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Vandenplas, Y., Broekaert, I., Domellöf, M., Indrio, F., Lapillonne, A., Pienar, C., . . . West, C. E. (2024). An ESPGHAN position paper on the diagnosis, management, and prevention of cow's milk allergy. Journal of Pediatric Gastroenterology and Nutrition - JPGN, 78(2), 386-413
Open this publication in new window or tab >>An ESPGHAN position paper on the diagnosis, management, and prevention of cow's milk allergy
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2024 (English)In: Journal of Pediatric Gastroenterology and Nutrition - JPGN, ISSN 0277-2116, E-ISSN 1536-4801, Vol. 78, no 2, p. 386-413Article in journal (Refereed) Published
Abstract [en]

A previous guideline on cow's milk allergy (CMA) developed by the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) was published in 2012. This position paper provides an update on the diagnosis, treatment, and prevention of CMA with focus on gastrointestinal manifestations. All systematic reviews and meta-analyses regarding prevalence, pathophysiology, symptoms, and diagnosis of CMA published after the previous ESPGHAN document were considered. Medline was searched from inception until May 2022 for topics that were not covered in the previous document. After reaching consensus on the manuscript, statements were formulated and voted on each of them with a score between 0 and 9. A score of ≥6 was arbitrarily considered as agreement. Available evidence on the role of dietary practice in the prevention, diagnosis, and management of CMA was updated and recommendations formulated. CMA in exclusively breastfed infants exists, but is uncommon and suffers from over-diagnosis. CMA is also over-diagnosed in formula and mixed fed infants. Changes in stool characteristics, feeding aversion, or occasional spots of blood in stool are common and in general should not be considered as diagnostic of CMA, irrespective of preceding consumption of cow's milk. Over-diagnosis of CMA occurs much more frequently than under-diagnosis; both have potentially harmful consequences. Therefore, the necessity of a challenge test after a short diagnostic elimination diet of 2–4 weeks is recommended as the cornerstone of the diagnosis. This position paper contains sections on nutrition, growth, cost, and quality of life.

Place, publisher, year, edition, pages
John Wiley & Sons, 2024
Keywords
amino acid formula, breastfeeding, CMA, diagnosis, disorder of gut-brain interaction
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:umu:diva-222675 (URN)10.1097/MPG.0000000000003897 (DOI)001174784400006 ()37491714 (PubMedID)2-s2.0-85166778800 (Scopus ID)
Available from: 2024-04-11 Created: 2024-04-11 Last updated: 2024-04-11Bibliographically approved
Moltu, S. J., Nordvik, T., Rossholt, M. E., Wendel, K., Chawla, M., Server, A., . . . Pfeiffer, H. (2024). Arachidonic and docosahexaenoic acid supplementation and brain maturation in preterm infants: a double blind RCT. Clinical Nutrition, 43(1), 176-186
Open this publication in new window or tab >>Arachidonic and docosahexaenoic acid supplementation and brain maturation in preterm infants: a double blind RCT
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2024 (English)In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 43, no 1, p. 176-186Article in journal (Refereed) Published
Abstract [en]

Background: Arachidonic acid (ARA) and docosahexaenoic acid (DHA) are important structural components of neural cellular membranes and possess anti-inflammatory properties. Very preterm infants are deprived of the enhanced placental supply of these fatty acids, but the benefit of postnatal supplementation on brain development is uncertain. The aim of this study was to test the hypothesis that early enteral supplementation with ARA and DHA in preterm infants improves white matter (WM) microstructure assessed by diffusion-weighted MRI at term equivalent age.

Methods: In this double-blind, randomized controlled trial, infants born before 29 weeks gestational age were allocated to either 100 mg/kg ARA and 50 mg/kg DHA (ARA:DHA group) or medium chain triglycerides (control). Supplements were started on the second day of life and provided until 36 weeks postmenstrual age. The primary outcome was brain maturation assessed by diffusion tensor imaging (DTI) using Tract-Based Spatial Statistics (TBSS) analysis.

