32 results on '"Foix‐L'Hélias, L"'
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2. Propositions sur la prise en charge en cas d’extrême prématurité – Le groupe de travail « Extrême Prématurité » pour la SFMP, le CNGOF et la SFN
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Bouvard, C., Evrard, A., Jabert, P., de Mezerac, I., Ancel, P.-Y., Breart, G., Bruel, H., Debillon, T., D’Ercole, C., Deruelle, P., Dreyfus, M., Foix-L’Helias, L., Goffinet, F., Jarreau, P.-H., Kuhn, P., and Langer, B.
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- 2020
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3. Devenir des enfants prématurés
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Torchin, H. and Foix-L’Hélias, L.
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- 2019
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4. Impact de l’enquête EPIPAGE 2 sur la prise en charge anténatale et postnatale entre 22 et 26 SA dans trois maternités de type III d’Île-de-France
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Salmon, F., Foix-L’Hélias, L., Lamau, M.-C., Ruiz, E., and Kayem, G.
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- 2018
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5. Infection néonatale bactérienne précoce (INBP) : quel algorithme de prise en charge en 2017 ?
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Gras-Le Guen, C., Foix-L’Hélias, L., and Boileau, P.
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- 2017
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6. Impact of clinical and/or histological chorioamnionitis on neurodevelopmental outcomes in preterm infants: A literature review
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Maisonneuve, E., Ancel, P.-Y., Foix-L’Hélias, L., Marret, S., and Kayem, G.
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- 2017
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7. Infections néonatales bactériennes précoces : évaluation des pratiques professionnelles dans 14 maternités d’Île-de-France en 2013
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Sikias, P., Parmentier, C., Imbert, P., Rajguru, M., Chavet, M.-S., Coquery, S., Foix-L’Hélias, L., and Boileau, P.
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- 2015
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8. Cohort Profile: the Etude Epidémiologique sur les Petits Ages Gestationnels-2 (EPIPAGE-2) preterm birth cohort
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Lorthe, Elsa, Benhammou, Valérie, Marchand-Martin, Laetitia, Pierrat, Véronique, Lebeaux, Cécile, Durox, Mélanie, Goffinet, François, Kaminski, Monique, Ancel, Pierre-Yves, Astruc, D, Kuhn, P, Langer, B, Matis, J, Ramousset, C, Hernandorena, X, Chabanier, P, Joly-Pedespan, L, Rebola, M, Costedoat, M, Leguen, A, Martin, C, Lecomte, B, Lemery, D, Vendittelli, F, Rochette, E, Beucher, G, Dreyfus, M, Guillois, B, Toure, Y, Rots, D, Burguet, A, Couvreur, S, Gouyon, J, Sagot, P, Colas, N, Franzin, A, Sizun, J, Beuchée, A, Pladys, P, Rouget, F, Dupuy, R, Soupre, D, Charlot, F, Roudaut, S, Favreau, A, Saliba, E, Reboul, L, Aoustin, E, Bednarek, N, Morville, P, Verrière, V, THIRIEZ, G, Balamou, C, Ratajczak, C, Marpeau, L, Marret, S, Barbier, C, Mestre, N, Kayem, G, Durrmeyer, X, Granier, M, Lapillonne, A, Ayoubi, M, Baud, O, Carbonne, B, Foix L’Hélias, L, Jarreau, P, Mitanchez, D, Boileau, P, Duffaut, C, Cornu, L, Moras, R, Salomon, D, Medjahed, S, Ahmed, K, Boulot, P, Cambonie, G, Daudé, H, Badessi, A, Tsaoussis, N, Poujol, M, Bédu, A, Mons, F, Bahans, C, Binet, M, Fresson, J, Hascoët, J, Milton, A, Morel, O, Vieux, R, Hilpert, L, Alberge, C, Arnaud, C, Vayssière, C, Baron, M, Charkaluk, M, Subtil, D, Truffert, P, Akowanou, S, Roche, D, Thibaut, M, D’Ercole, C, Gire, C, Simeoni, U, Bongain, A, DESCHAMPS, M, Zahed, M, Branger, B, Rozé, J, Winer, N, Gascoin, G, Sentilhes, L, Rouger, V, Dupont, C, Martin, H, Gondry, J, Krim, G, Baby, B, Popov, I, Debeir, M, Claris, O, Picaud, J, Rubio-Gurung, S, Cans, C, Ego, A, Debillon, T, Patural, H, Rannaud, A, Janky, E, Poulichet, A, Rosenthal, J, Coliné, E, Cabrera, C, Favre, A, Joly, N, Stouvenel, A, Châlons, S, Pignol, J, Laurence, P, Lochelongue, V, Robillard, P, Samperiz, S, Ramful, D, Asadullah, H, Blondel, B, Bonet, M, Brinis, A, Coquelin, A, Delormel, V, Esmiol, S, Fériaud, M, Foix-L’Hélias, L, Khemache, K, Khoshnood, B, Onestas, L, Quere, M, Rousseau, J, Rtimi, A, Saurel-Cubizolles, M, Tran, D, Sylla, D, Vasante-Annamale, L, Zeitlin, J, Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Conservatoire National des Arts et Métiers [CNAM] (CNAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Equipe 1 : EPOPé - Épidémiologie Obstétricale, Périnatale et Pédiatrique (CRESS - U1153), Conservatoire National des Arts et Métiers [CNAM] (CNAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Conservatoire National des Arts et Métiers [CNAM] (CNAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), AP-HP - Hôpital Cochin Broca Hôtel Dieu [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut Pascal (IP), Centre National de la Recherche Scientifique (CNRS)-Université Clermont Auvergne (UCA)-Institut national polytechnique Clermont Auvergne (INP Clermont Auvergne), Université Clermont Auvergne (UCA)-Université Clermont Auvergne (UCA), CHU Estaing [Clermont-Ferrand], and CHU Clermont-Ferrand
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[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,[SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics ,ComputingMilieux_MISCELLANEOUS - Abstract
International audience
- Published
- 2021
9. The Impact of Chorionicity on Pregnancy Outcome and Neurodevelopment at 2 Years Old Among Twins Born Preterm: The EPIPAGE-2 Cohort Study
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Tosello, B., primary, Garbi, A., additional, Blanc, J., additional, Lorthe, E., additional, Foix-L'Hélias, L., additional, D'Ercole, C., additional, Winer, N., additional, Subtil, D., additional, Goffinet, F., additional, Kayem, G., additional, Resseguier, N., additional, and Gire, C., additional
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- 2021
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10. The impact of chorionicity on pregnancy outcome and neurodevelopment at 2 years old among twins born preterm: the EPIPAGE-2 cohort study.
