Auteur(s) : Mertes Clara
Composante : MEDECINE
Date de création : 30-06-2021

Description : Médecine (pédiatrie), Introduction : Extreme prematurity is defined as birth before 28 weeks. The mortality, the significant morbidity as well as the uncertainty of the neurological development of this population represent a medical and ethical issue for neonatologists. In order to improve the prognosis of these children, a change in management was implemented with antenatal corticosteroid therapy started as early as 23 WA as well as a collegial decision procedure between the obstetrician and the pediatrician to define whether the child would be the subject of neonatal active resuscitation or palliative care. Method : To ensure that these changes were not accompanied by an increase in mortality and morbidity, we performed a retrospective study on PMSI data over the period from 2013 to 2019 in premature infants born before 28 weeks in Alsace. We compared the periods 2013-2015 to 2017-2019, considering that 2016 is a year of transition in the dissemination of changes in practices. We compared the 2 centers of Mulhouse and Strasbourg that deal with extremely preterm. We compared the data from the PMSI with those from the Hautepierre database. Results : 473 children were included in the study. Mortality was not significantly changed between the 2 periods OR 1.3 CI (0.83-2.09). We find an increase in the presence of the ductus arteriosus OR 15 (8-30), a decrease in bronchopulmonary dysplasia OR 0.38 (0.24-0.59) and HIV stage 3 and 4 OR 0.2 (0, 06-0.56). When comparing the data from the PMSI with that service database, we find a gap of- 10% in the number of patients included for stage 3 and 4 HIV bronchodysplasia and the presence of ductus arteriosus. Conclusion : The modification of extreme premature practices has not been accompanied by an increase in mortality. It seems to be associated with a decrease in morbidity, but the data from the PMSI are unreliable. However, these data seem to indicate an improvement in the prognosis of extremely preborn, Thèses et écrits académiques
Mots-clés libres : Très grand prématuré Dissertation universitaire, Programme de Médicalisation des Systèmes d'Information (PMSI), 618.92, Mortalité périnatale -- Alsace (France), Indices de morbidité, Médecine -- Informatique
Couverture : FR