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1.
  • Berglund, Staffan K., et al. (författare)
  • Marginally low birth weight increases the risk of underweight and short stature at three and a half years of age
  • 2016
  • Ingår i: Acta Paediatrica. - : John Wiley & Sons. - 0803-5253 .- 1651-2227. ; 105:6, s. 610-617
  • Tidskriftsartikel (refereegranskat)abstract
    • AIM: Little is known about the long-term health of marginally low birth weight (LBW) children. This study characterised growth among infants weighing 2,000g-2,500g and explored the prevalence and predictors of sustained growth restriction.METHOD: This prospective observational trial followed the weight and height of 281 Swedish marginally LBW children from birth to 3.5 years of age. Children with a standard deviation score (SDS) for body mass index or height below -2 were considered underweight and short respectively.RESULTS: The mean SDS for weight and height showed a rapid increase before 12-19 weeks of age. The most rapid weight gain was in infants born small for gestational age. However, at 3.5 years of age, 9.5% of the children remained underweight and 6.5% had short stature. Regression models showed that slow weight gain before 19 weeks of age was the strongest predictor for lasting underweight, while slow height gain before 19 weeks of age and male sex were associated with short stature.CONCLUSION: Marginally LBW infants were more likely to be underweight and have a short stature at 3.5 years of age and the absence of catch-up growth during the first five months after birth identified those at highest risk.
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2.
  • Baraldi, Erika, 1982-, et al. (författare)
  • Clinical Protocol & Research Process of Stockholm Preterm Interaction-Based Intervention, SPIBI
  • 2019
  • Ingår i: Pediatric Research. - : Springer Science and Business Media LLC. - 0031-3998 .- 1530-0447. ; 86:Suppl., s. 54-55
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundExtremely preterm (EPT) born children are at increased risk of cognitive and neurodevelopmental impairment, neuropsychiatric disorders and academic difficulties. Parents of EPT born children are extra vulnerable for anxiety, posttraumatic stress disorder and depression and the parent-child interaction is negatively affected by prematurity. There is some evidence that early interventions have beneficial effects on neurocognitive and motor outcomes (Spittle A et al 2015). Based on a previous intervention (Verkerk G et al 2012) and adjusted to the Swedish context with 480 days paid parental leave, we created a post–discharge intervention, SPIBI, for families of EPT born children.MethodThe aim of (SPIBI) is to improve the quality of the parent-child interaction, child development and parental mental health in families with EPT born children. . SPIBI is a randomized controlled beginning at discharge and lasting until the child is 12 months corrected age. The trial design is a two arm randomized trial with four recruiting sites in Stockholm. Intervention group (target, n=65) receives 10 visits and two telephone calls from a trained interventionist and the control group (target n=65) receives treatment as usual plus an extended follow-up program. The SPIBI-team has recruited and trained 6 multi-professional and NICU-experienced interventionists. The training takes one year (0.2 of full time) and the content was both theoretical and practical, including pilot-cases. ResultSPIBI is an ongoing research project, beginning the 1st of September 2018 and planning to end recruitment the 31st of August 2020 and finishing the home-visits in August 2021. By the end of April 2019, 33 eligible infants had been identified within the four neonatal units in Stockholm; of which 26 children approved and 7 children declined participation. At this stage, three children have dropped out of the study, because of severe social challenges and child death. Identified challenges have been social and medical vulnerability of the EPT-families, finding the optimal multi-professional balance of motoric, psychological, pedagogical and medical kernels of the intervention, ethical considerations when to ask families for participation, lack of long-term discharge-planning of the neonatal units and large geographical spread of NICUs as well as families.ConclusionIn conclusion, the protocol seem to be feasible and appreciated by parents in the target group. With regard to the small recruitment base, trials of this kind needs a long inclusion time. Since EPT-children and their parents displays a wide scope of difficulties and challenges, multi-professional cooperation is preferable, placing high demands of sensitivity, professional respect and time for long collaborative processes.
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3.
  • Baraldi, Erika, 1982-, et al. (författare)
  • Early intervention program of extreme preterm born infants, status report three years into the project
  • 2021
  • Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
    • Children born extremely preterm (e.g. before 28 gestational weeks, EPT) runs a greater risk of cognitive, motor and neurobehavioral impairment later in life, compared to children born at term. Moreover, being a parent of an EPT born child increases the probability of developing depression and posttraumatic stress disorder post-partum, as well as the premature birth may affect the parent-child interaction negatively. In an attempt to decrease the psychological and motoric negative impact of both the child and parents, our multi-professional team has developed an early intervention during the first year at home focusing om parent-child interaction of the EPT born children: Stockholm Preterm Interaction-Based Intervention, SPIBI (Baraldi et al., 2020a). The target of the RCT is 130 children and after 32 months 112 children has been included in the study, evenly distributed in the intervention group and control group. At children’s corrected age of one-year, parents from 14 of the first included families were interviewed about their experiences from the intervention program, resulting in a qualitative article. Three main themes of parental experiences of the first year at home emerged: child-related concerns (concerning child medical state, self-regulation and recovery), parental inner state (concerning loneliness, ambivalence and premature parental identity), and changed family dynamics (concerning the couple, siblings and intergenerational support). The parents from the  intervention group reported that the intervention had given them security, a sense that the interventionist has been knowledgeable and in some cases that the program was important but not necessary to them (Baraldi et al., 2020b). With 85% of the targeted subjects included it is clear that an extensive early home-visit intervention program is feasible in the Swedish context, even though the pandemic has slowed down the recruitment pace and has forced adjustments to be made such as the use of telemedicine, exclusion of toys in the follow-up process and intensified hygienic procedures.
