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Saurel-Cubizolles MJ, Marchand-Martin L, Pierrat V, Arnaud C, Burguet A, Fresson J, Marret S, Roze JC, Cambonie G, Matis J, Kaminski M, Ancel PY. Maternal employment and socio-economic status of families raising children born very preterm with motor or cognitive impairments: the EPIPAGE cohort study. Dev Med Child Neurol 2020; 62:1182-1190. [PMID: 32557556 DOI: 10.1111/dmcn.14587] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 04/24/2020] [Accepted: 04/26/2020] [Indexed: 11/28/2022]
Abstract
AIM To describe maternal employment and the socio-economic status of the household up to 8 years after the very preterm birth of a child, according to the presence and type of motor or cognitive impairment. METHOD A total of 1885 families from the French EPIPAGE cohort of children who were born very preterm between 1997 and 1998 were included. Motor and cognitive impairments were identified in children between the ages of 2 and 8 years in 770 families and were classified according to type. The 1115 families with children born very preterm without these impairments were considered the reference group. RESULTS Mothers of children with severe motor or cognitive impairments were less often working at 5 years after the birth than the reference mothers (21% and 30% vs 57%; p<0.001). Those working before birth returned to work less often and those not working started to work less often after the birth than did reference mothers. At 8 years, mothers of children with severe impairments reported financial difficulties more often than mothers of children without impairments. INTERPRETATION Despite a fairly protective regulatory framework in France, families of infants born very preterm with severe motor or cognitive impairments are socially underprivileged. Measures to maintain an acceptable standard of living for these families and their children are needed.
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Affiliation(s)
- Marie-Josephe Saurel-Cubizolles
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Laetitia Marchand-Martin
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Veronique Pierrat
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France.,Department of Neonatal Medicine, University Hospital Jeanne-de-Flandres, Lille, France
| | - Catherine Arnaud
- Inserm UMR 1027 (SPHERE Study of Perinatal, Child and Adolescent Health: Epidemiological Research and Evaluation), University Toulouse III Paul Sabatier, Toulouse, France
| | - Antoine Burguet
- Pediatric Department - Pédiatrie 2, University Hospital François Mitterrand, Dijon, France
| | - Jeanne Fresson
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France.,Department of Medical Information, Nancy University Hospital, Nancy, France
| | - Stephane Marret
- Department of Neonatal Medicine and Neuropediatrics, Rouen University Hospital, and INSERM UMR 1245 Team 4 Neovasc Perinatal Neurological Handicap, School of Medicine, Normandy University, Rouen, France
| | | | - Gilles Cambonie
- Department of Neonatal Medicine, University Hospital Arnaud de Villeneuve, Montpellier, France
| | - Jacqueline Matis
- Department of Neonatal Medicine, University Hospital, Strasbourg, France
| | - Monique Kaminski
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Pierre-Yves Ancel
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
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Pierrat V, Burguet A, Marchand-Martin L, Cambonie G, Coquelin A, Roze JC, Durox M, Guillois B, Morgan AS, Kaminski M. Variations in patterns of care across neonatal units and their associations with outcomes in very preterm infants: the French EPIPAGE-2 cohort study. BMJ Open 2020; 10:e035075. [PMID: 32571857 PMCID: PMC7311036 DOI: 10.1136/bmjopen-2019-035075] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To describe patterns of care for very preterm (VP) babies across neonatal intensive care units (NICUs) and associations with outcomes. DESIGN Prospective cohort study, EPIPAGE-2. SETTING France, 2011. PARTICIPANTS 53 (NICUs); 2135 VP neonates born at 27 to 31 weeks. OUTCOME MEASURES Clusters of units, defined by the association of practices in five neonatal care domains - respiratory, cardiovascular, nutrition, pain management and neurodevelopmental care. Mortality at 2 years corrected age (CA) or severe/moderate neuro-motor or sensory disabilities and proportion of children with scores below threshold on the neurodevelopmental Ages and Stages Questionnaire (ASQ). METHODS Hierarchical cluster analysis to identify clusters of units. Comparison of outcomes between clusters, after adjustment for potential cofounders. RESULTS Three clusters were identified: Cluster 1 with higher proportions of neonates free of mechanical ventilation at 24 hours of life, receiving early enteral feeding, and neurodevelopmental care practices (26 units; n=1118 babies); Cluster 2 with higher levels of patent ductus arteriosus and pain screening (11 units; n=398 babies); Cluster 3 with higher use of respiratory, cardiovascular and pain treatments (16 units; n=619 babies). No difference was observed between clusters for the baseline maternal and babies' characteristics. No differences in outcomes were observed between Clusters 1 and 3. Compared with Cluster 1, mortality at 2 years CA or severe/moderate neuro-motor or sensory disabilities was lower in Cluster 2 (adjusted OR 0.46, 95% CI 0.25 to 0.84) but with higher proportion of children with an ASQ below threshold (adjusted OR 1.49, 95% CI 1.07 to 2.08). CONCLUSION In French NICUs, care practices for VP babies were non-randomly associated. Differences between clusters were poorly explained by unit or population differences, but were associated with mortality and development at 2 years. Better understanding these variations may help to improve outcomes for VPT babies, as it is likely that some of these discrepancies are unwarranted.
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Affiliation(s)
- Veronique Pierrat
- Equipe EPOPé, U 1153, Université de Paris, CRESS, INSERM, INRA, Paris, France
- Department of Neonatal Medicine, Jeanne de Flandre Hospital, CHU Lille, Lille, France
| | - Antoine Burguet
- Department of Neonatal Pediatrics, Dijon University Hospital, Dijon, France
| | | | - Gilles Cambonie
- Neonatology and Neonatal Intensive Care Unit, Montpellier University Hospital Centre, Montpellier cedex 5, France
| | - Anaëlle Coquelin
- Equipe EPOPé, U 1153, Université de Paris, CRESS, INSERM, INRA, Paris, France
| | - J C Roze
- Paediatric Intensive Care, University Hospital Centre Nantes Clinic of Medical Paediatrics, Nantes, France
- Centre d'Investigation Clinique (CIC004), University Hospital Centre Nantes, Nantes, France
| | - Melanie Durox
- Equipe EPOPé, U 1153, Université de Paris, CRESS, INSERM, INRA, Paris, France
| | - Bernard Guillois
- Department of Neonatal Pediatrics and Intensive Care, University Hospital, Caen, France
| | - Andrei S Morgan
- Equipe EPOPé, U 1153, Université de Paris, CRESS, INSERM, INRA, Paris, France
- Institute for Womens' Health, University College London, London, UK
| | - Monique Kaminski
- Equipe EPOPé, U 1153, Université de Paris, CRESS, INSERM, INRA, Paris, France
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Desplanches T, Blondel B, Morgan AS, Burguet A, Kaminski M, Lecomte B, Marchand-Martin L, Rozé JC, Sagot P, Truffert P, Zeitlin J, Ancel PY, Fresson J. Volume of Neonatal Care and Survival without Disability at 2 Years in Very Preterm Infants: Results of a French National Cohort Study. J Pediatr 2019; 213:22-29.e4. [PMID: 31280891 DOI: 10.1016/j.jpeds.2019.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 05/10/2019] [Accepted: 06/03/2019] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To investigate the relation between neonatal intensive care unit (NICU) volume and survival, and neuromotor and sensory disabilities at 2 years in very preterm infants. STUDY DESIGN The EPIPAGE-2 (Etude Epidémiologique sur les Petits Âges Gestationnels-2) national prospective population-based cohort study was used to include 2447 babies born alive in 66 level III hospitals between 24 and 30 completed weeks of gestation in 2011. The outcome was survival without disabilities (levels 2-5 of the Gross Motor Function Classification System for cerebral palsy with or without unilateral or bilateral blindness or deafness). Units were grouped in quartiles according to volume, defined as the annual admissions of very preterm babies. Multivariate logistic regression analyses with population average models were used. RESULTS Survival at discharge was lower in hospitals with lower volumes of neonatal activity (aOR 0.55, 95% CI 0.33-0.91). Survival without neuromotor and sensory disabilities at 2 years increased with hospital volume, from 75% to 80.7% in the highest volume units. After adjustment for gestational age, small for gestational age, sex, maternal age, infertility treatment, multiple pregnancy, principal cause of prematurity, parental socioeconomic status, and mother's country of birth, survival without neuromotor or sensory disabilities was significantly lower in hospitals with a lower volume of neonatal activity (aOR 0.60, 95% CI 0.38-0.95) than in the highest quartile hospitals. CONCLUSIONS These results suggest that lower neonatal intensive care unit volume is associated with lower survival without an increase in disabilities at 2 years. These results could be useful to generate improvements of perinatal regionalization.
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Affiliation(s)
- Thomas Desplanches
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris Descartes University, Paris, France; CHRU Dijon, Department of Gynecology, Obstetrics, Fetal Medicine, and Infertility, University of Burgundy and Franche-Comté, Dijon, France.
| | - Béatrice Blondel
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris Descartes University, Paris, France
| | - Andrei Scott Morgan
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris Descartes University, Paris, France
| | - Antoine Burguet
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris Descartes University, Paris, France; Department of Neonatal Pediatrics, Dijon University Hospital, Dijon, France
| | - Monique Kaminski
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris Descartes University, Paris, France
| | | | - Laetitia Marchand-Martin
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris Descartes University, Paris, France
| | - Jean-Christophe Rozé
- Pediatric Intensive Care Unit, Mothers' and Children's Hospital, Nantes Teaching Hospital, Nantes, France
| | - Paul Sagot
- CHRU Dijon, Department of Gynecology, Obstetrics, Fetal Medicine, and Infertility, University of Burgundy and Franche-Comté, Dijon, France
| | - Patrick Truffert
- Neonatal Intensive Care Unit, Jeanne de Flandre Hospital, CHRU Lille, Lille, France
| | - Jennifer Zeitlin
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris Descartes University, Paris, France
| | - Pierre-Yves Ancel
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris Descartes University, Paris, France; Clinical Research Unit, Center for Clinical Investigation P1419, CHU Cochin Broca Hôtel-Dieu, Paris, France
| | - Jeanne Fresson
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris Descartes University, Paris, France; CHRU Nancy, Department of Medical Information, Nancy, France
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Mitha A, Piedvache A, Khoshnood B, Fresson J, Glorieux I, Roué JM, Blondel B, Durox M, Burguet A, Ancel PY, Kaminski M, Pierrat V. The impact of neonatal unit policies on breast milk feeding at discharge of moderate preterm infants: The EPIPAGE-2 cohort study. Matern Child Nutr 2019; 15:e12875. [PMID: 31310706 DOI: 10.1111/mcn.12875] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 06/26/2019] [Accepted: 07/09/2019] [Indexed: 01/30/2023]
Abstract
Facilitating factors and barriers to breast milk feeding (BMF) for preterm infants have been mainly studied in very preterm populations, but little is known about moderate preterm infants. We aimed to analyze hospital unit characteristics and BMF policies associated with BMF at discharge for infants born at 32 to 34 weeks' gestation. EPIPAGE-2, a French national cohort of preterm births, included 883 infants born at 32 to 34 weeks' gestation. We investigated kangaroo care in the first 24 hr, early involvement of parents in feeding support, volume of the unit, BMF information given to mothers hospitalized for threatened preterm delivery, protocols for BMF, presence of a professional trained in human lactation, unit training in neurodevelopmental care, and regional BMF initiation rates in the general population. Multilevel logistic regression analysis was used to investigate associations between unit policies and BMF at discharge, adjusted for individual characteristics and estimating odds ratios (ORs) and 95% confidence intervals (CIs). Overall, 59% (490/828) of infants received BMF at discharge (27% to 87% between units). Rates of BMF at discharge were higher with kangaroo care (adjusted OR 2.03 [95% CI 1.01, 4.10]), early involvement of parents in feeding support (1.94 [1.23, 3.04]), unit training in a neurodevelopmental care programme (2.57 [1.18, 5.60]), and in regions with a high level of BMF initiation in the general population (1.85 [1.05, 3.28]). Creating synergies by interventions at the unit and population level may reduce the variability in BMF rates at discharge for moderate preterm infants.
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Affiliation(s)
- Ayoub Mitha
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France.,Department of Neonatal Medicine, CHU Lille, Jeanne de Flandre Hospital, Lille, France
| | - Aurélie Piedvache
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France
| | - Babak Khoshnood
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France
| | - Jeanne Fresson
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France.,Department of Clinical Epidemiology and Biostatistics, CHRU Nancy, Nancy, France
| | - Isabelle Glorieux
- Department of Neonatology, Toulouse University Hospital, Toulouse, France
| | - Jean-Michel Roué
- Department of Neonatal Pediatrics and Intensive Care, Brest University Hospital, Brest, France
| | - Béatrice Blondel
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France
| | - Mélanie Durox
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France
| | - Antoine Burguet
- Department of Neonatal Pediatrics, Dijon University Hospital, Dijon, France
| | - Pierre-Yves Ancel
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France.,Clinical Research Unit, Center for Clinical Investigation P1419, Cochin Broca Hôtel-Dieu Hospital, Paris, France
| | - Monique Kaminski
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France
| | - Véronique Pierrat
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France.,Department of Neonatal Medicine, CHU Lille, Jeanne de Flandre Hospital, Lille, France
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Mitha A, Piedvache A, Glorieux I, Zeitlin J, Roué JM, Blondel B, Durox M, Burguet A, Kaminski M, Ancel PY, Pierrat V. Unit policies and breast milk feeding at discharge of very preterm infants: The EPIPAGE-2 cohort study. Paediatr Perinat Epidemiol 2019; 33:59-69. [PMID: 30698887 DOI: 10.1111/ppe.12536] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 11/02/2017] [Accepted: 12/10/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Facilitating factors and barriers to breast milk feeding (BMF) very preterm (VP) infants have been widely studied at the individual level. We aimed to describe and analyse factors associated with BMF at discharge for VP infants, with a special focus on unit policies aiming to support BMF. METHODS We described BMF at discharge in 3108 VP infants enrolled in EPIPAGE-2, a French national cohort. Variables of interest were kangaroo care during the 1st week of life (KC); unit's policies supporting BMF initiation (BMF information systematically given to mothers hospitalised for threatened preterm delivery and breast milk expression proposed within 6 hours after birth) and BMF maintenance (availability of protocols for BMF and a special room for mothers to pump milk); the presence in units of a professional trained in human lactation and regional BMF initiation rates in the general population. Associations were investigated by multilevel logistic regression analysis, with adjustment on individual factors. RESULTS In total, 47.2% of VP infants received BMF at discharge (range among units 21.1%-84.0%). Unit policies partly explained this variation, regardless of individual factors. BMF at discharge was associated with KC (adjusted odds ratio (aOR) 2.26 (95% confidence interval (CI) 1.40, 3.65)), with policies supporting BMF initiation (aOR 2.19 (95% CI 1.27, 3.77)) and maintenance (aOR 2.03 (95% CI 1.17, 3.55)), but not with BMF initiation rates in the general population. CONCLUSION Adopting policies of higher performing units could be an effective strategy for increasing BMF rates at discharge among VP infants.
