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  • 1. Aggett, P J
    et al.
    Haschke, F
    Heine, W
    Hernell, Olle
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Koletzko, B
    Rey, J
    Rubino, A
    Schöch, G
    Senterre, J
    Strobel, S
    Comment on antigen-reduced infant formulae. ESPGAN Committee on Nutrition.1993In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 82, no 3, 314-9 p.Article in journal (Refereed)
  • 2. Allansson Kjölhede, Elin
    et al.
    Gustafsson, Per E.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Gustafsson, P. A.
    Nelson, N.
    Overweight and obese children have lower cortisol levels than normal weight children2014In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 103, no 3, 295-299 p.Article in journal (Refereed)
    Abstract [en]

    AIM: The stress hormone cortisol is vital to survival, and a disturbed circadian rhythm can be deleterious to health. However, little is known about cortisol levels in healthy children. The aim of this study was to examine cortisol levels in relation to body mass index (BMI), age and sex. METHODS: Salivary samples were collected in early morning, late morning and evening, on four consecutive days, from 342 children aged 6-12years using Salivette((R)) tubes. Samples were analysed using a commercial enzyme immunoassay (EIA). School nurses measured the children's height and weight, and these measurements were used to calculate their BMI. RESULTS: The children displayed a circadian rhythm in cortisol secretion, with morning zeniths and evening nadirs. Average cortisol levels in early morning, late morning and evening were significantly lower in overweight and obese children than in their normal weight counterparts. Cortisol levels did not vary significantly with age or sex. CONCLUSION: Our findings may suggest cortisol suppression in overweight and obese children. We found no evidence that sex or age influences cortisol levels. These findings highlight the need for further research on the relationship between stress and obesity in children.

  • 3.
    Andersson, Christer
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hultdin, Johan
    Schmauch, Annelie
    Dahlquist, Gisela
    Acute intermittent porphyria in childhood - a population-based study2003In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 92, 562-568 p.Article in journal (Refereed)
  • 4. Andersson, Ola
    et al.
    Domellöf, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Andersson, Dan
    Hellström-Westas, Lena
    Effects of delayed cord clamping on neurodevelopment and infection at four months of age: a randomised trial2013In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 102, no 5, 525-531 p.Article in journal (Refereed)
    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 4months of life.

    Methods Full-term infants (n=382) were randomised to delayed (180sec) or early cord clamping (10sec). The Ages and Stages Questionnaire (ASQ) was used to assess neurodevelopment at 4months. Immunoglobulin G was measured at birth, 23days and 4months. Parents recorded any symptoms indicating infection during the first 4months 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 4months 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 23days (11.7 vs. 11.0g/L, p=0.004), but did not differ between the groups at 4months. Symptoms of infection were comparable between the groups.

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

  • 5. Austeng, Dordi
    et al.
    Blennow, Mats
    Ewald, Uwe
    Fellman, Vineta
    Fritz, Thomas
    Hellström-Westas, Lena
    Hellström, Ann
    Holmgren, Per Åke
    Holmström, Gerd
    Jakobsson, Peter
    Jeppsson, Annika
    Johansson, Kent
    Källén, Karin
    Lagercrantz, Hugo
    Laurini, Ricardo
    Lindberg, Eva
    Lundqvist, Anita
    Marsál, Karel
    Nilstun, Tore
    Nordén-Lindeberg, Solveig
    Norman, Mikael
    Olhager, Elisabeth
    Östlund, Ingrid
    Serenius, Fredrik
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Simic, Marija
    Sjörs, Gunnar
    Stigson, Lennart
    Stjernqvist, Karin
    Strömberg, Bo
    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)2010In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 99, no 7, 978-992 p.Article in journal (Refereed)
    Abstract [en]

    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.

  • 6. Barman, Malin
    et al.
    Jonsson, Karin
    Hesselmar, Bill
    Sandin, Anna
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Sandberg, Ann-Sofie
    Wold, Agnes E.
    No association between allergy and current 25-hydroxy vitamin D in serum or vitamin D intake2015In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 104, no 4, 405-413 p.Article in journal (Refereed)
    Abstract [en]

    Aim Vitamin D may be involved in allergy development, but there is conflicting evidence. We investigated if dietary intake of vitamin D and levels of 25OHD in serum differed between allergic and nonallergic adolescents and if serum 25OHD correlated with dietary intake of vitamin D or season of blood sampling.

    Methods Serum 25-hydroxy vitamin D (25OHD) levels were analysed in 13-year-old subjects with atopic eczema (n=55), respiratory allergy (n=55) or no allergy (n=55). Intake of fat-containing foods was assessed by food-frequency questionnaires, and total daily vitamin D intake was calculated. Logistic regression was used to adjust for gender, parental allergy and time of blood sampling.

    Results Subjects with atopic eczema or respiratory allergy did not differ from nonallergic controls regarding serum 25OHD levels or calculated vitamin D intake. Subjects sampled in the autumn had significantly higher levels of serum 25OHD than subjects sampled in the winter or spring. Serum 25OHD levels correlated to consumption of vitamin D-fortified lean milk (p=0.001).

    Conclusion The findings suggest no association between allergy and 25OHD levels in serum or vitamin D intake in adolescents. Serum 25OHD levels correlated to intake of vitamin D-fortified lean milk.

  • 7.
    Barman, Malin
    et al.
    Göteborg, Sweden.
    Jonsson, Karin
    Göteborg, Sweden.
    Sandin, Anna
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Wold, Agnes E.
    Göteborg, Sweden.
    Sandberg, Ann-Sofie
    Göteborg, Sweden.
    Serum fatty acid profile does not reflect seafood intake in adolescents with atopic eczema2014In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 103, no 9, 968-976 p.Article in journal (Refereed)
    Abstract [en]

    Aim: Long-chain polyunsaturated fatty acids (LCPUFAs) are immunomodulatory, but their role in allergy development is controversial. We investigated whether proportions of LCPUFAs in serum phospholipids were related to allergic diagnosis, seafood intake and LCPUFA proportions in cord blood.

    Methods: Serum was obtained from 148 birth cohort children at 13 years of age. Forty had atopic eczema, 53 had respiratory allergy, and 55 were nonallergic. Proportions of LCPUFAs were determined in serum phospholipids; cord blood from 128 of the individuals was previously analysed. Seafood intake was estimated using questionnaires.

    Results: Allergic and nonallergic individuals did not differ significantly regarding individual LCPUFAs. However, arachidonic acid over docosahexaenoic acid (DHA) ratio was higher in allergic, compared with nonallergic, adolescents. In nonallergic individuals, LCPUFA proportions in cord serum and adolescent serum correlated weakly. In individuals with atopic eczema and respiratory allergy, these correlations were weak or absent. A moderate correlation between seafood intake and serum DHA was seen in nonallergic individuals and those with respiratory allergy, but not in those with atopic eczema.

    Conclusion: Serum LCPUFA pattern was similar in allergic and nonallergic adolescents. Fatty acid metabolism may be altered in atopic eczema subjects, suggested by poor correlations between fatty acid intake and serum levels.

  • 8.
    Berglund, Staffan K
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Kriström, Berit
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Björn, Matias
    Lindberg, Josefine
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Westrup, Björn
    Norman, Mikael
    Domellöf, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Marginally low birth weight increases the risk of underweight and short stature at three and a half years of age2016In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227Article in journal (Refereed)
    Abstract [en]

    AIM: Little is known about the long-term health of marginally low birth weight (LBW) children. This study characterised growth among infants weighing 2,000g-2,500g and explored the prevalence and predictors of sustained growth restriction.

