References of "RIGO, Vincent"
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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 detailAssessment of Continuous Pain in Newborns admitted to NICUs in 18 European Countries
Anand, Kanwaljeet; Eriksson, Mats; Boyle, Elaine et al

in Acta Paediatrica (in press)

Aim: Continuous pain occurs routinely, even after invasive procedures, or inflammation and surgery, but clinical practices associated with assessments of continuous pain remain unknown. Methods: A ... [more ▼]

Aim: Continuous pain occurs routinely, even after invasive procedures, or inflammation and surgery, but clinical practices associated with assessments of continuous pain remain unknown. Methods: A prospective cohort study in 243 Neonatal Intensive Care Units (NICUs) from 18 European countries recorded frequency of pain assessments, use of mechanical ventilation, sedation, analgesia, or neuromuscular blockade for each neonate upto 28 days after NICU admission. Results: Only 2113/6648 (31·8%) of neonates received assessments of continuous pain, occurring variably among tracheal ventilation (TrV, 46·0%), noninvasive ventilation (NiV, 35· 0%), and no ventilation (NoV, 20· 1%) groups (p<0· 001). Daily assessments for continuous pain occurred in only 10·4% of all neonates (TrV: 14· 0%, NiV: 10· 7%, NoV: 7· 6%; p<0· 001). More frequent assessments of continuous pain occurred in NICUs with pain guidelines, nursing champions, and surgical admissions prompted (all p<0·01), and for newborns <32 weeks gestational age, those requiring ventilation, or opioids, sedatives-hypnotics, general anesthetics (O-SH-GA) (all p<0·001), or surgery (p=0· 028). Use of O-SH-GA drugs increased the odds for pain assessment in the TrV (OR:1· 60, p<0·001) and NiV groups (OR:1·40, p<0· 001). Conclusion: Assessments of continuous pain occurred in less than one-third of NICU admissions, and daily in only 10% of neonates. NICU clinical practices should consider including routine assessments of continuous pain in newborns. [less ▲]

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See detailPremière consultation ambulatoire du nouveau-né
RIGO, Vincent ULg; PIELTAIN, Catherine ULg; Schoffeniels, Colombe et al

in Revue Médicale de Liège (2017), 72(5), 253-259

The focus on outpatient follow-up of newborn infants increases as the duration of hospital stay after birth decreases. The first outpatient visit addresses the adequacy of the home transition. Appropriate ... [more ▼]

The focus on outpatient follow-up of newborn infants increases as the duration of hospital stay after birth decreases. The first outpatient visit addresses the adequacy of the home transition. Appropriate feedings are checked. Sudden infant death syndrome prevention and security advices are reminded. Realisation of both neonatal dried blood screen and hearing test is confirmed, as well as planning of specific follow-up appointments. The physical exam will focus on red flags for diseases or malformations with a delayed presentation. [less ▲]

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See detailSalmonella thyphimirium early onset neonatal sepsis
Thirion, Sophie ULg; RIGO, Vincent ULg; Snyers, Diane ULg et al

Poster (2017, May)

Background: Early onset neonatal sepsis due to salmonella spp is rare in developed countries. Vertical and horizontal transmissions were described, including faecal contamination of the birth canal. After ... [more ▼]

Background: Early onset neonatal sepsis due to salmonella spp is rare in developed countries. Vertical and horizontal transmissions were described, including faecal contamination of the birth canal. After a short incubation period, newborns may remain asymptomatic or present with sepsis or meningitis. Mortality rate as high as 58% were reported. Case Presentation Summary: We report a case of transplacental Salmonella Typhimurium infection in a premature infant. A mother with a one day history of fever and diarrhoea spontaneously delivered a premature boy at 35 weeks of gestation. On day 3, the infant presented with symptoms suggesting necrotizing enterocolitis: apnea, respiratory distress, feeding intolerance, bloody diarrhea and fever. Feeding were suspended and intravenous antibiotic therapy (ampicillin, amikacine and metronidazole) initiated. Laboratory data showed an inflammatory syndrome with elevated C-reactive proteine (71 mg/l), leukocytopenia (7270/mm3) and severe lymphopenia (580/mm3). Enterocolitis stage 1 (Bell classification) was diagnosed based on clinical and radiological evaluation. Salmonella spp were grown from the baby’s blood and stools and from the mother’s stools; the National Reference Center identified a Salmonella Typhimurium. Cerebrospinal fluid culture remained sterile. Clinical and biological evolutions were rapidly favourable with 14-days of cefotaxim IV. Maternal history revealed consumption of raw meat 3 days before delivery.Learning Points/Discussion: Salmonella spp should be considered in the differential diagnosis of early onset sepsis, particularly when mother presents gastrointestinal symptoms. Food safety education is crucial. The consumption of raw or uncooked meat during pregnancy should be avoided regardless toxoplasmosis immunization status. To avoid outbreaks in the neonatal ward (as reported in the literature), rapid detection and prompt institution of isolation and clustering measures are important. [less ▲]

