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Marret S.,University of Rouen | Marchand-Martin L.,French Institute of Health and Medical Research | Marchand-Martin L.,University Pierre and Marie Curie | Picaud J.-C.,Hopital de la Croix Rousse | And 10 more authors.
PLoS ONE | Year: 2013

Objective:To investigate the association of motor and cognitive/learning deficiencies and overall disabilities in very preterm (VPT) children and their relations to gestational age (GA) and brain lesions.Design, Setting, and Participants:EPIPAGE is a longitudinal population-based cohort study of children born before 33 weeks' gestation (WG) in 9 French regions in 1997-1998. Cumulating data from all follow up stages, neurodevelopmental outcomes were available for 90% of the 2480 VPT survivors at 8 years. Main outcomes were association of motor and cognitive deficiencies and existence of at least one deficiency (motor, cognitive, behavioral/psychiatric, epileptic, visual, and/or hearing deficiencies) in three GA groups (24-26, 27-28, and 29-32WG) and four groups of brain lesions (none, minor, moderate, or severe).Results:VPT had high rates of motor (14%) and cognitive (31%) deficiencies. Only 6% had an isolated motor deficiency, 23% an isolated cognitive one and 8% both types. This rate reached 20% among extremely preterm. Psychiatric disorders and epilepsy were observed in 6% and 2% of children, respectively. The risks of at least one severe or moderate deficiency were 11 and 29%. These risks increased as GA decreased; only 36% of children born extremely preterm had no reported deficiency. Among children with major white matter injury (WMI), deficiency rates reached 71% at 24-26WG, 88% at 27-28WG, and 80% at 29-32WG; more than 40% had associated motor and cognitive deficiencies. By contrast, isolated cognitive deficiency was the most frequent problem among children without major lesions.Conclusions:In VPT, the lower the GA, the higher the neurodisability rate. Cerebral palsy is common. Impaired cognitive development is more frequent. Its occurrence in case without WMI or early motor disorders makes long-term follow up necessary. The strong association between motor impairments, when they exist, and later cognitive dysfunction supports the hypothesis of a common origin of these difficulties. © 2013 Marret et al. Source

Vieux R.,University of Lorraine | Vieux R.,French Institute of Health and Medical Research | Vieux R.,Nancy University Hospital Center | Fresson J.,Maternite Regionale | And 4 more authors.
Archives of Disease in Childhood: Fetal and Neonatal Edition | Year: 2011

Objective: To determine the impact on glomerular filtration rate (GFR) and tubular function of drugs prescribed to very preterm infants during the first week of life. Design: Prospective multicentre cohort study of infants aged 27-31 weeks gestation. Methods: GFR was measured on day 2, and then weekly for 1 month, with 12-h urine collection by a standardised kinetic Jaffe method. Infants were classified into two groups according to their GFR on day 7 ('Low GFR' and 'High GFR') with regard to the median reference GFR for their gestational age. Tubular function was also measured weekly for 1 month. Statistical analysis was performed using logistic regression and a repeated measure analysis. Results: Data from 269 infants were analysed, 183 in the 'Low GFR' group and 86 in the 'High GFR' group. Perinatal factors did not differ in both groups. Significantly more infants were treated with ibuprofen in the 'Low GFR' group than in the 'High GFR' group, respectively, n=55 (30.0%) versus n=15 (17.4%), whereas aminoglycosides, glycopeptides and all other drugs commonly prescribed during the first week of life did not show a nephrotoxic effect at usual therapeutic dosage. Conclusions: Among all drugs described as nephrotoxic in very preterm infants, ibuprofen alone proved to be nephrotoxic in this study for a 1-month span follow-up. If GFR is lower than the median reference value on day 7 after ibuprofen infusion, physicians should keep in mind that glomerular clearance of drugs may stay decreased for the first month of life. Source

Vieux R.,Maternite Regionale | Vieux R.,University of Lorraine | Hascoet J.-M.,Maternite Regionale
Current Pediatric Reviews | Year: 2012

The impact on adult disease, of prenatal programming and of the environment during infancy has been widely described. Yet the increased morbidity due to this prenatal and neonatal environment seems to occur ever more early. Indeed, recent studies detected the consequences of prenatal programming in childhood, making it also an immediate concern for paediatricians. This review, focusing on oligonephropathy, aimed to give an up-dated view on when prenatal-programmed morbidity is first detectable, and on possible preventive strategies and treatments. As renal morbidity related to prenatal programming has been diagnosed in early childhood, at only two years old, it is now urgent to evaluate early strategies such as sports, low-protein or iron diets and antiproteinuric drugs, preventing an accentuation of glomerulosclerosis. A yearly follow-up seems appropriate for patients born small for gestation or preterm, including the measure of blood pressure and of albuminuria. A diet preventing protein and salt excess, and a smoking prohibition could delay the onset of glomerulosclerosis. The yearly follow-up would allow to diagnose it early enough to administer angiotensin converting enzyme inhibitors delaying the progression of renal sclerosis. © 2012 Bentham Science Publishers. Source

Azria E.,University of Paris Pantheon Sorbonne | Azria E.,University of Paris Descartes | Kayem G.,University of Paris Pantheon Sorbonne | Kayem G.,University of Paris Descartes | And 71 more authors.
PLoS ONE | Year: 2016

Objective. To determine whether breech presentation is an independent risk factor for neonatal morbidity, mortality, or long-term neurologic morbidity in very preterm infants. Design. Prospective population-based cohort. Population. Singletons infants without congenital malformations born from 27 to 32 completed weeks of gestation enrolled in France in 1997 in the EPIPAGE cohort. Methods. The neonatal and long-term follow-up outcomes of preterm infants were compared between those in breech presentation and those in vertex presentation. The relation of fetal presentation with neonatal mortality and neurodevelopmental outcomes was assessed using multiple logistic regression models. Results: Among the 1518 infants alive at onset of labor included in this analysis (351 in breech presentation), 1392 were alive at discharge. Among those eligible to follow up and alive at 8 years, follow-up data were available for 1188 children. Neonatal mortality was significantly higher among breech than vertex infants (10.8% vs. 7.5%, P = 0.05). However the differences were not significant after controlling for potential confounders. Neonatal morbidity did not differ significantly according to fetal presentation. Severe cerebral palsy was less frequent in the group born in breech compared to vertex presentation but there was no difference after adjustment. There was no difference according to fetal presentation in cognitive deficiencies/learning disabilities or overall deficiencies. Conclusion. Our data suggest that breech presentation is not an independent risk factor for neonatal mortality or long-term neurologic deficiencies among very preterm infants. © Copyright 2016 Azria et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Source

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