umu.sePublications
Change search
Refine search result
6789101112 401 - 450 of 570
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Rows per page
  • 5
  • 10
  • 20
  • 50
  • 100
  • 250
Sort
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
Select
The maximal number of hits you can export is 250. When you want to export more records please use the Create feeds function.
  • 401.
    Rönnqvist, Louise
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Domellöf, Erik
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Johansson, Anna-Maria
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Social Sciences, Department of Psychology.
    Faroogi, Aijaz
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Domellöf, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Riklund, Katrine
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Lindqvist, Thomas
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Birgander, Richard
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Effects of twin-births on IQ, handedness, and brain volumes in 8-years-old preterm born twins and matched singletons: a pilot study2016In: Developmental Medicine & Child Neurology, ISSN 0012-1622, E-ISSN 1469-8749, Vol. 58, no S6, p. 57-Article in journal (Refereed)
    Abstract [en]

    Background: Children born preterm have a high prevalence of long-term cognitive and behavioral disturbances. Still, studies of how preterm-twin-births may effect brain maturation and thus, contribute to long-term effects on brain-behavioral development and functions are rare.

    Aim: To investigate whether brain volumes differ between twin (TPB) and singleton preterm born (SPB) and full-term born children (FTB) and associate to long-term cognitive and behavioral outcomes as well as to gestational age (GA), birth weight (BW) and head circumference (BHC) at birth.

    Method: A sample of 22 twin born preterm (Mean GA=32.1, BW=1781), 23 matched singletons preterm (Mean GA=31.8, BW=1751), and 22 full-term singletons were included. All children were investigated by means of their cognition functions (WISC-IV), handedness performance index and brain volumes (3 Tesla MRI) at early school ages (M=7.8y) in 40 children (9 TPB, 10 SPB, 21 FTB).

    Results: The FTB-children performed better than both TPB and SPB on cognitive performance, and showed higher IQ. Brain volumes, especially Gray matter were stronger associated with IQ in the twins. Furthermore it was found that the SPB singletons had smaller Total Brain volume and less Grey Matter than FTB. The twins showed a higher prevalence of non-right handedness associated to GA, than both SPB and FTB. Independently of birth status, GA, BW and BHC were found to correlate positively with IQ, Total Brain volume, and Gray-and White matter volumes.

    Conclusion: Discordant handedness in TPB children and associations to lower GA indicate effect of twin-births on early functional laterality. The overall associations found between low GA/BW and smaller BHC at birth in preterm born and associations with lower IQ and smaller brain volumes at 8-y indicate that a very preterm birth are a higher predictor for long-term effects on brain development and cognitive performance than twin-birth per se.

  • 402.
    Rönnqvist, Louise
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Domellöf, Erik
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Johansson, Anna-Maria
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Riklund, Katrine
    Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Lindqvist, Thomas
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Diagnostic Radiology.
    Birgander, Richard
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Diagnostic Radiology.
    Long term effects of preterm births: associations between upper-limb kinematics, brain volumes and cognitive functions2014In: Congress Programme. 1st Clinical Movement Analysis Word Conference, 2014, p. 310-310Conference paper (Refereed)
    Abstract [en]

    INTRODUCTION and AIM

    Studies of long-term outcomes linked to a preterm birth have generally found increasing amount of neurodevelopmental and cognitive disabilities and delays. Still, few have addressed the upper-limb performance by means of kinematic outcomes in associations with cognitive functions and brain volumes. Thus, the main aim of this study was to investigate such possible relationships within school age preterm born children and in relation to their gestational age (GA) at birth.

    PATIENTS/MATERIALS and METHODS

    The present study is part of a longitudinal, ongoing multidisciplinary project with the goal to discover possible long-term effects of a preterm birth. In this sub-study 7-9-years-old children born preterm (PT) without early sign of neuropathology (N= 24, Mean GW=32, range 22-35) in comparison to age matched term born children (N=31) was included. Kinematics was measured by ProReflex, 3D-registration during task specific, bi- and uni-manual upper-limb movement performance. Additionally, functional brain volumes were investigated by 3-Tesla (T) magnetic resonance imaging (MRI) and cognitive functions by the Wechsler Intelligence Scale for Children, 4th edition (WISC-IV).

    RESULTS

    Our preliminary results show significant poorer upper-limb kinematics with more segmented and longer movement paths in the PT-born children in comparison to the term born, this was particular evident for thus children born very- and extremely PT (<32 GA). In agreement with this finding, a decreased total brain volume and regional gray matter reduction were significantly correlated with more segmented arm and head movement trajectories, and with poorer general IQ outcomes, as well as with lower gestational ages.

    DISCUSSION and CONCLUSIONS

    The findings from the present study show that a preterm birth, and especially a very- and extremely preterm birth, may cause long-term effects on the development of neurophysiology mechanism involved in the goal-directed upper-limb movements. Additionally, it shows that the development of the neuro-motor mechanisms also are associated with both cognitive functions and the general brain development. Thus, indicating that a very preterm birth seemingly still give neuro-developmental related problems when at school age.

  • 403.
    Rönnqvist, Louise
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Johansson, Anna-Maria
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Domellöf, Erik
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Kinematic analysis of sequential goal-directed movements in at-risk, preterm born children2014In: Gait & Posture, ISSN 0966-6362, E-ISSN 1879-2219, Vol. 39, no Suppl 1, p. 22-Article in journal (Other academic)
  • 404.
    Rönnqvist, Louise
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Lenfeldt, Niklas
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Johansson, Anna-Maria
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Riklund, Katrine
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Warntjes, Marcel J B
    Department Centre for Medical Image Science and Visualization, Linköping University.
    Domellöf, Erik
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Assessment of myelin and brain volumes at early school-age: long-term effects of a preterm birth2018In: Developmental Medicine & Child Neurology, ISSN 0012-1622, E-ISSN 1469-8749, Vol. 60, no S2, p. 20-Article in journal (Refereed)
    Abstract [en]

    Background

    Structural and functional alterations in white matter architecture are common described in children born preterm (PT) and associated to behavioral implications. Still, how critical gestational immaturity may associate with later myelination is less studied. This study aimed to explore the influence and associations between gestational age (GA) and birthweight (BW) in children born PT compared with fullterm (FT), on quantitative values of brain myelin and volumes.

    Patients and methods

    Participants included 60 children (mean age = 8.2 years) categorized based on GA (weeks); ranging from 25 - 35.4 in PTs (N=27); 38 - 41.9 in FTs (N=33). Volumetric brain measures were conducted by a 3.0-Tesla MRI-scanner and synthetic MRI (SyMRI) acquisition sequence, including synthesis of contrast weighted images. Automatic segmentation of total brain tissues (intracranial [ICV] and parenchymal [BPV] volume [ml]) generated gray-matter (GM), white-matter (WM), cerebrospinal fluid (CSF), and total myelin volume.

    Result

    Children born extremely PT (<27GW) displayed reductions of total BPV and WM compared to FTs, less myelinated content than very PT (VPT; < 32GW) and moderately PT (MPT; <36GW), and significant more CSF than FT-born. Significant positive correlation between respectively increasing GA (r= .48) and BW (r= .53) and amount of myelinated content were found for the PT-born.

    Conclusion

    Detection of diversity regarding myelination and brain-volumes and associations to risk factors related to gestational immaturity may be useful for increased understanding of long-term effects of degree of prematurity and allowing future investigations of how interventions effects brain myelination (and plasticity) in children born PT.

  • 405. Rösblad, Birgit
    Visual and proprioceptive control of arm movements: studies of development and dysfunction1994Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The aim of this dissertation was to examine the role of sensory information for control of goal-directed arm movements in children. The role of visual and proprioceptive information on the target for end point accuracy was examined in normal 4- to 12-year- old children (Study I), and in children with motor impairments (Study II). Accuracy in pointing with the unseen hand was found to improve rapidly during the age period tested, with the most pronounced development taking place in the preschool years. Visual specification of the target was superior to proprioceptive specification for all age groups tested. The performance of children with motor impairments was more variable than that of the non-impaired children, and this effect was most pronounced when visual information about the target was unavailable. The importance of visual information for controlling the transport and handling part of reaching movements were examined in normal 6- to 8-year-old children (Study III), and in children with developmental coordination disorders (Study IV). Object handling required visual information on both target and hand. For the transport phase of the movement visual information on target was sufficient, and sight of hand did not improve performance. The young children were relatively more impaired than the older children when lacking adequate visual information. The children with developmental coordination disorders responded to the withdrawal of visual information in a similar way to that of the normally developed children. A discontinuity at 7 years of age in the development of perceptual control of pointing movements, observed in Study I, was further investigated and confirmed in study V. In this study the ability to control movements visually and prorioceptively was also investigated and found to develop in parallel rather than one being a prerequisite for the other.

  • 406.
    Salazar, Mariano
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Högberg, Ulf
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Valladares, Eliette
    Nicaraguan Natl Autonomous Univ, Dept Obstet & Gynecol, Leon, Nicaragua.
    Persson, Lars-Åke
    Uppsala Univ, Dept Womens & Childrens Hlth, Uppsala, Sweden.
    Intimate partner violence and early child growth: a community-based cohort study in Nicaragua2012In: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 12, p. 82-Article in journal (Refereed)
    Abstract [en]

    Background: This study analyses whether a mother's exposure to different forms of Intimate Partner Violence (IPV) during pregnancy was associated with the index child linear growth, and whether these associations were modified by the gender of the child.

    Methods: A pregnancy cohort of 478 women in Leon, Nicaragua, resulted in 461 live births. From this group, 81% (375/461) children were available for anthropometric follow-up at 40 to 46 months. Analysis of covariance (ANCOVA) was used to assess the association between IPV and height-for-age Z-scores, adjusting for confounding factors.

    Results: Sixty-three percent (236/375) of the mothers had been exposed to some form of IPV during pregnancy (emotional, physical, sexual or controlling behavior). After adjustment for confounding factors, maternal exposure to any IPV during pregnancy was associated with 0.24 lower mean height-for-age Z-scores (p = 0.02). A separate analysis of each IPV type showed that emotional, physical or sexual IPV during pregnancy were not significantly associated with lower mean height-for-age Z-scores, whereas ever exposure to controlling behavior by the father of the child was related to 0.29 lower mean height-for-age Z-scores (p < 0.01) When stratified by gender, these associations remained significant only for young girls.

    Conclusions: This study has contributed to the growing amount of evidence pointing to the pervasive effect of different forms of IPV on child health. Our study highlights the relevance of maternal autonomy for linear child growth, especially for young girls in the Nicaraguan context.

