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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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Lemoine S, Chabernaud JL, Jost D, Prunet B. Re: Family presence during resuscitation in paediatric cardiac arrest: A systematic review. Offering parents the choice to view resuscitation of their child in case of sudden cardiac arrest. Resuscitation 2021; 164:153-154. [PMID: 33971267 DOI: 10.1016/j.resuscitation.2021.03.039] [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] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 03/02/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Sabine Lemoine
- Paris Fire Brigade Medical Emergency Department, Paris, France.
| | - Jean-Louis Chabernaud
- Delegate for International Relations, Paris-Saclay University, Antoine-Béclère Hospital, Assistance Publique-Hôpitaux de Paris, Clamart, France
| | - Daniel Jost
- Paris Fire Brigade Medical Emergency Department, Paris, France; Sudden Death Expertise Center (SDEC), INSERM U970, Paris, France
| | - Bertrand Prunet
- Paris Fire Brigade Medical Emergency Department, Paris, France
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Javaudin F, Roche M, Trutt L, Bunker I, Hamel V, Goddet S, Templier F, Potiron C, Le Bastard Q, Pes P, Bagou G, Chabernaud JL, Montassier E, Leclère B. Assessment of rewarming methods in unplanned out-of-hospital births from a prospective cohort. Scand J Trauma Resusc Emerg Med 2020; 28:50. [PMID: 32493456 PMCID: PMC7271438 DOI: 10.1186/s13049-020-00750-9] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 05/28/2020] [Indexed: 01/21/2023] Open
Abstract
Background Mobile intensive care units frequently manage unplanned out-of-hospital births (UOHB). Rewarming methods during pre-hospital management of UOHB have not yet been compared. The aim was to compare rewarming methods used during pre-hospital management in a large prospective cohort of UOHB in France. Methods We analysed UOHB from the prospective AIE cohort from 25 prehospital emergency medical services in France. The primary outcome was the change in body temperature from arrival at scene to arrival at hospital. Results From 2011 to 2018, 1854 UOHB were recorded, of whom 520 were analysed. We found that using incubator care was the most effective rewarming method (+ 0.8 °C during transport), followed by the combination of plastic bag, skin-to-skin and cap (+ 0.2 °C). The associations plastic bag + cap and skin-to-skin + cap did not allow the newborn to be warmed up but rather to maintain initial temperature (+ 0.0 °C). The results of the multivariate model were consistent with these observations, with better rewarming with the use of an incubator. We also identified circumstances of increased risk of hypothermia according to classification and regression tree, like premature birth (< 37 weeks of gestation) and/or low outside temperature (< 8.4 °C). Conclusions Using an incubator was the most effective rewarming method during pre-hospital management of UOHB in our French prospective cohort. Based on our model, in cases of term less than 37 weeks of gestation or between 37 and 40 weeks with a low outside temperature or initial hypothermia, using such a method would be preferred.
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Affiliation(s)
- François Javaudin
- Department of Emergency Medicine, University Hospital of Nantes, Nantes, France. .,MiHAR lab, University of Nantes, Nantes, France.
| | - Mélodie Roche
- Department of Emergency Medicine, District Hospital Centre, La Roche-sur-Yon, France
| | - Lucile Trutt
- Department of Medical Evaluation and Epidemiology, University Hospital of Nantes, Nantes, France
| | - Isabelle Bunker
- Pediatric Intensive Care Unit, University Hospital of Nantes, Nantes, France
| | - Valérie Hamel
- Department of Emergency Medicine, Toulouse Purpan University Hospital, Toulouse, France
| | - Sybille Goddet
- Department of Emergency Medicine, University Hospital of Dijon, Dijon, France
| | - François Templier
- Department of Emergency Medicine, University Hospital of Angers, Angers, France
| | - Christine Potiron
- Department of Emergency Medicine, University Hospital of Nantes, Nantes, France
| | - Quentin Le Bastard
- Department of Emergency Medicine, University Hospital of Nantes, Nantes, France.,MiHAR lab, University of Nantes, Nantes, France
| | - Philippe Pes
- Department of Emergency Medicine, University Hospital of Nantes, Nantes, France
| | - Gilles Bagou
- Department of Emergency Medicine, University Hospital of Lyon, Lyon, France
| | - Jean-Louis Chabernaud
- Neonatal Emergency Transport Team, SAMU 92, Neonatal Intensive Care Unit, South-Paris University Hospitals (AP-HP), A. Béclère Clamart University Hospital, Paris, France
| | - Emmanuel Montassier
- Department of Emergency Medicine, University Hospital of Nantes, Nantes, France.,MiHAR lab, University of Nantes, Nantes, France
| | - Brice Leclère
- MiHAR lab, University of Nantes, Nantes, France.,Department of Medical Evaluation and Epidemiology, University Hospital of Nantes, Nantes, France
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Lemoine S, Chabernaud JL, Travers S, Prunet B. COVID-19 in pediatric patients: What the prehospital teams need to know. Arch Pediatr 2020; 27:281-282. [PMID: 32402434 PMCID: PMC7200380 DOI: 10.1016/j.arcped.2020.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/25/2020] [Accepted: 05/02/2020] [Indexed: 01/27/2023]
Affiliation(s)
- Sabine Lemoine
- Paris Fire Brigade Medical Emergency Department, 1, place Jules-Renard, 75017 Paris, France.
