Background: In a study about cerebral tolerance to surfactant, more infants have been shown to maintain a stable cerebral status when treated by synthetic rather than porcine surfactant [Pediatr Res 1995;38:436]. The aim of this study is: 1) to evaluate the 1 year outcome of these infants,2) to validate the relevance of the parameters used to define infants at high risk for cerebral disability.

A prospective study of neonatal status with a follow-up of 4 to 7 years, was performed in 74 full-term newborns with acute fetal distress (AFD). They were born between 0.1.12.1971 ad 31.12.1975. Mental retardation (M.R.) occurred in 4,8% of the control children (born in 1972 without problem) and in 20,2% (15 children) of the children who suffered from AFD; in 12 of these 15 cases, IQ is between 65 and 90, in 3 between 50 and 65. The prognosis is worse only after unexpected neonatal distress, not after AFD with a known etiology, or after use of a forceps. The prognosis is better when FD secondary to a cord anomaly lead to an obstetrical operation. It is also better after cesarean section (1 MR among 17) or when the mother chose a private obstetrician (0 MR among 25. Apgar score has no prognostic value. Some neonatal clinical and EEG symptoms have a poor significance : persistence of anomalies at one week, seizures lasting more than 2 days. Severe retardation is always associated with cerebral palsy (C.P.). Among 12 children with moderate retardation, only one has a C.P., the 11 others have a poor--intellectual, social and/or affective--environment.

The prospective study covered 60 full-term newborns, who presented exclusively signs of acute fetal distress. It had two major aims: --the analysis of the clinical and EEG symptomatologies, allowing the assessment of the cerebral damage in the neonatal period; --the evaluation as to whether the post-asphyxia cerebral damage may remain undiagnosed in the neonatal period, sequellae revealing it secondarily. Clinical and EEG supervision was undertaken during the first week; it was continued till 3 years of age in 45 of the 56 survivors. During the first week of life, 50 infants had at least once, an abnormal neurologic manifestation. The signs for a poor outcome are "unexpected" fetal distress, Apgar score below 2 at 1 min., seizures occurring or persisting after 48 hours, severe clinical and/or EEG changes occurring more than once. Prognosis is considered as favorable if EEG or clinical examination are consistently normal, or if EEG and clinical examination are normalized at 6 days of life.