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Stoltz Sjöström, ElisabethORCID iD iconorcid.org/0000-0002-4649-0653
Publications (10 of 30) Show all publications
Späth, C., Zamir, I., Stoltz Sjöström, E. & Domellöf, M. (2020). Use of concentrated parenteral nutrition solutions is associated with improved nutrient intakes and postnatal growth in very low-birth-weight infants. JPEN - Journal of Parenteral and Enteral Nutrition, 44(2), 327-336
Open this publication in new window or tab >>Use of concentrated parenteral nutrition solutions is associated with improved nutrient intakes and postnatal growth in very low-birth-weight infants
2020 (English)In: JPEN - Journal of Parenteral and Enteral Nutrition, ISSN 0148-6071, E-ISSN 1941-2444, Vol. 44, no 2, p. 327-336Article in journal (Refereed) Published
Abstract [en]

Background: Evidence showing the beneficial effects of enhanced parenteral nutrition (PN) to very low-birth-weight (VLBW,<1500 g) infants is accumulating. However, PN composition and its impact on growth outcomes are questioned. This study aimed to investigate the associations between administration of a concentrated PN regime and intakes of energy and macronutrients as well as postnatal growth in VLBW infants. 

Methods: We compared 2 cohorts of VLBW infants born before (n = 74) and after (n =44) a concentrated PN regime was introduced into clinical use. Daily nutrition and fluid intake during the first 28 postnatal days and all available growth measurements during hospitalization were retrospectively collected from clinical charts. 

Results: Infants who received concentrated PN compared with original PN had higher parenteral intakes of energy (56 vs 45 kcal/kg/d, P < 0.001), protein (2.6 vs 2.2 g/kg/d, P = 0.008), and fat (1.5 vs 0.7 g/kg/d, P < 0.001) during the first postnatal week. Changes in standard deviation scores for weight and length from birth to postnatal day 28 were more positive in the concentrated PN group (mean [95% CI]; weight change: –0.77 [–1.02 to –0.52] vs –1.29 [–1.33 to –1.05], P = 0.005; length change: –1.01 [–1.36 to –0.65] vs –1.60 [–1.95 to –1.25], P = 0.025). There were no significant differences in fluid intake and infant morbidity between the groups. 

Conclusion: Our results suggest that concentrated PN is useful and seems to be safe for improving early nutrition and growth in VLBW infants.

Place, publisher, year, edition, pages
John Wiley & Sons, 2020
Keywords
amino acids, energy intake, nutrient intakes, parenteral nutrition, postnatal growth, very low-birth-weight infants
National Category
Pediatrics
Identifiers
urn:nbn:se:umu:diva-148009 (URN)10.1002/jpen.1522 (DOI)000514808000021 ()30747444 (PubMedID)
Available from: 2018-05-24 Created: 2018-05-24 Last updated: 2020-03-19Bibliographically approved
Klevebro, S., Westin, V., Stoltz Sjöström, E., Norman, M., Domellöf, M., Edstedt Bonamy, A.-K. & Hallberg, B. (2019). Early energy and protein intakes and associations with growth, BPD and ROP in extremely preterm infants. Clinical Nutrition, 38(3), 1289-1295
Open this publication in new window or tab >>Early energy and protein intakes and associations with growth, BPD and ROP in extremely preterm infants
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2019 (English)In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 38, no 3, p. 1289-1295Article in journal (Refereed) Published
Abstract [en]

Background & aim: Extremely preterm infants face substantial neonatal morbidity. Nutrition is important to promote optimal growth and organ development in order to reduce late neonatal complications. The aim of this study was to examine the associations of early nutritional intakes on growth and risks of bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP) in a high-risk population.

Methods: This population-based cohort study includes infants born before 27 0/7 weeks of gestational age without severe malformations and surviving ≥10 days. Intake of energy and protein on postnatal days 4–6 and association with weight standard deviation score (WSDS) from birth to day 7, as well as intakes of energy and protein on postnatal days 4–6 and 7 to 27, respectively, and association with composite outcome of death and BPD and separate outcomes of BPD and ROP were examined, and adjusted for potential confounders.

