| 1. |
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| 2. |
- Axelsson, Inge, 1947-, et al.
(författare)
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Inhaled corticosteroids in children with persistent asthma : effects of different drugs and delivery devices on growth
- 2019
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Ingår i: Cochrane Database of Systematic Reviews. - : John Wiley & Sons. - 1469-493X. ; :6
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Forskningsöversikt (refereegranskat)abstract
- Background: Inhaled corticosteroids (ICS) are the most effective treatment for children with persistent asthma. Although treatment with ICS is generally considered to be safe in children, the potential adverse effects of these drugs on growth remains a matter of concern for parents and physicians.Objectives: To assess the impact of different inhaled corticosteroid drugs and delivery devices on the linear growth of children with persistent asthma.Search methods: We searched the Cochrane Airways Trials Register, which is derived from systematic searches of bibliographic databases including CENTRAL, MEDLINE, Embase, CINAHL, AMED and PsycINFO. We handsearched respiratory journals and meeting abstracts. We also conducted a search of ClinicalTrials.gov and manufacturers' clinical trial databases, or contacted the manufacturer, to search for potential relevant unpublished studies. The literature search was initially conducted in September 2014, and updated in November 2015, September 2018, and April 2019.Selection criteria: We selected parallel‐group randomized controlled trials of at least three months' duration. To be included, trials had to compare linear growth between different inhaled corticosteroid molecules at equivalent doses, delivered by the same type of device, or between different devices used to deliver the same inhaled corticosteroid molecule at the same dose, in children up to 18 years of age with persistent asthma.Data collection and analysis: At least two review authors independently selected studies and assessed risk of bias in included studies. The data were extracted by one author and checked by another. The primary outcome was linear growth velocity. We conducted meta‐analyses using Review Manager 5.3 software. We used mean differences (MDs) and 95% confidence intervals (CIs ) as the metrics for treatment effects, and the random‐effects model for meta‐analyses. We did not perform planned subgroup analyses due to there being too few included trials.Main results: We included six randomized trials involving 1199 children aged from 4 to 12 years (per‐protocol population: 1008), with mild‐to‐moderate persistent asthma. Two trials were from single hospitals, and the remaining four trials were multicentre studies. The duration of trials varied from six to 20 months.One trial with 23 participants compared fluticasone with beclomethasone, and showed that fluticasone given at an equivalent dose was associated with a significant greater linear growth velocity (MD 0.81 cm/year, 95% CI 0.46 to 1.16, low certainty evidence). Three trials compared fluticasone with budesonide. Fluticasone given at an equivalent dose had a less suppressive effect than budesonide on growth, as measured by change in height over a period from 20 weeks to 12 months (MD 0.97 cm, 95% CI 0.62 to 1.32; 2 trials, 359 participants; moderate certainty evidence). However, we observed no significant difference in linear growth velocity between fluticasone and budesonide at equivalent doses (MD 0.39 cm/year, 95% CI ‐0.94 to 1.73; 2 trials, 236 participants; very low certainty evidence).Two trials compared inhalation devices. One trial with 212 participants revealed a comparable linear growth velocity between beclomethasone administered via hydrofluoroalkane‐metered dose inhaler (HFA‐MDI) and beclomethasone administered via chlorofluorocarbon‐metered dose inhaler (CFC‐MDI) at an equivalent dose (MD ‐0.44 cm/year, 95% CI ‐1.00 to 0.12; low certainty evidence). Another trial with 229 participants showed a small but statistically significant greater increase in height over a period of six months in favour of budesonide via Easyhaler, compared to budesonide given at the same dose via Turbuhaler (MD 0.37 cm, 95% CI 0.12 to 0.62; low certainty evidence).Authors' conclusions: This review suggests that the drug molecule and delivery device may impact the effect size of ICS on growth in children with persistent asthma. Fluticasone at an equivalent dose seems to inhibit growth less than beclomethasone and budesonide. Easyhaler is likely to have less adverse effect on growth than Turbuhaler when used for delivery of budesonide. However, the evidence from this systematic review of head‐to‐head trials is not certain enough to inform the selection of inhaled corticosteroid or inhalation device for the treatment of children with persistent asthma. Further studies are needed, and pragmatic trials and real‐life observational studies seem more attractive and feasible.
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| 3. |
- Back, Julia, et al.
(författare)
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Evidence of support used for drug treatments in pediatric cardiology
- 2021
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Ingår i: Health Science Reports. - : WILEY. - 2398-8835. ; 4:2
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Tidskriftsartikel (refereegranskat)abstract
- Background and aims: Clinical support systems are widely used in pediatric care. The aim of this study was to assess the support for drug treatments used at pediatric cardiac wards and intensive care units in Sweden.Methods: Drug information, such as type of drug, indication, dose, and route of administration, for all in-hospital pediatric cardiac patients, was included in the study. Treatments were classified as either on-label (based on product information) or off-label. Support for off-label treatment was stratified by the use of clinical support systems (the national database on drugs, local, or other clinical experience guidelines).Results: In all, 28 patients were included in the study. The total number of drug treatments was 233, encompassing 65 different drugs. Overall, 175 (75%) treatments were off-label. A majority of off-label drug treatments were supported by other sources of information shared by experts. A total of 7% of the drug treatments were used without support.Conclusion: Off-label drug treatment is still common in Swedish pediatric cardiac care. However, the majority of treatments were supported by the experience shared in clinical support systems.Key Points:Seventy-five percent of all prescriptions in pediatric cardiology care were off-label.A majority of patients received three or more drug treatments off-label.Use of clinical support systems and guidelines was common, but in 7% of all drug treatments, no support was found for the chosen treatment.
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| 4. |
- Berger, Vilma, et al.
(författare)
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Adolescents on psychotropic treatment displayed longer corrected QT intervals than unmedicated controls when they rose rapidly from the supine position
- 2024
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Ingår i: Acta Paediatrica. - : John Wiley & Sons. - 0803-5253 .- 1651-2227. ; 113:7, s. 1621-1629
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Tidskriftsartikel (refereegranskat)abstract
- Aim: Psychotropic medication can contribute to arrhythmia and identifying individuals at risk is crucial. This Swedish study compared the corrected QT (QTc) intervals of adolescents on psychotropic medication with unmedicated controls, when supine and after rising rapidly.Methods: The study was carried out at Östersund County Hospital in March 2022 and February to March 2023. It comprised 16 cases, aged 10–17 years and 28 controls. QTc intervals were measured with electrocardiography and calculated using Bazett's and Fridericia's formulas. Univariate and multiple linear regressions were used to assess differences in QTc intervals between the cases and controls and across sex, age and body mass index.Results: The mean QTc interval when supine, calculated with Bazett's formula, was longer for the adolescents on psychotropic medication than the controls (p = 0.046). The same was true for the mean QTc interval after rising rapidly from the supine position, calculated with both Bazett's formula (p = 0.009) and Fridericia's formula (p = 0.007). Mean QTc intervals varied by sex and age groups. Psychotropic medication prolonged QTc intervals, particularly in girls.Conclusion: Longer QTc intervals were found in adolescents on psychotropic medication, particularly after rising rapidly from the supine position.
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| 5. |
- Edler, Gertrud, et al.
(författare)
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Serious complications in male infant circumcisions in Scandinavia indicate that this always be performed as a hospital-based procedure
- 2016
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Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 105:7, s. 842-850
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Tidskriftsartikel (refereegranskat)abstract
- AimMore than 7000 male circumcisions are performed in Scandinavia every year. Circumcision is regulated in different ways in Sweden and Denmark and Norway. This study reviewed and described factors associated with complications of circumcision in infant boys in Scandinavia over the last two decades and discussed how these complications could be avoided. MethodsData on significant complications following circumcision on boys under the age of one in Scandinavia over the last 20 years were collected. Information was retrieved from testimonies of circumcisers, witnesses, medical records and verdicts. A systematic review was performed of fatal cases in the literature. ResultsWe found that 32 cases had been reported to the health authorities in the three countries, and we identified a total of 74 complications in these cases. These included four boys with severe bleeding and circulatory shock, which ended in the death of one boy. Other less serious complications may have occurred in other boys, but not been reported. ConclusionComplications following male circumcision in Scandinavia were relatively rare, but serious complications did occur. Based on the analyses of the severe cases, we argue that circumcision should only be performed at hospitals with 24-hour emergency departments.
