Cremer R.,Lille University Hospital Center |
Cremer R.,Lille University of Science and Technology |
Hubert P.,Reanimation Pediatrique |
Hubert P.,University of Paris Descartes |
And 6 more authors.
Intensive Care Medicine | Year: 2011
Purpose: Our goal is to assess the prevalence of questioning about the appropriateness of initiating or maintaining life-sustaining treatments (LST) in French-speaking paediatric intensive care units (PICUs) and to evaluate time utilisation related to decision-making processes (DMP). Methods: 18-month, multicentre, prospective, descriptive, observational study in 15 Frenchspeaking PICUs. Results: Among the 5,602 children admitted, 410 died (7.3%), including 175 after forgoing LST (42.7% of deaths). LST was questioned in 308 children (5.5%) with a prevalence of 13.3 per 100 patient-days. More than 30% of children survived despite the appropriateness of LST being questioned (23% despite a decision to forgo treatment). Median caregiver time spent on making and presenting the decisions was 11 h per child. Conclusions: In this study, on any given day in each 10-bed PICU, there was more than one child for whom a DMP was underway. Of children, 23% survived despite a decision to forgo LST being made, which underlines the need to elaborate a care plan for these children. Also, DMP represented a large amount of staff time that is undervalued but necessary to ensure optimal palliative practice in PICU. © jointly held by Springer and ESICM 2011.
PubMed | Pneumologie Pediatrique, Chirurgie Pediatrique and Reanimation pediatrique
Type: Journal Article | Journal: PloS one | Year: 2016
Congenital diaphragmatic hernia (CDH) is associated with a high incidence of respiratory problems, even after initial hospital discharge. These problems are likely to lead to re-hospitalization during infancy, although actual frequency of readmissions is unknown.We aimed to determine the rate of hospitalization for wheezing in infants with CDH between the time of initial discharge and 24 months of age, and to identify factors associated with readmission.Data about infants with CDH born in three French reference tertiary centers between January 2009 and March 2013 who were alive at hospital discharge, were extracted from a prospective national database.Ninety-two children were identified, and 86 were included in the analysis. In total, 116 wheezing episodes requiring a doctors visit occurred in 50 infants (58%) before 24 months of age. Twenty-two children (26%) were readmitted at least once for wheezing exacerbations. RSV was present in 6 of 15 (40%) of children with available nasal samples at first readmission, and 1 of 5 (20%) at second readmission. Thoracic herniation of the liver, low gestational age, longer initial hospitalization, need for oxygen therapy at home, and eczema were all significantly associated with readmission for wheezing exacerbations. Fifty-three infants (62%) received palivizumab prophylaxis, but there was no association with the overall rate of readmission for wheezing exacerbations or RSV-related hospitalization.The rate of readmission for wheezing among infants with CDH is high, and significantly influenced by several prenatal and neonatal factors. Palivizumab prophylaxis was not associated with the rate of readmission.
PubMed | Brest University Hospital Center, Unite de consultations externes, Nancy University Hospital Center, Institute Federatif Of Biologie and 20 more.
Type: Journal Article | Journal: European journal of human genetics : EJHG | Year: 2016
Heterozygous COL2A1 variants cause a wide spectrum of skeletal dysplasia termed type II collagenopathies. We assessed the impact of this gene in our French series. A decision tree was applied to select 136 probands (71 Stickler cases, 21 Spondyloepiphyseal dysplasia congenita cases, 11 Kniest dysplasia cases, and 34 other dysplasia cases) before molecular diagnosis by Sanger sequencing. We identified 66 different variants among the 71 positive patients. Among those patients, 18 belonged to multiplex families and 53 were sporadic. Most variants (38/44, 86%) were located in the triple helical domain of the collagen chain and glycine substitutions were mainly observed in severe phenotypes, whereas arginine to cysteine changes were more often encountered in moderate phenotypes. This series of skeletal dysplasia is one of the largest reported so far, adding 44 novel variants (15%) to published data. We have confirmed that about half of our Stickler patients (46%) carried a COL2A1 variant, and that the molecular spectrum was different across the phenotypes. To further address the question of genotype-phenotype correlation, we plan to screen our patients for other candidate genes using a targeted next-generation sequencing approach.