Results: The cohort comprised 296 infants with a median gestational age of 25 3/7 weeks. Expressed as daily intakes, every additional 10 kcal/kg/d of energy during days 4–6 was associated with 0.08 higher WSDS on day 7 (95% CI 0.06–0.11; p < 0.001). Between days 7 and 27, every 10 kcal/kg/d increase in energy intake was associated with a reduced risk of BPD of 9% (95% CI 1–16; p = 0.029) and any grade of ROP with a reduced risk of 6% (95% CI 2–9; p = 0.005) in multivariable models. This association was statistically significant in infants with ≤10 days of mechanical ventilation. In infants with >10 days of mechanical ventilation, a combined higher intake of energy and protein was associated with a reduced risk of BPD.

Conclusion: Early provision of energy and protein may reduce postnatal weight loss and risk of morbidity in extremely preterm infants.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Extremely preterm infant, Nutrition, Growth, Retinopathy of prematurity, Bronchopulmonary dysplasia
National Category
Pediatrics Nutrition and Dietetics
Research subject
Pediatrics
Identifiers
urn:nbn:se:umu:diva-147966 (URN)10.1016/j.clnu.2018.05.012 (DOI)000469891800037 ()29885776 (PubMedID)
Funder
Stockholm County Council
Available from: 2018-05-23 Created: 2018-05-23 Last updated: 2019-06-24Bibliographically approved
Alm, S., Stoltz Sjöström, E., Nilsson Sommar, J. & Domellöf, M. (2019). Erythrocyte transfusions increased the risk of elevated serum ferritin in very low birth weight infants and were associated with altered longitudinal growth. Acta Paediatrica
Open this publication in new window or tab >>Erythrocyte transfusions increased the risk of elevated serum ferritin in very low birth weight infants and were associated with altered longitudinal growth
2019 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227Article in journal (Refereed) Epub ahead of print
Abstract [en]

Aim: There has been a lack of population‐based longitudinal data on serum ferritin in very low birth weight (VLBW) infants during hospitalisation. Our aim was to fill this gap in the knowledge and investigate risk factors for elevated serum ferritin and associations between erythrocyte transfusions and longitudinal growth.

Methods: We retrospectively reviewed longitudinal data on 126 VLBW infants treated at Umeå University Hospital, Sweden, between 2010‐2013.

Results: The infants’ mean gestational age and birth weight were 26.9 weeks and 899 grams. Most (91%) received erythrocyte transfusions and the majority had multiple erythrocyte transfusions. There was a significant correlation between serum ferritin and the volume of transfusions. Almost two‐thirds had at least one serum ferritin measurement of more than 350 µg/L, indicating iron overload. In those with complete anthropometric data (n=78) there was no significant effect of serum ferritin concentrations in relation to longitudinal growth, but there was a positive association between the erythrocyte transfusion dose and longitudinal growth in VLBW infants born before 25 weeks.

Conclusion: This is the first population‐based study to investigate longitudinal data on serum ferritin in VLBW infants during hospitalisation. The unexpected positive finding in the subgroup born at less than 25 weeks needs further research with a larger cohort.

National Category
Medical and Health Sciences
Research subject
Pediatrics
Identifiers
urn:nbn:se:umu:diva-166850 (URN)10.1111/apa.15115 (DOI)
Available from: 2020-01-03 Created: 2020-01-03 Last updated: 2020-03-02Bibliographically approved
Challis, P., Larsson, L., Stoltz Sjöström, E., Serenius, F., Domellöf, M. & Elfvin, A. (2019). Validation of the diagnosis of necrotising enterocolitis in a Swedish population-based observational study. Acta Paediatrica, 108(5), 835-841
Open this publication in new window or tab >>Validation of the diagnosis of necrotising enterocolitis in a Swedish population-based observational study
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2019 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 108, no 5, p. 835-841Article in journal (Refereed) Published
Abstract [en]