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Affiliation(s)
- Ayoub Mitha
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center, Paris, France.,Paris Descartes University, Paris, France.,CHU Lille, Department of Neonatal Medicine, Jeanne de Flandre Hospital, Lille, France
| | - Aurélie Piedvache
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center, Paris, France
| | - Isabelle Glorieux
- Department of Neonatology, Toulouse University Hospital, Toulouse, France
| | - Jennifer Zeitlin
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center, Paris, France
| | - Jean-Michel Roué
- Department of Neonatal Pediatrics and Intensive Care, Brest University Hospital, Brest, France
| | - Béatrice Blondel
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center, Paris, France
| | - Mélanie Durox
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center, Paris, France
| | - Antoine Burguet
- Department of Neonatal Pediatrics, Dijon University Hospital Dijon, France
| | - Monique Kaminski
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center, Paris, France
| | - Pierre-Yves Ancel
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center, Paris, France.,Paris Descartes University, Paris, France.,Clinical Research Unit, Center for Clinical Investigation P1419, Cochin Broca Hôtel-Dieu Hospital, Paris, France
| | - Véronique Pierrat
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center, Paris, France.,CHU Lille, Department of Neonatal Medicine, Jeanne de Flandre Hospital, Lille, France
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Linder E, Burguet A, Nobili F, Vieux R. Neonatal renal replacement therapy: An ethical reflection for a crucial decision. Arch Pediatr 2018; 25:371-377. [PMID: 30143372 DOI: 10.1016/j.arcped.2018.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 06/05/2018] [Accepted: 06/20/2018] [Indexed: 10/28/2022]
Abstract
CONTEXT Technological advances in fetal and neonatal medicine, recent changes in the French legal framework, and encouraging results of the long-term outcomes in children with neonatal renal failure provide elements for an ethical reflection. METHODS We led a nationwide enquiry among French pediatric nephrologists, intensivists, and neonatologists, exploring the decision-making process when contemplating starting renal replacement therapy (RRT) or delivering palliative care to neonates or infants with pre-end-stage or end-stage renal disease; and the ethical quandaries at hand in such scenarios. RESULTS A total of 134 responses with complete national coverage were obtained. Care to be delivered to an infant in pre-end-stage or end-stage renal disease did not achieve consensus. Pediatric nephrologists were more prone to initiate a dialysis/graft program than pediatric intensivists. When chronic kidney disease was associated with comorbidities, especially neurological impairment, physicians, regardless of their subspecialty, were more reluctant to initiate conservative treatment. Many of the doctors surveyed did not give their opinion in these prenatal and/or postnatal situations, considered to be unique and warranting a multidisciplinary reflection. CONCLUSION Such ethical dilemmas are challenging for parents and physicians. They can only be overcome by taking into account both concrete on the ground realities and general principles and values acknowledged to be a basis for respecting the individual. In this way, it ensures humaneness and humanization of a practice that must meet a variety of challenges, one by one. The answer is not simple; it is always unique to each child and can only be approached by a multidisciplinary, time-consuming, open discussion, which will never totally erase uncertainty.
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Affiliation(s)
- E Linder
- Neonatal Department, Centre Hospitalier Universitaire de Strasbourg, 1, place de l'hôpital BP 426, 67091 Strasbourg cedex, France
| | - A Burguet
- Department of Neonatology, Centre Hospitalier Universitaire de Dijon, 1, rue Paul-Gaffarel, 21079 Dijon, France
| | - F Nobili
- Paediatric Nephrology Unit, Centre Hospitalier Universitaire Regional de Besancon, 3, boulevard Alexander-Fleming, 25030 Besançon cedex, France
| | - R Vieux
- Paediatric Nephrology Unit, Centre Hospitalier Universitaire Regional de Besancon, 3, boulevard Alexander-Fleming, 25030 Besançon cedex, France; Paediatric Department, Centre Hospitalier Universitaire Regional de Besançon, 25030 Besançon cedex, France; SMP, Franche-Comte University, 25030 Besançon, France.
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7
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Forner O, Schiby A, Ridley A, Thiriez G, Mugabo I, Morel V, Mulin B, Filiatre JC, Riethmuller D, Levy G, Semama D, Martin D, Chantegret C, Bert S, Godoy F, Sagot P, Rousseau T, Burguet A. Extremely premature infants: How does death in the delivery room influence mortality rates in two level 3 centers in France? Arch Pediatr 2018; 25:383-388. [PMID: 30041886 DOI: 10.1016/j.arcped.2018.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 05/27/2018] [Accepted: 06/20/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Mortality rates of very preterm infants may vary considerably between healthcare facilities depending on the neonates' place of inclusion in the cohort study. The objective of this study was to compare the mortality rates of live-born extremely preterm neonates observed in two French tertiary referral hospitals, taking into account the occurrence of neonatal death both in the delivery room and in the neonatal intensive care unit (NICU). METHODS Retrospective observational study including all pregnancy terminations, stillbirths and live-born infants within a 22- to 26-week 0/6 gestational age range was registered by two French level 3 university centers between 2009 and 2013. The mortality rates were compared between the two centers according to two places of inclusion: either the delivery room or the NICU. RESULTS A total of 344 infants were born at center A and 160 infants were born at center B. Among the live-born neonates, the rates of neonatal death were similar in center A (54/125, 43.2%) and center B (33/69, 47.8%; P=0.54). However, neonatal death occurred significantly more often in the delivery room at center A (31/54, 57.4%) than at center B (6/33, 18.2%; P<0.001). Finally, the neonatal death rate of live-born very preterm neonates admitted to the NICU was significantly lower in center A (25/94, 26.6%) than in center B (27/63, 42.9%; P=0.03). CONCLUSIONS This study points out how the inclusion of deaths in the delivery room when comparing neonatal death rates can lead to a substantial bias in benchmarking studies. Center A and center B each endorsed one of the two models of preferential place of neonatal death (delivery room or NICU) detailed in European studies. The reasons behind the two different models and their impact on how parents perceive supporting their neonate need further investigation.
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Affiliation(s)
- O Forner
- Service maternité-obstétrique, hôpital Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25000 Besançon, France.
| | - A Schiby
- Service réanimation néonatale et pédiatrique, hôpital Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
| | - A Ridley
- Service médecine pédiatrique, hôpital Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
| | - G Thiriez
- Service réanimation néonatale et pédiatrique, hôpital Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
| | - I Mugabo
- Service maternité-obstétrique, hôpital Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
| | - V Morel
- Service réanimation néonatale et pédiatrique, hôpital Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
| | - B Mulin
- Réseau périnatalité de Franche-Comté, hôpital Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
| | - J-C Filiatre
- Réseau périnatalité de Franche-Comté, hôpital Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
| | - D Riethmuller
- Service gynécologie obstétrique, hôpital Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
| | - G Levy
- Service gynécologie obstétrique, hôpital Nord Franche-Comté, 100, route de Moval, 90400 Trevenans, France
| | - D Semama
- Service réanimation néonatale et pédiatrique, hôpital d'enfants, 14, rue Paul-Gaffarel, 21000 Dijon, France
| | - D Martin
- Service réanimation néonatale et pédiatrique, hôpital d'enfants, 14, rue Paul-Gaffarel, 21000 Dijon, France
| | - C Chantegret
- Service réanimation néonatale et pédiatrique, hôpital d'enfants, 14, rue Paul-Gaffarel, 21000 Dijon, France
| | - S Bert
- Service maternité obstétrique, hôpital d'enfants, 14, rue Paul-Gaffarel, 21000 Dijon, France
| | - F Godoy
- Service réanimation néonatale et pédiatrique, hôpital d'enfants, 14, rue Paul-Gaffarel, 21000 Dijon, France
| | - P Sagot
- Service gynécologie obstétrique, CHU de Dijon, 14, rue Paul-Gaffarel, 21000 Dijon, France
| | - T Rousseau
- Service gynécologie obstétrique, CHU de Dijon, 14, rue Paul-Gaffarel, 21000 Dijon, France
| | - A Burguet
- Service réanimation néonatale et pédiatrique, hôpital d'enfants, 14, rue Paul-Gaffarel, 21000 Dijon, France
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Burguet A, Rousseau A. Oxytocin administration during spontaneous labor: Guidelines for clinical practice. Chapter 6: Fetal, neonatal and pediatric risks and adverse effects of using oxytocin augmentation during spontaneous labor. J Gynecol Obstet Hum Reprod 2017; 46:523-530. [PMID: 28476693 DOI: 10.1016/j.jogoh.2017.04.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- A Burguet
- Service de pédiatrie 2, CHU de Dijon, 14, boulevard Gaffarel, 21070 Dijon cedex, France; Réseau périnatal Franche-Comté, CHU de Besançon, 3, boulevard Alexandre-Flemming, 25030 Besançon cedex, France.
| | - A Rousseau
- EA 7285 RISCQ, UFR des sciences de la santé Simone-Veil, département de Maïeutique, université Versailles-Saint-Quentin, 2, avenue de la Source-de-la-Bièvre, 78180 Montigny-le-Bretonneux, France
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9
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Rousseau A, Burguet A. Oxytocin administration during spontaneous labor: Guidelines for clinical practice. Chapter 5: Maternal risk and adverse effects of using oxytocin augmentation during spontaneous labor. J Gynecol Obstet Hum Reprod 2017; 46:509-521. [PMID: 28473291 DOI: 10.1016/j.jogoh.2017.04.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- A Rousseau
- Département de Maïeutique, UFR des Sciences de la Santé Simone-Veil, Université Versailles-Saint-Quentin, 78180 Montigny-le-Bretonneux, France; EA 7285 RISCQ, UFR des Sciences de la Santé Simone-Veil, Université Versailles-Saint-Quentin, 78180 Montigny-le-Bretonneux, France.
| | - A Burguet
- Pédiatrie 2, CHU de Dijon, 21030 Dijon cedex, France; Réseau Périnatal Franche-Comté, CHU de Besançon, 25030 Besançon cedex, France
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10
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Dupont C, Carayol M, Le Ray C, Barasinski C, Beranger R, Burguet A, Chantry A, Chiesa C, Coulm B, Evrard A, Fischer C, Gaucher L, Guillou C, Leroy F, Phan E, Rousseau A, Tessier V, Vendittelli F, Deneux-Tharaux C, Riethmuller D. Recommandations pour l’administration d’oxytocine au cours du travail spontané. Texte court des recommandations. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.sagf.2016.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Dupont C, Carayol M, Le Ray C, Barasinski C, Beranger R, Burguet A, Chantry A, Chiesa C, Coulm B, Evrard A, Fischer C, Gaucher L, Guillou C, Leroy F, Phan E, Rousseau A, Tessier V, Vendittelli F, Deneux-Tharaux C, Riethmuller D. [Oxytocin administration during spontaneous labour: Guidelines for clinical practice. Guidelines short text]. ACTA ACUST UNITED AC 2017; 45:56-61. [PMID: 28238320 DOI: 10.1016/j.gofs.2016.12.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/21/2016] [Accepted: 12/21/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To define the different stages of spontaneous labour. To determine the indications, modalities of use and the effects of administering synthetic oxytocin. And to describe undesirable maternal and perinatal outcomes associated with the use of synthetic oxytocin. METHOD A systematic review was carried out by searching Medline database and websites of obstetrics learned societies until March 2016. RESULTS The 1st stage of labor is divided in a latence phase and an active phase, which switch at 5cm of cervical dilatation. Rate of cervical dilatation is considered as abnormal below 1cm per 4hour during the first part of the active phase, and below 1cm per 2hours above 7cm of dilatation. During the latent phase of the first stage of labor, i.e. before 5cm of cervical dilatation, it is recommended that an amniotomy not be performed routinely and not to use oxytocin systematically. It is not recommended to expect the active phase of labor to start the epidural analgesia if patient requires it. If early epidural analgesia was performed, the administration of oxytocin must not be systematic. If dystocia during the active phase, an amniotomy is recommended in first-line treatment. In the absence of an improvement within an hour, oxytocin should be administrated. However, in the case of an extension of the second stage beyond 2hours, it is recommended to administer oxytocin to correct a lack of progress of the presentation. If dynamic dystocia, it is recommended to start initial doses of oxytocin at 2mUI/min, to respect at least 30min intervals between increases in oxytocin doses delivered, and to increase oxytocin doses by 2mUI/min intervals without surpassing a maximum IV flow rate of 20mUI/min. The reported maternal adverse effects concern uterine hyperstimulation, uterine rupture and post-partum haemorrhage, and those of neonatal adverse effects concern foetal heart rate anomalies associated with uterine hyperstimulation, neonatal morbidity and mortality, neonatal jaundice, weak suck/poor breastfeeding latch and autism. CONCLUSION The widespread use of oxytocin during spontaneous labour must not be considered as simply another inoffensive prescription without any possible deleterious consequences for mother or foetus. Conditions for administering the oxytocin must therefore respect medical protocols. Indications and patient consent have to be report in the medical file.
