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Polglase GR, Brian Y, Tantanis D, Blank DA, Badurdeen S, Crossley KJ, Kluckow M, Gill AW, Camm E, Galinsky R, Thomas Songstad N, Klingenberg C, Hooper SB, Roberts CT. Endotracheal epinephrine at standard versus high dose for resuscitation of asystolic newborn lambs. Resuscitation 2024; 198:110191. [PMID: 38522732 DOI: 10.1016/j.resuscitation.2024.110191] [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: 12/05/2023] [Revised: 02/21/2024] [Accepted: 03/14/2024] [Indexed: 03/26/2024]
Abstract
INTRODUCTION Endotracheal (ET) epinephrine administration is an option during neonatal resuscitation, if the preferred intravenous (IV) route is unavailable. OBJECTIVES We assessed whether endotracheal epinephrine achieved return of spontaneous circulation (ROSC), and maintained physiological stability after ROSC, at standard and higher dose, in severely asphyxiated newborn lambs. METHODS Near-term fetal lambs were asphyxiated until asystole. Resuscitation was commenced with ventilation and chest compressions. Lambs were randomly allocated to: IV Saline placebo (5 ml/kg), IV Epinephrine (20 micrograms/kg), Standard-dose ET Epinephrine (100 micrograms/kg), and High-dose ET Epinephrine (1 mg/kg). After three allocated treatment doses, rescue IV Epinephrine was administered if ROSC had not occurred. Lambs achieving ROSC were monitored for 60 minutes. Brain histology was assessed for microbleeds. RESULTS ROSC in response to allocated treatment (without rescue IV Epinephrine) occurred in 1/6 Saline, 9/9 IV Epinephrine, 0/9 Standard-dose ET Epinephrine, and 7/9 High-dose ET Epinephrine lambs respectively. Blood pressure during CPR increased after treatment with IV Epinephrine and High-dose ET Epinephrine, but not Saline or Standard-dose ET Epinephrine. After ROSC, both ET Epinephrine groups had lower pH, higher lactate, and higher blood pressure than the IV Epinephrine group. Cortex microbleeds were more frequent in High-dose ET Epinephrine lambs (8/8 lambs examined, versus 3/8 in IV Epinephrine lambs). CONCLUSIONS The currently recommended dose of ET Epinephrine was ineffective in achieving ROSC. Without convincing clinical or preclinical evidence of efficacy, use of ET Epinephrine at this dose may not be appropriate. High-dose ET Epinephrine requires further evaluation before clinical translation.
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Affiliation(s)
- Graeme R Polglase
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | - Yoveena Brian
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | - Darcy Tantanis
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | - Douglas A Blank
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia; Department of Paediatrics, Monash University, Melbourne, VIC, Australia
| | - Shiraz Badurdeen
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia; Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia
| | - Kelly J Crossley
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | - Martin Kluckow
- Department of Neonatology, Royal North Shore Hospital & University of Sydney, Sydney, NSW, Australia
| | - Andrew W Gill
- Centre for Neonatal Research and Education, The University of Western Australia, Subiaco, WA, Australia
| | - Emily Camm
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | - Robert Galinsky
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | | | | | - Stuart B Hooper
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | - Calum T Roberts
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia; Department of Paediatrics, Monash University, Melbourne, VIC, Australia; Monash Newborn, Monash Children's Hospital, Melbourne, VIC, Australia.
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Alonso-Ojembarrena A, Ehrhardt H, Cetinkaya M, Lavizzari A, Szczapa T, Sartorius V, Rocha G, Sindelar R, Wald M, Heiring C, Soukka H, Danhaive O, Roehr CC, Cucerea M, Calkovska A, Dimitriou G, Barzilay B, Klingenberg C, Schulzke S, Plavka R, Tameliene R, O'Donnell CPF, van Kaam AH. Use of neonatal lung ultrasound in European neonatal units: a survey by the European Society of Paediatric Research. Arch Dis Child Fetal Neonatal Ed 2024:fetalneonatal-2024-327068. [PMID: 38604653 DOI: 10.1136/archdischild-2024-327068] [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: 02/27/2024] [Accepted: 04/02/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE Regarding the use of lung ultrasound (LU) in neonatal intensive care units (NICUs) across Europe, to assess how widely it is used, for what indications and how its implementation might be improved. DESIGN AND INTERVENTION International online survey. RESULTS Replies were received from 560 NICUs in 24 countries between January and May 2023. LU uptake varied considerably (20%-98% of NICUs) between countries. In 428 units (76%), LU was used for clinical indications, while 34 units (6%) only used it for research purposes. One-third of units had <2 years of experience, and only 71 units (13%) had >5 years of experience. LU was mainly performed by neonatologists. LU was most frequently used to diagnose respiratory diseases (68%), to evaluate an infant experiencing acute clinical deterioration (53%) and to guide surfactant treatment (39%). The main pathologies diagnosed by LU were pleural effusion, pneumothorax, transient tachypnoea of the newborn and respiratory distress syndrome. The main barriers for implementation were lack of experience with technical aspects and/or image interpretation. Most units indicated that specific courses and an international guideline on neonatal LU could promote uptake of this technique. CONCLUSIONS Although LU has been adopted in neonatal care in most European countries, the uptake is highly variable. The main indications are diagnosis of lung disease, evaluation of acute clinical deterioration and guidance of surfactant. Implementation may be improved by developing courses and publishing an international guideline.
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Affiliation(s)
- Almudena Alonso-Ojembarrena
- Neonatal Intensive Care Unit, Hospital Universitario Puerta del Mar, Cadiz, Spain
- Research Unit, Puerta del Mar University Hospital, Biomedical Research and Innovation Institute of Cádiz (INiBICA), Cadiz, Spain
| | - Harald Ehrhardt
- Division of Neonatology and Pediatric Intensive Care Medicine. Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
| | - Merih Cetinkaya
- Health Sciences University, Başaksehir. Cam and Sakura City Hospital, Istanbul, Turkey
| | - Anna Lavizzari
- Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Tomasz Szczapa
- II Department of Neonatology, Neonatal Biophysical Monitoring and Cardiopulmonary Therapies Research Unit, Poznan University of Medical Sciences, Poznan, Poland
| | - Victor Sartorius
- Divivion of Paediatric and Neonatal Critical Care, Hôpital Antoine-Béclère, Clamart, France
| | - Gustavo Rocha
- Department of Neonatology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Richard Sindelar
- Department of Women's and Children's Health, Uppsala Universitet, Uppsala, Sweden
| | - Martin Wald
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Paracelsus Medical University, University Hospital Salzburg, Salzburg, Austria
| | - Christian Heiring
- Department of Neonatology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Hanna Soukka
- Department of Pediatrics and Adolescent Medicine, University Hosptial of Turky and Turku University, Turku, Finland
| | - Olivier Danhaive
- Division of Neonatology, Saint-Luc University Hospital, UCLouvain, Brussels, Belgium
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Charles C Roehr
- National Perinatal Epidemiology Unit, Oxford Population Health, Medical Sciences Division, University of Oxford, Oxford, UK
- Newborn Services, Southmead Hospital, North Bristol Trust, Bristol, UK
- Newborn Services, Southmead Hospital. North Bristol Trust, Bristol, UK
| | - Manuela Cucerea
- Department of Neonatology, George Emil Palade University of Medicine Pharmacy Science and Technology of Targu Mures, Targu Mures, Romania
| | - Andrea Calkovska
- Department of Physiology, Jessenius Faculty of Medicine. Comenius University, Bratislava, Slovakia
| | | | - Bernard Barzilay
- Neonatology Division, Mayanei Hayeshua Medical Center, Bnei Brak, Tel Aviv, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - Claus Klingenberg
- Paediatric Research Group, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromso, Norway
- Department of Paediatrics and Adolescence Medicine, University Hospital of North Norway, Tromso, Norway
| | - Sven Schulzke
- Department of Neonatology, University Children's Hospital, Basel, Switzerland
| | - Richard Plavka
- Division of Neonatology, Department of Obstetrics and Gynecology, General Faculty Hospital and 1st Faculty of Medicine, Charles University, Prague, Czechia
| | - Rasa Tameliene
- Department of Neonatology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Anton H van Kaam
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Reproduction & Development, Amsterdam, The Netherlands
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Hemmingsen D, Moster D, Engdahl B, Klingenberg C. Hearing impairment after asphyxia and neonatal encephalopathy: a Norwegian population-based study. Eur J Pediatr 2024; 183:1163-1172. [PMID: 37991501 PMCID: PMC10950958 DOI: 10.1007/s00431-023-05321-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/25/2023] [Accepted: 10/28/2023] [Indexed: 11/23/2023]
Abstract
The purpose of this study is to evaluate the association between perinatal asphyxia, neonatal encephalopathy, and childhood hearing impairment. This is a population-based study including all Norwegian infants born ≥ 36 weeks gestation between 1999 and 2014 and alive at 2 years (n = 866,232). Data was linked from five national health registries with follow-up through 2019. Perinatal asphyxia was defined as need for neonatal intensive care unit (NICU) admission and an Apgar 5-min score of 4-6 (moderate) or 0-3 (severe). We coined infants with seizures and an Apgar 5-min score < 7 as neonatal encephalopathy with seizures. Infants who received therapeutic hypothermia were considered to have moderate-severe hypoxic-ischemic encephalopathy (HIE). The reference group for comparisons were non-admitted infants with Apgar 5-min score ≥ 7. We used logistic regression models and present data as adjusted odds ratios (aORs) with 95% confidence intervals (CI). The aOR for hearing impairment was increased in all infants admitted to NICU: moderate asphyxia aOR 2.2 (95% CI 1.7-2.9), severe asphyxia aOR 5.2 (95% CI 3.6-7.5), neonatal encephalopathy with seizures aOR 7.0 (95% CI 2.6-19.0), and moderate-severe HIE aOR 10.7 (95% CI 5.3-22.0). However, non-admitted infants with Apgar 5-min scores < 7 did not have increased OR of hearing impairment. The aOR for hearing impairment for individual Apgar 5-min scores in NICU infants increased with decreasing Apgar scores and was 13.6 (95% CI 5.9-31.3) when the score was 0. Conclusions: An Apgar 5-min score < 7 in combination with NICU admission is an independent risk factor for hearing impairment. Children with moderate-severe HIE had the highest risk for hearing impairment. What is Known: • Perinatal asphyxia and neonatal encephalopathy are associated with an increased risk of hearing impairment. • The strength of the association, and how other co-morbidities affect the risk of hearing impairment, is poorly defined. What is New: • Among neonates admitted to a neonatal intensive care unit (NICU), decreased Apgar 5-min scores, and increased severity of neonatal encephalopathy, were associated with a gradual rise in risk of hearing impairment. • Neonates with an Apgar 5-min score 7, but without NICU admission, did not have an increased risk of hearing impairment.
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Affiliation(s)
- Dagny Hemmingsen
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of North Norway, N-9038, Tromsø, Norway.
- Paediatric Research Group, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway.
| | - Dag Moster
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Bo Engdahl
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Claus Klingenberg
- Paediatric Research Group, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway
- Department of Paediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway
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Murphy MC, Miletin J, Klingenberg C, Guthe HJ, Rigo V, Plavka R, Bohlin K, Barroso Pereira A, Juren T, Alih E, Galligan M, O’Donnell CPF. Prophylactic Oropharyngeal Surfactant for Preterm Newborns at Birth: A Randomized Clinical Trial. JAMA Pediatr 2024; 178:117-124. [PMID: 38079168 PMCID: PMC10714282 DOI: 10.1001/jamapediatrics.2023.5082] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 04/06/2023] [Accepted: 08/15/2023] [Indexed: 02/06/2024]
Abstract
Importance Preterm newborns at risk of respiratory distress syndrome are supported with continuous positive airway pressure (CPAP). Many newborns worsen despite CPAP and are intubated for surfactant administration, an effective therapy for treatment of respiratory distress syndrome. Endotracheal intubation is associated with adverse effects. Pharyngeal administration of surfactant to preterm animals and humans has been reported as an alternative. Objective To assess whether giving prophylactic oropharyngeal surfactant to preterm newborns at birth would reduce the rate of intubation for respiratory failure. Design, Setting, and Participants This unblinded, parallel-group randomized clinical trial (Prophylactic Oropharyngeal Surfactant for Preterm Infants [POPART]) was conducted from December 17, 2017, to September 11, 2020, at 9 tertiary neonatal intensive care units in 6 European countries. Newborns born before 29 weeks of gestation without severe congenital anomalies, for whom intensive care was planned, were eligible for inclusion. The data were analyzed from July 27, 2022, to June 20, 2023. Intervention Newborns were randomly assigned to receive oropharyngeal surfactant at birth in addition to CPAP or CPAP alone. Randomization was stratified by center and gestational age (GA). Main Outcomes and Measures The primary outcome was intubation in the delivery room for bradycardia and/or apnea or in the neonatal intensive care unit for prespecified respiratory failure criteria within 120 hours of birth. Caregivers were not masked to group assignment. Results Among 251 participants (mean [SD] GA, 26 [1.5] weeks) who were well matched at study entry, 126 (69 [54.8%] male) with a mean (SD) birth weight of 858 (261) grams were assigned to the oropharyngeal surfactant group, and 125 (63 [50.4%] male) with a mean (SD) birth weight of 829 (253) grams were assigned to the control group. The proportion of newborns intubated within 120 hours was not different between the groups (80 [63.5%) in the oropharyngeal surfactant group and 81 [64.8%] in the control group; relative risk, 0.98 [95% CI, 0.81-1.18]). More newborns assigned to the oropharyngeal surfactant group were diagnosed with and treated for pneumothorax (21 [16.6%] vs 8 [6.4%]; P = .04). Conclusions and Relevance This randomized clinical trial found that administration of prophylactic oropharyngeal surfactant to newborns born before 29 weeks' GA did not reduce the rate of intubation in the first 120 hours of life. These findings suggest that administration of surfactant into the oropharynx immediately after birth in addition to CPAP should not be routinely used. Trial Registration EudraCT: 2016-004198-41.
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Affiliation(s)
- Madeleine C. Murphy
- National Maternity Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
- National Children’s Research Centre, Dublin, Ireland
| | - Jan Miletin
- Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Claus Klingenberg
- Paediatric Research Group, Faculty of Health Sciences, UiT–The Arctic University of Norway, Tromsø, Norway
- Department of Pediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway
| | | | - Vincent Rigo
- Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | | | - Kajsa Bohlin
- Karolinska University Hospital, Stockholm, Sweden
- Karolinska Institutet, Stockholm, Sweden
| | | | - Tomáš Juren
- University Hospital Brno, Brno, Czech Republic
| | - Ekele Alih
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Marie Galligan
- Clinical Research Centre, School of Medicine, University College Dublin, Dublin, Ireland
| | - Colm P. F. O’Donnell
- National Maternity Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
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Bjerkhaug AU, Ramalingham S, Mboizi R, Le Doare K, Klingenberg C. The immunogenicity and safety of Group B Streptococcal maternal vaccines: A systematic review. Vaccine 2024; 42:84-98. [PMID: 38072754 DOI: 10.1016/j.vaccine.2023.11.056] [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: 10/24/2023] [Revised: 11/22/2023] [Accepted: 11/27/2023] [Indexed: 01/01/2024]
Abstract
PURPOSE To systematically review immunogenicity and safety data of maternal group B streptococcal (GBS) vaccines in published clinical trials until July 2023. METHODS EMBASE, MEDLINE, Cochrane Library and clinicaltrial.gov. databases were searched for clinical studies that reported immunogenicity and/or safety of GBS vaccine in non-pregnant adults, pregnant women and infants between 1st of January 1996 to 31st of July 2023. Pairs of reviewers independently selected, data extracted, and assessed the risk of bias of the studies. Discrepancies were resolved by consensus. (PROSPERO CRD42020185213). RESULTS We retrieved 1472 records from the literature search; 20 studies and 6 sub-studies were included, involving 4440 non-pregnant participants and 1325 pregnant women with their newborns. There was a significantly higher IgG Geometric Mean Concentration (GMC) and IgG placental transfer ratios in vaccinated compared to placebo groups, with peak response 4-8 weeks after vaccination. Placental transfer ratio varied from 0.4 to 1.4 across five studies. The different clinical trials used different assays that limited direct comparison. There were no significant differences in the risk of serious adverse events (adjusted OR 0.73; 95 % CI 0.49-1.07), serious adverse events leading to withdrawal (adjusted OR 0.44; 95 % CI 0.13-1.51), and systemic illness or fever (adjusted OR 1.05; 95 % CI 0.26-4.19) between the vaccine and placebo groups. CONCLUSIONS The published clinical trials show significant IgG GMC response in subjects receiving the conjugated capsular polysaccharide and surface subunit protein vaccines compared to placebo. In current clinical trials of experimental GBS maternal vaccines, there have been no observed serious adverse events of special interest directly linked to vaccination.
