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  • 1.
    Austeng, Dordi
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Oftalmiatrik.
    Blennow, Mats
    Ewald, Uwe
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik.
    Fellman, Vineta
    Fritz, Thomas
    Hellström-Westas, Lena
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik.
    Hellström, Ann
    Holmgren, Per Ake
    Holmström, Gerd
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Oftalmiatrik.
    Jakobsson, Peter
    Jeppsson, Annika
    Johansson, Kent
    Kallen, Karin
    Lagercrantz, Hugo
    Laurini, Ricardo
    Lindberg, Eva
    Lundqvist, Anita
    Marsal, Karel
    Nilstun, Tore
    Nordén Lindeberg, Solveig
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Norman, Mikael
    Olhager, Elisabeth
    Oestlund, Ingrid
    Serenius, Fredrik
    Simic, Marija
    Sjörs, Gunnar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik.
    Stigson, Lennart
    Stjernqvist, Karin
    Strömberg, Bo
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik.
    Tornqvist, Kristina
    Wennergren, Margareta
    Wallin, Agneta
    Westgren, Magnus
    Incidence of and risk factors for neonatal morbidity after active perinatal care: extremely preterm infants study in Sweden (EXPRESS)2010Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 99, nr 7, s. 978-992Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims: The aim of this study was to determine the incidence of neonatal morbidity in extremely preterm infants and to identify associated risk factors. Methods: Population based study of infants born before 27 gestational weeks and admitted for neonatal intensive care in Sweden during 2004-2007. Results: Of 638 admitted infants, 141 died. Among these, life support was withdrawn in 55 infants because of anticipation of poor long-term outcome. Of 497 surviving infants, 10% developed severe intraventricular haemorrhage (IVH), 5.7% cystic periventricular leucomalacia (cPVL), 41% septicaemia and 5.8% necrotizing enterocolitis (NEC); 61% had patent ductus arteriosus (PDA) and 34% developed retinopathy of prematurity (ROP) stage >= 3. Eighty-five per cent needed mechanical ventilation and 25% developed severe bronchopulmonary dysplasia (BPD). Forty-seven per cent survived to one year of age without any severe IVH, cPVL, severe ROP, severe BPD or NEC. Tocolysis increased and prolonged mechanical ventilation decreased the chances of survival without these morbidities. Maternal smoking and higher gestational duration were associated with lower risk of severe ROP, whereas PDA and poor growth increased this risk. Conclusion: Half of the infants surviving extremely preterm birth suffered from severe neonatal morbidities. Studies on how to reduce these morbidities and on the long-term health of survivors are warranted.

  • 2.
    Beltempo, Marc
    et al.
    Univ Toronto, Mt Sinai Hosp, Maternal Infant Care Res Ctr, Dept Paediat, Toronto, ON, Canada.
    Isayama, Tetsuya
    McMaster Univ, Clin Epidemiol & Biostat, Toronto, ON, Canada.
    Vento, Maximo
    Hlth Res Inst La Fe, Spanish Neonatal Network, Ave Fernando Abril Martorell, Valencia, Spain.
    Lui, Kei
    Univ New South Wales, Royal Hosp Women, Natl Perinatal Epidemiol & Statist Unit, Australian & New Zealand Neonatal Network, Randwick, NSW, Australia.
    Kusuda, Satoshi
    Tokyo Womens Med Univ, Maternal & Perinatal Ctr, Neonatal Res Network Japan, Tokyo, Japan.
    Lehtonen, Liisa
    Univ Turku, Turku Univ Hosp, Dept Pediat, Turku, Finland.
    Sjörs, Gunnar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Perinatal, neonatal och barnkardiologisk forskning.
    Hakansson, Stellan
    Umea Univ Hosp, Dept Pediat, Swedish Neonatal Qual Register, Neonatal Serv, Umea, Sweden.
    Adams, Mark
    Univ Zurich, Univ Hosp Zurich, Dept Neonatol, Swiss Neonatal Network, Zurich, Switzerland.
    Noguchi, Akihiko
    Illinois Neonatal Network, St Louis, IL USA.
    Reichman, Brian
    Sheba Med Ctr, Gertner Inst Epidemiol & Hlth Policy Res, Israel Neonatal Network, Tel Hashomer, Israel.
    Darlow, Brian A.
    Univ Otago, Dept Paediat, Australia & New Zealand Neonatal Network, Christchurch, New Zealand.
    Morisaki, Naho
    Natl Ctr Child Hlth & Dev, Dept Social Med, Neonatal Res Network Japan, Tokyo, Japan.
    Bassler, Dirk
    Univ Zurich, Univ Hosp Zurich, Dept Neonatol, Swiss Neonatal Network, Zurich, Switzerland.
    Pratesi, Simone
    Careggi Univ Hosp, Neonatal Intens Care Unit, TIN Toscane Online, Florence, Italy.
    Lee, Shoo K.
    Univ Toronto, Mt Sinai Hosp, Maternal Infant Care Res Ctr, Dept Paediat, Toronto, ON, Canada.
    Lodha, Abhay
    Univ Calgary, Pediat & Community Hlth Sci, Calgary, AB, Canada.
    Modi, Neena
    Imperial Coll London, Dept Med, Neonatal Data Anal Unit, Sect Neonatal Med,UK Neonatal Collaborat, Chelsea & Westminster Hosp Campus, London, England.
    Helenius, Kjell
    Univ Turku, Turku Univ Hosp, Dept Pediat, Turku, Finland.
    Shah, Prakesh S.
    Univ Toronto, Mt Sinai Hosp, Maternal Infant Care Res Ctr, Dept Paediat, Toronto, ON, Canada.
    Respiratory Management of Extremely Preterm Infants: An International Survey2018Ingår i: Neonatology, ISSN 1661-7800, E-ISSN 1661-7819, Vol. 114, nr 1, s. 28-36Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

