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  • 1.
    Beltempo, Marc
    et al.
    Univ Toronto, Mt Sinai Hosp, Maternal Infant Care Res Ctr, Dept Paediat, Toronto, ON, Canada.
    Isayama, Tetsuya
    McMaster Univ, Clin Epidemiol & Biostat, Toronto, ON, Canada.
    Vento, Maximo
    Hlth Res Inst La Fe, Spanish Neonatal Network, Ave Fernando Abril Martorell, Valencia, Spain.
    Lui, Kei
    Univ New South Wales, Royal Hosp Women, Natl Perinatal Epidemiol & Statist Unit, Australian & New Zealand Neonatal Network, Randwick, NSW, Australia.
    Kusuda, Satoshi
    Tokyo Womens Med Univ, Maternal & Perinatal Ctr, Neonatal Res Network Japan, Tokyo, Japan.
    Lehtonen, Liisa
    Univ Turku, Turku Univ Hosp, Dept Pediat, Turku, Finland.
    Sjörs, Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Perinatal, Neonatal and Pediatric Cardiology Research.
    Hakansson, Stellan
    Umea Univ Hosp, Dept Pediat, Swedish Neonatal Qual Register, Neonatal Serv, Umea, Sweden.
    Adams, Mark
    Univ Zurich, Univ Hosp Zurich, Dept Neonatol, Swiss Neonatal Network, Zurich, Switzerland.
    Noguchi, Akihiko
    Illinois Neonatal Network, St Louis, IL USA.
    Reichman, Brian
    Sheba Med Ctr, Gertner Inst Epidemiol & Hlth Policy Res, Israel Neonatal Network, Tel Hashomer, Israel.
    Darlow, Brian A.
    Univ Otago, Dept Paediat, Australia & New Zealand Neonatal Network, Christchurch, New Zealand.
    Morisaki, Naho
    Natl Ctr Child Hlth & Dev, Dept Social Med, Neonatal Res Network Japan, Tokyo, Japan.
    Bassler, Dirk
    Univ Zurich, Univ Hosp Zurich, Dept Neonatol, Swiss Neonatal Network, Zurich, Switzerland.
    Pratesi, Simone
    Careggi Univ Hosp, Neonatal Intens Care Unit, TIN Toscane Online, Florence, Italy.
    Lee, Shoo K.
    Univ Toronto, Mt Sinai Hosp, Maternal Infant Care Res Ctr, Dept Paediat, Toronto, ON, Canada.
    Lodha, Abhay
    Univ Calgary, Pediat & Community Hlth Sci, Calgary, AB, Canada.
    Modi, Neena
    Imperial Coll London, Dept Med, Neonatal Data Anal Unit, Sect Neonatal Med,UK Neonatal Collaborat, Chelsea & Westminster Hosp Campus, London, England.
    Helenius, Kjell
    Univ Turku, Turku Univ Hosp, Dept Pediat, Turku, Finland.
    Shah, Prakesh S.
    Univ Toronto, Mt Sinai Hosp, Maternal Infant Care Res Ctr, Dept Paediat, Toronto, ON, Canada.
    Respiratory Management of Extremely Preterm Infants: An International Survey2018In: Neonatology, ISSN 1661-7800, E-ISSN 1661-7819, Vol. 114, no 1, p. 28-36Article in journal (Refereed)
    Abstract [en]

