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1.
  • Carlsson, Lena M S, 1957, et al. (författare)
  • Bariatric surgery and prevention of type 2 diabetes in Swedish obese subjects.
  • 2012
  • Ingår i: The New England journal of medicine. - : Massachusetts Medical Society. - 1533-4406 .- 0028-4793. ; 367:8, s. 695-704
  • Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
    • Weight loss protects against type 2 diabetes but is hard to maintain with behavioral modification alone. In an analysis of data from a nonrandomized, prospective, controlled study, we examined the effects of bariatric surgery on the prevention of type 2 diabetes.
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4.
  • Stoltz Sjöström, Elisabeth, et al. (författare)
  • Micronutrient Intakes Affect Early Growth in Extremely Preterm Infants : Preliminary Results from a Swedish Cohort
  • 2011
  • Ingår i: Pediatric Research. - : Nature Publishing Group. - 1530-0447 .- 0031-3998.
  • Konferensbidrag (refereegranskat)abstract
    • Background: Extremely preterm infants generally experience postnatal growth failure. It is still unclear if this is related to micronutrient intakes.Aim: To investigate the effect of micronutrient intakes (calcium, zinc, iron, phosphorus, sodium, potassium, chloride, magnesium, vitamin A, vitamin D, vitamin E, folate and vitamin B12) on growth during the first 28 days of life in extremely preterm infants.Method: From the EXPRESS cohort (all infants born < 27 gestational weeks between 2004-2007 in Sweden), those who survived the first 28 days were included (n=524). Daily parenteral and enteral intakes and anthropometric measurements were retrieved from hospital records.Results: Preliminary analyses of data from 333 infants (mean±SD gestational age 25.2±1.0 weeks, birth weight 753±168g) showed that macronutrient intakes were lower than recommended (energy 98±13kcal/kg/day, protein 2.9±0.4g/kg/day). Infants showed postnatal growth failure: mean standard deviation scores decreased by 2.2 for weight, 2.3 for length and 1.4 for head circumference. Intakes of micronutrients were generally low, e.g. adjusted enteral intakes of calcium were 66.6±21.4 mg/kg/day. The exception was iron, with a high parenteral intake of 2.7±1.6 mg/kg/day, mainly from blood transfusions. Adjusting for protein intake and other confounders, calcium intakes were positively correlated with head growth (r=+0.19, p=0.006) and iron intakes were negatively correlated with length gain (r=-0.18, p=0.009).Conclusions: Low calcium intakes and high iron intakes were associated with poor growth with regard to head circumference and length, respectively. If these results are confirmed, optimized micronutrient intakes may improve early growth in extremely preterm infants.
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5.
  • Stoltz Sjöström, Elisabeth, et al. (författare)
  • Nutrient intakes independently affect growth in extremely preterm infants: results from a population-based study
  • 2013
  • Ingår i: Acta Paediatrica. - : Wiley-Blackwell. - 0803-5253 .- 1651-2227. ; 102:11, s. 1067-1074
  • Tidskriftsartikel (refereegranskat)abstract
    • AimTo explore associations between energy and macronutrient intakes and early growth in extremely low gestational age (ELGA) infants. less thanbrgreater than less thanbrgreater thanMethodsRetrospective population-based study of all ELGA infants (andlt;27weeks) born in Sweden during 2004-2007. Detailed data on nutrition and anthropometric measurements from birth to 70days of postnatal age were retrieved from hospital records. less thanbrgreater than less thanbrgreater thanResultsStudy infants (n=531) had a meanSD gestational age of 25.3 +/- 1.1weeks and a birth weight of 765 +/- 170g. Between 0 and 70days, average daily energy and protein intakes were 120 +/- 11kcal/kg and 3.2 +/- 0.4g/kg, respectively. During this period, standard deviation scores for weight, length and head circumference decreased by 1.4, 2.3 and 0.7, respectively. Taking gestational age, baseline anthropometrics and severity of illness into account, lower energy intake correlated with lower gain in weight (r=+0.315, pandlt;0.001), length (r=+0.215, pandlt;0.001) and head circumference (r=+0.218, pandlt;0.001). Protein intake predicted growth in all anthropometric outcomes, and fat intake was positively associated with head circumference growth. less thanbrgreater than less thanbrgreater thanConclusionExtremely low gestational age infants received considerably less energy and protein than recommended and showed postnatal growth failure. Nutrient intakes were independent predictors of growth even after adjusting for severity of illness. These findings suggest that optimized energy and macronutrient intakes may prevent early growth failure in these infants.
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7.
  • Alm, Stina, et al. (författare)
  • Erythrocyte transfusions increased the risk of elevated serum ferritin in very low birth weight infants and were associated with altered longitudinal growth
  • 2020
  • Ingår i: Acta Paediatrica. - : John Wiley & Sons. - 0803-5253 .- 1651-2227. ; 109:7, s. 1354-1360
  • Tidskriftsartikel (refereegranskat)abstract
    • Aim: There has been a lack of population‐based longitudinal data on serum ferritin in very low birth weight (VLBW) infants during hospitalisation. Our aim was to fill this gap in the knowledge and investigate risk factors for elevated serum ferritin and associations between erythrocyte transfusions and longitudinal growth.Methods: We retrospectively reviewed longitudinal data on 126 VLBW infants treated at Umeå University Hospital, Sweden, between 2010‐2013.Results: The infants’ mean gestational age and birth weight were 26.9 weeks and 899 grams. Most (91%) received erythrocyte transfusions and the majority had multiple erythrocyte transfusions. There was a significant correlation between serum ferritin and the volume of transfusions. Almost two‐thirds had at least one serum ferritin measurement of more than 350 µg/L, indicating iron overload. In those with complete anthropometric data (n=78) there was no significant effect of serum ferritin concentrations in relation to longitudinal growth, but there was a positive association between the erythrocyte transfusion dose and longitudinal growth in VLBW infants born before 25 weeks.Conclusion: This is the first population‐based study to investigate longitudinal data on serum ferritin in VLBW infants during hospitalisation. The unexpected positive finding in the subgroup born at less than 25 weeks needs further research with a larger cohort.
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8.
  • Alm, Stina, et al. (författare)
  • Prevalence and risk factors for post discharge feeding problems in children born extremely preterm
  • 2023
  • Ingår i: Journal of Pediatric Gastroenterology and Nutrition - JPGN. - : Wolters Kluwer. - 0277-2116 .- 1536-4801. ; 76:4, s. 498-504
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: Preterm infants have a high risk of post discharge feeding problems, but there is a lack of population-based studies in infants born extremely preterm and little is known about underlying mechanisms.The objectives were to assess the incidence of post discharge feeding problems and underweight in a population-based cohort of infants born extremely preterm in Sweden (EXPRESS) and identify perinatal risk factors.Methods: Perinatal health data and prenatal/postnatal growth data was prospectively collected in the cohort. Data on clinical diagnoses related to feeding problems were obtained from the Swedish Patient Register, population prevalence data was also obtained. The main outcome was a composite of post discharge feeding problem diagnosis and/or underweight at 2.5 years of age.Results: In total, 66 children (19%) had post discharge feeding problems diagnosed before 2 years and/or underweight at 2.5 years of age. The risk of feeding problems when compared to the general population was significantly higher, with an odds ratio (OR) of 193 (95% CI 137.6-270.9). The strongest risk factors for feeding problems were the number of days on mechanical ventilation during the first eight postnatal weeks, OR of 1.59 (CI 95% 1.29-1.98), and the Clinical Risk Index for Babies-score, OR of 1.14 (CI 95% 1.03-1.26).Conclusions: Post discharge feeding problems and underweight are common in children born extremely preterm. The strongest perinatal risk factor for later feeding problems was early treatment with mechanical ventilation. Identifying infants at risk of post discharge feeding problems might be useful for targeting of nutritional support.
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9.
