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Bouazza N, Cambonie G, Flamant C, Rideau A, Tauzin M, Patkai J, Gascoin G, Lumia M, Aikio O, Lui G, Bournaud LF, Walsh-Papageorgiou A, Tortigue M, Baruteau AE, Kallio J, Hallman M, Diallo A, Levoyer L, Treluyer JM, Roze JC. Prophylactic Intravenous Acetaminophen in Extremely Premature Infants: Minimum Effective Dose Research by Bayesian Approach. Paediatr Drugs 2024; 26:83-93. [PMID: 37978159 PMCID: PMC10770203 DOI: 10.1007/s40272-023-00602-w] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/10/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Patent ductus arteriosus (PDA) in preterm infants is associated with increased morbidities and mortality. Prophylactic treatment with cyclooxygenase inhibitors, as indomethacin or ibuprofen, failed to demonstrate significant clinical benefits. Acetaminophen may represent an alternative treatment option. OBJECTIVE This study evaluated the minimum effective dose of prophylactic acetaminophen to close the ductus and assessed the safety and tolerability profile in extremely preterm infants at 23-26 weeks of gestation. METHODS A dose finding trial with Bayesian continual reassessment method was performed in a multicenter study with premature infants hospitalized in neonatal intensive care unit. Infants of 23-26 weeks of gestation and post-natal age ≤ 12 h were enrolled. Four intravenous acetaminophen dose levels were predefined. The primary outcome was the ductus arteriosus closing at two consecutive echocardiographies or at day 7. The main secondary objectives included the safety of acetaminophen on hemodynamics and biological hepatic function. RESULTS A total of 29 patients were analyzed sequentially for the primary analysis with 20 infants assigned to the first dose level followed by 9 infants to the second dose level. No further dose level increase was necessary. The posterior probabilities of success, estimated from the Bayesian logistic model, were 46.1% [95% probability interval (PI), 24.9-63.9] and 67.6% (95% PI, 51.5-77.9) for dose level 1 and 2, respectively. A closing or closed pattern was observed among 19 patients at the end of treatment [65.5% (95% confidence interval (CI), 45.7-82.0)]. No change in alanine aminotransferase values was observed during treatment. A significant decrease in aspartate aminotransferase values was observed with postnatal age. No change in systolic and diastolic blood pressures was observed during treatment. CONCLUSIONS Minimum effective dose to close the ductus was 25 mg/kg loading dose then 10 mg/kg/6 h for 5 days in extremely preterm infants. Acetaminophen was well tolerated in this study following these doses. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04459117.
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Affiliation(s)
- Naïm Bouazza
- EA 7323, Université Paris Cité, Pharmacologie et évaluations thérapeutiques chez l'enfant et la femme enceinte, Paris, France.
- Unité de Recherche Clinique, Université Paris Cité Necker/Cochin, Hôpital Tarnier, Paris, France.
- CIC-1419 Inserm, Cochin-Necker, Paris, France.
| | - Gilles Cambonie
- Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital, 371 Avenue du Doyen Giraud, 34295, Montpellier, France
- Pathogenesis and Control of Chronic Infection, INSERM, UMR 1058, University of Montpellier, Montpellier, France
| | - Cyril Flamant
- Department of Neonatology, CHU Nantes, Nantes, France
| | - Aline Rideau
- Department of Pediatrics, Robert Debré Hospital, APHP, Paris, France
| | - Manon Tauzin
- Neonatal Intensive Care Unit, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Juliana Patkai
- Neonatology Department, Port-Royal Hospital, 75014, Paris, France
| | - Géraldine Gascoin
- Department of Neonatology, Angers University Hospital, Angers, France
| | - Mirka Lumia
- Department of Children and Adolescents, New Children's Hospital, Pediatric Research Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Outi Aikio
- Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, and Research Unit of Clinical Medicine and MRC Oulu, University of Oulu, Oulu, Finland
| | - Gabrielle Lui
- Service de Pharmacologie Clinique, Hôpital Cochin, AP-HP, Groupe Hospitalier Paris Centre, Paris, France
| | - Léo Froelicher Bournaud
- Service de Pharmacologie Clinique, Hôpital Cochin, AP-HP, Groupe Hospitalier Paris Centre, Paris, France
| | | | - Marine Tortigue
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
- Department of Pediatric Cardiology and Pediatric Cardiac Surgery, FHU PRECICARE, Nantes Université, CHU Nantes, Nantes, France
- Nantes Université, CHU Nantes, INSERM, CIC FEA 1413, Nantes, France
| | - Alban-Elouen Baruteau
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
- Department of Pediatric Cardiology and Pediatric Cardiac Surgery, FHU PRECICARE, Nantes Université, CHU Nantes, Nantes, France
- Nantes Université, CHU Nantes, INSERM, CIC FEA 1413, Nantes, France
- Nantes Université, INRAE, UMR 1280, PhAN, Nantes, France
| | - Jaana Kallio
- Department of Children and Adolescents, New Children's Hospital, Pediatric Research Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Mikko Hallman
- Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, and Research Unit of Clinical Medicine and MRC Oulu, University of Oulu, Oulu, Finland
| | - Alpha Diallo
- Clinical Trial Safety and Public Health, ANRS|Emerging Infectious Diseases, Paris, France
- Clinical Research Safety Department, INSERM, Paris, France
| | - Léa Levoyer
- Clinical Trial Safety and Public Health, ANRS|Emerging Infectious Diseases, Paris, France
- Clinical Research Safety Department, INSERM, Paris, France
| | - Jean-Marc Treluyer
- EA 7323, Université Paris Cité, Pharmacologie et évaluations thérapeutiques chez l'enfant et la femme enceinte, Paris, France
- Unité de Recherche Clinique, Université Paris Cité Necker/Cochin, Hôpital Tarnier, Paris, France
- CIC-1419 Inserm, Cochin-Necker, Paris, France
- Service de Pharmacologie Clinique, Hôpital Cochin, AP-HP, Groupe Hospitalier Paris Centre, Paris, France
| | - Jean-Christophe Roze
- Nantes Université, CHU Nantes, INSERM, CIC FEA 1413, Nantes, France
- Nantes Université, INRAE, UMR 1280, PhAN, Nantes, France
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Dupont C, Bocquet A, Brancato S, Chalumeau M, Darmaun D, de Luca A, Feillet F, Frelut ML, Guimber D, Lapillonne A, Linglart A, Peretti N, Roze JC, Siméoni U, Turck D, Chouraqui JP. Cow's milk-based infant formula supplements in breastfed infants and primary prevention of cow's milk allergy: A commentary of the Committee on Nutrition of the French Society of Pediatrics. Arch Pediatr 2023; 30:591-594. [PMID: 37709607 DOI: 10.1016/j.arcped.2023.07.005] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 07/07/2023] [Indexed: 09/16/2023]
Abstract
The role of nutritional interventions for the primary prevention of cow's milk allergy (CMA) remains debated as well as the role of early introduction of allergenic foods, which is largely encouraged from the beginning of complementary feeding. Considering the introduction of cow's milk protein (CMP), current recommendations suggest avoidance of any cow's milk formula (CMF) supplements in breastfed infants in the maternity ward. By contrast, based on poor evidence, some authors support systematic supplements of CMP in breastfed children at risk of allergy from the first week of life. The Committee on Nutrition of the French Society of Pediatrics considers that such a proposal requires more clinical studies and mainly randomized and placebo-controlled clinical trials before becoming a recommendation.
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Affiliation(s)
- Christophe Dupont
- Paris Descartes University, Pediatric gastroenterology, Clinique Marcel Sembat, Ramsay Group, Boulogne Billancourt, France.
| | - Alain Bocquet
- French association of ambulatory paediatrics, France
| | - Sandra Brancato
- Institut de Recherche pour le Développement, Brignon, France
| | - Martin Chalumeau
- Paris Descartes University, APHP Necker-Enfants Malades hospital, Paris, France
| | | | - Arnaud de Luca
- Tours University and Inserm UMR 1069, 37000 Tours, France
| | | | | | - Dominique Guimber
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Lille University Jeanne de Flandre Children's Hospital and Faculty of Medicine, University of Lille, INSERM U995, 59037 Lille, France
| | - Alexandre Lapillonne
- Paris Descartes University, APHP Necker-Enfants Malades hospital, Paris, France; CNRC, Baylor College of Medicine, Houston, TX, USA
| | - Agnès Linglart
- Paris-Sud, University, CHU de Bicêtre, 94270 Le Kremlin-Bicêtre, France
| | - Noel Peretti
- Pediatric Nutrition, University Pediatric Hospital of Lyon and INSERM U1060, CarMeN laboratory; Claude Bernard Lyon-1 University, F-69008 France
| | - Jean-Christophe Roze
- Neonatology and pediatric intensive care unit, Univesity hospital of Nantes and UMR 1280 INRA, Nantes University. France
| | - Umberto Siméoni
- Division of Pediatrics and DOHaD Lab, Woman, Mother and Child Department, Centre Hospitalier Universitaire Vaudois (CHUV), 21 rue du Bugnon, 1011 Lausanne, Switzerland
| | - Dominique Turck
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Lille University Jeanne de Flandre Children's Hospital and Faculty of Medicine, University of Lille, INSERM U995, 59037 Lille, France
| | - Jean-Pierre Chouraqui
- Paediatric Division of Nutrition and Gastro-enterology, Pediatric Department, Grenoble-Alpes University Hospital (CHUGA), Grenoble, France
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Gire C, Beltran Anzola A, Marret S, Foix L’Hélias L, Roze JC, Granier M, Patural H, Lecomte B, Guillois B, Souksi Medioni I, Bednarek Weirauch N, Claris O, Hascoët JM, Kuhn P, Zahed M, Boucekine M, Ancel PY, Arnaud C, Cambonie G, Dorriere Datin V. Cognitive Training for Visuospatial Processing in Children Aged 5½ to 6 Years Born Very Preterm With Working Memory Dysfunction: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2331988. [PMID: 37676661 PMCID: PMC10485729 DOI: 10.1001/jamanetworkopen.2023.31988] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/20/2023] [Indexed: 09/08/2023] Open
Abstract
Importance Compared with term-born peers, children born very preterm generally perform poorly in executive functions, particularly in working memory and inhibition. By taking advantage of neuroplasticity, computerized cognitive training of working memory in those children could improve visuospatial processing by boosting visual inhibition via working memory. Objective To evaluate the long-term effect of cognitive working memory training on visuospatial processing in children aged 5½ to 6 years born very preterm who have working memory impairment. Design, Setting, and Participants This multicenter (18 French university hospitals), open-label randomized clinical trial with 2 parallel groups (EPIREMED) was conducted from November 2016 to April 2018, with the last follow-up during August 2019. Eligible children from the EPIPAGE 2 cohort were aged 5½ to 6 years, were born between 24 and 34 weeks' gestation, and had a global intelligence quotient greater than 70 and a working memory index less than 85. Data were analyzed from February to December 2020. Intervention Children were randomized 1:1 to standard care management and a working memory cognitive training program (Cogmed software) for 8 weeks (25 sessions) (intervention) or to standard management (control). Main Outcomes and Measures The primary outcome was the visuospatial index score from the Wechsler Preschool and Primary Scale of Intelligence, 4th Edition. Secondary outcomes were working memory, intellectual functioning, executive and attention processes, language skills, behavior, quality of life, and schooling. Neurobehavioral assessments were performed at inclusion and after finishing training at 6 months (intermeditate assessment; secondary outcomes) and at 16 months (final assessment; primary outcome). Results There were 169 children randomized, with a mean (SD) age of 5 years 11 months (2 months); 91 (54%) were female. Of the participants, 84 were in the intervention group (57 of whom [68%] completed at least 15 cognitive training sessions) and 85 were in the control group. The posttraining visuospatial index score was not different between groups at a mean (SD) of 3.0 (1.8) months (difference, -0.6 points; 95% CI, -4.7 to 3.5 points) or 12.9 (2.6) months (difference, 0.1 points; 95% CI, -5.4 to 5.1 points). The working memory index score in the intervention group significantly improved from baseline at the intermediate time point (difference, 4.7 points; 95% CI, 1.2-8.1 points), but this improvement was not maintained at the final assessment. Conclusions and Relevance This randomized clinical trial found no lasting effect of a cognitive training program on visuospatial processing in children aged 5½ to 6 years with working memory disorders who were born very preterm. The findings suggest that this training has limited long-term benefits for improving executive function. Transient benefits seemed to be associated with the developmental state of executive functions. Trial Registration ClinicalTrials.gov Identifier: NCT02757794.
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Affiliation(s)
- Catherine Gire
- Department of Neonatology, North Hospital, Assistance Publique–Hôpitaux de Marseille University Hospital, Marseille, France
- Faculty of Medicine, Centre for Research on Health Services and Quality of Life–Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France
| | - Any Beltran Anzola
- Department of Neonatology, North Hospital, Assistance Publique–Hôpitaux de Marseille University Hospital, Marseille, France
- Faculty of Medicine, Centre for Research on Health Services and Quality of Life–Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France
| | - Stéphane Marret
- Department of Neonatal Pediatrics & Intensive Care, University Hospital of Rouen, Rouen, France
| | - Laurence Foix L’Hélias
- Department of Neonatology, Armand Trousseau Hospital, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Jean-Christophe Roze
- Department of Neonatal & Pediatric Intensive Care, University Hospital of Nantes, Nantes, France
| | - Michèle Granier
- Department of Neonatology, Sud Francilien Hospital, Corbeil-Essonnes, France
| | - Hugues Patural
- Department of Neonatal & Pediatric Intensive Care, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Bénédicte Lecomte
- Department of Neonatal & Pediatric Intensive Care, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Bernard Guillois
- Department of Neonatal & Intensive Care, University Hospital of Caen Normandie, Caen, France
| | | | | | - Olivier Claris
- Department of Neonatology & Neonatal Intensive Care, University Hospital of Lyon, Lyon, France
| | - Jean-Michel Hascoët
- Department of Neonatology, Regional University Hospital of Nancy, Nancy, France
| | - Pierre Kuhn
- Department of Neonatology, Regional University Hospital of Strasbourg, Strasbourg, France
| | - Meriem Zahed
- Department of Neonatology, North Hospital, Assistance Publique–Hôpitaux de Marseille University Hospital, Marseille, France
| | - Mohamed Boucekine
- Faculty of Medicine, Centre for Research on Health Services and Quality of Life–Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France
| | - Pierre-Yves Ancel
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Center of Research in Epidemiology and Statistics, Paris University, INSERM, Paris, France
- Clinical Research Unit, Center for Clinical Investigation, CHU Cochin Broca Hôtel-Dieu, Paris, France
| | - Catherine Arnaud
- Clinical Epidemiology Unit, University Hospital Toulouse, Toulouse, France
- Center for Epidemiology and Research in Population Health, University of Toulouse, INSERM, Paul Sabatier University, Toulouse, France
| | - Gilles Cambonie
- Department of Neonatal Pediatrics and Intensive Care, University Hospital of Montpellier, Montpellier, France
| | - Valérie Dorriere Datin
- Department of Neonatal & Intensive Care, University Hospital of Caen Normandie, Caen, France
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Reynold de Seresin M, Roy A, Theveniaut C, Le Goff J, Chopin C, Rouger V, Roze JC, Flamant C, Muller JB. Assessing of executive functions in daily life in preterm children aged 3-4 years old from the "Behavior Rating Inventory of Executive Function-Preschool version" questionnaire. Front Pediatr 2023; 11:999100. [PMID: 37565238 PMCID: PMC10410931 DOI: 10.3389/fped.2023.999100] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 06/26/2023] [Indexed: 08/12/2023] Open
Abstract
Background Executive functions (EFs) are a set of neuropsychological skills permitting solving problems in a new situation by regulating action, behavior, and emotional response. As cerebral maturation remains vulnerable in preterm children, a higher risk of developing cognitive disorders including EFs exist compared to term children. Aims The aim of this study was to estimate the incidence of preschool EF impairments through proxy reports in children born preterm before 34 weeks of gestational age using the Behavior Rating Inventory of Executive Function-Preschool (BRIEF-P) version. Secondary aims were to report neonatal, child, or socioeconomic factors associated with EF disorders. Results Parents of 357 children born preterm aged 3-4 years old completed the BRIEF-P version. Impairment in EFs was clinically significant for 13.5% of preterm children (n = 47; 95% CI = 0.10-0.18) compared to 5.1% in term children. A low parental socioeconomic level was significantly associated with impaired parent-rated EF (19.1% vs. 5.3%, p = 0.003). Conclusions Proxy reports of EF impairment are about twice as frequent as in term children. EF difficulties are not related to neonatal or child severity factors in contrast with the parental socioeconomic level. Using a parent-rated questionnaire may be a useful and easy tool to identify early the daily life impact of EF disorders on clinical follow-up of preterm children.This study was recorded in the Clinical Trials Register under identifier NCT03700463.
