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1.	Orban, Kristina, et al. (author) Changes in Parents' Time Use and Its Relationship to Child Obesity 2014 In: Physical & Occupational Therapy in Pediatrics. - Philadelphia : Taylor & Francis. - 0194-2638 .- 1541-3144. ; 34:1, s. 44-61 Journal article (peer-reviewed)abstract Objective: The aim was to explore any change in parents' time use together with their children, changes in their perceived occupational value, and its relationship to children's body mass index (BMI) over the course of a one-year occupation-focused family intervention. Method: The study sample consisted of participants in one arm of a randomized controlled trial, involving mothers and fathers (n = 30) of 17 children aged 4-6 years who were considered obese. Data were collected by time-geographical diaries during the intervention and by measuring the parents' occupational value and the children's BMI before and after the intervention. Results: At the end of the intervention, an increase was shown in the amount of time parents spent together with their children during weekdays (p = .042) and the parents perceived occupational value (p = .013). Children's BMI z-score changed with -0.11 units. Conclusion: Collaboration with parents may be useful in interventions aiming at facilitating a normal weight development among children. © 2014 Informa Healthcare USA, Inc.
2.	Orban, Kristina, et al. (author) Effect of an occupation-focused family intervention on change in parents’ time use and children’s body mass index 2014 In: American Journal of Occupational Therapy. - 0272-9490. ; 68:6, s. e217-e226 Journal article (peer-reviewed)abstract OBJECTIVE. This study explored factors related to changes in the time parents spent with their children with obesity and associated decreases in children’s body mass index (BMI) z-scores after an occupation-focused intervention.METHOD. Parents participated in a 1-yr occupation-focused intervention to promote healthy family lifestyles. Data on 40 parents of 22 children with obesity ages 4–6 yr were collected before and after intervention and analyzed using linear and multiple regression methods.RESULTS. Parents increased time spent with their children by an average of 91 min/day. Parents’ finances, perceived satisfaction in daily occupations, low BMI, and mastery at inclusion were associated with increased time spent with their children. Mothers’ subjective health and high mastery and fathers’ perceived occupational value and education explained 67% of the variance in children’s BMI z-scores.CONCLUSION. The results indicate important factors to consider in developing interventions that facilitate occupational engagement and health among children with obesity and their families.
3.	Orban, Kristina, et al. (author) Effect of an Occupation-Focused Family Intervention on Change in Parents' Time Use and Children's Body Mass Index. 2014 In: American Journal of Occupational Therapy. - Bethesda : AOTA Press. - 0272-9490 .- 1943-7676. ; 68:6, s. 217-226 Journal article (peer-reviewed)abstract OBJECTIVE. This study explored factors related to changes in the time parents spent with their children with obesity and associated decreases in children's body mass index (BMI) z-scores after an occupation-focused intervention. METHOD. Parents participated in a 1-yr occupation-focused intervention to promote healthy family lifestyles. Data on 40 parents of 22 children with obesity ages 4-6 yr were collected before and after intervention and analyzed using linear and multiple regression methods. RESULTS. Parents increased time spent with their children by an average of 91 min/day. Parents' finances, perceived satisfaction in daily occupations, low BMI, and mastery at inclusion were associated with increased time spent with their children. Mothers' subjective health and high mastery and fathers' perceived occupational value and education explained 67% of the variance in children's BMI z-scores. CONCLUSION. The results indicate important factors to consider in developing interventions that facilitate occupational engagement and health among children with obesity and their families.
4.	Orban, Kristina, et al. (author) Shared patterns of daily occupations among parents of children Aged 4-6 years old with obesity 2012 In: Journal of Occupational Science. - Melbourne : Taylor & Francis. - 1442-7591 .- 2158-1576. ; 19:3, s. 241-257 Journal article (peer-reviewed)abstract The prevalence of childhood obesity is increasing and is associated with how families manage their daily occupations. Previous studies suggest that it should be possible to identify patterns of daily occupations that promote health and prevent illness. However, it is unknown how family members' patterns are shared. This study aimed at gaining knowledge about parents' shared patterns of daily occupations. Thirty parents enrolled in a randomized controlled trial involving parents of children aged 4–6 years old with obesity, were included. The study used a mixed methods design. Data from time-geographical diaries describing daily occupations on one ordinary weekday were collected. A sequential exploratory strategy design was used, with qualitative and quantitative data analysis. Four main groups of family types were identified: the togetherness focused family, the child focused family, the individual focused family and the parent-child focused family. These groups' shared patterns of daily occupations differed in terms of divisions of household work, paid work and the amount of time spent together as a family. The results highlight and generate a new understanding of how parents' shared patterns of daily occupations are shaped in families. © 2012 Taylor & Francis Group, LLC. All rights reserved.