  • 3.
    Darlow, Brian A.
    et al.
    Univ Otago, Dept Paediat, Australia & New Zealand Neonatal Network, Christchurch, New Zealand..
    Lui, Kei
    Univ New South Wales, Australian & New Zealand Neonatal Network, Royal Hosp Women, Natl Perinatal Epidemiol & Stat Unit, Randwick, NSW, Australia..
    Kusuda, Satoshi
    Tokyo Womens Med Univ, Maternal & Perinatal Ctr, Neonatal Res Network Japan, Shinjuku Ku, Tokyo, Japan..
    Reichman, Brian
    Sheba Med Ctr, Israel Neonatal Network, Gertner Inst Epidemiol & Hlth Policy Res, Tel Hashomer, Israel..
    Håkansson, Stellan
    Umea Univ Hosp, Dept Pediat, Swedish Neonatal Qual Register, Neonatal Serv, Umea, Sweden..
    Bassler, Dirk
    Univ Zurich, Univ Hosp Zurich, Dept Neonatol, Swiss Neonatal Network, Frauenklinikstr, Zurich, Switzerland..
    Modi, Neena
    Imperial Coll London, UK Neonatal Collaborat, Sect Neonatal Med, Dept Med,Neonatal Data Anal Unit, Chelsea & Westminster Hosp Campus, London, England..
    Lee, Shoo K.
    Mt Sinai Hosp, Dept Paediat, Toronto, ON, Canada.;Univ Toronto, Toronto, ON, Canada.;Mt Sinai Hosp, Maternal Infant Care Res Ctr, Canadian Neonatal Network, Toronto, ON, Canada..
    Lehtonen, Liisa
    Turku Univ Hosp, Dept Pediat, Finnish Med Birth Register, Turku, Finland.;Turku Univ Hosp, Dept Pediat, Register Congenital Malformat, Turku, Finland..
    Vento, Maximo
    Hlth Res Inst La Fe, Spanish Neonatal Network, Ave Fernando Abril Martorell, Valencia, Spain..
    Isayama, Tetsuya
    Mt Sinai Hosp, Dept Paediat, Toronto, ON, Canada.;Univ Toronto, Toronto, ON, Canada..
    Sjörs, Gunnar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Helenius, Kjell K.
    Turku Univ Hosp, Dept Pediat, Finnish Med Birth Register, Turku, Finland.;Turku Univ Hosp, Dept Pediat, Register Congenital Malformat, Turku, Finland..
    Adams, Mark
    Univ Zurich, Univ Hosp Zurich, Dept Neonatol, Swiss Neonatal Network, Frauenklinikstr, Zurich, Switzerland..
    Rusconi, Franca
    Meyer Childrens Univ Hosp, Unit Epidemiol, TIN Toscane Online, Viale Pieraccini, Florence, Italy.;Reg Hlth Agcy, Via Pietro Dazzi, Florence, Italy..
    Morisaki, Naho
    Natl Ctr Child Hlth & Dev, Neonatal Res Network Japan, Dept Social Med, Setagaya Ku, Tokyo, Japan..
    Shah, Prakesh S.
    Mt Sinai Hosp, Dept Paediat, Toronto, ON, Canada.;Univ Toronto, Toronto, ON, Canada.;Mt Sinai Hosp, Maternal Infant Care Res Ctr, Canadian Neonatal Network, Toronto, ON, Canada..
    International variations and trends in the treatment for retinopathy of prematurity2017Ingår i: British Journal of Ophthalmology, ISSN 0007-1161, E-ISSN 1468-2079, Vol. 101, nr 10, s. 1399-1404Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To compare the rates of retinopathy of prematurity (ROP) and treatment of ROP by laser or intravitreal anti-vascular endothelial growth factor among preterm neonates from high-income countries participating in the International Network for Evaluating Outcomes (iNeo) of neonates.

