| 1. |
- Ahlqvist-Bjorkroth, Sari, et al.
(författare)
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Improving NICU staff decision-making with parents in medical rounds : a pilot study of reflective group dialogue intervention
- 2023
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Ingår i: Frontiers in Pediatrics. - : Frontiers Media S.A.. - 2296-2360. ; 11
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The communication skills of healthcare professionals play a crucial role in successful shared decision-making with parents in neonatal intensive care. Improving communication skills can be achieved through practice and reflection on personal experiences after authentic interaction events with parents. The process of reflection typically involves three phases: description, reflection, and critical reflection. In this study, our aim was to explore the acceptability of the Reflective Group Dialogue intervention and its effectiveness in supporting the reflective process.Methods: This qualitative pilot study was conducted in the neonatal intensive care unit at Uppsala University Children's Hospital, Sweden. The sample consisted of nine medical rounds with seven families, five neonatologists, seven registered nurses, and five assistant nurses. Purposive sampling was used to collect the data. The intervention comprised four elements: (1) before the intervention, a recorded presentation on shared decision-making was given to the entire unit staff, (2) an observation of a normal medical round discussion with parents, (3) an interview with parents about their experience after the same round, and (4) a reflective discussion with the participating health care professionals after the round. The parent interviews and reflective discussions were audio-recorded and transcribed verbatim. They were analyzed using thematic analysis as a theoretical strategy.Results: Both parents and staff widely accepted the intervention and found it beneficial. We identified four discussions that remained in the descriptive phase of the reflection process, four that reached the reflective phase, and one that reached the critical reflection phase. The descriptive discussions were characterized by using a single perspective to reflect, often based on personal opinions. The reflective discussions included analyzing interaction sequences from both staff and parent perspectives and were primarily based on actual observations of communication during medical rounds. The critical discussion led to a new awareness of current practices concerning parental involvement in decision-making. These discussions also utilized "what-if" thinking to evaluate potential new practices and their pros and cons.Conclusions: The intervention seems promising as it was perceived as beneficial by the recipients and facilitated reflection in most cases. However, to enhance the feasibility of the intervention, some improvements are discussed.
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| 2. |
- Ali, Hassan, et al.
(författare)
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Cost Estimation of CO2 Absorption Plants for CO2 Mitigation – Method and Assumptions
- 2019
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Ingår i: International Journal of Greenhouse Gas Control. - : Elsevier BV. - 1750-5836. ; 88, s. 10-23
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Tidskriftsartikel (refereegranskat)abstract
- The estimates of post combustion CO2 capture costs reported in the literature range from 50 €/tCO2 to 128 €/tCO2, reflecting differences in the cost estimation methods used, scopes of the analyses, and assumptions made. This variation in calculated costs is important when evaluating the feasibility of a technology and highlights the importance of ensuring consistency and transparency in cost estimations. This study establishes a cost estimation tool that highlights the effects of different assumptions on the overall cost of a capture plant and identifies the crucial technical and economic factors. The input is a simplified process flow diagram and equipment list. Detailed installation factors and the equipment cost are the two main elements used to derive the capital expenditures (CAPEX), which represent a fundamental component of the cost estimation approach. A detailed installation factor sheet is used for the capital cost estimation. The method is applied to a Base case that involves the capture of CO2 from the flue gas of a process industry, giving a capture cost of 62.5 €/tCO2. The Base case results reveal that the steam cost, electricity cost, and capital cost are the main contributors. This method can provide an overview of the main cost drivers, and a sensitivity analysis of the variable input parameters can be performed simply and quickly. The results obtained using this method can be valuable in the early phase of the project and contribute to decision making.
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| 3. |
- Ali, Hassan, et al.
(författare)
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Cost estimation of heat recovery networks for utilization of industrial excess heat for carbon dioxide absorption
- 2018
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Ingår i: International Journal of Greenhouse Gas Control. - : Elsevier BV. - 1750-5836. ; 74, s. 219-228
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Tidskriftsartikel (refereegranskat)abstract
- The absorption of CO 2 using solvents (e.g., amines) is considered a state-of-the-art, albeit energy-intensive process for CO 2 capture. While it is generally recognized that the utilization of waste heat has potential to reduce the energy-associated costs for CO 2 capture, the cost of waste heat recovery is seldom quantified. In this work, the cost of heat-collecting steam networks for waste heat recovery for solvent regeneration is estimated. Two types of networks are applied to waste heat recovery from the flue gases of four process industries (cement, silicon, iron & steel, and pulp & paper) via a heat recovery steam generator (HRSG). A novel approach is presented that estimates the capital and operational expenditures for waste heat recovery from process industries. The results show that the overall cost (CAPEX + OPEX) of steam generated from one hot flue gas source is in the range of 1.1–4.1 €/t steam. The cost is sensitive to economic parameters, installation factors, the overall heat transfer coefficient, steam pressure, and to the complexity of the steam network. The cost of steam from an existing natural gas boiler is roughly 5–20-times higher than that of steam generated from recovered waste heat. The CAPEX required to collect the heat is the predominant factor in the cost of steam generation from waste heat. The major contributor to the CAPEX is the heat recovery steam generator, although the length of the steam pipeline (when heat is collected from two sources or over long distances) is also important for the CAPEX.
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| 4. |
- Aromada, Solomon Aforkoghene, et al.
