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Delettre N, Billion E, Guyonnet C, Jarreau PH, Patkaï J, Tazi A. Outbreak of group B Streptococcus in a neonatal care unit confirmed by whole-genome sequencing. Acta Paediatr 2024; 113:947-954. [PMID: 38183311 DOI: 10.1111/apa.17095] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/21/2023] [Accepted: 12/27/2023] [Indexed: 01/08/2024]
Abstract
AIM Clusters of group B Streptococcus (GBS) infections in neonatal intensive care units (NICU) are poorly documented. We aimed to assess GBS cross-transmission during an outbreak of GBS sepsis. METHODS The study was carried out between October and November 2021 in a French University Hospital. Neonatal intensive care unit (NICU) patients with GBS sepsis were included. Clinical data were retrieved from electronic patient records. Group B Streptococcus isolates were characterized at the molecular level using capsular genotyping and whole-genome sequencing (WGS). RESULTS The outbreak of GBS sepsis affected three very preterm neonates with a gestational age of less than 26 weeks, including one recurrent male index case aged 26 days, and two female secondary cases aged 5 and 17 days. The microbiological investigation identified a GBS isolate of capsular type III and Sequence Type 17 as responsible for the four infectious episodes. Whole-genome sequencing confirmed the identity between the isolates. The outbreak and the results of the microbiological investigations led to an immediate reinforcement of hygiene measures. CONCLUSION Clustered cases of GBS infections in NICU and horizontal transmission of the hypervirulent GBS Sequence Type 17 are likely underestimated. Prospective investigation of all nosocomial cases using WGS should contribute to improving vigilance regarding GBS cross-transmission and infection prevention.
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Affiliation(s)
- Nicolas Delettre
- Université Paris Cité, CNRS, INSERM, Institut Cochin, Paris, France
| | - Elodie Billion
- Assistance Publique - Hôpitaux de Paris Centre Université Paris Cité, Service de Médecine et Réanimation néonatales de Port-Royal, Paris, France
| | - Cécile Guyonnet
- Université Paris Cité, CNRS, INSERM, Institut Cochin, Paris, France
- Assistance Publique - Hôpitaux de Paris Centre Université Paris Cité, Service de Bactériologie, Centre National de Référence des Streptocoques, Paris, France
- Fédération Hospitalo-Universtaire Préma (Fighting Prematurity), Paris, France
| | - Pierre-Henri Jarreau
- Assistance Publique - Hôpitaux de Paris Centre Université Paris Cité, Service de Médecine et Réanimation néonatales de Port-Royal, Paris, France
- Fédération Hospitalo-Universtaire Préma (Fighting Prematurity), Paris, France
| | - Juliana Patkaï
- Assistance Publique - Hôpitaux de Paris Centre Université Paris Cité, Service de Médecine et Réanimation néonatales de Port-Royal, Paris, France
- Fédération Hospitalo-Universtaire Préma (Fighting Prematurity), Paris, France
| | - Asmaa Tazi
- Université Paris Cité, CNRS, INSERM, Institut Cochin, Paris, France
- Assistance Publique - Hôpitaux de Paris Centre Université Paris Cité, Service de Bactériologie, Centre National de Référence des Streptocoques, Paris, France
- Fédération Hospitalo-Universtaire Préma (Fighting Prematurity), Paris, France
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Mazuel M, Moulier V, Bourrel AS, Guillier C, Tazi A, Jarreau PH, Chollat C. Systematic culture of central catheters and infections related to catheters in a neonatal intensive care unit: an observational study. Sci Rep 2024; 14:8647. [PMID: 38622221 PMCID: PMC11018835 DOI: 10.1038/s41598-024-59371-2] [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] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/09/2024] [Indexed: 04/17/2024] Open
Abstract
Systematic culture of the tip of central lines is performed in many neonatal intensive care units (NICUs) to guide any subsequent antibiotic therapy. The clinical relevance of this procedure is debated, given the significant bacterial contamination during its removal. We aimed to describe infections related to catheters and assess the usefulness of central catheter systematic cultures for probabilistic antibiotic therapy in cases of suspicion of catheter-related infections in a NICU. A retrospective study in a NICU included all newborn patients hospitalized with a central catheter, between January 2018, and June 2019. The main outcome measures were bacterial catheter colonization, catheter-related infection rate, and simulation-based approach to antibiotic prescription. Three hundred and seventy-five newborns, with 634 central catheters were included. There were 273 (43%) catheters that were colonized by at least one microorganism. There were 183 cases of suspected sepsis, with 31 infections definitively related to the catheter. In our simulation antibiotic prescription approach, there was no significant difference in terms of the efficacy toward the microorganism(s) involved between the probabilistic antibiotic therapies proposed by the experts and those ultimately prescribed. Performing a catheter culture only if catheter-related infection is suspected could be an alternative to routine screening.
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Affiliation(s)
- Marie Mazuel
- Neonatal Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Robert Debré Children's Hospital, Paris, France
| | - Virginie Moulier
- University Department of Psychiatry, Centre d'Excellence Thérapeutique, Institut de Psychiatrie, Centre hospitalier du Rouvray, Sotteville-lès-Rouen, France
- Unité de Recherche Clinique, Etablissement Publique de Santé de Ville Evrard, 93332, Neuilly-sur-Marne, France
| | - Anne-Sophie Bourrel
- Department of Bacteriology, University Paris Cité, Assistance Publique-Hôpitaux de Paris, Cochin University Hospital, 75014, Paris, France
| | - Cyril Guillier
- Paediatric Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Armand Trousseau University Hospital, Sorbonne Université, Paris, France
| | - Asmaa Tazi
- Department of Bacteriology, University Paris Cité, Assistance Publique-Hôpitaux de Paris, Cochin University Hospital, 75014, Paris, France
| | - Pierre-Henri Jarreau
- Service de Médecine et Réanimation Néonatales de Port-Royal, Hôpital Cochin, APHP centre - Université Paris Cité, Paris, France
| | - Clément Chollat
- Department of Neonatal Paediatrics, APHP, Service de Néonatologie, Sorbonne Université, Hôpital Armand Trousseau, 26 Av. du Dr Arnold Netter, 75012, Paris, France.
- Université Paris Cité, INSERM, NeuroDiderot, 75019, Paris, 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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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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Tréluyer L, Zana-Taieb E, Jarreau PH, Benhammou V, Kuhn P, Letouzey M, Marchand-Martin L, Onland W, Pierrat V, Saade L, Ancel PY, Torchin H. Doxapram for apnoea of prematurity and neurodevelopmental outcomes at age 5-6 years. Arch Dis Child Fetal Neonatal Ed 2024:fetalneonatal-2023-326170. [PMID: 38228381 DOI: 10.1136/archdischild-2023-326170] [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: 08/03/2023] [Accepted: 12/15/2023] [Indexed: 01/18/2024]
Abstract
OBJECTIVE To assess the long-term neurodevelopmental impact of doxapram for treating apnoea of prematurity. DESIGN Secondary analysis of the French national cohort study EPIPAGE-2. Recruitment took place in 2011. A standardised neurodevelopmental assessment was performed at age 5-6 years. A 2:1 propensity score matching was used to control for the non-randomised assignment of doxapram treatment. SETTING Population-based cohort study. PATIENTS All children born before 32 weeks' gestation alive at age 5-6 years. INTERVENTIONS Blind and standardised assessment by trained neuropsychologists and paediatricians at age 5-6 years. MAIN OUTCOME MEASURES Neurodevelopmental outcomes at age 5-6 years assessed by trained paediatricians and neuropsychologists: cerebral palsy, developmental coordination disorders, IQ and behavioural difficulties. A composite criterion for overall neurodevelopmental disabilities was built. RESULTS The population consisted of 2950 children; 275 (8.6%) received doxapram. Median (IQR) gestational age was 29.4 (27.6-30.9) weeks. At age 5-6 years, complete neurodevelopmental assessment was available for 60.3% (1780 of 2950) of children and partial assessment for 10.6% (314 of 2950). In the initial sample, children receiving doxapram had evidence of greater clinical severity than those not treated. Doxapram treatment was associated with overall neurodevelopmental disabilities of any severity (OR 1.43, 95% CI 1.07 to 1.92, p=0.02). Eight hundred and twenty-one children were included in the 2:1 matched sample. In this sample, perinatal characteristics of both groups were similar and doxapram treatment was not associated with overall neurodevelopmental disabilities (OR 1.09, 95% CI 0.76 to 1.57, p=0.63). CONCLUSIONS In children born before 32 weeks' gestation, doxapram treatment for apnoea of prematurity was not associated with neurodevelopmental disabilities.
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Affiliation(s)
- Ludovic Tréluyer
- Sorbonne Paris-Nord, Inserm, INRAE, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Université Paris Cité, Paris, France
- Department of Neonatal Medicine of Port-Royal, Cochin Hospital, FHU PREMA, AP-HP Centre-Université Paris Cité, Paris, France
| | - Elodie Zana-Taieb
- Department of Neonatal Medicine of Port-Royal, Cochin Hospital, FHU PREMA, AP-HP Centre-Université Paris Cité, Paris, France
- Université Paris Cité, Inserm U955, Paris, France
| | - Pierre-Henri Jarreau
- Sorbonne Paris-Nord, Inserm, INRAE, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Université Paris Cité, Paris, France
- Department of Neonatal Medicine of Port-Royal, Cochin Hospital, FHU PREMA, AP-HP Centre-Université Paris Cité, Paris, France
| | - Valérie Benhammou
- Sorbonne Paris-Nord, Inserm, INRAE, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Université Paris Cité, Paris, France
| | - Pierre Kuhn
- Department of Neonatal Medicine, University Hospital of Strasbourg, Strasbourg, France
| | - Mathilde Letouzey
- Department of Neonatal Medicine, Poissy Saint-Germain Hospital, Poissy, France
| | - Laetitia Marchand-Martin
- Sorbonne Paris-Nord, Inserm, INRAE, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Université Paris Cité, Paris, France
| | - Wes Onland
- Department of Neonatal Medicine, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Véronique Pierrat
- Sorbonne Paris-Nord, Inserm, INRAE, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Université Paris Cité, Paris, France
- Department of Neonatology, CHI Créteil, Créteil, France
| | - Lauren Saade
- Department of Neonatal Medicine of Port-Royal, Cochin Hospital, FHU PREMA, AP-HP Centre-Université Paris Cité, Paris, France
| | - Pierre Yves Ancel
- Sorbonne Paris-Nord, Inserm, INRAE, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Université Paris Cité, Paris, France
- Clinical Research Unit, Center for Clinical Investigation P1419, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Héloïse Torchin
- Sorbonne Paris-Nord, Inserm, INRAE, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Université Paris Cité, Paris, France
- Department of Neonatal Medicine of Port-Royal, Cochin Hospital, FHU PREMA, AP-HP Centre-Université Paris Cité, Paris, France
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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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9
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Breinig S, Ehlinger V, Rozé JC, Storme L, Torchin H, Durrmeyer X, Cambonie G, Delacourt C, Jarreau PH, Berthomieu L, Brissaud O, Benhammou V, Gascoin G, Arnaud C, Ancel PY. Pulmonary hypertension among preterm infants born at 22 through 32 weeks gestation in France: Prevalence, survival, morbidity and management in the EPIPAGE-2 cohort study. Early Hum Dev 2023; 184:105837. [PMID: 37595540 DOI: 10.1016/j.earlhumdev.2023.105837] [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: 05/09/2023] [Revised: 07/16/2023] [Accepted: 07/30/2023] [Indexed: 08/20/2023]
Abstract
OBJECTIVE To determine the prevalence, short-term prognosis and pharmacologic management of pulmonary hypertension (PH) among very preterm infants born before 32 weeks gestation (WG). STUDY DESIGN In the EPIPAGE-2 French national prospective population-based cohort of preterm infants born in 2011, those presenting with PH were identified and prevalence was estimated using multiple imputation. The primary outcome was survival without severe morbidity at discharge and was compared between infants with or without PH after adjusting for confounders, using generalized estimating equations models. Subgroup analysis was performed according to gestational age (GA) groups. RESULTS Among 3383 eligible infants, 3222 were analyzed. The prevalence of PH was 6.0 % (95 % CI, 5.2-6.9), 14.5 % in infants born at 22-27+6 WG vs 2.7 % in infants born at 28-31+6 WG (P < .001). The primary outcome (survival without severe morbidity at discharge) occurred in 30.2 % of infants with PH vs 80.2 % of infants without PH (P < .001). Adjusted incidence rate ratios for survival without severe morbidity among infants with PH were 0.42 (0.32-0.57) and 0.52 (0.39-0.69) in infants born at 22-27+6 weeks gestation and those born at 28-31+6 weeks, respectively. Among infants with PH, 92.2 % (95 % CI, 87.7-95.2) received sedation and/or analgesia, 63.5 % (95 % CI, 56.6-69.9) received inhaled NO and 57.6 % (95 % CI, 50.9-64.0) received hemodynamic treatments. CONCLUSION In this population-based cohort of very preterm infants, the prevalence of PH was 6 %. PH was associated with a significant decrease of survival without severe morbidity in this population.
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Affiliation(s)
- Sophie Breinig
- Neonatal and Pediatric Intensive Care Unit, Children's Hospital, 330 Avenue de Grande-Bretagne, Toulouse Cedex 9, France; Center for Epidemiology and Research in POPulation health (CERPOP), UMR1295, Toulouse University, Inserm, Toulouse, France.
| | - Virginie Ehlinger
- Center for Epidemiology and Research in POPulation health (CERPOP), UMR1295, Toulouse University, Inserm, Toulouse, France
| | | | - Laurent Storme
- Neonatal Intensive Care Unit, Lille University Hospital, Lille, France
| | - Heloise Torchin
- Neonatal Intensive Care Unit, Maternité Cochin-Port Royal, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Gilles Cambonie
- Neonatal and Pediatric Intensive Care Unit, Montpellier University Hospital, Montpellier, France
| | - Christophe Delacourt
- Department of Pediatric Pneumology, Necker Children's Hospital, Paris University Hospital, Paris, France
| | - Pierre-Henri Jarreau
- Neonatal Intensive Care Unit, Maternité Cochin-Port Royal, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Lionel Berthomieu
- Neonatal and Pediatric Intensive Care Unit, Children's Hospital, 330 Avenue de Grande-Bretagne, Toulouse Cedex 9, France
| | - Olivier Brissaud
- Neonatal and Pediatric Intensive Care Unit, Bordeaux University Hospital, Bordeaux, France
| | - Valérie Benhammou
- INSERM, U1153, Obstetrical, Perinatal and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne, Paris, France
| | - Geraldine Gascoin
- Center for Epidemiology and Research in POPulation health (CERPOP), UMR1295, Toulouse University, Inserm, Toulouse, France; Neonatal Intensive Care Unit, Children's Hospital, Toulouse University Hospital, Toulouse, France
| | - Catherine Arnaud
- Center for Epidemiology and Research in POPulation health (CERPOP), UMR1295, Toulouse University, Inserm, Toulouse, France; Clinical Epidemiology Unit, Toulouse University Hospital, Toulouse, France
| | - Pierre-Yves Ancel
- INSERM, U1153, Obstetrical, Perinatal and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne, Paris, France
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10
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Grapin M, Mirand A, Pinquier D, Basset A, Bendavid M, Bisseux M, Jeannoël M, Kireche B, Kossorotoff M, L'Honneur AS, Robin L, Ville Y, Renolleau S, Lemee V, Jarreau PH, Desguerre I, Lacaille F, Leruez-Ville M, Guillaume C, Henquell C, Lapillonne A, Schuffenecker I, Aubart M. Severe and fatal neonatal infections linked to a new variant of echovirus 11, France, July 2022 to April 2023. Euro Surveill 2023; 28:2300253. [PMID: 37261730 PMCID: PMC10236930 DOI: 10.2807/1560-7917.es.2023.28.22.2300253] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 06/01/2023] [Indexed: 06/02/2023] Open
Abstract
We report nine severe neonatal infections caused by a new variant of echovirus 11. All were male, eight were twins. At illness onset, they were 3-5 days-old and had severe sepsis and liver failure. This new variant, detected in France since April 2022, is still circulating and has caused more fatal neonatal enterovirus infections in 2022 and 2023 (8/496; 1.6%, seven associated with echovirus 11) compared with 2016 to 2021 (7/1,774; 0.4%). National and international alerts are warranted.
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Affiliation(s)
- Mathilde Grapin
- Paediatric Intensive Care Unit, Necker-Enfants malades University Hospital, Assistance Publique Hôpitaux de Paris, Paris Cité University, Paris, France
- These authors contributed equally to the work and share the first authorship
| | - Audrey Mirand
- These authors contributed equally to the work and share the first authorship
- Clermont-Ferrand University Hospital, 3IHP - Infection Inflammation et Interaction Hôtes Pathogènes Virology Department, French Reference Centre for enteroviruses and parechovirus, coordination laboratory, Clermont-Ferrand, France
- Auvergne University, LMGE UMR CNRS 6023, Team Epidemiology and pathophysiology of enterovirus Infection, Clermont-Ferrand, France
| | - Didier Pinquier
- Neonatal and Paediatric Intensive Care Units, Rouen University Hospital, Rouen, France
| | - Aurélie Basset
- Neonatal Intensive Care Unit, Cochin-Port Royal University Hospital, Assistance Publique Hôpitaux de Paris, Paris Cité University, Paris, France
| | - Matthieu Bendavid
- Paediatric Intensive Care Unit, Necker-Enfants malades University Hospital, Assistance Publique Hôpitaux de Paris, Paris Cité University, Paris, France
| | - Maxime Bisseux
- Clermont-Ferrand University Hospital, 3IHP - Infection Inflammation et Interaction Hôtes Pathogènes Virology Department, French Reference Centre for enteroviruses and parechovirus, coordination laboratory, Clermont-Ferrand, France
- Auvergne University, LMGE UMR CNRS 6023, Team Epidemiology and pathophysiology of enterovirus Infection, Clermont-Ferrand, France
| | - Marion Jeannoël
- Hospices Civils de Lyon, Virology Department, French Reference Centre for enteroviruses and parechoviruses, associated laboratory, Lyon, France
| | - Bérengère Kireche
- Neonatal and Paediatric Intensive Care Units, Orléans Regional Hospital, Orléans, France
| | - Manoelle Kossorotoff
- Paediatric Neurology Department, Necker-Enfants malades University Hospital, Assistance Publique Hôpitaux de Paris, Paris Cité University, Paris, France
| | - Anne-Sophie L'Honneur
- Virology laboratory, Cochin University Hospital, Assistance Publique Hôpitaux de Paris, Paris Cité University, Paris, France
| | - Lila Robin
- Neonatal and Paediatric Intensive Care Units, Orléans Regional Hospital, Orléans, France
| | - Yves Ville
- Obstetrics and Fetal Medicine Department, Necker-Enfants malades University Hospital, Assistance Publique Hôpitaux de Paris, Paris Cité University, Paris, France
| | - Sylvain Renolleau
- Paediatric Intensive Care Unit, Necker-Enfants malades University Hospital, Assistance Publique Hôpitaux de Paris, Paris Cité University, Paris, France
| | - Véronique Lemee
- Virology Department, Rouen University Hospital, Rouen, France
| | - Pierre-Henri Jarreau
- Neonatal Intensive Care Unit, Cochin-Port Royal University Hospital, Assistance Publique Hôpitaux de Paris, Paris Cité University, Paris, France
| | - Isabelle Desguerre
- Paediatric Neurology Department, Necker-Enfants malades University Hospital, Assistance Publique Hôpitaux de Paris, Paris Cité University, Paris, France
| | - Florence Lacaille
- Pediatric Gastroenterology-Hepatology-Nutrition Unit, Necker-Enfants malades University Hospital, Assistance Publique Hôpitaux de Paris, University of Paris, Paris, France
| | - Marianne Leruez-Ville
- Clinical Microbiology laboratory and Virology unit, Necker-Enfants malades University Hospital, Assistance Publique Hôpitaux de Paris, Paris Cité University, Paris, France
| | | | - Cécile Henquell
- Clermont-Ferrand University Hospital, 3IHP - Infection Inflammation et Interaction Hôtes Pathogènes Virology Department, French Reference Centre for enteroviruses and parechovirus, coordination laboratory, Clermont-Ferrand, France
- Auvergne University, LMGE UMR CNRS 6023, Team Epidemiology and pathophysiology of enterovirus Infection, Clermont-Ferrand, France
| | - Alexandre Lapillonne
- Neonatal Intensive Care Unit, Necker-Enfants malades University Hospital, Assistance Publique Hôpitaux de Paris, Paris Cité University, Paris, France
| | - Isabelle Schuffenecker
- These authors contributed equally to the work and share the last authorship
- Hospices Civils de Lyon, Virology Department, French Reference Centre for enteroviruses and parechoviruses, associated laboratory, Lyon, France
| | - Mélodie Aubart
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Imagine Institute, Institut National de la Santé et de la Recherche Médicale U1163, Paris, France
- These authors contributed equally to the work and share the last authorship
- Paediatric Neurology Department, Necker-Enfants malades University Hospital, Assistance Publique Hôpitaux de Paris, Paris Cité University, Paris, France
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11
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Desurmont MG, Bremond-Gignac D, Torchin H, Vacherot B, Jarreau PH, Daruich A. Retinopathy of prematurity detection: a retrospective quality improvement project before-after implementation of retinal digital imaging for screening. Eur J Pediatr 2023:10.1007/s00431-023-04951-z. [PMID: 37076746 DOI: 10.1007/s00431-023-04951-z] [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: 01/24/2023] [Revised: 03/16/2023] [Accepted: 03/24/2023] [Indexed: 04/21/2023]
Abstract
Screening of retinopathy of prematurity (ROP) was modified in a level-3 neonatal intensive care unit by the introduction of a wide-field retinal imaging. The aim of this study was to evaluate whether retinopathy of prematurity (ROP) diagnosis was improved or not compared to previously used binocular indirect ophthalmoscopy (BIO). This was a retrospective, uncontrolled, quality improvement project. Records of consecutive premature newborns screened for ROP over two 1-year periods were reviewed. Systemic factors potentially influencing the occurrence of ROP were investigated using uni- and multivariable linear regression followed by stepwise forward regression. ROP screening was performed by ophthalmologists using BIO in 2014, and digital wide-field retinal imaging (Panocam™ pro) in 2019. Records of N = 297 patients were analyzed (N = 159 in 2014 and N = 138 in 2019). The proportion of ROP diagnosed at any stage, over the total number of neonates screened, was significantly higher in 2019 (n = 46/138, 33.1%) compared to 2014 (n = 11/159, 6.9%) (p < 0.0001). Most neonates presented with mild forms of ROP during both 1-year periods analyzed. After adjustment for all parameters influencing ROP occurrence, the variables contributing independently to the diagnosis of any stage of ROP were birth weight (p = 0.002), duration of mechanical ventilation (p = 0.028) and wide-field fundus camera-assisted screening (p < 0.001). CONCLUSION After adjusting for many recognized systemic factors influencing the development of ROP, screening by wide-field digital retinal imaging was independently associated with higher ROP detection. WHAT IS KNOWN • No consensus has been reached to replace binocular indirect ophthalmoscopy by retinal imaging for ROP screening. • Diagnostic accuracy and high sensitivity and specificity has been reported for wide-field digital imaging. WHAT IS NEW • The introduction of wide-field imaging for ROP screening in at level-3 reference center was independently associated to higher ROP detection.
