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Biomedical subjects

C Amiel-Tison

Publications and source records attributed to C Amiel-Tison.

At least 37 records · Page 2Linked to original sources
PubMed1988

Cerebral handicap in full-term newborns related to late pregnancy and/or labor.

The improving results of modern obstetrics, anesthesiology and immediate pediatric care have to be assessed. Clinical methods are available, providing guidelines for a simple neuro-sensorial assessment of the full-term newborn. When abnormalities are detected at the first assessment, the newborn will be assessed daily or every other day, as the symptomatology often rapidly changes. Based on these repeated evaluations, a gradation of 3 levels of severity is established, by the end of the first week: mild (1) includes tone abnormalities and hyperexcitability but no seizures and no CNS depression; moderate (2) includes CNS depression +/- isolated seizures; severe (3) includes coma and repeated seizures. Though this gradation represents an empirical cut-off in a continuum of signs and symptoms indicating brain dysfunction at birth, correlations with late outcome are reasonably good. Individual prognosis is out of our reach, specially in grade 2 infants. However, as a group estimation of late outcome, this gradation is satisfactory. Neurobehavioral competence in the full-term newborn is such that one assessment performed within normal limits in the first 3 days allows a reasonable prediction of a normal outcome, no matter how dreadful the pregnancy and/or delivery has been. Therefore neurological assessment of the full-term newborn in the first week of life can be considered as a good marker for the quality of perinatal care, and good feed-back information for the obstetrical staff.(ABSTRACT TRUNCATED AT 250 WORDS)

Birth Injuries↗
PubMed1988

Cerebral handicap in full-term neonates related to the mechanical forces of labour.

Sometimes the relationship between peripartum events and neonatal CNS injury is obvious: for example, following complete abruptio placentae or umbilical cord prolapse and occlusion with a delay of many minutes before delivery of the baby. These circumstances are, of course, rare in modern obstetrics. Usually, when a neonate develops neurological injury, a host of various potentially adverse peripartum factors are assumed to be the aetiology, but without definitive evidence. Among these latter factors are those we have focused on in this paper: the mechanical forces exerted on the fetal head during labour when the full-term fetus is in cephalic presentation. The mechanical events during the first stage of labour are reviewed, showing how uterine contractions result in cervical dilatation and descent and rotation of the fetal head. The consequences of these forces on the fetal intracranial pressure and blood flow are discussed: FHR remains normal up to a certain pressure threshold, above which decelerations occur. In other words, excessive pressures applied to the fetal head, either spontaneously (e.g. uterine tetany) or iatrogenically (e.g. traumatic forceps delivery or excessive fundal pressure) can increase fetal intracranial pressure to such a degree as to result in significant decreases in cerebral blood flow that are associated with fetal heart rate decelerations. Even when decelerations are simultaneous to contractions, decelerations cannot be considered as reflex and innocuous, as they are indeed associated with a decreasing cerebral blood flow. They must therefore be considered and evaluated in the management of labour. Cord compression and functional modifications of intervillous space by mechanical forces may further compromise the biological status of the fetus, leading to severe asphyxia. Neurological evaluation of the neonate within the first few days after delivery is currently the only way to provide the obstetricians with information on the possible consequences of an abnormal labour. The assessment of normality of the CNS in the neonate born at term, and its value in predicting late outcome are discussed. When abnormalities are detected after one or repeated assessments, abnormal neurological signs and symptoms are classified into three grades at the end of the first week. According to our data, a good correlation exists between this neonatal grading of cerebral dysfunction and late outcome. A careful evaluation of fetal head deformation, extensive caput succedaneum, and extensive retinal haemorrhages can help to interpret an abnormal labour retrospectively.(ABSTRACT TRUNCATED AT 400 WORDS)

Asphyxia Neonatorum↗
PubMed1988

Prediction in very preterm infants of satisfactory neurodevelopmental progress at 12 months.

This study was performed to find out how well ultrasound brain-scanning and neurological examination of very preterm infants, together and separately, predicted normal neurodevelopmental progress at 12 months corrected age. 111 infants born at less than 33 weeks gestation were scanned at discharge from the neonatal unit, and neurological examinations were performed at a gestation-equivalent age at or near term. During the first year of life repeated neurological and developmental testing was carried out. At 12 months a diagnosis of normal progress or of major or minor neurodevelopmental disorders was made. 56 (50 per cent) infants with both a favourable ultrasound scan and normal neurological findings had a 98 per cent (90 to 99 per cent) probability of normal progress at 12 months, and a 100 per cent (93 to 100 per cent) probability of having no major disorder. Separately, ultrasound scanning and neurological examination were not such good predictors of normal outcome, although they selected larger groups of infants with high probabilities of progressing normally. Ultrasound brain-scanning and neurological examination can be used in combination to identify potentially normal preterm infants when they are discharged to their homes.

Central Nervous System↗
PubMed1988

[Cerebral Doppler technic during labor using signal monitoring at the level of the fetal scalp].

The purpose of modern obstetrics is to obtain tracers of the fetal cerebral risk during labor, enabling to deliver the child before cerebral ischemia occurs. Recording of the fetal heart and measurement of acid-base balance are remarkable tracers; however, a much better precision is desired to avoid unnecessary or too late caesarean sections. Blood velocity measurement by Döppler at the level of the vessels at the base of the fetal skull is technically possible during labor; this has been demonstrated in 8 fetuses. The major cerebral index D/S during labor is 0.40 +/- 0.04, i.e. slightly lower than the mean index measured at the cord (0.50 +/- 0.07). In case of decelerations, it decreases to a mean value of 0.22 +/- 0.02. These preliminary results permit to hope that long-term measurements with continuous Döppler, of the arterial fetal cerebral flow, provide a direct and accurate tracer of the risk of cerebral ischemia during labor.