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Affiliation(s)
- C Dupont
- Pôle IMER, Réseau périnatal Aurore, hospices civils de Lyon, 69003 Lyon, France; HESPER EA 7425, université Lyon, université Claude-Bernard-Lyon 1, 69008 Lyon, France.
| | - M Carayol
- Service de PMI, direction des familles et de la petite enfance, mairie de Paris, 75196 Paris, France
| | - C Le Ray
- Maternité Port Royal, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 75014 Paris, France; Inserm U1153, épidémiologie obstétricale, périnatale et pédiatrique (équipe EPOPé), centre de recherche en épidémiologie et statistiques Sorbonne Paris Cité (CRESS), DHU risques et grossesse, université Paris Descartes, 75014 Paris, France
| | - C Barasinski
- EA 4681 PEPRADE, université d'Auvergne, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - R Beranger
- Inserm U1085, IRSET, équipe 9 « recherches épidémiologiques sur l'environnement, la reproduction et le développement », 35000 Rennes, France
| | | | - A Chantry
- Inserm U1153, épidémiologie obstétricale, périnatale et pédiatrique (équipe EPOPé), centre de recherche en épidémiologie et statistiques Sorbonne Paris Cité (CRESS), DHU risques et grossesse, université Paris Descartes, 75014 Paris, France; École de sages-femmes Baudelocque, université Paris Descartes, DHU risques et grossesse, Assistance publique-Hôpitaux de Paris, 75014 Paris, France
| | - C Chiesa
- Inserm U1153, épidémiologie obstétricale, périnatale et pédiatrique (équipe EPOPé), centre de recherche en épidémiologie et statistiques Sorbonne Paris Cité (CRESS), DHU risques et grossesse, université Paris Descartes, 75014 Paris, France
| | - B Coulm
- Inserm U1153, épidémiologie obstétricale, périnatale et pédiatrique (équipe EPOPé), centre de recherche en épidémiologie et statistiques Sorbonne Paris Cité (CRESS), DHU risques et grossesse, université Paris Descartes, 75014 Paris, France
| | - A Evrard
- Association bien naître, 69003 Lyon, France
| | - C Fischer
- Maternité Port Royal, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 75014 Paris, France
| | - L Gaucher
- HESPER EA 7425, université Lyon, université Claude-Bernard-Lyon 1, 69008 Lyon, France; Hôpital Femme-Mère-Enfant, hospices civils de Lyon, 69500 Bron, France; Pôle information médicale évaluation recherche, 69003 Lyon, France
| | - C Guillou
- Clinique Natecia, 69008 Lyon, France
| | - F Leroy
- Hôpital Montélimar, 26200 Montélimar, France
| | - E Phan
- Association d'usagers, collectif inter-associatif autour de la naissance (CIANE), 75014 Paris, France
| | - A Rousseau
- Département de Maïeutique, UFR des sciences de la santé Simone-Veil, université Versailles-Saint-Quentin, 78000 Versailles, France
| | - V Tessier
- Département hospitalo-universitaire « risques et grossesse », groupe hospitalier Cochin, AP-HP, 53, avenue de l'Observatoire, 75014 Paris, France
| | - F Vendittelli
- EA 4681 PEPRADE, université d'Auvergne, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - C Deneux-Tharaux
- Inserm U1153, épidémiologie obstétricale, périnatale et pédiatrique (équipe EPOPé), centre de recherche en épidémiologie et statistiques Sorbonne Paris Cité (CRESS), DHU risques et grossesse, université Paris Descartes, 75014 Paris, France
| | - D Riethmuller
- Pôle Mère-Femme, CHRU de Besançon, 3, boulevard Fleming, 25000 Besançon, France
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Baurand A, Falcon-Eicher S, Laurent G, Villain E, Bonnet C, Thauvin-Robinet C, Jacquot C, Eicher JC, Gourraud JB, Schmitt S, Bézieau S, Giraud M, Dumont S, Kuentz P, Probst V, Burguet A, Kyndt F, Faivre L. Incomplete Timothy syndrome secondary to a mosaic mutation of the CACNA1C gene diagnosed using next-generation sequencing. Am J Med Genet A 2016; 173:531-536. [PMID: 27868338 DOI: 10.1002/ajmg.a.38045] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 10/14/2016] [Indexed: 11/12/2022]
Abstract
Autosomal dominant genetic diseases can occur de novo and in the form of somatic mosaicism, which can give rise to a less severe phenotype, and make diagnosis more difficult given the sensitivity limits of the methods used. We report the case of female child with a history of surgery for syndactyly of the hands and feet, who was admitted at 6 years of age to a pediatric intensive care unit following cardiac arrest. The electrocardiogram (ECG) showed a long QT interval that on occasions reached 500 ms. Despite the absence of facial dysmorphism and the presence of normal psychomotor development, a diagnosis of Timothy syndrome was made given the association of syndactyly and the ECG features. Sanger sequencing of the CACNA1C gene, followed by sequencing of the genes KCNQ1, KCNH2, KCNE1, KCNE2, were negative. The subsequent analysis of a panel of genes responsible for hereditary cardiac rhythm disorders using Haloplex technology revealed a recurrent mosaic p.Gly406Arg missense mutation of the CACNA1C gene in 18% of the cells. This mosaicism can explain the negative Sanger analysis and the less complete phenotype in this patient. Given the other cases in the literature, mosaic mutations in Timothy syndrome appear more common than previously thought. This case demonstrates the importance of using next-generation sequencing to identify mosaic mutations when the clinical picture supports a specific mutation that is not identified using conventional testing. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Amandine Baurand
- Centre de Génétique et Centre de Référence des Maladies Rares-Anomalies du Développement et Syndromes Malformatifs, CHU Dijon, Dijon, France
| | - Sylvie Falcon-Eicher
- Cardiologie Pédiatrique, CHU Dijon, Dijon, France.,Cardiologie et Centre de Compétence des Troubles du Rythme Cardiaque Héréditaires, CHU Dijon, Dijon, France
| | - Gabriel Laurent
- Cardiologie et Centre de Compétence des Troubles du Rythme Cardiaque Héréditaires, CHU Dijon, Dijon, France
| | - Elisabeth Villain
- Cardiologie Pédiatrique, Hôpital Necker-Enfants Malades, Paris, France
| | - Caroline Bonnet
- Cardiologie Pédiatrique, CHU Dijon, Dijon, France.,Cardiologie et Centre de Compétence des Troubles du Rythme Cardiaque Héréditaires, CHU Dijon, Dijon, France
| | - Christel Thauvin-Robinet
- Centre de Génétique et Centre de Référence des Maladies Rares-Anomalies du Développement et Syndromes Malformatifs, CHU Dijon, Dijon, France
| | - Caroline Jacquot
- Centre de Génétique et Centre de Référence des Maladies Rares-Anomalies du Développement et Syndromes Malformatifs, CHU Dijon, Dijon, France
| | - Jean-Christophe Eicher
- Cardiologie et Centre de Compétence des Troubles du Rythme Cardiaque Héréditaires, CHU Dijon, Dijon, France
| | | | | | | | | | - Solenne Dumont
- Service de Génétique Médicale, CHU Nantes, Nantes, France
| | - Paul Kuentz
- EA4271, Génétique des Anomalies du Développement, Université de Bourgogne-Franche Comté, Dijon, France
| | - Vincent Probst
- Institut du Thorax, INSERM U1087, CHU Nantes, Nantes, France
| | | | - Florence Kyndt
- Institut du Thorax, INSERM U1087, CHU Nantes, Nantes, France.,Service de Génétique Médicale, CHU Nantes, Nantes, France
| | - Laurence Faivre
- Centre de Génétique et Centre de Référence des Maladies Rares-Anomalies du Développement et Syndromes Malformatifs, CHU Dijon, Dijon, France.,Cardiologie et Centre de Compétence des Troubles du Rythme Cardiaque Héréditaires, CHU Dijon, Dijon, France.,EA4271, Génétique des Anomalies du Développement, Université de Bourgogne-Franche Comté, Dijon, France
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13
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Bouillon C, Léandri R, Desch L, Ernst A, Bruno C, Cerf C, Chiron A, Souchay C, Burguet A, Jimenez C, Sagot P, Fauque P. Does Embryo Culture Medium Influence the Health and Development of Children Born after In Vitro Fertilization? PLoS One 2016; 11:e0150857. [PMID: 27008092 PMCID: PMC4805279 DOI: 10.1371/journal.pone.0150857] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 02/19/2016] [Indexed: 01/14/2023] Open
Abstract
In animal studies, extensive data revealed the influence of culture medium on embryonic development, foetal growth and the behaviour of offspring. However, this impact has never been investigated in humans. For the first time, we investigated in depth the effects of embryo culture media on health, growth and development of infants conceived by In Vitro Fertilization until the age of 5 years old. This single-centre cohort study was based on an earlier randomized study. During six months, in vitro fertilization attempts (No. 371) were randomized according to two media (Single Step Medium—SSM group) or Global medium (Global group). This randomized study was stopped prematurely as significantly lower pregnancy and implantation rates were observed in the SSM group. Singletons (No. 73) conceived in the randomized study were included (42 for Global and 31 for SSM). The medical data for gestational, neonatal and early childhood periods were extracted from medical records and parental interviews (256 variables recorded). The developmental profiles of the children in eight domains (social, self-help, gross motor, fine motor, expressive language, language comprehension, letter knowledge and number knowledge – 270 items) were compared in relation to the culture medium. The delivery rate was significantly lower in the SSM group than in the Global group (p<0.05). The culture medium had no significant effect on birthweight, risk of malformation (minor and major), growth and the frequency of medical concerns. However, the children of the Global group were less likely than those of the SSM group to show developmental problems (p = 0.002), irrespective of the different domains. In conclusion, our findings showed that the embryo culture medium may have an impact on further development.
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Affiliation(s)
- Céline Bouillon
- Service de Médecine et Biologie de la Reproduction, Centre Hospitalier Régional Universitaire de Tours, Tours, France
| | - Roger Léandri
- Centre d’Assistance Médicale à la Procréation, Hôpital Paule de Viguier, Groupe de Recherche en Fertilité Humaine, EA 3694, Toulouse, France
| | - Laurent Desch
- Laboratoire de Biologie de la Reproduction, Hôpital de Dijon, Equipe GAD, Génétique des Anomalies du Développement, EA 4271, Université de Bourgogne, Dijon, France
| | - Alexandra Ernst
- LEAD—CNRS UMR 5022, Université de Bourgogne, Pôle AAFE, Dijon, France
| | - Céline Bruno
- Laboratoire de Biologie de la Reproduction, Hôpital de Dijon, Equipe GAD, Génétique des Anomalies du Développement, EA 4271, Université de Bourgogne, Dijon, France
| | - Charline Cerf
- LEAD—CNRS UMR 5022, Université de Bourgogne, Pôle AAFE, Dijon, France
| | - Alexandra Chiron
- Laboratoire de Biologie de la Reproduction, SELAFA BIOFFICE—Clinique Jean Villar, Bruges, France
| | - Céline Souchay
- LEAD—CNRS UMR 5022, Université de Bourgogne, Pôle AAFE, Dijon, France
| | - Antoine Burguet
- Service de Pédiatrie, Hôpital de Dijon, Université de Bourgogne, Dijon, France
| | - Clément Jimenez
- Service de Biologie de la Reproduction-CECOS, Institut des maladies neurodégénérativesCNRS UMR 5293, Université de Bordeaux, Bordeaux, France
| | - Paul Sagot
- Service de Gynécologie-Obstétrique, Médecine Fœtale et Stérilité Conjugale, Hôpital de Dijon, Université de Bourgogne, Dijon, France
| | - Patricia Fauque
- Laboratoire de Biologie de la Reproduction, Hôpital de Dijon, Equipe GAD, Génétique des Anomalies du Développement, EA 4271, Université de Bourgogne, Dijon, France
- * E-mail:
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14
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Ancel PY, Goffinet F, Kuhn P, Langer B, Matis J, Hernandorena X, Chabanier P, Joly-Pedespan L, Lecomte B, Vendittelli F, Dreyfus M, Guillois B, Burguet A, Sagot P, Sizun J, Beuchée A, Rouget F, Favreau A, Saliba E, Bednarek N, Morville P, Thiriez G, Marpeau L, Marret S, Kayem G, Durrmeyer X, Granier M, Baud O, Jarreau PH, Mitanchez D, Boileau P, Boulot P, Cambonie G, Daudé H, Bédu A, Mons F, Fresson J, Vieux R, Alberge C, Arnaud C, Vayssière C, Truffert P, Pierrat V, Subtil D, D'Ercole C, Gire C, Simeoni U, Bongain A, Sentilhes L, Rozé JC, Gondry J, Leke A, Deiber M, Claris O, Picaud JC, Ego A, Debillon T, Poulichet A, Coliné E, Favre A, Fléchelles O, Samperiz S, Ramful D, Branger B, Benhammou V, Foix-L'Hélias L, Marchand-Martin L, Kaminski M, Kaminski M. Survival and morbidity of preterm children born at 22 through 34 weeks' gestation in France in 2011: results of the EPIPAGE-2 cohort study. JAMA Pediatr 2015; 169:230-8. [PMID: 25621457 DOI: 10.1001/jamapediatrics.2014.3351] [Citation(s) in RCA: 475] [Impact Index Per Article: 52.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Up-to-date estimates of the health outcomes of preterm children are needed for assessing perinatal care, informing parents, making decisions about care, and providing evidence for clinical guidelines. OBJECTIVES To determine survival and neonatal morbidity of infants born from 22 through 34 completed weeks' gestation in France in 2011 and compare these outcomes with a comparable cohort in 1997. DESIGN, SETTING, AND PARTICIPANTS The EPIPAGE-2 study is a national, prospective, population-based cohort study conducted in all maternity and neonatal units in France in 2011. A total of 2205 births (stillbirths and live births) and terminations of pregnancy at 22 through 26 weeks' gestation, 3257 at 27 through 31 weeks, and 1234 at 32 through 34 weeks were studied. Cohort data were collected from January 1 through December 31, 1997, and from March 28 through December 31, 2011. Analyses for 1997 were run for the entire year and then separately for April to December; the rates for survival and morbidities did not differ. Data are therefore presented for the whole year in 1997 and the 8-month and 6-month periods in 2011. MAIN OUTCOMES AND MEASURES Survival to discharge and survival without any of the following adverse outcomes: grade III or IV intraventricular hemorrhage, cystic periventricular leukomalacia, severe bronchopulmonary dysplasia, retinopathy of prematurity (stage 3 or higher), or necrotizing enterocolitis (stages 2-3). RESULTS A total of 0.7% of infants born before 24 weeks' gestation survived to discharge: 31.2% of those born at 24 weeks, 59.1% at 25 weeks, and 75.3% at 26 weeks. Survival rates were 93.6% at 27 through 31 weeks and 98.9% at 32 through 34 weeks. Infants discharged home without severe neonatal morbidity represented 0% at 23 weeks, 11.6% at 24 weeks, 30.0% at 25 weeks, 47.5% at 26 weeks, 81.3% at 27 through 31 weeks, and 96.8% at 32 through 34 weeks. Compared with 1997, the proportion of infants surviving without severe morbidity in 2011 increased by 14.4% (P < .001) at 25 through 29 weeks and 6% (P < .001) at 30 through 31 weeks but did not change appreciably for those born at less than 25 weeks. The rates of antenatal corticosteroid use, induced preterm deliveries, cesarean deliveries, and surfactant use increased significantly in all gestational-age groups, except at 22 through 23 weeks. CONCLUSIONS AND RELEVANCE The substantial improvement in survival in France for newborns born at 25 through 31 weeks' gestation was accompanied by an important reduction in severe morbidity, but survival remained rare before 25 weeks. Although improvement in survival at extremely low gestational age may be possible, its effect on long-term outcomes requires further studies. The long-term results of the EPIPAGE-2 study will be informative in this regard.