Ackermann O.,Hepatologie Pediatrique |
Ackermann O.,University Paris - Sud |
Branchereau S.,Chirurgie Pediatrique |
Franchi-Abella S.,Radiologie Pediatrique |
And 12 more authors.
American Journal of Transplantation | Year: 2012
Hepatic artery thrombosis (HAT), one of the most severe complications of pediatric orthotopic liver transplantation (OLT), often compromises graft and/or child survival. Of 590 OLT performed in 516 children over a 20-year period, 45 were complicated by early HAT, during the first 2 weeks after transplantation. Systematic Doppler ultrasonographic detection of HAT allowed successful surgical revascularization in 19 instances, resulting in a 20-year graft survival rate of 77% versus 24% of cases when revascularization was not attempted or failed. A combination of surgical emergency revascularization, biliary interventional radiology, biliary surgery and/or retransplantation resulted in an 80% 20-year patient survival rate, identical to that of transplanted children who did not experience early HAT. The majority of long-term survivors with their initial graft had normal liver tests, no biliary dilation on ultrasonography and minimal or moderate fibrosis on liver histology. A failed attempt at revascularization did not significantly alter patient survival. Despite these encouraging results, for the children and their parents to overcome the entire process in terms of reoperations, repeated radiological interventions, number of hospitalizations and emotional stress, remains an ordeal of such magnitude that it justifies renewed efforts to progress in the prevention of this complication. Early detection by systematic ultrasonography, urgent attempt at surgical revascularization and assiduous care for biliary complications allow a long-term survival identical to that of other transplanted children and the salvage of close to one-third of the original grafts. © Copyright 2012 The American Society of Transplantation and the American Society of Transplant Surgeons.
PubMed | University Paris - Sud, Service de radiologie pediatrique, Service de Gynecologie Obstetrique et Diagnostique antenatal, Reanimation pediatrique and 3 more.
Type: | Journal: Annals of neurology | Year: 2017
While vein of Galen aneurysmal malformations (VGAM) can be diagnosed in the fetus, the challenge is predicting the occurrence of its two major complications: cardiopulmonary failure and encephalomalacia. This study attempts to determine which fetal brain MRI features might be used to predict the development of these complications at birth.The cohort was extracted from a prospectively-assembled database of VGAM cases managed at a single referral centre from 2000 to 2014. Of 251 patients with VGAM, 83 cases were diagnosed prenatally. A total of 58 patient charts having at least one fetal MRI were reviewed. Patterns of brain parenchyma, hydrocephalus and so-called middle cerebral artery (MCA) pseudo-feeders were correlated with cardiac failure, pulmonary hypertension and encephalomalacia at birth.The median gestational age at fetal MRI was 32.3 WP (2.3). Nine fetuses (16%) had encephalomalacia. Thirty-one fetuses (53%) had MCA pseudo-feeders. Twenty-six fetuses (45%) had prenatal hydrocephalus. Prenatal MCA pseudo-feeders were a risk factor for encephalomalacia at birth (p=0.001). MCA pseudo-feeders and hydrocephalus were risk factors for both severe cardiac failure (p=0.01 and p=0.04, respectively) and severe pulmonary hypertension (p=0.014 and p=0.05, respectively) at birth.MCA pseudo-feeders are the result of impaired cerebral blood flow, and are thus a risk factor for further brain-melting at birth. Their presence can be used for informing parents and as an aid in management decisions. This article is protected by copyright. All rights reserved.
