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  • 1. Alken, Jenny
    et al.
    Håkansson, Stellan
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Ekeus, Cecilia
    Gustafson, Pelle
    Norman, Mikael
    Rates of Extreme Neonatal Hyperbilirubinemia and Kernicterus in Children and Adherence to National Guidelines for Screening, Diagnosis, and Treatment in Sweden2019Ingår i: JAMA Network Open, E-ISSN 2574-3805, Vol. 2, nr 3, artikel-id e190858Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    IMPORTANCE Neonatal hyperbilirubinemia can cause lifelong neurodevelopmental impairment (kernicterus) even in high-resource settings. A better understanding of the incidence and processes leading to kernicterus may help in the design of preventive measures. OBJECTIVES To determine incidence rates of hazardous hyperbilirubinemia and kernicterus among near-term to term newborns and to evaluate health care professional adherence to best practices. DESIGN, SETTING, AND PARTICIPANTS This population-based nationwide cohort study used prospectively collected data on the highest serum bilirubin level for all infants born alive at 35 weeks' gestation or longer and admitted to neonatal care at all 46 delivery and 37 neonatal units in Sweden from 2008 to 2016. Medical records for newborns with hazardous hyperbilirubinemia were evaluated for best neonatal practices and for a diagnosis of kernicterus up to 2 years of age. Data analyses were performed between September 2017 and February 2018. EXPOSURES Extreme (serum bilirubin levels, 25.0-29.9mg/dL [425-509 mu mol/L]) and hazardous (serum bilirubin levels, >30.0mg/dL [>510 mu mol/L]) neonatal hyperbilirubinemia. MAIN OUTCOMES AND MEASURES The primary outcome was kernicterus, defined as hazardous neonatal hyperbilirubinemia followed by cerebral palsy, sensorineural hearing loss, gaze paralysis, or neurodevelopmental retardation. Secondary outcomeswere health care professional adherence to national guidelines using a predefined protocol with 10 key performance indicators for diagnosis and treatment as well as assessment of whether bilirubin-associated brain damage might have been avoidable. RESULTS Among 992 378 live-born infants (958 051 term births and 34 327 near-term births), 494 (320 boys; mean [SD] birth weight, 3505 [527] g) developed extreme hyperbilirubinemia (50 per 100 000 infants), 6.8 per 100 000 infants developed hazardous hyperbilirubinemia, and 1.3 per 100 000 infants developed kernicterus. Among 13 children developing kernicterus, brain injury was assessed as potentially avoidable for 11 children based on the presence of 1 or several of the following possible causes: untimely or lack of predischarge bilirubin screening (n = 6), misinterpretation of bilirubin values (n = 2), untimely or delayed initiation of treatment with intensive phototherapy (n = 1), untimely or no treatment with exchange transfusion (n = 6), or lack of repeated exchange transfusions despite indication (n = 1). CONCLUSIONS AND RELEVANCE Hazardous hyperbilirubinemia in near-term or term newborns still occurs in Sweden and was associated with disabling brain damage in 13 per million births. For most of these cases, health care professional noncompliance with best practices was identified, suggesting that a substantial proportion of these cases might have been avoided.

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  • 2.
    Björklund, Verna
    et al.
    New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
    Saxén, Harri
    New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
    Hertting, Olof
    Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
    Malchau Carlsen, Emma Louise
    Department of Intensive Care for Newborns and Infants, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
    Hoffmann, Steen
    Neisseria and Streptococcus Reference Laboratory, Department of Bacteria, Statens Serum Institut, Copenhagen, Denmark.
    Håkansson, Stellan
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Stefánsson Thors, Valtýr
    University of Iceland, Faculty of Medicine, Reykjavik, Iceland; Children's Hospital Iceland, Landspitali University Hospital, Reykjavik, Iceland.
    Haraldsson, Ásgeir
    University of Iceland, Faculty of Medicine, Reykjavik, Iceland; Children's Hospital Iceland, Landspitali University Hospital, Reykjavik, Iceland.
    Brigtsen, Anne Karin
    Department of Neonatal Intensive Care, Clinic of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.
    Döllner, Henrik
    Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Children's Clinic, St. Olavs University Hospital, Trondheim, Norway.
    Huhtamäki, Heikki
    Research Service Unit, Oulu University Hospital, Oulu, Finland; Department of Paediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland.
    Pokka, Tytti
    Research Service Unit, Oulu University Hospital, Oulu, Finland; Department of Paediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland.
    Ruuska, Terhi Susanna
    Department of Paediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland; Biocenter Oulu and Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland.
    Early-onset group B streptococcal infections in five Nordic countries with different prevention policies, 1995 to 20192024Ingår i: Eurosurveillance, ISSN 1025-496X, E-ISSN 1560-7917, Vol. 29, nr 3, artikel-id 2300193Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Neonatal early-onset disease caused by group B Streptococcus (GBS) is a leading cause of infant morbidity. Intrapartum antibiotic prophylaxis (IAP) is effective in preventing early-onset GBS disease, but there is no agreement on the optimal strategy for identifying the pregnant women requiring this treatment, and both risk-based prophylaxis (RBP) and GBS screening-based prophylaxis (SBP) are used.

    Aim: The aim of this study was to evaluate the effect of SBP as a public health intervention on the epidemiology of early-onset GBS infections.

    Methods: In 2012, Finland started the universal SBP, while Denmark, Iceland, Norway and Sweden continued with RBP. We conducted an interrupted time series analysis taking 2012 as the intervention point to evaluate the impact of this intervention. The incidences of early- and late-onset GBS infections during Period I (1995-2011) and Period II (2012-2019) were collected from each national register, covering 6,605,564 live births.

    Results: In Finland, a reduction of 58% in the incidence of early-onset GBS disease, corresponding to an incidence rate ratio (IRR) of 0.42 (95% CI: 0.34-0.52), was observed after 2012. At the same time, the pooled IRR of other Nordic countries was 0.89 (95% CI: 0.80-1.0), specifically 0.89 (95% CI: 0.70-1.5) in Denmark, 0.34 (95% CI: 0.15-0.81) in Iceland, 0.72 (95% CI: 0.59-0.88) in Norway and 0.97 (95% CI: 0.85-1.1) in Sweden.

    Conclusions: In this ecological study of five Nordic countries, early-onset GBS infections were approximately halved following introduction of the SBP approach as compared with RBP.

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  • 3.
    Björkström, Markus V
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Hall, Lina
    Söderlund, Stina
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Håkansson, Eva Grahn
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi, Klinisk bakteriologi.
    Håkansson, Stellan
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Domellöf, Magnus
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Intestinal flora in very low-birth weight infants2009Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 98, nr 11, s. 1762-1767Artikel i tidskrift (Refereegranskat)
    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.

  • 4.
    Bonnevier, Anna
    et al.
    Lasarettet i Ystad, Ystad, Sweden.
    Björklund, Lars
    Skånes universitetssjukhus Lund, Lund, Sweden.
    Elfvin, Anders
    Sahlgrenska universitetssjukhuset, Göteborg, Sweden Sahlgrenska universitetssjukhuset - Göteborg, Sweden.
    Håkansson, Stellan
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Altman, Maria
    Karolinska Universitetssjukhuset, Stockholm, Sweden.
    Att födas några veckor för tidigt – spelar det någon roll?: [Born a few weeks too early; does it matter?]2019Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 116, artikel-id FSR7Artikel i tidskrift (Refereegranskat)
    Abstract [sv]

    Lätt och måttligt underburna barn utgör mer än 80 procent av för tidigt födda och svarar för nästan 40 procent av alla neonatala vårddygn. En allt större del av vårdtiden utgörs nu av hemvård. I nyföddhetsperioden drabbas dessa barn ofta av andningsstörningar, hypoglykemi, hypotermi och uppfödningssvårigheter. Jämfört med fullgångna har de ökad risk för perinatal död och neurologiska komplikationer. På längre sikt har dessa barn ökad risk för kognitiv nedsättning, neuropsykiatriska diagnoser och lungproblem. I vuxen ålder har de, jämfört med fullgångna, genomsnittligt lägre utbildningsgrad och inkomst och ökad risk att behöva långtidssjukskrivning, socialbidrag eller handikappersättning.

  • 5.
    Challis, Pontus
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Källén, Karin
    Department of Clinical Sciences, Obstetrics and Gynecology, Lund University Faculty of Medicine, Lund, Sweden.
    Björklund, Lars
    Department of Clinical Sciences, Paediatrics, Lund University, Lund, Sweden.
    Elfvin, Anders
    Department of Pediatrics, Institute of Clinical Sciences, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden; Department of Pediatrics, Sahlgrenska University Hospital, Göteborg, Sweden.
    Farooqi, Aijaz
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Håkansson, Stellan
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Ley, David
    Department of Clinical Sciences, Paediatrics, Lund University, Lund, Sweden.
    Norman, Mikael
    Division of Pediatrics, Department of Clinical Science, Technology, Karolinska Institutet, Stockholm, Sweden; Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden.
    Normann, Erik
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Serenius, Fredrik
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik. Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Sävman, Karin
    Department of Pediatrics, Institute of Clinical Sciences, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden.
    Hellström-Westas, Lena
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Um-Bergström, Petra
    Department of Pediatrics, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden; Clinical Science and Education at Södersjukhuset, Karolinska Institute, Stockholm, Sweden.
    Ådén, Ulrika
    Division of Pediatrics, Department of Clinical Science, Technology, Karolinska Institutet, Stockholm, Sweden; Departments of Biomedical and Clinical Sciences and Pediatrics, Linköping University, Linköping, Sweden.
    Abrahamsson, Thomas
    Departments of Biomedical and Clinical Sciences and Pediatrics, Linköping University, Linköping, Sweden; Department of Pediatrics, Linköping University Hospital, Linköping, Sweden.
    Domellöf, Magnus
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Factors associated with the increased incidence of necrotising enterocolitis in extremely preterm infants in Sweden between two population-based national cohorts (2004-2007 vs 2014-2016)2023Ingår i: Archives of Disease in Childhood: Fetal and Neonatal Edition, ISSN 1359-2998, E-ISSN 1468-2052, Vol. 109, nr 1, s. 87-93Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To investigate potential risk factors behind the increased incidence of necrotising enterocolitis (NEC) in Swedish extremely preterm infants.

    DESIGN: Registry data from two population-based national cohorts were studied. NEC diagnoses (Bell stage ≥II) were validated against hospital records.

    PATIENTS: All liveborn infants <27 weeks of gestation 2004-2007 (n=704) and 2014-2016 (n=895) in Sweden.

    MAIN OUTCOME MEASURES: NEC incidence.

    RESULTS: The validation process resulted in a 28% reduction of NEC cases but still confirmed a higher NEC incidence in the later epoch compared with the earlier (73/895 (8.2%) vs 27/704 (3.8%), p=0.001), while the composite of NEC or death was lower (244/895 (27.3%) vs 229/704 (32.5%), p=0.022). In a multivariable Cox regression model, censored for mortality, there was no significant difference in early NEC (0-7 days of life) between epochs (HR=0.9 (95% CI 0.5 to 1.9), p=0.9), but being born in the later epoch remained an independent risk factor for late NEC (>7 days) (HR=2.7 (95% CI 1.5 to 5.0), p=0.001). In propensity score analysis, a significant epoch difference in NEC incidence (12% vs 2.8%, p<0.001) was observed only in the tertile of infants at highest risk of NEC, where the 28-day mortality was lower in the later epoch (35% vs 50%, p=0.001). More NEC cases were diagnosed with intramural gas in the later epoch (33/73 (45.2%) vs 6/26 (23.1%), p=0.047).

    CONCLUSIONS: The increase in NEC incidence between epochs was limited to cases occurring after 7 days of life and was partly explained by increased survival in the most extremely preterm infants. Misclassification of NEC is common.

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  • 6.
    Challis, Pontus
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Nydert, Per
    Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Neonatology, Karolinska University Hospital, Stockholm, Sweden.
    Håkansson, Stellan
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Norman, Mikael
    Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Neonatology, Karolinska University Hospital, Stockholm, Sweden.
    Association of Adherence to Surfactant Best Practice Uses with Clinical Outcomes among Neonates in Sweden2021Ingår i: JAMA Network Open, E-ISSN 2574-3805, Vol. 4, nr 5, artikel-id e217269Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Importance: While surfactant therapy for respiratory distress syndrome (RDS) in preterm infants has been evaluated in clinical trials, less is known about how surfactant is used outside such a framework.

    Objective: To evaluate registered use, off-label use, and omissions of surfactant treatment by gestational age (GA) and associations with outcomes, mainly among very preterm infants (GA <32 weeks).

    Design, Setting, and Participants: This population-based cohort study used registry data for 97377 infants born in Sweden between 2009 and 2018. Infants did not have malformations and were admitted for neonatal care. Data analysis was conducted from June 2019 to June 2020.

