[Discharge to the home of the large premature infant. Findings of North Pas-de-Calais (Epipage). Regional Group of Perinatal Epidemiology].
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Birth Weight↗
Biomedical subjects
V Pierrat
Publications and source records attributed to V Pierrat.
-Development and evaluation of transfusion practices in a population of newborn infants less than 33 weeks gestational age.
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Anemia, Neonatal↗
[Incidence, evolution and prognosis of posthemorrhagic ventriculomegaly in a population of newborns of less than 33 weeks gestational age].
BACKGROUND: Posthemorrhagic ventriculomegaly is one of the most important neurological problems encountered in the premature new-born. The aim of this study was to evaluate its incidence in a tertiary neonatal unit at Lille, France, to study its evolution, the risk of ventriculoperitoneal shunt and the neurodevelopmental outcome. PATIENTS AND METHODS: Ninety-one neonates with posthemorrhagic ventriculomegaly, born before 33 weeks of gestational age (GA) and admitted in this unit between January 1989 and December 1995 were retrospectively studied. Clinical data, evolution of ventriculomegaly and outcome at 2 years were extracted from the files. RESULTS: Incidence of ventriculomegaly was stable along the study period, around 6.1% of the admissions of neonates with the same GA; 44 had moderate ventriculomegaly and 47 severe. The mean GA was 28.7 +/- 1.9 weeks. Fifteen percent of the newborns had received corticosteroids before delivery. Spontaneous delivery (P = 0.04) and infection (P = 0.002) were more frequent in case of severe ventriculomegaly. Ventriculoperitoneal shunt was inserted in 19.1% (9/47) of infants with severe ventriculomegaly. Outcome in this population was poor. Forty-nine (54%) died before the end of the first year of life. Thirteen (30.9%) of the survivors developed cerebral palsy. In 12 out of these 13 cases, cerebral palsy was associated with parenchymal involvement in the neonatal period. CONCLUSION: Long-term prognosis of ventriculomegaly is poor. In front of new therapeutic approach, an active policy towards prevention with large use of antenatal corticosteroids would allow to reduce incidence, mortality and morbidity in the neonatal period.
Cerebral Hemorrhage↗
The predictive value of cranial ultrasound and of somatosensory evoked potentials after nerve stimulation for adverse neurological outcome in preterm infants.
Thirty-nine preterm infants were studied to compare the predictive value of somatosensory evoked responses (SEPs) following median-nerve and posterior tibial-nerve stimulation with the predictive value of cranial ultrasound. With regard to the SEP, a normal median-nerve response was by no means a guarantee of a normal outcome. A normal posterior tibial-nerve response, however, almost guaranteed a normal outcome, but the test was very time consuming and the number of false positive responses was high (sensitivity 95.6%, specificity 50%). The presence of parenchymal involvement, either due to a haemorrhage or cystic leukomalacia predicted cerebral palsy with a sensitivity of 95.6% and specificity of 68.5%. The combination of an abnormal posterior tibial response and the presence of parenchymal brain lesions had the best predictive value with a sensitivity of 91.3% and a specificity of 81.2%. These results show that, although posterior tibial-nerve responses have a better predictive value than median-nerve responses, these values were lower than that of cranial ultrasound. The best prediction was obtained when a combination of posterior-tibial responses and cranial ultrasound was used.
Cerebral Hemorrhage↗
Somatosensory evoked potentials in preterm infants with intrauterine growth retardation.
In order to further evaluate both the maturation as well as the prognostic value of the somatosensory evoked potentials (SEPs) with regard to neurodevelopmental outcome, SEPs were performed after the first week of life in 56 small-for-gestational age (SGA) preterm neonates. Twenty-five had a prolonged N1 latency while 30 had a normal N1 latency around discharge. One child had an accelerated N1 latency. No correlation was found between the severity of intrauterine growth retardation in relation to birthweight, head circumference or birthweight ratio. None of the children developed cerebral palsy (CP) at follow-up. Developmental quotient (DQ) was calculated in 42 children. The mean DQ of the 21 neonates with an abnormal SEP at discharge was 79.24 +/- 18.56 while the mean DQ of the 21 children with a normal SEP at discharge was 92.52 +/- 11.31. Among the children with a normal N1 latency at discharge the number of breast-fed children was significantly higher than the number of formula-fed neonates (P < 0.05). We conclude that an abnormal SEP around term age in SGA preterm neonates does not imply an increased risk of developing CP. Breast-milk appears to have a beneficial effect on the development of the SEPs in children with intrauterine growth retardation.
