[Information in perinatal medicine: ethical aspects]. / L'information dans le contexte du soin périnatal: aspects éthiques.

Besides the undeniable need to respect parental autonomy, providing information is a legal and moral obligation, to be informed a basic right. The act of informing should be considered as an exchange and necessarily begins by listening to the other. According to the jurisprudence of the Court of Cassation that draws on Article 35 of the Deontological Code, information has to be clear (implying an educational effort, availability and to check that the information has been well understood), appropriate (adapted to each situation and person) and honest (which supposes a moral contract between parents and physicians). Loyalty implies a consideration of the uncertainty underlying medical practice, and of the limitations in arriving at a prognosis. Indeed, caution needs to be exercised in conveying information, taking into account the risk of its becoming self-fulfilling, which could modify the way in which parents take care of their child. The information given has to be coherent, both within the spatial dimension (coherence of information between the different maternity services in the perinatal network) and the temporal dimension (coherence of information between pre- and postnatal stages). It must be acknowledged that information is essentially subjective. There is a fundamental difference between coherence and uniformity, and as regards information, uniformity is neither possible nor desirable. In each situation, priority must be given to oral information delivered in an appropriate material context. The principle of establishing, in the medical file, a written trace of the information given at various stages is one way to guarantee its coherence.

Pharmacokinetic study of piperacillin in newborns relating to gestational and postnatal age.

The pharmacokinetics of piperacillin after a single 75-mg/kg intravenous injection as analyzed in 28 neonates with gestational ages of 29 to 40 weeks (A = 29 to 31 weeks, B = 33 to 35 weeks, C = 38 to 42 weeks) and birth weights of 860 to 3900 g during 35 courses. Serum concentrations of piperacillin were determined by high pressure liquid chromatography. A one compartment open model characterized the disposition of piperacillin. Twenty courses were given between Day 3 and Day 5 of life. The elimination half-life and total body clearance were related to gestational age. Differences were significant between Groups A and B and Group C for half-life (4.3 +/- 1.9 and 3.35 +/- 0.75 vs. 2.47 +/- 0.72 hours) and for clearance (1.68 +/- 0.6 and 1.8 +/- 0.4 vs. 2.46 +/- 0.36 ml/min/kg). Volumes of distribution were similar in the 3 groups, from 516 +/- 108 to 633 +/- 226 ml/kg. Fourteen courses were given from Day 9 to Day 11 of life. The same differences were observed between Groups A and B and Group C. Elimination half-life was significantly reduced with simultaneous increase of the total body clearance. In clinical practice, 75-mg/kg intravenous injections every 12 hours during the first week of life and every 8 hours in the second week provide appropriate concentrations in infants of less than 36 weeks gestational age. In full term newborns the 75-mg dosage is appropriate but the number of injections must be increased to 3/24 h for the first week and 4 times daily thereafter.

Comparison of four methods for measuring elevation of FRC in mechanically ventilated infants.

The aim of the study was to compare measurements of the elevation of functional residual capacity (FRC) above the relaxation volume obtained in 34 mechanically ventilated infants (median weight 2.6 kg, range 1.2-9) from four different methods: (1) direct measurement of the complete exhalation volume after brief disconnection from the ventilator, (2) calculated measurement from total positive end-expiratory pressure (PEEP) measured by end-expiratory occlusion of the breathing circuit, (3) extrapolated evaluation from the mathematical model of Brody, (4) extrapolated evaluation from the passive expiration method. We considered the direct measurement (1) as the "gold standard". Measurements obtained by total PEEP (2) and by the Brody's mathematical model (3) provided similar results than the direct measurement. Conversely, graphical extrapolation from the passive expiration method (4) underestimated the elevation of FRC. In conclusion, we suggest using the mathematical extrapolation from the Brody's model to evaluate the elevation of FRC in mechanically ventilated infants: this method is non-invasive, does not require disruption of gas flow, can be easily performed with all the neonatal ventilators, and allows continuous breath-by-breath measurements.

Effects of nasal continuous positive airway pressure (NCPAP) on breathing pattern in spontaneously breathing premature newborn infants.

