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  • 1.
    Adaikina, Alena
    et al.
    Univ Auckland, Liggins Inst, Auckland, New Zealand..
    Derraik, José G. B.
    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. Univ Auckland, Liggins Inst, Auckland, New Zealand.;Univ Auckland, Sch Med, Fac Med & Hlth Sci, Dept Paediat Child & Youth Hlth, Auckland, New Zealand.;Chiang Mai Univ, Res Inst Hlth Sci, Environm Occupat Hlth Sci & Noncommunicable Dis Re, Chiang Mai, Thailand..
    Mcmillan, Janene
    Univ Auckland, Liggins Inst, Auckland, New Zealand..
    Colle, Patricia
    Univ Auckland, Liggins Inst, Auckland, New Zealand..
    Hofman, Paul L.
    Univ Auckland, Liggins Inst, Auckland, New Zealand..
    Gusso, Silmara
    Univ Auckland, Liggins Inst, Auckland, New Zealand.;Univ Auckland, Exercise Sci Dept, Auckland, New Zealand..
    Feasibility study on a longer side-alternating vibration therapy protocol (15 min per session) in children and adolescents with mild cerebral palsy2023In: Frontiers in Pediatrics , E-ISSN 2296-2360, Vol. 11, article id 1231068Article in journal (Refereed)
    Abstract [en]

    Objective: Previous studies on side-alternating vibration therapy (sVT) have usually used a 9 min intervention protocol. We performed a feasibility study aimed at assessing the safety, acceptability, and potential effectiveness of a longer sVT protocol (15 min per session) in children and adolescents with cerebral palsy (CP).

    Methods: Fifteen participants aged 5.2-17.4 years (median = 12.4 years) with CP GMFCS level II underwent 20 weeks of sVT consisting of 15 min sessions 4 days/week. Participants were assessed at baseline and after the intervention period, including mobility (six-minute walk-test; 6MWT), body composition (whole-body dual-energy x-ray absorptiometry scans), and muscle function (force plate).

    Results: Adherence level to the 15 min VT protocol was 83% on average. There were no adverse events reported. After 20 weeks, there was some evidence for an increase in the walking distance covered in 6MWT (+43 m; p = 0.0018) and spine bone mineral density (+0.032 g/cm(2); p = 0.012) compared to baseline.

    Conclusions: The 15 min sVT protocol is feasible and well tolerated. The results also suggest potential benefits of this protocol to mobility and bone health. Randomized controlled trials are needed to reliably ascertain the potential effectiveness of a longer sVT protocol on physical function and body composition in young people with CP.

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  • 2.
    Adaikina, Alena
    et al.
    Univ Auckland, Liggins Inst, Auckland, New Zealand.;Univ Auckland, Liggins Inst, Bldg 505 level 2, 85 Pk Rd, Auckland 1042, Auckland, New Zealand..
    Derraik, José G. B.
    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. Univ Auckland, Liggins Inst, Auckland, New Zealand.;Chiang Mai Univ, Res Inst Hlth Sci, NCD Ctr Excellence, Chiang Mai, Thailand..
    Taylor, Janice
    Starship Childrens Hosp, Child Dev Unit, Auckland, New Zealand.;Starship Childrens Hosp, Newborn Serv, Auckland, New Zealand..
    O'Grady, Gina L.
    Starship Childrens Hosp, Paediat Neurol Dept, Auckland, New Zealand..
    Hofman, Paul L.
    Univ Auckland, Liggins Inst, Auckland, New Zealand..
    Gusso, Silmara
    Univ Auckland, Liggins Inst, Auckland, New Zealand.;Univ Auckland, Exercise Sci Dept, Auckland, New Zealand..
    Vibration Therapy as an Early Intervention for Children Aged 2-4 Years with Cerebral Palsy: A Feasibility Study2023In: Physical & Occupational Therapy in Pediatrics, ISSN 0194-2638, E-ISSN 1541-3144, Vol. 43, no 5, p. 564-581Article in journal (Refereed)
    Abstract [en]

    Aims: To evaluate the feasibility and acceptability of vibration therapy (VT) in preschool children with cerebral palsy (CP) and obtain preliminary data on its potential effectiveness.

    Methods: Nine children aged 2.5-4.8 years (4 boys) with CP GMFCS levels I-III participated in a single-group feasibility study, undergoing a 12-week control period without intervention, followed by 12 weeks of home-based VT (four times/week, 9 min/day, frequency 20 Hz). We assessed adherence to VT protocol, adverse events, and family acceptability of VT. Clinical assessments included motor function (GMFM-66), body composition (DXA), mobility (10-meter walk/run test), and health-related quality of life (PedsQL).

    Results: VT was well tolerated and acceptable to families, with high adherence levels reported (mean = 93%). There were no observed between-period differences (Delta Control vs Delta VT) except for an improvement in the PedsQL "Movement & Balance" dimension with VT (p = 0.044). Nonetheless, changes after the VT but not the Control period were suggestive of potential treatment benefits for mobility, gross motor function, and body composition (lean mass and legs bone mineral density).

    Conclusion: Home-based VT is feasible and acceptable for preschool children with CP. Our preliminary data suggest potential health benefits from VT for these children, supporting larger randomized trials to assess its effectiveness properly.

  • 3.
    Ahlqvist-Bjorkroth, Sari
    et al.
    Univ Turku, Dept Psychol & Speech Language Pathol, Turku, Finland.;Univ Turku, Dept Clin Med, Turku, Finland..
    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.
    Nyberg, Jenni
    Univ Turku, Dept Psychol & Speech Language Pathol, Turku, Finland..
    Normann, Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Axelin, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. Uppsala Univ, Dept Womens & Childrens Hlth, Uppsala, Sweden.;Univ Turku, Dept Nursing Sci, Turku, Finland..
    Improving NICU staff decision-making with parents in medical rounds: a pilot study of reflective group dialogue intervention2023In: Frontiers in Pediatrics , E-ISSN 2296-2360, Vol. 11, article id 1249345Article in journal (Refereed)
    Abstract [en]

    Introduction: The communication skills of healthcare professionals play a crucial role in successful shared decision-making with parents in neonatal intensive care. Improving communication skills can be achieved through practice and reflection on personal experiences after authentic interaction events with parents. The process of reflection typically involves three phases: description, reflection, and critical reflection. In this study, our aim was to explore the acceptability of the Reflective Group Dialogue intervention and its effectiveness in supporting the reflective process.

    Methods: This qualitative pilot study was conducted in the neonatal intensive care unit at Uppsala University Children's Hospital, Sweden. The sample consisted of nine medical rounds with seven families, five neonatologists, seven registered nurses, and five assistant nurses. Purposive sampling was used to collect the data. The intervention comprised four elements: (1) before the intervention, a recorded presentation on shared decision-making was given to the entire unit staff, (2) an observation of a normal medical round discussion with parents, (3) an interview with parents about their experience after the same round, and (4) a reflective discussion with the participating health care professionals after the round. The parent interviews and reflective discussions were audio-recorded and transcribed verbatim. They were analyzed using thematic analysis as a theoretical strategy.

    Results: Both parents and staff widely accepted the intervention and found it beneficial. We identified four discussions that remained in the descriptive phase of the reflection process, four that reached the reflective phase, and one that reached the critical reflection phase. The descriptive discussions were characterized by using a single perspective to reflect, often based on personal opinions. The reflective discussions included analyzing interaction sequences from both staff and parent perspectives and were primarily based on actual observations of communication during medical rounds. The critical discussion led to a new awareness of current practices concerning parental involvement in decision-making. These discussions also utilized "what-if" thinking to evaluate potential new practices and their pros and cons.

    Conclusions: The intervention seems promising as it was perceived as beneficial by the recipients and facilitated reflection in most cases. However, to enhance the feasibility of the intervention, some improvements are discussed.

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  • 4.
    Akerman, Sara
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care. Uppsala Ctr Paediat Anaesthes & Intens Care Res, Uppsala, Sweden..
    Axelin, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. Univ Turku, Dept Nursing Sci, Turku, Finland..
    Traube, Chani
    Weill Cornell Med Ctr, Dept Pediat, New York, NY USA..
    Frithiof, Robert
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care. Uppsala Ctr Paediat Anaesthes & Intens Care Res, Uppsala, Sweden..
    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.
    Adapting the Cornell assessment of pediatric delirium for Swedish context: translation, cultural validation and inter-rater reliability2024In: BMC Pediatrics, E-ISSN 1471-2431, Vol. 24, no 1, article id 413Article in journal (Refereed)
    Abstract [en]

    Background: Pediatric delirium causes prolonged hospital stays, increased costs, and distress for children and caregivers. Currently, there is no delirium screening tool available in Sweden that has been translated, culturally validated, and tested for reliability. This study aimed to translate, culturally adapt, and assess the suitability of the Cornell Assessment of Pediatric Delirium (CAPD) for implementation in Swedish healthcare settings.

    Methods: The CAPD was translated and culturally adapted to Swedish context following the ten-step process recommended by the International Society for Pharmacoeconomics and Outcomes Task Force for Translation and Cultural Adaptation. The Swedish CAPD was tested in the pediatric intensive care unit of Uppsala University Hospital, a tertiary hospital in Sweden. Inter-rater reliability was tested using intraclass correlation coefficient (ICC), with both Registered Nurses (RNs) and Assistant Nurses (ANs) conducting parallel measurements using the Swedish CAPD. A reliability score of ICC > 0.75 was considered indicative of good reliability.

    Results: After translation of the CAPD into Swedish, 10 RNs participated in the cultural adaptation process. Issues related to word choice, education, and instructions were addressed. Wording improvements were made to ensure accurate interpretation. Supplementary training sessions were organized to strengthen users' proficiency with the Swedish CAPD. Additional instructions were provided to enhance clarity and usability. Inter-rater reliability testing resulted in an ICC of 0.857 (95% CI: 0.708-0.930), indicating good reliability.

    Conclusion: This study successfully translated and culturally adapted the CAPD to align with Swedish contextual parameters. The resulting Swedish CAPD demonstrated good inter-rater reliability, establishing its viability as a tool for measuring delirium among pediatric patients in Swedish pediatric intensive care units. Trail registration Not applicable.

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  • 5.
    Albert, Benjamin B.
    et al.
    Univ Auckland, Liggins Inst, Auckland, New Zealand..
    Derraik, José G. B.
    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. Univ Auckland, Liggins Inst, Auckland, New Zealand.
    Xia, Yin-Yin
    Chongqing Med Univ, Innovat Ctr Social Risk Governance Hlth, Res Ctr Med & Social Dev, Sch Publ Hlth & Management, Chongqing, Peoples R China..
    Norris, Tom
    Univ Leicester, Coll Life Sci, Leicester, Leics, England..
    Zhang, Ting
    Chongqing Med Univ, Affiliated Hosp 1, Dept Obstet & Gynaecol, Chongqing, Peoples R China..
    Han, Ting-Li
    Chongqing Med Univ, Affiliated Hosp 1, Dept Obstet & Gynaecol, Chongqing, Peoples R China.;Chongqing Med Univ, Canada China New Zealand Joint Lab Maternal & Fet, Chongqing, Peoples R China..
    Chang, Chen
    Chongqing Med Univ, Affiliated Hosp 1, Dept Obstet & Gynaecol, Chongqing, Peoples R China.;Chongqing Med Univ, Canada China New Zealand Joint Lab Maternal & Fet, Chongqing, Peoples R China..
    Rowan, Angela
    Fonterra Cooperat Grp Ltd, Palmerston North, New Zealand..
    Gallier, Sophie
    Fonterra Cooperat Grp Ltd, Palmerston North, New Zealand..
    Souza, Renato T.
    Univ Estadual Campinas, Dept Obstet & Gynaecol, Campinas, Brazil..
    Hammond, Judith J.
    Auckland UniServ Ltd, Auckland, New Zealand..
    Zhou, Wei
    Chongqing Hlth Ctr Women & Children, Dept Obstet, Chongqing, Peoples R China..
    Zhang, Hua
    Chongqing Med Univ, Affiliated Hosp 1, Dept Obstet & Gynaecol, Chongqing, Peoples R China.;Chongqing Med Univ, Canada China New Zealand Joint Lab Maternal & Fet, Chongqing, Peoples R China..
    Qi, Hong-Bo
    Chongqing Med Univ, Affiliated Hosp 1, Dept Obstet & Gynaecol, Chongqing, Peoples R China.;Chongqing Med Univ, Canada China New Zealand Joint Lab Maternal & Fet, Chongqing, Peoples R China..
    Baker, Philip N.
    Chongqing Med Univ, Affiliated Hosp 1, Dept Obstet & Gynaecol, Chongqing, Peoples R China.;Chongqing Med Univ, Canada China New Zealand Joint Lab Maternal & Fet, Chongqing, Peoples R China..
    Supplementation with milk enriched with complex lipids during pregnancy: A double-blind randomized controlled trial2021In: PLOS ONE, E-ISSN 1932-6203, Vol. 16, no 2, article id e0244916Article in journal (Refereed)
    Abstract [en]

    Background Gangliosides are a class of sphingolipids that are present in the cell membranes of vertebrates. Gangliosides influence a broad range of cellular processes through effects on signal transduction, being found abundantly in the brain, and having a role in neurodevelopment.

    Objective We aimed to assess the effects of maternal daily consumption of ganglioside-enriched milk vs non-enriched milk and a non-supplemented group of pregnant women on maternal ganglioside levels and pregnancy outcomes.

    Design Double-blind parallel randomized controlled trial.

    Methods 1,500 women aged 20-40 years were recruited in Chongqing (China) between 11 and 14 weeks of a singleton pregnancy, and randomized into three groups: Control-received standard powdered milk formulation (>= 4 mg gangliosides/day); Complex milk lipid-enhanced (CML-E) group-same formulation enriched with complex milk lipids (>= 8 mg gangliosides/day) from milk fat globule membrane; Reference-received no milk. Serum ganglioside levels were measured in a randomly selected subsample of 250 women per group.

    Results CML-E milk was associated with marginally greater total gangliosides levels in maternal serum compared to Control (13.02 vs 12.69 mu g/ml; p = 0.034) but not to Reference group. CML-E milk did not affect cord blood ganglioside levels. Among the 1500 women, CML-E milk consumption was associated with a lower rate of gestational diabetes mellitus than control milk [relative risk 0.80 (95% CI 0.64, 0.99)], but which was not different to the Reference group. CML-E milk supplementation had no other effects on maternal or newborn health.

    Conclusions Maternal supplementation with milk fat globule membrane, as a source of gangliosides, was not associated with any adverse health outcomes, and did not increase serum gangliosides compared with the non-supplemented reference group.

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  • 6.
    Andersen, Randi Dovland
    et al.
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Nursing, Stockholm, Sweden;Telemark Hosp, Dept Child & Adolescent Hlth Serv, POB 2900 Kjorbekk, N-3710 Skien, Norway.
    Munsters, Josanne M. A.
    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.
    Vederhus, Bente Johanne
    Haukeland Hosp, Dept Pediat, Bergen, Norway.
    Gradin, Maria
    Orebro Univ, Fac Med & Hlth, Dept Paediat, Orebro, Sweden.
    Pain assessment practices in Swedish and Norwegian neonatal care units2018In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 32, no 3, p. 1074-1082Article in journal (Refereed)
    Abstract [en]

    Background

    The use of measurement scales to assess pain in neonates is considered a prerequisite for effective management of pain, but these scales are still underutilised in clinical practice.