    Methods: A retrospective cohort study was conducted on extremely preterm infants weighing <1500 g at 24(0) to 27(6) weeks' gestation who were admitted to neonatal units in Australia/New Zealand, Canada, Finland, Israel, Japan, Spain, Sweden, Switzerland, Tuscany (Italy) and the UK between 2007 and 2013. Pairwise comparisons of ROP treatment in survivors between countries were evaluated by Poisson and multivariable logistic regression analyses after adjustment for confounders. A composite outcome of death or ROP treatment was compared between countries using logistic regression and standardised ratios.

    Results: Of 48 087 infants included in the analysis, 81.8% survived to 32 weeks postmenstrual age, and 95% of survivors were screened for ROP. Rates of any ROP ranged from 25.2% to 91.0% in Switzerland and Japan, respectively, among those examined. The overall rate of those receiving treatment was 24.9%, which varied from 4.3% to 30.4%. Adjusted risk ratios for ROP treatment were lower for Switzerland in all pairwise comparisons, whereas Japan displayed significantly higher ratios. Comparisons of the composite outcome between countries revealed similar, but less marked differences.

    Conclusions: Rates of any ROP and ROP treatment varied significantly between iNeo members, while an overall decline in ROP treatment was observed during the study period. It is unclear whether these variations represent differences in care practices, diagnosis and/or treatment thresholds.

  • 4.
    Darlow, Brian A.
    et al.
    Univ Otago, Dept Paediat, Australian & New Zealand Neonatal Network, Christchurch, New Zealand.
    Vento, Maximo
    Hlth Res Inst La Fe, Spanish Neonatal Network, Ave Fernando Abril Martorell, Valencia, Spain.
    Beltempo, Marc
    McGill Univ, Montreal Childrens Hosp, Dept Pediat, Montreal, PQ, Canada.
    Lehtonen, Liisa
    Turku Univ Hosp, Dept Pediat, Finnish Med Birth Register, Turku, Finland;Turku Univ Hosp, Dept Pediat, Register Congenital Malformat, Turku, Finland.
    Hakansson, Stellan
    Umea Univ Hosp, Dept Pediat Neonatal Serv, Swedish Neonatal Qual Register, Umea, Sweden.
    Reichman, Brian
    Sheba Med Ctr, Gertner Inst Epidemiol & Hlth Policy Res, Israel Neonatal Network, Tel Hashomer, Israel.
    Helenius, Kjell
    Turku Univ Hosp, Dept Pediat, Finnish Med Birth Register, Turku, Finland;Turku Univ Hosp, Dept Pediat, Register Congenital Malformat, Turku, Finland.
    Sjörs, Gunnar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Perinatal, neonatal och barnkardiologisk forskning. Swedish Neonatal Qual Register, Uppsala, Sweden.
    Sigali, Emilio
    Univ Hosp Pisa, Dept Pediat, Div Neonatol, TIN Toscane Online, Pisa, Italy;Univ Hosp Pisa, Dept Pediat, Neonatal Intens Care Unit, Pisa, Italy.
    Lee, Shoo
    Mt Sinai Hosp, Canadian Neonatal Network, Dept Paediat, Toronto, ON, Canada;Univ Toronto, Toronto, ON, Canada.
    Noguchi, Akihiko
    Illinois Neonatal Network, St Louis, IL USA.
    Morisaki, Naho
    Natl Ctr Child Hlth & Dev, Dept Social Med, Neonatal Res Network Japan, Tokyo, Japan.
    Kusuda, Satoshi
    Tokyo Womens Med Univ, Maternal & Perinatal Ctr, Neonatal Res Network Japan, Tokyo, Japan.
    Bassler, Dirk
    Univ Zurich, Univ Hosp Zurich, Dept Neonatol, Swiss Neonatal Network, Zurich, Switzerland.
    San Feliciano, Laura
    Univ Salamanca, Dept Pediat, Spanish Neonatal Network, Salamanca, Spain.
    Adams, Mark
    Univ Zurich, Univ Hosp Zurich, Dept Neonatol, Swiss Neonatal Network, Zurich, Switzerland.
    Isayama, Tetsuya
    McMaster Univ, Clin Epidemiol & Biostat, Toronto, ON, Canada.
    Shah, Prakesh S.
    Mt Sinai Hosp, Dept Pediat, Toronto, ON, Canada;Univ Toronto, Dept Pediat, Toronto, ON, Canada;Mt Sinai Hosp, Maternal Infant Care Res Ctr, Toronto, ON, Canada.
    Lui, Kei
    Univ New South Wales, Royal Hosp Women, Natl Perinatal Epidemiol & Statist Unit, Australian & New Zealand Neonatal Network, Randwick City, NSW, Australia.
    Variations in Oxygen Saturation Targeting, and Retinopathy of Prematurity Screening and Treatment Criteria in Neonatal Intensive Care Units: An International Survey2018Ingår i: Neonatology, ISSN 1661-7800, E-ISSN 1661-7819, Vol. 114, nr 4, s. 323-331Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