  • 407.
    Samuelson, Gösta
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    An epidemiological study of child health and nutrition in a northern Swedish county1971Doctoral thesis, comprehensive summary (Other academic)
  • 408.
    Samuelsson, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Holsti, Antti
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Adamsson, Marie
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Serenius, Fredrik
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics. Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Farooqi, Aijaz
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Behavioral Patterns in Adolescents Born at 23 to 25 Weeks of Gestation2017In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 140, no 1, article id e20170199Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: This study examined mental health outcomes in extremely preterm children (EPT) born at 23 to 25 weeks of gestation between 1992 and 1998 at 2 Swedish tertiary care centers that offered regional and active perinatal care to all live-born EPT infants. METHODS; We assessed 132 (98%) of the 134 EPT survivors at 10 to 15 years of age alongside term-born controls. Behavioral and emotional problems were evaluated by using Achenbach's Child Behavior Checklist and Teacher Report Form and Conners' Parent and Teacher scales for attention-deficit/hyperactivity disorder. RESULTS: Parents and teachers reported significantly more problems with internalizing behaviors as well as attention, social, and thought problems in EPT children than in controls, even when those with major neurodevelopmental disabilities (NDDs) were excluded. Multivariate analysis of covariance of the behavioral problems reported by parents and teachers revealed no interactions, hut significant main effects emerged for group status (EPT versus control) and sex, with all effect sizes being medium to large and accounting for 8% to 14% of the variance. Compared with the controls, EPT children without NDDs had significantly increased rates of >= 90th percentile for total Conners' attention-deficit/hyperactivity disorder problem scores (parents: 40% vs 15%, odds ratio: 3.7, P <.001) (teachers: 24% vs 9%, odds ratio: 3.3, P =.005). The corresponding rates were higher in the total population. CONCLUSIONS: EPT children with or without NDDs had behavioral problems characterized by a higher risk for anxiety and attention, social, and thought problems. These findings further strengthen the proposition that a preterm behavioral phenotype is recognizable in adolescents born EPT.

  • 409. Sandahl, Julie Damgaard
    et al.
    Abrahamsson, Jonas
    Heldrup, Jesper
    Jahnukainen, Kirsi
    Jonsson, Olafur G.
    Lausen, Birgitte
    Palle, Josefine
    Zeller, Bernward
    Forestier, Erik
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Kjeldsen, Eigil
    Hasle, Henrik
    Hyperdiploidy in childhood AML associated with low age and AML-M7. A NOPHO-AML: study and literature review2011In: 53rd ASH Annual Meeting and Exposition, December 10-13, 2011: Program: Oral and Poster Abstracts Session: 611. Leukemias - Biology, Cytogenetics and Molecular Markers in Diagnosis and Prognosis: Poster III Monday, December 12, 2011, 6:00 PM-8:00 PM Hall GH (San Diego Convention Center), 2011, Vol. 118, no 21, p. 1505-1505Conference paper (Refereed)
  • 410.
    Sandin, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Annus, T
    Björkstén, B
    Nilsson, L
    Riikjärv, M-A
    van Hage-Hamsten, M
    Bråbäck, Lennart
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Prevalence of self-reported food allergy and IgE antibodies to food allergens in Swedish and Estonian schoolchildren.2005In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 59, no 3, p. 399-403Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To compare the prevalence of self-reported food allergy and IgE antibodies to food allergens in wheezing and non-wheezing Estonian and Swedish schoolchildren, in the light of the disparities in the standard of living, food consumption and prevalence of respiratory allergies that still exist between Estonia and the Scandinavian countries. DESIGN AND SETTING: As a part of the ISAAC Phase II study, children from a random sample of schools in Tallinn in Estonia and Linköping and Ostersund in Sweden participated in skin prick tests to inhalant allergens and the parents replied to questionnaires. IgE antibodies against a panel of food allergens (egg white, milk, soy bean, fish, wheat and peanut) were taken from children with questionnaire-reported wheezing and a random sample of nonwheezing children. SUBJECTS: Children aged 10-11 y. RESULTS: The prevalence of self-reported food allergy was similar in Estonia and Sweden and about twice as high in wheezing children than in nonwheezing children. In Estonia, however, 3% of the children with perceived food allergy reported reactions from at least four different foods, as compared to 31% in Sweden. The prevalence of sensitisation to food allergens was similar in wheezing and nonwheezing children in Estonia (8%) while, in Swedish children, IgE antibodies to food allergens were more likely among wheezing children (Linköping 38 vs 11%, crude OR 5.1, 95% CI 2.2-11.6, and Ostersund 24 vs 7%, crude OR 4.1, 95% CI 1.9-8.5). CONCLUSION: Our study suggests that IgE-mediated food reactions were less likely in Estonian schoolchildren. Moreover, the perception of food allergy and thereby the meaning of self-reported food allergy appears to be different in the two countries.

  • 411.
    Sandin, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Björkstén, Bengt
    Bråbäck, Lennart
    Development of atopy and wheezing symptoms in relation to heredity and early pet keeping in a Swedish birth cohort2004In: Pediatric allergy and immunology, Vol. 15, no 4, p. 316-22Article in journal (Refereed)
  • 412.
    Sandin, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Björkstén, Bengt
    Böttcher, Malin
    Jenmalm, Maria
    Bråbäck, Lennart
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    High salivary secretory IgA antibody levels are associated with less late-onset wheezing in IgE-sensitized infants2011In: Pediatric Allergy and Immunology, ISSN 0905-6157, E-ISSN 1399-3038, Vol. 22, no 5, p. 477-481Article in journal (Refereed)
    Abstract [en]

    Low levels of secretory IgA (SIgA) and transient IgA deficiency have been associated with an increased risk for allergy, but data are conflicting. The aim was to assess the relationship between salivary SIgA antibody levels at 1 yr and wheezing at age four in a birth cohort, in particular the possible protective role of salivary SIgA in sensitized children. Saliva samples were obtained from all children (n = 67) with a positive skin prick test (SPT) at 1 yr and 212 children with a negative SPT. In all, 200 of these children responded to questionnaires at 4 yrs and 183 were skin prick tested at that age. The levels of salivary SIgA and salivary IgA antibodies to the most common food allergen egg and inhalant allergen cat were analyzed by ELISA. Serum was analyzed for IgE antibodies to egg and cat. Development of late-onset wheezing was associated with low SIgA levels in children with positive SPT to at least one allergen both at 1 and 4 yrs of age (p = 0.04), as well as in children with circulating IgE antibodies to egg or cat at 1 yr (p = 0.02). None of nine persistently sensitized children with SIgA levels in the upper quartile developed wheezing, when compared to 10/20 children with lower levels (p = 0.01). Older siblings, more than three infections during infancy, at least one smoking parent, and male gender, were all associated with SIgA in the upper quartile. In conclusion, high levels of SIgA antibodies in sensitized infants were associated with significantly less late-onset wheezing, supporting a protective role against development of asthmatic symptoms. Recurrent infections and other factors supporting an increased microbial pressure during infancy were associated with high levels of salivary SIgA.

  • 413.
    Sandin, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Bråbäck, Lennart
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Norin, Elisabeth
    Björkstén, Bengt
    Faecal short chain fatty acid pattern and allergy in early childhood2009In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 98, no 5, p. 823-827Article in journal (Refereed)
    Abstract [en]

    Aim: To investigate whether functional changes of the gut flora over time were related to sensitization and allergic symptoms at four years of age.

    Methods: The levels of short chain fatty acids (SCFAs) in faecal samples at one (n = 139) and four (n = 53) years of age were related to the development of positive skin prick tests (SPT) and allergic symptoms during the first four years of life.

    Results: Faecal acetic (p < 0.01) and propionic (p < 0.01) acids decreased from one to four years of age, while valeric acid (p < 0.001) increased. Low levels of i-butyric (p = 0.01), i-valeric (p = 0.03) and valeric acids (p = 0.02) at one year were associated with questionnaire-reported symptoms of food allergy at four years. Positive SPTs and allergic symptoms at four years were associated with low faecal levels of i-butyric, i-valeric and valeric acids. At one year of age, infants with, as compared to without older siblings had higher median levels of valeric acid.

    Conclusion: A slow functional maturation of the gut microflora, as measured by faecal levels of SCFAs is associated with allergy both at one and four years. The findings lend further support to an association between allergy and the development of microbial diversity.

  • 414.
    Sandlund, Marlene
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Domellöf, Erik
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Grip, Helena
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Rönnqvist, Louise
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Häger, Charlotte K.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Training of goal directed arm movements with motion interactive video games in children with cerebral palsy: a kinematic evaluation2014In: Developmental Neurorehabilitation, ISSN 1751-8423, E-ISSN 1751-8431, Vol. 17, no 5, p. 318-326Article in journal (Refereed)
    Abstract [en]

    Objective: The main aim of this study was to evaluate the quality of goal-directed arm movements in 15 children with cerebral palsy (CP) following four weeks of home-based training with motion interactive video games. A further aim was to investigate the applicability and characteristics of kinematic parameters in a virtual context in comparison to a physical context.

    Method: Kinematics and kinetics were captured while the children performed arm movements directed towards both virtual and physical targets.

    Results: The children’s movement precision improved, their centre of pressure paths decreased, as did the variability in maximal shoulder angles when reaching for virtual objects. Transfer to a situation with physical targets was mainly indicated by increased movement smoothness.

    Conclusion: Training with motion interactive games seems to improve arm motor control in children with CP. The results highlight the importance of considering both the context and the task itself when investigating kinematic parameters.

  • 415.
    Sandström, Olof
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Rosén, Anna
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics. Umeå University, Faculty of Medicine, Department of Medical Biosciences, Medical and Clinical Genetics.
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Role of HLA-DQ Genotyping in Celiac Disease2016In: Journal of Pediatric Gastroenterology and Nutrition - JPGN, ISSN 0277-2116, E-ISSN 1536-4801, Vol. 62, no 3, p. E30-E31Article in journal (Refereed)
  • 416.
    Sandström, Olof
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Rosén, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Lagerqvist, Carina
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Carlsson, Annelie
    Depertment of Clinical Sciences, Pediatrics, Lunds university.
    Hernell, Olle
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Högberg, Lotta
    Department of Clinical and Experimental Medicine, Linköping University.
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Transglutaminase IgA antibodies in a celiac disease mass screening and the role of HLA-DQ genotyping and endomysial antibodies in a sequential testing2013In: Journal of Pediatric Gastroenterology and Nutrition - JPGN, ISSN 0277-2116, E-ISSN 1536-4801, Vol. 57, no 4, p. 472-476Article in journal (Refereed)
    Abstract [en]

    Objectives: The aim of this study was to evaluate hypothetical screening strategies in a Swedish celiac disease (CD) mass screening.