    Background: There are significant international variations in chronic lung disease rates among very preterm infants yet there is little data on international variations in respiratory strategies. Objective: To evaluate practice variations in the respiratory management of extremely preterm infants born at <29 weeks' gestational age (GA) among 10 neonatal networks participating in the International Network for Evaluating Outcomes (iNeo) of Neonates collaboration. Methods: A web-based survey was sent to the representatives of 390 neonatal intensive care units from Australia/New Zealand, Canada, Finland, Illinois (USA), Israel, Japan, Spain, Sweden, Switzerland, and Tuscany (Italy). Responses were based on practices in 2015. Results: Overall, 321 of the 390 units responded (82%). The majority of units within networks (40-92%) mechanically ventilate infants born at 23-24 weeks' GA on continuous positive airway pressure (CPAP) with 30-39% oxygen in respiratory distress within 48 h after birth, but the proportion of units that offer mechanical ventilation for infants born at 25-26 weeks' GA at similar settings varied significantly (20-85% of units within networks). The most common respiratory strategy for infants born at 27-28 weeks' GA on CPAP with 30-39% oxygen with respiratory distress within 48 h after birth used by units also varied significantly among networks: mechanical ventilation (0-60%), CPAP (3-82%), intubation and surfactant administration with immediate extubation (0-75%), and less invasive surfactant administration (0-68%). Conclusions: There are marked variations but also similarities in respiratory management of extremely preterm infants between networks. Further collaboration and exploration is needed to better understand the association of these variations in practice with pulmonary outcomes. (c) 2018 S. Karger AG, Basel

  • 2. Berg, Johan Henrik Martin
    et al.
    Isacson, Manuela
    Basnet, Omkar
    Gurung, Rejina
    Golden Community, Lalitpur, Nepal.
    Subedi, Kalpana
    KC, Ashish
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Andersson, Ola
    Effect of Delayed Cord Clamping on Neurodevelopment at 3 Years: A Randomized Controlled Trial2021In: Neonatology, ISSN 1661-7800, E-ISSN 1661-7819, Vol. 118, no 3, p. 282-288Article in journal (Refereed)
    Abstract [en]

    Introduction: Iron deficiency (ID) is associated with poor neurodevelopment. We have previously shown that delayed umbilical cord clamping (CC) improves iron stores at 8 months and neurodevelopment at 1 year in term, healthy infants in Nepal.

    Objective: The aim of this study was to assess the effects of delayed CC (≥180 s) compared to early CC (≤60 s) on neurodevelopment using the Ages and Stages Questionnaire (ASQ) at age 3 years.

    Methods: In 2014, 540 healthy Nepalese infants born at term were randomized in a 1:1 ratio to delayed or early CC. At 3 years of age, ASQ assessment was performed by phone interviews with parents. A score >1 standard deviation below the mean was defined as "at risk" for developmental impairment.

    Results: At 3 years of age, 350 children were followed up, 170 (63.0%) in the early CC group and 180 (66.7%) in the delayed CC group. No significant differences in ASQ scores in any domains between groups were found. However, more girls were "at risk" for affected gross motor development in the early CC group: 14 (18.9%) versus 6 (6.3%), p = 0.02.

    Conclusion: There were no significant differences in ASQ scores in any domains between groups. In the subgroup analysis, fewer girls who underwent delayed CC were "at risk" for delayed gross motor development. Due to the pronounced difference in iron stores at 8 months postpartum in this cohort, follow-up studies at an older age are motivated since neurodevelopmental impairment after early ID may be more detectable with increasing age.

