References of "LEFEBVRE, Caroline"
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See detailMathematical bias in assessment of placental residual blood volume
RIGO, Vincent ULg; LEFEBVRE, Caroline ULg; Kalenga, Masendu ULg

in Journal of Perinatology (in press)

This letter suggest a new computation of the relative placental residual blood volume.

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See detailInstillation de surfactant chez le prématuré en respiration spontanée : méta-analyse
RIGO, Vincent ULg; LEFEBVRE, Caroline ULg; BROUX, Isabelle ULg

in Baud, Olivier; Saliba, Elie (Eds.) Congrès SFN-JFRN 2016, livre des communications (2016, December 15)

Justification: Lors du traitement par surfactant dit moins invasif (Less invasive surfactant therapy- LIST), le produit est instillé dans la trachée par un cathéter fin alors que l’enfant respire ... [more ▼]

Justification: Lors du traitement par surfactant dit moins invasif (Less invasive surfactant therapy- LIST), le produit est instillé dans la trachée par un cathéter fin alors que l’enfant respire spontanément sous CPAP. Différentes études ont donné des résultats variables mais encourageants. L’objectif de cette méta-analyse est de comparer le devenir respiratoire des prématurés traités par LIST avec celui de ceux traités par administration de surfactant par un tube endotrachéal. Méthodes : les études randomisées contrôlées (ERC) sont recherchées dans les bases de données et dans les références d’articles pertinents. Les devenirs respiratoires (dysplasie broncho-pulmonaire (DBP), décès ou DBP, échec précoce de CPAP, nécessité de ventilation invasive) et les morbidités classiques sont reprises de ces études. Pour chaque morbidité, le risque relatif (RR) des données mutualisées est calculé avec une analyse de Mantel-Haenszel à modèle d’effet aléatoire. Le RR est également calculé pour des sous-groupes établis selon l’intervention contrôle. Résultats : six ERC évaluent le LIST : 4 le comparent à l’INSURE (Intubation-Surfactant-Extubation), et les 2 autres à l’intubation (immédiate ou après maintient en CPAP) avec surfactant. Les méthodes LIST diminuent les risques de DBP (RR= 0,71 (0,52-0,99) ; nombre nécessaire à traiter NNT= 21), et de décès ou DBP (RR= 0,7 (0,58- 0,94) ; NNT= 15). L’échec précoce de CPAP et le recours à la ventilation invasive sont également réduits (RR= 0,67 (0,53-0,84) ; NNT= 8 et RR= 0,69 (0,53- 0,88) ; NNT= 6). Comparé à l’INSURE, le LIST diminue le risque combiné de décès ou DBP (RR= 0,63 (0,44-0,92) ; NNT= 11), et d’échec précoce de CPAP (RR=0,71 (0,53-0,96) ; NNT= 11). Les autres morbidités néonatales classiques sont similaires pour les différents groupes. Conclusions : une stratégie d’administration dite moins invasive de surfactant diminue les risques de morbidité respiratoire à moyen terme (DBP, décès ou DBP) et le recours à la ventilation invasive. Cette approche semble sure mais les données de suivi à long terme sont insuffisantes. [less ▲]

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See detailSurfactant instillation in spontaneously breathing preterm infants: a systematic review and meta-analysis.
RIGO, Vincent ULg; LEFEBVRE, Caroline ULg; BROUX, Isabelle ULg

in European Journal of Pediatrics (2016), 175(12), 1933-1942

Less invasive surfactant therapies (LIST) use surfactant instillation through a thin tracheal catheter in spontaneously breathing infants. This review and meta-analysis investigates respiratory outcomes ... [more ▼]

Less invasive surfactant therapies (LIST) use surfactant instillation through a thin tracheal catheter in spontaneously breathing infants. This review and meta-analysis investigates respiratory outcomes for preterm infants with respiratory distress syndrome treated with LIST rather than administration of surfactant through an endotracheal tube. Randomised controlled trial (RCT) full texts provided outcome data for bronchopulmonary dysplasia (BPD), death or BPD, early CPAP failure, invasive ventilation requirements and usual neonatal morbidities. Relative risks (RR) from pooled data, with subgroup analyses, were obtained from a Mantel-Haenszel analysis using a random effect model. Six RCTs evaluated LIST: 4 vs InSurE and 1 each vs delayed or immediate intubation for surfactant. LIST resulted in decreased risks of BPD (RR = 0.71 [0.52-0.99]; NNT = 21), death or BPD (RR = 0.74 [0.58-0.94]; NNT = 15) and early CPAP failure or invasive ventilation requirements (RR = 0.67 [0.53-0.84]; NNT = 8 and RR = 0.69 [0.53-0.88]; NNT = 6). Compared to InSurE, LIST decreased the risks of BPD or death (RR = 0.63 [0.44-0.92]; NNT = 11) and of early CPAP failure (RR = 0.71 [0.53-0.96]; NNT = 11). Common neonatal morbidities were not different. CONCLUSIONS: Respiratory management with LIST decreases the risks of BPD and BPD or death, and the need for invasive ventilation. This strategy appears safe, but long-term follow-up is lacking. WHAT IS KNOWN: • Initial management of preterm infants with CPAP decreases the risk of death or BPD, but many still require surfactant or invasive ventilation. • Surfactant can be instilled through a tracheal thin catheter while the infant breathes on CPAP, but improvement in BPD is inconsistent between studies. What is New: • Less invasive surfactant therapy (LIST) strategies decrease the risks of BPD, of death or BPD, and of CPAP failure compared to strategies where surfactant is administered through an endotracheal tube. • LIST strategies decrease the risks of the composite outcome of BPD or death and of early CPAP failure when compared to "intubation-surfactant-extubation" approaches. [less ▲]

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See detailCORD DONOR Safety
BAUDOUX, Etienne ULg; Lefebvre, Caroline ULg; FASTH, Anders

Conference (2014, May 16)

As for any cell donation, donor safety parameters must be included in the design of cord blood (CB) collection procedures. Until recently, CB donation has been regarded as a relatively safe procedure, and ... [more ▼]

As for any cell donation, donor safety parameters must be included in the design of cord blood (CB) collection procedures. Until recently, CB donation has been regarded as a relatively safe procedure, and practices have evolved from the early stages of CB banking to make reasonable provisions to protect mothers and infant donors from harm linked to CB donation: informed consent, exclusion of complicated pregnancies and deliveries, as well as of pre-term births, non-interference with obstetrical practices, use of trained staff for CB collection, standardized aseptic collection practices, donation limited to single births. Besides, professional standards foresee careful record keeping of clinical side effects that may occur in the course of CB collection. Since 2011 time to cord clamping has become a concern in the light of publications on iron depletion and post natal outcome, including neurological development, and linked to early or late cord clamping at birth. As data show benefits of late clamping in low birth weight infants in terms of anemia and iron stores, it now admitted by professional organizations to delay cord clamping for 1 minute after birth, especially for pre-term births. However, in full term births after uncomplicated pregnancy, that are the target population for CB donation, there is no clear indication to confirm or refute benefits of late clamping. In some countries, sometimes emotional awareness has increased about optimal timing of cord clamping, leading to some resistance to CB donation and to questioning of the harmless reputation of CB donation. CB banking professionals however have not changed their recommendations, leaving up to obstetrical teams the decision to collect or not, after risk benefit assessment. However, CB bankers remain with the duty of providing transparent and up to date information to mothers, as well as of setting up accurate policies regarding informed consent. [less ▲]

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