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Affiliation(s)
- Magali Reynold de Seresin
- Pediatric and Neonatal Intensive Care Unit, Nantes University Hospital, Nantes, France
- Réseau “Grandir Ensemble”, Nantes University Hospital, Nantes, France
| | - Arnaud Roy
- Department of Psychology, Psychology Laboratory, University of Angers, Angers, France
- Reference Center for Learning Disabilities, Nantes University Hospital, Nantes, France
- Univ Angers, Nantes Université, LPPL, SFR CONFLUENCES, Angers, France
| | - Camille Theveniaut
- Pediatric and Neonatal Intensive Care Unit, Nantes University Hospital, Nantes, France
- Réseau “Grandir Ensemble”, Nantes University Hospital, Nantes, France
| | - Justine Le Goff
- Reference Center for Learning Disabilities, Nantes University Hospital, Nantes, France
| | - Coline Chopin
- Reference Center for Learning Disabilities, Nantes University Hospital, Nantes, France
| | - Valérie Rouger
- Réseau “Grandir Ensemble”, Nantes University Hospital, Nantes, France
| | - Jean-Christophe Roze
- Pediatric and Neonatal Intensive Care Unit, Nantes University Hospital, Nantes, France
- Réseau “Grandir Ensemble”, Nantes University Hospital, Nantes, France
- Epidemiologie Clinique, Centre d'Investigation Clinique (CIC004), Nantes University Hospital, Nantes, France
| | - Cyril Flamant
- Pediatric and Neonatal Intensive Care Unit, Nantes University Hospital, Nantes, France
- Réseau “Grandir Ensemble”, Nantes University Hospital, Nantes, France
- Epidemiologie Clinique, Centre d'Investigation Clinique (CIC004), Nantes University Hospital, Nantes, France
| | - Jean-Baptiste Muller
- Pediatric and Neonatal Intensive Care Unit, Nantes University Hospital, Nantes, France
- Réseau “Grandir Ensemble”, Nantes University Hospital, Nantes, France
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Lefebvre T, Flamant C, Olivier M, Gascoin G, Bouet PE, Roze JC, Barrière P, Fréour T, Muller JB. Assisted reproductive techniques do not impact late neurodevelopmental outcomes of preterm children. Front Pediatr 2023; 11:1123183. [PMID: 37404562 PMCID: PMC10315460 DOI: 10.3389/fped.2023.1123183] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 06/06/2023] [Indexed: 07/06/2023] Open
Abstract
Objective Assisted reproductive technology (ART) increases the rate of preterm births, though few studies have analyzed outcomes for these infants. No data are available on 4-year-old children born prematurely after ART. The objective was to investigate whether ART affect the neurodevelopmental outcomes at 4 years in preterm infants born before 34 weeks of gestational age (GA). Methods and results A total of 166 ART and 679 naturally conceived preterm infants born before 34 weeks GA between 2013 and 2015 enrolled in the Loire Infant Follow-up Team were included. Neurodevelopment was assessed at 4 years using the age and stage questionnaire (ASQ) and the need for therapy services. The association between the socio-economic and perinatal characteristics and non-optimal neurodevelopment at 4 years was estimated. After adjustment, the ART preterm group remained significantly associated with a lower risk of having at least two domains in difficulty at ASQ: adjusted odds ratio (aOR) 0.34, 95% confidence interval (CI) (0.13-0.88), p = 0.027. The factors independently associated with non-optimal neurodevelopment at 4 years were male gender, low socio-economic level, and 25-30 weeks of GA at birth. The need for therapy services was similar between groups (p = 0.079). The long-term neurodevelopmental outcomes of preterm children born after ART are very similar, or even better than that of the spontaneously conceived children.
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Affiliation(s)
- Tiphaine Lefebvre
- Department of Biology and Reproductive Medicine, University Hospital of Nantes, Nantes, France
- Faculty of Medicine, University of Nantes, Nantes, France
| | - Cyril Flamant
- Faculty of Medicine, University of Nantes, Nantes, France
- Department of Neonatal Medicine, University Hospital of Nantes, Nantes, France
- Loire Infant Follow-up Team (LIFT) Network, Pays de La Loire, France
| | - Marion Olivier
- Loire Infant Follow-up Team (LIFT) Network, Pays de La Loire, France
| | - Géraldine Gascoin
- Loire Infant Follow-up Team (LIFT) Network, Pays de La Loire, France
- Department of Neonatal Medicine, University Hospital of Angers, Angers, France
| | - Pierre-Emmanuel Bouet
- Department of Obstetrics and Gynecology, University Hospital of Angers, Angers, France
| | - Jean-Christophe Roze
- Faculty of Medicine, University of Nantes, Nantes, France
- Department of Neonatal Medicine, University Hospital of Nantes, Nantes, France
- Loire Infant Follow-up Team (LIFT) Network, Pays de La Loire, France
| | - Paul Barrière
- Department of Biology and Reproductive Medicine, University Hospital of Nantes, Nantes, France
- Faculty of Medicine, University of Nantes, Nantes, France
| | - Thomas Fréour
- Department of Biology and Reproductive Medicine, University Hospital of Nantes, Nantes, France
- Faculty of Medicine, University of Nantes, Nantes, France
- Center for Research in Transplantation and Immunology, Inserm, University of Nantes, Nantes, France
| | - Jean-Baptiste Muller
- Department of Neonatal Medicine, University Hospital of Nantes, Nantes, France
- Loire Infant Follow-up Team (LIFT) Network, Pays de La Loire, France
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Pinquier D, Crépey P, Tissières P, Vabret A, Roze JC, Dubos F, Cahn-Sellem F, Javouhey E, Cohen R, Weil-Olivier C. Correction to: Preventing Respiratory Syncytial Virus in Children in France: A Narrative Review of the Importance of a Reinforced Partnership Between Parents, Healthcare Professionals, and Public Health Authorities. Infect Dis Ther 2023:10.1007/s40121-023-00807-z. [PMID: 37179278 DOI: 10.1007/s40121-023-00807-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
Affiliation(s)
- Didier Pinquier
- Department of Neonatal and Pediatric Intensive Care Medicine, Normadie University, UNIROUEN, INSERM U1245, CHU Rouen, 7600, Rouen, France
| | - Pascal Crépey
- University of Rennes, EHESP, CNRS, Inserm, Arènes-UMR 6051, RSMS-U 1309, Rennes, France
| | - Pierre Tissières
- Pediatric Intensive Care and Neonatal Medicine, AP-HP Paris Saclay University, Bicêtre Hospital, Le Kremlin-Bicêtre, Paris, France
- Institute of Integrative Biology of the Cell, Paris Saclay University, CNRS, DEA, Gif Sur Yvette, France
- FUH SEPSIS, APHP, Inserm, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - Astrid Vabret
- Department of Virology, Normandie University, UNICAEN, UNIROUEN, DYNAMICURE U1311, Caen University Hospital, Caen, France
| | - Jean-Christophe Roze
- Hôpital Mère Enfant, CHU de Nantes, 36 Boulevard Jean Monnet, 44093, Nantes, France
| | - François Dubos
- University of Lille, CHU Lille, Urgences Pédiatriques and Maladies Infectieuses, ULR2694 METRICS, Lille, France
| | - Fabienne Cahn-Sellem
- Private Practice, 24 Rue Volta, 92800, Puteaux, France
- AFPA (Association Française de Pédiatrie Ambulatoire), 155 Rue Edouard Branly, Zone de la Fouquetière, 44150, Ancenis, France
| | - Etienne Javouhey
- Pediatric Intensive Care Unit, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Lyon, France
- Université Claude Bernard Lyon 1-Hospices Civils de Lyon-bioMérieux, Joint Research Unit HCL-bioMérieux, 69003, Lyon, France
| | - Robert Cohen
- AFPA (Association Française de Pédiatrie Ambulatoire), 155 Rue Edouard Branly, Zone de la Fouquetière, 44150, Ancenis, France
- Service de Néonatologie, Centre Hospitalier Intercommunal de Créteil, GRC Gemini, Université Paris XII, Association Clinique et Thérapeutique Infantile du Val de Marne, Paris, France
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Simon L, Hadchouel A, Arnaud C, Frondas-Chauty A, Marret S, Flamant C, Darmaun D, Delacourt C, Marchand-Martin L, Ancel PY, Roze JC. Growth trajectory during the first 1000 days and later overweight in very preterm infants. Arch Dis Child Fetal Neonatal Ed 2023; 108:149-155. [PMID: 36008103 DOI: 10.1136/archdischild-2022-324321] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 08/03/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To identify the characteristics of early life growth associated with later overweight or obesity (OWO) in very preterm population. DESIGN Length, weight and body mass index (BMI) were prospectively recorded from three prospective, population-based cohorts with 5 years (Loire Infant Follow-up Team (LIFT), EPIPAGE2 (Etude EPIdémiologique sur les Petits Ages GEstationnels 2)) and 15 years (EPIPAGEADO, Etude EPIdémiologique sur les Petits Ages GEstationnels-Adolescents) of follow-up. Missing data were imputed. SETTING Regional (LIFT), national (EPIPAGE2) and multiregional (EPIPAGEADO) cohorts in France. PATIENTS Eligible infants born before 33 weeks of gestation in 1997 (EPIPAGEADO), between 2003 and 2014 (LIFT), and in 2011 (EPIPAGE2). MAIN OUTCOME MEASURES OWO was determined as BMI Z-score >85th percentile of the WHO reference curves at 5 years (LIFT, EPIPAGE2) and 15 years (EPIPAGEADO). RESULTS In EPIPAGEADO, LIFT and EPIPAGE2, BMI Z-scores were known for 302 adolescents, 1016 children and 2022 children, respectively. In EPIPAGEADO, OWO was observed in 42 (13.9%, 95% CI 10.5 to 18.3) adolescents. In multivariable models, birthweight Z-score, increase in weight Z-score during neonatal hospital stay and increase in BMI between discharge and at 2 years of corrected age were positively associated with OWO at 15 years (adjusted OR (aOR)=3.65, 95% CI 1.36 to 9.76; aOR=3.82, 95% CI 1.42 to 10.3; and aOR=2.55, 95% CI 1.72 to 3.78, respectively, by Z-score), but change in length Z-score during neonatal hospital stay was negatively associated (aOR=0.41, 95% CI 0.21 to 0.78, p=0.007). These four associations with OWO assessed at 5 years were confirmed in the LIFT and EPIPAGE2 cohorts. CONCLUSIONS Change in length Z-score during hospitalisation, a putative proxy of quality of neonatal growth, was negatively associated with risk of later OWO when change in BMI between discharge and at 2 years was included in the multivariable model.
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Affiliation(s)
- Laure Simon
- Department of Neonatology, CHU Nantes, Nantes, France .,INRAE, UMR 1280, Physiologie des Adaptations Nutritionnelles, Nantes University, Nantes, France
| | - Alice Hadchouel
- Pediatric Pulmonology, APHP, Hopital Necker-Enfants malades, Université de Paris Cité, Paris, France.,INSERM, U1151, Institut Necker-Enfants Malades, Paris, France
| | - Catherine Arnaud
- INSERM, UMR 1027, Universite Toulouse III Paul Sabatier, Toulouse, France
| | - Anne Frondas-Chauty
- Department of Neonatology, CHU Nantes, Nantes, France.,INRAE, UMR 1280, Physiologie des Adaptations Nutritionnelles, Nantes University, Nantes, France
| | - Stéphane Marret
- Department of Neonatology, CHU Rouen, Rouen, France.,INSERM U1245, Equipe 4, Rouen University, Rouen, France
| | - Cyril Flamant
- Department of Neonatology, CHU Nantes, Nantes, France.,INRAE, UMR 1280, Physiologie des Adaptations Nutritionnelles, Nantes University, Nantes, France
| | - Dominique Darmaun
- INRAE, UMR 1280, Physiologie des Adaptations Nutritionnelles, Nantes University, Nantes, France
| | - Christophe Delacourt
- Pediatric Pulmonology, APHP, Hopital Necker-Enfants malades, Université de Paris Cité, Paris, France.,INSERM, U1151, Institut Necker-Enfants Malades, Paris, France
| | - Laetitia Marchand-Martin
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM U1153, University of Paris, Paris, France
| | - Pierre Yves Ancel
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM U1153, University of Paris, Paris, France
| | - Jean-Christophe Roze
- Department of Neonatology, CHU Nantes, Nantes, France.,INRAE, UMR 1280, Physiologie des Adaptations Nutritionnelles, Nantes University, Nantes, France
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8
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Fouminet M, Barrois S, Derredinger I, Baraton L, Roze JC, Boscher C, Leguen CG, Muller JB. Identification of newborns at risk of early-onset neonatal infection: New French guidelines and practices at Nantes University Hospital. Arch Pediatr 2023; 30:71-73. [PMID: 36462991 DOI: 10.1016/j.arcped.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 08/24/2022] [Accepted: 11/11/2022] [Indexed: 12/05/2022]
Abstract
New French guidelines in 2017 aimed to improve the identification of newborns at risk of early-onset neonatal infection (EONI). Identification is based on perinatal risk factors, management of perinatal antibiotic prophylaxis, and standardized clinical assessment. We conducted a retrospective cross-study at the University Hospital of Nantes. The main objective was to assess implementation of the French guidelines. Of 1240 births included, 40% (501) required perinatal antibiotic prophylaxis (adequate in 67.3%) and 306 (24.7%) needed a standardized clinical assessment (performed in 69.2%). Only two newborns (0.16%) included in the study received neonatal antibiotic therapy. On the basis of the assessment conducted in our maternity ward, implementation of the recommendations seems to be effective.
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Affiliation(s)
- M Fouminet
- Pediatric and Neonatal Intensive Care Unit, Nantes University Hospital, 38 bld Jean Monnet, Nantes 44000, France
| | - S Barrois
- Pediatric and Neonatal Intensive Care Unit, Nantes University Hospital, 38 bld Jean Monnet, Nantes 44000, France
| | - I Derredinger
- Pediatric and Neonatal Intensive Care Unit, Nantes University Hospital, 38 bld Jean Monnet, Nantes 44000, France
| | - L Baraton
- Pediatric and Neonatal Intensive Care Unit, Nantes University Hospital, 38 bld Jean Monnet, Nantes 44000, France; Clinical Epidemiology, Clinical Investigation Center (CIC004), University Hospital Centre Nantes, France
| | - J C Roze
- Pediatric and Neonatal Intensive Care Unit, Nantes University Hospital, 38 bld Jean Monnet, Nantes 44000, France; Clinical Epidemiology, Clinical Investigation Center (CIC004), University Hospital Centre Nantes, France
| | - C Boscher
- Pediatric and Neonatal Intensive Care Unit, Nantes University Hospital, 38 bld Jean Monnet, Nantes 44000, France; Clinical Epidemiology, Clinical Investigation Center (CIC004), University Hospital Centre Nantes, France
| | - C Gras Leguen
- 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; Clinical Epidemiology, Clinical Investigation Center (CIC004), University Hospital Centre Nantes, France.
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9
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Danielo Jouhier M, Boscher C, Roze JC, Cailleau N, Chaligne F, Legrand A, Flamant C, Muller JB. Osteopathic manipulative treatment to improve exclusive breast feeding at 1 month. Arch Dis Child Fetal Neonatal Ed 2021; 106:591-595. [PMID: 33789971 DOI: 10.1136/archdischild-2020-319219] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 02/18/2021] [Accepted: 03/14/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Previous studies have assessed breastfeeding-support programmes. Among these, osteopathic manipulative treatment (OMT) is a frequently used approach, although without strong evidence of efficacy. METHODS A double-blind randomised controlled trial was conducted between July 2013 and March 2016. Breastfed term infants were eligible if one of the following criteria was met: suboptimal breastfeeding behaviour, maternal cracked nipples or maternal pain. The infants were randomly assigned to the intervention or the control group. The intervention consisted of two sessions of early OMT, while in the control group, the manipulations were performed on a doll behind a screen. The primary outcome was the exclusive breastfeeding rate at 1 month, which was assessed in an intention-to-treat analysis. Randomisation was computer generated and only accessible to the osteopath practitioner. The parents, research assistants and paediatricians were masked to group assignment. RESULTS One hundred twenty-eight mother-infant dyads were randomised, with 64 assigned to each group. In each group, five infants were lost to follow-up. In the intervention group, 31 of 59 (53%) of infants were still exclusively breast fed at 1 month vs 39 of 59 (66%) in the control group, (OR 0.55, 95% CI 0.26 to 1.17; p=0.12). After adjustment for suboptimal breastfeeding behaviour, caesarean section, use of supplements and breast shields, the adjusted OR was 0.44 (95% CI 0.17 to 1.11; p=0.08). No adverse effects were reported in either group. CONCLUSION OMT did not improve exclusive breast feeding at 1 month. TRIAL REGISTRATION NUMBER NCT01890668.