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Affiliation(s)
- Pierre-Yves Ancel
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris, France2Paris Descartes University, Paris, France3Clinical Research Unit, Center for Clinical Investigation
| | - François Goffinet
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris, France2Paris Descartes University, Paris, France4Maternité Port-Royal, Hospital University Department Risks
| | | | | | | | | | | | | | | | | | | | - Michel Dreyfus
- Department of Gynecology and Obstetrics, University Hospital, Caen, France
| | - Bernard Guillois
- Department of Neonatal Pediatrics and Intensive Care, University Hospital, Caen, France
| | - Antoine Burguet
- Department of Neonatal Pediatrics, University Hospital, Dijon, France
| | - Pierre Sagot
- Department of Gynecology and Obstetrics, University Hospital, Dijon, France
| | | | - Alain Beuchée
- Department of Pediatrics, University Hospital, Inserm-Irset U 1085, Rennes, France
| | - Florence Rouget
- Department of Pediatrics, University Hospital, Inserm-Irset U 1085, Rennes, France
| | - Amélie Favreau
- Department of Neonatal Pediatrics and Intensive Care, University Hospital, Tours, France
| | - Elie Saliba
- INSERM U 930, François Rabelais University, Tours, France
| | - Nathalie Bednarek
- Department of Neonatal Pediatrics, University Hospital, Reims, France
| | - Patrice Morville
- Department of Neonatal Pediatrics, University Hospital, Reims, France
| | - Gérard Thiriez
- Department of Neonatal Pediatrics, University Hospital, Besançon, France
| | - Loïc Marpeau
- Department of Gynecology and Obstetrics, University Hospital, Rouen, France
| | - Stéphane Marret
- Department of Neonatal Pediatrics and Intensive Care, Rouen University Hospital-Laboratory of microvascular endothelium and neonatal brain lesions, Rouen, France
| | - Gilles Kayem
- Department of Obstetrics and Gynecology, Louis Mourier Hospital, University Hospitals Paris Nord Val de Seine (HUPNVS)), Assistance Publique-Paris Hospitals (APHP), Paris Diderot University, Paris, France
| | - Xavier Durrmeyer
- Department of Neonatal Pediatrics and Intensive Care, CHI, CRC, Créteil, France
| | - Michèle Granier
- Department of Neonatal Pediatrics, Sud Francilien Hospital, Evry, France
| | - Olivier Baud
- Neonatal intensive care unit, Robert Debré Hospital, INSERM, UMR 676, Paris, France
| | - Pierre-Henri Jarreau
- Department of Neonatal Pediatrics and Intensive Care, Cochin Hotel Dieu Hospital, Paris, France
| | | | - Pascal Boileau
- Department of Neonatal Pediatrics, Poissy Saint Germain University Hospital, Poissy, France
| | - Pierre Boulot
- Department of Obstetrics and Gynecology, Arnaud de Villeneuve Hospital, Montpellier, France
| | - Gilles Cambonie
- Department of Neonatal Pediatrics and Intensive Care, Arnaud de Villeneuve Hospital, Montpellier, France
| | | | - Antoine Bédu
- Department of Neonatal Pediatrics, Mère-Enfant Hospital, Limoges, France
| | - Fabienne Mons
- Department of Neonatal Pediatrics, Mère-Enfant Hospital, Limoges, France
| | - Jeanne Fresson
- Department of Medical Information, Adolphe Pinard Maternity Unit, Nancy, France
| | - Rachel Vieux
- Department of Neonatal Pediatrics and Intensive Care, Adolphe Pinard Maternity Unit, Nancy, France
| | | | - Catherine Arnaud
- UMR 1027 INSERM, Paul-Sabatier Toulouse III University, Toulouse, France
| | | | - Patrick Truffert
- Department of Neonatal Pediatrics, Jeanne de Flandres Hospital, Lille, France
| | - Véronique Pierrat
- Department of Neonatal Pediatrics, Jeanne de Flandres Hospital, Lille, France
| | - Damien Subtil
- Department of Gynecology and Obstetrics, Jeanne de Flandre Hospital, Lille, France
| | - Claude D'Ercole
- Department of Gynecology and Obstetrics, Nord Hospital, Marseille, France
| | - Catherine Gire
- Department of Neonatal Pediatrics and Intensive Care, Nord Hospital, Marseille, France
| | - Umberto Simeoni
- Department of Neonatal Pediatrics and Intensive Care, La Conception Hospital, Marseille, France
| | - André Bongain
- Department of Gynecology and Obstetrics, Archet Hospital, Nice, France
| | - Loïc Sentilhes
- Department of Obstetrics and Gynecology, Angers University Hospital, Angers, France
| | - Jean-Christophe Rozé
- Department of Neonatal Medicine, Angers University Hospital and INSERM CIC 004, Nantes, France
| | - Jean Gondry
- Department of Obstetrics and gynecology, Amiens, France
| | - André Leke
- Department of Pediatrics, Amiens, France
| | | | - Olivier Claris
- Department of Neonatal Pediatrics and Intensive Care, University Hospital, Lyon, France
| | - Jean-Charles Picaud
- Department of Neonatal Pediatrics and Intensive Care, La Croix Rousse Hospital, Lyon, France
| | - Anne Ego
- INSERM CIC003, University Hospital, Grenoble, France
| | - Thierry Debillon
- Department of Neonatal Pediatrics, University Hospital, Grenoble, France
| | | | - Eliane Coliné
- University Hospital, Pointe à Pitre, Guadeloupe, France
| | - Anne Favre
- Department of Neonatal Pediatrics and Intensive Care, Cayenne Hospital, Cayenne, Guyane, France
| | | | - Sylvain Samperiz
- Department of Neonatal Pediatrics and Intensive Care, University Hospital Felix Guyon, Saint-Denis, La Réunion, France
| | - Duksha Ramful
- Department of Neonatal Pediatrics and Intensive Care, University Hospital Felix Guyon, Saint-Denis, La Réunion, France
| | - Bernard Branger
- Fédération des Réseaux de Santé en Périnatalité [FFRSP], Nantes, France
| | - Valérie Benhammou
- Inserm UMR1153, Perinatal and Pediatric Epidemiology Team, Paris, France
| | | | | | - Monique Kaminski
- Inserm UMR1153, Perinatal and Pediatric Epidemiology Team, Paris, France
| | - Monique Kaminski
- Inserm UMR1153, Perinatal and Pediatric Epidemiology Team, Paris, France
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Mitanchez D, Burguet A, Simeoni U. Infants born to mothers with gestational diabetes mellitus: mild neonatal effects, a long-term threat to global health. J Pediatr 2014; 164:445-50. [PMID: 24331686 DOI: 10.1016/j.jpeds.2013.10.076] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 09/23/2013] [Accepted: 10/28/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Delphine Mitanchez
- Division of Neonatology, Department of Perinatology, Armand Trousseau Hospital, Paris, France; Pierre et Marie Curie Paris 6 University, Faculté de Médecine, Paris, France.
| | - Antoine Burguet
- Division of Pediatrics 2, Hôpital du Bocage, Dijon Cedex, Paris, France; INSERM UMR S 953, Paris, France
| | - Umberto Simeoni
- Department of Neonatology, Assistance Publique - Hôpitaux de Marseille, Marseille, France; UMR608 INSERM, Aix-Marseille University, Marseille, France
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Savajols E, Burguet A, Grimaldi M, Godoy F, Sagot P, Semama DS. Maternal haemoglobin and short-term neonatal outcome in preterm neonates. PLoS One 2014; 9:e89530. [PMID: 24586850 PMCID: PMC3934893 DOI: 10.1371/journal.pone.0089530] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 01/22/2014] [Indexed: 12/05/2022] Open
Abstract
Objective To determine whether there is a significant association between maternal haemoglobin measured before delivery and short-term neonatal outcome in very preterm neonates. Study design We included prospectively all live births occurring from 25 to 32+6 weeks of gestation in a tertiary care centre between January 1st 2009 and December 31st 2011. Outborn infants and infants presenting with lethal malformations were excluded. Three hundred and thirty-nine mothers and 409 infants met the inclusion criteria. For each mother-infant pair a prospective record of epidemiologic data was performed and maternal haemoglobin concentration recorded within 24 hours before delivery was retrospectively researched. Maternal haemoglobin was divided into quartiles with the second and the third one regarded as reference as they were composed of normal haemoglobin values. Short-term outcome was defined as poor in case of death during hospital stay and/or grades III/IV intraventricular haemorrhage and/or periventricular leukomalacia and/or necessity of ventriculoperitoneal shunt. Results The global rate of poor short-term neonatal outcome was 11.4% and was significantly associated with low maternal haemoglobin values. This association remained significant after adjustment for antenatal corticosteroids therapy, gestational age, parity, mechanism of preterm birth, mode of delivery and birth weight (aOR = 2.97 CI 95% [1.36–6.47]). There was no relation between short-term neonatal outcome and high maternal haemoglobin concentration values. Conclusion We show that low maternal haemoglobin concentration at delivery is an independent risk factor for poor short-term neonatal outcome in very preterm neonates. This study is one of the first to show such an association within the preterm population.
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Affiliation(s)
- Elodie Savajols
- Department of Paediatrics, Centre Hospitalier Universitaire, Dijon, France
| | - Antoine Burguet
- Department of Paediatrics, Centre Hospitalier Universitaire, Dijon, France
| | - Marianne Grimaldi
- Department of Paediatrics, Centre Hospitalier Universitaire, Dijon, France
| | - Florence Godoy
- Department of Paediatrics, Centre Hospitalier Universitaire, Dijon, France
| | - Paul Sagot
- Department of Obstetrics, Centre Hospitalier Universitaire, Dijon, France
| | - Denis S. Semama
- Department of Paediatrics, Centre Hospitalier Universitaire, Dijon, France
- * E-mail:
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Burguet A, Menget A, Chary-Tardy AC, Savajols E, Abed N, Thiriez G. [Variables determining the amount of care for very preterm neonates: the concept of medical stance]. Arch Pediatr 2013; 21:134-41. [PMID: 24355651 DOI: 10.1016/j.arcped.2013.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 09/18/2013] [Accepted: 11/15/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To compare the amount of medical interventions on very preterm neonates (24-31 weeks of gestation) in two French university tertiary care centers, one of which is involved in a Neonatal Developmental Care program. A secondary objective is to assess whether this difference in medical interventions can be linked to a difference in mortality and morbidity rates. METHODS We prospectively included all very preterm neonates free from lethal malformation born live in these two centers between 2006 and 2010. These inclusion criteria were met by 1286 patients, for whom we compared the rate of five selected medical interventions: birth by caesarean section, chest intubation in the delivery room, surfactant therapy, pharmacological treatment of patent ductus arteriosus, and red blood cell transfusion. RESULTS The rates of the five medical interventions were systematically lower in the center that is involved in Neonatal Developmental Care. There was no significant difference in survival at discharge with no severe cerebral ultrasound scan abnormalities between the two centers. There were, however, significantly higher rates of bronchopulmonary dysplasia and nosocomial sepsis and longer hospital stays when the patients were not involved in a Neonatal Developmental Care program. DISCUSSION This benchmarking study shows that in France, in the first decade of the 21st century, there are as many ways to handle very preterm neonates as there are centers in which they are born. This brings to light the concept of medical stance, which is the general care approach prior to the treatment itself. This medical stance creates the overall framework for the staff's decision-making regarding neonate care. The different parameters structuring medical stance are discussed. Moreover, this study raises the problematic issue of the aftermath of benchmarking studies when the conclusion is an increase of morbidity in cases where procedure leads to more interventions.
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Affiliation(s)
- A Burguet
- Service de pédiatrie 2, CHU de Dijon, hôpital du Bocage, 21079 Dijon cedex, France; Inserm-UMR S 953, recherche épidémiologique en santé périnatale et santé des femmes et des enfants, hôpital Cochin, 75014 Paris, France; UMPC université Paris 06, UMR S 953, 75005 Paris, France.
| | - A Menget
- Service de réanimation pédiatrique et néonatologie, CHU de Besançon, hôpital Saint-Jacques, 25000 Besançon, France
| | - A-C Chary-Tardy
- Service de pédiatrie 2, CHU de Dijon, hôpital du Bocage, 21079 Dijon cedex, France
| | - E Savajols
- Service de pédiatrie 2, CHU de Dijon, hôpital du Bocage, 21079 Dijon cedex, France
| | - N Abed
- Service de pédiatrie 2, CHU de Dijon, hôpital du Bocage, 21079 Dijon cedex, France
| | - G Thiriez
- Service de réanimation pédiatrique et néonatologie, CHU de Besançon, hôpital Saint-Jacques, 25000 Besançon, France
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Bodeau-Livinec F, Zeitlin J, Blondel B, Arnaud C, Fresson J, Burguet A, Subtil D, Marret S, Rozé JC, Marchand-Martin L, Ancel PY, Kaminski M. Do very preterm twins and singletons differ in their neurodevelopment at 5 years of age? Arch Dis Child Fetal Neonatal Ed 2013; 98:F480-7. [PMID: 23864442 DOI: 10.1136/archdischild-2013-303737] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Twins have inconsistently shown poorer outcomes than singletons. Although a high proportion of twins are born very preterm, data are sparse on the long-term outcomes in very preterm twins. The objective of this study was to compare mortality and neurodevelopmental outcomes of very preterm singletons and twins and to study outcomes in relation to factors specific to twins. DESIGN Birth cohort study Etude Epidemiologique sur les Petits Ages Gestationnels (EPIPAGE). SETTING Nine regions in France. PATIENTS All very preterm live births occurring from 22 to 32 weeks of gestation in all maternity wards of nine French regions in 1997 (n=2773). MAIN OUTCOMES MEASURES Neurodevelopmental status, including cerebral palsy, and a cognitive assessment with the Kaufman Assessment Battery for Children, with scores on the Mental Processing Composite (MPC) scale, was available for 1732 and 1473 children at 5 years of age, respectively. RESULTS Among live births, twins had higher hospital mortality than singletons (adjusted (a)OR: 1.4 (95% CI 1.1 to 1.9)). Among survivors, there was no crude difference at 5 years between twins and singletons in the prevalence of cerebral palsy (8.0% vs 9.1%, respectively), MPC <70 (9.5% vs 11.1%) and mean MPC (94.6 vs 94.4). However, after adjustment for sex, gestational age, intrauterine growth restriction and social factors, twins were more likely to have lower MPC scores (mean difference: -2.4 (95% CI-4.8 to 0.01)). Live born twins had a higher risk of mortality when birth weight discordance was present (aOR:2.9 (95% CI 1.7 to 4.8)), but there were no differences in long-term outcomes. CONCLUSIONS Compared with very preterm singletons, twins had higher mortality, no difference with respect to severe deficiencies, but slightly lower MPC scores at 5 years.
