Aims of the study.-This prospective study aimed to analyze the relationship between EEG at 6 weeks after birth and cognitive outcome at the age of 5 in children born very preterm who did not present with severe neonatal cerebral abnormalities.Patients and methods.-EEGs were recorded at 6 weeks of age in infants born <29 weeks of gestation or weighing < 1000 g at birth. At 5 years, study participants underwent a neurological assessment and cognitive evaluation with the Kaufman Assessment Battery for Children (K-ABC).Results.-Fifty-eight children had an EEG at 6 weeks after birth. Fifty-one were evaluated at 5 years. Twenty-six children (51.0%) had one or more disabilities: neuromotor, sensory, behavioral, and/or cognitive. Children with EEG abnormalities had significantly more disabilities (20 of 25, 80%) than children with normal EEG (6 of 26, 23%) (P=0.0002). Thirty-five children underwent complete K-ABC assessment. Multiple linear regression analysis indicated a significant relationship between the overall EEG abnormalities (normal, dysmature, and/or disorganized) and two scales: mental processing composite (MPC) scales (P=0.0121), and sequential processing scales (P=0.0012). Dysmature EEGs were more predictive of lower MPC and sequential processing scales than disorganized EEGs. Immature occipital slow waves (i.e., too high for conceptional age) were consistently recorded in children with dysmature EEGs and associated with the lowest K-ABC scores.Conclusion.-EEG abnormalities recorded at 6 weeks after birth, such as immature occipital slow waves, were associated with later cognitive impairments. EEG. at 6 weeks can be an early and reliable tool for assessing the risk of future cognitive impairment. (C) 2013 Elsevier Masson SAS. All rights reserved.

Objective: To analyze EEG findings, especially chronic-stage EEG abnormalities, i.e., dysmature and disorganized patterns, during the late neonatal period in very premature infants without severe early cranial ultrasound and/or EEG abnormalities.Methods: EEGs were recorded at 6 weeks of life in very immature or hypotrophic premature infants (less than 29 weeks gestational age or less than 1000 g at birth). EEG findings were correlated with the children's psychomotor and sensorial assessment at 12-month corrected age.Results: Fifty-eight infants were studied. Abnormal EEGs were observed in 28 infants: 7 infants with dysmature EEGs, 13 infants with disorganized EEGs, and 8 infants with dysmature-disorganized EEGs. At 12-month corrected age, 15 of 28 infants had various neurological abnormalities. Normal EEGs were observed in 30 infants. None of these infants showed any marked motor or cognitive impairment. The neurological abnormality difference between these two groups of infants was highly significant (p < 0.0001).Conclusion: At 6 weeks of life, EEG may be helpful in refining neurological risk in very premature neonates.Significance: EEGs recorded at 6 weeks of age may be a valuable predictive tool in addition to early EEG and cranial ultrasound. (C) 2010 Published by Elsevier Ireland Ltd. on behalf of International Federation of Clinical Neurophysiology.

The hepatitis B serovaccination is efficient with four vaccinal doses. In infants born to hepatitis Be antigen-positive carrier mothers the efficacy could be improved increasing the dose of hepatitis B immunoglobulins (0.6 ml/kg) at birth and adding a second dose (0.6 ml/kg) at 3 weeks of life. A careful serological follow-up could be also suggested.

MOTS CLÉS Prévention de l’hépatite B ; Nouveau-né ; Antigène HBs ; Antigène HBe Résumé But. — Évaluer l’efficacité de la sérovaccination de l’hépatite B chez des nouveau-nés de mères porteuses chroniques de l’hépatite B. Patients et méthodes. — Cette étude a été réalisée sur neuf ans chez des nouveau-nés de mères porteuses chroniques de l’hépatite B. Ceux-ci ont reçu à la naissance 0,3 ml/kg d’immunoglobulines anti-HBs et un vaccin contre l’hépatite B renouvelé ensuite à un, deux et 12 mois, seul chez les enfants de mères AgHBs+, AgHBe− et associé avec une deuxième dose d’immunoglobulines anti-HBs à un mois chez les enfants de mères AgHBs+ et AgHBe+. Résultats. — Soixante enfants ont été inclus. Cinquante-sept enfants (95,0 %) n’ont pas été contaminés. Les deux enfants contaminés étaient nés de mères porteuses chroniques des AgHBs et AgHBe. Le premier a présenté une hépatite chronique par contamination anténatale probable et le second une hépatite aiguë par contamination périnatale verticale. Seize enfants (31,4 %) avaient une mauvaise réponse vaccinale un à trois mois après la troisième dose vaccinale. Conclusion. — La sérovaccination anti-VHB est efficace avec un schéma vaccinal de quatre doses, mais pourrait être encore améliorée chez les enfants nés de mères porteuses chroniques des AgHBs et AgHBe en proposant à la naissance une dose d’immunoglobulines de 0,6 ml/kg, renouvelée à trois semaines de vie et en assurant une surveillance sérologique attentive. © 2009 Elsevier Masson SAS. Tous droits réservés.