5.	Önnerfält, Jenny, et al. (author) A family-based intervention targeting parents of preschool children with overweight and obesity : Conceptual framework and study design of LOOPS- Lund Overweight and Obesity Preschool Study 2012 In: BMC Public Health. - London, UK : BioMed Central. - 1471-2458. ; 12:1 Journal article (peer-reviewed)abstract Background: As the rate of overweight among children is rising there is a need for evidence-based research that will clarify what the best interventional strategies to normalize weight development are. The overall aim of the Lund Overweight and Obesity Preschool Study (LOOPS) is to evaluate if a family-based intervention, targeting parents of preschool children with overweight and obesity, has a long-term positive effect on weight development of the children. The hypothesis is that preschool children with overweight and obesity, whose parents participate in a one-year intervention, both at completion of the one-year intervention and at long term follow up (2-, 3- and 5-years) will have reduced their BMI-for-age z-score.Methods/Design: The study is a randomized controlled trial, including overweight (n=160) and obese (n=80) children 4-6-years-old. The intervention is targeting the parents, who get general information about nutrition and exercise recommendations through a website and are invited to participate in a group intervention with the purpose of supporting them to accomplish preferred lifestyle changes, both in the short and long term. To evaluate the effect of various supports, the parents are randomized to different interventions with the main focus of: 1) supporting the parents in limit setting by emphasizing the importance of positive interactions between parents and children and 2) influencing the patterns of daily activities to induce alterations of everyday life that will lead to healthier lifestyle. The primary outcome variable, child BMI-for-age z-score will be measured at referral, inclusion, after 6 months, at the end of intervention and at 2-, 3- and 5-years post intervention. Secondary outcome variables, measured at inclusion and at the end of intervention, are child activity pattern, eating habits and biochemical markers as well as parent BMI, exercise habits, perception of health, experience of parenthood and level of parental stress.Discussion: The LOOPS project will provide valuable information on how to build effective interventions to influence an unhealthy weight development to prevent the negative long-term effects of childhood obesity.Trial registration: ClinicalTrials.gov NCT00916318© 2012 Önnerfält et al.; licensee BioMed Central Ltd.
6.	Amer-Wåhlin, Isis, et al. (author) Brain-specific NSE and S-100 proteins in umbilical blood after normal delivery 2001 In: Clinica Chimica Acta. - 0009-8981. ; 304:1-2, s. 57-63 Journal article (peer-reviewed)abstract BACKGROUND: To determine normal blood levels of brain-specific proteins S-100 and neuron specific enolase (NSE) in healthy newborns and their mothers following uncomplicated birth. METHODS: Umbilical artery and vein blood and maternal venous blood was collected at 112 consecutive uncomplicated deliveries. Venous blood samples were taken from 18 of the neonates 3 days after birth. S-100 and NSE were analyzed quantitatively by double antibody immunoluminometric assay (Sangtec Medical AB, Sweden). RESULTS: Compared with adults, healthy neonates had higher levels of both S-100 and NSE. For S-100, median levels (range) were 1.10 microg/l (0.38-5.50 microg/l and 0.98 microg/l (0.43-2.70 microg/l) in umbilical artery and vein, respectively. For NSE, median levels (range) in umbilical artery blood and vein were 27 microg/l (10-140 microg/l) and 10.75 microg/l (8.80->/=200 microg/l) respectively. The maternal venous blood levels of both S-100 and NSE were significantly lower than in their infants. At 3 days of life, neonatal venous levels of the proteins were still high: S-100, 0.48-9.70 microg/l; NSE, 17->/=200 microg/l. In contrast to adults, haemolysis affected the S-100 levels in umbilical blood significantly. CONCLUSION: Concentrations of both S-100 and NSE in blood are greater in newborns after normal birth than in healthy adults. The higher levels in umbilical artery blood than in umbilical vein blood are consistent with a fetal origin of these proteins. High levels in venous blood at 3 days of life suggest that the high levels at birth are not related to the birth process but reflect a high activity of these proteins during fetal development.
7.	Hafström, Maria, 1962, et al. (author) Cerebral Palsy in Extremely Preterm Infants 2018 In: Pediatrics. - : American Academy of Pediatrics (AAP). - 0031-4005 .- 1098-4275. ; 141:1 Journal article (peer-reviewed)abstract BACKGROUND AND OBJECTIVES: The risk of cerebral palsy (CP) is high in preterm infants and is often accompanied by additional neurodevelopmental comorbidities. The present study describes lifetime prevalence of CP in a population-based prospective cohort of children born extremely preterm, including the type and severity of CP and other comorbidities (ie, developmental delay and/or cognitive impairment, neurobehavioral morbidity, epilepsy, vision and hearing impairments), and overall severity of disability. In this study, we also evaluate whether age at assessment, overall severity of disability, and available sources of information influence outcome results.METHODS: All Swedish children born before 27 weeks' gestation from 2004 to 2007 were included (the Extremely Preterm Infants in Sweden Study). The combination of neonatal information, information from clinical examinations and neuropsychological assessments at 2.5 and 6.5 years of age, original medical chart reviews, and extended chart reviews was used.RESULTS: The outcome was identified in 467 (94.5%) of eligible children alive at 1 year of age. Forty-nine (10.5%) children had a lifetime diagnosis of CP, and 37 (76%) were ambulatory. Fourteen (29%) had CP diagnosed after 2.5 years of age, 37 (76%) had at least 1 additional comorbidity, and 27 (55%) had severe disability. The probability for an incomplete evaluation was higher in children with CP compared with children without CP.CONCLUSIONS: Children born extremely preterm with CP have various comorbidities and often overall severe disability. The importance of long-term follow-up and of obtaining comprehensive outcome information from several sources in children with disabilities is shown.
