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Biomedical subjects

Olivier Claris

Publications and source records attributed to Olivier Claris.

13 recordsLinked to original sources
PubMed2006

Effect of latency period after premature rupture of membranes on 2 years infant mortality (DOMINOS study).

OBJECTIVE: To assess the impact of a short latency period after preterm premature rupture of the membranes (PPROM) on infant mortality. STUDY DESIGN: A prospective cohort study of women with PPROM between 24(0/7) and 33(6/7) weeks' in singleton gestation was performed in all maternity wards of the Rhône-Alpes Region. Neonatal and infant outcomes were compared according to the latency period (<48 h and > or =48 h). The primary outcome was the mortality rate and the secondary outcome was a composite variable of significant neurological disorders at 2 years of age. Outcomes was stratified according to gestational age at rupture. Univariate and multiple logistic regression analyses were used with SAS statistical software. RESULTS: Out of 471 women recruited in the study at a mean gestational age of 30.5+/-0.2 weeks, 170 (37%) presented with a <48-h latency period, and 301 (63%), a > or =48-h latency period. While prior to 30 weeks' gestation, the mortality rate was higher in neonates with a short latency period (16.3% versus 7.3%, p < 0.01) with pulmonary disease being the major cause of death, a short latency period was associated with a lower mortality rate after 30 weeks' gestation (0% versus 3.7%, p=0.02). After adjusting for confounding factors, a <48-h latency period remained an independent factor associated with infant mortality prior to 30 week's gestation (odds ratio 3.8, 95% confidence interval 1.3-11.7). Significant neurological disorders were not modified by the length of the latency period. CONCLUSION: For PPROM that occur before 30 weeks' gestation, a short latency period was associated with a higher infant mortality rate. Inversely, it was associated with a lower mortality rate after 30 weeks'. There is an urgent need for a thorough evaluation of expectant management of PPROM after 30 weeks' gestation.

Adult↗
PubMed2006

Identification of newborns with Fetal Growth Restriction (FGR) in weight and/or length based on constitutional growth potential.

This study was carried out to build statistical models for defining FGR (Fetal Growth Restriction) in weight and/or length after taking growth potential of an infant into account. From a cohort of pregnant women having given birth to 47,733 infants in 141 French maternity units, two statistical models gave individualized limits of birth weight and birth length (based on the 5th centile) below which, after adjustment for its individual growth potential, a newborn must be considered as FGR in weight and/or in length. A sample of 906 infants had measures taken of cord blood growth factors (IGF1, IGFBP3). The FGR(W) definition (weight<5th centile for growth potential) permitted the identification of infants who presented rates of maternal hypertension (13.6%) and of Apgar score at 5 min<6 (2.9%) higher than in the classical group SGA(W) (weight<5th centile for sex and gestational age) (9.6% and 2.2% respectively). By combining FGR(W) and SGA(W), a subgroup of infants, not currently recognized as SGA, presented very high rates of maternal hypertension (19.9%) and of low Apgar score (3.9%). Conversely a subgroup of infants, currently recognized as SGA(W), had rates as low as in the normal infants group, and had to be considered as "constitutionally small" (that is to say 24% of the SGA(W)). Combining FGR(W) and FGR(L) (length<5th centile of growth potential), 7.6% of infants appeared growth-restricted, and 1.8% appeared constitutionally small in weight and/or in length. The FGR(W)-FGR(L) infants showed the lowest mean values of IGF1 (126.2+/-3.2) and IGFBP3 (0.86+/-0.03). These new definitions of FGR(W) and FGR(L) could help to better identify infants at birth requiring neonatal care, and monitoring of growth catch-up and neurodevelopmental outcome.

Adult↗
PubMed2005

A prospective population-based study of 598 cases of PPROM between 24 and 34 weeks' gestation: description, management, and mortality (DOMINOS cohort).

