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75 neonates with birth weights less than or equal to 1,250 g were admitted to a neonatal intensive care unit. 34 were followed up for about 4 years. 44% (15) of the surviving children are normal; 35% (12) present with minor sequellae compatible with normal familial, social and school life; 14.7% (5) presents with moderate sequellae; 6% (2) present with major sequellae. None presents with hydrocephalus, bedridden encephalopathy, deafness or blindness. Among these 34 children, 12 have growth retardation. All children with sequellae presented with important neurologic involvement during the neonatal period. No silent period was observed during follow-up. An early screening for the disorders is possible. The neonatal risks, often unappreciated or underestimated are, in most cases, foreseeable when taking into account the mother's history and course of pregnancy. Thanks to improvement of in utero screening techniques, proper cooperation between obstetricians and pediatricians should allow for selecting a better management for all very low birth weight prematures.

In 1981, 151 neonates with birth weight (B.W.) less than or equal to 1500 g were admitted to the Port-Royal Intensive Care Unit (ICU) (31% of admissions), 81% being born outside. Total mortality was 26% (53% less than or equal to 1000 g). For children who died, the median hospital stay was 9 days; in survivors, it was 69d (109d for BW less than or equal to 1000 g 71d for BW 1001-1250 g, 61d for BW 1251-1500 g), similar in hypotrophic and eutrophic infants. Average weight at direct discharge from Port-Royal ICU was 2627 +/- 565 g. The smaller the infants were at birth, the later they were discharged after assumed term. Complications (more frequent in smaller infants) played a major part in discharge delay. The cost of initial care included every step from birth to final discharge, all hospital charges and transports. Average cost per survivor was 200,356 F, but it reached 336,545 F, in patients with bronchopulmonary dysplasia and 354,605 F in those with necrotizing enterocolitis. Although the mostly good quality of survival justifies these expenses, the authors advocate increased prevention of very early prematurity and severe intra-uterine growth retardation, and development of maternal transport, as well as of prenatal call for a neonatal team in cases of unexpected birth out a of a perinatal center.

Fibrinogen, factors V, II and VII + X assays have been performed by micromethod on day 1, 2 and 3 in 275 newborn infants (full-term and premature) over a period of one year -- 20 infants had proved bacterial infection (from maternal contamination) with positive cultures. The control group included 20 normal newborns in the same range of gestational age. The increase of the fibrinogen level in the infected infants appeared to be significant on day 1 and 2 but not on day 3 (Day 1: 4,06 g/l +/- 0,74 g/l versus 2,06 g/l +/- 0,28 g/l in normal newborn. p less than 0.0001; on Day 2: 4,20 +/- 0,86 g/l versus 2,32 g/l +/- 0,09 g/l p less than 0.001; on Day 3: 3,68 g/l +/- 0,62 versus 3,36 +/- 0,66 g/l). The level of fibrinogen measured in the newborn period by the micromethod was in a accordance with former works showing that it is up th the adult value after the 3rd day of life. Since the micromethod on capillary blood requires only 140 microliters of blood (whereas 2 ml with macromethod) this fibrinogen determination appears to be a rapid and reliable method for the diagnosis of neonatal infection due to materno-fetal contamination.

Within 4 years 10 months (1981-1985), the Port-Royal Neonatal Intensive Care Unit admitted 2,400 neonates, one third with a birthweight below 1,501 g; 4,631 cranial ultrasound studies were performed in 1,488 of those neonates, mostly less than 1,501 g, detecting 392 consecutive peri-intraventricular hemorrhages (PIVH), of which 130 were major forms (from unilateral grade III to bilateral grade IV PIVH). Overall survival rates were 91% in grade I, 85% in grade II, 42% in grade III, 26% in grade IV; survival rate was significantly lower in bilateral than in unilateral grade II and III PIVH. In major PIVH, deaths occurred early (58% in the first week after birth). Post-hemorrhagic dilatation was constant but mostly regressive; true active hydrocephalus appeared in 1 unilateral grade III PIVH and 8 bilateral grade III PIVH, with ventriculo-peritoneal shunt in the second month of life in 5 infants (2 died), and 4 deaths (surgery not feasible). The neurological and developmental outcome of 42 of 46 survivors (4 losts to follow-up) was evaluated beyond one year of age in 12 unilateral grade III PIVH (10 normal children, 1 minor sequela, 1 moderate sequela), 16 bilateral grade III PIVH (7 normal children, 3 minor sequelae, 1 moderate sequela, 5 major sequelae), 13 unilateral grade IV PIVH (8 normal children, 1 minor sequela, 3 moderate sequelae, 1 major sequela), 1 bilateral grade IV PIVH (major sequela). A persistent major dilatation after 6-9 months of age bore an ominous prognosis.(ABSTRACT TRUNCATED AT 250 WORDS)