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See detailL'histiocytose de Langerhans, une cause rare de Blueberry Muffin Syndrome
Kreins, Nathalie; Kalenga, Masendu ULiege; RIGO, Vincent ULiege

in Tijdschrift van de Belgische Kinderarts = Journal du Pédiatre Belge (2015, March 12), 17(1), 72

La présentation du Blueberry Muffin Syndrome est typique, et permet de rapidement orienter le bilan étiologique. La biopsie cutanée est importante pour établir le diagnostic, qui lui-même conditionne le ... [more ▼]

La présentation du Blueberry Muffin Syndrome est typique, et permet de rapidement orienter le bilan étiologique. La biopsie cutanée est importante pour établir le diagnostic, qui lui-même conditionne le pronostic. [less ▲]

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See detailImplementation of placental transfusion protocol
Lefebvre, Caroline; MASSON, Véronique ULiege; Kalenga, Masendu ULiege et al

in Tijdschrift van de Belgische Kinderarts = Journal du Pédiatre Belge (2015, March 12), 17(1), 72

A clear protocol for placental transfusion gives the opportunity to improve care of preterm infants. Initial information session and simulation practice for medical and midwifes staffs helps with its ... [more ▼]

A clear protocol for placental transfusion gives the opportunity to improve care of preterm infants. Initial information session and simulation practice for medical and midwifes staffs helps with its implementation. Delayed clamping and cord milking are not difficult after a learning phase like for most new procedures. [less ▲]

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See detailBenefits of placental transfusion in very preterm infants
Lefebvre, Caroline; MASSON, Véronique ULiege; Kalenga, Masendu ULiege et al

in Tijdschrift van de Belgische Kinderarts = Journal du Pédiatre Belge (2015, March), 17(1), 84

Introduction Cord clamping is not a trivial process. Its timing influences the significant physiological changes involved with this nearly universal practice. While the fetal and placental blood volumes ... [more ▼]

Introduction Cord clamping is not a trivial process. Its timing influences the significant physiological changes involved with this nearly universal practice. While the fetal and placental blood volumes add up to 100-120 ml/kg, their distributions differ between preterm and term neonates. The placenta accounts for 50% of the total blood volume in preterm infants and for only 33% in term neonates. Placental transfusion for 60 seconds increases neonatal blood volume by ± 16 ml/kg. In randomized trials, delayed cord clamping in preterm birth is associated with a more stable transitional circulation, a decrease need for inotropic support, and reduce blood transfusions, necrotizing enterocolitis, and intraventricular hemorrhages. Given those benefits, placental transfusion is integrated systematically in our management of preterm births since October 2013. This study aims to confirm expected benefits in a clinical setting. Patients and Methods We conducted a retro-prospective trial in a single tertiary care center. Very preterm infants (VPTi; <32 weeks GA) and VLBWi (BW<1500g) born between April 1st and September 30th 2013 were managed conventionally, with early cord clamping and constitute the control group. These data were collected retrospectively. October 2013 is the month for the new protocols implementation, and infants born this month are not included. Data from VPTi and VLBWi with delayed cord clamping or cord milking were collected prospectively from November 1st 2013 to April 30st 2014. Exclusion criteria were maternal and fetal vital emergencies, Rhesus sensitization, known major congenital abnormalities, tight nuchal cord, meconium teinted liquor, or mother infection by HIV or hepatitis. Results Fifty-two patients are included in the control group. In the second period, 26/XX preterm infants received a placental transfusion, including 6 with a 60 seconds delay in cord clamping and 20 with cord milking. Maternal and neonates’ characteristics were not significantly different. Mean birth weights (BW) were 1208g in the control and 1157g in the placental transfusion groups, with mean gestational age of 28 weeks 4/7 and 28 weeks 6/7, respectively. Mean arterial pressure is significantly increased with placental transfusion (H0 p=0.0006), (H12 p=0.032), (H24 p=0.01). Hemoglobin (H24 p=0,01) and hematocrit (H0 p=0,03), (H12 p=0,05), (H24 p=0,007) are also significantly higher. The number of transfusions per patient transfused (early group 3±2.5 vs. placental transfusion 1±0.4) is significantly lower (p=0.038). No infant with a BW>950g managed with delayed clamping or cord milking did required a transfusion. Conclusion Placental transfusion is associated with a higher blood pressure during the first 24 hours. Placental transfusion also reduces transfusion requirements, with reduction in the number of multi-transfused patients. We found this procedure safe and did not identify short or medium term adverse effects. For preterm infants, the third stage of labor management should evolve toward a more physiological practice, with systematic placental transfusion. [less ▲]