(författare)
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Techno-Economic Assessment of Different Heat Exchangers for CO2 Capture
- 2020
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Ingår i: Energies. - : MDPI AG. - 1996-1073 .- 1996-1073. ; 13:23
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Tidskriftsartikel (refereegranskat)abstract
- We examined the cost implications of selecting six different types of heat exchangers as the lean/rich heat exchanger in an amine-based CO2 capture process. The difference in total capital cost between different capture plant scenarios due to the different costs of the heat exchangers used as the lean/rich heat exchanger, in each case, is in millions of Euros. The gasketed-plate heat exchanger (G-PHE) saves significant space, and it saves considerable costs. Selecting the G-PHE instead of the shell and tube heat exchangers (STHXs) will save euro33 million-euro39 million in total capital cost (CAPEX), depending on the type of STHX. About euro43 million and euro2 million in total installed costs (CAPEX) can be saved if the G-PHE is selected instead of the finned double-pipe heat exchanger (FDP-HX) or welded-plate heat exchanger, respectively. The savings in total annual cost is also in millions of Euros/year. Capture costs of euro5/tCO(2)-euro6/tCO(2) can be saved by replacing conventional STHXs with the G-PHE, and over euro6/tCO(2) in the case of the FDP-HX. This is significant, and it indicates the importance of clearly stating the exact type and not just the broad classification of heat exchanger used as lean/rich heat exchanger. This is required for cost estimates to be as accurate as possible and allow for appropriate comparisons with other studies. Therefore, the gasketed-plate heat exchanger is recommended to save substantial costs. The CO2 capture costs of all scenarios are most sensitive to the steam cost. The plate and frame heat exchangers (PHEs) scenario's capture cost can decline from about euro77/tCO(2) to euro59/tCO(2) or rise to euro95/tCO(2).
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| 5. |
- Backes, Carl, et al.
(författare)
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Outcomes Following a Comprehensive versus a Selective Approach for Infants Born at 22 Weeks of Gestation.
- 2019
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Ingår i: Journal of Perinatology. - : Springer Science and Business Media LLC. - 0743-8346 .- 1476-5543. ; 39:1, s. 39-47
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To examine outcomes at two institutions with different approaches to care among infants born at 22 weeks of gestation.Study design: Retrospective, cohort study (2006–2015). Enrollment was limited to mother–infant dyads at 22 weeks of gestation. Proactive care was defined as provision of antenatal corticosteroids and neonatal resuscitation and intensive care. One center (Uppsala, Sweden; UUCH) provided proactive care to all mother–infant dyads (comprehensive center); the other center (Nationwide Children’s Hospital, USA; NCH) initiated or withheld treatment based on physician and family preferences (selective center). Differences in outcomes between the two centers were evaluated.Result: Among 112 live-born infants at 22 weeks of gestation, those treated at UUCH had in-hospital survival rates higher than those at NCH (21/40, 53% vs. 6/72, 8%; P < 0.01). Among the subgroup of infants receiving proactive care (UUCH: 40/40, 100%; NCH: 16/72, 22%) survival was higher at UUCH than at NCH (21/40, 53% vs. 3/16, 19%; P < 0.05).Conclusion: Even when mother–infant dyads were provided proactive care at NCH (selective center), survival was lower than infants provided proactive care at UUCH (comprehensive center). Differences between the approaches to care at the two centers at 22 weeks of gestation merits further investigation.
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| 6. |
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| 7. |
- Carlsen Misic, Martina, 1986-, et al.
(författare)
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Clonidine as analgesia during retinopathy of prematurity screening in preterm infants (cloROP) : protocol for a randomised controlled trial
- 2022
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 12:9
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Tidskriftsartikel (refereegranskat)abstract
- Introduction Preterm infants are at risk of negative consequences from stress and pain at the same time as they often are in need of intensive care that includes painful interventions. One of the frequent painful procedures preterm infants undergo is eye examination screening to detect early signs of ROP (retinopathy of prematurity). These examinations are both stressful and painful, and despite a multitude of research studies, no conclusive pain-relieving treatment has been demonstrated. The main aim of this trial is to investigate the analgesic effect of clonidine during ROP eye examinations.Methods and analysis The planned study is a multicentre randomised controlled trial with a crossover design. Infants will be recruited from two different neonatal intensive care units (NICUs) in Sweden. Infants born before gestation week 30 (and therefore eligible for ROP screening) and cared for in either of the NICUs will be eligible for inclusion in the study. The primary outcome will be Premature Infant Pain Profile–Revised score within 30 s after starting the examination. Secondary outcomes will be changes in the galvanic skin response parameters (area small peaks, area huge peaks, peaks per second and average rise time) within 30 s after starting the eye examination, together with the number and evaluation of adverse events reported within 72 hours after the examination and the examining physician’s assessment of how easy the infant was to examine.Ethics and dissemination Approval from the Swedish Ethical Review Authority and the Swedish Medical Products Agency has been obtained for the study. Parents of eligible infants will be getting both verbal and written information about the study including that participation is voluntary. Data will be collected and treated in accordance with the European general data protection regulations. The results will be reported on group level and published in a scientific journal.
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| 8. |
- Carlsen Misic, Martina, 1986-, et al.
