1
|
Coquery SS, Georges A, Cortey A, Floch C, Avran D, Gatbois E, Mehler-Jacob C, de Stampa M. Discharge of newborns with risk factors of severe hyperbilirubinemia: description of a hospital at home-based care monitoring and phototherapy. Eur J Pediatr 2022; 181:3075-3084. [PMID: 35695955 DOI: 10.1007/s00431-022-04461-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 03/29/2022] [Accepted: 03/31/2022] [Indexed: 11/03/2022]
Abstract
Neonatal jaundice is common and associated with delay in hospital discharge and risk of neurological sequelae if not treated. The objectives of the study were to report on our experience of the monitoring and treatment of neonatal jaundice in a home care setting and its feasibility and safety for neonates with high risk of severe hyperbilirubinemia. The 2-year study has been led in the greater Paris University Hospital At Home (Assistance Publique-Hôpitaux de Paris). The device of the intervention was the Bilicocoon® Bag, a light-emitting diode sleeping bag worn by the neonate when the total serum bilirubin value exceeds intensive phototherapy threshold, according to the guidelines from the American Academy of Pediatrics. One hundred and thirty-nine neonates had participated in the intervention and 39 (28%) were treated by phototherapy at home, as continuation of inpatient phototherapy or started at home. Seventy-five percent of the sample had more than two risk factors for development of severe hyperbilirubinemia. Twenty five percent of the cohort who received phototherapy at home had lower gestational age (p < 0.014) and had younger age at discharge from maternity (p < 0.09). Median length of stay in hospital at home was 5 days. Two patients needed readmission in conventional hospital (1%) for less than 24 h. In multivariate model, the length of stay decreased with the higher gestational age (p < 0.001) and increased significantly with the older age at discharge, the birth weight < 10th percentile, and a treatment by phototherapy at home. Conclusion: Hospital at home, which is a whole strategy using an effective and convenient phototherapy device combined with a specialized medical follow-up, could be an alternative to conventional hospitalization for neonates at high risk of severe jaundice. The maternity discharge is facilitated, the mother-infant bonding can be promoted, and the risk of conventional rehospitalization is minimal, while guaranteeing the safety of this specific care. What is Known: • Managing neonatal jaundice is provided in conventional hospital with phototherapy. • Neonatal jaundice increases the risk of prolonged hospitalization or readmission. What is New: • Phototherapy is feasible in hospital at home for neonates with high risk of severe hyperbilirubinemia. • The care pathway of neonates from conventional hospital to hospital at home is described.
Collapse
Affiliation(s)
- Sarah Spyridakis Coquery
- Assistance Publique Hôpitaux de Paris (AP-HP), Hospitalisation À Domicile (HAD), 14 rue Vésale, 75005, Paris, France
| | - Alexandre Georges
- Assistance Publique Hôpitaux de Paris (AP-HP), Hospitalisation À Domicile (HAD), 14 rue Vésale, 75005, Paris, France
| | - Anne Cortey
- Assistance Publique Hôpitaux de Paris (AP-HP), Centre National de Référence en Hémobiologie Périnatale (CNRHP), 26 avenue du Dr Arnold-Netter, 75571, Paris, France
| | - Corinne Floch
- Assistance Publique Hôpitaux de Paris (AP-HP), Hôpital Louis Mourier, 178 rue des Renouillers, 92700, Colombes, France
| | - David Avran
- Assistance Publique Hôpitaux de Paris (AP-HP), Hospitalisation À Domicile (HAD), 14 rue Vésale, 75005, Paris, France
| | - Edith Gatbois
- Assistance Publique Hôpitaux de Paris (AP-HP), Hospitalisation À Domicile (HAD), 14 rue Vésale, 75005, Paris, France
| | - Claire Mehler-Jacob
- Assistance Publique Hôpitaux de Paris (AP-HP), Hospitalisation À Domicile (HAD), 14 rue Vésale, 75005, Paris, France
| | - Matthieu de Stampa
- Assistance Publique Hôpitaux de Paris (AP-HP), Hospitalisation À Domicile (HAD), 14 rue Vésale, 75005, Paris, France. .,Unité Mixte de Recherche (UMR), UVSQ, 1018 INSERM, Paris, France.
