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Master Thesis

Evaluation des pratiques d’utilisation du Palivizumab (SYNAGIS®) en France. Implication des réseaux de santé en périnatalité

Abstract : Introduction: There is an increase in preterm infants. These have respiratory weakness exposing them to morbidity and mortality from major RSV infections. The Palivizumab’s indications differ between France Authorisation on the Market, the recommendations of the French Society of Neonatology and Transparency Committee of the National Health Authority. The aims of this study is to make an inventory of Palivizumab prescription in France in 2015 and try to determine the possible role of perinatal health networks in it. Method: We performed a descriptive multicenter national survey through a computerized questionnaire mailed to a referent physician of each neonatology center between the months of May and August 2015. The influence of the network was evaluated by comparing the homogeneity of the answers between the centers within networks issuing recommendations and those from networks which do not emit. Results: 98 centers participated in the survey giving a national involvement rate of 40%. Sixty-seven percent of centers declare follow the recommendations of the SFN. In practice, they are not observed that in 12-45% of scenarios. The establishment of prophylaxis Palivizumab is more homogeneous when the recommendations of learned societies are identically : children under the age of six months born prematurely <29 SA, 91% of centers include all children. When real and gestational ages are more important other factors influence prescription. Sixty-five percent of the centers take into account the presence of bronchopulmonary dysplasia either 28 days of life to be 36 weeks corrected age. The introduction of prophylaxis is conditioned by a DBP at D28 for 20% of the centers, a DBP 36SA to 20% and 25% for local protocol. Environmental factors (siblings, community care arrangements, passive smoking) influence up to 70% of surveyed hospitals. Pathologies such as cystic fibrosis, pulmonary malformations, diaphragmatic hernia are subject to prescription without off-label to 94% of the centers. The influence of recommendations by a network is not highlighted on a sample of 34 centers across 5 Great West networks. Conclusion: This survey highlights significant variations in prescribing prophylaxis Palivizumab probably from divergent recommendations as well as definitions of bronchopulmonary dysplasia. Environmental factors have an important role for prescribers centers that do not appear in the current recommendations.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-01245820
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Submitted on : Thursday, December 17, 2015 - 4:43:37 PM
Last modification on : Wednesday, August 23, 2017 - 4:32:45 PM
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Charlotte Petriat. Evaluation des pratiques d’utilisation du Palivizumab (SYNAGIS®) en France. Implication des réseaux de santé en périnatalité . Médecine humaine et pathologie. 2015. ⟨dumas-01245820⟩

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