(författare)
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Clonidine as analgesia during retinopathy of prematurity screening in preterm infants -cloROP
- 2024
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Konferensbidrag (refereegranskat)abstract
- BackgroundPreterm infants are vulnerable and sensitive to stimuli, during their stay in neonatal intensive care they undergo frequent stressful and painful procedures. One of these painful procedures is the screening for retinopathy of prematurity, ROP. In Sweden all preterm infants born before gestation week 30 undergo ROP-screening. The screening involves regular eye examinations to detect ROP at the early stages and these examinations are both stressful and painful. Several studies have investigated different ways of pain management during eye examinations with inconsequent results. No study has investigated Clonidine as pain management during ROP-screening. AimThe aim of this clinical trial is to investigate the analgesic effect of clonidine during ROP eyeexaminations.MethodThis study is a multicenter randomized controlled clinical trial with a crossover design. Infants born before gestation week 30 and therefore undergoing ROP-screening, will be eligible for inclusion in the study. Infants will be recruited from two Swedish NICUs (neonatal intensive care units). The NICUs use different examination techniques, where NICU A uses indirect ophthalmoscopy while NICU B uses RetCam. A total of 50 infants will be recruited (25 at each NICU). During the first eye examination the infant will be randomized to either clonidine 4mcg/kg or sterile water in the equivalent dose 60 minutes before the eye examination. The order of the treatment is blinded for everyone except the nurse preparing the study solution. During the second eye examination the infant will receive the study solution, (intervention or placebo) that he/she did not receive the first time. The primary outcome of the study is pain assessment with the Premature Infant Pain Profile – Revised. The infants´ face and monitor showing oxygen saturation and heart rate will be videorecorded to be able to assess the pain afterwards. The secondary outcome is Galvanic Skin Response where three probes are attached to the infant’s foot sole to register changes in the sweat gland activity in response to stimuli such as pain or stress. The ophthalmologist performing the eye examination will also rate how easy it was to examine the infant by marking an X on a 10cm VAS scale with “very easy to examine” on one end and “very difficult to examine” on the other end. Data collection is ongoing with 19 infants included at the moment.
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| 9. |
- Challis, Pontus, et al.
(författare)
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Factors associated with the increased incidence of necrotising enterocolitis in extremely preterm infants in Sweden between two population-based national cohorts (2004-2007 vs 2014-2016)
- 2024
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Ingår i: Archives of Disease in Childhood. - : BMJ Publishing Group Ltd. - 1359-2998 .- 1468-2052. ; 109:1, s. 87-93
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Tidskriftsartikel (refereegranskat)abstract
- Objective To investigate potential risk factors behind the increased incidence of necrotising enterocolitis (NEC) in Swedish extremely preterm infants.Design Registry data from two population-based national cohorts were studied. NEC diagnoses (Bell stage >= II) were validated against hospital records.Patients All liveborn infants <27 weeks of gestation 2004-2007 (n=704) and 2014-2016 (n=895) in Sweden.Main outcome measures NEC incidence.Results The validation process resulted in a 28% reduction of NEC cases but still confirmed a higher NEC incidence in the later epoch compared with the earlier (73/895 (8.2%) vs 27/704 (3.8%), p=0.001), while the composite of NEC or death was lower (244/895 (27.3%) vs 229/704 (32.5%), p=0.022). In a multivariable Cox regression model, censored for mortality, there was no significant difference in early NEC (0-7 days of life) between epochs (HR=0.9 (95% CI 0.5 to 1.9), p=0.9), but being born in the later epoch remained an independent risk factor for late NEC (>7 days) (HR=2.7 (95% CI 1.5 to 5.0), p=0.001). In propensity score analysis, a significant epoch difference in NEC incidence (12% vs 2.8%, p<0.001) was observed only in the tertile of infants at highest risk of NEC, where the 28-day mortality was lower in the later epoch (35% vs 50%, p=0.001). More NEC cases were diagnosed with intramural gas in the later epoch (33/73 (45.2%) vs 6/26 (23.1%), p=0.047).Conclusions The increase in NEC incidence between epochs was limited to cases occurring after 7 days of life and was partly explained by increased survival in the most extremely preterm infants. Misclassification of NEC is common.
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| 10. |
- Diderholm, Barbro, 1965-, et al.
(författare)
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The Impact of Restricted versus Liberal Early Fluid Volumes on Plasma Sodium, Weight Change, and Short-Term Outcomes in Extremely Preterm Infants
- 2022
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Ingår i: Nutrients. - : MDPI AG. - 2072-6643. ; 14:4
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Tidskriftsartikel (refereegranskat)abstract
- The optimal fluid requirements for extremely preterm infants are not fully known. We examined retrospectively the fluid intakes during the first week of life in two cohorts of extremely preterm infants born at 22-26 weeks of gestation before (n = 63) and after a change from a restrictive to a more liberal (n = 112) fluid volume allowance to improve nutrient provision. The cohorts were similar in gestational age and birth weight, but antenatal steroid exposure was more frequent in the second era. Although fluid management resulted in a cumulative difference in the total fluid intake over the first week of 87 mL/kg (p < 0.001), this was not reflected in a mean weight loss (14 +/- 5% at a postnatal age of 4 days in both groups) or mean peak plasma sodium (142 +/- 5 and 143 +/- 5 mmol/L in the restrictive and liberal groups, respectively). The incidences of hypernatremia (>145 and >150 mmol/L), PDA ligation, bronchopulmonary dysplasia, and IVH were also similar. We conclude that in this cohort of extremely preterm infants a more liberal vs. a restricted fluid allowance during the first week had no clinically important influence on early changes in body weight, sodium homeostasis, or hospital morbidities.
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| 11. |
- Ernstson, Ulf, 1958, et al.