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See detailIs early aggressive feeding dangerous for extremely low birth weight infants?
Blecic, Anne-Sophie; Delbos, Marion; RIGO, Vincent ULiege et al

in Tijdschrift van de Belgische Kinderarts = Journal du Pédiatre Belge (2015), 17(1), 83

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See detailLE CANCER DU TRES JEUNE ENFANT : EPIDEMIOLOGIE LIEGEOISE
Fontaine, C; RIGO, Vincent ULiege; FORGET, Patricia ULiege et al

in Tijdschrift van de Belgische Kinderarts = Journal du Pédiatre Belge (2015), 17(1), 47

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See detailCerebellar hemorrhage : a rare condition in the term infant
MERINDOL, Ninon; BROUX, Isabelle ULiege; DECORTIS, Thierry et al

Poster (2015)

Cerebellar hemorrhage is a rare condition in full-term newborns. Early diagnosis based on the identification of risk factors, particular clinical signs and correct medical imaging is primordial to ... [more ▼]

Cerebellar hemorrhage is a rare condition in full-term newborns. Early diagnosis based on the identification of risk factors, particular clinical signs and correct medical imaging is primordial to optimize the immediate treatment and to assess the long term prognosis. [less ▲]

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See detailPrevention of preterm birth in women at risk: selected topics
Roelens, Kristien; Roberfroid, Dominique; Ahmadzai, Nadera et al

Report (2014)

Environ 7 bébés sur 100 viennent au monde trop tôt en Belgique. Le Centre Fédéral d’Expertise des Soins de Santé (KCE) a examiné, en collaboration avec le Collège pour la mère et le nouveau-né quelques ... [more ▼]

Environ 7 bébés sur 100 viennent au monde trop tôt en Belgique. Le Centre Fédéral d’Expertise des Soins de Santé (KCE) a examiné, en collaboration avec le Collège pour la mère et le nouveau-né quelques mesures courantes de prévention de l’accouchement prématuré. Une menace spontanée d’accouchement prématuré n’aboutit pas systématiquement à un accouchement dans les jours qui suivent. Pour éviter les angoisses inutiles et les effets secondaires des traitements, il est donc intéressant d’affiner l’évaluation du risque, ce qui est possible grâce à certains tests fiables et sûrs. De cette manière, des hospitalisations et des traitements superflus sont évités. Le KCE recommande donc de rembourser ces tests. Si le risque d’accouchement prématuré est confirmé, l’administration de corticoïdes et de sulfate de magnésium à la mère permet de protéger les poumons et le cerveau du bébé. Chez les femmes avec des antécédents d’accouchement prématuré, la progestérone administrée par voie vaginale à partir du deuxième trimestre permet de diminuer le risque de prématurité et de complications chez le bébé. [less ▲]

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See detailUne occlusion digestive inhabituelle chez un prématuré, à propos d’un cas.
Fontaine, Célia; GILSON, Nathalie ULiege; PIELTAIN, Catherine ULiege et al

Poster (2014, March 20)

Appendicitis in the newborn is a rare but difficult diagnosis. Delayed diagnosis and a risk of complications as digestive perforation, peritonitis and sepsis are associated with a high mortality and ... [more ▼]