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4.
  • Baraldi, Erika, 1982-, et al. (författare)
  • Innovative multiprofessional early intervention aiming at improving development of prematurely born children
  • 2024
  • Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
    • Abstract: Extremely preterm born children and their parents is a vulnerable group with a high risk of developmental delays, academic challenges and parental mental health difficulties. Previously interventions have been medical focusing of increasing survival, but recently post-discharge interventions improving long-term development have been presented. This abstract concerns a novel multiprofroessional intervention, Stockholm Preterm Interaction-Based Intervention (SPIBI) aiming at consolidation of expertise from educational, behavioral and medical fields in benefit of the child development and family well-being.  Rationale and purpose: SPIBIs purpose is to enhance the parent-child interaction, child cognitive and motor development, child preschool social participation and parental mental health in families with extreme preterm born infants.Description of methods, results, or modes of inquiry: In a novel RCT a strengths-based post-discharge intervention targeting extreme preterm born (EPT= born before 28 gestational weeks) infants and their parents is being tested. 130 EPT born children and their parents have been randomly allocated to an intervention group receiving 10 home visits during the first year at home, or a control group receiving treatment as usual with an extended follow-up program. The novel intervention is named Stockholm Preterm Interaction-Based Intervention (SPIBI).Innovation: The field of long-term development of extremely born infants is innovative in itself, since the field consist of a severely vulnerable population on the verge of viability, who did not survive twenty years ago. The innovation in SPIBI is its consolidation of practical knowledge as well as research concerning the challenges of extreme prematurity from a medical (brain developmental), special educational (preschool behavioral), physiotherapeutic (motor), psychological (parent-child-interactional and cognitive) perspective. Working together will benefit the child and family as a whole, since extreme prematurity is a nuanced field with implications for several aspects of development. Despite this, previous international research from the field is almost always unidisciplinary.Implications for policy or practice: The outcome will influence practice at a regional and possible national level, concerning how a low cost early intervention may improve several outcomes and reduce challenges for a group of children with a high risk of developmental delays.Relationship to principles of diversity, equity, and inclusion: The extreme preterm born population often has double challenges, both concerning developmental delays and socioeconomic hardships, both internationally and in a Swedish context. Giving this vulnerable population initial extra support is ultimately a question of equity, increasing the chance of participating in fully inclusive learning environments ahead.Methods used to encourage audience engagement When presenting the poster, these 3 questions will be continuously discussed with researchers passing by:1.     What do parents to medically fragile infants who have been balancing on the verge of death, need when the family comes back home from the hospital?2.     What are the key elements of multidisciplinary and multiprofessional co-operation between medicine, psychology and special education?3.     What may be the different needs of different groups of families with extreme preterm born children, regarding socioeconomic background, severity of prematurity and migration statues?
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5.
  • Baraldi, Erika, 1982-, et al. (författare)
  • Insights Gained from Stockholm Preterm Interaction-Based Intervention - A Critical View
  • 2022
  • Konferensbidrag (refereegranskat)abstract
    • SPIBI is a strength-based early intervention targeting parent-child interaction amongst extremely preterm born infants, currently tested in an RCT in Sweden. Of 130 infants, 72% have reached 12 months of age. Based on interviews with 17 parents’ and 6 intervention providers we identified SPIBI strengths and shortcomings. SPIBI seems feasible, is possible to integrate it into home-visiting practice and is appreciated by parents. Identified challenges are geographical distance; recruitment obstacles including Covid-19, leading to longer-term implementation; service-provider fatigue; and social adversities amongst some eligible participants requiring ethical considerations. Future improvements include: reconsidering inclusion criteria, increasing use of e-health, and exploring the possibility of a tiered approach.
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7.
  • Baraldi, Erika, 1982-, et al. (författare)
  • Parents’ Experiences of the First Year at Home with an Infant Born Extremely Preterm with and without Post-Discharge Intervention : Ambivalence, Loneliness, and Relationship Impact
  • 2020
  • Ingår i: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1661-7827 .- 1660-4601. ; 17:24
  • Tidskriftsartikel (refereegranskat)abstract
    • With increasing survival rates of children born extremely preterm (EPT), before gestational week 28, the post-discharge life of these families has gained significant research interest. Quantitative studies of parental experiences post-discharge have previously reported elevated levels depressive symptoms, posttraumatic stress-disorder and anxiety among the parents. The current investigation aims to qualitatively explore the situation for parents of children born EPT in Sweden during the first year at home. Semi-structured interviews were performed with 17 parents of 14 children born EPT; eight parents were from an early intervention group and nine parents from a group that received treatment as usual, with extended follow-up procedures. Three main themes were identified using a thematic analytic approach: child-related concerns, the inner state of the parent, and changed family dynamics. Parents in the intervention group also expressed themes related to the intervention, as a sense of security and knowledgeable interventionists. The results are discussed in relation to different concepts of health, parent–child interaction and attachment, and models of the recovery processes. In conclusion, parents describe the first year at home as a time of prolonged parental worries for the child as well as concerns regarding the parent’s own emotional state.
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8.