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  • 3.
    Darlow, Brian A.
    et al.
    Univ Otago, Dept Paediat, Australian & New Zealand Neonatal Network, Christchurch, New Zealand.
    Vento, Maximo
    Hlth Res Inst La Fe, Spanish Neonatal Network, Ave Fernando Abril Martorell, Valencia, Spain.
    Beltempo, Marc
    McGill Univ, Montreal Childrens Hosp, Dept Pediat, Montreal, PQ, Canada.
    Lehtonen, Liisa
    Turku Univ Hosp, Dept Pediat, Finnish Med Birth Register, Turku, Finland;Turku Univ Hosp, Dept Pediat, Register Congenital Malformat, Turku, Finland.
    Hakansson, Stellan
    Umea Univ Hosp, Dept Pediat Neonatal Serv, Swedish Neonatal Qual Register, Umea, Sweden.
    Reichman, Brian
    Sheba Med Ctr, Gertner Inst Epidemiol & Hlth Policy Res, Israel Neonatal Network, Tel Hashomer, Israel.
    Helenius, Kjell
    Turku Univ Hosp, Dept Pediat, Finnish Med Birth Register, Turku, Finland;Turku Univ Hosp, Dept Pediat, Register Congenital Malformat, Turku, Finland.
    Sjörs, Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Perinatal, Neonatal and Pediatric Cardiology Research. Swedish Neonatal Qual Register, Uppsala, Sweden.
    Sigali, Emilio
    Univ Hosp Pisa, Dept Pediat, Div Neonatol, TIN Toscane Online, Pisa, Italy;Univ Hosp Pisa, Dept Pediat, Neonatal Intens Care Unit, Pisa, Italy.
    Lee, Shoo
    Mt Sinai Hosp, Canadian Neonatal Network, Dept Paediat, Toronto, ON, Canada;Univ Toronto, Toronto, ON, Canada.
    Noguchi, Akihiko
    Illinois Neonatal Network, St Louis, IL USA.
    Morisaki, Naho
    Natl Ctr Child Hlth & Dev, Dept Social Med, Neonatal Res Network Japan, Tokyo, Japan.
    Kusuda, Satoshi
    Tokyo Womens Med Univ, Maternal & Perinatal Ctr, Neonatal Res Network Japan, Tokyo, Japan.
    Bassler, Dirk
    Univ Zurich, Univ Hosp Zurich, Dept Neonatol, Swiss Neonatal Network, Zurich, Switzerland.
    San Feliciano, Laura
    Univ Salamanca, Dept Pediat, Spanish Neonatal Network, Salamanca, Spain.
    Adams, Mark
    Univ Zurich, Univ Hosp Zurich, Dept Neonatol, Swiss Neonatal Network, Zurich, Switzerland.
    Isayama, Tetsuya
    McMaster Univ, Clin Epidemiol & Biostat, Toronto, ON, Canada.
    Shah, Prakesh S.
    Mt Sinai Hosp, Dept Pediat, Toronto, ON, Canada;Univ Toronto, Dept Pediat, Toronto, ON, Canada;Mt Sinai Hosp, Maternal Infant Care Res Ctr, Toronto, ON, Canada.
    Lui, Kei
    Univ New South Wales, Royal Hosp Women, Natl Perinatal Epidemiol & Statist Unit, Australian & New Zealand Neonatal Network, Randwick City, NSW, Australia.
    Variations in Oxygen Saturation Targeting, and Retinopathy of Prematurity Screening and Treatment Criteria in Neonatal Intensive Care Units: An International Survey2018In: Neonatology, ISSN 1661-7800, E-ISSN 1661-7819, Vol. 114, no 4, p. 323-331Article in journal (Refereed)
    Abstract [en]

    Background: Rates of retinopathy of prematurity (ROP) and ROP treatment vary between neonatal intensive care units (NICUs). Neonatal care practices, including oxygen saturation (SpO2) targets and criteria for the screening and treatment of ROP, are potential contributing factors to the variations. Objectives: To survey variations in SpO2 targets in 2015 (and whether there had been recent changes) and criteria for ROP screening and treatment across the networks of the International Network for Evaluating Outcomes in Neonates (iNeo). Methods: Online prepiloted questionnaires on treatment practices for preterm infants were sent to the directors of 390 NICUs in 10 collaborating iNeo networks. Nine questions were asked and the results were summarized and compared. Results: Overall, 329/390 (84%) NICUs responded, and a majority (60%) recently made changes in upper and lower SpO2 target limits, with the median set higher than previously by 2–3% in 8 of 10 networks. After the changes, fewer NICUs (15 vs. 28%) set an upper SpO2 target limit > 95% and fewer (3 vs. 5%) a lower limit < 85%. There were variations in ROP screening criteria, and only in the Swedish network did all NICUs follow a single guideline. The initial retinal examination was carried out by an ophthalmologist in all but 6 NICUs, and retinal photography was used in 20% but most commonly as an adjunct to indirect ophthalmoscopy. Conclusions: There is considerable variation in SpO2 targets and ROP screening and treatment criteria, both within networks and between countries.

