Objectives: Mortality rates of very preterm infants may vary considerably between healthcare facilities depending on the neonates' place of inclusion in the cohort study. The objective of this study was to compare the mortality rates of live-born extremely preterm neonates observed in two French tertiary referral hospitals, taking into account the occurrence of neonatal death both in the delivery room and in the neonatal intensive care unit (NICU). Methods: Retrospective observational study including all pregnancy terminations, stillbirths and live born infants within a 22- to 26-week (0/6) gestational age range was registered by two French level 3 university centers between 2009 and 2013. The mortality rates were compared between the two centers according to two places of inclusion: either the delivery room or the NICU. Results: A total of 344 infants were born at center A and 160 infants were born at center B. Among the live-born neonates, the rates of neonatal death were similar in center A (54/125, 43.2%) and center B (33/69, 47.8%; P = 0.54). However, neonatal death occurred significantly more often in the delivery room at center A (31/54, 57.4%) than at center B (6/33, 18.2%; P < 0.001). Finally, the neonatal death rate of live born very preterm neonates admitted to the NICU was significantly lower in center A (25/94, 26.6%) than in center B (27/63, 42.9%; P = 0.03). Conclusions: This study points out how the inclusion of deaths in the delivery room when comparing neonatal death rates can lead to a substantial bias in benchmarking studies. Center A and center B each endorsed one of the two models of preferential place of neonatal death (delivery room or NICU) detailed in European studies. The reasons behind the two different models and their impact on how parents perceive supporting their neonate need further investigation. (C) 2018 Elsevier Masson SAS. All rights reserved.

To determine whether extrauterine growth is associated with neurologic outcomes and if this association varies by prenatal growth profile.For 1493 preterms from the EPIPAGE (Étude Épidémiologique sur les Petits Âges Gestationnels [Epidemiological Study on Small Gestational Ages]) cohort, appropriate for gestational-age (AGA) was defined by birth weight >-2 SD and small for gestational-age (SGA) by birth weight ≤-2 SD. Extra-uterine growth was defined by weight gain or loss between birth and 6 months by z-score change. Growth following-the-curve (FTC) was defined as weight change -1 to +1 SD, catch-down-growth (CD) as weight loss ≥1 SD, and catch-up-growth (CU) as weight gain ≥1 SD. At 5 years, a complete medical examination (n = 1305) and cognitive evaluation with the Kauffman Assessment Battery for Children (n = 1130) were performed. Behavioral difficulties at 5 years and school performance at 8 years were assessed (n = 1095).Overall, 42.5% of preterms were AGA-FTC, 20.2% AGA-CD, 17.1% AGA-CU, 5.6% SGA-FTC, and 14.5% SGA-CU. Outcomes did not differ between CU and FTC preterm AGA infants. Risk of cerebral palsy was greater for AGA-CD compared with AGA-FTC (aOR 2.26 [95% CI 1.37-3.72]). As compared with children with SGA-CU, SGA-FTC children showed no significant increased risk of cognitive deficiency (aOR 1.41[0.94-2.12]) or school difficulties (aOR 1.60 [0.84-3.03]). Compared with AGA-FTC, SGA showed increased risk of cognitive deficiency (SGA-FTC aOR 2.19 [1.25-3.84]) and inattention-hyperactivity (SGA-CU aOR 1.65 [1.05-2.60]).Deficient postnatal growth was associated with poor neurologic outcome for AGA and SGA preterm infants. CU growth does not add additional benefits. Regardless of type of postnatal growth, SGA infants showed behavioral problems and cognitive deficiency.

