| 1. |
- Andersson Grönlund, Marita, 1959-, et al.
(författare)
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Ophthalmological findings in a sample of Swedish children aged 4-15 years
- 2006
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Ingår i: Acta Ophthalmologica Scandinavica. - : Munksgaard Forlag. - 1395-3907 .- 1600-0420. ; 84:2, s. 169-76
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: To characterize ophthalmological findings in a sample of Swedish children aged 4-15 years.METHODS: A prospective cross-sectional comprehensive ophthalmological investigation was performed on a sample of 143 children (67 girls, 76 boys) aged 4-15 years.RESULTS: Visual acuity (VA) in the better eye >or=1.0 (0.3 logMAR). Amblyopia was found in 0.7% of subjects. A total of 68% of the children had no refractive errors. Hyperopia (>or=2.0 dioptres [D] in spherical equivalent [SE]) was found in 9% and myopia (>or=0.5 D SE) in 6% of children. Astigmatism (>or=0.75 D) was recorded in 22% and anisometropia (>or=1.0 D SE) in 3%. A total of 8% were optically corrected. Strabismus was recorded in 3.5%. Signs of visuoperceptual problems were reported in 3% of the children.CONCLUSION: This sample of Swedish children may serve as a comparison group regarding ophthalmological findings in children aged 4-15 years.
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| 5. |
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| 6. |
- Aring, Eva, 1959, et al.
(författare)
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Strabismus and binocular functions in a sample of Swedish children aged 4-15 years
- 2005
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Ingår i: Strabismus. - : Taylor & Francis. - 0927-3972 .- 1744-5132. ; 13:2, s. 55-61
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To investigate strabismus, head posture, nystagmus, stereoacuity, ocular motility, near point of convergence (NPC) and accommodative convergence to accommodation ratio (AC/A) in a sample of Swedish children. METHODS: A prospective cross-sectional study was carried out on 143 children, 4-15 years of age. RESULTS: Heterotropia was found in five children (3.5%), four with esotropia and one with exotropia. One child with esotropia had a slight overaction of both inferior oblique muscles. Heterophoria was found in 37 children (26%) at near and/or distance fixation and it was four times more common at near than at distance. In 29 children, heterophoria was found at one distance only and orthophoria at the other. Orthophoria at both near and distance fixation was noted in 101 children (70.5%). The near point of convergence was < or =6 cm in 97% of the children and 97% had stereoacuity of 60" or better. In the whole group, the median AC/A ratio calculated with the heterophoria method was 5.6/1 prism diopters/diopters (PD/D) and with the gradient method, 1.3/1 PD/D. No anomalous head postures or nystagmus were observed and all children had normal versions. CONCLUSION: In this study, 143 well-defined children were investigated with a battery of accurately described tests, commonly used in clinical practice. These results are in agreement with those of other studies examining one or few variables in larger populations and the authors therefore conclude that their results may be used for comparisons with different patient groups.
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| 7. |
- Aring, Eva, 1959, et al.
(författare)
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Visual fixation development in children.
- 2007
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Ingår i: Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv für klinische und experimentelle Ophthalmologie. - : Springer Science and Business Media LLC. - 0721-832X .- 1435-702X. ; 245:11, s. 1659-65
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The ability to keep steady fixation on a target is one of several aspects of good visual function. However, there are few reports on visual fixation during childhood in healthy children. METHODS: An infrared eye-tracking device (Orbit) was used to analyse binocular fixation behaviour in 135 non-clinical participants aged 4-15 years. The children wore goggles and their heads were restrained using a chin and forehead rest, while binocularly fixating a stationary target for 20 s. RESULTS: The density of fixations around the centre of gravity increased with increasing age (p < 0.01), and the time of fixation without intruding movements increased with increasing age (p = 0.02), while intruding saccades decreased with increasing age (p < 0.01). The number of blinks and drifts did not differ between 4 and 15 years, and there were no significant differences with regard to gender or laterality in any of the investigated variables. No nystagmus was observed. CONCLUSION: This study establishes values for visual fixation behaviour in a non-clinical population aged 4-15 years, which can be used for identifying children with fixation abnormalities.
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| 8. |
- Cakir, B., et al.
(författare)
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IGF1, serum glucose, and retinopathy of prematurity in extremely preterm infants
- 2020
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Ingår i: Jci Insight. - : American Society for Clinical Investigation. - 2379-3708. ; 5:19
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND. Hyperglycemia, insulin insensitivity, and low IGF1 levels in extremely preterm infants are associated with an increased risk of retinopathy of prematurity (ROP), but the interactions are incompletely understood. METHODS. In 117 extremely preterm infants, serum glucose levels and parenteral glucose intake were recoded daily in the first postnatal week. Serum IGF1 levels were measured weekly. Mice with oxygen-induced retinopathy alone versus oxygen-induced retinopathy plus streptozotocin-induced hyperglycemia/hypoinsulinemia were assessed for glucose, insulin, IGF1, IGFBP1, and IGFBP3 in blood and liver. Recombinant human IGF1 was injected to assess the effect on glucose and retinopathy. RESULTS. The highest mean plasma glucose tertile of infants positively correlated with parenteral glucose intake [r (39) = 0.67, P < 0.0001]. IGF1 plasma levels were lower in the high tertile compared with those in low and intermediate tertiles at day 28 (P = 0.038 and P = 0.03). In high versus lower glucose tertiles, ROP was more prevalent (34 of 39 versus 19 of 39) and more severe (ROP stage 3 or higher; 71% versus 32%). In oxygen-induced retinopathy, hyperglycemia/hypoinsulinemia decreased liver IGF1 expression (P < 0.0001); rh-IGF1 treatment improved normal vascular regrowth (P = 0.027) and reduced neovascularization (P < 0.0001). CONCLUSION. In extremely preterm infants, high early postnatal plasma glucose levels and signs of insulin insensitivity were associated with lower IGF1 levels and increased ROP severity. In a hyperglycemia retinopathy mouse model, decreased insulin signaling suppressed liver IGF1 production, lowered serum IGF1 levels, and increased neovascularization. IGF1 supplementation improved retinal revascularization and decreased pathological neovascularization. The data support IGF1 as a potential treatment for prevention of ROP.
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| 13. |
- Grönlund, Marita Andersson, 1959, et al.
(författare)
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Ophthalmological findings in children and adolescents with Silver-Russell syndrome.
