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Ågren, Johan
Alternative names
Publications (10 of 29) Show all publications
Backes, C., Söderström, F., Ågren, J., Sindelar, R., Bartlett, C., Rivera, B., . . . Normann, E. (2019). Outcomes Following a Comprehensive versus a Selective Approach for Infants Born at 22 Weeks of Gestation.. Journal of Perinatology, 39(1), 39-47
Open this publication in new window or tab >>Outcomes Following a Comprehensive versus a Selective Approach for Infants Born at 22 Weeks of Gestation.
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2019 (English)In: Journal of Perinatology, ISSN 0743-8346, E-ISSN 1476-5543, Vol. 39, no 1, p. 39-47Article in journal (Refereed) Published
Abstract [en]

Objective: To examine outcomes at two institutions with different approaches to care among infants born at 22 weeks of gestation.

Study design: Retrospective, cohort study (2006–2015). Enrollment was limited to mother–infant dyads at 22 weeks of gestation. Proactive care was defined as provision of antenatal corticosteroids and neonatal resuscitation and intensive care. One center (Uppsala, Sweden; UUCH) provided proactive care to all mother–infant dyads (comprehensive center); the other center (Nationwide Children’s Hospital, USA; NCH) initiated or withheld treatment based on physician and family preferences (selective center). Differences in outcomes between the two centers were evaluated.

Result: Among 112 live-born infants at 22 weeks of gestation, those treated at UUCH had in-hospital survival rates higher than those at NCH (21/40, 53% vs. 6/72, 8%; P < 0.01). Among the subgroup of infants receiving proactive care (UUCH: 40/40, 100%; NCH: 16/72, 22%) survival was higher at UUCH than at NCH (21/40, 53% vs. 3/16, 19%; P < 0.05).

Conclusion: Even when mother–infant dyads were provided proactive care at NCH (selective center), survival was lower than infants provided proactive care at UUCH (comprehensive center). Differences between the approaches to care at the two centers at 22 weeks of gestation merits further investigation.

National Category
Pediatrics
Research subject
Pediatrics
Identifiers
urn:nbn:se:uu:diva-368850 (URN)10.1038/s41372-018-0248-y (DOI)000453409800008 ()
Available from: 2018-12-08 Created: 2018-12-08 Last updated: 2019-01-16Bibliographically approved
Biskop, E., Paulsdotter, T., Hellström-Westas, L., Ågren, J. & Thernström Blomqvist, Y. (2019). Parental participation during therapeutic hypothermia for neonatal hypoxicischemic encephalopathy. Sexual & Reproductive HealthCare, 20, 77-80
Open this publication in new window or tab >>Parental participation during therapeutic hypothermia for neonatal hypoxicischemic encephalopathy
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2019 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 20, p. 77-80Article in journal (Refereed) Published
Abstract [en]

Objectives: To examine parental participation in the care of newborn infants receiving therapeutic hypothermia, and to explore the possible impact of in-born vs out-born status, and location of hospital accommodation. Study design: Retrospective, quantitative and descriptive design. Main outcome measures: Infants medical charts were reviewed for defined aspects of parental participation (infant holding, tube feeding, and diaper change), and related to their in-born vs out-born status, and whether the parents were accommodated in the NICU or elsewhere. All infants have been cared for at the University Hospital Neonatal Intensive Care Unit, serving as a regional referral center for hypothermia treatment. This study is a part of a population-based regional cohort of asphyxiated newborn infants (n = 112) that received therapeutic hypothermia in 2007-2015. Results: Parents engaged in holding (60/112, 54%) or tube feeding (59/112, 53%) their infant. Parents of inborn infants (24/112, 21%) were more likely to check the placement of the feeding tube (11/24, 46% vs 15/88, 17%; p < 0.01) and change diapers (9/24, 38% vs 14/88, 16%; p < 0.05) than parents of out-born infants (88/112, 79%). A similar pattern of more extensive involvement was observed for both mothers and fathers who stayed at the neonatal intensive care compared to those accommodated elsewhere (p < 0.05). Conclusions: Active parental participation is feasible at the NICU even during therapeutic hypothermia. Timely postnatal transfer of parents of out-born/transported infants, and the provision of on-site accommodation may influence the quality of parental involvement.