8.	Hellström-Westas, Lena, et al. (author) Early prediction of outcome with aEEG in preterm infants with large intraventricular hemorrhages 2001 In: Neuropediatrics. - : Georg Thieme Verlag KG. - 0174-304X .- 1439-1899. ; 32:6, s. 319-324 Journal article (peer-reviewed)abstract BACKGROUND: The electrocortical background contains prognostic information in full-term asphyxiated newborn infants already during the first postnatal hours. In preterm infants with intra-ventricular hemorrhages (IVH) the background activity in EEG and amplitude-integrated EEG (aEEG) is depressed during the first days of life, and the extent of the depression correlates with the degree of IVH. However, it has not been previously evaluated whether very early aEEG can predict later outcome also in pre-term infants. OBJECTIVE: To investigate if early prediction of outcome is possible from aEEG in preterm infants with large IVH. METHODS: aEEG recordings from the first postnatal week were investigated in 64 preterm infants with IVH grade III - IV. For every 24-hour period the aEEG background pattern was classified, and the maximum and minimum numbers of bursts/h, respectively,were counted. Outcome was divided into three categories: died (n = 36), survived (n = 28) with "poor" outcome, i.e., severe cerebral palsy and not able to walk and/or mental retardation (n = 8), and survived with "fair" outcome, i.e., healthy or mild cerebral palsy (n = 19). One surviving child was lost in the follow-up. RESULTS: There were significant differences in maximum bursts/h (MaxB) at 0-24 hours (p = 0.033), 24-48 hours (p = 0.011), 48-72 hours (p=0.049) and 72-96 hours (p=0.032), respectively, between the infants who died and the surviving infants. At 24-48 hours the median (range) MaxB in the surviving infants with "fair" outcome was 156 (103-179) versus 102 (73-156) in the surviving infants with "poor" outcome (p = 0.002). With the assumption that MaxB < 130 was predictive of death or survival with "poor" outcome, 68 % and 78% of infants were correctly predicted at 0-24 hours and 24-48 hours, respectively. CONCLUSIONS: This study shows that outcome may be predicted with aEEG already during the first days of life in preterm infants with large IVH. The findings should be confirmed in prospective studies since they may have clinical implications if specific medical interventions become available.
9.	Herbst, Andreas, et al. (author) Different types of acid-base changes at birth, fetal heart rate patterns, and infant outcome at 4 years of age 1997 In: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 76:10, s. 953-958 Journal article (peer-reviewed)abstract BACKGROUND: To study the relationship between different types of acidemia in umbilical artery blood at birth, fetal heart rate (FHR) patterns during labor, and infant long-term outcome. METHODS: Case-control study of 48 infants with pure high base deficit (base deficit (BD) > or = 12 mmol/L and pCO2 < 8.0 kPa), 51 with mixed acidemia (BD > or = 12 mmol/L and pCO2 > or = 8.0 kPa), born at or after term, and controls matched for maternal age, parity, and gestational age at birth. FHR patterns during labor and the results of developmental screening at age 4 were compared between the groups. RESULTS: Late decelerations were associated with pure high base deficit and complicated variable decelerations with mixed acidemia. Both types of acidemia were correlated with Apgar scores below 7 at 1 minute, and mixed acidemia with more admissions to the neonatal intensive care unit. Developmental screening at age 4 years showed no significant differences between infants with mixed acidemia or pure high base deficit and controls. Twelve infants with mixed acidemia and six controls had deficits in language/speech development. CONCLUSIONS: Late decelerations may be an indicator of a metabolic component of acidemia and complicated variable decelerations an indicator of mixed acidemia. The higher rate of admissions to the neonatal intensive care unit in cases with mixed acidemia may suggest that a concomitant hypercapnia (resulting in lower pH) in metabolic acidemia at birth may be of importance for the outcome. A possible relation between acidemia at birth and deficits in speech/language development should be further evaluated.
10.	Herbst, Andreas, et al. (author) Mode of delivery in breech presentation at term: increased neonatal morbidity with vaginal delivery 2001 In: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 80:8, s. 731-737 Journal article (peer-reviewed)abstract OBJECTIVE: To compare the neonatal outcome in planned vaginal delivery and planned cesarean section in term singleton pregnancies with breech presentation in a Scandinavian clinic with a high rate of vaginal breech delivery. METHODS: A retrospective study including 1050 term singleton breech pregnancies delivered at a Swedish tertiary referral center during 1988 to 2000. For 699 patients (67%) a vaginal delivery was planned, of whom 603 (86%) were delivered vaginally. In 327 (31%) cases a cesarean section was planned and performed. These two groups were compared regarding rates of acidemia at birth (cord artery pH <7.05), low Apgar scores and neonatal neurological morbidity. Long term sequels among infants with a complicated neonatal course were also identified. RESULTS: Acidemia at birth, Apgar score below 7 at 5 minutes, and referral to neonatal intensive care unit all occurred at higher rates in planned vaginal delivery (5.3%, 3.6%, and 8.9%, respectively), than in planned cesarean delivery (0, 0, and 4.0%). The rate of neonatal neurological morbidity was 24/699 (3.4%) in planned vaginal delivery (18 cases with cerebral symptoms and six cases of brachial plexus palsy) compared to one case (cerebral symptoms) after a planned cesarean. These differences were all statistically significant (p< or =0.002). Of the neurologically affected neonates, two died and four had cerebral palsy (one delivered by planned cesarean section) at follow up. CONCLUSION: Neonatal morbidity may be reduced with planned cesarean delivery in breech presentation, also in a Scandinavian setting.