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Tosello, B, Garbi, A, Blanc, J, Lorthe, E, Foix‐L'Hélias, L, D'Ercole, C, Winer, N, Subtil, D, Goffinet, F, Kayem, G, Resseguier, N, Gire, C, Ancel, Pierre‐Yves, Arnaud, Catherine, Boileau, Pascal, Debillon, Thierry, Delorme, Pierre, Desplanches, Thomas, Diguisto, Caroline, and Gascoin, Géraldine
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PREGNANCY outcomes ,HIGH-risk pregnancy ,FETOFETAL transfusion ,TWINS ,INTENSIVE care units ,COHORT analysis ,PREMATURE infant diseases ,AGE distribution ,CHORION ,SYMPTOMS ,PLACENTA ,LONGITUDINAL method ,MULTIPLE pregnancy - Abstract
Objective: To compare the short- and mid-term outcomes of preterm twins by chorionicity of pregnancy.Design: Prospective nationwide population-based EPIPAGE-2 cohort study.Setting: 546 maternity units in France, between March and December 2011.Population: A total of 1700 twin neonates born between 24 and 34 weeks of gestation.Methods: The association of chorionicity with outcomes was analysed using multivariate regression models.Main Outcome Measures: First, survival at 2-year corrected age with or without neurosensory impairment, and second, perinatal, short-, and mid-term outcomes (survival at discharge, survival at discharge without severe morbidity) were described and compared by chorionicity.Results: In the EPIPAGE 2 cohort, 1700 preterm births were included (850 twin pregnancies). In all, 1220 (71.8%) were from dichorionic (DC) pregnancies and 480 from monochorionic (MC) pregnancies. MC pregnancies had three times more medical terminations than DC pregnancies (1.67 versus 0.51%, P < 0.001), whereas there were three times more stillbirths in MC than in DC pregnancies (10.09 versus 3.78%, P < 0.001). Both twins were alive at birth in 86.6% of DC pregnancies compared with 80.0% among MC pregnancies (P = 0.008). No significant difference according to chorionicity was found regarding neonatal deaths and morbidities. Likewise, for children born earlier than 32 weeks, the 2-year follow-up neurodevelopmental results were not significantly different between DC and MC twins.Conclusions: This study confirms that MC pregnancies have a higher risk of adverse outcomes. However, the outcomes among preterm twins admitted to neonatal intensive care units are similar irrespective of chorionicity.Tweetable Abstract: Monochorionicity is associated with adverse perinatal outcomes, but outcomes for preterm twins are comparable irrespective of their chorionicity. [ABSTRACT FROM AUTHOR]- Published
- 2021
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11. Changes in conditions at birth in France from 1995 to 2016: Results of the National Perinatal Surveys
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Blondel, B., primary, Pierrat, V., additional, and Foix-L’Hélias, L., additional
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- 2018
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12. Que retenir des recommandations HAS-SFN 2017 sur l’infection néonatale bactérienne précoce (INBP) ?
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Gras-Le-Guen, C., primary, Foix-L’Hélias, L., additional, Tourneux, P., additional, Boileau, P., additional, Lavie, E., additional, Astruc, D., additional, Biran, V., additional, Bonacorsi, S., additional, Castel, C., additional, Chavet, M.-S., additional, Coquery, S., additional, Gras-le-Guen, C., additional, Imbert, P., additional, Nizard, J., additional, Parmentier, C., additional, Quentin, R., additional, Rajguru, M., additional, Raymond, J., additional, Rodriguez, C., additional, Romain, O., additional, and Sikias, P., additional
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- 2018
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13. Que retenir des recommandations HAS-SFN 2017 sur l’infection néonatale bactérienne précoce (INBP) ?
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Boileau, P., Foix-L’Hélias, L., Lavie, E., Astruc, D., Biran, V., Bonacorsi, S., Castel, C., Chavet, M.-S., Coquery, S., Gras-le-Guen, C., Imbert, P., Nizard, J., Parmentier, C., Quentin, R., Rajguru, M., Raymond, J., Rodriguez, C., Romain, O., Sikias, P., Tourneux, P., and Gras-Le-Guen, C.
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- 2018
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14. Delivery room management of extremely preterm infants: the EPIPAGE-2 study.
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Perlbarg, J., Ancel, P. Y., Khoshnood, B., Durox, M., Boileau, P., Garel, M., Kaminski, M., Goffinet, F., Foix-L'Hélias, L., and Epipage-2 Ethics group
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PREMATURE infants ,GESTATIONAL age ,INFANT mortality ,NEONATAL intensive care ,HOSPITAL emergency services ,SURVIVAL ,PASSIVE euthanasia ,HOSPITAL birthing centers - Abstract
Objective: To analyse the delivery room management of babies born between 22 and 26 weeks of completed gestational age and to identify the factors associated with the withholding or withdrawal of intensive care.Study Design: Population-based cohort study.Patients and Methods: Our study population comprised 2145 births between 22 and 26 completed weeks enrolled in the EPIPAGE-2 study, a French cohort of very preterm infants born in 2011. The primary outcome measure was withholding or withdrawal of intensive care in the delivery room.Results: Among infants born alive at 22-23 weeks, intensive care was withheld or withdrawn for >90%. At 24 weeks, resuscitative measures were withheld or withdrawn for 38%, at 25 weeks for 8% and at 26 weeks for 3%. Other factors besides gestational age at birth associated with this withholding or withdrawal for infants born at 24-26 weeks were birth weight <600 g, emergency delivery (within 24 h of the mother's admission) and singleton pregnancy. Although rates of withholding or withdrawal of intensive care varied substantially between maternity units (from 0% to 100%), the variability was primarily explained by differences in distributions of gestational age at birth.Conclusions: Although gestational age is only one factor predicting survival of preterm infants, practices in France appear to be based primarily on this factor, which thus has direct effects on the survival of extremely preterm infants. The ethical implications of basing life and death decisions only on gestational age before 25 weeks require further examination. [ABSTRACT FROM AUTHOR]- Published
- 2016
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15. Infecciones bacterianas neonatales tempranas y tardías
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Letouzey, M., Boileau, P., and Foix-L’Hélias, L.
