Cognitive outcome at 5 years in very premature children without severe early cerebral abnormalities. Relationships with EEG at 6 weeks after birth.

AIMS OF THE STUDY: This prospective study aimed to analyze the relationship between EEG at 6 weeks after birth and cognitive outcome at the age of 5 in children born very preterm who did not present with severe neonatal cerebral abnormalities. PATIENTS AND METHODS: EEGs were recorded at 6 weeks of age in infants born <29 weeks of gestation or weighing <1000 g at birth. At 5 years, study participants underwent a neurological assessment and cognitive evaluation with the Kaufman Assessment Battery for Children (K-ABC). RESULTS: Fifty-eight children had an EEG at 6 weeks after birth. Fifty-one were evaluated at 5 years. Twenty-six children (51.0%) had one or more disabilities: neuromotor, sensory, behavioral, and/or cognitive. Children with EEG abnormalities had significantly more disabilities (20 of 25, 80%) than children with normal EEG (6 of 26, 23%) (P=0.0002). Thirty-five children underwent complete K-ABC assessment. Multiple linear regression analysis indicated a significant relationship between the overall EEG abnormalities (normal, dysmature, and/or disorganized) and two scales: mental processing composite (MPC) scales (P=0.0121), and sequential processing scales (P=0.0012). Dysmature EEGs were more predictive of lower MPC and sequential processing scales than disorganized EEGs. Immature occipital slow waves (i.e., too high for conceptional age) were consistently recorded in children with dysmature EEGs and associated with the lowest K-ABC scores. CONCLUSION: EEG abnormalities recorded at 6 weeks after birth, such as immature occipital slow waves, were associated with later cognitive impairments. EEG at 6 weeks can be an early and reliable tool for assessing the risk of future cognitive impairment.

[Congenital methemoglobinemia: a rare case of cyanosis in the newborn]. / Methémoglobinémie congénitale récessive: une cause rare de cyanose du nouveau-né

We report the case of a newborn presenting a cyanosis after the birth with a good general state. Congenital methemoglobinemia is a rare disease which is characterized by a brutal appearance, in early infancy, of a bluish skin color not regressing with oxygen inspiration, and by a good general state. It is due to the recessive autosomal NADH-cytochrome b5 reductase (EC. 1.6.2.2) deficiency. This enzyme normally allows the reduction of the physiologically formed methemoglobinemia. Two forms of congenital methemoglobinemia have to be distinguished: the benign form (type I) and the severe form (type II).

Serum opioid activity after physical exercise in rats.

In order to study the effect of exercise on the total serum opioid activity, female rats were trained for 3 weeks on a motor-driven treadmill and the experiment was ended by a final strenuous run until exhaustion. The serum samples were taken immediately after the final run and were analyzed by radioreceptor assay. Despite considerable interindividual variations, serum opioid activity, expressed in met-enkephalin equivalents (ME eq +/- S.D.), was significantly higher in the exercising group (74.5+/-50.5 pmol ME eq/ml) than in the control group (35.7+/-20.2 pmol ME eq/ml). Because of the much lower molar levels of beta endorphin and met-enkephalin, this result suggests that many other opioid peptides might be involved in that increase.

[Carbamazepine-fluvoxamine interaction. Consequences for the carbamazepine plasma level]. / Interaction carbamazépine-fluvoxamine. Conséquences sur le taux plasmatique de carbamazépine.

The current practices concerning psychotropic drugs use plasma levels for the therapeutic adaptation and for the prevention of overdose and side effects. We observed, among two patients treated with constant dosages of carbamazepine (CBZ), that the addition of fluvoxamine (FLV) has increased significantly plasma levels of CBZ. The first patient, suffering of an affective bipolar trouble (ICD-10), was hospitalized for major depression. His admission treatment was CBZ (800 mg/day) and cyamemazine (75 mg/day). The introduction of the FLV (200 mg/day) was justified by the symptomatology. Then, plasma levels of CBZ increased progressively. No clinic or biological side effect was observed. Rapidly, CBZ oral dosages were decreased, but the plasma levels of CBZ reached the therapeutic window only when the FLV prescription was definitively stopped. The other patient was hospitalized for an acute exacerbation of a paranoiac disorder. He was treated with haloperidol for this episode. For five years, he received CBZ for neuralgia of the Trigeminus. The emergence of a depressive disorder justified a FLV treatment. From the introduction of FLV, plasma levels of CBZ were significantly increased. The reduction, then the stop of the FLV treatment, has allowed the standardization of plasma concentrations of CBZ. Three similar studies were found in the literature. The danger of this interaction was notified in two studies (one case each). Furthermore, in the third study (three cases) was put forward the hypothesis of a new therapeutic pathway. this hypothesis was suggested by the fact that these two medications were proposed independently to treat impulsive behaviors.(ABSTRACT TRUNCATED AT 250 WORDS)

Neonatal seizures--recent aspects.