| |
Collapse
|
2
|
Bian H, Zheng ZH, Wei D, Wen A, Zhang Z, Lian JQ, Kang WZ, Hao CQ, Wang J, Xie RH, Dong K, Xia JL, Miao JL, Kang W, Li G, Zhang D, Zhang M, Sun XX, Ding L, Zhang K, Jia J, Ding J, Li Z, Jia Y, Liu LN, Zhang Z, Gao ZW, Du H, Yao N, Wang Q, Wang K, Geng JJ, Wang B, Guo T, Chen R, Zhu YM, Wang LJ, He Q, Yao RR, Shi Y, Yang XM, Zhou JS, Ma YN, Wang YT, Liang X, Huo F, Wang Z, Zhang Y, Yang X, Zhang Y, Gao LH, Wang L, Chen XC, Tang H, Liu SS, Wang QY, Chen ZN, Zhu P. Safety and efficacy of meplazumab in healthy volunteers and COVID-19 patients: a randomized phase 1 and an exploratory phase 2 trial. Signal Transduct Target Ther 2021; 6:194. [PMID: 34001849 PMCID: PMC8127508 DOI: 10.1038/s41392-021-00603-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/08/2021] [Accepted: 03/18/2021] [Indexed: 02/06/2023] Open
Abstract
Recent evidence suggests that CD147 serves as a novel receptor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Blocking CD147 via anti-CD147 antibody could suppress the in vitro SARS-CoV-2 replication. Meplazumab is a humanized anti-CD147 IgG2 monoclonal antibody, which may effectively prevent SARS-CoV-2 infection in coronavirus disease 2019 (COVID-19) patients. Here, we conducted a randomized, double-blinded, placebo-controlled phase 1 trial to evaluate the safety, tolerability, and pharmacokinetics of meplazumab in healthy subjects, and an open-labeled, concurrent controlled add-on exploratory phase 2 study to determine the efficacy in COVID-19 patients. In phase 1 study, 59 subjects were enrolled and assigned to eight cohorts, and no serious treatment-emergent adverse event (TEAE) or TEAE grade ≥3 was observed. The serum and peripheral blood Cmax and area under the curve showed non-linear pharmacokinetic characteristics. No obvious relation between the incidence or titer of positive anti-drug antibody and dosage was observed in each cohort. The biodistribution study indicated that meplazumab reached lung tissue and maintained >14 days stable with the lung tissue/cardiac blood-pool ratio ranging from 0.41 to 0.32. In the exploratory phase 2 study, 17 COVID-19 patients were enrolled, and 11 hospitalized patients were involved as concurrent control. The meplazumab treatment significantly improved the discharged (P = 0.005) and case severity (P = 0.021), and reduced the time to virus negative (P = 0.045) in comparison to the control group. These results show a sound safety and tolerance of meplazumab in healthy volunteers and suggest that meplazumab could accelerate the recovery of patients from COVID-19 pneumonia with a favorable safety profile.
Collapse
Affiliation(s)
- Huijie Bian
- National Translational Science Center for Molecular Medicine and Department of Cell Biology, Fourth Military Medical University, Xi'an, China.
| | - Zhao-Hui Zheng
- Department of Clinical Immunology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Ding Wei
- National Translational Science Center for Molecular Medicine and Department of Cell Biology, Fourth Military Medical University, Xi'an, China
| | - Aidong Wen
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Zheng Zhang
- National Translational Science Center for Molecular Medicine and Department of Cell Biology, Fourth Military Medical University, Xi'an, China
| | - Jian-Qi Lian
- Center for Infectious Diseases, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Wen-Zhen Kang
- Center for Infectious Diseases, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Chun-Qiu Hao
- Center for Infectious Diseases, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Jing Wang
- Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Rong-Hua Xie
- Department of Clinical Immunology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Ke Dong
- Department of Clinical Diagnosis, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Jie-Lai Xia
- College of Military Preventive Medicine, Fourth Military Medical University, Xi'an, China
| | - Jin-Lin Miao
- National Translational Science Center for Molecular Medicine and Department of Cell Biology, Fourth Military Medical University, Xi'an, China
| | - Wen Kang
- Center for Infectious Diseases, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Guoquan Li
- Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Di Zhang
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Mingru Zhang
- Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Xiu-Xuan Sun
- National Translational Science Center for Molecular Medicine and Department of Cell Biology, Fourth Military Medical University, Xi'an, China
| | - Likun Ding
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Kui Zhang
- Department of Clinical Immunology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Junfeng Jia
