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Archives de pédiatrie
Volume 17, n° 1
pages 19-25 (janvier 2010)
Doi : 10.1016/j.arcped.2009.10.002
Received : 23 November 2008 ;  accepted : 8 October 2009
Devenir respiratoire à court terme d’une population d’enfants nés à 34, 35 et 36 SA dans une maternité de niveau III
Short-term respiratory outcome of late preterm newborn in a center of level III
 

V. Champion , X. Durrmeyer, G. Dassieu
Service de réanimation néonatale, hôpital intercommunal de Créteil, 40, avenue de Verdun, 94000 Créteil, France 

Auteur correspondant.
Résumé

Le taux de prématurité modérée a nettement augmenté ces 10 dernières années. Les enfants concernés ont un risque augmenté de morbidité, notamment respiratoire. L’âge limite de l’indication des corticoïdes anténataux reste à 34 semaines d’aménorrhée (SA). L’objectif de cette étude était de donner les caractéristiques épidémiologiques d’une population d’enfants nés à 34, 35 et 36 SA et de rechercher les facteurs de risque de détresse respiratoire. Il s’agit d’une étude descriptive, monocentrique incluant 59, 55 et 72 enfants nés respectivement à 34, 35 et 36 SA, dans une maternité niveau III en 2005 et 2006 pour les 34 SA et en 2006 pour les 35 et 36 SA. Dans 63 % et 49 % respectivement des grossesses à 34 et 35 SA, une morbidité maternelle était présente. Le taux de césarienne avant travail était de 36 % chez les 34 SA et de 25 % chez les 35 SA. Chez 57 % des 34 SA et 27 % des 35 SA, une corticothérapie anténatale avait été réalisée. Une détresse respiratoire a été observée chez 27 % des 34 SA, 18 % des 35 SA et 8 % des 36 SA, alors que 8,5 % des 34 SA et 5,5 % des 35 SA ont été intubés. Une hospitalisation en réanimation néonatale ou unité de soins intensifs (USI) a été nécessaire pour 39 % des 34 SA, 29 % des 35 SA et 11 % des 36 SA. Seul l’âge gestationnel est apparu comme un facteur de risque significatif de détresse respiratoire. Il y avait une forte tendance à une diminution du taux de détresse respiratoire chez les enfants dont les mères avaient reçu des corticoïdes (odds-ratio =0,39, p =0,06).

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Summary

The rate of infants born at 34–36 weeks gestation has increased over the last 10 years. These babies are at higher risk of morbidity and mortality than full-term infants. At present, prenatal steroids are given until 34 weeks. The purpose of this study was to present the epidemiologic data of the late preterm infants and look for respiratory distress risk factors. This is a descriptive, single-center study including 59, 55 and 72 children born at 34, 35 and 36 weeks gestation, respectively, in a level III center in 2005 and 2006 for babies born at 34 weeks and in 2006 for the babies born at 35 and 36 weeks. Of the mothers who delivered at 34 and 35 weeks, 63% and 49%, respectively, had a morbidity. The cesarean-section delivery rate before labor was 36% for the infants born at 34 weeks and 25% for the infants born at 35 weeks. Prenatal steroids were used for 57% of the mothers who delivered at 34 weeks and for 27% of the mothers who delivered at 35 weeks. In the population of the babies born at 34 weeks, a mean delay between the last dose of steroid and delivery was 18.9 days. Of the infants born at 34, 35 and 36 weeks, 27%, 18% and 8% suffered from respiratory distress. The mechanical ventilation rate was 8.5% and 5.5% for the infants born at 34 and 35 weeks’ gestation. Surfactant was given to all infants born at 34 weeks who were intubated. Twenty percent of the 34-week-gestation infants and 12.7% of the 35-week-gestation infants required mechanical ventilation or noninvasive continuous positive airway pressure. Respiratory distress was mainly caused by respiratory distress syndrome or transient tachypnea of the newborn. There were no cases of meconium aspiration syndrome. There was 1 case of infection and 2 cases of pneumothorax. One-third of the infants born at 34–35 weeks were admitted to the neonatal intensive care unit. The number dropped to 11% at 36 weeks’ gestation. The gestational age was the only significant risk factor for respiratory distress. There was a strong tendency of the respiratory distress rate to decrease in the babies whose mothers had received steroids (odds ratio=0.39, p =0.06).

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Mots clés : Prématurité, Détresse respiratoire, Corticothérapie anténatale, Césarienne




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