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Klein C, Borowski A, Miclo M, Plancq MC, Tourneux P, Gouron R. Antibiotic treatment of hand wounds in children: Contribution of a decision tree. Hand Surg Rehabil 2024; 43:101678. [PMID: 38428635 DOI: 10.1016/j.hansur.2024.101678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 02/19/2024] [Accepted: 02/19/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND The need for prophylactic antibiotic treatment of hand wounds in children requiring emergency surgical exploration is still controversial. Our starting hypothesis was that the absence of prophylactic antibiotic treatment in this setting (as specified by a decision tree) does not increase the likelihood of surgical site infection. METHODS A decision tree for antibiotic prescription was developed by a working group in compliance with the guidelines issued by the French High Authority for Health, as part of a clinical pathway. One injection of intravenous antibiotics was prescribed for bite injuries, open joint injuries, injuries left untreated for more than 24 h, and suspected contaminated wounds. All children admitted for surgical treatment of a hand wound between July 2018 and March 2023 were included. Demographic data, antibiotic prescription and onset of postoperative surgical site infection were recorded. RESULTS The 238 children included had a mean age of 8 ± 4.8 years; 102 received antibiotics and 136 did not. Eleven children (4.6%) had superficial surgical site infection requiring no revision surgery or antibiotic therapy. 206 children (86.5%) were treated following the decision tree. Ten had superficial surgical site infection: 3 received antibiotics (3.7% of the 80 who were treated) and 7 did not (5.5% of the 126 not treated) (p = 0.74). Thirty-two patients (13.5%) were off-protocol, only 1 of whom received antibiotics for superficial surgical site infection. DISCUSSION Applying the decision tree standardized the prescription of antibiotics in hand wounds, was not associated with a significantly greater rate of surgical site infection, and avoided exposure to antibiotics for 61.1% of the children, thus limiting potential adverse events. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Céline Klein
- Department of Paediatric Orthopaedics, Amiens Picardie University Hospital and University of Picardie Jules Verne, Amiens, France; MP3CV-EA7517, CURS - Amiens Picardie University Hospital and Jules Verne University of Picardie, Amiens, France.
| | - Alexandrine Borowski
- Department of Paediatric Orthopaedics, Amiens Picardie University Hospital and University of Picardie Jules Verne, Amiens, France
| | - Matthieu Miclo
- Department of Anaesthesiology, Amiens Picardie University Hospital and University of Picardie Jules Verne, Amiens, France
| | - Marie-Christine Plancq
- Department of Paediatric Orthopaedics, Amiens Picardie University Hospital and University of Picardie Jules Verne, Amiens, France
| | - Pierre Tourneux
- Pediatric Intensive Care Unit, Amiens University Medical Center, Amiens, France; PériTox Laboratory UMR_I 01, UFR de Medicine, University of Picardie Jules Verne, Amiens, France
| | - Richard Gouron
- Department of Paediatric Orthopaedics, Amiens Picardie University Hospital and University of Picardie Jules Verne, Amiens, 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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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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4
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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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5
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Chardon K, Delanaud S, Tourneux P, Stephan Blanchard E. How to Control Exposure to Fifth-Generation Radiofrequencies in Preterm Newborns in Incubator. Neonatology 2023; 120:666-669. [PMID: 37343536 DOI: 10.1159/000530658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 04/06/2023] [Indexed: 06/23/2023]
Abstract
Infant and family centered development care reduces infant distress and supports the parent and infant's individual abilities. However, a new environmental factor is daily encountered: the radiofrequency electromagnetic fields (RF EMFs) with the most recent fifth-generation (5G) technology. Currently, the effects of RF EMF during development are discussed in animal models. The neonatal intensive care units are not spared from this stressor. The objective of this study was to evaluate the efficacy of a novel, electromagnetically insulating incubator cover to prevent the preterm infant from RF EMF exposure. A personal dosimeter was placed on the mattress of a closed incubator. Periods of exposure to low, medium, and high levels of 5G RF were delivered in the presence or absence of the incubator cover. The use of a silver-copper cover reduced the intensity of 5G radiofrequency levels from 52% to 57% (p < 0.0001), allowing to easily apply the precautionary principle.
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Affiliation(s)
- Karen Chardon
- PeriTox Laboratory, UMR-I 01 INERIS, Picardie Jules Verne University, Amiens, France
| | - Stéphane Delanaud
- PeriTox Laboratory, UMR-I 01 INERIS, Picardie Jules Verne University, Amiens, France
| | - Pierre Tourneux
- PeriTox Laboratory, UMR-I 01 INERIS, Picardie Jules Verne University, Amiens, France
- Neonatal Intensive Care Unit, Amiens University Hospital, Amiens, France
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6
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Szcrupak C, Tourneux P. A French nationwide survey of phototherapy in very preterm and moderately preterm infants. Arch Pediatr 2023:S0929-693X(23)00080-5. [PMID: 37236888 DOI: 10.1016/j.arcped.2023.04.002] [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: 06/15/2022] [Revised: 03/07/2023] [Accepted: 04/29/2023] [Indexed: 05/28/2023]
Abstract
Phototherapy for jaundice in preterm infants should always be administered in accordance with specific guidelines. However, guidelines on phototherapy in very preterm and moderately preterm infants are currently lacking in France. We performed a nationwide quality improvement study of the management of jaundice in these preterm infants and compared the results with the international guidelines. Of the 275 maternity units initially contacted, 165 (60.0%) replied. Our results showed that clinical practice differs markedly from one unit to another - notably with regard to the prescription, administration, and monitoring of phototherapy and the reference curves used. Even though there is limited evidence on the safety and efficacy of phototherapy in very or moderately preterm infants, a French expert committee should be encouraged to develop consensus guidelines and thus improve quality of care in this setting.
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Affiliation(s)
- C Szcrupak
- Réanimation Néonatale, pôle Femme-Couple-Enfant, CHU Amiens, France
| | - P Tourneux
- Réanimation Néonatale, pôle Femme-Couple-Enfant, CHU Amiens, France; PériTox, Laboratoire mixte INERIS, UMR-I 01, UFR de Médecine, Université de Picardie Jules Verne, Amiens, France.
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7
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Ducros M, Tourneux P, Fontaine C. Early discharge from maternity ward in response to the COVID-19 pandemic: Impact on emergency attendance. Arch Pediatr 2023; 30:25-30. [PMID: 36481161 PMCID: PMC9682060 DOI: 10.1016/j.arcped.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 09/06/2022] [Accepted: 11/11/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND In response to the coronavirus disease 2019 (COVID-19) epidemic, our maternity department had to rapidly implement a protocol for early postpartum discharge. We evaluated the benefits and risks of early postpartum discharge. METHODS We performed an observational, single-center case-control study over a 3 month-period during the COVID-19 outbreak (from June 1 to August 31, 2020), following implementation of the early discharge policy. Newborns were classified into an early discharge group (within 48-72 h of a vaginal delivery and within 72-96 h of a cesarean delivery) or a standard discharge group (more than 72 h after a vaginal delivery and more than 96 h after a cesarean delivery). The primary outcome measure was inappropriate pediatric emergency department visits within 28 days of delivery. RESULTS A total of 546 newborns were included. A total of 22 (8.9%) of the 246 newborns in the early discharge group attended the pediatric emergency department vs. 30 (10.0%) of the 300 newborns in the standard discharge group (p = 0.65). Nine visits (40.9%) were considered inappropriate in the early discharge group vs. 13 (43.3%) in the standard discharge group (p = 0.83). Likewise, the intergroup difference in the hospital readmission rate was not statistically significant. DISCUSSION The implementation of early discharge and early follow-up did not result in a significantly greater need (vs. standard discharge) for inappropriate emergency visit or hospital readmission during the first 28 days postpartum, regardless of the parity and breastfeeding status.
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Affiliation(s)
- M. Ducros
- Neonatal Intensive Care Unit, Amiens University Medical Center, Amiens, France
| | - P. Tourneux
- Neonatal Intensive Care Unit, Amiens University Medical Center, Amiens, France,PériTox UMR_I 01, UFR de médecine, Université de Picardie Jules Verne, Amiens, France
| | - C. Fontaine
- Neonatal Intensive Care Unit, Amiens University Medical Center, Amiens, France,Corresponding author at: Neonatal Intensive Care Unit, Amiens University Hospital, 1 rue du Professeur Christian Cabrol, F-80054 Amiens cedex 1, France
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8
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Tchidjou HK, Palandri L, Righi E, Monti M, Ricard J, Pouplin S, Tourneux P, Klein C. Symptom clusters helping the assessment of SARS-COV-2-infected children: Amiens cohort versus European data. Medicine (Baltimore) 2022; 101:e29524. [PMID: 35839021 PMCID: PMC9377676 DOI: 10.1097/md.0000000000029524] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 04/14/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Since December 2019, the novel coronavirus (SARS-CoV-2) pandemic, caused >240 million cases and >5 million deaths. Given the current wider dissemination of pediatric cases, it is important to address questions regarding the clinical picture in children or if there are clinical patterns that may help us identify in an early stage what can be the prognosis and help clinicians with patient management. The study aimed to investigate in a French monocentric cohort and other European cohorts the presence of symptom clusterization and its possible connection to illness categories to help medical first-line screening and orientation in the pediatric emergency department (ED). METHODS We conducted a retrospective cohort study describing clinical, laboratory, and radiological characteristics of SARS-CoV-2-infected children admitted to pediatric ED to assess the presence of symptom clustering. A scoping review of the literature was performed to further investigate symptom clusters. RESULTS Of 1086 tested children, 48 tested positive to SARS-CoV-2. The clinical, laboratory, and radiological characteristics of our sample were fully described. Two distinct clusters of clinical phenotypes were identified as well as their potential association with illness categories in SARS-CoV-2-infected children. Comparison with similar European cohorts highlights how symptoms coming from the mucocutaneous-enteric, and the respiratory clusters are associated with a more severe clinical picture. CONCLUSIONS This study promotes the importance to identify early prognostic patterns to help clinicians in the decision process, especially in COVID-19 pediatric patients.
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Affiliation(s)
| | - Lucia Palandri
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Italy
| | - Elena Righi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Italy
| | - Marco Monti
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Italy
| | - Jannick Ricard
- Pediatric Emergency Services, Amiens University Hospital, Amiens, France
| | - Suzanne Pouplin
- Pediatric Emergency Services, Amiens University Hospital, Amiens, France
| | - Pierre Tourneux
- Pediatric Intensive Care Unit, Amiens University Hospital, Amiens, France
| | - Celine Klein
- Department of Pediatric Orthopedics, Amiens University Hospital, Amiens, France
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Zana‐Taïeb E, Sizun J, Kuhn P, Reynaud A, Allen A, Berne‐Audeoud F, Bouvard C, Brandicourt A, Caeymaex L, Denoual H, Duboz MA, Evrard A, Fichtner C, Fischer‐Fumeaux C, Girard L, Gonnaud F, Haumont D, Hüppi P, Knezovic N, Laprugne‐Garcia E, Legouais S, Mons F, Pelofy V, Picaud J, Pierrat V, Pladys P, Renesme L, Rideau A, Souet G, Tscherning C, Thiriez G, Tourneux P, Touzet M, Truffert P, Zaoui C, Zores‐Koenig C. Practical recommendations on room sizes for hospitalised newborn infants and their families based on a systematic review of the literature. Acta Paediatr 2022; 111:1109-1114. [PMID: 35194839 DOI: 10.1111/apa.16308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/18/2022] [Accepted: 02/21/2022] [Indexed: 11/30/2022]
Abstract
AIM Neonatal unit design may affect the neurodevelopment of hospitalised neonates and the well-being of parents and healthcare staff (HCS). We aimed to provide recommendations regarding the minimum area required for a hospital room for a single neonate and their family. METHODS We searched PubMed and Web of Science for relevant articles published from 1 January 2011 to 1 May 2021 by using the keywords NICU and facility design. Recommendations were developed after internal and external review by a multidisciplinary group including 15 professionals and parent representatives. RESULTS We identified 314 studies and developed six recommendations from four eligible studies. Recommendations for room size were developed according to three perspectives: opinions of users, who emphasised the need for a spacious room; proposals of organisations by HCS, which advocated for a minimum floor area of 11.2-18 m2 in a single non-family room and 15.3-24 m2 in a single-family room; and simulation methods indicating that the minimum floor area in the neonatal unit should be 18.5-24 m2 . CONCLUSION Units need to provide a minimum room size to allow for optimal newborn development and a better experience for parents and caregivers.
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Affiliation(s)
- Elodie Zana‐Taïeb
- Department of Neonatal Medicine Cochin‐Port Royal Hospital FHU PREMA Paris AP‐HP France
| | - Jacques Sizun
- Department of Neonatal Medicine Children Hospital Toulouse France
| | - Pierre Kuhn
- Department of Neonatal Medecine. CHU Hautepierre Strasbourg France
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10
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Tourneux P, Thiriez G, Renesme L, Zores C, Sizun J, Kuhn P. Optimising homeothermy in neonates: a systematic review and clinical guidelines from the French Neonatal Society. Acta Paediatr 2022; 111:1490-1499. [PMID: 35567516 DOI: 10.1111/apa.16407] [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: 02/17/2022] [Revised: 05/11/2022] [Accepted: 05/12/2022] [Indexed: 11/28/2022]
Abstract
AIM Thermal instability is harmful on the newborn infant. We sought to draw up practical guidelines on maintaining homeothermy alongside skin-to-skin contact. METHODS A systematic analysis of the literature identified relevant studies between 2000 and 2021 in the PubMed database. Selected publications were evaluated, and their level of evidence were graded, in order to underpin the development of clinical guidelines. RESULTS We identified 7 meta-analyses and 64 clinical studies with a focus on newborn infants homeothermy. Skin-to-skin contact is the easiest and most rapidly implementable method to prevent body heat loss. Alongside skin-to-skin contact, monitoring the newborn infant's body temperature with a target of 37.0°C is essential. For newborn infants <32 weeks of gestation, a skullcap and a polyethylene bag should be used in the delivery room or during transport. To limit water loss, inhaled gases humidification and warming is recommended, and preterm infants weighing less than 1600 g should be nursed in a closed, convective incubator. With regard to incubators, there are no clear benefits for single vs. double-wall incubators as well as for air vs. skin servo control. CONCLUSION Alongside skin-to-skin contact, a bundle of practical guidelines could improve the maintenance of homeothermy in the newborn infant.