  • Baraldi, Erika, 1982-, et al. (författare)
  • Stockholm Preterm Interaction-Based Intervention, SPIBI
  • 2019
  • Konferensbidrag (refereegranskat)abstract
    • BakgrundI Sverige föds mellan 300 och 400 barn innan den 28 graviditetsveckan. Omkring 2/3 av de extremt prematurfödda barnen har ingen eller en mild funktionsnedsättning medan 1/3 har medelsvår till svår funktionsnedsättning vid skolstart (Serenius et al, 2016). De vanligaste svårigheterna efter extrem prematur födsel är intellektuell funktionsnedsättning (Jarjour, 2015), i synnerhet svårigheter med arbetsminnet och den exekutiva funktionsutvecklingen (Stålnacke et al., 2018;  Mulder et al., 2009). Även neuropsykiatriska funktionsnedsättningar som ADHD (Burnett et al., 2014) och autism är överrepresenterade i gruppen prematurfödda barn, 8- 29% av de extremt prematurfödda barnen skattas positivs på screeningtest för AST (Johnson et al., 2010; Kim, 2016 & Padilla et al., 2015).Inte bara barnet påverkas av den extremt för tidiga födseln, även föräldrarna kastas snabbt in i ett stressigt föräldraskap till ett skört och ofta sjukt spädbarn som inte är som de föreställde sig under graviditeten. Dessa stressiga omständigheter bidrar till att föräldrarna löper en ökad risk för posttraumatisk stress och depressiva symtom än föräldrar till fullgångna barn (Holditch-Davis et al, 2003; Holditch-Davis et al, 2015; Kong et al., 2013 & Singer på al., 1999). Dessutom påverkas samspelet mellan föräldrar och barn och familjesituationen negativt (Forcada-Guex et al., 2006; Saigal et al., 2000 & Treyvaut et al., 2014). När en förälder är psykiskt labil påverkar detta barnet på ett socialt, beteendemässigt och funktionellt sätt, ända till det för tidigt föda barnet är i förskoleåldern (Huhtala et al., 2011 & Huhtala et al., 2014). Det ger därför dubbel utdelning att ta hand om föräldrarna till tidigt födda barn, både genom att påverka den vuxne direkt och barnet indirekt.Svenska Prematurförbundet (SPF) har under flera år pekat på de långsiktiga effekterna av för tidig födsel och därmed behovet av långsiktigt stöd till de drabbade familjerna (Prematurförbundet, 2019). Efter utskrivning från sjukhuset rapporterar många av föräldrarna att de känner sig ensamma, stressade och oroliga. Sådana stödprogram har inte införts eller utvärderats tidigare i Sverige.Sammanfattningsvis, utifrån risken för negativa långtidseffekter av extrem prematuritet samt Prematurförbundets önskan om ytterligare stöd, finns ett tydligt behov av interventioner riktade till barnen och deras föräldrar i syfte att stödja föräldra-barnsamspelet, barnets utveckling på sikt samt föräldrarnas psykiska hälsa. SPIBI är et interventionsprogram som ämnar fylla det behovet.MetodSPIBI består av en tvärprofessionell forskargrupp med neonatologer, psykologer, fysioterapeut och specialpedagog. Forskargruppen har designat en RCT i syfte att utvärdera effekten av ett samspelsbaserat interventionsprogram för extremt prematurfödda spädbarn och deras föräldrar, med sin början i utskrivningsprocessen som pågår under förta året hemma. Studien består av två armar, en interventionsgrupp och en kontrollgrupp, och barnen rekryteras från Stockholms fyra neonatalavdelningar under två års tid (sept 2018-sept 2020). Målet är att rekrytera 130 familjer på två år. Interventionsgruppen (IG) får 10 hembesök och två telefonsamtal från en specialutbildad behandlare. Interventionens fokus är styrkebaserat stöd av föräldra-barnsamspelet, öka förälderns lyhördhet för barnets signaler, stödja föräldern i att ge optimalt utvecklingsstöd till barnet samt öka barnets självreglerande förmåga. I det nationella uppföljningsprogrammet får alla extremt prematurfödda barn uppföljning vid 3 månader, 12 månader, 24 månader KÅ. Kontrollgruppens (KG) barn får utöver detta ett utökat uppföljningsprogram.  Studiens sex behandlare arbetar inom neontalvården till vardags och har utöver detta fått en ettårig utbildning i SPIBI en dag per vecka, med både teoretisk grund och praktisk träning i interventionen, inklusive sex pilotfallshembesök. Pilotfallen videofilmades och diskuterades i grupp under handledning. Handledningen gavs direkt av de två holländska forskarna Karen Koldewijn och Marie-Jeanne Wolf från Amsterdam Academic Medical Centre som forskat på den snarlika TOP-interventionen i över 20 år och kunnat påvisa effekt på motoriken (Koldewijn et al., 2009; Meijssen et al., 2011; Flierman et al., 2016 & Koldewijn et al., 2010). Grunden till SPIBI interventionen kom utöver TOP-programmet från Cochrane-rapporten från 2015 om post-discharge interventions (Spittle et al., 2015).ResultatSPIBI är ett pågående forskningsprojekt som hittills rekryterat 44 barn, medan ytterligare 12 familjer tackat nej till deltagande i studien. I nuläget har två barn uteslutits ur studien av svåra psykosociala skäl och ytterligare två barn har avlidit under första året hemma. Identifierade utmaningar har varit den sociala och medicinska skörhet som de här familjerna behöver hantera, att hitta den optimala tvärprofessionella balansen mellan fysioterapeutiska, psykologiska, pedagogiska och medicinska inslag i interventionen, otillräcklig utskrivningsplanering från de olika sjukhusen, stor geografisk spridning på sjukhusenheterna samt den etiska frågan när i barnets liv det optimala tillfället för frågan om studiedeltagande är. Eftersom rekryteringsprocessen idag kommit halvvägs tidsmässigt kan inga resultat presenteras än, men med ett 80 % deltagande i studien och mycket positiv återkoppling från familjerna kan man dra slutsatsen att denna forskning är efterfrågad och ett viktigt nästa steg i utvecklingen av vården för våra allra mest sköra patienter.SlutsatserSlutsatsen är att SPIBI-protokollet är både genomförbart i klinisk praxis och samtidigt uppskattat av föräldrarna i målgruppen. Med hänsyn taget till den smala rekryteringsbasen kan denna typ av studie kräva en lång inkluderingstid alternativt inkludering på nationell nivå. Eftersom extremt prematurfödda barn och deras föräldrar uppvisar en rad svårigheter och utmaningar, är tvärprofessionellt samarbete att föredra vilket ställer höga krav på lyhördhet, professionell respekt och got om tid för samarbete. På Perinataldagarna kan forskningsprocessen och interventionsprogrammet presenteras i syfte att öka förståelsen för uppföljningen och behovet av ett integrerat föräldrastöd.
