Antoine Payot

Université de Montréal | UdeM · Department of Pediatrics

Communication with parents is an essential component of neonatal care. For extremely preterm infants born at less than 25 weeks, this process is complicated by the substantial risk of mortality or major morbidity. For some babies with specific prognostic factors, the majority die. Although many of these deaths occur after admission to the intensive...

ABSRACT Pregnancy termination for fetal anomaly (TOPFA) is a possible outcome of a pregnancy complicated by a fetal anomaly detected during routine prenatal care. Limited research is available on the quality of the counselling offered to women, in terms of enabling them to make an informed decision. The goal of this descriptive cohort study was to...

In the hospital milieu, daily questions relate to highly invested areas such as quality of life and death issues, choices to continue or stop active treatment, and the legitimacy of those who take part in such decisions. Stemming from an ethnographic study carried out in a hematology-oncology transplant unit in a Montreal pediatric hospital, we dis...

Background: Recent advances in immunology, genomics, and cellular therapy have opened numerous therapeutic possibilities in pediatric hematology-oncology, generating new hope in poor prognosis situations. How decisions are made when it comes to treatments and aims needs to be explored in this new technological context. In particular, their impact...

Grieving a child following cancer is a substantially difficult task. The objectives of this research were: 1) to describe current quality of life (QoL), psychological distress and symptoms of grief of bereaved parents, and 2) to explore the role of possible contributors of QoL and psychological distress. Forty-six parents (32 mothers) of children w...

Le curriculum de médecine de la Faculté de médecine de l’Université de Montréal connait plusieurs mutations majeures, dont l’adoption d’une nouvelle approche relationnelle dite de partenariat avec le patient et ses proches. L’approche repose sur le postulat du patient considéré comme acteur en possession d’un savoir important pour la formation des...

Pregnancies can be complicated by findings of congenital malformations of the fetus or threatened preterm labour. A physician's prognosis regarding the outcomes of these high-risk pregnancies plays an important role in counselling parents. There is substantial discrepancy and variability in medical prognostication, influenced by many factors not ye...

Aim: To explore and compare acute and long-term care professionals' perspectives about pediatric palliative care. Methods: Focus group interviews were conducted in 2016-2017 with professionals from acute (Emergency Department, Intensive Care Unit) and long-term care (Complex Care Service, Palliative Care) teams. Results: Fifty-eight participan...

Background Discomfort exists discussing goals of care (GOC) with families of children with advanced life-threatening illnesses. There also exists important variability in the management of these patients. Objectives This study seeks to explore the perceptions of pediatric specialists involved in the care of children with life-threatening illnesses...

Introduction : Discomfort exists discussing goals of care with families of children with advanced life-threatening illnesses. There also exists important variability in the management of these patients. This study seeks to explore the perceptions of pediatric specialists involved in the care of children with life-threatening illnesses with regards...

Study objective: Children with medical complexity represent a fragile population and account for the majority of patients followed in pediatric palliative care. Little is known in regard to the role of the emergency department (ED) in caring for the families of children with medical complexity. Methods: Semistructured focus groups were held with...

Quality of life (QOL) measures are increasingly used when important prognostication and treatment decisions need to be made in the care of a critically ill child. Unfortunately, health-care professionals and families experience difficulties when attempting to accurately predict and estimate QOL for a patient. Aspects such as subjectivity, complexit...

Objective: To assess the influence of resiliency and stress on parental perspectives of the future quality of life (QOL) of neonatal intensive care unit (NICU) newborns at high risk of neurodevelopmental disability. Study design: We conducted a prospective multicenter questionnaire study. Perspectives from parents of newborns at high risk of dis...

Aims: This study explored how paediatric healthcare professionals experienced and coped with end-of-life conflicts and identified how to improve coping strategies. Methods: A questionnaire was distributed to all 2,300 professionals at a paediatric university hospital, covering the frequency of end-of-life conflicts, participants, contributing fa...

Objective To evaluate whether the antenatal consultation for preterm labour worries or reassures women, and to identify factors contributing to these feelings. Design This is a prospective survey study from April 2012 to September 2013. This mixed-methodology tool was co-constructed with patients and first tested in a single-centre pilot study. S...

