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Bodet LM, Danielo M, Rozé JC, Flamant C, Muller JB. Father newborn skin-to-skin wheelchair transfer from delivery room to neonatal care unit: Possible change in practices. Arch Pediatr 2022; 29:100-104. [PMID: 35039187 DOI: 10.1016/j.arcped.2021.11.005] [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: 06/11/2021] [Revised: 09/21/2021] [Accepted: 11/28/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate the transfer of newborns from the delivery room to the neonatal care unit with their fathers on wheelchairs in terms of the safety of the procedure and paternal anxiety. METHODS A prospective observational single-center before-and-after pilot study was conducted from February to May 2018 at the University Maternity Hospital of Nantes. Safe transfer was judged on the basis of episodes of hypothermia or hypoglycemia. Paternal anxiety was assessed with the State-Trait Anxiety Inventory (STAI) scale after newborn transfer. RESULTS Overall, 70 preterm newborns were enrolled, 44 were carried in wheelchairs in the father's arms (target group) and 26 were transferred in an incubator (control group). After adjusting for gestational age and birthweight, there were no statistically significantly differences between the target and the control group in the rates of hypothermia (43.9% vs 30.8%, p = 0,59) and hypoglycemia (9.52% vs 19.23%, p = 0,19). The STAI scale score was not significantly different between groups after incubator transfer or wheelchair transfer, at 35 ± 8.2 and 38 ± 10.2, respectively (p = 0.07). CONCLUSION Transferring a newborn to the neonatal care unit via wheelchair with the father is a safe alternative to incubator transfer.
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Affiliation(s)
- L M Bodet
- Pediatric and Neonatal Intensive Care Unit, Nantes University Hospital, 38 bld Jean Monnet, Nantes 44000, France.
| | - M Danielo
- Maternity, Ancenis Hospital, Ancenis 44156, France
| | - J C Rozé
- Pediatric and Neonatal Intensive Care Unit, Nantes University Hospital, 38 bld Jean Monnet, Nantes 44000, France
| | - C Flamant
- Pediatric and Neonatal Intensive Care Unit, Nantes University Hospital, 38 bld Jean Monnet, Nantes 44000, France
| | - J B Muller
- Pediatric and Neonatal Intensive Care Unit, Nantes University Hospital, 38 bld Jean Monnet, Nantes 44000, France
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2
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Delorme P, Kayem G, Lorthe E, Sentilhes L, Zeitlin J, Subtil D, Rozé JC, Vayssière C, Durox M, Ancel PY, Pierrat V, Goffinet F. Neurodevelopment at 2 years and umbilical artery Doppler in cases of very preterm birth after prenatal hypertensive disorder or suspected fetal growth restriction: EPIPAGE-2 prospective population-based cohort study. Ultrasound Obstet Gynecol 2020; 56:557-565. [PMID: 32212388 DOI: 10.1002/uog.22025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 02/26/2020] [Accepted: 03/13/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To investigate the association between absent or reversed end-diastolic flow (ARED) on umbilical artery Doppler ultrasound and poor neurological outcome at 2 years of age after very preterm birth associated with suspected fetal growth restriction (FGR) or maternal hypertensive disorders. METHODS The study population comprised all very preterm (22-31 completed weeks) singleton pregnancies delivered because of suspected FGR and/or maternal hypertensive disorders that had umbilical artery Doppler and 2-year follow-up available included in EPIPAGE-2, a prospective, nationwide, population-based cohort of preterm births in France in 2011. Univariate and two-level multivariable logistic regression analyses were used to assess the association of ARED in the umbilical artery, as compared with normal or reduced end-diastolic flow, with severe or moderate neuromotor and/or sensory disability and with an Ages and Stages Questionnaire (ASQ) score below a threshold. This was defined as a score more than 2 SD below the mean in any of the five domains, at age 2, adjusting for gestational age at delivery. ASQ is used to identify children at risk of developmental delay requiring reinforced follow-up and further evaluation. Descriptive statistics and bivariate tests were weighted according to the duration of the inclusion periods. RESULTS The analysis included 484 children followed up at 2 years of age, for whom prenatal umbilical artery Doppler ultrasound was available. Among them, 8/484 (1.6%) had severe or moderate neuromotor and/or sensory disability, and 156/342 (45.4%) had an ASQ score below the threshold. Compared with normal or reduced end-diastolic flow in the umbilical artery (n = 305), ARED (n = 179) was associated with severe or moderate neuromotor and/or sensory disability (adjusted odds ratio (OR), 11.3; 95% CI, 1.4-93.2) but not with an ASQ score below the threshold (adjusted OR, 1.2; 95% CI, 0.8-1.9). CONCLUSION Among children delivered before 32 weeks of gestation due to suspected FGR and/or maternal hypertensive disorder who survived until 2 years of age, prenatal ARED in the umbilical artery was associated with a higher incidence of severe or moderate neuromotor and/or sensory disability. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- P Delorme
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), FHU PREMA Paris Descartes University, Paris, France
- Sorbonne Université, AP-HP, Department of Gynaecology and Obstetrics, Trousseau Hospital, Paris, France
| | - G Kayem
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), FHU PREMA Paris Descartes University, Paris, France
- Sorbonne Université, AP-HP, Department of Gynaecology and Obstetrics, Trousseau Hospital, Paris, France
| | - E Lorthe
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), FHU PREMA Paris Descartes University, Paris, France
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - L Sentilhes
- Department of Obstetrics and Gynaecology, Bordeaux University Hospital, Bordeaux, France
| | - J Zeitlin
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), FHU PREMA Paris Descartes University, Paris, France
| | - D Subtil
- Université de Lille, CHU Lille, Hop Jeanne de Flandre, EA 2694 - Santé Publique: Épidémiologie et Qualité des Soins, Lille, France
| | - J C Rozé
- CHU, Centre Hospitalo-Universitaire Hôtel-Dieu, Nantes, France
| | - C Vayssière
- UMR 1027 INSERM, Team SPHERE, Université Toulouse III Paul Sabatier, Toulouse, France
- CHU de Toulouse, Service de Gynécologie Obstétrique, Toulouse, France
| | - M Durox
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), FHU PREMA Paris Descartes University, Paris, France
| | - P Y Ancel
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), FHU PREMA Paris Descartes University, Paris, France
- URC-CIC P1419, HUPC, Assistance Publique Hôpitaux de Paris, Paris, France
| | - V Pierrat
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), FHU PREMA Paris Descartes University, Paris, France
- CHU Lille, Department of Neonatal Medicine, Jeanne de Flandre Hospital, Lille, France
| | - F Goffinet
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), FHU PREMA Paris Descartes University, Paris, France
- Department of Obstetrics and Gynaecology, AP-HP Cochin Port Royal, FHU PREMA Paris, France
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Peretti N, Darmaun D, Chouraqui JP, Bocquet A, Briend A, Feillet F, Frelut ML, Guimber D, Hankard R, Lapillonne A, Rozé JC, Simeoni U, Turck D, Dupont C. Vegetarian diet in children and adolescents: A health benefit? Arch Pediatr 2020; 27:173-175. [PMID: 32331916 DOI: 10.1016/j.arcped.2020.03.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 02/03/2020] [Accepted: 03/28/2020] [Indexed: 12/23/2022]
Affiliation(s)
- N Peretti
- Université de Lyon, Hospices Civils de Lyon, CaRMEN, 69000 Lyon, France.
