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de Barbeyrac C, Roth P, Noël C, Anselem O, Gaudin A, Roumegoux C, Azcona B, Castel C, Noret M, Letamendia E, Stirnemann J, Ville Y, Lapillonne A, Viallard ML, Kermorvant-Duchemin E. The role of perinatal palliative care following prenatal diagnosis of major, incurable fetal anomalies: a multicentre prospective cohort study. BJOG 2021; 129:752-759. [PMID: 34665920 DOI: 10.1111/1471-0528.16976] [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] [Accepted: 06/17/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe prenatal decision-making processes and birth plans in pregnancies amenable to planning perinatal palliative care. DESIGN Multicentre prospective observational study. SETTING Nine Multidisciplinary Centres for Prenatal Diagnosis of the Paris-Ile-de-France region. POPULATION All cases of major and incurable fetal anomaly eligible for TOP where limitation of life-sustaining treatments for the neonate was discussed in the prenatal period between 2015 and 2016. METHODS Cases of congenital defects amenable to perinatal palliative care were prospectively included in each centre. Prenatal diagnosis, decision-making process, type of birth plan, birth characteristics, pregnancy and neonatal outcome were collected prospectively and anonymously. MAIN OUTCOME MEASURE Final decision reached following discussions in the antenatal period. RESULTS We identified 736 continuing pregnancies with a diagnosis of a severe fetal condition eligible for TOP. Perinatal palliative care was considered in 102/736 (13.9%) pregnancies (106 infants); discussions were multidisciplinary in 99/106 (93.4%) cases. Prenatal birth plans involved life-sustaining treatment limitation and comfort care in 73/736 (9.9%) of the pregnancies. The main reason for planning palliative care at birth was short-term inevitable death in 39 cases (53.4%). In all, 76/106 (71.7%) infants were born alive, and 18/106 (17%) infants were alive at last follow-up, including four with a perinatal palliative care birth plan. CONCLUSIONS Only a small proportion of severe and incurable fetal disorders were potentially amenable to limitation of life-sustaining interventions. Perinatal palliative care may not be considered a universal alternative to termination of pregnancy. TWEETABLE ABSTRACT Perinatal palliative care is planned in 10% of continuing pregnancies with a major and incurable fetal condition eligible for TOP.
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Affiliation(s)
- C de Barbeyrac
- Department of Neonatal Medicine, AP-HP, Hôpital Necker-Enfants malades, Université de Paris, Paris, France
| | - P Roth
- Department Obstetrics and Fetal Medicine, AP-HP, Hôpital Necker-Enfants malades, Université de Paris, EA7328, Paris, France
| | - C Noël
- Department Obstetrics and Fetal Medicine, Centre Hospitalier René Dubos, Pontoise, France
| | - O Anselem
- Department of Department Obstetrics and Fetal Medicine, AP-HP, Hôpital Cochin - Port-Royal, Paris, France
| | - A Gaudin
- Department of Neonatal Medicine, AP-HP, Hôpital Robert-Debré, Paris, France
| | - C Roumegoux
- Department of Neonatal Medicine, AP-HP, Hôpital Jean-Verdier, Bondy, France
| | - B Azcona
- Department of Neonatal Medicine, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - C Castel
- Department of Neonatal Medicine, Centre Hospitalier Intercommunal de Poissy-Saint-Quentin, Poissy, France
| | - M Noret
- Department of Obstetrics, AP-HP, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - E Letamendia
- Maternity Unit, AP-HP, Hôpital Antoine Béclère, Clamart, France
| | - J Stirnemann
- Department Obstetrics and Fetal Medicine, Centre Hospitalier René Dubos, Pontoise, France
| | - Y Ville
- Department Obstetrics and Fetal Medicine, Centre Hospitalier René Dubos, Pontoise, France
| | - A Lapillonne
- Department of Neonatal Medicine, AP-HP, Hôpital Necker-Enfants malades, Université de Paris, Paris, France
| | - M-L Viallard
- Palliative Medicine Unit, AP-HP, Hôpital Necker-Enfants malades, Université de Paris, Paris, France
| | - E Kermorvant-Duchemin
- Department of Neonatal Medicine, AP-HP, Hôpital Necker-Enfants malades, Université de Paris, Paris, France
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Dorsi M, Giuseppi A, Lesage F, Stirnemann J, De Saint Blanquat L, Nicloux M, Assaf Z, Khen Dunlop N, Kermorvant-Duchemin E, Magny JF, Ville Y, Lapillonne A. Prenatal factors associated with neonatal survival of infants with congenital chylothorax. J Perinatol 2018; 38:31-34. [PMID: 29048403 DOI: 10.1038/jp.2017.150] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 08/11/2017] [Accepted: 08/14/2017] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Congenital chylothorax is a rare disease and prognostic factors are key element in properly informing parents. This study aimed at determining the prenatal factors associated with neonatal survival in a cohort of liveborn infants with congenital chylothorax. STUDY DESIGN Observational monocentric cohort study including all liveborn neonates consecutively admitted for congenital chylothorax. RESULTS Neonatal mortality was 32% (16/50). Prematurity (or birth weight), persistence of hydrops at birth and the absence of thoracoamniotic shunt procedure were significantly associated with mortality, whereas prenatal diagnosis of pleural effusion, side of pleural effusion, hydrops fetalis and amniodrainage were not. In case of prenatal diagnosis of hydrops fetalis, the reversal in utero of hydrops fetalis was significantly associated with survival (P=0.001). In case of thoracoamniotic shunting, the interval between thoracoamniotic shunting intervention and delivery was significantly longer for patients who survived (P=0.03). CONCLUSIONS Thoracoamniotic shunting and reversal of hydrops significantly improves survival, whereas prematurity worsened outcome of liveborn infants with congenital chylothorax. Our data also suggest that the interval between thoracoamniotic shunting and birth appears to be crucial; the longer the interval, the more likely is the reversal of antenatal hydrops and neonatal survival.