BACKGROUND: Newborns born prematurely or with congenital malformations are at risk of neurologic sequelae. Critical decisions are frequently taken by the healthcare professionals with the family based on predictions of functional impairments and their impact on future quality of life (QOL). No known study has examined how parents envision this futu...

BACKGROUND: Very little is known regarding the role of the pediatric emergency department (ED) in pediatric palliative care (PPC). OBJECTIVES: To explore pediatric emergency medicine healthcare professionals perspectives regarding their role in PPC and to compare these to other health care professionals understandings of the EDs role in PPC. DESIGN...

BACKGROUND: Continuity of care in pediatric palliative care (PPC) is complex, especially when critical care providers become involved during acute unexpected health events. OBJECTIVES: To explore and compare acute care and long-term care providers opinions about PPC. DESIGN/METHODS: A qualitative study was conducted from January to October 2016. Si...

Questionnaire parents of preterm infants

QOL questionnaire in parents of preterm infants

Introduction: Very little is known regarding the emergency department’s (ED) role in the care of paediatric patients with complex chronic and life-limiting illnesses. In fact, the provision of paediatric palliative care (PPC) in the paediatric ED has, of yet, never been explored. This study aims to explore pediatric emergency medicine healthcare pr...

Predicting neurological outcomes of neonates with acute brain injury is an essential component of shared decision-making, in order to guide the development of treatment goals and appropriate care plans. It can aid parents in imagining the child's future, and guide timely and ongoing treatment decisions, including shifting treatment goals and focusi...

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Conclusion: A model for antenatal consultations is proposed. This approach encourages clinicians to explore individual patients' lived experiences and engage in trusting empowering relationships. Moreover, it calls on physicians to enhance patients' relational autonomy by becoming advocates for their patients within healthcare institutions and pro...

Objective: To explore prospective mothers' perspectives regarding antenatal consultations by neonatology teams for threatened preterm delivery. Study design: In a prospective multicenter study, women at risk of preterm delivery between 26 and 32 weeks of gestational age were surveyed during the 72 hours following their antenatal consultation. Th...

Background: Parents and their preterm infants (born between 32-37 weeks of gestation) are often overlooked by the healthcare system. And very little attention is given to the relationship parents develop with their infants in the neonatal unit (NNU). Specifically, very few studies focused on fathers and how they establish a relationship with their...

This article presents the "Montreal model", offering the patient, if he wishes, to become a patient partner for all the decisions that concerns him. We are presently witnessing, presently, major transformations in western societies. Chronic diseases affect a growing proportion of the population, leading a transition from the ascendancy of acute car...

In neonatology, many choices to withhold or withdraw treatments are made based on long-term projections of the child’s quality of life. These projections are essentially made considering medical facts of possible physical or intellectual disabilities. Physicians and parents generally talk about quality of life, whether it is to decide not to resusc...

The question of the fetus as a patient is sensitive and we cannot ignore it. To deny the fetus any kind of status is troubling, especially when all prenatal screening and diagnostic tests are directed toward evaluating the fetus’s health and development. On the other hand, one can understand the risks of allowing the fetus to have its own juridical...

Chapter 3. The application of an integrated model of partnership-patient in the professionals of the health training: towards new one humanist paradigm and ethics of co-construction knowledges in health This article presents the “Montreal model”, offering the patient, if he wishes, to become a patient partner for all the decisions that concerns him...

Jivraj & al (1) present the results of a small survey study showing clinicians' predominant acceptance of elective ventilation for subsequent organ donation of babies born with anencephaly in a regional British clinical community, either at the request or with the agreement of parents. This appears in the context of highly mediatized cases in the U...

Peut-il être acceptable de mentir à un patient? Face à plusieurs interventions possibles, doit-on rester neutres, faire une recommandation, n’en offrir qu’une? Comment gérer les dilemmes éthiques qui polarisent les équipes? Devant les contraintes sociales, politiques et administratives qui croissent sans cesse et un pluralisme des valeurs grandissa...

To determine the causes and process of death in neonates in Canada. Prospective observational study. Nineteen tertiary level neonatal units in Canada. 942 neonatal deaths (215 full-term and 727 preterm). Explored the causes and process of death using data on: (1) the rates of withdrawal of life-sustaining treatment (WLST); (2) the reasons for raisi...