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Affiliation(s)
- Marie-Gwenola Desurmont
- Ophthalmology Department, Necker-Enfants Malades University Hospital, AP-HP, Paris Cité University, 149 Rue de Sèvres, 75015, Paris, France
| | - Dominique Bremond-Gignac
- Ophthalmology Department, Necker-Enfants Malades University Hospital, AP-HP, Paris Cité University, 149 Rue de Sèvres, 75015, Paris, France
- INSERM, UMRS1138, Team 17, From physiopathology of ocular diseases to clinical development, Sorbonne Paris Cité University, Centre de Recherche des Cordeliers, Paris, France
| | - Héloïse Torchin
- Neonatology Intensive Care Unit of Port-Royal, AP-HP.Centre Université de Paris Cochin Hospital, FHU Prema, Paris, France
- University of Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPe, INSERM U1153, Paris University, Paris, France
| | - Brigitte Vacherot
- Neonatology Intensive Care Unit of Port-Royal, AP-HP.Centre Université de Paris Cochin Hospital, FHU Prema, Paris, France
| | - Pierre-Henri Jarreau
- Neonatology Intensive Care Unit of Port-Royal, AP-HP.Centre Université de Paris Cochin Hospital, FHU Prema, Paris, France
- University of Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPe, INSERM U1153, Paris University, Paris, France
| | - Alejandra Daruich
- Ophthalmology Department, Necker-Enfants Malades University Hospital, AP-HP, Paris Cité University, 149 Rue de Sèvres, 75015, Paris, France.
- INSERM, UMRS1138, Team 17, From physiopathology of ocular diseases to clinical development, Sorbonne Paris Cité University, Centre de Recherche des Cordeliers, Paris, France.
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12
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Tréluyer L, Chevallier M, Jarreau PH, Baud O, Benhammou V, Gire C, Marchand-Martin L, Marret S, Pierrat V, Ancel PY, Torchin H. Intraventricular Hemorrhage in Very Preterm Children: Mortality and Neurodevelopment at Age 5. Pediatrics 2023; 151:e2022059138. [PMID: 36919442 PMCID: PMC10071431 DOI: 10.1542/peds.2022-059138] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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] [Accepted: 12/22/2022] [Indexed: 03/16/2023] Open
Abstract
OBJECTIVES The objectives were to describe mortality and causes of death in children with intraventricular hemorrhage (IVH) and to study neurodevelopmental outcomes. METHODS The study was a secondary analysis of the French national prospective and population-based cohort EPIPAGE-2. Children were recruited in 2011. A standardized assessment was conducted at age 5. Children born before 32 weeks' gestation and admitted to a NICU were eligible. Exposure was IVH defined by the Papile classification. Main outcomes were mortality, causes of death, and neurodevelopmental outcomes at age 5. RESULTS Among the 3468 children included, 578 (16.7%) had grade 1 IVH, 424 (12.2%) grade 2 IVH, and 114 (3.3%) grade 3 IVH; 144 (4.1%) had intraparenchymal hemorrhage (IPH). Mortality was 29.7% (36 of 114) for children with grade 3 IVH and 74.4% (109 of 144) for those with IPH; 67.6% (21 of 31) and 88.7% (86 of 97) of deaths, respectively, were because of withholding and withdrawing of life-sustaining treatment. As compared with no IVH, low-grade IVH was not associated with measured neurodevelopmental disabilities at age 5. High-grade IVH was associated with moderate and severe neurodevelopmental disabilities, reduced full-scale IQ, and cerebral palsy. CONCLUSIONS Rates of neurodevelopmental disabilities at age 5 did not differ between children without IVH and those with low-grade IVH. For high-grade IVH, mortality rate was high, mostly because of withholding and withdrawal of life-sustaining treatment, and we found a strong association with overall neurodevelopmental disabilities in survivors.
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Affiliation(s)
- Ludovic Tréluyer
- CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, Université Paris Cité, Paris, France
- Department of Neonatal Medicine of Port Royal, Cochin Hospital, FHU PREMA, AP-HP Centre – Université Paris Cité, Paris, France
| | - Marie Chevallier
- NICU, Grenoble Alps University Hospital Centre Couples and Children Section, Grenoble, France
- TIMC-IMAG Research Department, Grenoble Alps University, Grenoble, France
| | - Pierre-Henri Jarreau
- CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, Université Paris Cité, Paris, France
- Department of Neonatal Medicine of Port Royal, Cochin Hospital, FHU PREMA, AP-HP Centre – Université Paris Cité, Paris, France
| | - Olivier Baud
- Division of Neonatology and Pediatric Intensive Care, Children’s University Hospital of Geneva, Geneva, Switzerland
- Université Paris Cité, Inserm U1141, Paris, France
| | - Valérie Benhammou
- CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, Université Paris Cité, Paris, France
| | - Catherine Gire
- Department of Neonatology, North Hospital, University Hospital of Marseille,Chemin des Bourrelys, CEDEX 20, Marseille, France
| | - Laetitia Marchand-Martin
- CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, Université Paris Cité, Paris, France
| | - Stéphane Marret
- Department of Neonatal Pediatrics, Intensive Care, and Neuropediatrics, Rouen University Hospital, Rouen, France and INSERM Unit 1245, Team Perinatal Handicap, School of Medicine of Rouen, Normandy University, Normandy, France
| | - Véronique Pierrat
- CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, Université Paris Cité, Paris, France
- Department of Neonatal Medicine, CHU Lille, Jeanne de Flandre Hospital, Lille, France
| | - Pierre-Yves Ancel
- CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, Université Paris Cité, Paris, France
- Clinical Research Unit, Center for Clinical Investigation P1419, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Héloïse Torchin
- CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, Université Paris Cité, Paris, France
- Department of Neonatal Medicine of Port Royal, Cochin Hospital, FHU PREMA, AP-HP Centre – Université Paris Cité, Paris, France
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13
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Anselem O, Goffinet F, Jarreau PH, Zeitlin J, Monier I. Perinatal survival among very preterm singletons born after detection of early-onset fetal growth restriction with or without maternal hypertensive disorders: A population-based study in France. Eur J Obstet Gynecol Reprod Biol 2023; 282:43-49. [PMID: 36634405 DOI: 10.1016/j.ejogrb.2023.01.004] [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: 07/11/2022] [Revised: 12/28/2022] [Accepted: 01/03/2023] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To investigate the management and survival of very preterm singletons born because of fetal growth restriction (FGR) with or without maternal hypertensive disorders in France. STUDY DESIGN From a population-based cohort of very preterm births between 22 and 31 weeks in France in 2011, the study population included all non-anomalous singleton pregnancies delivered because of detected FGR with or without maternal hypertensive disorders. Antenatal detection of FGR was defined as an estimated fetal weight <10th percentile with or without fetal Doppler abnormalities or growth arrest. All fetuses were alive at the time of detection of FGR. Indicators of active perinatal management (antenatal steroids, pre-labor cesarean and birth in level 3 maternity unit) and fetal/neonatal outcomes (terminations of pregnancy (TOP), stillbirths, neonatal deaths and survival to discharge) were compared by gestational age between FGR associated with maternal hypertensive disorders and isolated FGR. RESULTS Overall, 398 pregnancies delivered before 32 weeks for FGR associated with hypertensive disorders and 234 for isolated FGR. Active perinatal care was rare before 26 weeks in both groups and about one in five cases associated with maternal hypertensive disorders received steroids and was born by prelabor cesarean compared to none for isolated FGR. Before 25 weeks of gestation age, more pregnancies resulted in TOP when FGR was associated with hypertensive disorders compared to isolated FGR (respectively, 76.2 % vs 28.0 % at 22-23 weeks, P = 0.002 and 57.9 % vs 21.1 % at 24 weeks, P = 0.028) whereas stillbirths were more common among isolated FGR (respectively, 23.8 % vs 72.0 % at 22-23 weeks, P = 0.002 and 36.8 % vs 73.7 % at 24 weeks, P = 0.030). Survival to discharge was higher at any gestational age when the cause of birth was FGR associated with hypertensive disorders compared to isolated FGR. CONCLUSION The management and pregnancy outcomes differed when FGR was associated with maternal hypertensive disorders or isolated. The proportion of TOP was higher when FGR was associated with hypertensive disorders and the proportion of stillbirths was higher in isolated FGR.
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Affiliation(s)
- Olivia Anselem
- Port-Royal Maternity Unit, Groupe Hospitalier Cochin Broca Hôtel-Dieu, AP-HP, Université Paris, FHU Prema, Paris, France
| | - François Goffinet
- Port-Royal Maternity Unit, Groupe Hospitalier Cochin Broca Hôtel-Dieu, AP-HP, Université Paris, FHU Prema, Paris, France; Université Paris Cité, Centre of Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), INSERM, INRA, Paris, France
| | - Pierre-Henri Jarreau
- Université Paris Cité, Centre of Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), INSERM, INRA, Paris, France; Department of Neonatal Medicine, Cochin-Port Royal Hospital, FHU PREMA, AP-HP Centre, Paris, France
| | - Jennifer Zeitlin
- Université Paris Cité, Centre of Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), INSERM, INRA, Paris, France
| | - Isabelle Monier
- Université Paris Cité, Centre of Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), INSERM, INRA, Paris, France.
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14
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Caillaud I, Torchin H, Basset A, Mouillé M, Jarreau PH, Zana-Taïeb É. [Caregivers' experiences with extreme prematurity]. Soins Psychiatr 2022; 43:10-13. [PMID: 36731975 DOI: 10.1016/j.spsy.2022.11.003] [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] [Indexed: 11/13/2022]
Abstract
Neonatal intensive care units receive very immature premature newborns. Mortality and morbidity rates remain high in this particularly fragile population. Caregivers involved with the child and his or her parents may experience moral distress. There are few studies on the experience of caregivers in these situations. Training, service architecture and sharing of experiences with specifically trained psychologists can improve this experience in these highly technical services.
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Affiliation(s)
- Isabelle Caillaud
- Service de médecine et réanimation néonatales de Port-Royal, AP-HP, Université Paris Cité, Site Cochin, 123 boulevard de Port-Royal, 75014 Paris, France
| | - Héloïse Torchin
- Service de médecine et réanimation néonatales de Port-Royal, AP-HP, Université Paris Cité, Site Cochin, 123 boulevard de Port-Royal, 75014 Paris, France; Fédération hospitalo-universitaire Combattre la prématurité (FHU Préma), Maternité de Port-Royal, AP-HP, 123 boulevard de Port-Royal, 75014 Paris, France; Centre de recherche en épidémiologie et statistiques/Cress, Inserm, Inrae, Université Paris Cité, 1 place du Parvis Notre-Dame, 75004 Paris, France
| | - Aurélie Basset
- Service de médecine et réanimation néonatales de Port-Royal, AP-HP, Université Paris Cité, Site Cochin, 123 boulevard de Port-Royal, 75014 Paris, France; Fédération hospitalo-universitaire Combattre la prématurité (FHU Préma), Maternité de Port-Royal, AP-HP, 123 boulevard de Port-Royal, 75014 Paris, France
| | - Marion Mouillé
- Service de médecine et réanimation néonatales de Port-Royal, AP-HP, Université Paris Cité, Site Cochin, 123 boulevard de Port-Royal, 75014 Paris, France; Fédération hospitalo-universitaire Combattre la prématurité (FHU Préma), Maternité de Port-Royal, AP-HP, 123 boulevard de Port-Royal, 75014 Paris, France
| | - Pierre-Henri Jarreau
- Service de médecine et réanimation néonatales de Port-Royal, AP-HP, Université Paris Cité, Site Cochin, 123 boulevard de Port-Royal, 75014 Paris, France; Fédération hospitalo-universitaire Combattre la prématurité (FHU Préma), Maternité de Port-Royal, AP-HP, 123 boulevard de Port-Royal, 75014 Paris, France; Centre de recherche en épidémiologie et statistiques/Cress, Inserm, Inrae, Université Paris Cité, 1 place du Parvis Notre-Dame, 75004 Paris, France
| | - Élodie Zana-Taïeb
- Service de médecine et réanimation néonatales de Port-Royal, AP-HP, Université Paris Cité, Site Cochin, 123 boulevard de Port-Royal, 75014 Paris, France; Fédération hospitalo-universitaire Combattre la prématurité (FHU Préma), Maternité de Port-Royal, AP-HP, 123 boulevard de Port-Royal, 75014 Paris, France.
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15
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Tréluyer L, Jarreau PH, Marchand-Martin L, Benhammou V, Nuytten A, Berquin P, Marret S, Pierrat V, Ancel PY, Torchin H. Bronchopulmonary Dysplasia and Risk of Developmental Delay: An EPIPAGE-2 Cohort Study. Neonatology 2022; 119:124-128. [PMID: 34879383 DOI: 10.1159/000520451] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 06/20/2021] [Accepted: 10/25/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Overall and respiratory management of preterm children are constantly evolving, which might have changed both the pathophysiology and neurodevelopmental consequences of bronchopulmonary dysplasia (BPD). OBJECTIVES The objective of this study is to determine whether the previously shown association between BPD and risk of developmental delay persists. METHODS The study population was children born before 32 weeks' gestation from the French prospective cohort EPIPAGE-2. The exposure was BPD assessed at 36 weeks' postmenstrual age. The main outcome was risk of developmental delay defined by an Age & Stages Questionnaires (ASQ) score below threshold at 24 months' corrected age. RESULTS The analyzed population included 2,706 children. Among those with available ASQ score, 196/1,587 had BPD and 671/1,587 had an ASQ score below threshold. BPD was associated with an ASQ score below threshold (odds ratio 1.52, 95% confidence interval 1.11-2.08; p = 0.008). CONCLUSIONS BPD was strongly associated with risk of developmental delay.
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Affiliation(s)
- Ludovic Tréluyer
- Epidemiology and Statistics Research Center/CRESS, INSERM, INRAE, University of Paris, Paris, France
| | - Pierre-Henri Jarreau
- Epidemiology and Statistics Research Center/CRESS, INSERM, INRAE, University of Paris, Paris, France.,Department of Neonatal Medicine, Cochin-Port Royal Hospital, FHU PREMA, AP-HP Centre, Paris, France
| | - Laetitia Marchand-Martin
- Epidemiology and Statistics Research Center/CRESS, INSERM, INRAE, University of Paris, Paris, France
| | - Valerie Benhammou
- Epidemiology and Statistics Research Center/CRESS, INSERM, INRAE, University of Paris, Paris, France
| | - Alexandra Nuytten
- Department of Neonatal Medicine, CHU Lille, 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
| | - Patrick Berquin
- Department of Pediatric Neurology, Amiens-Picardie University Hospital, University of Picardie Jules Verne, Amiens, France
| | - Stéphane Marret
- Department of Neonatal Pediatrics, Intensive Care, and Neuropediatrics, Rouen University Hospital, Rouen, France and INSERM Unit 1245, Team Perinatal Handicap, School of Medicine of Rouen, Normandy University, Normandy, France
| | - Véronique Pierrat
- Epidemiology and Statistics Research Center/CRESS, INSERM, INRAE, University of Paris, Paris, France.,Department of Neonatal Medicine, CHU Lille, Jeanne de Flandre Hospital, Lille, France
| | - Pierre-Yves Ancel
- Epidemiology and Statistics Research Center/CRESS, INSERM, INRAE, University of Paris, Paris, France.,Clinical Research Unit, Center for Clinical Investigation P1419, Assitance Publique Hôpitaux de Paris, Paris, France
| | - Héloïse Torchin
- Epidemiology and Statistics Research Center/CRESS, INSERM, INRAE, University of Paris, Paris, France.,Department of Neonatal Medicine, Cochin-Port Royal Hospital, FHU PREMA, AP-HP Centre, Paris, France
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16
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Dudoignon B, Khirani S, Amaddeo A, Ben Ammar R, De Luca D, Torchin H, Lapillonne A, Jarreau PH, Fauroux B. Effect of the measurement of the work of breathing on the respiratory outcome of preterms. J Matern Fetal Neonatal Med 2021; 35:7126-7131. [PMID: 34187296 DOI: 10.1080/14767058.2021.1944093] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
RATIONALE There are no validated criteria for the choice of the optimal type of noninvasive respiratory support (NRS) and most appropriate settings in preterms. METHODS The work of breathing (WOB) during oxygen (O2) alone, nasal continuous positive pressure (nCPAP) and high flow nasal cannula (HFNC) was compared in preterm babies (23-30 weeks' gestation, "physiological group") needing any type of noninvasive respiratory support ("baseline" NRS) at 4 weeks of life. Babies were thereafter treated with the NRS associated with the greatest reduction in WOB ("optimal NRS"). The respiratory outcome at 36 weeks" gestation of these babies was compared to a "control" group treated with NRS based on standard noninvasive parameters. Preterm babies were prospectively enrolled in 3 centers and randomized into the "physiological" or "control" group. RESULTS Thirty babies were randomized. WOB with "baseline" NRS was higher than the "optimal" NRS and the consequent NRS chosen by physicians (p = 0.001). WOB was lower during HFNC than during O2 (p = 0.032) but WOB was comparable between nCPAP and HFNC, and between nCPAP and O2. Notably, WOB was near to normal during spontaneous breathing with O2. Respiratory outcome at 36 week' gestation was comparable between the 2 groups. CONCLUSION The optimization of NRS by means of the measurement of WOB in preterms requiring any type of NRS at 4 weeks of life was able to decrease the WOB but had no effect on the clinical outcome at 36 weeks' gestation.
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Affiliation(s)
- Benjamin Dudoignon
- Research unit INSERM U 955, Créteil, France.,Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker Enfants-Malades, Paris, France
| | - Sonia Khirani
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker Enfants-Malades, Paris, France.,EA 7330 VIFASOM (Vigilance, Fatigue, Sommeil et Santé Publique), Paris Descartes University, Paris, France.,ASV Santé, Gennevilliers, France
| | - Alessandro Amaddeo
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker Enfants-Malades, Paris, France.,EA 7330 VIFASOM (Vigilance, Fatigue, Sommeil et Santé Publique), Paris Descartes University, Paris, France
| | - Rafik Ben Ammar
- Pediatrics and Neonatal Critical Care, "A. Beclere" Medical Center, APHP - South Paris University Hospitals, Clamart, France
| | - Daniele De Luca
- Pediatrics and Neonatal Critical Care, "A. Beclere" Medical Center, APHP - South Paris University Hospitals, Clamart, France.,Physiopathologie et Innovation Thérapeutique, INSERM-U999 LabEx - LERMIT, Clamart, France
| | - Heloise Torchin
- Port Royal Medicine and Neonatal Intensive Care Unit, AP-HP, Hôpital Cochin, Paris, France
| | - Alexandre Lapillonne
- Neonatal Intensive Care Unit, AP-HP, Hôpital Necker Enfants-Malades, Paris, France.,Imagine Institue, EA7328-PACT, Paris Descartes University, Paris, France
| | - Pierre-Henri Jarreau
- Port Royal Medicine and Neonatal Intensive Care Unit, AP-HP, Hôpital Cochin, Paris, France
| | - Brigitte Fauroux
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker Enfants-Malades, Paris, France.,EA 7330 VIFASOM (Vigilance, Fatigue, Sommeil et Santé Publique), Paris Descartes University, Paris, France
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17
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Guillier C, Carrière D, Pansiot J, Maroni A, Billion E, Ringot M, Benoist JF, Jacques S, Matrot B, Jarreau PH, Vaiman D, Baud O, Zana-Taïeb E. Nebulized curcumin protects neonatal lungs from antenatal insult in rats. Am J Physiol Lung Cell Mol Physiol 2021; 321:L545-L552. [PMID: 34159801 DOI: 10.1152/ajplung.00195.2021] [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] [Indexed: 01/22/2023] Open
Abstract
Intrauterine growth restriction (IUGR) increases the risk of bronchopulmonary dysplasia (BPD), one of the major complications of prematurity. Antenatal low-protein diet (LPD) exposure in rats induces IUGR and mimics BPD-related alveolarization disorders. Peroxisome proliferator-activated receptor-γ (PPARγ) plays a key role in normal lung development and was found deregulated following LPD exposure. The objective of this article was to investigate the effects of nebulized curcumin, a natural PPARγ agonist, to prevent IUGR-related abnormal lung development. We studied rat pups antenatally exposed to an LPD or control diet (CTL) and treated with nebulized curcumin (50 mg/kg) or vehicle from postnatal (P) days 1 to 5. The primary readouts were lung morphometric analyses at P21. Immunohistochemistry (P21) and microarrays (P6 and P11) were compared within animals exposed to LPD versus controls, with and without curcumin treatment. Quantitative morphometric analyses revealed that LPD induced abnormal alveolarization as evidenced by a significant increase in mean linear intercept (MLI) observed in P21 LPD-exposed animals. Early curcumin treatment prevented this effect, and two-way ANOVA analysis demonstrated significant interaction between diet and curcumin both for MLI [F(1,39) = 12.67, P = 0.001] and radial alveolar count at P21 [F(1,40) = 6.065, P = 0.0182]. Immunohistochemistry for fatty acid binding protein 4 (FABP4), a major regulator of PPARγ pathway, showed a decreased FABP4+ alveolar cell density in LPD-exposed animals treated by curcumin. Transcriptomic analysis showed that early curcumin significantly prevented the activation of profibrotic pathways observed at P11 in LPD-exposed animals. Nebulized curcumin appears to be a promising strategy to prevent alveolarization disorders in IUGR rat pups, targeting pathways involved in lung development.