    METHOD: This prospective observational trial followed the weight and height of 281 Swedish marginally LBW children from birth to 3.5 years of age. Children with a standard deviation score (SDS) for body mass index or height below -2 were considered underweight and short respectively.

    RESULTS: The mean SDS for weight and height showed a rapid increase before 12-19 weeks of age. The most rapid weight gain was in infants born small for gestational age. However, at 3.5 years of age, 9.5% of the children remained underweight and 6.5% had short stature. Regression models showed that slow weight gain before 19 weeks of age was the strongest predictor for lasting underweight, while slow height gain before 19 weeks of age and male sex were associated with short stature.

    CONCLUSION: Marginally LBW infants were more likely to be underweight and have a short stature at 3.5 years of age and the absence of catch-up growth during the first five months after birth identified those at highest risk.

  • 9.
    Bergström, Erik
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Blomquist, Hans K Son
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Is the prevalence of overweight and obesity declining among 4-year-old Swedish children?2009In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 98, no 12, 1956-1958 p.Article in journal (Refereed)
    Abstract [en]

    AIM: To investigate the trend in overweight and obesity prevalence among 4-year-old Swedish children. METHODS: Height and weight data registered at the regular health check up at the child health centres in the county of Västerbotten during the years 2007/2008 (2225 boys and 2156 girls) were analysed and compared with data from 2002/2003 (2231 boys and 2176 girls). Overweight and obesity were estimated using the International Obesity Task Force cut-off values (ISO BMI). RESULTS: In both boys and girls, overweight prevalence (ISO BMI > 25) decreased over the 5-year period, boys from 17.2% to 14.2% and girls from 22.3% to 19.0%. Among girls, there was also a decrease in obesity prevalence (ISO BMI > 30) from 5.7% to 3.1%. CONCLUSION: The result of this study indicates that the overweight and obesity epidemic among Swedish pre-school children may be levelling off.

  • 10.
    Bergström, Erik
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hernell, Olle
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Persson, L A
    Dietary changes in Swedish adolescents.1993In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 82, no 5, 472-80 p.Article in journal (Refereed)
    Abstract [en]

    A school-based dietary survey, using seven-day records, was performed in two cohorts of Swedish adolescents; 14- and 17-year-olds. The study comprised 366 boys and 365 girls. When compared to previous studies in Sweden, a striking finding was a decrease in dietary fat intake and an increase in carbohydrate intake. However, the relative intake of saturated fat had not changed (15% of total energy). The dietary change was mainly due to an increased consumption of cereal products. There were no major differences in dietary habits or nutrient density of the food between the two age groups, or between boys and girls. The mean intakes of protein, fat and carbohydrate, expressed as a percentage of the total energy intake, were 15, 33 and 52%, respectively. The mean intakes of vitamins and minerals were low only for selenium. The boys had a high iron intake (1.5 and 1.7 times the recommended intake for 14- and 17-year-olds, respectively) while the mean iron intake for girls was 0.9 times the recommended dietary allowances in both age groups. The intake of dietary salt was higher in boys than in girls (7.7 g and 9.0 g per day in 14- and 17-year-old boys, respectively, and 5.8 g per day in both 14- and 17-year-old girls). In a long-term health perspective, this positive change in nutrient intake in adolescents may contribute to a reduction in the incidence of diet-related diseases in Sweden.(ABSTRACT TRUNCATED AT 250 WORDS)

  • 11.
    Berhan, Yonas
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Möllsten, Anna
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Carlsson, Annelie
    Lund Univ, Dept Clin Sci, Lund, Sweden.
    Högberg, Lotta
    Linköping Univ, Dept Clin & Expt Med, Div Pediat, Linköping, Sweden.
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Dahlquist, Gisela
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Five-region study finds no evidence of undiagnosed type 2 diabetes in Swedish 11- to 13-year-olds2014In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 103, no 10, 1078-1082 p.Article in journal (Refereed)
    Abstract [en]

    AIM: Childhood obesity is now an established public health problem in most developed countries, and there is concern about a parallel increase of type 2 diabetes. The aim of this study was to estimate the prevalence of undiagnosed type 2 diabetes in overweight Swedish school children from 11 to 13 years of age.

    METHODS: Body mass index (BMI) was measured in 5528 schoolchildren in the 6th grade, from 11 to 13 years of age, in five different regions in Sweden. Overweight was defined by international age- and sex-specific BMI cut-offs, corresponding to adult BMI cut-offs of 25 kg/m(2) at 18 years of age (ISO-BMI ≥25, n = 1275). Haemoglobin A1c (HbA1c) was measured in 1126 children with ISO-BMI ≥25. Children with a Diabetes Control and Complications Trial aligned HbA1c ≥6.1% on two occasions underwent an oral glucose tolerance test (OGTT) to establish the diabetes diagnosis.

    RESULTS: Of 1126 children with ISO-BMI ≥25, 24 (2.1%) had at least one HbA1c value ≥6.1%. Three of them had HbA1c ≥6.1% on two occasions, and all of them had a normal OGTT.

    CONCLUSION: In this cross-sectional, population-based screening study of a high-risk group of 11- to 13-year-old Swedish school children, we found no indication of undiagnosed diabetes or impaired glucose tolerance.

  • 12.
    Birkeland, Anna-Lena
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Rydberg, Annika
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    The complexity of the psychosocial situation in children and adolescents with heart disease2005In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 94, no 10, 1495-1501 p.Article in journal (Refereed)
    Abstract [en]

    Aim: To describe the psychosocial situation of children/adolescents with heart disease and their families, an inventory method was worked out.

    Methods: Ninety-seven children/adolescents with congenital heart disease (CHD) were graded into three categories with respect to complexity of CHD. Group I included 42 patients with malformations requiring standardized operations. Group II included 20 patients with more complicated malformations, and group III included 35 patients with very complex malformations. The patients were compared with controls without heart disease, matched for age and gender. The psychosocial impact of CHD was measured by the inventory.

    Results: The most frequent problems in the patient group were healthcare and treatment-related needs (71/97) in the external sphere, family symptoms (68/97) in the interpersonal sphere, and somatic symptoms (19/97) in the personal sphere. Corresponding numbers in the controls were treatment-related needs (15/97), family (9/97) and somatic symptoms (25/97). Fifty per cent of the symptoms in the patient groups were mild, 30% moderate and 20% severe. The most severe symptoms were found in the interpersonal sphere, where family symptoms constituted the most severe variable. The frequency of severe problems in the personal sphere was 11% in the patients and 1% in the controls. This inventory method differentiates the grades of medical complexity both regarding number and severity of psychosocial symptoms. It indicates severe personal problems in the most complex group and shows that they have severe personal problems independent of family problems.

    Conclusion: This study elucidates the psychosocial complexity in children/adolescents with CHD, which has clinical implications in developing a psychosocial care programme.

