Periventricular hemorrhagic infarction (PVHI) associated with intraventricular hemorrhage (IVH) in premature infants: Outcome at 2 years of age.

OBJECTIVE: Neonates can develop periventricular hemorrhagic infarction (PVHI) in association with intraventricular hemorrhage (IVH). The prognosis of this condition remains under debate. The aim of this study was to compare the neurological outcome at 2 years of age for neonates who have IVH with and without PVHI. METHODS: This retrospective single-center study (2010-2017) included all neonates who had at least a grade II IVH on ultrasound (US). The population was divided into two groups: Group 1 had grade II-III IVH without PVHI and Group 2 had grade II-III IVH with PVHI. All clinical and imaging (US and magnetic resonance images) data were reviewed. Neurological sequelae were classified as either mild (favorable outcome), or moderate or severe (unfavorable outcome), based on the follow-up report at the age of 2 years. RESULTS: A total of 25 of the 46 infants meeting the inclusion criteria were excluded due to missing clinical or imaging data at diagnosis or follow-up. Of the remaining 21 infants, all were preterm and had grade II-III IVH, either with PVHI (n = 10) or without (n = 11). The neurological prognosis was unfavorable for both groups. Except for the size of the lesion, no radiological findings appeared to be significantly associated with an unfavorable prognosis. Overall, 11 of the infants died early in life; i.e., the mortality rate was 52% (n = 11/21). The deaths were not due to neurological complications of prematurity. C-section was more common in the PVHI group. CONCLUSION: PVHI does not appear to be predictive of an unfavorable outcome. Lesion size may be a predictive factor for an unfavorable prognosis in children with PVHI.

Predictors of Long-Term Mortality in Oldest Old Patients (90+) Hospitalized to Medical Wards via the Emergency Department: The SAFES Cohort.

OBJECTIVES: To identify risk factors for long-term mortality in patients aged 90 years and over who are admitted to hospital through the emergency department. DESIGN: Prospective cohort study (SAFES cohort; Sujet Agé Fragile - Évaluation Suivi). SETTING: 8 university teaching hospitals and one regional, non-academic hospital in France. PARTICIPANTS: Among 1306 patients in the SAFES cohort, 291 patients aged 90 or over were included. MEASUREMENTS: At inclusion, we recorded socio-demographic data (age, sex, level of education, living alone or in an institution, number of children, presence of helper/caregiver), and data from geriatric evaluation (dependence status, risk of depression, dementia, delirium, nutritional status, walking disorders, risk of falls, comorbidities, risk of pressure sores). Vital status at 36 months was obtained from the treating physician, the general practitioner, administrative registers, or during follow-up consultations. RESULTS: Among 291 patients included, 190 (65.3%) had died at 36 months. Risk factors for mortality at 36 months identified by multivariate analysis were risk of malnutrition (HR 1.6, 95%CI 1.1-2.3, p=0.004) and delirium (HR 1.6, 95%CI 1.1-2.3, p=0.01). CONCLUSION: Risk of malnutrition and presence of delirium are risk factors for mortality at 36 months in subjects aged 90 years and over hospitalized through the emergency department.