BACKGROUND Recommendations encourage informing mothers at risk of preterm labor. OBJECTIVES To evaluate whether prenatal consultations for preterm labor worry or reassure women at risk of preterm delivery. DESIGN/METHODS This was a prospective survey of hospitalized women at risk of preterm delivery 26 to 32 weeks GA, who had met the neonatologis...

BACKGROUND Recommendations about prenatal counseling for pre-term labor, based on expert opinions, emphasize informing parents. Mothers' perspectives are lacking. OBJECTIVES To evaluate mother's experiences of prenatal consultations for preterm labor. DESIGN/METHODS This was a prospective survey of hospitalized women at risk of preterm delivery 2...

BACKGROUND Recommendations about prenatal counseling for preterm labor are based on expert opinions, while mothers' perspectives are lacking. OBJECTIVES To evaluate mother's expectations from the prenatal consultation for preterm labor. DESIGN/METHODS This was a prospective survey of hospitalized women at risk of preterm delivery 26 to 32 weeks'...

Evidence suggests children and adolescents are consuming stimulants and nonstimulants in the hopes of improving academic performance through cognitive enhancement. As such, clinicians may be faced with requests to prescribe enhancers for their paediatric patients. In this article, we analyse the ethics of cognitive enhancement in paediatrics in the...

International policies regulating clinical ethics committees' (CEC) roles are non-existent. Nonetheless, CECs have established themselves in several countries and there exist striking differences in the way these work. This international practice variation stems from the ways CECs developed, within particular legal, political, social and profession...

Some couples may choose to continue the pregnancy unable to decide for termination of pregnancy. Such situations recently occurred in neonatology units and may lead to neonatal palliative care. Faced with all uncertainties inherent to medicine and the future of the baby, medical teams must inform parents of different possible outcome step by step....

Guidelines recommend supportive care for all newborns >26 weeks' gestational age and recognize the importance of prenatal consultation by a neonatalogist for mothers at risk of premature delivery. These recommendations are drawn from medical expert opinions and emphasize informing parents about prematurity. The literature regarding parents' perspec...

Objective To evaluate the caregivers’ opinions regarding decision-making in termination of pregnancy (TOP) for fetal anomaly.

To evaluate the caregivers' opinions regarding decision-making in termination of pregnancy (TOP) for fetal anomaly. Questionnaire survey using a semi-structured survey based on visual analogue scales, sent to all multidisciplinary centres for prenatal diagnosis in France. Answers were received from 26 centres nation-wide. Response rate was 39% (213...

Background: Spontaneously breathing preterm infants have short physiologic inspiratory times (IT). This population is particularly vulnerable to lung injury caused by volu-and/or barotrauma. Ventilating with short IT could reduce both the risk of volutrauma and the risk of air trapping, allowing the lung to empty between cycles and eventually enabl...

Supplements added to human milk might expose infants to allergens such as cow’s milk protein.

Thyroid transcription factor 1 (TITF1/NKX2.1) is expressed in the thyroid, lung, ventral forebrain, and pituitary. In the lung, TITF1/NKX2.1 activates the expression of genes critical for lung development and function. Titf/Nkx2.1(-/-) mice have pituitary and thyroid aplasia but also impairment of pulmonary branching. Humans with heterozygous TITF1...

Parents at risk of delivering a baby at the threshold of viability are faced with a critical decision. When a child is born between 23 and 25 weeks of gestation, parents are asked to decide whether or not to resuscitate their child. In essence, they are faced with a choice between life and death. We conducted a qualitative study to explore how pare...

Unlabelled: In order to assess the current use of medical and social services of children of drug-abusing mothers in regard to their short term outcome in a Swiss urban community hospital, we compared hospital, private paediatricians and home nursing records of 37 of these children with 37 matched control children from birth to 18 months of age. C...

Children of drug abusing mothers require particular care during hospitalization at birth and after their hospital discharge. This study was designed to quantify the use of the care services offered to these newborns. Results show that most of these children require a long neonatal hospitalization (33.6 days± 26) during part of which they do not req...

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