11.	Herbst, Andreas, et al. (author) Vaginal breach delivery 2002 In: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 81:11, s. 1092-1092 Journal article (peer-reviewed)
12.	Hernandez-Andrade, Edgar, et al. (author) Perinatal adaptive response of the adrenal and carotid blood flow in sheep fetuses subjected to total cord occlusion 2005 In: Journal of Maternal-Fetal & Neonatal Medicine. - 1476-7058. ; 17:2, s. 101-109 Journal article (peer-reviewed)abstract Objective. To investigate the perinatal adaptive response of the adrenal blood flow/adrenal fractional moving blood volume (AFMBV) and carotid blood flow (CBF), in sheep fetuses subjected to severe acute intrauterine hypoxia/asphyxia induced by total cord occlusion.Methods. Adrenal blood flow velocity, AFMBV and CBF were measured in 13 exteriorized fetal sheep; eight of them underwent total umbilical cord occlusion to induce severe acute hypoxia/asphyxia. Five lambs were used as sham controls. Middle adrenal artery pulsatility index (MAAPI) and mean velocity (MAAMV) were recorded with pulsed Doppler ultrasound. AFMBV was estimated using power Doppler ultrasound. CBF was recorded with a transonic flowmeter. In the neonatal period, after resuscitation all lambs were followed for a 4-hour period and AFMBV and CBF were recorded. Mean arterial blood pressure (MABP) and fetal heart rate were recorded continuously. Arterial cortisol levels were measured at the beginning and at the end of the fetal and neonatal periods.Results. Following the total cord occlusion, there was a significant reduction in the CBF, MABP, and heart rate and adrenal flow/AFMBV after 2, 4 and 5?min, respectively. Cortisol levels in the asphyctic lambs at the end of the cord occlusion were significantly lower than those in controls. After resuscitation, the asphyctic lambs showed increased AFMBV and cortisol levels, and reduced MABP as compared to control lambs. No differences were found in CBF, MAAPI and MAAMV. Thereafter, no differences were observed between the two groups in any of the studied parameters. At the end of the cord occlusion period, there was a significant correlation between AFMBV and MABP (r?=?0.69), between AFMBV and CBF (r?=?0.65) and between CBF and MABP (r?=?0.89).Conclusion. During severe acute intrauterine hypoxia, the fetal lamb is able to maintain the blood flow to the brain and the adrenal gland for 3-5?min. Changes in the AFMBV and the CBF were highly correlated to the changes in MABP. Adrenal FMBV and cortisol levels were higher in lamb neonates exposed to severe intrauterine asphyxia.
13.	Hjern, Anders, et al. (author) Perinatal complications and socio-economic differences in cerebral palsy in Sweden - a national cohort study 2008 In: BMC Pediatrics. - : Springer Science and Business Media LLC. - 1471-2431. ; 8 Journal article (peer-reviewed)abstract Background: There is a controversy regarding the existence of a socio-economic gradient for cerebral palsy. Perinatal emergencies and preterm birth increase the risk for the offspring to develop cerebral palsy. The aim of this study was to investigate the association of socio-economic indicators with cerebral palsy (CP) and the role of perinatal health as mediator of this association. Methods: Register study of a national cohort of 805,543 children born 1987-93, including 1,437 children with cerebral palsy that were identified in hospital discharge data from national registers. Socio-economic indicators of the household were taken from the Census of 1985. Logistic regression and chi-square analyses of linearity were used to test hypotheses. Results: There was a linear association between the incidence of CP (excluding cases caused by registered injuries or malformations) as well as of major perinatal indicators and the socioeconomic status (SES) of the household of the mother (p < 0.001). Children in households with low SES had a higher odds ratio of CP ( OR 1.49 [95% C.I. 1.16-1.91]) compared with high SES after adjustment for demographic confounders. This OR decreased to 1.36 (1.05-1.71) after adjustment for perinatal indicators with preterm birth as the most important mediating variable. Conclusion: This study suggests that there is a continuous socio-economic gradient for CP in Sweden. Further studies in more complete populations of children with cerebral palsy are needed to confirm this. Perinatal complications seem to mediate some of this
14.	Hogan, Linda, et al. (author) How often is a low 5-min Apgar score in term newborns due to asphyxia? 2007 In: European Journal of Obstetrics, Gynecology, and Reproductive Biology. - : Elsevier BV. - 0301-2115. ; 130:2, s. 169-175 Journal article (peer-reviewed)abstract Objective: To evaluate how often low 5-min Apgar scores (AS(5-min)) at term are associated with asphyxia. Study design: A cohort- and case-control study, including all 183 term infants with AS(5-min) below 7 born at Lund University Hospital during 1993-2002, antepartum deaths excluded. The control group included 183 randomly selected term newborns with AS(5-min) 9-10. Cardiotocography (CTG) traces were assessed blinded to group and outcome. Obstetric and pediatric files were reviewed. Results: After excluding infants with severe malformations, indications of hypoxia were found at the following rates in cases with AS(5-min) below 4 (N = 30), scores 4-6 (N = 143), and controls (N = 182)-abnormal admission CTG: 38%, 8% and 0.6%; abnormal CTG before birth: 88%, 69% and 18%; obstetrical catastrophe: 28%, 6% and 0.6%; interventions for fetal distress: 83%, 48% and 9%; cord artery pH below 7.15: 69%, 54% and 7%; hypoxic ischemic encephalopathy or hypoxic death: 70%, 14% and none. All differences between each case group and controls were statistically significant (p < 0.0001). Conclusions: In the absence of severe malformations, the vast majority of AS(5-min) below 4, and at least half of scores 4-6 could be attributed to birth asphyxia. Signs of hypoxia usually appeared during labor, but were present at admission in 38% of cases with AS(5-min) below 4.
15.	Ingemarsson, Ingemar, et al. (author) Long term outcome after umbilical artery acidaemia at term birth: influence of gender and duration of fetal heart rate abnormalities 1997 In: British Journal of Obstetrics and Gynaecology. - : Wiley. - 1365-215X .- 1470-0328 .- 1471-0528. ; 104:10, s. 1123-1127 Journal article (peer-reviewed)abstract OBJECTIVE: To study the outcome after acidaemia at term birth, and the relation to gender and duration of pathological fetal heart rate changes. DESIGN: Population based study of 154 infants with umbilical artery pH < 7.05 at term birth. Neonatal outcome and the result of developmental screening at age four years were compared with a control group with pH > 7.10. Fetal heart rate traces in infants with acidaemia were reviewed, and the relation between duration of fetal heart rate changes and outcome was analysed. RESULTS: Of the 154 newborns with acidaemia at birth, 10 had encephalopathy, of which two died and two developed cerebral palsy. Nine of these 10 infants were boys, and eight had pH < 7.00. Male newborns (n = 39) more often had pronounced acidaemia (pH < 7.00) than females (n = 22). Although few infants had severe impairment, infants born with acidaemia significantly more often had speech problems at follow up than controls (19/102 versus 8/98; P = 0.03). In infants with acidaemia, duration of abnormal fetal heart rate changes was significantly associated with neonatal encephalopathy and speech problems at age four years. CONCLUSIONS: Acidaemia at term birth was associated with neonatal encephalopathy and with speech problems at four years of age. Boys had more often pronounced acidaemia and a complicated course. A protracted abnormal fetal heart rate trace was associated with poor outcome.
