[Agenesis of the corpus callosum. An example of prognosis uncertainty in fetal medicine]. / Agénésie du corps calleux. Un exemple d'incertitude pronostique en médecine foetale.

OBJECTIVE: For an increasing number of fetal pathologies, means of diagnosis have progressed faster than knowledge of the prognosis. Decisions are extremely difficult for the medical staff and the parents each time that outcome is uncertain. Agenesis of the corpus callosum, whose diagnosis may be certain through ultrasonography and MRI illustrates this situation well. METHODS: A historical multicentric study enabled us to analyze 37 cases of agenesis of the corpus callosum with a prenatal diagnosis and 10 cases with a post-natal one. RESULTS: Among the 37 prenatal diagnoses, we found 28 cases of medical abortions according to the French law and 9 newborns. Among the 9 newborns, we observed one neonatal death related to an acute fetal distress and 3 post-natal deaths between 1 and 3 months. Among the 10 cases diagnosed after birth, one died, 7 are in good health with a follow-up from 7 months to 6 years and 2 have neurological disturbances. CONCLUSION: Therefore, it seems essential to deepen knowledge of the prognosis and the evolutivity of this affliction in order to give the parents more precise information. However, knowledge of the prognosis is difficult because of the large number of abortions performed for medical reasons. Only a multicentric study, with a long-term pediatric follow-up, will enable us to better understand the prognosis of corpus callosum agenesis.

[Bronchopulmonary dysplasia. Course over 3 years in 88 children born between 1984 and 1988]. / Dysplasie bronchopulmonaire. Evolution à 2 ans de 88 enfants nés entre 1984 et 1988.

BACKGROUND: The survival and outcome of infants with bronchopulmonary dysplasia (BD) depend on the patient's maturity, the severity of the BD and nutritional problems. This study evaluates the specific role of chronic pulmonary failure in the growth and development of infants recovering from BD. POPULATION AND METHODS: 88 infants admitted for BD from January 1984 to December 1988, having gestational age from 25 to 41 weeks 5 days (mean: 29) and birth weight from 680 to 3,400 g (mean: 1,195) were studied. All infants were given respiratory support for 6 to 914 days (mean 84) and oxygen therapy for 28 to 1,232 days (mean: 119). 29 infants were given corticosteroids for more than 1 month. The outcome of the 80 infants with gestational ages of less than 33 weeks was compared to that of 272 infants with the same gestational age but not suffering from BD on their 28th day. The infants in both groups were examined at 2 years of age and classified as: a) handicapped (neurologic deficit, IQ < 80, hearing loss, blindness, convulsions); b) doubtful (transitory neurology dysfunction); c) normal. RESULTS: Of the 88 infants still living at the age of 28 days, 19 died before the age of 2 years: 16 of the 64 surviving infants who could be followed until the age of 2 years were classified as handicapped, 13 were considered doubtful and 35 were normal. The more significant risk factors for neurodevelopmental impairment were: a) the presence of porencephaly and/or ventricular dilatation on brain ultrasonography; b) head circumference < -2 SD at the end of hospital stay; c) oxygen therapy and hospitalization > 5-6 months. The group of infants with BD had a higher death rate (24% vs. 3.7 in the group without BD) and more frequent neurodevelopmental impairment at gestational ages of > 31-32 weeks. CONCLUSIONS: BD is an extra risk for the survival and neurodevelopment of infants with gestational age > 31 weeks.