(författare)
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Projektet GSA ”Grensregional Statistik- och Analysarbete”
- 2007
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Sammendrag av vurderingen Arbeidet vi har gjennomført viser at basen speiler både makroøkonomiske (overnasjonale og nasjonale) endringer og endringer som er generert av de spesielle forutsetningene i selve grenseregionen. Basen inneholder variabler og data som gjør det mulig å bidra til beskrivelsen av sentrale samfunnsmessige trekk i grenseregionen. Databasen er testet i forhold til beskrivelser av pendling, sysselsetting og utdanning. Vi har også sett på basens muligheter for å generere statistiske analyser av næringsutvikling. Studien visar att det är möjligt att göra analyser med hjälp av databasen med avseende på in- och utpendling. Vidare att det är möjligt att analysera och grafiskt visualisera in- och utpendling med hjälp av GIS. Det senare möjliggörs genom att data finns på kommunnivå. Det finns potential att utveckla GIS-studien. Via en förbättrad och individorienterad databas (GSA II) är det möjligt att åstadkomma kraftfulla rumsliga analyser av gränsregionen. Datasettene som er lagt inn i basen er aggregert til et nivå som begrenser analysemulighetene. Derfor er det viktig at datasettene brytes ned til mindre aggregerte nivåer. Det är komplicerat att göra jämförande analyser mellan kommuner med hjälp av den data som ryms i GSA II; bedömningen blir i-dagsläget av praxis mer kvalitativ än kvantitativ. En stor del av de ingående variablerna i databasen utgörs av förtätade data på nationell nivå. För att besvara de frågor som är betydelsefulla för gränsregionen framöver är det nödvändigt att data måste framställas i riktning neråt till en mindre aggregerad nivå. Databasen bør bygges ut med flere variabler med tilknyttede datasett. Dette gjelder i særlig grad variabler og datasett som gjør det mulig å gå inn i analyser av om Grenseregionen eventuelt har komparative fortrinn som kan ha betydning for innovasjonsevnen. Forutsetningen for at Grensestatistikkdatabasen skal kunne utvikles til et tjenlig redskap er at arbeidet tilføres tilstrekkelig ressurser, dels til videreutvikling av basen, dels til analysearbeid og tilrettelegging av data for brukere – i første rekke gjelder dette bedrifter og offentlige myndigheter og beslutningstakere. Centrum för Regional Analys og Stiftelsen Østfoldforskning har i løpet av arbeidet med rapporten utviklet en omforent ambisjon om å samarbeide videre om regionale analyser av Grenseregionen som kan gi bidrag til å forstå regionens innovasjonspotensiale bedre.
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| 12. |
- Farooqi, Aijaz, et al.
(författare)
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One-year survival and outcomes of infants born at 22 and 23 weeks of gestation in Sweden 2004-2007, 2014-2016 and 2017-2019
- 2024
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Ingår i: Archives of Disease in Childhood-Fetal and Neonatal Edition. - : BMJ Publishing Group Ltd. - 1359-2998 .- 1468-2052. ; 109:1, s. 10-17
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveTo explore associations between perinatal activity and survival in infants born at 22 and 23 weeks of gestation in Sweden. Design/SettingData on all births at 22 and 23 weeks' gestational age (GA) were prospectively collected in 2004-2007 (T1) or obtained from national registers in 2014-2016 (T2) and 2017-2019 (T3). Infants were assigned perinatal activity scores based on 3 key obstetric and 4 neonatal interventions. Main outcomeOne-year survival and survival without major neonatal morbidities (MNM): intraventricular haemorrhage grade 3-4, cystic periventricular leucomalacia, surgical necrotising enterocolitis, retinopathy of prematurity stage 3-5 or severe bronchopulmonary dysplasia. The association of GA-specific perinatal activity score and 1-year survival was also determined. Results977 infants (567 live births and 410 stillbirths) were included: 323 born in T1, 347 in T2 and 307 in T3. Among live-born infants, survival at 22 weeks was 5/49 (10%) in T1 and rose significantly to 29/74 (39%) in T2 and 31/80 (39%) in T3. Survival was not significantly different between epochs at 23 weeks (53%, 61% and 67%). Among survivors, the proportions without MNM in T1, T2 and T3 were 20%, 17% and 19% for 22 weeks and 17%, 25% and 25% for 23 weeks' infants (p>0.05 for all comparisons). Each 5-point increment in GA-specific perinatal activity score increased the odds for survival in first 12 hours of life (adjusted OR (aOR) 1.4; 95% CI 1.3 to 1.6) in addition to 1-year survival (aOR 1.2; 95% CI 1.1 to 1.3), and among live-born infants it was associated with increased survival without MNM (aOR 1.3; 95% CI 1.1 to 1.4). ConclusionIncreased perinatal activity was associated with reduced mortality and increased chances of survival without MNM in infants born at 22 and 23 weeks of GA.
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| 13. |
- Frid, Ingrid, et al.
(författare)
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Critically ill neonates displayed stable vital parameters and reduced metabolic acidosis during neonatal emergency airborne transport in Sweden
- 2018
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Ingår i: Acta Paediatrica. - : WILEY. - 0803-5253 .- 1651-2227. ; 107:8, s. 1357-1361
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Tidskriftsartikel (refereegranskat)abstract
- Aim: This study evaluated the medical quality of acute airborne transports carried out by a neonatal emergency transport service in a Swedish healthcare region from 2012 to 2015. Methods: The transport charts and patient records of all infants transported to the regional centre were reviewed for transport indications and vital parameters and outcomes. Results: We identified 187 acute airborne transports and the main indications for referral were therapeutic hypothermia after perinatal asphyxia, extremely preterm birth and respiratory failure. There were 37 deaths, but none of these occurred during transport and none of the deaths that occurred within 24 hours after transport were found to be related to the transport per se. No differences were found in vital parameters or ventilator settings before and after transport, except for an improvement in blood pH (7.22 +/- 0.13 versus 7.27 +/- 0.13, mean +/- SD, p < 0.01), due to a decrease in base deficit (-8.0 +/- 6.8 versus -5.4 +/- 6.3 mmol, p < 0.001), while the partial pressure of carbon dioxide remained unchanged. Conclusion: During air transport, critically ill neonates displayed stable vital parameters and reduced metabolic acidosis. No transport-related mortality was found, but the high number of extremely preterm infants transported indicates the potential for improving in-utero transport.
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| 14. |
- Kassman, Håkan, 1962, et al.
