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  • 1.
    Agren, Johan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Zelenin, Sergey
    Department of Woman and Child Health, Karolinska Institute, Sweden.
    Svensson, Lill-Britt
    Department of Woman and Child Health, Karolinska Institute, Sweden.
    Nejsum, Lene N
    The Water and Salt Research Center, Aarhus University, Denmark.
    Nielsen, Soren
    The Water and Salt Research Center, Aarhus University, Denmark.
    Aperia, Anita
    Department of Woman and Child Health, Karolinska Institute, Sweden.
    Sedin, Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Antenatal Corticosteroids and Postnatal Fluid Restriction Produce Differential Effects on AQP3 Expression, Water Handling, and Barrier Function in Perinatal Rat Epidermis2010In: Dermatology research and practice, ISSN 1687-6113Article in journal (Refereed)
    Abstract [en]

    Loss of water through the immature skin can lead to hypothermia and dehydration in preterm infants. The water and glycerol channel aquaglyceroporin-3 (AQP3) is abundant in fetal epidermis and might influence epidermal water handling and transepidermal water flux around birth. To investigate the role of AQP3 in immature skin, we measured in vivo transepidermal water transport and AQP3 expression in rat pups exposed to clinically relevant fluid homeostasis perturbations. Preterm (E18) rat pups were studied after antenatal corticosteroid exposure (ANS), and neonatal (P1) rat pups after an 18 h fast. Transepidermal water loss (TEWL) and skin hydration were determined, AQP3 mRNA was quantified by RT-PCR, and in-situ hybridization and immunocytochemistry were applied to map AQP3 expression. ANS resulted in an improved skin barrier (lower TEWL and skin hydration), while AQP3 mRNA and protein increased. Fasting led to loss of barrier integrity along with an increase in skin hydration. These alterations were not paralleled by any changes in AQP3. To conclude, antenatal corticosteroids and early postnatal fluid restriction produce differential effects on skin barrier function and epidermal AQP3 expression in the rat. In perinatal rats, AQP3 does not directly determine net water transport through the skin.

  • 2. Amer-Wåhlin,
    et al.
    van den Berg,
    Berglund,
    Blennow,
    Dahlström,
    Ewald, Uwe
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Hagberg,
    Jonsson,
    Kierkegaard,
    Sjörs, Gunnar
    Sävman,
    Westas,
    Ågren, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Asfyxi och neonatal HLR, SFOG2013Report (Other academic)
  • 3.
    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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  • 4. 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.

  • 5.
    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.

  • 6.
    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.

  • 7.
    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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  • 8.
    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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  • 9.
    Frid, Ingrid
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    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.
    Kjellberg, Mattias
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Normann, Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Sindelar, Richard
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Critically ill neonates displayed stable vital parameters and reduced metabolic acidosis during neonatal emergency airborne transport in Sweden2018In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 107, no 8, p. 1357-1361Article in journal (Refereed)
    Abstract [en]

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

  • 10.
    Hellström, Sara
    et al.
    Sahlgrens Univ Hosp, Dept Obstet & Gynecol, Reg Vastra Gotaland, Gothenburg, Sweden.;Sahlgrens Univ Hosp, Queen Silv Childrens Hosp, Div Neonatol, Dept Pediat, Gothenburg, Sweden..
    Jonsdotter, Andrea
    Sahlgrens Univ Hosp, Dept Obstet & Gynecol, Reg Vastra Gotaland, Gothenburg, Sweden.;Univ Gothenburg, Inst Clin Sci, Sahlgrenska Acad, Ctr Perinatal Med & Hlth, Gothenburg, Sweden..
    Jonsson, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Clinical Obstetrics.
    Pettersson, Karin
    Karolinska Inst, CLINTEC, Clin Intervent Sci & Technol, Stockholm, Sweden..
    Saltvedt, Sissel
    Karolinska Inst, Karolinska Univ Hosp, Dept Womens & Childrens Hlth, Stockholm, Sweden..
    Herbst, Andreas
    Lund Univ, Skane Univ Hosp, Inst Clin Sci Lund, Dept Obstet & Gynecol, Lund, 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.
    Ådén, Ulrika
    Karolinska Inst, Karolinska Univ Hosp, Dept Womens & Childrens Hlth, Stockholm, Sweden.;Linköping Univ, Dept Biomed & Clin Sci, Linköping, Sweden..
    Domellöf, Magnus
    Umeå Univ, Dept Clin Sci Pediat, Umeå, Sweden..
    Hagberg, Henrik
    Sahlgrens Univ Hosp, Dept Obstet & Gynecol, Reg Vastra Gotaland, Gothenburg, Sweden.;Univ Gothenburg, Inst Clin Sci, Sahlgrenska Acad, Ctr Perinatal Med & Hlth, Gothenburg, Sweden..
    Carlsson, Ylva
    Sahlgrens Univ Hosp, Dept Obstet & Gynecol, Reg Vastra Gotaland, Gothenburg, Sweden.;Univ Gothenburg, Inst Clin Sci, Sahlgrenska Acad, Ctr Perinatal Med & Hlth, Gothenburg, Sweden..
    A follow up on the feasibility after national implementation of magnesium sulfate for neuroprotection prior to preterm birth2023In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 102, no 12, p. 1741-1748Article in journal (Refereed)
    Abstract [en]

    Introduction

    The risk for brain injury manifested as cerebral palsy is higher in very preterm born children than in term. Prenatal administration of magnesium sulfate (MgSO4) has been shown to be neuroprotective and reduces the proportion of very preterm born children later diagnosed with cerebral palsy. A Swedish national clinical practice guideline was implemented in March 2020, stipulating the administration of a single intravenous dose of 6 g MgSO4 1–24 h prior to delivery before gestational age 32+0, aiming for 90% treatment coverage. The aim of this study was to evaluate the feasibility of this new clinical practice guideline in the first year of its implementation.