  • 5.
    Karlsson, Victoria
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Heinemann, Ann-Britt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Sjörs, Gunnar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Nyqvist, Kerstin Hedberg
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Ågren, Johan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Early Skin-to-Skin Care in Extremely Preterm Infants: Thermal Balance and Care Environment2012Ingår i: Journal of Pediatrics, ISSN 0022-3476, E-ISSN 1097-6833, Vol. 161, nr 3, s. 422-426Artikel i tidskrift (Refereegranskat)
    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.

  • 6.
    Koller-Smith, Louise I. M.
    et al.
    Univ Technol Sydney, Fac Hlth Sci, Sydney, NSW, Australia..
    Shahr, Prakesh S.
    Mt Sinai Hosp, Dept Pediat, Toronto, ON, Canada.;Univ Toronto, Toronto, ON, Canada.;Mt Sinai Hosp, Maternal Infant Care Res Ctr, Toronto, ON, Canada..
    Ye, Xiang Y.
    Mt Sinai Hosp, Maternal Infant Care Res Ctr, Toronto, ON, Canada..
    Sjörs, Gunnar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Perinatal, neonatal och barnkardiologisk forskning.
    Wang, Yueping A.
    Univ Technol Sydney, Fac Hlth Sci, Sydney, NSW, Australia..
    Chow, Sharon S. W.
    Univ Technol Sydney, Fac Hlth Sci, Sydney, NSW, Australia..
    Darlow, Brian A.
    Univ Otago, Dept Paediat, Christchurch, New Zealand..
    Lee, Shoo K.
    Mt Sinai Hosp, Dept Pediat, Toronto, ON, Canada.;Univ Toronto, Toronto, ON, Canada.;Mt Sinai Hosp, Maternal Infant Care Res Ctr, Toronto, ON, Canada..
    Håkanson, Stellan
    Umea Univ, Umea, Sweden..
    Lui, Kei
    Univ Technol Sydney, Fac Hlth Sci, Sydney, NSW, Australia.;Royal Hosp Women, Dept Newborn Care, Barker St, Sydney, NSW 2031, Australia..
    Comparing very low birth weight versus very low gestation cohort methods for outcome analysis of high risk preterm infants2017Ingår i: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 17, artikel-id 166Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Compared to very low gestational age (<32 weeks, VLGA) cohorts, very low birth weight (<1500 g; VLBW) cohorts are more prone to selection bias toward small-for-gestational age (SGA) infants, which may impact upon the validity of data for benchmarking purposes. Method: Data from all VLGA or VLBW infants admitted in the 3 Networks between 2008 and 2011 were used. Two-thirds of each network cohort was randomly selected to develop prediction models for mortality and composite adverse outcome (CAO: mortality or cerebral injuries, chronic lung disease, severe retinopathy or necrotizing enterocolitis) and the remaining for internal validation. Areas under the ROC curves (AUC) of themodels were compared. Results: VLBW cohort (24,335 infants) had twice more SGA infants (20.4% vs. 9.3%) than the VLGA cohort (29,180 infants) and had a higher rate of CAO (36.5% vs. 32.6%). The two models had equal prediction power for mortality and CAO (AUC 0.83), and similarly for all other cross-cohort validations (AUC 0.81-0.85). Neither model performed well for the extremes of birth weight for gestation (<1500 g and >= 32 weeks, AUC 0.50-0.65; >= 1500 g and >= 32 weeks, AUC 0.60-0.62). Conclusion: There was no difference in prediction power for adverse outcome between cohorting VLGA or VLBW despite substantial bias in SGA population. Either cohorting practises are suitable for international benchmarking.