Results: We included 120 infants (60 per group) in the trial; mean (range) gestational age was 26+3 (22+6 - 28+6) weeks and postmenstrual age at scan was 41+3 (39+1 - 47+0) weeks. Ninety-two infants underwent MRI imaging, and of these, 90 had successful T1/T2 weighted MR images and 74 had DTI data of acceptable quality. TBSS did not show significant differences in mean or axial diffusivity between the groups, but demonstrated significantly higher fractional anisotropy in several large WM tracts in the ARA:DHA group, including corpus callosum, the anterior and posterior limb of the internal capsula, inferior occipitofrontal fasciculus, uncinate fasciculus, and the inferior longitudinal fasciculus. Radial diffusivity was also significantly lower in several of the same WM tracts in the ARA:DHA group.

Conclusion: This study suggests that supplementation with ARA and DHA at doses matching estimated fetal accretion rates improves WM maturation compared to control treatment, but further studies are needed to ascertain any functional benefit.

Clinical trial registration: www.clinicaltrials.gov; ID:NCT03555019.

Place, publisher, year, edition, pages
Elsevier, 2024
Keywords
Arachidonic acid, Brain, Docosahexaenoic acid, Fatty acid supplementation, Neurodevelopment, Preterm
National Category
Pediatrics
Identifiers
urn:nbn:se:umu:diva-218310 (URN)10.1016/j.clnu.2023.11.037 (DOI)2-s2.0-85179437525 (Scopus ID)
Funder
The Research Council of NorwaySwedish Research Council
Available from: 2023-12-21 Created: 2023-12-21 Last updated: 2023-12-21Bibliographically approved
Jensen, G. B., Domellöf, M., Ahlsson, F., Elfvin, A., Navér, L. & Abrahamsson, T. (2024). Effect of human milk-based fortification in extremely preterm infants fed exclusively with breast milk: a randomised controlled trial. eClinicalMedicine, 68, Article ID 102375.
Open this publication in new window or tab >>Effect of human milk-based fortification in extremely preterm infants fed exclusively with breast milk: a randomised controlled trial
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2024 (English)In: eClinicalMedicine, E-ISSN 2589-5370, Vol. 68, article id 102375Article in journal (Refereed) Published
Abstract [en]

Background: Mortality and severe morbidity remain high in extremely preterm infants. Human milk-based nutrient fortifiers may prevent serious complications and death. We aimed to investigate whether supplementation with human milk-based fortifier (HMBF), as compared to bovine milk-based fortifier (BMBF), reduced the incidence of the composite outcome of necrotising enterocolitis (NEC), sepsis, and mortality in extremely preterm infants exclusively fed human milk.

Methods: In this multicentre, randomised controlled trial at 24 neonatal units in Sweden, extremely preterm infants born between gestational week 22 + 0 and 27 + 6 fed exclusively human breast milk (mother's own and/or donor milk), were randomly assigned (1:1) to receive targeted fortification with either HMBF or BMBF. Randomisation was conducted before the enteral feeds reached 100 mL/kg/day, and was stratified by enrolment site, gestational age, singleton/twin, and sex. The allocation was concealed before inclusion, but after randomisation the study was not blinded for the clinical staff. For the NEC diagnosis, the study group was masked to an independent radiologist, and the final assessment of NEC and culture-proven sepsis was done by a blinded consensus panel review. The primary outcome was the composite of NEC stage II–III, culture-proven sepsis, and mortality from inclusion to discharge, no longer than postmenstrual week 44 + 0, in the intention-to-treat population (ClinicalTrials.gov, NCT03797157).

Findings: Between February 21st, 2019, and May 21st, 2021, 229 neonates were randomly assigned (115 HMBF, 114 BMBF). After exclusion of one infant due to parents’ withdrawal of consent, 228 infants were included in the intention-to-treat analysis. Of the 115 infants assigned to HMBF, 41 (35.7%) fulfilled the criteria of either NEC, sepsis, or death, compared with 39 (34.5%) of 113 infants assigned to BMBF (OR 1.05, 95% CI 0.61–1.81, p = 0.86). Adverse events did not differ significantly between groups.

Interpretation: Supplementation with HMBF, as compared with BMBF, did not reduce the incidence of the composite outcome of NEC, sepsis, or death. Our results do not support routine supplementation with HMBF as a nutritional strategy to prevent NEC, sepsis, or death in extremely preterm infants exclusively fed human milk. Funding: ALF grant, Prolacta Bioscience, Swedish Research Council, and Research Council for Southeast Sweden.