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9.
  • Baraldi, Erika, 1982-, et al. (författare)
  • Stockholm preterm interaction-based intervention (SPIBI) - study protocol for an RCT of a 12-month parallel-group post-discharge program for extremely preterm infants and their parents
  • 2020
  • Ingår i: BMC Pediatrics. - : Springer Science and Business Media LLC. - 1471-2431. ; 20:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Improved neonatal care has resulted in increased survival rates among infants born after only 22 gestational weeks, but extremely preterm children still have an increased risk of neurodevelopmental delays, learning disabilities and reduced cognitive capacity, particularly executive function deficits. Parent-child interaction and parental mental health are associated with infant development, regardless of preterm birth. There is a need for further early interventions directed towards extremely preterm (EPT) children as well as their parents. The purpose of this paper is to describe the Stockholm Preterm Interaction-Based Intervention (SPIBI), the arrangements of the SPIBI trial and the chosen outcome measurements.Methods: The SPIBI is a randomized clinical trial that includes EPT infants and their parents upon discharge from four neonatal units in Stockholm, Sweden. Inclusion criteria are EPT infants soon to be discharged from a neonatal intensive care unit (NICU), with parents speaking Swedish or English. Both groups receive three initial visits at the neonatal unit before discharge during the recruitment process, with a strengths-based and development-supportive approach. The intervention group receives ten home visits and two telephone calls during the first year from a trained interventionist from a multi-professional team. The SPIBI intervention is a strengths-based early intervention programme focusing on parental sensitivity to infant cues, enhancing positive parent-child interaction, improving self-regulating skills and supporting the infant’s next small developmental step through a scaffolding process and parent-infant co-regulation. The control group receives standard follow-up and care plus extended assessment. The outcomes of interest are parent-child interaction, child development, parental mental health and preschool teacher evaluation of child participation, with assessments at 3, 12, 24 and 36 months corrected age (CA). The primary outcome is emotional availability at 12 months CA.Discussion: If the SPIBI shows positive results, it could be considered for clinical implementation for child-support, ethical and health-economic purposes. Regardless of the outcome, the trial will provide valuable information about extremely preterm children and their parents during infancy and toddlerhood after regional hospital care in Sweden.Trial registration: The study was registered in ClinicalTrials.gov in October 2018 (NCT03714633).
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10.
  • Baraldi, Erika, 1982-, et al. (författare)
  • The development of a post-discharge intervention program in Sweden for extremely preterm infants and their caregivers, through home visits during their first year of life
  • 2019
  • Konferensbidrag (refereegranskat)abstract
    • Sweden has a proactive neonatal intensive care, saving children born from gestation week 22, with a 90% survival rate in the extremely preterm (EPT) group. With increased survival rates, the long-term outcome of the EPT children has gained much research interest. Recent studies indicate that 1/3 of the EPT-children in Sweden show moderate to severe neurodevelopmental deficits when beginning school. An interdisciplinary research team has designed an intervention for EPT infants and their caregivers in their home-environment after hospital discharge and throughout the first year of life. The aim of the ongoing randomized controlled trial is to study intervention effects on the children’s cognitive, motor and psychosocial function, the parental mental health and the infant-parent interaction. This paper present the intervention’s theory of change, the validity considerations, and an overview of the syllabus of the training given to the interdisciplinary team of six clinicians who serve as interventionists. 
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11.
  • Berglund, Staffan, 1975-, et al. (författare)
  • Effects of iron supplementation of LBW infants on cognition and behavior at 3 years
  • 2013
  • Ingår i: Pediatrics. - : American Academy of Pediatrics (AAP). - 0031-4005 .- 1098-4275. ; 131, s. 47-55
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: Low birth weight (LBW) infants are at increased risk of cognitive and behavioral problems and at risk for iron deficiency, which is associated with impaired neurodevelopment. We hypothesized that iron supplementation of LBW infants would improve cognitive scores and reduce behavioral problems. METHODS: In a randomized controlled trial, 285 marginally LBW (2000-2500 g) infants received 0, 1, or 2 mg/kg/day of iron supplements from 6 weeks to 6 months of age. At 3.5 years of age, these infants and 95 normal birth weight controls were assessed with a psychometric test (Wechsler Preschool and Primary Scale of Intelligence) and a questionnaire of behavioral problems (Child Behavior Checklist; CBCL). RESULTS: There were no significant differences in IQ between the LBW groups or LBW infants versus controls. Mean (SD) full-scale IQ was 105.2 (14.5), 104.2 (14.7), and 104.5 (12.7) in the placebo, 1 mg, and 2 mg groups, respectively (P = .924). However, for behavioral problems, there was a significant effect of intervention. The prevalence of children with CBCL scores above the US subclinical cutoff was 12.7%, 2.9%, and 2.7% in the placebo, 1-mg, and 2-mg groups, respectively (P = .027), compared with 3.2% in controls. Relative risk (95% confidence interval) for CBCL score above cutoff in placebo-treated children versus supplemented was 4.5 (1.4-14.2). CONCLUSIONS: Early iron supplementation of marginally LBW infants does not affect cognitive functions at 3.5 years of age but significantly reduces the prevalence of behavioral problems. The study suggests a causal relation between infant iron deficiency and later behavioral problems.
