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Sökning: L773:1359 2998 OR L773:1468 2052

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1.
  • Hellgren, K., et al. (författare)
  • Visual and cerebral sequelae of very low birth weight in adolescents
  • 2007
  • Ingår i: Arch Dis Child Fetal Neonatal Ed. - : BMJ. - 1359-2998 .- 1468-2052. ; 92:4
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: To describe the visual functions and relate them to MRI findings and the intellectual level in adolescents born with very low birth weight (VLBW). DESIGN: Population-based case-control study. PATIENTS: 59 15-year-old VLBW adolescents and 55 sex and age-matched controls with normal birth weight. MAIN OUTCOME MEASURES: Objective clinical findings (visual acuity, stereo acuity and cycloplegic refraction) were recorded. Structured history taking was used to identify visual difficulties. The intellectual level was assessed with the Wechsler Intelligence Scale for Children (WISC). All VLBW adolescents underwent MRI of the brain. RESULTS: Significant differences were found between the VLBW adolescents and controls regarding visual acuity (median -0.11 and -0.2, respectively; p=0.004), stereo acuity (median 60'' and 30'', respectively; p<0.001), prevalence of astigmatism (11/58 and 0/55, respectively; p<0.001) and in full-scale IQ (mean IQ 85 and 97, respectively; p<0.001) and performance IQ (mean 87 and 99, respectively; p=0.002). The structured history also revealed a borderline significant difference between the groups (mean problems 0.46 and 0.15 respectively; p=0.051). 30% (17/57) of the VLBW adolescents had abnormal MRI findings and performed worse in all tests, compared with both the VLBW adolescents without MRI pathology and the normal controls. CONCLUSION: This study confirms previous observations that VLBW adolescents are at a disadvantage regarding visual outcome compared with those with normal birth weight. In 47%, visual dysfunction was associated with abnormal MRI findings and in 33% with learning disabilities. The adolescents with abnormal MRI findings had more pronounced visual and cognitive dysfunction. The findings indicate a cerebral causative component for the visual dysfunction seen in the present study.
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  • Baldursdottir, S, et al. (författare)
  • Basic principles of neonatal bubble CPAP: effects on CPAP delivery and imposed work of breathing when altering the original design
  • 2020
  • Ingår i: Archives of disease in childhood. Fetal and neonatal edition. - : BMJ. - 1468-2052 .- 1359-2998. ; 105:5, s. 550-554
  • Tidskriftsartikel (refereegranskat)abstract
    • The original bubble continuous positive airway pressure (bCPAP) design has wide-bore tubing and a low-resistance interface. This creates a stable airway pressure that is reflected by the submersion depth of the expiratory tubing. Several systems with alterations to the original bCPAP design are now available. Most of these are aimed for use in low-income and middle-income countries and have not been compared with the original design.ObjectiveWe identified three major alterations to the original bCPAP design: (1) resistance of nasal interface, (2) volume of dead space and (3) diameter of expiratory tubing. Our aim was to study the effect of these alterations on CPAP delivery and work of breathing in a mechanical lung model. Dead space should always be avoided and was not further tested.MethodsThe effect of nasal interface resistance and expiratory tubing diameter was evaluated with simulated breathing in a mechanical lung model without interface leakage. The main outcome was delivered CPAP and imposed work of breathing.ResultsHigh-resistance interfaces and narrow expiratory tubing increased the work of breathing. Additionally, narrow expiratory tubing resulted in higher CPAP levels than indicated by the submersion depth.ConclusionOur study shows the significant effect on CPAP delivery and imposed work of breathing when using high-resistance interfaces and narrow expiratory tubing in bCPAP systems. New systems should include low-resistance interfaces and wide-bore tubing and be compared with the original bCPAP. Referring to all systems that bubble as bCPAP is misleading and potentially hazardous.
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5.
  • Binotti, M, et al. (författare)
  • Heart rate assessment using NeoTapAdvancedSupport: a simulation study
  • 2019
  • Ingår i: Archives of disease in childhood. Fetal and neonatal edition. - : BMJ. - 1468-2052 .- 1359-2998. ; 104:4, s. F440-F442
  • Tidskriftsartikel (refereegranskat)abstract
    • NeoTapAdvancedSupport (NeoTapAS) is a mobile application, based on a screen tapping method that calculates the heart rate (HR). We aimed to evaluate the accuracy of NeoTapAS in reliably determining HR from auscultation in a high-fidelity simulated newborn resuscitation scenario.MethodsPaediatric residents assessed HR by auscultation plus NeoTapAS in an asphyxiated term infant scenario and orally communicated the estimated HR. An external observer simultaneously documented the actual HR set in the manikin and the communicated HR.ResultsOne hundred and sixty HR measurements were recorded. The agreement between communicated and set HR was good (Cohen’s kappa 0.80, 95% CI 0.72 to 0.87; Bangdiwala’s weighted agreement strength statistic 0.93). Bland-Altman plot showed a mean difference between communicated and set HR values of 1 beats per minute (bpm) (95% agreement limits −9 to 11 bpm).ConclusionNeoTapAS showed a good accuracy in estimating HR and it could be an important resource in settings with limited availability of ECG monitor.
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  • Bonamy, AKE, et al. (författare)
  • Wide variation in severe neonatal morbidity among very preterm infants in European regions
  • 2019
  • Ingår i: Archives of disease in childhood. Fetal and neonatal edition. - : BMJ. - 1468-2052 .- 1359-2998. ; 104:1, s. F36-F45
  • Tidskriftsartikel (refereegranskat)abstract
    • To investigate the variation in severe neonatal morbidity among very preterm (VPT) infants across European regions and whether morbidity rates are higher in regions with low compared with high mortality rates.DesignArea-based cohort study of all births before 32 weeks of gestational age.Setting16 regions in 11 European countries in 2011/2012.PatientsSurvivors to discharge from neonatal care (n=6422).Main outcome measuresSevere neonatal morbidity was defined as intraventricular haemorrhage grades III and IV, cystic periventricular leukomalacia, surgical necrotizing enterocolitis and retinopathy of prematurity grades ≥3. A secondary outcome included severe bronchopulmonary dysplasia (BPD), data available in 14 regions. Common definitions for neonatal morbidities were established before data abstraction from medical records. Regional severe neonatal morbidity rates were correlated with regional in-hospital mortality rates for live births after adjustment on maternal and neonatal characteristics.Results10.6% of survivors had a severe neonatal morbidity without severe BPD (regional range 6.4%–23.5%) and 13.8% including severe BPD (regional range 10.0%–23.5%). Adjusted inhospital mortality was 13.7% (regional range 8.4%–18.8%). Differences between regions remained significant after consideration of maternal and neonatal characteristics (P<0.001) and severe neonatal morbidity rates were not correlated with mortality rates (P=0.50).ConclusionSevere neonatal morbidity rates for VPT survivors varied widely across European regions and were independent of mortality rates.
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8.
  • Boyle, Breidge, et al. (författare)
  • Estimating Global Burden of Disease due to congenital anomaly : An analysis of European data
  • 2018
  • Ingår i: Archives of Disease in Childhood: Fetal and Neonatal Edition. - : BMJ. - 1359-2998 .- 1468-2052. ; 103:1, s. 22-28
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective To validate the estimates of Global Burden of Disease (GBD) due to congenital anomaly for Europe by comparing infant mortality data collected by EUROCAT registries with the WHO Mortality Database, and by assessing the significance of stillbirths and terminations of pregnancy for fetal anomaly (TOPFA) in the interpretation of infant mortality statistics. Design, setting and outcome measures EUROCAT is a network of congenital anomaly registries collecting data on live births, fetal deaths from 20 weeks' gestation and TOPFA. Data from 29 registries in 19 countries were analysed for 2005-2009, and infant mortality (deaths of live births at age <1 year) compared with the WHO Mortality Database. Eight EUROCAT countries were excluded from further analysis on the basis that this comparison showed poor ascertainment of survival status. Results According to WHO, 17%-42% of infant mortality was attributed to congenital anomaly. In 11 EUROCAT countries, average infant mortality with congenital anomaly was 1.1 per 1000 births, with higher rates where TOPFA is illegal (Malta 3.0, Ireland 2.1). The rate of stillbirths with congenital anomaly was 0.6 per 1000. The average TOPFA prevalence was 4.6 per 1000, nearly three times more prevalent than stillbirths and infant deaths combined. TOPFA also impacted on the prevalence of postneonatal survivors with non-lethal congenital anomaly. Conclusions By excluding TOPFA and stillbirths from GBD years of life lost (YLL) estimates, GBD underestimates the burden of disease due to congenital anomaly, and thus declining YLL over time may obscure lack of progress in primary, secondary and tertiary prevention.
