Babak Khoshnood

Predictors of the risk of cognitive deficiency in very preterm infants: the EPIPAGE prospective cohort

Aim:u2002 To assess cerebral lesions and other medical as well as social characteristics as predictors of risk of mild and severe cognitive deficiencies in very preterm infants.

Screening for fetal spina bifida at the 11–13-week scan using three anatomical features of the posterior brain

To evaluate the contribution of examination of specific anatomical features of the fetal posterior brain on mid‐sagittal first‐trimester ultrasound examination to the early detection of open spina bifida.

Visualization of intracranial translucency at the 11–13-week scan is improved after specific training

To evaluate the ability to confidently identify intracranial translucency (IT) in a clinical practice and following specific training of 10 operators.

Women's interpretation of an abnormal result on measurement of fetal nuchal translucency and maternal serum screening for prenatal testing of Down syndrome

To assess the effects of sociodemographic and health‐provider factors on womens understanding of abnormal results on measurement of nuchal translucency (NT) and maternal serum screening (MSS), 18 months after the implementation of a policy aimed at increasing womens awareness regarding MSS.

Long-term trends for socio-economic differences in prenatal diagnosis of Down syndrome: diffusion of services or persistence of disparities?

Objectiveu2002 To assess long‐term trends in disparities for prenatal diagnosis of Down syndrome in relation to policy changes.

Relationship between the Prevalence of Methicillin-Resistant Staphylococcus aureus Infection and Indicators of Nosocomial Infection Control Measures: A Population-Based Study in French Hospitals •

OBJECTIVEnTo assess whether infection control indicators are associated with the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) infection in French hospitals.nnnMETHODSnWe linked the database for the 2006 national prevalence survey of nosocomial infection with the database of infection control indicators (comprised of ICALIN, an indicator of infection control organization, resources, and action, and ICSHA, an indicator of alcohol-based handrub consumption) recorded from hospitals by the Ministry of Health. Data on MRSA infection were obtained from the national prevalence survey database and included the site and origin of infection, the microorganism responsible, and its drug resistance profile. Because the prevalence of MRSA infection was low and often nil, especially in small hospitals, we restricted our analysis to hospitals with at least 300 patients. We used a multilevel logistic regression model to assess the joint effects of patient-level variables (eg, age, sex, or infection) and hospital-level variables (infection control indicators).nnnRESULTSnTwo hundred two hospitals had at least 300 patients, for a total of 128,631 patients. The overall prevalence of MRSA infection was 0.34% (95% confidence interval [CI], 0.29%-0.39%). The mean value for ICSHA was 7.8 L per 1,000 patient-days (median, 6.1 L per 1,000 patient-days; range, 0-33 L per 1,000 patient-days). The mean value for ICALIN was 92 of a possible 100 points (median, 94.5; range, 67-100). Multilevel analyses showed that ICALIN scores were associated with the prevalence of MRSA infection (odds ratio for a score change of 1 standard deviation, 0.80; 95% CI, 0.69-0.93). We found no association between prevalence of MRSA infection and ICSHA. Other variables significantly associated with the prevalence of MRSA infection were sex, vascular or urinary catheter, previous surgery, and the McCabe score.nnnCONCLUSIONSnWe found a significant association between the prevalence of MRSA infection and ICALIN that suggested that a higher ICALIN score may be predictive of a lower prevalence of MRSA infection.

Measurement of nuchal translucency for prenatal screening of congenital heart defects: a population-based evaluation

(1) Assess sensitivity of the measurement of nuchal translucency (NT), for the prenatal screening of congenital heart defect (CHD) on population‐based data; (2) examine whether the sensitivity of NT varies for specific types of cardiac defects.

Évolution du diagnostic prénatal, des interruptions de grossesse et de la mortalité périnatale des enfants avec cardiopathie congénitale

