Mouraux, T.; Rooman, R.; Thiry-Counson, G.; Van Aken, S.; Vanbesien, J.; Van Casteren, V. <br/> <br/>Abstract: We aimed to investigate care processes and outcomes among children and adolescents with type 1 diabetes treated in hospital-based multidisciplinary paediatric diabetes centres. Our retrospective cross-sectional study among 12 Belgian centres included data from 974 patients with type 1 diabetes, aged 0-18 years. Questionnaires were used to collect data on demographic and clinical characteristics, as well as process of care completion and outcomes of care in 2008. Most patients lived with both biological or adoption parents (77 %) and had at least one parent of Belgian origin (78 %). Nearly all patients (>/=95 %) underwent determination of HbA(1c) and BMI. Screening for retinopathy (55 %) and microalbuminuria (73 %) was less frequent, but rates increased with age and diabetes duration. Median HbA(1c) was 61 mmol/mol (7.7 %) [interquartile range 54-68 mmol/mol (7.1-8.4 %)] and increased with age and insulin dose. HbA(1c) was higher among patients on insulin pump therapy. Median HbA(1c) significantly differed between centres [from 56 mmol/mol (7.3 %) to 66 mmol/mol (8.2 %)]. Incidence of severe hypoglycaemia was 30 per 100 patient-years. Admissions for ketoacidosis had a rate of 3.2 per 100 patient-years. Patients not living with both biological or adoption parents had higher HbA(1c) and more admissions for ketoacidosis. Parents' country of origin was not associated with processes and outcomes of care. Conclusion: Outcomes of care ranked well compared to other European countries, while complication screening rates were intermediate. The observed centre variation in HbA(1c) remained unexplained. Outcomes were associated with family structure, highlighting the continuing need for strategies to cope with this emerging challenge. http://hdl.handle.net/2268/141893 Title: Prise en charge du nouveau-né en extra-hospitalier <br/> <br/>Author, co-author: VIELLEVOYE, Renaud http://hdl.handle.net/2268/141891 Title: Encéphalopathie anoxo-ischémique et neuroprotection par hypothermie contrôlée <br/> <br/>Author, co-author: VIELLEVOYE, Renaud