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Article ; Online: Evolution of Carboxyhemoglobin in Children Supported by Extracorporeal Membrane Oxygenation: An Observational Single-Center Study.

Brohan, Orlane / Liet, Jean-Michel / Dejoie, Thomas / Jegard, Julien / Gaultier, Aurélie / Bourgoin, Pierre / Joram, Nicolas / Chenouard, Alexis

ASAIO journal (American Society for Artificial Internal Organs : 1992)

2023 Volume 69, Issue 9, Page(s) 879–884

Abstract: Carboxyhemoglobin (COHb) is potentially a novel marker of hemolysis on extracorporeal membrane oxygenation (ECMO) and may be useful as an indicator for circuit-related complication in adults, but little is known about COHb levels in children. An ... ...

Abstract	Carboxyhemoglobin (COHb) is potentially a novel marker of hemolysis on extracorporeal membrane oxygenation (ECMO) and may be useful as an indicator for circuit-related complication in adults, but little is known about COHb levels in children. An observational single-center study was performed between January 2018 and December 2021. Fifty-eight children were included and COHb levels were obtained along with routine blood gas analysis before, during, and after ECMO support. From the 6th hour of ECMO support, the COHb level increased relative to the pre-ECMO level, with an adjusted mean difference of 0.44 (95% confidence interval [CI], 0.26-0.62; p < 0.001) and remained higher during ECMO run and within 6 hours after weaning ( p < 0.001). Among the 18 children (31%) who experienced at least one circuit-related complication leading to a circuit change, we observed a significant decrease in COHb levels within 24 hours after the circuit change, compared with the 24 hours before (adjusted mean difference, 0.54%; 95% CI, 0.27-0.80; p < 0.001). The maximal daily COHb level was able to predict circuit-related complications within 24 hours following COHb measurement with an area under the receiver operating characteristic (ROC) curve of 0.85 (95% CI, 0.77-0.92; p < 0.001).
MeSH term(s)	Adult ; Humans ; Child ; Carboxyhemoglobin/analysis ; Extracorporeal Membrane Oxygenation/adverse effects ; Hemolysis ; Retrospective Studies
Chemical Substances	Carboxyhemoglobin (9061-29-4)
Language	English
Publishing date	2023-08-01
Publishing country	United States
Document type	Observational Study ; Journal Article
ZDB-ID	759982-1
ISSN	1538-943X ; 0162-1432 ; 1058-2916
ISSN (online)	1538-943X
ISSN	0162-1432 ; 1058-2916
DOI	10.1097/MAT.0000000000001983
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Article ; Online: Acinar Dysplasia in a Full-Term Newborn with a NKX2.1 Variant.

Soreze, Yohan / Nathan, Nadia / Jegard, Julien / Hervieux, Erik / Clermidi, Pauline / Sileo, Chiara / Louvrier, Camille / Legendre, Marie / Coulomb L'Herminé, Aurore

Neonatology

2023 Volume 121, Issue 1, Page(s) 133–136

Abstract: Acinar dysplasia (AcDys) is one of the three main diffuse developmental disorders of the lung. The transcription factor NK2 homeobox 1 (NKX2.1) partly controls the synthesis of surfactant proteins by type 2 alveolar epithelial cells (AEC2), and germline ... ...

Abstract	Acinar dysplasia (AcDys) is one of the three main diffuse developmental disorders of the lung. The transcription factor NK2 homeobox 1 (NKX2.1) partly controls the synthesis of surfactant proteins by type 2 alveolar epithelial cells (AEC2), and germline mutations are known to be associated with brain-lung thyroid syndrome. We report the case of a full-term neonate who developed refractory respiratory failure with pulmonary hypertension requiring venoarterial extracorporeal membrane oxygenation. Histological examination of the lung biopsy specimen was consistent with the diagnosis of AcDys. Molecular analyses led to the identification of the missense heterozygous variant in NKX2.1 (NM_001079668) c.731A>G p.(Tyr244Cys), which is predicted to be pathogenic. After 5 weeks, because AcDys is a fatal disorder and the patient's status worsened, life-sustaining therapies were withdrawn, and she died after a few hours. This study is the first to extend the phenotype of NKX2.1 pathogenic variant, to a fatal form of AcDys.
MeSH term(s)	Infant, Newborn ; Female ; Humans ; Mutation ; Lung/metabolism ; Transcription Factors/genetics ; Transcription Factors/metabolism ; Respiratory Insufficiency/genetics ; Respiratory Insufficiency/therapy ; Respiratory Distress Syndrome, Newborn/diagnosis ; Respiratory Distress Syndrome, Newborn/genetics
Chemical Substances	Transcription Factors
Language	English
Publishing date	2023-11-30
Publishing country	Switzerland
Document type	Case Reports
ZDB-ID	2266911-5
ISSN	1661-7819 ; 1661-7800
ISSN (online)	1661-7819
ISSN	1661-7800
DOI	10.1159/000534076
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Article ; Online: Effectiveness of intraoperative use of dexmedetomidine in reducing the incidence of tachyarrhythmia after congenital cardiac surgery in neonates and infants: a doubly robust method estimation analysis.