| | - Jean-Louis Chabernaud
- Délégation aux relations internationales, université Paris-Saclay, hôpital Antoine-Béclère, groupe hospitalo-universitaire (GHU), AP-HP, 157, rue Porte-de-Trivaux, 92140 Clamart, France
| | - Stephane Travers
- Paris Fire Brigade Medical Emergency Department, 1, place Jules-Renard, 75017 Paris, France
| | - Bertrand Prunet
- Paris Fire Brigade Medical Emergency Department, 1, place Jules-Renard, 75017 Paris, France
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Combier E, Roussot A, Chabernaud JL, Cottenet J, Rozenberg P, Quantin C. Out-of-maternity deliveries in France: A nationwide population-based study. PLoS One 2020; 15:e0228785. [PMID: 32092074 PMCID: PMC7039464 DOI: 10.1371/journal.pone.0228785] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/22/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction In France, many maternity hospitals have been closed as a result of hospital restructuring in an effort to reduce costs through economies of scale. These closures have naturally increased the distance between home and the closest maternity ward for women throughout the country. However, studies have shown a positive correlation between this increase in distance and the incidence of unplanned out-of-maternity deliveries (OMD). This study was conducted to estimate the frequency of OMD in France, to identify the main risk factors and to assess their impact on maternal mortality and neonatal morbidity and mortality. Materials and methods We conducted a population-based observational retrospective study using data from 2012 to 2014 obtained from the French hospital discharge database. We included 2,256,797 deliveries and 1,999,453 singleton newborns in mainland France, among which, 6,733 (3.0‰) were OMD. The adverse outcomes were maternal mortality in hospital or during transport, stillbirth, neonatal mortality, neonatal hospitalizations, and newborn hypothermia and polycythemia. The socio-residential environment was also included in the regression analysis. Maternal and newborn adverse outcomes associated with OMD were analyzed with Generalized Estimating Equations regressions. Results The distance to the nearest maternity unit was the main factor for OMD. OMD were associated with maternal death (aRR 6.5 [1.6–26.3]) and all of the neonatal adverse outcomes: stillbirth (3.3 [2.8–3.8]), neonatal death (1.9 [1.2–3.1]), neonatal hospitalization (1.2 [1.1–1.3]), newborn hypothermia (5.9 [5.2–6.6]) and newborn polycythemia (4.8 [3.5–6.4]). Discussion In France, OMD increased over the study period. OMD were associated with all the adverse outcomes studied for mothers and newborns. Caregivers, including emergency teams, need to be better prepared for the management these at-risk cases. Furthermore, the increase in adverse outcomes, and the additional generated costs, should be considered carefully by the relevant authorities before any decisions are made to close or merge existing maternity units.
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Affiliation(s)
- Evelyne Combier
- Biostatistics and Bioinformatics (DIM), Inserm, France University Hospital, Bourgogne Franche-Comté University, Dijon, France
| | - Adrien Roussot
- Biostatistics and Bioinformatics (DIM), Inserm, France University Hospital, Bourgogne Franche-Comté University, Dijon, France
| | - Jean-Louis Chabernaud
- Neonatal and Pediatric Emergency Transport Team and NICU, Antoine-Beclere Hospital, AP-HP, Paris Saclay University, Clamart, France
| | - Jonathan Cottenet
- Biostatistics and Bioinformatics (DIM), Inserm, France University Hospital, Bourgogne Franche-Comté University, Dijon, France
| | - Patrick Rozenberg
- Versailles Saint-Quentin University, Department of Obstetrics and Gynecology, Poissy-Saint Germain Hospital, Poissy, France
| | - Catherine Quantin
- Biostatistics and Bioinformatics (DIM), Inserm, France University Hospital, Bourgogne Franche-Comté University, Dijon, France
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), INSERM, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
- * E-mail:
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6
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Carbajal R, Lode N, Ayachi A, Chouakri O, Henry-Larzul V, Kessous K, Normand A, Courtois E, Rousseau J, Cimerman P, Chabernaud JL. Premedication practices for tracheal intubation in neonates transported by French medical transport teams: a prospective observational study. BMJ Open 2019; 9:e034052. [PMID: 31727669 PMCID: PMC6886912 DOI: 10.1136/bmjopen-2019-034052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Premedication practices for neonatal tracheal intubations have not yet been described for neonatal transport teams. Our objective is to describe the use of sedation/analgesia (SA) for tracheal intubations and to assess its tolerance in neonates transported by medical transport teams in France. SETTING This prospective observational study was part of the EPIPPAIN 2 project and collected around-the-clock data on SA practices in neonates intubated by all five paediatric medical transport teams of the Paris region during a 2-month period. Intubations were classified as emergent, semiemergent and non-emergent. Sedation level and conditions of intubation were assessed with the Tonus, Reactivity, Awareness and Conditions of intubation to Help in Endotracheal intubation Assessment (TRACHEA score). The scores range from 0 to 10 representing an increasing ladder from adequate to inadequate sedation, and from excellent to very poor conditions of intubation. PARTICIPANTS 40 neonates intubated in 28 different centres. RESULTS The mean (SD) age was 34.9 (3.9) weeks, and 62.5% were intubated in the delivery room. 30/40 (75%) of intubations were performed with the use of SA. In 18/30 (60.0%) intubations performed with SA, the drug regimen was the association of sufentanil and midazolam. Atropine was given in 19/40 intubations. From the 16, 21 and 3 intubations classified as emergent, semiemergent and non-emergent, respectively, 8 (50%), 19 (90.5%) and 3 (100%) were performed with SA premedication. 79.3% of intubations performed with SA had TRACHEA scores of 3 or less. 22/40 (55%) infants had at least one of the following adverse events: muscle rigidity, bradycardia below 100/min, desaturation below 80% and nose or pharynx-larynx bleeding. 7/24 (29.2%) of those who had only one attempt presented at least one of these adverse events compared with 15/16 (93.8%) of those who needed two or more attempts (p<0.001). CONCLUSION SA premedication is largely feasible for tracheal intubations performed in neonates transported by medical transport teams including intubations judged as emergent or semiemergent. TRIAL REGISTRATION NUMBER NCT01346813; Results.