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  • Carbajal, Ricardo, et al. (författare)
  • Sedation and analgesia for neonates in NICUs across the United Kingdom : The Europain survey.
  • 2014
  • Ingår i: Archives of Disease in Childhood. - London, United Kingdom : BMJ Group. - 1359-2998 .- 1468-2052. ; 99 (Suppl 1), s. A62-A62
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Pain and stress induced by mechanical ventilation, invasive procedures, or painful diseases supports the use of sedation/analgesia (S/A) in newborns admitted to Neonatal Units (NNUs). To date, these practices have not been studied on a large scale.Objective: To determine current clinical practices regarding the use of S/A drugs in NNUs across the United Kingdom (UK).Design/Methods: A European epidemiological observational study on clinical practices regarding bedside use of S/A collected data for all neonates in participating NNUs until the infant left the unit (discharge, death, transfer) or for up to 28 days. Data collection occurred via an online database for 1 month at each NNU. Neonates up to 44 weeks gestation were included.Results: From February 2013 to May 2013, 66 UK NNUs collected data on 2691 eligible neonates. Of these, 713 received tracheal ventilation and 1978 had spontaneous breathing or non-invasive ventilation. The median (IQR) gestational age of ventilated neonates [32.1 (27.9-38.6)] was lower than for non-ventilated neonates [37.0 (34.1-39.7), p < 0.001]. Overall, more ventilated neonates [83.0% (n = 592)] received S/A drugs than non-ventilated neonates [7.4% (n = 147); p < 0.001]. The table shows S/A drugs used in ventilated neonates. fetalneonatal;99/Suppl_1/A62-b/T1T1T1 Abstract PC.77 Table   Ventilated and S/A, n = 592 Non-ventilated, and S/A n = 147 Fentanyl 105 (17.7%) 4 (2;7%) Midazolam 55 (9.3%) 3 (2.0%) Paracetamol 17 (2.9%) 92 (62.6%) Morphine 592 (91.6%) 44 (29.9%) Sufentanil 2 (0.3%) 0 Neuroblocker 352 (59.4%) 0 CONCLUSIONS: Most ventilated but few non-ventilated neonates receive S/A therapy in UK NNUs. Wide variations in rates of S/A use and drugs used exist among centres.
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10.
  • Challis, Pontus, et al. (författare)
  • Factors associated with the increased incidence of necrotising enterocolitis in extremely preterm infants in Sweden between two population-based national cohorts (2004-2007 vs 2014-2016)
  • 2024
  • Ingår i: Archives of Disease in Childhood-Fetal and Neonatal Edition. - : BMJ Publishing Group Ltd. - 1359-2998 .- 1468-2052. ; 109, s. 87-93
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective To investigate potential risk factors behind the increased incidence of necrotising enterocolitis (NEC) in Swedish extremely preterm infants.Design Registry data from two population-based national cohorts were studied. NEC diagnoses (Bell stage >= II) were validated against hospital records.Patients All liveborn infants <27 weeks of gestation 2004-2007 (n=704) and 2014-2016 (n=895) in Sweden.Main outcome measures NEC incidence.Results The validation process resulted in a 28% reduction of NEC cases but still confirmed a higher NEC incidence in the later epoch compared with the earlier (73/895 (8.2%) vs 27/704 (3.8%), p=0.001), while the composite of NEC or death was lower (244/895 (27.3%) vs 229/704 (32.5%), p=0.022). In a multivariable Cox regression model, censored for mortality, there was no significant difference in early NEC (0-7 days of life) between epochs (HR=0.9 (95% CI 0.5 to 1.9), p=0.9), but being born in the later epoch remained an independent risk factor for late NEC (>7 days) (HR=2.7 (95% CI 1.5 to 5.0), p=0.001). In propensity score analysis, a significant epoch difference in NEC incidence (12% vs 2.8%, p<0.001) was observed only in the tertile of infants at highest risk of NEC, where the 28-day mortality was lower in the later epoch (35% vs 50%, p=0.001). More NEC cases were diagnosed with intramural gas in the later epoch (33/73 (45.2%) vs 6/26 (23.1%), p=0.047).Conclusions The increase in NEC incidence between epochs was limited to cases occurring after 7 days of life and was partly explained by increased survival in the most extremely preterm infants. Misclassification of NEC is common.
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11.
  • Challis, Pontus, et al. (författare)
  • Factors associated with the increased incidence of necrotising enterocolitis in extremely preterm infants in Sweden between two population-based national cohorts (2004-2007 vs 2014-2016)
  • 2024
  • Ingår i: Archives of Disease in Childhood. - : BMJ Publishing Group Ltd. - 1359-2998 .- 1468-2052. ; 109:1, s. 87-93
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective To investigate potential risk factors behind the increased incidence of necrotising enterocolitis (NEC) in Swedish extremely preterm infants.Design Registry data from two population-based national cohorts were studied. NEC diagnoses (Bell stage >= II) were validated against hospital records.Patients All liveborn infants <27 weeks of gestation 2004-2007 (n=704) and 2014-2016 (n=895) in Sweden.Main outcome measures NEC incidence.Results The validation process resulted in a 28% reduction of NEC cases but still confirmed a higher NEC incidence in the later epoch compared with the earlier (73/895 (8.2%) vs 27/704 (3.8%), p=0.001), while the composite of NEC or death was lower (244/895 (27.3%) vs 229/704 (32.5%), p=0.022). In a multivariable Cox regression model, censored for mortality, there was no significant difference in early NEC (0-7 days of life) between epochs (HR=0.9 (95% CI 0.5 to 1.9), p=0.9), but being born in the later epoch remained an independent risk factor for late NEC (>7 days) (HR=2.7 (95% CI 1.5 to 5.0), p=0.001). In propensity score analysis, a significant epoch difference in NEC incidence (12% vs 2.8%, p<0.001) was observed only in the tertile of infants at highest risk of NEC, where the 28-day mortality was lower in the later epoch (35% vs 50%, p=0.001). More NEC cases were diagnosed with intramural gas in the later epoch (33/73 (45.2%) vs 6/26 (23.1%), p=0.047).Conclusions The increase in NEC incidence between epochs was limited to cases occurring after 7 days of life and was partly explained by increased survival in the most extremely preterm infants. Misclassification of NEC is common.
