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Kaul YF, Karimi AG, Johansson M, Montgomery C, Hellström-Westas L, Wikström J, Kochukhova O. Mri findings, looking behaviour and affect recognition in very preterm children: A pilot study. Physiol Behav 2024; 280:114553. [PMID: 38615730 DOI: 10.1016/j.physbeh.2024.114553] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 03/21/2024] [Accepted: 04/11/2024] [Indexed: 04/16/2024]
Abstract
Children born very preterm often exhibit atypical gaze behaviors, affect recognition difficulties and are at risk for cerebral white matter damage. This study explored links between these sequalae. In 24 12-year-old children born very preterm, ventricle size using Evans and posterior ventricle indices, and corpus callosum area were used to measure white matter thickness. The findings revealed a correlation between less attention towards the eyes and larger ventricle size. Ventricle and posterior corpus callosum sizes were correlated to affect-recognition proficiency. Findings suggest a link between white matter damage, gaze behavior, and affect recognition accuracy, emphasizing a relation with social perception.
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Affiliation(s)
- Ylva Fredriksson Kaul
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Department of Surgical Sciences, Neuroradiology, Uppsala University, Uppsala, Sweden
| | - Annette Geeb Karimi
- Department of Surgical Sciences, Neuroradiology, Uppsala University, Uppsala, Sweden; Radiology Department, Uppsala University Hospital, Uppsala, Sweden
| | - Martin Johansson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Cecilia Montgomery
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | - Johan Wikström
- Department of Surgical Sciences, Neuroradiology, Uppsala University, Uppsala, Sweden
| | - Olga Kochukhova
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Department of Psychology, Uppsala University, Uppsala, Sweden.
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Karimi A, Setänen S, Larsson E, Holmström G, Kaul YF, Kochukhova O, Johansson M, Montgomery C, Hellström-Westas L, Wikström J. Correction to: Brain MRI findings and their association with visual impairment in young adolescents born very preterm. Neuroradiology 2024:10.1007/s00234-024-03349-4. [PMID: 38598161 DOI: 10.1007/s00234-024-03349-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Affiliation(s)
- Annette Karimi
- Department of Surgical Sciences, Neuroradiology, Uppsala University, Uppsala, Sweden.
- Radiology Department, Uppsala University Hospital, Uppsala, Sweden.
| | - Sirkku Setänen
- Department of Pediatric Neurology, University of Turku, Turku, Finland
- Department of Pediatrics, Turku University Hospital, Turku, Finland
| | - Eva Larsson
- Department of Surgical Sciences, Ophthalmology, Uppsala University, Uppsala, Sweden
| | - Gerd Holmström
- Department of Surgical Sciences, Ophthalmology, Uppsala University, Uppsala, Sweden
| | | | - Olga Kochukhova
- Departments of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Departments of Psychology, Uppsala University, Uppsala, Sweden
| | - Martin Johansson
- Departments of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Cecilia Montgomery
- Departments of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | - Johan Wikström
- Department of Surgical Sciences, Neuroradiology, Uppsala University, Uppsala, Sweden
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Vayssière C, Yli B, Ayres-de-Campos D, Ugwumadu A, Loussert L, Hellström-Westas L, Timonen S, Schwarz C, Nunes I, Roth GE. EUROPEAN ASSOCIATION OF PERINATAL MEDICINE (EAPM) Position statement: Use of appropriate terminology for situations related to inadequate fetal oxygenation in labor. Eur J Obstet Gynecol Reprod Biol 2024; 294:55-57. [PMID: 38218158 DOI: 10.1016/j.ejogrb.2024.01.006] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2024]
Abstract
In high-resource countries, adverse perinatal outcomes are currently rare in term, non-malformed fetuses, undergoing labor, but they remain a leading cause of medico-legal dispute. Precise terminology is important to describe situations related to inadequate fetal oxygenation in labor, to ensure appropriate communication between healthcare professionals and adequate transmission of information to parents. This position statement provides consensus definitions from European perinatologists and midwives regarding the most appropriate terminology to describe situations related to inadequate fetal oxygenation in labor: suspected fetal hypoxia, severe newborn acidemia, newborn metabolic acidosis, and hypoxic-ischemic encephalopathy. It also identifies terms that are imprecise or nonspecific to this situation, and should therefore be avoided by healthcare professionals: fetal well-being, fetal stress, fetal distress, non-reassuring fetal state, and birth asphyxia.
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Affiliation(s)
- Christophe Vayssière
- Department of Obstetrics-Gynecology-Reproduction, Paule de Viguier Hospital, CHU Toulouse, University of Toulouse III, France
| | - Branka Yli
- Delivery Department, Oslo University Hospital, Oslo, Norway
| | | | | | - Lola Loussert
- Department of Obstetrics-Gynecology-Reproduction, Paule de Viguier Hospital, CHU Toulouse, University of Toulouse III, France
| | | | | | | | - Inês Nunes
- Department of Obstetrics and Gynecology, Centro Hospitalar Vila Nova de Gaia/Espinho, CINTESIS - Centro de Investigação em Tecnologias e Serviços de Saúde, University of Porto, Porto, Portugal
| | - Georges-Emmanuel Roth
- Department of Obstetrics and Gynecology, CHU Strasbourg, France, University of Strasbourg, France
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Tran HTT, Le HT, Tran DM, Nguyen GTH, Hellström-Westas L, Alfven T, Olson L. Therapeutic hypothermia after perinatal asphyxia in Vietnam: medium-term outcomes at 18 months - a prospective cohort study. BMJ Paediatr Open 2024; 8:e002208. [PMID: 38388007 PMCID: PMC10882320 DOI: 10.1136/bmjpo-2023-002208] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/31/2024] [Indexed: 02/24/2024] Open
Abstract
AIM To determine neurodevelopmental outcome at 18 months after therapeutic hypothermia for hypoxic-ischaemic encephalopathy (HIE) infants in Vietnam, a low-middle-income country. METHOD Prospective cohort study investigating outcomes at 18 months in severely asphyxiated outborn infants who underwent therapeutic hypothermia for HIE in Hanoi, Vietnam, during the time period 2016-2019. Survivors were examined at discharge and at 6 and 18 months by a neonatologist, a neurologist and a rehabilitation physician, who were blinded to the infants' clinical severity during hospitalisation using two assessment tools: the Ages and Stages Questionnaire (ASQ) and the Hammersmith Infant Neurological Examination (HINE), to detect impairments and promote early interventions for those who require it. RESULTS In total, 130 neonates, 85 (65%) with moderate and 45 (35%) with severe HIE, underwent therapeutic hypothermia treatment using phase change material. Forty-three infants (33%) died during hospitalisation and in infancy. Among the 87 survivors, 69 (79%) completed follow-up until 18 months. Nineteen children developed cerebral palsy (8 diplegia, 3 hemiplegia, 8 dyskinetic), and 11 had delayed neurodevelopment. At each time point, infants with a normal or delayed neurodevelopment had significantly higher ASQ and HINE scores (p<0.05) than those with cerebral palsy. CONCLUSION The rates of mortality and adverse neurodevelopment rate were high and comparable to recently published data from other low-middle-income settings. The ASQ and HINE were useful tools for screening and evaluation of neurodevelopment and neurological function.
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Affiliation(s)
- Hang Thi Thanh Tran
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
- Neonatal Care Center, Vietnam National Children's Hospital, Ha Noi, Viet Nam
| | - Ha Thi Le
- Neonatal Care Center, Vietnam National Children's Hospital, Ha Noi, Viet Nam
| | | | | | | | - Tobias Alfven
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
- Sachs' Children and Youth Hospital, Stockholm, Sweden
| | - Linus Olson
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Karimi A, Setänen S, Larsson E, Holmström G, Fredriksson Kaul Y, Kochukhova O, Johansson M, Montgomery C, Hellström-Westas L, Wikström J. Brain MRI findings and their association with visual impairment in young adolescents born very preterm. Neuroradiology 2024; 66:145-154. [PMID: 37870588 PMCID: PMC10761469 DOI: 10.1007/s00234-023-03235-5] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 10/04/2023] [Indexed: 10/24/2023]
Abstract
PURPOSE Very preterm birth increases risk for neonatal white matter injury, but there is limited data on to what extent this persists into adolescence and how this relates to ophthalmological outcomes. The aim of this study was to assess brain MRI findings in 12-year-old children born very preterm compared to controls and their association with concurrent ophthalmological outcomes. METHODS We included 47 children born very preterm and 22 full-term controls (gestational age <32 and >37 weeks, respectively). Brain MRI findings were studied in association with concurrent ophthalmological outcomes at 12-year follow-up. RESULTS Evans index (0.27 vs 0.25, p<0.001) and a proposed "posterior ventricle index" (0.47 vs 0.45, p=0.018) were increased in children born very preterm. Higher gestational age associated with larger corpus callosum area (β=10.7, 95%CI 0.59-20.8). Focal white matter lesions were observed in 15 (32%) of very preterm children and in 1 (5%) of full-term controls. Increased posterior ventricle index increased risk for visual acuity ≤1.0 (OR=1.07×1011, 95%CI=7.78-1.48×1021) and contrast sensitivity <0.5 (OR=2.6×1027, 95%CI=1.9×108-3.5×1046). Decreased peritrigonal white matter thickness associated with impaired visual acuity (β=0.04, 95%CI 0.002-0.07). CONCLUSION More white matter lesions and evidence of lower white matter volume were found in children born very preterm compared with full-term controls at 12-year follow-up. The association between larger posterior ventricle index and reduced visual acuity and contrast sensitivity suggests disturbances of the posterior visual pathway due to diffuse white matter lesions.
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Affiliation(s)
- Annette Karimi
- Department of Surgical Sciences, Neuroradiology, Uppsala University, Uppsala, Sweden.
- Radiology Department, Uppsala University Hospital, Uppsala, Sweden.
| | - Sirkku Setänen
- Department of Pediatric Neurology, University of Turku, Turku, Finland
- Department of Pediatrics, Turku University Hospital, Turku, Finland
| | - Eva Larsson
- Department of Surgical Sciences, Ophthalmology, Uppsala University, Uppsala, Sweden
| | - Gerd Holmström
- Department of Surgical Sciences, Ophthalmology, Uppsala University, Uppsala, Sweden
| | | | - Olga Kochukhova
- Departments of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Departments of Psychology, Uppsala University, Uppsala, Sweden
| | - Martin Johansson
- Departments of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Cecilia Montgomery
- Departments of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | - Johan Wikström
- Department of Surgical Sciences, Neuroradiology, Uppsala University, Uppsala, Sweden
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Challis P, Källén K, Björklund L, Elfvin A, Farooqi A, Håkansson S, Ley D, Norman M, Normann E, Serenius F, Sävman K, Hellström-Westas L, Um-Bergström P, Ådén U, Abrahamsson T, Domellöf M. Factors associated with the increased incidence of necrotising enterocolitis in extremely preterm infants in Sweden between two population-based national cohorts (2004-2007 vs 2014-2016). Arch Dis Child Fetal Neonatal Ed 2023; 109:87-93. [PMID: 37788898 PMCID: PMC10804036 DOI: 10.1136/archdischild-2023-325784] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/28/2023] [Indexed: 10/05/2023]
Abstract
OBJECTIVE To investigate potential risk factors behind the increased incidence of necrotising enterocolitis (NEC) in Swedish extremely preterm infants. DESIGN Registry data from two population-based national cohorts were studied. NEC diagnoses (Bell stage ≥II) were validated against hospital records. PATIENTS All liveborn infants <27 weeks of gestation 2004-2007 (n=704) and 2014-2016 (n=895) in Sweden. MAIN OUTCOME MEASURES NEC incidence. RESULTS The validation process resulted in a 28% reduction of NEC cases but still confirmed a higher NEC incidence in the later epoch compared with the earlier (73/895 (8.2%) vs 27/704 (3.8%), p=0.001), while the composite of NEC or death was lower (244/895 (27.3%) vs 229/704 (32.5%), p=0.022). In a multivariable Cox regression model, censored for mortality, there was no significant difference in early NEC (0-7 days of life) between epochs (HR=0.9 (95% CI 0.5 to 1.9), p=0.9), but being born in the later epoch remained an independent risk factor for late NEC (>7 days) (HR=2.7 (95% CI 1.5 to 5.0), p=0.001). In propensity score analysis, a significant epoch difference in NEC incidence (12% vs 2.8%, p<0.001) was observed only in the tertile of infants at highest risk of NEC, where the 28-day mortality was lower in the later epoch (35% vs 50%, p=0.001). More NEC cases were diagnosed with intramural gas in the later epoch (33/73 (45.2%) vs 6/26 (23.1%), p=0.047). CONCLUSIONS The increase in NEC incidence between epochs was limited to cases occurring after 7 days of life and was partly explained by increased survival in the most extremely preterm infants. Misclassification of NEC is common.
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Affiliation(s)
- Pontus Challis
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Karin Källén
- Department of Clinical Sciences, Obstetrics and Gynecology, Lund University Faculty of Medicine, Lund, Sweden
| | - Lars Björklund
- Department of Clinical Sciences, Lund, Paediatrics, Lund University, Lund, Sweden
| | - Anders Elfvin
- Department of Pediatrics, Institute of Clinical Sciences, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden
- Department of Pediatrics, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Aijaz Farooqi
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Stellan Håkansson
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - David Ley
- Department of Clinical Sciences, Lund, Paediatrics, Lund University, Lund, Sweden
| | - Mikael Norman
- Division of Pediatrics, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Erik Normann
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Fredrik Serenius
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Karin Sävman
- Department of Pediatrics, Institute of Clinical Sciences, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden
| | | | - Petra Um-Bergström
- Department of Pediatrics, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Clinical Science and Education at Södersjukhuset, Karolinska Institute, Stockholm, Sweden
| | - Ulrika Ådén
- Division of Pediatrics, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden
- Departments of Biomedical and Clinical Sciences and Pediatrics, Linköping University, Linköping, Sweden
| | - Thomas Abrahamsson
- Departments of Biomedical and Clinical Sciences and Pediatrics, Linköping University, Linköping, Sweden
- Department of Pediatrics, Linköping University Hospital, Linköping, Sweden
| | - Magnus Domellöf
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
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Berg J, Källén K, Andolf E, Hellström-Westas L, Ekéus C, Alvan J, Vitols S. Economic Evaluation of Elective Cesarean Section on Maternal Request Compared With Planned Vaginal Birth-Application to Swedish Setting Using National Registry Data. Value Health 2023; 26:639-648. [PMID: 36396536 DOI: 10.1016/j.jval.2022.10.003] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 09/06/2022] [Accepted: 10/01/2022] [Indexed: 05/03/2023]
Abstract
OBJECTIVES There is a lack of consensus around the definition of delivery by cesarean section (CS) on maternal request, and clinical practice varies across and within countries. Previous economic evaluations have focused on specific populations and selected complications. Our aim was to evaluate the cost-effectiveness of CS on maternal request compared with planned vaginal birth in a Swedish context, based on a systematic review of benefits and drawbacks and national registry data on costs. METHODS We used the results from a systematic literature review of somatic risks for long- and short-term complications for mother and child, in which certainty was rated low, moderate, or high using the Grading of Recommendations Assessment, Development and Evaluation. Swedish national registry data were used for healthcare costs of delivery and complications. Utilities for long-term complications were based on a focused literature review. We constructed a decision tree and conducted separate analyses for primi- and multiparous women. Costs and effects were discounted by 3% and the time horizon was varied between 1 and 20 years. RESULTS Planned vaginal birth leads to lower healthcare costs and somatic health gains compared with elective CS without medical indication over up to 20 years. Although there is uncertainty around, for example, quality-of-life effects, results remain stable across sensitivity analyses. CONCLUSIONS CS on maternal request leads to increased hospitalization costs in a Swedish setting, taking into account short- and long-term consequences for both mother and child. Future research needs to study the psychological consequences related to different delivery methods, costs in outpatient care, and productivity losses.
