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Hellström-Westas, LenaORCID iD iconorcid.org/0000-0003-3498-6069
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Publications (10 of 65) Show all publications
Norman, M., Hallberg, B., Abrahamsson, T., Björklund, L. J., Domellöf, M., Farooqi, A., . . . Håkansson, S. (2019). Association Between Year of Birth and 1-Year Survival Among Extremely Preterm Infants in Sweden During 2004-2007 and 2014-2016. Journal of the American Medical Association (JAMA), 321(12), 1188-1199
Open this publication in new window or tab >>Association Between Year of Birth and 1-Year Survival Among Extremely Preterm Infants in Sweden During 2004-2007 and 2014-2016
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2019 (English)In: Journal of the American Medical Association (JAMA), ISSN 0098-7484, E-ISSN 1538-3598, Vol. 321, no 12, p. 1188-1199Article in journal (Refereed) Published
Abstract [en]

IMPORTANCE Since 2004-2007, national guidelines and recommendations have been developed for the management of extremely preterm births in Sweden. If and how more uniform management has affected infant survival is unknown. OBJECTIVE To compare survival of extremely preterm infants born during 2004-2007 with survival of infants born during 2014-2016. DESIGN, SETTING AND PARTICIPANTS All births at 22-26weeks' gestational age (n = 2205) between April 1, 2004, and March 31, 2007, and between January 1, 2014, and December 31, 2016, in Sweden were studied. Prospective data collection was used during 2004-2007. Data were obtained from the Swedish pregnancy, medical birth, and neonatal quality registries during 2014-2016. EXPOSURES Delivery at 22-26 weeks' gestational age. MAIN OUTCOMES AND MEASURES The primary outcomewas infant survival to the age of 1 year. The secondary outcome was 1-year survival among live-born infants who did not have any major neonatal morbidity (specifically, without intraventricular hemorrhage grade 3-4, cystic periventricular leukomalacia, necrotizing enterocolitis, retinopathy of prematurity stage 3-5, or severe bronchopulmonary dysplasia). RESULTS During 2004-2007, 1009 births (3.3/1000 of all births) occurred at 22-26 weeks' gestational age compared with 1196 births (3.4/1000 of all births) during 2014-2016 (P =.61). One-year survival among live-born infants at 22-26 weeks' gestational age was significantly lower during 2004-2007 (497 of 705 infants [70%]) than during 2014-2016 (711 of 923 infants [77%]) (difference, -7%[95% CI, -11% to -2.2%], P =.003). One-year survival among live-born infants at 22-26 weeks' gestational age and without any major neonatal morbidity was significantly lower during 2004-2007 (226 of 705 infants [32%]) than during 2014-2016 (355 of 923 infants [38%]) (difference, -6%[95% CI, -11% to -1.7%], P =.008). CONCLUSIONS AND RELEVANCE Among live births at 22-26 weeks' gestational age in Sweden, 1-year survival improved between 2004-2007 and 2014-2016.

Place, publisher, year, edition, pages
AMER MEDICAL ASSOC, 2019
National Category
Pediatrics Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-382455 (URN)10.1001/jama.2019.2021 (DOI)000463074900015 ()30912837 (PubMedID)
Available from: 2019-05-10 Created: 2019-05-10 Last updated: 2019-05-10Bibliographically 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
Hellström-Westas, L. (2018). Amplitude-integrated electroencephalography for seizure detection in newborn infants. Seminars in Fetal & Neonatal Medicine, 23(3), 175-182
Open this publication in new window or tab >>Amplitude-integrated electroencephalography for seizure detection in newborn infants
2018 (English)In: Seminars in Fetal & Neonatal Medicine, ISSN 1744-165X, E-ISSN 1878-0946, Vol. 23, no 3, p. 175-182Article in journal (Refereed) Published
Abstract [en]

The amplitude-integrated electroencephalogram (aEEG) is a filtered and compressed EEG trend that can be used for long-term monitoring of brain function in patients of all ages. aEEG is increasingly used in neonatal intensive care units since several studies have shown its utility in high-risk newborn infants. Main indications for aEEG monitoring include early evaluation of brain function after perinatal asphyxia and seizure detection. The aEEG is usually recorded from one or two channels derived from parietal, central, or frontal leads. Although the aEEG is very useful for identifying high-risk infants and infants with seizures, the compressed trend has limitations with regards to detection of individual seizures. However, modern monitors also display the corresponding EEG (aEEG/EEG), which increases the probability of detecting single brief seizures. For improved evaluation of electrocortical brain activity the aEEG/EEG should be assessed together with repeated conventional EEGs or multi-channel EEG monitoring in a multi-disciplinary team.