  • 13.
    Björkström, Markus V
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hall, Lina
    Söderlund, Stina
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Håkansson, Eva Grahn
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Clinical Bacteriology.
    Håkansson, Stellan
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Domellöf, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Intestinal flora in very low-birth weight infants2009In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 98, no 11, 1762-1767 p.Article in journal (Refereed)
    Abstract [en]

    AIM: To study the early faecal microbiota in very low-birth weight infants (VLBW, <1500 g), possible associations between faecal microbiota and faecal calprotectin (f-calprotectin) and to describe the faecal microbiota in cases with necrotizing enterocolitis (NEC) before diagnosis. METHODS: Stool samples from the first weeks of life were analysed in 48 VLBW infants. Bacterial cultures were performed and f-calprotectin concentrations were measured. In three NEC cases, cultures were performed on stool samples obtained before diagnosis. RESULTS: Bifidobacteria and lactobacilli were often identified in the first stool sample, 55% and 71% of cases, respectively within the first week of life. A positive correlation between lactic acid bacteria (LAB) and volume of enteral feed was found. Other bacteria often identified were Escherichia coli, Enterococcus and Staphyloccus sp. F-calprotectin was not associated with any bacterial species. All NEC cases had an early colonization of LAB. Prior to onset of disease, all cases had a high colonization of non-E. coli Gram-negative species. CONCLUSION: In contrast to the previous studies in VLBW infants, we found an early colonization with LAB. We speculate that this may be due to early feeding of non-pasteurized breast milk.

  • 14. Carlsson, Goran
    et al.
    Kriström, Berit
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Nordenskjold, Magnus
    Henter, Jan-Inge
    Fadeel, Bengt
    Ovarian failure in HAX1-deficient patients: is there a gender-specific difference in pubertal development in severe congenital neutropenia or Kostmann disease?2013In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 102, no 1, 78-82 p.Article in journal (Refereed)
    Abstract [en]

    Aim Severe congenital neutropenia (SCN) is a rare disorder of myelopoiesis characterized by neutropenia, recurrent bacterial infections and a maturation arrest of the myelopoiesis in the bone marrow. Homozygous mutations in the HAX1 gene were described in patients with autosomal recessive SCN or Kostmann disease. Some of these patients display neurological disease. We noted, during the course of clinical management of patients with Kostmann disease, insufficient pubertal development in female patients, but not in our male patients. The study objective was to provide a detailed account of this phenotype and its possible relation to HAX1 mutations. Methods Detailed clinical histories and laboratory investigations of three patients with Kostmann disease belonging to the original kindred in northern Sweden described by Rolf Kostmann are reported. Results We report one male patient with normal puberty and two female patients with insufficient pubertal development. Elevated levels of LH and FSH were recorded in both patients. All three patients harbour the same p.Glu190X mutation in the HAX1 gene. Conclusions We show for the first time that female patients with Kostmann disease display primary gonadal insufficiency. This suggests a possible role for HAX1 in the development and/or function of the human ovary.

  • 15.
    Dahlquist, Gisela
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Celiac disease and insulin-dependent diabetes mellitus - no proof for a causal association1995In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 84, no 12, 1337-1338 p.Article in journal (Refereed)
  • 16.
    Dahlquist, Gisela
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Mustonen, L
    Analysis of 20 years of prospective registration of childhood onset diabetes time trends and birth cohort effects. Swedish Childhood Diabetes Study Group.2000In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 89, no 10, 1231-7 p.Article in journal (Refereed)
    Abstract [en]

    The Swedish Childhood Diabetes Registry has been recording all cases of childhood onset diabetes nationwide, with a high level of ascertainment, since 1 July 1977. The present report describes and analyses the 8358 childhood onset cases occurring between 1 January 1978 and 31 December 1997. The mean annual incidence was 26.4/100,000 children per year (1978: 21.1 and 1997: 31.9). There was a significant log-linear increase over time, with a mean annual increase of 1.7%. The steepest mean increase was seen among the young onset cases (2.5%) and the steepest yearly increase (6.3%) was seen in this age group during the last 10-y period. A shift towards a younger age at onset was clearly indicated, as the age at onset was less during the last compared with the first 10-y period of observation. The increase over time was similar between the sexes and during winter and summer. When analysing the six full birth cohorts covered, we found no clear-cut shift in the trend. Birth cohorts (1978-82) up to 5 y of onset showed a time variability but no clear trend over time. Ecological analyses associating cumulative incidence by birth cohort to breastfeeding frequency showed no significant association. A statistically significant log-linear association was found to the official estimate of gross domestic product adjusted for similar price levels (p = 0.002). CONCLUSION: The incidence of childhood onset diabetes is rapidly increasing in Sweden, with a shift towards the younger age groups but with no trend in birth cohorts. Precipitating rather than initiating environmental risk factors are suggested, and the correlation to gross domestic product may suggest risk factors associated with wealth-such as a high growth rate, a known risk factor for childhood diabetes.

  • 17.
    Dahlquist, Gisela
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Möllsten, Anna
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Källén, B
    Hospitalization for vascular complications in childhood onset type 1 diabetes--effects of gender and age at onset.2008In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 97, no 4, 483-8 p.Article in journal (Refereed)
    Abstract [en]

    AIMS: To study the cumulative incidence of hospitalization for severe diabetic vascular complications in childhood onset type 1 diabetes patients with special regards to age at onset and gender. METHODS: The Swedish Childhood Diabetes Register (SCDR) was linked to the Swedish Hospital Discharge Register up to 31 December 2004. The following diagnoses were traced: diabetic kidney disease, myocardial infarction, stroke, lower limb arterial disease and diabetes with multiple complications. Cox proportional hazards survival method was applied with the following covariates: maternal age, birthweight deviation from gestational week standard, age at onset and gender. RESULTS: Until 31 December 9974 children had been followed for at least 10 years corresponding to 141 839 person years at risk and 103 (7.3 per 1000 person years) had been hospitalized at least once at the maximum duration of follow-up of 26 years. Diabetic kidney disease was the most common cause of hospitalization and 63 patients had more than one diabetic complication. Female gender (RR=2.02, 95% CI=1.05-3.89) and age at onset of diabetes (RR=1.37, 95% CI=1.20-1.56) were significant risk factors for severe complication. CONCLUSIONS: Hospitalization for severe diabetic complications at a maximum follow-up of 26 years is rather low in Sweden. There is a higher hospitalization rate among females than among males, and also among patients diagnosed with diabetes after 10 years of age than among patients diagnosed before the age of 10 years.

  • 18.
    De Chateau, Peter
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Wiberg, Britt
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Long-term effect on mother-infant behaviour of extra contact during the first hour post partum: I. First observations at 36 hours1977In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 66, no 2, 137-143 p.Article in journal (Refereed)
    Abstract [en]

    Abstract The immediate post partum period may be particularly important for the developing relationship between mother and infant; little is as yet known, however, of the long-term effects of hospital practice during this period. This study examines the effect of extra contact during the first hour following delivery. An extra skin to skin contact and suckling contact was given to 22 primiparous mothers and their infants. One control group of 20 primiparous mothers and infants and a second one of 20 multiparous mothers and infants was given routine care immediately after birth. All mothers and infants were healthy with normal pregnancies and deliveries. At 36 hours a first observation was made of maternal and infant behaviour during breast feeding in all three groups. At this stage primiparae with extra contact showed behaviour much more like the behaviour of multiparae with routine care. Infants of primiparae with routine care cried most frequently. The behaviour of mothers of boys differed more from group to group than did that of mothers of girls.

  • 19.
    de Chateau, Peter
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Wiberg, Britt
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Long-term effect on mother-infant behaviour of extra contact during the first hour post partum: II. A follw-up at three months1977In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 66, no 2, 145-151 p.Article in journal (Refereed)
    Abstract [en]

    Abstract Primiparous mothers and their infants who had an extra 15–20 minutes' suckling and skin to skin contact during the first hour after delivery, behaved differently at 36 hours post partum compared with a control group without this extra contact. The present study is a 3-month follow-up of these mothers and infants by means of direct observation of mother-infant free play and a personal interview with the mothers. Mothers in the extra contact group spent more time kissing and looking en face at their infants; these infants smiled more often and cried less frequently. A greater proportion of the mothers with extra contact were still breast feeding at 3 months. The influence of extra contact on behaviour was more pronounced in boy–mother than in girl–mother pairs.

