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Mazuel M, Moulier V, Bourrel AS, Guillier C, Tazi A, Jarreau PH, Chollat C. Systematic culture of central catheters and infections related to catheters in a neonatal intensive care unit: an observational study. Sci Rep 2024; 14:8647. [PMID: 38622221 PMCID: PMC11018835 DOI: 10.1038/s41598-024-59371-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/09/2024] [Indexed: 04/17/2024] Open
Abstract
Systematic culture of the tip of central lines is performed in many neonatal intensive care units (NICUs) to guide any subsequent antibiotic therapy. The clinical relevance of this procedure is debated, given the significant bacterial contamination during its removal. We aimed to describe infections related to catheters and assess the usefulness of central catheter systematic cultures for probabilistic antibiotic therapy in cases of suspicion of catheter-related infections in a NICU. A retrospective study in a NICU included all newborn patients hospitalized with a central catheter, between January 2018, and June 2019. The main outcome measures were bacterial catheter colonization, catheter-related infection rate, and simulation-based approach to antibiotic prescription. Three hundred and seventy-five newborns, with 634 central catheters were included. There were 273 (43%) catheters that were colonized by at least one microorganism. There were 183 cases of suspected sepsis, with 31 infections definitively related to the catheter. In our simulation antibiotic prescription approach, there was no significant difference in terms of the efficacy toward the microorganism(s) involved between the probabilistic antibiotic therapies proposed by the experts and those ultimately prescribed. Performing a catheter culture only if catheter-related infection is suspected could be an alternative to routine screening.
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Affiliation(s)
- Marie Mazuel
- Neonatal Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Robert Debré Children's Hospital, Paris, France
| | - Virginie Moulier
- University Department of Psychiatry, Centre d'Excellence Thérapeutique, Institut de Psychiatrie, Centre hospitalier du Rouvray, Sotteville-lès-Rouen, France
- Unité de Recherche Clinique, Etablissement Publique de Santé de Ville Evrard, 93332, Neuilly-sur-Marne, France
| | - Anne-Sophie Bourrel
- Department of Bacteriology, University Paris Cité, Assistance Publique-Hôpitaux de Paris, Cochin University Hospital, 75014, Paris, France
| | - Cyril Guillier
- Paediatric Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Armand Trousseau University Hospital, Sorbonne Université, Paris, France
| | - Asmaa Tazi
- Department of Bacteriology, University Paris Cité, Assistance Publique-Hôpitaux de Paris, Cochin University Hospital, 75014, Paris, France
| | - Pierre-Henri Jarreau
- Service de Médecine et Réanimation Néonatales de Port-Royal, Hôpital Cochin, APHP centre - Université Paris Cité, Paris, France
| | - Clément Chollat
- Department of Neonatal Paediatrics, APHP, Service de Néonatologie, Sorbonne Université, Hôpital Armand Trousseau, 26 Av. du Dr Arnold Netter, 75012, Paris, France.
- Université Paris Cité, INSERM, NeuroDiderot, 75019, Paris, France.
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Marret S, Chadie A, Muller JB, Chollat C. [Neurodevelopment and neuroprotection in young children]. Gynecol Obstet Fertil Senol 2024:S2468-7189(24)00086-2. [PMID: 38492741 DOI: 10.1016/j.gofs.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/08/2024] [Indexed: 03/18/2024]
Abstract
In France, the most pessimistic estimates put the prevalence of neurodevelopmental disorders (NDD) at 15 % of births. The two largest populations of newborns at highest risk of NDD are premature babies and babies born into siblings with one or more infants who already have an autism spectrum disorder or another NDD. The high prevalence of these disorders justifies a health promotion policy, centred on the child and his or her family. Prevention is based on the early identification of high-risk factors, by informing families and training pregnancy and early childhood professionals, and implementing perinatal prevention protocols for high-risk newborns (antenatal corticosteroid therapy and magnesium sulfate for women at risk of preterm delivery before 32 weeks, developmental care, therapeutic hypothermia for full-term infants with early neonatal encephalopathy presumed to be anoxic). Preventing the severity of NDD depends on their early identification, as early as possible in the highest plastic "1000 days" developmental window, a smooth flow of diagnosis and care for mothers and children, and the establishment of an ecosystem that includes multi-modal early intervention, at the best in multi-disciplinary teams such as the early medical and social action centres, support for families through guidance programs and inclusion in the community, first in day-care centers and then in nursery schools.
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Affiliation(s)
- Stéphane Marret
- Service de pédiatrie néonatale et réanimation - neuropédiatrie, hôpital Charles-Nicolle, CHU de Rouen et Unité Inserm 1245, UFR santé de Rouen, université de Normandie, Rouen, France.
| | - Alexandra Chadie
- Service de pédiatrie néonatale et réanimation - neuropédiatrie, hôpital Charles-Nicolle, CHU de Rouen et Unité Inserm 1245, UFR santé de Rouen, université de Normandie, Rouen, France
| | - Jean-Baptiste Muller
- Service de pédiatrie néonatale et réanimation - neuropédiatrie, hôpital Charles-Nicolle, CHU de Rouen et Unité Inserm 1245, UFR santé de Rouen, université de Normandie, Rouen, France
| | - Clément Chollat
- Service de néonatologie, hôpital Armand Trousseau, AP-HP, université Paris Cité, Inserm, NeuroDiderot, Paris, France
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Rostoker H, Guillois B, Caradec A, Lecomte F, Oriot D, Chollat C. Creation of a rating scale to teach Less Invasive Surfactant Administration (LISA) in simulation. BMC Med Educ 2024; 24:146. [PMID: 38355497 PMCID: PMC10868031 DOI: 10.1186/s12909-024-05118-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 01/30/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Simulation-based training is gaining increasing prominence in neonatology training. The Less Invasive Surfactant Administration (LISA) method is starting to be taught in simulation. The aim of this educational study was to develop and validate a rating scale for teaching the LISA method in simulation. METHODS The Downing framework was used to create this performance-rating scale. A first version of the scale was submitted to 12 French and Belgian experts to obtain their opinions. Consensus was reached using a modified Delphi method. The performance of 40 pediatricians was then evaluated with this scale on a preterm neonate manikin simulating a neonatal respiratory distress syndrome. Each run was evaluated using the scale by two independent observers based on video recordings. RESULTS The Cronbach alpha score of the rating scale was 0.72. The intraclass correlation coefficient (ICC) was 0.91 and the scores between raters were not significantly different. Finally, this rating scale correctly distinguished the experienced from the inexperienced learners (p < 0.01). CONCLUSIONS This rating scale is one of the first rating scales for the evaluation and teaching of the LISA method in simulation. This tool has ample potential for use in clinical practice to evaluate the performance of surfactant administration in preterm neonates.
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Affiliation(s)
- Hélène Rostoker
- Sorbonne Université, Department of Neonatal Paediatrics, Trousseau Hospital, APHP, F-75012, Paris, France
| | - Bernard Guillois
- Normandie Simulation Center in Health Care (NorSimS), 14033, Caen, France
- Université Caen Normandie, 14032, Caen, France
| | - Amaya Caradec
- P2ULSE, Hôpital Trousseau, APHP centre - Sorbonne Université, Paris, France
| | - François Lecomte
- Service des urgences de l'hôpital Cochin, APHP centre, Université de Paris Cité, Paris, France
| | - Denis Oriot
- ABS Lab, Simulation Laboratory, Faculty of Medicine of Poitiers, Poitiers, France
| | - Clément Chollat
- Sorbonne Université, Department of Neonatal Paediatrics, Trousseau Hospital, APHP, F-75012, Paris, France.
- Université Paris Cité, Inserm, NeuroDiderot, F-75019, Paris, France.
