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Velde CD, Reigstad H, Tjora E, Guthe HJT, Hansen EV, Molven A, Njølstad PR. Congenital hyperinsulinism. Tidsskr Nor Laegeforen 2023; 143:23-0425. [PMID: 38088279 DOI: 10.4045/tidsskr.23.0425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
This clinical review will give doctors who work with children and neonates an introduction to the diagnosis and treatment of congenital hyperinsulinism, the most common cause of persistent neonatal hypoglycaemia. The condition is a rare monogenic disorder characterised by elevated insulin secretion and is a result of mutations in genes that regulate insulin secretion from pancreatic beta cells. The anabolic effect of insulin induces systemic glucose uptake and inhibits gluconeogenesis, glycogenolysis, ketogenesis and lipolysis. Low levels of glucose and ketone bodies in the blood are harmful to the central nervous system and can lead to brain damage or death. Early diagnosis and treatment of congenital hyperinsulinism are therefore crucial for a good prognosis.
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Affiliation(s)
| | - Hallvard Reigstad
- Seksjon for nyfødte, Barne- og ungdomsklinikken, Haukeland universitetssjukehus
| | - Erling Tjora
- Seksjon for gastroenterologi og ernæring, Barne- og ungdomsklinikken, Haukeland universitetssjukehus
| | | | - Eirik Vangsøy Hansen
- Seksjon for endokrinologi og metabolisme, Barne- og ungdomsklinikken, Haukeland universitetssjukehus
| | - Anders Molven
- Klinisk institutt 1, Universitetet i Bergen, og, Avdeling for patologi, og, Seksjon for kreftgenomikk, Haukeland universitetssjukehus
| | - Pål Rasmus Njølstad
- Klinisk institutt 2, Universitetet i Bergen, og, Barne- og ungdomsklinikken, Haukeland universitetssjukehus
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2
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Gråbø H, Reigstad H, Garborg KK. H. Gråbø og medarbeidere svarer. Tidsskr Nor Laegeforen 2023; 143:23-0330. [PMID: 37254983 DOI: 10.4045/tidsskr.23.0330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
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Gråbø H, Garborg KK, Reigstad H. Forebygger probiotika nekrotiserende enterokolitt hos ekstremt premature? Tidsskr Nor Laegeforen 2023; 143:22-0544. [PMID: 36919293 DOI: 10.4045/tidsskr.22.0544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
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Reigstad H, Hufthammer KO, Rønnestad AE, Klingenberg C, Stensvold HJ, Markestad T. Early surfactant and non-invasive ventilation versus intubation and surfactant: a propensity score-matched national study. BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2022-001527. [PMID: 36053649 PMCID: PMC9335034 DOI: 10.1136/bmjpo-2022-001527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/23/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To compare outcome after less invasive surfactant administration (LISA) and primary endotracheal intubation (non-LISA) in infants born before gestational age (GA) 28 weeks. SETTING All neonatal intensive care units (NICUs) in Norway during 2012-2018. METHODS Defined population-based data were prospectively entered into a national registry. We compared LISA infants with all non-LISA infants and with non-LISA infants who received surfactant following intubation. We used propensity score (PS) matching to identify non-LISA infants who were similar regarding potential confounders. MAIN OUTCOME VARIABLES Rate and duration of mechanical ventilation (MV), survival, neurological and gastrointestinal morbidity, and need of supplemental oxygen or positive pressure respiratory support at postmenstrual age (PMA) 36 and 40 weeks. RESULTS We restricted analyses to GA 25-27 weeks (n=843, 26% LISA) because LISA was rarely used at lower GAs. There was no significant association between NICUs regarding proportions treated with LISA and proportions receiving MV. In the PS-matched datasets, fewer LISA infants received MV (61% vs 78%, p<0.001), and they had fewer days on MV (mean difference 4.1, 95% CI 0.0 to 8.2 days) and lower mortality at PMA 40 weeks (absolute difference 6%, p=0.06) compared with all the non-LISA infants, but only a lower rate of MV (64% vs 97%, p<0.001) and fewer days on MV (mean difference 5.8, 95% CI 0.6 to 10.9 days) compared with non-LISA infants who received surfactant after intubation. CONCLUSION LISA reduced the rate and duration of MV but had no other clear benefits.
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Affiliation(s)
- Hallvard Reigstad
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | | | - Arild E Rønnestad
- Women and Children's division, Department of Neonatal Intensive Care, Rikshospitalet, Oslo Universitetssykehus, Oslo, Norway.,Norwegian Neonatal Network, Rikshospitalet University Hospital, Oslo, Norway
| | - Claus Klingenberg
- Department of Paediatrics, University Hospital of North Norway, Tromso, Norway.,Pediatric Research Group, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Hans Jørgen Stensvold
- Neonatal Department, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Trond Markestad
- Department of Clinical Science, Universitetet i Bergen Det medisinske fakultet, Bergen, Norway.,Department of Research, Innlandet Hospital Trust, Brumunddal, Norway
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5
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Rasmussen MI, Hansen ML, Pichler G, Dempsey E, Pellicer A, EL-Khuffash A, A S, Piris-Borregas S, Alsina M, Cetinkaya M, Chalak L, Özkan H, Baserga M, Sirc J, Fuchs H, Ergenekon E, Arruza L, Mathur A, Stocker M, Otero Vaccarello O, Szczapa T, Sarafidis K, Królak-Olejnik B, Memisoglu A, Reigstad H, Rafińska-Ważny E, Hatzidaki E, Peng Z, Gkentzi D, Viellevoye R, De Buyst J, Mastretta E, Wang P, Hahn GH, Bender L, Cornette L, Tkaczyk J, del Rio R, Fumagalli M, Papathoma E, Wilinska M, Naulaers G, Sadowska-Krawczenko I, Lecart C, Couce ML, Fredly S, Heuchan AM, Karen T, Greisen G. Extremely Preterm Infant Admissions Within the SafeBoosC-III Consortium During the COVID-19 Lockdown. Front Pediatr 2021; 9:647880. [PMID: 34322460 PMCID: PMC8310995 DOI: 10.3389/fped.2021.647880] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 06/15/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To evaluate if the number of admitted extremely preterm (EP) infants (born before 28 weeks of gestational age) differed in the neonatal intensive care units (NICUs) of the SafeBoosC-III consortium during the global lockdown when compared to the corresponding time period in 2019. Design: This is a retrospective, observational study. Forty-six out of 79 NICUs (58%) from 17 countries participated. Principal investigators were asked to report the following information: (1) Total number of EP infant admissions to their NICU in the 3 months where the lockdown restrictions were most rigorous during the first phase of the COVID-19 pandemic, (2) Similar EP infant admissions in the corresponding 3 months of 2019, (3) the level of local restrictions during the lockdown period, and (4) the local impact of the COVID-19 lockdown on the everyday life of a pregnant woman. Results: The number of EP infant admissions during the first wave of the COVID-19 pandemic was 428 compared to 457 in the corresponding 3 months in 2019 (-6.6%, 95% CI -18.2 to +7.1%, p = 0.33). There were no statistically significant differences within individual geographic regions and no significant association between the level of lockdown restrictions and difference in the number of EP infant admissions. A post-hoc analysis based on data from the 46 NICUs found a decrease of 10.3%in the total number of NICU admissions (n = 7,499 in 2020 vs. n = 8,362 in 2019). Conclusion: This ad hoc study did not confirm previous reports of a major reduction in the number of extremely pretermbirths during the first phase of the COVID-19 pandemic. Clinical Trial Registration: ClinicalTrial.gov, identifier: NCT04527601 (registered August 26, 2020), https://clinicaltrials.gov/ct2/show/NCT04527601.