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Affiliation(s)
- Cyril Guillier
- Institut National de la Santé Et de la Recherche Médicale (INSERM) U1141, Paris, France.,Assistance Publique-Hôpitaux de Paris, Service de Médecine et Réanimation néonatales de Port-Royal, Paris, France.,Université Paris Descartes, Paris, France
| | - Diane Carrière
- Institut National de la Santé Et de la Recherche Médicale (INSERM) U1141, Paris, France.,Assistance Publique-Hôpitaux de Paris, Service de Médecine et Réanimation néonatales de Port-Royal, Paris, France.,Université Paris Descartes, Paris, France
| | - Julien Pansiot
- Institut National de la Santé Et de la Recherche Médicale (INSERM) U1141, Paris, France.,Université Paris Diderot, Paris, France
| | - Arielle Maroni
- Institut National de la Santé Et de la Recherche Médicale (INSERM) U1141, Paris, France.,Université Paris Descartes, Paris, France
| | - Elodie Billion
- Institut National de la Santé Et de la Recherche Médicale (INSERM) U1141, Paris, France.,Assistance Publique-Hôpitaux de Paris, Service de Médecine et Réanimation néonatales de Port-Royal, Paris, France.,Université Paris Descartes, Paris, France
| | - Maud Ringot
- Institut National de la Santé Et de la Recherche Médicale (INSERM) U1141, Paris, France.,Université Paris Diderot, Paris, France
| | - Jean-François Benoist
- Assistance Publique-Hôpitaux de Paris, Service de Biochimie-Hormonologie, Hôpital Robert Debré, Paris, France
| | - Sébastien Jacques
- Genom'ic. INSERM U1016, Centre National de la Recherche Scientifique (CNRS) Unite Mixte de Recherche (UMR) 8104, Paris, France
| | - Boris Matrot
- Institut National de la Santé Et de la Recherche Médicale (INSERM) U1141, Paris, France.,Université Paris Diderot, Paris, France
| | - Pierre-Henri Jarreau
- Assistance Publique-Hôpitaux de Paris, Service de Médecine et Réanimation néonatales de Port-Royal, Paris, France.,Université Paris Descartes, Paris, France.,Fondation PremUp, Paris, France.,Université de Paris, Epidemiology and Statistics Research Center (CRESS), INSERM, Institut national de la recherche agronomique (INRA), Paris, France
| | - Daniel Vaiman
- Institut Cochin, Inserm U1016-CNRS UMRS 104, Paris, France
| | - Olivier Baud
- Institut National de la Santé Et de la Recherche Médicale (INSERM) U1141, Paris, France.,Université Paris Diderot, Paris, France.,Assistance Publique-Hôpitaux de Paris, Service de Réanimation et Pédiatrie néonatales, Hôpital Robert Debré, Paris, France.,Division of Neonatology and Pediatric Intensive Care, Children's University Hospital of Geneva and University of Geneva, Geneva, Switzerland
| | - Elodie Zana-Taïeb
- Institut National de la Santé Et de la Recherche Médicale (INSERM) U1141, Paris, France.,Assistance Publique-Hôpitaux de Paris, Service de Médecine et Réanimation néonatales de Port-Royal, Paris, France.,Fondation PremUp, Paris, France
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18
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Charkaluk ML, Rousseau J, Dehouck-Vallois M, Jarreau PH, Nuytten A, Treluyer L, Ancel PY, Torchin H. Occurrence and severity of acute respiratory infections during the first year among very preterm infants: an Epipage-2 cohort analysis. Eur J Pediatr 2021; 180:1833-1840. [PMID: 33527179 DOI: 10.1007/s00431-021-03956-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 11/20/2020] [Revised: 01/15/2021] [Accepted: 01/18/2021] [Indexed: 11/25/2022]
Abstract
This study aims to describe the incidence of acute respiratory infections (ARI) during the first year in infants born before 32 weeks' gestation, and to analyze and study the risk factors as well as factors associated with oxygen requirement among infants with an ARI, in the palivizumab era. This study included 2571 infants from a nationwide French population-based cohort (Epipage 2). ARI at 1-year corrected age was identified by parental questionnaires. Risk and severity factors included those already known, and detailed information about neonatal morbidities. ARI occurred in 52.2% (n = 1349) of infants. Oxygen therapy was used in 33.2% (n = 391) of infants with an ARI. Risk factors for AII were male sex, bronchopulmonary dysplasia, presence of siblings at home, and childcare in the community together with incomplete treatment palivizumab. Mechanical ventilation in the neonatal period, bronchopulmonary dysplasia, and discharge between October and March were associated with more frequent oxygen requirement. No other factors describing neonatal morbidities were associated with risk of ARI or oxygen requirement.Conclusion: ARIs are still very common during the first year of life of very preterm children, and oxygen therapy is frequently needed. Educational strategies are needed in all families with a very preterm infant. What is Known: • Acute respiratory infections (ARIs) are the first cause of rehospitalizations in preterm children, with bronchopulmonary dysplasia being the main risk factor. • Palivizumab prophylaxis has proven its effect against severe RSV infections, but it is not universal. What is New: • No factor describing neonatal morbidity, except BPD, was associated with ARI occurrence or severity. • BPD and discharge during RSV season were the only factors associated with O2 requirement during ARI.
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Affiliation(s)
- Marie-Laure Charkaluk
- Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, University of Paris, F-75004, Paris, France.
- Service de néonatologie, Hôpital Saint Vincent de Paul, GHICL, Boulevard de Belfort, 59020, Lille cedex, France.
- Université Catholique de Lille, F-59000, Lille, France.
| | | | | | - Pierre-Henri Jarreau
- Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, University of Paris, F-75004, Paris, France
- Department of Neonatal Medicine, Cochin Port-Royal Hospital, FHU PREMA, APHP.centre, Paris, France
| | - Alexandra Nuytten
- Univ. Lille, CHU Lille, ULR 2694 - METRICS : Évaluation des technologies de santé et des pratiques médicales, F-59000, Lille, France
- Clinique de néonatalogie, Hôpital Jeanne de Flandre, CHU Lille, F-59000, Lille, France
| | - Ludovic Treluyer
- Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, University of Paris, F-75004, Paris, France
- CHU Amiens-Picardie, F-80054, Amiens, France
| | - Pierre-YvesY Ancel
- Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, University of Paris, F-75004, Paris, France
- CIC P1419, AP-HP, APHP.CUP, F-75014, Paris, France
| | - Héloïse Torchin
- Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, University of Paris, F-75004, Paris, France
- Department of Neonatal Medicine, Cochin Port-Royal Hospital, FHU PREMA, APHP.centre, Paris, France
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19
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El Rafei R, Jarreau PH, Norman M, Maier RF, Barros H, Reempts PV, Pedersen P, Cuttini M, Zeitlin J. Variation in very preterm extrauterine growth in a European multicountry cohort. Arch Dis Child Fetal Neonatal Ed 2021; 106:316-323. [PMID: 33268469 DOI: 10.1136/archdischild-2020-319946] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 06/16/2020] [Revised: 10/25/2020] [Accepted: 10/26/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Extrauterine growth restriction (EUGR) among very preterm infants is related to poor neurodevelopment, but lack of consensus on EUGR measurement constrains international research. Our aim was to compare EUGR prevalence in a European very preterm cohort using commonly used measures. DESIGN Population-based observational study. SETTING 19 regions in 11 European countries. PATIENTS 6792 very preterm infants born before 32 weeks' gestational age (GA) surviving to discharge. MAIN OUTCOME MEASURES We investigated two measures based on discharge-weight percentiles with (1) Fenton and (2) Intergrowth (IG) charts and two based on growth velocity (1) birth weight and discharge-weight Z-score differences using Fenton charts and (2) weight-gain velocity using Patel's model. We estimated country-level relative risks of EUGR adjusting for maternal and neonatal characteristics and associations with population differences in healthy newborn size, measured by mean national birth weight at 40 weeks' GA. RESULTS About twofold differences in EUGR prevalence were observed between countries for all indicators and these persisted after case-mix adjustment. Discharge weight <10th percentile using Fenton charts varied from 24% (Sweden) to 60% (Portugal) and using IG from 13% (Sweden) to 43% (Portugal), while low weight-gain velocity ranged from 35% (Germany) to 62% (UK). Mean term birth weight strongly correlated with both percentile-based measures (Spearman's rho=-0.90 Fenton, -0.84 IG, p<0.01), but not Patel's weight-gain velocity (rho: -0.38, p=0.25). CONCLUSIONS Very preterm infants have a high prevalence of EUGR, with wide variations between countries in Europe. Variability associated with mean term birth weight when using common postnatal growth charts complicates international benchmarking.
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Affiliation(s)
- Rym El Rafei
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team,EPOPé, INSERM, INRA, F-75004, Paris, France
- Sorbonne Université, Collège Doctoral, F-75005, Paris, France
| | - Pierre-Henri Jarreau
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team,EPOPé, INSERM, INRA, F-75004, Paris, France
- Université Paris Descartes and Assistance Publique Hôpitaux de Paris, Hôpitaux Universitaire Paris Centre Site Cochin, DHU Risks in pregnancy, Service de Médecine et Réanimation néonatales de Port-Royal, Paris, France
| | - Mikael Norman
- Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatal Medicine, Karolinska Institute, Stockholm, Sweden
| | - Rolf Felix Maier
- Children's Hospital, Philipps-Universitat Marburg, Marburg, Hessen, Germany
| | - Henrique Barros
- EPIUnit-Institute of Public Health, University of Porto, Porto, Portugal
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto, Porto, Portugal
| | - Patrick Van Reempts
- Neonatology, Laboratory of Experimental Medicine and Pediatrics, Division of Neonatology, University of Antwerp, Antwerp. Study Centre for Perinatal Epidemiology Flanders, Brussels, Belgium
| | | | - Marina Cuttini
- Clinical Care and Management Innovation Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Jennifer Zeitlin
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team,EPOPé, INSERM, INRA, F-75004, Paris, France
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20
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Hirt D, Kubota Kilengelela J, Jarreau PH, Tréluyer JM, Marcou V. Nevirapine Pharmacokinetics in Neonates Between 25 and 32 Weeks Gestational Age for the Prevention of Mother-to-Child Transmission of HIV. Pediatr Infect Dis J 2021; 40:344-346. [PMID: 33710978 DOI: 10.1097/inf.0000000000002994] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Eleven newborns from 25 to 32 weeks of gestational age, weighting from 0.66 to 1.60 kg received 2 mg/kg doses of nevirapine syrup. In 15 samples, collected 8.75-89 hours after drug intake, concentrations ranged from 0.65 to 16.68 mg/L. Three nevirapine dose of 2 mg/kg at day 0, 2 and 6 days of life achieved nevirapine concentrations above the proposed nevirapine target for HIV prophylaxis for at least 11 days.
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Affiliation(s)
- Déborah Hirt
- From the EA7323, Evaluation des thérapeutiques et pharmacologie périnatale et pédiatrique, Université de Paris and
- Service de Pharmacologie Clinique, AP-HP, Hôpital Cochin, Paris, France
- INSERM, U1018, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Jean Kubota Kilengelela
- Service de Médecine et Réanimation néonatales de Port-Royal, APHP Centre-Université de Paris, hôpital Cochin-Broca
| | - Pierre-Henri Jarreau
- Service de Médecine et Réanimation néonatales de Port-Royal, APHP Centre-Université de Paris, hôpital Cochin-Broca
- INSERM, INRA, Université de Paris, Centre de Recherche en Epidémiologie et Statistiques/CRESS
| | - Jean-Marc Tréluyer
- From the EA7323, Evaluation des thérapeutiques et pharmacologie périnatale et pédiatrique, Université de Paris and
- Service de Pharmacologie Clinique, AP-HP, Hôpital Cochin, Paris, France
- INSERM, U1018, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Valérie Marcou
- Service de Médecine et Réanimation néonatales de Port-Royal, APHP Centre-Université de Paris, hôpital Cochin-Broca
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21
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Tournoud C, Capaldo L, Garnier R, Gnansia E, Jarreau PH, Moesch C, Nisse P, Quénel P, Yazbeck C, Labadie M. [Reprint of: Guidelines for pregnant women and their unborn children exposed to methylmercury. Recommendations of the French Society of Clinical Toxicology associated with the French Society of Analytical Toxicology, the French Society of Public Health, the French Society of Environnmental Health, the French Society of Pediatrics, the French Society of Neonatalogy, the National College of Obstetrician Gynecologists]. Gynecol Obstet Fertil Senol 2021; 49:225-238. [PMID: 33423946 DOI: 10.1016/j.gofs.2020.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Christine Tournoud
- Centre antipoison Est, CHRU, 54000 Nancy, France; Société de toxicologie clinique, 75010 Paris, France.
| | - Lise Capaldo
- Société de toxicologie clinique, 75010 Paris, France; Urgences adultes, hôpital Pellegrin, CHU, 33000 Bordeaux, France
| | - Robert Garnier
- Société de toxicologie clinique, 75010 Paris, France; Centre antipoison, AP-HP, 75010 Paris, France
| | | | - Pierre-Henri Jarreau
- Service de médecine et réanimation néonatales de Port-Royal, hôpitaux universitaires Paris Centre, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 75014 Paris, France; Société française de pédiatrie et société française de néonatologie, France
| | - Christian Moesch
- Laboratoire de pharmacologie et de toxicologie, CHU, 87042 Limoges, France; Société française de toxicologie analytique, 92380 Garches, France
| | - Patrick Nisse
- Société de toxicologie clinique, 75010 Paris, France; Centre antipoison, CHU, 59037 Lille, France
| | - Philippe Quénel
- Inserm, EHESP, Institut de recherche en santé, environnement et travail (Irset), UMR_S 1085, Université de Rennes, 35000 Rennes, France; Société française de santé publique, 54520 Laxou, France
| | - Chadi Yazbeck
- Gynécologie-obstétrique et médecine de la reproduction, hôpital Foch, 92150 Suresnes, France; Gynécologie-obstétrique et médecine de la reproduction, CMC Pierre-Cherest, Hartmann, 92200 Neuilly-sur-Seine, France; Collège national des gynécologues obstétriciens français, 75002 Paris, France
| | - Magali Labadie
- Société de toxicologie clinique, 75010 Paris, France; Centre antipoison, CHU, 33076 Bordeaux, France
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22
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Zeitlin J, Maier RF, Cuttini M, Aden U, Boerch K, Gadzinowski J, Jarreau PH, Lebeer J, Norman M, Pedersen P, Petrou S, Pfeil JM, Toome L, van Heijst A, Van Reempts P, Varendi H, Barros H, Draper ES. Cohort Profile: Effective Perinatal Intensive Care in Europe (EPICE) very preterm birth cohort. Int J Epidemiol 2021; 49:372-386. [PMID: 32031620 PMCID: PMC7266542 DOI: 10.1093/ije/dyz270] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 12/12/2019] [Indexed: 12/29/2022] Open
Affiliation(s)
- Jennifer 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
| | - Rolf F Maier
- Children's Hospital, University Hospital, Philipps University Marburg, Marburg, Germany
| | - Marina Cuttini
- Clinical Care and Management Innovation Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Ulrika Aden
- Department of Womeńs and Childreńs Health, Karolinska Institutet, Stockholm, Sweden
| | - Klaus Boerch
- Department of Paediatrics, Hvidovre Hospital, Copenhagen University Hospital, Hvidovre, Denmark
| | - Janusz Gadzinowski
- Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Pierre-Henri Jarreau
- Université Paris Descartes and Assistance Publique Hôpitaux de Paris, Hôpitaux Universitaire Paris Centre Site Cochin, DHU Risks in pregnancy, Service de Médecine et Réanimation néonatales de Port-Royal, Paris, France
| | - Jo Lebeer
- Department of Primary & Interdisciplinary Care, Disability Studies, Faculty of Medicine, University of Antwerp, Antwerp, Belgium
| | - Mikael Norman
- Department of Clinical Science, Intervention and Technology, Division of Pediatrics, Karolinska Institutet, Stockholm, Sweden.,Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | | | - Stavros Petrou
- The University of Warwick, Warwick Medical School (WMS), Coventry, UK.,University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, UK
| | - Johanna M Pfeil
- European Foundation for the Care of Newborn Infants (EFCNI), Munich, Germany
| | - Liis Toome
- Tallinn Children's Hospital, Tallinn, Estonia and University of Tartu, Tartu, Estonia
| | - Arno van Heijst
- Department of Neonatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Patrick Van Reempts
- Department of Neonatology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium and Study Centre for Perinatal Epidemiology, Brussels, Belgium
| | - Heili Varendi
- University of Tartu, Tartu University Hospital, Tartu, Estonia
| | - Henrique Barros
- EPIUnit--Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
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23
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Bénin A, Blanc M, Chollat C, Jarreau PH, Goffinet F, Tsatsaris V, Delorme P. The cause of birth is associated with neonatal prognosis in late preterm singletons. J Gynecol Obstet Hum Reprod 2020; 49:101920. [PMID: 32971309 DOI: 10.1016/j.jogoh.2020.101920] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/17/2020] [Accepted: 09/18/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Recent studies have shown that the cause of very preterm births may be related to neonatal morbidity and mortality. Even though these risks are lower among late preterm births, this group accounts for the vast majority of all preterm births. The objective of this study was to evaluate the relation of neonatal morbidity and mortality to the cause of late preterm birth. MATERIALS AND METHODS This retrospective observational cohort study included all women who gave birth to liveborn singletons from 34 to 36 weeks+6 days of gestation in a French level III maternity hospital in the 5-year period 2013-2017. The causes of preterm delivery were divided into 6 mutually exclusive groups. The main outcome was a composite neonatal morbidity criterion, defined by at least one among the following criteria: neonatal respiratory distress, neurological complications, neonatal sepsis, severe necrotizing enterocolitis, and neonatal hypoglycemia. We analyzed the association between cause of preterm delivery and neonatal morbidity after adjustment for gestational age and antenatal corticosteroid therapy. The reference group was preterm labor, defined by spontaneous preterm labor with intact membranes. RESULTS During the study period, there were a total of 27 110 births, including 1114 singleton births at 34 to 36 weeks of gestation + 6 days (4.1%). Among the 968 late preterm births included, the risk of neonatal morbidity in the group with preterm premature rupture of membranes (PPROM) was similar to that in the preterm labor (reference) group: adjusted odds ratio (aOR) 1.2 (95% CI, 0.8-1.8). All the other causes of late preterm birth were associated with a higher risk of neonatal morbidity than the reference group: aOR 2.0 [95% CI, 1.1-3.5] for hypertensive disorders without suspected fetal growth restriction (FGR) (9.1% of cases), aOR 2.4 [95% CI, 1.4-4.2] for hypertensive disorders with suspected FGR (8.9%), aOR 4.2 [95% CI, 2.2-8.0] for suspected FGR without hypertensive disorders (5.8%), and aOR 4.4 [95% CI, 2.2-8.8] for vaginal bleeding related to abnormal placental insertion (4.7%). CONCLUSION Among infants born from 34 to 36 weeks + 6 days of gestation, PPROM and preterm labor had similar risks of neonatal morbidity, while the other causes were associated with a risk of neonatal morbidity at least twice that with preterm labor.
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Affiliation(s)
- Amélie Bénin
- Maternité Port-Royal, AP-HP, APHP. Centre-Université de Paris, FHU PREMA, Paris, France(1).
| | - Matthieu Blanc
- Maternité Port-Royal, Service de réanimation néonatale, AP-HP, APHP. Centre-Université de Paris, Paris, France
| | - Clément Chollat
- Maternité Port-Royal, Service de réanimation néonatale, AP-HP, APHP. Centre-Université de Paris, Paris, France; INSERM U1245, Genetics and Pathophysiology of Neurodevelopmental Disorders, Team 4 Neovasc, Institute of Research and Innovation in Biomedicine, Normandy University, Rouen, France
| | - Pierre-Henri Jarreau
- Maternité Port-Royal, Service de réanimation néonatale, AP-HP, APHP. Centre-Université de Paris, Paris, France
| | - François Goffinet
- Maternité Port-Royal, AP-HP, APHP. Centre-Université de Paris, FHU PREMA, Paris, France(1); Université de Paris, INSERM U1153, Equipe de recherche en Epidémiologie Obstétricale, Périnatale et Pédiatrique (EPOPé), Centre de Recherche Epidémiologie et Biostatistique Sorbonne Paris Cité (CRESS), Paris, France
| | - Vassilis Tsatsaris
- Maternité Port-Royal, AP-HP, APHP. Centre-Université de Paris, FHU PREMA, Paris, France(1)
| | - Pierre Delorme
- Université de Paris, INSERM U1153, Equipe de recherche en Epidémiologie Obstétricale, Périnatale et Pédiatrique (EPOPé), Centre de Recherche Epidémiologie et Biostatistique Sorbonne Paris Cité (CRESS), Paris, France; Sorbonne Université, AP-HP, Department of Gynaecology and Obstetrics, Trousseau Hospital, Paris, France
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24
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Foissac F, Zheng Y, Hirt D, Lui G, Bouazza N, Ville Y, Goffinet F, Rozenberg P, Kayem G, Mandelbrot L, Benaboud S, Jarreau PH, Tréluyer JM. Maternal Betamethasone for Prevention of Respiratory Distress Syndrome in Neonates: Population Pharmacokinetic and Pharmacodynamic Approach. Clin Pharmacol Ther 2020; 108:1026-1035. [PMID: 32394434 DOI: 10.1002/cpt.1887] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 04/25/2020] [Indexed: 02/02/2023]
Abstract
Despite antenatal corticosteroids therapy, respiratory distress syndrome (RDS) is still a leading cause of neonatal morbidity and mortality in premature newborns. To date, the relationship between in utero fetal drug exposure and occurrence of RDS remains poorly evaluated. This study aims to describe the pharmacokinetics of betamethasone in pregnant women and to evaluate the transplacental drug transfer and administration scheme for the prevention of RDS. Pregnant women > 27 weeks' gestation and who received at least a single dose of betamethasone for prevention of RDS were enrolled. Maternal, cord blood, and amniotic fluid betamethasone time-courses were analyzed using the Monolix software. A total of 220 maternal blood, 56 cord blood, and 26 amniotic fluid samples were described by a two-compartment model with two effect compartments linked by rate transfer constants. Apparent clearances and volumes of distribution parameters were allometrically scaled for a 70 kg third trimester pregnant woman. The impact of a twin pregnancy was found to increase maternal clearance by 28%. Using a fetal-to-mother exposure ratio, the median (95% confidence interval (CI)) transplacental transfer of betamethasone was estimated to 35% (95% CI 0.11-0.67). After adjustment for gestational age and twin pregnancy, RDS was found to be associated to the time spent in utero below quantifiable concentrations (i.e., < 1 ng/mL): odds ratio of 1.10 (95% CI 1.01-1.19) per day increase (P < 0.05). Trying to take into account both efficacy and safety, we simulated different dosing schemes in order to maintain a maximum of fetuses above 1 ng/mL without exceeding the total standard dose.