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Chollat C, Tourrel F, Houivet E, Gillet R, Verspyck E, Lecointre M, Marret S, Compère V. Low-Dose Remifentanil in Preterm Cesarean Section with General Anesthesia: A Randomized Controlled Trial. Paediatr Drugs 2024; 26:71-81. [PMID: 37713021 DOI: 10.1007/s40272-023-00591-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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/23/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND AND OBJECTIVE The conventional technique of general anesthesia induction during a Cesarean section involves the use of opioids only after cord clamping. We hypothesized that the use of remifentanil before cord clamping might reduce the use of maternal supplemental anesthetic agents and improve the maternal hemodynamics status and neonatal adaptation of the preterm neonate. METHODS A phase III, double-blind, randomized, placebo-controlled, hospital-based trial enrolled parturients undergoing a Cesarean section under general anesthesia before 37 weeks of gestation. Block randomization allocated pregnant women to remifentanil or placebo. The primary outcome was the rate of newborns with Apgar scores < 7 at 5 min. Secondary outcomes were maternal hemodynamic parameters, complications of anesthetic induction, use of adjuvant anesthetic agents, neonatal respiratory distress, umbilical cord pH, and lactate levels. RESULTS A total of 52/55 participants were analyzed, comprising 27 women in the remifentanil group and 25 in the placebo group. Nine of 27 (33.3%) neonates had an Apgar score < 7 at 5 min in the remifentanil group versus 11/25 (44.0%) in the placebo group (p = 0.45, odds ratio = 0.66, 95 confidence interval 0.20-2.18). The blood cord gases, cognitive, behavior, sensory, sleeping, and feeding scores at 1 and 2 years of corrected age were not different. For the mothers, hemodynamic parameters, anesthesia duration, and the cumulative treatment dose until cord clamping did not differ between the groups. CONCLUSIONS The use of a low dose of remifentanil before cord clamping for a Cesarean section appears to be safe both for the mother and the preterm newborn, but it does not improve maternal or neonatal outcomes. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov: NCT02029898.
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Affiliation(s)
- Clément Chollat
- Service de NéonatoloDepartment of Neonatal Pediatrics, Trousseau Hospital, APHP, Sorbonne Université, 26 Av. du Dr Arnold Netter, 75012, Paris, France.
- Université Paris Cité, Inserm, NeuroDiderot, 48 boulevard Sérurier, 75019, Paris, France.
| | - Fabien Tourrel
- Clinique de l'Europe, 73, boulevard de l'Europe, 76100, Rouen, France
| | - Estelle Houivet
- Department of Biostatistics, CHU Rouen, 37 boulevard Gambetta, 76000, Rouen, France
| | - Romain Gillet
- Department of Anesthesiology and Critical Care, CHU Rouen, 37 boulevard Gambetta, 76000, Rouen, France
| | - Eric Verspyck
- Department of Obstetrics and Gynaecology, Rouen University Hospital, 37 boulevard Gambetta, 76000, Rouen, France
- Normandie University, UNIROUEN, INSERM U1245, Normandy Centre for Genomic and Personalized Medicine, 22 boulevard Gambetta, 76000, Rouen, France
| | - Maryline Lecointre
- Normandie University, UNIROUEN, INSERM U1245, Normandy Centre for Genomic and Personalized Medicine, 22 boulevard Gambetta, 76000, Rouen, France
| | - Stéphane Marret
- Normandie University, UNIROUEN, INSERM U1245, Normandy Centre for Genomic and Personalized Medicine, 22 boulevard Gambetta, 76000, Rouen, France
- Department of Neonatal Pediatrics and Intensive Care, Rouen University Hospital, 37 boulevard Gambetta, 76000, Rouen, France
| | - Vincent Compère
- Department of Anesthesiology and Critical Care, CHU Rouen, 37 boulevard Gambetta, 76000, Rouen, France
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Marret S, Chollat C, Sentilhes L. Prenatal Intravenous Magnesium and Neurodevelopmental Outcomes in Offspring. JAMA 2023; 330:2306-2307. [PMID: 38112818 DOI: 10.1001/jama.2023.21723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Affiliation(s)
- Stéphane Marret
- Department of Neonatology and Intensive Care-Neuropediatrics, Rouen University Hospital-Charles-Nicolle, Rouen, France
| | - Clément Chollat
- Department of Neonatal Pediatrics, Trousseau University Hospital, Paris, France
| | - Loïc Sentilhes
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
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Maroni A, Aubelle MS, Chollat C. Fetal, Preterm, and Term Neonate Exposure to Remifentanil: A Systematic Review of Efficacy and Safety. Paediatr Drugs 2023; 25:537-555. [PMID: 37541994 DOI: 10.1007/s40272-023-00583-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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND Owing to its pharmacodynamic properties, especially the rapid onset and short duration of its action, the use of remifentanil in obstetric anesthesia, as well as in neonatology, might be increasingly used. OBJECTIVE We conducted a systematic review to assess the efficacy and safety of remifentanil in preterm and term neonates. Outcomes of interest were neonatal adaptation after fetal exposure; neonatal pain, distress, and discomfort control during invasive procedures; and the occurrence of hemodynamic effects or respiratory depression induced by remifentanil infusion. METHODS Given the different contexts of use, we have organized this work into three parts: (A) use of remifentanil for labor or cesarean section, with exposure of the fetus before birth, (B) brief use for neonatal procedural analgesia, and (C) prolonged use for sedation/analgesia of neonates. The bibliographic search was conducted based on keywords using electronic medical databases (DATABASE, Cochrane Library, PubMed, and EMBASE) from 1 January 2000 until 31 December 2022. RESULTS Twenty-two articles were included (10 in part A, 5 in part B and 7 in part C). Prospective, controlled, randomized, blinded, and intention-to-treat trials were retained. Neonates were well adapted after exposure to remifentanil in the fetal period. Pain, stress, and discomfort were controlled during a brief or prolonged invasive procedure when remifentanil was used for sedation/analgesia. The physiological parameters were stable and the procedures were straightforward. Chest wall rigidity appeared to be a common side effect, but this can be managed by slow and continuous infusion and by using the minimum effective dose. CONCLUSIONS Remifentanil appears to be effective and safe in the short term in preterm and full-term neonates. However, its safety is compromised by the risk of chest wall rigidity. It should be used in appropriate neonatal units and in the presence of physicians able to monitor its side effects. Long-term outcomes have not been evaluated, to our knowledge.
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Affiliation(s)
- Arielle Maroni
- Pediatric Intensive Care Unit, Robert Debré University Hospital, APHP, 75019, Paris, France
| | | | - Clément Chollat
- Department of Neonatal Paediatrics, Trousseau Hospital, APHP, Sorbonne Université, 26 Av. du Dr Arnold Netter, 75012, Paris, France.
- Université Paris Cité, Inserm, NeuroDiderot, 75019, Paris, France.
