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 i...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.
Individualised developmental care has gradually become an international standard in neonatology over the last two decades. It is particularly useful in the case of very premature babies, as it makes it possible to humani...Individualised developmental care has gradually become an international standard in neonatology over the last two decades. It is particularly useful in the case of very premature babies, as it makes it possible to humanise and personalise the care given to each infant, as well as providing support for their families. Individualised developmental care represents a revolution in the way care is provided, the environment in which it is carried out, and parental involvement. Parents are no longer visitors, but care partners.Changing a team's practices towards individualized developmental care requires structured training and support for professionals. In particular, they need to learn how to analyse the child's behavior correctly (observation), to deduce the best time and the best way to intervene with each child according to his own abilities and needs. Professionals must provide parental guidance, from birth through discharge home.Individualized developmental care helps to reduce the impact of prematurity on the immediate postnatal health and long-term development of premature babies, as well as on the parent-child relationship and the parents' well-being. They help to reduce the complications associated with extreme prematurity and the lengthy hospitalization required to manage it.
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 in...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.
Girault N, Quiroga L, Jedrecy S
… +3 more, Bertin S, Djonouma N, Fossati P
Rev Prat
· 2026 Mar · PMID 41878960
Neuroimaging techniques have a rightful place in the field of psychiatry. They are essential for differential diagnosis, especially when the psychiatric presentation is atypical. Furthermore, they associate brain dysfunc...Neuroimaging techniques have a rightful place in the field of psychiatry. They are essential for differential diagnosis, especially when the psychiatric presentation is atypical. Furthermore, they associate brain dysfunction with psychiatric disorders, but they cannot yet provide a definitive psychiatric diagnosis. However, from a therapeutic perspective, brain MRI is a very useful tool for neuronavigation techniques in combination with rTMS. From a neurobiological perspective, advances in genetics are allowing the development of genomic tests to guide antidepressant therapy and predict a diagnosis of bipolar disorder. In addition, psychedelics such as psilocybin offer promising alternatives for the treatment of depression. Similarly, ketamine, an antagonist of NMDA-type glutamatergic receptors, has shown efficacy in the management of suicidal crises and in the treatment of depressive disorders. Finally, antagonism of orexin receptors offer a new avenue for treating insomnia.
Chatelet F, Morgand M, Rouzaud C
… +1 more, Verillaud B
Rev Prat
· 2026 Mar · PMID 41878959
Sinonasal and petrous bone fungal infections are rare and life-threatening conditions that essentialy arise in immunocompromised patients. They are mainly due to Aspergillus in patients with hematological diseases and to...Sinonasal and petrous bone fungal infections are rare and life-threatening conditions that essentialy arise in immunocompromised patients. They are mainly due to Aspergillus in patients with hematological diseases and to Mucorales in diabetic. Invasive fungal sinusitis can be acute (invasive aspergillosis, rhino-orbito-cerebral mucormycosis) but chronic invasive sinusitis can also exist (invasive chronic fungal sinusitis and granulomatous invasive fungal sinusitis). Petrous bone fungal infections are similar to bacterial necrotizing otitis externa and are most often due to Aspergillus. The diagnosis must be made as early as possible with surgical biopsies, to allow early therapeutic management. Histopathological analysis is essential to confirm the diagnosis. The treatment is multidisciplinary and combines antifungal treatments with etiological care, sometimes associated with debridement surgery especially for mucormycosis.
Digestive angiodysplasia are acquired, superficial vascular lesions of the digestive tract, frequently implicated in overt or occult digestive gastrointestinal bleeding episodes. Their pathophysiology is not fully unders...Digestive angiodysplasia are acquired, superficial vascular lesions of the digestive tract, frequently implicated in overt or occult digestive gastrointestinal bleeding episodes. Their pathophysiology is not fully understood. They preferentially affect the elderly and comorbid patients. Their association with aortic stenosis is known as Heyde's syndrome. Diagnosis is based on digestive endoscopy (upper gastrointestinal endoscopy, colonoscopy and small bowel capsule endoscopy). Non-specific treatment includes management of blood thinners, iron supplementation (oral or intravenous) and blood transfusions. The specific first-line treatment is endoscopic destruction (argon plasma electrocoagulation being the most common), if necessary, by deep enteroscopy (with double balloon technique) in their jejunal and ileal locations. If endoscopic treatment fails, other treatments may be considered. In Heyde's syndrome, aortic valve replacement (surgical or transcatheter, TAVI) is often effective. Some pharmacological treatments have been shown to be effective, most notably long-acting release somatostatin analogues, followed by thalidomide (which has a poorer safety and tolerability profile). Bevacizumab, radiological embolization and surgery are only considered in most refractory or salvage cases.
Bladder and sphincter disorders are common in neurological conditions (stroke, multiple sclerosis, Parkinson's disease, spinal cord injury, peripheral neuropathies, etc.). The type of dysfunction varies depending on the...Bladder and sphincter disorders are common in neurological conditions (stroke, multiple sclerosis, Parkinson's disease, spinal cord injury, peripheral neuropathies, etc.). The type of dysfunction varies depending on the location and extent of the lesion. Treatment must prevent urological and extra-urological complications, improve quality of life, and promote patient autonomy. It must ensure proper bladder emptying (urination), maintain low bladder pressure, and achieve satisfactory urethral resistance. Depending on the initial assessment and follow-up, several treatments may be offered, the most invasive of which are discussed in a specialized neuro-urology center. Patient follow-up is based on keeping a voiding diary and regular morphological and functional assessment of the lower and upper urinary tract (renal-vesical ultrasound, renal function assessment, urodynamic assessment, urethrocystoscopy, retrograde and voiding urethrocystography). The frequency of follow-up is adapted to the urological and nephrological risk. A sudden worsening of urological symptoms, the occurrence of recurrent urinary tract infections, the appearance of gross hematuria, and/or deterioration of renal function are red flags that require urgent treatment at a specialized neuro-urology center.
Gender dysphoria, also referred to as "gender incongruence," describes the distress arising from the misalignment between an individual's experienced gender and their sex assigned at birth. Historically regarded as a psy...Gender dysphoria, also referred to as "gender incongruence," describes the distress arising from the misalignment between an individual's experienced gender and their sex assigned at birth. Historically regarded as a psychiatric disorder, it is now recognized as a medical condition requiring appropriate care, largely due to scientific advancements and advocacy for transgender rights. Epidemiological data indicate a rising demand for gender-affirming care, particularly among adolescents, although disparities persist across cultural and healthcare contexts. The diagnosis, as defined by the DSM-5 and ICD-11, necessitates a thorough assessment to differentiate it from psychiatric or neurodevelopmental disorders. Management relies on a multidisciplinary approach that integrates psychological support, social assistance, and medical or surgical interventions tailored to individual needs. This article examines the historical evolution of the perception and treatment of gender dysphoria, from its pathologization in the 1950s-1960s to the adoption of a more inclusive approach. It also explores the long-term effects of gender transition, highlighting improvements in patient well-being while addressing the issue of post-transition regret and appropriate management strategies.