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Affiliation(s)
- Aline U Bjerkhaug
- Paediatric Research Group, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway; Department of Paediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway.
| | - Shouwmika Ramalingham
- Paediatric Research Group, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway
| | - Robert Mboizi
- Makerere University Johns Hopkins University (MU-JHU) Research Collaboration (MUJHU CARE LTD), Kampala, Uganda
| | - Kirsty Le Doare
- Makerere University Johns Hopkins University (MU-JHU) Research Collaboration (MUJHU CARE LTD), Kampala, Uganda; Centre for Neonatal and Paediatric Infection, Maternal and Neonatal Vaccine Immunology Research Group, St Georgés University of London, United Kingdom
| | - Claus Klingenberg
- Paediatric Research Group, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway; Department of Paediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway
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Huncikova Z, Stensvold HJ, Øymar KAA, Vatne A, Lang AM, Støen R, Brigtsen AK, Moster D, Eriksen BH, Selberg T, Rønnestad A, Klingenberg C. Variation in antibiotic consumption in very preterm infants-a 10 year population-based study. J Antimicrob Chemother 2024; 79:143-150. [PMID: 37986613 PMCID: PMC10761275 DOI: 10.1093/jac/dkad358] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/02/2023] [Indexed: 11/22/2023] Open
Abstract
OBJECTIVES Wide variations in antibiotic use in very preterm infants have been reported across centres despite similar rates of infection. We describe 10 year trends in use of antibiotics and regional variations among very preterm infants in Norway. PATIENTS AND METHODS All live-born very preterm infants (<32 weeks gestation) admitted to any neonatal unit in Norway during 2009-18 were included. Main outcomes were antibiotic consumption expressed as days of antibiotic therapy (DOT) per 1000 patient days (PD), regional variations in use across four health regions, rates of sepsis and sepsis-attributable mortality and trends of antibiotic use during the study period. RESULTS We included 5296 infants: 3646 (69%) were born at 28-31 weeks and 1650 (31%) were born before 28 weeks gestation with similar background characteristics across the four health regions. Overall, 80% of the very preterm infants received antibiotic therapy. The most commonly prescribed antibiotics were the combination of narrow-spectrum β-lactams and aminoglycosides, but between 2009 and 2018 we observed a marked reduction in their use from 100 to 40 DOT per 1000 PD (P < 0.001). In contrast, consumption of broad-spectrum β-lactams remained unchanged (P = 0.308). There were large variations in consumption of vancomycin, broad-spectrum β-lactams and first-generation cephalosporins, but no differences in sepsis-attributable mortality across regions. CONCLUSIONS The overall antibiotic consumption was reduced during the study period. Marked regional variations remained in consumption of broad-spectrum β-lactams and vancomycin, without association to sepsis-attributable mortality. Our results highlight the need for antibiotic stewardship strategies to reduce consumption of antibiotics that may enhance antibiotic resistance development.
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Affiliation(s)
- Zuzana Huncikova
- Paediatric Department, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Hans Jørgen Stensvold
- Department of Neonatal Intensive Care, Clinic of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Knut Asbjørn Alexander Øymar
- Paediatric Department, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Anlaug Vatne
- Paediatric Department, Stavanger University Hospital, Stavanger, Norway
| | - Astri Maria Lang
- Paediatric Department, Akershus University Hospital, Lørenskog, Norway
| | - Ragnhild Støen
- Department of Paediatrics, St.Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Anne Karin Brigtsen
- Department of Neonatal Intensive Care, Clinic of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Dag Moster
- Department of Paediatrics and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Beate Horsberg Eriksen
- Department of Paediatrics, Møre and Romsdal Hospital Trust, Ålesund, Norway
- Clinical Research Unit, Norwegian University of Science and Technology, Trondheim, Norway
| | - Terje Selberg
- Department of Paediatric and Adolescent Medicine, Ostfold County Hospital, Gralum, Norway
| | - Arild Rønnestad
- Department of Neonatal Intensive Care, Clinic of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
- Department of Paediatric and Adolescent Medicine, Ostfold County Hospital, Gralum, Norway
- Medical Faculty, Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Claus Klingenberg
- Department of Paediatrics and Adolescent Medicine, University Hospital of North Norway, Tromsø, Norway
- Paediatric Research Group, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway
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Arwehed S, Axelin A, Björklund LJ, Thernström Blomqvist Y, Heiring C, Jonsson B, Klingenberg C, Metsäranta M, Ågren J, Lehtonen L. Nordic survey showed wide variation in discharge practices for very preterm infants. Acta Paediatr 2024; 113:48-55. [PMID: 37540833 DOI: 10.1111/apa.16934] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/01/2023] [Accepted: 08/02/2023] [Indexed: 08/06/2023]
Abstract
AIM We aimed to describe clinical practices and criteria for discharge of very preterm infants in Nordic neonatal units. METHODS Medical directors of all 89 level-2 and level-3 units in Denmark, Finland, Iceland, Norway and Sweden were invited by e-mail to complete a web-based multiple-choice survey with the option to make additional free-text comments. RESULTS We received responses from 83/89 units (93%). In all responding units, discharge readiness was based mainly on clinical assessment with varying criteria. In addition, 36% used formal tests of cardiorespiratory stability and 59% used criteria related to infant weight or growth. For discharge with feeding tube, parental ability to speak the national language or English was mandatory in 45% of units, with large variation among countries. Post-discharge home visits and video-consultations were provided by 59% and 51%, respectively. In 54% of units, parental preparation for discharge were not initiated until the last two weeks of hospital stay. CONCLUSION Discharge readiness was based mainly on clinical assessment, with criteria varying among units despite similar population characteristics and care structures. This variation indicates a lack of evidence base and may unnecessarily delay discharge; further studies of this matter are needed. Earlier parental preparation and use of interpreters might facilitate earlier discharge.
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Affiliation(s)
- Sofia Arwehed
- Department of Women's and Children's Health, Uppsala University and Uppsala University Hospital, Uppsala, Sweden
| | - Anna Axelin
- Department of Women's and Children's Health, Uppsala University and Uppsala University Hospital, Uppsala, Sweden
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Lars J Björklund
- Department of Clinical Sciences, Lund, Paediatrics, Lund University and Skåne University Hospital, Lund, Sweden
| | - Ylva Thernström Blomqvist
- Department of Women's and Children's Health, Uppsala University and Uppsala University Hospital, Uppsala, Sweden
| | - Christian Heiring
- Department of Neonatology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Baldvin Jonsson
- Department of Women's and Children's Health, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Claus Klingenberg
- Paediatric Research Group, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway
- Department of Pediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Marjo Metsäranta
- Department of Pediatrics, University of Helsinki and Helsinki University Hospital (HUH), Helsinki, Finland
| | - Johan Ågren
- Department of Women's and Children's Health, Uppsala University and Uppsala University Hospital, Uppsala, Sweden
| | - Liisa Lehtonen
- Department of Paediatrics and Adolescent Medicine, Turku University, Hospital and University of Turku, Turku, Finland
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Thaulow CM, Klingenberg C. C.H. Thaulow og C. Klingenberg svarer. Tidsskr Nor Laegeforen 2023; 143:23-0535. [PMID: 37668122 DOI: 10.4045/tidsskr.23.0535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023] Open
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Huncikova Z, Vatne A, Stensvold HJ, Lang AM, Støen R, Brigtsen AK, Salvesen B, Øymar KAA, Rønnestad A, Klingenberg C. Late-onset sepsis in very preterm infants in Norway in 2009-2018: a population-based study. Arch Dis Child Fetal Neonatal Ed 2023; 108:478-484. [PMID: 36732047 PMCID: PMC10447404 DOI: 10.1136/archdischild-2022-324977] [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: 10/05/2022] [Accepted: 01/13/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To evaluate epidemiology and outcomes among very preterm infants (<32 weeks' gestation) with culture-positive and culture-negative late-onset sepsis (LOS). DESIGN Cohort study using a nationwide, population-based registry. SETTING 21 neonatal units in Norway. PARTICIPANTS All very preterm infants born 1 January 2009-31 December 2018 and admitted to a neonatal unit. MAIN OUTCOME MEASURES Incidences, pathogen distribution, LOS-attributable mortality and associated morbidity at discharge. RESULTS Among 5296 very preterm infants, we identified 582 culture-positive LOS episodes in 493 infants (incidence 9.3%) and 282 culture-negative LOS episodes in 282 infants (incidence 5.3%). Extremely preterm infants (<28 weeks' gestation) had highest incidences of culture-positive (21.6%) and culture-negative (11.1%) LOS. The major causative pathogens were coagulase-negative staphylococci (49%), Staphylococcus aureus (15%), group B streptococci (10%) and Escherichia coli (8%). We observed increased odds of severe bronchopulmonary dysplasia (BPD) associated with both culture-positive (adjusted OR (aOR) 1.7; 95% CI 1.3 to 2.2) and culture-negative (aOR 1.6; 95% CI 1.3 to 2.6) LOS. Only culture-positive LOS was associated with increased odds of cystic periventricular leukomalacia (cPVL) (aOR 2.2; 95% CI 1.4 to 3.4) and severe retinopathy of prematurity (ROP) (aOR 1.8; 95% CI 1.2 to 2.8). Culture-positive LOS-attributable mortality was 6.3%, higher in Gram-negative (15.8%) compared with Gram-positive (4.1%) LOS, p=0.009. Among extremely preterm infants, survival rates increased from 75.2% in 2009-2013 to 81.0% in 2014-2018, p=0.005. In the same period culture-positive LOS rates increased from 17.1% to 25.6%, p<0.001. CONCLUSIONS LOS contributes to a significant burden of disease in very preterm infants and is associated with increased odds of severe BPD, cPVL and severe ROP.
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Affiliation(s)
- Zuzana Huncikova
- Paediatric Department, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Science, University of Bergen, Bergen, Hordaland, Norway
| | - Anlaug Vatne
- Paediatric Department, Stavanger University Hospital, Stavanger, Norway
| | - Hans Jorgen Stensvold
- Neonatal Department, Oslo University Hospital Rikshospitalet, Oslo, Norway
- Faculty of Medicine, Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Astri Maria Lang
- Paediatric Department, Akershus University Hospital, Lorenskog, Norway
| | - Ragnhild Støen
- Department of Paediatrics, St. Olav University Hospital, Trondheim, Norway
| | - Anne Karin Brigtsen
- Department of Neonatal Intensive Care, Oslo University Hospital Ullevaal, Oslo, Norway
| | - Bodil Salvesen
- Department of Paediatrics and Adolescents Medicine, Haukeland University Hospital, Bergen, Norway
| | - Knut Asbjørn Alexander Øymar
- Paediatric Department, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Science, University of Bergen, Bergen, Hordaland, Norway
| | - Arild Rønnestad
- Neonatal Department, Oslo University Hospital Rikshospitalet, Oslo, Norway
- Faculty of Medicine, Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Claus Klingenberg
- Department of Paediatrics, University Hospital of North Norway, Tromso, Norway
- Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
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Thaulow CM, Klingenberg C. [Penicillin at any price?]. Tidsskr Nor Laegeforen 2023; 143:23-0172. [PMID: 37376941 DOI: 10.4045/tidsskr.23.0172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
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11
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Laborie LB, Klingenberg C, Rasmussen H, Gundersen T, Rosendahl K. [L. Laborie et al. respond]. Tidsskr Nor Laegeforen 2023; 143:23-0400. [PMID: 37376942 DOI: 10.4045/tidsskr.23.0400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
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12
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Klingenberg C, Andresen JH. Probiotika profylakse hos premature og ulik tolkning av evidens. Tidsskr Nor Laegeforen 2023; 143:23-0329. [PMID: 37254984 DOI: 10.4045/tidsskr.23.0329] [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: 06/02/2023] Open
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13
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Bargheet A, Klingenberg C, Esaiassen E, Hjerde E, Cavanagh JP, Bengtsson-Palme J, Pettersen VK. Development of early life gut resistome and mobilome across gestational ages and microbiota-modifying treatments. EBioMedicine 2023; 92:104613. [PMID: 37187112 DOI: 10.1016/j.ebiom.2023.104613] [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] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 04/21/2023] [Accepted: 04/27/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Gestational age (GA) and associated level of gastrointestinal tract maturation are major factors driving the initial gut microbiota composition in preterm infants. Besides, compared to term infants, premature infants often receive antibiotics to treat infections and probiotics to restore optimal gut microbiota. How GA, antibiotics, and probiotics modulate the microbiota's core characteristics, gut resistome and mobilome, remains nascent. METHODS We analysed metagenomic data from a longitudinal observational study in six Norwegian neonatal intensive care units to describe the bacterial microbiota of infants of varying GA and receiving different treatments. The cohort consisted of probiotic-supplemented and antibiotic-exposed extremely preterm infants (n = 29), antibiotic-exposed very preterm (n = 25), antibiotic-unexposed very preterm (n = 8), and antibiotic-unexposed full-term (n = 10) infants. The stool samples were collected on days of life 7, 28, 120, and 365, and DNA extraction was followed by shotgun metagenome sequencing and bioinformatical analysis. FINDINGS The top predictors of microbiota maturation were hospitalisation length and GA. Probiotic administration rendered the gut microbiota and resistome of extremely preterm infants more alike to term infants on day 7 and ameliorated GA-driven loss of microbiota interconnectivity and stability. GA, hospitalisation, and both microbiota-modifying treatments (antibiotics and probiotics) contributed to an elevated carriage of mobile genetic elements in preterm infants compared to term controls. Finally, Escherichia coli was associated with the highest number of antibiotic-resistance genes, followed by Klebsiella pneumoniae and Klebsiella aerogenes. INTERPRETATION Prolonged hospitalisation, antibiotics, and probiotic intervention contribute to dynamic alterations in resistome and mobilome, gut microbiota characteristics relevant to infection risk. FUNDING Odd-Berg Group, Northern Norway Regional Health Authority.
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Affiliation(s)
- Ahmed Bargheet
- Host-Microbe Interaction Research Group, Department of Medical Biology, UiT The Arctic University of Norway, Tromsø, Norway; Paediatric Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway; Center for New Antibacterial Strategies, UiT The Arctic University of Norway, Tromsø, Norway
| | - Claus Klingenberg
- Paediatric Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway; Center for New Antibacterial Strategies, UiT The Arctic University of Norway, Tromsø, Norway; Department of Paediatrics, University Hospital of North Norway, Tromsø, Norway
| | - Eirin Esaiassen
- Paediatric Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway; Department of Paediatrics, University Hospital of North Norway, Tromsø, Norway
| | - Erik Hjerde
- Center for New Antibacterial Strategies, UiT The Arctic University of Norway, Tromsø, Norway; Department of Chemistry, Norstruct, UiT The Arctic University of Norway, Tromsø, Norway
| | - Jorunn Pauline Cavanagh
- Paediatric Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway; Center for New Antibacterial Strategies, UiT The Arctic University of Norway, Tromsø, Norway
| | - Johan Bengtsson-Palme
- Division of Systems Biology, Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, SE-412 96, Sweden; Department of Infectious Diseases, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10A, Gothenburg, SE-413 46, Sweden; Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden
| | - Veronika Kuchařová Pettersen
- Host-Microbe Interaction Research Group, Department of Medical Biology, UiT The Arctic University of Norway, Tromsø, Norway; Paediatric Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway; Center for New Antibacterial Strategies, UiT The Arctic University of Norway, Tromsø, Norway.
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14
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Stocker M, Klingenberg C, Navér L, Nordberg V, Berardi A, El Helou S, Fusch G, Bliss JM, Lehnick D, Dimopoulou V, Guerina N, Seliga-Siwecka J, Maton P, Lagae D, Mari J, Janota J, Agyeman PKA, Pfister R, Latorre G, Maffei G, Laforgia N, Mózes E, Størdal K, Strunk T, Giannoni E. Less is more: Antibiotics at the beginning of life. Nat Commun 2023; 14:2423. [PMID: 37105958 PMCID: PMC10134707 DOI: 10.1038/s41467-023-38156-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023] Open
Abstract
Antibiotic exposure at the beginning of life can lead to increased antimicrobial resistance and perturbations of the developing microbiome. Early-life microbiome disruption increases the risks of developing chronic diseases later in life. Fear of missing evolving neonatal sepsis is the key driver for antibiotic overtreatment early in life. Bias (a systemic deviation towards overtreatment) and noise (a random scatter) affect the decision-making process. In this perspective, we advocate for a factual approach quantifying the burden of treatment in relation to the burden of disease balancing antimicrobial stewardship and effective sepsis management.
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Affiliation(s)
- Martin Stocker
- Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland.
| | - Claus Klingenberg
- Paediatric Research Group, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway
- Dept. of Pediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Lars Navér
- Department of Neonatology, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Viveka Nordberg
- Department of Neonatology, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Alberto Berardi
- Neonatal Intensive Care Unit, Mother and Child Department, Policlinico University Hospital, Modena, Italy
| | - Salhab El Helou
- Division of Neonatology, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton Health Sciences, Hamilton, Canada
| | - Gerhard Fusch
- Division of Neonatology, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton Health Sciences, Hamilton, Canada
| | - Joseph M Bliss
- Department of Pediatrics, Women & Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University, Richmond, USA
| | - Dirk Lehnick
- Biostatistics and Methodology, CTU-CS, Department of Health Sciences and Medicine, University of Lucerne, Luzern, Switzerland
| | - Varvara Dimopoulou
- Clinic of Neonatology, Department Mother-Woman-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Nicholas Guerina
- Department of Pediatrics, Women & Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University, Richmond, USA
| | - Joanna Seliga-Siwecka
- Department of Neonatology and Neonatal Intensive Care, Medical University of Warsaw, Warszawa, Poland
| | - Pierre Maton
- Service néonatal, Clinique CHC-Montlegia, groupe santé CHC, Liège, Belgium
| | - Donatienne Lagae
- Neonatology and Neonatal Intensive Care Unit, CHIREC-Delta Hospital, Brussels, Belgium
| | - Judit Mari
- Department of Paediatrics, University of Szeged, Szeged, Hungary
| | - Jan Janota
- Neonatal Unit, Department of Obstetrics and Gynecology, Motol University Hospital Prague, Prague, Czech Republic
- Department of Neonatology, Thomayer University Hospital Prague, Prague, Czech Republic
| | - Philipp K A Agyeman
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Riccardo Pfister
- Neonatology and Paediatric Intensive Care Unit, Geneva University Hospitals and Geneva University, Geneva, Switzerland
| | - Giuseppe Latorre
- Neonatology and Neonatal Intensive Care Unit, Ecclesiastical General Hospital F. Miulli, Acquaviva delle Fonti, Italy
| | - Gianfranco Maffei
- Neonatology and Neonatal Intensive Care Unit, Policlinico Riuniti Foggia, Foggia, Italy
| | - Nichola Laforgia
- Neonatologia e Terapia Intensiva Neonatale, University of Bari, Bari, Italy
| | - Enikő Mózes
- Perinatal Intensive Care Unit, Department of Obstetrics and Gynaecology, Semmelweis University, Budapest, Hungary
| | - Ketil Størdal
- Institute of Clinical Medicine, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Tobias Strunk
- Neonatal Directorate, Child and Adolescent Health Service, King Edward Memorial Hospital, Perth, Western, Australia
| | - Eric Giannoni
- Clinic of Neonatology, Department Mother-Woman-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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15
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Laborie LB, Klingenberg C, Rasmussen H, Gundersen T, Rosendahl K. Hofteleddsdysplasi hos spedbarn – screening, behandling og oppfølging. Tidsskr Nor Laegeforen 2023; 143:22-0542. [PMID: 37097239 DOI: 10.4045/tidsskr.22.0542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Hip dysplasia occurs in up to 3 % of neonates and if untreated can lead to dislocated hip, osteoarthritis and the need for a hip prosthesis. The study aimed to identify routines for ultrasound screening, treatment and follow-up of hip dysplasia in Norwegian hospitals. MATERIAL AND METHOD An online questionnaire was sent to radiologists responsible for paediatric examinations at all hospitals with paediatric departments. INTERPRETATION Routines for screening, treatment and follow-up of hip dysplasia varied to a considerable degree between the hospitals.
