[Persistent central diabetes insipidus in a very low birth weight infant]. / Diabète insipide central idiopathique chez un très grand prématuré

Central diabetes insipidus (DI) is extremely rare during the neonatal period. Most cases of central DI are secondary to a known aetiology. Substitutive treatment with desmopressin is effective with nasal or oral preparation, but doses are variable and must be tailored individually. We report on a case in a very low birth weight infant with an idiopathic central DI during the first month of life. He was successfully treated with oral desmopressin. The treatment was maintained after discharge with low doses desmospressin.

[Neonatal enterovirus myocarditis]. / Myocardite néonatale à entérovirus.

UNLABELLED: Enterovirus infections in neonates are difficult to diagnose. Diphasic pattern and possibly fatal myocarditis must be anticipated. CASE REPORT: A 14-day-old girl had presented a heart failure after an initial episode of gastroenteritis and supraventricular tachycardia. Investigation demonstrated global myocardial dysfunction. Diagnosis of neonatal enterovirus myocarditis was made by polymerase chain reaction detection of viral genome. Heart failure was controlled with medical treatment. CONCLUSION: Enterovirus myocarditis is typically a biphasic illness. Rapid diagnosis of enteroviral infection in neonatal period may be made by polymerase chain reaction detection of viral genome. There is anecdoctal evidence that immunoglobulin infusions may improve outcome.

Outborn status with a medical neonatal transport service and survival without disability at two years. A population-based cohort survey of newborns of less than 33 weeks of gestation.

OBJECTIVE: Prenatal events are thought to play an important role in long-term handicap, but the specific role of perinatal factors remains controversial. Our study, conducted in the context of this debate, aimed to break down the various components of perinatal management and to assess the relationship between these components and survival without disability at the age of two years. STUDY DESIGN: A prospective geographically-defined study was conducted in 1985 in the Paris metropolitan area. It covered 53430 births (stillbirths and live births), including 539 that occurred between 25 and 32 weeks gestation. The relationship between perinatal management and survival without disability was studied by a multivariate analysis (logistic regression). The analysis was restricted to a group of 202 infants born at 31 or 32 week's gestation, to avoid indication bias. RESULTS: An inborn status (delivery in a tertiary care facility) exerted a protective effect on survival without disability at the age of two years (Adjusted Odds Ratio (OR)=7.51 [1.51; 37.4]), even though the area we studied possessed an excellent Medical Neonatal Transport Service. Multiple pregnancies also seemed to have a protective effect (Adjusted OR=2.45 [0.96; 6.27]). No statistically significant association was seen between survival without disability at two years and the presence of a hospital staff paediatrician in the delivery room. CONCLUSION: These results lead us to consider what the concept of inborn/outborn represents in the perinatal management of infants at high risk.

[Bronchopulmonary dysplasia. Course over 3 years in 88 children born between 1984 and 1988]. / Dysplasie bronchopulmonaire. Evolution à 2 ans de 88 enfants nés entre 1984 et 1988.

BACKGROUND: The survival and outcome of infants with bronchopulmonary dysplasia (BD) depend on the patient's maturity, the severity of the BD and nutritional problems. This study evaluates the specific role of chronic pulmonary failure in the growth and development of infants recovering from BD. POPULATION AND METHODS: 88 infants admitted for BD from January 1984 to December 1988, having gestational age from 25 to 41 weeks 5 days (mean: 29) and birth weight from 680 to 3,400 g (mean: 1,195) were studied. All infants were given respiratory support for 6 to 914 days (mean 84) and oxygen therapy for 28 to 1,232 days (mean: 119). 29 infants were given corticosteroids for more than 1 month. The outcome of the 80 infants with gestational ages of less than 33 weeks was compared to that of 272 infants with the same gestational age but not suffering from BD on their 28th day. The infants in both groups were examined at 2 years of age and classified as: a) handicapped (neurologic deficit, IQ < 80, hearing loss, blindness, convulsions); b) doubtful (transitory neurology dysfunction); c) normal. RESULTS: Of the 88 infants still living at the age of 28 days, 19 died before the age of 2 years: 16 of the 64 surviving infants who could be followed until the age of 2 years were classified as handicapped, 13 were considered doubtful and 35 were normal. The more significant risk factors for neurodevelopmental impairment were: a) the presence of porencephaly and/or ventricular dilatation on brain ultrasonography; b) head circumference < -2 SD at the end of hospital stay; c) oxygen therapy and hospitalization > 5-6 months. The group of infants with BD had a higher death rate (24% vs. 3.7 in the group without BD) and more frequent neurodevelopmental impairment at gestational ages of > 31-32 weeks. CONCLUSIONS: BD is an extra risk for the survival and neurodevelopment of infants with gestational age > 31 weeks.

