| 1. |
- Back, Julia, et al.
(author)
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Evidence of support used for drug treatments in pediatric cardiology
- 2021
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In: Health Science Reports. - : WILEY. - 2398-8835. ; 4:2
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Journal article (peer-reviewed)abstract
- Background and aims: Clinical support systems are widely used in pediatric care. The aim of this study was to assess the support for drug treatments used at pediatric cardiac wards and intensive care units in Sweden.Methods: Drug information, such as type of drug, indication, dose, and route of administration, for all in-hospital pediatric cardiac patients, was included in the study. Treatments were classified as either on-label (based on product information) or off-label. Support for off-label treatment was stratified by the use of clinical support systems (the national database on drugs, local, or other clinical experience guidelines).Results: In all, 28 patients were included in the study. The total number of drug treatments was 233, encompassing 65 different drugs. Overall, 175 (75%) treatments were off-label. A majority of off-label drug treatments were supported by other sources of information shared by experts. A total of 7% of the drug treatments were used without support.Conclusion: Off-label drug treatment is still common in Swedish pediatric cardiac care. However, the majority of treatments were supported by the experience shared in clinical support systems.Key Points:Seventy-five percent of all prescriptions in pediatric cardiology care were off-label.A majority of patients received three or more drug treatments off-label.Use of clinical support systems and guidelines was common, but in 7% of all drug treatments, no support was found for the chosen treatment.
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| 2. |
- Berger, Vilma, et al.
(author)
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Adolescents on psychotropic treatment displayed longer corrected QT intervals than unmedicated controls when they rose rapidly from the supine position
- 2024
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In: Acta Paediatrica. - : John Wiley & Sons. - 0803-5253 .- 1651-2227. ; 113:7, s. 1621-1629
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Journal article (peer-reviewed)abstract
- Aim: Psychotropic medication can contribute to arrhythmia and identifying individuals at risk is crucial. This Swedish study compared the corrected QT (QTc) intervals of adolescents on psychotropic medication with unmedicated controls, when supine and after rising rapidly.Methods: The study was carried out at Östersund County Hospital in March 2022 and February to March 2023. It comprised 16 cases, aged 10–17 years and 28 controls. QTc intervals were measured with electrocardiography and calculated using Bazett's and Fridericia's formulas. Univariate and multiple linear regressions were used to assess differences in QTc intervals between the cases and controls and across sex, age and body mass index.Results: The mean QTc interval when supine, calculated with Bazett's formula, was longer for the adolescents on psychotropic medication than the controls (p = 0.046). The same was true for the mean QTc interval after rising rapidly from the supine position, calculated with both Bazett's formula (p = 0.009) and Fridericia's formula (p = 0.007). Mean QTc intervals varied by sex and age groups. Psychotropic medication prolonged QTc intervals, particularly in girls.Conclusion: Longer QTc intervals were found in adolescents on psychotropic medication, particularly after rising rapidly from the supine position.
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| 3. |
- Irewall, Tommie, et al.
(author)
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A longitudinal follow-up of continuous laryngoscopy during exercise test scores in athletes irrespective of laryngeal obstruction, respiratory symptoms, and intervention
- 2023
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In: BMC Sports Science, Medicine and Rehabilitation. - : BioMed Central (BMC). - 2052-1847. ; 15:1
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Journal article (peer-reviewed)abstract
- Background: Exercise-induced laryngeal obstruction (EILO) is diagnosed by the continuous laryngoscopy during exercise (CLE) test. Whether or how much CLE test scores vary over time is unknown. This study aimed to compare CLE test scores in athletes over time, irrespective of respiratory symptoms and grade of laryngeal obstruction. Methods: Ninety-eight athletes previously screened for EILO were invited for a follow-up CLE test irrespective of CLE scores and respiratory symptoms. Twenty-nine athletes aged 16–27 did a follow-up CLE test 3–23 months after the baseline test. Laryngeal obstruction at the glottic and supraglottic levels was graded by the observer during exercise, at baseline and follow-up, using a visual grade score (0–3 points). Results: At baseline, 11 (38%) of the 29 athletes had moderate laryngeal obstruction and received advice on breathing technique; among them, 8 (73%) reported exercise-induced dyspnea during the last 12 months. At follow-up, 8 (73%) of the athletes receiving advice on breathing technique had an unchanged supraglottic score. Three (17%) of the 18 athletes with no or mild laryngeal obstruction at baseline had moderate supraglottic obstruction at follow-up, and none of the 3 reported exercise-induced dyspnea. Conclusions: In athletes with repeated testing, CLE scores remain mostly stable over 3–24 months even with advice on breathing technique to those with EILO. However, there is some intraindividual variability in CLE scores over time. Trial registration: ISRCTN, ISRCTN60543467, 2020/08/23, retrospectively registered, ISRCTN – ISRCTN60543467: Investigating conditions causing breathlessness in athletes.