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  • Chevallier, M, et al. (författare)
  • Mortality and significant neurosensory impairment in preterm infants: an international comparison
  • 2022
  • Ingår i: Archives of disease in childhood. Fetal and neonatal edition. - : BMJ. - 1468-2052 .- 1359-2998. ; 107:3, s. 317-323
  • Tidskriftsartikel (refereegranskat)abstract
    • To compare mortality and rates of significant neurosensory impairment (sNSI) at 18–36 months’ corrected age in infants born extremely preterm across three international cohorts.DesignRetrospective analysis of prospectively collected neonatal and follow-up data.SettingThree population-based observational cohort studies: the Australian and New Zealand Neonatal Network (ANZNN), the Canadian Neonatal and Follow-up Networks (CNN/CNFUN) and the French cohort Etude (Epidémiologique sur les Petits Ages Gestationnels: EPIPAGE-2).PatientsExtremely preterm neonates of <28 weeks’ gestation in year 2011.Main outcome measuresPrimary outcome was composite of mortality or sNSI defined by cerebral palsy with no independent walking, disabling hearing loss and bilateral blindness.ResultsOverall, 3055 infants (ANZNN n=960, CNN/CNFUN n=1019, EPIPAGE-2 n=1076) were included in the study. Primary composite outcome rates were 21.3%, 20.6% and 28.4%; mortality rates were 18.7%, 17.4% and 26.3%; and rates of sNSI among survivors were 4.3%, 5.3% and 3.3% for ANZNN, CNN/CNFUN and EPIPAGE-2, respectively. Adjusted for gestational age and multiple births, EPIPAGE-2 had higher odds of composite outcome compared with ANZNN (OR 1.71, 95% CI 1.38 to 2.13) and CNN/CNFUN (OR 1.72, 95% CI 1.39 to 2.12). EPIPAGE-2 did have a trend of lower odds of sNDI but far short of compensating for the significant increase in mortality odds. These differences may be related to variations in perinatal approach and practices (and not to differences in infants’ baseline characteristics).ConclusionsComposite outcome of mortality or sNSI for extremely preterm infants differed across high-income countries with similar baseline characteristics and access to healthcare.
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  • Cuttini, M, et al. (författare)
  • Breastfeeding outcomes in European NICUs: impact of parental visiting policies
  • 2019
  • Ingår i: Archives of disease in childhood. Fetal and neonatal edition. - : BMJ. - 1468-2052 .- 1359-2998. ; 104:2, s. F151-
  • Tidskriftsartikel (refereegranskat)abstract
    • The documented benefits of maternal milk for very preterm infants have raised interest in hospital policies that promote breastfeeding. We investigated the hypothesis that more liberal parental policies are associated with increased breastfeeding at discharge from the neonatal unit.DesignProspective area-based cohort study.SettingNeonatal intensive care units (NICUs) in 19 regions of 11 European countries.PatientsAll very preterm infants discharged alive in participating regions in 2011–2012 after spending >70% of their hospital stay in the same NICU (n=4407).Main outcome measuresWe assessed four feeding outcomes at hospital discharge: any and exclusive maternal milk feeding, independent of feeding method; any and exclusive direct breastfeeding, defined as sucking at the breast. We computed a neonatal unit Parental Presence Score (PPS) based on policies regarding parental visiting in the intensive care area (range 1–10, with higher values indicating more liberal policies), and we used multivariable multilevel modified Poisson regression analysis to assess the relation between unit PPS and outcomes.ResultsPolicies regarding visiting hours, duration of visits and possibility for parents to stay during medical rounds and spend the night in unit differed within and across countries. After adjustment for potential confounders, infants cared for in units with liberal parental policies (PPS≥7) were about twofold significantly more likely to be discharged with exclusive maternal milk feeding and exclusive direct breastfeeding.ConclusionUnit policies promoting parental presence and involvement in care may increase the likelihood of successful breastfeeding at discharge for very preterm infants.
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  • de Vries, LS, et al. (författare)
  • Role of cerebral function monitoring in the newborn
  • 2005
  • Ingår i: Archives of disease in childhood. Fetal and neonatal edition. - : BMJ. - 1359-2998 .- 1468-2052. ; 90:3, s. 201-207
  • Forskningsöversikt (refereegranskat)abstract
    • For many years, newborn infants admitted to neonatal intensive care units have had routine electrocardiography and been monitored for respiratory rate, heart rate, oxygen saturation, and blood pressure. Only recently has it also been considered important to monitor brain function using continuous electroencephalography. The role of cerebral function monitoring in sick full term and preterm infants is reviewed.
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  • Donaldsson, S, et al. (författare)
  • COVID-19: minimising contaminated aerosol spreading during CPAP treatment
  • 2020
  • Ingår i: Archives of disease in childhood. Fetal and neonatal edition. - : BMJ. - 1468-2052 .- 1359-2998. ; 105:6, s. F669-F671
  • Tidskriftsartikel (refereegranskat)abstract
    • The COVID-19 pandemic has raised concern for healthcare workers getting infected via aerosol from non-invasive respiratory support of infants. Attaching filters that remove viral particles in air from the expiratory limb of continuous positive airway pressure (CPAP) devices should theoretically decrease the risk. However, adding filters to the expiratory limb could add to expiratory resistance and thereby increase the imposed work of breathing (WOB).ObjectiveTo evaluate the effects on imposed WOB when attaching filters to the expiratory limb of CPAP devices.MethodsTwo filters were tested on three CPAP systems at two levels of CPAP in a mechanical lung model. Main outcome was imposed WOB.ResultsThere was a minor increase in imposed WOB when attaching the filters. The differences between the two filters were small.ConclusionTo minimise contaminated aerosol generation during CPAP treatment, filters can be attached to expiratory tubing with only a minimal increase in imposed WOB in a non-humidified environment. Care has to be taken to avoid filter obstruction and replace filters as recommended.
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  • Draper, ES, et al. (författare)
  • EPICE cohort: two-year neurodevelopmental outcomes after very preterm birth
  • 2020
  • Ingår i: Archives of disease in childhood. Fetal and neonatal edition. - : BMJ. - 1468-2052 .- 1359-2998. ; 105:4, s. F350-
  • Tidskriftsartikel (refereegranskat)abstract
    • To determine whether the variation in neurodevelopmental disability rates between populations persists after adjustment for demographic, maternal and infant characteristics for an international very preterm (VPT) birth cohort using a standardised approach to neurodevelopmental assessment at 2 years of age.DesignProspective standardised cohort study.Setting15 regions in 10 European countries.PatientsVPT births: 22+0–31+6 weeks of gestation.Data collectionStandardised data collection tools relating to pregnancy, birth and neonatal care and developmental outcomes at 2 years corrected age using a validated parent completed questionnaire.Main outcome measuresCrude and standardised prevalence ratios calculated to compare rates of moderate to severe neurodevelopmental impairment between regions grouped by country using fixed effects models.ResultsParent reported rates of moderate or severe neurodevelopmental impairment for the cohort were: 17.3% (ranging 10.2%–26.1% between regions grouped by country) with crude standardised prevalence ratios ranging from 0.60 to 1.53. Adjustment for population, maternal and infant factors resulted in a small reduction in the overall variation (ranging from 0.65 to 1.30).ConclusionThere is wide variation in the rates of moderate to severe neurodevelopmental impairment for VPT cohorts across Europe, much of which persists following adjustment for known population, maternal and infant factors. Further work is needed to investigate whether other factors including quality of care and evidence-based practice have an effect on neurodevelopmental outcomes for these children.
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  • El Rafei, R, et al. (författare)
  • Postnatal growth restriction and neurodevelopment at 5 years of age: a European extremely preterm birth cohort study
  • 2023
  • Ingår i: Archives of disease in childhood. Fetal and neonatal edition. - : BMJ. - 1468-2052 .- 1359-2998. ; 108:5, s. F492-F498
  • Tidskriftsartikel (refereegranskat)abstract
    • To investigate whether extrauterine growth restriction (EUGR) during the neonatal hospitalisation by sex among extremely preterm (EPT) infants is associated with cerebral palsy (CP) and cognitive and motor abilities at 5 years of age.Study designPopulation-based cohort of births <28 weeks of gestation with data from obstetric and neonatal records and parental questionnaires and clinical assessments at 5 years of age.Setting11 European countries.Patients957 EPT infants born in 2011–2012.Main outcomesEUGR at discharge from the neonatal unit was defined as (1) the difference between Z-scores at birth and discharge with <−2 SD as severe, −2 to −1 SD as moderate using Fenton’s growth charts (Fenton) and (2) average weight-gain velocity using Patel’s formula in grams (g) per kilogram per day (Patel) with <11.2 g (first quartile) as severe, 11.2–12.5 g (median) as moderate. Five-year outcomes were: a CP diagnosis, intelligence quotient (IQ) using the Wechsler Preschool and Primary Scales of Intelligence tests and motor function using the Movement Assessment Battery for Children, second edition.Results40.1% and 33.9% children were classified as having moderate and severe EUGR, respectively, by Fenton and 23.8% and 26.3% by Patel. Among children without CP, those with severe EUGR had lower IQ than children without EUGR (−3.9 points, 95% Confidence Interval (CI)=−7.2 to −0.6 for Fenton and −5.0 points, 95% CI=−8.2 to −1.8 for Patel), with no interaction by sex. No significant associations were observed between motor function and CP.ConclusionsSevere EUGR among EPT infants was associated with decreased IQ at 5 years of age.