    Methods: Of 10,041 Swedish sixth graders born in 1993 invited to a population-based CD mass screening, 7208 participated. Anti-tissue transglutaminase (tTG) immunoglobulin (Ig) A were analyzed in all children and total serum IgA (s-IgA) in 7161 children. Additional analyses of tTG-IgG, endomysial antibodies (EMA) IgA and IgG, and human leukocyte antigen (HLA) alleles were performed according to a standardized protocol. Children with elevated levels of serological markers were recommended to undergo a small intestinal biopsy to verify diagnosis, and 153 children with CD were thus identified. Sensitivity, specificity, positive predictive values (PPVs) and negative predictive values (NPVs) were calculated and receiver operating characteristic curves were plotted.

    Results: By lowering the cutoff for tTG-IgA, 17 additional cases of CD were identified at the cost of 32 biopsies. All children with tTG-IgA >50 U/mL (10 times the recommended upper limit of normal) had gluten enteropathy. Area under the receiver operating characteristic curve for tTG-IgA was 0.988. All cases carried HLA-DQ2 or HLA-DQ8, as did 53% of the controls. For different hypothetical screening strategies, sensitivity, specificity, PPV, and NPV ranged between 87.6% and 100%, 99.5% and 99.9%, 79.7% and 89.7%, and 99.7% and 100%, respectively. Efforts to increase sensitivity by lowering tTG-IgA cutoff would result in increased number of small intestinal biopsies and lower PPV. Sequential testing for both EMA and HLA-DQ genotyping would reduce the number of negative small intestinal biopsies.

    Conclusions: tTG-IgA is a robust marker when used in CD mass screening and its performance can be enhanced by sequential testing for EMA or HLA-DQ genotyping.

  • 417.
    Sandvig, Axel
    et al.
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience. Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.
    Arnell, Kai
    Malm, Jan
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Eklund, Anders
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Koskinen, Lars-Owe D.
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Analysis of Codman microcerebrospinal fluid shunt2018In: Brain and Behavior, ISSN 2162-3279, E-ISSN 2162-3279, Vol. 8, no 10, article id e01002Article in journal (Refereed)
    Abstract [en]

    Introduction: Ventriculo-peritoneal cerebrospinal fluid (CSF) shunt is the most common method of treating pediatric hydrocephalus. The Codman microadjustable valve (CMAV) is a CSF shunt constructed for children. The objective of the study was (a) to analyze complications after insertion of a CMAV shunt in hydrocephalic children, (b)to analyze complications after replacing a CMAV by an adult-type Codman Hakim adjustable valve shunt (CHAV), and to (c) analyze the in vitro characteristics of the CMAV shunt and correlate the findings with the clinical performance of the shunt.

    Methods: A retrospective study analyzed a cohort of hydrocephalic children who had received a CMAV shunt and later replaced by a CHAV shunt. We report on the complications that resulted from replacing the CMAV with the CHAV. We tested six CMAV shunts with or without an antisiphon device (ASD) in which opening pressure, resistance, sensitivity to abdominal pressure, ASD position dependency, and function were determined. The test results were correlated with the clinical performance of the shunt in the retrospective study.

    Results: Thirty-seven children (19 boys, 18 girls) were identified. Within the first month after shunt placement, a total of 10 patients (27%) developed complications including infections, hygromas, and shunt dysfunction. Shunt survival varied from 1week to 145 months. Over the 10-year follow-up period, 13 children had their shunts replaced, six of them with a CHAV without any further complications. A bench test of the CMAV was done to test whether the opening pressure was in agreement with the manufacturer's specifications. Our results were generally in agreement with specifications stated by the manufacturer.

    Conclusion: Replacing a CMAV with a CHAV was well tolerated by the patients. Bench test results were generally in agreement with manufacturers specifications. Replacing a CMAV with a CHAV in pediatric hydrocephalus patients can be accomplished safely.

  • 418. Schmiegelow, K
    et al.
    Forestier, E
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hellebostad, M
    Heyman, M
    Kristinsson, J
    Söderhäll, S
    Taskinen, M
    Long-term results of NOPHO ALL-92 and ALL-2000 studies of childhood acute lymphoblastic leukemia.2010In: Leukemia, ISSN 0887-6924, E-ISSN 1476-5551, Vol. 24, no 2, p. 345-54Article in journal (Refereed)
    Abstract [en]

    Analysis of 2668 children with acute lymphoblastic leukemia (ALL) treated in two successive Nordic clinical trials (Nordic Society of Paediatric Haematology and Oncology (NOPHO) ALL-92 and ALL-2000) showed that 75% of all patients are cured by first-line therapy, and 83% are long-term survivors. Improvements in systemic and intrathecal chemotherapy have reduced the use of central nervous system (CNS) irradiation to <10% of the patients and provided a 5-year risk of isolated CNS relapse of 2.6%. Improved risk stratification and chemotherapy have eliminated the previous independent prognostic significance of gender, CNS leukemia and translocation t(1;19)(q23;p13), whereas the post-induction level of minimal residual disease (MRD) has emerged as a new risk grouping feature. Infant leukemia, high leukocyte count, T-lineage immunophenotype, translocation t(4;11)(q21;q23) and hypodiploidy persist to be associated with lower cure rates. To reduce the overall toxicity of the treatment, including the risk of therapy-related second malignant neoplasms, the current NOPHO ALL-2008 protocol does not include CNS irradiation in first remission, the dose of 6-mercaptopurine is reduced for patients with low thiopurine methyltransferase activity, and the protocol restricts the use of hematopoietic stem cell transplantation in first remission to patients without morphological remission after induction therapy or with high levels of MRD after 3 months of therapy.

  • 419. Schmiegelow, K
    et al.
    Heyman, M
    Gustafsson, G
    Lausen, B
    Wesenberg, F
    Kristinsson, J
    Vettenranta, K
    Schroeder, H
    Forestier, E
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Rosthoej, S
    The degree of myelosuppression during maintenance therapy of adolescents with B-lineage intermediate risk acute lymphoblastic leukemia predicts risk of relapse.2010In: Leukemia, ISSN 0887-6924, E-ISSN 1476-5551, Vol. 24, no 4, p. 715-20Article in journal (Refereed)
    Abstract [en]

    Drug doses, blood levels of drug metabolites and myelotoxicity during 6-mercaptopurine/methotrexate (MTX) maintenance therapy were registered for 59 adolescents (>or=10 years) and 176 non-adolescents (<10 years) with B-cell precursor acute lymphoblastic leukemia (ALL) and a white blood cell count (WBC) <50 x 10(9)/l at diagnosis. Event-free survival was lower for adolescents than non-adolescents (pEFS(12y):0.71 vs 0.83, P=0.04). For adolescents staying in remission, the mean WBC during maintenance therapy (mWBC) was related to age (r(S)=0.36, P=0.02), which became nonsignificant for those who relapsed (r(S)=0.05, P=0.9). The best-fit multivariate Cox regression model to predict risk of relapse included mWBC and thiopurine methyltransferase activity, which methylates mercaptopurine and reduces the intracellular availability of cytotoxic 6-thioguanine nucleotides (coefficient: 0.11, P=0.02). The correlation of mWBC to the risk of relapse was more pronounced for adolescents (coefficient=0.65, P=0.003) than for non-adolescents (coefficient=0.42, P=0.04). Adolescents had higher mean neutrophil counts (P=0.002) than non-adolescents, but received nonsignificantly lower mercaptopurine and MTX doses during maintenance therapy. Red blood cell MTX levels were significantly related to the dose of MTX among adolescents who stayed in remission (r(S)=0.38, P=0.02), which was not the case for those who developed a relapse (r(S)=0.15, P=0.60). Thus, compliance to maintenance therapy may influence the risk of relapse for adolescents with ALL.

  • 420. Schrier, Lenneke
    et al.
    de Kam, Marieke L.
    McKinnon, Rachel
    Bakri, Amalina Che
    Oostdijk, Wilma
    Sas, Theo C. J.
    Menke, Leonie A.
    Otten, Barto J.
    Keizer-Schrama, Sabine M. P. F. de Muinck
    Kriström, Berit
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Ankarberg-Lindgren, Carina
    Burggraaf, Jacobus
    Albertsson-Wikland, Kerstin
    Wit, Jan M.
    Comparison of Body Surface Area versus Weight-Based Growth Hormone Dosing for Girls with Turner Syndrome2014In: Hormone Research in Paediatrics, ISSN 1663-2818, E-ISSN 1663-2826, Vol. 81, no 5, p. 319-330Article in journal (Refereed)
    Abstract [en]

    Background/Aims: Growth Hormone (GH) dosage in childhood is adjusted for body size, but there is no consensus whether body weight (BW) or body surface area (BSA) should be used. We aimed at comparing the biological effect and cost-effectiveness of GH treatment dosed per m(2) BSA in comparison with dosing per kg BW in girls with Turner syndrome (TS). Methods: Serum IGF-I, GH dose, and adult height gain (AHG) from girls participating in two Dutch and five Swedish studies on the efficacy of GH were analyzed, and the cumulative GH dose and costs were calculated for both dose adjustment methods. Additional medication included estrogens (if no spontaneous puberty occurred) and oxandrolone in some studies. Results: At each GH dose, the serum IGF-I standard deviation score remained stable over time after an initial increase after the start of treatment. On a high dose (at 1 m(2) equivalent to 0.056-0.067 mg/kg/day), AHG was at least equal on GH dosed per m(2) BSA compared with dosing per kg BW. The cumulative dose and cost were significantly lower if the GH dose was adjusted for m(2) BSA. Conclusion: Dosing GH per m(2) BSA is at least as efficacious as dosing per kg BW, and is more cost-effective. (C) 2014 S. Karger AG, Basel

  • 421.
    Serenius, Fredrik
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Kylbehandling av nyfödda barn som drabbats av allvarlig syrebrist under förlossningen2009Report (Other academic)
    Abstract [sv]

    SBU:s bedömning av kunskapsläget

    Förlossningsasfyxi innebär att barnet i samband med födelsen drabbas av en kombination av syrebrist och nedsatt blodförsörjning. Om asfyxin är allvarlig kan barnet kort efter födelsen utveckla symtom på hjärnskada, så kallad hypoxisk ischemisk encefalopati (HIE). Vid måttlig till svår asfyxi kan skadorna på hjärna och andra organ till följd av syrebrist bli mycket allvarliga, och en del av barnen avlider. Hos dem som överlever finns en ökad risk för måttliga eller svåra funktionshinder, t ex i form av cerebral pares (CP) eller syn- och hörselskador. Kylbehandling är en ny metod för behandling av HIE efter asfyxi i samband med födelsen och ges som ett komplement till sedvanlig symtomlindrande behandling.

    • Kylbehandling av fullgångna nyfödda barn som har drabbats av måttliga eller svåra symtom på hjärnskada (HIE) till följd av allvarlig förlossningsasfyxi minskar risken för att barnen dör eller drabbas av svårt funktionshinder (Evidensstyrka 2)*. Det vetenskapliga underlaget är dock otillräckligt* för att bedöma metodens effekter på längre sikt än 18 månader.