    Material and methods

    Data on MgSO4 treatment were collected by reviewing the medical charts of women who gave birth to live born children in gestational age 22+0–31+6 during the period of March 1, 2020 to February 28, 2021, at five Swedish university hospitals. Women with pre-eclampsia, eclampsia, or high elevated liver enzymes low platelets (HELLP) were excluded.

    Results

    A total of 388 women were eligible and 79% received treatment with MgSO4. Of the 21% not receiving treatment, 9% did not receive treatment due to lack of knowledge about the clinical practice guideline, 9% were not possible to treat and 3% had missing data. The proportion treated increased from 72% to 87% from the first to the last 3 months. Of those treated, 81% received the drug within the stipulated timeframe (mean 8.7 h, median 3.4 h).

    Conclusions

    There was a positive trend over time in the proportion of women receiving MgSO4 treatment, but the a priori target of 90% was not reached during the first year of implementation. Our findings indicate that this target could be reached with additional information to clinicians.

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  • 11.
    Hellström-Westas, Lena
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Boylan, Geraldine
    Department of Paediatrics & Child Health, University College Cork, Cork, Ireland.
    Ågren, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Systematic review of neonatal seizure management strategies provides guidance on anti-epileptic treatment2015In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 104, no 2Article, review/survey (Refereed)
    Abstract [en]

    There is a lack of scientific evidence to support the best management of neonatal seizures. Current strategies for neonatal seizure management were investigated by analysis of all surveys published during the time period 2000-2012. Methods for seizure diagnosis and availability of electroencephalogram (EEG), including monitoring, varied. Phenobarbital was the drug of first choice, and the use of off-label drugs and treatment times varied. We conclude that there is an urgent need for more evidence-based studies to guide neonatal seizure management.

  • 12.
    Jonsson, Maria
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Ågren, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Nordén Lindeberg, Solveig
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Ohlin, Andreas
    Hanson, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Neonatal Encephalopathy and the Association to Asphyxia in Labor: EDITORIAL COMMENT2015In: Obstetrical and Gynecological Survey, ISSN 0029-7828, E-ISSN 1533-9866, Vol. 70, no 4, p. 233-235Article in journal (Other academic)
  • 13.
    Jonsson, Maria
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Ågren, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Nordén-Lindeberg, Solveig
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Ohlin, Andreas
    Department of Pediatrics, Örebro University Hospital, Sweden.
    Hanson, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Neonatal encephalopathy and the association to asphyxia in labor2014In: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 211, no 6, p. 667.e1-667.e8Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: In cases with moderate and severe neonatal encephalopathy, we aimed to determine the proportion that was attributable to asphyxia during labor and to investigate the association between cardiotocographic (CTG) patterns and neonatal outcome.

    STUDY DESIGN: In a study population of 71,189 births from 2 Swedish university hospitals, 80 cases of neonatal encephalopathy were identified. Cases were categorized by admission CTG patterns (normal or abnormal) and by the presence of asphyxia (cord pH, <7.00; base deficit, ≥12 mmol/L). Cases with normal admission CTG patterns and asphyxia at birth were considered to experience asphyxia related to labor. CTG patterns were assessed for the 2 hours preceding delivery.

    RESULTS: Admission CTG patterns were normal in 51 cases (64%) and abnormal in 29 cases (36%). The rate of cases attributable to asphyxia (ie, hypoxic ischemic encephalopathy) was 48 of 80 cases (60%), most of which evolved during labor (43/80 cases; 54%). Both severe neonatal encephalopathy and neonatal death were more frequent with an abnormal, rather than with a normal, admission CTG pattern (13 [45%] vs 11 [22%]; P = .03), and 6 [21%] vs 3 [6%]; P = .04), respectively. Comparison of cases with an abnormal and a normal admission CTG pattern also revealed more frequently observed decreased variability (12 [60%] and 8 [22%], respectively) and more late decelerations (8 [40%] and 1 [3%], respectively).

    CONCLUSION: Moderate and severe encephalopathy is attributable to asphyxia in 60% of cases, most of which evolve during labor. An abnormal admission CTG pattern indicates a poorer neonatal outcome and more often is associated with pathologic CTG patterns preceding delivery.

  • 14.
    Jonsson, Maria
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Ågren, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Nordén-Lindeberg, Solveig
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Ohlin, Andreas
    Hanson, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Suboptimal care and metabolic acidemia is associated with neonatal encephalopathy but not with neonatal seizures alone: a population-based clinical audit2014In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 93, no 5, p. 477-482Article in journal (Refereed)
    Abstract [en]

    ObjectiveTo determine the incidence of moderate to severe neonatal encephalopathy (NE) and neonatal seizures without encephalopathy, and the association with metabolic acidemia. Secondly, to investigate the occurrence of suboptimal intrapartum care and its impact on neonatal outcome. DesignClinical audit. SettingTwo university hospitals in Sweden. PopulationNeonates 34weeks with moderate or severe NE and neonatal seizures alone, i.e. without encephalopathy, from a population of 71189 births, where umbilical blood gases were routinely analyzed. MethodsNeonates were categorized depending on the presence of metabolic acidemia at birth by umbilical artery pH<7.00, base deficit 12mmol/L. Records were audited for suboptimal care and a decision was made on whether management was assessed to have impacted neonatal outcome. Main outcome measuresEncephalopathy and seizures alone. ResultsWe identified 80 neonates with NE and 30 with seizures alone, of which 48 (60%) and none, respectively, had metabolic acidemia. Suboptimal care could be assessed in 77 and occurred in 28 (36%) NE cases and in one neonate with seizures alone (p<0.001). In 47 NE cases with metabolic acidemia, suboptimal care occurred in 22 (47%) vs. 6/30 (20%) without metabolic acidemia (p=0.02). Suboptimal care had an impact on outcome in 18/77 (23%) NE cases but in no cases with seizures alone. ConclusionSuboptimal care was commonly seen with NE, particularly in neonates with metabolic acidemia, and also affected neonatal outcome. No such associations were found in neonates with seizures alone.