Apprécier la relation entre la qualité de la corticothérapie anténatale (CAN) (dose totale reçue et délai entre la cure et la naissance) et le devenir hospitalier neurologique et respiratoire des grands prématurés hospitalisés dans un établissement de type 3. Etude observationnelle avec recueil prospectif des données de prématurés de 270/6 à 32 SA6/6, de janvier 2005 à décembre 2012. Dans notre population de 1046 prématurés, quelque soit la qualité de la CAN (absence, 12 mg, 24 mg < 7 jours, 24 mg ≥7 jours), il existe un bénéfice significatif de la CAN sur le score composite définissant un mauvais devenir hospitalier (décès hospitalier et/ou lésions ETF sévères) : respectivement de 83,9 ; 90,5 ; 94,2 et 93,8%, p=0,001. Le risque d'être traité par surfactant est au plus bas en cas de cures complètes <7 jours : respectivement de 75,0 ; 66,5 ; 52,1 et 60,3%, p<0,001. A l'inverse, la CAN (délai et dose) n'influence pas l'oxygénodépendance à J28. Un ajustement sur le terme, le poids, et les causes de prématurité ne modifie pas ces résultats. Nous avons montré que la qualité de la CAN influence différemment le devenir neurologique et respiratoire hospitalier des grands prématurés de 27 à 32SA.

Objectives To evaluate growth for children born very preterm with particular focus on those born small-for-gestational age (SGA) or with ex utero growth restraint (GA), and to identify risk factors for short stature at 5 years of age.Study design Population-based study of children born at less than 33 completed weeks of gestation (Etude Epidemiologique sur les Petits Ages Gestationnels (EPIPAGE)). Short stature was defined as height <-2SD on WHO growth curves. Ex utero GA was considered to have occurred in children with appropriate size for gestational age at birth and with a height and/or below -2SD at 2 years of corrected age. Logistic regression models were used to test associations between risk factors and short stature.Results The authors measured height at 5 years of for 1597 of 2193 children (73%), 5.6% (95% CI 4.6 to 6.9) of whom were diagnosed as having a short Height was measured at 2 and 5 years of age in 1417 children. Among these, 24% of those born SGA and of those with ex utero GA (p=0.002) had a short at 5 years. Predictors of short stature were SGA or length <-2SD, maternal height <= 160 cm, gestational age <29 weeks and systemic corticosteroids. Breastfeeding at discharge decreased the risk of short stature.Conclusions Short stature at 5 years of age is common in children born preterm. The highest was observed in the group with ex utero GR. Systemic steroids have a long-term impact on growth and should be used with caution. Breastfeeding at discharge appeared to be protective.

OBJECTIVE: To evaluate the effects of maternal smoking during pregnancy on foetal growth in preterm infants with gestational age (GA) <33 weeks. POPULATION AND METHODS:Prospective observational cross-sectional study from two French perinatal networks cohort of preterm infants. Cases were 358 very preterm infants (GA 24–32 weeks) divided into two groups as maternal smokers (129) and non-smokers (229). 361 term infants (GA 37–41 weeks) also divided into two groups as maternal smokers (129) and non-smokers (232) served as comparison group (controls). We studied the influence of maternal smoking on foetal anthropometric growth parameters (BW, BL and head circumference defined according to AUDIPOG curves) in groups and compared cases and controls. Other causes of foetal growth restriction were excluded. RESULTS: Maternal characteristics (age, height, pre-pregnancy body weight, parity, foetus sex) were similar in both groups and sub-groups. Mothers who smoked were younger (P <0.001), more likely to be unemployed (P <0.001) and to have undergone less school education (P <0.001). Smoking did not alter foetal growth in preterm infants: maternal smokers versus non-smokers BW (P = 0.52), BL (P = 0.44) and HC (P = 0.81). Growth restriction was marked in term infants with BW (P <0.001), BL (P <0.001) and HC (P <0.01). In multivariate analysis, after adjustment for other confounding factors, foetal growth appeared to be significantly altered by maternal smoking during pregnancy only in term infants. CONCLUSION: Our study suggests that effects of maternal smoking during pregnancy on foetal growth are gestational age-dependent.