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Affiliation(s)
- Ricardo Carbajal
- Service des Urgences Pédiatriques, Hôpital Trousseau, Paris, France
- Médecine Sorbonne Université, INSERM UMR 1153 Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Paris, France
| | - Noella Lode
- Neonatal Transport Team, SMUR Pédiatrique, Hôpital Robert Debré, SAMU de Paris (AP-HP), Paris, France
| | - Azzedine Ayachi
- Neonatal Transport Team, SMUR Pédiatrique, SAMU de Seine Saint Denis (AP-HP), Montreuil, France
| | - Ourida Chouakri
- Neonatal Transport Team, SMUR Pédiatrique Necker, Hôpital Necker, SAMU de Paris (AP-HP), Paris, France
| | | | - Katia Kessous
- Neonatal Transport Team, SMUR Pédiatrique, Hôpital Robert Debré, SAMU de Paris (AP-HP), Paris, France
| | - Audrey Normand
- Neonatal Transport Team, SMUR Pédiatrique, Hôpital Antoine Béclère, SAMU des Hauts de Seine, Hôpitaux Universitaires Paris-Sud (AP-HP), Clamart, Hauts de Seine, France
| | - Emilie Courtois
- Paediatric Emergency Department, Assitance Publique-Hôpitaux de Paris, Paris, France
| | - Jessica Rousseau
- INSERM UMR 1153 Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Paris, France
| | - Patricia Cimerman
- Centre National de Ressources de Lutte Contre la Douleur, Hopital Armand Trousseau, Paris, France
| | - Jean-Louis Chabernaud
- Neonatal Transport Team, SMUR Pédiatrique, Hôpital Antoine Béclère, SAMU des Hauts de Seine, Hôpitaux Universitaires Paris-Sud (AP-HP), Clamart, Hauts de Seine, France
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Lemoine S, Chabernaud JL, Briche F, Renard A, Jost D, Tourtier JP. Re: Gulati et al.'s article "Presetting ECG electrodes for earlier heart rate detection in the delivery room.": Prehospital use of ECG electrodes by nonmedical emergency professionals: An additional source of help during unexpected out-of-hospital births. Resuscitation 2019; 132:e1. [PMID: 30316519 DOI: 10.1016/j.resuscitation.2018.05.029] [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] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 05/23/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Sabine Lemoine
- Paris Fire Brigade Medical Emergency Department, Paris, France.
| | - Jean-Louis Chabernaud
- Division of Pediatrics and Neonatal Critical Care, FAME Department, South Paris University Hospitals, "A. Beclere" Medical Center - APHP, Paris, France
| | | | - Aurelien Renard
- Military Teaching Hospital, HIA Sainte Anne, Emergency Department, Toulon, France
| | - Daniel Jost
- Paris Fire Brigade Medical Emergency Department, Paris, France; Sudden Death Expertise Center (SDEC), INSERM U970, Paris, France
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Bonnet C, Chabernaud JL. [We must retain the right to give birth anonymously!]. Rev Prat 2019; 69:247-250. [PMID: 30983245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Lemoine S, Jost D, Chabernaud JL, Tourtier JP. Reply to Letter: Re: Dell'Orto et al.'s letter "Feasibility of whole body hypothermia for neonates without congenital heart defects surviving in-hospital cardiac arrest unrelated to perinatal asphyxia": Whole-Body hypothermia after In-Hospital cardiac arrest. reply to Dell'Orto et al. Resuscitation 2017; 119:e9. [PMID: 28789989 DOI: 10.1016/j.resuscitation.2017.07.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 07/31/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Sabine Lemoine
- Paris Fire Brigade Medical Emergency Department, 1 place Jules Renard, 75 017 Paris, France.
| | - Daniel Jost
- Paris Fire Brigade Medical Emergency Department, Paris, France; Sudden Death Expertise Center (SDEC), INSERM U970, Paris, France
| | - Jean-Louis Chabernaud
- Division of Pediatrics and Neonatal Critical Care, South Paris University Hospitals, "A. Béclere" Medical Center- APHP, Paris, France
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Sellam A, Lode N, Ayachi A, Jourdain G, Chabernaud JL, Dauger S, Jones P. Correction: Passive hypothermia (≥35 - <36°C) during transport of newborns with hypoxic-ischaemic encephalopathy. PLoS One 2017; 12:e0179068. [PMID: 28562652 PMCID: PMC5451081 DOI: 10.1371/journal.pone.0179068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Bélondrade P, Lefort H, Bertho K, Perrochon JC, Jost D, Tourtier JP, Chabernaud JL. Guidelines for care of the newborn baby at birth knowledge by prehospital emergency physicians. Anaesth Crit Care Pain Med 2015; 35:17-23. [PMID: 29610057 DOI: 10.1016/j.accpm.2015.06.004] [Citation(s) in RCA: 4] [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: 09/03/2014] [Accepted: 06/16/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION In 2010, the International Liaison Committee On Resuscitation (ILCOR) guidelines for care of the newborn baby immediately after birth were published. MATERIALS AND METHODS Using a questionnaire that was distributed to a sample of 44 prehospital emergency physicians (April 2014), we assessed knowledge of these guidelines, in particular specificities for newborns as compared to adults. Twenty-five questions, starting with a birth with no problems to one resulting in neonatal distress, were used to profile the practice of the surveyed physicians. RESULTS Among the solicited physicians, 30 responded to the questionnaire (68%). Priority was given to efficient respiratory resuscitation during the first minutes of extrauterine life and the difficulties of newborn respiratory adaptation are well-known, but their implementation remains imperfectly understood. The assessment showed very mixed results, partly explained by the low frequency of newborn scenarios experienced by the practitioners who responded to the questionnaire. CONCLUSION To move from guidelines to their practical implementation is always delicate, with room for improvement such as continuing education, knowledge assessment and practice in the context of a quality approach. Well accepted, this evaluation process could be renewed upon publication of the next guidelines on this subject, thus contributing to their knowledge.