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See detailRigid catheters reduced duration of less invasive surfactant therapy procedures in manikins.
RIGO, Vincent ULg; Debauche, Christian; Maton, Pierre et al

in Acta Paediatrica (2017)

Aim: Different catheters can be used for less invasive surfactant therapy (LIST): feeding tubes inserted with or without Magill forceps, different angiocatheters and centre specific devices, such as ... [more ▼]

Aim: Different catheters can be used for less invasive surfactant therapy (LIST): feeding tubes inserted with or without Magill forceps, different angiocatheters and centre specific devices, such as umbilical catheters affixed to a stylet. This study compared the effectiveness of LIST devices and endotracheal tubes (ETT). Methods: Video recordings of 20 neonatologists simulating different LIST techniques on two manikin heads were analysed. Procedural effectiveness was evaluated by the duration of procedures and failure rates. Ease of use was scored. Results: The median procedure time for the Neonatal Intubation Trainer was significantly longer with feeding tubes without Maggil forceps. For the more difficult ALS Baby Trainer, successful procedures lasted a median of 24 (17-32) seconds with ETT, 24 (15-36) seconds with stylet-guided catheters and 34 (27-46) seconds and 37 (29-42) seconds with 13cm and 30cm angiocatheters, respectively. Both methods using feeding tubes were statistically slower than ETT intubation, lasting 32 (25-44) seconds and 39 (27-95) seconds with or without Maggil forceps. Failure rates (7-20%) were no different between the LIST methods. Techniques using feeding tubes were rated as more difficult. Conclusion: Only rigid or stylet-guided catheters required tracheal catheterisation times similar to those of endotracheal intubation and neonatologists found them easier.  KEY NOTES • This manikin study used video recordings of 20 neonatologists to compare the effectiveness of devices for less invasive surfactant therapy (LIST) and endotracheal tubes. • The durations of tracheal catheterisation for LIST using rigid or stylet-guided catheters were no different from those obtained with endotracheal tubes, but feeding tubes with or without Maggil forceps required longer procedures. • Neonatologists found rigid or stylet-guided catheters easier to use. [less ▲]

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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 detailCathéters pour instillation moins invasive de SURFACTANT : une étude de simulation
RIGO, Vincent ULg; Debauche, Christian; Maton, Pierre et al

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

Introduction et objectifs : l’instillation trachéale de surfactant par un cathéter fin (Less invasive surfactant therapy- LIST) chez le prématuré sous CPAP permet de diminuer la morbidité respiratoire ... [more ▼]

Introduction et objectifs : l’instillation trachéale de surfactant par un cathéter fin (Less invasive surfactant therapy- LIST) chez le prématuré sous CPAP permet de diminuer la morbidité respiratoire. Plusieurs cathéters sont décrits à cette fin : une sonde oro-gastrique insérée avec (LISA-Köln, K) ou sans pince de Maggil (Take Care- Ankara, A), un cathéter veineux de 13 cm (MIST- Hobart, H), un cathéter d’angiographie de 30 cm (Stockholm, S) ou un cathéter ombilical fixé à un stylet d’intubation utilisé localement (Liège, L). L’objectif de l’étude est d’évaluer l’efficacité de ces techniques en prenant l’INSURE (Intubation-Surfactant-Extubation) comme référence. Intervention : 20 néonatologues travaillant dans 4 services ayant des stratégies d’administration du surfactant différentes ont participé. Ils ont simulé ces 6 techniques sur deux têtes d’intubation de difficulté croissante. L’efficacité de l’intervention est évaluée par le taux d’échec et la durée de procédure mesurée sur vidéo. Chaque intervenant apprécie la facilité d’utilisation sur une échelle de 1 à 9 (Difficile> facile). Résultats : Pour le premier modèle, les durées médianes de procédure pour Köln et Ankara sont allongées [K: 21s (IQR 17-24); A: 23s (15-42); H: 10s (8-16); S: 12s (10-22); L (10-20); INSURE: 14s (11-21); p<.0001]. Pour le second modèle, seul Liège permet une durée de procédure similaire à l’INSURE [K: 32s (25-44); A: 39s (27-95); H: 34s (27-46); S: 37s (29-42); L: 24s (15-35); INSURE: 24s (17-32); p<.002]. Les taux d’échec des méthodes LIST sont similaires entre eux (de 3 à 8/ 40 essais), mais supérieurs à celui de l’INSURE (0/40). Köln et Ankara sont considérés comme plus difficiles [scores de facilité : K: 5 (4-6); A: 3 (2-4); H: 6,5 (6-7); S: 7 (4-8); L: 8 (6,5-8); INSURE: 7 (6-8); p<.001]. Conclusions : les cathéters plus rigides sont plus efficaces et perçus comme plus simples d’utilisation. L’insertion d’un cathéter guidé et incurvé pourrait être plus rapide dans les cas difficiles. [less ▲]