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Affiliation(s)
- Pierre Tourneux
- Neonatal Intensive Care Unit, Amiens University Hospital, Amiens, France
- PériTox Laboratory UMR_I 01, UFR de Médecine, University of Picardie Jules Verne, Amiens, France
| | - Gérard Thiriez
- Pediatric Intensive Care, Neonatology and Pediatric Emergencies Departments, Besancon University Hospital, Besancon, France
| | - Laurent Renesme
- Neonatal Intensive Care Unit, University Hospital of Bordeaux, Bordeaux, France
| | - Claire Zores
- Neonatal Intensive Care Unit, Hôpital de Hautepierre, Strasbourg University Hospital, Strasbourg, France
- Institut des Neurosciences Cellulaires et Intégratives, UPR 3212, CNRS et Université de Strasbourg, France
| | - Jacques Sizun
- Neonatal Intensive Care Unit, Toulouse University Hospital, Toulouse, France
| | - Pierre Kuhn
- Neonatal Intensive Care Unit, Hôpital de Hautepierre, Strasbourg University Hospital, Strasbourg, France
- Institut des Neurosciences Cellulaires et Intégratives, UPR 3212, CNRS et Université de Strasbourg, France
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11
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Basset A, Zana-Taïeb E, Bénard M, Gascoin G, Tourneux P, Pierrat V, Butin M, Brémaud-Csizmadia C, Torchin H. Nurses and physicians at high risk of burnout in French level III neonatal intensive care units: an observational cross-sectional study. J Perinatol 2022; 42:669-670. [PMID: 35094021 DOI: 10.1038/s41372-021-01266-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 10/20/2021] [Accepted: 10/29/2021] [Indexed: 11/09/2022]
Affiliation(s)
- A Basset
- Department of Neonatal Medicine, Cochin-Port Royal Hospital, FHU PREMA, AP-HP, Paris, F-75014, France.
| | - E Zana-Taïeb
- Department of Neonatal Medicine, Cochin-Port Royal Hospital, FHU PREMA, AP-HP, Paris, F-75014, France
| | - M Bénard
- Department of Neonatal Medicine, Children Hospital, 31000, Toulouse, France
| | - G Gascoin
- Department of Neonatal Medicine, University Hospital, 49000, Angers, France
| | - P Tourneux
- Department of Neonatal Medicine, Pôle Femme-Couple-Enfant, University Hospital, PériTox, UMR_I 01, UFR de Médecine, UPJV, 80000, Amiens, France
| | - V Pierrat
- Department of Neonatal Medicine, Jeanne de Flandre Hospital, F-59000, Lille, France.,University of Paris, Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, F-75004, Paris, France
| | - M Butin
- Department of Neonatal Medicine, Femme Mère Enfant Hospital, Hospices Civils de Lyon, Infectiology Research International Center, Unité INSERM U1111 CNRS UMR5308 ENS de Lyon, Lyon University, 69000, Lyon, France
| | - C Brémaud-Csizmadia
- University Hospital, Neonatal and Paediatric Intensive Care Unit, 86000, Poitiers, France
| | - H Torchin
- Department of Neonatal Medicine, Cochin-Port Royal Hospital, FHU PREMA, AP-HP, Paris, F-75014, France.,University of Paris, Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, F-75004, Paris, France
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12
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Bagory H, De Broucker C, Tourneux P, Balcaen T, Gondry J, Foulon A, Sergent F. [Efficacy and safety of oral misoprostol 25μg vs. vaginal dinoprostone in induction of labor at term]. Gynecol Obstet Fertil Senol 2022; 50:229-235. [PMID: 34871786 DOI: 10.1016/j.gofs.2021.11.011] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 10/29/2021] [Accepted: 11/28/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To compare the efficacy and safety of oral misoprostol 25μg compared to vaginal dinoprostone in the induction of labor at term. METHODS Analytic, retrospective study of patients induced at term by prostaglandins with an unfavorable cervix, over two consecutive periods from 01/01/2019 to 19/02/2020 and from 20/02/2020 to 07/04/2021, within a regional level III university hospital center. We compared the safety and the efficacy between the oral misoprostol Angusta® used since 20/02/2020 and the vaginal dinoprostone previously used in gel or diffuser. The primary endpoint was the rate of vaginal deliveries within 24h. Secondary endpoints were cesarean section rate, indications for cesarean section, uterine contractility abnormalities and neonatal outcomes. RESULTS Our study found no difference in terms of efficacy with similar rates of vaginal deliveries within 24h (51.88% vs. 51.25%; P=0.87) and caesarean sections (misoprostol group: 19.42% vs. dinoprostone group: 16.62%; P=0.33). However, the tolerance criteria revealed in the dinoprostone group an increase in tachysystole (misoprostol group: 9.28% vs. dinoprostone group: 16.90%; P=0.003) and acidosis (arterial pH<7.10, misoprostol group: 3.83% vs. dinoprostone group: 9.29%; P=0.006). CONCLUSION No difference in efficacy was found between the two induction techniques. Oral misoprostol 25μg seems to be better tolerated from a maternal and fetal point of view.
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Affiliation(s)
- H Bagory
- Service de gynécologie-obstétrique et médecine de la reproduction, pôle Femme Couple - Enfants, CHU Amiens-Picardie, 1, rond-point du Professeur-Christian-Cabrol, 80054 Amiens cedex 1, France; Université Picardie Jules-Verne, faculté de médecine, 3, rue des Louvels, 80000 Amiens, France.
| | - C De Broucker
- Service de gynécologie-obstétrique et médecine de la reproduction, pôle Femme Couple - Enfants, CHU Amiens-Picardie, 1, rond-point du Professeur-Christian-Cabrol, 80054 Amiens cedex 1, France; Université Picardie Jules-Verne, faculté de médecine, 3, rue des Louvels, 80000 Amiens, France
| | - P Tourneux
- PériTox UM_I 01, université Picardie Jules-Verne, faculté de médecine, 3, rue des Louvels, 80000 Amiens, France; Université Picardie Jules-Verne, faculté de médecine, 3, rue des Louvels, 80000 Amiens, France; Service de néonatalogie, pôle Femme Couple - Enfants, CHU Amiens-Picardie, 1, rond-point du Professeur-Christian-Cabrol, 80054 Amiens cedex 1, France
| | - T Balcaen
- Service d'information médicale, pôle PRIME, CHU Amiens-Picardie, 1, rond-point du Professeur-Christian-Cabrol, 80054 Amiens cedex 1, France
| | - J Gondry
- Service de gynécologie-obstétrique et médecine de la reproduction, pôle Femme Couple - Enfants, CHU Amiens-Picardie, 1, rond-point du Professeur-Christian-Cabrol, 80054 Amiens cedex 1, France; Université Picardie Jules-Verne, faculté de médecine, 3, rue des Louvels, 80000 Amiens, France
| | - A Foulon
- Service de gynécologie-obstétrique et médecine de la reproduction, pôle Femme Couple - Enfants, CHU Amiens-Picardie, 1, rond-point du Professeur-Christian-Cabrol, 80054 Amiens cedex 1, France; Université Picardie Jules-Verne, faculté de médecine, 3, rue des Louvels, 80000 Amiens, France
| | - F Sergent
- Service de gynécologie-obstétrique et médecine de la reproduction, pôle Femme Couple - Enfants, CHU Amiens-Picardie, 1, rond-point du Professeur-Christian-Cabrol, 80054 Amiens cedex 1, France; Université Picardie Jules-Verne, faculté de médecine, 3, rue des Louvels, 80000 Amiens, France
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13
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Caron F, Tourneux P, Tchidjou HK, Taleb A, Gouron R, Panuel M, Klein C. Incidence of child abuse with subdural hemorrhage during the first year of the COVID-19 pandemic: a nationwide study in France. Eur J Pediatr 2022; 181:2433-2438. [PMID: 35302178 PMCID: PMC8929282 DOI: 10.1007/s00431-022-04387-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/20/2022] [Accepted: 01/21/2022] [Indexed: 02/02/2023]
Abstract
UNLABELLED The global COVID-19 pandemic prompted governments to impose unprecedented sanitary measures, such as social distancing, curfews, and lockdowns. In France and other countries, the first COVID-19 lockdown raised concerns about an increased risk of child abuse. Abusive head trauma (AHT) is one of the most serious forms of child abuse in children aged 0-24 months and constitutes the leading cause of death in children under 2 years of age. Subdural hemorrhage (SDH) is present in 89% of cases of AHT and constitutes one of the most specific, objective clinical presentations in the diagnosis of child abuse. In a French nationwide study, we sought to evaluate the potential impact of the first year of the COVID-19 pandemic on the incidence of hospital admissions for child abuse with SDH, relative to the two previous years. We conducted a nationwide, retrospective study of data in the French national hospital discharge summary database by applying the International Classification of Diseases (10th Revision) codes for SDH and for child abuse. After including children aged up to 24 months with a diagnosis of child abuse and/or SDH following hospital admission anywhere in France between January 1, 2018, and December 31, 2020, we compared the incidence of child abuse, the incidence of SDH + child abuse, and the demographic data for 2020 with the corresponding values for 2018 and 2019. There were no significant differences in the number of hospital admissions due to child abuse or SDH + child abuse between 2020 and the 2018/2019 control years. The incidence of SDH + child abuse was higher among boys than among girls. There were significantly fewer hospital admissions in May 2020 (p = 0.01) and significantly more in December 2020 (p = 0.03), relative to the same months in the two preceding years. There was a nonsignificant trend toward a lower incidence of hospital admission for child abuse in 2020, relative to 2019 (decrease: 6.4%) and 2018 (decrease: 7.6%). CONCLUSION When considering children under the age of 24 months in France, the incidence of hospital admission for SDH in the context of child abuse was not significantly higher in 2020 than in the two previous years. WHAT IS KNOWN • The impact of COVID-19 lockdown on child abuse and more specifically on subdural hemorrhage remains unknown. WHAT IS NEW • There was no increase in hospitalizations for child abuse and AHT. • We found that boys are more often victims of child abuse and subdural hemorrhage among children aged less than 12 months.
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Affiliation(s)
- Fiorella Caron
- Pediatric Intensive Care Unit, Amiens University Medical Center, Amiens, France
| | - Pierre Tourneux
- Pediatric Intensive Care Unit, Amiens University Medical Center, Amiens, France
- PériTox Laboratory UMR_I 01, UFR de Medicine, University of Picardie Jules Verne, Amiens, France
| | | | - Ariski Taleb
- Department of Medical Information, Montreuil-sur-Mer Medical Center, Montreuil-sur-Mer, France
| | - Richard Gouron
- Department of Pediatric Orthopedics, University of Picardie Jules Verne and Amiens Picardie University Medical Center, Amiens, France
| | - Michel Panuel
- Department of Medical Imaging Hôpital Nord, Hôpitaux de Marseille, Assistance Publique, Marseille, France
| | - Céline Klein
- Department of Pediatric Orthopedics, University of Picardie Jules Verne and Amiens Picardie University Medical Center, Amiens, France
- Service d’Orthopédie Pédiatrique, CHU Amiens-Picardie, 1 rue du Professeur Cabrol, 80054 Amiens Cedex 1, France
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14
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Bouzerar R, Madar O, Tourneux P, Couteaux C, Jany B, Promelle V. Optic disc morphology in preterm children. Influence of gestational age and birth weight. J Fr Ophtalmol 2021; 44:1584-1588. [PMID: 34696897 DOI: 10.1016/j.jfo.2021.03.009] [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: 01/13/2021] [Accepted: 03/08/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The characteristics of the optic disc and the development of the optic nerve can affect visual function in children. The purpose of our study was to assess optic disc morphology in preterm infants and to determine whether it is influenced by gestational age, birth weight and the presence of a retinopathy of prematurity. METHODS In a retrospective study, RetCam fundus images of 109 premature newborns admitted to our tertiary-level neonatal intensive care unit were reviewed. We evaluated the cup to disc ratio (C/D), optic disc diameter, cup diameter, shape of the optic disc, adherence to the ISNT rule, and presence of a peripapillary atrophy. RESULTS Of 218 photos, we found the following results: mean±SD gestational age 28.5±2.7 weeks, mean±SD birth weight 1122±394g, mean C/D 0.32. There was no significant correlation between C/D and gestational age or birth weight. Vertical disc diameter was greater than horizontal disc diameter, with a mean ratio (horizontal/vertical) of 4/5, lending an oval shape to the optic disc. Nineteen infants had retinopathy of prematurity in both eyes; ninety-three percent had peripapillary atrophy. CONCLUSION In our study, optic disc morphology in premature newborns was not influenced by gestational age, birth weight or presence of premature retinopathy.
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Affiliation(s)
- R Bouzerar
- Medical Image processing unit, Department of Imaging, Amiens University Hospital, Amiens, France
| | - O Madar
- Department of Ophthalmology, Amiens University Hospital, Amiens, France
| | - P Tourneux
- Pediatric intensive care unit, Amiens University Hospital, Université de Picardie Jules Verne, Amiens, France
| | - C Couteaux
- Department of Orthoptics, Department of Ophthalmology, Amiens University Hospital, Amiens, France
| | - B Jany
- Department of Ophthalmology, Amiens University Hospital, Amiens, France
| | - V Promelle
- Department of Ophthalmology, Amiens University Hospital, CHIMERE research group, Université de Picardie Jules Verne, 80054 Amiens cedex 1, France.