    Exposures: Timing and number of surfactant administrations, off-label use, and omission of use. Registered use was defined by drug label (1-3 administrations for RDS). Omissions were defined as surfactant not administered despite mechanical ventilation for RDS.

    Main Outcome and Measures: In-hospital survival, pneumothorax, intraventricular hemorrhage grade 3 to 4, duration of mechanical ventilation, use of postnatal systemic corticosteroids for lung disease, treatment with supplemental oxygen at 28 days' postnatal age and at 36 weeks' postmenstrual age. Odds ratios (ORs) were calculated and adjusted for any prenatal corticosteroid treatment, cesarean delivery, GA, infant sex, Apgar score at 10 minutes, and birth weight z score of less than -2.

    Results: In total, 7980 surfactant administrations were given to 5209 infants (2233 [42.9%] girls; 2976 [57.1%] boys): 629 (12.1%) born at full term, 691 (13.3%) at 32 to 36 weeks' GA, 1544 (29.6%) at 28 to 31 weeks' GA, and 2345 (45.0%) at less than 28 weeks' GA. Overall, 977 infants (18.8%) received off-label use. In 1364 of 3508 infants (38.9%) with GA of 22 to 31 weeks, the first administration of surfactant was given more than 2 hours after birth, and this was associated with higher odds of pneumothorax (adjusted OR [aOR], 2.59; 95% CI, 1.76-3.83), intraventricular hemorrhage grades 3 to 4 (aOR, 1.71; 95% CI, 1.23-2.39), receipt of postnatal corticosteroids (aOR, 1.57; 95% CI, 1.22-2.03), and longer duration of assisted ventilation (aOR, 1.34; 95% CI, 1.04-1.72) but also higher survival (aOR, 1.45; 95% CI, 1.10-1.91) than among infants treated within 2 hours of birth. In 146 infants (2.8%), the recommended maximum of 3 surfactant administrations was exceeded but without associated improvements in outcome. Omission of surfactant treatment occurred in 203 of 3551 infants (5.7%) who were receiving mechanical ventilation and was associated with lower survival (aOR, 0.49; 95% CI, 0.30-0.82). In full-term infants, 336 (53.4%) of those receiving surfactant had a diagnosis of meconium aspiration syndrome. Surfactant for meconium aspiration was not associated with improved neonatal outcomes.

    Conclusions and Relevance: In this study, adherence to best practices and labels for surfactant use in newborn infants varied, with important clinical implications for neonatal outcomes.

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  • 7. Darlow, Brian A
    et al.
    Lui, Kei
    Kusuda, Satoshi
    Reichman, Brian
    Håkansson, Stellan
    Swedish Neonatal Quality Register, Department of Pediatrics/Neonatal Services, Umeå University Hospital, Umeå, Sweden.
    Bassler, Dirk
    Modi, Neena
    Lee, Shoo K
    Lehtonen, Liisa
    Vento, Maximo
    Isayama, Tetsuya
    Sjörs, Gunnar
    Helenius, Kjell K
    Adams, Mark
    Rusconi, Franca
    Morisaki, Naho
    Shah, Prakesh S
    International variations and trends in the treatment for retinopathy of prematurity2017Ingår i: British Journal of Ophthalmology, ISSN 0007-1161, E-ISSN 1468-2079, Vol. 101, nr 10, s. 1399-1404Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To compare the rates of retinopathy of prematurity (ROP) and treatment of ROP by laser or intravitreal anti-vascular endothelial growth factor among preterm neonates from high-income countries participating in the International Network for Evaluating Outcomes (iNeo) of neonates.

    METHODS: weeks' gestation who were admitted to neonatal units in Australia/New Zealand, Canada, Finland, Israel, Japan, Spain, Sweden, Switzerland, Tuscany (Italy) and the UK between 2007 and 2013. Pairwise comparisons of ROP treatment in survivors between countries were evaluated by Poisson and multivariable logistic regression analyses after adjustment for confounders. A composite outcome of death or ROP treatment was compared between countries using logistic regression and standardised ratios.

    RESULTS: Of 48 087 infants included in the analysis, 81.8% survived to 32 weeks postmenstrual age, and 95% of survivors were screened for ROP. Rates of any ROP ranged from 25.2% to 91.0% in Switzerland and Japan, respectively, among those examined. The overall rate of those receiving treatment was 24.9%, which varied from 4.3% to 30.4%. Adjusted risk ratios for ROP treatment were lower for Switzerland in all pairwise comparisons, whereas Japan displayed significantly higher ratios. Comparisons of the composite outcome between countries revealed similar, but less marked differences.

    CONCLUSIONS: Rates of any ROP and ROP treatment varied significantly between iNeo members, while an overall decline in ROP treatment was observed during the study period. It is unclear whether these variations represent differences in care practices, diagnosis and/or treatment thresholds.

  • 8. Darlow, Brian A
    et al.
    Vento, Máximo
    Beltempo, Marc
    Lehtonen, Liisa
    Håkansson, Stellan
    Swedish Neonatal Quality Register, Department of Pediatrics/Neonatal Services, Umeå University Hospital, Umeå, Sweden.
    Reichman, Brian
    Helenius, Kjell
    Sjörs, Gunnar
    Sigali, Emilio
    Lee, Shoo
    Noguchi, Akihiko
    Morisaki, Naho
    Kusuda, Satoshi
    Bassler, Dirk
    San Feliciano, Laura
    Adams, Mark
    Isayama, Tetsuya
    Shah, Prakesh S
    Lui, Kei
    Variations in Oxygen Saturation Targeting, and Retinopathy of Prematurity Screening and Treatment Criteria in Neonatal Intensive Care Units: An International Survey2018Ingår i: Neonatology, ISSN 1661-7800, E-ISSN 1661-7819, Vol. 114, nr 4, s. 323-331Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Rates of retinopathy of prematurity (ROP) and ROP treatment vary between neonatal intensive care units (NICUs). Neonatal care practices, including oxygen saturation (SpO2) targets and criteria for the screening and treatment of ROP, are potential contributing factors to the variations.

    OBJECTIVES: To survey variations in SpO2 targets in 2015 (and whether there had been recent changes) and criteria for ROP screening and treatment across the networks of the International Network for Evaluating Outcomes in Neonates (iNeo).

    METHODS: Online prepiloted questionnaires on treatment practices for preterm infants were sent to the directors of 390 NICUs in 10 collaborating iNeo networks. Nine questions were asked and the results were summarized and compared.

    RESULTS: Overall, 329/390 (84%) NICUs responded, and a majority (60%) recently made changes in upper and lower SpO2 target limits, with the median set higher than previously by 2-3% in 8 of 10 networks. After the changes, fewer NICUs (15 vs. 28%) set an upper SpO2 target limit > 95% and fewer (3 vs. 5%) a lower limit < 85%. There were variations in ROP screening criteria, and only in the Swedish network did all NICUs follow a single guideline. The initial retinal examination was carried out by an ophthalmologist in all but 6 NICUs, and retinal photography was used in 20% but most commonly as an adjunct to indirect ophthalmoscopy.

    CONCLUSIONS: There is considerable variation in SpO2 targets and ROP screening and treatment criteria, both within networks and between countries.

  • 9. Di Renzo, G C
    et al.
    Melin, P
    Berardi, A
    Blennow, M
    Carbonell-Estrany, X
    Donzelli, G P
    Håkansson, Stellan
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Hod, M
    Hughes, R
    Kurtzer, M
    Poyart, C
    Shinwell, E
    Stray-Pedersen, B
    Wielgos, M
    El Helali, N
    Intrapartum GBS screening and antibiotic prophylaxis: a European consensus conference2015Ingår i: The Journal of Maternal-Fetal & Neonatal Medicine, ISSN 1476-7058, E-ISSN 1476-4954, Vol. 7-8, s. 766-782Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Abstract Group B streptococcus (GBS) remains worldwide a leading cause of severe neonatal disease. Since the end of the 1990s, various strategies for prevention of the early onset neonatal disease have been implemented and have evolved. When a universal antenatal GBS screening-based strategy is used to identify women who are given an intrapartum antimicrobial prophylaxis, a substantial reduction of incidence up to 80% has been reported in the USA as in other countries including European countries. However recommendations are still a matter of debate due to challenges and controversies on how best to identify candidates for prophylaxis and to drawbacks of intrapartum administration of antibiotics. In Europe, some countries recommend either antenatal GBS screening or risk-based strategies, or any combination, and others do not have national or any other kind of guidelines for prevention of GBS perinatal disease. Furthermore, accurate population-based data of incidence of GBS neonatal disease are not available in some countries and hamper good effectiveness evaluation of prevention strategies. To facilitate a consensus towards European guidelines for the management of pregnant women in labor and during pregnancy for the prevention of GBS perinatal disease, a conference was organized in 2013 with a group of experts in neonatology, gynecology-obstetrics and clinical microbiology coming from European representative countries. The group reviewed available data, identified areas where results were suboptimal, where revised procedures and new technologies could improve current practices for prevention of perinatal GBS disease. The key decision issued after the conference is to recommend intrapartum antimicrobial prophylaxis based on a universal intrapartum GBS screening strategy using a rapid real time testing.

  • 10.
    Ellberg, Lotta
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi. Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Högberg, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Lundman, Berit
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Källén, Karin
    Department of Reproductive Epidemiology, Tornblad Institute, Lund University, Lund, Sweden.
    Håkansson, Stellan
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Lindh, Viveca
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Maternity care options influences readmission of newborns2008Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 97, nr 5, s. 579-583Artikel i tidskrift (Refereegranskat)
    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.

  • 11.
    Farooqi, Aijaz
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Håkansson, Stellan
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik. Pediatrics, Swedish Neonatal Quality Register, Umeå Universitet, Umeå, Sweden.
    Serenius, Fredrik
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Kallen, Karin
    Department of Reproductive Epidemiology, Lund University, Lund, Sweden.
    Björklund, Lars
    Departments of Clinical Sciences and Pediatrics, Skåne University Hospital Lund, Lund, Sweden.
    Normann, Erik
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Domellöf, Magnus
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Ådén, Ulrika
    Woman and Child Health, Karolinska Institute, Stockholm, Sweden.
    Abrahamsson, Thomas
    Department of Biomedical and Clinical Sciences, Pediatrics, Linköping University, Linköping, Sweden.
    Elfvin, Anders
    Department of Pediatrics, Institute of Clinical Sciences, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden; Department of Pediatrics, Sahlgrenska University Hospital, Göteborg, Sweden.
    Sävman, Karin
    Department of Pediatrics, Sahlgrenska University Hospital, Göteborg, Sweden.
    Bergström, Petra Um
    Clinical Science and Education at Sodersjukhuset, Karolinska Institute, Stockholm, Sweden.
    Stephansson, Olof
    Departments of Medicine and Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden.
    Ley, David
    Department of Clinical Sciences, Pediatrics, Lund University, Lund, Sweden.
    Hellstrom-Westas, Lena
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Norman, Mikael
    Neonatal Medicine, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden; Department of Clinical Sciences Intervention and Technology, Karolinska Institute, Stockholm, Sweden.
    One-year survival and outcomes of infants born at 22 and 23 weeks of gestation in Sweden 2004-2007, 2014-2016 and 2017-20192024Ingår i: Archives of Disease in Childhood: Fetal and Neonatal Edition, ISSN 1359-2998, E-ISSN 1468-2052, Vol. 109, nr 1, s. 10-17Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

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

  • 12. Gagliardi, Luigi
    et al.
    Rusconi, Franca
    Reichman, Brian
    Adams, Mark
    Modi, Neena
    Lehtonen, Liisa
    Kusuda, Satoshi
    Vento, Maximo
    Darlow, Brian A.
    Bassler, Dirk
    Isayama, Tetsuya
    Norman, Mikael
    Håkansson, Stellan
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Lee, Shoo K.
    Lui, Kei
    Yang, Junmin
    Shah, Prakeshkumar
    Neonatal outcomes of extremely preterm twins by sex pairing: an international cohort study2021Ingår i: Archives of Disease in Childhood: Fetal and Neonatal Edition, ISSN 1359-2998, E-ISSN 1468-2052, Vol. 106, nr 1, s. F17-F24Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective Infant boys have worse outcomes than girls. In twins, the 'male disadvantage' has been reported to extend to female co-twins via a 'masculinising' effect. We studied the association between sex pairing and neonatal outcomes in extremely preterm twins. Design Retrospective cohort study Setting Eleven countries participating in the International Network for Evaluating Outcomes of Neonates. Patients Liveborn twins admitted at 23-29 weeks' gestation in 2007-2015. Main outcome measures We examined in-hospital mortality, grades 3/4 intraventricular haemorrhage or cystic periventricular leukomalacia (IVH/PVL), bronchopulmonary dysplasia (BPD), retinopathy of prematurity requiring treatment and a composite outcome (mortality or any of the outcomes above). Results Among 20 924 twins, 38% were from male-male pairs, 32% were from female-female pairs and 30% were sex discordant. We had no information on chorionicity. Girls with a male co-twin had lower odds of mortality, IVH/PVL and the composite outcome than girl-girl pairs (reference group): adjusted OR (aOR) (95% CI) 0.79 (0.68 to 0.92), 0.83 (0.72 to 0.96) and 0.88 (0.79 to 0.98), respectively. Boys with a female co-twin also had lower odds of mortality: aOR 0.86 (0.74 to 0.99). Boys from male-male pairs had highest odds of BPD and composite outcome: aOR 1.38 (1.24 to 1.52) and 1.27 (1.16 to 1.39), respectively. Conclusions Sex-related disparities in outcomes exist in extremely preterm twins, with girls having lower risks than boys and opposite-sex pairs having lower risks than same-sex pairs. Our results may help clinicians in assessing risk in this large segment of extremely preterm infants.