Aim: The definition of necrotising enterocolitis (NEC) is based on clinical and radiological signs that can be difficult to interpret. The aim of the present study was to validate the incidence of NEC in the Extremely Preterm Infants in Sweden Study (EXPRESS)

Methods: The EXPRESS study consisted of all 707 infants born before 27 + 0 gestational weeks during the years 2004–2007 in Sweden. Of these infants, 38 were recorded as having NEC of Bell stage II or higher. Hospital records were obtained for these infants. Furthermore, to identify missed cases, all infants with a sudden reduction of enteral nutrition, in the EXPRESS study were identified (n = 71). Hospital records for these infants were obtained. Thus, 108 hospital records were obtained and scored independently by two neonatologists for NEC.

Results: Of 38 NEC cases in the EXPRESS study, 26 were classified as NEC after validation. Four cases not recorded in the EXPRESS study were found. The incidence of NEC decreased from 6.3% to 4.3%.

Conclusion: Validation of the incidence of NEC revealed over- and underestimation of NEC in the EXPRESS study despite carefully collected data. Similar problems may occur in other national data sets or quality registers.

Keywords
Bells staging, Extremely premature infants, Necrotising enterocolitis, Validation
National Category
Pediatrics
Research subject
Pediatrics
Identifiers
urn:nbn:se:umu:diva-155463 (URN)10.1111/apa.14585 (DOI)000465091200009 ()30238614 (PubMedID)2-s2.0-85054621996 (Scopus ID)
Funder
Swedish Research Council, 2016-02095
Available from: 2019-01-16 Created: 2019-01-16 Last updated: 2019-05-27Bibliographically approved
Zamir, I., Tornevi, A., Abrahamsson, T., Ahlsson, F., Engström, E., Hallberg, B., . . . Domellöf, M. (2018). Hyperglycemia in extremely preterm infants: insulin treatment, mortality and nutrient intakes. Journal of Pediatrics, 200, 104-110
Open this publication in new window or tab >>Hyperglycemia in extremely preterm infants: insulin treatment, mortality and nutrient intakes
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2018 (English)In: Journal of Pediatrics, ISSN 0022-3476, E-ISSN 1097-6833, Vol. 200, p. 104-110Article in journal (Refereed) Published
Abstract [en]

Objective: To explore the prevalence of hyperglycemia and the associations between nutritional intakes, hyperglycemia, insulin treatment, and mortality in extremely preterm infants.

Study design: Prospectively collected data from the Extremely Preterm Infants in Sweden Study (EXPRESS) was used in this study and included 580 infants born <27 gestational weeks during 2004-2007. Available glucose measurements (n = 9850) as well as insulin treatment and nutritional data were obtained retrospectively from hospital records for the first 28 postnatal days as well as 28- and 70-day mortality data.

Results: Daily prevalence of hyperglycemia >180 mg/dL (10 mmol/L) of up to 30% was observed during the first 2 postnatal weeks, followed by a slow decrease in its occurrence thereafter. Generalized additive model analysis showed that increasing parenteral carbohydrate supply with 1 g/kg/day was associated with a 1.6% increase in glucose concentration (P < .001). Hyperglycemia was associated with more than double the 28-day mortality risk (P < .01). In a logistic regression model, insulin treatment was associated with lower 28- and 70-day mortality when given to infants with hyperglycemia irrespective of the duration of the hyperglycemic episode (P < .05).