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20.
  • El Rafei, R, et al. (författare)
  • Variation in very preterm extrauterine growth in a European multicountry cohort
  • 2021
  • Ingår i: Archives of disease in childhood. Fetal and neonatal edition. - : BMJ. - 1468-2052 .- 1359-2998. ; 106:3, s. F316-F323
  • Tidskriftsartikel (refereegranskat)abstract
    • Extrauterine growth restriction (EUGR) among very preterm infants is related to poor neurodevelopment, but lack of consensus on EUGR measurement constrains international research. Our aim was to compare EUGR prevalence in a European very preterm cohort using commonly used measures.DesignPopulation-based observational study.Setting19 regions in 11 European countries.Patients6792 very preterm infants born before 32 weeks’ gestational age (GA) surviving to discharge.Main outcome measuresWe investigated two measures based on discharge-weight percentiles with (1) Fenton and (2) Intergrowth (IG) charts and two based on growth velocity (1) birth weight and discharge-weight Z-score differences using Fenton charts and (2) weight-gain velocity using Patel’s model. We estimated country-level relative risks of EUGR adjusting for maternal and neonatal characteristics and associations with population differences in healthy newborn size, measured by mean national birth weight at 40 weeks’ GA.ResultsAbout twofold differences in EUGR prevalence were observed between countries for all indicators and these persisted after case-mix adjustment. Discharge weight <10th percentile using Fenton charts varied from 24% (Sweden) to 60% (Portugal) and using IG from 13% (Sweden) to 43% (Portugal), while low weight-gain velocity ranged from 35% (Germany) to 62% (UK). Mean term birth weight strongly correlated with both percentile-based measures (Spearman’s rho=−0.90 Fenton, −0.84 IG, p<0.01), but not Patel’s weight-gain velocity (rho: −0.38, p=0.25).ConclusionsVery preterm infants have a high prevalence of EUGR, with wide variations between countries in Europe. Variability associated with mean term birth weight when using common postnatal growth charts complicates international benchmarking.
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21.
  • Falk, M, et al. (författare)
  • Interface leakage during neonatal CPAP treatment: a randomised, cross-over trial
  • 2021
  • Ingår i: Archives of disease in childhood. Fetal and neonatal edition. - : BMJ. - 1468-2052 .- 1359-2998. ; 106:6, s. F663-F667
  • Tidskriftsartikel (refereegranskat)abstract
    • To determine leakage for two neonatal continuous positive airway pressure (CPAP) interfaces and evaluate leak-corrective manoeuvres.DesignThe ToNIL (Trial of NCPAP Interface Leakage) study was a randomised, clinical, cross-over trial with data collection between August 2018 and October 2019. The primary outcome was blinded to the treating staff.SettingOne secondary, 8-bed neonatal intensive care unit (NICU) and three larger (>15 beds), academic NICU referral centres.PatientsNewborn infants with CPAP were screened (n=73), and those with stable spontaneous breathing, low oxygen requirement, postmenstrual age (PMA) over 28 weeks and no comorbidities were eligible. In total, 50 infants were included (median PMA 33 completed weeks).InterventionsLeakage was measured for both prongs and nasal mask, before and after leak-corrective manoeuvres. Interface application was performed in a randomised order by a nurse, blinded to the measured leakage.Main outcome measures30 s average leakage, measured in litres per minute (LPM).ResultsAnalyses showed a significantly lower leakage (mean difference 0.86 LPM, 95% CI 0.07 to 1.65) with prongs (median 2.01 LPM, IQR 1.00–2.80) than nasal mask (median 2.45 LPM, IQR 0.99–5.11). Leak-corrective manoeuvres reduced leakage significantly for both prongs (median 1.22 LPM, IQR 0.54–1.87) and nasal mask (median 2.35 LPM, IQR 0.76–4.75).ConclusionsLarge leakages were common for both interfaces, less with prongs. Simple care manoeuvres reduced leakage for both interfaces. This is the first report of absolute leakage for nasal interfaces and should encourage further studies on leakage during CPAP treatment.
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22.
  • Farooqi, Aijaz, et al. (författare)
  • One-year survival and outcomes of infants born at 22 and 23 weeks of gestation in Sweden 2004-2007, 2014-2016 and 2017-2019
  • 2024
  • Ingår i: Archives of Disease in Childhood-Fetal and Neonatal Edition. - : BMJ Publishing Group Ltd. - 1359-2998 .- 1468-2052. ; 109:1, s. 10-17
  • Tidskriftsartikel (refereegranskat)abstract
    • ObjectiveTo explore associations between perinatal activity and survival in infants born at 22 and 23 weeks of gestation in Sweden. Design/SettingData on all births at 22 and 23 weeks' gestational age (GA) were prospectively collected in 2004-2007 (T1) or obtained from national registers in 2014-2016 (T2) and 2017-2019 (T3). Infants were assigned perinatal activity scores based on 3 key obstetric and 4 neonatal interventions. Main outcomeOne-year survival and survival without major neonatal morbidities (MNM): intraventricular haemorrhage grade 3-4, cystic periventricular leucomalacia, surgical necrotising enterocolitis, retinopathy of prematurity stage 3-5 or severe bronchopulmonary dysplasia. The association of GA-specific perinatal activity score and 1-year survival was also determined. Results977 infants (567 live births and 410 stillbirths) were included: 323 born in T1, 347 in T2 and 307 in T3. Among live-born infants, survival at 22 weeks was 5/49 (10%) in T1 and rose significantly to 29/74 (39%) in T2 and 31/80 (39%) in T3. Survival was not significantly different between epochs at 23 weeks (53%, 61% and 67%). Among survivors, the proportions without MNM in T1, T2 and T3 were 20%, 17% and 19% for 22 weeks and 17%, 25% and 25% for 23 weeks' infants (p>0.05 for all comparisons). Each 5-point increment in GA-specific perinatal activity score increased the odds for survival in first 12 hours of life (adjusted OR (aOR) 1.4; 95% CI 1.3 to 1.6) in addition to 1-year survival (aOR 1.2; 95% CI 1.1 to 1.3), and among live-born infants it was associated with increased survival without MNM (aOR 1.3; 95% CI 1.1 to 1.4). ConclusionIncreased perinatal activity was associated with reduced mortality and increased chances of survival without MNM in infants born at 22 and 23 weeks of GA.
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23.
  • Fransson, A-L, et al. (författare)
  • Temperature variation in newborn babies: importance of physical contact with the mother.
  • 2005
  • Ingår i: Archives of disease in childhood. Fetal and neonatal edition. - : BMJ. - 1359-2998 .- 1468-2052. ; 90:6
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Hypothermia is a major cause of deterioration and death in the neonatal period. Temperature deviations are key signs of illness. OBJECTIVE: To determine normal patterns of temperature variation in newborn babies and the influence of external factors. METHODS: Abdominal and foot skin temperature were continuously recorded in 27 healthy full term babies during the first two days of life and related to the care situation-that is, whether the baby was with the mother or in its cot. The recordings were made using no wires to avoid interference with the care of the neonate. Ambient temperature was close to 23 degrees C during the study period. RESULTS: Mean rectal and abdominal and foot skin temperature were lower on day 1 than day 2. The foot skin temperature was directly related to the care situation, being significantly higher when the baby was with the mother. The abdominal skin temperature was much less influenced by external factors. When the neonates were with their mothers, the mean difference between rectal temperature and abdominal skin temperature was 0.2 degrees C compared with a mean difference between rectal temperature and foot skin temperature of 1.5 degrees C, indicating a positive heat balance. In the cot the corresponding temperature differences were 0.7 degrees C and 7.5 degrees C. A temperature difference between rectal and foot skin temperature of 7-8 degrees C indicates a heat loss close to the maximum for which a neonate can compensate (about 70 W/m2). CONCLUSION: This study emphasises the importance of close physical contact with the mothers for temperature regulation during the first few postnatal days.
