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Holmström, Gerd
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Publications (10 of 56) Show all publications
Hellström, A., Källen, K., Carlsson, B., Holmström, G., Jakobsson, P., Lundgren, P., . . . Hellgren, K. (2018). Extreme prematurity, treated retinopathy, bronchopulmonary dysplasia and cerebral palsy are significant risk factors for ophthalmological abnormalities at 6.5 years of age. Acta Paediatrica, 107(5), 811-821
Open this publication in new window or tab >>Extreme prematurity, treated retinopathy, bronchopulmonary dysplasia and cerebral palsy are significant risk factors for ophthalmological abnormalities at 6.5 years of age
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2018 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 107, no 5, p. 811-821Article in journal (Refereed) Published
Abstract [en]

Aim: This study evaluated the contributions of various prenatal and postnatal predictive factors to a documented high prevalence of ophthalmological abnormalities in children aged 6.5 years who were born extremely preterm.

Methods: We carried out a prospective population‐based study of all children born in Sweden at a gestational age of 22 + 0 to 26 + 6 weeks based on the Extremely Preterm Infants in Sweden Study. The main outcome measures were a combined score of visual impairment, refractive errors and strabismus at 6.5 years of age. Models of univariate and multivariable regression were used to analyse potential prenatal and postnatal predictive factors at different clinically relevant time‐points from one minute after birth to 30 months.

Results: We focused on 399 known extremely preterm survivors and compared them to 300 full‐term controls. Significant antecedents for ophthalmological abnormalities included prematurity per se, retinopathy of prematurity that required treatment, severe bronchopulmonary dysplasia and cerebral palsy. Severe intraventricular haemorrhage was no longer a significant risk factor when we adjusted it for the 30‐month cognitive and neuromotor development outcomes.

Conclusion: This time‐course risk analysis model showed a changing panorama of significant risk factors for ophthalmological abnormalities in children aged 6.5 years who were born extremely preterm.

Keywords
Bronchopulmonary dysplasia, Intraventricular haemorrhage, Ophthalmological outcome, Perinatal risk factors, Retinopathy of prematurity
National Category
Pediatrics Ophthalmology
Identifiers
urn:nbn:se:uu:diva-353365 (URN)10.1111/apa.14206 (DOI)000430115100015 ()29281748 (PubMedID)
Funder
Swedish Research Council, 2006-3858]Swedish Research Council, 2009-4250]Swedish Society of Medicine
Available from: 2018-06-19 Created: 2018-06-19 Last updated: 2018-06-19Bibliographically approved
Hreinsdottir, J., Kaul, Y. F., Hellström-Westas, L., Rosander, K., von Hofsten, C. & Holmström, G. (2018). Impaired cognitive ability at 2.5 years predicts later visual and ophthalmological problems in children born very preterm. Acta Paediatrica, 107(5), 822-830
Open this publication in new window or tab >>Impaired cognitive ability at 2.5 years predicts later visual and ophthalmological problems in children born very preterm
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2018 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 107, no 5, p. 822-830Article in journal (Refereed) Published
Abstract [en]

Aim: To identify possible predictive factors for visual problems at 6.5 years in children born very preterm.

Methods: During 2004–2007, all very preterm infants (gestational age [GA] <32 weeks) in Uppsala County, Sweden were screened for retinopathy of prematurity (ROP) neonatally; at four months, visual tracking was tested; at 2.5 years, visuospatial and cognitive tests were carried out. At 6.5 years, 84 preterm children and a reference group of 64 full‐term children underwent ophthalmological testing.

Results: Mean visual acuity (VA) did not differ between the groups, but subnormal VA (≤0.8) was more common in the preterm group (31% vs 14%; p < 0.05). More often than full‐term children, preterm children had impaired contrast sensitivity (<0.5) (36% vs 19%; p < 0.05) and strabismus (8% vs 0%; p < 0.05). Low GA, ROP, intraventricular haemorrhage 3‐4/periventricular leukomalacia and cognitive disability at 2.5 years predicted ophthalmological and visual problems at 6.5 years. Visual tracking ability at four months was not predictive of ophthalmological outcome.