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Affiliation(s)
- Lene Bjerke Laborie
- Radiologisk avdeling, seksjon for barn, Haukeland universitetssjukehus, og, Klinisk institutt 1, Universitetet i Bergen
| | - Claus Klingenberg
- Barne- og ungdomsavdelingen, Universitetssykehuset Nord-Norge, og, Institutt for klinisk medisin, UiT Norges arktiske universitet
| | - Hanne Rasmussen
- Ortopedisk avdeling, Universitetssykehuset Nord-Norge, Tromsø
| | - Trude Gundersen
- Ortopedisk avdeling, seksjon for barn, Haukeland universitetssjukehus, og, Klinisk institutt 1, Universitetet i Bergen
| | - Karen Rosendahl
- Røntgenavdelingen, seksjon for barn, Universitetssykehuset Nord-Norge, Tromsø, og, Forskningsgruppe for medisinsk avbildning, Institutt for klinisk medisin, UiT Norges arktiske universitet
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16
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Norman M, Padkaer Petersen J, Stensvold HJ, Thorkelsson T, Helenius K, Brix Andersson C, Ørum Cueto H, Domellöf M, Gissler M, Heino A, Håkansson S, Jonsson B, Klingenberg C, Lehtonen L, Metsäranta M, Rønnestad AE, Trautner S. Preterm birth in the Nordic countries-Capacity, management and outcome in neonatal care. Acta Paediatr 2023. [PMID: 36912750 DOI: 10.1111/apa.16753] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/07/2023] [Accepted: 03/09/2023] [Indexed: 03/14/2023]
Abstract
AIM Organisation of care, perinatal and neonatal management of very preterm infants in the Nordic regions were hypothesised to vary significantly. The aim of this observational study was to test this hypothesis. METHODS Information on preterm infants in the 21 greater healthcare regions of Denmark, Finland, Iceland, Norway and Sweden was gathered from national registers in 2021. Preterm birth rates, case-mix, perinatal interventions, neonatal morbidity and survival to hospital discharge in very (<32 weeks) and extremely preterm infants (<28 weeks of gestational age) were compared. RESULTS Out of 287 642 infants born alive, 16 567 (5.8%) were preterm, 2389 (0.83%) very preterm and 800 (0.28%) were extremely preterm. In very preterm infants, exposure to antenatal corticosteroids varied from 85% to 98%, live births occurring at regional centres from 48% to 100%, surfactant treatment from 28% to 69% and use of mechanical ventilation varied from 13% to 77% (p < 0.05 for all comparisons). Significant regional variations within and between countries were also seen in capacity in neonatal care, case-mix and number of admissions, whereas there were no statistically significant differences in survival or major neonatal morbidities. CONCLUSION Management of very preterm infants exhibited significant regional variations in the Nordic countries.
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Affiliation(s)
- Mikael Norman
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Jesper Padkaer Petersen
- The Danish Clinical Quality Program - National Clinical Registries (RKKP), Aarhus, Denmark
- Department of Paediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Hans Jørgen Stensvold
- Department of Neonatal Intensive Care, Clinic of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Thordur Thorkelsson
- Department of Neonatal Medicine, Children's Hospital Iceland, Landspitali University Hospital, Reykjavík, Iceland
| | - Kjell Helenius
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland
- Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Charlotte Brix Andersson
- The Danish Clinical Quality Program - National Clinical Registries (RKKP), Aarhus, Denmark
- Department of Obstetrics and Gynaecology, Aalborg University Hospital, Thisted, Denmark
| | - Heidi Ørum Cueto
- The Danish Clinical Quality Program - National Clinical Registries (RKKP), Aarhus, Denmark
| | - Magnus Domellöf
- Department of Clinical Sciences, Paediatrics, Umeå University, Umeå, Sweden
| | - Mika Gissler
- Department of Knowledge Brokers, THL Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Anna Heino
- Department of Knowledge Brokers, THL Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Stellan Håkansson
- Department of Clinical Sciences, Paediatrics, Umeå University, Umeå, Sweden
| | - Baldvin Jonsson
- Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Claus Klingenberg
- Paediatric Research Group, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway
- Department of Paediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Liisa Lehtonen
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland
- Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Marjo Metsäranta
- Department of Paediatrics, New Children's Hospital, Paediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Arild E Rønnestad
- Department of Neonatal Intensive Care, Clinic of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
- Medical Faculty, Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Simon Trautner
- The Danish Clinical Quality Program - National Clinical Registries (RKKP), Aarhus, Denmark
- Department of Intensive Care of Newborns and Small Children, University Hospital of Copenhagen, Copenhagen, Denmark
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17
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Vatne A, Hapnes N, Stensvold HJ, Dalen I, Guthe HJ, Støen R, Brigtsen AK, Rønnestad AE, Klingenberg C. Early Empirical Antibiotics and Adverse Clinical Outcomes in Infants Born Very Preterm: A Population-Based Cohort. J Pediatr 2023; 253:107-114.e5. [PMID: 36179887 DOI: 10.1016/j.jpeds.2022.09.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 09/15/2022] [Accepted: 09/22/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the association between empirical antibiotic therapy in the first postnatal week in uninfected infants born very preterm and the risk of adverse outcomes until discharge. STUDY DESIGN Population-based, nationwide registry study in Norway including all live-born infants with a gestational age <32 weeks surviving first postnatal week without sepsis, intestinal perforation, or necrotizing enterocolitis (NEC) between 2009 and 2018. Primary outcomes were severe NEC, death after the first postnatal week, and/or a composite outcome of severe morbidity (severe NEC, severe bronchopulmonary dysplasia [BPD], severe retinopathy of prematurity, late-onset sepsis, or cystic periventricular leukomalacia). The association between empirical antibiotics and adverse outcomes was assessed using multivariable logistic regression models, adjusting for known confounders. RESULTS Of 5296 live-born infants born very preterm, 4932 (93%) were included. Antibiotics were started in first postnatal week in 3790 of 4932 (77%) infants and were associated with higher aOR of death (aOR 9.33; 95% CI: 1.10-79.5, P = .041), severe morbidity (aOR 1.88; 95% CI: 1.16-3.05, P = .01), and severe BPD (aOR 2.17; 95% CI: 1.18-3.98; P = .012), compared with those not exposed. Antibiotics ≥ 5 days were associated with higher odds of severe NEC (aOR 2.27; 95% CI: 1.02-5.06; P = .045). Each additional day of antibiotics was associated with 14% higher aOR of death or severe morbidity and severe BPD. CONCLUSIONS Early and prolonged antibiotic exposure within the first postnatal week was associated with severe NEC, severe BPD, and death after the first postnatal week.
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Affiliation(s)
- Anlaug Vatne
- Paediatric Department, Stavanger University Hospital, Stavanger, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Nina Hapnes
- Paediatric Department, Stavanger University Hospital, Stavanger, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Hans Jørgen Stensvold
- Department of Neonatal Intensive Care, Clinic of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Ingvild Dalen
- Department of Research, Section of Biostatistics, Stavanger University Hospital, Stavanger, Norway
| | - Hans Jørgen Guthe
- Department of Paediatrics and Adolescents Medicine, Haukeland University Hospital, Bergen, Norway
| | - Ragnhild Støen
- Paediatric Department, St. Olav's University Hospital, Trondheim, Norway
| | - Anne Karin Brigtsen
- Department of Neonatal Intensive Care, Clinic of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Arild E Rønnestad
- Department of Neonatal Intensive Care, Clinic of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway; Medical faculty, Institute for clinical medicine, University of Oslo, Oslo, Norway
| | - Claus Klingenberg
- Paediatric Research Group, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway; Department of Pediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway.
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18
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Grodås KTM, Døllner H, Thaulow CM, Knudsen PK, Tønnessen A, Skeibrok M, Klingenberg C. Gentamicin serum concentration measurement in children. Tidsskr Nor Laegeforen 2023; 143:22-0238. [PMID: 36655955 DOI: 10.4045/tidsskr.22.0238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Gentamicin is often used to treat serious paediatric infections. It has been standard practice in Norway to measure the serum concentration of gentamicin immediately prior to the second or third dose (pre-dose [trough] concentration) to assess the risk of toxicity. The clinical significance of such measurements in children has not previously been evaluated in Norway. MATERIAL AND METHOD This is a retrospective study of routine pre-dose samples obtained for the measurement of serum gentamicin in paediatric patients aged 1 month to 17 years at four hospitals in Norway. Clinical data were extracted from electronic medical records from two of the hospitals. All children received treatment with intravenous gentamicin at a dose of 7 mg/kg once daily in accordance with Norwegian guidelines. RESULTS The most common indications for treatment were febrile urinary tract infection, febrile neutropenia, and suspected or confirmed sepsis. The median (interquartile range) duration of treatment in 353 episodes at two of the hospitals was 4 (3-5) days. Serum gentamicin pre-dose samples were analysed for 1,288 treatment episodes across four hospitals. In 1,223 episodes (95 %), the pre-dose sample showed a serum gentamicin concentration of less than 0.6 mg/L. In 7 episodes (0.5 %), the pre-dose sample showed an elevated gentamicin concentration, defined as greater than 1.0 mg/L. INTERPRETATION An in most cases mildly elevated serum gentamicin concentration was found in the pre-dose sample in 7 of 1,288 treatment episodes. Routine measurement of serum gentamicin via a pre-dose sample should in future be reserved for children receiving long-term gentamicin treatment, those with impaired kidney function, or those who are also receiving nephro- or ototoxic drugs.
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Affiliation(s)
| | - Henrik Døllner
- Barne- og ungdomsklinikken, St. Olavs hospital, og, Institutt for klinisk og molekylær medisin, Fakultet for medisin og helsevitenskap, NTNU
| | - Christian Magnus Thaulow
- Klinisk institutt II, Universitetet i Bergen, og, Barne- og ungdomsavdelingen, Haukeland universitetssjukehus
| | | | - Anders Tønnessen
- Det helsevitenskapelige fakultet, UiT Norges arktiske universitet
| | | | - Claus Klingenberg
- Barne- og ungdomsavdelingen, Universitetssykehuset Nord-Norge, og, Institutt for klinisk medisin, Det helsevitenskapelige fakultet, UiT Norges arktiske universitet
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Gjerstad AC, Skrunes R, Tøndel C, Åsberg A, Leh S, Klingenberg C, Døllner H, Hammarstrøm C, Bjerre AK. Kidney biopsy diagnosis in childhood in the Norwegian Kidney Biopsy Registry and the long-term risk of kidney replacement therapy: a 25-year follow-up. Pediatr Nephrol 2023; 38:1249-1256. [PMID: 35994104 PMCID: PMC9925570 DOI: 10.1007/s00467-022-05706-y] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/16/2022] [Accepted: 07/27/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is scarce information on biopsy-verified kidney disease in childhood and its progression to chronic kidney disease stage 5 (CKD 5). This study aims to review biopsy findings in children, and to investigate risk of kidney replacement therapy (KRT). METHODS We conducted a retrospective long-term follow-up study of children included in the Norwegian Kidney Biopsy Registry (NKBR) and in the Norwegian Renal Registry (NRR) from 1988 to 2021. RESULTS In total, 575 children with a median (interquartile range, IQR) age of 10.7 (6.1 to 14.1) years were included, and median follow-up time (IQR) after kidney biopsy was 14.3 (range 8.9 to 21.6) years. The most common biopsy diagnoses were minimal change disease (MCD; n = 92), IgA vasculitis nephritis (IgAVN; n = 76), IgA nephropathy (n = 63), and focal and segmental glomerulosclerosis (FSGS; n = 47). In total, 118 (20.5%) of the biopsied children reached CKD 5, median (IQR) time to KRT 2.3 years (7 months to 8.4 years). Most frequently, nephronophthisis (NPHP; n = 16), FSGS (n = 30), IgA nephropathy (n = 9), and membranoproliferative glomerulonephritis (MPGN; n = 9) led to KRT. CONCLUSIONS The risk of KRT after a kidney biopsy diagnosis is highly dependent on the diagnosis. None of the children with MCD commenced KRT, while 63.8% with FSGS and 100% with NPHP reached KRT. Combining data from kidney biopsy registries with registries on KRT allows for detailed information concerning the risk for later CKD 5 after biopsy-verified kidney disease in childhood. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Ann Christin Gjerstad
- Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.
| | - Rannveig Skrunes
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Camilla Tøndel
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Anders Åsberg
- The Norwegian Renal Registry, Oslo University Hospital - Rikshospitalet, Oslo, Norway
- Department of Transplantation Medicine, Oslo University Hospital - Rikshospitalet, Oslo, Norway
- Department of Pharmacy, University of Oslo, Oslo, Norway
| | - Sabine Leh
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - Claus Klingenberg
- Department of Pediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway
- Paediatric Research Group, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway
| | - Henrik Døllner
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Children's Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Clara Hammarstrøm
- Department of Pathology, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Anna Kristina Bjerre
- Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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20
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Klingenberg C. IgA-nefropati og behandling. Tidsskr Nor Laegeforen 2022; 142:22-0739. [PMID: 36511746 DOI: 10.4045/tidsskr.22.0739] [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: 12/14/2022] Open
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21
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Thaulow CM, Lindemann PC, Klingenberg C. Meticillinresistente gule stafylokokker i sårsekret hos barn. Tidsskriftet 2022; 142:22-0186. [DOI: 10.4045/tidsskr.22.0186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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22
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Giannoni E, Dimopoulou V, Klingenberg C, Navér L, Nordberg V, Berardi A, el Helou S, Fusch G, Bliss JM, Lehnick D, Guerina N, Seliga-Siwecka J, Maton P, Lagae D, Mari J, Janota J, Agyeman PKA, Pfister R, Latorre G, Maffei G, Laforgia N, Mózes E, Størdal K, Strunk T, Stocker M. Analysis of Antibiotic Exposure and Early-Onset Neonatal Sepsis in Europe, North America, and Australia. JAMA Netw Open 2022; 5:e2243691. [PMID: 36416819 PMCID: PMC9685486 DOI: 10.1001/jamanetworkopen.2022.43691] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
IMPORTANCE Appropriate use of antibiotics is life-saving in neonatal early-onset sepsis (EOS), but overuse of antibiotics is associated with antimicrobial resistance and long-term adverse outcomes. Large international studies quantifying early-life antibiotic exposure along with EOS incidence are needed to provide a basis for future interventions aimed at safely reducing neonatal antibiotic exposure. OBJECTIVE To compare early postnatal exposure to antibiotics, incidence of EOS, and mortality among different networks in high-income countries. DESIGN, SETTING, AND PARTICIPANTS This is a retrospective, cross-sectional study of late-preterm and full-term neonates born between January 1, 2014, and December 31, 2018, in 13 hospital-based or population-based networks from 11 countries in Europe and North America and Australia. The study included all infants born alive at a gestational age greater than or equal to 34 weeks in the participating networks. Data were analyzed from October 2021 to March 2022. EXPOSURES Exposure to antibiotics started in the first postnatal week. MAIN OUTCOMES AND MEASURES The main outcomes were the proportion of late-preterm and full-term neonates receiving intravenous antibiotics, the duration of antibiotic treatment, the incidence of culture-proven EOS, and all-cause and EOS-associated mortality. RESULTS A total of 757 979 late-preterm and full-term neonates were born in the participating networks during the study period; 21 703 neonates (2.86%; 95% CI, 2.83%-2.90%), including 12 886 boys (59.4%) with a median (IQR) gestational age of 39 (36-40) weeks and median (IQR) birth weight of 3250 (2750-3750) g, received intravenous antibiotics during the first postnatal week. The proportion of neonates started on antibiotics ranged from 1.18% to 12.45% among networks. The median (IQR) duration of treatment was 9 (7-14) days for neonates with EOS and 4 (3-6) days for those without EOS. This led to an antibiotic exposure of 135 days per 1000 live births (range across networks, 54-491 days per 1000 live births). The incidence of EOS was 0.49 cases per 1000 live births (range, 0.18-1.45 cases per 1000 live births). EOS-associated mortality was 3.20% (12 of 375 neonates; range, 0.00%-12.00%). For each case of EOS, 58 neonates were started on antibiotics and 273 antibiotic days were administered. CONCLUSIONS AND RELEVANCE The findings of this study suggest that antibiotic exposure during the first postnatal week is disproportionate compared with the burden of EOS and that there are wide (up to 9-fold) variations internationally. This study defined a set of indicators reporting on both dimensions to facilitate benchmarking and future interventions aimed at safely reducing antibiotic exposure in early life.
