uu.seUppsala universitets publikasjoner
Endre søk
Begrens søket
12 1 - 50 of 65
RefereraExporteraLink til resultatlisten
Permanent link
Referera
Referensformat
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Annet format
Fler format
Språk
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Annet språk
Fler språk
Utmatningsformat
  • html
  • text
  • asciidoc
  • rtf
Treff pr side
  • 5
  • 10
  • 20
  • 50
  • 100
  • 250
Sortering
  • Standard (Relevans)
  • Forfatter A-Ø
  • Forfatter Ø-A
  • Tittel A-Ø
  • Tittel Ø-A
  • Type publikasjon A-Ø
  • Type publikasjon Ø-A
  • Eldste først
  • Nyeste først
  • Skapad (Eldste først)
  • Skapad (Nyeste først)
  • Senast uppdaterad (Eldste først)
  • Senast uppdaterad (Nyeste først)
  • Disputationsdatum (tidligste først)
  • Disputationsdatum (siste først)
  • Standard (Relevans)
  • Forfatter A-Ø
  • Forfatter Ø-A
  • Tittel A-Ø
  • Tittel Ø-A
  • Type publikasjon A-Ø
  • Type publikasjon Ø-A
  • Eldste først
  • Nyeste først
  • Skapad (Eldste først)
  • Skapad (Nyeste først)
  • Senast uppdaterad (Eldste først)
  • Senast uppdaterad (Nyeste først)
  • Disputationsdatum (tidligste først)
  • Disputationsdatum (siste først)
Merk
Maxantalet träffar du kan exportera från sökgränssnittet är 250. Vid större uttag använd dig av utsökningar.
  • 1.
    Andersson, Ola
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik.
    Domellof, Magnus
    Andersson, Dan
    Hellström-Westas, Lena
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik.
    Effect of Delayed vs Early Umbilical Cord Clamping on Iron Status and Neurodevelopment at Age 12 Months A Randomized Clinical Trial2014Inngår i: JAMA PEDIATR, ISSN 2168-6203, Vol. 168, nr 6, s. 547-554Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    IMPORTANCE Prevention of iron deficiency in infancy may promote neurodevelopment. Delayed cord clamping (DCC) can prevent iron deficiency during the first 6 months of life. However, no data are available on long-term effects on infant outcomes in relation to time for umbilical cord clamping. OBJECTIVE To investigate effects of DCC, as compared with early cord clamping (ECC), on infant iron status and neurodevelopment at age 12 months in a European setting. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial of 382 full-term infants born after a low-risk pregnancy at a Swedish county hospital. Follow-up at 12 months included evaluation of iron status (ferritin level, transferrin saturation, transferrin receptor level, reticulocyte hemoglobin level, and mean cell volume) and parental assessment of neurodevelopment by the Ages and Stages Questionnaire, second edition (ASQ). INTERVENTIONS Infants were randomized to DCC (>= 180 seconds after delivery) or ECC (<= 10 seconds after delivery). MAIN OUTCOMES AND MEASURES The main outcome was iron status at age 12 months; the secondary outcome was ASQ score. RESULTS In total, 347 of 382 infants (90.8%) were assessed. The DCC and ECC groups did not differ in iron status (mean ferritin level, 35.4 vs 33.6 ng/mL, respectively; P =.40) or neurodevelopment (mean ASQ total score, 229.6 vs 233.1, respectively; P =.42) at age 12 months. Predictors of ferritin levels were infant sex and ferritin in umbilical cord blood. Predictors of ASQ score were infant sex and breastfeeding within 1 hour after birth. For both outcomes, being a boy was associated with lower results. Interaction analysis showed that DCC was associated with an ASQ score 5 points higher among boys (mean [SD] score, 229 [43] for DCC vs 224 [39] for ECC) but 12 points lower among girls (mean [SD] score, 230 [39] for DCC vs 242 [36] for ECC), out of a maximum of 300 points (P =.04 for the interaction term). CONCLUSIONS AND RELEVANCE Delayed cord clamping did not affect iron status or neurodevelopment at age 12 months in a selected population of healthy term-born infants. However, it may not be possible to demonstrate minor effects on neurodevelopment with the size of the study population and the chosen method for assessment. The current data indicate that sex may influence the effects on infant development after DCC in different directions. The magnitude and biological reason for this finding remain to be investigated.

  • 2.
    Andersson, Ola
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik.
    Domellöf, Magnus
    Andersson, Dan
    Hellström-Westas, Lena
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik.
    Effects of delayed cord clamping on neurodevelopment and infection at four months of age: a randomised trial2013Inngår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 102, nr 5, s. 525-531Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIM:

    To investigate the effect that delayed and early umbilical cord clamping have on neurodevelopment, immunoglobulin G (IgG) and symptoms of infection during the first 4 months of life.

    METHODS:

    Full-term infants (n = 382) were randomised to delayed (≥180 sec) or early cord clamping (≤10 sec). The Ages and Stages Questionnaire (ASQ) was used to assess neurodevelopment at 4 months. Immunoglobulin G was measured at birth, 2-3 days and 4 months. Parents recorded any symptoms indicating infection during the first 4 months of life.