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Affiliation(s)
| | | | - Gerhard Pichler
- Department of Pediatrics, Medical University of Graz, Graz, Austria
| | - Eugene Dempsey
- Infant Centre and Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Adelina Pellicer
- Department of Neonatology, La Paz University Hospital, Madrid, Spain
| | - Afif EL-Khuffash
- Department of Pediatrics, The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Shashidhar A
- St. Johns Medical College Hospital, Bengaluru, India
| | | | - Miguel Alsina
- Neonatology Department, Hospital Clínic-Maternintat, Barcelona, Spain
| | - Merih Cetinkaya
- Department of Neonatology, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Lina Chalak
- Division of Pediatrics - Neonatal-Perinatal, University of Texas (UT) Southwestern, Dallas, TX, United States
| | - Hilal Özkan
- Division of Neonatology, Department of Pediatrics, Uludag University Medical Faculty, Uludag, Turkey
| | - Mariana Baserga
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
| | - Jan Sirc
- Third Faculty of Medicine, Institute for the Care of the Mother and Child, Charles University, Prague, Czechia
| | - Hans Fuchs
- Center for Pediatrics, Department of Neonatology, Medical Center, University of Freiburg, Freiburg, Germany
| | - Ebru Ergenekon
- Department of Neonatology, Gazi University Hospital, Ankara, Turkey
| | - Luis Arruza
- Division of Neonatology, Instituto del Niño y del Adolescente, Hospital Clinico San Carlos-Health Research Institute San Carlos (IdISSC), Madrid, Spain
| | - Amit Mathur
- Department of Neonatal-Perinatal Medicine, Saint Louis University School of Medicine, St. Louis, MO, United States
| | - Martin Stocker
- Neonatal and Pediatric Intensive Care Unit, Children's Hospital Lucerne, Lucerne, Switzerland
| | | | - Tomasz Szczapa
- Department of Neonatology, Neonatal Biophysical Monitoring and Cardiopulmonary Therapies Research Unit, Poznan University of Medical Sciences, Poznań, Poland
| | - Kosmas Sarafidis
- First Department of Neonatology, Aristotle University, Hippokrateion General Hospital, Thessaloniki, Greece
| | | | - Asli Memisoglu
- Department of Neonatology, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Hallvard Reigstad
- Department of Neonatology, Haukeland University Hospital, Bergen, Norway
| | | | - Eleftheria Hatzidaki
- Department of Neonatology and Neonatal Intensive Care Unit (NICU), University Hospital of Heraklion, Crete, Greece
| | - Zhang Peng
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Despoina Gkentzi
- Neonatal Intensive Care Unit (NICU), Department of Pediatrics, Patras Medical School, Patras, Greece
| | - Renaud Viellevoye
- Neonatal Intensive Care Unit, Department of Pediatrics, University of Liege, Liege, Belgium
| | - Julie De Buyst
- Neonatal Intensive Care Unit (NICU), Tivoli Hospital, La Louviere, Belgium
| | - Emmanuele Mastretta
- S.C. Neonatologia - Pres Osp S. Anna – Citta della Salute e della Scienza di Torino, Torino, Italy
| | - Ping Wang
- Department of Neonatology, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | | | - Lars Bender
- Department of Neonatology, Aalborg University Hospital, Aalborg, Denmark
| | - Luc Cornette
- Department of Neonatology, AZ St-Jan Bruges, Bruges, Belgium
| | - Jakub Tkaczyk
- Department of Neonatology, University Hospital Motol, Prague, Czechia
| | - Ruth del Rio
- Department of Neonatology, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Monica Fumagalli
- Department of Neonatology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Evangelia Papathoma
- Neonatal Intensive Care Unit, “Alexandra” University and State Maternity Hospital, Athens, Greece
| | - Maria Wilinska
- Neonatology Department, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Gunnar Naulaers
- Department of Neonatology, University Hospital Leuven, Leuven, Belgium
| | - Iwona Sadowska-Krawczenko
- Department of Neonatology, Collegium Medicum in Bydgoszcz Nicolaus Copernicus University, Toruń, Poland
| | - Chantal Lecart
- Department of Neonatology, Grand Hôpital de Charleroi (GHdC), Charleroi, Belgium
| | - María Luz Couce
- Neonatology Department, University Clinical Hospital of Santiago de Compostela, Health Research Institute of Santiago de Compostela, Santiago, Spain
| | - Siv Fredly
- Department of Neonatology, Oslo University Hospital, Oslo, Norway
| | - Anne Marie Heuchan
- Department of Neonatology, Royal Hospital for Children, Glasgow, United Kingdom
| | - Tanja Karen
- Department of Neonatology, University Hospital Zurich, Zurich, Switzerland
| | - Gorm Greisen
- Department of Neonatology, Rigshospitalet, Copenhagen, Denmark
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Martin-Almedina S, Ogmen K, Sackey E, Grigoriadis D, Karapouliou C, Nadarajah N, Ebbing C, Lord J, Mellis R, Kortuem F, Dinulos MB, Polun C, Bale S, Atton G, Robinson A, Reigstad H, Houge G, von der Wense A, Becker WH, Jeffery S, Mortimer PS, Gordon K, Josephs KS, Robart S, Kilby MD, Vallee S, Gorski JL, Hempel M, Berland S, Mansour S, Ostergaard P. Correction: Janus-faced EPHB4-associated disorders: novel pathogenic variants and unreported intrafamilial overlapping phenotypes. Genet Med 2021; 23:1376-1377. [PMID: 34040196 PMCID: PMC8257488 DOI: 10.1038/s41436-021-01202-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
| | - Kazim Ogmen
- Molecular and Clinical Sciences Institute, St George's University of London, London, UK
| | - Ege Sackey
- Molecular and Clinical Sciences Institute, St George's University of London, London, UK
| | - Dionysios Grigoriadis
- Molecular and Clinical Sciences Institute, St George's University of London, London, UK
| | - Christina Karapouliou
- Molecular and Clinical Sciences Institute, St George's University of London, London, UK
| | - Noeline Nadarajah
- Molecular and Clinical Sciences Institute, St George's University of London, London, UK
| | - Cathrine Ebbing
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | | | - Rhiannon Mellis
- North Thames Genomic Laboratory Hub, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Fanny Kortuem
- Institute of Human Genetics, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Mary Beth Dinulos
- Departments of Pediatrics - Section of Genetics and Child Development, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.,Geisel School of Medicine at Dartmouth College, Hanover, NH, USA
| | - Cassandra Polun
- Department of Child Health, University of Missouri School of Medicine, Columbia, MO, USA
| | - Sherri Bale
- GeneDx, 207 Perry Parkway, Gaithersburg, MD, USA
| | - Giles Atton
- Molecular and Clinical Sciences Institute, St George's University of London, London, UK
| | - Alexandra Robinson
- Molecular and Clinical Sciences Institute, St George's University of London, London, UK.,University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Hallvard Reigstad
- Neonatal intensive care unit, Children's Department, Haukeland University Hospital, Bergen, Norway
| | - Gunnar Houge
- Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
| | - Axel von der Wense
- Department of Neonatology and Paediatric Intensive Care, Altona Children's Hospital, Hamburg, Germany
| | | | - Steve Jeffery
- Molecular and Clinical Sciences Institute, St George's University of London, London, UK
| | - Peter S Mortimer
- Molecular and Clinical Sciences Institute, St George's University of London, London, UK.,Dermatology & Lymphovascular Medicine, St George's Universities NHS Foundation Trust, London, UK
| | - Kristiana Gordon
- Molecular and Clinical Sciences Institute, St George's University of London, London, UK.,Dermatology & Lymphovascular Medicine, St George's Universities NHS Foundation Trust, London, UK
| | - Katherine S Josephs
- Molecular and Clinical Sciences Institute, St George's University of London, London, UK.,South West Thames Regional Genetics Service, St George's NHS Foundation Trust, London, UK
| | - Sarah Robart
- North Thames Genomic Laboratory Hub, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Mark D Kilby
- The Institute of Metabolism & Systems Research, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK.,West Midlands Fetal Medicine Centre, Birmingham Women's & Children's Foundation Trust, Birmingham, UK
| | - Stephanie Vallee
- Departments of Pediatrics - Section of Genetics and Child Development, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Jerome L Gorski
- Department of Child Health, University of Missouri School of Medicine, Columbia, MO, USA
| | - Maja Hempel
- Institute of Human Genetics, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Siren Berland
- Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
| | - Sahar Mansour
- Molecular and Clinical Sciences Institute, St George's University of London, London, UK. .,South West Thames Regional Genetics Service, St George's NHS Foundation Trust, London, UK.
| | - Pia Ostergaard
- Molecular and Clinical Sciences Institute, St George's University of London, London, UK.