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Affiliation(s)
- Eric Giannoni
- Clinic of Neonatology, Department Mother-Woman-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Varvara Dimopoulou
- Clinic of Neonatology, Department Mother-Woman-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Claus Klingenberg
- Paediatric Research Group, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway
- Department of Pediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Lars Navér
- Department of Neonatology, Karolinska University Hospital and Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Viveka Nordberg
- Department of Neonatology, Karolinska University Hospital and Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Alberto Berardi
- Neonatal Intensive Care Unit, Mother and Child Department, Policlinico University Hospital, Modena, Italy
| | - Salhab el Helou
- Division of Neonatology, Department of Pediatrics, McMaster Children’s Hospital, McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Gerhard Fusch
- Division of Neonatology, Department of Pediatrics, McMaster Children’s Hospital, McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Joseph M. Bliss
- Department of Pediatrics, Women & Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University, Providence
| | - Dirk Lehnick
- Biostatistics and Methodology, CTU-CS, Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Nicholas Guerina
- Department of Pediatrics, Women & Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University, Providence
| | - Joanna Seliga-Siwecka
- Department of Neonatology and Neonatal Intensive Care, Medical University of Warsaw, Warsaw, Poland
| | - Pierre Maton
- Service Néonatal, Clinique CHC-Montlegia, Groupe Santé CHC, Liège, Belgium
| | - Donatienne Lagae
- Neonatology and Neonatal Intensive Care Unit, CHIREC-Delta Hospital, Brussels, Belgium
| | - Judit Mari
- Department of Paediatrics, University of Szeged, Szeged, Hungary
| | - Jan Janota
- Neonatal Unit, Department of Obstetrics and Gynecology, Motol University Hospital Prague, Prague, Czech Republic
- Department of Pathological Physiology, 1st Medical School, Charles University Prague, Prague, Czech Republic
- Department of Neonatology, Thomayer University Hospital Prague, Prague, Czech Republic
| | - Philipp K. A. Agyeman
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Riccardo Pfister
- Neonatology and Paediatric Intensive Care Unit, Geneva University Hospitals and Geneva University, Geneva, Switzerland
| | - Giuseppe Latorre
- Neonatology and Neonatal Intensive Care Unit, Ecclesiastical General Hospital F. Miulli, Acquaviva delle Fonti, Italy
| | - Gianfranco Maffei
- Neonatology and Neonatal Intensive Care Unit, Policlinico Riuniti Foggia, Foggia, Italy
| | - Nicola Laforgia
- Neonatologia e Terapia Intensiva Neonatale, University of Bari, Bari, Italy
| | - Enikő Mózes
- Perinatal Intensive Care Unit, Department of Obstetrics and Gynaecology, Semmelweis University, Budapest, Hungary
| | - Ketil Størdal
- Institute of Clinical Medicine, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Tobias Strunk
- Neonatal Directorate, Child and Adolescent Health Service, King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Martin Stocker
- Department of Pediatrics, Children’s Hospital Lucerne, Lucerne, Switzerland
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van Veenendaal NR, Labrie NH, Mader S, van Kempen AAMW, van der Schoor SRD, van Goudoever JB, Bertino E, Bhojnagarwala B, Bodrogi E, Bohlin K, Bracht M, Bührer C, Domellöf M, Embleton N, Endl C, Ertl T, Funke S, Gangi S, Garg S, Guimarães H, Haiden N, Koskinen E, Klingenberg C, Klisch O, Kobberup H, Kovalova OM, Krolak‐Olejnik B, Lapillonne A, Lee S, Lehtonen L, McKechnie L, Mimoso G, Molloy E, Moltu SJ, Mulder AL, Nádor C, Normann E, O'Brien K, Van Overmeire B, Pavlyshyn H, Pellicer A, Picaud J, Poets CF, Rabe H, Ryan E, Sadowska‐Krawczenko I, Salvesen B, Sanakova P, Sarapuk I, Schuler R, Senterre T, Strola P, Thomas M, Vento M, Voloshko V, Weis J, Wiedermannová H, Zabakas K. An international study on implementation and facilitators and barriers for parent‐infant closeness in neonatal units. Pediatr Investig 2022; 6:179-188. [PMID: 36203512 PMCID: PMC9523817 DOI: 10.1002/ped4.12339] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 05/31/2022] [Indexed: 11/11/2022] Open
Abstract
Importance Parent‐infant closeness and active parent participation in neonatal care are important for parent and infant health. Objective To give an overview of current neonatal settings and gain an in‐depth understanding of facilitators and barriers to parent‐infant closeness, zero‐separation, in 19 countries. Methods Neonatal intensive care unit (NICU) professionals, representing 45 NICUs from a range of geographic regions in Europe and Canada, were purposefully selected and interviewed June–December 2018. Thematic analysis was conducted to identify, analyze and report patterns (themes) for parent‐infant closeness across the entire series of interviews. Results Parent‐infant separation during infant and/or maternity care is very common (42/45 units, 93%), despite the implementation of family integrated care (FICare) practices, including parent participation in medical rounds (17/45, 38%), structured education sessions for parents (16/45, 36%) and structured training for healthcare professionals (22/45, 49%). NICU professionals encountered four main themes with facilitators and barriers for parent‐infant closeness on and between the hospital, unit, staff, and family level: Culture (jointly held characteristics, values, thinking and behaviors about parental presence and participation in the unit), Collaboration (the act of working together between and within different levels), Capacities (resources and policies), and Coaching (education to acquire and transfer knowledge and skills). Interpretation Implementing parent‐infant closeness in the NICU is still challenging for healthcare professionals. Further optimization in neonatal care towards zero‐separation and parent‐infant closeness can be achieved by enforcing the ‘four Cs for Closeness’: Culture, Collaboration, Capacities, and Coaching.
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Affiliation(s)
- Nicole R. van Veenendaal
- Department of Pediatrics and Neonatology OLVG Amsterdam The Netherlands
- Amsterdam UMC, location Vrije Universiteit and location University of Amsterdam Department of Pediatrics, Emma Children's Hospital Amsterdam The Netherlands
| | - Nanon H.M. Labrie
- Department of Pediatrics and Neonatology OLVG Amsterdam The Netherlands
- Department of Language, Literature and Communication Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Silke Mader
- European Foundation for Care of Newborn Infants Munich Germany
| | | | | | - Johannes B. van Goudoever
- Amsterdam UMC, location Vrije Universiteit and location University of Amsterdam Department of Pediatrics, Emma Children's Hospital Amsterdam The Netherlands
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24
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Achten NB, Plötz FB, Klingenberg C, Stocker M, Bokelaar R, Bijlsma M, Giannoni E, van Rossum AMC, Benitz WE. Erratum to Stratification of Culture-Proven Early-Onset Sepsis Cases by the Neonatal Early-Onset Sepsis Calculator: An Individual Patient Data Meta-Analysis [The Journal of Pediatrics 234(2021):77-84]. J Pediatr 2022; 247:184-189. [PMID: 35752464 DOI: 10.1016/j.jpeds.2022.05.050] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Niek B Achten
- Department of Pediatrics, Tergooi Hospital, Blaricum, The Netherlands; Faculty of Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands; Department of Pediatrics, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Frans B Plötz
- Department of Pediatrics, Tergooi Hospital, Blaricum, The Netherlands; Faculty of Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Claus Klingenberg
- Department of Pediatrics and Adolescent Medicine, University Hospital of North Norway, Tromsø, Norway; Pediatric Research Group, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway
| | - Martin Stocker
- Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Robin Bokelaar
- Department of Pediatrics, Tergooi Hospital, Blaricum, The Netherlands
| | - Merijn Bijlsma
- Departments of Neurology and General Pediatrics, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Eric Giannoni
- Department Woman-Mother-Child, Clinic of Neonatology, Lausanne University Hospital, Lausanne, Switzerland
| | - Annemarie M C van Rossum
- Department of Pediatrics, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - William E Benitz
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
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Ohnstad MO, Stensvold HJ, Pripp AH, Tvedt CR, Jelsness-Jørgensen LP, Astrup H, Eriksen BH, Klingenberg C, Mreihil K, Pedersen T, Rettedal S, Selberg TR, Solberg R, Støen R, Rønnestad AE. Predictors of extubation success: a population-based study of neonates below a gestational age of 26 weeks. BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2022-001542. [PMID: 36053650 PMCID: PMC9367191 DOI: 10.1136/bmjpo-2022-001542] [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: 05/11/2022] [Accepted: 07/19/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The aim of the study was to investigate first extubation attempts among extremely premature (EP) infants and to explore factors that may increase the quality of clinical judgement of extubation readiness. DESIGN AND METHOD A population-based study was conducted to explore first extubation attempts for EP infants born before a gestational age (GA) of 26 weeks in Norway between 1 January 2013 and 31 December 2018. Eligible infants were identified via the Norwegian Neonatal Network database. The primary outcome was successful extubation, defined as no reintubation within 72 hours after extubation. RESULTS Among 482 eligible infants, 316 first extubation attempts were identified. Overall, 173 (55%) infants were successfully extubated, whereas the first attempt failed in 143 (45%) infants. A total of 261 (83%) infants were extubated from conventional ventilation (CV), and 55 (17%) infants were extubated from high-frequency oscillatory ventilation (HFOV). In extubation from CV, pre-extubation fraction of inspired oxygen (FiO2) ≤0.35, higher Apgar score, higher GA, female sex and higher postnatal age were important predictors of successful extubation. In extubation from HFOV, a pre-extubation FiO2 level ≤0.35 was a relevant predictor of successful extubation. CONCLUSIONS The correct timing of extubation in EP infants is important. In this national cohort, 55% of the first extubation attempts were successful. Our results suggest that additional emphasis on oxygen requirement, sex and general condition at birth may further increase extubation success when clinicians are about to extubate EP infants for the first time.
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Affiliation(s)
- Mari Oma Ohnstad
- Department for Postgraduate Studies, Lovisenberg Diaconal University College, Oslo, Norway .,Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway
| | - Hans Jørgen Stensvold
- Department of Neonatal Intensive Care, Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.,Norwegian Neonatal Network, Oslo University Hospital, Oslo, Norway
| | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo, Norway.,Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Christine Raaen Tvedt
- Department for Postgraduate Studies, Lovisenberg Diaconal University College, Oslo, Norway
| | - Lars-Petter Jelsness-Jørgensen
- Department for Postgraduate Studies, Lovisenberg Diaconal University College, Oslo, Norway.,Department of Health and Welfare, Østfold University College, Halden, Norway.,Department of Internal Medicine, Østfold Hospital Trust, Kalnes, Norway
| | - Henriette Astrup
- Department of Pediatric and Adolescent Medicine, Sorlandet Hospital Trust, Kristiansand, Norway
| | - Beate Horsberg Eriksen
- Department of Paediatrics, Møre og Romsdal Hospital Trust, Alesund, Norway.,Clinical Research Unit, Norwegian University of Science and Technology, Trondheim, Norway
| | - Claus Klingenberg
- Faculty of Health Sciences, University of Tromsø, Tromso, Norway.,Department of Pediatrics, University Hospital of North Norway, Tromso, Norway
| | - Khalaf Mreihil
- Department of Pediatric and Adolescent Medicine, Akershus University Hospital, Lorenskog, Norway
| | - Tanja Pedersen
- Neonatal Intensive Care Unit, Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Siren Rettedal
- Department of Paediatrics, Stavanger University Hospital, Stavanger, Norway.,Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Terje Reidar Selberg
- Department of Pediatric and Adolescent Medicine, Ostfold County Hospital, Gralum, Norway
| | - Rønnaug Solberg
- Department of Paediatrics, Vestfold Hospital Trust, Tonsberg, Norway.,Department of Paediatric Research, Oslo University Hospital, Oslo, Norway
| | - Ragnhild Støen
- Department of Paediatrics, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway.,Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Arild E Rønnestad
- Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway.,Department of Neonatal Intensive Care, Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.,Norwegian Neonatal Network, Oslo University Hospital, Oslo, Norway.,Research group for clinical neonatal medicine and epidemiology, Institute of clinical medicine, Oslo, Norway
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26
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Reigstad H, Hufthammer KO, Rønnestad AE, Klingenberg C, Stensvold HJ, Markestad T. Early surfactant and non-invasive ventilation versus intubation and surfactant: a propensity score-matched national study. BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2022-001527. [PMID: 36053649 PMCID: PMC9335034 DOI: 10.1136/bmjpo-2022-001527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/23/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To compare outcome after less invasive surfactant administration (LISA) and primary endotracheal intubation (non-LISA) in infants born before gestational age (GA) 28 weeks. SETTING All neonatal intensive care units (NICUs) in Norway during 2012-2018. METHODS Defined population-based data were prospectively entered into a national registry. We compared LISA infants with all non-LISA infants and with non-LISA infants who received surfactant following intubation. We used propensity score (PS) matching to identify non-LISA infants who were similar regarding potential confounders. MAIN OUTCOME VARIABLES Rate and duration of mechanical ventilation (MV), survival, neurological and gastrointestinal morbidity, and need of supplemental oxygen or positive pressure respiratory support at postmenstrual age (PMA) 36 and 40 weeks. RESULTS We restricted analyses to GA 25-27 weeks (n=843, 26% LISA) because LISA was rarely used at lower GAs. There was no significant association between NICUs regarding proportions treated with LISA and proportions receiving MV. In the PS-matched datasets, fewer LISA infants received MV (61% vs 78%, p<0.001), and they had fewer days on MV (mean difference 4.1, 95% CI 0.0 to 8.2 days) and lower mortality at PMA 40 weeks (absolute difference 6%, p=0.06) compared with all the non-LISA infants, but only a lower rate of MV (64% vs 97%, p<0.001) and fewer days on MV (mean difference 5.8, 95% CI 0.6 to 10.9 days) compared with non-LISA infants who received surfactant after intubation. CONCLUSION LISA reduced the rate and duration of MV but had no other clear benefits.
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Affiliation(s)
- Hallvard Reigstad
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | | | - Arild E Rønnestad
- Women and Children's division, Department of Neonatal Intensive Care, Rikshospitalet, Oslo Universitetssykehus, Oslo, Norway.,Norwegian Neonatal Network, Rikshospitalet University Hospital, Oslo, Norway
| | - Claus Klingenberg
- Department of Paediatrics, University Hospital of North Norway, Tromso, Norway.,Pediatric Research Group, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Hans Jørgen Stensvold
- Neonatal Department, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Trond Markestad
- Department of Clinical Science, Universitetet i Bergen Det medisinske fakultet, Bergen, Norway.,Department of Research, Innlandet Hospital Trust, Brumunddal, Norway
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Berisha G, Solberg R, Klingenberg C, Solevåg AL. Neonatal Impedance Cardiography in Asphyxiated Piglets-A Feasibility Study. Front Pediatr 2022; 10:804353. [PMID: 35281226 PMCID: PMC8913887 DOI: 10.3389/fped.2022.804353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/26/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Impedance cardiography (ICG) is a non-invasive method for continuous cardiac output measurement and has the potential to improve monitoring and treatment of sick neonates. PhysioFlow® is a signal-morphology ICG-system showing promising results in adults with low and high cardiac output, but no data from neonates or neonatal models exist. The aim of this study was to investigate PhysioFlow® feasibility in asphyxiated newborn piglets. METHODS Fifteen piglets, under continuous arterial heart rate (HR) and blood pressure (BP) monitoring, were asphyxiated until asystole. Cardiopulmonary resuscitation was performed and the piglets monitored after return of spontaneous circulation (ROSC). Arterial lactate was measured at baseline, every 5 min throughout asphyxiation, at asystole, and at 10 min and later every 30 min after ROSC. PhysioFlow® measured cardiac stroke volume (SV) and HR, and calculated cardiac index (CI) (L/m2/min). Registrations with a signal quality < 75% were excluded, and registrations recorded for 30 min from start of asphyxia analyzed. Pearson correlations were calculated for CI; and HR, mean BP and blood lactate. RESULTS The piglets were asphyxiated for median (interquartile range) 30 (20-35) min and had a lactate at asystole of 15.0 (9.1-17.0) mmol/L. Out of a total of 20.991 registrations in all animals combined, there were 10.148 (48.3%) registrations with a signal quality ≥ 75%. Signal quality ≥ 75% varied in individual piglets from 7 to 82% of registrations. We analyzed 1.254 registrations recorded 30 min from initiation of asphyxia, i.e., in piglets with brief asphyxia times, this included cardiopulmonary resuscitation and post-ROSC observation. There was a positive correlation between CI and SVI (r = 0.90, p < 0.001), and between CI and HR (r = 0.446, p < 0.001). There was no correlation between CI, or mean BP or lactate (p = 0.98 and 0.51, respectively). CONCLUSION About half of ICG-registrations in asphyxiated piglets were of good quality. However, signal quality was highly variable between piglets. In total, there was a higher proportion of reliable ICG-registrations than reported from clinical delivery room studies using electrical velocimetry. Our data are physiologically plausible and supports further research evaluating PhysioFlow® for cardiac output monitoring in perinatal asphyxia. In particular, factors influencing inter-individual variations in signal quality should be explored.