[Future of premature infants of less than 33 weeks gestational age: results of an inquiry undertaken in 1985 in the Paris region]. / Devenir des prématurés de moins de 33 semaines d'âge gestationnel: résultats d'une enquête menée en 1985 dans la région parisienne.

Improvements in combining obstetrics and neonatology led to a trend to intervene earlier in premature babies born before the 33rd week of gestational age. The enquiry that was carried out in 1985 in the Paris geographical region had as its objective to assess on the one part how many premature deliveries occurred between the 25th and 33rd week of amenorrhea and on the other hand what happened in the short term to the infants born from these pregnancies, i.e., their mortality; and for those who survived, their quality of life. The study was carried out on a representative sample of the deliveries in 1985 in the four departments of the Paris region--Paris and the three departments of the Petite Couronne--where half of all deliveries were assessed. The enquiry covered 53,430 deliveries for which the overall prematurity rate was 4.5%, and those deliveries that occurred before 33 weeks of gestational age constituted 1.0% (539 babies). Twenty children were lost for follow-up after a year. This was 4.9% of the live births and 6.3% of the live children who left the neonatology centres. At 2 years of age, the numbers that were not followed up were eventually 24, which was 5.8% of live births and 7.6% of those that left the centres of neonatology. The results show a very high rate of antepartum mortality but also of mortality during and after labour. Only 379 infants out of the 539 (70%) were transferred into special care baby units. By 1 year of age, the survivors were 57% of the total number of deliveries and 75% of the live births and 82% of those transferred to the special units. As far as concerned those that were live born, the survival rate at the age of 1 year varied considerably according to the duration of the pregnancy. The number of those that survived a pregnancy of less than 27 weeks was low (31%). It was, at 28 weeks, 53%. This is the age where births have to be registered. It reached 87% of the live births that occurred at 32 weeks. One has to point out that there is no statistically significant difference between 27 and 28 weeks of gestation. Whereas there is a significant difference (p less than 0.05) with those delivered at 29 weeks (75%). 80% of those 291 infants that were examined at 1 year of age were considered to be normal as far as psychomotor and sensorial behaviour was concerned.(ABSTRACT TRUNCATED AT 400 WORDS)

[Necrotic funisitis]. / Funiculites nécrotiques.

The authors report eighty eight cases of a perticular type of funisitis characterized by perivascular necrosis of Wharton's jelly. The accompanying leucocyte reaction is weak, and sometimes nil, and the inflammatory lesions of the placenta are also moderate, and sometimes absent. The necrosis of the cord is, however, sufficiently pronounced to be visible to the naked eye. The neonate is often--but not always--very premature, but rarely shows clinical signs of infection (only one case in five). It nonetheless presents with hyperleucocytosis from birth, often severely, but this clears up within a few days, even in the absence of antibiotherapy. A very high rate of blood IgM is also often observed in these infants, on the day of birth. Immediate survival and postnatal development often present no problems. The etiology is not known. There are indirect arguments in favor of a rare germ which cannot be visualized by routine techniques, or possibly a virus. But this remains to be proved. Some observers have suggested that it is the fruit of a particular diathesis, with a tissular reaction to a non-infectious aggression by some modification of the amniotic fluid but this too remains to be established.

[Bronchopulmonary dysplasia]. / Dysplasie broncho-pulmonaire.

A retrospective study of 2 125 preterm infants, who were ventilated at the Institut de Puériculture in Paris over 9 years (1974-1982) for respiratory distress at birth, showed that 45 (2%) developed clinical and radiological bronchopulmonary dysplasia (BPD): 8 minimal forms, 23 moderate forms and 14 severe forms, 30 of these patients survived (66%). The pathogenesis of this chronic respiratory disease is multifactorial: oxygen + pressure + duration + endotracheal intubation. Efforts should be made to limit the damaging effect of each of these factors, which should be kept down to the minimum values compatible with adequate oxygenation. The presence of emphysema and of a patent ductus arteriosus has also been incriminated, but they may reflect the severity of the initial lung lesion. Rickets, whose incidence was found to be 27%, majors respiratory distress. In the ensuing months, babies with BPD are susceptible to recurrent viral or bacterial respiratory tract infection, failure to thrive and cor pulmonale. The presence of the mother and the care of a psychomotor development specialist are needed for these infants who will be confined for months in conditions which are unsuited to their sensory, physical, emotional and cognitive development.