| | - D Darmaun
- Université Nantes-Atlantique, 44300 Nantes, France
| | | | - A Bocquet
- Université de Franche-Comté, 25000 Besançon, France
| | - A Briend
- Institut de recherche pour le développement, 13002 Marseille, France
| | - F Feillet
- Université de Lorraine, 54000 Nancy, France
| | | | - D Guimber
- Université de Lille, 59000 Lille, France
| | - R Hankard
- Université de Tours, 37000 Tours, France
| | | | - J C Rozé
- Université Nantes-Atlantique, 44300 Nantes, France
| | - U Simeoni
- Institut de recherche pour le développement, 13002 Marseille, France
| | - D Turck
- Université de Lille, 59000 Lille, France
| | - C Dupont
- Université Paris Descartes, 75006 Paris, France
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- Société Française de Pédiatrie, hôpital Necker Carré Necker, 149, rue de Sèvres, 75015 Paris, France
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4
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Bichali S, Brault D, Masserot C, Boscher C, Couec ML, Deslandes G, Pissard S, Leverger G, Vauzelle C, Elefant E, Rozé JC, Cortey A, Chenouard A. Maternal consumption of quinine-containing sodas may induce G6PD crises in breastfed children. Eur J Pediatr 2017; 176:1415-1418. [PMID: 28828525 DOI: 10.1007/s00431-017-2998-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 08/08/2017] [Accepted: 08/13/2017] [Indexed: 10/19/2022]
Abstract
UNLABELLED Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common human enzyme defect often presenting with neonatal jaundice and/or hemolytic anemia. G6PD hemolytic events are linked with exposure to a pro-oxidant agent. We here report three cases of initial G6PD crises in breastfed children secondary to maternal consumption of a tonic drink which contains quinine. Quinine was found in breast milk of one of the mothers after she consumed tonic water. CONCLUSION The amount of quinine that is transmitted through breast milk appears to be sufficient to induce G6PD crises in breastfed children. We hence recommend that consumption of quinine-containing sodas during breastfeeding should be avoided in populations with a high prevalence of G6PD deficiency. What is Known: • G6PD hemolytic events are linked with exposure to a pro-oxidant agent. • Ingestion of fava beans by a mother who was breastfeeding has been reported to induce a neonatal G6PD crisis. What is New: • Maternal consumption of tonic drink which contains quinine appears to be sufficient to induce G6PD crises in breastfed children. • Maternal consumption of quinine-containing sodas during breastfeeding should be avoided in populations with a high prevalence of G6PD deficiency.
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Affiliation(s)
- S Bichali
- Department of Pediatric Intensive Care, Nantes University Hospital, Nantes, France
| | - D Brault
- Neonatal Intensive Care Unit, Argenteuil Hospital, Argenteuil, France
| | - C Masserot
- Department of Pediatric Oncology, Trousseau University Hospital, Paris, France
| | - C Boscher
- Department of Pediatric Intensive Care, Nantes University Hospital, Nantes, France
| | - M L Couec
- Pediatric Oncology and Haematology Unit, Nantes University Hospital, Nantes, France
| | - G Deslandes
- Pharmacology and Toxicology Unit, Nantes University Hospital, Nantes, France
| | - S Pissard
- Department of Genetics, Henri Mondor University Hospital, and IMRB U955eq2, Créteil, France
| | - G Leverger
- Department of Pediatric Oncology, Trousseau University Hospital, Paris, France
| | - C Vauzelle
- Reference Center on Teratogenic Agents, Trousseau University Hospital, Paris, France
| | - E Elefant
- Reference Center on Teratogenic Agents, Trousseau University Hospital, Paris, France
| | - J C Rozé
- Department of Pediatric Intensive Care, Nantes University Hospital, Nantes, France
| | - A Cortey
- National Reference Center in Perinatal Hemobiology, Trousseau University Hospital, Paris, France
| | - Alexis Chenouard
- Department of Pediatric Intensive Care, Nantes University Hospital, Nantes, France.
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5
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Schönherr-Hellec S, Klein G, Delannoy J, Ferraris L, Friedel I, Rozé JC, Butel MJ, Aires J. Comparative phenotypic analysis of "Clostridium neonatale" and Clostridium butyricum isolates from neonates. Anaerobe 2017; 48:76-82. [PMID: 28739338 DOI: 10.1016/j.anaerobe.2017.07.002] [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: 05/30/2017] [Revised: 07/19/2017] [Accepted: 07/20/2017] [Indexed: 12/30/2022]
Abstract
"Clostridium neonatale" was recently described as a new species within the Cluster I of the Clostridium genus sensu stricto. In this study, we characterized "C. neonatale" isolates (n = 42) and compared their phenotypic properties with those of Clostridium butyricum (n = 26), a close related species. Strains isolated from fecal samples of healthy neonates were tested for different phenotypic characteristics. Compared to C. butyricum, "C. neonatale" showed a significant higher surface hydrophobicity (p = 0.0047), exopolysaccharide production (p = 0.0069), aero-tolerance (p = 0.0222) and viability at 30 °C (p = 0.0006). A lower swimming ability (p = 0.0146) and tolerance against bile (0.3%) (p = 0.0494), acid (pH 4.5) (p < 0.0001), osmolarity (NaCl 5%, p = 0.0188) and temperature at 50 °C (p = 0.0013) characterized "C. neonatale" strains. Our results showed that "C. neonatale" behaves very differently from C. butyricum and suggests specific responses to environmental changes. Besides it is the first study on clinical isolates for these two anaerobic members of the newborns' gut microbiota and broadens our knowledge about their phenotypic traits.