    Aim

    The aim of this study was to describe and compare pain assessment practices including the use of pain measurement scales in Norwegian and Swedish neonatal care units.

    Methods

    A unit survey investigating practices regarding pain assessment and the use of pain measurement scales was sent to all neonatal units in Sweden and Norway (n = 55). All Norwegian and 92% of Swedish units responded.

    Results

    A majority of the participating units (86.5%) assessed pain. Swedish units assessed and documented pain and used pain measurement scales more frequently than Norwegian units. The most frequently used scales were different versions of Astrid Lindgren's Pain Scale (ALPS) in Sweden and Echelle Douleur Inconfort Noveau-Ne (EDIN), ALPS and Premature Infant Pain Profile (PIPP) in Norway. Norwegian head nurses had more confidence in their pain assessment method and found the use of pain measurement scales more important than their Swedish colleagues.

    Conclusion

    The persisting difference between Swedish and Norwegian units in pain assessment and the use of pain measurement scales are not easily explained. However, the reported increased availability and reported use of pain measurement scales in neonatal care units in both countries may be seen as a contribution towards better awareness and recognition of pain, better pain management and potentially less suffering for vulnerable neonates.

  • 7.
    Andersson, Anna Karin
    et al.
    Mälardalen Univ, Sch Hlth Care & Welf, Västerås, Sweden..
    Almqvist, Lena
    Mälardalen Univ, Sch Hlth Care & Welf, Västerås, Sweden..
    Strand Brodd, Katarina
    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.
    Harder, Maria
    Mälardalen Univ, Sch Hlth Care & Welf, Västerås, Sweden..
    Meaningful everyday life situations from the perspective of children born preterm: A photo-elicitation interview study with six-year-old children2023In: PLOS ONE, E-ISSN 1932-6203, Vol. 18, no 8, article id e0284217Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of the study was to explore meaningful everyday life situations as perceived by six-year-old children born preterm.

    Materials and methods: The study had a descriptive qualitative design with an inductive approach. Ten, six-year-old children born preterm, not diagnosed with any disabilities, participated. Data was collected by photo-elicitation interviews to stimulate and help the children to describe their meaningful everyday life situations. A qualitative content analysis according to Elo and Kyngas was applied.

    Results: The children's descriptions of meaningful everyday life situations can be understood as being in an active and dynamic process, representing the core category. The analysis resulted in three generic categories, as the children described the significance of having significant circumstances and doing things. The experiences the children gain when they do things create their desire for further development.

    Discussion: The results reveal that children born preterm are able to reflect on and give detailed descriptions of situations of importance to them. The study suggests that if six-year-old children born preterm are given the opportunity to share their views they can take an active role e.g. in planning and carrying through of interventions by health care services.

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  • 8.
    Andersson, Björn
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Paediatric Inflammation, Metabolism and Child Health Research.
    Markasz, Laszlo
    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.
    Mobini-Far, Hamid
    Uppsala Univ Hosp, Dept Pathol, Uppsala, Sweden..
    Engstrand Lilja, Helene
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Paediatric Inflammation, Metabolism and Child Health Research.
    Vascular adhesion protein-1 expression is reduced in the intestines of infants with necrotizing enterocolitis: an observational research study2022In: BMC Pediatrics, E-ISSN 1471-2431, Vol. 22, article id 640Article in journal (Refereed)
    Abstract [en]

    Background: Necrotizing enterocolitis (NEC) is an inflammatory bowel disease in preterm neonates with high morbidity and mortality. The only treatment available is supportive with broad-spectrum antibiotics and gastrointestinal rest. Better understanding of the pathogenesis is crucial for the development of new therapies. Vascular adhesion protein-1 (VAP-1), expressed in human blood vessels and lymphatic, plays a crucial role in the pathogenesis of inflammatory diseases in adults. The aim of the study was to investigate the VAP-1 expression in the intestines of infants affected by NEC.

    Methods: Intestinal tissues from 42 preterm infants with NEC were examined with immunohistochemical staining using antibodies against VAP-1 and semi-automated digital image analysis was performed to determine tissue protein expression of VAP-1 in blood vessels located in the submucosa. Intestinal tissue from 26 neonates that underwent laparotomy and ileostomy due to other intestinal surgical conditions served as controls. Clinical data and protein expression were compared between the NEC-group and Controls.

    Results: Mean gestational age was lower in NEC infants compared to controls, 26.6 +/- 3.0 gestational weeks versus 36.5 +/- 4.0 (p < 0.001) but without any significant difference in median postnatal age at surgery; for NEC 8 (5-27) days and for controls 3 (1-36) days (p = 0.6). Low VAP-1 correlated with increased risk for developing NEC in the logistic regression (p < 0.001). Multiple linear regression showed that both gestational age and NEC were independent predictors of VAP-1 expression.

    Conclusion: VAP-1 may play a role in the pathogenesis of NEC. Diminished expression of VAP-1 independent of maturation could indicate arrested vascular development in infants suffering from NEC. Further studies are needed to elucidate the role of VAP-1 in NEC.

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  • 9.
    Angelhoff, Charlotte
    et al.
    Linkoping Univ, Div Nursing Sci, Dept Social & Welf Studies, Norrkoping, Sweden;Linkoping Univ, Dept Clin & Expt Med, Linkoping, Sweden;Linkoping Univ, Dept Paediat, Linkoping, Sweden.
    Blomqvist, Ylva Thernström
    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.
    Helmer, Charlotte Sahlen
    Linkoping Univ, Div Nursing Sci, Dept Social & Welf Studies, Norrkoping, Sweden;Linkoping Univ, Dept Clin & Expt Med, Linkoping, Sweden;Linkoping Univ, Dept Paediat, Linkoping, Sweden.
    Olsson, Emma
    Orebro Univ, Dept Pediat, Orebro, Sweden;Orebro Univ, Ctr Hlth Care Sci, Orebro, Sweden.
    Shorey, Shefaly
    Natl Univ Singapore, Natl Univ Hlth Syst, Yong Loo Lin Sch Med, Alice Lee Ctr Nursing Studies, Singapore, Singapore.
    Frostell, Anneli
    Linkoping Univ, Div Psychol, Dept Behav Sci & Learning, Linkoping, Sweden.
    Mörelius, Evalotte
    Linkoping Univ, Div Nursing Sci, Dept Social & Welf Studies, Norrkoping, Sweden;Linkoping Univ, Dept Clin & Expt Med, Linkoping, Sweden.
    Effect of skin-to-skin contact on parents' sleep quality, mood, parent-infant interaction and cortisol concentrations in neonatal care units: study protocol of a randomised controlled trial2018In: BMJ Open, E-ISSN 2044-6055, Vol. 8, no 7, article id e021606Article in journal (Refereed)
    Abstract [en]

    Introduction: Separation after preterm birth is a major stressor for infants and parents. Skin-to-skin contact (SSC) is a method of care suitable to use in the neonatal intensive care unit (NICU) to minimise separation between parents and infants. Less separation leads to increased possibilities for parent-infant interaction, provided that the parents' sleep quality is satisfactory. We aimed to evaluate the effect of continuous SSC on sleep quality and mood in parents of preterm infants born <33 weeks of gestation as well as the quality of parent-infant interaction and salivary cortisol concentrations at the time of discharge.

    Methods and analysis: A randomised intervention study with two arms-intervention versus standard care. Data will be collected from 50 families. Eligible families will be randomly allocated to intervention or standard care when transferred from the intensive care room to the family-room in the NICU. The intervention consists of continuous SSC for four consecutive days and nights in the family-room. Data will be collected every day during the intervention and again at the time of discharge from the hospital. Outcome measures comprise activity tracker (Actigraph); validated self-rated questionnaires concerning sleep, mood and bonding; observed scorings of parental sensitivity and emotional availability and salivary cortisol. Data will be analysed with pairwise, repeated measures, Mann Whitney U-test will be used to compare groups and analysis of variance will be used to adjust for different hospitals and parents' gender.

    Ethics and dissemination: The study is approved by the Regional Research Ethics Board at an appropriate university (2016/89-31). The results will be published in scientific journals. We will also use conferences and social media to disseminate our findings.

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    FULLTEXT01
  • 10.
    Arwehed, Sofia
    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.
    Nordic survey showed wide variation in discharge practices for very preterm infants2023Conference paper (Other academic)
  • 11.
    Arwehed, Sofia
    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.
    Axelin, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, SWEDESD - Sustainability Learning and Research Centre. Department of Nursing Science University of Turku, Turku, Finland.
    Björklund, Lars J.
    Department of Clinical Sciences, Lund, Paediatrics Lund University and Skåne University Hospital Lund Sweden.
    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.
    Heiring, Christian
    Department of Neonatology Copenhagen University Hospital Rigshospitalet Denmark.
    Jonsson, Baldvin
    Department of Women's and Children's Health Karolinska Institute and Karolinska University Hospital Stockholm Sweden.
    Klingenberg, Claus
    Paediatric Research Group, Faculty of Health Sciences UiT‐The Arctic University of Norway Tromsø Norway;Department of Pediatrics and Adolescence Medicine University Hospital of North Norway Tromsø Norway.
    Metsäranta, Marjo
    Department of Pediatrics University of Helsinki and Helsinki University Hospital (HUH) Helsinki Finland.
    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.
    Lehtonen, Liisa
    Department of Paediatrics and Adolescent Medicine Turku University, Hospital and University of Turku Turku Finland.
    Nordic survey showed wide variation in discharge practices for very preterm infants2023In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227Article in journal (Refereed)
    Abstract [en]

    Aim

    We aimed to describe clinical practices and criteria for discharge of very preterm infants in Nordic neonatal units.

    Methods

    Medical directors of all 89 level-2 and level-3 units in Denmark, Finland, Iceland, Norway and Sweden were invited by e-mail to complete a web-based multiple-choice survey with the option to make additional free-text comments.

    Results

    We received responses from 83/89 units (93%). In all responding units, discharge readiness was based mainly on clinical assessment with varying criteria. In addition, 36% used formal tests of cardiorespiratory stability and 59% used criteria related to infant weight or growth. For discharge with feeding tube, parental ability to speak the national language or English was mandatory in 45% of units, with large variation among countries. Post-discharge home visits and video-consultations were provided by 59% and 51%, respectively. In 54% of units, parental preparation for discharge were not initiated until the last two weeks of hospital stay.

    Conclusion

    Discharge readiness was based mainly on clinical assessment, with criteria varying among units despite similar population characteristics and care structures. This variation indicates a lack of evidence base and may unnecessarily delay discharge; further studies of this matter are needed. Earlier parental preparation and use of interpreters might facilitate earlier discharge.

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  • 12.
    Askelöf, Ulrica
    et al.
    Karolinska Inst, Div Obstet & Gynecol, Dept Clin Sci Intervent & Technol, Stockholm, Sweden.;Sahlgrens Univ Hosp, Swedish Natl Umbil Cord Blood Bank, Gothenburg, Sweden..
    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).
    Domellöf, Magnus
    Umea Univ, Dept Clin Sci, Unit Pediat, Umea, Sweden..
    Fasth, Anders
    Sahlgrens Univ Hosp, Swedish Natl Umbil Cord Blood Bank, Gothenburg, Sweden.;Univ Gothenburg, Inst Clin Sci, Dept Pediat, Gothenburg, Sweden..
    Hallberg, Boubou
    Karolinska Inst, CLINTEC, Dept Neonatol, Stockholm, Sweden.;Univ Hosp, Stockholm, 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.
    Pettersson, Karin
    Karolinska Inst, Div Obstet & Gynecol, Dept Clin Sci Intervent & Technol, Stockholm, Sweden.;Sahlgrens Univ Hosp, Swedish Natl Umbil Cord Blood Bank, Gothenburg, Sweden..
    Westgren, Magnus
    Karolinska Inst, Div Obstet & Gynecol, Dept Clin Sci Intervent & Technol, Stockholm, Sweden.;Sahlgrens Univ Hosp, Swedish Natl Umbil Cord Blood Bank, Gothenburg, Sweden..
    Wiklund, Ingela E.
    Danderyd Hosp, Dept Clin Sci, Stockholm, Sweden..
    Gotherstrom, Cecilia
    Karolinska Inst, Div Obstet & Gynecol, Dept Clin Sci Intervent & Technol, Stockholm, Sweden.;Sahlgrens Univ Hosp, Swedish Natl Umbil Cord Blood Bank, Gothenburg, Sweden.;Karolinska Inst, Ctr Hematol & Regenerat Med, Stockholm, Sweden..
    Wait a minute?: An observational cohort study comparing iron stores in healthy Swedish infants at 4 months of age after 10-, 60-and 180-second umbilical cord clamping2017In: BMJ Open, E-ISSN 2044-6055, Vol. 7, no 12, article id e017215Article in journal (Refereed)
    Abstract [en]

    Background and objective: Umbilical cord blood (UCB) is a valuable stem cell source used for transplantation. Immediate umbilical cord (UC) clamping is widely practised, but delayed UC clamping is increasingly advocated to reduce possible infant anaemia. The aim of this study was to investigate an intermediate UC clamping time point and to evaluate iron status at the age of 4 months in infants who had the UC clamped after 60 s and compare the results with immediate and late UC clamping.

    Design: Prospective observational study with two historical controls.

    Setting: A university hospital in Stockholm, Sweden, and a county hospital in Halland, Sweden.

    Methods: Iron status was assessed at 4 months in 200 prospectively recruited term infants whose UC was clamped 60 s after birth. The newborn baby was held below the uterine level for the first 30 s before placing the infant on the mother’s abdomen for additional 30 s. The results were compared with data from a previously conducted randomised controlled trial including infants subjected to UC clamping at ≤10 s (n=200) or ≥180 s (n=200) after delivery.

    Results: After adjustment for age differences at the time of follow-up, serum ferritin concentrations were 77, 103 and 114 µg/L in the 10, 60 and 180 s groups, respectively. The adjusted ferritin concentration was significantly higher in the 60 s group compared with the 10 s group (P=0.002), while the difference between the 60 and 180 s groups was not significant (P=0.29).

    Conclusion: In this study of healthy term infants, 60 s UC clamping with 30 s lowering of the baby below the uterine level resulted in higher serum ferritin concentrations at 4 months compared with 10 s UC clamping. The results suggest that delaying the UC clamping for 60 s reduces the risk for iron deficiency.