  • 7.
    Maleka, Aglaia
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för immunologi, genetik och patologi, Experimentell och klinisk onkologi.
    Enblad, Gunilla
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för immunologi, genetik och patologi, Experimentell och klinisk onkologi.
    Sjörs, Gunnar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Lindqvist, Anna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Ullenhag, Gustav
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för immunologi, genetik och patologi, Experimentell och klinisk onkologi.
    Treatment of metastatic malignant melanoma with vemurafenib during pregnancy2013Ingår i: Journal of Clinical Oncology, ISSN 0732-183X, Vol. 31, nr 11, s. e192-e193Artikel i tidskrift (Refereegranskat)
  • 8.
    Maleka, Aglaia
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för radiologi, onkologi och strålningsvetenskap.
    Enblad, Gunilla
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för radiologi, onkologi och strålningsvetenskap, Enheten för onkologi.
    Sjörs, Gunnar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik.
    Lindqvist, Anna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Ullenhag, Gustav J.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för radiologi, onkologi och strålningsvetenskap, Enheten för onkologi.
    Treatment of Metastatic Malignant Melanoma With Vemurafenib During Pregnancy2013Ingår i: Journal of Clinical Oncology, ISSN 0732-183X, E-ISSN 1527-7755, Vol. 31, nr 11, s. E192-E193Artikel i tidskrift (Refereegranskat)
  • 9.
    Norby, Ulrika
    et al.
    Lund Univ, Tornblad Inst, Inst Clin Sci, Ctr Reprod Epidemiol, Lund, Sweden.;Stockholm Cty Council, Hlth & Med Care Adm, Dept E Hlth & Strateg IT, POB 17533, SE-11891 Stockholm, Sweden..
    Forsberg, Lisa
    Karolinska Univ Hosp, Dept Pediat, Stockholm, Sweden.;Karolinska Inst, Dept Clin Sci Intervent & Technol CLINTEC, Stockholm, Sweden..
    Wide, Katarina
    Karolinska Univ Hosp, Dept Pediat, Stockholm, Sweden.;Karolinska Inst, Dept Clin Sci Intervent & Technol CLINTEC, Stockholm, Sweden..
    Sjörs, Gunnar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik.
    Winbladh, Birger
    Sachs Childrens & Youth Hosp, Karolinska Inst, Dept Clin Sci & Educ, Stockholm, Sweden..
    Kallen, Karin
    Lund Univ, Tornblad Inst, Inst Clin Sci, Ctr Reprod Epidemiol, Lund, Sweden..
    Neonatal Morbidity After Maternal Use of Antidepressant Drugs During Pregnancy2016Ingår i: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 138, nr 5, artikel-id e20160181Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To estimate the rate of admissions to NICUs, as well as infants' morbidity and neonatal interventions, after exposure to antidepressant drugs in utero. METHODS: Data on pregnancies, deliveries, prescription drug use, and health status of the newborn infants were obtained from the Swedish Medical Birth Register, the Prescribed Drug Register, and the Swedish Neonatal Quality Register. We included 741 040 singletons, born between July 1, 2006, and December 31, 2012. Of the infants, 17 736 (2.4%) had mothers who used selective serotonin reuptake inhibitors (SSRIs) during pregnancy. Infants exposed to an SSRI were compared with nonexposed infants, and infants exposed during late pregnancy were compared with those exposed during early pregnancy only. The results were analyzed with logistic regression analysis. RESULTS: After maternal use of an SSRI, 13.7% of the infants were admitted to the NICU compared with 8.2% in the population (adjusted odds ratio: 1.5 [95% confidence interval: 1.4-1.5]). The admission rate to the NICU after treatment during late pregnancy was 16.5% compared with 10.8% after treatment during early pregnancy only (adjusted odds ratio: 1.6 [95% confidence interval: 1.5-1.8]). Respiratory and central nervous system disorders and hypoglycemia were more common after maternal use of an SSRI. Infants exposed to SSRIs in late pregnancy compared with early pregnancy had a higher risk of persistent pulmonary hypertension (number needed to harm: 285). CONCLUSIONS: Maternal use of antidepressants during pregnancy was associated with increased neonatal morbidity and a higher rate of admissions to the NICU. The absolute risk for severe disease was low, however.