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Affiliation(s)
- Marie Danielo Jouhier
- Department of Neonatal Medicine, University Hospital Centre Nantes, Nantes, France.,Clinical Epidemiology, Clinical investigation Center (CIC004), University Hospital Centre Nantes, Nantes, France
| | - Cécile Boscher
- Department of Neonatal Medicine, University Hospital Centre Nantes, Nantes, France.,Clinical Epidemiology, Clinical investigation Center (CIC004), University Hospital Centre Nantes, Nantes, France
| | - Jean-Christophe Roze
- Department of Neonatal Medicine, University Hospital Centre Nantes, Nantes, France.,Clinical Epidemiology, Clinical investigation Center (CIC004), University Hospital Centre Nantes, Nantes, France
| | | | | | - Arnaud Legrand
- Clinical Epidemiology, Clinical investigation Center (CIC004), University Hospital Centre Nantes, Nantes, France
| | - Cyril Flamant
- Department of Neonatal Medicine, University Hospital Centre Nantes, Nantes, France.,Clinical Epidemiology, Clinical investigation Center (CIC004), University Hospital Centre Nantes, Nantes, France
| | - Jean-Baptiste Muller
- Department of Neonatal Medicine, University Hospital Centre Nantes, Nantes, France .,Clinical Epidemiology, Clinical investigation Center (CIC004), University Hospital Centre Nantes, Nantes, France
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10
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Bouazza N, Treluyer JM, Foissac F, Urien S, Aikio O, Roze JC, Hallman M. Pharmacokinetics of Intravenous Paracetamol (Acetaminophen) and Ductus Arteriosus Closure After Premature Birth. Clin Pharmacol Ther 2021; 110:1087-1095. [PMID: 34314519 DOI: 10.1002/cpt.2380] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 06/03/2021] [Indexed: 11/06/2022]
Abstract
In preterm infants, a high risk of hemodynamically significant patent ductus arteriosus (PDA) exists and its persistence is associated with an increased risk of severe morbidity. Current pharmacological options include ibuprofen or indomethacin. However, treatment by indomethacin or ibuprofen of a large PDA was shown to reduce early pulmonary hemorrhage and later medical treatment but had no effect on neonatal death or morbidity. Early prophylactic treatment of ductus arteriosus by paracetamol seems to be an attractive opportunity to reduce life-threatening morbidity. However, there are currently no data regarding the pharmacokinetics (PK) and pharmacodynamics of paracetamol in preterm neonates in this potential new indication. In this study, we aimed to develop a population PK model for paracetamol and investigate the relationship between paracetamol exposure levels and time to contraction of the ductus. Data were modeled using Monolix software. A one-compartment model adequately described the paracetamol concentration-time course. A Weibull model adequately described the time to contraction of the ductus. Our results suggest that the dosage used in this study (i.e., first day 42.5 mg/kg, then 30 mg/kg/day) allows for reaching the maximum inhibition response from paracetamol regarding the time to close the ductus. However, this study pointed out a lower effect of paracetamol on extremely preterm neonates (below 27 weeks). Therefore, a dose-finding study focusing specifically on extremely preterm neonates with treatment efficacy and toxicity is strongly needed.
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Affiliation(s)
- Naïm Bouazza
- Equipe d'Accueil 7323, Université de Paris, Paris, France.,Centre d'Investigation Clinique-1419 Institut National de la Santé et de la Recherche Médicale, Cochin-Necker, Paris, France.,Clinical Research Unit, Tarnier Hospital, Paris, France
| | - Jean-Marc Treluyer
- Equipe d'Accueil 7323, Université de Paris, Paris, France.,Centre d'Investigation Clinique-1419 Institut National de la Santé et de la Recherche Médicale, Cochin-Necker, Paris, France.,Clinical Research Unit, Tarnier Hospital, Paris, France.,Clinical Pharmacology Department, Cochin Hospital Paris, Paris, France
| | - Frantz Foissac
- Equipe d'Accueil 7323, Université de Paris, Paris, France.,Centre d'Investigation Clinique-1419 Institut National de la Santé et de la Recherche Médicale, Cochin-Necker, Paris, France.,Clinical Research Unit, Tarnier Hospital, Paris, France
| | - Saïk Urien
- Equipe d'Accueil 7323, Université de Paris, Paris, France.,Clinical Research Unit, Tarnier Hospital, Paris, France
| | - Outi Aikio
- Research Unit for Pediatrics, Pediatric Neurology, Pediatric Surgery, Child Psychiatry, Dermatology, Clinical Genetics, Obstetrics and Gynecology, Otorhinolaryngology and Ophthalmology and Medical Research Center Oulu, University of Oulu, Oulu, Finland.,Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
| | - Jean-Christophe Roze
- Neonatal Department, Institut National de la Santé et de la Recherche Médicale-Centre Hospitalo-Universitaire Clinical Investigation Center 1413, et Unité Mixte de Recherche- Institut national de la recherche en agronomie 1280, Physiologie des Adaptations Nutritionnelles, Nantes University Hospital, Nantes, France
| | - Mikko Hallman
- Research Unit for Pediatrics, Pediatric Neurology, Pediatric Surgery, Child Psychiatry, Dermatology, Clinical Genetics, Obstetrics and Gynecology, Otorhinolaryngology and Ophthalmology and Medical Research Center Oulu, University of Oulu, Oulu, Finland.,Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
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11
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Chouraqui JP, Turck D, Briend A, Darmaun D, Bocquet A, Feillet F, Frelut ML, Girardet JP, Guimber D, Hankard R, Lapillonne A, Peretti N, Roze JC, Siméoni U, Dupont C. Religious dietary rules and their potential nutritional and health consequences. Int J Epidemiol 2021; 50:12-26. [PMID: 33207368 DOI: 10.1093/ije/dyaa182] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 08/24/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The vast majority of the world population declares affiliation to a religion, predominantly Christianity and Islam. Many religions have special dietary rules, which may be more or less strictly adhered to. METHODS Religious food rules were collected from holy books and religious websites as well as their translation into dietary practices. The literature was searched for potential associations between these rules and potential nutritional consequences. RESULTS Jewish, Islamic and Indian religions support prolonged breastfeeding. Religious avoidance of alcohol is probably beneficial to health. When strictly applied, a few rules may lead to nutritional inadequacies, mainly in populations living in unfavourable socio-economic or environmental conditions. In Jewish and Muslim observants, animal slaughtering procedures may increase the risk of iron deficiency. Jews may be at risk of excess sodium intake related to home-prepared foods. A vegan diet, as observed by some believers, often by drifting from original precepts, or by some Hindus or Buddhists, may result in vitamin B12, calcium, iron, zinc, selenium and n-3 fatty acids deficiencies. CONCLUSION When implemented in accordance with the rules, most religious food precepts are not detrimental to health, as suggested by the fact that they have more or less been followed for millennia. Nevertheless, some practices may lead to nutritional inadequacies, such as iron, calcium, vitamin D and vitamin B12 deficiencies. Patients with low socio-economic status, children and women of childbearing age are of particular risk of such deficiencies. Being aware of them should help health professionals to take an individualized approach to decide whether to supplement or not.
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Affiliation(s)
- Jean-Pierre Chouraqui
- Pediatric Nutrition and Gastroenterology Unit, Division of Pediatrics, Woman, Mother and Child Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Dominique Turck
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Lille University Jeanne de Flandre Children's Hospital and Faculty of Medicine, University of Lille; INFINITE-INSERM U1286, Lille, France
| | - André Briend
- Institut de Recherche Pour le Développement, Marseille, France
| | | | - Alain Bocquet
- French Association of Ambulatory Paediatrics, Orléans, France
| | | | | | - Jean-Philippe Girardet
- Cabinet de Pédiatrie, 81000 Albi, Pierre et Marie Curie-Paris 6, University 75005, Paris, France
| | - Dominique Guimber
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Lille University Jeanne de Flandre Children's Hospital and Faculty of Medicine, University of Lille, Lille, France
| | | | - Alexandre Lapillonne
- Paris Descartes University, APHP Necker-Enfants Malades Hospital, Paris, France and CNRC, Baylor College of Medicine, Houston, TX, USA
| | - Noel Peretti
- Pediatric Nutrition, University Pediatric Hospital of Lyon and INSERM U1060, CarMeN laboratory, Claude Bernard Lyon-1 University, France
| | - Jean-Christophe Roze
- Neonatology and Pediatric Intensive Care Unit, Univesity Hospital of Nantes and UMR 1280 INRA, Nantes University, France
| | - Umberto Siméoni
- Division of Pediatrics and DOHaD Lab, Woman, Mother and Child Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Christophe Dupont
- Pediatric Gastroenterology Department, Necker Enfants-Malades Hospital, Paris Descartes University, Paris, France
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12
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Dain C, Roze JC, Olivier M, Bossard M, Praud M, Flamant C. Neurodevelopmental outcome at 24 months of healthy infants at birth with an umbilical artery blood pH ≤ 7 and/or hyperlactacidemia ≥ 7 mmol/L. Birth 2021; 48:178-185. [PMID: 33511681 DOI: 10.1111/birt.12527] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 06/28/2020] [Accepted: 12/09/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The incidence of acidosis in term and healthy newborns and the consequences for their neurodevelopment are poorly understood. The aim of our study was to assess neurodevelopmental outcomes at 24 months of age via a parental questionnaire (ASQ, Ages and Stages Questionnaires) for a sample of infants born at term with an umbilical arterial blood pH ≤ 7 or/and hyperlactacidemia ≥ 7 mmol/L. In addition, we compared these groups' neurodevelopmental outcomes with a control group. METHODS During the 29 months of the study, we retrospectively included all children who had an umbilical artery (UA) cord blood pH ≤ 7 and/or lactates ≥ 7 mmol/L with good clinical adaptation. We also included a control group of term newborns with normal gases at birth. Ages and Stages questionnaires were sent to parents at 24 months of age. RESULTS Among the 9016 births during the study, 7.1% of babies had a UA pH ≤ 7 and/or lactates ≥ 7 mmol/L. The ASQ was considered non-optimal for 32.2% and 36.3% of respondents in the acidosis and control group, respectively, without any significant difference (P = 0.382). After matching for gestational age and sex, there was also no significant difference in the rate of non-optimal ASQ. The percentage of abnormal communication was significantly higher in the control group (19.7% vs 11.4%, P = 0.015). CONCLUSIONS Isolated biochemical umbilical cord blood abnormalities in term or near-term newborns with good adaptation do not appear to have a long-term impact on development. These results are rather reassuring, and the absence of specific follow-up for these children seems reasonable.
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Affiliation(s)
- Clémence Dain
- Department of Neonatal Medicine, Departmental Hospital Centre of Vendee, La Roche sur Yon, France
| | | | - Marion Olivier
- Loire Infant Follow-up Team" (LIFT) Network, Pays De Loire, France
| | - Margot Bossard
- Maternity Hospital, Cholet Hospital Center, Cholet, France
| | | | - Cyril Flamant
- Department of Neonatal Medicine, Nantes University Hospital, Nantes, France
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13
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Saurel-Cubizolles MJ, Marchand-Martin L, Pierrat V, Arnaud C, Burguet A, Fresson J, Marret S, Roze JC, Cambonie G, Matis J, Kaminski M, Ancel PY. Maternal employment and socio-economic status of families raising children born very preterm with motor or cognitive impairments: the EPIPAGE cohort study. Dev Med Child Neurol 2020; 62:1182-1190. [PMID: 32557556 DOI: 10.1111/dmcn.14587] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 04/24/2020] [Accepted: 04/26/2020] [Indexed: 11/28/2022]
Abstract
AIM To describe maternal employment and the socio-economic status of the household up to 8 years after the very preterm birth of a child, according to the presence and type of motor or cognitive impairment. METHOD A total of 1885 families from the French EPIPAGE cohort of children who were born very preterm between 1997 and 1998 were included. Motor and cognitive impairments were identified in children between the ages of 2 and 8 years in 770 families and were classified according to type. The 1115 families with children born very preterm without these impairments were considered the reference group. RESULTS Mothers of children with severe motor or cognitive impairments were less often working at 5 years after the birth than the reference mothers (21% and 30% vs 57%; p<0.001). Those working before birth returned to work less often and those not working started to work less often after the birth than did reference mothers. At 8 years, mothers of children with severe impairments reported financial difficulties more often than mothers of children without impairments. INTERPRETATION Despite a fairly protective regulatory framework in France, families of infants born very preterm with severe motor or cognitive impairments are socially underprivileged. Measures to maintain an acceptable standard of living for these families and their children are needed.
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Affiliation(s)
- Marie-Josephe Saurel-Cubizolles
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Laetitia Marchand-Martin
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Veronique Pierrat
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France.,Department of Neonatal Medicine, University Hospital Jeanne-de-Flandres, Lille, France
| | - Catherine Arnaud
- Inserm UMR 1027 (SPHERE Study of Perinatal, Child and Adolescent Health: Epidemiological Research and Evaluation), University Toulouse III Paul Sabatier, Toulouse, France
| | - Antoine Burguet
- Pediatric Department - Pédiatrie 2, University Hospital François Mitterrand, Dijon, France
| | - Jeanne Fresson
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France.,Department of Medical Information, Nancy University Hospital, Nancy, France
| | - Stephane Marret
- Department of Neonatal Medicine and Neuropediatrics, Rouen University Hospital, and INSERM UMR 1245 Team 4 Neovasc Perinatal Neurological Handicap, School of Medicine, Normandy University, Rouen, France
| | | | - Gilles Cambonie
- Department of Neonatal Medicine, University Hospital Arnaud de Villeneuve, Montpellier, France
| | - Jacqueline Matis
- Department of Neonatal Medicine, University Hospital, Strasbourg, France
| | - Monique Kaminski
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Pierre-Yves Ancel
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
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14
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Vivanti AJ, Deruelle P, Picone O, Guillaume S, Roze JC, Mulin B, Kochert F, De Beco I, Mahut S, Gantois A, Barasinski C, Petitprez K, Pauchet-Traversat AF, Droy A, Benachi A. Post-natal follow-up for women and neonates during the COVID-19 pandemic: French National Authority for Health recommendations. J Gynecol Obstet Hum Reprod 2020; 49:101805. [PMID: 32407898 PMCID: PMC7212945 DOI: 10.1016/j.jogoh.2020.101805] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION In the context of the stage 3 SARS-Cov-2 epidemic situation, it is necessary to put forward a method of rapid response for an HAS position statement in order to answer to the requests from the French Ministry of Solidarity and Health, healthcare professionals and/or health system users' associations, concerning post-natal follow-up for women and neonates during the COVID-19 pandemic. METHODS A simplified 7-step process that favours HAS collaboration with experts (healthcare professionals, health system users' associations, scientific societies etc.), the restrictive selection of available evidence and the use of digital means of communication. A short and specific dissemination format, which can be quickly updated in view of the changes in available data has been chosen.
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Affiliation(s)
- Alexandre J Vivanti
- Service de Gynécologie Obstétrique, Hôpital Antoine Béclère, AP-HP, Université Paris-Saclay, Clamart, France.
| | - Philippe Deruelle
- Collège National des Gynécologues Obstétriciens Français, France; Service de Gynécologie-Obstétrique, Hôpital de Hautepierre, Faculté de Médecine de Strasbourg, Strasbourg, France
| | - Olivier Picone
- Collège National des Gynécologues Obstétriciens Français, France; Division of Obstetrics and Gynecology, "Louis Mourier" Hospital, Paris University, IAME INSERM U1137, APHP Paris, France; Groupe de Recherche sur les Infections pendant la Grossesse
| | | | | | | | | | | | | | | | - Chloé Barasinski
- Collège National des Sages-Femmes de France, France; Université Clermont Auvergne, CNRS, CHU Clermont-Ferrand, SIGMA, INSTITUT PASCAL, F-63000 Clermont-Ferrand, France
| | - Karine Petitprez
- Guidelines Department, French National Authority for Health, Saint-Denis, France
| | | | - Alcyone Droy
- Guidelines Department, French National Authority for Health, Saint-Denis, France
| | - Alexandra Benachi
- Service de Gynécologie Obstétrique, Hôpital Antoine Béclère, AP-HP, Université Paris-Saclay, Clamart, France; Collège National des Gynécologues Obstétriciens Français, France
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15
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Vivanti AJ, Deruelle P, Picone O, Guillaume S, Roze JC, Mulin B, Kochert F, De Beco I, Mahut S, Gantois A, Barasinski C, Petitprez K, Pauchet-Traversat AF, Droy A, Benachi A. Follow-up for pregnant women during the COVID-19 pandemic: French national authority for health recommendations. J Gynecol Obstet Hum Reprod 2020; 49:101804. [PMID: 32407897 PMCID: PMC7212959 DOI: 10.1016/j.jogoh.2020.101804] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION In the context of the stage 3 SARS-Cov-2 epidemic situation, it is necessary to put forward a method of rapid response for an HAS position statement in order to answer to the requests from the French Ministry of Solidarity and Health, healthcare professionals and/or health system users' associations concerning follow-up of pregnant women during the COVID-19 outbreak. METHODS A simplified 7-step process that favours HAS collaboration with experts (healthcare professionals, health system users' associations, scientific societies etc.), the restrictive selection of available evidence and the use of digital means of communication. A short and specific dissemination format, which can be quickly updated in view of the changes in available data has been chosen.