    RESULTS:

    The total scores from the ASQ did not differ between groups. However, the delayed cord clamping (DCC) group had a higher mean (SD) score in the problem-solving domain [55.3 (7.2) vs. 53.5 (8.2), p = 0.03] at 4 months and a lower mean (SD) score in the personal-social domain [49.5 (9.3) vs. 51.8 (8.1), p = 0.01]. The IgG level was higher in the DCC group at 2-3 days (11.7 vs. 11.0 g/L, p = 0.004), but did not differ between the groups at 4 months. Symptoms of infection were comparable between the groups.

    CONCLUSION:

    Delayed cord clamping did not affect overall neurodevelopment or symptoms of infection up to 4 months of age, but may have an impact on specific neurodevelopmental domains.

  • 3.
    Andersson, Ola
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik.
    Hellström-Westas, Lena
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik.
    Andersson, Dan
    Clausen, Jesper
    Domellöf, Magnus
    Effects of delayed compared with early umbilical cord clamping on maternal postpartum hemorrhage and cord blood gas sampling: a randomized trial2013Inngår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 92, nr 5, s. 567-574Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective

    To investigate the effect of delayed cord clamping (DCC) compared with early cord clamping (ECC) on maternal postpartum hemorrhage (PPH) and umbilical cord blood gas sampling.

    Design

    Secondary analysis of a parallel-group, single-center, randomized controlled trial.

    Setting

    Swedish county hospital.

    Population

    382 term deliveries after a low-risk pregnancy.

    Methods

    Deliveries were randomized to DCC (≥180 seconds, n = 193) or ECC (≤10 seconds, n = 189). Maternal blood loss was estimated by the midwife. Samples for blood gas analysis were taken from one umbilical artery and the umbilical vein, from the pulsating unclamped cord in the DCC group and from the double-clamped cord in the ECC group. Samples were classified as valid when the arterial-venous difference was -0.02 or less for pH and 0.5 kPa or more for pCO2.

    Main outcome measures

    PPH and proportion of valid blood gas samples.

    Results

    The differences between the DCC and ECC groups with regard to PPH (1.2%, p = 0.8) and severe PPH (-2.7%, p = 0.3) were small and non-significant. The proportion of valid blood gas samples was similar between the DCC (67%, n = 130) and ECC (74%, n = 139) groups, with 6% (95% confidence interval: -4%-16%, p = 0.2) fewer valid samples after DCC.

    Conclusions

    Delayed cord clamping, compared with early, did not have a significant effect on maternal postpartum hemorrhage or on the proportion of valid blood gas samples. We conclude that delayed cord clamping is a feasible method from an obstetric perspective.

  • 4.
    Andersson, Ola
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik.
    Hellström-Westas, Lena
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik.
    Andersson, Dan
    Domellöf, Magnus
    Effect of delayed versus early umbilical cord clamping on neonatal outcomes and iron status at 4 months: a randomised controlled trial2011Inngår i: BMJ. British Medical Journal, E-ISSN 1756-1833, Vol. 343, s. d7157-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To investigate the effects of delayed umbilical cord clamping, compared with early clamping, on infant iron status at 4 months of age in a European setting.

    Design: Randomised controlled trial.

    Setting: Swedish county hospital.

    Participants: 400 full term infants born after a low risk pregnancy.

    Intervention: Infants were randomised to delayed umbilical cord clamping (>= 180 seconds after delivery) or early clamping (<= 10 seconds after delivery).

    Main outcome measures: Haemoglobin and iron status at 4 months of age with the power estimate based on serum ferritin levels. Secondary outcomes included neonatal anaemia, early respiratory symptoms, polycythaemia, and need for phototherapy.

    Results: At 4 months of age, infants showed no significant differences in haemoglobin concentration between the groups, but infants subjected to delayed cord clamping had 45% (95% confidence interval 23% to 71%) higher mean ferritin concentration (117 mu g/L v 81 mu g/L, P<0.001) and a lower prevalence of iron deficiency (1 (0.6%) v 10 (5.7%), P=0.01, relative risk reduction 0.90; number needed to treat=20 (17 to 67)). As for secondary outcomes, the delayed cord clamping group had lower prevalence of neonatal anaemia at 2 days of age (2 (1.2%) v 10 (6.3%), P=0.02, relative risk reduction 0.80, number needed to treat 20 (15 to 111)). There were no significant differences between groups in postnatal respiratory symptoms, polycythaemia, or hyperbilirubinaemia requiring phototherapy.

    Conclusions: Delayed cord clamping, compared with early clamping, resulted in improved iron status and reduced prevalence of iron deficiency at 4 months of age, and reduced prevalence of neonatal anaemia, without demonstrable adverse effects. As iron deficiency in infants even without anaemia has been associated with impaired development, delayed cord clamping seems to benefit full term infants even in regions with a relatively low prevalence of iron deficiency anaemia.

  • 5.
    Andersson, Ola
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Internationell mödra- och barnhälsovård (IMCH). Department of Research and Development, Region Halland, Sweden.
    Hellström-Westas, Lena
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik.
    Domellöf, Magnus
    Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden.
    Elective caesarean: does delay in cord clamping for 30 s ensure sufficient iron stores at 4 months of age? A historical cohort control study2016Inngår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, nr 11, artikkel-id e012995Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To compare iron stores in infants born after elective caesarean section (CS) and a 30 s delay of umbilical cord clamping with those born vaginally after early (≤10 s) or delayed (≥180 s) cord clamping.