Bourgoin, Pierre / Jegard, Julien / Joram, Nicolas / Fox, Sylvain / Biard, Marc / Fernandez, Modesto / Baruteau, Alban Elouen / Dejoie, Thomas / Ferdynus, Cyril / Chenouard, Alexis

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery

2023 Volume 63, Issue 4

Abstract: Objectives: The antiarrhythmic effects of dexmedetomidine (DEX) have been suggested, but there are controversial reports on the effectiveness of intraoperative use of DEX to reduce the incidence of postoperative tachyarrhythmia (POT).: Methods: From ... ...

Abstract	Objectives: The antiarrhythmic effects of dexmedetomidine (DEX) have been suggested, but there are controversial reports on the effectiveness of intraoperative use of DEX to reduce the incidence of postoperative tachyarrhythmia (POT). Methods: From a local European Congenital Heart Surgery Association database, we included patients operated for congenital heart diseases under cardiopulmonary bypass within a 5-year period (2017-2021), during which intraoperative use of high dose of DEX (1-1.4 µg/kg/h) was implemented. A doubly robust matching estimation of the causal effect of DEX on the incidence of POT was conducted. We combined a multimodal estimation model in patients not exposed to DEX (disease risk score) as well as a regression analysis in a matched cohort for patients exposured to DEX. Results: From a cohort of 593 surgeries (514 patients) occurring during the study period, doubly matched analysis consisted of the analysis of 426 surgeries conducted under DEX or not (213 per group). The probability of developing POT in patients exposed to DEX was 6.6% (95% confidence interval 0.032-0.099) vs 14.5% (95% confidence interval 0.098-0.193) in the group of patients not exposed to DEX. The doubly robust matched estimation method showed a mean reduction of 8.8% (95% confidence interval -0.137 to -0.023) of POT when DEX is used for intraoperative anaesthesia. Conclusions: The use of high doses of DEX during anaesthesia for congenital heart surgery in neonates and infants is associated with a moderate but significant reduction of POT.
MeSH term(s)	Infant, Newborn ; Humans ; Infant ; Dexmedetomidine/therapeutic use ; Incidence ; Cardiac Surgical Procedures/adverse effects ; Tachycardia/epidemiology ; Tachycardia/prevention & control ; Tachycardia/chemically induced ; Heart Defects, Congenital/surgery
Chemical Substances	Dexmedetomidine (67VB76HONO)
Language	English
Publishing date	2023-03-01
Publishing country	Germany
Document type	Journal Article
ZDB-ID	639293-3
ISSN	1873-734X ; 1010-7940 ; 1567-4258
ISSN (online)	1873-734X
ISSN	1010-7940 ; 1567-4258
DOI	10.1093/ejcts/ezad076
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Article ; Online: Usefulness of implementation of a protective mechanical ventilation bundle during extracorporeal membrane oxygenation for pediatric acute respiratory distress syndrome.

Jegard, Julien / Levy, Yael / Guellec, Isabelle / Guilbert, Julia / Soreze, Yohann / Piloquet, Jean-Eudes / Starck, Julie / Jean, Sandrine / Léger, Pierre-Louis / Rambaud, Jerome

Minerva pediatrics

2022

Abstract: Objective: Defining the best ventilatory settings under ECMO remains a challenging question. Despite a well-defined ARDS treatment before ECMO initiation, there is no recommendation on how to ventilate a patient under ECMO for P-ARDS. Only a few ... ...

