Cognitive outcome at 5 years in very premature children without severe early cerebral abnormalities. Relationships with EEG at 6 weeks after birth.

AIMS OF THE STUDY: This prospective study aimed to analyze the relationship between EEG at 6 weeks after birth and cognitive outcome at the age of 5 in children born very preterm who did not present with severe neonatal cerebral abnormalities. PATIENTS AND METHODS: EEGs were recorded at 6 weeks of age in infants born <29 weeks of gestation or weighing <1000 g at birth. At 5 years, study participants underwent a neurological assessment and cognitive evaluation with the Kaufman Assessment Battery for Children (K-ABC). RESULTS: Fifty-eight children had an EEG at 6 weeks after birth. Fifty-one were evaluated at 5 years. Twenty-six children (51.0%) had one or more disabilities: neuromotor, sensory, behavioral, and/or cognitive. Children with EEG abnormalities had significantly more disabilities (20 of 25, 80%) than children with normal EEG (6 of 26, 23%) (P=0.0002). Thirty-five children underwent complete K-ABC assessment. Multiple linear regression analysis indicated a significant relationship between the overall EEG abnormalities (normal, dysmature, and/or disorganized) and two scales: mental processing composite (MPC) scales (P=0.0121), and sequential processing scales (P=0.0012). Dysmature EEGs were more predictive of lower MPC and sequential processing scales than disorganized EEGs. Immature occipital slow waves (i.e., too high for conceptional age) were consistently recorded in children with dysmature EEGs and associated with the lowest K-ABC scores. CONCLUSION: EEG abnormalities recorded at 6 weeks after birth, such as immature occipital slow waves, were associated with later cognitive impairments. EEG at 6 weeks can be an early and reliable tool for assessing the risk of future cognitive impairment.

[Efficacy of combined active-passive immunization in neonates born to hepatitis B surface antigen positive mothers: a study of 60 cases]. / Efficacité de la sérovaccination chez des nouveau-nés de mères antigènes HBs positif: à propos de 60 observations.

OBJECTIVES: To evaluate the efficacy of hepatitis B serovaccination in neonates born to HBsAg carrier mothers. MATERIALS AND METHODS: This study was performed in neonates born to HBsAg carrier mothers. They received one dose of hepatitis B immunoglobulins (0.3 ml/kg) at birth and four doses of vaccine (0, 1, 2 and 12 months of age). A second dose of hepatitis B immunoglobulins was given at 1 month of age in neonates born to hepatitis B antigen-positive carrier mothers. RESULTS: Sixty infants were included. Fifty-seven infants (95.0%) were not infected. The two infected infants were born to hepatitis Be antigen-positive carrier mothers. One infant was chronically infected by hepatitis B virus antenatal transmission and the second one developed an acute hepatitis by vertical perinatal transmission. One to 3 months after the third vaccinal dose, 16 infants (31.4%) were poor responders to vaccine. CONCLUSION: The hepatitis B serovaccination is efficient with four vaccinal doses. In infants born to hepatitis Be antigen-positive carrier mothers the efficacy could be improved increasing the dose of hepatitis B immunoglobulins (0.6 ml/kg) at birth and adding a second dose (0.6 ml/kg) at 3 weeks of life. A careful serological follow-up could be also suggested.

Hepatitis B e antigen positive mother hepatitis B e antigen long persistence in her non-infected baby.

UNLABELLED: We report the case of a baby born to a hepatitis B virus (HBV) carrier mother. This infant had a hepatitis B e antigen (HBeAg) in the serum until 6 months of age. Serial sera samples were analysed for HBV markers. No breakthrough of HBV infection was detected. The origin of this HBV marker has been questioned. CONCLUSION: HBeAg can persist at a non-infected baby born to an HBeAg-positive mother up to the age of 6 months.

[Interest of EEG in full-term newborns with isolated unilateral ischemic stroke]. / Place de l'EEG lors d'un accident vasculaire cérébral ischémique unilatéral du nouveau-né à terme sans hypoxo-ischémie associée.

In full-term newborns, unilateral and recurrent clonic seizures which occur during the first 48 hours of life suggest an isolated unilateral ischemic stroke. These focal seizures are isolated, occuring during a short period, or make up a status epilepticus. Electroencephalogram (EEG) is a key tool for crisis and focal cerebral process diagnosis. It also allows to assess antiepileptic drugs effectiveness. But cerebral imaging is necessary to confirm vascular origin of the cerebral impairment. Hematologic data are also needful to look for a family thromphilia. Some particular unilateral EEG abnormalities could be associated with controlateral motor sequelae or long term behavioral problems. These findings may be used for prospective studies aimed at specifying possible links between EEG abnormalities and long term outcome.

Re-hospitalization in infants younger than 29 weeks' gestation in the EPIPAGE cohort.