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Affiliation(s)
- Jenny Berg
- Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU), Stockholm, Sweden.
| | - Karin Källén
- Institute of Clinical Sciences, Department of Obstetrics and Gynaecology, Unit of Reproduction Epidemiology, Tornblad Institute, Lund University, Lund, Sweden
| | - Ellika Andolf
- Department of Clinical Sciences, Division of Obstetrics, and Gynaecology, Karolinska Institute, Danderyd Hospital, Stockholm, Sweden
| | | | - Cecilia Ekéus
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Jonatan Alvan
- Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU), Stockholm, Sweden
| | - Sigurd Vitols
- Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU), Stockholm, Sweden; Department of Medicine, Karolinska Institute, Stockholm, Sweden
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Johansson M, Kaul YF, Montgomery C, Larsson E, Hellström-Westas L, Kochukhova O. Different aspects of visual perception are important for 12-year social functioning depending on gestational age. Acta Paediatr 2023. [PMID: 37073096 DOI: 10.1111/apa.16794] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/14/2023] [Accepted: 04/18/2023] [Indexed: 04/20/2023]
Abstract
AIM Perceptual mechanisms in social functioning might promote interventions. We investigated relations between visual perception and social functioning, in preterm children. METHODS A prospective preterm cohort born in Uppsala County, Sweden, in 2004-2007 and 49 full-term controls were examined at 12 years. Aspects of visual perception, including static shapes, emotions, and time to detect biological motion, were related to social functioning and visual acuity. RESULTS The preterm group comprised 25 extremely preterm children, EPT, born below 28 gestational weeks and 53 children born between 28-31 weeks. Preterm children had difficulties in perception of static shapes (p=0.004) and biological motion, p<0.001), but not in emotion perception, compared to controls. In the EPT children, poorer shape perception and lower scores on emotion perception were associated with more social problems (p=0.008) and lower visual acuity (p=0.004). Shape perception explained more variance in social functioning than emotion perception. In controls, fewer social problems were linked to faster biological motion perception (p=0.04). CONCLUSION Static shape and biological motion perception was affected in the preterm groups. Biological motion perception was relevant for social functioning in full-term children. In EPT children, only shape perception was linked to social functioning, suggesting differential visual perception mechanisms for social deficits.
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Affiliation(s)
- Martin Johansson
- Departments of Women's and Children's Health1, Neuroscience/ophthamology2, Psychology3, Uppsala University, Sweden
| | - Ylva Fredriksson Kaul
- Departments of Women's and Children's Health1, Neuroscience/ophthamology2, Psychology3, Uppsala University, Sweden
| | - Cecilia Montgomery
- Departments of Women's and Children's Health1, Neuroscience/ophthamology2, Psychology3, Uppsala University, Sweden
| | - Eva Larsson
- Departments of Women's and Children's Health1, Neuroscience/ophthamology2, Psychology3, Uppsala University, Sweden
| | - Lena Hellström-Westas
- Departments of Women's and Children's Health1, Neuroscience/ophthamology2, Psychology3, Uppsala University, Sweden
| | - Olga Kochukhova
- Departments of Women's and Children's Health1, Neuroscience/ophthamology2, Psychology3, Uppsala University, Sweden
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Morsing E, Lundgren P, Hård AL, Rakow A, Hellström-Westas L, Jacobson L, Johnson M, Nilsson S, Ley D, Sävman K, Hellström A. [Survival and prematurity-related neonatal diagnoses among children born before 24 gestational weeks in Sweden 2007-2018]. Lakartidningen 2023; 120:22108. [PMID: 36892137] [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] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
Children born before 24 gestational weeks had high neonatal morbidity and a majority had one or more neurodevelopmental disorders in addition to somatic diagnoses in childhood. Active Swedish perinatal care of infants with gestational age <24 weeks has resulted in a survival rate of more than 50 percent. Resuscitation of these immature infants is controversial, and some countries offer comfort care only. In a retrospective review of medical files and registries of 399 Swedish infants born before 24 gestational weeks, a majority had severe prematurity-related neonatal diagnoses. In childhood (2-13 years), 75 percent had at least one neurodevelopmental disorder and 88 percent had one or more prematurity-related somatic diagnosis (permanent or transient) that was likely to affect their quality of life. Long-term consequences for surviving infants should be considered in general recommendations as well as in parental information.
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Affiliation(s)
- Eva Morsing
- med dr, överläkare, neonatalvården, Skånes universitetssjukhus Lund
| | - Pia Lundgren
- med dr, överläkare, ögonkliniken, Sahlgrenska universitetssjukhuset, Göteborg
| | - Anna-Lena Hård
- med dr, ögonläkare, institutionen för neurovetenskap och fysiologi, Göteborgs universitet
| | - Alexander Rakow
- docent, överläkare, neonatalvården, Karolinska universitetssjukhuset Solna
| | - Lena Hellström-Westas
- professor, överläkare, institutionen för kvinnors och barns hälsa, Uppsala universitet
| | - Lena Jacobson
- docent, överläkare, ögonkliniken, Karolinska universitetssjukhuset Solna
| | - Mats Johnson
- docent, överläkare, barn- och ungdomspsykiatri, Sahlgrenska universitetssjukhuset, Göteborg
| | - Staffan Nilsson
- prof, statistiker, biomedicin, Sahlgrenska akademin, Göteborg
| | - David Ley
- prof, över-läkare, neonatalvården, Skånes universitetssjukhus Lund
| | - Karin Sävman
- med dr, överläkare, neonatal-vården, Sahlgrenska universitetssjukhuset, Göteborg
| | - Ann Hellström
- professor, överläkare, ögonkliniken, Sahlgrenska universitetssjukhuset, Göteborg
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Ali S, Altamimi T, Annink K, Bartmann P, Beato N, Belker K, Ben-David D, Benders M, Bhattacharya S, Anbu Chakkarapani A, Anbu Chakkarapani A, Charbonneau L, Cherkerzian S, Chowdhury RA, Christou H, de Ribaupierre D, Dehaes M, Domogalla C, Duerden EG, El-Dib M, Elanbari M, Elshibiny H, Engel C, Felderhoff U, Flemmer AW, Franceschini MA, Franz A, Garvey A, Groenendaal F, Gupta S, Hannon K, Hellström-Westas L, Herber-Jonat S, Holz S, Hüning B, Inder T, Jamil A, Jilson T, Kebaya LMN, Keller M, Khalifa AKM, Kim SH, Kittel J, Koch L, Kowalczyk A, Kühr J, St Lawrence K, Lee S, Marandyuk B, Marlow N, Mayorga PC, Meyer R, Meyerink P, Miró J, More K, Munk A, Munster C, Musabi M, Nuyt AM, Peters J, Plum A, Poirier N, Pöschl J, Raboisson MJ, Robinson J, Roychaudhuri S, Rüdiger M, Sarközy G, Saugstad OD, Segerer H, Soni N, Stein A, Steins-Rang C, Sunwoo J, Szakmar E, Tang L, Taskin E, Vahidi H, Waldherr S, Wieg C, Winkler S, Wu R, Yajamanyam PK, Yapicioglu-Yildizdas H. Proceedings of the 14th International Newborn Brain Conference: Other forms of brain monitoring, such as NIRS, fMRI, biochemical, etc. J Neonatal Perinatal Med 2023; 16:S63-S73. [PMID: 37599543 DOI: 10.3233/npm-239004] [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: 08/22/2023]
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El-Dib M, Abend NS, Austin T, Boylan G, Chock V, Cilio MR, Greisen G, Hellström-Westas L, Lemmers P, Pellicer A, Pressler RM, Sansevere A, Tsuchida T, Vanhatalo S, Wusthoff CJ, Wintermark P, Aly H, Chang T, Chau V, Glass H, Lemmon M, Massaro A, Wusthoff C, deVeber G, Pardo A, McCaul MC. Neuromonitoring in neonatal critical care part I: neonatal encephalopathy and neonates with possible seizures. Pediatr Res 2022:10.1038/s41390-022-02393-1. [PMID: 36476747 DOI: 10.1038/s41390-022-02393-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 05/05/2022] [Revised: 08/12/2022] [Accepted: 08/19/2022] [Indexed: 12/12/2022]
Abstract
The blooming of neonatal neurocritical care over the last decade reflects substantial advances in neuromonitoring and neuroprotection. The most commonly used brain monitoring tools in the neonatal intensive care unit (NICU) are amplitude integrated EEG (aEEG), full multichannel continuous EEG (cEEG), and near-infrared spectroscopy (NIRS). While some published guidelines address individual tools, there is no consensus on consistent, efficient, and beneficial use of these modalities in common NICU scenarios. This work reviews current evidence to assist decision making for best utilization of neuromonitoring modalities in neonates with encephalopathy or with possible seizures. Neuromonitoring approaches in extremely premature and critically ill neonates are discussed separately in the companion paper. IMPACT: Neuromonitoring techniques hold promise for improving neonatal care. For neonatal encephalopathy, aEEG can assist in screening for eligibility for therapeutic hypothermia, though should not be used to exclude otherwise eligible neonates. Continuous cEEG, aEEG and NIRS through rewarming can assist in prognostication. For neonates with possible seizures, cEEG is the gold standard for detection and diagnosis. If not available, aEEG as a screening tool is superior to clinical assessment alone. The use of seizure detection algorithms can help with timely seizures detection at the bedside.
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Affiliation(s)
- Mohamed El-Dib
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Nicholas S Abend
- Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia and the University of Pennsylvania, Philadelphia, PA, USA
| | - Topun Austin
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Geraldine Boylan
- INFANT Research Centre & Department of Paediatrics & Child Health, University College Cork, Cork, Ireland
| | - Valerie Chock
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - M Roberta Cilio
- Department of Pediatrics, Division of Pediatric Neurology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Gorm Greisen
- Department of Neonatology, Rigshospitalet, Copenhagen University Hospital & Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lena Hellström-Westas
- Department of Women's and Children's Health, Uppsala University, and Division of Neonatology, Uppsala University Hospital, Uppsala, Sweden
| | - Petra Lemmers
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Adelina Pellicer
- Department of Neonatology, La Paz University Hospital, Madrid, Spain; Neonatology Group, IdiPAZ, Madrid, Spain
| | - Ronit M Pressler
- Department of Clinical Neurophysiology, Great Ormond Street Hospital for Children NHS Trust, and Clinical Neuroscience, UCL- Great Ormond Street Institute of Child Health, London, UK
| | - Arnold Sansevere
- Department of Neurology and Pediatrics, George Washington University School of Medicine and Health Sciences; Children's National Hospital Division of Neurophysiology, Epilepsy and Critical Care, Washington, DC, USA
| | - Tammy Tsuchida
- Department of Neurology and Pediatrics, George Washington University School of Medicine and Health Sciences; Children's National Hospital Division of Neurophysiology, Epilepsy and Critical Care, Washington, DC, USA
| | - Sampsa Vanhatalo
- Department of Clinical Neurophysiology, Children's Hospital, BABA Center, Neuroscience Center/HILIFE, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Moghadam SM, Airaksinen M, Nevalainen P, Marchi V, Hellström-Westas L, Stevenson NJ, Vanhatalo S. An automated bedside measure for monitoring neonatal cortical activity: a supervised deep learning-based electroencephalogram classifier with external cohort validation. Lancet Digit Health 2022; 4:e884-e892. [PMID: 36427950 DOI: 10.1016/s2589-7500(22)00196-0] [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] [Received: 09/19/2022] [Accepted: 10/06/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Electroencephalogram (EEG) monitoring is recommended as routine in newborn neurocritical care to facilitate early therapeutic decisions and outcome predictions. EEG's larger-scale implementation is, however, hindered by the shortage of expertise needed for the interpretation of spontaneous cortical activity, the EEG background. We developed an automated algorithm that transforms EEG recordings to quantified interpretations of EEG background and provides simple intuitive visualisations in patient monitors. METHODS In this method-development and proof-of-concept study, we collected visually classified EEGs from infants recovering from birth asphyxia or stroke. We used unsupervised learning methods to explore latent EEG characteristics, which guided the supervised training of a deep learning-based classifier. We assessed the classifier performance using cross-validation and an external validation dataset. We constructed a novel measure of cortical function, brain state of the newborn (BSN), from the novel EEG background classifier and a previously published sleep-state classifier. We estimated clinical utility of the BSN by identification of two key items in newborn brain monitoring, the onset of continuous cortical activity and sleep-wake cycling, compared with the visual interpretation of the raw EEG signal and the amplitude-integrated (aEEG) trend. FINDINGS We collected 2561 h of EEG from 39 infants (gestational age 35·0-42·1 weeks; postnatal age 0-7 days). The external validation dataset included 105 h of EEG from 31 full-term infants. The overall accuracy of the EEG background classifier was 92% in the whole cohort (95% CI 91-96; range 85-100 for individual infants). BSN trend values were closely related to the onset of continuous EEG activity or sleep-wake cycling, and BSN levels showed robust difference between aEEG categories. The temporal evolution of the BSN trends showed early diverging trajectories in infants with severely abnormal outcomes. INTERPRETATION The BSN trend can be implemented in bedside patient monitors as an EEG interpretation that is intuitive, transparent, and clinically explainable. A quantitative trend measure of brain function might harmonise practices across medical centres, enable wider use of brain monitoring in neurocritical care, and might facilitate clinical intervention trials. FUNDING European Training Networks Funding Scheme, the Academy of Finland, Finnish Pediatric Foundation (Lastentautiensäätiö), Aivosäätiö, Sigrid Juselius Foundation, HUS Children's Hospital, HUS Diagnostic Center, National Health and Medical Research Council of Australia.
