OBJECT Intraventicular hemorrhage (IVH) is a common complication of preterm birth, and the prognosis of IVH is incompletely characterized. The objective of this study was to describe the outcomes of IVH in a population-based cohort with minimal selection bias. METHODS All very preterm (≥ 30 completed weeks) patients born in the province of Nova Scotia were included in a comprehensive database. This database was screened for infants born to residents of Nova Scotia from January 1, 1993, to December 31, 2010. Among very preterm infants successfully resuscitated at birth, the numbers of infants who died, were disabled, developed cerebral palsy, developed hydrocephalus, were blind, were deaf, or had cognitive/language scores assessed were analyzed by IVH grade. The relative risk of each outcome was calculated (relative to the risk for infants without IVH). RESULTS Grades 2, 3, and 4 IVH were significantly associated with an increased overall mortality, primarily in the neonatal period, and the risk increased with increasing grade of IVH. Grade 4 IVH was significantly associated with an increased risk of disability (RR 2.00, p < 0.001), and the disability appeared to be primarily due to cerebral palsy (RR 6.07, p < 0.001) and cognitive impairment (difference in mean MDI scores between Grade 4 IVH and no IVH: −19.7, p < 0.001). No infants with Grade 1 or 2 IVH developed hydrocephalus, and hydrocephalus and CSF shunting were not associated with poorer outcomes when controlling for IVH grade. CONCLUSIONS Grades 1 and 2 IVH have much better outcomes than Grades 3 or 4, including a 0% risk of hydrocephalus in the Grade 1 and 2 IVH cohort. Given the low risk of selection bias, the results of this study may be helpful in discussing prognosis with families of very preterm infants diagnosed with IVH.

In BC, the incidence of new cases of MMC has decreased between 1971 and 2016, while the probability of survival for these patients has increased. Despite earlier and more universal post-natal repair, long-term outcomes have not improved significantly over time. Future research should focus on developing ways of reducing disability and improving quality of life for MMC patients and their families.

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Background: Chronic motor cortex stimulation (MCS) has been used to treat medically refractory neuropathic pain over the past 20 years. We investigated this procedure using a prospective multicentre randomized blinded crossover trial. Methods: Twelve subjects with three different neuropathic pain syndromes had placement of MCS systems after which they were randomized to receive low ("subtherapeutic") or high ("therapeutic") stimulation for 12 weeks, followed by a crossover to the other treatment group for 12 weeks. The primary outcome measure was the pain visual analogue scale (VAS). Secondary outcome measures included McGill Pain Questionnaire (MPQ), Beck Depression Inventory-II, medication log, work status, global impression of change, and SF-36 quality of life scale. Results: The trial was halted early due to lack of efficacy. One subject withdrew early due to protocol violation and five subjects withdrew early due to transient adverse events. Six subjects with upper extremity pain completed the study. There was no significant change in VAS with low or high stimulation and no significant improvement in any of the outcome measures from low to high stimulation. SF-36 role physical and mental health scores were worse with high compared to low stimulation (p = 0.024, p = 0.005). Conclusions: We failed to show that MCS is an effective treatment for refractory upper extremity neuropathic pain and suggest that previous studies may have been skewed by placebo effects, or ours by nocebo. We suggest that a healthy degree of skepticism is warranted when considering this invasive therapy for upper extremity pain syndromes.RÉSUMÉ: Stimulation du cortex moteur pour traiter la douleur neuropathique: une étude randomisée avec permutation. Contexte: La stimulation chronique du cortex moteur (SCM) a été utilisée pour traiter la douleur neuropathique réfractaire au traitement médical au cours des 20 dernières années. Nous avons étudié cette technique au moyen d'un essai prospectif multicentrique randomisé à double insu avec permutation. Méthode: Un système de SCM a été mis en place chez douze sujets atteints de trois syndromes différents de douleur neuropathique. Ils ont été assignés au hasard au groupe recevant une stimulation faible (« sous-thérapeutique ») ou élevée (« thérapeutique ») pendant 12 semaines avec permutation des groupes et traitement pendant 12 semaines additionnelles. Le critère d'évaluation primaire était le résultat obtenu à l'échelle visuelle analogue (EVA). Les critères d'évaluation secondaires comprenaient le questionnaire McGill sur la douleur, l'Inventaire de dépression de Beck II, un journal de la médication, la situation d'emploi, l'impression globale de changement et l'échelle SF-36 de qualité de vie. Résultats: L'étude a été interrompue précocement en raison du manque d'efficacité. Un sujet a été exclu tôt pour cause de non-respect du protocole et 5 sujets se sont retirés peu de temps après le début du traitement en raison d'effets indésirables passagers. Six sujets présentant de la douleu...