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  • 451.
    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)
  • 452.
    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.

  • 453.
    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.

  • 454.
    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.

  • 455.
    Starnberg, Josefine
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Neurodevelopment and cardiovascular risk in 7-year old children born with marginally low birth weight2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Being born preterm (<37+0 gestational weeks) or with low birth weight (LBW, <2500 g) has been associated with a number of adverse health outcomes later in life. Most studied are cardiovascular and neurodevelopmental consequences in those born preterm and with very LBW (<1500 g). However, a majority of LBW children are born with a birth weight between 2000 and 2500 g, herein referred to as marginally LBW. The long-term risk profile for this substantially large group of children, is not known.

    Aim: The aim of this study was to explore cardiovascular risk and neurocognitive development in marginally LBW children born in Sweden.

    Method: This was originally a randomized controlled double-blinded trial aiming to explore the effects of iron supplementation in 285 children born with marginally LBW. The children were randomized to receive 0 mg/kg/day (placebo), 1 mg/kg/day or 2 mg/kg/day of iron supplements between 6 weeks and 6 months of age. As part of this observational follow-up study, 95 matched control children born with normal birth weight (NBW, 2501-4500 g) were recruited former to the first follow-up at 3.5-years. This thesis presents data from a follow-up at 7 years, including anthropometric data, blood pressure (BP), body composition (from a dual-energy X-ray absorptiometry) and laboratory markers of cardiovascular risk such as fasting glucose, insulin and lipid profile. Also, the children were tested using the validated neurocognitive tests WISC-IV (Wechsler Intelligence Scale for Children), Beery VMI (Beery-Buktenica developmental test of visual-motor integration) and TEA-Ch (Test of Everyday Attention for Children).

    Results: The marginally LBW children were thinner (15.1 vs 15.5 kg/m2, p=0.046), shorter (122.4 vs 124.9 cm, p=0.001) and had a higher prevalence of underweight (10.7 % vs 2.9 %, p=0.050) compared to their NBW peers. In addition, the LBW children had a significantly larger prevalence of high fasting insulin levels (>90th percentile of the control group). The subgroup of children born small for gestational age (SGA) also had a higher mean fasting glucose level, compared to NBW controls. There were no differences in prevalence of overweight or having an adverse lipid profile between the groups. The marginally LBW children who had received iron supplements, as part of the original intervention trial, had approximately 2 mmHg lower systolic BP, compared to the placebo group (p=0.026). The odds of having a high BP was lowered by 68 % (OR 0.32; CI 0.11-0.96) in the supplemented groups.

    The marginally LBW children had 3.1 points lower verbal comprehension IQ (p=0.004), 3.5 points lower Beery VMI (p=0.028) and poorer selective attention compared to those born with NBW.

    Conclusions: The marginally LBW children were thinner and shorter and they had an imbalanced glucose and insulin homeostasis, particularly those born SGA. Early iron supplements lowered systolic BP to a level similar to controls, suggesting a novel hypothesis regarding a long term protective effect against adverse programming. Finally, the children born with marginally LBW had poorer neurocognitive outcomes, prompting particular attention at school age.

  • 456.
    Starnberg, Josefine
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Norman, Mikael
    Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
    Westrup, Björn
    Division of Neonatology, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
    Domellöf, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Berglund, Staffan
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Early signs of cardiovascular risk at 7 years of age in children born with marginally low birth weightManuscript (preprint) (Other academic)
    Abstract [en]

    Background: Low birth weight (LBW, <2500 g) may predict an increased risk of an adverse cardiovascular profile later in life, but the magnitude in different settings and age at appearance are still unclear. We explored laboratory markers of cardiovascular risk inchildren born with marginally LBW (2000-2500 g).

    Methods: This was a prospective observational study including 285 Swedish marginally LBW children and 95 normal birth weight (NBW, 2501-4500 g) controls. At 3.5 and 7 years of age, blood samples for glucose, insulin, homeostatic model assessment for insulin resistance (HOMA-IR), high-sensitive C-reactive protein (hs-CRP), cholesterol, triglycerides, high- and low-density lipoprotein (HDL and LDL), apolipoprotein B (ApoB) and apolipoprotein A1 (ApoA1) were assessed and compared between the groups.

    Results: No significant differences in levels of insulin, HOMA-IR, hs-CRP or blood lipids were observed between marginally LBW and NBW children. However, at 7 years there was a higher proportion of marginally LBW children with elevated levels of insulin, defined as above the 90th percentile of the control group (21 % vs 8.6 %, p=0.038). Furthermore, in marginally LBW children born small for gestational age, fasting glucose was significantly higher compared to controls (4.7 vs 4.5 mmol/L, p=0.020).