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Affiliation(s)
- Saeed Montazeri Moghadam
- BABA Center, Pediatric Research Center, Department of Clinical Neurophysiology, Children's Hospital, HUS imaging, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Physiology, University of Helsinki, Helsinki, Finland.
| | - Manu Airaksinen
- BABA Center, Pediatric Research Center, Department of Clinical Neurophysiology, Children's Hospital, HUS imaging, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Physiology, University of Helsinki, Helsinki, Finland
| | - Päivi Nevalainen
- BABA Center, Pediatric Research Center, Department of Clinical Neurophysiology, Children's Hospital, HUS imaging, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Viviana Marchi
- Department of Developmental Neuroscience, Stella Maris Scientific Institute, IRCCS Fondazione Stella Maris Foundation, Pisa, Italy
| | | | - Nathan J Stevenson
- Brain Modelling Group, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Sampsa Vanhatalo
- BABA Center, Pediatric Research Center, Department of Clinical Neurophysiology, Children's Hospital, HUS imaging, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Physiology, University of Helsinki, Helsinki, Finland
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Hellström A, Jacobson L, Al-Hawasi A, Hellström-Westas L, Rakow A, Johnson M, Sävman K, Holmstrom G, Larsson E, Gränse L, Saric M, Sunnqvist B, Smith L, Hård AL, Morsing E, Lundgren P. Retrospective evaluation of ophthalmological and neurological outcomes for infants born before 24 weeks gestational age in a Swedish cohort. BMJ Open 2022; 12:e055567. [PMID: 35922112 PMCID: PMC9353003 DOI: 10.1136/bmjopen-2021-055567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES To retrospectively evaluate ophthalmological and neurological outcomes in a Swedish cohort of infants born before 24 weeks gestational age (GA) and explore risk factors for visual impairment. SETTING Eye and paediatric clinics in Sweden. PARTICIPANTS Infants screened for retinopathy of prematurity (ROP) (n=399), born before 24 weeks GA, 2007-2018. Cases were excluded if ophthalmological follow-up records could not be traced. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcomes were ophthalmological, including visual acuity (VA), refractive error, strabismus, nystagmus and cerebral visual impairment (CVI). Secondary outcomes comprised neonatal and neurological morbidities. Data were retrospectively retrieved from medical records. RESULTS The 355 assessed children had a median GA of 23 weeks and 2 days and a median birth weight of 565 g. At the last available ophthalmological examination, the median age was 4.8 years (range 0.5-13.2 years). Nystagmus was recorded in 21.1%, strabismus in 34.8%, and 51.0% wore spectacles. Seventy-three of 333 (21.9%) were visually impaired, defined as being referred to a low vision clinic and/or having a VA less than 20/60 at 3.5 years of age or older. ROP treatment was a significant risk factor for visual impairment (OR 2.244, p=0.003). Visually impaired children, compared with children without visual impairment, more often had neurological deficits such as intellectual disability 63.8% versus 33.3% (p<0.001), epilepsy 21.1% versus 7.5% (p=0.001) and autism spectrum disorders 32.8% versus 20.9% (p=0.043). Nine of the 355 children had been diagnosed with CVI. CONCLUSIONS Children born before 24 weeks GA frequently had visual impairment in association with neurological deficits. CVI was rarely diagnosed. A multidisciplinary approach for the evaluation and habilitation of these vulnerable infants is warranted. National follow-up guidelines need to be developed and implemented.
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Affiliation(s)
- Ann Hellström
- The Sahlgrenska Centre for Pediatric Ophthalmology Research, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden
| | - Lena Jacobson
- Department of Clinical Neuroscience, Section for Eye and Vision, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children's Hospital, Neuropediatric Department, Karolinska Universitetssjukhuset, Stockholm, Sweden
| | - Abbas Al-Hawasi
- Department of Biomedical and Clinical Science, Linköping University, Linköping, Sweden
| | | | - Alexander Rakow
- Department of Woman and Child Health, Karolinska Institutet, Stockholm, Sweden
| | - Mats Johnson
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Karin Sävman
- Region Västra Götaland, Department of Neonatology, The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute for Clinical Sciences, Department of Pediatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gerd Holmstrom
- Department of Surgical Sciences, Uppsala Universitet, Uppsala, Sweden
| | - Eva Larsson
- Department of Surgical Sciences, Uppsala Universitet, Uppsala, Sweden
| | - Lotta Gränse
- Department of Clinical Sciences, Ophthalmology, Skåne University Hospital Lund, Lund, Sweden
| | - Marie Saric
- Department of Clinical Sciences, Ophthalmology, Umeå Universitet Medicinska fakulteten, Umea, Sweden
| | | | - Lois Smith
- The Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Anna-Lena Hård
- The Sahlgrenska Centre for Pediatric Ophthalmology Research, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden
| | - Eva Morsing
- Department of Pediatrics, Clinical Sciences, Skåne University Hospital Lund, Lund, Sweden
| | - Pia Lundgren
- The Sahlgrenska Centre for Pediatric Ophthalmology Research, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden
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Morsing E, Lundgren P, Hård AL, Rakow A, Hellström-Westas L, Jacobson L, Johnson M, Nilsson S, Smith LEH, Sävman K, Hellström A. Neurodevelopmental disorders and somatic diagnoses in a national cohort of children born before 24 weeks of gestation. Acta Paediatr 2022; 111:1167-1175. [PMID: 35318709 PMCID: PMC9454084 DOI: 10.1111/apa.16316] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 12/16/2021] [Revised: 02/11/2022] [Accepted: 02/24/2022] [Indexed: 12/29/2022]
Abstract
AIM This study investigated childhood diagnoses in children born extremely preterm before 24 weeks of gestation. METHODS Diagnoses of neurodevelopmental disorders and selected somatic diagnoses were retrospectively retrieved from national Swedish registries for children born before 24 weeks from 2007 to 2018. Their individual medical files were also examined. RESULTS We studied 383 children born at a median of 23.3 (range 21.9-23.9) weeks, with a median birthweight of 565 (range 340-874) grams. Three-quarters (75%) had neurodevelopmental disorders, including speech disorders (52%), intellectual disabilities (40%), attention deficit hyperactivity disorder (30%), autism spectrum disorders (24%), visual impairment (22%), cerebral palsy (17%), epilepsy (10%) and hearing impairment (5%). More boys than girls born at 23 weeks had intellectual disabilities (45% vs. 27%, p < 0.01) and visual impairment (25% vs. 14%, p < 0.01). Just over half of the cohort (55%) received habilitation care. The majority (88%) had somatic diagnoses, including asthma (63%) and failure to thrive/short stature (39%). CONCLUSION Most children born before 24 weeks had neurodevelopmental disorders and/or additional somatic diagnoses in childhood and were referred to habilitation services. Clinicians should be aware of the multiple health and developmental problems affecting these children. Resources are needed to identify their long-term support needs at an early stage.
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Affiliation(s)
- Eva Morsing
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Pia Lundgren
- The Sahlgrenska Centre for Pediatric Ophthalmology Research, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna-Lena Hård
- The Sahlgrenska Centre for Pediatric Ophthalmology Research, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Alexander Rakow
- Department of Women's and Children's Health, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | | | - Lena Jacobson
- The Sahlgrenska Centre for Pediatric Ophthalmology Research, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Division of Eye and Vision, Department of Clinical Neuroscience, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Mats Johnson
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Staffan Nilsson
- Department of Mathematical Sciences, Chalmers University of Technology, Gothenburg, Sweden.,Department of Laboratory Medicine, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lois E H Smith
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Karin Sävman
- Region Västra Götaland, Department of Neonatology, The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ann Hellström
- The Sahlgrenska Centre for Pediatric Ophthalmology Research, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Larsson SM, Hellström-Westas L, Hillarp A, Åkeson PK, Domellöf M, Askelöf U, Götherström C, Andersson O. Haemoglobin and red blood cell reference intervals during infancy. Arch Dis Child 2022; 107:351-358. [PMID: 34674992 PMCID: PMC8938674 DOI: 10.1136/archdischild-2021-321672] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 01/21/2021] [Accepted: 08/27/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVES There is a need for updated haematological reference data in infancy. This study aimed to define intervals for haemoglobin and red blood cell biomarkers based on data from a large cohort of longitudinally followed Swedish infants. DESIGN Longitudinal cohort study. SETTING Two Swedish study centres. PARTICIPANTS Three community-based populations including 442 presumably healthy infants born at term and with umbilical cord clamping delayed to 30 s or more after birth. METHODS Blood samples were collected from umbilical cord blood (a), at 48-118 hours (b), at 4 months (c) and at 12 months (d). Reference intervals as the 2.5th and 97.5th percentiles were calculated in coherence with Clinical and Laboratory Standards Institute guidelines. RESULTS Reference intervals for haemoglobin (g/L) were: (a) 116-189, (b) 147-218, (c) 99-130, (d) 104-134, and for mean cell volume (fL): (a) 97-118, (b) 91-107, (c) 71-85, (d) 70-83. Reference intervals for erythrocyte counts, reticulocyte counts, reticulocyte haemoglobin, mean cell haemoglobin and mean cell haemoglobin concentration were also estimated. According to the WHO definition of anaemia, a haemoglobin value less than 110 g/L, 16% of this presumably healthy cohort could be classified as anaemic at 12 months. CONCLUSION We found mainly narrower reference intervals compared with previously published studies. The reference intervals for each parameter varied according to the infants' age, demonstrating the necessity of age definitions when presenting infant reference intervals. The discrepancy with the WHO classification for anaemia at 12 months, despite favourable conditions in infancy, needs future investigation.
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Affiliation(s)
- Sara Marie Larsson
- Department of Clinical Chemistry, Halland Hospital, Halmstad/Varberg, Sweden .,Department of Clinical Sciences Lund, Paediatrics, Lund University, Lund, Sweden
| | | | - Andreas Hillarp
- Department of Translational Medicine, Lund University, Lund, Sweden
| | - Pia Karlsland Åkeson
- Department of Clinical Sciences Malmö, Preventive Paediatrics, Lund University, Lund, Sweden
| | - Magnus Domellöf
- Department of Clinical Sciences, Paediatrics, Umeå University, Umeå, Sweden
| | - Ulrica Askelöf
- Department of Clinical Science, Intervention and Technology, Division of Obstetrics and Gynecology, Karolinska Institute, Stockholm, Sweden
| | - Cecilia Götherström
- Department of Clinical Science, Intervention and Technology, Division of Obstetrics and Gynecology, Karolinska Institute, Stockholm, Sweden
| | - Ola Andersson
- Department of Clinical Sciences Lund, Paediatrics, Lund University, Lund, Sweden
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Dickmark M, Ågren J, Hellström-Westas L, Jonsson M. Risk factors for seizures in the vigorous term neonate: A population-based register study of singleton births in Sweden. PLoS One 2022; 17:e0264117. [PMID: 35176121 PMCID: PMC8853521 DOI: 10.1371/journal.pone.0264117] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 02/03/2022] [Indexed: 11/24/2022] Open
Abstract
Background Neonatal seizures have been associated with increased mortality and impaired neurodevelopment and, knowledge about risk factors may be useful for prevention. Clear associations have been established between labor-related risk factors and seizures in asphyxiated neonates. However, there is limited information about why some vigorous term-born infants experience seizures. Objectives Our aim was to assess antepartum and intrapartum risk factors for seizures in vigorous term-born neonates. Methods This was a national cohort study of singleton infants born at term in Sweden from 2009–2015. Vigorous was defined as an Apgar score of at least 7 at 5 and 10 minutes. Data on the mothers and infants were obtained from the Swedish Medical Birth Register and the Swedish Neonatal Quality Register. A diagnosis of neonatal seizures was the main outcome measure and the exposures were pregnancy and labor variables. Logistic regression analysis was used and the results are expressed as adjusted odds ratios (aOR) with 95% confidence intervals (CI). Results The incidence of neonatal seizures was 0.81/1,000 for 656 088 births. Seizures were strongly associated with obstetric emergencies (aOR 4.0, 95% CI 2.2–7.4), intrapartum fever and/or chorioamnionitis (aOR 3.4, 95% CI 2.1–5.3), and intrapartum fetal distress (aOR 3.0, 95% CI 2.4–3.7). Other associated intrapartum factors were: labor dystocia, occiput posterior position, operative vaginal delivery, and Cesarean delivery. Some maternal factors more than doubled the risk: a body mass of more than 40 (aOR 2.6, 95% CI 1.4–4.8), hypertensive disorders (aOR 2.3, 95% CI 1.7–3.1) and diabetes mellitus (aOR 2.6, 95% CI 1.7–4.1). Conclusion A number of intrapartum factors were associated with an increased risk of seizures in vigorous term-born neonates. Obstetric emergencies, intrapartum fever and/or chorioamnionitis and fetal distress were the strongest associated risks. The presence of such factors, despite a reassuring Apgar score could prompt close surveillance.
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Affiliation(s)
- Malin Dickmark
- Department of Obstetrics and Gynecology, Uppsala University Hospital, Uppsala, Sweden
| | - Johan Ågren
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | | | - Maria Jonsson
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- * E-mail:
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Isacson M, Thies-Lagergren L, Oras P, Hellström-Westas L, Andersson O. Umbilical cord clamping and management of the third stage of labor: A telephone-survey describing Swedish midwives’ clinical practice. Eur J Midwifery 2022; 6:6. [PMID: 35274089 PMCID: PMC8832505 DOI: 10.18332/ejm/145697] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 05/29/2021] [Accepted: 01/10/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The timing of cord clamping impacts children’s short- and long-term well-being. When making clinical decisions, midwives incorporate their tacit and professional knowledge, experience and current evidence. There appears to be a lack of knowledge regarding Swedish midwives’ management of the third stage of labor and cord clamping practice. The aim of this study was to explore Swedish midwives’ clinical practice concerning umbilical cord clamping and the third stage of labor in spontaneous vaginal births. METHODS The study was designed as a cross-sectional telephone survey including 13 questions. Midwives were randomly selected from 48 births units in Sweden. Two midwives from each unit were interviewed. The primary outcome was timing of umbilical cord clamping practice in full-term infants. Secondary outcomes were the management of the third stage of labor including prophylactic use of synthetic oxytocin, the timing of cord clamping in preterm infants, controlled cord traction, uterine massage, and cord milking. RESULTS Altogether, 95 midwives were interviewed. In full-term infants, all midwives preferred late cord clamping. Considerable heterogeneity was seen regarding the practices of synthetic oxytocin administration postpartum, controlled cord traction, uterine massage or cord milking, and cord clamping in preterm infants. CONCLUSIONS Midwives in Sweden modify recommendations regarding delayed cord clamping in a way they might perceive as more natural and practical in their daily, clinical work. The study revealed a reluctance toward the administration of prophylactic oxytocin due to fear that the drug could pass to the infant. An overall large variation of the management of the third stage of labor was seen.