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Affiliation(s)
- Alexandre J Vivanti
- Service de Gynécologie Obstétrique, Hôpital Antoine Béclère, AP-HP, Université Paris-Saclay, 92140 Clamart, France.
| | - Philippe Deruelle
- Collège National des Gynécologues Obstétriciens Français, 75002 Paris, France; Service de Gynécologie Obstétrique, Hôpital de Hautepierre, Faculté de Médecine de Strasbourg, 67000 Strasbourg, France
| | - Olivier Picone
- Collège National des Gynécologues Obstétriciens Français, 75002 Paris, France; Division of Obstetrics and Gynecology, "Louis Mourier" Hospital, Paris University, IAME INSERM U1137, APHP (Paris, France) GRIG (Groupe de Recherche sur les Infections pendant la Grossesse), 92700 Colombes
| | - Sophie Guillaume
- Collège National des Sages-Femmes de France, 75015 Paris, France
| | | | - Blandine Mulin
- French Federation of Perinatal Health Networks, 31000 Toulouse, France
| | - Fabienne Kochert
- French Association of Ambulatory Paediatrics, 33400 Talence, France
| | | | - Sophie Mahut
- College of General Medicine, 75017 Paris 8, France
| | - Adrien Gantois
- Collège National des Sages-Femmes de France, 75015 Paris, France
| | - Chloé Barasinski
- Collège National des Sages-Femmes de France, 75015 Paris, France; Université Clermont Auvergne, CNRS, CHU Clermont-Ferrand, SIGMA, INSTITUT PASCAL, F63000 ClermontFerrand, France
| | - Karine Petitprez
- Guidelines Department, French National Authority for Health, 93200 Saint-Denis, France
| | | | - Alcyone Droy
- Guidelines Department, French National Authority for Health, 93200 Saint-Denis, France
| | - Alexandra Benachi
- Service de Gynécologie Obstétrique, Hôpital Antoine Béclère, AP-HP, Université Paris-Saclay, 92140 Clamart, France; Collège National des Gynécologues Obstétriciens Français, 75002 Paris, France
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Pierrat V, Burguet A, Marchand-Martin L, Cambonie G, Coquelin A, Roze JC, Durox M, Guillois B, Morgan AS, Kaminski M. Variations in patterns of care across neonatal units and their associations with outcomes in very preterm infants: the French EPIPAGE-2 cohort study. BMJ Open 2020; 10:e035075. [PMID: 32571857 PMCID: PMC7311036 DOI: 10.1136/bmjopen-2019-035075] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To describe patterns of care for very preterm (VP) babies across neonatal intensive care units (NICUs) and associations with outcomes. DESIGN Prospective cohort study, EPIPAGE-2. SETTING France, 2011. PARTICIPANTS 53 (NICUs); 2135 VP neonates born at 27 to 31 weeks. OUTCOME MEASURES Clusters of units, defined by the association of practices in five neonatal care domains - respiratory, cardiovascular, nutrition, pain management and neurodevelopmental care. Mortality at 2 years corrected age (CA) or severe/moderate neuro-motor or sensory disabilities and proportion of children with scores below threshold on the neurodevelopmental Ages and Stages Questionnaire (ASQ). METHODS Hierarchical cluster analysis to identify clusters of units. Comparison of outcomes between clusters, after adjustment for potential cofounders. RESULTS Three clusters were identified: Cluster 1 with higher proportions of neonates free of mechanical ventilation at 24 hours of life, receiving early enteral feeding, and neurodevelopmental care practices (26 units; n=1118 babies); Cluster 2 with higher levels of patent ductus arteriosus and pain screening (11 units; n=398 babies); Cluster 3 with higher use of respiratory, cardiovascular and pain treatments (16 units; n=619 babies). No difference was observed between clusters for the baseline maternal and babies' characteristics. No differences in outcomes were observed between Clusters 1 and 3. Compared with Cluster 1, mortality at 2 years CA or severe/moderate neuro-motor or sensory disabilities was lower in Cluster 2 (adjusted OR 0.46, 95% CI 0.25 to 0.84) but with higher proportion of children with an ASQ below threshold (adjusted OR 1.49, 95% CI 1.07 to 2.08). CONCLUSION In French NICUs, care practices for VP babies were non-randomly associated. Differences between clusters were poorly explained by unit or population differences, but were associated with mortality and development at 2 years. Better understanding these variations may help to improve outcomes for VPT babies, as it is likely that some of these discrepancies are unwarranted.
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Affiliation(s)
- Veronique Pierrat
- Equipe EPOPé, U 1153, Université de Paris, CRESS, INSERM, INRA, Paris, France
- Department of Neonatal Medicine, Jeanne de Flandre Hospital, CHU Lille, Lille, France
| | - Antoine Burguet
- Department of Neonatal Pediatrics, Dijon University Hospital, Dijon, France
| | | | - Gilles Cambonie
- Neonatology and Neonatal Intensive Care Unit, Montpellier University Hospital Centre, Montpellier cedex 5, France
| | - Anaëlle Coquelin
- Equipe EPOPé, U 1153, Université de Paris, CRESS, INSERM, INRA, Paris, France
| | - J C Roze
- Paediatric Intensive Care, University Hospital Centre Nantes Clinic of Medical Paediatrics, Nantes, France
- Centre d'Investigation Clinique (CIC004), University Hospital Centre Nantes, Nantes, France
| | - Melanie Durox
- Equipe EPOPé, U 1153, Université de Paris, CRESS, INSERM, INRA, Paris, France
| | - Bernard Guillois
- Department of Neonatal Pediatrics and Intensive Care, University Hospital, Caen, France
| | - Andrei S Morgan
- Equipe EPOPé, U 1153, Université de Paris, CRESS, INSERM, INRA, Paris, France
- Institute for Womens' Health, University College London, London, UK
| | - Monique Kaminski
- Equipe EPOPé, U 1153, Université de Paris, CRESS, INSERM, INRA, Paris, France
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Moreau M, Remy M, Nusinovici S, Rouger V, Molines L, Flamant C, Legendre G, Roze JC, Salle A, Van Bogaert P, Coutant R, Gascoin G. Neonatal and neurodevelopmental outcomes in preterm infants according to maternal body mass index: A prospective cohort study. PLoS One 2019; 14:e0225027. [PMID: 31805081 PMCID: PMC6894768 DOI: 10.1371/journal.pone.0225027] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 10/28/2019] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Maternal obesity is associated with an increase in maternal, foetal and neonatal morbidity and mortality. The aim of our study was to evaluate the relationships between maternal pre-pregnancy body mass index and (1) neonatal outcome in preterm infants, and (2) neurodevelopmental outcome at 2 years of corrected age. METHOD We conducted a single-centre cohort study. Infants born between 24+0 and 33+6 weeks of gestation between January 2009 and December 2013, hospitalised in the neonatal intensive care unit of Angers University Hospital, and with available data regarding maternal pre-pregnancy body mass index were eligible. Three groups were defined according to maternal body mass index: normal (n = 418), overweight (n = 136) and obese (n = 89). The primary outcome was neurodevelopment at 2 years of corrected age. Children with a non-optimal neuromotor and/or psychomotor assessment and/or a sensory disability were regarded as having a "non-optimal neurodevelopmental outcome". Neuromotor function was regarded as non-optimal when cerebral palsy was present or when the clinical examination revealed neurological signs of abnormal muscular tone. Psychomotor assessment was regarded as non-optimal if the revised Brunet-Lézine test was < 85 or when the overall score in the parental Ages and Stages Questionnaire (ASQ) was < 185. Finally, sensory disabilities such as blindness and children who required a hearing aid were taken into account. The secondary outcome was the composite criteria of neonatal complications. Multivariable analysis included the following variables: mother's age, gestational age, smoking during pregnancy, magnesium sulphate and steroid treatment during pregnancy, twin status, gender, socioeconomic status and social security benefits for those with low incomes. RESULTS The study population was composed of 643 preterm infants. Among them, 520 were assessed at 2 years. There was no difference in the proportion of infants with non-optimal neurodevelopmental outcomes between the three groups (16.6% for obese, 13.5% for overweight, 16.9% for normal body mass index mothers; p = 0.73). According to multivariable analysis, being born from an overweight or obese mother was not associated with an increased risk of non-optimal neuro-development at 2 years (adjusted OR = 0.84 [0.40-1.76] for obese, adjusted OR = 0.83 [0.43-1.59] for overweight mothers). There was no difference in the proportion of preterm infants with a non-optimal composite criterion of neonatal complications between the three groups. In the multivariable analysis, being born from an overweight or obese mother was not associated with an increased risk of non-optimal neonatal outcomes (adjusted OR = 0.95 [0.49-1.83] for obese, adjusted OR = 1.18 [0.69-2.01] for overweight mothers). CONCLUSION In this large prospective cohort of preterm infants born before 34 weeks of gestation, we found no relationship between maternal body mass index and neurodevelopmental outcomes at 2 years of corrected age and no relationship between maternal body mass index and neonatal outcomes. Other prematurity-related factors may be more relevant for neurodevelopmental outcome than the mother's pre-pregnancy BMI.
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Affiliation(s)
- Marie Moreau
- Department of Neonatal Medicine, Angers University Hospital, Angers, France
| | - Mathilde Remy
- Department of Neonatal Medicine, Angers University Hospital, Angers, France
| | - Simon Nusinovici
- CIC 1413, Nantes University Hospital, Nantes, France
- Loire Infant Follow-Up Team (LIFT) Network, Pays de Loire, France
| | - Valérie Rouger
- Loire Infant Follow-Up Team (LIFT) Network, Pays de Loire, France
| | - Lisa Molines
- Department of Neonatal Medicine, Angers University Hospital, Angers, France
| | - Cyril Flamant
- Loire Infant Follow-Up Team (LIFT) Network, Pays de Loire, France
- Department of Neonatal Medicine, Nantes University Hospital, Nantes, France
| | - Guillaume Legendre
- Department of Obstetrics and Gynaecology, Angers University Hospital, Angers, France
| | - Jean-Christophe Roze
- Loire Infant Follow-Up Team (LIFT) Network, Pays de Loire, France
- Department of Neonatal Medicine, Nantes University Hospital, Nantes, France
| | - Agnès Salle
- Department of Endocrinology, Diabetology and Nutrition, Angers University Hospital, Angers, France
| | - Patrick Van Bogaert
- Loire Infant Follow-Up Team (LIFT) Network, Pays de Loire, France
- Department of Paediatric Neurology, Angers University Hospital, Angers, France
| | - Régis Coutant
- Department of Paediatric Endocrinology, Angers University Hospital, Angers, France
| | - Géraldine Gascoin
- Department of Neonatal Medicine, Angers University Hospital, Angers, France
- Loire Infant Follow-Up Team (LIFT) Network, Pays de Loire, France
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18
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Molines L, Nusinovici S, Moreau M, Remy M, May-Panloup P, Flamant C, Roze JC, Van Bogaert P, Bouet PE, Gascoin G. Impact of mode of conception on neonatal and neurodevelopmental outcomes in preterm infants. Hum Reprod 2018; 34:356-364. [DOI: 10.1093/humrep/dey345] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 11/04/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Lisa Molines
- Department of Neonatal Medicine, Angers University Hospital, Angers, France
| | - Simon Nusinovici
- INSERM CIC 1413, Clinical Investigation Center, Nantes University Hospital, Nantes, France
- Loire Infant Follow-up Team (LIFT) Network, Pays de Loire, France
| | - Marie Moreau
- Department of Neonatal Medicine, Angers University Hospital, Angers, France
| | - Mathilde Remy
- Department of Neonatal Medicine, Angers University Hospital, Angers, France
| | - Pascale May-Panloup
- Department of Reproductive Biology, Angers University Hospital, Angers, France
| | - Cyril Flamant
- Loire Infant Follow-up Team (LIFT) Network, Pays de Loire, France
- Department of Neonatal Medicine, Nantes University Hospital, Nantes, France
| | - Jean-Christophe Roze
- Loire Infant Follow-up Team (LIFT) Network, Pays de Loire, France
- Department of Neonatal Medicine, Nantes University Hospital, Nantes, France
| | - Patrick Van Bogaert
- Loire Infant Follow-up Team (LIFT) Network, Pays de Loire, France
- Department of Paediatric Neurology, Angers University Hospital, Angers, France
| | | | - Géraldine Gascoin
- Department of Neonatal Medicine, Angers University Hospital, Angers, France
- Loire Infant Follow-up Team (LIFT) Network, Pays de Loire, France
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Basset H, Nusinovici S, Huetz N, Sentilhes L, Berlie I, Flamant C, Roze JC, Gascoin G. Efficacy of Antenatal Corticosteroid Treatment on Neurodevelopmental Outcome according to Head Circumference at Birth. Neonatology 2018; 113:55-62. [PMID: 29073596 DOI: 10.1159/000479675] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 07/21/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND There are concerns about the efficacy of antenatal corticosteroid treatment (ACT) in the growth-restricted fetus. OBJECTIVE To evaluate the effect of ACT on neurodevelopmental outcome at 2 years of corrected age according to the z score of birth head circumference (ZS HC) in a large prospective cohort of preterm infants. METHODS This study was conducted as a population-based, prospective, multicenter study, including 4,965 infants born between 24 and 33 weeks' gestation and whose status regarding ACT and the measurement of head circumference at birth were available. They were evaluated at 2 years of corrected age to assess neurological outcome. Three approaches were considered to estimate the effect of ACT on neurodevelopment: (i) logistic regression with adjustment on propensity score, (ii) weighted logistic regression using the inverse probability of treatment weighting method, and (iii) 1:1 matching of gestational age, ZS HC, and propensity score between treated and nontreated infants. RESULTS ACT was documented in 60% of infants. Three groups of infants were considered according to their ZS HC: between -3 and -1 standard deviation (SD), -1 and +1 SD, and +1 and +3 SD, respectively. ACT was associated with a significant improvement of neurodevelopmental outcome only for infants with an ZS HC of between +1 and +3 SD (adjusted OR 1.72; 95% CI 1.06-2.79). Moreover, ORs estimated in the -3 to -1 and +1 to +3 categories were significantly different. CONCLUSION We found beneficial effects of ACT on neurodevelopmental outcomes at 2 years of corrected age only in preterm infants with a ZS HC >1 SD.
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Affiliation(s)
- Helene Basset
- Department of Neonatal Medicine, Le Mans Hospital, Le Mans, France
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20
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Durrmeyer X, Marchand-Martin L, Porcher R, Gascoin G, Roze JC, Storme L, Favrais G, Ancel PY, Cambonie G. Abstention or intervention for isolated hypotension in the first 3 days of life in extremely preterm infants: association with short-term outcomes in the EPIPAGE 2 cohort study. Arch Dis Child Fetal Neonatal Ed 2017; 102:490-496. [PMID: 28302697 DOI: 10.1136/archdischild-2016-312104] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 01/27/2017] [Accepted: 02/22/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To compare outcomes at hospital discharge for preterm infants born before 29 weeks of gestation who had at least one episode of isolated hypotension during their first 72 hours of life for which they did or did not receive antihypotensive treatment. DESIGN Etude Epidémiologique sur les Petits Ages Gestationnels 2 (EPIPAGE 2) French national prospective population-based cohort study in 2011. SETTING 60 neonatal intensive care units. PATIENTS All infants with a minimum mean arterial blood pressure less than gestational age (in weeks) (minMAP<GA) within 72 hours of birth. Infants whose reason for receiving antihypotensive treatments was isolated hypotension only were compared with untreated hypotensive infants by propensity score matching. TREATMENTS Fluid bolus and/or inotropes and/or corticosteroids. MAIN OUTCOMES AND MEASURES The primary outcome was survival at hospital discharge without major morbidity, defined as any of necrotising enterocolitis, severe cerebral abnormalities, severe bronchopulmonary dysplasia or severe retinopathy of prematurity. RESULTS Among the 1532 infants with available data, 662 had a minMAP<GA; 206 were treated for unknown or other reasons than isolated hypotension, 131 were treated for isolated hypotension only and 325 were untreated; 119 infants from each of these last two groups were matched. Treated infants had a significantly higher survival rate without major morbidity (61.3% vs 48.7%; OR, 1.67, 95% CI 1.00 to 2.78, p=0.049) and a lower rate of severe cerebral abnormalities (10.1% vs 26.5%, p=0.002). CONCLUSIONS In this population, antihypotensive treatment was associated with improved short-term outcomes. Therapeutic abstention should be cautiously considered for early isolated hypotension in extremely premature infants.
