[Neurologic development in premature infants under 33 weeks of gestational age: determination of risk of neurological abnormalities in a prospective regional survey with a control group]. / Devenir neurologique des prématurés de moins de 33 semaines: détermination du risque d'anomalie neurologique dans une enquête régionale prospective avec groupe témoin.

AIM: The purpose of this population-based study was to compare the incidence of neurodevelopmental disability and its risk factors between preterm and full-term infants matched as control group. POPULATION AND METHODS: The preterm cohort included 203 infants born between 25 and 33 weeks of gestational age in the region of Franche-Comté (France) during a two-year-period. The control group included 196 full-term infants born in the same maternities. Survival up to the date of follow-up was 171/203 (84%) for preterms and 195/196 (99.5%) for full-term infants (uncorrected age, mean 12 months). Neurodevelopmental assessments were performed by pediatricians or physicians on 164/171 surviving preterms (96% follow-up) and 179/195 full-terms (92%). RESULTS: Thirty-two (19.5%) preterm infants had disability, ten of these (6%) showing severe disability. Five (2.8%) full-term infants had disability, one of these (.5%) having severe disability. Risk factors predicting a disability included in a multivariate approach: prematurity (odds-ratio [OR]: 7.8), maternal age > 37 (OR: 3.0), lack of profession for both parents (OR: 3.7), male gender (OR: 2.9). The pediatrician observed a disability more frequently than the physician (OR: 2.46). Likewise, risk factors predicting a severe disability included: prematurity (OR: 10.8), lack of profession for both parents (OR: 5.8) and monochorial twin-placentation (OR: 4.5). CONCLUSIONS: Prematurity is not the only risk factor to be taken into account for neurodevelopmental evaluation of premature infants, but its influence still remains widely predominant.

Systemic cat scratch disease: hepatic and splenic involvement about 3 pediatric cases.

Numerous diseases can lead to multinodular lesions of liver and spleen; surgical biopsy can be required for the etiologic diagnosis. Among these diseases, systemic cat scratch disease has been recently described. Macroscopical appearance of the lesions is evocative and must be known by surgeons. Three children with systemic cat scratch disease involving liver and spleen are reported.

[Comparison of morbidity and therapeutic load in premature twins and single births]. / Comparaison de la morbidité et de la charge thérapeutique des jumeaux et singuliers prématurés.

A prospective study was performed in order to compare birth weights, gestational ages at birth, perinatal and neonatal morbidity and mortality rates and therapeutic burdens given to 157 premature twins and 389 premature singletons. This study did not show real differences between premature twins and singletons, as if multiple pregnancies do not lead to other significant pathology than prematurity. The only observed differences were higher rates of breech presentation, wet lung disease, and lower rates of materno-foetal infection and pulmonary hypertension syndrome for premature twins.

[Bourneville tuberous sclerosis manifested by prenatal finding of intracardiac tumors]. / Sclérose tubéreuse de Bourneville à révélation anté-néonatale par tumeurs intracardiaques.

Neonatal cardiac rhabdomyoma is the most frequent cardiac tumour in the newborn, and a classical way to diagnose tuberous sclerosis (Bourneville's disease). The authors report 4 cases, including 2 antenatal diagnosis: 2 of them had arrhythmia, one with asystolic cardiac failure and the other with cyanosis due to a right-left shunt; the tumour was asymptomatic in the 2 others. The 4 babies had clinical and radiological neurologic signs of tuberous sclerosis, initially or during the course of the disease. The authors discuss the polymorphism of the clinical presentation of tuberous sclerosis in the newborn. Although tuberous sclerosis is transmitted through a dominant gene, the expressivity and the penetrance are very variable. The authors discuss the examination and investigation of at risk family members. The genetic counsel is difficult but very important because of the poor neurologic prognosis of the disease.

[Counseling for the prevention of HIV infections in pediatric situations]. / Conseils de prévention de l'infection au VIH en situation pédiatrique.

