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Tréluyer L, Zana-Taieb E, Jarreau PH, Benhammou V, Kuhn P, Letouzey M, Marchand-Martin L, Onland W, Pierrat V, Saade L, Ancel PY, Torchin H. Doxapram for apnoea of prematurity and neurodevelopmental outcomes at age 5-6 years. Arch Dis Child Fetal Neonatal Ed 2024; 109:443-449. [PMID: 38228381 DOI: 10.1136/archdischild-2023-326170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 12/15/2023] [Indexed: 01/18/2024]
Abstract
OBJECTIVE To assess the long-term neurodevelopmental impact of doxapram for treating apnoea of prematurity. DESIGN Secondary analysis of the French national cohort study EPIPAGE-2. Recruitment took place in 2011. A standardised neurodevelopmental assessment was performed at age 5-6 years. A 2:1 propensity score matching was used to control for the non-randomised assignment of doxapram treatment. SETTING Population-based cohort study. PATIENTS All children born before 32 weeks' gestation alive at age 5-6 years. INTERVENTIONS Blind and standardised assessment by trained neuropsychologists and paediatricians at age 5-6 years. MAIN OUTCOME MEASURES Neurodevelopmental outcomes at age 5-6 years assessed by trained paediatricians and neuropsychologists: cerebral palsy, developmental coordination disorders, IQ and behavioural difficulties. A composite criterion for overall neurodevelopmental disabilities was built. RESULTS The population consisted of 2950 children; 275 (8.6%) received doxapram. Median (IQR) gestational age was 29.4 (27.6-30.9) weeks. At age 5-6 years, complete neurodevelopmental assessment was available for 60.3% (1780 of 2950) of children and partial assessment for 10.6% (314 of 2950). In the initial sample, children receiving doxapram had evidence of greater clinical severity than those not treated. Doxapram treatment was associated with overall neurodevelopmental disabilities of any severity (OR 1.43, 95% CI 1.07 to 1.92, p=0.02). Eight hundred and twenty-one children were included in the 2:1 matched sample. In this sample, perinatal characteristics of both groups were similar and doxapram treatment was not associated with overall neurodevelopmental disabilities (OR 1.09, 95% CI 0.76 to 1.57, p=0.63). CONCLUSIONS In children born before 32 weeks' gestation, doxapram treatment for apnoea of prematurity was not associated with neurodevelopmental disabilities.
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Affiliation(s)
- Ludovic Tréluyer
- Sorbonne Paris-Nord, Inserm, INRAE, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Université Paris Cité, Paris, France
- Department of Neonatal Medicine of Port-Royal, Cochin Hospital, FHU PREMA, AP-HP Centre-Université Paris Cité, Paris, France
| | - Elodie Zana-Taieb
- Department of Neonatal Medicine of Port-Royal, Cochin Hospital, FHU PREMA, AP-HP Centre-Université Paris Cité, Paris, France
- Université Paris Cité, Inserm U955, Paris, France
| | - Pierre-Henri Jarreau
- Sorbonne Paris-Nord, Inserm, INRAE, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Université Paris Cité, Paris, France
- Department of Neonatal Medicine of Port-Royal, Cochin Hospital, FHU PREMA, AP-HP Centre-Université Paris Cité, Paris, France
| | - Valérie Benhammou
- Sorbonne Paris-Nord, Inserm, INRAE, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Université Paris Cité, Paris, France
| | - Pierre Kuhn
- Department of Neonatal Medicine, University Hospital of Strasbourg, Strasbourg, France
| | - Mathilde Letouzey
- Department of Neonatal Medicine, Poissy Saint-Germain Hospital, Poissy, France
| | - Laetitia Marchand-Martin
- Sorbonne Paris-Nord, Inserm, INRAE, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Université Paris Cité, Paris, France
| | - Wes Onland
- Department of Neonatal Medicine, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Véronique Pierrat
- Sorbonne Paris-Nord, Inserm, INRAE, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Université Paris Cité, Paris, France
- Department of Neonatology, CHI Créteil, Créteil, France
| | - Lauren Saade
- Department of Neonatal Medicine of Port-Royal, Cochin Hospital, FHU PREMA, AP-HP Centre-Université Paris Cité, Paris, France
| | - Pierre Yves Ancel
- Sorbonne Paris-Nord, Inserm, INRAE, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Université Paris Cité, Paris, France