(författare)
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The effect of oxygen and volatile combustibles on the sulphation of gaseous KCl
- 2013
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Ingår i: Combustion and Flame. - : Elsevier BV. - 1556-2921 .- 0010-2180. ; 160:10, s. 2231-2241
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Tidskriftsartikel (refereegranskat)abstract
- Sulphur/sulphate containing additives, such as elemental sulphur (S) and ammonium sulphate (NH4)(2)SO4), can be used for sulphation of KCl during biomass combustion. These additives convert KCl to an alkali sulphate and a more efficient sulphation is normally achieved for ammonium sulphate compared to sulphur. The presence of SO3 is thus of greater importance than that of SO2. Oxygen and volatile combustibles could also have an effect on the sulphation of gaseous KCl. This paper is based on results obtained during co-combustion of wood chips and straw pellets in a 12 MW circulating fluidised bed (CFB) boiler. Ammonium sulphate was injected at three positions in the boiler i.e. in the upper part of the combustion chamber, in the cyclone inlet, and in the cyclone. The sulphation of KCl was investigated at three air excess ratios (lambda = 1.1, 1.2 and 1.4). Several measurement tools were applied including IACM (on-line measurements of gaseous alkali chlorides), deposit probes (chemical composition in deposits collected) and gas analysis. The position for injection of ammonium sulphate had a great impact on the sulphation efficiency for gaseous KCl at the different air excess ratios. There was also an effect of oxygen on the sulphation efficiency when injecting ammonium sulphate in the cyclone. Less gaseous KCl was reduced during air excess ratio lambda = 1.1 compared to the higher air excess ratios. The optimal position and conditions for injection of ammonium sulphate were identified by measuring KCl with IACM. A correlation was observed between the sulphation of gaseous KCl and reduced chlorine content in the deposits. The experimental observations were evaluated using a detailed reaction mechanism. It was used to model the effect of volatile combustibles on the sulphation of gaseous MCI by SO3. The calculations supported the proposition that the presence of combustibles at the position of SO3 injection (i.e. AS) causes reduction of SO3 to SO2.
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| 15. |
- Larsson, Christina, et al.
(författare)
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Parents experiences of discharge readiness from a Swedish neonatal intensive care unit
- 2017
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Ingår i: Nursing Open. - : WILEY. - 2054-1058. ; 4:2, s. 90-95
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Tidskriftsartikel (refereegranskat)abstract
- Aim: The aim of this study was to describe how parents experienced the support at, and preparation for discharge from, the NICU and how they experienced the first time at home. Design: A qualitative design with quantitative elements was applied. Methods: A questionnaire study. Data were analysed using qualitative content analysis with quantitative elements. Results: The majority of included parents felt adequately prepared for going home and sufficiently supported during the first period home. Negative experiences were related to lack of time for preparation, lack of support and information, especially about the infant's food intake, breastfeeding, and tube feeding, and lack of follow-up counselling post discharge. This study supports that parents who are closely involved in their infant's care at the NICU, and who stay with the infant at the NICU around the clock, are well prepared for the transition to home.
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| 16. |
- Norman, M., et al.
(författare)
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Association Between Year of Birth and 1-Year Survival Among Extremely Preterm Infants in Sweden During 2004-2007 and 2014-2016
- 2019
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Ingår i: Jama-Journal of the American Medical Association. - Chicago : American Medical Association (AMA). - 0098-7484 .- 1538-3598. ; 321:12, s. 1188-1199
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Tidskriftsartikel (refereegranskat)abstract
- IMPORTANCE Since 2004-2007, national guidelines and recommendations have been developed for the management of extremely preterm births in Sweden. If and how more uniform management has affected infant survival is unknown. OBJECTIVE To compare survival of extremely preterm infants born during 2004-2007 with survival of infants born during 2014-2016. DESIGN, SETTING AND PARTICIPANTS All births at 22-26weeks' gestational age (n = 2205) between April 1, 2004, and March 31, 2007, and between January 1, 2014, and December 31, 2016, in Sweden were studied. Prospective data collection was used during 2004-2007. Data were obtained from the Swedish pregnancy, medical birth, and neonatal quality registries during 2014-2016. EXPOSURES Delivery at 22-26 weeks' gestational age. MAIN OUTCOMES AND MEASURES The primary outcomewas infant survival to the age of 1 year. The secondary outcome was 1-year survival among live-born infants who did not have any major neonatal morbidity (specifically, without intraventricular hemorrhage grade 3-4, cystic periventricular leukomalacia, necrotizing enterocolitis, retinopathy of prematurity stage 3-5, or severe bronchopulmonary dysplasia). RESULTS During 2004-2007, 1009 births (3.3/1000 of all births) occurred at 22-26 weeks' gestational age compared with 1196 births (3.4/1000 of all births) during 2014-2016 (P =.61). One-year survival among live-born infants at 22-26 weeks' gestational age was significantly lower during 2004-2007 (497 of 705 infants [70%]) than during 2014-2016 (711 of 923 infants [77%]) (difference, -7%[95% CI, -11% to -2.2%], P =.003). One-year survival among live-born infants at 22-26 weeks' gestational age and without any major neonatal morbidity was significantly lower during 2004-2007 (226 of 705 infants [32%]) than during 2014-2016 (355 of 923 infants [38%]) (difference, -6%[95% CI, -11% to -1.7%], P =.008). CONCLUSIONS AND RELEVANCE Among live births at 22-26 weeks' gestational age in Sweden, 1-year survival improved between 2004-2007 and 2014-2016.
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| 17. |
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| 18. |
- Normann, Dag, et al.
(författare)
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Hyperfinite type structures
- 1999
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Ingår i: JOURNAL OF SYMBOLIC LOGIC. - : ASSN SYMBOLIC LOGIC INC. ; 64:3, s. 1216-1242
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Tidskriftsartikel (refereegranskat)
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| 19. |
- Normann, Erik, et al.