Abstract	Objective: Defining the best ventilatory settings under ECMO remains a challenging question. Despite a well-defined ARDS treatment before ECMO initiation, there is no recommendation on how to ventilate a patient under ECMO for P-ARDS. Only a few descriptive studies are available on ventilatory settings during respiratory ECMO. We aim at evaluating the usefulness of a protective ventilation bundle under ECMO and its capacity to reduce the ventilatory pressure in our ECMO center. Methods: We performed a monocentric retrospective study from January 2007 to December 2018. All children aged from 1 month to 18 years old and requiring an extracorporeal membrane oxygenation for a refractory acute respiratory distress syndrome were included. A protective mechanical ventilation under ECMO bundle has been developed in 2014. We compare the period 1 (before 2014) to the period 2 (after 2014). Results: Eighty-three patient had been included during the study. We reported a significant increase of PEEP and mean pressure respectively at day 3, day 7 and day 14 of ECMO during the period 2. Conversely, the driving pressure were significantly lower in the period 2 at day 3 (p: 0.009), day 7 (p:0.001) and day 14 (p: 0.001). We also shown a strong increase in the use of prone positioning during ECMO in the period 2 (p: 0.01). There was no significant effect of our bundle on the length of mechanical ventilation, of hospitalization and on the survival rate. Conclusions: The implementation of a protective mechanical ventilation bundle during ECMO is usefulness to apply for lower ventilatory pressure and higher use of prone positioning. Nonetheless, the lack of power of our study prevents us from showing its efficacy on outcome criteria.
Language	English
Publishing date	2022-02-15
Publishing country	Italy
Document type	Journal Article
ZDB-ID	3062664-X
ISSN	2724-5780
ISSN (online)	2724-5780
DOI	10.23736/S2724-5276.22.06391-1
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Article: The Wide Spectrum of COVID-19 Clinical Presentation in Children.

Nathan, Nadia / Prevost, Blandine / Sileo, Chiara / Richard, Nicolas / Berdah, Laura / Thouvenin, Guillaume / Aubertin, Guillaume / Lecarpentier, Thibault / Schnuriger, Aurélie / Jegard, Julien / Guellec, Isabelle / Taytard, Jessica / Corvol, Harriet

Journal of clinical medicine

2020 Volume 9, Issue 9

Abstract: Background: ...

Abstract	Background:
Keywords	covid19
Language	English
Publishing date	2020-09-12
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm9092950
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Article ; Online: Extracorporeal membrane oxygenation for immunocompromised children with acute respiratory distress syndrome: a French referral center cohort.

Robert, Blandine / Guellec, Isabelle / Jegard, Julien / Jean, Sandrine / Guilbert, Julia / Soreze, Yohan / Starck, Julie / Piloquet, Jean-Eudes / Leger, Pierre-Louis / Rambaud, Jerome

Minerva pediatrics

2020 Volume 74, Issue 5, Page(s) 537–544

Abstract: Background: Immunocompromised children are likely to develop a refractory acute respiratory distress syndrome (ARDS). The usefulness of providing extracorporeal life support (ECLS) to these patients is a subject of debate. The aim of our study was to ... ...

Abstract	Background: Immunocompromised children are likely to develop a refractory acute respiratory distress syndrome (ARDS). The usefulness of providing extracorporeal life support (ECLS) to these patients is a subject of debate. The aim of our study was to report the outcomes and to compare factors associated with mortality between immunocompromised and non-immunocompromised children supported with veno-venous ECMO. Methods: We performed a retrospective monocentric study in the French pediatric ECMO center of Armand Trousseau Hospital, including all pediatric patients aged from 1 month to 18 years requiring ECLS for ARDS. Results: Between 2007 and 2018, one hundred and eleven (111) patients underwent ECMO for respiratory failure; among them twenty-five (25) were immunocompromised. Survival rate at 6 months after intensive care discharge was significantly lower for immunocompromised patients compared to non-immunocompromised ones (41.7% vs. 62.8%; P=0.0.04). ARDS severity was similar between the 2 groups. Fungal pneumonias were reported only in immunocompromised patients (12.5% versus 0% in the control group; P=0.0.001). Bleeding complications were significantly more frequent in the immunocompromised group and blood product transfusions were also more frequently required in this group. Conclusions: Six months after intensive care discharge, survival rate of immunocompromised children supported with ECMO for pediatric ARDS is lower than for non-immunocompromised patients. But the expectation for a favorable outcome is real and it is worth it if their condition is likely to be compatible with a good long-term quality of life.
MeSH term(s)	Humans ; Child ; Extracorporeal Membrane Oxygenation/adverse effects ; Retrospective Studies ; Quality of Life ; Respiratory Distress Syndrome/therapy ; Referral and Consultation
Language	English
Publishing date	2020-09-22
Publishing country	Italy
Document type	Journal Article
ZDB-ID	3062664-X
ISSN	2724-5780
ISSN (online)	2724-5780
DOI	10.23736/S2724-5276.20.05725-4
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Article ; Online: The Wide Spectrum of COVID-19 Clinical Presentation in Children