    DESIGN: Prospective observational study with historical control.

    SETTING: Swedish county hospital.

    POPULATION: 64 infants born after elective CS were compared with a historical control of 166 early clamped and 168 delayed clamped after vaginal birth.

    METHODS: Blood and iron status were measured in blood samples collected at birth, 48-96 hours after birth, 4 and 12 months of age.

    PRIMARY AND SECONDARY OUTCOME MEASURES: Ferritin at 4 months of age was the primary outcome, second outcome measures were other indicators of iron status, and haemoglobin, at 4 and 12 months of age, as well as respiratory distress at 1 and 6 hours after birth.

    RESULTS: At 4 months infants born by elective CS had better iron status than those born vaginally subjected to early cord clamping, shown by higher adjusted mean difference of ferritin concentration (39 µg/L (95% CI 10 to 60)) and mean cell volume (1.8 fL (95% CI 0.6 to 3.0)); and lower levels of transferrin receptors (-0.39 mg/L (95% CI -0.69 to -0.08)). No differences were seen between infants born after elective CS and delayed clamped vaginally born infants at 4 months. No differences were found between groups at 12 months of age.

    CONCLUSIONS: Waiting to clamp the umbilical cord for 30 s after elective CS results in higher iron stores at 4 months of age compared with early cord clamping after vaginal birth, and seems to ensure iron status comparable with those achieved after 180 s delayed cord clamping after vaginal birth.

  • 6.
    Andersson, Ola
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik.
    Lindquist, Barbro
    Hosp Halland, Habilitat Ctr, Halmstad, Sweden..
    Lindgren, Magnus
    Lund Univ, Dept Psychol, Lund, Sweden..
    Stjernqvist, Karin
    Lund Univ, Dept Psychol, Lund, Sweden..
    Domellof, Magnus
    Umea Univ, Dept Clin Sci, Pediat Unit, Umea, Sweden..
    Hellström-Westas, Lena
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik.
    Effect of Delayed Cord Clamping on Neurodevelopment at 4 Years of Age A Randomized Clinical Trial2015Inngår i: JAMA pediatrics, ISSN 2168-6203, E-ISSN 2168-6211, Vol. 169, nr 7, s. 631-638Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    IMPORTANCE Prevention of iron deficiency in infancy may promote neurodevelopment. Delayuci umbilical cord clamping (CC) prevents iron deficiency at 4 to 6 months of age, but long-term effects after 12 months of age have not been reported. OBJECTIVE To investigate the effects of delayed CC compared with early CC on neurodevelopment at 4 years of age. DESIGN, SETTING, AND PARTICIPANTS Follow-up of a randomized clinical trial conducted from April 16, 2008, through May 21, 2010, at a Swedish county hospital. Children who were included in the original study (n = 382) as full-term infants born after a low-risk pregnancy were invited to return for follow-up at 4 years of age. Wechsler Preschool and Primary Scale of Intelligence (WPPSI-111) and Movement Assessment Battery for Children (Movement ABC) scores (collected between April 18, 2012, and July 5, 2013) were assessed by a blinded psychologist. Between April 11, 2012, and August 13, 2013, parents recorded their child's development using the Ages and Stages Questionnaire, Third Edition (ASQ) and behavior using the Strengths and Difficulties Questionnaire. All data were analyzed by intention to treat. INTERVENTIONS Randomization to delayed CC (>= 180 seconds after delivery) or early CC (<= 10 seconds after delivery). MAIN OUTCOMES AND MEASURES The main outcome was full-scale IQ as assessed by the were development as assessed by the scales from the WPPSI-III and Movement ABC, development as recorded using the ASQ, and behavior using the Strengths and Difficulties Questionnaire. RESULTS We assessed 263 children (68.8%). No differences were found in WPPSI-III scores between groups. Delayed CC improved the adjusted mean differences (AMDs) in the ASQ personal-social (AMD, 2.8; 95% Cl, 0.8-4.7) and fine-motor (AMD, 2.1; 95% Cl, 0.2-4.0) domains and the Strengths and Difficulties Questionnaire prosocial subscale (AMD, 0.5; 95% Cl, >0.0-0.9). Fewer children in the delayed-CC group had results below the cutoff in the ASQ fine-motor domain (11.0% vs 3.7%; P =.02) and the Movement ABC bicycle-trail task (12.9% vs 3.8%; P =.02). Boys who received delayed CC had significantly higher AMDs in the WPPSI-III processing-speed quotient (AMD, 4.2; 95% Cl, 0.8-7.6; P =.02), Movement ABC bicycle-trail task (AMD, 0.8; 95% Cl, 0.1-1.5; P =.03), and fine-motor (AMD, 4.7; 95% Cl, 1.0-8.4; P =.01) and personal-social (AMD, 4.9; 95% Cl, 1.6-8.3; P =.004) domains of the ASQ. CONCLUSIONS AND RELEVANCE Delayed CC compared with early CC improved scores in the fine-motor at 4 years of age, especially in boys, indicating that optimizing the time to CC may affect neurodevelopment in a low-risk population of children born in a high-income country.