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Affiliation(s)
- Frantz Foissac
- Pediatric and Perinatal Drug Evaluation and Pharmacology, Université de Paris, Paris, France.,URC/CIC Paris Descartes Necker Cochin, Necker-Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France.,CIC-1419 Inserm, Cochin-Necker, Paris, France
| | - Yi Zheng
- Pediatric and Perinatal Drug Evaluation and Pharmacology, Université de Paris, Paris, France.,Clinical Pharmacology Department, AP-HP Paris Centre Hospital Group, Paris, France
| | - Déborah Hirt
- Pediatric and Perinatal Drug Evaluation and Pharmacology, Université de Paris, Paris, France.,Clinical Pharmacology Department, AP-HP Paris Centre Hospital Group, Paris, France
| | - Gabrielle Lui
- Pediatric and Perinatal Drug Evaluation and Pharmacology, Université de Paris, Paris, France.,Clinical Pharmacology Department, AP-HP Paris Centre Hospital Group, Paris, France
| | - Naïm Bouazza
- Pediatric and Perinatal Drug Evaluation and Pharmacology, Université de Paris, Paris, France.,URC/CIC Paris Descartes Necker Cochin, Necker-Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France.,CIC-1419 Inserm, Cochin-Necker, Paris, France
| | - Yves Ville
- Maternity, Hôpital Necker - Enfants Malades, AP-HP, Paris, France.,EA 7328, Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - François Goffinet
- Port-Royal Maternity Unit, Cochin Hospital, AP-HP, Paris, France.,Obstetrical, Perinatal, and Pediatric Epidemiology Team and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM and Université Paris Descartes, Paris, France
| | - Patrick Rozenberg
- Department of Gynecology and Obstetrics, Poissy-Saint Germain Hospital, Poissy, France.,EA 7285, Paris Saclay University, Montigny-Le-Bretonneux, France
| | - Gilles Kayem
- Obstetrical, Perinatal, and Pediatric Epidemiology Team and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM and Université Paris Descartes, Paris, France.,Department of Obstetrics and Gynecology, Trousseau Hospital, AP-HP, Paris, France
| | - Laurent Mandelbrot
- Department of Obstetrics and Gynecology, Louis Mourier Hospital, AP-HP, Colombes, France.,INSERM, IAME, UMR 1137, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Sihem Benaboud
- Pediatric and Perinatal Drug Evaluation and Pharmacology, Université de Paris, Paris, France.,Clinical Pharmacology Department, AP-HP Paris Centre Hospital Group, Paris, France
| | - Pierre-Henri Jarreau
- Université de Paris, Neonatal Intensive Care Unit of Port-Royal, Paris Centre University Hospitals, APHP, Paris, France.,Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
| | - Jean-Marc Tréluyer
- Pediatric and Perinatal Drug Evaluation and Pharmacology, Université de Paris, Paris, France.,URC/CIC Paris Descartes Necker Cochin, Necker-Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France.,CIC-1419 Inserm, Cochin-Necker, Paris, France.,Clinical Pharmacology Department, AP-HP Paris Centre Hospital Group, Paris, France
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25
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Nuytten A, Behal H, Duhamel A, Jarreau PH, Torchin H, Milligan D, Maier RF, Zemlin M, Zeitlin J, Truffert P. Postnatal Corticosteroids Policy for Very Preterm Infants and Bronchopulmonary Dysplasia. Neonatology 2020; 117:308-315. [PMID: 32454484 DOI: 10.1159/000507195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 12/18/2019] [Accepted: 03/10/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Postnatal corticosteroids (PNC) are effective for reducing bronchopulmonary dysplasia (BPD) in very preterm neonates but are associated with adverse effects including an increased risk of cerebral palsy. PNC use in Europe is heterogeneous across regions. This study aimed to assess whether European neonatal intensive care units (NICUs) with a low use of PNC or an explicit policy to reduce PNC use had higher risks of mortality or BPD. METHODS We included 3,126 infants in 105 NICUs born between 24 + 0 and 29 + 6 weeks' gestational age in 19 regions in 11 countries in the EPICE cohort. First, we identified clusters of NICUs using hierarchical clustering based on PNC use and BPD prevalence and compared case mix and mortality between the clusters. Second, a multilevel analysis was performed to evaluate the association between a restrictive PNC policy and BPD occurrence. RESULTS There were 3 clusters of NICUs: 52 with low PNC use and a low BPD rate, 37 with low PNC use and a high BPD rate, and 16 with high PNC use and a medium BPD rate. Neonatal mortality did not differ between clusters (p = 0.88). A unit policy of restricted PNC use was not associated with a higher risk of BPD (odds ratio 0.68; 95% confidence interval: 0.45-1.03) after adjustment. CONCLUSION Up to 49% of NICUs had low PNC use and low BPD rates, without a difference in mortality. Infants hospitalized in NICUs with a stated policy of low PNC use did not have an increased risk of BPD.
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Affiliation(s)
- Alexandra Nuytten
- Department of Neonatology, Jeanne de Flandre Hospital, Lille CHRU, Lille, France,
- Université Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, France,
| | - Hélène Behal
- Université Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, France
| | - Alain Duhamel
- Université Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, France
| | - Pierre-Henri Jarreau
- Université Paris Descartes and Assistance Publique Hôpitaux de Paris, Hôpitaux Universitaire Paris Centre Site Cochin, Service de Médecine et Réanimation néonatales de Port-Royal, Paris, France
- Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (Epopé), INSERM UMR 1153, Center for Epidemiology and Biostatistics Sorbonne Paris Cité, Paris Descartes University, Paris, France
| | - Heloïse Torchin
- Université Paris Descartes and Assistance Publique Hôpitaux de Paris, Hôpitaux Universitaire Paris Centre Site Cochin, Service de Médecine et Réanimation néonatales de Port-Royal, Paris, France
- Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (Epopé), INSERM UMR 1153, Center for Epidemiology and Biostatistics Sorbonne Paris Cité, Paris Descartes University, Paris, France
| | | | - Rolf F Maier
- Children's Hospital, University Hospital, Philipps University Marburg, Marburg, Germany
| | - Michael Zemlin
- Department for General Pediatrics and Neonatology, Saarland University, Homburg, Germany
| | - Jennifer Zeitlin
- Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (Epopé), INSERM UMR 1153, Center for Epidemiology and Biostatistics Sorbonne Paris Cité, Paris Descartes University, Paris, France
| | - Patrick Truffert
- Department of Neonatology, Jeanne de Flandre Hospital, Lille CHRU, Lille, France
- Université Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, France
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26
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Reed RA, Morgan AS, Zeitlin J, Jarreau PH, Torchin H, Pierrat V, Ancel PY, Khoshnood B. Machine-Learning vs. Expert-Opinion Driven Logistic Regression Modelling for Predicting 30-Day Unplanned Rehospitalisation in Preterm Babies: A Prospective, Population-Based Study (EPIPAGE 2). Front Pediatr 2020; 8:585868. [PMID: 33614539 PMCID: PMC7886676 DOI: 10.3389/fped.2020.585868] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 12/29/2020] [Indexed: 11/28/2022] Open
Abstract
Introduction: Preterm babies are a vulnerable population that experience significant short and long-term morbidity. Rehospitalisations constitute an important, potentially modifiable adverse event in this population. Improving the ability of clinicians to identify those patients at the greatest risk of rehospitalisation has the potential to improve outcomes and reduce costs. Machine-learning algorithms can provide potentially advantageous methods of prediction compared to conventional approaches like logistic regression. Objective: To compare two machine-learning methods (least absolute shrinkage and selection operator (LASSO) and random forest) to expert-opinion driven logistic regression modelling for predicting unplanned rehospitalisation within 30 days in a large French cohort of preterm babies. Design, Setting and Participants: This study used data derived exclusively from the population-based prospective cohort study of French preterm babies, EPIPAGE 2. Only those babies discharged home alive and whose parents completed the 1-year survey were eligible for inclusion in our study. All predictive models used a binary outcome, denoting a baby's status for an unplanned rehospitalisation within 30 days of discharge. Predictors included those quantifying clinical, treatment, maternal and socio-demographic factors. The predictive abilities of models constructed using LASSO and random forest algorithms were compared with a traditional logistic regression model. The logistic regression model comprised 10 predictors, selected by expert clinicians, while the LASSO and random forest included 75 predictors. Performance measures were derived using 10-fold cross-validation. Performance was quantified using area under the receiver operator characteristic curve, sensitivity, specificity, Tjur's coefficient of determination and calibration measures. Results: The rate of 30-day unplanned rehospitalisation in the eligible population used to construct the models was 9.1% (95% CI 8.2-10.1) (350/3,841). The random forest model demonstrated both an improved AUROC (0.65; 95% CI 0.59-0.7; p = 0.03) and specificity vs. logistic regression (AUROC 0.57; 95% CI 0.51-0.62, p = 0.04). The LASSO performed similarly (AUROC 0.59; 95% CI 0.53-0.65; p = 0.68) to logistic regression. Conclusions: Compared to an expert-specified logistic regression model, random forest offered improved prediction of 30-day unplanned rehospitalisation in preterm babies. However, all models offered relatively low levels of predictive ability, regardless of modelling method.
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Affiliation(s)
- Robert A Reed
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, Paris, France
| | - Andrei S Morgan
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, Paris, France.,Elizabeth Garrett Anderson Institute for Womens' Health, University College London (UCL), London, United Kingdom.,SAMU 93, SMUR Pédiatrique, CHI André Gregoire, Groupe Hospitalier Universitaire Paris Seine-Saint-Denis, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Jennifer Zeitlin
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, Paris, France
| | - Pierre-Henri Jarreau
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, Paris, France.,APHP.5, Service de Médecine et Réanimation Néonatales de Port-Royal, Paris, France
| | - Héloïse Torchin
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, Paris, France.,APHP.5, Service de Médecine et Réanimation Néonatales de Port-Royal, Paris, France
| | - Véronique Pierrat
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, Paris, France.,CHU Lille, Department of Neonatal Medicine, Jeanne de Flandre Lille, France
| | - Pierre-Yves Ancel
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, Paris, France.,Clinical Research Unit, Center for Clinical Investigation P1419, APHP.5, Paris, France
| | - Babak Khoshnood
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, Paris, France
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27
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Reed RA, Morgan AS, Zeitlin J, Jarreau PH, Torchin H, Pierrat V, Ancel PY, Khoshnood B. Assessing the risk of early unplanned rehospitalisation in preterm babies: EPIPAGE 2 study. BMC Pediatr 2019; 19:451. [PMID: 31752782 PMCID: PMC6870221 DOI: 10.1186/s12887-019-1827-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 11/08/2019] [Indexed: 11/29/2022] Open
Abstract
Background Gaining a better understanding of the probability, timing and prediction of rehospitalisation amongst preterm babies could help improve outcomes. There is limited research addressing these topics amongst extremely and very preterm babies. In this context, unplanned rehospitalisations constitute an important, potentially modifiable adverse event. We aimed to establish the probability, time-distribution and predictability of unplanned rehospitalisation within 30 days of discharge in a population of French preterm babies. Methods This study used data from EPIPAGE 2, a population-based prospective study of French preterm babies. Only those babies discharged home alive and whose parents responded to the one-year survey were eligible for inclusion in our study. For Kaplan-Meier analysis, the outcome was unplanned rehospitalisation censored at 30 days. For predictive modelling, the outcome was binary, recording unplanned rehospitalisation within 30 days of discharge. Predictors included routine clinical variables selected based on expert opinion. Results Of 3841 eligible babies, 350 (9.1, 95% CI 8.2–10.1) experienced an unplanned rehospitalisation within 30 days. The probability of rehospitalisation progressed at a consistent rate over the 30 days. There were significant differences in rehospitalisation probability by gestational age. The cross-validated performance of a ten predictor model demonstrated low discrimination and calibration. The area under the receiver operating characteristic curve was 0.62 (95% CI 0.59–0.65). Conclusions Unplanned rehospitalisation within 30 days of discharge was infrequent and the probability of rehospitalisation progressed at a consistent rate. Lower gestational age increased the probability of rehospitalisation. Predictive models comprised of clinically important variables had limited predictive ability.
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Affiliation(s)
- Robert Anthony Reed
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, F-75004, Paris, France
| | - Andrei Scott Morgan
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, F-75004, Paris, France. .,Elizabeth Garrett Anderson Institute for Womens' Health, UCL, London, UK. .,SAMU 93, SMUR Pédiatrique, CHI André Gregoire, Groupe Hospitalier Universitaire Paris Seine-Saint-Denis, Assistance Publique des Hôpitaux de Paris, Paris, France.
| | - Jennifer Zeitlin
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, F-75004, Paris, France
| | - Pierre-Henri Jarreau
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, F-75004, Paris, France.,APHP.5, Service de Médecine et Réanimation Néonatales de Port-Royal, Paris, France
| | - Héloïse Torchin
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, F-75004, Paris, France.,APHP.5, Service de Médecine et Réanimation Néonatales de Port-Royal, Paris, France
| | - Véronique Pierrat
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, F-75004, Paris, France.,Department of Neonatal Medicine, CHU Lille, Jeanne de Flandre, Lille, France
| | - Pierre-Yves Ancel
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, F-75004, Paris, France.,Clinical Research Unit, Center for Clinical Investigation P1419, APHP.5, F-75014, Paris, France
| | - Babak Khoshnood
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, F-75004, Paris, France
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28
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Torchin H, Combarel D, Aubelle MS, Lopez C, Dubray L, El Ayoubi M, Tsatsaris V, Jarreau PH, Guibourdenche J, Zana-Taïeb E. Association of serum angiogenic factors with bronchopulmonary dysplasia. The ANGIODYS cohort study. Pregnancy Hypertens 2019; 18:82-87. [PMID: 31577982 DOI: 10.1016/j.preghy.2019.09.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 08/20/2019] [Accepted: 09/21/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Angiogenic factors may be involved in lung development. To evaluate the relations between maternal and cord blood angiogenic factors (sFlt-1, placental growth factor [PlGF], soluble endogline [sEng], transforming growth factor β [TGF-beta]) and their association with moderate and severe bronchopulmonary dysplasia (BPD) in very preterm growth-restricted infants. STUDY DESIGN Prospective monocentric cohort study. Twenty-four mother-child dyads featuring antepartum preeclampsia, intra-uterine growth restriction (IUGR) and birth before 30 weeks' gestation were included. This ensured a 80% power to test whether sFlt-1 maternal levels would be twice as high in cases of BPD as in the absence of BPD. MAIN OUTCOME MEASURES Four pro/anti-angiogenic factors from two pathways (sFlt-1, PlGF and sEng, TGF-beta) were measured in maternal serum before delivery (at the time of hospitalization or the day of birth) and in neonates' cord blood. Neonatal outcome was moderate to severe BPD, defined as oxygen requirement for at least 28 days and persistent need for oxygen or ventilatory support at 36 weeks' postmenstrual age. RESULTS sFlt-1 levels were positively correlated in maternal serum and cord blood (rs = 0.83, p < .001) but levels of PlGF and TGF-beta and its receptor sEng were not. Among all the factors studied in cord and maternal blood, none was associated with BPD. CONCLUSIONS In IUGR preterm babies born before 30 weeks' gestation from preeclamptic mothers, serum sFlt-1, PlGF and sEng, TGF-β levels were not correlated with BPD. The increased BPD risk in preterm neonates born from preeclamptic mothers cannot be related to high sFlt-1 levels.
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Affiliation(s)
- Héloïse Torchin
- Service de Médecine et Réanimation néonatales de Port Royal, 53 avenue de l'Observatoire, 75014 Paris, France; Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, F-75004 Paris, France.
| | - David Combarel
- Assistance Publique - Hopitaux de Paris, Service d'hormonologie, Paris, Île-de-France, France
| | - Marie-Stéphanie Aubelle
- Service de Médecine et Réanimation néonatales de Port Royal, 53 avenue de l'Observatoire, 75014 Paris, France
| | - Clémence Lopez
- Service de Médecine et Réanimation néonatales de Port Royal, 53 avenue de l'Observatoire, 75014 Paris, France
| | - Lauréline Dubray
- Service de Médecine et Réanimation néonatales de Port Royal, 53 avenue de l'Observatoire, 75014 Paris, France
| | - Mayass El Ayoubi
- Service de Médecine et Réanimation néonatales de Port Royal, 53 avenue de l'Observatoire, 75014 Paris, France; Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, F-75004 Paris, France
| | - Vassilis Tsatsaris
- Assistance Publique - Hopitaux de Paris, Hopital Cochin Maternité Port Royal, Paris, Île-de-France, France; INSERM UMR_S1139, Paris, France
| | - Pierre-Henri Jarreau
- Service de Médecine et Réanimation néonatales de Port Royal, 53 avenue de l'Observatoire, 75014 Paris, France; Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, F-75004 Paris, France
| | - Jean Guibourdenche
- Assistance Publique - Hopitaux de Paris, Service d'hormonologie, Paris, Île-de-France, France; INSERM UMR_S1139, Paris, France
| | - Elodie Zana-Taïeb
- Service de Médecine et Réanimation néonatales de Port Royal, 53 avenue de l'Observatoire, 75014 Paris, France; INSERM, U1141, Hopital Robert Debré, 75019 Paris, Île-de-France, France
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Tournoud C, Capaldo L, Garnier R, Gnansia E, Jarreau PH, Moesch C, Nisse P, Quénel P, Yazbeck C, Labadie M. Recommandations de bonne pratique sur la prise en charge des femmes enceintes exposées au mercure organique et leurs enfants à naître. Recommandations de la Société de toxicologie clinique, associée à la Société française de toxicologie analytique, à la Société française de santé publique, à la Société francophone de santé environnement, à la Société française de pédiatrie, à la Société française de néonatalogie, au Collège national des gynécologues obstétriciens. Toxicologie Analytique et Clinique 2019. [DOI: 10.1016/j.toxac.2019.02.004] [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: 10/27/2022]
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Chollat C, Maroni A, Aubelle MS, Guillier C, Patkai J, Zana-Taïeb E, Keslick A, Torchin H, Jarreau PH. Efficacy and Safety Aspects of Remifentanil Sedation for Intubation in Neonates: A Retrospective Study. Front Pediatr 2019; 7:450. [PMID: 31788457 PMCID: PMC6853995 DOI: 10.3389/fped.2019.00450] [Citation(s) in RCA: 3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/17/2019] [Indexed: 01/05/2023] Open
Abstract
Objective: To evaluate the efficacy and safety of remifentanil as a premedication in neonates undergoing elective intubation. Study Design: This retrospective study focused on neonates admitted to the Neonatal Intensive Care Unit of Port-Royal, Paris Centre University Hospitals, France, between June 2016 and November 2017, who received remifentanil before an elective intubation. First, atropine (10 μg/kg) was administered intravenously as a bolus, followed by remifentanil, which was administrated continuously. The dose of remifentanil was reduced twice during the study period in order to administer the minimum effective dose and thus reduce possible adverse events. Results: Fifty-four neonates were exposed to remifentanil and atropine. The intubating conditions were excellent or good for 46 procedures (85%) and the median Acute Pain in Newborn Infants score was 2 (IQ 25-75: 0-5) before the sedation, 1 (0-2) during the laryngoscopy, and 0 (0-0) after the intubation. The intubation was successful at the first attempt for 18 patients (33%). Chest wall rigidity occurred in 6 procedures (11%), other respiratory problems in 5 (9%), and laryngospasm in 1 (2%). Some of the procedures were complicated by bradycardia (23%) or desaturation (37%). Conclusions: Remifentanil and atropine prior to intubation provided satisfactory intubating conditions in neonates. Nevertheless, severe adverse effects (such as chest wall rigidity) are a potential risk, possibly related to the total dose received. These data do not support the safety of using remifentanil alone prior to intubation in neonates.
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Affiliation(s)
- Clément Chollat
- Neonatal Intensive Care Unit of Port-Royal, Paris Centre University Hospitals, APHP, Paris Descartes University, Paris, France
| | - Arielle Maroni
- Neonatal Intensive Care Unit of Port-Royal, Paris Centre University Hospitals, APHP, Paris Descartes University, Paris, France
| | - Marie-Stéphanie Aubelle
- Neonatal Intensive Care Unit of Port-Royal, Paris Centre University Hospitals, APHP, Paris Descartes University, Paris, France
| | - Cyril Guillier
- Neonatal Intensive Care Unit of Port-Royal, Paris Centre University Hospitals, APHP, Paris Descartes University, Paris, France
| | - Juliana Patkai
- Neonatal Intensive Care Unit of Port-Royal, Paris Centre University Hospitals, APHP, Paris Descartes University, Paris, France
| | - Elodie Zana-Taïeb
- Neonatal Intensive Care Unit of Port-Royal, Paris Centre University Hospitals, APHP, Paris Descartes University, Paris, France
| | - Aurélie Keslick
- Neonatal Intensive Care Unit of Port-Royal, Paris Centre University Hospitals, APHP, Paris Descartes University, Paris, France
| | - Héloïse Torchin
- Neonatal Intensive Care Unit of Port-Royal, Paris Centre University Hospitals, APHP, Paris Descartes University, Paris, France
| | - Pierre-Henri Jarreau
- Neonatal Intensive Care Unit of Port-Royal, Paris Centre University Hospitals, APHP, Paris Descartes University, Paris, France
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Moitry M, Zarca K, Granier M, Aubelle MS, Charrier N, Vacherot B, Caputo G, Mimouni M, Jarreau PH, Durand-Zaleski I. Effectiveness and efficiency of tele-expertise for improving access to retinopathy screening among 351 neonates in a secondary care center: An observational, controlled before-after study. PLoS One 2018; 13:e0206375. [PMID: 30365544 PMCID: PMC6203387 DOI: 10.1371/journal.pone.0206375] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 10/11/2018] [Indexed: 11/19/2022] Open
Abstract
In France, secondary care hospitals encounter difficulties to adhere to retinopathy of prematurity (ROP) screening guidelines. Our objective was to assess the effectiveness and efficacy of a tele-expertise program for ROP screening in neonatal intensive care units without on-site ophthalmologists. We evaluated the impact of a tele-expertise program funded by the Paris Region Health Authority in a secondary care center general hospital of the Paris Region (CHSF), where there was previously no on-site ophthalmologist. We performed an observational, controlled before-after study, with a university tertiary care center with on-site ophthalmologists (Port-Royal) as the control group. Recruitment and data collection for both periods took place from 1 January 2012 to 31 December 31 2012, and from 1 January 2014 to 31 March 2015. The primary endpoint was the percentage of compliance with screening guidelines, secondary endpoints included pain scores and costs. Over the two periods, at total of 351 infants were recruited in the CHSF. Implementation of the tele-expertise resulted in an absolute +57.3% increase in the proportion of examinations realized in accordance with guidelines (3.8% during the "before" period and 61.1% during the "after" period, p<0.001). As compared with the control group, the proportion of infants appropriately screened improved (57.5% versus 43.1%, p = 0.002); median pain score on the acute pain rating scale for neonates during examination was significantly higher (median score 5.5/10, range [2.5-5.7] versus 2.0/10, range [1.0-3.1], p = 0.002). Screening rates in the control group remained unchanged. The average cost per examination increased from €337 in the "before" period to €353 in the "after period" in the tele-expertise group. The implementation of tele-expertise for ROP screening in the CHSF medical center resulted in a major improvement of access to care with a small cost increase. The issue of pain control during examination with tele-expertise should be further addressed.
