Objective: The study aimed to address the challenge of early assessment of neonatal hypoxic-ischemic encephalopathy (HIE) severity to identify candidates for therapeutic hypothermia (TH). The objective was to develop an automated classification model for neonatal EEGs, enabling accurate HIE severity assessment 24/7. Methods: EEGs recorded within 6 h of life after perinatal anoxia were visually graded into 3 severity groups (HIE French Classification) and quantified using 6 qEEG markers measuring amplitude, continuity and frequency content. Machine learning models were developed on a dataset of 90 EEGs and validated on an independent dataset of 60 EEGs. Results: The selected model achieved an overall accuracy of 80.6% in the development phase and 80% in the validation phase. Notably, the model accurately identified 28 out of 30 children for whom TH was indicated after visual EEG analysis, with only 2 cases (moderate EEG abnormalities) not recommended for cooling. Conclusions: The combination of clinically relevant qEEG markers led to the development of an effective automated EEG classification model, particularly suited for the post-anoxic latency phase. This model successfully discriminated neonates requiring TH. Significance: The proposed model has potential as a bedside clinical decision support tool for TH. (c) 2024 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Objectives: Controlled therapeutic hypothermia (CTH) is a standard of care in the management of neonatal hypoxic-ischemic encephalopathy HIE in newborns after 36 weeks of gestational age (WGA) in France. The electroencephalogram (EEG) plays a major role in HIE diagnosis and fol-low-up. We conducted a French national survey on the current use of EEG in newborn undergoing CTH.Methods: Between July and October 2021, an email survey was sent to the heads of the Neonatal intensive care units (NICUs) in metropolitan and overseas French departments and territories. Results: Out of 67, 56 (83%) of NICUs responded. All of them performed CTH in children born after 36 WGA with clinical and biological criteria of moderate to severe HIE. 82% of the NICUs used conventional EEG (cEEG) before 6 h of life (H6), prior to CTH being performed, to inform decisions about its use. However, half of the 56 NICUs had limited access after regular working hours. 51 of the 56 centers (91%) used cEEG, either short-lasting or continuous monitoring during cooling, while 5 centers conducted only amplitude EEG (aEEG). Only 4 of 56 centers (7%) used cEEG systematically both prior to CTH and for continuous monitoring under CTH.Discussion: The use of cEEG in the management of neonatal HIE was widespread in NICUs, but with significant disparities when considering 24-hour access. The introduction of a centralized neurophysiological on-call system grouping several NICUs would be of major interest for most centers which do not have the facility of EEG outside working hours.& COPY; 2023 Elsevier Masson SAS. All rights reserved.

