To determine whether extrauterine growth is associated with neurologic outcomes and if this association varies by prenatal growth profile.For 1493 preterms from the EPIPAGE (Étude Épidémiologique sur les Petits Âges Gestationnels [Epidemiological Study on Small Gestational Ages]) cohort, appropriate for gestational-age (AGA) was defined by birth weight >-2 SD and small for gestational-age (SGA) by birth weight ≤-2 SD. Extra-uterine growth was defined by weight gain or loss between birth and 6 months by z-score change. Growth following-the-curve (FTC) was defined as weight change -1 to +1 SD, catch-down-growth (CD) as weight loss ≥1 SD, and catch-up-growth (CU) as weight gain ≥1 SD. At 5 years, a complete medical examination (n = 1305) and cognitive evaluation with the Kauffman Assessment Battery for Children (n = 1130) were performed. Behavioral difficulties at 5 years and school performance at 8 years were assessed (n = 1095).Overall, 42.5% of preterms were AGA-FTC, 20.2% AGA-CD, 17.1% AGA-CU, 5.6% SGA-FTC, and 14.5% SGA-CU. Outcomes did not differ between CU and FTC preterm AGA infants. Risk of cerebral palsy was greater for AGA-CD compared with AGA-FTC (aOR 2.26 [95% CI 1.37-3.72]). As compared with children with SGA-CU, SGA-FTC children showed no significant increased risk of cognitive deficiency (aOR 1.41[0.94-2.12]) or school difficulties (aOR 1.60 [0.84-3.03]). Compared with AGA-FTC, SGA showed increased risk of cognitive deficiency (SGA-FTC aOR 2.19 [1.25-3.84]) and inattention-hyperactivity (SGA-CU aOR 1.65 [1.05-2.60]).Deficient postnatal growth was associated with poor neurologic outcome for AGA and SGA preterm infants. CU growth does not add additional benefits. Regardless of type of postnatal growth, SGA infants showed behavioral problems and cognitive deficiency.

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.

The objective of this work is to specify, by reference to the normal newborn, the current contribution of the electroencephalogram in the hypoxic-ischemic encephalopathy of the full-term newborn. Both digitized traditional EEG and cerebral function monitoring (CFM) will be considered. We first describe the main features of normal and pathological EEGs. A good knowledge of the organization of the sleep-wakefulness cycles, in relationship with the EEG, is essential. Very early recordings (before 6 hours of life) are needed to put the indications of neuroprotective treatments (hypothermia). Between the normal or near-normal tracings, which are associated with a good prognosis, and the very pathological tracings (inactive, paroxysmal), which are associated with a poor vital or functional prognosis, the interpretation of "intermediate" tracings - mainly represented by other types of discontinuous tracings - must take into account characteristics of bursts and discontinuities, postnatal age, the evolution of successive tracings, and pharmacological treatments. A flowchart is used to illustrate our strategy of EEG watching over a full-term newborn after an acute fetal distress.

Following the pioneering work of C. Dreyfus-Brisac and N. Monod, research into neonatal electroencephalography (EEG) has developed tremendously in France. French neurophysiologists who had been trained in Paris (France) collaborated on a joint project on the introduction, development, and currently available neonatal EEG recording techniques. They assessed the analytical criteria for the different maturational stages and standardized neonatal EEG terminology on the basis of the large amount of data available in the French and the English literature. The results of their work were presented in 1999. Since the first edition, technology has moved towards the widespread use of digitized recordings. Although the data obtained with analog recordings can be applied to digitized EEG tracings, the present edition, including new published data, is illustrated with digitized recordings. Herein, the reader can find a comprehensive description of EEG features and neonatal behavioural states at different gestational ages, and also a definition of the main aspects and patterns of both pathological and normal EEGs, presented in glossary form. In both sections, numerous illustrations have been provided. This precise neonatal EEG terminology should improve homogeneity in the analysis of neonatal EEG recordings, and facilitate the setting up of multicentric studies on certain aspects of normal EEG recordings and various pathological patterns.

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.

