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Ego A, Debillon T, Sourd D, Mitton N, Fresson J, Zeitlin J. Identifying Newborns with Hypoxic-Ischemic Encephalopathy in Hospital Discharge Data: A Validation Study. J Pediatr 2024; 268:113950. [PMID: 38336200 DOI: 10.1016/j.jpeds.2024.113950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 01/18/2024] [Accepted: 02/04/2024] [Indexed: 02/12/2024]
Abstract
Hospital discharge databases (HDDs) are increasingly used for research on health of newborns. Linkage between a French population-based cohort of newborns with hypoxic-ischemic encephalopathy (HIE) and national HDD showed that the HIE ICD-10 code was not accurately reported. Our results suggest that HDD should not be used for research on neonatal HIE without prior validation of HIE ICD-10 codes.
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Affiliation(s)
- Anne Ego
- Public Health Department CHU Grenoble Alpes, Univ. Grenoble Alpes, CNRS, Grenoble INP∗, TIMC-IMAG, Grenoble, France, ∗Institute of Engineering Univ, Grenoble Alpes; INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), FHU PREMA, Paris Descartes University, Paris, France; Univ. Grenoble Alpes, Inserm CIC1406, CHU de Grenoble, Grenoble, France.
| | - T Debillon
- Department of Neonatology CHU Grenoble Alpes, Univ. Grenoble Alpes, CNRS, Grenoble INP∗, TIMC-IMAG, Grenoble, France, ∗Institute of Engineering Univ, Grenoble Alpes
| | - D Sourd
- Public Health Department CHU Grenoble Alpes, Univ. Grenoble Alpes, CNRS, Grenoble INP∗, TIMC-IMAG, Grenoble, France, ∗Institute of Engineering Univ, Grenoble Alpes
| | - N Mitton
- Department of Bioinformatics CHU Grenoble Alpes, Univ. Grenoble Alpes, Grenoble, France
| | - J Fresson
- Population Health Office, DREES, Paris, France
| | - J Zeitlin
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), FHU PREMA, Paris Descartes University, Paris, France
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Debillon T, Tourneux P, Guellec I, Jarreau PH, Flamant C. Respiratory distress management in moderate and late preterm infants: The NEOBS Study. Arch Pediatr 2021; 28:392-397. [PMID: 33934933 DOI: 10.1016/j.arcped.2021.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/22/2021] [Accepted: 03/16/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To investigate the characteristics and management of respiratory failure (RF) in moderate-to-late preterm infants. METHODS NEOBS was a prospective, multicenter, observational study conducted in 46 neonatal intensive care units caring for preterm infants (30+0/7 to 36+6/7 weeks of gestation [WG]) in France in 2018. The cohort was stratified into two groups: 30-33 WG (group 1) and 34-36 WG (group 2). Infants with early neonatal RF were included and the outcomes assessed were maternal, pregnancy, and delivery characteristics and how RF was managed. RESULTS Of the 560 infants analyzed, 279 were in group 1 and 281 were in group 2. Most pregnancies were singleton (64.1%), and 67.4% of women received prenatal corticosteroids (mostly two doses). Infants were delivered by cesarean section in 59.6% of cases; 91.7% of the infants had an Apgar score ≥7 at 5min. More than 90% of infants were hospitalized post-birth (median duration, 36 and 15 days for groups 1 and 2, respectively). Medical intervention was required for 95.7% and 90.4% of the infants in group 1 and group 2, respectively, and included noninvasive ventilation (continuous positive airway pressure [CPAP]: 88.5% and 82.9%; high-flow nasal cannula: 55.0% and 44.7%, or other) and invasive ventilation (19.7% and 13.2%). The two main diagnoses of RF were respiratory distress syndrome (39.8%) and transient tachypnea of the newborn (57.3%). Surfactant was administered to 22.5% of the infants, using the less invasive surfactant administration (LISA) method for 34.4% of the patients. In the overall population, 8.6% of the infants had respiratory and/or hemodynamic complications. CONCLUSIONS The NEOBS study demonstrated that CPAP was widely used in the delivery room and the LISA method was chosen for 34.4% of the surfactant administrations for the management of RF in moderate-to-late preterm infants. The incidence of RF-related complications was low.
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Affiliation(s)
- T Debillon
- Neonatology Intensive Care Unit, University Hospital of Grenoble, CS 10217, 38043 Grenoble Cedex 9, France.
| | - P Tourneux
- Neonatal Intensive Care Unit, University Hospital of Amiens, France-PériTox UMR_I 01, University of Picardy Jules Verne, 1, rond point du Professeur Christian Cabrol, 80054 Amiens, France
| | - I Guellec
- Neonatal and Pediatric Intensive Care Unit, University Hospital of Trousseau, AP-HP, 26, avenue du Dr Arnold Netter, 75012 Paris, France
| | - P-H Jarreau
- NICU of Port-Royal, AP-HP Centre-Université de Paris, Cochin Hospital, 123, boulevard de Port-Royal, 75014 Paris, France
| | - C Flamant
- Neonatal Intensive Care Unit, University Hospital of Nantes, 38, boulevard Jean Monnet, 44000 Nantes, France
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Riethmuller D, Forey PL, Equy V, Grand S, De Schlichting E, Hoffmann P, Debillon T. [Spontaneous ping-pong fracture during vaginal delivery]. ACTA ACUST UNITED AC 2021; 49:706-708. [PMID: 33631393 DOI: 10.1016/j.gofs.2021.02.004] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Indexed: 11/16/2022]
Affiliation(s)
- D Riethmuller
- Département de gynéco-obstétrique et médecine de la reproduction, CHU de Grenoble Alpes, Grenoble, France.
| | - P-L Forey
- Département de gynéco-obstétrique et médecine de la reproduction, CHU de Grenoble Alpes, Grenoble, France
| | - V Equy
- Département de gynéco-obstétrique et médecine de la reproduction, CHU de Grenoble Alpes, Grenoble, France
| | - S Grand
- Service de radiologie interventionnelle, CHU de Grenoble Alpes, Grenoble, France
| | - E De Schlichting
- Service de neurochirurgie, CHU de Grenoble Alpes, Grenoble, France
| | - P Hoffmann
- Département de gynéco-obstétrique et médecine de la reproduction, CHU de Grenoble Alpes, Grenoble, France
| | - T Debillon
- Service de pédiatrie, CHU de Grenoble Alpes, Grenoble, France
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Ancel PY, Breart G, Bruel H, Debillon T, D'Ercole C, Deruelle P, Dreyfus M, Foix-L'Helias L, Goffinet F, Jarreau PH, Kuhn P, Langer B. [Propositions for perinatal care at extremely low gestational ages - Working group on "Extremely low gestational ages" for SFMP, CNGOF, and SFN]. Gynecol Obstet Fertil Senol 2020; 48:850-857. [PMID: 33022445 DOI: 10.1016/j.gofs.2020.09.021] [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] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES International literature suggests that active perinatal management at extremely low gestational ages improves survival without increasing the risk of impairment in survivors, compared to less active management. Although these results are limited to a small number of countries, they question current practices in France. New propositions on perinatal management of extremely preterm infants have carried out by the French Society of Perinatal Medicine, the French Society of Neonatology and the National College of French Obstetricians and Gynecologists. METHODS This group was set up in 2015 on the initiative of the professional societies and in collaboration with parents' and users' associations. The work was based on a review of the literature on the prognosis of extremely preterm children, as well as on recommendations by European societies. Based on this information, a text was produced, submitted to all members of the working group and definitively validated in April 2019. RESULTS This text offers a decision-making guideline for the management at extremely low gestational ages. Its principles are: the administration of steroids independently of management (resuscitation or comfort care); a prognostic evaluation and a collegial decision, outside the context of the emergency; a consensus on the information to be given to parents before going to inform them and gather their opinion. CONCLUSIONS These new propositions will contribute to modifying perinatal care at extremely low gestational ages in France.