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  • 13.
    Aurpibul, Linda
    et al.
    Chiang Mai Univ, Res Inst Hlth Sci, NCD Ctr Excellence, Chiang Mai, Thailand..
    Butler, Eadaoin M.
    Univ Auckland, A Better Start Natl Sci Challenge, Auckland, New Zealand.;Univ Auckland, Liggins Inst, Auckland, New Zealand..
    Wongthanee, Antika
    Chiang Mai Univ, Fac Med, Dept Internal Med, Chiang Mai, Thailand..
    Rerkasem, Amaraporn
    Chiang Mai Univ, Res Inst Hlth Sci, NCD Ctr Excellence, Chiang Mai, Thailand..
    Pruenglampoo, Sakda
    Chiang Mai Univ, Res Inst Hlth Sci, NCD Ctr Excellence, Chiang Mai, Thailand..
    Mangklabruks, Ampica
    Chiang Mai Univ, Fac Med, Dept Internal Med, Chiang Mai, Thailand..
    Rerkasem, Kittipan
    Chiang Mai Univ, Res Inst Hlth Sci, NCD Ctr Excellence, Chiang Mai, Thailand.;Chiang Mai Univ, Fac Med, Dept Surg, Chiang Mai, Thailand..
    Derraik, José G. B.
    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. Chiang Mai Univ, Res Inst Hlth Sci, NCD Ctr Excellence, Chiang Mai, Thailand.;Univ Auckland, A Better Start Natl Sci Challenge, Auckland, New Zealand.;Univ Auckland, Liggins Inst, Auckland, New Zealand.;Zhejiang Univ, Sch Med, Childrens Hosp, Endocrinol Dept, Hangzhou, Peoples R China..
    Birth order is associated with an increased risk of obesity in young adults in Thailand2021In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 75, no 3, p. 305-308Article in journal (Refereed)
    Abstract [en]

    Background There is a growing body of evidence showing that early life events are associated with increased risk of cardiovascular and metabolic diseases later in adult life. However, there is a paucity of data in this field from Asian populations. In this study, we examined the association of birth order with obesity risk and cardiometabolic outcomes in young adults in Thailand. Methods Participants were the offspring from a birth cohort study in Chiang Mai (northern Thailand), who were followed up at similar to 20.5 years of age. Clinical assessments included anthropometry, blood pressure, fasting blood samples and carotid intima-media thickness. Insulin sensitivity was estimated using homeostatic model assessment of insulin resistance (HOMA-IR). Participants were stratified into two groups: first-borns and later-borns. Health outcomes between groups were compared using multivariable models adjusting for important confounders, in particular maternal body mass index (BMI). Results A total of 559 participants were studied: 316 first-borns (46% males) and 243 later-borns (47% males). Adjusted models showed anthropometric differences, with first-borns being 2.3 kg heavier (p=0.023) with a BMI 0.86 kg/m(2) greater (p=0.019) than later-borns. Thus, rates of obesity were higher in first-borns than in later-borns (6.6% vs 2.9%), so that first-borns had an adjusted relative risk of obesity 3.3 times greater than later-borns [95% CI 1.42 to 7.88; p=0.006]. There were no observed differences in cardiovascular or metabolic parameters assessed, including HOMA-IR. Conclusion As observed in other populations, first-borns in Thailand had greater BMI and an increased risk of obesity in young adulthood. However, we observed no other cardiometabolic differences between first- and later-borns.

  • 14.
    Axelin, Anna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, SWEDESD - Sustainability Learning and Research Centre. Department of Nursing Science, University of Turku, Turku, Finland.
    Feeley, Nancy
    Cambell-Yeo, Marsha
    Silnes Tandberg, Bente
    Szczapa, Tomasz
    Wielenga, Joke
    Weis, Janne
    Pavicic Bosnjak, Anita
    Jonsdottir, Rakel B
    George, Kendall
    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. Neonatal Intensive Care Unit, University Children’s Hospital, Uppsala, Sweden.
    Bohlin, Kajsa
    Lehtonen, Liisa
    Symptoms of depression in parents after discharge from NICU associated with family-centred care2022In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 78, no 6, p. 1676-1687Article in journal (Refereed)
    Abstract [en]

    AIMS: The aim of this study was to examine the potential association of family-centred care as perceived by parents during a NICU stay with parents' depressive symptoms at discharge and at 4 months corrected for infant age.

    DESIGN: A longitudinal, multicentre cohort study was conducted from 2018 to 2020 in 23 NICUs across 15 countries.

    METHODS: Parents (n = 635 mothers, n = 466, fathers) of infants (n = 739) born before 35 weeks of gestation and admitted to the participating NICUs were enrolled to the study during the first weeks of their infants' hospitalizations. They responded to Digi-FCC daily text messages inquiring about their perception of family-centred care provided by NICU staff. In addition, they completed a questionnaire assessing their overall perception of family-centred care at discharge. Parents' depressive symptoms were measured by the Edinburgh Postnatal Depression Scale at discharge and again after discharge when their infants were at 4 months corrected for age.

    RESULTS: The mothers' and the fathers' perceptions of family-centred care were associated with their depressive symptoms at discharge and at 4 months corrected age, controlling for gestational age, multiple birth, parent education and relationship status. Parents' participation in infant care, care-related decisions and emotional support provided to parents by staff explained the variation in the parents' perceptions of family-centred care. The factors facilitating the implementation of family-centred care included unlimited access to the unit for the parents and for their significant others, as well as amenities for parents.

    CONCLUSIONS: Our study shows that family-centred NICU care associates with parents' depressive symptoms after a NICU stay.

    IMPACT: Depression is common in parents of preterm infants. The provision of family-centred care may protect the mental well-being of parents of preterm infants.

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  • 15. Backes, Carl H.
    et al.
    Sindelar, Richard
    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.
    Janvier, Annie
    Management, treatment and ethical considerations in the care of mother-infant dyads at less than 25 weeks of gestations2022In: Seminars in Perinatology, ISSN 0146-0005, E-ISSN 1558-075X, Vol. 46, no 1, article id 151535Article in journal (Refereed)
    Abstract [en]

    Infants born at less than 25 weeks of gestation represent a small fraction of all preterm births. Caring for these fragile patients is complex because of their significant risks of mortality and adverse outcomes. In the last decades, in view of decreased mortality without increased morbidity as reported from different centers, many clinicians are now more likely to consider providing intensive care treatment to infants born at less than 25 weeks of gestation. But in other settings, palliative care is still considered standard practice, particularly at 22 and 23 weeks of gestation.

  • 16.
    Backes, Carl H.
    et al.
    Nationwide Childrens Hosp, Abigail Wexner Res Inst, Ctr Perinatal Res, Columbus, OH 43205 USA.;Ohio State Univ, Dept Pediat, Wexner Med Ctr, Columbus, OH 43210 USA.;Nationwide Childrens Hosp, Ctr Heart, Columbus, OH 43205 USA.;Ohio State Univ, Dept Obstet & Gynecol, Wexner Med Ctr, Columbus, OH 43210 USA..
    Sindelar, Richard
    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.
    Janvier, Annie
    CHU Ste Justine, Div Neonatol, Clin Eth Unit, Dept Pediat,Palliat Care Unit,Unite Rech Eth Clin, Montreal, PQ, Canada.;Univ Montreal, Dept Pediat & Clin Eth, Montreal, PQ, Canada..
    Opportunities and recommendations in the care of mother-infant dyads at less than 25 weeks of gestation2022In: Seminars in Perinatology, ISSN 0146-0005, E-ISSN 1558-075X, Vol. 46, no 2, article id 151552Article in journal (Other academic)
  • 17. Backes, Carl
    et al.
    Söderström, Fanny
    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.
    Ågren, Johan
    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.
    Sindelar, Richard
    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.
    Bartlett, CV
    Rivera, BK
    Mitchell, CC
    Shepherd, Edward
    Nelin, Leif
    Normann, Erik
    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.
    Outcomes Following a Comprehensive versus a Selective Approach for Infants Born at 22 Weeks of Gestation.2019In: Journal of Perinatology, ISSN 0743-8346, E-ISSN 1476-5543, Vol. 39, no 1, p. 39-47Article in journal (Refereed)
    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.

  • 18.
    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

  • 19.
    Bengtsson, Frida
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Ekéus, Cecilia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Clinical Obstetrics.
    Hagelroth, Amelie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    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.
    Neonatal outcomes of elective labor induction in low-risk term pregnancies2023In: Scientific Reports, E-ISSN 2045-2322, Vol. 13, article id 15830Article in journal (Refereed)
    Abstract [en]

    The rate of labor induction has increased in recent years. The results of previously conducted studies examining associations between elective induction of labor (IOL) and neonatal outcomes have been contradictory. The aim of this study was to examine the intrinsic neonatal risks following IOL. We conducted a population-based cohort study, including all women with recorded low-risk singleton pregnancies at a gestational age between 37+0 and 41+6 weeks in Sweden from 1999 to 2017. Data were collected from the Swedish Medical Birth register. Two study groups were compared-the elective induction group with the spontaneous labor onset group. The results showed that the rate of elective IOL increased from 7.2% in 1999 to 16.4% in 2017. Elective IOL was associated with a higher OR for chorioamnionitis, bacterial sepsis, intracranial hemorrhage, assisted ventilation, hyperbilirubinemia, APGAR<7 at 5 min, and neonatal seizures compared to deliveries with spontaneous labor onset. Regarding mortality outcomes, no significant differences were shown between the groups for either early term or full-term deliveries. We conclude that IOL is associated with neonatal complications, although causality could not be established in this observational study. It is important to be aware of the increased risk and perform IOL with caution.

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  • 20.
    Berggren, Sara
    et al.
    Univ Gothenburg, Sahlgrenska Acad, Dept Paediat, Vitaminvagen 21,Plan 2, S-41650 Gothenburg, Sweden.;Halland Hosp Halmstad, Dept Paediat, Halmstad, Sweden.;Hlth Ctr Halland, Hlth Ctr Hyltebruk, Halmstad, Sweden..
    Andersson, Ola
    Lund Univ, Dept Clin Sci Lund, Pediat Neonatol, Lund, Sweden..
    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.
    Dahlgren, Jovanna
    Univ Gothenburg, Sahlgrenska Acad, Dept Paediat, Vitaminvagen 21,Plan 2, S-41650 Gothenburg, Sweden..
    Roswall, Josefine
    Univ Gothenburg, Sahlgrenska Acad, Dept Paediat, Vitaminvagen 21,Plan 2, S-41650 Gothenburg, Sweden.;Halland Hosp Halmstad, Dept Paediat, Halmstad, Sweden..
    Serum osteocalcin levels at 4 months of age were associated with neurodevelopment at 4 years of age in term-born children2022In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 111, no 2, p. 338-345Article in journal (Refereed)
    Abstract [en]

    Aim: The hormone osteocalcin influenced neurodevelopment and cognition in mice models; this human study explored potential associations between total serum levels in human infants and neurodevelopment at 4 years of age.

    Methods: The data were based on two Swedish birth cohorts from 2008 to 2009. We followed 158 healthy full-term vaginal births (51% girls) by measuring serum osteocalcin in cord blood and at 4, 12 and 36 months. The values were compared with neurodevelopment tests at 4 years of age.

    Results: There was an association between osteocalcin at 4 months and later full-scale intelligence quotient (IQ; r(2) 0.031, p < 0.05). Children with osteocalcin levels in the highest quartile scored 5.6 (95% confidence interval [1.3, 9.9]) points higher than those in the lowest quartile, with mean scores of 118.8 +/- 8.8 and 113.2 +/- 9.2 (p < 0.05). They also scored higher on gross motor skills (p < 0.05) and showed greater ability during the drawing trail test (p < 0.005). Cord levels of osteocalcin were negatively associated with processing speed and fine motor development at 4 years, but levels at 12 and 36 months were not associated with later neurodevelopment.

    Conclusion: Osteocalcin levels in infancy appeared to be associated with later IQ and motor development, but more research is needed.

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  • 21.
    Biskop, Emilia
    et al.
    Univ Hosp, Neonatal Intens Care Unit, Uppsala, Sweden.
    Paulsdotter, Therese
    Univ Hosp, Neonatal Intens Care Unit, Uppsala, 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. Univ Hosp, Neonatal Intens Care Unit, Uppsala, Sweden.
    Ågren, Johan
    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. Univ Hosp, Neonatal Intens Care Unit, Uppsala, Sweden.
    Thernström Blomqvist, Ylva
    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. Univ Hosp, Neonatal Intens Care Unit, Uppsala, Sweden.
    Parental participation during therapeutic hypothermia for neonatal hypoxicischemic encephalopathy2019In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 20, p. 77-80Article in journal (Refereed)
    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.

  • 22.
    Biskop Lindgren, Emilia
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research.
    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.
    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.
    Grandahl, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research.
    To Feel Abandoned in an Insecure Situation: Parents' Experiences of Separation From Their Newborn Due to the Mother Being COVID-19 Positive2023In: Advances in Neonatal Care, ISSN 1536-0903, E-ISSN 1536-0911, Vol. 23, no 4, p. 304-310Article in journal (Refereed)
    Abstract [en]

    Background: 

    The COVID-19 pandemic resulted in changes in neonatal care, sometimes resulting in a separation between parents and their newborn. Knowledge about parents' experiences of this separation is limited.

    Purpose: 

    To explore parents' experiences of separation from their newborn due to COVID-19.

    Methods: 

    Interviews with parents (n = 11) separated from their newborn.

    Results: 

    The parents' experiences of being separated from their newborn were expressed under 3 themes: “To create a sense of safety in an insecure situation”; “Unexpected start to parenthood”; and “To be reunited.” Parents felt abandoned and alone, even if they had support from significant others. Although they considered the separation as undesired, wanting to be with their newborn infant, it was secondary to not wanting to infect the infant with COVID-19. Furthermore, lacking information about a potentially lethal virus adds to the uncertainty that comes with having a newborn. The separation affected the whole family, some for a long time afterward.

    Implications for Practice and Research: 

    If a new situation with potentially life-threatening effects, like the COVID-19 pandemic, occurs again, considering the experiences of these parents is paramount. Precautions should be taken to minimize the potential harm. If a separation between newborns and parents is inevitable, parents need preparation and transparent information prior to the separation and before the reunion. Well-thought-out policies must be in place to minimize the impact of a separation on both parties. Parents should be able to have a deputy parent present during an undesired but necessary separation from their newborn.

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  • 23.
    Blixt, Ingrid
    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. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research Sörmland.
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research Sörmland. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research.
    Funkquist, Eva-Lotta
    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.
    Partners' experiences of breastfeeding: a qualitative evaluation of a breastfeeding support intervention in Sweden2024In: International Breastfeeding Journal, E-ISSN 1746-4358, Vol. 19, article id 6Article in journal (Refereed)
    Abstract [en]

    Background: The World Health Organization states that women and their families need breastfeeding support from the healthcare system. However, knowledge about the most effective way to involve the partner in breastfeeding is lacking. A qualitative evaluation can provide insight and knowledge about the partner's experiences towards a breastfeeding support intervention and thus contribute to how forthcoming breastfeeding support policies are designed. The aim of this study was to explore partners' experiences regarding breastfeeding while participating in The Breastfeeding Study.

