RESUMEN
Clinical and radiological knowledge of language development in the former premature infant compared to the newborn allows us to argue for exploration of the sensorimotor co-factors required for proper language development. There are early representations of the maternal language in the infant's visual, auditory, and sensorimotor areas, activated or stabilized by orofacial and articulatory movements. The functional architecture of language is different for vulnerable children such as premature infants. We have already mentioned the impact of early dysfunction of the facial praxis fine motor skills in this population presenting comprehension disorders. A recent meta-analysis confirms the increasing difficulty of understanding between 3 and 12 years, questioning the quality of the initial linguistic processes. A precise analysis of language, referenced from 3 years of age, should be completed by sensorimotor tests to assess possible constraints in automating neurolinguistic foundations. The usual assessment at this age can exclude sensory disturbances and communication and offers guidance and socialization. However, a recent study shows the ineffectiveness of "language-reinforced immersion" at 2 and 3 years in a population of vulnerable children. The LAMOPRESCO study of language and motor skills in the premature infant (National PHRC 2010) has assessed language and sensorimotor skills of preterm-born (<33 weeks) 3.5-year-old children without cerebral palsy. Fragile children were randomized into 2 groups, 1 stimulated by a specific individual protocol, the other given guidance. The primary endpoint was phonology, assuming that it is composed of very early good-quality sensorimotor integration stabilized by the child's oral facial motor skills before 5 years of age. This developmental integrative dynamic validates the "motor theory of speech perception." Early and accurate assessment of language and the patient's constraints should differentiate and specify management strategies for all children, whatever their background and pathologies.
Asunto(s)
Desarrollo del Lenguaje , Preescolar , Lóbulo Frontal/anatomía & histología , Humanos , Lactante , Recién Nacido , Recien Nacido Prematuro , Discapacidades para el Aprendizaje/prevención & control , Imagen por Resonancia Magnética , Habla , Lóbulo Temporal/anatomía & histologíaRESUMEN
Postnatal urinary ascites is a rare occurrence compared with other causes of peritoneal effusion at this age and its frequency in prenatal diagnosis. Spontaneous rupture of the bladder was diagnosed in a premature male infant presenting with postnatal ascites and anuric renal insufficiency. Surgical repair was required. No predisposing factor was associated with this rare complication. The urinary origin of the ascites was diagnosed based on the biochemical composition, allowing us to understand its mechanism and to treat it.
Asunto(s)
Insuficiencia Renal/etiología , Vejiga Urinaria/lesiones , Anuria/etiología , Anuria/cirugía , Ascitis/etiología , Ascitis/cirugía , Humanos , Recién Nacido , Recien Nacido Prematuro , Masculino , Insuficiencia Renal/cirugía , Rotura Espontánea/complicaciones , Rotura Espontánea/cirugía , Vejiga Urinaria/cirugíaRESUMEN
OBJECTIVE: To evaluate whether magnesium sulphate (MgSO(4)) given to women at risk of very-preterm birth would be neuroprotective in preterm newborns. PATIENTS AND METHODS: In 18 French centres, women with fetuses of gestational age less than 33 weeks whose birth was expected within 24 hours were randomised from 1993 to 2003 with follow-up of infants until two years of age after discharge. They received a single injection of 0.1 mg/l de MgSO(4) (4g) or isotonic 0.9% saline over 30 minutes. This study is registered as an International Standard Randomised Controlled Trial, number 00120588. Analyses were based on intention to treat. RESULTS: Data from 688 infants were analysed of which 606 were followed up and 10 were lost to follow-up. Comparing infants who received MgSO(4) or placebo, respectively, has shown a decrease of all primary endpoints (total mortality, severe white matter injury and their combined outcome) and of all secondary endpoints (motor dysfunction, cerebral palsy, cognitive dysfunction and their combined outcomes at two years of age) in the MgSO(4) group. The decrease was nearly significant or significant for gross motor dysfunction (OR: 0.65 [0.41-1.02]) and combined criteria: death and cerebral palsy (OR: 0.65 [0.42-1.03]); death and gross motor dysfunction (OR: 0.62 [0.41-0.93]); death, cerebral palsy and cognitive dysfunction (OR: 0.68 [0.47-1.00]). No major maternal adverse effects were observed in the MgSO(4) group. DISCUSSION AND CONCLUSION: Given its beneficial effects and safety, the use of prenatal low-dose MgSO(4) for preventing neurodisabilities of very-preterm infants should be discussed either as a stand-alone treatment or as part of a combination treatment, at least in the context of clinical trials.