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Affiliation(s)
- Manuela Isacson
- Neonatology research group, Section of Pediatrics, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Li Thies-Lagergren
- Midwifery research, reproductive, perinatal and sexual health, Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
- Department of Obstetrics and Gynaecology, Helsingborg Hospital, Helsingborg, Sweden
| | - Paola Oras
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | | | - Ola Andersson
- Neonatology research group, Section of Pediatrics, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden
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Abou Mehrem A, Al Awad E, Anninck K, Au-Young S, Aydinol N, Bartmann P, Benders M, Benlamri A, Bolderheij L, Celik Y, Chan N, Chau C, Chau V, Chen X, Chetcuti Ganado C, Coetser A, Cools F, Da Rocha G, Deigner HP, Dereymaeker A, Deshmukh L, Domonoske R, Dossani S, Dsouza JM, El Gamal M, Eshemokhai P, Esser M, Fiedrich E, Franz A, Ghosh A, Groenendaal F, Grunau RE, Venkata SKRG, Hamitoglu S, Hellström-Westas L, Irvine L, Jansen K, Javadyan A, Jenkin G, Kamanga N, Kaur N, Keles E, Keller M, Kelly E, Kesting SJ, Kgwadi D, Kim B, Kohl M, Kowal D, Kricitober JD, Leijser L, LePine M, Lim YP, Lodha A, Londhe A, Ly L, Maes E, Malhotra A, Marlow N, Mathew JL, McDonald C, McLean M, Metcalfe C, Meyer R, Miller SP, Miller S, Mogajane T, Mohammad K, Momin S, Montpetit J, Mukiza N, Murthy P, Scott JN, Nakibuuka V, Nakwa F, Naulaers G, Noort J, Ntuli N, Ondongo-Ezhet C, Paul R, Pepper M, Plum A, Rombough B, Saugstad O, Scotland J, Scott J, Seake K, Sebunya R, Selvanathan T, Sepeng L, Simsek H, Steins-Rang C, Stonestreet B, Tang S, Taskin E, Thewissen L, Thomas S, Thomas R, van Kwawegen A, van Rensburg J, Velaphi S, Wu Y, Yaman A, Yapicioglu-Yildizdas H, Yawno T, Zaki P, Zein H, Zhou L. Proceedings of the 13th International Newborn Brain Conference: Neuroprotection strategies in the neonate. J Neonatal Perinatal Med 2022; 15:427-439. [PMID: 35431186 DOI: 10.3233/npm-229003] [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: 06/14/2023]
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Naseh N, Canto Moreira N, Vaz TF, Gonzalez Tamez K, Ferreira H, Kaul YF, Johansson M, Diderholm B, Ahlsson F, Ågren J, Hellström-Westas L. Early Hyperglycemia in Very Preterm Infants Is Associated with Reduced White Matter Volume and Worse Cognitive and Motor Outcomes at 2.5 Years. Neonatology 2022; 119:745-752. [PMID: 36108597 DOI: 10.1159/000524923] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 04/25/2022] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Hyperglycemia in very preterm infants is associated with increased morbidity and mortality. We aimed to investigate potential associations between early hyperglycemia, neonatal cerebral magnetic resonance imaging (MRI), and neurodevelopment at 2.5 years. METHODS The study population included 69 infants with gestational age (GA) 22.3-31.9 weeks (n = 29 with GA <28 weeks), born 2011-2014. Plasma glucose concentrations during the first week were checked according to clinical routines. Hyperglycemia was defined as glucose concentrations above 8.3 mmol/L (150 mg/dL) and above 10 mmol/L (180 mg/dL), respectively, categorized as the highest glucose days 0-2, number of days above 8.3 and 10 mmol/L, and prolonged (yes/no) 2 days or more above 8.3 and 10 mmol/L. The MRI analysis included morphological assessment, regional brain volumes, and assessment of apparent diffusion coefficient (ADC). Neurodevelopmental impairment (NDI) developed in 13 of 67 infants with available outcomes, of which 57 were assessed with the Bayley-III. Univariate and multiple linear and logistic regressions were performed with adjustments for GA, birth weight z-scores, and illness severity expressed as days on mechanical ventilation. RESULTS Hyperglycemia above 8.3 mmol/L and 10 mmol/L was present in 47.8% and 31.9% of the infants. Hyperglycemia correlated independently with lower white matter volume, but not with other regional brain volumes, and was also associated with lower ADC values in white matter. Hyperglycemia also correlated with lower Bayley-III cognitive and motor scores in infants with GA <28 weeks, but there was no significant effect on NDI. CONCLUSION Early hyperglycemia is associated with white matter injury and poorer neurodevelopment in very preterm infants.
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Affiliation(s)
- Nima Naseh
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Nuno Canto Moreira
- Departments of Neuroradiology, Uppsala University Hospital and Karolinska University Hospital, Uppsala, Sweden
| | - Tânia F Vaz
- Faculty of Sciences, Institute of Biophysics and Biomedical Engineering, University of Lisbon, Lisbon, Portugal
| | - Karla Gonzalez Tamez
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Hugo Ferreira
- Faculty of Sciences, Institute of Biophysics and Biomedical Engineering, University of Lisbon, Lisbon, Portugal
| | | | - Martin Johansson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Barbro Diderholm
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Fredrik Ahlsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Johan Ågren
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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20
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Mohammad K, Craig AK, Chang T, Tam EWY, Ayed M, de Vries LS, El-Dib MA, Esser MJ, Ferriero DM, Hellström-Westas L, Miller SP, Soul JS, Vollmer B, Glass HC, Smyser CD. Training in neonatal neurocritical care: a proposal for a hybrid model of competence by design and time-based methods. Pediatr Res 2021:10.1038/s41390-021-01727-9. [PMID: 34537823 DOI: 10.1038/s41390-021-01727-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/09/2021] [Revised: 08/10/2021] [Accepted: 08/17/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Neonatal neurocritical care (NNCC) is a rapidly advancing field with limited fellowship training available in locally developed, non-accredited programs. A standardized survey aimed to understand the training backgrounds of individuals practicing NNCC, the structure of existing clinical NNCC services/training programs, and suggested clinical competencies for new graduates. METHODS We developed an anonymous survey electronically sent to members of societies related to NNCC. Using the survey results as a guide, we discuss a competence by design (CBD) curriculum as a complementary approach to traditional time-based training. RESULTS There were 82 responses to the survey from 30 countries; 95% of respondents were physicians. Thirty-one (42%) institutions reported having an NNCC service, 24 (29%) individuals reported formal NNCC training, 81% reported "significant variability" across NNCC training programs, and 88% were both in favor of standardizing training programs and pursuing formal accreditation for NNCC in the next 5 years. CONCLUSIONS The survey results demonstrate international interest in standardizing NNCC training and development of an accreditation or certification process. We propose consideration of a CBD-type curriculum as a training approach to focus on the development of specific NNCC competencies, rather than assuming the acquisition of these competencies based on time as a surrogate. IMPACT Continued growth and development in the field of NNCC has led to increasing need for training programs suited to meet the diverse needs of trainees from varied backgrounds. We present the results of an international survey that assessed the structure of existing training programs and the priority areas in which graduates must demonstrate competence, highlighting the combination of CBD and time-based training as one approach to address these recommendations. The survey results support interest in translating published training competencies, existing expertise, and infrastructure across centers into a standardized curriculum for NNCC including certification opportunities.
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Affiliation(s)
- Khorshid Mohammad
- Department of Pediatrics, Section of Neonatology, University of Calgary, Calgary, AB, Canada.
| | - Alexa K Craig
- Department of Pediatrics, Division of Pediatric Neurology, Barbara Bush Children's Hospital at Maine Medical Center, Portland, ME, USA
| | - Taeun Chang
- Department of Neurology, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA
| | - Emily W Y Tam
- Department of Pediatrics, Division of Neurology, Neurosciences and Mental Health, The Hospital for Sick Children and University of Toronto, SickKids Research Institute, Toronto, ON, Canada
| | - Mariam Ayed
- Department of Neonatology, Farwaniya Hospital, Kuwait City, Kuwait
| | - Linda S de Vries
- Department of Neonatology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Mohamed A El-Dib
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael J Esser
- Department of Pediatrics, Alberta Children's Hospital and Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Donna M Ferriero
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | | | - Steven P Miller
- Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | - Janet S Soul
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Brigitte Vollmer
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Neonatal and Paediatric Neurology, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Hannah C Glass
- Department of Neurology and Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
- Department of Pediatrics, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, USA
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Christopher D Smyser
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO, USA
- Department of Pediatrics, Washington University in St. Louis, St. Louis, MO, USA
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21
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Oras P, Ljungberg T, Hellström-Westas L, Funkquist EL. A breastfeeding support program changed breastfeeding patterns but did not affect the mothers' self-efficacy in breastfeeding at two months. Early Hum Dev 2020; 151:105242. [PMID: 33137580 DOI: 10.1016/j.earlhumdev.2020.105242] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 09/10/2020] [Revised: 10/20/2020] [Accepted: 10/20/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Even though the biological norm in humans is frequent on demand breastfeeding, sparse feeding intervals have become the cultural norm in most Western countries due to a history of on schedule breastfeeding. This discrepancy between the biological basis and the culturally driven practice continues to interfere with women's ability to breastfeed. AIM Our aim was to describe breastfeeding patterns in 2-month-old infants before and after the implementation of a breastfeeding support program. A secondary aim was to investigate the relationship between breastfeeding patterns and the mother's self-efficacy in breastfeeding. METHODS The study had a baseline/intervention design and was part of a larger project aiming to revive the Ten Steps to Successful Breastfeeding program. The larger project included breastfeeding training for health care professionals and provision of breastfeeding information to parents, including information about on demand breastfeeding. Data were gathered via breastfeeding diaries (n = 79 mothers from each group) and the Breastfeeding Self-efficacy Scale-Short Form (n = 83 in the baseline group and n = 79 in the intervention group). RESULTS On demand breastfeeding patterns were more common in the intervention group (97.5%) than in the baseline group (74.7%) (p < 0.001), and breastfeeding sessions were more frequent in the intervention group (a median of 14 times per 24 h versus 11 times in the baseline group; p = 0.026). Self-efficacy in breastfeeding did not differ between the groups, but was higher in mothers with exclusive breastfeeding. CONCLUSIONS Knowledge about infants' breastfeeding behavior can strengthen on demand breastfeeding. Exclusive breastfeeding is associated with higher self-efficacy.
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Affiliation(s)
- Paola Oras
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
| | | | | | - Eva-Lotta Funkquist
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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22
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Ådén U, Sävman K, Hellström-Westas L. [Not Available]. Lakartidningen 2020; 117:20171. [PMID: 33259049] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
| | | | - Lena Hellström-Westas
- professor, överläkare, institutionen för kvinnors och barns hälsa, Uppsala universitet
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23
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Zaigham M, Hellström-Westas L, Domellöf M, Andersson O. Prelabour caesarean section and neurodevelopmental outcome at 4 and 12 months of age: an observational study. BMC Pregnancy Childbirth 2020; 20:564. [PMID: 32977763 PMCID: PMC7517619 DOI: 10.1186/s12884-020-03253-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/14/2020] [Indexed: 11/10/2022] Open
Abstract
Background With prelabour caesarean section rates growing globally, there is direct and indirect evidence of negative cognitive outcomes in childhood. The objective of this study was to assess the short-term neurodevelopmental outcomes after prelabour caesarean section as compared to vaginally born infants. Methods We conducted a prospective, observational study of infants delivered by prelabour caesarean section at the Hospital of Halland, Halmstad, Sweden and compared their development with an historical group of infants born by non-instrumental vaginal delivery. Results Infants born by prelabour caesarean section were compared with a group of vaginally born infants. Follow-up assessments were performed at 4 and 12 months. Prelabour caesarean infants (n = 66) had significantly lower Ages and Stages Questionnaire, second edition (ASQ-II) scores in all domains (communication, gross motor, fine motor, problem solving and personal-social) at 4 months of age with an adjusted mean difference (95% CI) of − 20.7 (− 28.7 to − 12.6) in ASQ-II total score as compared to vaginally born infants (n = 352). These differences remained for gross-motor skills at the 12 month assessment, adjusted mean difference (95% CI) -4.7 (− 8.8 to − 0.7), n = 62 and 336. Conclusions Adverse neurodevelopmental outcomes in infants born by prelabour caesarean section may be apparent already a few months after birth. Additional studies are warranted to explore this relationship further.
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Affiliation(s)
- Mehreen Zaigham
- Department of Obstetrics & Gynaecology, Lund University and Skåne University Hospital, 205 01, Malmö, Sweden.
| | | | - Magnus Domellöf
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Ola Andersson
- Department of Clinical Sciences Lund, Pediatrics, Lund University, Lund, Sweden
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24
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Tataranno ML, Gui L, Hellström-Westas L, Toet M, Groenendaal F, Claessens NHP, Schuurmans J, Fellman V, Sävman K, de Vries LS, Huppi P, Benders MJNL. Morphine affects brain activity and volumes in preterms: An observational multi-center study. Early Hum Dev 2020; 144:104970. [PMID: 32276190 DOI: 10.1016/j.earlhumdev.2020.104970] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 11/13/2019] [Revised: 02/04/2020] [Accepted: 02/04/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We hypothesized that morphine has a depressing effect on early brain activity, assessed using quantitative aEEG/EEG parameter and depressed activity will be associated with brain volumes at term in extremely preterm infants. STUDY DESIGN 174 preterm infants were enrolled in 3 European tertiary NICUs (mean GA:26 ± 1wks) and monitored during the first 72 h after birth with continuous 2 channel aEEG. Six epochs of aEEG recordings were selected and minimum amplitude of aEEG (min aEEG), percentage of time amplitude <5 μV (% of time < 5 μV), spontaneous activity transients (SATrate) and interSAT interval (ISI) were calculated. For infants receiving morphine, the cumulative morphine dosage was calculated. In a subgroup of 58 infants, good quality MRI at term equivalent age (TEA) and the cumulative morphine dose until TEA were available. The effects of morphine administration and cumulative dose on aEEG/EEG measures and on brain volumes were investigated. RESULTS Morphine administration had a significant effect on all quantitative aEEG/EEG measures, causing depression of early brain activity [longer ISI (β 2.900), reduced SAT rate (β -1.386), decreased min aEEG (β -0.782), and increased % of time < 5 μV (β 14.802)] in all epochs. A significant effect of GA and postnatal age on aEEG/EEG measures was observed. Cumulative morphine dose until TEA had a significant negative effect on total brain volume (TBV) (β -8.066) and cerebellar volume (β -1.080). CONCLUSIONS Administration of sedative drugs should be considered when interpreting aEEG/EEG together with the negative dose dependent morphine impact on brain development.