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| 6. |
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| 7. |
- Granbom, Elin, 1986-, et al.
(författare)
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Evaluating national guidelines for the prophylactic treatment of respiratory syncytial virus in children with congenital heart disease
- 2014
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Ingår i: Acta Pædiatrica. - : Wiley. - 1651-2227 .- 0803-5253. ; 103:8, s. 840-845
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Tidskriftsartikel (refereegranskat)abstract
- Aim: This is the first study to evaluate compliance with the 2003 Swedish national guidelines for prophylactic treatment of respiratory syncytial virus (RSV) in children with congenital heart disease (CHD). We estimated the relative risk (RR) of children with CHD being hospitalised with a RSV infection, studied the extent to which RSV prophylactic treatment with palivizumab corresponded to the guidelines and determined the morbidity of children with CHD who developed RSV infection despite prophylaxis. Methods: This national observational study comprised prospectively registered data on 219 children with CHD treated with palivizumab, medical records on RSV cases and information on hospitalisation rates of children with CHD and RSV infection. Results: The calculated RR of children with CHD being hospitalised with RSV infection was 2.06 (950/0 Cl 1.6-2.6; p < 0.0001) compared with children without CHD. Approximately half of the patients (49%) born before the RSV season and 25% born during the RSV season did not start treatment as recommended by the guidelines. Conclusion: Having CHD increased the rate and estimated RR of children being hospitalised with RSV infection. The guidelines were not followed for about half of the children born before a RSV season and a quarter of the children born during a RSV season and need updating.
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| 8. |
- Granbom, Elin, et al.
(författare)
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Respiratory tract infection and risk of hospitalization in children with congenital heart defects during season and off-season : a Swedish national study
- 2016
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Ingår i: Pediatric Cardiology. - New York : Springer. - 0172-0643 .- 1432-1971. ; 37:6, s. 1098-1105
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Tidskriftsartikel (refereegranskat)abstract
- Respiratory tract infections (RTI) are common among young children, and congenital heart defect (CHD) is a risk factor for severe illness and hospitalization. This study aims to assess the relative risk of hospitalization due to RTI in winter and summer seasons for different types of CHD. All children born in Sweden and under the age of two, in 2006-2011, were included. Heart defects were grouped according to type. Hospitalization rates for respiratory syncytial virus (RSV) infection and RTI in general were retrieved from the national inpatient registry. The relative risk of hospitalization was calculated by comparing each subgroup to other types of CHD and otherwise healthy children. The relative risk of hospitalization was increased for all CHD subgroups, and there was a greater increase in risk in summer for the most severe CHD. This included RSV infection, as well as RTI in general. The risk of hospitalization due to RTI is greater for CHD children. Prophylactic treatment with palivizumab, given to prevent severe RSV illness, is only recommended during winter. We argue that information to healthcare staff and parents should include how the risk of severe infectious respiratory tract illnesses, RSV and others, is present all year round for children with CHD.
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| 9. |
- Granbom, Elin, 1986-
(författare)
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Respiratory tract infections in children with congenital heart disease
- 2016
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Respiratory Syncytial Virus (RSV) infection is common among young children. Congenital Heart Disease (CHD) is a risk factor of severe illness and hospitalization. Palivizumab prophylaxis reduces the severity of RSV infection and reduces the risk of hospitalization for children at high risk of severe illness, such as children born premature or with CHD.The aim of this thesis was to evaluate compliance with national guidelines for prophylactic treatment and to study the Relative Risk (RR) of hospitalization due to RSV and unspecified Respiratory Tract Infection (RTI) for children with CHD.In a prospective study, questionnaires were sent to all paediatric cardiology centres in Sweden with questions about prophylactic treatment. Hospitalization rates were retrieved from the national inpatient registry. Heart defects were grouped according to type and the relative risk of hospitalization was calculated for each group and for summer and winter seasons.Half of the patients received prophylactic treatment later than recommended in the guidelines. The risk of hospitalization due to RSV infection was increased (RR=2.06 95% CI 1.6-2.6; p < 0.0001) for children with CHD compared to children without CHD. The RR of hospitalization was also increased for all CHD subgroups, and was further increased during summer for children with the more severe CHD.We conclude that guidelines for prophylactic treatment were not followed and that the risk of hospitalization due to RSV and unspecified RTI was increased for all subgroups of CHD. The risk was increased both during winter and summer and we therefore argue that information to health personnel and parents should include that the risk of severe RTI is present all year round for children with CHD.
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| 10. |
- Grut, Viktor, et al.
(författare)
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National cohort study showed that infants with Down's syndrome faced a high risk of hospitalisation for the respiratory syncytial virus
- 2017
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Ingår i: Acta Paediatrica. - : John Wiley & Sons. - 0803-5253 .- 1651-2227. ; 106:9, s. 1519-1524
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Tidskriftsartikel (refereegranskat)abstract
- Aim: The respiratory syncytial virus (RSV) is a leading cause of hospitalisation in infants. We investigated this risk in children with Down's syndrome under two years of age, adjusted for other known risk factors. Methods: This national, retrospective 1: 2 matched cohort study comprised all Swedish children born with Down's from 2006 to 2011, who were each randomly matched to two controls without Down's. Data on RSV hospitalisation and risk factors for RSV were obtained from national registers. The risk of RSV hospitalisation was assessed using multivariable Cox regression with pairwise stratification. Results: The study comprised 814 children with Down's and 1628 controls. We found that 82 children with Down's (10.1%) and 22 controls (1.4%) were hospitalised for RSV. The hazard ratio for children with Down's was 4.00 (95% confidence interval 1.58-10.13) for up to one year of age and 6.60 (95% CI: 2.83-15.38) for up to two years of age, adjusted for other risk factors. During the second year of life, RSV hospitalisation continued for children with Down's, while it was minimal for the controls. Conclusion: Children with Down's faced a high risk of RSV hospitalisation, which continued beyond the first year of age.
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| 11. |
- Irevall, T., et al.
(författare)
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B12 deficiency is common in infants and is accompanied by serious neurological symptoms
- 2017
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Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 106:1, s. 101-104
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Tidskriftsartikel (refereegranskat)abstract
- Aim: Adverse neurological symptoms have been linked to vitamin B12 deficiency in infants. This explorative study described the clinical presentation associated with vitamin B12 deficiency in this age group. Methods: The study comprised infants who were born between 2004 and 2012 and were tested for vitamin B12 levels after they were admitted to a hospital with neurological symptoms at less than one year of age. Vitamin B12 deficiency was defined as low cobalamin in serum and/or increased homocysteine and/or increased methylmalonate. It was diagnosed according to the applicable International Classification of Diseases, 10th revision, and recorded as vitamin B12 deficiency in the medical records. All information was retrieved from medical records and compared to symptomatic infants with normal levels. Results: Of the 121 infants tested, 35 had vitamin B12 deficiency and 86 had normal levels. Vitamin B12 deficiency was diagnosed at an average age of 1.7 months and was more common among boys. Seizures and apparent life-threatening events were the most common symptoms among infants with B12 deficiency compared to infants with normal levels. Conclusion: Vitamin B12 deficiency was more common in infants than we expected and presented with severe symptoms, such as seizures and apparent life-threatening events.
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| 12. |
- Irewall, Tommie, et al.
