Laurent Tauzin - Academia.edu (original) (raw)
Papers by Laurent Tauzin
Archives de Pédiatrie, 2004
Les solutions antiseptiques sont couramment utilisées pour la désinfection cutanée mais ne sont p... more Les solutions antiseptiques sont couramment utilisées pour la désinfection cutanée mais ne sont pas dépourvues d'effets secondaires. Chez l'enfant prématuré, l'application de certaines solutions antiseptiques peut entraîner des brûlures sévères. Nous rapportons le cas d'un nouveau-né prématuré ayant présenté à 35 semaines d'âge corrigé des brûlures étendues après utilisation accidentelle de serviettes antiseptiques contenant de l'isopropanol, au cours de toilettes effectuées par sa mère dans l'unité de néonatologie. Les lésions ont évolué vers un décollement cutané généralisé, entraînant le décès de l'enfant. L'intoxication à l'isopropanol par voie transcutanée a déjà été décrite chez le nouveau-né et le nourrisson. Sa toxicité l'a exclu de la composition des solutions antiseptiques couramment utilisées en néonatologie. Cependant, l'isopropanol est encore présent dans de nombreux produits ménagers ou cosmétiques, et son effet potentiellement toxique pour les enfants n'est pas clairement signalé. Il serait souhaitable qu'une mention « produit toxique chez l'enfant et le nouveau-né » figure sur les produits contenant de l'isopropanol accessibles au grand public. À titre individuel, les professionnels de santé pourraient également informer les parents quant aux risques potentiels d'intoxication du nouveau-né par voie transcutanée.
Acta Paediatrica, 2012
Sir, In their retrospective study, Laurent Tauzin et al. (1) were able to demonstrate that a pers... more Sir, In their retrospective study, Laurent Tauzin et al. (1) were able to demonstrate that a persistent PDA (pPDA) had no significant effects in 177 VLBW infants born at ‡25 weeks’ gestational age with regard to mortality rate and major morbidities (the rate of necrotizing enterocolitis, intraventricular haemorrhage grades I–II and III–IV, periventricular leucomalacia, late-onset infections and pathological hearing screening). However, it is important to note that many of these outcomes occurred more frequently in the pPDA group (e.g. mortality 21% vs. 9%); moreover, and contrary to what is stated in the abstract section, the rate of bronchopulmonary dysplasia was significantly higher in the pPDA group (p = 0.01) (1). The presented results are somewhat in line with a recently published leading article by Dr W. E. Benitz, suggesting to employ interventions aimed at closing a patent ductus arteriosus (PDA) in preterm neonates restrictively (2). In accordance with the work presented by Tauzin et al., I do agree that indiscriminative efforts aimed at closing a PDA (be it pharmacologically or surgically) in very and extremely preterm infants should be abandoned, given the possible potent side effects associated with this approach. Based on my clinical experience, the decision to treat or not treat a PDA is made for each infant individually, based foremost on clinical grounds and on serial echocardiographic studies. Unfortunately, Tauzin et al. fail to provide the reader with some important clinical ⁄ echocardiographic data, that is, ‘What was the size of the PDA prior to medical intervention (COX inhibitor, ibuprofen), and what was the size of the pPDA after that intervention?’ These data are most crucial as the real and clinically important question seems to be How to change a haemodynamically relevant PDA into a PDA that does not compromise the infant¢s circulation (either decreased in size or fully closed)? Also, it is very important to be aware of the fact that assessment of a PDA in a preterm constitutes a dynamic endeavour rather than a static process. Clinical reasons that favour active treatment include low blood pressure requiring use of inotropes ⁄ vasopressors; oliguria requiring use of diuretics; respiratory failure secondary to pulmonary oedema leading to increased oxygen requirements and feeding intolerance requiring prolonged use of parenteral nutrition, given that these complications can be attributed to a haemodynamically relevant PDA (which I do admit can be a difficult task). These clinical findings are corroborated by serial echocardiographic studies demonstrating increased left atrium ⁄ aortic ratio, size of PDA and haemodynamic compromise of the systemic circulation (pathological diastolic flow in middle cerebral artery, and mesenteric and renal artery). It is important to perform serial echocardiography to demonstrate changes over time as demonstrated by O¢Rourke et al. (3). Of note, in their study, serial echocardiographic assessment allowed significantly earlier identification and treatment of PDA versus awaiting the evolution of clinical signs. Moreover, and of importance, severe intraventricular haemorrhage and ventilator days were significantly decreased after introduction of echocardiography (3). Moreover, the use of various biomarkers (BNP and Nterminal pro-BNP) may be promising diagnostic tools in the assessment of the significance of PDA (4). Hence, it is prudent to reserve treatment of PDA and pPDA to infants with clinically significant ductus on the basis of the clinical status complemented by serial echocardiography and to individualize the decision to treat. By using this individual approach that takes into consideration a bundle of information gathered at the bedside, we will be able to provide the vulnerable preterm infant with adequate treatment, thus avoiding unnecessary complications and excessive morbidity as seen in the study by Tauzin et al. (1).