  • 10.
    Serenius, Fredrik
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Blennow, Mats
    Department of Pediatrics, Karolinska University Hospital, Huddinge, Stockholm, Sweden.
    Marsal, Karel
    Department of Obstetrics and Gynecology, Lund University, Sweden.
    Sjörs, Gunnar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Kallen, Karin
    Centre for Reproductive Epidemiology, Lund University, Sweden.
    Intensity of Perinatal Care for Extremely Preterm Infants: Outcomes at 2.5 Years2015Ingår i: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 135, nr 5, s. E1163-E1172Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To examine the association between intensity of perinatal care and outcome at 2.5 years' corrected age (CA) in extremely preterm (EPT) infants (<27 weeks) born in Sweden during 2004-2007. METHODS: A national prospective study in 844 fetuses who were alive at the mother's admission for delivery: 707 were live born, 137 were stillborn. Infants were assigned a perinatal activity score on the basis of the intensity of care (rates of key perinatal interventions) in the infant's region of birth. Scores were calculated separately for each gestational week (gestational age [GA]-specific scores) and for the aggregated cohort (aggregated activity scores). Primary outcomes were 1-year mortality and death or neurodevelopmental disability (NDI) at 2.5 years' CA in fetuses who were alive at the mother's admission. RESULTS: Each 5-point increment in GA-specific activity score reduced the stillbirth risk (adjusted odds ratio [aOR]: 0.90; 95% confidence interval [CI]: 0.83-0.97) and the 1-year mortality risk (aOR: 0.84; 95% CI: 0.78-0.91) in the primary population and the 1-year mortality risk in live-born infants (aOR: 0.86; 95% CI: 0.79-0.93). In health care regions with higher aggregated activity scores, the risk of death or NDI at 2.5 years' CA was reduced in the primary population (aOR: 0.69; 95% CI: 0.50-0.96) and in live-born infants (aOR: 0.68; 95% CI: 0.48-0.95). Risk reductions were confined to the 22- to 24-week group. There was no difference in NDI risk between survivors at 2.5 years' CA. CONCLUSIONS: Proactive perinatal care decreased mortality without increasing the risk of NDI at 2.5 years' CA in EPT infants. A proactive approach based on optimistic expectations of a favorable outcome is justified.

  • 11.
    Serenius, Fredrik
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik.
    Sjörs, Gunnar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik.
    Blennow, Mats
    Department of Pediatrics, Karolinska University Hospital, Huddinge, Stockholm, Sweden.
    Fellman, Vineta
    Department of Pediatrics, Lund University, Sweden.
    Holmström, Gerd
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Oftalmiatrik.
    Maršál, Karel
    Department of Obstetrics and Gynecology, Lund University, Sweden.
    Lindberg, Eva
    Department of Pediatrics, Örebro University, Sweden.
    Olhager, Elisabeth
    Department of Pediatrics, Linköping University, Sweden.
    Stigson, Lennart
    Department of Pediatrics, Sahlgrenska University Hospital, Göteborg, Sweden.
    Westgren, Magnus
    Department of Obstetrics and Gynecology, Karolinska University Hospital, Huddinge, Stockholm, Sweden.
    Källen, Karin
    Centre for Reproductive Epidemiology, Lund University, Sweden.
    EXPRESS study shows significant regional differences in 1-year outcome of extremely preterm infants in Sweden2014Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 103, nr 1, s. 27-37Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: The aim of this study was to investigate differences in mortality up to 1 year of age in extremely preterm infants (before 27 weeks) born in seven Swedish healthcare regions.