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See detailAjustement des marqueurs d’insertion des tubes endotrachéaux selon l’âge gestationnel.
RIGO, Vincent ULg; Fayoux, Pierre

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

Introduction et objectifs: le positionnement adéquat d’un tube endotrachéal (TET) peut être difficile en raison de la marge de manœuvre limitée associée aux faibles distances laryngo-trachéales du ... [more ▼]

Introduction et objectifs: le positionnement adéquat d’un tube endotrachéal (TET) peut être difficile en raison de la marge de manœuvre limitée associée aux faibles distances laryngo-trachéales du prématuré. Les marqueurs distaux censés faciliter l’évaluation de ce positionnement ne sont pas standardisés entre les fabriquants, et le marquage généralement unique par taille de tube ne tient pas compte de la croissance associée à l’âge gestationnel. L’objectif de l’étude est de décrire les distances entre les cordes vocales (CV) et la moitié de la trachée en fonction de l’âge gestationnel et proposer des nouveaux marquages adaptés. Méthodes : la moitié de la longueur de la trachée ajoutée à la hauteur de la lame postérieure du cricoïde permet d’estimer la distance entre les CV et la moitié de la trachée (CV-MiTr). Ces longueurs sont issues à postériori d’une base de données prospective reprenant les distances détaillées du larynx et de la trachée mesurées lors d’autopsies de fœtus et nouveau-nés exempts de malformation des voies respiratoires (Fayoux et coll., Journal of anatomy 2008). Une corrélation est établie avec l’âge gestationnel. Résultats : les données proviennent de 121 patients. Il existe une corrélation linéaire entre la distance CV-MiTr et l’AG (r=0,91; y=2,6043+0,6275x; p<.0001). Des marqueurs d’insertion positionnés à 17,7; 18,9; 20,8; 22,7; 24,6 et 26,4 mm correspondraient à des AG de 24, 26, 29, 32, 35 et 38 semaines respectivement. Ils pourraient être indiqués par des lignes de couleurs contrastées. Conclusion : la relation linéaire entre la distance CV-mi-trachée et l’AG donne l’opportunité de revoir les marqueurs d’insertion des tubes endotrachéaux pour les patients les plus petits. Ces nouveaux marqueurs devraient être comparés cliniquement à ceux actuellement en usage avant d’être généralisés. [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 detailDevices for less invasive surfactant therapy: a manikin study
RIGO, Vincent ULg; Debauche, Christian; Maton, Pierre et al

in European Journal of Pediatrics (2016, November), 175(11), 1756

Background: “Less invasive surfactant therapy” (LIST), or tracheal instillation of surfactant through a small catheter in spontaneously breathing infants, is gaining popularity. Different catheters are ... [more ▼]

Background: “Less invasive surfactant therapy” (LIST), or tracheal instillation of surfactant through a small catheter in spontaneously breathing infants, is gaining popularity. Different catheters are currently used for this purpose: a nasogastric tube inserted with (LISA) or without (Take Care) Magill’s forceps, a 13 cm 16G adult angiocath (MIST), a 30 cm F4 angiography catheter (Stockholm). We developed a specific device by combining a F5 umbilical catheter and an intubation stylet (Liege). We aimed to compare those 5 devices using INSURE as a reference. Methods: 20 neonatologists from 4 institutions supporting different surfactant instillation policies intubated 2 manikin heads with the 5 catheters and an endotracheal tube in a predetermined random sequence. Water was flushed trough the catheter. Video review provided times between laryngoscope (T1) or catheter insertion (T2) in the mouth and water flowing from the trachea. Participants gave an ease of use score (range: 1-9) for each catheter. Results: Procedural times were longer with the Take Care method and shorter with the Liège device (Table). Failure rates were higher for LIST procedures than for INSURE. Take Care and LISA were rated as more difficult, while Liège, Stockholm and INSURE were considered easier. Conclusions: LIST procedures remain difficult, even on a manikin. The choice of catheter is important. A device combining the rigidity of a stylet with the soft distal end of an umbilical catheter is associated with procedures of shorter duration and is considered easier by neonatologists. [less ▲]

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See detailOrganisation du post-partum à la sortie- Besoins spéciaux- Suivi des enfants à risque
RIGO, Vincent ULg

in Barlow, P; Ceysens, G; EMONTS, Patrick (Eds.) et al Guide du post-partum (2016)

