[Cardiac surgery in Cameroon. Results at one year of the pilot phase]. / Chirurgie cardiaque au Cameroun. Résultats à un an de la phase pilote.

In the framework of implementation of his national program for control and prevention of cardiovascular diseases, Cameroonian government has set up a cardiac surgery project. We report in this manuscript results of one year follow up of the patients operated during the pilot phase. From September 22 till 26, 2008, 11 patients have been operated in Cameroun. Surgical procedures were 5 mitral mechanic valve replacement, 2 aortic mechanic valve replacement, 1 atrial septal defect closure, 2 pace maker implantation. No intrahospital death was observed. One patient died at 11th month after the operation due to mitral valve thrombosis and attributed to lack of compliance. One patient presented low cardiac output, pneumonia and a pleural effusion. 2 patients presented 2 minor complications consisting of pericarditis and superficial wound infection. The results of the pilot phase of cardiac surgery in Cameroon are effective. However, the sustainability of the program require human, material capacity building, and funding mechanism as well.

Is minor neurological dysfunction at 12 years related to behaviour and cognition?

Behavioural and cognitive development at 12 years were studied in 172 children with and 174 children without minor neurological dysfunction (MND). MND could be differentiated into fine manipulative disability, co-ordination problems, hypotonia and choreiform dyskinesia. Fine manipulative disability related significantly to problems of cognition and behaviour; co-ordination problems to cognitive problems; and hypotonia and choreiform dyskinesia to behavioural problems, the former more than the latter. Socio-economic status and family adversity contributed to the risk for development of both cognitive and behavioural problems; gender did not. The onset of puberty seemed to change these relationships: follow-up is needed for definite conclusions.

Minor neurological dysfunction and behavioural development. A report from the Groningen Perinatal Project.

In a follow-up study of 230 children a statistically significant relation was found between the neonatal neurological diagnosis and the presence of minor neurological dysfunctions at the age of 6 years: of 167 normal newborns, 7% turned out to have MND at follow-up versus 21% of 63 (mildly) abnormal neonates. Interval complications occurred especially in the latter group of MND children. Their presence may have hampered recovery. Both follow-up and neonatal neurological diagnoses were in a varying degree related to undesired behaviour as reported by parents and teachers, such as 'clumsy', 'difficult to handle', 'hyperactive', 'irritable' and 'temper tantrums'. However, only to a limited extent the variance of the behaviour was explained by the neurological findings. It was concluded that, although the neurological condition of a child may determine his vulnerability for environmental influence to a certain extent, the contribution of both sex and environment on behavioural development is preponderant.

Neurological sequelae in high- and low-optimality obstetrics.

Neonatal neurological findings and the results of a neurological follow-up examination at 4 years of age were compared in two groups of subjects. The first group contained 39 children with an extremely low obstetrical optimality score, the second one contained 38 children with an extremely high obstetrical optimality score. More children were neurologically deviant in the first group than in the second one, both shortly after birth and at 4 years. The predictive power of the neonatal neurological examination was less in the low-optimality group, probably due to false-negative diagnoses in preterm infants.

The recovery rate of neurologically deviant newborns.

1507 newborns were examined neurologically at term; 80 of them were found to be abnormal. These were re-examined at 4 years of age, together with a control group of neonatally normal children. One child in the study group died, 8 were severely handicapped, 10 were mildly abnormal (MND = minor neurological dysfunction). In the control group 6 children turned out to have MND at 4 years. All but one of them had suffered interval complications, mainly before the age of 18 months. The relationships between the follow-up findings and the obstetrical, neonatal neurological and paediatric observations, family history and interval data are discussed. There appears to be a cumulative effect. The parents' reports on behaviour at age 4 suggest differences between the neonatally abnormal and normal groups, especially when MND is present at 4 years.

Predictive value of neonatal neurological examination: a follow-up study at 18 months.

From a cohort of 1507 infants in the Perinatal Project at University Hospital, Groningen, 80 infants who had been neurologically abnormal in the neonatal period and 80 controls were neurologically re-examined at 18 months of age. Of the 80 abnormal infants, one had died at age three months and 13 other remained abnormal at 18 months, of whom five had severe neurological dysfunction. Two of the control infants had mild abnormalities at 18 months. The rate of false negative results was low, but there was a high rate of false positive results, indicating a high frequency of transient neonatal morbidity. This study demonstrates the sensitivity of the neonatal neurological examination in selecting newborn infants who are in special need of attention.

Obstetrical condition and neonatal neurological morbidity. An analysis with the help of the optimality concept.

In order to increase understanding of the origin of neonatal neurological morbidity, the relationship between the obstetrical and neonatal neurological conditions was studied in a 3-year cohort containing 3162 singleton infants. The infants were neurologically examined at term age according to the technique described by Prechtl. Obstetrical data were documented extensively. Prechtl's optimality concept was applied in the analysis. A statistically significant relationship was found between the obstetrical and neonatal neurological optimality scores. There was no sex difference in the obstetrical optimality, whereas there was in the neurological optimality, to the advantage of the girls. It could be shown that obstetrical conditions such as acidemia, preterm birth and intrauterine growth retardation have a stronger relationship to neurological morbidity when the accompanying obstetrical optimality is lower. In obstetrical practice the application of the optimality concept to obstetrical and neurological data is a helpful complementary refinement.

Obstetrical-neonatal neurological relationship. A replication study.

A study concerning the relationship between neonatal neurological abnormality and 3 parameters of pre- and perinatal condition in a birth cohort of 1507 infants was replicated in a second cohort of 1655 infants. The 3 parameters chosen were preterm birth, intrauterine growth retardation and neonatal acidemia. The neurological examination in the second cohort was carried out by other examiners than in the first cohort. The incidence of neurological abnormality was again found to be raised in all 3 categories and again least in the acidemic subgroup. Also the finding could be confirmed that only in about half of the neurologically abnormal infants could the 3 parameters have exerted any effect at all, which implies the necessity of further analysis. This replication study shows that neurological examination in the newborn period is a reliable tool for the evaluation of the condition of infants with respect to their pre- and perinatal history.

Preterm birth, growth retardation and acidemia in relation to neurological abnormality of the newborn.

The Groningen Perinatal Project is a follow-up study relating pre- and perinatal conditions to early and late neurological sequelae. A description is given of the first cohort of 1507 children, examined neurologically during the neonatal period, and of their mothers and their pregnancies. In this preliminary analysis three 'final pathways' are considered, i.e. intrauterine growth retardation, preterm birth and acidemia (pH in umbilical vein below 7.20). Significant relationships were found between the 'final pathways' and the neurological findings. Since, however, these relationships account for only a small part of the variance of the latter, it is concluded that the (cumulative) effect of other antenatal variables must be taken into account as well. Results of analyses to this effect will be reported in forthcoming publications.