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7
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Martin-Almedina S, Ogmen K, Sackey E, Grigoriadis D, Karapouliou C, Nadarajah N, Ebbing C, Lord J, Mellis R, Kortuem F, Dinulos MB, Polun C, Bale S, Atton G, Robinson A, Reigstad H, Houge G, von der Wense A, Becker WH, Jeffery S, Mortimer PS, Gordon K, Josephs KS, Robart S, Kilby MD, Vallee S, Gorski JL, Hempel M, Berland S, Mansour S, Ostergaard P. Janus-faced EPHB4-associated disorders: novel pathogenic variants and unreported intrafamilial overlapping phenotypes. Genet Med 2021; 23:1315-1324. [PMID: 33864021 PMCID: PMC8257501 DOI: 10.1038/s41436-021-01136-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/18/2021] [Accepted: 02/18/2021] [Indexed: 01/13/2023] Open
Abstract
Purpose Several clinical phenotypes including fetal hydrops, central conducting lymphatic anomaly or capillary malformations with arteriovenous malformations 2 (CM-AVM2) have been associated with EPHB4 (Ephrin type B receptor 4) variants, demanding new approaches for deciphering pathogenesis of novel variants of uncertain significance (VUS) identified in EPHB4, and for the identification of differentiated disease mechanisms at the molecular level. Methods Ten index cases with various phenotypes, either fetal hydrops, CM-AVM2, or peripheral lower limb lymphedema, whose distinct clinical phenotypes are described in detail in this study, presented with a variant in EPHB4. In vitro functional studies were performed to confirm pathogenicity. Results Pathogenicity was demonstrated for six of the seven novel EPHB4 VUS investigated. A heterogeneity of molecular disease mechanisms was identified, from loss of protein production or aberrant subcellular localization to total reduction of the phosphorylation capability of the receptor. There was some phenotype–genotype correlation; however, previously unreported intrafamilial overlapping phenotypes such as lymphatic-related fetal hydrops (LRFH) and CM-AVM2 in the same family were observed. Conclusion This study highlights the usefulness of protein expression and subcellular localization studies to predict EPHB4 variant pathogenesis. Our accurate clinical phenotyping expands our interpretation of the Janus-faced spectrum of EPHB4-related disorders, introducing the discovery of cases with overlapping phenotypes.
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Affiliation(s)
| | - Kazim Ogmen
- Molecular and Clinical Sciences Institute, St George's University of London, London, UK
| | - Ege Sackey
- Molecular and Clinical Sciences Institute, St George's University of London, London, UK
| | - Dionysios Grigoriadis
- Molecular and Clinical Sciences Institute, St George's University of London, London, UK
| | - Christina Karapouliou
- Molecular and Clinical Sciences Institute, St George's University of London, London, UK
| | - Noeline Nadarajah
- Molecular and Clinical Sciences Institute, St George's University of London, London, UK
| | - Cathrine Ebbing
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | | | - Rhiannon Mellis
- North Thames Genomic Laboratory Hub, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Fanny Kortuem
- Institute of Human Genetics, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Mary Beth Dinulos
- Departments of Pediatrics - Section of Genetics and Child Development, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.,Geisel School of Medicine at Dartmouth College, Hanover, NH, USA
| | - Cassandra Polun
- Department of Child Health, University of Missouri School of Medicine, Columbia, MO, USA
| | - Sherri Bale
- GeneDx, 207 Perry Parkway, Gaithersburg, MD, USA
| | - Giles Atton
- Molecular and Clinical Sciences Institute, St George's University of London, London, UK
| | - Alexandra Robinson
- Molecular and Clinical Sciences Institute, St George's University of London, London, UK.,University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Hallvard Reigstad
- Neonatal intensive care unit, Children's Department, Haukeland University Hospital, Bergen, Norway
| | - Gunnar Houge
- Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
| | - Axel von der Wense
- Department of Neonatology and Paediatric Intensive Care, Altona Children's Hospital, Hamburg, Germany
| | | | - Steve Jeffery
- Molecular and Clinical Sciences Institute, St George's University of London, London, UK
| | - Peter S Mortimer
- Molecular and Clinical Sciences Institute, St George's University of London, London, UK.,Dermatology & Lymphovascular Medicine, St George's Universities NHS Foundation Trust, London, UK
| | - Kristiana Gordon
- Molecular and Clinical Sciences Institute, St George's University of London, London, UK.,Dermatology & Lymphovascular Medicine, St George's Universities NHS Foundation Trust, London, UK
| | - Katherine S Josephs
- Molecular and Clinical Sciences Institute, St George's University of London, London, UK.,South West Thames Regional Genetics Service, St George's NHS Foundation Trust, London, UK
| | - Sarah Robart
- North Thames Genomic Laboratory Hub, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Mark D Kilby
- The Institute of Metabolism & Systems Research, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK.,West Midlands Fetal Medicine Centre, Birmingham Women's & Children's Foundation Trust, Birmingham, UK
| | - Stephanie Vallee
- Departments of Pediatrics - Section of Genetics and Child Development, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Jerome L Gorski
- Department of Child Health, University of Missouri School of Medicine, Columbia, MO, USA
| | - Maja Hempel
- Institute of Human Genetics, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Siren Berland
- Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
| | - Sahar Mansour
- Molecular and Clinical Sciences Institute, St George's University of London, London, UK. .,South West Thames Regional Genetics Service, St George's NHS Foundation Trust, London, UK.
| | - Pia Ostergaard
- Molecular and Clinical Sciences Institute, St George's University of London, London, UK.
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Mjelle AB, Guthe HJT, Reigstad H, Bjørke‐Monsen AL, Markestad T. Serum concentrations of C-reactive protein in healthy term-born Norwegian infants 48-72 hours after birth. Acta Paediatr 2019; 108:849-854. [PMID: 30222898 DOI: 10.1111/apa.14578] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 09/03/2018] [Accepted: 09/12/2018] [Indexed: 11/28/2022]
Abstract
AIM To determine serum C-reactive protein (CRP) concentrations in healthy term-born infants shortly after birth. METHODS We sampled blood from 182 infants along with the routine neonatal screening programme at 48-72 hours of age from consecutively recruited healthy infants without signs of infection and a gestational age (GA) of at least 37 weeks. The blood was stored at minus 20°C until analysis in one assay after the end of the study. RESULTS The CRP levels were positively skewed. The median concentration was 5.0 mg/L, 48.9% of the neonates had values <5.0 mg/L, 19.8% ≥10.0 mg/L, 7.1% ≥20.0 mg/L and 1.1% (2 neonates) >30 mg/L. The CRP level was positively related to GA and duration of labour, slightly higher in boys than girls and after vaginal compared to Caesarean delivery. CONCLUSION In healthy neonates born at term, the CRP concentrations did not vary substantially with various common perinatal clinical conditions, and levels above 30 mg/L were uncommon at two to three days of age.
