Ricardo Carbajal - Academia.edu (original) (raw)

Papers by Ricardo Carbajal

Anales De Pediatria, Aug 1, 2015

BMJ Open

ObjectivesAcute bronchiolitis is a major public health issue with high number of infants hospital... more ObjectivesAcute bronchiolitis is a major public health issue with high number of infants hospitalised worldwide each year. In France, hospitalisations mostly occur between October and March and peak in December. A reduction of emergency visits for bronchiolitis has been observed at onset of the COVID-19 outbreak. We aimed to assess the pandemic effects on the hospitalisations for bronchiolitis during the 2020–2021 winter (COVID-19 period) compared with three previous winters (pre-COVID-19).DesignRetrospective, observational and cross-sectional study.SettingTertiary university paediatric hospital in Paris (France).ParticipantsAll infants aged under 12 months who were hospitalised for acute bronchiolitis during the autumn/winter seasons (1 October to 31 March) from 2017 to 2021 were included. Clinical and laboratory data were collected using standardised forms.ResultsDuring the COVID-19 period was observed, a 54.3% reduction in hospitalisations for bronchiolitis associated with a dela...

Frontiers in Pharmacology

Objectives: No consensus exists about the doses of analgesics, sedatives, anesthetics, and paraly... more Objectives: No consensus exists about the doses of analgesics, sedatives, anesthetics, and paralytics used in critically ill neonates. Large-scale, detailed pharmacoepidemiologic studies of prescription practices are a prerequisite to future research. This study aimed to describe the detailed prescriptions of these drug classes in neonates hospitalized in neonatal intensive care units (NICU) from computerized prescription records and to compare prescriptions by gestational age.Materials and Methods: We included all neonates requiring intensive care in 30 French level III units from 2014 through 2020 with a computerized prescription for an analgesic, sedative, anesthetic, or paralytic agent. We described frequencies of prescription, methods of administration, concomitant drug prescriptions, and dosing regimen, and compared them across gestational ages.Results: Among 65,555 neonates, 29,340 (44.8%) were prescribed at least one analgesic (acetaminophen in 37.2% and opioids in 17.8%), s...

The Journal of Pediatrics, 2021

BMJ Open, 2019

ObjectivesPremedication practices for neonatal tracheal intubations have not yet been described f... more ObjectivesPremedication practices for neonatal tracheal intubations have not yet been described for neonatal transport teams. Our objective is to describe the use of sedation/analgesia (SA) for tracheal intubations and to assess its tolerance in neonates transported by medical transport teams in France.SettingThis prospective observational study was part of the EPIPPAIN 2 project and collected around-the-clock data on SA practices in neonates intubated by all five paediatric medical transport teams of the Paris region during a 2-month period. Intubations were classified as emergent, semiemergent and non-emergent. Sedation level and conditions of intubation were assessed with the Tonus, Reactivity, Awareness and Conditions of intubation to Help in Endotracheal intubation Assessment (TRACHEA score). The scores range from 0 to 10 representing an increasing ladder from adequate to inadequate sedation, and from excellent to very poor conditions of intubation.Participants40 neonates intub...

Pediatric Research, 2019

1,9 on behalf of the Neurodevelopmental Care Study Group of EPIPAGE-2 BACKGROUND: Parents of pret... more 1,9 on behalf of the Neurodevelopmental Care Study Group of EPIPAGE-2 BACKGROUND: Parents of preterm neonates wish greater involvement in pain management; little is known about factors associated with this involvement. We aim to describe perceived maternal information on infants' pain during hospitalization (PMIP), to study associations between PMIP and mothers' attitudes during painful procedures, and to identify individual and contextual factors associated with PMIP. METHODS: Analyses of questionnaires from the French national cohort study of preterm neonates, EPIPAGE-2. PMIP was derived from mothers' answers to questions about information perceived on both pain assessment and management. RESULTS: Among 3056 eligible neonates born before 32 weeks, 1974, with available maternal reports, were included in the study. PMIP was classified as "sufficient," "little, not sufficient," or "insufficient, or none" for 22.7, 45.9, and 31.3% of neonates, respectively. Mothers reporting PMIP as "sufficient" were more frequently present and more likely comforting their child during painful procedures. Factors independently associated with "sufficient" PMIP were high maternal education, gestational age <29 weeks, daily maternal visits, perception of high team support, and implementation of the neonatal and individualized developmental care and assessment program. CONCLUSION: Perceived maternal information on premature infants' pain reported as sufficient increased maternal involvement during painful procedures and was associated with some units' policies.

