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Neurodevelopmental disorder account for 30 to 60% of patients requiring cardiac surgery for congenital heart disease. Surgery before the age of one is a major risk factor of neurodevelopmental disorder. In October 2020, Lille University Hospital has launched a pediatric cardiac surgery program with a systematic neurodevelopmental follow-up program for infants requiring cardiac surgery before the age of one. This program includes: a clinical evaluation by a neurologist the day before surgery and before hospital discharge with a specific neurodevelopmental care pathway divided in 3 categories: pathway A, B or C depending on several factors (type of congenital heart disease, associated genetic disorder, operative or postoperative complications, electroencephalogram or magnetic resonance imaging anomalies). Between October 2020 and May 2022, 64 infants (300 [164–454] days) were included. Fourteen patients (22%) had genetic disorder. Thirty patients had curative surgery, 19 palliative cardiac surgery, 4 balloon aortic valvuloplasty, 11 were not yet operated. Eighteen patients were assigned to pathway A (general pediatrician follow-up with parental neurodevelopmental questionnaire at key ages). Twenty-six children were assigned to pathway C (specific follow-up in medico-psycho-social centers for children with disability requiring special treatments like a speech therapist, psychomotor therapist...). Six children were assigned to pathway B (neurologic systematic reevaluation 3 months after surgery before reassignment to pathway A or C). One hundred percent of parental questionnaires ASQ (ages and stages questionnaires) for neurodevelopmental follow-up were gathered at 6 months in pathway A and B, but only 64% in pathway C. In total, 100% of 12 months ASQ were gathered in pathway A and B, but only 82% in pathway C. This specific screening for neurodevelopmental disorder program allows to identify fragile infants needing specific follow-up. Efforts still remain to be done in getting back the ASQ questionnaires in order not to lose any patients during follow-up. [ABSTRACT FROM AUTHOR]

Summary Pediatric EEG in the intensive care unit (ICU) requires specific technical requirements in order to yield relevant data depending upon clinical scenario: diagnosis of electroclinical or subclinical seizures, their quantification before and after therapeutic changes and sometimes evaluation of severity of cortical dysfunction. The urgent nature of these indications implies the rapid set-up of the EEG system by qualified staff and possibility of maintaining the electrodes in place during long periods of time. Various techniques are available today for EEG monitoring, the interpretation of which depends on the contribution of an experienced physician. Among recent techniques, those most commonly used are trend curves obtained via signal analysis such as amplitude EEG (a-EEG) and density spectral array (DSA) or compressed spectral array (CSA). Trend curves enable the digital creation of a display graph containing several hours of transformed and compressed EEG recorded data. Visualized on one sole display graph, these trend curves can facilitate the identification of very slow changes in EEG background activity and their variation (alertness cycles, changes linked to treatment administrations) as well as seizure patterns and their quantification. In this chapter, we propose a brief overview of monitoring techniques, followed by a review of the various data yielded by EEG monitoring as well as the relevance of this type of management; finally, detailed clinical indications will be discussed after thorough analysis of the literature. [ABSTRACT FROM AUTHOR]

Summary: Pathological features on very premature EEG concern background abnormalities and abnormal patterns. Positive rolandic sharp waves keep an important place regarding diagnosis and prognosis. Background abnormalities give essential complementary informations. Unusual patterns (abnormal localisation or morphological aspect, high amplitude) remain early markers of cerebral lesions. Analysis of these pathological features must always take into account treatment given to the baby, which can by itself modify the EEG. [Copyright &y& Elsevier]

Résumé L’électroencéphalogramme (EEG) est un examen clé dans la prise en charge des convulsions néonatales, principal mode de révélation des accidents vasculaires cérébraux artériels et ischémiques du nouveau-né (AVCian). Il doit être réalisé dès que possible en cas de convulsion ou de suspicion de convulsion. Certains aspects de l’EEG sont évocateurs d’AVCian comme l’asymétrie du tracé de fond avec présence de pointes focales. L’EEG doit être prolongé et associé à une vidéo car les crises paucisymptomatiques ou infracliniques sont fréquentes, y compris sous la forme d’état de mal. Il n’a pas été démontré jusqu’à présent que les aspects EEG étaient prédictifs du devenir à long terme cognitif et épileptique. The EEG has a key role in the management of neonatal seizures, which are the typical mode of revelation of neonatal ischemic stroke. The EEG should be started as soon as possible in case of suspected seizure. Some EEG features are evocative of neonatal stroke, typically asymmetry of background activity with the presence of focal spikes and focal seizures. The EEG should be prolonged and always associated with a video as pauci-symptomatic or subclinical seizures are frequent, including some status epilepticus. Video-EEG monitoring is therefore essential to judge the efficacy of anticonvulsant therapy. There is insufficient evidence so far to state if some EEG aspects are predictive of long-term cognitive and epileptic outcomes. [ABSTRACT FROM AUTHOR]

Résumé Au cours de la période postnatale précoce, la prise en charge d’un nouveau-né présentant un accident vasculaire cérébral (AVC) ischémique nécessite une surveillance biologique et un bilan complémentaire adapté à la recherche de pathologies associées. L’objectif de cette revue de la littérature est de proposer des recommandations sur ces explorations. À la lecture de la bibliographie, trois grands cadres nosologiques spécifiques à la période postnatale émergent et doivent orienter ce bilan : les anomalies métaboliques dont l’hypoglycémie, les infections postnatales précoces et les anomalies cardio-vasculaires. Selon le contexte typique ou atypique de survenue de l’AVC, des bilans de base et orientés sont proposés. Des situations néonatales à risque de survenue d’un AVC ischémique pour lesquelles l’état neurologique du nouveau-né nécessite une vigilance particulière sont également décrites. Neonatal monitoring and other explorations required just after neonatal arterial ischemic stroke (NAIS) diagnosis remain elusive. This review attempts to propose guidelines on this topic. During neonatal period, three major contexts related to NAIS emerge: 1) Metabolic disorders including hypoglycemia; 2) Early post-natal infections; 3) Cardio-vascular anomalies. Different patient profiles have been defined (typical, atypical and at risk profiles). According to these profiles, a final decisional tree including biological monitoring and complementary explorations has been suggested to caregivers. [ABSTRACT FROM AUTHOR]