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Radjack R, de Wit SD, Chollat C, Di C, Moro MR. [Transcultural competencies of perinatal caregivers: A practical situation]. Gynecol Obstet Fertil Senol 2023; 51:348-351. [PMID: 37080292 DOI: 10.1016/j.gofs.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 04/10/2023] [Accepted: 04/12/2023] [Indexed: 04/22/2023]
Affiliation(s)
- Rahmeth Radjack
- AP-HP, Maison de Solenn, Maison des adolescents de l'hôpital Cochin, 75014 Paris, France; Université de Paris, PCPP, 92100 Boulogne-Billancourt, France; Inserm, UVSQ, CESP, Team DevPsy, université Paris-Saclay, 94807 Villejuif, France.
| | | | - Clément Chollat
- Sorbonne université, Department of Neonatal Paediatrics, Trousseau Hospital, AP-HP, 75012 Paris, France; Inserm, NeuroDiderot, université Paris cité, 75019 Paris, France
| | - Charles Di
- AP-HP, Maison de Solenn, Maison des adolescents de l'hôpital Cochin, 75014 Paris, France; Université de Paris, PCPP, 92100 Boulogne-Billancourt, France; Inserm, UVSQ, CESP, Team DevPsy, université Paris-Saclay, 94807 Villejuif, France
| | - Marie Rose Moro
- AP-HP, Maison de Solenn, Maison des adolescents de l'hôpital Cochin, 75014 Paris, France; Université de Paris, PCPP, 92100 Boulogne-Billancourt, France; Inserm, UVSQ, CESP, Team DevPsy, université Paris-Saclay, 94807 Villejuif, France
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Durrmeyer X, Walter-Nicolet E, Chollat C, Chabernaud JL, Barois J, Chary Tardy AC, Berenguer D, Bedu A, Zayat N, Roué JM, Beissel A, Bellanger C, Desenfants A, Boukhris R, Loose A, Massudom Tagny C, Chevallier M, Milesi C, Tauzin M. Premedication before laryngoscopy in neonates: Evidence-based statement from the French society of neonatology (SFN). Front Pediatr 2022; 10:1075184. [PMID: 36683794 PMCID: PMC9846576 DOI: 10.3389/fped.2022.1075184] [Citation(s) in RCA: 4] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/01/2022] [Indexed: 01/06/2023] Open
Abstract
CONTEXT Laryngoscopy is frequently required in neonatal intensive care. Awake laryngoscopy has deleterious effects but practice remains heterogeneous regarding premedication use. The goal of this statement was to provide evidence-based good practice guidance for clinicians regarding premedication before tracheal intubation, less invasive surfactant administration (LISA) and laryngeal mask insertion in neonates. METHODS A group of experts brought together by the French Society of Neonatology (SFN) addressed 4 fields related to premedication before upper airway access in neonates: (1) tracheal intubation; (2) less invasive surfactant administration; (3) laryngeal mask insertion; (4) use of atropine for the 3 previous procedures. Evidence was gathered and assessed on predefined questions related to these fields. Consensual statements were issued using the GRADE methodology. RESULTS Among the 15 formalized good practice statements, 2 were strong recommendations to do (Grade 1+) or not to do (Grade 1-), and 4 were discretionary recommendations to do (Grade 2+). For 9 good practice statements, the GRADE method could not be applied, resulting in an expert opinion. For tracheal intubation premedication was considered mandatory except for life-threatening situations (Grade 1+). Recommended premedications were a combination of opioid + muscle blocker (Grade 2+) or propofol in the absence of hemodynamic compromise or hypotension (Grade 2+) while the use of a sole opioid was discouraged (Grade 1-). Statements regarding other molecules before tracheal intubation were expert opinions. For LISA premedication was recommended (Grade 2+) with the use of propofol (Grade 2+). Statements regarding other molecules before LISA were expert opinions. For laryngeal mask insertion and atropine use, no specific data was found and expert opinions were provided. CONCLUSION This statement should help clinical decision regarding premedication before neonatal upper airway access and favor standardization of practices.
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Affiliation(s)
- Xavier Durrmeyer
- Neonatal Intensive Care Unit, Centre Hospitalier Intercommunal de Créteil, Créteil, France.,Université Paris Est Créteil, Faculté de Santé de Créteil, IMRB, GRC CARMAS, Créteil, France
| | - Elizabeth Walter-Nicolet
- Neonatal Medicine and Intensive Care Unit, Saint Joseph Hospital, Paris, France.,University of Paris-Cité, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, Paris, France
| | - Clément Chollat
- Department of Neonatology, Hôpital Armand Trousseau, APHP, Sorbonne Université, Paris, France
| | - Jean-Louis Chabernaud
- Division of Neonatal and Pediatric Critical Care Transportation, Hôpital Antoine Beclere, AP-HP, Paris - Saclay University Hospital, Clamart, France
| | - Juliette Barois
- Department of Neonatology and Neonatal Intensive Care, CH de Valenciennes, Valenciennes, France
| | - Anne-Cécile Chary Tardy
- Department of Neonatology and Neonatal Intensive Care, Centre Hospitalier Universitaire de Dijon, Dijon, France
| | - Daniel Berenguer
- Department of Pediatric Anesthesia and Pediatric Transport (SMUR Pédiatrique), Hôpital des Enfants, CHU de Bordeaux, Bordeaux, France
| | - Antoine Bedu
- Department of Neonatal Pediatrics and Intensive Care, Limoges University Hospital, Limoges, France
| | - Noura Zayat
- Department of Neonatal Intensive Care and Pediatric Transport, CHU de Nantes, Nantes, France
| | - Jean-Michel Roué
- Department of Pediatric and Neonatal Critical Care, Brest University Hospital, Brest, France
| | - Anne Beissel
- Neonatal Intensive Care Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - Claire Bellanger
- Department of Neonatology and Neonatal Intensive Care, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Aurélie Desenfants
- Department of Neonatology, CHU Nimes, Université Montpellier, Nimes, France
| | - Riadh Boukhris
- Department of Neonatology, Pôle Femme-Mère-Nouveau-Né, Hôpital Jeanne de Flandre, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Anne Loose
- Department of Neonatology, CHRU de Tours, Hôpital Bretonneau, Tours, France
| | - Clarisse Massudom Tagny
- Department of Neonatology and Neonatal Intensive Care, Grand Hôpital de L'Est Francilien, Meaux, France
| | - Marie Chevallier
- Department of Neonatal Intensive Care Unit, CHU Grenoble, Grenoble, France.,TIMC-IMAG Research Department, Grenoble Alps University, Grenoble, France
| | - Christophe Milesi
- Department of Neonatal Medicine and Pediatric Intensive Care, Montpellier University Hospital, Université de Montpellier, Montpellier, France
| | - Manon Tauzin
- Neonatal Intensive Care Unit, Centre Hospitalier Intercommunal de Créteil, Créteil, France
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Chollat C, Bertrand E, Petit-Ledo A, de Vansay C, Voisin C, Dabaj I, Gillibert A, Marret S. Cerebral Palsy in Very Preterm Infants: A Nine-Year Prospective Study in a French Population-Based Tertiary Center. J Pediatr 2021; 237:183-189.e6. [PMID: 34144033 DOI: 10.1016/j.jpeds.2021.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 06/01/2021] [Accepted: 06/11/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To describe the prevalence of cerebral palsy (CP) at age 2 years in infants born before 33 weeks of gestation and to analyze the fetal neuroprotective effect of the antenatal administration of magnesium sulfate (MgSO4) treatment on CP. STUDY DESIGN Preterm infants born before 33 weeks of gestation and discharged from the Rouen University Hospital's Neonatal Intensive Care Unit between 2007 and 2015 were included. At age 2 years, pediatricians of the perinatal network of Eure and Seine-Maritime counties administered standardized questionnaires analyzing motor, cognitive, and behavioral items, derived from the Denver and Amiel-Tison scales. A routine protocol based on MgSO4 infusion was introduced in 2010. The primary outcome measure was the occurrence of CP according to the Surveillance of Cerebral Palsy in Europe network definition. RESULTS A total of 1759 very preterm infants were included, among whom 138 (7.8%) died and 148 (9.1%) were lost to follow-up. Assuming that those lost to follow-up had no CP, at 2 years, 55 of 1621 infants (3.4%; 95% CI, 2.6%-4.4%) had CP. After statistical adjustment for birth term and antenatal corticosteroid use, a significant decrease in CP was observed after implementation of a protocol of MgSO4 administration in mothers before imminent preterm birth at <33 weeks of gestation (aOR, 0.53; 95% CI, 0.29-0.98; P = .04). CONCLUSIONS The prevalence of CP at 2 years after very preterm birth was low. The implementation of a neuroprotective protocol with MgSO4 was associated with reduced CP occurrence; however, several relevant limitations must be considered for interpretation.