  • Alvfors, Per, 1954-, et al. (författare)
  • Research and development challenges for Swedish biofuel actors – three illustrative examples : Improvement potential discussed in the context of Well-to-Tank analyses
  • 2010
  • Rapport (övrigt vetenskapligt/konstnärligt)abstract
    • Currently biofuels have strong political support, both in the EU and Sweden. The EU has, for example, set a target for the use of renewable fuels in the transportation sector stating that all EU member states should use 10% renewable fuels for transport by 2020. Fulfilling this ambition will lead to an enormous market for biofuels during the coming decade. To avoid increasing production of biofuels based on agriculture crops that require considerable use of arable area, focus is now to move towards more advanced second generation (2G) biofuels that can be produced from biomass feedstocks associated with a more efficient land use. Climate benefits and greenhouse gas (GHG) balances are aspects often discussed in conjunction with sustainability and biofuels. The total GHG emissions associated with production and usage of biofuels depend on the entire fuel production chain, mainly the agriculture or forestry feedstock systems and the manufacturing process. To compare different biofuel production pathways it is essential to conduct an environmental assessment using the well-to-tank (WTT) analysis methodology. In Sweden the conditions for biomass production are favourable and we have promising second generation biofuels technologies that are currently in the demonstration phase. In this study we have chosen to focus on cellulose based ethanol, methane from gasification of solid wood as well as DME from gasification of black liquor, with the purpose of identifying research and development potentials that may result in improvements in the WTT emission values. The main objective of this study is thus to identify research and development challenges for Swedish biofuel actors based on literature studies as well as discussions with the the researchers themselves. We have also discussed improvement potentials for the agriculture and forestry part of the WTT chain. The aim of this study is to, in the context of WTT analyses, (i) increase knowledge about the complexity of biofuel production, (ii) identify and discuss improvement potentials, regarding energy efficiency and GHG emissions, for three biofuel production cases, as well as (iii) identify and discuss improvement potentials regarding biomass supply, including agriculture/forestry. The scope of the study is limited to discussing the technologies, system aspects and climate impacts associated with the production stage. Aspects such as the influence on biodiversity and other environmental and social parameters fall beyond the scope of this study. We find that improvement potentials for emissions reductions within the agriculture/forestry part of the WTT chain include changing the use of diesel to low-CO2-emitting fuels, changing to more fuel-efficient tractors, more efficient cultivation and manufacture of fertilizers (commercial nitrogen fertilizer can be produced in plants which have nitrous oxide gas cleaning) as well as improved fertilization strategies (more precise nitrogen application during the cropping season). Furthermore, the cultivation of annual feedstock crops could be avoided on land rich in carbon, such as peat soils and new agriculture systems could be introduced that lower the demand for ploughing and harrowing. Other options for improving the WTT emission values includes introducing new types of crops, such as wheat with higher content of starch or willow with a higher content of cellulose. From the case study on lignocellulosic ethanol we find that 2G ethanol, with co-production of biogas, electricity, heat and/or wood pellet, has a promising role to play in the development of sustainable biofuel production systems. Depending on available raw materials, heat sinks, demand for biogas as vehicle fuel and existing 1G ethanol plants suitable for integration, 2G ethanol production systems may be designed differently to optimize the economic conditions and maximize profitability. However, the complexity connected to the development of the most optimal production systems require improved knowledge and involvement of several actors from different competence areas, such as chemical and biochemical engineering, process design and integration and energy and environmental systems analysis, which may be a potential barrier.
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10.
  • Alvfors, Per, et al. (författare)
  • Research and development challenges for Swedish biofuel actors – three illustrative examples
  • 2010
  • Rapport (övrigt vetenskapligt/konstnärligt)abstract
    • Currently biofuels have strong political support, both in the EU and Sweden. The EU has, for example, set a target for the use of renewable fuels in the transportation sector stating that all EU member states should use 10% renewable fuels for transport by 2020. Fulfilling this ambition will lead to an enormous market for biofuels during the coming decade. To avoid increasing production of biofuels based on agriculture crops that require considerable use of arable area, focus is now to move towards more advanced second generation (2G) biofuels that can be produced from biomass feedstocks associated with a more efficient land use.Climate benefits and greenhouse gas (GHG) balances are aspects often discussed in conjunction with sustainability and biofuels. The total GHG emissions associated with production and usage of biofuels depend on the entire fuel production chain, mainly the agriculture or forestry feedstock systems and the manufacturing process. To compare different biofuel production pathways it is essential to conduct an environmental assessment using the well-to-tank (WTT) analysis methodology. In Sweden the conditions for biomass production are favourable and we have promising second generation biofuels technologies that are currently in the demonstration phase. In this study we have chosen to focus on cellulose based ethanol, methane from gasification of solid wood as well as DME from gasification of black liquor, with the purpose of identifying research and development potentials that may result in improvements in the WTT emission values. The main objective of this study is thus to identify research and development challenges for Swedish biofuel actors based on literature studies as well as discussions with the the researchers themselves. We have also discussed improvement potentials for the agriculture and forestry part of the WTT chain. The aim of this study is to, in the context of WTT analyses, (i) increase knowledge about the complexity of biofuel production, (ii) identify and discuss improvement potentials, regarding energy efficiency and GHG emissions, for three biofuel production cases, as well as (iii) identify and discuss improvement potentials regarding biomass supply, including agriculture/forestry. The scope of the study is limited to discussing the technologies, system aspects and climate impacts associated with the production stage. Aspects such as the influence on biodiversity and other environmental and social parameters fall beyond the scope of this study. We find that improvement potentials for emissions reductions within the agriculture/forestry part of the WTT chain include changing the use of diesel to low-CO2-emitting fuels, changing to more fuel-efficient tractors, more efficient cultivation and manufacture of fertilizers (commercial nitrogen fertilizer can be produced in plants which have nitrous oxide gas cleaning) as well as improved fertilization strategies (more precise nitrogen application during the cropping season). Furthermore, the cultivation of annual feedstock crops could be avoided on land rich in carbon, such as peat soils and new agriculture systems could be introduced that lower the demand for ploughing and harrowing. Other options for improving the WTT emission values includes introducing new types of crops, such as wheat with higher content of starch or willow with a higher content of cellulose. From the case study on lignocellulosic ethanol we find that 2G ethanol, with co-production of biogas, electricity, heat and/or wood pellet, has a promising role to play in the development of sustainable biofuel production systems. Depending on available raw materials, heat sinks, demand for biogas as vehicle fuel and existing 1G ethanol plants suitable for integration, 2G ethanol production systems may be designed differently to optimize the economic conditions and maximize profitability. However, the complexity connected to the development of the most optimal production systems require improved knowledge and involvement of several actors from different competence areas, such as chemical and biochemical engineering, process design and integration and energy and environmental systems analysis, which may be a potential barrier. Three important results from the lignocellulosic ethanol study are: (i) the production systems could be far more complex and intelligently designed than previous studies show, (ii) the potential improvements consist of a large number of combinations of process integration options wich partly depends on specific local conditions, (iii) the environmental performance of individual systems may vary significantly due to systems design and local conditons.From the case study on gasification of solid biomass for the production of biomethane we find that one of the main advantages of this technology is its high efficiency in respect to converting biomass into fuels for transport. For future research we see a need for improvements within the gas up-grading section, including gas cleaning and gas conditioning, to obtain a more efficient process. A major challenge is to remove the tar before the methanation reaction. Three important results from the biomethane study are: (i) it is important not to crack the methane already produced in the syngas, which indicates a need for improved catalysts for selective tar cracking, (ii) there is a need for new gas separation techniques to facilitate the use of air oxidation agent instead of oxygen in the gasifier, and (iii) there is a need for testing the integrated process under realistic conditions, both at atmospheric and pressurized conditions. From the case study on black liquor gasification for the production of DME we find that the process has many advantages compared to other biofuel production options, such as the fact that black liquor is already partially processed and exists in a pumpable, liquid form, and that the process is pressurised and tightly integrated with the pulp mill, which enhances fuel production efficiency. However, to achieve commercial status, some challenges still remain, such as demonstrating that materials and plant equipment meet the high availability required when scaling up to industrial size in the pulp mill, and also proving that the plant can operate according to calculated heat and material balances. Three important results from the DME study are: (i) that modern chemical pulp mills, having a potential surplus of energy, could become important suppliers of renewable fuels for transport, (ii) there is a need to demonstrate that renewable DME/methanol will be proven to function in large scale, and (iii) there is still potential for technology improvements and enhanced energy integration. Although quantitative improvement potentials are given in the three biofuel production cases, it is not obvious how these potentials would affect WTT values, since the biofuel production processes are complex and changing one parameter impacts other parameters. The improvement potentials are therefore discussed qualitatively. From the entire study we have come to agree on the following common conclusions: (i) research and development in Sweden within the three studied 2G biofuel production technologies is extensive, (ii) in general, the processes, within the three cases, work well at pilot and demonstration scale and are now in a phase to be proven in large scale, (iii) there is still room for improvement although some processes have been known for decades, (iv) the biofuel production processes are complex and site specific and process improvements need to be seen and judged from a broad systems perspective (both within the production plant as well as in the entire well-to-tank perspective), and (v) the three studied biofuel production systems are complementary technologies. Futher, the process of conducting this study is worth mentioning as a result itself, i.e. that many different actors within the field have proven their ability and willingness to contribute to a common report, and that the cooperation climate was very positive and bodes well for possible future collaboration within the framework of the f3 center. Finally, judging from the political ambitions it is clear that the demand for renewable fuels will significantly increase during the coming decade. This will most likely result in opportunities for a range of biofuel options. The studied biofuel options all represent 2G biofuels and they can all be part of the solution to meet the increased renewable fuel demand.
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11.