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Affiliation(s)
- Pascal Bélondrade
- Service des urgences/Samu, Centre hospitalier de Cayenne, rue des Flamboyants, BP 6006, 97300 Cayenne, France
| | - Hugues Lefort
- Service médical d'urgence, Brigade de sapeurs-pompiers de Paris, 1, place Jules-Renard, 75017 Paris, France.
| | - Kilian Bertho
- Antenne médicale spécialisée de Satory, 34, rue de la Martinière, 78000 Versailles, France
| | | | - Daniel Jost
- Service médical d'urgence, Brigade de sapeurs-pompiers de Paris, 1, place Jules-Renard, 75017 Paris, France
| | - Jean-Pierre Tourtier
- Service médical d'urgence, Brigade de sapeurs-pompiers de Paris, 1, place Jules-Renard, 75017 Paris, France
| | - Jean-Louis Chabernaud
- Smur pédiatrique (Samu 92), Pôle FAME, Hôpital Antoine-Béclère, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France
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12
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Gortner L, Misselwitz B, Milligan D, Zeitlin J, Kollée L, Boerch K, Agostino R, Van Reempts P, Chabernaud JL, Bréart G, Papiernik E, Jarreau PH, Carrapato M, Gadzinowski J, Draper E. Rates of bronchopulmonary dysplasia in very preterm neonates in Europe: results from the MOSAIC cohort. Neonatology 2011; 99:112-7. [PMID: 20733331 DOI: 10.1159/000313024] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Accepted: 04/08/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND A considerable local variability in the rate of bronchopulmonary dysplasia (BPD) has been recorded previously. OBJECTIVES The objectives of the present study were to describe regional differences in the rate of BPD in very preterm neonates from a European population-based cohort and to further delineate risk factors. METHODS 4,185 survivors to 36 weeks' postmenstrual age of 4,984 live-born infants born at 24+0-31+6 weeks' gestation in 2003 (the MOSAIC cohort) in 10 European regions were enrolled using predefined structured questionnaires. RESULTS Overall median gestational age of preterms without BPD was 30 weeks (range 23-31), median birth weight 1,320 g (range 490-3,150) compared with 27 weeks (23-31) and 900 g (370-2,460) in those with BPD. The region-specific crude rate of BPD ranged from 10.2% (Italian region) to 24.8% (UK Northern region). Maternal hypertension, immaturity, male gender, small for gestational age, Apgar <7 and region of care were associated with an increased incidence of BPD on multivariate analysis. CONCLUSION A wide variability of BPD between European regions may be explained by different local practices; the strongest association however was with degree of immaturity.
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Affiliation(s)
- Ludwig Gortner
- Pediatric University Hospital, University of Saarland, Homburg, Germany.
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13
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Viallard ML, Suc A, De Broca A, Bétrémieux P, Hubert P, Parat S, Chabernaud JL, Canouï P, Porée N, Wood C, Mazouz W, Blanchet V, Aubry R. Modalités pratiques d’une sédation en phase terminale ou en fin de vie en pédiatrie : prise de décision, mise en œuvre et surveillance. Médecine Palliative : Soins de Support - Accompagnement - Éthique 2010. [DOI: 10.1016/j.medpal.2010.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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14
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Zeitlin J, Draper ES, Kollée L, Milligan D, Boerch K, Agostino R, Gortner L, Van Reempts P, Chabernaud JL, Gadzinowski J, Bréart G, Papiernik E. Differences in rates and short-term outcome of live births before 32 weeks of gestation in Europe in 2003: results from the MOSAIC cohort. Pediatrics 2008; 121:e936-44. [PMID: 18378548 DOI: 10.1542/peds.2007-1620] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Advances in perinatal medicine increased survival after very preterm birth in all countries, but comparative population-based data on these births are not readily available. This analysis contrasts the rates and short-term outcome of live births before 32 weeks of gestation in 10 European regions. METHODS The Models of Organizing Access to Intensive Care for Very Preterm Births (MOSAIC) study collected prospective data on all very preterm births in 10 European regions covering 494,463 total live births in 2003. The analysis sample was live births between 24 and 31 weeks of gestation without lethal congenital anomalies (N = 4908). Outcomes were rates of preterm birth, in-hospital mortality, intraventricular hemorrhage grades III and IV or cystic periventricular leukomalacia and bronchopulmonary dysplasia. Mortality and morbidity rates were standardized for gestational age and gender. RESULTS Live births between 24 and 31 weeks of gestation were 9.9 per 1000 total live births with a range from 7.6 to 13.0 in the MOSAIC regions. Standardized mortality was doubled in high versus low mortality regions (18%-20% vs 7%-9%) and differed for infants < or = 28 weeks of gestation as well as 28 to 31 weeks of gestation. Morbidity among survivors also varied (intraventricular hemorrhage/periventricular leukomalacia ranged from 2.6% to < or = 10% and bronchopulmonary dysplasia from 10.5% to 21.5%) but differed from mortality rankings. A total of 85.2 very preterm infants per 10,000 total live births were discharged from the hospital alive with a range from 64.1 to 117.1; the range was 10 to 31 per 10,000 live births for infants discharged with a diagnosis of neurologic or respiratory morbidity. CONCLUSIONS Very preterm mortality and morbidity differed between European regions, raising questions about variability in treatment provided to these infants. Comparative follow-up studies are necessary to evaluate the impact of these differences on rates of cerebral palsy and other disabilities associated with preterm birth.
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Affiliation(s)
- Jennifer Zeitlin
- Department of Obstetrics and Gynecology, INSERM, UMR S149, Epidemiological Research Unit on Perinatal and Women's Health, and Université Pierre et Marie Curie-Paris6, Paris, France.