Objectives. - To evaluate the efficacy of hepatitis B serovaccination in neonates born to HBsAg carrier mothers.Materials and methods. - This study was performed in neonates born to HBsAg carrier mothers. They received one dose of hepatitis B immunoglobulins (0,3 ml/kg) at birth and four doses of vaccine (0, 1, 2 and 12 months of age). A second dose of hepatitis B immunoglobulins was given at 1 month of age in neonates born to hepatitis Be antigenpositive carrier mothers.Results. - Sixty infants were included. Fifty-seven infants (95,0%) were not infected. The two infected infants were born to hepatitis Be antigen-positive carrier mothers. One infant was chronically infected by hepatitis B virus antenatal transmission and the second one developed an acute hepatitis by vertical perinatal transmission. One to 3 months after the third vaccinal dose, 16 infants (31,4%) were poor responders to vaccine.Conclusion. - The hepatitis B serovaccination is efficient with four vaccinal. doses. In infants born to hepatitis Be antigen-positive carrier mothers the efficacy could be improved increasing the dose of hepatitis B immunoglobulins (0,6 ml/kg) at birth and adding a second dose (0,6 ml/kg) at 3 weeks of life. A careful serological follow-up could be also suggested. (C) 2009 Elsevier Masson SAS. All rights reserved.

We report the case of a baby born to a hepatitis B virus (HBV) carrier mother. This infant had a hepatitis B e antigen (HBeAg) in the serum until 6 months of age. Serial sera samples were analysed for HBV markers. No breakthrough of HBV infection was detected. The origin of this HBV marker has been questioned.Conclusion: HBeAg can persist at a non-infected baby born to an HBeAg-positive mother up to the age of 6 months.

In full-term newborns, unilateral and recurrent clonic seizures which occur during the first 48 hours of life suggest an isolated unilateral ischemic stroke. These focal seizures are isolated, occuring during a short period, or make up a status epilepticus. Electroencephalogram (EEG) is a key tool for crisis and focal cerebral process diagnosis. It also allows to assess antiepileptic drugs effectiveness. But cerebral imaging is necessary to confirm vascular origin of the cerebral impairment. Hematologic data are also needful to look for a family thromphilia. Some particular unilateral EEG abnormalities could be associated with controlateral motor sequelae or long term behavioral problems. These findings may be used for prospective studies aimed at specifying possible links between EEG abnormalities and long term outcome.

AIM:To estimate the re-hospitalization rate of extremely preterm children during infancy and associated factors after the recent improvement in survival rates.METHOD:The cohort included all children born before 29 wk of gestation in nine French regions in 1997. All admissions between discharge from initial hospitalization and 9 mo after birth were considered. Factors studied included the child's characteristics at birth and during neonatal hospitalization, risk factors for infection after discharge and parents' socio-demographic characteristics. Adjusted odds ratios (aOR) for re-hospitalization for all reasons and for respiratory disorders were obtained from logistic regression models.RESULTS:Of the 376 children, 178 were re-admitted at least once (47.3%; 95% CI: 42.3-52.4). Fifty-five percent of the hospitalized children were admitted at least once for respiratory disorders. The re-hospitalization rate was higher for children who had had chronic lung disease (aOR: 2.2; 95% CI: 1.3-3.7), those initially discharged between August and October (aOR: 2.5; 95% CI: 1.2-5.1) or between November and January (aOR: 3.2; 95% CI: 1.5-6.8), and children living with other children under six (aOR: 3.4; 95 %CI: 1.6-7.5). Re-hospitalizations were associated with neither gestational age nor the duration of neonatal hospitalization. Adjusted odds ratios for re-hospitalization for respiratory tract disorders were very similar to those for the overall hospitalizations.CONCLUSION:Infants born before 29 wk have a very high risk of re-hospitalization. The associated factors can help define high-risk groups at discharge from the neonatal unit who need special surveillance.