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Affiliation(s)
- M L Tataranno
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, the Netherlands
| | - L Gui
- Division of Development and Growth, Department of Pediatrics, University of Geneva, Geneva, Switzerland
| | - L Hellström-Westas
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - M Toet
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, the Netherlands
| | - F Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, the Netherlands
| | - N H P Claessens
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, the Netherlands
| | - J Schuurmans
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, the Netherlands
| | - V Fellman
- Lund University, Department of Clinical Sciences, Lund, Pediatrics, Skåne University Hospital, Lund, Sweden
| | - K Sävman
- Department of Pediatrics, Perinatal Center, Institute of Clinical Sciences, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
| | - L S de Vries
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, the Netherlands
| | - P Huppi
- Division of Development and Growth, Department of Pediatrics, University of Geneva, Geneva, Switzerland
| | - M J N L Benders
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, the Netherlands.
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25
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Larsson SM, Hillarp A, Hellström-Westas L, Domellöf M, Lundahl T, Andersson O. When age really matters; ferritin reference intervals during infancy revisited. Scandinavian Journal of Clinical and Laboratory Investigation 2019; 79:590-594. [DOI: 10.1080/00365513.2019.1681028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Sara Marie Larsson
- Department of Clinical Chemistry, Hospital of Halland, Varberg Sweden
- Department of Clinical Sciences Lund, Pediatrics/Neonatology, Lund University, Lund, Sweden
| | - Andreas Hillarp
- Department of Clinical Chemistry, Hospital of Halland, Varberg Sweden
| | | | - Magnus Domellöf
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Tom Lundahl
- Department of Clinical Chemistry, Hospital of Halland, Varberg Sweden
| | - Ola Andersson
- Department of Clinical Sciences Lund, Pediatrics/Neonatology, Lund University, Lund, Sweden
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26
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Kaul YF, Rosander K, Grönqvist H, Strand Brodd K, Hellström-Westas L, von Hofsten C. Reaching skills of infants born very preterm predict neurodevelopment at 2.5 years. Infant Behav Dev 2019; 57:101333. [PMID: 31238256 DOI: 10.1016/j.infbeh.2019.101333] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 05/13/2019] [Accepted: 06/09/2019] [Indexed: 12/26/2022]
Abstract
The purpose was to investigate associations between quality of reaching for moving objects at 8 months corrected age and neurodevelopment at 2.5 years in children born very preterm (gestational age (GA), 24-31 weeks). Thirtysix infants were assessed while reaching for moving objects. The movements were recorded by a 3D motion capture system. Reaching parameters included aiming, relative length of the reach, number of movement units, proportion of bimanual coupled reaches and number of hits. Neurodevelopment was assessed at 2.5 years by the Bayley Scales of Infant Development III. There were strong associations between infant reaching kinematics and neurodevelopment of cognition and language but the patterns differed: in children born extremely preterm (GA < 28 weeks), planning and control of reaching was strongly related to outcome, while in children born very preterm (GA 28-31 weeks) number of hits and bimanual strategies were of greater relevance. In conclusion, for extremely preterm infants, basic problems on how motion information is incorporated with action planning prevail, while in very preterm infants the coordination of bimanual reaches is more at the focus. We conclude that the results reflect GA related differences in neural vulnerability and that early motor coordination deficits have a cascading effect on neurodevelopment.
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Affiliation(s)
| | | | - Helena Grönqvist
- Department of Women's and Children's Health, Uppsala University, Sweden.
| | - Katarina Strand Brodd
- Department of Women's and Children's Health, Uppsala University, Sweden; Centre for Clinical Research Sörmland, Uppsala University, Sweden.
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27
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Norman M, Hallberg B, Abrahamsson T, Björklund LJ, Domellöf M, Farooqi A, Foyn Bruun C, Gadsbøll C, Hellström-Westas L, Ingemansson F, Källén K, Ley D, Maršál K, Normann E, Serenius F, Stephansson O, Stigson L, Um-Bergström P, Håkansson S. Association Between Year of Birth and 1-Year Survival Among Extremely Preterm Infants in Sweden During 2004-2007 and 2014-2016. JAMA 2019; 321:1188-1199. [PMID: 30912837 PMCID: PMC6439685 DOI: 10.1001/jama.2019.2021] [Citation(s) in RCA: 170] [Impact Index Per Article: 34.0] [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] [Received: 11/12/2018] [Accepted: 02/19/2019] [Indexed: 12/11/2022]
Abstract
Importance Since 2004-2007, national guidelines and recommendations have been developed for the management of extremely preterm births in Sweden. If and how more uniform management has affected infant survival is unknown. Objective To compare survival of extremely preterm infants born during 2004-2007 with survival of infants born during 2014-2016. Design, Setting and Participants All births at 22-26 weeks' gestational age (n = 2205) between April 1, 2004, and March 31, 2007, and between January 1, 2014, and December 31, 2016, in Sweden were studied. Prospective data collection was used during 2004-2007. Data were obtained from the Swedish pregnancy, medical birth, and neonatal quality registries during 2014-2016. Exposures Delivery at 22-26 weeks' gestational age. Main Outcomes and Measures The primary outcome was infant survival to the age of 1 year. The secondary outcome was 1-year survival among live-born infants who did not have any major neonatal morbidity (specifically, without intraventricular hemorrhage grade 3-4, cystic periventricular leukomalacia, necrotizing enterocolitis, retinopathy of prematurity stage 3-5, or severe bronchopulmonary dysplasia). Results During 2004-2007, 1009 births (3.3/1000 of all births) occurred at 22-26 weeks' gestational age compared with 1196 births (3.4/1000 of all births) during 2014-2016 (P = .61). One-year survival among live-born infants at 22-26 weeks' gestational age was significantly lower during 2004-2007 (497 of 705 infants [70%]) than during 2014-2016 (711 of 923 infants [77%]) (difference, -7% [95% CI, -11% to -2.2%], P = .003). One-year survival among live-born infants at 22-26 weeks' gestational age and without any major neonatal morbidity was significantly lower during 2004-2007 (226 of 705 infants [32%]) than during 2014-2016 (355 of 923 infants [38%]) (difference, -6% [95% CI, -11% to -1.7%], P = .008). Conclusions and Relevance Among live births at 22-26 weeks' gestational age in Sweden, 1-year survival improved between 2004-2007 and 2014-2016.
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Affiliation(s)
- Mikael Norman
- Division of Pediatrics, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
- Swedish Neonatal Quality Register, Umeå University Hospital, Umeå, Sweden
| | - Boubou Hallberg
- Division of Pediatrics, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Thomas Abrahamsson
- Departments of Clinical and Experimental Medicine and Pediatrics, Linköping University, Linköping, Sweden
| | - Lars J. Björklund
- Departments of Clinical Sciences and Pediatrics, Lund University and Skåne University Hospital, Lund, Sweden
| | - Magnus Domellöf
- Departments of Clinical Sciences and Pediatrics, Umeå University, Umeå Sweden
| | - Aijaz Farooqi
- Departments of Clinical Sciences and Pediatrics, Umeå University, Umeå Sweden
| | - Cathrine Foyn Bruun
- Departments of Clinical Sciences and Pediatrics, Umeå University, Umeå Sweden
| | - Christian Gadsbøll
- Departments of Clinical and Experimental Medicine and Pediatrics, Linköping University, Linköping, Sweden
- Departments of Clinical Sciences and Pediatrics, Lund University and Skåne University Hospital, Lund, Sweden
| | | | - Fredrik Ingemansson
- Department of Pediatrics, Ryhov County Hospital, Jönköping County Council, Jonkoping, Sweden
| | - Karin Källén
- Centre for Reproductive Epidemiology, Lund University, Lund, Sweden
| | - David Ley
- Departments of Clinical Sciences and Pediatrics, Lund University and Skåne University Hospital, Lund, Sweden
| | - Karel Maršál
- Departments of Clinical Sciences and Obstetrics and Gynecology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Erik Normann
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Fredrik Serenius
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Olof Stephansson
- Division of Clinical Epidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Division of Obstetrics and Gynecology, Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Lennart Stigson
- Department of Pediatrics, Institute for Clinical Sciences, Queen Silvia Children’s Hospital, Sahlgrenska Academy, Göteborg University, Göteborg, Sweden
| | - Petra Um-Bergström
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Sachs’ Children and Youth Hospital, Department of Neonatal Medicine, Södersjukhuset, Stockholm, Sweden
| | - Stellan Håkansson
- Swedish Neonatal Quality Register, Umeå University Hospital, Umeå, Sweden
- Departments of Clinical Sciences and Pediatrics, Umeå University, Umeå Sweden
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Löfving A, Domellöf M, Hellström-Westas L, Andersson O. Reference intervals for reticulocyte hemoglobin content in healthy infants. Pediatr Res 2018; 84:657-661. [PMID: 30140071 DOI: 10.1038/s41390-018-0046-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 01/23/2018] [Revised: 04/06/2018] [Accepted: 04/26/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Iron deficiency anemia in childhood is a serious public health problem worldwide. Reticulocyte hemoglobin content (Ret-He) is a novel biomarker of iron deficiency adopted for adults but there is a lack of reference intervals for Ret-He in infants. The aim of this study was to provide data from healthy infants. METHODS Swedish infants (n = 456), born at term after normal pregnancies were included. Ret-He was measured at birth (umbilical cord sample), 48-72 h, 4 months, and 12 months. Reference intervals were calculated as ±2 standard deviations from the mean of Ret-He. RESULTS Reference intervals for newborn Ret-He were 27.4 to 36.0 pg/L (N = 376) in the cord sample, 28.1-37.7 pg/L (N = 253) at 48-72 h, 25.6-33.4 pg/L (N = 341) at four months and 24.9-34.1 pg/L (N = 288) at 12 months. Ret-He was significantly lower among iron-deficient infants, at 4 months mean difference (95% CI) -4.2 pg/L (-6.1 to -2.4) and at 12 months mean difference (95% CI) -3.4 pg/L (-5.0 to -1.8). CONCLUSIONS This longitudinal study presents Ret-He reference intervals based on non-anemic and non-iron-deficient infants and constitutes a step towards standardizing Ret-He as a pre-anemia biomarker of iron deficiency in children.
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Affiliation(s)
- Anders Löfving
- Department of Pediatrics, Hospital of Halland, Halmstad, Sweden
| | - Magnus Domellöf
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | | | - Ola Andersson
- Department of Pediatrics, Hospital of Halland, Halmstad, Sweden. .,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
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29
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Ericson J, Eriksson M, Hoddinott P, Hellström-Westas L, Flacking R. Breastfeeding and risk for ceasing in mothers of preterm infants-Long-term follow-up. Matern Child Nutr 2018; 14:e12618. [PMID: 29733102 PMCID: PMC6175451 DOI: 10.1111/mcn.12618] [Citation(s) in RCA: 20] [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] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 03/12/2018] [Accepted: 03/15/2018] [Indexed: 12/04/2022]
Abstract
Breastfeeding is challenging for mothers of preterm infants. The aim of this paper is to describe risk factors for ceasing breastfeeding and methods of feeding until 12 months postnatal age in mothers who breastfed their preterm infants at discharge from neonatal intensive care units (NICUs). The data come from a randomised controlled trial, which evaluated the effectiveness on exclusive breastfeeding at 8 weeks of proactive telephone support compared with reactive support offered to mothers of preterm infants following discharge from NICU. Six NICUs across Sweden randomised a total of 493 mothers. We used regression and survival analyses to assess the risk factors for ceasing breastfeeding and the long‐term outcomes of the intervention. The results showed that 305 (64%) of the infants were breastfed at 6 months and 49 (21%) at 12 months. Partial breastfeeding at discharge, low maternal educational level, and longer length of stay in the NICU increased the risk for ceasing breastfeeding during the first 12 months. Furthermore, the Kaplan–Meier analysis showed that the proportion of mothers who ceased breastfeeding did not differ between the intervention (n = 231) and controls (n = 262) during the first 12 months (log‐rank test p = .68). No difference was found between groups on method of feeding. More than 85% of the infants were fed directly at the breast. These findings provide important insights for health professionals who are supporting mothers of preterm infants to breastfeed long term. Registered in http://www.clinicaltrials.gov (NCT01806480).
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Affiliation(s)
- Jenny Ericson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Centre for Clinical Research Dalarna, Falun, Sweden.,Department of Paediatrics, Falu Hospital, Falun, Sweden.,School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Mats Eriksson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professionals Research Unit, University of Stirling, Stirling, UK
| | | | - Renée Flacking
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
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Hreinsdottir J, Fredriksson Kaul Y, Hellström-Westas L, Rosander K, von Hofsten C, Holmström G. Impaired cognitive ability at 2.5 years predicts later visual and ophthalmological problems in children born very preterm. Acta Paediatr 2018; 107:822-830. [PMID: 29288532 DOI: 10.1111/apa.14209] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 09/21/2017] [Revised: 12/20/2017] [Accepted: 12/22/2017] [Indexed: 02/06/2023]
Abstract
AIM To identify possible predictive factors for visual problems at 6.5 years in children born very preterm. METHODS During 2004-2007, all very preterm infants (gestational age [GA] <32 weeks) in Uppsala County, Sweden were screened for retinopathy of prematurity (ROP) neonatally; at four months, visual tracking was tested; at 2.5 years, visuospatial and cognitive tests were carried out. At 6.5 years, 84 preterm children and a reference group of 64 full-term children underwent ophthalmological testing. RESULTS Mean visual acuity (VA) did not differ between the groups, but subnormal VA (≤0.8) was more common in the preterm group (31% vs 14%; p < 0.05). More often than full-term children, preterm children had impaired contrast sensitivity (<0.5) (36% vs 19%; p < 0.05) and strabismus (8% vs 0%; p < 0.05). Low GA, ROP, intraventricular haemorrhage 3-4/periventricular leukomalacia and cognitive disability at 2.5 years predicted ophthalmological and visual problems at 6.5 years. Visual tracking ability at four months was not predictive of ophthalmological outcome. CONCLUSION Children born preterm had more ophthalmological problems at 6.5 years of age, including subtle dysfunctions. ROP, early brain injury and impaired cognitive function around 2.5 years predicted later ophthalmological dysfunctions.