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Affiliation(s)
- Anders Batman Mjelle
- Department of Clinical Medicine University of Bergen Bergen Norway
- Department of Pediatric and Adolescent Medicine Haukeland University Hospital Bergen Norway
| | - Hans Jørgen Timm Guthe
- Department of Pediatric and Adolescent Medicine Haukeland University Hospital Bergen Norway
| | - Hallvard Reigstad
- Department of Pediatric and Adolescent Medicine Haukeland University Hospital Bergen Norway
| | - Anne Lise Bjørke‐Monsen
- Laboratory of Clinical Biochemistry Haukeland University Hospital Bergen Norway
- Department of Clinical Science University of Bergen Bergen Norway
| | - Trond Markestad
- Department of Clinical Science University of Bergen Bergen Norway
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10
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Collett K, Johnsen SL, Kessler J, Reigstad H, Askeland C, Ebbing C. Pregnant woman with polyhydramnios and fetus with small intestinal atresia. Tidsskr Nor Laegeforen 2017; 137:16-1094. [PMID: 28925193 DOI: 10.4045/tidsskr.16.1094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Bentsen MH, Satrell E, Reigstad H, Johnsen SL, Vollsæter M, Røksund OD, Greve G, Berg A, Markestad T, Halvorsen T. Mid-childhood outcomes after pre-viable preterm premature rupture of membranes. J Perinatol 2017; 37:1053-1059. [PMID: 28661513 DOI: 10.1038/jp.2017.97] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 04/20/2017] [Accepted: 04/27/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Investigate cardiorespiratory outcomes in children surviving previable preterm premature rupture of membranes (PV-PPROM) before 22 weeks' gestational age (GA) with minimum 2 weeks latency. STUDY DESIGN Single institution, follow-up of retrospectively identified children who were born after PV-PPROM during 2000-2004, and individually matched preterm-born controls. RESULTS Eleven PV-PPROM and matched control children were included at mean age of 10.5 and 10.7 years. Rupture of membranes occurred at mean GA 182 and 276 weeks and birth at 283 and 286 weeks, respectively. Compared to controls, the PV-PPROM group had significantly poorer lung function, findings on echocardiography indicating mild pulmonary hypertension, and lower peak oxygen consumption. Chart reviews suggested more motor difficulties and a tendency towards more problems with learning and attention. CONCLUSION The findings highlight a preterm-born sub-group in need of targeted long-term monitoring and possibly interventions regarding future cardiorespiratory and neurodevelopmental function.
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Affiliation(s)
- M H Bentsen
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, Faculty of Medicine and Odontology, University of Bergen, Norway
| | - E Satrell
- Department of Clinical Science, Faculty of Medicine and Odontology, University of Bergen, Norway
| | - H Reigstad
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - S L Johnsen
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - M Vollsæter
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, Faculty of Medicine and Odontology, University of Bergen, Norway
| | - O D Røksund
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway.,Department of Occupational Therapy, Physiotherapy and Radiography, Bergen University College, Bergen, Norway
| | - G Greve
- Department of Clinical Science, Faculty of Medicine and Odontology, University of Bergen, Norway.,Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - A Berg
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, Faculty of Medicine and Odontology, University of Bergen, Norway
| | - T Markestad
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, Faculty of Medicine and Odontology, University of Bergen, Norway
| | - T Halvorsen
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, Faculty of Medicine and Odontology, University of Bergen, Norway
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12
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Laborie LB, Markestad TJ, Davidsen H, Brurås KR, Aukland SM, Bjørlykke JA, Reigstad H, Indrekvam K, Lehmann TG, Engesæter IØ, Engesæter LB, Rosendahl K. Selective ultrasound screening for developmental hip dysplasia: effect on management and late detected cases. A prospective survey during 1991-2006. Pediatr Radiol 2014; 44:410-24. [PMID: 24337789 DOI: 10.1007/s00247-013-2838-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 10/19/2013] [Accepted: 11/08/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Early treatment is considered essential for developmental dysplasia of the hip (DDH), but the choice of screening strategy is debated. OBJECTIVE We evaluated the effect of a selective ultrasound (US) screening programme. MATERIALS AND METHODS All infants born in a defined region during 1991-2006 with increased risk of developmental dysplasia of the hip, i.e. clinical hip instability, breech presentation, congenital foot deformities or a family history of DDH, underwent US screening at age 1-3 days. Severe sonographic dysplasia and dislocatable/dislocated hips were treated with abduction splints. Mild dysplasia and pathological instability, i.e. not dislocatable/dislocated hips were followed clinically and sonographically until spontaneous resolution, or until treatment became necessary. The minimum observation period was 5.5 years. RESULTS Of 81,564 newborns, 11,539 (14.1%) were identified as at-risk, of whom 11,190 (58% girls) were included for further analyses. Of the 81,564 infants, 2,433 (3.0%) received early treatment; 1,882 (2.3%) from birth and 551 (0.7%) after 6 weeks or more of clinical and sonographic surveillance. An additional 2,700 (3.3%) normalised spontaneously after watchful waiting from birth. Twenty-six infants (0.32 per 1,000, 92% girls, two from the risk group) presented with late subluxated/dislocated hips (after 1 month of age). An additional 126 (1.5 per 1,000, 83% girls, one from the risk group) were treated after isolated late residual dysplasia. Thirty-one children (0.38 per 1,000) had surgical treatment before age 5 years. Avascular necrosis was diagnosed in seven of all children treated (0.27%), four after early and three after late treatment. CONCLUSION The first 16 years of a standardised selective US screening programme for developmental dysplasia of the hip resulted in acceptable rates of early treatment and US follow-ups and low rates of late subluxated/dislocated hips compared to similar studies.
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13
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Skadberg B, Markestad T, Reigstad H, Bjerknes R, Greve G, Njølstad PR. Minneord. Tidsskriftet 2014. [DOI: 10.4045/tidsskr.14.0829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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14
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Abstract
AIMS To evaluate the effect of elective caesarean section (CS) before term and early enteral nutrition on length of parenteral nutrition and hospital stay in infants with gastroschisis. METHODS Retrospective review of all infants with gastroschisis treated in a regional level III hospital from 1993 to 2008. During 1993-97, there was no established standard for management of pregnancy or delivery while a protocol on close foetal monitoring and early elective CS was adhered to for 1998-2008. Introduction of human milk on the first day after complete closure of the abdominal wall and rapid increase was the policy during the whole period. RESULTS With early elective CS, no foetal deaths occurred after 28-week gestational age (GA). Ten infants were born during the first period and 20 during the second period at a median GA (range) of 36.5 (34-40) and 35 (34-37) weeks (p = 0.013). Seven and 20, respectively, were born by CS. Median (range) days before full enteral feeds and hospital stay were 11.5 (7-39) and 13.0 (7-46) (p = 0.85), and 17.5 (12-36) and 22.5 (13-195) (p = 0.67), respectively. One child died of volvulus after discharge. CONCLUSION Close surveillance of pregnancy, elective preterm caesarean section, early surgery and active approach to primary closure and early enteral feeds appears to be a safe and effective line of management in gastroschisis.