  • 13. Gemmell, L
    et al.
    Martin, L
    Murphy, K E
    Modi, N
    Håkansson, Stellan
    Swedish Neonatal Quality Register, Department of Pediatrics/ Neonatal Services, Umeå University Hospital, Umeå, Sweden.
    Reichman, B
    Lui, K
    Kusuda, S
    Sjörs, G
    Mirea, L
    Darlow, B A
    Mori, R
    Lee, S K
    Shah, P S
    Hypertensive disorders of pregnancy and outcomes of preterm infants of 24 to 28 weeks' gestation2016Ingår i: Journal of Perinatology, ISSN 0743-8346, E-ISSN 1476-5543, Vol. 36, nr 12, s. 1067-1072Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To examine the relationship between hypertensive disorders of pregnancy (HDPs) and mortality and major morbidities in preterm neonates born at 24 to 28 weeks of gestation.

    STUDY DESIGN: weeks of gestation during 2007 to 2010 from 6 national neonatal databases. The incidence of HDP was compared across countries, and multivariable logistic regression analyses were conducted to examine the association of HDP and neonatal outcomes including mortality to discharge, bronchopulmonary dysplasia, severe brain injury, necrotizing enterocolitis and treated retinopathy of prematurity.

    RESULTS: The incidence of HDP in the entire cohort was 13% (range 11 to 16% across countries). HDP was associated with reduced odds of mortality (adjusted odds ratio (aOR) 0.77; 95% confidence interval (CI) 0.67 to 0.88), severe brain injury (aOR 0.74; 95% CI 0.62 to 0.89) and treated retinopathy (aOR 0.82; 95% CI 0.70 to 0.96), but increased odds of bronchopulmonary dysplasia (aOR 1.16; 95% CI 1.05 to 1.27).

    CONCLUSIONS: In comparison with neonates born to mothers without HDP, neonates of HDP mothers had lower odds of mortality, severe brain injury and treated retinopathy, but higher odds of bronchopulmonary dysplasia. The impact of maternal HDP on newborn outcomes was inconsistent across outcomes and among countries; therefore, further international collaboration to standardize terminology, case definition and data capture is warranted.

  • 14.
    Granlund, Margareta
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi, Klinisk bakteriologi.
    Axemo, P
    Bremme, K
    Bryngelsson, A-L
    Carlsson Wallin, M
    Ekström, C-M
    Håkansson, Stellan
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Jacobsson, B
    Källén, K
    Spetz, E
    Tessin, I
    Antimicrobial resistance in colonizing group B Streptococci before the implementation of a Swedish intrapartum antibiotic prophylaxis program2010Ingår i: European Journal of Clinical Microbiology and Infectious Diseases, ISSN 0934-9723, E-ISSN 1435-4373, Vol. 29, nr 10, s. 1195-1201Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The prevalence of antibiotic resistance and their genetic determinants in colonizing group B streptococci (GBS) sampled in a Swedish nationwide survey was examined. In five GBS isolates (1.3%), kanamycin/amikacin resistance and the presence of the aphA-3 gene was identified. Three of these isolates carried the aad-6 gene and were streptomycin-resistant. Screening with kanamycin and streptomycin 1,000-μg disks enabled a rapid and easy detection of these isolates. In all, 312/396 (79%) GBS were tetracycline-resistant and 95% of the examined isolates harbored the tetM gene. Among the 22 (5.5%) GBS resistant to erythromycin and/or clindamycin, the ermB gene was detected in nine isolates (41%) and erm(A/TR) in ten isolates (45%). A high level of erythromycin and clindamycin resistance with minimum inhibitory concentrations (MICs) >256 mg/L was found in four serotype V isolates that harbored ermB. The erythromycin/clindamycin resistance was distributed among all of the common serotypes Ia, Ib, II, III, IV, and V, but was not present in any of the 44 serotype III isolates associated to clonal complex 17. Screening for penicillin resistance with 1-μg oxacillin disks showed a homogenous population with a mean inhibition zone of 20 mm. A change in the present oxacillin breakpoints for GBS is suggested.

  • 15. Grunewald, Charlotta
    et al.
    Håkansson, Stellan
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Högberg, Ulf
    Luthander, Charlotte Millde
    Sandin-Bojö, Ann-Kristin
    Wiklund, Ingela
    Svensk förlossningsvård säkras i ett rikstäckande projekt: tvärprofessionell samverkan en grundpelare i »Säker förlossningsvård«2012Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 109, nr 19, s. 956-959Artikel i tidskrift (Refereegranskat)
  • 16. Grunewald, Charlotta
    et al.
    Håkansson, Stellan
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Saltvedt, Sissel
    Källén, Karin
    Significant effects on neonatal morbidity and mortality after regional change in management of post-term pregnancy2011Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 90, nr 1, s. 26-32Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective. To evaluate the effects on neonatal morbidity of a regional change in induction policy for post-term pregnancy from 43(+0) to 42(+0) gestational weeks (GWs).

    Design and setting. Nationwide retrospective register study between 2000 and 2007. Population. All singleton pregnancies with a gestational age of >41(+2) GW (n= 119,198).

    Methods. All Swedish counties were divided into three groups where study group allocation was designated by the proportion of pregnancies >42(+2) GW among all pregnancies of >41(+2) GW. Stockholm county formed a separate group. Main outcome measures. Perinatal morbidity.

    Results. In counties with the most active management, 19% of pregnancies >41(+2) GW were delivered at >42(+2) GW during 2000-2004 compared to 7.1% in 2005-2007. In the least active counties, corresponding figures were 21.0% compared to 19.4%. During 2005-2007, the odds ratios for meconium aspiration and 5-minute Apgar score of ≤6 in the least compared to most active counties, were 1.55 (95% CI: 1.03-2.33) and 1.26 (95% CI: 1.06-1.51). In Stockholm >42(+2) GW seen among pregnancies of >41(+2) decreased from 21.0% in 2000-2004 to 5.9% in 2005-2007. Reduced perinatal death risks by 48%, meconium aspiration of 51% and low Apgar scores by 31% in 2005-2007 compared with 2000-2004 were observed. Rates of operative deliveries at >41(+2) GW in Stockholm were unaltered.

    Conclusion. A significant reduction in perinatal morbidity was found, with no influence on operative delivery rates for post-term pregnancy in Stockholm. We advocate a nationwide change toward more active management of post-term pregnancies.

  • 17. Gudmundsdottir, Anna
    et al.
    Johansson, Stefan
    Håkansson, Stellan
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Norman, Mikael
    Kallen, Karin
    Bonamy, Anna-Karin
    The Importance of Echocardiography and an Individual Approach to Patent Ductus Arteriosus Treatment in Extremely Preterm Infants2015Ingår i: Neonatology, ISSN 1661-7800, E-ISSN 1661-7819, Vol. 107, nr 4, s. 257-257Artikel i tidskrift (Refereegranskat)
  • 18. Gudmundsdottir, Anna
    et al.
    Johansson, Stefan
    Håkansson, Stellan
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Norman, Mikael
    Källen, Karin
    Bonamy, Anna-Karin
    Timing of Pharmacological Treatment for Patent Ductus Arteriosus and Risk of Secondary Surgery, Death or Bronchopulmonary Dysplasia: A Population-Based Cohort Study of Extremely Preterm Infants2015Ingår i: Neonatology, ISSN 1661-7800, E-ISSN 1661-7819, Vol. 107, nr 2, s. 87-92Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The optimal timing of pharmacological treatment for patent ductus arteriosus (PDA) in extremely pre-term infants is unknown. Objective: To investigate whether timing of pharmacological PDA treatment is associated with a risk of secondary PDA surgery or death before 3 months of age, or bronchopulmonary dysplasia (BPD) in extremely preterm infants. Methods: In this population-based cohort of infants born before 27 gestational weeks in Sweden in 2004-2007, 290/585 infants (50%) received pharmacological PDA treatment. Cox proportional hazards regression estimated the hazard ratio (HR, with 95% confidence interval, Cl) of secondary PDA surgery or death as a composite outcome in relation to postnatal age at the start of pharmacological treatment: early (0-2 days); intermediate (3-6 days); late (>= 7 days). Furthermore, the odds ratio (OR, with 95% Cl) of BPD was estimated in relation to postnatal age at PDA treatment by conditional logistic regression. Results: The median postnatal age at the start of pharmacological PDA treatment was 4 days. 102 infants had secondary PDA surgery. Timing of PDA treatment was not associated with risk of PDA surgery or death; adjusted HRs were 0.89 (95% CI 0.57-1.39) after an intermediate start and 1.10(95% CI 0.53-2.28) after a late start, compared to an early start of treatment. Compared to the early start of PDA treatment, the intermediate start was not associated with any risk of BPD, while late PDA treatment was associated with a lower BPD risk; adjusted ORs were 0.83 (95% CI 0.42-1.64) and 0.28 (95% CI 0.13-0.61), respectively. Conclusion: Timing of pharmacological PDA treatment after extremely preterm birth is not associated with the risk of secondary PDA surgery or death. Moreover, expectant PDA management is not associated with an increased risk of BPD.

  • 19. Helenius, Kjell
    et al.
    Sjörs, Gunnar
    National Quality Registry for Neonatal Care, Department of Pediatrics/Neonatal Services, University Hospital of Umeå, Umeå, Sweden.
    Shah, Prakesh S
    Modi, Neena
    Reichman, Brian
    Morisaki, Naho
    Kusuda, Satoshi
    Lui, Kei
    Darlow, Brian A
    Bassler, Dirk
    Håkansson, Stellan
    National Quality Registry for Neonatal Care, Department of Pediatrics/Neonatal Services, University Hospital of Umeå, Umeå, Sweden.
    Adams, Mark
    Vento, Maximo
    Rusconi, Franca
    Isayama, Tetsuya
    Lee, Shoo K
    Lehtonen, Liisa
    Survival in very preterm infants: an international comparison of 10 national neonatal networks2017Ingår i: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 140, nr 6, artikel-id e20171264Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To compare survival rates and age at death among very preterm infants in 10 national and regional neonatal networks.

    METHODS: A cohort study of very preterm infants, born between 24 and 29 weeks' gestation and weighing <1500 g, admitted to participating neonatal units between 2007 and 2013 in the International Network for Evaluating Outcomes of Neonates. Survival was compared by using standardized ratios (SRs) comparing survival in each network to the survival estimate of the whole population.

    RESULTS: Network populations differed with respect to rates of cesarean birth, exposure to antenatal steroids and birth in nontertiary hospitals. Network SRs for survival were highest in Japan (SR: 1.10; 99% confidence interval: 1.08-1.13) and lowest in Spain (SR: 0.88; 99% confidence interval: 0.85-0.90). The overall survival differed from 78% to 93% among networks, the difference being highest at 24 weeks' gestation (range 35%-84%). Survival rates increased and differences between networks diminished with increasing gestational age (GA) (range 92%-98% at 29 weeks' gestation); yet, relative differences in survival followed a similar pattern at all GAs. The median age at death varied from 4 days to 13 days across networks.

    CONCLUSIONS: The network ranking of survival rates for very preterm infants remained largely unchanged as GA increased; however, survival rates showed marked variations at lower GAs. The median age at death also varied among networks. These findings warrant further assessment of the representativeness of the study populations, organization of perinatal services, national guidelines, philosophy of care at extreme GAs, and resources used for decision-making.

  • 20. Hines, Delaney
    et al.
    Modi, Neena
    Lee, Shoo K
    Isayama, Tetsuya
    Sjörs, Gunnar
    Swedish Neonatal Quality Register, Department of Pediatrics/Neonatal Services, Umeå University Hospital, Umeå, Sweden.
    Gagliardi, Luigi
    Lehtonen, Liisa
    Vento, Maximo
    Kusuda, Satoshi
    Bassler, Dirk
    Mori, Rintaro
    Reichman, Brian
    Håkansson, Stellan
    Swedish Neonatal Quality Register, Department of Pediatrics/Neonatal Services, Umeå University Hospital, Umeå, Sweden.
    Darlow, Brian A
    Adams, Mark
    Rusconi, Franca
    San Feliciano, Laura
    Lui, Kei
    Morisaki, Naho
    Musrap, Natasha
    Shah, Prakesh S
    Scoping review shows wide variation in the definitions of bronchopulmonary dysplasia in preterm infants and calls for a consensus2017Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 106, nr 3, s. 366-374Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The use of different definitions for bronchopulmonary dysplasia (BPD) has been an ongoing challenge. We searched papers published in English from 2010 and 2015 reporting BPD as an outcome, together with studies that compared BPD definitions between 1978 and 2015. We found that the incidence of BPD ranged from 6% to 57%, depending on the definition chosen, and that studies that investigated correlations with long-term pulmonary and/or neurosensory outcomes reported moderate-to-low predictive values regardless of the BPD criteria.