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Affiliation(s)
- Clément Chollat
- INSERM U1245, Genetics and Pathophysiology of Neurodevelopmental Disorders Team, Institute of Research and Innovation in Biomedicine, Faculty of Medicine, Normandy University, Caen, France; Neonatal Intensive Care Unit, Port-Royal, Paris Center University Hospitals, APHP, Paris Descartes University, Paris, France
| | - Emmanuelle Bertrand
- INSERM U1245, Genetics and Pathophysiology of Neurodevelopmental Disorders Team, Institute of Research and Innovation in Biomedicine, Faculty of Medicine, Normandy University, Caen, France; Department of Neonatal Pediatrics and Intensive Care-Neuropediatrics, CHU Rouen, Rouen, France
| | - Alice Petit-Ledo
- Department of Neonatal Pediatrics and Intensive Care-Neuropediatrics, CHU Rouen, Rouen, France
| | | | - Caroline Voisin
- Department of Neonatal Pediatrics and Intensive Care-Neuropediatrics, CHU Rouen, Rouen, France
| | - Ivana Dabaj
- INSERM U1245, Genetics and Pathophysiology of Neurodevelopmental Disorders Team, Institute of Research and Innovation in Biomedicine, Faculty of Medicine, Normandy University, Caen, France; Department of Neonatal Pediatrics and Intensive Care-Neuropediatrics, CHU Rouen, Rouen, France
| | | | - Stéphane Marret
- INSERM U1245, Genetics and Pathophysiology of Neurodevelopmental Disorders Team, Institute of Research and Innovation in Biomedicine, Faculty of Medicine, Normandy University, Caen, France; Department of Neonatal Pediatrics and Intensive Care-Neuropediatrics, CHU Rouen, Rouen, France.
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Bénin A, Blanc M, Chollat C, Jarreau PH, Goffinet F, Tsatsaris V, Delorme P. The cause of birth is associated with neonatal prognosis in late preterm singletons. J Gynecol Obstet Hum Reprod 2020; 49:101920. [PMID: 32971309 DOI: 10.1016/j.jogoh.2020.101920] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/17/2020] [Accepted: 09/18/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Recent studies have shown that the cause of very preterm births may be related to neonatal morbidity and mortality. Even though these risks are lower among late preterm births, this group accounts for the vast majority of all preterm births. The objective of this study was to evaluate the relation of neonatal morbidity and mortality to the cause of late preterm birth. MATERIALS AND METHODS This retrospective observational cohort study included all women who gave birth to liveborn singletons from 34 to 36 weeks+6 days of gestation in a French level III maternity hospital in the 5-year period 2013-2017. The causes of preterm delivery were divided into 6 mutually exclusive groups. The main outcome was a composite neonatal morbidity criterion, defined by at least one among the following criteria: neonatal respiratory distress, neurological complications, neonatal sepsis, severe necrotizing enterocolitis, and neonatal hypoglycemia. We analyzed the association between cause of preterm delivery and neonatal morbidity after adjustment for gestational age and antenatal corticosteroid therapy. The reference group was preterm labor, defined by spontaneous preterm labor with intact membranes. RESULTS During the study period, there were a total of 27 110 births, including 1114 singleton births at 34 to 36 weeks of gestation + 6 days (4.1%). Among the 968 late preterm births included, the risk of neonatal morbidity in the group with preterm premature rupture of membranes (PPROM) was similar to that in the preterm labor (reference) group: adjusted odds ratio (aOR) 1.2 (95% CI, 0.8-1.8). All the other causes of late preterm birth were associated with a higher risk of neonatal morbidity than the reference group: aOR 2.0 [95% CI, 1.1-3.5] for hypertensive disorders without suspected fetal growth restriction (FGR) (9.1% of cases), aOR 2.4 [95% CI, 1.4-4.2] for hypertensive disorders with suspected FGR (8.9%), aOR 4.2 [95% CI, 2.2-8.0] for suspected FGR without hypertensive disorders (5.8%), and aOR 4.4 [95% CI, 2.2-8.8] for vaginal bleeding related to abnormal placental insertion (4.7%). CONCLUSION Among infants born from 34 to 36 weeks + 6 days of gestation, PPROM and preterm labor had similar risks of neonatal morbidity, while the other causes were associated with a risk of neonatal morbidity at least twice that with preterm labor.
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Affiliation(s)
- Amélie Bénin
- Maternité Port-Royal, AP-HP, APHP. Centre-Université de Paris, FHU PREMA, Paris, France(1).
| | - Matthieu Blanc
- Maternité Port-Royal, Service de réanimation néonatale, AP-HP, APHP. Centre-Université de Paris, Paris, France
| | - Clément Chollat
- Maternité Port-Royal, Service de réanimation néonatale, AP-HP, APHP. Centre-Université de Paris, Paris, France; INSERM U1245, Genetics and Pathophysiology of Neurodevelopmental Disorders, Team 4 Neovasc, Institute of Research and Innovation in Biomedicine, Normandy University, Rouen, France
| | - Pierre-Henri Jarreau
- Maternité Port-Royal, Service de réanimation néonatale, AP-HP, APHP. Centre-Université de Paris, Paris, France
| | - François Goffinet
- Maternité Port-Royal, AP-HP, APHP. Centre-Université de Paris, FHU PREMA, Paris, France(1); Université de Paris, INSERM U1153, Equipe de recherche en Epidémiologie Obstétricale, Périnatale et Pédiatrique (EPOPé), Centre de Recherche Epidémiologie et Biostatistique Sorbonne Paris Cité (CRESS), Paris, France
| | - Vassilis Tsatsaris
- Maternité Port-Royal, AP-HP, APHP. Centre-Université de Paris, FHU PREMA, Paris, France(1)
| | - Pierre Delorme
- Université de Paris, INSERM U1153, Equipe de recherche en Epidémiologie Obstétricale, Périnatale et Pédiatrique (EPOPé), Centre de Recherche Epidémiologie et Biostatistique Sorbonne Paris Cité (CRESS), Paris, France; Sorbonne Université, AP-HP, Department of Gynaecology and Obstetrics, Trousseau Hospital, Paris, France
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11
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Chollat C, Lecointre M, Leuillier M, Remy-Jouet I, Do Rego JC, Abily-Donval L, Ramdani Y, Richard V, Compagnon P, Dureuil B, Marret S, Gonzalez BJ, Jégou S, Tourrel F. Beneficial Effects of Remifentanil Against Excitotoxic Brain Damage in Newborn Mice. Front Neurol 2019; 10:407. [PMID: 31068895 PMCID: PMC6491788 DOI: 10.3389/fneur.2019.00407] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 04/04/2019] [Indexed: 01/15/2023] Open
Abstract
Background: Remifentanil, a synthetic opioid used for analgesia during cesarean sections, has been shown in ex vivo experiments to exert anti-apoptotic activity on immature mice brains. The present study aimed to characterize the impact of remifentanil on brain lesions using an in vivo model of excitotoxic neonatal brain injury. Methods: Postnatal day 2 (P2) mice received three intraperitoneal injections of remifentanil (500 ng/g over a 10-min period) or saline just before an intracortical injection of ibotenate (10 μg). Cerebral reactive oxygen species (ROS) production, cell death, in situ labeling of cortical caspase activity, astrogliosis, inflammation mediators, and lesion size were determined at various time points after ibotenate injection. Finally, behavioral tests were performed until P18. Results: In the injured neonatal brain, remifentanil significantly decreased ROS production, cortical caspase activity, DNA fragmentation, interleukin-1β levels, and reactive astrogliosis. At P7, the sizes of the ibotenate-induced lesions were significantly reduced by remifentanil treatment. Performance on negative geotaxis (P6-8) and grasping reflex (P10-12) tests was improved in the remifentanil group. At P18, a sex specificity was noticed; remifentanil-treated females spent more time in the open field center than did the controls, suggesting less anxiety in young female mice. Conclusions: In vivo exposure to remifentanil exerts a beneficial effect against excitotoxicity on the developing mouse brain, which is associated with a reduction in the size of ibotenate-induced brain lesion as well as prevention of some behavioral deficits in young mice. The long-term effect of neonatal exposure to remifentanil should be investigated.
