Anne Ego - Profile on Academia.edu (original) (raw)

Papers by Anne Ego

041 Impact of perinatal care network improvement program on post-partum hemorrhage-related morbidity

BMJ Quality & Safety, 2010

Introduction Post-partum haemorrhage (PPH) remains the leading cause of maternal morbidity and mo... more Introduction Post-partum haemorrhage (PPH) remains the leading cause of maternal morbidity and mortality in France and worldwide. PPH can occur in any parturient. Perinatal care network is defined as a practioners’ and women's hospitals’ association organising mother and child management around the birth period. The aim of our medical practice improvement program (MPIP) was to standardise the management of PPH in every women hospital of the network according to the French guidelines.1 The aim of the study was to measure the impact of the MPIP on PPH-related morbidity.2 Program The MPIP created a common management guideline and critical care chart resulting from the chart of each of the 11 low risk women's hospitals. These guidelines included initial aggressive and timed management of the uterine tone, vascular and coagulation resuscitation. The critical care chart included three sections: the first one was the graduated timed common chart (poster and verso of the data collection paper support); the second is the intensive care data collection paper support; the third one is the prevention chart poster for high risk patients. Five training teams performed educational program for midwives, paramedics and medical doctors. Impact of the MPIP was measured by the haemorrhage-related morbidity of the transferred patients in 2006 after MPIP versus 2004 before MPIP. Collected data was the adequacy of the management to the protocol and PPH-related morbidity indicators. Results The results are described in Abstract 041 table 1. Despite the limited number of cases, it can be observed a trend for better detection of PPH (0.88% to 1.25%) and for better and more rapid management of PPH in the primary care units. When PPH became so severe that ICU transfer is indicated, no more hemorrhagic shock had been noted after MPIP. Red blood cells transfusion, procoagulant treatment and embolisation are less required in the tertiary care unit leading to quicker discharge from obstetrics ICU. Abstract 041 Table 1 Comparison of the severe PPH management and related morbidity before and afer MPIP 2004 before MPIP 2006 after MPIP p Deliveries (Low risk) 21373 20 619 NA PPH 189 259 0.26 Transfer to obstetrics ICU 16 13 0.004 Transfer delay (min) 205 (90–300) 158 (60–270) 0.001 Haemorrhagic shock 5 0 0.001 Transfusion 5 2 0.05 Procoagulant complement 9 4 0.10 Uterine A embolisation 7 2 0.26 Discharge after 12 h from the obstetrics ICU 11/16 12/13 NS Improving the obstetrics care at the nearest of the patient could be the new challenge for maternal risk management as suspected in ICM and FIGO joint guidelines3 and in the French perinatal networks study.4 Intractable obstetrics haemorrhage mortality can be reduced by a tertiary care safety programimproving management of patients at high risk of HPP.5 Any delay or indecision in PPH primary care management contributes to the severity of the disease and to maternal morbidity, despite adequate secondary obstetrics ICU. Perinatal networks training programs are of interest in the primary units. Egypt's nationwide program for safe motherhood in the 1990’s reversed the regional situations of substandard care and reduced the maternal mortality by 52% in these areas.6 On the perinatal care network scale, Medical Practice Improvement Program leading to an initial aggressive management of PPH could avoid the evolution to severe maternal morbidity. It could be a public health project in developed as well as in developing countries. Introduction L'hémorragie du post-partum (HPP) est la première cause de mort matenelle en France et dans le monde. Elle peut survenir chez toute parturiente même considérée comme à bas risque obstétrical. Les réseaux de soins périnatals regroupent les professionnels en charge de la santé de la mère et de l'enfant. L'objectif du programme d'EPP décrit était l'amélioration de la prise en charge des HPP dans le réseau périnatal OMBREL Nord France en référentiel aux RPC françaises et la mesure de son impact sur la morbidité maternelle.1 Le programme d'EPP comprenait la création d'un protocole de soins commun aux 11 maternités et de trois documents: une affiche, une feuille de réanimation et un document de prévention. Le protocole de soins basé sur une PEC agressive de l'atonie utérine et de la réanimation maternelle était chronométré. Cinq équipes de formateurs diffusaient ces documents au cours d'un programme éducatif qui concernait les sages-femmes, médecins et infirmières. L'impact de l'EPP était mesuré par l'évaluation de la PEC et de la morbidité chez les patientes transférrées pour HPP en unité de soins continus obstétricaux (USIO) en 2006 après l'EPP versus 2004 avant EPP.2 Résultats Les résultats sont décrits dans le Abstract 041 tableau 1. Malgré un nombre limité de patientes, sont observés une tendance à une meilleure détection de l'HPP (0.88% vs 1.25%) et une PEC plus souvent adéquate et plus rapide dans les…