    CONCLUSION: A comprehensive and evidence-based definition for BPD needs to be developed for benchmarking and prognostic use.

  • 21.
    Hoffman, Karin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Brömster, Therése
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Håkansson, Stellan
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    van den Berg, Johannes
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Monitoring of pain and stress in an infant with asphyxia during induced hypothermia: a case report2013Ingår i: Advances in Neonatal Care, ISSN 1536-0903, E-ISSN 1536-0911, Vol. 13, nr 4, s. 252-261Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The purpose of this article was to study an infant who suffered from asphyxia undergoing induced hypothermia with regard to (1) describe the pain and stress as measured by physiological variables skin conductance algesimeter (SCA) and pain rating scales, (2) the correlation between SCA and pain rating scales, and (3) how temperature cycles in the cooling blanket affect the response of the sympathetic nervous system as measured by the SCA and physiological variables. A single prospective case study was used for this article. Data were recorded every 15 minutes for 96 hours. Each observation was categorized according to treatment phase: cooling 0 to 72 hours, rewarming, and controlled normal temperature up to 96 hours. Structured observations were carried out and all nursing care was documented. In addition, 5 periods with no other nursing interventions were identified in which data were recorded every minute for analysis. Skin conductance algimetry showed a variable response during treatment. During cooling, 68% of the 15-minute periods, signs of stress and pain were recorded. During rewarming, the corresponding figure was 83%. During the time sequences with normal temperature, 89% of the periods were associated with stress and pain. During 80% of the nursing procedures, the SCA showed stress and pain. There was no correlation between the pain-rating scales and SCA. When the cooling blanket temperature was lower than core temperature, the infant had more stress and pain according to SCA (P < .001) and an increase in heart rate and blood pressure (P < .001). In infants during induced hypothermia, SCA seem to detect pain and stress. Future evaluation of SCA for the detection of pain and stress during hypothermia treatment is necessary. Pain-rating scales do not appear reliable in this case report.

  • 22.
    Håkansson, Stellan
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Minskning av neonatala infektioner med grupp B-streptokocker2018Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 115, nr 4, artikel-id EY96Artikel i tidskrift (Refereegranskat)
  • 23.
    Håkansson, Stellan
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Axemo, Pia
    Department of Obstetrics and Gynecology, Academic Hospital, Uppsala, Sweden.
    Bremme, Katarina
    Department of Women and Child Health, Karolinska Institute, Stockholm, Sweden.
    Bryngelsson, Anna-Lena
    Department of Obstetrics and Gynecology, University Hospital, Örebro, Sweden.
    Wallin, Marie Carlsson
    Department of Obstetrics and Gynecology, Ystad Hospital, Ystad, Sweden.
    Ekström, Carl-Magnus
    Department of Obstetrics and Gynecology, Vrinnevi Hospital, Norrköping, Sweden.
    Granlund, Margareta
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi, Klinisk bakteriologi.
    Jacobsson, Bo
    Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Göteborg, Sweden Read More: http://informahealthcare.com/doi/abs/10.1080/00016340701802888.
    Källén, Karin
    Department of Reproductive Epidemiology, Tornblad Institute, Lund University, Lund, Sweden.
    Spetz, Eva
    Department of Obstetrics and Gynecology, Östersund Hospital, Östersund, Sweden.
    Tessin, Ingemar
    Department of Pediatrics, Queen Silvia Children's Hospital, Göteborg, Sweden.
    Group B streptococcal carriage in Sweden: a national study on risk factors for mother and infant colonisation2008Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 87, nr 1, s. 50-58Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: To study group B streptococcus (GBS) colonisation in parturients and infants in relation to obstetric outcome and to define serotypes and antibiotic resistance in GBS isolates acquired.

    Methods: A population-based, national cohort of parturients and their infants was investigated. During 1 calendar week in 2005 all women giving birth (n=1,754) were requested to participate in the study.

    Results: A total of 1,569 mother/infant pairs with obstetric and bacteriological data were obtained. Maternal carriage rate was 25.4% (95% confidence interval (CI): 23.3–27.6). In GBS-positive mothers with vaginal delivery and no intrapartum antibiotics, the infant colonisation rate was 68%. Some 30% of infants were colonised after acute caesarean section, and 0% were colonised after an elective procedure. Duration of transport of maternal recto/vaginal swabs of more than 1 day impeded culture sensitivity. Infant mMales were more frequently colonised than females (76.9 versus 59.8%, odds ratio (OR): 2.16; 95% CI: 1.27–3.70), as were infants born after rupture of membranes ≥24 h (p =0.039). Gestational age, birth weight and duration of labor did not significantly influence infant colonisation. Some 30% of parturients with at least one risk factor for neonatal disease received intrapartum antibiotics. The most common GBS serotypes were type III and V. Some 5% of the isolates were resistant to clindamycin and erythromycin, respectively.

    Conclusions: Maternal GBS prevalence and infant transfer rate were high in Sweden. Males were more frequently colonised than females. The sensitivity of maternal cultures decreased with the duration of sample transport. Clindamycin resistance was scarce. The use of intrapartum antibiotics was limited in parturients with obstetric risk factors for early onset group B streptococcal disease.

     

  • 24.
    Håkansson, Stellan
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Kaellen, Karin
    Bullarbo, Maria
    Holmgren, Per-Åke
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Bremme, Katarina
    Larsson, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Norman, Margareta
    Noren, Hakan
    Ortmark-Wrede, Catharina
    Pettersson, Karin
    Saltvedt, Sissel
    Sondell, Birgitta
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Tokarska, Magdalena
    von Vultee, Anna
    Jacobsson, Bo
    Real-time PCR-assay in the delivery suite for determination of group B streptococcal colonization in a setting with risk-based antibiotic prophylaxis2014Ingår i: The Journal of Maternal-Fetal & Neonatal Medicine, ISSN 1476-7058, E-ISSN 1476-4954, Vol. 27, nr 4, s. 328-332Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: Intrapartum antibiotic prophylaxis (IAP) reduces the incidence of neonatal early onset group B streptococcal infections. The present study investigated if an automated PCR-assay, used bedside by the labor ward personnel was manageable and could decrease the use of IAP in a setting with a risk-based IAP strategy. Methods: The study comprises two phases. Phase 1 was a multicenter, randomized, controlled trial. Women with selected risk-factors were allocated either to PCR-IAP (prophylaxis given if positive or indeterminate) or IAP. A vaginal/rectal swab and superficial swabs from the neonate for conventional culture were also obtained. Phase 2 was non-randomized, assessing an improved version of the assay. Results: Phase 1 included 112 women in the PCR-IAP group and 117 in the IAP group. Excluding indeterminate results, the assay showed a sensitivity of 89% and a specificity of 90%. In 44 % of the PCR assays the result was indeterminate. The use of IAP was lower in the PCR group (53 versus 92%). Phase 2 included 94 women. The proportion of indeterminate results was reduced (15%). The GBS colonization rate was 31%. Conclusion: The PCR assay, in the hands of labor ward personnel, can be useful for selection of women to which IAP should be offered.

  • 25.
    Håkansson, Stellan
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    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 disease2008Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 97, nr 10, s. 1386-1389Artikel i tidskrift (Refereegranskat)
    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.

  • 26.
    Håkansson, Stellan
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Lilja, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Jacobsson, Bo
    Kaellen, Karin
    Reduced incidence of neonatal early-onset group B streptococcal infection after promulgation of guidelines for risk-based intrapartum antibiotic prophylaxis in Sweden: analysis of a national population-based cohort2017Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 96, nr 12, s. 1475-1483Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    IntroductionThis study aimed to investigate the incidence of neonatal early-onset group B streptococcal (GBS) infection in Sweden after promulgation of guidelines (2008) for risk factor-based intrapartum antibiotic prophylaxis, and evaluate the presence of risk factors and obstetric management in mothers. Material and methodsNational registers were searched for infants with early-onset GBS infection during 2006-2011. Medical records of cases and case mothers were abstracted. Verified cases of sepsis/meningitis and cases with clinical sepsis/pneumonia were documented, as well as risk factors in case mothers and timeliness of intrapartum antibiotic prophylaxis administration. ResultsThere were 227 cases with verified infection, with an incidence of 0.34 of live births during the whole period. There was a significant decrease after promulgation of guidelines, from 0.40 to 0.30 parts per thousand [odds ratio (OR) 0.75, 95% confidence interval (CI) 0.57-0.99]. A significant decrease in the number of cases with clinical GBS sepsis/pneumonia was also observed. In parturients with one or more risk factors, the incidence of any GBS infection was reduced by approximately 50% (OR 0.47, 95% CI 0.35-0.64), although there were many cases where the opportunity for timely administration of intrapartum antibiotic prophylaxis was missed. In infants of mothers without risk factor(s) there was no reduction in early-onset GBS morbidity. The mortality in verified cases was 4.8% (95% CI 2.1-7.6). ConclusionsThe introduction of national guidelines for risk-based intrapartum antibiotic prophylaxis coincided with a significant 50% risk reduction of neonatal early-onset GBS infection in infants of parturients presenting with one or more risk factors. A stricter adherence to guidelines could probably have reduced the infant morbidity further.

  • 27.
    Isayama, Tetsuya
    et al.
    Division of Neonatology, Center for Maternal-Fetal Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan.
    Kusuda, Satoshi
    Neonatal Research Network Japan, Maternal and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan.
    Adams, Mark
    Swiss Neonatal Network, Department of Neonatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
    Berti, Elettra
    Neonatal Intensive Care Unit, Medical Surgical Fetal-Neonatal Department, Anna Meyer Children's University Hospital, Florence, Italy.
    Battin, Malcolm
    Department of Neonatology, Auckland District Health Board, Auckland, New Zealand.
    Helenius, Kjell
    Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland; Department of Clinical Medicine, University of Turku, Turku, Finland.
    Håkansson, Stellan
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Vento, Maximo
    Division of Neonatology, Health Research Institute La Fe, Valencia, Spain.
    Norman, Mikael
    Department of Neonatal Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.
    Reichman, Brian
    Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel.
    Noguchi, Akihiko
    Illinois Neonatal Network, Saint Louis University, IL, Saint Louis, United States.
    Lee, Shoo K.
    Department of Pediatrics, Mount Sinai Hospital, Ontario, Toronto, Canada; Department of Pediatrics, University of Toronto, Ontario, Toronto, Canada.
    Bassler, Dirk
    Swiss Neonatal Network, Department of Neonatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
    Lui, Kei
    Department of Newborn Care, Royal Hospital for Women and School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, NSW, Sydney, Australia.
    Lehtonen, Liisa
    Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland; Department of Clinical Medicine, University of Turku, Turku, Finland.
    Yang, Junmin
    Department of Pediatrics, Mount Sinai Hospital, Ontario, Toronto, Canada.
    Shah, Prakesh S.
    Department of Pediatrics, Mount Sinai Hospital, Ontario, Toronto, Canada; Department of Pediatrics, University of Toronto, Ontario, Toronto, Canada.
    International Variation in the Management of Patent Ductus Arteriosus and Its Association with Infant Outcomes: A Survey and Linked Cohort Study2022Ingår i: The Journal of Pediatrics, ISSN 0022-3476, E-ISSN 1097-6833, Vol. 244, s. 24-29Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To assess whether treating patients with a presymptomatic patent ductus arteriosus (PDA), based on early routine echocardiography, performed regardless of clinical signs, improved outcomes. Study design: This multicenter, survey-linked retrospective cohort study used an institutional-level questionnaire and individual patient-level data and included infants of <29 weeks of gestation born in 2014-2016 and admitted to tertiary neonatal intensive care units (NICUs) of 9 population-based national or regional neonatal networks. Infants in NICUs receiving treatment of presymptomatic PDA identified by routine echocardiography and those not were compared for the primary composite outcome (early death [≤7 days after birth] or severe intraventricular hemorrhage) and secondary outcomes (any in-hospital mortality and major morbidities). Results: The unit survey (response rates of 86%) revealed a wide variation among networks in the treatment of presymptomatic PDA (7%-86%). Among 246 NICUs with 17 936 infants (mean gestational age of 26 weeks), 126 NICUs (51%) with 7785 infants treated presymptomatic PDA. The primary outcome of early death or severe intraventricular hemorrhage was not significantly different between the NICUs treating presymptomatic PDA and those who did not (17% vs 21%; aOR 1.00, 95% CI 0.85-1.18). The NICUs treating presymptomatic PDA had greater odds of retinopathy of prematurity treatment (13% vs 7%; aOR 1.47, 95% CI 1.01-2.12); however, it was not significant in a sensitivity analysis excluding Japanese data. Conclusions: Treating presymptomatic PDA detected by routine echocardiography was commonplace but associated with no significant benefits. Well-designed trials are needed to assess the efficacy and safety of early targeted PDA treatment.