Acta Paediatrica, 2012
Because New Caledonia is geographically isolated from the nearest cardiac surgical centre, surgic... more Because New Caledonia is geographically isolated from the nearest cardiac surgical centre, surgical closure of ductus arteriosus is not performed in very low-birthweight (VLBW) infants who have a persistent patent ductus in spite of having undergone treatment with ibuprofen. This study aimed at investigating the possible effect of persistent patent ductus in VLBW infants. The study included 177 VLBW infants born at 25-31 weeks of gestation from January 2006 to May 2011. Mortality and major morbidities were compared between infants with a persistent patent ductus (n = 33) and those without it (n = 104). Statistical associations between potential neonatal risk factors and significant morbidities were identified using multivariate regression analyses. Rates of mortality and major morbidities, including the rate of bronchopulmonary dysplasia, necrotizing enterocolitis, intraventricular haemorrhage grades I-II and III-IV, periventricular leucomalacia, late-onset infections and failure of hearing screening, were insignificantly higher in VLBW infants with a persistent patent ductus than in those without it. This study adds further evidence that persistent patent ductus arteriosus has no significant effect on mortality and morbidity in VLBW infants born at ≥25 weeks' gestational age.
Acta Paediatrica, 2013
The use of plain radiographs provides limited information on the placement of peripherally insert... more The use of plain radiographs provides limited information on the placement of peripherally inserted central catheters (PICCs). Moreover, changes in upper extremity positioning cause migration of the catheters in neonates. This study aimed to investigate the use of echocardiography for determining catheter tip position, compared with plain radiographs, in low birthweight (LBW) infants in a tertiary neonatal intensive care unit. The study examined the placement of 109 catheters in 89 infants born between September 2010 and December 2012. The placement of these catheters was controlled by echocardiography, with the patient's shoulder in adduction and the elbow in flexion. The number of catheter tips, echocardiographically identified within the heart, was expressed as a percentage of the total catheters deemed to be well positioned on plain radiographs. The number of catheter tips that were echocardiographically identified within the heart was significant (25%, p < 0.001). Twenty-three catheters were repositioned to be outside of the heart, without any complications. This study demonstrated the value of echocardiography for identifying the positioning of catheter tips in LBW infants. Echocardiography, coupled with initial plain radiographs, should be the gold standard for assessing PICC tip positions in those infants.
Journal of Adolescent Health, 2011
Recent studies show that low birth weight infants are at a risk of increased arterial blood press... more Recent studies show that low birth weight infants are at a risk of increased arterial blood pressure (BP) in adulthood. This study aimed to distinguish the influence of low birth weight either as a result of fetal growth restriction or preterm birth on arterial properties in adolescents. Methods: The effect of low birth weight on BP and arterial stiffness was examined among 90 adolescents aged 14 years who were either born at term with an appropriate birth weight for gestational age (controls, n ϭ 41); born preterm with an appropriate birth weight for gestational age (n ϭ 25); or born at term and small for gestational age (SGA) (n ϭ 24). The pulse wave velocity between the carotid and radial arteries was measured to assess arterial stiffness. Results: As compared with control subjects, adolescents born with low birth weight as a result of preterm birth were found to have increased systolic BP and carotid-radial pulse wave velocity (117 Ϯ 11 mm Hg vs. 123 Ϯ 11 mm Hg, p ϭ .04 and 7.0 Ϯ .9 m/s vs. 7.7 Ϯ 1.0 m/s, p ϭ .01, respectively), whereas those who were born at term and SGA exhibited values similar to the controls (114 Ϯ 15 mm Hg and 6.8 Ϯ .9 m/s). Conclusion: Preterm birth, rather than being SGA at term, increases BP and arterial stiffness in adolescents.
Introduction : plusieurs etudes epidemiologiques ont montre que le petit poids de naissance pourr... more Introduction : plusieurs etudes epidemiologiques ont montre que le petit poids de naissance pourrait jouer un role promoteur de l'hypertension arterielle a l'âge adulte. Cependant les roles respectifs du retard de croissance intra-uterin et de la prematurite demeurent mal determines. Objectifs: comparer les profils de pression arterielle (PA) et de rigidite arterielle d'adolescents nes soit prematurement et eutrophiques (groupe 1 ; n = 25), soit nes a terme et hypotrophiques (groupe 2 ; n = 24), soit a terme et eutrophiques (groupe 3 ; n = 41). Methodologie : la pression arterielle systemique a ete mesuree par methode automatique oscillometrique et la rigidite arterielle a ete evaluee par la mesure de la vitesse de l'onde de pouls (VOP) entre les arteres carotide et radiale. Resultats : 90 adolescents, âges de 13,9 ±1,2 ans, ont ete etudies. Les sujets du groupe 1 etaient nes a 33,6 ±1,5 semaines d'amenorrhee. Les PAS, PAM, PAD et la VOP etaient significativement...
un facteur de risque cardio-vasculaire majeur. L'évolution récente de sa fréquence, son début pré... more un facteur de risque cardio-vasculaire majeur. L'évolution récente de sa fréquence, son début précoce constituent une préoccupation majeure. En particulier, l'association d'un rebond précoce d'adiposité au développement ultérieur de l'obésité est établie. Il est remarquable de constater que, plus précocement encore, de nombreux évènements survenant au cours du développement pré-, per-et postnatal, sont susceptibles de déterminer le risque de troubles cardio-vasculaires et métaboliques graves à l'âge adulte. Ainsi, le retard de croissance intra-utérine (RCIU) et donc des facteurs nutritionnels prénatals, la nutiriton postnatale précoce, et même la prématurité se révèlent porteurs d'un rsique supplémentaire de conséquences à long terme. A côté du risque de troubles du développement neuro-psychique, qui constitue actuellement une préoccupation majeure, peut ainsi être pressenti un risque cardiovasculaire et métabolique susceptible de ne se révéler qu'à l'âge adulte.