Appendicitis in the newborn is a rare but difficult diagnosis. Delayed diagnosis and a risk of complications as digestive perforation, peritonitis and sepsis are associated with a high mortality and morbidity risk. [less ▲]

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See detailPrise en charge des enfants à risque de sevrage.
Counson, Florence; Decortis, Thierry; Kalenga, Masendu ULiege et al

in Tijdschrift van de Belgische Kinderarts = Journal du Pédiatre Belge (2014, March)

Description of care and outcomes of infants at risk of withdrawal syndrom from in utero exposure to addictive of psychotropic drugs.

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See detailThrombose veineuse rénale : un cas didactique
Tribolet, Sophie ULiege; DRESSE, Marie-Françoise ULiege; Lombet, Jacques et al

in Journal du pédiatre Belge (2014)

On retiendra que, devant toute hématurie macroscopique accompagnée d’une thrombocytopénie, d’une masse abdominale et/ou d’une anurie, voire d’une hypertension artérielle chez un nouveau-né, le diagnostic ... [more ▼]

On retiendra que, devant toute hématurie macroscopique accompagnée d’une thrombocytopénie, d’une masse abdominale et/ou d’une anurie, voire d’une hypertension artérielle chez un nouveau-né, le diagnostic de thrombose veineuse rénale doit être évoqué. L’échographie Doppler rénale est l’examen de choix pour le confirmer. En l’absence de consensus thérapeutique, outre la surveillance et la correction éventuelle des troubles hydroélectrolytiques, une héparinothérapie pourrait être initiée afin d’éviter l’extension thrombotique. La fibrinolyse est à réserver aux cas exceptionnels d’atteinte bilatérale. Cette pathologie reste malheureusement grevée d’une morbidité importante, avec parfois une atrophie, une insuffisance rénale et une hypertension artérielle. [less ▲]

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See detailCOMMENT J’EXPLORE ET TRAITE UNE THROMBOSE VEINEUSE RÉNALE NÉONATALE : à propos d’un cas
Tribolet, S.; DRESSE, Marie-Françoise ULiege; Lombet, J. et al

in Revue Médicale de Liège (2014), 69(4), 169-174

Neonatal renal vein thrombosis is a rare condition. The present case is rather unfrequent and particularly educative since it shows the complete diagnostic triad including hematuria, flank mass and ... [more ▼]

Neonatal renal vein thrombosis is a rare condition. The present case is rather unfrequent and particularly educative since it shows the complete diagnostic triad including hematuria, flank mass and thrombocytopenia. The diagnosis relies on the demonstration, by Doppler ultrasound, of an obstructed renal venous bed. The investigation is completed by a platelet count and the determination of the prothrombin time, of the activated partial thromboplastin time as well as of the concentration of fibrinogen. The screening also includes the search for a possible etiology, such as a deficiency in coagulation proteins, the presence of antiphospholipid antibodies or of a genetic mutation of one of the coagulation factors. Since there exist no evidence based guidelines for the management of the disease, we will discuss the diagnosis and treatment in relation with the published literature. [less ▲]

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See detailIncidence of hypo- and hyper-capnia in a cross-sectional European cohort of ventilated newborn infants.
van Kaam, Anton; De Jaegere, AP; Rimensberger, Peter et al

in Archives of Disease in Childhood - Fetal & Neonatal Edition (2013), 98(4), 323-6

OBJECTIVE: To determine the incidence of hypo- and hyper-capnia in a European cohort of ventilated newborn infants. DESIGN AND SETTING: Two-point cross-sectional prospective study in 173 European neonatal ... [more ▼]