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Affiliation(s)
| | - G Klein
- EA 4065, Faculty of Pharmacy, Paris Descartes University, Paris, France
| | - J Delannoy
- EA 4065, Faculty of Pharmacy, Paris Descartes University, Paris, France
| | - L Ferraris
- EA 4065, Faculty of Pharmacy, Paris Descartes University, Paris, France
| | - I Friedel
- EA 4065, Faculty of Pharmacy, Paris Descartes University, Paris, France
| | - J C Rozé
- Department of Neonatal Medicine, Nantes University Hospital, Nantes, France
| | - M J Butel
- EA 4065, Faculty of Pharmacy, Paris Descartes University, Paris, France
| | - J Aires
- EA 4065, Faculty of Pharmacy, Paris Descartes University, Paris, France.
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Bocquet A, Turck D, Briend A, Chouraqui JP, Darmaun D, Dupont C, Feillet F, Frelut ML, Girardet JP, Hankard R, Goulet O, Rieu D, Rozé JC, Simeoni U, Vidailhet M. [Are infant formulae named "taking over from breastfeeding" useful?]. Arch Pediatr 2015; 22:1213-6. [PMID: 26552623 DOI: 10.1016/j.arcped.2015.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 09/23/2015] [Indexed: 10/22/2022]
Affiliation(s)
- A Bocquet
- Université de Franche-Comté, 25000 Besançon, France.
| | - D Turck
- Université de Lille et Inserm U995, 59037 Lille, France
| | - A Briend
- Institut de recherche pour le développement, 13572 Marseille, France
| | | | - D Darmaun
- Université Nantes-Atlantique, 44300 Nantes, France
| | - C Dupont
- Université Paris Descartes, 75006 Paris, France
| | - F Feillet
- Université de Lorraine, 54000 Nancy, France
| | - M L Frelut
- Endocrinologie-diabète de l'enfant, hôpitaux universitaires Paris-Sud, CHU de Bicêtre, 94270 Le Kremlin-Bicêtre, France
| | - J P Girardet
- Université Pierre-et-Marie-Curie-Paris 6, 75005 Paris, France
| | - R Hankard
- Université de Tours et Inserm U1069, 37000 Tours, France
| | - O Goulet
- Université Paris Descartes, 75006 Paris, France
| | - D Rieu
- Université Montpellier-1, 34000 Montpellier, France
| | - J C Rozé
- Université Nantes-Atlantique, 44300 Nantes, France
| | - U Simeoni
- Université de Lausanne, CH-1011, Lausanne, Suisse
| | - M Vidailhet
- Université Paris Descartes, 75006 Paris, France
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7
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Frondas-Chauty A, Simon L, Branger B, Gascoin G, Flamant C, Ancel PY, Darmaun D, Rozé JC. Early growth and neurodevelopmental outcome in very preterm infants: impact of gender. Arch Dis Child Fetal Neonatal Ed 2014; 99:F366-72. [PMID: 24916576 DOI: 10.1136/archdischild-2013-305464] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND OBJECTIVE Nutrition in the neonatal unit may impact the neurological outcome of very preterm infants, and male preterms are more likely to suffer neonatal morbidity and adverse neurological outcomes. We hypothesised that growth during hospitalisation would impact neurological outcome differently, depending on infant gender. METHODS Surviving infants born between 1 January 2003 and 31 December 2009 with a gestational age <33 weeks, and enrolled in Loire Infant Follow-up Team, a regional cohort in western France, qualified for the study. Growth during neonatal hospitalisation was assessed by the change in weight z-score between birth and discharge, and infants where ranked into 5 classes, depending on their change in z-score (<-2, -2 to -1.01, -1 to -0.51, -0.50 to 0.01 and ≥0), the last class being the reference. The main outcome criterion was neurodevelopmental outcome at 2 years of corrected age. For each class of changes in weight z-score, crude or adjusted OR for non-optimal outcome was calculated for each gender, and compared between genders. RESULTS 1221 boys and 1056 girls were included. Gender and early growth interact, (p=0.02). Moreover when change in weight z-score varied from <-2 to (-0.50 to -0.01), adjusted OR for non-optimal outcome varied from 3.2 (1.5-6.8) to 2.2 (1.2-4.1) in boys versus 1.8 (0.7-4.2) to 0.95 (0.4-1.9) in girls. For each class, the OR was significantly higher in boys. CONCLUSIONS In very preterm infants, male neurodevelopment appears to be much more sensitive than female to poor postnatal growth.
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Affiliation(s)
- A Frondas-Chauty
- Department of Neonatal Medicine, University Hospital of Nantes, Nantes, France INRA UMR 1280, Physiologie des Adaptations Nutritionnelles, IMAD, CRNH Ouest, Nantes, France
| | - L Simon
- Department of Neonatal Medicine, University Hospital of Nantes, Nantes, France
| | - B Branger
- Loire Infant Follow-Up Team (LIFT) Network, Pays de Loire, France
| | - G Gascoin
- Department of Neonatal Medicine, University Hospital of Angers, Angers, France
| | - C Flamant
- Department of Neonatal Medicine, University Hospital of Nantes, Nantes, France INRA UMR 1280, Physiologie des Adaptations Nutritionnelles, IMAD, CRNH Ouest, Nantes, France
| | - P Y Ancel
- Institut National de la Santé et de la Recherche Médicale, Epidemiological Research Unit on Perinatal Health and Women's and Children's Health, Tenon Hospital, Paris, France
| | - D Darmaun
- INRA UMR 1280, Physiologie des Adaptations Nutritionnelles, IMAD, CRNH Ouest, Nantes, France Nantes University, IMAD, Nantes, France
| | - J C Rozé
- Department of Neonatal Medicine, University Hospital of Nantes, Nantes, France INRA UMR 1280, Physiologie des Adaptations Nutritionnelles, IMAD, CRNH Ouest, Nantes, France Loire Infant Follow-Up Team (LIFT) Network, Pays de Loire, France
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8
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Dailly E, Drouineau MH, Gournay V, Rozé JC, Jolliet P. Population pharmacokinetics of domperidone in preterm neonates. Eur J Clin Pharmacol 2008; 64:1197-200. [PMID: 18685840 DOI: 10.1007/s00228-008-0535-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2008] [Accepted: 06/30/2008] [Indexed: 11/27/2022]
Abstract
PURPOSE A population pharmacokinetic analysis was performed to define domperidone pharmacokinetic parameters in preterm neonates, as no pharmacokinetic data are available in this population. METHODS An oral domperidone solution was administered (0.75 mg/kg per day) in 32 preterm neonates (64 samples). Domperidone plasma concentration was measured by high-performance liquid chromatography (HPLC) assay, and a one-compartment model with first-order absorption was fitted to the data using NONMEM version V level 1.1. RESULTS The mean peak and trough plasma concentration values of domperidone were, respectively, 25.3 +/- 20.5 ng/ml and 15.4 +/- 11.4 ng/ml (mean +/- standard deviation). The pharmacokinetic parameters (interindividual variability%) were clearance (Cl/F) = 0.92 L/h (51.6%), volume of distribution (Vd/F) = 0.405 L (68%), and absorption constant rate (Ka) = 0.0843 h(-1) (55.8%). The clearance is not lower than values reported in adults. No influence of covariates (postnatal age, prematurity, weight, gender) on domperidone pharmacokinetic parameters was found. CONCLUSION This pilot study designed with a limited sampling strategy showed that domperidone plasma concentrations were consistent with those reported in adults, suggesting that domperidone dosage regimen currently used in preterm neonates is suitable.