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Affiliation(s)
- P-Y Ancel
- Paris, Société française de médecine périnatale, 75008 Paris, France.
| | - G Breart
- Paris, Société française de médecine périnatale, 75008 Paris, France
| | - H Bruel
- Le Havre, Société française de médecine périnatale, Société française de néonatologie, 76600 Le Havre, France
| | - T Debillon
- Grenoble, Société française de médecine périnatale, Société française de néonatologie, 38000 Grenoble, France
| | - C D'Ercole
- Marseille, Société française de médecine périnatale, Collège national des gynécologues et obstétriciens français, 13000 Marseille, France
| | - P Deruelle
- Strasbourg, Collège national des gynécologues obstétriciens français, 67000 Strasbourg, France
| | - M Dreyfus
- Caen, Société française de médecine périnatale, Collège national des gynécologues et obstétriciens français, 14000 Caen, France
| | - L Foix-L'Helias
- Paris, Société française de néonatologie, 75008 Paris, France
| | - F Goffinet
- Paris, Société française de médecine périnatale, Collège national des gynécologues et obstétriciens français, 75008 Paris, France
| | - P-H Jarreau
- Paris, Société française de néonatologie, 75008 Paris, France
| | - P Kuhn
- Strasbourg, Société française de néonatologie, 67000 Strasbourg, France
| | - B Langer
- Strasbourg, Société française de médecine périnatale, Collège national des gynécologues et obstétriciens français, 67000 Strasbourg, France
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Bonnet Ducrot S, Plantaz D, Mathieu N, Debillon T, Bost Bru C, Brenier-Pinchart MP, Fricker-Hidalgo H, Chevallier M. Neonatal fever: A puzzling case. Arch Pediatr 2018; 25:435-438. [PMID: 30249489 DOI: 10.1016/j.arcped.2018.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 03/27/2018] [Revised: 06/17/2018] [Accepted: 08/15/2018] [Indexed: 02/07/2023]
Abstract
Toxoplasmosis is a potentially serious fetal infection associated with maternal seroconversion of toxoplasmosis during pregnancy. Follow-up and treatment vary between different countries. We present a case of congenital toxoplasmosis with unusual physiopathology and symptomatology. The mother was immunized before the beginning of pregnancy but immunosuppressive treatments for Crohn disease maintained during the pregnancy could explain toxoplasmosis reactivation in the mother and congenital toxoplasmosis. The baby presented reversible B lymphopenia and hypogammaglobulinemia.
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Affiliation(s)
- S Bonnet Ducrot
- Neonatal Intensive Care Unit, Grenoble Alpes University, CS10217, Grenoble University Hospital, 38043 Grenoble, France.
| | - D Plantaz
- Department of Pediatrics, Unit of Pediatric Immuno-Hemato-Oncology, Grenoble Alpes University, CS10217, Grenoble University Hospital, 38043 Grenoble, France
| | - N Mathieu
- Hepato-gastroenterology Unit, Grenoble Alpes University, CS10217, Grenoble University Hospital, 38043 Grenoble, France
| | - T Debillon
- Neonatal Intensive Care Unit, Grenoble Alpes University, CS10217, Grenoble University Hospital, 38043 Grenoble, France; ThEMAS, TIMC-IMAG, CNRS UMR5525, Université Grenoble Alpes, 38041 Grenoble, France
| | - C Bost Bru
- Department of Pediatrics, General Pediatrics and Infectious Diseases, Grenoble Alpes University, CS10217, Grenoble University Hospital, 38043 Grenoble, France
| | - M-P Brenier-Pinchart
- Laboratory of Parasitology and Mycology, Grenoble Alpes University, CS10217, Grenoble University Hospital, 38043 Grenoble, France
| | - H Fricker-Hidalgo
- Laboratory of Parasitology and Mycology, Grenoble Alpes University, CS10217, Grenoble University Hospital, 38043 Grenoble, France
| | - M Chevallier
- Neonatal Intensive Care Unit, Grenoble Alpes University, CS10217, Grenoble University Hospital, 38043 Grenoble, France; ThEMAS, TIMC-IMAG, CNRS UMR5525, Université Grenoble Alpes, 38041 Grenoble, France
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Doutau J, Bost-Bru C, Gayot A, Wroblewski I, Pelloux I, Debillon T, Millet A. Épiglottite aiguë à Haemophilus influenzae b : conséquence grave du scepticisme vaccinal. Arch Pediatr 2017; 24:1267-1270. [DOI: 10.1016/j.arcped.2017.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 09/15/2017] [Indexed: 10/18/2022]
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Debillon T, de Launay C, Ego A. [Guidelines for the management of the cerebral arterial ischemic stroke in at term or near-term newborns]. Arch Pediatr 2017; 24:9S1-9S2. [PMID: 28867031 DOI: 10.1016/s0929-693x(17)30324-x] [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] [Indexed: 11/25/2022]
Affiliation(s)
- T Debillon
- Clinique universitaire de médecine néonatale et réanimation pédiatrique, CHU Grenoble Alpes, CS217, 38043 Grenoble Cedex, France; TIMC-Imag UMR 5525, université Grenoble-Alpes, 38000 Grenoble, France.
| | - C de Launay
- Centre de référence AVC du nouveau-né, CHU Grenoble Alpes, CS217, 38043 Grenoble Cedex, France
| | - A Ego
- TIMC-Imag UMR 5525, université Grenoble-Alpes, 38000 Grenoble, France
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Girard B, Bendavid M, Faivre JC, Salleron J, Debillon T, Claris O, Chabrol B, Schweitzer C, Gajdos V. Enseignement théorique du Diplôme d’études spécialisées de pédiatrie en France : évaluation nationale par les internes. Arch Pediatr 2017; 24:728-736. [DOI: 10.1016/j.arcped.2017.05.009] [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] [Received: 03/02/2017] [Revised: 05/03/2017] [Accepted: 05/21/2017] [Indexed: 10/19/2022]
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Couturier C, Cneude F, Spiteri A, Nugues F, Debillon T. [Neonatal hyperthyroidism: A sometimes challenging diagnosis]. Arch Pediatr 2017; 24:622-624. [PMID: 28583776 DOI: 10.1016/j.arcped.2017.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 01/11/2017] [Accepted: 04/19/2017] [Indexed: 10/19/2022]
Abstract
Graves disease complicates two pregnancies out of 1000 and when it is known before pregnancy, it warrants careful monitoring of the fetus and the newborn. We report on a case of neonatal hyperthyroidism, which revealed a previously unknown maternal thyroid disease. In this situation, neonatal signs can be misinterpreted, delaying the diagnosis. Neonatal hyperthyroidism is, however, a therapeutic emergency because of the risk of cardiac and neurological complications. The neonatologist must identify thyroid disease in the absence of a maternal history in order to promptly start therapy.