(författare)
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A longitudinal follow-up of continuous laryngoscopy during exercise test scores in athletes irrespective of laryngeal obstruction, respiratory symptoms, and intervention
- 2023
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Ingår i: BMC Sports Science, Medicine and Rehabilitation. - : BioMed Central (BMC). - 2052-1847. ; 15:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Exercise-induced laryngeal obstruction (EILO) is diagnosed by the continuous laryngoscopy during exercise (CLE) test. Whether or how much CLE test scores vary over time is unknown. This study aimed to compare CLE test scores in athletes over time, irrespective of respiratory symptoms and grade of laryngeal obstruction. Methods: Ninety-eight athletes previously screened for EILO were invited for a follow-up CLE test irrespective of CLE scores and respiratory symptoms. Twenty-nine athletes aged 16–27 did a follow-up CLE test 3–23 months after the baseline test. Laryngeal obstruction at the glottic and supraglottic levels was graded by the observer during exercise, at baseline and follow-up, using a visual grade score (0–3 points). Results: At baseline, 11 (38%) of the 29 athletes had moderate laryngeal obstruction and received advice on breathing technique; among them, 8 (73%) reported exercise-induced dyspnea during the last 12 months. At follow-up, 8 (73%) of the athletes receiving advice on breathing technique had an unchanged supraglottic score. Three (17%) of the 18 athletes with no or mild laryngeal obstruction at baseline had moderate supraglottic obstruction at follow-up, and none of the 3 reported exercise-induced dyspnea. Conclusions: In athletes with repeated testing, CLE scores remain mostly stable over 3–24 months even with advice on breathing technique to those with EILO. However, there is some intraindividual variability in CLE scores over time. Trial registration: ISRCTN, ISRCTN60543467, 2020/08/23, retrospectively registered, ISRCTN – ISRCTN60543467: Investigating conditions causing breathlessness in athletes.
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| 13. |
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| 14. |
- Irewall, Tommie, 1987-
(författare)
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Prevalence and incidence of and risk factors for asthma and exercise-induced laryngeal obstruction in elite endurance athletes
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Asthma is highly prevalent in endurance athletes, but we lack up-to-date information on the prevalence and incidence of asthma in cross-country skiers. Exercise-induced laryngeal obstruction (EILO) is an important differential diagnosis to exercise-induced asthma, and its symptoms can mimic asthma. The two conditions may co-exist, and misdiagnosis of EILO may result in unnecessary asthma treatment. The gold standard diagnostic test for EILO is continuous laryngoscopy during exercise (CLE). Aims: The aim of this thesis was to study the prevalence and incidence of asthma in endurance athletes, with a special focus on cross-country skiers. In addition, the thesis aimed to assess the prevalence of EILO in cross-country skiers and to study the intra-individual variability of laryngeal obstruction scores using the CLE test. Methods: Study 1 (papers I & II) comprised a cohort of elite endurance athletes who participated in an annual postal survey including questions regarding asthma, allergy, and exercise between 2011 and 2015. The invited athletes were Swedish elite skiers and orienteers, belonging to national teams, universities with elite sport contracts, Swedish National Elite Sport Schools, or national top ranking. The study population in paper I comprised adolescent skiers at Swedish National Elite Sport Schools (n=253) between 2011 and 2013, together with a reference population aged 16–20 years that was matched for school municipality (n=500) and invited in 2013. Paper II included all skiers and orienteers (n=666) participating in the prospective survey in 2011–2015. The incidence of physician- diagnosed asthma was defined as the number of incident cases of physician- diagnosed asthma divided by the summarized time at risk in person-years in the population without physician-diagnosed asthma at baseline. In study 2 (papers III & IV), elite skiers and competitive athletes (n=109) were screened for allergy, exercise-induced bronchoconstriction, and EILO at Östersund Hospital between 2015 and 2017. The participants answered a questionnaire regarding asthma, allergy, and exercise and underwent a CLE test, eucapnic voluntary hyperventilation (EVH) test, and skin prick test. Laryngeal obstruction was assessed at the glottic and supraglottic levels using a visual grade iv score (0–3 points). EILO was defined as ≥ 2 points at maximal effort exercise. Current asthma was defined as self-reported physician-diagnosed asthma and use of asthma medication in the last 12 months. All participants were invited to a follow-up examination off-season if the first examination was performed during the competitive season, or on-season if the first visit occurred during off-season. Paper III included 89 elite skiers that completed the first baseline visit. Paper IV included all 29 athletes that completed the baseline and follow-up testing regardless of diagnosis, treatment, and respiratory symptoms. Results: In paper I, the response rate was 96% in the skier population and 48% in the reference population. Skiers at Swedish National Elite Sport Schools had a higher prevalence of physician-diagnosed asthma than the reference population (27% vs. 19%, p=0.046). Median age at asthma onset was higher in skiers compared to in the reference population (12.0vs 8.0 years, p<0.001). Female sex, family history of asthma, nasal allergies, and being a skier were independent risk factors associated with physician-diagnosed asthma. In paper II, the response rate was 88.7% at baseline and decreased by year of follow-up. The population at risk at baseline consisted of 290 skiers and 159 orienteers, and the incidence rate (95% confidence interval [CI]) of physician- diagnosed asthma was 61.2 (45.7–80.3) per 1000 person-years. Risk factors for incident physician-diagnosed asthma were family history of asthma, being a skier, and wheezing without having a cold. In paper III, 24 (27%) of the 89 elite cross-country skiers fulfilled the study criterion for EILO. Current asthma was present in 34 (38%) skiers, whereof 10 (29%) of whom had concomitant EILO. A higher proportion of skiers with EILO and current asthma reported wheezing or shortness of breath following exercise compared to skiers with asthma only. In paper IV, the CLE score was mainly unchanged at follow-up after 3–23 months. In the 11 athletes with moderate supraglottic obstruction at first visit and receiving advice for breathing exercises, 3 (27%) had mild obstruction at follow- up. Among athletes without no or mild supraglottic obstruction at first visit, 3 (17%) had moderate laryngeal supraglottic obstruction at follow-up. Conclusions: Adolescent skiers have a high prevalence of self-reported physician-diagnosed asthma. The onset of asthma commonly occurs during early adolescence. Endurance athletes also have a high incidence of physician-diagnosed asthma v during their career, especially among skiers. Furthermore, skiers have a high prevalence of EILO, including nearly 30% of skiers with current asthma. In endurance athletes, the grade of laryngeal obstruction according to CLE was fairly stable when reassessed after 3–23 months, regardless of the grade of laryngeal obstruction, respiratory symptoms at baseline, and advice on breathing exercises after the first visit. Therefore, when assessing skiers with exercise-related respiratory symptoms, both EILO and asthma should be considered.
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| 15. |
- Jeremiasen, Ida, et al.
(författare)
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Outpatient prescription of pulmonary vasodilator therapy to preterm children with bronchopulmonary dysplasia
- 2023
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Ingår i: Acta Paediatrica. - : John Wiley & Sons. - 0803-5253 .- 1651-2227. ; 112:3, s. 403-416
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Tidskriftsartikel (refereegranskat)abstract
- Aim: The use of pulmonary vasodilator therapy in children born preterm is largely unknown. Our aim was to map prescription patterns in children with bronchopulmonary dysplasia in Sweden.Methods: This was a descriptive national registry-based study of children <7 years who had been prescribed a pulmonary vasodilator during 2007–2017, were born preterm and classified as having bronchopulmonary dysplasia. Information on prescriptions, patient characteristics and comorbidities were retrieved from the Swedish Prescribed Drug Register and linked to other national registers.Results: The study included 74 children, 54 (73%) born at 22–27 weeks' gestation and 20 (27%) at 28–36 weeks. Single therapy was most common, n = 64 (86.5%), and sildenafil was prescribed most frequently, n = 69 (93%). Bosentan, iloprost, macitentan and/or treprostinil were used mainly for combination therapies, n = 10 (13.5%). Patent ductus arteriosus or atrial septal defect were present in 29 (39%) and 25 (34%) children, respectively, and 20 (69%) versus 3 (12%) underwent closure. Cardiac catheterisation was performed in 19 (26%) patients. Median duration of therapy was 4.6 (1.9-6.8, 95% CI) months. Mortality was 9%.Conclusion: Preterm children with bronchopulmonary dysplasia were prescribed pulmonary vasodilators, often without prior catheterisation. Sildenafil was most commonly used. Diagnostic tools, effects, and drug safety need further evaluation.