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Affiliation(s)
- Xavier Durrmeyer
- Neonatal Intensive Care Unit, CHI Créteil, Créteil, France.,INSERM, U1153, Obstetrical, Perinatal and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne, Paris Descartes University, Paris, France
| | - Laetitia Marchand-Martin
- INSERM, U1153, Obstetrical, Perinatal and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne, Paris Descartes University, Paris, France
| | - Raphaël Porcher
- INSERM, U1153, METHODS Team, Epidemiology and Statistics Sorbonne Paris Cité Research Center, Paris Descartes University, Paris, France
| | - Geraldine Gascoin
- Department of Neonatal Medicine, Angers University Hospital, Angers, France
| | | | - Laurent Storme
- Department of Neonatal Medicine, Lille University Hospital, Lille, France
| | - Geraldine Favrais
- Department of Neonatal Medicine, Tours University Hospital, Tours, France
| | - Pierre-Yves Ancel
- INSERM, U1153, Obstetrical, Perinatal and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne, Paris Descartes University, Paris, France
| | - Gilles Cambonie
- Department of Neonatal Medicine, Montpellier University Hospital, Montpellier, France
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21
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Diguisto C, Goffinet F, Lorthe E, Kayem G, Roze JC, Boileau P, Khoshnood B, Benhammou V, Langer B, Sentilhes L, Subtil D, Azria E, Kaminski M, Ancel PY, Foix-L'Hélias L. Providing active antenatal care depends on the place of birth for extremely preterm births: the EPIPAGE 2 cohort study. Arch Dis Child Fetal Neonatal Ed 2017; 102:F476-F482. [PMID: 28667191 DOI: 10.1136/archdischild-2016-312322] [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: 11/10/2016] [Revised: 04/29/2017] [Accepted: 05/02/2017] [Indexed: 11/03/2022]
Abstract
UNLABELLED Survival rates of infants born before 25 weeks of gestation are low in France and have not improved over the past decade. Active perinatal care increases these infants' likelihood of survival. OBJECTIVE Our aim was to identify factors associated with active antenatal care, which is the first step of proactive perinatal care in extremely preterm births. METHODS The population included 1020 singleton births between 220/6 and 260/6 weeks of gestation enrolled in the Etude Epidémiologique sur les Petits Ages Gestationnels 2 study, a French national population-based cohort of very preterm infants born in 2011. The main outcome was 'active antenatal care' defined as the administration of either corticosteroids or magnesium sulfate or delivery by caesarean section for fetal rescue. A multivariable analysis was performed using a two-level multilevel model taking into account the maternity unit of delivery to estimate the adjusted ORs (aORs) of receiving active antenatal care associated with maternal, obstetric and place of birth characteristics. RESULTS Among the population of extremely preterm births, 42% received active antenatal care. After standardisation for gestational age, regional rates of active antenatal care varied between 22% (95% CI 5% to 38%) and 61% (95% CI 44% to 78%). Despite adjustment for individual and organisational characteristics, active antenatal care varied significantly between maternity units (p=0.03). Rates of active antenatal care increased with gestational age with an aOR of 6.46 (95% CI 3.40 to 12.27) and 10.09 (95% CI 5.26 to 19.36) for infants born at 25 and 26 weeks' gestation compared with those born at 24 weeks. No other individual characteristic was associated with active antenatal care. CONCLUSION Even after standardisation for gestational age, active antenatal care in France for extremely preterm births varies widely with place of birth. The dependence of life and death decisions on place of birth raises serious ethical questions.
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Affiliation(s)
- Caroline Diguisto
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France.,Maternité Olympe de Gouges, Centre Hospitalier Regional Universitaire Tours, Tours, France.,Université François Rabelais, Tours, France
| | - François Goffinet
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France.,DHU Risk in Pregnancy, Maternité Port Royal Paris Descartes University Cochin Broca Hotel Dieu Hospitals Assistance publique des hopitaux de Paris, Paris, France
| | - Elsa Lorthe
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France.,UPMC Univ Paris 06, Sorbonne Universités, Paris, France
| | - Gilles Kayem
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France.,UPMC Univ Paris 06, Sorbonne Universités, Paris, France.,Service de Gynécologie Obstétrique, Paris, France
| | - Jean-Christophe Roze
- Service de Néonatologie, CIC 004, INSERM, Nantes University Hospital, Nantes, France
| | - Pascal Boileau
- Service de Néonatologie, CHI Poissy St-Germain-en-Laye, University Versailles StQuentin-en-Yvelines, Versailles, France
| | - Babak Khoshnood
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Valérie Benhammou
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Bruno Langer
- Pole de Gynécologie Obstétrique, Hôpital de Hautepierre, Strasbourg, France
| | - Loic Sentilhes
- Department of Obstetrics and Gynecology, University Hospital Bordeaux, Bordeaux, France
| | - Damien Subtil
- Hôpital Jeanne de Flandre, CHRU-University, Lille Nord, France
| | - Elie Azria
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France.,Maternité Notre Dame de Bon Secours, Groupe Hospitalier Paris Saint Joseph, ParisDescartes University, DHU Risk in Pregnancy, Paris, France
| | - Monique Kaminski
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Pierre-Yves Ancel
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France.,URC CIC P1419, DHU Risk in Pregnancy, Cochin Hotel Dieu Hopital APHP, Paris, France
| | - Laurence Foix-L'Hélias
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France.,UPMC Univ Paris 06, Sorbonne Universités, Paris, France.,Service de Néonatologie, Hopital Armand Trousseau, APHP, Paris, France
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22
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Podevin G, De Vries P, Lardy H, Garignon C, Petit T, Azzis O, MCheik J, Roze JC. An easy-to-follow algorithm to improve pre-operative diagnosis for appendicitis in children. J Visc Surg 2016; 154:245-251. [PMID: 27640089 DOI: 10.1016/j.jviscsurg.2016.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
GOAL To evaluate physician compliance with use of a diagnostic algorithm for appendicitis in children. Our secondary objective was to determine the impact of the algorithm on diagnostic accuracy and morbidity. METHODS We conducted a clustered randomized trial in eight centers. A total of 866 patients were included and, depending on the period of randomization at particular centers, 543 patients were managed before the formal institution of the diagnostic algorithm; their diagnostic management was compared to that of the subsequent 323 patients. RESULTS There was a 29.1% mean increase in the use of imaging studies included in the algorithm after algorithm set-up, rising from 50.8 to 79.9% (P<0.02). When we used a composite endpoint of "poor results" (grouping patients with incorrect diagnoses and/or post-operative complications), no statistically significant difference was found between the two periods (85/543 (15.6%) before vs. 45/323 (13.9%) after set-up, P=0.5). But when the number of incorrect diagnoses of appendicitis made without the use of the algorithm was compared to that of patients who took advantage of the algorithm, the difference was highly significant (67/332 [20.2%] vs. 63/534 [11.8%], P<0.001), and the rate of unnecessary appendectomy decreased from 11.9 to 5.3% (P<0.01). CONCLUSIONS Our diagnostic algorithm improved the adherence to good practice for the diagnosis of appendicitis in children, reducing the rates of unnecessary appendectomy and morbidity. This strategy, combining laboratory tests and imaging, should permit pediatric surgeons to adapt their therapeutic approaches to specific cases.
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Affiliation(s)
- G Podevin
- Pole FME, Pediatic Surgery, CHU Angers, 4, rue Larrey, 49933 Angers, France.
| | - P De Vries
- Pediatic Surgery, CHU de Brest, 29000 Brest, France.
| | - H Lardy
- Pediatic Surgery, CHU de Tours, 37000 Tours, France.
| | - C Garignon
- Pediatic Surgery, centre hospitalier de St-Brieuc, 22000 St-Brieuc, France.
| | - T Petit
- Pediatic Surgery, CHU de Caen, 14000 Caen, France.
| | - O Azzis
- Pediatic Surgery, CHU de Rennes, 35000 Rennes, France.
| | - J MCheik
- Pediatic Surgery, CHU de Poitiers, 86000 Poitiers, France.
| | - J C Roze
- Pediatric CIC, CHU de Nantes, HUGOPEREN Network, 44000 Nantes, France.
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Guellec I, Lapillonne A, Marret S, Picaud JC, Mitanchez D, Charkaluk ML, Fresson J, Arnaud C, Flamant C, Cambonie G, Kaminski M, Roze JC, Ancel PY. Effect of Intra- and Extrauterine Growth on Long-Term Neurologic Outcomes of Very Preterm Infants. J Pediatr 2016; 175:93-99.e1. [PMID: 27318373 DOI: 10.1016/j.jpeds.2016.05.027] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 03/14/2016] [Accepted: 05/09/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine whether extrauterine growth is associated with neurologic outcomes and if this association varies by prenatal growth profile. STUDY DESIGN For 1493 preterms from the EPIPAGE (Étude Épidémiologique sur les Petits Âges Gestationnels [Epidemiological Study on Small Gestational Ages]) cohort, appropriate for gestational-age (AGA) was defined by birth weight >-2 SD and small for gestational-age (SGA) by birth weight ≤-2 SD. Extra-uterine growth was defined by weight gain or loss between birth and 6 months by z-score change. Growth following-the-curve (FTC) was defined as weight change -1 to +1 SD, catch-down-growth (CD) as weight loss ≥1 SD, and catch-up-growth (CU) as weight gain ≥1 SD. At 5 years, a complete medical examination (n = 1305) and cognitive evaluation with the Kauffman Assessment Battery for Children (n = 1130) were performed. Behavioral difficulties at 5 years and school performance at 8 years were assessed (n = 1095). RESULTS Overall, 42.5% of preterms were AGA-FTC, 20.2% AGA-CD, 17.1% AGA-CU, 5.6% SGA-FTC, and 14.5% SGA-CU. Outcomes did not differ between CU and FTC preterm AGA infants. Risk of cerebral palsy was greater for AGA-CD compared with AGA-FTC (aOR 2.26 [95% CI 1.37-3.72]). As compared with children with SGA-CU, SGA-FTC children showed no significant increased risk of cognitive deficiency (aOR 1.41[0.94-2.12]) or school difficulties (aOR 1.60 [0.84-3.03]). Compared with AGA-FTC, SGA showed increased risk of cognitive deficiency (SGA-FTC aOR 2.19 [1.25-3.84]) and inattention-hyperactivity (SGA-CU aOR 1.65 [1.05-2.60]). CONCLUSION Deficient postnatal growth was associated with poor neurologic outcome for AGA and SGA preterm infants. CU growth does not add additional benefits. Regardless of type of postnatal growth, SGA infants showed behavioral problems and cognitive deficiency.
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Affiliation(s)
- Isabelle Guellec
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris, France.
| | | | - Stephane Marret
- Rouen University Hospital, Neonatal Medicine, Rouen; Institute of Biomedical Research, University, Inserm Avenir Research Group, IFR 23, Rouen, France
| | - Jean-Charles Picaud
- Department of Neonatology, Human Nutrition Research Center, Hospital E. Herriot, Lyon, France
| | | | - Marie-Laure Charkaluk
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris, France
| | - Jeanne Fresson
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris, France; Clinical Epidemiology and Biostatistics Department, CHRU Nancy, Nancy, France
| | | | - Cyril Flamant
- Department of Neonatology, CHU Nantes, Nantes, France
| | - Gilles Cambonie
- Montpellier University Hospital Center, Neonatal and Pediatric Intensive Care Unit, Montpellier, France
| | - Monique Kaminski
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris, France
| | | | - Pierre-Yves Ancel
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris, France
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24
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Huetz N, Triau S, Leboucher B, Sentilhes L, Hanf M, Nguyen S, Flamant C, Roze JC, Gascoin G. Association of severe placental inflammation with death prior to discharge and cerebral palsy in preterm infants. BJOG 2016; 123:1956-1963. [PMID: 27428037 DOI: 10.1111/1471-0528.14177] [Citation(s) in RCA: 10] [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] [Accepted: 05/13/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The objective of our study was to identify placental patterns associated with death before discharge or cerebral palsy in a large cohort of preterm infants with a high follow-up rate at 2 years of corrected age. DESIGN Population-based monocentric study. SETTINGS Monocentric study in the maternity unit of the University Hospital of Angers, France between 24+0 and 33+6 weeks of gestation, between January 2008 and December 2011. POPULATION All singleton infants born alive with a placental examination were eligible. METHODS Clinical data (obstetric and neonatal) were collected prospectively through the LIFT cohort. Placental data were collected retrospectively from medical records. The main outcome measure was death before discharge or cerebral palsy. RESULTS We did not find any significant association between severe inflammatory lesions on the placenta and death [odds ratio (OR) 1.49; 95% CI 0.55-4.01; P = 0.43] or cerebral palsy (OR 1.41; 95% CI 0.43-4.62; P = 0.57). This lack of significant association persisted even after adjustment (aOR 0.9; 95% CI 0.20-2.30; P = 0.54; aOR 0.98; 95% CI 0.27-3.58; P = 0.97). CONCLUSION Our results do not provide evidence for a significant association between severe inflammatory placental lesions and either death before discharge or cerebral palsy at 2 years of corrected age in preterm infants born at <34 weeks of gestational age. Further studies remain necessary to confirm this result. TWEETABLE ABSTRACT We found no significant association between inflammatory placental lesions and death or cerebral palsy.
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Affiliation(s)
- N Huetz
- Department of Neonatal Medicine, Angers University Hospital, Angers, France
| | - S Triau
- Department of Pathology, Angers University Hospital, Angers, France
| | - B Leboucher
- Department of Neonatal Medicine, Angers University Hospital, Angers, France.,Loire Infant Follow-Up Team (LIFT) Network, Pays de Loire, France
| | - L Sentilhes
- Department of Obstetrics and Gynaecology, Angers University Hospital, Angers, France
| | - M Hanf
- Loire Infant Follow-Up Team (LIFT) Network, Pays de Loire, France
| | - S Nguyen
- Loire Infant Follow-Up Team (LIFT) Network, Pays de Loire, France.,Department of Paediatric Neurology, Angers University Hospital, Angers, France
| | - C Flamant
- Loire Infant Follow-Up Team (LIFT) Network, Pays de Loire, France.,Department of Neonatal Medicine, Nantes University Hospital, Nantes, France
| | - J C Roze
- Loire Infant Follow-Up Team (LIFT) Network, Pays de Loire, France.,Department of Neonatal Medicine, Nantes University Hospital, Nantes, France
| | - G Gascoin
- Department of Neonatal Medicine, Angers University Hospital, Angers, France. .,Loire Infant Follow-Up Team (LIFT) Network, Pays de Loire, France.
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Suply E, Leclair MD, Neunlist M, Roze JC, Flamant C. Spontaneous Intestinal Perforation and Necrotizing Enterocolitis: A 16-Year Retrospective Study from a Single Center. Eur J Pediatr Surg 2015; 25:520-5. [PMID: 25643249 DOI: 10.1055/s-0034-1396418] [Citation(s) in RCA: 7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP) are serious abdominal conditions that affect preterm infants but are poorly understood. This single-center retrospective study was performed to identify the factors associated with NEC and SIP. METHODS This study involved 3,464 preterm infants recruited over 16 years. A total of 136 NEC and 24 SIP were analyzed and adjusted odds ratios (aOR) were determined by logistic regression. RESULTS Compared with the controls, NEC was associated with a Z-score for birth weight lower than -1 (aOR = 2.1 [1.1-3.9], p = 0.02) and lower than -2 (aOR = 4.4 [1.8-10.4], p < 0.01). NEC was associated with gestational ages of less than 31 weeks and with breech presentations (aOR = 1.5 [1.0-2.3], p = 0.03). In contrast, compared with the controls, SIP was associated with gestational ages of less than 26 weeks (aOR = 17.4 [3.1-96.2], p < 0.001) and multiple pregnancy (aOR = 2.9 [1.2-6.9], p = 0.02). Rates of mortality and cerebral lesions were higher in patients with NEC (25.0 and 13.2%, respectively) than with the controls (10.1 and 6.9%, respectively) and similar between patients with SIP (12.5 and 8.3%, respectively) and the controls. CONCLUSIon: NEC and SIP differed in risk factors and prognosis. Early distinction of SIP from NEC could impact on surgical decision.