Abstract Background RSV is an extremely common respiratory pathogen and a leading cause of infant hospitalisation. An estimated 1 in 7 infants will develop an RSV lower respiratory tract infection (LRTI) requiring medical attention. The majority of infants hospitalised have no comorbidities and were born at term. Nirsevimab is the only preventative option designed to provide protection to all infants from RSV LRTI, from the start of their first RSV season, for the duration of that season. In the HARMONIE trial conducted in the UK, France, and Germany (EudraCT 2022-000099-20), we evaluated the impact of nirsevimab on all cause LRTI hospitalisations, as well as RSV LRTI specifically. Analyses looked at the efficacy of nirsevimab across subgroups that constitute the all infant population, all of whom are vulnerable throughout their first RSV season. Methods Individually randomised infants (≥29 weeks gestational age) received a single intramuscular injection of nirsevimab (< 5 kg 50 mg; ≥5 kg 100 mg), or no intervention (standard of care) before or during the RSV season. Following a single physical visit participants were monitored remotely for all cause LRTI hospitalisation (secondary endpoint, defined as treating physician decision to admit to in-patient care for >24 hours). Efficacy was evaluated through the RSV season. Adverse events (AEs) continue to be monitored for 365 days. Results 8058 infants were randomized, 4037 to the nirsevimab group and 4021 to the no intervention group. Efficacy against RSV LRTI was 83.21% (CI 67.77-92.04%) across all countries. Efficacy was consistent across infant subgroups, in those born at term (≥ 37 weeks: 84.41% (CI 64.92-94.10%)) or prematurely (< 37 weeks: 78.31% (CI 33.49-94.69%)) and not impacted by infant weight at randomisation (< 5kg: 82.12% CI 59.14-93.30% and ≥ 5kg 85.16% CI 57.01-96.25%). Efficacy against all cause LRTI hospitalisation was 58.04% (39.693- 71.19). Conclusion A single dose of nirsevimab given before or during the RSV season demonstrated a significant and sustained impact on RSV LRTI hospitalisations for the entire RSV season. Consistent efficacy was shown across subgroups comprising the all infant population.The potential impact of nirsevimab was reinforced by a reduction in all cause LRTI hospitalisations. Disclosures Saul N. Faust, FRCPCH PhD, AstraZeneca, Janssen, Pfizer, Moderna, GlaxoSmithKline, Novavax, Sanofi, Seqirus, Medimmune, Merck, MSD, Iliad and Valneva: Advisor/Consultant|AstraZeneca, Janssen, Pfizer, Moderna, GlaxoSmithKline, Novavax, Sanofi, Seqirus, Medimmune, Merck, MSD, Iliad and Valneva: Investigator Katrina Cathie, MBE, FRCPCH, AstraZeneca: Advisor/Consultant|GSK: Advisor/Consultant|Iliad: Advisor/Consultant|Janssen: Advisor/Consultant|MedImmune: Advisor/Consultant|Merck: Advisor/Consultant|Pfizer: Advisor/Consultant|Sanofi: Advisor/Consultant|Valneva: Advisor/Consultant SB Drysdale, FRCPCH, PhD, AstraZeneca: Advisor/Consultant|iLiAD: Advisor/Consultant|Janssen: Advisor/Consultant|Moderna: Advisor/Consultant|MSD: Advisor/Consultant|Pfizer: Advisor/Consultant|Sanofi: Advisor/Consultant|Valneva: Advisor/Consultant S Royal, FRCGP, Sanofi: Advisor/Consultant C Felter, MD, Sanofi: Employee NC Vassilouthis, MD, Sanofi: Employee Mathieu Bangert, PhD, Sanofi: Staff member K Mari, PhD, Sanofi: Employee R Nteene, MD, Sanofi: Employee M Roberts, MD, Sanofi: Employee P Tissieres, MD, Baxter: Advisor/Consultant|PAion: Advisor/Consultant|Sanofi: Advisor/Consultant|Sedana: Advisor/Consultant

La période des 1000 premiers jours de vie est reconnue comme étant une fenêtre de vulnérabilité pouvant avoir un impact à long terme sur la santé des individus. La cohorte PENSINE (Périnatalité, environnement, santé intestinale et nutrition de l'enfant) vise à évaluer l'impact de l'allaitement sur la santé intestinale de l'enfant. L'objectif principal de ce travail est de caractériser la cohorte PENSINE et la comparer à la population générale ayant accouché dans la maternité (groupe MAT) réalisant l'étude. La cohorte prospective PENSINE vise à déterminer l'impact de l'allaitement sur la santé intestinale des enfants à l'âge de 4 ans à partir de couples mère/enfant inclus à la maternité participant à l'étude. Les 180 premiers couples mère/enfant inclus ont été caractérisés et comparés à la population de la même maternité (groupe MAT) n'ayant pas participé à l'étude sur des variables d'intérêt de façon à identifier les spécificités de la cohorte. En réponse au critère d'évaluation principal, le groupe d'enfants allaités exclusivement pendant au moins 3 mois (AM) a été comparé au groupe d'enfants ayant reçu un allaitement artificiel et/ou mixte (AAm) selon ces mêmes variables d'intérêt afin d'évaluer l'homogénéité de la cohorte. Comparativement au groupe MAT, l'âge maternel moyen à l'accouchement (32,2 ± 4,3 vs 31,3 ± 5,3 ans ; p < 0,01), le terme moyen (40 + 1 ± 1,0 vs 39 + 2 ± 1,2 SA ; p < 0,001) et le taux d'allaitement exclusif pendant le séjour à la maternité (78,5 vs 60,0 % ; p < 0,001), étaient plus élevés dans la cohorte PENSINE, alors que le taux de prématurité était plus faible (1,6 vs 7,1 % ; p < 0,01). Le taux d'accouchement par voie basse (83,3 vs 81,2 % ; p = 0,47), le poids moyen de l'enfant à la naissance (3431 ± 416 vs 3363 ± 468 g ; p = 0,06) et la proportion de filles (57,6 vs 50,3 % ; p = 0,09) n'étaient pas différents entre les deux groupes. Excepté le taux d'allaitement exclusif pendant le séjour à la maternité, aucune différence significative n'était retrouvée pour ces mêmes variables entre les sous-groupes AM et AAm de la cohorte PENSINE. Cette analyse préliminaire montre que la cohorte PENSINE possède des spécificités par rapport à la population totale de la maternité. Il existe toutefois une homogénéité des données de naissance entre les enfants ayant été allaité exclusivement ou non lors des 3 premiers mois de vie. Ces informations seront à prendre en considération lors des analyses des variables cliniques, anthropométriques et biologiques afin d'évaluer leur impact sur la santé intestinale de l'enfant sain.