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Affiliation(s)
- E Dailly
- Clinical Pharmacology Department, CHU de Nantes, Nantes, France.
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9
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Courtin V, Liet JM, Prat M, Picherot G, Rozé JC. Épidémiologie des infections à méningocoque chez l'enfant en Loire-Atlantique et dans ses départements limitrophes de 1997 à 2002. Arch Pediatr 2005; 12:330. [PMID: 15734132 DOI: 10.1016/j.arcped.2004.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2004] [Accepted: 12/01/2004] [Indexed: 11/19/2022]
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10
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Denizot S, Boscher C, Le Vaillant C, Rozé JC, Gras Le Guen C. Distal arthrogryposis and neonatal hypotonia: an unusual presentation of Prader-Willi syndrome (PWS). J Perinatol 2004; 24:733-4. [PMID: 15510104 DOI: 10.1038/sj.jp.7211185] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The clinical features of Prader-Willi Syndrome (PWS) in the neonate are marked by hypotonia, absence of crying, and feeding difficulties, but the clinical nature of PWS in utero remains unclear. We report a case of PWS with fetal immobility and distal arthrogryposis in a girl admitted the first day of life to the neonatal intensive care unit for severe hypotonia and respiratory distress.
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Affiliation(s)
- S Denizot
- Département de périnatologie, CHU de Nantes, France
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11
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Larroque B, Bréart G, Kaminski M, Dehan M, André M, Burguet A, Grandjean H, Ledésert B, Lévêque C, Maillard F, Matis J, Rozé JC, Truffert P. Survival of very preterm infants: Epipage, a population based cohort study. Arch Dis Child Fetal Neonatal Ed 2004; 89:F139-44. [PMID: 14977898 PMCID: PMC1756022 DOI: 10.1136/adc.2002.020396] [Citation(s) in RCA: 243] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To evaluate the outcome for all infants born before 33 weeks gestation until discharge from hospital. DESIGN A prospective observational population based study. SETTING Nine regions of France in 1997. PATIENTS All births or late terminations of pregnancy for fetal or maternal reasons between 22 and 32 weeks gestation. MAIN OUTCOME MEASURE Life status: stillbirth, live birth, death in delivery room, death in intensive care, decision to limit intensive care, survival to discharge. RESULTS A total of 722 late terminations, 772 stillbirths, and 2901 live births were recorded. The incidence of very preterm births was 1.3 per 100 live births and stillbirths. The survival rate for births between 22 and 32 weeks was 67% of all births (including stillbirths), 85% of live births, and 89% of infants admitted to neonatal intensive care units. Survival increased with gestational age: 31% of all infants born alive at 24 weeks survived to discharge, 78% at 28 weeks, and 97% at 32 weeks. Survival among live births was lower for small for gestational age infants, multiple births, and boys. Overall, 50% of deaths after birth followed decisions to withhold or withdraw intensive care: 66% of deaths in the delivery room, decreasing with increasing gestational age; 44% of deaths in the neonatal intensive care unit, with little variation with gestational age. CONCLUSION Among very preterm babies, chances of survival varies greatly according to the length of gestation. At all gestational ages, a large proportion of deaths are associated with a decision to limit intensive care.
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Affiliation(s)
- B Larroque
- Epidemiological Research Unit on Perinatal and Women's Health, U149 INSERM Villejuif, France.
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12
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Debillon T, Gras-Leguen C, Leroy S, Caillon J, Rozé JC, Gressens P. Patterns of cerebral inflammatory response in a rabbit model of intrauterine infection-mediated brain lesion. Brain Res Dev Brain Res 2003; 145:39-48. [PMID: 14519492 DOI: 10.1016/s0165-3806(03)00193-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Although the fetal inflammatory response syndrome seems crucial to the association between intrauterine infection and white matter disease in human preterm infants, the underlying mechanisms remain unclear. Using our previously described rabbit model of cerebral cell death in the white matter and hippocampus induced by intrauterine Escherichia coli infection, we investigated inflammatory and astroglial responses in placenta and brain tissues, in correlation with cell death distribution. Brains and placentas were studied 12, 24, or 48 h following intrauterine inoculation of E. coli or saline (groups G12, G24, and G48). Diffuse monocyte-macrophage infiltrates positive for inducible nitric oxide synthase (i-NOS) were significantly more marked in G24 and G48 placentas than in controls. In the G48 fetuses with both diffuse cell death and focal periventricular white matter cysts mimicking cystic periventricular leukomalacia, a strong rabbit macrophage and inducible nitric oxide synthase immunostaining was observed at the border of these cystic lesions. In contrast, in the fetuses with only diffuse and significant cell death, no inflammatory or astroglial responses were detected in the white matter or hippocampus. Cell death was accompanied by i-NOS immunostaining in the hippocampus but not the white matter. Hippocampal cells positive for i-NOS usually displayed a neuronal phenotype. In this model, focal white matter cysts are accompanied by a robust inflammatory response, and diffuse cell death, which may mimic the white matter and hippocampal damage seen in very and extremely pre-term infants, occur in the absence of a detectable brain inflammatory response.
