Levieux K, Patural H, Harrewijn I, Hanf M, Gras Leguen C
Urgences pédiatriques, hôpital Mère-Enfant, CHU de Nantes, 9, quai Moncousu, 44093 Nantes cedex 1, France; ANCReMIN: association nationale des centres référents pour la mort inattendue du nourrisson France, centre hospitalier régional universitaire, hôpital Arnaud de Villeneuve, 375, avenue Doyen-Gaston-Giraud, 34295 Montpellier, France.
Réanimation pédiatrique et néonatale, CHU de Saint-Étienne, 42055 Saint-Étienne cedex 2, France; ANCReMIN: association nationale des centres référents pour la mort inattendue du nourrisson France, centre hospitalier régional universitaire, hôpital Arnaud de Villeneuve, 375, avenue Doyen-Gaston-Giraud, 34295 Montpellier, France.
Arch Pediatr. 2015 Apr;22(4):360-7. doi: 10.1016/j.arcped.2015.01.003. Epub 2015 Mar 4.
In France, nearly 500 infants still die unexpectedly every year. In 2009, the French Institute for Public Health Surveillance published a survey showing great heterogeneity in the management of sudden unexpected infant death (SUID) cases. The aim of this study was to evaluate the actual diagnostic approach to SUID in the different reference centers in France and to determine the degree to which the 2007 recommendations of the French National Authority for Health (Haute Autorité de santé [HAS]) are applied. We conducted a multicenter cross-sectional epidemiological study by email sent to the 36 SIDS reference centers with questions on examinations usually performed in SIDS cases. We also submitted six SUID test cases for death classification to the different reference physicians. Twenty-nine of 36 centers (80.5%) responded. Among the recommended tests, only blood cultures, analysis of cerebrospinal fluid, and a proposal to autopsy are done in 100% of the centers. Other investigations are not carried out systematically: skeleton radiography (65.5%), cranial CT scan (58%), eye fundus (20.7%), metabolic analysis (65.5%), and blood toxicology (62%). The main reasons for non-completion of these tests were hospital practices, lack of resources, technical difficulties, cost of tests, and difficulty in interpreting results (50% reported not knowing the postmortem biological standards). None of the institutions apply the HAS recommendations entirely. The classification of causes-of-death test cases also varied between the centers, with a maximum of 62% concordance in their responses. In 2013, in France, there is still substantial heterogeneity in the diagnostic set-up of SUIDS, a non-exhaustive implementation of the recommendations of the French National Authority for Health, and an unsatisfactory SUIDS classification tool because of considerable discordance between physicians. These results explain the current difficulties in obtaining reliable epidemiological data, because many teams do not use all the investigations recommended to find the cause of death. Therefore, the establishment of a national registry would provide accurate and up-to-date epidemiological, environmental, medical, and biological data to identify the events causing death and propose appropriate means of prevention.
在法国，每年仍有近500名婴儿意外死亡。2009年，法国公共卫生监测研究所发布的一项调查显示，婴儿猝死综合征（SUID）病例的处理存在很大差异。本研究的目的是评估法国不同参考中心对SUID的实际诊断方法，并确定法国国家卫生管理局（Haute Autorité de santé [HAS]）2007年建议的应用程度。我们通过电子邮件向36个婴儿猝死综合征参考中心进行了一项多中心横断面流行病学研究，询问了通常在婴儿猝死综合征病例中进行的检查。我们还向不同的参考医生提交了6个SUID测试病例进行死因分类。36个中心中有29个（80.5%）做出了回应。在推荐的检查中，只有血培养、脑脊液分析和尸检建议在100%的中心进行。其他检查并未系统开展：骨骼X光检查（65.5%）、头颅CT扫描（58%）、眼底检查（20.7%）、代谢分析（65.5%）和血液毒理学检查（62%）。未完成这些检查的主要原因是医院的操作规范、资源短缺、技术困难、检查费用以及结果解读困难（50%的受访者表示不知道死后生物学标准）。没有一家机构完全应用HAS的建议。死因测试病例的分类在各中心之间也存在差异，其回答的一致性最高为62%。2013年，在法国，SUIDS的诊断设置仍存在很大差异，法国国家卫生管理局的建议未得到充分实施，且由于医生之间存在相当大的分歧，SUIDS分类工具也不尽人意。这些结果解释了目前在获取可靠流行病学数据方面存在的困难，因为许多团队并未使用所有推荐的检查来查找死因。因此，建立一个国家登记处将提供准确和最新的流行病学、环境、医学和生物学数据，以确定导致死亡的事件并提出适当的预防措施。