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| 4. |
- Irewall, Tommie, 1987-
(author)
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Prevalence and incidence of and risk factors for asthma and exercise-induced laryngeal obstruction in elite endurance athletes
- 2021
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Doctoral thesis (other academic/artistic)abstract
- Background: Asthma is highly prevalent in endurance athletes, but we lack up-to-date information on the prevalence and incidence of asthma in cross-country skiers. Exercise-induced laryngeal obstruction (EILO) is an important differential diagnosis to exercise-induced asthma, and its symptoms can mimic asthma. The two conditions may co-exist, and misdiagnosis of EILO may result in unnecessary asthma treatment. The gold standard diagnostic test for EILO is continuous laryngoscopy during exercise (CLE). Aims: The aim of this thesis was to study the prevalence and incidence of asthma in endurance athletes, with a special focus on cross-country skiers. In addition, the thesis aimed to assess the prevalence of EILO in cross-country skiers and to study the intra-individual variability of laryngeal obstruction scores using the CLE test. Methods: Study 1 (papers I & II) comprised a cohort of elite endurance athletes who participated in an annual postal survey including questions regarding asthma, allergy, and exercise between 2011 and 2015. The invited athletes were Swedish elite skiers and orienteers, belonging to national teams, universities with elite sport contracts, Swedish National Elite Sport Schools, or national top ranking. The study population in paper I comprised adolescent skiers at Swedish National Elite Sport Schools (n=253) between 2011 and 2013, together with a reference population aged 16–20 years that was matched for school municipality (n=500) and invited in 2013. Paper II included all skiers and orienteers (n=666) participating in the prospective survey in 2011–2015. The incidence of physician- diagnosed asthma was defined as the number of incident cases of physician- diagnosed asthma divided by the summarized time at risk in person-years in the population without physician-diagnosed asthma at baseline. In study 2 (papers III & IV), elite skiers and competitive athletes (n=109) were screened for allergy, exercise-induced bronchoconstriction, and EILO at Östersund Hospital between 2015 and 2017. The participants answered a questionnaire regarding asthma, allergy, and exercise and underwent a CLE test, eucapnic voluntary hyperventilation (EVH) test, and skin prick test. Laryngeal obstruction was assessed at the glottic and supraglottic levels using a visual grade iv score (0–3 points). EILO was defined as ≥ 2 points at maximal effort exercise. Current asthma was defined as self-reported physician-diagnosed asthma and use of asthma medication in the last 12 months. All participants were invited to a follow-up examination off-season if the first examination was performed during the competitive season, or on-season if the first visit occurred during off-season. Paper III included 89 elite skiers that completed the first baseline visit. Paper IV included all 29 athletes that completed the baseline and follow-up testing regardless of diagnosis, treatment, and respiratory symptoms. Results: In paper I, the response rate was 96% in the skier population and 48% in the reference population. Skiers at Swedish National Elite Sport Schools had a higher prevalence of physician-diagnosed asthma than the reference population (27% vs. 19%, p=0.046). Median age at asthma onset was higher in skiers compared to in the reference population (12.0vs 8.0 years, p<0.001). Female sex, family history of asthma, nasal allergies, and being a skier were independent risk factors associated with physician-diagnosed asthma. In paper II, the response rate was 88.7% at baseline and decreased by year of follow-up. The population at risk at baseline consisted of 290 skiers and 159 orienteers, and the incidence rate (95% confidence interval [CI]) of physician- diagnosed asthma was 61.2 (45.7–80.3) per 1000 person-years. Risk factors for incident physician-diagnosed asthma were family history of asthma, being a skier, and wheezing without having a cold. In paper III, 24 (27%) of the 89 elite cross-country skiers fulfilled the study criterion for EILO. Current asthma was present in 34 (38%) skiers, whereof 10 (29%) of whom had concomitant EILO. A higher proportion of skiers with EILO and current asthma reported wheezing or shortness of breath following exercise compared to skiers with asthma only. In paper IV, the CLE score was mainly unchanged at follow-up after 3–23 months. In the 11 athletes with moderate supraglottic obstruction at first visit and receiving advice for breathing exercises, 3 (27%) had mild obstruction at follow- up. Among athletes without no or mild supraglottic obstruction at first visit, 3 (17%) had moderate laryngeal supraglottic obstruction at follow-up. Conclusions: Adolescent skiers have a high prevalence of self-reported physician-diagnosed asthma. The onset of asthma commonly occurs during early adolescence. Endurance athletes also have a high incidence of physician-diagnosed asthma v during their career, especially among skiers. Furthermore, skiers have a high prevalence of EILO, including nearly 30% of skiers with current asthma. In endurance athletes, the grade of laryngeal obstruction according to CLE was fairly stable when reassessed after 3–23 months, regardless of the grade of laryngeal obstruction, respiratory symptoms at baseline, and advice on breathing exercises after the first visit. Therefore, when assessing skiers with exercise-related respiratory symptoms, both EILO and asthma should be considered.