AIM:To determine the prognostic value of conventional electroencephalography (EEG) monitoring in neonatal hypoxic-ischemic encephalopathy (HIE).METHOD:In this multicentre retrospective study, 95 full-term neonates (mean of 39.3wks gestational age [SD  1.4], 36 [38%] females, 59 [62%] males) with HIE (2013-2016) undergoing therapeutic hypothermia were divided between favourable or adverse outcomes. Background EEG activity (French classification scale: 0-1-2-3-4-5) and epileptic seizure burden (epileptic seizure scale: 0-1-2) were graded for seven 6-hour periods. Conventional EEG monitoring was investigated by principal component analysis (PCA), with clustering methods to extract prognostic biomarkers of development at 2 years and infant death.RESULTS:Eighty-one per cent of infants with an adverse outcome had a French classification scale equal to or greater than 3 after H48 (100% at H6-12). The H6-12 epileptic seizure scale was equal to or greater than 1 for 39%, increased to 52% at H30-36 and then remained equal to or greater than 1 for 39% after H48. Forty-five per cent of infants with a favourable outcome had a H6-12 French classification scale equal to or greater than 3, which dropped to 5% after H48; 13% had a H6-12 epileptic seizure scale equal to or greater than 1 but no seizures after H48. Clustering methods based on PCA showed the high efficiency (96%) of conventional EEG monitoring for outcome prediction and allowed the definition of three prognostic EEG biomarkers: H6-78 French classification scale mean, H6-78 French classification scale slope, and H30-78 epileptic seizure scale mean.INTERPRETATION:Early lability and recovery of physiological features is prognostic of a favourable outcome. Seizure onset from the second day should also be considered to accurately predict neurodevelopment in HIE and support the importance of conventional EEG monitoring in HIE in infants cooled with therapeutic hypothermia.WHAT THIS PAPER ADDS:Comprehensive analysis showed the high prognostic efficiency (96%) of conventional electroencephalography (EEG) monitoring. Prognostic EEG biomarkers consist of the grade of background EEG activity, its evolution, and the mean seizure burden. Persistent seizures (H48) without an improvement in background EEG activity were consistently associated with an adverse outcome.

Background Patients in neonatal intensive care units (NICUs) are at high risk of adverse events. The effects of medical and paramedical education programmes to reduce these have not yet been assessed. Methods In this multicentre, stepped-wedge, cluster-randomised controlled trial done in France, we randomly assigned 12 NICUs to three clusters of four units. Eligible neonates were inpatients in a participating unit for at least 2 days, with a postmenstrual age of 42 weeks or less on admission. Each cluster followed a 4-month multifaceted programme including education about root-cause analysis and care bundles. The primary outcome was the rate of adverse events per 1000 patient-days, measured with a retrospective trigger-tool based chart review masked to allocation of randomly selected files. Analyses used mixed-effects Poisson modelling that adjusted for time. This trial is registered with ClinicalTrials.gov, NCT02598609. Findings Between Nov 23, 2015, and Nov 2, 2017, event rates were analysed for 3454 patients of these 12 NICUs for 65 830 patient-days. The event rate per 1000 patient-days reduced significantly from the control to the intervention period (33.9 vs 22.6; incidence rate ratio 0.67; 95% CI 0.50-0.88; p=0.0048). Interpretation A multiprofessional safety-promoting programme in NICUs reduced the rate of adverse events and severe and preventable adverse events in highly vulnerable patients. This programme could significantly improve care offered to critically ill neonates. Copyright (C) 2022 Published by Elsevier Ltd. All rights reserved.