OBJECTIVE: To determine the incidence of hypo- and hyper-capnia in a European cohort of ventilated newborn infants. DESIGN AND SETTING: Two-point cross-sectional prospective study in 173 European neonatal intensive care units. PATIENTS AND METHODS: Patient characteristics, ventilator settings and measurements, and blood gas analyses were collected for endotracheally ventilated newborn infants on two separate dates. RESULTS: A total of 1569 blood gas analyses were performed in 508 included patients with a mean+/-SD Pco2 of 48+/-12 mm Hg or 6.4+/-1.6 kPa (range 17-104 mm Hg or 2.3-13.9 kPa). Hypocapnia (Pco2<30 mm Hg or 4 kPa) and hypercapnia (Pco2>52 mm Hg or 7 kPa) was present in, respectively, 69 (4%) and 492 (31%) of the blood gases. Hypocapnia was most common in the first 3 days of life (7.3%) and hypercapnia after the first week of life (42.6%). Pco2 was significantly higher in preterm infants (49 mm Hg or 6.5 kPa) than term infants (43 mm Hg or 5.7 kPa) and significantly lower during pressure-limited ventilation (47 mm Hg or 6.3+/-1.6 kPa) compared with volume-targeted ventilation (51 mm Hg or 6.8+/-1.7 kPa) and high-frequency ventilation (50 mm Hg or 6.7+/-1.7 kPa). CONCLUSIONS: This study shows that hypocapnia is a relatively uncommon finding during neonatal ventilation. The higher incidence of hypercapnia may suggest that permissive hypercapnia has found its way into daily clinical practice. [less ▲]

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See detailUtilité de la PCR dans le diagnostic de l'infection néonatale à Streptocoque du groupe B (GBS)
PIERART, Julie ULiege; RIGO, Vincent ULiege; SENTERRE, Thibault ULiege et al

Poster (2013, March 15)

INTRODUCTION Le SGB représente la première cause d’infection néonatale précoce sévère dans les pays industrialisés. Sa mise en évidence par la culture peut être difficile après une antibiothérapie, une ... [more ▼]

INTRODUCTION Le SGB représente la première cause d’infection néonatale précoce sévère dans les pays industrialisés. Sa mise en évidence par la culture peut être difficile après une antibiothérapie, une antibioprophylaxie intrapartale ou en présence d’un volume de sang insuffisant. La PCR SGB a été développée pour améliorer la sensibilité du dépistage maternel à l’accouchement. Les travaux de Bergeron et coll. ont montré la fiabilité et la rapidité de cette technique (1). Dans notre hôpital, cette technique a été utilisée sur le sang et parfois le liquide céphalo-rachidien (LCR) des nouveau-nés à risque ou suspects d’infection. L’objectif de notre étude est de déterminer son utilité et d’évaluer son impact sur le diagnostic de l’infection néonatale à SGB. MATERIEL ET METHODE Etude rétrospective chez les enfants de moins de 3 mois hospitalisés au sein des services de néonatologie et pédiatrie du CHR de la Citadelle du 01/01/2006 au 31/12/2009 inclus. Les patients chez lesquels du SGB avait été mis en évidence par culture et de tous ceux ayant bénéficiés d’une PCR SGB sur le sang ou le LCR sont sélectionnés. Les données cliniques et biologiques des patients pour lesquels du SGB était mis en évidence par PCR, hémoculture et/ou culture du LCR sont analysées. Une classification en infection à SGB confirmée ou infirmée, précoce ou tardive est effectuée. Les calculs de sensibilité et spécificité de la PCR sont réalisés en fonction de la nature de l’échantillon et de l’infection. RESULTATS Sur 9.448 naissances vivantes, 2.595 patients sont sélectionnés avec un total de 2668 PCR réalisées (95% sur le sang et 5% sur le LCR). Douze patients répondaient aux critères d’infection confirmée à SGB : 10 précoces et 2 tardives. La culture n’était positive que chez 5 d’entre eux. Au final, les incidences des l’infections précoces et tardives à SGB sont respectivement de 1,05‰ et 0,2‰ des naissances vivantes. La PCR sur le sang montre une sensibilité de 50%, une spécificité de 99,9% et une valeur prédictive négative de 99,8%. La sensibilité et la spécificité de la PCR SGB sur le LCR sont de 100%. CONCLUSION La PCR permet une évaluation plus précise de l’incidence des infections à SGB. Cependant, réalisée sur le sang, elle est coûteuse et peu sensible. Son utilisation ne se justifie donc pas chez le nouveau-né asymptomatique évalué uniquement en raison de facteurs de risque. Au niveau du LCR, elle est précieuse au diagnostic. Par l’identification rapide du SGB, la PCR permettrait d’adapter le spectre, la posologie et la durée de l’antibiothérapie lorsque la culture reste négative chez un enfant infecté. [less ▲]