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Affiliation(s)
- M Dorsi
- Department of Neonatal Intensive Care, APHP Necker Hospital, Paris, France
| | - A Giuseppi
- Department of Neonatal Intensive Care, APHP Necker Hospital, Paris, France
| | - F Lesage
- Department of Pediatric Intensive Care, APHP Necker Hospital, Paris, France
| | - J Stirnemann
- Paris Descartes University (EA 7328), Sorbonne Paris Cite, France.,Department of Obstetrics, APHP Necker Hospital, Paris, France
| | | | - M Nicloux
- Department of Neonatal Intensive Care, APHP Necker Hospital, Paris, France
| | - Z Assaf
- Department of Neonatal Intensive Care, APHP Necker Hospital, Paris, France
| | - N Khen Dunlop
- Paris Descartes University (EA 7328), Sorbonne Paris Cite, France.,Department of Pediatric Surgery, APHP Necker Hospital, Paris, France
| | - E Kermorvant-Duchemin
- Department of Neonatal Intensive Care, APHP Necker Hospital, Paris, France.,Paris Descartes University (EA 7328), Sorbonne Paris Cite, France
| | - J-F Magny
- Department of Neonatal Intensive Care, APHP Necker Hospital, Paris, France.,Paris Descartes University (EA 7328), Sorbonne Paris Cite, France
| | - Y Ville
- Paris Descartes University (EA 7328), Sorbonne Paris Cite, France.,Department of Obstetrics, APHP Necker Hospital, Paris, France
| | - A Lapillonne
- Department of Neonatal Intensive Care, APHP Necker Hospital, Paris, France.,Paris Descartes University (EA 7328), Sorbonne Paris Cite, France
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Tauzin M, Felix A, Michot C, Dedieu C, Aoust L, Fortas F, Guillier C, Ngo J, Wachter PY, Petermann L, Kermorvant-Duchemin E. Le monde des jumeaux : aspects épidémiologiques et génétiques, enjeux obstétricaux, risques spécifiques et devenir. Arch Pediatr 2017; 24:1299-1311. [DOI: 10.1016/j.arcped.2017.09.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 06/28/2017] [Accepted: 09/27/2017] [Indexed: 11/16/2022]
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Meau-Petit V, Tasseau A, Lebail F, Ayachi A, Layouni I, Patkai J, Gaudin A, Huon C, Chabernaud JL, Dugelay F, Kermorvant-Duchemin E, Lodé N, Ducrocq S, Boithias C, Péjoan H, Boissinot C, Harvey B, Othmani K, Bolot P, Vermersch AI, Zupan-Simunek V. Hypothermie contrôlée du nouveau-né à terme après asphyxie périnatale. Arch Pediatr 2010; 17:282-9. [DOI: 10.1016/j.arcped.2009.10.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Accepted: 10/17/2009] [Indexed: 10/19/2022]
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Eleni-dit-Trolli S, Kermorvant-Duchemin E, Huon C, Mokthari M, Husseini K, Brunet ML, Dupont C, Lapillonne A. Early individualised parenteral nutrition for preterm infants. Arch Dis Child Fetal Neonatal Ed 2009; 94:F152-3. [PMID: 18838470 DOI: 10.1136/adc.2007.136333] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Considerable effort should be made to optimise parenteral nutrition of preterm infants in order to limit the development of postnatal growth restriction. A monocentric before-and-after study design was used to determine the effects of computerising parenteral nutrition ordering on the composition of parenteral nutrition (PN) solutions and early clinical outcomes of preterm infants born < or =28 weeks of gestation. Parenteral protein intake during the first week of life and parenteral lipid, glucose and energy intakes during the first and second week of life were significantly higher in infants assessed after the introduction of computerised parenteral nutrition ordering. This led to a significant reduction in the cumulative energy deficit over the first 28 days of life and to an improvement in both early growth and pulmonary outcome. Computerising the PN ordering process improves the nutrient content of the PN solutions and early postnatal outcome.
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Affiliation(s)
- S Eleni-dit-Trolli
- Department of Neonatology and Nutrition, Saint-Vincent de Paul Hospital, 74 Avenue Denfert Rochereau, Paris, France
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