(författare)
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Association between Chlamydia pneumoniae antibodies and wheezing in young children and the influence of sex
- 2006
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Ingår i: Thorax. - : BMJ. - 0040-6376 .- 1468-3296. ; 61:12, s. 1054-1058
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The proposed association between Chlamydia pneumoniae (Cpn) infection and wheezing needs further clarification. METHODS: Serum samples obtained from 1581 children aged 4 years in a population based cohort were tested for antibodies to Cpn and IgE antibodies to common allergens. Data on environmental factors and disease were collected prospectively from birth. RESULTS: The occurrence of IgG antibodies to Cpn at 4 years of age was associated with reported wheezing at different ages; however, these findings were most often not significant. In girls, the occurrence of anti-Cpn IgG was associated with wheezing at the ages of 1, 2, and 4 years (odds ratios (ORs) 3.41 (95% confidence interval (CI) 1.46 to 7.96), 2.13 (95% CI 1.02 to 4.44), and 2.01 (95% CI 1.14 to 3.54), respectively), and even higher ORs were observed for each age category when only high level antibody responses to Cpn were analysed. At the time of blood sampling the association between anti-Cpn IgG and wheezing was restricted to girls without atopic sensitisation (OR 2.39 (95% CI 1.25 to 4.57). No associations with wheezing were detected in boys, in whom IgE sensitisation was inversely associated with the presence of anti-Cpn IgG (OR 0.49 (95% CI 0.26 to 0.90)). CONCLUSIONS: This study suggests an association between evidence of earlier Cpn infection and a history of wheezing in young girls. Infection with Cpn may be an important risk factor for wheezing and possibly for non-atopic asthma, predominantly in girls.
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| 20. |
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| 21. |
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| 22. |
- Normann, Erik, 1966-
(författare)
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Chlamydia pneumoniae in Children - Epidemiology and Clinical Implications
- 2003
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Chlamydia pneumoniae is a human respiratory tract pathogen. Seroepidemiological studies indicate that C. pneumoniae infection is most common in school-aged children and infrequently detected in younger children.The aims of this study were to further elucidate the prevalence of C. pneumoniae in paediatric populations and to describe the clinical implications of these infections.The study population consisted of 367 children with respiratory tract diseases, 453 presumed healthy children at day-care, 69 children undergoing adenoidectomy and 1585 children from a population based cohort. Family members to infected day-care children were investigated. The laboratory methods used were polymerase chain reaction (PCR) on specimen from upper respiratory tract, serology by microimmunofluorescence (MIF), and immunohistochemistry (IHC) on adenoid tissue specimen. Personal data and medical history were obtained by the means of questionnaires and by the study of patient records.In children younger than five years, the prevalence of C. pneumoniae was 17% as detected by PCR. This prevalence started to increase with increasing age from two years of age. The corresponding increase in serology as detected by MIF started at the age of four years. The prevalence at day-care centres varied from 4 to 39%. Both PCR and MIF underestimated the prevalence of C. pneumoniae detected by IHC. Families to infected children were investigated: mothers were more often infected than fathers were.Most C. pneumoniae infections in small children were confined to the upper respiratory tract. These infections were usually mild or asymptomatic. Symptomatic disease may be of prolonged nature. No subsequent illness after C. pneumoniae infection was detected at follow-up after four years. In general, no association between C. pneumoniae and asthma was found, but C. pneumoniae may be of importance for asthma in some susceptible individuals. Previous C. pneumoniae infection reduced the risk for later atopy.In conclusion, C. pneumoniae is a common finding in small children and most often causes relatively mild disease. If the acquisition of this infection early in life will have any implications for future health remains to be investigated.
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| 23. |
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| 25. |
- Normann, Erik, et al.
(författare)
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Chlamydia pneumoniae infection predicts a reduced risk for subsequent atopic disease.
- 2005
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Ingår i: Acta Paediatr. - 0803-5253. ; 94:6, s. 705-10
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To investigate long-term effects on children previously infected with Chlamydia pneumoniae. METHODS: A follow-up questionnaire was sent to all participants from a former population-based study in order to investigate health status during the 4 y that had elapsed between the two studies. In the original study, the prevalence of C. pneumoniae infection was 23% as determined by PCR analyses on throat swab specimens. These PCR results were found to have no detectable correlation for clinical disease. The main outcome measures in this follow-up study were the reported prevalence of respiratory tract infections, asthma and allergy. RESULTS: Approximately 83% completed the follow-up questionnaire. No increase in respiratory tract infections was reported by children previously found to have C. pneumoniae infection. A diagnosis of allergy was more common in the former PCR-negative population (13.4% vs 4.7%, p<0.03). The differences were most apparent in the population with atopic heredity. In a logistic regression model with different suggested risk factors for allergy, earlier infection with C. pneumoniae reduced the risk for allergy (OR=0.13; 95% CI: 0.02-0.99). This was not found for asthma. CONCLUSION: A positive PCR test for C. pneumoniae in young children was associated with a lower risk of developing allergic airway disease in this study population, and did not predict an increase in respiratory tract infections.
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| 26. |
- Normann, Erik, et al.
(författare)
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Intestinal microbial profiles in extremely preterm infants with and without necrotizing enterocolitis
- 2013
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Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 102:2, s. 129-136
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Tidskriftsartikel (refereegranskat)abstract
- Aim Necrotizing enterocolitis (NEC) represents one of the gravest complications in premature infants. The suggested role of intestinal microbiota in the development of NEC needs to be elucidated. Methods This prospective single-centre casecontrol study applied barcoded pyrosequencing to map the bacterial composition of faecal samples from extremely preterm infants. Ten patients were diagnosed with NEC and matched to healthy controls with regard to sex, gestational age and mode of delivery prior to analysis of the samples. Results Enterococcus, Bacillales and Enterobacteriaceae dominated the flora. Although not statistically significant, a high relative abundance of Bacillales and Enterobacteriaceae was detected at early time points in patients developing NEC, while healthy controls had a microbiota more dominated by Enterococcus. A low diversity of intestinal microbial flora was found without any differences between NEC patients and controls. In 16 healthy controls, Firmicutes (Enterococcus and Bacillales) dominated the faecal flora during the first weeks after birth and were then succeeded by Enterobacteriaceae. Conclusion No significant differences in the composition of intestinal microbiota of patients developing NEC were detected; however, some findings need to be scrutinized in subsequent studies.