Place, publisher, year, edition, pages
ELSEVIER IRELAND LTD, 2019
Keywords
Neonatal intensive care, Chart review, Therapeutic hypothermia, Neonatal hypoxic-ischemic encephalopathy, Parental participation, Parental involvement
National Category
Pediatrics Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-387928 (URN)10.1016/j.srhc.2019.03.004 (DOI)000470192400015 ()31084824 (PubMedID)
Available from: 2019-06-27 Created: 2019-06-27 Last updated: 2019-06-28Bibliographically approved
Söderström, F., Normann, E., Holmström, G., Larsson, E., Ahlsson, F., Sindelar, R. & Ågren, J. (2019). Reduced rate of retinopathy of prematurity after implementing lower oxygen saturation targets.. Journal of Perinatology, 39, 409-414
Open this publication in new window or tab >>Reduced rate of retinopathy of prematurity after implementing lower oxygen saturation targets.
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2019 (English)In: Journal of Perinatology, ISSN 0743-8346, E-ISSN 1476-5543, Vol. 39, p. 409-414Article in journal (Refereed) Published
Abstract [en]

Objective: To evaluate an implementation of lower oxygen saturation targets with retinopathy of prematurity (ROP) as primary outcome, in infants at the lowest extreme of prematurity.

Study design: Retrospective cohort including infants born at 22-25 weeks of gestation in 2005-2015 (n = 325), comparing high (87-93%) and low (85-90%) targets; infants transferred early were excluded from the main analysis to avoid bias.

Results: Overall survival was 76% in high saturation era, and 69% in low saturation era (p = .17). Treatment-requiring ROP was less common in low saturation group (14% vs 28%, p < .05) with the most prominent difference in the most immature infants. Including deceased infants in the analysis, necrotizing enterocolitis was more frequent in low saturation era (21% vs 10%, p < .05).

Conclusions: Implementing lower saturation targets resulted in a halved incidence of treatment-requiring ROP; the most immature infants seem to benefit the most. An association between lower oxygenation and necrotizing enterocolitis cannot be excluded.

National Category
Pediatrics
Research subject
Pediatrics
Identifiers
urn:nbn:se:uu:diva-368851 (URN)10.1038/s41372-018-0300-y (DOI)000459549600010 ()30617284 (PubMedID)
Available from: 2018-12-08 Created: 2018-12-08 Last updated: 2019-03-26Bibliographically approved
Liljeström, L., Wikström, A.-K., Ågren, J. & Jonsson, M. (2018). Antepartum risk factors for moderate to severe neonatal hypoxic ischemic encephalopathy: a Swedish national cohort study. Acta Obstetricia et Gynecologica Scandinavica, 97(5), 615-623
Open this publication in new window or tab >>Antepartum risk factors for moderate to severe neonatal hypoxic ischemic encephalopathy: a Swedish national cohort study
2018 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 97, no 5, p. 615-623Article in journal (Refereed) Published
Abstract [en]

Introduction

Our aim was to identify antepartum risk factors for neonatal hypoxic ischemic encephalopathy, with a focus on maternal body mass index and height.

Material and methods

National population-based cohort study of 692 428 live-born infants 36 gestational weeks in Sweden, 2009-2015. Data from the Swedish Medical Birth Register and the Swedish Neonatal Quality Register were linked. Short maternal stature was defined as 155 cm, and overweight as body mass index 25 kg/m(2). Therapeutic hypothermia served as surrogate marker of moderate to severe hypoxic ischemic encephalopathy. Associations between maternal and infant characteristics and hypoxic ischemic encephalopathy were calculated with logistic regression analyses, and risks were presented as odds ratios with 95% confidence intervals.