Health care professionals who are not adequately informed may have irrational attitudes when caring for HIV-infected pediatric patients. Prevention of contamination rests on thorough knowledge of high-risk pediatric groups and of potentially contaminating situations. In the delivery room and in intensive care settings, a broad set of measures for preventing contamination by blood is needed, whereas in maternity wards preventive steps are needed only during cord stump care. In pediatric departments, care should be taken to avoid injuries with sharp, blood-soiled instruments and to cover all skin lesions. HIV-infected children should be allowed to participate in group activities if they are healthy enough to do so. If an injury should occur, management includes immediate disinfection, reporting, and serial serologic testing, as well as early AZT therapy.

[Chronic intestinal pseudo-obstruction syndrome in infants and associated anomalies]. / Le syndrome de pseudo-obstruction intestinale chronique du nourrisson et les anomalies associées.

The authors report 2 cases of functional intestinal pseudo-obstruction in infancy associated with intestinal and urologic anomalies. In the first case many intestinal obstructions occurred from the age of 3 weeks and the boy was operated on at 14 months of age. A short small bowel and an intestinal malrotation were found at surgery; the alimentary canal was completely aperistaltic, and an ileostomy was performed. Further operations were carried out, for obstruction due to adhesions, and lastly to perform another ileostomy. An antenatal diagnosis of megacystis had been made with ultrasonography. In the second case, the pseudo-obstruction syndrome occurred at the age of 1 month, due to a volvulus of the small bowel with malrotation. A second operation, one month later because of lack of intestinal transit showed an aperistaltic bowel and a colostomy was performed. The intestinal continuity was set up again at the age of 9 months and a fractional feeding was started. A megacystis was found during urologic investigations. Growth is correct for both children at 3 years of age. A review of the literature allowed to list the most frequent digestive or extradigestive anomalies associated with this syndrome.

[Pain in newborn infants hospitalized in pediatric intensive care unit]. / La douleur chez le nouveau-né hospitalisé en réanimation pédiatrique.

The increasing aggressivity of the modern technology connected with neonatal resuscitation had led to the recognition by paediatricians of the existence of pain in the newborn, and of the necessity to treat this condition. The neurophysiological development of the neonate is such that it allows pain perceptions even in premature infants; a number of clinical parameters have therefore been described for pain recognition in neonates. An antalgic therapeutic scheme to be used for treatment of pain in the intensive care unit is proposed.

[Search for early indications for reintubation after mechanical ventilation weaning of the newborn]. / Recherche de critères précoces de réintubation après sevrage de la ventilation mécanique du nouveau-né.

Early predictive factors for successful extubation were investigated, in order to determine the best moment for respiratory weaning of the newborn, and the risk of subsequent reintubation. PaO2/FiO2 ratio, PCO2 and respiratory rate were measured 2 h after extubation in 100 newborn infants. There was no statistically significant difference for the PaO2/FiO2 ratio and PCO2 between infants who were successfully extubated (group 1) and those who required subsequent reintubation (group 2). By contrast, the respiratory rate 2 h after extubation was significantly higher in group 2, and a respiratory rate greater than 70/min appears to be the earliest ventilatory modification predictive of the need for further mechanical ventilation before the occurrence of hypoxemia and respiratory acidosis.

[Efficacy of nifedipine on refractory hypoxemia associated with diaphragmatic hernia in the newborn infant. Apropos of a case]. / Efficacité de la nifédipine sur l'hypoxémie réfractaire associée à la hernie diaphragmatique du nouveau-né. A propos d'une observation.

A 3,200 g birth weight, 38-week gestational age neonate developed very severe persistent pulmonary hypertension following surgical repair of a left diaphragmatic hernia. Despite administration of dopamine, dobutamine, and tolazoline, a significant alveolar-arterial oxygen difference (660 mmHg) was found at age 41 hours. Nifedipine was then administered sublingually in a dose of 1 mg/kg and produced an immediate and dramatic improvement in the right radial artery pO2 that was sustained despite persistence of the right-to-left shunt. We discuss the mode of action of this vasodilating agent that, when added to major therapeutic agents, proved capable of completely reversing a hazardous neonatal situation.