Outcomes at 7 Years of Age of Former Very Preterm Neonates with Repeated Surfactant Treatment for Prolonged Respiratory Distress in the Neonatal Period.

This study aimed at evaluating the 7-year outcomes of 118 very preterm newborns (VPNs, gestational age = 26 ± 1.4 w) involved in a randomized controlled trial. They presented neonatal respiratory distress (RDS), requiring ventilation for 14 ± 2 days post-natal age (PNA). A repeated instillation of 200 mg/kg poractant alfa (SURF) did not improve early bronchopulmonary dysplasia, but the SURF infants needed less re-hospitalization than the controls for respiratory problems at 1- and 2-year PNA. There was no growth difference at 7.1 ± 0.3 years between 41 SURF infants and 36 controls (80% of the eligible children), and 7.9% SURF infants vs. 28.6% controls presented asthma (p = 0.021). The children underwent cognitive assessment (WISC IV) and pulmonary function testing (PFT), measuring their spirometry, lung volume, and airway resistance. The spirometry measures showed differences (p < 0.05) between the SURF infants and the controls (mean ± standard deviation (median z-score)) for FEV1 (L/s) (1.188 ± 0.690(-0.803) vs. 1.080 ± 0.243 (-1.446)); FEV1 after betamimetics (1.244 ± 0.183(-0.525) vs. 1.091 ± 0.20(-1.342)); FVC (L) (1.402 ± 0.217 (-0.406) vs. 1.265 ± 0.267 (-1.141)), and FVC after betamimetics (1.452 ± 0.237 (-0.241) vs. 1.279 ± 0.264 (-1.020)). PFT showed no differences in the volumes or airway resistance. The global IQ median (interquartile range) was 89 (82:99) vs. 89 (76:98), with 61% of the children >85 in both groups. Repeated surfactant treatment in VPNs presenting severe RDS led to the attenuation of early lung injuries, with an impact on long-term pulmonary sequelae, without differences in neurodevelopmental outcomes.

Neurodevelopment at seven years and parents' feelings of prematurely born children.

Background: The evolution of knowledge and technical advances in neonatal resuscitation have improved the survival of very premature babies. However, the long-term neurodevelopmental prognosis and cognitive and learning abilities are still uncertain. Objective: This study aimed to evaluate the neurodevelopment and learning abilities of 7-year-old children born prematurely, and their parents' feelings at 8 years of age. Patients and methods: Data from children born before 33 weeks gestation in a level III maternity hospital and involved in a regional follow-up network were analyzed at 7 years of age. Neurodevelopmental abnormalities were defined as cerebral palsy, hearing or visual impairment, and/or behavioral abnormalities. School performance was evaluated by the EDA test. A parents' questionnaire assessed their feelings about the child's and family's quality of life at 8 years of age. Results: At 7 years of age, 51% of the 238 children presented neurodevelopmental abnormalities: 3.3% with cerebral palsy, 6.2% with hearing impairments, 50.7% with visual impairments, and 11.3% with behavioral disorders. The children with neurodevelopmental abnormalities had lower gestational age (29.0 ± 2.0 vs. 30.0 ± 2.1 weeks, p = 0.003) and more EEG abnormalities during the neonatal period (31.1% vs. 19.8%, p = 0.048) than the children without abnormalities. Ninety-four percent of the children with abnormalities were enrolled in normal schools, 33% with special support. In the overall cohort, 31% of the children had all academic performance scores in the normal range of the reference population. At 8 years old, 39% of the parents of children with neurodevelopmental abnormalities felt that their child's situation significantly impacted their quality of life compared to 14% of parents of children without neurodevelopmental abnormality (p = 0.022). Conclusion: Half of children born very prematurely present with long-term neurodevelopmental abnormalities, which their parents feel significantly impacts their quality of life.

Influence of body mobility on attention networks in school-aged prematurely born children: A controlled trial.

School-aged prematurely born children (PC) have a higher risk of academic difficulties, which may be partly explained by attention difficulties. It has been suggested that children's attentional performance might be influenced by their body posture and spontaneous body motion. The aim of this study (ClinicalTrials.gov - NCT03125447) was to test the influence of three body mobility conditions on the three functions of attention (alertness, orienting, and executive control) among school-aged PC vs. term-born children (TC). Notably, 21 PC and 21 TC performed the Attention Network Test for Children in three body mobility conditions, namely, sitting and standing imposed fixed postures and a free-to-move condition. The children's median reaction times were compared between trials (1) with and without alerting cues, (2) with valid and invalid orienting cues, and (3) with and without distracting information, to calculate the performance of alertness, orienting, and executive control, respectively. Results showed that with distracting information, PC exhibited significantly slower responses in the standing-still posture than in the sitting-still posture (1,077 ± 240 vs. 1,175 ± 273 ms, p < 0.05), but not TC. No difference was observed with the free-to-move condition. PC and TC did not significantly differ in alertness or orienting, regardless of body mobility condition. These data suggest that PC must use executive resources to stand still and maintain position, which impairs their performance during executive tasks. We speculate that these results may be related to less developed postural control and motor inhibition in PC.