Despite various international regulatory initiatives over the last 20 years, many challenges remain in the field of paediatric drug development and evaluation. Indeed, drug research and development is still focused essentially on adult indications, thereby excluding many paediatric patients, limiting the feasibility of trials and favouring competing developments. Off-label prescribing persists and the development of age-appropriate dosage forms for children remains limited. Against this background, the members of this panel (TR) recommend the launch of multi-partner exchange forums on specific topics in order to focus new drug research and development on the real, unmet medical needs of children and adolescents, and in keeping with the underlying mechanisms of action. Scientific information sharing and cooperation between stakeholders are also essential for defining reference evaluation methods in each medical field. These forums can be organised through existing paediatric facilities and research networks at the French and European level. The latter are specifically dedicated to paediatric research and can facilitate clinical trial implementation and patient enrolment. Moreover, specific grants and public/private partnerships are still needed to support studies on the repositioning of drugs in paediatric indications, and pharmacokinetic studies aimed at defining appropriate dosages. The development of new pharmaceutical forms, better suited for paediatric use, and the promotion of resulting innovations will stimulate future investments. Initiatives to gather observational safety and efficacy data following off-label and/or derogatory early access should also be encouraged to compensate for the lack of information available in these situations. Finally, the creation of Ethics Committees (EC) with a specific "mother-child" advisory expertise should be promoted to ensure that the current regulation (Jardé law in France) is implemented whilst also taking into account the paediatric specificities in medical trials.

Malgré les initiatives réglementaires internationales des 20 dernières années, de nombreux défis persistent dans le développement et l’évaluation des médicaments en pédiatrie. En effet, la recherche et le développement des médicaments restent essentiellement orientés vers les indications adultes excluant ainsi de nombreux enfants malades, limitant la faisabilité des essais pédiatriques et favorisant les développements concurrentiels. La prescription hors-autorisation de mise sur le marché (hors-AMM) des médicaments persiste et le développement des formes galéniques adaptées à l’âge de l’enfant reste limité. Dans ce contexte, les membres de la table ronde recommandent la constitution de forums d’échanges thématiques multipartenaires pour orienter la recherche et le développement de nouveaux médicaments sur les besoins réels, non couverts des enfants et adolescents malades, et en rapport avec les mécanismes d’action des médicaments. Des interactions scientifiques multipartenaires sont également nécessaires pour définir des méthodologies d’évaluation de référence par domaine médical. Les échanges pourront être organisés via des structures/réseaux de recherche pédiatrique existants à l’échelon national et européen. L’implication de ces structures dédiées à la recherche pédiatrique facilitera aussi la mise en place et le recrutement dans les essais. De plus, la création d’appels à projets spécifiques et les partenariats privé-public restent nécessaires pour soutenir les études de repositionnement des médicaments dans les indications pédiatriques et les études pharmacocinétiques visant à déterminer les posologies adéquates. Le développement des nouvelles galéniques mieux adaptées à la pédiatrie et la valorisation concrète des innovations conséquentes permettra de dynamiser les futurs investissements. Des initiatives de collecte de données observationnelles de sécurité et d’efficacité après utilisation sur accès dérogatoires, hors-AMM et/ou post-AMM doivent également être favorisées pour pallier la perte d’informations observée dans ces contextes. Enfin, la création de Comité de protection des personnes (CPP) avec une spécificité « mère–enfants » paraît souhaitable afin d’appliquer la réglementation actuelle (loi Jardé) en prenant en considération les spécificités pédiatriques dans les essais médicamenteux.