Asunto(s)
Mortalidad Infantil , Enfermedades del Prematuro/prevención & control , Sulfato de Magnesio/farmacología , Enfermedades del Sistema Nervioso/prevención & control , Trabajo de Parto Prematuro/tratamiento farmacológico , Tocolíticos/farmacología , Adulto , Parálisis Cerebral/epidemiología , Parálisis Cerebral/mortalidad , Parálisis Cerebral/prevención & control , Femenino , Humanos , Recién Nacido , Recien Nacido Prematuro , Enfermedades del Prematuro/epidemiología , Enfermedades del Prematuro/mortalidad , Leucomalacia Periventricular/epidemiología , Leucomalacia Periventricular/mortalidad , Leucomalacia Periventricular/prevención & control , Estudios Longitudinales , Masculino , Morbilidad , Enfermedades del Sistema Nervioso/epidemiología , Enfermedades del Sistema Nervioso/mortalidad , Embarazo , Resultado del Embarazo , Estudios Prospectivos , Resultado del TratamientoRESUMEN
A fatal case of meningoencephalitis caused by Bacillus cereus, an uncommon but potential pathogen, resistant to most beta-lactam antibiotics, is described in a 28-day old premature neonate. Difficulties for clinical diagnosis and treatment are discussed. A review of the literature (26 published cases) is given. Early diagnosis of neonatal B. cereus infection is crucial as it leads to a standard treatment including vancomycin.
Asunto(s)
Infecciones por Bacillaceae/patología , Bacillus cereus , Enfermedades del Prematuro/patología , Antibacterianos/uso terapéutico , Infecciones por Bacillaceae/tratamiento farmacológico , Bacillus cereus/efectos de los fármacos , Técnicas Bacteriológicas , Diagnóstico Diferencial , Resistencia a Múltiples Medicamentos , Quimioterapia Combinada , Resultado Fatal , Femenino , Humanos , Recién Nacido , Enfermedades del Prematuro/diagnóstico , Enfermedades del Prematuro/tratamiento farmacológicoAsunto(s)
Hepatitis Viral Humana/diagnóstico , Infecciones por Herpesviridae/diagnóstico , Herpesvirus Humano 6/aislamiento & purificación , Antibacterianos , Secuencia de Bases , ADN Viral/análisis , Quimioterapia Combinada/uso terapéutico , Hepatitis Viral Humana/congénito , Hepatitis Viral Humana/tratamiento farmacológico , Infecciones por Herpesviridae/congénito , Infecciones por Herpesviridae/tratamiento farmacológico , Humanos , Recién Nacido , Masculino , Datos de Secuencia Molecular , Reacción en Cadena de la PolimerasaAsunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/complicaciones , Infecciones por Citomegalovirus/complicaciones , Infecciones por Citomegalovirus/etiología , Enteritis/complicaciones , Enfermedades del Íleon/complicaciones , Perforación Intestinal/complicaciones , Infecciones Oportunistas Relacionadas con el SIDA/virología , Infecciones por Citomegalovirus/virología , Enteritis/virología , Humanos , Enfermedades del Íleon/virología , Recién Nacido , MasculinoRESUMEN
A male newborn exhibited congenital cutis laxa, bone disease and multiple fractures, and lethal ruptured arterial dissections. At post-mortem examination, the histologic elastic tissue of skin and arteries was dysplastic. The bone fragility is unexplained.
Asunto(s)
Disección Aórtica/congénito , Cutis Laxo/congénito , Fracturas Espontáneas/complicaciones , Arterias , Cutis Laxo/complicaciones , Humanos , Recién Nacido , Masculino , Rotura EspontáneaRESUMEN
It is suggested that the circuits of continuous flow rate ventilators should be modified for more accurate control of ventilation parameters. Reduction in compressible volume and increase in caliber of the expiratory section have resulted in a better control of pressure curve and level of expiratory pressure and in reduction of condensation in the inspiratory circuit.
Asunto(s)
Ventilación Pulmonar , Ventiladores Mecánicos , Seguridad de Equipos , Humanos , Recién Nacido , Respiración ArtificialRESUMEN
Nineteen peripheral arteries were examined by Doppler US 1 month to 2 years after their catheterization. Two of them were completely obstructed and 4 showed signs of arterial stenosis. No functional repercussion was observed. This minor risk seems low as compared to the advantages of the technique.
Asunto(s)
Arteriopatías Oclusivas/diagnóstico , Cateterismo/efectos adversos , Síndrome de Dificultad Respiratoria del Recién Nacido/terapia , Reología , Grado de Desobstrucción Vascular , Arteriopatías Oclusivas/etiología , Arterias , Estudios de Seguimiento , Humanos , Lactante , Recién NacidoRESUMEN
Interstitial emphysema of the right lung occurring as a complication of hyaline membrane disease in a premature infant was successfully treated by bronchial occlusion with a balloon catheter. This technique was simpler and safer than selective intubation of the left main bronchus.