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24.
  • Gagliardi, L, et al. (författare)
  • Neonatal outcomes of extremely preterm twins by sex pairing: an international cohort study
  • 2021
  • Ingår i: Archives of disease in childhood. Fetal and neonatal edition. - : BMJ. - 1468-2052 .- 1359-2998. ; 106:1, s. F17-F24
  • Tidskriftsartikel (refereegranskat)abstract
    • Infant boys have worse outcomes than girls. In twins, the ‘male disadvantage’ has been reported to extend to female co-twins via a ‘masculinising’ effect. We studied the association between sex pairing and neonatal outcomes in extremely preterm twins.DesignRetrospective cohort studySettingEleven countries participating in the International Network for Evaluating Outcomes of Neonates.PatientsLiveborn twins admitted at 23–29 weeks’ gestation in 2007–2015.Main outcome measuresWe examined in-hospital mortality, grades 3/4 intraventricular haemorrhage or cystic periventricular leukomalacia (IVH/PVL), bronchopulmonary dysplasia (BPD), retinopathy of prematurity requiring treatment and a composite outcome (mortality or any of the outcomes above).ResultsAmong 20 924 twins, 38% were from male-male pairs, 32% were from female-female pairs and 30% were sex discordant. We had no information on chorionicity. Girls with a male co-twin had lower odds of mortality, IVH/PVL and the composite outcome than girl-girl pairs (reference group): adjusted OR (aOR) (95% CI) 0.79 (0.68 to 0.92), 0.83 (0.72 to 0.96) and 0.88 (0.79 to 0.98), respectively. Boys with a female co-twin also had lower odds of mortality: aOR 0.86 (0.74 to 0.99). Boys from male-male pairs had highest odds of BPD and composite outcome: aOR 1.38 (1.24 to 1.52) and 1.27 (1.16 to 1.39), respectively.ConclusionsSex-related disparities in outcomes exist in extremely preterm twins, with girls having lower risks than boys and opposite-sex pairs having lower risks than same-sex pairs. Our results may help clinicians in assessing risk in this large segment of extremely preterm infants.
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25.
  • Grossmann, KR, et al. (författare)
  • Outcome at early school age and adolescence after hypothermia-treated hypoxic-ischaemic encephalopathy: an observational, population-based study
  • 2023
  • Ingår i: Archives of disease in childhood. Fetal and neonatal edition. - : BMJ. - 1468-2052 .- 1359-2998. ; 108:3, s. 295-301
  • Tidskriftsartikel (refereegranskat)abstract
    • We aimed to describe long-term outcomes following hypoxic–ischaemic encephalopathy (HIE) treated with therapeutic hypothermia (TH).DesignProspective, population-based observational study.SettingTertiary level neonatal intensive care units and neonatal outpatient clinic, Karolinska University Hospital, Stockholm, Sweden.PatientsSixty-six infants treated with TH due to HIE between 2007 and 2009.InterventionsAt 6–8 years and 10–12 years of age, children were assessed using a standardised neurological examination, the Movement Assessment Battery for Children, Second Edition (MABC-2) and the Wechsler Intelligence Scales for Children IV/V. Parents completed the Five-to-Fifteen (FTF) questionnaire.Main outcome measuresAdverse outcome among survivors was defined as cerebral palsy (CP), epilepsy, hearing or visual impairment, full-scale IQ (FSIQ) below 85, attention deficit disorder with/without hyperactivity, autism spectrum disorder or developmental coordination disorder.ResultsMortality was 12%. Seventeen per cent of survivors developed CP. Mean FSIQ was normal in children without major neuromotor impairment. Assessment in early adolescence revealed emerging deficits in 26% of children with a previously favourable outcome. The proportion of children exhibiting executive difficulties increased from 7% to 19%. This was reflected also by a significantly increased proportion of children with an FTF score >90th percentile compared with norms in early adolescence. The proportion of children with an MABC-2 score ≤5th percentile was also significantly increased compared with norms.ConclusionsSurvivors without major neuromotor impairment have normal intelligence. The incidence of executive difficulties appears to be increased in this patient population. More subtle difficulties may go undetected at early school-age.
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26.
  • Gunnarsdottir, K, et al. (författare)
  • Do newborn infants exhale through the CPAP system? Secondary analysis of a randomised cross-over trial
  • 2023
  • Ingår i: Archives of disease in childhood. Fetal and neonatal edition. - : BMJ. - 1468-2052 .- 1359-2998. ; 108:3, s. 232-236
  • Tidskriftsartikel (refereegranskat)abstract
    • During nasal continuous positive airway pressure (nCPAP) treatment in neonates, leakage is inevitable and can lead to reduced distending pressure in the lungs of the infant. In current practice, neither leakage nor expiratory flow is measured, which makes it difficult to assess if exhalation is through the device or entirely through leakages.ObjectiveTo examine if infants treated with nCPAP exhale through the CPAP system.Design and settingSecondary data analyses from the ToNIL trial on leakages during nCPAP treatment. We retrospectively examined respiratory curves for the 50 infants included in the trial, using NI LabVIEW 2015. Each infant was measured with both prongs and nasal masks. A flow recording was classified as exhalation through the system if more than 50% of all expirations showed reverse flow, each for a minimum duration of 0.1 s.Patients50 infants were included, born with a mean gestational age (GA) of 34 weeks, median birth weight of 1948 g and mean age at measurement 6.5 days. Inclusion criteria were CPAP treatment and a postmenstrual age (PMA) of 28–42 weeks.ResultsIn our measurements, 32/50 infants exhaled through the CPAP system in at least one recording with either nasal mask or prongs. Leakages exceeding 0.3 L/min were seen in 97/100 recordings.ConclusionsDuring nCPAP treatment, infants can exhale through the CPAP system and leakage was common. Measuring expiratory flows and leakages in clinical settings could be valuable in optimising CPAP treatment of infants.Trial registration numberNCT03586856.
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27.
  • Hellström, William, et al. (författare)
  • Fetal haemoglobin and bronchopulmonary dysplasia in neonates: An observational study
  • 2021
  • Ingår i: Archives of Disease in Childhood: Fetal and Neonatal Edition. - : BMJ. - 1359-2998 .- 1468-2052. ; 106, s. 88-92
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: Early decrease in fetal haemoglobin (HbF) is an indicator of loss of endogenous blood components that might have predictive value for development of bronchopulmonary dysplasia (BPD). The link between HbF and BPD has not been evaluated. Design: Retrospective observational study. Setting: Tertiary level neonatal intensive care unit, referral centre for Southern Sweden. Patients: 452 very preterm infants (<30 gestational weeks) born 2009-2015. Interventions: Regular clinical practice. Main outcome measures: Mean HbF, haemoglobin (Hb) and partial oxygen pressure (PaO2) levels calculated from 11 861 arterial blood gas analyses postnatal week 1. Relationship between HbF (%) and BPD (requirement of supplemental oxygen at 36 weeks' postmenstrual age) and the modifying influence of PaO2 (kPa) and total Hb (g/L) was evaluated. Results: The mean gestational age (GA) at birth was 26.4 weeks, and 213 (56%) infants developed BPD. A 10% increase in HbF was associated with a decreased prevalence of BPD, OR 0.64 (95% CI 0.49 to 0.83; p<0.001). This association remained when adjusting for mean PaO2 and Hb. Infants with an HbF in the lowest quartile had an OR of 27.1 (95% CI 11.6 to 63.4; p<0.001) for development of BPD as compared with those in the highest quartile. The area under the curve for HbF levels and development of BPD in the full statistical model was 0.871. Conclusions: Early rapid postnatal decline in HbF levels was associated with development of BPD in very preterm infants. The association between HbF and BPD was not mediated by increased oxygen exposure. The potential benefit of minimising loss of endogenous blood components on BPD outcome will be investigated in a multicentre randomised trial. © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.