    Conclusions: While there were no significant differences in lipid profile or hs-CRP between marginally LBW children and controls, marginally LBW children showed, already at age 7, increased prevalence of elevated insulin levels, partly confounded by maternal birth country. The results indicate that a long-term risk of imbalanced glucose homeostasis is present, also in this common group of LBW children.

  • 457.
    Starnberg, Josefine
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Norman, Mikael
    Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
    Westrup, Björn
    Division of Neonatology, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
    Domellöf, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Berglund, Staffan K
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Lower cognitive test scores at age 7 in children born with marginally low birth weight2018In: Pediatric Research, ISSN 0031-3998, E-ISSN 1530-0447, Vol. 83, no 6, p. 1129-1135Article in journal (Refereed)
    Abstract [en]

    Background: Being born with very low birth weight (<1500 g) is associated with poorer neurocognition later in life. The aim of this study was to explore neurodevelopmental functions in those born with marginally LBW (2000–2500 g).

    Methods: This was originally a randomized controlled trial investigating the effects of early iron supplementation in 285 marginally LBW children. Herein, we explored the combined marginally LBW group and compared their results to 95 normal birth weight (NBW; 2501–4500 g) controls in an observational design. At 7 years, a pediatric psychologist tested the children using Wechsler Intelligence Scale for Children (WISC IV), Beery–Buktenica developmental test of Visual–Motor Integration (Beery VMI), and Test of Everyday Attention for Children (TEA-Ch).

    Results: The marginally LBW children had lower verbal comprehension intelligence quotient (IQ) (104 vs. 107, P=0.004), lower VMI scores (96.5 vs. 100, P=0.028), and lower total mean TEA-Ch scores (8.5 vs. 9.7, P=0.006), compared to controls. Also, the marginally LBW children group had a higher proportion of children below −1 SD for VMI and TEA-Ch.

    Conclusions: Marginally LBW children had lower verbal comprehension IQ, lower visual–motor integration, and lower attention performance than NBW children, suggesting an increased risk of cognitive difficulties in early school age

  • 458.
    Stecksén-Blicks, Christina
    Umeå University, Faculty of Medicine, Department of Odontology.
    Oral microflora and dietary intake in infants with congenital heart disease: a case-control study: authors' response to comment by Booth.2013In: European Archives of Paediatric Dentistry, ISSN 1818-6300, E-ISSN 1996-9805, Vol. 14, no 2, p. 57-Article in journal (Other academic)
  • 459. Stenhammar, Lars
    et al.
    Högberg, Lotta
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Laurin, Pia
    Myléus, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Fälth-Magnusson, Karin
    Coeliac disease and socio-economic status2014In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 103, no 8, article id e328Article in journal (Other academic)
    Abstract [en]

    In their interesting article on coeliac disease (CD) and socio-economic status, Whyte et al (1) report that CD is more common in children living in areas of the UK with higher socio-economic status than areas with low status. In 1996, we reported that a group of 72 Swedish children with CD were breastfed for a significantly shorter time than the 288 age-matched reference children included in the study (2). In addition, infants with CD were less likely to be breastfed when gluten was introduced into their diet. This article is protected by copyright. All rights reserved.

  • 460.
    Stensils, Robert
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Prematurity as risk factor for early interventional closure of atrial septal defect2017Independent thesis Basic level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 461.
    Stoltz Sjöström, Elisabeth
    Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.
    Betydelsen av tidigt näringsintag för tillväxt och hälsa hos extremt tidigt födda barn2015In: Dietistaktuellt, ISSN 1102-9285, Vol. XXIV, no 1, p. 10-13Article in journal (Other academic)
  • 462.
    Stoltz Sjöström, Elisabeth
    Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.
    Nutritionsbehandling till prematurfödda barn avgörande för tillväxt och utveckling2018In: Nordisk Nutrition, ISSN 1654-8337, no 1, p. 30-32Article in journal (Other academic)
  • 463.
    Stoltz Sjöström, Elisabeth
    Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.
    Nutrium-Express - Tidigt näringsintag hos extremt underburna barn2012In: Dietistaktuellt, ISSN 1102-9285, Vol. 21, no 1, p. 20-22Article in journal (Other (popular science, discussion, etc.))
  • 464.
    Stoltz Sjöström, Elisabeth
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Nutrium-EXPRESS studien: tidigt näringsintag hos extremt prematura barn2011In: Dietistaktuellt, ISSN 1102-9285, Vol. XX, no 1, p. 20-21Article in journal (Other (popular science, discussion, etc.))
  • 465.
    Stoltz Sjöström, Elisabeth
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    The impact of early nutrition on extremely preterm infants2014Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background Modern neonatal care has improved the survival rate of extremely preterm infants. These infants are at high risk of malnutrition and growth failure during 3-4 months of hospital care. The objectives of this study was to investigate nutritional intakes during hospitalization and explore associations between nutritional intakes, postnatal growth and retinopathy of prematurity (ROP). Perioperative nutrition in infants undergoing surgery for patent ductus arteriosus (PDA) was also investigated.

