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Biomedical subjects

V Pierrat

Publications and source records attributed to V Pierrat.

At least 19 recordsLinked to original sources
PubMed2004

[Nutrition and bronchopulmonary dysplasia].

Bronchopulmonary dysplasia remains a frequent complication of extreme prematurity. In preterm neonates catch-up and pulmonary alveolar growth occur during the first two years of life. However 10 to 25% of preterm infants with bronchopulmonary dysplasia are under-nourished after two years of age, and 30 to 60% of them also suffer from persistent airway obstruction, hyperinflation and bronchial hyperreactivity. Recommendations on nutritional requirements in this population are not yet clearly defined, but an adequate nutritional status in prenatal and early postnatal period can have long-term consequences on brain and lung development. There are a few randomised trial of nutrition for preterm infants with bronchopulmonary dysplasia after discharge. Caloric and protein requirements in this population are probably higher than in full-term infants. Moreover there are potential benefits in using specific nutrients: supplementation with long chain polyunsaturated fatty acids could decrease lung inflammation injuries, glutamine is the main source of energy of pneumocyte, vitamin A is essential for lung development, inositol is necessary for surfactant synthesis, vitamin E and selenium have anti-oxidant effects. Controlled nutritional trial are needed with a long term follow-up in late childhood in order to test their effects on growth and pulmonary status.

Bronchopulmonary Dysplasia↗
PubMed2003

[Recombinant human erythropoietin: analysis of a policy of treatment in an hospital based population of very-low-birthweight infants].

AIM OF THE STUDY: To evaluate a policy of treatment with human recombinant erythropoietin (rhEPO) and to describe factors related to red blood cell transfusions (RBCTs) in treated neonates. STUDY: Prospective, observative study. PATIENTS AND METHODS: One-hundred and sixty-five neonates with gestational age (GA) < 30 weeks and/or birthweight < 1000g admitted between may 1998 and october 1999. Ninety were excluded (congenital malformations n = 6, deaths n = 16, referral to a general hospital before discharge n = 67, ECMO n = 1). Data about the characteristics of the population, the severity of the neonatal period, hemoglobin at birth, blood loses, treatment with rhEPO, number of red blood cells transfusions (RBCTs) and donors were recorded in all infants. RESULTS: Thirty-eight in seventy-five (51%) neonates received 112 blood transfusions. Eighty-eight were prescribed after day 15. In most of the cases (n = 68), RBCTs were done according to the protocol. In 20 cases (23%) infants were transfused during a late-onset infection. No difference was observed between the non-transfused (group I) and the transfused neonates (group II) with regards to the drug administration: first dose on day 3 +/- 2, number of injections (17 +/- 4 vs 18 +/- 1, ns). The start of oral supplementation with iron was late (12j +/- 8 vs 19j +/- 10, ns). Infants in group II had a lower birthweight (850 +/- 240 vs 1050 +/- 160 g, p < 0,01) for a similar GA (28 +/- 1SA vs 28 +/- 2SA, ns) in association with an increased number of small for date babies (p = 0.03). Antenatal steroïds administration (89 vs 74%, ns), administration of surfactant (59 vs 81%, ns) were similar in the two groups. The Clinical Risk Index for Babies was higher in group II: 5 +/- 3 vs 2 +/- 1 (p < 0,001) as was the duration of oxygen delivery (53 +/- 44 vs 14 +/- 20 days, p < 0,01) and postnatal administration of corticosteroïds ( 38% vs 3%, p < 0.01). CONCLUSION: The quality of iron administration, RBCTs and the limitation of donors could be improved in our population. Transfusions among neonates born before 30 weeks and/or with a birthweight of less than 1000 g and treated with rhEPO are associated with intrauterine malnutrition and a worse clinical condition on admission. Early identification of at risk neonates could improve prevention of RBCTs and the efficacy of rhEPO administration to preterm infants.

Erythrocyte Transfusion↗
PubMed2003

Neurological assessment at five years of age in infants born preterm.