Asunto(s)
Enfermedades del Prematuro/terapia , Enfisema Pulmonar/terapia , Bronquios , Catéteres de Permanencia , Femenino , Humanos , Enfermedad de la Membrana Hialina/complicaciones , Recién Nacido , Enfisema Pulmonar/etiología , Respiración ArtificialRESUMEN
A double blind therapeutic trial of ethyl clofibrate as a preventive treatment of hyperbilirubinemia in preterm neonates was performed in neonates of gestational ages ranging between 31 and 36 weeks. Forty-six children were given the treatment and 43 a placebo. A single 100 mg/kg dose of ethyl clofibrate was administered orally, between the 24th and the 48th hour of life. Significant results in the treated neonates are as follows: a lesser intensity of jaundice from the 48th hour of treatment; a lesser need for repeated bilirubinemia assay for the control of evolution and a lesser use of phototherapy if the serum concentration of clofibric acid is above or equal to the 140 micrograms therapeutic level before the 24th hour of treatment. The analysis of results also shows that the therapeutic clofibric acid serum level is reduced in 66% of neonates of relatively high gestational ages (34-36 weeks) and in 33% only of neonates of lower gestational ages (31-33 weeks). This study, added to the previous therapeutic trial performed in at term neonates, shows the efficacy of clofibrate in the preventive treatment of hyperbilirubinemia in preterm neonates. Further studies will allow to define the exact dosage according to gestational age.
Asunto(s)
Clofibrato/uso terapéutico , Enfermedades del Prematuro/prevención & control , Ictericia Neonatal/prevención & control , Bilirrubina/sangre , Ensayos Clínicos como Asunto , Método Doble Ciego , Femenino , Edad Gestacional , Humanos , Recién Nacido , Ictericia Neonatal/terapia , Masculino , Fototerapia , Factores de TiempoRESUMEN
The ultrasonic detection of periventricular leukomalacia is described in two neonatal patients. Confirmation of this condition by CT and post mortem was obtained in one case. CT scan and further echography was positive in the other. Neither patient had evidence of an intracranial hemorrhage. It is suggested that echography is of value in the early diagnosis of this lesion which may be similar to intraparenchymal hemorrhage in its mechanism and prognosis.
Asunto(s)
Ventrículos Cerebrales/patología , Ecoencefalografía , Encefalomalacia/patología , Recien Nacido Prematuro , Encefalopatías/diagnóstico , Isquemia Encefálica/complicaciones , Diagnóstico Diferencial , Encefalomalacia/diagnóstico , Encefalomalacia/etiología , Hemorragia/diagnóstico , Humanos , Recién Nacido , Masculino , Tomografía Computarizada por Rayos XRESUMEN
The neonatal diagnosis of neuro-muscular diseases is difficult. From a series of 11 neonates presenting with such diseases, ante and postnatal semiology has been studied. During pregnancy, hydramnios (7/11) and decreased active movements were the most frequent symptoms. Delivery was often dystotic (7/11). After birth, respiratory distress, lack of motility, hypotonia, and muscle and tendon retraction were the clinical manifestations (10/11). Knowledge of this semiology should facilitate the ante and postnatal screening of affected patients. The diagnosis depends on family history and, overall, on the results of muscle biopsy.
Asunto(s)
Enfermedades Neuromusculares/diagnóstico , Biopsia , Distocia/etiología , Femenino , Humanos , Recién Nacido , Hipotonía Muscular/etiología , Músculos/patología , Polihidramnios/etiología , Embarazo , Diagnóstico Prenatal , Radiografía Torácica , Síndrome de Dificultad Respiratoria del Recién Nacido/etiología , Factores de TiempoRESUMEN
In a preterm infant (28 week gestation), the chest film performed at 1 hour of life because of mild respiratory insufficiency showed a massive opacity of the right hemithorax. Congenital cystic adenomatoid malformation was suspected on the basis of ultrasonographic findings of multiple cysts. It was confirmed by further X ray examination and pathologic findings. This unusual case shows the ultrasonographic pattern and X ray evolution of this rare malformation.
Asunto(s)
Pulmón/anomalías , Humanos , Recién Nacido , Pulmón/diagnóstico por imagen , Masculino , Radiografía , UltrasonografíaRESUMEN
Serum C Reactive Protein (CRP) levels were measured in 36 neonates with a suspicion of sepsis. In the 11 children in whom septicemia was proven, CRP levels were abnormal in all cases, while hematologic data were significantly changed in 3 cases only (27%). In the 16 neonates who were not infected, CRP was abnormal in only one case, and hematologic data significantly changed in 2 (12%). In 9 neonates with at least 2 peripheral samples positive for the same organism, CRP and hematologic data were respectively abnormal in 6 (66%) and one (11%) cases.