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| 16. |
- Jeremiasen, Ida, et al.
(författare)
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Vasodilator therapy for pulmonary hypertension in children : a national study of patient characteristics and current treatment strategies
- 2021
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Ingår i: Pulmonary Circulation. - : John Wiley & Sons. - 2045-8932 .- 2045-8940. ; 11:4
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Tidskriftsartikel (refereegranskat)abstract
- Pulmonary vasodilator therapy is still often an off-label treatment for pulmonary hypertension in children. The aim of this nationwide register-based study was to assess patient characteristics and strategies for pulmonary vasodilator therapy in young Swedish children. Prescription information for all children below seven years of age at treatment initiation, between 2007 and 2017, was retrieved from the National Prescribed Drug Register, and medical information was obtained by linkage to other registers. All patients were categorized according to the WHO classification of pulmonary hypertension. In total, 233 patients had been prescribed pulmonary vasodilators. The treatment was initiated before one year of age in 61% (N = 143). Sildenafil was most common (N = 224 patients), followed by bosentan (N = 29), iloprost (N = 14), macitentan (N = 4), treprostinil (N = 2) and riociguat (N = 2). Over the study period, the prescription rate for sildenafil tripled. Monotherapy was most common, 87% (N = 203), while 13% (N = 20) had combination therapy. Bronchopulmonary dysplasia (N = 82, 35%) and/or congenital heart defects (N = 156, 67%) were the most common associated conditions. Eight percent (N = 18) of the patients had Down syndrome. Cardiac catheterization had been performed in 39% (N = 91). Overall mortality was 13% (N = 30) during the study period. This study provides an unbiased overview of national outpatient use of pulmonary vasodilator therapy in young children. Few cases of idiopathic pulmonary arterial hypertension were found, but a large proportion of pulmonary hypertension associated with congenital heart defects or bronchopulmonary dysplasia. Despite treatment, mortality was high, and additional pediatric studies are needed for a better understanding of underlying pathologies and evidence of treatment effects.
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| 17. |
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| 18. |
- Lennelöv, E., et al.
(författare)
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The Prevalence of Asthma and Respiratory Symptoms among Cross-Country Skiers in Early Adolescence
- 2019
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Ingår i: Canadian Respiratory Journal. - : Hindawi Publishing Corporation. - 1916-7245 .- 1198-2241. ; 2019
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To determine the prevalence of asthma and respiratory symptoms among Swedish cross-country skiers in early adolescence in comparison to a population-based reference group of similar ages.Methods: A postal questionnaire on asthma, asthma medication, allergy, respiratory symptoms, and physical activity was distributed to Swedish competitive cross-country skiers aged 12–15 years (n = 331) and a population-based reference group (n = 1000). The level of asthma control was measured by the Asthma Control Test.Results: The response rate was 27% (n = 87) among skiers and 29% (n = 292) in the reference group. The prevalence of self-reported asthma (physician-diagnosed asthma and use of asthma medication in the last 12 months) and the prevalence of reported wheezing during the last 12 months were 23% and 25%, respectively, among skiers, which were significantly higher than the values reported in the reference group (12% and 14%). Skiers exercised more hours/week than the reference group. Among adolescents with self-reported asthma, neither the usage of asthma medications nor the level of asthma control according to the Asthma Control Test differed between skiers and the reference group.Conclusions: Adolescent competitive cross-country skiers have an increased prevalence of respiratory symptoms and asthma compared to nonskiers.
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| 19. |
- Ludvigsson, Jonas F, et al.
(författare)
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Missgynna inte forskande ST-läkare!
- 2003
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Ingår i: Läkartidningen. - Stockholm : Sveriges läkarförbund. - 0023-7205 .- 1652-7518. ; 100:40, s. 3162-3165
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Tidskriftsartikel (refereegranskat)
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| 20. |
- Mattsson, H., et al.
(författare)
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Improved infrastructure and support needed for paediatric clinical trials in Sweden
- 2020
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Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 109:12, s. 2740-7
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Tidskriftsartikel (refereegranskat)abstract
- Aim There is a lack of authorised medicines for paediatric patients and improved drug development is necessary. The aim of this study was to evaluate the need for infrastructure and support for paediatric clinical trials in Sweden. Methods A web-based survey was sent to doctors and nurses involved in the care of neonates, children and adolescents assessing the current situation and future needs for paediatric clinical trials in Sweden. Questions regarding premises, competence, organisation, support for paediatric clinical trials and Good Clinical Practice Training were addressed. Results In total, 137 individuals responded to the survey (109 doctors and 28 nurses). Overall, 61% of the respondents had previous experience of paediatric clinical trials. Some respondents had access to trial units, but only 34% had used the trial unit for support. Half of the responders were interested in recurrent paediatric Good Clinical Practice training. Doctors responded that clinical work often had to be prioritised and emphasised the need for research time. Conclusion This study clearly shows the commitment for clinical trials among doctors and nurses involved in paediatric care in Sweden, but also that administrative, logistic and economic support in a sustainable setting and an expanded national collaboration are needed.
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| 21. |
- Naumburg, Estelle, et al.
(författare)
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Fetal tachycardia : intrauterine and postnatal course
- 1997
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Ingår i: Fetal Diagnosis and Therapy. - Basel : S. Karger. - 1015-3837 .- 1421-9964. ; 12:4, s. 205-209
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Tidskriftsartikel (refereegranskat)abstract
- Eighteen consecutive cases of fetal tachycardia referred to the department of Pediatric Cardiology, Uppsala University, were studied retrospectively. All cases were detected at a routine visit at an antenatal clinic. None of the cases had a structural heart disease. Fetal supraventricular tachycardia was found in 8 cases and atrial flutter in 10 cases. In 7 cases, hydrops and heart failure were diagnosed. Antenatal treatment with digoxin, alone or in combination with other antiarrhythmic drugs, was needed in 15 cases. In 10 cases an obvious effect of the therapy was observed. No intrauterine deaths occurred. One infant died postnatally. At birth, 4 infants were in need of neonatal intensive care when delivered. Antiarrhythmic treatment was started in 13 cases postnatally. Late relapse of tachycardia was reported in 3 children. In 1 of these cases the prenatal tachycardia had resolved spontaneously and the infant was not treated antenatally nor during the neonatal period. Although fetal tachycardia is a serious condition, antenatal treatment in combination with careful monitoring and induction of delivery in cases with deteriorating fetal condition result in a satisfactory outcome for the majority of infants. However, there is a risk of late recurrence.
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| 22. |
- Naumburg, Estelle, et al.
(författare)
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Increased risk of pulmonary hypertension following premature birth
- 2019
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Ingår i: BMC Pediatrics. - : Springer Science and Business Media LLC. - 1471-2431. ; 19:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Pulmonary hypertension (PAH) among children and adults has been linked to premature birth, even after adjustments for known risk factors such as congenital heart disease and chronic lung disease. The aim of this population-based registry study was to assess the risk of PAH following exposure to premature birth and other factors in the decades when modern neonatal care was introduced and survival rates increased.Methods: Data on pulmonary hypertension and perinatal factors were retrieved from population-based governmental and national quality registers. Cases were adults and children over five years of age with pulmonary hypertension born from 1973 to 2010 and individually matched to six controls by birth year and delivery hospital. Conditional multiple logistic regression was performed to assess the risk of pulmonary hypertension following premature birth and to adjust for known confounding factors for the total study population and for time of birth, grouped into five-year intervals.Results: In total, 128 cases and 768 controls were included in the study group. Preterm birth was over three times more common among cases (21%) than among controls (6%). The overall adjusted risk of pulmonary hypertension was associated with premature birth, OR = 4.48 (95% CI; 2.10–9.53). Maternal hypertension, several neonatal risk factors and female gender were independently associated with PAH when potential confounders were taken into account. For each five-year period, the risk of PAH following premature birth increased several times for children born in the 2000s and later, OR = 17.08 (95% CI 5.60–52.14).Conclusions: Preterm birth, along with other factors, significantly contributes to PAH. PAH following premature birth has increased over the last few decades. Our study indicates that new, yet unknown factors may play a role in the risk of preterm-born infants developing PAH later in life.