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Affiliation(s)
- Etienne Suply
- Department of Chirurgie Pédiatrique, CHU Nantes, Nantes, France
| | | | - Michel Neunlist
- Institut des Maladies de l'Appareil Digestif DHU 2020, INSERM U913, Nantes, France
| | | | - Cyril Flamant
- Department of Neonatology, CHU Nantes, Nantes, France
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26
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Guellec I, Marret S, Baud O, Cambonie G, Lapillonne A, Roze JC, Fresson J, Flamant C, Charkaluk ML, Arnaud C, Ancel PY. Intrauterine Growth Restriction, Head Size at Birth, and Outcome in Very Preterm Infants. J Pediatr 2015; 167:975-81.e2. [PMID: 26384436 DOI: 10.1016/j.jpeds.2015.08.025] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 07/10/2015] [Accepted: 08/06/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To determine whether small head circumference (HC) or birth weight (BW) or both are associated with neonatal and long-term neurologic outcome in very preterm infants. STUDY DESIGN All 2442 live births from the 1997 Epipage study between 26 and 32 weeks of gestational age in 9 regions of France were analyzed. A total of 1395 were tested at age 5 years for cognitive performance and 1315 with school performance reports at age 8 years. Symmetric growth restriction (SGR) was defined by HC and BW <20th percentile and in the same percentile range, and asymmetric growth restriction by at least 1 of HC and BW <20th percentile and the other in a higher decile range. There were 2 forms of asymmetric growth restriction: head growth restriction (HGR) and weight growth restriction (WGR). Appropriate for gestational age was defined by both BW and HC >20th percentile. RESULTS Compared with appropriate for gestational age, SGR was significantly associated with neonatal mortality (aOR 2.99, 95% CI 1.78-5.03), moderate and severe cognitive deficiency (aOR 1.65, 95% CI 1.01-2.71 and aOR 2.61, 95% CI 1.46-4.68, respectively), and poor school performance (aOR 1.79; 95% CI 1.13-2.83). HGR was significantly associated with severe cognitive deficiency (aOR 2.07, 95% CI 1.15-3.74). WGR was not significantly associated with cognitive or school performance despite higher rates of neonatal morbidity. CONCLUSIONS SGR in preterm infants was associated with neonatal mortality and impaired cognitive and school performance. The outcome of asymmetric growth restriction differed according to HC. HGR was associated with impaired cognitive function; WGR was not.
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Affiliation(s)
- Isabelle Guellec
- Institut National de la Santé et de la Recherche Médicale (INSERM), UMR 1153, Equipe de recherche en Epidémiologie Obstétricale, Périnatale et Pédiatrique, Paris, France; Assistance Publique - Hôpitaux de Paris, Department of Neonatology and Intensive Care, A. Trousseau Hospital, Paris, France.
| | - Stephane Marret
- Rouen University Hospital, Neonatal Medicine, Rouen, France; Institute of Biomedical Research, University, Inserm Avenir Research Group, IFR 23, Rouen, France
| | - Olivier Baud
- INSERM UMR 1141, Paris, France; Assistance Publique - Hôpitaux de Paris, Department of Neonatology, R. Debré Hospital, Paris, France
| | - Gilles Cambonie
- Montpellier University Hospital Center, Neonatal and Pediatric Intensive Care Unit, Montpellier, France
| | - Alexandre Lapillonne
- Assistance Publique - Hôpitaux de Paris, Department of Neonatology, Necker Hospital, Paris, France
| | - Jean-Christophe Roze
- Nantes University, Department of Neonatology, Maternite Regionale, Clinical Epidemiology and Biostatistics Department France, Nantes University, INSERM CIC004, Nantes, France
| | - Jeanne Fresson
- Institut National de la Santé et de la Recherche Médicale (INSERM), UMR 1153, Equipe de recherche en Epidémiologie Obstétricale, Périnatale et Pédiatrique, Paris, France; Clinical Epidemiology and Biostatistics Department, CHRU Nancy, France
| | - Cyril Flamant
- Nantes University, Department of Neonatology, Maternite Regionale, Clinical Epidemiology and Biostatistics Department France, Nantes University, INSERM CIC004, Nantes, France
| | - Marie-Laure Charkaluk
- Institut National de la Santé et de la Recherche Médicale (INSERM), UMR 1153, Equipe de recherche en Epidémiologie Obstétricale, Périnatale et Pédiatrique, Paris, France
| | - Catherine Arnaud
- Clinical Epidemiology and Biostatistics Department, CHRU Nancy, France
| | - Pierre-Yves Ancel
- Institut National de la Santé et de la Recherche Médicale (INSERM), UMR 1153, Equipe de recherche en Epidémiologie Obstétricale, Périnatale et Pédiatrique, Paris, France; Centre de Recherche Epidémiologie et Statistique Sorbonne Paris Cité DHU Risques et grossesse Université Paris Descartes, Paris, France
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27
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Madeleneau D, Aubelle MS, Pierron C, Lopez E, Patkai J, Roze JC, Jarreau PH, Gascoin G. Efficacy of a first course of Ibuprofen for patent ductus arteriosus closure in extremely preterm newborns according to their gestational age-specific Z-score for birth weight. PLoS One 2015; 10:e0124804. [PMID: 25875583 PMCID: PMC4395323 DOI: 10.1371/journal.pone.0124804] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 03/19/2015] [Indexed: 11/19/2022] Open
Abstract
Objective Therapeutic strategies for patent ductus arteriosus (PDA) in very preterm infants remain controversial. To identify infants likely to benefit from treatment, we analysed the efficacy of a first course of ibuprofen in small-for-gestational age (SGA) newborns. Study design This single-centre retrospective study included 185 infants born at 24+0–27+6 weeks of gestation with haemodynamically significant PDA, who were treated by intravenous ibuprofen (Pedea): 10 mg/kg on day one and 5 mg/kg on days two and three. Birth weight and gestational age (GA) were analysed with reference to the standard deviations from the Olsen growth curve to define GA-specific Z-scores for birth weights. The efficacy of treatment was evaluated by echocardiography 48 hours after the last dose of ibuprofen. The primary outcome was failure of the first course of ibuprofen associated in a composite criterion with the most severe outcomes. Results The risk of treatment failure increased according to a continuous gradient in SGA neonates. A higher risk was observed on multiple regression analysis (crude OR: 3.8; 95% CI [1.2–12.3] p = 0.02; adjusted OR: 12.8; 95% CI [2.3–70.5] p=0.003). Conclusion There is a linear relationship between infant birth weight and PDA treatment: the failure rate of a first course of ibuprofen increases with increasing degree of growth restriction.
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Affiliation(s)
- Doriane Madeleneau
- Department of Neonatal Medicine of Port-Royal, Groupe Hospitalier Cochin-Broca-Hôtel Dieu, APHP, Paris, France
| | - Marie-Stephanie Aubelle
- Department of Neonatal Medicine of Port-Royal, Groupe Hospitalier Cochin-Broca-Hôtel Dieu, APHP, Paris, France
| | - Charlotte Pierron
- Department of Neonatal Medicine of Port-Royal, Groupe Hospitalier Cochin-Broca-Hôtel Dieu, APHP, Paris, France
| | - Emmanuel Lopez
- Department of Neonatal Medicine of Port-Royal, Groupe Hospitalier Cochin-Broca-Hôtel Dieu, APHP, Paris, France
| | - Juliana Patkai
- Department of Neonatal Medicine of Port-Royal, Groupe Hospitalier Cochin-Broca-Hôtel Dieu, APHP, Paris, France
| | | | - Pierre-Henri Jarreau
- Department of Neonatal Medicine of Port-Royal, Groupe Hospitalier Cochin-Broca-Hôtel Dieu, APHP, Paris, France
| | - Geraldine Gascoin
- Department of Neonatal Medicine, Angers University Hospital, Angers, France
- * E-mail:
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28
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Halbwachs M, Muller JB, Nguyen The Tich S, Gascoin G, Chauty-Frondas A, Branger B, Rouger V, Roze JC, Flamant C. Predictive value of the parent-completed ASQ for school difficulties in preterm-born children <35 weeks' GA at five years of age. Neonatology 2014; 106:311-6. [PMID: 25198520 DOI: 10.1159/000363216] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [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: 12/05/2013] [Accepted: 04/28/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Preterm infants are at greater risk of developmental impairment and require close follow-up for early and optimal care. OBJECTIVES The objective of the present study was to determine from which age the parental Ages and Stages Questionnaire (ASQ) allows detection of school difficulties in preterm children <35 weeks' gestational age. METHODS Preterm children from the regional Loire Infant Follow-up Team network were evaluated with the Global School Adaptation (GSA) assessment tool at 5 years of age and at least one parental-completed ASQ at 18, 24, or 36 months. Children belonging to the first decile of the GSA score (<38) were considered to have severe school difficulties. Using overall ASQ scores as continuous variables, receiver operating characteristic (ROC) curves were generated at every age in order to identify preterm children with severe school difficulties. RESULTS GSA scores were obtained in 1,775 infants at 5 years of age, and at least one ASQ score at 18, 24, or 36 months was completed. Upon ROC analysis, we observed that the 18-, 24-, and 36-month ASQ scores produced respective area under the ROC curve values of 0.66 (0.64-0.69), 0.72 (0.70-0.75), and 0.77 (0.75-0.80) for predicting a GSA score in the first decile. An ASQ cutoff value of 255 at 36 months showed optimal discriminatory power for identifying significant school difficulties at 5 years of age. CONCLUSIONS The 36-month ASQ is a simple and cost-effective tool that can be employed to help predict future severe school difficulties at 5 years of age in preterm-born children.
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Affiliation(s)
- Marie Halbwachs
- Department of Neonatal Medicine, Nantes University Hospital, Nantes, France
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29
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Mura T, Picaud JC, Larroque B, Galtier F, Marret S, Roze JC, Truffert P, Kuhn P, Fresson J, Thiriez G, Arnaud C, Mercier G, Picot MC, Ancel PY, Ledesert B. Cognitive impairment at age 5 years in very preterm infants born following premature rupture of membranes. J Pediatr 2013; 163:435-40. [PMID: 23490036 DOI: 10.1016/j.jpeds.2013.01.039] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 12/07/2012] [Accepted: 01/16/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the relationship between preterm premature rupture of membranes (PPROM) and cognitive impairment in 5-year-old children born very preterm. STUDY DESIGN The Etude Epidémiologique sur les Petits Ages Gestationnels Study is a population-based cohort of children followed up from birth to age 5 years recruited in 9 French regions in 1997. We analyzed data from singletons born between 24 and 32 weeks gestation categorized into 4 groups according to etiology of prematurity: infants born after PPROM, after idiopathic preterm labor, in a vascular context (Vasc), and to women with other complications (Other). Cognitive development at age 5 years was assessed using the Mental Processing Composite score of the Kaufman-Assessment Battery for Children. RESULTS Among the 1051 children followed up to age 5 years, the mean Mental Processing Composite score was 93.6 ± 19.7, and 13.3% of the children (140 of 1051) had cognitive impairment. After adjustment for potential confounders, the risk of cognitive impairment among infants in the PPROM group was not significantly different than that in the idiopathic preterm labor group (OR, 1.09; 95% CI, 0.62-1.92) and the Other group (OR, 1.36; 95% CI, 0.75-2.47), but was lower than that in the Vasc group (OR, 1.86; 95% CI, 1.16-2.97). In the PPROM group, the risk of cognitive impairment was greater when the latency period (ie, time from rupture to delivery) was <3 days (OR, 2.32; 95% CI, 1.07-5.02). CONCLUSION Preterm infants born after PPROM are not at increased risk for cognitive impairment in childhood, but the time between PPROM and birth may influence that risk.
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Affiliation(s)
- Thibault Mura
- Clinical Investigation Center and Information Medical Department, University Hospital of Montpellier, Montpellier, France.
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30
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Gregoire N, Desfrere L, Roze JC, Kibleur Y, Koehne P. Population Pharmacokinetic Analysis of Ibuprofen Enantiomers in Preterm Newborn Infants. J Clin Pharmacol 2013; 48:1460-8. [DOI: 10.1177/0091270008323752] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Lautridou A, Ancel PY, Launay E, Denizot S, Orsonneau JL, Roze JC, Gras-Le Guen C. Umbilical cord blood procalcitonin as a risk factor for mortality in very premature infants. Eur J Clin Microbiol Infect Dis 2012; 31:2407-12. [PMID: 22382822 DOI: 10.1007/s10096-012-1583-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Accepted: 02/04/2012] [Indexed: 10/28/2022]
Abstract
Fetal inflammatory response syndrome is implicated as a cause of fetal or neonatal injury. We analyzed the relationship between the procalcitonin umbilical cord blood level and neonatal outcome. A total of 237 preterms born in a level III perinatal medicine unit of a French university hospital were enrolled in a prospective observational study. Measurement of the procalcitonin umbilical cord blood level was performed at birth. After hospitalization, surviving infants were enrolled in the regional follow-up program. Outcome data were recorded on standardized questionnaires. The main outcome measures were neonatal mortality and impaired functional outcome at 2 years of corrected age. The terciles of procalcitonin levels were calculated. Preterm infants of the third tercile were defined as infants with elevated procalcitonin. Among the 237 infants, 13 (5.5%) died during the neonatal period, 20 (8.4%) were lost to follow-up, and 31 (13.1%) were classified as having an impaired functional outcome. After adjustment, elevated cord blood procalcitonin (>0.33 ng/ml) was significantly associated with an increase in mortality (adjusted odds ratio [aOR] = 8.3 [1.4-48]; p = 0.018), but not with the 2-year impaired functional outcome (aOR = 1.0 [0.4-2.5]; p = 0.93). Elevated umbilical blood cord procalcitonin concentration is an independent risk factor of mortality in preterm infants at less than 33 weeks' gestation.
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Affiliation(s)
- A Lautridou
- Departement de Périnatologie, Hôpital Mère-Enfant, CHU de Nantes, Nantes, France
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32
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Homer L, Launay E, Joram N, Jacqueline C, Jarreau PH, Caillon J, Moyon T, Branger B, Potel G, Roze JC, Méhats C, Gras-Leguen C. Antenatal phosphodiesterase 4 inhibition restores postnatal growth and pulmonary development in a model of chorioamnionitis in rabbits. J Pharmacol Exp Ther 2011; 340:620-8. [PMID: 22160266 DOI: 10.1124/jpet.111.179085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Chorioamnionitis is implicated in the pathophysiology of bronchopulmonary disease, and the associated inflammatory response is responsible for adverse effects on alveolar development. The aim of this work was to analyze the effects of a phosphodiesterase 4 (PDE4)-selective inhibitor, rolipram (a modulator of the inflammatory response), in an experimental model of chorioamnionitis on pulmonary development and on the processes of infection and inflammation. Rabbit mothers were assigned to four groups: 1) saline serum inoculation (controls); 2) Escherichia coli intrauterine inoculation (C+); 3) rolipram infusion (R+); and 4) E. coli inoculation + rolipram infusion (C+R+). High rates of morbility and mortality were noticed in mothers and pups (5 of 13 pregnant rabbits in groups with rolipram). Alveolar development, inflammation, and infection were analyzed in pups at day 0 and day 5. At day 0, in the context of chorioamnionitis, rolipram significantly decreased birth weight (p < 0.01) relative to that of controls (p < 0.05). At day 5, weight normalized in group C+R+ but not in group C+ relative to controls (p < 0.001); moreover, alveolar airspace volume was preserved in group C+R+ but not in group C+ (p < 0.05). Interstitial volume decreased in group C+ versus controls (p < 0.05) but was preserved in group C+R+. Specific alveolar area was not significantly modified by rolipram. No significant difference was found concerning bronchoalveolar lavage cellularity, and all blood cultures remained sterile. In this model of impaired alveologenesis, rolipram significantly preserved specific alveolar density. However, PDE4 inhibition induced antenatal fetal demise and growth retardation.
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Affiliation(s)
- L Homer
- Centre Hospitalier Universitaire Brest, Service de Gynécologie Obstétrique et Médecine de la Reproduction, Brest, France
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Joram N, Launay E, Roze JC, Caillon J, Franco-Montoya ML, Bourbon J, Jarreau PH, Gras-Le Guen C. Betamethasone worsens chorioamnionitis-related lung development impairment in rabbits. Am J Perinatol 2011; 28:605-12. [PMID: 21494996 DOI: 10.1055/s-0031-1276734] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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] [Indexed: 10/18/2022]
Abstract
Although chorioamnionitis and glucocorticoids (GC) are both known to have potential adverse effects on alveolar development, the use of GC is generalized because of their demonstrated benefits in premature newborns. The objective of this study was to analyze the cumulative effects of GC and chorioamnionitis on lung development and infectious process. In a model of ESCHERICHIA COLI chorioamnionitis controlled by antibiotics, pregnant rabbits were randomized among five groups: (1) E. COLI infection alone, (2) infection plus one betamethasone injection (0.1 mg.kg(-1)), (3) infection plus two betamethasone injections, (4) betamethasone alone, (5) control. Lung morphometric analysis, bronchoalveolar lavage, and bacteriologic tissue cultures were performed after spontaneous delivery. In the context of chorioamnionitis, one betamethasone treatment significantly decreased birth weight and lung volume versus controls (30 ± 1.40 versus 52.40 ± 2.54 g, and 1.92 ± 0.67 versus 2.15 ± 0.74 cm(3), respectively, p < 0.05). Two betamethasone treatments significantly decreased specific alveolar area (279.8 ± 46 cm(2)/100 g versus 510.90 ± 54.1 cm(2)/100 g), specific interstitium volume (0.98 ± 0.09 cm(3)/100 g versus 1.78 ± 0.16 cm(3)/100 g), and specific elastin fiber length (57.4 ± 10.5 versus 183.6 ± 8.1 cm/100 g). These results suggest that glucocorticoid treatment might represent an additional risk factor for lung development in the instance of prenatal infection.
