SUMMARY The dramatic improvement in neonatal care during the last decade did not succeed in reducing the incidence of periventricular leukomalacia (PVL), suggesting that prenatal events may be the main target for PVL prevention. The studied cohort included 753 very preterm infants born between 24 and 32 weeks of gestational age, admitted to the intensive care unit and surviving at least 7 days; 69 (9.2%) of these infants had a diagnosis of cystic PVL. The highest PVL frequency was observed among the infants bom at 28 weeks of gestation (16%). Inflammatory prenatal events occurring during the last days or weeks before delivery and PVL occurrence are strongly correlated. Indeed, the combination of intra‐uterine infection and premature rupture of membranes is associated with a very high risk (22%). Prolongation of pregnancy with tocolysis for more than 24 hours also carries a significant. 8% risk of PVL. In contrast, chronic fetal distress of long duration, such as severe intra‐uterine growth retardation and pre‐cclampsia, is seldom followed by PVL (<2% risk). Similarly, rapid unexpected deliveries entail a minimal PVL risk (4%). Experimental and epidemiological confirmations of these data would have an influence on the management of both the preterm onset of labour and the premature rupture of membranes. RÉSUMÉ Leticomalacie périvetitriatlaire: récxamen de.s factettrs de risqué L'amélioration dans les soins neonataux durant les dix derntières années n'a pas réduit l'incidence de la leucomalacie périventriculaire (PVL). Suggérant que les événements prénataux doivent être la ciblc à viser pour la prévention de la PVL. Dans une cohorte de 753 grands prematures, nes de 24 a 32 semaines d'âge gestationnel, admis dans une unité de soins intensifs et ayant survecu au moins. 7 jours, un diagnostic de PVL kystique a pu être porté dans 69 cas (9.2%). La fréquence la plus élevée de PVL se situait chez les prématurés nés à 28 semaines de gestation (16%). Des événements mfcctieux durant les derniers jours ou semaines avant l'accouchement étaient fortement corrélés a la survenne d'une PVL. L'association d'infection intra‐utérine et de rupture prématurée des membranes constituait un très haut risque de PVL (22%) et la prolongation de la grossesse avec tocolyse de plus de 24 heurcs entraînait un risque de 8%. En revanche, une saiffrance foetale chronique, telle qu'un retard sévère de croissance intra‐utérine ou une toxémie gravidique, était rarement suivie de PVL.(risque <2%) et il en etait de même pour un accouchement rapide inopiné (4%). Une confirmation expérimentale et épidémiologique de ces données devrait avoir une influence sur la prise en charge de Paccouchement prématuré et des ruptures prématurées des membranes. ZUSAMMENFASSUNG Periventrikuläre Leukomalazie: Risikofaktoren Durch Verbesserungen in der Neugeborenenpflege in der vergangenen Dekade konnte die Häufigkeit der periventrikulären Leukomalazie (PVL) nicht vermindert werden, was vermuten läßt, daß man sich auf pränatale Faktoren zur Prävention der PVL konzentrieren...

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ContextNeonatal hyperthyroidism was first described in 1912 and in 1964 was shown to be linked to transplacental passage of maternal antibodies. Few multicenter studies have described the perinatal factors leading to fetal and neonatal dysthyroidism.ObjectiveTo show how fetal dysthyroidism (FD) and neonatal dysthyroidism (ND) can be predicted from perinatal variables, in particular, the levels of anti-thyrotropin receptor antibodies (TRAbs) circulating in the mother and child.Design and PatientsThis was a retrospective multicenter study of data from the medical records of all patients monitored for pregnancy from 2007 to 2014.SettingAmong 280,000 births, the medical records of 2288 women with thyroid dysfunction were selected and screened, and 417 women with Graves disease and positive for TRAbs during pregnancy were included.ResultsUsing the maternal TRAb levels, the cutoff value of 2.5 IU/L best predicted for FD, with a sensitivity of 100% and specificity of 64%. Using the newborn TRAb levels, the cutoff value of 6.8 IU/L best predicted for ND, with a sensitivity of 100% and a specificity of 94%. In our study, 65% of women with a history of Graves disease did not receive antithyroid drugs during pregnancy but still had infants at risk of ND.ConclusionsIn pregnant women with TRAb levels ≥2.5 IU/L, fetal ultrasound monitoring is essential until delivery. All newborns with TRAb levels ≥6.8 IU/L should be examined by a pediatrician with special attention for thyroid dysfunction and treated, if necessary.

Studies of antenatal and intrapartum factors involved in the development of cerebral palsy have identified intrauterine infection and chorioamnionitis as high risk situations for white matter damage, especially periventricular ledcomalacia. To characterise adverse or protective perinatal factors further, we undertook a multiple regression analysis of selected perinatal events in a population of 110 inborn premature neonates with documented chorioamnionitis. In the total population of 110 infants delivered at between 25 and 32 weeks, 101 (92%) survived the first week of life and two were subsequently excluded. Of the 99 remaining infants, 20 (20%) developed periventricular leukomalacia including 16 (80%) cystic lesions. Forty-five (45%) babies were born by lower segment caesarean section, and for 37 of these, this was carried out before labour. Fetal presentation at delivery was breech in 14 (26%) of those born vaginally and 23 (52%) of those born by lower segment caesarean section (OR 3 [95% CI 1.3-71). Among predetermined perinatal risk factors for periventricular leukomalacia, logistic regression analysis showed that delivery by caesarean section was associated with a dramatic decrease in the incidence of periventricular leukomalacia (OR 0.15 [95% CI 0-04-0-571). These preliminary results warrant confirmation and preferably a prospective study before considering caesarean section as a protective perinatal factor of periventricular leukomalacia.Despite a dramatic improvement in neonatal intensive care of very preterm infants together with a striking reduction in both perinatal morbidity and mortality, the prevalence of cerebral palsy has not decreased over the last two decades'. Periventricular leukomalacia has become a major cause of cerebral palsy', with an incidence of cerebral palsy following diagnosis of cystic periventricular leukomalacia in the neonate ranging from 38% to 93%=. Although its pathophysiology is still poorly understood, there is increasing evidence to suggest the role of prenatal events in the development of periventricular leukomalacia such as intrauterine infection, antenatal bleeding and prolonged preterm prelabour rupture of membranes3. Chorioamnionitis has recently been shown to be the main independent risk factor for developing cerebral palsy after prematurity". An increased rate of cerebral palsy among premature children after vaginal delivery has already been suggested3. However, the mode of delivery has not been hitherto identified as an independent risk factor for the development of periventricular leukomalacia. We have addressed this issue among a population of very premature infants born after chorioamnionitis in a single tertiary centre during a 42 month period.