Expérience du dépistage néonatal auditif en Haute-Normandie (Analyse des 100 000 premières naissances)

L incidence de la surdité permanente néonatale est de l ordre de 1 à 2 pour 1000 naissances. Il est désormais largement admis que le diagnostic et la prise en charge précoces de la surdité de l enfant assurent un développement de la communication et du langage de qualité supérieure, limitant ainsi les difficultés d insertions scolaire, sociale et professionnelle tout au long de la vie de l individu. En Haute-Normandie, le programme de dépistage, instauré progressivement à partir de 1999, en maternité et en néonatalogie, a été appliqué à plus de 100 000 naissances. Cette étude analyse à partir d'un recueil prospectif des données, la qualité de ce programme. Le protocole de dépistage se déroule en 2 étapes, en utilisant les OEAp et/ou les PEAa. Il a pour objectif de dépister toute surdité de degré égal ou supérieur à léger, qu elle soit unilatérale ou bilatérale. Cette étude démontre que le protocole mis en place couvre 99,8% des naissances, avec un taux de convocation diagnostique de 0,17%, et une valeur prédictive positive de 87,7%. Au total, 142 enfants ont été diagnostiqués de surdité bilatérale et 55 de surdité unilatérale, soit une incidence respective de 1,39 et 0,8 pour 1 000 naissances, comparable à celles retrouvées dans la littérature. Dans notre série, pour les surdités sévères et profondes, l âge médian d appareillage était de 6 à 7 mois et l âge médian d implantation cochléaire, réalisée chez 41,5% des enfants, était de 16,5 mois. 52,1% des enfants sourds avaient un facteur de risque de surdité identifié à la naissance. Nous avons donc pu mettre en évidence que le programme de dépistage universel de la surdité permanente néonatale dans notre région est efficient, et respecte les recommandations internationales. Cette expérience pourrait contribuer à la mise en place nationale d un tel programme, prévue par un arrêté ministériel depuis avril 2012.ROUEN-BU Médecine-Pharmacie (765402102) / SudocSudocFranceF

Association of the Duration of Antibiotic Therapy With Major Surgical Site Infection in Cochlear Implantation

International audienceImportance: Infection after cochlear implantation is a rare but serious event that can lead to meningitis. There is no consensus on prevention of infection in these patients, and each center applies its own strategy.Objective: To describe the rates of major surgical site infection for patients undergoing cochlear implantation who receive prolonged antibiotic treatment compared with those who receive a single perioperative dose of antibiotic prophylaxis.Design, setting, and participants: Retrospective cohort study of patients who underwent cochlear implantation between January 1, 2011, and July 8, 2015, with a postoperative follow-up of 1 to 3 years. In this multicenter study at 8 French university centers, 1180 patients (509 children and 671 adults) who underwent cochlear implantation during this period were included.Interventions: Prolonged antibiotic treatment vs single-dose antibiotic prophylaxis.Main outcomes and measures: Major infection and explantation.Results: Among 1180 patients (509 children [51.7% female] with a mean [SD] age of 4.6 [3.8] years and 671 adults [54.9% female] with a mean [SD] age of 54.8 [17.0] years), 12 patients (1.0%) developed a major infection, with 4 infections occurring in the prolonged antibiotic treatment group and 8 infections occurring in the antibiotic prophylaxis group (odds ratio, 2.45; 95% CI, 0.73-8.17). Children (9 of 509 [1.8%]) were more likely to develop infection than adults (3 of 671 [0.4%]). Among children, 4 infections occurred in the prolonged antibiotic group (n = 344), and 5 infections occurred in the antibiotic prophylaxis group (n = 158) (odds ratio, 2.78; 95% CI, 0.74-10.49). Among adults, 3 infections occurred in the antibiotic prophylaxis group (n = 365), whereas no infections occurred in the prolonged antibiotic treatment group (n = 290).Conclusions and relevance: After cochlear implantation, infection was rare, was less common among those who received prolonged antibiotic treatment, and was less likely to occur in adults than in children

Multicentre investigation on electrically evoked compound action potential and stapedius reflex: how do these objective measures relate to implant programming parameters?