Conclusion: Children born preterm had more ophthalmological problems at 6.5 years of age, including subtle dysfunctions. ROP, early brain injury and impaired cognitive function around 2.5 years predicted later ophthalmological dysfunctions.

Keywords
Cognition, Long term, Risk factor, Very preterm, Visual outcome
National Category
Ophthalmology Pediatrics
Identifiers
urn:nbn:se:uu:diva-348648 (URN)10.1111/apa.14209 (DOI)000430115100016 ()29288532 (PubMedID)
Available from: 2018-04-16 Created: 2018-04-16 Last updated: 2018-06-19Bibliographically approved
Holmström, G., Tornqvist, K., Al-Hawasi, A., Nilsson, Å., Wallin, A. & Hellström, A. (2018). Increased frequency of retinopathy of prematurity over the last decade and significant regional differences. Acta Ophthalmologica, 96(2), 142-148
Open this publication in new window or tab >>Increased frequency of retinopathy of prematurity over the last decade and significant regional differences
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2018 (English)In: Acta Ophthalmologica, ISSN 1755-375X, E-ISSN 1755-3768, Vol. 96, no 2, p. 142-148Article in journal (Refereed) Published
Abstract [en]

Purpose: Retinopathy of prematurity (ROP) causes childhood blindness globally in prematurely born infants. Although increased levels of oxygen supply lead to increased survival and reduced frequency of cerebral palsy, increased incidence of ROP is reported.

Methods: With the help of a Swedish register for ROP, SWEDROP, national and regional incidences of ROP and frequencies of treatment were evaluated from 2008 to 2015 (n=5734), as well as before and after targets of provided oxygen changed from 85-89% to 91-95% in 2014.

Results: Retinopathy of prematurity (ROP) was found in 31.9% (1829/5734) of all infants with a gestational age (GA) of <31weeks at birth and 5.7% of the infants (329/5734) had been treated for ROP. Analyses of the national data revealed an increased incidence of ROP during the 8-year study period (p=0.003), but there was no significant increase in the frequency of treatment. There were significant differences between the seven health regions of Sweden, regarding both incidence of ROP and frequency of treatment (p<0.001). Comparison of regional data before and after the new oxygen targets revealed a significant increase in treated ROP in one region [OR: 2.24 (CI: 1.11-4.49), p=0.024] and a borderline increase in one other [OR: 3.08 (CI: 0.99-9.60), p=0.052].

Conclusion: The Swedish national ROP register revealed an increased incidence of ROP during an 8-year period and significant regional differences regarding the incidence of ROP and frequency of treatment.

Place, publisher, year, edition, pages
WILEY, 2018
Keywords
incidence, oxygen, retinopathy of prematurity, treatment
National Category
Ophthalmology
Identifiers
urn:nbn:se:uu:diva-347537 (URN)10.1111/aos.13549 (DOI)000425369200039 ()29068172 (PubMedID)
Available from: 2018-04-04 Created: 2018-04-04 Last updated: 2018-04-04Bibliographically approved
Åkerblom, H., Holmström, G. & Larsson, E. (2018). The rim area of the optic nerve head, assessed with Heidelberg retina tomography, is smaller in prematurely born children than in children born at term. Acta Ophthalmologica, 96(7), Article ID 30218494.
Open this publication in new window or tab >>The rim area of the optic nerve head, assessed with Heidelberg retina tomography, is smaller in prematurely born children than in children born at term
2018 (English)In: Acta Ophthalmologica, ISSN 1755-375X, E-ISSN 1755-3768, Vol. 96, no 7, article id 30218494Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To examine the optic nerve head with Heidelberg tomography (HRT) in prematurely born school-age children and compare them to children born at term.