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Courcet JB, Faivre L, Michot C, Burguet A, Perez-Martin S, Alix E, Amiel J, Baumann C, Cordier MP, Cormier-Daire V, Delrue MA, Gilbert-Dussardier B, Goldenberg A, Jacquemont ML, Jaquette A, Kayirangwa H, Lacombe D, Le Merrer M, Toutain A, Odent S, Moncla A, Pelet A, Philip N, Pinson L, Poisson S, Kim-Han LQS, Roume J, Sanchez E, Willems M, Till M, Vincent-Delorme C, Mousson C, Vinault S, Binquet C, Huet F, Sarda P, Salomon R, Lyonnet S, Sanlaville D, Geneviève D. Clinical and molecular spectrum of renal malformations in Kabuki syndrome. J Pediatr 2013; 163:742-6. [PMID: 23535010 DOI: 10.1016/j.jpeds.2013.02.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 12/28/2012] [Accepted: 02/14/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine the frequency and types of renal malformations, and to evaluate renal function in a cohort of patients with Kabuki syndrome (KS). STUDY DESIGN Renal ultrasound scans and plasma creatinine measurements were collected from a French cohort of 94 patients with genotyped KS. Renal function was evaluated based on the estimated glomerular filtration rate. A genotype-phenotype study was conducted for renal and urinary tract malformations. RESULTS Renal malformations were present in 22% of cases, and urinary tract anomalies were present in 15%. Renal malformations were observed in 28% of the MLL2 mutation-positive group and in 0% of the MLL2 mutation-negative group (P = .015). No correlation was found between the presence or absence of renal or urinary tract malformations and the location or type of MLL2 mutation. Renal function was normal except for 1 patient with a MLL2 mutation diagnosed in the first days of life and severe renal disease due to unilateral renal agenesia and controlateral severe hypoplasia that progressed to the terminal stage at age 2 years. CONCLUSION Our study emphasizes the need for ultrasound and renal function screening in children diagnosed with KS.
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Affiliation(s)
- Jean-Benoît Courcet
- Pediatrics 1 and Medical Genetics, Center of Reference for Developmental Abnormalities and Malformative Syndromes, Children's Hospital, University of Burgundy, Dijon, France
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20
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Mitha A, Foix-L'Hélias L, Arnaud C, Marret S, Vieux R, Aujard Y, Thiriez G, Larroque B, Cambonie G, Burguet A, Boileau P, Rozé JC, Kaminski M, Truffert P, Ancel PY. Neonatal infection and 5-year neurodevelopmental outcome of very preterm infants. Pediatrics 2013; 132:e372-80. [PMID: 23878051 DOI: 10.1542/peds.2012-3979] [Citation(s) in RCA: 143] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To determine whether neonatal infections are associated with a higher risk of adverse neurodevelopment at 5 years of age in a population-based cohort of very preterm children. METHODS We included all live births between 22 and 32 weeks of gestation, from 9 regions in France, in 1997 (EPIPAGE study). Of the 2665 live births, 2277 were eligible for a follow-up evaluation at 5 years of age: 1769 had a medical examination and 1495 underwent cognitive assessment. Cerebral palsy and cognitive impairment were studied as a function of early-onset sepsis (EOS) and late-onset sepsis (LOS), after adjustment for potential confounding factors, in multivariate logistic regression models. RESULTS A total of 139 (5%) of the 2665 live births included in the study presented with EOS alone (without associated LOS), 752 (28%) had LOS alone (without associated EOS), and 64 (2%) displayed both EOS and LOS. At 5 years of age, the frequency of cerebral palsy was 9% (157 of 1769) and that of cognitive impairment was 12% (177 of 1495). The frequency of cerebral palsy was higher in infants with isolated EOS (odds ratio [OR]: 1.70 [95% confidence interval (CI): 0.84-3.45]) or isolated LOS (OR: 1.71 [95% CI: 1.14-2.56]) than in uninfected infants, and this risk was even higher in cases of combined EOS and LOS (OR: 2.33 [95% CI: 1.02-5.33]). There was no association between neonatal infection and cognitive impairment. CONCLUSIONS Neonatal infections in these very preterm infants were associated with a higher risk of cerebral palsy at the age of 5 years, particularly in infants presenting with both EOS and LOS.
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Affiliation(s)
- Ayoub Mitha
- Neonatal Unit Hôpital Jeanne de Flandre, Lille, France.
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Ferdynus C, Quantin C, Abrahamowicz M, Burguet A, Sagot P, Gouyon JB. Comparison of the ability of alternative birthweight and fetal weight standards to identify preterm newborns at increased risk of perinatal death. BJOG 2013; 120:1456-64. [DOI: 10.1111/1471-0528.12282] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2013] [Indexed: 11/28/2022]
Affiliation(s)
- C Ferdynus
- Centre d'Epidémiologie des Populations; Université de Bourgogne; Dijon France
- Unité de Soutien Méthodologique; University Hospital; Saint Denis de la Réunion France
| | - C Quantin
- CHRU; Service de Biostatistique et d'Informatique Médicale; CHU de Dijon France
- Inserm; U866; Dijon; Université de Bourgogne; Dijon France
| | - M Abrahamowicz
- Department of Epidemiology and Biostatistics; McGill University; Montreal QC Canada
- Department of Biostatistics; Réunion University (France) and CHU de La Reunion; Centre d'Etudes Périnatales de l'Océan Indien; Saint-Pierre Cedex France
| | - A Burguet
- Inserm; CIE1; Dijon France
- CHRU Dijon; Centre d'Investigation Clinique-Epidémiologie Clinique/Essais Cliniques; Dijon France
- Université de Bourgogne; Dijon France
| | - P Sagot
- Centre d'Epidémiologie des Populations; Université de Bourgogne; Dijon France
- Department of Obstetrics and Gynaecology; University Hospital; Dijon France
| | - J-B Gouyon
- Centre d'Epidémiologie des Populations; Université de Bourgogne; Dijon France
- Department of Paediatrics; University Hospital; Dijon France
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Charkaluk ML, Marchand-Martin L, Ego A, Zeitlin J, Arnaud C, Burguet A, Marret S, Rozé JC, Vieux R, Kaminski M, Ancel PY, Pierrat V. The influence of fetal growth reference standards on assessment of cognitive and academic outcomes of very preterm children. J Pediatr 2012; 161:1053-8. [PMID: 22765954 DOI: 10.1016/j.jpeds.2012.05.037] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Revised: 03/22/2012] [Accepted: 05/15/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare 3 methods of identifying small-for-gestational-age (SGA) status in very preterm children as related to cognitive function and academic outcome. STUDY DESIGN There were 1038 singletons in the Epipage Study, born before 33 weeks in 1997 without severe neurosensory impairment, who were classified as SGA when birth weight was below the 10th percentile according to: (1) birth weight (bw) reference: SGA(bw)/appropriate for gestational age (AGA)(bw); (2) intrauterine (intraut) reference: SGA(intraut)/AGA(intraut); and (3) intrauterine reference customized (cust) according to individual characteristics: SGA(cust)/AGA(cust). Cognitive function was assessed by the mental processing composite (MPC) score of the Kaufman Assessment Battery for Children at age 5 and academic achievement by a parental questionnaire at age 8. RESULTS Of the children, 15% were SGA(bw), 38% were SGA(intraut), and 39% were SGA(cust). All children SGA(bw) were also SGA(intraut) and SGA(cust). MPC was <85 in 32% of children and 27% had low academic achievement. AGA(bw)/SGA(intraut) children had a significantly increased risk of MPC <85 (adjusted OR 1.74, 95% CI 1.22-2.28) or low academic achievement (adjusted OR 1.64, 95% CI 1.05-2.55) compared with AGA(bw)/AGA(intraut) children. The SGA(cust) group was only slightly different from the SGA(intraut) group. CONCLUSIONS An intrauterine reference identified very preterm infants at risk of poor cognitive or academic outcomes better than a birth weight reference. Customization resulted in only slight modifications of the SGA group.
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Affiliation(s)
- Marie-Laure Charkaluk
- INSERM, UMR S953, Epidemiological Research on Perinatal Health and Women's and Children's Health, Hôpital Tenon, Paris, France.
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Pierrat V, Marchand-Martin L, Guemas I, Matis J, Burguet A, Picaud JC, Fresson J, Alberge C, Marret S, Roze JC, Kaminski M, Larroque B, Ancel PY. Height at 2 and 5 years of age in children born very preterm: the EPIPAGE study. Arch Dis Child Fetal Neonatal Ed 2011; 96:F348-54. [PMID: 21242241 DOI: 10.1136/adc.2010.185470] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate growth for children born very preterm with particular focus on those born small-for-gestational age (SGA) or with ex utero growth restraint (GR), and to identify risk factors for short stature at 5 years of age. STUDY DESIGN Population-based study of children born at less than 33 completed weeks of gestation (Étude Epidémiologique sur les Petits Ages Gestationnels (EPIPAGE)). Short stature was defined as height <-2SD on WHO growth curves. Ex utero GR was considered to have occurred in children with appropriate size for gestational age at birth and with a height and/or weight below -2SD at 2 years of corrected age. Logistic regression models were used to test associations between risk factors and short stature. RESULTS The authors measured height at 5 years of age for 1,597 of 2,193 children (73%), 5.6% (95% CI 4.6 to 6.9) of whom were diagnosed as having a short stature. Height was measured at 2 and 5 years of age in 1417 children. Among these, 24% of those born SGA and 36% of those with ex utero GR (p=0.002) had a short stature at 5 years. Predictors of short stature were SGA or birth length <-2SD, maternal height ≤ 160 cm, gestational age <29 weeks and systemic corticosteroids. Breastfeeding at discharge decreased the risk of short stature. CONCLUSIONS Short stature at 5 years of age is common in children born preterm. The highest incidence was observed in the group with ex utero GR. Systemic steroids have a long-term impact on growth and should be used with caution. Breastfeeding at discharge appeared to be protective.
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Affiliation(s)
- V Pierrat
- Neonatal Unit, University Teaching Hospital, Hôpital Jeanne de Flandre, Lille Cedex, France.
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Kayemba-Kay's S, Epstein S, Hindmarsh P, Burguet A, Ingrand P, Hankard R. Does plasma IGF-BP3 measurement contribute to the diagnosis of growth hormone deficiency in children? Ann Endocrinol (Paris) 2011; 72:218-23. [PMID: 21641574 DOI: 10.1016/j.ando.2011.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Revised: 09/01/2010] [Accepted: 01/06/2011] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To audit the contribution of plasma IGF-PB3 measurement to the diagnosis of growth hormone deficiency (GHD) in children. POPULATION AND METHODS Retrospective case study including boys and girls aged 0 to 18 years who attended our paediatric endocrinology clinic for short stature and/or post-irradiation follow-up, and had at least one GH provocative testing. Children with hypothyroidism, Laron or Kowarski syndromes, severe malnutrition, chronic renal failure and liver failure were excluded. RESULTS Fifty-eight children were enrolled and grouped as GHD [+] (19 cases) and GDH [-] (39 cases). IGF-I and IGF-BP3 assay was carried out in 88% and 62% cases respectively, both groups were comparable for age, sex, BMI, target height, pubertal stage and bone age. There was a significant difference in peak GH between GDH [-] and GHD [+] groups (41.8 mUI/L ± 21.7 versus 11.5 ± 5.9 mUI/L, P<0.00001, respectively). No difference was found between groups with regards to IGF-I Z-scores and IGF-BP3 Z-scores. There was, however, a positive correlation between IGF-I Z-scores and IGF-BP3 Z-scores (r=0.50; P<0.0016). IGF-BP3 measurement could not differentiate between GHD [+] and GHD [-] groups. CONCLUSIONS Measurement of plasma IGF-BP3 level contributes poorly to the diagnosis of GHD. We do not recommend it in routine use.
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Affiliation(s)
- S Kayemba-Kay's
- Paediatric Endocrinology Unit, Department of Pediatrics, Poitiers University Teaching Hospital, France.
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Kayemba-Kay's S, Ribrault A, Burguet A, Gouyon JB, Riethmuller D, Menget A, Hindmarsh PC. Maternal smoking during pregnancy and fetal growth. Effects in preterm infants of gestational age less than 33 weeks. Swiss Med Wkly 2010; 140:w13139. [PMID: 21181569 DOI: 10.4414/smw.2010.13139] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate the effects of maternal smoking during pregnancy on foetal growth in preterm infants with gestational age (GA) <33 weeks. POPULATION AND METHODS Prospective observational cross-sectional study from two French perinatal networks cohort of preterm infants. Cases were 358 very preterm infants (GA 24-32 weeks) divided into two groups as maternal smokers (129) and non-smokers (229). 361 term infants (GA 37-41 weeks) also divided into two groups as maternal smokers (129) and non-smokers (232) served as comparison group (controls). We studied the influence of maternal smoking on foetal anthropometric growth parameters (BW, BL and head circumference defined according to AUDIPOG curves) in groups and compared cases and controls. Other causes of foetal growth restriction were excluded. RESULTS Maternal characteristics (age, height, pre-pregnancy body weight, parity, foetus sex) were similar in both groups and sub-groups. Mothers who smoked were younger (P <0.001), more likely to be unemployed (P <0.001) and to have undergone less school education (P <0.001). Smoking did not alter foetal growth in preterm infants: maternal smokers versus non-smokers BW (P = 0.52), BL (P = 0.44) and HC (P = 0.81). Growth restriction was marked in term infants with BW (P <0.001), BL (P <0.001) and HC (P <0.01). In multivariate analysis, after adjustment for other confounding factors, foetal growth appeared to be significantly altered by maternal smoking during pregnancy only in term infants. CONCLUSION Our study suggests that effects of maternal smoking during pregnancy on foetal growth are gestational age-dependent.
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Affiliation(s)
- Simon Kayemba-Kay's
- Unité d’Endocrinologie Pédiatrique, Département de Pédiatrie, CHU de Poitiers, Poitiers, France.