    Methods: An exploratory, longitudinal and qualitative design was used. This study was part of The Breastfeeding Study, which took place in Sweden. The intervention was performed in line with the Ten Steps to Successful Breastfeeding. Partners in the in the intervention group (IG) were part of a structured breastfeeding support programme. An individual breastfeeding plan was established in cooperation with the parents-to-be during pregnancy, and the plan was followed up at the child healthcare centre. A purposive sample was recruited from March to December 2021. Interviews and diary entries from IG (n = 8) and control group (CG) (n = 8) during pregnancy and 2 months after birth were analysed by content analysis, in accordance with the COREQ guidelines.

    Results: Partners' experiences can be summarised under the main category of 'Striving to be part of the family and important that the family's everyday life was well-functioning'. IG partners experienced that both parents were involved and cooperated in the breastfeeding process and that guidance from healthcare professionals (HCPs) helped them to feel secure. CG partners experienced feeling excluded and not receiving support from HCPs.

    Conclusion: Both parents need to be targeted in breastfeeding support policies to meet the support needs. Midwives at antenatal care and child healthcare nurses at the child healthcare centre have important roles to play in providing structured breastfeeding support and a breastfeeding plan. Both IG and CG partners strived to become a part of the infant's life and to make family life work. Midwives should involve both parents in a reflective dialogue on how the partner can be involved, apart from just feeding the infant.

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  • 24.
    Blixt, Ingrid
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research Sörmland. 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.
    Rosenblad, Andreas Karlsson
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism. Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden.
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research Sörmland. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research.
    Funkquist, Eva-Lotta
    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.
    Breastfeeding training improved healthcare professional's self-efficacy to provide evidence-based breastfeeding support: A pre-post intervention study2023In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 125, article id 103794Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To describe healthcare professional's (HCP's) perceived self-efficacy in their ability to provide breastfeeding support before and after a breastfeeding training program.

    DESIGN: Pre-post intervention study.

    SETTING: Antenatal care and child healthcare (CHC) centres in Sweden during 2020.

    PARTICIPANTS: An intervention group consisting of 39 HCPs (midwives 51.3%, child healthcare nurses 46.2%) completing a questionnaire at baseline and after intervention, and a control group of 34 HCPs (midwives 61.8%, child healthcare nurses 38.2%) completing a questionnaire at baseline.

    INTERVENTION: A breastfeeding training program in line with the Ten Steps to Successful Breastfeeding and WHO recommendations about breastfeeding.

    MEASUREMENTS AND FINDINGS: The 11-item Breastfeeding Support Confidence Scale (BSCS) measures HCP's self-efficacy regarding providing breastfeeding support in line with Ten Steps to Successful Breastfeeding and WHO recommendations. The intervention group experienced a significantly increased self-efficacy from pre-intervention to post-intervention for 8 of the 11 BSCS items, with the overall BSCS index score increasing from 36.87 to 39.56 points (p = 0.001). The index score in the intervention group at follow-up was significantly higher than the corresponding score in the control group at baseline (p = 0.025). The intervention group had significantly higher scores at follow-up than the control group at baseline on the questions: "I'm sure that I can help mothers continue to breastfeed even if the infant doesn't follow the growth curve" (p = 0.026) and "I'm sure that I can help mothers continue to breastfeed when the breastfeeding is painful" (p = 0.048).

    KEY CONCLUSIONS: The breastfeeding training program improved HCP' self-efficacy to provide evidence-based support to breastfeeding mothers.

    IMPLICATIONS FOR PRACTICE: This training program is well suited to implement in clinical practice and follows the Ten Steps to Successful Breastfeeding.

    TRIAL REGISTRATION: ACTRN12623000648628.

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  • 25.
    Bolk, Jenny
    et al.
    Soder Sjukhuset, Sachs Children & Youth Hosp, Stockholm, Sweden;Karolinska Inst, Dept Womens & Childrens Hlth, Tomtebodavagen 18a, S-17177 Stockholm, Sweden.
    Farooqi, Aijaz
    Univ Umea, Inst Clin Sci, Pediat Unit, Umea, Sweden.
    Hafstrom, Maria
    St Olavs Hosp, Dept Paediat, Trondheim, Norway;Norwegian Univ Sci & Technol Trondheim, Dept Lab Med Childrens & Womens Hlth, Trondheim, Norway;Univ Gothenburg, Inst Clin Sci, Queen Silvia Childrens Hosp, Dept Pediat, Gothenburg, Sweden.
    Aden, Ulrika
    Karolinska Inst, Dept Womens & Childrens Hlth, Tomtebodavagen 18a, S-17177 Stockholm, Sweden;Karolinska Univ Hosp, Stockholm, Sweden.
    Serenius, Fredrik
    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. Univ Umeå, Inst Clin Sci, Pediat Unit, Umeå, Sweden.
    Developmental Coordination Disorder and Its Association With Developmental Comorbidities at 6.5 Years in Apparently Healthy Children Born Extremely Preterm2018In: JAMA pediatrics, ISSN 2168-6203, E-ISSN 2168-6211, Vol. 172, no 8, p. 765-774Article in journal (Refereed)
    Abstract [en]

    IMPORTANCE There are concerns that apparently healthy extremely preterm children face a risk of developing motor impairments, such as developmental coordination disorder.

    OBJECTIVE To evaluate the prevalence of developmental coordination disorder and associated comorbidities in a national cohort of apparently healthy children born at 22 to 26 gestational weeks, compared alongside term-born peers.

    DESIGN, SETTING, AND PARTICIPANTS This prospective, population-based cohort study included all children who were consecutively born at 22 to 26 gestational weeks in Sweden from April 1, 2004, through March 31, 2007. At 6.5 years, 441 preterm children were evaluated alongside 371 controls. A total of 275 preterm children (62.4%) and 359 term-born children (96.8%) did not have neurodevelopmental disabilities. Motor assessments were completed for 229 of 275 preterm children (83.3%) and 344 of 359 (95.8%) term-born children, who composed the final study sample. MAIN

    OUTCOMES AND MEASURES Developmental coordination disorder was defined as a score of the fifth percentile or lower on the Movement Assessment Battery for Children-Second Edition scale, using control group scores. Assessment tools included the Wechsler Intelligence Scale for Children-Fourth Edition, the Brown Attention-Deficit Disorder Scales, the Five to Fifteen questionnaire, and the Strengths and Difficulties questionnaire.

    RESULTS Of the 229 extremely preterm children and 344 term-born controls who underwent motor assessments, 115 (50.2%) and 194 (56.4%) were boys, respectively. Developmental coordination disorder was present in 85 of 229 (37.1%) preterm children and in 19 of 344 controls (5.5%) (adjusted odds ratio [OR], 7.92; 99% CI, 3.69-17.20). When preterm children with developmental coordination disorder were compared with term-born peers, the risk was increased for total behavioral problems, internalizing, externalizing, attentional problems, hyperactivity, perceptual problems, executive dysfunction, and poor social skills, with adjusted ORs varying from 2.66 (99% CI, 1.09-6.48) for time concepts to 9.06 (99% CI, 3.60-22.8) for attentional problems (all P < .01). When preterm children with and without developmental coordination disorder were compared, preterm children with developmental coordination disorder had more behavioral problems; the adjusted OR for total behavioral problems was 2.71 (99% CI, 1.15-6.37); for externalizing problems, 2.80 (99% CI, 1.10-7.12); for inattention, 3.38 (99% CI, 1.39-8.18); and for combined attention/hyperactivity problems, 3.68 (99% CI, 1.47-9.16) (all P < .01). Parents underestimated the children's motor problems and only a few of the children had received psychological care or physiotherapy.

    CONCLUSIONS AND RELEVANCE Children who were born extremely preterm faced a high risk for developmental coordination disorder with associated comorbidities. Our findings support the importance of a structured follow-up of motor function, behavior, and cognition.

  • 26.
    Bolk, Jenny
    et al.
    Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden;Sachs Children & Youth Hosp, Stockholm, Sweden.
    Kaul, Ylva Fredriksson
    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.
    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.
    Stjernqvist, Karin
    Lund Univ, Dept Psychol, Div Dev Psychol, Lund, Sweden.
    Padilla, Nelly
    Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden.
    Serenius, Fredrik
    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. Univ Umeå, Pediat, Inst Clin Sci, Umeå, Sweden.
    Hellgren, Kerstin
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden.
    Åden, Ulrika
    Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden.
    National population-based cohort study found that visual-motor integration was commonly affected in extremely preterm born children at six-and-a-half years2018In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 107, no 5, p. 831-837Article in journal (Refereed)
    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.

  • 27.
    Bolk, Jenny
    et al.
    Karolinska Inst, Dept Med Solna, Clin Epidemiol Div, Stockholm, Sweden.;Karolinska Inst, Dept Clin Sci & Educ, Sodersjukhuset, Stockholm, Sweden.;Soder Sjukhuset, Sachs Children & Youth Hosp, Stockholm, Sweden..
    Källén, Karin
    Lund Univ, Ctr Reprod Epidemiol, Lund, Sweden..
    Farooqi, Aijaz
    Univ Umeå, Inst Clin Sci, Unit Pediat, Umeå, Sweden..
    Hafström, Maria
    Univ Gothenburg, Queen Silvia Childrens Hosp, Inst Clin Sci, Dept Pediat, Gothenburg, Sweden.;Angered Hosp, Angered, Sweden..
    Fellman, Vineta
    Lund Univ, Dept Clin Sci, Pediat, Lund, Sweden.;Folkhalsan Res Ctr, Helsinki, Finland.;Univ Helsinki, Childrens Hosp, Clinicum, Helsinki, Finland..
    Åden, Ulrika
    Karolinska Univ Hosp, Stockholm, Sweden.;Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden..
    Serenius, 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. Univ Umeå, Inst Clin Sci, Unit Pediat, Umeå, Sweden.
    Perinatal risk factors for developmental coordination disorder in children born extremely preterm2023In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 112, no 4, p. 675-685Article in journal (Refereed)
    Abstract [en]

    Aim

    Children born extremely preterm frequently have developmental coordination disorder (DCD). We aimed to evaluate perinatal risk factors for DCD.

    Methods

    Swedish national cohort study including 226 children born before 27 gestational weeks without major neurodevelopmental disabilities at 6.5 years. Outcome was DCD, defined as ≤5th percentile on the Movement Assessment Battery for Children-Second Edition. Perinatal risk factors were evaluated using multivariable logistic regression.

    Results

    DCD was present in 84/226 (37.2%) children. Of the risk factors known at 40 weeks gestation, independent and significant risk factors for DCD were: mother's age at delivery (odds ratio [OR] 1.73, 95% confidence interval [CI] 1.07–2.80); pre-eclampsia (2.79, 1.14–6.80); mother born in a non-Nordic country (2.23, 1.00–4.99); gestational age per week increase (0.70, 0.50–0.99) and retinopathy of prematurity (2.48, 1.26–4.87). Of factors known at discharge, postnatal steroids exposure (2.24, 1.13–4.46) and mechanical ventilation (1.76, 1.06–2.09) were independent risk factors when added to the model in separate analyses.

    Conclusion

    The risk of DCD in children born extremely preterm was multifactorial and associated with gestational age largely mediated by ROP, maternal factors, pre-eclampsia, administration of postnatal steroids and mechanical ventilation. These risk factors are common among children born extremely preterm, contributing to their high risk of DCD.

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  • 28.
    Butler, Eadaoin M.
    et al.
    Univ Auckland, Liggins Inst, Auckland, New Zealand.;Univ Auckland, A Better Start Natl Sci Challenge, Auckland, New Zealand..
    Derraik, José G. B.
    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. Univ Auckland, Liggins Inst, Auckland, New Zealand.;Univ Auckland, Fac Med & Hlth Sci, Dept Paediat Child & Youth Hlth, Auckland, New Zealand.; Chiang Mai Univ, Res Inst Hlth Sci, Environm Occupat Hlth Sci & Noncommunicable Dis Re, Chiang Mai, Thailand..
    Burge, Alison
    Auckland Dist Hlth Board, Starship Community Serv, Auckland, New Zealand..
    Cutfield, Wayne S.
    Univ Auckland, Liggins Inst, Auckland, New Zealand.;Univ Auckland, A Better Start Natl Sci Challenge, Auckland, New Zealand..
    Leversha, Alison
    Univ Auckland, Fac Med & Hlth Sci, Dept Paediat Child & Youth Hlth, Auckland, New Zealand.;Auckland Dist Hlth Board, Starship Community Serv, Auckland, New Zealand..
    Caregiver Perception of Weight Status in 5-Year-Old Children From a Community of High Socioeconomic Deprivation in New Zealand2022In: Frontiers In Public Health, ISSN 2296-2565, Vol. 10, article id 641418Article in journal (Refereed)
    Abstract [en]

    BackgroundEarly childhood obesity is highly prevalent in Aotearoa New Zealand (NZ). Little is known about caregiver perception of children's weight status among those living in areas of high socioeconomic deprivation, particularly Maori and Pacific children. AimsTo explore caregiver perception of weight status among children starting school in areas of high socioeconomic deprivation and examine potential associations between the child's body mass index (BMI) z-score and their caregiver's perception of their child's body size or health. MethodsParticipants were 5-year-old children living in a community of high socioeconomic deprivation and their caregivers. Children had their weight and height measured. BMI z-scores were calculated according to World Health Organization standards. Caregivers were asked to assess their child's BMI and health status, and choose a silhouette that best represented their child's body size. ResultsOne hundred and six children (>75% Maori or Pacific) were included. Over half (58%) had overweight or obesity, with only 16% correctly perceived by their caregiver as overweight. These children tended to have higher BMI z-scores than those not correctly perceived as overweight. Caregivers chose larger silhouettes to represent children's body sizes as children's BMI z-scores increased. There was no discernible association between children's BMI z-scores and caregiver perception of children's health. ConclusionsCaregivers appeared to judge their child's body size in comparison to other children. The normalization of childhood obesity and infrequent caregiver recognition of this condition in children in communities with a high prevalence may impact the uptake and efficacy of intervention initiatives.