- Department of Clinical Immunology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Jin Ding
- Department of Clinical Immunology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Zhiqin Li
- Department of Clinical Immunology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yanyan Jia
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Lin-Na Liu
- Department of Pharmaceutics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Zhe Zhang
- Department of Clinical Diagnosis, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Zhao-Wei Gao
- Department of Clinical Diagnosis, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Hong Du
- Center for Infectious Diseases, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Na Yao
- Center for Infectious Diseases, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Qing Wang
- Department of Clinical Immunology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Ke Wang
- National Translational Science Center for Molecular Medicine and Department of Cell Biology, Fourth Military Medical University, Xi'an, China
| | - Jie-Jie Geng
- National Translational Science Center for Molecular Medicine and Department of Cell Biology, Fourth Military Medical University, Xi'an, China
| | - Bin Wang
- National Translational Science Center for Molecular Medicine and Department of Cell Biology, Fourth Military Medical University, Xi'an, China
| | - Ting Guo
- National Translational Science Center for Molecular Medicine and Department of Cell Biology, Fourth Military Medical University, Xi'an, China
| | - Ruo Chen
- National Translational Science Center for Molecular Medicine and Department of Cell Biology, Fourth Military Medical University, Xi'an, China
| | - Yu-Meng Zhu
- National Translational Science Center for Molecular Medicine and Department of Cell Biology, Fourth Military Medical University, Xi'an, China
| | - Li-Juan Wang
- National Translational Science Center for Molecular Medicine and Department of Cell Biology, Fourth Military Medical University, Xi'an, China
| | - Qian He
- National Translational Science Center for Molecular Medicine and Department of Cell Biology, Fourth Military Medical University, Xi'an, China
| | - Rui-Rui Yao
- National Translational Science Center for Molecular Medicine and Department of Cell Biology, Fourth Military Medical University, Xi'an, China
| | - Ying Shi
- National Translational Science Center for Molecular Medicine and Department of Cell Biology, Fourth Military Medical University, Xi'an, China
| | - Xiang-Min Yang
- National Translational Science Center for Molecular Medicine and Department of Cell Biology, Fourth Military Medical University, Xi'an, China
| | - Jian-Sheng Zhou
- National Translational Science Center for Molecular Medicine and Department of Cell Biology, Fourth Military Medical University, Xi'an, China
| | - Yi-Nan Ma
- National Translational Science Center for Molecular Medicine and Department of Cell Biology, Fourth Military Medical University, Xi'an, China
| | - Ya-Tao Wang
- National Translational Science Center for Molecular Medicine and Department of Cell Biology, Fourth Military Medical University, Xi'an, China
| | - Xue Liang
- National Translational Science Center for Molecular Medicine and Department of Cell Biology, Fourth Military Medical University, Xi'an, China
| | - Fei Huo
- National Translational Science Center for Molecular Medicine and Department of Cell Biology, Fourth Military Medical University, Xi'an, China
| | - Zhe Wang
- Department of Pathology, Fourth Military Medical University, Xi'an, China
| | - Yang Zhang
- National Translational Science Center for Molecular Medicine and Department of Cell Biology, Fourth Military Medical University, Xi'an, China
| | - Xu Yang
- National Translational Science Center for Molecular Medicine and Department of Cell Biology, Fourth Military Medical University, Xi'an, China
| | - Ye Zhang
- Center for Infectious Diseases, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Lu-Hua Gao
- Center for Infectious Diseases, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Ling Wang
- College of Military Preventive Medicine, Fourth Military Medical University, Xi'an, China
| | - Xiao-Chun Chen
- Jiangsu Pacific Meinuoke Biopharmaceutical Co. Ltd, Changzhou, China
| | - Hao Tang
- Jiangsu Pacific Meinuoke Biopharmaceutical Co. Ltd, Changzhou, China
| | - Shuang-Shuang Liu
- Jiangsu Pacific Meinuoke Biopharmaceutical Co. Ltd, Changzhou, China
| | - Qing-Yi Wang
- Department of Foreign Languages, Fourth Military Medical University, Xi'an, China
| | - Zhi-Nan Chen
- National Translational Science Center for Molecular Medicine and Department of Cell Biology, Fourth Military Medical University, Xi'an, China.
| | - Ping Zhu
- Department of Clinical Immunology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
| |
Collapse
|