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| 27. |
- Normann, Erik, et al.
(författare)
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Isolation of Non-Activated Monocytes from Human Umbilical Cord Blood
- 2010
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Ingår i: American Journal of Reproductive Immunology and Microbiology. - : Wiley. - 8755-8920 .- 1046-7408. ; 63:1, s. 66-72
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Tidskriftsartikel (refereegranskat)abstract
- Problem Methods for monocyte purification are common but few work with umbilical cord monocytes that do not activate the cell for subsequent culture analysis. Methods of study The collection procedure avoids use of needles and procedures that variably activate blood clotting and uses a purification procedure that involves diluted Ficoll, autologous serum to remove platelets and 42% and 51% Percoll step gradients for the final purification. The resulting monocytes were stimulated with bacterial lipopolysaccharide and formalin-treated bacteria Escherichia coli and group B streptococci (GBS) to secrete TNF-alpha and IL-1 beta, measured by ELISA. Results The purification procedure results in non-active but stimulation-competent monocytes with high yields (2.3-9 x 107 cells) and purity (from 70% to 98%). Conclusion We describe a procedure that is easy, uses common reagents and provides a uniformly high yield and purity of non-activated fetal monocytes for studies of innate defense responses.
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| 28. |
- Normann, Fredrik, 1982, et al.
(författare)
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Nitrogen and sulphur chemistry in pressurised flue gas systems: A comparison of modelling and experiments
- 2013
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Ingår i: International Journal of Greenhouse Gas Control. - : Elsevier BV. - 1750-5836. ; 12, s. 26-34
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Tidskriftsartikel (refereegranskat)abstract
- The nitrogen and sulphur chemistry is more significant during compression of flue gases than they are under atmospheric conditions. This fact became apparent during the development of oxy-fuel power plant technology to capture carbon dioxide (CO2). In the oxy-fuel power plant, the CO2-rich flue gas stream is compressed to enable efficient transport and storage. During this process, NOx and SOx are removed as acids in the condensed water. However, the chemistry of these steps is not understood well enough to allow for control and design of the process.In the present work, the gas- and liquid-phase chemistry of NOx and SOx at elevated pressures were evaluated by comparing a state-of-the-art reaction mechanism to the results of experimental investigations. The model used confirms previous observations of substantial absorption of NOx and SOx and subsequent formation of acids in pressurised flue gas systems. The results of the modelling show that the oxidation of NO into NO2 governs the absorption of NOx. The complex chemistry of the liquid phase, which includes reactions between HNO2, H2SO3, and possibly H2SO4, is critical for the rate of absorption of NOx and SOx from the gas to the liquid phase. This process is heavily dependent upon the pH level. The modelling suggests that N2O is formed as a stable product through the liquid-phase reactions.
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| 29. |
- Prusakov, Pavel, et al.
(författare)
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A global point prevalence survey of antimicrobial use in neonatal intensive care units : The no-more-antibiotics and resistance (NO-MAS-R) study
- 2021
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Ingår i: eClinicalMedicine. - : Elsevier. - 2589-5370. ; 32
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Tidskriftsartikel (refereegranskat)abstract
- Background: Global assessment of antimicrobial agents prescribed to infants in the neonatal intensive care unit (NICU) may inform antimicrobial stewardship efforts.Methods: We conducted a one-day global point prevalence study of all antimicrobials provided to NICU infants. Demographic, clinical, and microbiologic data were obtained including NICU level, census, birth weight, gestational/chronologic age, diagnoses, antimicrobial therapy (reason for use; length of therapy), antimicrobial stewardship program (ASP), and 30-day in-hospital mortality.Findings: On July 1, 2019, 26% of infants (580/2,265; range, 0-100%; median gestational age, 33 weeks; median birth weight, 1800 g) in 84 NICUs (51, high-income; 33, low-to-middle income) from 29 countries (14, high-income; 15, low-to-middle income) in five continents received >= 1 antimicrobial agent (92%, antibacterial; 19%, antifungal; 4%, antiviral). The most common reasons for antibiotic therapy were "rule-out" sepsis (32%) and "culture-negative" sepsis (16%) with ampicillin (40%), gentamicin (35%), amikacin (19%), vancomycin (15%), and meropenem (9%) used most frequently. For definitive treatment of presumed/confirmed infection, vancomycin (26%), amikacin (20%), and meropenem (16%) were the most prescribed agents. Length of therapy for culture-positive and "culture-negative" infections was 12 days (median; IQR, 8-14) and 7 days (median; IQR, 5-10), respectively. Mortality was 6% (42%, infection-related). An NICU ASP was associated with lower rate of antibiotic utilization (p = 0.02).Interpretation: Global NICU antibiotic use was frequent and prolonged regardless of culture results. NICU-specific ASPs were associated with lower antibiotic utilization rates, suggesting the need for their implementation worldwide.
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| 30. |
- Raiskila, Simo, et al.
