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Given the morbidity of open surgery, prenatal fetoscopic repair is becoming the preferred first-line procedure for myelomeningocele (MMC). Main outcomes were the obtention of a watertight repair at birth and the need for postnatal neurosurgical surgery including shunting within six months. Conclusions Laparotomy-assisted fetoscopic repair is a reasonable option for women that do not opt to terminate, both in terms of maternal and perinatal morbidity. [Extracted from the article]

19/23 (82.6%) fetuses with moderate/severe ventriculomegaly at T2 required HT postnatally. The aim of this study was to evaluate the evolution of fetal ventriculomegaly and the need for postnatal hydrocephalus treatment (HT) in cases with open neural tube defect (ONTD) repaired postnatally. [Extracted from the article]

Summary: Traditionally, the cerebellum has been regarded as a central component of the motor system. Recent studies suggest an important role played by the cerebellum in the development of cognitive and social functions. The objective of this study was to evaluate the incidence of cerebellar injury and to define the obstetrical, neonatal, and radiologic characteristics, as well as the functional outcomes in a population of very preterm infants. Methods: This retrospective study included neonates born before 30 weeks of gestational age between March 2004 and July 2007. Infants underwent MRI studies at a term-adjusted age; for each preterm infant with cerebellar injury, we identified two infants for the control group with normal MRI, matched on the basis of gestational age. We collected pertinent demographic, prenatal, and acute postnatal data for all infants. Follow-up assessment was performed at 2 years, using the Brunet-Lezine scale. Results: A total of 148 ex-preterm infants were studied. Cerebellar injury was present in 14 (9 %) cases and associated with supratentorial parenchymal injury in 90 %. Duration of ventilation was longer in children with cerebellar injury, compared to controls (19.5 days vs 16.5 days; P =0.03). The other neonatal criteria analyzed were comparable between the two groups. Global developmental, functional, and social-behavioral deficits were more common and profound in preterm infants with cerebellar injury, with no significant difference. Conclusion: This study confirms the high incidence of cerebellar injury in very preterm infants and the importance of a specific neurobehavioral follow-up. [Copyright &y& Elsevier]

Pendant le développement prénatal et postnatal précoce, les activités électriques synchrones peuvent être générées au sein des cortex sensoriels eux-mêmes, des structures sous-corticales ou être évoquées par l’activité des organes sensoriels, elle-même spontanée ou provoquée par les stimuli sensoriels. L’un des patterns EEG typique du prématuré, le « Delta-brush » (DB), qui associe une onde lente et des oscillations rapides, peut être généré de façon spontanée ou être évoqué dans les cortex sensorimoteur, visuel et auditif par les mouvements et par les stimuli sensoriels correspondants. L’objectif de la présente étude, dédiée aux réponses corticales aux stimuli auditifs (click), était de préciser les caractéristiques spatio-temporelles des DBs évoqués ainsi que leur rapport avec des potentiels évoqués auditifs corticaux du prématuré tel que décrits antérieurement. Pour cela, les enregistrements EEG ont été réalisés en haute résolution (32 électrodes) chez 30 nouveau-nés prématurés de 30 à 38 semaines d’âge gestationnel sans risque neurologique et la position des électrodes a été recalée sur des IRM 3D acquis chez d’autres prématurés représentatifs des âges étudiés. L’analyse spectrale des réponses au click a montré une augmentation significative de la puissance spectrale dans une large bande des fréquences, située au niveau de la partie moyenne et postérieure du lobe temporal. Ces réponses du cortex temporal avaient une prédominance droite, étaient plus amples dans le sommeil calme et diminuaient en puissance avec l’âge. Le moyennage des réponses a révélé que la composante lente du DB était une onde lente négative de grande amplitude qui culminait dans les régions temporales moyenne et postérieure successivement à 550 et 700 ms et correspondait au pôle négatif d’un dipôle s’inversant dans la région temporo-péri-sylvienne. Le DB évoqué par les stimuli auditifs reflète probablement l’activité du cortex auditif et représente un biomarqueur potentiel du fonctionnement normal du cortex auditif chez le prématuré. [ABSTRACT FROM AUTHOR]

Abstract: The premature rupture of membranes (PROM) is responsible for 30 % of the premature births because of a high risk of associated chorioamnionitis. PROM and the perinatal infection are recognized as 2 of the main risk factors of periventricular leukomalacia and white matter disease in very preterm neonates. Inflammation associated with PROM is likely to induce neuronal or glial cell death at a developmental stage of great vulnerability for the developing brain. Several mechanisms (release of cytokines, accumulation of free radicals, excitotoxicity, apoptosis...) account for this deleterious effect. The decision to actively extract a fetus subjected to a fetal inflammatory response syndrome should take account of the risks of a proved intrauterine infection for both the mother and the fetus and the risks for the neonate related to a very preterm birth per se. A reasonable attitude seems not to maintain a fetus in an undoubtful septic context in utero if a preterm birth in the very short term appears unevitable. Practically, no consensus gives a recommendation between aggressive or conservative management in case of PROM within 30 and 34 weeks''gestation. Expectant management seems to be indicated before 28 weeks''gestation and intentional delivery could be recommended beyond 34 weeks''gestation due to increased maternal risks compared to relatively low incidence of the complications of prematurity at this term. [Copyright &y& Elsevier]