  • Alvors, Per, et al. (författare)
  • Research and development challenges for Swedish biofuel actors – three illustrative examples : Improvement potential discussed in the context of Well-to-Tank analyses
  • 2010
  • Rapport (övrigt vetenskapligt/konstnärligt)abstract
    • Currently biofuels have strong political support, both in the EU and Sweden. The EU has, for example, set a target for the use of renewable fuels in the transportation sector stating that all EU member states should use 10% renewable fuels for transport by 2020. Fulfilling this ambition will lead to an enormous market for biofuels during the coming decade. To avoid increasing production of biofuels based on agriculture crops that require considerable use of arable area, focus is now to move towards more advanced second generation (2G) biofuels that can be produced from biomass feedstocks associated with a more efficient land use.Climate benefits and greenhouse gas (GHG) balances are aspects often discussed in conjunction with sustainability and biofuels. The total GHG emissions associated with production and usage of biofuels depend on the entire fuel production chain, mainly the agriculture or forestry feedstock systems and the manufacturing process. To compare different biofuel production pathways it is essential to conduct an environmental assessment using the well-to-tank (WTT) analysis methodology.In Sweden the conditions for biomass production are favourable and we have promising second generation biofuels technologies that are currently in the demonstration phase. In this study we have chosen to focus on cellulose based ethanol, methane from gasification of solid wood as well as DME from gasification of black liquor, with the purpose of identifying research and development potentials that may result in improvements in the WTT emission values. The main objective of this study is thus to identify research and development challenges for Swedish biofuel actors based on literature studies as well as discussions with the the researchers themselves. We have also discussed improvement potentials for the agriculture and forestry part of the WTT chain. The aim of this study is to, in the context of WTT analyses, (i) increase knowledge about the complexity of biofuel production, (ii) identify and discuss improvement potentials, regarding energy efficiency and GHG emissions, for three biofuel production cases, as well as (iii) identify and discuss improvement potentials regarding biomass supply, including agriculture/forestry. The scope of the study is limited to discussing the technologies, system aspects and climate impacts associated with the production stage. Aspects such as the influence on biodiversity and other environmental and social parameters fall beyond the scope of this study.We find that improvement potentials for emissions reductions within the agriculture/forestry part of the WTT chain include changing the use of diesel to low-CO2-emitting fuels, changing to more fuel-efficient tractors, more efficient cultivation and manufacture of fertilizers (commercial nitrogen fertilizer can be produced in plants which have nitrous oxide gas cleaning) as well as improved fertilization strategies (more precise nitrogen application during the cropping season). Furthermore, the cultivation of annual feedstock crops could be avoided on land rich in carbon, such as peat soils and new agriculture systems could be introduced that lower the demand for ploughing and harrowing. Other options for improving the WTT emission values includes introducing new types of crops, such as wheat with higher content of starch or willow with a higher content of cellulose.From the case study on lignocellulosic ethanol we find that 2G ethanol, with co-production of biogas, electricity, heat and/or wood pellet, has a promising role to play in the development of sustainable biofuel production systems. Depending on available raw materials, heat sinks, demand for biogas as vehicle fuel and existing 1G ethanol plants suitable for integration, 2G ethanol production systems may be designed differently to optimize the economic conditions and maximize profitability. However, the complexity connected to the development of the most optimal production systems require improved knowledge and involvement of several actors from different competence areas, such as chemical and biochemical engineering, process design and integration and energy and environmental systems analysis, which may be a potential barrier.Three important results from the lignocellulosic ethanol study are: (i) the production systems could be far more complex and intelligently designed than previous studies show, (ii) the potential improvements consist of a large number of combinations of process integration options wich partly depends on specific local conditions, (iii) the environmental performance of individual systems may vary significantly due to systems design and local conditons.From the case study on gasification of solid biomass for the production of biomethane we find that one of the main advantages of this technology is its high efficiency in respect to converting biomass into fuels for transport. For future research we see a need for improvements within the gas up-grading section, including gas cleaning and gas conditioning, to obtain a more efficient process. A major challenge is to remove the tar before the methanation reaction.Three important results from the biomethane study are: (i) it is important not to crack the methane already produced in the syngas, which indicates a need for improved catalysts for selective tar cracking, (ii) there is a need for new gas separation techniques to facilitate the use of air oxidation agent instead of oxygen in the gasifier, and (iii) there is a need for testing the integrated process under realistic conditions, both at atmospheric and pressurized conditions.From the case study on black liquor gasification for the production of DME we find that the process has many advantages compared to other biofuel production options, such as the fact that black liquor is already partially processed and exists in a pumpable, liquid form, and that the process is pressurised and tightly integrated with the pulp mill, which enhances fuel production efficiency. However, to achieve commercial status, some challenges still remain, such as demonstrating that materials and plant equipment meet the high availability required when scaling up to industrial size in the pulp mill, and also proving that the plant can operate according to calculated heat and material balances. Three important results from the DME study are: (i) that modern chemical pulp mills, having a potential surplus of energy, could become important suppliers of renewable fuels for transport, (ii) there is a need to demonstrate that renewable DME/methanol will be proven to function in large scale, and (iii) there is still potential for technology improvements and enhanced energy integration.Although quantitative improvement potentials are given in the three biofuel production cases, it is not obvious how these potentials would affect WTT values, since the biofuel production processes are complex and changing one parameter impacts other parameters. The improvement potentials are therefore discussed qualitatively. From the entire study we have come to agree on the following common conclusions: (i) research and development in Sweden within the three studied 2G biofuel production technologies is extensive, (ii) in general, the processes, within the three cases, work well at pilot and demonstration scale and are now in a phase to be proven in large scale, (iii) there is still room for improvement although some processes have been known for decades, (iv) the biofuel production processes are complex and site specific and process improvements need to be seen and judged from a broad systems perspective (both within the production plant as well as in the entire well-to-tank perspective), and (v) the three studied biofuel production systems are complementary technologies. Futher, the process of conducting this study is worth mentioning as a result itself, i.e. that many different actors within the field have proven their ability and willingness to contribute to a common report, and that the cooperation climate was very positive and bodes well for possible future collaboration within the framework of the f3 center.Finally, judging from the political ambitions it is clear that the demand for renewable fuels will significantly increase during the coming decade. This will most likely result in opportunities for a range of biofuel options. The studied biofuel options all represent 2G biofuels and they can all be part of the solution to meet the increased renewable fuel demand.
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12.
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13.
  • Challis, Pontus, et al. (författare)
  • Validation of the diagnosis of necrotising enterocolitis in a Swedish population-based observational study
  • 2019
  • Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 108:5, s. 835-841
  • Tidskriftsartikel (refereegranskat)abstract
    • Aim: The definition of necrotising enterocolitis (NEC) is based on clinical and radiological signs that can be difficult to interpret. The aim of the present study was to validate the incidence of NEC in the Extremely Preterm Infants in Sweden Study (EXPRESS)Methods: The EXPRESS study consisted of all 707 infants born before 27 + 0 gestational weeks during the years 2004–2007 in Sweden. Of these infants, 38 were recorded as having NEC of Bell stage II or higher. Hospital records were obtained for these infants. Furthermore, to identify missed cases, all infants with a sudden reduction of enteral nutrition, in the EXPRESS study were identified (n = 71). Hospital records for these infants were obtained. Thus, 108 hospital records were obtained and scored independently by two neonatologists for NEC.Results: Of 38 NEC cases in the EXPRESS study, 26 were classified as NEC after validation. Four cases not recorded in the EXPRESS study were found. The incidence of NEC decreased from 6.3% to 4.3%.Conclusion: Validation of the incidence of NEC revealed over- and underestimation of NEC in the EXPRESS study despite carefully collected data. Similar problems may occur in other national data sets or quality registers.
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14.
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15.
  • Ericson Sjöström, Monica, et al. (författare)
  • GP and patient predictions of sick-listing duration: How well do they correspond? A prospective observational study
  • 2014
  • Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 32:2, s. 73-77
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. To explore how well physicians and patients predict sick-listing duration and the correspondence between their respective predictions. To study possible gender differences concerning prediction accuracy. Design. Prospective observational study. Setting. Two medium-sized primary care centres (PCC) in western Sweden. Subjects. GPs at the PCCs and attending patients sick-listed for > 14 days. Main outcome measures. Sick-listing duration; patients' and GPs' predictions of the total duration of the individual patient's sick-listing. Results. A total of 127 patients (93 women, 34 men, mean age 45 years) and 10 GPs participated in the study. Neither the GPs nor the patients were able to predict the interval until return to work with high accuracy. The GPs' and the patients' perceptions concurred in only 26% of cases. There was a significant difference in the correspondence between the GPs' and patients' respective predictions of sick-listing duration compared with the actual duration. GPs' predictions were more accurate for medium-length duration (1.5-6 months), while patients' predictions were more accurate for long-duration (> 6 months) sick-listing. Patients with less education predicted long duration of sick-listing more accurately than those with more education. There was no significant difference between male and female patients' accuracy of prediction, or between GPs' accuracy of prediction of male vs. female patients' sick-listing duration. Conclusions. Prediction of total sick-listing duration was hard for both GP and patient; their respective predictions corresponded in only one-quarter of the cases. No gender differences were observed in the accuracy of prediction.
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18.