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Las infecciones son una patología frecuente en el período neonatal, que afectan al 1-5% de los recién nacidos. La tasa de mortalidad de estas infecciones neonatales sigue siendo preocupante a pesar de los avances en neonatología. Las consecuencias de las infecciones son posibles a corto plazo, pero también a largo plazo, con trastornos del neurodesarrollo en particular. Las características y consecuencias de las infecciones neonatales varían según se produzcan de forma precoz (en los primeros 3 días de vida) o tardía (entre el 3.° y el 28.° día de vida) y según el contexto en el que se produzcan (recién nacido a término o prematuro, en particular). El diagnóstico de las infecciones neonatales es difícil debido a los signos clínicos inespecíficos. La identificación de bacterias en la sangre o en el líquido cefalorraquídeo permite confirmar el diagnóstico. Las infecciones bacterianas neonatales tempranas están relacionadas sobre todo con el estreptococo del grupo B y Escherichia coli. Las infecciones bacterianas neonatales tardías pueden distinguirse según dos marcos nosológicos: infecciones adquiridas en la comunidad e infecciones asociadas a los cuidados, que son frecuentes en los recién nacidos prematuros.
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- 2021
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16. Clinical Chorioamnionitis and Neurodevelopment at 5 Years of Age in Children Born Preterm: The EPIPAGE-2 Cohort Study.
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Salmon F, Kayem G, Maisonneuve E, Foix-L'Hélias L, Benhammou V, Kaminski M, Marchand-Martin L, Kana G, Subtil D, Lorthe E, Ancel PY, and Letouzey M
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- Infant, Newborn, Infant, Pregnancy, Child, Female, Humans, Aged, 80 and over, Cohort Studies, Gestational Age, Tachycardia, Chorioamnionitis epidemiology, Premature Birth, Fetal Membranes, Premature Rupture epidemiology
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Objective: To assess the association between clinical chorioamnionitis and neurodevelopmental disorders at 5 years of age in children born preterm., Study Design: EPIPAGE 2 is a national, population-based cohort study of children born before 35 weeks of gestation in France in 2011. We included infants born alive between 24
0/7 and 346/7 weeks after preterm labor or preterm premature rupture of membranes. Clinical chorioamnionitis was defined as maternal fever before labor (>37.8°C) with ≥2 of the following criteria: maternal tachycardia, hyperleukocytosis, uterine contractions, purulent amniotic fluid, or fetal tachycardia. The primary outcome was a composite, including cerebral palsy, coordination disorders, cognitive disorders, sensory disorders, or behavioral disorders. We also analyzed each of these disorders separately as secondary outcomes. We performed a multivariable analysis using logistic regression models. We accounted for the nonindependence of twins and missing data by generalized estimating equation models and multiple imputations, respectively., Results: Among 2927 children alive at 5 years of age, 124 (3%) were born in a context of clinical chorioamnionitis. Overall, 8.2% and 9.6% of children exposed and unexposed, respectively, to clinical chorioamnionitis had moderate-to-severe neurodevelopmental disorders. After multiple imputations and multivariable analysis, clinical chorioamnionitis was not associated with the occurrence of moderate-to-severe neurodevelopmental disorders (aOR, 0.9; 95% CI, 0.5-1.8)., Conclusions: We did not find any association between clinical chorioamnionitis and neurodevelopmental disorders at 5 years of age in children born at <35 weeks of gestation after preterm labor or preterm premature rupture of membrane., Competing Interests: Declaration of Competing Interest The EPIPAGE 2 study was funded with support from the French Institute of Public Health Research/Institute of Public Health, and its partners. Partners include the French Health Ministry, National Institute of Health and Medical Research (INSERM), National Institute of Cancer, and National Solidarity Fund for Autonomy (CNSA); National Research Agency through the French EQUIPEX programme of investments in the future (reference ANR-11-EQPX-0038, ANR-19-COHO-001); PREMUP Foundation; Foundation of France (reference 11779); Foundation for Medical Research (SPF20160936356); and hospital clinical research programme Epinutri (DGOS13-040). Ministère de l'Enseignement Supérieur, De La Recherche et de L'Innovation (G13129KK); Apicil Foundation (R20065KK). The funding source had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval the manuscript; and the decision to submit the manuscript for publication. The authors declare no conflicts of interest., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)- Published
- 2024
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17. Circumstances, causes and timing of death in extremely preterm infants admitted to NICU: The EPIPAGE-2 study.
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Boileau P, Letouzey M, Morgan AS, Lorthe E, Kaminski M, Coquelin A, Azria E, Caeymaex L, Rouget F, Diguisto C, Claris O, Tosello B, Truffert P, Bétrémieux P, Benhammou V, Marchand-Martin L, Goffinet F, Ancel PY, and Foix-L'Hélias L
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- Infant, Infant, Newborn, Humans, Patient Discharge, Infant, Extremely Premature, Intensive Care Units, Neonatal
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Aim: To describe the circumstances, causes and timing of death in extremely preterm infants., Methods: We included from the EPIPAGE-2 study infants born at 24-26 weeks in 2011 admitted to neonatal intensive care units (NICU). Vital status and circumstances of death were used to define three groups of infants: alive at discharge, death with or without withholding or withdrawing life-sustaining treatment (WWLST). The main cause of death was classified as respiratory disease, necrotizing enterocolitis, infection, central nervous system (CNS) injury, other or unknown., Results: Among 768 infants admitted to NICU, 224 died among which 89 died without WWLST and 135 with WWLST. The main causes of death were respiratory disease (38%), CNS injury (30%) and infection (12%). Among the infants who died with WWLST, CNS injury was the main cause of death (47%), whereas respiratory disease (56%) and infection (20%) were the main causes in case of death without WWLST. Half (51%) of all deaths occurred within the first 7 days of life, and 35% occurred within 8 and 28 days., Conclusion: The death of extremely preterm infants in NICU is a complex phenomenon in which the circumstances and causes of death are intertwined., (© 2023 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)
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- 2023
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18. Early skin-to-skin contact and risk of late-onset-sepsis in very and extremely preterm infants.
