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Reginald S Sauve

Publications and source records attributed to Reginald S Sauve.

10 recordsLinked to original sources
PubMed2006

Intermediate-term outcomes of the arterial switch operation for transposition of great arteries in neonates: alive but well?

OBJECTIVES: This interprovincial inception cohort study outlines the operative and intermediate outcomes of all neonates at a single institution with a broad referral area who underwent the arterial switch operation for transposition of great arteries, including complex types. Predictors of outcome are explored. METHODS: A total of 88 consecutive neonates underwent the arterial switch operation between 1996 and 2004 with full-flow (150 mg/kg/min) cardiopulmonary bypass with selective deep hypothermic circulatory arrest. Overall and event-free survivals were calculated. Health and neurodevelopment (Bayley Scales of Infant Development II) were assessed at 18 to 24 months of age. Univariate and multivariate analyses, sensitivity, and specificity were determined to identify preoperative, intraoperative, and postoperative factors associated with mental and/or motor delay. RESULTS: There was 1 operative mortality (1.1%). At the average 4-year follow-up, survival was 98.9% and freedom from reintervention was 93.2%. Eighty-five children were assessed. Three were excluded because of unrelated postoperative diagnoses. For the remaining 82, mean scores were 89 +/- 17 (49-118) for mental skills and 92 +/- 15 (49-125) for motor skills. Anatomic complexity, cardiopulmonary bypass, and deep hypothermic circulatory arrest times were not associated with developmental outcome. Preoperative variables of low gestational age and high preoperative lactate correctly classified 84.1% of mentally and/or motor-delayed children. CONCLUSION: Transposition of great arteries, including complex types, can be corrected with low surgical risk and good intermediate survival; however, neurodevelopmental outcome is a concern. These data suggest that although anatomic complexity may not affect late outcome, there may be potentially modifiable preoperative factors that can be optimized to improve developmental outcomes.

Cardiac Surgical Procedures↗
PubMed2006

Does necrotising enterocolitis impact the neurodevelopmental and growth outcomes in preterm infants with birthweight < or =1250 g?

AIM: To compare the long-term growth and neurodevelopmental outcomes at 36 months adjusted age in preterm infants (birthweight (BW) < or = 1250 g) with necrotising enterocolitis (NEC) with BW-matched controls. METHODS: This is a case control study performed at a regional tertiary care neonatal intensive care unit. Infants with stage II or III NEC admitted to a regional tertiary care neonatal unit between 1995 and 2000 were identified. Each infant with NEC was matched by BW (+/-100 g) to next two infants admitted in the unit without NEC. Growth and neurodevelopmental outcomes at 36 months are compared. RESULTS: In total, 51 infants with NEC and 102 controls met study eligibility criteria and 146/153 (94.3%) were prospectively followed for 36 months. Infants with NEC had more culture-proven sepsis (35.3% vs. 10.8%, P < 0.001); patent ductus arteriosus requiring therapy (64.7% vs. 45%, P = 0.02), chronic lung disease (60.7% vs. 45%, P = 0.04) and longer hospital stay (84 days vs. 71 days, P < 0.0001). There were no significant differences in growth outcomes between the two groups at 36 months. Overall 24% of infants with NEC had one major neurodevelopmental disability compared with 10% among control infants. Infants who developed NEC had significantly higher cognitive delay (i.e. cognitive index <70) and visual impairment. A logistic regression model identified NEC as a predictor of cognitive delay. CONCLUSION: Preterm infants who develop NEC are at a significantly higher risk for developing neurodevelopmental disability. We recommend close neurodevelopmental follow up for all < or =1250 g infants who develop stage II or III NEC.

Case-Control Studies↗
PubMed2005

Breast is best for babies.

Breastfeeding is the optimal method of infant feeding. Breast milk provides almost all the necessary nutrients, growth factors and immunological components a healthy term infant needs, Other advantages of breastfeeding include reduction of incidences and severity of infections; prevention of allergies; possible enhancement of cognitive development; and prevention of obesity, hypertension and insulin-dependent diabetes mellitus. Health gains for breastfeeding mothers include lactation amenorrhea, early involution of the uterus, enhanced bonding between the mother and the infant, and reduction in incidence of ovarian and breast cancer. From the economic perspective, breastfeeding is less expensive than formula feeding. In most cases, maternal ingestion of medications and maternal infections are not contraindications to breastfeeding. Breastfeeding, however, is contraindicated in infants with galactosemia. The management of common breastfeeding issues, such as breast engorgement, sore nipples, mastitis and insufficient milk, is discussed. Breastfeeding should be initiated as soon after delivery as possible. To promote, protect and support breastfeeding, the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) developed the Baby-Friendly Hospital Initiative (BFHI) 10 Steps to Successful Breastfeeding. Healthcare professionals have an important role to play in promoting and protecting breastfeeding.

Breast Feeding↗
PubMed2004

Outcomes from an interprovincial program of newborn open heart surgery.

