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Torchin H, Tafflet M, Charkaluk ML, Letouzey M, Twillhaar S, Kana G, Benhammou V, Marret S, Basson E, Cambonie G, Datin-Dorrière V, Guellec I, Lebeaux C, Muller JB, Nuytten A, Kaminski M, Ancel PY, Pierrat V. Screening preterm-born infants for autistic traits may help to identify social communication difficulties at five years of age. Acta Paediatr 2024. [PMID: 38501897 DOI: 10.1111/apa.17214] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 02/27/2024] [Accepted: 03/12/2024] [Indexed: 03/20/2024]
Abstract
AIM This study compared neurodevelopmental screening questionnaires completed when preterm-born children reached 2 years of corrected age with social communication skills at 5.5 years of age. METHODS Eligible subjects were born in 2011 at 24-34 weeks of gestation, participated in a French population-based epidemiological study and were free of motor and sensory impairment at 2 years of corrected age. The Ages and Stages Questionnaire (ASQ) and the Modified Checklist for Autism in Toddlers (M-CHAT) were used at 2 years and the Social Communication Questionnaire (SCQ) at 5.5 years of age. RESULTS We focused on 2119 children. At 2 years of corrected age, the M-CHAT showed autistic traits in 20.7%, 18.5% and 18.2% of the children born at 24-26, 27-31 and 32-34 weeks of gestation, respectively (p = 0.7). At 5.5 years of age, 12.6%, 12.7% and 9.6% risked social communication difficulties, with an SCQ score ≥90th percentile (p = 0.2). A positive M-CHAT score at 2 years was associated with higher risks of social communication difficulties at 5.5 years of age (odds ratio 3.46, 95% confidence interval 2.04-5.86, p < 0.001). Stratifying ASQ scores produced similar results. CONCLUSION Using parental neurodevelopmental screening questionnaires for preterm-born children helped to identify the risk of later social communication difficulties.
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Affiliation(s)
- Héloise Torchin
- Université Paris Cite, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPE, French Institute for Medical Research and Health INSERM, INRAE, Paris, France
- Department of Neonatal Medicine, Cochin-Port Royal Hospital, FHU PREMA, AP-HP Centre, Paris, France
| | - Muriel Tafflet
- Université Paris Cite, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPE, French Institute for Medical Research and Health INSERM, INRAE, Paris, France
| | - Marie-Laure Charkaluk
- Université Paris Cite, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPE, French Institute for Medical Research and Health INSERM, INRAE, Paris, France
- Department of neonatology, Saint Vincent de Paul Hospital, GHICL, Lille, France
| | - Mathilde Letouzey
- Université Paris Cite, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPE, French Institute for Medical Research and Health INSERM, INRAE, Paris, France
- Department of Neonatal Pediatrics, Poissy Saint Germain Hospital, Poissy, France
| | - Sabrina Twillhaar
- Université Paris Cite, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPE, French Institute for Medical Research and Health INSERM, INRAE, Paris, France
| | - Gildas Kana
- Université Paris Cite, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPE, French Institute for Medical Research and Health INSERM, INRAE, Paris, France
| | - Valérie Benhammou
- Université Paris Cite, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPE, French Institute for Medical Research and Health INSERM, INRAE, Paris, France
| | - Stéphane Marret
- Department of Neonatal medicine - Intensive Care - Neuropediatrics, Rouen University Hospital, Rouen, France
- INSERM U1254 - Neovasc team - Perinatal handicap, Institute of Biomedical Research and Innovation, Normandy University, Rouen, France
| | - Eliane Basson
- Réseau AURORE-ECLAUR, Hôpital de la Croix-Rousse, Lyon, France
| | - Gilles Cambonie
- Department of Neonatal Medicine, Montpellier University Hospital, Montpellier, France
| | - Valérie Datin-Dorrière
- Centre hospitalier universitaire Caen, Department of neonatology, Caen, France
- Universite de Paris, CNRS UMR 8240 "LaPsyDE", Paris, France
| | - Isabelle Guellec
- Université Paris Cite, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPE, French Institute for Medical Research and Health INSERM, INRAE, Paris, France
- Neonatal intensive care unit, Nice University Hospital, Côte d'Azur University, Nice, France
| | - Cécile Lebeaux
- Department of Neonatalogy, Centre Hospitalier Intercommunal de Créteil and Reseau Perinatal du Val de Marne, Créteil, France
| | | | - Alexandra Nuytten
- CHU Lille, Department of Neonatal Medicine, Jeanne de Flandre Hospital, Lille, France
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, France
| | - Monique Kaminski
- Université Paris Cite, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPE, French Institute for Medical Research and Health INSERM, INRAE, Paris, France
| | - Pierre-Yves Ancel
- Université Paris Cite, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPE, French Institute for Medical Research and Health INSERM, INRAE, Paris, France
- Assistance Publique-Hôpitaux de Paris, Clinical Investigation Center P1419, Paris, France
| | - Véronique Pierrat
- Université Paris Cite, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPE, French Institute for Medical Research and Health INSERM, INRAE, Paris, France
- Department of Neonatalogy, Centre Hospitalier Intercommunal de Créteil and Reseau Perinatal du Val de Marne, Créteil, France
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Binet L, Debillon T, Beck J, Vilotitch A, Guellec I, Ego A, Chevallier M. Effect of gestational age on cerebral lesions in neonatal encephalopathy. Arch Dis Child Fetal Neonatal Ed 2024:fetalneonatal-2023-326131. [PMID: 38418209 DOI: 10.1136/archdischild-2023-326131] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 02/08/2024] [Indexed: 03/01/2024]
Abstract
OBJECTIVE To determine the risk on brain lesions according to gestational age (GA) in neonates with neonatal encephalopathy. DESIGN Secondary analysis of the prospective national French population-based cohort, Long-Term Outcome of NeonataL EncePhALopathy. SETTING French neonatal intensive care units. PATIENTS Neonates with moderate or severe neonatal encephalopathy (NE) born at ≥34 weeks' GA (wGA) between September 2015 and March 2017. MAIN OUTCOME MEASURES The results of MRI performed within the first 12 days were classified in seven injured brain regions: basal ganglia and thalami, white matter (WM), cortex, posterior limb internal capsule, corpus callosum, brainstem and cerebellum. A given infant could have several brain structures affected. Risk of brain lesion according to GA was estimated by crude and adjusted ORs (aOR). RESULTS MRI was available for 626 (78.8%) of the 794 included infants with NE. WM lesions predominated in preterm compared with term infants. Compared with 39-40 wGA neonates, those born at 34-35 wGA and 37-38 wGA had greater risk of WM lesions after adjusting for perinatal factors (aOR 4.0, 95% CI (1.5 to 10.7) and ORa 2.0, 95% CI (1.1 to 3.5), respectively). CONCLUSION WM is the main brain structure affected in late-preterm and early-term infants with NE, with fewer WM lesions as GA increases. This finding could help clinicians to estimate prognosis and improve the understanding of the pathophysiology of NE. TRIAL REGISTRATION NUMBER NCT02676063, ClinicalTrials.gov.
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Affiliation(s)
- Lauren Binet
- Neonatal Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - Thierry Debillon
- Neonatal Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France
- Université Grenoble Alpes, CNRS, Public Health Department, Grenoble Alpes, Grenoble Institute of Engineering, TIMC-IMAG, Grenoble, France
| | - Jonathan Beck
- Department of Neonatology, Reims University Hospital Alix de Champagne, Reims, France
| | - Antoine Vilotitch
- Univversité Grenoble Alpes, Data Engineering Unit, Public Health Department, Grenoble Alpes University Hospital, Grenoble, France
| | - Isabelle Guellec
- 7 Neonatal Intensive Care Medicine Department, University Hospital Nice Cote d'Azur, Nice, France
| | - Anne Ego
- Université Grenoble Alpes, CNRS, Public Health Department, Grenoble Alpes, Grenoble Institute of Engineering, TIMC-IMAG, Grenoble, France
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, F-75004, Paris, France
| | - Marie Chevallier
- Neonatal Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France
- Université Grenoble Alpes, CNRS, Public Health Department, Grenoble Alpes, Grenoble Institute of Engineering, TIMC-IMAG, Grenoble, France
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Debillon T, Beck J, Guellec I, Vilotitch A, Pierrat V, Baud O, Sentilhes L, Kayem G, Ego A. [Investigation of a French cohort of neonatal anoxo-ischemic encephalopathy in the era of therapeutic hypothermia: questions and answers.]. Gynecol Obstet Fertil Senol 2024:S2468-7189(24)00080-1. [PMID: 38428637 DOI: 10.1016/j.gofs.2024.02.025] [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] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 02/22/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVE to improve knowledge of Neonatal Hypoxic-Ischemic Encephalopathy, a prospective, nationwide, population-based cohort of affected children is being set up between September 2015 and March 2017. METHODS during this period, 794 cases are collected, with information on pregnancy, delivery, neonatal stay and outcome at the end of hospitalization. Clinical and parental questionnaire follow-up is planned until the child is 4 years old. RESULTS this article presents the clinical presentation of the newborns included, the analysis of factors associated with short-term outcome at hospital discharge and the organizational factors associated with treatment with Therapeutic Hypothermia. CONCLUSION these data illustrate the value of a prospective cohort to analyze the management of EAI in France.
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Affiliation(s)
- Thierry Debillon
- Service de Réanimation et Médecine Néonatale, CHU Grenoble Alpes, 38000 Grenoble, France; Université de Grenoble Alpes, CNRS, Département de Santé Publique, Institut d'ingénierie et de management Grenoble Alpes, TIMC-IMAG, 38000 Grenoble, France
| | - Jonathan Beck
- Service de Médecine et Réanimation Néonatale, Bâtiment Alix de Champagne et Service de Réanimation Soins continus Pédiatriques Bâtiment American Memorial Hospital II, CHU de Reims, 51100 Reims, France
| | - Isabelle Guellec
- Service de Réanimation Néonatale, CHU de Nice, Université de Nice Cote d'Azur, 06000 Nice, France; Universite Paris Cite, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPE, INSERM, INRAE, F-75004, Paris, France
| | - Antoine Vilotitch
- University de Grenoble Alpes Unité de Data Engineering, Pôle de Santé Publique, CHU Grenoble Alpes, 38000 Grenoble, France
| | - Véronique Pierrat
- Universite Paris Cite, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPE, INSERM, INRAE, F-75004, Paris, France; Department de Néonatalogie, CHI Créteil, 94000 Créteil, France
| | - Olivier Baud
- Division de Néonatalogie, Département de Pédiatrie, Université de Genève, Genève, Suisse
| | - Loïc Sentilhes
- Département de Gynécologie et Obstétrique, Hôpital Universitaire de Bordeaux, 33000 Bordeaux, France
| | - Gilles Kayem
- Universite Paris Cite, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPE, INSERM, INRAE, F-75004, Paris, France; Département d'Obstétrique et de Gynécologie, Hôpital Trousseau, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, 75012 Paris, France
| | - Anne Ego
- Université de Grenoble Alpes, CNRS, Département de Santé Publique, Institut d'ingénierie et de management Grenoble Alpes, TIMC-IMAG, 38000 Grenoble, France; Inserm CIC U1406, 38000 Grenoble, France
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Guellec I, Brunet A, Lapillonne A, Taine M, Torchin H, Favrais G, Gascoin G, Simon L, Heude B, Scherdel P, Kayem G, Delorme P, Jarreau PH, Ancel PY. Birth weight and head circumference discordance and outcome in preterms: results from the EPIPAGE-2 cohort. Arch Dis Child 2024:archdischild-2023-326336. [PMID: 38408861 DOI: 10.1136/archdischild-2023-326336] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 02/19/2024] [Indexed: 02/28/2024]
Abstract
OBJECTIVE To determine whether the relative measurement of birth weight (BW) and head circumference (HC) in preterm infants is associated with neurological outcomes. METHODS The EPIPAGE-2 Study included 3473 infants born before 32 weeks' gestation, classified based on their Z-score of BW and HC on the Fenton curves as concordant (≤1 SD apart) or discordant (>1 SD difference). We defined four mutually exclusive categories: discordant smaller BW (sBW) with BW-1SD and concordant small measurement (CsM) with BW and HC concordant and both ≤-1SD. Neurological outcomes at 5.5 years were evaluated with standard tests. RESULTS 2592 (74.8%) preterm neonates were categorised as CM, 258 (7.4%) CsM, 378 (10.9%) sHC and 239 (6.9%) sBW. Compared with the CM children, those born with CsM had significantly higher risks of cognitive deficiency (adjusted OR (aOR) 1.3, 95% CI (1.0 to 2.0)), developmental coordination disorders (aOR 2.6 (1.5 to 4.4)) and need for special school services (aOR 2.3 (1.5 to 3.7)). Those born with sBW had significantly lower risk of cognitive deficiency (aOR 0.6 (0.4 to 0.9)) and the sHC group significantly higher risk of developmental coordination disorders (aOR 1.8 (1.0 to 3.2)). CONCLUSIONS The relative discordance of these preterm infants' BW and HC was associated with their neurological outcomes. It merits further exploration as an indirect indicator of development. TRIAL REGISTRATION NUMBER NCT03078439.
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Affiliation(s)
- Isabelle Guellec
- Epope Team, Epidemiology and Statistics Research Center/CRESS, Université de Paris, Paris, France
- Neonatal Intensive Care, Nice Cote d'Azur University Hospital, Nice, France
| | - Adelaide Brunet
- Neonatal Intensive Care Unit, Port Royal University Hospital, Assistance publique Hopitaux de Paris, Paris, France
| | | | - Marion Taine
- Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), INSERM, Paris, France
| | - Héloïse Torchin
- Epope Team, Epidemiology and Statistics Research Center/CRESS, Université de Paris, Paris, France
- Neonatal Intensive Care Unit, Port Royal University Hospital, Assistance publique Hopitaux de Paris, Paris, France
| | - Geraldine Favrais
- Department of Neonatal Medicine, Centre Hospitalier Regional Universitaire de Tours, Tours, France
| | - Géraldine Gascoin
- Neonatal Intensive Care, University Hospital Centre Toulouse, Toulouse, France
| | - Laure Simon
- Department of Neonatalogy, CHU Nantes, Nantes, France
- INRAE, UMR 1280, Physiologie des Adaptations Nutritionnelles, Nantes University, Nantes, France
| | - Barbara Heude
- Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), INSERM, Paris, France
| | - Pauline Scherdel
- Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), INSERM, Paris, France
| | - Gilles Kayem
- Epope Team, Epidemiology and Statistics Research Center/CRESS, Université de Paris, Paris, France
- Department of Gynecology and Obstetrics, Hôpital Armand Trousseau, APHP, Sorbonne University, Paris, France
| | - Pierre Delorme
- Epope Team, Epidemiology and Statistics Research Center/CRESS, Université de Paris, Paris, France
- Department of Gynecology and Obstetrics, Hôpital Armand Trousseau, APHP, Sorbonne University, Paris, France
| | - Pierre-Henri Jarreau
- Epope Team, Epidemiology and Statistics Research Center/CRESS, Université de Paris, Paris, France
- Neonatal Intensive Care Unit, Port Royal University Hospital, Assistance publique Hopitaux de Paris, Paris, France
| | - Pierre-Yves Ancel
- Epope Team, Epidemiology and Statistics Research Center/CRESS, Université de Paris, Paris, France
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5
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Charkaluk ML, Kana GD, Benhammou V, Guellec I, Letouzey M, Morgan AS, Nuytten A, Torchin H, Twilhaar S, Cambonie G, Marret S, Ancel PY, Pierrat V. Neurodevelopment at age 5.5 years according to Ages & Stages Questionnaire at 2 years' corrected age in children born preterm: the EPIPAGE-2 cohort study. Arch Dis Child Fetal Neonatal Ed 2024:fetalneonatal-2023-325928. [PMID: 38290830 DOI: 10.1136/archdischild-2023-325928] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 01/14/2024] [Indexed: 02/01/2024]
Abstract
OBJECTIVE To report neurodevelopment at age 5.5 years according to developmental delay screening with the Ages & Stages Questionnaire (ASQ) in late infancy in preterm-born children. DESIGN Population-based cohort study, EPIPAGE-2. SETTING France, 2011-2017. PARTICIPANTS 2504 children born at 24-26, 27-31 and 32-34 weeks, free of cerebral palsy, deafness or blindness at 2 years' corrected age. MAIN OUTCOME MEASURES Moderate/severe, mild or no disability at age 5.5 years using gross and fine motor, sensory, cognitive and behavioural evaluations. Results of the ASQ completed between 22 and 26 months' corrected age described as positive screening or not. RESULTS Among 2504 participants, 38.3% had ASQ positive screening. The probability of having moderate/severe or mild disability was higher for children with ASQ positive versus negative screening: 14.2% vs 7.0%, adjusted OR 2.5 (95% CI 1.8 to 3.4), and 37.6% vs 29.7%, adjusted OR 1.5 (1.2 to 1.9). For children with ASQ positive screening, the probability of having neurodevelopmental disabilities at age 5.5 years was associated with the number of domain scores below threshold, very low gestational age and severe neonatal morbidities. For children with ASQ negative screening, this probability was increased for boys and children born small-for-gestational age. For both groups, maternal level of education was strongly associated with outcomes. CONCLUSION In preterm-born children, ASQ screening at 2 years' corrected age was associated with neurodevelopmental disabilities at age 5.5 years. However, other factors should be considered when interpreting the ASQ data to draw further follow-up. TRIAL REGISTRATION NUMBER 2016-A00333-48.
