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Javaudin F, Zayat N, Bagou G, Mitha A, Chapoutot AG. Prise en charge périnatale du nouveau-né lors d’une naissance en milieu extrahospitalier. ANNALES FRANCAISES DE MEDECINE D URGENCE 2022. [DOI: 10.3166/afmu-2022-0396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Les accouchements inopinés extrahospitaliers représentent environ 0,3 % des accouchements en France. La prise en charge du nouveau-né en préhospitalier par une équipe Smur fait partie de l’activité courante. L’évaluation initiale du nouveau-né comprend systématiquement la mesure de sa fréquence cardiaque (FC) et respiratoire (FR), l’appréciation de son tonus ainsi que la mesure de sa température axillaire. En cas de doute ou de transition incomplète un monitoring cardiorespiratoire sera immédiatement mis en place (FC, FR, SpO2). Nous faisons ici une mise au point sur les données connues et avons adapté les pratiques, si besoin, au contexte extrahospitalier, car la majeure partie des données rapportées dans la littérature concernent les prises en charge en maternité ou en milieu hospitalier. Nous abordons les points essentiels de la prise en charge des nouveau-nés, à savoir la réanimation cardiopulmonaire, le clampage tardif du cordon ombilical, la lutte contre l’hypothermie et l’hypoglycémie; ainsi que des situations particulières comme la prématurité, la conduite à tenir en cas de liquide méconial ou de certaines malformations congénitales. Nous proposons aussi quels peuvent être : le matériel nécessaire à la prise en charge des nouveau-nés en extrahospitalier, les critères d’engagement d’un renfort pédiatrique à la régulation ainsi que les méthodes de ventilation et d’abord vasculaire que l’urgentiste doit maîtriser. L’objectif de cette mise au point est de proposer des prises en charge les plus adaptées au contexte préhospitalier.
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Javaudin F, Roche M, Trutt L, Bunker I, Hamel V, Goddet S, Templier F, Potiron C, Le Bastard Q, Pes P, Bagou G, Chabernaud JL, Montassier E, Leclère B. Assessment of rewarming methods in unplanned out-of-hospital births from a prospective cohort. Scand J Trauma Resusc Emerg Med 2020; 28:50. [PMID: 32493456 PMCID: PMC7271438 DOI: 10.1186/s13049-020-00750-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 05/28/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Mobile intensive care units frequently manage unplanned out-of-hospital births (UOHB). Rewarming methods during pre-hospital management of UOHB have not yet been compared. The aim was to compare rewarming methods used during pre-hospital management in a large prospective cohort of UOHB in France. METHODS We analysed UOHB from the prospective AIE cohort from 25 prehospital emergency medical services in France. The primary outcome was the change in body temperature from arrival at scene to arrival at hospital. RESULTS From 2011 to 2018, 1854 UOHB were recorded, of whom 520 were analysed. We found that using incubator care was the most effective rewarming method (+ 0.8 °C during transport), followed by the combination of plastic bag, skin-to-skin and cap (+ 0.2 °C). The associations plastic bag + cap and skin-to-skin + cap did not allow the newborn to be warmed up but rather to maintain initial temperature (+ 0.0 °C). The results of the multivariate model were consistent with these observations, with better rewarming with the use of an incubator. We also identified circumstances of increased risk of hypothermia according to classification and regression tree, like premature birth (< 37 weeks of gestation) and/or low outside temperature (< 8.4 °C). CONCLUSIONS Using an incubator was the most effective rewarming method during pre-hospital management of UOHB in our French prospective cohort. Based on our model, in cases of term less than 37 weeks of gestation or between 37 and 40 weeks with a low outside temperature or initial hypothermia, using such a method would be preferred.
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Affiliation(s)
- François Javaudin
- Department of Emergency Medicine, University Hospital of Nantes, Nantes, France.
- MiHAR lab, University of Nantes, Nantes, France.