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| 5. |
- Jeremiasen, Ida, et al.
(author)
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Outpatient prescription of pulmonary vasodilator therapy to preterm children with bronchopulmonary dysplasia
- 2023
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In: Acta Paediatrica. - : John Wiley & Sons. - 0803-5253 .- 1651-2227. ; 112:3, s. 403-416
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Journal article (peer-reviewed)abstract
- Aim: The use of pulmonary vasodilator therapy in children born preterm is largely unknown. Our aim was to map prescription patterns in children with bronchopulmonary dysplasia in Sweden.Methods: This was a descriptive national registry-based study of children <7 years who had been prescribed a pulmonary vasodilator during 2007–2017, were born preterm and classified as having bronchopulmonary dysplasia. Information on prescriptions, patient characteristics and comorbidities were retrieved from the Swedish Prescribed Drug Register and linked to other national registers.Results: The study included 74 children, 54 (73%) born at 22–27 weeks' gestation and 20 (27%) at 28–36 weeks. Single therapy was most common, n = 64 (86.5%), and sildenafil was prescribed most frequently, n = 69 (93%). Bosentan, iloprost, macitentan and/or treprostinil were used mainly for combination therapies, n = 10 (13.5%). Patent ductus arteriosus or atrial septal defect were present in 29 (39%) and 25 (34%) children, respectively, and 20 (69%) versus 3 (12%) underwent closure. Cardiac catheterisation was performed in 19 (26%) patients. Median duration of therapy was 4.6 (1.9-6.8, 95% CI) months. Mortality was 9%.Conclusion: Preterm children with bronchopulmonary dysplasia were prescribed pulmonary vasodilators, often without prior catheterisation. Sildenafil was most commonly used. Diagnostic tools, effects, and drug safety need further evaluation.
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| 6. |
- Jeremiasen, Ida, et al.
(author)
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Vasodilator therapy for pulmonary hypertension in children : a national study of patient characteristics and current treatment strategies
- 2021
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In: Pulmonary Circulation. - : John Wiley & Sons. - 2045-8932 .- 2045-8940. ; 11:4
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Journal article (peer-reviewed)abstract
- Pulmonary vasodilator therapy is still often an off-label treatment for pulmonary hypertension in children. The aim of this nationwide register-based study was to assess patient characteristics and strategies for pulmonary vasodilator therapy in young Swedish children. Prescription information for all children below seven years of age at treatment initiation, between 2007 and 2017, was retrieved from the National Prescribed Drug Register, and medical information was obtained by linkage to other registers. All patients were categorized according to the WHO classification of pulmonary hypertension. In total, 233 patients had been prescribed pulmonary vasodilators. The treatment was initiated before one year of age in 61% (N = 143). Sildenafil was most common (N = 224 patients), followed by bosentan (N = 29), iloprost (N = 14), macitentan (N = 4), treprostinil (N = 2) and riociguat (N = 2). Over the study period, the prescription rate for sildenafil tripled. Monotherapy was most common, 87% (N = 203), while 13% (N = 20) had combination therapy. Bronchopulmonary dysplasia (N = 82, 35%) and/or congenital heart defects (N = 156, 67%) were the most common associated conditions. Eight percent (N = 18) of the patients had Down syndrome. Cardiac catheterization had been performed in 39% (N = 91). Overall mortality was 13% (N = 30) during the study period. This study provides an unbiased overview of national outpatient use of pulmonary vasodilator therapy in young children. Few cases of idiopathic pulmonary arterial hypertension were found, but a large proportion of pulmonary hypertension associated with congenital heart defects or bronchopulmonary dysplasia. Despite treatment, mortality was high, and additional pediatric studies are needed for a better understanding of underlying pathologies and evidence of treatment effects.