OBJECTIVES:Our objective was to evaluate the potential additional value of electroencephalogram (EEG) and evoked potentials in neonates with hypoxic-ischemic encephalopathy to predict their disability at 1 and 2 years old. METHODS:30 full-term infants after perinatal asphyxia who underwent therapeutic hypothermia were evaluated at 1 year and 2 years for disability using International Classification of Functioning, Disability and Health classification. Scores for EEG, sensory evoked potentials and brainstem auditory evoked potentials were evaluated after withdrawal of therapeutic hypothermia that lasted 72 h. A regression approach was investigated to build models allowing to distinguish neonates according to their disability at 1 and 2 years. Two models were built, the first by considering the clinical data and EEG before and after therapeutic hypothermia and the second by incorporating evoked potentials recording. RESULTS:Adding EEG and evoked potentials data after rewarming improved dramatically the accuracy of the model considering outcome at 1 and 2 years. INTERPRETATION:We propose to record systematically EEG and evoked potentials following rewarming to predict the outcome of neonates with hypoxic ischemic encephalopathy. Combination of altered evoked potentials with no improvement of EEG after rewarming appeared to be a robust criterion for a poor outcome.

Background: Aminoglycosides are the most prescribed antibiotics in neonatal intensive care units (NICU). Reducing exposure to antibiotics in the NICU is highly desirable, particularly through benchmarking methods. Methods: Description of aminoglycosides prescriptions in 23 French NICU using the same computerized system over a 4-year period (2017–2020). A benchmarking program of antibiotics prescription was associated. Results: The population included 53,818 patients. Exposition rates to gentamicin and amikacin were 31.7% (n = 17,049) and 9.1% (n = 4894), respectively. Among neonates exposed to gentamicin, 90.4% of gentamicin and 77.6% of amikacin treatments were started within the 1st week of life. Among neonates exposed to amikacin, 77.6% started amikacin within the 1st week. The average daily dose of gentamicin at first prescription increased over the study period from 3.9 in 2017 to 4.4 mg/kg/d in 2020 (p < 0.0001). Conversely, the corresponding amikacin daily doses decreased from 13.0 in 2017 to 12.3 mg/kg/d in 2020 (p = 0.001). The time interval between the first 2 doses of gentamicin was mainly distributed in 3 values during the first week of life: 49.4% at 24 h, 26.4% at 36 h, and 22.9% at 48 h. At first amikacin prescription, the time interval was distributed in 4 categories: 48% at 24 h, 4.1% at 30 h, 8.5% at 36 h, and 37.1% at 48 h. As compared to literature guidelines, the rates of overdose and underdose in gentamicin (1.5% and 2.7%) and amikacin (0.3% and 1.0%). They significantly decreased for gentamicin over the study period. In multivariate analysis, the factors significantly associated with GENT overdose were the year of admission, prematurity, length of stay, and duration of the treatment. Conclusion: This prescription strategy ensured a low rate of overdose and underdose, and some benefits of the benchmarking program is suggested.

Objective To capture the early effects of the coronavirus disease 2019 (COVID-19) pandemic on pediatric clinical research. Study design Pediatric clinical research networks from 20 countries and 50 of their affiliated research sites completed two surveys over one month from early May to early June 2020. Networks liaised with their affiliated sites and contributed to the interpretation of results through pan-European group discussions. Based on first detection dates of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), countries formed 1 early detecting and 1 late detecting cluster. We tested the hypothesis that this clustering influenced clinical research. Results Research sites were first impacted by the pandemic in mid-March 2020 (March 16 +/- 10 days, the same date as lockdown initiation; P = .99). From first impact up until early June, site initiation and feasibility analysis processes were affected for >50% of the sites. Staff were redirected to COVID-19 research for 44% of the sites, and 75.5% of sites were involved in pediatric COVID-19 research (only 6.3% reported COVID-19 cases in their other pediatric trials). Mitigation strategies were used differently between the early and late detecting country clusters and between countries with and without a pediatric COVID-19 research taskforce. Positive effects include the development of teleworking capacities. Conclusions Through this collaborative effort from pediatric research networks, we found that pediatric trials were affected and conducted with a range of unequally applied mitigations across countries during the pandemic. The global impact might be greater than captured. In a context where clinical research is increasingly multinational, this report reveals the importance of collaboration between national networks.