OBJECTIVES: To determine 18-month neurodevelopmental outcome of survivors of complex open heart surgery at </=6 weeks of age through an interprovincial program and to explore preoperative, operative, and postoperative outcome predictors. Study design Of 85 children from this inception cohort (21% mortality), 67 18-month-old survivors received multidisciplinary assessment including the Bayley Scales of Infant Development-II. Cumulative risk for adverse outcome was determined through univariate and multivariate analyses. RESULTS: Survival of the 85 children included 23 of 23 after arterial switch, 16 of 26 after Norwood, six of six after total anomalous pulmonary venous drainage repair, and 22 of 30 after miscellaneous repair. Outcomes were as follows: in-hospital death, 14 (16%); postdischarge death, four (5%); motor/sensory disability, three (4%); motor/mental delay (<70), 21 (25%); and intact survivors, 43 (50%). Cohort mental (84+/-17) and motor (80+/-22) scores were lower for those with chromosomal abnormalities, 67+/-16 and 61+/-17, respectively. Fifty-five percent of the outcome variance was explained by duration of preoperative ventilation, 18%; genetic anomaly, 5%; intraoperative variables, 18%; and postoperative variables, 14%. CONCLUSIONS: Risk for adverse outcome is cumulative, with preoperative determinants contributing significantly to total variance. Potentially modifiable variables should be sought in an attempt to improve outcome.

Cardiac Surgical Procedures↗
PubMed2004

Internipple distance and internipple index.

OBJECTIVE: To determine the internipple distance and internipple index in Chinese children. METHODS: The internipple distance and chest circumference were measured in 3,290 healthy Chinese children (1,715 males and 1,575 females) aged birth to 18 years seen at the Asian Medical Centre. The internipple distance and chest circumference were obtained at the end of expiration whenever possible, with a standard nonstretch tape measure graduated in millimeters with the arms hanging relaxed alongside the body. Patients under two years of age were measured supine and those over two years of age standing. The internipple distance was measured between the centers of both nipples, and the chest circumference was measured across the internipple line. The internipple index was calculated according to the formula: internipple distance (cm) multiplied by 100 and divided by chest circumference (cm). RESULTS: The internipple distance and chest circumference increased with age. The internipple index was highest in the neonatal period (26.4 +/- 1.6 for males and 26.3 +/- 2 for females), and decreased steadily until the age of four years (23.8 +/- 1.2 for males and 23.8 +/- 1.4 for females), and thereafter was relatively constant through the age of 18 years in males and the age of 11 years in females. In females, the internipple index decreased gradually from the age of 11 years to 18 years. CONCLUSIONS: While internipple index is a more practical way to assess nipple placement, there are ethnic differences in the internipple index. Proper reference standards should be used in the assessment whether the nipples are closely or widely spaced.

Adolescent↗
PubMed2003

Impact of bronchopulmonary dysplasia, brain injury, and severe retinopathy on the outcome of extremely low-birth-weight infants at 18 months: results from the trial of indomethacin prophylaxis in preterms.

CONTEXT: Despite more than 2 decades of outcomes research after very preterm birth, clinicians remain uncertain about the extent to which neonatal morbidities predict poor long-term outcomes of extremely low-birth-weight (ELBW) infants. OBJECTIVE: To determine the individual and combined prognostic effects of bronchopulmonary dysplasia (BPD), ultrasonographic signs of brain injury, and severe retinopathy of prematurity (ROP) on 18-month outcomes of ELBW infants. DESIGN: Inception cohort assembled for the Trial of Indomethacin Prophylaxis in Preterms (TIPP). SETTING AND PARTICIPANTS: A total of 910 infants with birth weights of 500 to 999 g who were admitted to 1 of 32 neonatal intensive care units in Canada, the United States, Australia, New Zealand, and Hong Kong between 1996 and 1998 and who survived to a postmenstrual age of 36 weeks. MAIN OUTCOME MEASURES: Combined end point of death or survival to 18 months with 1 or more of cerebral palsy, cognitive delay, severe hearing loss, and bilateral blindness. RESULTS: Each of the neonatal morbidities was similarly and independently correlated with a poor 18-month outcome. Odds ratios were 2.4 (95% confidence interval [CI], 1.8-3.2) for BPD, 3.7 (95% CI, 2.6-5.3) for brain injury, and 3.1 (95% CI, 1.9-5.0) for severe ROP. In children who were free of BPD, brain injury, and severe ROP the rate of poor long-term outcomes was 18% (95% CI, 14%-22%). Corresponding rates with any 1, any 2, and all 3 neonatal morbidities were 42% (95% CI, 37%-47%), 62% (95% CI, 53%-70%), and 88% (64%-99%), respectively. CONCLUSION: In ELBW infants who survive to a postmenstrual age of 36 weeks, a simple count of 3 common neonatal morbidities strongly predicts the risk of later death or neurosensory impairment.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2003

Congenital cytomegalovirus infection.

Cytomegalovirus (CMV) is the most common congenital infection in humans. Congenital CMV infection can follow either a primary or recurrent maternal infection, but the likelihood of fetal infection and the risk of associated damage is higher after a primary infection. Approximately 90% of congenitally infected infants are asymptomatic at birth. Jaundice, petechiae, and hepatosplenomegaly are the most frequently noted clinical triad in symptomatic infants. More frequent and more severe sequelae occur in symptomatic infants, notably psychomotor hearing loss and retardation. Congenital CMV infection can be diagnosed by isolation of the virus from the urine or saliva within the first three weeks of life. Rapid diagnosis can be accomplished by detection of CMV DNA by DNA amplification or hybridization techniques.

Cytomegalovirus↗