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Affiliation(s)
- Nicolas Joram
- CIC mère-enfant, Children's Hospital, CHU Nantes, Creteil, France.
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Pierrat V, Marchand-Martin L, Guemas I, Matis J, Burguet A, Picaud JC, Fresson J, Alberge C, Marret S, Roze JC, Kaminski M, Larroque B, Ancel PY. Height at 2 and 5 years of age in children born very preterm: the EPIPAGE study. Arch Dis Child Fetal Neonatal Ed 2011; 96:F348-54. [PMID: 21242241 DOI: 10.1136/adc.2010.185470] [Citation(s) in RCA: 29] [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] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate growth for children born very preterm with particular focus on those born small-for-gestational age (SGA) or with ex utero growth restraint (GR), and to identify risk factors for short stature at 5 years of age. STUDY DESIGN Population-based study of children born at less than 33 completed weeks of gestation (Étude Epidémiologique sur les Petits Ages Gestationnels (EPIPAGE)). Short stature was defined as height <-2SD on WHO growth curves. Ex utero GR was considered to have occurred in children with appropriate size for gestational age at birth and with a height and/or weight below -2SD at 2 years of corrected age. Logistic regression models were used to test associations between risk factors and short stature. RESULTS The authors measured height at 5 years of age for 1,597 of 2,193 children (73%), 5.6% (95% CI 4.6 to 6.9) of whom were diagnosed as having a short stature. Height was measured at 2 and 5 years of age in 1417 children. Among these, 24% of those born SGA and 36% of those with ex utero GR (p=0.002) had a short stature at 5 years. Predictors of short stature were SGA or birth length <-2SD, maternal height ≤ 160 cm, gestational age <29 weeks and systemic corticosteroids. Breastfeeding at discharge decreased the risk of short stature. CONCLUSIONS Short stature at 5 years of age is common in children born preterm. The highest incidence was observed in the group with ex utero GR. Systemic steroids have a long-term impact on growth and should be used with caution. Breastfeeding at discharge appeared to be protective.
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Affiliation(s)
- V Pierrat
- Neonatal Unit, University Teaching Hospital, Hôpital Jeanne de Flandre, Lille Cedex, France.
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Guellec I, Lapillonne A, Renolleau S, Charlaluk ML, Roze JC, Marret S, Vieux R, Monique K, Ancel PY. Neurologic outcomes at school age in very preterm infants born with severe or mild growth restriction. Pediatrics 2011; 127:e883-91. [PMID: 21382951 DOI: 10.1542/peds.2010-2442] [Citation(s) in RCA: 134] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To determine whether mild and severe growth restriction at birth among preterm infants is associated with neonatal mortality and cerebral palsy and cognitive performance at 5 years of age and school performance at 8 years of age. METHODS All 2846 live births between 24 and 32 weeks' gestation from 9 regions in France in 1997 were included in a prospective observational study (the EPIPAGE [Étude Epidémiologique sur les Petits Ages Gestationnels] study) and followed until 8 years of age. Infants were classified as "small-for-gestational-age" (SGA) if their birth weight for gestational age was at the <10th centile, "mildly-small-for-gestational-age" (M-SGA) if birth weight was at the ≥ 10th centile and <20th centile, and "appropriate-for-gestational-age" (AGA) if birth weight was at the ≥ 20th centile. RESULTS Among the children born between 24 and 28 weeks' gestation, the mortality rate increased from 30% in the AGA group to 42% in the M-SGA group and to 62% in the SGA group (P < .01). Birth weight was not significantly associated with any cognitive, behavioral, or motor outcomes at the age of 5 or any school performance outcomes at 8 years. For the children born between 29 and 32 weeks' gestation, SGA children had a higher risk for mortality (adjusted odds ratio [aOR]: 2.79 [95% confidence interval (CI): 1.50-5.20]), minor cognitive difficulties (aOR: 1.73 [95% CI: 1.12-2.69]), inattention-hyperactivity symptoms (aOR: 1.78 [95% CI: 1.10-2.89]), and school difficulties (aOR: 1.74 [1.07-2.82]) compared with AGA children. Being born M-SGA was associated with an increased risk for minor cognitive difficulties (aOR: 1.87 [95% CI: 1.24-2.82]) and behavioral difficulties (aOR: 1.66 [95% CI: 1.04-2.62]). CONCLUSIONS In preterm children, growth restriction was associated with mortality, cognitive and behavioral outcomes, as well as school difficulties.
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Affiliation(s)
- Isabelle Guellec
- INSERM, UMR 953, Epidemiological Research in Perinatal Health and Women's and Children Health, Bâtiment de recherche, Hôpital Tenon, Paris, France.
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Barbarot S, Chantier E, Kuster A, Hello M, Roze JC, Blouin E, Stalder JF. Symptomatic acquired zinc deficiency in at-risk premature infants: high dose preventive supplementation is necessary. Pediatr Dermatol 2010; 27:380-3. [PMID: 20653858 DOI: 10.1111/j.1525-1470.2010.01174.x] [Citation(s) in RCA: 14] [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] [Indexed: 11/29/2022]
Abstract
Zinc is a cofactor for several enzymes involved in many metabolisms. Zinc deficiency induces various disorders such as acrodermatitis enteropathica, either inherited or acquired. We report three cases of premature infants (24-31 wks gestational age) with low birthweight (650 to 940 g) and enteropathy, two of whom presented with necrotizing enterocolitis. All infants were fed by total parenteral nutrition. At a chronological age ranging from 73 to 80 days, all infants developed a periorificial dermatitis. Before the onset of the first signs, they had received zinc supplementation ranging from 146% to 195% of the recommended dose (400 microg/kg/day). Increased zinc supplementation over a course of 6-18 days induced a complete resolution of symptoms in all cases. No abnormality in the neurologic examination and no recurrence were observed at the end of the zinc treatment. Low birthweight premature infants with enteropathy on total parenteral nutrition are at risk of developing zinc deficiency. The usual recommended zinc supplementation is probably insufficient for those infants. A delay in the diagnosis of zinc deficiency may lead to severe complications.
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Delobel-Ayoub M, Arnaud C, White-Koning M, Casper C, Pierrat V, Garel M, Burguet A, Roze JC, Matis J, Picaud JC, Kaminski M, Larroque B. Behavioral problems and cognitive performance at 5 years of age after very preterm birth: the EPIPAGE Study. Pediatrics 2009; 123:1485-92. [PMID: 19482758 DOI: 10.1542/peds.2008-1216] [Citation(s) in RCA: 279] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES We compared the frequency of behavioral problems in very preterm and term children at 5 years of age. We hypothesized that behavioral problems would be associated with cognitive impairment and environmental factors and that differences between the 2 groups would be reduced but persist after adjusting for cognitive performance and environmental factors. PATIENTS AND METHODS The Etude Epidémiologique sur les Petits Ages Gestationnels (EPIPAGE) study was a prospective population-based cohort study that included all births occurring between 22 and 32 weeks' gestation and a control group of infants born at 39 to 40 weeks' gestation in 1997 in 9 French regions. Neonatal and obstetrics data were collected at birth. At 5 years of age, sociodemographic status and neurodevelopmental and cognitive development of the children, as well as maternal mental well-being, were assessed. The behavioral problems of 1102 very preterm and 375 term singletons without major impairments were studied by using the parent-completed Strengths and Difficulties Questionnaire. RESULTS Parents of very preterm children reported significantly more behavioral problems, with a twofold higher prevalence compared with term children for hyperactivity/inattention, emotional symptoms, and peer problems. Behavioral problems were associated with low cognitive performance, developmental delay, hospitalizations of the child, young maternal age, and poor maternal mental well-being. Very preterm children were still at higher risk of behavioral problems compared with term children after adjustment for cognitive performance and all others factors. CONCLUSIONS Behavioral problems were strongly related to cognitive impairment, but very preterm children were still at higher risk even after adjusting for cognitive performance. Early screening for behavioral problems should be encouraged for all very preterm children, and maternal well-being should also be the focus of special attention.
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Affiliation(s)
- Malika Delobel-Ayoub
- Institut National de la Santé et de la Recherche Médicale, U558, 37 Allées Jules Guesde, 31073 Toulouse Cedex, France.
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Gras-Le Guen C, Fournier S, Andre-Richet B, Caillon J, Chamoux C, Espaze E, Richet H, Roze JC, Lepelletier D. Almond oil implicated in a Staphylococcus capitis outbreak in a neonatal intensive care unit. J Perinatol 2007; 27:713-7. [PMID: 17805342 DOI: 10.1038/sj.jp.7211798] [Citation(s) in RCA: 15] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To develop an effective outbreak-control strategy by identifying the source and modes of transmission of Staphylococcus capitis in a 60-bed neonatal intensive care unit (NICU). STUDY DESIGN We conducted a study among neonates hospitalized during the outbreak (June 2000 through November 2003). All cases of S. capitis colonization or infection detected by clinical samples during the outbreak were included. The molecular analysis of the isolated was assessed by pulsed-field electrophoresis. We reported the description of the outbreak and the measures taken during this investigation. RESULT Thirty-three patients were colonized or infected by S. capitis. Mean gestational age was 28.5+/-4.4 weeks of gestation, mean birth weight was 1068+/-637.3 g and the mean length of hospital stay was 77.9+/-35.9 days. We observed that positive S. capitis cultures were over-represented in six beds of the NICU. Because S. capitis is known to thrive in lipid media, we cultured samples from the almond oil bottles assigned to these beds. S. capitis strain recovered from one of the almond oil sample was genetically identical to the strain recovered from the cases. CONCLUSION Almond oil is an unusual reservoir infection. Control policy allowed prompt institution of measures that were successful in ending the outbreak.
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MESH Headings
- Bacteremia/diagnosis
- Bacteremia/prevention & control
- Bacteremia/transmission
- Birth Weight
- Catheters, Indwelling/microbiology
- Cross Infection/diagnosis
- Cross Infection/prevention & control
- Cross Infection/transmission
- Disease Outbreaks
- Drug Contamination
- Drug Resistance, Multiple, Bacterial
- Electrophoresis, Gel, Pulsed-Field
- Female
- Gestational Age
- Humans
- Infant, Newborn
- Infant, Premature, Diseases/diagnosis
- Infant, Premature, Diseases/etiology
- Infant, Premature, Diseases/prevention & control
- Intensive Care Units, Neonatal
- Length of Stay
- Male
- Patient Isolation
- Plant Oils
- Risk Factors
- Staphylococcal Infections/diagnosis
- Staphylococcal Infections/prevention & control
- Staphylococcal Infections/transmission
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Affiliation(s)
- C Gras-Le Guen
- Réanimation pédiatrique et néonatale, CHU, Nantes, France.
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Fleury J, Picherot G, Cretolle C, Podevin G, David A, Caillon J, Roze JC, Gras-le Guen C. Currarino syndrome as an etiology of a neonatal Escherichia coli meningitis. J Perinatol 2007; 27:589-91. [PMID: 17724455 DOI: 10.1038/sj.jp.7211783] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [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: 11/08/2022]
Abstract
We report the case of a 29-day-old baby girl in whom Escherichia coli meningitis led to the diagnosis of Currarino syndrome (CS) (OMIM 176450), an autosomal-dominant genetic disorder associated with sacral agenesis, anorectal malformation, presacral masses and spinal cord malformations. Her condition improved with antibiotics and early surgical treatment. A familial study identified other genetically related individuals with similar symptoms.
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Affiliation(s)
- J Fleury
- Clinique Médicale Pédiatrique, Hôpital Mère Enfant CHU Nantes, CHU Nantes, France
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40
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Gras-Le Guen C, Boscher C, Godon N, Caillon J, Denis C, Nguyen JM, Kergueris MF, Roze JC. Therapeutic amoxicillin levels achieved with oral administration in term neonates. Eur J Clin Pharmacol 2007; 63:657-62. [PMID: 17497144 DOI: 10.1007/s00228-007-0307-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [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: 09/04/2006] [Accepted: 03/28/2007] [Indexed: 01/15/2023]
Abstract
AIMS The standard treatment of neonatal group B Streptococcus infection is intravenous amoxicillin for 10 days. We investigated whether effective serum amoxicillin concentrations could be reached by switching to oral amoxicillin after 48 h of intravenous administration in full-term neonates with group B Streptococcus infection. METHODS Over 2 years, we included 222 full-term neonates who had early onset group B streptococcal disease responsive to 48 h of intravenous amoxicillin, at which point they were asymptomatic and fed orally. They were switched to oral amoxicillin (300 or 200 mg/kg per day in four divided doses). Steady-state serum amoxicillin concentrations were determined 48 h later by high-performance liquid chromatography; values > or =5 mg/l were considered effective. RESULTS Mean gestational age was 39.32 +/- 1.5 weeks ,and mean birth weight was 3,422 +/- 533 g; 29 newborns were bacteremic. Median serum amoxicillin concentration on oral therapy was 31,.15 (range 11-118) and 25.80 (range 5-84.8) with 300 and 200 mg/kg per day, respectively. None of the infants had a concentration <5 mg/l (p < 0.001). Gastrointestinal tolerance was satisfactory; 216 patients were discharged at 5 days of age, and none was readmitted within the 3-month follow-up. CONCLUSION Early switching to the oral route in asymptomatic full-term newborns with early onset group B streptococcal disease maintained serum amoxicillin concentrations within our predefined therapeutic range (error risk<0.001). This strategy may hold potential for reducing treatment invasiveness and shortening hospital length of stay.
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Affiliation(s)
- Christele Gras-Le Guen
- Pediatric and Neonatal Critical Care Division, Department of Perinatology, Hôpital Mère Enfant, Centre Hospitalier Universitaire, 38 Bd J Monnet, 44099 Nantes, Cedex, France.
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41
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Vieux R, Fresson J, Hascoet JM, Blondel B, Truffert P, Roze JC, Matis J, Thiriez G, Arnaud C, Marpeau L, Kaminski M. Improving perinatal regionalization by predicting neonatal intensive care requirements of preterm infants: an EPIPAGE-based cohort study. Pediatrics 2006; 118:84-90. [PMID: 16818552 DOI: 10.1542/peds.2005-2149] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Perinatal regionalization has been organized into 3 ascending levels of care, fitting increasing degrees of pathology. Current recommendations specify that very premature infants be referred prenatally to level III facilities, yet not all very preterm neonates require level III intensive care. The objective of our study was to determine the antenatal factors that, in association with gestational age, predict the need for neonatal intensive care in preterm infants, to match the size of birth with the level of care required. METHODS Data were analyzed from a cohort of very preterm infants born in nine French regions in 1997. We defined the need for neonatal intensive care as follows: (1) the requirement for specialized management (mechanical ventilation for >48 hours, high frequency oscillation, or inhaled nitric oxide) or (2) poor outcome (transfer to a level III facility within the first 2 days of life or early neonatal death). Triplet pregnancies and pregnancies marked by fetal malformations or intensive care requirements for the mother before delivery were excluded. RESULTS We focused our study on 1262 neonates aged 30, 31 and 32 weeks' gestation, where the need for intensive care was 42.8%, 33.2%, and 22.8%, respectively. Multivariate analysis showed that the risk factors for intensive care requirement with low gestational age were twin pregnancies, maternal hypertension, antepartum hemorrhage, infection, and male gender. Antenatal steroid therapy and premature rupture of membranes were protective factors against intensive care requirement. CONCLUSION Infants <31 weeks' gestation should be referred to level III facilities. From 31 weeks' gestation, some infants can be safely handled in level IIb facilities. However, the quality of perinatal regionalization may only be fully assessed by long-term follow-up.
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Affiliation(s)
- Rachel Vieux
- Department of Neonatalogy, Maternite Regionale Universitaire, Nancy, France.