  • Gialamas, Spyros, et al. (författare)
  • Amino acid infusions in umbilical artery catheters enhance protein administration in infants born at extremely low gestational age
  • 2022
  • Ingår i: Acta Paediatrica. - : John Wiley & Sons. - 0803-5253 .- 1651-2227. ; 111:3, s. 536-545
  • Tidskriftsartikel (refereegranskat)abstract
    • AIM: It is challenging to provide extremely low gestational age neonates (ELGANs) with adequate protein supply. This study aimed to investigate whether amino acid (AA) infusion in the umbilical artery catheter (UAC) in ELGANs is safe and enhances protein supply and growth.METHOD: A before and after study including infants born <27 weeks, treated in Uppsala, Sweden, during 2004-2007, compared those receiving normal saline/10% dextrose in water with those receiving AA infusion in the UAC. Data were retrieved from the Extremely Preterm Infants in Sweden Study, hospital records and the Swedish Neonatal Quality Register. Group comparisons, univariate and multivariate analyses were conducted.RESULTS: AA group (n = 41, females 39%) received on average approximately 0.3 g/kg/day more protein during the first postnatal week, compared to control group (n = 30, females 40%) (unstandardised coefficient (B) 0.26, p .001) but no difference was noted during 8-28 postnatal days. The type of infusion was not associated with growth variables. The incidence of neonatal morbidities and UAC-related thrombosis did not differ between the groups.CONCLUSION: AA infusions in the UACs in ELGANs is safe and enhances protein supply during the first postnatal week. However, this practice is not associated with growth during the first 28 postnatal days.
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19.
  • Hamayun, Jawwad, et al. (författare)
  • Association between neonatal intakes and hyperglycemia, and left heart and aortic dimensions at 6.5 years of age in children born extremely preterm
  • 2021
  • Ingår i: Journal of Clinical Medicine. - : MDPI. - 2077-0383. ; 10:12
  • Tidskriftsartikel (refereegranskat)abstract
    • Survivors of extremely preterm birth (gestational age < 27 weeks) have been reported to exhibit an altered cardiovascular phenotype in childhood. The mechanisms are unknown. We investigated associations between postnatal nutritional intakes and hyperglycemia, and left heart and aortic dimensions in children born extremely preterm. Postnatal nutritional data and echocardiographic dimensions at 6.5 years of age were extracted from a sub-cohort of the Extremely Preterm Infants in Sweden Study (EXPRESS; children born extremely preterm between 2004–2007, n = 171, mean (SD) birth weight = 784 (165) grams). Associations between macronutrient intakes or number of days with hyperglycemia (blood glucose > 8 mmol/L) in the neonatal period (exposure) and left heart and aortic dimensions at follow-up (outcome) were investigated. Neonatal protein intake was not associated with the outcomes, whereas higher lipid intake was significantly associated with larger aortic root diameter (B = 0.040, p = 0.009). Higher neonatal carbohydrate intake was associated with smaller aorta annulus diameter (B = −0.016, p = 0.008). Longer exposure to neonatal hyperglycemia was associated with increased thickness of the left ventricular posterior wall (B = 0.004, p = 0.008) and interventricular septum (B = 0.004, p = 0.010). The findings in this study indicate that postnatal nutrition and hyperglycemia may play a role in some but not all long-lasting developmental adaptations of the cardiovascular system in children born extremely preterm.
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20.
  • Handl, Verena, et al. (författare)
  • Continuous iontronic chemotherapy reduces brain tumor growth in embryonic avian in vivo models
  • 2024
  • Ingår i: Journal of Controlled Release. - : ELSEVIER. - 0168-3659 .- 1873-4995. ; 369, s. 668-683
  • Tidskriftsartikel (refereegranskat)abstract
    • Local and long-lasting administration of potent chemotherapeutics is a promising therapeutic intervention to increase the efficiency of chemotherapy of hard-to-treat tumors such as the most lethal brain tumors, glioblastomas (GBM). However, despite high toxicity for GBM cells, potent chemotherapeutics such as gemcitabine (Gem) cannot be widely implemented as they do not efficiently cross the blood brain barrier (BBB). As an alternative method for continuous administration of Gem, we here operate freestanding iontronic pumps - "GemIPs" - equipped with a custom-synthesized ion exchange membrane (IEM) to treat a GBM tumor in an avian embryonic in vivo system. We compare GemIP treatment effects with a topical metronomic treatment and observe that a remarkable growth inhibition was only achieved with steady dosing via GemIPs. Daily topical drug administration (at the maximum dosage that was not lethal for the embryonic host organism) did not decrease tumor sizes, while both treatment regimes caused S-phase cell cycle arrest and apoptosis. We hypothesize that the pharmacodynamic effects generate different intratumoral drug concentration profiles for each technique, which causes this difference in outcome. We created a digital model of the experiment, which proposes a fast decay in the local drug concentration for the topical daily treatment, but a long-lasting high local concentration of Gem close to the tumor area with GemIPs. Continuous chemotherapy with iontronic devices opens new possibilities in cancer treatment: the long-lasting and highly local dosing of clinically available, potent chemotherapeutics to greatly enhance treatment efficiency without systemic side-effects. Significance statement: Iontronic pumps (GemIPs) provide continuous and localized administration of the chemotherapeutic gemcitabine (Gem) for treating glioblastoma in vivo. By generating high and constant drug concentrations near the vascularized growing tumor, GemIPs offer an efficient and less harmful alternative to systemic administration. Continuous GemIP dosing resulted in remarkable growth inhibition, superior to daily topical Gem application at higher doses. Our digital modelling shows the advantages of iontronic chemotherapy in overcoming limitations of burst release and transient concentration profiles, and providing precise control over dosing profiles and local distribution. This technology holds promise for future implants, could revolutionize treatment strategies, and offers a new platform for studying the influence of timing and dosing dependencies of already -established drugs in the fight against hard -to -treat tumors.
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21.
  • Idvall, Ewa, et al. (författare)
  • A tentative model for developing strategic and clinical nursing quality indicators : postoperative pain management
  • 1999
  • Ingår i: International journal of nursing practice. - 1322-7114. ; 5:4, s. 216-226
  • Tidskriftsartikel (refereegranskat)abstract
    • The purpose of the study was to evaluate the usefulness of a tentative model, based on important aspects of surgical nursing care, for designing strategic and clinical quality indicators. Objective postoperative pain management was chosen for the model because it is a priority area in surgical nursing care. Items within a questionnaire were designed by using the tentative model as a base and by means of a literature review. The questionnaire, directed to clinical nurses (n = 233), was compiled to establish the validity and the usefulness of the indicators. Fourteen items were assessed as essential for achieving high quality outcomes in postoperative pain management (11 as realistic to carry out, and 13 as possible for nurses to influence) with mean scores > or = 4 (on a 5-point scale). The conclusion reached was that the tentative model combined with a literature search was found to be effective for designing items that might be useful as strategic and clinical indicators of quality in postoperative pain management.
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22.
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23.
  • Idvall, Ewa, et al. (författare)
  • Patient and nurse assessment of quality of care in postoperative pain management
  • 2002
  • Ingår i: Quality & Safety in Health Care. - 1475-3898. ; 11:4, s. 327-334
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: To describe and compare patient and nurse assessments of the quality of care in postoperative pain management, to investigate differences between subgroups of patients, and to compare patient assessments in different departments. Design: Patient and nurse questionnaires. Setting: Five surgical wards in general surgery, orthopaedics, and gynaecology in a central county hospital in Sweden. Sample: Two hundred and nine inpatients and 64 registered nurses. The response rates were 96% for the patients and 99% for the nurses; there were 196 paired patient-nurse assessments. Method: The Strategic and Clinical Quality Indicators in Postoperative Pain Management patient questionnaire was used which comprises14 items in four subscales (communication, action, trust, and environment). The items were scored on a 5 point scale with higher values indicating a higher quality of care. Five complementary questions on levels of pain intensity and overall satisfaction with pain relief were scored on an 11 point scale. Twelve of the 14 items in the patient questionnaire and two of the complementary questions were adjusted for use in the nurse questionnaire. Results: The patients’ mean (SD) score on the total scale (scale range 14–70) was 58.6 (8.9) and the nurses’ mean (SD) score (scale range 12–60) was 48.1 (6.2). The percentage of patients who scored 1 or 2 for an individual item (disagreement) ranged from 0.5% to 52.0%, while for nurses the percentage ranged from 0.0% to 34.8%. Forty two patients (24%) reported more pain than they expected; these patients assessed the quality of care lower. There were differences between patient and nurse assessments concerning the environment subscale, the question on overall satisfaction, and patients’ experience of worst possible pain intensity. Conclusion: The results provided valuable baseline data and identified important areas for quality improvement in postoperative pain management.
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24.
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25.