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28.
  • Hinder, MK, et al. (författare)
  • T-piece resuscitators: can they provide safe ventilation in a low compliant newborn lung?
  • 2021
  • Ingår i: Archives of disease in childhood. Fetal and neonatal edition. - : BMJ. - 1468-2052 .- 1359-2998. ; 106:1, s. F25-
  • Tidskriftsartikel (refereegranskat)abstract
    • T-piece resuscitators (TPRs) are used for primary newborn resuscitation in birthing and emergency rooms worldwide. A recent study has shown spikes in peak inflation pressure (PIP) over set values with two brands of TPRs inbuilt into infant warmer/resuscitation platforms. We aimed to compare delivered ventilation between two TPR drivers with inflation pressure spikes to a standard handheld TPR in a low test lung compliance (Crs), leak-free bench test model.MethodsA single operator provided positive pressure ventilation to a low compliance test lung model (Crs 0.2–1 mL/cmH2O) at set PIP of 15, 25, 35 and 40 cmH2O. Two TPR devices with known spikes (Draeger Resuscitaire, GE Panda) were compared with handheld Neopuff (NP). Recommended settings for positive end-expiratory pressure (5 cmH2O), inflation rate of 60/min and gas flow rate 10 L/min were used.Results2293 inflations were analysed. Draeger and GE TPR drivers delivered higher mean PIP (Panda 18.9–49.5 cmH2O; Draeger 21.2–49.2 cmH2O and NP 14.8–39.9 cmH2O) compared with set PIP and tidal volumes (TVs) compared with the NP (Panda 2.9–7.8 mL; Draeger 3.8–8.1 mL; compared with NP 2.2–6.0 mL), outside the prespecified acceptable range (±10% of set PIP and ±10% TV compared with NP).ConclusionThe observed spike in PIP over set values with Draeger and GE Panda systems resulted in significantly higher delivered volumes compared with the NP with identical settings. Manufacturers need to address these differences. The effect on patient outcomes is unknown.
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29.
  • Hinder, M, et al. (författare)
  • T-piece resuscitators: how do they compare?
  • 2019
  • Ingår i: Archives of disease in childhood. Fetal and neonatal edition. - : BMJ. - 1468-2052 .- 1359-2998. ; 104:2, s. F122-F127
  • Tidskriftsartikel (refereegranskat)abstract
    • The T-piece resuscitator (TPR) has seen increased use as a primary resuscitation device with newborns. Traditional TPR design uses a high resistance expiratory valve to produce positive end expiratory pressure (PEEP) or continuous positive airway pressure (CPAP) at resuscitation. A new TPR device that uses a dual flow ratio valve (fluidic flip) to produce PEEP/CPAP is now available (rPAP). We aimed to compare the measured ventilation performance of different TPR devices in a controlled bench test study.Design/methodsSingle operator provided positive pressure ventilation to an incremental testlung compliance (Crs) model (0.5–5 mL/cmH2O) with five different brands of TPR device (Atom, Neopuff, rPAP, GE Panda warmer and Draeger Resuscitaire). At recommended peak inflation pressure (PIP) 20 cmH2O, PEEP of 5 cmH2O and rate of 60 inflations per minute.Results1864 inflations were analysed. Four of the five devices tested demonstrated inadvertent elevations in mean PEEP (5.5–10.3 cmH2O, p<0.001) from set value as Crs was increased, while one device (rPAP) remained at the set value. Measured PIP exceeded the set value in two infant warmer devices (GE and Draeger) with inbuilt TPR at Crs of 0.5 (24.5 and 23.5 cmH2O, p<0.001). Significant differences were seen in tidal volumes across devices particularly at higher Crs (p<0.001).ConclusionsResults show important variation in delivered ventilation from set values due to inherent TPR device design characteristics with a range of lung compliances expected at birth. Device-generated inadvertent PEEP and overdelivery of PIP may be clinically deleterious for term and preterm newborns or infants with larger Crs during resuscitation.
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30.
  • Hjalmarson, Ola, 1941, et al. (författare)
  • Persisting hypoxaemia is an insufficient measure of adverse lung function in very immature infants.
  • 2014
  • Ingår i: Archives of disease in childhood. Fetal and neonatal edition. - : BMJ. - 1468-2052 .- 1359-2998. ; 99:4
  • Tidskriftsartikel (refereegranskat)abstract
    • Bronchopulmonary dysplasia (BPD), defined as protracted neonatal hypoxaemia, is considered a risk factor for respiratory disease in adulthood. The relationship between this diagnosis and the actual lung injury appearing in very immature infants is, however, unknown.
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31.
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32.
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33.
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34.
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35.
  • Lee, PMY, et al. (författare)
  • Association of maternal body mass index with intellectual disability risk
  • 2021
  • Ingår i: Archives of disease in childhood. Fetal and neonatal edition. - : BMJ. - 1468-2052 .- 1359-2998. ; 106:6, s. F584-F590
  • Tidskriftsartikel (refereegranskat)abstract
    • The study aimed to investigate the association between maternal body mass index (BMI) in early pregnancy and children’s intellectual disability (ID) risk in the absence of chromosomal disorders, neurofibromatosis and tuberous sclerosis, taking adverse birth outcomes, maternal hypertension/diabetes and maternal socioeconomic status into consideration.MethodsWe conducted a cohort study of singletons without common genetic defects born in Sweden during 1992–2006, and followed them from birth until 31 December 2014 (n=1 186 836). Cox proportional hazards models were used to analyse the association between maternal BMI in early pregnancy and the risk of offspring’s ID.ResultsThe risk of ID was higher in children born to mothers who were underweight (HR=1.21, 95% CI=1.07 to 1.36), overweight (HR=1.28, 95% CI=1.21 to 1.34) or had obesity class I (HR=1.63, 95% CI=1.53 to 1.74), obesity class II (HR=2.08, 95% CI=1.88 to 2.30) and obesity class III (HR=2.31, 95% CI=1.46 to 3.65) than in children born to normal weight mothers. Results remained consistent after excluding children with adverse birth outcome or born to mothers with gestational hypertension/diabetes. Analysis stratified by maternal education and annual household income showed that the association between maternal underweight and children’s ID risk was attenuated among children of mothers with tertiary education or with high income.ConclusionsOur findings suggest that maternal underweight or overweight/obesity in early pregnancy was associated with the development of ID in their offspring. This association was independent of the effect of adverse birth outcomes and maternal hypertension/diabetes. High socioeconomic status may attenuate the risk of ID among children of underweight mothers. This study highlights the importance of improving health education before conception to reduce children’s ID risk.
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36.
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37.
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38.
  • Nagy, E, et al. (författare)
  • Disorders of vision in neonatal hypoxic-ischaemic encephalopathy: a systematic review
  • 2021
  • Ingår i: Archives of disease in childhood. Fetal and neonatal edition. - : BMJ. - 1468-2052 .- 1359-2998. ; 106:4, s. 357-362
  • Tidskriftsartikel (refereegranskat)abstract
    • Neonatal hypoxic-ischaemic encephalopathy (HIE) following perinatal asphyxia in term infants is associated with neonatal mortality and a high risk of neurodevelopmental impairment later in life. Visual disorders are an accepted complication of HIE and the association has been cited in the literature many times. This review aims to study the evidence for this association and assess the quality of the data on which this is based.DesignA systematic literature review was conducted and 922 citations were assessed using standard methods outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol.ResultsThe results demonstrate that the majority of studies have reported on various neurodevelopmental outcomes but rarely specifically vision. Based on limited currently available data, extracted from a number of small studies, an association of neonatal HIE with visual impairments seems to exist but detail is lacking. Notably, in the existing studies, there is a striking lack of consistency in the methods used to diagnose HIE and, similarly, a wide variation in the methods employed to measure visual function.ConclusionsTo explore the observed association further in terms of prognosis and the effects of HIE treatments on visual outcomes, future studies will need to address the issues of standardised diagnostic criteria, severity grading and robust, age-appropriate visual assessment.