Summary: The newborn infant is prone to motor phenomena of various physiological mechanisms and pathological significance whereas they can share close clinical patterns. A detailed clinical analysis, that should be supported by a video EEG recording, is necessary. That may help to distinguish myoclonus, jitteriness or seizures. Some rare phenomenom such as hyperekplexia or myotonia have also to be known. The pregnancy and birth history, the clinical examination and the search for association of various motor phenomena give essential clues for the diagnosis. Misdiagnosing non epileptic phenomona as seizures has to be avoided as it leads to unnecessary anticonvulsivant therapy with potential harmful effects. [Copyright &y& Elsevier]

Summary: Following the pioneering work of C. Dreyfus-Brisac and N. Monod, research into neonatal electroencephalography (EEG) has developed tremendously in France. French neurophysiologists who had been trained in Paris (France) collaborated on a joint project on the introduction, development, and currently available neonatal EEG recording techniques. They assessed the analytical criteria for the different maturational stages and standardized neonatal EEG terminology on the basis of the large amount of data available in the French and the English literature. The results of their work were presented in 1999. Since the first edition, technology has moved towards the widespread use of digitized recordings. Although the data obtained with analog recordings can be applied to digitized EEG tracings, the present edition, including new published data, is illustrated with digitized recordings. Herein, the reader can find a comprehensive description of EEG features and neonatal behavioural states at different gestational ages, and also a definition of the main aspects and patterns of both pathological and normal EEGs, presented in glossary form. In both sections, numerous illustrations have been provided. This precise neonatal EEG terminology should improve homogeneity in the analysis of neonatal EEG recordings, and facilitate the setting up of multicentric studies on certain aspects of normal EEG recordings and various pathological patterns. [Copyright &y& Elsevier]

The electroencephalogram (EEG), an easy-to-use and non invasive cerebral investigation, is a useful tool for diagnosis and early prognosis in newborn babies. In newborn full term babies manifesting abnormal clinical signs, EEG can point focal lesions or specific aetiology. EEG background activity and sleep organization have a high prognostic value. Tracings recorded over long period can detect seizures, with or without clinical manifestations, and differentiate them from paroxysmal non epileptic movements. The EEG should therefore be recorded at the beginning of the first symptoms, and if possible before any seizure treatment. When used as a neonatal prognostic tool, EEG background activity is classified as normal, abnormal (type A and type B discontinuous and hyperactive rapid tracing) or highly abnormal (inactive, paroxysmal, low voltage plus theta tracing). In such cases, the initial recording must be made between 12 and 48 h after birth, and then between 4 and 8 days of life. Severe EEG abnormalities before 12 h of life have no reliable prognostic value but may help in the choice of early neuroprotective treatment of acute cerebral hypoxia-ischemia. During presumed hypoxic-ischemic encephalopathy, unusual EEG patterns may indicate another diagnosis. In premature newborn babies (29–32 w GA) with neurological abnormalities, EEG use is the same as in term newborns. Without any neurological abnormal sign, EEG requirements depend on GA and the mother’s or child’s risk factors. Before 28 w GA, when looking for positive rolandic sharp waves (PRSW), EEG records are to be acquired systematically at D2–D3, D7–D8, 31–32 and 36 w GA. It is well known that numerous and persistent PRSW are related to periventricular leukomalacia (PVL) and indicate a bad prognosis. In babies born after 32 GA with clinically severe symptoms, an EEG should be performed before D7. Background activity, organization and maturation of the tracing are valuable diagnosis and prognosis indicators. These recommendations are designed (1) to get a maximum of precise informations from a limited number of tracings and (2) to standardize practices and thus facilitate comparisons and multicenter studies. [Copyright &y& Elsevier]

Objectifs Étudier l’efficacité des triptans prescrits « en situation réelle » dans le traitement de la crise migraineuse avec ou sans aura typique chez l’enfant et l’adolescent. Sujets/matériels et méthodes Étude rétrospective, monocentrique, chez les enfants de cinq à dix-huit ans, atteints d’une migraine avec ou sans aura typique vérifiant les critères de l’ICHD-3 bêta ayant bénéficié d’un triptan prescrit à la consultation de neuropédiatrie, hors AMM ou dans l’AMM. Résultats principaux Cinquante-neuf patients étaient inclus, dont 32 (54 %) avaient essayé le sumatriptan en spray nasal. Une efficacité était retrouvée chez 19 (59 %) des patients et des effets indésirables chez 17 (53 %) des patients. Les autres triptans étaient peu utilisés. Les obstacles rencontrés en vie réelle étaient surtout liés aux limitations de prescription et de prise des triptans probablement liés à leur statut hors AMM. Conclusions L’efficacité du sumatriptan en spray nasal n’était que légèrement inférieure, en comparaison à celle observée dans les essais cliniques. Une information des médecins prescripteurs et des familles permettrait une utilisation plus fréquente des triptans et une meilleure prise en charge thérapeutique de la crise migraineuse en pédiatrie. [ABSTRACT FROM AUTHOR]