METHODS: Sixty-three 5-16-year-old children born with a gestational age (GA) of ≤32 weeks were included in the study and compared to 54 children of the same age, born at term. In the preterm group, 29 children had had retinopathy of prematurity (ROP) and nine children had neurological complications. The optic nerve head was assessed with HRT. Three measurements were performed, and the different topographic parameters were noted.

RESULTS: Rim area of the optic nerve was significantly smaller in prematurely born children than in children born at term. The mean difference was 0.146 mm2 (p = 0.02). No difference between the groups was found regarding disc area or cup area. In the preterm group, both disc and rim areas were reduced with increasing GA. No correlations with birthweight, ROP or neurological complications were found.

CONCLUSION: Reduced rim area of the optic nerve head was found in preterm children of school age. Previous ROP or neurological complication did not influence the result, suggesting the preterm birth per se was the reason for the reduction. Establishing whether this finding was caused by disturbed maturation of the optic nerve or by injury of the axons, or a combination of the two, will require further research.

Keywords
Heidelberg retina tomography, children, optic nerve head, prematurely born
National Category
Clinical Medicine
Research subject
Ophtalmology
Identifiers
urn:nbn:se:uu:diva-360768 (URN)10.1111/aos.13785 (DOI)30218494 (PubMedID)
Available from: 2018-09-18 Created: 2018-09-18 Last updated: 2018-12-06Bibliographically approved
Lundgren, P., Lundberg, L., Helgren, G., Holmström, G., Hard, A.-L., Smith, L. E., . . . Hellstrom, A. (2017). Aggressive Posterior Retinopathy of Prematurity Is Associated with Multiple Infectious Episodes and Thrombocytopenia. Neonatology, 111(1), 79-85
Open this publication in new window or tab >>Aggressive Posterior Retinopathy of Prematurity Is Associated with Multiple Infectious Episodes and Thrombocytopenia
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2017 (English)In: Neonatology, ISSN 1661-7800, E-ISSN 1661-7819, Vol. 111, no 1, p. 79-85Article in journal (Refereed) Published
Abstract [en]

Background: The most severe form of rapidly progressing retinopathy of prematurity (ROP) is termed aggressive posterior ROP (APROP). APROP frequently causes severe visual impairment in affected preterm infants despite timely and appropriate laser treatment. Objectives: We investigated the postnatal characteristics associated with APROP development in a national Swedish cohort. Methods: This retrospective, 1: 1 matched case-control study included all infants that developed APROP in zone 1 (n = 9) between 2008 and 2012. Control infants, matched for gestational age and birth weight, developed ROP no worse than stage 2 (n = 9). We retrieved data from medical records on infant birth characteristics, postnatal morbidities, and blood analyses from birth to the first ROP treatment. Infectious episodes included sepsis, C-reactive protein >= 10 mg/l, and other clinical signs of infection that required antibiotic treatment. A plate-let count < 100 x 10(9)/l was considered to be thrombocytopenia. Results: All APROP cases postnatally developed at least two infectious episodes, one in the first month and one around the time of ROP diagnosis. All APROP cases exhibited thrombocytopenia in the first month, and 6/9 exhibited thrombocytopenia around the time of ROP diagnosis. Compared to the controls, APROP cases more frequently developed necrotizing enterocolitis (8/9 vs. 1/9; p < 0.01) and sepsis (9/9 vs. 3/9; p < 0.01), and they had significantly lower median platelet counts (90 x 10 (9)/l, range 4-459, vs. 158 x 10(9)/l, range 20-500; p < 0.001). Conclusion: Multiple infectious episodes and thrombocytopenia, particularly around the time of ROP diagnosis, were associated with APROP development.