Archives des maladies du coeur et des vaisseaux
We report the short and mid-term results of the Norwood procedure (Stage one) in 20 patients with... more We report the short and mid-term results of the Norwood procedure (Stage one) in 20 patients with hypoplastic left heart syndrome or univentricular heart with aortic obstruction. Seven patients were prenatally diagnosed. Preoperatively there was obstruction to pulmonary venous return in 6 cases, a mild to moderate tricuspid regurgitation in 6 cases, and 11 patients were supported by mechanical ventilation with multiorgan failure in 5 cases. The surgery was performed under cardiopulmonary bypass at a mean age and weight of 12.9 days and 3 kg, respectively. Nine patients (45%) died within 30 days postoperatively, whereas 5 had delayed sternal closure. The mean duration of mechanical ventilation and ICU stay were 5.7 and 11 days, respectively. Two patients were reoperated for bronchial compression and tracheotomy. Systemic venous thrombosis occurred in 5 patients. In multivariate analysis, an older age at surgery was correlated with postoperative hospital death (p = 0.03). Among the 11 patients discharged home after Stage one procedure, 5 patients underwent balloon dilation for recoarctation and one patient died at home. A bidirectional cavopulmonary anastomosis was performed in 8 patients at a mean age of 0.76 year, with one postoperative death. After a mean follow-up of 1 year (+/- 1.97 years), the 9 remaining patients are all in NYHA class I, at a mean age of 2.2 years. Their mean transcutaneous saturation is 81%. The Norwood procedure (Stage one) is associated with high hospital mortality. However, the functional status of the survivors is correct, like in patients with other type of univentricular hearts. Moreover, although the causes of death in our patients are often not clarified, other studies show that the leading causes of deaths in our patients are often not clarified, other studies show that the leading causes of death in those patients are correctable. In conclusion, the option of a Norwood procedure (Stage one) should be proposed in patients with hypoplastic left heart syndrome (or variant).
La Revue de Médecine Interne, 2004
Reçu le 3 mars 2003 ; accepté le 2 octobre 2003 Résumé Propos.-L'exploration de la circulation ar... more Reçu le 3 mars 2003 ; accepté le 2 octobre 2003 Résumé Propos.-L'exploration de la circulation artérielle par échographie-doppler demande une étude des surfaces artérielles et du flux pulsé artériel. Afin de vérifier la pertinence de ces mesures, nous avons étudié leurs variabilités intra-et interindividuelles. Méthodes.-Nous avons analysé la circulation artérielle humérale de 13 sujets sains par échographie BD couplée à une étude doppler, au moyen d'une sonde de 7,5 MHz, à 15 cm en amont de la fossette antécubitale. L'exploration BD a permis de mesurer la surface du vaisseau en systole et en diastole (SS et SD) par une coupe transversale avec une profondeur de 4 cm. Les vélocités maximales, minimales et moyennes (V max , V moy , V min) ainsi que l'intégrale temps vitesse (ITV) ont été mesurées sur le même site par doppler pulsé. Nous avons mesuré la pression artérielle (PAS et PAD) par méthode oscillométrique au niveau du bras. Nous avons déduit d'autres paramètres tels que le débit artériel (D), la compliance artérielle brachiale (C), les index de résistance et de pulsatilité (IR, IP). Chaque mesure a été répétée dans les mêmes conditions par le même puis par un second examinateur expérimenté. Résultats.-L'étude de variabilité intra-et interindividuelle selon la méthode statistique de Bland et Altman montre que les valeurs des coefficients de variation, des biais et des limites de concordances des mesures sont acceptables pour SS, SD, l'ITV, D, les vélocités maximales, moyennes et minimales, C, IR et IP. Conclusion.-L'échographie-doppler conventionnelle offre une méthode reproductible d'appréciation de la circulation artérielle périphérique.
La Revue de Médecine Interne, 2007
Propos.-Le retard de croissance intra-utérin et la prématurité peuvent favoriser la survenue de m... more Propos.-Le retard de croissance intra-utérin et la prématurité peuvent favoriser la survenue de maladies cardiovasculaires à l'âge adulte. Actualités et points forts.-La prématurité et le retard de croissance intra-utérin entraînent des modifications durables du développement d'organes comme le système artériel et les reins. Parmi celles-ci, des modifications structurales des artères de gros calibre à la naissance des enfants nés avec un faible poids, secondaires à la prématurité ou à un retard de croissance intra-utérin, pourraient conduire à une augmentation de la pression artérielle et de la rigidité artérielle à long terme. En l'état actuel, ces notions sont encore mal connues et nous semblent, d'une particulière importance compte tenu de la grande fréquence de la prématurité et du retard de croissance intra-utérin. Perspectives et projets.-L'identification de marqueurs cliniques et paracliniques, ainsi qu'une meilleure compréhension du lien pathogénique entre ces conditions périnatales et l'accroissement du risque cardiovasculaire à l'âge adulte sont susceptibles de faire émerger des actions de prévention des maladies cardiovasculaires dans cette population.
Acta paediatrica (Oslo, Norway : 1992), 2015
The aim of this review was to identify the underlying relationship between preterm birth and the ... more The aim of this review was to identify the underlying relationship between preterm birth and the development of cardiovascular diseases. Preterm birth significantly affects the elastin content and viscoelastic properties of the vascular extracellular matrix in human arteries. Inadequate elastin synthesis during early development may cause a permanent increase in arterial stiffness in adulthood. Early and permanent alterations in viscoelastic properties may lead to hypertension and cardiovascular disease development in adults born prematurely.