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Affiliation(s)
- T Debillon
- Service de Néonatologie, Hôpital Mère-Enfant, 9 Quai Moncousu, CHRU, 44 093 Nantes 01, France.
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13
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Feki H, Liet JM, Gournay V, Rozé JC. [Transient left myocardial dysfunction: a cause of neonatal hypoxemia]. Arch Pediatr 2002; 9:506-10. [PMID: 12053546 DOI: 10.1016/s0929-693x(01)00834-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
UNLABELLED Refractory hypoxemia in the newborn requires an accurate diagnostic investigation for an optimal and prompt management. CASE REPORT After a short delivery, a post-term newborn developed a severe hypoxemia with patchy pulmonary alveolar opacities and systolic right-to-left extrapulmonary shunting through the ductus arteriosus. Echocardiography ruled out a cardiac malformation and showed dilated left atrium with left-to-right shunting by the ovale foramen due to left ventricular dysfunction. Inotropic support associated with mechanical ventilation allowed a rapid improvement. CONCLUSION A pathophysiological analysis is needed in case of severe neonatal hypoxemia. Doppler ultrasound is a non invasive and rapid method allowing the adjustment of the therapeutic strategy.
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Affiliation(s)
- H Feki
- Service de réanimation néonatale et pédiatrique, hôpital Mère-Enfant, CHU Nantes, 9, Quai-Moncousu, 44093 Nantes, France
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14
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Mamelle N, David S, Lombrail P, Rozé JC. [Indicators and evaluation tools for perinatal care networks]. J Gynecol Obstet Biol Reprod (Paris) 2001; 30:641-55; discussion 655-6. [PMID: 11917360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Since the regionalization of perinatal services and the laws on the safety of child-birth were announced on the 9th October 1998, conventions and rules establishing relationships between doctors in perinatal networks have gradually been set up. In order to assess the impact, functioning and effectiveness of this care organisation on the health of mothers an childs, a common study design is essential. Such a common protocol, with the same methodology, allows the comparison of observed results from one perinatal network to another. With this objective, four leading societies in the field, the French National College of Gynaecologists and Obstetricians (CNGOF), the National Federation of Neonatal Pediatricians (FNPN), the French Society of Perinatal Medicine (SFPM) and the Association of Computerised Medical Records in Perinatalogy, Obstetrics and Gynaecology (AUDIPOG) set up a workshop in order to elaborate a common text, which was adopted by the Administrative Councils of the four societies. This contractual text, co-operatively elaborated, is now introduced to the scientific community. It was prepared from scientific papers and international recommendations in the field of perinatal regionalization, leading to a protocol giving information on objectives, study population, study design and assessment criteria. For this, a list of questions was proposed, including the impact of perinatal network, its acceptability by doctors and families, its functioning and its effectiveness on the health of mother and child. The means of data collection were then presented, whether from institutional sources of perinatal data (completed from specific registers or studies), or from the information system France-Perinat, especially designed for the evaluation of the perinatal networks.
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Affiliation(s)
- N Mamelle
- INSERM U 369, Equipe Epidémiologie de la croissance et du développement, 151, cours Albert-Thomas, 69424 Lyon
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15
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Abstract
An association between chorioamnionitis and periventricular leukomalacia has been reported in human preterm infants. However, whether this link is causal has not been convincingly established, and the underlying molecular mechanisms remain unclear. The objective of this study was to establish a reproducible model of cerebral white matter disease in preterm rabbits after intrauterine infection. Escherichia coli was inoculated into both uterine horns of laparotomized pregnant rabbits when gestation was 80% complete. The fetuses were delivered by cesarean section and killed 12, 24, or 48 h after the inoculation. Programmed cell death in the white matter was evaluated by hematoxylin-eosin-saffron staining and in situ fragmented DNA labeling (terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling). In a first group of 14 pregnant rabbits not treated with antibiotics, all fetuses delivered 48 h after inoculation were stillborn, whereas fetuses extracted 12 or 24 h after inoculation were alive. No significant cell death was detected in the live fetuses compared with the control noninfected rabbits. In a second group of five pregnant rabbits treated with ceftriaxone initiated 24 h after the inoculation and continued until cesarean section was performed 48 h after inoculation, 13 fetuses were alive, but all showed evidence of extensive programmed cell death in the white matter by hematoxylin-eosin-saffron staining and terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling. White matter damage became histologically detectable only 48 h after inoculation. Three of the 13 brains displayed periventricular white matter cysts mimicking human cystic periventricular leukomalacia. The high reproducibility of white matter damage in our model should permit further studies aimed at unraveling the molecular mechanisms of periventricular leukomalacia.
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Affiliation(s)
- T Debillon
- Departement de Perinatologie, Hôpital Mère-Enfant, Nantes, France
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16
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Boog G, Winer N, Le Vaillant C, Caroit-Cambazard Y, Trémouillac C, Debillon T, Rozé JC. [Practical problems of the functioning of the perinatal network in the Loire region]. Arch Pediatr 2000; 6 Suppl 2:216s-219s. [PMID: 10370485 DOI: 10.1016/s0929-693x(99)80417-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- G Boog
- Service d'obstétrique, de médecine faetale, CHU de Nantes, France
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17
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Branger B, Beringue F, Nomballais MF, Bouderlique C, Brossier JP, Savagner C, Seguin G, Boog G, Rozé JC. [Fetal and neonatal mortality from 22 weeks of amenorrhea in the Loire area]. J Gynecol Obstet Biol Reprod (Paris) 1999; 28:373-9. [PMID: 10480069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
BACKGROUND The Pays de Loire has a low perinatal mortality indicators among French regions but this could be due to under-notification. OBJECTS To explore this hypothesis we undertook a survey in order to identify all fetal and neonatal deaths occurring at a gestionnal age of 22 weeks or more. We also tried to examine and analyze the causes of death. METHODS All maternity (26) and neonatal wards (5) in the region took part in the survey in 1995. Clinicians were asked to fill out a questionnaire for all deaths occurring from gestational age (GA) 22 weeks and/or concerning a birthweight of a least 500 g. Only perinatal deaths related to parents living in the Pays de Loire were included in the study. RESULTS Two hundred and sixty seven perinatal deaths were identified out of a total 29,440 births (9.1 /1000). Eighty three (2.8 /1000) were termination of pregnancy for medical reasons, of which 82% were motivated by chromosomic illness. Ninety-nine stillbirths fell (3.4 /1000) into two GA periods: 24 to 27 weeks (20%) and 38 to 41 weeks (2%). The cause of stillbirths remained unknown in 50% of cases despite a post-mortem examination rate of 87%. There were 29 deaths (1 /1000) in the immediate per and post-partum, 40% of which occurred at GA 22 to 25 weeks. Another 38% occurred at GA 36 to 40 weeks and these were related to undectected malformations or infections. Neonatal and intensive care units reported 56 neonatal deaths (1.9 /1000). GA was under 33 weeks for 44% of them. Deaths were caused by usual complications of severe prematurity, neurologic diseases and malformations. Thirty-two percent of total deaths were not notified to the French Authority: 25% of deaths for termination of pregnancy for medical reasons and 7% for stillbirths and per and post partum deaths. CONCLUSION This survey suggests that the Pays de Loire perinatal mortality indicators remained low compared with other French regions, even after adjustment for this under notification. This casts doubts on the validity of perinatal mortality monitoring based on official notifications. The cause may lie in the inadequacy of legislation of the particular circumstances of perinatal deaths.
