[Outcome of 404 premature infants born before 32 weeks of gestation in 1978-1980]. / Devenir de 404 prématurés nés avant 32 semaines de gestation en 1978-1980.

The outcome of 404 prematures born before 32 weeks of gestation and admitted on the first day of life to the Institut de Puériculture (IP) in 1978-1980 was studied with respect to post-menstrual age and birth weight: 83 (20,5%) died during the hospitalization. Of the 321 still alive after the neonatal hospitalization, 71% were followed until at least 2 years of age; 3,1% died unexpectedly at home. There was a 8% handicap rate (9 with cerebral palsy and 9 with psychomotor deficiency) in the survivors. The problems of the children without handicap consisted mostly of strabismus and psychosocial disturbances. Thus, on admission to the IP on the first day of life during 1978-1980, according to gestational age (a) less than 28 weeks, (b) between 28 and 29 weeks 6 days (c) between 30 and 31 weeks 6 days, a premature presented the following risks: death during hospitalization: (a) 47%, (b) 20% and (c) 15%; death at home (b) 5%, (c) 1%; handicap (a) 3%, (b) 10%, (c) 5%; normal survival (a) 47%, (b) 63%, (c) 75%. This study shows the value of gestational age in estimating the outcome of prematures and the utility of analysing the results according to the 2 variables of gestational age and birth weight.

[Bronchopulmonary dysplasia]. / Dysplasie broncho-pulmonaire.

A retrospective study of 2 125 preterm infants, who were ventilated at the Institut de Puériculture in Paris over 9 years (1974-1982) for respiratory distress at birth, showed that 45 (2%) developed clinical and radiological bronchopulmonary dysplasia (BPD): 8 minimal forms, 23 moderate forms and 14 severe forms, 30 of these patients survived (66%). The pathogenesis of this chronic respiratory disease is multifactorial: oxygen + pressure + duration + endotracheal intubation. Efforts should be made to limit the damaging effect of each of these factors, which should be kept down to the minimum values compatible with adequate oxygenation. The presence of emphysema and of a patent ductus arteriosus has also been incriminated, but they may reflect the severity of the initial lung lesion. Rickets, whose incidence was found to be 27%, majors respiratory distress. In the ensuing months, babies with BPD are susceptible to recurrent viral or bacterial respiratory tract infection, failure to thrive and cor pulmonale. The presence of the mother and the care of a psychomotor development specialist are needed for these infants who will be confined for months in conditions which are unsuited to their sensory, physical, emotional and cognitive development.

[Prolonged Q-T interval with functional A-V block in neonates and young infants (author's transl)]. / Allongement de l'espace QT avec bloc auriculo-ventriculaire fonctionnel chez le nouveau-né et le jeune nourrisson.

A prolonged Q-T interval (0.56 to 0.70 s.) with second degree A-V block was present in 5 children. Auscultation in utero (2 cases) or at birth (1 case) and syncopal attacks at 15 days and 2 months of life led to the discovery of the arrhythmia which was complicated with torsades de pointes. One patient died at 1 month of age; another is treated with propranolol and an internal pacemaker; the last 3 recovered, either spontaneously or with propranolol. The originality of this syndrome of unknown etiology is due to the A-V block, secondary to delayed repolarization (prolonged Q-T interval). Torsades de pointes and ventricular fibrillation are the main risks. Treatment includes beta adrenergic blocking agents associated with a temporarily implanted pacemaker. In a few cases, the internal pacemaker has to be left permanently.