| | - Mélodie Roche
- Department of Emergency Medicine, District Hospital Centre, La Roche-sur-Yon, France
| | - Lucile Trutt
- Department of Medical Evaluation and Epidemiology, University Hospital of Nantes, Nantes, France
| | - Isabelle Bunker
- Pediatric Intensive Care Unit, University Hospital of Nantes, Nantes, France
| | - Valérie Hamel
- Department of Emergency Medicine, Toulouse Purpan University Hospital, Toulouse, France
| | - Sybille Goddet
- Department of Emergency Medicine, University Hospital of Dijon, Dijon, France
| | - François Templier
- Department of Emergency Medicine, University Hospital of Angers, Angers, France
| | - Christine Potiron
- Department of Emergency Medicine, University Hospital of Nantes, Nantes, France
| | - Quentin Le Bastard
- Department of Emergency Medicine, University Hospital of Nantes, Nantes, France
- MiHAR lab, University of Nantes, Nantes, France
| | - Philippe Pes
- Department of Emergency Medicine, University Hospital of Nantes, Nantes, France
| | - Gilles Bagou
- Department of Emergency Medicine, University Hospital of Lyon, Lyon, France
| | - Jean-Louis Chabernaud
- Neonatal Emergency Transport Team, SAMU 92, Neonatal Intensive Care Unit, South-Paris University Hospitals (AP-HP), A. Béclère Clamart University Hospital, Paris, France
| | - Emmanuel Montassier
- Department of Emergency Medicine, University Hospital of Nantes, Nantes, France
- MiHAR lab, University of Nantes, Nantes, France
| | - Brice Leclère
- MiHAR lab, University of Nantes, Nantes, France
- Department of Medical Evaluation and Epidemiology, University Hospital of Nantes, Nantes, France
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Combier E, Roussot A, Chabernaud JL, Cottenet J, Rozenberg P, Quantin C. Out-of-maternity deliveries in France: A nationwide population-based study. PLoS One 2020; 15:e0228785. [PMID: 32092074 PMCID: PMC7039464 DOI: 10.1371/journal.pone.0228785] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/22/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction In France, many maternity hospitals have been closed as a result of hospital restructuring in an effort to reduce costs through economies of scale. These closures have naturally increased the distance between home and the closest maternity ward for women throughout the country. However, studies have shown a positive correlation between this increase in distance and the incidence of unplanned out-of-maternity deliveries (OMD). This study was conducted to estimate the frequency of OMD in France, to identify the main risk factors and to assess their impact on maternal mortality and neonatal morbidity and mortality. Materials and methods We conducted a population-based observational retrospective study using data from 2012 to 2014 obtained from the French hospital discharge database. We included 2,256,797 deliveries and 1,999,453 singleton newborns in mainland France, among which, 6,733 (3.0‰) were OMD. The adverse outcomes were maternal mortality in hospital or during transport, stillbirth, neonatal mortality, neonatal hospitalizations, and newborn hypothermia and polycythemia. The socio-residential environment was also included in the regression analysis. Maternal and newborn adverse outcomes associated with OMD were analyzed with Generalized Estimating Equations regressions. Results The distance to the nearest maternity unit was the main factor for OMD. OMD were associated with maternal death (aRR 6.5 [1.6–26.3]) and all of the neonatal adverse outcomes: stillbirth (3.3 [2.8–3.8]), neonatal death (1.9 [1.2–3.1]), neonatal hospitalization (1.2 [1.1–1.3]), newborn hypothermia (5.9 [5.2–6.6]) and newborn polycythemia (4.8 [3.5–6.4]). Discussion In France, OMD increased over the study period. OMD were associated with all the adverse outcomes studied for mothers and newborns. Caregivers, including emergency teams, need to be better prepared for the management these at-risk cases. Furthermore, the increase in adverse outcomes, and the additional generated costs, should be considered carefully by the relevant authorities before any decisions are made to close or merge existing maternity units.
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Affiliation(s)
- Evelyne Combier
- Biostatistics and Bioinformatics (DIM), Inserm, France University Hospital, Bourgogne Franche-Comté University, Dijon, France
| | - Adrien Roussot
- Biostatistics and Bioinformatics (DIM), Inserm, France University Hospital, Bourgogne Franche-Comté University, Dijon, France
| | - Jean-Louis Chabernaud
- Neonatal and Pediatric Emergency Transport Team and NICU, Antoine-Beclere Hospital, AP-HP, Paris Saclay University, Clamart, France
| | - Jonathan Cottenet
- Biostatistics and Bioinformatics (DIM), Inserm, France University Hospital, Bourgogne Franche-Comté University, Dijon, France
| | - Patrick Rozenberg
- Versailles Saint-Quentin University, Department of Obstetrics and Gynecology, Poissy-Saint Germain Hospital, Poissy, France
| | - Catherine Quantin
- Biostatistics and Bioinformatics (DIM), Inserm, France University Hospital, Bourgogne Franche-Comté University, Dijon, France
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), INSERM, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
- * E-mail:
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Javaudin F, Hamel V, Legrand A, Goddet S, Templier F, Potiron C, Pes P, Bagou G, Montassier E. Unplanned out-of-hospital birth and risk factors of adverse perinatal outcome: findings from a prospective cohort. Scand J Trauma Resusc Emerg Med 2019; 27:26. [PMID: 30825876 PMCID: PMC6397745 DOI: 10.1186/s13049-019-0600-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 02/10/2019] [Indexed: 11/10/2022] Open
Abstract