Objectives: The aims of this study were to collect data on electrically evoked compound action potential (eCAP) and electrically evoked stapedius reflex thresholds (eSRT) in HiResolutionTM cochlear implant (CI) users, and to explore the relationships between these objective measures and behavioural measures of comfort levels (M-levels). Methods: A prospective study on newly implanted subjects was designed. The eCAP was measured intra-operatively and at first fitting through neural response imaging (NRI), using the SoundWaveTM fitting software. The eSRT was measured intra-operatively by visual monitoring of the stapes, using both single-electrode stimulation and speech bursts (four electrodes stimulated at the same time). Measures of M-levels were performed according to standard clinical practice and collected at first fitting, 3 and 6 months of CI use. Results: One hundred seventeen subjects from 14 centres, all implanted unilaterally with a HiResolution CII Bionic Ear® or HiRes 90K®, were included in the study. Speech burst stimulation elicited a significantly higher eSRT success rate than single-electrode stimulation, 84 vs. 64% respectively. The NRI success rate was 81% intra-operatively, significantly increasing to 96% after 6 months. Fitting guidelines were defined on the basis of a single NRI measurement. Correlations, analysis of variance, and multiple regression analysis were applied to generate a predictive model for the M-levels. Discussion: Useful insights were produced into the behaviour of objective measures according to time, electrode location, and fitting parameters. They may usefully assist in programming the CI when no reliable feedback is obtained through standard behavioural procedures

COVID-19 outcomes in patients with inflammatory rheumatic and musculoskeletal diseases treated with rituximab: a cohort study

International audienceBackground: Various observations have suggested that the course of COVID-19 might be less favourable in patients with inflammatory rheumatic and musculoskeletal diseases receiving rituximab compared with those not receiving rituximab. We aimed to investigate whether treatment with rituximab is associated with severe COVID-19 outcomes in patients with inflammatory rheumatic and musculoskeletal diseases.Methods: In this cohort study, we analysed data from the French RMD COVID-19 cohort, which included patients aged 18 years or older with inflammatory rheumatic and musculoskeletal diseases and highly suspected or confirmed COVID-19. The primary endpoint was the severity of COVID-19 in patients treated with rituximab (rituximab group) compared with patients who did not receive rituximab (no rituximab group). Severe disease was defined as that requiring admission to an intensive care unit or leading to death. Secondary objectives were to analyse deaths and duration of hospital stay. The inverse probability of treatment weighting propensity score method was used to adjust for potential confounding factors (age, sex, arterial hypertension, diabetes, smoking status, body-mass index, interstitial lung disease, cardiovascular diseases, cancer, corticosteroid use, chronic renal failure, and the underlying disease [rheumatoid arthritis vs others]). Odds ratios and hazard ratios and their 95% CIs were calculated as effect size, by dividing the two population mean differences by their SD. This study is registered with ClinicalTrials.gov, NCT04353609.Findings: Between April 15, 2020, and Nov 20, 2020, data were collected for 1090 patients (mean age 55·2 years [SD 16·4]); 734 (67%) were female and 356 (33%) were male. Of the 1090 patients, 137 (13%) developed severe COVID-19 and 89 (8%) died. After adjusting for potential confounding factors, severe disease was observed more frequently (effect size 3·26, 95% CI 1·66-6·40, p=0·0006) and the duration of hospital stay was markedly longer (0·62, 0·46-0·85, p=0·0024) in the 63 patients in the rituximab group than in the 1027 patients in the no rituximab group. 13 (21%) of 63 patients in the rituximab group died compared with 76 (7%) of 1027 patients in the no rituximab group, but the adjusted risk of death was not significantly increased in the rituximab group (effect size 1·32, 95% CI 0·55-3·19, p=0·53).Interpretation: Rituximab therapy is associated with more severe COVID-19. Rituximab will have to be prescribed with particular caution in patients with inflammatory rheumatic and musculoskeletal diseases