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Affiliation(s)
- Marie Moitry
- Laboratoire d’Épidémiologie et de Santé Publique, Strasbourg, France
- Service de Santé Publique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Kevin Zarca
- Assistance Publique-Hôpitaux de Paris, DRCD-URC Eco Ile-de-France (AP-HP), Paris, France
- Assistance Publique-Hôpitaux de Paris, service de santé publique, Henri Mondor-Albert- Chenevier, Créteil, France
| | - Michèle Granier
- Service de réanimation néonatale, Hôpitaux Sud Francilien, Evry, France
| | - Marie-Stéphanie Aubelle
- Service de Médecine et Réanimation Néonatales de Port-Royal, Assistance Publique, Hôpitaux de Paris, Hôpital Cochin, Paris, France
- DHU Risques et grossesse, Université Paris Descartes, Paris, France
| | | | - Brigitte Vacherot
- Service de Médecine et Réanimation Néonatales de Port-Royal, Assistance Publique, Hôpitaux de Paris, Hôpital Cochin, Paris, France
| | - Georges Caputo
- Service d’ophtalmologie pédiatrique, Fondation Rothschild, Paris, France
| | - Maroua Mimouni
- Assistance Publique-Hôpitaux de Paris, DRCD-URC Eco Ile-de-France (AP-HP), Paris, France
| | - Pierre-Henri Jarreau
- Service de Médecine et Réanimation Néonatales de Port-Royal, Assistance Publique, Hôpitaux de Paris, Hôpital Cochin, Paris, France
- DHU Risques et grossesse, Université Paris Descartes, Paris, France
| | - Isabelle Durand-Zaleski
- Assistance Publique-Hôpitaux de Paris, DRCD-URC Eco Ile-de-France (AP-HP), Paris, France
- Assistance Publique-Hôpitaux de Paris, service de santé publique, Henri Mondor-Albert- Chenevier, Créteil, France
- Faculté de Médecine, Université Paris-Est & ECEVE UMRS, Créteil, France
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Bassler D, Shinwell ES, Hallman M, Jarreau PH, Plavka R, Carnielli V, Meisner C, Engel C, Koch A, Kreutzer K, van den Anker JN, Schwab M, Halliday HL, Poets CF. Long-Term Effects of Inhaled Budesonide for Bronchopulmonary Dysplasia. N Engl J Med 2018; 378:148-157. [PMID: 29320647 DOI: 10.1056/nejmoa1708831] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The long-term effects on neurodevelopment of the use of inhaled glucocorticoids in extremely preterm infants for the prevention or treatment of bronchopulmonary dysplasia are uncertain. METHODS We randomly assigned 863 infants (gestational age, 23 weeks 0 days to 27 weeks 6 days) to receive early (within 24 hours after birth) inhaled budesonide or placebo. The prespecified secondary long-term outcome was neurodevelopmental disability among survivors, defined as a composite of cerebral palsy, cognitive delay (a Mental Development Index score of <85 [1 SD below the mean of 100] on the Bayley Scales of Infant Development, Second Edition, with higher scores on the scale indicating better performance), deafness, or blindness at a corrected age of 18 to 22 months. RESULTS Adequate data on the prespecified composite long-term outcome were available for 629 infants. Of these infants, 148 (48.1%) of 308 infants assigned to budesonide had neurodevelopmental disability, as compared with 165 (51.4%) of 321 infants assigned to placebo (relative risk, adjusted for gestational age, 0.93; 95% confidence interval [CI], 0.80 to 1.09; P=0.40). There was no significant difference in any of the individual components of the prespecified outcome. There were more deaths in the budesonide group than in the placebo group (82 [19.9%] of 413 infants vs. 58 [14.5%] of 400 infants for whom vital status was available; relative risk, 1.37; 95% CI, 1.01 to 1.86; P=0.04). CONCLUSIONS Among surviving extremely preterm infants, the rate of neurodevelopmental disability at 2 years did not differ significantly between infants who received early inhaled budesonide for the prevention of bronchopulmonary dysplasia and those who received placebo, but the mortality rate was higher among those who received budesonide. (Funded by the European Union and Chiesi Farmaceutici; ClinicalTrials.gov number, NCT01035190 .).
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Affiliation(s)
- Dirk Bassler
- From the Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich (D.B.), and the Division of Pediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Basel (J.N.A.) - both in Switzerland; Ziv Medical Center, Faculty of Medicine in the Galilee, Bar-Ilan University, Ramat Gan, Israel (E.S.S.); the Department of Children and Adolescents, Oulu University Hospital, and PEDEGO Research Unit, Medical Research Center Oulu, University of Oulu, Oulu, Finland (M.H.); Assistance Publique-Hôpitaux de Paris, Département Hospitalo-Universitaire Risques et Grossesse, Université Paris Descartes, Hôpital Cochin, Service de Médecine et Réanimation Néonatales de Port-Royal, Paris (P.-H.J.); Charles University, General Faculty Hospital and 1st Faculty of Medicine in Prague, Prague, Czech Republic (R.P.); Polytechnical University of Marche, Salesi Children's Hospital, Ancona, Italy (V.C.); Institute for Clinical Epidemiology and Applied Biometry (C.M.), University Children's Hospital Tübingen, Center for Pediatric Clinical Studies (C.E.), Department of Neonatology, University Children's Hospital (A.K., K.K., C.F.P.), and Department of Clinical Pharmacology and Department of Pharmacy and Biochemistry, University Hospital and University of Tübingen (M.S.), Tübingen, and Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart (M.S.) - all in Germany; Intensive Care and Department of Pediatric Surgery, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands (J.N.A.); the Division of Clinical Pharmacology, Children's National Health System, Washington, DC (J.N.A.); and the Department of Child Health at Queen's University Belfast, Institute of Clinical Science, Belfast, United Kingdom (H.L.H.)
| | - Eric S Shinwell
- From the Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich (D.B.), and the Division of Pediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Basel (J.N.A.) - both in Switzerland; Ziv Medical Center, Faculty of Medicine in the Galilee, Bar-Ilan University, Ramat Gan, Israel (E.S.S.); the Department of Children and Adolescents, Oulu University Hospital, and PEDEGO Research Unit, Medical Research Center Oulu, University of Oulu, Oulu, Finland (M.H.); Assistance Publique-Hôpitaux de Paris, Département Hospitalo-Universitaire Risques et Grossesse, Université Paris Descartes, Hôpital Cochin, Service de Médecine et Réanimation Néonatales de Port-Royal, Paris (P.-H.J.); Charles University, General Faculty Hospital and 1st Faculty of Medicine in Prague, Prague, Czech Republic (R.P.); Polytechnical University of Marche, Salesi Children's Hospital, Ancona, Italy (V.C.); Institute for Clinical Epidemiology and Applied Biometry (C.M.), University Children's Hospital Tübingen, Center for Pediatric Clinical Studies (C.E.), Department of Neonatology, University Children's Hospital (A.K., K.K., C.F.P.), and Department of Clinical Pharmacology and Department of Pharmacy and Biochemistry, University Hospital and University of Tübingen (M.S.), Tübingen, and Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart (M.S.) - all in Germany; Intensive Care and Department of Pediatric Surgery, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands (J.N.A.); the Division of Clinical Pharmacology, Children's National Health System, Washington, DC (J.N.A.); and the Department of Child Health at Queen's University Belfast, Institute of Clinical Science, Belfast, United Kingdom (H.L.H.)
| | - Mikko Hallman
- From the Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich (D.B.), and the Division of Pediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Basel (J.N.A.) - both in Switzerland; Ziv Medical Center, Faculty of Medicine in the Galilee, Bar-Ilan University, Ramat Gan, Israel (E.S.S.); the Department of Children and Adolescents, Oulu University Hospital, and PEDEGO Research Unit, Medical Research Center Oulu, University of Oulu, Oulu, Finland (M.H.); Assistance Publique-Hôpitaux de Paris, Département Hospitalo-Universitaire Risques et Grossesse, Université Paris Descartes, Hôpital Cochin, Service de Médecine et Réanimation Néonatales de Port-Royal, Paris (P.-H.J.); Charles University, General Faculty Hospital and 1st Faculty of Medicine in Prague, Prague, Czech Republic (R.P.); Polytechnical University of Marche, Salesi Children's Hospital, Ancona, Italy (V.C.); Institute for Clinical Epidemiology and Applied Biometry (C.M.), University Children's Hospital Tübingen, Center for Pediatric Clinical Studies (C.E.), Department of Neonatology, University Children's Hospital (A.K., K.K., C.F.P.), and Department of Clinical Pharmacology and Department of Pharmacy and Biochemistry, University Hospital and University of Tübingen (M.S.), Tübingen, and Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart (M.S.) - all in Germany; Intensive Care and Department of Pediatric Surgery, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands (J.N.A.); the Division of Clinical Pharmacology, Children's National Health System, Washington, DC (J.N.A.); and the Department of Child Health at Queen's University Belfast, Institute of Clinical Science, Belfast, United Kingdom (H.L.H.)
| | - Pierre-Henri Jarreau
- From the Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich (D.B.), and the Division of Pediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Basel (J.N.A.) - both in Switzerland; Ziv Medical Center, Faculty of Medicine in the Galilee, Bar-Ilan University, Ramat Gan, Israel (E.S.S.); the Department of Children and Adolescents, Oulu University Hospital, and PEDEGO Research Unit, Medical Research Center Oulu, University of Oulu, Oulu, Finland (M.H.); Assistance Publique-Hôpitaux de Paris, Département Hospitalo-Universitaire Risques et Grossesse, Université Paris Descartes, Hôpital Cochin, Service de Médecine et Réanimation Néonatales de Port-Royal, Paris (P.-H.J.); Charles University, General Faculty Hospital and 1st Faculty of Medicine in Prague, Prague, Czech Republic (R.P.); Polytechnical University of Marche, Salesi Children's Hospital, Ancona, Italy (V.C.); Institute for Clinical Epidemiology and Applied Biometry (C.M.), University Children's Hospital Tübingen, Center for Pediatric Clinical Studies (C.E.), Department of Neonatology, University Children's Hospital (A.K., K.K., C.F.P.), and Department of Clinical Pharmacology and Department of Pharmacy and Biochemistry, University Hospital and University of Tübingen (M.S.), Tübingen, and Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart (M.S.) - all in Germany; Intensive Care and Department of Pediatric Surgery, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands (J.N.A.); the Division of Clinical Pharmacology, Children's National Health System, Washington, DC (J.N.A.); and the Department of Child Health at Queen's University Belfast, Institute of Clinical Science, Belfast, United Kingdom (H.L.H.)
| | - Richard Plavka
- From the Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich (D.B.), and the Division of Pediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Basel (J.N.A.) - both in Switzerland; Ziv Medical Center, Faculty of Medicine in the Galilee, Bar-Ilan University, Ramat Gan, Israel (E.S.S.); the Department of Children and Adolescents, Oulu University Hospital, and PEDEGO Research Unit, Medical Research Center Oulu, University of Oulu, Oulu, Finland (M.H.); Assistance Publique-Hôpitaux de Paris, Département Hospitalo-Universitaire Risques et Grossesse, Université Paris Descartes, Hôpital Cochin, Service de Médecine et Réanimation Néonatales de Port-Royal, Paris (P.-H.J.); Charles University, General Faculty Hospital and 1st Faculty of Medicine in Prague, Prague, Czech Republic (R.P.); Polytechnical University of Marche, Salesi Children's Hospital, Ancona, Italy (V.C.); Institute for Clinical Epidemiology and Applied Biometry (C.M.), University Children's Hospital Tübingen, Center for Pediatric Clinical Studies (C.E.), Department of Neonatology, University Children's Hospital (A.K., K.K., C.F.P.), and Department of Clinical Pharmacology and Department of Pharmacy and Biochemistry, University Hospital and University of Tübingen (M.S.), Tübingen, and Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart (M.S.) - all in Germany; Intensive Care and Department of Pediatric Surgery, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands (J.N.A.); the Division of Clinical Pharmacology, Children's National Health System, Washington, DC (J.N.A.); and the Department of Child Health at Queen's University Belfast, Institute of Clinical Science, Belfast, United Kingdom (H.L.H.)
| | - Virgilio Carnielli
- From the Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich (D.B.), and the Division of Pediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Basel (J.N.A.) - both in Switzerland; Ziv Medical Center, Faculty of Medicine in the Galilee, Bar-Ilan University, Ramat Gan, Israel (E.S.S.); the Department of Children and Adolescents, Oulu University Hospital, and PEDEGO Research Unit, Medical Research Center Oulu, University of Oulu, Oulu, Finland (M.H.); Assistance Publique-Hôpitaux de Paris, Département Hospitalo-Universitaire Risques et Grossesse, Université Paris Descartes, Hôpital Cochin, Service de Médecine et Réanimation Néonatales de Port-Royal, Paris (P.-H.J.); Charles University, General Faculty Hospital and 1st Faculty of Medicine in Prague, Prague, Czech Republic (R.P.); Polytechnical University of Marche, Salesi Children's Hospital, Ancona, Italy (V.C.); Institute for Clinical Epidemiology and Applied Biometry (C.M.), University Children's Hospital Tübingen, Center for Pediatric Clinical Studies (C.E.), Department of Neonatology, University Children's Hospital (A.K., K.K., C.F.P.), and Department of Clinical Pharmacology and Department of Pharmacy and Biochemistry, University Hospital and University of Tübingen (M.S.), Tübingen, and Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart (M.S.) - all in Germany; Intensive Care and Department of Pediatric Surgery, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands (J.N.A.); the Division of Clinical Pharmacology, Children's National Health System, Washington, DC (J.N.A.); and the Department of Child Health at Queen's University Belfast, Institute of Clinical Science, Belfast, United Kingdom (H.L.H.)
| | - Christoph Meisner
- From the Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich (D.B.), and the Division of Pediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Basel (J.N.A.) - both in Switzerland; Ziv Medical Center, Faculty of Medicine in the Galilee, Bar-Ilan University, Ramat Gan, Israel (E.S.S.); the Department of Children and Adolescents, Oulu University Hospital, and PEDEGO Research Unit, Medical Research Center Oulu, University of Oulu, Oulu, Finland (M.H.); Assistance Publique-Hôpitaux de Paris, Département Hospitalo-Universitaire Risques et Grossesse, Université Paris Descartes, Hôpital Cochin, Service de Médecine et Réanimation Néonatales de Port-Royal, Paris (P.-H.J.); Charles University, General Faculty Hospital and 1st Faculty of Medicine in Prague, Prague, Czech Republic (R.P.); Polytechnical University of Marche, Salesi Children's Hospital, Ancona, Italy (V.C.); Institute for Clinical Epidemiology and Applied Biometry (C.M.), University Children's Hospital Tübingen, Center for Pediatric Clinical Studies (C.E.), Department of Neonatology, University Children's Hospital (A.K., K.K., C.F.P.), and Department of Clinical Pharmacology and Department of Pharmacy and Biochemistry, University Hospital and University of Tübingen (M.S.), Tübingen, and Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart (M.S.) - all in Germany; Intensive Care and Department of Pediatric Surgery, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands (J.N.A.); the Division of Clinical Pharmacology, Children's National Health System, Washington, DC (J.N.A.); and the Department of Child Health at Queen's University Belfast, Institute of Clinical Science, Belfast, United Kingdom (H.L.H.)
| | - Corinna Engel
- From the Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich (D.B.), and the Division of Pediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Basel (J.N.A.) - both in Switzerland; Ziv Medical Center, Faculty of Medicine in the Galilee, Bar-Ilan University, Ramat Gan, Israel (E.S.S.); the Department of Children and Adolescents, Oulu University Hospital, and PEDEGO Research Unit, Medical Research Center Oulu, University of Oulu, Oulu, Finland (M.H.); Assistance Publique-Hôpitaux de Paris, Département Hospitalo-Universitaire Risques et Grossesse, Université Paris Descartes, Hôpital Cochin, Service de Médecine et Réanimation Néonatales de Port-Royal, Paris (P.-H.J.); Charles University, General Faculty Hospital and 1st Faculty of Medicine in Prague, Prague, Czech Republic (R.P.); Polytechnical University of Marche, Salesi Children's Hospital, Ancona, Italy (V.C.); Institute for Clinical Epidemiology and Applied Biometry (C.M.), University Children's Hospital Tübingen, Center for Pediatric Clinical Studies (C.E.), Department of Neonatology, University Children's Hospital (A.K., K.K., C.F.P.), and Department of Clinical Pharmacology and Department of Pharmacy and Biochemistry, University Hospital and University of Tübingen (M.S.), Tübingen, and Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart (M.S.) - all in Germany; Intensive Care and Department of Pediatric Surgery, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands (J.N.A.); the Division of Clinical Pharmacology, Children's National Health System, Washington, DC (J.N.A.); and the Department of Child Health at Queen's University Belfast, Institute of Clinical Science, Belfast, United Kingdom (H.L.H.)
| | - Alexander Koch
- From the Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich (D.B.), and the Division of Pediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Basel (J.N.A.) - both in Switzerland; Ziv Medical Center, Faculty of Medicine in the Galilee, Bar-Ilan University, Ramat Gan, Israel (E.S.S.); the Department of Children and Adolescents, Oulu University Hospital, and PEDEGO Research Unit, Medical Research Center Oulu, University of Oulu, Oulu, Finland (M.H.); Assistance Publique-Hôpitaux de Paris, Département Hospitalo-Universitaire Risques et Grossesse, Université Paris Descartes, Hôpital Cochin, Service de Médecine et Réanimation Néonatales de Port-Royal, Paris (P.-H.J.); Charles University, General Faculty Hospital and 1st Faculty of Medicine in Prague, Prague, Czech Republic (R.P.); Polytechnical University of Marche, Salesi Children's Hospital, Ancona, Italy (V.C.); Institute for Clinical Epidemiology and Applied Biometry (C.M.), University Children's Hospital Tübingen, Center for Pediatric Clinical Studies (C.E.), Department of Neonatology, University Children's Hospital (A.K., K.K., C.F.P.), and Department of Clinical Pharmacology and Department of Pharmacy and Biochemistry, University Hospital and University of Tübingen (M.S.), Tübingen, and Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart (M.S.) - all in Germany; Intensive Care and Department of Pediatric Surgery, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands (J.N.A.); the Division of Clinical Pharmacology, Children's National Health System, Washington, DC (J.N.A.); and the Department of Child Health at Queen's University Belfast, Institute of Clinical Science, Belfast, United Kingdom (H.L.H.)
| | - Karen Kreutzer
- From the Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich (D.B.), and the Division of Pediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Basel (J.N.A.) - both in Switzerland; Ziv Medical Center, Faculty of Medicine in the Galilee, Bar-Ilan University, Ramat Gan, Israel (E.S.S.); the Department of Children and Adolescents, Oulu University Hospital, and PEDEGO Research Unit, Medical Research Center Oulu, University of Oulu, Oulu, Finland (M.H.); Assistance Publique-Hôpitaux de Paris, Département Hospitalo-Universitaire Risques et Grossesse, Université Paris Descartes, Hôpital Cochin, Service de Médecine et Réanimation Néonatales de Port-Royal, Paris (P.-H.J.); Charles University, General Faculty Hospital and 1st Faculty of Medicine in Prague, Prague, Czech Republic (R.P.); Polytechnical University of Marche, Salesi Children's Hospital, Ancona, Italy (V.C.); Institute for Clinical Epidemiology and Applied Biometry (C.M.), University Children's Hospital Tübingen, Center for Pediatric Clinical Studies (C.E.), Department of Neonatology, University Children's Hospital (A.K., K.K., C.F.P.), and Department of Clinical Pharmacology and Department of Pharmacy and Biochemistry, University Hospital and University of Tübingen (M.S.), Tübingen, and Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart (M.S.) - all in Germany; Intensive Care and Department of Pediatric Surgery, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands (J.N.A.); the Division of Clinical Pharmacology, Children's National Health System, Washington, DC (J.N.A.); and the Department of Child Health at Queen's University Belfast, Institute of Clinical Science, Belfast, United Kingdom (H.L.H.)
| | - Johannes N van den Anker
- From the Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich (D.B.), and the Division of Pediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Basel (J.N.A.) - both in Switzerland; Ziv Medical Center, Faculty of Medicine in the Galilee, Bar-Ilan University, Ramat Gan, Israel (E.S.S.); the Department of Children and Adolescents, Oulu University Hospital, and PEDEGO Research Unit, Medical Research Center Oulu, University of Oulu, Oulu, Finland (M.H.); Assistance Publique-Hôpitaux de Paris, Département Hospitalo-Universitaire Risques et Grossesse, Université Paris Descartes, Hôpital Cochin, Service de Médecine et Réanimation Néonatales de Port-Royal, Paris (P.-H.J.); Charles University, General Faculty Hospital and 1st Faculty of Medicine in Prague, Prague, Czech Republic (R.P.); Polytechnical University of Marche, Salesi Children's Hospital, Ancona, Italy (V.C.); Institute for Clinical Epidemiology and Applied Biometry (C.M.), University Children's Hospital Tübingen, Center for Pediatric Clinical Studies (C.E.), Department of Neonatology, University Children's Hospital (A.K., K.K., C.F.P.), and Department of Clinical Pharmacology and Department of Pharmacy and Biochemistry, University Hospital and University of Tübingen (M.S.), Tübingen, and Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart (M.S.) - all in Germany; Intensive Care and Department of Pediatric Surgery, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands (J.N.A.); the Division of Clinical Pharmacology, Children's National Health System, Washington, DC (J.N.A.); and the Department of Child Health at Queen's University Belfast, Institute of Clinical Science, Belfast, United Kingdom (H.L.H.)
| | - Matthias Schwab
- From the Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich (D.B.), and the Division of Pediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Basel (J.N.A.) - both in Switzerland; Ziv Medical Center, Faculty of Medicine in the Galilee, Bar-Ilan University, Ramat Gan, Israel (E.S.S.); the Department of Children and Adolescents, Oulu University Hospital, and PEDEGO Research Unit, Medical Research Center Oulu, University of Oulu, Oulu, Finland (M.H.); Assistance Publique-Hôpitaux de Paris, Département Hospitalo-Universitaire Risques et Grossesse, Université Paris Descartes, Hôpital Cochin, Service de Médecine et Réanimation Néonatales de Port-Royal, Paris (P.-H.J.); Charles University, General Faculty Hospital and 1st Faculty of Medicine in Prague, Prague, Czech Republic (R.P.); Polytechnical University of Marche, Salesi Children's Hospital, Ancona, Italy (V.C.); Institute for Clinical Epidemiology and Applied Biometry (C.M.), University Children's Hospital Tübingen, Center for Pediatric Clinical Studies (C.E.), Department of Neonatology, University Children's Hospital (A.K., K.K., C.F.P.), and Department of Clinical Pharmacology and Department of Pharmacy and Biochemistry, University Hospital and University of Tübingen (M.S.), Tübingen, and Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart (M.S.) - all in Germany; Intensive Care and Department of Pediatric Surgery, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands (J.N.A.); the Division of Clinical Pharmacology, Children's National Health System, Washington, DC (J.N.A.); and the Department of Child Health at Queen's University Belfast, Institute of Clinical Science, Belfast, United Kingdom (H.L.H.)
