. . . "P\u00E9rinatologie -- Dissertation universitaire" . . "2013" . "Score de gravit\u00E9" . "Facteurs biologiques" . "D\u00E9c\u00E8s" . . "P\u00E9riode postnatale" . "Early biological factors and outcome in very preterm infants" . "S\u00E9quelles neurologiques" . "Chlor\u00E9mie" . . "Facteurs cliniques p\u00E9rinatals et param\u00E8tres biologiques pr\u00E9dictifs du pronostic chez l'enfant pr\u00E9matur\u00E9" . "Our aim was to identify early biochemical abnormalities associated with adverse outcome in very preterm infants. Based on an 8-year population-study for assessing the outcome in 1067 very preterm babies admitted to the neonatal intensive care unit of Dijon university hospital, two research axes were explored: 1) the impact of plasma chloride abnormalities on neurological morbidities; 2) the association between hypoproteinemia on the first day of life (D1) and adverse outcome. These issues were assessed by 4 studies, performed on the initial population and on 3 other cohorts.We found that hyperchloremia results in severe metabolic acidosis during the first 7-10 days of life, but this is not associated with adverse neurological outcome (intraventricular haemorrhage and/or cerebral palsy at 18 months of corrected age). The tight control of chloride intake by parenteral nutrition or \u201Cinadvertent\u201D administration represents a good means for lowering the incidence of metabolic acidosis after birth.We also showed that hypoproteinemia (D1) has prognostic value for impaired outcome (death or survival with severe cerebral ultrasound findings) and that total plasma protein has a predictive performance comparable with other validated illness severity scores. These results provide additional insight into factors influencing mortality and morbidity for preterm babies. Our findings raise the interest in addressing the above issues in future investigations on: 1) pathophysiological mechanisms underlying the association between biological abnormalities and impaired outcome, 2) their possible therapeutic implications and 3) the development of new severity scores for very preterm babies." . . . "Protid\u00E9mie" . "Th\u00E8ses et \u00E9crits acad\u00E9miques" . "Facteurs cliniques p\u00E9rinatals et param\u00E8tres biologiques pr\u00E9dictifs du pronostic chez l'enfant pr\u00E9matur\u00E9" . . "Pronostic" . . . . "L\u2019objectif de ce travail \u00E9tait de d\u00E9crire les facteurs biologiques pr\u00E9coces influen\u00E7ant le pronostic des enfants grands pr\u00E9matur\u00E9s. A partir d\u2019une population de 1 067 enfants admis en r\u00E9animation n\u00E9onatale au CHU de Dijon de 2001 \u00E0 2008 et faisant l\u2019objet d\u2019un recueil prospectif de donn\u00E9es clinico-biologiques p\u00E9rinatales, deux objectifs de recherche ont \u00E9t\u00E9 identifi\u00E9s : 1) \u00E9valuer l\u2019impact des troubles de la chlor\u00E9mie au cours de l\u2019adaptation postnatale sur la morbidit\u00E9 neurologique\u00A0; 2) caract\u00E9riser la possible association entre l\u2019hypoprotid\u00E9mie du premier jour de vie\u00A0(J1) et le pronostic d\u00E9favorable. Ces objectifs ont \u00E9t\u00E9 approfondis dans 4 \u00E9tudes, r\u00E9alis\u00E9es sur la population initiale et sur 3 autres cohortes de grands pr\u00E9matur\u00E9s. Nous avons observ\u00E9 que l\u2019hyperchlor\u00E9mie entraine une acidose m\u00E9tabolique s\u00E9v\u00E8re dans les 7 \u00E0 10 premiers jours de vie sans que ceci ne s\u2019associe \u00E0 un pronostic neurologique d\u00E9favorable (h\u00E9morragie intraventriculaire et/ou paralysie c\u00E9r\u00E9brale \u00E0 18 mois d\u2019\u00E2ge corrig\u00E9). Les r\u00E9sultats ont montr\u00E9 l\u2019importance de contr\u00F4ler les apports de chlore des m\u00E9dicaments et de la nutrition parent\u00E9rale, afin de pr\u00E9venir toute acidose m\u00E9tabolique ind\u00E9sirable apr\u00E8s la naissance. Les \u00E9tudes sur la protid\u00E9mie ont montr\u00E9 que l\u2019hypoprotid\u00E9mie \u00E0 J1 est un facteur ind\u00E9pendant associ\u00E9 au d\u00E9c\u00E8s ou \u00E0 la survie avec anomalies neurologiques s\u00E9v\u00E8res et que son pouvoir pr\u00E9dictif de pronostic d\u00E9favorable est comparable \u00E0 celui d\u2019autres scores de gravit\u00E9 valid\u00E9s. Ce travail contribue \u00E0 la compr\u00E9hension des facteurs p\u00E9rinatals influen\u00E7ant le pronostic du grand pr\u00E9matur\u00E9 et ouvre de nouvelles perspectives de recherche sur la prise en charge de ces enfants vuln\u00E9rables." . . . . . "Text" . . "Pr\u00E9matur\u00E9" . "Neurologie p\u00E9diatrique" . .