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Master Thesis

Association entre sédation/analgésie continue lors de la ventilation mécanique précoce et devenir neurodéveloppemental à 2 ans d’âge corrigé chez les nouveau-nés prématurés nés avant 32 SA : résultats de l’étude Epipage 2

Abstract : Importance - Routine analgesia and/or sedation are currently not recommended for mechanically ventilated neonates, although mechanical ventilation causes pain and discomfort. Objective - To evaluate the association between exposure to analgesia and/or sedation and survival and sensorimotor outcomes at age 2 in ventilated premature infants. Design - Comparison of treated versus untreated infants from the French national Epipage 2 cohort using inverse propensity score weighting after multiple imputation. Setting - Sixty six neonatal intensive care units in France between March and December 2011. Participants - Premature infants born before 32 weeks of gestation intubated within 1hour after birth, not extubated at 24 hours of life. Exposure - Continuous opioids and/or midazolam infusion started before seven days of life and before the first extubation. Untreated infants did not receive these treatments before first extubation or the first week of life, whichever came first. Main outcomes and measures - The primary outcomes were survival and survival without moderate or severe neuromotor or sensory impairment at age 2. Secondary outcomes included survival without major morbidity at discharge, cumulated duration of mechanical ventilation, duration of hospital stay and Ages and Stages Questionnaire scores at age 2. Results - Among 981 eligible infants, 922 were included (450 treated, 472 untreated; mean (SD) gestational age: 27.28 (1.95) weeks, mean birthweight: 1021 (315) g; 445 girls). At age 2, survival was significantly increased in the treated group (RD 4.7%; 95%CI, 0.3 to 9.1; P= .037) without any difference between treated and untreated infants for survival without moderate or severe neuromotor or sensory impairment (RD 5.3%; 95%CI, 0.3 to 11.0; P= .063). Conclusion and relevance - Continuous analgesia and/or sedation in very premature infants during an initial episode of mechanical ventilation continued after 24 hours of age was associated with improved survival without any difference in survival without moderate or severe neuromotor or sensory impairment at two years, supporting the long-term safety of the studied treatments. These results advocate for wider use of analgesics and/or sedatives in this context.
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Master Thesis
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Submitted on : Monday, November 22, 2021 - 3:45:21 PM
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  • HAL Id : dumas-03440902, version 1

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Marie-Amélie de Tristan. Association entre sédation/analgésie continue lors de la ventilation mécanique précoce et devenir neurodéveloppemental à 2 ans d’âge corrigé chez les nouveau-nés prématurés nés avant 32 SA : résultats de l’étude Epipage 2. Médecine humaine et pathologie. 2020. ⟨dumas-03440902⟩

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