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Affiliation(s)
- Marie-Laure Charkaluk
- Université Paris Cité, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, F-75004 Paris, France
- Department of Neonatology, Saint Vincent de Paul Hospital, GHICL, F -59800 Lille, France
| | - Gildas Delavoix Kana
- Université Paris Cité, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, F-75004 Paris, France
| | - Valérie Benhammou
- Université Paris Cité, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, F-75004 Paris, France
| | - Isabelle Guellec
- Université Paris Cité, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, F-75004 Paris, France
- Neonatal Intensive Care Unit, Nice Côte d'Azur, Archet University Hospital, Nice, France
| | - Mathilde Letouzey
- Université Paris Cité, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, F-75004 Paris, France
- Department of Neonatal Pediatrics, Poissy Saint Germain Hospital, Poissy, France
| | - Andrei Scott Morgan
- Université Paris Cité, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, F-75004 Paris, France
- Elizabeth Garrett Anderson Institute for Women's Health London, University College London, London, UK
| | - Alexandra Nuytten
- Department of Neonatology, Saint Vincent de Paul Hospital, GHICL, F -59800 Lille, France
| | - Héloïse Torchin
- Université Paris Cité, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, F-75004 Paris, France
- Department of Neonatal Medicine, Cochin-Port Royal Hospital, FHU PREMA, AP-HP Centre, 75014 Paris, France
| | | | - Gilles Cambonie
- Department of Neonatal Medicine, Montpellier University Hospital, Montpellier, France
| | - Stéphane Marret
- Department of Neonatal Medicine - Intensive Care - Neuropediatrics, Rouen University Hospital, Rouen, France
- INSERM U1245 - Neovasc team - Perinatal handicap, Institute of Biomedical Research and Innovation, Normandy University, Rouen, France
| | - Pierre Yves Ancel
- Université Paris Cité, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, F-75004 Paris, France
- Clinical Investigation Center P1419, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Véronique Pierrat
- Université Paris Cité, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, F-75004 Paris, France
- Department of Neonatalogy, CHI Créteil, F-94028 Créteil, France
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Tourneux P, Debillon T, Flamant C, Jarreau PH, Schwartz D, Athea Y, Guellec I. Early factors associated with continuous positive airway pressure failure in moderate and late preterm infants - response. Eur J Pediatr 2024; 183:979-980. [PMID: 38047959 DOI: 10.1007/s00431-023-05349-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Affiliation(s)
- Pierre Tourneux
- Neonatal Intensive Care Unit, University Hospital Center of Amiens, Jules Verne University of Picardy, 80054, Amiens Cedex 1, Amiens, France.
| | - Thierry Debillon
- Neonatology Intensive Care Unit, University Hospital of Grenoble, Grenoble, France
| | - Cyril Flamant
- Neonatal Intensive Care Unit, University Hospital of Nantes, Nantes, France
| | - Pierre-Henri Jarreau
- Neonatal Intensive Care Unit of Port-Royal, AP-HP, University of Paris, Paris, France
| | | | - Yoni Athea
- Medical Affairs, Chiesi SAS, Bois Colombes, France
| | - Isabelle Guellec
- Neonatal and Paediatric Intensive Care Unit, University Hospital of l'Archet, Nice, France
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7
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Tréluyer L, Nuytten A, Guellec I, Jarreau PH, Benhammou V, Cambonie G, Truffert P, Marchand-Martin L, Ancel PY, Torchin H. Neurodevelopment and healthcare utilisation at age 5-6 years in bronchopulmonary dysplasia: an EPIPAGE-2 cohort study. Arch Dis Child Fetal Neonatal Ed 2023; 109:26-33. [PMID: 37364896 DOI: 10.1136/archdischild-2023-325376] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 06/07/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVE We aimed to study neurodevelopmental outcomes and healthcare utilisation at age 5-6 years in very preterm children with bronchopulmonary dysplasia (BPD). DESIGN Prospective and national population-based study. SETTING All the neonatal units in 25 French regions (21 of the 22 metropolitan regions and 4 overseas regions). PATIENTS Children born before 32 weeks' gestation in 2011. INTERVENTIONS Blind, comprehensive and standardised assessment by trained neuropsychologists and paediatricians at age 5-6 years. MAIN OUTCOME MEASURES Overall neurodevelopmental disabilities, behavioural difficulties, developmental coordination disorders, full-scale IQ, cerebral palsy, social interaction disorders, rehospitalisation in the previous 12 months and detailed developmental support. RESULTS Of the 3186 children included, 413 (11.7%) had BPD. The median gestational age of children with BPD was 27 weeks (IQR 26.0-28.0) and without BPD was 30 weeks (28.0-31.0). At age 5-6 years, 3150 children were alive; 1914 (60.8%) had a complete assessment. BPD was strongly associated with mild, moderate and severe overall neurodevelopmental disabilities (OR 1.49, 95% CI 1.05 to 2.20; 2.20, 1.41 to 3.42 and 2.71, 1.67 to 4.40). BPD was associated with developmental coordination disorders, behavioural difficulties, lower IQ score as well as rehospitalisation in the last 12 months and developmental support. The association between BPD and cerebral palsy was statistically significant before adjustment but not in adjusted analyses. CONCLUSIONS BPD was strongly and independently associated with many neurodevelopmental disabilities. Improving medical and neurodevelopmental management of BPD in very preterm children should be a priority to reduce its long-term consequences.
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Affiliation(s)
- Ludovic Tréluyer
- Epidemiology and Statistics Research Center/CRESS, INSERM, INRAE, Paris Cité University, Paris, France
- Department of Neonatal Medicine of Port-Royal, Cochin Hospital, FHU PREMA, AP-HP Centre, Université Paris Cité, Paris, France
| | - Alexandra Nuytten
- CHU Lille, Department of Neonatal Medicine, Jeanne de Flandre Hospital, Lille, France
- CHU Lille, ULR 2694-METRICS: Évaluation des technologies de santé et des pratiques médicales, University of Lille, Lille, France
| | - Isabelle Guellec
- Department of Neonatal Medecine, University Hospital of Nice, Nice, France
| | - Pierre-Henri Jarreau
- Epidemiology and Statistics Research Center/CRESS, INSERM, INRAE, Paris Cité University, Paris, France
- Department of Neonatal Medicine of Port-Royal, Cochin Hospital, FHU PREMA, AP-HP Centre, Université Paris Cité, Paris, France
| | - Valérie Benhammou
- Epidemiology and Statistics Research Center/CRESS, INSERM, INRAE, Paris Cité University, Paris, France
| | - Gilles Cambonie
- Department of Neonatal Medicine, Montpellier University Hospital, Montpellier, France
| | - Patrick Truffert
- CHU Lille, Department of Neonatal Medicine, Jeanne de Flandre Hospital, Lille, France
- CHU Lille, ULR 2694-METRICS: Évaluation des technologies de santé et des pratiques médicales, University of Lille, Lille, France
| | - Laetitia Marchand-Martin
- Epidemiology and Statistics Research Center/CRESS, INSERM, INRAE, Paris Cité University, Paris, France
| | - Pierre Yves Ancel
- Epidemiology and Statistics Research Center/CRESS, INSERM, INRAE, Paris Cité University, Paris, France
- Clinical Research Unit, Center for Clinical Investigation P1419, Assistance Publique Hôpitaux de Paris, F-75014, Paris, France
| | - Héloïse Torchin
- Epidemiology and Statistics Research Center/CRESS, INSERM, INRAE, Paris Cité University, Paris, France
- Department of Neonatal Medicine of Port-Royal, Cochin Hospital, FHU PREMA, AP-HP Centre, Université Paris Cité, Paris, France
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Guellec I, Debillon T, Flamant C, Jarreau PH, Serraz B, Tourneux P. Management of respiratory distress in moderate and late preterm infants: clinical trajectories in the Neobs study. Eur J Pediatr 2023; 182:5661-5672. [PMID: 37823928 PMCID: PMC10746757 DOI: 10.1007/s00431-023-05259-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 03/30/2023] [Revised: 10/03/2023] [Accepted: 10/03/2023] [Indexed: 10/13/2023]
Abstract
Management of respiratory distress (RD) in the extremely preterm newborn meets recommendations. Few data are available concerning the management and the clinical course of moderate and late preterms with RD. Clinical course and management among moderate (30-33 weeks (wks) of gestation) and late preterms (34-36 wks) were assessed in the Neobs study, a French neonatal observational cohort study (2018) of preterms with RD in the first 24 h of life. Clinical course was defined as stable (use of non-invasive ventilation (NIV) only), initially severe (initial use of invasive ventilation (IV)), and worsening (switch off IV after NIV support). Surfactant therapy instillation and withdrawal of all ventilator support at 72 h were recorded. Among moderate (n = 279) and late (n = 281) preterms, the clinical course was similar (p < 0.27): stable (82.1 and 86.8%), worsening (11.8% and 9.3%), and initially severe RD (6.1% and 3.9%), respectively. Surfactant was administered more frequently in the moderate versus late preterm groups (28.3% vs 16.7%; p < 0.001). The recommended surfactant dose (200 mg/kg) was administered in 53.3-83.3% of moderate and 42.1-63.2% of late preterms according to the clinical course. Withdrawal of ventilatory support at 72 h was observed in 40.0% and 70.0% of moderate and late preterms, respectively (p < 0.05), and was significantly (p < 0.001) associated with clinical course (the minus proportion among the worsening group). CONCLUSION While the proportion of clinical course pattern is similar in moderate and late preterm infants, the management of RD varies with gestational age, with late preterm infants being managed later in life and moderate premature infants weaned from ventilation at a later stage. WHAT IS KNOWN • There is a lack of clear guidance on the management of respiratory distress (RD) in moderate-to-late preterm infants. • Neobs was a multicentre, observational study designed to characterise the real-world management of moderate-to-late preterm infants with RD in France. WHAT IS NEW • Secondary analyses of Neobs study data found that ventilatory support strategies were dependent on gestational age despite a similar clinical course. • At 30-33 weeks of gestation (wks), infants were more likely to receive non-invasive ventilation at delivery, while 34-36 wks infants were more likely to be managed using a wait-and-see approach.
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Affiliation(s)
- Isabelle Guellec
- Neonatal Intensive Care Unit, University Hospital of Nice-Côte d'Azur, 06200, Nice, France.
| | - Thierry Debillon
- Neonatology Intensive Care Unit, University Hospital of Grenoble, Grenoble, France
| | - Cyril Flamant
- Neonatal Intensive Care Unit, University Hospital of Nantes, Nantes, France
| | - Pierre-Henri Jarreau
- Neonatal Intensive Care Unit of Port-Royal, AP-HP Centre-Université de Paris, Paris, France
| | | | - Pierre Tourneux
- Neonatal Intensive Care Unit, University Hospital of Amiens, University of Picardy Jules Verne, Amiens, France
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Tourneux P, Debillon T, Flamant C, Jarreau PH, Serraz B, Guellec I. Early factors associated with continuous positive airway pressure failure in moderate and late preterm infants. Eur J Pediatr 2023; 182:5399-5407. [PMID: 37750912 PMCID: PMC10746609 DOI: 10.1007/s00431-023-05090-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 04/05/2023] [Revised: 06/20/2023] [Accepted: 06/27/2023] [Indexed: 09/27/2023]
Abstract
To determine the early factors associated with continuous positive airway pressure (CPAP) failure in moderate-to-late preterm infants (32 + 0/7 to 36 + 6/7 weeks' gestation) from the NEOBS cohort study. The NEOBS study was a multi-center, prospective, observational study in 46 neonatal intensive care units in France, which included preterm and late preterm infants with early neonatal respiratory distress. This analysis included a subset of the NEOBS population who had respiratory distress and required ventilatory support with CPAP within the first 24 h of life. CPAP failure was defined as the need for tracheal intubation within 72 h of CPAP initiation. Maternal and neonatal clinical parameters in the delivery room and clinical data at 3 h of life were analyzed. CPAP failure occurred in 45/375 infants (12%), and compared with infants with CPAP success, they were mostly singletons (82.2% vs. 62.1%; p < 0.01), had a lower Apgar score at 10 min of life (9.1 ± 1.3 vs. 9.6 ± 0.8; p = 0.02), and required a higher fraction of inspired oxygen (FiO2; 34.4 ± 15.9% vs. 22.8 ± 4.1%; p < 0.0001) and a higher FiO2*positive end-expiratory pressure (PEEP) (1.8 ± 0.9 vs. 1.1 ± 0.3; p < 0.0001) at 3 h. FiO2 value of 0.23 (R2 = 0.73) and FiO2*PEEP of 1.50 (R2 = 0.75) best predicted CPAP failure. The risk of respiratory distress and early CPAP failure decreased 0.7 times per 1-week increase in gestational age and increased 1.7 times with every one-point decrease in Apgar score at 10 min and 19 times with FiO2*PEEP > 1.50 (vs. ≤ 1.50) at 3 h (R2 of the overall model = 0.83). Conclusion: In moderate-to-late preterm infants, the combination of singleton pregnancy, lower Apgar score at 10 min, and FiO2*PEEP > 1.50 at 3 h can predict early CPAP failure with increased accuracy. What is Known: •Respiratory distress syndrome (RSD) represents an unmet medical need in moderate-to-late preterm births and is commonly treated with continuous positive airway pressure (CPAP) to reduce mortality and the need for additional ventilatory support. • Optimal management of RSD is yet to be established, with several studies suggesting that identification of predictive factors for CPAP failure can aid in the prompt treatment of infants likely to experience this failure. What is New: •Secondary analysis of the observational NEOBS study indicated that oxygen requirements during CPAP therapy, especially the product of fraction of inspired oxygen (FiO2) and positive end-expiratory pressure (PEEP), are important factors associated with early CPAP failure in moderate-to-late term preterm infants. •The combination of a singleton pregnancy, low Apgar score at 10 minutes, and high FiO2*PEEP at 3 hours can predict early CPAP failure with increased accuracy, highlighting important areas for future research into the prevention of CPAP failure.
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Affiliation(s)
- Pierre Tourneux
- Neonatal Intensive Care Unit, University Hospital Center of Amiens, Jules Verne University of Picardy, Amiens, France.
| | - Thierry Debillon
- Neonatology Intensive Care Unit, University Hospital of Grenoble, Grenoble, France
| | - Cyril Flamant
- Neonatal Intensive Care Unit, University Hospital of Nantes, Nantes, France
| | - Pierre-Henri Jarreau
- Neonatal Intensive Care Unit of Port-Royal, AP-HP,, University of Paris , Paris, France
| | | | - Isabelle Guellec
- Neonatal and Paediatric Intensive Care Unit, University Hospital of L'Archet, Nice, France
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10
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Irtan S, Coulomb-Lhermine A, Lanz C, Tabone MD, Pasqualini C, Dumont B, Thebaud E, Guellec I, Verschuur A. Number of lymph nodes sampled in SFCE/SIOP 2001 patients with Wilms tumour: Is the goal of more than six achievable? Pediatr Blood Cancer 2023; 70:e30107. [PMID: 36453594 DOI: 10.1002/pbc.30107] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 09/30/2022] [Accepted: 10/31/2022] [Indexed: 12/04/2022]
Abstract
AIM The number of lymph nodes (LN) that should be sampled during nephrectomy for Wilms tumour (WT) remains controversial but of utmost importance for staging purposes. The aim of this French national retrospective study of patients enrolled in SIOPWT2001 trial was to analyse the number of LN sampled according to their site and to determine if the number of six asked by the International Society of Paediatric Oncology - Renal Tumour Study Group (SIOP-RTSG) UMBRELLA protocol is achievable. METHODS We reviewed the data collected on central pathology review forms from 2002 to 2014 for only unilateral WT. LN were divided whether they were clearly identified by surgeons at nephrectomy or only found by pathologists on the nephrectomy specimen. RESULTS A total of 539 patients (240 male/299 female) were included (458 localized/81 metastatic). Median age at surgery was 41.3 months [0-189]. The number of LN sampled was 0, 1-6, ≥7 and unknown in 69 (12.8%), 293 (54.3%), 160 (29.7%) and 17 (3.2%) cases, respectively. The number of patients with sampled LN were higher if LN were identified by both the pathologist and the surgeon (n = 231, 42.8%) (p = < .001). At least one invaded LN (LN+) was found in 66 patients (12.2%), more than half being found among patients having LN sampled by both pathologist and surgeon (p < .001). The mean number of identified LN was six if no LN+ was detected on final histological analysis, while it was 11 in case of LN+ (p < .001). CONCLUSIONS The aim of sampling more than six LN is achievable, but only with the active collaboration of both surgeons and pathologists.
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Affiliation(s)
- Sabine Irtan
- Department of Visceral and Neonatal Paediatric Surgery, Sorbonne Université, Hôpital Armand Trousseau - APHP, Paris, France
| | - Aurore Coulomb-Lhermine
- Sorbonne Université, Service d'Anatomie et Cytologie Pathologiques, Hôpital Armand Trousseau - APHP, Paris, France
| | - Camille Lanz
- Department of Visceral and Neonatal Paediatric Surgery, Sorbonne Université, Hôpital Armand Trousseau - APHP, Paris, France
| | - Marie-Dominique Tabone
- Department of Pediatric Hemato-Oncology, Sorbonne Université, Hôpital Armand Trousseau - APHP, Paris, France
| | - Claudia Pasqualini
- Department of Pediatric Hemato-Oncology, Institut Gustave Roussy, Villejuif, France
| | - Benoit Dumont
- Department of Pediatric Hemato-Oncology, Institut Léon Bérard, Lyon, France
| | - Estelle Thebaud
- Department of Pediatric Hemato-Oncology, Hôpitaux Universitaires de Nantes, Nantes, France
| | - Isabelle Guellec
- Neonatal Intensive Care Unit, APHP.6 Hôpital Armand Trousseau, Paris, France
| | - Arnauld Verschuur
- Pediatric Hemato-Oncology Unit, Groupe Hospitalier La Timone, APHM, Marseille, France
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11
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Beck J, Debillon T, Guellec I, Vilotitch A, Loron G, Bednarek N, Ancel PY, Pierrat V, Ego A. Healthcare organizational factors associated with delayed therapeutic hypothermia in neonatal hypoxic-ischemic encephalopathy: the LyTONEPAL cohort. Eur J Pediatr 2023; 182:181-190. [PMID: 36269426 DOI: 10.1007/s00431-022-04666-7] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/12/2022] [Accepted: 10/14/2022] [Indexed: 01/12/2023]
Abstract
Initiation of therapeutic hypothermia (TH) within 6 h of life is a major concern for treating neonatal hypoxic ischemic encephalopathy (HIE). We aimed to determine clinical and healthcare organizational factors associated with delayed TH in a French population-based cohort of neonates with moderate/severe HIE. Time to reach a rectal temperature of 34 °C defines optimal and delayed (within and over 6 h, respectively) TH. Clinical and healthcare organizational factors associated with delayed TH were analysed among neonates born in cooling centres (CCs) and non-cooling centres (non-CCs). Among 629 neonates eligible for TH, 574 received treatment (91.3%). TH was delayed in 29.8% neonates and in 20.3% and 36.2% of those born in CCs and non-CCs, respectively. Neonates with moderate HIE were more exposed to delayed TH in both CCs and non-CCs. After adjustment for HIE severity, maternal and neonatal characteristics and circumstances of birth were not associated with increased risk of delayed TH. However, this risk was 2 to 5 times higher in maternities with < 1999 annual births, when the delay between birth and call for transfer (adjusted odds ratio [aOR] 2.47, 95% confidence interval [CI] [1.03 to 5.96]) or between call for transfer and admission (aOR 6.06, 95%CI [2.60 to 14.12]) was > 3 h and when an undesirable event occurred during transfer (aOR 2.66, 95%CI [1.11 to 6.37]. Conclusion: Increasing early identification of neonates who could benefit from TH and access to TH in non-CCs before transfer are modifiable factors that could improve care of neonates with HIE. Trial registration: The trial was registered at ClinicalTrials.gov (NCT02676063). What is Known: • International recommendations are to initiate therapeutic hypothermia before 6 h of life in neonates with moderate or severe hypoxic ischemic encephalopathy. What is New: •In this French population-based cohort of infants with hypoxic ischemic encephalopathy, nearly one-third of neonates eligible for treatment did not have access to hypothermia in the therapeutic window of 6 h of life. . • Among infants born in non-cooling centres, healthcare organizational factors involved in delayed care were the small size of maternities (1999 annual births), a time interval of more than 3 h between birth and call for transfer and between call for transfer and admission in neonatology, and the occurrence of an undesirable event during transfer.
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Affiliation(s)
- Jonathan Beck
- Université Paris Cité, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, 75004, Paris, France.