Birth Weight↗
[Cerebral infarction: ultrasonic diagnosis and semeiologic peculiarities in premature newborn infants].
BACKGROUND: Cerebral infarction in the preterm neonate is rarely associated with focal seizures. Its diagnosis is usually made on a routinely performed ultrasound scan. CASE REPORTS: Case no 1: A wedge-shaped area of increased echogenicity in the left parietal region suggesting a localized cerebral infarction was diagnosed on ultrasound scan performed in a preterm neonate born at 33 weeks of gestational age (GA) in whom electrical activity showed bilateral spiked theta-waves. The diagnosis was confirmed by CT scan and MRI. At 3 years of age, neurological and psychological evaluation was normal. Case no 2: This patient with intrauterine growth retardation was born at 31 weeks of GA after elective cesaerean section for Rhesus incompatibility. Two exchange-transfusions had been performed in utero. At day one an increased area of echogenicity lining a hypoechogenic parenchyma was noted in the parietal region suggesting its antenatal origin. The child died on day 8. CONCLUSIONS: Against other causes of parenchymal hyperechogenicity diagnosed on ultrasound scan such as periventricular leucomalacia or venous infarction--the long term prognosis of cerebral infarction, if the child survives, is usually good in the premature neonate.
Cerebral Infarction↗
[Hypoxic-ischemic encephalopathy of the full term newborn. Contribution of the electroencephalogram and trans-fontanelle echography to the prognostic evaluation. Report of 29 cases].
This study was aimed at assessing by EEG recording and cranial imaging the cerebral function of 29 full term newborns presenting with hypoxic-ischemic encephalopathy and at establishing a correlation between the results and the neurological outcome. A correlation between the Sarnar's classification and the neurological outcome was observed, except for the intermediate grade. In this case, impairment of the EEG was variable and neurological prognosis was sometimes evidenced by cranial imaging. Unfavorable neurological outcome occurred when thalamic lesions were present, independently of clinical signs and EEG abnormalities.
Brain Ischemia↗
The use of evoked potentials in the neonatal intensive care unit.
The data reported in the literature and our own findings have shown, that evoked potentials (EPs) can be performed at the bedside and provide additional information about the integrity of the central nervous system. Auditory brainstem responses (ABRs) are especially useful for early identification of audiological problems and whenever possible, at risk newborn infants (table II) should be screened using either ABRs or other methods like the otoacoustic emission before discharge. ABRs appear to be less useful in predicting neurological impairment, especially in the preterm infant. Visual evoked potentials (VEPs) can easily be performed at the bedside and are of predictive value for both neurological and visual outcome in the fullterm infant with hypoxic ischaemic encephalopathy (HIE) and the preterm infant in whom the cysts extend into the deep white matter. VEPs will help to identify at an early stage those infants who will suffer severe visual impairment being cortically mediated. Somatosensory evoked potentials (SEPs) are the most difficult to perform of the EPs, but adapting filter settings and stimulation rate it is also possible to obtain responses following stimulation of both the median and posterior tibial nerve. Median nerve SEPs are of predictive value in the fullterm infant with HIE with regard to neurodevelopmental outcome. In the preterm infant however, the predictive value is not so good for the median nerve and more data are needed to assess the predictive value of the posterior tibial nerve SEP.
Evoked Potentials↗
Prognostic value of early somatosensory evoked potentials in neonates with cystic leukomalacia.
Somatosensory evoked potentials (SEPs) were performed between 31 and 49 weeks postmenstrual age on 33 neonates with extensive cystic leukomalacia. 27 had periventricular leukomalacia (PVL), while six had deep white matter lesions. All but two of the 27 infants with PVL had a reproducible potential at discharge, being delayed in 11 and within the normal range in 14. No potentials could be obtained in any of the infants with cysts in the deep white matter. All surviving infants developed severe neurological sequelae, irrespective of the N1 being delayed or within normal range. These data suggest that in infants with an ultrasound diagnosis of cystic leukomalacia, little additional information with regard to neurodevelopmental outcome is provided by performing median nerve SEPs, especially for those infants in whom the cystic lesions are restricted to the occipital periventricular white matter.