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Joram N, Boscher C, Denizot S, Loubersac V, Winer N, Roze JC, Gras-Le Guen C. Umbilical cord blood procalcitonin and C reactive protein concentrations as markers for early diagnosis of very early onset neonatal infection. Arch Dis Child Fetal Neonatal Ed 2006; 91:F65-6. [PMID: 16371391 PMCID: PMC2672656 DOI: 10.1136/adc.2005.074245] [Citation(s) in RCA: 59] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Procalcitonin (PCT) and C reactive protein (CRP) concentrations in umbilical cord blood of 197 neonates were measured to evaluate their value as markers of infection. Sixteen of the neonates were infected. The sensitivity, specificity, and negative and positive predictive values were respectively 87.5%, 98.7%, 87.5%, and 98.7% for PCT and 50%, 97%, 67%, and 94% for CRP. Serum PCT in cord blood seems to be a useful and early marker of antenatal infection.
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Affiliation(s)
- N Joram
- Département de Périnatologie, Hôpital Mère Enfant, Nantes, France
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Gregoire N, Gualano V, Geneteau A, Millerioux L, Brault M, Mignot A, Roze JC. Population pharmacokinetics of ibuprofen enantiomers in very premature neonates. J Clin Pharmacol 2005; 44:1114-24. [PMID: 15342612 DOI: 10.1177/0091270004268320] [Citation(s) in RCA: 24] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objective of the present study was to evaluate the pharmacokinetic parameters for both S- and R-ibuprofen enantiomers in very premature neonates (gestational age strictly inferior to 28 weeks) and possible relationships between the pharmacokinetic parameters and various covariates. Newborns were randomized to receive ibuprofen or placebo for the prophylactic treatment of patent ductus arteriosus (PDA) at an initial dose of 10 mg/kg ibuprofen within 6 hours after birth, followed by two 5-mg/kg doses at 24-hour intervals (n = 52). If a PDA was still present afterwards, a curative course of ibuprofen using the same dosage regimen was administered (n = 10). A sparse sampling strategy was used because only 2 samples were collected after the third prophylactic injection and 1 after the third curative injection. A model including the chiral transformation of R- to S-ibuprofen was fitted to the concentration-time data using a population approach (NONMEM). R- and S-ibuprofen t(1/2) were about 10 hours and 25.5 hours, respectively. After prophylactic treatment, the mean clearance of R-ibuprofen (CLR = 12.7 mL/h) was about 2.5-fold higher than for S-ibuprofen (CLS = 5.0 mL/h). In addition, clearance of R- and S-ibuprofen increased significantly with gestational age. The mean estimation of R-ibuprofen clearance was found to be higher than for S-ibuprofen, and the clearance of both enantiomers increased with gestational age. This should be considered to assess pharmacokinetic-pharmacodynamic relationships of ibuprofen in premature neonates and subsequently to understand and refine the use of ibuprofen in managing PDA either as a prophylactic or curative treatment.
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Affiliation(s)
- Nicolas Gregoire
- Aster-Cephac 90 avenue des Hauts de la Chaume BP28 86281, Saint-Benoit, France
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Burguet A, Kaminski M, Truffert P, Menget A, Marpeau L, Voyer M, Roze JC, Escande B, Cambonie G, Hascoet JM, Grandjean H, Breart G, Larroque B. Does smoking in pregnancy modify the impact of antenatal steroids on neonatal respiratory distress syndrome? Results of the Epipage study. Arch Dis Child Fetal Neonatal Ed 2005; 90:F41-5. [PMID: 15613572 PMCID: PMC1721825 DOI: 10.1136/adc.2003.041772] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [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: 11/03/2022]
Abstract
OBJECTIVES To assess the relation between cigarette smoking during pregnancy and neonatal respiratory distress syndrome (RDS) in very preterm birth, and to analyse the differential effect of antenatal steroids on RDS among smokers and non-smokers. DESIGN A population based cohort study (the French Epipage study). SETTING Regionally defined births in France. METHODS A total of 858 very preterm liveborn singletons (27-32 completed weeks of gestation) of the French Epipage study were included in this analysis. The odds ratio for RDS in relation to smoking in pregnancy was estimated using a logistic regression to control for gestational age. The odds ratio for RDS in relation to antenatal steroids was estimated taking into account an interaction between antenatal steroids and cigarette smoking, using multiple logistic regression to control for gestational age, birthweight ratio, main causes of preterm birth, mode of delivery, and sex. RESULTS The odds ratio for RDS in relation to smoking in pregnancy adjusted for gestational age (aOR) was 0.59 (95% confidence interval (CI) 0.44 to 0.79). The aOR for RDS in relation to antenatal steroids was 0.31 (95% CI 0.19 to 0.49) in babies born to non-smokers and 0.63 (95% CI 0.38 to 1.05) in those born to smokers; the difference was significant (p = 0.04). CONCLUSIONS Cigarette smoking during pregnancy is associated with a decrease in the risk of RDS in very preterm babies. Although antenatal steroids reduce the risk of RDS in babies born to both smokers and non-smokers, the reduction is smaller in those born to smokers.
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Affiliation(s)
- A Burguet
- Department of Neonatology, University Hospital, Besançon, France.
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Gournay V, Roze JC, Kuster A, Daoud P, Cambonie G, Hascoet JM, Chamboux C, Blanc T, Fichtner C, Savagner C, Gouyon JB, Flurin V, Thiriez G. Prophylactic ibuprofen versus placebo in very premature infants: a randomised, double-blind, placebo-controlled trial. Lancet 2004; 364:1939-44. [PMID: 15567009 DOI: 10.1016/s0140-6736(04)17476-x] [Citation(s) in RCA: 116] [Impact Index Per Article: 5.8] [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: 11/28/2022]
Abstract
BACKGROUND Patent ductus arteriosus is a common complication of prematurity that frequently requires surgical or medical treatment. The benefit of prophylactic treatment by indometacin, a cyclo-oxygenase inhibitor, remains uncertain compared with curative treatment. This benefit could be improved with ibuprofen, another cyclo-oxygenase inhibitor with fewer adverse effects than indometacin on renal, mesenteric, and cerebral perfusion. We aimed to compare prophylactic and curative ibuprofen in the treatment of this abnormality in very premature infants. METHODS We did a randomised controlled trial in infants younger than 28 weeks of gestation, who were randomly assigned to receive either three doses of ibuprofen or placebo within 6 h of birth. After day 3, symptomatic patent ductus arteriosus was treated first by open curative ibuprofen, then back-up indometacin, surgery, or both. The primary endpoint was need for surgical ligation. Analysis was per protocol. FINDINGS The study was stopped prematurely after 135 enrollments because of three cases of severe pulmonary hypertension in the prophylactic group. 65 infants received prophylactic ibuprofen, and 66 received placebo. Prophylaxis reduced the need for surgical ligation from six (9%) to zero (p=0.03), and decreased the rate of severe intraventricular haemorrhage from 15 (23%) to seven (11%) (p=0.10). However, survival was not improved (47 [71%] placebo vs 47 [72%] treatment, p=1.00), because of high frequency of adverse respiratory, renal, and digestive events. INTERPRETATION In premature infants, prophylactic ibuprofen reduces the need for surgical ligation of patent ductus arteriosus, but does not reduce mortality or morbidity. Therefore, it should not be preferred to early curative ibuprofen.
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Affiliation(s)
- V Gournay
- Service de Réanimation Pédiatrique et Néonatale, Hôpital de la Mère et de l'Enfant, Centre Hospitalier Universitaire (CHU) de Nantes, Quai Moncousu, 44000 Nantes, France.
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de la Cochetiere MF, Piloquet H, des Robert C, Darmaun D, Galmiche JP, Roze JC. Early intestinal bacterial colonization and necrotizing enterocolitis in premature infants: the putative role of Clostridium. Pediatr Res 2004; 56:366-70. [PMID: 15201403 DOI: 10.1203/01.pdr.0000134251.45878.d5] [Citation(s) in RCA: 169] [Impact Index Per Article: 8.5] [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: 11/06/2022]
Abstract
Necrotizing enterocolitis (NEC) is among the most severe conditions that can affect preterm infants. Although the etiology of NEC remains unknown, initial bacterial colonization could play a pivotal role in the development of NEC. To further explore the putative relationship between pathogen microorganisms and NEC, we conducted a prospective case-control study in 12 preterm infants with a new approach based on molecular techniques. Over an inclusion period of 24 mo, 12 neonates of <34 wk gestational age admitted to the neonatal unit were enrolled. The group included three cases of NEC, and nine control infants without evidence of NEC who were matched for gestational age and birth weight. Stool samples were collected at weekly intervals from all infants. PCR and temporal temperature gradient gel electrophoresis of 16S ribosomal DNA were used to detect the establishment of bacterial communities in the digestive tract. A salient feature of the bacteriological pattern was observed only in the three infants who later developed NEC: A band corresponding to the Clostridium perfringens subgroup could be detected in early samples, before diagnosis. There was no evidence for this specific band in any of the nine controls. To our knowledge, the current report is the first to demonstrate that the use of molecular techniques based on the study of bacterial 16S rRNA genes allowed the recognition of C. perfringens species in the first 2 wk of life of three infants who later displayed symptoms of NEC. A significant temporal relationship was thus established between early colonization by Clostridium and the later development of NEC. Compared with conventional bacteriological culturing methods, the use of this new molecular approach to analyze the gastrointestinal ecosystem should therefore allow a more complete and rapid assessment of intestinal flora. Although the current data do not constitute definitive proof that the identified bacterial species was a causative agent in the development of NEC, they outline the promise of this new technique based on molecular biology, and suggest that large-scale studies on a much wider population at high risk for NEC may be warranted.
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Gras-Le Guen C, Lepelletier D, Debillon T, Gournay V, Espaze E, Roze JC. Contamination of a milk bank pasteuriser causing a Pseudomonas aeruginosa outbreak in a neonatal intensive care unit. Arch Dis Child Fetal Neonatal Ed 2003; 88:F434-5. [PMID: 12937053 PMCID: PMC1721613 DOI: 10.1136/fn.88.5.f434] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
An environmental investigation and a cohort study were carried out to analyse an outbreak of infection caused by a serotype O10 Pseudomonas aeruginosa in a neonatal intensive care unit. Thirty one cases of infection were recorded, including four lethal ones. The outbreak was stopped by eradicating the environmental sources: a contaminated milk bank pasteuriser and bottle warmer.
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Affiliation(s)
- C Gras-Le Guen
- Département de périnatologie, Hôpital Mère-Enfant, CHU Nantes, France
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Debillon T, N'Guyen S, Muet A, Quere MP, Moussaly F, Roze JC. Limitations of ultrasonography for diagnosing white matter damage in preterm infants. Arch Dis Child Fetal Neonatal Ed 2003; 88:F275-9. [PMID: 12819157 PMCID: PMC1721566 DOI: 10.1136/fn.88.4.f275] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.7] [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: 11/04/2022]
Abstract
OBJECTIVES To compare the accuracy of ultrasonography (US) and magnetic resonance imaging (MRI) in diagnosing white matter abnormalities in preterm infants and to determine the specific indications for MRI. DESIGN Prospective cohort study. SETTING A neonatal intensive care unit in France. PATIENTS All preterm infants (</= 33 weeks gestation) without severe respiratory distress syndrome precluding MRI. MAIN OUTCOME MEASURES US and MRI performed contemporaneously during the third postnatal week were analysed by an independent observer. The findings were compared with those of a term MRI scan, the results of which were taken as the final diagnosis. Statistical analysis was performed to determine which early imaging study best predicted the term MRI findings. RESULTS The early US and MRI findings (79 infants) correlated closely for severe lesions (cystic periventricular leucomalacia and parenchymal infarction; kappa coefficient = 0.86) but not for moderate lesions (non-cystic leucomalacia and parenchymal punctate haemorrhages; kappa = 0.62). Overall, early MRI findings predicted late MRI findings in 98% of patients (95% confidence interval (CI) 89.5 to 99.9) compared with only 68% for early US (95% CI 52.1 to 79.2). CONCLUSIONS US is highly effective in detecting severe lesions of the white matter in preterm infants, but MRI seems to be necessary for the diagnosis of less severe damage. MRI performed at about the third week of life is highly predictive of the final diagnosis at term.
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MESH Headings
- Age Factors
- Brain Infarction/diagnosis
- Brain Infarction/diagnostic imaging
- Brain Injuries/diagnosis
- Brain Injuries/diagnostic imaging
- Echoencephalography
- Humans
- Infant, Low Birth Weight
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/diagnosis
- Infant, Premature, Diseases/diagnostic imaging
- Intensive Care, Neonatal
- Leukomalacia, Periventricular/diagnosis
- Leukomalacia, Periventricular/diagnostic imaging
- Magnetic Resonance Imaging
- Predictive Value of Tests
- Prospective Studies
- Sensitivity and Specificity
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Affiliation(s)
- T Debillon
- Neonatal Intensive Care Unit, University Hospital, Nantes, France.
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Gras-Le Guen C, Debillon T, Toquet C, Jarry A, Winer N, Jacqueline C, Kergueris MF, Bingen E, Roze JC, Potel G, Bugnon D. Persistent bacteremia in rabbit fetuses despite maternal antibiotic therapy in a novel intrauterine-infection model. Antimicrob Agents Chemother 2003; 47:2125-30. [PMID: 12821457 PMCID: PMC161868 DOI: 10.1128/aac.47.7.2125-2130.2003] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2002] [Revised: 01/22/2003] [Accepted: 04/02/2003] [Indexed: 11/20/2022] Open
Abstract
The effect of optimized maternal therapy by bactericidal agents was evaluated in a reproducible rabbit model of Escherichia coli maternofetal infection simulating human pharmacokinetics. Intravenous antibiotic therapy was begun in the pregnant rabbit 12 h after bacterial intrauterine inoculation, using a computer-controlled pump to simulate human pharmacokinetics of ceftriaxone (1 g/day) associated or not with gentamicin (3 mg/kg of body weight/day). Data were compared for fetal survival, quantitative blood cultures, fetal histology in treated versus untreated groups, and maternal and fetal antibiotic concentrations in plasma in treated animals. Antibiotic therapy led to dramatic improvement in maternal outcome (100% survival versus 100% death in the untreated group in association with maternal septicemia). Fetal survival also improved, with the two-drug combination providing a more potent effect. After 3 days of treatment, 32% of fetuses survived with one-drug therapy and 62% with two-drug therapy (Yates corrected chi(2), P < 0.05). In untreated animals, bacterial counts in blood cultures increased rapidly during the first 24 h up to 8.1 +/- 0.5 log CFU/ml, but remained relatively constant at all times with antibiotic treatment: 4.5 +/- 0.7 log CFU/ml at the start of treatment and 6.2 +/- 0.4 and 5.2 +/- 0.9 log CFU/ml after 72 h for one- and two-drug therapy, respectively (data are means +/- standard deviations). The failure of animals to be cured after 3 days of treatment was not due to an inadequate concentration of ceftriaxone, as the residual level in fetal serum at sacrifice was more than 1000 times the MIC of the microbe. Unexpectedly, inflammation in fetal lung decreased in the treated group after as little as 24 h of antibiotic therapy, despite persistent bacteremia. Although maternal outcome improved and drug concentrations were above the MIC, the treatment did not achieve sterilization of fetuses in utero for this rabbit E. coli maternofetal infection. However, fetal survival showed some improvement, and the histologic features of lung inflammation were reduced.
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Affiliation(s)
- C Gras-Le Guen
- Laboratoire d'Antibiologie Clinique et Expérimentale, Faculté de Médecine de Nantes, Centre Hospitalier Universitaire de Nantes, Nantes, France
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Debillon T, Gras-Leguen C, Vérielle V, Caillon J, Roze JC, Gressens P. Effect of maternal antibiotic treatment on fetal periventricular white matter cell death in a rabbit intrauterine infection model. Acta Paediatr 2003; 92:81-6. [PMID: 12650305 DOI: 10.1111/j.1651-2227.2003.tb00474.x] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To evaluate the effects of maternal antibiotic treatment on fetal brain cell death in a rabbit intrauterine infection model. METHODS After Escherichia coli uterine-horn inoculation in 22 pregnant rabbits, followed at various times by ceftriaxone and caesarean section, cell death in white matter (histology and fragmented DNA staining) from fetuses killed at extraction was compared across groups using the Mantel-Haenszel test and Fisher's exact test for small numbers. RESULTS White matter cell death was consistently present at 48 h, with ceftriaxone initiation at 24 h (group 1), detectable at 84 but not 60 h, with ceftriaxone initiation at 12 h, and significantly reduced at 84 h with ceftriaxone initiation at 6 h (60% vs 100% in group 1, p < 0.001, Fisher's exact test). CONCLUSION Early maternal antibiotic therapy delays white matter cell death in rabbit fetuses exposed to intrauterine infection. This may provide a window for preventing white matter damage.
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Affiliation(s)
- T Debillon
- Service de Néonatologie, Hôpital Mère-Enfant, CHRU Nantes, Nantes, France.
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