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Publications (10 of 10) Show all publications
Karlsson, V., Thernström Blomqvist, Y. & Ågren, J. (2022). Nursing care of infants born extremely preterm. Seminars in Fetal & Neonatal Medicine, 27(3), Article ID 101369.
Open this publication in new window or tab >>Nursing care of infants born extremely preterm
2022 (English)In: Seminars in Fetal & Neonatal Medicine, ISSN 1744-165X, E-ISSN 1878-0946, Vol. 27, no 3, article id 101369Article in journal (Refereed) Published
Abstract [en]

With improving survival at the lowest gestations an increasing number of tiny and vulnerable infants are being cared for, and optimal outcomes require an approach to care that takes their specific characteristics into account. These include immature organ function and a risk for iatrogenic injury, and parental/familial strain due to the high degree of uncertainty, infant-mother separation, and long hospital stay. While the challenges in providing nursing care to these infants are obvious it is also clear that this field has tremendous potential to influence both short and long-term outcomes of this population. This mini-review discusses aspects of the nursing care provided to infants born at the very lowest gestations and their families, with focus on doing less harm by establishing an adequate care environment, actively promoting parental closeness and care-giving, and conservative skin care.

Place, publisher, year, edition, pages
ElsevierElsevier BV, 2022
Keywords
Insensible water loss, Skin to skin care, Immaturity, Family integrated care
National Category
Pediatrics
Identifiers
urn:nbn:se:uu:diva-481702 (URN)10.1016/j.siny.2022.101369 (DOI)000824410900007 ()35739009 (PubMedID)
Available from: 2022-08-16 Created: 2022-08-16 Last updated: 2024-01-15Bibliographically approved
Karlsson, V., Sporre, B., Fredén, F. & Ågren, J. (2022). Randomized controlled trial of low vs high oxygen during neonatal anesthesia: Oxygenation, feasibility, and oxidative stress. Pediatric Anaesthesia, 32(9), 1062-1069
Open this publication in new window or tab >>Randomized controlled trial of low vs high oxygen during neonatal anesthesia: Oxygenation, feasibility, and oxidative stress
2022 (English)In: Pediatric Anaesthesia, ISSN 1155-5645, E-ISSN 1460-9592, Vol. 32, no 9, p. 1062-1069Article in journal (Refereed) Published
Abstract [en]

Background To reduce risk for intermittent hypoxia a high fraction of inspired oxygen is routinely used during anesthesia induction. This differs from the cautious dosing of oxygen during neonatal resuscitation and intensive care and may result in significant hyperoxia. Aim In a randomized controlled trial, we evaluated oxygenation during general anesthesia with a low (23%) vs a high (80% during induction and recovery, and 40% during maintenance) fraction of inspired oxygen, in newborn infants undergoing surgery. Method Thirty-five newborn infants with postconceptional age of 35-44 weeks were included (17 infants in low and 18 in high oxygen group). Oxygenation was monitored by transcutaneous partial pressure of oxygen, pulse oximetry, and cerebral oxygenation. Predefined SpO2 safety targets dictated when to increase inspired oxygen. Results At start of anesthesia, oxygenation was similar in both groups. Throughout anesthesia, the high oxygen group displayed significant hyperoxia with higher (difference-20.3 kPa, 95% confidence interval (CI)-28.4 to 12.2, p < .001) transcutaneous partial pressure of oxygen values than the low oxygen group. While SpO2 in the low oxygen group was lower (difference - 5.8%, 95% CI -9.3 to -2.4, p < .001) during anesthesia, none of the infants spent enough time below SpO(2) safety targets to mandate supplemental oxygen, and cerebral oxygenation was within the normal range and not statistically different between the groups. Analysis of the oxidative stress biomarker urinary F-2-Isoprostane revealed no differences between the low and high oxygen group. Conclusion We conclude that in healthy newborn infants, use of low oxygen during general anesthesia was feasible, while the prevailing practice of using high levels of inspired oxygen resulted in significant hyperoxia. The trade-off between careful dosing of oxygen and risks of hypo- and hyperoxia in neonatal anesthesia should be further examined.