  • 28. Isayama, Tetsuya
    et al.
    Kusuda, Satoshi
    Reichman, Brian
    Lee, Shoo K.
    Lehtonen, Liisa
    Norman, Mikael
    Adams, Mark
    Bassler, Dirk
    Helenius, Kjell
    Håkansson, Stellan
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Yang, Junmin
    Jain, Amish
    Shah, Prakesh S.
    Neonatal Intensive Care Unit-Level Patent Ductus Arteriosus Treatment Rates and Outcomes in Infants Born Extremely Preterm2020Ingår i: Journal of Pediatrics, ISSN 0022-3476, E-ISSN 1097-6833, Vol. 220, s. 34-39.e05Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: To assess associations between neonatal intensive care unit (NICU)- level patent ductus arteriosus (PDA) treatment rates (pharmacologic or surgical) and neonatal outcomes.

    Study design: This cohort study included infants born at 24-28 weeks of gestation and birth weight <1500 g in 2007-2015 in NICUs caring for >= 100 eligible infants in 6 countries. The ratio of observed/expected (O/E) PDA treatment rates was derived for each NICU by estimating the expected rate using a logistic regression model adjusted for potential confounders and network. The primary composite outcome was death or severe neurologic injury (grades III-IV intraventricular hemorrhage or periventricular leukomalacia). The associations between the NICU-level O/E PDA treatment ratio and neonatal outcomes were assessed using linear regression analyses including a quadratic effect (a square term) of the O/E PDA treatment ratio.

    Results: From 139 NICUs, 39 096 infants were included. The overall PDA treatment rate was 45% in the cohort (13%-77% by NICU) and the O/E PDA treatment ratio ranged from 0.30 to 2.14. The relationship between the O/E PDA treatment ratio and primary composite outcome was U-shaped, with the nadir at a ratio of 1.13 and a significant quadratic effect (P<.001). U-shaped relationships were also identified with death, severe neurologic injury, and necrotizing enterocolitis.

    Conclusions: Both low and high PDA treatment rates were associated with death or severe neurologic injury, whereas a moderate approach was associated with optimal outcomes.

  • 29.
    Jacobsson, Bo
    et al.
    Avdelningen för obstetrik och gynekologi, institutionen för kliniska vetenskaper, Göteborgs universitet, Göteborg, Sweden.
    Pettersson, Karin
    Enheten för obstetrik och gynekologi, institutionen för klinisk vetenskap, intervention och teknik (CLINTEC), Karolinska institutet, Stockholm, Sweden.
    Modzelewska, Dominika
    Avdelningen för obstetrik och gynekologi, institutionen för kliniska vetenskaper, Göteborgs Universitet, Göteborg, Sweden.
    Abrahamsson, Thomas
    Avdelningen för pediatrik, institutionen för klinisk och experimentell medicin, Linköpings universitet, Linköping, Sweden.
    Bergman, Lina
    Institutionen för kvinnors och barns hälsa, Centrum för klinisk forskning, Uppsala universitet, Uppsala, Sweden.
    Håkansson, Stellan
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Förtidsbörd största perinatala problemet: 5,7 procent av graviditeter i Sverige slutar för tidigt, inte klarlagt varför – kostar miljardbelopp varje år: [Preterm delivery: an overview on epidemiology, pathophysiology and consequences for the individual and the society]2019Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 116, artikel-id FR6FArtikel i tidskrift (Refereegranskat)
    Abstract [sv]

    Förtidsbörd utgör 5,7 procent av alla förlossningar i Sverige. Internationellt rapporteras från vissa länder upp till 18 procent. Den biologiska förståelsen av de mekanismer som resulterar i förtidsbörd är fortfarande mycket begränsad. Neonatalvården av för tidigt födda barn har gjort mycket stora framsteg under de senaste decennierna. Nya vårdformer har etablerats, t ex familjecentrerad vård och sjukhusassisterad hemvård i slutet av vårdtiden. Cirka 15 miljoner barn föds för tidigt i världen varje år. De flesta av dem är födda under graviditetsvecka 32–36 och svarar för huvuddelen av mortalitet och neurologiska funktionshinder bland för tidigt födda. 

  • 30.
    Karlsson, Björn-Markus
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Lindkvist, Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Statistik.
    Lindkvist, Markus
    Karlsson, Marcus
    Lundström, Ronnie
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Håkansson, Stellan
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Wiklund, Urban
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Radiofysik.
    van den Berg, Johannes
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Sound and vibration: effects on infants' heart rate and heart rate variability during neonatal transport2012Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 101, nr 2, s. 148-154Artikel i tidskrift (Refereegranskat)
    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.

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  • 31. Kelly, L E
    et al.
    Shah, P S
    Håkansson, Stellan
    Department of Pediatrics/Neonatal Services, Swedish Neonatal Quality Register, Umeå University Hospital, Umeå, Sweden.
    Kusuda, S
    Adams, M
    Lee, S K
    Sjörs, G
    Department of Pediatrics/Neonatal Services, Swedish Neonatal Quality Register, Umeå University Hospital, Umeå, Sweden.
    Vento, M
    Rusconi, F
    Lehtonen, L
    Reichman, B
    Darlow, B A
    Lui, K
    Feliciano, L S
    Gagliardi, L
    Bassler, D
    Modi, N
    Perinatal health services organization for preterm births: a multinational comparison2017Ingår i: Journal of Perinatology, ISSN 0743-8346, E-ISSN 1476-5543, Vol. 37, nr 7, s. 762-768Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To explore population characteristics, organization of health services and comparability of available information for very low birth weight or very preterm neonates born before 32 weeks' gestation in 11 high-income countries contributing data to the International Network for Evaluating Outcomes of Neonates (iNeo).

    STUDY DESIGN: We obtained population characteristics from public domain sources, conducted a survey of organization of maternal and neonatal health services and evaluated the comparability of data contributed to the iNeo collaboration from Australia, Canada, Finland, Israel, Italy, Japan, New Zealand, Spain, Sweden, Switzerland and UK.

    RESULTS: All countries have nationally funded maternal/neonatal health care with >90% of women receiving prenatal care. Preterm birth rate, maternal age, and neonatal and infant mortality rates were relatively similar across countries. Most (50 to >95%) between-hospital transports of neonates born at non-tertiary units were conducted by designated transport teams; 72% (8/11 countries) had designated transfer and 63% (7/11 countries) mandate the presence of a physician. The capacity of 'step-down' units varied between countries, with capacity for respiratory care available in <10% to >75% of units. Heterogeneity in data collection processes for benchmarking and quality improvement activities were identified.

    CONCLUSIONS: Comparability of healthcare outcomes for very preterm low birth weight neonates between countries requires an evaluation of differences in population coverage, healthcare services and meta-data.

  • 32. Koller-Smith, Louise I. M.
    et al.
    Shahr, Prakesh S.
    Ye, Xiang Y.
    Sjörs, Gunnar
    Wang, Yueping A.
    Chow, Sharon S. W.
    Darlow, Brian A.
    Lee, Shoo K.
    Håkansson, Stellan
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Lui, Kei
    Comparing very low birth weight versus very low gestation cohort methods for outcome analysis of high risk preterm infants2017Ingår i: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 17, artikel-id 166Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Compared to very low gestational age (<32 weeks, VLGA) cohorts, very low birth weight (<1500 g; VLBW) cohorts are more prone to selection bias toward small-for-gestational age (SGA) infants, which may impact upon the validity of data for benchmarking purposes. Method: Data from all VLGA or VLBW infants admitted in the 3 Networks between 2008 and 2011 were used. Two-thirds of each network cohort was randomly selected to develop prediction models for mortality and composite adverse outcome (CAO: mortality or cerebral injuries, chronic lung disease, severe retinopathy or necrotizing enterocolitis) and the remaining for internal validation. Areas under the ROC curves (AUC) of themodels were compared. Results: VLBW cohort (24,335 infants) had twice more SGA infants (20.4% vs. 9.3%) than the VLGA cohort (29,180 infants) and had a higher rate of CAO (36.5% vs. 32.6%). The two models had equal prediction power for mortality and CAO (AUC 0.83), and similarly for all other cross-cohort validations (AUC 0.81-0.85). Neither model performed well for the extremes of birth weight for gestation (<1500 g and >= 32 weeks, AUC 0.50-0.65; >= 1500 g and >= 32 weeks, AUC 0.60-0.62). Conclusion: There was no difference in prediction power for adverse outcome between cohorting VLGA or VLBW despite substantial bias in SGA population. Either cohorting practises are suitable for international benchmarking.

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  • 33. Lehtonen, Liisa
    et al.
    Lee, Shoo K.
    Kusuda, Satoshi
    Lui, Kei
    Norman, Mikael
    Bassler, Dirk
    Håkansson, Stellan
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Vento, Maximo
    Darlow, Brian A.
    Adams, Mark
    Puglia, Monia
    Isayama, Tetsuya
    Noguchi, Akihiko
    Morisaki, Naho
    Helenius, Kjell
    Reichman, Brian
    Shah, Prakesh S.
    Family Rooms in Neonatal Intensive Care Units and Neonatal Outcomes: An International Survey and Linked Cohort Study2020Ingår i: The Journal of Pediatrics, ISSN 0022-3476, E-ISSN 1097-6833, Vol. 226, s. 112-117Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: To evaluate the proportion of neonatal intensive care units with facilities supporting parental presence in their infants’ rooms throughout the 24-hour day (ie, infant-parent rooms) in high-income countries and to analyze the association of this with outcomes of extremely preterm infants.

    Study design: In this survey and linked cohort study, we analyzed unit design and facilities for parents in 10 neonatal networks of 11 countries. We compared the composite outcome of mortality or major morbidity, length of stay, and individual morbidities between neonates admitted to units with and without infant-parent rooms by linking survey responses to patient data from 2015 for neonates of less than 29 weeks of gestation.

    Results: Of 331 units, 13.3% (44/331) provided infant-parent rooms. Patient-level data were available for 4662 infants admitted to 159 units in 7 networks; 28% of the infants were cared for in units with infant-parent rooms. Neonates from units with infant-parent rooms had lower odds of mortality or major morbidity (aOR, 0.76; 95% CI, 0.64-0.89), including lower odds of sepsis and bronchopulmonary dysplasia, than those from units without infant-parent rooms. The adjusted mean length of stay was 3.4 days shorter (95%, CI –4.7 to −3.1) in the units with infant-parent rooms.

    Conclusions: The majority of units in high-income countries lack facilities to support parents' presence in their infants' rooms 24 hours per day. The availability vs absence of infant-parent rooms was associated with lower odds of composite outcome of mortality or major morbidity and a shorter length of stay.

  • 34. Lui, Kei
    et al.
    Lee, Shoo K
    Kusuda, Satoshi
    Adams, Mark
    Vento, Maximo
    Reichman, Brian
    Darlow, Brian A
    Lehtonen, Liisa
    Modi, Neena
    Norman, Mikael
    Håkansson, Stellan
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Bassler, Dirk
    Rusconi, Franca
    Lodha, Abhay
    Yang, Junmin
    Shah, Prakesh S
    Trends in Outcomes for Neonates Born Very Preterm and Very Low Birth Weight in 11 High-Income Countries2019Ingår i: Journal of Pediatrics, ISSN 0022-3476, E-ISSN 1097-6833, Vol. 215, s. 32-40.e14Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To evaluate outcome trends of neonates born very preterm in 11 high-income countries participating in the International Network for Evaluating Outcomes of neonates.

    STUDY DESIGN: In a retrospective cohort study, we included 154 233 neonates admitted to 529 neonatal units between January 1, 2007, and December 31, 2015, at 240/7 to 316/7 weeks of gestational age and birth weight <1500 g. Composite outcomes were in-hospital mortality or any of severe neurologic injury, treated retinopathy of prematurity, and bronchopulmonary dysplasia (BPD); and same composite outcome excluding BPD. Secondary outcomes were mortality and individual morbidities. For each country, annual outcome trends and adjusted relative risks comparing epoch 2 (2012-2015) to epoch 1 (2007-2011) were analyzed.

    RESULTS: For composite outcome including BPD, the trend decreased in Canada and Israel but increased in Australia and New Zealand, Japan, Spain, Sweden, and the United Kingdom. For composite outcome excluding BPD, the trend decreased in all countries except Spain, Sweden, Tuscany, and the United Kingdom. The risk of composite outcome was lower in epoch 2 than epoch 1 in Canada (adjusted relative risks 0.78; 95% CI 0.74-0.82) only. The risk of composite outcome excluding BPD was significantly lower in epoch 2 compared with epoch 1 in Australia and New Zealand, Canada, Finland, Japan, and Switzerland. Mortality rates reduced in most countries in epoch 2. BPD rates increased significantly in all countries except Canada, Israel, Finland, and Tuscany.