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  • 29.
    Butler, Eadaoin M.
    et al.
    A Better Start Natl Sci Challenge, Auckland, New Zealand.;Univ Auckland, Liggins Inst, Auckland, New Zealand..
    Pillai, Avinesh
    Univ Auckland, Ctr Longitudinal Res, Growing Up New Zealand, Auckland, New Zealand..
    Morton, Susan M. B.
    A Better Start Natl Sci Challenge, Auckland, New Zealand.;Univ Auckland, Ctr Longitudinal Res, Growing Up New Zealand, Auckland, New Zealand..
    Seers, Blake M.
    Univ Auckland, Dept Stat, Auckland, New Zealand..
    Walker, Caroline G.
    Univ Auckland, Ctr Longitudinal Res, Growing Up New Zealand, Auckland, New Zealand..
    Ly, Kien
    Univ Auckland, Ctr Longitudinal Res, Growing Up New Zealand, Auckland, New Zealand..
    Tautolo, El-Shadan
    A Better Start Natl Sci Challenge, Auckland, New Zealand.;Auckland Univ Technol, Dept Publ Hlth & Psychosocial Studies, Auckland, New Zealand..
    Glover, Marewa
    A Better Start Natl Sci Challenge, Auckland, New Zealand.;Massey Univ, Coll Hlth, Sch Publ Hlth, Auckland, New Zealand.;Ctr Res Excellence Indigenous Sovereignty & Smoki, Auckland, New Zealand..
    Taylor, Rachael W.
    A Better Start Natl Sci Challenge, Auckland, New Zealand.;Univ Otago, Dept Med, Dunedin, New Zealand..
    Cutfield, Wayne S.
    A Better Start Natl Sci Challenge, Auckland, New Zealand.;Univ Auckland, Liggins Inst, Auckland, New Zealand..
    Derraik, José G. B.
    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. A Better Start Natl Sci Challenge, Auckland, New Zealand.;Univ Auckland, Liggins Inst, Auckland, New Zealand.;Zhejiang Univ, Childrens Hosp, Dept Endocrinol, Sch Med, Hangzhou, Peoples R China..
    A prediction model for childhood obesity in New Zealand2021In: Scientific Reports, E-ISSN 2045-2322, Vol. 11, article id 6380Article in journal (Refereed)
    Abstract [en]

    Several early childhood obesity prediction models have been developed, but none for New Zealand's diverse population. We aimed to develop and validate a model for predicting obesity in 4-5-year-old New Zealand children, using parental and infant data from the Growing Up in New Zealand (GUiNZ) cohort. Obesity was defined as body mass index (BMI) for age and sex >= 95th percentile. Data on GUiNZ children were used for derivation (n=1731) and internal validation (n=713). External validation was performed using data from the Prevention of Overweight in Infancy Study (POI, n=383) and Pacific Islands Families Study (PIF, n=135) cohorts. The final model included: birth weight, maternal smoking during pregnancy, maternal pre-pregnancy BMI, paternal BMI, and infant weight gain. Discrimination accuracy was adequate [AUROC=0.74 (0.71-0.77)], remained so when validated internally [AUROC=0.73 (0.68-0.78)] and externally on PIF [AUROC=0.74 [0.66-0.82)] and POI [AUROC=0.80 (0.71-0.90)]. Positive predictive values were variable but low across the risk threshold range (GUiNZ derivation 19-54%; GUiNZ validation 19-48%; and POI 8-24%), although more consistent in the PIF cohort (52-61%), all indicating high rates of false positives. Although this early childhood obesity prediction model could inform early obesity prevention, high rates of false positives might create unwarranted anxiety for families.

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  • 30.
    Butler, Eadaoin M.
    et al.
    Better Start Natl Sci Challenge, Auckland, New Zealand.;Univ Auckland, Liggins Inst, Auckland 92019, New Zealand..
    Reynolds, Abigail J.
    Univ Auckland, Liggins Inst, Auckland 92019, New Zealand.;Dartmouth Coll, Hanover, NH 03755 USA..
    Derraik, José G. B.
    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. Better Start Natl Sci Challenge, Auckland, New Zealand.;Univ Auckland, Liggins Inst, Auckland 92019, New Zealand.;Zhejiang Univ, Childrens Hosp, Sch Med, Hangzhou, Peoples R China..
    Wilson, Brooke C.
    Univ Auckland, Liggins Inst, Auckland 92019, New Zealand..
    Cutfield, Wayne S.
    Better Start Natl Sci Challenge, Auckland, New Zealand.;Univ Auckland, Liggins Inst, Auckland 92019, New Zealand..
    Grigg, Celia P.
    Univ Auckland, Liggins Inst, Auckland 92019, New Zealand..
    The views of pregnant women in New Zealand on vaginal seeding: a mixed-methods study2021In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 21, article id 49Article in journal (Refereed)
    Abstract [en]

    Background: Vaginal seeding is the administration of maternal vaginal bacteria to babies following birth by caesarean section (CS), intended to mimic the microbial exposure that occurs during vaginal birth. Appropriate development of the infant gut microbiome assists early immune development and might help reduce the risk of certain health conditions later in life, such as obesity and asthma. We aimed to explore the views of pregnant women on this practice.

    Methods: We conducted a sequential mixed-methods study on the views of pregnant women in New Zealand (NZ) on vaginal seeding. Phase one: brief semi-structured interviews with pregnant women participating in a clinical trial of vaginal seeding (n=15); and phase two: online questionnaire of pregnant women throughout NZ (not in the trial) (n=264). Reflexive thematic analysis was applied to interview and open-ended questionnaire data. Closed-ended questionnaire responses were analysed using descriptive statistics.

    Results: Six themes were produced through analysis of the open-ended data: "seeding replicates a natural process", "microbiome is in the media", "seeding may have potential benefits", "seeking validation by a maternity caregiver", "seeding could help reduce CS guilt", and "the unknowns of seeding". The idea that vaginal seeding replicates a natural process was suggested by some as an explanation to help overcome any initial negative perceptions of it. Many considered vaginal seeding to have potential benefit for the gut microbiome, while comparatively fewer considered it to be potentially beneficial for specific conditions such as obesity. Just under 30% of questionnaire respondents (n=78; 29.5%) had prior knowledge of vaginal seeding, while most (n=133; 82.6%) had an initially positive or neutral reaction to it. Few respondents changed their initial views on the practice after reading provided evidence-based information (n=60; 22.7%), but of those who did, most became more positive (n=51; 86.4%).

    Conclusions: Given its apparent acceptability, and if shown to be safe and effective for the prevention of early childhood obesity, vaginal seeding could be a non-stigmatising approach to prevention of this condition among children born by CS. Our findings also highlight the importance of lead maternity carers in NZ remaining current in their knowledge of vaginal seeding research.

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  • 31.
    Bäcke, Pyrola
    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. Univ Hosp, Neonatal Intens Care Unit, Uppsala, Sweden.
    Bruschettini, Matteo
    Lund Univ, Skane Univ Hosp, Dept Clin Sci Lund, Paediat, Lund, Sweden.;Lund Univ, Skane Univ Hosp, Cochrane Sweden, Lund, Sweden..
    Sibrecht, Greta
    Poznan Univ Med Sci, Newborns Infect Dis Dept, Poznan, Poland..
    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. Univ Hosp, Neonatal Intens Care Unit, Uppsala, Sweden.
    Olsson, Emma
    Örebro Univ, Fac Med & Hlth, Dept Pediat, Örebro, Sweden.;Örebro Univ, Sch Hlth Sci, Fac Med & Hlth, Örebro, Sweden..
    Pharmacological interventions for pain and sedation management in newborn infants undergoing therapeutic hypothermia2022In: Cochrane Database of Systematic Reviews, E-ISSN 1469-493X, no 11Article, review/survey (Refereed)
    Abstract [en]

    Background

    Newborn infants affected by hypoxic‐ischemic encephalopathy (HIE) undergo therapeutic hypothermia. As this treatment seems to be associated with pain, and intensive and invasive care is needed, pharmacological interventions are often used. Moreover, painful procedures in the newborn period can affect pain responses later in life, impair brain development, and possibly have a long‐term negative impact on neurodevelopment and quality of life.

    Objectives

    To determine the effects of pharmacological interventions for pain and sedation management in newborn infants undergoing therapeutic hypothermia. Primary outcomes were analgesia and sedation, and all‐cause mortality to discharge.

    Search methods

    We searched CENTRAL, PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and the trial register ISRCTN in August 2021. We also checked the reference lists of relevant articles to identify additional studies.

    Selection criteria

    We included randomized controlled trials (RCT), quasi‐RCTs and cluster‐randomized trials comparing drugs used for the management of pain or sedation, or both, during therapeutic hypothermia: any opioids (e.g. morphine, fentanyl), alpha‐2 agonists (e.g. clonidine, dexmedetomidine), N‐Methyl‐D‐aspartate (NMDA) receptor antagonist (e.g. ketamine), other analgesics (e.g. paracetamol), and sedatives (e.g. benzodiazepines such as midazolam) versus another drug, placebo, no intervention, or non‐pharmacological interventions. 

    Primary outcomes were analgesia and sedation, and all‐cause mortality to discharge.

    Data collection and analysis

    Two review authors independently assessed studies identified by the search strategy for inclusion. We planned to use the GRADE approach to assess the certainty of evidence. We planned to assess the methodological quality of included trials using Cochrane Effective Practice and Organisation of Care Group (EPOC) criteria (assessing randomization, blinding, loss to follow‐up, and handling of outcome data). We planned to evaluate treatment effects using a fixed‐effect model with risk ratio (RR) for categorical data and mean, standard deviation (SD), and mean difference (MD) for continuous data. 

    Main results

    We did not find any completed studies for inclusion. Amongst the four excluded studies, topiramate and atropine were used in two and one trial, respectively; one study used dexmedetomidine and was initially reported in 2019 to be a randomized trial. However, it was an observational study (correction in 2021). We identified one ongoing study comparing dexmedetomidine to morphine.

    Authors' conclusions

    We found no studies that met our inclusion criteria and hence there is no evidence to recommend or refute the use of pharmacological interventions for pain and sedation management in newborn infants undergoing therapeutic hypothermia.

    Plain language summary

    Drugs to manage pain and sedation during cooling in newborns following poor brain oxygenation at birth (hypoxic‐ischaemic encephalopathy)

    Review question

    Do drugs save lives, or improve pain and sedation, in newborns who have poor brain oxygenation at birth ('hypoxic‐ischaemic encephalopathy') and who are undergoing cooling?

    Background

    Lack of oxygen at birth may damage the brain of the newborn. Babies with less severe brain damage may make a full recovery or only have mild problems. For other babies with more serious damage, this may lead to death or to problems later in life. For instance, some of these babies develop cerebral palsy, intellectual disabilities, or other problems. We currently only have cooling as an approach to treat this condition. Cooling is achieved by the use of special helmets or, more frequently, of thermal mattresses. Cooling may cause pain, which can also have a long‐term negative impact on development and quality of life. The aim of this review was to assess if drugs can reduce pain, discomfort and mortality.

    Key results

    We have not identified any studies that addressed the review question. We identified four potential studies, but we excluded them due to the type of drug or study design. One study is ongoing. 

    How up to date is this review?

    We searched for studies that were available up to August 2021.

  • 32.
    Bäcke, Pyrola
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. Univ Hosp, Neonatal Intens Care Unit, Uppsala, Sweden..
    Bruschettini, Matteo
    Lund Univ, Dept Pediat, Lund, Sweden.;Skane Univ Hosp, Cochrane Sweden, Res & Dev, Lund, Sweden..
    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. Univ Hosp, Neonatal Intens Care Unit, Uppsala, Sweden..
    Olsson, Emma
    Örebro Univ, Fac Med & Hlth, Dept Pediat, Örebro, Sweden.;Örebro Univ, Sch Hlth Sci, Fac Med & Hlth, S-70182 Örebro, Sweden..
    Interventions for the management of Pain and Sedation in Newborns undergoing Therapeutic hypothermia for hypoxic-ischemic encephalopathy (IPSNUT): protocol of a systematic review2022In: Systematic Reviews, E-ISSN 2046-4053, Vol. 11, no 1, article id 101Article, review/survey (Refereed)
    Abstract [en]

    Background: Clinical research has shown that therapeutic hypothermia after neonatal hypoxic-ischemic injury improves survival without disability. There is no consensus regarding pain relief or sedation during therapeutic hypothermia in newborns; however, therapeutic hypothermia seems to be associated with pain and stress, and adequate analgesia and sedation are central to maximize the effect of therapeutic hypothermia. Pain needs to be adequately managed in all patients, especially the newborn infant due to the potential short- and long-term negative effects of inadequately treated pain in this population. Methods: We will perform a systematic review of pharmacological and non-pharmacological interventions for the management of pain and sedation in newborn infants undergoing therapeutic hypothermia for hypoxic-ischemic encephalopathy. We will include randomized, quasi-randomized controlled trials and observational studies. The use of pharmacological or non-pharmacological interventions will be compared to other pharmacological and or non-pharmacological interventions or no intervention/placebo. The primary outcomes for this review will be analgesia and sedation assessed with validated pain scales, circulatory instability, mortality to discharge, and moderate-to-severe neurodevelopmental disability. We will search the following databases: CINAHL, ClinicalTrials.gov, Cochrane Library, Embase, PubMed, Scopus, and Web of Science. Two independent researchers will screen the records for inclusion, extract data using a data extraction form, and assess the risk of bias in the included trials. Discussion: The result of this review will summarize the knowledge regarding the management of pain and sedation in infants treated with therapeutic hypothermia and potentially provide clinicians with guidance on the effective and safe methods.

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  • 33.
    Bäcke, Pyrola
    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. Univ Hosp, Neonatal Intens Care Unit, Uppsala, Sweden..
    Bruschettini, Matteo
    Lund Univ, Dept Pediat, Lund, Sweden.;Cochrane Sweden, Lund, Sweden.;Skane Univ Hosp, Res & Educ, Lund, Sweden..
    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. Univ Hosp, Neonatal Intens Care Unit, Uppsala, Sweden..
    Sibrecht, Greta
    Poznan Univ Med Sci, Newborns Infect Dis Dept, Poznan, Poland..
    Olsson, Emma
    Örebro Univ, Fac Med & Hlth, Dept Pediat, Örebro, Sweden.;Örebro Univ, Fac Med & Hlth, Sch Hlth Sci, S-70182 Örebro, Sweden..
    Interventions for the Management of Pain and Sedation in Newborns Undergoing Therapeutic Hypothermia for Hypoxic-Ischemic Encephalopathy: A Systematic Review2023In: Pediatric Drugs, ISSN 1174-5878, E-ISSN 1179-2019, Vol. 25, no 1, p. 27-41Article, review/survey (Refereed)
    Abstract [en]

    Background

    Newborn infants undergoing therapeutic hypothermia (TH) are exposed to multiple painful and stressful procedures. The aim of this systematic review was to assess benefits and harms of pharmacological and non-pharmacological interventions for the management of pain and sedation in newborn infants undergoing TH for hypoxic-ischemic encephalopathy.

    Methods

    We included randomized and observational studies reporting any intervention (either drugs or non-pharmacological interventions) to manage pain and sedation in newborn infants (> 33 weeks' gestational age) undergoing TH. We included any dose, duration and route of administration. We also included any type and duration of non-pharmacological interventions. Our prespecified primary outcomes were analgesia and sedation assessed using validated pain scales in the neonatal population; circulatory instability; mortality to discharge; and neurodevelopmental disability. A systematic literature search was conducted in the PubMed, Embase, CINAHL, Cochrane CENTRAL, Scopus, and Web of Science databases, with no language restrictions. Included studies underwent risk-of-bias assessment (Cochrane risk-of-bias tool and ROBINS-I) and data extraction performed by two authors independently. The plan had been to use effect measures such as mean difference for continuous outcomes and risk ratio for dichotomous outcomes, however the included studies are presented in a narrative synthesis due to their paucity and heterogeneity.

    Results

    Ten studies involving 3551 infants were included-one trial and nine observational studies. Most studies examined the use of phenobarbital or other antiepileptic drugs with primary outcomes related to seizure activity. The single trial that was included compared pentoxifylline with placebo. Among the primary outcomes, six studies reported circulatory instability and five reported mortality to discharge without relevant differences; two studies reported on neurodevelopmental disability and one study reported on pain scale. Three studies were ongoing.