Keywords
Brain monitoring, Electroencephalography, Antiepileptic treatment, Neonatal encephalopathy, Intraventricular hemorrhage, White matter damage
National Category
Pediatrics
Identifiers
urn:nbn:se:uu:diva-387457 (URN)10.1016/j.siny.2018.02.003 (DOI)000439674400004 ()29472139 (PubMedID)
Available from: 2019-06-25 Created: 2019-06-25 Last updated: 2019-06-25Bibliographically approved
Hellström-Westas, L. (2018). Amplitude-integrated electroencephalography for seizure detection in newborn infants. Seminars in Fetal & Neonatal Medicine, 23(3), 175-182
Open this publication in new window or tab >>Amplitude-integrated electroencephalography for seizure detection in newborn infants
2018 (English)In: Seminars in Fetal & Neonatal Medicine, ISSN 1744-165X, E-ISSN 1878-0946, Vol. 23, no 3, p. 175-182Article in journal (Refereed) Published
Abstract [en]

The amplitude-integrated electroencephalogram (aEEG) is a filtered and compressed EEG trend that can be used for long-term monitoring of brain function in patients of all ages. aEEG is increasingly used in neonatal intensive care units since several studies have shown its utility in high-risk newborn infants. Main indications for aEEG monitoring include early evaluation of brain function after perinatal asphyxia and seizure detection. The aEEG is usually recorded from one or two channels derived from parietal, central, or frontal leads. Although the aEEG is very useful for identifying high-risk infants and infants with seizures, the compressed trend has limitations with regards to detection of individual seizures. However, modern monitors also display the corresponding EEG (aEEG/EEG), which increases the probability of detecting single brief seizures. For improved evaluation of electrocortical brain activity the aEEG/EEG should be assessed together with repeated conventional EEGs or multi-channel EEG monitoring in a multi-disciplinary team. (C) 2018 Elsevier Ltd. All rights reserved.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Brain monitoring, Electroencephalography, Antiepileptic treatment, Neonatal encephalopathy, Intraventricular hemorrhage, White matter damage
National Category
Pediatrics
Identifiers
urn:nbn:se:uu:diva-386299 (URN)10.1016/j.siny.2018.02.003 (DOI)000439674400004 ()29472139 (PubMedID)
Available from: 2019-07-18 Created: 2019-07-18 Last updated: 2019-07-18Bibliographically approved
Ericson, J., Eriksson, M., Hoddinott, P., Hellström-Westas, L. & Flacking, R. (2018). Breastfeeding and risk for ceasing in mothers of preterm infants-Long-term follow-up. Maternal and Child Nutrition, 14(4), Article ID e12618.
Open this publication in new window or tab >>Breastfeeding and risk for ceasing in mothers of preterm infants-Long-term follow-up
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2018 (English)In: Maternal and Child Nutrition, ISSN 1740-8695, E-ISSN 1740-8709, Vol. 14, no 4, article id e12618Article in journal (Refereed) Published
Abstract [en]

Breastfeeding is challenging for mothers of preterm infants. The aim of this paper is to describe risk factors for ceasing breastfeeding and methods of feeding until 12 months postnatal age in mothers who breastfed their preterm infants at discharge from neonatal intensive care units (NICUs). The data come from a randomised controlled trial, which evaluated the effectiveness on exclusive breastfeeding at 8 weeks of proactive telephone support compared with reactive support offered to mothers of preterm infants following discharge from NICU. Six NICUs across Sweden randomised a total of 493 mothers. We used regression and survival analyses to assess the risk factors for ceasing breastfeeding and the long-term outcomes of the intervention. The results showed that 305 (64%) of the infants were breastfed at 6 months and 49 (21%) at 12 months. Partial breastfeeding at discharge, low maternal educational level, and longer length of stay in the NICU increased the risk for ceasing breastfeeding during the first 12 months. Furthermore, the Kaplan-Meier analysis showed that the proportion of mothers who ceased breastfeeding did not differ between the intervention (n = 231) and controls (n = 262) during the first 12 months (log-rank test p = .68). No difference was found between groups on method of feeding. More than 85% of the infants were fed directly at the breast. These findings provide important insights for health professionals who are supporting mothers of preterm infants to breastfeed long term.