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15
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Debillon T, Tourneux P, Guellec I, Jarreau PH, Flamant C. Respiratory distress management in moderate and late preterm infants: The NEOBS Study. Arch Pediatr 2021; 28:392-397. [PMID: 33934933 DOI: 10.1016/j.arcped.2021.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/22/2021] [Accepted: 03/16/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To investigate the characteristics and management of respiratory failure (RF) in moderate-to-late preterm infants. METHODS NEOBS was a prospective, multicenter, observational study conducted in 46 neonatal intensive care units caring for preterm infants (30+0/7 to 36+6/7 weeks of gestation [WG]) in France in 2018. The cohort was stratified into two groups: 30-33 WG (group 1) and 34-36 WG (group 2). Infants with early neonatal RF were included and the outcomes assessed were maternal, pregnancy, and delivery characteristics and how RF was managed. RESULTS Of the 560 infants analyzed, 279 were in group 1 and 281 were in group 2. Most pregnancies were singleton (64.1%), and 67.4% of women received prenatal corticosteroids (mostly two doses). Infants were delivered by cesarean section in 59.6% of cases; 91.7% of the infants had an Apgar score ≥7 at 5min. More than 90% of infants were hospitalized post-birth (median duration, 36 and 15 days for groups 1 and 2, respectively). Medical intervention was required for 95.7% and 90.4% of the infants in group 1 and group 2, respectively, and included noninvasive ventilation (continuous positive airway pressure [CPAP]: 88.5% and 82.9%; high-flow nasal cannula: 55.0% and 44.7%, or other) and invasive ventilation (19.7% and 13.2%). The two main diagnoses of RF were respiratory distress syndrome (39.8%) and transient tachypnea of the newborn (57.3%). Surfactant was administered to 22.5% of the infants, using the less invasive surfactant administration (LISA) method for 34.4% of the patients. In the overall population, 8.6% of the infants had respiratory and/or hemodynamic complications. CONCLUSIONS The NEOBS study demonstrated that CPAP was widely used in the delivery room and the LISA method was chosen for 34.4% of the surfactant administrations for the management of RF in moderate-to-late preterm infants. The incidence of RF-related complications was low.
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Affiliation(s)
- T Debillon
- Neonatology Intensive Care Unit, University Hospital of Grenoble, CS 10217, 38043 Grenoble Cedex 9, France.
| | - P Tourneux
- Neonatal Intensive Care Unit, University Hospital of Amiens, France-PériTox UMR_I 01, University of Picardy Jules Verne, 1, rond point du Professeur Christian Cabrol, 80054 Amiens, France
| | - I Guellec
- Neonatal and Pediatric Intensive Care Unit, University Hospital of Trousseau, AP-HP, 26, avenue du Dr Arnold Netter, 75012 Paris, France
| | - P-H Jarreau
- NICU of Port-Royal, AP-HP Centre-Université de Paris, Cochin Hospital, 123, boulevard de Port-Royal, 75014 Paris, France
| | - C Flamant
- Neonatal Intensive Care Unit, University Hospital of Nantes, 38, boulevard Jean Monnet, 44000 Nantes, France
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16
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de Tristan MA, Martin-Marchand L, Roué JM, Anand KJS, Pierrat V, Tourneux P, Kuhn P, Milesi C, Benhammou V, Ancel PY, Carbajal R, Durrmeyer X. Association of Continuous Opioids and/or Midazolam During Early Mechanical Ventilation with Survival and Sensorimotor Outcomes at Age 2 Years in Premature Infants: Results from the French Prospective National EPIPAGE 2 Cohort. J Pediatr 2021; 232:38-47.e8. [PMID: 33395567 DOI: 10.1016/j.jpeds.2020.12.069] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 12/23/2020] [Accepted: 12/29/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To evaluate the association of early continuous infusions of opioids and/or midazolam with survival and sensorimotor outcomes at age 2 years in very premature infants who were ventilated. STUDY DESIGN This national observational study included premature infants born before 32 weeks of gestation intubated within 1 hour after birth and still intubated at 24 hours from the French EPIPAGE 2 cohort. Infants only treated with bolus were excluded. Treated infants received continuous opioid and/or midazolam infusion started before 7 days of life and before the first extubation. Naive infants did not receive these treatments before the first extubation, or received them after the first week of life, or never received them. This study compared treated (n = 450) vs naive (n = 472) infants by using inverse probability of treatment weighting after multiple imputation in chained equations. The primary outcomes were survival and survival without moderate or severe neuromotor or sensory impairment at age 2 years. RESULTS Survival at age 2 years was significantly higher in the treated group (92.5% vs 87.9%, risk difference, 4.7%; 95% CI, 0.3-9.1; P = .037), but treated and naive infants did not significantly differ for survival without moderate or severe neuromotor or sensory impairment (86.6% vs 81.3%; risk difference, 5.3%; 95% CI -0.3 to 11.0; P = .063). These results were confirmed by sensitivity analyses using 5 alternative models. CONCLUSIONS Continuous opioid and/or midazolam infusions in very premature infants during initial mechanical ventilation that continued past 24 hours of life were associated with improved survival without any difference in moderate or severe sensorimotor impairments at age 2 years.
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Affiliation(s)
- Marie-Amélie de Tristan
- Center of Research in Epidemiology and Statistics, University of Paris, CRESS, INSERM, INRA, Paris, France
| | - Laetitia Martin-Marchand
- Center of Research in Epidemiology and Statistics, University of Paris, CRESS, INSERM, INRA, Paris, France
| | - Jean-Michel Roué
- Neonatal Intensive Care Unit, University Hospital of Brest, Brest, France
| | - Kanwaljeet J S Anand
- Department of Pediatrics, Anesthesiology, Perioperative & Pain Medicine, Stanford University School of Medicine, Stanford, CA
| | - Véronique Pierrat
- Center of Research in Epidemiology and Statistics, University of Paris, CRESS, INSERM, INRA, Paris, France; Department of Neonatal Medicine, Jeanne de Flandre Hospital, Lille University Hospital, Lille, France
| | - Pierre Tourneux
- Neonatal Intensive Care Unit, CHU Amiens - University of Picardie Jules Verne, Amiens, France
| | - Pierre Kuhn
- Neonatal Intensive Care Unit, CHU Strasbourg, France, University of Strasbourg, INSERM Institute of Cellular and Integrative Neurosciences, Strasbourg, France
| | - Christophe Milesi
- Pediatric and Neonatal Intensive Care Unit, University Hospital of Montpellier, Montpellier, France
| | - Valérie Benhammou
- Center of Research in Epidemiology and Statistics, University of Paris, CRESS, INSERM, INRA, Paris, France
| | - Pierre-Yves Ancel
- Center of Research in Epidemiology and Statistics, University of Paris, CRESS, INSERM, INRA, Paris, France
| | - Ricardo Carbajal
- Center of Research in Epidemiology and Statistics, University of Paris, CRESS, INSERM, INRA, Paris, France; Pediatric Emergency Department, Assistance Publique des Hôpitaux de Paris, Armand Trousseau Hospital, Paris, France; Sorbonne University, Faculty of Medecine, Paris, France
| | - Xavier Durrmeyer
- Center of Research in Epidemiology and Statistics, University of Paris, CRESS, INSERM, INRA, Paris, France; Neonatal Intensive Care Unit, Hospital Center Intercommunal Créteil, Créteil, France; University of Paris East Créteil, Faculty of Medecine, Mondor Biomedical Research Institute, Clinical Research Group Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis, Créteil, France.
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17
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Dubos C, Querne L, Brenac W, Tourneux P. Association between hypothermia in the first day of life and survival in the preterm infant. Arch Pediatr 2021; 28:197-203. [PMID: 33750613 DOI: 10.1016/j.arcped.2021.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/15/2020] [Accepted: 02/13/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Hypothermia is associated with elevated mortality in the preterm infant. The preterm infant's thermoregulatory capacity is limited, and the thermal environment in an incubator is often perturbed by nursing procedures. We evaluated the incidence of a postnatal low body temperature and hypothermia in preterm infants and its association with mortality. METHODS We measured the lowest body temperature during the first 24h of life (TBody Nadir 24h) and hypothermia (TBody Nadir 24h<36.0°C) in preterm infants (gestational age: 230-316 weeks) in a neonatal intensive care unit. Prenatal and neonatal characteristics associated with mortality were identified in univariate and multivariable analyses. RESULTS A total of 102 preterm infants were included, with a mean gestational age at birth of 28.4±2.3 weeks. The incidence of hypothermia during the first 24h was 53%. A Cox multivariate regression model indicated that TBody Nadir 24h (hazard ratio (HR) [95% confidence interval]: 0.57 [0.36-0.90]; P=0.017), gestational age (0.62 [0.50-0.76]; P<0.001), and amine use (4.55 [2.01-10.28]; P=0.001) were significantly associated with mortality. When considering a threshold for TBody Nadir 24h, a value of 35.0°C had the highest HR (3.30 [1.42-7.68]; P<0.01). CONCLUSION In preterm infants, the incidence of hypothermia during the first 24h of life was 53%. TBody Nadir 24h had an influence on mortality, independently of other factors (notably birth weight and amine use). Within the framework of a quality improvement strategy, the implementation of a thermoregulation bundle is required to prevent hypothermia and decrease mortality in preterm infants.
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Affiliation(s)
- C Dubos
- Paediatric intensive care unit, Amiens university hospital, 80054 Amiens, France; PériTox Laboratory UMR_I 01, UFR de médecine, University of Picardie-Jules-Verne, 80054 Amiens, France
| | - L Querne
- INSERM U-1105, Paediatric neurology unit, Amiens university hospital, Amiens, France
| | - W Brenac
- Gynaecology-Obstetrics Unit, Amiens university hospital, 80054 Amiens, France
| | - P Tourneux
- Paediatric intensive care unit, Amiens university hospital, 80054 Amiens, France; PériTox Laboratory UMR_I 01, UFR de médecine, University of Picardie-Jules-Verne, 80054 Amiens, France.
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18
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Abstract
The primary objective of the study was to assess the prevalence of burnout among paediatric residents during the coronavirus disease 2019 (COVID-19) outbreak in France. The secondary objective was to identify risk factors associated with burnout in this population. In a nationwide, cross-sectional survey, a questionnaire was e-mailed to all paediatric residents in France in the first week of May 2020. The prevalence of burnout was assessed with the validated French-language version of the Maslach Burnout Inventory - Human Services Survey. The questionnaire also contained items on the residents' sociodemographic characteristics and professional situation. Three hundred and forty paediatric residents completed the questionnaire. The median age was 27 (interquartile range 25-28) and 285 (83.8%, 95% confidence interval (CI) [79.5-87.6]) of the residents were women. The prevalence of burnout was 37.4%, 95%CI [32.2-42.7]. There was no association between burnout and exposure to the consequences of COVID-19, which may be related to the low incidence of severe COVID-19 among children. In contrast, the hours worked per week and the anxiety scores were significantly associated with burnout.Conclusion: The level of burnout among French paediatric residents is a matter of concern for residents, and cannot be ascribed to the COVID-19 outbreak. Preventive actions should be implemented, with a reduction in working hours and support programs to help manage work-related anxiety. What is Known: • Burnout is a concern for both residents and the patients they care for. • Natural disasters disrupt the health care organizations and increase the burnout rate. What is New: • The prevalence of burnout among paediatric residents in France is 37.4%, 95%CI [32.2-42.7]. • COVID-19 outbreak is not associated with burnout in this population but anxiety and working hours per week might be modifiable risk factors.
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Affiliation(s)
- Ludovic Treluyer
- Paediatric Intensive Care Unit, CHU Amiens-Picardie, Amiens, France
- PériTox UMR_I 01, UFR de Médecine, Jules Verne University of Picardie, Amiens, France
| | - Pierre Tourneux
- Paediatric Intensive Care Unit, CHU Amiens-Picardie, Amiens, France
- PériTox UMR_I 01, UFR de Médecine, Jules Verne University of Picardie, Amiens, France
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19
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Dubos C, Delanaud S, Brenac W, Chahin Yassin F, Carpentier M, Tourneux P. The newborn infant's thermal environment in the delivery room when skin-to-skin care has to be interrupted. J Matern Fetal Neonatal Med 2020; 35:3707-3713. [PMID: 33106055 DOI: 10.1080/14767058.2020.1838479] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Newborns are prone to hypothermia immediately following birth. Hypothermia is associated with increased morbidity and mortality rates. We sought to assess the thermal environment and metabolic costs associated with exposure to various situations in the delivery room when skin-to-skin care (SSC) has to be curtailed. METHODS Environmental variables (air temperature: T a; relative humidity: RH; radiative temperature: T r; and air convection velocity) were recorded during sequences reproducing SSC, in the maternity unit's various rooms ("passive environments") and in incubators ("active environments"). Analytical calorimetry was then used to calculate the body heat loss (BHL) from these data. RESULTS The analysis of 1280 measurements of T a, RH, T r, and air convection velocity in SSC, passive and active environments revealed that (i) the thermohygrometric environment during SSC was optimal (T a: 32.7 ± 3.2 °C; RH: 50.9 ± 5.6%), (ii) BHL rose when SSC had to be interrupted, and (iii) the use of a radiant incubator prevented hypothermia and reduced dry BHL but not humid BHL (9.4 ± 1.5 kcal/kg/h; p < .001), relative to SSC (5.8 ± 2.0 kcal/kg/h; p < .001). CONCLUSION The newborn infant's thermohygrometric environment is optimal during SSC in the delivery room. When SSC was interrupted, Ta and RH always decreased, and BHL increased in all passive environments.
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Affiliation(s)
- Céline Dubos
- Pediatric Intensive Care Unit, CHU Amiens-Picardie, Amiens, France.,PériTox Laboratory UMR_I 01, UFR de Médecine, Jules Verne University of Picardie, Amiens, France
| | - Stéphane Delanaud
- PériTox Laboratory UMR_I 01, UFR de Médecine, Jules Verne University of Picardie, Amiens, France.,Health Engineering Institute (2IS), Jules Verne University of Picardie, Amiens, France
| | - William Brenac
- Gynecology-Obstetrics Unit, CHU Amiens-Picardie, Amiens, France
| | - Fatima Chahin Yassin
- PériTox Laboratory UMR_I 01, UFR de Médecine, Jules Verne University of Picardie, Amiens, France
| | | | - Pierre Tourneux
- Pediatric Intensive Care Unit, CHU Amiens-Picardie, Amiens, France.,PériTox Laboratory UMR_I 01, UFR de Médecine, Jules Verne University of Picardie, Amiens, France
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20
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Pezron J, Tellai L, Tourneux P. Spontaneous umbilical cord hematoma with a favorable outcome. Arch Pediatr 2020; 27:380-382. [PMID: 32893110 DOI: 10.1016/j.arcped.2020.07.004] [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: 01/09/2020] [Revised: 06/16/2020] [Accepted: 07/24/2020] [Indexed: 11/15/2022]
Abstract
Umbilical cord hematoma is a rare but serious complication of pregnancy or childbirth that often results in neonatal hypoxia-ischemia and death. We describe a newborn infant with spontaneous umbilical cord hematoma, resulting in transient hypoxia-ischemia. Treatment with therapeutic hypothermia was rapidly initiated by a multidisciplinary team of obstetricians, midwives, and neonatologists. Risk factors for umbilical cord hematoma reported in the literature were investigated. The neurological signs, electroencephalogram, and blood analysis results improved rapidly. This case report demonstrates that the effective management of anoxia-ischemia caused by umbilical cord hematoma can lead to a positive outcome for the newborn infant.