Place, publisher, year, edition, pages
Elsevier, 2024
Keywords
Breast milk, Necrotising enterocolitis, Nutrient fortifier, Nutrition, Preterm infant, Sepsis
National Category
Pediatrics
Identifiers
urn:nbn:se:umu:diva-221554 (URN)10.1016/j.eclinm.2023.102375 (DOI)2-s2.0-85185336024 (Scopus ID)
Funder
Swedish Research Council, 2019-01005Swedish Research Council, 2020-01111Medical Research Council of Southeast Sweden (FORSS)
Available from: 2024-03-06 Created: 2024-03-06 Last updated: 2024-03-06Bibliographically approved
Svensson, L., Chmielewski, G., Czyżewska, E., Domellöf, M., Konarska, Z., Pieścik-Lech, M., . . . Chmielewska, A. (2024). Effect of low-dose iron supplementation on early development in breastfed infants: a randomized clinical trial. JAMA pediatrics
Open this publication in new window or tab >>Effect of low-dose iron supplementation on early development in breastfed infants: a randomized clinical trial
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2024 (English)In: JAMA pediatrics, ISSN 2168-6203, E-ISSN 2168-6211Article in journal (Refereed) Epub ahead of print
Abstract [en]

Importance: Breastfed infants are at risk of iron deficiency, which is associated with suboptimal development. There is a paucity of evidence on the effects of iron supplementation on child development, and current guidelines are divergent.

Objective: To assess whether daily iron supplementation, 1 mg/kg, between 4 and 9 months in exclusively or predominantly breastfed infants improves psychomotor development at 12 months.

Design, Setting, and Participants: This was a randomized, double-blind, placebo-controlled trial conducted between December 2015 and May 2020 with follow-up through May 2023 in an outpatient setting in Poland and Sweden. Participants were healthy singleton infants born at term with birth weight greater than 2500 g who were exclusively or predominantly breastfed (>50%) and did not have anemia (hemoglobin >10.5 g/dL) at age 4 months. Exclusion criteria included major illness, congenital anomaly, food allergy, and difficulty communicating with caregivers.

Interventions: Iron (micronized microencapsulated ferric pyrophosphate), 1 mg/kg, or placebo (maltodextrin) once daily from age 4 to 9 months.

Main Outcomes and Measures: The primary outcome was psychomotor development assessed by motor score of Bayley Scales of Infant and Toddler Development III at 12 months, adjusted for gestational age, sex, and maternal education. Secondary outcomes included cognitive and language scores at 12 months; motor, cognitive, and language scores at 24 and 36 months; iron deficiency (serum ferritin <12 ng/mL), and iron deficiency anemia (iron deficiency and hemoglobin <10.5 g/dL) at 12 months.

Results: Of 221 randomized infants (111 female), 200 (90%) were included in the intention-to-treat analysis (mean [SD] age, 12.4 [0.8] months). Iron supplementation (n = 104) compared to placebo (n = 96) had no effect on psychomotor development (mean difference [MD] for motor score, -1.07 points; 95% CI, -4.69 to 2.55), cognitive score (MD, -1.14; 95% CI, -4.26 to 1.99), or language score (MD, 0.75; 95% CI, -2.31 to 3.82) at 12 months. There were no significant differences at 24 and 36 months. The intervention did not reduce the risk for iron deficiency (relative risk [RR], 0.46; 95% CI, 0.16 to 1.30) or iron deficiency anemia (RR, 0.78; 95% CI, 0.05 to 12.46) at 12 months.

Conclusion and Relevance: No benefit was found with daily low-dose iron supplementation between 4 and 9 months with respect to psychomotor development, risk of iron deficiency, or iron deficiency anemia among breastfed infants in a setting of low risk of anemia.