Keywords
bottle, breast milk, feeding, mother, neonatal, RCT
National Category
Nursing Pediatrics Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-369765 (URN)10.1111/mcn.12618 (DOI)000448900800013 ()29733102 (PubMedID)
Available from: 2018-12-17 Created: 2018-12-17 Last updated: 2018-12-17Bibliographically approved
Otterman, G., Lahne, K., Arkema, E., Lucas, S., Janson, S. & Hellström-Westas, L. (2018). Childhood death rates declined in Sweden from 2000 to 2014 but deaths from external causes were not always investigated. Acta Paediatrica
Open this publication in new window or tab >>Childhood death rates declined in Sweden from 2000 to 2014 but deaths from external causes were not always investigated
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2018 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227Article in journal (Refereed) Epub ahead of print
National Category
Medical and Health Sciences
Research subject
Pediatrics
Identifiers
urn:nbn:se:uu:diva-347798 (URN)
Funder
The Swedish Crime Victim Compensation and Support Authority
Available from: 2018-04-07 Created: 2018-04-07 Last updated: 2018-04-07
Otterman, G., Lahne, K., Arkema, E. V., Lucas, S., Janson, S. & Hellström-Westas, L. (2018). Childhood death rates declined in Sweden from 2000-2014 but deaths from external causes were not always investigated.. Acta Paediatrica, 108(1), 160-168
Open this publication in new window or tab >>Childhood death rates declined in Sweden from 2000-2014 but deaths from external causes were not always investigated.
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2018 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 108, no 1, p. 160-168Article in journal (Refereed) Published
Abstract [en]

AIM: Countries that conduct systematic child death reviews report a high proportion of modifiable characteristics among deaths from external causes and this study examined the trends in Sweden.

METHODS: We analysed individual level data on external, ill-defined and unknown causes from the Swedish cause of death register from 2000-2014 and mortality rates were estimated for children under the age of one and for those aged 1-14 and 15-17 years.

RESULTS: Child deaths from all causes were 7,914 and 2,006 (25%) were from external, ill-defined and unknown causes: 610 (30%) were infants, 692 (34%) were 1-14 and 704 (35%) were 15-17. The annual average was 134 cases (range 99-156) during the study period. Mortality rates from external, ill-defined and unknown causes in children under 18 fell 19%, from 7.4 to 6.0 per 100,000 population. A sizeable number of infant deaths (8.0%) were registered without a death certificate during the study period, but these counts were lower in children aged 1-14 (1.3%) and 15-17 (0.9%).

CONCLUSION: Childhood deaths showed a sustained decline from 2000-2014 in Sweden and a quarter were from external, ill-defined or unknown causes. Systematic, interagency death reviews could yield information that could prevent future deaths. This article is protected by copyright. All rights reserved.

Keywords
Cause of death, Child death review, Child mortality, Register data, Sweden
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-347800 (URN)10.1111/apa.14309 (DOI)000452620600028 ()29520820 (PubMedID)
Funder
The Swedish Crime Victim Compensation and Support Authority
Available from: 2018-04-07 Created: 2018-04-07 Last updated: 2019-01-15Bibliographically approved
Wikström, S., Hövel, H., Pupp, I. H., Fellman, V., Hüppi, P. S., Ley, D. & Hellström-Westas, L. (2018). Early Electroencephalography Suppression and Postnatal Morbidities Correlate with Cerebral Volume at Term-Equivalent Age in Very Preterm Infants. Neonatology, 113(1), 15-20
Open this publication in new window or tab >>Early Electroencephalography Suppression and Postnatal Morbidities Correlate with Cerebral Volume at Term-Equivalent Age in Very Preterm Infants
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2018 (English)In: Neonatology, ISSN 1661-7800, E-ISSN 1661-7819, Vol. 113, no 1, p. 15-20Article in journal (Refereed) Published
Abstract [en]

Background: Early brain activity is associated with long-term outcome. Establishing a relation also with postnatal brain growth may increase our understanding of early life influences on preterm brain development.