Background: Little is known about the influence of anaesthesia for caesarean section on outcome in very preterm infants.Methods: A prospective, population-based, cohort study (the EPIPAGE cohort) included all births before 33 weeks in nine French regions in 1997. Of 2360 infants live-born between 27 and 32 weeks, 1338 were delivered by caesarean section with general anaesthesia (n = 711, 53.1%). spinal anaesthesia (n = 419, 31.3%), or epidural anaesthesia (n = 208, 15.6%). Neonatal mortality was compared among these three groups Using bi-(according to gestational age and to anaesthetic technique) and multivariate analyses.Results: Neonatal mortality was 10.1% with general anaesthesia, 12.2% with spinal anaesthesia and 7.7% with epidural anaesthesia. After adjustment for gestational age and characteristics of pregnancy, delivery and neonate, spinal anaesthesia was associated with a higher risk of neonatal death than general anaesthesia (adjusted odds ratio, 1.7; 95% confidence interval 1.1 to 2.6).Conclusion: In this population-based study, spinal anaesthesia was associated with all increased risk of neonatal mortality in very preterm infants compared to general anaesthesia (and epidural anaesthesia), independently from gestational age and characteristics of the pregnancies, deliveries and neonates. Although this multivariate analysis does not prove a Causal relationship, the results suggest it could exist, particularly if maternal haemodynamics are poorly controlled. With recent significant change in file conduct of spinal anaesthesia, further studies are needed to investigate potential harmful effects of anaesthesia oil very preterm infants delivered by caesarean section. (C) 2008 Elsevier Ltd. All rights reserved.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 34 - N° HS1 - p. 249-254

Objective To assess the impact of antenatal corticosteroids (ACS) on neonatal mortality, cerebral lesions and 5-year neurodevelopmental outcome of infants born at 24-27 and 28-32 weeks of gestational age (GA).Design Observational population-based study including all births at GAs between 22 and 32 weeks in 1997 in nine regions of France. Survivors were assessed at the age of 5 years.Sample and methods The population enrolled in the follow up comprised 2323 infants; there were 23 deaths before age 5 years and outcome at 5 years was available for up to 1781 subjects. Two GA subgroups (24-27 and 28-32 weeks of GA) were analysed separately. Propensity scores were used to reduce bias in the estimation of the association between ACS treatment and outcomes.Main outcome measures Neonatal death, neonatal white matter injury, cerebral palsy, mental processing composite (MPC) of the Kaufman Assessment Battery for Children test and behavioural difficulties at 5 years.Results In the 28- to 32-week GA subgroup, there was a significant association between ACS and a decreased risk of both neonatal death (OR = 0.61 [0.41-0.91]) and white matter injury (OR = 0.60 [0.46-0.79]) but only a nonsignificant trend for improved 5-year outcome (cerebral palsy, MPC < 70). In the 24- to 27-week GA subgroup, ACS was associated with a significant decrease risk of neonatal death (OR = 0.43 [0.27-0.68]) but there was only a trend for a lower risk of white matter injury and no beneficial impact on outcome at 5 years. Limiting the analysis to only those who received complete courses of ACS did not modify the results.Conclusion The study shows that ACS therapy greatly increases the survival of very preterm infants, including the most immature, but there is little evidence that ACS affects long-term neurodevelopmental and behavioural outcome in 28- to 32-week survivors, and none in <28-week survivors.