- 2011
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Ingår i: The British journal of ophthalmology. - : BMJ. - 1468-2079 .- 0007-1161. ; 95:5, s. 637-41
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Tidskriftsartikel (refereegranskat)abstract
- Aim To evaluate ophthalmological findings in children with Silver-Russell syndrome (SRS). Methods An ophthalmological evaluation including visual acuity (VA), refraction, strabismus, near point of convergence (NPC), slit-lamp examination, ophthalmoscopy, axial length measurements and full-field electroretinogram was performed on 18 children with SRS (8 girls, 10 boys; mean age 11.6 years). Fundus photographs were taken for digital image analysis. Data were compared with data on an age- and gender-matched reference group (ref) of school children (n=99). Results Seventeen out of 18 children with SRS had ophthalmological abnormalities. Best corrected VA of the best eye was <0.1 log of the minimal angle of resolution in 11 children (ref n=98) (p<0.0001), and 11 children had refractive errors (ref n=33) (p=0.05). Anisometropia (>/=1 dioptre) was noted in three of the children (ref n=3) (p=0.046). Subnormal stereo acuity and NPC were found in 2/16 (ref=0) (p=0.02). The total axial length in both eyes was shorter compared with that in controls (p<0.006 and p<0.001). Small optic discs were found in 3/16, large cup in 3/16 and increased tortuosity of retinal vessels in 4/13 children with SRS. Conclusion Children with SRS, who are severely intrauterine growth retarded, show significant ophthalmological abnormalities. Based on the present findings, ophthalmological examination is recommended in children with SRS.
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| 14. |
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| 15. |
- Grönlund, Marita Andersson, 1959, et al.
(författare)
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Relationships between ophthalmological and neuropaediatric findings in children adopted from Eastern Europe.
- 2010
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Ingår i: Acta ophthalmologica. - : Wiley. - 1755-3768 .- 1755-375X .- 1395-3907 .- 1600-0420. ; 88:2, s. 227-34
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: This study aimed to evaluate and relate visual function, ocular dimensions and neuropaediatric findings in adoptees from Eastern Europe. METHODS: We studied 72 of 99 children, born during 1990-95 and adopted from Eastern Europe to western Sweden during 1993-97. The children (mean age 7.5 years, range 4.8-10.5 years; 41 boys, 31 girls) were examined after a mean period of 5 years post-adoption by a multidisciplinary team. Correlations between ophthalmological findings and neuropaediatric data were analysed. RESULTS: Bivariate and regression analyses indicate a significant positive correlation between visual acuity (VA) and perceptual organization (p < 0.001), as well as between strabismus and verbal comprehension (p < 0.02). Fetal alcohol syndrome (FAS) was correlated with low VA (p < 0.02), subnormal stereovision (p < 0.009) and small optic discs (p < 0.02). Small head circumference was related to low VA (p < 0.015) and small optic discs (p < 0.03). Furthermore, small optic discs were related to low birthweight (p < 0.005) and preterm birth (p < 0.01). Large optic cups were correlated with poorer perceptual organization (p < 0.02). CONCLUSIONS: In this group of adoptees from Eastern Europe, ophthalmological findings were correlated to neuropaediatric findings, especially those arising from prenatal adverse events resulting in growth deficiency and central nervous system damage. Therefore, it is important and valuable with an ophthalmological examination in children adopted from Eastern Europe.
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| 16. |
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| 17. |
- Grönlund, Marita Andersson, 1959, et al.
(författare)
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Visual and ocular findings in children adopted from eastern Europe
- 2004
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Ingår i: Br J Ophthalmol. - : BMJ Publishing Group Ltd. ; 88:11, s. 1362-1267
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: To evaluate ophthalmological findings in children adopted from eastern Europe. METHODS: A prospective study on 72/99 children, born 1990-5 and adopted from eastern Europe to western Sweden during 1993-7 was performed. The children (41 boys; mean age 7.5 years) were compared with an age and sex matched reference group ("ref") of Swedish children. RESULTS: 78% of the adopted children had abnormal ocular findings. 26% (ref 4%) had visual acuity (VA) of the better eye < or = 0.5 (> or = 0.3 logMAR) (p = 0.0001) and 8% (ref 0%) were visually impaired (p = 0.01). Amblyopia was found in 15% (ref 2%) (p = 0.005). 22% (ref 10%) were hyperopic (> or = 2.0 D SE) (NS) and 10% (ref 1%) were myopic (> or = 0.5 D SE) (p = 0.03). Astigmatism (> or = 0.75 D) was found in 51% (ref 23%) (p = 0.004). 32% (ref 2%) had strabismus (p<0.0001), mostly esotropia. Four cases had bilateral optic nerve hypoplasia, in three of whom a history of suspected prenatal alcohol exposure was documented. One child had congenital glaucoma. Signs of visuoperceptual problems were recorded in 37% (ref 1%) (p<0.0001). CONCLUSION: In this study, children adopted from eastern Europe had a high frequency of ophthalmological findings. Consequently, it is strongly recommended that an ophthalmological examination be performed in these children after arrival in their new home country.
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| 18. |
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| 19. |
- Grönlund, Marita Andersson, 1959, et al.
(författare)
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Visual function and ocular features in children and adolescents with attention deficit hyperactivity disorder, with and without treatment with stimulants.
- 2007
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Ingår i: Eye (London, England). - : Springer Science and Business Media LLC. - 0950-222X .- 1476-5454. ; 21:4, s. 494-502
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: To investigate visual function and ocular features in children with attention deficit hyperactivity disorder (AD/HD) and establish whether treatment with stimulants is reflected in functioning of the visual system. METHODS: Detailed ophthalmologic evaluations without and with stimulants were performed in 42 children (37 boys) with AD/HD, mean age 12 years, and compared with a reference group (ref; n=50; mean age 11.9 years; 44 boys). For a comparison between two groups, Mann-Whitney's U-test was used for ordered and continuous variables; for dichotomous variables, Fisher's exact test was used. For paired comparison (with and without treatment), sign test was used. RESULTS: In all, 83% had visual acuity of >0.8 (<0.1 logMAR) without treatment, 90% with stimulants (ref 98%; P=0.032 and n.s., respectively). Heterophoria was found in 29% without, and in 27% with, stimulants (ref 10%; P=0.038 and n.s., respectively) and subnormal stereovision (>60 s of arc) in 26% (ref 6%; P=0.016) without stimulants, and in 27%, with (P=0.014). Abnormal convergence (>6 cm or absent) was noted in 24% (ref 6%; P=0.031) without treatment and in 17%, with (n.s.). Astigmatism (> or =1.0 D) was observed in 24% (ref 6%; P=0.03), and signs of visuoperceptual problems in 21% (ref 2%; P=0.007). We found smaller optic discs (n=8/38) and neuroretinal rim areas (n=7/38) (P<0.0001) and decreased tortuosity of retinal arteries (n=6/34) (P=0.0002) than that of controls. CONCLUSIONS: Children with AD/HD had a high frequency of ophthalmologic findings, which were not significantly improved with stimulants. They presented subtle morphological changes of the optic nerve and retinal vasculature, indicating an early disturbance of the development of these structures.