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Beaino G, Khoshnood B, Kaminski M, Pierrat V, Marret S, Matis J, Ledésert B, Thiriez G, Fresson J, Rozé JC, Zupan-Simunek V, Arnaud C, Burguet A, Larroque B, Bréart G, Ancel PY. Predictors of cerebral palsy in very preterm infants: the EPIPAGE prospective population-based cohort study. Dev Med Child Neurol 2010; 52:e119-25. [PMID: 20163431 DOI: 10.1111/j.1469-8749.2010.03612.x] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM The aim of this study was to assess the independent role of cerebral lesions on ultrasound scan, and several other neonatal and obstetric factors, as potential predictors of cerebral palsy (CP) in a large population-based cohort of very preterm infants. METHOD As part of EPIPAGE, a population-based prospective cohort study, perinatal data and outcome at 5 years of age were recorded for 1812 infants born before 33 weeks of gestation in nine regions of France in 1997. RESULTS The study group comprised 942 males (52%) and 870 females with a mean gestational age of 30 weeks (SD 2 wks; range 24-32 wks) and a mean birthweight of 1367 g (SD 393 g; range 450-2645 g). CP was diagnosed at 5 years of age in 159 infants (prevalence 9%; 95% confidence interval [CI] 7-10%), 97 males and 62 females, with a mean gestational age of 29 weeks (SD 2 wks; range 24-32 wks) and a mean birthweight of 1305 g (SD 386 g; range 500-2480 g). Among this group, 67% walked without aid, 14% walked with aid, and 19% were unable to walk. Spastic, ataxic, and dyskinetic CP accounted for 89%, 7%, and 4% of cases respectively. The prevalence of CP was 61% among infants with cystic periventricular leukomalacia, 50% in infants with intraparenchymal haemorrhage, 8% in infants with grade I intraventricular haemorrhage, and 4% in infants without a detectable cerebral lesion. After controlling for cerebral lesions and obstetric and neonatal factors, only male sex (odds ratio [OR] 1.52; 95% CI 1.03-2.25) and preterm premature rupture of membranes or preterm labour (OR 1.72; 95% CI 0.95-3.14) were predictors of the development of CP in very preterm infants. INTERPRETATION Cerebral lesions were the most important predictor of CP in very preterm infants. In addition, infant sex and preterm premature rupture of membranes or preterm labour were also independent predictors of CP.
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Affiliation(s)
- Ghada Beaino
- INSERM, UMR S953, Epidemiological Research Unit on Perinatal Health and Women's and Children's Health, Hôpital Tenon, and UMPC University Paris, Paris, France.
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Gouyon JB, Vintejoux A, Sagot P, Burguet A, Quantin C, Ferdynus C. Neonatal outcome associated with singleton birth at 34-41 weeks of gestation. Int J Epidemiol 2010; 39:769-76. [DOI: 10.1093/ije/dyq037] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Burguet A, Ferdynus C, Thiriez G, Bouthet MF, Kayemba-Kays S, Sanyas P, Menget A, Mulin B, Riethmuller D, Maillet R, Brousse C, Magnin G, Boisselier P, Sagot P, Pierre F, Gouyon B, Gouyon JB. Very preterm birth: who has access to antenatal corticosteroid therapy? Paediatr Perinat Epidemiol 2010; 24:63-74. [PMID: 20078831 DOI: 10.1111/j.1365-3016.2009.01090.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We describe the administration of antenatal corticosteroid therapy (ACT) for liveborn very preterm neonates in a population-based study. A total of 790 very preterm neonates (between 24 and 31 full weeks of gestation) were included in this regionally defined population of very preterm neonates in France. The main outcome measure was non-access to ACT. Data were analysed using logistic and polytomous models to control for neonatal and sociodemographic characteristics, mechanisms of very preterm birth and neonatal network organisation. As compared with level III, births in levels I-II maternity units were closely related to non-access to ACT (60.1% vs. 8.8%), but not to pregnancy follow-up (19.7% vs. 17.8%). Only 6.3% of very preterm neonates that benefited from antepartum referral did nor receive ACT. Births associated with rupture of membranes and gestational hypertension were significantly more often transferred to level-III units (73.8% and 68.3% respectively) than those due to maternal bleeding and spontaneous labour (57.0% and 50.7% respectively), and the neonates had a lower probability of not receiving ACT (8.5%, 11.5%, 23.0%, 31.2% respectively). Very preterm neonates referred in utero to a level-III unit came from a more favourable socio-economic environment. Non-access to ACT was more often observed in neonates born to 14- to 24-year-old mothers, smokers, of low socio-economic status, and preterm birth resulting from maternal bleeding or spontaneous labour. These data from a French regional study show that access to ACT is not only explained by practitioners' support of recommendations. In our population-based study, ACT access was related to socio-economic factors and to the mechanisms of very preterm birth. Improving the rate of access to ACT should take these organisational, medical and socio-economic dimensions into account.
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Affiliation(s)
- Antoine Burguet
- Inserm, CIE1, CHRU Dijon, Centre d'Investigation Clinique - Epidémiologie Clinique/Essais Cliniques, Université de Bourgogne, 21030 Dijon, France.
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Burguet A, Pez O, Debaene B, Untersteller M, Bettinger G, Kayemba-Kays S, Thiriez G, Bouthet MF, Sanyas P, Menget A, Mulin B, Maillet R, Boisselier P, Pierre F, Gouyon JB. [Very preterm birth: is maternal anesthesia a risk factor for neonatal intubation in the delivery room?]. Arch Pediatr 2009; 16:1547-53. [PMID: 19854034 DOI: 10.1016/j.arcped.2009.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2008] [Revised: 01/30/2009] [Accepted: 09/03/2009] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the risk of tracheal intubation at birth in very premature neonates related to the type of maternal anesthesia in case of elective cesarean. POPULATION AND METHODS All 219 live-born very premature neonates (28-32 weeks of gestation), delivered after an elective cesarean in the 27 maternity wards of 2 French semi-rural neonatal networks. Eighty-three percent (182/219) were delivered in level III maternity wards in university hospitals. RESULTS Of the very preterm neonates, 33.3% (73/219) were intubated in the delivery room, either for respiratory distress syndrome or a low APGAR score. Very preterm neonates delivered after maternal general anesthesia were more often intubated than those delivered after spinal anesthesia (48.7% vs 25.2%; OR: 2.8; 95% CI: 1.8-5.1). The risk of intubation related to maternal general anesthesia remained statistically significant after an adjustment for gestational age, fetal growth retardation, respiratory distress syndrome, type of maternity ward, and a propensity score that took into account maternal sociodemographic characteristics and the causes of very preterm birth (aOR: 3.4; 95% CI: 1.4-8.2). The risk of intubation related to general anesthesia was lower after adjusting for the 5-min APGAR score (aOR: 2.8; 95% CI: 1.0-7.3). CONCLUSION Very preterm neonates delivered after cesarean with general anesthesia require tracheal intubation in the delivery room more often than those delivered with spinal anesthesia. This study cannot assess a causal link between anesthesia and the need for neonatal intubation. However, neonatologists have to be aware of the type of maternal anesthesia because it may interfere with the non-invasive ventilation support policy of the very preterm neonate.
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Affiliation(s)
- A Burguet
- CIE1, Inserm, Centre d'Investigation Clinique, d'Epidémiologie Clinique et d'Essais Cliniques, Université de Bourgogne, CHRU de Dijon, 21000 Dijon, France.
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Delobel-Ayoub M, Arnaud C, White-Koning M, Casper C, Pierrat V, Garel M, Burguet A, Roze JC, Matis J, Picaud JC, Kaminski M, Larroque B. Behavioral problems and cognitive performance at 5 years of age after very preterm birth: the EPIPAGE Study. Pediatrics 2009; 123:1485-92. [PMID: 19482758 DOI: 10.1542/peds.2008-1216] [Citation(s) in RCA: 279] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES We compared the frequency of behavioral problems in very preterm and term children at 5 years of age. We hypothesized that behavioral problems would be associated with cognitive impairment and environmental factors and that differences between the 2 groups would be reduced but persist after adjusting for cognitive performance and environmental factors. PATIENTS AND METHODS The Etude Epidémiologique sur les Petits Ages Gestationnels (EPIPAGE) study was a prospective population-based cohort study that included all births occurring between 22 and 32 weeks' gestation and a control group of infants born at 39 to 40 weeks' gestation in 1997 in 9 French regions. Neonatal and obstetrics data were collected at birth. At 5 years of age, sociodemographic status and neurodevelopmental and cognitive development of the children, as well as maternal mental well-being, were assessed. The behavioral problems of 1102 very preterm and 375 term singletons without major impairments were studied by using the parent-completed Strengths and Difficulties Questionnaire. RESULTS Parents of very preterm children reported significantly more behavioral problems, with a twofold higher prevalence compared with term children for hyperactivity/inattention, emotional symptoms, and peer problems. Behavioral problems were associated with low cognitive performance, developmental delay, hospitalizations of the child, young maternal age, and poor maternal mental well-being. Very preterm children were still at higher risk of behavioral problems compared with term children after adjustment for cognitive performance and all others factors. CONCLUSIONS Behavioral problems were strongly related to cognitive impairment, but very preterm children were still at higher risk even after adjusting for cognitive performance. Early screening for behavioral problems should be encouraged for all very preterm children, and maternal well-being should also be the focus of special attention.
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Affiliation(s)
- Malika Delobel-Ayoub
- Institut National de la Santé et de la Recherche Médicale, U558, 37 Allées Jules Guesde, 31073 Toulouse Cedex, France.
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Ferdynus C, Quantin C, Abrahamowicz M, Platt R, Burguet A, Sagot P, Binquet C, Gouyon JB. Can birth weight standards based on healthy populations improve the identification of small-for-gestational-age newborns at risk of adverse neonatal outcomes? Pediatrics 2009; 123:723-30. [PMID: 19171644 DOI: 10.1542/peds.2007-2564] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To develop neonatal growth standards based on (1) the entire population of live births and (2) a healthy subpopulation and compare them in identifying infants as small for gestational age and at risk of adverse neonatal outcomes. PATIENTS AND METHODS We included all births, between 28 and 41 weeks of gestation, reported in Burgundy (France) from 2000 to 2006. Fetal deaths, multiple births, and chromosomal aberrations were excluded. We first estimated separate birth weight distributions at each week of gestation for (1) all neonates and (2) only infants born from women without maternal diseases. Small for gestational age was defined as a birth weight below the 10th percentile of the corresponding standard. We assessed the associations of small for gestational age on the basis of the alternative definitions, with mortality and major neonatal outcomes. RESULTS We included 127 584 live births. For term newborns, small for gestational age was significantly associated with an increased risk of death with both standards. In contrast, for preterm newborns (32-36 weeks), small for gestational age was not significantly associated with mortality and morbidity. Very preterm infants (28-31 weeks) identified as small for gestational age according to the healthy-population standard were at higher risk of chronic lung disease and intraventricular hemorrhage. When using the entire-population standard, small for gestational age was associated with chronic lung disease but not intraventricular hemorrhage. The area under the receiver operating characteristic for predicting an intraventricular hemorrhage was significantly greater for small for gestational age defined with the healthy-population standard compared with small for gestational age classified with the entire-population standard. CONCLUSIONS Neonatal growth standards based on healthy populations could improve the identification of very preterm neonates as small for gestational age and at risk of intraventricular hemorrhage.
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Affiliation(s)
- Cyril Ferdynus
- Cellule d'Evaluation du Réseau Périnatal de Bourgogne, 1 Boulevard Jeanne d'Arc, B P-77908, 21079 Dijon Cedex, France.
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Larroque B, Ancel PY, Marret S, Marchand L, André M, Arnaud C, Pierrat V, Rozé JC, Messer J, Thiriez G, Burguet A, Picaud JC, Bréart G, Kaminski M. Neurodevelopmental disabilities and special care of 5-year-old children born before 33 weeks of gestation (the EPIPAGE study): a longitudinal cohort study. Lancet 2008; 371:813-20. [PMID: 18328928 DOI: 10.1016/s0140-6736(08)60380-3] [Citation(s) in RCA: 530] [Impact Index Per Article: 33.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The increasing survival rates of children who are born very preterm raise issues about the risks of neurological disabilities and cognitive dysfunction. We aimed to investigate neurodevelopmental outcome and use of special health care at 5 years of age in a population-based cohort of very preterm children. METHODS We included all 2901 livebirths between 22 and 32 completed weeks of gestation from nine regions in France in Jan 1-Dec 31, 1997, and a reference group of 667 children from the same regions born at 39-40 weeks of gestation. At 5 years of age, children had a medical examination and a cognitive assessment with the Kaufman assessment battery for children (K-ABC), with scores on the mental processing composite (MPC) scale recorded. Data for health-care use were collected from parents. Severe disability was defined as non-ambulatory cerebral palsy, MPC score less than 55, or severe visual or hearing deficiency; moderate deficiency as cerebral palsy walking with aid or MPC score of 55-69; and minor disability as cerebral palsy walking without aid, MPC score of 70-84, or visual deficit (<3/10 for one eye). FINDINGS In total, 1817 (77%) of the 2357 surviving children born very preterm had a medical assessment at 5 years and 396 (60%) of 664 in the reference group. Cerebral palsy was diagnosed in 159 (9%) of children born very preterm. Scores for MPC were available for 1534 children born very preterm: 503 (32%) had an MPC score less than 85 and 182 (12%) had an MPC score less than 70. Of the 320 children in the reference group, the corresponding values were 37 (12%) and 11 (3%), respectively. In the very preterm group, 83 (5%) had severe disability, 155 (9%) moderate disability, and 398 (25%) minor disability. Disability was highest in children born at 24-28 completed weeks of gestation (195 children [49%]), but the absolute number of children with disabilities was higher for children born at 29-32 weeks (441 children [36%]). Special health-care resources were used by 188 (42%) of children born at 24-28 weeks and 424 (31%) born at 29-32 weeks, compared with only 63 (16%) of those born at 39-40 weeks. INTERPRETATION In children who are born very preterm, cognitive and neuromotor impairments at 5 years of age increase with decreasing gestational age. Many of these children need a high level of specialised care. Prevention of the learning disabilities associated with cognitive deficiencies in this group is an important goal for modern perinatal care for children who are born very preterm and for their families.
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Affiliation(s)
- Béatrice Larroque
- INSERM, UMR S149, IFR69, Research Unit on Perinatal Health and Women's Health, Villejuif, France; Université Pierre et Marie Curie-Paris 6, Paris, France.