  • 4.
    Ewald, Uwe
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Child Health and Nutrition.
    Family-Centered Care: More than a Good Feeling?2017In: Neonatology, ISSN 1661-7800, E-ISSN 1661-7819, Vol. 112, no 3, p. 301-302Article in journal (Other academic)
  • 5.
    Latheef, Faiza
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Neuropediatrics/Paediatric oncology. Reg Vastmanland, Dept Hosp Pharm, Västerås, Sweden.
    Wahlgren, Hanna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Engstrand Lilja, Helene
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Pediatric Surgery.
    Diderholm, Barbro
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Perinatal, Neonatal and Pediatric Cardiology Research.
    Paulsson, Mattias
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Neuropediatrics/Paediatric oncology.
    The Risk of Necrotizing Enterocolitis following the Administration of Hyperosmolar Enteral Medications to Extremely Preterm Infants2021In: Neonatology, ISSN 1661-7800, E-ISSN 1661-7819, Vol. 118, no 1, p. 73-79Article in journal (Refereed)
    Abstract [en]

    Introduction: Necrotizing enterocolitis (NEC) is a disease predominantly affecting preterm infants. The administration of hyperosmolar solutions could lead to the development of NEC. The objective of this study was to measure the osmolality of enteral medications used in clinical practice and to assess the risk of NEC following exposure to hyperosmolar medications.

    Methods: A retrospective cohort study in extremely preterm infants (gestational age <28 weeks) born between 2010 and 2016 at a tertiary neonatal intensive care unit in Sweden. 465 infants were identified via the Swedish Neonatal Quality register. Data relating to enteral administrations received during a two-week period were collected from the medical records. The osmolalities of medications were measured using an osmometer. Logistic regression was used to calculate the odds ratio of developing NEC.

    Results: A total of 253 patients met the inclusion criteria. The osmolalities of 5 commonly used medications significantly exceeded the recommended limit of 450 mOsm/kg set by the American Academy of Paediatrics (AAP). Most patients (94%) received at least one hyperosmolar medication. No significant risk of developing NEC could be found.

    Conclusion: The medications used in clinical practice can significantly exceed the limit set by the AAP. This study does not indicate an increased risk of developing NEC in extremely preterm infants following exposure to hyperosmolar medications. Further studies in larger cohorts are needed to determine the specific cut-off level of osmolality in relation to the pathogenesis of NEC.

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  • 6. Linnér, Agnes
    et al.
    Thernström Blomqvist, Ylva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Perinatal, Neonatal and Pediatric Cardiology Research.
    Jonsson, Kristina
    Lilliesköld, Siri
    Norman, Mikael
    Parental Experiences of Neonatal Care: A Nationwide Study on Determinants of Excellence2023In: Neonatology, ISSN 1661-7800, E-ISSN 1661-7819, p. 1-10Article in journal (Refereed)
  • 7.
    Lundgren, Pia
    et al.
    Univ Gothenburg, Sahlgrenska Acad, Inst Neurosci & Physiol, Dept Clin Neurosci,Sect Ophthalmol, Gothenburg, Sweden.
    Lundberg, Linnea
    Univ Gothenburg, Sahlgrenska Acad, Inst Neurosci & Physiol, Dept Clin Neurosci,Sect Ophthalmol, Gothenburg, Sweden.
    Helgren, Gunnel
    Univ Gothenburg, Sahlgrenska Acad, Inst Neurosci & Physiol, Dept Clin Neurosci,Sect Ophthalmol, Gothenburg, Sweden.
    Holmström, Gerd
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ophthalmology.
    Hard, Anna-Lena
    Univ Gothenburg, Sahlgrenska Acad, Inst Neurosci & Physiol, Dept Clin Neurosci,Sect Ophthalmol, Gothenburg, Sweden.
    Smith, Lois E.
    Harvard Med Sch, Boston Childrens Hosp, Dept Ophthalmol, Boston, MA USA.
    Wallin, Agneta
    St Eriks Eye Hosp, Stockholm, Sweden.
    Hallberg, Boubou
    Karolinska Inst, Dept Neonatol, Stockholm, Sweden;Univ Hosp, Stockholm, Sweden.
    Hellstrom, Ann
    Univ Gothenburg, Sahlgrenska Acad, Inst Neurosci & Physiol, Dept Clin Neurosci,Sect Ophthalmol, Gothenburg, Sweden.
    Aggressive Posterior Retinopathy of Prematurity Is Associated with Multiple Infectious Episodes and Thrombocytopenia2017In: Neonatology, ISSN 1661-7800, E-ISSN 1661-7819, Vol. 111, no 1, p. 79-85Article in journal (Refereed)
    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.