  • 20.
    Domellöf, Magnus
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Lind, Torbjörn
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Lönnerdal, Bo
    Persson, Lars Ake
    Dewey, Kathryn G
    Hernell, Olle
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Effects of mode of oral iron administration on serum ferritin and haemoglobin in infants.2008In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 97, no 8, 1055-60 p.Article in journal (Refereed)
    Abstract [en]

    AIM: To investigate effects of iron-fortified foods (FFs) and medicinal iron drops (MD) on iron status in infants. METHODS: Data from one MD and one FF study were compared. Infants were divided into groups depending on the predominant source and amount of dietary iron during 6-9 months of age: MD: Medicinal iron drops (1 mg/kg/day). FF: iron intake >1.3 mg/kg/day, predominantly from FF and no iron supplements. Low iron (LI) group: iron intake <1.3 mg/kg/day and no iron supplements. RESULTS: Mean iron intake did not differ between MD (n = 30) and FF (n = 35) groups but was lower in the LI (n = 232) group. The FF group had significantly higher mean Hb at 9 months compared to the MD and LI groups (120 vs. 115 g/L and 120 vs. 116 g/L, respectively, p < or = 0.005). The MD group had significantly higher mean SF at 9 months compared to the FF and the LI groups (46 vs. 23 microg/L and 46 vs. 26 microg/L, respectively, p < 0.001). CONCLUSIONS: Our results suggest that, in healthy, term, nonanaemic 6-9-month-old infants, iron given as medicinal iron drops is primarily deposited into iron stores while iron given as iron-fortified foods is primarily utilized for Hb synthesis.

  • 21. Duchén, Karel
    et al.
    Lindberg, Anders
    Kiplok, Kaire
    Kriström, Berit
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Using a spontaneous profile rather than stimulation test makes the KIGS idiopathic growth hormone deficiency model more accessible for clinicians2017In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 106, no 9, 1481-1486 p.Article in journal (Refereed)
    Abstract [en]

    Aim: Children treated with a growth hormone (GH) for idiopathic growth hormone deficiency (IGHD) may be monitored with the first-year prediction model from the Pfizer International Growth Database (KIGS) using auxology, age, GH dose and the maximum GH concentration from a stimulation test (GH(max)stim). We tested the hypothesis that using a 12-hour spontaneous profile (GH(max)12h) would be as accurate. Methods: We studied 98 prepubertal Swedish children (78boys) aged2-12 years enrolled in KIGS. The first-year growth was predicted using the GH(max) from the GHprofile and a stimulation test, and both of these were compared separately with the observed growth response. Results: The increased height observed in the first year was 0.74 standard deviation scores (SDS), and the studentised residuals for the predicted and observed growth with GH(max)stim (-0.16 SDS) and GH(max)12h (-0.22) were similar. Individual predictions calculated with stimulated or spontaneous GH(max) showed a significant correlation (r = 0.80). Conclusion: We validated the KIGS IGHD prediction model and found that the stimulated GH(max) peak can be reliably replaced by the GH(max) 12h with similar accuracy. This makes the model more accessible for clinicians, who can then provide realistic expectations for the growth response during the first year of treatment.

  • 22.
    Edler, Gertrud
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Axelsson, Inge
    Barker, Gillian M
    Lie, Susanne
    Naumburg, Estelle
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics. Unit of Research, Education and Development, Östersund Hospital, Östersund, Sweden.
    Serious complications in male infant circumcisions in Scandinavia indicate that this always be performed as a hospital-based procedure2016In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 105, no 7, 842-850 p.Article in journal (Refereed)
    Abstract [en]

    AIM: More than 7000 male circumcisions are performed in Scandinavia every year. Circumcision is regulated in different ways in Sweden and Denmark and Norway. This study reviewed and described factors associated with complications of circumcision in infant boys in Scandinavia over the last two decades and discussed how these complications could be avoided.

    METHODS: Data on significant complications following circumcision on boys under the age of one in Scandinavia over the last 20 years were collected. Information was retrieved from testimonies of circumcisers, witnesses, medical records and verdicts. A systematic review was performed of fatal cases in the literature.

    RESULTS: We found that 32 cases had been reported to the health authorities in the three countries, and we identified a total of 74 complications in these cases. These included four boys with severe bleeding and circulatory shock, which ended in the death of one boy. Other less serious complications may have occurred in other boys, but not been reported.

    CONCLUSION: Complications following male circumcision in Scandinavia were relatively rare, but serious complications did occur. Based on the analyses of the severe cases, we argue that circumcision should only be performed at hospitals with 24-hour emergency departments. 

  • 23.
    Ellberg, Lotta
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology. Umeå University, Faculty of Medicine, Department of Nursing.
    Högberg, Ulf
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Lundman, Berit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Källén, Karin
    Department of Reproductive Epidemiology, Tornblad Institute, Lund University, Lund, Sweden.
    Håkansson, Stellan
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Lindh, Viveca
    Umeå University, Faculty of Medicine, Department of Nursing.
    Maternity care options influences readmission of newborns2008In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 97, no 5, 579-583 p.Article in journal (Refereed)
    Abstract [en]

    Aim: To analyse morbidity and mortality in healthy newborn infants in relation to various routines of post-natal follow-up. Design: cross-sectional study. Setting: maternity care in Sweden. Population: healthy infants born at term between 1999 and 2002 (n = 197 898).

    Methods: Assessment of post-natal follow-up routines after uncomplicated childbirth in 48 hospitals and data collected from the Swedish Medical Birth Register, Hospital Discharge Register and Cause-of-Death Register. Main outcome measure: neonatal mortality and readmission as proxy for morbidity.

    Results: During the first 28 days, 2.1% of the infants were readmitted generally because of infections, jaundice and feeding-related problems. Infants born in hospitals with a routine neonatal examination before 48 h and a home care programme had a readmission rate [OR, 1.3 (95% CI, 1.16–1.48)] higher than infants born in hospitals with routine neonatal examination after 48 h and 24-h care. There were 26 neonatal deaths.

    Conclusion: Post-delivery care options and routines influence neonatal morbidity as measured by hospital readmission rate. A final infant examination at 49–72 h and an active follow-up programme may reduce the risk of readmission.

  • 24. Fantahun, Mesganaw
    et al.
    Berhane, Yemane
    Wall, Stig
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Högberg, Ulf
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Women's involvement in household decision-making and strengthening social capital-crucial factors for child survival in Ethiopia.2007In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 96, no 4, 582-589 p.Article in journal (Refereed)
  • 25.
    Farooqi, Aijaz
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Serenius, Fredrik
    Uppsala Univ, Sect Pediat, Dept Womens & Childrens Hlth, Uppsala, Sweden.
    Behaviours related to executive functions and learning skills at 11years of age after extremely preterm birth: a Swedish national prospective follow-up study2013In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 102, no 6, 625-634 p.Article in journal (Refereed)
    Abstract [en]

    Aim We investigated a national cohort of children born extremely immature (<26weeks gestation, EI) regarding the nature, frequency and severity of the behavioural problems related to the executive functions (EF) and concerning learning skills, from the perspectives of parents and teachers. Methods At 11years of age 86 of 89 survivors of this cohort were studied and compared with an equal number of controls. Behaviours related to EF, and learning skills were assessed by a validated instrument, namely the Five to Fifteen questionnaire sent by mail to parents and teachers. Results Compared with controls, parents of EI children reported significantly more problems in behaviours related to EF in all areas assessed (Attention, Hyperactivity/Impulsivity, Hypoactivity, Planning/Organizing, and Working Memory). Teachers ratings showed a similar pattern. EI children also displayed deficient skills in the 4 standard measures of learning skills. Multivariate analysis revealed that prematurity, gender and behavioural composite score was associated with learning skills. Only a relatively small proportion of EI children (1030%) exhibited clinically significant impairments. Conclusion Despite a favourable outcome in many school-age children born at the threshold of viability, these are at increased risk of developing behavioural problems related to EF.