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39.
  • Ng, IHX, et al. (författare)
  • Burden of hypoxia and intraventricular haemorrhage in extremely preterm infants
  • 2020
  • Ingår i: Archives of disease in childhood. Fetal and neonatal edition. - : BMJ. - 1468-2052 .- 1359-2998. ; 105:3, s. F242-F247
  • Tidskriftsartikel (refereegranskat)abstract
    • Thresholds of cerebral hypoxia through monitoring of near-infrared spectroscopy tissue oxygenation index (TOI) were used to investigate the relationship between intraventricular haemorrhage (IVH) and indices of hypoxia.DesignProspective observational study.SettingA single-centre neonatal intensive care unit.PatientsInfants <28 weeks’ gestation with an umbilical artery catheter.MethodsThresholds of hypoxia were determined from mean values of TOI using sequential Χ2 tests and used alongside thresholds from existing literature to calculate percentage of time in hypoxia and burden of hypoxia below each threshold. These indices were then compared between IVH groups.Results44 infants were studied for a median of 18.5 (range 6–21) hours in the first 24 hours of life. Sequential Χ2 analysis yielded a TOI threshold of 71% to differentiate between IVH (16 infants) and no IVH (28 infants). Percentage of time in hypoxia was significantly higher in infants with IVH than those without, using thresholds of 60%–67%. Burden of hypoxia was significantly higher in infants with IVH than without, using thresholds of 62%–80%. With the threshold of 71%, percentage of time in hypoxia was lower by 12.2% with a 95% CI of (−25.7 to 1.2) (p=0.073), and the burden of hypoxia was lower by 29.2% hour (%h) (95% CI −55.2 to −3.1)%h (p=0.012) in infants without IVH than those with IVH.ConclusionsUsing defined TOI thresholds, infants with IVH spent higher percentage of time in hypoxia with higher burden of cerebral hypoxia than those without, in the first 24 hours of life.
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40.
  • Nilsson, Anders K., 1982, et al. (författare)
  • Preterm infant circulating sex steroid levels are not altered by transfusion with adult male plasma: a retrospective multicentre cohort study
  • 2022
  • Ingår i: Archives of Disease in Childhood-Fetal and Neonatal Edition. - : BMJ. - 1359-2998 .- 1468-2052. ; 107:6, s. 577-582
  • Tidskriftsartikel (refereegranskat)abstract
    • Sex hormones delivered via plasma transfusions from adult male donors to very preterm infants do not alter the circulating plasma concentrations in the infant, irrespective of gender. Objective To determine if plasma transfusions with male donor plasma to very preterm infants affect circulatory levels of sex steroids. Design and patients Retrospective multicentre cohort study in 19 infants born at gestational age Setting Three neonatal intensive care units in Sweden. Main outcome measures Concentrations of sex steroids and sex hormone-binding globulin (SHBG) in donor plasma and infant plasma measured before and after a plasma transfusion and at 6, 12, 24 and 72 hours. Results The concentrations of progesterone, dehydroepiandrosterone and androstenedione were significantly lower in donor plasma than in infant plasma before the transfusion (median (Q1-Q3) 37.0 (37.0-37.0), 1918 (1325-2408) and 424 (303-534) vs 901 (599-1774), 4119 (2801-14 645) and 842 (443-1684) pg/mL), while oestrone and oestradiol were higher in donor plasma (17.4 (10.4-20.1) and 16.0 (11.7-17.2) vs 3.1 (1.1-10.2) and 0.25 (0.25-0.25) pg/mL). Median testosterone and dihydrotestosterone (DHT) levels were 116-fold and 21-fold higher in donor plasma than pre-transfusion levels in female infants, whereas the corresponding difference was not present in male infants. Plasma sex steroid levels were unchanged after completed transfusion compared with pre-transfusion levels, irrespective of the gender of the receiving infant. The SHBG concentration was significantly higher in donor than in recipient plasma (22.8 (17.1-33.5) vs 10.2 (9.1-12.3) nmol/L) before transfusion but did not change in the infants after the transfusion. Conclusions A single transfusion of adult male plasma to preterm infants had no impact on circulating sex steroid levels.
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41.
  • Nordenström, Kajsa, et al. (författare)
  • Low risk of necrotising enterocolitis in enterally fed neonates with critical heart disease: An observational study
  • 2020
  • Ingår i: Archives of Disease in Childhood: Fetal and Neonatal Edition. - : BMJ. - 1359-2998 .- 1468-2052. ; 105:6, s. 609-614
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: We aimed to investigate the frequency of necrotising enterocolitis (NEC) in infants with critical congenital heart disease (CCHD) hypothesising that preoperative enteral feeding does not increase the risk of NEC. Background: When NEC affects term infants, underlying risk factors such as asphyxia, sepsis or CCHD are often found. Due to fear of NEC development in infants with CCHD great caution is practised in many countries to defer preoperative enteral feeding, but in Sweden this is routinely provided. Design, setting and patients: An observational study of all infants born with CCHD who were admitted to Queen Silvia Children's Hospital in Gothenburg between 2010 and 2017. The International Classification of Diseases 10th Revision diagnosis code of NEC was used to identify NEC cases in this group. Infants described as fully fed' or who were fed at least 45 mL/kg/day before cardiac surgery were identified. Main outcome measures: NEC in infants with CCHD in relation to preoperative enteral feeding. Results: There were 458 infants with CCHD admitted during the study period. 408/458 were born at term and 361/458 required prostaglandin E1 before surgery. In total, 444/458 infants (97%) were fully fed or fed at least 45 mL/kg daily before cardiac surgery. Four of 458 infants developed NEC (0.9%). All four had other risk factors for NEC. Conclusions: This study showed a low risk of NEC in term infants fed enterally before cardiac surgery. We speculate that preoperative enteral feeding of neonates with CCHD does not increase the risk of NEC development. © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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42.
  • Norman, Elisabeth, et al. (författare)
  • Placental transfer and pharmacokinetics of thiopentone in newborn infants.
  • 2010
  • Ingår i: Archives of disease in childhood. Fetal and neonatal edition. - : BMJ. - 1468-2052 .- 1359-2998. ; 95, s. 277-282
  • Tidskriftsartikel (refereegranskat)abstract
    • Background and Objectives Thiopentone, a short-acting barbiturate, has been introduced as premedication for intubation in newborn infants. The objectives of this study were to assess the pharmacokinetics of thiopentone in newborn infants, and to unravel whether placental transfer of the drug should be taken into account if administered to infants exposed to it during delivery. Methods Plasma concentrations were assessed with high-pressure liquid chromatography in samples from delivering mothers (n=27) receiving a median dose of 5.5 mg/kg (range 3.8-7.7) thiopentone for Caesarean section in gestational week 37.6 (range 25.7-41.4) and from corresponding umbilical cord blood (n=28). In infants (n=30) born at 35.4 weeks gestation (range 27.9-42.0) undergoing surgery at a median postnatal age of 24.5 h (range 4-521), repeated blood levels were assessed after administering a dose of 3 mg/kg thiopentone on clinical indication before intubation (seven samples per infant from 5 min to 48 h after administration). Results The umbilical/maternal concentration ratio was 0.7, the mean concentration of thiopentone was 55.7 micromol/l (SD+/-15.3) in mothers and 39.3 micromol/l (SD+/-12.5) in venous cord blood. In newborn infants undergoing surgery, the terminal half-life of thiopentone was 8 h (interquartile range (IQR) 2.5-10.8), and clearance 0.092 l/min per kg/postnatal age in days (IQR 0.02-0.1). Conclusions Thiopentone might be used as premedication for short-lasting intubation after birth, for example, for surfactant administration. During the first 4 h after birth the dose needs to be adjusted for maternal dosage as well as for the weight of the infant.