Introduction The first 1000 days of life could contribute to individual susceptibility to the later development of chronic non-communicable diseases. Nutrition in early life appears to be an important determinant factor for a sustainable child’s health. In this study, we propose to investigate the impact of exclusive breast feeding on gut health in children. Methods and analysis A prospective cohort of newborns (n=350) will be recruited at birth and followed up to 4 years of age. The main objective is to evaluate the link between exclusive breast feeding for at least 3 months and the gut health of the child at 4 years. The primary endpoint of assessment of gut health will be based on the non-invasive measurement of faecal secretory IgA (sIgA) as a sensitive biomarker of the intestinal ecosystem. The presence of gastrointestinal disorders will be defined according to the clinical criteria of Rome IV. Information on parent’s nutritional habits and life style, breastfeeding duration and child’s complementary feeding will be collected along the follow-up. Cord blood cells and plasma at birth will be purified for further analysis. The meconium and stools collected at birth, 6 months, 2 years and 4 years of age will allow sIgA analysis. Ethics and dissemination This clinical study has obtained the approval from the national ethical committee. We plan to publish the results of the study in peer-review journals and by means of national and international conference. Trial registration number NCT04195425 .

As stated by Cheng and colleagues,[1][1] temptations to use unproven medications and strategies instead of relying on scientific evidence are high when facing the frightening coronavirus disease 2019 (COVID-19) pandemic. Most medical and scientific communities have reacted promptly to better fight

EEG is an important tool for early cerebral evaluation in neonatal hypoxo-ischemic encephalopathy (HIE). The aim of our study was to precise the EEG prognosis value before starting hypothermia and during 72 h hypothermia in neurodevelopment evaluation with at least 2 years clinical follow-up. We analyzed 98 newborns admitted for suspicion of HIE. First EEG was done before 6 h of life, it was surveyed continuously and analyzed twice a day during 72 H hypothermia and in 12 h following rewarming. EEG recordings were characterized according to the French classification. The neurologic outcome was assessed at 24 months. Eighty-four infants completed neurodevelopmental follow-up. 18 of newborns died during the neonatal period. Among the survivors, 64%, 21% and 15% had respectively normal, moderate and severe outcomes. The first EEG before hypothermia do not correlated with the neurodevelopmental outcome. On the other hand, The EEG characteristics between 36 and 60 h of life, correlated strongly with the outcome. Normal or mildly abnormal EEG (minor abnormalities or discontinuous tracing type A) after the first 48 h had 95% positive predictive value EEG for normal or moderate impairment at 2 years (negative predictive value 77%, specificity 91%). Severe EEG abnormalities (discontinuous tracing type B, paroxysmal or inactive tracings) within the first 48 h had respectively 96% and 76% negative and positive value for poor outcomes (severe outcome or death) (sensitivity 91% and specificity 89%).

OBJECTIVES:The primary objective of this study is to determine the current level of patient medication exposure in Level 3 Neonatal Wards (L3NW). The secondary objective is to evaluate in the first month of life the rate of medication prescription not cited in the Summary of Product Characteristics (SmPC). A database containing all the medication prescriptions is collected as part of a prescription benchmarking program in the L3NW.MATERIAL AND METHODS:The research is a two-year observational cohort study (2017-2018) with retrospective analysis of medications prescribed in 29 French L3NW. Seventeen L3NW are present since the beginning of the study and 12 have been progressively included. All neonatal units used the same computerized system of prescription, and all prescription data were completely de-identified within each hospital before being stored in a common data warehouse.RESULTS:The study population includes 27,382 newborns. Two hundred and sixty-one different medications (International Nonproprietary Names, INN) were prescribed. Twelve INN (including paracetamol) were prescribed for at least 10% of patients, 55 for less than 10% but at least 1% and 194 to less than 1%. The lowest gestational ages (GA) were exposed to the greatest number of medications (18.0 below 28 weeks of gestation (WG) to 4.1 above 36 WG) (p<0.0001). In addition, 69.2% of the 351 different combinations of an medication INN and a route of administration have no indication for the first month of life according to the French SmPC. Ninety-five percent of premature infants with GA less than 32 weeks received at least one medication not cited in SmPC.CONCLUSION:Neonates remain therapeutic orphans. The consequences of polypharmacy in L3NW should be quickly assessed, especially in the most immature infants.