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| 23. |
- Naumburg, Estelle, et al.
(författare)
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Intrauterine exposure to diagnostic X rays and risk of childhood leukemia subtypes
- 2001
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Ingår i: Radiation Research. - 0033-7587 .- 1938-5404. ; 156, s. 718-
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Tidskriftsartikel (refereegranskat)abstract
- The relationship between childhood leukemia and prenatal exposure to low-dose ionizing radiation remains debatable. This population-based case-control study investigated the association between prenatal exposure to diagnostic X-ray examinations (for different types of examinations and at different stages of pregnancy) and the risk of childhood lymphatic and myeloid leukemia. All children born and diagnosed with leukemia between 1973-1989 in Sweden (578 lymphatic and 74 myeloid) were selected as cases, and each was matched (by sex and year of birth) to a healthy control child (excluding Down's syndrome). Exposure data were abstracted blindly from all available medical records. Odds ratios (OR) and 95% confidence intervals (CI) were calculated by conditional logistic regression. It was found that prenatal X-ray examinations resulting in direct fetal exposure were not associated with a significant overall increased risk for childhood leukemia (OR = 1.11, 95% CI 0.83-1.47), for lymphatic leukemia (OR = 1.04, 95% CI 0.77-1.40), or for myeloid leukemia (OR = 1.49, 95% CI 0.48-4.72). There was little evidence of a dose response or variation in risk by trimester of exposure or age at diagnosis. Thus X-ray examinations performed during pregnancy in the 1970s and 1980s in Sweden did not affect the risk of childhood leukemia discernibly.
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| 24. |
- Naumburg, Estelle
(författare)
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Nya forskningsresultat om perinatala riskfaktorer : återupplivning med syrgas ökar risk for barnleukemi
- 2002
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Ingår i: Läkartidningen. - Stockholm : Sveriges läkarförbund. - 0023-7205 .- 1652-7518. ; 99:24, s. 2745-2747
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Tidskriftsartikel (refereegranskat)abstract
- The five studies presented in this thesis were all conducted in Sweden as population based case-control studies. Children with Down's syndrome were excluded. A total of 652 cases were encompassed in the studies. Exposure data were blindly extracted from standardized medical records. There was no association between prenatal exposure to ultrasound or diagnostic x-rays and childhood leukemia. A history of maternal lower genital tract infection significantly increased the risk of childhood leukemia. This association was especially evident in children diagnosed at four years or older or in infancy. Resuscitation with 100% oxygen with a facemask and bag directly postpartum was associated with increased risk of childhood lymphatic leukemia. Previously described exposure risks related to childhood leukemia could not be confirmed by these studies. However, this thesis indicates that events during pregnancy or the neonatal period are associated with increased risks of lymphatic and infant leukemia.
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| 25. |
- Naumburg, Estelle, et al.
(författare)
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Perinatal exposure to infection and risk of childhood leukemia
- 2002
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Ingår i: Medical and Pediatric Oncology. - : Wiley. - 0098-1532 .- 1096-911X. ; 38, s. 391-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: A population-based case-control study was conducted to investigate the association between childhood leukemia and infectious exposures during pregnancy and early neonatal period.PROCEDURE: Children born and diagnosed with leukemia between 1973 and 1989 in Sweden (578 lymphatic, 74 myeloid) were selected as cases. One control was randomly selected for each case and individually matched by sex, month, and year of birth. Children with Down's syndrome were excluded. Exposure data were blindly abstracted from antenatal, obstetric, and other standardized medical records. Odds ratios (OR) and 95% confidence intervals (CI) were calculated by conditional logistic regression.RESULTS: A history of maternal infection was not significantly associated with childhood leukemia, OR = 1.25 (95% CI 0.95-1.65). Maternal lower genital tract infection significantly increased the risk of childhood leukemia, OR = 1.78 (95% CI 1.17-2.72), and especially for children over 4 years of age at diagnosis, OR = 2.01 (95% CI 1.12-3.80). Neonatal infection was not associated with the risk of leukemia. The results remained unaltered after adjustment for potential confounders, and separate analyses for myeloid and lymphoid leukemia.CONCLUSIONS: We could document an association between exposure to maternal lower genital tract infection in utero, and a subsequent risk for childhood leukemia, which indicate the importance of an early exposure.
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| 26. |
- Naumburg, Estelle, 1962-
(författare)
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Perinatal Risk Factors for Childhood Leukemia
- 2002
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of the studies described in this thesis was to assess the association between certain perinatal factors and the risk of childhood lymphatic and myeloid leukemia and infant leukemia. The five studies presented were all conducted in Sweden as population-based case-control studies. All cases were born and diagnosed between 1973-89 with leukemia up to the age of 16 years. A control was individually matched to each case. As Down’s syndrome entails a major risk for childhood leukemia, children with Down’s syndrome were excluded. The studies comprised a total of 652 cases, 47 of whom were diagnosed before the age of one year. Exposure data were extracted blindly from antenatal, obstetric, pediatric and other standardized medical records.No association was found between prenatal exposure to ultrasound or diagnostic x-ray and childhood lymphatic or myeloid leukemia. Infant leukemia was associated with prenatal exposure to x-ray. A history of maternal lower genital tract infection significantly increased the risk of childhood leukemia, especially among children diagnosed at four years or older or in infancy. Factors such as young maternal age, and mothers working with children or in the health sector were associated with infant leukemia. Resuscitation with 100% oxygen with a face-mask and bag directly postpartum was associated with an increased risk of childhood lymphatic leukemia. The oxygen-related risk further increased if the manual ventilation lasted for three minutes or more. There was no association between lymphatic or infant leukemia and supplementary oxygen later in the neonatal period or other birth-related factors. Low Apgar scores at one and five minutes were associated with a non-significantly increased risk of lymphatic leukemia, and were significantly associated with infant leukemia.Previously reported relations between childhood leukemia and exposures such as maternal diagnostic x-ray and birth related factors could not be confirmed by these studies. However, the present studies indicate that events during pregnancy or during the neonatal period are associated with increased risks of childhood and infant leukemia. These events can either be non-specific, such as exposure to maternal lower genital tract infection, or specific, such as the use of supplementary oxygen directly postpartum.
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| 27. |
- Naumburg, Estelle, et al.
(författare)
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Prenatal characteristics of infants with a neuronal migration disorder : a national-based study
- 2012
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Ingår i: International Journal of Pediatrics. - : Hindawi Limited. - 1687-9740 .- 1687-9759. ; , s. 1-5
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Tidskriftsartikel (refereegranskat)abstract
- The development of the central nervous system is complex and includes dorsal and ventral induction, neuronal proliferation, and neuronal migration, organization, and myelination. Migration occurs in humans in early fetal life. Pathogenesis of malformations of the central nervous system includes both genetic and environmental factors. Few epidemiological studies have addressed the impact of prenatal exposures. All infants born alive and included in the Swedish Medical Birth Register 1980-1999 were included in the study. By linkage to the Patient Register, 820 children with a diagnosis related to a neuronal migration abnormality were identified. Through copies of referrals for computer tomography or magnetic resonance imaging of the brain, the diagnosis was confirmed in 17 children. Median age of the mothers was 29 years. At the start of pregnancy, four out of 17 women smoked. Almost half of the women had a body mass index that is low or in the lower range of average. All infants were born at term with normal birth weights. Thirteen infants had one or more concomitant diseases or malformations. Two infants were born with rubella syndrome. The impact of low maternal body mass index and congenital infections on neuronal migration disorders in infants should be addressed in future studies.
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| 28. |
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| 29. |
- Naumburg, Estelle, et al.