  • 15.
    Karlsson, Victoria
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Heinemann, Ann-Britt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Sjörs, Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Nyqvist, Kerstin Hedberg
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Ågren, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Early Skin-to-Skin Care in Extremely Preterm Infants: Thermal Balance and Care Environment2012In: Journal of Pediatrics, ISSN 0022-3476, E-ISSN 1097-6833, Vol. 161, no 3, p. 422-426Article in journal (Refereed)
    Abstract [en]

    Objective

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

    Study design

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

    Results

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

    Conclusion

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

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  • 16.
    Karlsson, Victoria
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. Univ Childrens Hosp, Neonatol Div, Uppsala, Sweden..
    Sporre, Bengt
    Uppsala Univ Hosp, Anaesthesiol & Intens Care Div, Uppsala, Sweden..
    Fredén, Filip
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Ågren, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. Univ Childrens Hosp, Neonatol Div, Uppsala, Sweden..
    Randomized controlled trial of low vs high oxygen during neonatal anesthesia: Oxygenation, feasibility, and oxidative stress2022In: Pediatric Anaesthesia, ISSN 1155-5645, E-ISSN 1460-9592, Vol. 32, no 9, p. 1062-1069Article in journal (Refereed)
    Abstract [en]

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

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  • 17.
    Karlsson, Victoria
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Sporre, Bengt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Fredén, Filip
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    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.
    Randomized controlled trial of room air vs. 80% oxygen for induction of neonatal anesthesia: Feasibility and safetyManuscript (preprint) (Other academic)
  • 18.
    Karlsson, Victoria
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. Univ Hosp, Unit Pediat Anesthesia, Uppsala, Sweden.;Univ Childrens Hosp, Div Neonatol, Uppsala, Sweden..
    Sporre, Bengt
    Univ Hosp, Unit Pediat Anesthesia, 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, Div Neonatol, 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, Div Neonatol, Uppsala, Sweden..
    Poor performance of main-stream capnography in newborn infants during general anesthesia2017In: Pediatric Anaesthesia, ISSN 1155-5645, E-ISSN 1460-9592, Vol. 27, no 12, p. 1235-1240Article in journal (Refereed)
    Abstract [en]

    Background

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

    Aims

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

    Methods

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

    Results

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

    Conclusion

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

  • 19.
    Karlsson, Victoria
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Sporre, Bengt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    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.
    Transcutaneousp PCO2 monitoring in newborn infants during general anesthesia is technically feasible2016In: Anesthesia and Analgesia, ISSN 0003-2999, EISSN 1526-7598, Vol. 123, no 4, p. 1004-1007, article id 10.1213/ANE.0000000000001462Article in journal (Refereed)
  • 20.
    Karlsson, Victoria
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care. 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.
    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.
    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.
    Nursing care of infants born extremely preterm2022In: Seminars in Fetal & Neonatal Medicine, ISSN 1744-165X, E-ISSN 1878-0946, Vol. 27, no 3, article id 101369Article in journal (Refereed)
    Abstract [en]

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

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  • 21.
    Kjällström, Barbro
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Sedin, Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Ågren, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Clothing reduces evaporative water and heatloss in preterm infants2011In: Journal of Neonatal-Perinatal Medicine, ISSN 1934-5798, Vol. 4, no 2, p. 89-92Article in journal (Refereed)
    Abstract [en]

    Newborn preterm infants have large losses of fluid from their immature skin. To minimize fluid and heat loss and reduce the risk of dehydration and hypothermia, infants are routinely nursed in humidified and temperature-controlled incubators. The incubator care can be interrupted by periods of skin-to-skin care (STS). However, data are limited on how to reduce fluid and heat loss from very preterm infants during STS. To investigate the effect of clothing during STS we measured the evaporation of water from the surface of a body/skin model designed to simulate the skin temperature and ambient conditions of an extremely preterm infant during the first days of life. A semi-permeable membrane was placed on top of a water filled chamber heated to body temperature and kept in an incubator at relevant environmental conditions. The evaporation rate (ER) was determined by evaporimetry from the membrane surface alone or from the membrane covered with layers of fabric. The effect of fabric clothing was also determined in a group of extremely preterm infants during incubator care. The evaporation rate (ER) was 51 ± 2.7 g/m2 h from the membrane only. When layers of fabric were applied, ER decreased for each added layer. The ER and temperatures recorded in the model system were in the range relevant for preterm infants. In the infants, fabric clothing also resulted in a decreased ER. We conclude that layers of a simple cotton fabric provide a significant barrier to vapor diffusion thereby reducing evaporative loss of water and heat.

  • 22.
    Liljeström, Lena
    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), Clinical Obstetrics.
    Wikström, Anna-Karin
    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), Clinical Obstetrics.
    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.
    Jonsson, Maria
    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), Clinical Obstetrics.
    Antepartum risk factors for moderate to severe neonatal hypoxic ischemic encephalopathy: a Swedish national cohort study2018In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 97, no 5, p. 615-623Article in journal (Refereed)
    Abstract [en]

    Introduction

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

    Material and methods

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

    Results

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

    Conclusions

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

  • 23.
    Lundqvist, M.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Ågren, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Flink, Roland
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Clinical Neurophysiology.
    Wickstrom, R.
    Pediatric Neurology Unit, Department of Women′s and Children′s Health, Karolinska Institute, Stockholm, Sweden.
    Adverse effects following lidocaine treatment are limited with current dosing regimens2013In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 102, no 11, p. E485-E486Article in journal (Refereed)
  • 24.
    Lundqvist, M.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Ågren, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Hellström-Westas, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Flink, Roland
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Clinical Neurophysiology.
    Wickstrom, R.
    Pediatric Neurology Unit, Department of Women′s and Children′s Health, Karolinska Institutet, Stockholm, Sweden.
    Efficacy and safety of lidocaine for treatment of neonatal seizures2013In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 102, no 9, p. 863-867Article in journal (Refereed)
    Abstract [en]