Conclusions: Hyperglycemia is common in extremely preterm infants throughout the first postnatal month. Glucose infusions seem to have only a minimal impact on glucose concentrations. In the EXPRESS cohort, insulin treatment was associated with lower mortality in infants with hyperglycemia. Current practices of hyperglycemia treatment in extremely preterm infants should be reevaluated and assessed in randomized controlled clinical trials.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
neonatology, nutrition
National Category
Pediatrics
Research subject
Pediatrics
Identifiers
urn:nbn:se:umu:diva-146880 (URN)10.1016/j.jpeds.2018.03.049 (DOI)000442390400020 ()2-s2.0-85046719751 (Scopus ID)
Funder
Swedish Research Council, 2016-02095Västerbotten County Council, VLL-640871
Available from: 2018-04-20 Created: 2018-04-20 Last updated: 2019-10-01Bibliographically approved
Westin, V., Klevebro, S., Domellöf, M., Vanpée, M., Hallberg, B. & Stoltz Sjöström, E. (2018). Improved nutrition for extremely preterm infants: a population based observational study. Clinical Nutrition ESPEN, 23, 245-251
Open this publication in new window or tab >>Improved nutrition for extremely preterm infants: a population based observational study
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2018 (English)In: Clinical Nutrition ESPEN, ISSN 2405-4577, Vol. 23, p. 245-251Article in journal (Refereed) Published
Abstract [en]

Background and aims Extremely preterm (EPT) infants are at high risk for malnutrition due to immaturity and medical complications and they often accumulate nutritional deficits and experience growth faltering during treatment at neonatal intensive care units (NICUs). Enhanced intake of energy and protein during the first weeks of life improves weight gain and head circumference growth. The optimal nutritional strategy for these infants' health and long-term development remains unknown. Nutritional regiments have been identified as a potential area for improvement in Swedish NICUs. The aim of this study was to evaluate changes in nutritional intake over time during the first 56 postnatal days in EPT (<27 gestational weeks; n = 316) infants, who were treated in NICUs during 2004–2011 in Stockholm, using a population-based study approach.

Methods Several different nutritional interventions were implemented over the 8-year period. Nutrition and growth data were obtained retrospectively from hospital records. All intakes of enteral and parenteral nutrients were retrieved daily during the first 28 postnatal days and on days 35, 42, 49 and 56.

Results Energy intake (median) increased from 77 kcal/kg/d during the 2004–2005 period to 98 kcal/kg/d during the 2010–2011 period on days 4–6. Median protein intake increased from 2.4 g/kg/d during 2004–2005 to 3.6 g/kg/d during 2010–2011. Energy and protein intake during postnatal days 0–6 increased continuously over the 8 years and protein intake increased during all 56 postnatal days. Full enteral feeds were reached earlier and the proportion of enteral feeds during the first week was higher during 2008–2009 compared to all other years. A significant improvement in growth was primarily noted by comparing the 2004–2005 period to subsequent years.