Hypoxo-ischemic encephalopathy (HIE) is by far the most frequent etiology in neonatal encephalopathy). It is an important cause of neonatal mortality and long-term neurosensorial and cognitive impairment. Therapeutic hypothermia is nowadays the only therapeutic neuroprotective mean to decrease second state lesions within 6 hours after hypoxo-ischemia with an effect on mortality and morbidity rates as well as on seizures. The aim of our study was to precise EEG criteria in starting hypothermia decision and in prognosis evaluation with at least 2 years clinical follow-up. We analyzed 120 newborns admitted, between January 2013 and February 2015, in the neonatal intensive care for suspicion of HIE. First EEG was done before 6 hours of life, it was surveyed continuously and analyzed twice a day during 72-hour hypothermia and in 12 hours following rewarming. Three grades classification were used according to French EEG classification. EEG characteristics were analyzed for the decision of hypothermia and to determine prognosis in hours following warming and compared to the neurodevelopment evaluation at 2 years old using standardized scales. The evolution of infants with initial grades 0 or 1 EEG was characterized by normal or mild neurodevelopment impairment. Infants with initial grade 3 on EEG, without improvement within the first 48 hours were always associated with severe outcome (severe neurological impairment or death). For the other initial grade 3, who improve within the first 48 hours under hypothermia, as well as the initial grade 2, a variable outcome, between normal to severe neurological sequelae, were noted. Our results confirmed that Conventional EEG remains the gold standard for hypothermia decision and in prognostic evaluation [1], [2]. However, prospective longitudinal studies in large cohort are necessary to better clarify grade 2 EEG abnormalities in order to improve the prognosis evaluation; specially background and specific EEG pattern.

In neonatal hypoxo-ischemic encephalopathy (HIE), therapeutic hypothermia is nowadays the only effective neuroprotective mean in order to decrease second state lesions within 6h after anoxo-ischemia. Hypothermia has a positive effect on mortality and morbidity rates as well as on seizures. Conventional EEG (cEEG) is an important tool for early neonatal cerebral function evaluation before deciding hypothermia. EEG monitoring during 72h hypothermia and after rewarming is also crucial for prognosis.

The administration of several intravenous products on the same catheter is a very common situation in neonatology, where the stakes are high and the dangers sometimes unknown to clinicians. A large number of factors are involved in this administration, directly related to the installation of the infusion line. Moreover, the therapeutics used are often limited, and excluding classic “Marketing Authorization”. Some of these products may prove to be incompatible and thus lose their effectiveness, or even generate particles that are likely to be administered to the patient. We must be aware of these risks in order to optimize the prescription and administration of these intravenous products, especially as we treat fragile and immature patients. The aim of this work is to review the literature on the subject for the prescribers of neonatology units.

Le devenir neurologique d’un nouveau-né avec anoxo-ischémie périnatale est une préoccupation importante des pédiatres de néonatologie. Depuis 2010, les nouveau-nés à terme avec une anoxo-ischémie bénéficient d’un traitement par hypothermie contrôlée pendant 72heures. Actuellement, l’évaluation du pronostic neurologique à moyen à long terme repose principalement par l’évaluation de l’examen clinique, de l’électro-encéphalogramme (EEG) et de l’IRM cérébrale. L’objectif de ce travail était d’évaluer les potentiels évoqués sensitifs du nerf médian et les potentiels évoqués du tronc cérébral comme éléments pronostiques du développement psychomoteur à 6 mois. Les paramètres électrophysiologiques des potentiels évoqués les plus pertinents dans ce contexte seront présentés.