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Affiliation(s)
- Jonina Hreinsdottir
- Department of Neuroscience; Ophthalmology; Uppsala University; Uppsala Sweden
| | | | | | | | | | - Gerd Holmström
- Department of Neuroscience; Ophthalmology; Uppsala University; Uppsala Sweden
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Bolk J, Fredriksson Kaul Y, Hellström-Westas L, Stjernqvist K, Padilla N, Serenius F, Hellgren K, Åden U. National population-based cohort study found that visual-motor integration was commonly affected in extremely preterm born children at six-and-a-half years. Acta Paediatr 2018; 107:831-837. [PMID: 29356073 DOI: 10.1111/apa.14231] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 10/05/2017] [Revised: 12/20/2017] [Accepted: 01/16/2018] [Indexed: 11/27/2022]
Abstract
AIM This study aimed to explain the relationship between visual-motor integration (VMI) abilities and extremely preterm (EPT) birth, by exploring the influence of perinatal variables, cognition, manual dexterity and ophthalmological outcomes. METHODS This was part of the population-based national Extremely Preterm Infant Study in Sweden (EXPRESS) study. We studied 355 children, born at a gestational age of <27 weeks from April 2004 to March 2007, and 364 term-born controls. At six-and-a-half years of age, we assessed VMI, cognitive function, motor skills and vision. VMI impairment was classified as <-1 standard deviation (SD). RESULTS The mean (SD) VMI score was 87 (±12) in preterm children compared to 98 (±11) in controls (p < 0.001). VMI impairment was present in 55% of preterm infants and in 78% of children born at 22-23 weeks. Male sex and postnatal steroids showed a weak association with poorer visual-motor performance, whereas low manual dexterity and cognitive function showed a stronger association. CONCLUSION Poor VMI performance was common in this EXPRESS cohort of children born EPT. Its strong association to cognition and manual dexterity confirms that all of these factors need to be taken into account when evaluating risks in preterm born children.
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Affiliation(s)
- Jenny Bolk
- Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
- Sachs' Children and Youth Hospital; Stockholm Sweden
| | - Ylva Fredriksson Kaul
- Department of Women's and Children's Health; Uppsala University Hospital; Uppsala Sweden
| | - Lena Hellström-Westas
- Department of Women's and Children's Health; Uppsala University Hospital; Uppsala Sweden
| | - Karin Stjernqvist
- Division of Developmental Psychology; Department of Psychology; Lund University; Lund Sweden
| | - Nelly Padilla
- Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
| | - Fredrik Serenius
- Department of Women's and Children's Health; Uppsala University Hospital; Uppsala Sweden
- Institute of Clinical Sciences, Pediatrics; University of Umeå; Umeå Sweden
| | - Kerstin Hellgren
- Department of Clinical Neuroscience; Karolinska Institutet; Stockholm Sweden
| | - Ulrika Åden
- Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
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Ericson J, Eriksson M, Hellström-Westas L, Hoddinott P, Flacking R. Proactive telephone support provided to breastfeeding mothers of preterm infants after discharge: a randomised controlled trial. Acta Paediatr 2018; 107:791-798. [PMID: 29405368 PMCID: PMC5947616 DOI: 10.1111/apa.14257] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 08/17/2017] [Revised: 12/04/2017] [Accepted: 01/29/2018] [Indexed: 12/20/2022]
Abstract
Aim The aim was to evaluate the effectiveness of proactive telephone support provided to breastfeeding mothers of preterm infants after discharge from neonatal intensive care units (NICU). Methods Between March 2013 and December 2015, a randomised controlled trial was conducted at six NICUs across Sweden. At each NICU, a breastfeeding support team recruited, randomised and delivered the support to participating mothers. The intervention group received a daily proactive telephone call up to 14 days after discharge from the support team. The control group could initiate telephone contact themselves. Primary outcome was exclusive breastfeeding eight weeks after discharge. Secondary outcomes were maternal satisfaction with breastfeeding, attachment, quality of life and parental stress. Results In total, 493 mothers were randomised, 231 to intervention group and 262 to control group. There were no differences between the groups for exclusive breastfeeding, odds ratio 0.96, 95% CI 0.66–1.38, nor for maternal satisfaction with breastfeeding, attachment or quality of life. The intervention group reported significantly less parental stress than the controls, t = 2.44, 95% CI 0.03–0.23, effect size d = 0.26. Conclusion In this trial, proactive telephone support was not associated with increased exclusive breastfeeding prevalence eight weeks following discharge. However, intervention group mothers showed significantly lower parental stress.
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Affiliation(s)
- Jenny Ericson
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
- Centre for Clinical Research Dalarna; Falun Sweden
- Department of Paediatrics; Falu Hospital; Falun Sweden
| | - Mats Eriksson
- Faculty of Medicine and Health; School of Health Sciences; Örebro University; Örebro Sweden
| | | | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professionals Research Unit; University of Stirling; Stirling UK
| | - Renée Flacking
- School of Education, Health and Social Studies; Dalarna University; Falun Sweden
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Wikström S, Hövel H, Hansen Pupp I, Fellman V, Hüppi PS, Ley D, Hellström-Westas L. Early Electroencephalography Suppression and Postnatal Morbidities Correlate with Cerebral Volume at Term-Equivalent Age in Very Preterm Infants. Neonatology 2018; 113:15-20. [PMID: 28934743 DOI: 10.1159/000479423] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 02/08/2017] [Accepted: 07/12/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND Early brain activity is associated with long-term outcome. Establishing a relation also with postnatal brain growth may increase our understanding of early life influences on preterm brain development. OBJECTIVES The aim of this study was to investigate whether early electroencephalography (EEG) activity in infants born very preterm is associated with brain volumes at term, and whether postnatal morbidity affects this association. METHODS Very preterm infants (n = 38) with a median gestational age (GA) of 25.6 weeks had early recordings of single-channel EEG. The percentage of suppressed EEG, i.e., interburst intervals (IBI%) between 24 and 72 h of age, was analyzed in relation to brain volumes on magnetic resonance imaging performed at term-equivalent age, taking into account neonatal morbidities. RESULTS Early electrocortical depression and a higher IBI% were associated with increased cerebrospinal fluid volume (CSFV) and lower total brain volume relative to intracranial volume, also after adjustment for GA, postnatal morbidities, morphine administration, and postnatal head growth. Overall, an increase in IBI% to 1 SD from the mean corresponded with an increase in CSFV to +0.7 SD and a decrease in brain volume to -0.7 SD. The presence of 2 or more postnatal morbidities were associated with around 10% lower brain volumes. CONCLUSIONS More suppressed early EEG activity of very preterm infants is associated with lower brain volume and increased CSFV at term age, also when adjusting for postnatal morbidities. The findings indicate the importance of pre- and early postpartal determinants of postnatal brain growth, possibly also including activity-dependent mechanisms for brain growth.
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Affiliation(s)
- Sverre Wikström
- School of Medical Sciences, Örebro University, Örebro, Sweden
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Askelöf U, Andersson O, Domellöf M, Fasth A, Hallberg B, Hellström-Westas L, Pettersson K, Westgren M, Wiklund IE, Götherström C. Wait a minute? An observational cohort study comparing iron stores in healthy Swedish infants at 4 months of age after 10-, 60- and 180-second umbilical cord clamping. BMJ Open 2017; 7:e017215. [PMID: 29289934 PMCID: PMC5778270 DOI: 10.1136/bmjopen-2017-017215] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Umbilical cord blood (UCB) is a valuable stem cell source used for transplantation. Immediate umbilical cord (UC) clamping is widely practised, but delayed UC clamping is increasingly advocated to reduce possible infant anaemia. The aim of this study was to investigate an intermediate UC clamping time point and to evaluate iron status at the age of 4 months in infants who had the UC clamped after 60 s and compare the results with immediate and late UC clamping. DESIGN Prospective observational study with two historical controls. SETTING A university hospital in Stockholm, Sweden, and a county hospital in Halland, Sweden. METHODS Iron status was assessed at 4 months in 200 prospectively recruited term infants whose UC was clamped 60 s after birth. The newborn baby was held below the uterine level for the first 30 s before placing the infant on the mother's abdomen for additional 30 s. The results were compared with data from a previously conducted randomised controlled trial including infants subjected to UC clamping at ≤10 s (n=200) or ≥180 s (n=200) after delivery. RESULTS After adjustment for age differences at the time of follow-up, serum ferritin concentrations were 77, 103 and 114 µg/L in the 10, 60 and 180 s groups, respectively. The adjusted ferritin concentration was significantly higher in the 60 s group compared with the 10 s group (P=0.002), while the difference between the 60 and 180 s groups was not significant (P=0.29). CONCLUSION In this study of healthy term infants, 60 s UC clamping with 30 s lowering of the baby below the uterine level resulted in higher serum ferritin concentrations at 4 months compared with 10 s UC clamping. The results suggest that delaying the UC clamping for 60 s reduces the risk for iron deficiency. TRIAL REGISTRATION NUMBER NCT01245296.
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Affiliation(s)
- Ulrica Askelöf
- Department of Clinical Science, Intervention and Technology, Division of Obstetrics and Gynecology, Karolinska Institutet, Stockholm, Sweden
- The Swedish National Umbilical Cord Blood Bank, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ola Andersson
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Magnus Domellöf
- Department of Clinical Sciences, Unit for Pediatrics, Umeå University, Umeå, Sweden
| | - Anders Fasth
- The Swedish National Umbilical Cord Blood Bank, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Pediatrics, Institution of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Boubou Hallberg
- Department of Neonatology, CLINTEC, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | | | - Karin Pettersson
- Department of Clinical Science, Intervention and Technology, Division of Obstetrics and Gynecology, Karolinska Institutet, Stockholm, Sweden
- The Swedish National Umbilical Cord Blood Bank, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Magnus Westgren
- Department of Clinical Science, Intervention and Technology, Division of Obstetrics and Gynecology, Karolinska Institutet, Stockholm, Sweden
- The Swedish National Umbilical Cord Blood Bank, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ingela E Wiklund
- Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - Cecilia Götherström
- Department of Clinical Science, Intervention and Technology, Division of Obstetrics and Gynecology, Karolinska Institutet, Stockholm, Sweden
- The Swedish National Umbilical Cord Blood Bank, Sahlgrenska University Hospital, Gothenburg, Sweden
- Center for Hematology and Regenerative Medicine, Karolinska Institutet, Stockholm, Sweden
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Karlsson V, Sporre B, Hellström-Westas L, Ågren J. Poor performance of main-stream capnography in newborn infants during general anesthesia. Paediatr Anaesth 2017; 27:1235-1240. [PMID: 29072363 DOI: 10.1111/pan.13266] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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] [Accepted: 09/20/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Endtidal (ET) measurement of carbon dioxide is well established for intraoperative respiratory monitoring of adults and children, but the method's accuracy for intraoperative use in small newborn infants has been less extensively investigated. AIMS The aim of this study was to compare carbon dioxide from ET measurements with arterialized capillary blood samples in newborn infants during general anesthesia and surgery. METHODS Endtidal carbon dioxide was continuously measured during anesthesia and surgery and compared with simultaneous blood gas analyses obtained from capillary blood samples. Fifty-nine sample sets of ET to blood gas carbon dioxide were obtained from 23 prospectively enrolled infants with a gestational age of 23-41 weeks and a birth weight of 670-4110 g. RESULTS Endtidal levels of carbon dioxide were considerably lower in all sample sets and only 4/23 individual ET-blood gas sample pairs differed <7.5 mm Hg (1 kPa). Bland-Altman analysis indicated a poor agreement with a bias of -13 ± 7 mm Hg and a precision of ±14 mm Hg. The performance of ET measurements was particularly poor in infants weighing below 2.5 kg, in infants in need of respiratory support prior to anesthesia, and when the true (blood gas) carbon dioxide level was high, above 45 mm Hg. CONCLUSION Main-stream capnography during anesthesia and surgery correlated poorly to blood gas values in small and/or respiratory compromised infants. We conclude that caution should be exercised when relying solely on ET measurements to guide mechanical ventilation in the OR.
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Affiliation(s)
- Victoria Karlsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Unit for Pediatric Anesthesia, University Hospital, Uppsala, Sweden.,Neonatology Division, University Children's Hospital, Uppsala, Sweden
| | - Bengt Sporre
- Unit for Pediatric Anesthesia, University Hospital, Uppsala, Sweden
| | - Lena Hellström-Westas
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Neonatology Division, University Children's Hospital, Uppsala, Sweden
| | - Johan Ågren
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Neonatology Division, University Children's Hospital, Uppsala, Sweden
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Weeke LC, van Ooijen IM, Groenendaal F, van Huffelen AC, van Haastert IC, van Stam C, Benders MJ, Toet MC, Hellström-Westas L, de Vries LS. Rhythmic EEG patterns in extremely preterm infants: Classification and association with brain injury and outcome. Clin Neurophysiol 2017; 128:2428-2435. [PMID: 29096216 PMCID: PMC5700118 DOI: 10.1016/j.clinph.2017.08.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 07/16/2017] [Accepted: 08/23/2017] [Indexed: 11/17/2022]
Abstract
Most rhythmic EEG patterns in extremely preterm infants related to head position. Clear ictal discharges were only observed in one out of 77 infants (1.3%). PEDs were prevalent, but their significance is not known. PEDs were not related to brain injury or poor cognition.
Objective Classify rhythmic EEG patterns in extremely preterm infants and relate these to brain injury and outcome. Methods Retrospective analysis of 77 infants born <28 weeks gestational age (GA) who had a 2-channel EEG during the first 72 h after birth. Patterns detected by the BrainZ seizure detection algorithm were categorized: ictal discharges, periodic epileptiform discharges (PEDs) and other waveforms. Brain injury was assessed with sequential cranial ultrasound (cUS) and MRI at term-equivalent age. Neurodevelopmental outcome was assessed with the BSITD-III (2 years) and WPPSI-III-NL (5 years). Results Rhythmic patterns were observed in 62.3% (ictal 1.3%, PEDs 44%, other waveforms 86.3%) with multiple patterns in 36.4%. Ictal discharges were only observed in one and excluded from further analyses. The EEG location of the other waveforms (p < 0.05), but not PEDs (p = 0.238), was significantly associated with head position. No relation was found between the median total duration of each pattern and injury on cUS and MRI or cognition at 2 and 5 years. Conclusions Clear ictal discharges are rare in extremely preterm infants. PEDs are common but their significance is unclear. Rhythmic waveforms related to head position are likely artefacts. Significance Rhythmic EEG patterns may have a different significance in extremely preterm infants.