- Department of Neonatology, Reims University Hospital Alix de Champagne, Reims, France.
| | - Thierry Debillon
- Univ. Grenoble Alpes, CNRS, Neonatal Intensive Care Unit Grenoble Alpes University Hospital, Grenoble INP Institute of Engineering Univ. Grenoble Alpes, TIMC-IMAG, 38000, Grenoble, France
| | - Isabelle Guellec
- Université Paris Cité, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, 75004, Paris, France
- Neonatal Intensive Care Unit, Nice University Hospital, Côte d'Azur University, Nice, France
| | - Antoine Vilotitch
- Center for Clinical Investigation U1406, Grenoble Alpes University Hospital, Grenoble, France
| | - Gauthier Loron
- Department of Neonatology, Reims University Hospital Alix de Champagne, Reims, France
- Université de Reims Champagne Ardenne, 3804, 51097, Reims, CReSTIC EA, France
| | - Nathalie Bednarek
- Department of Neonatology, Reims University Hospital Alix de Champagne, Reims, France
- Université de Reims Champagne Ardenne, 3804, 51097, Reims, CReSTIC EA, France
| | - Pierre-Yves Ancel
- Université Paris Cité, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, 75004, Paris, France
- Center for Clinical Investigation P1419, APHP, APHP Centre-Université Paris Cité, 75014, Paris, France
| | - Véronique Pierrat
- Université Paris Cité, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, 75004, Paris, France
- Department of Neonatology, CHI Créteil, Créteil, France
| | - Anne Ego
- Center for Clinical Investigation U1406, Grenoble Alpes University Hospital, Grenoble, France
- Public Health Department, Univ. Grenoble Alpes, CNRS, Grenoble Alpes University Hospital, Grenoble INP Institute of Engineering Univ. Grenoble Alpes, TIMC-IMAG, 38000, Grenoble, France
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12
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Verspyck E, Gascoin G, Senat MV, Ego A, Simon L, Guellec I, Monier I, Zeitlin J, Subtil D, Vayssiere C. [Ante- and postnatal growth charts in France - guidelines for clinical practice from the Collège national des gynécologues et obstétriciens français (CNGOF) and from the Société française de néonatologie (SFN)]. Gynecol Obstet Fertil Senol 2022; 50:570-584. [PMID: 35781088 DOI: 10.1016/j.gofs.2022.06.008] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To recommend the most appropriate biometric charts for the detection of antenatal growth abnormalities and postnatal growth surveillance. METHODS Elaboration of specific questions and selection of experts by the organizing committee to answer these questions; analysis of the literature by experts and drafting conclusions by assigning a recommendation (strong or weak) and a quality of evidence (high, moderate, low, very low) and for each question; all these recommendations have been subject to multidisciplinary external review (obstetrician gynecologists, pediatricians). The objective for the reviewers was to verify the completeness of the literature review, to verify the levels of evidence established and the consistency and applicability of the resulting recommendations. The overall review of the literature, quality of evidence and recommendations were revised to take into consideration comments from external reviewers. RESULTS Antenatally, it is recommended to use all WHO fetal growth charts for EFW and common ultrasound biometric measurements (strong recommendation; low quality of evidence). Indeed, in comparison with other prescriptive curves and descriptive curves, the WHO prescriptive charts show better performance for the screening of SGA (Small for Gestational Age) and LGA (Large for Gestational Age) with adequate proportions of fetuses screened at extreme percentiles in the French population. It also has the advantages of having EFW charts by sex and biometric parameters obtained from the same perspective cohort of women screened by qualified sonographers who measured the biometric parameters according to international standards. Postnatally, it is recommended to use the updated Fenton charts for the assessment of birth measurements and for growth monitoring in preterm infants (strong recommendation; moderate quality of evidence) and for the assessment of birth measurements in term newborn (expert opinion). CONCLUSION It is recommended to use WHO fetal growth charts for antenatal growth monitoring and Fenton charts for the newborn.
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Affiliation(s)
- E Verspyck
- Service de gynécologie-obstétrique, CHU de Rouen, université de Rouen, Rouen, France.
| | - G Gascoin
- Service de néonatologie, CHU de Toulouse, université de Toulouse, hôpital des enfants, Toulouse, France
| | - M-V Senat
- Service de gynécologie-obstétrique, CHU du Kremlin-Bicêtre, université du Kremlin-Bicêtre, Le Kremlin-Bicêtre, France
| | - A Ego
- Pôle santé publique, CHU de Grenoble-Alpes, Grenoble, France
| | - L Simon
- Service de néonatologie, CHU de Nantes, université de Nantes, Nantes, France
| | - I Guellec
- Service de néonatologie, CHU de Nice, université de Nice, Nice, France
| | - I Monier
- Inserm UMR1153, équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), CRESS, Sorbonne Paris-Cité, Paris, France; Service de gynécologie-obstétrique, université Paris Saclay, hôpital Antoine-Béclère, AP-HP, Clamart, France
| | - J Zeitlin
- Inserm UMR1153, équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), CRESS, Sorbonne Paris-Cité, Paris, France
| | - D Subtil
- Service de gynécologie-obstétrique, CHU de Lille, université de Lille, Lille, France
| | - C Vayssiere
- Service de gynécologie-obstétrique, CHU de Toulouse, hôpital Paule-de-Viguier, Toulouse, France; Team SPHERE (Study of Perinatal, pediatric and adolescent Health: Epidemiological Research and Evaluation), CERPOP, UMR 1295, Toulouse III University, Toulouse, France
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Irtan S, Reignier PL, Durandy A, Hervieux E, Constant I, Lemale J, Soreze Y, Leger PL, Audry G, Rambaud J, Guellec I. Feasibility of open abdomen surgery treatment for near fatal necrotizing enterocolitis in preterm infants. J Pediatr Surg 2022; 57:1336-1341. [PMID: 34696919 DOI: 10.1016/j.jpedsurg.2021.09.044] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 09/24/2021] [Accepted: 09/26/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Necrotizing Enterocolitis (NEC) remained a dramatic complication leading to death or neonatal morbidities in preterms. For some, Intra-Abdominal Hypertension (IAH) and Abdominal Compartment Syndrome worsened the multi-organ failure. An open abdomen surgery could be an alternative to conventional surgical treatment to move beyond this stage. OBJECTIVES To retrospectively describe the clinical course, pre- and post-operative features of preterms suffering from severe NEC with IAH treated by open abdomen surgery and referred to our center from October 2007 to September 2019. Our secondary objective is to identify various risk factors for mortality in this population. METHODS Data on neonatal, clinical, biological, pre and post-operative features and outcome were collected. Univariate analyses were performed to compare their pre and post-operative features stratifying on outcome. RESULTS Among 29 included patients, 14 (48%) survived to discharge without short bowel syndrome. Death was associated with an earlier postnatal age at NEC (16.3 ± 9.1 versus 31.3 ± 25.9 days; p = 0.004) and followed a withdrawal of treatment in 60% of cases. Surgery was associated with a significant improvement of respiratory and hemodynamic features (decrease of mean ventilator pressure from 13.1 ± 5.4 to 11.3 ± 4.0 cmH2O, p < 0.001), oxygen requirement (mean FiO2 decreased from 65.0% ± 31.2 to 49.0% ± 24.6, p < 0.001) and inotropic score (from 38.6 ± 70.1 to 29.9 ± 64.3, p < 0.001). In the survival group, pre and post-operative findings exhibited a significant increase of serum lactate concentrations from 2.7 ± 1.6 to 11.0 ± 20.3 mmol/L (p = 0.02) but a similar pH. CONCLUSION Open abdomen surgery could be considered to rescue preterms with near fatal NEC. IAH and Abdominal Compartment Syndrome in these preterms should be investigated through further studies. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Sabine Irtan
- Department of Visceral and Neonatal Pediatric Surgery, Sorbonne University, Armand Trousseau University Hospital, APHP.6, Paris, France
| | - Pierre-Louis Reignier
- Department of Visceral and Neonatal Pediatric Surgery, Sorbonne University, Armand Trousseau University Hospital, APHP.6, Paris, France
| | - Amélie Durandy
- Neonatal Intensive Care Unit, CH Poissy Saint-Germain-en-Laye, Poissy, France
| | - Erik Hervieux
- Department of Visceral and Neonatal Pediatric Surgery, Sorbonne University, Armand Trousseau University Hospital, APHP.6, Paris, France
| | - Isabelle Constant
- Department of Anesthesiology and Intensive Care, Sorbonne University, Armand Trousseau University Hospital, GRC 29, APHP.6, Paris, France
| | - Julie Lemale
- Nutrition and Gastroenteterology, Pediatric Department, Sorbonne University, Armand Trousseau University Hospital, APHP.6, France
| | - Yohan Soreze
- Neonatal and Pediatric Care Unit, Sorbonne University, Armand Trousseau University Hospital, AP-HP.6, Paris, France
| | - Pierre-Louis Leger
- Neonatal and Pediatric Care Unit, Sorbonne University, Armand Trousseau University Hospital, AP-HP.6, Paris, France
| | - Georges Audry
- Department of Visceral and Neonatal Pediatric Surgery, Sorbonne University, Armand Trousseau University Hospital, APHP.6, Paris, France
| | - Jérôme Rambaud
- Neonatal and Pediatric Care Unit, Sorbonne University, Armand Trousseau University Hospital, AP-HP.6, Paris, France
| | - Isabelle Guellec
- Neonatal and Pediatric Care Unit, Sorbonne University, Armand Trousseau University Hospital, AP-HP.6, Paris, France.
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Meau‐Petit V, Levy Y, Guellec I. Utilisation of neonatologist-performed echocardiography in shock among neonatologists with interest in haemodynamic: International survey. Acta Paediatr 2022; 111:971-978. [PMID: 35138655 DOI: 10.1111/apa.16280] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/24/2021] [Accepted: 02/03/2022] [Indexed: 11/29/2022]
Abstract
AIM Neonatologist-performed echocardiography (NPE) is recommended during shock. We aimed to assess factors associated with NPE utilisation in the NICU and physiological information obtained during management of shock. METHODS An Internet-based survey, sent to neonatologists with interest in haemodynamics, studying NPE utilisation in shock management through a real clinical case and correlating its use with responders' training and NICU settings. RESULTS Fifty-nine completed surveys were received from the United Kingdom: 38%, Western Europe: 32%, Canada: 23% and other countries: 7%. Whilst managing the given clinical case, 90% of responders expected first NPE to exclude congenital heart disease-although only 61% could exclude it confidently (71% in trained clinicians vs. 29% without training; p < 0.01). NPE utilisation prior to initiate treatment was significantly correlated with mean number of neonatologists able to perform NPE in the NICU (4.9 vs. 2.9 neonatologists per unit; p = 0.02). Similarly, for ongoing therapeutic guidance, NPE was more used in trained clinicians (p < 0.01). 88% and 81% of responders studied a combination of multiple parameters to assess filling and systemic flow, respectively. CONCLUSION Neonatologist-performed echocardiography during shock management differs with previous training and number of doctors able to perform echocardiography in NICU. This study highlighted the need for enhanced training implementation.
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Affiliation(s)
- Virginie Meau‐Petit
- Evelina London Children’s hospital Guy’s and St Thomas’ Foundation Trust London UK
| | - Yael Levy
- Armand Trousseau hospital Assistance Publique Hôpitaux de Paris Paris France
| | - Isabelle Guellec
- Armand Trousseau hospital Assistance Publique Hôpitaux de Paris Paris France
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Lorain P, Bower A, Gottardi E, Dommergues M, Foix L'Helias L, Guellec I, Kayem G. Risk factors for hypoxic-ischemic encephalopathy in cases of severe acidosis: A case-control study. Acta Obstet Gynecol Scand 2022; 101:471-478. [PMID: 35338480 DOI: 10.1111/aogs.14326] [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: 09/22/2021] [Revised: 01/14/2022] [Accepted: 01/17/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The aim of the study was to identify the obstetric risk factors for hypoxic-ischemic encephalopathy (HIE) in infants with asphyxia at birth. MATERIAL AND METHODS This multicenter case-control study covered the 5-year period from 2014 through 2018 and included newborns ≥36 weeks of gestation with an umbilical pH at birth ≤7.0. Cases were newborns who developed moderate or severe HIE; they were matched with controls with pH ≤7.0 at birth over the same period without moderate or severe HIE. The factors studied were maternal, gestational, intrapartum, delivery-related, and neonatal characteristics. A multivariable analysis was performed to study the maternal, obstetric, and neonatal factors independently associated with moderate or severe HIE. RESULTS Our review of the records identified 41 cases and 98 controls. Compared with controls, children with moderate or severe HIE had a lower 5-min Apgar score, lower umbilical artery pH, and higher cord lactate levels at birth and at 1 h of life. Obstetric factors associated with moderate or severe HIE were the occurrence of an acute event (adjusted odds ratio [aOR] 6.4; 95% confidence interval [CI] 1.8-22.5), maternal fever (aOR 3.5; 95% CI 1.0-11.9), and thick meconium during labor (aOR 2.9; 95% CI 1.0-8.6). CONCLUSIONS HIE is associated with a lower 5-min Apgar score and with the severity of acidosis at birth and at 1 h of life. In newborns with a pH <7.0 at birth, the occurrence of an acute obstetric event, maternal fever, and thick meconium are independent factors associated with moderate or severe HIE.
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Affiliation(s)
- Perrine Lorain
- Department of Gynecology and Obstetrics, Trousseau Hospital - Assistance Publique-Hopitaux de Paris, Sorbonne University, Paris, France
| | - Alexandra Bower
- Department of Neonatology, Trousseau Hospital - Assistance Publique-Hopitaux de Paris, Sorbonne University, Paris, France
| | - Elsa Gottardi
- Department of Gynecology and Obstetrics, Trousseau Hospital - Assistance Publique-Hopitaux de Paris, Sorbonne University, Paris, France
| | - Marc Dommergues
- Department of Gynecology and Obstetrics, Pitié Salpétrière Hospital - Assistance Publique-Hopitaux de Paris, Sorbonne University, Paris, France
| | - Laurence Foix L'Helias
- Department of Neonatology, Trousseau Hospital - Assistance Publique-Hopitaux de Paris, Sorbonne University, Paris, France.,Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Research Center for Epidemiology and BioStatistics Sorbonne Paris Cité (CRESS), DHU Risks in pregnancy, Paris Descartes University, Paris, France
| | - Isabelle Guellec
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Research Center for Epidemiology and BioStatistics Sorbonne Paris Cité (CRESS), DHU Risks in pregnancy, Paris Descartes University, Paris, France.,Neonatal Intensive Care Unit, Trousseau Hospital - Assistance Publique-Hopitaux de Paris, Sorbonne University, Paris, France
| | - Gilles Kayem
- Department of Gynecology and Obstetrics, Trousseau Hospital - Assistance Publique-Hopitaux de Paris, Sorbonne University, Paris, France.,Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Research Center for Epidemiology and BioStatistics Sorbonne Paris Cité (CRESS), DHU Risks in pregnancy, Paris Descartes University, Paris, France
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16
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Bower A, Lorain P, Kayem G, Dommergues M, Foix‐L’Hélias L, Guellec I. Perinatal outcome and need of care for term asphyxiated newborns without moderate or severe hypoxic-ischemic encephalopathy. Acta Paediatr 2022; 111:576-583. [PMID: 34837273 DOI: 10.1111/apa.16199] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 11/25/2021] [Indexed: 12/01/2022]
Abstract
AIM Birth asphyxia can lead to organ dysfunction, varying from isolated biological acidosis to hypoxic-ischemic encephalopathy (HIE). Pathophysiology of moderate or severe HIE is now well known and guidelines exist regarding the care required in this situation. However, for newborns without moderate or severe HIE, no consensus is available. Our objective was to describe the immediate neonatal consequences and need for care of asphyxiated newborns without moderate or severe HIE. METHODS Multicentre retrospective study from January 2015 to December 2017 in two academic centres, including neonates ≥37 gestational weeks with pathological foetal acidemia (umbilical arterial pH<7.00 and/or lactate≥10 mmol/L). RESULTS Among 18 550 births, 161 (0.9%) had pathological foetal acidemia. 142 (88.0%) were not diagnosed with moderate or severe HIE. Among them, 82 (58.0%) were hospitalised. 13 (9.0%) had respiratory failure and required nutritional support. 100 (70.0%) underwent blood sampling, which showed at least one biological anomaly in 66 (66.0%) of cases. CONCLUSION Newborns born with pathological foetal acidemia without the occurrence of moderate or severe HIE had metabolic disorders and could need organ support. A prospective study describing this vulnerable population would help to establish consensus guidelines for the management of this population.
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Affiliation(s)
- Alexandra Bower
- Neonatal Intensive Care Department Trousseau University Hospital APHP Paris France
| | - Perrine Lorain
- Department of Obstetrics and Gynaecology FHU PREMA Trousseau University Hospital Paris France
| | - Gilles Kayem
- Department of Obstetrics and Gynaecology FHU PREMA Trousseau University Hospital Paris France
- Sorbonne University Paris France
| | - Marc Dommergues
- Sorbonne University Paris France
- Department of Obstetrics and Gynaecology La Pitié‐Salpêtrière University Hospital Paris France
| | - Laurence Foix‐L’Hélias
- Neonatal Intensive Care Department Trousseau University Hospital APHP Paris France
- Sorbonne University Paris France
| | - Isabelle Guellec
- Sorbonne University Paris France
- Pediatric Intensive Care Unit APHP Hôpital Armand Trousseau ‐ Sorbonne Université Paris France
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17
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Jegard J, Levy Y, Guellec I, Guilbert J, Soreze Y, Piloquet JE, Starck J, Jean S, Léger PL, Rambaud J. Usefulness of implementation of a protective mechanical ventilation bundle during extracorporeal membrane oxygenation for pediatric acute respiratory distress syndrome. Minerva Pediatr (Torino) 2022:S2724-5276.22.06391-1. [PMID: 35166483 DOI: 10.23736/s2724-5276.22.06391-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
OBJECTIVE Defining the best ventilatory settings under ECMO remains a challenging question. Despite a well-defined ARDS treatment before ECMO initiation, there is no recommendation on how to ventilate a patient under ECMO for P-ARDS. Only a few descriptive studies are available on ventilatory settings during respiratory ECMO. We aim at evaluating the usefulness of a protective ventilation bundle under ECMO and its capacity to reduce the ventilatory pressure in our ECMO center. METHODS We performed a monocentric retrospective study from January 2007 to December 2018. All children aged from 1 month to 18 years old and requiring an extracorporeal membrane oxygenation for a refractory acute respiratory distress syndrome were included. A protective mechanical ventilation under ECMO bundle has been developed in 2014. We compare the period 1 (before 2014) to the period 2 (after 2014). RESULTS Eighty-three patient had been included during the study. We reported a significant increase of PEEP and mean pressure respectively at day 3, day 7 and day 14 of ECMO during the period 2. Conversely, the driving pressure were significantly lower in the period 2 at day 3 (p: 0.009), day 7 (p:0.001) and day 14 (p: 0.001). We also shown a strong increase in the use of prone positioning during ECMO in the period 2 (p: 0.01). There was no significant effect of our bundle on the length of mechanical ventilation, of hospitalization and on the survival rate. CONCLUSIONS The implementation of a protective mechanical ventilation bundle during ECMO is usefulness to apply for lower ventilatory pressure and higher use of prone positioning. Nonetheless, the lack of power of our study prevents us from showing its efficacy on outcome criteria.