OBJECTIVE(S): Description of mothers' characteristics, obstetricians' practices, and PPROM-linked mortality in all 81 maternity hospitals in the Rhône-Alpes Region, over a period of 2 years. STUDY DESIGN: Prospective cohort study of 598 women with PPROM between 24 and 34 weeks' gestation, leading to 680 births. At time of PPROM, collection of mothers' socio-economic characteristics, medical and obstetric histories and PPROM circumstances. Collection of perinatal management, neonates' medical status and postnatal referral. RESULTS: The birth rate after PPROM between 24 and 34 weeks' gestation was 0.47% (95% CI: 0.42-0.48). Sixty percent of PPROM occurred before 32 weeks' gestation and 98% of births before 37 weeks. The incidence of previous PPROM was 14.3%. Antibiotics, corticosteroids, and tocolytics were given to 82, 78, and 52% of women, respectively. The rate of antibiotics and antenatal corticosteroids varied with gestational age (lower rates for antibiotics just after the limit of viability (23-24 weeks) and after 32 weeks, higher rates of corticosteroids between 26 and 30 weeks). The PPROM-birth interval became shorter as gestation advanced. The incidence of C-section was 58.7% (n = 270), C-section before labour being the most frequent mode of delivery. Sixty-seven percent of neonates were born in Level-3 hospitals. The overall neonatal mortality rate at 28 days decreased with gestational age at PPROM, and was 17.2% (16/93), 3% (6/200), and 0.41% (1/241) at 24-27, 28-31 and 32-33 weeks of PPROM, respectively. CONCLUSION(S): After PPROM, antibiotics and antenatal corticosteroids were widely used in our cohort, and C-section rates were elevated. With that up-to-date management, the perinatal mortality rate was less than 3% following PPROM after 28 weeks' gestation.

Adolescent↗
PubMed2005

Oral vitamin A, E and D supplementation of pre-term newborns either breast-fed or formula-fed: a 3-month longitudinal study.

BACKGROUND: In contrast to the studies of vitamin A and E status in children, adolescents and adults, information on preterm infants is scarce. In the present investigation we examined the vitamin A, D and E status of pre-term infants at birth, and verified whether, at 1 and 3 months, breast or formula feeding affected the plasma concentration of those vitamins while being supplemented with Uvesterol ADEC. PATIENTS AND METHODS: In this prospective study, 2 groups of consecutively recruited preterm newborns fed either breast milk or formula received 3000 IU of vitamin A, 5 IU of vitamin E and 1000 IU of vitamin D daily. Vitamin A and E were measured by high performance liquid chromatography and spectrophotometry. 25-hydroxyvitamin D, a surrogate marker for vitamin D status, was measured by radioimmunoassay, and retinol binding-protein concentration was measured by immunonephelometry. RESULTS: At birth, formula-fed and breast-milk fed infants had similar plasma concentrations of vitamin A (0.75 +/- 0.20 and 0.64 +/- 0.21 micromol/L, ns), 25-hydroxyvitamin D (34.4 +/- 25.6 and 47.5 +/- 26.7 nmol/L, ns) and vitamin E (9.5 +/- 3.2 and 8.4 +/- 3.3 micromol/L, ns). Vitamins A and E, and retinol binding-protein concentrations steadily increased with time in both groups of infants without attaining, at 3 months, values considered normal in term infants and in young children. At 3 months of age, concentrations of 25-hydroxyvitamin D reached values comparable to those observed in term infants. CONCLUSION: Plasma concentrations of vitamins A and E and of retinol binding-protein steadily increased during the the study without reaching full repletion values. At the conclusion of the study, the type of nutrition did not affect plasma vitamin concentrations.

Adult↗
PubMed2004

Bone mineralization and growth are enhanced in preterm infants fed an isocaloric, nutrient-enriched preterm formula through term.

BACKGROUND: Because recent data on the effects of mineral concentrations in preterm infant formula on bone mineralization are lacking, recommendations for the mineral content of preterm infant formula differ greatly between committees. OBJECTIVE: The goal of the study was to assess the effects of an isocaloric, nutrient-enriched preterm formula, which was fed from the age when full enteral feedings were tolerated through expected term, on bone mineralization in preterm infants. DESIGN: We conducted a prospective, randomized, double-blind study in healthy, preterm infants (gestational age of 28-32 wk) who were fed either a control preterm formula (n=20) or an isocaloric, nutrient-enriched preterm formula (n=21) until 3 mo of age (ie, approximate expected term). Serum calcium indexes were taken throughout the study, and bone mass was determined by using dual-energy X-ray absorptiometry at hospital discharge and expected term. RESULTS: A total of 37 infants (experimental formula, n=19; control formula, n=18) completed the study. Compared with control subjects, infants fed the experimental formula had 25% and 40% higher intakes of calcium and phosphorus, respectively. Serum calcium, phosphorus, osteocalcin, and alkaline phosphatase concentrations and urinary collagen type I cross-linked N-telopetide concentrations were not significantly different between the groups at any time point. The bone mineral content of infants fed the experimental formula was 23% (P=0.039) and 35% (P=0.002) higher at hospital discharge and expected term, respectively. CONCLUSIONS: Bone mineralization at hospital discharge and expected term was significantly higher in preterm infants fed the isocaloric, nutrient-enriched formula than in those fed control formula. Continuation of the experimental formula beyond hospital discharge, through expected term, further improved bone mineralization.

