Doctor :Marie Chevallier
Title : Severe intraventricular hemorrhage in preterm infants : prevention et consequences. From Epipage 2 study
supervisors: Thierry Debillon, Anne Ego, Pierre-Yves Ancel
Doctoral school : ED Ingénierie pour la Santé la Cognition et l’Environnement, Université Grenoble Alpes
Date of thesis defense : 10/2020
Jury :Eric Verspick, Aline Rideau, Thuy Mai Luu, Sophie Alexander, Sylvie N’Guyen The Tich.
Background – Preventing severe intraventricular hemorrhage (IVH) is always a daily challenge in neonatology intensive care unit (NICU). Despite of many progress realized during last decades, their incidence remains stable, around 10%.Objectives – This PhD work has two main objectives: (i) identify perinatal risk factors of IVH through Epipage 2 cohort and (ii) examinate factors associated with worse neurosensory outcome at 2 years of corrected age with comparison between 3 cohorts: from Canada, France, Australia and New Zealand.Methods – This present work incorporated 2studies and 1 project: 1- The association between the main cause of delivery and IVH was studied with multinomial regression model in infants < 32 weeks of gestational age (GA). 2- A propensity score was used to analyse if early extubation was a risk factor of IVH in infants born under 29 weeks of GA. 3/Concerning the third project data of the three international cohort will be pooled in order to be analyzed together.Results – Abruptio placenta and preterm labor (PL) with inflammation were associated with grade 3 and 4 IVH (only grade 4 IVH for PL). Otherwise early extubation was not associated with severe IVH.Conclusion – Concerning severe IVH, our work shows that taking account the causes of prematurity is crucial and new gentle ventilation strategies are relatively safe. The comparison between different population based cohorts could contribute to deeply understand and enhance the care to improve the outcome.