PloS one, 2017

Extracorporeal membrane oxygenation support is indicated in severe and refractory respiratory or ... more Extracorporeal membrane oxygenation support is indicated in severe and refractory respiratory or circulatory failures. Neurological complications are typically represented by acute ischemic or hemorrhagic lesions, which induce higher morbidity and mortality. The primary goal of this study was to assess the prognostic value of cerebral tissue oxygen saturation (StcO2) on mortality in neonates and young infants treated with ECMO. A secondary objective was to evaluate the association between StcO2 and the occurrence of cerebral lesions. This was a prospective study in infants < 3 months of age admitted to a pediatric intensive care unit and requiring ECMO support. The assessment of cerebral perfusion was made by continuous StcO2 monitoring using near-infrared spectroscopy (NIRS) sensors placed on the two temporo-parietal regions. Neurological lesions were identified by MRI or transfontanellar echography. Thirty-four infants <3 months of age were included in the study over a perio...

Acta paediatrica (Oslo, Norway : 1992), Jan 3, 2017

Continuous pain occurs routinely, even after invasive procedures, or inflammation and surgery, bu... more Continuous pain occurs routinely, even after invasive procedures, or inflammation and surgery, but clinical practices associated with assessments of continuous pain remain unknown. A prospective cohort study in 243 Neonatal Intensive Care Units (NICUs) from 18 European countries recorded frequency of pain assessments, use of mechanical ventilation, sedation, analgesia, or neuromuscular blockade for each neonate upto 28 days after NICU admission. Only 2113/6648 (31·8%) of neonates received assessments of continuous pain, occurring variably among tracheal ventilation (TrV, 46·0%), noninvasive ventilation (NiV, 35·0%), and no ventilation (NoV, 20·1%) groups (p<0·001). Daily assessments for continuous pain occurred in only 10·4% of all neonates (TrV: 14·0%, NiV: 10·7%, NoV: 7·6%; p<0·001). More frequent assessments of continuous pain occurred in NICUs with pain guidelines, nursing champions, and surgical admissions prompted (all p<0·01), and for newborns <32 weeks gestationa...

Italian Journal of Pediatrics, 2017

Anales de Pediatría, 2016

The Lancet Respiratory Medicine, 2015

Archives of Disease in Childhood, 2014

Background Neonates admitted to NICUs are frequently subjected to invasive procedures, often with... more Background Neonates admitted to NICUs are frequently subjected to invasive procedures, often with sub-optimal analgesic treatment. Objective To determine the number of invasive procedures and analgesic practices in NICUs. Methods Invasive procedures and corresponding analgesic therapies on days 1-14 of NICU admission were prospectively

BMC pediatrics, Jan 7, 2014

Premedication before neonatal intubation is heterogeneous and contentious. The combination of a s... more Premedication before neonatal intubation is heterogeneous and contentious. The combination of a short acting, rapid onset opioid with a muscle relaxant is considered suitable by many experts. The purpose of this study was to describe the tolerance and conditions of intubation following anaesthesia with atropine, sufentanil and atracurium in very premature infants. Monocentric, prospective observational study in premature infants born before 32 weeks of gestational age, hospitalised in the NICU and requiring semi-urgent or elective intubation. Intubation conditions, heart rate, pulse oxymetry (SpO2), arterial blood pressure and transcutaneous PCO2 (TcPCO2) were collected in real time during 30 minutes following the first drug injection. Repeated physiological measurements were analysed using mixed linear models. Thirty five intubations were performed in 24 infants with a median post conceptional age of 27.6 weeks and a median weight of 850 g at the time of intubation. The first attem...

Pediatric Critical Care Medicine, 2013

Objectives: To describe the frequency and nature of premedications used prior to neonatal endotra... more Objectives: To describe the frequency and nature of premedications used prior to neonatal endotracheal intubation. To confront observed practice with current recommendations. To identify risk factors for the absence of premedication. Design, Setting and Patients: Data concerning intubations were collected prospectively at the bedside as part of an observational study collecting around-the-clock data on all painful or stressful procedures performed in neonates during the first 14 days of their admission to 13 tertiary care units in the region of Paris, France between 2005 and 2006. Interventions: Observational study. Measurements and Main Results: Specific premedication prior to endotracheal intubation was assessed. Ninety one intubations carried out on the same number of patients were analysed. The specific premedication rate was 56% and included mostly opioids (67%) and midazolam (53%). When compared to recent guidance from the American Academy of Pediatrics, used premedications could be classified as "preferred" (12%), "acceptable" (18%), "not recommended" (27%) or "not described" (43%). In univariate analysis, infants without a specific premedication when compared to others were younger at the time of intubation (median age: 0.7 vs 2.0 days), displayed significantly more frequent spontaneous breathing at the time of intubation (31% vs 12%) and a higher percentage of analgesia for all other painful procedures (median values : 16% vs 6%). In multivariate analysis, no factor remained statistically significant. Conclusions: Premedication use prior to neonatal intubation was not systematically used and when used it was most frequently inconsistent with recent recommendations. No patient-or centre-related independent risk factor for the absence of premedication was identified in this study.