[Thoughts on current management of severe neonatal hyperbilirubinemia]. / Réflexions autour de la prise en charge en maternité des ictères sévères.

In recent years, the threat of kernicterus reappeared with the extension of early discharge of newborns. By the same time new knowledge and technologies have improved the management of neonatal hyperbilirubinemia. Early bilirubin measurement helps to identify those newborns who will be at risk of hyperbilirubinemia after discharge. This measurement can be made instantaneously in a non invasive way using a transcutaneous measurement device. Fibreoptic and conventional phototherapies can be modulated according to the nature and the intensity of hyperbilirubinemia. In a near future enzymatic inhibitors such as Sn-mesoporphyrin will be probably available for the treatment of severe hyperbilirubinemia.

[New technique of nasal continuous positive pressure in neonatology]. / Nouvelle technique de pression positive continue par voie nasale en néonatologie.

BACKGROUND: Early treatment with nasal continuous positive airway pressure (CPAP) in newborns with respiratory distress syndrome is useful, by recruiting alveoli and restoring the functional residual capacity. POPULATION AND METHODS: Nasal CPAP was supplied by the Infant Flow Driver (Electro Medical Equipment). From 15 June 1994 to 15 December 1994, 42 neonates received nasal CPAP. Their mean birthweight and gestational age were 1511 +/- 411 g and 30.9 +/- 2.5 weeks, respectively. Fifteen infants had been ventilated for hyaline membrane disease and nasal CPAP was applied immediately after extubation. In the other 27 infants, nasal CPAP was given soon after birth (respiratory distress syndrome: 20 neonates; apneic spells: seven neonates). RESULTS: Three infants needed subsequent mechanical ventilation because of the severity of the disease (one had spontaneous pneumothorax); four infants received exogenous surfactant (Curosurf, one single dose) within a brief period of mechanical ventilation (30-45 min). There were no failure of extubation, and no intracranial lesions. Excess of pharyngeal secretion and abdominal distension were common. CONCLUSION: Early treatment with nasal CPAP reduces the need for mechanical ventilation. Furthermore, surfactant therapy required by a moderate to severe disease is possible with a rather short period of artificial ventilation.

Incidence of ischemic-hemorrhagic cerebral lesions in premature infants of gestational age < or = 28 weeks: a prospective ultrasound study.

While it is well accepted that the incidence of intraventricular hemorrhage (IVH) increases with decreasing gestational age (GA), the majority of studies report their findings on the basis of birthweight (BW) rather than GA. Over a 5-year period, 199 infants born at or below 28 weeks of gestation were entered into a prospective cranial ultrasound study stratified according to GA. One hundred and five (53%) had normal ultrasound findings. The overall incidence of IVH, as expected, rose with decreasing GA but we were unable to show any clear influence of BW or growth retardation on its occurrence. Incidence of grades I, IIa, IIb and III IVH were 8, 10, 16 and 11%, respectively. Leukomalacia, bleeding in the posterior fossa and in the cerebellum occurred in 4, 7 and 2% of the population, respectively.

Influence of perinatal, developmental and environmental factors on cognitive abilities of preterm children without major impairments at 5 years.

The relative role of perinatal factors (birthweight, gestational age, gender, asphyxia, mechanical ventilation and cerebral lesions), developmental factors (neuromotor development during the first 18 months of life) and environmental factors (socio-economic status and bilingualism) on cognitive abilities was evaluated in a cohort of preterm children who had been prospectively examined for haemorrhage (PVH) and periventricular leucomalacia (PVL) and followed-up to 5 years of age. Standardized neurological examinations and development assessment including tests of cognitive function were carried out. Major impairments could be ascribed to the presence of large PVL changes. Among the 226 children without major impairment, the overall incidence of neuropsychological anomalies (neuromotor, language, visual, auditory and behaviour anomalies) was 46.5% and did not differ within ultrasound groups (normal scans, PVH and small PVL). However, children with small changes of PVL presented more abnormal neuromotor development within the first 18 months of life and had more complex neuropsychological anomalies at 5 years. The multiple regression analysis (General Intellectual Index (GII) predicted = 113.7 - coefficient x social class - 8.5 x bilingualism - 5.5 x dystonia + 1.4 x gestational age + 8 x mechanical ventilation) showed that socioeconomic status was the most important factor affecting the General Intellectual Index (GII). The contribution of sex and cerebral lesions was not significant. As children grew-up, environmental factors seemed to overcome perinatal factors.