    METHODS: National prospective observational study of consecutively born, extremely preterm infants in Sweden 2004-2007. Mortality was compared between regions. Crude and adjusted odds ratios and 95% CI were calculated.

    RESULTS: Among 844 foetuses alive at mother's admission for delivery, regional differences were identified in perinatal mortality for the total group (22-26 weeks) and in the stillbirth and perinatal and 365-day mortality rates for the subgroup born at 22-24 weeks. Among 707 infants born alive, regional differences were found both in mortality before 12 h and in the 365-day mortality rate for the subgroup (22-24 weeks) and for the total group (22-26 weeks). The mortality rates were consistently lower in two healthcare regions. There were no differences in the 365-day mortality rate for infants alive at 12 h or for infants born at 25 weeks. Neonatal morbidity rates among survivors were not higher in regions with better survival rates. Perinatal practices varied between regions.

    CONCLUSION: Mortality rates in extremely preterm infants varied considerably between Swedish healthcare regions in the first year after birth, particularly between the most immature infants.

  • 12. Shah, Prakesh S.
    et al.
    Lee, Shoo K.
    Lui, Kei
    Sjörs, Gunnar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik.
    Mori, Rintaro
    Reichman, Brian
    Hakansson, Stellan
    Feliciano, Laura San
    Modi, Neena
    Adams, Mark
    Darlow, Brian
    Fujimura, Masanori
    Kusuda, Satoshi
    Haslam, Ross
    Mirea, Lucia
    The International Network for Evaluating Outcomes of very low birth weight, very preterm neonates (iNeo): a protocol for collaborative comparisons of international health services for quality improvement in neonatal care2014Ingår i: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 14, s. 110-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The International Network for Evaluating Outcomes in Neonates (iNeo) is a collaboration of population-based national neonatal networks including Australia and New Zealand, Canada, Israel, Japan, Spain, Sweden, Switzerland, and the UK. The aim of iNeo is to provide a platform for comparative evaluation of outcomes of very preterm and very low birth weight neonates at the national, site, and individual level to generate evidence for improvement of outcomes in these infants. Methods/design: Individual-level data from each iNeo network will be used for comparative analysis of neonatal outcomes between networks. Variations in outcomes will be identified and disseminated to generate hypotheses regarding factors impacting outcome variation. Detailed information on physical and environmental factors, human and resource factors, and processes of care will be collected from network sites, and tested for association with neonatal outcomes. Subsequently, changes in identified practices that may influence the variations in outcomes will be implemented and evaluated using quality improvement methods. Discussion: The evidence obtained using the iNeo platform will enable clinical teams from member networks to identify, implement, and evaluate practice and service provision changes aimed at improving the care and outcomes of very low birth weight and very preterm infants within their respective countries. The knowledge generated will be available worldwide with a likely global impact.