Place, publisher, year, edition, pages
American Medical Association (AMA), 2024
National Category
Pediatrics
Identifiers
urn:nbn:se:umu:diva-224848 (URN)10.1001/jamapediatrics.2024.1095 (DOI)001225475300003 ()38739382 (PubMedID)2-s2.0-85193240641 (Scopus ID)
Funder
Region Västerbotten, RV-982798Swedish Research Council, 2019-01005Swedish Society of Medicine, SLS-959720
Available from: 2024-06-11 Created: 2024-06-11 Last updated: 2024-06-11
Zamir, I., Stoltz Sjöström, E., van den Berg, J., Naumburg, E. & Domellöf, M. (2024). Insulin resistance prior to term age in very low birthweight infants: a prospective study. BMJ Paediatrics Open, 8(1), Article ID e002470.
Open this publication in new window or tab >>Insulin resistance prior to term age in very low birthweight infants: a prospective study
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2024 (English)In: BMJ Paediatrics Open, E-ISSN 2399-9772, Vol. 8, no 1, article id e002470Article in journal (Refereed) Published
Abstract [en]

Objective: To explore the glucose-related hormone profile of very low birthweight (VLBW) infants and assess the association between neonatal hyperglycaemia and insulin resistance during the admission period.

Design: A prospective observational study—the Very Low Birth Weight Infants, Glucose and Hormonal Profiles over Time study.

Setting: A tertiary neonatal intensive care unit and four neonatal units in county hospitals in Sweden.

Patients: 48 infants born <1500 g (VLBW) during 2016–2019.

Outcome measures: Plasma concentrations of glucose-related hormones and proteins (C-peptide, insulin, ghrelin, glucagon-like peptide 1 (GLP-1), glucagon, leptin, resistin and proinsulin), insulin:C-peptide and proinsulin:insulin ratios, Homoeostatic Model Assessment 2 (HOMA2) and Quantitative Insulin Sensitivity Check (QUICKI) indices, measured on day of life (DOL) 7 and at postmenstrual age 36 weeks.

Results: Lower gestational age was significantly associated with higher glucose, C-peptide, insulin, proinsulin, leptin, ghrelin, resistin and GLP-1 concentrations, increased HOMA2 index, and decreased QUICKI index and proinsulin:insulin ratio. Hyperglycaemic infants had significantly higher glucose, C-peptide, insulin, leptin and proinsulin concentrations, and lower QUICKI index, than normoglycaemic infants. Higher glucose and proinsulin concentrations and insulin:C-peptide ratio, and lower QUICKI index on DOL 7 were significantly associated with longer duration of hyperglycaemia during the admission period.

Conclusions: VLBW infants seem to have a hormone profile consistent with insulin resistance. Lower gestational age and hyperglycaemia are associated with higher concentrations of insulin resistance markers.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2024
National Category
Pediatrics
Identifiers
urn:nbn:se:umu:diva-220760 (URN)10.1136/bmjpo-2023-002470 (DOI)2-s2.0-85184815394 (Scopus ID)
Funder
Umeå UniversityRegion Västerbotten, RV-832421Region Västerbotten, RV-930256Samariten foundation for paediatric research, 2016-0221Samariten foundation for paediatric research, 2017-0275Samariten foundation for paediatric research, 2018-0450
Available from: 2024-02-12 Created: 2024-02-12 Last updated: 2024-04-24Bibliographically approved
Domellöf, M. & Sjöberg, A. (2024). Iron - a background article for the nordic nutrition recommendations 2023. Food & Nutrition Research, 68, Article ID 10451.
Open this publication in new window or tab >>Iron - a background article for the nordic nutrition recommendations 2023
2024 (English)In: Food & Nutrition Research, ISSN 1654-6628, E-ISSN 1654-661X, Vol. 68, article id 10451Article, review/survey (Refereed) Published
Abstract [en]

Iron absorption from foods is generally lower than that of most other nutrients and is highly variable depending on individual iron status and iron bioavailability in the meal. Several large population groups in the Nordic and Baltic countries are at risk of iron deficiency, including infants, young children, menstruating females, pregnant women as well as vegetarians. Iron deficiency leads to anemia, fatigue, and limited capacity for physical activity. Of particular concern is that iron deficiency anemia in young children is associated with impaired neurodevelopment. A comprehensive literature search has been performed and summarized. New factorial calculations have been performed considering iron losses, iron absorption and iron requirements in various population groups. Recent data on iron intakes and the prevalence of iron deficiency in the Nordic countries are presented. Average requirements and tentative recommended intakes are presented for 12 different population groups. Pregnant women and those with high menstrual blood losses should consume iron-rich food and undergo screening for iron deficiency. Infants should consume iron-rich complementary foods and cow’s milk should be avoided as a drink before 12 months of age and limited to < 500 mL/day in toddlers. Vegetarians should consume a diet including wholegrains, legumes, seeds, and green vegetables together with iron absorption enhancers. There is no evidence that iron intake per se increases the risk of cancer or diabetes. Iron absorption from foods is generally lower than that of most other nutrients and can vary between <2 and 50% depending on individual iron status and iron bioavailability in the meal.