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Affiliation(s)
- Lauren C Weeke
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands
| | - Inge M van Ooijen
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands
| | - Alexander C van Huffelen
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands; Department of Clinical Neurophysiology, University Medical Center Utrecht, The Netherlands
| | - Ingrid C van Haastert
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands
| | - Carolien van Stam
- Department of Clinical Psychology, University Medical Center Utrecht, The Netherlands
| | - Manon J Benders
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands
| | - Mona C Toet
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands
| | | | - Linda S de Vries
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands.
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Abstract
OBJECTIVE There are indications that the prevalence of exclusively breastfed preterm infants is decreasing in Sweden. The objective was to investigate trends in exclusive breast feeding at discharge from Swedish neonatal units and associated factors in preterm infants. DESIGN, SETTING AND PARTICIPANTS This is a register study with data from the Swedish Neonatal Quality Register. Data from 29 445 preterm infants (gestational age (GA) <37 weeks) who were born during the period 2004-2013 were retrieved. Data included maternal, perinatal and neonatal characteristics. Data were analysed for the whole population as well as for 3 GA groups. RESULTS From 2004 to 2013, the prevalence of exclusive breast feeding decreased, in extremely preterm (GA 22-27 weeks) from 55% to 16%, in very preterm (GA 28-31 weeks) from 41% to 34% and in moderately preterm infants (GA 32-36 weeks) from 64% to 49%. The decline was statistically significant (p<0.001) in all 3 GA groups. This decline remained significant when adjustments were made for factors negatively associated with exclusive breast feeding and which became more prevalent during the study period, that is, small for GA (all groups) and maternal mental illness (very preterm and moderately preterm infants). CONCLUSIONS In the past 10 years, Sweden has experienced a lower rate of exclusive breast feeding in preterm infants, especially in extremely preterm infants. The factors analysed in this study explain only a small proportion of this decline. The decline in exclusive breast feeding at discharge from neonatal units raises concern and present challenges to the units to support and promote breast feeding.
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Affiliation(s)
- Jenny Ericson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Centre for Clinical Research Dalarna, Falun, Sweden
- Department of Pediatrics, Falu Hospital, Falun, Sweden
| | - Renée Flacking
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | | | - Mats Eriksson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
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Abstract
OBJECTIVE To compare iron stores in infants born after elective caesarean section (CS) and a 30 s delay of umbilical cord clamping with those born vaginally after early (≤10 s) or delayed (≥180 s) cord clamping. DESIGN Prospective observational study with historical control. SETTING Swedish county hospital. POPULATION 64 infants born after elective CS were compared with a historical control of 166 early clamped and 168 delayed clamped after vaginal birth. METHODS Blood and iron status were measured in blood samples collected at birth, 48-96 hours after birth, 4 and 12 months of age. PRIMARY AND SECONDARY OUTCOME MEASURES Ferritin at 4 months of age was the primary outcome, second outcome measures were other indicators of iron status, and haemoglobin, at 4 and 12 months of age, as well as respiratory distress at 1 and 6 hours after birth. RESULTS At 4 months infants born by elective CS had better iron status than those born vaginally subjected to early cord clamping, shown by higher adjusted mean difference of ferritin concentration (39 µg/L (95% CI 10 to 60)) and mean cell volume (1.8 fL (95% CI 0.6 to 3.0)); and lower levels of transferrin receptors (-0.39 mg/L (95% CI -0.69 to -0.08)). No differences were seen between infants born after elective CS and delayed clamped vaginally born infants at 4 months. No differences were found between groups at 12 months of age. CONCLUSIONS Waiting to clamp the umbilical cord for 30 s after elective CS results in higher iron stores at 4 months of age compared with early cord clamping after vaginal birth, and seems to ensure iron status comparable with those achieved after 180 s delayed cord clamping after vaginal birth.
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Affiliation(s)
- Ola Andersson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of Research and Development, Region Halland, Sweden
| | | | - Magnus Domellöf
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
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Oras P, Thernström Blomqvist Y, Hedberg Nyqvist K, Gradin M, Rubertsson C, Hellström-Westas L, Funkquist EL. Skin-to-skin contact is associated with earlier breastfeeding attainment in preterm infants. Acta Paediatr 2016; 105:783-9. [PMID: 27100380 DOI: 10.1111/apa.13431] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [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: 11/20/2015] [Revised: 02/07/2016] [Accepted: 04/07/2016] [Indexed: 11/28/2022]
Abstract
AIM This study investigated the effects of skin-to-skin contact on breastfeeding attainment, duration and infant growth in preterm infants, as this has not been sufficiently explored. METHODS A prospective longitudinal study on Kangaroo mother care was carried out, comprising 104 infants with a gestational age of 28 + 0 to 33 + 6 and followed up to one year of corrected age. Parents and staff recorded the duration of skin-to skin contact during the stay in the neonatal intensive care unit (NICU). Medical data were collected through patient records, and follow-up questionnaires were filled in by parents. RESULTS The 53 infants who attained full breastfeeding in the NICU did so at a median (range) of 35 + 0 (32 + 1 to 37 + 5) weeks of postmenstrual age, and skin-to-skin contact was the only factor that influenced earlier attainment in the regression analysis (R(2) 0.215 p < 0.001). The daily duration of skin-to-skin contact during the stay in the NICU did not affect the duration of breastfeeding or infant growth after discharge. Furthermore, infant growth was not affected by the feeding strategy of exclusive, partial breastfeeding or no breastfeeding. CONCLUSION A longer daily duration of skin-to-skin contact in the NICU was associated with earlier attainment of exclusive breastfeeding.
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Affiliation(s)
- Paola Oras
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
| | | | | | - Maria Gradin
- Department of Paediatrics; Faculty of Medicine and Health; Örebro University; Örebro Sweden
| | | | | | - Eva-Lotta Funkquist
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
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40
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Kaul YF, Rosander K, von Hofsten C, Brodd KS, Holmström G, Kaul A, Böhm B, Hellström-Westas L. Visual tracking in very preterm infants at 4 mo predicts neurodevelopment at 3 y of age. Pediatr Res 2016; 80:35-42. [PMID: 27027722 DOI: 10.1038/pr.2016.37] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 06/07/2015] [Accepted: 12/05/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND Typically developing infants track moving objects with eye and head movements in a smooth and predictive way at 4 mo of age, but this ability is delayed in very preterm infants. We hypothesized that visual tracking ability in very preterm infants predicts later neurodevelopment. METHOD In 67 very preterm infants (gestational age<32 wk), eye and head movements were assessed at 4 mo corrected age while the infant tracked a moving object. Gaze gain, smooth pursuit, head movements, and timing of gaze relative the object were analyzed off line. Results of the five subscales included in the Bayley Scales of Infant Development (BSID-III) at 3 y of age were evaluated in relation to the visual tracking data and to perinatal risk factors. RESULTS Significant correlations were obtained between gaze gain and cognition, receptive and expressive language, and fine motor function, respectively, also after controlling for gestational age, severe brain damage, retinopathy of prematurity, and bronchopulmonary dysplasia. CONCLUSION This is the first study demonstrating that the basic ability to visually track a moving object at 4 mo robustly predicts neurodevelopment at 3 y of age in children born very preterm.
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Affiliation(s)
| | | | | | - Katarina Strand Brodd
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden
| | - Gerd Holmström
- Department of Neuroscience/Ophthalmology, Uppsala University, Uppsala, Sweden
| | - Alexander Kaul
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Birgitta Böhm
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
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Weeke LC, Toet MC, van Rooij LGM, Groenendaal F, Boylan GB, Pressler RM, Hellström-Westas L, van den Broek MPH, de Vries LS. Lidocaine response rate in aEEG-confirmed neonatal seizures: Retrospective study of 413 full-term and preterm infants. Epilepsia 2015; 57:233-42. [PMID: 26719344 DOI: 10.1111/epi.13286] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To investigate the seizure response rate to lidocaine in a large cohort of infants who received lidocaine as second- or third-line antiepileptic drug (AED) for neonatal seizures. METHODS Full-term (n = 319) and preterm (n = 94) infants, who received lidocaine for neonatal seizures confirmed on amplitude-integrated EEG (aEEG), were studied retrospectively (January 1992-December 2012). Based on aEEG findings, the response was defined as good (>4 h no seizures, no need for rescue medication); intermediate (0-2 h no seizures, but rescue medication needed after 2-4 h); or no clear response (rescue medication needed <2 h). RESULTS Lidocaine had a good or intermediate effect in 71.4%. The response rate was significantly lower in preterm (55.3%) than in full-term infants (76.1%, p < 0.001). In full-term infants the response to lidocaine was significantly better than midazolam as second-line AED (21.4% vs. 12.7%, p = 0.049), and there was a trend for a higher response rate as third-line AED (67.6% vs. 57%, p = 0.086). Both lidocaine and midazolam had a higher response rate as third-line AED than as second-line AED (p < 0.001). Factors associated with a good response to lidocaine were the following: higher gestational age, longer time between start of first seizure and administration of lidocaine, lidocaine as third-line AED, use of new lidocaine regimens, diagnosis of stroke, use of digital aEEG, and hypothermia. Multivariable analysis of seizure response to lidocaine included lidocaine as second- or third-line AED and seizure etiology. SIGNIFICANCE Seizure response to lidocaine was seen in ~70%. The response rate was influenced by gestational age, underlying etiology, and timing of administration. Lidocaine had a significantly higher response rate than midazolam as second-line AED, and there was a trend for a higher response rate as third-line AED. Both lidocaine and midazolam had a higher response rate as third-line compared to second-line AED, which could be due to a pharmacologic synergistic mechanism between the two drugs.
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Affiliation(s)
- Lauren C Weeke
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mona C Toet
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Linda G M van Rooij
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Geraldine B Boylan
- Irish Centre for Fetal and Neonatal Translational Research, University College Cork, Cork, Ireland
| | - Ronit M Pressler
- Section of Clinical Neurosciences, UCL - Institute of Child Health, London, United Kingdom
| | | | | | - Linda S de Vries
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
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Steen E, Bonamy AK, Norman M, Hellström-Westas L. Preterm birth may be a larger risk factor for increased blood pressure than intrauterine growth restriction. Acta Paediatr 2015; 104:1098-103. [PMID: 26094552 DOI: 10.1111/apa.13095] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 09/24/2014] [Revised: 02/02/2015] [Accepted: 06/16/2015] [Indexed: 01/04/2023]
Abstract
AIM Very low birthweight (VLBW) and prematurity have been associated with an increased risk of high blood pressure (BP). We compared BP and salivary cortisol responses to a stressful situation between adolescents with a VLBW and controls. METHODS We compared three groups aged 12-17 years: 30 born VLBW but appropriate for gestational age (AGA) at a mean of 27 weeks, 19 born VLBW but small for gestational age (SGA) at a mean of 31 weeks and 43 term-born AGA controls. Three consecutive BP measurements were performed before a magnetic resonance imaging (MRI) examination. Salivary cortisol and perceived stress were assessed before and after the MRI. RESULTS Systolic and diastolic BP decreased significantly for each repeated measurement in the VLBW-SGA group and controls, but remained unchanged in the VLBW-AGA group. The third systolic BP measurement was 9-12 mmHg higher in the VLBW-AGA group than the other groups (p < 0.05). There were no differences in salivary cortisol between the groups, before and after the MRI or between the sexes. CONCLUSION Dynamic BP responses differed between adolescents born VLBW-AGA and the other groups, indicating that extremely preterm birth may be a larger risk factor for increased BP than intrauterine growth restriction.
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Affiliation(s)
- Emma Steen
- Department of Clinical Sciences; Lund University; Lund Sweden
- Department of Neonatology; Karolinska University Hospital; Stockholm Sweden
| | - Anna-Karin Bonamy
- Department of Women's and Children's Health; Karolinska Institutet Stockholm; Stockholm Sweden
| | - Mikael Norman
- Department of Neonatology; Karolinska University Hospital; Stockholm Sweden
- Department of Clinical Science, Intervention and Technology; Karolinska Institutet Stockholm; Stockholm Sweden
| | - Lena Hellström-Westas
- Department of Clinical Sciences; Lund University; Lund Sweden
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
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Oras P, Blomqvist YT, Nyqvist KH, Gradin M, Rubertsson C, Hellström-Westas L, Funkquist EL. Breastfeeding Patterns in Preterm Infants Born at 28-33 Gestational Weeks. J Hum Lact 2015; 31:377-85. [PMID: 25956792 DOI: 10.1177/0890334415586406] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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: 12/11/2014] [Accepted: 04/20/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Studies of breastfeeding patterns during preterm infants' first year of life are scarce but are important for providing breastfeeding mothers of preterm infants with optimal support. OBJECTIVE This study aimed to describe breastfeeding patterns in preterm infants up to 1 year of corrected age. METHODS As part of a larger study on kangaroo mother care in Sweden, a 24-hour breastfeeding diary was sent home after discharge from hospital, and at 2, 6, and 12 months of the infant's corrected age. Eighty-three mothers responded to the follow-up questionnaires, and the number of respondents to the breastfeeding diary was 48 at discharge, 43 at 2 months, 22 at 6 months, and 8 at 12 months. Infants were born at a median (range) gestational age of 32 (28-33) weeks. Breastfeeding patterns were analyzed according to durations, frequencies per 24 hours, and intervals between sessions. RESULTS In exclusively breastfed infants, the median (range) breastfeeding session frequency was 14 (8-26) times per 24 hours including 4 (1-9) times per night after discharge (n = 24) and 10 (6-25) times per 24 hours including 2 (0-5) times per night at 2 months (n = 23). In partially breastfed infants, the median (range) frequency was 5 (1-14) times per 24 hours including 2 (0-4) times per night at 6 months (n = 20) and 5.5 (1-12) times per 24 hours including 2 (0-3) times per night at 12 months (n = 8). CONCLUSION Mothers reported large variations in breastfeeding patterns, with higher median breastfeeding session frequencies than previously described in term infants in affluent settings.