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See detailLe lactobezoar: une cause méconnue d'abdomen aigu
Kalenga, Masendu ULiege; Lagae, Donatienne; RIGO, Vincent ULiege

Poster (2013, March 15)

Le lactobezoar, agglomération pathologique de particules de lait et de mucus, peut causer chez le prématuré une obstruction digestive et mimer un abdomen aigu. La prise en charge est le plus souvent ... [more ▼]

Le lactobezoar, agglomération pathologique de particules de lait et de mucus, peut causer chez le prématuré une obstruction digestive et mimer un abdomen aigu. La prise en charge est le plus souvent médicale. [less ▲]

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See detailAutomated respiratory cycles selection is highly specific and improves respiratory mechanics analysis.
RIGO, Vincent ULiege; Graas, Estelle ULiege; Rigo, Jacques ULiege

in Pediatric Critical Care Medicine (2012), 13(4), 234-9

OBJECTIVE:: Selected optimal respiratory cycles should allow calculation of respiratory mechanic parameters focusing on patient-ventilator interaction. New computer software automatically selecting ... [more ▼]

OBJECTIVE:: Selected optimal respiratory cycles should allow calculation of respiratory mechanic parameters focusing on patient-ventilator interaction. New computer software automatically selecting optimal breaths and respiratory mechanic derived from those cycles are evaluated. DESIGN:: Retrospective study. SETTING:: University level III neonatal intensive care unit. SUBJECTS:: Ten mins synchronized intermittent mandatory ventilation and assist/control ventilation recordings from ten newborns. INTERVENTION:: The ventilator provided respiratory mechanic data (ventilator respiratory cycles) every 10 secs. Pressure, flow, and volume waves and pressure volume, pressure flow, and ventilator volume flow loops were reconstructed from continuous pressure/volume recordings. Visual assessment determined assisted leak-free optimal respiratory cycles (selected respiratory cycles). New software graded the quality of cycles (automated respiratory cycles). Respiratory mechanic values were derived from both sets of optimal cycles. We evaluated quality selection and compared mean values and their variability according to ventilatory mode and respiratory mechanic provenance. To assess discriminating power, all 45 "t" values obtained from interpatient comparisons were compared for each respiratory mechanic parameter. MEASUREMENTS AND MAIN RESULTS:: A total of 11,724 breaths are evaluated. automated respiratory cycle/selected respiratory cycle selections agreement is high: 88% of maximal kappa with linear weighting. Specificity and positive predictive values are 0.98 and 0.96, respectively. Averaged values are similar between automated respiratory cycle and ventilator respiratory cycle. C20/C alone is markedly decreased in automated respiratory cycle (1.27 +/- 0.37 vs. 1.81 +/- 0.67). Tidal volume apparent similarity disappears in assist/control: automated respiratory cycle tidal volume (4.8 +/- 1.0 mL/kg) is significantly lower than for ventilator respiratory cycle (5.6 +/- 1.8 mL/kg). Coefficients of variation decrease for all automated respiratory cycle parameters in all infants. "t" values from ventilator respiratory cycle data are two to three times higher than ventilator respiratory cycles. CONCLUSIONS:: Automated selection is highly specific. Automated respiratory cycle reflects most the interaction of both ventilator and patient. Improving discriminating power of ventilator monitoring will likely help in assessing disease status and following trends. Averaged parameters derived from automated respiratory cycles are more precise and could be displayed by ventilators to improve real-time fine tuning of ventilator settings. [less ▲]