Analyse d’une cohorte française d’encéphalopathies néonatales anoxo-ischémiques à l’ère de l’hypothermie thérapeutique: questions-réponses

Gynécologie obstétrique fertilité & sénologie, Feb 1, 2024

Variations in neonatal mortality of preterm infants with intraparenchymal haemorrhage in Europe: the EPICE cohort

Archives of disease in childhood. Fetal and neonatal edition, Jan 25, 2024

Research Square (Research Square), Jul 27, 2023

We evaluated the association between mechanical ventilation (MV) and secondary brain injury (SBI)... more We evaluated the association between mechanical ventilation (MV) and secondary brain injury (SBI) in infants with moderate neonatal encephalopathy (NE) under therapeutic hypothermia (TH) in the rst 72 hours of life. MV was not associated with SBISO. Hypotension was greater in the MV group, which had greater use of sedatives. The question of ventilation, therapeutic hypothermia (TH) and moderate NE remains unresolved in the literature and in current practice. Our study shows that Neonatal Intensive Care Units vary in their use of mechanical ventilation in infants with moderate neonatal encephalopathy. Mechanical ventilation does not appear to reduce the incidence of secondary brain injury, apart from hypotension, which is often associated with sedation.

Research Square (Research Square), Sep 7, 2022

Initiation of therapeutic hypothermia (TH) within 6 hr of life is a major concern for treating ne... more Initiation of therapeutic hypothermia (TH) within 6 hr of life is a major concern for treating neonatal hypoxic ischemic encephalopathy (HIE). We aimed to determine clinical and organizational factors associated with delayed TH in a French population-based cohort of neonates with moderate or severe HIE. Time to reach a rectal temperature of 34°C de nes optimal and delayed (within and > 6 hr) TH. Clinical and organizational factors associated with delayed TH were analysed among neonates born in cooling centres (CCs) and non-cooling centres (non-CCs). Among 629 neonates eligible for TH, 574 received treatment (91.3%). TH was delayed in 29.8% neonates and in 20.3% and 36.2% of those born in CCs and non-CCs, respectively. Neonates with moderate HIE were more exposed to delayed TH in both CCs and non-CCs. After adjustment for HIE severity, maternal and neonatal characteristics and circumstances of birth were not associated with increased risk of delayed TH. However, this risk was 2 to 5 times higher in maternities with < 1999 annual births, when the delay between birth and call for transfer (adjusted odds ratio [aOR] 2.47, 95% con dence interval [CI] [1.03 to 5.96]) or between call for transfer and admission (aOR 6.06, 95%CI [2.60 to 14.12]) was > 3 hr and when an undesirable event occurred during transfer (aOR 2.66, 95%CI [1.11 to 6.37]. Increasing early identi cation of neonates who could bene t from TH together with access to TH in non-CCs before transfer are modi able factors that could improve the care of neonates with HIE. International recommendations are to initiate therapeutic hypothermia before 6 hours of life in neonates with moderate or severe hypoxic ischemic encephalopathy. In this French population-based cohort of infants with hypoxic ischemic encephalopathy, nearly one third of neonates eligible for treatment did not have access to hypothermia in the therapeutic window of 6 hours of life. Rates of delayed therapeutic hypothermia > 6 hours were higher among neonates with less severe signs of neonatal asphyxia and moderate hypoxic ischemic encephalopathy and neonates born in a non-cooling center. Among infants born in non-cooling centers, organizational factors involved in delayed care were the small size of maternities (< 1999 annual births), a time interval of more than 3 hours between birth and call for transfer and between call for transfer and admission in neonatology, and the occurrence of an undesirable event during transfer.