    Conclusions

    We found limited evidence to establish the benefits and harms of the interventions for the management of pain and sedation in newborn infants undergoing TH. Long-term outcomes were not reported. Given the very low certainty of evidence-due to imprecision of the estimates, inconsistency and limitations in study design (all nine observational studies with overall serious risk of bias)-for all outcomes, clinical trials are required to determine the most effective interventions in this population.

    Systematic Review Registration

    PROSPERO registration number: CRD42020205755.

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  • 34.
    Bäcke, Pyrola
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. Univ Childrens Hosp, Neonatal Intens Care Unit, Uppsala, Sweden.;Uppsala Univ, Dept Womens & Childrens Hlth, S-75185 Uppsala, Sweden..
    Hjelte, Beatrice
    Univ Childrens Hosp, Neonatal Intens Care Unit, Uppsala, 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. Univ Childrens Hosp, Neonatal Intens Care Unit, Uppsala, Sweden.;Uppsala Univ, Dept Womens & Childrens Hlth, S-75185 Uppsala, Sweden..
    Ågren, Johan
    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. Univ Childrens Hosp, Neonatal Intens Care Unit, Uppsala, Sweden.;Uppsala Univ, Dept Womens & Childrens Hlth, S-75185 Uppsala, Sweden..
    Thernström Blomqvist, Ylva
    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. Univ Childrens Hosp, Neonatal Intens Care Unit, Uppsala, Sweden.;Uppsala Univ, Dept Womens & Childrens Hlth, S-75185 Uppsala, Sweden..
    When all I wanted was to hold my baby-The experiences of parents of infants who received therapeutic hypothermia2021In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 110, no 2, p. 480-486Article in journal (Refereed)
    Abstract [en]

    Aim The knowledge is limited about how parents experience the time when their infant is receiving therapeutic hypothermia (TH) after severe perinatal asphyxia. The aim of this study was to explore parents' experience of closeness and involvement in their infant's care while in the neonatal intensive care unit (NICU) with their newborn undergoing TH. Methods Face-to-face, semi-structured interviews were conducted with parents (n = 11) whose infants (n = 8, aged 3-5 years at the time of the study) underwent TH at a level III Swedish NICU during 2013-2016. The interviews were analysed using qualitative content analysis. Results All the parents shared the trauma of being both physically and psychologically separated from their infant. They all described a need for information and emotional support, and reported that the NICU staff had influenced the extent to which they as parents had been able to be near and actively participate in the care. Parents described the wish to be closer to their infant and to be more actively involved in their infant's care. Conclusion Strategies to enable parent-infant closeness and active guidance from staff might help alleviate the emotional stress of parents and promote their participation during TH.

  • 35.
    Bäcke, Pyrola
    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. Neonatal Intensive Care Unit, University Hospital, Uppsala, Sweden.
    Thies-Lagergren, Li
    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. Neonatal Intensive Care Unit, University Hospital, Uppsala, Sweden.
    Neonatal resuscitation after birth – Swedish midwives’ experiences of, and perceptions about, separation between mothers and their newborn babies2023In: European Journal of Midwifery, E-ISSN 2585-2906, Vol. 7, p. 1-8Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION This study aimed to investigate midwives' experiences of and perceptions about mother-baby separation during resuscitation of the baby following birth. METHODS A qualitative study was conducted using an author-designed questionnaire. Fifty-four midwives from two Swedish birth units with different working methods regarding neonatal resuscitation - at the mother's bedside in the birth room or in a designated resuscitation room outside the birth room - completed the questionnaire. Data were analyzed using qualitative content analysis. RESULTS Most midwives had experience of removing a newborn baby in need of critical care from the birth room, thus separating the mother and baby. The midwives identified the difficulties and challenges involved in carrying out emergency care in the birth room after birth and had divergent opinions about what they considered possible in these birth situations. They agreed on the benefits, for both mother and baby, in performing emergency care in the birth room and avoiding a separation altogether, if possible. CONCLUSIONS There are good opportunities to reduce separation of mother and baby after birth; training, knowledge, education and the right environmental conditions are important factors in successfully implementing new ways of working. It is possible to work towards reducing separation and this work should continue and strive to eliminate separation as far as possible.

  • 36.
    Cato, Karin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research.
    Funkquist, Eva-Lotta
    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.
    Rosenblad, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism. Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Statistics. Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden.
    Instrument development and an intervention to increase parents' self-efficacy regarding their infant's sleep2024In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 39, article id 100944Article in journal (Refereed)
    Abstract [en]

    Objective

    Many Swedish parents experience that their infant has sleeping problems. Parents’ self-efficacy regarding their infants’ sleep may play an important role in how they perceive these problems. This pilot study aimed to develop an instrument measuring parents’ self-efficacy regarding their infant’s sleep and to examine if parents’ self-efficacy was affected by an intervention focusing on parental education.

    Method

    Mothers and fathers, at a maternity unit in Sweden, were drawn into either an intervention (n = 46) or a control (n = 42) group. The intervention group received a home visit from a nurse who provided information about infant sleep; the importance of attachment; and advice regarding sleep, breastfeeding and bed sharing, including guidelines for safe bed sharing. Three months later, the participants answered questions on background data, breastfeeding, sleep and self-efficacy.

    Results

    The 11-item two-factor Uppsala Parental Self-Efficacy about Infant Sleep Instrument (UPPSEISI) was constructed to measure parents’ perceived self-efficacy. In adjusted analyses, being in the intervention group was associated with a higher self-efficacy (P = 0.035), as were being a mother (P = 0.003) and being satisfied with one’s own sleep (P = 0.007), while parents’ own sleeping problems were associated with a lower self-efficacy (P = 0.015).

    Conclusion

    Importantly, parental education may increase parents’ self-efficacy regarding their infant’s sleep.

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  • 37.
    Chalak, L.
    et al.
    Univ Texas Southwestern Med Ctr Dallas, Dallas, TX 75390 USA..
    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.
    Bonifacio, S.
    Stanford Univ, Sch Med, Dept Pediat, Div Neonatal & Dev Med, 750 Welch Rd,Suite 315, Palo Alto, CA 94304 USA..
    Tsuchida, T.
    George Washington Univ, Childrens Natl Hosp, Sch Med & Hlth Sci, Dept Neurol & Pediat,Div Neurophysiol Epilepsy &, 111 Michigan Ave NW,West Wing,4th Floor, Washington, DC 20010 USA..
    Chock, V
    Stanford Univ, Sch Med, Dept Pediat, Div Neonatal & Dev Med, 750 Welch Rd,Suite 315, Palo Alto, CA 94304 USA..
    El-Dib, M.
    Harvard Med Sch, Brigham & Womens Hosp, Dept Pediat Newborn Med, 75 Francis St,CWN 418, Boston, MA 02115 USA..
    Massaro, An N.
    George Washington Univ, Sch Med, Dept Pediat, Washington, DC USA.;Childrens Natl Hosp, Div Neonatol, Washington, DC USA..
    Garcia-Alix, A.
    Hosp St Joan Deu, Inst Recerca St Joan Deu, Barcelona, Spain.;Univ Barcelona, Barcelona, Spain.;NeNe Fdn, Madrid, Spain.;Passeig St Joan Deu 2, Barcelona 08950, Spain..
    Bedside and laboratory neuromonitoring in neonatal encephalopathy2021In: Seminars in Fetal & Neonatal Medicine, ISSN 1744-165X, E-ISSN 1878-0946, Vol. 26, no 5, article id 101273Article, review/survey (Refereed)
    Abstract [en]

    Several bedside and laboratory neuromonitoring tools are currently used in neonatal encephalopathy (NE) to assess 1) brain function [amplitude-integrated electroencephalogram (aEEG) and EEG], 2) cerebral oxygenation delivery and consumption [near-infrared spectroscopy (NIRS)] and 3) blood and cerebrospinal fluid biomarkers. The aim of the review is to provide the role of neuromonitoring in understanding the development of brain injury in these newborns and better predict their long-term outcome. Simultaneous use of these monitoring modalities may improve our ability to provide meaningful prognostic information regarding ongoing treatments. Evidence will be summarized in this review for each of these modalities, by describing (1) the methods, (2) the clinical evidence in context of NE both before and with hypothermia, and (3) the research and future directions.

  • 38.
    Challis, Pontus
    et al.
    Umeå Univ, Dept Clin Sci, Pediat, Umeå, Sweden.;Umeå Univ Klin Vetenskap, Pediat, S-90185 Umeå, Sweden..
    Kallen, Karin
    Lund Univ, Fac Med, Dept Clin Sci Obstet & Gynecol, Lund, Sweden..
    Bjorklund, Lars
    Lund Univ, Dept Clin Sci, Paediat, Lund, Sweden..
    Elfvin, Anders
    Univ Gothenburg, Inst Clin Sci, Sahlgrenska Acad, Dept Pediat, Gothenburg, Sweden.;Sahlgrens Univ Hosp, Dept Pediat, Gothenburg, Sweden..
    Farooqi, Aijaz
    Umeå Univ, Dept Clin Sci, Pediat, Umeå, Sweden..
    Hakansson, Stellan
    Umeå Univ, Dept Clin Sci, Pediat, Umeå, Sweden..
    Ley, David
    Lund Univ, Dept Clin Sci, Paediat, Lund, Sweden..
    Norman, Mikael
    Karolinska Inst, Dept Clin Sci Intervent & Technol, Div Pediat, Stockholm, Sweden.;Karolinska Univ Hosp, Dept Neonatal Med, Stockholm, Sweden..
    Normann, Erik
    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.
    Serenius, 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. Umeå Univ, Dept Clin Sci, Pediat, Umeå, Sweden..
    Savman, Karin
    Univ Gothenburg, Inst Clin Sci, Sahlgrenska Acad, Dept Pediat, Gothenburg, Sweden..
    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.
    Um-Bergstrom, Petra
    Karolinska Inst, Sodersjukhuset, Dept Pediat, Stockholm, Sweden.;Karolinska Inst, Sodersjukhuset, Clin Sci & Educ, Stockholm, Sweden..
    Aden, Ulrika
    Karolinska Inst, Dept Clin Sci Intervent & Technol, Div Pediat, Stockholm, Sweden.;Linköping Univ, Dept Biomed & Clin Sci & Pediat, Linköping, Sweden..
    Abrahamsson, Thomas
    Linköping Univ, Dept Biomed & Clin Sci & Pediat, Linköping, Sweden.;Linköping Univ Hosp, Dept Pediat, Linköping, Sweden..
    Domellof, Magnus
    Umeå Univ, Dept Clin Sci, Pediat, Umeå, Sweden..
    Factors associated with the increased incidence of necrotising enterocolitis in extremely preterm infants in Sweden between two population-based national cohorts (2004-2007 vs 2014-2016)2024In: Archives of Disease in Childhood: Fetal and Neonatal Edition, ISSN 1359-2998, E-ISSN 1468-2052, Vol. 109, no 1, p. 87-93Article in journal (Refereed)
    Abstract [en]

    Objective To investigate potential risk factors behind the increased incidence of necrotising enterocolitis (NEC) in Swedish extremely preterm infants.Design Registry data from two population-based national cohorts were studied. NEC diagnoses (Bell stage >= II) were validated against hospital records.Patients All liveborn infants <27 weeks of gestation 2004-2007 (n=704) and 2014-2016 (n=895) in Sweden.Main outcome measures NEC incidence.Results The validation process resulted in a 28% reduction of NEC cases but still confirmed a higher NEC incidence in the later epoch compared with the earlier (73/895 (8.2%) vs 27/704 (3.8%), p=0.001), while the composite of NEC or death was lower (244/895 (27.3%) vs 229/704 (32.5%), p=0.022). In a multivariable Cox regression model, censored for mortality, there was no significant difference in early NEC (0-7 days of life) between epochs (HR=0.9 (95% CI 0.5 to 1.9), p=0.9), but being born in the later epoch remained an independent risk factor for late NEC (>7 days) (HR=2.7 (95% CI 1.5 to 5.0), p=0.001). In propensity score analysis, a significant epoch difference in NEC incidence (12% vs 2.8%, p<0.001) was observed only in the tertile of infants at highest risk of NEC, where the 28-day mortality was lower in the later epoch (35% vs 50%, p=0.001). More NEC cases were diagnosed with intramural gas in the later epoch (33/73 (45.2%) vs 6/26 (23.1%), p=0.047).Conclusions The increase in NEC incidence between epochs was limited to cases occurring after 7 days of life and was partly explained by increased survival in the most extremely preterm infants. Misclassification of NEC is common.

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  • 39.
    Challis, Pontus
    et al.
    Umea Univ, Dept Clin Sci, Paediat, SE-90185 Umea, Sweden.
    Larsson, Linn
    Umea Univ, Dept Clin Sci, Paediat, SE-90185 Umea, Sweden.
    Sjöström, Elisabeth Stoltz
    Umea Univ, Dept Food & Nutr, Umea, Sweden.
    Serenius, Fredrik
    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. Umea Univ, Dept Clin Sci, Paediat, SE-90185 Umea, Sweden.
    Domellöf, Magnus
    Umea Univ, Dept Clin Sci, Paediat, SE-90185 Umea, Sweden.
    Elfvin, Anders
    Univ Gothenburg, Sahlgrenska Acad, Inst Clin Sci, Dept Pediat, Gothenburg, Sweden.
    Validation of the diagnosis of necrotising enterocolitis in a Swedish population-based observational study2019In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 108, no 5, p. 835-841Article in journal (Refereed)
    Abstract [en]

    Aim: The definition of necrotising enterocolitis (NEC) is based on clinical and radiological signs that can be difficult to interpret. The aim of the present study was to validate the incidence of NEC in the Extremely Preterm Infants in Sweden Study (EXPRESS).

    Methods :The EXPRESS study consisted of all 707 infants born before 27 + 0 gestational weeks during the years 2004-2007 in Sweden. Of these infants, 38 were recorded as having NEC of Bell stage II or higher. Hospital records were obtained for these infants. Furthermore, to identify missed cases, all infants with a sudden reduction of enteral nutrition, in the EXPRESS study were identified (n = 71). Hospital records for these infants were obtained. Thus, 108 hospital records were obtained and scored independently by two neonatologists for NEC.

    Results: Of 38 NEC cases in the EXPRESS study, 26 were classified as NEC after validation. Four cases not recorded in the EXPRESS study were found. The incidence of NEC decreased from 6.3% to 4.3%.

    Conclusion: Validation of the incidence of NEC revealed over- and underestimation of NEC in the EXPRESS study despite carefully collected data. Similar problems may occur in other national data sets or quality registers.