Keywords
Aggressive posterior retinopathy of prematurity, Preterm infant, Thrombocytopenia, Sepsis
National Category
Pediatrics
Identifiers
urn:nbn:se:uu:diva-359813 (URN)10.1159/000448161 (DOI)000390554700013 ()27631399 (PubMedID)
Funder
EU, FP7, Seventh Framework Programme, 305485
Available from: 2018-09-14 Created: 2018-09-14 Last updated: 2018-09-14Bibliographically approved
Molnar, A., Rosén, R. M., Nilsson, M., Larsson, E. K., Holmström, G. & Hellgren, K. M. (2017). Central macular thickness in 6.5-year-old children born extremely preterm is strongly associated with gestational age even when adjusted for risk factors. Retina, 37(12), 2281-2288
Open this publication in new window or tab >>Central macular thickness in 6.5-year-old children born extremely preterm is strongly associated with gestational age even when adjusted for risk factors
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2017 (English)In: Retina, ISSN 0275-004X, E-ISSN 1539-2864, Vol. 37, no 12, p. 2281-2288Article in journal (Refereed) Published
Abstract [en]

Purpose:To assess the macular thickness in 6.5-year-old children born extremelypreterm (EPT) in comparison with children born at term and to investigate risk factorsassociated with the macular thickness in the preterm group.

Methods:A population-based study of 6.5-year-old children born before the gestationalage of 27 weeks and age-matched control subjects. Macular assessments with opticalcoherence tomography were performed, and the results were compared with neonatal riskfactors and sex.

Results:Adequate optical coherence tomography measurements were obtained from134 children born EPT (mean gestational age of 25 weeks [range 23–26]) and 145 controlsubjects. The mean (range) of central macula thickness was significantly increased (P,0.001)in the EPT group (right eyes: 282mm [238–356], left eyes: 283mm[229–351]), compared withthe control group (right eyes: 249mm [208–293], left eyes: 248mm[207–290]). A multiple linearmixed model analysis of the EPT group revealed gestational age, retinopathy of prematurity,and male gender as important risk factors for an increased macular thickness. The macularthickness decreased by 3.9mm per gestational week, when adjusted for retinopathy of pre-maturity and sex.

Conclusion:Extremely preterm birth constitutes a substantial risk factor for a thickcentral macula, even when adjusted for retinopathy of prematurity and male gender.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2017
National Category
Ophthalmology
Research subject
Ophtalmology
Identifiers
urn:nbn:se:uu:diva-317548 (URN)10.1097/IAE.0000000000001469 (DOI)000425214400009 ()28098724 (PubMedID)
Funder
Swedish Society of MedicineSven Jerring FoundationStockholm County Council
Available from: 2017-03-16 Created: 2017-03-16 Last updated: 2018-04-10Bibliographically approved
Molnar, A. E. C., Andreasson, S. O., Larsson, E. K. B., Åkerblom, H. M. & Holmström, G. E. (2017). Reduction of Rod and Cone Function in 6.5-Year-Old Children Born Extremely Preterm. JAMA ophthalmology, 135(8), 854-861
Open this publication in new window or tab >>Reduction of Rod and Cone Function in 6.5-Year-Old Children Born Extremely Preterm
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2017 (English)In: JAMA ophthalmology, ISSN 2168-6165, E-ISSN 2168-6173, Vol. 135, no 8, p. 854-861Article in journal (Refereed) Published
Abstract [en]