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Affiliation(s)
- J Pezron
- Réanimation pédiatrique, centre hospitalier universitaire d'Amiens-Picardie, 1, rue du Professeur Christian Cabrol, 80054 Amiens, France
| | - L Tellai
- Néonatalogie, centre hospitalier de Laon (Hauts-de-France), 80054 Amiens, France
| | - P Tourneux
- Réanimation pédiatrique, centre hospitalier universitaire d'Amiens-Picardie, 1, rue du Professeur Christian Cabrol, 80054 Amiens, France; PériTox UMI-01, UFR médecine, université de Picardie Jules Verne, 80054 Amiens, France.
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Caron F, Plancq MC, Tourneux P, Gouron R, Klein C. Was child abuse underdetected during the COVID-19 lockdown? Arch Pediatr 2020; 27:399-400. [PMID: 32807622 PMCID: PMC7410011 DOI: 10.1016/j.arcped.2020.07.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 07/30/2020] [Indexed: 12/23/2022]
Affiliation(s)
- F Caron
- Service d'orthopédie pédiatrique, Groupe hospitalier Sud, CHU d'Amiens-Picardie, 80054 Amiens cedex 1, France
| | - M-C Plancq
- Service d'orthopédie pédiatrique, Groupe hospitalier Sud, CHU d'Amiens-Picardie, 80054 Amiens cedex 1, France
| | - P Tourneux
- Médecine néonatale et réanimation pédiatrique, pôle femme-couple-enfant, Groupe hospitalier Sud, 80054 Amiens cedex 1, France
| | - R Gouron
- Service d'orthopédie pédiatrique, Groupe hospitalier Sud, CHU d'Amiens-Picardie, 80054 Amiens cedex 1, France
| | - C Klein
- Service d'orthopédie pédiatrique, Groupe hospitalier Sud, CHU d'Amiens-Picardie, 80054 Amiens cedex 1, France.
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22
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Zores‐Koenig C, Kuhn P, Caeymaex L, Allen A, Berne‐Audeoud F, Bouvard C, Brandicourt A, Casper C, Denoual H, Duboz MA, Evrard A, Fichtner C, Fischer‐Fumeaux C, Girard L, Gonnaud F, Haumont D, Hüppi P, Knezovic N, Laprugne‐Garcia E, Legouais S, Mons F, Pelofy V, Picaud J, Pierrat V, Pladys P, Renaud A, Renesme L, Sizun J, Souet G, Thiriez G, Tourneux P, Touzet M, Truffert P, Zaoui C, Zana‐Taieb E. Recommendations on neonatal light environment from the French Neonatal Society. Acta Paediatr 2020; 109:1292-1301. [PMID: 31955460 DOI: 10.1111/apa.15173] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 10/30/2019] [Accepted: 01/13/2020] [Indexed: 01/21/2023]
Abstract
AIM Hospital light may affect neonatal neurosensory development and the well-being of parents and caregivers. We aimed to issue practical recommendations regarding the optimal light environment for neonatal units. METHODS A systematic evaluation was performed using PubMed to identify relevant papers published in English or French up to July 2018, and the different grades of evidence were evaluated. RESULTS We identified 89 studies and one meta-analysis and examined 31 eligible studies. The major results were that natural or artificial light should not exceed 1000 lux and that all changes in light level should be gradual. Light protection should be used for infants of <32 weeks of postmenstrual age and but must be individualised to each infant. Infants should not be exposed to continuous high light levels regardless of their term and postnatal age. Cycled light before discharge seemed to be safe and beneficial. For medical caregivers' well-being, higher light levels and access to natural light are recommended. Special attention should be given to protecting neonatal patients from high light levels that may be necessary when performing specific care procedures. CONCLUSION Consideration of general principles and practical applications can improve the neonatal light environment for newborn infants, parents and caregivers.
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Affiliation(s)
- Claire Zores‐Koenig
- Médecine et Réanimation du Nouveau‐né Hôpital de Hautepierre CHU Strasbourg Strasbourg France
- Institut des Neurosciences Cellulaires et Intégratives UPR 3212 CNRS et Université de Strasbourg Strasbourg France
| | - Pierre Kuhn
- Médecine et Réanimation du Nouveau‐né Hôpital de Hautepierre CHU Strasbourg Strasbourg France
- Institut des Neurosciences Cellulaires et Intégratives UPR 3212 CNRS et Université de Strasbourg Strasbourg France
| | - Laurence Caeymaex
- Neonatal Intensive Care Unit Centre Hospitalier Intercommunal de Créteil Créteil France
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23
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Pladys P, Zaoui C, Girard L, Mons F, Reynaud A, Casper C, Kuhn P, Souet G, Fichtner C, Laprugne‐garcia E, Legouais S, Zores C, Thiriez G, Duboz MA, Knezovic‐Daniel N, Renesme L, Brandicourt A, Gonnaud F, Picaud JC, Julie‐Fische C, Tourneux P, Truffert P, Berne Audeoud F, Pierrat V, Caeymaex L, Granier M, Bouvard C, Evrard A, Saliba E, Allen A, Sizun J, Zana‐Taieb E, Huppi P. French neonatal society position paper stresses the importance of an early family-centred approach to discharging preterm infants from hospital. Acta Paediatr 2020; 109:1302-1309. [PMID: 31774567 DOI: 10.1111/apa.15110] [Citation(s) in RCA: 6] [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: 04/30/2019] [Revised: 11/23/2019] [Accepted: 11/25/2019] [Indexed: 12/01/2022]
Abstract
AIM The families of hospitalised preterm infants risk depression and post-traumatic stress and the preterm infants risk re-hospitalisation. The French neonatal society's aim was to review the literature on how the transition from hospital to home could limit these risks and to produce a position paper. METHODS A systematic literature review was performed covering 1 January 2000 to 1 January 2018, and multidisciplinary experts examined the scientific evidence. RESULTS We identified 939 English and French papers and 169 are quoted in the position paper. Most studies stressed the importance of early, personalised and progressive involvement of the family. Healthcare staff and families should assess discharge preparations jointly. This evaluation should assess the capacities of the newborn infant, with regard to its physiological maturity. It should also assess the family's ability to supply the medical, psychological and social assistance required before and after discharge. There should be a structured follow-up process that includes effective communication, various tools, interventions, networks, health and social professionals. CONCLUSION Discharge preparations may improve the transition from hospital to home and the outcomes for the parents and newborn preterm infant. This early family-centred approach should be structured, coordinated and based on individual needs and circumstances.
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Affiliation(s)
- Patrick Pladys
- CHU Rennes Inserm LTSI ‐ UMR 1099 Univ Rennes Rennes France
| | | | | | | | - Audrey Reynaud
- SOS‐Prema family association Boulogne‐Billancourt France
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24
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Charvillat O, Plancq MC, Haraux E, Tourneux P, Gouron R, Klein C. Aplasia cutis congenita of both knees: A new therapeutic strategy. Arch Pediatr 2020; 27:277-280. [PMID: 32417075 DOI: 10.1016/j.arcped.2020.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 05/02/2020] [Indexed: 10/24/2022]
Abstract
Aplasia cutis congenita is defined as the absence of all layers of the skin. The condition involves mainly the scalp but it can affect any area of skin on the body. A clear therapeutic strategy is not available. Here, we describe the 6-year clinical outcome of a patient with aplasia cutis congenita of both knees following treatment with an artificial dermis and a thin skin graft.
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Affiliation(s)
- O Charvillat
- Department of Pediatric Orthopedic Surgery, Amiens University Medical Center and Jules Verne University of Picardie, 80054 Amiens cedex 1, France
| | - M-C Plancq
- Department of Pediatric Orthopedic Surgery, Amiens University Medical Center and Jules Verne University of Picardie, 80054 Amiens cedex 1, France
| | - E Haraux
- Department of Pediatric Orthopedic Surgery, Amiens University Medical Center and Jules Verne University of Picardie, 80054 Amiens cedex 1, France
| | - P Tourneux
- Médecine néonatale et réanimation pédiatrique, pôle femme-couple-enfant, groupe hospitalier Sud, 80054 Amiens cedex 1, France
| | - R Gouron
- Department of Pediatric Orthopedic Surgery, Amiens University Medical Center and Jules Verne University of Picardie, 80054 Amiens cedex 1, France
| | - C Klein
- Department of Pediatric Orthopedic Surgery, Amiens University Medical Center and Jules Verne University of Picardie, 80054 Amiens cedex 1, France.
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Royer M, Libessart M, Dubaele JM, Tourneux P, Marçon F. Controlling Risks in the Compounding Process of Individually Formulated Parenteral Nutrition: Use of the FMECA Method (Failure modes, effects, and Criticality Analysis). Pharmaceutical Technology in Hospital Pharmacy 2020. [DOI: 10.1515/pthp-2019-0020] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractParenteral nutrition (PN) in the neonatal intensive care unit (NICU) involves a succession of risky processes. The objective was to identify and prioritize the risks associated with PN in order to improve the quality of the pathway. A failure modes, effects, and criticality analysis (FMECA) was used to identify potential PN pathway failure modes. A multidisciplinary working group conducted a functional analysis of the processes, then listed the failure modes (FM). The FM criticality was assessed on a scale from 1 to 5 for occurrence (O), severity (S), and detection (D). The risk priority number (RPN), ranging from 1 to 125, was calculated. The FMECA identified 99 FM (prescription (n=28), preparation (n=48), and administration (n=23)). The median RPN was 12, with scores ranging from 3 to 48. 25 % of the scores had an RPN>21.75.Among them, 12 were associated with prescription FM, 5 were associated with FM related to preparation and 8 were associated with a FM linked to administration. It allowed us to prioritize areas of potential quality improvement for parenteral nutrition of the preterm infant. The results demonstrated the need for the presence of a clinical pharmacist in the NICU to ensure the quality of PN process.
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Affiliation(s)
- Mathilde Royer
- Pharmacy, Centre Hospitalier Universitaire d’AmiensHôpital Sud, Avenue rene laennec, Amiens, Hauts-de-France80054, France
| | - Maïté Libessart
- Pharmacy, Centre Hospitalier Universitaire d’AmiensHôpital Sud, Avenue rene laennec, Amiens, Hauts-de-France80054, France
| | - Jean-Marc Dubaele
- Pharmacy, Centre Hospitalier Universitaire d’AmiensHôpital Sud, Avenue rene laennec, Amiens, Hauts-de-France80054, France
| | - Pierre Tourneux
- Pediatric Urgent and Intensive Care, Centre Hospitalier Universitaire d’AmiensHôpital Sud, Avenue rene laennec, Amiens, Hauts-de-France80054, France
| | - Fréderic Marçon
- Pharmacy, Centre Hospitalier Universitaire d’AmiensHôpital Sud, Avenue rene laennec, Amiens, Hauts-de-France80054, France
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26
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Besset D, Selmaoui B, Tourneux P, Leke A, Delanaud S, de Seze R, Stephan Blanchard E. Environmental radiofrequency electromagnetic field levels in a department of pediatrics. Environ Res 2020; 181:108894. [PMID: 31740038 DOI: 10.1016/j.envres.2019.108894] [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] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 10/30/2019] [Accepted: 11/03/2019] [Indexed: 06/10/2023]
Abstract
Preterm neonates constitute a vulnerable population that is highly sensitive to its environment. Given the increased use of wireless communication devices (mobile and digital enhanced cordless telecommunications, WiFi networks, etc.), neonates hospitalized in a department of pediatrics are potentially exposed to radiofrequency electromagnetic fields (RF-EMF). Strikingly, data on RF-EMF levels in pediatric units have not previously been published. The objective of the present study was thus to quantify the RF-EMF levels in a 34-bed tertiary department of pediatrics with a neonatal critical care unit (NCCU) and a neonatal intensive care unit (NICU). To this end, we used triaxle antenna dosimeters to map the RF-EMF levels in the environment and to measure spot emissions from medical devices. In a first set of experiments, RF-EMF levels at 144 points in the staff area and in the children's rooms in the NCCU and NICU were evaluated over a 24-h period. In a second set of measurements performed in a Faraday chamber, we measured the RF-EMF levels emitted by the medical devices to which neonates are potentially exposed in the department of pediatrics. The RF-EMF levels were significantly higher in the NCCU than in the NICU (p < 0.05). Although the two units did not differ significantly with regard to the average maximum values, the single greatest value recorded in the NCCU (6 V/m GSM + UMTS 900 (UL) frequency band, in the staff area) was more than twice that recorded in the NICU (3.70 V/m in the UMTS 2100 (UL) frequency band, in the children's rooms). The NCCU and NICU did not differ significantly with regard to the time during which the RF-EMF level at each measurement point was more than two standard deviations above its mean. The RF-EMF level was significantly higher during the day than during the night (p < 0.001). The various medical devices used in the NICU did not emit detectable amounts of RF. Overall, RF-EMF levels in the NCCU and NICU were very low. It is probable that the RF-EMFs measured here were primarily generated by the parents' and staff members' activities, rather than by medical devices. However, a combination of low-level, chronic exposure with transient, elevated peak values in a vulnerable population of preterm neonates may be of particular concern. In a department of pediatrics, decreasing preterm neonates' exposure to RF-EMFs should primarily involve a limitation on the use of wireless communication devices by staff members and parents.