ISSN: 2077-0383 ; Journal of Clinical Medicine ; https://hal.sorbonne-universite.fr/hal-02988401 ; Journal of Clinical Medicine, MDPI, 2020, 9 (9), pp.2950. ⟨10.3390/jcm9092950⟩

2020

Abstract: International audience ... Background: Ten months after its appearance in December 2019, SARS-CoV-2 has infected more than 25 million patients worldwide. Because children were first identified as potential spreaders of the virus, schools were closed in ... ...

Abstract	International audience Background: Ten months after its appearance in December 2019, SARS-CoV-2 has infected more than 25 million patients worldwide. Because children were first identified as potential spreaders of the virus, schools were closed in several countries. However, it rapidly became evident that the number of hospitalized children infected by SARS-CoV-2 was dramatically lower than that of adults. To date, only hypotheses have been raised to explain this difference, so it is of great importance to describe the presentation of this disease among children. Here, we describe a wide spectrum of COVID-19 manifestation in children in a dedicated pediatric unit in France. Methods: Patients hospitalized with COVID-19 who were diagnosed on the basis of either positive SARS-CoV-2 RT-PCR in nasopharyngeal swabs and/or typical aspects in chest-computed tomography (CT) were included between March and May 2020 in Paris. Results: Twenty-three patients were included on the basis of positive RT-PCR (n = 20) and/or typical aspects in CT (n = 4). The median age was 4.9 years [0.1-17.6]. Patients were grouped by age (<2 years old: n = 14, 61%; 2-10 years old: n = 2, 9%; >10 years old: n = 7, 30%). Overweight or obesity was reported in only three patients. At presentation, the most frequent symptom in the overall cohort was fever (n = 18, 78%), followed by acute rhinitis (n = 9, 64%) and cough (n = 7, 50%) in the under 2-year-old group and cough (n = 4, 57%), fatigue, dyspnea and abdominal pain (n = 3, 43% each) in the over 10-year-old group. Five patients required ICU treatment, four of whom were aged >10 years, two presented with acute myocarditis, and two were sickle cell disease patients who presented with acute chest syndrome. Discussion and conclusion: The youngest patients seem to present milder forms of COVID-19 without the need for ICU treatment and with a shorter length of hospitalization. More severe evolutions were observed in teenagers, with, however, favorable outcomes. Given the context of closed schools and confinement, the infection of these children suggests intra-familial transmission that needs to be further assessed. This description might help to understand the intriguing differences in COVID-19 severity across age-classes.
Keywords	COVID-19 ; MIS-C ; PIMS-TS ; SARS-CoV-2 ; acute respiratory distress syndrome ; children ; infants ; [SDV]Life Sciences [q-bio] ; covid19
Subject code	610
Language	English
Publishing date	2020-07-15
Publisher	HAL CCSD
Publishing country	fr
Document type	Article ; Online
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Article ; Online: The Wide Spectrum of COVID-19 Clinical Presentation in Children

ISSN: 2077-0383 ; Journal of Clinical Medicine ; https://hal.sorbonne-universite.fr/hal-02988401 ; Journal of Clinical Medicine, MDPI, 2020, 9 (9), pp.2950. ⟨10.3390/jcm9092950⟩