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Le Ray I, Kuhn P, Letouzey M, Roué JM, Mitha A, Glorieux I, Foix-L'Hélias L, Marchand-Martin L, Ancel PY, Kaminski M, and Pierrat V
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- Infant, Newborn, Humans, Child, Infant, Extremely Premature, Skin, Infant, Very Low Birth Weight, Staphylococcus, Kangaroo-Mother Care Method methods, Sepsis epidemiology
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Background: To evaluate the association between exposure to early skin-to-skin contact (SSC) and incidence of late-onset sepsis (LOS) in extremely and very preterm infants., Methods: Observational study using the national population-based EPIPAGE-2 cohort in 2011. A propensity score for SSC exposure was used to match infants with and without exposure to SSC before day 4 of life and binomial log regression used to estimate risk ratios and CIs in the matched cohort. The primary outcome was at least one episode of LOS during hospitalization. Secondary outcomes were the occurrence of any late-onset neonatal infection (LONI), LOS with Staphylococcus or Staphylococcus aureus, incidence of LOS and LONI per 1000 central venous catheter days., Results: Among the 3422 included infants, 919 were exposed to early SSC. The risk ratio (RR) for LOS was 0.86 (95% CI, 0.67-1.10), for LONI was 1.00 (95% CI, 0.83-1.21), and for LOS with Coagulase-negative Staphylococcus or Staphylococcus aureus infection was 0.91 (95% CI, 0.68-1.21) and 0.77 (95% CI, 0.31-1.87). The incidence RR for LOS per-catheter day was 0.87 (95% CI, 0.64-1.18)., Conclusion: Early SSC exposure was not associated with LOS or LONI risk. Thus, their prevention should not be a barrier to a wider use of SSC., Impact: Kangaroo Mother Care decreased neonatal infection rates in middle-income countries. Skin-to-skin contact is beneficial for vulnerable preterm infants but barriers exist to its implementation. In a large population-based study using a propensity score methods, we found that skin-to-skin contact before day 4 of life was not associated with a decreased risk of late-onset-sepsis in very and extremely preterm infants. Early skin-to-skin contact was not associated with an increased risk of any late-onset-neonatal-infection, in particular with staphylococcus. The fear of neonatal infection should not be a barrier to a wider use of early skin-to-skin contact in this population., (© 2022. The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.)
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- 2023
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19. Early-onset neonatal sepsis in the Paris area: a population-based surveillance study from 2019 to 2021.
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Sikias P, Biran V, Foix-L'Hélias L, Plainvert C, Boileau P, and Bonacorsi S
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- Infant, Infant, Newborn, Humans, Female, Pregnancy, Escherichia coli, Infant, Premature, Paris epidemiology, Anti-Bacterial Agents therapeutic use, Incidence, Streptococcus agalactiae, Neonatal Sepsis drug therapy, Sepsis epidemiology, Streptococcal Infections prevention & control
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Background: Early-onset neonatal sepsis (EOS) is a rare condition but an important cause of severe morbidity and mortality in neonates., Methods: This is a prospective observational study in neonates born at ≥34 weeks of gestation (WG). The primary endpoint was EOS, defined by isolation of pathogenic species from blood culture and/or cerebrospinal fluid culture within 72 hours after birth. Data on EOS were collected exhaustively from all maternity wards in Paris area (April 2019-March 2021)., Results: 108 EOS were recorded (annual incidence, 0.32 per 1000 live births; 95% CI 0.26 to 0.38). In term infants, the most frequent pathogens were group B Streptococcus (GBS) (n=47) and Escherichia coli (n=20); in late preterm infants, the most frequent pathogens were E. coli (n=15) and GBS (n=7). Fifteen meningitis cases were diagnosed. Five E. coli strains (14%) were resistant to both amoxicillin and gentamicin, which is an empiric treatment for EOS. Of the 54 infants with GBS infections, 35 were born from mothers with negative GBS prepartum screening test and 8 from mothers with no screening. Two deaths were reported, both in term infants ( Proteus mirabilis and E. coli )., Conclusion: In neonates ≥34 WG born in the Paris area, GBS was twice as frequent as E. coli in term infants. EOS was six times more frequent in late preterm than in term infants and was due to E. coli in 60% of cases. Prevention of GBS EOS and empiric antibiotic treatment of EOS could be improved., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2023
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20. Reply.
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Letouzey M, Foix-L'Hélias L, and Lorthe E
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- 2022
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21. Early Antibiotic Exposure and Adverse Outcomes in Very Preterm Infants at Low Risk of Early-Onset Sepsis: The EPIPAGE-2 Cohort Study.
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Letouzey M, Lorthe E, Marchand-Martin L, Kayem G, Charlier C, Butin M, Mitha A, Kaminski M, Benhammou V, Ancel PY, Boileau P, and Foix-L'Hélias L
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- Anti-Bacterial Agents adverse effects, Cohort Studies, Female, Fetal Growth Retardation, Humans, Infant, Infant, Newborn, Infant, Premature, Pregnancy, Prospective Studies, Bronchopulmonary Dysplasia drug therapy, Bronchopulmonary Dysplasia epidemiology, Infant, Premature, Diseases drug therapy, Infant, Premature, Diseases epidemiology, Sepsis drug therapy, Sepsis epidemiology
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Objective: To assess the association between early empirical antibiotics and neonatal adverse outcomes in very preterm infants without risk factors for early-onset sepsis (EOS)., Study Design: This is a secondary analysis of the EPIPAGE-2 study, a prospective national population-based cohort that included all liveborn infants at 22-31 completed weeks of gestation in France in 2011. Infants at high risk of EOS (ie, born after preterm labor or preterm premature rupture of membranes or from a mother who had clinical chorioamnionitis or had received antibiotics during the last 72 hours) were excluded. Early antibiotic exposure was defined as antibiotic therapy started at day 0 or day 1 of life, irrespective of the duration and type of antibiotics. We compared treated and untreated patients using inverse probability of treatment weighting based on estimated propensity scores., Results: Among 648 very preterm infants at low risk of EOS, 173 (26.2%) had received early antibiotic treatment. Early antibiotic exposure was not associated with death or late-onset sepsis or necrotizing enterocolitis (OR, 1.04; 95% CI, 0.72-1.50); however, it was associated with higher odds of severe cerebral lesions (OR, 2.71; 95% CI, 1.25-5.86) and moderate-severe bronchopulmonary dysplasia (BPD) (OR, 2.30; 95% CI, 1.21-4.38)., Conclusions: Early empirical antibiotic therapy administrated in very preterm infants at low risk of EOS was associated with a higher risk of severe cerebral lesions and moderate-severe BPD., (Copyright © 2021 Elsevier Inc. All rights reserved.)