  • Idvall, Ewa, et al. (författare)
  • Quality indicators in postoperative pain management : a validation study
  • 2001
  • Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 15:4, s. 331-338
  • Tidskriftsartikel (refereegranskat)abstract
    • In a previous study, strategic and clinical quality indicators were developed from a tentative model to assess high quality in postoperative pain management. The aim of the present study was to investigate the content validity of these 15 indicators. The indicators were compiled in a questionnaire, and two groups of nurses (n=210, n=321) scored each indicator on a 5-point scale (strongly disagree to strongly agree) from three different standpoints: whether it was essential for achieving high quality, whether it was realistic to carry out, and whether it was possible for nurses to influence management. The respondents were also asked to choose the most crucial indicators for the quality of care. The results showed that both groups of nurses judged the 15 indicators to have content validity from all three standpoints. Both groups also found the same six indicators to be the most crucial. These indicators concerned detecting and acting on signs and symptoms, performing prescriptions, informing and educating, acting on behalf of patients, competence/knowledge, and attitudes. The validated indicators should be useful to consider when implementing a strategy for postoperative pain management and when planning to evaluate the quality of care.
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26.
  • Klevebro, Susanna, et al. (författare)
  • Early energy and protein intakes and associations with growth, BPD and ROP in extremely preterm infants
  • 2019
  • Ingår i: Clinical Nutrition. - : Elsevier. - 0261-5614 .- 1532-1983. ; 38:3, s. 1289-1295
  • Tidskriftsartikel (refereegranskat)abstract
    • Background & aim: Extremely preterm infants face substantial neonatal morbidity. Nutrition is important to promote optimal growth and organ development in order to reduce late neonatal complications. The aim of this study was to examine the associations of early nutritional intakes on growth and risks of bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP) in a high-risk population.Methods: This population-based cohort study includes infants born before 27 0/7 weeks of gestational age without severe malformations and surviving ≥10 days. Intake of energy and protein on postnatal days 4–6 and association with weight standard deviation score (WSDS) from birth to day 7, as well as intakes of energy and protein on postnatal days 4–6 and 7 to 27, respectively, and association with composite outcome of death and BPD and separate outcomes of BPD and ROP were examined, and adjusted for potential confounders.Results: The cohort comprised 296 infants with a median gestational age of 25 3/7 weeks. Expressed as daily intakes, every additional 10 kcal/kg/d of energy during days 4–6 was associated with 0.08 higher WSDS on day 7 (95% CI 0.06–0.11; p < 0.001). Between days 7 and 27, every 10 kcal/kg/d increase in energy intake was associated with a reduced risk of BPD of 9% (95% CI 1–16; p = 0.029) and any grade of ROP with a reduced risk of 6% (95% CI 2–9; p = 0.005) in multivariable models. This association was statistically significant in infants with ≤10 days of mechanical ventilation. In infants with >10 days of mechanical ventilation, a combined higher intake of energy and protein was associated with a reduced risk of BPD.Conclusion: Early provision of energy and protein may reduce postnatal weight loss and risk of morbidity in extremely preterm infants.
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27.
  • Kovács, Anikó, 1961, et al. (författare)
  • Effect of Radiotherapy After Breast-Conserving Surgery Depending on the Presence of Tumor-Infiltrating Lymphocytes : A Long-Term Follow-Up of the SweBCG91RT Randomized Trial
  • 2019
  • Ingår i: Journal of Clinical Oncology. - 0732-183X. ; 37:14, s. 1179-87
  • Tidskriftsartikel (refereegranskat)abstract
    • PURPOSE: The effects of radiotherapy (RT) on the basis of the presence of stromal tumor infiltrating lymphocytes (TILs) have not been studied. The purpose of this study was to analyze the association of TILs with the effect of postoperative RT on ipsilateral breast tumor recurrence (IBTR) in a large randomized trial. METHODS: In the SweBCT91RT (Swedish Breast Cancer Group 91 Radiotherapy) trial, 1,178 patients with breast cancer stage I and II were randomly assigned to breast-conserving surgery plus postoperative RT or breast-conserving surgery only and followed for a median of 15.2 years. Tumor blocks were retrieved from 1,003 patients. Stromal TILs were assessed on whole-section hematoxylin-eosin-stained slides using a dichotomized cutoff of 10%. Subtypes were scored using immunohistochemistry on tissue microarray. In total, 936 patients were evaluated. RESULTS: Altogether, 670 (71%) of patients had TILs less than 10%. In a multivariable regression analysis with IBTR as dependent variable and RT, TILs, subtype, age, and grade as independent variables, RT (hazard ratio [HR], 0.42; 95% CI, 0.29 to 0.61; P < .001), high TILs (HR, 0.61; 95% CI, 0.39 to 0.96, P = .033) grade (3 v 1; HR, 2.17; 95% CI, 1.08 to 4.34; P = .029), and age (≥ 50 v < 50 years; HR, 0.55; 95% CI, 0.38 to 0.80; P = .002) were predictive of IBTR. RT was significantly beneficial in the low TILs group (HR, 0.37; 95% CI, 0.24 to 0.58; P < .001) but not in the high TILs group (HR, 0.58; 95% CI, 0.28 to 1.19; P = .138). The test for interaction between RT and TILs was not statistically significant (P = .317). CONCLUSION: This study shows that high values of TILs in the primary tumor independently seem to reduce the risk for an IBTR. Our findings further suggest that patients with breast cancer with low TILs may derive a larger benefit from RT regarding the risk of IBTR.
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28.
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29.
  • Larsson, Linn, et al. (författare)
  • Blood transfusions are not a risk factor for necrotizing enterocolitis in extremely preterm infants
  • 2014
  • Ingår i: Archives of Disease in Childhood. - : BMJ Publishing Group Ltd. - 0003-9888 .- 1468-2044. ; 99:Suppl 2, s. A177-A177
  • Tidskriftsartikel (refereegranskat)abstract
    • Background:  Transfusion practices are highly variable between hospitals and previous studies have suggested that blood transfusions may increase the risk of necrotizing enterocolitis (NEC).Aim: To explore the association between blood transfusions and incidence of NEC in extremely preterm infants.Methods: We used data from a Swedish population-based study including extremely preterm infants (<27 weeks) born between 2004–2007, (n = 602). All data on blood transfusions and haemoglobin (Hb) concentrations up to 28 days of age was collected for survivors. We performed a nested case-control study where two controls were chosen for each case of NEC (n = 21).Results: During the first 28 days of life, infants received a median (25th-75th percentile) of 6 (3–9) blood transfusions resulting in 75 (44–120) ml/kg of blood. Predictors for receiving a higher volume of blood transfusions were days on respiratory support (R = 0.345, p < 0.001), hospital (R = 0.339, p < 0.001), low birth weight (R = -0.236, p < 0.001) and total steroid dose (R = 0.209, p < 0.001). Hb was not a significant predictor.Overall NEC incidence was 5.8%. There was no significant difference between NEC cases and controls in number of blood transfusions (p = 0.420), volume of blood transfused from birth to NEC diagnosis (p = 0.274), or during the 48 h preceding NEC diagnosis (p = 0.459).Conclusions: Blood transfusions were given liberally in Sweden compared to other studied populations. Morbidity related variables, especially those related to respiratory illness, were significant predictors of blood transfusion. NEC incidence was comparable with other populations but no significant association was found between blood transfusions and NEC among these extremely preterm infants.
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30.
  • Lund, Anna My, et al. (författare)
  • Mother's Own Milk and Its Relationship to Growth and Morbidity in a Population-based Cohort of Extremely Preterm Infants
  • 2022
  • Ingår i: Journal of Pediatric Gastroenterology and Nutrition. - : Wolters Kluwer. - 0277-2116 .- 1536-4801. ; 74:2, s. 292-300
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives:The aim of the study was to evaluate the relationships between intake of mother's own milk (MOM), compared with intake of pasteurized donor milk (DM), and postnatal growth, incidence of retinopathy of prematurity (ROP) and bronchopulmonary dysplasia (BPD), in extremely preterm infants.Methods:Swedish population-based cohort of surviving extremely preterm infants born 2004 to 2007. Exposure to MOM and DM was investigated from birth until 32 weeks postmenstrual age (PMA) in 453 infants. Primary outcome variables were change in z-score (Δ) from birth to 32 weeks PMA for weight, length, and head circumference (HC). Secondary outcomes were incidence of ROP and BPD. Mixed models adjusting for confounders were used to investigate the association between exposures and outcomes.Results:Infants' mean gestational age (GA) was 25.4 weeks. Unadjusted, MOM (per 10 mL · kg-1 · day-1) was associated with Δweight and ΔHC with beta estimates of 0.03 z-score units (95% CI, 0.02-0.04, P < 0.001) and 0.03 z-score units (95% CI, 0.01-0.05, P = 0.003), respectively. After adjustment for predefined confounders, the association remained significant for Δweight and ΔHC. A similar pattern was found between Δweight and each 10% increase of MOM. Unadjusted, a higher intake of MOM (mL · kg-1 · day-1) was significantly associated to a lower probability of any ROP and severe ROP; however, these associations did not remain in the adjusted analyses. No associations were found between MOM (mL · kg-1 · day-1) and BPD. Moreover, no associations were found between DM and growth or morbidity outcomes.Conclusions:An increased intake of MOM, as opposed to DM (and not formula feeding), was associated with improved postnatal weight gain and HC growth from birth until 32 weeks PMA in extremely preterm infants. Interventions aiming at increasing early intake of unpasteurized MOM for extremely preterm infants should be encouraged.