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15
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Zeitlin J, Gwanfogbe CD, Delmas D, Pilkington H, Jarreau PH, Chabernaud JL, Bréart G, Papiernik E. Risk factors for not delivering in a level III unit before 32 weeks of gestation: results from a population-based study in Paris and surrounding districts in 2003. Paediatr Perinat Epidemiol 2008; 22:126-35. [PMID: 18298686 DOI: 10.1111/j.1365-3016.2007.00921.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [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: 11/27/2022]
Abstract
Delivery of very preterm babies in maternity units with on-site neonatal intensive care (level III units) is associated with lower mortality and morbidity. This analysis explores risk factors for not delivering in a level III unit, using data from a population-based study of very preterm births in Paris and surrounding districts in 2003. The sample for analysis included resident women with a fetus alive at the onset of labour between 24 and 31 weeks of gestation (n = 641). Characteristics of women delivering in and those not in level III units were compared using logistic regression. Further analysis was carried out for the subgroup of women not already scheduled to deliver in a level III unit. Twenty-nine per cent of women did not deliver in level III units; in the subgroup scheduled to deliver in level I or II units, 43% were not transferred. Women were less likely to deliver in a level III unit if they had a singleton pregnancy, a gestation of <26 weeks or at 31 weeks, experienced antenatal haemorrhaging, lived in socially deprived neighbourhoods or at a greater distance from the nearest level III. Women scheduled to deliver in a maternity unit with a special care nursery were also less likely to deliver in a level III unit. In contrast, preterm rupture of membranes and fetal growth restriction increased the likelihood of a level III delivery. These results underline the importance of controlling for clinical characteristics when analysing perinatal outcome by place of delivery and show how socioeconomic factors, known to impact on the risk of having a preterm birth, can also affect access to appropriate care.
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Affiliation(s)
- Jennifer Zeitlin
- INSERM, UMR S149, Epidemiological Research Unit on Perinatal and Women's Health, and Université Pierre et Marie Curie-Paris 6, Paris, France.
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16
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Chanzy S, Msélati JC, Jourdain G, Chabernaud JL. Infection néonatale à coxsackie B avec myocardite fulminante, après une sortie précoce de maternité. Arch Pediatr 2005; 12:618-9. [PMID: 15885556 DOI: 10.1016/j.arcped.2005.02.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2005] [Accepted: 02/23/2005] [Indexed: 11/26/2022]
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17
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Gatti H, Castel C, Andrini P, Durand P, Carlus C, Chabernaud JL, Vial M, Dehan M, Boithias C. Malaises graves et morts subites après une naissance normale à terme : à propos de six cas. Arch Pediatr 2004; 11:432-5. [PMID: 15135426 DOI: 10.1016/j.arcped.2004.02.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2003] [Accepted: 02/16/2004] [Indexed: 10/26/2022]
Abstract
Cardiorespiratory arrest occurring within the first two hours of life of a perfectly normal newborn is a very seldom event hitherto unreported. Six infants born after an uneventful pregnancy by normal vaginal delivery, with a normal Apgar score and physical examination, were found with unexpected cardiorespiratory arrest requiring cardiac and respiratory resuscitation early after birth. All were lying in the prone position, their face covered up while facing mother's abdomen, breast or neck. All mothers were primipara. All newborns but one died. Biological and bacteriological samples were normal and early onset neonatal sepsis was ruled out. Autopsy, performed in five infants, was not contributive. We hypothesize that the sudden and unexpected cardiorespiratory arrest occurring in these normal newborns was secondary to acute upper airway obstruction. To prevent this life threatening post-natal asphyxic episode, it is essential to ensure that the face of a newborn lying down upon mother's breast and abdomen is properly and continuously cleared.
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Affiliation(s)
- H Gatti
- Service de pédiatrie et réanimation néonatales, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92141 Clamart, France
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18
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Chéron G, Chabernaud JL, Dalmas S, Floret D, Leveau P, Mardegan P, Martinot A, Massol V, Minguet JM, Orliaguet G, Pédespan L, Wodey E. Recommandations concernant la mise en place, la gestion, l’utilisation et l’évaluation d’une salle d’accueil des urgences vitales pédiatriques. Arch Pediatr 2004; 11:44-50. [PMID: 14700761 DOI: 10.1016/j.arcped.2003.09.031] [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] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The pediatric resuscitation room is the place where children suffering from vital distress are cared for in the emergency unit. Recommendations for its organization, functioning and evaluation have been ruled on by experts from six medical societies involved in these emergencies. They concern all the hospital's physicians, nurses and administrative directors.
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Affiliation(s)
- G Chéron
- Département des urgences pédiatriques, hôpital Necker-Enfants-Malades, AP-HP, 149, rue de Sèvres, 75743 Paris 15, France.
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19
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Serfaty A, Crenn-Hebert C, Deprez M, Bertrand M, Chabernaud JL, Joly J, Guillonneau M, Papiernik E. [Regionalization of very preterm birth care sites in Ile-de France in 1998]. Sante Publique 2003; 15:491-502. [PMID: 14964017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
The objective of this article is to describe the conditions under which very premature babies were born in the Paris region between June 1 and December 31, 1998, that is to say those born prior to reaching 33 weeks of term (SA) and/or having a birth weight less than 1500 grams. The study looked at all pre-term births, including medical terminations of pregnancy (TOP), occurring in one of the 135 maternity units in the Paris region. Between June 1 and December 31, 1998, 1337 mothers gave birth to babies prior to reaching 33 weeks of term (SA) and/or having a birth weight less than 1500 grams in 84 maternity units in the Paris region, 263 of which had a medical termination of pregnancy (20%). These mothers were older than average for the region (25% were 35 years old or older); 4.3% of them do not have social insurance coverage. The remaining 1074 mothers (excluding TOP) gave birth to 1290 children, of which 202 were stillbirths, 46 died in the labor ward and 1042 were admitted to a neo-natal unit. Of the same group of 1074 mothers, 195 (18%) had a multiple pregnancy--175 twins, 19 triplets, and 1 quadruplet 60% of them (599 women) who had very premature or low birth weight babies (excluding TOPs) delivered them in a tertiary perinatal centre (TPC). This proportion varies according to two variables: 1) the community in which the family lives (40% in the Seine-et-Marne department, the eastern region of Paris and a district without TPCs, to 70% in the Hauts-de-Seine, a northern district), and 2) whether the pregnancy is single (58.8%), twin (72.6%) or triple (84.2%). In utero transfer accounts for 62.7% of the mothers who delivered in TPC, who were transferred prior to delivery. This type of study is useful for measuring the implementation of the regionalisation high-risk perinatal care and access to adequate services. It clearly demonstrates that inequities in access to care exist for women by district of residence.
