Anne Ego - Academia.edu (original) (raw)
Papers by Anne Ego
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…
Gynécologie obstétrique fertilité & sénologie, Feb 1, 2024
Archives of disease in childhood. Fetal and neonatal edition, Jan 25, 2024
Research Square (Research Square), Jul 27, 2023
Research Square (Research Square), Sep 7, 2022
BMC Pediatrics, May 8, 2020
The Journal of Pediatrics, Jun 1, 2023
European Journal of Pediatrics, Oct 21, 2022
Perfectionnement en Pédiatrie, Mar 1, 2022
Archives De Pediatrie, May 1, 2013
Pediatric Research, Nov 1, 2011
Archives De Pediatrie, Sep 1, 2017
Pediatric Research, Oct 22, 2022
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.
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
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 …
Obstetrics & Gynecology, 2016
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…
Gynécologie obstétrique fertilité & sénologie, Feb 1, 2024
Archives of disease in childhood. Fetal and neonatal edition, Jan 25, 2024
Research Square (Research Square), Jul 27, 2023
Research Square (Research Square), Sep 7, 2022
BMC Pediatrics, May 8, 2020
The Journal of Pediatrics, Jun 1, 2023
European Journal of Pediatrics, Oct 21, 2022
Perfectionnement en Pédiatrie, Mar 1, 2022
Archives De Pediatrie, May 1, 2013
Pediatric Research, Nov 1, 2011
Archives De Pediatrie, Sep 1, 2017
Pediatric Research, Oct 22, 2022
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.
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
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 …
Obstetrics & Gynecology, 2016