Thyroxine Threshold Is Linked to Impaired Outcomes in Preterm Infants.

Transient hypothyroxinaemia of prematurity (THOP) presents as decreased free thyroxine without an increase in thyroid stimulating hormone. Thyroxine availability is important in case of premature birth, and THOP could be associated with impaired adaptation to extra-uterine life but the association of thyroxine level and clinical status has not yet been clearly defined. Aim: To defined a free thyroxine threshold likely associated with neonatal clinical impairment and outcomes at age three years. Methods: This retrospective cohort study included infants born before or at 28 weeks' gestation at the Regional Maternity in Nancy, France. We defined a free thyroxine threshold as a function of clinical impairment by Receiver Operating Curve analysis, validated by log likelihood iteration in binary logistic regression, in infants born from October 2008 to December 2012 and meeting neonatal clinical impairment criteria. This threshold was validated in a distinct cohort of infants born from January 2014 to December 2016. Clinical impairment was defined as assisted ventilation requirement at seven days of age plus four minor clinical disorders among heart rate, blood pressure, temperature, serum sodium and potassium, APGAR score at five minutes, vasopressor treatment and patent ductus arteriosus. The first cohort was assessed at age three years for neurodevelopmental outcomes. Results: We identified a ≤10 pmol/L threshold with 85.7% sensitivity and 51% specificity. From the first and second cohorts, 196 and 176 infants respectively had available data, and 85% (97/112) and 26% (20/78) with free thyroxine ≤10 pmol/L met clinical impairment criteria. For infants with values >10 pmol/L, 41% (35/84) and 3% (3/98) from the first and second cohorts met impairment criteria. Of 147 children with available data at age 3 years, 65% (58/89) with neonatal free thyroxine ≤10 pmol/L had adverse neurodevelopmental outcomes vs. 34% (20/58) with >10 pmol/L (OR 3.55; 95% confidence interval, 1.77-7.13; p < 0.001). Conclusion: A free thyroxine level ≤10 pmol/L in infants is associated with neonatal clinical impairment and poor outcome at age three years.

Networks as culture: understanding and accounting for risks within networks of medico-social actors.

The anthropological part of the present research project addresses the issue of risk and uncertainties relating to perinatality and disability, and draws from the discourses of professionals in a perinatal network in the French Lorraine region. From an anthropological point of view, it is necessary to determine how and to what extent the views of professionals determine the network's management policies. The place conferred to 'the user' in these representations is one of several important issues to be analysed in order to gain better understanding of the management of relationships that result from it. What is the position of professionals who 'negotiate' and 'organise' the cost of the risk of disability when grasped in connection with their images of the 'users' (children and parents)? This qualitative study consisted of 40 semi-structured interviews conducted with 20 medical, social, and community professionals, all involved directly or indirectly with the network. The results demonstrate the importance of a network assessment as a 'culture' from the social and cultural relations of network professionals. These relations form the cement of a structure made of interpersonal ties and rooted in particular histories around a 'user' that are conveyed through individual narratives.

EEG at 6 weeks of life in very premature neonates.

OBJECTIVE: To analyze EEG findings, especially chronic-stage EEG abnormalities, i.e., dysmature and disorganized patterns, during the late neonatal period in very premature infants without severe early cranial ultrasound and/or EEG abnormalities. METHODS: EEGs were recorded at 6 weeks of life in very immature or hypotrophic premature infants (less than 29 weeks gestational age or less than 1000 g at birth). EEG findings were correlated with the children's psychomotor and sensorial assessment at 12-month corrected age. RESULTS: Fifty-eight infants were studied. Abnormal EEGs were observed in 28 infants: 7 infants with dysmature EEGs, 13 infants with disorganized EEGs, and 8 infants with dysmature-disorganized EEGs. At 12-month corrected age, 15 of 28 infants had various neurological abnormalities. Normal EEGs were observed in 30 infants. None of these infants showed any marked motor or cognitive impairment. The neurological abnormality difference between these two groups of infants was highly significant (p<0.0001). CONCLUSION: At 6 weeks of life, EEG may be helpful in refining neurological risk in very premature neonates. SIGNIFICANCE: EEGs recorded at 6 weeks of age may be a valuable predictive tool in addition to early EEG and cranial ultrasound.