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Affiliation(s)
- Gazmend Berisha
- Department of Paediatric and Adolescent Medicine, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Rønnaug Solberg
- Department of Pediatric Research, Institute of Surgical Research, Oslo University Hospital Rikshospitalet, University of Oslo, Oslo, Norway.,Department of Pediatrics, Vestfold Hospital Trust, Tønsberg, Norway
| | - Claus Klingenberg
- Department of Paediatrics, University Hospital of North Norway, Tromsø, Norway.,Paediatric Research Group, Department of Clinical Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Anne Lee Solevåg
- Department of Paediatric and Adolescent Medicine, Oslo University Hospital, Nydalen, Norway
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Abstract
OBJECTIVES We aimed to study whether national and local antibiotic stewardship projects have reduced the antibiotic use in newborns and to monitor potential changes in adverse outcomes. METHODS In a nationwide, population-based study from Norway, we included all hospital live births from 34 weeks' gestation (n = 282 046) during 2015 to 2019. The primary outcome was the proportion of newborns treated with antibiotics from 0 to 28 days after birth. The secondary outcomes were the overall duration of antibiotic treatment and by categories: culture-positive sepsis, clinical sepsis, and no sepsis. RESULTS A total of 7365 (2.6%) newborns received intravenous antibiotics during the period, with a reduction from 3.1% in 2015 to 2.2% in 2019 (30% decrease; P < .001). Hospitals with antibiotic stewardship projects experienced the largest reduction (48% vs 23%; P < .001). We found a small decrease in the median duration of antibiotic treatment in newborns without sepsis from 2.93 to 2.66 days (P = .011), and geographical variation was reduced during the study period. The overall number of days with antibiotic treatments was reduced by 37% from 2015 to 2019 (119.1 of 1000 vs 75.6 of 1000; P < .001). Sepsis was confirmed by blood culture in 206 newborns (incidence rate: 0.73 cases per 1000 live births). We found no increase in sepsis with treatment onset >72 hours of life, and sepsis-attributable deaths remained at a low level. CONCLUSIONS During the study period, a substantial decrease in the proportion of newborns treated with antibiotics was observed together with a decline in treatment duration for newborns without culture-positive sepsis.
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Affiliation(s)
| | - Arild Rønnestad
- NICU, Clinic of Pediatric and Adolescent Medicine.,Neonatal Clinical and Epidemiological Research Group, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine
| | - Claus Klingenberg
- Paediatric Research Group, Faculty of Health Sciences, University of Tromsø-The Arctic University of Norway, Tromsø, Norway.,Department of Paediatrics, University Hospital of North Norway, Tromsø, Norway
| | - Hans Jørgen Stensvold
- NICU, Clinic of Pediatric and Adolescent Medicine.,Neonatal Clinical and Epidemiological Research Group, Oslo University Hospital, Oslo, Norway
| | - Ketil Størdal
- NICU, Clinic of Pediatric and Adolescent Medicine.,Pediatric Research Institute, Faculty of Medicine, University of Oslo, Oslo, Norway
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Stefferud MJ, Einang AG, Klingenberg C. Parents of children with Down syndrome and their experiences with the healthcare services. Tidsskr Nor Laegeforen 2021; 141:21-0024. [PMID: 34597006 DOI: 10.4045/tidsskr.21.0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Children and adolescents with Down syndrome have a comprehensive need for follow-up in the primary and specialist healthcare services. MATERIAL AND METHOD In June 2019, we published a questionnaire on the Facebook group of the Norwegian Network for Down syndrome. The purpose was to investigate user experiences among parents of children and adolescents with Down syndrome in the age group 0-20 years, in their encounter with the healthcare services. RESULTS We received 174 responses. Those most satisfied were parents of children who received follow-up for secondary diagnoses such as vision problems, heart defects and endocrine disorders. Those least satisfied were parents of children with problems associated with behaviour, sleep and puberty. Approximately 6 out of 10 parents reported no negative experiences in their encounter with the healthcare services, but 29/161 (18 %) reported that the diagnosis of Down syndrome had contributed to treatment failure by the paediatrician or in the child rehabilitation service. INTERPRETATION The study indicates a need for improved follow-up of children and adolescents with Down syndrome, both in the primary and specialist healthcare services.
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Haack J, Hauck C, Klingenberg C, Pirner M, Warnecke S. A Consistent BGK Model with Velocity-Dependent Collision Frequency for Gas Mixtures. J Stat Phys 2021; 184:31. [PMID: 34720185 PMCID: PMC8549943 DOI: 10.1007/s10955-021-02821-2] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 09/03/2021] [Indexed: 06/13/2023]
Abstract
We derive a multi-species BGK model with velocity-dependent collision frequency for a non-reactive, multi-component gas mixture. The model is derived by minimizing a weighted entropy under the constraint that the number of particles of each species, total momentum, and total energy are conserved. We prove that this minimization problem admits a unique solution for very general collision frequencies. Moreover, we prove that the model satisfies an H-Theorem and characterize the form of equilibrium.
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Affiliation(s)
- J. Haack
- Los Alamos National Laboratory, Los Alamos, NM 87545 USA
| | - C. Hauck
- Oak Ridge National Laboratory, 1 Bethel Valley Road, Bldg. 5700, Oak Ridge, TN 37831-6164 USA
| | - C. Klingenberg
- Universität Würzburg, Emil-Fischer-Str. 40, 97074 Würzburg, Germany
| | - M. Pirner
- Universität Würzburg, Emil-Fischer-Str. 40, 97074 Würzburg, Germany
| | - S. Warnecke
- Universität Würzburg, Emil-Fischer-Str. 40, 97074 Würzburg, Germany
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Bjerkhaug AU, Granslo HN, Klingenberg C. Metabolic responses in neonatal sepsis-A systematic review of human metabolomic studies. Acta Paediatr 2021; 110:2316-2325. [PMID: 33851423 DOI: 10.1111/apa.15874] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 04/09/2021] [Indexed: 12/17/2022]
Abstract
AIM To systematically review human metabolomic studies investigating metabolic responses in septic neonates. METHODS A systematic literature search was performed in the databases MEDLINE, EMBASE and Cochrane library up to the 1st of January 2021. We included studies that assessed neonatal sepsis and the following outcomes; (1) change in the metabolism compared to healthy neonates and/or (2) metabolomics compared to traditional diagnostic tools of neonatal sepsis. The screened abstracts were independently considered for eligibility by two researchers. PROSPERO ID CRD42020164454. RESULTS The search identified in total 762 articles. Fifteen articles were assessed for eligibility. Four studies were included, with totally 78 neonates. The studies used different diagnostic criteria and had between 1 and 16 sepsis cases. All studies with bacterial sepsis found alterations in the glucose and lactate metabolism, reflecting possible redistribution of glucose consumption from mitochondrial oxidative phosphorylation to the lactate and pentose phosphate pathway. We also found signs of increased oxidative stress and fatty acid oxidation in sepsis cases. CONCLUSION We found signs of metabolomic signatures in neonatal sepsis. This may lead to better understanding of sepsis pathophysiology and detection of new candidate biomarkers. Results should be validated in large-scale multicentre studies.
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Affiliation(s)
- Aline U. Bjerkhaug
- Paediatric Research Group Faculty of Health Sciences UiT‐The Arctic University of Norway Tromsø Norway
| | - Hildegunn Norbakken Granslo
- Paediatric Research Group Faculty of Health Sciences UiT‐The Arctic University of Norway Tromsø Norway
- Department of Paediatrics and Adolescence Medicine University Hospital of North Norway Tromsø Norway
| | - Claus Klingenberg
- Paediatric Research Group Faculty of Health Sciences UiT‐The Arctic University of Norway Tromsø Norway
- Department of Paediatrics and Adolescence Medicine University Hospital of North Norway Tromsø Norway
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Johnsen M, Klingenberg C, Brand M, Revhaug A, Andreassen G. Antenatal breastmilk expression for women with diabetes in pregnancy - a feasibility study. Int Breastfeed J 2021; 16:56. [PMID: 34301285 PMCID: PMC8299162 DOI: 10.1186/s13006-021-00393-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 10/20/2020] [Accepted: 06/08/2021] [Indexed: 11/10/2022] Open
Abstract
Background Mothers with diabetes are less likely to achieve successful breastfeeding. Antenatal breastmilk expression (ABE) may facilitate earlier breastfeeding, but feasibility of introducing ABE and its acceptance among Scandinavian women have previously not been investigated. Methods This observational trial was conducted between the 1 January 2019 and the 12 March 2020 in Tromsø, Norway. We aimed to determine the feasibility of ABE in terms of practicality and acceptability among women with medically (metformin or insulin) treated diabetes. Women were invited to participate during antenatal visits from 32 weeks gestation. Participants received instruction and started ABE from gestation week 37 + 0. Participants, and their infants, were followed until 6–8 weeks after birth. We collected data on breastfeeding rates, infant hypoglycemia, transfer to the neonatal unit, and the women’s overall experience and satisfaction with antenatal breastmilk expression. Results Twenty-eight of 34 (82%) invited women consented to participate. All started ABE from week 37 + 0, and continued until hospital admission. No women reported any discomfort or side effects. Labor was induced at 38 weeks gestation. Twenty-four women brought harvested colostrum to the maternity ward, which was given to their infants during the first 24 h of life. Breastfeeding rates at discharge were 24/28 (86%) and 21/27 (78%) at 6–8 weeks after delivery. Seven (25%) infants were transferred to the neonatal unit; four because of hypoglycemia. Maternal satisfaction assessed 6–8 weeks after delivery revealed that all participants felt positive about the ABE, but one woman would not recommend it to other pregnant women. Conclusions Implementing a structured ABE guideline for women with medically treated diabetes was feasible. The intervention was associated with high level of satisfaction among study participants. No obvious side effects were observed, and breastfeeding rates at discharge and 6–8 weeks after delivery were higher than in comparable studies. Trial registration The study was registered at the research study registry at the University Hospital of North Norway (Nr 2018/7181).
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Affiliation(s)
- Maren Johnsen
- Department of Obstetrics and Gynecology, Division of Surgery, Oncology and Women's Health, University Hospital of North Norway, Tromsø, Norway.
| | - Claus Klingenberg
- Paediatric Research Group, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway.,Department of Paediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Meta Brand
- Department of Obstetrics and Gynecology, Division of Surgery, Oncology and Women's Health, University Hospital of North Norway, Tromsø, Norway
| | - Arthur Revhaug
- Department of Digestive Surgery, Institute of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway.,Division of Surgery, Oncology and Women's Health, University Hospital North Norway, Tromsø, Norway
| | - Gunnbjørg Andreassen
- Department of Obstetrics and Gynecology, Division of Surgery, Oncology and Women's Health, University Hospital of North Norway, Tromsø, Norway
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Thaulow CM, Lindemann PC, Klingenberg C. Antibiotic resistance in paediatric UTIs in Norway. Tidsskr Nor Laegeforen 2021; 141:20-0889. [PMID: 34182746 DOI: 10.4045/tidsskr.20.0889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Urinary tract infections are common in children. The purpose of this study was to describe national resistance data from urinary isolates from children with a view to informing antibiotic use. METHOD We conducted an observational study based on culture responses with resistance determination in urine from the Norwegian Surveillance System for Antimicrobial Drug Resistance (NORM). All urinary isolates from children (0-17 years) in the period 2013-17 were included and compared with urinary isolates from adults. For cephalexin resistance, we used data from two Norwegian hospitals covering the period 2015-19. RESULTS Of 13 211 urinary isolates included in the NORM register, 589 (4.5 %) were from children. Weighted by the number of data collection days, Escherichia coli accounted for 85.2 % of the isolates from children. For E. coli, there was a higher proportion of trimethoprim resistance in urine samples from children (27.0 %) compared to adults (22.9 %), p = 0.02. For ciprofloxacin, we found a lower resistance rate in E. coli in urine samples from children (5.7 %) compared to adults (8.7 %), p = 0.03. For other selected antibiotics, we found the following resistance rates in E. coli in children: nitrofurantoin (0.5 %), mecillinam (4.0 %), cephalexin (4.3 %), amoxicillin-clavulanic acid (7.2 %) and trimethoprim-sulfamethoxazole (24.1 %). INTERPRETATION Pivmecillinam, cephalexin and amoxicillin-clavulanic acid are relevant choices in the empirical treatment of upper urinary tract infections. Nitrofurantoin and pivmecillinam are relevant for lower urinary tract infections. Trimethoprim and trimethoprim-sulfamethoxazole should only be used after resistance determination.
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Holte K, Ersdal H, Klingenberg C, Eilevstjønn J, Stigum H, Jatosh S, Kidanto H, Størdal K. Expired carbon dioxide during newborn resuscitation as predictor of outcome. Resuscitation 2021; 166:121-128. [PMID: 34098031 DOI: 10.1016/j.resuscitation.2021.05.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/26/2021] [Accepted: 05/17/2021] [Indexed: 11/30/2022]
Abstract
AIM To explore and compare expired CO2 (ECO2) and heart rate (HR), during newborn resuscitation with bag-mask ventilation, as predictors of 24-h outcome. METHODS Observational study from March 2013 to June 2017 in a rural Tanzanian hospital. Side-stream measures of ECO2, ventilation parameters, HR, clinical information, and 24-h outcome were recorded in live born bag-mask ventilated newborns with initial HR < 120 bpm. We analysed the data using logistic regression models and compared areas under the receiver operating curves (AUC) for ECO2 and HR within three selected time intervals after onset of ventilation (0-30 s, 30.1-60 s and 60.1-300 s). RESULTS Among 434 included newborns (median birth weight 3100 g), 378 were alive at 24 h, 56 had died. Both ECO2 and HR were independently significant predictors of 24-h outcome, with no differences in AUCs. In the first 60 s of ventilation, ECO2 added extra predictive information compared to HR alone. After 60 s, ECO2 lost significance when adjusted for HR. In 70% of newborns with initial ECO2 <2% and HR < 100 bpm, ECO2 reached ≥2% before HR ≥ 100 bpm. Survival at 24 h was reduced by 17% per minute before ECO2 reached ≥2% and 44% per minute before HR reached ≥100 bpm. CONCLUSIONS Higher levels and a faster rise in ECO2 and HR during newborn resuscitation were independently associated with improved survival compared to persisting low values. ECO2 increased before HR and may serve as an earlier predictor of survival.
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Affiliation(s)
- Kari Holte
- Department of Paediatrics and Adolescence Medicine, Østfold Hospital Trust, Norway; Faculty of Health Sciences, University of Stavanger, Norway.
| | - Hege Ersdal
- Faculty of Health Sciences, University of Stavanger, Norway; Critical Care and Anaesthesiology Research Group, Stavanger University Hospital, Norway
| | - Claus Klingenberg
- Department of Paediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway; Paediatric Research Group, Faculty of Health Sciences, University of Tromsø - Arctic University of Norway, Tromsø, Norway
| | - Joar Eilevstjønn
- Strategic Research Department, Laerdal Medical, Stavanger, Norway
| | - Hein Stigum
- Norwegian Institute of Public Health, Oslo, Norway
| | | | - Hussein Kidanto
- Medical College, Agakhan University, Dar es Salaam, Tanzania
| | - Ketil Størdal
- Department of Paediatrics and Adolescence Medicine, Østfold Hospital Trust, Norway; Norwegian Institute of Public Health, Oslo, Norway; Department of Paediatric Research, Faculty of Medicine, University of Oslo, Norway
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Hemmingsen D, Stenklev NC, Klingenberg C. Extended high frequency audiometry thresholds in healthy school children. Int J Pediatr Otorhinolaryngol 2021; 144:110686. [PMID: 33838463 DOI: 10.1016/j.ijporl.2021.110686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 12/21/2020] [Revised: 02/15/2021] [Accepted: 03/18/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Extended high frequency (EHF) audiometry is the recommended method for monitoring oxotoxic hearing loss in children. This study aims to provide high quality reference audiological data for the EHF range in healthy children. METHODS Participants were 126 healthy schoolchildren between 6 and 14 years of age. All participants were term born with normal birthweight, had not suffered severe neonatal illness and had no history of middle ear disease. RESULTS The averaged mean (SD) hearing threshold for the EHF 9, 10, 11.2, 12.5, 14 and 16 kHz was -0.4 (6.0) dB HL. The lowest mean hearing thresholds were observed at 14 kHz with -4.2 (8.7) dB and at 16 kHz with -6.4 (12.1) dB HL. We found significantly lower thresholds at 16 kHz for children aged 6-9 years (-8.7 dB HL) compared to age 10-14 years (-3.9 db HL), p 0.042. For both age groups the inter-subject variability increased in the highest frequencies. We found no significant differences in mean hearing thresholds between right and left ears at any frequency, and no gender differences in the EHF range. CONCLUSION Our findings support that decreased hearing sensitivity in the EHF's may start around or even before the age of 10 years. In order to use EHF audiometry for ototoxic monitoring in children, we suggest to establish an international reference standard for hearing levels in children under the age of 18. Specific references for different age groups are needed as hearing in the EHF range appears to gradually deteriorate from an early age. CLINICAL TRIAL REGISTRATION NCT03253614.
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Affiliation(s)
- Dagny Hemmingsen
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of North Norway, 9038 Tromsø, Norway; Paediatric Research Group, Faculty of Health Sciences, University of Tromsø-Arctic University of Norway, Postboks 6050 Langnes, 9037, Tromsø, Norway.
| | | | - Claus Klingenberg
- Paediatric Research Group, Faculty of Health Sciences, University of Tromsø-Arctic University of Norway, Postboks 6050 Langnes, 9037, Tromsø, Norway; Department of Paediatrics and Adolescence Medicine, University Hospital of North Norway, 9038 Tromsø, Norway.