    CONCLUSIONS: In most countries, mortality decreased whereas BPD increased for neonates born very preterm.

  • 35.
    Lui, Kei
    et al.
    Royal Hospital for Women, National Perinatal Epidemiology and Statistic Unit, University of New South Wales, Randwick, Australia.
    Vento, Maximo
    Division of Neonatology and Health Research Institute, University and Polytechnic Hospital La Fe, Avenida Fernando Abril Martorell 106, Valencia, Spain.
    Modi, Neena
    Neonatal Data Analysis Unit, Section of Neonatal Medicine, Department of Medicine, Imperial College London, Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London, United Kingdom.
    Kusuda, Satoshi
    Department of Pediatrics, Kyorin University, 6-20-2 Mitaka, Tokyo, Japan.
    Lehtonen, Liisa
    Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Department of Clinical Medicine, University of Turku, Kiinamyllynkatu 4-8, Turku, Finland.
    Håkansson, Stellan
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Rusconi, Franca
    Unit of Epidemiology, Meyer Children's University Hospital, Viale Pieraccini 24, Florence, Italy.
    Bassler, Dirk
    Department of Neonatology, University Hospital Zurich and University of Zurich, Frauenklinikstrasse 10, Zurich, Switzerland.
    Reichman, Brian
    Women and Children's Health Research Unit, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel.
    Yang, Jie
    Department of Pediatrics and Maternal-infant Care Research Centre, Mount Sinai Hospital, 600 University Avenue, M5G 1X5, Toronto, Ontario, Canada.
    Shah, Prakesh S.
    Department of Pediatrics and Maternal-infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada.
    Darlow, Brian A. (Medarbetare/bidragsgivare)
    Helenius, Kjell (Medarbetare/bidragsgivare)
    Adams, Mark (Medarbetare/bidragsgivare)
    Norman, Mikael (Medarbetare/bidragsgivare)
    Isayama, Tetsuya (Medarbetare/bidragsgivare)
    Battin, Malcolm (Medarbetare/bidragsgivare)
    Inter-center variability in neonatal outcomes of preterm infants: A longitudinal evaluation of 298 neonatal units in 11 countries2021Ingår i: Seminars in Fetal & Neonatal Medicine, ISSN 1744-165X, E-ISSN 1878-0946, Vol. 26, nr 1, artikel-id 101196Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Collaboration and cooperation of clinicians and neonatal units at regional, national, and international levels are key features of many networks or systems that aim to improve neonatal outcomes. Network performance is typically assessed by comparing individual, unit-level outcomes. In this paper, we provide insight into another dimension, i.e., inter-center outcome variation in 10 national/regional neonatal collaborations from 11 high-income countries. We illustrate the use of coefficients of variation for evaluation of mortality and a composite outcome of mortality, severe neurological injury, treated retinopathy of prematurity, and bronchopulmonary dysplasia, as a measure of inter-center variation. These inter-center variation estimates could help to identify areas of opportunities and challenges for each country/region; they also provide “macro”-level evaluations that can be useful for clinicians, administrators, managers and policy makers.

  • 36. Luthander, Charlotte Millde
    et al.
    Kallen, Karin
    Nyström, Monica E.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Departmentof Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institute, Stockholm.
    Hogberg, Ulf
    Håkansson, Stellan
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Harenstam, Karin P.
    Grunewald, Charlotta
    Results from the National Perinatal Patient Safety Program in Sweden: the challenge of evaluation2016Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 95, nr 5, s. 596-603Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: We studied the effects of the national Perinatal Patient Safety Program in Sweden, addressing local improvement measures, changes in the proportion of low Apgar score and the number of settled injury claims due to asphyxia.

    Material and methods: Final reports on achieved improvements from all Swedish obstetric units were analyzed and categories of the improvement measures taken in perinatal risk areas were established. Data on all term newborns during 2006–12 were obtained from the Medical Birth Registry. Incidence of 5-min Apgar score <7 was analyzed before, during and after the intervention. The odds ratio for low Apgar score in period ÍII vs. period I was calculated. Patient injury claims from The Swedish National Patient Insurance Company (LÖF) were analyzed.

    Results: Numerous local improvement initiatives were reported. The incidence of 5-min Apgar score <7 on a national level remained unchanged during the study periods. The units with the highest rate of Apgar score <7 showed a significant decrease in Apgar score of 4–6 after the intervention, whereas units with the lowest rate of Apgar score <7 showed a significant increase in Apgar score <7 after the intervention. A decline in settled claims due to substandard care was observed (7.5%, 2012–14; p for trend 0.049).

    Conclusion: The national incidence of low Apgar score remained unchanged but a reduction of settled claims of severely asphyxiated neonates was observed. The study highlights the need for robust designs when evaluating large-scale initiatives for improving patient safety at delivery, along with the difficulties in performing them.

  • 37. Martin, Lisa J
    et al.
    Sjörs, Gunnar
    Reichman, Brian
    Darlow, Brian A
    Morisaki, Naho
    Modi, Neena
    Bassler, Dirk
    Mirea, Lucia
    Adams, Mark
    Kusuda, Satoshi
    Lui, Kei
    Feliciano, Laura San
    Håkansson, Stellan
    Swedish Neonatal Quality Register, Department of Pediatrics/Neonatal Services, Umeå University Hospital, Umeå, Sweden.
    Isayama, Tetsuya
    Mori, Rintaro
    Vento, Max
    Lee, Shoo K
    Shah, Prakesh S
    Country-Specific vs. Common Birthweight-for-Gestational Age References to Identify Small for Gestational Age Infants Born at 24-28 weeks: an International Study2016Ingår i: Paediatric and Perinatal Epidemiology, ISSN 0269-5022, E-ISSN 1365-3016, Vol. 30, nr 5, s. 450-461Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Controversy exists as to whether birthweight-for-gestational age references used to classify infants as small for gestational age (SGA) should be country specific or based on an international (common) standard. We examined whether different birthweight-for-gestational age references affected the association of SGA with adverse outcomes among very preterm neonates.

    METHODS: Singleton infants (n = 23 788) of 24(0) -28(6) weeks' gestational age in nine high-resource countries were classified as SGA (<10th centile) using common and country-specific references based on birthweight and estimated fetal weight (EFW). For each reference, the adjusted relative risk (aRR) for the association of SGA with composite outcome of mortality or major morbidity was estimated.

    RESULTS: The percentage of infants classified as SGA differed slightly for common compared with country specific for birthweight references [9.9% (95% CI 9.5, 10.2) vs. 11.1% (95% CI 10.7, 11.5)] and for EFW references [28.6% (95% CI 28.0, 29.2) vs. 24.6% (95% CI 24.1, 25.2)]. The association of SGA with the composite outcome was similar when using common or country-specific references for the total sample for birthweight [aRRs 1.47 (95% CI 1.43, 1.51) and 1.48 (95% CI 1.44, 1.53) respectively] and for EFW references [aRRs 1.35 (95% CI 1.31, 1.38) and 1.39 (95% CI 1.35, 1.43) respectively].

    CONCLUSION: Small for gestational age is associated with higher mortality and morbidity in infants born <29 weeks' gestational age. Although common and country-specific birthweight/EFW references identified slightly different proportions of SGA infants, the risk of the composite outcome was comparable.

  • 38.
    Moreira, Alvaro
    et al.
    Department of Pediatrics, University of Texas Health San Antonio, TX, San Antonio, United States.
    Benvenuto, Domenico
    Department of Biostatistics, Epidemiology and Molecular Pathology, Università Campus Bio-Medico di Roma, Rome, Italy.
    Fox-Good, Christopher
    Department of Pediatrics, University of Texas Health San Antonio, TX, San Antonio, United States.
    Alayli, Yasmeen
    Department of Pediatrics, University of Texas Health San Antonio, TX, San Antonio, United States.
    Evans, Mary
    Department of Pediatrics, University of Texas Health San Antonio, TX, San Antonio, United States.
    Jonsson, Baldvin
    Department of Women's and Children's Health, Karolinska Institutet, Solna, Sweden.
    Håkansson, Stellan
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Harper, Nathan
    Veterans Administration Research Center for AIDS and HIV-1 Infection, Center for Personalized Medicine, South Texas Veterans Health Care System, TX, San Antonio, United States.
    Kim, Jennifer
    Department of Pediatrics, University of Texas Health San Antonio, TX, San Antonio, United States.
    Norman, Mikael
    Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
    Bruschettini, Matteo
    Department of Pediatrics, Lund University, Lund, Sweden.
    Development and Validation of a Mortality Prediction Model in Extremely Low Gestational Age Neonates2022Ingår i: Neonatology, ISSN 1661-7800, E-ISSN 1661-7819, Vol. 119, nr 4, s. 418-427Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Introduction: Understanding factors that associate with neonatal death may lead to strategies or interventions that can aid clinicians and inform families. Objective: The aim of the study was to develop an early prediction model of neonatal death in extremely low gestational age (ELGA, <28 weeks) neonates. Methods: A predictive cohort study of ELGA neonates was derived from the Swedish Neonatal Quality Register between the years 2011 to May 2021. The goal was to use readily available clinical variables, collected within the first hour of birth, to predict in-hospital death. Data were split into a train cohort (80%) to build the model and tested in 20% of randomly selected neonates. Model performance was assessed via area under the receiver operating characteristic curve (AUC) and compared to validated mortality prediction models and an external cohort of neonates. Results: Among 3,752 live-born extremely preterm infants (46% girls), in-hospital mortality was 18% (n = 685). The median gestational age and birth weight were 25.0 weeks (interquartile range [IQR] 24.0, 27.0) and 780 g (IQR 620, 940), respectively. The proposed model consisted of three variables: birth weight (grams), Apgar score at 5 min of age, and gestational age (weeks). The BAG model had an AUC of 76.9% with a 95% confidence interval (CI) (72.6%, 81.3%), while birth weight and gestational age had an AUC of 73.1% (95% CI: 68.4%,77.9%) and 71.3% (66.3%, 76.2%). In the validation cohort, the BAG model had an AUC of 68.9%. Conclusion: The BAG model is a new mortality prediction model in ELGA neonates that was developed using readily available information.

  • 39.
    Norman, Mikael
    et al.
    Division of Pediatrics, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Novum, Blickagangen 6A, Stockholm, Sweden.
    Gadsbøll, Christian
    Department of Clinical Sciences, Lund University, Lund, Sweden.
    Björklund, Lars J.
    Department of Clinical Sciences, Lund University, Lund, Sweden.
    Farooqi, Aijaz
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Håkansson, Stellan
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Ley, David
    Department of Clinical Sciences, Lund University, Lund, Sweden.
    Place of Birth of Extremely Preterm Infants in Sweden2021Ingår i: Journal of the American Medical Association (JAMA), ISSN 0098-7484, E-ISSN 1538-3598, Vol. 326, nr 24, s. 2529-2530Artikel i tidskrift (Refereegranskat)
  • 40. Norman, Mikael
    et al.
    Hallberg, Boubou
    Abrahamsson, Thomas
    Bjorklund, Lars J.
    Domellöf, Magnus
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Farooqi, Aijaz
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Bruun, Cathrine Foyn
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Gadsboll, Christian
    Hellstrom-Westas, Lena
    Ingemansson, Fredrik
    Kallen, Karin
    Ley, David
    Marsal, Karel
    Normann, Erik
    Serenius, Fredrik
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Stephansson, Olof
    Stigson, Lennart
    Um-Bergstrom, Petra
    Håkansson, Stellan
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Association Between Year of Birth and 1-Year Survival Among Extremely Preterm Infants in Sweden During 2004-2007 and 2014-20162019Ingår i: Journal of the American Medical Association (JAMA), ISSN 0098-7484, E-ISSN 1538-3598, Vol. 321, nr 12, s. 1188-1199Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    IMPORTANCE: Since 2004-2007, national guidelines and recommendations have been developed for the management of extremely preterm births in Sweden. If and how more uniform management has affected infant survival is unknown.

    OBJECTIV: To compare survival of extremely preterm infants born during 2004-2007 with survival of infants born during 2014-2016.

    DESIGN, SETTING AND PARTICIPANTS: All births at 22-26weeks' gestational age (n = 2205) between April 1, 2004, and March 31, 2007, and between January 1, 2014, and December 31, 2016, in Sweden were studied. Prospective data collection was used during 2004-2007. Data were obtained from the Swedish pregnancy, medical birth, and neonatal quality registries during 2014-2016. EXPOSURES Delivery at 22-26 weeks' gestational age.