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Affiliation(s)
- A Serfaty
- Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, Colombes
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20
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Gouyon-Cornet B, Bréart G, Chabernaud JL, Dehan M, Foucaud P, Gigonnet JM, Gouyon JB, Lejeune C, Lequien P. Évaluation nationale des besoins en lits de réanimation et soins intensifs néonatals. Arch Pediatr 2003; 10:969-78. [PMID: 14613690 DOI: 10.1016/j.arcped.2003.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
UNLABELLED The setting up of the so-called "decrees on perinatal safety" on October 1998 has been associated with many difficulties which were apparently related to the lack of beds for intensive care units, special care units and neonatal medicine. This led to a national survey. OBJECTIVES The aim of the survey was : (1) to collect the number of neonates requiring hospitalization in NICU and special care units over a 1-week period in metropolitan France and overseas departments and territories; (2) to assess the needs in equipments and care-givers. METHODS The writs to be included in the survey were previously identified. Each day of hospitalization was classified as needing an intensive care unit, a special care unit or a neonatal unit. Then it was classified as well fitted or badly fitted. RESULTS Two hundred and forty units (90% of the French units) from 204 hospitals participated in the survey and 3678 neonates were included and accumulated 17 583 days of hospitalization (NICU: 2728; special care: 5047; neonatal medicine: 9808). One thousand and five hundred and ninety hospitalization days did not fit well either with the technical level required by the neonate or/and with the location of the parents' home (9.2%): 23.1% in overseas departments and territories; 12% in metropolitan France. The main reasons for maladjustment were: a too high technical level: (59%); an insufficient technical level: (21%) (19 neonates could not be admitted in a NICU as they needed). The survey included 158 NICU and special care units. Taking into consideration the French law: the lack in equipment was: 294 ventilators, 231 cardio-respiratory monitors, 116 pulse oxymeters and 513 blood pressure monitors; 561 additional pediatricians were needed to allow a medical night duties including seven doctors in each NICU and each special care unit; 1878 additional nurses were also needed. Making the assumption that the mean occupation rate of the neonatal beds should be 70%, the needs were calculated for 1000 live births: metropolitan France: 0.76 (0.74; 0.78) in NICU; 1.45 (1.43-1.47) in special care units; overseas departments and territories: 2 (1.8-2.5) in NICU; 3.5 (3.2-3.8) in special care units. CONCLUSION Finally, the main deficit was not related to the number of beds but to the equipment and number of care-givers. The status of overseas departments and territories was particularly worrying.
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Affiliation(s)
- B Gouyon-Cornet
- Service de pédiatrie, hôpital d'enfants, boulevard Maréchal-de-Lattre-de-Tassigny, 21034 cedex Dijon, France.
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21
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Chabernaud JL. [Severe respiratory syncytial virus infection]. Arch Pediatr 2003; 10:468-9. [PMID: 12878347 DOI: 10.1016/s0929-693x(03)00088-5] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- J L Chabernaud
- SMUR pédiatrique 92, 157, rue de la Porte-de-Trivaux, hôpital Antoine-Béclère, 92141 Clamart, France
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22
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Chouakri O, Ktari F, Lavaud J, Maury I, Lode N, Durand S, Chabernaud JL, Arbaoui H, Lemouchi A, Barbier ML. [Severe bacterial infections in children. Survey by the pediatric mobile intensive care unit AP/HP in the Ile-de-France area]. Arch Pediatr 2001; 8 Suppl 4:712s-720s. [PMID: 11582917 DOI: 10.1016/s0929-693x(01)80186-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This study involves 106 infants (neonatal period ruled out), victims of severe bacterial infections managed from 1st january 1998 to 30 April 2001 by the four paediatric Mobile Intensive Care Unit (P.M.I.C.U.) teams AP-HP in Ile-de-France area. 46.2% of the whole infants are primary interventions (home, medical room, airport) and primary-secondary interventions (hospital emergencies) whereas 53.8% are related to secondary transports of infants who have been hospitalized and suffered from severe bacterial disorders complicating their original disease. 51% are meningitidis infections, rather due to streptococcus pneumoniae and meningococcis, associated with severe infectious purpura. 20.75% are toxic shock syndromes in patients suffering from chronic affections (sickle cell anemia), acquired or congenital immunodeficiencies; 19.8% of the cases are severe bacterial pneumonia (staphylococcal pleuro-pneumopathies, bordetella pertussis cough) or surinfected viral infections (VRS bronchiolitis, pneumonia due to mycoplasma pneumoniae and para-influenzae III). Authors study various characteristics of the two patient's groups, their immediate management by local medical team and by the P.M.I.C.U. team, their early term outcome. 65% of children recovered apparently without sequelae, 19% died, and 16% healed but with significant sequelaes, notably neurological damage. Meningitidis due to Streptococcus pneumoniae are particularly severe, because of their prognostic (10 deaths, 8 severe sequelae among the 26 cases). These observations prompted us to recommend early immunization of infants at 2-3 months post natal age by the new vaccine conjugated up to 7 valences such as "Prevenar". If this vaccine have been available for this patient series, may be avoided 8 deaths, 7 severe sequelae, with 1 septic shock syndrome due to streptococcus pneumoniae and another serious infection in a homozygous sickle cell disease.