This study reports the neonatal aspects and prognosis of seizures observed in 71 neonates from 1.3. 1980 to 30.6 1981. Forty-five were full-term, 26 preterm babies. Twenty-one children had status epilepticus (SE), 50 isolated crises (IC). An etiology was found in 68 cases. Acute fetal distress (AFD) was observed in half of the cases. AFD and intracranial hemorrhages represented 62% of the etiologies in term babies, 42% in preterm. Fifteen children died in the neonatal period. The outcome of the 56 survivors was followed until at least two years of age. Forty-one children were neurologically normal; 15 were not: 9 had a cerebral palsy, 12 a mental retardation, 1 was deaf, 4 were epileptic. Sequelae occurred in 24.3% of term, 31.6% of preterm survivors (p less than or equal to 0.01). The outcome was normal in 8 out of 15 living children with SE (53%), in 32 out of 41 (78%) with IC (p less than or equal to 0.01). The prognosis of hypoxic-ischemic seizures was good if crises lasted less than two days. Treatment was discontinued as soon as possible, during the days following the end of the crises and the recovery from the initial disease, without adverse effects. Convulsions following obstetrical abnormalities were less frequent, and the prognosis was better in premature babies than in previous studies.

[Premature infants delivered by cesarean section before the 32d week of pregnancy]. / Les prématurés nés par césarienne avant 32 semaines de grossesse.

Sixty-one premature babies delivered by caesarean section (Group C) before the 32nd week of amenorrhoea were compared with 83 control babies (Group T) born by vaginal delivery. The mortality was comparable: 28 and 32.5%, which is statistically more significant in children born before the 28th week of pregnancy (100 and 66% respectively) and weighing less than 1000 g (53 and 57%). Caesarean section improves the prognosis in multiple pregnancies. Morbidity (respiratory troubles, neurological troubles, infections and jaundice) is hardly different in the two groups. Infections in the lungs are less frequent, but broncho-pulmonary dysplasias are more frequent after caesarean section. Sixty-seven per cent of babies in Group C, and 64% in Group T had normal neuro-psychological development. Severe sequellae were found respectively in 9 and 18% of the infants, the difference being due to motor neurone disease of cerebral origin in respectively 0 and 6 cases. Mortality and the sequellae were identical in the two groups in breech presentations. This study does not support extending the indications for caesarean section in pregnancies under 32 weeks.

[Partial trisomy of chromosome 3 resulting from paternal translocation]. / Trisomie partielle du chromosome 3 résultant d'une translocation paternelle.

The authors report a case of a 3 year-old patient presenting with partial trisomy of the short arm of chromosome 3. According to 21 previously published cases, the main features characterizing this chromosomal abnormality which is mainly observed in males are: cranio-facial dysmorphy, cardiac and genito-urinary malformations, psychomotor retardation. Cytogenetic studies always show an inherited balanced translocation allowing a possible prenatal diagnosis.

[Acute fetal distress and mental retardation. A prospective study (author's transl)]. / Souffrance foetale aiguë et déficiences mentales. Etude prospective.

A prospective study of neonatal status with a follow-up of 4 to 7 years, was performed in 74 full-term newborns with acute fetal distress (AFD). They were born between 0.1.12.1971 ad 31.12.1975. Mental retardation (M.R.) occurred in 4,8% of the control children (born in 1972 without problem) and in 20,2% (15 children) of the children who suffered from AFD; in 12 of these 15 cases, IQ is between 65 and 90, in 3 between 50 and 65. The prognosis is worse only after unexpected neonatal distress, not after AFD with a known etiology, or after use of a forceps. The prognosis is better when FD secondary to a cord anomaly lead to an obstetrical operation. It is also better after cesarean section (1 MR among 17) or when the mother chose a private obstetrician (0 MR among 25. Apgar score has no prognostic value. Some neonatal clinical and EEG symptoms have a poor significance : persistence of anomalies at one week, seizures lasting more than 2 days. Severe retardation is always associated with cerebral palsy (C.P.). Among 12 children with moderate retardation, only one has a C.P., the 11 others have a poor--intellectual, social and/or affective--environment.

[Diagnosis and outcome of cerebral distress in newborn infants who presented signs of fetal hypoxia. Prospective study]. / Diagnostic et evolution de la souffrance cerebrale chez les nouveau-nes ayant presente des signes d'hypoxie foetale. Etude prospective.

The prospective study covered 60 full-term newborns, who presented exclusively signs of acute fetal distress. It had two major aims: --the analysis of the clinical and EEG symptomatologies, allowing the assessment of the cerebral damage in the neonatal period; --the evaluation as to whether the post-asphyxia cerebral damage may remain undiagnosed in the neonatal period, sequellae revealing it secondarily. Clinical and EEG supervision was undertaken during the first week; it was continued till 3 years of age in 45 of the 56 survivors. During the first week of life, 50 infants had at least once, an abnormal neurologic manifestation. The signs for a poor outcome are "unexpected" fetal distress, Apgar score below 2 at 1 min., seizures occurring or persisting after 48 hours, severe clinical and/or EEG changes occurring more than once. Prognosis is considered as favorable if EEG or clinical examination are consistently normal, or if EEG and clinical examination are normalized at 6 days of life.