AIM: To evaluate the agreement between Touwen's neurological examination and a derived simplified one, created to be applied at the age of 5 y to infants born preterm. METHODS: 185 children born at a gestational age (GA) of <33 wk and/or with a birthweight <1501 g, free of cerebral palsy, underwent Touwen's neurological examination at a mean age of 5 y and 8 mo (5-6.5 y). One-hundred and seventy had a full examination and were included into the study. They were born at a mean GA of 30 wk (range 24-35 wk) with a mean birthweight of 1250 g (range 600-2690 g). A simplified examination, based on the clinical experience of two of the authors, was created a priori. The data were reviewed retrospectively and the concordance between the two forms was assessed. The reviewers were blinded to the original categorization from the long form. RESULTS: On the basis of the original Touwen's neurological examination, the 170 children were classified into 122 with a normal neurological examination, 41 with grade 1 minor neurological dysfunction (MND) and 7 with grade 2 MND, giving 28% of the cohort with MND. The concordance between the two forms was excellent, with an agreement in 169 out of 170 subjects. None of the infants with the most complex form of MND was misclassified. CONCLUSION: The simplicity of this examination could allow its diffusion and its use in follow-up programmes. It could improve the quality of routinely collected follow-up data of preterm neonates.

Birth Weight↗
PubMed2001

Ultrasound diagnosis and neurodevelopmental outcome of localised and extensive cystic periventricular leucomalacia.

AIMS: To compare the ultrasound (US) evolution and neurodevelopmental outcome of infants with localised (grade II) and extensive (grade III) cystic periventricular leucomalacia (c-PVL). METHODS: Over a nine year period, c-PVL was diagnosed in 96/3451 (2.8%) infants in two hospital cohorts. Eighteen were excluded from the study. Thirty nine infants with grade II PVL were compared with 39 infants with grade III PVL. RESULTS: The two populations were comparable for gestational age and birth weight. In infants with grade II PVL, cysts were noted to develop more often after the first month of life (53%) in contrast with grade III PVL (22%) (odds ratio (OR) 3.81 (95% confidence interval (CI) 1.19 to 12.63)). Cysts were also more often unilateral in grade II (54%) than in grade III PVL (0%) (OR indefinite; RR 3.17 (95% CI 2.16 to 4.64)). At 40 weeks postmenstrual age (PMA), cysts were no longer seen on US in 13/38 infants with grade II PVL, with ventriculomegaly being the only visible sequel in nine cases. In grade III PVL, cysts were still present in 25 of the 27 surviving infants. Nine infants with grade II PVL were free of motor sequelae at follow up compared with one infant with grade III PVL (OR 8.07 (95% CI 0.92 to 181.66)). Twenty two out of 29 children with grade II PVL who developed cerebral palsy achieved independent walking compared with 3/26 with grade III PVL (OR 75 (95% CI 11.4 to 662)). CONCLUSIONS: In the cohort studied, 50% of the infants with c-PVL had a more localised form (grade II). In grade II PVL, the cysts developed beyond the first month of life in more than half of the cases and were often no longer visible, on US, at 40 weeks PMA. In order not to miss this diagnosis, sequential US should also be performed beyond the first month of life. Mild ventriculomegaly noted at term can sometimes be due to grade II c-PVL. Cerebral palsy was slightly less common and tended to be less severe in infants with grade II PVL than in those with grade III PVL.

Age of Onset↗
PubMed2000

[Congenital hernia of the diaphragm. A retrospective study of 123 cases recorded in the Neonatal Medicine Department, URHC in Lille between 1985 and 1996].