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Affiliation(s)
- O Chouakri
- SMUR pédiatrique, Hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75743 Paris, France
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23
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Simeoni U, Chabernaud JL, Claris O, Storme L, Dosquet P. [Blood products and substitutes]. Arch Pediatr 2000; 6 Suppl 2:488s-490s. [PMID: 10370581 DOI: 10.1016/s0929-693x(99)80513-2] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- U Simeoni
- Service de pédiatrie 2, Hôpitaux universitaires de Strasbourg, Clamart, France
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24
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Roy RD, Langford S, Chabernaud JL, Petresen S, Peitersen N, Kollée L, Niijima SI, Agostino R, Macagnob F, Derganc M, Novak-Antolic Z, Kornhauser P, Primo J, Field D, Job L, Deming DD, Hopper AO, Peverini RL. Newborn transport around the world. ACTA ACUST UNITED AC 1999. [DOI: 10.1053/siny.1999.0109] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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25
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Chabernaud JL. [Analysis and point-of-view of mobile emergency service pediatricians]. J Gynecol Obstet Biol Reprod (Paris) 1998; 27:176-81. [PMID: 10048996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- J L Chabernaud
- Service de Réanimation Néonatale, Hôpital Antoine-Béclère, Clamart
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26
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Chabernaud JL. [Organization and execution of transportation for the newborn]. Soins Pediatr Pueric 1998:3-7. [PMID: 10410094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Affiliation(s)
- J L Chabernaud
- Service de réanimation néonatale, Hôpital Antoine Béclère, Clamart
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27
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Chabernaud JL. [The safety of childbirth and the obstetrical-pediatric network]. Soins Pediatr Pueric 1998:8-10. [PMID: 10410095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Affiliation(s)
- J L Chabernaud
- Service de réanimation néonatale, Hôpital Antoine Béclère, Clamart
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28
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Baud O, Lacaze-Masmonteil T, Monsaingeon-Lion A, Chabernaud JL, Zupan V, Boithias C, André P, Gross E, Dehan M. Single blood donor exposure programme for preterm infants: a large open study and an analysis of the risk factors to multiple donor exposure. Eur J Pediatr 1998; 157:579-82. [PMID: 9686821 DOI: 10.1007/s004310050883] [Citation(s) in RCA: 6] [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: 10/28/2022]
Abstract
UNLABELLED As the need for blood transfusions of very preterm infants remains considerable, various strategies are considered to minimize exposure to multiple blood donors along with blood wastage. In a large population of very preterm infants born between 24 and 31 weeks' gestation, we undertook an open study to assess the efficacy of a single blood donor exposure programme and to determine, among the population enrolled in this programme, the risk factors for exposure to multiple donors. One hundred and forty-two neonates were included in a single donor exposure programme with a 35-day expiry date blood unit. Though no inflation in the total number of transfusions was noticed, there was a 55% overall reduction in the total number of required donors. To determine the risk factors for exposure to multiple donors in this population, 114 neonates alive after the expiry date of the first unit of packed red blood cells were selected. The greatest and the most extending transfusion requirements were observed in very preterm infants born before 28 weeks' gestation and in those born after but with an intra-uterine growth retardation below the 10th percentile. Indeed, 70% of those high-risk infants were exposed to a second blood donor and more than 85% of the group exposed to a second donor belonged to this high-risk population. CONCLUSION Neonates with a very high risk of a more-than-one donor exposure were born before 28 weeks' gestation or between 28 and 31 weeks but with an intra-uterine growth retardation below the 10th percentile.
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Affiliation(s)
- O Baud
- Service de Réanimation et Pédiatrie Néonatales, Hôpital Antoine Béclère, Clamart, France
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29
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Baud O, Boithias C, Lacaze-Masmonteil T, Ville Y, Guibert M, Zupan V, Chabernaud JL, André P, Nordmann P, Frydman R, Dehan M. [Maternofetal disseminated candidiasis and high-grade prematurity]. Arch Pediatr 1997; 4:331-4. [PMID: 9183404 DOI: 10.1016/s0929-693x(97)86449-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Despite the frequency of vaginal yeast colonization, serious candidiasis infections in pregnant patients or neonates remain rare. Four cases of disseminated congenital candidiasis in very preterm infants are reported. CASE REPORTS Congenital Candida albicans infection has been diagnosed in four very preterm infants. In three cases, the mothers had intrauterine devices in place throughout pregnancy. A careful macroscopic examination of the umbilical cord and placenta after birth has allowed an early management strategy in three cases. In all cases, a serious infectious alveolitis occurred. A pronounced increase in white blood cells (> 50,000/mm3) and high levels of both segmented neutrophil and band cells, despite the frequent normality of the CRP, constituted other features. Infection was controlled by parenteral amphotericin B or fluconazole. In one case, serious thrombocytopenia occurred after the first amphotericin B injection requiring substitution for fluconazole. The outcome was unfavourable in two cases with an extensive periventricular leukomalacia. CONCLUSION Congenital candidiasis in these four very preterm neonates has several features in common: intrauterine contraceptive device during pregnancy, characteristic chorioamnionitis and funisitis, high WBC count, infectious alveolitis. Fluconazole as alternative to amphotericine B therapy is proposed.
