| 1. |
- Axelin, Anna, et al.
(författare)
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Symptoms of depression in parents after discharge from NICU associated with family-centred care
- 2022
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Ingår i: Journal of Advanced Nursing. - : John Wiley & Sons. - 0309-2402 .- 1365-2648. ; 78:6, s. 1676-1687
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: The aim of this study was to examine the potential association of family-centred care as perceived by parents during a NICU stay with parents' depressive symptoms at discharge and at 4 months corrected for infant age.DESIGN: A longitudinal, multicentre cohort study was conducted from 2018 to 2020 in 23 NICUs across 15 countries.METHODS: Parents (n = 635 mothers, n = 466, fathers) of infants (n = 739) born before 35 weeks of gestation and admitted to the participating NICUs were enrolled to the study during the first weeks of their infants' hospitalizations. They responded to Digi-FCC daily text messages inquiring about their perception of family-centred care provided by NICU staff. In addition, they completed a questionnaire assessing their overall perception of family-centred care at discharge. Parents' depressive symptoms were measured by the Edinburgh Postnatal Depression Scale at discharge and again after discharge when their infants were at 4 months corrected for age.RESULTS: The mothers' and the fathers' perceptions of family-centred care were associated with their depressive symptoms at discharge and at 4 months corrected age, controlling for gestational age, multiple birth, parent education and relationship status. Parents' participation in infant care, care-related decisions and emotional support provided to parents by staff explained the variation in the parents' perceptions of family-centred care. The factors facilitating the implementation of family-centred care included unlimited access to the unit for the parents and for their significant others, as well as amenities for parents.CONCLUSIONS: Our study shows that family-centred NICU care associates with parents' depressive symptoms after a NICU stay.IMPACT: Depression is common in parents of preterm infants. The provision of family-centred care may protect the mental well-being of parents of preterm infants.
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| 2. |
- Bohlin, Kajsa
(författare)
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Surfactant metabolism in the newborn : the impact of ventilation strategy and lung disease
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Developmental deficiency in pulmonary surfactant leads to respiratory distress syndrome (RDS) in preterm infants, but all newborns may have impaired surfactant metabolism secondary to lung disease or ventilator induced lung injury. Exogenous surfactant treatment is usually administered in conjunction with mechanical ventilation. If instead surfactant administration is followed by nasal continuous positive airway pressure (nCPAP), the treatment response appears to be more sustained. The aims of the thesis were to (1) distinguish normal and abnormal surfactant turnover in term and preterm infants using a novel stable isotope technique, (2) determine if high frequency oscillatory ventilation (HFOV) decreases surfactant production in preterm infants with RDS, (3) systematically examine stable isotope methodology for in vivo studies of surfactant metabolism (4) follow-up the implementation of INSURE, i.e. surfactant administration during a brief intubation, and (5) experimentally test the hypothesis, that surfactant administration followed by spontaneous breathing improves the treatment response. After an intravenous infusion of stable isotope (13C) labeled precursors for surfactant phospholipid, the 13C-enrichment over time was measured in serial tracheal aspirates using gas chromatography/mass spectrometry. Term infants without lung disease had significantly faster endogenous surfactant turnover compared to preterm infants with RDS. Term infants with severe respiratory failure exhibited disrupted surfactant metabolism and decreased amounts of surfactant phospholipids in tracheal aspirates, suggesting delayed maturity of the surfactant system or impairment from the underlying disease. HFOV versus conventional ventilation did not affect the surfactant metabolic indices in preterm infants with RDS. The method yielded reproducible data and similar surfactant metabolic indices regardless of mass spectrometry instrumentation and the surfactant phospholipid pool being analysed. Fractional catabolic rate, which is tracer independent, is suggested to be the primary measure of surfactant turnover. A retrospective, 10-year follow-up of all inborn infants with RDS (n=420, gestational age >=27 to <34 weeks) at two Stockholm neonatal units showed that after the implementation of INSURE, the number of infants requiring mechanical ventilation was reduced by 50%, with no adverse effects on outcome. Surfactant treatment by INSURE resulted in a sustained improvement in oxygenation and a significant reduction in additional surfactant doses. In a preterm rabbit model, animals received radiolabeled surfactant and were randomized to spontaneous breathing or mechanical ventilation. The mechanical ventilation group exhibited impaired tissue association of labeled surfactant, lower dynamic compliance and evidence of surfactant inactivation, consistent with a poorer treatment response. In conclusion, this investigation is one of the first to describe normal surfactant turnover in vivo in term infants. Severe lung disease in term infants disrupts endogenous surfactant metabolism similar to that of infants with developmental surfactant deficiency. Mode of mechanical ventilation has minimal impact on endogenous surfactant turnover in preterm infants with RDS. However, the treatment response to exogenous surfactant is significantly impaired by mechanical ventilation, both clinically and experimentally. The INSURE strategy for surfactant treatment is a powerful approach to improve the treatment response and reduce the need for mechanical ventilation in moderately preterm infants.
