Cerebellar hemorrhage : a rare condition in the term infant
; BROUX, Isabelle ; et al
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 ▲]Detailed reference viewed: 30 (5 ULg)
Is early aggressive feeding dangerous for extremely low birth weight infants?
; ; RIGO, Vincent et al
in Tijdschrift van de Belgische Kinderarts = Journal du Pédiatre Belge (2015), 17(1), 83Detailed reference viewed: 29 (8 ULg)
Automated respiratory cycles selection is highly specific and improves respiratory mechanics analysis.
RIGO, Vincent ; Graas, Estelle ; Rigo, Jacques
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 ▲]Detailed reference viewed: 39 (4 ULg)
Precision of continuous neonatal ventilator respiratory mechanics is improved with selected optimal respiratory cycles.
RIGO, Vincent ; ; RIGO, Jacques
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 ▲]Detailed reference viewed: 27 (1 ULg)
Contribution à l'étude de la surveillance de la mécanique ventilatoire du nouveau-né ventilé.
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 ▲]Detailed reference viewed: 62 (6 ULg)
Secretory phospholipase A2 pathway in various types of lung injury in neonates and infants: a multicentre translational study
; ; Rigo, Vincent
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 ▲]Detailed reference viewed: 14 (0 ULg)
Surfactant Replacement Therapy in Preterm Infants: A European Survey
; ; 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 ▲]Detailed reference viewed: 47 (3 ULg)
Ventilation Practices in the Neonatal Intensive Care Unit: A Cross-Sectional Study.
; ; et al
in Journal of Pediatrics (2010), 157(5), 767-711-3
Objective: To assess current ventilation practices in newborn infants. Study design: We conducted a 2-point cross-sectional study in 173 European neonatal intensive care units, including 535 infants (mean ... [more ▼]
Objective: To assess current ventilation practices in newborn infants. Study design: We conducted a 2-point cross-sectional study in 173 European neonatal intensive care units, including 535 infants (mean gestational age 28 wks and birth weight 1024 g). Patient characteristics, ventilator settings and measurements were collected bedside from endotracheally ventilated infants. Results: 457 (85%) of the patients were conventionally ventilated. Time cycled pressure limited (TCPL) ventilation was used in 59% of these patients, most often combined with synchronized intermittent mandatory ventilation (51%). Newer conventional ventilation modes like volume targeted and pressure support ventilation were used in, respectively, 9% and 7% of the patients. The mean tidal volume, measured in 84% of the conventionally ventilated patients, was 5.7±2.3 ml/kg. The mean positive end-expiratory pressure (PEEP) was 4.5±1.1 cmH2O and rarely exceeded 7 cmH2O. Conclusions: TCPL ventilation is the most commonly used mode in neonatal ventilation. Tidal volumes are usually targeted between 4–7 ml/kg and PEEP between 4–6 cmH2O. Newer ventilation modes are only used in a minority of patients. [less ▲]Detailed reference viewed: 108 (5 ULg)
Automated respiratory cycles selection improves the variability of respiratory mechanics monitoring.
Rigo, Vincent ; ; Rigo, Jacques
in Rimensberger, Peter (Ed.) 10th European Conference on Pediatric and Neonatal Ventilation program (2010, April)Detailed reference viewed: 25 (4 ULg)
Accident vasculaire cérébral en période néonatale: à propos d'un cas.
Vervoort, Anne ; Rigo, Vincent ; Viellevoye, Renaud
in Vandenplas, Yvan (Ed.) 38ème Congrès annuel de la Société Belge de Pédiatrie: Proceedings 2010 (2010, March)Detailed reference viewed: 109 (6 ULg)
Amélioration de la variabilité des paramètres continus de mécanique ventilatoire en sélectionnant les respirations de bonne qualité.
Rigo, Vincent ; Rigo, Jacques
in Storme, Laurent (Ed.) JFRN 2009 (2009, November 23)Detailed reference viewed: 28 (2 ULg)
Newborns need another tune: « I will survive » sets neonatal resuscitation rhythm.
Rigo, Vincent ; Rigo, Jacques
in Annals of Emergency Medicine (2009), 53(6), 837Detailed reference viewed: 71 (14 ULg)
A rare case of placental choriangioma associated with neonatal diffuse hemangomatosis.
Capelle, Xavier ; Syrios, Petros ; Chantraine, Frédéric et al
in Journal de Gynécologie, Obstétrique et Biologie de la Reproduction (2009), 38(3), 246-249
Placental chorioangioma is a benign vascular tumor. Lesions larger than 4cm may cause fetal and maternal complications. Its association with disseminated neonatal hemangiomatosis is rarely described. We ... [more ▼]
Placental chorioangioma is a benign vascular tumor. Lesions larger than 4cm may cause fetal and maternal complications. Its association with disseminated neonatal hemangiomatosis is rarely described. We report a case of a large chorioangioma associated with an hydrops foetalis and disseminated neonatal hemangiomatosis. The relationship between placental chorioangioma and hemangioma is briefly discussed. [less ▲]Detailed reference viewed: 136 (15 ULg)
La pyknocytose infantile : une anemie neonatale mal connue a propos de 5cas.