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- 2022
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22. Perinatal outcome and need of care for term asphyxiated newborns without moderate or severe hypoxic-ischemic encephalopathy.
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Bower A, Lorain P, Kayem G, Dommergues M, Foix-L'Hélias L, and Guellec I
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- Female, Humans, Infant, Newborn, Pregnancy, Prospective Studies, Retrospective Studies, Acidosis etiology, Acidosis therapy, Asphyxia Neonatorum complications, Asphyxia Neonatorum diagnosis, Asphyxia Neonatorum therapy, Hypoxia-Ischemia, Brain therapy
- Abstract
Aim: Birth asphyxia can lead to organ dysfunction, varying from isolated biological acidosis to hypoxic-ischemic encephalopathy (HIE). Pathophysiology of moderate or severe HIE is now well known and guidelines exist regarding the care required in this situation. However, for newborns without moderate or severe HIE, no consensus is available. Our objective was to describe the immediate neonatal consequences and need for care of asphyxiated newborns without moderate or severe HIE., Methods: Multicentre retrospective study from January 2015 to December 2017 in two academic centres, including neonates ≥37 gestational weeks with pathological foetal acidemia (umbilical arterial pH<7.00 and/or lactate≥10 mmol/L)., Results: Among 18 550 births, 161 (0.9%) had pathological foetal acidemia. 142 (88.0%) were not diagnosed with moderate or severe HIE. Among them, 82 (58.0%) were hospitalised. 13 (9.0%) had respiratory failure and required nutritional support. 100 (70.0%) underwent blood sampling, which showed at least one biological anomaly in 66 (66.0%) of cases., Conclusion: Newborns born with pathological foetal acidemia without the occurrence of moderate or severe HIE had metabolic disorders and could need organ support. A prospective study describing this vulnerable population would help to establish consensus guidelines for the management of this population., (©2021 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)
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- 2022
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23. Cause of preterm birth and late-onset sepsis in very preterm infants: the EPIPAGE-2 cohort study.
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Letouzey M, Foix-L'Hélias L, Torchin H, Mitha A, Morgan AS, Zeitlin J, Kayem G, Maisonneuve E, Delorme P, Khoshnood B, Kaminski M, Ancel PY, Boileau P, and Lorthe E
- Subjects
- Adult, Cohort Studies, Female, Fetal Growth Retardation, Humans, Infant, Newborn, Infant, Premature, Diseases etiology, Pregnancy, Infant, Premature, Premature Birth, Sepsis physiopathology
- Abstract
Background: The pathogenesis of late-onset sepsis (LOS) in preterm infants is poorly understood and knowledge about risk factors, especially prenatal risk factors, is limited. This study aimed to assess the association between the cause of preterm birth and LOS in very preterm infants., Methods: 2052 very preterm singletons from a national population-based cohort study alive at 72 h of life were included. Survival without LOS was compared by cause of preterm birth using survival analysis and Cox regression models., Results: 437 (20.1%) had at least one episode of LOS. The frequency of LOS varied by cause of preterm birth: 17.1% for infants born after preterm labor, 17.9% after preterm premature rupture of membranes, 20.3% after a placental abruption, 20.3% after isolated hypertensive disorders, 27.5% after hypertensive disorders with fetal growth restriction (FGR), and 29.4% after isolated FGR. In multivariate analysis, when compared to infants born after preterm labor, the risk remained higher for infants born after hypertensive disorders (hazard ratio HR = 1.7, 95% CI = 1.2-2.5), hypertensive disorders with FGR (HR = 2.6, 95% CI = 1.9-3.6) and isolated FGR (HR = 2.9, 95% CI = 1.9-4.4)., Conclusion: Very preterm infants born after hypertensive disorders or born after FGR had an increased risk of LOS compared to those born after preterm labor., Impact: Late-onset sepsis risk differs according to the cause of preterm birth. Compared with those born after preterm labor, infants born very preterm because of hypertensive disorders of pregnancy and/or fetal growth restriction display an increased risk for late-onset sepsis. Antenatal factors, in particular the full spectrum of causes leading to preterm birth, should be taken into consideration to better prevent and manage neonatal infectious morbidity and inform the parents., (© 2021. The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.)
- Published
- 2021
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24. Predicting the risk of infant mortality for newborns operated for congenital heart defects: A population-based cohort (EPICARD) study of two post-operative predictive scores.
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Lelong N, Tararbit K, Le Page-Geniller LM, Cohen J, Kout S, Foix-L'Hélias L, Boileau P, Chalumeau M, Goffinet F, and Khoshnood B
- Abstract
Background: Whereas no global severity score exists for congenital heart defects (CHD), risk (Risk Adjusted Cardiac Heart Surgery-1: RACHS-1) and/or complexity (Aristotle Basic Complexity: ABC) scores have been developed for those who undergo surgery. Population-based studies for assessing the predictive ability of these scores are lacking., Objective: To assess the predictive ability of RACHS-1 and ABC scores for the risk of infant mortality using population-based cohort (EPICARD) data for newborns with structural CHD., Methods: The study population comprised 443 newborns who underwent curative surgery. We assessed the predictive ability of each score alone and in conjunction with an a priori selected set of predictors of infant mortality. Statistical analysis included logistic regression models for which we computed model calibration, discrimination (ROC), and a rarely used but clinically meaningful measure of variance explained (Tjur's coefficient of discrimination)., Results: The risk of mortality increased with increasing RACHS-1 and the ABC scores and models based on both scores had adequate calibration. Model discrimination was higher for the RACHS-1-based model (ROC 0.68, 95% CI, 0.58-0.79) than the ABC-based one (ROC 0.59, 95% CI, 0.49-0.69), P = 0.03. Neither score had the good predictive ability when this was assessed using Tjur's coefficient., Conclusions: Even if the RACHS-1 score had better predictive ability, both scores had low predictive ability using a variance-explained measure. Because of this limitation and the fact that neither score can be used for newborns with CHD who do not undergo surgery, it is important to develop new predictive models that comprise all newborns with structural CHD., Competing Interests: The authors have no competing interests to disclose., (© 2021 The Authors. Health Science Reports published by Wiley Periodicals LLC.)
