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BACKGROUND: Bradycardia in preterm infants may require anticholinergic therapy (diphemanil methylsulphate). Such treatment may cause prolongation of QT interval and auriculoventricular block. CASE REPORTS: Three premature infants born before 34 weeks of gestational age were given 6-8 mg/kg/d diphemanil because they suffered from bradycardiac episodes. Aggravation and/or persistence of bradycardia required withdrawal of gavage feeding: heart block occurred within a few hours which subsided after cessation of diphemanil and oral refeeding. Diphemanil at progressive dosage was later introduced safely in two of these infants. CONCLUSION: The short interval of time between the oral feeding withdrawal and occurrence of heart block justified therapy be stopped or transiently reduced whenever oral feeding must be interrupted.

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We report the case of a newborn who showed typical signs of rickets at birth craniotabes and severe hypocalcemia. The diagnosis of fetal rickets was confirmed by radiography. Maternal deficiency was revealed by an excessively low vitamin D level. The multiparous Moroccan mother had suffered low back pain and paraesthesia for several years. She wore the veil and rarely left her home. Nutritional and vitamin D deficiency was demonstrated. We report this exceptional case to recall the importance of vitamin D in the development of fetal calcium supply, the prevention of gravid osteomalacia and the prevention of neonatal hypocalcemia. Vitamin D supplementation (ideally 1000 IU per day during the third trimester or at least one 100,000 IU dose at the sixth and eighth months or a single dose of 2 to 3,000,000 IU at the sixth month) should be the rule in pregnancy.

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The development of cardiorespirography with data processing enables to perform polygraphic recordings. However the standardized results supplied by this new generation of equipment cannot be used directly and need to be validated and analized by the clinician. The confrontation of the cardiac and respiratory curves allows a semiological analysis of the cardiac and respiratory functions and of their relationships in the various syndromic contexts encountered in the neonate (bradycardia and other cardiac arythmia, central or obstructive apnea, thoracic hypoampliation, periodic breathing).

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OBJECTIVE: Determine the circumstances and conditions concerning ethical problems raised by medical abortions treated in a certain number of University Hospitals. METHODS: Survey using a questionnaire during the first three months of 1993 in 15 gynaecology-obstetrics wards in University Hospitals in France. RESULTS: Fourteen responses were analysed. Usually with complementary open comments. CONCLUSION: Situations raising ethical problems concerning fetal medicine were encountered in approximately 5% of the pregnancies followed at the university Hospitals. Medical abortion was performed in 2% of the pregnancies. Gynaecologist-obstetricians prefer maintaining their control over prenatal diagnosis, especially when the outcome in medical abortion.

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BACKGROUND: Post-natal growth curves for low birth-weight infants published in 1948 by Dancis et al are still used in many neonatal units. The aim of this study is to determine whether these curves are still valid or not. POPULATION AND METHODS: Thirty or more infants whose birthweights were 1000 +/- 125, 1250 +/- 125, 1500 +/- 125, 1750 +/- 125, 2000 +/- 125, 2250 +/- 125 and 2500 +/- 125 g were included in the study from September 1989 to September 1992. Inclusion criteria were: gestational age (GA) less than 37 weeks, absence of intra-uterine growth retardation, enteral feeding during the first post-natal week, absence of severe post-natal disease. The curves of weight were compared to those obtained by Dancis. RESULTS: The six curves established for those infants having a birthweight from 1250 +/- 125 to 2500 +/- 125 g were quite similar to Dancis' curves. The number of infants weighing 1000 +/- 125 g at birth was not sufficient to be included in the study. CONCLUSIONS: The curves established by Dancis from low birth-weight infants of all types (including intra-uterine growth retardation) are still valid to follow post-natal growth of appropriate weight for GA premature infants.

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OBJECTIVE: To evaluate the regional programme designed to train personnel for resuscitation of the neonate in the delivery room and organized in the district of Centre, France in 1990. STUDY: Transversal study. SITE: The different maternities of the district. POPULATION: 31 maternities, 156 persons in charge of neonates in the delivery room including medical personnel (doctors, mid-wives) and paramedics, with or without any special training in 1990. METHOD: A single evaluator visited each maternity and met the personnel involved. The modalities of the evaluation were not given in advance and included a census of the personnel who had participated in the training programme and changes in material. The success of the training programme was evaluated on a theoretical and practical basis for the personnel and on the number of severe meconium aspirations observed. RESULTS: The training programme had reached 53% of the personnel involved. It had a wide impact both in terms of changed material and in neonatal resuscitation rates compared with untrained personnel. The number of severe meconium aspirations fell from 3 in 1989 to 0 in 1990.