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| 24. |
- Holmberg, Kirsten, et al.
(författare)
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Health complaints in children with attention-deficit/hyperactivity disorder
- 2006
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Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 95:6, s. 664-70
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To assess recurrent subjective health complaints in Swedish schoolchildren with attention-deficit/hyperactivity disorder (ADHD). Methods: Cohort study of 577 fourth-graders (10-y-olds) in one municipality in Stockholm County. All children were screened for attention and behaviour problems through interviews with their parents and teachers. Children with high scores underwent further clinical and cognitive assessments. Information about health complaints was collected from the children themselves in a classroom questionnaire. The 516 children for whom there was information from all three data sources were included in the final study population. Hypotheses were tested in multivariate analyses with adjustment for sex and parental education. Results: Recurrent abdominal pain (RAP), sleeping problems and tiredness were associated with ADHD (stratified relative risks: 2.2 [1.4-3.4], 1.7 [1.1-2.7] and 2.7 [1.7-4.1], respectively), while there was no association with headache. Conclusion: This study indicates that treatment strategies for children with ADHD need to include an effective evaluation and treatment of RAP, tiredness and sleeping disturbances. Evaluation of ADHD should be considered in children with recurrent health complaints.
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| 25. |
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| 26. |
- Martin, Lene, et al.
(författare)
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Visual fields in children with attention-deficit / hyperactivity disorder before and after treatment with stimulants.
- 2008
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Ingår i: Acta ophthalmologica. - : Wiley. - 1755-3768 .- 1755-375X. ; 86:3, s. 259-64
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: This study aimed to evaluate visual function in children with attention-deficit/hyperactivity disorder (ADHD), to correlate these data with the morphology of the optic nerve, and to find out if and how psychostimulant medication affects visual functions. METHODS: The visual acuity (VA) and visual fields (VFs) of 18 children with ADHD (two girls and 16 boys), aged 6-17 years, were examined before and after treatment with psychostimulants. A control group, consisting of 24 children (nine girls and 15 boys), aged 7-18 years, were examined twice to evaluate the repeatability of the tests and the learning effect. Fundus photographs were analysed by digital planimetry. RESULTS: Visual acuity increased significantly (p = 0.0039) in the ADHD group after treatment. The difference between the two VF examinations was significantly larger in the ADHD group compared with the control group (p = 0.036). Significantly more ADHD subjects had subnormal VF results without stimulants, compared with controls (p = 0.0043), but with stimulants the difference was no longer significant. CONCLUSIONS: Children with ADHD showed better VA and VF results with than without psychostimulant medication.
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| 27. |
- Raffa, Lina H., et al.
(författare)
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Ocular dimensions in relation to auxological data in a sample of Swedish children aged 4-15 years
- 2014
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Ingår i: Acta Ophthalmologica. - : Wiley. - 1755-375X .- 1755-3768. ; 92:7, s. 682-688
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Tidskriftsartikel (refereegranskat)abstract
- PurposeThe purpose was to characterize normal growth patterns of ocular and optical components and to relate them to auxological data in a sample of Swedish children aged 4-15years. MethodsA prospective cross-sectional study was carried out in 143 Swedish children with a mean age of 9.8years. Variables including gestational age (GA), weight, length and head circumference (HCF) at birth and at the time of assessment were registered. Visual acuity (VA), cycloplegic refraction and biometric measures were obtained. Palpebral fissure length and inner canthal distance were measured. Optic disc morphology as seen on fundus photographs was analysed. ResultsChildren born more mature, with male predilection, were found to have deeper anterior and vitreous chamber depths, longer axial lengths and thinner crystalline lens thickness. No correlations were found between ocular biometric measurements and VA or refraction after adjustment for confounding variables. Inner canthal distance was significantly correlated with birth length (p=0.03), height, weight, BMI and HCF (p=0.0008, p=0.0007, p=0.037, and p=0.04, respectively) at time of assessment. Total axial length was found to be significantly correlated with GA (p=0.0226) and length at assessment in girls (p=0.0084). Right optic disc and rim areas decreased with increasing age (p=0.0078 and p=0.0107, respectively); however, optic disc parameters were not dependent on any other variable. ConclusionThese normative values may serve as a basis for the ocular findings and their relationship to auxological data in Caucasian children aged 4-15years, as well as for future comparison in patients with paediatric ocular pathologies.
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| 28. |
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| 29. |
- Allvin, Kerstin, 1970, et al.
(författare)
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Birth weight is the most important predictor of abnormal retinal vascularisation in moderately preterm infants
- 2014
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Ingår i: Acta Paediatrica. - : Wiley-Blackwell Publishing Inc.. - 0803-5253 .- 1651-2227. ; 103:6, s. 594-600
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To find predictors of abnormal retinal vascularisation in moderately to late preterm newborn infants considered to have no risk of developing retinopathy of prematurity.METHODS: Seventy-eight infants (34 girls) were recruited from a longitudinal study of otherwise healthy premature children born at a gestational age of 32 + 0-36 + 6 weeks. Retinal vessel morphology was evaluated at mean postnatal age 7 days. Insulin-like growth factor-I (IGF-I) levels were analysed in umbilical cord blood.RESULTS: Of the 78 infants, 21 (27%) had abnormal retinal vessel morphology; they had significantly lower median (range) birth weight [1850 g, (1190-3260), vs. 2320, (1330-3580), p < 0.0001], shorter birth length [43.0 cm, (38-49), vs. 46.0, (40-50), p < 0.0001] and smaller head circumference [31.0 cm, (27.7-34.0), vs. 32.0, (27.5-36.5), p = 0.003]. They also had significantly lower gestational age [34 + 1 weeks, (32 + 2-35 + 3), vs. 34 + 6, (32 + 2-36 + 6), p = 0.004] and mean ± SD IGF-I levels (24.6 ± 17.0 μg/L vs. 46.7 ± 21.5, p < 0.0001). A higher percentage of these infants were small for gestational age (57.1% vs. 15.8%, p = 0.001), and maternal hypertension/preeclampsia rates were also higher (47.6% vs. 19.3%, p = 0.03). Step-wise logistic regression showed that birth weight was the strongest predictor of abnormal retinal vascularisation (p < 0.0001, odds ratio 0.040, 95% confidence interval 0.007-0.216).CONCLUSION: In this population of moderately to late preterm newborns, birth weight appeared to affect the retinal vascular system.