    MAIN OUTCOMES AND MEASURES: The primary outcomewas infant survival to the age of 1 year. The secondary outcome was 1-year survival among live-born infants who did not have any major neonatal morbidity (specifically, without intraventricular hemorrhage grade 3-4, cystic periventricular leukomalacia, necrotizing enterocolitis, retinopathy of prematurity stage 3-5, or severe bronchopulmonary dysplasia).

    RESULTS: During 2004-2007, 1009 births (3.3/1000 of all births) occurred at 22-26 weeks' gestational age compared with 1196 births (3.4/1000 of all births) during 2014-2016 (P =.61). One-year survival among live-born infants at 22-26 weeks' gestational age was significantly lower during 2004-2007 (497 of 705 infants [70%]) than during 2014-2016 (711 of 923 infants [77%]) (difference, -7%[95% CI, -11% to -2.2%], P =.003). One-year survival among live-born infants at 22-26 weeks' gestational age and without any major neonatal morbidity was significantly lower during 2004-2007 (226 of 705 infants [32%]) than during 2014-2016 (355 of 923 infants [38%]) (difference, -6%[95% CI, -11% to -1.7%], P =.008).

    CONCLUSIONS AND RELEVANCE: Among live births at 22-26 weeks' gestational age in Sweden, 1-year survival improved between 2004-2007 and 2014-2016.

  • 41.
    Norman, Mikael
    et al.
    Division of Pediatrics, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden; Swedish Neonatal Quality Register, Umeå University Hospital, Umeå, Sweden.
    Hallberg, Boubou
    Division of Pediatrics, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden.
    Abrahamsson, Thomas
    Departments of Clinical and Experimental Medicine and Pediatrics, Linköping University, Linköping, Sweden.
    Björklund, Lars J.
    Departments of Clinical Sciences and Pediatrics, Lund University, Skåne University Hospital, Lund, Sweden.
    Domellöf, Magnus
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Farooqi, Aijaz
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Bruun, Cathrine Foyn
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Gadsbøll, Christian
    Departments of Clinical and Experimental Medicine and Pediatrics, Linköping University, Linköping, Sweden; Departments of Clinical Sciences and Pediatrics, Lund University, Skåne University Hospital, Lund, Sweden.
    Hellström-Westas, Lena
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Ingemansson, Fredrik
    Department of Pediatrics, Ryhov County Hospital, Jönköping County Council, Jönköping, Sweden.
    Källén, Karin
    Centre for Reproductive Epidemiology, Lund University, Lund, Sweden.
    Ley, David
    Departments of Clinical Sciences and Pediatrics, Lund University, Skåne University Hospital, Lund, Sweden.
    Maršál, Karel
    Departments of Clinical Sciences and Obstetrics and Gynecology, Lund University, Skåne University Hospital, Lund, Sweden.
    Normann, Erik
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Serenius, Fredrik
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Stephansson, Olof
    Division of Clinical Epidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
    Stigson, Lennart
    Department of Pediatrics, Institute for Clinical Sciences, Queen Silvia Children's Hospital, Sahlgrenska Academy, Göteborg University, Göteborg, Sweden.
    Um-Bergström, Petra
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Sachs' Children and Youth Hospital, Department of Neonatal Medicine, Södersjukhuset, Stockholm, Sweden.
    Håkansson, Stellan
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik. Swedish Neonatal Quality Register, Umeå University Hospital, Umeå, Sweden.
    [Editorial comment] Association between year of birth and 1-year survival among extremely preterm infants in Sweden during 2004-2007 and 2014-20162019Ingår i: Obstetrical and Gynecological Survey, ISSN 0029-7828, E-ISSN 1533-9866, Vol. 74, nr 8, s. 456-458Artikel i tidskrift (Övrigt vetenskapligt)
  • 42. Norman, Mikael
    et al.
    Hellstrom, Ann
    Hallberg, Boubou
    Wallin, Agneta
    Gustafson, Pelle
    Tornqvist, Kristina
    Håkansson, Stellan
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik. Swedish Neonatal Qual Registry, Umea, Sweden.
    Holmstrom, Gerd
    Prevalence of Severe Visual Disability Among Preterm Children With Retinopathy of Prematurity and Association With Adherence to Best Practice Guidelines2019Ingår i: JAMA Network Open, E-ISSN 2574-3805, Vol. 2, nr 1, artikel-id e186801Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    IMPORTANCE Retinopathy of prematurity (ROP) can cause severe visual disability even in high-resource settings. A better understanding of the prevalence and processes leading to ROP-induced severe visual impairment may help health care professionals design preventive measures. OBJECTIVES To determine the prevalence of severe visual disability among children born preterm in Sweden, evaluate adherence to best practice, and determine the health system's structural capacity. DESIGN, SETTING, AND PARTICIPANTS Population-based, nationwide cohort study of 1 310 227 children born between January 1, 2004, and December 31, 2015, in Sweden, of whom 17 588 (1.3%) were born very preterm (<32 weeks of gestation). Children born preterm with a verified diagnosis of severe visual disability had their medical records reviewed for evaluation of ROP screening, diagnosis, and treatment. In addition, a questionnaire on structural capacity was sent to all ophthalmology departments. EXPOSURES Stages 4 and 5 ROP. MAIN OUTCOMES AND MEASURES The primary outcome was prevalence of severe visual disability (visual acuity similar to 20/200 for both eyes) associated with ROP stages 4 and 5. Secondary outcomes included adherence to national ROP guidelines using a predefined protocol with 15 key performance indicators for screening, diagnosis, and treatment; assessment of whether visual disability was deemed avoidable; and examination of structural capacity, including information on equipment and facilities, staffing, and patients. RESULTS Seventeen children (10 boys; mean [range] birth weight, 756 [454-1900] g; mean [range] gestational age, 25 [22-33] weeks) became severely visually disabled because of ROP, corresponding to a prevalence of 1 in 1000 very preterm infants (< 32 weeks of gestational age) and 1 in 77 000 for all live births. Severe visual impairment was considered potentially avoidable in 11 of 17 affected children (65%) owing to untimely or no screening, missed diagnosis, or untimely and suboptimal treatment. Large variations in infrastructure (facilities, guidelines, staffing, and annual patient numbers) were also identified as potential contributors to these findings. CONCLUSIONS AND RELEVANCE Retinopathy of prematurity still causes severe visual disability in Sweden, resulting in 1 affected infant per 1000 very preterm births. In most of these infants, noncompliance with best practice was identified, indicating that a significant proportion could have been avoided.

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  • 43.
    Norman, Mikael
    et al.
    Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden; Swedish Neonatal Quality Register (www.snq.se), Stockholm, Sweden.
    Håkansson, Stellan
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik. Swedish Neonatal Quality Register (www.snq.se), Stockholm, Sweden.
    The Swedish Neonatal Network for outcomes improvement2023Ingår i: Pediatric Medicine, E-ISSN 2617-5428, Vol. 6, artikel-id 9Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    A vision for Swedish neonatal care is that all newborn infants receive the care they need, when they need it, that the experience is excellent for all families, and that neonatal care is executed by the highest quality and safety standards. To support this vision, the Swedish Neonatal Quality Register (SNQ) was founded with a mission to provide stake holders, professionals and the public with data and knowledge that would stimulate quality improvement (QI), research and development in neonatal care. SNQ covers all infants admitted to all 37 neonatal units (level I–III) serving the approximately 115,000 annual births in Sweden. Quality indicators include capacity and availability (number of beds, staffing, equipment), process (interventions) and outcome (survival and morbidity) measures for medical as well as nursing care. To better understand how neonatal care is associated with long-term outcome, the results of a national follow-up program at 2- and 5½-year-of-age are also reported to SNQ. In addition, parental experiences of neonatal care have recently become an integrated part of the database. SNQ’s completeness and validity, especially for preterm infants, has been found to be excellent. SNQ is therefore used as a tool for benchmarking over time and between unit and regions. Robust data from more than 230,000 neonatal admissions are available. Besides stimulating a continuously increasing number of clinical research projects, the data from SNQ has been found useful by Swedish authorities, professional and stakeholder organizations, local hospital administrations, teachers, as well as by the attending team in the neonatal unit. The most recent development with daily data collection in >95% of all admissions opens for new and more dynamic insights into the course of several neonatal conditions, as well as for timely outreach of results.

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  • 44. Norman, Mikael
    et al.
    Håkansson, Stellan
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik. Umeå University Hospital.
    Kusuda, Satoshi
    Vento, Maximo
    Lehtonen, Liisa
    Reichman, Brian
    Darlow, Brian A.
    Adams, Mark
    Bassler, Dirk
    Isayama, Tetsuya
    Rusconi, Franca
    Lee, Shoo
    Lui, Kei
    Yang, Junmin
    Shah, Prakesh S.
    Neonatal Outcomes in Very Preterm Infants With Severe Congenital Heart Defects: An International Cohort Study2020Ingår i: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 9, nr 5, artikel-id e015369Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Very preterm infants are at high risk of death or severe morbidity. The objective was to determine the significance of severe congenital heart defects (CHDs) for these risks. Methods and Results This cohort study included infants from 10 countries born from 2007-2015 at 24 to 31 weeks' gestation with birth weights <1500 g. Severe CHDs were defined by International Classification of Diseases, Ninth Revision (ICD-9) and Tenth (ICD-10) codes and categorized as those compromising systemic output, causing sustained cyanosis, or resulting in congestive heart failure. The primary outcome was in-hospital mortality. Secondary outcomes were neonatal brain injury, necrotizing enterocolitis, bronchopulmonary dysplasia, and retinopathy of prematurity. Adjusted and propensity score-matched odds ratios (ORs) were calculated. Analyses were stratified by type of CHD, gestational age, and network. A total of 609 (0.77%) infants had severe CHD and 76 371 without any malformation served as controls. The mean gestational age and birth weight were 27.8 weeks and 1018 g, respectively. The mortality rate was 18.6% in infants with CHD and 8.9% in controls (propensity score-matched OR, 2.30; 95% CI, 1.61-3.27). Severe CHD was not associated with neonatal brain injury, necrotizing enterocolitis, or retinopathy of prematurity, whereas the OR for bronchopulmonary dysplasia increased. Mortality was higher in all types, with the highest propensity score-matched OR (4.96; 95% CI, 2.11-11.7) for CHD causing congestive heart failure. While mortality did not differ between groups at <27 weeks' gestational age, adjusted OR for mortality in infants with CHD increased to 10.9 (95% CI, 5.76-20.70) at 31 weeks' gestational age. Rates of CHD and mortality differed significantly between networks. Conclusions Severe CHD is associated with significantly increased mortality in very preterm infants.

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  • 45.
    Norman, Mikael
    et al.
    Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden.
    Jonsson, Baldvin
    Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Womeńs and Childreńs Health, Karolinska Institutet, Stockholm, Sweden.
    Söderling, Jonas
    Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
    Björklund, Lars J.
    Department of Clinical Sciences, Lund, Lund University, Skåne University Hospital, Lund, Sweden.
    Håkansson, Stellan
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Patterns of respiratory support by gestational age in very preterm infants2023Ingår i: Neonatology, ISSN 1661-7800, E-ISSN 1661-7819, Vol. 120, nr 1, s. 142-152Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: A detailed understanding of respiratory support patterns in preterm infants is lacking. The aim was to explore and visualize this practice in Sweden.

    Methods: Preterm infants with gestational ages of 22-31 weeks, admitted to neonatal units reporting daily to the Swedish Neonatal Quality Register and discharged alive in November 2015-April 2022, were included in this descriptive cohort study. Proportions receiving mechanical ventilation, noninvasive support, or supplemental oxygen were calculated and graphically displayed for each gestational week and postnatal day (range 0-97) up to hospital discharge or 36 weeks of postmenstrual age.

    Results: Respiratory support in 148,515 days of care (3,368 infants; 54% males; median [interquartile range] birthweight = 1,215 [900-1,525] g) was evaluated. Trajectories showed distinct nonlinear patterns for each category of respiratory support, but differences in respiratory support over the gestational age range were linear: the proportion of infants on mechanical ventilation decreased by -11.7 to -7.3% (variability in estimates related to the postnatal day chosen for regression analysis) for each week higher gestational age (r = -0.99 to -0.87, p ≤ 0.001). The corresponding proportions of infants with supplemental oxygen decreased by -12.4% to -4.5% for each week higher gestational age (r = -0.98 to -0.94, p < 0.001). At 36 weeks of postmenstrual age, dependencies on mechanical ventilation, noninvasive support, and supplemental oxygen varied from 3%, 84%, and 94% at 22 weeks to 0%, 3%, and 5% at 31 weeks of gestational age, respectively.

    Conclusions: Respiratory support patterns in very preterm infants follow nonlinear, gestational age-specific postnatal trajectories in a dose-response-related fashion.