| | - Henry L Halliday
- From the Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich (D.B.), and the Division of Pediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Basel (J.N.A.) - both in Switzerland; Ziv Medical Center, Faculty of Medicine in the Galilee, Bar-Ilan University, Ramat Gan, Israel (E.S.S.); the Department of Children and Adolescents, Oulu University Hospital, and PEDEGO Research Unit, Medical Research Center Oulu, University of Oulu, Oulu, Finland (M.H.); Assistance Publique-Hôpitaux de Paris, Département Hospitalo-Universitaire Risques et Grossesse, Université Paris Descartes, Hôpital Cochin, Service de Médecine et Réanimation Néonatales de Port-Royal, Paris (P.-H.J.); Charles University, General Faculty Hospital and 1st Faculty of Medicine in Prague, Prague, Czech Republic (R.P.); Polytechnical University of Marche, Salesi Children's Hospital, Ancona, Italy (V.C.); Institute for Clinical Epidemiology and Applied Biometry (C.M.), University Children's Hospital Tübingen, Center for Pediatric Clinical Studies (C.E.), Department of Neonatology, University Children's Hospital (A.K., K.K., C.F.P.), and Department of Clinical Pharmacology and Department of Pharmacy and Biochemistry, University Hospital and University of Tübingen (M.S.), Tübingen, and Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart (M.S.) - all in Germany; Intensive Care and Department of Pediatric Surgery, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands (J.N.A.); the Division of Clinical Pharmacology, Children's National Health System, Washington, DC (J.N.A.); and the Department of Child Health at Queen's University Belfast, Institute of Clinical Science, Belfast, United Kingdom (H.L.H.)
| | - Christian F Poets
- From the Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich (D.B.), and the Division of Pediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Basel (J.N.A.) - both in Switzerland; Ziv Medical Center, Faculty of Medicine in the Galilee, Bar-Ilan University, Ramat Gan, Israel (E.S.S.); the Department of Children and Adolescents, Oulu University Hospital, and PEDEGO Research Unit, Medical Research Center Oulu, University of Oulu, Oulu, Finland (M.H.); Assistance Publique-Hôpitaux de Paris, Département Hospitalo-Universitaire Risques et Grossesse, Université Paris Descartes, Hôpital Cochin, Service de Médecine et Réanimation Néonatales de Port-Royal, Paris (P.-H.J.); Charles University, General Faculty Hospital and 1st Faculty of Medicine in Prague, Prague, Czech Republic (R.P.); Polytechnical University of Marche, Salesi Children's Hospital, Ancona, Italy (V.C.); Institute for Clinical Epidemiology and Applied Biometry (C.M.), University Children's Hospital Tübingen, Center for Pediatric Clinical Studies (C.E.), Department of Neonatology, University Children's Hospital (A.K., K.K., C.F.P.), and Department of Clinical Pharmacology and Department of Pharmacy and Biochemistry, University Hospital and University of Tübingen (M.S.), Tübingen, and Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart (M.S.) - all in Germany; Intensive Care and Department of Pediatric Surgery, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands (J.N.A.); the Division of Clinical Pharmacology, Children's National Health System, Washington, DC (J.N.A.); and the Department of Child Health at Queen's University Belfast, Institute of Clinical Science, Belfast, United Kingdom (H.L.H.)
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Dravet-Gounot P, Morin C, Jacques S, Dumont F, Ely-Marius F, Vaiman D, Jarreau PH, Méhats C, Zana-Taïeb E. Lung microRNA deregulation associated with impaired alveolarization in rats after intrauterine growth restriction. PLoS One 2017; 12:e0190445. [PMID: 29287116 PMCID: PMC5747455 DOI: 10.1371/journal.pone.0190445] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 12/14/2017] [Indexed: 12/14/2022] Open
Abstract
Intrauterine growth restriction (IUGR) was recently described as an independent risk factor of bronchopulmonary dysplasia, the main respiratory sequelae of preterm birth. We previously showed impaired alveolarization in rat pups born with IUGR induced by a low-protein diet (LPD) during gestation. We conducted a genome-wide analysis of gene expression and found the involvement of several pathways such as cell adhesion. Here, we describe our unbiased microRNA (miRNA) profiling by microarray assay and validation by qPCR at postnatal days 10 and 21 (P10 and P21) in lungs of rat pups with LPD-induced lung-alveolarization disorder after IUGR. We identified 13 miRNAs with more than two-fold differential expression between control lungs and LPD-induced IUGR lungs. Validated and predicted target genes of these miRNAs were related to “tissue repair” at P10 and “cellular communication regulation” at P21. We predicted the deregulation of several genes associated with these pathways. Especially, E2F3, a transcription factor involved in cell cycle control, was expressed in developing alveoli, and its mRNA and protein levels were significantly increased at P21 after IUGR. Hence, IUGR affects the expression of selected miRNAs during lung alveolarization. These results provide a basis for deciphering the mechanistic contributions of IUGR to impaired alveolarization.
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Affiliation(s)
- Pauline Dravet-Gounot
- Inserm, U1016, Institut Cochin, Paris, France
- CNRS, UMR8104, Paris, France
- Université Paris Descartes, Faculté de Médecine, Paris, France
- AP-HP, Maternité Port Royal, Service de Médecine et Réanimation Néonatales, Paris, France
- DHU Risques et grossesse, Maternité Port-Royal, Paris, France
| | - Cécile Morin
- Inserm, U1016, Institut Cochin, Paris, France
- CNRS, UMR8104, Paris, France
- Université Paris Descartes, Faculté de Médecine, Paris, France
- DHU Risques et grossesse, Maternité Port-Royal, Paris, France
| | - Sébastien Jacques
- Inserm, U1016, Institut Cochin, Paris, France
- CNRS, UMR8104, Paris, France
- Université Paris Descartes, Faculté de Médecine, Paris, France
| | - Florent Dumont
- Inserm, U1016, Institut Cochin, Paris, France
- CNRS, UMR8104, Paris, France
- Université Paris Descartes, Faculté de Médecine, Paris, France
| | - Fabiola Ely-Marius
- Inserm, U1016, Institut Cochin, Paris, France
- CNRS, UMR8104, Paris, France
- Université Paris Descartes, Faculté de Médecine, Paris, France
| | - Daniel Vaiman
- Inserm, U1016, Institut Cochin, Paris, France
- CNRS, UMR8104, Paris, France
- Université Paris Descartes, Faculté de Médecine, Paris, France
- DHU Risques et grossesse, Maternité Port-Royal, Paris, France
| | - Pierre-Henri Jarreau
- Université Paris Descartes, Faculté de Médecine, Paris, France
- AP-HP, Maternité Port Royal, Service de Médecine et Réanimation Néonatales, Paris, France
- DHU Risques et grossesse, Maternité Port-Royal, Paris, France
- Inserm U1141, Paris, France
- Premup, Paris, France
| | - Céline Méhats
- Inserm, U1016, Institut Cochin, Paris, France
- CNRS, UMR8104, Paris, France
- Université Paris Descartes, Faculté de Médecine, Paris, France
- DHU Risques et grossesse, Maternité Port-Royal, Paris, France
- * E-mail:
| | - Elodie Zana-Taïeb
- Université Paris Descartes, Faculté de Médecine, Paris, France
- AP-HP, Maternité Port Royal, Service de Médecine et Réanimation Néonatales, Paris, France
- DHU Risques et grossesse, Maternité Port-Royal, Paris, France
- Inserm U1141, Paris, France
- Premup, Paris, France
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Norman M, Piedvache A, Børch K, Huusom LD, Bonamy AKE, Howell EA, Jarreau PH, Maier RF, Pryds O, Toome L, Varendi H, Weber T, Wilson E, van Heijst A, Cuttini M, Mazela J, Barros H, van Reempts P, Draper ES, Zeitlin J. Association of Short Antenatal Corticosteroid Administration-to-Birth Intervals With Survival and Morbidity Among Very Preterm Infants: Results From the EPICE Cohort. Obstet Gynecol Surv 2017. [DOI: 10.1097/01.ogx.0000527932.57928.01] [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: 11/25/2022]
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Zeitlin J, Bonamy AKE, Piedvache A, Cuttini M, Barros H, Van Reempts P, Mazela J, Jarreau PH, Gortner L, Draper ES, Maier RF. Variation in term birthweight across European countries affects the prevalence of small for gestational age among very preterm infants. Acta Paediatr 2017; 106:1447-1455. [PMID: 28470839 DOI: 10.1111/apa.13899] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 02/18/2017] [Accepted: 04/03/2017] [Indexed: 12/14/2022]
Abstract
AIM This study assessed the prevalence of small for gestational age (SGA) among very preterm (VPT) infants using national and European intrauterine references. METHODS We generated country-specific and common European intrauterine growth references for 11 European countries, according to Gardosi's approach and Hadlock's foetal growth model, using national data on birthweights by sex. These references were applied to the Effective Perinatal Intensive Care in Europe (EPICE) cohort, which comprised 7766 live VPT births without severe congenital anomalies under 32 weeks of gestation in 2011-2012, to estimate the prevalence of infants with SGA birthweights, namely those below the 10th percentile. RESULTS The SGA prevalence was 31.8% with country-specific references and 34.0% with common European references. The European references yielded a 10-point difference in the SGA prevalence between countries with lower term birthweights (39.9%) - Portugal, Italy and France - and higher term birthweights, namely Denmark, the Netherlands, Sweden (28.9%; p < 0.001). This was not observed with country-specific references, where the respective figures were 32.4% and 33.9% (p = 0.34), respectively. CONCLUSION One-third of VPT infants were SGA according to intrauterine references. Common European references showed significant differences in SGA prevalence between countries with high and low-term birthweights.
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Affiliation(s)
- Jennifer Zeitlin
- INSERM; Obstetrical, Perinatal and Pediatric Epidemiology Research Team; Centre for Epidemiology and Biostatistics (U1153); Paris-Descartes University; Paris France
| | - Anna-Karin Edstedt Bonamy
- Clinical Epidemiology Unit; Department of Medicine Solna and Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
| | - Aurelie Piedvache
- INSERM; Obstetrical, Perinatal and Pediatric Epidemiology Research Team; Centre for Epidemiology and Biostatistics (U1153); Paris-Descartes University; Paris France
| | - Marina Cuttini
- Clinical Care and Management Innovation Research Area; Bambino Gesù Children's Hospital; IRCCS, Rome Italy
| | - Henrique Barros
- EPIUnit-Institute of Public Health; University of Porto; Porto Portugal
- Department of Clinical Epidemiology, Predictive Medicine and Public Health; University of Porto Medical School; Porto Portugal
| | - Patrick Van Reempts
- Department of Neonatology; Antwerp University Hospital; University of Antwerp; Edegem and Study Centre for Perinatal Epidemiology Flanders; Brussel Belgium
| | - Jan Mazela
- Poznan University of Medical Sciences; Poznan Poland
| | - Pierre-Henri Jarreau
- Université Paris V René Descartes and Assistance Publique Hôpitaux de Paris; Hôpitaux Universitaire Paris Centre Site Cochin; Service de Médecine et Réanimation néonatales de Port-Royal; Paris France
| | - Ludwig Gortner
- Children's Hospital; University Hospital; University of Saarland; Homburg/Saar Germany
| | | | - Rolf F. Maier
- Children's Hospital; University Hospital; Philipps University; Marburg Germany
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Norman M, Piedvache A, Børch K, Huusom LD, Bonamy AKE, Howell EA, Jarreau PH, Maier RF, Pryds O, Toome L, Varendi H, Weber T, Wilson E, Van Heijst A, Cuttini M, Mazela J, Barros H, Van Reempts P, Draper ES, Zeitlin J. Association of Short Antenatal Corticosteroid Administration-to-Birth Intervals With Survival and Morbidity Among Very Preterm Infants: Results From the EPICE Cohort. JAMA Pediatr 2017; 171:678-686. [PMID: 28505223 PMCID: PMC5710338 DOI: 10.1001/jamapediatrics.2017.0602] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Administration-to-birth intervals of antenatal corticosteroids (ANS) vary. The significance of this variation is unclear. Specifically, to our knowledge, the shortest effective administration-to-birth interval is unknown. OBJECTIVE To explore the associations between ANS administration-to-birth interval and survival and morbidity among very preterm infants. DESIGN, SETTING, AND PARTICIPANTS The Effective Perinatal Intensive Care in Europe (EPICE) study, a population-based prospective cohort study, gathered data from 19 regions in 11 European countries in 2011 and 2012 on 4594 singleton infants with gestational ages between 24 and 31 weeks, without severe anomalies and unexposed to repeated courses of ANS. Data were analyzed November 2016. EXPOSURE Time from first injection of ANS to delivery in hours and days. MAIN OUTCOMES AND MEASURES Three outcomes were studied: in-hospital mortality; a composite of mortality or severe neonatal morbidity, defined as an intraventricular hemorrhage grade of 3 or greater, cystic periventricular leukomalacia, surgical necrotizing enterocolitis, or stage 3 or greater retinopathy of prematurity; and severe neonatal brain injury, defined as an intraventricular hemorrhage grade of 3 or greater or cystic periventricular leukomalacia. RESULTS Of the 4594 infants included in the cohort, 2496 infants (54.3%) were boys, and the mean (SD) gestational age was 28.5 (2.2) weeks and mean (SD) birth weight was 1213 (400) g. Mortality for the 662 infants (14.4%) unexposed to ANS was 20.6% (136 of 661). Administration of ANS was associated with an immediate and rapid decline in mortality, reaching a plateau with more than 50% risk reduction after an administration-to-birth interval of 18 to 36 hours. A similar pattern for timing was seen for the composite mortality or morbidity outcome, whereas a significant risk reduction of severe neonatal brain injury was associated with longer administration-to-birth intervals (greater than 48 hours). For all outcomes, the risk reduction associated with ANS was transient, with increasing mortality and risk for severe neonatal brain injury associated with administration-to-birth intervals exceeding 1 week. Under the assumption of a causal relationship between timing of ANS and mortality, a simulation of ANS administered 3 hours before delivery to infants who did not receive ANS showed that their estimated decline in mortality would be 26%. CONCLUSIONS AND RELEVANCE Antenatal corticosteroids may be effective even if given only hours before delivery. Therefore, the infants of pregnant women at risk of imminent preterm delivery may benefit from its use.
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Affiliation(s)
- Mikael Norman
- Division of Pediatrics, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden,Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Aurelie Piedvache
- INSERM Joint Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, University Hospital Department Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Klaus Børch
- Department of Neonatology, Hvidovre University Hospital, Hvidovre, Denmark
| | | | - Anna-Karin Edstedt Bonamy
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden,Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Elizabeth A. Howell
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York,Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Pierre-Henri Jarreau
- University Paris Descartes and Department of Neonatal Medicine and Intensive Care Unit of Port-Royal, Cochin University Hospital, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Rolf F. Maier
- Children’s Hospital, University Hospital, Philipp University of Marburg, Marburg, Germany
| | - Ole Pryds
- Department of Neonatology, Hvidovre University Hospital, Hvidovre, Denmark
| | - Liis Toome
- Tallinn Children’s Hospital, Tallinn, Estonia,University of Tartu, Tartu, Estonia
| | - Heili Varendi
- Tartu University Hospital, University of Tartu, Tartu, Estonia
| | - Tom Weber
- Department of Obstetrics, Hvidovre University Hospital, Hvidovre, Denmark
| | - Emilija Wilson
- Division of Pediatrics, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden,Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Arno Van Heijst
- Department of Neonatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marina Cuttini
- Research Unit of Perinatal Epidemiology, Clinical Care and Management Innovation Research Area, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Jan Mazela
- Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Henrique Barros
- Epidemiology Research Unit, Institute of Public Health, University of Porto, Porto, Portugal
| | - Patrick Van Reempts
- Department of Neonatology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium,Study Centre for Perinatal Epidemiology Flanders, Brussels, Belgium
| | | | - Jennifer Zeitlin
- INSERM Joint Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, University Hospital Department Risks in Pregnancy, Paris Descartes University, Paris, France
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Banigé M, Estellat C, Biran V, Desfrere L, Champion V, Benachi A, Ville Y, Dommergues M, Jarreau PH, Mokhtari M, Boithias C, Brioude F, Mandelbrot L, Ceccaldi PF, Mitanchez D, Polak M, Luton D. Study of the Factors Leading to Fetal and Neonatal Dysthyroidism in Children of Patients With Graves Disease. J Endocr Soc 2017; 1:751-761. [PMID: 29130077 PMCID: PMC5677510 DOI: 10.1210/js.2017-00189] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 04/20/2017] [Indexed: 12/27/2022] Open
Abstract
CONTEXT Neonatal hyperthyroidism was first described in 1912 and in 1964 was shown to be linked to transplacental passage of maternal antibodies. Few multicenter studies have described the perinatal factors leading to fetal and neonatal dysthyroidism. OBJECTIVE To show how fetal dysthyroidism (FD) and neonatal dysthyroidism (ND) can be predicted from perinatal variables, in particular, the levels of anti-thyrotropin receptor antibodies (TRAbs) circulating in the mother and child. DESIGN AND PATIENTS This was a retrospective multicenter study of data from the medical records of all patients monitored for pregnancy from 2007 to 2014. SETTING Among 280,000 births, the medical records of 2288 women with thyroid dysfunction were selected and screened, and 417 women with Graves disease and positive for TRAbs during pregnancy were included. RESULTS Using the maternal TRAb levels, the cutoff value of 2.5 IU/L best predicted for FD, with a sensitivity of 100% and specificity of 64%. Using the newborn TRAb levels, the cutoff value of 6.8 IU/L best predicted for ND, with a sensitivity of 100% and a specificity of 94%. In our study, 65% of women with a history of Graves disease did not receive antithyroid drugs during pregnancy but still had infants at risk of ND. CONCLUSIONS In pregnant women with TRAb levels ≥2.5 IU/L, fetal ultrasound monitoring is essential until delivery. All newborns with TRAb levels ≥6.8 IU/L should be examined by a pediatrician with special attention for thyroid dysfunction and treated, if necessary.
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Affiliation(s)
- Maïa Banigé
- Department of Neonatology, Obstetrics and Gynecology, University Hospitals Paris Nord Val de Seine, Assistance Publique Hôpitaux de Paris, Beaujon Hospital, Clichy 92118, France
| | - Candice Estellat
- Department of Epidemiology and Clinical Research, Assistance Publique Hôpitaux de Paris, Bichat Hospital, University Hospitals Paris Nord Val de Seine, UMR 1123 ECEVE/CIC-EC 1425, Inserm, Paris 75184, France
| | - Valerie Biran
- Department of Neonatal Pediatrics and Intensive Care, Assistance Publique Hôpitaux de Paris, Robert Debré Hospital, Paris Diderot University, Paris 75013, France
| | - Luc Desfrere
- Department of Neonatal Pediatrics and Intensive Care, Assistance Publique Hôpitaux de Paris, Louis Mourier Hospital, University Hospitals Paris Nord Val de Seine, Colombes 92700, France
| | - Valerie Champion
- Department of Neonatal Pediatrics, Assistance Publique Hôpitaux de Paris, Armand Trousseau Hospital, Pierre and Marie Curie University (UPMC), Paris 75005, France
| | - Alexandra Benachi
- Department of Obstetrics and Gynecology, Assistance Publique Hôpitaux de Paris, Antoine Béclère Hospital, Paris-Sud University, Clamart 92140, France
| | - Yves Ville
- Department of Obstetrics and Gynecology, Assistance Publique Hôpitaux de Paris, Necker-Enfants Malades, Paris Descartes University, Paris 75006, France
| | - Marc Dommergues
- Department of Obstetrics and Gynecology, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Pierre and Marie Curie University (UPMC), Paris 75005, France
| | - Pierre-Henri Jarreau
- Department of Neonatal Pediatrics and Intensive Care, Assistance Publique Hôpitaux de Paris, Port-Royal Hospital, Paris Descartes University, Paris 75006, France
| | - Mostafa Mokhtari
- Department of Neonatal Pediatrics and Intensive Care, Assistance Publique Hôpitaux de Paris, Kremlin Bicêtre Hospital, Bicêtre 94270, France
| | - Claire Boithias
- Department of Neonatal Pediatrics and Intensive Care, Assistance Publique Hôpitaux de Paris, Kremlin Bicêtre Hospital, Bicêtre 94270, France
| | - Frederic Brioude
- Department of Endocrinology Pediatrics, Assistance Publique Hôpitaux de Paris, Armand Trousseau Hospital, Paris 75012, France
| | - Laurent Mandelbrot
- Department of Obstetrics and Gynecology, Assistance Publique Hôpitaux de Paris, Louis Mourier Hospital, University Hospitals Paris Nord Val de Seine, Colombes 92700, France
| | - Pierre-François Ceccaldi
- Department of Neonatology, Obstetrics and Gynecology, University Hospitals Paris Nord Val de Seine, Assistance Publique Hôpitaux de Paris, Beaujon Hospital, Clichy 92118, France
| | - Delphine Mitanchez
- Department of Neonatal Pediatrics, Assistance Publique Hôpitaux de Paris, Armand Trousseau Hospital, Pierre and Marie Curie University (UPMC), Paris 75005, France
| | - Michel Polak
- Department of Paediatric Endocrinology (APHP), Necker-Enfants Malades, Paris Descartes University, Paris 75006, France
| | - Dominique Luton
- Department of Neonatology, Obstetrics and Gynecology, University Hospitals Paris Nord Val de Seine, Assistance Publique Hôpitaux de Paris, Beaujon Hospital, Clichy 92118, France
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Bonet M, Cuttini M, Piedvache A, Boyle EM, Jarreau PH, Kollée L, Maier RF, Milligan D, Van Reempts P, Weber T, Barros H, Gadzinowki J, Draper ES, Zeitlin J. Changes in management policies for extremely preterm births and neonatal outcomes from 2003 to 2012: two population-based studies in ten European regions. BJOG 2017; 124:1595-1604. [PMID: 28294506 DOI: 10.1111/1471-0528.14639] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate changes in maternity and neonatal unit policies towards extremely preterm infants (EPTIs) between 2003 and 2012, and concurrent trends in their mortality and morbidity in ten European regions. DESIGN Population-based cohort studies in 2003 (MOSAIC study) and 2011/2012 (EPICE study) and questionnaires from hospitals. SETTING 70 hospitals in ten European regions. POPULATION Infants born at <27 weeks of gestational age (GA) in hospitals participating in both the MOSAIC and EPICE studies (1240 in 2003, 1293 in 2011/2012). METHODS We used McNemar's Chi2 test, paired t-tests and conditional logistic regression for comparisons over time. MAIN OUTCOMES MEASURES Reported policies, mortality and morbidity of EPTIs. RESULTS The lowest GA at which maternity units reported performing a caesarean section for acute distress of a singleton non-malformed fetus decreased from an average of 24.7 to 24.1 weeks (P < 0.01) when parents were in favour of active management, and 26.1 to 25.2 weeks (P = 0.01) when parents were against. Units reported that neonatologists were called more often for spontaneous deliveries starting at 22 weeks GA in 2012 and more often made decisions about active resuscitation alone, rather than in multidisciplinary teams. In-hospital mortality after live birth for EPTIs decreased from 50% to 42% (P < 0.01). Units reporting more active management in 2012 than 2003 had higher mortality in 2003 (55% versus 43%; P < 0.01) and experienced larger declines (55 to 44%; P < 0.001) than units where policies stayed the same (43 to 37%; P = 0.1). CONCLUSIONS European hospitals reporting changes in management policies experienced larger survival gains for EPTIs. TWEETABLE ABSTRACT Changes in reported policies for management of extremely preterm births were related to mortality declines.