Bien que la majorité des enfants ne nécessitent qu’un suivi de médecine préventive classique, différentes situations imposent une attention particulière pour permettre un dépistage et une prise en charge ... [more ▼]

Bien que la majorité des enfants ne nécessitent qu’un suivi de médecine préventive classique, différentes situations imposent une attention particulière pour permettre un dépistage et une prise en charge précoce. La discussion qui précède ne peut évidement être complète, et a pour but de rappeler des conditions fréquentes ou exemplatives. La recherche et la transmission des informations pendant la grossesse favorise la planification et la mise en place du suivi dès avant la naissance. Une communication adéquate entre les équipes anténatales, néonatales, pédiatriques et de post-partum permet d’améliorer l’organisation et l’efficacité des soins. Pour les intervenants du post-partum, la connaissance des conditions qui requièrent une attention particulière permet aussi de rappeler et renforcer les étapes initiales de prise en charge auprès des parents. [less ▲]

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See detailConjonctivite neonatale a Neisseria Gonorrhoeae : illustration clinique, prophylaxie et perspectives d'avenir
Tribolet, Sophie ULg; Gillard, Perrine ULg; Lefevre, Annabelle et al

in Archives de Pédiatrie (2016), 23(3), 297-300

A 6-day-old infant presented with a bilateral suppurative ocular discharge with a conjunctival erythema. Polymerase chain reaction was performed on the pus and showed the presence of Neisseria gonorrhoeae ... [more ▼]

A 6-day-old infant presented with a bilateral suppurative ocular discharge with a conjunctival erythema. Polymerase chain reaction was performed on the pus and showed the presence of Neisseria gonorrhoeae DNA. Therapy with intravenous cefotaxime was initiated and completed with local application of tobramycin. This infection was associated with a small unilateral corneal lesion, with rapid resolution. This case provides the opportunity to focus on newborn suppurative conjunctivitis and its treatment. The different prophylaxes available (silver nitrate, povidone-iodine, local antibiotics, etc.) and their respective advantages and disadvantages are reviewed. There is no clear consensus on the most effective solution. Additionally, universal prophylaxis is challenged in several countries, where it is no longer recommended. [less ▲]

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See detailInfection néonatale précoce à entérovirus: quand faut-il y penser?
Lagae, Donatienne; RIGO, Vincent ULg; Senterre, Jean-Marc et al

in Revue Médicale de Liège (2016), 71(2), 78-82

Enterovirus (EV) may cause a broad spectrum of clinical syndromes and even cause a sepsis-like picture. Although they are responsible for high morbidity and mortality rates, viral testing does not appear ... [more ▼]

Enterovirus (EV) may cause a broad spectrum of clinical syndromes and even cause a sepsis-like picture. Although they are responsible for high morbidity and mortality rates, viral testing does not appear in the algorithms for the evaluation of neonatal infections. During the month of June 2013, we identified 3 cases of EV meningitis in our unit of neonatology. All three infants had fever during the first week of life and their clinical examination revealed an irritability. The EV infection was detected by Real-Time Polymerase Chain Reaction (RT-PCR) EV on the cerebrospinal fluid (CSF). Two of the patients also had a positive RT-PCR EV in the blood. The 3 newborns were discharged from the hospital after a few days with no adverse outcome. Our clinical observations and the literature review suggest that EV infections in neonates ought to be identified as soon as possible by an early RT-PCR EV on the blood, and on the CSF if a lumbar puncture is indicated. This could help reduce the administration of antibiotics and the length of hospital stay. [less ▲]

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See detailDifférents manomètres pour améliorer la ventilation au masque et ballon
RIGO, Vincent ULg; Kreins, Nathalie; Eiras da Silva, Sandra et al

in Baud, Olivier; Saliba, Elie (Eds.) Congrès SFN-JFRN 2016, livre des communications (2015, December 17)

INTRODUCTION Les pressions employées lors de la ventilation au ballon sont difficiles à évaluer et souvent inadéquates. Les ballons disposent d’un connecteur où brancher un manomètre (manom) à ressort ou ... [more ▼]