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| 7. |
- Mattsson, H., et al.
(author)
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Improved infrastructure and support needed for paediatric clinical trials in Sweden
- 2020
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In: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 109:12, s. 2740-7
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Journal article (peer-reviewed)abstract
- Aim There is a lack of authorised medicines for paediatric patients and improved drug development is necessary. The aim of this study was to evaluate the need for infrastructure and support for paediatric clinical trials in Sweden. Methods A web-based survey was sent to doctors and nurses involved in the care of neonates, children and adolescents assessing the current situation and future needs for paediatric clinical trials in Sweden. Questions regarding premises, competence, organisation, support for paediatric clinical trials and Good Clinical Practice Training were addressed. Results In total, 137 individuals responded to the survey (109 doctors and 28 nurses). Overall, 61% of the respondents had previous experience of paediatric clinical trials. Some respondents had access to trial units, but only 34% had used the trial unit for support. Half of the responders were interested in recurrent paediatric Good Clinical Practice training. Doctors responded that clinical work often had to be prioritised and emphasised the need for research time. Conclusion This study clearly shows the commitment for clinical trials among doctors and nurses involved in paediatric care in Sweden, but also that administrative, logistic and economic support in a sustainable setting and an expanded national collaboration are needed.
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| 8. |
- Reynisson, Björn, et al.
(author)
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QTc interval-dependent body posture in pediatrics
- 2020
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In: BMC Pediatrics. - : BMC. - 1471-2431. ; 20:1, s. 1-7
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Journal article (peer-reviewed)abstract
- Background: Syncope is a common and often benign disorder presenting at the pediatric emergency department. Long-QT syndrome may be presented with syncope, ventricular arrhythmias or sudden death and is vital to exclude as an underlying cause in children presented with syncope. Few studies have assessed QTc in relation to body posture in children. In this study, we assessed the QTc interval while laying down and during active standing in children with known long-QT syndrome compared to healthy controls.Methods: Children aged 1-18 years with long-QT syndrome (N = 17) matched to two healthy controls (N = 34) were included in this case-control study. The ECG standing was performed immediately after the ECG in the supine position. The QTc interval and QTc-difference by changing the body position were calculated.Results: All children with long-QT syndrome were treated with propranolol. QTc was prolonged among long-QT syndrome children while lying down and when standing up, compared to controls. A prolongation of QTc appeared when standing up for both cases and controls. There was no significant difference in QTc increase between the groups. A QTc over 440 ms was observed among four cases lying down and in eight cases while standing, but not in any of the controls. The standing test with a cut-off of 440 ms showed a sensitivity of 47% and a specificity of 100% for case-status in our study.Conclusion: QTc measured on ECG when rapidly rising up is prolonged in both healthy and LQTS children. More importantly, it prolongs more in children with LQTS and increases in pathological levels.
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| 9. |
- Tanghöj, Gustaf, et al.