OBJECTIVE: The aim of the study was to assess the influence of nasal continuous positive airway pressure (NCPAP) on breathing pattern in preterm newborns. DESIGN: Prospective study. SETTING: Neonatal intensive care unit. PATIENTS: Ten premature newborn infants on NCPAP (gestational age range from 27 to 32 weeks, mean birth weight 1300+/-460 g) admitted in our neonatal intensive care unit (NICU) for respiratory distress syndrome. METHODS: Breathing patterns and changes in lung volumes level were obtained using respiratory inductive plethysmography (RIP), at random CPAP levels (0, 2, 4, 6 and 8 cmH2O). Raw data were analysed for end-expiratory lung volume level (EELV-level), tidal volume (Vt), respiratory rate, phase angle and labour breathing index (LBI). RESULTS: CPAP increased EELV-level by 2.1+/-0.3xVt from 0 to 8 cmH2O ( p<0.01). Vt increased by 43% from CPAP of 0 cmH2O to CPAP of 8 cmH2O ( p<0.01). We also found that CPAP lowered the phase angle (from 76+/-21 degrees at CPAP of 0 cmH2O to 30+/-15 degrees at CPAP of 8 cmH2O; p<0.01 ) and LBI (from 1.7+/-0.8 at CPAP of 0 cmH2O to 1.2+/-0.3 at CPAP of 8 cmH2O; p<0.05). CONCLUSION: NCPAP improves the breathing strategy of premature infants with respiratory failure, as reflected by improved thoraco-abdominal synchrony, increased Vt and reduction of the LBI. This effect is associated with an increase in EELV-level with CPAP level. However, further investigations are necessary to establish the best CPAP level that ensures both safety and efficiency.

A new application of an old method for respiratory mechanics measurements: the passive inflation method in newborn infants during pressure-controlled ventilation.

We have previously described a passive inflation method during constant inspiratory flow for measuring total respiratory elastance and resistance during mechanical ventilation in newborns. The simple method for measuring respiratory mechanics had been assessed during decelerating inspiratory flow obtained with pressure controlled ventilation (PCV). We report an application of this method to preterm and full-term mechanically ventilated newborn infants and a comparison with the occlusion method. Twenty-one newborn infants (birth weight 1,060 to 3,650 g; gestational age 26 to 41 weeks), between 1 to 55 days of postnatal age, were enrolled in the study. They were ventilated with a "Servo ventilator 900C," first set in the pressure-controlled mode and then in the volume-controlled mode without changing the tidal volume (VT), inspiratory time or ventilator rate. Flow was measured through a pneumotachograph inserted between the endotracheal tube (ETT) and the breathing circuit; VT was obtained by integration of flow and airway pressure measured directly at the airway opening. Flow, volume, and pressure were plotted on analog X/Y tables to obtain pressure-volume (P/V) and flow-volume (V/V) loops, as well as pressure-time curves. Occlusion was performed by using the end-inspiratory and the end-expiratory pause buttons of the ventilator. The passive inflation method during PCV was based on the analysis of P/V and V/V loops and provided compliance (Crs(PC)infl.), resistance Rrs(PC)infl.) of the respiratory system, and intrinsic positive end-expiratory pressure (PEEP(PC)i,infl.). These values were compared with (1) compliance (Crs(PC)occl.) and intrinsic positive end-expiratory pressure (PEEP(PC)i,occl.) measured by the occlusion method during PCV; (2) static (Crs(VC),occl.) and dynamic (Crs(VC),dyn.) compliance, airway (R(aw)(VC),), tissue (Rrs(VC),visc.) and total resistance (Rrs(VC),occl.), and intrinsic positive end-expiratory pressure (PEEP(VC)i,occl.) measured by the occlusion method during volume-controlled ventilation. Crs(PC),infl. correlated well with Crs(PC),occl., Crs(VC),occl., and Crs(VC),dyn.. Furthermore, Crs(PC),infl. and Crs(VC),dyn. did not differ significantly. Rrs(PC),infl. correlated well and did not differ significantly from total inspiratory resistance, i.e., the sum of R(aw)(VC) and Rrs(VC),vis. PEEPPC,i,infl. correlated well and did not differ significantly from PEEP(PC)i.occl. and from PEEP(VC),i,occl. The passive inflation method can be used during PCV with a decelerating flow waveform. It provides dynamic compliance, inspiratory resistance of the respiratory system, and intrinsic PEEP from the analysis of V/V and P/V loops recorded at the airway opening. This technique is simple to use and well tolerated by preterm and full-term ventilated newborn infants. It can be a good alternative to occlusion methods.

Dynamic behavior of respiratory system during nasal continuous positive airway pressure in spontaneously breathing premature newborn infants.