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Affiliation(s)
- Julien Jegard
- Pediatric and Neonatal Intensive Care Unit, Armand-Trousseau Hospital, APHP, Sorbonne University, Paris, France
| | - Yael Levy
- Pediatric and Neonatal Intensive Care Unit, Armand-Trousseau Hospital, APHP, Sorbonne University, Paris, France
| | - Isabelle Guellec
- Pediatric and Neonatal Intensive Care Unit, Armand-Trousseau Hospital, APHP, Sorbonne University, Paris, France
| | - Julia Guilbert
- Pediatric and Neonatal Intensive Care Unit, Armand-Trousseau Hospital, APHP, Sorbonne University, Paris, France
| | - Yohann Soreze
- Pediatric and Neonatal Intensive Care Unit, Armand-Trousseau Hospital, APHP, Sorbonne University, Paris, France
| | - Jean-Eudes Piloquet
- Pediatric and Neonatal Intensive Care Unit, Armand-Trousseau Hospital, APHP, Sorbonne University, Paris, France
| | - Julie Starck
- Pediatric and Neonatal Intensive Care Unit, Armand-Trousseau Hospital, APHP, Sorbonne University, Paris, France
| | - Sandrine Jean
- Pediatric and Neonatal Intensive Care Unit, Armand-Trousseau Hospital, APHP, Sorbonne University, Paris, France
| | - Pierre-Louis Léger
- Pediatric and Neonatal Intensive Care Unit, Armand-Trousseau Hospital, APHP, Sorbonne University, Paris, France
| | - Jerome Rambaud
- Pediatric and Neonatal Intensive Care Unit, Armand-Trousseau Hospital, APHP, Sorbonne University, Paris, France -
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Rozé JC, Morel B, Lapillonne A, Marret S, Guellec I, Darmaun D, Bednarek N, Moyon T, Marchand-Martin L, Benhammou V, Pierrat V, Flamant C, Gascoin G, Mitanchez D, Cambonie G, Storme L, Tosello B, Biran V, Claris O, Picaud JC, Favrais G, Beuchée A, Loron G, Gire C, Durrmeyer X, Gressens P, Saliba E, Ancel PY. Association Between Early Amino Acid Intake and Full-Scale IQ at Age 5 Years Among Infants Born at Less Than 30 Weeks' Gestation. JAMA Netw Open 2021; 4:e2135452. [PMID: 34846527 PMCID: PMC8634058 DOI: 10.1001/jamanetworkopen.2021.35452] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
IMPORTANCE An international expert committee recently revised its recommendations on amino acid intake for very preterm infants, suggesting that more than 3.50 g/kg/d should be administered only to preterm infants in clinical trials. However, the optimal amino acid intake during the first week after birth in these infants is unknown. OBJECTIVE To evaluate the association between early amino acid intake and cognitive outcomes at age 5 years. DESIGN, SETTING, AND PARTICIPANTS Using the EPIPAGE-2 (Epidemiologic Study on Small-for-Gestational-Age Children-Follow-up at Five and a Half Years) cohort, a nationwide prospective population-based cohort study conducted at 63 neonatal intensive care units in France, a propensity score-matched analysis was performed comparing infants born at less than 30 weeks' gestation who had high amino acid intake (3.51-4.50 g/kg/d) at 7 days after birth with infants who did not. Participants were recruited between April 1 and December 31, 2011, and followed up from September 1, 2016, to December 31, 2017. Full-scale IQ (FSIQ) was assessed at age 5 years. A confirmatory analysis used neonatal intensive care unit preference for high early amino acid intake as an instrumental variable to account for unmeasured confounding. Statistical analysis was performed from January 15 to May 15, 2021. EXPOSURES Amino acid intake at 7 days after birth. MAIN OUTCOMES AND MEASURES The primary outcome was an FSIQ score greater than -1 SD (ie, ≥93 points) at age 5 years. A complementary analysis was performed to explore the association between amino acid intake at day 7 as a continuous variable and FSIQ score at age 5 years. Data from cerebral magnetic resonance imaging at term were available for a subgroup of preterm infants who participated in the EPIRMEX (Cerebral Abnormalities Detected by MRI, Realized at the Age of Term and the Emergence of Executive Functions) ancillary study. RESULTS Among 1789 preterm infants (929 boys [51.9%]; mean [SD] gestational age, 27.17 [1.50] weeks) with data available to determine exposure to amino acid intake of 3.51 to 4.50 g/kg/d at 7 days after birth, 938 infants were exposed, and 851 infants were not; 717 infants from each group could be paired. The primary outcome was known in 396 of 646 exposed infants and 379 of 644 nonexposed infants who were alive at age 5 years and was observed more frequently among exposed vs nonexposed infants (243 infants [61.4%] vs 206 infants [54.4%], respectively; odds ratio [OR], 1.33 [95% CI, 1.00-1.71]; absolute risk increase in events [ie, the likelihood of having an FSIQ score >-1 SD at age 5 years] per 100 infants, 7.01 [95% CI, 0.06-13.87]; P = .048). In the matched cohort, correlation was found between amino acid intake per 1.00 g/kg/d at day 7 and FSIQ score at age 5 years (n = 775; β = 2.43 per 1-point increase in FSIQ; 95% CI, 0.27-4.59; P = .03), white matter area (n = 134; β = 144 per mm2; 95% CI, 3-285 per mm2; P = .045), anisotropy of the corpus callosum (n = 50; β = 0.018; 95% CI, 0.016-0.021; P < .001), left superior longitudinal fasciculus (n = 42; β = 0.018; 95% CI, 0.010-0.025; P < .001), and right superior longitudinal fasciculus (n = 42; β = 0.014 [95% CI, 0.005-0.024; P = .003) based on magnetic resonance imaging at term. Confirmatory and sensitivity analyses confirmed these results. For example, the adjusted OR for the association between the exposure and the primary outcome was 1.30 (95% CI, 1.16-1.46) using the instrumental variable approach among 978 participants in the overall cohort, and the adjusted OR was 1.35 (95% CI, 1.05-1.75) using multiple imputations among 1290 participants in the matched cohort. CONCLUSIONS AND RELEVANCE In this cohort study, high amino acid intake at 7 days after birth was associated with an increased likelihood of an FSIQ score greater than -1 SD at age 5 years. Well-designed randomized studies with long-term follow-up are needed to confirm the benefit of this nutritional approach.
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Affiliation(s)
- Jean-Christophe Rozé
- Department of Neonatal Medicine, Nantes University Hospital, Nantes, France
- Epidémiologie Clinique, Centre d’Investigation Clinique, Nantes University Hospital, Institut National de la Santé et de la Recherche Médicale (INSERM), Nantes, France
- Unité Mixte de Recherche (UMR) 1280, Physiologie des Adaptations Nutritionnelles, Nantes University, Institut National de la Recherche Agronomique (INRAE), Nantes, France
| | - Baptiste Morel
- UMR 1253, iBrain, Tours University, INSERM, Tours, France
| | - Alexandre Lapillonne
- Department of Neonatal Medicine, Assistance Publique Hopitaux de Paris, Necker Enfants Malades Hospital, Paris, France
| | - Stéphane Marret
- Department of Neonatal Medicine, Rouen University Hospital, Rouen, France
| | - Isabelle Guellec
- Department of Neonatal Medicine, Assistance Publique Hopitaux de Paris, Trousseau Hospital, Paris, France
| | - Dominique Darmaun
- Unité Mixte de Recherche (UMR) 1280, Physiologie des Adaptations Nutritionnelles, Nantes University, Institut National de la Recherche Agronomique (INRAE), Nantes, France
| | - Nathalie Bednarek
- EA 3804, Department of Neonatal Medicine, Reims University Hospital, Champagne-Ardennes University, Reims, France
| | - Thomas Moyon
- Unité Mixte de Recherche (UMR) 1280, Physiologie des Adaptations Nutritionnelles, Nantes University, Institut National de la Recherche Agronomique (INRAE), Nantes, France
| | - Laetitia Marchand-Martin
- Obstetrical Perinatal and Pediatric Epidemiology Research Team, U1153 Epidemiology and Biostatistics Sorbonne, University of Paris, INSERM, Paris, France
| | - Valérie Benhammou
- Obstetrical Perinatal and Pediatric Epidemiology Research Team, U1153 Epidemiology and Biostatistics Sorbonne, University of Paris, INSERM, Paris, France
| | - Véronique Pierrat
- Obstetrical Perinatal and Pediatric Epidemiology Research Team, U1153 Epidemiology and Biostatistics Sorbonne, University of Paris, INSERM, Paris, France
- Department of Neonatal Medicine, Jeanne de Flandre Hospital, Lille University Hospital, Lille, France
| | - Cyril Flamant
- Department of Neonatal Medicine, Nantes University Hospital, Nantes, France
- Epidémiologie Clinique, Centre d’Investigation Clinique, Nantes University Hospital, Institut National de la Santé et de la Recherche Médicale (INSERM), Nantes, France
| | - Géraldine Gascoin
- Department of Neonatal Medicine, Angers University Hospital, Angers, France
| | - Delphine Mitanchez
- Department of Neonatal Medicine, Tours University Hospital, Tours, France
| | - Gilles Cambonie
- Department of Neonatal Medicine, Montpellier University Hospital, Montpellier, France
| | - Laurent Storme
- Department of Neonatal Medicine, Jeanne de Flandre Hospital, Lille University Hospital, Lille, France
| | - Bathélémie Tosello
- Department of Neonatology, Assistance Publique Hopitaux de Marseille, Aix-Marseille Universite, Marseille, France
| | - Valérie Biran
- Department of Neonatology, University of Paris, Robert-Debre Hospital, Assistance Publique Hopitaux de Paris, Paris, France
| | - Olivier Claris
- Department of Neonatology, Hospices Civils de Lyon, Lyon, France
| | | | | | - Alain Beuchée
- Department of Neonatology, Rennes University Hospital, Rennes, France
| | - Gauthier Loron
- EA 3804, Department of Neonatal Medicine, Reims University Hospital, Champagne-Ardennes University, Reims, France
| | - Catherine Gire
- Department of Neonatal Medicine, Montpellier University Hospital, Montpellier, France
| | - Xavier Durrmeyer
- Department of Neonatology, Centre Inter-Communal de Créteil, Créteil, France
| | - Pierre Gressens
- NeuroDiderot, Robert-Debré Hospital, University of Paris, INSERM, Paris, France
| | - Elie Saliba
- UMR 1253, iBrain, Tours University, INSERM, Tours, France
| | - Pierre-Yves Ancel
- Obstetrical Perinatal and Pediatric Epidemiology Research Team, U1153 Epidemiology and Biostatistics Sorbonne, University of Paris, INSERM, Paris, France
- Clinical Investigation Centre P1419, Assistance Publique-Hôpitaux de Paris, Paris, France
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Debillon T, Tourneux P, Guellec I, Jarreau PH, Flamant C. Respiratory distress management in moderate and late preterm infants: The NEOBS Study. Arch Pediatr 2021; 28:392-397. [PMID: 33934933 DOI: 10.1016/j.arcped.2021.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 10/21/2020] [Revised: 01/22/2021] [Accepted: 03/16/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To investigate the characteristics and management of respiratory failure (RF) in moderate-to-late preterm infants. METHODS NEOBS was a prospective, multicenter, observational study conducted in 46 neonatal intensive care units caring for preterm infants (30+0/7 to 36+6/7 weeks of gestation [WG]) in France in 2018. The cohort was stratified into two groups: 30-33 WG (group 1) and 34-36 WG (group 2). Infants with early neonatal RF were included and the outcomes assessed were maternal, pregnancy, and delivery characteristics and how RF was managed. RESULTS Of the 560 infants analyzed, 279 were in group 1 and 281 were in group 2. Most pregnancies were singleton (64.1%), and 67.4% of women received prenatal corticosteroids (mostly two doses). Infants were delivered by cesarean section in 59.6% of cases; 91.7% of the infants had an Apgar score ≥7 at 5min. More than 90% of infants were hospitalized post-birth (median duration, 36 and 15 days for groups 1 and 2, respectively). Medical intervention was required for 95.7% and 90.4% of the infants in group 1 and group 2, respectively, and included noninvasive ventilation (continuous positive airway pressure [CPAP]: 88.5% and 82.9%; high-flow nasal cannula: 55.0% and 44.7%, or other) and invasive ventilation (19.7% and 13.2%). The two main diagnoses of RF were respiratory distress syndrome (39.8%) and transient tachypnea of the newborn (57.3%). Surfactant was administered to 22.5% of the infants, using the less invasive surfactant administration (LISA) method for 34.4% of the patients. In the overall population, 8.6% of the infants had respiratory and/or hemodynamic complications. CONCLUSIONS The NEOBS study demonstrated that CPAP was widely used in the delivery room and the LISA method was chosen for 34.4% of the surfactant administrations for the management of RF in moderate-to-late preterm infants. The incidence of RF-related complications was low.
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Affiliation(s)
- T Debillon
- Neonatology Intensive Care Unit, University Hospital of Grenoble, CS 10217, 38043 Grenoble Cedex 9, France.
| | - P Tourneux
- Neonatal Intensive Care Unit, University Hospital of Amiens, France-PériTox UMR_I 01, University of Picardy Jules Verne, 1, rond point du Professeur Christian Cabrol, 80054 Amiens, France
| | - I Guellec
- Neonatal and Pediatric Intensive Care Unit, University Hospital of Trousseau, AP-HP, 26, avenue du Dr Arnold Netter, 75012 Paris, France
| | - P-H Jarreau
- NICU of Port-Royal, AP-HP Centre-Université de Paris, Cochin Hospital, 123, boulevard de Port-Royal, 75014 Paris, France
| | - C Flamant
- Neonatal Intensive Care Unit, University Hospital of Nantes, 38, boulevard Jean Monnet, 44000 Nantes, France
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Walter‐Nicolet E, Marchand‐Martin L, Guellec I, Biran V, Moktari M, Zana‐Taieb E, Magny J, Desfrère L, Waszak P, Boileau P, Chauvin G, Saint Blanquat L, Borrhomée S, Droutman S, Merhi M, Zupan V, Karoui L, Cimerman P, Carbajal R, Durrmeyer X. Premedication practices for neonatal tracheal intubation: Results from the EPIPPAIN 2 prospective cohort study and comparison with EPIPPAIN 1. Paediatric and Neo Pain 2021; 3:46-58. [PMID: 35547594 PMCID: PMC8975199 DOI: 10.1002/pne2.12048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/17/2021] [Accepted: 03/03/2021] [Indexed: 11/25/2022]
Abstract
To describe the frequency and nature of premedication practices for neonatal tracheal intubation (TI) in 2011; to identify independent risk factors for the absence of premedication; to compare data with those from 2005 and to confront observed practices with current recommendations. Data concerning TI performed in neonates during the first 14 days of their admission to participating neonatal/pediatric intensive care units were prospectively collected at the bedside. This study was part of the Epidemiology of Procedural Pain in Neonates study (EPIPPAIN 2) conducted in 16 tertiary care units in the region of Paris, France, in 2011. Multivariate analysis was used to identify factors associated with premedication use and multilevel analysis to identify center effect. Results were compared with those of the EPIPPAIN 1 study, conducted in 2005 with a similar design, and to a current guidance for the clinician for this procedure. One hundred and twenty‐one intubations carried out in 121 patients were analyzed. The specific premedication rate was 47% and drugs used included mainly propofol (26%), sufentanil (24%), and ketamine (12%). Three factors were associated with the use of a specific premedication: nonemergent TI (Odds ratio (OR) [95% CI]: 5.3 [1.49‐20.80]), existence of a specific written protocol in the ward (OR [95% CI]:4.80 [2.12‐11.57]), and the absence of a nonspecific concurrent analgesia infusion before TI (OR [95% CI]: 3.41 [1.46‐8.45]). No center effect was observed. The specific premedication rate was lower than the 56% rate observed in 2005. The drugs used were more homogenous and consistent with the current recommendations than in 2005, especially in centers with a specific written protocol. Premedication use prior to neonatal TI was low, even for nonemergent procedures. Scientific consensus, implementation of international or national recommendations, and local written protocols are urgently needed to improve premedication practices for neonatal intubation.
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Affiliation(s)
- Elizabeth Walter‐Nicolet
- Medicine and Neonatal Intensive Care Unit Saint Joseph Hospital Paris France
- INSERM U1153, Epidemiology and Statistics Sorbonne Paris Cité Research Center Obstetrical, Perinatal and Pediatric Epidemiology Team Paris France
| | - Laetitia Marchand‐Martin
- INSERM U1153, Epidemiology and Statistics Sorbonne Paris Cité Research Center Obstetrical, Perinatal and Pediatric Epidemiology Team Paris France
| | - Isabelle Guellec
- INSERM U1153, Epidemiology and Statistics Sorbonne Paris Cité Research Center Obstetrical, Perinatal and Pediatric Epidemiology Team Paris France
- Paediatric and Neonatal Intensive Care Unit, Trousseau Hospital Assistance Publique – Hôpitaux de Paris Paris France
- Medicine Sorbonne University Paris France
| | - Valérie Biran
- Neonatal Intensive Care Unit Assistance Publique – Hôpitaux de Paris CHU Robert Debré University Paris Diderot, Sorbonne Paris Cité Paris France
- Inserm U1141 University Paris Diderot, Sorbonne Paris Cité Paris France
| | - Mostafa Moktari
- Pediatric and Neonatal Intensive Care Unit Bicêtre Hospital Assistance Publique – Hôpitaux de Paris Paris France
- Espace Ethique/Ile de France ‐ Saint‐Louis Hospital Assistance Publique ‐Hôpitaux de Paris Paris France
| | - Elodie Zana‐Taieb
- Port‐Royal Maternity Neonatal Intensive Care Unit Cochin‐Port Royal Hospital Assistance Publique‐Hôpitaux de Paris Paris France
| | - Jean‐François Magny
- Neonatal Intensive Care Unit Necker‐Enfants Maladies Hospital Assistance Publique – Hôpitaux de Paris Paris France
| | - Luc Desfrère
- Neonatal Intensive Care Unit Louis Mourier Hospital Assistance Publique – Hôpitaux de Paris Paris France
| | - Paul Waszak
- Medicine and Neonatal Intensive Care Unit Delafontaine Hospital Saint Denis France
| | - Pascal Boileau
- Neonatal Intensive Care Unit Centre Hospitalier Intercommunal Poissy‐Saint Germain Poissy France
- Inserm U1185 Université Paris Saclay Le Kremlin‐Bicêtre France
| | - Gilles Chauvin
- Neonatal Intensive Care Unit Argenteuil Hospital Argenteuil France
| | - Laure Saint Blanquat
- Pediatric and Neonatal Intensive Care Unit Necker‐enfants Malades Hospital Assistance Publique – Hôpitaux de Paris Paris France
| | | | - Stéphanie Droutman
- Pediatric and Neonatal Intensive Care Unit Centre Hospitalier Intercommunal André Grégoire Montreuil France
| | - Mona Merhi
- Neonatal Intensive Care Unit Centre Hospitalier Sud Francilien Corbeil‐Essonnes France
| | - Véronique Zupan
- Neonatal Intensive Care Unit Antoine Béclère Hospital Assistance Publique – Hôpitaux de Paris Clamart France
| | - Leila Karoui
- Neonatal Intensive Care Unit, Grand hôpital de l’Est francilien, site de Meaux Meaux France
| | - Patricia Cimerman
- Centre National de Ressources de lutte contre la Douleur, Trousseau Hospital Assistance Publique – Hôpitaux de Paris Paris France
| | - Ricardo Carbajal
- INSERM U1153, Epidemiology and Statistics Sorbonne Paris Cité Research Center Obstetrical, Perinatal and Pediatric Epidemiology Team Paris France
- Medicine Sorbonne University Paris France
- Paediatric Emergency Department, Trousseau Hospital Assistance Publique – Hôpitaux de Paris Paris France
| | - Xavier Durrmeyer
- INSERM U1153, Epidemiology and Statistics Sorbonne Paris Cité Research Center Obstetrical, Perinatal and Pediatric Epidemiology Team Paris France
- Neonatal Intensive Care Unit Centre Hospitalier Intercommunal de Créteil University Paris Est Créteil Créteil France
- Faculté de Médecine de Créteil IMRB, GRC CARMAS Université Paris Est Créteil Créteil France
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Robert B, Guellec I, Jegard J, Jean S, Guilbert J, Soreze Y, Starck J, Piloquet JE, Leger PL, Rambaud J. Extracorporeal membrane oxygenation for immunocompromised children with acute respiratory distress syndrome: a French referral center cohort. Minerva Pediatr 2020. [PMID: 32960001 DOI: 10.23736/s0026-4946.20.05725-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Immunocompromised children are likely to develop a refractory acute respiratory distress syndrome (ARDS). The usefulness of providing extracorporeal life support (ECLS) to these patients is a subject of debate. The aim of our study was to report the outcomes and to compare factors associated with mortality between immunocompromised and non-immunocompromised children supported with veno-venous ECMO. METHODS We performed a retrospective monocentric study in the French pediatric ECMO center of Armand Trousseau Hospital, including all pediatric patients aged from 1 month to 18 years requiring ECLS for ARDS. RESULTS Between 2007 and 2018, one hundred and eleven (111) patients underwent ECMO for respiratory failure; among them twenty-five (25) were immunocompromised. Survival rate at 6 months after intensive care discharge was significantly lower for immunocompromised patients compared to non-immunocompromised ones (41.7% vs. 62.8%; p = 0.04). ARDS severity was similar between the 2 groups. Fungal pneumonias were reported only in immunocompromised patients (12.5% versus 0% in the control group; p = 0.001). Bleeding complications were significantly more frequent in the immunocompromised group and blood product transfusions were also more frequently required in this group. CONCLUSIONS Six months after intensive care discharge, survival rate of immunocompromised children supported with ECMO for pediatric ARDS is lower than for nonimmunocompromised patients. But, the expectation for a favorable outcome is real and it is worth it if their condition is likely to be compatible with a good long-term quality of life.