INTRODUCTION Les pressions employées lors de la ventilation au ballon sont difficiles à évaluer et souvent inadéquates. Les ballons disposent d’un connecteur où brancher un manomètre (manom) à ressort ou une ligne vers un manom à cadran. Cependant, l’addition d’une variable à surveiller pourrait constituer une interférence et majorer le risque de fuite ou de rythme ventilatoire inadéquat. Cette étude évalue l’influence de manom simples sur la qualité de la ventilation. MÉTHODES Les participants aux Journées Belges de Pédiatrie pouvaient ventiler un mannequin aux voies respiratoires étanches avec un capteur de débit trachéal. Une pression de 25 mbar et une fréquence de 40 à 60/’ étaient visées. Une séquence de 45’’ avec un manom à ressort (R), une séquence avec un manom à cadran (C) et une sans (O) étaient réalisées dans un ordre aléatoire. La pression de pointe du ballon (P), le volume inspiratoire (VTi), et la fréquence de ventilation (FR) de chaque insufflation ont été analysées. La fuite autour du masque fut estimée en comparant VTi à un volume théorique dérivé d’une calibration avec masque scellé. RÉSULTATS Cinq néonatologues (Néo), 15 pédiatres et 11 internes ont réalisé 5279 insufflations. Les P obtenues avec un manom étaient plus élevées (O:176 mbar; R:184 mbar*; C:194 mbar*#) [*p<.05 vs O; #:p<.05 vs R] VTi augmentait légèrement (O:31 ml; R:3.11 ml*; C:3.21 ml*) FR était systématiquement trop élevé (77-82 bpm). L’usage d’un manom ne modifiait pas les paramètres pour les internes. Pour les Néo, ajouter un manom améliorait P, VTi et la fuite (P -O: 167 mbar; R and C: 204 mbar*) Sur les premières séquences de ventilation, le manom améliorait les paramètres (P-O: 124 mbar;R: 163 mbar*; C: 204 mbar*#), (VTi-O:21 ml; R:30.8 ml*; C:3.31 ml*#), (Fuite-O: 3816%; R: 2712%*; C: 3413%*#). CONCLUSIONS La ventilation au ballon reste difficile. Les pressions obtenues étaient éloignées de l’objectif, et le rythme souvent trop élevé. Si le manomètre permet d’améliorer les pressions et volumes obtenus, surtout en cas de ventilation sans feed-back préalable, cet effet bénéfique s’observe surtout pour les opérateurs expérimentés. Enfin, un congrès scientifique permet de recruter une population variée pour une étude de simulation simple. [less ▲]

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See detailThe Good, the Bad, the Marginal: respiratory management of <29 weeks infants according to subjective assessment of perinatal adaptation.
RIGO, Vincent ULg; KALENGA, Masendu ULg

Poster (2015, October)

Background Even if a primary CPAP strategy gives benefits in extremely preterm infants, many still require intubation at birth. Half of those initially managed with primary CPAP will require further ... [more ▼]

Background Even if a primary CPAP strategy gives benefits in extremely preterm infants, many still require intubation at birth. Half of those initially managed with primary CPAP will require further support: surfactant administration or mechanical ventilation. Those infants have increased risks of death and neonatal morbidities, and will require longer duration of respiratory support. Identifying them early, during the birth stabilization process, might lead to improvements in respiratory care. A subjective classification of perinatal adaptation as Good, Bad or Marginal has been suggested but requires further evaluation. We aimed to evaluate respiratory management according to perinatal adaptation. Methods Premature infants of less than 29 weeks and admitted between 01/2013 and 07/2014 were retrospectively studied. Neonatal database and discharge summaries provided neonatal care and outcome data. Good perinatal adaptation (GPA) was considered for infants with good respiratory drive, tone and low oxygen requirement in the delivery room. Infants with marginal (M) PA had intermittent respiratory drive, normocardia with ventilation, and decreasing FiO2. Bad (B) PA is considered with hypotonia, bradycardia, apnea and high FiO2. Data are presented as mean +/- SD, median (interquartile range) or incidence and analyzed with ANOVA, Kuskal-Wallis test or Chi2. Results Sixteen infants had GPA, 19 MPA and 23 BPA. GA was 26 4/7 wk (24-28) and BW was 885  187g. Risk factors for bad adaptation are (NS) male gender, lower GA, and no complete antenatal steroid exposure. Apgar at 1 min. increases with better PA [B3 (2-5); M6 (3-7) and G8 (7-8)*] (*p<.05 vs B & M), and improves at 5 min.: [B7 (6-7); M7 (6-8); G 9 (8-9)*]. Risk of intubation at birth is associated with poorer adaptation (B 87%; M 47%; G 12%, p<.01) Primary CPAP success was not different according to group (B 3/3; M66%; G56%). Surfactant while on CPAP (LISA method) was given to 11/16 patients, including 7 delivery room administrations. If intubated by day 3, duration of first invasive ventilation was shorter (NS) for GPA (9h) [MPA (15h), BPA (29h)]. Early neonatal death tended to decrease with better PA: 26%, 16% and 0% (p=.08). There is no difference in BPD -36 wk (B 19%, M13%, G 12%). Conclusions Infants with better perinatal adaptation have increased chances of being initially managed with CPAP. Primary CPAP success may be improved with less invasive surfactant therapy. Outside of the delivery room, perinatal adaptation assessment tends to identify risk of early neonatal death, but is not predictive of respiratory outcomes. [less ▲]