Place, publisher, year, edition, pages
SNF Swedish Nutrition Foundation, 2024
Keywords
Anemia, Ferritin, Iron, Iron deficiency, Nutrition recommendations
National Category
Nutrition and Dietetics
Identifiers
urn:nbn:se:umu:diva-222340 (URN)10.29219/fnr.v68.10451 (DOI)2-s2.0-85186429945 (Scopus ID)
Available from: 2024-03-18 Created: 2024-03-18 Last updated: 2024-03-18Bibliographically approved
Domellöf, M. & Sjöberg, A. (2024). Iron: a background article for the nordic nutrition recommendations 2023. Journal of Food and Nutrition Research, 68, Article ID 10451.
Open this publication in new window or tab >>Iron: a background article for the nordic nutrition recommendations 2023
2024 (English)In: Journal of Food and Nutrition Research, ISSN 1336-8672, E-ISSN 1338-4260, Vol. 68, article id 10451Article, review/survey (Refereed) Published
Abstract [en]

Iron absorption from foods is generally lower than that of most other nutrients and is highly variable depending on individual iron status and iron bioavailability in the meal. Several large population groups in the Nordic and Baltic countries are at risk of iron deficiency, including infants, young children, menstruating females, pregnant women as well as vegetarians. Iron deficiency leads to anemia, fatigue, and limited capacity for physical activity. Of particular concern is that iron deficiency anemia in young children is associated with impaired neurodevelopment. A comprehensive literature search has been performed and summarized. New factorial calculations have been performed considering iron losses, iron absorption and iron requirements in various population groups. Recent data on iron intakes and the prevalence of iron deficiency in the Nordic countries are presented. Average requirements and tentative recommended intakes are presented for 12 different population groups. Pregnant women and those with high menstrual blood losses should consume iron-rich food and undergo screening for iron deficiency. Infants should consume iron-rich complementary foods and cow’s milk should be avoided as a drink before 12 months of age and limited to < 500 mL/day in toddlers. Vegetarians should consume a diet including wholegrains, legumes, seeds, and green vegetables together with iron absorption enhancers. There is no evidence that iron intake per se increases the risk of cancer or diabetes. Iron absorption from foods is generally lower than that of most other nutrients and can vary between <2 and 50% depending on individual iron status and iron bioavailability in the meal.

Place, publisher, year, edition, pages
SNF Swedish Nutrition Foundation, 2024
Keywords
Anemia, Ferritin, Iron, Iron deficiency, Nutrition recommendations
National Category
Nutrition and Dietetics
Identifiers
urn:nbn:se:umu:diva-222225 (URN)10.29219/fnr.v68.10451 (DOI)2-s2.0-85186429945 (Scopus ID)
Available from: 2024-03-14 Created: 2024-03-14 Last updated: 2024-03-14Bibliographically approved
Yeung, E., Biedrzycki, R. J., Gómez Herrera, L. C., Issarapu, P., Dou, J., Marques, I. F., . . . Guan, W. (2024). Maternal age is related to offspring DNA methylation: a meta-analysis of results from the pace consortium. Aging Cell, Article ID e14194.
Open this publication in new window or tab >>Maternal age is related to offspring DNA methylation: a meta-analysis of results from the pace consortium
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2024 (English)In: Aging Cell, ISSN 1474-9718, E-ISSN 1474-9726, article id e14194Article in journal (Refereed) Epub ahead of print
Abstract [en]