OBJECTIVE:To estimate the prevalence of cerebral palsy at 2 years of age among children born very preterm, according to gestational age, infant gender, plurality, and neonatal cranial ultrasound abnormalities.METHODS:All infants born between 22 and 32 weeks of gestation in 9 regions of France in 1997 were included in this prospective, population-based, cohort study. The main outcome measure was cerebral palsy prevalence at 2 years. Of the 2364 survivors eligible for follow-up evaluation, 1954 (83%) were assessed at 2 years of age.RESULTS:Among the 1954 children assessed at 2 years, 8.2% had cerebral palsy. Bilateral spastic cerebral palsy, hemiplegia, and monoplegia accounted for 72%, 9%, and 10% of cases, respectively. Fifty percent of the children with cerebral palsy walked independently at the age of 2, 31% were unable to walk but could sit independently, and 19% could not sit (unable to maintain head and trunk control). The prevalence of cerebral palsy was 20% at 24 to 26 weeks of gestation, compared with 4% at 32 weeks. On the basis of ultrasound findings in the neonatal period, we found that 17% of children with isolated grade III intraventricular hemorrhage and 25% of children with white matter damage (ie, ventricular dilation, persistent echodensities, or cystic periventricular leukomalacia) had cerebral palsy, compared with 4% of children with normal ultrasound scans.CONCLUSIONS:Despite recent improvements in survival rates, cerebral palsy remains highly prevalent among very preterm children. Severe cranial ultrasound abnormalities predict motor disability strongly, but one third of infants with cerebral palsy had no ultrasound abnormalities.

The objective was to determine whether the temperament of very preterm singleton infants born before 29 weeks' gestation differs from their full-term counterparts at 9 months and to examine the influence of neurological sequelae on temperament in very preterm infants. The parents of very preterm infants from nine French regions and a group of full-term infants were sent the Infant Characteristics Questionnaire when the infants were 9 months old. The analysis included 266 singleton very preterm infants from the same regions born before 29 weeks' gestation and 546 full-term singleton infants. There were no significant differences for the Difficult, Unadaptable, and Unpredictable scales between very premature and term infants. Very preterm infants had a slightly higher Dull scale score than term infants. After taking into account mother's age, duration of hospitalization, and cerebral lesions found on neonatal ultrasound scans, this difference was no longer significant. Among very premature infants, those with cerebral lesions as diagnosed by neonatal ultrasound scan were rated higher on the Dull and Unadaptable scales. Delays in development at 9 months were also related to higher Dull and Unpredictable scales. These data suggest that prematurity does not affect temperament ratings at 9 months as assessed by the mother. However, very preterm infants with neurological insults, documented by the neonatal cerebral ultrasound or by a delay in development, are rated higher by their mothers on the Dull, Unadaptable, and Unpredictable scales.

Objectives: To assess the relation between cigarette smoking during pregnancy and neonatal respiratory distress syndrome (RDS) in very preterm birth, and to analyse the differential effect of antenatal steroids on RDS among smokers and non-smokers.Design: A population based cohort study (the French Epipage study).Setting: Regionally defined births in France.Methods: A total of 858 very preterm liveborn singletons (27-32 completed weeks of gestation) of the French Epipage study were included in this analysis. The odds ratio for RDS in relation to smoking in pregnancy was estimated using a logistic regression to control for gestational age. The odds ratio for RDS in relation to antenatal steroids was estimated taking into account an interaction between antenatal steroids and cigarette smoking, using multiple logistic regression to control for gestational age, birthweight ratio, main causes of preterm birth, mode of delivery, and sex.Results: The odds ratio for RDS in relation to smoking in pregnancy adjusted for gestational age (aOR) was 0.59 (95% confidence interval (CI) 0.44 to 0.79). The aOR for RDS in relation to antenatal steroids was 0.31 (95% CI 0.19 to 0.49) in babies born to non-smokers and 0.63 (95% CI 0.38 to 1.05) in those born to smokers; the difference was significant (p = 0.04).Conclusions: Cigarette smoking during pregnancy is associated with a decrease in the risk of RDS in very preterm babies. Although antenatal steroids reduce the risk of RDS in babies born to both smokers and non-smokers, the reduction is smaller in those born to smokers.