  • 8.
    Naseh, Nima
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Perinatal, Neonatal and Pediatric Cardiology Research.
    Canto Moreira, Nuno
    Uppsala Univ Hosp, Dept Neuroradiol, Uppsala, Sweden; Karolinska Univ Hosp, Uppsala, Sweden.
    Vaz, Tania F.
    Univ Lisbon, Inst Biophys & Biomed Engn, Fac Sci, Lisbon, Portugal..
    Gonzalez Tamez, Karla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Perinatal, Neonatal and Pediatric Cardiology Research.
    Ferreira, Hugo
    Univ Lisbon, Inst Biophys & Biomed Engn, Fac Sci, Lisbon, Portugal..
    Fredriksson Kaul, Ylva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Perinatal, Neonatal and Pediatric Cardiology Research.
    Johansson, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Perinatal, Neonatal and Pediatric Cardiology Research.
    Diderholm, Barbro
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Perinatal, Neonatal and Pediatric Cardiology Research.
    Ahlsson, Fredrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Perinatal, Neonatal and Pediatric Cardiology Research.
    Ågren, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Perinatal, Neonatal and Pediatric Cardiology Research.
    Hellström-Westas, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Perinatal, Neonatal and Pediatric Cardiology Research.
    Early Hyperglycemia in Very Preterm Infants Is Associated with Reduced White Matter Volume and Worse Cognitive and Motor Outcomes at 2.5 Years2022In: Neonatology, ISSN 1661-7800, E-ISSN 1661-7819, Vol. 119, no 6, p. 745-752Article in journal (Refereed)
    Abstract [en]

    Introduction: Hyperglycemia in very preterm infants is associated with increased morbidity and mortality. We aimed to investigate potential associations between early hyperglycemia, neonatal cerebral magnetic resonance imaging (MRI), and neurodevelopment at 2.5 years.

    Methods: The study population included 69 infants with gestational age (GA) 22.3-31.9 weeks (n = 29 with GA <28 weeks), born 2011-2014. Plasma glucose concentrations during the first week were checked according to clinical routines. Hyperglycemia was defined as glucose concentrations above 8.3 mmol/L (150 mg/dL) and above 10 mmol/L (180 mg/dL), respectively, categorized as the highest glucose days 0-2, number of days above 8.3 and 10 mmol/L, and prolonged (yes/no) 2 days or more above 8.3 and 10 mmol/L. The MRI analysis included morphological assessment, regional brain volumes, and assessment of apparent diffusion coefficient (ADC). Neurodevelopmental impairment (NDI) developed in 13 of 67 infants with available outcomes, of which 57 were assessed with the Bayley-III. Univariate and multiple linear and logistic regressions were performed with adjustments for GA, birth weight z-scores, and illness severity expressed as days on mechanical ventilation.

    Results: Hyperglycemia above 8.3 mmol/L and 10 mmol/L was present in 47.8% and 31.9% of the infants. Hyperglycemia correlated independently with lower white matter volume, but not with other regional brain volumes, and was also associated with lower ADC values in white matter. Hyperglycemia also correlated with lower Bayley-III cognitive and motor scores in infants with GA <28 weeks, but there was no significant effect on NDI.

    Conclusion: Early hyperglycemia is associated with white matter injury and poorer neurodevelopment in very preterm infants.