Absorptiometry, Photon↗
PubMed2004

[Mortality and morbidity of low-birth-weight infants. Current prognosis and future perspectives].

In a retrospective epidemiologic study conducted from January 1996 to December 2002, 2555 low-birth-weight infants (less than 2500 g) were admitted to the neonatal intensive care unit of E Herriot Hospital in Lyon, France. Very low birth weight (795 infants) was defined as a birth weight below 1500 g. The total mortality rate among these latter infants was 8%. The mortality rate was less than 25% among infants with a gestational age of at least 25 weeks. Neonatal morbidity mainly consisted of respiratory distress syndrome and cerebral hemorrhage. Sequelae at age 2 years (corrected) affected less than 10% of surviving in very-low-birth-weight infants. Gestational age is thus an important predictor of survival and functional outcome in very-low-birth-weight infants.

Cerebral Hemorrhage↗
PubMed2002

Nitrogen utilization and bone mineralization in very low birth weight infants fed partially hydrolyzed preterm formula.

Partialy hydrolyzed formulas have been proposed for term and preterm infants, but decreased nitrogen and calcium intestinal absorption rates, together with plasma amino acid imbalances have been reported in preterm infants. We evaluated a new formula with modified nitrogen and calcium sources (glycerophosphate). During their second week of life, 16 preterm infants were randomly assigned to 1 of 2 groups: 9 were fed the new partially hydrolyzed formula and 7 a conventional formula. A nutrient balance was performed at the end of the first month of life. Amino acid concentrations and whole-body mineralization were measured at the end of study period (theoretical term). Birth weight and gestational age (mean +/- SD) were similar in the 2 groups (28.9 +/- 7.0 wks and 1,183 +/- 242 g v 27.7 +/- 1.0 wks and 1,139 +/- 162 g). Median nitrogen absorption rate (85% v 89%; P = .03) was lower in infants fed the new formula than in those fed the conventional one. After correction for difference in nitrogen intake, there was no significant difference in N retained between the 2 groups (P = .11). Plasma amino acid concentrations were also similar in the 2 groups. At theoretical term, median bone mineral content was not significantly different between the 2 groups (50 g/kg v 55 g/kg; P = .17) and it was close to the reference values obtained in term neonates just after birth. As long as nitrogen content is 10% higher in protein hydrolyzed formula than in entire protein formula, appropriate nitrogen retention, plasma amino acid profile can be achieved with the new partially hydrolyzed formula. In both groups, bone mineralization at theoretical term was close to the mineralization observed term neonates just after birth.

Amino Acids↗
PubMed2002

Early treatment with erythropoietin beta ameliorates anemia and reduces transfusion requirements in infants with birth weights below 1000 g.

OBJECTIVE: To investigate whether recombinant erythropoietin (rhEPO) reduces the need for transfusion in extremely low birth weight (ELBW) infants (birth weight 500-999 g) and to determine the optimal time for treatment. METHODS: In a blinded multicenter trial, 219 ELBW infants were randomized on day 3 to one of 3 groups: early rhEPO group (rhEPO from the first week for 9 weeks, n = 74), late rhEPO group (rhEPO from the fourth week for 6 weeks, n = 74), or control group (no rhEPO, n = 71). All infants received enteral iron (3-9 mg/kg/day) from the first week. The rhEPO beta dose was 750 IU/kg/week. Success was defined as no transfusion and hematocrit levels never below 30%. RESULTS: Success rate was 13% in the early rhEPO group, 11% in the late rhEPO group, and 4% in the control group (P =.026 for early rhEPO versus control group). Median transfusion volume was 0.4 versus 0.5 versus 0.7 mL/kg/day (P =.02) and median donor exposure was 1.0 versus 1.0 versus 2.0 (P =.05) in the early rhEPO group, the late rhEPO group, and the control group, respectively. Infection risk was not increased and weight gain was not delayed with rhEPO beta. CONCLUSION: Early rhEPO beta treatment effectively reduces the need for transfusion in ELBW infants.

Anemia, Neonatal↗