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18
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Liet JM, Piloquet H, Marchini JS, Maugère P, Bobin C, Rozé JC, Darmaun D. Leucine metabolism in preterm infants receiving parenteral nutrition with medium-chain compared with long-chain triacylglycerol emulsions. Am J Clin Nutr 1999; 69:539-43. [PMID: 10075342 DOI: 10.1093/ajcn/69.3.539] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although medium-chain triacylglycerols (MCTs) may be utilized more efficiently than long-chain triacylglycerols (LCTs), their effect on protein metabolism remains controversial. OBJECTIVE The aim of the study was to compare the effects of mixed MCT-LCT and pure LCT emulsions on leucine metabolism in preterm infants. DESIGN Fourteen preterm [gestational age: 30+/-1 wk; birth weight: 1409+/-78 g (x +/- SE)] neonates were randomly assigned to receive, from the first day of life, either a 50:50 MCT-LCT (mixed MCT group; n = 7) or an LCT (LCT group; n = 7) lipid emulsion as part of an isonitrogenous, isoenergetic total parenteral nutrition program. On the fourth day, infants received intravenous feeding providing 3 g lipid, 15 g glucose, and 3 g amino acids kg(-1) x d(-1) and underwent 1) indirect calorimetry and 2) a primed, 2-h infusion of H13CO3Na to assess the recovery of 13C in breath, immediately followed by 3) a 3-h infusion of L-[1-13C]leucine. RESULTS The respiratory quotient tended to be slightly but not significantly higher in the mixed MCT than in the LCT group (0.96+/-0.06 compared with 0.93+/-0.03). We did not detect a significant difference between the mixed MCT and LCT groups with regard to release of leucine from protein breakdown (B; 309+/-40 compared with 257+/-46 micromol x kg(-1) x h(-1)) and nonoxidative leucine disposal (NOLD; 296+/-36 compared with 285+/-49 micromol x kg(-1) x h(-1)). In contrast, leucine oxidation was greater in the mixed MCT than in the LCT group (113+/-10 compared with 67+/-10 micromol x kg(-1) x h(-1); P = 0.007). Net leucine balance (NOLD - B) was less positive in the mixed MCT than in the LCT group (-14+/-9 compared with 28+/-10 micromol x kg(-1) x h(-1); P = 0.011). CONCLUSION Mixed MCTs may not be as effective as LCT-containing emulsions in promoting protein accretion in parenterally fed preterm neonates.
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Affiliation(s)
- J M Liet
- Division of Neonatology, Hôpital Mère-Enfant, CHU de Nantes, and Centre de Recherche en Nutrition Humaine, France
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19
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Rozé JC, Gras C, Boscher C, Winner N, Debillon T, Boog G. [Perinatal care: advantages and disadvantages of network functioning. Analysis and point-of-view of university hospital center pediatricians]. J Gynecol Obstet Biol Reprod (Paris) 1998; 27:153-61. [PMID: 10048993] [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] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- J C Rozé
- Département de Périnatalogie, Hôpital Mère-Enfant, CHR, Nantes
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20
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Mercier JC, Lacaze T, Storme L, Rozé JC, Dinh-Xuan AT, Dehan M. Disease-related response to inhaled nitric oxide in newborns with severe hypoxaemic respiratory failure. French Paediatric Study Group of Inhaled NO. Eur J Pediatr 1998; 157:747-52. [PMID: 9776535 DOI: 10.1007/s004310050928] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Inhaled nitric oxide (iNO) has been shown to improve oxygenation in severe persistent pulmonary hypertension of the newborn (PPHN). However, PPHN is often associated with various lung diseases. Thus, response to iNO may depend upon the aetiology of neonatal acute respiratory failure. A total of 150 (29 preterm and 121 term) newborns with PPHN were prospectively enrolled on the basis of oxygenation index (OI) higher than 30 and 40, respectively. NO dosage was stepwise increased (10-80 ppm) during conventional mechanical or high-frequency oscillatory ventilation while monitoring the oxygenation. Effective dosages ranged from 5 to 20 ppm in the responders, whereas iNO levels were unsuccessfully increased up to 80 ppm in the nonresponders. Within 30 min of iNO therapy, OI was significantly reduced in either preterm neonates (51+/-21 vs 23+/-17, P < .0001) or term infants with idiopathic or acute respiratory distress syndrome (45+/-20 vs 20+/-17, P < .0001), 'idiopathic' PPHN (39+/-14 vs 14+/-9, P < .0001), and sepsis (55+/-25 vs 26+/-20, P < .0001) provided there was no associated refractory shock. Improvement in oxygenation was less significant and sustained (OI=41+/-16 vs 28+/-18, P < .001) in term neonates with meconium aspiration syndrome and much less (OI=58+/-25 vs 46+/-32, P < .01) in those with congenital diaphragmatic hernia. Only 21 of the 129 term newborns (16%) required extracorporeal membrane oxygenation (57% survival). Survival was significantly associated with the magnitude in the reduction in OI at 30 min of iNO therapy, a gestational age > or =34 weeks, and associated diagnosis other than congenital diaphragmatic hernia. Conclusion, iNO improves the oxygenation in most newborns with severe hypoxaemic respiratory failure including preterm neonates. However, response to iNO is disease-specific. Furthermore, iNO when combined with adequate alveolar recruitment and limited barotrauma using exogenous surfactant and HFOV may obviate the need for extracorporeal membrane oxygenation in many term infants.
