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La protection du cerveau en développement et des handicaps de l'enfant prématuré : impact du sulfate de magnésium et du rémifentanil

Abstract : Better protecting the developing brain of very preterm infants remains a dailychallenge for all specialists in perinatal care. Despite improvement of neonatal mortality andmorbidity, very preterm infants remain vulnerable and at risk of developing neurologicalimpairments. To limit the occurrence of such events, implementing of neuroprotectionduring brain development is essential. Neuroprotection in the context of preterm birth is thesubject of extensive research, but few strategies have currently been demonstrated to beeffective. One part of these strategies takes place before birth, as antenatal corticosteroidsadministration that is known to reduce intraventricular hemorrhage, or in utero transfer totertiary maternity hospitals. There is now strong evidence to support antenatal magnesiumsulfate infusion in order to prevent cerebral palsy in context of prematurity.Neuroprotection may also occur after birth and evaluate the benefit/risk balance for eachpotentially deleterious drug administered during this period, such as anesthetics, is one ofthose strategies. Fetuses and preterm newborns are exposed to general anesthesia duringcesarean delivery or in neonatal intensive care when sedation and analgesia isrecommended. The role of these agents remains extremely controversial and could appearto be neurotoxic.This thesis work is part of the development and evaluation of neuroprotectionstrategies for preterm neonates. The first part aims at the follow up of the French PREMAGcohort to evaluate the children for any long-term deleterious effects of magnesium sulfate,and to assess developmental and psychomotor outcomes at school-age. The second part isdevoted to the evaluation of the in vivo impact of remifentanil, synthetic opiate, on theimmature brain of mouse pups in an excitotoxic condition.
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Submitted on : Monday, February 25, 2019 - 2:58:18 PM
Last modification on : Thursday, November 28, 2019 - 3:28:57 AM


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  • HAL Id : tel-02048311, version 2



Clément Chollat. La protection du cerveau en développement et des handicaps de l'enfant prématuré : impact du sulfate de magnésium et du rémifentanil. Pharmacologie. Normandie Université, 2017. Français. ⟨NNT : 2017NORMR149⟩. ⟨tel-02048311v2⟩



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