Results

Moderate to severe hypoxic ischemic encephalopathy occurred in 0.67/1000 infants. Nulliparity, previous cesarean delivery, short stature, overweight, gestational age, occiput posterior presentation and birthweight were all independently associated with hypoxic ischemic encephalopathy. The risk of hypoxic ischemic encephalopathy increased with decreasing maternal height and increasing body mass index. Compared with non-short women (156 cm) with normal weight (body mass index <25 kg/m(2)), those with both short stature and overweight had increased risk of hypoxic ischemic encephalopathy (odds ratio 3.66; 95% confidence intervals 2.41-5.55). Among parous women with both short stature and overweight, the risk was almost sixfold (odds ratio 5.74; 95% confidence intervals 3.41-9.66).

Conclusions

Antepartum risk factors for moderate to severe hypoxic ischemic encephalopathy included nulliparity, previous cesarean delivery, short stature, overweight, gestational age, occiput posterior presentation and birthweight. The combination of maternal short stature and overweight was associated with a more than threefold risk of subsequent hypoxic ischemic encephalopathy.

Keywords
Asphyxia, body mass index, hypoxic ischemic encephalopathy, maternal height, overweight, risk factors, short stature, therapeutic hypothermia
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-354099 (URN)10.1111/aogs.13316 (DOI)000430099900014 ()29450878 (PubMedID)
Funder
Swedish Research Council, 20143561Swedish Research Council, 2012-00087
Available from: 2018-06-19 Created: 2018-06-19 Last updated: 2018-06-19Bibliographically approved
Frid, I., Ågren, J., Kjellberg, M., Normann, E. & Sindelar, R. (2018). Critically ill neonates displayed stable vital parameters and reduced metabolic acidosis during neonatal emergency airborne transport in Sweden. Acta Paediatrica, 107(8), 1357-1361
Open this publication in new window or tab >>Critically ill neonates displayed stable vital parameters and reduced metabolic acidosis during neonatal emergency airborne transport in Sweden
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2018 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 107, no 8, p. 1357-1361Article in journal (Refereed) Published
Abstract [en]

Aim: This study evaluated the medical quality of acute airborne transports carried out by a neonatal emergency transport service in a Swedish healthcare region from 2012 to 2015. Methods: The transport charts and patient records of all infants transported to the regional centre were reviewed for transport indications and vital parameters and outcomes. Results: We identified 187 acute airborne transports and the main indications for referral were therapeutic hypothermia after perinatal asphyxia, extremely preterm birth and respiratory failure. There were 37 deaths, but none of these occurred during transport and none of the deaths that occurred within 24 hours after transport were found to be related to the transport per se. No differences were found in vital parameters or ventilator settings before and after transport, except for an improvement in blood pH (7.22 +/- 0.13 versus 7.27 +/- 0.13, mean +/- SD, p < 0.01), due to a decrease in base deficit (-8.0 +/- 6.8 versus -5.4 +/- 6.3 mmol, p < 0.001), while the partial pressure of carbon dioxide remained unchanged. Conclusion: During air transport, critically ill neonates displayed stable vital parameters and reduced metabolic acidosis. No transport-related mortality was found, but the high number of extremely preterm infants transported indicates the potential for improving in-utero transport.

Place, publisher, year, edition, pages
WILEY, 2018
Keywords
Airborne transportation, Asphyxia, Base deficit, Preterms, Surgery
National Category
Pediatrics
Identifiers
urn:nbn:se:uu:diva-361673 (URN)10.1111/apa.14295 (DOI)000438490100013 ()29480945 (PubMedID)
Available from: 2018-10-08 Created: 2018-10-08 Last updated: 2018-10-08Bibliographically approved
Naseh, N., Gonzalez, K. E., Vaz, T., Ferreira, H., Kaul, Y. F., Johansson, M., . . . Hellström-Westas, L. (2017). Early Hyperglycemia And Brain MRI Findings In Very Preterm Infants. Acta Paediatrica, 106(SI 469), 16-16
Open this publication in new window or tab >>Early Hyperglycemia And Brain MRI Findings In Very Preterm Infants
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2017 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 106, no SI 469, p. 16-16Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Objective: A previous study in extremely preterm infants demonstrated an association between hyperglycemia >8.3 mmol/l (150 mg/dl) on the first day of life and white matter reduction. The objectives of the present study were to further investigate possible associations between hyperglycemia and abnormal brain development and to evaluate the effect of hyperglycemia on neurodevelopment.

