References of "BROUX, Isabelle"
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See detailRigid catheters reduced duration of less invasive surfactant therapy procedures in manikins.
RIGO, Vincent ULiege; 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 ULiege; LEFEBVRE, Caroline ULiege; BROUX, Isabelle ULiege

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

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 ULiege; 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 detailSubjective assessment of perinatal adaptation and respiratory management in <29 weeks infants
RIGO, Vincent ULiege; BROUX, Isabelle ULiege; de HALLEUX, Virginie ULiege 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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See detailIs early aggressive feeding dangerous for extremely low birth weight infants?
Blecic, Anne-Sophie; Delbos, Marion; RIGO, Vincent ULiege et al

in Tijdschrift van de Belgische Kinderarts (2015), 17(1), 83

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See detailCerebellar hemorrhage : a rare condition in the term infant
MERINDOL, Ninon; BROUX, Isabelle ULiege; DECORTIS, Thierry et al

Poster (2015)

Cerebellar hemorrhage is a rare condition in full-term newborns. Early diagnosis based on the identification of risk factors, particular clinical signs and correct medical imaging is primordial to ... [more ▼]

Cerebellar hemorrhage is a rare condition in full-term newborns. Early diagnosis based on the identification of risk factors, particular clinical signs and correct medical imaging is primordial to optimize the immediate treatment and to assess the long term prognosis. [less ▲]

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