- Published
- 2021
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25. The impact of chorionicity on pregnancy outcome and neurodevelopment at 2 years old among twins born preterm: the EPIPAGE-2 cohort study.
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Tosello B, Garbi A, Blanc J, Lorthe E, Foix-L'Hélias L, D'Ercole C, Winer N, Subtil D, Goffinet F, Kayem G, Resseguier N, and Gire C
- Subjects
- Age Factors, Child, Preschool, Cohort Studies, Female, France, Humans, Infant, Infant, Newborn, Infant, Premature, Male, Placenta pathology, Pregnancy, Pregnancy Outcome, Pregnancy, Twin, Chorion pathology, Diseases in Twins epidemiology, Infant, Premature, Diseases epidemiology, Neurodevelopmental Disorders epidemiology
- Abstract
Objective: To compare the short- and mid-term outcomes of preterm twins by chorionicity of pregnancy., Design: Prospective nationwide population-based EPIPAGE-2 cohort study., Setting: 546 maternity units in France, between March and December 2011., Population: A total of 1700 twin neonates born between 24 and 34 weeks of gestation., Methods: The association of chorionicity with outcomes was analysed using multivariate regression models., Main Outcome Measures: First, survival at 2-year corrected age with or without neurosensory impairment, and second, perinatal, short-, and mid-term outcomes (survival at discharge, survival at discharge without severe morbidity) were described and compared by chorionicity., Results: In the EPIPAGE 2 cohort, 1700 preterm births were included (850 twin pregnancies). In all, 1220 (71.8%) were from dichorionic (DC) pregnancies and 480 from monochorionic (MC) pregnancies. MC pregnancies had three times more medical terminations than DC pregnancies (1.67 versus 0.51%, P < 0.001), whereas there were three times more stillbirths in MC than in DC pregnancies (10.09 versus 3.78%, P < 0.001). Both twins were alive at birth in 86.6% of DC pregnancies compared with 80.0% among MC pregnancies (P = 0.008). No significant difference according to chorionicity was found regarding neonatal deaths and morbidities. Likewise, for children born earlier than 32 weeks, the 2-year follow-up neurodevelopmental results were not significantly different between DC and MC twins., Conclusions: This study confirms that MC pregnancies have a higher risk of adverse outcomes. However, the outcomes among preterm twins admitted to neonatal intensive care units are similar irrespective of chorionicity., Tweetable Abstract: Monochorionicity is associated with adverse perinatal outcomes, but outcomes for preterm twins are comparable irrespective of their chorionicity., (© 2020 Royal College of Obstetricians and Gynaecologists.)
- Published
- 2021
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26. Association of early antibiotic exposure and necrotizing enterocolitis: causality or confounding bias?
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Letouzey M, Foix-L'Hélias L, Boileau P, and Lorthe E
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- Anti-Bacterial Agents adverse effects, Humans, Infant, Newborn, Infant, Premature, Enterocolitis, Necrotizing chemically induced, Enterocolitis, Necrotizing drug therapy, Enterocolitis, Necrotizing epidemiology, Infant, Newborn, Diseases drug therapy, Infant, Premature, Diseases drug therapy
- Published
- 2020
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27. Preterm premature rupture of membranes at 22-25 weeks' gestation: perinatal and 2-year outcomes within a national population-based study (EPIPAGE-2).
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Lorthe E, Torchin H, Delorme P, Ancel PY, Marchand-Martin L, Foix-L'Hélias L, Benhammou V, Gire C, d'Ercole C, Winer N, Sentilhes L, Subtil D, Goffinet F, and Kayem G
- Subjects
- Adrenal Cortex Hormones therapeutic use, Adult, Anti-Bacterial Agents therapeutic use, Bronchopulmonary Dysplasia epidemiology, Cerebral Intraventricular Hemorrhage epidemiology, Cesarean Section, Child, Preschool, Enterocolitis, Necrotizing epidemiology, Female, Fetal Membranes, Premature Rupture therapy, Fetal Viability, France, Humans, Infant, Infant, Extremely Premature, Infant, Newborn, Infant, Premature, Labor, Obstetric, Leukomalacia, Periventricular epidemiology, Magnesium Sulfate therapeutic use, Patient Transfer, Pregnancy, Pregnancy Trimester, Second, Prenatal Care, Retinopathy of Prematurity epidemiology, Survival Rate, Tocolysis, Tocolytic Agents therapeutic use, Cerebral Palsy epidemiology, Fetal Membranes, Premature Rupture epidemiology, Fetal Mortality, Gestational Age, Infant, Premature, Diseases epidemiology, Perinatal Mortality, Stillbirth epidemiology
- Abstract
Background: Most clinical guidelines state that with early preterm premature rupture of membranes, obstetric and pediatric teams must share a realistic and individualized appraisal of neonatal outcomes with parents and consider their wishes for all decisions. However, we currently lack reliable and relevant data, according to gestational age at rupture of membranes, to adequately counsel parents during pregnancy and to reflect on our policies of care at these extreme gestational ages., Objective: We sought to describe both perinatal and 2-year outcomes of preterm infants born after preterm premature rupture of membranes at 22-25 weeks' gestation., Study Design: EPIPAGE-2 is a French national prospective population-based cohort of preterm infants born in 546 maternity units in 2011. Inclusion criteria in this analysis were women diagnosed with preterm premature rupture of membranes at 22-25 weeks' gestation and singleton or twin gestations with fetus(es) alive at rupture of membranes. Latency duration, antenatal management, and outcomes (survival at discharge, survival at discharge without severe morbidity, and survival at 2 years' corrected age without cerebral palsy) were described and compared by gestational age at preterm premature rupture of membranes., Results: Among the 1435 women with a diagnosis of preterm premature rupture of membranes, 379 were at 22-25 weeks' gestation, with 427 fetuses (331 singletons and 96 twins). Median gestational age at preterm premature rupture of membranes and at birth were 24 (interquartile range 23-25) and 25 (24-27) weeks, respectively. For each gestational age at preterm premature rupture of membranes, nearly half of the fetuses were born within the week after the rupture of membranes. Among the 427 fetuses, 51.7% were survivors at discharge (14.1%, 39.5%, 66.8%, and 75.8% with preterm premature rupture of membranes at 22, 23, 24, and 25 weeks, respectively), 38.8% were survivors at discharge without severe morbidity, and 46.4% were survivors at 2 years without cerebral palsy, with wide variations by gestational age at preterm premature rupture of membranes. Survival at 2 years without cerebral palsy was low with preterm premature rupture of membranes at 22 and 23 weeks but reached approximately 60% and 70% with preterm premature rupture of membranes at 24 and 25 weeks., Conclusion: Preterm premature rupture of membranes at 22-25 weeks is associated with high incidence of mortality and morbidity, with wide variations by gestational age at preterm premature rupture of membranes. However, a nonnegligible proportion of children survive without severe morbidity both at discharge and at 2 years' corrected age., (Copyright © 2018 Elsevier Inc. All rights reserved.)