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| 30. |
- Aring, Eva, 1959, et al.
(författare)
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Strabismus, binocular functions and ocular motility in children with hydrocephalus.
- 2007
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Ingår i: Strabismus. - : Informa UK Limited. - 0927-3972 .- 1744-5132. ; 15:2, s. 79-88
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To investigate heterotropia, heterophoria, head posture, nystagmus, stereo acuity, ocular motility and near point of convergence (NPC) in children with hydrocephalus treated surgically before 1 year of age. In addition, the effects of being born with hydrocephalus, the effect of the etiology of hydrocephalus, number of shunt revisions and the size of the ventricles on these variables were studied. METHODS: A population-based study was performed in 75 children and the results were compared with the results of an age- and sex-matched group (comp group) (n = 140). RESULTS: Heterotropia 68.9% (comp group 3.6%; p < 0.001), abnormal head posture 41.3% (comp group 0; p < 0.001), nystagmus 44.0% (comp group 0; p < 0.001), stereo acuity < or =60'' 33.8% (comp group 97.1%; p < 0.001) and ocular motility defects 69.7% (comp group 0.7%; p < 0.001) were more common among children with hydrocephalus than in the comparison group. Children with overt hydrocephalus at birth had significantly more heterotropia (p = 0.0006), esotropia (p = 0.002), abnormal head posture (p = 0.02) and motility defects (p = 0.003) compared to those with hydrocephalus developing during the first year of life. The etiology, number of shunt revisions and the size of the ventricles had no significant effect on any of the investigated variables. CONCLUSIONS: Children with hydrocephalus surgically treated before the age of one year commonly present orthoptic abnormalities. The etiology of hydrocephalus, number of shunt revisions and ventricle size seem to be of minor importance compared with the age of onset of hydrocephalus with regard to the risk for orthoptic abnormalities.
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| 31. |
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| 33. |
- Hansen-Pupp, Ingrid, et al.
(författare)
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Postnatal Decrease in Circulating Insulin-Like Growth Factor-I and Low Brain Volumes in Very Preterm Infants.
- 2011
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Ingår i: The Journal of clinical endocrinology and metabolism. - : The Endocrine Society. - 1945-7197 .- 0021-972X. ; 96:4, s. 1129-1135
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Tidskriftsartikel (refereegranskat)abstract
- Context: IGF-I and IGF binding protein-3 (IGFBP-3) are essential for growth and maturation of the developing brain. Objective: The aim of this study was to evaluate the association between postnatal serum concentrations of IGF-I and IGFBP-3 and brain volumes at term in very preterm infants. Design: Fifty-one infants with a mean (sd) gestational age (GA) of 26.4 (1.9) wk and birth weight (BW) of 888 (288) g were studied, with weekly blood sampling of IGF-I and IGFBP-3 from birth until 35 gestational weeks (GW) and daily calculation of protein and caloric intake. Magnetic resonance images obtained at 40 GW were segmented into total brain, cerebellar, cerebrospinal fluid, gray matter, and unmyelinated white matter volumes. Main Outcome Measures: We evaluated brain growth by measuring brain volumes using magnetic resonance imaging. Results: Mean IGF-I concentrations from birth to 35 GW correlated with total brain volume, unmyelinated white matter volume, gray matter volume, and cerebellar volume [r = 0.55 (P < 0.001); r = 0.55 (P < 0.001); r = 0.44 (P = 0.002); and r = 0.58 (P < 0.001), respectively]. Similar correlations were observed for IGFBP-3 concentrations. Correlations remained after adjustment for GA, mean protein and caloric intakes, gender, severe brain damage, and steroid treatment. Protein and caloric intakes were not related to brain volumes. Infants with BW small for GA had lower mean concentrations of IGF-I (P = 0.006) and smaller brain volumes (P = 0.001-0.013) than infants with BW appropriate for GA. Conclusion: Postnatal IGF-I and IGFBP-3 concentrations are positively associated with brain volumes at 40 GW in very preterm infants. Normalization of the IGF-I axis, directly or indirectly, may support normal brain development in very preterm infants.
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| 34. |
- Hellström, Ann, 1959, et al.
(författare)
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Docosahexaenoic Acid and Arachidonic Acid Levels Are Associated with Early Systemic Inflammation in Extremely Preterm Infants
- 2020
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Ingår i: Nutrients. - : MDPI AG. - 2072-6643. ; 12:7
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Tidskriftsartikel (refereegranskat)abstract
- Fetal and early postnatal inflammation have been associated with increased morbidity in extremely preterm infants. This study aimed to demonstrate if postpartum levels of docosahexaenoic acid (DHA) and arachidonic acid (AA) were associated with early inflammation. In a cohort of 90 extremely preterm infants, DHA and AA in cord blood, on the first postnatal day and on postnatal day 7 were examined in relation to early systemic inflammation, defined as elevated C-reactive protein (CRP) and/or interleukin-6 (IL-6) within 72 h from birth, with or without positive blood culture. Median serum level of DHA was 0.5 mol% (95% CI (confidence interval) 0.2-0.9,P= 0.006) lower than the first postnatal day in infants with early systemic inflammation, compared to infants without signs of inflammation, whereas levels of AA were not statistically different between infants with and without signs of inflammation. In cord blood, lower serum levels of both DHA (correlation coefficient -0.40;P= 0.010) and AA (correlation coefficient -0.54;p< 0.001) correlated with higher levels of IL-6. Levels of DHA or AA did not differ between infants with and without histological signs of chorioamnionitis or fetal inflammation. In conclusion, serum levels of DHA at birth were associated with the inflammatory response during the early postnatal period in extremely preterm infants.
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| 35. |
- Hellström, Ann, 1959, et al.