    • Det vetenskapliga underlaget är otillräckligt* för att dra säkra slutsatser om biverkningar och komplikationer relaterade till kylbehandling. Inga allvarliga biverkningar eller komplikationer har identifierats i de studier som granskats i denna rapport, men dessa studier har inte varit specifikt upplagda för att studera detta.

    • Det vetenskapliga underlaget är otillräckligt* för att dra säkra slutsatser om metodens kostnadseffektivitet. Det faktum att metodens merkostnader är relativt måttliga och effekterna goda, talar dock för att metoden är kostnadseffektiv.

    • Det är oklart hur behandlingen ska utföras på bästa sätt. Därför är det viktigt att erfarenheter och resultat av behandlingen följs upp, t ex med hjälp av ett centralt kvalitetsregister. Det är också angeläget med fortsatt forskning för att vinna kunskap om optimal praxis och eventuella komplikationer och biverkningar.

  • 422.
    Serenius, Fredrik
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Blennow, Mats
    Marsal, Karel
    Sjors, Gunnar
    Kallen, Karin
    Intensity of Perinatal Care for Extremely Preterm Infants: Outcomes at 2.5 Years2015In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 135, no 5, p. E1163-E1172Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To examine the association between intensity of perinatal care and outcome at 2.5 years' corrected age (CA) in extremely preterm (EPT) infants (<27 weeks) born in Sweden during 2004-2007. METHODS: A national prospective study in 844 fetuses who were alive at the mother's admission for delivery: 707 were live born, 137 were stillborn. Infants were assigned a perinatal activity score on the basis of the intensity of care (rates of key perinatal interventions) in the infant's region of birth. Scores were calculated separately for each gestational week (gestational age [GA]-specific scores) and for the aggregated cohort (aggregated activity scores). Primary outcomes were 1-year mortality and death or neurodevelopmental disability (NDI) at 2.5 years' CA in fetuses who were alive at the mother's admission. RESULTS: Each 5-point increment in GA-specific activity score reduced the stillbirth risk (adjusted odds ratio [aOR]: 0.90; 95% confidence interval [CI]: 0.83-0.97) and the 1-year mortality risk (aOR: 0.84; 95% CI: 0.78-0.91) in the primary population and the 1-year mortality risk in live-born infants (aOR: 0.86; 95% CI: 0.79-0.93). In health care regions with higher aggregated activity scores, the risk of death or NDI at 2.5 years' CA was reduced in the primary population (aOR: 0.69; 95% CI: 0.50-0.96) and in live-born infants (aOR: 0.68; 95% CI: 0.48-0.95). Risk reductions were confined to the 22- to 24-week group. There was no difference in NDI risk between survivors at 2.5 years' CA. CONCLUSIONS: Proactive perinatal care decreased mortality without increasing the risk of NDI at 2.5 years' CA in EPT infants. A proactive approach based on optimistic expectations of a favorable outcome is justified.

  • 423.
    Serenius, Fredrik
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics. Section for Pediatrics, Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Ewald, Uwe
    Farooqi, Aijaz
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Fellman, Vineta
    Hafstrom, Maria
    Hellgren, Kerstin
    Marsal, Karel
    Ohlin, Andreas
    Olhager, Elisabeth
    Stjernqvist, Karin
    Stromberg, Bo
    Aden, Ulrika
    Kallen, Karin
    Neurodevelopmental Outcomes Among Extremely Preterm Infants 6.5 Years After Active Perinatal Care in Sweden2016In: JAMA pediatrics, ISSN 2168-6203, E-ISSN 2168-6211, Vol. 170, no 10, p. 954-963Article in journal (Refereed)
    Abstract [en]

    IMPORTANCE Active perinatal care increases the rate of survival of extremely preterm infants, but there are concerns that improved survival might increase the rate of disabled survivors. OBJECTIVE To determine the neurodevelopmental outcomes of a national cohort of children 6.5 years of age who had been born extremely preterm (<27 weeks' gestational age) in Sweden. DESIGN, SETTING, AND PARTICIPANTS Population-based prospective cohort study of consecutively born extremely preterm infants. All of these infants were born in Sweden during the period from April 1, 2004, to March 31, 2007. Of 707 live-born extremely preterm infants, 486 (68.7%) survived to 6.5 years of age. These children were assessed and compared with matched controls who had been born at term. Comparison estimates were adjusted for demographic differences. Assessments ended in February 2014, and analysis started thereafter. MAIN OUTCOMES AND MEASURES Cognitive ability was measured with the fourth edition of the Wechsler Intelligence Scale for Children (WISC-IV), and the mean (SD) scores of the children who had been born extremely preterm were compared with those of the controls. Clinical examinations and parental questionnaires were used for diagnosis of cerebral palsy, hearing and vision impairments, and cognition for the children who were not assessed with the WISC-IV. RESULTS Of 486 eligible infants who were born extremely preterm, 441 (90.7%) were assessed at 6.5 years of age (59 by medical record review only) alongside 371 controls. The adjusted mean (SD) full-scale WISC-IV score was 14.2 (95% CI, 12.1-16.3) points lower for children who had been born extremely preterm than for controls. Cognitive disability was moderate for 18.8% of extremely preterm children and 2.2% of controls (P < .001), and it was severe for 11.1% of extremely preterm children and 0.3% of controls (P < .001). Cerebral palsy was observed in 9.5% of extremely preterm children and 0.0% of controls (P < .001), blindness was observed in 2.0% of extremely preterm children and 0.0% of controls (P < .001), and hearing impairment was observed in 2.1% of extremely preterm children and 0.5% of controls (P = .07). Overall, 36.1%(95% CI, 31.7%-40.6%) of extremely preterm children had no disability, 30.4%(95% CI 26.3%-34.8%) had mild disability, 20.2%(95% CI, 16.6%-24.2%) had moderate disability, and 13.4%(95% CI, 10.5%-16.9%) had severe disability. For extremely preterm children, moderate or severe overall disability decreased with gestational age at birth (adjusted odds ratio per week, 0.65 [95% CI, 0.54-0.79]; P < .001) and increased from 26.6% to 33.5%(P = .01) for children assessed both at 2.5 and 6.5 years. CONCLUSIONS AND RELEVANCE Of the 441 extremely preterm infants who had received active perinatal care, 293 (66.4%) had no or mild disability at 6.5 years; of the 371 controls, 11 (3.0%) had moderate or severe disability. Disability rates at 6.5 years increased relative to the rates at 2.5 years. Results are relevant for health care professionals and planners, and for clinicians counseling families facing extremely preterm births.

  • 424.
    Serenius, Fredrik
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics. Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Farooqi, Aijaz
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Fellman, V.
    Hafstrom, M.
    Kallen, K.
    Lindberg, E.
    Marsal, K.
    Olhager, E.
    Stjernqvist, K.
    Stromberg, B.
    Aden, U.
    Developmental problems in extremely preterm children with borderline intellectual functioning and free from neurosensory disabilities at 6.5 years in Sweden (the EXPRESS study)2016In: EUROPEAN JOURNAL OF PEDIATRICS, ISSN 0340-6199, Vol. 175, no 11, p. 1551-1552Article in journal (Refereed)
  • 425.
    Serenius, Fredrik
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics. Uppsala Univ, Dept Womens & Childrens Hlth, Sect Pediat, S-75185 Uppsala, Sweden.
    Kallen, Karin
    Blennow, Mats
    Ewald, Uwe
    Fellman, Vineta
    Holmstrom, Gerd
    Lindberg, Eva
    Lundqvist, Pia
    Marsal, Karel
    Norman, Mikael
    Olhager, Elisabeth
    Stigson, Lennart
    Stjernqvist, Karin
    Vollmer, Brigitte
    Stromberg, Bo
    Neurodevelopmental Outcome in Extremely Preterm Infants at 2.5 Years After Active Perinatal Care in Sweden2013In: Journal of the American Medical Association (JAMA), ISSN 0098-7484, E-ISSN 1538-3598, Vol. 309, no 17, p. 1810-1820Article in journal (Refereed)
    Abstract [en]

    Importance Active perinatal care increases survival of extremely preterm infants; however, improved survival might be associated with increased disability among survivors. Objective To determine neurodevelopmental outcome in extremely preterm children at 2.5 years (corrected age). Design, Setting, and Participants Population-based prospective cohort of consecutive extremely preterm infants born before 27 weeks of gestation in Sweden between 2004 and 2007. Of 707 live-born infants, 491 (69%) survived to 2.5 years. Survivors were assessed and compared with singleton control infants who were born at term and matched by sex, ethnicity, and municipality. Assessments ended in February 2010 and comparison estimates were adjusted for demographic differences. Main Outcomes and Measures Cognitive, language, and motor development was assessed with Bayley Scales of Infant and Toddler Development (3rd edition; Bayley-III), which are standardized to mean (SD) scores of 100 (15). Clinical examination and parental questionnaires were used for diagnosis of cerebral palsy and visual and hearing impairments. Assessments were made by week of gestational age. Results At a median age of 30.5 months (corrected), 456 of 491 (94%) extremely preterm children were evaluated (41 by chart review only). For controls, 701 had information on health status and 366 had Bayley-III assessments. Mean (SD) composite Bayley-III scores (cognition, 94 [12.3]; language, 98 [16.5]; motor, 94 [15.9]) were lower than the corresponding mean scores for controls (cognition, 104 [10.6]; P < .001; adjusted difference in mean scores, 9.2 [99% CI, 6.9-11.5]; language, 109 [12.3]; P < .001; adjusted difference in mean scores, 9.3 [99% Cl, 6.4-12.3]; and motor, 107 [13.7]; P < .001; adjusted difference in mean scores, 12.6 [99% Cl, 9.5-15.6]). Cognitive disability was moderate in 5% of the extremely preterm group vs 0.3% in controls (P < .001) and it was severe in 6.3% of the extremely preterm group vs 0.3% in controls (P < .001). Language disability was moderate in 9.4% of the extremely preterm group vs 2.5% in controls (P < .001) and severe in 6.6% of the extremely preterm group vs 0% in controls (P < .001). Other comparisons between the extremely preterm group vs controls were for cerebral palsy (7.0% vs 0.1%; P < .001), for blindness (0.9% vs 0%; P = .02), and for hearing impairment (moderate and severe, 0.9% vs 0%; P = .02, respectively). Overall, 42% (99% CI, 36%-48%) of extremely preterm children had no disability, 31% (99% CI, 25%-36%) had mild disability, 16% (99% CI, 12%-21%) had moderate disability, and 11% (99% CI, 7.2%-15%) had severe disability. Moderate or severe overall disability decreased with gestational age at birth (22 weeks, 60%; 23 weeks, 51%; 24 weeks, 34%; 25 weeks, 27%; and 26 weeks, 17%; P for trend < .001). Conclusions and Relevance Of children born extremely preterm and receiving active perinatal care, 73% had mild or no disability and neurodevelopmental outcome improved with each week of gestational age. These results are relevant for clinicians counseling families facing extremely preterm birth. JAMA. 2013;309(17):1810-1820

  • 426.
    Serenius, Fredrik
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Sjörs, Gunnar
    Blennow, Mats
    Fellman, Vineta
    Holmstrom, Gerd
    Marsal, Karel
    Lindberg, Eva
    Olhager, Elisabeth
    Stigson, Lennart
    Westgren, Magnus
    Källen, Karin
    EXPRESS study shows significant regional differences in 1-year outcome of extremely preterm infants in Sweden2014In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 103, no 1, p. 27-37Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to investigate differences in mortality up to 1year of age in extremely preterm infants (before 27weeks) born in seven Swedish healthcare regions.