16.	Krebs, L, et al. (author) Long-term outcome in term breech infants with low Apgar score--a population-based follow-up 2001 In: European Journal of Obstetrics, Gynecology, and Reproductive Biology. - 0301-2115. ; 100:1, s. 5-8 Journal article (peer-reviewed)abstract OBJECTIVE: To investigate the relation between low Apgar score in breech infants and handicap in childhood. STUDY DESIGN: A case-control study. A questionnaire to mothers of 323 non-malformed, singleton infants delivered in breech presentation at term, 105 cases with Apgar score below 7 at 5 min and 218 controls. RESULTS: Four cases (4.6%) and one control (0.5%) had cerebral palsy. In infants without cerebral palsy, speech/language problems were more frequent than controls (10.6 versus 3.2%) (P=0.02). There were no differences in rates of deficits in attention, motor control and perception (DAMP), epilepsy, cognitive developmental delay or learning disabilities. Absence of any handicap or disability was reported in 65 cases (75%) compared to 172 controls (92%) (OR: 3.9; 95% CI: 1.9-7.9). CONCLUSION: Even though low Apgar score indicates an increased risk of neurological sequelae, most (75%) breech infants with low Apgar score are without a handicap/disability at follow-up.
17.	Ley, David, et al. (author) Different responses of myocardial and cerebral blood flow to cord occlusion in exteriorized fetal sheep 2004 In: Pediatric Research. - 1530-0447. ; 55:4, s. 568-575 Journal article (peer-reviewed)abstract Type and duration of fetal asphyxial insult affect the distribution of blood flow to the heart and brain. The purpose of this study was to describe dynamic and quantitative changes in regional myocardial and cerebral blood flow (CBF) during fetal asphyxia induced by total occlusion of the umbilical cord. Eleven exteriorized fetal sheep were subjected to total umbilical cord occlusion and five fetal sheep served as sham controls. Regional blood flow (BF) to the brain and heart was quantified using radioactive microspheres before and after 5 min of occlusion and finally when fetal mean arterial blood pressure had decreased below 25 mm Hg, 9.8 (0.8) [mean (SD)] min after occlusion. Right coronary arterial (RCA) blood flow velocity and carotid BF were registered continuously. Mean values of arterial pH and oxygen content (mL O-2/100 mL) were 7.08 (0.11) and 4.4 (2.9) before cord occlusion and decreased to 6.83 (0.05) and 1.4 (0.9) at 5 min after occlusion (p < 0.01, respectively). Carotid BF was significantly below preocclusion values by 2.5 min (p < 0.05), whereas RCA velocity time integral per minute remained above preocclusion values for 9 min. CBF decreased from 316 (24) before cord occlusion to 156 (30) mL/min/100 g at 5 min (p < 0.01), whereas right myocardial BF was maintained at 792 (125) and 751 (183) mL/min/100 g, respectively. CBF decreased rapidly after total cord occlusion whereas myocardial BF increased and was maintained until shortly before cardiac arrest, suggesting the myocardium to be better preserved during this type of insult in already partially asphyxiated fetuses.
18.	Linninge, Caroline, et al. (author) The Microbiota of the Gut in Preschool Children With Normal and Excessive Body Weight 2012 In: Obesity. - : Wiley. - 1930-739X .- 1930-7381. ; 20:11, s. 2257-2261 Journal article (peer-reviewed)abstract The aim of this study was to investigate the gut microbiota in preschool children with and without overweight and obesity. Twenty overweight or obese children and twenty children with body mass index within the normal range (age: 4-5 years) were recruited from the south of Sweden. The gut microbiota was accessed by quantitative polymerase chain reactions and terminal restriction fragment length polymorphism and calprotectin was measured in faeces. Liver enzymes were quantified in obese/overweight children. The concentration of the Gram-negative family Enterobacteriaceae was significantly higher in the obese/overweight children (P=0.036) while levels of Desulfovibrio and Akkermansia muciniphila-like bacteria were significantly lower in the obese/overweight children (P=0.027 and P=0.030, respectively). No significant differences were found in content of Lactobacillus, Bifidobacterium or the Bacteroides fragilis group. The diversity of the dominating bacterial community tended to be less diverse in the obese/overweight group, but the difference was not statistically significant. Concentration of Bifidobacterium was inversely correlated to alanine aminotransferase in obese/overweight children. The faecal levels of calprotectin did not differ between the study groups. These findings indicate that the gut microbiota differed among preschool children with obesity/overweight compared with children with body mass index within the normal range.
19.	Norberg, C., et al. (author) Body mass index (BMI) and dental caries in 5-year-old children from southern Sweden 2012 In: Community Dentistry and Oral Epidemiology. - : Wiley. - 0301-5661 .- 1600-0528. ; 40:4, s. 315-322 Journal article (peer-reviewed)abstract Objectives The aim of the present survey was to study the association between dental caries and body mass index (BMI) in Swedish preschool children (born in 1999). Methods A population-based and cross-sectional study design was used comprising all 920 5-year-old children in a defined area in and around the city of Lund. Anthropometric measures for the calculation of BMI were retrieved for each child from recordings at Child Health Care Centers (CHC). The occurrence of caries and fillings in the primary dentition, defined as deft (decayed, extracted, or filled primary teeth) and dt (decayed primary teeth), was collected from the children's dental records. Results The mean BMI was 16.1 (no differences between boys and girls). About 19.2% were overweight, of which 5.1% were obese. Overweight or obese children did not have higher deft or dt than others. However, children with low BMI (below -1 SD of national mean values for Swedish 5-year-olds) had statistically significantly higher deft and dt than children with normal BMI. Conclusions Children with low BMI may be at risk of caries development. Low BMI may be associated with eating habits endangering dental health.