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12.
  • Berglund, Staffan, 1975-, et al. (författare)
  • Effects of iron supplementation on serum hepcidin and serum erythropoietin in low-birth-weight infants
  • 2011
  • Ingår i: American Journal of Clinical Nutrition. - : American Society for Nutrition. - 0002-9165 .- 1938-3207. ; 94:6, s. 1553-1561
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: The iron-regulatory hormone hepcidin has not been studied in infants, who experience large physiologic changes in iron status. OBJECTIVE: The objective was to study hepcidin and erythropoietin and their correlation with iron status in iron-replete and iron-deficient low-birth-weight (LBW) infants-a group at particular risk of iron deficiency (ID). DESIGN: We randomly assigned 285 otherwise healthy LBW infants to receive, from 6 wk to 6 mo of age, 3 doses of iron supplements: 0 (placebo), 1, or 2 mg/kg daily. Hepcidin, erythropoietin, hemoglobin, and variables of iron status were analyzed. RESULTS: Serum hepcidin did not change over time in the placebo group, despite a rapid decrease in serum ferritin. In iron-supplemented infants, hepcidin increased significantly, reaching a mean (±SD) concentration of 19.2 ± 2.5 ng/mL in the 2-mg/kg group compared with 13.0 ± 2.6 ng/mL in the placebo group at age 6 mo (P < 0.001). The difference was even larger between iron-deficient and iron-replete infants. Hepcidin was independently positively correlated with ferritin at all ages and was negatively correlated with the transferrin receptor concentration at age 6 wk and with transferrin at age 6 mo. Erythropoietin was initially similar between groups but decreased significantly in iron-supplemented infants. In addition to being negatively correlated with hemoglobin, it was also independently negatively correlated with indicators of iron status. CONCLUSIONS: Hepcidin is closely associated with iron status and may be a useful indicator of iron stores and ID in infants. Erythropoietin is negatively correlated with iron status, which suggests a feedback mechanism that needs further study. This trial is registered at clinicaltrials.gov as NCT00558454.
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13.
  • Berglund, Staffan, 1975-, et al. (författare)
  • Iron supplements reduce the risk of iron deficiency anemia in marginally low birth weight infants
  • 2010
  • Ingår i: Pediatrics. - : American Academy of Pediatrics. - 0031-4005 .- 1098-4275. ; 126:4, s. e874-e883
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: Low birth weight infants are at risk for iron deficiency (ID). Most LBW infants have marginally low birth weight (MLBW, 2000–2500 g) and it is not known whether they benefit from iron supplements. The objective of this trial was to study the effects of iron supplementation in MLBW infants. METHOD: In a randomized controlled trial, we assigned 285 healthy, MLBW infants to receive iron supplements at a dose of 0 (placebo), 1, or 2 mg/kg per day between 6 weeks and 6 months of age. Hemoglobin levels, ferritin levels, transferrin saturation, mean cell volume, and transferrin receptor levels were analyzed at 6 months. Growth and morbidity were monitored. RESULTS: Iron supplementation resulted in significant dose-dependent effects on hemoglobin and all iron status indicators at 6 months. The prevalence of ID at 6 months was 36% in the placebo group, 8.2% in the 1 mg/kg per day group, and 3.8% in the 2 mg/kg per day group (P < .001). The prevalence rates of ID anemia (IDA) were 9.9%, 2.7%, and 0%, respectively (P = .004). Among infants who were exclusively breastfed at 6 weeks, the prevalence of IDA was 18% in the placebo group. There were no significant differences between groups in growth or morbidity. CONCLUSIONS: MLBW infants have relatively high risks of ID and IDA, especially if they are breastfed. Iron supplementation at 2 mg/kg per day from 6 weeks to 6 months reduces this risk effectively, with no short-term adverse effects on morbidity or growth.
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14.
  • Berglund, Staffan K., et al. (författare)
  • Effects of iron supplementation of low-birth-weight infants on cognition and behavior at 7 years : a randomized controlled trial
  • 2018
  • Ingår i: Pediatric Research. - New York : Nature Publishing Group. - 0031-3998 .- 1530-0447. ; 83, s. 111-118
  • Tidskriftsartikel (refereegranskat)abstract
    • Background Low-birth-weight infants (LBW) are at an increased risk of iron deficiency that has been associated with impaired neurodevelopment. We hypothesized that iron supplementation of LBW infants improves cognitive scores and reduces behavioral problems until school age.Methods We randomized 285 marginally LBW (2,000-2,500 g) infants to receive 0, 1, or 2 mg/kg/day of iron supplements from 6 weeks to 6 months of age. At 7 years of age, 205 participants were assessed regarding cognition using Wechsler Intelligence Scale for Children (WISC-IV) and behavior using the parental questionnaires Child Behavior Checklist (CBCL) and Five to Fifteen (FTF).Results There were no significant differences between the intervention groups in WISC-IV or FTF. However, the CBCL scores for externalizing problems were significantly different, in favor of supplemented children (P=0.045). When combining the supplemented groups, they had significantly lower scores for externalizing behavior compared with placebo (median (interquartile range): 44 [34;51] vs. 48.5 [41;56] P=0.013), and their risk ratio (95% confidence interval) for a total behavioral score above the cutoff for clinical problems was 0.31 (0.09-1.0), P=0.054.Conclusion Lower scores of externalizing behavior in supplemented children support our previous findings at 3 years, and suggest that iron supplementation may have long-lasting effects on behavioral functions.