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Foix-L'Hélias L, Marret S, Ancel PY, Marchand L, Arnaud C, Fresson J, Picaud JC, Rozé JC, Theret B, Burguet A, Larroque B, Kaminski M. Impact of the use of antenatal corticosteroids on mortality, cerebral lesions and 5-year neurodevelopmental outcomes of very preterm infants: the EPIPAGE cohort study. BJOG 2008; 115:275-82. [PMID: 18081606 DOI: 10.1111/j.1471-0528.2007.01566.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the impact of antenatal corticosteroids (ACS) on neonatal mortality, cerebral lesions and 5-year neurodevelopmental outcome of infants born at 24-27 and 28-32 weeks of gestational age (GA). DESIGN Observational population-based study including all births at GAs between 22 and 32 weeks in 1997 in nine regions of France. Survivors were assessed at the age of 5 years. SAMPLE AND METHODS The population enrolled in the follow up comprised 2323 infants; there were 23 deaths before age 5 years and outcome at 5 years was available for up to 1781 subjects. Two GA subgroups (24-27 and 28-32 weeks of GA) were analysed separately. Propensity scores were used to reduce bias in the estimation of the association between ACS treatment and outcomes. MAIN OUTCOME MEASURES Neonatal death, neonatal white matter injury, cerebral palsy, mental processing composite (MPC) of the Kaufman Assessment Battery for Children test and behavioural difficulties at 5 years. RESULTS In the 28- to 32-week GA subgroup, there was a significant association between ACS and a decreased risk of both neonatal death (OR = 0.61 [0.41-0.91]) and white matter injury (OR = 0.60 [0.46-0.79]) but only a nonsignificant trend for improved 5-year outcome (cerebral palsy, MPC < 70). In the 24- to 27-week GA subgroup, ACS was associated with a significant decrease risk of neonatal death (OR = 0.43 [0.27-0.68]) but there was only a trend for a lower risk of white matter injury and no beneficial impact on outcome at 5 years. Limiting the analysis to only those who received complete courses of ACS did not modify the results. CONCLUSION The study shows that ACS therapy greatly increases the survival of very preterm infants, including the most immature, but there is little evidence that ACS affects long-term neurodevelopmental and behavioural outcome in 28- to 32-week survivors, and none in <28-week survivors.
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Affiliation(s)
- L Foix-L'Hélias
- Inserm, UMR S149, Research Unit on Perinatal Health and Women's Health, Villejuif, France.
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Arnaud C, Daubisse-Marliac L, White-Koning M, Pierrat V, Larroque B, Grandjean H, Alberge C, Marret S, Burguet A, Ancel PY, Supernant K, Kaminski M. Prevalence and Associated Factors of Minor Neuromotor Dysfunctions at Age 5 Years in Prematurely Born Children. ACTA ACUST UNITED AC 2007; 161:1053-61. [DOI: 10.1001/archpedi.161.11.1053] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Burguet A, Di Maio M, Besnier-Di Maio S, Kayemba-Kay's S, Nassimi A, Bouthet MF, Pierre F, Boisselier P. [Very preterm birth less than 33 weeks' gestation: how setting-up of a perinatal network does influence the activity of the neonatal tertiary care unit? The experience of the Poitou-Charentes region, France]. J Gynecol Obstet Biol Reprod (Paris) 2007; 36:479-85. [PMID: 17368961 DOI: 10.1016/j.jgyn.2007.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2006] [Revised: 10/18/2006] [Accepted: 02/06/2007] [Indexed: 05/14/2023]
Abstract
OBJECTIVES To evaluate the impact of regional perinatal network setting on very preterm neonates (gestational age<33 weeks) referral and activity of regional level 3 NCIU, and short-term outcome of infants cared for. POPULATION AND METHODS Comparison of data from medical records of hospital days and hospital outcome of very preterm neonates born before and after the setting-up of regional perinatal network (2002-2005). RESULTS The setting-up of the Poitou-Charentes perinatal network has led to a 45% rise in number of very preterm neonates admitted to the level 3 neonatal care (114 in 2002, 166 in 2005), number of hospitalisation days has also increased by 31% in neonatology unit (2181 days in 2002, 2864 days in 2005) but remained stable in intensive care unit. A transient rise in neonatal mortality was observed, although the incidence of severe ultrasonographic cerebral abnormalities and that of bronchopulmonary dysplasia were lowered. CONCLUSION Setting-up of perinatal network in Poitou-Charentes (France) has led to improved access to level 3 neonatal care, with rise in very preterm neonates survival and low incidence of short-term sequelae.
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MESH Headings
- Female
- France
- Gestational Age
- Hospital Mortality
- Humans
- Infant Mortality
- Infant, Newborn
- Infant, Premature/growth & development
- Infant, Premature, Diseases/epidemiology
- Infant, Premature, Diseases/prevention & control
- Infant, Small for Gestational Age
- Infant, Very Low Birth Weight
- Intensive Care Units, Neonatal/standards
- Intensive Care Units, Neonatal/statistics & numerical data
- Length of Stay
- Male
- Neonatology/methods
- Neonatology/standards
- Outcome Assessment, Health Care
- Perinatal Care
- Premature Birth
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Affiliation(s)
- A Burguet
- Service de pédiatrie, CHU de Poitiers, 86021 Poitiers cedex, France; Réseau périnatal Poitou-Charentes, Futuropole, BP 50044, 86361 Chasseneuil du Poitou cedex, France.
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Delobel-Ayoub M, Kaminski M, Marret S, Burguet A, Marchand L, N'Guyen S, Matis J, Thiriez G, Fresson J, Arnaud C, Poher M, Larroque B. Behavioral outcome at 3 years of age in very preterm infants: the EPIPAGE study. Pediatrics 2006; 117:1996-2005. [PMID: 16740841 DOI: 10.1542/peds.2005-2310] [Citation(s) in RCA: 112] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Our goal was to compare the prevalence of behavioral problems between very preterm children and term children at 3 years of age and examine the factors associated with behavioral problems in very preterm children. METHODS We conducted a prospective population-based cohort study: the EPIPAGE (Etude Epidémiologique sur les Petits Ages Gestationnels) study. All infants born between 22 and 32 weeks of gestation in 9 regions of France in 1997 were included and compared with a control group of infants born at term. Sociodemographic status, obstetric, and neonatal data were collected at birth and in the neonatal units. At 3 years of age, the behavioral problems of 1228 very preterm singleton children without major neurodisabilities, and 447 term children were studied using the Strengths and Difficulties Questionnaire completed by the parents. RESULTS Very preterm children were more likely than controls to have behavioral difficulties. Among very preterm children, several medical conditions were associated with a high total difficulty score: major neonatal cerebral lesions diagnosed by cranial ultrasonographic studies, hospitalization within the last year, poor health, and psychomotor delay. A high birth order and sociodemographic factors such as young maternal age and low educational level of the mother were also identified as risk factors for behavioral difficulties. The differences between very preterm children and controls remained significant after adjustment for sociodemographic characteristics, neonatal complications, and neurodevelopmental status, for a high total difficulties score, hyperactivity, conduct problems, and for peer problems. For emotional problems, the difference was at the limit of significance. CONCLUSIONS Very preterm children have a higher risk of behavioral problems at 3 years of age compared with term-born children. Health and neurodevelopmental status of the child were significantly associated with behavioral difficulties.
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Ancel PY, Livinec F, Larroque B, Marret S, Arnaud C, Pierrat V, Dehan M, N'Guyen S, Escande B, Burguet A, Thiriez G, Picaud JC, André M, Bréart G, Kaminski M. Cerebral palsy among very preterm children in relation to gestational age and neonatal ultrasound abnormalities: the EPIPAGE cohort study. Pediatrics 2006; 117:828-35. [PMID: 16510664 DOI: 10.1542/peds.2005-0091] [Citation(s) in RCA: 220] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To estimate the prevalence of cerebral palsy at 2 years of age among children born very preterm, according to gestational age, infant gender, plurality, and neonatal cranial ultrasound abnormalities. METHODS All infants born between 22 and 32 weeks of gestation in 9 regions of France in 1997 were included in this prospective, population-based, cohort study. The main outcome measure was cerebral palsy prevalence at 2 years. Of the 2364 survivors eligible for follow-up evaluation, 1954 (83%) were assessed at 2 years of age. RESULTS Among the 1954 children assessed at 2 years, 8.2% had cerebral palsy. Bilateral spastic cerebral palsy, hemiplegia, and monoplegia accounted for 72%, 9%, and 10% of cases, respectively. Fifty percent of the children with cerebral palsy walked independently at the age of 2, 31% were unable to walk but could sit independently, and 19% could not sit (unable to maintain head and trunk control). The prevalence of cerebral palsy was 20% at 24 to 26 weeks of gestation, compared with 4% at 32 weeks. On the basis of ultrasound findings in the neonatal period, we found that 17% of children with isolated grade III intraventricular hemorrhage and 25% of children with white matter damage (ie, ventricular dilation, persistent echodensities, or cystic periventricular leukomalacia) had cerebral palsy, compared with 4% of children with normal ultrasound scans. CONCLUSIONS Despite recent improvements in survival rates, cerebral palsy remains highly prevalent among very preterm children. Severe cranial ultrasound abnormalities predict motor disability strongly, but one third of infants with cerebral palsy had no ultrasound abnormalities.
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Affiliation(s)
- Pierre-Yves Ancel
- INSERM U149 Research Unit on Perinatal Health and Women's Health, Villejuif, France.
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Ancel PY, Marret S, Larroque B, Arnaud C, Zupan-Simunek V, Voyer M, Rozé JC, Matis J, Burguet A, Ledésert B, André M, Pierrat V, Kaminski M. Are maternal hypertension and small-for-gestational age risk factors for severe intraventricular hemorrhage and cystic periventricular leukomalacia? Results of the EPIPAGE cohort study. Am J Obstet Gynecol 2005; 193:178-84. [PMID: 16021076 DOI: 10.1016/j.ajog.2004.11.057] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the relationships between different causes of preterm delivery (eg, maternal hypertension, small-for-gestational age [SGA], other) and cerebral damage (eg, cystic periventricular leukomalacia [c-PVL], grade III intraventricular hemorrhage [IVH], and intra-parenchymal hemorrhage [IPH]). STUDY DESIGN This study included 1902 very preterm singletons who were transferred to neonatal intensive care units in 9 French regions. We used logistic regression models to compare the risk of cerebral injury associated with maternal hypertension, SGA, and all other causes of preterm delivery. RESULTS We found that the risk of c-PVL and grade III IVH was higher in infants born after preterm premature rupture of membranes (PPROM) with short latency or idiopathic preterm labor than in infants born to hypertensive mothers. We show that SGA and antepartum maternal hemorrhage significantly increase the risk of IPH. CONCLUSION Our results show that infants born to hypertensive mothers have a lower risk of cerebral injuries than infants born following idiopathic preterm labor and PPROM because they are less exposed to prenatal infection.
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Affiliation(s)
- Pierre-Yves Ancel
- Inserm U149 Research Unit on Perinatal Health and Women's Health, Villejuif, France.
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Burguet A. [What diagnostic tools can be used to assess antenatal exposure to smoking? Pediatric experience]. J Gynecol Obstet Biol Reprod (Paris) 2005; 34 Spec No 1:3S249-54. [PMID: 15980797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
In France, one out of four infants is born to a smoking mother. The short-, mid-, and long-term effects of antenatal exposure to smoking are only partially known. En Europe, it is generally accepted that most smoking mothers are aware of their smoking habit. Nevertheless, certain mothers deny their smoking or minimize the number of cigarettes smoked. The impact of anti-smoking campaigns on the frequency of maternal smoking and its recognition are unknown. The question is determine whether an objective marker of smoking in the neonatal period would be useful for individual care or epidemiological research. Cotinine and CO are the most widely used neonatalagy.
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Affiliation(s)
- A Burguet
- Service de Pédiatrie, Hôpital Jean Bernard, CHU de Poitiers, 86021 Poitiers Cedex.
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Nabet C, Ancel PY, Burguet A, Kaminski M. Smoking during pregnancy and preterm birth according to obstetric history: French national perinatal surveys. Paediatr Perinat Epidemiol 2005. [PMID: 15787882 DOI: 10.1111/j.13653016.2005.00639.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The relation between smoking and preterm delivery is not totally known. Our aim was to determine whether smoking during pregnancy was associated with preterm birth among women at different risk according to their obstetric history. The study was based on data from the 1998 French national perinatal survey. Of the 13073 singleton live births, 4.7% were preterm; 15% of the pregnant women were moderate (one to nine cigarettes per day) and 10% heavy smokers (at least 10 cigarettes per day). Smoking heavily was related to preterm birth (crude odds ratio [OR] = 1.35, 95% confidence interval [95% CI]: [1.04, 1.74]). Multivariable logistic regression showed a relation between smoking and preterm birth among multiparae without previous adverse pregnancy outcomes; the associated adjusted ORs (AORs) were 1.25 [95% CI 0.83, 1.87] among moderate smokers and 1.46 [95% CI 0.98, 2.20] among heavy smokers. The corresponding AORs were 0.69 [95% CI 0.46, 1.05]) and 0.96 [95% CI 0.59, 1.56] for primiparae and 1.11 [95% CI 0.63, 1.93] and 0.50 [95% CI 0.25, 0.98] for multiparae with previous adverse pregnancy outcomes. Our study showed a relation between heavy smoking during pregnancy and preterm birth mostly for women with low obstetric risk.
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Affiliation(s)
- Cathy Nabet
- Epidemiological Research Unit on Perinatal and Women's Health, INSERM U149, Villejuif, France.
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Abstract
The relation between smoking and preterm delivery is not totally known. Our aim was to determine whether smoking during pregnancy was associated with preterm birth among women at different risk according to their obstetric history. The study was based on data from the 1998 French national perinatal survey. Of the 13073 singleton live births, 4.7% were preterm; 15% of the pregnant women were moderate (one to nine cigarettes per day) and 10% heavy smokers (at least 10 cigarettes per day). Smoking heavily was related to preterm birth (crude odds ratio [OR] = 1.35, 95% confidence interval [95% CI]: [1.04, 1.74]). Multivariable logistic regression showed a relation between smoking and preterm birth among multiparae without previous adverse pregnancy outcomes; the associated adjusted ORs (AORs) were 1.25 [95% CI 0.83, 1.87] among moderate smokers and 1.46 [95% CI 0.98, 2.20] among heavy smokers. The corresponding AORs were 0.69 [95% CI 0.46, 1.05]) and 0.96 [95% CI 0.59, 1.56] for primiparae and 1.11 [95% CI 0.63, 1.93] and 0.50 [95% CI 0.25, 0.98] for multiparae with previous adverse pregnancy outcomes. Our study showed a relation between heavy smoking during pregnancy and preterm birth mostly for women with low obstetric risk.