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| 3. |
- Gustafsson, Anna, et al.
(författare)
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Antisecretory factor in breastmilk is associated with reduced incidence of sepsis in preterm infants
- 2023
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Ingår i: Pediatric Research. - 0031-3998 .- 1530-0447. ; 95:3, s. 762-69
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Tidskriftsartikel (refereegranskat)abstract
- Background: Antisecretory Factor (AF) is a protein present in breastmilk that regulates inflammatory processes. We aimed to investigate the level of AF in mothers’ own milk (MOM) in relation to sepsis and other neonatal morbidities in preterm infants. Methods: Samples of breastmilk and infant plasma were collected at 1, 4, and 12 weeks after birth from 38 mothers and their 49 infants born before 30 weeks gestation. AF-compleasome in MOM was determined by a sandwich enzyme-linked immunosorbent assay (ELISA) and inflammatory markers in infant plasma by a panel of 92 inflammatory proteins. Neonatal treatments and outcomes were recorded. Results: The level of AF in MOM week 1 was lower for infants with later sepsis compared to no sepsis (p = 0.005). Corrected for nutritional intake of MOM, higher levels of AF decreased the risk for sepsis, OR 0.24. AF in MOM week 1 was negatively correlated to inflammatory proteins in infant plasma week 4, markedly IL-8, which was also associated with infant sepsis. Overall, higher AF levels in MOM was associated with fewer major morbidities of prematurity. Conclusion: Mother’s milk containing high levels of antisecretory factor is associated with reduced risk for sepsis and inflammation in preterm infants. Impact: High level of antisecretory factor (AF) in mothers’ own milk is associated with less risk for later sepsis in preterm infants.Receiving mothers’ milk with low AF levels during the first week after birth is correlated with more inflammatory proteins in infant’s plasma 2–4 weeks later.Human breastmilk has anti-inflammatory properties, and antisecretory factor in mothers’ own milk is a component of potential importance for infants born preterm.The findings suggest that food supplementation with AF to mothers of preterm infants to increase AF-levels in breastmilk may be a means to decrease the risk of inflammatory morbidities of prematurity.
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| 4. |
- Gustafsson, Anna, et al.
(författare)
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Changes in Antisecretory Factor in Human Milk During the Postpartum and Length of Gestation.
- 2022
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Ingår i: Journal of human lactation : official journal of International Lactation Consultant Association. - : SAGE Publications. - 1552-5732. ; 38:1, s. 131-140
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Tidskriftsartikel (refereegranskat)abstract
- Preterm infants are more susceptible to inflammatory complications than term infants. Human milk contains numerous bioactive components protecting the newborn infant. Antisecretory factor, a protein regulating secretory and inflammatory processes by complex binding with complement factors, is present in human milk.To describe antisecretory factor (1) in mother's own milk in term and preterm infants; and (2) in donor milk before and after Holder pasteurization.The study was prospective, longitudinal, explorative, and descriptive. Antisecretory factor-compleasome was determined using sandwich enzyme-linked immunosorbent assay in longitudinal human milk samples over 12 weeks from mothers (N = 87) of term (n = 41) and of preterm (n = 46) infants and 20 anonymized donor human milk samples before and after Holder pasteurization.Antisecretory factor-compleasome was overall higher in colostrum versus mature milk (p < .001) and no difference was found in term or preterm colostrum (p = .82). In mature milk, compleasome was higher and more variable in the preterm group (p = .01). After Holder pasteurization, compleasome levels increased (p < .001).Antisecretory factor followed the pattern of other immunological factors with high levels in colostrum. After preterm birth, levels of antisecretory factor were higher and more variable in mature milk. Holder pasteurization did not degrade antisecretory factor, indicating preserved anti-inflammatory properties in donor human milk.
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| 5. |
- Henckel, Ewa, et al.
(författare)
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A novel association between ykl-40, a marker of structural lung disease, and short telomere length in 10-year-old children with bronchopulmonary dysplasia
- 2021
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Ingår i: Children. - : MDPI. - 2227-9067. ; 8:2
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Tidskriftsartikel (refereegranskat)abstract
- Extremely preterm infants are born with immature lungs and are exposed to an inflammatory environment as a result of oxidative stress. This may lead to airway remodeling, cellular aging and the development of bronchopulmonary dysplasia (BPD). Reliable markers that predict the long-term consequences of BPD in infancy are still lacking. We analyzed two biomarkers of cellular aging and lung function, telomere length and YKL-40, respectively, at 10 years of age in children born preterm with a history of BPD (n = 29). For comparison, these markers were also evaluated in sex-and-age-matched children born at term with childhood asthma (n = 28). Relative telomere length (RTL) was measured in whole blood with qPCR and serum YKL-40 with ELISA, and both were studied in relation to gas exchange and the regional ventilation/perfusion ratio using three-dimensional V/Q-scintigraphy (single photon emission computer tomography, SPECT) in children with BPD. Higher levels of YKL-40 were associated with shorter leukocyte RTL (Pearson’s correlation: −0.55, p = 0.002), but were not associated with a lower degree of matching between ventilation and perfusion within the lung. Serum YKL-40 levels were significantly higher in children with BPD compared to children with asthma (17.7 vs. 13.2 ng/mL, p < 0.01). High levels of YKL-40 and short RTLs were associated to the need for ventilatory support more than 1 month in the neonatal period (p < 0.01). The link between enhanced telomere shortening in childhood and structural remodeling of the lung, as observed in children with former BPD but not in children with asthma at the age of 10 years, suggests altered lung development related to prematurity and early life inflammatory exposure. In conclusion, relative telomere length and YKL-40 may serve as biomarkers of altered lung development as a result of early-life inflammation in children with a history of prematurity.