Journal of developmental origins of health and disease, 2014
Recent studies have shown that a low birth weight is a risk factor for increased systemic blood p... more Recent studies have shown that a low birth weight is a risk factor for increased systemic blood pressure (BP) in adulthood. Further, systemic BP and arterial stiffness (AS) are reported to be increased in adolescents born prematurely. The purpose of this study was to characterize systemic BP and AS in young adults born preterm. Systemic BP was measured using an automated oscillometric device. AS was assessed by measuring the right carotid-radial pulse wave velocity (PWV) using a validated non-invasive automated method. Systemic BP, pulse pressure, and PWV [mean (confidence intervals)] were compared between 16 adults (age 21 years) born preterm (age at birth 32 weeks of gestation) with a birth weight (1710 g) appropriate for their gestational age and 15 adults (21 years) born at term (40 weeks of gestation) with a birth weight (3430 g) appropriate for their gestational age. Adults born preterm had a significantly higher systolic BP [122 mmHg (114-144) v. 112 (106-127)], mean BP [89 m...
![Research paper thumbnail of [Impact of gestational age and birthweight on long-term cardiovascular health]](https://attachments.academia-assets.com/70361529/thumbnails/1.jpg)
](La Revue de médecine interne / fondée ... par la Société nationale francaise de médecine interne, 2007
Intra-uterine growth restriction and preterm birth can lead to cardiovascular diseases in adultho... more Intra-uterine growth restriction and preterm birth can lead to cardiovascular diseases in adulthood. Preterm birth and intra-uterine growth restriction induce long-term changes in organ development such as arterial system and kidney function. Among these changes, the impairment of arterial wall structure or properties occurring in low birth weight babies, as a result of preterm birth and intra-uterine growth restriction, may lead on a long-term to an elevation of arterial pressure and arterial stiffness. These notions are still not completely understood and seem of high importance in regard to the high frequency in preterm birth and intra-uterine growth restriction. Identifying clinical, paraclinical markers and better understanding a link between adverse perinatal conditions and cardiovascular diseases might improve actions for preventing cardiovascular diseases in adulthood in this population.
Archives de pédiatrie : organe officiel de la Sociéte française de pédiatrie, 2007
Archives des maladies du coeur et des vaisseaux
Recent studies show that low birth weight (LBW) infants are at risk of increased arterial blood p... more Recent studies show that low birth weight (LBW) infants are at risk of increased arterial blood pressure (BP) in adulthood. Previous work from our centre and others suggests that arterial stiffness (AS) is increased in such patients. However, the respective roles of preterm birth and of intrauterine growth restriction (IUGR) are unclear. To characterize AS and BP in adolescents who were: born at term with an appropriate birth weight for gestational age (GA) (group 1, n=41); born preterm with an appropriate birth weight for GA (group 2, n=25); born at term and small for GA (group 3, n=24). Systemic BP was measured with an automated oscillometric device. AS was assessed by measuring pulse wave velocity (PWV) between carotid and radial arteries. 90 adolescents were studied at a mean (SD) age of 13.9 (1.2) years. Subjects from group 2 were born with a 33.6 (1.5) GA. Systolic BP, mean BP, and PWV were significantly increased in group 2 subjects in comparison to both group 1 (123 +/- 11 v...
La Pediatria medica e chirurgica : Medical and surgical pediatrics
Several studies suggest that adverse events during foetal life can program cardiovascular disease... more Several studies suggest that adverse events during foetal life can program cardiovascular diseases in adulthood. Barker et al. identified a relationship between low birth weight and an increased risk of arterial hypertension, carotid arteriosclerosis, and mortality by coronary heart disease or stroke in adulthood. These findings led to the "foetal origins" hypothesis, which is that cardiovascular disease originates in the adaptations to an adverse intrauterine environment. Such adaptations may permanently alter the cardiovascular structure and physiology through the process of programming. Several factors, such as impaired foetal growth, premature birth or postnatal growth of low birth weight infants may be involved, but to which extent is still unclear.
Archives de pédiatrie : organe officiel de la Sociéte française de pédiatrie, 2004
Antiseptic solutions are commonly used for skin care but are not always safe. In preterm infants,... more Antiseptic solutions are commonly used for skin care but are not always safe. In preterm infants, application of antiseptic solutions can lead to serious burns. We report the case of a premature newborn who developed severe burns at 35 weeks post-conceptional age, after his mother used disposable antiseptic towels containing isopropyl alcohol for his skin care. Burns outcome led to diffuse skin burn and death of the baby. Several cases of isopropyl alcohol poisoning through skin absorption have been reported in neonate and infants. Because of its neonatal toxicity, isopropyl alcohol has been excluded from composition of antiseptic solutions commonly used in neonatology. However, isopropyl alcohol is still available in many housecleaning and cosmetic products, while its toxic effects in children are not clearly mentioned. A specific mention "toxic for infants and children" should appear on mass consumption products containing isopropyl alcohol. Moreover, health workers may ...
La Revue de médecine interne / fondée ... par la Société nationale francaise de médecine interne, 2004
Ultrasonography Doppler in the assessment of arterial peripheral circulation. The ultrasonography... more Ultrasonography Doppler in the assessment of arterial peripheral circulation. The ultrasonography-Doppler study of peripheral arterial circulation requires measurements of arterial area and arterial blood flow. The aim of this study was to assess their variabilities, intra- and interobserver. We studied brachial arterial circulation of 13 volunteers. Two experimented investigators carried out the examinations. Arterial blood pressure measurements were obtained at the level of the brachial artery of the left arm by means of a semi automated oscillometric device. The brachial artery was approached by ultrasound scan in semi-decubitus position, the arm in exterior rotation and abduction. Brachial artery cross-sectional areas were obtained by a transversal view with a depth of 4-15-cm upstream the antecubital fossa of the forearm. Cross sectional areas were measured at end diastole (SD) and end systole (SS). We measured maximal systolic and diastolic velocities (Vmax and Vmin), mean vel...
