Impact of the use of antenatal corticosteroids on mortality, cerebral lesions and 5-year neurodevelopmental outcomes of very preterm infants: the EPIPAGE cohort study.

OBJECTIVE: To assess the impact of antenatal corticosteroids (ACS) on neonatal mortality, cerebral lesions and 5-year neurodevelopmental outcome of infants born at 24-27 and 28-32 weeks of gestational age (GA). DESIGN: Observational population-based study including all births at GAs between 22 and 32 weeks in 1997 in nine regions of France. Survivors were assessed at the age of 5 years. SAMPLE AND METHODS: The population enrolled in the follow up comprised 2323 infants; there were 23 deaths before age 5 years and outcome at 5 years was available for up to 1781 subjects. Two GA subgroups (24-27 and 28-32 weeks of GA) were analysed separately. Propensity scores were used to reduce bias in the estimation of the association between ACS treatment and outcomes. MAIN OUTCOME MEASURES: Neonatal death, neonatal white matter injury, cerebral palsy, mental processing composite (MPC) of the Kaufman Assessment Battery for Children test and behavioural difficulties at 5 years. RESULTS: In the 28- to 32-week GA subgroup, there was a significant association between ACS and a decreased risk of both neonatal death (OR = 0.61 [0.41-0.91]) and white matter injury (OR = 0.60 [0.46-0.79]) but only a nonsignificant trend for improved 5-year outcome (cerebral palsy, MPC < 70). In the 24- to 27-week GA subgroup, ACS was associated with a significant decrease risk of neonatal death (OR = 0.43 [0.27-0.68]) but there was only a trend for a lower risk of white matter injury and no beneficial impact on outcome at 5 years. Limiting the analysis to only those who received complete courses of ACS did not modify the results. CONCLUSION: The study shows that ACS therapy greatly increases the survival of very preterm infants, including the most immature, but there is little evidence that ACS affects long-term neurodevelopmental and behavioural outcome in 28- to 32-week survivors, and none in <28-week survivors.

[Neonatal management of a child exposed to tobacco smoke in utero]. / Prise en charge néonatale d'un enfant exposé in utero au tabac.

The gravidic toxicity of the nicotinism on the fetus is now established. Certain long-term effects related to some substances, including certain unquestionable carcinogens, still remain to be evaluated. The risk of preterm birth is increased and the incidence of the intra-uterine growth retardation is high. Behavioral and physiological disorders, in particular metabolic, cardiac and respiratory disorders are observed from the first day of life. The risk of oro-facial malformations is not excluded. At mid-term the number of ORL and respiratory complications is higher and the risk of sudden infant death is almost doubled. The neonatale period should be used to assess the state of the newborn and to renew recommendations and advice for prevention. Breast feeding should and encouraged. This assessment also gives the mother an additional opportunity to reduce, to even cease smoking. A specialized consultation can be proposed if needed.

[Is early treatment of infants at risk of spastic diplegia warranted?]. / La prise en charge précoce de l'enfant à risque de diplégie spastique est-elle utile? Est-elle opportune?

OBJECTIVE: To test the possible link between first investigation and development of spastic diplegia. METHOD: A long-term retrospective study was carried out in the Neonatal Medicine Department of Arras Hospital, the C.A.M.S.P. of that town and with corresponding therapists. RESULTS: The study undertaken from January 1, 1991, to December 31, 1997, involved 56 children suspected of developing spastic diplegia and requiring a specialized course of treatment during the evolution of disease. In 32, evolution of disease was favourable, and in 24 spastic diplegia developed. An unfavourable evolution was significantly associated with late intervention of rehabilitation. CONCLUSION: Although few pre- or neonatal factors differentiated the two groups of children in their opposite evolution, haemorrhage during pregnancy and early detection seem to be determining factors in spastic diplegia.

[Ureaplasma urealyticum respiratory infection in newborn infants]. / Infections respiratoires à Ureaplasma urealyticum chez le nouveau-né.

UNLABELLED: The neonatal respiratory infection by Ureaplasma urealyticum is rare, but it could represent a major risk for the newborn infants. CASE REPORTS: A term newborn infant presented an early respiratory distress with persistent pulmonary hypertension, requiring artificial ventilation and inhaled nitric oxide therapy. Tracheal aspirates were positive for Ureaplasma urealyticum, although his mother was not contamined. A preterm newborn infant (gestational age: 33 weeks) presented a severe respiratory distress, requiring mechanical ventilation. The tracheal aspirates we positive for Ureaplasma urealyticum, as well as his mother's cervico-vaginal swab. Both recovered thanks to antibiotics (intravenous macrolid during ten days). The outcome was favorable for both babies. CONCLUSION: Neonatal infection due to Ureaplasma is serious. The clinical diagnosis is difficult, recalling group B streptococcal infection. Clinical aggravation, despite antibiotics associated with negative bacteriological standard detection, leads one to evoke this diagnosis and perform specific bacteriological cultures.