The end-expiratory lung-volume level of premature newborn infants is maintained above passive resting volume during active breathing, through the combination of reduced time constant and high respiratory rate. To determine whether nasal continuous positive airway pressure (NCPAP) alters this characteristic dynamic breathing pattern, we studied the effects of various NCPAP levels on the dynamic elevation of end-expiratory lung volume level (DeltaEELV) in spontaneously breathing premature newborn infants, using respiratory inductive plethysmography (RIP). Eleven premature newborn infants with moderate respiratory failure were included. NCPAP levels were set in a random order to 0, 2, 4, and 6 cm H2O. Tidal volume (Vt), rib-cage contribution to Vt (%RC), phase angle between abdominal and thoracic motions (theta), respiratory rate (RR), and inspiratory and expiratory times (Ti and Te) were continuously recorded by RIP. The slope of the linear part of the expiratory flow-volume relation was extrapolated up to zero flow level to evaluate the dynamic elevation of the functional residual capacity (FRC) (DeltaEELV). The time-constant of the respiratory system (tauRS) was calculated as the slope of the linear part of the expiratory flow-volume loop. At NCPAP = 6 cm H2O, DeltaEELV reached 0.6 +/- 0.2 times the Vt at NCPAP = 0 cm H2O. An increase in NCPAP level resulted in a significant decrease in DeltaEELV (P < 0.01). A decrease in DeltaEELV during NCPAP was associated with a significant increase in Te from 0.62 +/- 0.13 sec at NCPAP = 0 cm H2O to 0.80 +/- 0.07 sec at NCPAP = 6 cm H2O (P < 0.05), and a decrease in tauRS from 0.4 +/- 0.1 sec at NCPAP = 0 cm H2O to 0.24 +/- 0.04 sec at NCPAP = 6 cm H2O (P < 0.01). These results indicate that the characteristic spontaneous breathing pattern causing a dynamic elevation of FRC is abolished by NCPAP. We speculate that the dynamic volume-preserving mechanisms resulting from expiratory flow braking are no longer required during NCPAP, as the constant pressure may passively elevate FRC.

Respiratory mechanics in mechanically ventilated newborns: a comparison between passive inflation and occlusion methods.

A passive inflation method was described for measuring total respiratory elastance and resistance during mechanical ventilation in adult patients (Rossi et al., J Appl Physiol 58:1849, 1985). We applied this method to preterm and full-term mechanically ventilated newborn infants and we compared the results with those obtained by the occlusion method. We performed 37 tests in 16 newborn infants (B.W. 880-4,500 g; G.A. 28-42 weeks), between 1 and 45 days of postnatal age, ventilated with a Servo Ventilator 900C, set in controlled-volume mode. Flow was measured through a pneumotachograph inserted between the endotracheal tube (ETT) and the breathing circuit, tidal volume by integration of flow and airway pressure directly at the airway opening. Flow, volume, and pressure were recorded on an X/Y plotter to obtain pressure-volume (P/V), flow-volume (V/V) loops, and pressure-time curves. Occlusion was performed by using the end-inspiratory and the end-expiratory pause buttons of the ventilator. Analysis of P/V and V/V loops provided respiratory system compliance (Crs, infl.), resistance (Rrs, infl.), and "intrinsic positive end-expiratory pressure" (PEEPi, infl.). These values were compared with Crs, occl., Rrs, occl., and PEEPi, occl. measured by the occlusion method. The measurements were well correlated (Crs, infl./Crs, occl.: r = 0.90; Rrs, infl./Rrs, occl.: r = 0.91; PEEPi, infl./PEEPi, occl.: r = 0.91). Rrs, infl./Rrs, occl. and PEEPi, infl./PEEPi, occl. did not differ significantly. However, Crs, occl. was 15% higher than Crs, infl. (P less than 0.01). The passive inflation method is simple to use and well tolerated in preterm and full-term ventilated newborn infants, it provides accurate results, and can be a good alternative to occlusion methods. It requires, however, a constant inflation flow and adaptation to the ventilator.

Two years' follow-up of newborn infants after extracorporeal membrane oxygenation (ECMO).