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Affiliation(s)
- Blandine Robert
- Pediatric and Neonatal Intensive Care Unit, Armand-Trousseau Hospital, Sorbonne University, Paris, France
| | - Isabelle Guellec
- Pediatric and Neonatal Intensive Care Unit, Armand-Trousseau Hospital, Sorbonne University, Paris, France
| | - Julien Jegard
- Pediatric and Neonatal Intensive Care Unit, Armand-Trousseau Hospital, Sorbonne University, Paris, France
| | - Sandrine Jean
- Pediatric and Neonatal Intensive Care Unit, Armand-Trousseau Hospital, Sorbonne University, Paris, France
| | - Julia Guilbert
- Pediatric and Neonatal Intensive Care Unit, Armand-Trousseau Hospital, Sorbonne University, Paris, France
| | - Yohan Soreze
- Pediatric and Neonatal Intensive Care Unit, Armand-Trousseau Hospital, Sorbonne University, Paris, France
| | - Julie Starck
- Pediatric and Neonatal Intensive Care Unit, Armand-Trousseau Hospital, Sorbonne University, Paris, France
| | - Jean-Eudes Piloquet
- Pediatric and Neonatal Intensive Care Unit, Armand-Trousseau Hospital, Sorbonne University, Paris, France
| | - Pierre-Louis Leger
- Pediatric and Neonatal Intensive Care Unit, Armand-Trousseau Hospital, Sorbonne University, Paris, France
| | - Jerome Rambaud
- Pediatric and Neonatal Intensive Care Unit, Armand-Trousseau Hospital, Sorbonne University, Paris, France -
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Nathan N, Prevost B, Sileo C, Richard N, Berdah L, Thouvenin G, Aubertin G, Lecarpentier T, Schnuriger A, Jegard J, Guellec I, Taytard J, Corvol H. The Wide Spectrum of COVID-19 Clinical Presentation in Children. J Clin Med 2020; 9:jcm9092950. [PMID: 32932612 PMCID: PMC7564665 DOI: 10.3390/jcm9092950] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/04/2020] [Accepted: 09/07/2020] [Indexed: 01/08/2023] Open
Abstract
Background: Ten months after its appearance in December 2019, SARS-CoV-2 has infected more than 25 million patients worldwide. Because children were first identified as potential spreaders of the virus, schools were closed in several countries. However, it rapidly became evident that the number of hospitalized children infected by SARS-CoV-2 was dramatically lower than that of adults. To date, only hypotheses have been raised to explain this difference, so it is of great importance to describe the presentation of this disease among children. Here, we describe a wide spectrum of COVID-19 manifestation in children in a dedicated pediatric unit in France. Methods: Patients hospitalized with COVID-19 who were diagnosed on the basis of either positive SARS-CoV-2 RT-PCR in nasopharyngeal swabs and/or typical aspects in chest-computed tomography (CT) were included between March and May 2020 in Paris. Results: Twenty-three patients were included on the basis of positive RT-PCR (n = 20) and/or typical aspects in CT (n = 4). The median age was 4.9 years [0.1–17.6]. Patients were grouped by age (<2 years old: n = 14, 61%; 2–10 years old: n = 2, 9%; >10 years old: n = 7, 30%). Overweight or obesity was reported in only three patients. At presentation, the most frequent symptom in the overall cohort was fever (n = 18, 78%), followed by acute rhinitis (n = 9, 64%) and cough (n = 7, 50%) in the under 2-year-old group and cough (n = 4, 57%), fatigue, dyspnea and abdominal pain (n = 3, 43% each) in the over 10-year-old group. Five patients required ICU treatment, four of whom were aged >10 years, two presented with acute myocarditis, and two were sickle cell disease patients who presented with acute chest syndrome. Discussion and conclusion: The youngest patients seem to present milder forms of COVID-19 without the need for ICU treatment and with a shorter length of hospitalization. More severe evolutions were observed in teenagers, with, however, favorable outcomes. Given the context of closed schools and confinement, the infection of these children suggests intra-familial transmission that needs to be further assessed. This description might help to understand the intriguing differences in COVID-19 severity across age-classes.
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Affiliation(s)
- Nadia Nathan
- Pediatric Pulmonology Department, APHP Hôpital Trousseau, Sorbonne Université, 75012 Paris, France; (N.N.); (B.P.); (N.R.); (L.B.); (G.T.); (G.A.); (J.T.)
- Sorbonne Université, Inserm UMR_S933, Childhood Genetic Disorders, 75012 Paris, France
| | - Blandine Prevost
- Pediatric Pulmonology Department, APHP Hôpital Trousseau, Sorbonne Université, 75012 Paris, France; (N.N.); (B.P.); (N.R.); (L.B.); (G.T.); (G.A.); (J.T.)
| | - Chiara Sileo
- Pediatric Radiology Department, APHP Hôpital Trousseau, Sorbonne Université, 75012 Paris, France;
| | - Nicolas Richard
- Pediatric Pulmonology Department, APHP Hôpital Trousseau, Sorbonne Université, 75012 Paris, France; (N.N.); (B.P.); (N.R.); (L.B.); (G.T.); (G.A.); (J.T.)
- Sorbonne Université, Centre de Recherche Saint-Antoine (CRSA), Inserm UMR_S938, 75012 Paris, France;
| | - Laura Berdah
- Pediatric Pulmonology Department, APHP Hôpital Trousseau, Sorbonne Université, 75012 Paris, France; (N.N.); (B.P.); (N.R.); (L.B.); (G.T.); (G.A.); (J.T.)
- Sorbonne Université, Centre de Recherche Saint-Antoine (CRSA), Inserm UMR_S938, 75012 Paris, France;
| | - Guillaume Thouvenin
- Pediatric Pulmonology Department, APHP Hôpital Trousseau, Sorbonne Université, 75012 Paris, France; (N.N.); (B.P.); (N.R.); (L.B.); (G.T.); (G.A.); (J.T.)
- Sorbonne Université, Centre de Recherche Saint-Antoine (CRSA), Inserm UMR_S938, 75012 Paris, France;
| | - Guillaume Aubertin
- Pediatric Pulmonology Department, APHP Hôpital Trousseau, Sorbonne Université, 75012 Paris, France; (N.N.); (B.P.); (N.R.); (L.B.); (G.T.); (G.A.); (J.T.)
- Sorbonne Université, Centre de Recherche Saint-Antoine (CRSA), Inserm UMR_S938, 75012 Paris, France;
| | - Thibault Lecarpentier
- Pediatric Emergency Department, APHP Hôpital Trousseau, Sorbonne Université, 75012 Paris, France;
| | - Aurélie Schnuriger
- Sorbonne Université, Centre de Recherche Saint-Antoine (CRSA), Inserm UMR_S938, 75012 Paris, France;
- Virology Department, APHP Hôpital Trousseau, Sorbonne Université, 75012 Paris, France
| | - Julien Jegard
- Pediatric and Neonatal Intensive Care Unit, APHP Hôpital Trousseau, Sorbonne Université, 75012 Paris, France; (J.J.); (I.G.)
| | - Isabelle Guellec
- Pediatric and Neonatal Intensive Care Unit, APHP Hôpital Trousseau, Sorbonne Université, 75012 Paris, France; (J.J.); (I.G.)
| | - Jessica Taytard
- Pediatric Pulmonology Department, APHP Hôpital Trousseau, Sorbonne Université, 75012 Paris, France; (N.N.); (B.P.); (N.R.); (L.B.); (G.T.); (G.A.); (J.T.)
- Sorbonne Université, Inserm UMR_S1158, Experimental and clinical respiratory neurophysiology, 75013 Paris, France
| | - Harriet Corvol
- Pediatric Pulmonology Department, APHP Hôpital Trousseau, Sorbonne Université, 75012 Paris, France; (N.N.); (B.P.); (N.R.); (L.B.); (G.T.); (G.A.); (J.T.)
- Sorbonne Université, Centre de Recherche Saint-Antoine (CRSA), Inserm UMR_S938, 75012 Paris, France;
- Correspondence:
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23
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Rambaud J, Allioux C, Jean S, Guilbert J, Guellec I, Demoulin M, Carbajal R, Guedj R, Leger PL. Nosocomial Infections in Neonates Supported by Extracorporeal Membrane Oxygenation: First French Retrospective Study. Indian J Crit Care Med 2019; 23:392-395. [PMID: 31645822 PMCID: PMC6775718 DOI: 10.5005/jp-journals-10071-23231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
How to cite this article: Rambaud J, Allioux C, Jean S, Guilbert J, Guellec I, Demoulin M, et al. Nosocomial Infections in Neonates Supported by Extracorporeal Membrane Oxygenation: First French Retrospective Study. Indian J Crit Care Med 2019;23(9):392–395.
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Affiliation(s)
- Jerome Rambaud
- Neonatal and Pediatric Intensive Care Unit, Armand-Trousseau Hospital, Paris, France
- Jerome Rambaud, Neonatal and Pediatric Intensive Care Unit, Armand-Trousseau Hospital, Paris, France, Phone: 33-33-0171738527, e-mail:
| | - Cecile Allioux
- Neonatal and Pediatric Intensive Care Unit, Armand-Trousseau Hospital, Paris, France
| | - Sandrine Jean
- Neonatal and Pediatric Intensive Care Unit, Armand-Trousseau Hospital, Paris, France
| | - Julia Guilbert
- Neonatal and Pediatric Intensive Care Unit, Armand-Trousseau Hospital, Paris, France
| | - Isabelle Guellec
- Neonatal and Pediatric Intensive Care Unit, Armand-Trousseau Hospital, Paris, France
| | - Maryne Demoulin
- Neonatal and Pediatric Intensive Care Unit, Armand-Trousseau Hospital, Paris, France
| | - Ricardo Carbajal
- Neonatal and Pediatric Intensive Care Unit, Armand-Trousseau Hospital, Paris, France
| | - Romain Guedj
- Neonatal and Pediatric Intensive Care Unit, Armand-Trousseau Hospital, Paris, France
| | - Pierre Louis Leger
- Neonatal and Pediatric Intensive Care Unit, Armand-Trousseau Hospital, Paris, France
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Geslain G, Guellec I, Guedj R, Guilbert J, Jean S, Valentin C, Demoulin M, Soreze Y, Carbajal R, Leger PL, Rambaud J. Incidence and risk factors of ventilator-associated pneumonia in neonatal intensive care unit: a first French study. Minerva Anestesiol 2018; 84:829-835. [DOI: 10.23736/s0375-9393.18.12296-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Escourrou G, Renesme L, Zana E, Rideau A, Marcoux MO, Lopez E, Gascoin G, Kuhn P, Tourneux P, Guellec I, Flamant C. How to assess hemodynamic status in very preterm newborns in the first week of life? J Perinatol 2017; 37:987-993. [PMID: 28471441 DOI: 10.1038/jp.2017.57] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 09/16/2016] [Revised: 02/12/2017] [Accepted: 03/28/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND Assessing hemodynamic status in preterm newborns is an essential task, as many studies have shown increased morbidity when hemodynamic parameters are abnormal. Although oscillometric monitoring of arterial blood pressure (BP) is widely used due to its simplicity and lack of side effects, these values are not always correlated with microcirculation and oxygen delivery. OBJECTIVES This review focuses on different tools for the assessment of hemodynamic status in preterm newborns. These include the measurement of clinical (BP, capillary refill time and urinary output (UO)) or biological parameters (lactate analysis), functional echocardiography, and near-infrared spectroscopy (NIRS). We describe the concepts and techniques involved in these tools in detail, and examine the interest and limitations of each type of assessment. CONCLUSIONS This review highlights the complementarities between the different parameters used to assess hemodynamic status in preterm newborns during the first week of life. The analysis of arterial BP measured by oscillometric monitoring must take into account other clinical data, in particular capillary refill time and UO, and biological data such as lactate levels. Echocardiography improves noninvasive hemodynamic management in newborns but requires specific training. In contrast, NIRS may be useful in monitoring the clinical course of infants at risk of, or presenting with, hypotension. It holds the potential for early and noninvasive identification of silent hypoperfusion in critically ill preterm infants. However, more data are needed to confirm the usefulness of this promising tool in significantly changing the outcome of these infants.
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Affiliation(s)
- G Escourrou
- Department of Neonatal Medicine, CH Montreuil, Montreuil, France
| | - L Renesme
- Department of Neonatal Medicine, CHU Bordeaux, France
| | - E Zana
- Department of Neonatal Medicine, Port Royal Maternity, Paris, France
| | - A Rideau
- Department of Neonatal Medicine, CHU Paris, France
| | - M O Marcoux
- Paediatric Intensive Care Unit, CHU Toulouse, France
| | - E Lopez
- Department of Neonatal Medicine, CHU Tours, France
| | - G Gascoin
- Department of Neonatal Medicine, CHU Angers, France
| | - P Kuhn
- Department of Neonatal Medicine, CHU Strasbourg, France
| | - P Tourneux
- Department of Neonatal Medicine, CHU Amiens, France
| | - I Guellec
- Department of Neonatal Medicine, CHU Paris, France
| | - C Flamant
- Department of Neonatal Medicine, CHU Nantes, Service de Réanimation néonatale, Nantes, France
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Rambaud J, Guilbert J, Guellec I, Jean S, Durandy A, Demoulin M, Amblard A, Carbajal R, Leger PL. [Extracorporeal membrane oxygenation in critically ill neonates and children]. Arch Pediatr 2017; 24:578-586. [PMID: 28416430 DOI: 10.1016/j.arcped.2017.03.001] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 01/02/2017] [Accepted: 03/11/2017] [Indexed: 10/19/2022]
Abstract
Extracorporeal membrane oxygenation is used as a last resort during neonatal and pediatric resuscitation in case of refractory circulatory or respiratory failure under maximum conventional therapies. Different types of ECMO can be used depending on the initial failure. The main indications for ECMO are refractory respiratory failure (acute respiratory distress syndrome, status asthmaticus, severe pneumonia, meconium aspiration syndrome, pulmonary hypertension) and refractory circulatory failure (cardiogenic shock, septic shock, refractory cardiac arrest). The main contraindications are a gestational age under 34 weeks or birth weight under 2kg, severe underlying pulmonary disease, severe immune deficiency, a neurodegenerative disease and hereditary disease of hemostasis. Neurological impairment can occur during ECMO (cranial hemorrhage, seizure or stroke). Nosocomial infections and acute kidney injury are also frequent complications of ECMO. The overall survival rate of ECMO is about 60 %. This survival rate can change depending on the initial disease: from 80 % for meconium aspiration syndrome to less than 10 % for out-of-hospital refractory cardiac arrest. Recently, mobile ECMO units have been created. These units are able to perform ECMO out of a referral center for untransportable critically ill patients.
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Affiliation(s)
- J Rambaud
- Service de réanimation néonatale et pédiatrique, CHU d'Armand-Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France; Université Pierre et Marie Curie (UPMC), 75005 Paris, France.
| | - J Guilbert
- Service de réanimation néonatale et pédiatrique, CHU d'Armand-Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - I Guellec
- Service de réanimation néonatale et pédiatrique, CHU d'Armand-Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - S Jean
- Service de réanimation néonatale et pédiatrique, CHU d'Armand-Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - A Durandy
- Service de réanimation néonatale et pédiatrique, CHU d'Armand-Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France; Université Pierre et Marie Curie (UPMC), 75005 Paris, France
| | - M Demoulin
- Service de réanimation néonatale et pédiatrique, CHU d'Armand-Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France; Université Pierre et Marie Curie (UPMC), 75005 Paris, France
| | - A Amblard
- Service de réanimation néonatale et pédiatrique, CHU d'Armand-Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - R Carbajal
- Service de réanimation néonatale et pédiatrique, CHU d'Armand-Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - P-L Leger
- Service de réanimation néonatale et pédiatrique, CHU d'Armand-Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France; Unité Inserm U1141, hôpital Robert-Debré, 75019 Paris, France
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Clair MP, Rambaud J, Flahault A, Guedj R, Guilbert J, Guellec I, Durandy A, Demoulin M, Jean S, Mitanchez D, Chalard F, Sileo C, Carbajal R, Renolleau S, Léger PL. Prognostic value of cerebral tissue oxygen saturation during neonatal extracorporeal membrane oxygenation. PLoS One 2017; 12:e0172991. [PMID: 28278259 PMCID: PMC5344369 DOI: 10.1371/journal.pone.0172991] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 01/02/2017] [Accepted: 01/31/2017] [Indexed: 12/02/2022] Open
Abstract
Objectives Extracorporeal membrane oxygenation support is indicated in severe and refractory respiratory or circulatory failures. Neurological complications are typically represented by acute ischemic or hemorrhagic lesions, which induce higher morbidity and mortality. The primary goal of this study was to assess the prognostic value of cerebral tissue oxygen saturation (StcO2) on mortality in neonates and young infants treated with ECMO. A secondary objective was to evaluate the association between StcO2 and the occurrence of cerebral lesions. Study design This was a prospective study in infants < 3 months of age admitted to a pediatric intensive care unit and requiring ECMO support. Measurements The assessment of cerebral perfusion was made by continuous StcO2 monitoring using near-infrared spectroscopy (NIRS) sensors placed on the two temporo-parietal regions. Neurological lesions were identified by MRI or transfontanellar echography. Results Thirty-four infants <3 months of age were included in the study over a period of 18 months. The ECMO duration was 10±7 days. The survival rate was 50% (17/34 patients), and the proportion of brain injuries was 20% (7/34 patients). The mean StcO2 during ECMO in the non-survivors was reduced in both hemispheres (p = 0.0008 right, p = 0.03 left) compared to the survivors. StcO2 was also reduced in deceased or brain-injured patients compared to the survivors without brain injury (p = 0.002). Conclusion StcO2 appears to be a strong prognostic factor of survival and of the presence of cerebral lesions in young infants during ECMO.