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Affiliation(s)
- I Reigstad
- Department of Clinical Medicine, University of Bergen, Haukeland University Hospital, Norway
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15
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Rosendahl K, Dezateux C, Fosse KR, Aase H, Aukland SM, Reigstad H, Alsaker T, Moster D, Lie RT, Markestad T. Immediate treatment versus sonographic surveillance for mild hip dysplasia in newborns. Pediatrics 2010; 125:e9-16. [PMID: 20026501 DOI: 10.1542/peds.2009-0357] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE We conducted a blinded, randomized, controlled trial to examine whether mildly dysplastic but stable or instable hips would benefit from early treatment, as compared with watchful waiting. PATIENTS AND METHODS A total of 128 newborns with mild hip dysplasia (sonographic inclination angle [alpha angle] of 43 degrees -49 degrees ) and stable or instable but not dislocatable hips were randomly assigned to receive either 6 weeks of abduction treatment (immediate-treatment group) or follow-up alone (active-sonographic-surveillance group). The main outcome measurement was the acetabular inclination angle, measured by radiograph, at 1 year of age. RESULTS Both groups included 64 newborns, and there was no loss to follow-up. With the exception of a small but statistically significant excess of girls in the active-sonographic-surveillance group, there were no statistically significant differences in baseline characteristics between the 2 groups. The mean inclination angle at 12 months was 24.2 degrees for both groups (difference: 0.1 [95% confidence interval (CI): -0.8 to 0.9]), and all children had improved and were without treatment. The mean alpha angle was 59.7 degrees in the treatment group and 57.1 degrees in the active-surveillance group for a difference of 2.6 degrees evaluated after 1.5 and 3 months (95% CI: 1.8 to 3.4; P < .001). At 1.5 months of age, the hips had improved in all treated children but not in 5 children under active surveillance (P = .06). Among the sonographic-surveillance group, 47% received treatment after the initial surveillance period of 1.5 months. CONCLUSIONS Active-sonographic-surveillance halved the number of children requiring treatment, did not increase the duration of treatment, and yielded similar results at 1-year follow-up. Given a reported prevalence of 1.3% for mildly dysplastic but stable hips, a strategy of active surveillance would reduce the overall treatment rate by 0.6%. Our results may have important implications for families as well as for health care costs.
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Affiliation(s)
- Karen Rosendahl
- Diagnostic Radiology, Great Ormond Street Hospital for Children, London, United Kingdom.
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16
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Westby Wold SH, Sommerfelt K, Reigstad H, Rønnestad A, Medbø S, Farstad T, Kaaresen PI, Støen R, Leversen KT, Irgens LM, Markestad T. Neonatal mortality and morbidity in extremely preterm small for gestational age infants: a population based study. Arch Dis Child Fetal Neonatal Ed 2009; 94:F363-7. [PMID: 19439434 DOI: 10.1136/adc.2009.157800] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To assess if growth restricted (small for gestational age, SGA) extremely preterm infants have excess neonatal mortality and morbidity. METHODS This was a cohort study of all infants born alive at 22-27 weeks' post menstrual age in Norway during 1999-2000. Outcomes were compared between those who were SGA, defined as a birth weight less than the fifth percentile for post menstrual age, and those who had weights at or above the fifth percentile. RESULTS Of 365 infants with a post menstrual age of <28 weeks, 31 (8%) were SGA. Among infants with a post menstrual age of <28 weeks, only chronic lung disease was associated with SGA status (OR 2.7, 95% CI 1.0 to 7.2). SGA infants with a post menstrual age of 26-27 weeks had excess neonatal mortality (OR 3.8, 95% CI 1.3 to 11), chronic lung disease and a significantly higher mean number of days (age) before tolerating full enteral nutrition. SGA infants with a post menstrual age of 22-25 weeks had an excess risk of necrotising enterocolitis. CONCLUSION Extremely preterm SGA infants had excess neonatal mortality and morbidity in terms of necrotising enterocolitis and chronic lung disease.
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Affiliation(s)
- S H Westby Wold
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.
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17
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Abstract
Newborn children normally lose up to 10% of their birth weight during the first week of life. With greater weight loss one must consider low intake and pathological losses. We describe a 6-day-old girl with nearly 19% weight loss and hypertonic dehydration caused by hypogalactia. Principles for treatment of hypertonic dehydration and strategies for finding these children are discussed.
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18
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Sandtorv L, Reigstad H, Bruarøy S, Elgen I, Lægreid L. Har legemiddelassistert rehabilitering i svangerskapet konsekvenser for barna? Tidsskriftet 2009; 129:287-90. [DOI: 10.4045/tidsskr.09.33335] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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19
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Reigstad H. [Metabolic inborn error with acute debut in newborns]. Tidsskr Nor Laegeforen 2008; 128:1537. [PMID: 18604904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
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20
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Markestad T, Kaaresen PI, Rønnestad A, Reigstad H, Lossius K, Medbø S, Zanussi G, Engelund IE, Skjaerven R, Irgens LM. Early death, morbidity, and need of treatment among extremely premature infants. Pediatrics 2005; 115:1289-98. [PMID: 15867037 DOI: 10.1542/peds.2004-1482] [Citation(s) in RCA: 247] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To determine outcomes, in terms of perinatal and early death, need for treatment, and morbidity at the time of discharge home, among extremely preterm infants. DESIGN A prospective observational study of all infants with a gestational age (GA) of 22 to 27 completed weeks or a birth weight of 500 to 999 g who were born in Norway in 1999 and 2000. RESULTS Of 636 births, 174 infants (27%) were stillborn or died in the delivery room, 86 (14%) died in the NICU, and 376 (59%) were discharged from the hospital. The risk of being registered as stillborn or not being resuscitated increased with decreasing GA below 25 weeks. The survival rates for all births and for infants admitted to a NICU were, respectively, 0% for <23 weeks, 16% and 39% for 23 weeks, 44% and 60% for 24 weeks, 66% and 80% for 25 weeks, 72% and 84% for 26 weeks, 82% and 93% for 27 weeks, and 69% and 90% for >27 weeks. For the survivors, days of mechanical ventilation decreased from a median of 37 days to 3 days and the proportion in need of oxygen at 36 weeks' postconceptional age decreased from 67% to 26% at 23 and 27 weeks' GA, respectively. At 40 weeks' postconceptional age, the respective figures were 11% and 6%. The proportion with retinopathy of prematurity (ROP) requiring treatment decreased from 33% for GA of 23 weeks to 0% for >25 weeks. Periventricular hemorrhage of more than grade 2 occurred for 6% of the survivors and significant periventricular leukomalacia occurred for 5%, with no significant association with GA. The proportion of survivors without severe neurosensory or pulmonary morbidity increased from 44% for 23 weeks' to 86% for 27 weeks' GA. Apart from ROP, the morbidity rate was not associated with GA. CONCLUSIONS The survival rate was high and the morbidity rate at discharge home was low in the present study, compared with previous population-based studies. With the exception of ROP, the morbidity rates among the survivors were not higher at the lowest GAs, possibly because withholding treatment was considered more acceptable for the most immature infants. The need for intensive care increased markedly for survivors with the lowest GAs.
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Affiliation(s)
- Trond Markestad
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway.
