[Early prediction of risk of bronchopulmonary dysplasia]. / Evaluation précoce du risque de dysplasie bronchopulmonaire.

Bronchopulmonary dysplasia (BPD) has become a frequent and worrying issue in neonatal intensive care units (NICU). The aim of this retrospective study was to define more precisely the incidence of BPD within a population of 2,216 newborns admitted at less than 24 hrs of life. 138 cases of BPD were diagnosed. The BPD rates decrease exponentially with regard to gestational ages (GA) [67% at less than 28 weeks (w), 37% at 28-29 w, 22% at 30 w, 9% at 31-32 w, 3% at 33-34 w and 0.4% at greater than or equal to 35 w]. The presence of hyaline membrane disease (HMD) increases the GA related risks by 1.5, 2, 3, 10, 20 and 40 times at less than 28 w, 28-29 w, 30 w, 31-32 w, 33-34 w and greater than or equal to 35 w, respectively. Other factors such as interstitial emphysema, refractory hypoxemia and hypotrophy associated with HMD, have been found associated with increased risks. A chart taking into account all these parameters has been constructed allowing the determination of individual risks of developing BPD during the first days of life.

[Evaluation of short term prognosis of bronchopulmonary dysplasia]. / Evaluation du pronostic à court terme de la dysplasie bronchopulmonaire.

Assessing the short-term prognosis of bronchopulmonary dysplasia (BPD) (duration of mechanical ventilation, of O2 therapy, and risk of death) is often uncertain at the early stages of the disease. From a retrospective study of 124 cases of BPD, we made a search for factors of poor prognosis which could be recognized early. Among the 124 BPD, 56 (45%) had a severe disease (mechanical ventilation for greater than 3 months and/or O2 for greater than 4 months), and 24 of them (20%) died. Two types of factors have been identified as linked to a poor prognosis (risk of evolution towards a severe disease in a proportion of 70 to 90%): some respiratory events (refractory hypoxemia, recurrent pneumothorax, interstitial emphysema, no improvement of hyaline membrane disease at 3-4 days of life in babies less than 32 weeks gestational age) and hemodynamic failures (cardiac failure due to persistent ductus arteriosus, collapse following infection or anoxia). We have also defined different values of a ventilatory index (I = mean airway pressure x FiO2) which allows the neonatologists to estimate the final prognosis of BPD during the first two months of life.

[Pre-eclampsia: a cause of fetal heart failure?]. / La toxémie gravidique: une cause d'insuffisance cardiaque foetale?

The authors report the case of a newborn whose mother presented with pre-eclampsia. Intrauterine growth retardation, peripheral edema, ascitis and pleural effusion were present at birth. The authors suggest that placental vascular abnormalities could be responsible for fetal heart failure and edema syndrome.

[Clinical and anatomo-pathologic study of 59 cases of sudden infant death]. / Etude clinique et anatomo-pathologique de 59 cas de mort subite du nourrisson.

A proper organization has been set up at Antoine-Béclère's hospital in order to study the infants who died suddenly. Between July 1985 and July 1987, 69 cases (10 babies less than 1 week of age) were admitted. The purpose of this work was, for the 59 sudden deaths of infants aged more than 1 week (35 males, 24 females), to present the results of a definite protocol of investigation (past history, clinical examination, laboratory and pathological data) for determining either the etiology or the mechanism of these deaths. A thorough investigation was performed in 45/52 cases (no autopsy in 7 cases). A definite diagnosis was possible in 38/45: 13 viral infections, 5 gastro-esophageal reflux, 13 viral infections associated with reflux, 9 with an additional event (massive alimentary inhalation, slipping under blankets, major hyperthermia) to either a viral infection or a reflux, 1 cardiac malformation, 1 metabolic disorder, 2 accidents and 1 infanticide. With this protocol, 7/45 deaths remained unexplained. This medical approach of the problem of sudden deaths in infants is beneficial to the counselling of the parents and to the management of subsequent children.