BACKGROUND: During the last ten years, new therapeutic strategies have been used in order to improve the management of congenital diaphragmatic hernia (CDH). CDH is associated with pulmonary hypoplasia, abnormal pulmonary vascular reactivity and pulmonary immaturity. Between 1985 and 1990, mechanical hyperventilation and early surgery were provided systematically. Since 1991, the management of CDH in our institution has involved a preoperative stabilization with exogenous surfactant replacement, gentle ventilation, high-frequency oscillation, nitric oxide or extracorporeal membrane oxygenation. PURPOSE: To analyse the impact of the new therapeutic strategy on the survival and outcome of newborns with CDH. METHODS: Retrospective review of all infants with CDH admitted to our institution from 1985 through 1996. Mortality and morbidity were compared between period I (1985-1990) and period II (1991-1996). RESULTS: Between 1985 and 1996, 123 neonates were admitted to our Neonatal Department. Nine of them had another severe congenital malformation and were excluded from the study. Survival was 23% (12/52) in period I and 56% (35/62) in period II (p < 0.001). In period II, complications were more frequent among survivors in whom an extracorporeal membrane oxygenation was required (13 infants): bronchopulmonary dysplasia 77% (10/13), gastroesophageal reflux 61% (8/13), and hypotrophy 61% (8/13). CONCLUSION: These data demonstrate a significant improvement in survival in CDH since the implementation of new therapeutic modalities. Nevertheless, a significant morbidity exists among the infants who survive a severe respiratory failure.

Bronchopulmonary Dysplasia↗
PubMed2000

Two years' follow-up of newborn infants after extracorporeal membrane oxygenation (ECMO).

OBJECTIVE: Extracorporeal membrane oxygenation (ECMO) is a technique of extracorporeal oxygenation used in newborn infants with refractory hypoxemia after failure of maximal conventional medical management, when mortality risk is higher than 80%. We retrospectively reviewed all the neonates treated by ECMO between October 1991 and September 1997 in our newborn intensive care unit. METHODS: Fifty-seven patients were treated with ECMO for severe respiratory failure: congenital diaphragmatic hernia (CDH) (n=23), neonatal sepsis (NS) (n=14), meconium aspiration syndrome (MAS) (n=12), and others (n=8). Mean gestational age and birth weight were 38+/-2 weeks and 3200+/-500 g, respectively. Oxygenation index was 61+/-8. Both venovenous (n=28) or venoarterial ECMO (n=29) were used. The mean time at ECMO initiation was 47 h (range 8 h-2 months). The mean duration was 134+/-68 h. In each case of VA ECMO, carotid reconstruction was performed. Survival at 2 years was 40/57 (70%) (CDH 12/23 (52%), NS 11/14 (79%), MAS 12/12 (100%), others 5/8). Follow-up at 2 years was available in 36 survivors. RESULTS: Neurodevelopmental outcome was not related to the initial diagnosis: normal neurologic development (n=30), cerebral palsy (n=5), and neurologic developmental delay (n=1). Two patients remained oxygen dependant at 2 years, and four required surgical treatment for severe gastroesophageal reflux. Respiratory and digestive sequelae were more frequent in the CDH group (P<0.01). Patency and flow of the repaired carotid artery was assessed in 20 infants at 1 year of age using Doppler ultrasonography: normal (n=10), <50% stenosis (n=9), and >50% stenosis (n=1). CONCLUSION: ECMO increased survival of newborn infants with refractory hypoxemia. However, higher a survival rate and lower morbidity were found in non-CDH infants than in congenital diaphragmatic hernia.

Brain Ischemia↗
PubMed1998

[Incidence, evolution and prognosis of posthemorrhagic ventriculomegaly in a population of newborns of less than 33 weeks gestational age].

BACKGROUND: Posthemorrhagic ventriculomegaly is one of the most important neurological problems encountered in the premature new-born. The aim of this study was to evaluate its incidence in a tertiary neonatal unit at Lille, France, to study its evolution, the risk of ventriculoperitoneal shunt and the neurodevelopmental outcome. PATIENTS AND METHODS: Ninety-one neonates with posthemorrhagic ventriculomegaly, born before 33 weeks of gestational age (GA) and admitted in this unit between January 1989 and December 1995 were retrospectively studied. Clinical data, evolution of ventriculomegaly and outcome at 2 years were extracted from the files. RESULTS: Incidence of ventriculomegaly was stable along the study period, around 6.1% of the admissions of neonates with the same GA; 44 had moderate ventriculomegaly and 47 severe. The mean GA was 28.7 +/- 1.9 weeks. Fifteen percent of the newborns had received corticosteroids before delivery. Spontaneous delivery (P = 0.04) and infection (P = 0.002) were more frequent in case of severe ventriculomegaly. Ventriculoperitoneal shunt was inserted in 19.1% (9/47) of infants with severe ventriculomegaly. Outcome in this population was poor. Forty-nine (54%) died before the end of the first year of life. Thirteen (30.9%) of the survivors developed cerebral palsy. In 12 out of these 13 cases, cerebral palsy was associated with parenchymal involvement in the neonatal period. CONCLUSION: Long-term prognosis of ventriculomegaly is poor. In front of new therapeutic approach, an active policy towards prevention with large use of antenatal corticosteroids would allow to reduce incidence, mortality and morbidity in the neonatal period.