Background In France, while most babies are delivered at hospital, emergency medical services (EMS) weekly manage calls for unplanned out-of-hospital births. The objective of our study was to describe neonatal morbidity and mortality, defined as death or neonatal intensive care unit hospitalization at Day 7, in a prospective multicentric cohort of unplanned out-of-hospital births. Methods We prospectively analyzed out-of-hospital births from 25 prehospital EMS units in France. The primary outcome was neonatal morbidity and mortality, and the secondary outcome was risk factors associated with neonatal morbidity and mortality. A univariate logistic regression was first made, followed by a multivariate logistic regression with backward selection. Results From October 2011 to August 2018, a total of 1670 unplanned out-of-hospital births were included. Of these, 1652 (99.2%) were singleton and 1537 (93.5%) had prenatal care. Maternal mean age of the study population was 30 ± 5.5 (range 15 to 48). The majority of women were multiparous, but 13% were nulliparous. Overall, 45.3% of these unplanned out-of-hospital births were medically-driven, either by phone during medical regulation (12.5%) or on scene by the prehospital emergency medical service units (32.9%). The prevalence of neonatal morbidity and mortality was 6.3% (n = 106) after an unplanned out-of-hospital birth (death before Day 7: n = 20; 1.2%). The multivariate logistic regression found that multiparity (adjusted Odds Ratio = 70.7 [4.7–1062]), prematurity (adjusted Odds Ratio = 6.7 [2.1–21.4]), maternal pathology (adjusted Odds Ratio = 2.8 [1.0–7.5]) and hypothermia (adjusted Odds Ratio = 2.8 [1.1–7.6]) were independent predictive factors of neonatal morbidity and mortality. Conclusions Our study assessed for the first time risk factors for adverse perinatal outcome in a large and multicenter cohort of unplanned out-of-hospital births. We have to improve temperature management in the out-of-hospital field and future trials are required to investigate strategies to optimize newborns management in the prehospital area. Electronic supplementary material The online version of this article (10.1186/s13049-019-0600-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- François Javaudin
- Department of Emergency Medicine, CHU Nantes, Nantes University Hospital, 44000, Nantes, France.,MiHAR lab, Université de Nantes, 44000, Nantes, France
| | - Valérie Hamel
- Emergency Department, Toulouse Purpan University Hospital, Toulouse, France
| | | | - Sybille Goddet
- Samu-21, CHU de Dijon, SAU-Smur, CH du Creusot, Dijon, France
| | - François Templier
- Emergency Department, SAMU 49, University Hospital of Angers, Angers, France
| | - Christine Potiron
- Department of Emergency Medicine, CHU Nantes, Nantes University Hospital, 44000, Nantes, France
| | - Philippe Pes
- Department of Emergency Medicine, CHU Nantes, Nantes University Hospital, 44000, Nantes, France
| | - Gilles Bagou
- Samu, groupement hospitalier Édouard-Herriot, Lyon, France
| | - Emmanuel Montassier
- Department of Emergency Medicine, CHU Nantes, Nantes University Hospital, 44000, Nantes, France. .,MiHAR lab, Université de Nantes, 44000, Nantes, France.
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Bélondrade P, Lefort H, Bertho K, Perrochon JC, Jost D, Tourtier JP, Chabernaud JL. Guidelines for care of the newborn baby at birth knowledge by prehospital emergency physicians. Anaesth Crit Care Pain Med 2015; 35:17-23. [PMID: 29610057 DOI: 10.1016/j.accpm.2015.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 06/16/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION In 2010, the International Liaison Committee On Resuscitation (ILCOR) guidelines for care of the newborn baby immediately after birth were published. MATERIALS AND METHODS Using a questionnaire that was distributed to a sample of 44 prehospital emergency physicians (April 2014), we assessed knowledge of these guidelines, in particular specificities for newborns as compared to adults. Twenty-five questions, starting with a birth with no problems to one resulting in neonatal distress, were used to profile the practice of the surveyed physicians. RESULTS Among the solicited physicians, 30 responded to the questionnaire (68%). Priority was given to efficient respiratory resuscitation during the first minutes of extrauterine life and the difficulties of newborn respiratory adaptation are well-known, but their implementation remains imperfectly understood. The assessment showed very mixed results, partly explained by the low frequency of newborn scenarios experienced by the practitioners who responded to the questionnaire. CONCLUSION To move from guidelines to their practical implementation is always delicate, with room for improvement such as continuing education, knowledge assessment and practice in the context of a quality approach. Well accepted, this evaluation process could be renewed upon publication of the next guidelines on this subject, thus contributing to their knowledge.
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Affiliation(s)
- Pascal Bélondrade
- Service des urgences/Samu, Centre hospitalier de Cayenne, rue des Flamboyants, BP 6006, 97300 Cayenne, France
| | - Hugues Lefort
- Service médical d'urgence, Brigade de sapeurs-pompiers de Paris, 1, place Jules-Renard, 75017 Paris, France.
| | - Kilian Bertho
- Antenne médicale spécialisée de Satory, 34, rue de la Martinière, 78000 Versailles, France
| | | | - Daniel Jost
- Service médical d'urgence, Brigade de sapeurs-pompiers de Paris, 1, place Jules-Renard, 75017 Paris, France
| | - Jean-Pierre Tourtier
- Service médical d'urgence, Brigade de sapeurs-pompiers de Paris, 1, place Jules-Renard, 75017 Paris, France
| | - Jean-Louis Chabernaud
- Smur pédiatrique (Samu 92), Pôle FAME, Hôpital Antoine-Béclère, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France
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