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21
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Rønnestad A, Abrahamsen TG, Medbø S, Reigstad H, Lossius K, Kaaresen PI, Engelund IE, Irgens LM, Markestad T. Septicemia in the first week of life in a Norwegian national cohort of extremely premature infants. Pediatrics 2005; 115:e262-8. [PMID: 15687417 DOI: 10.1542/peds.2004-1834] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To investigate the incidence, causes, predictors, and outcomes of septicemia in the first week of life in a national cohort of extremely premature infants. METHODS A prospective study of survival of all infants with gestational age of <28 weeks or birth weight of <1000 g who were born in Norway in 1999-2000 was performed. Data on the maternal prenatal history, delivery, and neonatal course, including detailed information on episodes of microbiologically verified septicemia, were collected on predefined forms. Septicemia was reported in 2 groups, ie, episodes diagnosed on the day of delivery (ie, very early-onset septicemia [VEOS]) and episodes diagnosed from day 2 to day 7 of life (ie, early-onset septicemia [EOS]). Logistic regression models were used for the selection of variables for predictor analysis in each group. RESULTS Of 462 included infants, VEOS occurred for 15 (32.5 per 1000 population) and EOS for 15 (35.5 per 1000 population). The most prevalent bacteria were Escherichia coli in VEOS (n = 9) and staphylococci (coagulase-negative staphylococci and Staphylococcus aureus) (n = 15) in EOS. Case fatality rates were 40% and 13%, respectively. Independent predictive factors for VEOS were clinical chorioamnionitis (odds ratio [OR]: 10.5; 95% confidence interval [CI]: 3.3-33.4) and high maternal age (OR: 1.2; 95% CI: 1.0-1.3), whereas not receiving systemic antibiotic therapy within 2 days of age (OR: 13.6; 95% CI: 3.7-50.2) and receiving nasal continuous positive airway pressure (n-CPAP) support at 24 hours of age (OR: 9.8; 95% CI: 2.5-38.4) independently predicted septicemia after the first day of life. CONCLUSIONS Whereas vertically transmitted septicemia was dominated by Gram-negative bacteria, with predictors being exclusively of maternal origin, EOS was dominated by typically nosocomial flora, with n-CPAP treatment at 24 hours of age being a powerful predictor. Early n-CPAP treatment, as opposed to mechanical ventilation, as a powerful predictor of septicemia in the early neonatal period, even with adjustment for early systemic antibiotic treatment, is a new observation among extremely premature infants that warrants additional study.
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MESH Headings
- Chorioamnionitis/complications
- Continuous Positive Airway Pressure
- Escherichia coli/isolation & purification
- Escherichia coli Infections/epidemiology
- Escherichia coli Infections/mortality
- Escherichia coli Infections/transmission
- Female
- Humans
- Incidence
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/epidemiology
- Infant, Premature, Diseases/microbiology
- Infant, Premature, Diseases/mortality
- Infant, Very Low Birth Weight
- Infectious Disease Transmission, Vertical
- Logistic Models
- Male
- Maternal Age
- Norway/epidemiology
- Pregnancy
- Prospective Studies
- Risk Factors
- Sepsis/congenital
- Sepsis/epidemiology
- Sepsis/microbiology
- Sepsis/mortality
- Staphylococcal Infections/epidemiology
- Staphylococcal Infections/mortality
- Staphylococcal Infections/transmission
- Staphylococcus/isolation & purification
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Affiliation(s)
- Arild Rønnestad
- Department of Pediatrics, Rikshospitalet University Hospital, Sognsveien 20, 0027 Oslo, Norway.
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22
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Rønnestad A, Abrahamsen TG, Medbø S, Reigstad H, Lossius K, Kaaresen PI, Egeland T, Engelund IE, Irgens LM, Markestad T. Late-onset septicemia in a Norwegian national cohort of extremely premature infants receiving very early full human milk feeding. Pediatrics 2005; 115:e269-76. [PMID: 15687416 DOI: 10.1542/peds.2004-1833] [Citation(s) in RCA: 141] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To investigate the occurrence of and risk factors for late-onset septicemia (LOS) in a national cohort of extremely premature infants who received very early full human milk feeding. METHODS A prospective study of all infants born in Norway in 1999 and 2000 with gestational age of <28 weeks or birth weight of <1000 g was performed. Extensive clinical information, including data on feeding practices and episodes of septicemia, was collected on predefined forms. LOS was defined as growth of bacteria or fungi in blood cultures in conjunction with clinical symptoms consistent with systemic infection occurring after day 6 of life. Cox regression models, including models allowing for time-dependent covariates, were applied in the analysis of LOS. RESULTS Of 464 eligible infants, 462 (99.6%) were enrolled and 405 (87.7%) survived until day 7. LOS was diagnosed for 80 (19.7%). The predominant pathogens were coagulase-negative staphylococci, followed by Candida spp. Case fatality rates associated with septicemia were 10% in general and 43% for Candida spp septicemia. Necrotizing enterocolitis or bowel perforation was diagnosed for 19 infants (4%). Enteral feeding with human milk was initiated within the third day for 98% of patients, and 92% were receiving full enteral feeding (FEF) with human milk within the third week. Both high Clinical Risk Index for Babies scores and an umbilical venous catheter in situ at 7 days of age significantly predicted LOS. However, the overall most influential risk factor for LOS was the number of days without establishment of FEF with human milk, with an adjusted relative risk of 3.7 (2.0-6.9) for LOS if FEF was not established within the second week of life. CONCLUSIONS The incidence and case fatality rate of septicemia for this cohort of extremely preterm infants were lower than values in comparable studies. The main difference, compared with other studies, was the feeding practice, and the data suggest that very early FEF with human milk significantly reduces the risk of LOS among extremely premature infants.
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MESH Headings
- Candida/isolation & purification
- Candidiasis/epidemiology
- Candidiasis/mortality
- Catheterization, Peripheral/adverse effects
- Disease-Free Survival
- Enteral Nutrition
- Female
- Humans
- Incidence
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/epidemiology
- Infant, Premature, Diseases/microbiology
- Infant, Premature, Diseases/mortality
- Infant, Very Low Birth Weight
- Male
- Milk, Human
- Norway/epidemiology
- Proportional Hazards Models
- Prospective Studies
- Risk Factors
- Sepsis/epidemiology
- Sepsis/microbiology
- Staphylococcal Infections/epidemiology
- Staphylococcal Infections/mortality
- Staphylococcus/isolation & purification
- Umbilical Veins
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Affiliation(s)
- Arild Rønnestad
- Department of Pediatrics, Rikshospitalet University Hospital, Sognsveien 20, 0027 Oslo, Norway.
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Laegreid LM, Bruarøy S, Reigstad H. [Fetal injury and alcohol drinking during pregnancy]. Tidsskr Nor Laegeforen 2005; 125:445-7. [PMID: 15742019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
BACKGROUND There is still an ongoing discussion whether moderate alcohol consumption during pregnancy is harmful to the fetus. In most western countries, however, total abstinence is recommended. MATERIAL AND METHODS Over the last five years we have seen 64 infants and children with alcohol-related disorders. We present the clinical records of one alcohol-damaged child, and present the latest recommended categorisation of alcohol-related disorders in infants and children. RESULTS In our experience, some women with heavy alcohol consumption are allowed to continue their abuse without interference from health professionals. Children of women with moderate alcohol consumption may be seriously damaged. Updated research on pregnancy and alcohol that we have reviewed provide clear evidence that brain structure as well as brain function are affected by heavy prenatal alcohol exposure. INTERPRETATION Use of alcohol in pregnancy, also in moderate amounts, is a serious risk factor for fetal damage. Therefore complete abstinence from alcohol during pregnancy should be recommended. For the alcohol-damaged children, early recognition and appropriate treatment will give the child a better opportunity for future optimal development.
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Reigstad H. [Albumin solutions in neonatal medicine]. Tidsskr Nor Laegeforen 2003; 123:1910. [PMID: 12830284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
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25
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Markestad T, Reigstad H. [Screening for alloimmune thrombocytopenia]. Tidsskr Nor Laegeforen 2002; 122:650; author reply 650-1. [PMID: 11998723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
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Abstract
A case of congenital absence of the nose is presented. The etiology of this rare condition is unknown. A review of the literature reveals that the previously applied terms, e.g. 'arhinia', are unclear. In the reviewed cases there seems to be a pattern of facial anomalies associated with nasal absence. In most cases, one could probably expect a lack of the olfactory bulbs and tracts. We suggest a new terminology and summarize the aims of the radiological evaluation of this condition.