Place, publisher, year, edition, pages
John Wiley & SonsWiley, 2022
Keywords
F2-Isoprostanes, hyperoxia, neonatal anesthesia, oxidative stress, oxygenation
National Category
Pediatrics Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-483581 (URN)10.1111/pan.14519 (DOI)000824216300001 ()35791748 (PubMedID)
Funder
Gillbergska stiftelsen
Available from: 2022-08-31 Created: 2022-08-31 Last updated: 2024-01-15Bibliographically approved
Thernström Blomqvist, Y., Ågren, J. & Karlsson, V. (2022). The Swedish approach to nurturing extremely preterm infants and their families: A nursing perspective. Seminars in Perinatology, 46(1), Article ID 151542.
Open this publication in new window or tab >>The Swedish approach to nurturing extremely preterm infants and their families: A nursing perspective
2022 (English)In: Seminars in Perinatology, ISSN 0146-0005, E-ISSN 1558-075X, Seminars in perinatology, ISSN 0146-0005, Vol. 46, no 1, article id 151542Article, review/survey (Refereed) Published
Abstract [en]

Nurturing extremely premature infants is a complicated task that not only necessitates a systematic approach to the immature physiology and its medical management, but also to the needs of the family. Infants born at 22-24 weeks require many weeks of intensive care including a long duration of mechanical ventilation, numerous stressful medical interventions, and for the parents to spend a lot of time in the Neonatal Intensive Care unit (NICU). This paper aims to outline the Swedish nursing approach to nurturing these infants and their families. The nursing care is structured so the parents are the primary caregivers supported by the staff and is based on: timely expression and provision of mother's own breast milk, early and prolonged skin-to-skin contact and close collaboration with the family. While this presentation is based on a single-center's experience, it well represents the general features of nursing provided to extremely preterm infants in Swedish NICUs.

Place, publisher, year, edition, pages
ElsevierElsevier BV, 2022
Keywords
Extremely preterm infants, Family-centered care, Family-integrated care, Neonatal intensive care, Parenting, Skin-to-skin contact
National Category
Pediatrics Nursing
Identifiers
urn:nbn:se:uu:diva-467936 (URN)10.1016/j.semperi.2021.151542 (DOI)000750188000010 ()34911652 (PubMedID)
Available from: 2022-02-24 Created: 2022-02-24 Last updated: 2024-01-15Bibliographically approved
Thernström Blomqvist, Y., Karlsson, V., Dawit, F., Sindelar, R. & Ågren, J. (2020). Physiological Stability in Very Preterm Infants During Skin-to-Skin Contact as Assessed by Near-Infrared Spectroscopy. Advances in Neonatal Care, 20(6), 495-498
Open this publication in new window or tab >>Physiological Stability in Very Preterm Infants During Skin-to-Skin Contact as Assessed by Near-Infrared Spectroscopy
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2020 (English)In: Advances in Neonatal Care, ISSN 1536-0903, E-ISSN 1536-0911, Vol. 20, no 6, p. 495-498Article in journal (Refereed) Published
Abstract [en]

Background: 

Skin-to-skin contact (SSC) has been demonstrated to allow adequate thermal stability in high-technology settings with extremely preterm infants, while other aspects on how SSC influences basic physiological parameters have been less extensively investigated.

Purpose: 

To evaluate physiological stability during SSC and incubator care in a group of preterm infants born at a gestational age (GA) of 32 weeks or less and receiving respiratory support.

Methods: 

Descriptive, observational study including 10 preterm infants (GA 22-32 weeks, postnatal age 2-48 days) were evaluated during SSC compared with flanking time periods in the incubator. Cerebral and systemic regional oxygen saturation (rSao2), pulse oximetry (Spo2), heart rate (HR), and body temperature were recorded, and the fractional tissue oxygen extraction (fTOE) was calculated.

Results: 

A total of 16 periods of SSC (mean duration 3 hours 30 minutes) were evaluated, 9 during nasal continuous positive airway pressure and 7 during mechanical ventilation. Cerebral rSao2 was 68% ± 4% (SE) and 69% ± 4% during incubator care and SSC, respectively (P = .56). Somatic rSao2 was 64% ± 4% during incubator care and 66% ± 4% during SSC (P = .54). Also, fTOE, HR, and Spo2 was similar during the 2 modes of care. Body temperature increased during SSC (P < .01).