- Published
- 2018
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28. Providing active antenatal care depends on the place of birth for extremely preterm births: the EPIPAGE 2 cohort study.
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Diguisto C, Goffinet F, Lorthe E, Kayem G, Roze JC, Boileau P, Khoshnood B, Benhammou V, Langer B, Sentilhes L, Subtil D, Azria E, Kaminski M, Ancel PY, and Foix-L'Hélias L
- Subjects
- Adult, Cohort Studies, Female, France epidemiology, Gestational Age, Humans, Infant, Infant, Extremely Premature, Infant, Newborn, Male, Pregnancy, Survival Rate, Infant Mortality, Prenatal Care statistics & numerical data, Residence Characteristics statistics & numerical data
- Abstract
Survival rates of infants born before 25 weeks of gestation are low in France and have not improved over the past decade. Active perinatal care increases these infants' likelihood of survival., Objective: Our aim was to identify factors associated with active antenatal care, which is the first step of proactive perinatal care in extremely preterm births., Methods: The population included 1020 singleton births between 22
0/6 and 260/6 weeks of gestation enrolled in the Etude Epidémiologique sur les Petits Ages Gestationnels 2 study, a French national population-based cohort of very preterm infants born in 2011. The main outcome was 'active antenatal care' defined as the administration of either corticosteroids or magnesium sulfate or delivery by caesarean section for fetal rescue. A multivariable analysis was performed using a two-level multilevel model taking into account the maternity unit of delivery to estimate the adjusted ORs (aORs) of receiving active antenatal care associated with maternal, obstetric and place of birth characteristics., Results: Among the population of extremely preterm births, 42% received active antenatal care. After standardisation for gestational age, regional rates of active antenatal care varied between 22% (95% CI 5% to 38%) and 61% (95% CI 44% to 78%). Despite adjustment for individual and organisational characteristics, active antenatal care varied significantly between maternity units (p=0.03). Rates of active antenatal care increased with gestational age with an aOR of 6.46 (95% CI 3.40 to 12.27) and 10.09 (95% CI 5.26 to 19.36) for infants born at 25 and 26 weeks' gestation compared with those born at 24 weeks. No other individual characteristic was associated with active antenatal care., Conclusion: Even after standardisation for gestational age, active antenatal care in France for extremely preterm births varies widely with place of birth. The dependence of life and death decisions on place of birth raises serious ethical questions., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)- Published
- 2017
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29. Assessment and care of the newborn at term
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Letouzey M, Foix-L'Hélias L, Castel C, and Boileau P
- Subjects
- Humans, Infant, Newborn, Neonatal Screening
- Abstract
Competing Interests: M. Letouzey, L. Foix-L’Hélias, C. Castel et P. Boileau déclarent n’avoir aucun lien d’intérêts.
- Published
- 2017
30. Cause of Preterm Birth as a Prognostic Factor for Mortality.
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Delorme P, Goffinet F, Ancel PY, Foix-L'Hélias L, Langer B, Lebeaux C, Marchand LM, Zeitlin J, Ego A, Arnaud C, Vayssiere C, Lorthe E, Durrmeyer X, Sentilhes L, Subtil D, Debillon T, Winer N, Kaminski M, D'Ercole C, Dreyfus M, Carbonne B, and Kayem G
- Subjects
- Adult, Female, France epidemiology, Gestational Age, Hospital Mortality, Humans, Infant, Infant Mortality, Infant, Newborn, Obstetric Labor, Premature epidemiology, Pregnancy, Prognosis, Prospective Studies, Risk Factors, Young Adult, Abruptio Placentae epidemiology, Fetal Growth Retardation epidemiology, Fetal Membranes, Premature Rupture epidemiology, Hypertension, Pregnancy-Induced epidemiology, Premature Birth etiology, Premature Birth mortality
- Abstract
Objective: To investigate the association of the cause of preterm birth on in-hospital mortality of preterm neonates born from 24 to 34 weeks of gestation., Methods: L'Etude épidémiologique sur les petits âges gestationnels (EPIPAGE)-2 is a prospective, nationwide, population-based cohort of very preterm births. After dividing causes of preterm birth into six mutually exclusive groups, we analyzed the association of each cause with in-hospital deaths of preterm neonates born alive with adjustment for organizational, maternal, and obstetric factors., Results: The analysis included 3,138 singleton live births from 24 to 34 weeks of gestation with a newborn in-hospital mortality rate of 5.0% (95% confidence interval 4.5-5.7). Preterm labor was the most frequent cause of preterm birth (n=1,293 [43.5%]) followed by preterm premature rupture of membranes (n=765 [23.9%]), hypertensive disorders without suspected fetal growth restriction (n=397 [12.7%]), hypertensive disorders with suspected fetal growth restriction (n=408 [10.9%]), placental abruption after an uncomplicated pregnancy (n=92 [3.0%]), and suspected fetal growth restriction without hypertensive disorders (n=183 [5.9%]). Neonates born because of suspected fetal growth restriction with or without hypertensive disorders (adjusted odds ratio [OR] 3.0 [1.9-4.7] and adjusted OR 2.3 [1.1-4.6], respectively) had higher adjusted risks of in-hospital death than those born after preterm labor. Risks of in-hospital mortality for preterm births caused by preterm premature rupture of membranes (adjusted OR 1.3 [0.9-1.9]), hypertensive disorders without fetal growth restriction (adjusted OR 0.7 [0.4-1.4]), or placental abruption (adjusted OR 1.6 [0.7-3.7]) were similar to those born after preterm labor., Conclusion: Among neonates born alive before 34 weeks of gestation, only those born because of suspected fetal growth restriction have a higher mortality risk than those born after preterm labor.
- Published
- 2016
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31. [Early-onset neonatal infection: assessment of professional practices in 14 maternity wards in the Île-de-France region in 2013].