Journal of Developmental Origins of Health and Disease, 2015
Archives de Pédiatrie, 2004
Les solutions antiseptiques sont couramment utilisées pour la désinfection cutanée mais ne sont p... more Les solutions antiseptiques sont couramment utilisées pour la désinfection cutanée mais ne sont pas dépourvues d'effets secondaires. Chez l'enfant prématuré, l'application de certaines solutions antiseptiques peut entraîner des brûlures sévères. Nous rapportons le cas d'un nouveau-né prématuré ayant présenté à 35 semaines d'âge corrigé des brûlures étendues après utilisation accidentelle de serviettes antiseptiques contenant de l'isopropanol, au cours de toilettes effectuées par sa mère dans l'unité de néonatologie. Les lésions ont évolué vers un décollement cutané généralisé, entraînant le décès de l'enfant. L'intoxication à l'isopropanol par voie transcutanée a déjà été décrite chez le nouveau-né et le nourrisson. Sa toxicité l'a exclu de la composition des solutions antiseptiques couramment utilisées en néonatologie. Cependant, l'isopropanol est encore présent dans de nombreux produits ménagers ou cosmétiques, et son effet potentiellement toxique pour les enfants n'est pas clairement signalé. Il serait souhaitable qu'une mention « produit toxique chez l'enfant et le nouveau-né » figure sur les produits contenant de l'isopropanol accessibles au grand public. À titre individuel, les professionnels de santé pourraient également informer les parents quant aux risques potentiels d'intoxication du nouveau-né par voie transcutanée.
Acta Paediatrica, 2012
Sir, In their retrospective study, Laurent Tauzin et al. (1) were able to demonstrate that a pers... more Sir, In their retrospective study, Laurent Tauzin et al. (1) were able to demonstrate that a persistent PDA (pPDA) had no significant effects in 177 VLBW infants born at ‡25 weeks’ gestational age with regard to mortality rate and major morbidities (the rate of necrotizing enterocolitis, intraventricular haemorrhage grades I–II and III–IV, periventricular leucomalacia, late-onset infections and pathological hearing screening). However, it is important to note that many of these outcomes occurred more frequently in the pPDA group (e.g. mortality 21% vs. 9%); moreover, and contrary to what is stated in the abstract section, the rate of bronchopulmonary dysplasia was significantly higher in the pPDA group (p = 0.01) (1). The presented results are somewhat in line with a recently published leading article by Dr W. E. Benitz, suggesting to employ interventions aimed at closing a patent ductus arteriosus (PDA) in preterm neonates restrictively (2). In accordance with the work presented by Tauzin et al., I do agree that indiscriminative efforts aimed at closing a PDA (be it pharmacologically or surgically) in very and extremely preterm infants should be abandoned, given the possible potent side effects associated with this approach. Based on my clinical experience, the decision to treat or not treat a PDA is made for each infant individually, based foremost on clinical grounds and on serial echocardiographic studies. Unfortunately, Tauzin et al. fail to provide the reader with some important clinical ⁄ echocardiographic data, that is, ‘What was the size of the PDA prior to medical intervention (COX inhibitor, ibuprofen), and what was the size of the pPDA after that intervention?’ These data are most crucial as the real and clinically important question seems to be How to change a haemodynamically relevant PDA into a PDA that does not compromise the infant¢s circulation (either decreased in size or fully closed)? Also, it is very important to be aware of the fact that assessment of a PDA in a preterm constitutes a dynamic endeavour rather than a static process. Clinical reasons that favour active treatment include low blood pressure requiring use of inotropes ⁄ vasopressors; oliguria requiring use of diuretics; respiratory failure secondary to pulmonary oedema leading to increased oxygen requirements and feeding intolerance requiring prolonged use of parenteral nutrition, given that these complications can be attributed to a haemodynamically relevant PDA (which I do admit can be a difficult task). These clinical findings are corroborated by serial echocardiographic studies demonstrating increased left atrium ⁄ aortic ratio, size of PDA and haemodynamic compromise of the systemic circulation (pathological diastolic flow in middle cerebral artery, and mesenteric and renal artery). It is important to perform serial echocardiography to demonstrate changes over time as demonstrated by O¢Rourke et al. (3). Of note, in their study, serial echocardiographic assessment allowed significantly earlier identification and treatment of PDA versus awaiting the evolution of clinical signs. Moreover, and of importance, severe intraventricular haemorrhage and ventilator days were significantly decreased after introduction of echocardiography (3). Moreover, the use of various biomarkers (BNP and Nterminal pro-BNP) may be promising diagnostic tools in the assessment of the significance of PDA (4). Hence, it is prudent to reserve treatment of PDA and pPDA to infants with clinically significant ductus on the basis of the clinical status complemented by serial echocardiography and to individualize the decision to treat. By using this individual approach that takes into consideration a bundle of information gathered at the bedside, we will be able to provide the vulnerable preterm infant with adequate treatment, thus avoiding unnecessary complications and excessive morbidity as seen in the study by Tauzin et al. (1).