Brain↗
[Recurrent cutaneous herpes in the newborn and acyclovir].
The authors report two cases of cutaneous recurrent herpes occurring after a neonatal herpes simplex virus type 2 (HSV2) infection and comment on the role of acute or suppressive therapy by aciclovir (ACV). The two infants were not treated by ACV after the neonatal period. None of the recurrent cutaneous herpes episodes was followed by viral widespread. One case reported by Bergström et al on a relapse of HSV2 encephalitis occurring after a cutaneous herpes in a child argues for the use of ACV in recurrent herpes. However, ACV might alter host defense response to HSV2 infection in neonates and children. Thus, it seems not yet recommended to use ACV either as acute or suppressive therapy in recurrent cutaneous herpes unless a progression of the viral disease is noted.
Acyclovir↗
[Self mutilation in children. Current data].
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Child↗
Prediction of neurodevelopmental outcome in the preterm infant: short latency cortical somatosensory evoked potentials compared with cranial ultrasound.
One hundred and twenty six preterm infants, with a gestational age of 34 weeks or less, were studied to compare the predictive value of somatosensory evoked potentials (SEPs) with that of cranial ultrasound. A normal N1 latency was no guarantee of a normal outcome, nor did a persistently delayed N1 latency always correlate with a poor outcome. As a predictor of cerebral palsy, SEPs had a sensitivity of 44% and a specificity of 92%. The presence of a large haemorrhage (grade IIb/III) or cystic leukomalacia on cranial ultrasound predicted cerebral palsy with a sensitivity of 73.6% and a specificity of 83.1%. These results demonstrate that the role of SEPs recorded after median nerve stimulation is limited in preterm infants.
Brain Diseases↗
Effect of prenatal betamethasone/thyrotropin releasing hormone treatment on somatosensory evoked potentials in preterm newborns.
The maternal administration of betamethasone and thyrotropin releasing hormone (TRH) to accelerate the maturation of the fetus is an increasingly adopted strategy to prevent neonatal morbidity in preterm infants. The effect of this prenatal treatment on the neural maturation of the infant was assessed by measuring somatosensory evoked potentials (SEP) in preterm infants (gestational age 29-36 wk) on the 1st postnatal day, at the age of 1 wk, and before discharge. The N1 latency values of the SEP obtained in 14 infants who were exposed prenatally to betamethasone/TRH were compared with the N1 latencies measured in 12 control infants. On the 1st postnatal day, the N1 latencies in the betamethasone/TRH-treated infants were strikingly shorter (p less than 0.01) than in the controls. However, at the age of 1 wk and at discharge, the N1 latency values of both groups were similar. In conclusion, the present study provides the first solid evidence for the concept that the prenatal exposure to betamethasone/TRH accelerates the SEP-assessed neural maturation of the human fetus, that this prenatal acceleration is followed by a compensatory relative deceleration during the early neonatal period, and that the subsequent SEP-assessed neural maturation proceeds at a normal velocity.
Betamethasone↗
Prognostic value of early somatosensory evoked potentials for adverse outcome in full-term infants with birth asphyxia.
SEPs were examined during the first weeks of life in 34 infants with mild to severe birth asphyxia, in an attempt to provide a more accurate prediction of neurodevelopmental outcome. Normal, delayed and absent responses were compared with the infant's acute clinical condition, imaging findings using different imaging techniques and neurodevelopmental outcome. All infants with normal SEPs were normal at follow-up. All but two of the infants with a delayed or absent response died or suffered from severe neurological sequelae. A delayed or absent N1 latency carried a risk for death or severe handicap of 71 and 100%, respectively, compared with 25 and 89% for moderate or severe encephalopathy on neurological assessment, and 29 and 85% for moderate or severe changes seen using different imaging techniques. SEPs may provide useful additional information when assessing the infant with birth asphyxia.