20.	Thorngren-Jerneck, Kristina, et al. (author) Cerebral Glucose Metabolism and Early EEG/aEEG in Term Newborn Infants with Hypoxic-Ischemic Encephalopathy. 2003 In: Pediatric Research. - 1530-0447. ; 54:6, s. 854-860 Journal article (peer-reviewed)
21.	Thorngren-Jerneck, Kristina, et al. (author) Cerebral glucose metabolism measured by positron emission tomography in term newborn infants with hypoxic ischemic encephalopathy 2001 In: Pediatric Research. - 1530-0447. ; 49:4, s. 495-501 Journal article (peer-reviewed)abstract Total and regional cerebral glucose metabolism (CMRgl) was measured by positron emission tomography with 2-(F-18) fluoro-2-deoxy-D-glucose ((18)FDG) in 20 term infants with hypoxic ischemic encephalopathy (HIE) after perinatal asphyxia. All infants had signs of perinatal distress, and 15 were severely acidotic at birth. Six infants developed mild HIE, twelve moderate HIE, and two severe HIE during their first days of life. The positron emission tomographic scans were performed at 4-24 d of age (median, 11 d). One hour before scanning, 2-3.7 MBq/kg (54-100 µCi/kg) (18)FDG was injected i.v. No sedation was used. Quantification of CMRgl was based on a new method employing the glucose metabolism of the erythrocytes, requiring only one blood sample. In all infants, the most metabolically active brain areas were the deep subcortical parts, thalamus, basal ganglia, and sensorimotor cortex. Frontal, temporal, and parietal cortex were less metabolically active in all infants. Total CMRgl was inversely correlated with the severity of HIE (p < 0.01). Six infants with mild HIE had a mean (range) CMRgL of 55.5 (37.7-100.8) mol.min(-1).100 g(-1), 11 with moderate HIE had 26.6 (13.0-65.1) µmol.min(-1).100 g(-1), and two with severe HIE had 10.4 and 15.0 µmol.min(-1).100 g(-1), respectively. Five of six infants who developed cerebral palsy had a mean (range) CMRgl of 18.1 (10.2-31.4) µmol.min(-1).100 g(-1) compared with 41.5 (13.0-100.8) µmol.min(-1).100 g(-1) in the infants with no neurologic sequela at 2 y. We conclude that CMRgl measured during the subacute period after perinatal asphyxia in term infants is highly correlated with the severity of HIE and short-term outcome.
22.	Thorngren-Jerneck, Kristina (author) Cerebral Injury in Perinatal Asphyxia, epidemiological, clinical, neurophysiological and neuromatabolic investigations 2002 Doctoral thesis (other academic/artistic)abstract Perinatal asphyxia with hypoxic ischemic encephalopathy (HIE) is the most important cause of perinatal mortality and cerebral palsy (CP) in infants born at term. The aim of the thesis was to investigate epidemiology of perinatal asphyxia, and to investigate early clinical neurological symptoms after perinatal asphyxia in relation to cerebral glucose metabolism (CMRgl) measured by 18-FDG-PET, neurophysiological function, some biochemical markers, also in relation to long-term outcome. The main purpose was to investigate hypoxic-ischemic brain injury in relation to cerebral metabolism, neurophysiology, and neurochemistry in order to evaluate prognostic tools after perinatal asphyxia. After the hypoxic-ischemic event there is evidence of a time-window before the permanent brain injury is established. In the near future, interventional treatment for hypoxic-ischemic brain injury may become a reality in infants born at term who have suffered perinatal asphyxia and hypoxia-ischemia. It is therefore of high priority to evaluate methods for early prediction of outcome that could be used for selecting infants with the highest risks of developing brain injury after asphyxia. The epidemiological problem of perinatal asphyxia was defined in two large population-based studies. The first study showed several obstetric and infant risk factors (e.g. breech presentation, high birth weight) to be associated with low 5 minute Apgar score in term infants. Mortality and the risk for severe neurological morbidity (CP, epilepsy and mental retardation) were increased in these infants. The second study showed that the majority (65 %) of children with CP are born at term. In term infants there is a strong correlation between some perinatal risk factors (abruptio placentae, breech presentation and low Apgar score) and development of CP. Cerebral glucose metabolism, measured by FDG-PET in the sub-acute period after perinatal asphyxia, was significantly reduced in term infants who developed moderate or severe HIE and subsequently CP. Early postnatal electro-cortical background activity, and delayed epileptic seizure activity were significantly correlated with CMRgl measured during the sub-acute phase after asphyxia, reflecting the degree of cerebral injury. The fifth study showed postnatal increased serum S100 reflecting the extent of brain damage in infants with HIE after asphyxia, suggesting S100 protein to be a complementary prognostic tool in predicting the risk for CP. A fetal/neonatal sheep model was developed, intended to reflect the clinical situation in newborn infants who had suffered a severe perinatal asphyxia. The model, incorporating the transition from fetal to neonatal life, was used to study early cerebral glucose metabolism with FDG-PET. The global CMRgl was significantly reduced in newborn lambs 4 hours after asphyxia induced by fetal umbilical cord occlusion.