  • 26. Funkquist, E-L
    et al.
    Tuvemo, T
    Jonsson, B
    Serenius, Fredrik
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Nyqvist, KH
    Preterm appropriate for gestational age infants: size at birth explains subsequent growth2010In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 99, no 12, 1828-1833 p.Article in journal (Refereed)
    Abstract [en]

     Preterm AGA infants with higher SDS for weight, length and HC at birth are at higher risk of inadequate growth during their hospital stay.

  • 27. Granberg, Marie
    et al.
    Rydberg, Annika
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Fisher, Anne G
    Activities in daily living and schoolwork task performance in children with complex congenital heart disease.2008In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 97, no 9, 1270-4 p.Article in journal (Refereed)
    Abstract [en]

    AIM: To examine if children with complex congenital heart disease (CHD) differ significantly from healthy children in performance of activities in daily living (ADL) and schoolwork tasks. METHODS: Fourteen children with complex CHD (3-14 years) were matched in pairs by age and gender to healthy children (n = 14). The ADL Taxonomy was used to evaluate ability to perform ADL and the School Version of the Assessment of Motor and Process Skills (AMPS) to evaluate quality of schoolwork task performance. RESULTS: The children with complex CHD had significantly lower mean ADL, school motor and school process performance. Eight of the pairs differed significantly in school motor ability, ten in school process performance and nine in ability to perform ADL. CONCLUSION: This study indicates that there is a difference in overall performance both in ADL and schoolwork task performance between children with complex CHD and healthy children. These findings may suggest that early interventions should be provided for children with complex CHD, who often do not receive such services, in order to enhance participation in childhood ADL and schoolwork.

  • 28.
    Granbom, Elin
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Fernlund, Eva
    Department of Paediatrics, University Hospital of Linköping and Children's Heart Centre, Lund, Sweden.
    Sunnegårdh, Jan
    Department of Cardiology at the Queen Silvia Children′s Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Lundell, Bo
    Paediatric Cardiology, Astrid Lindgren Children's Hospital, Stockholm, Sweden.
    Naumburg, Estelle
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Evaluating national guidelines for the prophylactic treatment of respiratory syncytial virus in children with congenital heart disease2014In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 103, no 8, 840-845 p.Article in journal (Refereed)
    Abstract [en]

    Aim: This is the first study to evaluate compliance with the 2003 Swedish national guidelines for prophylactic treatment of respiratory syncytial virus (RSV) in children with congenital heart disease (CHD). We estimated the relative risk (RR) of children with CHD being hospitalised with a RSV infection, studied the extent to which RSV prophylactic treatment with palivizumab corresponded to the guidelines and determined the morbidity of children with CHD who developed RSV infection despite prophylaxis. Methods: This national observational study comprised prospectively registered data on 219 children with CHD treated with palivizumab, medical records on RSV cases and information on hospitalisation rates of children with CHD and RSV infection. Results: The calculated RR of children with CHD being hospitalised with RSV infection was 2.06 (950/0 Cl 1.6-2.6; p < 0.0001) compared with children without CHD. Approximately half of the patients (49%) born before the RSV season and 25% born during the RSV season did not start treatment as recommended by the guidelines. Conclusion: Having CHD increased the rate and estimated RR of children being hospitalised with RSV infection. The guidelines were not followed for about half of the children born before a RSV season and a quarter of the children born during a RSV season and need updating.

  • 29. Gras, Luuk
    et al.
    Wallon, Martine
    Pollak, Arnold
    Cortina-Borja, Mario
    Evengård, Birgitta
    Clinic of Clinical Bacteriology, Karolinska University Hospital Huddinge, Stockholm, Sweden.
    Hayde, Michael
    Petersen, Eskild
    Gilbert, Ruth
    Association between prenatal treatment and clinical manifestations of congenital toxoplasmosis in infancy: a cohort study in 13 European centres2005In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 94, no 12, 1721-1731 p.Article in journal (Refereed)
    Abstract [en]

    Only early versus no prenatal treatment for intracranial lesions showed a statistically significant benefit. A large randomized controlled trial and/or meta-analysis of individual patient data from cohort studies is required to confirm these findings.

  • 30. Grjibovski, Andrej M
    et al.
    Yngve, Agneta
    Bygren, Lars Olov
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Socialmedicin. Unit for Preventive Nutrition, Department of Biosciences at Novum, Karolinska Institutet, Huddinge, Sweden.
    Sjöström, Michael
    Socio-demographic determinants of initiation and duration of breastfeeding in northwest Russia2005In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 94, no 5, 588-594 p.Article in journal (Refereed)
    Abstract [en]

    Aim: This study examines socio-demographic determinants of initiation and duration of breastfeeding in a community-based cohort in northwest Russia.

    Methods: All infants born to women who were registered at the antenatal clinics in Severodvinsk in 1999 comprised the cohort (n = 1399) and were followed up at 1 y. Data on maternal and infant characteristics as well as the duration of breastfeeding were obtained from medical records. Proportional hazard analysis was applied to quantify the effect of the selected factors on the risk of breastfeeding discontinuation adjusted for potential confounders.

    Results: Only 1.3% of infants were never breastfed. Breastfeeding rates were 75.0% and 47.2% at 3 and 6 mo, respectively. Maternal age and early initiation of prenatal care were positively associated with breastfeeding initiation rates. Increased risks of breastfeeding discontinuation were found in teenage mothers (OR= 1.45, 95% CI: 1.06-1.99), in mothers with basic education (OR= 1.68, 95% CI: 1.06-2.66) and in unmarried mothers (OR= 1.19, 95% CI: 1.03-1.38). Women with no previous deliveries were more likely to breastfeed longer (OR= 0.74, 95% CI: 0.62-0.90).

    Conclusions: Compared with previous studies in Russia, almost universal initiation and considerably higher rates of breastfeeding at specific time points were found. Social variations in initiation and duration of breastfeeding should raise concern of inequalities in breastfeeding practices in transitional Russia.

  • 31. Grut, Viktor
    et al.
    Söderström, Lars
    Naumburg, Estelle
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics. Unit of Research, Education and Development, Östersund Hospital, Östersund, Sweden.
    National cohort study showed that infants with Down's syndrome faced a high risk of hospitalisation for the respiratory syncytial virus2017In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 106, no 9, 1519-1524 p.Article in journal (Refereed)
    Abstract [en]

    Aim: The respiratory syncytial virus (RSV) is a leading cause of hospitalisation in infants. We investigated this risk in children with Down's syndrome under two years of age, adjusted for other known risk factors. Methods: This national, retrospective 1: 2 matched cohort study comprised all Swedish children born with Down's from 2006 to 2011, who were each randomly matched to two controls without Down's. Data on RSV hospitalisation and risk factors for RSV were obtained from national registers. The risk of RSV hospitalisation was assessed using multivariable Cox regression with pairwise stratification. Results: The study comprised 814 children with Down's and 1628 controls. We found that 82 children with Down's (10.1%) and 22 controls (1.4%) were hospitalised for RSV. The hazard ratio for children with Down's was 4.00 (95% confidence interval 1.58-10.13) for up to one year of age and 6.60 (95% CI: 2.83-15.38) for up to two years of age, adjusted for other risk factors. During the second year of life, RSV hospitalisation continued for children with Down's, while it was minimal for the controls. Conclusion: Children with Down's faced a high risk of RSV hospitalisation, which continued beyond the first year of age.