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Affiliation(s)
- Ø E Olsen
- Department of Radiology, Haukeland University Hospital, 5021 Bergen, Norway.
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27
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Reigstad H, Markestad T. [Treatment of extremely premature infants--which limits and what problems?]. Tidsskr Nor Laegeforen 2001; 121:711-4. [PMID: 11293356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
In Norway about 300 babies with a birthweight of 500-999 grams and 200 with a gestational age of 24-27 weeks are born annually. This gives a total of 320-330 babies who come under the definition of extreme prematurity. Obstetric care is important in order to avoid premature birth, or, when premature birth is unavoidable, to find the optimal time and place for delivery. There is ongoing discussion of what constitutes reasonable lower limits for offering life support. The survival rate for babies born before 24 gestational weeks is low and the risk of serious neurological damage high. The risk of severe lung disease is reduced with pre- and postnatal treatment with corticosteroids and postnatal treatment with surfactant, but excessive corticosteroid treatment may possibly increase the risk of neurological damage. Despite major recent progress in the treatment of the preterm baby, significant understanding of why disabilities occur is lacking.
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Affiliation(s)
- H Reigstad
- Barneklinikken Haukeland Sykehus 5021 Bergen.
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Søvik O, Njølstad PR, Reigstad H, Brackman D, Teslo I, Brunvand L. [Diagnosis and treatment of congenital hyperinsulinism--to Paris at any price?]. Tidsskr Nor Laegeforen 2001; 121:612-4. [PMID: 11301621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND Persistent hyperinsulinaemic hypoglycaemia of infancy (PHHI) is a hyperfunctional disorder of pancreatic insulin-producing cells with hypertrophic beta-cells present either focally or diffusely. With an estimated frequency of 1:50,000 live births, Norway will on average have one case per year. It is clearly difficult to maintain expertise in diagnostics and treatment with such a low incidence. MATERIAL AND METHODS We report three Norwegian patients with PHHI who were successfully treated at Hôpital des Enfants Malades in Paris. RESULTS Two patients were shown to have focal hyperinsulinism treated with partial pancreas resection. After follow-up of three and a half and two years respectively, these patients have normal glucose tolerance and exocrine pancreatic function. One patient with diffuse hyperinsulinism was operated with subtotal (90%) pancreatectomy. At 2.5-years follow-up this patient has slight glucose intolerance whereas her fasting blood glucose is low normal. The exocrine pancreatic function is normal. INTERPRETATION Patients with PHHI should be referred to a centre where the possibility of focal hyperinsulinism can be thoroughly explored.
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Affiliation(s)
- O Søvik
- Barneklinikken, Haukeland Sykehus, 5021 Bergen.
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Reigstad H. [Resuscitation of newborn infants]. Tidsskr Nor Laegeforen 2000; 120:14. [PMID: 10815471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
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Abstract
UNLABELLED We report on three siblings with non-immune hydrops fetalis. Congenital pulmonary lymphangiectasia was diagnosed in two of them. One of these, a girl still alive and suffering from frequent airway infections, has bilateral pleural effusions and distal congenital lymphoedema. CONCLUSION To our knowledge, this is the first report of non-immune hydrops fetalis and congenital pulmonary lymphangiectasia occurring in siblings.
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Affiliation(s)
- P R Njølstad
- Department of Medical Genetics, University of Bergen, Norway.
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31
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Albrechtsen S, Rasmussen S, Reigstad H, Markestad T, Irgens LM, Dalaker K. Evaluation of a protocol for selecting fetuses in breech presentation for vaginal delivery or cesarean section. Am J Obstet Gynecol 1997; 177:586-92. [PMID: 9322628 DOI: 10.1016/s0002-9378(97)70150-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Our purpose was to evaluate, with respect to obstetric intervention and neonatal outcome, a protocol for selecting fetuses in breech presentation for vaginal delivery or cesarean section. STUDY DESIGN A clinical follow-up study was performed between 1984 and 1992 of all term singleton deliveries in breech presentation. Each case selected for vaginal delivery had a matched control in vertex presentation. RESULTS A total of 1212 infants presented as breech. Vaginal delivery increased from 45% to 57% (p = 0.004), and cesarean section for failure of vaginal delivery declined from 21% to 6% (p < 0.00001). None, however, died or had long-term sequelae because of a complicated or failed vaginal breech delivery. A total of 8.8% of those delivered vaginally in breech versus 5.0% of those in vertex presentation were admitted to the neonatal intensive care unit (p = 0.009). Among those with vaginal delivery, 2.5% in breech presentation were given the clinical diagnosis of birth asphyxia versus none in the vertex position (p = 0.0001). CONCLUSION Breech presentation at term may be selected for vaginal delivery if properly managed.
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Affiliation(s)
- S Albrechtsen
- Department of Obstetrics and Gynecology, University of Bergen, Norway
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Kiserud T, Gjelland K, Bognø H, Waardal M, Reigstad H, Rosendahl K. Echogenic material in the fetal gallbladder and fetal disease. Ultrasound Obstet Gynecol 1997; 10:103-106. [PMID: 9286018 DOI: 10.1046/j.1469-0705.1997.10020103.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The presence of echogenic material within the gallbladder is probably a rare finding in the fetus, and the list of predisposing factors known for postnatal life seems not to be applicable to prenatal diagnosis. In the present study 1656 obstetric scans were performed on referrals to the Unit of Fetal Medicine. No echogenic gallbladder contents were found before 28 weeks. In the subgroup of 523 fetuses who were examined during gestational weeks 28-42, six fetuses were found to have echogenic material in the gallbladder. The echogenicities were found in patients who had the following: extra-amniotic hematoma with intrauterine growth retardation and oligohydramnios, tetralogy of Fallot, trisomy 21 with atrioventricular septal defect and transient ascites, early abnormally distended fetal gallbladder, chromosomal aberration (translocation 10; 11) with bilateral clubfoot, and gastroschisis. Echogenic densities had disappeared at ultrasound scans performed during early postnatal life in four cases, were absent at five weeks in one case, and still present as calculi 8 months after birth in one case. Although no causative conclusions can be drawn from the report, these conditions are suggested as possible predisposing factors for the presence of echogenic material in the fetal gallbladder.
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Affiliation(s)
- T Kiserud
- Department of Obstetrics and Gynecology, University Hospital of Bergen, Norway
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Thordarson H, Haram K, Nedrebø BG, Reigstad H. [Diabetes in pregnancy--without clinical significance?]. Tidsskr Nor Laegeforen 1997; 117:2360-1. [PMID: 9265287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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34
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Reigstad H, Grønlie I. [Clearing after erroneously administered racemic adrenaline]. Tidsskr Nor Laegeforen 1997; 117:1647. [PMID: 9198955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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35
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Haram K, Thordarson H, Nedrebø BG, Reigstad H. [Diabetes mellitus in pregnancy]. Tidsskr Nor Laegeforen 1996; 116:3452-8. [PMID: 9019848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The authors highlight some aspects of diabetes mellitus that complicate pregnancy. Several complications, e.g. hypoglycaemia, hyperglycaemia and macrosomia are described briefly. Macrosomia can be diagnosed by ultrasound examination, which should be performed every other week from the 24th week of gestation. Accelerated abdominal circumference (> or = 1.2 cm/week) between 32 and 39 weeks and excess thickness of soft tissue over the proximal humerus of the foetus after the 32nd week (> 13 mm at term) may imply development of macrosomia. The elevated risk related to adiposity and poor metabolic control can be avoided by intensive treatment. Intensive metabolic treatment can also reduce the frequency of preeclampsia and polyhydramnion. Ketoacidosis and intrauterine foetal death may be consequences of poor diabetic control. The authors discuss infectious problems, some aspects of treatment, e.g. risk of preterm delivery, dietary treatment and insulin, indications for delivery and various neonatal problems.