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  • 46. Norman, Mikael
    et al.
    Källén, Karin
    Wahlström, Erik
    Håkansson, Stellan
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik. Swedish Neonatal Quality Register (SNQ), Västerbotten county council, Umeå, Sweden.
    The Swedish Neonatal Quality Register: contents, completeness and validity2019Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 108, nr 8, s. 1411-1418Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

  • 47.
    Norman, Mikael
    et al.
    Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Novum, Karolinska Institutet, Blickagangen 6A, Stockholm, Sweden; Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden; Swedish Neonatal Quality Register, Stockholm, Sweden.
    Navér, Lars
    Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Novum, Karolinska Institutet, Blickagangen 6A, Stockholm, Sweden; Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden.
    Söderling, Jonas
    Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
    Ahlberg, Mia
    Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Department of Women's Health, Karolinska University Hospital, Stockholm, Sweden.
    Hervius Askling, Helena
    Division of Infectious Diseases, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
    Aronsson, Bernice
    Public Health Agency of Sweden, Stockholm, Sweden.
    Byström, Emma
    Public Health Agency of Sweden, Stockholm, Sweden.
    Jonsson, Jerker
    Public Health Agency of Sweden, Stockholm, Sweden.
    Sengpiel, Verena
    Region Västra Götaland, Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Ludvigsson, Jonas F.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Håkansson, Stellan
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik. Swedish Neonatal Quality Register, Stockholm, Sweden.
    Stephansson, Olof
    Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Department of Women's Health, Karolinska University Hospital, Stockholm, Sweden.
    Association of Maternal SARS-CoV-2 Infection in Pregnancy with Neonatal Outcomes2021Ingår i: Journal of the American Medical Association (JAMA), ISSN 0098-7484, E-ISSN 1538-3598, Vol. 325, nr 20, s. 2076-2086Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Importance: The outcomes of newborn infants of women testing positive for SARS-CoV-2 in pregnancy is unclear.

    Objective: To evaluate neonatal outcomes in relation to maternal SARS-CoV-2 test positivity in pregnancy.

    Design, Setting, and Participants: Nationwide, prospective cohort study based on linkage of the Swedish Pregnancy Register, the Neonatal Quality Register, and the Register for Communicable Diseases. Ninety-two percent of all live births in Sweden between March 11, 2020, and January 31, 2021, were investigated for neonatal outcomes by March 8, 2021. Infants with malformations were excluded. Infants of women who tested positive for SARS-CoV-2 were matched, directly and using propensity scores, on maternal characteristics with up to 4 comparator infants.

    Exposures: Maternal test positivity for SARS-CoV-2 in pregnancy.

    Main Outcomes and Measures: In-hospital mortality; neonatal resuscitation; admission for neonatal care; respiratory, circulatory, neurologic, infectious, gastrointestinal, metabolic, and hematologic disorders and their treatments; length of hospital stay; breastfeeding; and infant test positivity for SARS-CoV-2.

    Results: Of 88159 infants (49.0% girls), 2323 (1.6%) were delivered by mothers who tested positive for SARS-CoV-2. The mean gestational age of infants of SARS-CoV-2-positive mothers was 39.2 (SD, 2.2) weeks vs 39.6 (SD, 1.8) weeks for comparator infants, and the proportions of preterm infants (gestational age <37 weeks) were 205/2323 (8.8%) among infants of SARS-CoV-2-positive mothers and 4719/85836 (5.5%) among comparator infants. After matching on maternal characteristics, maternal SARS-CoV-2 test positivity was significantly associated with admission for neonatal care (11.7% vs 8.4%; odds ratio [OR], 1.47; 95% CI, 1.26-1.70) and with neonatal morbidities such as respiratory distress syndrome (1.2% vs 0.5%; OR, 2.40; 95% CI, 1.50-3.84), any neonatal respiratory disorder (2.8% vs 2.0%; OR, 1.42; 95% CI, 1.07-1.90), and hyperbilirubinemia (3.6% vs 2.5%; OR, 1.47; 95% CI, 1.13-1.90). Mortality (0.30% vs 0.12%; OR, 2.55; 95% CI, 0.99-6.57), breastfeeding rates at discharge (94.4% vs 95.1%; OR, 0.84; 95% CI, 0.67-1.05), and length of stay in neonatal care (median, 6 days in both groups; difference, 0 days; 95% CI, -2 to 7 days) did not differ significantly between the groups. Twenty-one infants (0.90%) of SARS-CoV-2-positive mothers tested positive for SARS-CoV-2 in the neonatal period; 12 did not have neonatal morbidity, 9 had diagnoses with unclear relation to SARS-CoV-2, and none had congenital pneumonia.

    Conclusions and Relevance: In a nationwide cohort of infants in Sweden, maternal SARS-CoV-2 infection in pregnancy was significantly associated with small increases in some neonatal morbidities. Given the small numbers of events for many of the outcomes and the large number of statistical comparisons, the findings should be interpreted as exploratory..

  • 48.
    Norman, Mikael
    et al.
    Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden.
    Nilsson, David
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Kemiska institutionen.
    Trygg, Johan
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Kemiska institutionen.
    Håkansson, Stellan
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Perinatal risk factors for mortality in very preterm infants: A nationwide, population-based discriminant analysis2022Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 111, nr 8, s. 1526-1535Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: To assess the strength of associations between interrelated perinatal risk factors and mortality in very preterm infants.

    Methods: Information on all live-born infants delivered in Sweden at 22–31 weeks of gestational age (GA) from 2011 to 2019 was gathered from the Swedish Neonatal Quality Register, excluding infants with major malformations or not resuscitated because of anticipated poor prognosis. Twenty-seven perinatal risk factors available at birth were exposures and in-hospital mortality outcome. Orthogonal partial least squares discriminant analysis was applied to assess proximity between individual risk factors and mortality, and receiver operating characteristic (ROC) curves were used to estimate discriminant ability.

    Results: In total, 638 of 8,396 (7.6%) infants died. Thirteen risk factors discriminated reduced mortality; the most important were higher Apgar scores at 5 and 10 min, GA and birthweight. Restricting the analysis to preterm infants <28 weeks’ GA (n = 2939, 16.9% mortality) added antenatal corticosteroid therapy as significantly associated with lower mortality. The area under the ROC curve (the C-statistic) using all risk factors was 0.86, as determined after both internal and external validation.

    Conclusion: Apgar scores, gestational age and birthweight show stronger associations with mortality in very preterm infants than several other perinatal risk factors available at birth.

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  • 49.
    Norman, Mikael
    et al.
    Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden.
    Padkær Petersen, Jesper
    The Danish Clinical Quality Program – National Clinical Registries (RKKP), Aarhus, Denmark; Department of Paediatrics, Aarhus University Hospital, Aarhus, Denmark.
    Stensvold, Hans Jørgen
    Department of Neonatal Intensive Care, Clinic of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.
    Thorkelsson, Thordur
    Department of Neonatal Medicine, Children's Hospital Iceland, Landspitali University Hospital, Reykjavík, Iceland.
    Helenius, Kjell
    Department of Paediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland; Department of Clinical Medicine, University of Turku, Turku, Finland.
    Brix Andersson, Charlotte
    The Danish Clinical Quality Program – National Clinical Registries (RKKP), Aarhus, Denmark; Department of Obstetrics and Gynaecology, Aalborg University Hospital, Thisted, Denmark.
    Ørum Cueto, Heidi
    The Danish Clinical Quality Program – National Clinical Registries (RKKP), Aarhus, Denmark.
    Domellöf, Magnus
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Gissler, Mika
    Department of Knowledge Brokers, THL Finnish Institute for Health and Welfare, Helsinki, Finland.
    Heino, Anna
    Department of Knowledge Brokers, THL Finnish Institute for Health and Welfare, Helsinki, Finland.
    Håkansson, Stellan
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Jonsson, Baldvin
    Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
    Klingenberg, Claus
    Paediatric Research Group, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway; Department of Paediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway.
    Lehtonen, Liisa
    Department of Paediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland; Department of Clinical Medicine, University of Turku, Turku, Finland.
    Metsäranta, Marjo
    Department of Paediatrics, New Children's Hospital, Paediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
    Rønnestad, Arild E.
    Department of Neonatal Intensive Care, Clinic of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway; Medical Faculty, Institute for Clinical Medicine, University of Oslo, Oslo, Norway.
    Trautner, Simon
    The Danish Clinical Quality Program – National Clinical Registries (RKKP), Aarhus, Denmark; Department of Intensive Care of Newborns and Small Children, University Hospital of Copenhagen, Copenhagen, Denmark.
    Preterm birth in the Nordic countries—Capacity, management and outcome in neonatal care2023Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 112, nr 7, s. 1422-1433Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: Organisation of care, perinatal and neonatal management of very preterm infants in the Nordic regions were hypothesised to vary significantly. The aim of this observational study was to test this hypothesis.

    Methods: Information on preterm infants in the 21 greater healthcare regions of Denmark, Finland, Iceland, Norway and Sweden was gathered from national registers in 2021. Preterm birth rates, case-mix, perinatal interventions, neonatal morbidity and survival to hospital discharge in very (<32 weeks) and extremely preterm infants (<28 weeks of gestational age) were compared.

    Results: Out of 287 642 infants born alive, 16 567 (5.8%) were preterm, 2389 (0.83%) very preterm and 800 (0.28%) were extremely preterm. In very preterm infants, exposure to antenatal corticosteroids varied from 85% to 98%, live births occurring at regional centres from 48% to 100%, surfactant treatment from 28% to 69% and use of mechanical ventilation varied from 13% to 77% (p < 0.05 for all comparisons). Significant regional variations within and between countries were also seen in capacity in neonatal care, case-mix and number of admissions, whereas there were no statistically significant differences in survival or major neonatal morbidities.

    Conclusion: Management of very preterm infants exhibited significant regional variations in the Nordic countries.

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  • 50. Persson, Martina
    et al.
    Shah, Prakesh S.
    Rusconi, Franca
    Reichman, Brian
    Modi, Neena
    Kusuda, Satoshi
    Lehtonen, Liisa
    Håkansson, Stellan
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Yang, Junmin
    Isayama, Tetsuya
    Beltempo, Marc
    Lee, Shoo
    Norman, Mikael
    Association of Maternal Diabetes With Neonatal Outcomes of Very Preterm and Very Low-Birth-Weight Infants: an International Cohort Study2018Ingår i: JAMA pediatrics, ISSN 2168-6203, E-ISSN 2168-6211, Vol. 172, nr 9, s. 867-875Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    IMPORTANCE: Diabetes in pregnancy is associated with a 2-times to 3-times higher rate of very preterm birth than in women without diabetes. Very preterm infants are at high risk of death and severe morbidity. The association of maternal diabetes with these risks is unclear.

    OBJECTIVE: To determine the associations between maternal diabetes and in-hospital mortality, as well as neonatal morbidity in very preterm infants with a birth weight of less than 1500 g.

    DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study was conducted at 7 national networks in high-income countries that are part of the International Neonatal Network for Evaluating Outcomes in Neonates and used prospectively collected data on 76 360 very preterm, singleton infants without malformations born between January 1, 2007, and December 31, 2015, at 24 to 31 weeks' gestation with birth weights of less than 1500 g, 3280 (4.3%) of whom were born to diabetic mothers. EXPOSURES Any type of diabetes during pregnancy.

    MAIN OUTCOMES AND MEASURES: The primary outcome was in-hospital mortality. The secondary outcomes were severe neonatal morbidities, including intraventricular hemorrhages of grade 3 to 4, cystic periventricular leukomalacia, retinopathy of prematurity needing treatment and bronchopulmonary dysplasia, and other morbidities, including respiratory distress, treated patent ductus arteriosus, and necrotizing enterocolitis. Odds ratios (ORs) with 95% confidence intervals were estimated, adjusted for potential confounders, and stratified by gestational age (GA), sex, and network.

    RESULTS: The mean (SD) birth weight of offspring born to mothers with diabetes was significantly higher at 1081 (262) g than in offspring born to mothers without diabetes (mean [SD] birth weight, 1027 [270] g). Of 76 360 infants, 25 962 (34%) and 33 598 (44%) were born before 28 weeks of gestation to mothers with and without diabetes, respectively. Mothers with diabetes were older and had more hypertensive disorders, antenatal steroid treatments, and deliveries by cesarean delivery than mothers without diabetes. Infants of mothers with diabetes were born at a later GA than infants of mothers without diabetes. In-hospital mortality (6.6% vs 8.3%) and the composite of mortality and severe morbidity (31.6% vs 40.6%) were lower in infants of mothers with diabetes. However, in adjusted analyses, no significant differences in in-hospital mortality (adjusted OR, 1.16 (95% CI, 0.97-1.39) or the composite of mortality and severe morbidity (adjusted OR, 0.99 (95% CI, 0.88-1.10) were observed. With few exceptions, outcomes of infants born to mothers with and without diabetes were similar regardless of infant sex, GA, or country of birth.

    CONCLUSIONS AND RELEVANCE: In high-resource settings, maternal diabetes is not associated with an increased risk of in-hospital mortality or severe morbidity in very preterm infants with a birth weight of fewer than 1500 g.

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