BMC Pediatrics, May 8, 2020

Background: One major limitation for less invasive surfactant administration (LISA) is the diffic... more Background: One major limitation for less invasive surfactant administration (LISA) is the difficulty in providing sedation before this procedure and the competitive risk of respiratory depression versus avoidance of intubation for most sedative or analgesic drugs used in this context. The objective of this study is to compare the need for mechanical ventilation within 72 h of life following premedication with propofol, versus placebo (rescue with ketamine), for the LISA procedure in preterm neonates born before 32 weeks gestational age (wGA). Methods: ProLISA is a phase III, non-inferiority, multicenter, double blind, randomized, placebo controlled trial designed according to the SPIRIT Statement. Neonates born before 32 wGA in 12 geographically dispersed Neonatal Intensive Care Units in France needing surfactant will be included from September 2019 to September 2022. A sample of 542 patients is needed. The neonate is randomized to the intervention (propofol) or control placebo group. Open label rescue treatment with ketamine is possible in both groups if FANS (Faceless Acute Neonatal pain Scale) is ≥6. To guide drug administration, FANS is scored before attempting laryngoscopy. Once an adequate score has been obtained, LISA is performed according to a standardized protocol. The primary outcome is the need for mechanical ventilation within 72 h of life. Secondary outcomes are tolerance of the procedure, pain evaluation, hemodynamic and neurologic parameters after the intervention, morbidities before discharge and neurodevelopmental assessment at 2 years of age. Discussion: This paper describes the first multicenter, double-blind, randomized, placebo-controlled trial on this topic and will provide crucial information to support implementation of the LISA procedure.

Glycemia and Neonatal Encephalopathy: Outcomes in the LyTONEPAL (Long-Term Outcome of Neonatal Hypoxic EncePhALopathy in the Era of Neuroprotective Treatment With Hypothermia) Cohort

The Journal of Pediatrics, Jun 1, 2023

Healthcare organizational factors associated with delayed therapeutic hypothermia in neonatal hypoxic-ischemic encephalopathy: the LyTONEPAL cohort

European Journal of Pediatrics, Oct 21, 2022

Impact de l’âge gestationnel sur la fréquence et le type des lésions cérébrales des nouveau-nés atteints d’encéphalopathie anoxo-ischémique

Perfectionnement en Pédiatrie, Mar 1, 2022

Neuroprotection par hypothermie lors des encéphalopathies anoxo-ischémiques

Archives De Pediatrie, May 1, 2013

Pediatric Research, Nov 1, 2011

Background: Being born small for gestational age (SGA) is associated with developmental disabilit... more Background: Being born small for gestational age (SGA) is associated with developmental disabilities but associations may vary depending on the definition of SGA. To analyse the impact of this definition on the relation between SGA and cognitive or school outcome. Methods: 980 singletons born before 33 weeks in 1997 in France, part of the Epipage study, free of cerebral palsy, were classified SGA when birth weight was < 10 th percentile, according to 3 French standards: 1. neonatal standard: nSGA or nAGA; 2. intrauterine standard using Hadlock's formula: fSGA or fAGA; 3. customised standard taking into account maternal characteristics: cSGA or cAGA. Outcomes were cognitive dysfunction at age 5 defined as a score < -1 SD for the term control group (K-ABC battery), and school difficulties at age 8. Results: 149 children were nSGA (15.2 %), 368 fSGA (37.6 %) and 378 (38.6 %) cSGA. All nSGA children were fSGA and cSGA. Cognitive dysfunction was present in 300 children (35.0 %) and school difficulties in 173 (25.1 %). Children nAGA/fSGA did not have a significant increase of cognitive dysfunction compared to children nAGA/fAGA. Compared to children nAGA/fAGA, children nSGA/fSGA had an adjusted OR of school difficulties of 2.48 [1.52;4.05] while it was 1. 63 [1.05;2.55] for children nAGA/fSGA. Children fAGA/cSGA (N=18) had a higher rate of school difficulties compared to children fAGA/cAGA (p=0.03). Intratuerine standard for birth weight is more appropriate than neonatal one to predict school outcome for very preterm singletons. The utility of customisation should be clarified.