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  • 9. Ohlin, Andreas
    et al.
    Backman, Anders
    Ewald, Uwe
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Schollin, Jens
    Bjorkqvist, Maria
    Diagnosis of Neonatal Sepsis by Broad-Range 165 Real-Time Polymerase Chain Reaction2012In: Neonatology, ISSN 1661-7800, E-ISSN 1661-7819, Vol. 101, no 4, p. 241-246Article in journal (Refereed)
    Abstract [en]

    Background: The standard diagnostic test (blood culture) for suspected neonatal sepsis has limitations in sensitivity and specificity, and 165 polymerase chain reaction (PCR) has been suggested as a new diagnostic tool for neonatal sepsis.

    Objectives: To develop and evaluate a new real-time PCR method for detection of bacterial DNA in blood samples collected from infants with suspected neonatal sepsis.

    Methods: Immediately after blood culture, a study sample of 0.5-1.0 ml whole blood was collected and used for a novel 16S real-time PCR assay. All positive samples were sequenced. Detailed case studies were performed in all cases with conflicting results, to verify if PCR could detect pathogens in culture negative sepsis.

    Results: 368 samples from 317 infants were included. When compared with blood culture, the assay yielded a sensitivity of 79%, a specificity of 90%, a positive predictive value of 59%, and a negative predictive value of 96%. Seven of the 31 samples with a positive PCR result and a negative blood culture had definite or suspected bacterial sepsis. In five samples, PC:R (but not blood culture) could detect a pathogen that was present in a blood culture collected more than 24 h prior to the PCR sample.

    Conclusions: This study presents an evaluation of a new real-time PCR technique that can detect culture-positive sepsis, and suggests that PCR has the potential to detect bacteria in culture-negative samples even after the initiation of intravenous antibiotics. Copyright (C) 2011 S. Karger AG, Basel

  • 10. Olischar, Monika
    et al.
    Shany, Eilon
    Aygun, Canan
    Azzopardi, Denis
    Hunt, Rod W.
    Toet, Mona C.
    Hamosh, Ada
    de Vries, Linda S.
    Hellström-Westas, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Theda, Christiane
    Amplitude-Integrated Electroencephalography in Newborns with Inborn Errors of Metabolism2012In: Neonatology, ISSN 1661-7800, E-ISSN 1661-7819, Vol. 102, no 3, p. 203-211Article in journal (Refereed)
    Abstract [en]

    Background: The utility of amplitude-integrated electroencephalography (aEEG) monitoring has been established for patients with neonatal hypoxic-ischemic encephalopathy.

    Objective: To evaluate the role of aEEG in the diagnostic process and treatment of patients with encephalopathy due to inborn errors of metabolism. Methods: Cases collected through an international registry were divided into 5 groups of metabolic disorders. Common aEEG features were sought for each group.

    Results: In total, 21/30 (70%) cases had abnormal aEEG background patterns, 18/30 (60%) showed seizure activity. Patients with disorders of energy metabolism, hyperammonemia, and organic/amino acidopathies often showed marked aEEG depression with seizure activity. In contrast, aEEGs of patients with peroxisomal disorders did not show major background abnormalities but seizures were present in 5/6 subjects. We report two features of interest: firstly, two tracings displayed an unusual upward shift of the lower aEEG amplitude margin. Secondly, aEEGs of infants with non-ketotic hyperglycinemia showed a pattern we refer to as 'high-frequency burst-suppression pattern'.

    Conclusions: aEEG in patients with inborn errors of metabolism frequently reveals abnormalities and assists clinicians in the clinical assessment, management and monitoring of these patients.