(författare)
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Effect of Enteral Lipid Supplement on Severe Retinopathy of Prematurity A Randomized Clinical Trial
- 2021
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Ingår i: JAMA Pediatrics. - : American Medical Association (AMA). - 2168-6203 .- 2168-6211. ; 175:4, s. 359-367
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Tidskriftsartikel (refereegranskat)abstract
- IMPORTANCE Lack of arachidonic acid (AA) and docosahexaenoic acid (DHA) after extremely preterm birth may contribute to preterm morbidity, including retinopathy of prematurity (ROP). OBJECTIVE To determine whether enteral supplementation with fatty acids from birth to 40 weeks' postmenstrual age reduces ROP in extremely preterm infants. DESIGN, SETTING, AND PARTICIPANTS The Mega Donna Mega trial, a randomized clinical trial, was a multicenter study performed at 3 university hospitals in Sweden from December 15, 2016, to December 15, 2019. The screening pediatric ophthalmologists were masked to patient groupings. A total of 209 infants born at less than 27 weeks' gestation were tested for eligibility, and 206 infants were included. Efficacy analyses were performed on as-randomized groups on the intention-to-treat population and on the per-protocol population using as-treated groups. Statistical analyses were performed from February to April 2020. INTERVENTIONS Infants received either supplementation with an enteral oil providing AA (100mg/kg/d) and DHA (50mg/kg/d) (AA:DHA group) or no supplementation within 3 days after birth until 40 weeks' postmenstrual age. MAIN OUTCOMES AND MEASURES The primary outcomewas severe ROP (stage 3 and/or type 1). The secondary outcomes were AA and DHA serum levels and rates of other complications of preterm birth. RESULTS A total of 101 infants (58 boys [57.4%]; mean [SD] gestational age, 25.5 [1.5] weeks) were included in the AA:DHA group, and 105 infants (59 boys [56.2%]; mean [SD] gestational age, 25.5 [1.4] weeks) were included in the control group. Treatment with AA and DHA reduced severe ROP compared with the standard of care (16 of 101 [15.8%] in the AA:DHA group vs 35 of 105 [33.3%] in the control group; adjusted relative risk, 0.50 [95% CI, 0.28-0.91]; P =.02). The AA:DHA group had significantly higher fractions of AA and DHA in serum phospholipids compared with controls (overall mean difference in AA:DHA group, 0.82 mol% [95% CI, 0.46-1.18 mol%]; P <.001; overall mean difference in control group, 0.13 mol% [95% CI, 0.01-0.24 mol%]; P =.03). There were no significant differences between the AA:DHA group and the control group in the rates of bronchopulmonary dysplasia (48 of 101 [47.5%] vs 48 of 105 [45.7%]) and of any grade of intraventricular hemorrhage (43 of 101 [42.6%] vs 42 of 105 [40.0%]). In the AA:DHA group and control group, respectively, sepsis occurred in 42 of 101 infants (41.6%) and 53 of 105 infants (50.5%), serious adverse events occurred in 26 of 101 infants (25.7%) and 26 of 105 infants (24.8%), and 16 of 101 infants (15.8%) and 13 of 106 infants (12.3%) died. CONCLUSIONS AND RELEVANCE This study found that, compared with standard of care, enteral AA:DHA supplementation lowered the risk of severe ROP by 50% and showed overall higher serum levels of both AA and DHA. Enteral lipid supplementation with AA:DHA is a novel preventive strategy to decrease severe ROP in extremely preterm infants.
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| 36. |
- Hellström, Ann, 1959, et al.
(författare)
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Retrospective evaluation of ophthalmological and neurological outcomes for infants born before 24 weeks gestational age in a Swedish cohort
- 2022
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Ingår i: Bmj Open. - : BMJ. - 2044-6055. ; 12:8
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To retrospectively evaluate ophthalmological and neurological outcomes in a Swedish cohort of infants born before 24 weeks gestational age (GA) and explore risk factors for visual impairment. Setting Eye and paediatric clinics in Sweden. Participants Infants screened for retinopathy of prematurity (ROP) (n=399), born before 24 weeks GA, 2007-2018. Cases were excluded if ophthalmological follow-up records could not be traced. Primary and secondary outcome measures Primary outcomes were ophthalmological, including visual acuity (VA), refractive error, strabismus, nystagmus and cerebral visual impairment (CVI). Secondary outcomes comprised neonatal and neurological morbidities. Data were retrospectively retrieved from medical records. Results The 355 assessed children had a median GA of 23 weeks and 2 days and a median birth weight of 565 g. At the last available ophthalmological examination, the median age was 4.8 years (range 0.5-13.2 years). Nystagmus was recorded in 21.1%, strabismus in 34.8%, and 51.0% wore spectacles. Seventy-three of 333 (21.9%) were visually impaired, defined as being referred to a low vision clinic and/or having a VA less than 20/60 at 3.5 years of age or older. ROP treatment was a significant risk factor for visual impairment (OR 2.244, p=0.003). Visually impaired children, compared with children without visual impairment, more often had neurological deficits such as intellectual disability 63.8% versus 33.3% (p<0.001), epilepsy 21.1% versus 7.5% (p=0.001) and autism spectrum disorders 32.8% versus 20.9% (p=0.043). Nine of the 355 children had been diagnosed with CVI. Conclusions Children born before 24 weeks GA frequently had visual impairment in association with neurological deficits. CVI was rarely diagnosed. A multidisciplinary approach for the evaluation and habilitation of these vulnerable infants is warranted. National follow-up guidelines need to be developed and implemented.
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| 37. |
- Hellström, William, et al.
(författare)
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Fetal haemoglobin and bronchopulmonary dysplasia in neonates: An observational study
- 2021
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Ingår i: Archives of Disease in Childhood: Fetal and Neonatal Edition. - : BMJ. - 1359-2998 .- 1468-2052. ; 106, s. 88-92
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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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| 38. |
- Hellström, William, et al.