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43.
  • Nystrom, FK, et al. (författare)
  • Diagnostic values of the femoral pulse palpation test
  • 2020
  • Ingår i: Archives of disease in childhood. Fetal and neonatal edition. - : BMJ. - 1468-2052 .- 1359-2998. ; 105:4, s. F375-F379
  • Tidskriftsartikel (refereegranskat)abstract
    • To calculate diagnostic values of the femoral pulse palpation to detect coarctation of the aorta or other left-sided obstructive heart anomalies in newborn infants.DesignPopulation-based cohort study.SettingStockholm-Gotland County 2008–2012.PatientsAll singleton live-born infants without chromosomal trisomies, at ≥35 gestational weeks, followed-up until 1–2 years of age.Main outcome measuresDiagnostic values and ORs for the femoral pulse test and subsequent diagnosis of coarctation of the aorta or left-sided obstructive heart malformation.ResultsAmong the 118 592 included infants, 432 had weak or absent femoral pulses at the newborn examination. Seventy-eight infants were diagnosed with coarcation of the aorta and 48 with other left-sided obstructive heart malformations. The diagnostic values for the femoral pulse palpation test to detect coarctation of the aorta were: sensitivity: 19.2%, specificity: 99.6, positive predictive value: 3.5% and negative predictive value: 99.9%. For left-sided heart malformations: sensitivity: 8.3%, specificity: 99.6%, positive predictive value: 0.9% and negative predictive value: 100%. Sensitivity for coarctation of the aorta increased from 16.7% when examined at <12 hours of age to 30.0% at ≥96 hours of age.ConclusionsThe femoral pulse test to detect coarctation of the aorta and left-sided heart malformations has limited sensitivity, whereas specificity is high. As many infants with life-threatening cardiac malformations leave the maternity ward undiagnosed, further efforts are necessary to improve the diagnostic yield of the routine newborn examination.
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44.
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45.
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46.
  • Piyasena, C., et al. (författare)
  • Prediction of severe retinopathy of prematurity using the WINROP algorithm in a birth cohort in South East Scotland
  • 2014
  • Ingår i: Archives of Disease in Childhood: Fetal and Neonatal Edition. - : BMJ. - 1359-2998 .- 1468-2052. ; 99
  • Tidskriftsartikel (refereegranskat)abstract
    • PURPOSE: We tested the ability of the 'Weight, IGF-1, Neonatal Retinopathy of Prematurity (WINROP)' clinical algorithm to detect preterm infants at risk of severe Retinopathy of Prematurity (ROP) in a birth cohort in the South East of Scotland. In particular, we asked the question: 'are weekly weight measurements essential when using the WINROP algorithm?' STUDY DESIGN: This was a retrospective cohort study. Anonymised clinical data were uploaded to the online WINROP site, and infants at risk of developing severe ROP were identified. The results using WINROP were compared with the actual ROP screening outcomes. Infants with incomplete weight data were included in the whole group, but were excluded from a subgroup analysis of infants with complete weight data. In addition, data were manipulated to test whether missing weight data points in the early neonatal period would lead to loss of sensitivity of the algorithm. RESULTS: The WINROP algorithm had 73% sensitivity for detecting infants at risk of severe ROP when all infants were included and 87% when the complete weight data subgroup was analysed. Manipulation of data from the complete weight data subgroup demonstrated that one or two missing weight data points in the early postnatal period lead to loss of sensitivity performance by WINROP. IMPLICATIONS: The WINROP program offers a non-invasive method of identifying infants at high risk of severe ROP and also identifying those not at risk. However, for WINROP to function optimally, it has to be used as recommended and designed, namely weekly body weight measurements are required.
  •  
47.
  • Rennie, JM, et al. (författare)
  • Characterisation of neonatal seizures and their treatment using continuous EEG monitoring: a multicentre experience
  • 2019
  • Ingår i: Archives of disease in childhood. Fetal and neonatal edition. - : BMJ. - 1468-2052 .- 1359-2998. ; 104:5, s. F493-F501
  • Tidskriftsartikel (refereegranskat)abstract
    • The aim of this multicentre study was to describe detailed characteristics of electrographic seizures in a cohort of neonates monitored with multichannel continuous electroencephalography (cEEG) in 6 European centres.MethodsNeonates of at least 36 weeks of gestation who required cEEG monitoring for clinical concerns were eligible, and were enrolled prospectively over 2 years from June 2013. Additional retrospective data were available from two centres for January 2011 to February 2014. Clinical data and EEGs were reviewed by expert neurophysiologists through a central server.ResultsOf 214 neonates who had recordings suitable for analysis, EEG seizures were confirmed in 75 (35%). The most common cause was hypoxic-ischaemic encephalopathy (44/75, 59%), followed by metabolic/genetic disorders (16/75, 21%) and stroke (10/75, 13%). The median number of seizures was 24 (IQR 9–51), and the median maximum hourly seizure burden in minutes per hour (MSB) was 21 min (IQR 11–32), with 21 (28%) having status epilepticus defined as MSB>30 min/hour. MSB developed later in neonates with a metabolic/genetic disorder. Over half (112/214, 52%) of the neonates were given at least one antiepileptic drug (AED) and both overtreatment and undertreatment was evident. When EEG monitoring was ongoing, 27 neonates (19%) with no electrographic seizures received AEDs. Fourteen neonates (19%) who did have electrographic seizures during cEEG monitoring did not receive an AED.ConclusionsOur results show that even with access to cEEG monitoring, neonatal seizures are frequent, difficult to recognise and difficult to treat.Oberservation study numberNCT02160171
  •  
48.
  • Ross, Joanna, et al. (författare)
  • Perinatal mental distress and infant morbidity in Ethiopia : a cohort study
  • 2011
  • Ingår i: Archives of Disease in Childhood. - : BMJ. - 1359-2998 .- 1468-2052. ; 96:1, s. F59-F64
  • Tidskriftsartikel (refereegranskat)abstract
    • Persistent perinatal CMD was associated with infant diarrhoea in this low-income country setting. The observed relationship was independent of maternal health-promoting practices. Future research should further explore the mechanisms underlying the observed association to inform intervention strategies.
  •  
49.
  •  
50.
  • Scrivens, A, et al. (författare)
  • Survey of transfusion practices in preterm infants in Europe
  • 2023
  • Ingår i: Archives of disease in childhood. Fetal and neonatal edition. - : BMJ. - 1468-2052 .- 1359-2998. ; 108:4, s. 360-366
  • Tidskriftsartikel (refereegranskat)abstract
    • Preterm infants commonly receive red blood cell (RBC), platelet and fresh frozen plasma (FFP) transfusions. The aim of this Neonatal Transfusion Network survey was to describe current transfusion practices in Europe and to compare our findings to three recent randomised controlled trials to understand how clinical practice relates to the trial data.MethodsFrom October to December 2020, we performed an online survey among 597 neonatal intensive care units (NICUs) caring for infants with a gestational age (GA) of <32 weeks in 18 European countries.ResultsResponses from 343 NICUs (response rate: 57%) are presented and showed substantial variation in clinical practice. For RBC transfusions, 70% of NICUs transfused at thresholds above the restrictive thresholds tested in the recent trials and 22% below the restrictive thresholds. For platelet transfusions, 57% of NICUs transfused at platelet count thresholds above 25×109/L in non-bleeding infants of GA of <28 weeks, while the 25×109/L threshold was associated with a lower risk of harm in a recent trial. FFP transfusions were administered for coagulopathy without active bleeding in 39% and for hypotension in 25% of NICUs. Transfusion volume, duration and rate varied by factors up to several folds between NICUs.ConclusionsTransfusion thresholds and aspects of administration vary widely across European NICUs. In general, transfusion thresholds used tend to be more liberal compared with data from recent trials supporting the use of more restrictive thresholds. Further research is needed to identify the barriers and enablers to incorporation of recent trial findings into neonatal transfusion practice.
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