Acta Paediatrica, 2012
Because New Caledonia is geographically isolated from the nearest cardiac surgical centre, surgic... more Because New Caledonia is geographically isolated from the nearest cardiac surgical centre, surgical closure of ductus arteriosus is not performed in very low-birthweight (VLBW) infants who have a persistent patent ductus in spite of having undergone treatment with ibuprofen. This study aimed at investigating the possible effect of persistent patent ductus in VLBW infants. The study included 177 VLBW infants born at 25-31 weeks of gestation from January 2006 to May 2011. Mortality and major morbidities were compared between infants with a persistent patent ductus (n = 33) and those without it (n = 104). Statistical associations between potential neonatal risk factors and significant morbidities were identified using multivariate regression analyses. Rates of mortality and major morbidities, including the rate of bronchopulmonary dysplasia, necrotizing enterocolitis, intraventricular haemorrhage grades I-II and III-IV, periventricular leucomalacia, late-onset infections and failure of hearing screening, were insignificantly higher in VLBW infants with a persistent patent ductus than in those without it. This study adds further evidence that persistent patent ductus arteriosus has no significant effect on mortality and morbidity in VLBW infants born at ≥25 weeks' gestational age.
Acta Paediatrica, 2013
The use of plain radiographs provides limited information on the placement of peripherally insert... more The use of plain radiographs provides limited information on the placement of peripherally inserted central catheters (PICCs). Moreover, changes in upper extremity positioning cause migration of the catheters in neonates. This study aimed to investigate the use of echocardiography for determining catheter tip position, compared with plain radiographs, in low birthweight (LBW) infants in a tertiary neonatal intensive care unit. The study examined the placement of 109 catheters in 89 infants born between September 2010 and December 2012. The placement of these catheters was controlled by echocardiography, with the patient's shoulder in adduction and the elbow in flexion. The number of catheter tips, echocardiographically identified within the heart, was expressed as a percentage of the total catheters deemed to be well positioned on plain radiographs. The number of catheter tips that were echocardiographically identified within the heart was significant (25%, p < 0.001). Twenty-three catheters were repositioned to be outside of the heart, without any complications. This study demonstrated the value of echocardiography for identifying the positioning of catheter tips in LBW infants. Echocardiography, coupled with initial plain radiographs, should be the gold standard for assessing PICC tip positions in those infants.
Journal of Adolescent Health, 2011
Recent studies show that low birth weight infants are at a risk of increased arterial blood press... more Recent studies show that low birth weight infants are at a risk of increased arterial blood pressure (BP) in adulthood. This study aimed to distinguish the influence of low birth weight either as a result of fetal growth restriction or preterm birth on arterial properties in adolescents. Methods: The effect of low birth weight on BP and arterial stiffness was examined among 90 adolescents aged 14 years who were either born at term with an appropriate birth weight for gestational age (controls, n ϭ 41); born preterm with an appropriate birth weight for gestational age (n ϭ 25); or born at term and small for gestational age (SGA) (n ϭ 24). The pulse wave velocity between the carotid and radial arteries was measured to assess arterial stiffness. Results: As compared with control subjects, adolescents born with low birth weight as a result of preterm birth were found to have increased systolic BP and carotid-radial pulse wave velocity (117 Ϯ 11 mm Hg vs. 123 Ϯ 11 mm Hg, p ϭ .04 and 7.0 Ϯ .9 m/s vs. 7.7 Ϯ 1.0 m/s, p ϭ .01, respectively), whereas those who were born at term and SGA exhibited values similar to the controls (114 Ϯ 15 mm Hg and 6.8 Ϯ .9 m/s). Conclusion: Preterm birth, rather than being SGA at term, increases BP and arterial stiffness in adolescents.
Introduction : plusieurs etudes epidemiologiques ont montre que le petit poids de naissance pourr... more Introduction : plusieurs etudes epidemiologiques ont montre que le petit poids de naissance pourrait jouer un role promoteur de l'hypertension arterielle a l'âge adulte. Cependant les roles respectifs du retard de croissance intra-uterin et de la prematurite demeurent mal determines. Objectifs: comparer les profils de pression arterielle (PA) et de rigidite arterielle d'adolescents nes soit prematurement et eutrophiques (groupe 1 ; n = 25), soit nes a terme et hypotrophiques (groupe 2 ; n = 24), soit a terme et eutrophiques (groupe 3 ; n = 41). Methodologie : la pression arterielle systemique a ete mesuree par methode automatique oscillometrique et la rigidite arterielle a ete evaluee par la mesure de la vitesse de l'onde de pouls (VOP) entre les arteres carotide et radiale. Resultats : 90 adolescents, âges de 13,9 ±1,2 ans, ont ete etudies. Les sujets du groupe 1 etaient nes a 33,6 ±1,5 semaines d'amenorrhee. Les PAS, PAM, PAD et la VOP etaient significativement...
un facteur de risque cardio-vasculaire majeur. L'évolution récente de sa fréquence, son début pré... more un facteur de risque cardio-vasculaire majeur. L'évolution récente de sa fréquence, son début précoce constituent une préoccupation majeure. En particulier, l'association d'un rebond précoce d'adiposité au développement ultérieur de l'obésité est établie. Il est remarquable de constater que, plus précocement encore, de nombreux évènements survenant au cours du développement pré-, per-et postnatal, sont susceptibles de déterminer le risque de troubles cardio-vasculaires et métaboliques graves à l'âge adulte. Ainsi, le retard de croissance intra-utérine (RCIU) et donc des facteurs nutritionnels prénatals, la nutiriton postnatale précoce, et même la prématurité se révèlent porteurs d'un rsique supplémentaire de conséquences à long terme. A côté du risque de troubles du développement neuro-psychique, qui constitue actuellement une préoccupation majeure, peut ainsi être pressenti un risque cardiovasculaire et métabolique susceptible de ne se révéler qu'à l'âge adulte.