(author)
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Atrial Septal Defect in Children : The Incidence and Risk Factors for Diagnosis
- 2020
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In: Congenital Heart Disease. - Henderson : Tech Science Press. - 1747-079X .- 1747-0803. ; 15:5, s. 287-299
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Journal article (peer-reviewed)abstract
- Objective: Secundum atrial septal defect (ASD II) is a common congenital heart defect, and interatrial communications among preterm children is even more common. The objective of this study was to calculate the incidence of ASD II in children, with assessment to gestational age at birth. Further, to assess maternal, prenatal and postnatal risk factors associated with ASD II among children of different gestational age at birth.Design: This national registry based retrospective incidence study was supplemented with a national case-control study, using the Swedish Register of Congenial Heart Disease, Swedish Medical Birth Register and Statistics Sweden. All children, 0-18 years of age, born in Sweden and diagnosed with an ASD II between 2010 and 2015 were included in the study and compared with children without diagnosis of ASD II.Results: The yearly overall incidence of ASD II was 150 per 100 000 live births. However, this incidence ranged from 449 per 100 000 live births to 1737 per 100 000 live births, with higher incidence among preterm children. ASD II was associated with a presence of persistent ductus arteriosus; OR = 8.11 (Cl 95% 2.80-16.69), female gender; OR = 1.39 (Cl 95% 1.18-1.63) and being small for gestational age; OR = 1.86 (Cl 95% 1.29-2.68). Born preterm was also associated with ASD II; born at 32-36 gestational children; OR = 3.21 (Cl 95% 2.46-4.19), and born <32 gestational weeks; OR = 4.02 (Cl 95% 2.80-7.12).Conclusion: Preterm children have a higher incidence of ASD II than previously found, increasing with lower gestational age at birth. Preterm birth is an independent risk factor for ASD II diagnosis with three to four times, suggesting that this group of children may need new structured follow up program with careful assessment of indication when need of treatment and closure.
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| 10. |
- Tanghöj, Gustaf, et al.
(author)
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Predictors of the Need for an Atrial Septal Defect Closure at Very Young Age
- 2020
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In: Frontiers in Cardiovascular Medicine. - : Frontiers Media S.A.. - 2297-055X. ; 6
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Journal article (peer-reviewed)abstract
- An asymptomatic Atrial Septal Defect (ASD) is often closed at the age of 3-5 years using a transcatheter or surgical technique. Symptomatic ASD or ASD associated with pulmonary hypertension (PHT) may require earlier closure, particularly in combination with other non-cardiac risk factors for PHT, but the indications for early closure and the potential risk for complications are largely unknown. The aim of this study was to assess risk factors for needing ASD closure during the first and second years of life. This case-control study included all children treated with surgical or percutaneous ASD closure between 2000 and 2014 at two out of three pediatric heart centers in Sweden. "Cases" were children with ASD closure at <= 1 or <= 2 years of age. Clinical data were retrieved from medical journals and national registries. Overall, 413 children were included. Of these, 131 (32%) were <= 2 years, and 50 (12%) were <= 1 year. Risk factors associated with a <= 2 years ASD closure were preterm birth, OR = 2.4 (95% CI: 1.5-3.9); additional chromosomal abnormalities, OR = 3.4 (95% CI: 1.8-6.5); pulmonary hypertension, OR = 5.8 (95% CI: 2.6-12.6); and additional congenital heart defects, OR = 2.6 (95% CI: 1.7-4.1). These risk associations remained after adjustments for confounding factors, such as need for neonatal respiratory support, neonatal pulmonary diseases, neonatal sepsis, additional congenital heart defects (CHD) and chromosomal abnormalities. ASD size:body weight ratio of 2.0, as well as a ratio of 0.8 (upper and lower limit of the ASD size:body weight ratios), was associated with increased risk of an early ASD closure. Risk factors such as very premature birth, very low birth weight, congenital, and chromosomal abnormalities, neonatal pulmonary disease and need for ventilation support, as well as pulmonary hypertension, were associated with very early (<1 year of age) ASD closure. Several independent neonatal risk factors were associated with an increased risk of early ASD closure at 2 and at 1 year of age. An ASD size:body weight ratio is a poor predictor for indications for ASD closure.
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| 11. |
- Tanghöj, Gustaf, et al.