Valla F.V.,Reanimation Pediatrique
Aktuelle Ernahrungsmedizin | Year: 2016
Parenteral nutrition (PN) is indicated in case of intestinal failure, as oral or enteral nutrition cannot fulfil nutritional requirements. Children specific nutritional needs differ from adults' and also vary with age. Some non-essential amino-acids are essential in the youngest, and the required quantities of each nutrient, even reported to patient's weight, depend on age. Consequently, paediatric designed PN solutions are needed to meet children's requirements. Individualized compounded PN requires expert prescribers and its production must meet high standards of good compounding practices. By contrast, industrial 3-chamber PN offer a continuously available, safe and easy-to-use choice that meets the nutritional requirements of a wide range of patients, as long as their requirement aren't too different from age-standards. An industrially prepared, heat-sterilized, standardized 3-chamber PN bag range (Numeta®, Baxter), specifically designed for paediatrics, is now available in Europe. It encompasses two formulations designed according to ESPGHAN/ASPEN PN guidelines and is adapted to children from 0 to 18 years of age. Numeta® range offers relative flexibility in its use (possible nutrient additions, optional lipid infusion when accurate). Micronutrients have to be added as 3-chamber PN never provide vitamins nor trace elements for stability reasons. Age-related nutritional recommendations from scientific societies guide the initiation of PN which will then be adapted according to both its efficacy and tolerance. This paper focuses further on the advantages and prescription practical aspects of ready to use PN solutions. © Georg Thieme Verlag KG Stuttgart New York.
Popescu M.,Pharmacie a usage interieur |
Vialet R.,Reanimation pediatrique |
Loundou A.,Laboratoire Of Sante Publique |
Peyron F.,Pharmacie a usage interieur |
Bues-Charbit M.,Pharmacie a usage interieur
Annales Francaises d'Anesthesie et de Reanimation | Year: 2011
In pediatric units, most of the intravenous medications are prepared by the attending nurse at the bedside that can be affected by an error margin, so can be imprecise. Despite the possible consequences of imprecise medications administration, published studies on the topic are scarce. The main objective of this study was to measure the difference between the prescribed vancomycine concentration and the actual concentration measured in the medication administered to the patient. The secondary objective was to determine which step in the preparation was linked to the difference in concentrations. It was a prospective study, setting in a pediatric and neonatal university hopsital intensive care unit. Over a 3-month period, an aliquot from every preparation for continuous infusion of vancomycin, made at the bedside by a nurse, was collected and the modalities of the preparation noted. Vancomycin concentration was measured by high performance liquid chromatography. Sixty-four preparations, accounting for 24 patients (gestationnal age: 67±75weeks, weigh: 4.8±6.5kg) were included. Vancomycin concentrations ranged from 3.33 to 60.0mg/mL. Measured concentration were in mean 7% smaller than prescribed concentration (P<10 -3), with a large confidence interval (75.8%-120.4% of the prescribed concentration). Imprecision the preparations was much higher than this admitted for manufactured preparation. We could not highlight any factor related to the difference in concentrations, but one third of the preparation did not respect all the ISO 7886 standards for syringes use. Bedside vancomycin preparations, like preparations for other molecules, are far more imprecise than industrial intravenous medications. Our results urge that all pediatric intravenous medications should be made only by manufacturers or pharmacists. However, it also urged clinical studies, in parallel to pharmacodynamic and pharmacokinetic studies, to make intravenous treatments as accurate as they should be. © 2011 Elsevier Masson SAS.
Jones P.,University College London |
Peters M.J.,University College London |
Pinto da Costa N.,Reanimation Pediatrique |
Kurth T.,Institute National Of La Sante Et Of La Recherche Medical |
And 9 more authors.