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Affiliation(s)
- Clément Chollat
- INSERM U1245, Genetics and Pathophysiology of Neurodevelopment Disorders Team, Faculty of Medicine, Institute of Research and Innovation in Biomedicine, Normandy University, Rouen, France.,Neonatal Intensive Care Unit of Port-Royal, Paris Centre University Hospitals, APHP, Paris Descartes University, Paris, France
| | - Maryline Lecointre
- INSERM U1245, Genetics and Pathophysiology of Neurodevelopment Disorders Team, Faculty of Medicine, Institute of Research and Innovation in Biomedicine, Normandy University, Rouen, France
| | - Matthieu Leuillier
- INSERM U1245, Genetics and Pathophysiology of Neurodevelopment Disorders Team, Faculty of Medicine, Institute of Research and Innovation in Biomedicine, Normandy University, Rouen, France
| | - Isabelle Remy-Jouet
- INSERM U1096, Biology Oxidative Stress Systems Platform, Institute for Research and Innovation in Biomedicine, Normandy University, Rouen, France
| | | | - Lénaïg Abily-Donval
- INSERM U1245, Genetics and Pathophysiology of Neurodevelopment Disorders Team, Faculty of Medicine, Institute of Research and Innovation in Biomedicine, Normandy University, Rouen, France.,Department of Neonatal Pediatrics and Intensive Care, Rouen University Hospital, Rouen, France
| | - Yasmina Ramdani
- INSERM U1245, Genetics and Pathophysiology of Neurodevelopment Disorders Team, Faculty of Medicine, Institute of Research and Innovation in Biomedicine, Normandy University, Rouen, France
| | - Vincent Richard
- INSERM U1096, Biology Oxidative Stress Systems Platform, Institute for Research and Innovation in Biomedicine, Normandy University, Rouen, France
| | | | - Bertrand Dureuil
- Department Anesthetics and Intensive Care, Rouen University Hospital, Rouen, France
| | - Stéphane Marret
- INSERM U1245, Genetics and Pathophysiology of Neurodevelopment Disorders Team, Faculty of Medicine, Institute of Research and Innovation in Biomedicine, Normandy University, Rouen, France.,Department of Neonatal Pediatrics and Intensive Care, Rouen University Hospital, Rouen, France
| | - Bruno José Gonzalez
- INSERM U1245, Genetics and Pathophysiology of Neurodevelopment Disorders Team, Faculty of Medicine, Institute of Research and Innovation in Biomedicine, Normandy University, Rouen, France
| | - Sylvie Jégou
- INSERM U1245, Genetics and Pathophysiology of Neurodevelopment Disorders Team, Faculty of Medicine, Institute of Research and Innovation in Biomedicine, Normandy University, Rouen, France
| | - Fabien Tourrel
- INSERM U1245, Genetics and Pathophysiology of Neurodevelopment Disorders Team, Faculty of Medicine, Institute of Research and Innovation in Biomedicine, Normandy University, Rouen, France.,Department Anesthetics and Intensive Care, Rouen University Hospital, Rouen, France
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12
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Chollat C, Joly A, Houivet E, Bénichou J, Marret S. School-age human figure drawings by very preterm infants: Validity of the Draw-a-Man test to detect behavioral and cognitive disorders. Arch Pediatr 2019; 26:220-225. [PMID: 30885603 DOI: 10.1016/j.arcped.2019.02.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 11/07/2018] [Accepted: 02/16/2019] [Indexed: 10/27/2022]
Abstract
Detecting an abnormal developmental trajectory in very preterm infants remains challenging. The objective of this study was to determine the correlation between the Draw-a-Man test (DAMT) and behavioral and cognitive disabilities in very preterm infants. From the school-age follow-up of the Premag study, which evaluated the neuroprotective effect of prenatal magnesium sulfate before 33 weeks of gestation, 281 human figure drawings were assessed (mean age, 11 years). Behavioral and cognitive disabilities were associated with delayed DAMTs but test performance indicators were insufficient to use DAMT as a screening or a diagnostic test.
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Affiliation(s)
- C Chollat
- Department of neonatal pediatrics and intensive care-neuropediatrics, Rouen university hospital, 1, rue de Germont, 76000 Rouen, France; INSERM U1245, Normandie university, UNIROUEN, Rouen university hospital, 22, boulevard Gambetta, 76183 Rouen, France; Department of neonatal intensive care, Port-Royal university hospital, AP-HP, 123, boulevard Port-Royal, 75014 Paris, France.
| | - A Joly
- Department of neonatal pediatrics and intensive care-neuropediatrics, Rouen university hospital, 1, rue de Germont, 76000 Rouen, France
| | - E Houivet
- Department of biostatistics, Rouen university hospital, 1, rue de Germont, 76000 Rouen, France
| | - J Bénichou
- Department of biostatistics, Rouen university hospital, 1, rue de Germont, 76000 Rouen, France; Inserm U657, Rouen university hospital, 1, rue de Germont, 76000 Rouen, France
| | - S Marret
- Department of neonatal pediatrics and intensive care-neuropediatrics, Rouen university hospital, 1, rue de Germont, 76000 Rouen, France; INSERM U1245, Normandie university, UNIROUEN, Rouen university hospital, 22, boulevard Gambetta, 76183 Rouen, France
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13
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Chollat C, Sentilhes L, Marret S. Protection of brain development by antenatal magnesium sulphate for infants born preterm. Dev Med Child Neurol 2019; 61:25-30. [PMID: 30294845 DOI: 10.1111/dmcn.14038] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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] [Accepted: 08/03/2018] [Indexed: 12/28/2022]
Abstract
Cerebral palsy (CP) remains the most significant neurological disorder associated with preterm birth. It disrupts quality of life and places huge cost burdens on society. Antenatal magnesium sulphate administration to females before 32 weeks' gestation has proven to be an effective intervention to reduce the rate of CP. In models of hypoxia, hypoxia-ischemia, inflammation, and excitotoxicity in various animal species, magnesium sulphate preconditioning decreased the resulting lesion sizes and inflammatory cytokine levels, prevented cell death, and improved long-term cognitive and motor behaviours. In humans, meta-analyses of five randomized controlled trials using magnesium sulphate as a neuroprotectant showed prevention of CP at 2 years. The benefit remained consistent regardless of gestational age, cause of preterm birth, and total dose received. Antenatal magnesium sulphate treatment is now recommended by the World Health Organization and by many obstetric societies. Its cost-effectiveness further justifies its widespread implementation. WHAT THIS PAPER ADDS: Neuroprotective effect of magnesium sulphate to reduce cerebral palsy in infants born preterm when administered to females at risk of imminent preterm birth. Neuroprotection regardless of gestational age, cause of preterm birth, and total dose. Antenatal magnesium sulphate treatment has good cost-effectiveness.