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Kuwelker K, Langeland N, Löhr IH, Gidion J, Manyahi J, Moyo SJ, Blomberg B, Klingenberg C. Use of probiotics to reduce infections and death and prevent colonization with extended-spectrum beta-lactamase (ESBL)-producing bacteria among newborn infants in Tanzania (ProRIDE Trial): study protocol for a randomized controlled clinical trial. Trials 2021; 22:312. [PMID: 33926519 PMCID: PMC8082054 DOI: 10.1186/s13063-021-05251-3] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 04/07/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) has emerged as an urgent global health threat and is by the World Health Organization ranked as priority 1 among pathogens in need of new treatment. Studies have shown high mortality in Tanzanian children with ESBL-E infections. Gut colonization of ESBL-E, which is a potential risk factor of ESBL-E infections, is reported to be very high among children in Tanzania. Probiotics may potentially reduce gut colonization of multidrug-resistant bacteria. However, there is limited data on whether probiotics may reduce ESBL-E carriage in infants. The ProRIDE Trial aims to evaluate whether the use of probiotics can reduce morbidity and mortality among infants in Haydom, Tanzania, and whether this effect is associated with a reduction in ESBL-E colonization and/or infections. METHODS/DESIGN This large randomized double-blinded placebo-controlled trial aims to recruit 2000 newborn infants at Haydom Lutheran Hospital and the surrounding area in the period of November 2020 to November 2021. Participants will be enrolled from days 0 to 3 after birth and randomized to receive probiotics or placebo for 4 weeks. Participants will be followed-up for 6 months, during which three visits will be made to collect clinical and demographic information, as well as rectal swabs and fecal samples which will be subjected to laboratory analysis. The primary composite outcome is the prevalence of death and/or hospitalization at 6 months of age. DISCUSSION As the use of probiotics may give a more favorable gut composition, and thereby improve health and reduce morbidity and mortality, the results may have implications for future therapy guidelines in Africa and internationally. TRIAL REGISTRATION ClinicalTrials.gov NCT04172012. Registered on November 21, 2019.
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Affiliation(s)
- Kanika Kuwelker
- Norwegian National Advisory Unit on Tropical Infectious Diseases, Haukeland University Hospital, Haukelandsbakken, 5009 Bergen, Norway
| | - Nina Langeland
- Norwegian National Advisory Unit on Tropical Infectious Diseases, Haukeland University Hospital, Haukelandsbakken, 5009 Bergen, Norway
- Department of Clinical Science, University of Bergen, Laboratory Building, Haukeland University Hospital, Jonas Lies veg 87, 5021 Bergen, Norway
| | - Iren Høyland Löhr
- Department of Medical Microbiology, Stavanger University Hospital, Gerd Ragna Bloch Thorsens gate, 4011 Stavanger, Norway
| | - Joshua Gidion
- Department of Paediatrics, Haydom Lutheran Hospital, Mbulu, Manyara Tanzania
| | - Joel Manyahi
- Department of Clinical Science, University of Bergen, Laboratory Building, Haukeland University Hospital, Jonas Lies veg 87, 5021 Bergen, Norway
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, MUHAS, P.O. Box 65005, Dar es Salaam, Tanzania
| | - Sabrina John Moyo
- Department of Clinical Science, University of Bergen, Laboratory Building, Haukeland University Hospital, Jonas Lies veg 87, 5021 Bergen, Norway
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, MUHAS, P.O. Box 65005, Dar es Salaam, Tanzania
| | - Bjørn Blomberg
- Norwegian National Advisory Unit on Tropical Infectious Diseases, Haukeland University Hospital, Haukelandsbakken, 5009 Bergen, Norway
- Department of Clinical Science, University of Bergen, Laboratory Building, Haukeland University Hospital, Jonas Lies veg 87, 5021 Bergen, Norway
| | - Claus Klingenberg
- Department of Paediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway
- Paediatric Research Group, Faculty of Health Sciences, University of Tromsø-Arctic University of Norway, Tromsø, Norway
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Molloy EJ, Lavizzari A, Klingenberg C, Profit J, Zupancic JAF, Davis AS, Mosca F, Bearer CF, Roehr CC. Neonates in the COVID-19 pandemic. Pediatr Res 2021; 89:1038-1040. [PMID: 32746446 DOI: 10.1038/s41390-020-1096-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Eleanor J Molloy
- Paediatrics, Academic Centre, Children's Hospital Ireland (CHI) at Tallaght, Trinity College, the University of Dublin, Dublin, Ireland. .,Trinity Translational Medicine Institute (TTMI) & Trinity Research in Childhood Centre (TRICC), Dublin, Ireland. .,Neonatology, Coombe Women and Infants' University Hospital, Dublin, Ireland. .,Neonatology, CHI at Crumlin, Dublin, Ireland.
| | - Anna Lavizzari
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
| | - Claus Klingenberg
- Department of Paediatric and Adolescent Medicine, University Hospital of North Norway, Tromso, Norway.,Paediatric Research Group, Department of Clinical Medicine, UiT- The Arctic University of Norway, Tromso, Norway
| | - Jochen Profit
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA.,California Perinatal Quality Care Collaborative, Palo Alto, CA, USA
| | - John A F Zupancic
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Division of Newborn Medicine, Harvard Medical School, Boston, MA, USA
| | - Alexis S Davis
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Fabio Mosca
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Cynthia F Bearer
- Division of Neonatology, Department of Pediatrics, Rainbow Babies & Children's Hospital, University Hospitals of Cleveland, Cleveland, OH, USA.,Department of Pediatrics, Case Western Reserve University, Cleveland, OH, USA
| | - Charles C Roehr
- Newborn Services, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Lavizzari A, Klingenberg C, Profit J, Zupancic JAF, Davis AS, Mosca F, Molloy EJ, Roehr CC. International comparison of guidelines for managing neonates at the early phase of the SARS-CoV-2 pandemic. Pediatr Res 2021; 89:940-951. [PMID: 32541844 DOI: 10.1038/s41390-020-0976-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [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: 04/03/2020] [Revised: 05/04/2020] [Accepted: 05/13/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND The COVID-19 pandemic threatens global newborn health. We describe the current state of national and local protocols for managing neonates born to SARS-CoV-2-positive mothers. METHODS Care providers from neonatal intensive care units on six continents exchanged and compared protocols on the management of neonates born to SARS-CoV-2-positive mothers. Data collection was between March 14 and 21, 2020. We focused on central protocol components, including triaging, hygiene precautions, management at delivery, feeding protocols, and visiting policies. RESULTS Data from 20 countries were available. Disease burden varied between countries at the time of analysis. In most countries, asymptomatic infants were allowed to stay with the mother and breastfeed with hygiene precautions. We detected discrepancies between national guidance in particular regarding triaging, use of personal protection equipment, viral testing, and visitor policies. Local protocols deviated from national guidance. CONCLUSIONS At the start of the pandemic, lack of evidence-based guidance on the management of neonates born to SARS-CoV-2-positive mothers has led to ad hoc creation of national and local guidance. Compliance between collaborators to share and discuss protocols was excellent and may lead to more consensus on management, but future guidance should be built on high-level evidence, rather than expert consensus. IMPACT At the rapid onset of the COVID19 pandemic, all countries presented protocols in place for managing infants at risk of COVID19, with a certain degree of variations among regions. A detailed review of ad hoc guidelines is presented, similarities and differences are highlighted. We provide a broad overview of currently applied recommendations highlighting the need for international context-relevant coordination.
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Affiliation(s)
- Anna Lavizzari
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Claus Klingenberg
- Department of Paediatric and Adolescent Medicine, University Hospital of North Norway, Tromso, Norway.,Paediatric Research Group, Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromso, Norway
| | - Jochen Profit
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA.,California Perinatal Quality Care Collaborative, Palo Alto, CA, USA
| | - John A F Zupancic
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Division of Newborn Medicine, Harvard Medical School, Boston, MA, USA
| | - Alexis S Davis
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Fabio Mosca
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Eleanor J Molloy
- Paediatrics, Academic Centre, Children's Hospital Ireland (CHI) at Tallaght, Trinity College, the University of Dublin, Dublin, Ireland.,Trinity Translational Medicine Institute, St James' Hospital, Dublin, Ireland.,Neonatology, Coombe Women and Infants' University Hospital, Dublin, Ireland.,Neonatology, CHI at Crumlin, Dublin, Ireland
| | - Charles C Roehr
- Newborn Services, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Rypdal M, Rypdal V, Jakobsen PK, Ytterstad E, Løvsletten O, Klingenberg C, Rypdal K. Modelling suggests limited change in the reproduction number from reopening Norwegian kindergartens and schools during the COVID-19 pandemic. PLoS One 2021; 16:e0238268. [PMID: 33630842 PMCID: PMC7906341 DOI: 10.1371/journal.pone.0238268] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 02/09/2021] [Indexed: 01/10/2023] Open
Abstract
Background To suppress the COVID-19 outbreak, the Norwegian government closed all schools on March 13, 2020. The kindergartens reopened on April 20, and the schools on April 27 and May 11 of 2020. The effect of these measures is largely unknown since the role of children in the spread of the SARS-CoV-2 virus is still unclear. There are only a few studies of school closures as a separate intervention to other social distancing measures, and little research exists on the effect of school opening during a pandemic. Objective This study aimed to model the effect of opening kindergartens and the schools in Norway in terms of a change in the reproduction number (R). A secondary objective was to assess if we can use the estimated R after school openings to infer the rates of transmission between children in schools. Methods We used an individual-based model (IBM) to assess the reopening of kindergartens and schools in two Norwegian cities, Oslo, the Norwegian capital, with a population of approximately 680 000, and Tromsø, which is the largest city in Northern Norway, with a population of approximately 75 000. The model uses demographic information and detailed data about the schools in both cities. We carried out an ensemble study to obtain robust results in spite of the considerable uncertainty that remains about the transmission of SARS-CoV-2. Results We found that reopening of Norwegian kindergartens and schools are associated with a change in R of 0.10 (95%CI 0.04–0.16) and 0.14 (95%CI 0.01–0.25) in the two cities under investigation if the in-school transmission rates for the SARS-CoV-2 virus are equal to what has previously been estimated for influenza pandemics. Conclusion We found only a limited effect of reopening schools on the reproduction number, and we expect the same to hold true in other countries where nonpharmaceutical interventions have suppressed the pandemic. Consequently, current R-estimates are insufficiently accurate for determining the transmission rates in schools. For countries that have closed schools, planned interventions, such as the opening of selected schools, can be useful to infer general knowledge about children-to-children transmission of SARS-CoV-2.
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Affiliation(s)
- Martin Rypdal
- Department of Mathematics and Statistics, UiT–The Arctic University of Norway, Tromsø, Norway
- * E-mail:
| | - Veronika Rypdal
- Department of Clinical Medicine, UiT–The Arctic University of Norway, Tromsø, Norway
- Department of Pediatrics, University Hospital of North Norway, Tromsø, Norway
| | - Per Kristen Jakobsen
- Department of Mathematics and Statistics, UiT–The Arctic University of Norway, Tromsø, Norway
| | - Elinor Ytterstad
- Department of Mathematics and Statistics, UiT–The Arctic University of Norway, Tromsø, Norway
| | - Ola Løvsletten
- Department of Community Medicine, UiT–The Arctic University of Norway, Tromsø, Norway
| | - Claus Klingenberg
- Department of Clinical Medicine, UiT–The Arctic University of Norway, Tromsø, Norway
- Department of Pediatrics, University Hospital of North Norway, Tromsø, Norway
| | - Kristoffer Rypdal
- Department of Mathematics and Statistics, UiT–The Arctic University of Norway, Tromsø, Norway
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Pain M, Wolden R, Jaén-Luchoro D, Salvà-Serra F, Iglesias BP, Karlsson R, Klingenberg C, Cavanagh JP. Staphylococcus borealis sp. nov., isolated from human skin and blood. Int J Syst Evol Microbiol 2021; 70:6067-6078. [PMID: 33048039 DOI: 10.1099/ijsem.0.004499] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
When analysing a large cohort of Staphylococcus haemolyticus, using whole-genome sequencing, five human isolates (four from the skin and one from a blood culture) with aberrant phenotypic and genotypic traits were identified. They were phenotypically similar with yellow colonies, nearly identical 16S rRNA gene sequences and initially speciated as S. haemolyticus based on 16S rRNA gene sequence and MALDI-TOF MS. However, compared to S. haemolyticus, these five strains demonstrate: (i) considerable phylogenetic distance with an average nucleotide identity <95 % and inferred DNA-DNA hybridization <70 %; (ii) a pigmented phenotype; (iii) urease production; and (iv) different fatty acid composition. Based on the phenotypic and genotypic results, we conclude that these strains represent a novel species, for which the name Staphylococcus borealis sp. nov. is proposed. The novel species belong to the genus Staphylococcus and is coagulase- and oxidase-negative and catalase-positive. The type strain, 51-48T, is deposited in the Culture Collection University of Gothenburg (CCUG 73747T) and in the Spanish Type Culture Collection (CECT 30011T).
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Affiliation(s)
- Maria Pain
- Pediatric Infection Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Runa Wolden
- Pediatric Infection Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Daniel Jaén-Luchoro
- Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden.,Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Francisco Salvà-Serra
- Department of Clinical Microbiology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden.,Culture Collection University of Gothenburg (CCUG), Sahlgrenska Academy, University of Gothenburg, Sweden.,Microbiology, Department of Biology, University of the Balearic Islands, Palma de Mallorca, Spain.,Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden
| | - Beatriz Piñeiro Iglesias
- Department of Clinical Microbiology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden.,Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden
| | - Roger Karlsson
- Department of Clinical Microbiology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden.,Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden
| | - Claus Klingenberg
- Department of Paediatrics, University Hospital of North Norway, Tromsø, Norway.,Pediatric Infection Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Jorunn Pauline Cavanagh
- Department of Paediatrics, University Hospital of North Norway, Tromsø, Norway.,Pediatric Infection Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
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Rypdal V, Jørandli S, Hemmingsen D, Solbu MD, Klingenberg C. Exposure to an Extended-Interval, High-Dose Gentamicin Regimen in the Neonatal Period Is Not Associated With Long-Term Nephrotoxicity. Front Pediatr 2021; 9:779827. [PMID: 34917565 PMCID: PMC8669790 DOI: 10.3389/fped.2021.779827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 11/05/2021] [Indexed: 11/29/2022] Open
Abstract
Objectives: To assess the association between gentamicin exposure and subclinical signs of nephrotoxicity in school children who were exposed to a high-dose gentamicin regimen in the neonatal period. Methods: Children receiving three or more doses (6 mg/kg) of gentamicin as neonates were invited to a follow-up in school age. We evaluated potential signs of subclinical nephrotoxicity with four validated urine biomarkers: protein-creatinine ratio (PCR), albumin-creatinine ratio (ACR), kidney injury molecule-1 (KIM-1), and N-acetyl-beta-D-glucosaminidase (NAG) normalized for urine creatinine (NAG-Cr). In addition, blood pressure was measured. The measures of gentamicin exposure were cumulative dose (mg/kg) and highest trough plasma concentration (TPC) in mg/L. We used logistic and linear regression and non-parametric kernel regression to analyze the relationship between gentamicin exposure and the urine biomarkers. Results: A total of 222 gentamicin exposed children were included. As neonates, the children were exposed to a median (interquartile range-IQR) cumulative gentamicin dose of 36 (26-42) mg/kg and the median (IQR) TPC was 1.0 (0.7-1.3) mg/L. At follow-up, 15 children (6.8%) had either one abnormal urine biomarker value (13 children) or two abnormal urine biomarker values (2 children). These 17 biomarker values were all marginally above the suggested upper cutoff, and included the following markers; KIM-1 (n = 2), NAC-Cr (n = 5), ACR (n = 6), and PCR (n = 4). All other 207 children had normal sets of all four urine biomarkers. One child had hypertension. There were no differences in gentamicin exposure, gestational age (GA) at birth or birth weight between the group of 15 children with one or two abnormal urine biomarker values compared to the other 207 children who had normal biomarker values. Using different regression analyses, we did not find any association between gentamicin exposure (cumulative dose and/or TPC) and the urine biomarker values. Conclusions: Exposure to an extended-interval, high-dose gentamicin regimen in the neonatal period was not associated with signs of subclinical nephrotoxicity in schoolchildren. We therefore suggest that the gentamicin treatment regimen evaluated in this study is safe in terms of long-term nephrotoxicity. Clinical Trial Registration: ClinicalTrials.gov, identifier: NCT03253614.