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15.
  • Berglund, Staffan K, et al. (författare)
  • Iron Supplementation Until 6 Months Protects Marginally Low-Birth-Weight Infants From Iron Deficiency During Their First Year of Life
  • 2015
  • Ingår i: Journal of Pediatric Gastroenterology and Nutrition - JPGN. - : Lippincott Williams & Wilkins. - 0277-2116 .- 1536-4801. ; 60:3, s. 390-395
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: Low-birth-weight (LBW) infants (<2500 g) have an increased risk of iron deficiency (ID) during their first 6 months of life. The optimal dose and duration of iron supplementation to LBW infants are, however, unknown. The objective of the present study was to investigate the long-term effect on iron status and growth in marginally LBW (2000-2500 g) infants, of iron supplements given until 6 months of life. Methods: In a randomized controlled trial, 285 healthy marginally LBW infants received 0, 1, or 2 mg . kg(-1).day(-1) of iron supplements from 6 weeks to 6 months of age: At 12 months and 3.5 years of life we measured length, weight, head circumference, and indicators of iron status (hemoglobin, ferritin, mean corpuscular volume, and transferrin saturation) and assessed the prevalence of iron depletion, functional ID, and ID anemia. Results: At 12 months of age, there was a significant difference in ferritin between the groups (P = 0.00 6). Furthermore, there was a significant difference in the prevalence of iron depletion (23.7%, 10.6%, and 6.8%, respectively, in the placebo, 1-mg, and 2-mg groups, P = 0.009) and similar nonsignificant trends for functional ID and ID anemia. At 3.5 years of life there were no significant differences in iron status and the mean prevalence of iron depletion was 3.2%. Anthropometric data were not affected by the intervention. Conclusions: Iron supplements with 2 mg . kg(-1) . day(-1) until 6 months of life effectively reduces the risk of ID during the first 12 months of life and is an effective intervention for preventing early ID in marginally LBW infants.
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16.
  • Lindberg, Josefine, et al. (författare)
  • Lower systolic blood pressure at age 7 y in low-birth-weight children who received iron supplements in infancy : results from a randomized controlled trial
  • 2017
  • Ingår i: American Journal of Clinical Nutrition. - : Elsevier BV. - 0002-9165 .- 1938-3207. ; 106:2, s. 475-480
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Low birth weight (LBW) (≤2500 g) is associated with iron deficiency in infancy and high blood pressure (BP) later in life.Objective: We investigated the effect of iron supplementation that was given to LBW infants on midchildhood BP.Design: The study was a randomized, double-blind, controlled trial that included 285 marginally LBW (2000–2500-g) infants at 2 Swedish centers between May 2004 and November 2007. The infants were randomly assigned to receive a placebo or 1 or 2 mg Fe · kg−1 · d−1 from 6 wk to 6 mo of age. In secondary analyses at the age of 7 y, systolic blood pressure (SBP), diastolic blood pressure (DBP), and the prevalence of children with BP within the hypertensive range (>90th percentile) were compared between the groups.Results: BP was analyzed via intention to treat in 189 children (66%). The mean ± SD SBP was 103 ± 8.1, 101 ± 7.5, and 101 ± 7.8 mm Hg in children who had received the placebo (n = 70), 1 mg Fe · kg−1 · d−1 (n = 54), or 2 mg Fe · kg−1 · d−1 (n= 65), respectively. When the iron-supplemented groups were combined in covariate-adjusted analyses, the mean SBP in LBW children who had received iron supplementation in infancy was 2.2 mm Hg (95% CI: 0.3, 4.2 mm Hg) lower than in those who were unsupplemented (P = 0.026). Multivariate logistic regression showed that iron supplementation in infancy reduced the odds of having an SBP within the hypertensive range at 7 y of age (OR: 0.32; 95% CI: 0.11, 0.96). For DBP, there were no significant differences between the intervention groups.Conclusions: LBW children who receive iron supplementation (1 or 2 mg Fe · kg−1 · d−1) in infancy have lower SBP at 7 y. This (to our knowledge) novel observation suggests that the increased risk of hypertension that is observed in children and adults who are born small might be reduced with early micronutrient interventions.
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17.
  • Lindberg, Josefine, et al. (författare)
  • Overweight, obesity, and body composition in 3.5-and 7-year-old Swedish children born with marginally low birth weight
  • 2015
  • Ingår i: The Journal of Pediatrics. - : Elsevier. - 0022-3476 .- 1097-6833. ; 167:6, s. 1246-1252.e3
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: To assess the prevalence of overweight/obese children and to explore body composition in a Swedish cohort of preschool children born with marginally low birth weight (MLBW, ie, 2000-2500 g).Study design: We included 285 Swedish children with MLBW (44% small for gestational age), and 95 control children with normal birth weights. At 3.5 years and 7 years of age, we assessed anthropometrics, including the prevalence of overweight/obese children. At 7 years, dual-energy X-ray was used for body composition.Results: There were no significant differences between groups in the prevalence of overweight/obesity or in skinfold thickness; however, at 3.5 years, mean height, weight, and BMI in children with MLBW were 2.1 cm (95% CI 1.2-3.1), 1.2 kg (95% CI 0.7-1.6), and 0.47 kg/m(2) (95% CI 0.17-0.76) lower compared with controls. The corresponding mean differences also were lower in children with MLBW compared with control children at 7 years; 2.5 cm (95% CI 0.9-4.1), 1.6 kg (95% CI 0.6-2.8), and 0.48 kg/m(2) (95% CI 0.01-0.94). The differences were greater in those born small for gestational age. Dual-energy X-ray analyses showed lower fat-free mass index in MLBW infants and a similar trend in fat mass index. Within children with MLBW, BMI at 7 years correlated positively to growth velocity in infancy.Conclusion: Children with MLBW had lower BMI and did not show increased risk of overweight or obesity up to 7 years. Nevertheless, the BMI in MLBW children was positively correlated to growth-velocity in infancy.