OBJECTIVE: Extracorporeal membrane oxygenation (ECMO) is a technique of extracorporeal oxygenation used in newborn infants with refractory hypoxemia after failure of maximal conventional medical management, when mortality risk is higher than 80%. We retrospectively reviewed all the neonates treated by ECMO between October 1991 and September 1997 in our newborn intensive care unit. METHODS: Fifty-seven patients were treated with ECMO for severe respiratory failure: congenital diaphragmatic hernia (CDH) (n=23), neonatal sepsis (NS) (n=14), meconium aspiration syndrome (MAS) (n=12), and others (n=8). Mean gestational age and birth weight were 38+/-2 weeks and 3200+/-500 g, respectively. Oxygenation index was 61+/-8. Both venovenous (n=28) or venoarterial ECMO (n=29) were used. The mean time at ECMO initiation was 47 h (range 8 h-2 months). The mean duration was 134+/-68 h. In each case of VA ECMO, carotid reconstruction was performed. Survival at 2 years was 40/57 (70%) (CDH 12/23 (52%), NS 11/14 (79%), MAS 12/12 (100%), others 5/8). Follow-up at 2 years was available in 36 survivors. RESULTS: Neurodevelopmental outcome was not related to the initial diagnosis: normal neurologic development (n=30), cerebral palsy (n=5), and neurologic developmental delay (n=1). Two patients remained oxygen dependant at 2 years, and four required surgical treatment for severe gastroesophageal reflux. Respiratory and digestive sequelae were more frequent in the CDH group (P<0.01). Patency and flow of the repaired carotid artery was assessed in 20 infants at 1 year of age using Doppler ultrasonography: normal (n=10), <50% stenosis (n=9), and >50% stenosis (n=1). CONCLUSION: ECMO increased survival of newborn infants with refractory hypoxemia. However, higher a survival rate and lower morbidity were found in non-CDH infants than in congenital diaphragmatic hernia.

Effects of inhaled nitric oxide on gas exchange and acute lung injury in premature lambs with moderate hyaline membrane disease.

OBJECTIVE: The purpose of this study was to examine whether inhaled nitric oxide (iNO) may change lung injury in moderate hyaline membrane disease (HMD). METHODS: Fifteen moderately premature lambs (128 days gestation, term=147 days) were randomly assigned to treatment with 20 ppm inhaled NO (n=7) from the onset of ventilation or control (n=8). Except for inhaled NO, treatments were intentionally similar to those applied in clinical situations. After porcine surfactant administration (Curosurf, 100 mg/kg), mechanical ventilator settings were modified during the course of the study to maintain PaCO(2) between 40 and 50 mmHg and post-ductal SpO(2) between 90 and 95%. The main studied parameters were gas exchanges parameters, respiratory mechanics (static compliance and functional residual capacity) and pulmonary vascular permeability and/or filtration rate indices. RESULTS: We found that 20 ppm of inhaled NO for 5 h significantly reduce ventilatory and oxygen requirements, but only during the first hour of mechanical ventilation. No increase in extravascular lung water content (5.41+/-0.96 vs. 5.46+/-1.09 ml/g bloodless dry lung in the control group and in the NO group, respectively) and no impairment of the respiratory mechanics could be found in the NO-treated group. However, inhaled NO increased the albumin lung leak index in this model (6.09+/-1.51 in the NO-treated group vs. 4.08+/-1.93 in the control group; P<0.05). CONCLUSIONS: Our results do not therefore support a detrimental effect of short-term exposure to low doses of NO inhalation in moderate HMD. However, it may induce an increase in lung vascular protein leakage. The pathophysiological consequences of this finding remain to be elucidated.

Effects of nonrigid reclining infant seat on preterm behavioral states and motor activity.

Twenty preterm neonates in an intensive care unit (mean gestational age, 30 weeks; mean birthweight, 1375 g) were randomly assigned to an experimental or a control group. The experimental infants were placed twice a day (for 3-h sessions) in a nonrigid reclining seat for a 6- to 7-week period. Before discharge from intensive care, the behavioral states and motor activity of the neonates were monitored during sleep-wake behavior observations (2 h). The experimental group subjects slept more, were quieter, and made fewer movements such as cloni, contraction and startles. The discussion centers on the distinct advantages of using nonrigid infant seats in a reclining position in intensive care units.

[Hypoxic-ischemic encephalopathy of the full term newborn. Contribution of the electroencephalogram and trans-fontanelle echography to the prognostic evaluation. Report of 29 cases]. / Encéphalopathie anoxo-ischémique du nouveau-né à terme. Apport de l'électroencéphalogramme et de l'échographie transfontanellaire à l'évaluation pronostique. A propos de 29 observations.