(författare)
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Low fraction of fetal haemoglobin is associated with retinopathy of prematurity in the very preterm infant
- 2022
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Ingår i: British Journal of Ophthalmology. - : BMJ. - 0007-1161 .- 1468-2079. ; 106, s. 970-974
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Tidskriftsartikel (refereegranskat)abstract
- Background: Blood loss and adult blood transfusions are common during the neonatal period in preterm infants. The objective of the study was to clarify if degree of loss of fetal haemoglobin (HbF) was associated with later retinopathy of prematurity (ROP). Methods: Retrospective observational cohort study. In total, 452 infants born <30 gestational weeks at a tertiary level neonatal intensive care unit in Sweden in 2009-2015 were included, 385 of whom had final ROP outcome. Mean fractions of HbF (%) during the first postnatal week were calculated from 11 861 arterial blood gas analyses. The relationship between fractions of HbF (%) and ROP was evaluated. Results: The mean (SD) gestational age (GA) at birth was 26.4 (1.8) weeks. In total, 104 (27 %) infants developed ROP. Higher fraction of HbF (%) was associated with a lower prevalence of ROP, OR by a 10% increase 0.83 (95% CI: 0.71 to 0.97; p=0.019), following adjustment for GA at birth, small for GA and sex. Infants with HbF (%) in the lowest quartile had OR of 22.0 (95% CI: 8.1 to 59.2; p<0.001) for ROP development compared with those in the highest quartile. The predictive ability (area under the curve) of HbF (%) in the full model during the first week was 0.849 for ROP. Conclusions: Early low fraction of HbF is independently associated with abnormal retinal neurovascular development in the very preterm infant. The potential benefit of minimising blood loss on development of ROP will be investigated in a multicenter randomised trial (NCT04239690). © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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| 39. |
- Hellström, William, et al.
(författare)
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Postnatal serum IGF-1 levels associate with brain volumes at term in extremely preterm infants
- 2023
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Ingår i: Pediatric Research. - : Springer Science and Business Media LLC. - 0031-3998 .- 1530-0447. ; 93:3, s. 666-674
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Tidskriftsartikel (refereegranskat)abstract
- Background Growth factors important for normal brain development are low in preterm infants. This study investigated the link between growth factors and preterm brain volumes at term. Material/methods Infants born <28 weeks gestational age (GA) were included. Endogenous levels of insulin-like growth factor (IGF)-1, brain-derived growth factor, vascular endothelial growth factor, and platelet-derived growth factor (expressed as area under the curve [AUC] for serum samples from postnatal days 1, 7, 14, and 28) were utilized in a multivariable linear regression model. Brain volumes were determined by magnetic resonance imaging (MRI) at term equivalent age. Results In total, 49 infants (median [range] GA 25.4 [22.9-27.9] weeks) were included following MRI segmentation quality assessment and AUC calculation. IGF-1 levels were independently positively associated with the total brain (p < 0.001, beta = 0.90), white matter (p = 0.007, beta = 0.33), cortical gray matter (p = 0.002, beta = 0.43), deep gray matter (p = 0.008, beta = 0.05), and cerebellar (p = 0.006, beta = 0.08) volume adjusted for GA at birth and postmenstrual age at MRI. No associations were seen for other growth factors. Conclusions Endogenous exposure to IGF-1 during the first 4 weeks of life was associated with total and regional brain volumes at term. Optimizing levels of IGF-1 might improve brain growth in extremely preterm infants. Impact High serum levels of insulin-like growth factor (IGF)-1 during the first month of life were independently associated with increased total brain volume, white matter, gray matter, and cerebellar volume at term equivalent age in extremely preterm infants. IGF-1 is a critical regulator of neurodevelopment and postnatal levels are low in preterm infants. The effects of IGF-1 levels on brain development in extremely preterm infants are not fully understood. Optimizing levels of IGF-1 may benefit early brain growth in extremely preterm infants. The effects of systemically administered IGF-1/IGFBP3 in extremely preterm infants are now being investigated in a randomized controlled trial (Clinicaltrials.gov: NCT03253263).
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| 40. |
- Hortensius, Lisa M., et al.
(författare)
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Serum docosahexaenoic acid levels are associated with brain volumes in extremely preterm born infants
- 2021
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Ingår i: Pediatric Research. - : Springer Science and Business Media LLC. - 0031-3998 .- 1530-0447. ; 90:6, s. 1177-1185
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Tidskriftsartikel (refereegranskat)abstract
- Background: Docosahexaenoic acid (DHA) and arachidonic acid (AA) are important for fetal brain growth and development. Our aim was to evaluate the association between serum DHA and AA levels and brain volumes in extremely preterm infants. Methods: Infants born at <28 weeks gestational age in 2013–2015, a cohort derived from a randomized controlled trial comparing two types of parenteral lipid emulsions, were included (n = 90). Serum DHA and AA levels were measured at postnatal days 1, 7, 14, and 28, and the area under the curve was calculated. Magnetic resonance (MR) imaging was performed at term-equivalent age (n = 66), and volumes of six brain regions were automatically generated. Results: After MR image quality assessment and area under the curve calculation, 48 infants were included (gestational age mean [SD] 25.5 [1.4] weeks). DHA levels were positively associated with total brain (B = 7.966, p = 0.012), cortical gray matter (B = 3.653, p = 0.036), deep gray matter (B = 0.439, p = 0.014), cerebellar (B = 0.932, p = 0.003), and white matter volume (B = 3.373, p = 0.022). AA levels showed no association with brain volumes. Conclusions: Serum DHA levels during the first 28 postnatal days were positively associated with volumes of several brain structures in extremely preterm infants at term-equivalent age. Impact: Higher serum levels of DHA in the first 28 postnatal days are positively associated with brain volumes at term-equivalent age in extremely preterm born infants.Especially the most immature infants suffer from low DHA levels in the first 28 postnatal days, with little increase over time.Future research is needed to explore whether postnatal fatty acid supplementation can improve brain development and may serve as a nutritional preventive and therapeutic treatment option in extremely preterm infants.
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| 41. |
- Hård, Anna-Lena, 1949, et al.
(författare)
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Subnormal visual perception in school-aged ex-preterm patients in a paediatric eye clinic
- 2004
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Ingår i: Eye. - : Springer Science and Business Media LLC. - 0950-222X .- 1476-5454. ; 18:6, s. 628-34
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The aim of this study was to assess visual perception at school age of children born preterm with known lesions to the posterior visual pathways or with ophthalmologic signs that might indicate such lesions. METHODS: The study group consisted of 91 patients born before the 37th gestational week. Visual perception was assessed using the TVPS-R (Test of Visual Perceptual Skills - Revised) and a structured interview. In addition, ophthalmologic and orthoptic examinations were performed. RESULTS: On the test of visual perception, 67% of the patients had results below the third percentile of the American reference group. This is to be compared with 10% of Swedish full-term controls. Scores below the third percentile were observed in 87% of the patients with known brain lesions, 48% of those with strabismus without known brain lesion, and 86% of those with reduced visual acuity in the absence of strabismus and known brain lesion. CONCLUSIONS: Reduced visual perception is common among children born preterm who have strabismus and/or reduced visual acuity, as well as in those with known brain lesions. This study emphasises the need to find tools to identify and assess those patients who have visual perceptual problems that may restrict their ability to meet the demands of daily life.