  • 11.
    Olsson, Karl Wilhelm
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Sindelar, Richard
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Future Benefits of Sequential Echocardiography: Unmasking the Indications for Treatment of Patent Ductus Arteriosus in Extremely Preterm Infants2015In: Neonatology, ISSN 1661-7800, E-ISSN 1661-7819, Vol. 108, no 2, p. 99-99Article in journal (Refereed)
  • 12. Pellicer, Adelina
    et al.
    Greisen, Gorm
    Benders, Manon
    Claris, Olivier
    Dempsey, Eugene
    Fumagalli, Monica
    Gluud, Christian
    Hagmann, Cornelia
    Hellström-Westas, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Hyttel-Sorensen, Simon
    Lemmers, Petra
    Naulaers, Gunnar
    Pichler, Gerhard
    Roll, Claudia
    van Bel, Frank
    van Oeveren, Wim
    Skoog, Maria
    Wolf, Martin
    Austin, Topun
    The SafeBoosC Phase II Randomised Clinical Trial: A Treatment Guideline for Targeted Near-Infrared-Derived Cerebral Tissue Oxygenation versus Standard Treatment in Extremely Preterm Infants2013In: Neonatology, ISSN 1661-7800, E-ISSN 1661-7819, Vol. 104, no 3, p. 171-178Article in journal (Refereed)
    Abstract [en]

    Near-infrared spectroscopy-derived regional tissue oxygen saturation of haemoglobin (rSto(2)) reflects venous oxygen saturation. If cerebral metabolism is stable, rSto(2) can be used as an estimate of cerebral oxygen delivery. The SafeBoosC phase II randomised clinical trial hypothesises that the burden of hypo- and hyperoxia can be reduced by the combined use of close monitoring of the cerebral rSto(2) and a treatment guideline to correct deviations in rSto(2) outside a predefined target range. Aims: To describe the rationale for and content of this treatment guideline. Methods: Review of the literature and assessment of the quality of evidence and the grade of recommendation for each of the interventions. Results and Conclusions: A clinical intervention algorithm based on the main determinants of cerebral perfusion-oxygenation changes during the first hours after birth was generated. The treatment guideline is presented to assist neonatologists in making decisions in relation to cerebral oximetry readings in preterm infants within the SafeBoosC phase II randomised clinical trial. The evidence grades were relatively low and the guideline cannot be recommended outside a research setting. 

  • 13.
    Rana, Nisha
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Global Health Research on Implementation and Sustainability. Life Line Nepal, Kathmandu, Nepal.
    KC, Ashish
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Global Health Research on Implementation and Sustainability. UNICEF, Hlth Sect, UN House, Lalitpur, Nepal.
    Målqvist, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Global Health Research on Implementation and Sustainability.
    Subedi, Kalpana
    Paropakar Matern & Womens Hosp, Kathmandu, Nepal.
    Andersson, Ola
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Child Health and Nutrition. Reg Halland, Dept Res & Dev, Halmstad, Sweden.
    Effect of Delayed Cord Clamping of Term Babies on Neurodevelopment at 12 Months: A Randomized Controlled Trial.2019In: Neonatology, ISSN 1661-7800, E-ISSN 1661-7819, Vol. 115, no 1, p. 36-42Article in journal (Refereed)
    Abstract [en]

    Background: Delayed cord clamping (DCC) is associated with an improved iron status at 8 months, a reduction of anemia at 12 months, and an improved development at 4 years. Assessment of the development after DCC has not been performed earlier in a setting with a high prevalence of iron deficiency.

    Objective: The aim of this paper was to investigate the effects of DCC compared to early cord clamping (ECC) on the development evaluated with the Ages and Stages Questionnaire (ASQ) at 12 months of age.

    Method: We conducted a randomized controlled trial investigating the effect of DCC (≥180 s) versus ECC (≤60 s) in 540 full-term deliveries. Twelve months after delivery, the parents reported their infant’s development by ASQ. Infants having a score < 1 standard deviation (SD) under the mean score were considered “at risk” of affected neurodevelopment.