    Methods: National prospective observational study of consecutively born, extremely preterm infants in Sweden 2004-2007. Mortality was compared between regions. Crude and adjusted odds ratios and 95% CI were calculated.

    Results: Among 844 foetuses alive at mother's admission for delivery, regional differences were identified in perinatal mortality for the total group (22-26weeks) and in the stillbirth and perinatal and 365-day mortality rates for the subgroup born at 22-24weeks. Among 707 infants born alive, regional differences were found both in mortality before 12h and in the 365-day mortality rate for the subgroup (22-24weeks) and for the total group (22-26weeks). The mortality rates were consistently lower in two healthcare regions. There were no differences in the 365-day mortality rate for infants alive at 12h or for infants born at 25weeks. Neonatal morbidity rates among survivors were not higher in regions with better survival rates. Perinatal practices varied between regions.

    Conclusion: Mortality rates in extremely preterm infants varied considerably between Swedish healthcare regions in the first year after birth, particularly between the most immature infants.

  • 427. Shah, Prakesh S.
    et al.
    Kusuda, Satoshi
    Håkansson, Stellan
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Reichman, Brian
    Lui, Kei
    Lehtonen, Liisa
    Modi, Neena
    Vento, Maximo
    Adams, Mark
    Rusconi, Franca
    Norman, Mikael
    Darlow, Brian A.
    Lodha, Abhay
    Yang, Junmin
    Bassler, Dirk
    Helenius, Kjell K.
    Isayama, Tetsuya
    Lee, Shoo K.
    Neonatal Outcomes of Very Preterm or Very Low Birth Weight Triplets2018In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 142, no 6, article id e20181938Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To compare the neonatal outcomes of very preterm triplets with those of matched singletons using a large international cohort. METHODS: A retrospective matched-cohort study of preterm triplets and singletons born between 2007 and 2013 in the International Network for Evaluation of Outcomes in neonates database countries and matched by gestational age, sex, and country of birth was conducted. The primary outcome was a composite of mortality or severe neonatal morbidity (severe neurologic injury, treated retinopathy of prematurity, and bronchopulmonary dysplasia). Unadjusted and adjusted odds ratios with 95% confidence intervals (CIs) were calculated for model 1 (maternal hypertension and birth weight z score) and model 2 (variables in model 1, antenatal steroids, and mode of birth). Models were fitted with generalizing estimating equations and random effects modeling to account for clustering. RESULTS: A total of 6079 triplets of 24 to 32 weeks' gestation or 500 to 1499 g birth weight and 18 232 matched singletons were included. There was no difference in the primary outcome between triplets and singletons (23.4% vs 24.0%, adjusted odds ratio: 0.91, 95% CI: 0.83-1.01 for model 1 and 1.00, 95% CI: 0.90-1.11 for model 2). Rates of severe neonatal morbidities did not differ significantly between triplets and singletons. The results were also similar for a subsample of the cohort (1648 triplets and 4944 matched singletons) born at 24 to 28 weeks' gestation. CONCLUSIONS: No significant differences were identified in mortality or major neonatal morbidities between triplets who were very low birth weight or very preterm and matched singletons.

  • 428. Shah, Prakesh S.
    et al.
    Lee, Shoo K.
    Lui, Kei
    Sjors, Gunnar
    Mori, Rintaro
    Reichman, Brian
    Håkansson, Stellan
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Feliciano, Laura San
    Modi, Neena
    Adams, Mark
    Darlow, Brian
    Fujimura, Masanori
    Kusuda, Satoshi
    Haslam, Ross
    Mirea, Lucia
    The International Network for Evaluating Outcomes of very low birth weight, very preterm neonates (iNeo): a protocol for collaborative comparisons of international health services for quality improvement in neonatal care2014In: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 14, p. 110-Article in journal (Refereed)
    Abstract [en]

    Background: The International Network for Evaluating Outcomes in Neonates (iNeo) is a collaboration of population-based national neonatal networks including Australia and New Zealand, Canada, Israel, Japan, Spain, Sweden, Switzerland, and the UK. The aim of iNeo is to provide a platform for comparative evaluation of outcomes of very preterm and very low birth weight neonates at the national, site, and individual level to generate evidence for improvement of outcomes in these infants. Methods/design: Individual-level data from each iNeo network will be used for comparative analysis of neonatal outcomes between networks. Variations in outcomes will be identified and disseminated to generate hypotheses regarding factors impacting outcome variation. Detailed information on physical and environmental factors, human and resource factors, and processes of care will be collected from network sites, and tested for association with neonatal outcomes. Subsequently, changes in identified practices that may influence the variations in outcomes will be implemented and evaluated using quality improvement methods. Discussion: The evidence obtained using the iNeo platform will enable clinical teams from member networks to identify, implement, and evaluate practice and service provision changes aimed at improving the care and outcomes of very low birth weight and very preterm infants within their respective countries. The knowledge generated will be available worldwide with a likely global impact.

  • 429. Shah, Prakesh S.
    et al.
    Lui, Kei
    Sjors, Gunnar
    Mirea, Lucia
    Reichman, Brian
    Adams, Mark
    Modi, Neena
    Darlow, Brian A.
    Kusuda, Satoshi
    Feliciano, Laura San
    Yang, Junmin
    Håkansson, Stellan
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Mori, Rintaro
    Bassler, Dirk
    Figueras-Aloy, Josep
    Lee, Shoo K.
    Neonatal Outcomes of Very Low Birth Weight and Very Preterm Neonates: An International Comparison2016In: Journal of Pediatrics, ISSN 0022-3476, E-ISSN 1097-6833, Vol. 177, p. 144-152Article in journal (Refereed)
    Abstract [en]

    Objective To compare rates of a composite outcome of mortality or major morbidity in very-preterm/very low birth weight infants between 8 members of the International Network for Evaluating Outcomes.

    Study design We included 58 004 infants born weighing < 1500 g at 24 degrees-31(6) weeks' gestation from databases in Australia/New Zealand, Canada, Israel, Japan, Spain, Sweden, Switzerland, and the United Kingdom. We compared a composite outcome (mortality or any of grade >= 3 peri-intraventricular hemorrhage, periventricular echodensity/echolucency, bronchopulmonary dysplasia, or treated retinopathy of prematurity) between each country and all others by using standardized ratios and pairwise using logistic regression analyses.

    Results Despite differences in population coverage, included neonates were similar at baseline. Composite outcome rates varied from 26% to 42%. The overall mortality rate before discharge was 10% (range: 5% [Japan]-17% [Spain]). The standardized ratio (99% CIs) estimates for the composite outcome were significantly greater for Spain 1.09 (1.04-1.14) and the United Kingdom 1.16 (1.11-1.21), lower for Australia/New Zealand 0.93 (0.89-0.97), Japan 0.89 (0.86-0.93), Sweden 0.81 (0.73-0.90), and Switzerland 0.77 (0.69-0.87), and nonsignificant for Canada 1.04 (0.99-1.09) and Israel 1.00 (0.93-1.07). The adjusted odds of the composite outcome varied significantly in pairwise comparisons.

    Conclusions We identified marked variations in neonatal outcomes between countries. Further collaboration and exploration is needed to reduce variations in population coverage, data collection, and case definitions. The goal would be to identify carepractices and health care organizational factors, which has the potential to improve neonatal outcomes.

  • 430. Shahroor, Maher
    et al.
    Lehtonen, Liisa
    Lee, Shoo K.
    Håkansson, Stellan
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Vento, Maximo
    Darlow, Brian A.
    Adams, Mark
    Mori, Annalisa
    Lui, Kei
    Bassler, Dirk
    Morisaki, Naho
    Modi, Neena
    Noguchi, Akihiko
    Kusuda, Satoshi
    Beltempo, Marc
    Helenius, Kjell
    Isayama, Tetsuya
    Reichman, Brian
    Shah, Prakesh S.
    Unit-Level Variations in Healthcare Professionals' Availability for Preterm Neonates < 29 Weeks' Gestation: An International Survey2019In: Neonatology, ISSN 1661-7800, E-ISSN 1661-7819, Vol. 116, no 4, p. 347-355Article in journal (Refereed)
    Abstract [en]

    Introduction: The availability of and variability in healthcare professionals in neonatal units in different countries has not been well characterized. Our objective was to identify variations in the healthcare professionals for preterm neonates in 10 national or regional neonatal networks participating in the International Network for Evaluating Outcomes (iNeo) of neonates.

    Method: Online, pre-piloted questionnaires about the availability of healthcare professionals were sent to the directors of 390 tertiary neonatal units in 10 international networks: Australia/New Zealand, Canada, Finland, Illinois, Israel, Japan, Spain, Sweden, Switzerland, and Tuscany.

    Results: Overall, 325 of 390 units (83%) responded. About half of the units (48%; 156/325) cared for 11-30 neonates/day and had team-based (43%; 138/325) care models. Neonatologists were present 24 h a day in 59% of the units (191/325), junior doctors in 60% (194/325), and nurse practitioners in 36% (116/325). A nurse-to-patient ratio of 1:1 for infants who are unstable and require complex care was used in 52% of the units (170/325), whereas a ratio of 1:1 or 1:2 for neonates requiring multisystem support was available in 59% (192/325) of the units. Availability of a respiratory therapist (15%, 49/325), pharmacist (40%, 130/325), dietitian (34%, 112/325), social worker (81%, 263/325), lactation consultant (45%, 146/325), parent buddy (6%, 19/325), or parents' resource personnel (11%, 34/325) were widely variable between units.

