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OBJECTIVE: The purpose of this study was to examine the relationships between different causes of preterm delivery (eg, maternal hypertension, small-for-gestational age [SGA], other) and cerebral damage (eg, cystic periventricular leukomalacia [c-PVL], grade III intraventricular hemorrhage [IVH], and intra-parenchymal hemorrhage [IPH]). STUDY DESIGN: This study included 1902 very preterm singletons who were transferred to neonatal intensive care units in 9 French regions. We used logistic regression models to compare the risk of cerebral injury associated with maternal hypertension, SGA, and all other causes of preterm delivery. RESULTS: We found that the risk of c-PVL and grade III IVH was higher in infants born after preterm premature rupture of membranes (PPROM) with short latency or idiopathic preterm labor than in infants born to hypertensive mothers. We show that SGA and antepartum maternal hemorrhage significantly increase the risk of IPH. CONCLUSION: Our results show that infants born to hypertensive mothers have a lower risk of cerebral injuries than infants born following idiopathic preterm labor and PPROM because they are less exposed to prenatal infection. [ABSTRACT FROM AUTHOR]

When deciding elective caesarean in women near the term of pregnancy, we may balance benefits and risks for the mother as well as for the infant: short-term risk of mother-infant separation due to admission to NICU for respiratory distress syndrome and also for sepsis and hypoglycemia; long-term risks of chronic environmental diseases such as asthma, type-1diabetes, allergy and even obesity. [ABSTRACT FROM AUTHOR]

Unlabelled: Oculoauriculovertebral dysplasia, also called Goldenhar syndrome, includes several anomalies: epibulbar dermoids or lipodermoids, microtia, mandibular hypoplasia, vertebral, skeletal, cardiac and kidney anomalies, among others. Tumours have also been observed in patients with oculoauriculovertebral dysplasia. We report the first case of oculoauriculovertebral dysplasia associated with a neuroblastoma. This tumour consists of cells identical to early migratory neural crest cells in the embryo. Several theories have been proposed regarding the pathogenetic explanation of oculoauriculovertebral dysplasia. Currently, some researchers have suggested a deficiency in mesodermal formation or defective interaction between neural crest and mesoderm as a possible aetiology.Conclusion: It is suggested that the case reported here is an additional argument for an anomaly in neural crest cell migration or interaction with the mesoderm in the pathogenesis of oculoauriculovertebral dysplasia. [ABSTRACT FROM AUTHOR]

Résumé L’accident vasculaire cérébral ischémique artériel néonatal (AVCian) touche 6 à 17 naissances à terme sur 100 000. Une grande proportion des enfants concernés ont des séquelles motrice et cognitive à long terme. L’objectif de cet article est de faire une revue de la littérature sur le devenir des enfants après un AVCian afin de décrire la trajectoire développementale et comportementale et les séquelles et de proposer un suivi consensuel pour améliorer la prise en charge et le pronostic à long terme. Environ 30 % des enfants présentant un AVCian développent une paralysie cérébrale unilatérale nécessitant un suivi spécialisé et prolongé en médecine physique et réadaptation. L’efficience intellectuelle globale des enfants avec lésions unilatérales est le plus souvent préservée, excepté lorsque la taille de la lésion est très importante ou lorsqu’il existe une épilepsie sévère. Contrairement aux adultes, les enfants après un AVCian néonatal (en particulier gauche) ne présentent pas de troubles du langage à type d’aphasie, mais 50 à 90 % présentent des troubles du développement de la parole ou du langage dans leur versant expressif et réceptif. Plusieurs études montrent aussi une vulnérabilité des fonctions exécutives et visuo-spatiales. Afin de préciser les déficiences, les limitations d’activité et restrictions de participation découlant d’un AVCian, des évaluations avec des outils fiables doivent être réalisées systématiquement, précocement et de façon répétée jusqu’à l’adolescence. Elles doivent être faites par des équipes pluridisciplinaires permettant un suivi développemental dans toutes ses dimensions : motricité, cognition, comportement, autonomie, réussite scolaire et plus généralement participation. Neonatal Arterial Ischemic Stroke (NAIS) affects 6-17 newborns on 100 000-birth term neonates, most of these children keeping long-term motor and cognitive impairments. Based on a literature review, the objectives of this paper are to describe motor and cognitive outcomes after a NAIS and to propose a consensual monitoring of these children to improve their management. About 30 % of children after a NAIS will develop a unilateral cerebral palsy requiring a management by a team with expertise in physical medicine and rehabilitation. Unlike adults, especially after a left NAIS, children will not present aphasia but between 50 and 90 % will present disorders of speech and language in expression and/or reception. After NAIS, the global intellectual efficiency is usually preserved except when the size of the lesion is very important or when severe epilepsy occurs. Several studies are also in favor of vulnerability in visuospatial functions. To quantify impairments, activity limitations and participation restrictions resulting from this NAIS, early and at least yearly evaluations with reliable tools must be carried out systematically until puberty. A multidisciplinary team with a longitudinal follow-up, in all the different developmental dimensions, must conduct these evaluations in term of motor skills, cognitive impairment, behavior, autonomy, quality of life, and participation. Consequences on family functioning need to be evaluate in order to help children and family coping with this event. [ABSTRACT FROM AUTHOR]