This study was aimed at assessing by EEG recording and cranial imaging the cerebral function of 29 full term newborns presenting with hypoxic-ischemic encephalopathy and at establishing a correlation between the results and the neurological outcome. A correlation between the Sarnar's classification and the neurological outcome was observed, except for the intermediate grade. In this case, impairment of the EEG was variable and neurological prognosis was sometimes evidenced by cranial imaging. Unfavorable neurological outcome occurred when thalamic lesions were present, independently of clinical signs and EEG abnormalities.

Evolution of the prematurity before the 32nd week from 1980 to 1985 in a tertiary perinatal center in Lille, France.

127 infants were born alive before the 32nd week of gestation in the H. Salengro obstetrical unit from the University Hospital of Lille from January 1980 to December 1985. During this period the annual number of deliveries was constant, 2700. Two periods were considered, 1980-1982 and 1983-1985. The number of such premature infants increased slightly: from 56 to 71. The most striking feature was the dramatic increase in infants born after induction of delivery for fetal reasons. Another finding is the statistically significant lowering of gestational age and birthweight of the spontaneously born infants. These trends counterweight the efficacy of the policy of prevention. When considering the morbidity and the mortality, hyaline membrane disease still plays a preeminent role in this population.

Successful management of severe chylothorax with argon plasma fulguration and fibrin glue in a premature infant.

Post-traumatic neonatal chylothorax is a rare entity. Management includes medical and surgical treatment. We describe here a newborn who developed a severe chylothorax after repair of an oesophageal atresia. The chylothorax was treated successfully by a combination of argon beam coagulation of the mediastinum and fibrin glue application. However, the patient developed complete thrombosis of the left femoral vein with clot extension to the inferior vena cava which resolved after infusion of recombinant tissue plasminogen activator (rt-PA). The use of argon plasma coagulation and mediastinal fibrin glue application for treating postoperative chylothorax appears to be attractive and is easy to perform even in small premature infants and may replace a more extensive surgical procedure. However, the coagulation profile should be monitored and special care should be taken to prevent vascular thrombosis after surgery.

[Contribution to the definition of high-risk groups of low birth weight infants]. / Contribution à la définition des groupes à haut risque d'enfants de faible poids de naissance.

Follow-up studies of low birth weight infants concern usually infants selected on the basis of either the birthweight--inferior or equal to 1500 g--or the gestational age: the upper limit is 31 or 32 weeks. To determine the most pertinent criterium, mortality and neurodevelopmental outcome at two years were compared in 3 groups, selected on the above criteria from a cohort of 369 infants with a birthweight below 2,000 grams admitted in 1983 in the neonatal unit of the University hospital of Lille. Under 1501 grams the rate of small for gestational age infants is high: it could be a part of the explanation for the high rate of minor sequelae. When cohorts are selected on the basis of gestational age, it appears that mortality is low at 32 weeks but the rate of major and moderate sequelae is still high: that fact must be considered when premature induced delivery comes in discussion. Because these criteria select different high risk populations, mortality and neurodevelopmental follow-up studies should include all infants with gestational age inferior or equal to 32 weeks and/or birthweight inferior or equal to 1,500 grams.

[Co-sleeping and sudden infant death syndrome]. / Cosleeping et mort subite du nourrisson.

Bedsharing has recently become a controversial subject. Some authors, mainly from North America, assign to bedsharing a positive effect on the efficacy and duration of breast-feeding. Moreover, it would protect against sudden infant death syndrome (SIDS). Conversely, other studies consider bedsharing as an additional risk factor for SIDS. From the literature data, there is some evidence for an increased risk of SIDS when bedsharing is associated with maternal smoking and alcohol consumption. Bedsharing cannot be recommended as an absolutely safe practice. Breast-feeding mothers should be aware of these potential hazards.

[Prematurity and sudden infant death syndrome. Polysomnography in question]. / Prématurité et syndrome de mort subite du nourrisson. La polysomnographie en question.

Systematic recording of cardiorespirographic events has been recommended by some authors in premature and/or very low birth weight infants before or shortly after hospital's discharge. Their objective is the recognition of babies at risk of sudden infant death syndrome (SIDS) and prevention by home monitoring. After an extensive review of the recent literature, prematurity itself does not appear as a risk factor of SIDS. Late apneas are common, but their prognostic significance remains uncertain. Although it is clear that bronchopulmonary dysplasia carries a greater risk of acute life threatening events and infantile death, their prevention mainly relies upon an adequate oxygen supplementation. As a consequence no more than the general infant population, premature infants require neither polysomnographic recording nor home monitoring.