    Methods This is a population-based study of Swedish extremely preterm infants (<27 weeks) born during 2004-2007 (n=602). Detailed data on nutritional supply and anthropometric measurements during hospitalization were retrospectively retrieved from hospital records. Comprehensive data on cohort characteristics, neonatal morbidity and infant mortality were obtained from the Extremely Preterm Infants in Sweden Study (EXPRESS).

    Results During the first 70 days of life, intakes of energy, protein and several micronutrients, with the exception of iron and some vitamins, were less than estimated requirements, and infants showed severe postnatal growth failure. Energy and protein intake predicted growth in all anthropometric outcomes even when adjusting for severity of illness, and fat intake was positively associated with head growth. Low folate intake was positively correlated with poor weight and length gain while high iron intake, mainly explained by blood transfusions, was negatively associated with poor length gain. Furthermore, a low energy intake was associated with severe ROP (stage 3-5). An increased energy intake of 10 kcal/kg/d was associated with 24% decrease in severe ROP (p=0.01). During the first month, 99% of the infants were exclusively fed human milk. Infants who underwent surgery for PDA (n=140) were malnourished, with energy and macronutrient intakes below minimum estimated requirements before, during and after surgery.

    Conclusions The severe postnatal growth failure observed in Swedish extremely preterm infants may be prevented by improved intakes of energy, protein, fat and folate and a reduction of the number of blood transfusions. Human milk is the main enteral food source and analyses of human milk macronutrient contents facilitates individualized fortification. Provision of adequate energy intakes during the first four weeks of life may be an effective way to reduce the risk of severe ROP. Perioperative nutrition in infants undergoing PDA surgery needs to be improved. The study results have important implications for nutritional regimens, postnatal growth and health outcome in this new generation of survivors.

  • 466.
    Stoltz Sjöström, Elisabeth
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Lundgren, Pia
    Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Öhlund, Inger
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Holmström, Gerd
    Department of Neuroscience, Ophthalmology, Uppsala University, Uppsala, Sweden.
    Hellström, Ann
    Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Domellöf, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Low energy intake during the first 4 weeks of life increases the risk for severe retinopathy of prematurity in extremely preterm infants2016In: Archives of Disease in Childhood: Fetal and Neonatal Edition, ISSN 1359-2998, E-ISSN 1468-2052, Vol. 101, no 2, p. F108-F113Article in journal (Refereed)
    Abstract [en]

    Objectives: Poor weight gain during the first weeks of life in preterm infants is closely associated with the risk of developing retinopathy of prematurity (ROP) and insufficient nutrition might be an important contributing factor. This study aimed to evaluate the effect of energy and macronutrient intakes during the first four weeks of life on the risk for severe ROP.

    Study design: Population-based study including all Swedish extremely preterm infants born before 27 gestational weeks during a 3-year period. Each infant was classified according to the maximum stage of ROP in either eye as assessed prospectively until full retinal vascularization. Detailed daily data of actual intakes of enteral and parenteral nutrition as well as growth data were obtained from hospital records.

    Results: Of the included 498 infants, 172 (34.5 %) had severe ROP (stages 3-5) and 96 (19.3 %) were treated. Energy and macronutrient intakes were less than recommended and the infants showed severe postnatal growth failure. Higher intakes of energy, fat and carbohydrates, but not protein, were significantly associated with a lower risk of severe ROP. Adjusting for morbidity, an increased energy intake of 10kcal/kg/d was associated with a 24 % decrease in severe ROP (p<0.01).

    Conclusions: We showed that energy intake during the first four weeks of life was an independent risk factor for severe ROP. This implies that provision of adequate energy from parenteral and enteral sources during the first four weeks of life may be an effective method for reducing the risk of severe ROP in extremely preterm infants.

