[Perinatal management and neurological outcome of newborns hospitalized with Rhesus hemolytic disease]. / Prise en charge périnatale et devenir neurologique à moyen terme des nouveau-nés hospitalisés pour maladie hémolytique par immunisation anti-D.

OBJECTIVES: To evaluate perinatal management and neurological outcome in a group of infants born with Rhesus fetomaternal allo-immunization. PATIENTS AND METHODS: Between 1 January and 31 December 2005, all newborns admitted to neonatal unit of Rouen tertiary centre for Rhesus hemolytic disease were included in a retrospective study and divided in two groups. The newborns who were treated with intrauterine transfusion are in the group 1 and those who needed only postnatal treatment in the group 2. In each case, were considered antenatal management (ultrasonographic data, middle cerebral artery peak systolic velocity, intrauterine transfusion), postnatal treatment (phototherapy, exchange transfusion, transfusion requirements) and neurological outcome. RESULTS: Among 42 cases of Rhesus allo-immunization observed in six years, 28 newborns (67%) were admitted for neonatal cares. No case of fetal hydrops was noted. But 16/28 (57%) were preterm with a median term of 35 weeks gestation (32-36 weeks). In group 1 of six infants who had received intrauterine transfusion (IUT), only one (17%) needed postnatal exchange transfusion, and all six received one to three blood transfusions after their birth. In group 2 of 22 infants who did not receive IUT, 6/22 (27%) needed postnatal exchange and 18/22 (82%) of them received one to four blood transfusions. Phototherapy duration and albumin requirements were similar in both groups. Three deaths occurred, one due to necrotizing enterocolitis and the other two later on due to sudden infant death and fulminant meningococcemia. Neurological outcome of the remaining 25 children was normal. DISCUSSION AND CONCLUSION: Rhesus alloimmunization remain a situation at risk. Neonatal clinical presentation is less severe than previously described due to improvement in antenatal management. Infants required less postnatal exchange transfusion when they received intrauterine transfusion but more frequent blood transfusions.

[Breastfeeding and Cytomegalovirus infection in preterm infants. How to reduce the risks?]. / Cytomégalovirus néonatal et allaitement maternel chez le nouveau-né prématuré. Quelles propositions?

In France, screening for cytomegalovirus infection (CMV) during pregnancy is not recommended in routine. The transmission of CMV through breastmilk from mothers to preterm infants is frequent (15-20%). The frequency of neuro-sensorial handicap related to congenital CMV infection in very preterm infants is not well documented. We report the case of a female infant born at 30 weeks of gestation. At 15 days, she developed cholestatic jaundice. Urine cultures were positive for CMV. Diagnostic procedure showed no other cause for jaundice. At 40 days, the infant presented with hepato-splenomegaly, purpura and abnormal skin color related to a symptomatic, secondary CMV infection, probably transmitted through breastmilk. Ganciclovir was begun for 21 days. At 12 months, she presents with normal development. This observation raises questions about breastfeeding in very preterm infants. Unexplained prematurity could reflect recent infection or reactivation in the mother. Thus, because of the well-known risks of prematurity on one hand, and CMV infection on the other, we suggest that detection of CMV seropositive mothers should be considered before allowing breastfeeding. If the mother has serologic evidence of recent infection or reactivation, freezing breastmilk at -20 degrees C for 3 days may be an option in order to reduce virolactia, especially during early lactation. This may reduce the risk of postnatal vertical virus transmission with minimal logistical difficulties and without interrupting breastfeeding.

Hyper-echogenic colon: a prenatal sign of cystinuria?

We suggest the term 'hyper-echogenic colon' to describe a hyperechoic foetal colonic content with no other intestinal abnormality. This is a rare pattern, which to our knowledge, has never been correlated with a specific pathology. The accidental observation of a cystine kidney stone in an infant who presented with this sign during the prenatal period made it possible to diagnose this disease retrospectively in two other children.

[Hip dislocation. Organization of screening and follow-up]. / La maladie luxante de hanche. Organisation du dépistage et de la prise en charge.

Early detection and low-risk treatment are the two main objectives of the management of developmental dislocation of the hip. The best way to evaluate neonatal hips is to perform clinical and ultrasound examinations at the same time, and to confront their results. Early diagnosis allows to restrict treatment to infants with neonatal dislocation who do not improve by 4 weeks of age. On the other hand, neonates with reductible dislocated hips must be treated at birth and followed at the joint consultation. Early diagnosis and management must not decrease later efforts to detect dislocated hip until walking age.

[Bilateral diaphragmatic hernia. Apropos of 2 cases]. / La hernie diaphragmatique bilatérale. A propos de deux observations.

Two cases of bilateral posterolateral diaphragmatic hernia are reported, due to their rarity. Both rapidly led to death. One of them was associated with severe malformations of the upper limbs. An abnormality of the cervical segment of the neural crest at the end of the first month of pregnancy may explain both types of malformations.

[Intermediate neurological development of 60 neonates weighing 1500 grams or less at birth. Predictive value of initial findings (clinical aspects, electroencephalograms and brain imaging)]. / Evolution neurologique à moyen terme de 60 nouveau-nés pesant 1,500 grammes ou moins à la naissance. Valeur prédictive des données initiales (clinique, électroencéphalogramme et imagerie encéphalique).

60 low birthweight (less than or equal to 1,500 g) are distributed according to existence or not, and intensity of brain disturbances, during the neonatal period; appreciated by neurological examinations, early EEG and brain imaging during the second month of life. At 18 months, at least, neurological outcome is normal for 46 children (but 6 had transient neuromotor anomalies), 14 have sequelae (7 mild, 7 major). All children with clinical neurological examination carried out during the neonatal period are normal at follow up. It is true also for the children without EEG anomaly and normal brain imaging. The early prediction of neurological outcome can be made easily with consideration of these three data. Standardised test are proposed, during the neonatal period, for these low birth weight infants.