  • 32. Hanson, Lars A
    et al.
    Silfverdal, Sven Arne
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    The mother's immune system is a balanced threat to the foetus, turning to protection of the neonate.2009In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 98, no 2, 221-228 p.Article in journal (Refereed)
    Abstract [en]

    Immunological tolerance by the mother prevents rejection of the foetus, but aberrations may increase risk of abnormalities like spontaneous abortion, or foetal growth restriction. The neonate is normally colonized with mother's gut microflora, mainly composed of protective anaerobes. This least threatening form of microbial colonization of the neonate, is impaired by sectio delivery, but supported by breastfeeding. Mother's transplacental IgG, secretory IgA and other milk components help protect the neonate together with its own slowly expanding immune system. CONCLUSION: The mother's immune system tolerates her foetus via several mechanisms. Failure to do so may cause foetal growth retardation, or spontaneous abortion. The mother and the neonate cooperate in preventing infections in the offspring.

  • 33.
    Hedman, Linnea
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Department of Health Sciences, Division of Nursing, Luleå University of Technology, Luleå, Sweden.
    Stridsman, Caroline
    Andersson, Martinmanannn00
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Backman, Helena
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Jansson, Sven-Arne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Rönmark, Eva
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Population-based study shows that teenage girls with asthma had impaired health-related quality of life2017In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 106, no 7, 1128-1135 p.Article in journal (Refereed)
    Abstract [en]

    AIM: This study examined the health-related quality of life (HRQoL) of teenagers with and without asthma, including the impact of their sex, allergic conditions, smoking, living conditions and physical activity.

    METHODS: The Obstructive Lung Disease in Northern Sweden (OLIN) studies recruited a cohort of schoolchildren in 2006. The parents of all children aged 7-8 years in three municipalities were invited to complete a questionnaire and 2,585 (96%) participated. The cohort was followed up at the ages of 11-12 years and 14-15 years with high participation rates. At 14-15 years, the HRQoL questionnaire KIDSCREEN-10 and Asthma Control Test were added.

    RESULTS: Girls with current asthma at 14-15 years had a lower mean HRQoL score than girls without asthma (46.4 versus 49.3, p<0.001), but this was not seen among boys (53.8 versus 52.8, p=0.373). Poor HRQoL was related to current asthma, uncontrolled asthma and teenage onset of asthma. It was also related to eczema, living in a single parent household, maternal smoking, daily smoking and inversely related to physical activity.

    CONCLUSION: Teenage girls with asthma had lower HRQoL than girls without asthma. Possible interventions to improve HRQoL among teenagers with asthma were identified: increasing asthma control, preventing smoking and promoting physical activity. 

  • 34.
    Henje Blom, Eva
    et al.
    Karolinska Institutet, University of California San Francsisco.
    Ho, Tiffany C.
    Connolly, Colm G.
    LeWinn, Kaja Z.
    Sacchet, Matthew D.
    Tymofiyeva, Olga
    Weng, Helen Y.
    Yang, Tony T.
    The neuroscience and context of adolescent depression2016In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 105, no 4, 358-365 p.Article, review/survey (Refereed)
    Abstract [en]

    Adolescent depression is a growing public health concern with an increased risk of negative health outcomes, including suicide. The use of antidepressants and psychotherapy has not halted its increasing prevalence, and there is a critical need for effective prevention and treatment. We reviewed the neuroscience of adolescent depression, with a focus on the neurocircuitry of sustained threat and summarised contextual factors that have an impact on brain development and the pathophysiology of depression. We also reviewed novel treatment models.

    Conclusion: Attention to the relevant neurocircuitry and contextual factors implicated in adolescent depression is necessary to advance prevention and treatment development.

  • 35.
    Henje Blom, Eva
    et al.
    Karolinska Institutet, University of California San Francsisco.
    Olsson, E M
    Serlachius, E
    Ericson, M
    Ingvar, M
    Heart rate variability (HRV) in adolescent females with anxiety disorders and major depressive disorder.2010In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 99, no 4, 604-11 p.Article in journal (Refereed)
    Abstract [en]

    AIM: The aim of this study was to investigate heart rate variability (HRV) in a clinical sample of female adolescents with anxiety disorders (AD) and/or major depressive disorder (MDD) compared with healthy controls and to assess the effect of selective serotonin reuptake inhibitors (SSRI) on HRV.

    METHODS: Heart rate variability was measured in adolescent female psychiatric patients with AD and/or MDD (n = 69), mean age 16.8 years (range: 14.5-18.4), from 13 out-patient clinics and in healthy controls (n = 65), mean age 16.5 years (range: 15.9-17.7). HRV was registered in the sitting position during 4 min with no interventions.

    RESULTS: Logarithmically transformed high frequency HRV (HF), low frequency HRV (LF) and standard deviation of inter beat intervals (SDNN) were lower in the clinical sample compared with the controls (Cohen's d for HF = 0.57, LF = 0.55, SDNN = 0.60). This was not explained by body mass index, blood pressure or physical activity. Medication with SSRI explained 15.5% of the total variance of HF, 3.0% of LF and 6.5% of SDNN.

    CONCLUSIONS: Adolescent female psychiatric patients with AD and/or MDD show reduced HRV compared with healthy controls. Medication with SSRI explained a part of this difference.

  • 36. Heurlin, N
    et al.
    Dahlquist, Gisela
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Elinder, G
    Hammarström, L
    Petrini, B
    Fatal outcome of disseminated Mycobacterium avium infection in childhood. A case of primary incompetent monocyte/macrophage function?1996In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 85, no 12, 1511-1513 p.Article in journal (Refereed)
    Abstract [en]

    Disseminated BCG infection rarely heals, and disseminated disease caused by the Mycobacterium avium complex usually has a poor prognosis with a short time to death. The case of a boy who died after 9 years of diagnosed disseminated M. avium complex infection is described. He showed no signs of previously known immunodeficiency except an incompetent primary monocyte/macrophage function. This case has been commented on in Acta Paediatrica Scandinavia (1982) as "the first infant to survive a generalized BCG infection".

  • 37. Holm, S
    et al.
    Andersson, Yvonne
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Gothefors, Leif
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Lindberg, T
    Increased protein absorption after acute gastroenteritis in children.1992In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 81, no 8, 585-8 p.Article in journal (Refereed)
    Abstract [en]

    We investigated the intestinal absorption of the macromolecule human alpha-lactalbumin during and after an episode of acute gastroenteritis in children. Twenty children were studied in the acute phase and 17 excreted rotavirus. Eleven children were studied again 5-8 weeks later (convalescent phase). Human alpha-lactalbumin serum concentrations in the acute phase were similar but in the convalescent phase they were significantly (p less than 0.001) higher than those in the reference children. The serum concentrations were also higher in the convalescent than in the acute phase (p = 0.021). This study suggests that there is an increased absorption of proteins from the gut into the circulation 5-8 weeks after rotavirus gastroenteritis.