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Affiliation(s)
- C Couturier
- Clinique universitaire de néonatologie, HCE CHU de Grenoble, CS10217, 38430 Grenoble cedex 09, France; Clinique universitaire de pédiatrie, HCE CHU de Grenoble, CS10217, 38430 Grenoble cedex 09, France.
| | - F Cneude
- Clinique universitaire de néonatologie, HCE CHU de Grenoble, CS10217, 38430 Grenoble cedex 09, France; Clinique universitaire de pédiatrie, HCE CHU de Grenoble, CS10217, 38430 Grenoble cedex 09, France
| | - A Spiteri
- Clinique universitaire de néonatologie, HCE CHU de Grenoble, CS10217, 38430 Grenoble cedex 09, France; Clinique universitaire de pédiatrie, HCE CHU de Grenoble, CS10217, 38430 Grenoble cedex 09, France
| | - F Nugues
- Clinique universitaire de néonatologie, HCE CHU de Grenoble, CS10217, 38430 Grenoble cedex 09, France; Clinique universitaire de pédiatrie, HCE CHU de Grenoble, CS10217, 38430 Grenoble cedex 09, France
| | - T Debillon
- Clinique universitaire de néonatologie, HCE CHU de Grenoble, CS10217, 38430 Grenoble cedex 09, France; Clinique universitaire de pédiatrie, HCE CHU de Grenoble, CS10217, 38430 Grenoble cedex 09, France
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Milleret C, Epiard C, Douchin S, Pernod G, Debillon T. Early antithrombotic treatment with warfarin oral suspension in severe neonatal protein C deficiency. Arch Pediatr 2017; 24:363-366. [DOI: 10.1016/j.arcped.2017.01.007] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 08/15/2016] [Accepted: 01/05/2017] [Indexed: 11/26/2022]
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Saliba E, Debillon T, Auvin S, Baud O, Biran V, Chabernaud JL, Chabrier S, Cneude F, Cordier AG, Darmency-Stamboul V, Diependaele JF, Debillon T, Dinomais M, Durand C, Ego A, Favrais G, Gruel Y, Hertz-Pannier L, Husson B, Marret S, N’Guyen The Tich S, Perez T, Saliba E, Valentin JB, Vuillerot C. Accidents vasculaires cérébraux ischémiques artériels néonatals : synthèse des recommandations. Arch Pediatr 2017; 24:180-188. [DOI: 10.1016/j.arcped.2016.11.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 07/25/2016] [Accepted: 11/22/2016] [Indexed: 12/01/2022]
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Lafenetre M, Herbigneaux R, Michoud M, Descours G, Debillon T. À propos d’un cas d’ostéomyélite de la maladie des griffes du chat. Arch Pediatr 2016; 23:188-91. [DOI: 10.1016/j.arcped.2015.11.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 08/05/2015] [Accepted: 11/16/2015] [Indexed: 11/29/2022]
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Chabrier S, Vuillerot C, Égo A, Debillon T. Infarctus cérébral artériel à révélation néonatale (grande prématurité exclue) : pourquoi des recommandations ? Arch Pediatr 2014; 21:934-7. [DOI: 10.1016/j.arcped.2014.06.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 06/19/2014] [Indexed: 10/25/2022]
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Simon-Ghediri MJ, Piollet A, Chacqueneau AL, Parra J, Stagnara J, Debillon T. Premiers bilans des stages des internes de spécialité en pédiatrie ambulatoire. Arch Pediatr 2014. [DOI: 10.1016/s0929-693x(14)71550-7] [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: 10/25/2022]
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Vuillerot C, Chevignard M, Debillon T, Kossorotoff M, Zerat M, Husson B, Renaud C, Chabrier S. Quelles recommandations autour de la prise en charge MPR des nouveau-nés ayant un pronostic d’hémiplégie après infarctus cérébral néonatal ? Ann Phys Rehabil Med 2014. [DOI: 10.1016/j.rehab.2014.03.112] [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: 10/25/2022]
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Vuillerot C, Chevignard M, Debillon T, Kossorotoff M, Zerat M, Husson B, Renaud C, Chabrier S. Perinatal arterial ischemic stroke: Guidelines for diagnosis, management and rehabilitation of newborn with a high risk of hemiplegia. Ann Phys Rehabil Med 2014. [DOI: 10.1016/j.rehab.2014.03.062] [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: 10/25/2022]
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Gerin M, Wroblewski I, Bost-Bru C, N’guyen MA, Debillon T. Méningo-encéphalite après vaccination anti-amarile : syndrome de YEL-AND. Arch Pediatr 2014; 21:384-7. [DOI: 10.1016/j.arcped.2014.01.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 09/15/2013] [Accepted: 01/18/2014] [Indexed: 10/25/2022]
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Prunier-Duparge J, Desrumaux A, Debillon T, Bost-Bru C, Jannel C, Gayot A, Wroblewski I. Présentation inhabituelle d’une infection grave à Mycoplasma pneumoniae, à propos de 2 observations. Arch Pediatr 2013; 20:1143-6. [DOI: 10.1016/j.arcped.2013.07.003] [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] [Received: 04/11/2013] [Revised: 04/30/2013] [Accepted: 07/13/2013] [Indexed: 10/26/2022]
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Chevignard M, Vuillerot C, Kossorotoff M, Zerah M, Husson B, Saliou G, Debillon T, Renaud C, Chabrier S. Presentation of the French National Reference Centre for Pediatric Stroke. Ann Phys Rehabil Med 2013. [DOI: 10.1016/j.rehab.2013.07.770] [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: 10/26/2022]
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Chevignard M, Vuillerot C, Kossorotoff M, Zerah M, Husson B, Saliou G, Debillon T, Renaud C, Chabrier S. Présentation du Centre national de référence AVC de l’enfant. Ann Phys Rehabil Med 2013. [DOI: 10.1016/j.rehab.2013.07.762] [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: 11/26/2022]
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Chacqueneau AL, Desrumaux-Becquet A, Debillon T, NGuyen MA, Bessaguet S, Bost-Bru C, Leroy P, Wroblewski I. [A child with sepsis-associated encephalopathy]. Arch Pediatr 2013; 20:1120-5. [PMID: 23953625 DOI: 10.1016/j.arcped.2013.06.027] [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: 12/05/2012] [Revised: 01/28/2013] [Accepted: 06/19/2013] [Indexed: 11/27/2022]
Abstract
Sepsis-associated encephalopathy (SAE) is a diffuse brain dysfunction due to a systemic response to infection. We report the case of a 4-year-old girl with fever and vomiting for 48h, brought to the university hospital of Grenoble because of vigilance disorders, loss of verbal fluency, and a cerebellar syndrome. She had a biological infectious syndrome. Infectious encephalitis was suggested first, but the cerebral scan and the lumbar punction were normal. Magnetic resonance imaging (MRI) showed a diffuse brain edema with extended involvement of cortical and basal ganglia. The electroencephalogram was globally slow. The infectious syndrome was explained by perforated appendicitis with peritonitis, treated by surgery and antibiotic therapy. Other infectious explorations were negative. No metabolic or autoimmune diseases were found. Hence, our final diagnosis was sepsis-associated encephalopathy. After 1 year of follow-up care, her clinical exam, MRI, and EEG were normal. Sepsis-associated encephalopathy has been increasingly described in the adult population, but until today only three pediatric cases have been published. It is diagnosed when the patient has a severe infectious syndrome associated with neurologic symptoms, mostly vigilance or consciousness disorders, no signs of shock, and only when other potential reasons have been ruled out. The MRI shows non-specific diffuse lesions with vasogenic edema on the subcortical substance or on the basal ganglia and the thalami. The electroencephalogram is slowed down on the whole. The main differential diagnoses are infectious encephalitis, acute disseminated encephalomyelitis, and cerebral vasculitis. Posterior reversible encephalopathy syndrome is an MRI diagnosis that presents characteristics similar to SAE. In the future, it could be discovered that it is the same physiopathology. At the moment, we only treat the symptoms and the causative infection. Most of the time, patients have neurologic sequelae that affect their verbal fluency. It can persist from a few months up to 6yrs. Although quite slow, the neurologic progression is good. The mechanisms are studied and there are hopes for specific treatments. The main explanation seems to be immune with alterations of the blood-brain barrier. Cytokines and activated leukocytes may attack the cerebral substance.