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Affiliation(s)
- Clément Chollat
- INSERM U1245, Genetics and Pathophysiology of Neurodevelopmental Disorders, Team 4 Neovasc, Institute of Research and Innovation in Biomedicine, Rouen School of Medicine, Normandy University, Rouen, France.,Department of Neonatal Intensive Care, Port Royal University Hospital, APHP, Paris, France
| | - Loic Sentilhes
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
| | - Stéphane Marret
- INSERM U1245, Genetics and Pathophysiology of Neurodevelopmental Disorders, Team 4 Neovasc, Institute of Research and Innovation in Biomedicine, Rouen School of Medicine, Normandy University, Rouen, France.,Department of Neonatal Paediatrics and Intensive Care and Neuropaediatrics, Charles-Nicolle University Hospital, Rouen, France
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14
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Chollat C, Maroni A, Aubelle MS, Guillier C, Patkai J, Zana-Taïeb E, Keslick A, Torchin H, Jarreau PH. Efficacy and Safety Aspects of Remifentanil Sedation for Intubation in Neonates: A Retrospective Study. Front Pediatr 2019; 7:450. [PMID: 31788457 PMCID: PMC6853995 DOI: 10.3389/fped.2019.00450] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/17/2019] [Indexed: 01/05/2023] Open
Abstract
Objective: To evaluate the efficacy and safety of remifentanil as a premedication in neonates undergoing elective intubation. Study Design: This retrospective study focused on neonates admitted to the Neonatal Intensive Care Unit of Port-Royal, Paris Centre University Hospitals, France, between June 2016 and November 2017, who received remifentanil before an elective intubation. First, atropine (10 μg/kg) was administered intravenously as a bolus, followed by remifentanil, which was administrated continuously. The dose of remifentanil was reduced twice during the study period in order to administer the minimum effective dose and thus reduce possible adverse events. Results: Fifty-four neonates were exposed to remifentanil and atropine. The intubating conditions were excellent or good for 46 procedures (85%) and the median Acute Pain in Newborn Infants score was 2 (IQ 25-75: 0-5) before the sedation, 1 (0-2) during the laryngoscopy, and 0 (0-0) after the intubation. The intubation was successful at the first attempt for 18 patients (33%). Chest wall rigidity occurred in 6 procedures (11%), other respiratory problems in 5 (9%), and laryngospasm in 1 (2%). Some of the procedures were complicated by bradycardia (23%) or desaturation (37%). Conclusions: Remifentanil and atropine prior to intubation provided satisfactory intubating conditions in neonates. Nevertheless, severe adverse effects (such as chest wall rigidity) are a potential risk, possibly related to the total dose received. These data do not support the safety of using remifentanil alone prior to intubation in neonates.
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Affiliation(s)
- Clément Chollat
- Neonatal Intensive Care Unit of Port-Royal, Paris Centre University Hospitals, APHP, Paris Descartes University, Paris, France
| | - Arielle Maroni
- Neonatal Intensive Care Unit of Port-Royal, Paris Centre University Hospitals, APHP, Paris Descartes University, Paris, France
| | - Marie-Stéphanie Aubelle
- Neonatal Intensive Care Unit of Port-Royal, Paris Centre University Hospitals, APHP, Paris Descartes University, Paris, France
| | - Cyril Guillier
- Neonatal Intensive Care Unit of Port-Royal, Paris Centre University Hospitals, APHP, Paris Descartes University, Paris, France
| | - Juliana Patkai
- Neonatal Intensive Care Unit of Port-Royal, Paris Centre University Hospitals, APHP, Paris Descartes University, Paris, France
| | - Elodie Zana-Taïeb
- Neonatal Intensive Care Unit of Port-Royal, Paris Centre University Hospitals, APHP, Paris Descartes University, Paris, France
| | - Aurélie Keslick
- Neonatal Intensive Care Unit of Port-Royal, Paris Centre University Hospitals, APHP, Paris Descartes University, Paris, France
| | - Héloïse Torchin
- Neonatal Intensive Care Unit of Port-Royal, Paris Centre University Hospitals, APHP, Paris Descartes University, Paris, France
| | - Pierre-Henri Jarreau
- Neonatal Intensive Care Unit of Port-Royal, Paris Centre University Hospitals, APHP, Paris Descartes University, Paris, France
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15
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Chollat C, Sentilhes L, Marret S. Fetal Neuroprotection by Magnesium Sulfate: From Translational Research to Clinical Application. Front Neurol 2018; 9:247. [PMID: 29713307 PMCID: PMC5911621 DOI: 10.3389/fneur.2018.00247] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 03/28/2018] [Indexed: 12/12/2022] Open
Abstract
Despite improvements in perinatal care, preterm birth still occurs regularly and the associated brain injury and adverse neurological outcomes remain a persistent challenge. Antenatal magnesium sulfate administration is an intervention with demonstrated neuroprotective effects for preterm births before 32 weeks of gestation (WG). Owing to its biological properties, including its action as an N-methyl-d-aspartate receptor blocker and its anti-inflammatory effects, magnesium is a good candidate for neuroprotection. In hypoxia models, including hypoxia-ischemia, inflammation, and excitotoxicity in various species (mice, rats, pigs), magnesium sulfate preconditioning decreased the induced lesions’ sizes and inflammatory cytokine levels, prevented cell death, and improved long-term behavior. In humans, some observational studies have demonstrated reduced risks of cerebral palsy after antenatal magnesium sulfate therapy. Meta-analyses of five randomized controlled trials using magnesium sulfate as a neuroprotectant showed amelioration of cerebral palsy at 2 years. A meta-analysis of individual participant data from these trials showed an equally strong decrease in cerebral palsy and the combined risk of fetal/infant death and cerebral palsy at 2 years. The benefit remained similar regardless of gestational age, cause of prematurity, and total dose received. These data support the use of a minimal dose (e.g., 4 g loading dose ± 1 g/h maintenance dose over 12 h) to avoid potential deleterious effects. Antenatal magnesium sulfate is now recommended by the World Health Organization and many pediatric and obstetrical societies, and it is requisite to maximize its administration among women at risk of preterm delivery before 32 WG.
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Affiliation(s)
- Clément Chollat
- INSERM U1245, Team 4 Neovasc, School of Medicine of Rouen, Institute of Innovation and Biomedical Research, Normandie University, Rouen, France.,Department of Neonatal Intensive Care, Port-Royal University Hospital, APHP, Paris, France
| | - Loïc Sentilhes
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
| | - Stéphane Marret
- INSERM U1245, Team 4 Neovasc, School of Medicine of Rouen, Institute of Innovation and Biomedical Research, Normandie University, Rouen, France.,Department of Neonatal Pediatrics and Intensive Care - Neuropediatrics, Rouen University Hospital, Rouen, France
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16
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Abstract
Antenatal administration of magnesium sulfate is an important part of the neuroprotective strategy for preterm infants. Strong evidence from five randomized controlled trials and five meta-analyses has demonstrated that magnesium sulfate, when administered before preterm delivery, significantly reduces the risk of cerebral palsy at two years. Through secondary analyses of randomized controlled trials and other original clinical studies, this state-of-the-art review highlights the absence of serious adverse effects in both pregnant women and neonates, as well as the impact of maternal body mass index and preeclamptic status on the maternal and neonatal magnesium levels, which could influence the magnitude of the neuroprotective effect. Although antenatal magnesium sulfate is a cost-effective strategy, some practice surveys have demonstrated that the use of magnesium sulfate is not sufficient and that its use is heterogeneous, differing among different maternity wards. Since 2010, an increasing number of obstetrical societies have recommended its use to improve the neurological outcomes of preterm infants, especially the International Federation of Gynecology and Obstetrics and World Health Organization in 2015, and France in 2017. Considering the neuroprotective impact of magnesium sulfate when administered before delivery, postnatal administration should be considered, and its effects should be assessed using randomized controlled trials.