Archives De Pediatrie, Sep 1, 2017

Recommandations pour la prise en charge de l'infection par le virus de l'hépatite C chez les usag... more Recommandations pour la prise en charge de l'infection par le virus de l'hépatite C chez les usagers de drogues injeactables

Risk factors for unfavorable outcome at discharge of newborns with hypoxic-ischemic encephalopathy in the era of hypothermia

Pediatric Research, Oct 22, 2022

Cerebral injuries in neonatal encephalopathy treated with hypothermia: French LyTONEPAL cohort

Pediatric Research, Nov 20, 2021

Hypothermia is widely used for infants with hypoxic–ischemic neonatal encephalopathy but its impa... more Hypothermia is widely used for infants with hypoxic–ischemic neonatal encephalopathy but its impact remains poorly described at a population level. We aimed to describe brain imaging in infants born at ≥36 weeks’ gestation, with moderate/severe encephalopathy treated with hypothermia. Descriptive analysis of brain MRI and discharge neurological examination for infants included in the French national multicentric prospective observational cohort LyTONEPAL. Among 575 eligible infants, 479 (83.3%) with MRI before 12 days of life were included. MRI was normal for 48.2% (95% CI 43.7–52.8). Among infants with brain injuries, 62.5% (95% CI 56.2–68.5) had damage to more than one structure, 19.8% (95% CI 15.0–25.3) showed a pattern-associating injuries of basal ganglia/thalami (BGT), white matter (WM) and cortex. Overall, 68.4% (95% CI 62.0–74.3) of infants with normal MRI survived with a normal neurological examination. The rate of death was 15.4% (95% CI 12.3–19.0), predominantly for infants with the combined BGT, cortex, and/or WM injuries. Among infants with neonatal encephalopathy treated with hypothermia, two-thirds of those with normal MRI survived with a normal neurological examination at discharge. When present, brain injuries often involved more than one structure. The trial was registered at ClinicalTrials.gov (NCT02676063). In this multicentric cohort of infants with neonatal encephalopathy (LYTONEPAL) two-thirds survived with normal MRI and neurological examination at discharge. In total, 10% of newborns showed a pattern associating injuries of the basal ganglia—thalami, white matter, and cortex, which was correlated with a high risk of death at discharge. The evolution of MRI techniques and sequences in the era of hypothermia calls for a revisiting of imaging protocol in neonatal encephalopathy, especially for the timing. The neurological examination did not give evidence of brain injuries, thus questioning the reproducibility of the clinical exam or the neonatal brain functionality. In this multicentric cohort of infants with neonatal encephalopathy (LYTONEPAL) two-thirds survived with normal MRI and neurological examination at discharge. In total, 10% of newborns showed a pattern associating injuries of the basal ganglia—thalami, white matter, and cortex, which was correlated with a high risk of death at discharge. The evolution of MRI techniques and sequences in the era of hypothermia calls for a revisiting of imaging protocol in neonatal encephalopathy, especially for the timing. The neurological examination did not give evidence of brain injuries, thus questioning the reproducibility of the clinical exam or the neonatal brain functionality.

Infarctus cérébral artériel à révélation néonatale (grande prématurité exclue) : pourquoi des recommandations ?

Archives De Pediatrie, Sep 1, 2014

S. Chabriera, C. Vuillerota,b, A. Égoa,c, T. Debillona,c,d,*, Au nom du Comité de Rédaction des R... more S. Chabriera, C. Vuillerota,b, A. Égoa,c, T. Debillona,c,d,*, Au nom du Comité de Rédaction des Recommandations a Centre national de référence de l’AVC de l’enfant, hôpital Bellevue, CHU de Saint-Étienne, 42055 Saint-Étienne cedex 2, France b Service central de rééducation pédiatrique, hôpital Femme-Mère-Enfant, hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron cedex, France c TIMC-Imag UMR 5525, université Grenoble Alpes, 38000 Grenoble, France d Clinique universitaire de médecine néonatale et réanimation pédiatrique, CHU de Grenoble, CS217, 38043 Grenoble cedex, France Disponible en ligne sur