Objective: The purpose of this study was to examine the relationships between different causes of preterm delivery (eg, maternal hypertension, small-for-gestational age [SGA], other) and cerebral damage (eg, cystic periventricular leukomalacia [c-PVL], grade III intraventricular hemorrhage [IVH], and intra-parenchymal hemorrhage [IPH]).Study design: This study included 1902 very preterm singletons who were transferred to neonatal intensive care units in 9 French regions. We used logistic regression models to compare the risk of. cerebral injury associated with maternal hypertension, SGA, and all other causes of preterm delivery.Results: We found that the risk of c-PVL and grade III IVH was higher in infants born after preterm premature rupture of membranes (PPROM) with short latency or idiopathic preterm labor than in infants born to hypertensive mothers. We show that SGA and antepartum maternal hemorrhage significantly increase the risk of IPH.Conclusion: Our results show that infants born to hypertensive mothers have a lower risk of cerebral injuries than infants born following idiopathic preterm labor and PPROM because they are less exposed to prenatal infection. (c) 2005 Elsevier Inc. All rights reserved.

La face et ses constituants sont régulièrement concernés dans les syndromes malformatifs qu’ils soient d’origine génétique, toxique, infectieuse ou physique. Cette atteinte peut être morphologique et/ou biométrique. De nombreuses tables de référence de mesures ont été proposées, mais ces tables ne prennent pas en compte les variations biométriques en fonction de l’origine ethnique du fœtus. Or certaines caractéristiques de la face, morphologiques et/ou biométriques, sont plus ou moins accentuées selon le groupe ethnique, et permettent de rattacher l’individu à son groupe d’origine.

AIM:To estimate the re-hospitalization rate of extremely preterm children during infancy and associated factors after the recent improvement in survival rates.METHOD:The cohort included all children born before 29 wk of gestation in nine French regions in 1997. All admissions between discharge from initial hospitalization and 9 mo after birth were considered. Factors studied included the child's characteristics at birth and during neonatal hospitalization, risk factors for infection after discharge and parents' socio-demographic characteristics. Adjusted odds ratios (aOR) for re-hospitalization for all reasons and for respiratory disorders were obtained from logistic regression models.RESULTS:Of the 376 children, 178 were re-admitted at least once (47.3%; 95% CI: 42.3-52.4). Fifty-five percent of the hospitalized children were admitted at least once for respiratory disorders. The re-hospitalization rate was higher for children who had had chronic lung disease (aOR: 2.2; 95% CI: 1.3-3.7), those initially discharged between August and October (aOR: 2.5; 95% CI: 1.2-5.1) or between November and January (aOR: 3.2; 95% CI: 1.5-6.8), and children living with other children under six (aOR: 3.4; 95 %CI: 1.6-7.5). Re-hospitalizations were associated with neither gestational age nor the duration of neonatal hospitalization. Adjusted odds ratios for re-hospitalization for respiratory tract disorders were very similar to those for the overall hospitalizations.CONCLUSION:Infants born before 29 wk have a very high risk of re-hospitalization. The associated factors can help define high-risk groups at discharge from the neonatal unit who need special surveillance.

OBJECTIVE To evaluate the prevalence of cranial ultrasound abnormalities in very preterm infants as a function of gestational age, plurality, intrauterine growth restriction, and death before discharge. STUDY DESIGN A prospective, population-based cohort of 2667 infants born between 22 and 32 weeks of gestation in 1997 in nine regions of France, transferred to a neonatal intensive care unit, for whom at least one cranial ultrasound scan was available. RESULTS The frequencies of white matter damage (WMD), major WMD, cystic periventricular leukomalacia (PVL), periventricular parenchymal hemorrhagic involvement, and intraventricular hemorrhage with ventricular dilatation were 21%, 8%, 5%, 3%, and 3%, respectively. The risk of WMD increased with decreasing gestational age. Mean age at diagnosis of cystic PVL was older for the most premature infants. Intraventricular hemorrhage with ventricular dilatation was associated with a higher risk of cystic PVL. Intrauterine growth restriction was not associated with a lower prevalence of cystic PVL. CONCLUSION The frequency of WMD is high in very preterm babies and is strongly related to gestational age. The incidence of cystic PVL did not differ between babies with intrauterine growth restriction and babies who were appropriate for gestational age.