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 35 - N° 5 - p. 455-464OBJECTIVEnTo examine population-based overall and malformation-specific trends in the prenatal diagnosis, pregnancy termination, and perinatal mortality for congenital heart disease (CHD) during a period of rapid progress in prenatal diagnosis and medical management of CHD and to explore the impact of prenatal diagnosis on early neonatal mortality for specific (isolated) cardiac malformations.nnnMETHODSnA total of 1982 cases of CHD, which were not associated with a known chromosomal anomaly, were obtained from the Paris Registry of Congenital Malformations. Main outcome measures were trends in the proportions diagnosed and terminated prior to birth, stillbirth and early (<1 day, one-week) neonatal mortality for (1) all cases; (2) all cases excluding isolated ventricular septal defects; and (3) malformation-specific trends for transposition of great arteries, hypoplastic left heart syndrome, coarctation of aorta, and tetralogy of Fallot. Analyses included cusum and binomial regression models for analysis of the trends during 1983-2000.nnnRESULTSnPrenatal diagnosis rates for CHD increased from 23.0% (95%CI: 19.0-27.4) in 1983-1988 to 47.3% (95%CI: 43.8-50.8) in 1995-2000. Termination rates increased between 1983 and 1989 (9.9%; 95%CI: 7.2-13.2) and 1989 and 1994 (14.7%; 95%CI: 12.3-17.4) but seemed to remain stable thereafter. Other than for hypoplastic left heart syndrome, pregnancy termination was exceptional for the other 3 specific malformations examined. Early neonatal mortality decreased to less than a third in the period 1995-2000 as compared with 1983-1989 (risk ratio, first week mortality: 0.31; 95%CI: 0.18-0.53). First week mortality was significantly lower for cases of transposition of great arteries diagnosed before birth (risk difference: 15.4%; 95% CI: 4.0-26.7).nnnCONCLUSIONnProgress in clinical management, together with policies for increased access to prenatal diagnosis, has resulted in both a substantial increase in the prenatal diagnosis and considerable reductions in early neonatal mortality of CHD in the Parisian population.

Individual and organisational determinants associated with maintenance tocolysis in the management of preterm labour: a multilevel analysis.

Background Clinical guidelines do not recommend maintenance tocolysis for the management of preterm labour. The French national survey EVAPRIMA revealed it was administered to more than 50% of women hospitalised for preterm labour. Our aim was to identify the individual and organisational determinants associated with maintenance tocolysis. Methods The study was a secondary analysis of the prospective population-based EVAPRIMA study database. Population study included every women hospitalised for preterm labour and at risk of receiving maintenance tocolysis, over a one month period, in 99 randomly selected French maternity units. Main outcome was the prescription of maintenance tocolysis. The association between maintenance tocolysis and individual (maternal or obstetrical) and organisational determinants were evaluated with multilevel analysis. Results Of the 531 women included, 68.9% (95% CI 0.65–0.73) received maintenance tocolysis. The only individual factor associated with maintenance tocolysis was gestational age at admission; the rate of maintenance tocolysis was higher among women hospitalised before 32 weeks of gestation. The significantly different rates between maternity units demonstrated the existence of a maternity unit effect. Maintenance tocolysis was also associated with organisational determinants and was more frequent in level 1 (ORau200a=u200a6.54[2.21–19.40]) and level 2 maternity units (ORau200a=u200a3.68[1.28–10.59]), in units with less than 1500 deliveries/year (ORau200a=u200a5.27[4.43–19.44]), and in specific areas of France. Conclusion A maternity unit effect, explained partly by the organisational characteristics of the units, plays a major role in the practice of maintenance tocolysis. Widespread dissemination of these results might improve adherence to clinical guidelines.

Disparités socioéconomiques dans le dépistage prénatal de la trisomie 21 par marqueurs sériques : évolution entre 1998 et 2003 en France

OBJECTIVESnTo compare trends in the use of and the opportunity for making an informed choice, regarding maternal serum screening for Downs syndrome.nnnMETHODSnData were based on the national perinatal surveys of 1998 and 2003, which comprise representative samples of births in France. We used logistic regression models and likelihood ratio tests for testing the statistical significance of interactions between time trends and socioeconomic factors.nnnRESULTSnWe found a generalized increase between 1998 and 2003 in both the use of screening and in the opportunity for making an informed choice. The use of screening increased more however, for women with primary or no education (OR=3.0; 95% CI, 2.2-4.1) as compared with those with education levels beyond a high school diploma (OR: 1.8; 95% CI, 1.7-2.0). On the contrary, trends in informed choice were comparable across socioeconomic groups. Hence, disparities in the opportunity for informed choice were essentially unchanged.nnnCONCLUSIONSnThe use of serum screening, and the opportunity for informed choice regarding the test, became more widespread for women from all socioeconomic categories between 1998 and 2003. These trends were accompanied by a decrease in socioeconomic disparities in the use of screening but not in the opportunity for making an informed choice.