Asphyxia Neonatorum↗
[Duplex Doppler ultrasonography of intra-renal arteries. Normal and pathological aspects].
Duplex Doppler ultrasonography may explore renal perfusion in frequent diseases such as renal obstruction, reno-vascular hypertension, acute or chronic renal failure or diabetic renal complications by measuring Pourcelot's resistive index (RI) of renal parenchyma arteries for each kidney. A statistical and prospective study was performed on 574 patients. In healthy patients, the RI values, equal for each kidney were included in 0.45 and 0.7 (mean RI = 0.59). For other values, there was a renal pathology. Patients with idiopathic hypertension (mean RI = 0.59) or non obstructive dilatation (mean RI = 0.61) did not have an RI significantly different from healthy patients. In cases of renal obstruction, there was a significant increase in the RI for the pathological kidney (mean RI of 0.73). The sensitivity and the specificity was 100% for acute obstructions examined during the first 48 hours. In contrast, in case of renal artery stenosis greater than 70% there was a significant decrease in the RI for pathological kidney. So the RI increased significantly in both kidneys: when there was renal failure with active disease within the tubulo-interstitial compartment (mean RI of 0.77); in all cases of diabetic nephropathy (mean RI of 0.74) where the RI increased early before laboratory signs. Duplex Doppler ultrasonography may be an original method for renal explorations by providing not only morphological data but also physiological data with the perfusion study.
Adolescent↗
Somatosensory evoked potentials and adaptation to extrauterine life: a longitudinal study.
In order to compare longitudinal data with existing cross sectional extrauterine life data on somatosensory evoked potentials (SEPs), two groups of appropriate for gestational age optimal premature infants were studied. Group A consisted of 8 infants born between 34 and 36 weeks gestational age (GA). In this group, SEPs were recorded within 24 hours after delivery and then every 48-72 hours until discharge. Group B consisted of 7 infants born between 29 and 33 weeks GA. In these infants, SEPs were recorded at weekly intervals from the second week onwards. In group A, a marked decreased in the N1 latency was seen during the first week of life. Six infants had initial values above the normal range. During the second week of life this decrease paralleled the cross sectional data. In group B all the infants had a N1 latency within the normal range and the longitudinal data paralleled the cross sectional data. These findings must be taken into consideration when SEPs are used to assess the neurological integrity of the newborn during the first week of life.
Adaptation, Physiological↗
The role of short latency somatosensory evoked responses in infants with rapidly progressive ventricular dilatation.
The effect of hydrocephalus on somatosensory evoked potentials was studied in nine infants. An increase in N1 latency was found in five infants studied longitudinally during a period of progressive ventricular dilatation. A marked decrease in N1 latency was noted in 7 infants, within one week following shunt insertion and in two infants who showed spontaneous arrest of ventricular growth. A correlation was found between cerebrospinal fluid pressure and the delay in N1 latency, but the number of infants studied is still small. SEPs appear to be a useful additional test when assessing infants with progressive ventricular dilatation. Once a baseline value for N1 has been obtained following shunt insertion, SEPs may subsequently be useful when assessing a child with possible shunt dysfunction.
Cerebral Hemorrhage↗
[Contribution to the definition of high-risk groups of low birth weight infants].
Follow-up studies of low birth weight infants concern usually infants selected on the basis of either the birthweight--inferior or equal to 1500 g--or the gestational age: the upper limit is 31 or 32 weeks. To determine the most pertinent criterium, mortality and neurodevelopmental outcome at two years were compared in 3 groups, selected on the above criteria from a cohort of 369 infants with a birthweight below 2,000 grams admitted in 1983 in the neonatal unit of the University hospital of Lille. Under 1501 grams the rate of small for gestational age infants is high: it could be a part of the explanation for the high rate of minor sequelae. When cohorts are selected on the basis of gestational age, it appears that mortality is low at 32 weeks but the rate of major and moderate sequelae is still high: that fact must be considered when premature induced delivery comes in discussion. Because these criteria select different high risk populations, mortality and neurodevelopmental follow-up studies should include all infants with gestational age inferior or equal to 32 weeks and/or birthweight inferior or equal to 1,500 grams.
Child Development↗