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Affiliation(s)
- Marie-Philippine Clair
- Department of Neonatal and Pediatric intensive care unit, Trousseau Hospital, AP-HP, Paris, France
| | - Jérôme Rambaud
- Department of Neonatal and Pediatric intensive care unit, Trousseau Hospital, AP-HP, Paris, France
| | - Adrien Flahault
- Laboratory of Central Neuropeptides in the Regulation of Body Fluid Homeostasis and Cardiovascular Functions, Center for Interdisciplinary Research in Biology (CIRB), INSERM, U1050, Paris, France
- CNRS, UMR 7241, Paris, France
| | - Romain Guedj
- Department of Emergency medicine, Trousseau Hospital, AP-HP, Paris, France
| | - Julia Guilbert
- Department of Neonatal and Pediatric intensive care unit, Trousseau Hospital, AP-HP, Paris, France
| | - Isabelle Guellec
- Department of Neonatal and Pediatric intensive care unit, Trousseau Hospital, AP-HP, Paris, France
| | - Amélie Durandy
- Department of Neonatal and Pediatric intensive care unit, Trousseau Hospital, AP-HP, Paris, France
| | - Maryne Demoulin
- Department of Neonatal and Pediatric intensive care unit, Trousseau Hospital, AP-HP, Paris, France
| | - Sandrine Jean
- Department of Neonatal and Pediatric intensive care unit, Trousseau Hospital, AP-HP, Paris, France
| | | | - François Chalard
- Department of Pediatric Radiology, Trousseau Hospital, AP-HP, Paris, France
| | - Chiara Sileo
- Department of Pediatric Radiology, Trousseau Hospital, AP-HP, Paris, France
| | - Ricardo Carbajal
- Department of Neonatal and Pediatric intensive care unit, Trousseau Hospital, AP-HP, Paris, France
- Department of Emergency medicine, Trousseau Hospital, AP-HP, Paris, France
- UPMC Pierre et Marie Curie University, Paris VI, France
| | - Sylvain Renolleau
- Department of Pediatric intensive care unit, Necker Hospital, AP-HP, Paris, France
| | - Pierre-Louis Léger
- Department of Neonatal and Pediatric intensive care unit, Trousseau Hospital, AP-HP, Paris, France
- * E-mail:
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Monier I, Ancel PY, Ego A, Guellec I, Jarreau PH, Kaminski M, Goffinet F, Zeitlin J. Gestational age at diagnosis of early-onset fetal growth restriction and impact on management and survival: a population-based cohort study. BJOG 2017; 124:1899-1906. [DOI: 10.1111/1471-0528.14555] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2016] [Indexed: 12/01/2022]
Affiliation(s)
- I Monier
- Inserm UMR 1153; Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé); Center for Epidemiology and Statistics Sorbonne Paris Cité; DHU Risks in pregnancy; Paris Descartes University; Paris France
- Antoine Beclere Maternity Unit; Department of Obstetrics and Gynaecology; South Paris University Hospitals; AP-HP; Paris France
| | - P-Y Ancel
- Inserm UMR 1153; Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé); Center for Epidemiology and Statistics Sorbonne Paris Cité; DHU Risks in pregnancy; Paris Descartes University; Paris France
| | - A Ego
- Inserm UMR 1153; Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé); Center for Epidemiology and Statistics Sorbonne Paris Cité; DHU Risks in pregnancy; Paris Descartes University; Paris France
- Clinical Research Centre (CICO3); Grenoble University Hospital; Grenoble France
| | - I Guellec
- Inserm UMR 1153; Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé); Center for Epidemiology and Statistics Sorbonne Paris Cité; DHU Risks in pregnancy; Paris Descartes University; Paris France
- Paediatric and Neonatal Intensive Care Unit; Armand-Trousseau Hospital; AP-HP; Paris France
| | - P-H Jarreau
- Department of Neonatal Medicine and Intensive Care Unit of Port-Royal; Cochin University Hospital; AP-HP; DHU Risks in Pregnancy; Paris France
| | - M Kaminski
- Inserm UMR 1153; Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé); Center for Epidemiology and Statistics Sorbonne Paris Cité; DHU Risks in pregnancy; Paris Descartes University; Paris France
| | - F Goffinet
- Inserm UMR 1153; Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé); Center for Epidemiology and Statistics Sorbonne Paris Cité; DHU Risks in pregnancy; Paris Descartes University; Paris France
- Port-Royal Maternity Unit; Department of Obstetrics and Gynaecology; Cochin University Hospital; AP-HP; Paris France
| | - J Zeitlin
- Inserm UMR 1153; Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé); Center for Epidemiology and Statistics Sorbonne Paris Cité; DHU Risks in pregnancy; Paris Descartes University; Paris France
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29
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Bougouin W, Marijon E, Planquette B, Karam N, Dumas F, Celermajer D, Jost D, Lamhaut L, Beganton F, Cariou A, Meyer G, Jouven X, Bureau C, Charpentier J, Salem OBH, Guillemet L, Arnaout M, Ferre A, Geri G, Mongardon N, Pène F, Chiche JD, Mira JP, Labro G, Belon F, Luu VP, Chenet J, Besch G, Puyraveau M, Piton G, Capellier G, Martin M, Lascarrou JB, Le Thuaut A, Lacherade JC, Martin-Lefèvre L, Fiancette M, Vinatier I, Lebert C, Bachoumas K, Yehia A, Henry-Laguarrigue M, Colin G, Reignier J, Privat E, Escutnaire J, Dumont C, Baert V, Vilhelm C, Hubert H, Robert-Edan V, Lakhal K, Quartin A, Hobbs B, Cely C, Bell C, Pham T, Schein R, Geng Y, Ng C, Ehrmann S, Gandonnière CS, Boisramé-Helms J, Le Tilly O, De Bretagne IB, Mercier E, Mankikian J, Bretagnol A, Meziani F, Halimi JM, Le Guellec CB, Gaudry S, Hajage D, Tubach F, Pons B, Boulet E, Boyer A, Chevrel G, Lerolle N, Carpentier D, de Prost N, Lautrette A, Mayaux J, Nseir S, Ricard JD, Dreyfuss D, Robert R, Garzotto F, Kipnis E, Tetta C, Ronco C, Schnell D, Aurelie B, Reynaud M, Clec’h C, Benyamina M, Vincent F, Mariat C, Bornstain C, Gloulou O, Boussarsar M, Zelmat SA, Batouche DD, Chaffi B, Mazour F, Benatta N, Fathallah I, Aloui R, Zoubli A, Rouleau S, Kouraichi N, Fathallah I, Kouraichi N, Salem S, Vicaut E, Megarbane B, Ambroise D, Loriot AM, Bourgogne E, Megarbane B, Leroy C, Ghadhoune H, Jihene G, Trabelsi I, Allouche H, Brahmi H, Samet M, Ghord HE, Lebeau R, Laplanche JL, Benturquia N, Cohen Y, Megarbane B, Blel Y, M’rad A, Essafi F, Benabderrahim A, Jouffroy R, Resiere D, Sanchez B, Inamo J, Megarbane B, Morel J, Batouche DD, Zerhouni A, Tabeliouna K, Negadi A, Mentouri Z, Le Gall F, Hanouz JL, Normand H, Khoury A, Sall FS, Legrand M, De Luca A, Pugin A, Pazart L, Vidal C, Leroux F, Khoury A, L’Her E, Marjanovic N, Khoury A, Desmettre T, Terreaux J, Lambert C, Ragey SP, Baboi L, Bazin JE, Koffel C, Dhonneur G, Bouzit Z, Bradai L, Ayed IB, Aissa F, Darmon M, Haouache H, Marechal Y, Biston P, Piagnerelli M, Bortolotti P, Colling D, Colas V, Voisin B, Dewavrin F, Onimus T, Cantier M, Girardie P, Saulnier F, Urbina T, Nguyen Y, Druoton AL, Soudant M, Barraud D, Conrad M, Cravoisy-Popovic A, Nace L, Morisot A, Bollaert PE, Martin R, Bitker L, Richard JC, Brossier D, Goyer I, Marquis C, Lampin M, Duhamel A, Béhal H, Guérot E, Dhaoui T, Godeffroy V, Devouge E, Evrard D, Delepoulle F, Racoussot S, Grandbastien B, Lampin M, Heilbronner C, Roy E, Canet E, Masson A, Hadchouel-Duvergé A, Rigourd V, Delacroix E, Wroblewski I, Pin I, Ego A, Payen V, Debillon T, Millet A, De Montmollin E, Denot J, Berthelot V, Thueux E, Reymond M, De Larrard A, Amblard A, Leger PL, Aoul NT, Lemiale V, Oziel J, Voiriot G, Brule N, Moreau AS, Marhbène T, Sellami S, Jamoussi A, Ayed S, Mhiri E, Slim L, Khelil JB, Besbes M, Neuville M, Chawki S, Hamdi A, Ciroldi M, Cottereau A, Obadia E, Zerbib Y, Andrejak C, Ricome S, Dupont H, Baudin F, Timsit JF, Dureau P, Tanguy A, Arbelot C, Ben HK, Charfeddine A, Granger B, Laporte L, Hermetet C, Regaieg K, Khemakhem R, Sonneville R, Chelly H, Cheikh CM, Mountij H, Rghioui K, Haddad W, Cherkab R, Barrou H, Naima A, bennani OM, Regaieg K, Fayssoil A, Douib A, Samet A, Cungi PJ, Nguyen C, Cotte J, D’aranda E, Meaudre E, Avaro JP, Slaoui MT, Mokline A, Stojkovic T, Rahmani I, Laajili A, Amri H, Gharsallah L, Gasri B, Tlaili S, Hammouda R, Messadi AA, Behin A, Ogna A, Lofaso F, Laforet P, Wahbi K, Prigent H, Duboc D, Orlikowski D, Eymard B, Annane D, Le Guennec L, Cholet C, Bréchot N, Hekimian G, Besset S, Lebreton G, Nieszkowska A, Trouillet JL, Leprince P, Combes A, Luyt CE, Griton M, Sesay M, De Panthou NS, Bienvenu T, Biais M, Nouette-Gaulain K, Fossat G, Baudin F, Coulanges C, Bobet S, Dupont A, Courtes L, Benzekri D, Kamel T, Muller G, Bercault N, Barbier F, Runge I, Skarzynski M, Mathonnet A, Boulain T, Jouan Y, Teixera N, Hassen-Khodja C, Guillon A, Gaborit C, Grammatico-Guillon L, Rebière C, Azoulay E, Misset B, Ruckly S, Garrouste-Orgeas M, Kentish-Barnes N, Duranteau J, Thuong M, Joseph L, Renault A, Lesieur O, Larbi AGS, Viquesnel G, Zuber B, Marque S, Kandelman S, Pichon N, Floccard B, Galon M, Chevret S, Kentish-Barnes N, Seegers V, Legriel S, Jaber S, Lefrant JY, Reuter D, Guisset O, Cracco C, Seguin A, Durand-Gasselin J, Thirion M, Cohen-Solal Z, Foulgoc H, Rogier J, Delobbe E, Schortgen F, Asfar P, Julie BH, Grimaldi D, Fabien G, Anguel N, Sigismond L, Matthieu HL, Gonzalez F, François L, Guitton C, Schenck M, Jean-Marc D, Radermacher P, Kentish-Barnes N, Makunza JN, Nathalie MK, Pierre A, Adolphe KM, Mahieu R, Reydel T, Jamet A, Chudeau N, Huntzinger J, Grange S, Courte A, Lemarie J, Gibot S, Champey J, Dellamonica J, Du Cheyron D, Contou D, Tadié JM, Cour M, Beduneau G, Marchalot A, Guérin L, Jochmans S, Terzi N, Preau S, Brun-Buisson C, Dessap AM, Vedrenne-Cloquet M, Breinig S, Jung C, Brussieux M, Marcoux MO, Durrmeyer X, Blondé R, Angoulvant F, Grasset J, Naudin J, Dauger S, Remy S, Kolev-Descamp K, Demaret J, Monneret G, Javouhey E, Chomton M, Sauthier M, Vallieres E, Jouvet P, Geslain G, Guellec I, Rambaud J, Schmidt M, Schellongowski P, Dorget A, Patroniti N, Taccone FS, Miranda DR, Reuter J, Prodanovic H, Pierrot M, Balik M, Park S, Guérin C, Papazian L, Jean R, Ayzac L, Loundou A, Forel JM, Mezidi M, Aublanc M, Perinel-Ragey S, Lissonde F, Louf-Durier A, Tapponnier R, Yonis H, Coudroy R, Frat JP, Boissier F, Thille AW, Richard F, Le Gullou-Guillemette H, Fahri J, Kouatchet A, Bodet-Contentin L, Garot D, Le Pennec D, Vecellio L, Tavernier E, Dequin PF, Messika J, Martin Y, Maquigneau N, Puechberty C, Stoclin A, Villard S, Dechanet A, De Jong A, Monnin M, Girard M, Chanques G, Molinari N, Decavèle M, Campion S, Ainsouya R, Niérat MC, Raux M, Similowski T, Demoule A, Razazi K, Tchir M, May F, Carteaux G, Pauline RB, Marc A, Bedos JP, Mehrsa K, Mauger-Briche C, Mijon F, Trouiller P, Sztrymf B, Cretallaz P, Mermillod-Blondin R, Savary D, Sedghiani I, Doghri H, Jendoubi A, Hamdi D, Cherif MA, Hechmi YZE, Zouheir J, Persico N, Maltese F, Ferrigno C, Bablon A, Marmillot C, Roch A, Sedghiani I, Papin G, Gainnier M, Argaud L, Christophe A, Souweine B, Goldgran-Toledano D, Marcotte G, Dumenil AS, Carole S, Cecchini J, Tuffet S, Fartoukh M, Roux D, Thyrault M, Armand MD, Chauveau S, Wesner N, Monnier-Cholley L, Bigé N, Ait-Oufella H, Guidet B, Dubée V, Labroca P, Lemarié J, Chiesa G, Laroyenne I, Borrini L, Klotz R, Sy QP, Cristina MC, Paysant J, Fillâtre P, Gacouin A, Revest M, Tattevin P, Flecher E, Le Tulzo Y, Jamme M, Daviaud F, Marin N, Thy M, Duceau B, Ardisson F, Sandrine V, Venot M, Schlemmer B, Zafrani L, Pons S, Styfalova L, Bouadma L, Radjou A, Lebut J, Mourvillier B, Dorent R, Dilly MP, Nataf P, Wolff M, Le Gall A, Bourcier S, Tandjaoui-Lambiotte Y, Das V, Alves M, Bigé N, Kamilia C, Rania A, Baccouch N, Turki O, Ben HC, Bahloul M, Bouaziz M, Dupuis C, Perozziello A, Letheulle J, Valette M, Herrmann-Storck C, Crosby L, Elkoun K, Madeux B, Martino F, Migueres H, Piednoir P, Posch M, Thiery G, Huynh-Ky MT, Bouchard PA, Sarrazin JF, Lellouche F, Nay MA, Lortat-Jacob B, Rozec B, Colnot M, Belin N, Barrot L, Navellou JC, Patry C, Chaignat C, Claveau M, Claude F, Aubron C, Mcquilten Z, Bailey M, Board J, Buhr H, Cartwright B, Dennis M, Forrest P, Hodgson C, Mcilroy D, Murphy D, Murray L, Pellegrino V, Pilcher D, Sheldrake J, Tran H, Vallance S, Cooper J, Bombled C, Vidal C, Margetis D, Amour J, Coart D, Dubois J, Van Herpe T, Mesotten D, Bailly S, Lucet J, Lepape A, L’hériteau F, Aupée M, Bervas C, Boussat S, Berger-Carbonne A, Machut A, Savey A, Tudesq JJ, Valade S, Galicier L, De Bazelaire C, Munoz-Bongrand N, Mignard X, Biard L, Mokart D, Nyunga M, Bruneel F, Rabbat A, Perez P, Meert AP, Benoit D, Mariotte E, Ehooman F, Hamidfar-Roy R, Hourmant Y, Mailloux A, Beurton A, Teboul JL, Girroto V, Laura G, Richard C, Monnet X, Dubée V, Merdji H, Dang J, Preda G, Baudel JL, Desnos C, Zeitouni M, Belaroussi I, Parrot A, Blayau C, Fulgencio JP, Quesnel C, Labbe V, De Chambrun MP, Beloncle F, Merceron S, Fedun Y, Lecomte B, Devaquet J, Puidupin M, Verdière B, Amoura Z, Vuillard C, Xavier J, Bourlier D, David A, Caroline S, David M, Gerald S, Olivier S, Humbert M, Laurent S, Dujardin O, Bouglé A, Ait HN, Salem JE, El-Helali N, Coppere Z, Gibelin A, Taconet C, Djibre M, Maamar A, Colobert E, Fillatre P, Uhel F, Camus C, Moraly J, Dahoumane R, Maury E, Tan BK, Emmanuel V, Pauline M, Laurence P, Philippe P, Zahar JR, Catherine H, Christian P, Karim AB, Mounia H, Laura T, Rasoldier VH, Mager G, Eraldi JP, Gelinotte S, Bougerol F, Dehay J, Rigaud JP, Declercq PL, Michel J, Aissa N, Henard S, Guerci P, Latar I, Levy B, Girerd N, Kimmoun A, Abdallah SB, Nakaa S, Hraiech K, Braiek DB, Adhieb A, M’ghirbi A, Ousji A, Hammouda Z, Abroug F, Sellami W, Hajjej Z, Samoud W, Labbene I, Ferjani M, Medhioub FK, Allela R, Algia NB, Cherif S, Attia D, Herinjatovo A, Francois XL, Bouhouri MA, Slaoui MT, Soufi A, Khaleq K, Hamoudi D, Nsiri A, Harrar R, Maury E, Goursaud S, Gauberti M, Labeyrie PE, Gaberel T, Agin V, Maubert E, Vivien D, Gakuba C, Armel A, Abdou R, Kalouch S, Yaqini K, Chlilek A, Sellami W, Yedder SB, Tonnelier A, Hervé F, Halley G, Frances JL, Moriconi M, Saoli M, Garnero A, Demory D, Arnal JM, Canoville B, Daubin C, Brunet J, Ghezala HB, Snouda S, Ben CI, Kaddour M, Ouanes I, Marzouk M, Haniez F, Jaillet H, Maas H, Andrivet P, Darné C, Viau F, Ghezala HB, Ouanes I, Dangers L, Montlahuc C, Perbet S, Ouanes I, Hamouda Z, Nakee S, Ouanes-Besbes L, Meddeb K, Khedher A, Sma N, Ayachi J, Khelfa M, Fraj N, Lakhal HB, Hammed H, Boukadida R, Hafsa H, Chouchene I, Boussarsar M, Ben BD, Ouanes-Besbes L, Benatti K, Dafir A, Aissaoui W, Elallame W, Haddad W, Cherkab R, Elkettani C, Barrou L, Hamou ZA, Repessé X, Charron C, Aubry A, Paternot A, Maizel J, Slama M, Vieillard-Baron A, Trifi A, Abdellatif S, Fatnassi M, Daly F, Nasri R, Ismail KB, Lakhal SB, Bazalgette F, Daurat A, Roger C, Muller L, Doyen D, Plattier R, Robert A, Hyvernat H, Bernardin G, Jozwiak M, Gimenez J, Mercado P, Depret F, Tilouch N, Mater H, Habiba BSA, Jaoued O, Gharbi R, Hassen MF, Elatrous S, Pasquier P, Vuillemin Q, Schaal JV, Martinez T, Duron S, Trousselard M, Schwartzbrod PE, Baugnon T, Dupic L, Gout CD, De Saint Blanquat L, Séguret S, Le Ficher G, Orliaguet G, Hubert P, Bigé N, Leblanc G, Briand R, Brousse L, Brunet V, Chatelain L, Prat D, Jacobs F, Demars N, Hamzaoui O, Moneger G, Sztrymf B, Duburcq-Gury E, Satre-Buisson L, Duburcq T, Poissy J, Robriquet L, Jourdain M, Sécheresse T, Miquet M, Simond A, Usseglio P, Hamdaoui Y, Boussarsar M, Desailly V, Brun P, Iglesias P, Huet J, Masseran C, Claudon A, Ebeyer C, Truong T, Tesnière A, Mignon A, Gaudry S, Resiere D, Valentino R, Fabre J, Roze B, Ferge JL, Charbatier C, Marie S, Scholsser M, Aitsatou S, Raad M, Cabie A, Mehdaoui H, Cousin C, Rousseau C, Llitjos JF, Alby-Laurent F, Toubiana J, Belaidouni N, Cherruault M, Tamburini J, Bouscary D, Fert S, Delile E, Besnier E, Coquerel D, Nevière