[Contribution to the study of the management of extremely premature infants in metropolitan France (with the exception of Ile-de-France)]. / Contribution à l'étude de la prise en charge des grands prématurés en France métropolitaine (à l'exception de I'Ile-de-France).

BACKGROUND: Regionalization of perinatal care is one of the purposes of the last 'Plan du Gouvernement pour la Périnatalité' (French Government's Perinatal Project). The aims of the study are first to investigate the site of admission of the very low birth weight infants and secondly to analyze postnatal transfer policies. POPULATION AND METHODS: Neonatal units in France (excluding Ile-de-France area), using exogenous surfactant were asked for their number of intensive care costs (1-5, 6-10, more than 10) and for the yearly rate of admission preterms less than 33 weeks gestational age. They were also classified as academic or not. RESULTS: One hundred and six out of 129 units participated. Ten units were excluded because they did not use surfactants. Among the 71 non academic units, the number of intensive care cots was less than six in 57/71 (80%) vs 1/25 (4%) in the academic units. There was no relationship between the number of admission and transfer policy. In 29 units with less than six cots, and in 20 of those with 20 admissions or less, transfer occurred exceptionally or never. CONCLUSIONS: The concept of "critical mass", usually recommends to ensure expertise, is not warranted in most French neonatology units. It is worrisome to state that many small units do not transfer any children or do it for a limited number. On the other hand, a majority of the infants transferred post-natally could have drawn benefit from in utero transfer. From these data, it is possible to assume that regionalization of perinatal care is far from achieved in most parts of the French territory.

[Perinatal spinal cord injuries]. / Traumatismes médullaires périnatals.

BACKGROUND: Injury to the spinal cord is still observed in the neonate. Its prognosis is poor. CASE REPORTS: The first neonate was delivered by cesarean section for breech presentation with hyperextension of the neck. She rapidly developed acute respiratory distress and paraplegia. MRI showed spinal cord hemorrhage involving the cervical and upper thoracic cord with rupture of the cord. The patient died a few weeks later. The second neonate was delivered vaginally in breech presentation without any difficulty. She progressively developed tetraplegia evolving into spasticity. MRI showed stretching of cervical spinal cord. The patient later developed sphincter disturbances, repeated urinary and pulmonary infection and severe scoliosis. CONCLUSIONS: Early prenatal damage to the spinal cord was possible in the first patient. Ultrasonography could help to evaluate the extent of damage. The condition leads to difficult ethical and therapeutic problems.

[Cerebral infarction: ultrasonic diagnosis and semeiologic peculiarities in premature newborn infants]. / Infarctus artériel cérébral: diagnostic échographique et particularités sémiologiques chez le nouveau-né prématuré.

BACKGROUND: Cerebral infarction in the preterm neonate is rarely associated with focal seizures. Its diagnosis is usually made on a routinely performed ultrasound scan. CASE REPORTS: Case no 1: A wedge-shaped area of increased echogenicity in the left parietal region suggesting a localized cerebral infarction was diagnosed on ultrasound scan performed in a preterm neonate born at 33 weeks of gestational age (GA) in whom electrical activity showed bilateral spiked theta-waves. The diagnosis was confirmed by CT scan and MRI. At 3 years of age, neurological and psychological evaluation was normal. Case no 2: This patient with intrauterine growth retardation was born at 31 weeks of GA after elective cesaerean section for Rhesus incompatibility. Two exchange-transfusions had been performed in utero. At day one an increased area of echogenicity lining a hypoechogenic parenchyma was noted in the parietal region suggesting its antenatal origin. The child died on day 8. CONCLUSIONS: Against other causes of parenchymal hyperechogenicity diagnosed on ultrasound scan such as periventricular leucomalacia or venous infarction--the long term prognosis of cerebral infarction, if the child survives, is usually good in the premature neonate.

[For or against the early use of nasal continuous positive pressure and exogenous surfactant in hyaline membrane disease. Physiopathologic arguments]. / Pour ou contre une utilisation précoce de la pression positive continue nasale et du surfactant exogène au cours de la maladie des membranes hyalines. Arguments physiopathologiques.

The use of nasal CPAP in the treatment of respiratory distress syndrome in very premature newborns follows pathophysiological basis. The authors emphasize the usefulness of nasal CPAP and surfactant in the treatment of respiratory distress syndrome. The aim of this strategy is to reduce alveolar atelectasis, thus reducing the incidence and the severity of respiratory distress syndrome, together with a possible reduction of the incidence of bronchopulmonary dysplasia.