    Results: At 12 months of age, 332 (61.5%) infants were assessed. Fewer children in the DCC group were “at risk” of having affected neurodevelopment measured by the ASQ total score, 21 (7.8%) versus 49 (18.1%) in the ECC group. The relative risk was 0.43 (0.26–0.71). Infants in the DCC group had higher mean total scores (SD), 290.4 (10.4) versus 287.2 (10.1), p = 0.01. Significantly fewer infants in the delayed group were “at risk” and had higher scores in the domains “communication”, “gross motor”, and “personal-social”. Conclusions: DCC after 3 min was associated with an improvement of the overall neurodevelopment assessed at 12 months of age as compared to infants in the group with cord clamping within 1 min.

  • 14.
    van Kaam, Anton H
    et al.
    Department of Neonatology, Emma Children’s Hospital, Academic Medical Center, Amsterdam, The Netherlands.
    De Jaegere, Anne P
    Department of Neonatology, Emma Children’s Hospital, Academic Medical Center, Amsterdam, The Netherlands.
    Borensztajn, Dorine
    Department of Neonatology, Emma Children’s Hospital, Academic Medical Center, Amsterdam, The Netherlands.
    Rimensberger, Peter C
    Pediatric and Neonatal Intensive Care, Department of Pediatrics, University Hospital of Geneva, Geneva, Switzerland.
    Surfactant replacement therapy in preterm infants: a European survey2011In: Neonatology, ISSN 1661-7800, E-ISSN 1661-7819, Vol. 100, no 1, p. 71-77Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Exogenous surfactant is an undisputed treatment for neonatal respiratory distress syndrome but its efficacy is highly dependent on the treatment strategy. International guidelines have published recommendations on the optimal surfactant replacement strategy.

    OBJECTIVE: To determine how evidence-based guidelines on surfactant replacement therapy are implemented in daily clinical practice.

    METHODS: Data on surfactant replacement therapy, including preparation, dosing and timing, were collected in 173 European neonatal intensive care units (NICUs) by questionnaire and in a cohort of preterm infants mechanically ventilated on two separate predefined dates in these units.

    RESULTS: All NICUs used animal-derived surfactant in the treatment of respiratory distress syndrome, with Poractant being most widely used (86%). The most frequently used first dose was 100 mg/kg (58%) and 200 mg/kg (39%) and all NICUs allowed for repeat dosing. 39% of the NICUs claimed to use prophylactic treatment (<15 min of life). Data on surfactant treatment were collected in 338 infants, with a median gestational age of 27 weeks and a birth weight of 860 g. All infants were treated with animal-derived surfactant. The median first dose was 168 mg/kg in the Poractant group compared with 100 mg/kg in the Beractant and Bovactant groups. Prophylactic treatment was used in 23% of the infants and 28% of the infants received surfactant >2 h after birth. 43% of the infants received multiple doses.

    CONCLUSIONS: With the exception of surfactant timing, guidelines on surfactant replacement therapy seem to be implemented in daily clinical practice in European NICUs.

  • 15.
    Wikström, Sverre
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Neuropediatrics/Paediatric oncology. Orebro Univ, Sch Med Sci, Orebro, Sweden.
    Hövel, Holger
    Lund Univ, Skane Univ Hosp, Dept Pediat & Clin Sci, Lund, Sweden..
    Pupp, Ingrid Hansen
    Lund Univ, Skane Univ Hosp, Dept Pediat & Clin Sci, Lund, Sweden..
    Fellman, Vineta
    Lund Univ, Skane Univ Hosp, Dept Pediat & Clin Sci, Lund, Sweden..
    Hüppi, Petra S.
    Univ Hosp Geneva, Dept Pediat, Geneva, Switzerland..
    Ley, David
    Lund Univ, Skane Univ Hosp, Dept Pediat & Clin Sci, Lund, Sweden..
    Hellström-Westas, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Perinatal, Neonatal and Pediatric Cardiology Research.
    Early Electroencephalography Suppression and Postnatal Morbidities Correlate with Cerebral Volume at Term-Equivalent Age in Very Preterm Infants2018In: Neonatology, ISSN 1661-7800, E-ISSN 1661-7819, Vol. 113, no 1, p. 15-20Article in journal (Refereed)
    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.

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