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See detailSedation and analgesia practices in neonatal intensive care units (EUROPAIN): results from a prospective cohort study.
Carbajal, R; Eriksson, M; Courtois, E et al

in Lancet Respiratory Medicine (2015), 3(10),

BACKGROUND: Neonates who are in pain or are stressed during care in the intensive care unit (ICU) are often given sedation or analgesia. We investigated the current use of sedation or analgesia in ... [more ▼]

BACKGROUND: Neonates who are in pain or are stressed during care in the intensive care unit (ICU) are often given sedation or analgesia. We investigated the current use of sedation or analgesia in neonatal ICUs (NICUs) in European countries. METHODS: EUROPAIN (EUROpean Pain Audit In Neonates) was a prospective cohort study of the management of sedation and analgesia in patients in NICUs. All neonates admitted to NICUs during 1 month were included in this study. Data on demographics, methods of respiration, use of continuous or intermittent sedation, analgesia, or neuromuscular blockers, pain assessments, and drug withdrawal syndromes were gathered during the first 28 days of admission to NICUs. Multivariable linear regression models and propensity scores were used to assess the association between duration of tracheal ventilation (TV) and exposure to opioids, sedatives-hypnotics, or general anaesthetics in neonates (O-SH-GA). This study is registered with ClinicalTrials.gov, number NCT01694745. FINDINGS: From Oct 1, 2012, to June 30, 2013, 6680 neonates were enrolled in 243 NICUs in 18 European countries. Mean gestational age of these neonates was 35.0 weeks (SD 4.6) and birthweight was 2384 g (1007). 2142 (32%) neonates were given TV, 1496 (22%) non-invasive ventilation (NIV), and 3042 (46%) were kept on spontaneous ventilation (SV). 1746 (82%), 266 (18%), and 282 (9%) neonates in the TV, NIV, and SV groups, respectively, were given sedation or analgesia as a continuous infusion, intermittent doses, or both (p<0.0001). In the participating NICUs, the median use of sedation or analgesia was 89.3% (70.0-100) for neonates in the TV group. Opioids were given to 1764 (26%) of 6680 neonates and to 1589 (74%) of 2142 neonates in the TV group. Midazolam was given to 576 (9%) of 6680 neonates and 536 (25%) neonates of 2142 neonates in the TV group. 542 (25%) neonates in the TV group were given neuromuscular blockers, which were administered as continuous infusions to 146 (7%) of these neonates. Pain assessments were recorded in 1250 (58%) of 2138, 672 (45%) of 1493, and 916 (30%) of 3017 neonates in the TV, NIV, and SV groups, respectively (p<0.0001). In the univariate analysis, neonates given O-SH-GA in the TV group needed a longer duration of TV than did those who were not given O-SH-GA (mean 136.2 h [SD 173.1] vs 39.8 h [94.7] h; p<0.0001). Multivariable and propensity score analyses confirmed this association (p<0.0001). INTERPRETATION: Wide variations in sedation and analgesia practices occur between NICUs and countries. Widespread use of O-SH-GA in intubated neonates might prolong their need for mechanical ventilation, but further research is needed to investigate the therapeutic and adverse effects of O-SH-GA in neonates, and to develop new and safe approaches for sedation and analgesia. FUNDING: European Community's Seventh Framework Programme [less ▲]

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See detailSmall manometers improve bag and mask ventilation: a manikin study
RIGO, Vincent ULg; Kreins, Nathalie; Eiras da Silva, Sandra et al

Poster (2015, September)

INTRODUCTION: Self-inflating bags (SIB) remain widely used for neonatal resuscitation. Insufflation pressures from SIB are difficult to assess and can be inadequate. Ventilation monitoring improves ... [more ▼]

