Évaluation de la tension artérielle à l âge de deux ans des prématurés de moins de 33 semaines d'aménorrhée au CHU de Rouen

La prévalence de l'hypertension artérielle en pédiatrie a augmenté ces dernières années. Malgré l'harmonisation récente de la définition de l'hypertension artérielle et une tolérance moindre des chiffres élevés, celle-ci reste encore sous-diagnostiquée. La prématurité et le petit poids de naissance sont apparus comme deux facteurs de risque d augmentation de la tension artérielle se manifestant précocement dans l enfance et pouvant progresser vers l hypertension artérielle à l adolescence ou chez les jeunes adultes. Méthodes : Nous avons réalisé une étude épidémiologique au CHU de Rouen afin d'évaluer la tension artérielle à l'âge de deux ans et d'analyser les facteurs de risque en période foetale et néonatale chez d'anciens prématurés. Résultats : Notre étude est une étude descriptive, monocentrique et rétrospective concernant les prématurés de moins de 33 semaines d'aménorrhée. Nous avons inclus 181 anciens prématurés nés entre le 01/01/2007 et le 32/12/2010. Le terme de naissance moyen était de 29,6 SA +/- 2,0 SA et le poids de naissance moyen de 1308,7 g +/- 399,2 g. Sur les 4 années étudiées, seulement 31 % des prématurés ont eu une mesure de la tension artérielle lors de la consultation à l'âge de deux ans, malgré une augmentation du nombre de mesure par année entre 2007 et 2010. La tension artérielle systolique moyenne était de 98 mm Hg +/- 12 mm Hg et diastolique moyenne de 56 mm Hg +/- 11 mm Hg. Une tension artérielle normale, définie par des valeurs inférieures au 90ème percentile pour l'âge, le sexe et la taille, a été retrouvée chez seulement 48,1 % des enfants. La primiparité et le périmètre crânien de naissance inférieur au 10ème percentile étaient significativement associés à des chiffres de tension artérielle anormale à l'âge de deux ans. Conclusion : Cette étude est la première étude dans notre centre sur la tension artérielle à l âge de deux ans de nos anciens prématurés. L hypertension artérielle chez les enfants reste encore sous-diagnostiquée. Chaque grand prématuré devrait bénéficier d un dosage de créatinine plasmatique avant la sortie d'hospitalisation vers 36 semaines d aménorrhée d'âge corrigé, d'une prise annuelle de la tension artérielle et d'une recherche de protéinurie par bandelette urinaire une fois par an également, voire même d'une recherche plus sensible de microalbuminurie sur échantillon, afin de dépister les enfants à risque d exprimer précocement des signes de réduction néphronique.ROUEN-BU Médecine-Pharmacie (765402102) / SudocSudocFranceF

Outcome at Two Years of Very Preterm Infants Born after Rupture of Membranes before Viability

International audienc

Neonatal Meningoencephalitis Caused by Streptococcus gallolyticus

International audienc

Association of Intraventricular Hemorrhage and Death With Tocolytic Exposure in Preterm Infants