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  • 40.
    Chiavaroli, Valentina
    et al.
    Univ Auckland, Liggins Inst, Private Bag 92019, Auckland, New Zealand.;Pescara Publ Hosp, Neonatal Intens Care Unit, Pescara, Italy..
    Derraik, José G. B.
    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. Univ Auckland, Liggins Inst, Private Bag 92019, Auckland, New Zealand.;Univ Auckland, Better Start Natl Sci Challenge, Auckland, New Zealand.;Zhejiang Univ, Endocrinol Dept, Childrens Hosp, Sch Med, Hangzhou, Peoples R China..
    Jayasinghe, Thilini N.
    Univ Auckland, Liggins Inst, Private Bag 92019, Auckland, New Zealand..
    Rodrigues, Raquel O.
    Univ Auckland, Liggins Inst, Private Bag 92019, Auckland, New Zealand..
    Biggs, Janene B.
    Univ Auckland, Liggins Inst, Private Bag 92019, Auckland, New Zealand..
    Battin, Malcolm
    Auckland City Hosp, Newborn Serv, Auckland, New Zealand..
    Hofman, Paul L.
    Univ Auckland, Liggins Inst, Private Bag 92019, Auckland, New Zealand..
    O'Sullivan, Justin M.
    Univ Auckland, Liggins Inst, Private Bag 92019, Auckland, New Zealand..
    Cutfield, Wayne S.
    Univ Auckland, Liggins Inst, Private Bag 92019, Auckland, New Zealand.;Univ Auckland, Better Start Natl Sci Challenge, Auckland, New Zealand..
    Lower insulin sensitivity remains a feature of children born very preterm2021In: Pediatric Diabetes, ISSN 1399-543X, E-ISSN 1399-5448, Vol. 22, no 2, p. 161-167Article in journal (Refereed)
    Abstract [en]

    Background: The first report of children born very preterm (<32 weeks of gestation) having insulin resistance was made 16 years ago. However, neonatal care has improved since. Thus, we aimed to assess whether children born very preterm still have lower insulin sensitivity than term controls.

    Methods: Participants were prepubertal children aged 5 to 11 years born very preterm (<32 weeks of gestation; n = 51; 61% boys) or at term (37-41 weeks; n = 50; 62% boys). Frequently sampled intravenous glucose tolerance tests were performed, and insulin sensitivity was calculated using Bergman's minimal model. Additional clinical assessments included anthropometry, body composition using whole-body dual-energy X-ray absorptiometry scans, clinic blood pressure, and 24-hour ambulatory blood pressure monitoring.

    Results: Children born very preterm were 0.69 standard deviation score (SDS) lighter (P < .001), 0.53 SDS shorter (P = .003), and had body mass index 0.57 SDS lower (P = .003) than children born at term. Notably, children born very preterm had insulin sensitivity that was 25% lower than term controls (9.4 vs 12.6 x 10(-4) minutes(-1)center dot[mU/L]; P = .001). Other parameters of glucose metabolism, including fasting insulin levels, were similar in the two groups. The awake systolic blood pressure (from 24-hour monitoring) tended to be 3.1 mm Hg higher on average in children born very preterm (P = .054), while the clinic systolic blood pressure was 5.4 mm Hg higher (P = .002).

    Conclusions: Lower insulin sensitivity remains a feature of children born very preterm, despite improvements in neonatal intensive care. As reported in our original study, our findings suggest the defect in insulin action in prepubertal children born very pretermis primarily peripheral and not hepatic.

  • 41.
    Chiavaroli, Valentina
    et al.
    Univ Auckland, Liggins Inst, Auckland, New Zealand.;Pescara Publ Hosp, Neonatal Intens Care Unit, Pescara, Italy..
    Hopkins, Sarah A.
    Univ Auckland, Liggins Inst, Auckland, New Zealand.;Univ Auckland, Fac Med & Hlth Sci, Dept Psychol Med, Auckland, New Zealand..
    Biggs, Janene B.
    Univ Auckland, Liggins Inst, Auckland, New Zealand..
    Rodrigues, Raquel O.
    Univ Auckland, Liggins Inst, Auckland, New Zealand.;Univ Kentucky, Coll Publ Hlth, Dept Hlth Behav & Soc, Lexington, KY USA..
    Seneviratne, Sumudu N.
    Univ Auckland, Liggins Inst, Auckland, New Zealand.;Univ Colombo, Fac Med, Dept Paediat, Colombo, Sri Lanka..
    Baldi, James C.
    Univ Otago, Dunedin Sch Med, Dept Med, Dunedin, New Zealand..
    McCowan, Lesley M. E.
    Univ Auckland, Fac Med & Hlth Sci, Dept Obstet & Gynaecol, Auckland, New Zealand..
    Cutfield, Wayne S.
    Univ Auckland, Liggins Inst, Auckland, New Zealand.;Univ Auckland, Better Start Natl Sci Challenge, Auckland, New Zealand..
    Hofman, Paul L.
    Univ Auckland, Liggins Inst, Auckland, New Zealand..
    Derraik, José G. B.
    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. Univ Auckland, Liggins Inst, Auckland, New Zealand.;Uppsala Univ, Dept Womens & Childrens Hlth, Uppsala, Sweden.;Chiang Mai Univ, Res Inst Hlth Sci, Chiang Mai, Thailand..
    The associations between maternal BMI and gestational weight gain and health outcomes in offspring at age 1 and 7 years2021In: Scientific Reports, E-ISSN 2045-2322, Vol. 11, no 1, article id 20865Article in journal (Refereed)
    Abstract [en]

    In secondary analyses of a randomised controlled trial of exercise during pregnancy, we examined associations between mid-pregnancy maternal body mass index (BMI) and excessive gestational weight gain (GWG) with offspring health. Follow-up data were available on 57 mother-child pairs at 1-year and 52 pairs at 7-year follow-ups. Clinical assessments included body composition and fasting blood tests. At age 1 year, increased maternal BMI in mid-gestation was associated with greater weight standard deviation scores (SDS) in the offspring (p = 0.035), with no observed associations for excessive GWG. At age 7 years, greater maternal BMI was associated with increased weight SDS (p < 0.001), BMI SDS (p = 0.005), and total body fat percentage (p = 0.037) in their children. Irrespective of maternal BMI, children born to mothers with excessive GWG had greater abdominal adiposity (p = 0.043) and less favourable lipid profile (lower HDL-C and higher triglycerides). At 7 years, maternal BMI and excessive GWG had compounded adverse associations with offspring adiposity. Compared to offspring of mothers with overweight/obesity plus excessive GWG, children of normal-weight mothers with adequate and excessive GWG were 0.97 and 0.64 SDS lighter (p = 0.002 and p = 0.014, respectively), and 0.98 and 0.63 SDS leaner (p = 0.001 and p = 0.014, respectively). Both greater maternal BMI in mid-pregnancy and excessive GWG were independently associated with increased adiposity in offspring at 7 years.

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  • 42.
    Curtiss, Jennifer
    et al.
    Nationwide Childrens Hosp, Dept Clin Nutr & Lactat, Columbus, OH 43205 USA..
    Griffiths, Pamela
    Phoenix Childrens Hosp, Dept Neonatol, Phoenix, AZ USA..
    Stephenson, Kevin G.
    Nationwide Childrens Hosp, Dept Psychol, Columbus, OH USA..
    Puthoff, Teresa D.
    Nationwide Childrens Hosp, Dept Pharm Serv, Columbus, OH USA..
    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.
    Bapat, Roopali
    Nationwide Childrens Hosp, Dept Pediat, Columbus, OH USA..
    Lendrum-Gatten, Britany
    Nationwide Childrens Hosp, Dept Neonatol, Columbus, OH USA..
    Lindamood, Kristen
    Boston Childrens Hosp, NICU, Boston, MA USA..
    Lumbaca, Leah
    Nationwide Childrens Hosp, Dept Neonatal Therapy, Columbus, OH USA..
    Mehling, Margaret
    Nationwide Childrens Hosp, Dept Psychol, Columbus, OH USA..
    Peck, Lauren H.
    Nationwide Childrens Hosp, Dept Pharm Serv, Columbus, OH USA..
    Stonestreet, Barbara S.
    Women & Infants Hosp Rhode Isl, Dept Pediat, Providence, RI USA..
    Susey, Kelly
    Nationwide Childrens Hosp, Dept Neonatal Therapy, Columbus, OH USA..
    Susi, Molly
    Nationwide Childrens Hosp, Dept Neonatal Therapy, Columbus, OH USA..
    Zhang, Huayan
    Childrens Hosp Philadelphia, Dept Pediat, Philadelphia, PA USA..
    Lynch, Susan
    Univ North Carolina Syst, Dept Pediat, Chapel Hill, NC USA..
    The Optimal State Scoring Tool: guidance for interdisciplinary care of infants with severe bronchopulmonary dysplasia and its relation to linear growth2023In: Journal of Perinatology, ISSN 0743-8346, E-ISSN 1476-5543, Vol. 43, p. 1301-1307Article in journal (Refereed)
    Abstract [en]

    Objective: Infants with severe bronchopulmonary dysplasia (sBPD) have complex medical courses. We developed the clinician-rated Optimal State Scoring Tool (OSST) that measures factors relevant to clinical improvement of sBPD and investigated preliminary validity using linear growth outcome and OSST scores in sBPD patients.

    Methods: Tool development process and pilot findings are provided for 13 patients evaluated longitudinally. OSST scores, length measurements, and steroid dependency values were obtained. Changes in OSST scores and lengths were examined using linear mixed-effect models.

    Results: OSST scores were significantly correlated with linear growth (95% CI 0.36, 0.57). The steroid-dependent group showed significantly slower rate of linear growth (95% CI 0.74, 1.05) and slower rate of increase in OSST scores (95% CI 0.99, 2.13) compared to the non-steroid-dependent group, with the OSST showing the largest effect size.

    Conclusion: Pilot data reflect promising evidence for OSST construct validity in monitoring clinical outcomes in sBPD patients.

  • 43.
    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.

  • 44.
    Dellenmark-Blom, M.
    et al.
    Sahlgrens Univ Hosp, Queen Silv Childrens Hosp, Dept Pediat Surg, Gothenburg, Sweden.;Gothenburg Univ, Queen Silv Childrens Hosp, Inst Clin Sci, Dept Pediat, S-41685 Gothenburg, Sweden..
    Reilly, C.
    Gothenburg Univ, Queen Silv Childrens Hosp, Inst Clin Sci, Dept Pediat, S-41685 Gothenburg, Sweden..
    Öst, E.
    Karolinska Univ Hosp, Dept Pediat Surg, Stockholm, Sweden.;Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden..
    Ax, S. Örnö
    Sahlgrens Univ Hosp, Queen Silv Childrens Hosp, Dept Pediat Surg, Gothenburg, Sweden.;Gothenburg Univ, Queen Silv Childrens Hosp, Inst Clin Sci, Dept Pediat, S-41685 Gothenburg, Sweden..
    Svensson, J. F.
    Karolinska Univ Hosp, Dept Pediat Surg, Stockholm, Sweden.;Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden..
    Kassa, Ann-Marie
    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. Univ Childrens Hosp, Dept Pediat Surg, Uppsala, Sweden..
    Jönsson, L.
    Sahlgrens Univ Hosp, Queen Silv Childrens Hosp, Dept Pediat Surg, Gothenburg, Sweden.;Gothenburg Univ, Queen Silv Childrens Hosp, Inst Clin Sci, Dept Pediat, S-41685 Gothenburg, Sweden..
    Abrahamsson, K.
    Sahlgrens Univ Hosp, Queen Silv Childrens Hosp, Dept Pediat Surg, Gothenburg, Sweden.;Gothenburg Univ, Queen Silv Childrens Hosp, Inst Clin Sci, Dept Pediat, S-41685 Gothenburg, Sweden..
    Gatzinsky, V.
    Sahlgrens Univ Hosp, Queen Silv Childrens Hosp, Dept Pediat Surg, Gothenburg, Sweden.;Gothenburg Univ, Queen Silv Childrens Hosp, Inst Clin Sci, Dept Pediat, S-41685 Gothenburg, Sweden..
    Tollne, AM.
    Karolinska Univ Hosp, Dept Pediat Surg, Stockholm, Sweden..
    Omling, E.
    Lund Univ, Dept Pediat, Clin Sci, Lund, Sweden.;Skane Univ Hosp Lund, Dept Pediat Surg, Lund, Sweden..
    Stenström, P.
    Lund Univ, Dept Pediat, Clin Sci, Lund, Sweden.;Skane Univ Hosp Lund, Dept Pediat Surg, Lund, Sweden..
    Lilja, H. Engstrand
    Karolinska Univ Hosp, Dept Pediat Surg, Stockholm, Sweden.;Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden..
    Schooling experiences in children with long-gap esophageal atresia compared with children with esophageal atresia and primary anastomosis: a Swedish study2023In: Orphanet Journal of Rare Diseases, E-ISSN 1750-1172, Vol. 18, article id 233Article in journal (Refereed)
    Abstract [en]

    Background: Children with long-gap esophageal atresia (LGEA) risk living with aerodigestive morbidity and mental health difficulties. No previous study has investigated their experiences of schooling, despite the importance of schools in children's development, learning and social relationships. We aimed to describe experiences of schooling in children with LGEA in Sweden in comparison with children with EA who had primary anastomosis.

    Method: Children with LGEA aged 3-17 were recruited nationwide in Sweden. One parent completed a survey on their child's school-based supports (according to definitions from the Swedish National Agency for Education), school absence, school satisfaction, school functioning (PedsQL 4.0), mental health (Strength and Difficulties Questionnaire) and current symptomatology. School data were compared between 26 children with LGEA to that from 95 children with EA who had PA, a hypothesized milder affected group. Mental health level was determined using validated norms; abnormal & GE; 90 percentile. Data were analyzed using descriptives, correlation and Mann-Whitney-U test. Significance level was p < 0.05.

    Results: Formal school-based support was reported in 17 (65.4%) children with LGEA and concerned support with nutritional intake (60%), education (50%) and medical/special health needs (35%). The prevalence of school-based support was significantly higher compared to children with PA overall (36.8%, p = 0.013) and regarding nutritional intake support (20%, p < 0.001). In children with LGEA, school-based support was related to low birth weight (p = 0.036), young child age (p = 0.014), height & LE; -2SD for age/sex (p = 0.024) and an increased number of aerodigestive symptoms (p < 0.05). All children with LGEA who had abnormal mental health scores had school-based support, except for one child. Nine children with LGEA (36%) had school absence & GE; 1times/month the past year, more frequently because of colds/airway infections (p = 0.045) and GI-specific problems compared to PA (p = 0.003). School functioning scores were not significantly different from children with PA (p = 0.34) but correlated negatively with school-based support (< 0.001) and school absence (p = 0.002). One parent out of 26 reported their child's school satisfaction as "not good".

    Conclusions: Children with LGEA commonly receive school-based support, reflecting multifaceted daily needs and disease severity. School absence is frequent and related to poorer school functioning. Future research focusing on academic achievement in children with EA is needed.

