Saint-André-lez-Lille, France
Saint-André-lez-Lille, France

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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 | Year: 2011

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attention to the views of parents and provided respectful support to the neonates when life-sustaining treatment is withdrawn.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.


Fily A.,Service de Medecine Neonatale
Journal of Headache and Pain | Year: 2012

The prevalence and characterization of migraine triggers have not been rigorously studied in children and adolescents. Using a questionnaire, we retrospectively studied the prevalence of 15 predefined trigger factors in a clinic-based population. In 102 children and adolescents fulfilling the Second Edition of The International Headache Classification criteria for paediatric migraine, at least one migraine trigger was reported by the patient and/or was the parents' interpretation in 100% of patients. The mean number of migraine triggers reported per subject was 7. Mean time elapsed between exposure to a trigger factor and attack onset was comprised between 0 and 3 h in 88 patients (86%). The most common individual trigger was stress (75.5% of patients), followed by lack of sleep (69.6%), warm climate (68.6%) and video games (64.7%). Stress was also the most frequently reported migraine trigger always associated with attacks (24.5%). In conclusion, trigger factors were frequently reported by children and adolescents with migraine and stress was the most frequent. © The Author(s) 2011.


PubMed | Reanimation et soins continus pediatriques, Bordeaux University Hospital Center, Service de medecine neonatale and Limoges University Hospital Center
Type: Journal Article | Journal: Archives de pediatrie : organe officiel de la Societe francaise de pediatrie | Year: 2016

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.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.).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.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.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.


Gascoin-Lachambre G.,French Institute of Health and Medical Research | Gascoin-Lachambre G.,Groupe Hospitalier Cochin Saint Vincent Of Paul | Buffat C.,Laboratoire Of Biochimie Et Of Biologie Moleculaire | Rebourcet R.,French Institute of Health and Medical Research | And 8 more authors.
Placenta | Year: 2010

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.


PubMed | CIC 1426, Service de medecine neonatale, Center Detudes Perinatales Of Locean Indien Ea 7388 and CIC 1432
Type: Journal Article | Journal: Journal of clinical pharmacy and therapeutics | Year: 2016

The neonatal intensive care units (NICUs) are at the highest risk of drug dose error of all hospital wards. NICUs also have the most complicated prescription modalities. The computerization of the prescription process is currently recommended to decrease the risk of preventable adverse drug effects (pADEs) in NICUs. However, Computer Prescribing Order Entry-Clinical Decision Support (C.P.O.E./C.D.S.) systems have been poorly studied in NICUs, and their technical compatibility with neonatal specificities has been limited.We set up a performance study of the preselected prescription of drugs for neonates, which limited the role of the prescriber to choosing the drugs and their indications.A single 29 bed neonatal ward used this neonatal C.P.O.E./C.D.S. system for all prescriptions of all hospitalized newborns over an 18-month period. The preselected prescription of drugs was based on the indication, gestational age, body weight and post-natal age. The therapeutic protocols were provided by a formulary reference (330 drugs) that had been specifically designed for newborns. The preselected prescription also gave complete information about preparation and administration of drugs by nurses. The prescriber was allowed to modify the preselected prescription but alarms provided warning when the prescription was outside the recommended range. The main clinical characteristics and all items of each line of prescription were stored in a data warehouse, thus enabling this study to take place.Seven hundred and sixty successive newborns (from 24 to 42weeks gestation) were prescribed 52392 lines of prescription corresponding to 65 drugs; About 304% of neonates had at least one out of licensed prescription; A prescription out of the recommended range for daily dose was recorded for 10% of all drug prescriptions. WHAT IS NEW?: The C.P.O.E./C.D.S. systems can currently provide a complete preselected prescription in NICUs according to dose rules, which are specific to newborns and also comply with local specificities (therapeutic protocols and formulation of drugs). The role of the prescriber is limited to the choice of drugs and their indications. The prescriber still retains the possibility of modifying each item of the prescription, with all other prescription items being calculated by the C.P.O.E. system. In these conditions, the prescribers rarely modified the preselected prescription and the rate of out of range prescription was low. A multicentric study is required to confirm and extend these observations.This study showed the feasibility of preselected prescription in NICUs and a low rate of out of range prescriptions. The preselected prescription could play a key role in lowering the dose error rate in NICUs.