INTRODUCTION: Self-inflating bags (SIB) remain widely used for neonatal resuscitation. Insufflation pressures from SIB are difficult to assess and can be inadequate. Ventilation monitoring improves pressure control, but is not accessible to most resuscitators. Small spring manometer or a pressure line to a needle and dial manometer can be connected through a side port on the SIB. Those devices are cheap and easily available, but their efficacy needs to be assessed. Observation of the manometer could also be considered as a distraction, with increased risk of leak or inadequate insufflation rate. We therefore aimed to evaluate the effect of mechanical manometers on the quality of insufflations with a SIB. MATERIALS AND METHODS: Participants to the Belgian Pediatric Society meeting were invited to ventilate a manikin with a 300 ml SIB. The leak-free manikin was modified with a flow-meter at tracheal level connected to a neonatal test lung. Participants had to aim for a 25 mbar pressure and a rate of 40-60 during 3 sequences of 45 seconds. A spring (S), a dial (D) manometer or nothing (N) was added to the SIB in random sequence. Pressure data from the SIB and flow data from the manikin were obtained through a ventilation monitor. Peak pressure (PIP), tidal volume (VTi), and insufflations rate (RR) were calculated for each breath. Theoretical leak was evaluated by subtracting real from theoretical volumes derived from a leak free calibration (taped facemask). Data were analyzed with ANOVA and posthoc Bonferroni. RESULTS Five neonatologists (Neo), 15 pediatricians (Ped) and 11 residents ventilated the manikin for a total of 5279 insufflations. Manometer use was associated with an increase in PIP (N: 17+-6 mbar; S: 18+-4 mbar*; D: 19+-4 mbar*#) [*p<.05 vs N; #:p<.05 vs S]. Changes in VTi (N: 3+-1 ml; S: 3.1+-1 ml*; D: 3.2+-1 ml*) and RR (77-82 bpm) were small. Leak did not increase. The effect of manometer use on PIP, VTi and leak was more important with Neo (PIP-N: 16+-7 mbar; S and D: 20+-4 mbar*) and Ped. With residents, no change occurred in PIP (~17 mbar), Vti (2.9 ml) or leak (31-35%). However, for first sequences of ventilation, manometer use was associated with higher PIP (N: 12+-4 mbar; S: 16+-3 mbar*; D: 20+-4 mbar*#), VTi (N:2+-1 ml; S:3+-0.8 ml*; D:3.3+-1 ml*#) and lower leaks (N: 38+-16%; S: 27+-12%*; D: 34+-13%*#). This observation for first sequences was found in all 3 categories of providers. CONCLUSIONS Bag and mask ventilation remains difficult. In this model, the addition of a manometer is associated with improved pressures and VTi, and with decreased theoretical leak. This effect is predominant for initial (“naïve”) ventilation with a dial manometer, and is also related to operator experience. Small, inexpensive manometers have the potential to improve SIB ventilation of newborn infants. [less ▲]

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See detailRespiratory monitoring to improve neonatal support at birth
RIGO, Vincent ULg

Conference (2015, July 15)

The assessment of an infant’s condition at birth or during resuscitation remains mostly clinical and can be a challenge for practitioners [1-3]. In 2005, the addition of the transcutaneous oxygen ... [more ▼]

The assessment of an infant’s condition at birth or during resuscitation remains mostly clinical and can be a challenge for practitioners [1-3]. In 2005, the addition of the transcutaneous oxygen saturation monitoring was suggested in the European guidelines [4] only to become part of AAP and ERC recommendations in 2010 [5, 6] By contrast, in the NICU, data from multimodal monitoring systems are generally integrated to the clinical evaluation to optimize newborn infants’ intensive care. Thus, respiratory mechanic information’s given by the ventilator provides useful informations on pressure, volume, leaks and respiratory function of the intubated infant [7]. While ventilation is the main intervention to support difficult transition to extra-uterine life, monitoring infants and medical procedures is only slowly integrating clinical practice in the delivery room [8]. Use of an experimental respiratory function monitor (RFM) at birth was suggested initially in 1984 in a study evaluating mask and bag ventilation in 9 term infants [9]. It reappeared 30 years later in a manikin study that discussed future use for research and as a training tool [10]. The RFM is connected to a computer for recording. A hot wire anemometer interposed between the mask and the pressure providing device (self-inflating bag SIB or T-piece) supply flow data, and therefore informations on tidal volume (VT), inspiratory and expiratory times, and leaks. The pressure line can be fitted at the T-piece gas inlet, the T-piece itself, or at a port on the SIB. Oxygen concentration can be quantified at the gas inlet, and integrated to the recording. Additionally, the software can accommodate heart rate and oxygen saturation data from a pulse oxymeter. A small webcam can also document both the infant’s visual aspect and actions undertaken. Clinical and simulation studies did highlight some technical difficulties of birth resuscitation and suggested ways to overcome them. Holding the face mask appropriately is surprisingly a difficult task. Large leaks are common, and are associated with lower VT’s [11]. Use of RFM in simulation studies allowed to investigate placement and hold of face masks [12]. Trainees also improved their technique when provided with RFM feedback [13]. RFM has been used to evaluate different pressure providing devices [14, 15]. The negative influence of chest compressions on the efficacy of manikin ventilation was documented with RFM [16]. In clinical practice, RFM was shown to decrease mask leak and helped to avoid excessive VT [17]. Currently, a randomized controlled trial evaluates if guiding neonatal resuscitation with RFM will improve infants’ outcomes. Studies with RFM in the delivery room did improve our understanding of respiratory adaptation at birth. Patterns of initial respirations have been further characterized, with long or delayed expirations observed mostly in preterm infants [18]. Very preterm infants’ respiration starts with increasing VT’s followed by smaller breaths and increased CO2 exhalation[19]. With face mask ventilation, VT’s have a large variability, with lower volumes occurring when active inspiration is absent [11]. Additionally, obstructive phenomena (when positive pressure is not associated with insufflatory flow) seem common in the first minutes of life [20]. Our neonatal stabilization room now benefits from a RFM. This tool already has multiple applications. For new residents and for outreach training, the RFM helps to improve mask ventilation teaching on a leak-free manikin. Combined video and RFM recordings can be reviewed for educational and auditing purposes. We used it in a manikin study, to assess if different types of small manometers could improve bag and mask ventilation. Finally, RFM helps to evaluate the outcome of a resuscitation intervention in a randomized controlled trial. We are investigating the effect of either prophylactic suction before ventilation (as recommended by the AAP [6]) or no systematic suction (as in the ERC guidelines [5]) on the incidence of airway obstructions and neonatal adaptation. [less ▲]