IMPORTANCE The function of rods and cones in children born extremely preterm has not yet been fully investigated. OBJECTIVE To compare retinal function via full-field electroretinographic (ffERG) recordings in 6.5-year-old children born extremely preterm with children born at term. DESIGN, SETTING, AND PARTICIPANTS A subcohort study was conducted from July 1, 2010, to January 15, 2014, of the national Extremely Preterm Infants in Sweden Study, including preterm children (< 27 weeks' gestational age) and children born at term, at 6.5 years of age and living in the Uppsala health care region in Sweden. Full-field electroretinography was performed binocularly, using DTL electrodes and electroretinographic (ERG) protocols with flash strengths of 0.009, 0.17, 3.0, and 12.0 candelas (cd)/s/m(2), together with 30-Hz flicker and 3.0 cd/s/m(2) single-cone flash. MAIN OUTCOMES AND MEASURES The ffERG recordings were analyzed, and their associations with gestational age and retinopathy of prematurity were examined. RESULTS Adequate ffERG recordings were obtained from 52 preterm children (19 girls and 33 boys; mean [SD] age at examination, 6.6 [0.1] years) and 45 children born at term (22 girls and 23 boys; mean [SD] age at examination, 6.6 [0.1] years). Lower amplitudes of the combined rod and cone responses (the a-wave of the dark-adapted ERG protocol of 3.0 cd/s/m(2): mean difference, -48.9 mu V [95% CI, -80.0 to -17.9 mu V]; P =. 003; the a-wave of the dark-adapted ERG protocol of 12.0 cd/s/m(2): mean difference, -55.7 mu V [95% CI, -92.5 to -18.8 mu V]; P = .004), as well as of the isolated cone response (30-Hz flicker ERG: mean difference, -12.1 mu V [95% CI, -22.5 to -1.6 mu V]; P = .03), were found in the preterm group in comparison with the group born at term. The implicit time of the combined rod and cone responses (the a-wave of the dark-adapted ERG protocol of 12.0 cd/s/m(2)) was longer (mean difference, 1.2 milliseconds [95% CI, 0.3-2.0 milliseconds]; P = .01) in the preterm group, as were the isolated cone responses (30-Hz flicker ERG: mean difference, 1.2 milliseconds [95% CI, 0.5-1.8 milliseconds]; P < .001), than in the group born at term. No association was found between the ffERG recordings and gestational age or retinopathy of prematurity in the preterm group. CONCLUSIONS AND RELEVANCE Both rod function and cone function were reduced in children born extremely preterm when compared with children born at term. There was no association with retinopathy of prematurity in the preterm group, which suggests that being born extremely preterm may be one of the main reasons for a general retinal dysfunction.

National Category
Ophthalmology
Identifiers
urn:nbn:se:uu:diva-333605 (URN)10.1001/jamaophthalmol.2017.2069 (DOI)000407437700010 ()
Available from: 2017-11-17 Created: 2017-11-17 Last updated: 2017-11-17Bibliographically approved
Lundgren, P., Lundberg, L., Hellgren, G., Holmström, G., Hard, A. L., Smith, L. E., . . . Hellstrom, A. (2016). Aggressive posterior retinopathy of prematurity is associated with multiple infectious episodes and thrombocytopenia. European Journal of Pediatrics, 175(11), 1842-1842
Open this publication in new window or tab >>Aggressive posterior retinopathy of prematurity is associated with multiple infectious episodes and thrombocytopenia
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2016 (English)In: European Journal of Pediatrics, ISSN 0340-6199, E-ISSN 1432-1076, Vol. 175, no 11, p. 1842-1842Article in journal, Meeting abstract (Refereed) Published
National Category
Pediatrics Ophthalmology
Identifiers
urn:nbn:se:uu:diva-315015 (URN)000390040701525 ()
Available from: 2017-02-08 Created: 2017-02-08 Last updated: 2017-11-29Bibliographically approved
Holmström, G., Hellström, A., Jakobsson, P., Lundgren, P., Tornqvist, K. & Wallin, A. (2016). Five years of treatment for retinopathy of prematurity in Sweden: results from SWEDROP, a national quality register. British Journal of Ophthalmology, 100(12), 1656-1661
Open this publication in new window or tab >>Five years of treatment for retinopathy of prematurity in Sweden: results from SWEDROP, a national quality register
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2016 (English)In: British Journal of Ophthalmology, ISSN 0007-1161, E-ISSN 1468-2079, Vol. 100, no 12, p. 1656-1661Article in journal (Refereed) Published
Abstract [en]