Worldwide trends to delay childbearing have increased parental ages at birth. Older parental age may harm offspring health, but mechanisms remain unclear. Alterations in offspring DNA methylation (DNAm) patterns could play a role as aging has been associated with methylation changes in gametes of older individuals. We meta-analyzed epigenome-wide associations of parental age with offspring blood DNAm of over 9500 newborns and 2000 children (5–10 years old) from the Pregnancy and Childhood Epigenetics consortium. In newborns, we identified 33 CpG sites in 13 loci with DNAm associated with maternal age (PFDR < 0.05). Eight of these CpGs were located near/in the MTNR1B gene, coding for a melatonin receptor. Regional analysis identified them together as a differentially methylated region consisting of 9 CpGs in/near MTNR1B, at which higher DNAm was associated with greater maternal age (PFDR = 6.92 × 10−8) in newborns. In childhood blood samples, these differences in blood DNAm of MTNR1B CpGs were nominally significant (p < 0.05) and retained the same positive direction, suggesting persistence of associations. Maternal age was also positively associated with higher DNA methylation at three CpGs in RTEL1-TNFRSF6B at birth (PFDR < 0.05) and nominally in childhood (p < 0.0001). Of the remaining 10 CpGs also persistent in childhood, methylation at cg26709300 in YPEL3/BOLA2B in external data was associated with expression of ITGAL, an immune regulator. While further study is needed to establish causality, particularly due to the small effect sizes observed, our results potentially support offspring DNAm as a mechanism underlying associations of maternal age with child health.

Place, publisher, year, edition, pages
John Wiley & Sons, 2024
Keywords
aging, child, DNA methylation, melatonin, receptor
National Category
Pediatrics
Identifiers
urn:nbn:se:umu:diva-225931 (URN)10.1111/acel.14194 (DOI)001234420300001 ()38808605 (PubMedID)2-s2.0-85194821046 (Scopus ID)
Available from: 2024-06-12 Created: 2024-06-12 Last updated: 2024-06-12
Molin, J., Domellöf, M., Häggström, C., Vanky, E., Zamir, I., Östlund, E. & Bixo, M. (2024). Neonatal outcome following metformin-treated gestational diabetes mellitus: a population-based cohort study. Acta Obstetricia et Gynecologica Scandinavica
Open this publication in new window or tab >>Neonatal outcome following metformin-treated gestational diabetes mellitus: a population-based cohort study
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2024 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412Article in journal (Refereed) Epub ahead of print
Abstract [en]

Introduction: Neonatal hypoglycemia is a common complication associated with gestational diabetes and therefore relevant to consider in evaluations of maternal treatment. We aimed to investigate the risk of neonatal hypoglycemia in offspring exposed to metformin treatment alone (MT) or combined with insulin (MIT) in comparison with nutrition therapy alone (NT), and insulin treatment alone (IT). In addition, we investigated MT in comparison with MIT. Secondary outcomes included neonatal anthropometrics, respiratory morbidity, hyperbilirubinemia, 5-min Apgar score, and preterm birth.

Material and methods: This Swedish population-based cohort included 16 181 women diagnosed with gestational diabetes, and their singleton offspring born in 2019–2021. We estimated risk as adjusted odds ratio (aOR) with 95% confidence interval (CI), using individual-level, linkage register-data in multivariable logistic regression models.

Results: In the main analysis, MT was associated with a lower risk of neonatal hypoglycemia versus NT (aOR 0.85, 95% CI: 0.74–0.96), versus MIT (0.74 [0.64–0.87]), and versus IT (0.47 [0.40–0.55]), whereas MIT was associated with a similar risk of neonatal hypoglycemia versus NT (1.14 [0.99–1.30]) and with lower risk versus IT (0.63 [0.53–0.75]). However, supplemental feeding rates were lower for NT versus pharmacological treatments (p < 0.001). In post hoc subgroup analyses including only exclusively breastfed offspring, the risk of neonatal hypoglycemia was modified and similar among MT and NT, and higher in MIT versus NT. Insulin exposure, alone or combined with metformin, was associated with increased risk of being large for gestational age. Compared with NT, exposure to any pharmacological treatment was associated with significantly lower risk of 5-min Apgar score < 4. All other secondary outcomes were comparable among the treatment categories.

Conclusions: The risk of neonatal hypoglycemia appears to be comparable among offspring exposed to single metformin treatment and nutrition therapy alone, and the lower risk that we observed in favor of metformin is probably explained by a difference in supplemental feeding practices rather than metformin per se. By contrast, the lower risk favoring metformin exposure over insulin exposure was not explained by supplemental feeding. However, further investigations are required to determine whether the difference is an effect of metformin per se or mediated by other external factors.

