Since the year 2000, medical research has progressed and many advances have been made. Our little ones have fortunately benefited from it but there is still progress to be made in certain areas.
Antenatal screening for Down syndrome: efficient thanks to NIPT
Down syndrome affects approximately 27 pregnancies out of 10,000 and the risk increases with maternal age. NIPT, non-invasive prenatal screening for Down syndrome, is a genetic test which looks for the over-representation of chromosome 21 in the free DNA of the fetus circulating in the maternal blood. It is now proposed (i.e. not required) in all maternity wards and, reimbursed by Social Security since January 2019. When the test shows a risk of Down syndrome, it is always followed by an amniocentesis in order to establish the karyotype of the fetus and thus make the diagnosis. The reliability of the NIPT is more than 99% and its objective is not only to improve screening for Down syndrome but also to limit amniocentesis (and the risk of miscarriage, which is 1%), invasive and costly examinations if there are any.
Neonatal screening: MCAD deficiency is now part of it
The Guthrie test, carried out in the maternity ward, can detect 5 potentially serious rare diseases : phenylketonuria, congenital hypothyroidism, congenital adrenal hyperplasia, sickle cell anemia and cystic fibrosis (latest arrival in 2002). “ In 2019, it will be the turn of the MCAD deficit to also be part of the test » explains Michel Roussey, professor of pediatrics. “ And this, thanks to basic tandem spectrometry (MS/MS), technique allowing the detection of 30 to 50 metabolic diseases with a single drop of blood “. MCAD deficiency can lead to coma and rapid death of the baby. Treatment: take the precaution of never leaving him on an empty stomach.
Prematurity: babies live better
The survival of babies born prematurely has improved significantly compared to the 1990s, the rate increased by 6% according to a study. Thus, it is 99% for those born between 32 and 34 weeks of pregnancy (SG). 93% between 27 and 31 SG, 52% between 22 and 26 SG. This study by researchers from the Inserm ÉPOPé team was carried out on 5,500 children followed since their birth in 2011 and the results compared with the first survey in 1997. Other good news is that these little premature babies suffer half as many motor and sensory disabilities ( walking, hearing, vision) at the age of 2 years. This progress would be linked to improving pregnancy care (such as taking corticosteroids by the future mother to improve the maturation of the fetal lungs when there is a risk of prematurity) and postnatal care. Better health then, but what about support from parents? During 2019, will the public authorities endorse the proposed law allowing paternity leave to be extended by the duration of the baby’s hospitalization? He needs both his parents.
Vaccination: obligatory for all infants
Since January 1, 2018, 11 vaccines are mandatory for babies born after this date. These are: DT-Polio (diphtheria-tetanus-poliomyelitis), MMR (measles-mumps-rubella), vaccines againstHaemophilus influenzae type B, whooping cough, hepatitis B, meningococcus C and pneumococcus. Thanks to them, lives have been saved. Unfortunately, the coverage of certain vaccines, such as MMR, is still insufficient. However, it must be 95% to eliminate the disease. In 2019, measles made headlines again!
These compulsory vaccinations condition entry and maintenance in any school, daycare, summer camp or other community (only the DT-Polio is required for children born before 2018). The Minister of Health is rubbing her hands: the first figures from Public Health France for the period January-May 2018 already show an increase in vaccination coverage children aged 12 months (i.e. even before the law comes into force).
Unexpected death of the newborn: vigilance is always required
Thanks to prevention actions in the 1990s relating to infant sleeping and the environment, the number of deaths due to IMD (unexpected infant death) has fallen spectacularly by 75%. This is very good but not enough because there are still almost 400 per year. “ Half of these unexpected deaths could be avoided, explains Elisabeth Briand-Huchet, referring doctor for the association naitre-et-vivre.org, sleeping habits are not yet fully integrated “. Parents do not always respect them and some professionals are still skeptical. In addition, the bed is not secure enough (presence of bed bumper, soft toys, baby wedges, sharing the bed with an adult, etc.). Furthermore, the number of future smoking mothers don’t go down. However, nicotine passes through the placenta, attaches to an area of the fetal brain which should normally allow the awakening reflex to be triggered in the event of breathing difficulties. We say it again: sleeping on your back without any accessories in the bed for maximum safety.
Medicine for bronchiolitis
Bronchiolitis, this viral infection of the respiratory tract, is potentially dangerous, particularly for infants,– 30% of children under 2 years old are affected by bronchiolitis each year. The French laboratory Sanofi and the British AstraZeneca have received approval from the European Medicines Agency for a vaccine aimed at preventing bronchiolitis in babies. Concretely, it is a monoclonal antibody called Beyfortus. The drug Beyfortus is a preventive solution against severe forms of respiratory syncytial virus (RSV) bronchiolitis, the cause of 80% of bronchiolitis.. Nirsevimab (Beyfortus) is administered intramuscularly into the thigh as a single injection. It is administered during the first season of RSV circulation. It is not a vaccine, but a monoclonal antibody.
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Pediatric cancers: less burdensome treatments
Cancer is the leading cause of death from disease in children. Every year, 2,500 children under the age of 18 are affected, especially before the age of 5. Among the most common tumors: acute leukemia (25 to 30%), brain tumors (around 20%). This is followed by lymphomas (cancers of the lymph nodes) and neuroblastomas (of the sympathetic nervous system). The overall cure rate, for all cancers combined, is currently 80 % and continues to grow gradually.
« Progress over the past 20 years has often focused on reduction of after-effects after treatment » explains Professor François Doz, pediatric oncologist. “ Biological characterization of tumors makes it possible to define distinct risk groups “. In forms of cancer “ favorable », the reduction in the intensity of treatments could be carried out without altering the chances of recovery. Reducing the doses of chemotherapy and radiotherapy as well as reducing the indications for mutilating surgery makes it possible to improve the quality of life of children. In the forms “ unfavorable », the development of new treatments (targeted drugs, immunotherapy for example) is necessary. Good news, the therapeutic trials of innovative treatments are now more numerous among children.
Vaccination announced against 5 types of meningococci
Today, vaccination against meningococci B is only recommended. Only vaccination against meningococci C is obligatory in infants. But on April 26, 2024, the HAS (High Health Authority) announced a new measure following a notable increase in meningococcal meningitis. In fact, from 2025 all babies will have to be vaccinated against 5 types of meningococci. In addition to vaccination against those in group C, babies will need to be vaccinated against those in groups A, B, W and Y.
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- How to protect baby from sudden infant death syndrome
- Recognizing the Symptoms of Premature Birth