International audienceImportance: No trials to date have demonstrated the benefits of tocolysis on death and/or neonatal morbidity in preterm infants; tocolytics may affect the fetal blood-brain barrier.Objectives: To assess the risks associated with tocolysis in women delivering prematurely as measured by death and/or intraventricular hemorrhage (IVH) in preterm infants and to compare the association of calcium channel blockers (CCBs) nifedipine and nicardipine hydrochloride vs atosiban used for tocolysis with death and/or IVH.Design, Settings, and Participants: The French 2011 EPIPAGE-2 (Enquête Épidémiologique sur les Petits Âges Gestationnels) cohort was limited to mothers admitted for preterm labor without fever, who delivered from 24 to 31 weeks of gestation from April 1 through December 31, 2011. Groups of preterm infants with vs without tocolytic exposure and groups with atosiban vs CCB exposure were compared. Data analysis was performed from June 7, 2014, through September 3, 2017.Exposures: Tocolytics.Main Outcomes and Measures: The primary outcome was a composite of death and/or IVH in preterm infants. Secondary outcomes included death, IVH, and a composite of death and/or grades III to IV IVH.Results: A total of 1127 mothers (mean [SD] age, 25.5 [6.0] years) experienced preterm labor and gave birth to 1343 preterm infants with a male to female ratio of 1.23 and mean (SD) gestational age of 27 (2.5) weeks. Of these, 789 mothers (70.0%) received tocolytics; 314 (39.8%) received only atosiban, and 118 (15.0%) received only a CCB. In the first analysis, the primary outcome (death and/or IVH) was not significantly different in preterm infants with vs without tocolytic exposure (183 of 363 [50.4%] vs 207 of 363 [57.0%]; relative risk [RR], 0.88; 95% CI, 0.77-1.01; P = .07). The secondary outcome (death and/or grades III-IV IVH) was significantly lower in preterm infants with vs without tocolytic exposure (92 of 363 [25.3%] vs 118 of 363 [32.5%]; RR, 0.78; 95% CI, 0.62-0.98; P = .03). Other outcomes did not differ significantly. In the secondary analysis, death and/or IVH was not significantly different in preterm infants with atosiban vs CCB exposure (96 of 214 [44.9%] vs 62 of 121 [51.2%]; RR, 0.88; 95% CI, 0.70-1.10; P = .26), nor was IVH (77 of 197 [39.1%] vs 48 of 106 [45.3%]; RR, 0.86; 95% CI, 0.66-1.13; P = .29).Conclusions and Relevance: In this population-based study, findings suggest that tocolytics were associated with a reduction of death and severe IVH. Other studies are necessary to compare perinatal outcomes after use of atosiban vs CCBs

Anthropometric data and parent’s level at 2 years of age.

<p>SD: Standard deviation</p><p>Anthropometric data and parent’s level at 2 years of age.</p

Comparison in Outcomes at Two-Years of Age of Very Preterm Infants Born in 2000, 2005 and 2010

<div><p>Objective</p><p>To investigate alteration in 2-year neurological/behavioral outcomes of very preterm infants born in a French level three neonatal intensive care unit.</p><p>Methods</p><p>We conducted a prospective, comparative study of very preterm infants born before 33 weeks’ gestation at 5-year intervals in 2000, 2005 and 2010 at Rouen University Hospital. Neonatal mortality/morbidities, ante- and neonatal treatments, and at age 2 years motor, cognitive and behavioral data were collected by standardized questionnaires.</p><p>Results</p><p>We included 536 very preterm infants. Follow-up rates at two years old were 78% in 2000, 93% in 2005 and 92% in 2010 respectively. No difference in gestational age, birthweight, neonatal mortality/morbidities was observed except a decrease in low grade subependymal/intraventricular hemorrhages. Care modifications concerned use of antenatal magnesium sulfate, breast-feeding and post-natal corticosteroid therapy. Significant improvement in motor outcome and dramatic decrease in cerebral palsy rates (12% in 2000, 6% in 2005, 1% in 2010, <i>p</i><0.001) were observed, as were improvements in feeding behavior. Although a non significant difference to better psychosocial behavior was reported, there was no difference in cognitive outcome.</p><p>Conclusions</p><p>Improvement in neuromotor outcome and behavior was reported. This could be due to multiple modifications in care: including administration of magnesium sulfate to women at risk of preterm birth, increase in breast-feeding, decrease in low grade subependymal/intraventricular hemorrhages, and decrease in post-natal corticosteroid therapy, all of which require further investigation in other studies. Extended follow-up until school age is mandatory for better detection of cognitive, learning and behavioral disorders.</p></div

Perinatal characteristics of 2000, 2005 and 2010 cohorts.

<p># Persistence difference between 2005 and 2010,</p><p>† Persistence difference between 2000 and 2010,</p><p>■ Persistence difference between 2000 and 2005SD: Standard deviation, PDA: patent ductus arteriosus</p><p>Perinatal characteristics of 2000, 2005 and 2010 cohorts.</p

Flow chart of the study.

<p>Flow chart of the study.</p

Anthropometric data and parent’s level at 2 years of age.

<p>SD: Standard deviation</p><p>Anthropometric data and parent’s level at 2 years of age.</p

Outcomes at 2 years of age in the survivors of 2000, 2005 and 2010 cohorts.

<p>† Persistance difference between 2000 and 2010,</p><p>■ Persistance difference between 2000 and 2005</p><p>Outcomes at 2 years of age in the survivors of 2000, 2005 and 2010 cohorts.</p