PLoS ONE | Year: 2013
Background: Atropine has is currently recommended to facilitate haemodynamic stability during critical care intubation. Our objective was to determine whether atropine use at induction influences ICU mortality. Methodology/Principal Findings: A 2-year prospective, observational study of all first non-planned intubations, September 2007-9 in PICU and Intensive Care Transport team of Hôpital Robert Debré, Paris, 4 other PICUs and 5 NICUs in the Paris Region, France. Follow-up was from intubation to ICU discharge. A propensity score was used to adjust for patient specific characteristics influencing atropine prescription. 264/333 (79%) intubations were included. The unadjusted ICU mortality was 7.2% (9/124) for those who received atropine compared to 15.7% (22/140) for those who did not (OR 0.42, 95%CI 0.19-0.95, p = 0.04). One child died during intubation (1/264, 0.4%). Two age sub-groups of neonates (≤28 days) and older children (>28 days, <8 years) were examined. This difference in mortality arose from the higher mortality in children aged over one month when atropine was not used (propensity score adjusted OR 0.22, 95%CI 0.06-0.85, p = 0.028). No effect was seen in neonates (propensity score adjusted OR 1.3, 95%CI 0.31-5.1 p = 0.74). Using the propensity score, atropine maintained the mean heart rate 45.9 bpm above that observed when no atropine was used in neonates (95%CI 34.3-57.5, p<0.001) and 43.5 bpm for older children (95%CI 25.5-61.5 bpm, p<0.001). Conclusions/Significance: Atropine use during induction was associated with a reduction in ICU mortality in children over one month. This effect is independent of atropine's capacity to attenuate bradycardia during intubation which occurred similarly in neonates and older children. This result needs to be confirmed in a study using randomised methodology. © 2013 Jones et al.
PubMed | Pediatrie Generale, Pharmacie, Service de Pharmacologie Pediatrique et Pharmacogenetique and Reanimation pediatrique
Type: Journal Article | Journal: International journal of clinical pharmacy | Year: 2015
Anti-inflammatory drugs have been suspected on several occasions to have promoted development of bacterial infection among varicella patients. Some countries have not implemented childhood varicella vaccination. Three cases in our hospital suggested the predisposing role of NSAIDs in varicella patient deterioration. Open access to these drugs widely increases their use and patient information should be continually provided in the medical offices and at dispensing pharmacy counters. Taking account of the benefit/risk balance and applying the simple precautionary principle, it would be appropriate to be cautious about the use of NSAIDs in the paediatric population.
PubMed | Center Hospitalier Regional Orleans, Service de Reanimation, Center Chirurgical Marie Lannelongue, Nantes University Hospital Center and 6 more.
Type: Journal Article | Journal: Annals of intensive care | Year: 2016
Cardiogenic shock which corresponds to an acute state of circulatory failure due to impairment of myocardial contractility is a very rare disease in children, even more than in adults. To date, no international recommendations regarding its management in critically ill children are available. An experts recommendations in adult population have recently been made (Levy et al. Ann Intensive Care 5(1):52, 2015; Levy et al. Ann Intensive Care 5(1):26, 2015). We present herein recommendations for the management of cardiogenic shock in children, developed with the grading of recommendations assessment, development, and evaluation system by an expert group of the Groupe Francophone de Ranimation et Urgences Pdiatriques (French Group for Pediatric Intensive Care and Emergencies). The recommendations cover four major fields of application such as: recognition of early signs of shock and the patient pathway, management principles and therapeutic goals, monitoring hemodynamic and biological variables, and circulatory support (indications, techniques, organization, and transfer criteria). Major principle care for children with cardiogenic shock is primarily based on clinical and echocardiographic assessment. There are few drugs reported as effective in childhood in the medical literature. The use of circulatory support should be facilitated in terms of organization and reflected in the centers that support these children. Children with cardiogenic shock are vulnerable and should be followed regularly by intensivist cardiologists and pediatricians. The experts emphasize the multidisciplinary nature of management of children with cardiogenic shock and the importance of effective communication between emergency medical assistance teams (SAMU), mobile pediatric emergency units (SMUR), pediatric emergency departments, pediatric cardiology and cardiac surgery departments, and pediatric intensive care units.