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  • 45.
    Dellenmark-Blom, Michaela
    et al.
    Queen Silvia Childrens Hosp, Inst Clin Sci, Dept Pediat, Gothenburg, Sweden.;Sahlgrens Univ Hosp, Queen Silvia Childrens Hosp, Dept Pediat Surg, Gothenburg, Sweden.;Queen Silvia Childrens Hosp, Dept Pediat Surg, S-41685 Gothenburg, Sweden..
    Ax, Sofie Örnö
    Queen Silvia Childrens Hosp, Inst Clin Sci, Dept Pediat, Gothenburg, Sweden.;Sahlgrens Univ Hosp, Queen Silvia Childrens Hosp, Dept Pediat Surg, Gothenburg, Sweden..
    Lilja, Helene Engstrand
    Sahlgrens Univ Hosp, Queen Silvia Childrens Hosp, Dept Pediat Surg, Gothenburg, Sweden.;Karolinska Univ Hosp, Dept Pediat Surg, Stockholm, Sweden.;Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden..
    Reilly, Colin
    Queen Silvia Childrens Hosp, Inst Clin Sci, Dept Pediat, Gothenburg, Sweden..
    Svensson, Jan F.
    Karolinska Univ Hosp, Dept Pediat Surg, Stockholm, Sweden.;Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden..
    Kassa, Ann-Marie
    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. Univ Childrens Hosp, Dept Pediat Surg, Uppsala, Sweden..
    Jönsson, Linus
    Queen Silvia Childrens Hosp, Inst Clin Sci, Dept Pediat, Gothenburg, Sweden.;Sahlgrens Univ Hosp, Queen Silvia Childrens Hosp, Dept Pediat Surg, Gothenburg, Sweden..
    Abrahamsson, Kate
    Queen Silvia Childrens Hosp, Inst Clin Sci, Dept Pediat, Gothenburg, Sweden.;Sahlgrens Univ Hosp, Queen Silvia Childrens Hosp, Dept Pediat Surg, Gothenburg, Sweden..
    Gatzinsky, Vladimir
    Queen Silvia Childrens Hosp, Inst Clin Sci, Dept Pediat, Gothenburg, Sweden.;Sahlgrens Univ Hosp, Queen Silvia Childrens Hosp, Dept Pediat Surg, Gothenburg, Sweden..
    Omling, Erik
    Lund Univ, Skane Univ Hosp, Dept Pediat Surg, Lund, Sweden..
    Tollne, Annamaria
    Karolinska Univ Hosp, Dept Pediat Surg, Stockholm, Sweden..
    Stenström, Pernilla
    Lund Univ, Skane Univ Hosp, Dept Pediat Surg, Lund, Sweden..
    Öst, Elin
    Karolinska Univ Hosp, Dept Pediat Surg, Stockholm, Sweden.;Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden..
    Prevalence of Mental Health Problems, Associated Factors, and Health-Related Quality of Life in Children with Long-Gap Esophageal Atresia in Sweden2023In: Journal of Pediatric Surgery, ISSN 0022-3468, E-ISSN 1531-5037, Vol. 58, no 9, p. 1646-1655Article in journal (Refereed)
    Abstract [en]

    Background: Children with long-gap esophageal atresia (LGEA) face a high risk of digestive and respiratory morbidity, but their mental health outcomes have not been investigated. We aimed to identify the prevalence of mental health problems in children with LGEA, associated factors and health-related quality of life (HRQOL).

    Methods: Twenty-six children with LGEA aged 3-17 were recruited nationwide in Sweden. One of their parents and adolescents aged 11-17 completed information on the child's mental health (Strength and Difficulties Questionnaire), generic (PedsQL 4.0) and condition-specific HRQOL (EA-QOL). Parents gave information on current child symptomatology. Mental health level was determined using validated norms; abnormal >= 90 percentile/borderline >= 80 percentile/normal. Elevated levels were considered borderline/abnormal. Data were analyzed using descriptives, correlation and Mann-Whitney-U test. Significance level was p < 0.05.

    Results: Twelve children with LGEA aged 3-17 (46%) had elevated scores of >= 1 mental health domain in parent-reports, whereas 2 adolescents (15%) in self-reports. In parent-reports, 31% of the children had elevated levels of peer relationship problems, with associated factors being child sex male (p = 0.037), airway infections (p = 0.002) and disturbed night sleep (p = 0.025). Similarly, 31% showed elevated levels of hyperactivity/inattention, and associated factors were male sex (p = 0.005), asthma (p = 0.028) and disturbed night sleep (p = 0.036). Elevated levels of emotional symptoms, seen in 20%, were related to swallowing difficulties (p = 0.038) and vomiting problems (p = 0.045). Mental health problems correlated negatively with many HRQOL domains (p < 0.05).

    Conclusions: Children with LGEA risk mental health difficulties according to parent-reports, especially peer relationship problems and hyperactivity/inattention, with main risk factors being male sex, airway problems and sleep disturbances. This should be considered in follow-up care and research, particularly since their mental health problems may impair HRQOL.

  • 46.
    Derraik, Jose G. B.
    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), Perinatal, Neonatal and Pediatric Cardiology Research. Univ Auckland, Liggins Inst, Auckland, New Zealand;Univ Auckland, Better Start Natl Sci Challenge, Auckland, New Zealand.
    Pasupathy, D.
    Kings Coll London, Sch Life Course Sci, Dept Women & Childrens Hlth, London, England.
    McCowan, L. M. E.
    Univ Auckland, Dept Obstet & Gynaecol, Auckland, New Zealand;Natl Womens Hosp, Auckland Dist Hlth Board, Auckland, New Zealand.
    Poston, L.
    Kings Coll London, Sch Life Course Sci, Dept Women & Childrens Hlth, London, England.
    Taylor, R. S.
    Univ Auckland, Dept Obstet & Gynaecol, Auckland, New Zealand.
    Simpson, N. A. B.
    Univ Leeds, Leeds Inst Biomed & Clin Sci, Sect Obstet & Gynaecol, Leeds, W Yorkshire, England.
    Dekker, G. A.
    Univ Adelaide, Adelaide Med Sch, Robinson Res Inst, Discipline Obstet & Gynaecol, Adelaide, SA, Australia.
    Myers, J.
    Univ Manchester, Maternal & Fetal Heath Res Ctr, Manchester, Lancs, England.
    Vieira, M. C.
    Kings Coll London, Sch Life Course Sci, Dept Women & Childrens Hlth, London, England.
    Cutfield, W. S.
    Univ Auckland, Liggins Inst, Auckland, New Zealand;Univ Auckland, Better Start Natl Sci Challenge, Auckland, New Zealand.
    Ahlsson, Fredrik
    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.
    Paternal contributions to large-for-gestational-age term babies: findings from a multicenter prospective cohort study2019In: Journal of Developmental Origins of Health and Disease, ISSN 2040-1744, E-ISSN 2040-1752, Vol. 10, no 5, p. 529-535, article id PII S2040174419000035Article in journal (Refereed)
    Abstract [en]

    We assessed whether paternal demographic, anthropometric and clinical factors influence the risk of an infant being born large-for-gestational-age (LGA). We examined the data on 3659 fathers of term offspring (including 662 LGA infants) born to primiparous women from Screening for Pregnancy Endpoints (SCOPE). LGA was defined as birth weight >90th centile as per INTERGROWTH 21st standards, with reference group being infants <= 90th centile. Associations between paternal factors and likelihood of an LGA infant were examined using univariable and multivariable models. Men who fathered LGA babies were 180 g heavier at birth (P<0.001) and were more likely to have been born macrosomic (P<0.001) than those whose infants were not LGA. Fathers of LGA infants were 2.1 cm taller (P<0.001), 2.8 kg heavier (P<0.001) and had similar body mass index (BMI). In multivariable models, increasing paternal birth weight and height were independently associated with greater odds of having an LGA infant, irrespective of maternal factors. One unit increase in paternal BMI was associated with 2.9% greater odds of having an LGA boy but not girl; however, this association disappeared after adjustment for maternal BMI. There were no associations between paternal demographic factors or clinical history and infant LGA. In conclusion, fathers who were heavier at birth and were taller were more likely to have an LGA infant, but maternal BMI had a dominant influence on LGA.

  • 47.
    Derraik, José G. B.
    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), Perinatal, Neonatal and Pediatric Cardiology Research. Chiang Mai Univ, NCD Ctr Excellence, Res Inst Hlth Sci, Chiang Mai, Thailand.;Univ Auckland, Liggins Inst, Auckland 92019, New Zealand.;Uppsala Univ, Dept Womens & Childrens Hlth, Uppsala, Sweden.;Zhejiang Univ, Childrens Hosp, Sch Med, Hangzhou, Peoples R China..
    Parklak, Wason
    Chiang Mai Univ, NCD Ctr Excellence, Res Inst Hlth Sci, Chiang Mai, Thailand..
    Albert, Benjamin B.
    Univ Auckland, Liggins Inst, Auckland 92019, New Zealand..
    Boonyapranai, Kongsak
    Chiang Mai Univ, NCD Ctr Excellence, Res Inst Hlth Sci, Chiang Mai, Thailand..
    Rerkasem, Kittipan
    Chiang Mai Univ, NCD Ctr Excellence, Res Inst Hlth Sci, Chiang Mai, Thailand.;Chiang Mai Univ, Fac Med, Dept Surg, Chiang Mai, Thailand..
    Fundamentals of Data Collection in Clinical Studies: Simple Steps to Avoid "Garbage In, Garbage Out"2021In: International Journal of Lower Extremity Wounds, ISSN 1534-7346, E-ISSN 1552-6941, Vol. 20, no 3, p. 183-187, article id 1534734620938234Article, review/survey (Refereed)
    Abstract [en]

    Many fundamental steps underpin the delivery of high-quality clinical research. In this article, we provide a brief commentary on some important aspects associated with the collection and management of data during clinical studies, which, if overlooked, will lead to poor-quality research. In particular, we discuss the key aspects that should help early career researchers maximize the relevance and impact of their clinical research.

  • 48.
    Dickmark, Malin
    et al.
    Uppsala Univ Hosp, Dept Obstet & Gynecol, Uppsala, Sweden..
    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.
    Jonsson, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Clinical Obstetrics.
    Risk factors for seizures in the vigorous term neonate: A population-based register study of singleton births in Sweden2022In: PLOS ONE, E-ISSN 1932-6203, Vol. 17, no 2, article id e0264117Article in journal (Refereed)
    Abstract [en]

    Background Neonatal seizures have been associated with increased mortality and impaired neurodevelopment and, knowledge about risk factors may be useful for prevention. Clear associations have been established between labor-related risk factors and seizures in asphyxiated neonates. However, there is limited information about why some vigorous term-born infants experience seizures. Objectives Our aim was to assess antepartum and intrapartum risk factors for seizures in vigorous term-born neonates. Methods This was a national cohort study of singleton infants born at term in Sweden from 2009-2015. Vigorous was defined as an Apgar score of at least 7 at 5 and 10 minutes. Data on the mothers and infants were obtained from the Swedish Medical Birth Register and the Swedish Neonatal Quality Register. A diagnosis of neonatal seizures was the main outcome measure and the exposures were pregnancy and labor variables. Logistic regression analysis was used and the results are expressed as adjusted odds ratios (aOR) with 95% confidence intervals (CI). Results The incidence of neonatal seizures was 0.81/1,000 for 656 088 births. Seizures were strongly associated with obstetric emergencies (aOR 4.0, 95% CI 2.2-7.4), intrapartum fever and/or chorioamnionitis (aOR 3.4, 95% CI 2.1-5.3), and intrapartum fetal distress (aOR 3.0, 95% CI 2.4-3.7). Other associated intrapartum factors were: labor dystocia, occiput posterior position, operative vaginal delivery, and Cesarean delivery. Some maternal factors more than doubled the risk: a body mass of more than 40 (aOR 2.6, 95% CI 1.4-4.8), hypertensive disorders (aOR 2.3, 95% CI 1.7-3.1) and diabetes mellitus (aOR 2.6, 95% CI 1.7-4.1). Conclusion A number of intrapartum factors were associated with an increased risk of seizures in vigorous term-born neonates. Obstetric emergencies, intrapartum fever and/or chorioamnionitis and fetal distress were the strongest associated risks. The presence of such factors, despite a reassuring Apgar score could prompt close surveillance.

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  • 49.
    Diderholm, Barbro
    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.
    Normann, Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Research and Development, Gävleborg. 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.
    Sindelar, Richard
    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.
    The Impact of Restricted versus Liberal Early Fluid Volumes on Plasma Sodium, Weight Change, and Short-Term Outcomes in Extremely Preterm Infants2022In: Nutrients, E-ISSN 2072-6643, Vol. 14, no 4, article id 795Article in journal (Refereed)
    Abstract [en]

    The optimal fluid requirements for extremely preterm infants are not fully known. We examined retrospectively the fluid intakes during the first week of life in two cohorts of extremely preterm infants born at 22-26 weeks of gestation before (n = 63) and after a change from a restrictive to a more liberal (n = 112) fluid volume allowance to improve nutrient provision. The cohorts were similar in gestational age and birth weight, but antenatal steroid exposure was more frequent in the second era. Although fluid management resulted in a cumulative difference in the total fluid intake over the first week of 87 mL/kg (p < 0.001), this was not reflected in a mean weight loss (14 +/- 5% at a postnatal age of 4 days in both groups) or mean peak plasma sodium (142 +/- 5 and 143 +/- 5 mmol/L in the restrictive and liberal groups, respectively). The incidences of hypernatremia (>145 and >150 mmol/L), PDA ligation, bronchopulmonary dysplasia, and IVH were also similar. We conclude that in this cohort of extremely preterm infants a more liberal vs. a restricted fluid allowance during the first week had no clinically important influence on early changes in body weight, sodium homeostasis, or hospital morbidities.

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  • 50. Dykes, Charlotta
    et al.
    Hellman, Carola
    Funkquist, Eva-Lotta
    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.
    Bramhagen, Ann-Cathrine
    Parents experience a sense of guilt when their newborn is diagnosed small for gestational age, SGA. A grounded theory study in Sweden2022In: Journal of Pediatric Nursing: Nursing Care of Children and Families, ISSN 0882-5963, E-ISSN 1532-8449, Vol. 62, p. e8-e15Article in journal (Refereed)
    Abstract [en]

    Background: To become a parent of a child who is born small for gestational age can lead to challenges in addition to the newly acquired parenting role. There is currently a lack of knowledge regarding parents' experiences of having a child born small for gestational age.

    Purpose: The purpose of this study was to describe the experience of becoming a parent of a child small for gestational age

    Design and method: A qualitative inductive approach was chosen with grounded theory as a method, a strategic selection was used and individual interviews with open questions were performed.

    Results: The results showed that the parents expressed guilt over the child's size and focused on the ability to nourish their child to keep their unexpectedly small child alive. An experienced concern about the child's food intake could be seen throughout the entire interview material and the need for information was great. A common experience of the parents was that constant feeding of the child dominates their lives.

    Conclusion: The conclusion is that the unexpectedly small size of the child awakens the parent's instinct to provide life-sustaining care and the parents need increased support and more information around the child's condition. This requires well-trained professionals, because parents to children born SGA often harbour feelings of unpreparedness and guilt.

    Practice implications: Increased understanding and knowledge about the parents' experience of having a child born SGA, healthcare services can optimize the potential for better attachment between parent and child as well as offer appropriate support.

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