Method: Retrospective study of cerebral MRIs performed at term equivalent age in 75 very preterm infants (GA 22–31 weeks) born 2011–2015. The highest glucose values for each day, and the number of days with glucose >8.3 mmol/l during the first week of life were analyzed in relation to clinical data and MRI (1.5 T). The MRI evaluation included: visual scoring of gray and white matter abnormalities; measurement of apparent diffusion coefficient (ADC) in periventricular white matter, basal ganglia and pons, and a newly developed method for semi-automatic segmentation of brain volumes. MRI data were analyzed without knowledge of clinical data. No infant had IVH grade 3–4. No infant received insulin. Follow up at 2.5 years of corrected age is ongoing; data including Bayley Scales of Infant Development (BSID-III) was available in 45 infants.

Results: Clinical data are shown in the table. Significant (p < 0.05) univariate correlations were found between GA, BW, days on mechanical ventilation, highest blood glucose levels on days 2–5 and number of days with glucose >8.3 mmol/l, PVL and white matter volume. Days with glucose >8.3 mmol/l correlated independently with reduced white matter volume (p = 0.045), but not GA and days on mechanical ventilation. When BW was included in the analysis, days with glucose >8.3 mmol/l reached borderline significance (p = 0.068), but no other factor reached significance. For PVL, days of mechanical ventilation was the only independently associated factor (p = 0.012). In the 45 infants with follow up, only days with glucose >8.3 mmol/l was independently associated with a lower motor index on BSID-III.

Conclusion: Prolonged duration of high blood glucose >8.3 mmol/l during the first week of life in very preterm infants is associated with reduced white matter volume and may also be associated with poorer motor performance at 2.5 years.

National Category
Pediatrics
Identifiers
urn:nbn:se:uu:diva-333331 (URN)10.1111/apa.13877/full (DOI)000405213500022 ()
Available from: 2017-11-15 Created: 2017-11-15 Last updated: 2017-11-15Bibliographically approved
Karlsson, V., Sporre, B., Hellström-Westas, L. & Ågren, J. (2017). Poor performance of main-stream capnography in newborn infants during general anesthesia. Pediatric Anaesthesia, 27(12), 1235-1240
Open this publication in new window or tab >>Poor performance of main-stream capnography in newborn infants during general anesthesia
2017 (English)In: Pediatric Anaesthesia, ISSN 1155-5645, E-ISSN 1460-9592, Vol. 27, no 12, p. 1235-1240Article in journal (Refereed) Published
Abstract [en]

Background

Endtidal (ET) measurement of carbon dioxide is well established for intraoperative respiratory monitoring of adults and children, but the method's accuracy for intraoperative use in small newborn infants has been less extensively investigated.

Aims

The aim of this study was to compare carbon dioxide from ET measurements with arterialized capillary blood samples in newborn infants during general anesthesia and surgery.

Methods

Endtidal carbon dioxide was continuously measured during anesthesia and surgery and compared with simultaneous blood gas analyses obtained from capillary blood samples. Fifty-nine sample sets of ET to blood gas carbon dioxide were obtained from 23 prospectively enrolled infants with a gestational age of 23-41 weeks and a birth weight of 670-4110 g.

Results

Endtidal levels of carbon dioxide were considerably lower in all sample sets and only 4/23 individual ET-blood gas sample pairs differed <7.5 mm Hg (1 kPa). Bland-Altman analysis indicated a poor agreement with a bias of -13 7 mm Hg and a precision of +/- 14 mm Hg. The performance of ET measurements was particularly poor in infants weighing below 2.5 kg, in infants in need of respiratory support prior to anesthesia, and when the true (blood gas) carbon dioxide level was high, above 45 mm Hg.

Conclusion

Main-stream capnography during anesthesia and surgery correlated poorly to blood gas values in small and/or respiratory compromised infants. We conclude that caution should be exercised when relying solely on ET measurements to guide mechanical ventilation in the OR.