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Affiliation(s)
- Veronika Rypdal
- Department of Pediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway.,Pediatric Research Group, Faculty of Health Sciences, University of Tromsø-The Arctic University of Norway, Tromsø, Norway
| | - Sondre Jørandli
- The Faculty of Health Sciences, Medical School, University of Tromsø-The Arctic University of Norway, Tromsø, Norway
| | - Dagny Hemmingsen
- Pediatric Research Group, Faculty of Health Sciences, University of Tromsø-The Arctic University of Norway, Tromsø, Norway.,Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of North Norway, Tromsø, Norway
| | - Marit Dahl Solbu
- Section of Nephrology, University Hospital of North Norway, Tromsø, Norway.,Metabolic and Renal Research Group, University of Tromsø-The Arctic University of Norway, Tromsø, Norway
| | - Claus Klingenberg
- Department of Pediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway.,Pediatric Research Group, Faculty of Health Sciences, University of Tromsø-The Arctic University of Norway, Tromsø, Norway
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Vatne A, Klingenberg C, Rettedal S, Øymar K. Early-Onset Sepsis in Neonates - A Population-Based Study in South-West Norway From 1996 to 2018. Front Pediatr 2021; 9:634798. [PMID: 33816402 PMCID: PMC8010672 DOI: 10.3389/fped.2021.634798] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 02/23/2021] [Indexed: 01/25/2023] Open
Abstract
Background: The epidemiology of early-onset sepsis (EOS) may change over time. Longitudinal surveillance of causative pathogens, antibiotic susceptibility patterns and antibiotic therapy is important for optimal therapy strategies. Objectives: To describe the incidence of culture-confirmed EOS, causative pathogens, antibiotic susceptibility patterns and antibiotic therapy over a 23-year period. Methods: Retrospective population-based study from a single-center neonatal intensive care unit at Stavanger University Hospital, Norway, covering a population in South-West Norway, during the 23-year period 1996-2018. Results: Of 104,377 live born infants, 101 infants (0.97/1,000) had culture-confirmed EOS; 89 with Gram positive and 12 with Gram-negative bacteria. The EOS-attributable mortality was 6/101 (5.8%). For the three most prevalent pathogens the incidences were; Group B streptococcus (GBS) 0.57/1,000, Escherichia coli 0.11/1,000 and viridans group streptococci (VGS) 0.10/1,000. GBS was the most common pathogen (59/93; 63%) in infants with gestational age (GA) ≥ 28 weeks. In contrast, among extremely preterm infants (GA <28 weeks) the incidence of E. coli infection was higher than for GBS infection. The second most common bacterial pathogens causing EOS among term infants were VGS. There was no change in the incidence of EOS for the entire study period, but from 2000 to 2018 there was a mean decline in EOS by 6% per year (95% CI 1%-10%) (p = 0.019). The incidences of GBS and E. coli did not change during the study period. The initial empirical antibiotic regimen for EOS was in all cases a combination of benzylpenicillin or ampicillin and an aminoglycoside, but in 21/101 (21%) of cases a broad-spectrum antibiotic was either added or substituted this regimen. In 2/101 (2%) EOS cases, the pathogens were nonsusceptible to the empirical antibiotic regimen. All E. coli isolates were susceptible to aminoglycosides. Conclusion: GBS was the most common causative pathogens in EOS, but E. coli dominated in infants with GA <28 weeks. There was no change in the incidence of EOS during the entire study period. The current empiric regimen with benzylpenicillin and gentamicin provides a very high coverage for EOS in our setting.
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Affiliation(s)
- Anlaug Vatne
- Department of Pediatrics, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Claus Klingenberg
- Department of Paediatrics, University Hospital of North Norway, Tromsø, Norway.,Paediatric Research Group, Department of Clinical Medicine, University of Tromsø-The Arctic University of Norway, Tromsø, Norway
| | - Siren Rettedal
- Department of Pediatrics, Stavanger University Hospital, Stavanger, Norway
| | - Knut Øymar
- Department of Pediatrics, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
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Affiliation(s)
- Claus Klingenberg
- Department of Pediatrics, University Hospital of North Norway; Pediatric Research Group, Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsø, Norway
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44
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Holte K, Ersdal H, Eilevstjønn J, Gomo Ø, Klingenberg C, Thallinger M, Linde J, Stigum H, Yeconia A, Kidanto H, Størdal K. Positive End-Expiratory Pressure in Newborn Resuscitation Around Term: A Randomized Controlled Trial. Pediatrics 2020; 146:peds.2020-0494. [PMID: 32917847 DOI: 10.1542/peds.2020-0494] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND International guidelines for resuscitation recommend using positive end-expiratory pressure (PEEP) during ventilation of preterm newborns. Reliable PEEP-valves for self-inflating bags have been lacking, and effects of PEEP during resuscitation of term newborns are insufficiently studied. The objective was to determine if adding a new PEEP valve to the bag-mask during resuscitation of term and near-term newborns could improve heart rate response. METHODS This randomized controlled trial was performed at Haydom Lutheran Hospital in Tanzania (September 2016 to June 2018). Helping Babies Breathe-trained midwives performed newborn resuscitation using self-inflating bags with or without a new, integrated PEEP valve. All live-born newborns who received bag-mask ventilation at birth were eligible. Heart rate response measured by ECG was the primary outcome, and clinical outcome and ventilation data were recorded. RESULTS Among 417 included newborns (median birth weight 3200 g), 206 were ventilated without and 211 with PEEP. We found no difference in heart rate response. Median (interquartile range) measured PEEP in the PEEP group was 4.7 (2.0-5.6) millibar. The PEEP group received lower tidal volumes (4.9 [1.9-8.2] vs 6.3 [3.9-10.5] mL/kg; P = .02) and had borderline lower expired CO2 (2.9 [1.5-4.3] vs 3.3 [1.9-5.0] %; P = .05). Twenty four-hour mortality was 9% in both groups. CONCLUSIONS We found no evidence for improved heart rate response during bag-mask ventilation with PEEP compared with no PEEP. The PEEP valve delivered a median PEEP within the intended range. The findings do not support routine use of PEEP during resuscitation of newborns around term.
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Affiliation(s)
- Kari Holte
- Department of Pediatrics and Adolescence Medicine, Østfold Hospital Trust, Grålum, Norway; .,Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Hege Ersdal
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.,Departments of Anesthesiology and Intensive Care
| | - Joar Eilevstjønn
- Strategic Research Department, Laerdal Medical, Stavanger, Norway
| | - Øystein Gomo
- Strategic Research Department, Laerdal Medical, Stavanger, Norway
| | - Claus Klingenberg
- Department of Pediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway.,Pediatric Research Group, Faculty of Health Sciences, University of Tromsø-Arctic University of Norway, Tromsø, Norway
| | - Monica Thallinger
- Department of Anesthesiology and Intensive Care, Vestre Viken Hospital Trust, Bærum, Norway
| | - Jørgen Linde
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.,Pediatrics and Adolescence Medicine, and
| | - Hein Stigum
- Norwegian Institute of Public Health, Oslo, Norway
| | - Anita Yeconia
- Haydom Lutheran Hospital, Mbulu, Manyara, Tanzania; and
| | - Hussein Kidanto
- Research, Stavanger University Hospital, Stavanger, Norway.,Medical College, Agakhan University, Dar es Salaam, Tanzania
| | - Ketil Størdal
- Department of Pediatrics and Adolescence Medicine, Østfold Hospital Trust, Grålum, Norway.,Norwegian Institute of Public Health, Oslo, Norway
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Hikmat O, Naess K, Engvall M, Klingenberg C, Rasmussen M, Tallaksen CME, Samsonsen C, Brodtkorb E, Ostergaard E, de Coo R, Pias-Peleteiro L, Isohanni P, Uusimaa J, Darin N, Rahman S, Bindoff LA. The impact of gender, puberty, and pregnancy in patients with POLG disease. Ann Clin Transl Neurol 2020; 7:2019-2025. [PMID: 32949115 PMCID: PMC7545595 DOI: 10.1002/acn3.51199] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/28/2020] [Accepted: 08/28/2020] [Indexed: 12/31/2022] Open
Abstract
Objective To study the impact of gender, puberty, and pregnancy on the expression of POLG disease, one of the most common mitochondrial diseases known. Methods Clinical, laboratory, and genetic data were collected retrospectively from 155 patients with genetically confirmed POLG disease recruited from seven European countries. We used the available data to study the impact of gender, puberty, and pregnancy on disease onset and deterioration. Results We found that disease onset early in life was common in both sexes but there was also a second peak in females around the time of puberty. Further, pregnancy had a negative impact with 10 of 14 women (71%) experiencing disease onset or deterioration during pregnancy. Interpretation Gender clearly influences the expression of POLG disease. While onset very early in life was common in both males and females, puberty in females appeared associated both with disease onset and increased disease activity. Further, both disease onset and deterioration, including seizure aggravation and status epilepticus, appeared to be associated with pregnancy. Thus, whereas disease activity appears maximal early in life with no subsequent peaks in males, both menarche and pregnancy appear associated with disease onset or worsening in females. This suggests that hormonal changes may be a modulating factor.
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Affiliation(s)
- Omar Hikmat
- Department of Paediatrics and Adolescent Medicine, Haukeland University Hospital, Bergen, 5021, Norway.,Department of Clinical Medicine (K1), University of Bergen, Bergen, Norway
| | - Karin Naess
- Centre for Inherited Metabolic Diseases, Karolinska University Hospital, Stockholm, Sweden.,Department of Medical Biochemistry and Biophysics, Karolinska Institute, Stockholm, Sweden
| | - Martin Engvall
- Centre for Inherited Metabolic Diseases, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Claus Klingenberg
- Department of Paediatric and Adolescent Medicine, University Hospital of North Norway, Tromso, Norway.,Paediatric Research Group, Department of Clinical Medicine, UiT- The Arctic University of Norway, Tromso, Norway
| | - Magnhild Rasmussen
- Women and Children's Division, Department of Clinical Neurosciences for Children, Oslo University Hospital, Oslo, Norway.,Unit for Congenital and Hereditary Neuromuscular Disorders, Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Chantal M E Tallaksen
- Department of Neurology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Christian Samsonsen
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Neurology and Clinical Neurophysiology, St. Olav's University Hospital, Trondheim, Norway
| | - Eylert Brodtkorb
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Neurology and Clinical Neurophysiology, St. Olav's University Hospital, Trondheim, Norway
| | - Elsebet Ostergaard
- Department of Clinical Genetics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Rene de Coo
- Department of Neurology, Medical Spectrum Twente, Enschede, The Netherlands.,Department of Genetics and Cell Biology, University of Maastricht, Maastricht, The Netherlands
| | | | - Pirjo Isohanni
- Department of Pediatric Neurology, Children's Hospital, Helsinki University Hospital, Helsinki, Finland.,Stem Cells and Metabolism Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Johanna Uusimaa
- PEDEGO Research Unit, University of Oulu, Oulu, Finland.,Department of Pediatric Neurology, Clinic for Children and Adolescents, Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Niklas Darin
- Department of Pediatrics, The Queen Silvia Children's Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Shamima Rahman
- Mitochondrial Research Group, UCL Great Ormond Street Institute of Child Health, London, United Kingdom.,Metabolic Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, United Kingdom
| | - Laurence A Bindoff
- Department of Clinical Medicine (K1), University of Bergen, Bergen, Norway.,Department of Neurology, Haukeland University Hospital, Bergen, 5021, Norway
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Tangeraas T, Sæves I, Klingenberg C, Jørgensen J, Kristensen E, Gunnarsdottir G, Hansen EV, Strand J, Lundman E, Ferdinandusse S, Salvador CL, Woldseth B, Bliksrud YT, Sagredo C, Olsen ØE, Berge MC, Trømborg AK, Ziegler A, Zhang JH, Sørgjerd LK, Ytre-Arne M, Hogner S, Løvoll SM, Kløvstad Olavsen MR, Navarrete D, Gaup HJ, Lilje R, Zetterström RH, Stray-Pedersen A, Rootwelt T, Rinaldo P, Rowe AD, Pettersen RD. Performance of Expanded Newborn Screening in Norway Supported by Post-Analytical Bioinformatics Tools and Rapid Second-Tier DNA Analyses. Int J Neonatal Screen 2020; 6:51. [PMID: 33123633 PMCID: PMC7570219 DOI: 10.3390/ijns6030051] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [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: 05/15/2020] [Accepted: 06/22/2020] [Indexed: 12/12/2022] Open
Abstract
In 2012, the Norwegian newborn screening program (NBS) was expanded (eNBS) from screening for two diseases to that for 23 diseases (20 inborn errors of metabolism, IEMs) and again in 2018, to include a total of 25 conditions (21 IEMs). Between 1 March 2012 and 29 February 2020, 461,369 newborns were screened for 20 IEMs in addition to phenylketonuria (PKU). Excluding PKU, there were 75 true-positive (TP) (1:6151) and 107 (1:4311) false-positive IEM cases. Twenty-one percent of the TP cases were symptomatic at the time of the NBS results, but in two-thirds, the screening result directed the exact diagnosis. Eighty-two percent of the TP cases had good health outcomes, evaluated in 2020. The yearly positive predictive value was increased from 26% to 54% by the use of the Region 4 Stork post-analytical interpretive tool (R4S)/Collaborative Laboratory Integrated Reports 2.0 (CLIR), second-tier biochemical testing and genetic confirmation using DNA extracted from the original dried blood spots. The incidence of IEMs increased by 46% after eNBS was introduced, predominantly due to the finding of attenuated phenotypes. The next step is defining which newborns would truly benefit from screening at the milder end of the disease spectrum. This will require coordinated international collaboration, including proper case definitions and outcome studies.
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Affiliation(s)
- Trine Tangeraas
- Norwegian National Unit for Newborn Screening, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, 0424 Oslo, Norway; (I.S.); (J.J.); (E.K.); (J.S.); (E.L.); (C.S.); (Ø.E.O.); (M.C.B.); (A.K.T.); (A.Z.); (J.H.Z.); (L.K.S.); (M.Y.-A.); (S.H.); (S.M.L.); (M.R.K.O.); (D.N.); (H.J.G.); (A.S.-P.); (A.D.R.); (R.D.P.)
| | - Ingjerd Sæves
- Norwegian National Unit for Newborn Screening, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, 0424 Oslo, Norway; (I.S.); (J.J.); (E.K.); (J.S.); (E.L.); (C.S.); (Ø.E.O.); (M.C.B.); (A.K.T.); (A.Z.); (J.H.Z.); (L.K.S.); (M.Y.-A.); (S.H.); (S.M.L.); (M.R.K.O.); (D.N.); (H.J.G.); (A.S.-P.); (A.D.R.); (R.D.P.)
| | - Claus Klingenberg
- Department of Paediatrics, University Hospital of North Norway, 9019 Tromsø, Norway;
- Paediatric Research Group, Department of Clinical Medicine, UiT The Artic University of Norway, 9019 Tromsø, Norway
| | - Jens Jørgensen
- Norwegian National Unit for Newborn Screening, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, 0424 Oslo, Norway; (I.S.); (J.J.); (E.K.); (J.S.); (E.L.); (C.S.); (Ø.E.O.); (M.C.B.); (A.K.T.); (A.Z.); (J.H.Z.); (L.K.S.); (M.Y.-A.); (S.H.); (S.M.L.); (M.R.K.O.); (D.N.); (H.J.G.); (A.S.-P.); (A.D.R.); (R.D.P.)
| | - Erle Kristensen
- Norwegian National Unit for Newborn Screening, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, 0424 Oslo, Norway; (I.S.); (J.J.); (E.K.); (J.S.); (E.L.); (C.S.); (Ø.E.O.); (M.C.B.); (A.K.T.); (A.Z.); (J.H.Z.); (L.K.S.); (M.Y.-A.); (S.H.); (S.M.L.); (M.R.K.O.); (D.N.); (H.J.G.); (A.S.-P.); (A.D.R.); (R.D.P.)
- Paediatric Research Group, Department of Clinical Medicine, UiT The Artic University of Norway, 9019 Tromsø, Norway
| | - Gunnþórunn Gunnarsdottir
- Department of Paediatrics, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, 0424 Oslo, Norway; (G.G.); (R.L.); (T.R.)
| | | | - Janne Strand
- Norwegian National Unit for Newborn Screening, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, 0424 Oslo, Norway; (I.S.); (J.J.); (E.K.); (J.S.); (E.L.); (C.S.); (Ø.E.O.); (M.C.B.); (A.K.T.); (A.Z.); (J.H.Z.); (L.K.S.); (M.Y.-A.); (S.H.); (S.M.L.); (M.R.K.O.); (D.N.); (H.J.G.); (A.S.-P.); (A.D.R.); (R.D.P.)
| | - Emma Lundman
- Norwegian National Unit for Newborn Screening, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, 0424 Oslo, Norway; (I.S.); (J.J.); (E.K.); (J.S.); (E.L.); (C.S.); (Ø.E.O.); (M.C.B.); (A.K.T.); (A.Z.); (J.H.Z.); (L.K.S.); (M.Y.-A.); (S.H.); (S.M.L.); (M.R.K.O.); (D.N.); (H.J.G.); (A.S.-P.); (A.D.R.); (R.D.P.)
| | - Sacha Ferdinandusse
- Laboratory Genetic Metabolic Diseases, Department of Clinical Chemistry, Amsterdam University Medical Centers, University of Amsterdam, AZ 1105 Amsterdam, The Netherlands;
| | - Cathrin Lytomt Salvador
- Norwegian National Unit for Diagnostics of Congenital Metabolic Disorders, Department of Medical Biochemistry, Oslo University Hospital, 0424 Oslo, Norway; (C.L.S.); (B.W.); (Y.T.B.)
| | - Berit Woldseth
- Norwegian National Unit for Diagnostics of Congenital Metabolic Disorders, Department of Medical Biochemistry, Oslo University Hospital, 0424 Oslo, Norway; (C.L.S.); (B.W.); (Y.T.B.)
| | - Yngve T Bliksrud
- Norwegian National Unit for Diagnostics of Congenital Metabolic Disorders, Department of Medical Biochemistry, Oslo University Hospital, 0424 Oslo, Norway; (C.L.S.); (B.W.); (Y.T.B.)
| | - Carlos Sagredo
- Norwegian National Unit for Newborn Screening, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, 0424 Oslo, Norway; (I.S.); (J.J.); (E.K.); (J.S.); (E.L.); (C.S.); (Ø.E.O.); (M.C.B.); (A.K.T.); (A.Z.); (J.H.Z.); (L.K.S.); (M.Y.-A.); (S.H.); (S.M.L.); (M.R.K.O.); (D.N.); (H.J.G.); (A.S.-P.); (A.D.R.); (R.D.P.)