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Affiliation(s)
- O Baud
- Service de pédiatrie et réanimation néonatales, hôpital Antoine-Béclère, Clamart, France
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30
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Baud O, Boithias C, Lacaze-Masmonteil T, Guibert M, Zupan V, Chabernaud JL, André P, Nordmann P, Dehan M. [Thrombopenia induced by amphotericin B in an extremely premature infant with congenital candidiasis]. Arch Pediatr 1996; 3:831-2. [PMID: 8998545 DOI: 10.1016/0929-693x(96)82174-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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31
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Chabernaud JL, Lacaze T, Zupan V, Boithias C, Gross E, Dehan M. [Platelet transfusions in neonatology]. Transfus Clin Biol 1995; 2:17-25. [PMID: 7728265 DOI: 10.1016/s1246-7820(05)80018-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Thrombocytopenia occurs in 20% to 40% of infants admitted to a neonatal intensive care unit. Approximately 30% of the newborns with severe thrombocytopenia below 50.10(9)/l platelets receive platelet transfusions. The etiology may be: bacterial infection, DIC and immune mediated thrombocytopenia. The consequences of thrombocytopenia are significant risks of severe intracranial hemorrhage and neurologic morbidity. Therapeutic platelet transfusions are given to actively bleeding neonates with less than 50.10(9)/l platelets. Prophylactic platelet concentrates are usually given to infants with platelets counts below 20.10(9)/l. The standard platelet concentrate (CMV-negative donor) is the product of choice for newborns. Fetal intracranial hemorrhage is possible as soon as 20 weeks of gestation in allo-immune thrombocytopenia. Actually percutaneous umbilical blood sampling is very useful to measure fetal platelets count in order to decide in utero maternal platelet transfusion. Maternal irradiated plateletpheresis concentrates are preferentially infused in this indication. At the end of pregnancy, cesarean section is preferred to normal vaginal delivery if fetal thrombocytopenia below 100.10(9)/l is observed. In pregnant women with auto-immune thrombocytopenia, the decision to carry out percutaneous umbilical blood samples should be weigh relatively to the 3-5% estimated risk of serious consequences. Platelets transfusions are particularly successful in immune thrombocytopenia but less effective in other clinical circumstances.
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Affiliation(s)
- J L Chabernaud
- Service de réanimation néonatale, Hôpital Antoine-Béclère, Clamart
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32
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Dehan M, Magny JF, Zupan V, Debillon T, Vial M, Chabernaud JL, Gabilan JC. [Recent progresses in neonatology]. Arch Fr Pediatr 1993; 50:163-70. [PMID: 8343025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- M Dehan
- Service de Pédiatrie et Réanimation Néonatale, Hôpital Antoine-Béclère, Clamart
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Chabernaud JL. [Sudden infant death. What to do at the site of the tragedy]. Soins Gynecol Obstet Pueric Pediatr 1992:13-5. [PMID: 1492279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Chabernaud JL. [Antenatal pediatric assistance]. Soins Gynecol Obstet Pueric Pediatr 1990:20-2. [PMID: 2244260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Chabernaud JL. [Resuscitation in the delivery room]. Soins Gynecol Obstet Pueric Pediatr 1990:14-9. [PMID: 2244259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Dehan M, Imbert MC, Gautier JP, Benisvy C, Roset F, Magny JF, Saby MA, Dworzak P, Guyot H, Chabernaud JL. [Clinical and anatomo-pathologic study of 59 cases of sudden infant death]. Arch Fr Pediatr 1988; 45:541-8. [PMID: 3214247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
A proper organization has been set up at Antoine-Béclère's hospital in order to study the infants who died suddenly. Between July 1985 and July 1987, 69 cases (10 babies less than 1 week of age) were admitted. The purpose of this work was, for the 59 sudden deaths of infants aged more than 1 week (35 males, 24 females), to present the results of a definite protocol of investigation (past history, clinical examination, laboratory and pathological data) for determining either the etiology or the mechanism of these deaths. A thorough investigation was performed in 45/52 cases (no autopsy in 7 cases). A definite diagnosis was possible in 38/45: 13 viral infections, 5 gastro-esophageal reflux, 13 viral infections associated with reflux, 9 with an additional event (massive alimentary inhalation, slipping under blankets, major hyperthermia) to either a viral infection or a reflux, 1 cardiac malformation, 1 metabolic disorder, 2 accidents and 1 infanticide. With this protocol, 7/45 deaths remained unexplained. This medical approach of the problem of sudden deaths in infants is beneficial to the counselling of the parents and to the management of subsequent children.
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Affiliation(s)
- M Dehan
- Service de Réanimation Néonatale, Hôpital Antoine-Béclère
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Saby MA, Guibert M, Magny JF, Praud JP, Chabernaud JL, Dehan M, Gabilan JC. [Intravenous-intramuscular bioequivalency of ceftriaxone in newborn infants]. Arch Fr Pediatr 1987; 44:615-7. [PMID: 3442464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
In 6 neonates over 7 days of life, comparison of maximum and residual serum concentrations of ceftriaxone after intra-venous or intra-muscular administration showed the bio-equivalence of both ways. In both cases a single daily injection obtained bacterial serum levels on most of the strains responsible for secondary bacterial infections in neonates.
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Affiliation(s)
- M A Saby
- Service de Pédiatrie et Réanimation néonatales, Hôpital Antoine-Béclère, Clamart
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Barbier ML, Chabernaud JL, Lavaud J, Février YM, Johanet S. [Emergency medical transport of children in the Ile-de-France area]. Arch Fr Pediatr 1987; 44:413-7. [PMID: 3619580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Pediatric emergency medical service is available since 1976 in France. Presently, 4 such services are available in the Paris area for neonatal and pediatric emergencies. Coordination of these services was established in 1980, to establish a close collaboration between the various medical teams by linking them in a synergic way. This resulted, in 1985, in 6,740 transports of children, 83% of which in an emergency. Neonatal pathology accounted for 70% of the transports and 53% of transported children required assisted ventilation. The importance of these pediatric emergency services, their specificity and their level of technicality suggest that they contributed to the decrease of the pediatric and neonatal morbidity and mortality recorded in the past decade.
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Saby MA, Gross E, Magny JF, Chabernaud JL, Praud JP, Dehan M, Gross B, Gabilan JC. [Post-transfusion hemolysis in premature infants. Apropos of 8 cases of post-transfusion hemolysis in premature infants]. Arch Fr Pediatr 1987; 44:167-71. [PMID: 3579478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Accidents related to blood transfusion have become rare in neonates, due to the application of very strict rules. The 8 reported cases of post-transfusion hemolysis occurred in prematures less than 32 weeks gestational age. Signs consisted of hemoglobinuria and/or severe jaundice. In some patients exchange-transfusion had to be performed. Immuno-hematologic, bacteriologic and technical investigations did not show the etiology of these accidents. No similar clinical reports were found in the literature. Some authors suggest a mechanical origin.
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