- Clinical Research Unit, Center for Clinical Investigation P1419, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Héloïse Torchin
- Sorbonne Paris-Nord, Inserm, INRAE, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Université Paris Cité, Paris, France
- Department of Neonatal Medicine of Port-Royal, Cochin Hospital, FHU PREMA, AP-HP Centre-Université Paris Cité, Paris, France
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Storm KK, Smits A, Hutten GJ, Simons SHP. Doxapram for apnea of prematurity - the importance of maintaining equipoise. Arch Dis Child Fetal Neonatal Ed 2024:fetalneonatal-2024-327012. [PMID: 38503483 DOI: 10.1136/archdischild-2024-327012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2024] [Indexed: 03/21/2024]
Affiliation(s)
- Kelly K Storm
- Department of Neonatal and Pediatric Intensive Care, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Anne Smits
- Neonatal Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - G Jeroen Hutten
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Reproduction & Development, Amsterdam, The Netherlands
| | - Sinno H P Simons
- Department of Neonatal and Pediatric Intensive Care, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
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Allegaert K, Salaets T, Wade K, Short MA, Ward R, Singh K, Turner MA, Davis JM, Lewis T. The neonatal adverse event severity scale: current status, a stakeholders' assessment, and future perspectives. Front Pediatr 2024; 11:1340607. [PMID: 38259600 PMCID: PMC10800487 DOI: 10.3389/fped.2023.1340607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 12/20/2023] [Indexed: 01/24/2024] Open
Abstract
To support informed decisions on drug registration and prescription, clinical trials need tools to assess the efficacy and safety signals related to a given therapeutic intervention. Standardized assessment facilitates reproducibility of results. Furthermore, it enables weighted comparison between different interventions, instrumental to facilitate shared decisions. When focused on adverse events in clinical trials, tools are needed to assess seriousness, causality and severity. As part of such a toolbox, the international Neonatal Consortium (INC) developed a first version of the neonatal adverse event severity scale (NAESS). This version underwent subsequent validation in retro-and prospective trials to assess its applicability and impact on the inter-observer variability. Regulators, sponsors and academic researchers also reported on the use of the NAESS in regulatory documents, trial protocols and study reports. In this paper, we aim to report on the trajectory, current status and impact of the NAESS score, on how stakeholders within INC assess its relevance, and on perspectives to further develop this tool.
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Affiliation(s)
- Karel Allegaert
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
- Department of Clinical Pharmacy, Erasmus MC, Rotterdam, Netherlands
| | - Thomas Salaets
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Pediatric Cardiology, University Hospitals, Leuven, Belgium
| | - Kelly Wade
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Mary A. Short
- International Neonatal Consortium, Communications Workgroup, Tucson, AZ, United States
| | - Robert Ward
- Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
| | - Kanwaljit Singh
- International Neonatal Consortium, Critical Path Institute, Tucson, AZ, United States
| | - Mark A. Turner
- Institute of Lifecourse and Medical Sciences, University of Liverpool, Liverpool Health Partners, Liverpool, United Kingdom
- Centre for Women’s Health Research, Liverpool Women’s Hospital, Liverpool, United Kingdom
| | - Jonathan M. Davis
- Department of Pediatrics, Tufts Children’s Hospital, Tufts University School of Medicine, Boston, MA, United States
| | - Tamorah Lewis
- Department of Pediatrics, City School of Medicine, Kansas Children’s Mercy Hospital, University of Missouri Kansas, Kansas City, MO, United States
- Division of Clinical Pharmacology and Toxicology, Hospital for Sick Children, Toronto, ON, Canada
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