Background/aims Retinopathy of prematurity (ROP) is a sight-threatening disease, requiring efficient screening and treatment. The present study aims to describe various aspects on treatment for ROP in Sweden. Methods Data on treatment for ROP in infants born in 2008-2012 were extracted from Swedish national register for retinopathy of prematurity, a web-based national register. Results During 2008-2012, 3488 infants with a gestational age (GA) at birth of <31 weeks had been screened for ROP in Sweden. Altogether, 30.3% (1057/3488) of the infants developed ROP and 5.2% (181/3488) were treated. Type 1 ROP was found in at least one eye in 83.2% (149/179) of the treated infants. One third of the eyes (32.2% right, 29.9% left eyes) were treated more than once. Laser was the only treatment in 90% of the eyes. Mean number of laser spots at first laser session was 1177 and 1386 in right and left eyes, respectively. Number of laser spots correlated negatively with GA at birth (p=0.01). There was no change in frequency of treatment or number of laser spots during the 5-year period. Anti-vascular endothelial growth factor injections were performed in 28 eyes, encircling band was used in five eyes and vitrectomies were performed in seven eyes. Twenty-six retinal surgeons performed 9.4 (range 1-37) treatment sessions in the 181 infants. Conclusions The present study reveals similar incidences of ROP and frequencies of treatment during the 5-year study period. Many surgeons were involved in treatment of a rather limited number of infants. The results call for national discussions on organisation of ROP treatment.

National Category
Ophthalmology Pediatrics
Identifiers
urn:nbn:se:uu:diva-311172 (URN)10.1136/bjophthalmol-2015-307263 (DOI)000388353500013 ()26969711 (PubMedID)
Available from: 2016-12-22 Created: 2016-12-22 Last updated: 2017-11-29Bibliographically approved
Stoltz Sjöström, E., Lundgren, P., Öhlund, I., Holmström, G., Hellström, A. & Domellöf, M. (2016). Low energy intake during the first 4 weeks of life increases the risk for severe retinopathy of prematurity in extremely preterm infants.. Archives of Disease in Childhood: Fetal and Neonatal Edition, 101(2), F108-F113
Open this publication in new window or tab >>Low energy intake during the first 4 weeks of life increases the risk for severe retinopathy of prematurity in extremely preterm infants.
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2016 (English)In: Archives of Disease in Childhood: Fetal and Neonatal Edition, ISSN 1359-2998, E-ISSN 1468-2052, Vol. 101, no 2, p. F108-F113Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Poor weight gain during the first weeks of life in preterm infants is closely associated with the risk of developing the retinopathy of prematurity (ROP) and insufficient nutrition might be an important contributing factor. This study aimed to evaluate the effect of energy and macronutrient intakes during the first 4 weeks of life on the risk for severe ROP (stages 3-5).

STUDY DESIGN: A population-based study including all Swedish extremely preterm infants born before 27 gestational weeks during a 3-year period. Each infant was classified according to the maximum stage of ROP in either eye as assessed prospectively until full retinal vascularisation. The detailed daily data of actual intakes of enteral and parenteral nutrition and growth data were obtained from hospital records.

RESULTS: Of the included 498 infants, 172 (34.5%) had severe ROP and 96 (19.3%) were treated. Energy and macronutrient intakes were less than recommended and the infants showed severe postnatal growth failure. Higher intakes of energy, fat and carbohydrates, but not protein, were significantly associated with a lower risk of severe ROP. Adjusting for morbidity, an increased energy intake of 10 kcal/kg/day was associated with a 24% decrease in severe ROP.

CONCLUSIONS: We showed that low energy intake during the first 4 weeks of life was an independent risk factor for severe ROP. This implies that the provision of adequate energy from parenteral and enteral sources during the first 4 weeks of life may be an effective method for reducing the risk of severe ROP in extremely preterm infants.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-274821 (URN)10.1136/archdischild-2014-306816 (DOI)000371325900005 ()25678632 (PubMedID)
Available from: 2016-01-26 Created: 2016-01-26 Last updated: 2017-11-30Bibliographically approved
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