23.	Thorngren-Jerneck, Kristina, et al. (author) Early adiposity rebound predicts overweight and obesity at 15 years of age 2009 In: Acta paediatrica. - 0803-5253. ; 98, s. 248-248 Conference paper (peer-reviewed)
24.	Thorngren-Jerneck, Kristina, et al. (author) Early determinants for overweight and obesity at five years of age 2009 In: Acta paediatrica. - 0803-5253. ; 98, s. 248-248 Conference paper (peer-reviewed)
25.	Thorngren-Jerneck, Kristina, et al. (author) Low 5-minute Apgar score: a population-based register study of 1 million term births 2001 In: Obstetrics and Gynecology. - 1873-233X. ; 98:1, s. 65-70 Journal article (peer-reviewed)abstract OBJECTIVE: To determine the rate of 5-minute Apgar scores below 7 in term infants (at least 37 weeks) in Sweden during 1988-1997, evaluate the influence of obstetric risk factors on low 5-minute Apgar scores, and to study the infant prognosis regarding infant mortality, neonatal neurologic morbidity, and outcome. METHODS: Data were collected from the Swedish Medical Birth Registry 1988-1997, and the National Hospital Discharge Registry. Odds ratios (OR) and risk ratios were calculated. RESULTS: Among 1,028,705 term newborns, 7787 (0.76%) had 5-minute Apgar scores below 7. The annual rate of low Apgar scores decreased from 0.77% in 1988 to 0.63% in 1992, but thereafter increased to 0.82% in 1998. The highest OR was found for vaginal breech delivery (OR 6.7), birth weights above 5 kg (OR 6.3), and second born twins (OR 4.1). Primiparity, maternal age, smoking, post-date pregnancy, epidural analgesia, male infant gender, and being born at night, were also significant risk factors for Apgar below 7 at 5 minutes. The infant mortality rate was 48 per 1000 (OR 14.4), and the ORs were 31.4 for a diagnosis with cerebral palsy, 7.9 for epilepsy, and 9.5 for mental retardation. CONCLUSION: Several obstetric risk factors are associated with low 5-minute Apgar score in term infants. Mortality and the risk of severe neurologic morbidity are increased in these infants.
26.	Thorngren-Jerneck, Kristina, et al. (author) Perinatal factors associated with cerebral palsy in children born in Sweden. 2006 In: Obstetrics and Gynecology. - 1873-233X. ; 108:6, s. 1499-1505 Journal article (peer-reviewed)abstract OBJECTIVE: To identify perinatal factors associated with cerebral palsy (CP). METHODS: This was a case-control study based on the Swedish Medical Birth Registry and the Swedish Hospital Discharge Registry, including 2,303 infants born in Sweden 1984-1998 with a diagnosis of CP and 1.6 million infants without this diagnosis. Odds ratios (ORs) with 95% confidence intervals (Cis) were calculated. RESULTS: Infants born preterm had a highly increased risk for CP, and constituted 35% of all cases; OR 34 (95% CI 29-39) in weeks23-27, OR 37 (95% CI 32-42) in weeks 28-29, OR 26 (95% CI 23-30) in weeks 30-31, and OR 3.9 (95% CI 3.4-4.4) in weeks 32-36. Boys had a higher risk (sex ratio 1.36:1), particularly before term (sex ratio 1.55:1). Other factors associated with CP were being small or large for gestational age at birth, abruptio placentae (OR 8.6, 95% CI 5.6-13.3), maternal insulin-dependent diabetes mellitus type 1 (OR 2.1, 95% CI 1.4-3.1), preeclampsia (OR 1.5, 95% CI 1.3-2.4), being a twin (OR 1.4, 95% CI 1.1-1.6), maternal age older than 40 years (OR 1.4, 95% CI 1.1-1.8) or 35-39 years (OR 1.2, 95% CI 1.1-1.4), primiparity (OR 1.2, 95% CI 1.1-1.3), and smoking (OR 1.2, 95% CI 1.1-1.3). In term infants, low Apgar scores were associated with a high risk for CP; OR 62 (95% CI 52-74) at score 6 at 5 minutes, OR 498 (95% CI 458-542) at score 3. Other factors associated with CP in term infants were breech presentation at vaginal birth (OR 3.0, 95% CI 2.4-3.7), instrumental delivery (OR 1.9, 95% CI 1.6-2.3), and emergency cesarean delivery (OR 1.8, 95% CI 1.6-2.0). CONCLUSION: Preterm birth entails a high risk for CP, but 65% of these children are born at term. Several obstetric factors and low Apgar scores are associated with CP.
27.	Thorngren-Jerneck, Kristina, et al. (author) Reduced postnatal cerebral glucose metabolism measured by PET after asphyxia in near term fetal lambs 2001 In: Journal of Neuroscience Research. - : Wiley. - 1097-4547 .- 0360-4012. ; 66:5, s. 844-850 Journal article (peer-reviewed)abstract The effects of fetal asphyxia on cerebral function and development, involve the transition from fetal to neonatal life. Changes in cerebral glucose metabolism may be an early postnatal indicator of fetal asphyxia. The objective is to develop an experimental lamb model involving the transition from fetal to neonatal life and to examine the effect of fetal asphyxia with cerebral hypoxic ischemia on early postnatal cerebral glucose metabolism. Fetal asphyxia was induced by total umbilical cord occlusion in eight near-term fetal lambs (134-138 days) with the ewe under isoflurane-opiate anesthesia. The mean occlusion time until cardiac arrest was 14.5 (4.2) min (SD). Lambs were immediately delivered and standardized resuscitation was instituted after 2 min asystole. At 4 hr postnatal age, [18-F]Fluoro-2-deoxy-glucose (18-FDG) was injected intravenously in eight asphyxiated lambs and in eight controls. Cerebral glucose metabolism was examined by positron emission tomography (PET). As a result the mean arterial blood pressure, acid-base values, blood glucose and serum lactate at 4 hr postnatal age did not differ significantly between lambs subjected to umbilical cord occlusion and controls. EEG was abnormal in all lambs subjected to cord occlusion and normal in the controls at 4 hr postnatal age. Global cerebral metabolic rate (CMRgl) as determined by PET was significantly lower in lambs subjected to cord occlusion mean/median (SD) 22.2/19.6 (8.4) micromol/min/100 g) than in controls mean/median (SD) 37.8/35.9 (6.1); P < 0.01). Global CMRgl is significantly reduced in newborn lambs 4 hr after fetal asphyxia induced by umbilical cord occlusion. A reduction in CMRgl is an early indicator of global hypoxic cerebral ischemia.