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Affiliation(s)
- A-L Chacqueneau
- Clinique universitaire de réanimation pédiatrique et médecine néonatale, CHU, CS 10217, 38043 Grenoble cedex 9, France.
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Debillon T, Chevalier M, Ego A, Cneude F. Neuroprotection par hypothermie lors des encéphalopathies anoxo-ischémiques. Arch Pediatr 2013. [DOI: 10.1016/s0929-693x(13)71385-x] [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: 10/26/2022]
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Chalançon M, Debillon T, Dieterich K, Commare MC. [A rare cause of respiratory failure in infants: distal spinal-muscular atrophy 1 (DSMA1 or SMARD1)]. Arch Pediatr 2012; 19:1082-5. [PMID: 22981475 DOI: 10.1016/j.arcped.2012.07.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Revised: 05/16/2012] [Accepted: 07/13/2012] [Indexed: 11/29/2022]
Abstract
Distal spinal-muscular atrophy 1 (DSMA1) or spinal-muscular atrophy with respiratory distress type 1 (SMARD1) is a rare neuromuscular disorder resulting from IGHMBP2 mutations. It is an autosomal recessive disease. We present the case of a 1-year-old girl admitted for respiratory failure associated with pneumonia. Right hemidiaphragmic elevation on the chest radiograph and distal retractions suggested the diagnosis of DSMA1. It was confirmed by muscle biopsy and molecular analysis. This unrecognized diagnosis should be considered when respiratory failure develops in the first year of life and is associated with diaphragmatic paralysis and distal muscle atrophy. Electromyography with measurement of nerve conduction velocity and muscle biopsy suggest the diagnosis, which must be confirmed by genetic analysis. After identifying the mutations, it is possible to perform prenatal diagnosis.
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Affiliation(s)
- M Chalançon
- Service de médecine néonatale et réanimation pédiatrique, hôpital Couple Enfant, CHU de Grenoble, 38043 Grenoble cedex 09, France.
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Millet A, Desrumaux A, Gayot A, Tristan A, Emeriaud G, Debillon T, Wroblewski I. Un cas de pneumopathie nécrosante à Staphylococcus aureus sécréteur de toxine leucocidine de Panton Valentine chez un nourrisson. Arch Pediatr 2012; 19:718-21. [DOI: 10.1016/j.arcped.2012.04.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 12/11/2011] [Accepted: 04/23/2012] [Indexed: 11/27/2022]
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Chabaud F, David-Tchouda S, Belin V, Fau S, Equy V, Carraby S, Debillon T. Influence du lieu d’hospitalisation sur le devenir à court terme des prématurés nés à 34 semaines d’aménorrhée. Arch Pediatr 2012; 19:391-5. [DOI: 10.1016/j.arcped.2012.01.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Revised: 12/14/2011] [Accepted: 01/24/2012] [Indexed: 11/30/2022]
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Baron-Janaillac M, Cneude F, Bavoux F, Cornali P, Jobert V, Fiacre A, Debillon T, Andrini P. [Are mydriatic eyedrops dangerous for pre-term infants?]. Arch Pediatr 2011; 18:299-302. [PMID: 21269817 DOI: 10.1016/j.arcped.2010.12.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Revised: 08/05/2010] [Accepted: 12/21/2010] [Indexed: 11/17/2022]
Abstract
The funduscopic examination is essential in neonatology to screen for retinopathy in the pre-term infant. Mydriatic eyedrops, which are used for this examination, are known to induce digestive side effects. We present a case of necrotizing enterocolitis developing in a pre-term infant as a complication of mydriatics. This infant was a girl born at 28 weeks gestation and 5 days, with Down's syndrome, who died on the 44th day of life, due to necrotizing enterocolitis, after instillation of 1 drop of atropine 0.3% in each eye. The chronology of events, the application method, and the clinical symptoms of atropine impregnation argue in favor of a causal relationship between atropine and necrotizing enterocolitis. The review of the literature made on the basis of this observation shows that side effects of mydriatic eyedrops are frequent in pre-term infants and raise the question of atropine hypersensitivity in pre-term infants with Down's syndrome.
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Affiliation(s)
- M Baron-Janaillac
- Service de néonatologie et de réa-néonatologie, CHU de Grenoble, boulevard de chantourne, 38700 La Tronche, France.
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Millet A, Salomons GS, Cneude F, Corne C, Debillon T, Jakobs C, Struys E, Hamelin S. Novel mutations in pyridoxine-dependent epilepsy. Eur J Paediatr Neurol 2011; 15:74-7. [PMID: 20427214 DOI: 10.1016/j.ejpn.2010.03.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Revised: 03/24/2010] [Accepted: 03/26/2010] [Indexed: 11/25/2022]
Abstract
PURPOSE Pyridoxine-Dependent Epilepsy (PDE) is a rare autosomal recessive disease with neonatal seizures resistant to conventional anti-epileptic drugs. This metabolic disease has to be diagnosed early and treated to improve outcome. We report on two new mutations that open new prenatal prospects and suggest a new diagnostic procedure. CASE REPORT We describe PDE in a neonate carrying two novel mutations in the ALDH7A1 gene: c.[852_856delCTTAG] + [1230C > A]; p.[(Phe410Leu)] + p.[(Leu285CysfsX26)]. This case also illustrates that diagnosis could have been made without any pyridoxine withdrawal, thanks to the measurement of biomarkers. The patient was successfully treated with pyridoxine supplementation and currently shows normal neurological development.