Keywords
capnography, infant, mechanical ventilation, neonatal, perioperative, surgery
National Category
Pediatrics
Identifiers
urn:nbn:se:uu:diva-341986 (URN)10.1111/pan.13266 (DOI)000414571000009 ()29072363 (PubMedID)
Available from: 2018-02-19 Created: 2018-02-19 Last updated: 2018-06-27
Späth, C., Sjöström, E. S., Ahlsson, F., Ågren, J. & Domellöf, M. (2017). Sodium supply influences plasma sodium concentration and the risks of hyper- and hyponatremia in extremely preterm infants. Pediatric Research, 81(3), 455-460
Open this publication in new window or tab >>Sodium supply influences plasma sodium concentration and the risks of hyper- and hyponatremia in extremely preterm infants
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2017 (English)In: Pediatric Research, ISSN 0031-3998, E-ISSN 1530-0447, Vol. 81, no 3, p. 455-460Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Hyper- and hyponatremia occur frequently in extremely preterm infants. Our purpose was to investigate plasma sodium (P-Na) concentrations, the incidence of hyper and hyponatremia, and the impact of possible predisposing factors in extremely preterm infants. METHODS: In this observational study, we analyzed data from the EXtremely PREterm (< 27wk.) infants in Sweden Study (EXPRESS, n = 707). Detailed nutritional, laboratory, and weight data were collected retrospectively from patient records. RESULTS: Mean +/- SD P-Na increased from 135.5 +/- 3.0 at birth to 144.3 +/- 6.1 mmol/l at a postnatal age of 3 d and decreased thereafter. Fifty percent of infants had hypernatremia (P-Na > 145 mmol/l) during the first week of life while 79% displayed hyponatremia (P-Na < 135 mmol/l) during week 2. Initially, the main sodium sources were blood products and saline injections/infusions, gradually shifting to parenteral and enteral nutrition towards the end of the first week. The major deter, minant of P-Na and the risks of hyper- and hyponatremia was sodium supply. Fluid volume provision was associated with postnatal weight change but not with P-Na. CONCLUSION: The supply of sodium, rather than fluid volume, is the major factor determining P-Na concentrations and the risks of hyper- and hyponatremia.

Place, publisher, year, edition, pages
NATURE PUBLISHING GROUP, 2017
National Category
Pediatrics
Identifiers
urn:nbn:se:uu:diva-320874 (URN)10.1038/pr.2016.264 (DOI)000396297000016 ()27935901 (PubMedID)
Available from: 2017-04-26 Created: 2017-04-26 Last updated: 2017-04-26Bibliographically approved
Karlsson, V., Sporre, B. & Ågren, J. (2016). Transcutaneousp PCO2 monitoring in newborn infants during general anesthesia is technically feasible. Anesthesia and Analgesia, ISSN 0003-2999, EISSN 1526-7598, 123(4), 1004-1007, Article ID 10.1213/ANE.0000000000001462.
Open this publication in new window or tab >>Transcutaneousp PCO2 monitoring in newborn infants during general anesthesia is technically feasible
2016 (English)In: Anesthesia and Analgesia, ISSN 0003-2999, EISSN 1526-7598, Vol. 123, no 4, p. 1004-1007, article id 10.1213/ANE.0000000000001462Article in journal (Refereed) Published
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-353906 (URN)10.1213/ANE.0000000000001462 (DOI)
Available from: 2018-06-17 Created: 2018-06-17 Last updated: 2018-09-26Bibliographically approved
Jonsson, M., Ågren, J., Nordén Lindeberg, S., Ohlin, A. & Hanson, U. (2015). Neonatal Encephalopathy and the Association to Asphyxia in Labor: EDITORIAL COMMENT. Obstetrical and Gynecological Survey, 70(4), 233-235
Open this publication in new window or tab >>Neonatal Encephalopathy and the Association to Asphyxia in Labor: EDITORIAL COMMENT
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2015 (English)In: Obstetrical and Gynecological Survey, ISSN 0029-7828, E-ISSN 1533-9866, Vol. 70, no 4, p. 233-235Article in journal, Editorial material (Other academic) Published
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-257120 (URN)10.1097/01.ogx.0000464927.25351.4a (DOI)000353029800003 ()
Available from: 2015-06-30 Created: 2015-06-30 Last updated: 2017-12-04Bibliographically approved
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