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Affiliation(s)
- M Bonet
- 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
| | - M Cuttini
- Clinical Care and Management Innovation Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - A Piedvache
- 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
| | - E M Boyle
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - P H Jarreau
- Service de Médecine et Réanimation néonatales de Port-Royal, DHU Risks in Pregnancy, Université Paris Descartes and Assistance Publique Hôpitaux de Paris, Hôpitaux Universitaire Paris Centre Site Cochin, Paris, France
| | - L Kollée
- Department of Neonatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - R F Maier
- Children's Hospital, University Hospital, Philipps University Marburg, Marburg, Germany
| | - Dwa Milligan
- University of Newcastle, Newcastle-upon-Tyne, UK
| | - P Van Reempts
- Department of Neonatology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium.,Study Centre for Perinatal Epidemiology Flanders, Brussels, Belgium
| | - T Weber
- Department of Obstetrics, Hvidovre University Hospital, Hvidovre, Denmark
| | - H Barros
- EPIUnit-Institute of Public Health, University of Porto, Porto, Portugal
| | - J Gadzinowki
- Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland
| | - E S Draper
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - 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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Monier I, Ancel PY, Ego A, Jarreau PH, Lebeaux C, Kaminski M, Goffinet F, Zeitlin J. Fetal and neonatal outcomes of preterm infants born before 32 weeks of gestation according to antenatal vs postnatal assessments of restricted growth. Am J Obstet Gynecol 2017; 216:516.e1-516.e10. [PMID: 28188770 DOI: 10.1016/j.ajog.2017.02.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 01/16/2017] [Accepted: 02/01/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Fetal growth restriction is defined using ultrasound parameters during pregnancy or as a low birthweight for gestational age after birth, but these definitions are not always concordant. OBJECTIVE The purpose of this study was to investigate fetal and neonatal outcomes based on antenatal vs postnatal assessments of growth restriction. STUDY DESIGN From the EPIPAGE 2 population-based prospective study of very preterm births in France in 2011, we included 2919 singleton nonanomalous infants 24-31 weeks gestational age. We constituted 4 groups based on whether the infant was suspected with fetal growth restriction during pregnancy and/or was small for gestational age with a birthweight <10th percentile of intrauterine norms by sex: 1) suspected with fetal growth restriction/small for gestational age 2) not suspected with fetal growth restriction/small for gestational age 3) suspected with fetal growth restriction/not small for gestational age and 4) not suspected with fetal growth restriction/not small for gestational age. We estimated relative risks of perinatal mortality and morbidity for these groups adjusting for maternal and neonatal characteristics. RESULTS We found that 22.2% of infants were suspected with fetal growth restriction/small for gestational age, that 11.4% infants were not suspected with fetal growth restriction/small for gestational age, that 3.0% infants were suspected with fetal growth restriction/not small for gestational age, and that 63.4% infants were not suspected with fetal growth restriction/not small for gestational age. Compared with infants who were not suspected with fetal growth restriction/not small-for-gestational-age infants, small-for-gestational-age infants suspected and not suspected with fetal growth restriction had higher risks of stillbirth or termination of pregnancy (adjusted relative risk, 2.0 [95% confidence interval, 1.6-2.5] and adjusted relative risk, 2.8 [95% confidence interval, 2.2-3.4], respectively), in-hospital death (adjusted relative risk, 2.8 [95% confidence interval, 2.0-3.7] and adjusted relative risk, 2.0 [95% confidence interval, 1.5-2.8], respectively), and bronchopulmonary dysplasia (adjusted relative risk, 1.3 [95% confidence interval, 1.2-1.4] and adjusted relative risk, 1.3 [95% confidence interval, 1.1-1.4], respectively), but not severe brain lesions. Risks were not increased for infants suspected with fetal growth restriction but not small-for-gestational-age. CONCLUSION Antenatal and postnatal assessments of fetal growth restriction were not concordant for 14% of very preterm infants. In these cases, birthweight appears to be the more relevant parameter for the identification of infants with higher risks of adverse short-term outcomes.
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Nuytten A, Behal H, Duhamel A, Jarreau PH, Mazela J, Milligan D, Gortner L, Piedvache A, Zeitlin J, Truffert P. Correction: Evidence-Based Neonatal Unit Practices and Determinants of Postnatal Corticosteroid-Use in Preterm Births below 30 Weeks GA in Europe. A Population-Based Cohort Study. PLoS One 2017; 12:e0172408. [PMID: 28192535 PMCID: PMC5305057 DOI: 10.1371/journal.pone.0172408] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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El Ayoubi M, Patkai J, Bordarier C, Desfrere L, Moriette G, Jarreau PH, Zeitlin J. Impact of fetal growth restriction on neurodevelopmental outcome at 2 years for extremely preterm infants: a single institution study. Dev Med Child Neurol 2016; 58:1249-1256. [PMID: 27520849 DOI: 10.1111/dmcn.13218] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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] [Accepted: 06/24/2016] [Indexed: 01/28/2023]
Abstract
AIM We evaluated the impact of fetal growth restriction on neurodevelopmental outcomes at 2 years corrected age for infants born before 27 weeks gestational age. METHOD Data on infants born before 27 weeks gestational age between 1999 and 2008 (n=463), admitted to a tertiary neonatal unit in Paris, were used to compare neurological outcomes at 2 years for infants with birthweight lower than the 10th centile and birthweight of at least the 10th centile, using intrauterine reference curves. Outcomes were cerebral palsy (CP) and the Brunet-Lézine assessment of cognitive development, which provides age-corrected overall and domain-specific (global and fine motor skills, language and social interaction) developmental quotients. Models were adjusted for perinatal and social factors. RESULTS Seventy-two percent of infants were discharged alive. Eighty-three percent (n=268) were evaluated at 2 years. Six percent had CP. Fetal growth restriction was not associated with the risk of CP. After adjustment, children with a birthweight lower than the 10th centile had a global developmental quotient 4.7 points lower than those with birthweight of at least the 10th centile (p<0.001); differences were greatest for fine motor and social skills (-4.7, p=0.053 and -7.3, p<0.001 respectively). INTERPRETATION In extremely preterm children, fetal growth restriction was associated with poorer neurodevelopmental outcomes at 2 years, but not with CP.
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Affiliation(s)
- Mayass El Ayoubi
- 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.,Service de Médecine et Réanimation Néonatales de Port-Royal, Hôpitaux Universitaire Paris Centre Site Cochin, Université Paris V René Descartes and Assistance Publique Hôpitaux de Paris, Paris, France
| | - Juliana Patkai
- Service de Médecine et Réanimation Néonatales de Port-Royal, Hôpitaux Universitaire Paris Centre Site Cochin, Université Paris V René Descartes and Assistance Publique Hôpitaux de Paris, Paris, France
| | - Cécile Bordarier
- Service de Médecine et Réanimation Néonatales de Port-Royal, Hôpitaux Universitaire Paris Centre Site Cochin, Université Paris V René Descartes and Assistance Publique Hôpitaux de Paris, Paris, France
| | - Luc Desfrere
- Service de Médecine et Réanimation Néonatales - Maternité de Louis Mourier, Hôpitaux Universitaires Paris Nord-Val de Seine, Paris, France
| | - Guy Moriette
- Service de Médecine et Réanimation Néonatales de Port-Royal, Hôpitaux Universitaire Paris Centre Site Cochin, Université Paris V René Descartes and Assistance Publique Hôpitaux de Paris, Paris, France
| | - Pierre-Henri Jarreau
- Service de Médecine et Réanimation Néonatales de Port-Royal, Hôpitaux Universitaire Paris Centre Site Cochin, Université Paris V René Descartes and Assistance Publique Hôpitaux de Paris, Paris, France
| | - Jennifer 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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Rideau Batista Novais A, Pham H, Van de Looij Y, Bernal M, Mairesse J, Zana-Taieb E, Colella M, Jarreau PH, Pansiot J, Dumont F, Sizonenko S, Gressens P, Charriaut-Marlangue C, Tanter M, Demene C, Vaiman D, Baud O. Transcriptomic regulations in oligodendroglial and microglial cells related to brain damage following fetal growth restriction. Glia 2016; 64:2306-2320. [PMID: 27687291 DOI: 10.1002/glia.23079] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [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: 07/28/2016] [Revised: 09/15/2016] [Accepted: 09/19/2016] [Indexed: 11/06/2022]
Abstract
Fetal growth restriction (FGR) is a major complication of human pregnancy, frequently resulting from placental vascular diseases and prenatal malnutrition, and is associated with adverse neurocognitive outcomes throughout life. However, the mechanisms linking poor fetal growth and neurocognitive impairment are unclear. Here, we aimed to correlate changes in gene expression induced by FGR in rats and abnormal cerebral white matter maturation, brain microstructure, and cortical connectivity in vivo. We investigated a model of FGR induced by low-protein-diet malnutrition between embryonic day 0 and birth using an interdisciplinary approach combining advanced brain imaging, in vivo connectivity, microarray analysis of sorted oligodendroglial and microglial cells and histology. We show that myelination and brain function are both significantly altered in our model of FGR. These alterations, detected first in the white matter on magnetic resonance imaging significantly reduced cortical connectivity as assessed by ultrafast ultrasound imaging. Fetal growth retardation was found associated with white matter dysmaturation as shown by the immunohistochemical profiles and microarrays analyses. Strikingly, transcriptomic and gene network analyses reveal not only a myelination deficit in growth-restricted pups, but also the extensive deregulation of genes controlling neuroinflammation and the cell cycle in both oligodendrocytes and microglia. Our findings shed new light on the cellular and gene regulatory mechanisms mediating brain structural and functional defects in malnutrition-induced FGR, and suggest, for the first time, a neuroinflammatory basis for the poor neurocognitive outcome observed in growth-restricted human infants. GLIA 2016;64:2306-2320.
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Affiliation(s)
- Aline Rideau Batista Novais
- Institut National de la Santé et de la Recherche Médicale (Inserm) U1141, Paris, France.,Assistance Publique - Hôpitaux de Paris, Service de Réanimation et Pédiatrie Néonatales, Groupe Hospitalier Robert Debré, Paris, France.,Université Paris Diderot, Paris, France.,Fondation PremUp, Paris, France
| | - Hoa Pham
- Institut National de la Santé et de la Recherche Médicale (Inserm) U1141, Paris, France.,Fondation PremUp, Paris, France
| | - Yohan Van de Looij
- Laboratory for Functional and Metabolic Imaging (LIFMET), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.,Division of Development and Growth, Department of Child and Adolescent Medicine, Geneva University Hospital and School of Medicine, Geneva, Switzerland
| | - Miguel Bernal
- Institut Langevin, CNRS UMR 7587, Inserm U979, ESPCI ParisTech, PSL Research University, Paris, France
| | - Jerome Mairesse
- Institut National de la Santé et de la Recherche Médicale (Inserm) U1141, Paris, France.,Fondation PremUp, Paris, France
| | - Elodie Zana-Taieb
- Institut National de la Santé et de la Recherche Médicale (Inserm) U1141, Paris, France.,Fondation PremUp, Paris, France.,Université Paris-Descartes, Paris, France.,Assistance Publique - Hôpitaux de Paris, Service de Médecine et Réanimation Néonatales de Port-Royal, Groupe Hospitalier Cochin, Broca, Hôtel-Dieu, Paris, France
| | - Marina Colella
- Institut National de la Santé et de la Recherche Médicale (Inserm) U1141, Paris, France.,Fondation PremUp, Paris, France
| | - Pierre-Henri Jarreau
- Fondation PremUp, Paris, France.,Université Paris-Descartes, Paris, France.,Assistance Publique - Hôpitaux de Paris, Service de Médecine et Réanimation Néonatales de Port-Royal, Groupe Hospitalier Cochin, Broca, Hôtel-Dieu, Paris, France
| | - Julien Pansiot
- Institut National de la Santé et de la Recherche Médicale (Inserm) U1141, Paris, France.,Fondation PremUp, Paris, France
| | - Florent Dumont
- Institut Cochin, Inserm U1016, UMR8104 CNRS, Paris, France
| | - Stéphane Sizonenko
- Division of Development and Growth, Department of Child and Adolescent Medicine, Geneva University Hospital and School of Medicine, Geneva, Switzerland
| | - Pierre Gressens
- Institut National de la Santé et de la Recherche Médicale (Inserm) U1141, Paris, France.,Université Paris Diderot, Paris, France.,Fondation PremUp, Paris, France
| | - Christiane Charriaut-Marlangue
- Institut National de la Santé et de la Recherche Médicale (Inserm) U1141, Paris, France.,Université Paris Diderot, Paris, France.,Fondation PremUp, Paris, France
| | - Mickael Tanter
- Institut Langevin, CNRS UMR 7587, Inserm U979, ESPCI ParisTech, PSL Research University, Paris, France
| | - Charlie Demene
- Institut Langevin, CNRS UMR 7587, Inserm U979, ESPCI ParisTech, PSL Research University, Paris, France
| | - Daniel Vaiman
- Institut Cochin, Inserm U1016, UMR8104 CNRS, Paris, France
| | - Olivier Baud
- Institut National de la Santé et de la Recherche Médicale (Inserm) U1141, Paris, France. .,Assistance Publique - Hôpitaux de Paris, Service de Réanimation et Pédiatrie Néonatales, Groupe Hospitalier Robert Debré, Paris, France. .,Université Paris Diderot, Paris, France. .,Fondation PremUp, Paris, France.
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Torchin H, Ancel PY, Goffinet F, Hascoët JM, Truffert P, Tran D, Lebeaux C, Jarreau PH. Placental Complications and Bronchopulmonary Dysplasia: EPIPAGE-2 Cohort Study. Pediatrics 2016; 137:e20152163. [PMID: 26908662 PMCID: PMC4771126 DOI: 10.1542/peds.2015-2163] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [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] [Accepted: 12/18/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To investigate the relationship between placenta-mediated pregnancy complications and bronchopulmonary dysplasia (BPD) in very preterm infants. METHODS National prospective population-based cohort study including 2697 singletons born before 32 weeks' gestation. The main outcome measure was moderate to severe BPD. Three groups of placenta-mediated pregnancy complications were compared with no placenta-mediated complications: maternal disorders only (gestational hypertension or preeclampsia), fetal disorders only (antenatal growth restriction), and both maternal and fetal disorders. RESULTS Moderate to severe BPD rates were 8% in infants from pregnancies with maternal disorders, 15% from both maternal and fetal disorders, 23% from fetal disorders only, and 9% in the control group (P < .001). When we adjusted for gestational age, the risk of moderate to severe BPD was greater in the groups with fetal disorders only (odds ratio [OR] = 6.6; 95% confidence interval [CI], 4.1-10.7), with maternal and fetal disorders (OR = 3.7; 95% CI, 2.5-5.5), and with maternal disorders only (OR = 1.7; 95% CI, 1.0-2.7) than in the control group. When we also controlled for birth weight, the relationship remained in groups with fetal disorders only (OR = 4.2; 95% CI, 2.1-8.6) and with maternal and fetal disorders (OR = 2.1; 95% CI, 1.1-3.9). CONCLUSIONS Placenta-mediated pregnancy complications with fetal consequences are associated with moderate to severe BPD in very preterm infants independently of gestational age and birth weight, but isolated maternal hypertensive disorders are not. Fetal growth restriction, more than birth weight, could predispose to impaired lung development.
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Affiliation(s)
- Héloïse Torchin
- INSERM U1153, Epidemiology and Statistics Sorbonne Paris Cité Research Center, Obstetrical, Perinatal and Pediatric Epidemiology Team, Paris, France; DHU Risk in Pregnancy, Cochin Hotel-Dieu Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France;
| | - Pierre-Yves Ancel
- INSERM U1153, Epidemiology and Statistics Sorbonne Paris Cité Research Center, Obstetrical, Perinatal and Pediatric Epidemiology Team, Paris, France;,DHU Risk in Pregnancy, Cochin Hotel-Dieu Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France;,Paris Descartes University, Paris, France;,Unité de Recherche Clinique - Centre d' Investigation Clinique
| | - François Goffinet
- INSERM U1153, Epidemiology and Statistics Sorbonne Paris Cité Research Center, Obstetrical, Perinatal and Pediatric Epidemiology Team, Paris, France;,DHU Risk in Pregnancy, Cochin Hotel-Dieu Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France;,Paris Descartes University, Paris, France;,Maternité Port-Royal, and
| | | | - Patrick Truffert
- Jeanne de Flandre Hospital, Department of Neonatology CHRU de Lille, Lille Cedex, France
| | - Diep Tran
- INSERM U1153, Epidemiology and Statistics Sorbonne Paris Cité Research Center, Obstetrical, Perinatal and Pediatric Epidemiology Team, Paris, France
| | - Cécile Lebeaux
- INSERM U1153, Epidemiology and Statistics Sorbonne Paris Cité Research Center, Obstetrical, Perinatal and Pediatric Epidemiology Team, Paris, France
| | - Pierre-Henri Jarreau
- DHU Risk in Pregnancy, Cochin Hotel-Dieu Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France;,Paris Descartes University, Paris, France;,Service de Médecine et Réanimation Néonatales de Port-Royal, Assistance Publique, Hôpitaux de Paris, Hôpital Cochin, Paris, France
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Bassler D, Plavka R, Shinwell ES, Hallman M, Jarreau PH, Carnielli V, Van den Anker JN, Meisner C, Engel C, Schwab M, Halliday HL, Poets CF. Early Inhaled Budesonide for the Prevention of Bronchopulmonary Dysplasia. N Engl J Med 2015; 373:1497-506. [PMID: 26465983 DOI: 10.1056/nejmoa1501917] [Citation(s) in RCA: 154] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Systemic glucocorticoids reduce the incidence of bronchopulmonary dysplasia among extremely preterm infants, but they may compromise brain development. The effects of inhaled glucocorticoids on outcomes in these infants are unclear. METHODS We randomly assigned 863 infants (gestational age, 23 weeks 0 days to 27 weeks 6 days) to early (within 24 hours after birth) inhaled budesonide or placebo until they no longer required oxygen and positive-pressure support or until they reached a postmenstrual age of 32 weeks 0 days. The primary outcome was death or bronchopulmonary dysplasia, confirmed by means of standardized oxygen-saturation monitoring, at a postmenstrual age of 36 weeks. RESULTS A total of 175 of 437 infants assigned to budesonide for whom adequate data were available (40.0%), as compared with 194 of 419 infants assigned to placebo for whom adequate data were available (46.3%), died or had bronchopulmonary dysplasia (relative risk, stratified according to gestational age, 0.86; 95% confidence interval [CI], 0.75 to 1.00; P=0.05). The incidence of bronchopulmonary dysplasia was 27.8% in the budesonide group versus 38.0% in the placebo group (relative risk, stratified according to gestational age, 0.74; 95% CI, 0.60 to 0.91; P=0.004); death occurred in 16.9% and 13.6% of the patients, respectively (relative risk, stratified according to gestational age, 1.24; 95% CI, 0.91 to 1.69; P=0.17). The proportion of infants who required surgical closure of a patent ductus arteriosus was lower in the budesonide group than in the placebo group (relative risk, stratified according to gestational age, 0.55; 95% CI, 0.36 to 0.83; P=0.004), as was the proportion of infants who required reintubation (relative risk, stratified according to gestational age, 0.58; 95% CI, 0.35 to 0.96; P=0.03). Rates of other neonatal illnesses and adverse events were similar in the two groups. CONCLUSIONS Among extremely preterm infants, the incidence of bronchopulmonary dysplasia was lower among those who received early inhaled budesonide than among those who received placebo, but the advantage may have been gained at the expense of increased mortality. (Funded by the European Union and Chiesi Farmaceutici; ClinicalTrials.gov number, NCT01035190.).
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Affiliation(s)
- Dirk Bassler
- From the Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich (D.B.), and the Department of Pediatric Pharmacology, University Children's Hospital, Basel (J.N.A.) - both in Switzerland; the Department of Neonatology (D.B., C.F.P.) and the Center for Pediatric Clinical Studies (C.E.), University Children's Hospital Tübingen, and the Institute for Clinical Epidemiology and Applied Biometry (C.M.) and the Department of Clinical Pharmacology (M.S.), University Hospital Tübingen, Tübingen, and Dr. Margarete Fischer Bosch Institute of Clinical Pharmacology, Stuttgart (M.S.) - all in Germany; Charles University, General University Hospital and First Faculty of Medicine, Prague, Czech Republic (R.P.); Ziv Medical Center, Zefat, Bar-Ilan University, Ramat Gan, Israel (E.S.S.); the Department of Pediatrics, Oulu University Hospital and University of Oulu, Oulu, Finland (M.H.); Assistance Publique-Hôpitaux de Paris, Département Hospitalo-Universitaire, Université Paris Descartes, Hôpital Cochin, Service de Médecine et Réanimation néonatales de Port-Royal, Paris (P.-H.J.); Polytechnic University of Marche, Salesi Children's Hospital, Ancona, Italy (V.C.); the Division of Pediatric Clinical Pharmacology, Children's National Medical Center, Washington, DC (J.N.A.); Intensive Care and Department of Pediatric Surgery, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands (J.N.A.); and the Department of Child Health at Queen's University Belfast, Institute of Clinical Science, Belfast, Northern Ireland (H.L.H.)