(författare)
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Risk Factors for Pulmonary Arterial Hypertension in Children and Young Adults
- 2017
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Ingår i: Pediatric Pulmonology. - : WILEY. - 8755-6863 .- 1099-0496. ; 52:5, s. 636-641
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Pulmonary hypertension (PH) has been linked to preterm birth explained by congenital heart defects and pulmonary diseases. Working hypothesis: Other factors may influence the risk of PH among adolescences and children born premature. Study design: This national registry-based study assess risk of PH following premature birth adjusted for known risk factors. Patient-subject selection and methodology: All cases born 1993-2010, identified by diagnostic codes applicable to PH and retrieved from the Swedish Registry of Congenital Heart Disease (N = 67). Six controls were randomly selected and matched to each case by year of birth and hospital by the Swedish Medical Birth Register (N = 402). Maternal and infant data related to preterm birth, pulmonary diseases, and congenital defects were retrieved. The association between preterm birth and pulmonary hypertension was calculated by conditional logistic regression taking into account potential confounding factors. Results: One third of the cases and seven percent of the controls were born preterm in our study. Preterm birth was associated with PH, OR = 8.46 (95% CI 2.97-24.10) (P < 0.0001) even after adjusting for confounding factors. Other factors, such as acute pulmonary diseases, congenital heart defects, congenital diaphragm herniation, and chromosomal disorders were also associated with PH in the multivariate analysis. Conclusions: Children and young adults born preterm are known to have an increased risk of PH, previously explained by congenital heart defects and pulmonary diseases. By adjusting for such factors, our study indicates that new factors may play a role in the risk of developing PH among children born preterm.
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| 30. |
- Naumburg, Estelle, et al.
(författare)
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Some neonatal risk factors for adult pulmonary arterial hypertension remain unknown
- 2015
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Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 104:11, s. 1104-1108
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Tidskriftsartikel (refereegranskat)abstract
- Aim: Pulmonary hypertension has been linked to premature birth, chronic lung disease, bronchopulmonary dysplasia and congenital heart disease. This national population-based registry study assessed the risk of adult pulmonary hypertension following premature birth, adjusted for known risk factors.Methods: We focused on adults in the Swedish Pulmonary Arterial Hypertension Registry, who were born prematurely, and controls randomly selected from the Swedish medical birth register and matched to each case by birth year and delivery hospital. Information on perinatal factors was also retrieved from the medical birth register. Conditional multiple logistic regression was used to evaluate the association between premature birth and adult pulmonary hypertension, taking into account the potential confounding factors.Results: The study population comprised 427 adults born between 1973 and 1996, with 61 cases and 366 controls. Adult pulmonary hypertension was associated with premature birth, with an odds ratio of 3.08 and 95% confidence interval of 1.21-7.87. The association did not alter after adjusting for potential confounders.Conclusion: By adjusting for factors linked to adult pulmonary hypertension, namely congenital heart defects, pulmonary diseases and premature birth, we were able to show that other unknown factors may influence the risk for pulmonary hypertension among adults who were born premature.
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| 31. |
- Naumburg, Estelle, et al.
(författare)
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Supplementary oxygen and risk of childhood lymphatic leukaemia
- 2002
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Ingår i: Acta Paediatrica. - 0803-5253 .- 1651-2227. ; 91, s. 1328-
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Tidskriftsartikel (refereegranskat)abstract
- AIM: Childhood leukaemia has been linked to several factors, such as asphyxia and birthweight, which in turn are related to newborn resuscitation. Based on the findings from a previous study a population-based case-control study was performed to investigate the association between childhood leukaemia and exposure to supplementary oxygen and other birth-related factors.METHODS: Children born in Sweden and diagnosed with lymphatic leukaemia between 1973 and 1989 (578 cases) were individually matched by gender and date of birth to a randomly selected control. Children with Down's syndrome were excluded. Exposure data were blindly gathered from antenatal, obstetric and other standardized medical records. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated by conditional logistic regression.RESULTS: Resuscitation with 100% oxygen with a facemask and bag immediately postpartum was significantly associated with an increased risk of childhood lymphatic leukaemia (OR = 2.57, 95% Cl 1.21-6.82). The oxygen-related risk further increased if the manual ventilation lasted for 3 min or more (OR = 3.54, 95% CI 1.16-10.80). Low Apgar scores at 1 and 5 min were associated with a non-significantly increased risk of lymphatic leukaemia. There were no associations between lymphatic leukaemia and supplementary oxygen later in the neonatal period or other birth-related factors.CONCLUSION: Resuscitation with 100% oxygen immediately postpartum is associated with childhood lymphatic leukaemia, but further studies are warranted to confirm the findings.
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| 32. |
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| 33. |
- Reynisson, Björn, et al.
(författare)
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QTc interval-dependent body posture in pediatrics
- 2020
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Ingår i: BMC Pediatrics. - : BMC. - 1471-2431. ; 20:1, s. 1-7
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Tidskriftsartikel (refereegranskat)abstract
- Background: Syncope is a common and often benign disorder presenting at the pediatric emergency department. Long-QT syndrome may be presented with syncope, ventricular arrhythmias or sudden death and is vital to exclude as an underlying cause in children presented with syncope. Few studies have assessed QTc in relation to body posture in children. In this study, we assessed the QTc interval while laying down and during active standing in children with known long-QT syndrome compared to healthy controls.Methods: Children aged 1-18 years with long-QT syndrome (N = 17) matched to two healthy controls (N = 34) were included in this case-control study. The ECG standing was performed immediately after the ECG in the supine position. The QTc interval and QTc-difference by changing the body position were calculated.Results: All children with long-QT syndrome were treated with propranolol. QTc was prolonged among long-QT syndrome children while lying down and when standing up, compared to controls. A prolongation of QTc appeared when standing up for both cases and controls. There was no significant difference in QTc increase between the groups. A QTc over 440 ms was observed among four cases lying down and in eight cases while standing, but not in any of the controls. The standing test with a cut-off of 440 ms showed a sensitivity of 47% and a specificity of 100% for case-status in our study.Conclusion: QTc measured on ECG when rapidly rising up is prolonged in both healthy and LQTS children. More importantly, it prolongs more in children with LQTS and increases in pathological levels.
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| 34. |
- Söderberg, Karin C, et al.
(författare)
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Childhood leukemia and magnetic fields in infant incubators
- 2002
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Ingår i: Epidemiology. - : Ovid Technologies (Wolters Kluwer Health). - 1044-3983 .- 1531-5487. ; 13, s. 45-
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Tidskriftsartikel (refereegranskat)abstract
- In studies of magnetic field exposure and childhood leukemia, power lines and other electrical installations close to the children's homes constitute the most extensively studied source of exposure. We conducted a study to assess whether exposure to magnetic fields in infant incubators is associated with an increased leukemia risk. We identified all children with leukemia born in Sweden between 1973 and 1989 from the national Cancer Registry and selected at random one control per case, individually matched by sex and time of birth, from the study base. We retrieved information about treatment in infant incubators from medical records. We made measurements of the magnetic fields inside the incubators for each incubator model kept by the hospitals. Exposure assessment was based on measurements of the magnetic field level inside the incubator, as well as on the length of treatment. For acute lymphoblastic leukemia, the risk estimates were close to unity for all exposure definitions. For acute myeloid leukemia, we found a slightly elevated risk, but with wide confidence intervals and with no indication of dose response. Overall, our results give little evidence that exposure to magnetic fields inside infant incubators is associated with an increased risk of childhood leukemia.
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| 35. |
- Tanghöj, Gustaf, et al.