AIM: To estimate the re-hospitalization rate of extremely preterm children during infancy and associated factors after the recent improvement in survival rates. METHOD: The cohort included all children born before 29 wk of gestation in nine French regions in 1997. All admissions between discharge from initial hospitalization and 9 mo after birth were considered. Factors studied included the child's characteristics at birth and during neonatal hospitalization, risk factors for infection after discharge and parents' socio-demographic characteristics. Adjusted odds ratios (aOR) for re-hospitalization for all reasons and for respiratory disorders were obtained from logistic regression models. RESULTS: Of the 376 children, 178 were re-admitted at least once (47.3%; 95% CI: 42.3-52.4). Fifty-five percent of the hospitalized children were admitted at least once for respiratory disorders. The re-hospitalization rate was higher for children who had had chronic lung disease (aOR: 2.2; 95% CI: 1.3-3.7), those initially discharged between August and October (aOR: 2.5; 95% CI: 1.2-5.1) or between November and January (aOR: 3.2; 95% CI: 1.5-6.8), and children living with other children under six (aOR: 3.4; 95 %CI: 1.6-7.5). Re-hospitalizations were associated with neither gestational age nor the duration of neonatal hospitalization. Adjusted odds ratios for re-hospitalization for respiratory tract disorders were very similar to those for the overall hospitalizations. CONCLUSION: Infants born before 29 wk have a very high risk of re-hospitalization. The associated factors can help define high-risk groups at discharge from the neonatal unit who need special surveillance.

[EEG and ischemic stroke in full-term newborns]. / EEG et accident vasculaire cérébral ischémique du nouveau-né à terme.

The aims of this study were to describe EEG anomalies in unilateral neonatal ischemic stroke without hypoxic-ischemic encephalopathy, and to determine possible links between these abnormalities and long-term outcome. In 6 full-term newborns without severe fetal distress ischemic stroke was confirmed by computed tomography and/or magnetic resonance imaging. Twenty EEGs were recorded during the neonatal period, 5 in acute stage and 15 later. The duration of the follow-up ranged from 3 to 9 years. All newborns developed unilateral clonic seizures, right-sided (5 cases) or left-sided (1 case); seizures began between 14 and 48 h of life. At follow-up, 3 children were normal at 2 and 6 years of age, while the 3 others had sequelae: epilepsy at 9 years of age in one, and unilateral mild cerebral palsy in the 2 others (3 and 4 years of age), with behavioral problems in one of them. Critical EEG discharges, rhythmic sharp waves and/or slow waves were recorded on the injured side. Abnormalities of interictal activity were excess of alpha or theta rhythms, transitory EEG discontinuity or low voltage. The 2 children with cerebral palsy had numerous unilateral post-ictal positive rolandic slow sharp waves (PRSSWs), which were similar to the positive rolandic sharp waves of premature infants; the child with behavioral problems had numerous positive left-sided temporal fast sharp waves. PRSSWs could be associated with contralateral motor sequelae, while positive left temporal fast sharp waves were associated with long term behavioral problems. These findings may be used for future prospective studies aimed at specifying the relation between EEG abnormalities and long-term outcome.

Normal EEG in very premature infants: reference criteria.

OBJECTIVES: Objectives were to precise EEG criteria of normality in very premature infants. METHODS: The neonatal electroencephalograms (EEGs) of 17 neurologically normal very premature infants recorded at a conceptional age (CA) of 26-28 weeks have been analyzed. The normality of the infants was defined as normal neonatal cranial ultrasound scans and normal neurological outcome at a minimum postnatal age of 2 years. RESULTS: All tracings were discontinuous. The bursts (amplitude >/=30 microV) were interhemispherically synchronous and lasted up to 3 min. The interburst intervals lasted up to 46 s. EEG patterns consisted mainly of slow waves (

Prognosis of hypoxic-ischaemic encephalopathy in full-term newborns--value of neonatal electroencephalography.

This study was performed to assess the predictive value of EEG in HIE following acute fetal distress. For 38 full-term neonates, EEG was recorded at least before 48 hours of life and between 2 and 7 days. Neurological outcome was evaluated at a minimum age of one year. Normal or slightly abnormal early EEGs (14 cases) were observed with normal outcome (13 cases) or minor sequelae (1 case). Extremely abnormal early EEGs were associated with death (5 cases), severe sequelae (4 cases) or normal outcome (1 case); among the "intermediate" group (14 cases), improvement of background activity before 7 days indicated a good prognosis (4/5), whereas identical or worsened activity was noted in all cases with a poor outcome. Of neonates 90% with very abnormal EEGs and 64.3% with "intermediate" EEG presented a significantly unfavourable outcome compared with neonates having normal recordings (p < 0.0001). The EEG before 48 hours has an excellent sensitivity rate (94.7%) but a less satisfactory specificity rate (68.4%).

[Convulsions in the fifth day of life. A critical study]. / Les convulsions du cinquième jour de vie. Etude critique.

BACKGROUND: Cases of fifth day fits, first described in 1977, remain rare. Their cause is not known and each report contributes to knowledge of the phenomenon. PATIENTS AND METHODS: Sixteen infants born between December 1971 and January 1992 were selected because they were admitted to our department for convulsions satisfying the criteria for fifth day fits. Their files were carefully analysed, with special attention paid to pregnancy, delivery, clinical status after birth, EEG during the crisis and some laboratory data. Follow-up was also considered. RESULTS: The frequency of these fits remained stable until 1985; only 2 cases have been seen since then. There was no seasonal variation. The characteristic EEG pattern was seen in only 10 patients. All the laboratory data were negative. Follow-up with sufficient duration (1 to 12 years) provided only 8 cases satisfying all the classical criteria. The convulsions of one patient could be attributed to perinatal anoxia, 2 other patients developed epilepsy, and possible perinatal causes could have been neglected in 2 cases. CONCLUSION: This study provides no new information on the cause of fifth day fits. Disturbances of brain maturation might be responsible.