    Conclusions: We identified variability in the availability and organization of the healthcare professionals between and within countries for the care of extremely preterm neonates. Further research is needed to associate healthcare workers' availability and outcomes. (C) 2019 S. Karger AG, Basel

  • 431. Shamir, Raanan
    et al.
    Koletzko, Berthold
    Agostoni, Carlo
    Braegger, Christian
    Campoy, Cristina
    Colomb, Virginie
    Domellöf, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Decsi, Tamas
    Fewtrell, Mary
    Goulet, Olivier
    Michaelsen, Kim F
    Kolaček, Sanja
    Mihatsch, Walter
    Moreno, Luis
    Puntis, John
    Rigo, Jacques
    Szajewska, Hania
    Turck, Dominique
    van Goudoever, Johannes B
    Re: ESPGHAN's 2008 recommendation for early introduction of complementary foods2012In: Maternal and Child Nutrition, ISSN 1740-8695, E-ISSN 1740-8709, Vol. 8, no 1, p. 136-138Article in journal (Refereed)
  • 432. Shiva, F
    et al.
    Ghotbi, F
    Padyab, Mojgan
    Infant feeding and hospitalization during the first six months of life.2007In: The Journal of the Pakistan Medical AssociationArticle in journal (Refereed)
    Abstract [en]

    To compare the frequency of hospitalization during the first six months of life between breast-fed and bottle-fed infants.

    METHOD:

    A descriptive cross-sectional study was conducted over twelve months, in hospital-based outpatient clinics. Mother-infant pairs, seen at the clinics during the study period, were enrolled. Infants were between the ages of 6-24 months and had been brought for routine check-ups, vaccinations or common childhood ailments. Subjects were recruited from babies with no congenital anomalies or chronic illnesses. Study team recorded necessary information about feeding practices, previous illnesses and hospitalizations on a structured questionnaire. Hospitalization rates in 3 groups of infants with different feeding methods i.e. predominant breastfeeding, partial breast-feeding, and bottle-feeding were compared. Results were analyzed using SPSS software, ANOVA was used for comparison of means between groups, and a p-value <0.05 was regarded as significant.

    RESULTS:

    A total of 606 mother-infant dyads were enrolled, of which 73% infants were on predominant breastfeeding at 6 months of age. The rate of all-cause hospitalization before six months of age was: 6.3%, 22.2% and 27.2% in infants with predominant breast-feeding, partial breast-feeding and bottle-feeding, respectively, (p < 0.001). Figures for admission due to infectious cause were 6%, 17.6% and 25.6%, respectively, (p < 0.001). Adjusted Odds ratio between bottle-fed and breast-fed babies was 5.3 for all-cause hospitalization, and 6.1 for hospitalization due to infectious illnesses.

    CONCLUSION:

    Our findings show that protective effect of breast-feeding is not limited to developing countries; it extends to young infants living in urbanized environments equipped with adequate sanitation and clean water supply.

  • 433. Shiva, F
    et al.
    Padyab, Mojgan
    Smoking practices and risk awareness in parents regarding passive smoke exposure of their preschool children: a cross-sectional study in Tehran.2008In: Indian Journal of Medical Sciences, ISSN 0019-5359, E-ISSN 1998-3654, Vol. 62, no 6, p. 228-235Article in journal (Refereed)
    Abstract [en]

    Young children living with parents who smoke are exposed to unacceptable health hazards.

    AIM:

    To determine patterns of parental smoking, the level of parental awareness about hazards of secondhand smoke, and the effect of risk awareness on smoking behavior.

    SETTING:

    Health centers affiliated with two teaching hospitals in Tehran.

    DESIGN:

    Cross-sectional.

    MATERIALS AND METHODS:

    Data was collected from parents of preschool children visiting the health centers, through face-to-face interview, during a period of 18 months.

    STATISTICAL ANALYSIS:

    Data was analyzed by multiple logistic regression, and analysis of variance was done for comparison of means.

    RESULTS:

    In a total of 647 families, prevalence of parental smoking was 35.7%, (231 families). In 97.8% of smoking families, only the fathers smoked; and in 5 (2.2%) families, both parents were regular smokers. Prevalence of smoking was higher in poor families as compared with families who were well-off (39% vs. 25%; P = 0.025), and also in families with lower educational level. There was no significant difference in risk awareness between smokers and nonsmokers (P > .05).

    CONCLUSION:

    Low socioeconomic status and low education were identified as risk factors for children's exposure to secondhand smoke; parental risk awareness had no apparent effect on the smoking behavior. Unlike western societies, fathers were the sole habitual smokers in most families. Since factors that influence smoking behavior vary in different cultures, interventional strategies that aim to protect children from the hazards of tobacco smoke need to target diverse issues in different ethnic backgrounds.

  • 434.
    Silfverdal, Sven Arne
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Ehlin, A
    Montgomery, S M
    Breast-feeding and a subsequent diagnosis of measles2009In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 98, no 4, p. 715-719Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Breast-feeding protects against many infectious diseases and may also influence immunization outcomes. AIM: This study investigated if breast-feeding protects against clinical measles and if it modified the effect of immunization. METHODS: We used logistic regression with data for 10 207 individuals from the 1970 British Cohort study (BCS70). Breast-feeding data were collected at five years of age, and information on clinical measles infection, as well as socio-economic measures was collected at the age of ten years. Breast feeding was categorized as: breast-fed <1 month (n = 1611), breast-fed for 1-3 months (n = 1016), breast-fed for more than three months (n = 1108), breast-feeding of uncertain duration (n = 21) and never breast-fed (n = 6451). RESULTS: Breast-feeding for more than three months was negatively associated with a diagnosis of clinical measles infection after adjustment for crowding, social class, measles vaccination, parity and sex with an odds ratio (95% confidence interval) of 0.69 (0.60-0.81) compared with those who never breast-fed. Measles vaccination was highly associated with low risk for measles with: 0.14 (0.13-0.16). Age at acute measles infection was not associated with breastfeeding. Breast-feeding did not notably alter measles immunization efficacy. CONCLUSION: Immunization against measles provides effective protection against the disease. A more modest reduction in the risk of a measles diagnosis is associated with breast-feeding. The associations with a diagnosis of measles for breast-feeding and measles immunization are independent of each other.

  • 435.
    Silfverdal, Sven Arne
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Flodmark, Carl-Erik
    Rombo, Lars
    Tansey, Susan P.
    Sidhu, Mohinder
    Trammel, James
    Emini, Emilio A.
    Gruber, William C.
    Scott, Daniel A.
    Gurtman, Alejandra
    13-Valent pneumococcal conjugate vaccine (PCV13) in children partially immunized with 7-valent pneumococcal conjugate vaccine (PCV7): A phase 3, open-label trial2013In: Vaccine, ISSN 0264-410X, E-ISSN 1873-2518, Vol. 31, no 9, p. 1284-1292Article in journal (Refereed)
    Abstract [en]

    Background: As 13-valent pneumococcal conjugate vaccine (PCV13) is introduced, children who began vaccination with 7-valent pneumococcal conjugate vaccine (PCV7) may complete their vaccination with PCV13. This open-label phase 3 study evaluated immunogenicity and safety of PCV13 in Swedish infants and toddlers previously given 1 or 2 doses of PCV7 during infancy. Methods: Healthy infants previously given PCV7 at ages 3 months (group 1; n = 118) or 3 and 5 months (group 2; n = 116) received PCV13 at ages 5 (group 1) and 12 months (both groups). IgG responses were assessed 1 month after each PCV13 dose and before the 12-month dose. Local reactions and systemic events were collected for 7 days postvaccination. Other adverse events were also collected. Results: Post-5-month dose, IgG geometric mean concentrations (GMCs) in group 1 were 1.56-4.70 mu g/ml for most PCV7 serotypes except 6B (0.40 mu g/ml) and 23F (0.57 mu g/ml) and 0.72-1.88 mu g/ml for most of the 6 additional serotypes, except 6A (0.28 mu g/ml). Post-12-month dose, IgG GMCs for the PCV7 serotypes were 2.93-9.63 mu g/ml (group 1) and 3.33-9.30 mu g/ml (group 2); and for the 6 additional serotypes, 1.85-14.65 mu g/ml (group 1) and 1.34-13.16 mu g/ml (group 2). GMCs increased by >4-fold in both groups from pre- to post-12-month dose. Proportions of subjects in group 1 with pneumococcal serotype-specific IgG concentrations >= 0.35 mu g/ml (WHO-designated postprimary reference antibody level) post-5-month dose were 92.2-99.1% for most PCV7 serotypes except 6B (53.0%) and 23F (62.6%) and 80.9-100.0% for most of the 6 additional serotypes except 6A (36.8%). Local reactions and fever were mostly mild or moderate. Conclusions: PCV13 was immunogenic and safe in infants and toddlers previously partially immunized with PCV7. Even a single dose in an infant or toddler induces an immune response to the 6 additional serotypes. (C) 2013 Published by Elsevier Ltd.

  • 436.
    Silfverdal, Sven Arne
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hogh, Birthe
    Department of Pediatrics, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark.
    Bergsaker, Marianne Riise
    Division of Infectious Disease Control, Norwegian Institute of Public Health, Oslo, Norway.
    Skerlikova, Helena
    GPP Practice, Dolny Kubin, Slovakia.
    Lommel, Patricia
    Global Clinical Development Center, GlaxoSmithKline Biologicals, Rixensart, Belgium.
    Borys, Dorota
    Global Clinical Development Center, GlaxoSmithKline Biologicals, Rixensart, Belgium.
    Schuerman, Lode
    Global Clinical Development Center, GlaxoSmithKline Biologicals, Rixensart, Belgium.
    Immunogenicity of a 2-dose priming and booster vaccination with the 10-valent pneumococcal nontypeable Haemophilus influenzae protein D conjugate vaccine2009In: The Pediatric Infectious Disease Journal, ISSN 0891-3668, E-ISSN 1532-0987, Vol. 28, no 10, p. e276-282Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The immunogenicity of the 10-valent pneumococcal nontypeable Haemophilus influenzae protein D-conjugate vaccine (PHiD-CV) was determined following a simplified 2-dose priming and the more commonly employed 3-dose priming both followed by a booster dose. METHODS: A total of 351 healthy subjects were primed with PHiD-CV at either 3 and 5 or 3, 4 and 5 months of age followed in all subjects by a booster dose at 11 to 12 months of age. Serotype-specific pneumococcal responses were measured by 22F-inhibition ELISA and opsonophagocytic assays 1 month following primary and booster vaccinations. RESULTS: Depending on the serotype, the percentages of subjects reaching the ELISA antibody threshold of 0.2 microg/mL were 92.8% to 98.0% following 2 primary doses and 96.1% to 100% following 3 primary doses except for serotype 6B (55.7% and 63.1%, respectively) and serotype 23F (69.3% and 77.6%, respectively). Opsonophagocytic activity (OPA) could be measured in 74.4% to 100% and 88.9% to 100% of the subjects after the 2-dose or 3-dose priming, respectively, except for serotype 1 (60.8% and 62.9%, respectively). In both groups, robust increases in ELISA antibodies and OPA titers were observed for all serotypes after the booster dose. Higher postprimary and postbooster ELISA antibody levels and OPA titers were observed for most serotypes following the 3+1 schedule. CONCLUSION: PHiD-CV was immunogenic in both schedules, but further effectiveness data are needed to fully understand the public health benefit to be expected from these schedules in terms of prevention against invasive and mucosal infections.