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See detailPrecision of continuous neonatal ventilator respiratory mechanics is improved with selected optimal respiratory cycles.
RIGO, Vincent ULiege; Graas, Estelle; RIGO, Jacques ULiege

in European journal of pediatrics (2012), 171(4), 689-96

Given their high apparent variability, bedside continuous respiratory mechanics (RM) parameters (excepting tidal volume (VT)) remain infrequently used for adjustment of neonatal ventilatory settings. RM ... [more ▼]

Given their high apparent variability, bedside continuous respiratory mechanics (RM) parameters (excepting tidal volume (VT)) remain infrequently used for adjustment of neonatal ventilatory settings. RM parameters provided by ventilator (VRC) from 10 recordings of newborns (10 minutes in synchronized intermittent mandatory ventilation and Assist/control (A/C)) were compared to those computed from visually selected assisted leak-free optimal respiratory cycles (SRC). Mean values, variability and ability to distinguish patients were compared between VRC and SRC. Dynamic resistances were more correlated (r²=0.95) than compliances (r²=0.42). VT’s were correlated only in A/C (r²=0.78). C20/C was significantly higher in VRC (1.81±0.67) than in SRC (1.23±0.36) and frequently out of neonatal reference range. In A/C ventilation, VT was higher in VRC (5.6 ±1.8 ml/kg) than in SRC (4.8 ±1.0 ml/kg) (p<0.05). Displayed VT’s don’t reflect those found in optimal assisted breaths and therefore have incomplete value in assessing adequacy of ventilator settings. The variability of RM parameters provided by the ventilator is large, and coefficients of variation were significantly lower with optimal respiratory cycles (for Resistance, Compliance, VT and C20/C: 27, 26, 18, 24% in SRC, 36, 35, 40, 33% in VRC). Selecting optimal cycles yields RM with a 2-3 times higher discriminating power between patients. Conclusion: Current ventilator’s RM parameters have limited clinical use. Using optimal breaths to calculate RM parameters improves precision and discriminating power. For integration to ventilatory care, automation of this selection must be implemented first. [less ▲]

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See detailDu traumatisme obstétrical à la désinsertion trachéale.
Lecomte, Laurie; DEMEZ, Pierre ULiege; François, Anne et al

Poster (2012, March)

Les désinsertions trachéales traumatiques néonatales sont exceptionnelles. Elles sont généralement associées à une intubation compliquée, mais quelques descriptions ont été faites de ruptures trachéales ... [more ▼]

Les désinsertions trachéales traumatiques néonatales sont exceptionnelles. Elles sont généralement associées à une intubation compliquée, mais quelques descriptions ont été faites de ruptures trachéales partielles dans le décours d’un traumatisme obstétrical. Quelle que soit l’étiologie de la lésion trachéale, la prise en charge peut être conservatrice (par cicatrisation « simple » autour d’un tube entotrachéal) ou chirurgicale (par réparation des lésions). [less ▲]

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See detailContribution à l'étude de la surveillance de la mécanique ventilatoire du nouveau-né ventilé.
RIGO, Vincent ULiege

Doctoral thesis (2012)

Mechanical ventilation, still a major intervention to improve prognosis in newborns, requires careful monitoring of ventilated infants. This monitoring integrates different parameters. Its classical focus ... [more ▼]