Limme, Boris ; Dresse, Marie-Françoise ; et al
in Archives de Pédiatrie (2008), 15(12), 1765-8
Infantile pyknocytosis (IP) is a rare hematological entity of newborns. It is a form of hemolytic anemia with unusual red cell morphology: the red blood cells are distorted, irregular, and small with many ... [more ▼]
Infantile pyknocytosis (IP) is a rare hematological entity of newborns. It is a form of hemolytic anemia with unusual red cell morphology: the red blood cells are distorted, irregular, and small with many projections. Spontaneous resolution usually occurs by 4-6months of age. OBSERVATION: We describe the clinical features and biological parameters of 5 cases of IP. The first symptoms were always early jaundice, which required phototherapy. Anemia was severe in all babies and red blood cell transfusion was needed. CONCLUSION: IP is a rare cause of neonatal anemia whose diagnosis is based on a careful peripheral blood smear examination. In our study, anemia was severe and required red blood cell transfusion. Ethnic specificity and familial occurrence are reported in our experience. [less ▲]Detailed reference viewed: 335 (16 ULg)
On-line respiratory mechanic monitoring in newborns: reproducibility and effect of ventilatory mode
Rigo, Vincent ; Rigo, Jacques
in Archives of Disease in Childhood (2008, November), 93(suppl II), 483
Objectives: Neonatal ventilator softwares provide information on respiratory mechanics (RM). Integration of those values with clinical variables could improve ventilation management. We investigated ... [more ▼]
Objectives: Neonatal ventilator softwares provide information on respiratory mechanics (RM). Integration of those values with clinical variables could improve ventilation management. We investigated accuracy and reproducibility of those variables in Assist Control (AC) and Synchronised Intermittent Mandatory Ventilation (SIMV) modes. [less ▲]Detailed reference viewed: 53 (11 ULg)
Necrotising enterocolitis after administration of intravenous immunoglobulin in very low birth weight preterms: a retrospective study
Viellevoye, Renaud ; Rigo, Vincent ; Rigo, Jacques
in Archives of Disease in Childhood (2008, November), 93(suppl II), 322
Background: Necrotising enterocolitis (NEC) is a major cause of mortality and morbidity in very low birth weight (VLBW) preterms. Pathogenesis remains unclear. Recently, we observed a few NEC occurring ... [more ▼]
Background: Necrotising enterocolitis (NEC) is a major cause of mortality and morbidity in very low birth weight (VLBW) preterms. Pathogenesis remains unclear. Recently, we observed a few NEC occurring within the 48 h following prophylactic administration of intravenous immunoglobulin (IVIgG). The aim of the present study was to evaluate the influence of IVIgG administration on the incidence of NEC in our neonatal intensive care unit (NICU). [less ▲]Detailed reference viewed: 55 (4 ULg)
On-line respiratory mechanics in newborns: stability and effect of ventilatory mode.
Rigo, Vincent ; Rigo, Jacques
in Berger, Th. (Ed.) 9th EPNV Final Program and Abstracts (2008, April 11)Detailed reference viewed: 12 (3 ULg)
Left atrial thrombus in a newborn with dilated cardiomyopathy
Rigo, Vincent ; ; Rigo, Jacques
in Edition Spéciale SBP, Vol 1 (2008, February 29)Detailed reference viewed: 31 (0 ULg)
Neonatal on-line respiratory mechanics: Stability and effect of ventilatory mode
Rigo, Vincent ; Rigo, Jacques
in Edition Spéciale SBP, Vol 1 (2008, February)Detailed reference viewed: 15 (3 ULg)
Actualités thérapeutiques dans l'hypertension arterielle pulmonaire persistante du nouveau-né
Viellevoye, Renaud ; Rigo, Vincent ; Rigo, Jacques
in Revue Médicale de Liège (2007), 62(5-6, May-Jun), 284-7
Persistent pulmonary hypertension of the newborn is a severe disease leading to persistent and refractory hypoxemia with bad outcomes. The introduction of inhaled nitric oxide therapy significantly ... [more ▼]
Persistent pulmonary hypertension of the newborn is a severe disease leading to persistent and refractory hypoxemia with bad outcomes. The introduction of inhaled nitric oxide therapy significantly improved short and long term prognosis of those infants. More recently, sildenafil also appeared promising, but regimen and indications still need to be delineated. [less ▲]Detailed reference viewed: 150 (7 ULg)