Marie-Françoise Muller

Mapping of normal brain maturation in infants on phase-sensitive inversion-recovery MR images

SummaryIt is illustrated that phase-sensitive inversion-recovery MR images are particularly well suited for the monitoring of brain maturation and myelination in the neonate and young infant. Provided appropriate timings are applied with the inversion-recovery MR pulse sequence, the myelinated areas show up as bright spots in the phase-sensitive images. The chronology of the appearance, and the location of these hyperintense zones correlate well with the chronology of brain maturation, as assessed by other means. In particular, the progressive functional capabilities of the infant correlate well with the progress of myelination, as exhibited by the MR images.

Diagnosis of severe birth asphyxia and early prediction of neonatal neurological outcome in term asphyxiated newborns.

Ten indicators available during the first two hours of life, such as clinical criteria of neonatal distress and postnatal arterial blood gases, were compared with the neonatal neurological course in sixty full term newborns with significant birth asphyxia in order to test their value for the diagnosis and the short-term prognosis of severe birth asphyxia. Birth asphyxia was defined as severe when it was followed by symptoms of moderate or severe post-asphyxial encephalopathy. We calculated a sensitivity lower than fifty percent for clinical criteria such as delay in establishing regular respiration and Apgar scores. It was clear that normal delay in establishing regular respiration and normal Apgar scores do not exclude severe birth asphyxia. Arterial pH and base deficit at thirty minutes of life were found to be the best criteria for the diagnosis of severe birth asphyxia, but lacked positive predictive value. The best predictive tool for the short-term neurological prognosis of birth asphyxia was a single score established at 30 minutes of life and based on the evaluation of consciousness, respiration and neonatal reflexes. Some aspects of the pathophysiology of birth asphyxia and the rationale for treatment of post-asphyxial metabolic acidosis are discussed.

Children Intolerant to Cow’s Milk May Suffer from Severe Insomnia

Brief nighttime awakenings are more frequent during the first 2 months of life than at later ages [1,2]. If one exludes the quiet awakenings that most often remain unnoticed by parents, and only consider nighttime crying, 78%–90% of infants sleep through the night at 9 months of age [1–6]. About 10% of children under 1 year of age present persistent settling difficulties and repeated awakenings during the night. The rate of sleep disruption then rises; regular wakings occur in up to 20% of children at 2 years of age [7, 8], and is still reported for 10% -15% of 3- and 4-year-old children [9, 10]. These sleep problems represent a challenge to both parents and pediatrician [2, 3,11–13]. Persistent difficulties in initiating and/or maintaining sleep have been attributed to a variety of causes. Adverse environmental conditions, such as excessive ambient noise or temperature [12, 13], psychological stress in the family [10, 15], mother’s depressed mood [6], inappropriate parental behavior [12, 13], constitutional temperament [2, 4,16-18], delayed effect of neonatal asphyxia [4, 7, 8], influence of breastfeeding [6,19], chronic physical discomfort, due to colics [13, 14], recurrent episodes of upper airway obstruction [20], otitis [12], or gastroesophageal reflux have all been reported as causes for the development of abnormal sleep homeostasis in children.