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Affiliation(s)
- Dimitri Besset
- PériTox-INERIS Laboratory UMR_I 01, Jules Verne University of Picardy, Amiens, France
| | - Brahim Selmaoui
- PériTox-INERIS Laboratory UMR_I 01, Jules Verne University of Picardy, Amiens, France
| | - Pierre Tourneux
- PériTox-INERIS Laboratory UMR_I 01, Jules Verne University of Picardy, Amiens, France; Neonatal Intensive Care Unit, CHU Amiens-Picardie, F-80000, Amiens, France
| | - André Leke
- PériTox-INERIS Laboratory UMR_I 01, Jules Verne University of Picardy, Amiens, France; Neonatal Intensive Care Unit, CHU Amiens-Picardie, F-80000, Amiens, France
| | - Stephane Delanaud
- PériTox-INERIS Laboratory UMR_I 01, Jules Verne University of Picardy, Amiens, France
| | - René de Seze
- PériTox-INERIS Laboratory UMR_I 01, Jules Verne University of Picardy, Amiens, France
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27
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Girard P, Plancq MC, Tourneux P, Deroussen F, Gouron R, Klein C. Extravasation of calcium solution in the child: Value of negative-pressure wound therapy. Arch Pediatr 2019; 26:407-410. [PMID: 31630900 DOI: 10.1016/j.arcped.2019.09.011] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 08/18/2019] [Accepted: 09/22/2019] [Indexed: 11/28/2022]
Abstract
The extravasation of a calcium solution into soft tissue constitutes a medical emergency, and a lack of adequate management can lead to significant functional and cosmetic sequelae. Here, we report on the management of and long-term outcome in two children who experienced calcium infusion leakage. We also describe the emergency procedures used in cases of extravasation and discuss the role of negative pressure wound therapy as an appropriate adjunct to conventional techniques for dealing with serious extravasation-related injuries.
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Affiliation(s)
- P Girard
- Service d'orthopédie pédiatrique, groupe hospitalier Sud, CHU Amiens-Picardie, 80054 Amiens cedex 1, France
| | - M-C Plancq
- Service d'orthopédie pédiatrique, groupe hospitalier Sud, CHU Amiens-Picardie, 80054 Amiens cedex 1, France
| | - P Tourneux
- Pôle femme-couple-enfant, médecine néonatale et réanimation pédiatrique, groupe hospitalier Sud, 80054 Amiens cedex 1, France
| | - F Deroussen
- Service d'orthopédie pédiatrique, groupe hospitalier Sud, CHU Amiens-Picardie, 80054 Amiens cedex 1, France
| | - R Gouron
- Service d'orthopédie pédiatrique, groupe hospitalier Sud, CHU Amiens-Picardie, 80054 Amiens cedex 1, France
| | - C Klein
- Service d'orthopédie pédiatrique, groupe hospitalier Sud, CHU Amiens-Picardie, 80054 Amiens cedex 1, France.
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28
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Renesme L, Allen A, Audeoud F, Bouvard C, Brandicourt A, Casper C, Cayemaex L, Denoual H, Duboz MA, Evrard A, Fichtner C, Fischer-Fumeaux CJ, Girard L, Gonnaud F, Haumont D, Hüppi P, Knezovic N, Laprugne-Garcia E, Legouais S, Mons F, Pelofy V, Picaud JC, Pierrat V, Pladys P, Reynaud A, Souet G, Thiriez G, Tourneux P, Touzet M, Truffert P, Zaoui C, Zana-Taieb E, Zores C, Sizun J, Kuhn P. Recommendation for hygiene and topical in neonatology from the French Neonatal Society. Eur J Pediatr 2019; 178:1545-1558. [PMID: 31463766 DOI: 10.1007/s00431-019-03451-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 07/10/2019] [Accepted: 08/09/2019] [Indexed: 11/24/2022]
Abstract
We sought to establish guidelines for hygiene care in newborns based on a systematic review of the literature and grading of evidence using the Groupe de Réflexion et d'Evaluation de l'Environement des Nouveau-nés (GREEN) methodology. We examined 45 articles and 4 reports from safety agencies. These studies recommend a tub bath (rather than a sponge bath) for full-term infants and a swaddle bath for preterm newborns. They also recommend against daily cleansing of preterm infants. The literature emphasized that hygiene care must consider the clinical state of the newborn, including the level of awareness and behavioral responses. Hospitalized newborns treated with topical agents may also experience high exposure to potentially harmful excipients of interest. Caregivers should therefore be aware of the excipients present in the different products they use. In high-resource countries, the available data do not support the use of protective topical agents for preterm infants.Conclusions: We recommend individualization of hygiene care for newborns. There is increasing concern regarding the safety of excipients in topical agents that are used in neonatology. A multidisciplinary approach should be used to identify an approach that requires lower levels of excipients and alternative excipients. What is known: • Hygiene care is one of the most basic and widespread types of care received by healthy and sick newborns worldwide. • There is no current guideline on hygiene for preterm or hospitalized term newborn. What is new: • The French Group of Reflection and Evaluation of the environment of Newborns (GREEN) provided here guidelines based on the current body of evidence. • Caregivers should be aware of the many issues related to hygiene care of newborns including newborns' behavioral responses to hygiene care, exposition to excipients of interest, and the potential risk of protective topical agents in a preterm infant. provided here guidelines based on the current body of evidence. • Caregivers should be aware of the many issues related to hygiene care of newborns including newborns' possible behavioral responses to hygiene care, exposition to excipients of interest and the potential risk of protective topical agents in a preterm infant.
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Affiliation(s)
- Laurent Renesme
- Unité de Néonatalogie Soins Intensifs-Pédiatrie de Maternité, Centre Aliénor d'Aquitaine, Centre Hospitalier Universitaire de Bordeaux, Place Amélie Raba Léon, 33000, Bordeaux, France.
| | - A Allen
- Port Royal Assitance Publique Hôpitaux de Paris, Paris, France
| | - F Audeoud
- Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | - C Bouvard
- Association SOS Préma, Boulogne-Billancourt, France
| | - A Brandicourt
- Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France
| | - C Casper
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - L Cayemaex
- Centre Hospitalier Inter-Communal de Créteil, Créteil, France
| | - H Denoual
- Centre Hospitalier du Mans, Le Mans, France
| | - M A Duboz
- Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - A Evrard
- Comité Inter-Associatif de la Naissance, Paris, France
| | - C Fichtner
- Centre Hospitalier Universitaire de Saint Etienne, Saint Etienne, France
| | | | - L Girard
- Association Co-Naître, Pertuis, France
| | - F Gonnaud
- Centre Hospitalier Universitaire de Lyon, Lyon, France
| | - D Haumont
- Hôpital Saint-Pierre Bruxelles, Brussels, Belgium
| | - P Hüppi
- Centre Hospitalier Universitaire de Genève, Genève, Switzerland
| | - N Knezovic
- Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
| | | | | | - F Mons
- Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - V Pelofy
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - J C Picaud
- Centre Hospitalier Universitaire de Lyon, Lyon, France
| | - V Pierrat
- Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - P Pladys
- Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - A Reynaud
- Association SOS Préma, Boulogne-Billancourt, France
| | - G Souet
- Agence Régionale de Santé Centre, Orleans, France
| | - G Thiriez
- Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - P Tourneux
- Centre Hospitalier Universitaire d'Amiens, Amiens, France
| | - M Touzet
- Port Royal Assitance Publique Hôpitaux de Paris, Paris, France
| | - P Truffert
- Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - C Zaoui
- Centre Hospitalier Général de Valenciennes, Valenciennes, France
| | - E Zana-Taieb
- Port Royal Assitance Publique Hôpitaux de Paris, Paris, France
| | - C Zores
- Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
| | - J Sizun
- Centre Hospitalier Universitaire de Brest, Brest, France
| | - P Kuhn
- Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
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Bessarion L, Ghostine G, Goudjil S, Tourneux P, Léké A, Kongolo G. Impact des mesures correctives sur les transfusions érythrocytaires du prématuré. Transfus Clin Biol 2019. [DOI: 10.1016/j.tracli.2019.06.301] [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: 10/26/2022]
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Walter-Nicolet E, Courtois E, Milesi C, Ancel PY, Beuchée A, Tourneux P, Benhammou V, Carbajal R, Durrmeyer X. Premedication practices for delivery room intubations in premature infants in France: Results from the EPIPAGE 2 cohort study. PLoS One 2019; 14:e0215150. [PMID: 30970001 PMCID: PMC6457540 DOI: 10.1371/journal.pone.0215150] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 03/27/2019] [Indexed: 11/19/2022] Open
Abstract
Objectives To assess premedication practices before tracheal intubation of premature newborns in the delivery room (DR). Study design From the national population-based prospective EPIPAGE 2 cohort in 2011, we extracted all live born preterms intubated in the DR in level-3 centers, without subsequent circulatory resuscitation. Studied outcomes included the rate and type of premedication, infants’ and maternities’ characteristics and survival and major neonatal morbidities at discharge from hospital. Univariate and multivariate analysis were performed and a generalized estimating equation was used to identify factors associated with premedication use. Results Out of 1494 included neonates born in 65 maternities, 76 (5.1%) received a premedication. Midazolam was the most used drug accounting for 49% of the nine drugs regimens observed. Premedicated, as compared to non premedicated neonates, had a higher median [IQR] gestational age (30 [28–31] vs 28 [27–30] weeks, p<10−3), median birth weight (1391 [1037–1767] vs 1074 [840–1440] g, p<10−3) and median 1-minute Apgar score (8 [6–9] vs 6 [3–8], p<10−3). Using univariate analyses, premedication was significantly less frequent after maternal general anesthesia and during nighttime and survival without major morbidity was significantly higher among premedicated neonates (56/73 (81.4%) vs 870/1341 (69.3%), p = 0.028). Only 10 centers used premedication at least once and had characteristics comparable to the 55 other centers. In these 10 centers, premedication rates varied from 2% to 75%, and multivariate analysis identified gestational age and 1-minute Apgar score as independent factors associated with premedication use. Conclusion Premedication rate before tracheal intubation was only 5.1% in the DR of level-3 maternities for premature neonates below 34 weeks of gestation in France in 2011 and seemed to be mainly associated with centers’ local policies.
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Affiliation(s)
| | - Emilie Courtois
- Paediatric Emergency Department. Trousseau Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Christophe Milesi
- Paediatric and Neonatal Intensive Care Unit, University Hospital Arnaud de Villeneuve, Montpellier, France
| | - Pierre-Yves Ancel
- INSERM, U1153, Epidemiology and Statistics Sorbonne Paris Cité Research Center, Obstetrical, Perinatal and Pediatric Epidemiology Team, Paris, France
- Paris Descartes University France, Paris, France
- URC - CIC P1419, Cochin Hotel-Dieu Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Alain Beuchée
- Division of Neonatology and CIC-1414, Department of Pediatrics, University Hospital, Rennes, France
- LTSI, Inserm U1099, Université de Rennes 1, Rennes, France
| | - Pierre Tourneux
- Neonatal and Paediatric Intensive Care Unit, University hospital, Amiens, France
- PériTox - UMI 01, Medicine University, Picardie Jules Verne University, Amiens, France
| | - Valérie Benhammou
- INSERM, U1153, Epidemiology and Statistics Sorbonne Paris Cité Research Center, Obstetrical, Perinatal and Pediatric Epidemiology Team, Paris, France
- Paris Descartes University France, Paris, France
| | - Ricardo Carbajal
- Paediatric Emergency Department. Trousseau Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France
- INSERM, U1153, Epidemiology and Statistics Sorbonne Paris Cité Research Center, Obstetrical, Perinatal and Pediatric Epidemiology Team, Paris, France
- Paris Descartes University France, Paris, France
- Paediatric and Neonatal Intensive Care Unit, Trousseau Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Xavier Durrmeyer
- INSERM, U1153, Epidemiology and Statistics Sorbonne Paris Cité Research Center, Obstetrical, Perinatal and Pediatric Epidemiology Team, Paris, France
- Neonatal Intensive Care Unit, Centre Hospitalier Intercommunal de Créteil, University Paris Est Créteil, Créteil, France
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Maiguy-Foinard A, Décaudin B, Tourneux P, Guillois B, Blanc T, Galène-Gromez S, Masse M, Odou P, Denies F, Dervaux B, Duhamel A, Storme L. Effect of multi-lumen perfusion line on catheter-related bacteremia in premature infants: study protocol for a cluster-randomized crossover trial. Trials 2019; 20:115. [PMID: 30744679 PMCID: PMC6371532 DOI: 10.1186/s13063-019-3218-6] [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] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 01/21/2019] [Indexed: 11/18/2022] Open
Abstract
Background Catheter-related bacteremia (CRB) is the most frequent nosocomial infection in neonatal intensive care unit (NICU) patients, especially in very low-birth-weight infants. Administration of injectable drugs in premature newborn infants has many particularities and several types of infusion incidents have been reported. The Edelvaiss® Multiline NEO device is a novel multi-lumen access infusion device adapted to the specificities of infusion in neonatology. This multicenter, randomized, controlled study was therefore designed to determine whether or not Edelvaiss® Multiline NEO reduces the risk of CRB in preterm newborn infants in an NICU. Methods/design This is a multicenter, randomized, controlled trial, using a cluster-randomized crossover design. Four investigator centers (four clusters) will participate in the study and will be randomized into two groups, corresponding to two different sequences (either the Edelvaiss® Multiline NEO or standard infusion system sequence, then vice versa). A total of 280 patients will be recruited. Infants will be enrolled in the study at the time of placing a single-lumen central venous catheter. Three visits recording specific data are planned in the study protocol. The primary outcome measure is the incidence density (ID) of CRB. For each patient, the total number of catheters and CRB incidents as well as the duration of stay in the NICU will be computed and considered for analysis. Discussion The study will provide high-quality evidence to determine whether the Multiline NEO device reduces the risk of CRB in preterm newborns in NICUs or not. Trial registration ClinicalTrials.gov, NCT02633124. Registered on 7 December 2015. Electronic supplementary material The online version of this article (10.1186/s13063-019-3218-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Aurélie Maiguy-Foinard
- Faculty of Pharmacy, EA 7365, Groupe de Recherche sur les formes Injectables et les Technologies Associées (GRITA), University of Lille Nord de France, F-59000, Lille, France.,Department of Pharmacy, University Hospital Center of Lille, CHU Lille, Institut de Pharmacie, F-59000, Lille, France
| | - Bertrand Décaudin
- Faculty of Pharmacy, EA 7365, Groupe de Recherche sur les formes Injectables et les Technologies Associées (GRITA), University of Lille Nord de France, F-59000, Lille, France. .,Department of Pharmacy, University Hospital Center of Lille, CHU Lille, Institut de Pharmacie, F-59000, Lille, France.