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31.
  • Lundgren, Pia, 1967, et al. (författare)
  • The Specificity of the WINROP Algorithm Can Be Significantly Increased by Reassessment of the WINROP Alarm
  • 2015
  • Ingår i: Neonatology. - : S. Karger AG. - 1661-7800 .- 1661-7819. ; 108:2, s. 152-156
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Retinopathy of prematurity (ROP) is a sight-threatening disease affecting extremely preterm infants. The introduction of new ROP screening surveillance systems, with higher sensitivity and specificity than established ROP screening guidelines, has the potential to reduce the number of stressful eye examinations in these infants. Objectives: To improve the specificity of the WINROP (Weight, Insulin-like growth factor-I, Neonatal, ROP) surveillance system, identifying extremely preterm infants requiring treatment for ROP. Methods: Two cohorts that had previously been subjected to WINROP analyses were included and reevaluated in this study. The weight at WINROP alarm for extremely preterm infants, born at gestational age <27 weeks, was reevaluated and by establishing 'safe' WINROP alarm weight limits, an intersample reassessment of WINROP alarm was performed. The two cohorts were as follows: (1) the Extremely Preterm Infants in Sweden Study (EXPRESS) cohort, infants born in Sweden during 2004-2007 (n = 407), and (2) extremely preterm infants in a North American co-hort, born during 2006-2009 (n = 566). Results: In the EXPRESS cohort, 12.5% (40/319) of the infants who previously received a WINROP alarm were now reassessed as having no alarm; the specificity of WINROP in EXPRESS increased from 23.9% (86/360) to 35.0% (126/360). In the North American cohort, 15.4% (81/526) were reassessed as having no alarm; the specificity increased from 8.5% (38/447) to 26.6% (119/447). The sensitivity persisted as 97.5% in EXPRESS (45/47) and 98.3% (117/119) in the North American cohort. Conclusions: The specificity of the WINROP surveillance system for extremely preterm infants can be significantly improved by reassessment using the weight at WINROP alarm. (c) 2015 S. Karger AG, Basel
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32.
  • Lundgren, Pia, 1967-, et al. (författare)
  • WINROP identifies severe retinopathy of prematurity at an early stage in a nation-based cohort of extremely preterm infants
  • 2013
  • Ingår i: PLOS ONE. - San Francisco : Public Library of Science, PLoS. - 1932-6203. ; 8:9
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: To evaluate the ability of a postnatal weight-gain algorithm (WINROP) to identify sight-threatening retinopathy of prematurity (ROP type 1) in a nation-based extremely preterm infant cohort.METHODS: This study enrolled all 707 live-born extremely preterm (gestational age [GA] <27 weeks) infants, born 2004-2007 in Sweden; the Extremely preterm Infants in Sweden Study (EXPRESS). WINROP analysis was performed retrospectively in 407 of the infants using weekly weight gain to assess the preterm infant's risk of developing ROP type 1 requiring treatment. GA, birthweight (BW), and weekly postnatal weight measurements were entered into WINROP. WINROP signals with an alarm to indicate if the preterm infant is at risk for ROP type 1.RESULTS: In this extremely preterm population, WINROP correctly identified 96% (45/47) of the infants who required treatment for ROP type 1. The median time from alarm to treatment was 9 weeks (range, 4-20 weeks).CONCLUSIONS: WINROP, an online surveillance system using weekly weight gain, identified extremely preterm infants at risk for ROP type 1 requiring treatment at an early stage and with high sensitivity in a Swedish nation-based cohort.
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33.
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34.
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35.
  • Lundkvist, Ellen, et al. (författare)
  • Fruit pouch consumption and dietary patterns related to BMIz at 18 months of age
  • 2021
  • Ingår i: Nutrients. - : MDPI. - 2072-6643. ; 13:7
  • Tidskriftsartikel (refereegranskat)abstract
    • Concerns have been raised that an overconsumption of baby food fruit pouches among toddlers might increase the risk of childhood obesity. This study aimed to quantify the consumption of fruit pouches and other fruit containing food products and to explore potential correlations between the consumption of these products and body-mass index z-score (BMIz) at 18 months, taking other predictive factors into consideration. The study was based on 1499 children and one-month-recall food frequency questionnaires from the Swedish population-based birth cohort NorthPop. Anthropometric outcome data were retrieved from child health care records. BMIz at 18 months of age was correlated to maternal BMI and gestational weight gain and inversely correlated to fruit juice consumption and breastfeeding. BMIz at 18 months of age was not correlated to consumption of fruit pouches, sugar-sweetened beverages, whole fruit or milk cereal drink. Overweight at 18 months of age was correlated to maternal BMI and inversely correlated to breastfeeding duration. To our knowledge, this is the first study that investigates possible associations between baby food fruit pouch consumption and overweight in toddlers. We found that moderate fruit pouch consumption is not associated with excess weight at 18 months of age.
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36.
  • Mangrio, Elisabeth, 1978-, et al. (författare)
  • Risk for mental illness and family composition after migration to Sweden
  • 2021
  • Ingår i: PLOS ONE. - : PLOS. - 1932-6203. ; 16:5
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: The aim of the present study is to determine how marital status and certain post-migration family structures are associated with the risk of mental illness among recently arrived Arabic- speaking refugees in Sweden. Methods: A cross-sectional study was conducted during 2015 and 2016. The study population was recruited by inviting all adult refugees who participated in the mandatory public integration support programme. All refugees that participated had received refugee status. A total of 681 of the invited participants returned the GHQ-12 questionnaires, through which the risk for mental illness was measured and only Arabic- speaking refugees (N=638) were included in the analyses. Results: Marital status per se was not associated with a risk for mental illness. However, for the whole study sample there was a statistical significant odds ratio of 1.72 (95% CI 1.03–2.86). For male Arabic-speaking refugees with a spouse or child left behind in the home country there was a borderline significant increased risk for mental illness, odds ratio = 1. 87 (95% CI 0.99–3.56). The risk for female Arabic-speaking refugees was non-significant, odds ratio = 1.35 (95% CI 0.55–3.33). Conclusions: Arabic- speaking refugees who were separated from family members reported an increased risk for mental illness after arriving in the host country. Actions to facilitate family reunion after arriving as a refugee (in Sweden) seems to be an important factor to promote mental health among refugees. 
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37.
  • Rodebjer Cairns, Sophie, et al. (författare)
  • Dietitians’ perspectives on challenges and prospects for group-based education to adults with type 1 diabetes : a qualitative study
  • 2022
  • Ingår i: BMC Endocrine Disorders. - : BioMed Central (BMC). - 1472-6823. ; 22:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Type 1 diabetes (T1DM) is an autoimmune disorder which can have short- and long-term adverse effects on health. Dietitians in diabetes offer specialist evidence-based advice to people with T1DM and provide education in either individual or group settings. The purpose of this study was to explore dietitians’ perception of, and role in, group-based education as well as prospects for development. Methods: This was a qualitative descriptive study conducted in Sweden using a convenience sampling of dietitians working in adult diabetes care. Semi-structured interviews were conducted with participants and data were analysed using a content analysis approach.  Results: Ten dietitians with a median experience of 14.5 years in diabetes care were interviewed. The informants were all appreciative of facilitating group-based education and perceived that it was beneficial for people with T1DM to be part of group processes, but the informants did also suggest that there were challenges for their professional role. The main challenges reported was to adjust the level of depth and complexity to the information provided and the lack of ability to individualize the education-sessions in a heterogenous group. None of the dietitians reported performing pre-assessment or follow-up audits on the group-based education. Conclusions: There was a great engagement from the dietitians, but they identified a lack of framework that address challenges regarding group-based education. The dietitians experienced examples of person-centred care while facilitating group-based education, which may benefit people with T1DM. Based on the results, it would be valuable to explore the pedagogic training level of Swedish dietitians and potential barriers in their ability to facilitate group-based education. We suggest that a framework for group-based education should be explored together with patient representatives to optimize the care given to ensure cost-effectiveness, optimize clinical outcomes, quality of life and equally accessible care for people with T1DM. 
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38.
  • Sjöholm, Kajsa, 1971, et al. (författare)
  • Weight Change-Adjusted Effects of Gastric Bypass Surgery on Glucose Metabolism: Two- and 10-Year Results From the Swedish Obese Subjects (SOS) Study.
  • 2016
  • Ingår i: Diabetes care. - : American Diabetes Association. - 1935-5548 .- 0149-5992. ; 39:4, s. 625-631
  • Tidskriftsartikel (refereegranskat)abstract
    • It has been suggested that weight change-independent effects on fasting insulin and glucose levels are present after gastric bypass (GBP) but not after banding and vertical banded gastroplasty (VBG). We therefore evaluated weight change-adjusted effects of GBP, compared with restrictive surgical procedures, on long-term changes in fasting levels of glucose, insulin, and homeostatic model assessment of insulin resistance (HOMA-IR) in the Swedish Obese Subjects (SOS) study.
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39.