Cerebral Hemorrhage↗
PubMed1997

The predictive value of cranial ultrasound and of somatosensory evoked potentials after nerve stimulation for adverse neurological outcome in preterm infants.

Thirty-nine preterm infants were studied to compare the predictive value of somatosensory evoked responses (SEPs) following median-nerve and posterior tibial-nerve stimulation with the predictive value of cranial ultrasound. With regard to the SEP, a normal median-nerve response was by no means a guarantee of a normal outcome. A normal posterior tibial-nerve response, however, almost guaranteed a normal outcome, but the test was very time consuming and the number of false positive responses was high (sensitivity 95.6%, specificity 50%). The presence of parenchymal involvement, either due to a haemorrhage or cystic leukomalacia predicted cerebral palsy with a sensitivity of 95.6% and specificity of 68.5%. The combination of an abnormal posterior tibial response and the presence of parenchymal brain lesions had the best predictive value with a sensitivity of 91.3% and a specificity of 81.2%. These results show that, although posterior tibial-nerve responses have a better predictive value than median-nerve responses, these values were lower than that of cranial ultrasound. The best prediction was obtained when a combination of posterior-tibial responses and cranial ultrasound was used.

Cerebral Hemorrhage↗
PubMed1996

Somatosensory evoked potentials in preterm infants with intrauterine growth retardation.

In order to further evaluate both the maturation as well as the prognostic value of the somatosensory evoked potentials (SEPs) with regard to neurodevelopmental outcome, SEPs were performed after the first week of life in 56 small-for-gestational age (SGA) preterm neonates. Twenty-five had a prolonged N1 latency while 30 had a normal N1 latency around discharge. One child had an accelerated N1 latency. No correlation was found between the severity of intrauterine growth retardation in relation to birthweight, head circumference or birthweight ratio. None of the children developed cerebral palsy (CP) at follow-up. Developmental quotient (DQ) was calculated in 42 children. The mean DQ of the 21 neonates with an abnormal SEP at discharge was 79.24 +/- 18.56 while the mean DQ of the 21 children with a normal SEP at discharge was 92.52 +/- 11.31. Among the children with a normal N1 latency at discharge the number of breast-fed children was significantly higher than the number of formula-fed neonates (P < 0.05). We conclude that an abnormal SEP around term age in SGA preterm neonates does not imply an increased risk of developing CP. Breast-milk appears to have a beneficial effect on the development of the SEPs in children with intrauterine growth retardation.

Birth Weight↗
PubMed1996

[Cerebral infarction: ultrasonic diagnosis and semeiologic peculiarities in premature newborn infants].

BACKGROUND: Cerebral infarction in the preterm neonate is rarely associated with focal seizures. Its diagnosis is usually made on a routinely performed ultrasound scan. CASE REPORTS: Case no 1: A wedge-shaped area of increased echogenicity in the left parietal region suggesting a localized cerebral infarction was diagnosed on ultrasound scan performed in a preterm neonate born at 33 weeks of gestational age (GA) in whom electrical activity showed bilateral spiked theta-waves. The diagnosis was confirmed by CT scan and MRI. At 3 years of age, neurological and psychological evaluation was normal. Case no 2: This patient with intrauterine growth retardation was born at 31 weeks of GA after elective cesaerean section for Rhesus incompatibility. Two exchange-transfusions had been performed in utero. At day one an increased area of echogenicity lining a hypoechogenic parenchyma was noted in the parietal region suggesting its antenatal origin. The child died on day 8. CONCLUSIONS: Against other causes of parenchymal hyperechogenicity diagnosed on ultrasound scan such as periventricular leucomalacia or venous infarction--the long term prognosis of cerebral infarction, if the child survives, is usually good in the premature neonate.