| | - Pierre Tourneux
- Department of Neonatal Pediatrics and Intensive Care, Amiens University Hospital Center, Amiens, France
| | - Bernard Guillois
- Department of Neonatal Pediatrics and Intensive Care, Caen University Hospital Center, Caen, France
| | - Thierry Blanc
- Department of Neonatal Pediatrics and Intensive Care, Rouen University Hospital Center, Rouen, France
| | - Sophie Galène-Gromez
- Department of Neonatal Pediatrics and Intensive Care, Rouen University Hospital Center, Rouen, France
| | - Morgane Masse
- Faculty of Pharmacy, EA 7365, Groupe de Recherche sur les formes Injectables et les Technologies Associées (GRITA), University of Lille Nord de France, F-59000, Lille, France.,Department of Pharmacy, University Hospital Center of Lille, CHU Lille, Institut de Pharmacie, F-59000, Lille, France
| | - Pascal Odou
- Faculty of Pharmacy, EA 7365, Groupe de Recherche sur les formes Injectables et les Technologies Associées (GRITA), University of Lille Nord de France, F-59000, Lille, France.,Department of Pharmacy, University Hospital Center of Lille, CHU Lille, Institut de Pharmacie, F-59000, Lille, France
| | - Fannette Denies
- Department of Pharmacy, University Hospital Center of Lille, CHU Lille, Institut de Pharmacie, F-59000, Lille, France.,Délégation à la Recherche Clinique et à l'Innovation (DRCI), CHU Lille, F-59000, Lille, France
| | - Benoît Dervaux
- Délégation à la Recherche Clinique et à l'Innovation (DRCI), CHU Lille, F-59000, Lille, France.,EA 2694 - Santé publique: épidémiologie et qualité des soins, University of Lille, CHU Lille, F-59000, Lille, France
| | - Alain Duhamel
- EA 2694 - Santé publique: épidémiologie et qualité des soins, University of Lille, CHU Lille, F-59000, Lille, France
| | - Laurent Storme
- Department of Neonatology, CHU Lille, Jeanne de Flandre Hospital, F-59000, Lille, France.,EA 4489 - Environnement Périnatal et Santé, University of Lille, CHU Lille, F-59000, Lille, France
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Bach V, Delanaud S, Barcat L, Bodin E, Tourneux P, Libert JP. Distal skin vasodilation in sleep preparedness, and its impact on thermal status in preterm neonates. Sleep Med 2019; 60:26-30. [PMID: 30777678 DOI: 10.1016/j.sleep.2018.12.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 12/11/2018] [Accepted: 12/15/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Prior to sleep onset in human adults, distal body temperatures change progressively from wakefulness levels (low skin temperatures and a high core temperature) to sleep levels (high skin temperatures and a low core temperature) due to distal skin vasodilation and greater body cooling. It is not known whether this sleep preparedness exists in preterm neonates, even though sleep has a key role in neonatal health and neurodevelopment. The present study's objectives were to determine whether sleep preparedness (as observed in adults) can be evidenced in preterm neonates, and to assess repercussions on thermal stress. METHODS During a 12-h night-time polysomnography session, skin temperatures (recorded with an infrared camera), sleep, and wakefulness episodes were measured in 18 nine-day-old preterm neonates. RESULTS Fifteen wakefulness episodes were considered. Our results highlighted significant pre-sleep distal skin vasodilation (mainly at the foot: an increase of 0.38 °C in the 20 min preceding sleep onset) for the first time in preterm neonates. This vasodilation occurred even though (1) most factors known to influence pre-sleep vasodilation in adults were not present in these neonates, and (2) the neonates were nursed in a nearly constant thermal environment. The vasodilatation-related increase in body heat loss corresponded to a 0.15°C/h fall in mean body temperature (calculated using partitional calorimetry). CONCLUSION Compensation for this body heat loss and the maintenance of body homeothermia would require a 4% increase in metabolic heat production. In neonates, this type of energy expenditure cannot be maintained for a long period of time.
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Affiliation(s)
- Véronique Bach
- PériTox, UMR_I 01, Jules Verne University of Picardy, CURS, Présidence UPJV, Amiens, France.
| | - Stéphane Delanaud
- PériTox, UMR_I 01, Jules Verne University of Picardy, CURS, Présidence UPJV, Amiens, France
| | - Lucie Barcat
- PériTox, UMR_I 01, Jules Verne University of Picardy, CURS, Présidence UPJV, Amiens, France; Médecine Néonatale et Réanimation Pédiatrique, Pôle Femme Couple Enfant, CHU Amiens, Amiens, France
| | - Emilie Bodin
- PériTox, UMR_I 01, Jules Verne University of Picardy, CURS, Présidence UPJV, Amiens, France; Neurologie Pédiatrique, Pôle Femme Couple Enfant, CHU Amiens, Amiens, France
| | - Pierre Tourneux
- PériTox, UMR_I 01, Jules Verne University of Picardy, CURS, Présidence UPJV, Amiens, France; Médecine Néonatale et Réanimation Pédiatrique, Pôle Femme Couple Enfant, CHU Amiens, Amiens, France
| | - Jean-Pierre Libert
- PériTox, UMR_I 01, Jules Verne University of Picardy, CURS, Présidence UPJV, Amiens, France
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Leke A, Raucy M, Chazal C, Goudjil S, Caron-Lesenechal E, Tourneux P, Ausseil J. Évaluation de la masse fonctionnelle intestinale chez des nouveau-nés porteurs de dérivation intestinale par le dosage de la Citrulline plasmatique. NUTR CLIN METAB 2018. [DOI: 10.1016/j.nupar.2018.09.184] [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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Bessarion L, Lorriaux C, Andry L, Goudjil S, Tourneux P, Leke A, Kongolo G. Compliance pour les recommandations HAS 2014 concernant la pratique de la transfusion érythrocytaire chez les prématurés de moins 32 semaines. Transfus Clin Biol 2018. [DOI: 10.1016/j.tracli.2018.08.125] [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: 10/28/2022]
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35
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Haraux E, Tourneux P, Kouakam C, Stephan-Blanchard E, Boudailliez B, Leke A, Klein C, Chardon K. Isolated hypospadias: The impact of prenatal exposure to pesticides, as determined by meconium analysis. Environ Int 2018; 119:20-25. [PMID: 29929047 DOI: 10.1016/j.envint.2018.06.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 06/04/2018] [Accepted: 06/04/2018] [Indexed: 06/08/2023]
Abstract
Although endocrine-disrupting chemicals (EDCs, including pesticides) are thought to increase the risk of hypospadias, no compounds have been formally identified in this context. Human studies may now be possible via the assessment of meconium as a marker of chronic prenatal exposure. The objective of the present study was to determine whether or not prenatal exposure to pesticides (as detected in meconium) constitutes a risk factor for isolated hypospadias. In a case-control study performed between 2011 and 2014 in northern France, male newborns with isolated hypospadias (n = 25) were matched at birth with controls (n = 58). Newborns with obvious genetic or hormonal anomalies, undescended testis, micropenis, a congenital syndrome or a family history of hypospadias were not included. Neonatal and parental data were collected. Foetal exposure was assessed by determining the meconium concentrations of the pesticides or metabolites (organophosphates, carbamates, phenylurea, and phenoxyherbicides) most commonly used in the region. Risk factors were assessed in a multivariate analysis. The pesticides most commonly detected in meconium were organophosphates (in up to 98.6% of samples, depending on the substance) and phenylurea (>85.5%). A multivariate analysis revealed an association between isolated hypospadias and the presence in meconium of the phenylurea herbicide isoproturon and of the phenoxyherbicide 2-methyl-4-chlorophenoxyacetic acid (odds ratio [95% confidence interval]: 5.94 [1.03-34.11] and 4.75 [1.20-18.76]) respectively). We conclude that prenatal exposure to these two herbicides (as assessed by meconium analysis) was correlated with the occurrence of isolated hypospadias. The results of our case-control study (i) suggest that prenatal exposure to pesticides interferes with the development of the male genitalia, and (ii) emphasize the importance of preventing pregnant women from being exposed to EDCs in general and pesticides in particular.
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Affiliation(s)
- Elodie Haraux
- Paediatric Surgery Unit, Amiens University Hospital, F-80054 Amiens, France; PeriTox - UMI 01, UFR de Médecine, Jules Verne University of Picardy, F-80054 Amiens, France.
| | - Pierre Tourneux
- PeriTox - UMI 01, UFR de Médecine, Jules Verne University of Picardy, F-80054 Amiens, France; Paediatric Intensive Care Unit, Amiens University Hospital, F-80054 Amiens, France.
| | - Christelle Kouakam
- PeriTox - UMI 01, UFR de Médecine, Jules Verne University of Picardy, F-80054 Amiens, France
| | - Erwan Stephan-Blanchard
- PeriTox - UMI 01, UFR de Médecine, Jules Verne University of Picardy, F-80054 Amiens, France.
| | - Bernard Boudailliez
- Department of Paediatrics, Amiens University Hospital, F-80054 Amiens, France.
| | - Andre Leke
- PeriTox - UMI 01, UFR de Médecine, Jules Verne University of Picardy, F-80054 Amiens, France; Neonatal Intensive Care Unit, Amiens University Hospital, F-80054 Amiens, France.
| | - Celine Klein
- Paediatric Surgery Unit, Amiens University Hospital, F-80054 Amiens, France.
| | - Karen Chardon
- PeriTox - UMI 01, UFR de Médecine, Jules Verne University of Picardy, F-80054 Amiens, France.
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Affiliation(s)
- Xavier Durrmeyer
- Neonatal Intensive Care Unit, Centre Hospitalier Intercommunal de Créteil, Creteil, France
| | | | - Agnes Dechartres
- Department of Biostatistics, Public Health and Biomedical Information, Pitié Salpetrière-Charlefoix Hospital (AP-HP), Paris, France
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Lahana A, Delanaud S, Erbani R, Glusko-Charlet A, Durand E, Haraux E, Ghyselen L, Libert JP, Tourneux P. Warming the premature infant in the delivery room: Quantification of the risk of hyperthermia. Med Eng Phys 2018; 59:70-74. [PMID: 30131113 DOI: 10.1016/j.medengphy.2018.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 04/20/2018] [Accepted: 06/11/2018] [Indexed: 10/28/2022]
Abstract
AIM The efficacy and safety of three polyethylene bags commonly used to prevent hypothermia in premature infants was assessed. METHODS To simulate transfer from the delivery room to a secondary care unit, a thermally stable, bonneted mannequin (skin temperature: 34.4 °C) was placed in a climate chamber under different conditions: with a radiant warmer, with various polyethylene bags (open on one side, closed by a draw-string at the neck, or a "life support pouch" with several access points) or without a bag. RESULTS With the radiant warmer turned on, the mean reduction in heat loss from the nude mannequin was 50.8 ± 1.7% (p < 0.0001, vs. warmer off). The mean reduction in heat loss (vs. no bag) was 55.0 ± 0.9% for the drawstring bag, 49.0 ± 2.2% for the standard bag (p = 0.0001), and 48.1 ± 0.7% for the life support pouch (p = 0.006). When a radiant warmer + polyethylene bag were used, heat stress (body temperature: 38 °C) and severe hyperthermia (40 °C) occurred after 11 and 34 min, respectively. CONCLUSION Caution must be taken when using a radiant warmer and polyethylene bag with a premature infant. Heat stress can occur in only 11 min. Continuous body temperature monitoring is therefore required.
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Affiliation(s)
- Armand Lahana
- Réanimation Néonatale, Pôle Femme - Couple - Enfant, CHU, avenue René Laennec, F-80480, Amiens, France
| | | | - Romain Erbani
- Réanimation Néonatale, Pôle Femme - Couple - Enfant, CHU, avenue René Laennec, F-80480, Amiens, France
| | - Anaïs Glusko-Charlet
- Réanimation Néonatale, Pôle Femme - Couple - Enfant, CHU, avenue René Laennec, F-80480, Amiens, France
| | - Estelle Durand
- PériTox, UMI INERIS-01, UFR de Médecine UPJV, Amiens, France
| | - Elodie Haraux
- PériTox, UMI INERIS-01, UFR de Médecine UPJV, Amiens, France; Chirurgie viscérale pédiatrique, Pôle Femme - Couple - Enfant, CHU, Amiens, France
| | | | | | - Pierre Tourneux
- Réanimation Néonatale, Pôle Femme - Couple - Enfant, CHU, avenue René Laennec, F-80480, Amiens, France; PériTox, UMI INERIS-01, UFR de Médecine UPJV, Amiens, France.
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Erbani R, Dégrugilliers L, Lahana A, Glusko-Charlet A, Haraux E, Durand E, Tourneux P. Failing to meet relative humidity targets for incubated neonates causes higher heat loss and metabolic costs in the first week of life. Acta Paediatr 2018; 107:1177-1183. [PMID: 28880399 DOI: 10.1111/apa.14063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 07/20/2017] [Accepted: 09/04/2017] [Indexed: 11/27/2022]
Abstract
AIM Frequent nursing procedures can modify a newborn infant's thermal environment when their incubator is opened. This study evaluated the impact of relative humidity (RH) on preterm infants in closed incubators and calculated their heat loss and additional metabolic cost. METHODS We studied 45 preterm infants born before 32 + 0 weeks, nursed at the neonatal intensive care unit at Amiens University Hospital, France from January 2009 to November 2011. Their body, skin and air temperatures and the incubator's RH were continuously recorded from day 1 to 8 of life, and the differences between the measured and target RH were calculated. Body heat loss (BHL) was also calculated. RESULTS On day one, the measured RH (68.7 ± 1.0%) was significantly lower than the target RH (75%, p < 0.05), but this difference, together with BHL (p < 0.001) and evaporative heat loss (p < 0.001), fell significantly over time (p < 0.05). The additional metabolic cost correlated with the difference between measured and target RH (p < 0.001). CONCLUSION RH from day 1 to 8 was below the recommended target value for preterm infants and resulted in high evaporative and greater total BHL and additional metabolic cost. The findings pose numerous challenges, including nursing care and incubator design.