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 clinical findings of a 40‐year‐old woman with recurrent migraine presenting with Wernicke's aphasia in accordance with the results of a standardized battery for language assessment (Boston Aphasia Diagnostic Examination). The patient had no evidence of parenchymal or vascular lesions on MRI and showed delta and theta slowing over the left posterior temporal leads on the EEG. Although the acute onset of a fluent aphasia suggested stroke as a likely etiology, the recurrence of aphasia as the initial symptom of migraine was related to cortical spreading depression and not to stroke.

Objective. Very preterm children call experience cognitive and behavioral difficulties. The aim Of this Study was to assess the impact. of very preterm birth on visuospatial processes at preschool age.Design and methods. Data come front the Epipage study. Participants underwent a follow-tip evaluation at age 5 years. During the psychological evaluation, children took subtests of the K-ABC and the WPPSI-R. Six subtests are based on visuospatial information.Results. The results concern 183 children assessed in the Lorraine region of France, who were born with birthweight appropriate for gestational age and had no neurological sequelae. Thirty-six children were born at term, 112 were born very prematurely (2832 GW), and 35 were born extremely prematurely (< 28 GW). Birth term was significantly correlated with performance on the six subtests. In all cases, the children born at term obtained higher scores compared to the children born very prematurely and extremely prematurely. Oil two subtests of the K-ABC, the children horn extremely prematurely obtained lower scores than those of the children born very prematurely. The mother's level Of education was correlated with performance oil three subtests.Conclusion. The results suggest that a very preterm birth can exert a negative impact oil visuospatial and visuomotor processes. These deficits may involve difficulties in sonic activities at school and in daily life. (C) 2009 Elsevier Masson SAS. All rights reserved.

Nocardiosis is a rare infectious disease in children. We report here a disseminated nocardiosis in a child with acute lymphoblastic leukemia. The patient presented prolonged febrile neutropenia and nodular pneumopathy. Based on the amplification of a 16S rDNA, a PCR assay detected Nocardia sp. in the patient's bronchoalveolar lavage (BAL) fluid. Culture of BAL samples yielded Nocardia nova colonies after 2 weeks of incubation. Hepatic, splenic, renal and cerebral localisations were detected on extension checkup. trimethoprime-sulfamethoxazole and amikacine were started given the results of PCR assay, with a good response. Improvement of the patient's general condition led to complete chemotherapy under ciprofloxacine and ceftriaxone treatment, without nocardiosis reactivation. Nocardiosis is a rare complication in children with acute lymphoblastic leukemia. trimethoprime-sulfamethoxazole prophylaxis is widely used to prevent Pneumocystis jiroveci infection in children with haematologic malignancies. As Nocardia species are usually sensible, trimethoprime-sulfamethoxazole could play a role in Nocardia prophylaxis in such population. In our patient, compliance with trimethoprime-sulfamethoxazole had been low. Nocardia species are relatively fastidious growth bacteria and are difficult to isolate with classical bacteriological techniques. Molecular methods are now available, with a good sensitivity and fast results allowing to start an appropriate antibiotherapy before culture results, as early treatment is a major prognosis factor in nocardiosis. Nocardia infection should be suspected in case of nodular pneumopathy in immunocompromised children. An extension checkup should be performed to detect secondary localisations.