  • 38. Holowko, N.
    et al.
    Chaparro, M. P.
    Nilsson, Karina
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Mishra, G.
    Koupil, Ilona
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Department of Sociology. Centre for Health Equity Studies,Stockholm University/Karolinska Institutet, Stockholm.
    Goodman, A.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Department of Sociology.
    Social inequality in BMI change and gestational weight gain in the first and second pregnancy among women in Sweden2015In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 104, 3-4 p.Article in journal (Other academic)
  • 39.
    Holsti, Antti
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Adamsson, M.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Serenius, F.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Farooqi, Aijaz
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Two-thirds of adolescents who received active perinatal care after extremely preterm birth had mild or no disabilities2016In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 105, no 11, 1288-1297 p.Article in journal (Refereed)
    Abstract [en]

    Aim: Active perinatal care (APC) increases the survival of extremely preterm (EPT) infants, but may increase the rate of disabilities. We examined neurodevelopmental outcomes in adolescents aged 10-15 years who were born EPT and received APC in two Swedish tertiary care centres.

    Methods: Cognitive function was assessed using the Wechsler Intelligence Scale for Children, and neurosensory impairments were assessed by reviewing the case records and a standard parent health questionnaire. The outcomes were compared to term-born controls.

    Results: We assessed 132 EPT adolescents and 103 controls. The rates of cerebral palsy, moderate to severe visual impairment and moderate to severe hearing impairment were 9%, 4% and 6%, respectively, for the EPT children and zero for the controls. Serious cognitive impairment was present in 31% of the EPT adolescents and 5% of the controls. Combining impairments across domains showed that 34% of EPT adolescents had moderate and severe disabilities compared with 5% of the controls. Impairments were more common at 23-24 weeks of gestational age (43%) than at 25 weeks (28.4%).

    Conclusion: Two-thirds (66%) of adolescents born EPT who received APC had mild or no disabilities. Our results are relevant for healthcare providers and clinicians counselling families.

  • 40.
    Häger-Ross, Charlotte
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Rösblad, Birgit
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Norms for grip strength in children aged 4-16 years2002In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 91, no 6, 617-625 p.Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to provide norms for grip strength in children. A total of 530 Swedish 4-16-y-olds was tested with the instrument Grippit. The instrument estimates peak grip strength over a 10s period, and sustained grip strength averaged across the 10s. The increase in grip strength with age was approximately parallel for boys and girls until 10 y of age, after which boys were significantly stronger than girls. Strong correlations existed between grip strength and the anthropometric measures weight, height and, in particular, hand length. Right-handed children were significantly stronger in their dominant hand, while left-handers did not show any strength difference between the hands. It is therefore suggested that when evaluating grip strength in left-handed children both hands should be assumed to be about equally strong, while right-handed children are expected to be up to 10% stronger with their right hand. Sustained grip strength was consistently about 80-85% of peak grip strength, with somewhat lower values in younger children. The present normative data for peak grip strength were slightly lower than 1980s' data from the USA and Australia, probably because of divergences in age grouping and in instruments used. CONCLUSION: Norms for grip strength including estimates of variation were provided for children aged 4-16 y. These data will enable therapists and physicians to compare a patient's score with the scores of normally developed children according to age, gender, handedness and body measures.

  • 41.
    Håkansson, Stellan
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Källen, Karin
    Center for Reproductive Epidemiology, Tornblad Institute, Lund University.
    High maternal body mass index increases the risk of neonatal early onset group B streptococcal disease2008In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 97, no 10, 1386-1389 p.Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to analyse the occurrence of neonatal early onset group B streptococcal (EOGBS) disease relative to maternal body mass index (BMI).

    Method: A cohort of Swedish parturients with an early pregnancy BMI registered was investigated. Data were retrieved from population-based registers during 1997–2001, (n = 344 127, elective caesarean section excluded). Medical records of all infants with a diagnosis of EOGBS septicaemia (P36.0) were scrutinized for verification of the diagnosis. There were 136 cases with blood culture-positive septicaemia and 112 cases with clinical infection. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using multiple logistic regression.

    Results: In obese parturients with BMI > 30, there was an 80% increased risk for verified neonatal EOGBS disease (OR 1.8, 95% CI 1.1–3.0). When cases with clinical sepsis were included a significant risk increment was also found in overweight women with BMI 25.0–29.9 (OR 1.5, 95% CI 1.1–2.0).

    Conclusion: Maternal obesity and overweight are risk factors associated with increased risk of neonatal EOGBS disease.

  • 42. Högberg, L
    et al.
    Webb, C
    Fälth-Magnusson, K
    Forslund, T
    Magnusson, K-E
    Danielsson, L
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Sandström, Olof
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Sundqvist, T
    Children with screening-detected coeliac disease show increased levels of nitric oxide products in urine2011In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 100, no 7, 1023-1027 p.Article in journal (Refereed)
    Abstract [en]

    Aim: Increased concentration of nitric oxide (NO) metabolites, nitrite and nitrate, in the urine is a strong indication of ongoing small intestinal inflammation, which is a hallmark of the enteropathy of coeliac disease (CD). It has previously been shown that children with symptomatic, untreated CD have increased levels of NO oxidation products in their urine. The aim of this study was to investigate whether screening-detected, asymptomatic coeliac children display the same urinary nitrite/nitrate pattern.

    Methods: In a multicenter screening study, serum samples were collected from 7208 12-year-old children without previously diagnosed CD. Sera were analysed for anti-human tissue transglutaminase (tTG) of isotype IgA. Small bowel biopsy was performed in antibody-positive children, yielding 153 new cases of CD. In the screening-detected individuals, the sum of nitrite and nitrate concentrations in the urine was analysed and used as an indicator of NO production. For comparison, 73 children with untreated, symptomatic CD were studied.

    Results: The nitrite/nitrate levels in children with screening-detected CD and those with untreated symptomatic CD did not differ significantly. Both groups had significantly increased urinary nitrite/nitrate concentrations compared to the children with normal small bowel biopsy (p < 0.001).

    Conclusion: Children with screening-detected CD have increased production of NO just as children with untreated symptomatic CD. High NO metabolite levels in the urine may indicate a pathogenetic feature of CD and be a marker of major clinical importance.

  • 43. Irevall, T.
    et al.
    Axelsson, I.
    Naumburg, Estelle
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics. Östersund Hosp, Unit Res Educ & Dev, Östersund, Sweden.
    B12 deficiency is common in infants and is accompanied by serious neurological symptoms2017In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 106, no 1, 101-104 p.Article in journal (Refereed)
    Abstract [en]

    Aim: Adverse neurological symptoms have been linked to vitamin B12 deficiency in infants. This explorative study described the clinical presentation associated with vitamin B12 deficiency in this age group. Methods: The study comprised infants who were born between 2004 and 2012 and were tested for vitamin B12 levels after they were admitted to a hospital with neurological symptoms at less than one year of age. Vitamin B12 deficiency was defined as low cobalamin in serum and/or increased homocysteine and/or increased methylmalonate. It was diagnosed according to the applicable International Classification of Diseases, 10th revision, and recorded as vitamin B12 deficiency in the medical records. All information was retrieved from medical records and compared to symptomatic infants with normal levels. Results: Of the 121 infants tested, 35 had vitamin B12 deficiency and 86 had normal levels. Vitamin B12 deficiency was diagnosed at an average age of 1.7 months and was more common among boys. Seizures and apparent life-threatening events were the most common symptoms among infants with B12 deficiency compared to infants with normal levels. Conclusion: Vitamin B12 deficiency was more common in infants than we expected and presented with severe symptoms, such as seizures and apparent life-threatening events.