Developmental Medicine & Child Neurology, Aug 18, 2017

Propofol for sedation during less invasive surfactant administration in preterm infants

Archives of Disease in Childhood-fetal and Neonatal Edition, May 8, 2017

Less invasive surfactant administration (LISA) in preterm infants with respiratory distress syndr... more Less invasive surfactant administration (LISA) in preterm infants with respiratory distress syndrome avoids mechanical ventilation and may further reduce the risk of death or bronchopulmonary dysplasia.1 A recent European survey indicates that the percentage of centres using LISA increased, but with wide variation in procedure. In particular, there is no consensus about whether sedation should be used.2 International guidelines recommend sedation for intubation but it can hamper spontaneous breathing, which is necessary for LISA. Recently, a study compared two groups …

PLOS ONE, Dec 31, 2013

The objective of this study was to describe the French practice of hypothermia treatment (HT) in ... more The objective of this study was to describe the French practice of hypothermia treatment (HT) in full-term newborns with hypoxic-ischemic encephalopathy (HIE) and to analyze the deviations from the guidelines of the French Society of Neonatology. Materials and Methods: From May 2010 to March 2012 we recorded all cases of HIE treated by HT in a French national database. The population was divided into three groups, "optimal HT" (OHT), ''late HT'' (LHT) and ''non-indicated'' HT (NIHT), according to the guidelines. Results: Of the 311 newborns registered in the database and having HT, 65% were classified in the OHT group, 22% and 13% in the LHT and NIHT groups respectively. The severity of asphyxia and HIE were comparable between newborns with OHT and LHT, apart from EEG. HT was initiated at a mean time of 12 hours of life in the LHT group. An acute obstetrical event was more likely to be identified among newborns with LHT (46%), compared to OHT (34%) and NIHT (22%). There was a gradation in the rate of complications from the NIHT group (29%) to the LHT (38%) group and the OHT group (52%). Despite an insignificant difference in the rates of death or abnormal neurological examination at discharge, nearly 60% of newborns in the OHT group had an MRI showing abnormalities, compared to 44% and 49% in the LHT and NIHT groups respectively. The conduct of the HT for HIE newborns is not consistent with French guidelines for 35% of newborns, 22% being explained by an excessive delay in the start of HT, 13% by the lack of adherence to the clinical indications. This first report illustrates the difficulties in implementing guidelines for HT and should argue for an optimization of perinatal care for HIE.

Obstetrics & Gynecology, 2016

To investigate the association of the cause of preterm birth on in-hospital mortality of preterm ... more To investigate the association of the cause of preterm birth on in-hospital mortality of preterm neonates born from 24 to 34 weeks of gestation. METHODS: L'Etude e ´pide ´miologique sur les petits a ˆges gestationnels (EPIPAGE)-2 is a prospective, nation-wide, population-based cohort of very preterm births. After dividing causes of preterm birth into six mutually exclusive groups, we analyzed the association of each cause with in-hospital deaths of preterm neonates born alive with adjustment for organizational, maternal, and obstetric factors.

PLOS ONE, Apr 4, 2019

To determine whether there is an association between severe intraventricular hemorrhage and early... more To determine whether there is an association between severe intraventricular hemorrhage and early extubation in preterm infants born before 29 weeks of gestational age and intubated at birth. This study included 1587 preterm infants from a nationwide French population cohort (EPI-PAGE-2). Secondary data on intubated preterm infants were analyzed. After gestational age and propensity score matching (1:1) we built two comparable groups: an early extubation group and a delayed extubation group. Each neonate in one group was paired with a neonate in the other group having the same propensity score and gestational age. Early extubation was defined as extubation within 48 hours of life. Severe intraventricular hemorrhages were defined as grade III or IV hemorrhages according to the Papile classification. After matching, there were 398 neonates in each group. Using a generalized estimating equation model, we found that intraventricular hemorrhage was not associated with early extubation (adjusted OR 0.9, 95%CI 0.6-1.4). This result was supported by sensitivity analyses.