The aims of this study were to describe EEG anomalies in unilateral neonatal ischemic stroke without hypoxic-ischemic encephalopathy, and to determine possible links between these abnormalities and long-term outcome. In 6 full-term newborns without severe fetal distress ischemic stroke was confirmed by computed tomography and/or magnetic resonance imaging. Twenty EEGs were recorded during the neonatal period, 5 in acute stage and 15 later. The duration of the follow-up ranged from 3 to 9 years. All newborns developed unilateral clonic seizures, right-sided (5 cases) or left-sided (1 case); seizures began between 14 and 48 h of life. At follow-up, 3 children were normal at 2 and 6 years of age, while the 3 others had sequelae: epilepsy at 9 years of age in one, and unilateral mild cerebral palsy in the 2 others (3 and 4 years of age), with behavioral problems in one of them. Critical EEG discharges, rhythmic sharp waves and/or slow waves were recorded on the injured side. Abnormalities of interictal activity were excess of alpha or theta rhythms, transitory EEG discontinuity or low voltage. The 2 children with cerebral palsy had numerous unilateral post-ictal positive rolandic slow sharp waves (PRSSWs), which were similar to the positive rolandic sharp waves of premature infants; the child with behavioral problems had numerous positive left-sided temporal fast sharp waves. PRSSWs could be associated with contralateral motor sequelae, while positive left temporal fast sharp waves were associated with long term behavioral problems. These findings may be used for future prospective studies aimed at specifying the relation between EEG abnormalities and long-term outcome.

The aims of this study were to describe EEG anomalies in unilateral neonatal ischemic stroke without hypoxic-ischemic encephalopathy, and to determine possible links between these abnormalities and long-term outcome. In 6 full-term newborns without severe fetal distress ischemic stroke was confirmed by computed tomography and/or magnetic resonance imaging. Twenty EEGs were recorded during the neonatal period, 5 in acute stage and 15 later. The duration of the follow-up ranged from 3 to 9 years. All newborns developed unilateral clonic seizures, right-sided (5 cases) or left-sided (I case); seizures began between 14 and 48 h of life. At follow-up, 3 children were normal at 2 and 6 years of age, while the 3 others had sequelae: epilepsy at 9 years of age in one, and unilateral mild cerebral palsy in the 2 others (3 and 4 years of age), with behavioral problems in one of them. Critical EEG discharges, rhythmic sharp waves and/or slow waves were recorded on the injured side. Abnormalities of interictal activity were excess of alpha or theta rhythms, transitory EEG discontinuity or low voltage. The 2 children with cerebral palsy had numerous unilateral post-ictal positive rolandic slow sharp waves (PRSSWs), which were similar to the positive rolandic sharp waves of premature infants; the child with behavioral problems had numerous positive left-sided temporal fast sharp waves. PRSSWs could be associated with controlateral motor sequelae, while positive left temporal fast sharp waves were associated with long term behavioral problems. These findings may be used for future prospective studies aimed at specifying the relation between EEG abnormalities and long-term outcome. (C) 2003 Editions scientifiques et medicales Elsevier SAS. Tous droits reserves.

Objectives: Objectives were to precise EEG criteria of normality in very premature infants.Methods: The neonatal electroencephalograms (EEGs) of 17 neurologically normal very premature infants recorded at a conceptional age (CA) of 26-28 weeks have been analyzed. The normality of the infants was defined as normal neonatal cranial ultrasound scans and normal neurological outcome at a minimum postnatal age of 2 years.Results: All tracings were discontinuous. The bursts (amplitude greater than or equal to 30 muV) were interhemispherically synchronous and lasted up to 3 min. The interburst intervals lasted up to 46 s. EEG patterns consisted mainly of slow waves (less than or equal to3 Hz), with high amplitude (up to 300 muV), occipital predominance and superimposed alpha, beta and theta rhythms. High amplitude theta rhythms predominated on temporal areas, beta rhythms were mainly central, whereas alpha rhythms were central and occipital. Sleep state differentiation began as early as 26 weeks CA. On a given trace, the existence of more mature graphoelements than expected for the CA reflected a normal increasing maturation.Conclusions: EEG has constant and reproductible patterns in normal very premature infants. This can constitute a basis for the determination of EEG criteria for neurological prognosis in infants of 26-28 weeks CA. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.