(author)
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Risk factors for adverse events within one year after atrial septal closure in children : a retrospective follow-up study
- 2020
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In: Cardiology in the Young. - : Cambridge University Press. - 1047-9511 .- 1467-1107. ; 30:3, s. 303-312
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Journal article (peer-reviewed)abstract
- Introduction: Secundum atrial septal defect is one of the most common congenital heart defects. Previous paediatric studies have mainly addressed echocardiographic and few clinical factors among children associated with adverse events. The aim of this study was to identify neonatal and other clinical risk factors associated with adverse events up to one year after closure of atrial septal defect.Methods: This retrospective case-control study includes children born in Sweden between 2000 and 2014 that were treated surgically or percutaneously for an atrial septal defect. Conditional logistic regression was used to evaluate the association between major and minor adverse events and potential risk factors, adjusting for confounding factors including prematurity, neonatal sepsis, neonatal general ventilatory support, symptomatic atrial septal defects, and pulmonary hypertension.Results: Overall, 396 children with 400 atrial septal defect closures were included. The median body weight at closure was 14.5 (3.5-110) kg, and the median age was 3.0 (0.1-17.8) years. Overall, 110 minor adverse events and 68 major events were recorded in 87 and 49 children, respectively. Only symptomatic atrial septal defects were associated with both minor (odds ratio (OR) = 2.18, confidence interval (CI) 95% 1.05-8.06) and major (OR = 2.80 CI 95% 1.23-6.37) adverse events.Conclusion: There was no association between the investigated neonatal comorbidities and major or minor events after atrial septal defect closure. Patients with symptomatic atrial septal defects had a two to four times increased risk of having a major event, suggesting careful management and follow-up of these children prior to and after closure.
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| 12. |
- Tanghöj, Gustaf, et al.
(author)
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Risk factors for isolated atrial septal defect secundum morbidity
- 2024
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In: Scientific Reports. - : Springer Nature. - 2045-2322. ; 14:1
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Journal article (peer-reviewed)abstract
- Atrial septal defect secundum is a common type of congenital heart defect and even more common among children born premature. The aim of this study was to assess premature birth as a potential associated risk factors for cardiac morbidity in children with isolated ASD II. In this retrospective national registry-based case–control study all children born in Sweden between 2010 and 2015 with an isolated ASD II diagnosis were included. Association between premature birth and cardiac morbidity in children with isolated ASD II was assessed by different outcomes-models using conditional logistic regression and adjustments were made for confounding factors. Overall, 11% of children with an isolated ASD II received treatment for heart failure. Down syndrome was the only independent risk factors for associated with cardiac morbidity in children with ASD II (OR = 2.25 (95%CI 1.25–4.07). Preterm birth in children was not associated with an increased risk of ASD II cardiac morbidity.
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| 13. |
- Tanghöj, Gustaf, 1979-
(author)
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Young children with atrial septal defect
- 2020
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Doctoral thesis (other academic/artistic)abstract
- Background: Secundum atrial septal defect (ASD II), situated within the fossa ovalis, is the third most common congenital heart defect and even more common among preterm children. Spontaneous closure usually occurs during the first year of life. Most children with an ASD II remain asymptomatic during early childhood. Guidelines recommend ASD II closure in the presence of a significant left-to-right shunt. Percutaneous device closure, which is most commonly used, and surgery are both considered safe, with few major adverse events.In Sweden, approximately 6% of all children are born preterm. The morbidity of preterm children includes increased risk of chronic pulmonary disease and altered cardiac morphology and function which remain into adulthood. Most studies on ASD II incidence and interventional and surgical risks following ASD II closure are based on otherwise healthy children. Preterm children are a special subset of patients with ASD II and the hypothesis in this thesis is that preterm birth may be associated with increased risks of ASD II diagnosis and adverse events following closure.Aim: The overall aim of this thesis was to assess the incidence of ASD II, independent risk factors associated to ASD II diagnosis, and adverse events following ASD II interventional closure.Methods: Paper I: A retrospective case-control study assessing associated risk factors for adverse events after percutaneous device closure among children with an interventional weight of less than 15 kg. Paper