[Course and neurological/behavioral development of preterm children]. / Parcours et développement neurologique et comportemental de l'enfant prématuré

Preterm birth remains a public health priority given that one child out of ten is born before 37 weeks of gestation. Survival without major neonatal morbidity has increased in high-income countries, in particular in France and in cases of extreme preterm birth before 27 weeks of gestation. Rate of severe handicaps, such as cerebral palsy, is probably decreasing, but specific cognitive disabilities in a variety of domains remain frequent, interfering with normal learning abilities at school and explaining the high rate of special education needs. Prevalence of sequelae increases when gestational age at birth decreases. However, because there are more moderate to late preterm children compared to very preterm children, the absolute number of children with specific cognitive or neurological disabilities is equivalent in these two groups. Better characterization of the development in a recent cohort of very preterm children is necessary to improve the early detection of variations in normal neurodevelopment and to propose trials with remediation actions targeting working memory and language for example. These protocols could decrease the rates of learning disabilities at school.

[Treatment of encephalopathy by hypothermia in the term newborn]. / Place de l'anoxie et du traitement par hypothermie dans l'encéphalopathie néonatale précoce du nouveau-né à terme.

Criteria defining the involvement of severe perinatal anoxia in neonatal encephalopathy in at-term newborns at birth are stringent and are rarely all present. The simultaneous action of pre- and intrapartum factors preceding neonatal hypoxic-ischemic encephalopathy are often observed. Cooling is recommended as there is evidence that it reduces mortality without increasing major disability in survivors. It must be conducted following strict clinical and electroencephalographic criteria. Other strategies for brain protection remain difficult to establish. Follow-up must be long enough to detect cognitive deficiencies, which are frequent, even if cerebral palsy is not observed.

[Epidemiological study of very preterm infants at Rouen University Hospital: changes in mortality, morbidity, and care over 11 years]. / Évolution de la mortalité, de la morbidité et de la prise en charge des grands prématurés dans un centre de niveau III : comparaison des années 2000, 2005 et 2010.

The very preterm birth rate has increased in the past few years. Despite advances in neonatal medicine, neurodevelopmental sequelae have not decreased, despite a perinatal plan published in France in 1994. We conducted an epidemiological comparative survey at Rouen University Hospital in order to analyze morbidity, mortality, and care of very of premature infants by comparing the years 2000, 2005, and 2010. This hospital draws on an area of 17,000 births per year. Our survey was a single-center prospective, descriptive, and comparative study. The three cohorts had the same characteristics and the mortality rate was constant for 11 years. Use of medically assisted procreation and maternal age increased over this period. Chorioamnionitis halved, whereas duration of intrapartum antibiotic therapy increased. Neonatal morbidity was stable for hyaline membrane disease, bronchopulmonary dysplasia, maternofetal or nosocomial infections, and necrotizing enterocolitis. Regarding neurological complications, intraventricular hemorrhages decreased and white matter lesions remained constant. The rate of severe retinopathy remained low. The duration of parenteral nutrition and assisted ventilation, use of postnatal corticosteroids, and length of hospitalization decreased. The breastfeeding rate has increased since 2000 in parallel with postnatal growth restriction : 39% of the premature infants had a weight under the 10th percentile at hospital discharge. Our study allowed us to follow up the changes in neonatal epidemiological characteristics, the mortality and morbidity of extreme premature infants over a period of 11 years and showed few significant changes. Knowledge of medical practices is essential to improve the short- and long-term outcome of premature infants.

Neurodevelopmental outcome in prenatally diagnosed isolated agenesis of the corpus callosum.

AIM: To evaluate long-term neurodevelopmental outcomes in children with prenatally diagnosed, isolated agenesis of the corpus callosum (ACC). METHODS: We retrospectively reviewed data for 20 children born between January 1991 and November 2003 in the Haute-Normandie region of France with a prenatal diagnosis of isolated ACC. We collected data on pre-and postnatal neuroimaging findings, clinical features at birth and neurodevelopmental outcomes. RESULTS: Follow-up ranged from 3 to 16 years. ACC was complete in 11 patients (55%), partial in 2 (10%), hypoplastic in 3 (15%) and associated with an interhemispheric cyst in 4 (20%). Neurodevelopmental outcome was normal in 11 (55%) patients, including 8 with complete ACC; moderate disability was present in 5 (25%) patients and severe disability in 4 (20%) patients. In 3 of the 4 patients with severe disability, postnatal cerebral magnetic resonance imaging (MRI) showed additional major cerebral abnormalities. CONCLUSION: Neurodevelopmental outcome was good in most of our patients with isolated ACC, with 80% of patients having normal outcomes or moderate disabilities. A prenatal diagnosis of isolated ACC may not warrant termination of pregnancy. A carefully interpreted prenatal cerebral MRI is crucial to detect associated cerebral abnormalities; a longer follow-up is necessary to look for moderate disabilities.