    Aim: Treatment of neonatal seizures still relies primarily on phenobarbital, despite an estimated efficacy of less than 50% and concern over neurodegenerative side effects. The objective of this study was to evaluate the efficacy and safety of lidocaine as second-line treatment of neonatal seizures in infants following benzodiazepine treatment but without previous treatment with phenobarbital. Methods: In a 10-year cohort, a retrospective chart review was conducted for all infants (gestational age >= 37 w, age <= 28 days) who had received lidocaine as second-line treatment of neonatal seizures prior to treatment with phenobarbital between January 2000 and June 2010. Infants were included if they had electroencephalographic seizures. Results: Cessation of seizure activity was seen in 16 of 30 infants based on clinical and electroencephalographic features, and a probable response was seen in an additional 3 of 30 patients. Suspected adverse effects were seen in only one patient, who developed a transient bradycardia. Conclusion: Lidocaine has a moderate efficacy as second-line therapy following benzodiazepines for treating neonatal seizures and is not frequently associated with cardiovascular adverse effects. Lidocaine should therefore be considered in the treatment of seizures in the neonatal period to a higher extent than is the case today.

  • 25.
    Malmqvist, Olle
    et al.
    Orebro Univ, Fac Med & Hlth, Dept Pediat, Orebro, Sweden.
    Ohlin, Andreas
    Orebro Univ, Fac Med & Hlth, Dept Pediat, Orebro, 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.
    Jonsson, Maria
    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), Clinical Obstetrics.
    Seizures in newborn infants without hypoxic ischemic encephalopathy - antenatal and labor-related risk factors: a case-control study2020In: The Journal of Maternal-Fetal & Neonatal Medicine, ISSN 1476-7058, E-ISSN 1476-4954, Vol. 33, no 5, p. 799-805Article in journal (Refereed)
    Abstract [en]

    Objective:

    To identify antepartum and intrapartum risk factors for neonatal seizures in the absence of hypoxic ischemic encephalopathy (HIE).

    Methods:

    Population-based case-control study. Of 98 484 births, 40 newborns at 34 gestational weeks or later had seizures within the first 7 days of life. Cases (n = 40) and controls (n = 160) were retrieved from the University hospitals of orebro for 1994-2013 and Uppsala for 2003-2013. Demographics and characteristics of pregnancy, labor, delivery, and neonatal data were analyzed. Crude odds ratio (OR) and adjusted odds ratios (AOR) with 95% confidence intervals (CIs) for antenatal and intrapartum factors were calculated using logistic regression analysis. Main outcome measure was neonatal seizures within the first 7 days of life.

    Results:

    The incidence of neonatal seizures without HIE was 0.41/1000 live births. Antenatal risk factors for neonatal seizures were as follows: short maternal stature (AOR: 5.4; 1.8-16.5); previous caesarean section (AOR: 4.8; 1.5-15.0); and assisted fertilization (AOR: 6.8; 1.3-35.2). Intrapartum risk factors were as follows: induction of labor (AOR: 5.7; 1.8-17.7); preterm birth (AOR: 13.5; 3.7-48.9); and head circumference >37 cm (AOR: 6.9; 1.4-34.8).

    Conclusions:

    Preterm birth was the strongest risk factor for neonatal seizures in the absence of HIE. The results also indicate that feto-pelvic disproportion is associated with the occurrence of seizures.

    Rationale:

    Antepartum and intrapartum risk factors for newborn seizures in the absence of HIE were investigated in a case-control study. Out of 98 484 births at 34 gestational weeks or more, 40 newborns had seizures without HIE. All had a normal Apgar score although they later presented with seizures. Preterm birth was the strongest risk factor (OR: 13.5; 95% CI: 3.7-48.9). Our results also indicate that feto-pelvic disproportion is of importance. Furthermore, a history of prior caesarean was associated with seizures. This is the first study to assess obstetric risk factors for newborn seizures separate from those with seizures and concomitant HIE. The distinction is of importance due to different etiologies, treatments, and preventive strategies.

  • 26.
    Munsters, Josanne
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Wallström, Linda
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Ågren, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Norsted, Torgny
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Sindelar, Richard
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Skin conductance measurements as pain assessment in newborn infants born at 22-27 weeks gestational age at different postnatal age2012In: Early Human Development, ISSN 0378-3782, E-ISSN 1872-6232, Vol. 88, no 1, p. 21-26Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: To assess pain or stress in newborn infants submitted to intensive care is important but difficult, as different observational pain scales are not always reliable in premature infants. As an indicator of pain, skin conductance (SC) measurements have detected increased sweating in newborn infants >28 gestational age (GA) submitted to heel lancing.

    OBJECTIVE: To measure SC during heel lancing and routine care in newborn infants, born at 22 to 27 GA, with special relation to postnatal age (PNA).

    METHODS: In six infants <28+0 GA and 4 infants ≥28+0 GA spontaneous SC activity and behavioural state (Neonatal Pain Agitation and Sedation Scale (N-PASS)) was measured before, during and after each intervention. Measurements were repeated in each patient at different PNA.

    RESULTS: Baseline SC prior to intervention took longer time to stabilise and was higher in <28 than in ≥28+0 PNA. The combination of heel lancing and squeezing gave an increased SC in <28 PNA, whereas heel lancing alone gave the same SC response in ≥28+0 PNA. A possibly continued immature response in SC measurements was not observed. Oral glucose admission prior to heel lancing increased SC. Routine care did not give any changes in SC. Except during orogastric tube placement no signs of discomfort or pain could be detected by the neonatal pain, agitation and sedation scale (N-PASS) in <28 PNA. to the combination of heel lancing and squeezing. A maturational development of the SC was observed in infants born <28 GA. SC seems to be able to differentiate between pain and discomfort.