Archives des maladies du coeur et des vaisseaux
We report the short and mid-term results of the Norwood procedure (Stage one) in 20 patients with... more We report the short and mid-term results of the Norwood procedure (Stage one) in 20 patients with hypoplastic left heart syndrome or univentricular heart with aortic obstruction. Seven patients were prenatally diagnosed. Preoperatively there was obstruction to pulmonary venous return in 6 cases, a mild to moderate tricuspid regurgitation in 6 cases, and 11 patients were supported by mechanical ventilation with multiorgan failure in 5 cases. The surgery was performed under cardiopulmonary bypass at a mean age and weight of 12.9 days and 3 kg, respectively. Nine patients (45%) died within 30 days postoperatively, whereas 5 had delayed sternal closure. The mean duration of mechanical ventilation and ICU stay were 5.7 and 11 days, respectively. Two patients were reoperated for bronchial compression and tracheotomy. Systemic venous thrombosis occurred in 5 patients. In multivariate analysis, an older age at surgery was correlated with postoperative hospital death (p = 0.03). Among the 11 patients discharged home after Stage one procedure, 5 patients underwent balloon dilation for recoarctation and one patient died at home. A bidirectional cavopulmonary anastomosis was performed in 8 patients at a mean age of 0.76 year, with one postoperative death. After a mean follow-up of 1 year (+/- 1.97 years), the 9 remaining patients are all in NYHA class I, at a mean age of 2.2 years. Their mean transcutaneous saturation is 81%. The Norwood procedure (Stage one) is associated with high hospital mortality. However, the functional status of the survivors is correct, like in patients with other type of univentricular hearts. Moreover, although the causes of death in our patients are often not clarified, other studies show that the leading causes of deaths in our patients are often not clarified, other studies show that the leading causes of death in those patients are correctable. In conclusion, the option of a Norwood procedure (Stage one) should be proposed in patients with hypoplastic left heart syndrome (or variant).
La Revue de Médecine Interne, 2004
Reçu le 3 mars 2003 ; accepté le 2 octobre 2003 Résumé Propos.-L'exploration de la circulation ar... more Reçu le 3 mars 2003 ; accepté le 2 octobre 2003 Résumé Propos.-L'exploration de la circulation artérielle par échographie-doppler demande une étude des surfaces artérielles et du flux pulsé artériel. Afin de vérifier la pertinence de ces mesures, nous avons étudié leurs variabilités intra-et interindividuelles. Méthodes.-Nous avons analysé la circulation artérielle humérale de 13 sujets sains par échographie BD couplée à une étude doppler, au moyen d'une sonde de 7,5 MHz, à 15 cm en amont de la fossette antécubitale. L'exploration BD a permis de mesurer la surface du vaisseau en systole et en diastole (SS et SD) par une coupe transversale avec une profondeur de 4 cm. Les vélocités maximales, minimales et moyennes (V max , V moy , V min) ainsi que l'intégrale temps vitesse (ITV) ont été mesurées sur le même site par doppler pulsé. Nous avons mesuré la pression artérielle (PAS et PAD) par méthode oscillométrique au niveau du bras. Nous avons déduit d'autres paramètres tels que le débit artériel (D), la compliance artérielle brachiale (C), les index de résistance et de pulsatilité (IR, IP). Chaque mesure a été répétée dans les mêmes conditions par le même puis par un second examinateur expérimenté. Résultats.-L'étude de variabilité intra-et interindividuelle selon la méthode statistique de Bland et Altman montre que les valeurs des coefficients de variation, des biais et des limites de concordances des mesures sont acceptables pour SS, SD, l'ITV, D, les vélocités maximales, moyennes et minimales, C, IR et IP. Conclusion.-L'échographie-doppler conventionnelle offre une méthode reproductible d'appréciation de la circulation artérielle périphérique.
La Revue de Médecine Interne, 2007
Propos.-Le retard de croissance intra-utérin et la prématurité peuvent favoriser la survenue de m... more Propos.-Le retard de croissance intra-utérin et la prématurité peuvent favoriser la survenue de maladies cardiovasculaires à l'âge adulte. Actualités et points forts.-La prématurité et le retard de croissance intra-utérin entraînent des modifications durables du développement d'organes comme le système artériel et les reins. Parmi celles-ci, des modifications structurales des artères de gros calibre à la naissance des enfants nés avec un faible poids, secondaires à la prématurité ou à un retard de croissance intra-utérin, pourraient conduire à une augmentation de la pression artérielle et de la rigidité artérielle à long terme. En l'état actuel, ces notions sont encore mal connues et nous semblent, d'une particulière importance compte tenu de la grande fréquence de la prématurité et du retard de croissance intra-utérin. Perspectives et projets.-L'identification de marqueurs cliniques et paracliniques, ainsi qu'une meilleure compréhension du lien pathogénique entre ces conditions périnatales et l'accroissement du risque cardiovasculaire à l'âge adulte sont susceptibles de faire émerger des actions de prévention des maladies cardiovasculaires dans cette population.
Acta paediatrica (Oslo, Norway : 1992), 2015
The aim of this review was to identify the underlying relationship between preterm birth and the ... more The aim of this review was to identify the underlying relationship between preterm birth and the development of cardiovascular diseases. Preterm birth significantly affects the elastin content and viscoelastic properties of the vascular extracellular matrix in human arteries. Inadequate elastin synthesis during early development may cause a permanent increase in arterial stiffness in adulthood. Early and permanent alterations in viscoelastic properties may lead to hypertension and cardiovascular disease development in adults born prematurely.