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Affiliation(s)
- Cathy Nabet
- Epidemiological Research Unit on Perinatal and Women's Health, INSERM U149, Villejuif, France.
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Fotso Kamdem A, Burguet A, Aubert D. [Gestational diabetes and urinary tract malformations: a hospital case-control study]. Prog Urol 2005; 15:53-8. [PMID: 15822393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
INTRODUCTION Urinary tract malformations represent the leading cause of renal failure in children. Gestational diabetes plays a controversial role in the development of urinary tract malformations. The purpose of this study was to assess the role of insulin-requiring gestational diabetes on the development of ureteric malformations in children. MATERIAL AND METHODS The authors report the results of a prospective case-control survey (102 cases, 104 controls) conducted in a teaching hospital. The role of insulin-requiring gestational diabetes on the development of urinary tract malformations was tested by logistic regression after adjustment for risk factors for urinary tract malformations 'family history of urinary tract malformations, parity, smoking, substance abuse during pregnancy). RESULTS Gestational diabetes is a risk factor for urinary tract malfornations after adjustment (aOR=5.1; 95%CI: 1.1-24.5), and for ureteropelvic junction syndrome (aOR=6.5; 95%CI: 1.1-39.4) and vesicoureteric reflux (aOR=5.9; 95%CI: 1.1-32.1). CONCLUSION All perinatal healthcare professionals must be familiar with the concept of insulin-requiring gestational diabetes as an uncommon, but fairly powerful risk factor for ureteric malformations.
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Affiliation(s)
- Arnaud Fotso Kamdem
- Service de Chirurgie Pédiatrique et Orthopédique, Hôpital Saint-Jacques, Besançon, France.
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Larroque B, N'guyen The Tich S, Guédeney A, Marchand L, Burguet A. Temperament at 9 months of very preterm infants born at less than 29 weeks' gestation: the Epipage study. J Dev Behav Pediatr 2005; 26:48-55. [PMID: 15718884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
The objective was to determine whether the temperament of very preterm singleton infants born before 29 weeks' gestation differs from their full-term counterparts at 9 months and to examine the influence of neurological sequelae on temperament in very preterm infants. The parents of very preterm infants from nine French regions and a group of full-term infants were sent the Infant Characteristics Questionnaire when the infants were 9 months old. The analysis included 266 singleton very preterm infants from the same regions born before 29 weeks' gestation and 546 full-term singleton infants. There were no significant differences for the Difficult, Unadaptable, and Unpredictable scales between very premature and term infants. Very preterm infants had a slightly higher Dull scale score than term infants. After taking into account mother's age, duration of hospitalization, and cerebral lesions found on neonatal ultrasound scans, this difference was no longer significant. Among very premature infants, those with cerebral lesions as diagnosed by neonatal ultrasound scan were rated higher on the Dull and Unadaptable scales. Delays in development at 9 months were also related to higher Dull and Unpredictable scales. These data suggest that prematurity does not affect temperament ratings at 9 months as assessed by the mother. However, very preterm infants with neurological insults, documented by the neonatal cerebral ultrasound or by a delay in development, are rated higher by their mothers on the Dull, Unadaptable, and Unpredictable scales.
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Affiliation(s)
- Béatrice Larroque
- INSERM U149, 16 avenue Paul Vaillant Couturier, 94807 Villejuif Cedex, France.
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Burguet A, Kaminski M, Truffert P, Menget A, Marpeau L, Voyer M, Roze JC, Escande B, Cambonie G, Hascoet JM, Grandjean H, Breart G, Larroque B. Does smoking in pregnancy modify the impact of antenatal steroids on neonatal respiratory distress syndrome? Results of the Epipage study. Arch Dis Child Fetal Neonatal Ed 2005; 90:F41-5. [PMID: 15613572 PMCID: PMC1721825 DOI: 10.1136/adc.2003.041772] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To assess the relation between cigarette smoking during pregnancy and neonatal respiratory distress syndrome (RDS) in very preterm birth, and to analyse the differential effect of antenatal steroids on RDS among smokers and non-smokers. DESIGN A population based cohort study (the French Epipage study). SETTING Regionally defined births in France. METHODS A total of 858 very preterm liveborn singletons (27-32 completed weeks of gestation) of the French Epipage study were included in this analysis. The odds ratio for RDS in relation to smoking in pregnancy was estimated using a logistic regression to control for gestational age. The odds ratio for RDS in relation to antenatal steroids was estimated taking into account an interaction between antenatal steroids and cigarette smoking, using multiple logistic regression to control for gestational age, birthweight ratio, main causes of preterm birth, mode of delivery, and sex. RESULTS The odds ratio for RDS in relation to smoking in pregnancy adjusted for gestational age (aOR) was 0.59 (95% confidence interval (CI) 0.44 to 0.79). The aOR for RDS in relation to antenatal steroids was 0.31 (95% CI 0.19 to 0.49) in babies born to non-smokers and 0.63 (95% CI 0.38 to 1.05) in those born to smokers; the difference was significant (p = 0.04). CONCLUSIONS Cigarette smoking during pregnancy is associated with a decrease in the risk of RDS in very preterm babies. Although antenatal steroids reduce the risk of RDS in babies born to both smokers and non-smokers, the reduction is smaller in those born to smokers.
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Affiliation(s)
- A Burguet
- Department of Neonatology, University Hospital, Besançon, France.
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Lamarche-Vadel A, Blondel B, Truffer P, Burguet A, Cambonie G, Selton D, Arnaud C, Lardennois C, du Mazaubrun C, N'Guyen S, Mathis J, Bréart G, Kaminski M. Re-hospitalization in infants younger than 29 weeks' gestation in the EPIPAGE cohort. Acta Paediatr 2004; 93:1340-5. [PMID: 15499955 DOI: 10.1080/08035250410032926] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
AIM To estimate the re-hospitalization rate of extremely preterm children during infancy and associated factors after the recent improvement in survival rates. METHOD The cohort included all children born before 29 wk of gestation in nine French regions in 1997. All admissions between discharge from initial hospitalization and 9 mo after birth were considered. Factors studied included the child's characteristics at birth and during neonatal hospitalization, risk factors for infection after discharge and parents' socio-demographic characteristics. Adjusted odds ratios (aOR) for re-hospitalization for all reasons and for respiratory disorders were obtained from logistic regression models. RESULTS Of the 376 children, 178 were re-admitted at least once (47.3%; 95% CI: 42.3-52.4). Fifty-five percent of the hospitalized children were admitted at least once for respiratory disorders. The re-hospitalization rate was higher for children who had had chronic lung disease (aOR: 2.2; 95% CI: 1.3-3.7), those initially discharged between August and October (aOR: 2.5; 95% CI: 1.2-5.1) or between November and January (aOR: 3.2; 95% CI: 1.5-6.8), and children living with other children under six (aOR: 3.4; 95 %CI: 1.6-7.5). Re-hospitalizations were associated with neither gestational age nor the duration of neonatal hospitalization. Adjusted odds ratios for re-hospitalization for respiratory tract disorders were very similar to those for the overall hospitalizations. CONCLUSION Infants born before 29 wk have a very high risk of re-hospitalization. The associated factors can help define high-risk groups at discharge from the neonatal unit who need special surveillance.
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Affiliation(s)
- A Lamarche-Vadel
- Research Unit on Perinatal Health and Women's Health, INSERM U149, Villejuif, France
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Burguet A, Kaminski M, Abraham-Lerat L, Schaal JP, Cambonie G, Fresson J, Grandjean H, Truffert P, Marpeau L, Voyer M, Rozé JC, Treisser A, Larroque B. The complex relationship between smoking in pregnancy and very preterm delivery. Results of the Epipage study. BJOG 2004; 111:258-65. [PMID: 14961888 DOI: 10.1046/j.1471-0528.2003.00037.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the relationship between cigarette smoking during pregnancy and very preterm births, according to the main mechanisms of preterm birth. DESIGN Case-control study (the French Epipage study). SETTING Regionally defined population of births in France. POPULATION Eight hundred and sixty-four very preterm live-born singletons (between 27 and 32 completed weeks of gestation) and 567 unmatched full-term controls. METHODS Data from the French Epipage study were analysed using a polytomous logistic regression model to control for social and demographic characteristics, pre-pregnancy body mass index and obstetric history. The main mechanisms of preterm delivery were classified as gestational hypertension, antepartum haemorrhage, premature rupture of membranes, spontaneous preterm labour and other miscellaneous mechanisms. MAIN OUTCOME MEASURES Odds ratios for very preterm birth for low to moderate (1-9 cigarettes/day) and heavy (>/=10 cigarettes/day) maternal smoking in pregnancy, estimated according to the main mechanisms leading to preterm birth. RESULTS Smokers were more likely to give birth to very preterm infants than non-smokers [adjusted odds ratio (aOR) 1.7, 95% confidence interval (CI) 1.3-2.2]. Heavy smoking significantly reduced the risk of very preterm birth due to gestational hypertension (aOR 0.5, 95% CI 0.3-1.0), whereas both low to moderate and heavy smoking increased the risk of very preterm birth due to all other mechanisms (aOR between 1.6 and 2.8). CONCLUSION These data from the Epipage study show that maternal smoking during pregnancy is a risk factor for very preterm birth. The impact of maternal smoking on very preterm birth appears to be complex: it lowers the risk of very preterm birth due to gestational hypertension, but increases the risk of very preterm birth due to other mechanisms. These findings might explain why maternal smoking is more closely related to preterm birth among multiparous women than among nulliparous women.
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Affiliation(s)
- Antoine Burguet
- Department of Neonatology, University Hospital, Besançon, France
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Larroque B, Bréart G, Kaminski M, Dehan M, André M, Burguet A, Grandjean H, Ledésert B, Lévêque C, Maillard F, Matis J, Rozé JC, Truffert P. Survival of very preterm infants: Epipage, a population based cohort study. Arch Dis Child Fetal Neonatal Ed 2004; 89:F139-44. [PMID: 14977898 PMCID: PMC1756022 DOI: 10.1136/adc.2002.020396] [Citation(s) in RCA: 243] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To evaluate the outcome for all infants born before 33 weeks gestation until discharge from hospital. DESIGN A prospective observational population based study. SETTING Nine regions of France in 1997. PATIENTS All births or late terminations of pregnancy for fetal or maternal reasons between 22 and 32 weeks gestation. MAIN OUTCOME MEASURE Life status: stillbirth, live birth, death in delivery room, death in intensive care, decision to limit intensive care, survival to discharge. RESULTS A total of 722 late terminations, 772 stillbirths, and 2901 live births were recorded. The incidence of very preterm births was 1.3 per 100 live births and stillbirths. The survival rate for births between 22 and 32 weeks was 67% of all births (including stillbirths), 85% of live births, and 89% of infants admitted to neonatal intensive care units. Survival increased with gestational age: 31% of all infants born alive at 24 weeks survived to discharge, 78% at 28 weeks, and 97% at 32 weeks. Survival among live births was lower for small for gestational age infants, multiple births, and boys. Overall, 50% of deaths after birth followed decisions to withhold or withdraw intensive care: 66% of deaths in the delivery room, decreasing with increasing gestational age; 44% of deaths in the neonatal intensive care unit, with little variation with gestational age. CONCLUSION Among very preterm babies, chances of survival varies greatly according to the length of gestation. At all gestational ages, a large proportion of deaths are associated with a decision to limit intensive care.
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Affiliation(s)
- B Larroque
- Epidemiological Research Unit on Perinatal and Women's Health, U149 INSERM Villejuif, France.
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Larroque B, Marret S, Ancel PY, Arnaud C, Marpeau L, Supernant K, Pierrat V, Rozé JC, Matis J, Cambonie G, Burguet A, Andre M, Kaminski M, Bréart G. White matter damage and intraventricular hemorrhage in very preterm infants: the EPIPAGE study. J Pediatr 2003; 143:477-83. [PMID: 14571224 DOI: 10.1067/s0022-3476(03)00417-7] [Citation(s) in RCA: 156] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the prevalence of cranial ultrasound abnormalities in very preterm infants as a function of gestational age, plurality, intrauterine growth restriction, and death before discharge. STUDY DESIGN A prospective, population-based cohort of 2667 infants born between 22 and 32 weeks of gestation in 1997 in nine regions of France, transferred to a neonatal intensive care unit, for whom at least one cranial ultrasound scan was available. RESULTS The frequencies of white matter damage (WMD), major WMD, cystic periventricular leukomalacia (PVL), periventricular parenchymal hemorrhagic involvement, and intraventricular hemorrhage with ventricular dilatation were 21%, 8%, 5%, 3%, and 3%, respectively. The risk of WMD increased with decreasing gestational age. Mean age at diagnosis of cystic PVL was older for the most premature infants. Intraventricular hemorrhage with ventricular dilatation was associated with a higher risk of cystic PVL. Intrauterine growth restriction was not associated with a lower prevalence of cystic PVL. CONCLUSION The frequency of WMD is high in very preterm babies and is strongly related to gestational age. The incidence of cystic PVL did not differ between babies with intrauterine growth restriction and babies who were appropriate for gestational age.
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Affiliation(s)
- Béatrice Larroque
- INSERM U149 Research Unit on Perinatal Health and Women's Health, 16 Avenue Paul Vaillant Couturier, 94807 Villejuif Cedex, France.
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Burguet A, Agnani G. [Smoking, fertility and very preterm birth]. J Gynecol Obstet Biol Reprod (Paris) 2003; 32:1S9-16. [PMID: 12592157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
In France, many couples in procreating age continue to smoke, despite recommendations to stop smoking before or during pregnancy. We reviewed the epidemiological associations between maternal or paternal smoking and both infertility and very preterm birth. It appears clearly that maternal smoking impairs natural and assisted fecundity. Furthermore, maternal smoking enhances the rate of ectopic pregnancies and spontaneous abortions. The role of maternal smoking on very preterm birth before 33 weeks of completed gestation appears in recent population based-study or case-control studies that include several hundred very preterm neonates. But the role of smoking on very preterm birth among hypertensive mothers and primiparae is still debated. The detrimental effect of smoking on fecundity appears to be reversible when the mother and father stop smoking. The real effect of interventions promoting cessation of smoking during pregnancy in reducing the rate of very preterm births remains to be studied.
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Affiliation(s)
- A Burguet
- Service de Pédiatrie II, Hôpital Saint-Jacques, Centre Hospitalier Universitaire, Besançon.
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