Mechanical ventilation, still a major intervention to improve prognosis in newborns, requires careful monitoring of ventilated infants. This monitoring integrates different parameters. Its classical focus is on blood gases and their proxy (pulse oxymetry, transcutaneous oxygen and carbon dioxide content), and also includes physical assessment, thoracic imaging and appraisal of ventilator settings. Use of currently available on-line respiratory mechanics (RM) as displayed by ventilators seems limited given a large apparent variability. As current respiratory support strategies aim to reduce exposure to mechanical ventilation and to decrease ventilator associated lung injuries, additional continuous monitoring tools could benefit neonatal patients. In a review of advanced biomedical devices in use in the neonatal intensive care units and areas where improvement or evaluation is necessary, the National Institute for Child Health and Human Development underlines simple tools for continuous assessment of vital pulmonary functions at the bedside. This research aims at finding solutions to that problem. In a first step, different respiratory mechanics parameters (dynamic compliance –Cdyn, dynamic resistance –Rdyn, tidal volume –VT and the overdistension parameter C20/C) are obtained from ventilatory recordings of newborns under respiratory support with the most commonly used neonatal ventilator to evaluate their clinical relevance. Those data present a high variability and therefore lack precision. It is possible to mathematically decrease this variability by using parameters averaged over a few minutes and to obtain reproducible results. Continuous pressure, flow and volume data from the ventilator allow construction of pressure-volume, pressure-flow and flow-volume loops. From those loops, Cdyn, Rdyn and VT can be computed by the Mead-Whittenberger method. Those values when derived from respiratory cycles with good appearance significantly differ from ventilator values. Given the lack of precision of ventilator derived respiratory mechanics data, a new strategy is developed to obtain those parameters only from optimal looking respiratory cycles. A new software is designed to reconstruct waves and loops from the ventilator continuous recordings. This software individualises respiratory cycles and compute Cdyn and Rdyn (least mean square method), VT and C20/C. Using 10 sets of two recordings (one in Synchronized Intermittent Mandatory Ventilation and one in Assist/Control ventilatory modes), visual evaluation of 11274 respiratory cycles selects 4847 cycles considered optimal looking. Those assisted cycles present no or minimal leak, good hysteresis of the pressure-volume loop, and no abnormalities of the flow curves. The coefficients of variation of the respiratory mechanics parameters obtained with this method are significantly decreased, by 25-27% from the ventilator values for Rdyn, Cdyn and C20/C, and by 60% for VT. This increase in parameters precision is associated with an improved capacity to discriminate different values. Analysis of discordant values between ventilator and optimal respiratory cycles is relevant. In A/C mode, the VTs from the selected respiratory cycles are lower than values reported by the ventilator, suggesting that currently available VTs give incomplete information for adjustment of ventilator settings. In SIMV mode, the weak correlation between Cdyn from both methods leads to question the relevance of ventilator informations. The important scattering of ventilator C20/Cs out of classical values, and the absence of correlation with values from selected respiratory cycles demonstrate the lack of validity of ventilator C20/Cs. Overall, the results suggest that the use of data derived from selected respiratory cycles could underlie the conception of RM monitoring tools to support ventilatory management. To avoid the heavy workload associated with visual respiratory cycles’ selection, the software is improved to automatically identify optimal cycles. The positive predictive values and specificity of this selection are high. Respiratory mechanics parameters from cycles selected automatically are very concordant with those from visually selected cycles. The last step of this work assesses the software potential with analysis of 21 recordings from various clinical situations. The discriminating power of automatically selected respiratory cycles’ parameters is tested in an extended population. Trending abilities of those parameters are evaluated. Analyses of respiratory mechanics parameters derived from automatically selected cycles are able to demonstrate differences of 4.6-7.1% and more between parameters from two 10min recordings. Averaging data over 3-7min allows to determine a 10% difference. Parameters averaged over 10min allow detection of 10% changes in most patients. Those results should allow building trend curves with clinically and statistically significant informations. In conclusion, the continuous respiratory mechanics analysis software developed and evaluated in this work should give precise informations on the dynamic evolution of RM parameters. Functions integrated in the last version of the software give immediate research opportunities, and should lead to clinical application in a very near future. Those parameters could then complete current informations integrated in ventilatory management. [less ▲]