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See detailConjonctivite néonatale à Neisseria Gonorrhoeae: pas seulement du passé
Tribolet, Sophie; Lefevre, Annabelle; Gillard, Perrine et al

in Tijdschrift van de Belgische Kinderarts = Journal du Pédiatre Belge (2015, March 13), 17(1), 113

L’ophtalmie néonatale n’appartient pas qu’au passé, l’incidence d’infections à Neisseria Gonorrhaea étant en augmentation en Belgique. Différentes prophylaxies sont proposées (nitrate d’argent, povidone ... [more ▼]

L’ophtalmie néonatale n’appartient pas qu’au passé, l’incidence d’infections à Neisseria Gonorrhaea étant en augmentation en Belgique. Différentes prophylaxies sont proposées (nitrate d’argent, povidone iodine, tétracycline, érythromycine, acide fusidique), avec leurs avantages et inconvénients respectifs. Aucun consensus clair n’est établi quant à la solution la plus efficace, certains remettant en doute leur utilisation dans les pays développés. [less ▲]

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See detailSubjective assessment of perinatal adaptation and respiratory management in <29 weeks infants
RIGO, Vincent ULg; BROUX, Isabelle ULg; de HALLEUX, Virginie ULg et al

Poster (2015, March 12)

Background A primary CPAP strategy is beneficial even in extremely preterm infants. Many still require intubation for stabilization. Half of those managed with primary CPAP will also require further ... [more ▼]

Background A primary CPAP strategy is beneficial even in extremely preterm infants. Many still require intubation for stabilization. Half of those managed with primary CPAP will also require further support: surfactant administration or mechanical ventilation, and have increased risks of death or neonatal morbidities, and will require longer respiratory support. Identifying them early, during the birth stabilization process, might lead to improvements in respiratory care. A subjective classification of perinatal adaptation as Good, Bad or Marginal has been suggested but not evaluated. Methods Single center retrospective study of <29 weeks premature infants admitted between 01/2013 and 07/2014. Neonatal database and discharge summaries provide neonatal care and outcome data. Good perinatal adaptation (GPA) is considered for infants with good respiratory drive, tone and low oxygen requirement in the delivery room. Infants with marginal (M) PA had intermittent respiratory drive, normocardia with ventilation, and decreasing FiO2. Bad (B) PA is considered with hypotonia, bradycardia, apnea and high FiO2. Results Among 58 infants (50 inborn), 16 had GPA, 19 MPA and 23 BPA. Risk factors for bad adaptation are (not significantly different-NS) male gender, lower GA , and absent/incomplete antenatal steroid exposure. Apgar score at 1 minute increases according to perinatal adaptation quality (B3,5; M5,5 and G7,4; p<0,01), with improvements at 5 minutes: 6,6; 7,0 (NS) and 8,3 (p(B)<0,01). Risk of intubation in the delivery room is associated with poorer adaptation: B83%, M58% and G12% (p<0,01). Primary CPAP success was not different according to groups (B 3/3; M66%; G56%). However, more infants with MPA received surfactant while on CPAP (LISA method): B 2/3; M:5/6 and G:4/7. This surfactant was given in the delivery room in 1, 4 and 2 infants respectively. For children intubated within day 3, the duration of the first invasive ventilation duration was 29 hours (B), 15h (M) and 9h (G), NS. Risk of early neonatal death decreases with improving perinatal adaptation: 26%, 16% (NS) and 0% (pB <0,05). Risk of BPD at 36 weeks is not different among groups (B 19%, M13%, G 12%), but combined risk of death or BPD at 36 weeks tends to decreases (B 43%, M 31%, G 12%, p=0,12). Conclusions Better perinatal adaptation improves chances of being initially managed with CPAP. CPAP success may be improved with less invasive surfactant therapy, especially in preterm infants with marginal adaptation. Perinatal adaptation assessment identifies mortality risk. [less ▲]

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