  • 437.
    Silfverdal, Sven Arne
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Skerlikova, Helena
    Zanova, Maria
    Papúchová, Danica
    Traskine, Magali
    Borys, Dorota
    Schuerman, Lode
    Anamnestic Immune Response in 3- to 4-year-old Children Previously Immunized With 10-valent Pneumococcal Nontypeable Haemophilus influenzae Protein D Conjugate Vaccine as 2 Dose or 3 Dose Priming and a Booster Dose in the First Year of Life.2011In: The Pediatric Infectious Disease Journal, ISSN 0891-3668, E-ISSN 1532-0987, Vol. 30, no 9, p. e155-e163Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:: Immunogenicity of 10-valent pneumococcal nontypeable Haemophilus influenzae proteind conjugate vaccine (PHiD-CV), administered as 2 dose or 3 dose priming followed by a booster dose, has been described previously. The present study evaluated immunologic memory following PHiD-CV vaccination according to these vaccination schedules. METHODS:: A dose of PHiD-CV (to test anamnestic responses) was administered to 172 children at 36 to 46 months of age; 110 of them had previously been vaccinated with PHiD-CV according to 2 + 1 or 3 + 1 schedules (PHiD-CV [2 + 1] and PHiD-CV [3 + 1] groups) and 62 were unprimed age-matched controls. To measure immune responses before and 7 to 10 days after the PHiD-CV dose, 22F-inhibition enzyme-linked immunosorbent assay and opsonophagocytic activity (OPA) assay were used. RESULTS:: Serotype-specific IgG geometric mean concentrations (GMCs) and OPA geometric mean titers (GMTs) increased substantially (from before to 7 to 10 days after the additional PHiD-CV dose) for all 10 vaccines and 2 cross-reactive serotypes (6A and 19A) in the children previously vaccinated with PHiD-CV, regardless of the vaccination schedule used. Antibody GMCs and OPA GMTs after the administration of the PHiD-CV dose were markedly higher in both previously PHiD-CV-vaccinated groups than in the unprimed control group, clearly demonstrating prior induction of immunologic memory. Antiprotein D antibody GMCs had also increased substantially from before to 7 to 10 days after vaccination in all 3 groups, with higher antibody GMCs in the previously vaccinated groups than in the control group. CONCLUSION:: PHiD-CV vaccination according to 2 + 1 or 3 + 1 schedules resulted in comparable anamnestic immune responses. These findings suggest that similar protective efficacy may be achieved with both the schedules.

  • 438.
    Silfverdal, Sven-Arne
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Icardi, Giancarlo
    Vesikari, Timo
    Flores, Sheryl A.
    Pagnoni, Marco F.
    Xu, Jin
    Liu, Frank
    Stek, Jon E.
    Boisnard, Florence
    Thomas, Stephane
    Ziani, Eddy
    Lee, Andrew W.
    A Phase III randomized, double-blind, clinical trial of an investigational hexavalent vaccine given at 2, 4, and 11-12 months2016In: Vaccine, ISSN 0264-410X, E-ISSN 1873-2518, Vol. 34, no 33, p. 3810-3816Article in journal (Refereed)
    Abstract [en]

    Background: Combination vaccines simplify vaccination visits and improve coverage and timeliness. DTaP5-HB-IPV-Hib is a new investigational, fully-liquid, combination vaccine designed to protect against 6 infectious diseases, including 5 pertussis antigens and OMPC instead of PT as conjugated protein for Hib component.

    Methods: In this multicenter, double-blind, comparator-controlled, Phase III study (NCT01480258) conducted in Sweden, Italy, and Finland, healthy infants were randomized 1:1 to receive one two immunization regimens. The DTaP5-HB-IPV-Hib Group received the investigational hexavalent vaccine (DTaP5-HB-IPV-Hib) and the Control Group received Infanrix-hexa (DTPa3-HBV-IPV/Hib) at 2, 4 and 11-12 months of age. Both groups received concomitantly Prevnar 13 (PCV13) and Rotateq (RV5) or Rotarix (RV1) at 2, 4 months of age and PCV13 at 11-12 months. Subjects administered RV5 received a 3rd dose at 5 months of age.

    Results: A total of 656 subjects were randomized to the DTaP5-HB-IPV-Hib Group and 659 subjects to Control Group. Immune responses to all vaccine antigens post-toddler dose were non-inferior in the DTaP5-HB-IPV-Hib Group as compared to the Control Group. Additionally, the post-dose 2 and pre-toddler DTaP5-HB-IPV-Hib anti-PRP responses were superior. The DTaP5-HB-IPV-Hib Group responses to concomitant RV1 were non-inferior compared to the Control Group. Solicited adverse event rates after any dose were similar in both groups, except for higher rates of pyrexia (6.4% difference; 95% CI: 1.5,11.3) and somnolence (5.8% difference; 95% CI: 1.7,9.8) in the DTaP5-HB-IPV-Hib Group. Vaccine-related serious adverse events occurred infrequently in the DTaP5-HB-IPV-Hib Group (0.3%) and the Control Group (0.5%).

    Conclusions: The safety and immunogenicity of DTaP5-HB-IPV-Hib is generally comparable to Control when administered in the 2, 4, 11-12 month schedule. Early Hib responses were superior versus Control. DTaP5-HB-IPV-Hib could provide a new hexavalent option for pediatric combination vaccines, aligned with recommended immunizations in Europe.

  • 439. Sjöberg, Rickard L
    et al.
    Nilsson, Kent W
    Leppert, Jerzy
    Obesity, shame, and depression in school-aged children: a population-based study.2005In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 116, no 3Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To investigate whether there is an association between adolescent obesity and depression in a nonclinical population and whether psychosocial and economic status and subjective experiences of shame (defined as experiences of being degraded or ridiculed by others) may account for such an association.

    METHOD: We examined associations between self-reported body mass index (BMI) and depression, controlling for gender, shame, parental employment, parental separation, and economy. The study was performed on a sample of 4703 adolescents (71% of the target population of 15- and 17-year-old students in 1 Swedish County) who answered the Survey of Adolescent Life in Vestmanland 2004.

    RESULTS: Obesity was significantly related to depression and depressive symptoms among 15- and 17-year-olds. Obesity was also significantly related to experiences of shame. All significant association between BMI grouping and depression according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition disappeared when shaming experiences, parental employment, and parental separation were controlled for. Adolescents who reported many experiences of shame had an increased risk (odds ratio: 11.3; confidence interval: 8.3-14.9) for being depressed.

    CONCLUSIONS: There is a significant statistical association between adolescent obesity and depression. Effects of experiences of shame, parental separation, and parental employment explain this association. These results suggest that clinical treatment of obesity may sometimes not just be a matter of diet and exercise but also of dealing with issues of shame and social isolation.

  • 440.
    Sjöberg, Veronika
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Immunology/Immunchemistry.
    Hollén, Elisabet
    Pietz, Grzegorz
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology.
    Magnusson, Karl-Eric
    Fälth-Magnusson, Karin
    Sundström, Mia
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Immunology/Immunchemistry.
    Holmgren Peterson, Kajsa
    Sandström, Olof
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hernell, Olle
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hammarström, Sten
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Immunology/Immunchemistry.
    Högberg, Lotta
    Hammarström, Marie-Louise
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Immunology/Immunchemistry.
    Noncontaminated dietary oats may hamper normalization of the intestinal immune status in childhood celiac disease2014In: Clinical and Translational Gastroenterology, ISSN 2155-384X, E-ISSN 2155-384X, Vol. 5, article id e58Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Life-long, strict gluten-free diet (GFD) is the only treatment for celiac disease (CD). Because there is still uncertainty regarding the safety of oats for CD patients, the aim was to investigate whether dietary oats influence the immune status of their intestinal mucosa.

    METHODS: Paired small intestinal biopsies, before and after >11 months on a GFD, were collected from children with CD who were enrolled in a randomized, double-blind intervention trial to either of two diets: standard GFD (GFD-std; n=13) and noncontaminated oat-containing GFD (GFD-oats; n=15). Expression levels of mRNAs for 22 different immune effector molecules and tight junction proteins were determined by quantitative reverse transcriptase (RT)-PCR.

    RESULTS: The number of mRNAs that remained elevated was higher in the GFD-oats group (P=0.05). In particular, mRNAs for the regulatory T cell (Treg) signature molecules interleukin-10 (IL-10) and transforming growth factor-β1 (TGF-β1), the cytotoxicity-activating natural killer (NK) receptors KLRC2/NKG2C and KLRC3/NKG2E, and the tight junction protein claudin-4 remained elevated. Between the two groups, most significant differences were seen for claudin-4 (P=0.003) and KLRC3/NKG2E (P=0.04).

    CONCLUSIONS: A substantial fraction of pediatric CD patients seem to not tolerate oats. In these patients, dietary oats influence the immune status of the intestinal mucosa with an mRNA profile suggesting presence of activated cytotoxic lymphocytes and Tregs and a stressed epithelium with affected tight junctions. Assessment of changes in levels of mRNA for claudin-4 and KLC3/NKG2E from onset to after a year on oats containing GFD shows promise to identify these CD patients.

  • 441.
    Sjöberg, Veronika
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Immunology/Immunchemistry.
    Sandström, Olof
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hedberg, Maria
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Immunology/Immunchemistry.
    Hammarström, Sten
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Immunology/Immunchemistry.
    Hernell, Olle
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hammarström, Marie-Louise
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Immunology/Immunchemistry.
    Intestinal T-cell responses in celiac disease: impact of celiac disease associated bacteria2013In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 1, p. e53414-Article in journal (Refereed)
    Abstract [en]

    A hallmark of active celiac disease (CD), an inflammatory small-bowel enteropathy caused by permanent intolerance to gluten, is cytokine production by intestinal T lymphocytes. Prerequisites for contracting CD are that the individual carries the MHC class II alleles HLA-DQ2 and/or HLA-DQ8 and is exposed to gluten in the diet. Dysbiosis in the resident microbiota has been suggested to be another risk factor for CD. In fact, rod shaped bacteria adhering to the small intestinal mucosa were frequently seen in patients with CD during the "Swedish CD epidemic" and bacterial candidates could later be isolated from patients born during the epidemic suggesting long-lasting changes in the gut microbiota. Interleukin-17A (IL-17A) plays a role in both inflammation and anti-bacterial responses. In active CD IL-17A was produced by both CD8(+) T cells (Tc17) and CD4(+) T cells (Th17), with intraepithelial Tc17 cells being the dominant producers. Gluten peptides as well as CD associated bacteria induced IL-17A responses in ex vivo challenged biopsies from patients with inactive CD. The IL-17A response was suppressed in patients born during the epidemic when a mixture of CD associated bacteria was added to gluten, while the reverse was the case in patients born after the epidemic. Under these conditions Th17 cells were the dominant producers. Thus Tc17 and Th17 responses to gluten and bacteria seem to pave the way for the chronic disease with interferon-γ-production by intraepithelial Tc1 cells and lamina propria Th1 cells. The CD associated bacteria and the dysbiosis they might cause in the resident microbiota may be a risk factor for CD either by directly influencing the immune responses in the mucosa or by enhancing inflammatory responses to gluten.