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See detailSecretory phospholipase A2 pathway in various types of lung injury in neonates and infants: a multicentre translational study
De Luca, Daniele; Capoluongo, Ettore; Rigo, Vincent ULiege

in BMC Pediatrics (2011), 11(101),

Background Secretory phospholipase A2 (sPLA2) is a group of enzymes involved in lung tissue inflammation and surfactant catabolism. sPLA2 plays a role in adults affected by acute lung injury and seems a ... [more ▼]

Background Secretory phospholipase A2 (sPLA2) is a group of enzymes involved in lung tissue inflammation and surfactant catabolism. sPLA2 plays a role in adults affected by acute lung injury and seems a promising therapeutic target. Preliminary data allow foreseeing the importance of such enzyme in some critical respiratory diseases in neonates and infants, as well. Our study aim is to clarify the role of sPLA2 and its modulators in the pathogenesis and clinical severity of hyaline membrane disease, infection related respiratory failure, meconium aspiration syndrome and acute respiratory distress syndrome. sPLA2 genes will also be sequenced and possible genetic involvement will be analysed. Methods/Design Multicentre, international, translational study, including several paediatric and neonatal intensive care units and one coordinating laboratory. Babies affected by the above mentioned conditions will be enrolled: broncho-alveolar lavage fluid, serum and whole blood will be obtained at definite time-points during the disease course. Several clinical, respiratory and outcome data will be recorded. Laboratory researchers who perform the bench part of the study will be blinded to the clinical data. Discussion This study, thanks to its multicenter design, will clarify the role(s) of sPLA2 and its pathway in these diseases: sPLA2 might be the crossroad between inflammation and surfactant dysfunction. This may represent a crucial target for new anti-inflammatory therapies but also a novel approach to protect surfactant or spare it, improving alveolar stability, lung mechanics and gas exchange. [less ▲]

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See detailSurfactant Replacement Therapy in Preterm Infants: A European Survey
van Kaam, Anton H.; De Jaegere, Anne P.; Borensztajn, Dorine et al

in Neonatology (2011), 100(1), 71-77

Background: Exogenous surfactant is an undisputed treatment for neonatal respiratory distress syndrome but its efficacy is highly dependent on the treatment strategy. International guidelines have ... [more ▼]

Background: Exogenous surfactant is an undisputed treatment for neonatal respiratory distress syndrome but its efficacy is highly dependent on the treatment strategy. International guidelines have published recommendations on the optimal surfactant replacement strategy. Objective: To determine how evidence-based guidelines on surfactant replacement therapy are implemented in daily clinical practice. Methods: Data on surfactant replacement therapy, including preparation, dosing and timing, were collected in 173 European neonatal intensive care units (NICUs) by questionnaire and in a cohort of preterm infants mechanically ventilated on two separate predefined dates in these units. Results: All NICUs used animal-derived surfactant in the treatment of respiratory distress syndrome, with Poractant being most widely used (86%). The most frequently used first dose was 100 mg/kg (58%) and 200 mg/kg (39%) and all NICUs allowed for repeat dosing. 39% of the NICUs claimed to use prophylactic treatment (<15 min of life). Data on surfactant treatment were collected in 338 infants, with a median gestational age of 27 weeks and a birth weight of 860 g. All infants were treated with animal-derived surfactant. The median first dose was 168 mg/kg in the Poractant group compared with 100 mg/kg in the Beractant and Bovactant groups. Prophylactic treatment was used in 23% of the infants and 28% of the infants received surfactant >2 h after birth. 43% of the infants received multiple doses. Conclusions: With the exception of surfactant timing, guidelines on surfactant replacement therapy seem to be implemented in daily clinical practice in European NICUs. [less ▲]

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