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  • 1.
    Klevebro, S.
    et al.
    Karolinska Inst, Dept Clin Sci Intervent & Technol, Stockholm, Sweden;South Gen Hosp, Sachs Children & Youth Hosp, Stockholm, Sweden.
    Hammar, U.
    Karolinska Inst, Inst Environm Med, Unit Biostat, Stockholm, Sweden.
    Holmström, Gerd
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Söderberg: Ophthalmic Biophysics.
    Bottai, M.
    Karolinska Inst, Inst Environm Med, Unit Biostat, Stockholm, Sweden.
    Hellstrom, A.
    Univ Gothenburg, Sahlgrenska Acad, Inst Neurosci & Physiol, Dept Ophthalmol, Gothenburg, Sweden.
    Hallberg, B.
    Karolinska Inst, Dept Clin Sci Intervent & Technol, Stockholm, Sweden;Karolinska Univ Hosp, Dept Neonatal Med, Stockholm, Sweden.
    Adherence to oxygen saturation targets increased in preterm infants when a higher target range and tighter alarm limits were introduced2019In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 108, no 9, p. 1584-1589Article in journal (Refereed)
    Abstract [en]

    Aim

    European consensus guidelines published in May 2013 recommended a target peripheral capillary oxygen saturation (SpO2) range of 90–95% for preterm infants. These were incorporated into guidelines at the Karolinska University Hospital, Sweden, in November 2013. This study compared clinical practice before and after those local guidelines.

    Methods

    We included infants who were born between 23 + 0 and 30 + 6 weeks from January 1, 2013 to December, 31 2015 and received intensive care in two Karolinska units. The lower saturation target of 88–92% and alarm limits of 85–95% used before November 2013 were compared to the new higher saturation target of 90–95% and alarm limits of 89–96%.

    Results

    Data from 399 infants were analysed. The mean SpO2 was 92.4% with the higher target (n = 301) and 91.1% with the lower target (n = 98). Using the higher instead of lower target meant that the SpO2 was within the prescribed target range more frequently (51% versus 30%) and the proportion of time with SpO2 >95% was increased by 9% (95% confidence interval 7–11%, p < 0.001).

    Conclusion

    The higher saturation target and tighter alarm limits led to higher mean oxygen saturation, increased adherence to the target and increased time with hyperoxaemia.

  • 2.
    Norman, Mikael
    et al.
    Karolinska Inst, Div Pediat, Dept Clin Sci Intervent & Technol, Stockholm, Sweden;Karolinska Univ Hosp, Dept Neonatal Med, Stockholm, Sweden;Vasterbotten Cty Council, Swedish Neonatal Qual Register SNQ, Umea, Sweden.
    Källén, Karin
    Vasterbotten Cty Council, Swedish Neonatal Qual Register SNQ, Umea, Sweden;Lund Univ, Ctr Reprod Epidemiol, Lund, Sweden.
    Wahlström, Erik
    Natl Board Hlth & Welf, Stockholm, Sweden.
    Håkansson, Stellan
    Vasterbotten Cty Council, Swedish Neonatal Qual Register SNQ, Umea, Sweden;Umea Univ, Dept Clin Sci, Div Pediat, Umea, Sweden.
    Skiöld, Beatrice
    Swedish Neonatal Soc, Stockholm, Sweden;Karolinska Inst, Stockholm, Sweden.
    Navér, Lars
    Karolinska Inst, Stockholm, Sweden.
    Domellöf, Magnus
    Umea Univ, Umea, Sweden.
    Abrahamsson, Thomas
    Linkoping Univ, Linkoping, Sweden.
    Stigson, Lennart
    Gothenburg Univ, Gothenburg, 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.
    Nyholm, Annika
    Umea Univ, Umea, Sweden.
    Ingemansson, Fredrik
    Jonkoping Acad, Jonkoping, Sweden.
    Holmström, Gerd
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Söderberg: Ophthalmic Biophysics.
    Björklund, Lars
    Lund Univ, Lund, Sweden.
    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.
    Wallin-Gyökeres, Annica
    Parent Representat, Stockholm, Sweden.
    The Swedish Neonatal Quality Register - contents, completeness and validity2019In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 108, no 8, p. 1411-1418Article in journal (Refereed)
    Abstract [en]

    Aim: To describe the Swedish Neonatal Quality Register (SNQ) and to determine its completeness and agreement with other registers.

    Methods: SNQ collects data for infants admitted to neonatal units during the first four postnatal weeks. Completeness and registers' agreement were determined cross-linking SNQ data with Swedish population registers (the Inpatient, Medical Birth and Cause of Death Registers) for a study period of five years.

    Results: In total, 84 712 infants were hospitalised. A total of 52 806 infants occurred in both SNQ and the population registers; 28 692 were only found in the population registers, and 3214 infants were only found in SNQ. Between gestational weeks 24-34, completeness of SNQ was 98-99%. Below and above these gestational ages, completeness was lower. Infants missing in SNQ were term or near-term in 99% of the cases, and their diagnoses indicated conditions managed in maternity units, or re-admissions for acute infections, managed in paediatric units. For most diagnoses, the agreement between SNQ and population registers was high, but some (bronchopulmonary dysplasia and grade of hypoxic-ischaemic encephalopathy) were often missing in the population registers.

    Conclusion: SNQ completeness and agreement against other registers, especially for preterm infants, is excellent. SNQ is a valid tool for benchmarking, quality improvement and research.

  • 3.
    Sandberg Melin, Camilla
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Söderberg: Ophthalmic Biophysics. centrum för forskning och utveckling Uppsala universitet/Gävleborg.
    Yu, Zhaohua
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Söderberg: Ophthalmic Biophysics.
    Söderberg, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Söderberg: Ophthalmic Biophysics.
    Detection and clinical follow-up of segmental glaucomatous optic nerve head damage using OCT.Manuscript (preprint) (Other academic)
  • 4.
    Söderberg, Per
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Söderberg: Ophthalmic Biophysics.
    Yu, Zhaohua
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Söderberg: Ophthalmic Biophysics.
    Sandberg Melin, Camilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Söderberg: Ophthalmic Biophysics. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Optic nerve head morphometry for glaucoma diagnosis, optimization of clinical measurement strategy2019In: Proceedings of SPIE, ISSN 0277-786X, Vol. 10858, p. 45:1-45:8, article id 108581CArticle in journal (Refereed)
    Abstract [en]

    The present study aimed to develop a strategy for evaluation of instant PIMD-2 pi measurements as a basis for clinical monitoring of glaucoma. PIMD-2 pi is a morphometric measure of the waist of the nerve fiber layer at the optic nerve head (ONH). Clinical measurements of PIMD-2 pi in patients with early to moderate stage glaucoma demonstrated a high variability among subjects. The high variability among subjects renders comparison of instant PIMD-2 pi measurements to tolerance limits for normality derived from a normative database inefficient. It is suggested to instead compare sequential measurements of PIMD-2 pi within a patient. Initially, the difference between an instant measurement and the average of previous measurements can be compared to tolerance limits for difference between measurements within subject. Once, a potential loss of PIMD-2 pi is detected, a sufficient number of measurements within a sufficiently wide time interval can be used to estimate the PIMD-2 pi loss rate with regression and the deviation of the estimated loss rate can be evaluated as a 95 % confidence interval for the loss rate. If the upper confidence limit excludes 0, a significant loss rate has been detected. The currently proposed strategy has the potential to detect glaucoma earlier than the current gold standard, computer perimetry, with less inconvenience for the patient.

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