  • 7.
    Askelöf, Ulrica
    et al.
    Karolinska Inst, Div Obstet & Gynecol, Dept Clin Sci Intervent & Technol, Stockholm, Sweden.;Sahlgrens Univ Hosp, Swedish Natl Umbil Cord Blood Bank, Gothenburg, Sweden..
    Andersson, Ola
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Internationell mödra- och barnhälsovård (IMCH).
    Domellöf, Magnus
    Umea Univ, Dept Clin Sci, Unit Pediat, Umea, Sweden..
    Fasth, Anders
    Sahlgrens Univ Hosp, Swedish Natl Umbil Cord Blood Bank, Gothenburg, Sweden.;Univ Gothenburg, Inst Clin Sci, Dept Pediat, Gothenburg, Sweden..
    Hallberg, Boubou
    Karolinska Inst, CLINTEC, Dept Neonatol, Stockholm, Sweden.;Univ Hosp, Stockholm, Sweden..
    Hellström-Westas, Lena
    Uppsala 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.
    Pettersson, Karin
    Karolinska Inst, Div Obstet & Gynecol, Dept Clin Sci Intervent & Technol, Stockholm, Sweden.;Sahlgrens Univ Hosp, Swedish Natl Umbil Cord Blood Bank, Gothenburg, Sweden..
    Westgren, Magnus
    Karolinska Inst, Div Obstet & Gynecol, Dept Clin Sci Intervent & Technol, Stockholm, Sweden.;Sahlgrens Univ Hosp, Swedish Natl Umbil Cord Blood Bank, Gothenburg, Sweden..
    Wiklund, Ingela E.
    Danderyd Hosp, Dept Clin Sci, Stockholm, Sweden..
    Gotherstrom, Cecilia
    Karolinska Inst, Div Obstet & Gynecol, Dept Clin Sci Intervent & Technol, Stockholm, Sweden.;Sahlgrens Univ Hosp, Swedish Natl Umbil Cord Blood Bank, Gothenburg, Sweden.;Karolinska Inst, Ctr Hematol & Regenerat Med, Stockholm, Sweden..
    Wait a minute?: An observational cohort study comparing iron stores in healthy Swedish infants at 4 months of age after 10-, 60-and 180-second umbilical cord clamping2017Inngår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, nr 12, artikkel-id e017215Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

    Design: Prospective observational study with two historical controls.

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

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

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

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

  • 8.
    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)2010Inngår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 99, nr 7, s. 978-992Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 9.
    Bengtsson, Jörgen
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Farmaceutiska fakulteten, Institutionen för farmaceutisk biovetenskap.
    Ederoth, P
    Ley, D
    Hansson, S
    Amer-Wåhlin, I
    Hellström-Westas, Lena
    Marsál, K
    Nordström, C-H
    Hammarlund-Udenaes, Margareta
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Farmaceutiska fakulteten, Institutionen för farmaceutisk biovetenskap.
    The influence of age on the distribution of morphine and morphine-3-glucuronide across the blood-brain barrier in sheep2009Inngår i: British Journal of Pharmacology, ISSN 0007-1188, E-ISSN 1476-5381, Vol. 157, nr 6, s. 1085-1096Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background and purpose

     The effect of age on the distribution of morphine and morphine-3-glucuronide (M3G) across the blood-brain barrier (BBB) was studied in a sheep model utilizing intracerebral microdialysis. The effect of neonatal asphyxia on brain drug distribution was also studied.

    Experimental approach

     Microdialysis probes were inserted into the cortex, striatum and blood of 11 lambs (127 gestation days) and six ewes. Morphine, 1 mg.kg(-1), was intravenously administered as a 10 min constant infusion. Microdialysis and blood samples were collected for up to 360 min and analysed using liquid chromatography-tandem mass spectrometry. The half-life, clearance, volume of distribution, unbound drug brain : blood distribution ratio (K(p,uu)) and unbound drug volume of distribution in brain (V(u,brain)) were estimated.

     Key results

     Morphine K(p,uu) was 1.19 and 1.89 for the sheep and premature lambs, respectively, indicating that active influx into the brain decreases with age. Induced asphyxia did not affect transport of morphine or M3G across the BBB. Morphine V(u,brain) measurements were higher in sheep than in premature lambs. The M3G K(p,uu) values were 0.27 and 0.17 in sheep and premature lambs, indicating a net efflux from the brain in both groups.

    Conclusions and implications

     The morphine K(p,uu) was above unity, indicating active transport into the brain; influx was significantly higher in premature lambs than in adult sheep. These results in sheep differ from those in humans, rats, mice and pigs where a net efflux of morphine from the brain is observed.