Charkaluk M.L.,Clinique de Pediatrie Saint Antoine | Charkaluk M.L.,French Institute of Health and Medical Research | Charkaluk M.L.,University Pierre and Marie Curie | Truffert P.,Service de Medecine Neonatale | And 6 more authors.
Acta Paediatrica, International Journal of Paediatrics | Year: 2010

Aim: To describe the development of very preterm children free of cerebral palsy or severe sensory impairment in the domains of gross and fine motor functions, language and sociability at a corrected age of 2 years; to identify factors associated with performances in each domain. Methods: A total of 347 children born in 1997 before 33 weeks of gestation, part of the EPIPAGE population-based cohort study, had their psychomotor development assessed with the Brunet-Lezine scale. Results: The study population had a mean gestational age of 30.1 ± 2.0 weeks. Lower developmental quotients (DQ) were observed in the study group compared to the reference sample (96 ± 13 vs 104 ± 8, p < 0.01). Fine motor function, language and sociability were all affected with a p value <0.01. Multivariate analysis showed that duration of intubation and parents' educational and occupational levels were the only variables significantly related to each developmental domain (p < 0.01). Conclusions: Children very preterm and free of severe disabilities had mild delays in multiple areas of development. The mechanisms by which neonatal factors played a role need further investigation. However socioeconomic status had a great impact on development and our results underline the need for improved support of socioeconomically disadvantaged parents after a preterm birth. © 2010 Foundation Acta Pædiatrica.


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 | Year: 2011

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.


Losacco V.,Unit of Epidemiology | Cuttini M.,Unit of Epidemiology | Greisen G.,Copenhagen University | Haumont D.,Free University of Brussels | And 6 more authors.
Archives of Disease in Childhood: Fetal and Neonatal Edition | Year: 2011

Objective: To describe the use of heel blood sampling and non-pharmacological analgesia in a large representative sample of neonatal intensive care units (NICUs) in eight European countries, and compare their self-reported practices with evidence-based recommendations. Methods: Information on use of heel blood sampling and associated procedures (oral sweet solutions, non-nutritive sucking, swaddling or positioning, topical anaesthetics and heel warming) were collected through a structured mail questionnaire. 284 NICUs (78% response rate) participated, but only 175 with ≥50 very low birth weight admissions per year were included in this analysis. Results: Use of heel blood sampling appeared widespread. Most units in the Netherlands, UK, Denmark, Sweden and France predominantly adopted mechanical devices, while manual lance was still in use in the other countries. The two Scandinavian countries and France were the most likely, and Belgium and Spain the least likely to employ recommended combinations of evidence-based pain management measures. Conclusions: Heel puncture is a common procedure in preterm neonates, but pain appears inadequately treated in many units and countries. Better compliance with published guidelines is needed for clinical and ethi cal reasons.


Saint-Faust M.,Service Route | Simeoni U.,Service de Medecine Neonatale
Medecine des Maladies Metaboliques | Year: 2012

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.


Pierrat V.,Service de Medecine Neonatale | Zaoui-Grattepanche C.,Center Hospitalier Of Valenciennes | Rousseau S.,Pole Mere enfant Labellise | Truffert P.,Service de Medecine Neonatale
Devenir | Year: 2012

In the field of prematurity and development, the last decade has seen the emergence of numerous research that led to a better understanding of the mechanisms and neuroanatomical brain lesions associated with pretermbirth. These lesions are diffuse affecting the organizational phase of the central nervous system and the establishment of inter-neuronal connections. They are linked to the deleterious sensory environment which is common for the baby born preterm. Deprivation of parental presence is a defining element of this sensory environment. Several strategies have been developed to provide preterm neonates an environment more suited to their needs and give parents a central place with their baby. The NIDCAP individualized care and developmental program is currently one that discusses things in their greater complexity. It is closely associated with the family-centered care philosophy. Kangaroo care, support for breastfeeding are also strategies that actively involve parents and whose benefits for babies have been demonstrated. Apart from their impact on quality of attachment, the most studied benefits include prevention of pain, sleep deprivation and the development of the pre-term baby. © Médecine & Hygiéne. Tous droits réservés pour tous pays.

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