(författare)
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Adverse events within 1 year after surgical and percutaneous closure of atrial septal defects in preterm children
- 2019
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Ingår i: Cardiology in the Young. - : Cambridge University Press. - 1047-9511 .- 1467-1107. ; 29:5, s. 626-636
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Atrial septal defect is the third most common CHD. A hemodynamically significant atrial septal defect causes volume overload of the right side of the heart. Preterm children may suffer from both pulmonary and cardiac comorbidities, including altered myocardial function. The aim of this study was to compare the rate of adverse events following atrial septal defect closure in preterm- and term-born children.Method: We performed a retrospective cohort study including children born in Sweden, who had a surgical or percutaneous atrial septal defect closure at the children’s hospitals in Lund and Stockholm, between 2000 and 2014, assessing time to the first event within 1 month or 1 year. We analysed differences in the number of and the time to events between the preterm and term cohort using the Kaplan–Meier survival curve, a generalised model applying zero-inflated Poisson distribution and Gary-Anderson’s method.Results: Overall, 413 children were included in the study. Of these, 93 (22.5%) were born prematurely. The total number of adverse events was 178 (110 minor and 68 major). There was no difference between the cohorts in the number of events, whether within 1 month or within a year, between major (p = 0.69) and minor (p = 0.84) events or frequencies of multiple events (p = 0.92).Conclusion: Despite earlier procedural age, larger atrial septal defects, and higher comorbidity than term children, preterm children appear to have comparable risk for complications during the first year after surgical or percutaneous closure.
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| 36. |
- Tanghöj, Gustaf, et al.
(författare)
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Atrial Septal Defect in Children : The Incidence and Risk Factors for Diagnosis
- 2020
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Ingår i: Congenital Heart Disease. - Henderson : Tech Science Press. - 1747-079X .- 1747-0803. ; 15:5, s. 287-299
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Secundum atrial septal defect (ASD II) is a common congenital heart defect, and interatrial communications among preterm children is even more common. The objective of this study was to calculate the incidence of ASD II in children, with assessment to gestational age at birth. Further, to assess maternal, prenatal and postnatal risk factors associated with ASD II among children of different gestational age at birth.Design: This national registry based retrospective incidence study was supplemented with a national case-control study, using the Swedish Register of Congenial Heart Disease, Swedish Medical Birth Register and Statistics Sweden. All children, 0-18 years of age, born in Sweden and diagnosed with an ASD II between 2010 and 2015 were included in the study and compared with children without diagnosis of ASD II.Results: The yearly overall incidence of ASD II was 150 per 100 000 live births. However, this incidence ranged from 449 per 100 000 live births to 1737 per 100 000 live births, with higher incidence among preterm children. ASD II was associated with a presence of persistent ductus arteriosus; OR = 8.11 (Cl 95% 2.80-16.69), female gender; OR = 1.39 (Cl 95% 1.18-1.63) and being small for gestational age; OR = 1.86 (Cl 95% 1.29-2.68). Born preterm was also associated with ASD II; born at 32-36 gestational children; OR = 3.21 (Cl 95% 2.46-4.19), and born <32 gestational weeks; OR = 4.02 (Cl 95% 2.80-7.12).Conclusion: Preterm children have a higher incidence of ASD II than previously found, increasing with lower gestational age at birth. Preterm birth is an independent risk factor for ASD II diagnosis with three to four times, suggesting that this group of children may need new structured follow up program with careful assessment of indication when need of treatment and closure.
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| 37. |
- Tanghöj, Gustaf, et al.
(författare)
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Early Complications After Percutaneous Closure of Atrial Septal Defect in Infants with Procedural Weight Less than 15 kg
- 2017
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Ingår i: Pediatric Cardiology. - : SPRINGER. - 0172-0643 .- 1432-1971. ; 38:2, s. 255-263
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Tidskriftsartikel (refereegranskat)abstract
- Atrial septal defect (ASD) is the most common congenital cardiac lesion accounting for 10-15% of all cardiac malformations. In the majority of cases, the secundum type of the ASD is closed percutaneously in the catheterization laboratory. Although transcatheter closure of ASD is considered safe and effective in pediatric patients, there are limited data regarding the efficacy and safety of device ASD closure in smaller infants. The aim of this study was to determine risk of complications within 72 h following device closure of ASD in children of body weight < 15 kg compared to larger children. Overall 252 children who underwent transcatheter closure of ASD at Children's Heart Centre in Lund, Sweden, between 1998 and 2015 were included. Data regarding demographics, comorbidity and complications occurring during and after device procedure until discharge were retrieved from the hospital's databases. Echocardiographic data were obtained from the digital and videotape recordings. Nearly half of the study cohort (n = 112; 44%) had a procedural weight < 15 (median 11.3) kg with a median procedural age of 2.02 years. Among this study group, 22 (9%) children had post-procedural in-hospital complications, of which 16 (7%) were considered as major and six (2%) considered as minor. No deaths occurred. There was no significant difference in of the occurrence of major or minor complications between the two groups (p = 0.32). Larger ASD was more often associated with minor complications, OR 1.37 (95% CI 0.99-1.89), which most often consisted of transient arrhythmias during or after the procedure. Percutaneous ASD device closure can be performed safely in low-weight infants with a risk of post-procedural in-hospital complications comparable to larger/older children. Nevertheless, careful considerations of the indications to device closure is needed, particularly in children with larger ASD, as recommended by the current international guidelines for ASD closure.
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| 38. |
- Tanghöj, Gustaf, et al.
(författare)
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Predictors of the Need for an Atrial Septal Defect Closure at Very Young Age
- 2020
-
Ingår i: Frontiers in Cardiovascular Medicine. - : Frontiers Media S.A.. - 2297-055X. ; 6
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Tidskriftsartikel (refereegranskat)abstract
- An asymptomatic Atrial Septal Defect (ASD) is often closed at the age of 3-5 years using a transcatheter or surgical technique. Symptomatic ASD or ASD associated with pulmonary hypertension (PHT) may require earlier closure, particularly in combination with other non-cardiac risk factors for PHT, but the indications for early closure and the potential risk for complications are largely unknown. The aim of this study was to assess risk factors for needing ASD closure during the first and second years of life. This case-control study included all children treated with surgical or percutaneous ASD closure between 2000 and 2014 at two out of three pediatric heart centers in Sweden. "Cases" were children with ASD closure at <= 1 or <= 2 years of age. Clinical data were retrieved from medical journals and national registries. Overall, 413 children were included. Of these, 131 (32%) were <= 2 years, and 50 (12%) were <= 1 year. Risk factors associated with a <= 2 years ASD closure were preterm birth, OR = 2.4 (95% CI: 1.5-3.9); additional chromosomal abnormalities, OR = 3.4 (95% CI: 1.8-6.5); pulmonary hypertension, OR = 5.8 (95% CI: 2.6-12.6); and additional congenital heart defects, OR = 2.6 (95% CI: 1.7-4.1). These risk associations remained after adjustments for confounding factors, such as need for neonatal respiratory support, neonatal pulmonary diseases, neonatal sepsis, additional congenital heart defects (CHD) and chromosomal abnormalities. ASD size:body weight ratio of 2.0, as well as a ratio of 0.8 (upper and lower limit of the ASD size:body weight ratios), was associated with increased risk of an early ASD closure. Risk factors such as very premature birth, very low birth weight, congenital, and chromosomal abnormalities, neonatal pulmonary disease and need for ventilation support, as well as pulmonary hypertension, were associated with very early (<1 year of age) ASD closure. Several independent neonatal risk factors were associated with an increased risk of early ASD closure at 2 and at 1 year of age. An ASD size:body weight ratio is a poor predictor for indications for ASD closure.
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| 39. |
- Tanghöj, Gustaf, et al.