  • Sjöström, Maria, et al. (författare)
  • A bidialectal experiment on voice Identification
  • 2008
  • Ingår i: Working Papers,: Department of Linguistics and Phonetics, Lund University, Sweden. - Lund. ; 53, s. 145-158
  • Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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40.
  • Sjöström, Maria, et al. (författare)
  • A Switch of Dialect as Disguise
  • 2006
  • Ingår i: Working Papers. ; 52, s. 113-116
  • Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
    • Criminals may purposely try to hide their identity by using a voice disguise such as imitating another dialect. This paper empirically investigates the power of dialect as an attribute that listeners use when identifying voices and how a switch of dialect affects voice identification. In order to delimit the magnitude of the perceptual significance of dialect and the possible impact of dialect imitation, a native bidialectal speaker was the target speaker in a set of four voice line-up experiments, two of which involved a dialect switch. Regardless of which dialect the bidialectal speaker spoke he was readily recognized. When the familiarization and target voices were of different dialects, it was found that the bidialectal speaker was significantly less well recognized. Dialect is thus a key feature for speaker identification that overrides many other features of the voice. Whether imitated dialect can be used for voice disguise to the same degree as native dialect switching demands further research.
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41.
  • Sjöström, Maria, et al. (författare)
  • A Switch of Dialect as Disguise
  • 2006
  • Ingår i: Proceedings from FONETIK 2006. ; , s. 113-116
  • Konferensbidrag (övrigt vetenskapligt/konstnärligt)
  •  
42.
  • Sjöström, Martin, et al. (författare)
  • Response to Radiotherapy After Breast-Conserving Surgery in Different Breast Cancer Subtypes in the Swedish Breast Cancer Group 91 Radiotherapy Randomized Clinical Trial.
  • 2017
  • Ingår i: Journal of clinical oncology : official journal of the American Society of Clinical Oncology. - 1527-7755. ; 35:28, s. 3222-3229
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose To evaluate the effect of adjuvant radiotherapy (RT) after breast conservation surgery in different breast cancer subtypes in a large, randomized clinical trial with long-term follow-up. Patients and Methods Tumor tissue was collected from 1,003 patients with node-negative, stage I and II breast cancer who were randomly assigned in the Swedish Breast Cancer Group 91 Radiotherapy trial between 1991 and 1997 to breast conservation surgery with or without RT. Systemic adjuvant treatment was sparsely used (8%). Subtyping was performed with immunohistochemistry and in situ hybridization on tissue microarrays for 958 tumors. Results RT reduced the cumulative incidence of ipsilateral breast tumor recurrence (IBTR) as a first event within 10 years for luminal A-like tumors (19% v 9%; P = .001), luminal B-like tumors (24% v 8%; P < .001), and triple-negative tumors (21% v 6%; P = .08), but not for human epidermal growth factor receptor 2-positive (luminal and nonluminal) tumors (15% v 19%; P = .6); however, evidence of an overall difference in RT effect between subtypes was weak ( P = .21). RT reduced the rate of death from breast cancer (BCD) for triple-negative tumors (hazard ratio, 0.35; P = .06), but not for other subtypes. Death from any cause was not improved by RT in any subtype. A hypothesized clinical low-risk group did not have a low risk of IBTR without RT, and RT reduced the rate of IBTR as a first event after 10 years (20% v 6%; P = .008), but had no effect on BCD or death from any cause. Conclusion Subtype was not predictive of response to RT, although, in our study, human epidermal growth factor receptor 2-positive tumors seemed to be most radioresistant, whereas triple-negative tumors had the largest effect on BCD. The effect of RT in the presumed low-risk luminal A-like tumors was excellent.
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43.
  • Späth, Cornelia, et al. (författare)
  • Associations between sodium supply, sodium imbalances and severe intraventricular haemorrhage in extremely preterm infants: A nested case-control study
  • Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
    • Background: Severe intraventricular haemorrhage (IVH) is a serious neonatal morbidity among extremely preterm infants that has been associated with adverse neurodevelopmental consequences. We aimed to explore the associations between sodium supply, sodium imbalances and severe IVH.Methods: We used data from the EXtremely PREterm Infants in Sweden Study (EXPRESS) including all extremely preterm infants (< 27 weeks) born during 2004 and 2007 in Sweden (n = 707) and conducted a nested case-control study. For every infant with severe IVH (grades 3 to 4, n = 70) one control infant with a normal cranial ultrasound, a birthday closest to the case infant, and matched for hospital, sex, gestational age, and birth weight was selected.Results: Sodium supply was higher in infants with severe IVH compared with controls [Daily sodium supply until postnatal day 2: Mean ± SD (mmol/kg/d): 5.49 ± 2.53 vs. 3.95 ± 1.91, P = 0.009]. This association did not remain significant when we excluded the amount of sodium delivered from transfused blood products from total sodium supply. High concentrations of or large fluctuations in plasma sodium were not related to severe IVH.Conclusion: Although our results suggest a relationship between sodium supply and severe IVH via blood product transfusions, it is unclear whether this represents an effect of solute or volume load.
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44.
  • Späth, Cornelia, et al. (författare)
  • Effects Of Early Sodium And Fluid Intakes On Sodium Levels And Weight Change In Extremely Preterm Infants
  • 2014
  • Ingår i: Archives of Disease in Childhood. - : BMJ. - 0003-9888 .- 1468-2044. ; 99:Suppl 2, s. A38-A38
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Hypernatremia is common in extremely preterm infants but it is unclear to what extent it is affected by sodium (Na) and fluid intakes. It is assumed that infants normally lose 5–10% of birth weight during the first postnatal days.Aim: To explore associations between early intakes of Na and fluids and biochemical levels of Na as well as weight change during early postnatal life.Method: We investigated a population-based cohort of Swedish extremely preterm infants (<27 gestational weeks). Detailed data of Na intakes, biochemical levels of Na and anthropometric measurements were retrospectively obtained from hospital records. Data are expressed as mean±SD.Results: Preliminary analyses of 547 infants (gestational age 25.3 ± 1.1, birth weight 762 ± 170g) showed that highest Na levels occurred at day 3 of life (144.3 ± 6.2mmol/L) and were associated with Na intake during the first 2 days of life (R=+0.25), gestational age (R=-0.23) and birth weight (R=-0.18) (p < 0.001 for all).Of included infants 32% lost more than 10% of birth weight during the first 3 days. There was a strong correlation between fluid intake within the first two days of life and weight change between birth and day 3 (R=+0.56, p < 0.001). Among those (27%) who lost between 5–10% in weight, fluid intakes were on average 103 mL/kg/d.Conclusion: Early Na levels were significantly correlated with early Na intake, low gestational age as well as low birth weight. In order to avoid hypernatremia and excessive weight loss, fluid and Na intakes during the first 2 days need to be strictly regulated.
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45.
  • Späth, Cornelia, et al. (författare)
  • Effects of two different parenteral nutrition regimen on plasma electrolyte concentrations in very low birth weight infants
  • Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
    • Introduction: Recent studies demonstrated an increased prevalence of electrolyte imbalances in preterm infants who received enhanced amounts of energy and protein within the first days after birth. The aim of this study was to investigate the effect of two parenteral nutritional (PN) regimen, which differ in energy and protein content, on intakes and plasma concentrations of electrolytes in very low birth weight (VLBW, < 1500 g) infants.Methods: We collected daily nutritional, growth, and nutritional biomarker data retrospectively from clinical charts for VLBW infants born before (n = 81) and after (n = 53) the implementation of a concentrated PN regimen at the neonatal intensive care unit at Umeå University Hospital (Umeå, Sweden).Results: During the first postnatal week, intakes of energy, protein, sodium, potassium, calcium, and phosphorous were significantly higher in infants who received the concentrated PN regimen compared with infants who received the original PN regimen. The prevalence of hypernatremia, hypophosphatemia, and hypercalcemia did not differ significantly between the groups. However, infants who received concentrated PN were less likely to develop hypokalaemia during the first postnatal week compared with infants who received original PN (30 vs. 76%, P < 0.001).Conclusion: A concentrated, energy- and protein-optimized, PN regimen requires careful adjustments of electrolytes in VLBW infants. During the first three postnatal days, a minimum potassium intake of 1 mmol/kg/d might be necessary to prevent early hypokalaemia. The risk of early hypernatremia was not affected by different sodium intakes.
  •  
46.