Journal of developmental origins of health and disease, 2014
Recent studies have shown that a low birth weight is a risk factor for increased systemic blood p... more Recent studies have shown that a low birth weight is a risk factor for increased systemic blood pressure (BP) in adulthood. Further, systemic BP and arterial stiffness (AS) are reported to be increased in adolescents born prematurely. The purpose of this study was to characterize systemic BP and AS in young adults born preterm. Systemic BP was measured using an automated oscillometric device. AS was assessed by measuring the right carotid-radial pulse wave velocity (PWV) using a validated non-invasive automated method. Systemic BP, pulse pressure, and PWV [mean (confidence intervals)] were compared between 16 adults (age 21 years) born preterm (age at birth 32 weeks of gestation) with a birth weight (1710 g) appropriate for their gestational age and 15 adults (21 years) born at term (40 weeks of gestation) with a birth weight (3430 g) appropriate for their gestational age. Adults born preterm had a significantly higher systolic BP [122 mmHg (114-144) v. 112 (106-127)], mean BP [89 m...
La Revue de médecine interne / fondée ... par la Société nationale francaise de médecine interne, 2007
Intra-uterine growth restriction and preterm birth can lead to cardiovascular diseases in adultho... more Intra-uterine growth restriction and preterm birth can lead to cardiovascular diseases in adulthood. Preterm birth and intra-uterine growth restriction induce long-term changes in organ development such as arterial system and kidney function. Among these changes, the impairment of arterial wall structure or properties occurring in low birth weight babies, as a result of preterm birth and intra-uterine growth restriction, may lead on a long-term to an elevation of arterial pressure and arterial stiffness. These notions are still not completely understood and seem of high importance in regard to the high frequency in preterm birth and intra-uterine growth restriction. Identifying clinical, paraclinical markers and better understanding a link between adverse perinatal conditions and cardiovascular diseases might improve actions for preventing cardiovascular diseases in adulthood in this population.
Archives de pédiatrie : organe officiel de la Sociéte française de pédiatrie, 2007
Archives des maladies du coeur et des vaisseaux
Recent studies show that low birth weight (LBW) infants are at risk of increased arterial blood p... more Recent studies show that low birth weight (LBW) infants are at risk of increased arterial blood pressure (BP) in adulthood. Previous work from our centre and others suggests that arterial stiffness (AS) is increased in such patients. However, the respective roles of preterm birth and of intrauterine growth restriction (IUGR) are unclear. To characterize AS and BP in adolescents who were: born at term with an appropriate birth weight for gestational age (GA) (group 1, n=41); born preterm with an appropriate birth weight for GA (group 2, n=25); born at term and small for GA (group 3, n=24). Systemic BP was measured with an automated oscillometric device. AS was assessed by measuring pulse wave velocity (PWV) between carotid and radial arteries. 90 adolescents were studied at a mean (SD) age of 13.9 (1.2) years. Subjects from group 2 were born with a 33.6 (1.5) GA. Systolic BP, mean BP, and PWV were significantly increased in group 2 subjects in comparison to both group 1 (123 +/- 11 v...
La Pediatria medica e chirurgica : Medical and surgical pediatrics
Several studies suggest that adverse events during foetal life can program cardiovascular disease... more Several studies suggest that adverse events during foetal life can program cardiovascular diseases in adulthood. Barker et al. identified a relationship between low birth weight and an increased risk of arterial hypertension, carotid arteriosclerosis, and mortality by coronary heart disease or stroke in adulthood. These findings led to the "foetal origins" hypothesis, which is that cardiovascular disease originates in the adaptations to an adverse intrauterine environment. Such adaptations may permanently alter the cardiovascular structure and physiology through the process of programming. Several factors, such as impaired foetal growth, premature birth or postnatal growth of low birth weight infants may be involved, but to which extent is still unclear.
Archives de pédiatrie : organe officiel de la Sociéte française de pédiatrie, 2004
Antiseptic solutions are commonly used for skin care but are not always safe. In preterm infants,... more Antiseptic solutions are commonly used for skin care but are not always safe. In preterm infants, application of antiseptic solutions can lead to serious burns. We report the case of a premature newborn who developed severe burns at 35 weeks post-conceptional age, after his mother used disposable antiseptic towels containing isopropyl alcohol for his skin care. Burns outcome led to diffuse skin burn and death of the baby. Several cases of isopropyl alcohol poisoning through skin absorption have been reported in neonate and infants. Because of its neonatal toxicity, isopropyl alcohol has been excluded from composition of antiseptic solutions commonly used in neonatology. However, isopropyl alcohol is still available in many housecleaning and cosmetic products, while its toxic effects in children are not clearly mentioned. A specific mention "toxic for infants and children" should appear on mass consumption products containing isopropyl alcohol. Moreover, health workers may ...
La Revue de médecine interne / fondée ... par la Société nationale francaise de médecine interne, 2004
Ultrasonography Doppler in the assessment of arterial peripheral circulation. The ultrasonography... more Ultrasonography Doppler in the assessment of arterial peripheral circulation. The ultrasonography-Doppler study of peripheral arterial circulation requires measurements of arterial area and arterial blood flow. The aim of this study was to assess their variabilities, intra- and interobserver. We studied brachial arterial circulation of 13 volunteers. Two experimented investigators carried out the examinations. Arterial blood pressure measurements were obtained at the level of the brachial artery of the left arm by means of a semi automated oscillometric device. The brachial artery was approached by ultrasound scan in semi-decubitus position, the arm in exterior rotation and abduction. Brachial artery cross-sectional areas were obtained by a transversal view with a depth of 4-15-cm upstream the antecubital fossa of the forearm. Cross sectional areas were measured at end diastole (SD) and end systole (SS). We measured maximal systolic and diastolic velocities (Vmax and Vmin), mean vel...
Journal of Developmental Origins of Health and Disease, 2015