II: A cohort study assessing a preterm and a term cohort and time to first adverse event within one month or one year after ASD II closure, as well as number of events. Paper III: A retrospective case-control study assessing the association between major and minor adverse events after ASD II closure, and potential paediatric risk factors. Paper IV: A national registry-based retrospective incidence and case-control study calculating the incidence of ASD II diagnosis among term and preterm children and assessing potential maternal, neonatal, and paediatric risk factors for ASD II.Results: Paper I: No independent risk factor was associated with adverse events after percutaneous device closure. However, major adverse events occurred in 11 (10%) of the children weighing less than 15 kg, compared with six (4%) children weighing over 15 kg (p = 0.04). Paper II: There was no difference between the preterm and term cohorts in time to first adverse event or in multiple adverse events within one month or within a year, neither in number of major events (p = 0.69) nor in number of minor events (p = 0.84). However, the preterm cohort was younger (2.1 versus 3.4 years, p < 0.01), lighter (11.6 versus 15.1 kg, p < 0.01), had a smaller ASD II size (12.0 versus 13.0 mm, p< 0.01), and a larger ASD II size to weight ratio (1.1 versus 0.8, p < 0.01) compared with the term cohort. Paper III: ASD II with significant clinical symptoms was associated with both minor OR = 2.18, (CI 95% 1.05–8.06) and major OR = 2.80 (CI 95% 1.23–6.37) adverse events following closure. Paper IV: The yearly overall incidence of ASD II was 150 per 100,000 live births. However, this incidence ranged from 449 to 1,737 per 100,000 live births, with higher incidence in preterm children. ASD II was associated with a presence of persistent ductus arteriosus; OR = 8.11 (CI 95% 2.80–16.69), female gender; OR = 1.39 (CI 95% 1.18–1.63), and being small for gestational age; OR = 1.86 (CI 95% 1.29–2.68). Being born preterm was also associated with ASD II diagnosis: born at 32–36 gestational weeks; OR = 3.21 (CI 95% 2.46–4.19), and born at < 32 gestational weeks; OR = 4.02 (CI 95% 2.80–7.12).Conclusions: Preterm children have a high incidence of ASD II diagnosis, increasing with lower gestational age at birth, and is an independent risk factor for ASD II diagnosis. Few adverse events occurred among children following ASD II closure, and there were no neonatal or paediatric risk factors (including procedural body weight and gestational age) associated with adverse events. There was an association between clinical symptomatic ASD II and major adverse events. Despite younger procedural age, larger ASD II size to weight ratio and increased comorbidity, preterm children appeared to have similar risks of adverse events during the first year after ASD II closure when compared with term children.Preterm children and children with symptomatic ASD II need careful management both prior to and after ASD II closure. A new, structured follow-up programme with assessment of indication and timing of treatment and closure should be considered for children born preterm.
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| 14. |
- Zamir, Itay, et al.
(author)
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Insulin resistance prior to term age in very low birthweight infants : a prospective study
- 2024
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In: BMJ Paediatrics Open. - : BMJ Publishing Group Ltd. - 2399-9772. ; 8:1
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Journal article (peer-reviewed)abstract
- Objective: To explore the glucose-related hormone profile of very low birthweight (VLBW) infants and assess the association between neonatal hyperglycaemia and insulin resistance during the admission period.Design: A prospective observational study—the Very Low Birth Weight Infants, Glucose and Hormonal Profiles over Time study.Setting: A tertiary neonatal intensive care unit and four neonatal units in county hospitals in Sweden.Patients: 48 infants born <1500 g (VLBW) during 2016–2019.Outcome measures: Plasma concentrations of glucose-related hormones and proteins (C-peptide, insulin, ghrelin, glucagon-like peptide 1 (GLP-1), glucagon, leptin, resistin and proinsulin), insulin:C-peptide and proinsulin:insulin ratios, Homoeostatic Model Assessment 2 (HOMA2) and Quantitative Insulin Sensitivity Check (QUICKI) indices, measured on day of life (DOL) 7 and at postmenstrual age 36 weeks.Results: Lower gestational age was significantly associated with higher glucose, C-peptide, insulin, proinsulin, leptin, ghrelin, resistin and GLP-1 concentrations, increased HOMA2 index, and decreased QUICKI index and proinsulin:insulin ratio. Hyperglycaemic infants had significantly higher glucose, C-peptide, insulin, leptin and proinsulin concentrations, and lower QUICKI index, than normoglycaemic infants. Higher glucose and proinsulin concentrations and insulin:C-peptide ratio, and lower QUICKI index on DOL 7 were significantly associated with longer duration of hyperglycaemia during the admission period.Conclusions: VLBW infants seem to have a hormone profile consistent with insulin resistance. Lower gestational age and hyperglycaemia are associated with higher concentrations of insulin resistance markers.
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