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The birth and subsequent hospitalization of very low birth weight premature infants can be a psychological shock for parents which may disturb further relationships between infant and parents. The parents' memories from the birth period of 94 very low birthweight premature infants (< 32 weeks of gestational age) have been analyzed by way of an interview. This study has shown the painful aspect of the birth and of the parents' first meeting with the infant. However, despite these first difficulties, the relationship normally improves with time.

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BACKGROUND: In neonatal units, there is a tendency to assume that any acutely sick infant with gastro-intestinal symptoms has necrotizing enterocolitis (NEC). This prospective study was conducted to find a better definition of enteropathy in preterm neonates and their risk factors. MATERIAL AND METHODS: All the 351 preterm neonates admitted to a neonatal unit from 1 August 1988 to 31 July 1989 were included in the study. A chart including 45 items was established for each infant, with special attention to data on the pregnancy, delivery, any early ischemic and/or infectious problem, nutrition and any gastro-intestinal (GI) problem. All the neonates were fed similarly, depending their maturation, gestational age and GI status. Each infant was assigned to one of 5 categories: 1) no GI problem; 2) transient obstruction; 3) NEC with pneumatosis; 4) hemorrhagic colitis without obstruction or pneumatosis; 5) other GI disease. RESULTS: 267 infants had no GI problem during their stay in the neonatal unit. 53 developed GI symptoms: 23 transient obstructions, 6 NEC, and 24 hemorrhagic colitis. The mean age at onset of symptoms in these last 3 categories was 7 days, 14 days and 23 days, respectively. Ten risk factors were found to be significantly correlated with GI disturbances: umbilical venous catheter, benzodiazepines, birth weight < 1,500 g, patent ductus arteriosus, ventilatory assistance, abnormal amniotic fluid, gestational age < 32 weeks, early antibiotic treatment, passage of meconium > 48 hours, episodes of apnoea and/or bradycardia. CONCLUSION: This follow-up shows that the GI disturbances of preterm neonates admitted to a neonatal unit, specially those having one or more risk factors, can be separated into 3 groups: 1) isolated intestinal obstruction, seen in the most immature babies during the first week of life with the risk of developing NEC; 2) frank blood in the stool, indicating colitis and possibly minor forms of NEC; 3) combined obstructive and hemorrhagic symptoms, typical of NEC.

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Cutaneous pigmentation, lingual leukoplasia and dystrophic changes of nails are present in the two cases. The other clinical manifestations are dental alterations, epiphora, loss of dermal ridges of the pulp with hyperhidrosis, atrophic skin of the dorsum of the hands. Dysphagia and bone marrow hypoplasia are present in one case. The proband (case 1) has normal values for the following: hemoglobin electrophoresis, pyruvate kinase, marrow and blood chromosome analysis. Biopsy of pigmented skin showed an atrophic epidermis with orthokeratotic-hyperkeratosis; in the higher dermis there were several melanophores. Multiple layers of vasal lamina are seen under electron microscopy. The parents and the two daughters are free of clinical or hematologic manifestations. The mother and her two affected sons have A1-BW 27 HLA haplotype. X-linked transmission is discussed.

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In this study, the urinary H.V.A. of new borns and of older children was measured. The urinary H.V.A. titer of the new borns was found to be significantly greater than in older children. Moreover the increase is more pronounced when those infants are born prematurely. Former studies have shown that the metabolism of central nervous system catecholamine reflected by the urinary titers of H.V.A. is as accurate as titers measured in the CSF. Recently several authors have found increased titers of urinary H.V.A. in autistic children. It is therefore possible that the elevated urinary H.V.A. titers in the new born are due to an immaturity of the dopaminergic structures. Blocking these structures provokes an accelerated catecholamine turnover, thereby increasing the levels of catecholamines metabolites (most notably H.V.A.).

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