  • 27. Nagase, Kiroaki
    et al.
    Ågren, Johan
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Saito, Akiko
    Liu, Kun
    Agre, Peter
    Hazama, Akihiro
    Yasui, Masato
    Molecular cloning and characterization of mouse aquaporin 62006In: Biochemical and Biophysical Research Communications, Vol. 352, p. 12-16Article in journal (Refereed)
  • 28.
    Naseh, Nima
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Perinatal, Neonatal and Pediatric Cardiology Research.
    Canto Moreira, Nuno
    Uppsala Univ Hosp, Dept Neuroradiol, Uppsala, Sweden; Karolinska Univ Hosp, Uppsala, Sweden.
    Vaz, Tania F.
    Univ Lisbon, Inst Biophys & Biomed Engn, Fac Sci, Lisbon, Portugal..
    Gonzalez Tamez, Karla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Perinatal, Neonatal and Pediatric Cardiology Research.
    Ferreira, Hugo
    Univ Lisbon, Inst Biophys & Biomed Engn, Fac Sci, Lisbon, Portugal..
    Fredriksson Kaul, Ylva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Perinatal, Neonatal and Pediatric Cardiology Research.
    Johansson, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Perinatal, Neonatal and Pediatric Cardiology Research.
    Diderholm, Barbro
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Perinatal, Neonatal and Pediatric Cardiology Research.
    Ahlsson, Fredrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Perinatal, Neonatal and Pediatric Cardiology Research.
    Ågren, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Perinatal, Neonatal and Pediatric Cardiology Research.
    Hellström-Westas, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Perinatal, Neonatal and Pediatric Cardiology Research.
    Early Hyperglycemia in Very Preterm Infants Is Associated with Reduced White Matter Volume and Worse Cognitive and Motor Outcomes at 2.5 Years2022In: Neonatology, ISSN 1661-7800, E-ISSN 1661-7819, Vol. 119, no 6, p. 745-752Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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  • 29.
    Naseh, Nima
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Gonzalez, Karla Elizabeth Tamez
    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..
    Vaz, T.
    Univ Lisbon, Fac Sci, Inst Biophys & Biomed Engn, Lisbon, Portugal..
    Ferreira, H.
    Univ Lisbon, Fac Sci, Inst Biophys & Biomed Engn, Lisbon, Portugal..
    Kaul, Ylva Fredriksson
    Johansson, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Ågren, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Canto Moreira, Nuno
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology. Karolinska Hosp, Solna, Sweden..
    Hellström-Westas, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Early Hyperglycemia And Brain MRI Findings In Very Preterm Infants2017In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 106, no SI 469, p. 16-16Article in journal (Other academic)
    Abstract [en]

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

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

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

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

  • 30.
    Rysavy, Matthew A.
    et al.
    Univ Iowa, Div Neonatol, Stead Family Dept Pediat, Iowa City, IA USA.
    Mehler, Katrin
    Univ Cologne, Childrens Hosp, Div Neonatol, Cologne, Germany.
    Oberthür, André
    Univ Cologne, Childrens Hosp, Div Neonatol, Cologne, Germany.
    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.
    Kusuda, Satoshi
    Kyorin Univ, Neonatal Res Network Japan, Dept Pediat, Tokyo, Japan.
    McNamara, Patrick J.
    Univ Iowa, Div Neonatol, Stead Family Dept Pediat, Iowa City, IA USA.
    Giesinger, Regan E.
    Univ Iowa, Div Neonatol, Stead Family Dept Pediat, Iowa City, IA USA.
    Kribs, Angela
    Univ Cologne, Childrens Hosp, Div Neonatol, Cologne, Germany.
    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.
    Carlson, Susan J.
    Univ Iowa, Div Neonatol, Stead Family Dept Pediat, Iowa City, IA USA.
    Klein, Jonathan M.
    Univ Iowa, Div Neonatol, Stead Family Dept Pediat, Iowa City, IA USA.
    Backes, Carl H.
    Ohio State Univ, Dept Pediat, Wexner Med Ctr, Columbus, OH 43210 USA; Ohio State Univ, Dept Obstet & Gynecol, Wexner Med Ctr, Columbus, OH 43210 USA.
    Bell, Edward F.
    Univ Iowa, Div Neonatol, Stead Family Dept Pediat, Iowa City, IA USA.
    An Immature Science: Intensive Care for Infants Born at ≤23 Weeks of Gestation2021In: The Journal of Pediatrics, ISSN 0022-3476, E-ISSN 1097-6833, Vol. 233, p. 16-25.e1Article in journal (Other academic)
  • 31.
    Rysavy, Matthew
    et al.
    Univ Texas Hlth Sci Ctr Houston, Houston, TX 77030 USA..
    Nakamura, Tomohiko
    Nagano Childrens Hosp, Nagano, Japan..
    Mehler, Katrin
    Univ Cologne, Cologne, Germany..
    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.
    McNamara, Patrick
    Univ Iowa, Iowa City, IA USA..
    Backes, Carl
    Nationwide Childrens Hosp, Columbus, OH USA..
    Use of 2.0-mm endotracheal tubes for periviable infants2022In: Journal of Perinatology, ISSN 0743-8346, E-ISSN 1476-5543, Vol. 42, no 9, p. 1275-1276Article in journal (Other academic)
  • 32.
    Sedin, Gunnar
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Ågren, Johan
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Water and heat--the priority for the newborn infant.2006In: Ups J Med Sci, ISSN 0300-9734, Vol. 111, no 1, p. 45-59Article in journal (Refereed)
  • 33.
    Sindelar, Richard
    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.
    Shepherd, Edward G.
    Nationwide Children’s Hospital, Ohio State University, Columbus, OH, USA.
    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.
    Panitch, Howard B.
    Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
    Abman, Steven H.
    Children’s Hospital Colorado, University of Colorado, Aurora, CO, USA.
    Nelin, Leif D.
    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.
    Established severe BPD: is there a way out? Change of ventilatory paradigms2021In: Pediatric Research, ISSN 0031-3998, E-ISSN 1530-0447, Vol. 90, no 6, p. 1139-1146Article in journal (Refereed)
    Abstract [en]

