Life-threatening hemorrhaging in neonatal ulcerated congenital hemangioma: two case reports.

IMPORTANCE: Congenital hemangiomas (CHs) are rare benign vascular tumors that differ from common infantile hemangiomas in that they grow in utero and are fully developed at birth. While ulceration is a common, predominantly benign complication in infantile hemangioma, little is known about the prognosis of ulcerated CH. However, it has been observed that ulcerated CH may be complicated by life-threatening bleeding episodes. OBSERVATIONS: We report 2 cases of ulcerated rapidly involuting congenital hemangiomas (RICH) that were complicated by life-threatening bleeding episodes in the neonatal period. In both cases, the CHs were fed by high-flow vessels and the ensuing massive bleeding was due to superficial vessel wall erosion induced by the ulceration. Both patients were successfully treated with intravascular embolization; one patient underwent additional hemostatic surgery. CONCLUSIONS AND RELEVANCE: These 2 cases highlight the importance of closely monitoring children with ulcerated CH because of the risk of severe bleeding. Embolization is the treatment of choice in the case of severe bleeding, as the natural history of RICH is to spontaneously regress.

Predictive value of the parent-completed ASQ for school difficulties in preterm-born children <35 weeks' GA at five years of age.

BACKGROUND: Preterm infants are at greater risk of developmental impairment and require close follow-up for early and optimal care. OBJECTIVES: The objective of the present study was to determine from which age the parental Ages and Stages Questionnaire (ASQ) allows detection of school difficulties in preterm children <35 weeks' gestational age. METHODS: Preterm children from the regional Loire Infant Follow-up Team network were evaluated with the Global School Adaptation (GSA) assessment tool at 5 years of age and at least one parental-completed ASQ at 18, 24, or 36 months. Children belonging to the first decile of the GSA score (<38) were considered to have severe school difficulties. Using overall ASQ scores as continuous variables, receiver operating characteristic (ROC) curves were generated at every age in order to identify preterm children with severe school difficulties. RESULTS: GSA scores were obtained in 1,775 infants at 5 years of age, and at least one ASQ score at 18, 24, or 36 months was completed. Upon ROC analysis, we observed that the 18-, 24-, and 36-month ASQ scores produced respective area under the ROC curve values of 0.66 (0.64-0.69), 0.72 (0.70-0.75), and 0.77 (0.75-0.80) for predicting a GSA score in the first decile. An ASQ cutoff value of 255 at 36 months showed optimal discriminatory power for identifying significant school difficulties at 5 years of age. CONCLUSIONS: The 36-month ASQ is a simple and cost-effective tool that can be employed to help predict future severe school difficulties at 5 years of age in preterm-born children.

Effect of sex and gestational age on neonatal body composition.

To determine the effects of length of gestation and sex on infant body composition, air displacement plethysmography was performed in forty-six full-term neonates at 3 d of life and during the week prior to hospital discharge in 180 preterm neonates. Fat mass, as a percentage of body weight, was higher in preterm than in term infants (13.4 (SD 4.2) v. 10.1 (sd 3.7) %, respectively; P= 0.001). The absolute amount of fat mass did not differ between preterm and full-term newborns (323 (SD 126) v. 335 (SD 138) g; P= 0.58), whereas lean body mass was lower in preterm than in term infants (2055 (SD 280) v. 2937 (SD 259) g, respectively; P< 0.001). Among full-term infants, fat mass was higher in females than in males (11.1 (SD 3.7) v. 9.0 (SD 3.3) %, respectively; P= 0.047), whereas we did not observe any sex difference in preterm infants (13.5 (SD 4.1) v. 13.4 (SD 4.3) %; P= 0.89). Our data suggest that by the time they are discharged from hospital: (1) preterm infants have a higher percentage of body fat than term neonates and (2) this is presumably due to a lesser accretion in lean body mass in the first few weeks of extra-uterine life, particularly in boys.

[Analgesia and sedation in premature newborns]. / Analgésie et sédation chez le nouveau-né prématuré.

Analgesics and sedatives are routinely prescribed in intensive care on intubated premature newborns, to ensure their comfort and limit pain. The results of two studies show that there is no significant link between prolonged exposure to these treatments and a more unfavourable long-term neurological outcome.