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18.
  • Mörelius, Evalotte, 1965-, et al. (författare)
  • The Stockholm Neonatal Family-Centered Care Study : Effects on Salivary Cortisol in Infants and their Mothers
  • 2011
  • Konferensbidrag (refereegranskat)abstract
    • BACKGROUND: Parental involvement in the care of preterm infants in neonatal intensive care units (NICUs) is common, but little is known about the effect on stress responses in mothers and infants.AIMS:To evaluate the effect of family-centered care on salivary cortisol reactivity in mothers and preterm infants and the correlation between the mothers’ and the preterm infants’ salivary cortisol levels.METHODS:This study is part of a randomized controlled trial conducted at two level-II NICUs, including Family Care (FC), where parents were able to stay 24 hours/day from admission to discharge, and Standard Care (SC). To investigate the cortisol response, saliva was collected from 289 preterm infants and their mothers before and after a diaper change at the time of discharge.RESULTS:No significant differences were found between the two groups in salivary cortisol reactivity, either in mothers or in infants. The results revealed a correlation between preterm infants’ and their mothers’ baseline and response cortisol in the FC group: r=0.31 (p=0.001) and r=0.24 (p=0.01), respectively. Such correlation was not observed in the SC group: r=0.14 (p=0.14) and r=0.18 (p=0.07), respectively.CONCLUSIONS: Family-centered care had no effect on salivary cortisol reactivity during diaper change. However, sharing the same environment may increase the concordance between preterm infants’ and their mothers’ salivary cortisol levels.
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19.
  • Mörelius, Evalotte, et al. (författare)
  • The Stockholm Neonatal Family-Centered Care Study : Effects on salivary cortisol in infants and their mothers
  • 2012
  • Ingår i: Early Human Development. - : Elsevier. - 0378-3782 .- 1872-6232. ; 88:7, s. 575-581
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Parental involvement in the care of preterm infants in neonatal intensive care units (NICUs) is common, but little is known about the effect on stress responses in mothers and infants. Aims: The aim of this study is to evaluate the effect of family-centered care on salivary cortisol reactivity in mothers and preterm infants and the correlation between the mothers and the preterm infants salivary cortisol levels. Methods: This study is part of a randomized controlled trial conducted at two level-II NICUs, including Family Care (FC), where parents were able to stay 24 h/day from admission to discharge, and Standard Care (SC). To investigate the cortisol response, saliva was collected from 289 preterm infants and their mothers before and after a diaper change at the time of discharge. Results: No significant differences were found between the two groups in salivary cortisol reactivity, either in mothers or in infants. The results revealed a correlation between preterm infants and their mothers baseline and response cortisol in the FC group: r = 0.31 (p = 0.001) and r = 0.24 (p = 0.01), respectively. Such correlation was not observed in the SC group: r = 0.14 (p = 0.14) and r = 0.18 (p = 0.07), respectively. Conclusions: Family-centered care had no effect on salivary cortisol reactivity during diaper change. However, sharing the same environment may increase the concordance between preterm infants and their mothers salivary cortisol levels.
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20.
  • Raiskila, Simo, et al. (författare)
  • Parents' presence and parent-infant closeness in 11 neonatal intensive care units in six European countries vary between and within the countries
  • 2017
  • Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 106:6, s. 878-888
  • Tidskriftsartikel (refereegranskat)abstract
    • Aim: Little is known about the amount of physical parent-infant closeness in neonatal intensive care units (NICUs), and this study explored that issue in six European countries.Methods: The parents of 328 preterm infants were recruited in 11 NICUs in Finland, Estonia, Sweden, Norway, Italy and Spain. They filled in daily diaries about how much time they spent in the NICU, in skin-to-skin contact (SSC) and holding their babies in the first two weeks of their hospitalisation.Results: The parents' NICU presence varied from a median of 3.3 (minimum 0.7-maximum 6.7) to 22.3 (18.7-24.0) hours per day (p < 0.001), SSC varied from 0.3 (0-1.4) to 6.6 (2.2-19.5) hours per day (p < 0.001) and holding varied from 0 (0-1.5) to 3.2 (0-7.4) hours per day (p < 0.001). Longer SSC was associated with singleton babies and more highly educated mothers. Holding the baby for longer was associated with gestational age. The most important factor supporting parent-infant closeness was the opportunity to stay overnight in the NICU. Having other children and the distance from home to the hospital had no impact on parent-infant closeness.Conclusion: Parents spent more time in NICUs if they could stay overnight, underlining the importance that these facilities play in establishing parent-infant closeness.
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21.