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Affiliation(s)
- Romain Erbani
- Réanimation et Surveillance Continue Pédiatriques; CHU Amiens; Amiens France
| | - Loïc Dégrugilliers
- Réanimation et Surveillance Continue Pédiatriques; CHU Amiens; Amiens France
- PeriTox-UMI 01; UFR de Médecine; Université de Picardie Jules Verne; Amiens France
| | - Armand Lahana
- Réanimation et Surveillance Continue Pédiatriques; CHU Amiens; Amiens France
| | | | - Elodie Haraux
- PeriTox-UMI 01; UFR de Médecine; Université de Picardie Jules Verne; Amiens France
| | - Estelle Durand
- PeriTox-UMI 01; UFR de Médecine; Université de Picardie Jules Verne; Amiens France
| | - Pierre Tourneux
- Réanimation et Surveillance Continue Pédiatriques; CHU Amiens; Amiens France
- PeriTox-UMI 01; UFR de Médecine; Université de Picardie Jules Verne; Amiens France
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Durrmeyer X, Breinig S, Claris O, Tourneux P, Alexandre C, Saliba E, Beuchée A, Jung C, Levy C, Marchand-Martin L, Marcoux MO, Dechartres A, Danan C. Effect of Atropine With Propofol vs Atropine With Atracurium and Sufentanil on Oxygen Desaturation in Neonates Requiring Nonemergency Intubation: A Randomized Clinical Trial. JAMA 2018; 319:1790-1801. [PMID: 29715354 PMCID: PMC6583687 DOI: 10.1001/jama.2018.3708] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Propofol or a combination of a synthetic opioid and muscle relaxant are both recommended for premedication before neonatal intubation but have yet to be compared. OBJECTIVE To compare prolonged desaturation during neonatal nasotracheal intubation after premedication with atropine-propofol vs atropine-atracurium-sufentanil treatment. DESIGN, SETTING, AND PARTICIPANTS Multicenter, double-blind, randomized clinical trial (2012-2016) in 6 NICUs in France that included 173 neonates requiring nonemergency intubation. The study was interrupted due to expired study kits and lack of funding. INTERVENTIONS Eighty-nine participants were randomly assigned to the atropine-propofol group and 82 to the atropine-atracurium-sufentanil group before nasotracheal intubation. MAIN OUTCOMES AND MEASURES The primary outcome was prolonged desaturation (Spo2 <80% lasting > 60 seconds), using intention-to-treat analysis using mixed models. Secondary outcomes assessed the characteristics of the procedure and its tolerance. RESULTS Of 173 neonates randomized (mean gestational age, 30.6 weeks; mean birth weight, 1502 g; 71 girls), 171 (99%) completed the trial. Of 89 infants, 53 (59.6%) in the atropine-propofol group vs 54 of 82 (65.9%) in the atropine-atracurium-sufentanil group achieved the primary outcome (adjusted RD, -6.4; 95% CI, -21.0 to 8.1; P = .38). The atropine-propofol group had a longer mean procedure duration than did the atropine-atracurium-sufentanil group (adjusted RD, 1.7 minutes; 95% CI, 0.1-3.3 minutes; P = .04); a less frequent excellent quality of sedation rate, 51.7% (45 of 87) vs 92.6% (75 of 81; P < .001); a shorter median time to respiratory recovery, 14 minutes (IQR, 8-34 minutes) vs 33 minutes (IQR, 15-56 minutes; P = .002), and shorter median time to limb movement recovery, 18 minutes (IQR, 10-43 minutes) vs 36 minutes (IQR, 19-65 minutes; P = .003). In the 60 minutes after inclusion, Spo2 was preserved significantly better in the atropine-propofol group (time × treatment interaction P = .02). Of the atropine-propofol group 20.6% had head ultrasound scans that showed worsening intracranial hemorrhaging (any or increased intraventricular hemorrhage) in the 7 days after randomization vs 17.6% in the atropine-atracurium-sufentanil group (adjusted RD, 1.2; 95% CI, -13.1 to 15.5, P = .87). Severe adverse events occurred in 11% of the atropine-propofol group and in 20% of the atropine-atracurium-sufentanil group. CONCLUSIONS AND RELEVANCE Among neonates undergoing nonemergency nasotracheal intubation, the frequency of prolonged desaturation did not differ significantly between atropine used with propofol or atropine used with atracurium and sufentanil. However, the study may have been underpowered to detect a clinically important difference, and further research may be warranted. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01490580, EudraCT number: 2009-014885-25.
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Affiliation(s)
- Xavier Durrmeyer
- Neonatal Intensive Care Unit, CHI Créteil, CRETEIL, France
- INSERM, U1153, Obstetrical, Perinatal and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne, Paris Descartes University, France
| | - Sophie Breinig
- Pediatric and Neonatal Intensive Care Unit, CHU Toulouse, Toulouse, France
| | - Olivier Claris
- Neonatal Intensive Care Unit, Hospices civils de Lyon, Lyon, France
| | | | | | - Elie Saliba
- Neonatal Intensive Care Unit, CHU Tours, Tours, France
| | - Alain Beuchée
- Neonatal Intensive Care Unit, CHU Rennes, Rennes, France
| | - Camille Jung
- Clinical Research Center, CHI Créteil, Créteil, France
| | - Corinne Levy
- ACTIV, St Maur, France
- IMRB- GRC GEMINI, Université Paris Est, Créteil, France
| | - Laetitia Marchand-Martin
- INSERM, U1153, Obstetrical, Perinatal and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne, Paris Descartes University, France
| | | | - Agnes Dechartres
- INSERM, U1153, METHODS Team, Epidemiology and Statistics Sorbonne Paris Cité Research Center, Paris Descartes University, Hotel-Dieu Hospital (AP-HP), France
| | - Claude Danan
- Neonatal Intensive Care Unit, CHI Créteil, CRETEIL, France
- Clinical Research Center, CHI Créteil, Créteil, France
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Carpentier E, Moreau F, Soriot-Thomas S, Tourneux P. Training program for pain assessment in the newborn. Arch Pediatr 2018; 25:35-38. [DOI: 10.1016/j.arcped.2017.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 10/11/2017] [Accepted: 11/06/2017] [Indexed: 01/06/2023]
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Dekens C, Fontaine C, Carpentier E, Barcat L, Gondry J, Tourneux P. [Maternal anxiety related to how the pediatrician provided prenatal information about preterm birth]. Arch Pediatr 2017; 24:1076-1082. [PMID: 28988636 DOI: 10.1016/j.arcped.2017.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 06/24/2017] [Accepted: 08/14/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Women hospitalized for preterm labor require clear information about prematurity. This study assessed whether or not specific written information about prematurity delivered at admission to the unit combined with an oral explanation from a pediatrician would decrease women's anxiety compared to an oral explanation alone. MATERIAL AND METHODS This was a prospective, single-center observational study. Women were included in the high-risk pregnancies department and distributed into two groups: receiving "only oral" information for a prenatal clinical consultation with a senior pediatrician or receiving "combined" oral information+a booklet about prematurity given to the women at admission. The primary endpoint was the change in anxiety-state (before and after the information procedure) evaluated by the State Trait Anxiety Inventory-Y (STAI-Y). RESULTS The anxiety score before receiving information did not differ between the two groups (STAI-Y-A "combined" group: 46.7±3.0 vs. "only oral" group: 42.7±2.74; P=0.55). After consultation with a pediatrician, the acute anxiety-state score STAI-Y-A decreased significantly in the "combined" group (-6.7±1.9) compared to the "only oral" group (-2.5±4.6; P<0.05). DISCUSSION A booklet about prematurity combined with oral information from a pediatrician reduced patients' anxiety more than oral information alone. Given that the psychology of the mother interacts with the pregnancy, it is necessary to provide clear and adapted information. Giving a booklet appears to be one of the modalities to improve information. Other modalities such as video documents have to be studied.
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Affiliation(s)
- C Dekens
- Service de médecine néonatale, pôle femme-couple-enfant, CHU d'Amiens-Picardie, 80054 Amiens cedex 1, France; Service de néonatologie, centre hospitalier Beauvais, avenue Léon-Blum, 60021 Beauvais cedex, France
| | - C Fontaine
- Service de médecine néonatale, pôle femme-couple-enfant, CHU d'Amiens-Picardie, 80054 Amiens cedex 1, France
| | - E Carpentier
- Service de médecine néonatale, pôle femme-couple-enfant, CHU d'Amiens-Picardie, 80054 Amiens cedex 1, France; Service de réanimation néonatale, pôle femme-couple-enfant, CHU d'Amiens-Picardie, 80054 Amiens cedex 1, France
| | - L Barcat
- Service de réanimation néonatale, pôle femme-couple-enfant, CHU d'Amiens-Picardie, 80054 Amiens cedex 1, France
| | - J Gondry
- Service de gynécologie-obstétrique, pôle femme-couple-enfant, CHU d'Amiens-Picardie, 80054 Amiens cedex 1, France
| | - P Tourneux
- Service de réanimation néonatale, pôle femme-couple-enfant, CHU d'Amiens-Picardie, 80054 Amiens cedex 1, France; PériTox (UMR-I 01), faculté de médecine, université de Picardie-Jules-Verne, Amiens, France.
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Toukam ME, Luisin M, Chevreau J, Lanta-Delmas S, Gondry J, Tourneux P. A predictive neonatal mortality score for women with premature rupture of membranes after 22-27 weeks of gestation. J Matern Fetal Neonatal Med 2017; 32:258-264. [PMID: 28950738 DOI: 10.1080/14767058.2017.1378327] [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: 10/18/2022]
Abstract
OBJECTIVE Premature rupture of the membranes (PROM) remains a leading cause of neonatal morbidity. The objectives of the present study were to analyze the outcomes of pregnancies complicated by PROM between 22 and 27+6 weeks of gestation (WG) and to study antepartum risk factors that might predict neonatal death. PATIENTS AND METHODS One hundred and seven pregnancies were analyzed over a 3-year period in a tertiary maternity hospital. The collected maternal and neonatal data were used to model and predict the outcome of PROM. RESULTS Prevalence of PROM (for live births) was 1.08%, and the overall survival rate was 59.8%. From preselected candidate variables, gestational age (GA) at PROM (p = .0002), a positive vaginal culture for pathogenic bacteria (p = .01), primiparity (p = .02), and the quantity of amniotic fluid (p = .03) were included in a multivariable logistic regression analysis. The corresponding adjusted odds ratios [95% confidence interval] were, respectively, 0.91 [0.87-0.96], 11.08 [1.65-74.42], 0.55 [0.33-0.91], and 0.97 [0.95-0.99]. These parameters were used to build a predictive score for neonatal death. CONCLUSIONS The survival rate after PROM at 22-27+6 weeks of gestation was 59.8%. Our predictive model (built using multivariable logistic regression) may be of value for obstetricians and neonatologists counseling couples after PROM.
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Affiliation(s)
- Michèle Eve Toukam
- a Département de Gynécologie-Obstétrique , Hôpital Robert Ballanger, Pôle Femme-enfant , Aulnay-sous-Bois , France
| | - Marion Luisin
- b Service de Gynécologie-Obstétrique , Pôle Femme Couple Enfant, Centre Hospitalier Universitaire d'Amiens , Amiens , France
| | - Julien Chevreau
- b Service de Gynécologie-Obstétrique , Pôle Femme Couple Enfant, Centre Hospitalier Universitaire d'Amiens , Amiens , France.,c Inserm UMR 1105, GRAMFC , Groupe de Recherches sur l'Analyse Multimodale de la Fonction Cérébrale, Université de Picardie Jules Verne, CHU Amiens , Amiens , France
| | - Ségolène Lanta-Delmas
- b Service de Gynécologie-Obstétrique , Pôle Femme Couple Enfant, Centre Hospitalier Universitaire d'Amiens , Amiens , France
| | - Jean Gondry
- b Service de Gynécologie-Obstétrique , Pôle Femme Couple Enfant, Centre Hospitalier Universitaire d'Amiens , Amiens , France.,c Inserm UMR 1105, GRAMFC , Groupe de Recherches sur l'Analyse Multimodale de la Fonction Cérébrale, Université de Picardie Jules Verne, CHU Amiens , Amiens , France
| | - Pierre Tourneux
- d Réanimation et surveillance continue pédiatrique , pôle femme couple enfant, Centre Hospitalier Universitaire d'Amiens , Amiens , France.,e PériTox , UFR de médecine, Université de Picardie Jules Verne, UMI 01 , Amiens , France
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Haraux E, Braun K, Buisson P, Stéphan-Blanchard E, Devauchelle C, Ricard J, Boudailliez B, Tourneux P, Gouron R, Chardon K. Response to Elwood, M. et al., Comment on: Maternal Exposure to Domestic Hair Cosmetics and Occupational Endocrine Disruptors Is Associated with a Higher Risk of Hypospadias in the Offspring. Int. J. Environ. Res. Public Health 2017, 14, 27. Int J Environ Res Public Health 2017; 14:ijerph14091071. [PMID: 28914781 PMCID: PMC5615608 DOI: 10.3390/ijerph14091071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 05/24/2017] [Accepted: 08/04/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Elodie Haraux
- Department of Paediatric Surgery, Amiens University Hospital, 80054 Amiens, France.
| | - Karine Braun
- Department of Paediatrics, Amiens University Hospital, 80054 Amiens, France.
| | - Philippe Buisson
- Department of Paediatric Surgery, Amiens University Hospital, 80054 Amiens, France.
| | | | | | - Jannick Ricard
- Department of Paediatric Surgery, Amiens University Hospital, 80054 Amiens, France.
| | - Bernard Boudailliez
- Department of Paediatrics, Amiens University Hospital, 80054 Amiens, France.
| | - Pierre Tourneux
- Department of Paediatric Intensive Care Unit, Amiens University Hospital, 80054 Amiens, France.
| | - Richard Gouron
- Department of Paediatric Surgery, Amiens University Hospital, 80054 Amiens, France.
| | - Karen Chardon
- PériTox-INERIS Laboratory, Jules Verne University of Picardy, 80054 Amiens, France.