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Affiliation(s)
- A Millet
- Division of Neonatology, Department of Paediatrics, Grenoble University Hospital, France
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Hamelin S, Delnard N, Cneude F, Debillon T, Vercueil L. Influence of hypothermia on the prognostic value of early EEG in full-term neonates with hypoxic ischemic encephalopathy. Neurophysiol Clin 2010; 41:19-27. [PMID: 21316017 DOI: 10.1016/j.neucli.2010.11.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Revised: 09/29/2010] [Accepted: 11/15/2010] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To determine the prognostic value of early electroencephalograms (EEG) in full-term neonates suffering from hypoxic ischemic encephalopathy (HIE) exposed to whole-body hypothermia (cooled group), compared to neonates treated conventionally (control group). METHODS The study included all term neonates born at Grenoble Hospital between 2000 and 2006 with symptoms of HIE. The first two EEGs were reviewed retrospectively and classified according to current electrophysiological criteria. In the cooled group, EEGs were recorded with a mean body temperature of 33°C. Neurological outcome was correlated with EEG pattern. RESULTS An EEG inactive or paroxysmal pattern was associated with death in 60% of the controls, while all survivors had neurological sequels. In the cooled group, this EEG pattern was only predictive of death in 40% while survivors had normal examination at 1 year of age. Mild abnormalities on the first EEG correlated with a good prognosis in both groups. The second EEG had a high predictive value, particularly in the cooled group. Persistence of inactivity at 3 days after birth was always associated with death. CONCLUSIONS After HIE, the first two EEGs are good prognostic indicators, also in the cooled group. Strong discontinuity in the EEG observed on the first hours after hypothermia induction can be associated with a good outcome. SIGNIFICANCE Early Stage 4 EEGs recorded during the hypothermia may not always indicate a poor prognosis in HIE.
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Affiliation(s)
- S Hamelin
- Neurophysiology, Grenoble University Hospital, 38043 Grenoble, France.
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Debillon T, Casper C. Devenir des enfants issus de grossesse gémellaire. Arch Pediatr 2009; 16:816-7. [DOI: 10.1016/s0929-693x(09)74164-8] [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: 11/16/2022]
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Azria E, Bétrémieux P, Caeymaex L, Debillon T, Fournié A, Huillery ML, Kuhn P, Lequien P, Altavilla A, Mahieu-Caputo D. L’information dans le contexte du soin périnatal : aspects éthiques. ACTA ACUST UNITED AC 2008; 36:476-83. [DOI: 10.1016/j.gyobfe.2008.02.014] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Debillon T, Cantagrel S, Zupan-Simunek V, Gressens P. Neuroprotection par hypothermie lors des encéphalopathies anoxo-ischémiques du nouveau-né à terme : état des connaissances. Arch Pediatr 2008; 15:157-61. [DOI: 10.1016/j.arcped.2007.11.002] [Citation(s) in RCA: 3] [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] [Received: 03/14/2007] [Revised: 11/05/2007] [Accepted: 11/16/2007] [Indexed: 10/22/2022]
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Abstract
UNLABELLED The HPA-15 platelet (PLT) group was recently described. Severe neonatal thrombocytopenia due to alloimmunization by HPA-15b has very rarely been observed. A 22-year-old mother, gravida 1/para 1, gave birth to a male infant who presented with a severe thrombocytopenia, the PLT count recorded to be 3 x10(9)/L. A few hours after birth, he developed purpura with extensive haematomas but without visceral or intracranial haemorrhage (ICH). Two PLT transfusions were given including one using maternal PLTs. The infant's PLT count was 267 x 10(9)/L on day 6. The maternal platelet group was HPA-15a/a and her infant was HPA-15a/b. Anti-HPA-15b antibodies was found in maternal serum. CONCLUSION HPA-15b maternal alloimmunization may induce severe neonatal thrombocytopenia. In order to establish the frequency of neonatal alloimmune thrombocytopenia (NAIT) due to anti-HPA-15b antibodies, an improved detection method is necessary.
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MESH Headings
- Adult
- Antigens, CD/blood
- Antigens, CD/immunology
- Antigens, Human Platelet/blood
- Antigens, Human Platelet/immunology
- Blood Group Incompatibility/complications
- Blood Group Incompatibility/diagnosis
- Blood Group Incompatibility/therapy
- Cesarean Section
- Female
- GPI-Linked Proteins
- Humans
- Infant, Newborn
- Male
- Maternal-Fetal Exchange/immunology
- Neoplasm Proteins/blood
- Neoplasm Proteins/immunology
- Platelet Transfusion
- Pregnancy
- Pregnancy Complications, Hematologic/immunology
- Purpura, Thrombocytopenic/etiology
- Thrombocytopenia, Neonatal Alloimmune/diagnosis
- Thrombocytopenia, Neonatal Alloimmune/immunology
- Thrombocytopenia, Neonatal Alloimmune/therapy
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Affiliation(s)
- P Moncharmont
- French Blood Establishment, Rhône-Alpes Lyon Department, Lyon, France.
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Azria E, Bétrémieux P, Caeymaex L, Debillon T, Fournié A, Huillery ML, Kuhn P, Lequien P, Altavilla A, Mathieu-Caputo D. L'information dans le contexte du soin périnatal: aspects éthiques. Arch Pediatr 2007; 14:1231-9. [PMID: 17826967 DOI: 10.1016/j.arcped.2007.07.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2007] [Accepted: 07/09/2007] [Indexed: 10/22/2022]
Abstract
Besides the undeniable need to respect parental autonomy, providing information is a legal and moral obligation, to be informed a basic right. The act of informing should be considered as an exchange and necessarily begins by listening to the other. According to the jurisprudence of the Court of Cassation that draws on Article 35 of the Deontological Code, information has to be clear (implying an educational effort, availability and to check that the information has been well understood), appropriate (adapted to each situation and person) and honest (which supposes a moral contract between parents and physicians). Loyalty implies a consideration of the uncertainty underlying medical practice, and of the limitations in arriving at a prognosis. Indeed, caution needs to be exercised in conveying information, taking into account the risk of its becoming self-fulfilling, which could modify the way in which parents take care of their child. The information given has to be coherent, both within the spatial dimension (coherence of information between the different maternity services in the perinatal network) and the temporal dimension (coherence of information between pre- and postnatal stages). It must be acknowledged that information is essentially subjective. There is a fundamental difference between coherence and uniformity, and as regards information, uniformity is neither possible nor desirable. In each situation, priority must be given to oral information delivered in an appropriate material context. The principle of establishing, in the medical file, a written trace of the information given at various stages is one way to guarantee its coherence.