    Improved survival of extremely preterm newborn infants has increased the number of infants at risk for developingbronchopulmonary dysplasia (BPD). Despite efforts to prevent BPD, many of these infants still develop severe BPD (sBPD) andrequire long-term invasive mechanical ventilation. The focus of research and clinical management has been on the prevention ofBPD, which has had only modest success. On the other hand, research on the management of the established sBPD patient hasreceived minimal attention even though this condition poses large economic and health problems with extensive morbidities andlate mortality. Patients with sBPD, however, have been shown to respond to treatments focused not only on ventilatory strategiesbut also on multidisciplinary approaches where neurodevelopmental support, growth promoting strategies, and aggressivetreatment of pulmonary hypertension improve their long-term outcomes. In this review we will try to present a physiology-basedventilatory strategy for established sBPD, emphasizing a possible paradigm shift from acute efforts to wean infants at all costs to amore chronic approach of stabilizing the infant. This chronic approach, herein referred to as chronic phase ventilation, aims atallowing active patient engagement, reducing air trapping, and improving ventilation-perfusion matching, while providingsufficient support to optimize late outcomes.

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  • 34.
    Spath, Cornelia
    et al.
    Umeå Univ, Dept Clin Sci Pediat, S-90185 Umeå, Sweden.
    Stoltz Sjostrom, Elisabeth
    Umeå Univ, Dept Food Nutr & Culinary Sci, Umeå, 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.
    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.
    Domellof, Magnus
    Umeå Univ, Dept Clin Sci Pediat, S-90185 Umeå, Sweden.
    Sodium supply from administered blood products was associated with severe intraventricular haemorrhage in extremely preterm infants2022In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 111, no 9, p. 1701-1708Article in journal (Refereed)
    Abstract [en]

    Aim The aim of this study was to investigate the associations between sodium supply, fluid volume, sodium imbalances and severe intraventricular haemorrhage (IVH) in extremely preterm (EPT) infants.

    Methods We used data from the EXtremely PREterm infants in Sweden Study (EXPRESS) cohort consisting of all infants born at 22 to 26 gestational weeks from 2004 to 2007 and conducted a nested case-control study. For every infant with severe IVH (grade 3 or peri-ventricular haemorrhagic infarction), one IVH-free control infant with the birthday closest to the case infant and matched for hospital, sex, gestational age and birth weight was selected (n = 70 case-control pairs).

    Results Total sodium supply and fluid volume were higher in infants with severe IVH compared with controls [daily total sodium supply until postnatal Day 2: mean +/- SD (mmol/kg/day): 5.49 +/- 2.53 vs. 3.95 +/- 1.91, p = 0.009]. These differences were accounted for by sodium and fluid from transfused blood products. High plasma sodium concentrations or large sodium fluctuations were not associated with severe IVH.

    Conclusion Our results suggest a relationship between sodium-rich transfusions of blood products and severe IVH in EPT infants. It is unclear whether this is an effect of sodium load, volume load or some other transfusion-related factor.

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  • 35.
    Späth, Cornelia
    et al.
    Umea Univ, Dept Clin Sci, Pediat, Umea, Sweden..
    Sjöström, Elisabeth Stoltz
    Umea Univ, Dept Food & Nutr, Umea, Sweden..
    Ahlsson, Fredrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Ågren, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Domellöf, Magnus
    Umea Univ, Dept Clin Sci, Pediat, Umea, Sweden..
    Sodium supply influences plasma sodium concentration and the risks of hyper- and hyponatremia in extremely preterm infants2017In: Pediatric Research, ISSN 0031-3998, E-ISSN 1530-0447, Vol. 81, no 3, p. 455-460Article in journal (Refereed)
    Abstract [en]

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

  • 36.
    Söderström, Fanny
    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.
    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.
    Holmström, Gerd
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ophthalmology.
    Larsson, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ophthalmology.
    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.
    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.
    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.
    Reduced rate of retinopathy of prematurity after implementing lower oxygen saturation targets.2019In: Journal of Perinatology, ISSN 0743-8346, E-ISSN 1476-5543, Vol. 39, p. 409-414Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 37.
    Söderström, Fanny
    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.
    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.
    Jonsson, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    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.
    Outcomes of a uniformly active approach to infants born at 22-24 weeks of gestation2021In: Archives of Disease in Childhood: Fetal and Neonatal Edition, ISSN 1359-2998, E-ISSN 1468-2052, Vol. 106, no 4, p. 413-417Article in journal (Refereed)
    Abstract [en]

    Objective

    To determine survival and outcomes in infants born at 22-24 weeks of gestation in a centre with a uniformly active approach to management of extremely preterm infants.

    Study design

    Single-centre retrospective cohort study including infants born 2006-2015. Short-term morbidities assessed included retinopathy of prematurity, necrotising enterocolitis, patent ductus arteriosus, intraventricular haemorrhage, periventricular malacia and bronchopulmonary dysplasia. Neurodevelopmental outcomes assessed included cerebral palsy, visual impairment, hearing impairment and developmental delay.