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Affiliation(s)
- Clément Chollat
- Institut National de la Santé et de la Recherche Médicale U1245, Genetics and Pathophysiology of Neurodevelopmental Disorders, Team 4 Neovasc, Institute of Research and Innovation in Biomedicine, Rouen School of Medicine, Normandy University, Caen; Department of Neonatal Intensive Care, Port Royal University Hospital, Paris, France
| | - Stéphane Marret
- Department of Neonatal Intensive Care, Port Royal University Hospital, Paris; Department of Neonatal Pediatrics and Intensive Care and Neuropediatrics, Charles-Nicolle University Hospital, Rouen, France
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17
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Lecuyer M, Rubio M, Chollat C, Lecointre M, Jégou S, Leroux P, Cleren C, Leroux-Nicollet I, Marpeau L, Vivien D, Marret S, Gonzalez BJ. Experimental and clinical evidence of differential effects of magnesium sulfate on neuroprotection and angiogenesis in the fetal brain. Pharmacol Res Perspect 2017; 5. [PMID: 28805973 PMCID: PMC5684858 DOI: 10.1002/prp2.315] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 01/05/2017] [Accepted: 01/10/2017] [Indexed: 01/25/2023] Open
Abstract
Clinical studies showed beneficial effects of magnesium sulfate regarding the risk of cerebral palsy. However, regimen protocols fluctuate worldwide and risks of adverse effects impacting the vascular system have been reported for human neonates, keeping open the question of the optimal dosing. Using clinically relevant concentrations and doses of magnesium sulfate, experiments consisted of characterizing, respectively, ex vivo and in vivo, the effects of magnesium sulfate on the nervous and vascular systems of mouse neonates by targeting neuroprotection, angiogenesis, and hemodynamic factors and in measuring, in human fetuses, the impact of a 4‐g neuroprotective loading dose of magnesium sulfate on brain hemodynamic parameters. Preclinical experiments using cultured cortical slices from mouse neonates showed that the lowest and highest tested concentrations of magnesium sulfate were equally potent to prevent excitotoxic‐induced cell death, cell edema, cell burst, and intracellular calcium increase, whereas no side effects were found regarding apoptosis. In contrast, in vivo data revealed that magnesium sulfate exerted dose‐dependent vascular effects on the fetal brain. In particular, it induced brain hypoperfusion, stabilization of Hif‐1α, long‐term upregulation of VEGF‐R2 expression, impaired endothelial viability, and altered cortical angiogenesis. Clinically, in contrast to 6‐g loading doses used in some protocols, a 4‐g bolus of magnesium sulfate did not altered fetal brain hemodynamic parameters. In conclusion, these data provide the first mechanistic evidence of double‐sword and dose‐dependent actions of magnesium sulfate on nervous and vascular systems. They strongly support the clinical use of neuroprotection protocols validated for the lowest (4‐g) loading dose of magnesium sulfate.
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Affiliation(s)
- Matthieu Lecuyer
- Normandie University, UNIROUEN, INSERM U1245 NeoVasc Team, Rouen University Hospital, IRIB, F76000 Normandy Centre for Genomic and Personalized Medicine, Rouen, France
| | - Marina Rubio
- INSERM U1237 unit "Serine proteases and Pathophysiology of the neurovascular Unit", Normandy University, Caen, France
| | - Clément Chollat
- Normandie University, UNIROUEN, INSERM U1245 NeoVasc Team, Rouen University Hospital, IRIB, F76000 Normandy Centre for Genomic and Personalized Medicine, Rouen, France.,Department of Neonatal Paediatrics and Intensive Care, Rouen Hospital, Rouen, France.,Department of Neonatal Intensive Care, Port-Royal University Hospital, APHP, Paris, France
| | - Maryline Lecointre
- Normandie University, UNIROUEN, INSERM U1245 NeoVasc Team, Rouen University Hospital, IRIB, F76000 Normandy Centre for Genomic and Personalized Medicine, Rouen, France
| | - Sylvie Jégou
- Normandie University, UNIROUEN, INSERM U1245 NeoVasc Team, Rouen University Hospital, IRIB, F76000 Normandy Centre for Genomic and Personalized Medicine, Rouen, France
| | - Philippe Leroux
- Normandie University, UNIROUEN, INSERM U1245 NeoVasc Team, Rouen University Hospital, IRIB, F76000 Normandy Centre for Genomic and Personalized Medicine, Rouen, France
| | - Carine Cleren
- Normandie University, UNIROUEN, INSERM U1245 NeoVasc Team, Rouen University Hospital, IRIB, F76000 Normandy Centre for Genomic and Personalized Medicine, Rouen, France
| | - Isabelle Leroux-Nicollet
- Normandie University, UNIROUEN, INSERM U1245 NeoVasc Team, Rouen University Hospital, IRIB, F76000 Normandy Centre for Genomic and Personalized Medicine, Rouen, France
| | - Loic Marpeau
- Normandie University, UNIROUEN, INSERM U1245 NeoVasc Team, Rouen University Hospital, IRIB, F76000 Normandy Centre for Genomic and Personalized Medicine, Rouen, France.,Department of Obstetrics, Rouen Hospital, Rouen, France
| | - Denis Vivien
- INSERM U1237 unit "Serine proteases and Pathophysiology of the neurovascular Unit", Normandy University, Caen, France
| | - Stéphane Marret
- Normandie University, UNIROUEN, INSERM U1245 NeoVasc Team, Rouen University Hospital, IRIB, F76000 Normandy Centre for Genomic and Personalized Medicine, Rouen, France.,Department of Neonatal Paediatrics and Intensive Care, Rouen Hospital, Rouen, France
| | - Bruno J Gonzalez
- Normandie University, UNIROUEN, INSERM U1245 NeoVasc Team, Rouen University Hospital, IRIB, F76000 Normandy Centre for Genomic and Personalized Medicine, Rouen, France
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le ray C, Valéry S, Delorme P, Chollat C, Lepercq J, Goffinet F. 398: Should preterm prom between 24 and 34 weeks of gestation be managed with home care? a before-and-after study in a tertiary center. Am J Obstet Gynecol 2017. [DOI: 10.1016/j.ajog.2016.11.656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Chollat C, Tourrel F, Marret S. Does Remifentanil Have a Place for Sedation in the Case of Endotracheal Intubation or Minimally Invasive Surfactant Therapy in Neonates? Neonatology 2017; 112:372-373. [PMID: 28866673 DOI: 10.1159/000479622] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 07/20/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Clément Chollat
- Department of Neonatal Intensive Care, Port-Royal Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
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Marret S, Jadas V, Kieffer A, Chollat C, Rondeau S, Chadie A. [Treatment of encephalopathy by hypothermia in the term newborn]. Arch Pediatr 2014; 21:1026-34. [PMID: 25080834 DOI: 10.1016/j.arcped.2014.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 05/31/2014] [Accepted: 06/17/2014] [Indexed: 11/25/2022]
Abstract
Criteria defining the involvement of severe perinatal anoxia in neonatal encephalopathy in at-term newborns at birth are stringent and are rarely all present. The simultaneous action of pre- and intrapartum factors preceding neonatal hypoxic-ischemic encephalopathy are often observed. Cooling is recommended as there is evidence that it reduces mortality without increasing major disability in survivors. It must be conducted following strict clinical and electroencephalographic criteria. Other strategies for brain protection remain difficult to establish. Follow-up must be long enough to detect cognitive deficiencies, which are frequent, even if cerebral palsy is not observed.
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Affiliation(s)
- S Marret
- Service de pédiatrie néonatale et réanimation, neuropédiatrie, centre de référence des troubles apprentissages, Camsp, hôpital Charles-Nicolle, CHU de Rouen, 1, rue de Germont, 76000 Rouen, France; Équipe Inserm, région (ERI28), Neovasc handicap périnatal, faculté de médecine et de pharmacie, université de Normandie, institut de recherche et d'innovation biomédicale, 76183 Rouen cedex, France.