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Escourrou G, Renesme L, Zana E, Rideau A, Marcoux MO, Lopez E, Gascoin G, Kuhn P, Tourneux P, Guellec I, Flamant C. How to assess hemodynamic status in very preterm newborns in the first week of life? J Perinatol 2017; 37:987-993. [PMID: 28471441 DOI: 10.1038/jp.2017.57] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 02/12/2017] [Accepted: 03/28/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND Assessing hemodynamic status in preterm newborns is an essential task, as many studies have shown increased morbidity when hemodynamic parameters are abnormal. Although oscillometric monitoring of arterial blood pressure (BP) is widely used due to its simplicity and lack of side effects, these values are not always correlated with microcirculation and oxygen delivery. OBJECTIVES This review focuses on different tools for the assessment of hemodynamic status in preterm newborns. These include the measurement of clinical (BP, capillary refill time and urinary output (UO)) or biological parameters (lactate analysis), functional echocardiography, and near-infrared spectroscopy (NIRS). We describe the concepts and techniques involved in these tools in detail, and examine the interest and limitations of each type of assessment. CONCLUSIONS This review highlights the complementarities between the different parameters used to assess hemodynamic status in preterm newborns during the first week of life. The analysis of arterial BP measured by oscillometric monitoring must take into account other clinical data, in particular capillary refill time and UO, and biological data such as lactate levels. Echocardiography improves noninvasive hemodynamic management in newborns but requires specific training. In contrast, NIRS may be useful in monitoring the clinical course of infants at risk of, or presenting with, hypotension. It holds the potential for early and noninvasive identification of silent hypoperfusion in critically ill preterm infants. However, more data are needed to confirm the usefulness of this promising tool in significantly changing the outcome of these infants.
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Affiliation(s)
- G Escourrou
- Department of Neonatal Medicine, CH Montreuil, Montreuil, France
| | - L Renesme
- Department of Neonatal Medicine, CHU Bordeaux, France
| | - E Zana
- Department of Neonatal Medicine, Port Royal Maternity, Paris, France
| | - A Rideau
- Department of Neonatal Medicine, CHU Paris, France
| | - M O Marcoux
- Paediatric Intensive Care Unit, CHU Toulouse, France
| | - E Lopez
- Department of Neonatal Medicine, CHU Tours, France
| | - G Gascoin
- Department of Neonatal Medicine, CHU Angers, France
| | - P Kuhn
- Department of Neonatal Medicine, CHU Strasbourg, France
| | - P Tourneux
- Department of Neonatal Medicine, CHU Amiens, France
| | - I Guellec
- Department of Neonatal Medicine, CHU Paris, France
| | - C Flamant
- Department of Neonatal Medicine, CHU Nantes, Service de Réanimation néonatale, Nantes, France
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45
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Carpentier E, Mur S, Aubry E, Pognon L, Rakza T, Flamein F, Sharma D, Tourneux P, Storme L. Safety and tolerability of subcutaneous treprostinil in newborns with congenital diaphragmatic hernia and life-threatening pulmonary hypertension. J Pediatr Surg 2017; 52:1480-1483. [PMID: 28389079 DOI: 10.1016/j.jpedsurg.2017.03.058] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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: 10/12/2016] [Revised: 02/27/2017] [Accepted: 03/18/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Prolonged pulmonary hypertension (PH) is highly predictive for pulmonary morbidity and death in infants with congenital diaphragmatic hernia (CDH). OBJECTIVES To report the effects and tolerability of subcutaneous treprostinil in newborns with severe CDH and late life-threatening PH. METHODS We recorded clinical and echocardiography data before and after starting subcutaneous treprostinil, on patients with severe CDH and late PH, refractory to inhaled nitric oxide and oral sildenafil. RESULTS 14 patients were treated with treprostinil (gestational age: 39.1±2.0weeks; birth weight: 3200±600g). Prior to treatment, the pre- and post-ductal SpO2 difference (Δ SpO2) was 14±10%. Treprostinil was initiated at a median age of 12days [5-157]. After starting treprostinil, ΔSpO2 decreased to 3% at day 7 (p<0.05), and the mean blood flow velocities in the right pulmonary arteries increased by 110% (p<0.05). 2 of the 14 patients died. At the age of follow up (12months to 3years), the 12 surviving infants were all weaned from respiratory support and discharged home. CONCLUSION The subcutaneous treprostinil improves pulmonary hemodynamics and outcomes in infants with CDH and life-threatening PH. We suggest that the treatment should be considered in infants with severe CDH and late PH. TYPE OF STUDY Case series with no comparison group. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- E Carpentier
- Department of Neonatology, University Hospital of Lille, 2 Avenue Oscar Lambret, 59037 Lille, France,; Department of Neonatology, University Hospital of Amiens, Place Laennec, 80054 Amiens, Cédex 1, France; PériTox Laboratory (UMI- 01), University of Amiens, UPJV, Place Laennec, 80054 Amiens, Cédex 1, France
| | - S Mur
- Department of Neonatology, University Hospital of Lille, 2 Avenue Oscar Lambret, 59037 Lille, France
| | - E Aubry
- Department of Pediatric Surgery, University Hospital of Lille, 2 Avenue Oscar Lambret, 59037 Lille, France; EA4489, Perinatal Environment and Health, FHU 1000 days for Health, University Lille - Nord de France, 2, Avenue Oscar Lambret, 59037 Lille, France
| | - L Pognon
- Department of Neonatology, University Hospital of Lille, 2 Avenue Oscar Lambret, 59037 Lille, France
| | - T Rakza
- Department of Neonatology, University Hospital of Lille, 2 Avenue Oscar Lambret, 59037 Lille, France,; EA4489, Perinatal Environment and Health, FHU 1000 days for Health, University Lille - Nord de France, 2, Avenue Oscar Lambret, 59037 Lille, France
| | - F Flamein
- Department of Neonatology, University Hospital of Lille, 2 Avenue Oscar Lambret, 59037 Lille, France,; EA4489, Perinatal Environment and Health, FHU 1000 days for Health, University Lille - Nord de France, 2, Avenue Oscar Lambret, 59037 Lille, France
| | - D Sharma
- Department of Pediatric Surgery, University Hospital of Lille, 2 Avenue Oscar Lambret, 59037 Lille, France; EA4489, Perinatal Environment and Health, FHU 1000 days for Health, University Lille - Nord de France, 2, Avenue Oscar Lambret, 59037 Lille, France
| | - P Tourneux
- Department of Neonatology, University Hospital of Amiens, Place Laennec, 80054 Amiens, Cédex 1, France; PériTox Laboratory (UMI- 01), University of Amiens, UPJV, Place Laennec, 80054 Amiens, Cédex 1, France.
| | - L Storme
- Department of Neonatology, University Hospital of Lille, 2 Avenue Oscar Lambret, 59037 Lille, France,; EA4489, Perinatal Environment and Health, FHU 1000 days for Health, University Lille - Nord de France, 2, Avenue Oscar Lambret, 59037 Lille, France
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46
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Lavongtheung A, Jedraszak G, Naepels P, Tourneux P, Gondry-Jouet C, Le Moing AG, Gondry J, Chevreau J. Should isolated fetal ventriculomegaly measured below 12 mm be viewed as a variant of the norm? Results of a 5-year experience in a prenatal referral center. J Matern Fetal Neonatal Med 2017; 31:2325-2331. [DOI: 10.1080/14767058.2017.1342801] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Anaïs Lavongtheung
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens Sud, Amiens CEDEX 1, France
| | - Guillaume Jedraszak
- Department of Genetics, University Hospital of Amiens, CHU Amiens Sud, Amiens CEDEX 1, France
| | - Philippe Naepels
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens Sud, Amiens CEDEX 1, France
| | - Pierre Tourneux
- Department of Neonatology, University Hospital of Amiens, CHU Amiens Sud, Amiens CEDEX 1, France
| | - Catherine Gondry-Jouet
- Department of Radiology, University Hospital of Amiens, CHU Amiens Sud, Amiens CEDEX 1, France
| | - Anne-Gaëlle Le Moing
- Department of Pediatric Neurology, University Hospital of Amiens, CHU Amiens Sud, Amiens CEDEX 1, France
| | - Jean Gondry
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens Sud, Amiens CEDEX 1, France
| | - Julien Chevreau
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens Sud, Amiens CEDEX 1, France
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Barcat L, Decima P, Bodin E, Delanaud S, Stephan-Blanchard E, Leke A, Libert JP, Tourneux P, Bach V. Distal skin vasodilation promotes rapid sleep onset in preterm neonates. J Sleep Res 2017; 26:572-577. [PMID: 28303621 DOI: 10.1111/jsr.12514] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 10/21/2016] [Accepted: 01/25/2017] [Indexed: 11/30/2022]
Abstract
Although sleep is of paramount importance for preterm neonates, care of the latter in a neonatal intensive care unit does not favour sleep. Given that several studies in adults have described a 'vegetative preparedness to sleep' (in which distal skin vasodilation before lights-out promotes rapid sleep onset), we looked at whether or not this process operates in preterm neonates. Sleep propensity was assessed in terms of the duration of a spontaneous episode of wakefulness (W). Skin temperatures at six body sites (the abdomen, pectoral region, eye, hand, thigh and foot) were measured (using infrared thermography) during nocturnal polysomnography in 29 9-day-old preterm neonates (postmenstrual age: 209 ± 9 days). We then determined whether the duration of the W episode depended upon the local skin temperatures measured at the start, during and end of the episode. The W episode was shorter when distal skin temperatures (thigh, hand and foot) and the pectoral temperature were higher at the end of the episode (i.e. at sleep onset). The relationship with the duration of the W episode was not significant for temperatures measured at the start of the W episode. We observed gradual distal vasodilation at the pectoral region, the thigh, hand and foot (i.e. affecting most of the body's skin surface) during W episodes. Our results constitute initial evidence to show that distal vasodilation may have a key role in facilitating sleep onset in very preterm neonates.
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Affiliation(s)
- Lucile Barcat
- PériTox, Jules Verne University of Picardy, Amiens, France.,Médecine Néonatale et Réanimation Pédiatrique, Pôle Femme Couple Enfant, Amiens, France
| | - Pauline Decima
- PériTox, Jules Verne University of Picardy, Amiens, France
| | - Emilie Bodin
- PériTox, Jules Verne University of Picardy, Amiens, France.,Neurologie Pédiatrique, Pôle Femme Couple Enfant, Amiens, France
| | | | | | - Andre Leke
- PériTox, Jules Verne University of Picardy, Amiens, France.,Médecine Néonatale et Réanimation Pédiatrique, Pôle Femme Couple Enfant, Amiens, France
| | | | - Pierre Tourneux
- PériTox, Jules Verne University of Picardy, Amiens, France.,Médecine Néonatale et Réanimation Pédiatrique, Pôle Femme Couple Enfant, Amiens, France
| | - Veronique Bach
- PériTox, Jules Verne University of Picardy, Amiens, France
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Bedu A, Renesme L, Tourneux P, Cortey A. Recommandations pour la prise en charge de l’ictère néonatal : du nouveau-né à terme ou proche du terme à l’enfant prématuré : un challenge pour la Société française de néonatologie ! Arch Pediatr 2017; 24:97-99. [DOI: 10.1016/j.arcped.2016.11.014] [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] [Received: 04/06/2016] [Revised: 07/15/2016] [Accepted: 11/18/2016] [Indexed: 10/20/2022]
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Leke L, Barois-Guilliot J, Grognet S, Tourneux P. Facteurs maternels et néonataux associés au succès de l’allaitement maternel chez les grands prématurés. NUTR CLIN METAB 2017. [DOI: 10.1016/j.nupar.2016.10.017] [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: 11/26/2022]
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50
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Haraux E, Braun K, Buisson P, Stéphan-Blanchard E, Devauchelle C, Ricard J, Boudailliez B, Tourneux P, Gouron R, Chardon K. Maternal Exposure to Domestic Hair Cosmetics and Occupational Endocrine Disruptors Is Associated with a Higher Risk of Hypospadias in the Offspring. Int J Environ Res Public Health 2016; 14:ijerph14010027. [PMID: 28036072 PMCID: PMC5295278 DOI: 10.3390/ijerph14010027] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 11/29/2016] [Accepted: 12/05/2016] [Indexed: 01/01/2023]
Abstract
Pregnant women are exposed to various chemical products at home and at work. Some of these products contain endocrine-disrupting chemicals (EDCs) such as cosmetics, pesticides, industrial chemicals, heavy metals, plastics or medications that could alter sexual differentiation and increase the risk of hypospadias. We evaluated maternal occupational and household exposures that could constitute risk factors for hypospadias. From 2011 to 2014, we enrolled 57 full-term newborns with hypospadias and three randomly selected controls per case (162 control newborns), matched for gestational age, from 11 maternity units in Picardy, France. Neonatal and parental data were collected at birth (personal characteristics, maternal lifestyle, and medical history). Maternal occupational exposure was assessed by a job-exposure matrix for EDCs from a job history questionnaire completed by mothers. Odds ratios (OR) and 95% confidence intervals (CI) were calculated with univariate and multivariable logistic regression, and adjusted for relevant covariates. Multivariate analysis showed a strong association between hypospadias and potential maternal occupational exposure to EDCs and maternal household use of hair cosmetics (OR 6.1, 95% CI: 1.1–34.9; OR: 9.6, 95% CI: 1.4–66.1, respectively). Our results suggest that maternal occupational exposure to EDCs is a risk factor for hypospadias and suggests a possible influence of household use of hair cosmetics during early pregnancy on the incidence of hypospadias in the offspring. A larger study with more accurate exposure assessment should evaluate the impact of EDCs in hair cosmetics on the incidence of hypospadias.
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Affiliation(s)
- Elodie Haraux
- Department of Paediatric Surgery, Amiens University Hospital, 80054 Amiens, France.
| | - Karine Braun
- Department of Paediatrics, Amiens University Hospital, 80054 Amiens, France.
| | - Philippe Buisson
- Department of Paediatric Surgery, Amiens University Hospital, 80054 Amiens, France.
| | | | | | - Jannick Ricard
- Department of Paediatric Surgery, Amiens University Hospital, 80054 Amiens, France.
| | - Bernard Boudailliez
- Department of Paediatrics, Amiens University Hospital, 80054 Amiens, France.
| | - Pierre Tourneux
- Department of Paediatric Intensive Care Unit, Amiens University Hospital, 80054 Amiens, France.
| | - Richard Gouron
- Department of Paediatric Surgery, Amiens University Hospital, 80054 Amiens, France.
| | - Karen Chardon
- PériTox-INERIS Laboratory, Jules Verne University of Picardy, 80054 Amiens, France.
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