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Affiliation(s)
- K Haram
- Kvinneklinikken, Haukeland Sykehus, Bergen
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Haram K, Thordarson H, Nedrebø BG, Reigstad H. [Pregnancy in diabetes]. Tidsskr Nor Laegeforen 1996; 116:3459-64. [PMID: 9019849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The authors review various aspects of gestational diabetes, including definition, screening, diagnostic procedures, complications (hypertension, macrosomia), clinical evaluation (ultrasound, non-stress test), treatment (diet, insulin), indications for delivery and neonatal aspects (hypoglycaemia, hypocalcaemia). Complications can be reduced by intensive dietary treatment and insulin. If the gestational diabetes is regulated well the woman can wait for spontaneous birth at term. In the case of pregnant women with less than optimal regulated diabetes, however, or with complications such as hypertension, macrosomia, previous stillbirth, labour can be induced preterm by local administration of prostaglandin or infusion of oxytocin. Physical training and weight reduction should be instituted to avoid later development of type II diabetes mellitus. There is still some uncertainty about different aspects of gestational diabetes.
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Affiliation(s)
- K Haram
- Kvinneklinikken, Haukeland Sykehus, Bergen
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Reigstad H, Markestad T, Moster D. [High-frequency oscillation in newborn infants. A promising therapeutic principle when respirator therapy is hazardous]. Tidsskr Nor Laegeforen 1994; 114:1925-7. [PMID: 8079316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
14 newborn infants were ventilated with oscillation because of severe respiratory distress syndrome (n = 3), pulmonary air leaks (n = 4), pulmonary hypoplasia (n = 4) or sepsis and pneumonia (n = 3). All but four of the infants were more easily stabilized by oscillation than by conventional ventilation. Four infants survived after 1-5 (mean three) days of oscillation, and none developed severe chronic lung disease. New commercial ventilators make this mode of ventilation of newborn infants relatively simple. Small premature babies who require high pressures with conventional ventilation, babies with pulmonary air leaks and babies with hypoplastic lungs may benefit from oscillation.
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Affiliation(s)
- H Reigstad
- Barneklinikken Haukeland Sykehus, Bergen
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Grønlie I, Alsaker T, Reigstad H. [Use of syringes for dosing of drugs for peroral use and inhalation]. Tidsskr Nor Laegeforen 1994; 114:1105. [PMID: 8009530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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39
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Haram K, Reigstad H, Markestad T. [Prenatal prevention of respiratory distress syndrome in newborn infants]. Tidsskr Nor Laegeforen 1993; 113:1698-700. [PMID: 8322294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
This article reviews the embryology, pathophysiology, clinical aspects and prophylactic treatment of respiratory distress syndrome (RDS). Prenatal prophylaxis with corticosteroids is indicated for gestational ages between 24 and 32 weeks, even if the effect of prophylaxis is uncertain before the 28th week. Prophylactic treatment is less important between the 32nd and 34th gestational week. Hypertension is not considered a contraindication, but premature rupture of the membranes is a relative contraindication. Corticosteroid treatment may be given, however, in combination with antibiotic prophylaxis.
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Affiliation(s)
- K Haram
- Kvinneklinikken, Haukeland sykehus, Bergen
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40
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Abstract
A newborn with cytomegalovirus disease with cerebral involvement was treated with ganciclovir for 21 days. The treatment resulted in only temporary cessation of virus shedding in the urine and probably had no ameliorating effect on the long-term clinical outcome.
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Affiliation(s)
- H Reigstad
- Department of Pediatrics, University of Bergen, Norway
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41
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Reigstad H, Markestad T. [Arterial catheters in newborn infants]. Tidsskr Nor Laegeforen 1990; 110:3731-3. [PMID: 2274939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The article summarizes one year's experience of arterial lines in at third-level department for newborn children. We successfully placed an arterial line in 69 out of 71 children. 13 out of 84 arterial lines were umbilical catheters, the others were introduced percutaneously in the radial or posterior tibial arteries. Both umbilical arterial and peripheral arterial lines were functioning satisfactorily, with very few complications, and no serious ones. An arterial line is a relatively simple and a safe method for good monitoring of newborn children in need of intensive care.
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MESH Headings
- Blood Pressure Monitors
- Catheterization, Peripheral/adverse effects
- Catheterization, Peripheral/instrumentation
- Catheters, Indwelling/adverse effects
- Humans
- Infant
- Infant, Newborn
- Infant, Newborn, Diseases/blood
- Infant, Newborn, Diseases/diagnosis
- Infant, Newborn, Diseases/physiopathology
- Monitoring, Physiologic/instrumentation
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Affiliation(s)
- H Reigstad
- Barneklinikken, Haukeland sykehus, Bergen
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Brandtzaeg P, Gaustad P, Vanberg PJ, Medbø S, Ledaal P, Reigstad H. [Clinical manifestations caused by group A streptococci]. Tidsskr Nor Laegeforen 1990; 110:2629-33. [PMID: 2219027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
We describe the symptomatology of different disease entities caused by group A beta-hemolytic streptococci (Streptococcus pyogenes, GAS). The case histories of four patients, two of whom died, emphasize the severity of certain clinical manifestations of GAS-infections. A 34 year-old woman was admitted to hospital four days after start of the symptoms. She presented a clinical picture very similar to that observed in fulminant meningococcal septicaemia; i.e. extensive skin haemorrhages, circulatory collapse, and multiple organ failure. She died within 12 hours of admission. GAS were isolated in blood culture. A seven day-old girl died before admission to hospital. GAS were isolated in blood cultures, cerebrospinal fluid and from her nose and throat. An eight year-old, psychomotoric retarded girl developed a severe left-sided pneumonia, empyema and scarlatina. GAS were detected in throat culture. She responded poorly to high doses of benzylpenicillin given intravenously. She recovered rapidly after thoracotomy and decortication of her left lung. Finally, we describe the case of an 11 year-old boy with rheumatic fever without cardiac involvement. The reported cases underline the need for careful diagnosis and penicillin treatment in cases of GAS-infections.
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Affiliation(s)
- P Brandtzaeg
- Seksjon for infeksjonsmedisin, Ullevål sykehus, Oslo
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Reigstad H, Alsaker T, Lund T. [Guidelines for diagnosis and treatment of meningococcal diseases at hospitals]. Tidsskr Nor Laegeforen 1989; 109:2181-2. [PMID: 2772887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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44
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Reigstad H, Markestad T, Gjengstø H. [Treatment of severe septicemia and meningitis in children]. Tidsskr Nor Laegeforen 1988; 108:1925-7. [PMID: 3206407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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45
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Reigstad H. [Meningococcal disease and high mortality]. Tidsskr Nor Laegeforen 1988; 108:1817. [PMID: 3420594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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46
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Reigstad H, Flaatten H. [The short bowel syndrome in children]. Tidsskr Nor Laegeforen 1986; 106:831-3. [PMID: 3090736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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47
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Flaatten H, Sommerschild H, Grønlie I, Kapstad L, Reigstad H, Hetlelid K. [Parenteral nutrition in the home]. Tidsskr Nor Laegeforen 1986; 106:200-4. [PMID: 3082033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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