| | - Øyvind E Olsen
- Norwegian National Unit for Newborn Screening, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, 0424 Oslo, Norway; (I.S.); (J.J.); (E.K.); (J.S.); (E.L.); (C.S.); (Ø.E.O.); (M.C.B.); (A.K.T.); (A.Z.); (J.H.Z.); (L.K.S.); (M.Y.-A.); (S.H.); (S.M.L.); (M.R.K.O.); (D.N.); (H.J.G.); (A.S.-P.); (A.D.R.); (R.D.P.)
| | - Mona C Berge
- Norwegian National Unit for Newborn Screening, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, 0424 Oslo, Norway; (I.S.); (J.J.); (E.K.); (J.S.); (E.L.); (C.S.); (Ø.E.O.); (M.C.B.); (A.K.T.); (A.Z.); (J.H.Z.); (L.K.S.); (M.Y.-A.); (S.H.); (S.M.L.); (M.R.K.O.); (D.N.); (H.J.G.); (A.S.-P.); (A.D.R.); (R.D.P.)
| | - Anette Kjoshagen Trømborg
- Norwegian National Unit for Newborn Screening, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, 0424 Oslo, Norway; (I.S.); (J.J.); (E.K.); (J.S.); (E.L.); (C.S.); (Ø.E.O.); (M.C.B.); (A.K.T.); (A.Z.); (J.H.Z.); (L.K.S.); (M.Y.-A.); (S.H.); (S.M.L.); (M.R.K.O.); (D.N.); (H.J.G.); (A.S.-P.); (A.D.R.); (R.D.P.)
| | - Anders Ziegler
- Norwegian National Unit for Newborn Screening, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, 0424 Oslo, Norway; (I.S.); (J.J.); (E.K.); (J.S.); (E.L.); (C.S.); (Ø.E.O.); (M.C.B.); (A.K.T.); (A.Z.); (J.H.Z.); (L.K.S.); (M.Y.-A.); (S.H.); (S.M.L.); (M.R.K.O.); (D.N.); (H.J.G.); (A.S.-P.); (A.D.R.); (R.D.P.)
| | - Jin Hui Zhang
- Norwegian National Unit for Newborn Screening, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, 0424 Oslo, Norway; (I.S.); (J.J.); (E.K.); (J.S.); (E.L.); (C.S.); (Ø.E.O.); (M.C.B.); (A.K.T.); (A.Z.); (J.H.Z.); (L.K.S.); (M.Y.-A.); (S.H.); (S.M.L.); (M.R.K.O.); (D.N.); (H.J.G.); (A.S.-P.); (A.D.R.); (R.D.P.)
| | - Linda Karlsen Sørgjerd
- Norwegian National Unit for Newborn Screening, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, 0424 Oslo, Norway; (I.S.); (J.J.); (E.K.); (J.S.); (E.L.); (C.S.); (Ø.E.O.); (M.C.B.); (A.K.T.); (A.Z.); (J.H.Z.); (L.K.S.); (M.Y.-A.); (S.H.); (S.M.L.); (M.R.K.O.); (D.N.); (H.J.G.); (A.S.-P.); (A.D.R.); (R.D.P.)
| | - Mari Ytre-Arne
- Norwegian National Unit for Newborn Screening, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, 0424 Oslo, Norway; (I.S.); (J.J.); (E.K.); (J.S.); (E.L.); (C.S.); (Ø.E.O.); (M.C.B.); (A.K.T.); (A.Z.); (J.H.Z.); (L.K.S.); (M.Y.-A.); (S.H.); (S.M.L.); (M.R.K.O.); (D.N.); (H.J.G.); (A.S.-P.); (A.D.R.); (R.D.P.)
| | - Silje Hogner
- Norwegian National Unit for Newborn Screening, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, 0424 Oslo, Norway; (I.S.); (J.J.); (E.K.); (J.S.); (E.L.); (C.S.); (Ø.E.O.); (M.C.B.); (A.K.T.); (A.Z.); (J.H.Z.); (L.K.S.); (M.Y.-A.); (S.H.); (S.M.L.); (M.R.K.O.); (D.N.); (H.J.G.); (A.S.-P.); (A.D.R.); (R.D.P.)
| | - Siv M Løvoll
- Norwegian National Unit for Newborn Screening, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, 0424 Oslo, Norway; (I.S.); (J.J.); (E.K.); (J.S.); (E.L.); (C.S.); (Ø.E.O.); (M.C.B.); (A.K.T.); (A.Z.); (J.H.Z.); (L.K.S.); (M.Y.-A.); (S.H.); (S.M.L.); (M.R.K.O.); (D.N.); (H.J.G.); (A.S.-P.); (A.D.R.); (R.D.P.)
| | - Mette R Kløvstad Olavsen
- Norwegian National Unit for Newborn Screening, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, 0424 Oslo, Norway; (I.S.); (J.J.); (E.K.); (J.S.); (E.L.); (C.S.); (Ø.E.O.); (M.C.B.); (A.K.T.); (A.Z.); (J.H.Z.); (L.K.S.); (M.Y.-A.); (S.H.); (S.M.L.); (M.R.K.O.); (D.N.); (H.J.G.); (A.S.-P.); (A.D.R.); (R.D.P.)
| | - Dionne Navarrete
- Norwegian National Unit for Newborn Screening, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, 0424 Oslo, Norway; (I.S.); (J.J.); (E.K.); (J.S.); (E.L.); (C.S.); (Ø.E.O.); (M.C.B.); (A.K.T.); (A.Z.); (J.H.Z.); (L.K.S.); (M.Y.-A.); (S.H.); (S.M.L.); (M.R.K.O.); (D.N.); (H.J.G.); (A.S.-P.); (A.D.R.); (R.D.P.)
| | - Hege J Gaup
- Norwegian National Unit for Newborn Screening, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, 0424 Oslo, Norway; (I.S.); (J.J.); (E.K.); (J.S.); (E.L.); (C.S.); (Ø.E.O.); (M.C.B.); (A.K.T.); (A.Z.); (J.H.Z.); (L.K.S.); (M.Y.-A.); (S.H.); (S.M.L.); (M.R.K.O.); (D.N.); (H.J.G.); (A.S.-P.); (A.D.R.); (R.D.P.)
| | - Rina Lilje
- Department of Paediatrics, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, 0424 Oslo, Norway; (G.G.); (R.L.); (T.R.)
| | - Rolf H Zetterström
- Centre for Inherited Metabolic Diseases, Karolinska University Hospital, Solna, Sweden, Department of Molecular Medicine and Surgery, Karolinska Institutet, SE-171 76 Stockholm, Sweden;
| | - Asbjørg Stray-Pedersen
- Norwegian National Unit for Newborn Screening, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, 0424 Oslo, Norway; (I.S.); (J.J.); (E.K.); (J.S.); (E.L.); (C.S.); (Ø.E.O.); (M.C.B.); (A.K.T.); (A.Z.); (J.H.Z.); (L.K.S.); (M.Y.-A.); (S.H.); (S.M.L.); (M.R.K.O.); (D.N.); (H.J.G.); (A.S.-P.); (A.D.R.); (R.D.P.)
| | - Terje Rootwelt
- Department of Paediatrics, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, 0424 Oslo, Norway; (G.G.); (R.L.); (T.R.)
- Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway
| | - Piero Rinaldo
- Biochemical Genetics Laboratory, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, NY 55902, USA;
| | - Alexander D Rowe
- Norwegian National Unit for Newborn Screening, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, 0424 Oslo, Norway; (I.S.); (J.J.); (E.K.); (J.S.); (E.L.); (C.S.); (Ø.E.O.); (M.C.B.); (A.K.T.); (A.Z.); (J.H.Z.); (L.K.S.); (M.Y.-A.); (S.H.); (S.M.L.); (M.R.K.O.); (D.N.); (H.J.G.); (A.S.-P.); (A.D.R.); (R.D.P.)
| | - Rolf D Pettersen
- Norwegian National Unit for Newborn Screening, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, 0424 Oslo, Norway; (I.S.); (J.J.); (E.K.); (J.S.); (E.L.); (C.S.); (Ø.E.O.); (M.C.B.); (A.K.T.); (A.Z.); (J.H.Z.); (L.K.S.); (M.Y.-A.); (S.H.); (S.M.L.); (M.R.K.O.); (D.N.); (H.J.G.); (A.S.-P.); (A.D.R.); (R.D.P.)
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Hikmat O, Naess K, Engvall M, Klingenberg C, Rasmussen M, Tallaksen CM, Brodtkorb E, Ostergaard E, de Coo IFM, Pias-Peleteiro L, Isohanni P, Uusimaa J, Darin N, Rahman S, Bindoff LA. Simplifying the clinical classification of polymerase gamma (POLG) disease based on age of onset; studies using a cohort of 155 cases. J Inherit Metab Dis 2020; 43:726-736. [PMID: 32391929 DOI: 10.1002/jimd.12211] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [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: 08/14/2019] [Revised: 01/02/2020] [Accepted: 01/03/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND Variants in POLG are one of the most common causes of inherited mitochondrial disease. Phenotypic classification of POLG disease has evolved haphazardly making it complicated and difficult to implement in everyday clinical practise. The aim of our study was to simplify the classification and facilitate better clinical recognition. METHODS A multinational, retrospective study using data from 155 patients with POLG variants recruited from seven European countries. RESULTS We describe the spectrum of clinical features associated with POLG variants in the largest known cohort of patients. While clinical features clearly form a continuum, stratifying patients simply according to age of onset-onset prior to age 12 years; onset between 12 and 40 years and onset after the age of 40 years, permitted us to identify clear phenotypic and prognostic differences. Prior to 12 years of age, liver involvement (87%), seizures (84%), and feeding difficulties (84%) were the major features. For those with onset between 12 and 40 years, ataxia (90%), peripheral neuropathy (84%), and seizures (71%) predominated, while for those with onset over 40 years, ptosis (95%), progressive external ophthalmoplegia (89%), and ataxia (58%) were the major clinical features. The earlier the onset the worse the prognosis. Patients with epilepsy and those with compound heterozygous variants carried significantly worse prognosis. CONCLUSION Based on our data, we propose a simplified POLG disease classification, which can be used to guide diagnostic investigations and predict disease course.
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Affiliation(s)
- Omar Hikmat
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine (K1), University of Bergen, Bergen, Norway
| | - Karin Naess
- Centre for Inherited Metabolic Diseases, Karolinska University Hospital, Stockholm, Sweden
- Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - Martin Engvall
- Centre for Inherited Metabolic Diseases, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Claus Klingenberg
- Department of Paediatric and Adolescent Medicine, University Hospital of North Norway, Tromso, Norway
- Paediatric Research Group, Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromso, Norway
| | - Magnhild Rasmussen
- Women and Children's Division, Department of Clinical Neurosciences for Children, Oslo University Hospital, Oslo, Norway
- Unit for Congenital and Hereditary Neuromuscular Disorders, Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Chantal Me Tallaksen
- Department of Neurology, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Eylert Brodtkorb
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Neurology and Clinical Neurophysiology, St. Olav's University Hospital, Trondheim, Norway
| | - Elsebet Ostergaard
- Department of Clinical Genetics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - I F M de Coo
- Department of Neurology, Medical Spectrum Twente, Enschede, The Netherlands
- Department of Genetics and Cell Biology, University of Maastricht, Maastricht, The Netherlands
| | | | - Pirjo Isohanni
- Department of Pediatric Neurology, Children's Hospital and Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Stem Cells and Metabolism Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Johanna Uusimaa
- PEDEGO Research Unit, University of Oulu, Oulu, Finland
- Biocenter Oulu, University of Oulu, Oulu, Finland
- Department of Pediatric Neurology, Clinic for Children and Adolescents, Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Niklas Darin
- Department of Pediatrics, The Queen Silvia Children's Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Shamima Rahman
- Mitochondrial Research Group, UCL Great Ormond Street Institute of Child Health, London, UK
- Metabolic Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Laurence A Bindoff
- Department of Clinical Medicine (K1), University of Bergen, Bergen, Norway
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
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48
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Størdal K, Bakken IJ, Greve-Isdahl M, Klingenberg C, Helland E, Nystad W, Hjellvik V, Gulseth HL. SARS-CoV-2 in children and adolescents in Norway: confirmed infection, hospitalisations and underlying conditions. Tidsskr Nor Laegeforen 2020; 140:20-0457. [PMID: 32815353 DOI: 10.4045/tidsskr.20.0457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Children and adolescents are at lower risk of disease caused by SARS-CoV-2. We describe the incidence of confirmed infection and hospitalisation of children and adolescents under the age of 20 in Norway, and specifically among those with underlying conditions. MATERIAL AND METHOD The Norwegian Directorate of Health has collaborated with the Norwegian Institute of Public Health on the establishment of a data extraction system to monitor the coronavirus outbreak. Data from the specialist health service (Norwegian Patient Registry, NPR), and the primary health service (Norwegian Registry for Primary Health Care, NRPHC) are linked to data on positive SARS-CoV-2 tests from the Surveillance System for Communicable Diseases (MSIS). This covers all persons living in Norway as of 1 March 2020, with data on confirmed infection up to and including 13 May 2020 and on hospitalisations up to and including 30 April 2020. RESULTS Of 8 125 persons with confirmed SARS-CoV-2 in the whole population, 493 (6.1 %) were under 20 years old. The median age of the under-20s was 15 years, and 252 (51 %) were girls. 3 % were hospitalised. No deaths were registered among patients aged under 20 in Norway. We found a somewhat larger share with confirmed SARS-CoV-2 in the group with diseases of the neuromuscular system. INTERPRETATION Few children and adolescents have had SARS-CoV-2 confirmed, and only a very few have been hospitalised. Underlying conditions may result in a lower threshold for testing, and hence a higher incidence of confirmed infection in this group, although higher risk cannot be excluded.
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49
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Johansen TB, Astrup E, Jore S, Nilssen H, Dahlberg BB, Klingenberg C, Berg AS, Greve-Isdahl M. Infection prevention guidelines and considerations for paediatric risk groups when reopening primary schools during COVID-19 pandemic, Norway, April 2020. Euro Surveill 2020; 25:2000921. [PMID: 32524956 PMCID: PMC7336110 DOI: 10.2807/1560-7917.es.2020.25.22.2000921] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
In response to the coronavirus disease (COVID-19) pandemic, most countries implemented school closures. In Norway, schools closed on 13 March 2020. The evidence of effect on disease transmission was limited, while negative consequences were evident. Before reopening, risk-assessment for paediatric risk groups was performed, concluding that most children can attend school with few conditions requiring preventative homeschooling. We here present infection prevention and control guidelines for primary schools and recommendations for paediatric risk groups.
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Affiliation(s)
- Tone Bjordal Johansen
- The Norwegian Institute of Public Health, Oslo, Norway,European Public Health Microbiology Training Programme (EUPHEM), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | | | - Solveig Jore
- The Norwegian Institute of Public Health, Oslo, Norway
| | - Hege Nilssen
- The Norwegian Directorate for Education and Training, Oslo, Norway
| | | | - Claus Klingenberg
- Paediatric Research Group, Faculty of Health Sciences, University of Tromsø-Arctic University of Norway, Tromsø, Norway,Department of Paediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway
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50
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Dretvik T, Solevåg AL, Finvåg A, Størdal EH, Størdal K, Klingenberg C. Active antibiotic discontinuation in suspected but not confirmed early-onset neonatal sepsis-A quality improvement initiative. Acta Paediatr 2020; 109:1125-1130. [PMID: 31999863 DOI: 10.1111/apa.15202] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 10/31/2019] [Revised: 12/25/2019] [Accepted: 01/27/2020] [Indexed: 11/29/2022]
Abstract
AIM To study whether a simple targeted intervention could reduce unwarranted antibiotic treatment in near-term and term neonates with suspected, but not confirmed early-onset sepsis. METHODS A quality improvement initiative in three Norwegian neonatal intensive care units. The intervention included an inter-hospital clinical practice guideline for discontinuing antibiotics after 36-48 hours if sepsis was no longer suspected and blood cultures were negative in neonates ≥ 34+0 weeks of gestation. Two units used procalcitonin in decision-making. We compared data 12-14 months before and after guideline implementation. The results are presented as median with interquartile ranges. RESULTS A total of 284 infants (2.5% of all births ≥ 34+0 weeks of gestation) received antibiotics before and 195 (1.8%) after guideline implementation (P = .0018). The two units that used procalcitonin discontinued antibiotics earlier after guideline implementation than the unit without procalcitonin. Neonates not diagnosed with sepsis were treated 49 (31-84) hours before and 48 (36-72) hours after guideline implementation (P = .68). In all infants, including those diagnosed with sepsis, antibiotic treatment duration was reduced from 108 (60-144) to 96 (48-120) hours (P = .013). CONCLUSION Antibiotic treatment duration for suspected, but not confirmed early-onset sepsis did not change. However, treatment duration for all infants and the proportion of infants commenced on antibiotics were reduced.
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Affiliation(s)
- Thomas Dretvik
- Department of Paediatric and Adolescent Medicine Akershus University Hospital Lørenskog Norway
| | - Anne Lee Solevåg
- Department of Paediatric and Adolescent Medicine Akershus University Hospital Lørenskog Norway
| | - Andreas Finvåg
- Paediatric Research Group Faculty of Health Sciences UiT‐The Arctic University of Norway Tromsø Norway
| | | | - Ketil Størdal
- Paediatric Department Ostfold Hospital Trust Fredrikstad Norway
- Department of non‐communicable diseases Norwegian Institute of Public Health Oslo Norway
| | - Claus Klingenberg
- Paediatric Research Group Faculty of Health Sciences UiT‐The Arctic University of Norway Tromsø Norway
- Department of Paediatrics and Adolescence Medicine University Hospital of North Norway Tromsø Norway
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