  • 10.
    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 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. Univ Hosp, Neonatal Intens Care Unit, Uppsala, Sweden.
    Ågren, Johan
    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. Univ Hosp, Neonatal Intens Care Unit, Uppsala, Sweden.
    Thernström Blomqvist, Ylva
    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. Univ Hosp, Neonatal Intens Care Unit, Uppsala, Sweden.
    Parental participation during therapeutic hypothermia for neonatal hypoxicischemic encephalopathy2019Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 20, s. 77-80Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 11.
    Bolk, J.
    et al.
    Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden..
    Kaul, Ylva Fredriksson
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik.
    Hellström-Westas, Lena
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik.
    Stjernqvist, K.
    Lund Univ, Dept Psychol, Lund, Sweden..
    Padilla, N.
    Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden..
    Serenius, Fredrik
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik.
    Hellgren, K.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Aden, U.
    Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden..
    Visual-Motor Integration In Extremely Preterm Born Children In Sweden2016Inngår i: European Journal of Pediatrics, ISSN 0340-6199, E-ISSN 1432-1076, Vol. 175, nr 11, s. 1530-1530Artikkel i tidsskrift (Fagfellevurdert)
  • 12.
    Bolk, Jenny
    et al.
    Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden;Sachs Children & Youth Hosp, Stockholm, Sweden.
    Kaul, Ylva Fredriksson
    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.
    Hellström-Westas, Lena
    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.
    Stjernqvist, Karin
    Lund Univ, Dept Psychol, Div Dev Psychol, Lund, Sweden.
    Padilla, Nelly
    Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden.
    Serenius, Fredrik
    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. Univ Umeå, Pediat, Inst Clin Sci, Umeå, Sweden.
    Hellgren, Kerstin
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden.
    Åden, Ulrika
    Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden.
    National population-based cohort study found that visual-motor integration was commonly affected in extremely preterm born children at six-and-a-half years2018Inngår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 107, nr 5, s. 831-837Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim: This study aimed to explain the relationship between visual‐motor integration (VMI) abilities and extremely preterm (EPT) birth, by exploring the influence of perinatal variables, cognition, manual dexterity and ophthalmological outcomes.

    Methods: This was part of the population‐based national Extremely Preterm Infant Study in Sweden (EXPRESS) study. We studied 355 children, born at a gestational age of <27 weeks from April 2004 to March 2007, and 364 term‐born controls. At six‐and‐a‐half years of age, we assessed VMI, cognitive function, motor skills and vision. VMI impairment was classified as <−1 standard deviation (SD).

    Results: The mean (SD) VMI score was 87 (±12) in preterm children compared to 98 (±11) in controls (p < 0.001). VMI impairment was present in 55% of preterm infants and in 78% of children born at 22–23 weeks. Male sex and postnatal steroids showed a weak association with poorer visual‐motor performance, whereas low manual dexterity and cognitive function showed a stronger association.

    Conclusion: Poor VMI performance was common in this EXPRESS cohort of children born EPT. Its strong association to cognition and manual dexterity confirms that all of these factors need to be taken into account when evaluating risks in preterm born children.

  • 13.
    Ericson, Jenny
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik.
    Eriksson, Mats
    Hellström-Westas, Lena
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik.
    Hagberg, Lars
    Hoddinott, Pat
    Flacking, Renée
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik.
    The effectiveness of proactive telephone support provided to breastfeeding mothers of preterm infants: study protocol for a randomized controlled trial2013Inngår i: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 13, s. 73-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Although breast milk has numerous benefits for infants' development, with greater effects in those born preterm (at < 37 gestational weeks), mothers of preterm infants have shorter breastfeeding duration than mothers of term infants. One of the explanations proposed is the difficulties in the transition from a Neonatal Intensive Care Unit (NICU) to the home environment. A person-centred proactive telephone support intervention after discharge from NICU is expected to promote mothers' sense of trust in their own capacity and thereby facilitate breastfeeding. Methods/design: A multicentre randomized controlled trial has been designed to evaluate the effectiveness and cost-effectiveness of person-centred proactive telephone support on breastfeeding outcomes for mothers of preterm infants. Participating mothers will be randomized to either an intervention group or control group. In the intervention group person-centred proactive telephone support will be provided, in which the support team phones the mother daily for up to 14 days after hospital discharge. In the control group, mothers are offered a person-centred reactive support where mothers can phone the breastfeeding support team up to day 14 after hospital discharge. The intervention group will also be offered the same reactive telephone support as the control group. A stratified block randomization will be used; group allocation will be by high or low socioeconomic status and by NICU. Recruitment will be performed continuously until 1116 mothers (I: 558 C: 558) have been included. Primary outcome: proportion of mothers exclusively breastfeeding at eight weeks after discharge. Secondary outcomes: proportion of breastfeeding (exclusive, partial, none and method of feeding), mothers satisfaction with breastfeeding, attachment, stress and quality of life in mothers/partners at eight weeks after hospital discharge and at six months postnatal age. Data will be collected by researchers blind to group allocation for the primary outcome. A qualitative evaluation of experiences of receiving/providing the intervention will also be undertaken with mothers and staff. Discussion: This paper presents the rationale, study design and protocol for a RCT providing person-centred proactive telephone support to mothers of preterm infants. Furthermore, with a health economic evaluation, the cost-effectiveness of the intervention will be assessed. Trial registration: NCT01806480

  • 14.
    Ericson, Jenny
    et al.
    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. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning Dalarna.
    Eriksson, Mats
    Örebro Universitet.
    Hellström-Westas, Lena
    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.
    Hoddinott, Pat
    University of Stirling, Stirling, Scotland.
    Flacking, Renée
    Högskolan Dalarna.
    Proactive telephone support provided to breastfeeding mothers of preterm infants after discharge: a randomised controlled trial2018Inngår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 107, nr 5, s. 791-798Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim: The aim was to evaluate the effectiveness of proactive telephone support provided to breastfeeding mothers of preterm infants after discharge from neonatal intensive care units (NICU).