Cet article expose les principales caractéristiques de l’EEG normal et leurs évolutions chez des prématurés de 24 à 30 semaines d’âge gestationnel. Peu de données sur ce sujet sont disponibles dans la littérature car le nombre de grands prématurés sans problème neurologique est faible. Cependant, la connaissance des aspects normaux de l’EEG est nécessaire dans la mesure où l’EEG participe à l’appréciation du pronostic neurologique dans cette tranche d’âge. L’activité de fond, d’abord très discontinue, devient progressivement continue sur de plus longues périodes et elle est totalement continue en sommeil agité à 30 semaines. Parallèlement, les périodes de silence électrique ou intervalles interbouffées sont de plus en plus brefs et la proportion du tracé sans activité cérébrale est de plus en plus faible. Si l’on considère la concordance entre une activité électrique riche et la présence de mouvements oculaires, une ébauche de différenciation des états de sommeil est présente dès 25 semaines et est acquise à 30 semaines. Les principales figures de l’EEG sont des ondes lentes de grande amplitude, d’autant plus lentes et voltées que l’enfant est plus prématuré. Les ondes lentes temporales en séquences, si caractéristiques entre 24 et 26 semaines vont devenir moins amples et moins nombreuses pour disparaître vers les 27–28 semaines, alors que les ondes lentes occipitales restent nombreuses, deviennent plus amples, surimposées de rythmes rapides. Les deux types d’ondes lentes frontales, rencontrées vers 24–27 semaines disparaissent ensuite, tout comme les bouffées amples, bilatérales et synchrones d’ondes lentes delta. Enfin, les bouffées diffuses d’éléments thêta enregistrées jusqu’à 27 semaines vont se localiser en regard des régions temporales notamment au cours du sommeil calme à 30 semaines. This article aims at summarizing normal EEG criteria and their maturational pattern in premature infants of 24 to 30 weeks gestational age. Although very premature infants with a normal outcome are not numerous, their normal EEG patterns must be known, as EEG constitutes a basis for neurological prognosis. Background activity is first discontinuous. Discontinuity decreases thereafter with increasing age, so that some long periods of continuous activity may be observed in active sleep, around 30 weeks of age. Conversely, interburst intervals become shorter and the proportion of time without EEG activity is decreasing. Based on EEG activity and eye movements, a rough sleep-state differentiation was described as soon as 25 weeks of gestational age and is completely achieved at 30 weeks. The main EEG figures are high-voltage delta waves of higher amplitude and slower frequency in younger infants. Temporal delta waves occur in sequences, these are very characteristic of the very premature infant; thereafter, they become smaller, less numerous and eventually disappear around 27–28 weeks. In contrast, occipital delta waves remain numerous and of high voltage, are usually bilateral and superimposed with fast rhythms. The two types of frontal delta waves that are observed in 24–27 weeks prematures disappear with maturation. Bursts of synchronized delta waves are less numerous than localized delta waves and also disappear before 28 weeks of age. Finally, diffuse theta bursts are mainly recorded at 26–27 weeks GA and become more localized in temporal areas with maturation. At 30 weeks, they are observed on temporal areas, mainly during slow-wave sleep.

This article aims at summarizing normal EEG criteria and their maturational pattern in premature infants of 24 to 30 weeks gestational age. Although very premature infants with a normal outcome are not numerous, their normal EEG patterns must be known, as EEG constitutes a basis for neurological prognosis. Background activity is first discontinuous. Discontinuity decreases thereafter with increasing age, so that some long periods of continuous activity may be observed in active sleep, around 30 weeks of age. Conversely, interburst intervals become shorter and the proportion of time without EEG activity is decreasing. Based on EEG activity and eye movements, a rough sleep-state differentiation was described as soon as 25 weeks of gestational age and is completely achieved at 30 weeks. The main EEG figures are high-voltage delta waves of higher amplitude and slower frequency in younger infants. Temporal delta waves occur in sequences, these are very characteristic of the very premature infant; thereafter, they become smaller, less numerous and eventually disappear around 27-28 weeks. In contrast, occipital delta waves remain numerous and of high voltage, are usually bilateral and superimposed with fast rhythms. The two types of frontal delta waves that are observed in 24-27 weeks prematures disappear with maturation. Bursts of synchronized delta waves are less numerous than localized delta waves and also disappear before 28 weeks of age. Finally, diffuse theta bursts are mainly recorded at 26-27 weeks GA and become more localized in temporal areas with maturation. At 30 weeks, they are observed on temporal areas, mainly during slow-wave sleep.

This paper summarizes the recommendations of the Groupe de Neurophysiologie Clinique de l'Enfant : -The technical conditions which should be fulfilled to get high-quality recordings are summarized in Appendix 1; -To get optimal information, EEG analysis should be precise, rigorous and standardised: -An interpretation protocol is joined in Appendix 2; -A synopsis of EEG development in prematures is provided in Appendix 3; -Tracing report must contain exact description of the recording for a precise and very useful application in patient care: Appendix 4; -An overview of EEG indications in very premature newborns is presented in Appendix 5.