Blood Flow Velocity↗
PubMed1986

[Discrimination of the mother tongue by newborn infants].

4-day-old infants from French-speaking families were examined for their ability to discriminate French from Russian sentences. The infants gave evidence of discrimination as well as preference for French.

Discrimination, Psychological↗
PubMed1985

[Safety of term birth and cesarean birth rates].

This was a parallel of the rate of caesarean section and neurological morbidity of the term newborn. This study was performed on all infants born at a gestational age of 37 weeks or greater in 1981 and 1982 at the Baudelocque Maternity Hospital. The results show a stable caesarean section rate during these two years: 21% in 1981, 20% in 1982; as for the safety of term birth there was only one case of perinatal insult during a vaginal birth responsible for cerebral dysfunction of moderate degree. There was a 18% operative maternal morbidity and there were no deaths. We concluded that a caesarean section rate of 20% in a University Hospital is justified by the virtual absence of neonatal morbidity with an acceptable maternal risk. This rate should not increase. The possible ways of decreasing this rate, while maintaining neonatal safety, must be studied. The original aspect of this work concerns the monitoring of the caesarean section rate by the incidence of neurological complications of all term births during a fixed period of time.

Cesarean Section↗
PubMed1983

Neonatal neurologic examinations of very preterm infants: comparison of results with ultrasound diagnosis of periventricular hemorrhage.

Seventy infants born before 33-weeks gestation were studied by serial ultrasound brain scans from the first days of life; twenty had periventricular hemorrhage (PVH). Weekly neurologic examinations were performed from age 5 to 10 days. Only measures of passive tone could be elicited before an age equivalent to 34-weeks gestation because the infants were very sick, and many were receiving treatment with mechanical ventilation. Gestation was the most important determinant of this aspect of neurologic functioning, and no effect of time from birth was noted. Before ages equivalent to 34-weeks gestation, no significant relationship was found between measures of passive tone, including the size of the popliteal angle, and PVH diagnosed by ultrasound. At ages equivalent to 34 weeks or more, measures of active as well as passive tone and reflexes were consistently elicited. No single measure discriminated between infants with or without PVH, but serial observations indicated that persisting imbalance of active tone and clonus were only noted in infants with PVH, including 7 of the 8 infants who had PVH complicated by ventricular enlargement. It was concluded that neurologic examination does not reliably diagnose PVH during the neonatal period in sick, very preterm infants. At an age equivalent to term, it may help to distinguish infants who sustained permanent brain damage in association with neonatal PVH which may lead to adverse sequelae at follow-up.

Cerebral Hemorrhage↗
PubMed1983

[Placental smears in a maternity ward. Importance of early diagnosis of neonatal bacterial infections caused by materno-fetal contamination].

Direct cytobacteriological investigation of the amniochorionic plate of the placenta has been used systematically in the Maternity Hospital as a test to detect amniotic infection. This test was practised on fresh placentae in the laboratory of Histology, preceding the examination of the placenta. The test gave, within 30 minutes of delivery, information about the presence of bacteria of fungi on the amniotic surface, their abundance and their morphology. The results of the placental smears were compared to the results of bacteriological cultures obtained from the placenta, the infant and occasionally the mother. The diagnosis of neonatal infection was established from clinical, biological and bacteriological criteria which were defined in advance. Two series are presented: the first concerns 2,514 cases selected in the delivery room over a period of 4 years for high risks infection, i.e. 1 in 6 of the 15,377 deliveries registered during this period. The rate of positive smears was 9%: 63% Gram positive, 17% Gram negative, and 20% mixed. The most common bacteriologically proven neonatal infections were streptococcus B (40%) and Escherichia coli (33%). The second is a prospective survey of 400 unselected consecutive cases observed during a period of 7 weeks: 1% of the smears were positive - and the test would have been justified in 1 in 5 cases. From these two surveys, it appears that placental smear is a good test to detect maternofetal contamination. The positive predictive value of the test is 80%. The negative predictive value is 98% and approaches 100% if cases where the mother received antibiotics before delivery are excluded.

Bacterial Infections↗
PubMed1982

[Necrotizing enterocolitis. A study of forty-six cases seen in a maternity hospital].

Forty-six cases of necrotizing enterocolitis were seen at the Baudelocque maternity hospital from august 1978 to october 1980. In eighteen cases, clinical signs associated with roentgenograms showing pneumatosis led to unequivocal diagnosis. A surgical procedure was done in nine of these patients, during the acute stage in four and later on in five. Diagnosis was strongly suspected in twenty-eight cases. Clinical features were less serious and included abdominal distension, bloody stools, and emesis. There were no roentgenological signs. None of these infants underwent surgery. Overall mortality rate was 7% (3/46). In comparison to previously published studies, our series shows lower perinatal risk factors, higher mean birthweight, and lower prematurity rate (14%). No evidence was found to support the responsibility of a specific bacterial agent. Corona virus was found in the stools of five out of eleven cases studied during the second epidemic wave in october 1979, suggesting a possible viral etiology. Several preventive steps have been taken. Breast-feeding has been encouraged. Each mother-infant pair has been isolated instead of grouping infants in night nurseries. Staff members have been given specific information on the means of preventing contamination.

Coronaviridae↗