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Méan M, Mallaret MR, Andrini P, Recule C, Debillon T, Pavese P, Croizé J. A neonatal specialist with recurrent methicillin-resistant Staphylococcus aureus (MRSA) carriage implicated in the transmission of MRSA to newborns. Infect Control Hosp Epidemiol 2007; 28:625-8. [PMID: 17464930 DOI: 10.1086/513616] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2006] [Accepted: 08/08/2006] [Indexed: 11/04/2022]
Abstract
This study reports an investigation of outbreaks of methicillin-resistant Staphylococcus aureus (MRSA) infection and colonization involving 17 newborns in the neonatal unit of a teaching hospital. A neonatal specialist colonized with MRSA that eventually became mupirocin-resistant was implicated as a recurrent source of transmission of MRSA to newborns.
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Affiliation(s)
- M Méan
- Unité d'Hygiène Hospitalière, Département de veille sanitaire, Centre Hospitalier Universitaire de Grenoble, BP217, 38043. Grenoble Cedex 9
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35
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Grandvuillemin I, Emeriaud G, Jacquier C, Piolat C, Durand C, Pasquier D, Wroblewski I, Debillon T. [Neonatal splenic injury: a difficult diagnosis]. Arch Pediatr 2006; 14:36-8. [PMID: 17123794 DOI: 10.1016/j.arcped.2006.10.002] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2005] [Accepted: 10/10/2006] [Indexed: 11/19/2022]
Abstract
Neonatal splenic injury is a rare but serious condition, due to the risk of haemorrhagic shock. We report on the case of a newborn infant with a neonatal respiratory distress that first evoked materno-fetal infection. Clinical deterioration, with anemia and abdominal distension, led then to the proper diagnosis. Dystocia seems to be the most likely cause of the splenic rupture in this report. Medical treatment is advocated as first line, while surgical treatment may be necessary in some cases. In the case surgery is inevitable, a conservative approach is preferable.
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Affiliation(s)
- I Grandvuillemin
- Service de médecine néonatale, CHU de Grenoble, 38093 Grenoble cedex 09, France.
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Abstract
In a retrospective study of 22 neonates with congenital diaphragmatic hernia, fetal lung volume (FLV) measured by magnetic resonance imaging was associated with survival; the best FLV ratio cut-off to predict mortality was 30% of expected FLV. This study supports a correlation between FLV and the chances of survival.
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Affiliation(s)
- M Bonfils
- Service de Réanimation Néonatale, CHU de Grenoble, BP 217, 38043 Grenoble Cedex 09, France
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Emeriaud G, Eberhard A, Benchetrit G, Debillon T, Baconnier P. Crit Care 2006; 10:P56. [DOI: 10.1186/cc4403] [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: 11/10/2022] Open
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Affiliation(s)
- F Plaisant
- Inserm U 676, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France
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Gras-Le Guen C, Jarry A, Vallette G, Toquet C, Colombeix C, Laboisse CL, Potel G, Roze JC, Bugnon D, Debillon T. Antibiotic therapy reduces nitrosative stress and programmed cell death in the rabbit foetal lung. Eur Respir J 2005; 25:88-95. [PMID: 15640328 DOI: 10.1183/09031936.04.10028904] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The correlation of clinical and epidemiological data suggests that intrauterine infection/inflammation can promote foetal lung injury. The aim of this study was: 1) to characterise the early inflammatory response elicited in infected foetal lungs, in terms of nitric oxide-derived oxidative stress and programmed cell death; and 2) to investigate the effects of antibiotic therapy on these parameters. A previously described rabbit experimental model of materno-foetal infection was used. Animals were divided into three groups: controls; Escherichia coli infected (12 h); and E. Coli infected (12 h) and treated (24 h gentamicin+ceftriaxone). Foetal lungs were examined in terms of histology, nitric oxide synthase (NOS) activity, immunohistochemical detection of 3-nitrotyrosine, and detection of apoptotic cells by the TUNEL assay and Hoechst staining. In the infected group, a moderate inflammatory response was observed, associated with a significant increase in inducible NOS activity, the formation of 3-nitrotyrosine residues in epithelial and immune cells, the down-regulation of constitutive NOS activity and clusters of apoptotic cells, as compared with the control group. Early antibiotic therapy, initiated at 12 h post-inoculation, elicited a significant decrease in the infection-induced nitrosative stress. Levels of 3-nitrotyrosine and of apoptotic cells were decreased in the infected-and-treated group compared with the infected group, mainly by the re-expression of constitutive NOS and of the basal level of inducible NOS. Altogether, these findings indicate that early antibiotic therapy can curb the inflammatory reaction and help avert antenatal lung injury, which is known to be involved in the onset of bronchopulmonary dysplasia.
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Affiliation(s)
- C Gras-Le Guen
- Laboratoire d'Antibiologie Clinique et Expérimentale, Faculté de Médecine, 1 rue G Veil, 44035 Nantes, France.
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40
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Affiliation(s)
- T Debillon
- Service de médecine néonatale, CHU de Grenoble, BP 217, 38043 Grenoble cedex 9, France.
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Debillon T, Gras-Leguen C, Leroy S, Caillon J, Rozé JC, Gressens P. Patterns of cerebral inflammatory response in a rabbit model of intrauterine infection-mediated brain lesion. Brain Res Dev Brain Res 2003; 145:39-48. [PMID: 14519492 DOI: 10.1016/s0165-3806(03)00193-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Although the fetal inflammatory response syndrome seems crucial to the association between intrauterine infection and white matter disease in human preterm infants, the underlying mechanisms remain unclear. Using our previously described rabbit model of cerebral cell death in the white matter and hippocampus induced by intrauterine Escherichia coli infection, we investigated inflammatory and astroglial responses in placenta and brain tissues, in correlation with cell death distribution. Brains and placentas were studied 12, 24, or 48 h following intrauterine inoculation of E. coli or saline (groups G12, G24, and G48). Diffuse monocyte-macrophage infiltrates positive for inducible nitric oxide synthase (i-NOS) were significantly more marked in G24 and G48 placentas than in controls. In the G48 fetuses with both diffuse cell death and focal periventricular white matter cysts mimicking cystic periventricular leukomalacia, a strong rabbit macrophage and inducible nitric oxide synthase immunostaining was observed at the border of these cystic lesions. In contrast, in the fetuses with only diffuse and significant cell death, no inflammatory or astroglial responses were detected in the white matter or hippocampus. Cell death was accompanied by i-NOS immunostaining in the hippocampus but not the white matter. Hippocampal cells positive for i-NOS usually displayed a neuronal phenotype. In this model, focal white matter cysts are accompanied by a robust inflammatory response, and diffuse cell death, which may mimic the white matter and hippocampal damage seen in very and extremely pre-term infants, occur in the absence of a detectable brain inflammatory response.
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Affiliation(s)
- T Debillon
- Service de Néonatologie, Hôpital Mère-Enfant, 9 Quai Moncousu, CHRU, 44 093 Nantes 01, France.