Conclusions Neonatal nutrition improved significantly in Stockholm from 2004 to 2011. Above all, parenteral nutrition was initiated more promptly during the first week and was provided at higher quantities. However, many of the EPT infants born during the later years still did not reach the recommended macronutrient intake levels. A significant weight gain improvement was observed between 2004–2005 and 2006–2011.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Enteral nutrition, energy, parenteral nutrition, preterm infant, protein
National Category
Pediatrics Nutrition and Dietetics
Research subject
Pediatrics
Identifiers
urn:nbn:se:umu:diva-140687 (URN)10.1016/j.clnesp.2017.09.004 (DOI)000444125800038 ()29460807 (PubMedID)
Available from: 2017-10-16 Created: 2017-10-16 Last updated: 2019-02-20Bibliographically approved
Stoltz Sjöström, E. (2018). Nutritionsbehandling till prematurfödda barn avgörande för tillväxt och utveckling. Nordisk Nutrition (1), 30-32
Open this publication in new window or tab >>Nutritionsbehandling till prematurfödda barn avgörande för tillväxt och utveckling
2018 (Swedish)In: Nordisk Nutrition, ISSN 1654-8337, no 1, p. 30-32Article in journal (Other academic) Published
Place, publisher, year, edition, pages
Swedish Nutrition Foundation, 2018
National Category
Pediatrics
Research subject
Pediatrics
Identifiers
urn:nbn:se:umu:diva-147562 (URN)
Available from: 2018-05-08 Created: 2018-05-08 Last updated: 2018-12-14Bibliographically approved
Domellöf, M. & Stoltz Sjöström, E. (2017). Enteral Iron Supplementation in Preterm Infants: Response to Letter to the Editor [Letter to the editor]. Journal of Pediatric Gastroenterology and Nutrition - JPGN, 64(1), e26
Open this publication in new window or tab >>Enteral Iron Supplementation in Preterm Infants: Response to Letter to the Editor
2017 (English)In: Journal of Pediatric Gastroenterology and Nutrition - JPGN, ISSN 0277-2116, E-ISSN 1536-4801, Vol. 64, no 1, p. e26-Article in journal, Letter (Refereed) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-127184 (URN)10.1097/MPG.0000000000001445 (DOI)
Available from: 2016-11-01 Created: 2016-11-01 Last updated: 2018-06-09Bibliographically approved
Späth, C., Stoltz Sjöström, E., Ahlsson, F., Ågren, J. & Domellöf, M. (2017). Sodium supply influences plasma sodium concentration and the risks of hyper- and hyponatremia in extremely preterm infants. Pediatric Research, 81, 455-460
Open this publication in new window or tab >>Sodium supply influences plasma sodium concentration and the risks of hyper- and hyponatremia in extremely preterm infants
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2017 (English)In: Pediatric Research, ISSN 0031-3998, E-ISSN 1530-0447, Vol. 81, p. 455-460Article in journal (Refereed) Published
Abstract [en]

Background: Hyper- and hyponatremia occur frequently in extremely preterm infants. Our purpose was to investigate plasma sodium (P-Na) concentrations, the incidence of hyper and hyponatremia, and the impact of possible predisposing factors in extremely preterm infants.

Methods: In this observational study, we analyzed data from the EXtremely PREterm (< 27 wk.) infants in Sweden Study (EXPRESS, n = 707). Detailed nutritional, laboratory, and weight data were collected retrospectively from patient records.

Results: Mean ± SD P-Na increased from 135.5 ± 3.0 at birth to 144.3 ± 6.1 mmol/l at a postnatal age of 3 d and decreased thereafter. Fifty percent of infants had hypernatremia (P-Na >145 mmol/l) during the first week of life while 79% displayed hyponatremia (P-Na < 135 mmol/l) during week 2. Initially, the main sodium sources were blood products and saline injections/infusions, gradually shifting to parenteral and enteral nutrition towards the end of the first week. The major determinant of P-Na and the risks of hyper- and hyponatremia was sodium supply. Fluid volume provision was associated with postnatal weight change but not with P-Na.

Conclusion: The supply of sodium, rather than fluid volume, is the major factor determining P-Na concentrations and the risks of hyper- and hyponatremia.

Place, publisher, year, edition, pages
Nature Publishing Group, 2017
National Category
Pediatrics
Research subject
Pediatrics
Identifiers
urn:nbn:se:umu:diva-128245 (URN)10.1038/pr.2016.264 (DOI)000396297000016 ()
Available from: 2016-11-30 Created: 2016-11-30 Last updated: 2019-11-04Bibliographically approved
Stoltz Sjöström, E. (2016). Betydelse av tidig nutrition för hälsa hos barn och vuxna. Nordisk Nutrition (3/4), 35-37
Open this publication in new window or tab >>Betydelse av tidig nutrition för hälsa hos barn och vuxna
2016 (Swedish)In: Nordisk Nutrition, ISSN 1654-8337, no 3/4, p. 35-37Article in journal (Other academic) Published
Place, publisher, year, edition, pages
Lund: SNF Swedish Nutrition Foundation, 2016
National Category
Nutrition and Dietetics
Research subject
Pediatrics
Identifiers
urn:nbn:se:umu:diva-128249 (URN)
Available from: 2016-11-30 Created: 2016-11-30 Last updated: 2018-06-09Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-4649-0653

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