  • Späth, Cornelia, et al. (författare)
  • Higher Parenteral Electrolyte Intakes in Preterm Infants During First Week of Life : Effects on Electrolyte Imbalances
  • 2022
  • Ingår i: Journal of Pediatric Gastroenterology and Nutrition - JPGN. - : Lippincott Williams & Wilkins. - 0277-2116 .- 1536-4801. ; 75:3, s. E53-E59
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: This study aimed to investigate the effects of a higher intake of electrolytes from parenteral nutrition (PN) on plasma electrolyte concentrations in very low birth weight (VLBW, <1500 g) infants.Methods: This was a single-center cohort study including all VLBW infants born before (n = 81) and after (n = 53) the implementation of a concentrated PN regimen. Daily nutritional intakes and plasma concentrations of sodium, chloride, potassium, phosphate, and calcium were collected from clinical charts.Results: During the first postnatal week, electrolyte intakes were higher in infants who received concentrated PN compared with infants who received original PN. Infants who received concentrated PN had a lower incidence of hypokalemia (<3.5 mmol/L; 30% vs 76%, P < 0.001) and severe hypophosphatemia (<1.0 mmol/L; 2.2% vs 17%, P = 0.02). While the relatively high prevalence of severe hypophosphatemia in infants who received original PN can be explained by a phosphorus intake below the recommendation, the potassium intake during the first 3 postnatal days (mean ± SD: 0.7 ± 0.2 mmol/kg/d) was within the recommendation. The prevalence of early hypernatremia was not affected by the different sodium intake in the 2 groups.Conclusions: In VLBW infants, a sodium-containing PN solution (about 2.7 mmol/100 mL) does not cause hypernatremia during the first days of life. Furthermore, providing at least 1 mmol potassium/kg/d during the first 3 postnatal days might be necessary to prevent early hypokalemia.
  •  
47.
  • Späth, Cornelia, et al. (författare)
  • Sodium supply from administered blood products was associated with severe intraventricular haemorrhage in extremely preterm infants
  • 2022
  • Ingår i: Acta Paediatrica. - : John Wiley & Sons. - 0803-5253 .- 1651-2227. ; 111:9, s. 1701-1708
  • Tidskriftsartikel (refereegranskat)abstract
    • Aim: The aim of this study was to investigate the associations between sodium supply, fluid volume, sodium imbalances and severe intraventricular haemorrhage (IVH) in extremely preterm (EPT) infants.Methods: We used data from the EXtremely PREterm infants in Sweden Study (EXPRESS) cohort consisting of all infants born at 22 to 26 gestational weeks from 2004 to 2007 and conducted a nested case–control study. For every infant with severe IVH (grade 3 or peri-ventricular haemorrhagic infarction), one IVH-free control infant with the birthday closest to the case infant and matched for hospital, sex, gestational age and birth weight was selected (n = 70 case–control pairs).Results: Total sodium supply and fluid volume were higher in infants with severe IVH compared with controls [daily total sodium supply until postnatal Day 2: mean ± SD (mmol/kg/day): 5.49 ± 2.53 vs. 3.95 ± 1.91, p = 0.009]. These differences were accounted for by sodium and fluid from transfused blood products. High plasma sodium concentrations or large sodium fluctuations were not associated with severe IVH.Conclusion: Our results suggest a relationship between sodium-rich transfusions of blood products and severe IVH in EPT infants. It is unclear whether this is an effect of sodium load, volume load or some other transfusion-related factor.
  •  
48.
  • Späth, Cornelia, et al. (författare)
  • Sodium supply influences plasma sodium concentration and the risks of hyper- and hyponatremia in extremely preterm infants
  • 2017
  • Ingår i: Pediatric Research. - : Nature Publishing Group. - 0031-3998 .- 1530-0447. ; 81, s. 455-460
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Hyper- and hyponatremia occur frequently in extremely preterm infants. Our purpose was to investigate plasma sodium (P-Na) concentrations, the incidence of hyper and hyponatremia, and the impact of possible predisposing factors in extremely preterm infants.Methods: In this observational study, we analyzed data from the EXtremely PREterm (< 27 wk.) infants in Sweden Study (EXPRESS, n = 707). Detailed nutritional, laboratory, and weight data were collected retrospectively from patient records.Results: Mean ± SD P-Na increased from 135.5 ± 3.0 at birth to 144.3 ± 6.1 mmol/l at a postnatal age of 3 d and decreased thereafter. Fifty percent of infants had hypernatremia (P-Na >145 mmol/l) during the first week of life while 79% displayed hyponatremia (P-Na < 135 mmol/l) during week 2. Initially, the main sodium sources were blood products and saline injections/infusions, gradually shifting to parenteral and enteral nutrition towards the end of the first week. The major determinant of P-Na and the risks of hyper- and hyponatremia was sodium supply. Fluid volume provision was associated with postnatal weight change but not with P-Na.Conclusion: The supply of sodium, rather than fluid volume, is the major factor determining P-Na concentrations and the risks of hyper- and hyponatremia.
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49.
  • Späth, Cornelia, 1980- (författare)
  • The impact of nutrition on growth, biomarkers, and health outcomes in preterm infants
  • 2019
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Introduction: Nutrients play a crucial role for growth and brain development after preterm birth. Meeting the nutritional needs of preterm infants is challenging. Particularly, the most immature infants have a high risk of malnutrition and poor growth during hospital care. To meet recommended energy and nutrient intakes during early postnatal life, a concentrated parenteral nutrition (PN) regimen was implemented in clinical use in 2012 at the neonatal intensive care unit at Umeå University Hospital (Umeå, Sweden). However, electrolyte homeostasis is labile after preterm birth and infants require an electrolyte supply that corresponds to their energy and protein intakes to avoid electrolyte disturbances. Although sodium imbalances such as hyper- and hyponatremia are common in the most immature preterm infants, there is limited knowledge to what extent these imbalances are affected by fluid volume and sodium supply. Furthermore, it is unclear whether the early high sodium concentrations lead to any adverse effects, including intraventricular hemorrhage, or simply reflect immediate adaptive processes after preterm birth.Aim: This thesis investigates the impact of nutrition on growth, nutritional biomarkers, and health outcomes in preterm infants born with a birth weight below 1500 g.Methods: We used data from two study populations. First, we collected data for all very low birth weight infants (< 1500 g) born between 2010 and 2013 and treated at Umeå University Hospital (Umeå, Sweden; n = 134). Second, we used data from the EXtremly PREterm infants in Sweden Study (EXPRESS). We included all infants born before 27 gestational weeks in Sweden between 2004 and 2007 who survived the first 24 h (n = 602). Data collection for both study populations included a) intakes of all parenteral and enteral nutritional products and other fluids during the first 28 postnatal days, b) all anthropometric measurements during hospital stay, c) perinatal data, and d) neonatal morbidity.Results: The concentrated PN regimen improved early energy and macronutrient intakes in very low birth weight infants. Furthermore, weight and length growth from postnatal week two to a postmenstrual age of 36 weeks improved in very low birth weight infants who received the concentrated PN regimen compared with infants who received the previous original PN regimen (Paper I). Increased parenteral energy and protein intakes provided by the concentrated PN regimen, did not induce a higher occurrence of electrolyte imbalances as electrolytes were supplied according to the current recommendations (Paper II). In the EXPRESS cohort, the majority of extremely preterm infants had hypernatremia during the first and hyponatremia during the second postnatal week. Gestational age and supply of sodium, rather than fluid volume, were the major factors determining the risks of hyper- and hyponatremia (Paper III). High total supply of sodium was significantly correlated with severe intraventricular hemorrhage if mostly mediated by blood product transfusions (Paper IV).Conclusions: Our results suggest that in very immature preterm infants a concentrated PN regimen improves early nutrient intakes and postnatal growth without causing electrolyte disturbances. Hyper- and hyponatremia are common and the supply of sodium is a major predictor. The impact of sodium on severe intraventricular hemorrhage needs further investigation.
  •  
50.
  • Späth, Cornelia, et al. (författare)
  • Use of concentrated parenteral nutrition solutions is associated with improved nutrient intakes and postnatal growth in very low-birth-weight infants
  • 2020
  • Ingår i: JPEN - Journal of Parenteral and Enteral Nutrition. - : John Wiley & Sons. - 0148-6071 .- 1941-2444. ; 44:2, s. 327-336
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Evidence showing the beneficial effects of enhanced parenteral nutrition (PN) to very low-birth-weight (VLBW,<1500 g) infants is accumulating. However, PN composition and its impact on growth outcomes are questioned. This study aimed to investigate the associations between administration of a concentrated PN regime and intakes of energy and macronutrients as well as postnatal growth in VLBW infants. Methods: We compared 2 cohorts of VLBW infants born before (n = 74) and after (n =44) a concentrated PN regime was introduced into clinical use. Daily nutrition and fluid intake during the first 28 postnatal days and all available growth measurements during hospitalization were retrospectively collected from clinical charts. Results: Infants who received concentrated PN compared with original PN had higher parenteral intakes of energy (56 vs 45 kcal/kg/d, P < 0.001), protein (2.6 vs 2.2 g/kg/d, P = 0.008), and fat (1.5 vs 0.7 g/kg/d, P < 0.001) during the first postnatal week. Changes in standard deviation scores for weight and length from birth to postnatal day 28 were more positive in the concentrated PN group (mean [95% CI]; weight change: –0.77 [–1.02 to –0.52] vs –1.29 [–1.33 to –1.05], P = 0.005; length change: –1.01 [–1.36 to –0.65] vs –1.60 [–1.95 to –1.25], P = 0.025). There were no significant differences in fluid intake and infant morbidity between the groups. Conclusion: Our results suggest that concentrated PN is useful and seems to be safe for improving early nutrition and growth in VLBW infants.
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