    Methods: Between March 2013 and December 2015, a randomised controlled trial was conducted at six NICUs across Sweden. At each NICU, a breastfeeding support team recruited, randomised and delivered the support to participating mothers. The intervention group received a daily proactive telephone call up to 14 days after discharge from the support team. The control group could initiate telephone contact themselves. Primary outcome was exclusive breastfeeding eight weeks after discharge. Secondary outcomes were maternal satisfaction with breastfeeding, attachment, quality of life and parental stress.

    Results: In total, 493 mothers were randomised, 231 to intervention group and 262 to control group. There were no differences between the groups for exclusive breastfeeding, odds ratio 0.96, 95% CI 0.66–1.38, nor for maternal satisfaction with breastfeeding, attachment or quality of life. The intervention group reported significantly less parental stress than the controls, t = 2.44, 95% CI 0.03–0.23, effect size d = 0.26.

    Conclusion: In this trial, proactive telephone support was not associated with increased exclusive breastfeeding prevalence eight weeks following discharge. However, intervention group mothers showed significantly lower parental stress.

  • 15.
    Ericson, Jenny
    et al.
    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. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning Dalarna. Falun Hospital; Dalarna Univ, Sch Educ Hlth & Social Studies, Falun, Sweden.
    Eriksson, Mats
    Orebro Univ, Fac Med & Hlth, Sch Hlth Sci, Orebro, Sweden.
    Hoddinott, Pat
    Univ Stirling, Nursing Midwifery & Allied Hlth Profess Res Unit, Stirling, Scotland.
    Hellström-Westas, Lena
    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. U.
    Flacking, Renee
    Dalarna Univ, Sch Educ Hlth & Social Studies, Falun, Sweden.
    Breastfeeding and risk for ceasing in mothers of preterm infants-Long-term follow-up2018Inngår i: Maternal and Child Nutrition, ISSN 1740-8695, E-ISSN 1740-8709, Vol. 14, nr 4, artikkel-id e12618Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Breastfeeding is challenging for mothers of preterm infants. The aim of this paper is to describe risk factors for ceasing breastfeeding and methods of feeding until 12 months postnatal age in mothers who breastfed their preterm infants at discharge from neonatal intensive care units (NICUs). The data come from a randomised controlled trial, which evaluated the effectiveness on exclusive breastfeeding at 8 weeks of proactive telephone support compared with reactive support offered to mothers of preterm infants following discharge from NICU. Six NICUs across Sweden randomised a total of 493 mothers. We used regression and survival analyses to assess the risk factors for ceasing breastfeeding and the long-term outcomes of the intervention. The results showed that 305 (64%) of the infants were breastfed at 6 months and 49 (21%) at 12 months. Partial breastfeeding at discharge, low maternal educational level, and longer length of stay in the NICU increased the risk for ceasing breastfeeding during the first 12 months. Furthermore, the Kaplan-Meier analysis showed that the proportion of mothers who ceased breastfeeding did not differ between the intervention (n = 231) and controls (n = 262) during the first 12 months (log-rank test p = .68). No difference was found between groups on method of feeding. More than 85% of the infants were fed directly at the breast. These findings provide important insights for health professionals who are supporting mothers of preterm infants to breastfeed long term.

  • 16.
    Ericson, Jenny
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik. Ctr Clin Res Dalarna, Falun, Sweden.;Falun Cent Hosp, Dept Pediat, Falun, Sweden..
    Flacking, Renee
    Dalarna Univ, Sch Educ Hlth & Social Studies, Falun, Sweden..
    Hellström-Westas, Lena
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik.
    Eriksson, Mats
    Univ Orebro, Sch Hlth Sci, Fac Med & Hlth, Orebro, Sweden..
    Changes in the prevalence of breast feeding in preterm infants discharged from neonatal units: a register study over 10 years2016Inngår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, nr 12, artikkel-id e012900Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: There are indications that the prevalence of exclusively breastfed preterm infants is decreasing in Sweden. The objective was to investigate trends in exclusive breast feeding at discharge from Swedish neonatal units and associated factors in preterm infants. Design, setting and participants: This is a register study with data from the Swedish Neonatal Quality Register. Data from 29 445 preterm infants (gestational age (GA) < 37 weeks) who were born during the period 2004-2013 were retrieved. Data included maternal, perinatal and neonatal characteristics. Data were analysed for the whole population as well as for 3 GA groups. Results: From 2004 to 2013, the prevalence of exclusive breast feeding decreased, in extremely preterm (GA 22-27 weeks) from 55% to 16%, in very preterm (GA 28-31 weeks) from 41% to 34% and in moderately preterm infants (GA 32-36 weeks) from 64% to 49%. The decline was statistically significant (p<0.001) in all 3 GA groups. This decline remained significant when adjustments were made for factors negatively associated with exclusive breast feeding and which became more prevalent during the study period, that is, small for GA (all groups) and maternal mental illness (very preterm and moderately preterm infants). Conclusions: In the past 10 years, Sweden has experienced a lower rate of exclusive breast feeding in preterm infants, especially in extremely preterm infants. The factors analysed in this study explain only a small proportion of this decline. The decline in exclusive breast feeding at discharge from neonatal units raises concern and present challenges to the units to support and promote breast feeding.

