Protection of the young child's brain: personal observations and thoughts in postwar stress syndrome and in natural catastrophes. The Nils Rosén von Rosenstein Lecture at Uppsala University, 6 May 1999.

This paper calls attention to the plight of children exposed to various traumas associated with wars and other natural disasters around the world. Little systematic attention has been paid to the mental health needs of child survivors of armed conflict. Our observations since 1968 and experiences around the world suggest that there are significant differences in the degree to which children have been prepared in anticipation of exposure to violence and in interventions applied after their exposure. It is the author's impression that prevention and intervention can be quite powerful when employed in these situations.

[Long-term fate of very-low-birth-weight children]. / Devenir d'enfants de très faible poids de naissance.

75 neonates with birth weights less than or equal to 1,250 g were admitted to a neonatal intensive care unit. 34 were followed up for about 4 years. 44% (15) of the surviving children are normal; 35% (12) present with minor sequellae compatible with normal familial, social and school life; 14.7% (5) presents with moderate sequellae; 6% (2) present with major sequellae. None presents with hydrocephalus, bedridden encephalopathy, deafness or blindness. Among these 34 children, 12 have growth retardation. All children with sequellae presented with important neurologic involvement during the neonatal period. No silent period was observed during follow-up. An early screening for the disorders is possible. The neonatal risks, often unappreciated or underestimated are, in most cases, foreseeable when taking into account the mother's history and course of pregnancy. Thanks to improvement of in utero screening techniques, proper cooperation between obstetricians and pediatricians should allow for selecting a better management for all very low birth weight prematures.

Long lasting effects of intrauterine growth retardation of 5-HT metabolism in the brain of developing rats.

Intrauterine growth retardation (IUGR) was achieved by ligating the artery and vein supplying one uterine horn in pregnant rats on the 5th day before delivery. At birth, the weight of the whole body and of the forebrain (but not that of the brain stem of about half of the offspring) were significantly lower than those of normal controls. This deficit persisted for at least the first 3 postnatal weeks. During the immediate period following birth, the concentrations of norepinephrine, dopamine, serotonin and 5-hydroxyindoleacetic acid (5-HIAA) were significantly higher in IUGR rats than in controls. Increased levels of serotonin and 5-HIAA were still observed in the forebrain and brain stem of 15-day-old IUGR rats and were associated with parallel increases in brain and serum free tryptophan levels. These results indicate that a transient insult in the fetal life could result in long-lasting alterations in 5-HT metabolism in CNS of developing rats.

Long lasting effects of intrauterine malnutrition on neurotransmitters metabolism in the brain of developing rats.

Intrauterine growth retardation (IUGR) was achieved by ligating the artery and vein supplying one uterine horn in pregnant rats on the 5th day before delivery. At birth, the weight of the whole body and of the forebrain (but not that of the brain stem of about half of offspring) were significantly lower than those of normal controls. This deficit persisted for at least the first 3 postnatal weeks. During the immediate period following birth, the concentrations of norepinephrine, dopamine, serotonin and 5-hydroxyindoleacetic acid (5-HIAA) were significantly higher in IUGR rats than in controls. Increased levels of serotonin and 5-HIAA were still observed in the forebrain and brain stem of 15-day-old IUGR rats and were associated with parallel increases in brain and serum free tryptophan levels. These results indicate that a transient insult in the fetal life could result in long-lasting alterations in 5-HT metabolism in the CNS of developing rats.

[Acute retinopathy of prematurity following oxygen therapy: current concepts (author's transl)]. / Données actuelles sur la rétinopathie aiguë du prématuré sous oxygénothérapie.

Five cases of retinopathy of prematurity have been observed among 1,750 premature infants at the Florence Geller Center in Cochin-Port-Royal--C.H.U. over a period of four years. In all cases, arterial PaO2 was more than 100 mmHg at least once. In the two worst cases, oxygen therapy given only during the first had been hours of life. The authors insist on the dangers of oxygen overdose immediately after birth or during transport to a Premature Infants Center. Laser photocoagulation was employed in four eyes: 2 with regression, 1 with cicatrisation, 1 with fibroplasia. Retinopathy of prematurity remains a danger in France, even if it is not as frequent as in the U.S.A. or Japan. Indirect ophthalmoscopy is essential for diagnosis and fluorography very useful to determine prognosis and treatment.

[Neonatal listeriosis. Apropos of 53 cases]. / Listériose néonatale. A propos de 53 cas.