Abstract 1314 Poster Session IV, Tuesday, 5/4 (poster 242) With the increasing survival of extremely premature infants, the need for early, simple and reliable tools to establish neurological prognosis evaluation is becoming crucial. Characteristics and usefulness of EEG are well assessed in mature newborns. The aim of this study is to define reference criteria for EEG in very premature infants. Methods: the neonatal EEGs of 17 neurologically normal preterm infants, < 28 weeks gestational age (GA) have been analyzed. EEGs have been recorded during 40 to 60 minutes, on day 3, 7 and 15 to 21 with the conventional method. Normality of the infants was defined as the absence of any clinical abnormality within the neonatal period, normal head ultrasounds, and normal neurological outcome at 2 years of age or more. The analysis assessed continuity (i.e. duration of bursts with an amplitude ≥30µv), discontinuity (i.e. duration of interburst intervals), EEG patterns (α, β, δ, θ rhythms and other transients), temporal and spatial organization as well as sleep-wake differentiation. Results: all tracings show discontinuities lasting up to 46 sec. Bursts are usually synchronous, lasting up to 3 minutes. EEG patterns consist mainly of δ waves (≤ 2 Hz), with high amplitude (up to 300µv) and occipital predominance. Other rhythms occur in short bursts: α, β, θ, intermixed with the δ waves. High rhythmic θ waves predominate on temporal areas, β waves are mainly rolandic, α waves are rolandic and occipital, reflecting spatial organization. These different rhythms are often organized in "spindle-shaped" bursts: the amplitude of the waves slightly increasing then decreasing during the burst. Sporadic multifocal sharp waves and frontal sharp transients may be observed. Variations in the continuity are related to the onset of clinical sleep differentiation. Some EEGs show patterns more mature than expected for the actual GA. Conclusion: in premature infants < 28 weeks GA, EEG is a useful tool with constant reference patterns in normal infants. The different rhythms occur in characteristic "spindle-shaped" bursts. Discontinuous intervals up to 46 sec are normally observed. Patterns more mature than expected for GA suggest a progressing maturation. Further studies are needed to delineate the limits between these physiologic tracings and the appearance of other patterns, in addition to the well-known positive rolandic sharp waves, recorded in infants presenting neurological abnormalities.

This study was performed to assess the predictive value of EEG in HIE following acute fetal distress. For 38 full-term neonates, EEG was recorded at least before 48 hours of life and between 2 and 7 days. Neurological outcome was evaluated at a minimum age of one year. Normal or slightly abnormal early EEGs (14 cases) were observed with normal outcome (13 cases) or minor sequelae (1 case). Extremely abnormal early EEGs were associated with death (5 cases), severe sequelae (4 cases) or normal outcome (1 case); among the "intermediate" group (14 cases), improvement of background activity before 7 days indicated a good prognosis (4/5), whereas identical or worsened activity was noted in all cases with a poor outcome. Of neonates 90% with very abnormal EEGs and 64.3% with "intermediate" EEG presented a significantly unfavourable outcome compared with neonates having normal recordings (p < 0.0001). The EEG before 48 hours has an excellent sensitivity rate (94.7%) but a less satisfactory specificity rate (68.4%).

Background. Cases of fifth day fits, first described in 1977, remain rare. Their cause is not known and each report contributes to knowledge of the phenomenon.Patients and methods. Sixteen infants born between December 1971 and January 1992 were selected because they were admitted to our department for convulsions satisfying the criteria for fifth day fits. Their files were carefully analysed, with special attention paid to pregnancy, delivery, clinical status after birth, EEG during the crisis and some laboratory data. Follow-up was also considered.Results. The frequency of these fits remained stable until 1985; only 2 cases have been seen since then. There was no seasonal variation. The characteristic EEG pattern was seen in only 10 patients. All the laboratory data were negative. Follow-up with sufficient duration (1 to 12 years) provided only 8 cases satisfying all the classical criteria. The convulsions of one patient could be attributed to perinatal anoxia, 2 other patients developed epilepsy, and possible perinatal causes could have been neglected in 2 cases.Conclusion. This study provides no new information on the cause of fifth day fits. Disturbances of brain maturation might be responsible,