(författare)
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Parent and nurse perceptions on the quality of family-centred care in 11 European NICUs
- 2016
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Ingår i: Australian Critical Care. - : Elsevier BV. - 1036-7314 .- 1878-1721. ; 29:4, s. 201-209
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Family-centred care (FCC) is a state-of-the-art practice in neonatal intensive care units (NICU) based on its shown benefits on the well-being of both infants and parents. However, there is no systematic knowledge about how FCC is implemented in different European contexts. OBJECTIVES: To describe parents' presence and the quality of FCC from the perspectives of mothers, fathers and nurses in 11 European NICUs. METHODS: A prospective survey was conducted in Finland, Sweden, Norway, Estonia, Spain and Italy. The perceived quality of FCC was measured using 8 text-message questions sent to the parents' mobile phones, one question each day, during the infant's hospital stay. Nurses answered corresponding questions through a Web questionnaire during a 3-month period. The responses were rated on a 7-point Likert scale. Parents who were not present in the unit during the day used a "0" response. RESULTS: A total of 262 families of preterm infants born before 35 gestational weeks participated in the study. Mothers gave 5045 responses, fathers gave 3971 responses and nurses gave 11,132 answers. The mothers were present during 92.7% and the fathers during 77.9% of the study days. The mothers rated the quality of FCC slightly higher than the fathers did (5.8 [95% CI 5.7-5.9] vs. 5.7 [95% CI 5.6-5.8], mean difference of 0.12 [95% CI 0.05-0.2], p<0.001). There was wide variation in the parents' presence and the quality of FCC between the units. The weakest aspects of FCC were emotional support, parents' participation in decision-making and fathers' participation in infant care. The perceived quality of FCC between the nurses and parents were comparable. CONCLUSIONS: This study showed a high perceived quality of FCC in 11 European units, as indicated by both parents and nurses. The innovative data-collection method and instrument successfully quantified each unit's FCC profile for further quality improvement and should be trialled in other NICUs and countries.
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| 31. |
- Raiskila, Simo, et al.
(författare)
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Parents' presence and parent-infant closeness in 11 neonatal intensive care units in six European countries vary between and within the countries
- 2017
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Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 106:6, s. 878-888
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Tidskriftsartikel (refereegranskat)abstract
- Aim: Little is known about the amount of physical parent-infant closeness in neonatal intensive care units (NICUs), and this study explored that issue in six European countries.Methods: The parents of 328 preterm infants were recruited in 11 NICUs in Finland, Estonia, Sweden, Norway, Italy and Spain. They filled in daily diaries about how much time they spent in the NICU, in skin-to-skin contact (SSC) and holding their babies in the first two weeks of their hospitalisation.Results: The parents' NICU presence varied from a median of 3.3 (minimum 0.7-maximum 6.7) to 22.3 (18.7-24.0) hours per day (p < 0.001), SSC varied from 0.3 (0-1.4) to 6.6 (2.2-19.5) hours per day (p < 0.001) and holding varied from 0 (0-1.5) to 3.2 (0-7.4) hours per day (p < 0.001). Longer SSC was associated with singleton babies and more highly educated mothers. Holding the baby for longer was associated with gestational age. The most important factor supporting parent-infant closeness was the opportunity to stay overnight in the NICU. Having other children and the distance from home to the hospital had no impact on parent-infant closeness.Conclusion: Parents spent more time in NICUs if they could stay overnight, underlining the importance that these facilities play in establishing parent-infant closeness.
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| 32. |
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| 33. |
- Söderström, Fanny, et al.
(författare)
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Outcomes of a uniformly active approach to infants born at 22-24 weeks of gestation
- 2021
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Ingår i: Archives of Disease in Childhood. - : BMJ Publishing Group Ltd. - 1359-2998 .- 1468-2052. ; 106:4, s. 413-417
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveTo determine survival and outcomes in infants born at 22-24 weeks of gestation in a centre with a uniformly active approach to management of extremely preterm infants.Study designSingle-centre retrospective cohort study including infants born 2006-2015. Short-term morbidities assessed included retinopathy of prematurity, necrotising enterocolitis, patent ductus arteriosus, intraventricular haemorrhage, periventricular malacia and bronchopulmonary dysplasia. Neurodevelopmental outcomes assessed included cerebral palsy, visual impairment, hearing impairment and developmental delay.ResultsTotal survival was 64% (143/222), ranging from 52% at 22 weeks to 70% at 24 weeks. Of 133 (93%) children available for follow-up at 2.5 years corrected age, 34% had neurodevelopmental impairment with 11% classified as moderately to severely impaired. Treatment-requiring retinopathy of prematurity, severe bronchopulmonary dysplasia, visual impairment and developmental delay correlated with lower gestational age.ConclusionsA uniformly active approach to all extremely preterm infants results in survival rates that are not distinctly different across the gestational ages of 22-24 weeks and more than 50% survival even in infants at 22 weeks. The majority were unimpaired at 2.5 years, suggesting that such an approach does not result in higher rates of long-term adverse neurological outcome.
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| 34. |
- Söderström, Fanny, et al.
(författare)
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Reduced rate of retinopathy of prematurity after implementing lower oxygen saturation targets.
- 2019
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Ingår i: Journal of Perinatology. - : Springer Science and Business Media LLC. - 0743-8346 .- 1476-5543. ; 39, s. 409-414
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To evaluate an implementation of lower oxygen saturation targets with retinopathy of prematurity (ROP) as primary outcome, in infants at the lowest extreme of prematurity.Study design: Retrospective cohort including infants born at 22-25 weeks of gestation in 2005-2015 (n = 325), comparing high (87-93%) and low (85-90%) targets; infants transferred early were excluded from the main analysis to avoid bias.Results: Overall survival was 76% in high saturation era, and 69% in low saturation era (p = .17). Treatment-requiring ROP was less common in low saturation group (14% vs 28%, p < .05) with the most prominent difference in the most immature infants. Including deceased infants in the analysis, necrotizing enterocolitis was more frequent in low saturation era (21% vs 10%, p < .05).Conclusions: Implementing lower saturation targets resulted in a halved incidence of treatment-requiring ROP; the most immature infants seem to benefit the most. An association between lower oxygenation and necrotizing enterocolitis cannot be excluded.
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