  • 17. Griesmaier, Elke
    et al.
    Enot, David Pierre
    Bachmann, Miriam
    Neubauer, Vera
    Hellström-Westas, Lena
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik.
    Kiechl-Kohlendorfer, Ursula
    Keller, Matthias
    Systematic characterization of amplitude-integrated EEG signals for monitoring the preterm brain2013Inngår i: Pediatric Research, ISSN 0031-3998, E-ISSN 1530-0447, Vol. 73, nr 2, s. 226-235Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: In preterm infants, the amplitude-integrated electroencephalogram (aEEG) is not established in clinical routine. The aim of this study was to derive normative data on aEEG parameters by means of longitudinal characterization and to evaluate the impact of gestational age (GA), postnatal age (PNA), postmenstrual age, sedation, and patent ductus arteriosus (PDA). METHODS: Recordings from 61 infants with GA 28-31 weeks were obtained during the first 72 h, then weekly until the age of 4 wk. Infants were divided into three groups: (i) no sedation, no PDA, (ii) sedation, no PDA, and (iii) sedation, PDA. Assessed parameters included background activity, cycling, amplitude, and log ratio of the maximum/minimum amplitude. RESULTS: GA and PNA had a significant impact within 72h. Sedation modified aEEG, and presence of PDA was associated with reduced aEEG scores within 72 h. The log ratio of the amplitude correlated with GA but was unaffected by sedation and PDA. CONCLUSION: Evaluation of electrocortical background activity within the first postnatal hours and longitudinally over days and weeks is important to better understand the postnatal factors impacting cerebral function in preterm infants. There is a need to agree on definitions and a standardized reporting system in order to permit comparisons between studies and establish aEEG as a method for routine monitoring of preterm infants.

  • 18. Hansen Pupp, Ingrid
    et al.
    Hövel, Holger
    Hellström, Ann
    Hellström-Westas, Lena
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik.
    Löfqvist, Chatarina
    Larsson, Elna-Marie
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för radiologi, onkologi och strålningsvetenskap, Enheten för radiologi.
    Lazeyras, Francois
    Fellman, Vineta
    Hüppi, Petra S.
    Ley, David
    Postnatal decrease in circulating insulin-like growth factor-I and low brain volumes in very preterm infants2011Inngår i: Journal of Clinical Endocrinology and Metabolism, ISSN 0021-972X, E-ISSN 1945-7197, Vol. 96, nr 4, s. 1129-1135Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Context: IGF-I and IGF binding protein-3 (IGFBP-3) are essential for growth and maturation of the developing brain. Objective: The aim of this study was to evaluate the association between postnatal serum concentrations of IGF-I and IGFBP-3 and brain volumes at term in very preterm infants. Design: Fifty-one infants with a mean (sd) gestational age (GA) of 26.4 (1.9) wk and birth weight (BW) of 888 (288) g were studied, with weekly blood sampling of IGF-I and IGFBP-3 from birth until 35 gestational weeks (GW) and daily calculation of protein and caloric intake. Magnetic resonance images obtained at 40 GW were segmented into total brain, cerebellar, cerebrospinal fluid, gray matter, and unmyelinated white matter volumes. Main Outcome Measures: We evaluated brain growth by measuring brain volumes using magnetic resonance imaging. Results: Mean IGF-I concentrations from birth to 35 GW correlated with total brain volume, unmyelinated white matter volume, gray matter volume, and cerebellar volume [r = 0.55 (P < 0.001); r = 0.55 (P < 0.001); r = 0.44 (P = 0.002); and r = 0.58 (P < 0.001), respectively]. Similar correlations were observed for IGFBP-3 concentrations. Correlations remained after adjustment for GA, mean protein and caloric intakes, gender, severe brain damage, and steroid treatment. Protein and caloric intakes were not related to brain volumes. Infants with BW small for GA had lower mean concentrations of IGF-I (P = 0.006) and smaller brain volumes (P = 0.001-0.013) than infants with BW appropriate for GA. Conclusion: Postnatal IGF-I and IGFBP-3 concentrations are positively associated with brain volumes at 40 GW in very preterm infants. Normalization of the IGF-I axis, directly or indirectly, may support normal brain development in very preterm infants.