    Results

    Total survival was 64% (143/222), ranging from 52% at 22 weeks to 70% at 24 weeks. Of 133 (93%) children available for follow-up at 2.5 years corrected age, 34% had neurodevelopmental impairment with 11% classified as moderately to severely impaired. Treatment-requiring retinopathy of prematurity, severe bronchopulmonary dysplasia, visual impairment and developmental delay correlated with lower gestational age.

    Conclusions

    A uniformly active approach to all extremely preterm infants results in survival rates that are not distinctly different across the gestational ages of 22-24 weeks and more than 50% survival even in infants at 22 weeks. The majority were unimpaired at 2.5 years, suggesting that such an approach does not result in higher rates of long-term adverse neurological outcome.

  • 38.
    Söderström, Fanny
    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.
    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.
    Early extubation is associated with shorter duration of mechanical ventilation and lower incidence of bronchopulmonary dysplasia2021In: Early Human Development, ISSN 0378-3782, E-ISSN 1872-6232, Vol. 163, article id 105467Article in journal (Refereed)
    Abstract [en]

    Introduction: Respiratory care of extremely preterm infants remains a challenge. The majority require invasive mechanical ventilation (MV), which is a contributing factor in developing bronchopulmonary dysplasia (BPD). It is important to keep MV to a minimum but there have been concerns that attempting extubation too early increases the risk for atelectasis, re-intubation, and further lung trauma. The aim of this study was to compare two different approaches to extubation. Methods: Single-center, retrospective cohort study including infants born at 22 + 0-25 + 6 weeks during 2005-2009 and 2011-2015, before and after implementing guidelines recommending delayed extubation. Primary outcomes were BPD, duration of MV and length of hospital stay. Results: Eighty-eight infants in the early era and 102 infants in the late era were included. Infants in the first period were younger at first extubation attempt, and a higher number of infants were extubated within 24 h, 72 h, and one week after birth. The number of infants re-intubated and postnatal age at re-intubation did not differ between the groups. The incidence of severe BPD was 28% in the early period compared to 48% in the later (p < 0.01). Infants in the late period had longer duration of MV (17 vs 27 days, p < 0.01) but similar length of hospital stay (118 vs 123, p = 0.21). Conclusion: After implementing guidelines recommending delayed extubation, the incidence of severe BPD was higher and the duration of MV was longer. This supports the strategy to attempt extubation early even in extremely preterm infants.

  • 39.
    Thernström Blomqvist, Ylva
    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.
    Karlsson, Victoria
    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.
    Dawit, Feven
    Astrid Lindgrens Children Hospital, Karolinska University Hospital, Stockholm, Sweden.
    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.
    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.
    Physiological Stability in Very Preterm Infants During Skin-to-Skin Contact as Assessed by Near-Infrared Spectroscopy2020In: Advances in Neonatal Care, ISSN 1536-0903, E-ISSN 1536-0911, Vol. 20, no 6, p. 495-498Article in journal (Refereed)
    Abstract [en]

    Background: 

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

    Purpose: 

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

    Methods: 

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

    Results: 

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

    Implications for Practice: 

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

    Implications for Research: 

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

  • 40.
    Thernström Blomqvist, Ylva
    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 Childrens 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, Perinatal, Neonatal and Pediatric Cardiology Research. Univ Childrens Hosp, Neonatal Intens Care Unit, Uppsala, Sweden..
    Karlsson, Victoria
    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, Neonatal Intens Care Unit, Uppsala, Sweden..
    The Swedish approach to nurturing extremely preterm infants and their families: A nursing perspective2022In: Seminars in Perinatology, ISSN 0146-0005, E-ISSN 1558-075X, Seminars in perinatology, ISSN 0146-0005, Vol. 46, no 1, article id 151542Article, review/survey (Refereed)
    Abstract [en]

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

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  • 41.
    Törn, Anna E.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Clinical Obstetrics.
    Hesselman, Susanne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Clinical Obstetrics. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Center for Clinical Research Dalarna.
    Johansen, Kine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Healthcare Sciences and e-Health.
    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.
    Wikström, Anna-Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Clinical Obstetrics.
    Jonsson, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Clinical Obstetrics.
    Outcomes in children after mild neonatal hypoxic ischaemic encephalopathy: A population‐based cohort study2023In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528Article in journal (Refereed)
    Abstract [en]

    Objective

    To investigate whether mild neonatal hypoxic ischaemic encephalopathy (HIE) in term born infants is associated with cerebral palsy, epilepsy, mental retardation and death up to 6 years of age.

    Design

    Population-based cohort study.

    Setting

    Sweden, 2009–2015.

    Population

    Live term born infants without congenital malformations or chromosomal abnormalities (n = 505 075).

    Methods

    Birth and health data were retrieved from Swedish national health and quality registers. Mild HIE was identified by diagnosis in either the Swedish Medical Birth Register or the Swedish Neonatal Quality Register. Cox proportional hazards regression was used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs).

    Main outcome measures

    A composite of the outcomes cerebral palsy, epilepsy, mental retardation and death up to 6 years of age.

    Results

    Median follow-up time was 3.3 years after birth. Of 414 infants diagnosed with mild HIE, 17 were classified according to the composite outcome and incidence rates were 12.6 and 2.9 per 1000 child-years in infants with and without HIE respectively. Infants with mild HIE was four times as likely to be diagnosed with the composite outcome (HR 4.42, 95% CI 2.75–7.12) compared with infants without HIE. When analysed separately, associations were found with cerebral palsy (HR 21.50, 95% CI 9.59–48.19) and death (HR 19.10, 95% CI 7.90–46.21). HRs remained essentially unchanged after adjustment for covariates.

    Conclusions

    Mild neonatal HIE was associated with neurological morbidity and mortality in childhood. Challenges include identifying infants who may develop morbidity and how to prevent adverse outcomes.