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| 6. |
- Henckel, Ewa, et al.
(författare)
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Hematopoietic cellular aging is not accelerated during the first 2 years of life in children born preterm
- 2020
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Ingår i: Pediatric Research. - : Nature Publishing Group. - 0031-3998 .- 1530-0447. ; 88
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Tidskriftsartikel (refereegranskat)abstract
- Background: Prematurity in itself and exposure to neonatal intensive care triggers inflammatory processes and oxidative stress, leading to risk for disease later in life. The effects on cellular aging processes are incompletely understood.Methods: Relative telomere length (RTL) was measured by qPCR in this longitudinal cohort study with blood samples taken at birth and at 2 years of age from 60 children (16 preterm and 44 term). Viral respiratory infections the first year were evaluated. Epigenetic biological DNA methylation (DNAm) age was predicted based on methylation array data in 23 children (11 preterm and 12 term). RTL change/year and DNAm age change/year was compared in preterm and term during the 2 first years of life.Results: Preterm infants had longer telomeres than term born at birth and at 2 years of age, but no difference in telomere attrition rate could be detected. Predicted epigenetic DNAm age was younger in preterm infants, but rate of DNAm aging was similar in both groups.Conclusions: Despite early exposure to risk factors for accelerated cellular aging, children born preterm exhibited preserved telomeres. Stress during the neonatal intensive care period did not reflect accelerated epigenetic DNAm aging. Early-life aging was not explained by preterm birth.Impact: Preterm birth is associated with elevated disease risk later in life. Preterm children often suffer from inflammation early in life. Stress-related telomere erosion during neonatal intensive care has been proposed. Inflammation-accelerated biological aging in preterm is unknown. We find no accelerated aging due to prematurity or infections during the first 2 years of life.
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| 7. |
- Olin, Axel, et al.
(författare)
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Stereotypic Immune System Development in Newborn Children
- 2018
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Ingår i: Cell. - : CELL PRESS. - 0092-8674 .- 1097-4172. ; 174:5, s. 1277-
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Tidskriftsartikel (refereegranskat)abstract
- Epidemiological data suggest that early life exposures are key determinants of immune-mediated disease later in life. Young children are also particularly susceptible to infections, warranting more analyses of immune system development early in life. Such analyses mostly have been performed in mouse models or human cord blood samples, but these cannot account for the complex environmental exposures influencing human newborns after birth. Here, we performed longitudinal analyses in 100 newborn children, sampled up to 4 times during their first 3 months of life. From 100 mu L of blood, we analyze the development of 58 immune cell populations by mass cytometry and 267 plasma proteins by immunoassays, uncovering drastic changes not predictable from cord blood measurements but following a stereotypic pattern. Preterm and term children differ at birth but converge onto a shared trajectory, seemingly driven by microbial interactions and hampered by early gut bacterial dysbiosis.
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| 8. |
- Svedenkrans, Jenny, et al.
(författare)
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Physical Activity in 6.5-Year-Old Children Born Extremely Preterm
- 2020
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Ingår i: Journal of Clinical Medicine. - : MDPI. - 2077-0383. ; 9:10
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Tidskriftsartikel (refereegranskat)abstract
- Physical activity (PA) can prevent cardiovascular diseases. Because of increased risks of impairments affecting motor activity, PA in children born preterm may differ from that in children born at term. In this prospective cohort study, we compared objectively measured PA in 71 children born extremely preterm (<27 weeks gestational age), to their 87 peers born at term, at 6.5 years of age. PA measured with accelerometer on the non-dominant wrist for 7 consecutive days was compared between index and control children and analyzed for associations to prenatal growth, major neonatal brain injury, bronchopulmonary dysplasia and neonatal septicemia, using ANOVA. Boys born extremely preterm spent on average 22 min less time per day in moderate to vigorous physical activity (MVPA) than control boys (95% CI: -8, -37). There was no difference in girls. Amongst children born extremely preterm, major neonatal brain injury was associated with 56 min less time in MVPA per day (95%CI: -88, -26). Subgroups of children born extremely preterm exhibit lower levels of physical activity which may be a contributory factor in the development of cardiovascular diseases as adults.
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