R, Richard V, Tamion F, Wei C, Louis H, Margaux S, Eliane A, Sophie O, Kimmoun A, Riad Z, Coroir M, Rémy B, Camille B, Joffre J, Aegerter P, Ilic D, Ginet M, Pignard C, Nguyen P, Mourey G, Samain E, Pili-Floury S, Jouffroy R, Nicolas C, Alvarez JC, Tomasso M, Philippe P, Raphalen JH, Frédéric JB, Vivien B, Pierre C, Baud F, Fredj H, Blel Y, Brahmi N, Ghezala HB, Hanak AS, Malissin I, Poupon J, Risede P, Chevillard L, Megarbane B, Barghouth M, M’rad A, Hmida MB, Thabet H, Liang H, Callebert J, Lagard C, Megarbane B, Habacha S, Chatbri B, Camillerapp C, Labat L, Soichot M, Garçon P, Goury A, Kerdjana L, Voicu S, Deye N, Megarbane B, Armel A, Anas B, Othman M, Moumine S, Kalouch S, Yakini KK, Chlilek A, Hajji A, Louati A, Khaldi A, Borgi A, Ghali N, Bouziri A, Menif K, Ben JN, Armel A, Brochon J, Dumitrescu M, Thévenot S, Saulnier JP, Husseini K, Laland C, Cremniter J, Bousseau A, Castel O, Brémaud-Csizmadia C, Diss M, Portefaix A, Berthiller J, Gillet Y, Aoul NT, Douah A, Addou Z, Youbi H, Moussati M, Belhabiche K, Mir S, Abada S, Amel Z, Aouffen N, Bouzit Z, Grati AH, Dhonneur GF, Boussarsar M, Lau N, Mezhari I, Roucaud N, Le Meur M, Paulet R, Coudray JM, Ghomari WI, Boumlik R, Peigne V, Daban JL, Boutonnet M, Lenoir B, Yassine H, Mohamed CC, Khalid A, Ihssan M, Said E, Said S, Jazia AB, Fatima J, Wafa S, Maha B, Khaoula BA, Sami T, Abdallah Taeib B, Medhioub FK, Rollet-Cohen V, Sachs P, Merchaoui Z, Renolleau S, Oualha M, Eloi M, Jean S, Demoulin M, Valentin C, Guilbert J, Walti H, Carbajal R, Leger PL, Karaca-Altintas Y, Botte A, Labreuche J, Drumez E, Devos P, Bour F, Leclerc F, Ahmed A, khaled M, Louati A, Aida B, Ammar K, Narjess G, Ahmed H, Asma B, Jaballah NB, Leger PL, Pansiot J, Besson V, Palmier B, Baud O, Cauli B, Charriaut-Marlangue C, Mansuy A, Michel F, Le Bel S, Boubnova J, Ughetto F, Ovaert C, Fouilloux V, Paut O, Jacquet-Lagrèze M, Tiebergien N, Hanna N, Evain JN, Baudin F, Courtil-Teyssedre S, Bompard D, Lilot M, Chardonal L, Fellahi JL, Claverie C, Pouessel G, Dorkenoo A, Renaudin JM, Eb M, Deschildre A, Leteurtre S, Yassine H, Kamal B, Adil O, Ouafa A, Mouhamed M, Rachid C, Lahoucine B, Dachraoui F, Nakkaa S, Zaineb H, Mlika D. Proceedings of Réanimation 2017, the French Intensive Care Society International Congress. Ann Intensive Care 2017. [PMCID: PMC5225387 DOI: 10.1186/s13613-016-0223-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Sicard M, Nusinovici S, Hanf M, Muller JB, Guellec I, Ancel PY, Gascoin G, Rozé JC, Flamant C. Fetal and Postnatal Head Circumference Growth: Synergetic Factors for Neurodevelopmental Outcome at 2 Years of Age for Preterm Infants. Neonatology 2017; 112:122-129. [PMID: 28482345 DOI: 10.1159/000464272] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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] [Received: 06/12/2016] [Accepted: 02/20/2017] [Indexed: 11/19/2022]
Abstract
UNLABELLED Preterm infants present higher risk of non-optimal neurodevelopmental outcome. Fetal and postnatal growth, in particular head circumference (HC), is associated with neurodevelopmental outcome. OBJECTIVES We aimed to calculate the relationship between HC at birth, HC delta Z-score (between birth and hospital discharge), and non-optimal neurodevelopmental outcome at 2 years of corrected age in preterm infants. METHODS Surviving infants born ≤34 weeks of gestation were included in the analysis. The relationship between the risk of being non-optimal at 2 years and both HC at birth and HC growth was assessed. The 2 Z-scores were considered first independently and then simultaneously to investigate their effect on the risk of non-optimality using a generalized additive model. RESULTS A total of 4,046 infants with both HC measures at birth and hospital discharge were included. Infants with small HC at birth (Z-score <-2 SD), or presenting suboptimal HC growth (dZ-score <-2 SD), are at higher risk of non-optimal neurodevelopmental outcome at 2 years (respectively OR 1.7 [95% CI 1.4-2] and OR 1.4 [95% CI 1.2-1.8]). Interestingly, patients cumulating small HC Z-score at birth (-2 SD) and presenting catch-down growth (HC dZ-score [-2 SD]) have a significantly increased risk for neurocognitive impairment (OR >2) while adjusting for gestational age, twin status, sex, and socioeconomic information. CONCLUSIONS HC at birth and HC dZ-score between birth and hospital discharge are synergistically associated to neurodevelopmental outcome at 2 years of corrected age, in a population-based prospective cohort of preterm infants born ≤34 weeks of gestation.
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Affiliation(s)
- Mélanie Sicard
- Department of Neonatal Medicine, Nantes University Hospital, Nantes, France
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Guellec I, Lapillonne A, Marret S, Picaud JC, Mitanchez D, Charkaluk ML, Fresson J, Arnaud C, Flamant C, Cambonie G, Kaminski M, Roze JC, Ancel PY. Effect of Intra- and Extrauterine Growth on Long-Term Neurologic Outcomes of Very Preterm Infants. J Pediatr 2016; 175:93-99.e1. [PMID: 27318373 DOI: 10.1016/j.jpeds.2016.05.027] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [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: 01/06/2016] [Revised: 03/14/2016] [Accepted: 05/09/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine whether extrauterine growth is associated with neurologic outcomes and if this association varies by prenatal growth profile. STUDY DESIGN For 1493 preterms from the EPIPAGE (Étude Épidémiologique sur les Petits Âges Gestationnels [Epidemiological Study on Small Gestational Ages]) cohort, appropriate for gestational-age (AGA) was defined by birth weight >-2 SD and small for gestational-age (SGA) by birth weight ≤-2 SD. Extra-uterine growth was defined by weight gain or loss between birth and 6 months by z-score change. Growth following-the-curve (FTC) was defined as weight change -1 to +1 SD, catch-down-growth (CD) as weight loss ≥1 SD, and catch-up-growth (CU) as weight gain ≥1 SD. At 5 years, a complete medical examination (n = 1305) and cognitive evaluation with the Kauffman Assessment Battery for Children (n = 1130) were performed. Behavioral difficulties at 5 years and school performance at 8 years were assessed (n = 1095). RESULTS Overall, 42.5% of preterms were AGA-FTC, 20.2% AGA-CD, 17.1% AGA-CU, 5.6% SGA-FTC, and 14.5% SGA-CU. Outcomes did not differ between CU and FTC preterm AGA infants. Risk of cerebral palsy was greater for AGA-CD compared with AGA-FTC (aOR 2.26 [95% CI 1.37-3.72]). As compared with children with SGA-CU, SGA-FTC children showed no significant increased risk of cognitive deficiency (aOR 1.41[0.94-2.12]) or school difficulties (aOR 1.60 [0.84-3.03]). Compared with AGA-FTC, SGA showed increased risk of cognitive deficiency (SGA-FTC aOR 2.19 [1.25-3.84]) and inattention-hyperactivity (SGA-CU aOR 1.65 [1.05-2.60]). CONCLUSION Deficient postnatal growth was associated with poor neurologic outcome for AGA and SGA preterm infants. CU growth does not add additional benefits. Regardless of type of postnatal growth, SGA infants showed behavioral problems and cognitive deficiency.
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Affiliation(s)
- Isabelle Guellec
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris, France.
| | | | - Stephane Marret
- Rouen University Hospital, Neonatal Medicine, Rouen; Institute of Biomedical Research, University, Inserm Avenir Research Group, IFR 23, Rouen, France
| | - Jean-Charles Picaud
- Department of Neonatology, Human Nutrition Research Center, Hospital E. Herriot, Lyon, France
| | | | - Marie-Laure Charkaluk
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris, France
| | - Jeanne Fresson
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris, France; Clinical Epidemiology and Biostatistics Department, CHRU Nancy, Nancy, France
| | | | - Cyril Flamant
- Department of Neonatology, CHU Nantes, Nantes, France
| | - Gilles Cambonie
- Montpellier University Hospital Center, Neonatal and Pediatric Intensive Care Unit, Montpellier, France
| | - Monique Kaminski
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris, France
| | | | - Pierre-Yves Ancel
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris, France
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Rambaud J, Leger PL, Larroquet M, Amblard A, Lode N, Alix-Seguin L, Demoulin M, Guilbert J, Jean S, Durandy A, Guellec I, Walti H, Carbajal R. Mise en place de la première unité mobile d’assistance circulatoire et respiratoire pédiatrique et néonatale en Île-de-France. Ann Fr Med Urgence 2016. [DOI: 10.1007/s13341-016-0622-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Rambaud J, Guellec I, Léger PL, Renolleau S, Guilbert J. Venoarterial extracorporeal membrane oxygenation support for neonatal and pediatric refractory septic shock. Indian J Crit Care Med 2015; 19:600-5. [PMID: 26628825 PMCID: PMC4637960 DOI: 10.4103/0972-5229.167038] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective: To report our institutional experience of veno-arterial extracorporeal membrane oxygenation (VA ECMO) in children with refractory septic shock. Materials and Methods: We retrospectively reviewed our ECMO database to identify patients who received VA ECMO for septic shock from January 2004 to June 2013 at our Pediatric Intensive Care Unit in Armand-Trousseau Hospital. We included all neonates and children up to the age of 18 years who received VA ECMO for septic shock. For each patient, we collected the pre-ECMO inotrope score, clinical circulatory and ventilatory parameters, infecting organism, ECMO duration and complications, and length of hospital stay. Main Results: The study included 14 neonates and 8 older children (the pediatric population, with a mean age of 30 months, range: 1–113 months). Survival was 64% among newborns and 50% among pediatric patients. Multiorgan failure or severity scores did not show any correlation with mortality (Pediatric Logistic Organ Dysfunction score, P = 0.94; the score for neonatal acute physiology-perinatal extension II, P = 0.34). In the pediatric population, the inotrope score was higher in the survivor group (127.5 vs. 332.5, P = 0.07). Blood samples taken shortly before cannulation showed that pH (P = 0.27), lactate level (P = 0.33), PaO2/FiO2 ratio (P = 0.49), or oxygenation index (P = 0.35) showed no correlation to success or failure of ECMO. Conclusion: ECMO can be safely used to resuscitate and support children with refractory septic shock. We recommend that patients with oliguria whose lactate level has not decreased within 6 h of starting maximum drug therapy be transferred to an ECMO referral center.
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Affiliation(s)
- Jerome Rambaud
- Pediatric and Neonatal Intensive Care Unit, Armand-Trousseau Hospital, Paris, France
| | - Isabelle Guellec
- Pediatric and Neonatal Intensive Care Unit, Armand-Trousseau Hospital, Paris, France
| | - Pierre-Louis Léger
- Pediatric and Neonatal Intensive Care Unit, Armand-Trousseau Hospital, Paris, France
| | - Sylvain Renolleau
- Pediatric and Neonatal Intensive Care Unit, Armand-Trousseau Hospital, Paris, France
| | - Julia Guilbert
- Pediatric and Neonatal Intensive Care Unit, Armand-Trousseau Hospital, Paris, France
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Rambaud J, Léger PL, Larroquet M, Amblard A, Lodé N, Guilbert J, Jean S, Guellec I, Casadevall I, Kessous K, Walti H, Carbajal R. Transportation of children on extracorporeal membrane oxygenation: one-year experience of the first neonatal and paediatric mobile ECMO team in the north of France. Intensive Care Med 2015; 42:940-941. [PMID: 26626061 DOI: 10.1007/s00134-015-4144-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2015] [Indexed: 11/30/2022]
Affiliation(s)
- J Rambaud
- Paediatric Intensive Care Unit, Armand-Trousseau Hospital, APHP, UPMC University, 26 Avenue du Dr Arnold Netter, 75012, Paris, France.
| | - P L Léger
- Paediatric Intensive Care Unit, Armand-Trousseau Hospital, APHP, UPMC University, 26 Avenue du Dr Arnold Netter, 75012, Paris, France
| | - M Larroquet
- Paediatric Surgery, Armand-Trousseau Hospital, APHP, UPMC University, Paris, France
| | - A Amblard
- Paediatric Intensive Care Unit, Armand-Trousseau Hospital, APHP, UPMC University, 26 Avenue du Dr Arnold Netter, 75012, Paris, France
| | - N Lodé
- Emergency Transport Unit, Robert Debré Hospital, Paris, France
| | - J Guilbert
- Paediatric Intensive Care Unit, Armand-Trousseau Hospital, APHP, UPMC University, 26 Avenue du Dr Arnold Netter, 75012, Paris, France
| | - S Jean
- Paediatric Intensive Care Unit, Armand-Trousseau Hospital, APHP, UPMC University, 26 Avenue du Dr Arnold Netter, 75012, Paris, France
| | - I Guellec
- Paediatric Intensive Care Unit, Armand-Trousseau Hospital, APHP, UPMC University, 26 Avenue du Dr Arnold Netter, 75012, Paris, France
| | - I Casadevall
- Emergency Transport Unit, Robert Debré Hospital, Paris, France
| | - K Kessous
- Emergency Transport Unit, Robert Debré Hospital, Paris, France
| | - H Walti
- Paediatric Intensive Care Unit, Armand-Trousseau Hospital, APHP, UPMC University, 26 Avenue du Dr Arnold Netter, 75012, Paris, France
| | - R Carbajal
- Paediatric Intensive Care Unit, Armand-Trousseau Hospital, APHP, UPMC University, 26 Avenue du Dr Arnold Netter, 75012, Paris, France
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Guellec I, Marret S, Baud O, Cambonie G, Lapillonne A, Roze JC, Fresson J, Flamant C, Charkaluk ML, Arnaud C, Ancel PY. Intrauterine Growth Restriction, Head Size at Birth, and Outcome in Very Preterm Infants. J Pediatr 2015; 167:975-81.e2. [PMID: 26384436 DOI: 10.1016/j.jpeds.2015.08.025] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [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: 05/22/2015] [Revised: 07/10/2015] [Accepted: 08/06/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To determine whether small head circumference (HC) or birth weight (BW) or both are associated with neonatal and long-term neurologic outcome in very preterm infants. STUDY DESIGN All 2442 live births from the 1997 Epipage study between 26 and 32 weeks of gestational age in 9 regions of France were analyzed. A total of 1395 were tested at age 5 years for cognitive performance and 1315 with school performance reports at age 8 years. Symmetric growth restriction (SGR) was defined by HC and BW <20th percentile and in the same percentile range, and asymmetric growth restriction by at least 1 of HC and BW <20th percentile and the other in a higher decile range. There were 2 forms of asymmetric growth restriction: head growth restriction (HGR) and weight growth restriction (WGR). Appropriate for gestational age was defined by both BW and HC >20th percentile. RESULTS Compared with appropriate for gestational age, SGR was significantly associated with neonatal mortality (aOR 2.99, 95% CI 1.78-5.03), moderate and severe cognitive deficiency (aOR 1.65, 95% CI 1.01-2.71 and aOR 2.61, 95% CI 1.46-4.68, respectively), and poor school performance (aOR 1.79; 95% CI 1.13-2.83). HGR was significantly associated with severe cognitive deficiency (aOR 2.07, 95% CI 1.15-3.74). WGR was not significantly associated with cognitive or school performance despite higher rates of neonatal morbidity. CONCLUSIONS SGR in preterm infants was associated with neonatal mortality and impaired cognitive and school performance. The outcome of asymmetric growth restriction differed according to HC. HGR was associated with impaired cognitive function; WGR was not.