53 cases of neonatal listeriosis were seen during the last five years at the Intensive Care Unit for newborn infants (Pr Minkowski) and the Neonatal Center (P. Varangot) of the Port-Royal Maternity Hospital. The significant decline in mortality to 22 p. 100, when compared with previous years, was attributed to improvements in the diagnosis during the first hours of life and the contribution of artificial ventilation. The most frequent initial clinical sign was respiratory distress (58 p. 100) whereas meningitis was relatively rare (11 p. 100). Discoloration of the amniotic fluid and a fever in the mother at the time of delivery, were also important diagnostic clues. The macroscopic examination of the placenta and particularly placental smears containing listeria monocytogenes (15 of the specimens) as well as the hematological alterations, particularly an increase of the fibrinogen level above 3-4 g/1 during the first 48 hous of life (72 p. 100 of the cases) contributed to an early diagnosis.

[Value of fibrinogen level measurement in neonatal infections due to maternal contamination]. / Intérêt de la mesure du taux de fibrinogène dans les infections néonatales par contamination maternelle

Fibrinogen, factors V, II and VII + X assays have been performed by micromethod on day 1, 2 and 3 in 275 newborn infants (full-term and premature) over a period of one year -- 20 infants had proved bacterial infection (from maternal contamination) with positive cultures. The control group included 20 normal newborns in the same range of gestational age. The increase of the fibrinogen level in the infected infants appeared to be significant on day 1 and 2 but not on day 3 (Day 1: 4,06 g/l +/- 0,74 g/l versus 2,06 g/l +/- 0,28 g/l in normal newborn. p less than 0.0001; on Day 2: 4,20 +/- 0,86 g/l versus 2,32 g/l +/- 0,09 g/l p less than 0.001; on Day 3: 3,68 g/l +/- 0,62 versus 3,36 +/- 0,66 g/l). The level of fibrinogen measured in the newborn period by the micromethod was in a accordance with former works showing that it is up th the adult value after the 3rd day of life. Since the micromethod on capillary blood requires only 140 microliters of blood (whereas 2 ml with macromethod) this fibrinogen determination appears to be a rapid and reliable method for the diagnosis of neonatal infection due to materno-fetal contamination.

[Neuro-psychological development of a group of children with neonatal respiratory distress treated with intermittent positive-pressure respirator]. / Evolution neuro-psychologique d'un groupe d'enfants atteints de détresse respiratoire neonatale traités sous respirateur à pression positive intermittente

The first results of long-term evolution of 99 children, most of which were premature, and who survived after intermittent positive pressure respiration for hyaline membrane disease, have been analyzed. No matched series could be set up. With a follow-up ranging from 3 1/2 years to 6 years, 51% of the children were normal, 12.5% presented with severe neurological and psychological sequellae, 31% had acceptable, sometimes slight handicap. As compared with series of the literature, prognosis was improved with intensive care and artificial respiration. This is far more obvious for the children at stage III, of which none survived without artificial respiration.

The use of critical levels of birth weight and "free bilirubin" as an approach for prevention of kernicterus.

Free bilirubin (FB) and total bilirubin (TB) were determined in 154 samples of blood taken from 112 jaundiced newborns: 51 prematures without hemolysis (19 of these with RDS); 26 full terms presenting ABO incompatibility; 35 newborns (both prematures and full terms) presenting rhesus incompatibility. Kernicterus was observed in seven cases and only three occurred in the TB group above 20 mg/100 ml; 57 cases had FB equal to or above 0.1 mg/100 ml and all kernicterus fell into this category. In the other 55 cases in which FB was less than 0.1 mg/100 ml no kernicterus was observed. In the group of healthy full-term newborns presenting ABO incompatibility, 15 had FB above or equal to 0.1 mg/100 ml ranging between 0.1 and 0.4 mg/100 ml; however no kernicterus was observed during the neonatal period. On the contrary, in the group of prematures a little more than half of the cases had a FB ranging from 0.1 to 0.4 mg/100 ml whereas four macroscopic kernicterus cases were observed. The difference between the two groups compels us to consider other factors than those acting on the albumin-bilirubin binding especially those acting on the blood-brain barrier and on the fixation of the pigment by the neurons. A second series of 605 consecutive autopsies, on a period of 10 years, on prematures excluding light-for-dates and cases of hemolysis, evaluates the distribution of 40 kernicterus as a function of birth weight. On this second series kernicterus appears with maximal frequency for birth weight between 1,000 and 1,250 g, with a nonnegligible frequency at 1,500 to 2,000 g and was absent between 2,000 and 2,500 g. 13 kernicterus were observed for a peak TB below 12 mg/100 ml. These results seem to justify a systematic determination of FB in the premature weighing less than 2,000 g from the 24th hour of life whether he has jaundice or not.