  • 13.
    Shah, Prakesh S.
    et al.
    Mt Sinai Hosp, Maternal Infant Care Res Ctr, Canadian Neonatal Network, Toronto, ON, Canada..
    Lui, Kei
    Univ New South Wales, Australian & New Zealand Neonatal Network, Royal Hosp Women, Natl Perinatal Epidemiol & Stat Unit, Randwick, NSW, Australia..
    Sjörs, Gunnar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Mirea, Lucia
    Mt Sinai Hosp, Maternal Infant Care Res Ctr, Canadian Neonatal Network, Toronto, ON, Canada.;Phoenix Childrens Hosp, Phoenix, AZ USA..
    Reichman, Brian
    Sheba Med Ctr, Israel Neonatal Network, Gertner Inst Epidemiol & Hlth Policy Res, Tel Hashomer, Israel..
    Adams, Mark
    Univ Zurich, Univ Zurich Hosp, Dept Neonatol, Swiss Neonatal Network, Zurich, Switzerland..
    Modi, Neena
    Imperial Coll London, Chelsea & Westminster Hosp Campus, UK Neonatal Collaborat, Neonatal Data Anal Unit,Sect Neonatal Med,Dept Me, London, England..
    Darlow, Brian A.
    Univ Otago, Dept Pediat, Australia & New Zealand Neonatal Network, Christchurch, New Zealand..
    Kusuda, Satoshi
    Tokyo Womens Med Univ, Neonatal Res Network Japan, Maternal & Perinatal Ctr, Shinjuku Ku, Tokyo, Japan..
    Feliciano, Laura San
    Hosp Univ Salamanca, Spanish Neonatal Network, Salamanca, Spain..
    Yang, Junmin
    Mt Sinai Hosp, Maternal Infant Care Res Ctr, Canadian Neonatal Network, Toronto, ON, Canada..
    Håkansson, Stellan
    Umea Univ Hosp, Dept Pediat, Swedish Neonatal Qual Register, Neonatal Serv, Umea, Sweden..
    Mori, Rintaro
    Natl Ctr Child Hlth & Dev, Neonatal Res Network Japan, Dept Hlth Policy, Tokyo, Japan..
    Bassler, Dirk
    Univ Zurich, Univ Zurich Hosp, Dept Neonatol, Swiss Neonatal Network, Zurich, Switzerland..
    Figueras-Aloy, Josep
    Hosp Clin Barcelona, Spanish Neonatal Network, Barcelona, Spain..
    Lee, Shoo K.
    Mt Sinai Hosp, Maternal Infant Care Res Ctr, Canadian Neonatal Network, Toronto, ON, Canada..
    Neonatal Outcomes of Very Low Birth Weight and Very Preterm Neonates: An International Comparison2016Ingår i: Journal of Pediatrics, ISSN 0022-3476, E-ISSN 1097-6833, Vol. 177, s. 144-152Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To compare rates of a composite outcome of mortality or major morbidity in very-preterm/very low birth weight infants between 8 members of the International Network for Evaluating Outcomes.

    Study design: We included 58 004 infants born weighing < 1500 g at 24 degrees-31(6) weeks' gestation from databases in Australia/New Zealand, Canada, Israel, Japan, Spain, Sweden, Switzerland, and the United Kingdom. We compared a composite outcome (mortality or any of grade >= 3 peri-intraventricular hemorrhage, periventricular echodensity/echolucency, bronchopulmonary dysplasia, or treated retinopathy of prematurity) between each country and all others by using standardized ratios and pairwise using logistic regression analyses.

    Results: Despite differences in population coverage, included neonates were similar at baseline. Composite outcome rates varied from 26% to 42%. The overall mortality rate before discharge was 10% (range: 5% [Japan]-17% [Spain]). The standardized ratio (99% CIs) estimates for the composite outcome were significantly greater for Spain 1.09 (1.04-1.14) and the United Kingdom 1.16 (1.11-1.21), lower for Australia/New Zealand 0.93 (0.89-0.97), Japan 0.89 (0.86-0.93), Sweden 0.81 (0.73-0.90), and Switzerland 0.77 (0.69-0.87), and nonsignificant for Canada 1.04 (0.99-1.09) and Israel 1.00 (0.93-1.07). The adjusted odds of the composite outcome varied significantly in pairwise comparisons.

    Conclusions: We identified marked variations in neonatal outcomes between countries. Further collaboration and exploration is needed to reduce variations in population coverage, data collection, and case definitions. The goal would be to identify carepractices and health care organizational factors, which has the potential to improve neonatal outcomes.

  • 14. Wiklund, Ingela
    et al.
    Ahlberg, Mia
    Dahlstrom, Anders
    Weichselbraun, Marianne
    Sjörs, Gunnar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik.
    Routine testing of umbilical cord blood after normal delivery should be discontinued2014Ingår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 5, nr 4, s. 165-166Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    On many newborns in Sweden routine samples of blood are taken from the umbilical cord after birth to measure the acid base balance. These tests were introduced with the aim to objectively measure the well-being and stress levels of the newborn. The information was to be used as a measurement of quality of care, for research and as a tool to help guide decisions around the care-needs of the newborn. After 10 years of routine analysis it has become clear that the results of these tests have limited clinical value and that they are a poor measurement of quality of care. 

  • 15.
    Ågren, Johan
    et al.
    Uppsala universitet, Medicinska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Sjörs, Gunnar
    Uppsala universitet, Medicinska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Sedin, Gunnar
    Uppsala universitet, Medicinska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Ambient humidity influences the rate of skin barrier maturation in extremely preterm infants.2006Ingår i: J Pediatr, ISSN 0022-3476, Vol. 148, nr 5, s. 613-7Artikel i tidskrift (Refereegranskat)
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