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| 42. |
- Lundgren, Pia, 1967, et al.
(författare)
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National cohort of infants born before 24 gestational weeks showed increased survival rates but no improvement in neonatal morbidity
- 2022
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Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 111:8, s. 1515-1525
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Tidskriftsartikel (refereegranskat)abstract
- Aim To describe survival and neonatal morbidities in infants born before 24 weeks of gestation during a 12-year period. Methods Data were retrieved from national registries and validated in medical files of infants born before 24 weeks of gestation 2007-2018 in Sweden. Temporal changes were evaluated. Results In 2007-2018, 282 live births were recorded at 22 weeks and 460 at 23 weeks of gestation. Survival to discharge from hospital of infants born alive at 22 and 23 weeks increased from 20% to 38% (p = 0.006) and from 45% to 67% (p < 0.001) respectively. Caesarean section increased from 12% to 22% (p = 0.038) for infants born at 22 weeks. Neonatal morbidity rates in infants alive at 40 weeks of postmenstrual age (n = 399) were unchanged except for an increase in necrotising enterocolitis from 0 to 33% (p = 0.017) in infants born at 22 weeks of gestation. Bronchopulmonary dysplasia was more common in boys than girls, 90% versus 82% (p = 0.044). The number of infants surviving to 40 weeks doubled over time. Conclusion Increased survival of infants born before 24 weeks of gestation resulted in increasing numbers of very immature infants with severe neonatal morbidities likely to have a negative impact on long-term outcome.
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| 43. |
- Morsing, Eva, et al.
(författare)
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Neurodevelopmental disorders and somatic diagnoses in a national cohort of children born before 24 weeks of gestation
- 2022
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Ingår i: Acta Paediatrica, International Journal of Paediatrics. - : Wiley. - 0803-5253 .- 1651-2227. ; 111:6, s. 1167-1175
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Tidskriftsartikel (refereegranskat)abstract
- Aim: This study investigated childhood diagnoses in children born extremely preterm before 24 weeks of gestation. Methods: Diagnoses of neurodevelopmental disorders and selected somatic diagnoses were retrospectively retrieved from national Swedish registries for children born before 24 weeks from 2007 to 2018. Their individual medical files were also examined. Results: We studied 383 children born at a median of 23.3 (range 21.9–23.9) weeks, with a median birthweight of 565 (range 340–874) grams. Three-quarters (75%) had neurodevelopmental disorders, including speech disorders (52%), intellectual disabilities (40%), attention deficit hyperactivity disorder (30%), autism spectrum disorders (24%), visual impairment (22%), cerebral palsy (17%), epilepsy (10%) and hearing impairment (5%). More boys than girls born at 23 weeks had intellectual disabilities (45% vs. 27%, p < 0.01) and visual impairment (25% vs. 14%, p < 0.01). Just over half of the cohort (55%) received habilitation care. The majority (88%) had somatic diagnoses, including asthma (63%) and failure to thrive/short stature (39%). Conclusion: Most children born before 24 weeks had neurodevelopmental disorders and/or additional somatic diagnoses in childhood and were referred to habilitation services. Clinicians should be aware of the multiple health and developmental problems affecting these children. Resources are needed to identify their long-term support needs at an early stage.
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| 44. |
- Pupp, Ingrid, et al.
(författare)
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Fresh-frozen plasma as a source of exogenous insulin-like growth factor-I in the extremely preterm infant
- 2009
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Ingår i: J Clin Endocrinol Metab. - : The Endocrine Society. - 1945-7197 .- 0021-972X. ; 94:2, s. 477-482
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Tidskriftsartikel (refereegranskat)abstract
- CONTEXT: Preterm birth is followed by a decrease in circulatory levels of IGF-I and IGF binding protein (IGFBP)-3, proteins with important neurogenic and angiogenic properties. OBJECTIVE: Our objective was to evaluate the effects of iv administration of fresh-frozen plasma (FFP) from adult donors on circulatory levels of IGF-I and IGFBP-3 in extremely preterm infants. DESIGN, SETTING, AND PATIENTS: A prospective cohort study was performed in 20 extremely preterm infants [mean (SD) gestational age 25.3 (1.3) wk] with clinical requirement of FFP during the first postnatal week. Sampling was performed before initiation of transfusion, directly after, and at 6, 12, 24, and 48 h after completed FFP transfusion. MAIN OUTCOME MEASURES: Concentrations of IGF-I and IGFBP-3 before and after transfusion of FFP were determined. RESULTS: FFP with a mean (SD) volume of 11 ml/kg (3.1) was administered at a median postnatal age of 2 d (range 1-7). Mean (SD) IGF-I and IGFBP-3 concentrations in administered FFP were 130 (39) and 2840 microg/liter (615), respectively. Immediately after FFP transfusion, mean (SD) concentrations of IGF-I increased by 133% from 11 (6.4) to 25 microg/liter (9.3) (P < 0.001) and IGFBP-3 by 61% from 815 (451) to 1311 microg/liter (508) (P < 0.001). Concentrations of IGF-I and IGFBP-3 remained higher at 6 (P < 0.001, P = 0.009) and 12 h (P = 0.017, P = 0.018), respectively, as compared with concentrations before FFP transfusion. Typical half-life of administrated IGF-I was 3.4 h for a 1-kg infant. CONCLUSION: Transfusion of FFP to extremely preterm infants during the first postnatal week elevates levels of IGF-I and IGFBP-3.
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| 45. |
- Raffa, Lina H., et al.