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Sikias P, Parmentier C, Imbert P, Rajguru M, Chavet MS, Coquery S, Foix-L'Hélias L, and Boileau P
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- Adult, Anti-Bacterial Agents therapeutic use, Bacteria isolation & purification, Bacterial Infections drug therapy, C-Reactive Protein analysis, Female, France, Gastric Juice microbiology, Guideline Adherence statistics & numerical data, Hospital Units, Humans, Infant, Newborn, Infectious Disease Transmission, Vertical, Practice Guidelines as Topic, Pregnancy, Pregnancy Complications, Infectious, Prospective Studies, Bacterial Infections diagnosis, Practice Patterns, Physicians' statistics & numerical data
- Abstract
Introduction: Early-onset neonatal infection remains a major cause of morbidity and mortality in neonates. Both universal vaginal screening for group-B streptococcus (GBS) and intrapartum antibiotic prophylaxis have decreased the incidence of early-onset GBS disease. Almost 12 years after the implementation of the French recommendations, we assessed the practices around screening, diagnosis, and treatment of early-onset neonatal infection in the Île-de-France region., Patients and Methods: We conducted a prospective, multicenter, observational study in 14 volunteer maternity wards from 18 to 31 March 2013. All live newborn infants delivered at 35 gestational weeks or more were eligible. Maternal, obstetrical, and neonatal characteristics were collected, as well as the management of suspected early-onset neonatal infections., Results: A total of 1194 mothers and 1217 neonates were included. Among the latter, 54% had bacteriological samplings at birth, with at least a gastric aspirate. Bacteriological samples were collected at birth in 85% of cases based on major or minor anamnestic infection criteria defined by the French National Authority for Health in 2002. In addition, 26% of neonates had at least one blood sample taken. Antibiotic treatment was administered in 4% of the infants with cefotaxime administered in two thirds of cases., Conclusion: An update of the French guidelines for the management of early-onset neonatal infections is required in order to improve targeting of newborn infants suspected of having an infection and to optimize the antibiotics administered. Moreover, the role of bacteriological sampling at birth needs to be clarified., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)
- Published
- 2015
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32. Survival and morbidity of preterm children born at 22 through 34 weeks' gestation in France in 2011: results of the EPIPAGE-2 cohort study.
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Ancel PY, Goffinet F, Kuhn P, Langer B, Matis J, Hernandorena X, Chabanier P, Joly-Pedespan L, Lecomte B, Vendittelli F, Dreyfus M, Guillois B, Burguet A, Sagot P, Sizun J, Beuchée A, Rouget F, Favreau A, Saliba E, Bednarek N, Morville P, Thiriez G, Marpeau L, Marret S, Kayem G, Durrmeyer X, Granier M, Baud O, Jarreau PH, Mitanchez D, Boileau P, Boulot P, Cambonie G, Daudé H, Bédu A, Mons F, Fresson J, Vieux R, Alberge C, Arnaud C, Vayssière C, Truffert P, Pierrat V, Subtil D, D'Ercole C, Gire C, Simeoni U, Bongain A, Sentilhes L, Rozé JC, Gondry J, Leke A, Deiber M, Claris O, Picaud JC, Ego A, Debillon T, Poulichet A, Coliné E, Favre A, Fléchelles O, Samperiz S, Ramful D, Branger B, Benhammou V, Foix-L'Hélias L, Marchand-Martin L, and Kaminski M
- Subjects
- Cohort Studies, Female, France, Gestational Age, Humans, Infant, Infant, Newborn, Intensive Care, Neonatal, Morbidity, Pregnancy, Prospective Studies, Survival Rate, Infant Mortality, Infant, Premature, Infant, Premature, Diseases mortality, Premature Birth mortality
- Abstract
Importance: Up-to-date estimates of the health outcomes of preterm children are needed for assessing perinatal care, informing parents, making decisions about care, and providing evidence for clinical guidelines., Objectives: To determine survival and neonatal morbidity of infants born from 22 through 34 completed weeks' gestation in France in 2011 and compare these outcomes with a comparable cohort in 1997., Design, Setting, and Participants: The EPIPAGE-2 study is a national, prospective, population-based cohort study conducted in all maternity and neonatal units in France in 2011. A total of 2205 births (stillbirths and live births) and terminations of pregnancy at 22 through 26 weeks' gestation, 3257 at 27 through 31 weeks, and 1234 at 32 through 34 weeks were studied. Cohort data were collected from January 1 through December 31, 1997, and from March 28 through December 31, 2011. Analyses for 1997 were run for the entire year and then separately for April to December; the rates for survival and morbidities did not differ. Data are therefore presented for the whole year in 1997 and the 8-month and 6-month periods in 2011., Main Outcomes and Measures: Survival to discharge and survival without any of the following adverse outcomes: grade III or IV intraventricular hemorrhage, cystic periventricular leukomalacia, severe bronchopulmonary dysplasia, retinopathy of prematurity (stage 3 or higher), or necrotizing enterocolitis (stages 2-3)., Results: A total of 0.7% of infants born before 24 weeks' gestation survived to discharge: 31.2% of those born at 24 weeks, 59.1% at 25 weeks, and 75.3% at 26 weeks. Survival rates were 93.6% at 27 through 31 weeks and 98.9% at 32 through 34 weeks. Infants discharged home without severe neonatal morbidity represented 0% at 23 weeks, 11.6% at 24 weeks, 30.0% at 25 weeks, 47.5% at 26 weeks, 81.3% at 27 through 31 weeks, and 96.8% at 32 through 34 weeks. Compared with 1997, the proportion of infants surviving without severe morbidity in 2011 increased by 14.4% (P < .001) at 25 through 29 weeks and 6% (P < .001) at 30 through 31 weeks but did not change appreciably for those born at less than 25 weeks. The rates of antenatal corticosteroid use, induced preterm deliveries, cesarean deliveries, and surfactant use increased significantly in all gestational-age groups, except at 22 through 23 weeks., Conclusions and Relevance: The substantial improvement in survival in France for newborns born at 25 through 31 weeks' gestation was accompanied by an important reduction in severe morbidity, but survival remained rare before 25 weeks. Although improvement in survival at extremely low gestational age may be possible, its effect on long-term outcomes requires further studies. The long-term results of the EPIPAGE-2 study will be informative in this regard.
- Published
- 2015
- Full Text
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