Résumé Actuellement, peu de données dans la littérature dans une démarche de type médecine basée sur les évidences sont disponibles pour confirmer l’intérêt thérapeutique et préciser les modalités spécifiques de la prise en charge rééducative précoce chez l’enfant après un accident vasculaire cérébral (AVC) néonatal. Cependant un certain nombre de données sur la plasticité cérébrale et l’effet de certaines interventions précoces sur celle-ci, ainsi que des résultats préliminaires chez l’enfant avec paralysie cérébrale sont très nettement en faveur d’une prise en charge précoce par une équipe expérimentée en médecine physique et réadaptation (MPR) pédiatrique en cas de déficit avéré. Il reste en revanche à déterminer l’intensité et le type d’intervention qui sont encore hautement variables en fonction des études et du type de déficit constaté. L’importance est donnée dans tous les cas à une prise en charge globale de l’enfant et de sa famille dans un objectif de limitation des conséquences en termes de limitation d’activité et de restriction de participation. Currently, in the literature of the evidence based medicine, little data are available to confirm the benefit and the specific procedures of an early intervention for a neonatal arterial ischemic stroke. However, data about the effect of an early physical rehabilitation program on the cerebral plasticity, and preliminary results of clinical studies in children with cerebral palsy strongly suggest the benefit of an early rehabilitation with a multidisciplinary approach. The type of the rehabilitation and its frequency must be determined because a wide variability in the practices exists. A comprehensive care, of the children and his family is necessary to limit the orthopaedics but also the social consequences of a neonatal stroke. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented regarding the prevention of cerebral palsy in preterm infants through the administration of antenatal magnesium sulphate, which was studied under trial sequential analysis (TSA) in the context of meta-analysis.

OBJECTIVES: To evaluate growth for children born very preterm with particular focus on those born small-for-gestational age (SGA) or with ex utero growth restraint (GR), and to identify risk factors for short stature at 5 years of age. STUDY DESIGN: Population-based study of children born at less than 33 completed weeks of gestation (Étude Epidémiologique sur les Petits Ages Gestationnels (EPIPAGE)). Short stature was defined as height <-2SD on WHO growth curves. Ex utero GR was considered to have occurred in children with appropriate size for gestational age at birth and with a height and/or weight below -2SD at 2 years of corrected age. Logistic regression models were used to test associations between risk factors and short stature. RESULTS: The authors measured height at 5 years of age for 1,597 of 2,193 children (73%), 5.6% (95% CI 4.6 to 6.9) of whom were diagnosed as having a short stature. Height was measured at 2 and 5 years of age in 1417 children. Among these, 24% of those born SGA and 36% of those with ex utero GR (p=0.002) had a short stature at 5 years. Predictors of short stature were SGA or birth length <-2SD, maternal height <= 160 cm, gestational age <29 weeks and systemic corticosteroids. Breastfeeding at discharge decreased the risk of short stature. CONCLUSIONS: Short stature at 5 years of age is common in children born preterm. The highest incidence was observed in the group with ex utero GR. Systemic steroids have a long-term impact on growth and should be used with caution. Breastfeeding at discharge appeared to be protective. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor about the epidemiology of congenital rubella syndrome in pregnancy.