(författare)
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Ocular morphology and visual function in relation to general growth in moderate-to-late preterm school-aged children
- 2016
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Ingår i: Acta Ophthalmologica. - : John Wiley & Sons. - 1755-375X .- 1755-3768. ; 94:7, s. 712-720
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To study ocular morphology and visual function in relation to general growth in moderate-to-late preterm (MLP) children.METHODS: Visual acuity (VA), refraction, optic disc parameters, biometric values and anthropometric measures were obtained from 50 eight-year-old MLP and 43 full-term children. Macular parameters were examined by optical coherence tomography. Serum insulin-like growth factor I (IGF-I) levels were analysed at birth and at assessment and delta IGF-I was calculated.RESULTS: Total macular volume was significantly less in MLP than in controls (both eyes p < 0.01). Macular volume correlated with head circumference (HCF) at assessment [right eye (RE) p = 0.002, r = 0.67; left eyes (LE) p = 0.01, r = 0.54] and refraction (both eyes p < 0.05, r = 0.4) in the MLP children. Furthermore, central retinal thickness correlated significantly with delta IGF-I (RE p = 0.03, r = -0.51, LE p = 0.006, r = -0.59) and refraction (both eyes p < 0.01, r = 0.5) and optic disc areas correlated with weight and height at assessment (all p < 0.05, r = 0.4). Total axial length correlated with HCF at assessment (both eyes p < 0.01, r = 0.5) and VA logMAR (both eyes p < 0.02, r = -0.4).CONCLUSIONS: Macular volume was significantly less in MLP children than in controls examined at 8 years of age. General growth of children and IGF-I levels seem to be involved in development of ocular growth and morphology.
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| 46. |
- Ygge, J., et al.
(författare)
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Fixation stability in normal children
- 2005
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Ingår i: Ann N Y Acad Sci. ; 1039, s. 480-3
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Tidskriftsartikel (refereegranskat)abstract
- Fixation stability was found to increase with increasing age (4-15 years) in normal children, but there was no directional preponderance in fixation location.
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| 47. |
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| 48. |
- Agyemang, Alex Adusei, et al.
(författare)
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Cerebellar Exposure to Cell-Free Hemoglobin Following Preterm Intraventricular Hemorrhage: Causal in Cerebellar Damage?
- 2017
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Ingår i: Translational Stroke Research. - : Springer Science and Business Media LLC. - 1868-4483 .- 1868-601X. ; 8:5, s. 461-473
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Tidskriftsartikel (refereegranskat)abstract
- Decreased cerebellar volume is associated with intraventricular hemorrhage (IVH) in very preterm infants and may be a principal component in neurodevelopmental impairment. Cerebellar deposition of blood products from the subarachnoid space has been suggested as a causal mechanism in cerebellar underdevelopment following IVH. Using the preterm rabbit pup IVH model, we evaluated the effects of IVH induced at E29 (3 days prior to term) on cerebellar development at term-equivalent postnatal day 0 (P0), term-equivalent postnatal day 2 (P2), and term-equivalent postnatal day 5 (P5). Furthermore, the presence of cell-free hemoglobin (Hb) in cerebellar tissue was characterized, and cell-free Hb was evaluated as a causal factor in the development of cerebellar damage following preterm IVH. IVH was associated with a decreased proliferative (Ki67-positive) portion of the external granular layer (EGL), delayed Purkinje cell maturation, and activated microglia in the cerebellar white matter. In pups with IVH, immunolabeling of the cerebellum at P0 demonstrated a widespread presence of cell-free Hb, primarily distributed in the white matter and the molecular layer. Intraventricular injection of the Hb scavenger haptoglobin (Hp) resulted in a corresponding distribution of immunolabeled Hp in the cerebellum and a partial reversal of the damaging effects observed following IVH. The results suggest that cell-free Hb is causally involved in cerebellar damage following IVH and that blocking cell-free Hb may have protective effects.
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| 49. |
- Andersson, Susann, 1965, et al.
(författare)
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Abnormal optic disc and retinal vessels in children with surgically treated hydrocephalus
- 2009
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Ingår i: British Journal of Ophthalmology. - 1468-2079. ; 93:4, s. 526-30
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: To investigate the morphology of the optic disc and retinal vessels in children with surgically treated hydrocephalus. METHODS: A prospective, population-based study was performed in 69 children (median age 9.6 years) with early surgically treated hydrocephalus. All children were examined by ophthalmoscopy. Additionally, optic disc and retinal vessel morphology was evaluated in 55 children by digital image analysis of ocular fundus photographs. RESULTS: Optic atrophy was found in 10 of 69 children (14%). In comparison with a reference group, the median optic-disc area was significantly smaller (p = 0.013) in the children with hydrocephalus. There was no corresponding difference in cup area, so the rim area was significantly smaller in the hydrocephalic children (p = 0.002). Children with hydrocephalus had an abnormal retinal vascular pattern, with significantly straighter retinal arteries and fewer central vessel branching points compared with controls (p<0.001 and p<0.001, respectively). CONCLUSION: Hydrocephalus is associated with subnormal optic disc and rim areas and an abnormal vascular pattern, indicating a pre/perinatal disturbance of the development of these structures. A promising finding is that the frequency of optic atrophy in the present study was lower than previously reported, most likely reflecting improved perinatal care and better regulation of the intracranial pressure.
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| 50. |
- Austeng, Dordi, et al.
(författare)
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Natural history of retinopathy of prematurity in infants born before 27 weeks' gestation in Sweden
- 2010
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Ingår i: Archives of ophthalmology (1960). - : American Medical Association. - 0003-9950. ; 128:10, s. 1289-1294
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate the natural history of retinopathy of prematurity (ROP) in 506 extremely preterm infants born before 27 weeks' gestation in Sweden during a 3-year period. Methods: A national population–based study was performed in Sweden from April 1, 2004, to March 31, 2007. According to the study protocol, initial eye examinations were to be performed at postnatal week 5, and examinations were repeated until the retina was completely vascularized or until criteria for treatment were met. The examinations were to be performed weekly, enabling study of the course and severity of ROP. In infants without ROP or with mild ROP without progression during the latest examinations, further examinations were performed weekly or every other week from postmenstrual age 35 weeks. Results: During the study, 368 infants (72.7%) developed ROP. Postmenstrual age at onset of ROP was significantly related to severity of ROP, even when controlling for gestational age (ie, the earlier the onset of ROP, the higher the risk of developing severe ROP). Site of onset of ROP was significantly related to gestational age at birth. The risk of nasal onset was almost doubled for every week of decrease in gestational age at birth. Nasal onset was associated with severe ROP, even after adjusting for gestational age at birth. Conclusion: This population-based study confirms results of the Cryotherapy for Retinopathy of Prematurity study and shows new correlations regarding time and site of onset of ROP, both of which are associated with disease severity.
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