28.	Thorngren-Jerneck, Kristina, et al. (author) S100 protein in serum as a prognostic marker for cerebral injury in term newborn infants with hypoxic ischemic encephalopathy 2004 In: Pediatric Research. - 1530-0447. ; 55:3, s. 406-412 Journal article (peer-reviewed)abstract The astroglial protein S100 is an established biochemical marker for CNS injury in the adult. The aim was to investigate whether S100 in serum is a prognostic marker of cerebral injury in term newborn infants, with hypoxic ischemic encephalopathy (HIE) after perinatal asphyxia. Serum S100 was measured on postnatal days 1-4 in 62 term infants with birth asphyxia. The infants were classified for HIE and had follow-up for at least 18 mo. Infants with moderate and severe HIE had significantly higher S100 levels on postnatal day 1 (p = 0.031) and day 2 (p = 0.008) than infants with mild or no HIE. The levels of S100 decreased on days 2 and 3 in all infants with HIE. The median S 100 level on postnatal day I was higher in nine infants who died neonatally and in 10 infants who developed cerebral palsy (CP), compared with 43 infants with no signs of impairment at follow up, 14.0 (0.5-60.0) mug/L, 20.7 (0.2-64.0) mug/L and 5.5 (0.7-120.0) mug/L, respectively. A level of S100 above 12 mug/L the first day of life was significantly more trequent in infants who died or developed CP than in infants with no impairment at follow LIP (P = 0.02). Increased S100 levels were significantly inversely correlated with perinatal pH in the infants and associated with abnormal CTG at admission to the labor ward. Early determination of serum S100 may reflect the extent of brain damage in infants with HIE after asphyxia.
29.	Thorngren-Jerneck, Kristina, et al. (author) Syrebrist vid födelsen - kan barnet få hjärnskada? 2003 In: Syrebrist vid födelsen - kan barnet få hjärnskada?. ; , s. 50-50 Conference paper (peer-reviewed)
30.	Wu, L, et al. (author) [Different types of acidemia at birth, fetal heart rate patterns and infants outcome at four years of age] 1998 In: Zhonghua fu chan ke za zhi. ; 33, s. 5-462 Journal article (peer-reviewed)abstract OBJECTIVE: To study the relations between different types of acidemia in umbilical artery at birth, fetal heart rate patter'ns (FHR) during laobr and infant long-term outcome. METHODS: 2,981 cases with singleton term pregnancy were selected for retrospective case-control study. Fetal monitoring was performed periodically during labor and umbilical blood gas was analyzed at birth and the infants outcome was followed up at age 4. RESULTS: There were 47 infants with pure metabolic acidemia and 67 infants with mixed acidemia. The incidence of FHR score < 6 and 6-7 at the end of first stage was significantly higher in the two study groups than that in the control group. Late deceleration was associated with pure metabolic acidemia and complicated variable deceleration with mixed acidemia. Both types of acidemia were correlated with Apgar scores below 7 at 1 minute after birth. Developmental screening at age 4 showed no significant differences between the two study groups and the control groups. In the mixed acidemia group there were slightly more infants had deficits in speech/language development. CONCLUSIONS: Late deceleration may be an indicator of pure metabolic acidemia and complicated variable deceleration be an indicator of mixed acidemia. Both types of acidemia were correlated with Apgar scores below 7 at 1 minute after birth. The relation between acidemia at birth and deficit in speech/language development should be further evaluated.
31.	Önnerfält, Jenny, et al. (author) Obese children aged 4–6 displayed decreased fasting and postprandial ghrelin levels in response to a test meal 2018 In: Acta Paediatrica, International Journal of Paediatrics. - : Wiley. - 0803-5253. ; 107:3, s. 523-528 Journal article (peer-reviewed)abstract Aim: Ghrelin is a hunger hormone that plays a role in glucose homoeostasis and its levels increase before a meal and decrease during and after eating. This study compared the fasting ghrelin and insulin levels of obese children aged 4–6 with those of normal weight children and tested postprandial ghrelin levels in the obese children after a standard breakfast. Methods: We recruited 67 children at Lund University Hospital from 2008 to 2011. They comprised 30 obese children from a weight study and 37 normal weight children receiving minor elective surgery. Their mean ages were 4.7 ± 0.6 and 4.3 ± 0.8 years, respectively. The obese children ate a standard breakfast, and postprandial ghrelin was measured after 60 minutes. Results: The obese children had lower ghrelin levels than the controls (p < 0.01). A significant inverse relation was found between body mass index and fasting ghrelin levels. Obese children had significantly lower fasting ghrelin levels after a standard breakfast (p < 0.01), but there were no gender-related differences. Conclusion: Obese children aged 4–6 years had reduced ghrelin and increased insulin levels in the fasting state and postprandial ghrelin was suppressed, suggesting that their energy metabolism was already dysregulated at this young age. Early obesity interventions are essential.

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