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Affiliation(s)
- Paola Oras
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | | | - Maria Gradin
- Department of Paediatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Christine Rubertsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | - Eva-Lotta Funkquist
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Affiliation(s)
- Linda Vries
- Department of Neonatology, Wilhelmina Children's’ Hospital, Utrecht, The Netherlands
| | - Lena Hellström-Westas
- Department of Women's and Children's Health, Uppsala University Hospital, Uppsala, Sweden
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Andersson O, Lindquist B, Lindgren M, Stjernqvist K, Domellöf M, Hellström-Westas L. Effect of Delayed Cord Clamping on Neurodevelopment at 4 Years of Age: A Randomized Clinical Trial. JAMA Pediatr 2015; 169:631-8. [PMID: 26010418 DOI: 10.1001/jamapediatrics.2015.0358] [Citation(s) in RCA: 150] [Impact Index Per Article: 16.7] [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: 11/14/2022]
Abstract
IMPORTANCE Prevention of iron deficiency in infancy may promote neurodevelopment. Delayed umbilical cord clamping (CC) prevents iron deficiency at 4 to 6 months of age, but long-term effects after 12 months of age have not been reported. OBJECTIVE To investigate the effects of delayed CC compared with early CC on neurodevelopment at 4 years of age. DESIGN, SETTING, AND PARTICIPANTS Follow-up of a randomized clinical trial conducted from April 16, 2008, through May 21, 2010, at a Swedish county hospital. Children who were included in the original study (n = 382) as full-term infants born after a low-risk pregnancy were invited to return for follow-up at 4 years of age. Wechsler Preschool and Primary Scale of Intelligence (WPPSI-III) and Movement Assessment Battery for Children (Movement ABC) scores (collected between April 18, 2012, and July 5, 2013) were assessed by a blinded psychologist. Between April 11, 2012, and August 13, 2013, parents recorded their child's development using the Ages and Stages Questionnaire, Third Edition (ASQ) and behavior using the Strengths and Difficulties Questionnaire. All data were analyzed by intention to treat. INTERVENTIONS Randomization to delayed CC (≥180 seconds after delivery) or early CC (≤10 seconds after delivery). MAIN OUTCOMES AND MEASURES The main outcome was full-scale IQ as assessed by the WPPSI-III. Secondary objectives were development as assessed by the scales from the WPPSI-III and Movement ABC, development as recorded using the ASQ, and behavior using the Strengths and Difficulties Questionnaire. RESULTS We assessed 263 children (68.8%). No differences were found in WPPSI-III scores between groups. Delayed CC improved the adjusted mean differences (AMDs) in the ASQ personal-social (AMD, 2.8; 95% CI, 0.8-4.7) and fine-motor (AMD, 2.1; 95% CI, 0.2-4.0) domains and the Strengths and Difficulties Questionnaire prosocial subscale (AMD, 0.5; 95% CI, >0.0-0.9). Fewer children in the delayed-CC group had results below the cutoff in the ASQ fine-motor domain (11.0% vs 3.7%; P = .02) and the Movement ABC bicycle-trail task (12.9% vs 3.8%; P = .02). Boys who received delayed CC had significantly higher AMDs in the WPPSI-III processing-speed quotient (AMD, 4.2; 95% CI, 0.8-7.6; P = .02), Movement ABC bicycle-trail task (AMD, 0.8; 95% CI, 0.1-1.5; P = .03), and fine-motor (AMD, 4.7; 95% CI, 1.0-8.4; P = .01) and personal-social (AMD, 4.9; 95% CI, 1.6-8.3; P = .004) domains of the ASQ. CONCLUSIONS AND RELEVANCE Delayed CC compared with early CC improved scores in the fine-motor and social domains at 4 years of age, especially in boys, indicating that optimizing the time to CC may affect neurodevelopment in a low-risk population of children born in a high-income country. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01581489.
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Affiliation(s)
- Ola Andersson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | | | | | - Magnus Domellöf
- Department of Clinical Sciences, Unit for Pediatrics, Umeå University, Umeå, Sweden
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Iyer KK, Roberts JA, Hellström-Westas L, Wikström S, Hansen Pupp I, Ley D, Vanhatalo S, Breakspear M. Cortical burst dynamics predict clinical outcome early in extremely preterm infants. Brain 2015; 138:2206-18. [PMID: 26001723 DOI: 10.1093/brain/awv129] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 03/19/2015] [Indexed: 01/15/2023] Open
Abstract
Intermittent bursts of electrical activity are a ubiquitous signature of very early brain activity. Previous studies have largely focused on assessing the amplitudes of these transient cortical bursts or the intervals between them. Recent advances in basic neuroscience have identified the presence of scale-free 'avalanche' processes in bursting patterns of cortical activity in other clinical contexts. Here, we hypothesize that cortical bursts in human preterm infants also exhibit scale-free properties, providing new insights into the nature, temporal evolution, and prognostic value of spontaneous brain activity in the days immediately following preterm birth. We examined electroencephalographic recordings from 43 extremely preterm infants (gestational age 22-28 weeks) and demonstrated that their cortical bursts exhibit scale-free properties as early as 12 h after birth. The scaling relationships of cortical bursts correlate significantly with later mental development-particularly within the first 12 h of life. These findings show that early preterm brain activity is characterized by scale-free dynamics which carry developmental significance, hence offering novel means for rapid and early clinical prediction of neurodevelopmental outcomes.
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Affiliation(s)
- Kartik K Iyer
- 1 Systems Neuroscience Group, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia 2 School of Medicine, Faculty of Medicine and Biomedical Sciences, University of Queensland, Australia
| | - James A Roberts
- 1 Systems Neuroscience Group, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | | | - Sverre Wikström
- 4 Department of Paediatrics, Karlstad Central Hospital, Sweden
| | - Ingrid Hansen Pupp
- 5 Department of Paediatrics, Institute for Clinical Sciences, Lund University, Lund, Sweden
| | - David Ley
- 5 Department of Paediatrics, Institute for Clinical Sciences, Lund University, Lund, Sweden
| | - Sampsa Vanhatalo
- 6 Department of Children's Clinical Neurophysiology, HUS Medical Imaging Centre, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland 7 Department of Paediatrics, Children's Hospital, University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Michael Breakspear
- 1 Systems Neuroscience Group, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia 8 The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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Pressler RM, Boylan GB, Marlow N, Blennow M, Chiron C, Cross JH, de Vries LS, Hallberg B, Hellström-Westas L, Jullien V, Livingstone V, Mangum B, Murphy B, Murray D, Pons G, Rennie J, Swarte R, Toet MC, Vanhatalo S, Zohar S. Bumetanide for the treatment of seizures in newborn babies with hypoxic ischaemic encephalopathy (NEMO): an open-label, dose finding, and feasibility phase 1/2 trial. Lancet Neurol 2015; 14:469-77. [PMID: 25765333 DOI: 10.1016/s1474-4422(14)70303-5] [Citation(s) in RCA: 172] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Preclinical data suggest that the loop-diuretic bumetanide might be an effective treatment for neonatal seizures. We aimed to assess dose and feasibility of intravenous bumetanide as an add-on to phenobarbital for treatment of neonatal seizures. METHODS In this open-label, dose finding, and feasibility phase 1/2 trial, we recruited full-term infants younger than 48 h who had hypoxic ischaemic encephalopathy and electrographic seizures not responding to a loading-dose of phenobarbital from eight neonatal intensive care units across Europe. Newborn babies were allocated to receive an additional dose of phenobarbital and one of four bumetanide dose levels by use of a bivariate Bayesian sequential dose-escalation design to assess safety and efficacy. We assessed adverse events, pharmacokinetics, and seizure burden during 48 h continuous electroencephalogram (EEG) monitoring. The primary efficacy endpoint was a reduction in electrographic seizure burden of more than 80% without the need for rescue antiepileptic drugs in more than 50% of infants. The trial is registered with ClinicalTrials.gov, number NCT01434225. FINDINGS Between Sept 1, 2011, and Sept 28, 2013, we screened 30 infants who had electrographic seizures due to hypoxic ischaemic encephalopathy. 14 of these infants (10 boys) were included in the study (dose allocation: 0·05 mg/kg, n=4; 0·1 mg/kg, n=3; 0·2 mg/kg, n=6; 0·3 mg/kg, n=1). All babies received at least one dose of bumetanide with the second dose of phenobarbital; three were withdrawn for reasons unrelated to bumetanide, and one because of dehydration. All but one infant also received aminoglycosides. Five infants met EEG criteria for seizure reduction (one on 0·05 mg/kg, one on 0·1 mg/kg and three on 0·2 mg/kg), and only two did not need rescue antiepileptic drugs (ie, met rescue criteria; one on 0·05 mg/kg and one on 0·3 mg/kg). We recorded no short-term dose-limiting toxic effects, but three of 11 surviving infants had hearing impairment confirmed on auditory testing between 17 and 108 days of age. The most common non-serious adverse reactions were moderate dehydration in one, mild hypotension in seven, and mild to moderate electrolyte disturbances in 12 infants. The trial was stopped early because of serious adverse reactions and limited evidence for seizure reduction. INTERPRETATION Our findings suggest that bumetanide as an add-on to phenobarbital does not improve seizure control in newborn infants who have hypoxic ischaemic encephalopathy and might increase the risk of hearing loss, highlighting the risks associated with the off-label use of drugs in newborn infants before safety assessment in controlled trials. FUNDING European Community's Seventh Framework Programme.
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Affiliation(s)
- Ronit M Pressler
- Section of Clinical Neurosciences and Neonatal Unit, University College London, London, UK.
| | - Geraldine B Boylan
- Irish Centre for Fetal and Neonatal Translational Research, University College Cork, Cork, Ireland
| | - Neil Marlow
- Section of Clinical Neurosciences and Neonatal Unit, University College London, London, UK
| | - Mats Blennow
- Neonatology, Karolinska University Hospital, Stockholm, Sweden
| | - Catherine Chiron
- Inserm U1129, Paris, France; University Paris Descartes, Paris, France
| | - J Helen Cross
- Section of Clinical Neurosciences and Neonatal Unit, University College London, London, UK
| | - Linda S de Vries
- Neonatology, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Boubou Hallberg
- Neonatology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Vincent Jullien
- Inserm U1129, Paris, France; University Paris Descartes, Paris, France
| | - Vicki Livingstone
- Irish Centre for Fetal and Neonatal Translational Research, University College Cork, Cork, Ireland
| | - Barry Mangum
- Duke Clinical Research Institute, Duke University, NC, USA
| | - Brendan Murphy
- Irish Centre for Fetal and Neonatal Translational Research, University College Cork, Cork, Ireland
| | - Deirdre Murray
- Irish Centre for Fetal and Neonatal Translational Research, University College Cork, Cork, Ireland
| | - Gerard Pons
- Inserm U1129, Paris, France; University Paris Descartes, Paris, France
| | - Janet Rennie
- Section of Clinical Neurosciences and Neonatal Unit, University College London, London, UK
| | - Renate Swarte
- Neonatology, Erasmus University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Mona C Toet
- Neonatology, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Sampsa Vanhatalo
- Children's Clinical Neurophysiology, Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland
| | - Sarah Zohar
- Department for Statistics, Inserm, Inserm U1138, Paris, France
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Stevenson NJ, Palmu K, Wikström S, Hellström-Westas L, Vanhatalo S. Measuring brain activity cycling (BAC) in long term EEG monitoring of preterm babies. Physiol Meas 2014; 35:1493-508. [PMID: 24901751 DOI: 10.1088/0967-3334/35/7/1493] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Measuring fluctuation of vigilance states in early preterm infants undergoing long term intensive care holds promise for monitoring their neurological well-being. There is currently, however, neither objective nor quantitative methods available for this purpose in a research or clinical environment. The aim of this proof-of-concept study was, therefore, to develop quantitative measures of the fluctuation in vigilance states or brain activity cycling (BAC) in early preterm infants. The proposed measures of BAC were summary statistics computed on a frequency domain representation of the proportional duration of spontaneous activity transients (SAT%) calculated from electroencephalograph (EEG) recordings. Eighteen combinations of three statistics and six frequency domain representations were compared to a visual interpretation of cycling in the SAT% signal. Three high performing measures (band energy/periodogram: R = 0.809, relative band energy/nonstationary frequency marginal: R = 0.711, g-statistic/nonstationary frequency marginal: R = 0.638) were then compared to a grading of sleep wake cycling based on the visual interpretation of the amplitude-integrated EEG trend. These measures of BAC are conceptually straightforward, correlate well with the visual scores of BAC and sleep wake cycling, are robust enough to cope with the technically compromised monitoring data available in intensive care units, and are recommended for further validation in prospective studies.
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Affiliation(s)
- Nathan J Stevenson
- Neonatal Brain Research Group, Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Ireland
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50
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Andersson O, Domellöf M, Andersson D, Hellström-Westas L. Effect of delayed vs early umbilical cord clamping on iron status and neurodevelopment at age 12 months: a randomized clinical trial. JAMA Pediatr 2014; 168:547-54. [PMID: 24756128 DOI: 10.1001/jamapediatrics.2013.4639] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [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: 11/14/2022]
Abstract
IMPORTANCE Prevention of iron deficiency in infancy may promote neurodevelopment. Delayed cord clamping (DCC) can prevent iron deficiency during the first 6 months of life. However, no data are available on long-term effects on infant outcomes in relation to time for umbilical cord clamping. OBJECTIVE To investigate effects of DCC, as compared with early cord clamping (ECC), on infant iron status and neurodevelopment at age 12 months in a European setting. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial of 382 full-term infants born after a low-risk pregnancy at a Swedish county hospital. Follow-up at 12 months included evaluation of iron status (ferritin level, transferrin saturation, transferrin receptor level, reticulocyte hemoglobin level, and mean cell volume) and parental assessment of neurodevelopment by the Ages and Stages Questionnaire, second edition (ASQ). INTERVENTIONS Infants were randomized to DCC (≥180 seconds after delivery) or ECC (≤10 seconds after delivery). MAIN OUTCOMES AND MEASURES The main outcome was iron status at age 12 months; the secondary outcome was ASQ score. RESULTS In total, 347 of 382 infants (90.8%) were assessed. The DCC and ECC groups did not differ in iron status (mean ferritin level, 35.4 vs 33.6 ng/mL, respectively; P = .40) or neurodevelopment (mean ASQ total score, 229.6 vs 233.1, respectively; P = .42) at age 12 months. Predictors of ferritin levels were infant sex and ferritin in umbilical cord blood. Predictors of ASQ score were infant sex and breastfeeding within 1 hour after birth. For both outcomes, being a boy was associated with lower results. Interaction analysis showed that DCC was associated with an ASQ score 5 points higher among boys (mean [SD] score, 229 [43] for DCC vs 224 [39] for ECC) but 12 points lower among girls (mean [SD] score, 230 [39] for DCC vs 242 [36] for ECC), out of a maximum of 300 points (P = .04 for the interaction term). CONCLUSIONS AND RELEVANCE Delayed cord clamping did not affect iron status or neurodevelopment at age 12 months in a selected population of healthy term-born infants. However, it may not be possible to demonstrate minor effects on neurodevelopment with the size of the study population and the chosen method for assessment. The current data indicate that sex may influence the effects on infant development after DCC in different directions. The magnitude and biological reason for this finding remain to be investigated. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01245296.
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Affiliation(s)
- Ola Andersson
- Department of Pediatrics, Hospital of Halland, Halmstad, Sweden2Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Magnus Domellöf
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Dan Andersson
- Department of Pediatrics, Hospital of Halland, Halmstad, Sweden
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