Objectives: The aim of this study was to investigate whether early electroencephalography (EEG) activity in infants born very preterm is associated with brain volumes at term, and whether postnatal morbidity affects this association.

Methods: Very preterm infants (n = 38) with a median gestational age (GA) of 25.6 weeks had early recordings of single-channel EEG. The percentage of suppressed EEG, i.e., interburst intervals (IBI%) between 24 and 72 h of age, was analyzed in relation to brain volumes on magnetic resonance imaging performed at term-equivalent age, taking into account neonatal morbidities.

Results: Early electrocortical depression and a higher IBI% were associated with increased cerebrospinal fluid volume (CSFV) and lower total brain volume relative to intracranial volume, also after adjustment for GA, postnatal morbidities, morphine administration, and postnatal head growth. Overall, an increase in IBI% to 1 SD from the mean corresponded with an increase in CSFV to +0.7 SD and a decrease in brain volume to -0.7 SD. The presence of 2 or more postnatal morbidities were associated with around 10% lower brain volumes.

Conclusions: More suppressed early EEG activity of very preterm infants is associated with lower brain volume and increased CSFV at term age, also when adjusting for postnatal morbidities. The findings indicate the importance of pre- and early postpartal determinants of postnatal brain growth, possibly also including activity-dependent mechanisms for brain growth.

Place, publisher, year, edition, pages
KARGER, 2018
Keywords
Electroencephalography, Magnetic resonance imaging, Preterm, Brain development, Cerebrospinal fluid
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-338983 (URN)10.1159/000479423 (DOI)000418304700003 ()28934743 (PubMedID)
Funder
Swedish Research Council, 0037, 14940, 0084
Available from: 2018-01-17 Created: 2018-01-17 Last updated: 2018-01-17Bibliographically 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
Bolk, J., Kaul, Y. F., Hellström-Westas, L., Stjernqvist, K., Padilla, N., Serenius, F., . . . Åden, U. (2018). National population-based cohort study found that visual-motor integration was commonly affected in extremely preterm born children at six-and-a-half years. Acta Paediatrica, 107(5), 831-837
Open this publication in new window or tab >>National population-based cohort study found that visual-motor integration was commonly affected in extremely preterm born children at six-and-a-half years
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2018 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 107, no 5, p. 831-837Article in journal (Refereed) Published
Abstract [en]

Aim: This study aimed to explain the relationship between visual‐motor integration (VMI) abilities and extremely preterm (EPT) birth, by exploring the influence of perinatal variables, cognition, manual dexterity and ophthalmological outcomes.

Methods: This was part of the population‐based national Extremely Preterm Infant Study in Sweden (EXPRESS) study. We studied 355 children, born at a gestational age of <27 weeks from April 2004 to March 2007, and 364 term‐born controls. At six‐and‐a‐half years of age, we assessed VMI, cognitive function, motor skills and vision. VMI impairment was classified as <−1 standard deviation (SD).

Results: The mean (SD) VMI score was 87 (±12) in preterm children compared to 98 (±11) in controls (p < 0.001). VMI impairment was present in 55% of preterm infants and in 78% of children born at 22–23 weeks. Male sex and postnatal steroids showed a weak association with poorer visual‐motor performance, whereas low manual dexterity and cognitive function showed a stronger association.

Conclusion: Poor VMI performance was common in this EXPRESS cohort of children born EPT. Its strong association to cognition and manual dexterity confirms that all of these factors need to be taken into account when evaluating risks in preterm born children.

Keywords
Children, Extremely preterm, Outcome, Perinatal risk factors, Visual-motor integration
National Category
Pediatrics
Identifiers
urn:nbn:se:uu:diva-353367 (URN)10.1111/apa.14231 (DOI)000430115100017 ()29356073 (PubMedID)
Funder
Swedish Research Council, 523-2011-3981Stockholm County Council, ALF-20160227Marianne and Marcus Wallenberg Foundation, 2011.0085The Swedish Medical AssociationThe Swedish Brain Foundation
Available from: 2018-06-19 Created: 2018-06-19 Last updated: 2018-06-19Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0003-3498-6069

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