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42
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Gras-Le Guen C, Lepelletier D, Debillon T, Gournay V, Espaze E, Roze JC. Contamination of a milk bank pasteuriser causing a Pseudomonas aeruginosa outbreak in a neonatal intensive care unit. Arch Dis Child Fetal Neonatal Ed 2003; 88:F434-5. [PMID: 12937053 PMCID: PMC1721613 DOI: 10.1136/fn.88.5.f434] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
An environmental investigation and a cohort study were carried out to analyse an outbreak of infection caused by a serotype O10 Pseudomonas aeruginosa in a neonatal intensive care unit. Thirty one cases of infection were recorded, including four lethal ones. The outbreak was stopped by eradicating the environmental sources: a contaminated milk bank pasteuriser and bottle warmer.
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Affiliation(s)
- C Gras-Le Guen
- Département de périnatologie, Hôpital Mère-Enfant, CHU Nantes, France
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Debillon T, N'Guyen S, Muet A, Quere MP, Moussaly F, Roze JC. Limitations of ultrasonography for diagnosing white matter damage in preterm infants. Arch Dis Child Fetal Neonatal Ed 2003; 88:F275-9. [PMID: 12819157 PMCID: PMC1721566 DOI: 10.1136/fn.88.4.f275] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To compare the accuracy of ultrasonography (US) and magnetic resonance imaging (MRI) in diagnosing white matter abnormalities in preterm infants and to determine the specific indications for MRI. DESIGN Prospective cohort study. SETTING A neonatal intensive care unit in France. PATIENTS All preterm infants (</= 33 weeks gestation) without severe respiratory distress syndrome precluding MRI. MAIN OUTCOME MEASURES US and MRI performed contemporaneously during the third postnatal week were analysed by an independent observer. The findings were compared with those of a term MRI scan, the results of which were taken as the final diagnosis. Statistical analysis was performed to determine which early imaging study best predicted the term MRI findings. RESULTS The early US and MRI findings (79 infants) correlated closely for severe lesions (cystic periventricular leucomalacia and parenchymal infarction; kappa coefficient = 0.86) but not for moderate lesions (non-cystic leucomalacia and parenchymal punctate haemorrhages; kappa = 0.62). Overall, early MRI findings predicted late MRI findings in 98% of patients (95% confidence interval (CI) 89.5 to 99.9) compared with only 68% for early US (95% CI 52.1 to 79.2). CONCLUSIONS US is highly effective in detecting severe lesions of the white matter in preterm infants, but MRI seems to be necessary for the diagnosis of less severe damage. MRI performed at about the third week of life is highly predictive of the final diagnosis at term.
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MESH Headings
- Age Factors
- Brain Infarction/diagnosis
- Brain Infarction/diagnostic imaging
- Brain Injuries/diagnosis
- Brain Injuries/diagnostic imaging
- Echoencephalography
- Humans
- Infant, Low Birth Weight
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/diagnosis
- Infant, Premature, Diseases/diagnostic imaging
- Intensive Care, Neonatal
- Leukomalacia, Periventricular/diagnosis
- Leukomalacia, Periventricular/diagnostic imaging
- Magnetic Resonance Imaging
- Predictive Value of Tests
- Prospective Studies
- Sensitivity and Specificity
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Affiliation(s)
- T Debillon
- Neonatal Intensive Care Unit, University Hospital, Nantes, France.
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44
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Gras-Le Guen C, Debillon T, Toquet C, Jarry A, Winer N, Jacqueline C, Kergueris MF, Bingen E, Roze JC, Potel G, Bugnon D. Persistent bacteremia in rabbit fetuses despite maternal antibiotic therapy in a novel intrauterine-infection model. Antimicrob Agents Chemother 2003; 47:2125-30. [PMID: 12821457 PMCID: PMC161868 DOI: 10.1128/aac.47.7.2125-2130.2003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2002] [Revised: 01/22/2003] [Accepted: 04/02/2003] [Indexed: 11/20/2022] Open
Abstract
The effect of optimized maternal therapy by bactericidal agents was evaluated in a reproducible rabbit model of Escherichia coli maternofetal infection simulating human pharmacokinetics. Intravenous antibiotic therapy was begun in the pregnant rabbit 12 h after bacterial intrauterine inoculation, using a computer-controlled pump to simulate human pharmacokinetics of ceftriaxone (1 g/day) associated or not with gentamicin (3 mg/kg of body weight/day). Data were compared for fetal survival, quantitative blood cultures, fetal histology in treated versus untreated groups, and maternal and fetal antibiotic concentrations in plasma in treated animals. Antibiotic therapy led to dramatic improvement in maternal outcome (100% survival versus 100% death in the untreated group in association with maternal septicemia). Fetal survival also improved, with the two-drug combination providing a more potent effect. After 3 days of treatment, 32% of fetuses survived with one-drug therapy and 62% with two-drug therapy (Yates corrected chi(2), P < 0.05). In untreated animals, bacterial counts in blood cultures increased rapidly during the first 24 h up to 8.1 +/- 0.5 log CFU/ml, but remained relatively constant at all times with antibiotic treatment: 4.5 +/- 0.7 log CFU/ml at the start of treatment and 6.2 +/- 0.4 and 5.2 +/- 0.9 log CFU/ml after 72 h for one- and two-drug therapy, respectively (data are means +/- standard deviations). The failure of animals to be cured after 3 days of treatment was not due to an inadequate concentration of ceftriaxone, as the residual level in fetal serum at sacrifice was more than 1000 times the MIC of the microbe. Unexpectedly, inflammation in fetal lung decreased in the treated group after as little as 24 h of antibiotic therapy, despite persistent bacteremia. Although maternal outcome improved and drug concentrations were above the MIC, the treatment did not achieve sterilization of fetuses in utero for this rabbit E. coli maternofetal infection. However, fetal survival showed some improvement, and the histologic features of lung inflammation were reduced.
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Affiliation(s)
- C Gras-Le Guen
- Laboratoire d'Antibiologie Clinique et Expérimentale, Faculté de Médecine de Nantes, Centre Hospitalier Universitaire de Nantes, Nantes, France
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45
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Debillon T, Gras-Leguen C, Vérielle V, Caillon J, Roze JC, Gressens P. Effect of maternal antibiotic treatment on fetal periventricular white matter cell death in a rabbit intrauterine infection model. Acta Paediatr 2003; 92:81-6. [PMID: 12650305 DOI: 10.1111/j.1651-2227.2003.tb00474.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To evaluate the effects of maternal antibiotic treatment on fetal brain cell death in a rabbit intrauterine infection model. METHODS After Escherichia coli uterine-horn inoculation in 22 pregnant rabbits, followed at various times by ceftriaxone and caesarean section, cell death in white matter (histology and fragmented DNA staining) from fetuses killed at extraction was compared across groups using the Mantel-Haenszel test and Fisher's exact test for small numbers. RESULTS White matter cell death was consistently present at 48 h, with ceftriaxone initiation at 24 h (group 1), detectable at 84 but not 60 h, with ceftriaxone initiation at 12 h, and significantly reduced at 84 h with ceftriaxone initiation at 6 h (60% vs 100% in group 1, p < 0.001, Fisher's exact test). CONCLUSION Early maternal antibiotic therapy delays white matter cell death in rabbit fetuses exposed to intrauterine infection. This may provide a window for preventing white matter damage.