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Affiliation(s)
- J C Mercier
- Department of Pediatrics, Hôpital Robert-Debré, Paris, France.
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21
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Winer N, Lefèvre M, Nomballais MF, David A, Rival JM, Gournay V, Debillon T, Rozé JC, Boog G. Persisting spongy myocardium. A case indicating the difficulty of antenatal diagnosis. Fetal Diagn Ther 1998; 13:227-32. [PMID: 9784643 DOI: 10.1159/000020843] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Persisting spongy myocardium (also known as noncompaction of the ventricular myocardium) is a rare and special form of cardiomyopathy. The few cases reported in the literature were detected postnatally and involved a high rate of cardiovascular complications. This anomaly of endomyocardial morphogenesis, which occurs during the embryonic phase at the stage of cardiac partitioning, is characterised by an excessive number of prominent trabeculae and by intertrabecular recesses within the myocardial wall. Antenatal detection is difficult in the absence of an associated malformation, which is the general situation. We report a case of antenatal cardiomyopathy which led to therapeutic abortion. The diagnosis of persisting spongy myocardium was made during fetopathologic examination.
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Affiliation(s)
- N Winer
- Service de Gynécologie-obstétrique B, Centre Hospitalier Régional et Universitaire, Nantes, France
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22
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Abstract
The aim of this study was to determine interobserver variation in Doppler assessment of mean left pulmonary arterial flow velocity, and its normal values during the first 24h of life. The interobserver variation was determined by a Bland and Altman analysis of the values of mean velocity measured in 21 newborns by 2 observers. Then, normal values of mean velocity were measured in 15 newborns at 5, 10 and 15 min of life in the delivery room, and in 14 other newborns at 1, 2, 6, 12 and 24h of life in the nursery unit. The interobserver variation was found to be acceptable. Mean velocity had a few variations within the first 24 h, but remained consistently above 20 cm s(-1). In conclusion, mean velocity values below 20 cm(-1) suggest low pulmonary blood flow.
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Affiliation(s)
- V Gournay
- Department of Neonatology, Hôpital Universitaire de Nantes, France
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23
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Affiliation(s)
- J C Rozé
- Service de Néonatalogie, Centre Hospitalier Universitaire de Nantes, France
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24
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Abstract
Newborn infants may have a high oxygen cost of breathing (OCB) at the time of being weaned from mechanical ventilation. We hypothesized that this increase in oxygen consumption (V'O2) could be reduced by using certain weaning ventilatory modes. We designed a study to assess V'O2 during three weaning ventilatory modes: patient triggered ventilation, synchronous intermittent mandatory ventilation (SIMV) and continuous positive airway pressure in 16 newborn infants before being weaned from mechanical ventilation In seven infants whose OCB was high. V'O2 was not significantly different between CV and PTV (8.9+/-0.6 versus 9.5+/-0.8, respectively) whereas it tended to increase to 10.8+/-1.1 mL x min(-1) x kg(-1) during SIMV and increased significantly to 11.9+/-0.8 mL x min(-1) x kg(-1). In the other nine infants whose OCB was normal, no significant variation of V'O2 was observed. Patient triggered ventilation was a weaning ventilatory mode that significantly reduced the increase in oxygen consumption observed in infants with a high oxygen cost of breathing, as compared to synchronous intermittent mandatory ventilation or continuous positive airway pressure. Further investigations in newborn infants with a high oxygen cost of breathing should be performed prior to routine use of patient triggered ventilation.
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Affiliation(s)
- J C Rozé
- Neonatal Dept, University Hospital of Nantes, France
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25
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Abstract
The feasibility of using a Finapres device to reproduce the beat to beat signal of arterial blood pressure in eight neonates was assessed and compared with intra-arterial measurement of arterial blood pressure in the umbilical artery, using a catheter. The two methods gave similar results. Continuous recording of arterial blood pressure in neonates using Finapres is feasible and reliable.
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Affiliation(s)
- E Drouin
- Department of Neonatology, Hôpital Universitaire de Nantes, France
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26
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Abstract
AIMS To determine whether it is possible to assess baroreflex sensitivity in neonates by studying only spontaneous variation in systolic blood pressure and heart rate. METHODS ECG and non-invasive blood pressure signals were continuously studied in 14 preterm neonates (term 29-32 weeks) and five term neonates (term 40-41 weeks). Non-invasive blood pressure measures were obtained using a Finapres placed around the child's wrist. Both signals (ECG and blood pressure), sampled at 400 Hz, were digitised by an A/D converter and stored in a binary mode on magnetic disk. An inhouse software QRS detection algorithm was used to define R peaks of the QRS complexes with an accuracy greater than 2 ms. Four 4 minute periods were recorded in each infant. The slope of the linear regression of RR intervals versus systolic blood pressure was calculated in each period and the mean value of the four slopes was then considered as the index of baroreflex sensitivity (in ms/mm Hg) in each neonate. RESULTS Spontaneous baroreflex sensitivity was lower in preterm neonates than in term neonates (mean(SD): 4.07 (2.19) ms/mm Hg vs 10.23 (2.92) ms/mm Hg). CONCLUSION Baroreflex sensitivity can be assessed in term and preterm neonates by studying spontaneous variations in systolic blood pressure alone. This method could be useful for studying the ontogeny of baroreflex sensitivity and might therefore provide information about the maturation of the autonomic nervous system.
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Affiliation(s)
- E Drouin
- Department of Neonatology, Hôpital Universitaire de Nantes, France
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27
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Abstract
Oxygen consumption (VO2) was measured during controlled and spontaneous ventilation with continuous positive airway pressure in newborn infants in whom chronic lung disease later developed. The oxygen cost of breathing (the difference in VO2 between spontaneous and controlled ventilation) was significantly higher in infants with chronic lung disease than in control infants (20.1% +/- 7.5% and 4.8% +/- 4.9% of VO2 during spontaneous ventilation (p < 0.05), respectively).