Cerebral Infarction↗
PubMed1996

[Hypoxic-ischemic encephalopathy of the full term newborn. Contribution of the electroencephalogram and trans-fontanelle echography to the prognostic evaluation. Report of 29 cases].

This study was aimed at assessing by EEG recording and cranial imaging the cerebral function of 29 full term newborns presenting with hypoxic-ischemic encephalopathy and at establishing a correlation between the results and the neurological outcome. A correlation between the Sarnar's classification and the neurological outcome was observed, except for the intermediate grade. In this case, impairment of the EEG was variable and neurological prognosis was sometimes evidenced by cranial imaging. Unfavorable neurological outcome occurred when thalamic lesions were present, independently of clinical signs and EEG abnormalities.

Brain Ischemia↗
PubMed1994

The use of evoked potentials in the neonatal intensive care unit.

The data reported in the literature and our own findings have shown, that evoked potentials (EPs) can be performed at the bedside and provide additional information about the integrity of the central nervous system. Auditory brainstem responses (ABRs) are especially useful for early identification of audiological problems and whenever possible, at risk newborn infants (table II) should be screened using either ABRs or other methods like the otoacoustic emission before discharge. ABRs appear to be less useful in predicting neurological impairment, especially in the preterm infant. Visual evoked potentials (VEPs) can easily be performed at the bedside and are of predictive value for both neurological and visual outcome in the fullterm infant with hypoxic ischaemic encephalopathy (HIE) and the preterm infant in whom the cysts extend into the deep white matter. VEPs will help to identify at an early stage those infants who will suffer severe visual impairment being cortically mediated. Somatosensory evoked potentials (SEPs) are the most difficult to perform of the EPs, but adapting filter settings and stimulation rate it is also possible to obtain responses following stimulation of both the median and posterior tibial nerve. Median nerve SEPs are of predictive value in the fullterm infant with HIE with regard to neurodevelopmental outcome. In the preterm infant however, the predictive value is not so good for the median nerve and more data are needed to assess the predictive value of the posterior tibial nerve SEP.

Evoked Potentials↗
PubMed1993

Prognostic value of early somatosensory evoked potentials in neonates with cystic leukomalacia.

Somatosensory evoked potentials (SEPs) were performed between 31 and 49 weeks postmenstrual age on 33 neonates with extensive cystic leukomalacia. 27 had periventricular leukomalacia (PVL), while six had deep white matter lesions. All but two of the 27 infants with PVL had a reproducible potential at discharge, being delayed in 11 and within the normal range in 14. No potentials could be obtained in any of the infants with cysts in the deep white matter. All surviving infants developed severe neurological sequelae, irrespective of the N1 being delayed or within normal range. These data suggest that in infants with an ultrasound diagnosis of cystic leukomalacia, little additional information with regard to neurodevelopmental outcome is provided by performing median nerve SEPs, especially for those infants in whom the cystic lesions are restricted to the occipital periventricular white matter.

Brain↗
PubMed1993

[Recurrent cutaneous herpes in the newborn and acyclovir].

The authors report two cases of cutaneous recurrent herpes occurring after a neonatal herpes simplex virus type 2 (HSV2) infection and comment on the role of acute or suppressive therapy by aciclovir (ACV). The two infants were not treated by ACV after the neonatal period. None of the recurrent cutaneous herpes episodes was followed by viral widespread. One case reported by Bergström et al on a relapse of HSV2 encephalitis occurring after a cutaneous herpes in a child argues for the use of ACV in recurrent herpes. However, ACV might alter host defense response to HSV2 infection in neonates and children. Thus, it seems not yet recommended to use ACV either as acute or suppressive therapy in recurrent cutaneous herpes unless a progression of the viral disease is noted.

Acyclovir↗