Implications for Practice: 

The present study reveals no differences in cerebral and somatic tissue oxygenation between periods of SSC and care in the incubator. The findings indicate that SSC supports physiological stability also during management of very preterm infants receiving respiratory support.

Implications for Research: 

Further studies directed to further optimize SSC performance should enable its safe implementation at gradually lower gestational and postnatal ages.

Keywords
neonatal intensive care, skin-to-skin contact, thermal balance
National Category
Pediatrics
Research subject
Clinical Physiology
Identifiers
urn:nbn:se:uu:diva-406894 (URN)10.1097/ANC.0000000000000764 (DOI)000610965300014 ()32384330 (PubMedID)
Available from: 2020-03-16 Created: 2020-03-16 Last updated: 2021-02-26Bibliographically approved
Karlsson, V. (2018). Aspects of neonatal intensive care and anesthesia: Thermal balance and respiratory management. (Doctoral dissertation). uppsala: Acta Universitatis Upsaliensis
Open this publication in new window or tab >>Aspects of neonatal intensive care and anesthesia: Thermal balance and respiratory management
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis is based on four articles originating from three studies conducted in the neonatal intensive care unit and the children’s operating deparment at Uppsala University Hospital, Sweden.

The overall aim was to obtain new knowledge about thermal balance and care environment in extremely preterm infants during skin-to-skin care (SSC), evaluate different methods of intraoperative monitoring of carbon dioxide (CO2), and to investigate how different levels of inhaled oxygen affect infants’ oxygenation during anesthesia and surgery. Study I investigated infant thermal balance and the physical environment for extremely preterm infants during SSC. Study II formed part of a prospective study to assess the performance of non-invasive transcutaneous and end-tidal technique to continuously monitor CO2 levels in the infants blood during anesthesia. Study III was a prospective randomized trial to investigate oxygenation during induction of anesthesia with room air versus high fraction (80%) of oxygen in healthy newborn infants.

The infants maintained normal body temperature during SSC. In comparison to care in an incubator, during SSC ambient humidity was lower and insensible water loss through the skin was higher. Compared to blood gas Pco, transcutaneous carbon dioxide monitoring yielded a bias of 0.3 ± 0.7 kPa, and end-tidal technique a bias of -1.9 ± 0.9 kPa. After intubation, saturation measured by pulse oximetry was lower (p < .05) in the group breathing room air than in the group with high oxygen (93% ± 6.7 and 99% ± 1.5). None of the infants spent time below the pre-specified safety oxygen saturation targets to mandate supplemental oxygen.

This thesis provides new knowledge about early initiation of SSC after birth for extremely preterm infants, the results will be useful to guide safe routines for implementation of early SSC. These results suggest that during anesthesia would transcutaneous monitoring of carbon dioxide be beneficial, end-tidal monitoring correlated poorly to blood gas and induction of general anesthesia in newborn infants can be safely performed without the use of high levels of supplemental oxygen. Taken together, this new knowledge has the potential to improve intraoperative respiratory management.

Place, publisher, year, edition, pages
uppsala: Acta Universitatis Upsaliensis, 2018. p. 46
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1475
Keywords
Neonatal, anesthesia, kangaroo-mother-care, skin-to-skin care, carbon dioxide
National Category
Clinical Medicine
Identifiers
urn:nbn:se:uu:diva-352668 (URN)978-91-513-0375-8 (ISBN)
Public defence
2018-09-14, Rosensalen, Akademiska sjukhuset Ingång 95/96, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2018-08-24 Created: 2018-06-27 Last updated: 2018-09-07Bibliographically approved
Larsson, C., Karlsson, V. & Blomqvist, Y. T. (2018). Nurse Decision Making and Attitudes About Circuit Disconnection During Ventilator Therapy at a Swedish Neonatal Intensive Care Unit. Advances in Neonatal Care, 18(6), E13-E20
Open this publication in new window or tab >>Nurse Decision Making and Attitudes About Circuit Disconnection During Ventilator Therapy at a Swedish Neonatal Intensive Care Unit
2018 (English)In: Advances in Neonatal Care, ISSN 1536-0903, E-ISSN 1536-0911, Vol. 18, no 6, p. E13-E20Article in journal (Refereed) Published
Abstract [en]

Background: There are many challenges to providing care to infants in need of ventilator therapy. Yet, few studies describe the practical handling of the ventilator circuit during nursing care.