2020

Abstract	International audience Background: Ten months after its appearance in December 2019, SARS-CoV-2 has infected more than 25 million patients worldwide. Because children were first identified as potential spreaders of the virus, schools were closed in several countries. However, it rapidly became evident that the number of hospitalized children infected by SARS-CoV-2 was dramatically lower than that of adults. To date, only hypotheses have been raised to explain this difference, so it is of great importance to describe the presentation of this disease among children. Here, we describe a wide spectrum of COVID-19 manifestation in children in a dedicated pediatric unit in France. Methods: Patients hospitalized with COVID-19 who were diagnosed on the basis of either positive SARS-CoV-2 RT-PCR in nasopharyngeal swabs and/or typical aspects in chest-computed tomography (CT) were included between March and May 2020 in Paris. Results: Twenty-three patients were included on the basis of positive RT-PCR (n = 20) and/or typical aspects in CT (n = 4). The median age was 4.9 years [0.1-17.6]. Patients were grouped by age (<2 years old: n = 14, 61%; 2-10 years old: n = 2, 9%; >10 years old: n = 7, 30%). Overweight or obesity was reported in only three patients. At presentation, the most frequent symptom in the overall cohort was fever (n = 18, 78%), followed by acute rhinitis (n = 9, 64%) and cough (n = 7, 50%) in the under 2-year-old group and cough (n = 4, 57%), fatigue, dyspnea and abdominal pain (n = 3, 43% each) in the over 10-year-old group. Five patients required ICU treatment, four of whom were aged >10 years, two presented with acute myocarditis, and two were sickle cell disease patients who presented with acute chest syndrome. Discussion and conclusion: The youngest patients seem to present milder forms of COVID-19 without the need for ICU treatment and with a shorter length of hospitalization. More severe evolutions were observed in teenagers, with, however, favorable outcomes. Given the context of closed schools and confinement, the infection of these children suggests intra-familial transmission that needs to be further assessed. This description might help to understand the intriguing differences in COVID-19 severity across age-classes.
Keywords	COVID-19 ; MIS-C ; PIMS-TS ; SARS-CoV-2 ; acute respiratory distress syndrome ; children ; infants ; [SDV]Life Sciences [q-bio] ; covid19
Subject code	610
Language	English
Publishing date	2020-07-15
Publisher	HAL CCSD
Publishing country	fr
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: The Wide Spectrum of COVID-19 Clinical Presentation in Children

ISSN: 2077-0383 ; Journal of Clinical Medicine ; https://hal.sorbonne-universite.fr/hal-02988401 ; Journal of Clinical Medicine, MDPI, 2020, 9 (9), pp.2950. ⟨10.3390/jcm9092950⟩

2020

Abstract	International audience Background: Ten months after its appearance in December 2019, SARS-CoV-2 has infected more than 25 million patients worldwide. Because children were first identified as potential spreaders of the virus, schools were closed in several countries. However, it rapidly became evident that the number of hospitalized children infected by SARS-CoV-2 was dramatically lower than that of adults. To date, only hypotheses have been raised to explain this difference, so it is of great importance to describe the presentation of this disease among children. Here, we describe a wide spectrum of COVID-19 manifestation in children in a dedicated pediatric unit in France. Methods: Patients hospitalized with COVID-19 who were diagnosed on the basis of either positive SARS-CoV-2 RT-PCR in nasopharyngeal swabs and/or typical aspects in chest-computed tomography (CT) were included between March and May 2020 in Paris. Results: Twenty-three patients were included on the basis of positive RT-PCR (n = 20) and/or typical aspects in CT (n = 4). The median age was 4.9 years [0.1-17.6]. Patients were grouped by age (<2 years old: n = 14, 61%; 2-10 years old: n = 2, 9%; >10 years old: n = 7, 30%). Overweight or obesity was reported in only three patients. At presentation, the most frequent symptom in the overall cohort was fever (n = 18, 78%), followed by acute rhinitis (n = 9, 64%) and cough (n = 7, 50%) in the under 2-year-old group and cough (n = 4, 57%), fatigue, dyspnea and abdominal pain (n = 3, 43% each) in the over 10-year-old group. Five patients required ICU treatment, four of whom were aged >10 years, two presented with acute myocarditis, and two were sickle cell disease patients who presented with acute chest syndrome. Discussion and conclusion: The youngest patients seem to present milder forms of COVID-19 without the need for ICU treatment and with a shorter length of hospitalization. More severe evolutions were observed in teenagers, with, however, favorable outcomes. Given the context of closed schools and confinement, the infection of these children suggests intra-familial transmission that needs to be further assessed. This description might help to understand the intriguing differences in COVID-19 severity across age-classes.
Keywords	COVID-19 ; MIS-C ; PIMS-TS ; SARS-CoV-2 ; acute respiratory distress syndrome ; children ; infants ; [SDV]Life Sciences [q-bio] ; covid19
Subject code	610
Language	English
Publishing date	2020-07-15
Publisher	HAL CCSD
Publishing country	fr
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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