  • 19. Hansen-Pupp, Ingrid
    et al.
    Hovel, Holger
    Lofqvist, Chatarina
    Hellström-Westas, Lena
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik.
    Fellman, Vineta
    Huppi, Petra S.
    Hellstrom, Ann
    Ley, David
    Circulatory insulin-like growth factor-I and brain volumes in relation to neurodevelopmental outcome in very preterm infants2013Inngår i: Pediatric Research, ISSN 0031-3998, E-ISSN 1530-0447, Vol. 74, nr 5, s. 564-569Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: To evaluate the relationships between postnatal change in circulatory insulin-like growth factor-I (IGF-I) concentrations, brain volumes, and developmental outcome at 2 y of age in very preterm infants. METHODS: IGF-I was measured weekly, and nutritional intake was calculated daily from birth until a postmenstrual age (PMA) of 35 wk. Individual beta coefficients for IGF-I, IGF-I(B), representing the rate of increase in IGF-I from birth until a PMA of 35 wk were calculated. Brain magnetic resonance imaging was performed at term age, with segmentation into total brain, cerebellar, gray matter, and unmyelinated white matter volume (UWMV). Developmental outcome was evaluated using Bayley Scales of Infant Development-II. RESULTS: Forty-nine infants, with mean gestational age (GA) of 26.0 wk, were evaluated at mean 24.6 mo corrected age. Higher IGF-I(B), UWMV, and cerebellar volume were associated with a decreased risk for a Mental Developmental Index (MDI) <85 (odds ratio (95% confidence interval): 0.6 (0.4-0.9), 0.96 (0.94-0.99), and 0.78 (0.6-0.96), respectively). In multivariate analysis, higher IGF-I(B) and higher UWMV combined with female gender constituted the two models with the highest predictive value for MDI > 85. CONCLUSION: A higher rate of increase in circulating IGF-I is associated with a decreased risk for subnormal MDI at 2 y of corrected age. This relationship is in part dependent on brain volume at term age.

  • 20. Heinemann, Ann-Britt
    et al.
    Hellström-Westas, Lena
    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, Pediatrik.
    Factors affecting parents' presence with their extremely preterm infants in a neonatal intensive care room2013Inngår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 102, nr 7, s. 695-702Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim To describe parents' experiences of factors that influenced their stay with their extremely preterm infants in a neonatal intensive care unit (NICU). Methods This study has a qualitative descriptive design based on semistructured interviews conducted with seven mothers and six fathers. Results Opportunities to stay overnight together with their infant facilitated parental presence, and opportunities for taking over their infant's care empowered the parents in their parental role and increased their motivation to stay. Kangaroo mother care helped them to feel in control and feel needed, which increased their presence. High levels of illumination and noise rendered it difficult for parents to sleep and stay overnight with the infant. Low staffing levels limited their use of kangaroo mother care when they had to wait for assistance to transfer the infant from the incubator. Several participants perceived the performance of painful procedures on their child as stressful and as an obstacle to their presence. Conclusion Kangaroo mother care and active involvement in the infant's care gave parents a sense of control and strengthened their motivation to be with their infant. High levels of noise and illumination and a dismissive staff attitude were obstacles to parents' presence.

  • 21.
    Hellström-Westas, Lena
    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. Univ Hosp, SE-75185 Uppsala, Sweden.
    Amplitude-integrated electroencephalography for seizure detection in newborn infants2018Inngår i: Seminars in Fetal & Neonatal Medicine, ISSN 1744-165X, E-ISSN 1878-0946, Vol. 23, nr 3, s. 175-182Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The amplitude-integrated electroencephalogram (aEEG) is a filtered and compressed EEG trend that can be used for long-term monitoring of brain function in patients of all ages. aEEG is increasingly used in neonatal intensive care units since several studies have shown its utility in high-risk newborn infants. Main indications for aEEG monitoring include early evaluation of brain function after perinatal asphyxia and seizure detection. The aEEG is usually recorded from one or two channels derived from parietal, central, or frontal leads. Although the aEEG is very useful for identifying high-risk infants and infants with seizures, the compressed trend has limitations with regards to detection of individual seizures. However, modern monitors also display the corresponding EEG (aEEG/EEG), which increases the probability of detecting single brief seizures. For improved evaluation of electrocortical brain activity the aEEG/EEG should be assessed together with repeated conventional EEGs or multi-channel EEG monitoring in a multi-disciplinary team.

  • 22.
    Hellström-Westas, Lena
    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.
    Amplitude-integrated electroencephalography for seizure detection in newborn infants2018Inngår i: Seminars in Fetal & Neonatal Medicine, ISSN 1744-165X, E-ISSN 1878-0946, Vol. 23, nr 3, s. 175-182Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The amplitude-integrated electroencephalogram (aEEG) is a filtered and compressed EEG trend that can be used for long-term monitoring of brain function in patients of all ages. aEEG is increasingly used in neonatal intensive care units since several studies have shown its utility in high-risk newborn infants. Main indications for aEEG monitoring include early evaluation of brain function after perinatal asphyxia and seizure detection. The aEEG is usually recorded from one or two channels derived from parietal, central, or frontal leads. Although the aEEG is very useful for identifying high-risk infants and infants with seizures, the compressed trend has limitations with regards to detection of individual seizures. However, modern monitors also display the corresponding EEG (aEEG/EEG), which increases the probability of detecting single brief seizures. For improved evaluation of electrocortical brain activity the aEEG/EEG should be assessed together with repeated conventional EEGs or multi-channel EEG monitoring in a multi-disciplinary team. (C) 2018 Elsevier Ltd. All rights reserved.

  • 23.
    Hellström-Westas, Lena
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik.
    Monitoring brain function with aEEG in term asphyxiated infants before and during cooling2013Inngår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 102, nr 7, s. 678-679Artikkel i tidsskrift (Fagfellevurdert)
  • 24.
    Hellström-Westas, Lena
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.