Purpose: To describe neonatal intensive care unit (NICU) nurses' decision making regarding whether or not to disconnect the ventilator circuit when changing the infant's position and to investigate the grounds for their decisions.

Methods: A descriptive questionnaire study with both quantitative and qualitative elements was conducted. In 2015, a convenience sample of nurses working in an NICU completed a questionnaire including both closed-ended and open-ended, free-text questions. Answers to the closed-ended questions were analyzed with descriptive statistics, whereas answers to the free-text questions were analyzed using qualitative content analysis.

Results: Nurses' decisions on whether to disconnect or keep the ventilator circuit closed were based on the infant's needs for ventilator support. The nurses gave several reasons and motivations both for why they disconnected the circuit and for why they did not. The handling of the circuit and the reasons and motivations given were inconsistent among the nurses.

Implications for Practice: This study highlights the need for continuous, repetitive education and training for NICU nurses, as well as demonstrating the importance of clear and distinct guidelines and working methods regarding the care of infants on ventilator support.

Implications for Research: Future research should continue to find ways of working and handling an infant on ventilator support that are least harmful to the infant.

Keywords
circuit disconnection, infants, neonatal intensive care unit, nursing, ventilator therapy
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-377718 (URN)10.1097/ANC.0000000000000564 (DOI)000457618300002 ()30299284 (PubMedID)
Available from: 2019-03-08 Created: 2019-03-08 Last updated: 2019-06-28Bibliographically 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
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
Karlsson, V., Heinemann, A.-B., Sjörs, G., Nyqvist, K. H. & Ågren, J. (2012). Early Skin-to-Skin Care in Extremely Preterm Infants: Thermal Balance and Care Environment. Journal of Pediatrics, 161(3), 422-426
Open this publication in new window or tab >>Early Skin-to-Skin Care in Extremely Preterm Infants: Thermal Balance and Care Environment
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2012 (English)In: Journal of Pediatrics, ISSN 0022-3476, E-ISSN 1097-6833, Vol. 161, no 3, p. 422-426Article in journal (Refereed) Published
Abstract [en]

Objective

To evaluate infant thermal balance and the physical environment in extremely preterm infants during skin-to-skin care (SSC).

Study design

Measurements were performed in 26 extremely preterm infants (gestational age 22-26 weeks; postnatal age, 2-9 days) during pretest (in incubator), test (during SSC), and posttest (in incubator) periods. Infants' skin temperature and body temperature, ambient temperature, and relative humidity were measured. Evaporimetry was used to determine transepidermal water loss, and insensible water loss through the skin was calculated.

Results

The infants maintained a normal body temperature during SSC. Transfer to and from SSC was associated with a drop in skin temperature, which increased during SSC. Ambient humidity and temperature were lower during SSC than during incubator care. Insensible water loss through the skin was higher during SSC.

Conclusion

SSC can be safely used in extremely preterminfants. SSC can be initiated during the first week of life and is feasible in infants requiring neonatal intensive care, including ventilator treatment. During SSC, the conduction of heat from parent to infant is sufficiently high to compensate for the increase in evaporative and convective heat loss. The increased water loss through the skin during SSC is small and should not affect the infant's fluid balance.

National Category
Pediatrics
Identifiers
urn:nbn:se:uu:diva-182517 (URN)10.1016/j.jpeds.2012.02.034 (DOI)000308141700014 ()22497906 (PubMedID)
Available from: 2012-10-15 Created: 2012-10-11 Last updated: 2018-06-27Bibliographically approved
Karlsson, V., Sporre, B., Fredén, F. & Ågren, J.Randomized controlled trial of room air vs. 80% oxygen for induction of neonatal anesthesia: Feasibility and safety.
Open this publication in new window or tab >>Randomized controlled trial of room air vs. 80% oxygen for induction of neonatal anesthesia: Feasibility and safety
(English)Manuscript (preprint) (Other academic)
National Category
Clinical Medicine
Identifiers
urn:nbn:se:uu:diva-352666 (URN)
Available from: 2018-06-06 Created: 2018-06-06 Last updated: 2018-06-27
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-0407-2143

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