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Affiliation(s)
- T Debillon
- Service de Néonatologie, Hôpital Mère-Enfant, CHRU Nantes, Nantes, France.
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46
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Abstract
UNLABELLED The aim of this study was to investigate pain management in neonatal intensive care units (NICUs) in France and to identify factors associated with variability across units. A questionnaire sent to 143 heads of level II or III NICUs investigated the use of pain scores, pain management organization and pharmacological treatment in five clinical situations (endotracheal intubation, prolonged mechanical ventilation, acute stage of necrotizing enterocolitis, central venous catheter insertion and cephalhaematoma). The response rate was 81%. Among the 35 (30%) units that used no pain scores, 40% ascribed this to lack of knowledge. Factors associated with failure to use pain scores were level II status, no university affiliation, no surgical patients and neonatal patients only. Among the units that scored pain, 78% used valid scores for acute pain and 73% for prolonged pain. Written guidelines were available for acute pain in 65% of units and for prolonged pain in 36%. The rate of pharmacotherapy use varied widely across the five clinical situations studied (from 16 to 77%) and across units for a given clinical situation. Also extremely variable were the regimens used in each situation and the dosages of analgesics and sedatives. Only 11% of units adjusted dosages to gestational age. CONCLUSION Pain assessment was performed in the most French NICUs, but a strong heterogeneity for pain treatment was observed. Reference to recently published pain management guidelines and new randomized trials could be useful to optimize pain treatment in NICUs.
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Affiliation(s)
- T Debillon
- Neonatal Intensive Care Unit, Mother and Child University Hospital, Nantes.
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47
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Debillon T, Zupan V, Ravault N, Magny JF, Dehan M. Development and initial validation of the EDIN scale, a new tool for assessing prolonged pain in preterm infants. Arch Dis Child Fetal Neonatal Ed 2001; 85:F36-41. [PMID: 11420320 PMCID: PMC1721270 DOI: 10.1136/fn.85.1.f36] [Citation(s) in RCA: 163] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To develop and validate a scale suitable for use in clinical practice as a tool for assessing prolonged pain in premature infants. METHODS Pain indicators identified by observation of preterm infants and selected by a panel of experts were used to develop the EDIN scale (Echelle Douleur Inconfort Nouveau-Né, neonatal pain and discomfort scale). A cohort of preterm infants was studied prospectively to determine construct validity, inter-rater reliability, and internal consistency of the scale. RESULTS The EDIN scale uses five behavioural indicators of prolonged pain: facial activity, body movements, quality of sleep, quality of contact with nurses, and consolability. The validation study included 76 preterm infants with a mean gestational age of 31.5 weeks. Inter-rater reliability was acceptable, with a kappa coefficient range of 0.59-0.74. Internal consistency was high: Cronbach's alpha coefficients calculated after deleting each item ranged from 0.86 to 0.94. To establish construct validity, EDIN scores in two extreme situations (pain and no pain) were compared, and a significant difference was observed. CONCLUSIONS The validation data suggest that the EDIN is appropriate for assessing prolonged pain in preterm infants. Further studies are warranted to obtain further evidence of construct validity by comparing scores in less extreme situations.
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Affiliation(s)
- T Debillon
- Neonatal Intensive Care Unit, Mother-Child University Hospital, 44 093 Nantes Cedex 01, France.
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48
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Savagner C, Branger B, Beringue F, Catala L, Le Bouedec S, Bouderlique C, Debillon T, Brossier JP, Seguin G, Boog G, Roze JC. [Gravely ill newborns (excluding greatly premature) in 1986 and 1995 in three deparments of Pays de la Loire]. Arch Pediatr 2000; 7:1171-9. [PMID: 11109943 DOI: 10.1016/s0929-693x(00)00126-3] [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: 11/30/2022]
Abstract
AIM Evaluation of the progress in the treatment of seriously ill newborn infants under hospital care over the nine-year period from 1986 to 1995 in three departments of the Pays de la Loire region in France. POPULATION AND METHODS The category of seriously ill newborn infants included only infants born after at least 32 weeks of gestation and having a Cullen severity score higher than 2. The two groups of seriously ill newborn infants at risk in 1986 and 1995 were first compared to a control group of healthy newborn babies delivered during the same years. The two groups were then compared with each other. RESULTS In 1986 and 1995, the numbers of births were respectively 32,876 and 29,446, and the numbers of seriously ill newborn infants under hospital care were respectively 307 and 245. However, between 1986 and 1995 the risk factors as well as the causes of morbidity had changed. The average period of hospitalization decreased by five days. The mortality rate dropped from 0.16% to 0.09% (P < 0.05) and the number of serious complications decreased from 0.07% to 0.03% (P < 0.05). CONCLUSION The improvement in the care of seriously ill newborn infants between the two reference periods, 1986 and 1995, may be attributed not only to technical progress but also to a better organization of the perinatal care in our region.
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Affiliation(s)
- C Savagner
- Unité de néonatologie, CHU Angers, France
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49
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Abstract
An association between chorioamnionitis and periventricular leukomalacia has been reported in human preterm infants. However, whether this link is causal has not been convincingly established, and the underlying molecular mechanisms remain unclear. The objective of this study was to establish a reproducible model of cerebral white matter disease in preterm rabbits after intrauterine infection. Escherichia coli was inoculated into both uterine horns of laparotomized pregnant rabbits when gestation was 80% complete. The fetuses were delivered by cesarean section and killed 12, 24, or 48 h after the inoculation. Programmed cell death in the white matter was evaluated by hematoxylin-eosin-saffron staining and in situ fragmented DNA labeling (terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling). In a first group of 14 pregnant rabbits not treated with antibiotics, all fetuses delivered 48 h after inoculation were stillborn, whereas fetuses extracted 12 or 24 h after inoculation were alive. No significant cell death was detected in the live fetuses compared with the control noninfected rabbits. In a second group of five pregnant rabbits treated with ceftriaxone initiated 24 h after the inoculation and continued until cesarean section was performed 48 h after inoculation, 13 fetuses were alive, but all showed evidence of extensive programmed cell death in the white matter by hematoxylin-eosin-saffron staining and terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling. White matter damage became histologically detectable only 48 h after inoculation. Three of the 13 brains displayed periventricular white matter cysts mimicking human cystic periventricular leukomalacia. The high reproducibility of white matter damage in our model should permit further studies aimed at unraveling the molecular mechanisms of periventricular leukomalacia.
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Affiliation(s)
- T Debillon
- Departement de Perinatologie, Hôpital Mère-Enfant, Nantes, France
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50
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Boog G, Winer N, Le Vaillant C, Caroit-Cambazard Y, Trémouillac C, Debillon T, Rozé JC. [Practical problems of the functioning of the perinatal network in the Loire region]. Arch Pediatr 2000; 6 Suppl 2:216s-219s. [PMID: 10370485 DOI: 10.1016/s0929-693x(99)80417-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- G Boog
- Service d'obstétrique, de médecine faetale, CHU de Nantes, France
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