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Madeleneau D, Aubelle MS, Pierron C, Lopez E, Patkai J, Roze JC, Jarreau PH, Gascoin G. Efficacy of a first course of Ibuprofen for patent ductus arteriosus closure in extremely preterm newborns according to their gestational age-specific Z-score for birth weight. PLoS One 2015; 10:e0124804. [PMID: 25875583 PMCID: PMC4395323 DOI: 10.1371/journal.pone.0124804] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 03/19/2015] [Indexed: 11/19/2022] Open
Abstract
Objective Therapeutic strategies for patent ductus arteriosus (PDA) in very preterm infants remain controversial. To identify infants likely to benefit from treatment, we analysed the efficacy of a first course of ibuprofen in small-for-gestational age (SGA) newborns. Study design This single-centre retrospective study included 185 infants born at 24+0–27+6 weeks of gestation with haemodynamically significant PDA, who were treated by intravenous ibuprofen (Pedea): 10 mg/kg on day one and 5 mg/kg on days two and three. Birth weight and gestational age (GA) were analysed with reference to the standard deviations from the Olsen growth curve to define GA-specific Z-scores for birth weights. The efficacy of treatment was evaluated by echocardiography 48 hours after the last dose of ibuprofen. The primary outcome was failure of the first course of ibuprofen associated in a composite criterion with the most severe outcomes. Results The risk of treatment failure increased according to a continuous gradient in SGA neonates. A higher risk was observed on multiple regression analysis (crude OR: 3.8; 95% CI [1.2–12.3] p = 0.02; adjusted OR: 12.8; 95% CI [2.3–70.5] p=0.003). Conclusion There is a linear relationship between infant birth weight and PDA treatment: the failure rate of a first course of ibuprofen increases with increasing degree of growth restriction.
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Affiliation(s)
- Doriane Madeleneau
- Department of Neonatal Medicine of Port-Royal, Groupe Hospitalier Cochin-Broca-Hôtel Dieu, APHP, Paris, France
| | - Marie-Stephanie Aubelle
- Department of Neonatal Medicine of Port-Royal, Groupe Hospitalier Cochin-Broca-Hôtel Dieu, APHP, Paris, France
| | - Charlotte Pierron
- Department of Neonatal Medicine of Port-Royal, Groupe Hospitalier Cochin-Broca-Hôtel Dieu, APHP, Paris, France
| | - Emmanuel Lopez
- Department of Neonatal Medicine of Port-Royal, Groupe Hospitalier Cochin-Broca-Hôtel Dieu, APHP, Paris, France
| | - Juliana Patkai
- Department of Neonatal Medicine of Port-Royal, Groupe Hospitalier Cochin-Broca-Hôtel Dieu, APHP, Paris, France
| | | | - Pierre-Henri Jarreau
- Department of Neonatal Medicine of Port-Royal, Groupe Hospitalier Cochin-Broca-Hôtel Dieu, APHP, Paris, France
| | - Geraldine Gascoin
- Department of Neonatal Medicine, Angers University Hospital, Angers, France
- * E-mail:
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El Ayoubi M, Jarreau PH, Van Reempts P, Cuttini M, Kaminski M, Zeitlin J. Does the antenatal detection of fetal growth restriction (FGR) have a prognostic value for mortality and short-term morbidity for very preterm infants? Results from the MOSAIC cohort. J Matern Fetal Neonatal Med 2015; 29:596-601. [DOI: 10.3109/14767058.2015.1012062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Mayass El Ayoubi
- INSERM, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Biostatistics (U1153), Paris-Descartes University, Paris, France,
- Service de Médecine et Réanimation néonatales de Port-Royal, Hôpitaux Universitaires Paris Centre Site Cochin, Université Paris V René Descartes and Assistance Publique Hôpitaux de Paris, Paris, France,
| | - Pierre-Henri Jarreau
- Service de Médecine et Réanimation néonatales de Port-Royal, Hôpitaux Universitaires Paris Centre Site Cochin, Université Paris V René Descartes and Assistance Publique Hôpitaux de Paris, Paris, France,
| | - Patrick Van Reempts
- Department of Neonatology, Antwerp University Hospital, University of Antwerp and Study Centre for Perinatal Epidemiology Flanders, Belgium, and
| | - Marina Cuttini
- Research Unit of Perinatal Epidemiology, Bambino Gesù Children’s Hospital, Viale Ferdinando Baldelli 41, Roma, Italy
| | - Monique Kaminski
- INSERM, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Biostatistics (U1153), Paris-Descartes University, Paris, France,
| | - Jennifer Zeitlin
- INSERM, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Biostatistics (U1153), Paris-Descartes University, Paris, France,
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Ancel PY, Goffinet F, Kuhn P, Langer B, Matis J, Hernandorena X, Chabanier P, Joly-Pedespan L, Lecomte B, Vendittelli F, Dreyfus M, Guillois B, Burguet A, Sagot P, Sizun J, Beuchée A, Rouget F, Favreau A, Saliba E, Bednarek N, Morville P, Thiriez G, Marpeau L, Marret S, Kayem G, Durrmeyer X, Granier M, Baud O, Jarreau PH, Mitanchez D, Boileau P, Boulot P, Cambonie G, Daudé H, Bédu A, Mons F, Fresson J, Vieux R, Alberge C, Arnaud C, Vayssière C, Truffert P, Pierrat V, Subtil D, D'Ercole C, Gire C, Simeoni U, Bongain A, Sentilhes L, Rozé JC, Gondry J, Leke A, Deiber M, Claris O, Picaud JC, Ego A, Debillon T, Poulichet A, Coliné E, Favre A, Fléchelles O, Samperiz S, Ramful D, Branger B, Benhammou V, Foix-L'Hélias L, Marchand-Martin L, Kaminski M, Kaminski M. Survival and morbidity of preterm children born at 22 through 34 weeks' gestation in France in 2011: results of the EPIPAGE-2 cohort study. JAMA Pediatr 2015; 169:230-8. [PMID: 25621457 DOI: 10.1001/jamapediatrics.2014.3351] [Citation(s) in RCA: 475] [Impact Index Per Article: 52.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Up-to-date estimates of the health outcomes of preterm children are needed for assessing perinatal care, informing parents, making decisions about care, and providing evidence for clinical guidelines. OBJECTIVES To determine survival and neonatal morbidity of infants born from 22 through 34 completed weeks' gestation in France in 2011 and compare these outcomes with a comparable cohort in 1997. DESIGN, SETTING, AND PARTICIPANTS The EPIPAGE-2 study is a national, prospective, population-based cohort study conducted in all maternity and neonatal units in France in 2011. A total of 2205 births (stillbirths and live births) and terminations of pregnancy at 22 through 26 weeks' gestation, 3257 at 27 through 31 weeks, and 1234 at 32 through 34 weeks were studied. Cohort data were collected from January 1 through December 31, 1997, and from March 28 through December 31, 2011. Analyses for 1997 were run for the entire year and then separately for April to December; the rates for survival and morbidities did not differ. Data are therefore presented for the whole year in 1997 and the 8-month and 6-month periods in 2011. MAIN OUTCOMES AND MEASURES Survival to discharge and survival without any of the following adverse outcomes: grade III or IV intraventricular hemorrhage, cystic periventricular leukomalacia, severe bronchopulmonary dysplasia, retinopathy of prematurity (stage 3 or higher), or necrotizing enterocolitis (stages 2-3). RESULTS A total of 0.7% of infants born before 24 weeks' gestation survived to discharge: 31.2% of those born at 24 weeks, 59.1% at 25 weeks, and 75.3% at 26 weeks. Survival rates were 93.6% at 27 through 31 weeks and 98.9% at 32 through 34 weeks. Infants discharged home without severe neonatal morbidity represented 0% at 23 weeks, 11.6% at 24 weeks, 30.0% at 25 weeks, 47.5% at 26 weeks, 81.3% at 27 through 31 weeks, and 96.8% at 32 through 34 weeks. Compared with 1997, the proportion of infants surviving without severe morbidity in 2011 increased by 14.4% (P < .001) at 25 through 29 weeks and 6% (P < .001) at 30 through 31 weeks but did not change appreciably for those born at less than 25 weeks. The rates of antenatal corticosteroid use, induced preterm deliveries, cesarean deliveries, and surfactant use increased significantly in all gestational-age groups, except at 22 through 23 weeks. CONCLUSIONS AND RELEVANCE The substantial improvement in survival in France for newborns born at 25 through 31 weeks' gestation was accompanied by an important reduction in severe morbidity, but survival remained rare before 25 weeks. Although improvement in survival at extremely low gestational age may be possible, its effect on long-term outcomes requires further studies. The long-term results of the EPIPAGE-2 study will be informative in this regard.
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Affiliation(s)
- Pierre-Yves Ancel
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris, France2Paris Descartes University, Paris, France3Clinical Research Unit, Center for Clinical Investigation
| | - François Goffinet
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris, France2Paris Descartes University, Paris, France4Maternité Port-Royal, Hospital University Department Risks
| | | | | | | | | | | | | | | | | | | | - Michel Dreyfus
- Department of Gynecology and Obstetrics, University Hospital, Caen, France
| | - Bernard Guillois
- Department of Neonatal Pediatrics and Intensive Care, University Hospital, Caen, France
| | - Antoine Burguet
- Department of Neonatal Pediatrics, University Hospital, Dijon, France
| | - Pierre Sagot
- Department of Gynecology and Obstetrics, University Hospital, Dijon, France
| | | | - Alain Beuchée
- Department of Pediatrics, University Hospital, Inserm-Irset U 1085, Rennes, France
| | - Florence Rouget
- Department of Pediatrics, University Hospital, Inserm-Irset U 1085, Rennes, France
| | - Amélie Favreau
- Department of Neonatal Pediatrics and Intensive Care, University Hospital, Tours, France
| | - Elie Saliba
- INSERM U 930, François Rabelais University, Tours, France
| | - Nathalie Bednarek
- Department of Neonatal Pediatrics, University Hospital, Reims, France
| | - Patrice Morville
- Department of Neonatal Pediatrics, University Hospital, Reims, France
| | - Gérard Thiriez
- Department of Neonatal Pediatrics, University Hospital, Besançon, France
| | - Loïc Marpeau
- Department of Gynecology and Obstetrics, University Hospital, Rouen, France
| | - Stéphane Marret
- Department of Neonatal Pediatrics and Intensive Care, Rouen University Hospital-Laboratory of microvascular endothelium and neonatal brain lesions, Rouen, France
| | - Gilles Kayem
- Department of Obstetrics and Gynecology, Louis Mourier Hospital, University Hospitals Paris Nord Val de Seine (HUPNVS)), Assistance Publique-Paris Hospitals (APHP), Paris Diderot University, Paris, France
| | - Xavier Durrmeyer
- Department of Neonatal Pediatrics and Intensive Care, CHI, CRC, Créteil, France
| | - Michèle Granier
- Department of Neonatal Pediatrics, Sud Francilien Hospital, Evry, France
| | - Olivier Baud
- Neonatal intensive care unit, Robert Debré Hospital, INSERM, UMR 676, Paris, France
| | - Pierre-Henri Jarreau
- Department of Neonatal Pediatrics and Intensive Care, Cochin Hotel Dieu Hospital, Paris, France
| | | | - Pascal Boileau
- Department of Neonatal Pediatrics, Poissy Saint Germain University Hospital, Poissy, France
| | - Pierre Boulot
- Department of Obstetrics and Gynecology, Arnaud de Villeneuve Hospital, Montpellier, France
| | - Gilles Cambonie
- Department of Neonatal Pediatrics and Intensive Care, Arnaud de Villeneuve Hospital, Montpellier, France
| | | | - Antoine Bédu
- Department of Neonatal Pediatrics, Mère-Enfant Hospital, Limoges, France
| | - Fabienne Mons
- Department of Neonatal Pediatrics, Mère-Enfant Hospital, Limoges, France
| | - Jeanne Fresson
- Department of Medical Information, Adolphe Pinard Maternity Unit, Nancy, France
| | - Rachel Vieux
- Department of Neonatal Pediatrics and Intensive Care, Adolphe Pinard Maternity Unit, Nancy, France
| | | | - Catherine Arnaud
- UMR 1027 INSERM, Paul-Sabatier Toulouse III University, Toulouse, France
| | | | - Patrick Truffert
- Department of Neonatal Pediatrics, Jeanne de Flandres Hospital, Lille, France
| | - Véronique Pierrat
- Department of Neonatal Pediatrics, Jeanne de Flandres Hospital, Lille, France
| | - Damien Subtil
- Department of Gynecology and Obstetrics, Jeanne de Flandre Hospital, Lille, France
| | - Claude D'Ercole
- Department of Gynecology and Obstetrics, Nord Hospital, Marseille, France
| | - Catherine Gire
- Department of Neonatal Pediatrics and Intensive Care, Nord Hospital, Marseille, France
| | - Umberto Simeoni
- Department of Neonatal Pediatrics and Intensive Care, La Conception Hospital, Marseille, France
| | - André Bongain
- Department of Gynecology and Obstetrics, Archet Hospital, Nice, France
| | - Loïc Sentilhes
- Department of Obstetrics and Gynecology, Angers University Hospital, Angers, France
| | - Jean-Christophe Rozé
- Department of Neonatal Medicine, Angers University Hospital and INSERM CIC 004, Nantes, France
| | - Jean Gondry
- Department of Obstetrics and gynecology, Amiens, France
| | - André Leke
- Department of Pediatrics, Amiens, France
| | | | - Olivier Claris
- Department of Neonatal Pediatrics and Intensive Care, University Hospital, Lyon, France
| | - Jean-Charles Picaud
- Department of Neonatal Pediatrics and Intensive Care, La Croix Rousse Hospital, Lyon, France
| | - Anne Ego
- INSERM CIC003, University Hospital, Grenoble, France
| | - Thierry Debillon
- Department of Neonatal Pediatrics, University Hospital, Grenoble, France
| | | | - Eliane Coliné
- University Hospital, Pointe à Pitre, Guadeloupe, France
| | - Anne Favre
- Department of Neonatal Pediatrics and Intensive Care, Cayenne Hospital, Cayenne, Guyane, France
| | | | - Sylvain Samperiz
- Department of Neonatal Pediatrics and Intensive Care, University Hospital Felix Guyon, Saint-Denis, La Réunion, France
| | - Duksha Ramful
- Department of Neonatal Pediatrics and Intensive Care, University Hospital Felix Guyon, Saint-Denis, La Réunion, France
| | - Bernard Branger
- Fédération des Réseaux de Santé en Périnatalité [FFRSP], Nantes, France
| | - Valérie Benhammou
- Inserm UMR1153, Perinatal and Pediatric Epidemiology Team, Paris, France
| | | | | | - Monique Kaminski
- Inserm UMR1153, Perinatal and Pediatric Epidemiology Team, Paris, France
| | - Monique Kaminski
- Inserm UMR1153, Perinatal and Pediatric Epidemiology Team, Paris, France
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Zana-Taieb E, Pham H, Franco-Montoya ML, Jacques S, Letourneur F, Baud O, Jarreau PH, Vaiman D. Impaired alveolarization and intra-uterine growth restriction in rats: a postnatal genome-wide analysis. J Pathol 2015; 235:420-30. [DOI: 10.1002/path.4470] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 09/17/2014] [Accepted: 10/13/2014] [Indexed: 02/06/2023]
Affiliation(s)
- E Zana-Taieb
- Université Paris Descartes; Paris France
- Fondation PremUp, 53 avenue de l'Observatoire, 75014 Paris; France
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1141; Paris France
- Assistance Publique - Hôpitaux de Paris, Service de Médecine et Réanimation Néonatales de Port-Royal, Groupe Hospitalier Cochin, Broca, Hôtel-Dieu, 53 Avenue de l'Observatoire, 75014 Paris; France
| | - H Pham
- Fondation PremUp, 53 avenue de l'Observatoire, 75014 Paris; France
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1141; Paris France
| | - ML Franco-Montoya
- Institut National de la Santé et de la Recherche Médicale (INSERM) U955 IMRB Equipe 04, Faculté de Médecine de Créteil, 94010 Créteil; France
| | - S Jacques
- Genom'ic, INSERM U1016, CNRS UMR8104, Paris; France
| | - F Letourneur
- Genom'ic, INSERM U1016, CNRS UMR8104, Paris; France
| | - O Baud
- Fondation PremUp, 53 avenue de l'Observatoire, 75014 Paris; France
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1141; Paris France
- Assistance Publique - Hôpitaux de Paris, Service de Réanimation et Pédiatrie Néonatales, Hôpital Robert Debré, Paris; France
- Université Paris Diderot; Paris France
| | - PH Jarreau
- Université Paris Descartes; Paris France
- Fondation PremUp, 53 avenue de l'Observatoire, 75014 Paris; France
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1141; Paris France
- Assistance Publique - Hôpitaux de Paris, Service de Médecine et Réanimation Néonatales de Port-Royal, Groupe Hospitalier Cochin, Broca, Hôtel-Dieu, 53 Avenue de l'Observatoire, 75014 Paris; France
| | - D Vaiman
- Institut Cochin, INSERM U1016-CNRS, UMRS 104; Paris France
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Orbach D, Sarnacki S, Brisse HJ, Gauthier-Villars M, Jarreau PH, Tsatsaris V, Baruchel A, Zerah M, Seigneur E, Peuchmaur M, Doz F. Neonatal cancer. Lancet Oncol 2014; 14:e609-20. [PMID: 24275134 DOI: 10.1016/s1470-2045(13)70236-5] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Neonatal cancer is rare and comprises a heterogeneous group of neoplasms with substantial histological diversity. Almost all types of paediatric cancer can occur in fetuses and neonates; however, the presentation and behaviour of neonatal tumours often differs from that in older children, leading to differences in diagnosis and management. The causes of neonatal cancer are unclear, but genetic factors probably have a key role. Other congenital abnormalities are frequently present. Teratoma and neuroblastoma are the most common histological types of neonatal cancer, with soft-tissue sarcoma, leukaemia, renal tumours, and brain tumours also among the more frequent types. Prenatal detection, most often on routine ultrasound or in the context of a known predisposition syndrome, is becoming more common. Treatment options pose challenges because of the particular vulnerability of the population. Neonatal cancer raises diagnostic, therapeutic, and ethical issues, and management requires a multidisciplinary approach.
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Affiliation(s)
- Daniel Orbach
- Department of Paediatric Oncology, Institut Curie, Paris, France
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50
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Zana-Taieb E, Butruille L, Franco-Montoya ML, Lopez E, Vernier F, Grandvuillemin I, Evain-Brion D, Deruelle P, Baud O, Delacourt C, Jarreau PH. Effect of two models of intrauterine growth restriction on alveolarization in rat lungs: morphometric and gene expression analysis. PLoS One 2013; 8:e78326. [PMID: 24278109 PMCID: PMC3836790 DOI: 10.1371/journal.pone.0078326] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [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: 05/21/2013] [Accepted: 09/11/2013] [Indexed: 01/21/2023] Open
Abstract
Intrauterine growth restriction (IUGR) in preterm infants increases the risk of bronchopulmonary dysplasia, characterized by arrested alveolarization. We evaluated the impact of two different rat models (nitric oxide synthase inhibition or protein deprivation) of IUGR on alveolarization, before, during, and at the end of this postnatal process. We studied IUGR rat pups of dams fed either a low protein (LPD) or a normal diet throughout gestation and pups of dams treated by continuous infusion of Nω-nitro-L-arginine methyl ester (L-NAME) or its diluent on the last four days of gestation. Morphometric parameters, alveolar surface (Svap), mean linear intercept (MLI) and radial alveolar count (RAC) and transcriptomic analysis were determined with special focus on genes involved in alveolarization. IUGR pups regained normal weight at day 21 in the two treated groups. In the LPD group, Svap, MLI and RAC were not different from those of controls at day 4, but were significantly decreased at day 21, indicating alveolarization arrest. In the L-NAME group, Svap and RAC were significantly decreased and MLI was increased at day 4 with complete correction at day 21. In the L-NAME model, several factors involved in alveolarization, VEGF, VEGF-R1 and –R2, MMP14, MMP16, FGFR3 and 4, FGF18 and 7, were significantly decreased at day 4 and/or day 10, while the various factors studied were not modified in the LPD group. These results demonstrate that only maternal protein deprivation leads to sustained impairment of alveolarization in rat pups, whereas L-NAME impairs lung development before alveolarization. Known growth factors involved in lung development do not seem to be involved in LPD-induced alveolarization disorders, raising the question of a possible programming of altered alveolarization.
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Affiliation(s)
- Elodie Zana-Taieb
- Institut National de la Santé Et de la Recherche Médicale (INSERM) U767, Paris, France
- PremUp, Paris, France
- Service de Médecine et Réanimation néonatales de Port-Royal, Groupe hospitalier Cochin, Broca, Hôtel-Dieu, Assistance Publique – Hôpitaux de Paris, Paris, France
- Université Paris Descartes, Paris, France
- * E-mail:
| | - Laura Butruille
- Unité environnement périnatal et croissance, EA4489, Faculté de Médecine, Pôle recherche, IFR 114,Université Lille Nord de France, Lille, France
| | | | - Emmanuel Lopez
- Institut National de la Santé Et de la Recherche Médicale (INSERM) U767, Paris, France
- PremUp, Paris, France
- Service de Médecine et Réanimation néonatales de Port-Royal, Groupe hospitalier Cochin, Broca, Hôtel-Dieu, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Flore Vernier
- Institut National de la Santé Et de la Recherche Médicale (INSERM) U767, Paris, France
- PremUp, Paris, France
| | - Isabelle Grandvuillemin
- Institut National de la Santé Et de la Recherche Médicale (INSERM) UMR 1076, Faculté de Pharmacie, Université de la Méditerranée. Marseille, France
| | - Danièle Evain-Brion
- Institut National de la Santé Et de la Recherche Médicale (INSERM) U767, Paris, France
- PremUp, Paris, France
- Université Paris Descartes, Paris, France
| | - Philippe Deruelle
- Unité environnement périnatal et croissance, EA4489, Faculté de Médecine, Pôle recherche, IFR 114,Université Lille Nord de France, Lille, France
| | - Olivier Baud
- PremUp, Paris, France
- Institut National de la Santé Et de la Recherche Médicale (INSERM) U676, Paris, France
- Service de Réanimation et Pédiatrie néonatales, Hôpital Robert Debré, Assistance Publique – Hôpitaux de Paris, Paris, France
- Université Paris Diderot, Paris, France
| | - Christophe Delacourt
- PremUp, Paris, France
- Institut National de la Santé Et de la Recherche Médicale (INSERM) U955 IMRB Equipe 04, Créteil, France
- Service de Pneumologie Pédiatrique, Hôpital Necker-Enfants Malades, Assistance Publique – Hôpitaux de Paris, Paris, France
- Université Paris Descartes, Paris, France
| | - Pierre-Henri Jarreau
- Institut National de la Santé Et de la Recherche Médicale (INSERM) U767, Paris, France
- PremUp, Paris, France
- Service de Médecine et Réanimation néonatales de Port-Royal, Groupe hospitalier Cochin, Broca, Hôtel-Dieu, Assistance Publique – Hôpitaux de Paris, Paris, France
- Université Paris Descartes, Paris, France
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