| | - V Jadas
- Service de pédiatrie néonatale et réanimation, neuropédiatrie, centre de référence des troubles apprentissages, Camsp, hôpital Charles-Nicolle, CHU de Rouen, 1, rue de Germont, 76000 Rouen, France; Équipe Inserm, région (ERI28), Neovasc handicap périnatal, faculté de médecine et de pharmacie, université de Normandie, institut de recherche et d'innovation biomédicale, 76183 Rouen cedex, France
| | - A Kieffer
- Service de pédiatrie néonatale et réanimation, neuropédiatrie, centre de référence des troubles apprentissages, Camsp, hôpital Charles-Nicolle, CHU de Rouen, 1, rue de Germont, 76000 Rouen, France; Équipe Inserm, région (ERI28), Neovasc handicap périnatal, faculté de médecine et de pharmacie, université de Normandie, institut de recherche et d'innovation biomédicale, 76183 Rouen cedex, France
| | - C Chollat
- Service de pédiatrie néonatale et réanimation, neuropédiatrie, centre de référence des troubles apprentissages, Camsp, hôpital Charles-Nicolle, CHU de Rouen, 1, rue de Germont, 76000 Rouen, France; Équipe Inserm, région (ERI28), Neovasc handicap périnatal, faculté de médecine et de pharmacie, université de Normandie, institut de recherche et d'innovation biomédicale, 76183 Rouen cedex, France
| | - S Rondeau
- Service de pédiatrie néonatale et réanimation, neuropédiatrie, centre de référence des troubles apprentissages, Camsp, hôpital Charles-Nicolle, CHU de Rouen, 1, rue de Germont, 76000 Rouen, France; Équipe Inserm, région (ERI28), Neovasc handicap périnatal, faculté de médecine et de pharmacie, université de Normandie, institut de recherche et d'innovation biomédicale, 76183 Rouen cedex, France
| | - A Chadie
- Service de pédiatrie néonatale et réanimation, neuropédiatrie, centre de référence des troubles apprentissages, Camsp, hôpital Charles-Nicolle, CHU de Rouen, 1, rue de Germont, 76000 Rouen, France; Équipe Inserm, région (ERI28), Neovasc handicap périnatal, faculté de médecine et de pharmacie, université de Normandie, institut de recherche et d'innovation biomédicale, 76183 Rouen cedex, France
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Chollat C, Enser M, Houivet E, Provost D, Bénichou J, Marpeau L, Marret S. School-age outcomes following a randomized controlled trial of magnesium sulfate for neuroprotection of preterm infants. J Pediatr 2014; 165:398-400.e3. [PMID: 24837863 DOI: 10.1016/j.jpeds.2014.04.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [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: 12/11/2013] [Revised: 03/14/2014] [Accepted: 04/03/2014] [Indexed: 11/19/2022]
Abstract
In a French randomized trial, children at school-age demonstrated no evidence of harm from fetal exposure to MgSO4 before very preterm birth. Motor dysfunction/death, qualitative behavioral disorders, cognitive difficulties, school grade repetition, and education services were decreased in the children exposed to MgSO4, although the differences were not significant.
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Affiliation(s)
- Clément Chollat
- Department of Neonatal Pediatrics and Intensive Care, Rouen University Hospital, Rouen, France; Region INSERM Team 28 "NeoVasc", Laboratory of Microvascular Endothelium and Neonate Brain Lesions, Institute for Biomedical Research, Rouen University, Rouen, France.
| | - Maya Enser
- Department of Anesthetics and Intensive Care, Rouen University Hospital, Rouen, France
| | - Estelle Houivet
- Department of Biostatistics, Rouen University Hospital, Rouen, France
| | - Delphine Provost
- Department of Anesthetics and Intensive Care, Rouen University Hospital, Rouen, France
| | - Jacques Bénichou
- Department of Biostatistics, Rouen University Hospital, Rouen, France
| | - Loïc Marpeau
- Region INSERM Team 28 "NeoVasc", Laboratory of Microvascular Endothelium and Neonate Brain Lesions, Institute for Biomedical Research, Rouen University, Rouen, France; Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen, France
| | - Stéphane Marret
- Department of Neonatal Pediatrics and Intensive Care, Rouen University Hospital, Rouen, France; Region INSERM Team 28 "NeoVasc", Laboratory of Microvascular Endothelium and Neonate Brain Lesions, Institute for Biomedical Research, Rouen University, Rouen, France
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Marret S, Pinto-Cardoso G, Abily-Donval L, Chadié A, Torre S, de Quelen R, Chollat C, Charollais A, Ancel PY. Repères dans le développement neurologique de l’enfant prématuré. Arch Pediatr 2014. [DOI: 10.1016/s0929-693x(14)71569-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Tourrel F, de Lendeu PK, Abily-Donval L, Chollat C, Marret S, Dufrasne F, Compagnon P, Ramdani Y, Dureuil B, Laudenbach V, Gonzalez BJ, Jégou S. The Antiapoptotic Effect of Remifentanil on the Immature Mouse Brain. Anesth Analg 2014; 118:1041-51. [DOI: 10.1213/ane.0000000000000159] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Jadas V, Brasseur-Daudruy M, Chollat C, Pellerin L, Devaux AM, Marret S. [The contribution of the clinical examination, electroencephalogram, and brain MRI in assessing the prognosis in term newborns with neonatal encephalopathy. A cohort of 30 newborns before the introduction of treatment with hypothermia]. Arch Pediatr 2013; 21:125-33. [PMID: 24374026 DOI: 10.1016/j.arcped.2013.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 09/16/2013] [Accepted: 11/19/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Perinatal asphyxia complicated by hypoxic ischemic brain injury remains a source of neurological lesions. A major aim of neonatologists is to evaluate the severity of neonatal encephalopathy (NE) and to evaluate prognosis. The purpose of this study was to determine the contribution of brain MRI compared to electroencephalogram (EEG) and clinical data in assessing patients' prognosis. MATERIALS AND METHODS Thirty newborns from the pediatric resuscitation unit at Rouen university hospital were enrolled in a retrospective study between January 2006 and December 2008, prior to introduction of hypothermia treatment. All 30 newborns had at least two anamnestic criteria of perinatal asphyxia, one brain MRI in the first 5 days of life and another after 7 days of life as well as an early EEG in the first 2 days of life. Then, the infants were seen in consultation to assess neurodevelopment. RESULTS This study showed a relation between NE stage and prognosis. During stage 1, prognosis was good, whereas stage 3 was associated with poor neurodevelopment outcome. Normal clinical examination before the 8th day of life was a good prognostic factor in this study. There was a relationship between severity of EEG after the 5th day of life and poor outcome. During stage 2, EEG patterns varied in severity, and brain MRI provided a better prognosis. Lesions of the basal ganglia and a decreased or absent signal of the posterior limb of the internal capsule were poor prognostic factors during brain MRI. These lesions were underestimated during standard MRI in the first days of life but were visible with diffusion sequences. Cognitive impairment affected 40% of surviving children, justifying extended pediatric follow-up. CONCLUSION This study confirms the usefulness of brain MRI as a diagnostic tool in hypoxic ischemic encephalopathy in association with clinical data and EEG tracings.
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Affiliation(s)
- V Jadas
- Service de pédiatrie néonatale et réanimation, centre d'éducation fonctionnelle de l'enfant, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France; Équipe région-Inserm EA 4309 Neovasc handicap neurologique périnatal, IRIB, faculté de médecine et pharmacie, université de Rouen, 76000 Rouen, France.
| | - M Brasseur-Daudruy
- Service de radiologie pédiatrique, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - C Chollat
- Service de pédiatrie néonatale et réanimation, centre d'éducation fonctionnelle de l'enfant, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France; Équipe région-Inserm EA 4309 Neovasc handicap neurologique périnatal, IRIB, faculté de médecine et pharmacie, université de Rouen, 76000 Rouen, France
| | - L Pellerin
- Service de pédiatrie générale, CHU de Caen, 14200 Caen, France
| | - A M Devaux
- Service de pédiatrie néonatale et réanimation, centre d'éducation fonctionnelle de l'enfant, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France; Équipe région-Inserm EA 4309 Neovasc handicap neurologique périnatal, IRIB, faculté de médecine et pharmacie, université de Rouen, 76000 Rouen, France
| | - S Marret
- Service de pédiatrie néonatale et réanimation, centre d'éducation fonctionnelle de l'enfant, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France; Équipe région-Inserm EA 4309 Neovasc handicap neurologique périnatal, IRIB, faculté de médecine et pharmacie, université de Rouen, 76000 Rouen, France
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