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Affiliation(s)
- Isabelle Guellec
- Institut National de la Santé et de la Recherche Médicale (INSERM), UMR 1153, Equipe de recherche en Epidémiologie Obstétricale, Périnatale et Pédiatrique, Paris, France; Assistance Publique - Hôpitaux de Paris, Department of Neonatology and Intensive Care, A. Trousseau Hospital, Paris, France.
| | - Stephane Marret
- Rouen University Hospital, Neonatal Medicine, Rouen, France; Institute of Biomedical Research, University, Inserm Avenir Research Group, IFR 23, Rouen, France
| | - Olivier Baud
- INSERM UMR 1141, Paris, France; Assistance Publique - Hôpitaux de Paris, Department of Neonatology, R. Debré Hospital, Paris, France
| | - Gilles Cambonie
- Montpellier University Hospital Center, Neonatal and Pediatric Intensive Care Unit, Montpellier, France
| | - Alexandre Lapillonne
- Assistance Publique - Hôpitaux de Paris, Department of Neonatology, Necker Hospital, Paris, France
| | - Jean-Christophe Roze
- Nantes University, Department of Neonatology, Maternite Regionale, Clinical Epidemiology and Biostatistics Department France, Nantes University, INSERM CIC004, Nantes, France
| | - Jeanne Fresson
- Institut National de la Santé et de la Recherche Médicale (INSERM), UMR 1153, Equipe de recherche en Epidémiologie Obstétricale, Périnatale et Pédiatrique, Paris, France; Clinical Epidemiology and Biostatistics Department, CHRU Nancy, France
| | - Cyril Flamant
- Nantes University, Department of Neonatology, Maternite Regionale, Clinical Epidemiology and Biostatistics Department France, Nantes University, INSERM CIC004, Nantes, France
| | - Marie-Laure Charkaluk
- Institut National de la Santé et de la Recherche Médicale (INSERM), UMR 1153, Equipe de recherche en Epidémiologie Obstétricale, Périnatale et Pédiatrique, Paris, France
| | - Catherine Arnaud
- Clinical Epidemiology and Biostatistics Department, CHRU Nancy, France
| | - Pierre-Yves Ancel
- Institut National de la Santé et de la Recherche Médicale (INSERM), UMR 1153, Equipe de recherche en Epidémiologie Obstétricale, Périnatale et Pédiatrique, Paris, France; Centre de Recherche Epidémiologie et Statistique Sorbonne Paris Cité DHU Risques et grossesse Université Paris Descartes, Paris, France
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Rambaud J, Guellec I, Guilbert J, Léger PL, Renolleau S. Calcium homeostasis disorder during and after neonatal extracorporeal membrane oxygenation. Indian J Crit Care Med 2015; 19:513-7. [PMID: 26430336 PMCID: PMC4578194 DOI: 10.4103/0972-5229.164797] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background and Aims: Extracorporeal membrane oxygenation (ECMO) is used during pediatric resuscitation in case of refractory hypoxemia or septic shock under maximum therapy. Previous studies describe calcium homeostasis dysregulation. The aim of this study was to confirmed of calcium homeostasis dysregulation in neonates under ECMO and supposed news explanation. Subjects and Methods: From November 2012 to July 2013, we performed a prospective single center observational study. Eleven neonatal patients were included. Blood was obtained before and during ECMO (day 7, 14 and 21) for parathyroid hormone (PTH), protein adjusted serum calcium, ionized calcium, magnesium, and calcitriol levels. All surviving patients underwent a consultation up to 6 months after ECMO weaning. Results: During ECMO PTH was inadequately high with normal serum calcium on day 7 (PTH: 73.54 ± 40 ng/l; calcemia: 2.33 ± 0.21 mmol/l), day 14 (PTH: 57.63 ± 29.57 ng/l; calcemia: 2.44 ± 0.43 mmol/l) and day 21 (PTH: 54.93 ± 8.43 ng/l; calcemia: 2.13 ± 0.09 mmol/l). The absence of correlation between serum calcium and PTH levels seem to confirm the dysregulation of PTH - serum calcium metabolism during ECMO. Six months after ECMO weaning, we noticed hypercalcemia with normal PTH. Conclusions: We confirmed the existence of severe disturbances of calcium homeostasis in neonates on ECMO and supposed the possible damage of calcium regulation. We did not succeed in finding clear explanations of these disturbances.
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Affiliation(s)
- Jerome Rambaud
- Paediatric Intensive Care Unit, Armand-Trousseau Hospital APHP (Paris Hospitals Public Assistance), UPMC (Pierre and Marie Curie University, Paris VI), Paris, France
| | - Isabelle Guellec
- Paediatric Intensive Care Unit, Armand-Trousseau Hospital APHP (Paris Hospitals Public Assistance), UPMC (Pierre and Marie Curie University, Paris VI), Paris, France
| | - Julia Guilbert
- Paediatric Intensive Care Unit, Armand-Trousseau Hospital APHP (Paris Hospitals Public Assistance), UPMC (Pierre and Marie Curie University, Paris VI), Paris, France
| | - Pierre-Louis Léger
- Paediatric Intensive Care Unit, Armand-Trousseau Hospital APHP (Paris Hospitals Public Assistance), UPMC (Pierre and Marie Curie University, Paris VI), Paris, France
| | - Sylvain Renolleau
- Paediatric Intensive Care Unit, Armand-Trousseau Hospital APHP (Paris Hospitals Public Assistance), UPMC (Pierre and Marie Curie University, Paris VI), Paris, France
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Pop Jora D, de Suremain N, Arnaud C, Gréteau S, Guellec I, Renolleau S, Carbajal R. Convulsions hyponatrémiques et bronchiolite à VRS : à propos de 3 cas. Arch Pediatr 2014; 21:1359-63. [DOI: 10.1016/j.arcped.2014.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 02/05/2014] [Accepted: 09/23/2014] [Indexed: 10/24/2022]
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Strullu M, Caye A, Lachenaud J, Cassinat B, Gazal S, Fenneteau O, Pouvreau N, Pereira S, Baumann C, Contet A, Sirvent N, Méchinaud F, Guellec I, Adjaoud D, Paillard C, Alberti C, Zenker M, Chomienne C, Bertrand Y, Baruchel A, Verloes A, Cavé H. Juvenile myelomonocytic leukaemia and Noonan syndrome. J Med Genet 2014; 51:689-97. [PMID: 25097206 DOI: 10.1136/jmedgenet-2014-102611] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Infants with Noonan syndrome (NS) are predisposed to developing juvenile myelomonocytic leukaemia (JMML) or JMML-like myeloproliferative disorders (MPD). Whereas sporadic JMML is known to be aggressive, JMML occurring in patients with NS is often considered as benign and transitory. However, little information is available regarding the occurrence and characteristics of JMML in NS. METHODS AND RESULTS Within a large prospective cohort of 641 patients with a germline PTPN11 mutation, we identified MPD features in 36 (5.6%) patients, including 20 patients (3%) who fully met the consensus diagnostic criteria for JMML. Sixty percent of the latter (12/20) had severe neonatal manifestations, and 10/20 died in the first month of life. Almost all (11/12) patients with severe neonatal JMML were males. Two females who survived MPD/JMML subsequently developed another malignancy during childhood. Although the risk of developing MPD/JMML could not be fully predicted by the underlying PTPN11 mutation, some germline PTPN11 mutations were preferentially associated with myeloproliferation: 10/48 patients with NS (20.8%) with a mutation in codon Asp61 developed MPD/JMML in infancy. Patients with a p.Thr73Ile mutation also had more chances of developing MPD/JMML but with a milder clinical course. SNP array and whole exome sequencing in paired tumoral and constitutional samples identified no second acquired somatic mutation to explain the occurrence of myeloproliferation. CONCLUSIONS JMML represents the first cause of death in PTPN11-associated NS. Few patients have been reported so far, suggesting that JMML may sometimes be overlooked due to early death, comorbidities or lack of confirmatory tests.
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Affiliation(s)
- Marion Strullu
- INSERM UMR_S1131, Institut Universitaire d'Hématologie, Université Paris Diderot, Paris-Sorbonne-Cité, Paris, France Département de Génétique, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Robert Debré, Paris, France
| | - Aurélie Caye
- INSERM UMR_S1131, Institut Universitaire d'Hématologie, Université Paris Diderot, Paris-Sorbonne-Cité, Paris, France Département de Génétique, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Robert Debré, Paris, France
| | - Julie Lachenaud
- INSERM UMR_S1131, Institut Universitaire d'Hématologie, Université Paris Diderot, Paris-Sorbonne-Cité, Paris, France Département de Génétique, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Robert Debré, Paris, France
| | - Bruno Cassinat
- INSERM UMR_S1131, Institut Universitaire d'Hématologie, Université Paris Diderot, Paris-Sorbonne-Cité, Paris, France Service de Biologie Cellulaire, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Saint Louis, Paris, France
| | - Steven Gazal
- INSERM UMR_1137, IAME, Plateforme de Génétique constitutionnelle-Nord (PfGC-Nord), Université Paris Diderot, Paris, France
| | - Odile Fenneteau
- Service d'Hématologie Biologique, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Robert Debré, Paris, France
| | - Nathalie Pouvreau
- Département de Génétique, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Robert Debré, Paris, France
| | - Sabrina Pereira
- Département de Génétique, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Robert Debré, Paris, France
| | - Clarisse Baumann
- Département de Génétique, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Robert Debré, Paris, France
| | - Audrey Contet
- Service d'Onco-Hématologie pédiatrique, Hôpital d'Enfants de Brabois, Vandoeuvre lès Nancy, France
| | - Nicolas Sirvent
- Service d'Onco-Hématologie pédiatrique, CHU de Nice, Nice, France
| | | | - Isabelle Guellec
- Réanimation néonatale pédiatrique, Paris Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Trousseau, Paris, France
| | - Dalila Adjaoud
- Service d'Onco-Hématologie pédiatrique, CHU de Grenoble, Grenoble, France
| | | | - Corinne Alberti
- Unité d'Epidémiolgie Clinique, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Robert Debré, Paris, France INSERM, U1123 et CIC-EC 1426, ECEVE, Université Paris Diderot, Paris-Sorbonne-Cité, Paris, France
| | - Martin Zenker
- Institute of Human Genetics, University Hospital Magdeburg, Magdeburg, Germany
| | - Christine Chomienne
- INSERM UMR_S1131, Institut Universitaire d'Hématologie, Université Paris Diderot, Paris-Sorbonne-Cité, Paris, France Service de Biologie Cellulaire, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Saint Louis, Paris, France
| | - Yves Bertrand
- Département d'Immunologie et Hématologie Pédiatrique, Institut d'Hémato-Oncologie Pédiatrique (IHOP), Lyon, France
| | - André Baruchel
- Service d'Hématologie pédiatrique, Assistance Publique des Hôpitaux de Paris AP-HP, Hôpital Robert Debré, Paris, France
| | - Alain Verloes
- Département de Génétique, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Robert Debré, Paris, France INSERM UMR_S1141, Hôpital Robert Debré, Université Paris Diderot, Paris-Sorbonne-Cité, Paris, France
| | - Hélène Cavé
- INSERM UMR_S1131, Institut Universitaire d'Hématologie, Université Paris Diderot, Paris-Sorbonne-Cité, Paris, France Département de Génétique, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Robert Debré, Paris, France
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Tatencloux S, Renolleau S, Guellec I. SFN P-24 - Encéphalopathie anoxo-ischémique du nouveau-né à terme, hypothermie et troubles métaboliques. Arch Pediatr 2014. [DOI: 10.1016/s0929-693x(14)71897-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Meau-Petit V, Thouvenin G, Guillemot-Lambert N, Champion V, Tillous-Borde I, Flamein F, de Saint Blanquat L, Essouri S, Guilbert J, Nathan N, Guellec I, Kout S, Epaud R, Lévy M. [Bronchopulmonary dysplasia-associated pulmonary arterial hypertension of very preterm infants]. Arch Pediatr 2012; 20:44-53. [PMID: 23266170 DOI: 10.1016/j.arcped.2012.10.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 09/05/2012] [Accepted: 10/26/2012] [Indexed: 11/17/2022]
Abstract
Bronchopulmonary dysplasia (BPD) of very preterm infants is a multifactorial chronic lung disease and its incidence has not decreased despite improvements in neonatal intensive care, including lung protective strategies. Pulmonary hypertension (PH) can complicate the course of BPD. Mortality in infants with BPD-associated PH is thought to be very high, but its incidence is unknown and a standard diagnostic and therapeutic strategy has not been well defined. In this article, we will first describe the current knowledge on the BPD-associated PH and the current treatments available for this pathology. We will then present the HTP-DBP Study, carried out in Paris (France) starting in 2012. The diagnosis of PH is suspected on echocardiographic criteria, but cardiac catheterization is considered the gold standard for diagnosis and evaluation of the severity of PH. Moreover, pulmonary vasoreactivity testing is used to guide the management of patients with PH. The pathogenesis of BPD-associated PH is poorly understood and even less is known about appropriate therapy. Today, optimizing ventilation and reducing the pulmonary vascular tone with specific pulmonary vasodilatator drugs are the main goals in treating HTP-associated DBP. Animal studies and a few clinical studies suggest that medications targeting the nitric oxide (NO) signaling pathway (NO inhalation, oral sildenafil citrate) could be effective treatments for BPD-associated PH, but they have not been approved for this indication. The HTP-DBP study is a French multicenter prospective observational study. The objective is to evaluate the frequency of BPD-associated PH, to describe its physiopathology, its severity (morbidity and mortality), and the effectiveness of current treatments.
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Affiliation(s)
- V Meau-Petit
- Service de maternité, réanimation, soins intensifs et pédiatrie néonatales, hôpital Necker-Enfants-Malades, AP-HP, Paris, France.
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Abstract
OBJECTIVE We compared two polymethylpentene oxygenators being used in our unit: the Maquet Quadrox-iD paediatric and the Medos Hilite 800LT. STUDY DESIGN A mono-centric, prospective pilot study was conducted on ten consecutive newborn patients who had been admitted to our hospital service for extracorporeal circulation (EC) treatment. We examined the rate of oxygen transfer, the CO2 removal capacity and the average sweep gas flow required to produce this result. We also assessed the disturbances of haemostasis, the need for labile blood products and the membrane oxygenator lifetime and cost of use. CONCLUSIONS According to our study, it seems to us that Medos Hilite 800LT membrane oxygenators demonstrate greater oxygen transfer and CO2 removal capacity than Maquet Quadrox-iD paediatric membrane oxygenators, at a similar cost. These results lead us to conclude that it is reasonable to continue using Medos Hilite 800LT membrane oxygenators. A broader comparison study would be necessary in order to support these initial results.
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Affiliation(s)
- J Rambaud
- Paediatric Intensive Care Unit, Armand-Trousseau Children's Hospital APHP (Paris Hospitals Public Assistance) UPMC (Pierre and Marie Curie University, Paris VI) Paris, France
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Guellec I, Lapillonne A, Renolleau S, Charlaluk ML, Roze JC, Marret S, Vieux R, Monique K, Ancel PY. Neurologic outcomes at school age in very preterm infants born with severe or mild growth restriction. Pediatrics 2011; 127:e883-91. [PMID: 21382951 DOI: 10.1542/peds.2010-2442] [Citation(s) in RCA: 134] [Impact Index Per Article: 10.3] [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
OBJECTIVE To determine whether mild and severe growth restriction at birth among preterm infants is associated with neonatal mortality and cerebral palsy and cognitive performance at 5 years of age and school performance at 8 years of age. METHODS All 2846 live births between 24 and 32 weeks' gestation from 9 regions in France in 1997 were included in a prospective observational study (the EPIPAGE [Étude Epidémiologique sur les Petits Ages Gestationnels] study) and followed until 8 years of age. Infants were classified as "small-for-gestational-age" (SGA) if their birth weight for gestational age was at the <10th centile, "mildly-small-for-gestational-age" (M-SGA) if birth weight was at the ≥ 10th centile and <20th centile, and "appropriate-for-gestational-age" (AGA) if birth weight was at the ≥ 20th centile. RESULTS Among the children born between 24 and 28 weeks' gestation, the mortality rate increased from 30% in the AGA group to 42% in the M-SGA group and to 62% in the SGA group (P < .01). Birth weight was not significantly associated with any cognitive, behavioral, or motor outcomes at the age of 5 or any school performance outcomes at 8 years. For the children born between 29 and 32 weeks' gestation, SGA children had a higher risk for mortality (adjusted odds ratio [aOR]: 2.79 [95% confidence interval (CI): 1.50-5.20]), minor cognitive difficulties (aOR: 1.73 [95% CI: 1.12-2.69]), inattention-hyperactivity symptoms (aOR: 1.78 [95% CI: 1.10-2.89]), and school difficulties (aOR: 1.74 [1.07-2.82]) compared with AGA children. Being born M-SGA was associated with an increased risk for minor cognitive difficulties (aOR: 1.87 [95% CI: 1.24-2.82]) and behavioral difficulties (aOR: 1.66 [95% CI: 1.04-2.62]). CONCLUSIONS In preterm children, growth restriction was associated with mortality, cognitive and behavioral outcomes, as well as school difficulties.
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Affiliation(s)
- Isabelle Guellec
- INSERM, UMR 953, Epidemiological Research in Perinatal Health and Women's and Children Health, Bâtiment de recherche, Hôpital Tenon, Paris, France.
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Guellec I, Nolent P, Flamant C, Léger P, Guilbert J, Hallalel F, Chevalier JY, Renolleau S. SFP-46 – Réanimation – Utilisation de la méthadone pour faciliter l’arrêt du fentanyl et limiter le syndrome de sevrage en réanimation pédiatrique. Arch Pediatr 2008. [DOI: 10.1016/s0929-693x(08)72113-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Nectoux J, Bahi-Buisson N, Guellec I, Coste J, De Roux N, Rosas H, Tardieu M, Chelly J, Bienvenu T. The p.Val66Met polymorphism in the BDNF gene protects against early seizures in Rett syndrome. Neurology 2008; 70:2145-51. [PMID: 18434641 DOI: 10.1212/01.wnl.0000304086.75913.b2] [Citation(s) in RCA: 42] [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: 11/15/2022] Open
Abstract
OBJECTIVE X chromosome inactivation and the MECP2 genotype do not provide the full explanations for the clinical differences between patients with Rett syndrome (RTT), suggesting the involvement of other factors. One MeCP2 target is the brain-derived neurotrophic factor (BDNF) gene. We investigated, according to the MECP2 genotype, the role of the BDNF functional polymorphism (Val66Met) on the severity of RTT. METHODS This polymorphism in BDNF was analyzed by PCR and dHPLC in 81 patients with RTT. We studied the association between the MECP2 and BDNF genotypes and the clinical features in each patient. RESULTS We found that some RTT features can be correlated with MECP2 genotypes. Missense mutations are associated with a more severe epileptic phenotype (early onset and drug resistance) than other mutations. Non-sense and late truncating mutations lead to a less severe phenotype regarding walking. The distribution of the Val66Met polymorphism was not significantly different between the different groups in regard to the severity of all tested symptoms. However, girls with RTT bearing the Val66Val genotype tend to present earlier seizures than girls with RTT bearing the Met66 allele. No girls with RTT with the Met66 allele presented early seizures. CONCLUSIONS Early onset of seizures is linked to the combined MECP2 and BDNF genotypes. The BDNF Met66 allele may protect against seizures, whereas missense mutations in the MBD of MECP2 are more frequently associated with early seizures.
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Affiliation(s)
- J Nectoux
- Laboratoire de Biochimie et Genetique Moleculaire, Hopital Cochin, Paris, France
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Bahi-Buisson N, Nadia BB, Guellec I, Isabelle G, Nabbout R, Rima N, Guet A, Agnès G, Nguyen G, Gérard N, Dulac O, Olivier D, Chiron C, Catherine C. Parental view of epilepsy in Rett Syndrome. Brain Dev 2008; 30:126-30. [PMID: 17707604 DOI: 10.1016/j.braindev.2007.07.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [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] [Received: 12/03/2006] [Revised: 06/06/2007] [Accepted: 07/10/2007] [Indexed: 11/22/2022]
Abstract
UNLABELLED Few instruments exist to measure the impact of epilepsy on the quality of life in Rett Syndrome (RS). METHODS We attended to describe seizures characteristics, parental opinion and quality of life related in RS by using a newly developed self administered questionnaire, postal sent to parents of French Association for Rett Syndrome (AFSR). RESULTS Two-hundred completed questionnaires were returned. Mean age of patients was 14.8+/-8.1 years [3-42]. Parents reported that 70% of children had epileptic and non-epileptic seizures and mean age at first seizures was 7.3+/-5.1 years [1-24]. No statistical difference was found between the ages of first seizures, diagnosis of epilepsy and introduction of treatment. Seizures had a negative impact on child and family's life (68% of cases), strongly correlated to the existence of generalized, prolonged, cyanotic and drug-resistant seizures, on the child's level of alertness and progress in communication skills and psycho-social consequences such as fear of seizures, and difficulties to find home care aids. CONCLUSIONS We identified major concerns of parents with RS that determine the impact of seizures on children and their family's quality of life. Our results suggest that in order to improve seizures management in RS, better information should reduce fear about seizures and should improve the quality of life of RS.
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Affiliation(s)
- Nadia Bahi-Buisson
- Service de Neuropédiatrie et Maladies, Assistance Publique-Hôpitaux de Paris, Métaboliques Hôpital Necker Enfants Malades, Paris, France.
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