  • 442.
    Sjöström, Anna
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Neonatal and adolescent outcomes in children born moderately preterm2017Independent thesis Basic level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 443. Skou, Anne-Sofie
    et al.
    Glosli, Heidi
    Jahnukainen, Kirsi
    Jarfelt, Marianne
    Jónmundsson, Guðmundur K
    Malmros-Svennilson, Johan
    Nysom, Karsten
    Hasle, Henrik
    Hjalmars, Ulf
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Renal, gastrointestinal, and hepatic late effects in survivors of childhood acute myeloid leukemia treated with chemotherapy only--a NOPHO-AML study.2014In: Pediatric Blood & Cancer, ISSN 1545-5009, E-ISSN 1545-5017, Vol. 61, no 9, p. 1638-1643Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: We investigated the spectrum, frequency, and risk factors for renal, gastrointestinal, and hepatic late adverse effects in survivors of childhood acute myeloid leukemia (AML) without relapse treated with chemotherapy alone according to three consecutive AML trials by the Nordic Society of Pediatric Hematology and Oncology (NOPHO).

    METHODS: A population-based cohort of children treated for AML according to the NOPHO-AML-84, -88, and -93 trials included 138 eligible survivors of whom 102 (74%) completed a questionnaire and 104 (75%) had a clinical examination and blood sampling performed. Eighty-five of 94 (90%) eligible sibling controls completed a similar questionnaire. Siblings had no clinical examination or blood sampling performed.

    RESULTS: At a median of 11 years (range 4-25) after diagnosis, renal, gastrointestinal, and hepatic disorders were rare both in survivors of childhood AML and in sibling controls, with no significant differences. Ferritin was elevated in 21 (21%) AML survivors but none had biochemical signs of liver damage. Viral hepatitis was present in three and cholelithiasis in two AML survivors. One adult survivor had hypertension, two had slightly elevated systolic blood pressure, and eight survivors had slightly elevated diastolic blood pressure. These persons all had normal creatinine and cystatin C levels. Marginal abnormalities in potassium, magnesium, calcium, or bicarbonate levels were found in 34 survivors.

    CONCLUSION: Survivors of childhood AML treated with chemotherapy only experienced few renal, gastrointestinal, and hepatic late effects.

  • 444. Skovbjerg, S
    et al.
    Roos, K
    Holm, Stig
    Grahn Håkansson, Eva
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Clinical Bacteriology.
    Nowrouzian, F
    Ivarsson, M
    Adlerberth, I
    Wold, AE
    Spray bacteriotherapy decreases middle ear fluid in children with secretory otitis media2009In: Archives of Disease in Childhood, ISSN 0003-9888, E-ISSN 1468-2044, Vol. 94, no 2, p. 92-98Article in journal (Refereed)
    Abstract [en]

    This study shows that spray treatment with S sanguinis may be effective against SOM. The mechanism for the effect remains to be investigated.

  • 445. Slupsky, Carolyn M.
    et al.
    He, Xuan
    Hernell, Olle
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Andersson, Yvonne
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Rudolph, Colin
    Lönnerdal, Bo
    West, Christina E.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Postprandial metabolic response of breast-fed infants and infants fed lactose-free vs regular infant formula: a randomized controlled trial2017In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 7, article id 3640Article in journal (Refereed)
    Abstract [en]

    Lactose intolerance is a major concern driving the growth of lactose-free foods including lactose-free infant formula. It is unknown what the metabolic consequence is of consumption of a formula where lactose has been replaced with corn syrup solids (CSS). Here, a randomized double-blinded intervention study was conducted where exclusively formula-fed infants were fed formula containing either lactose or CSS-based infant formula and compared with an equal number of exclusively breast-fed infants. Plasma metabolites and insulin were measured at baseline, 15, 30, 60, 90 and 120 min after feeding. Differences in plasma metabolite profiles for formula-fed infants included a rapid increase in circulating amino acids, creatinine and urea compared with breast-fed infants. At 120 min post-feeding, insulin was significantly elevated in formula-fed compared with breast-fed infants. Infants fed lactose-based formula had the highest levels of glucose at 120 min, and leucine, isoleucine, valine and proline at 90 and 120 min, whereas infants fed CSS-based formula had the lowest levels of non-esterified fatty acids at all time points, and glucose at 120 min. Overall, these differences highlight that changes in infant formula composition impact infant metabolism, and show that metabolomics is a powerful tool to help with development of improved infant formulas.

  • 446. Smith, Lucy K.
    et al.
    Morisaki, Naho
    Morken, Nils-Halvdan
    Gissler, Mika
    Deb-Rinker, Paromita
    Rouleau, Jocelyn
    Håkansson, Stellan
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Kramer, Michael R.
    Kramer, Michael S.
    An International Comparison of Death Classification at 22 to 25 Weeks' Gestational Age2018In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 142, no 1, article id e20173324Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To explore international differences in the classification of births at extremely low gestation and the subsequent impact on the calculation of survival rates.

    METHODS: We used national data on births at 22 to 25 weeks' gestation from the United States (2014; n = 11144), Canada (2009-2014; n = 5668), the United Kingdom (2014-2015; n = 2992), Norway (2010-2014; n = 409), Finland (2010-2015; n = 348), Sweden (2011-2014; n = 489), and Japan (2014-2015; n = 2288) to compare neonatal survival rates using different denominators: all births, births alive at the onset of labor, live births, live births surviving to 1 hour, and live births surviving to 24 hours.

    RESULTS: For births at 22 weeks' gestation, neonatal survival rates for which we used live births as the denominator varied from 3.7% to 56.7% among the 7 countries. This variation decreased when the denominator was changed to include stillbirths (ie, all births [1.8%-22.3%] and fetuses alive at the onset of labor [3.7%-38.2%]) or exclude early deaths and limited to births surviving at least 12 hours (50.0%-77.8%). Similar trends were seen for infants born at 23 weeks' gestation. Variation diminished considerably at 24 and 25 weeks' gestation.

    CONCLUSIONS: International variation in neonatal survival rates at 22 to 23 weeks' gestation diminished considerably when including stillbirths in the denominator, revealing the variation arises in part from differences in the proportion of births reported as live births, which itself is closely connected to the provision of active care.

  • 447.
    Solomons, Noel W.
    et al.
    Center for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM), Guatemala.
    Hernell, Olle
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    A perspective on the inappropriate infant feedingpractices observed among KwaZulu-Natal mothers: Professional expectations clash with human nature’s realities2009In: South African Journal of Clinical Nutrition, ISSN 1607-0658, Vol. 22, no 2, p. 56-57Article in journal (Refereed)
  • 448.
    Späth, Cornelia
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    The impact of nutrition on growth, biomarkers, and health outcomes in preterm infants2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Introduction: Nutrients play a crucial role for growth and brain development after preterm birth. Meeting the nutritional needs of preterm infants is challenging. Particularly, the most immature infants have a high risk of malnutrition and poor growth during hospital care. To meet recommended energy and nutrient intakes during early postnatal life, a concentrated parenteral nutrition (PN) regimen was implemented in clinical use in 2012 at the neonatal intensive care unit at Umeå University Hospital (Umeå, Sweden). However, electrolyte homeostasis is labile after preterm birth and infants require an electrolyte supply that corresponds to their energy and protein intakes to avoid electrolyte disturbances. Although sodium imbalances such as hyper- and hyponatremia are common in the most immature preterm infants, there is limited knowledge to what extent these imbalances are affected by fluid volume and sodium supply. Furthermore, it is unclear whether the early high sodium concentrations lead to any adverse effects, including intraventricular hemorrhage, or simply reflect immediate adaptive processes after preterm birth.

    Aim: This thesis investigates the impact of nutrition on growth, nutritional biomarkers, and health outcomes in preterm infants born with a birth weight below 1500 g.

    Methods: We used data from two study populations. First, we collected data for all very low birth weight infants (< 1500 g) born between 2010 and 2013 and treated at Umeå University Hospital (Umeå, Sweden; n = 134). Second, we used data from the EXtremly PREterm infants in Sweden Study (EXPRESS). We included all infants born before 27 gestational weeks in Sweden between 2004 and 2007 who survived the first 24 h (n = 602). Data collection for both study populations included a) intakes of all parenteral and enteral nutritional products and other fluids during the first 28 postnatal days, b) all anthropometric measurements during hospital stay, c) perinatal data, and d) neonatal morbidity.

    Results: The concentrated PN regimen improved early energy and macronutrient intakes in very low birth weight infants. Furthermore, weight and length growth from postnatal week two to a postmenstrual age of 36 weeks improved in very low birth weight infants who received the concentrated PN regimen compared with infants who received the previous original PN regimen (Paper I). Increased parenteral energy and protein intakes provided by the concentrated PN regimen, did not induce a higher occurrence of electrolyte imbalances as electrolytes were supplied according to the current recommendations (Paper II). In the EXPRESS cohort, the majority of extremely preterm infants had hypernatremia during the first and hyponatremia during the second postnatal week. Gestational age and supply of sodium, rather than fluid volume, were the major factors determining the risks of hyper- and hyponatremia (Paper III). High total supply of sodium was significantly correlated with severe intraventricular hemorrhage if mostly mediated by blood product transfusions (Paper IV).

    Conclusions: Our results suggest that in very immature preterm infants a concentrated PN regimen improves early nutrient intakes and postnatal growth without causing electrolyte disturbances. Hyper- and hyponatremia are common and the supply of sodium is a major predictor. The impact of sodium on severe intraventricular hemorrhage needs further investigation.

  • 449.
    Späth, Cornelia
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Stoltz Sjöström, Elisabeth
    Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.
    Ahlsson, Fredrik
    Uppsala universitet.
    Ågren, Johan
    Uppsala universitet.
    Domellöf, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Sodium supply influences plasma sodium concentration and the risks of hyper- and hyponatremia in extremely preterm infants2017In: Pediatric Research, ISSN 0031-3998, E-ISSN 1530-0447, Vol. 81, p. 455-460Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 450.
    Späth, Cornelia
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Zamir, Itay
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Stoltz Sjöström, Elisabeth
    Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.
    Domellöf, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Use of concentrated parenteral nutrition solutions is associated with improved nutrient intakes and postnatal growth in very low-birth-weight infants2019In: JPEN - Journal of Parenteral and Enteral Nutrition, ISSN 0148-6071, E-ISSN 1941-2444Article in journal (Refereed)
    Abstract [en]

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

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

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

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

6789101112 401 - 450 of 570
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf