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Saint-André-lez-Lille, France

Charkaluk M.L.,French Institute of Health and Medical Research | Charkaluk M.L.,Groupe Hospitalier Of Linstitut Catholique Lillois | Charkaluk M.L.,University Pierre and Marie Curie | Truffert P.,French Institute of Health and Medical Research | And 7 more authors.
Early Human Development

Aim: To study the predictive value of a developmental assessment at 2. years corrected age (CA) for schooling at age 8 in children born very preterm and free of disability or delay; to identify other factors associated with schooling in this population. Methods: 244 children born before 33. weeks in 1997, part of the population-based EPIPAGE cohort study, free of disability or delay, had their developmental quotient (DQ) evaluated with the Brunet-Lezine scale at 2. years CA. The mental processing composite (MPC) score was evaluated at age 5 with the K-ABC battery. Data on schooling were obtained at age 8 by postal questionnaire. Schooling was considered appropriate if the child was attending age-appropriate grade level in a regular classroom environment without support at school. Results: Schooling was appropriate for 172 (70%) children. The predictive value of a DQ ≥ 100 for appropriate schooling was 0.80 [0.75;0.85]. In children with a DQ at age 2 < 100, schooling varied significantly according to their MPC score at age 5 whereas it didn't in children with a DQ ≥ 100. In multivariate analysis, the rate of appropriate schooling was significantly related to global DQ at age 2 (p< 0.01), gestational age ≥ 29 weeks (p< 0.05), head circumference at age 2 (p< 0.05) and mother's educational level (p< 0.05). Conclusion: A DQ ≥ 100 cannot be solely used for the prediction of appropriate schooling at age 8. Mother's educational level, gestational age and head circumference at age 2 could be taken account. These factors could be used to individualise follow-up. © 2011 Elsevier Ltd. Source

Saint-Faust M.,Service Route | Simeoni U.,Service de medecine neonatale
Medecine des Maladies Metaboliques

Incidence of gestational diabetes is increasing worldwide, which is a great global health concern. In utero exposure to increasing maternal blood concentrations is associated with early perinatal consequences, increased risk for diabetes and obesity during childhood, and cardiovascular diseases at adulthood. These adverse effects during early life have led to the concept of developmental programming. The critical window of development is the best opportunity for intervention and prevention, but also a way to consider the preconceptional period. Obstetricians and pediatricians have an increased concern about these vulnerable infants. This review aimed at emphasizes the short-and long term outcomes of children in offspring of maternal diabetes. © 2012 Elsevier Masson SAS. Source

Gascoin-Lachambre G.,French Institute of Health and Medical Research | Buffat C.,Laboratoire Of Biochimie Et Of Biologie Moleculaire | Rebourcet R.,French Institute of Health and Medical Research | Chelbi S.T.,French Institute of Health and Medical Research | And 7 more authors.

Intra-uterine growth restriction (IUGR) is defined by a restriction of fetal growth during gestation. It is a prevalent significant public health problem that jeopardizes neonatal health but also that can have deleterious consequences later in adult life. Cullins constitute a family of seven proteins involved in cell scaffold and in selective proteolysis via the ubiquitin-proteasome system. Most Cullins are critical for early embryonic development and mutations in some Cullin genes have been identified in human syndromes including growth retardation. Our work hypothesis is that Cullins, particularly CUL4B and CUL7, are involved in placental diseases and especially in IUGR. Thus, expression of Cullins and their cofactors was analyzed in normal and pathological placentas. We show that they present a constant significant over-expression in IUGR placentas, whose extent is dependent on the position of the interrogated fragment along the cDNAs, suggesting the existence of different isoforms of the genes. Particularly, the CUL7 gene is up-regulated up to 10 times in IUGR and 15 times in preeclampsia associated with IUGR. The expression of cofactors of Cullins participating to functional complexes has also been evaluated and showed a similar significant increase in IUGR. Promoters of Cullin genes appeared to be under the control of the SP1 transcription factor. Finally, methylation levels of the CUL7 promoter in placental tissues are modulated according to the pathological conditions, with a significant hypomethylation in IUGR. These results concur to pinpoint the Cullin family as a new set of markers of IUGR. © 2009 Elsevier Ltd. All rights reserved. Source

Renesme L.,Bordeaux University Hospital Center | Bedu A.,Limoges University Hospital Center | Tourneux P.,Reanimation et soins continus pediatriques | Truffert P.,Service de medecine neonatale
Archives de Pediatrie

Background: Neonatal jaundice is a very frequent condition that occurs in approximately 50-70% of term or near-term (> 35 GA) babies in the 1st week of life. In some cases, a high bilirubin blood level can lead to kernicterus. There is no consensus for the management of neonatal jaundice and few countries have published national clinical practice guidelines for the management of neonatal jaundice. The aim of this study was to assess the quality of these guidelines. Methods: We conducted a systematic review of the literature for national clinical practice guidelines for the management of neonatal jaundice in term or near-term babies. Four independent reviewers assessed the quality of each guideline using the AGREE II evaluation. For each of the clinical practice guidelines, the management modalities were analyzed (screening, treatment, follow-up, etc.). Results: Seven national clinical practice guidelines were found (South Africa, USA AAP, UK NICE, Canada, Norway, Switzerland, and Israel). The AGREE II score showed widespread variation regarding the quality of these national guidelines. There was no major difference between the guidelines concerning the clinical management of these babies. Discussion: The NICE guideline is the most valuable guideline regarding the AGREE II score. NICE showed that, despite a strong and rigorous methodology, there is no evidenced-based recommended code of practice (RCP). Comparing RCPs, we found no major differences. Conclusion: The NICE guideline showed the best quality. The AGREE II instrument should be used as a framework when developing clinical practice guidelines to improve the quality of the future guideline. In France, a national guideline is needed for a more standardized management of neonatal jaundice. © 2015 Elsevier Masson SAS. Source

Garel M.,French Institute of Health and Medical Research | Caeymaex L.,Service de medecine neonatale | Caeymaex L.,University Paris - Sud | Goffinet F.,French Institute of Health and Medical Research | And 2 more authors.
Journal of Medical Ethics

Objectives: A statute enacted in 2005 modified the legislative framework of the rights of terminally ill persons in France. Ten years after the EURONIC study, which described the self-reported practices of neonatal caregivers towards ethical decision-making, a new study was conducted to assess the impact of the new law in neonatal intensive care units (NICU) and compare the results reported by EURONIC with current practices. Setting and design: The study was carried out in the same two NICU as in the EURONIC qualitative study. A third centre was added to increase the sample size. From February to October 2007, 19 physicians and 17 nurses participated in semistructured interviews very similar to those for EURONIC. Content analysis identified the recurring themes emerging from the interviews. Results: Compared with the EURONIC results, the caregivers reported that they pay greater attention to the views of parents and provided respectful support to the neonates when life-sustaining treatment is withdrawn. Active termination of life has become exceptional. The possibility of withdrawal of treatment, the administration of sedatives to control pain even at the risk of hastening death, the emphasis on sparing parents the burden of decision, and the relative ignorance of the law were very similar to the EURONIC findings. Conclusion: Both the medical and the legal regulation of practices has allowed more dialogue with the parents and more humane care for dying newborns. A new European study is necessary to investigate the possible changes in practices and attitudes also in other countries. Source

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