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Affiliation(s)
- J C Rozé
- Neonatal Department, Hôpital Universitaire de Nantes, France
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28
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Rozé JC, Chambille B, Dehan M, Gaultier C. Measurement of oxygen uptake in newborn infants during assisted and spontaneous ventilation. Respir Physiol 1994; 98:227-39. [PMID: 7817052 DOI: 10.1016/0034-5687(94)00056-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Measurements of oxygen uptake (VO2) and CO2 output (VCO2) are useful in critically ill patients. However, VO2 is not routinely measured in intensive care during mechanical ventilation (MV) especially in premature newborns. The present study describes a new method of measuring VO2 and VCO2 using a double open circuit which accounts for gas leaks around the uncuffed tracheal tube. The accuracy of the method was assessed with N2 and CO2 infusion. In case of leaks, VO2 and VCO2 measurement was significantly underestimated by the simple circuit method. This underestimation was not present with double circuit method. Five preterm newborns were studied. VO2 and VCO2 using the double open circuit were compared with the classic simple circuit. During MV, the mean underestimation assessed by the difference between simple and double circuit measurement was -12% (range from 0 to -29%) for VO2 and -14% (range 0 to -26%) for VCO2.
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Affiliation(s)
- J C Rozé
- Neonatal Department, Hôpital Universitaire, Nantes, France
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29
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Abstract
Nitric oxide inhalation can benefit newborn babies with right-to-left extrapulmonary shunt (EPS). Using doppler ultrasound, we compared the effects of nitric oxide on systemic oxygenation and mean pulmonary-blood-flow velocity (MPBFV) in severely hypoxic babies with or without EPS. With a median (interquartile range) dose of 20 (32) parts per million, oxygenation index decreased significantly in both groups (EPS, 49 [19] vs 11 [9]; non-EPS, 40 [11] vs 20 [13]). The decrease was significantly greater in the EPS group. MPBFV increased significantly in the EPS group (18 [4] vs 29 [8] m/s) only. Nitric oxide may improve systemic oxygenation in neonates with severe hypoxaemia secondary to EPS by increasing pulmonary blood flow, and in those without EPS by improving ventilation-perfusion matching.
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Affiliation(s)
- J C Rozé
- Department of Neonatology, Hôpital Universitaire, Nantes, France
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30
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Abstract
A randomised double blind study was designed to evaluate haemodynamic response to dobutamine and dopamine in 20 hypotensive preterm infants of less than 32 weeks' gestation. Neonates initially received dopamine or dobutamine 5 micrograms/kg/min. If mean arterial pressure (MAP) remained below 31 mm Hg, the infusion rate was increased in increments of 5 micrograms/kg/min. If 20 micrograms/kg/min of the initial drug failed to achieve a MAP above 30 mm Hg, it was discontinued and the other drug was administered at the same infusion rate. Left ventricular output (LVO) was measured by pulsed Doppler echocardiography. Mean (SE) MAP increased significantly from 24.4 (1.0) to 32.0 (1.4) mm Hg at a median dobutamine dosage of 20 micrograms/kg/min and from 25.6 (1.2) to 37.7 (1.5) mm Hg at a median dopamine dosage of 12.5 micrograms/kg/min. The percentage LVO increase was +21 (7)% with dobutamine compared with -14 (8)% with dopamine. Dobutamine failed to increase MAP above 30 mm Hg in six infants out of 10, whereas dopamine succeeded in all 10 infants. Six switches from dobutamine to dopamine were thus performed, providing a rise in MAP (29.2 (0.5) to 41.2 (2.0) mm Hg) and drop in LVO (356 (40) to 263 (36) ml/kg/min). These data indicate that dopamine is more effective than dobutamine in raising and maintaining MAP above 30 mm Hg; however dopamine does not increase LVO.
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Affiliation(s)
- J C Rozé
- Neonatal Intensive Care Unit, Hopital Mère Enfant, Centre Hospitalier Universitaire de Nantes, France
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31
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David A, Rozé JC, Rémond S, Branger B, Héloury Y. Hypoglossia-hypodactylia syndrome with jejunal atresia in an infant of a diabetic mother. Am J Med Genet 1992; 43:882-4. [PMID: 1642280 DOI: 10.1002/ajmg.1320430526] [Citation(s) in RCA: 20] [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] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Despite advances in therapy for maternal diabetes, pregnancies of diabetic women remained at an increased risk of spontaneous abortion or delivery of an infant with major malformation. We report on an infant of a diabetic mother with hypoglossia-hypodactylia associated with complete jejunal atresia. A common pathogenesis for these 2 malformations could be a vascular disruptive mechanism with in utero arterial thrombosis.
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Affiliation(s)
- A David
- Department of Pediatrics, Centre Hospitalier Régional et Universitaire, Nantes, France
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32
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David A, Rozé JC, Melon-David V. Adams-Oliver syndrome associated with congenital heart defect: not a coincidence. Am J Med Genet 1991; 40:126-7. [PMID: 1887843 DOI: 10.1002/ajmg.1320400128] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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33
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Rozé JC, Tohier C, Rigal E, Drugeon B, Mouzard A. [Posology of amikacin in newborn infants, adapted to the postconceptional age]. Arch Fr Pediatr 1989; 46:375-9. [PMID: 2764686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Two consecutive studies of amikacin plasma levels were performed in 63 and 64 neonates whose postconceptional age (PCA) ranged from 26 to 45 weeks. The first study, using a dose of 7.5 mg/kg every 12 hours, permitted to establish a dosage related to PCA. Half-life elimination of amikacin was strongly correlated with PCA (r = -0.42, p = 0.0009). The apparent volume of distribution was correlated with none of the variables studied. The mean volume of distribution was 640 +/- 190 ml/kg. From these data, the inferred dosage was 10 mg/kg, given at intervals of time predetermined as a function of PCA. A second prospective study proved the value of this PCA adapted dosage. The maximal concentrations obtained were higher (21.6 +/- 5.9 vs 18.5 +/- 4.6 micrograms/ml, p less than 0.001), the nadir concentrations were not significantly increased (5.7 +/- 3.1 vs 5.2 +/- 3.7 micrograms/ml, NS) and the number of nadir concentrations outside the desired interval of 2-8 micrograms/ml was smaller (p less than 0.01).
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Affiliation(s)
- J C Rozé
- Service de Néonatologie, Hôpital Laënnec, Centre Hospitalier Universitaire de Nantes
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