(författare)
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Risk factors for adverse events within one year after atrial septal closure in children : a retrospective follow-up study
- 2020
-
Ingår i: Cardiology in the Young. - : Cambridge University Press. - 1047-9511 .- 1467-1107. ; 30:3, s. 303-312
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Secundum atrial septal defect is one of the most common congenital heart defects. Previous paediatric studies have mainly addressed echocardiographic and few clinical factors among children associated with adverse events. The aim of this study was to identify neonatal and other clinical risk factors associated with adverse events up to one year after closure of atrial septal defect.Methods: This retrospective case-control study includes children born in Sweden between 2000 and 2014 that were treated surgically or percutaneously for an atrial septal defect. Conditional logistic regression was used to evaluate the association between major and minor adverse events and potential risk factors, adjusting for confounding factors including prematurity, neonatal sepsis, neonatal general ventilatory support, symptomatic atrial septal defects, and pulmonary hypertension.Results: Overall, 396 children with 400 atrial septal defect closures were included. The median body weight at closure was 14.5 (3.5-110) kg, and the median age was 3.0 (0.1-17.8) years. Overall, 110 minor adverse events and 68 major events were recorded in 87 and 49 children, respectively. Only symptomatic atrial septal defects were associated with both minor (odds ratio (OR) = 2.18, confidence interval (CI) 95% 1.05-8.06) and major (OR = 2.80 CI 95% 1.23-6.37) adverse events.Conclusion: There was no association between the investigated neonatal comorbidities and major or minor events after atrial septal defect closure. Patients with symptomatic atrial septal defects had a two to four times increased risk of having a major event, suggesting careful management and follow-up of these children prior to and after closure.
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| 40. |
- Tanghöj, Gustaf, et al.
(författare)
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Risk factors for isolated atrial septal defect secundum morbidity
- 2024
-
Ingår i: Scientific Reports. - : Springer Nature. - 2045-2322. ; 14:1
-
Tidskriftsartikel (refereegranskat)abstract
- Atrial septal defect secundum is a common type of congenital heart defect and even more common among children born premature. The aim of this study was to assess premature birth as a potential associated risk factors for cardiac morbidity in children with isolated ASD II. In this retrospective national registry-based case–control study all children born in Sweden between 2010 and 2015 with an isolated ASD II diagnosis were included. Association between premature birth and cardiac morbidity in children with isolated ASD II was assessed by different outcomes-models using conditional logistic regression and adjustments were made for confounding factors. Overall, 11% of children with an isolated ASD II received treatment for heart failure. Down syndrome was the only independent risk factors for associated with cardiac morbidity in children with ASD II (OR = 2.25 (95%CI 1.25–4.07). Preterm birth in children was not associated with an increased risk of ASD II cardiac morbidity.
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| 41. |
- Tanghöj, Gustaf, 1979-
(författare)
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Young children with atrial septal defect
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Secundum atrial septal defect (ASD II), situated within the fossa ovalis, is the third most common congenital heart defect and even more common among preterm children. Spontaneous closure usually occurs during the first year of life. Most children with an ASD II remain asymptomatic during early childhood. Guidelines recommend ASD II closure in the presence of a significant left-to-right shunt. Percutaneous device closure, which is most commonly used, and surgery are both considered safe, with few major adverse events.In Sweden, approximately 6% of all children are born preterm. The morbidity of preterm children includes increased risk of chronic pulmonary disease and altered cardiac morphology and function which remain into adulthood. Most studies on ASD II incidence and interventional and surgical risks following ASD II closure are based on otherwise healthy children. Preterm children are a special subset of patients with ASD II and the hypothesis in this thesis is that preterm birth may be associated with increased risks of ASD II diagnosis and adverse events following closure.Aim: The overall aim of this thesis was to assess the incidence of ASD II, independent risk factors associated to ASD II diagnosis, and adverse events following ASD II interventional closure.Methods: Paper I: A retrospective case-control study assessing associated risk factors for adverse events after percutaneous device closure among children with an interventional weight of less than 15 kg. Paper II: A cohort study assessing a preterm and a term cohort and time to first adverse event within one month or one year after ASD II closure, as well as number of events. Paper III: A retrospective case-control study assessing the association between major and minor adverse events after ASD II closure, and potential paediatric risk factors. Paper IV: A national registry-based retrospective incidence and case-control study calculating the incidence of ASD II diagnosis among term and preterm children and assessing potential maternal, neonatal, and paediatric risk factors for ASD II.Results: Paper I: No independent risk factor was associated with adverse events after percutaneous device closure. However, major adverse events occurred in 11 (10%) of the children weighing less than 15 kg, compared with six (4%) children weighing over 15 kg (p = 0.04). Paper II: There was no difference between the preterm and term cohorts in time to first adverse event or in multiple adverse events within one month or within a year, neither in number of major events (p = 0.69) nor in number of minor events (p = 0.84). However, the preterm cohort was younger (2.1 versus 3.4 years, p < 0.01), lighter (11.6 versus 15.1 kg, p < 0.01), had a smaller ASD II size (12.0 versus 13.0 mm, p< 0.01), and a larger ASD II size to weight ratio (1.1 versus 0.8, p < 0.01) compared with the term cohort. Paper III: ASD II with significant clinical symptoms was associated with both minor OR = 2.18, (CI 95% 1.05–8.06) and major OR = 2.80 (CI 95% 1.23–6.37) adverse events following closure. Paper IV: The yearly overall incidence of ASD II was 150 per 100,000 live births. However, this incidence ranged from 449 to 1,737 per 100,000 live births, with higher incidence in preterm children. ASD II was associated with a presence of persistent ductus arteriosus; OR = 8.11 (CI 95% 2.80–16.69), female gender; OR = 1.39 (CI 95% 1.18–1.63), and being small for gestational age; OR = 1.86 (CI 95% 1.29–2.68). Being born preterm was also associated with ASD II diagnosis: born at 32–36 gestational weeks; OR = 3.21 (CI 95% 2.46–4.19), and born at < 32 gestational weeks; OR = 4.02 (CI 95% 2.80–7.12).Conclusions: Preterm children have a high incidence of ASD II diagnosis, increasing with lower gestational age at birth, and is an independent risk factor for ASD II diagnosis. Few adverse events occurred among children following ASD II closure, and there were no neonatal or paediatric risk factors (including procedural body weight and gestational age) associated with adverse events. There was an association between clinical symptomatic ASD II and major adverse events. Despite younger procedural age, larger ASD II size to weight ratio and increased comorbidity, preterm children appeared to have similar risks of adverse events during the first year after ASD II closure when compared with term children.Preterm children and children with symptomatic ASD II need careful management both prior to and after ASD II closure. A new, structured follow-up programme with assessment of indication and timing of treatment and closure should be considered for children born preterm.
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- Zamir, Itay, et al.
(författare)
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Insulin resistance prior to term age in very low birthweight infants : a prospective study
- 2024
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Ingår i: BMJ Paediatrics Open. - : BMJ Publishing Group Ltd. - 2399-9772. ; 8:1
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To explore the glucose-related hormone profile of very low birthweight (VLBW) infants and assess the association between neonatal hyperglycaemia and insulin resistance during the admission period.Design: A prospective observational study—the Very Low Birth Weight Infants, Glucose and Hormonal Profiles over Time study.Setting: A tertiary neonatal intensive care unit and four neonatal units in county hospitals in Sweden.Patients: 48 infants born <1500 g (VLBW) during 2016–2019.Outcome measures: Plasma concentrations of glucose-related hormones and proteins (C-peptide, insulin, ghrelin, glucagon-like peptide 1 (GLP-1), glucagon, leptin, resistin and proinsulin), insulin:C-peptide and proinsulin:insulin ratios, Homoeostatic Model Assessment 2 (HOMA2) and Quantitative Insulin Sensitivity Check (QUICKI) indices, measured on day of life (DOL) 7 and at postmenstrual age 36 weeks.Results: Lower gestational age was significantly associated with higher glucose, C-peptide, insulin, proinsulin, leptin, ghrelin, resistin and GLP-1 concentrations, increased HOMA2 index, and decreased QUICKI index and proinsulin:insulin ratio. Hyperglycaemic infants had significantly higher glucose, C-peptide, insulin, leptin and proinsulin concentrations, and lower QUICKI index, than normoglycaemic infants. Higher glucose and proinsulin concentrations and insulin:C-peptide ratio, and lower QUICKI index on DOL 7 were significantly associated with longer duration of hyperglycaemia during the admission period.Conclusions: VLBW infants seem to have a hormone profile consistent with insulin resistance. Lower gestational age and hyperglycaemia are associated with higher concentrations of insulin resistance markers.
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