Place, publisher, year, edition, pages
John Wiley & Sons, 2024
Keywords
gestational diabetes mellitus, metformin, neonatal hypoglycemia, neonatal outcome, population-based, register-based
National Category
Obstetrics, Gynecology and Reproductive Medicine Endocrinology and Diabetes
Identifiers
urn:nbn:se:umu:diva-220881 (URN)10.1111/aogs.14787 (DOI)001153803000001 ()38288656 (PubMedID)2-s2.0-85183895565 (Scopus ID)
Funder
Region Västerbotten, C-ALF 7004352Umeå University, 310426017
Available from: 2024-02-15 Created: 2024-02-15 Last updated: 2024-02-15
Farooqi, A., Håkansson, S., Serenius, F., Kallen, K., Björklund, L., Normann, E., . . . Norman, M. (2024). One-year survival and outcomes of infants born at 22 and 23 weeks of gestation in Sweden 2004-2007, 2014-2016 and 2017-2019. Archives of Disease in Childhood: Fetal and Neonatal Edition, 109(1), 10-17
Open this publication in new window or tab >>One-year survival and outcomes of infants born at 22 and 23 weeks of gestation in Sweden 2004-2007, 2014-2016 and 2017-2019
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2024 (English)In: Archives of Disease in Childhood: Fetal and Neonatal Edition, ISSN 1359-2998, E-ISSN 1468-2052, Vol. 109, no 1, p. 10-17Article in journal (Refereed) Published
Abstract [en]

Objective: To explore associations between perinatal activity and survival in infants born at 22 and 23 weeks of gestation in Sweden.

Design/Setting: Data on all births at 22 and 23 weeks' gestational age (GA) were prospectively collected in 2004-2007 (T1) or obtained from national registers in 2014-2016 (T2) and 2017-2019 (T3). Infants were assigned perinatal activity scores based on 3 key obstetric and 4 neonatal interventions.

Main outcome: One-year survival and survival without major neonatal morbidities (MNM): intraventricular haemorrhage grade 3-4, cystic periventricular leucomalacia, surgical necrotising enterocolitis, retinopathy of prematurity stage 3-5 or severe bronchopulmonary dysplasia. The association of GA-specific perinatal activity score and 1-year survival was also determined.

Results: 977 infants (567 live births and 410 stillbirths) were included: 323 born in T1, 347 in T2 and 307 in T3. Among live-born infants, survival at 22 weeks was 5/49 (10%) in T1 and rose significantly to 29/74 (39%) in T2 and 31/80 (39%) in T3. Survival was not significantly different between epochs at 23 weeks (53%, 61% and 67%). Among survivors, the proportions without MNM in T1, T2 and T3 were 20%, 17% and 19% for 22 weeks and 17%, 25% and 25% for 23 weeks' infants (p>0.05 for all comparisons). Each 5-point increment in GA-specific perinatal activity score increased the odds for survival in first 12 hours of life (adjusted OR (aOR) 1.4; 95% CI 1.3 to 1.6) in addition to 1-year survival (aOR 1.2; 95% CI 1.1 to 1.3), and among live-born infants it was associated with increased survival without MNM (aOR 1.3; 95% CI 1.1 to 1.4).

Conclusion: Increased perinatal activity was associated with reduced mortality and increased chances of survival without MNM in infants born at 22 and 23 weeks of GA.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2024
Keywords
neonatology, paediatrics
National Category
Pediatrics Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:umu:diva-212258 (URN)10.1136/archdischild-2022-325164 (DOI)001006756400001 ()37290903 (PubMedID)2-s2.0-85164396139 (Scopus ID)
Funder
Region Stockholm, 2020-0443Karolinska Institute, 2020-0443Swedish Order of Freemasons
Available from: 2023-07-20 Created: 2023-07-20 Last updated: 2024-01-12Bibliographically approved
Projects
The role of iron in childhood cognitive and behavioural development: Can prevention of early iron deficiency during infancy reduce the risk of cognitive and behavioral problems at 4-7 years of age? [2012-00708_Forte]; Umeå UniversityEffects of early nutrition on brain development and cognitive/behavioural problems in children [2016-02095_VR]; Umeå UniversityEffects of early nutrition on brain development and cognitive/behavioral problems in children [2019-01005_VR]; Umeå University
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-0726-7029

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