  • 44.
    Ivarsson, Anneli
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Högberg, L
    Stenhammar, L
    The Swedish Childhood Coeliac Disease Working Group after 20 years: history and future.2010In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 99, no 9, 1429-1431 p.Article in journal (Refereed)
  • 45. Ivarsson, S A
    et al.
    Carlsson, A
    Bredberg, A
    Alm, J
    Aronsson, S
    Gustafsson, J
    Hagenäs, L
    Häger, A
    Kriström, Berit
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Marcus, C
    Moëll, C
    Nilsson, K O
    Tuvemo, T
    Westphal, O
    Albertsson-Wikland, K
    Aman, J
    Prevalence of coeliac disease in Turner syndrome.1999In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 88, no 9, 933-6 p.Article in journal (Refereed)
    Abstract [en]

    This study was undertaken to investigate the prevalence of coeliac disease in children and adolescents with Turner syndrome. Eighty-seven children and adolescents with Turner syndrome were screened for IgA-antiendomysium antibodies (EMA) and IgA-antigliadin antibodies (AGA), 5% (4/87) being found to be EMA-positive, and 15% (13/87) to have AGA levels above normal. Of the 10 patients who were either AGA- or EMA-positive and further investigated with intestinal biopsy, four manifested villous atrophy (i.e. all three of the EMA-positive patients, but only one of the seven AGA-positive patients). The results suggest EMA-positivity to be a good immunological marker for use in screening for coeliac disease, and such screening to be justified in patients with Turner syndrome.

  • 46.
    Johansson Kostenniemi, Urban
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Norman, David
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Borgström, Malin
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Silfverdal, Sven Arne
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    The clinical presentation of acute bacterial meningitis varies with age, sex and duration of illness2015In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 104, no 11, 1117-1124 p.Article in journal (Refereed)
    Abstract [en]

    AIM: This Swedish study reviewed differences in clinical presentation and laboratory findings of acute bacterial meningitis in children aged one month to 17 years in Vasterbotten County, Sweden. METHODS: A register-based study was performed for the period 1986 to 2013 using the Vasterbotten County Council's patient registration and laboratory records at the Department of Laboratory Medicine at Umea University Hospital. The medical records were reviewed to extract data and confirm the diagnosis. RESULTS: We found 103 cases of acute bacterial meningitis, and Haemophilus influenzae was the most common pathogen, causing 40.8% of all cases, followed by Streptococcus pneumoniae at 30.1% and Neisseria meningitidis at 9.7%. Significant differences in clinical presentation and laboratory findings were found. Younger children were more unwell than older ones and had more diffuse symptoms on admission. In addition, important sex-related differences were found that might explain the higher case fatality rates for boys than girls. For example, boys tended to have a higher disturbance in the blood-brain barrier, which is known to be a negative prognostic factor. CONCLUSION: This study showed that clinical presentation for acute bacterial meningitis varied with age and sex and, to a lesser extent, on the duration of the illness.

  • 47.
    Karling, Mats
    et al.
    Umeå University, Faculty of Medicine, Surgical and Perioperative Sciences.
    Renström, Maria
    Ljungman, Gustaf
    Acute and postoperative pain in children: a Swedish nationwide survey2002In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 91, no 6, 660-666 p.Article in journal (Refereed)
  • 48.
    Karling, Mats
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Stenlund, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Behavioural changes after anaesthesia: validity and liability of the Post Hospitalization Behavior Questionnaire in a Swedish paediatric population.2006In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 95, no 3, 340-346 p.Article in journal (Refereed)
    Abstract [en]

    AIM: To study the validity and liability of a Swedish translation of the Post Hospitalization Behavior Questionnaire (PHBQ) in children in Sweden. METHODS: The PHBQ was translated using a back-translation method. The subjects were 340 children, ages 2-13 y, admitted for elective surgery or diagnostic procedure with anaesthesia. The results were analysed using exploratory factor analysis with principal component analysis with Oblimin rotation. The fit to data was examined using confirmative factor analysis with a good measure of fit for the model (p>0.09 for all factors). RESULTS: Five factors emerged as being most consistent: general anxiety-withdrawal, eating disturbances, separation anxiety, regression-aggression and sleep anxiety. A panel of child psychologists confirmed the face validity of factors. Internal consistency (Chronbach's alpha) was adequate (0.75-0.87) for subscales and excellent for total score (0.93). Children less than 5 y old had higher scores than older children (mean 0.046+/-0.018 vs -0.0089+/-0.014, p<0.001). There were no gender differences. CONCLUSION: The results support a conclusion that a five-factor model better fits data from Swedish children than the original six-factor model.

  • 49.
    Karlsson, Björn-Markus
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Lindkvist, Marie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Lindkvist, Markus
    Karlsson, Marcus
    Lundström, Ronnie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Håkansson, Stellan
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Wiklund, Urban
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics.
    van den Berg, Johannes
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Sound and vibration: effects on infants' heart rate and heart rate variability during neonatal transport2012In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 101, no 2, 148-154 p.Article in journal (Refereed)
    Abstract [en]

    Aim: To measure the effect of sound and whole-body vibration on infants' heart rate and heart rate variability during ground and air ambulance transport.

    Methods: Sixteen infants were transported by air ambulance with ground ambulance transport to and from the airports. Whole-body vibration and sound levels were recorded and heart parameters were obtained by ECG signal.

    Results: Sound and whole-body vibration levels exceeded the recommended limits. Mean whole-body vibration and sound levels were 0.19m/s(2) and 73dBA, respectively. Higher whole-body vibration was associated with a lower heart rate (p<0.05), and higher sound level was linked to a higher heart rate (p=0.05). The heart rate variability was significantly higher at the end of the transport than at the beginning (p<0.01). Poorer physiologic status was associated with lower heart rate variability (p<0.001) and a lower heart rate (p<0.01). Infants wearing earmuffs had a lower heart rate (p<0.05).

    Conclusions: Sound and whole-body vibration during neonatal transport exceed recommended levels for adults and sound seem to have a more stressful effect on the infant than vibrations. Infants should wear earmuffs during neonatal transport because of the stress reducing effect.

  • 50.
    Kriström, Berit
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Karlberg, J
    Albertsson-Wikland, K
    Prediction of the growth response of short prepubertal children treated with growth hormone. Swedish Paediatric Study Group for GH treatment.1995In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 84, no 1, 51-7 p.Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to identify predictors of the growth response to growth hormone (GH) during the first 2 years of GH treatment, using auxological data and the maximum GH response (GHmax) to provocation tests. The patients were 169 prepubertal short children (27F, 142M), with Gmax values ranging from 0 to 65 mU/l. Their mean age (+/- SD) was 8.3 +/- 2.4 years (range 3-13 years), mean height SDS -3.0 +/- 0.7 (range -1.5 to -6.0 SDS) and mean pretreatment height velocity was normal (+/- 0.0 SDS) (range -1.6 to +0.9 SDS). The increase in height SDS during the first 2 years of GH treatment (0.1 U/kg/day) varied from 0.10 to 3.75 SDS, with younger children having a better growth response. Individual growth responses correlated (p < 0.001) with GHmax (r = -0.37), age (r = -0.35), 1-year pretreatment delta SDS (r = -0.25), mid-parental height SDS (r = 0.34), height SDS at start of treatment (r = -0.22) and difference between height SDS of an individual child at the onset of GH treatment and mid-parental height expressed in SDS (diff SDS) (r = -0.43). In a multiple stepwise linear regression model, diff SDS and log GHmax were found to be the strongest predictors of the magnitude of the growth response. In the short children in this study who exhibited a broad range of GHmax values, 33% of the growth response during the first 2 years of treatment could be predicted.

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