  • Starnberg, Josefine, 1991-, et al. (författare)
  • Early signs of cardiovascular risk at 7 years of age in children born with marginally low birth weight
  • Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
    • Background: Low birth weight (LBW, <2500 g) may predict an increased risk of an adverse cardiovascular profile later in life, but the magnitude in different settings and age at appearance are still unclear. We explored laboratory markers of cardiovascular risk inchildren born with marginally LBW (2000-2500 g).Methods: This was a prospective observational study including 285 Swedish marginally LBW children and 95 normal birth weight (NBW, 2501-4500 g) controls. At 3.5 and 7 years of age, blood samples for glucose, insulin, homeostatic model assessment for insulin resistance (HOMA-IR), high-sensitive C-reactive protein (hs-CRP), cholesterol, triglycerides, high- and low-density lipoprotein (HDL and LDL), apolipoprotein B (ApoB) and apolipoprotein A1 (ApoA1) were assessed and compared between the groups.Results: No significant differences in levels of insulin, HOMA-IR, hs-CRP or blood lipids were observed between marginally LBW and NBW children. However, at 7 years there was a higher proportion of marginally LBW children with elevated levels of insulin, defined as above the 90th percentile of the control group (21 % vs 8.6 %, p=0.038). Furthermore, in marginally LBW children born small for gestational age, fasting glucose was significantly higher compared to controls (4.7 vs 4.5 mmol/L, p=0.020).Conclusions: While there were no significant differences in lipid profile or hs-CRP between marginally LBW children and controls, marginally LBW children showed, already at age 7, increased prevalence of elevated insulin levels, partly confounded by maternal birth country. The results indicate that a long-term risk of imbalanced glucose homeostasis is present, also in this common group of LBW children.
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22.
  • Starnberg, Josefine, 1991-, et al. (författare)
  • Lower cognitive test scores at age 7 in children born with marginally low birth weight
  • 2018
  • Ingår i: Pediatric Research. - : Nature Publishing Group. - 0031-3998 .- 1530-0447. ; 83:6, s. 1129-1135
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Being born with very low birth weight (<1500 g) is associated with poorer neurocognition later in life. The aim of this study was to explore neurodevelopmental functions in those born with marginally LBW (2000–2500 g).Methods: This was originally a randomized controlled trial investigating the effects of early iron supplementation in 285 marginally LBW children. Herein, we explored the combined marginally LBW group and compared their results to 95 normal birth weight (NBW; 2501–4500 g) controls in an observational design. At 7 years, a pediatric psychologist tested the children using Wechsler Intelligence Scale for Children (WISC IV), Beery–Buktenica developmental test of Visual–Motor Integration (Beery VMI), and Test of Everyday Attention for Children (TEA-Ch).Results: The marginally LBW children had lower verbal comprehension intelligence quotient (IQ) (104 vs. 107, P=0.004), lower VMI scores (96.5 vs. 100, P=0.028), and lower total mean TEA-Ch scores (8.5 vs. 9.7, P=0.006), compared to controls. Also, the marginally LBW children group had a higher proportion of children below −1 SD for VMI and TEA-Ch.Conclusions: Marginally LBW children had lower verbal comprehension IQ, lower visual–motor integration, and lower attention performance than NBW children, suggesting an increased risk of cognitive difficulties in early school age
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23.
  •  
24.
  • Ullsten, Alexandra, 1967-, et al. (författare)
  • Efficacy of Live Lullaby Singing During Procedural Pain in Preterm and Term Neonates
  • 2017
  • Konferensbidrag (refereegranskat)abstract
    • Background: Acute and repeated pain has long-term negative impact on infants’ development and future behaviour. The use of analgesic drugs has negative side-effects, which emphasizes the need for complementary approaches to pain management.Aim: This study is the first clinical trial measuring if live lullaby singing can influence behavioural and physiological pain responses during venepuncture in preterm and term neonates.Method: Preterm and term infants (n=38) were subjected to venepuncture with and without live lullaby singing, in a randomised order with a cross over design. Parent-preferred lullabies were performed live and standard care was provided for all neonates. Behavioural and physiological pain responses were assessed.Results: The live lullaby singing did not show a statistically significant effect on the infants’ pain score. There was a significantly calmer breathing pattern in the lullaby intervention versus the control condition in the pre-needle stage. There were non-significant indications of fewer and shorter skin punctures with lullaby singing.Conclusions: The additive effect of live lullaby singing has not been shown to alleviate infants’ behavioural pain responses during venepuncture; however nor has it been shown to be harmful. More research is needed to explore the potential benefits of music therapy including the role of the parents.
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25.
  • Ullsten, Alexandra, 1967-, et al. (författare)
  • Efficacy of Live Lullaby Singing During Procedural Pain in Preterm and Term Neonates
  • 2017
  • Ingår i: Music and Medicine. - : PKP Publishing Services. - 1943-8621 .- 1943-863X. ; 9:2, s. 73-85
  • Tidskriftsartikel (refereegranskat)abstract
    • This clinical trial tested the pain relieving effect of live lullaby singing on behavioral and physiological pain responses during venepuncture in 38 preterm and full term neonates. Acute and repeated pain, as well as the use of analgesic drugs, may have long-term negative impact on infants’ development and future behaviour. This emphasizes the need for complementary approaches to pain management such as music therapy.Parent-preferred lullabies were performed live and standard care was provided for all neonates. Behavioral responses with regard to pain were assessed with Premature Infant Pain Profile-Revised (PIPP-R) and Behavioral Indicators of Infant Pain (BIIP). Heart rate, respiratory rate and oxygen saturation were measured each tenth second.Although the live lullaby singing did not show a statistically significant effect on the infants’ pain score, there was a significantly calmer breathing pattern in the lullaby intervention versus the control condition in the pre-needle stage, showing a non-significant trend towards higher oxygen saturation levels and calmer heart rate in the lullaby intervention versus the control condition in the pre-needle stage. There were non-significant indications of fewer and shorter skin punctures with lullaby singing. More research is needed to explore such positive trends in the data.
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