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  • 42.
    Ågren, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Monitoring fluid balance in the neonate2012In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 101, no 5, p. 444-445Article in journal (Refereed)
  • 43.
    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 proactive approach to mother-infant dyads at 22-24 weeks of gestation: Perspectives from a Swedish center2022In: Seminars in Perinatology, ISSN 0146-0005, E-ISSN 1558-075X, Vol. 46, no 1, article id 151536Article, review/survey (Refereed)
    Abstract [en]

    The care of infants born at the lowest extreme of gestation requires dedication, skill, and experience. Most centers apply a selective approach where intensive care at these gesta-tional ages is being offered to a varying proportion of infants depending on the views and experiences of the medical community, the individual physician, and the parents. Conse-quently, the outcomes differ dramatically with survival rates at 22-23 weeks ranging from 0 to greater than 50%. This paper presents the approach in a center with a long tradition of providing a comprehensive and uniformly active care to all mother-infant dyads from 22+0 weeks of gestation. Important features outlined include prenatal maternal referral and transfer, delivery room management, and initial intensive care.

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  • 44.
    Ågren, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    The Thermal Environment of the Intensive Care Nursery2015In: Fanaroff and Martin´s Neonatal-Perinatal Medicine 10th Edition: Diseases of the Fetus and Infant / [ed] Richard J. Martin, Avroy A. Fanaroff and Michele C. Walsh, Philadelphia: Elsevier Saunders , 2015, p. 502-512Chapter in book (Refereed)
  • 45.
    Ågren, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    The Thermal Environment of the Intensive Care Nursery2014In: Neonatal-Perinatal Medicine 10th Edition / [ed] Martin R, Fanaroff A, Walsh M, Philadelphia: Saunders Elsevier, 2014Chapter in book (Refereed)
  • 46.
    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.
    Thermal Environment of the Intensive Care Nursery2020In: Fanaroff and Martin's Neonatal-Perinatal Medicine: Diseases of the Fetus and Infant / [ed] Martin RJ, Fanaroff AA, Walsh MC, Philadelphia: Saunders Elsevier, 2020, 11, p. 566-576Chapter in book (Refereed)
  • 47.
    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.
    Using skin-to-skin contact for thermal control in very and extremely preterm infants must optimise heat exchange in order to maintain body temperature2020In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 109, no 4, p. 647-648Article in journal (Other academic)
  • 48.
    Ågren, Johan
    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.
    Segar, Jeffrey L.
    Med Coll Wisconsin, Dept Pediat, 8701 Watertown Plank Rd, Milwaukee, WI 53226 USA..
    Söderström, Fanny
    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.
    Bell, Edward F.
    Univ Iowa, Dept Pediat, Iowa City, IA 52242 USA..
    Fluid management considerations in extremely preterm infants born at 22-24 weeks of gestation2022In: Seminars in Perinatology, ISSN 0146-0005, E-ISSN 1558-075X, Seminars in perinatology, ISSN 0146-0005, Vol. 46, no 1, article id 151541Article, review/survey (Refereed)
    Abstract [en]

    Emerging data regarding the encouraging outcomes of extremely preterm infants from cen-ters taking active approaches to the care of these infants have prompted dialogue regarding optimal medical management. Among the multitude of decisions providers make in caring for extremely premature infants is the prescribing of parenteral fluids. Surprisingly, there are limited data to guide evidenced-based approaches to fluid and electrolyte management in this population. Immaturity of renal function and skin barriers contribute to the impaired capacity of the preterm infant to maintain salt and water homeostasis. This per-spective paper highlights developmental physiological properties of the kidney and skin, which the provider needs to understand to provide parenteral fluid therapy. Additionally, we provide recommendations for initial fluid and electrolyte management of the preterm infant based on novel data as well as the published literature.

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  • 49.
    Ågren, Johan
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Sjörs, Gunnar
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Sedin, Gunnar
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Ambient humidity influences the rate of skin barrier maturation in extremely preterm infants.2006In: J Pediatr, ISSN 0022-3476, Vol. 148, no 5, p. 613-7Article in journal (Refereed)
  • 50.
    Ågren, Johan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Zelenin, Sergey
    Håkansson, Mattias
    Eklöf, Ann-Christine
    Aperia, Anita
    Nejsum, Lene N.
    Nielsen, Sören
    Sedin, Gunnar
    Transepidermal water loss in developing rats: Role of aquaporins in the immature skin2003In: Pediatric Research, ISSN 0031-3998, E-ISSN 1530-0447, Vol. 53, no 4, p. 558-565Article in journal (Refereed)
    Abstract [en]

    In the extremely preterm infant, high transepidermal water loss (TEWL) can result in severe dehydration. TEWL has been attributed to the structural properties of the epidermis but might also be influenced by mechanisms that facilitate water transport. To investigate whether aquaporins (AQP) may be involved in the extreme losses of water through immature skin, we examined the presence and cellular distributions of AQP-1 and AQP-3 in embryonic and adult rat skin by immunohistochemistry. The expression of AQP mRNA in skin was analyzed with the use of semiquantitative reverse transcription-PCR. In rat pups of different embryonic (E) and postnatal (P) ages (days), TEWL and skin hydration were measured. AQP-1 was detected in dermal capillaries, and AQP-3 was abundant in basal epidermal layers. Both AQP displayed several times higher expression in embryonic than in adult skin. TEWL was highest at embryonic day 18 (E18) (133 +/- 18 g/m2h) and lower at E20 (25 +/- 1 g/m2h) and P4 (9 +/- 2 g/m2h). Skin hydration measured as skin electrical capacitance paralleled TEWL, being highest in fetal skin (794 +/- 15 pF at E18) and decreasing to 109 +/- 11 pF at E20 and to 0 +/- 0 pF at P4. We conclude that, as in infants, water loss through the skin of rats decreases markedly with maturation during the perinatal period. The expression and cellular localization of the AQP are such that they might influence skin hydration and water transport and contribute to the high losses of water through the immature skin.

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