  • 467.
    Stoltz Sjöström, Elisabeth
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Szymlek-Gay, Ewa A
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Öhlund, Inger
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Ahlsson, Fredrik
    Norman, Mikael
    Engström, Eva
    Hellström, Ann
    Fellman, Vineta
    Olhager, Elisabeth
    Domellöf, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Micronutrient Intakes Affect Early Growth in Extremely Preterm Infants: Preliminary Results from a Swedish Cohort2011Conference paper (Refereed)
    Abstract [en]

    Background: Extremely preterm infants generally experience postnatal growth failure. It is still unclear if this is related to micronutrient intakes.

    Aim: To investigate the effect of micronutrient intakes (calcium, zinc, iron, phosphorus, sodium, potassium, chloride, magnesium, vitamin A, vitamin D, vitamin E, folate and vitamin B12) on growth during the first 28 days of life in extremely preterm infants.

    Method: From the EXPRESS cohort (all infants born < 27 gestational weeks between 2004-2007 in Sweden), those who survived the first 28 days were included (n=524). Daily parenteral and enteral intakes and anthropometric measurements were retrieved from hospital records.

    Results: Preliminary analyses of data from 333 infants (mean±SD gestational age 25.2±1.0 weeks, birth weight 753±168g) showed that macronutrient intakes were lower than recommended (energy 98±13kcal/kg/day, protein 2.9±0.4g/kg/day). Infants showed postnatal growth failure: mean standard deviation scores decreased by 2.2 for weight, 2.3 for length and 1.4 for head circumference. Intakes of micronutrients were generally low, e.g. adjusted enteral intakes of calcium were 66.6±21.4 mg/kg/day. The exception was iron, with a high parenteral intake of 2.7±1.6 mg/kg/day, mainly from blood transfusions. Adjusting for protein intake and other confounders, calcium intakes were positively correlated with head growth (r=+0.19, p=0.006) and iron intakes were negatively correlated with length gain (r=-0.18, p=0.009).

    Conclusions: Low calcium intakes and high iron intakes were associated with poor growth with regard to head circumference and length, respectively. If these results are confirmed, optimized micronutrient intakes may improve early growth in extremely preterm infants.

  • 468.
    Stoltz Sjöström, Elisabeth
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Öhlund, Inger
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Ahlsson, Fredrik
    Domellöf, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Intakes of micronutrients are associated with early growth in extremely preterm infants2016In: Journal of Pediatric Gastroenterology and Nutrition - JPGN, ISSN 0277-2116, E-ISSN 1536-4801, Vol. 62, no 6, p. 885-892Article in journal (Refereed)
    Abstract [en]

    Objectives: The aim of the study was to describe micronutrient intakes and explore possible correlations to growth during the first 70 days of life in extremely preterm infants.

    Methods: Retrospective population-based study including extremely preterm infants (<27 weeks) born in Sweden during 2004-2007. Detailed nutritional and growth data were derived from hospital records.

    Results: Included infants (n = 531) had a mean gestational age of 25 weeks and 2 days and a mean birth weight of 765 g. Estimated and adjusted intakes of calcium, phosphorus magnesium, zinc, copper, selenium, vitamin D, and folate were lower than estimated requirements, whereas intakes of iron, vitamin K, and several water-soluble vitamins were higher than estimated requirements. High iron intakes were explained by blood transfusions. During the first 70 days of life, taking macronutrient intakes and severity of illness into account, folate intakes were positively associated with weight (P = 0.001) and length gain (P = 0.003) and iron intake was negatively associated with length gain (P = 0.006).

    Conclusions: Intakes of several micronutrients were inconsistent with recommendations. Even when considering macronutrient intakes and severity of illness, several micronutrients were independent predictors of early growth. Low intake of folate was associated with poor weight and length gain. Furthermore, high iron supply was associated with poor growth in length and head circumference. Optimized early micronutrient supply may improve early growth in extremely preterm infants.

  • 469.
    Stoltz Sjöström, Elisabeth
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Öhlund, Inger
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Ahlsson, Fredrik
    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Domellöf, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Intakes of micronutrients is associated with early growth in extremely preterm infants: a population-based studyManuscript (preprint) (Other academic)
    Abstract [en]

    Objectives: To describe micronutrient intakes and explore possible correlations to growth during the first 70 days of life in extremely preterm infants.

    Methods: Retrospective population-based study including extremely preterm infants (<27 weeks) born in Sweden during 2004-2007. Detailed nutritional and growth data were derived from hospital records.

    Results: Included infants (n=531), had a mean gestational age of 25 weeks+2 days and a mean birth weight of 765 g. Intakes of calcium, phosphorus magnesium, zinc, copper, iodine, vitamin D and folate were lower than estimated requirements while intakes of iron, vitamin K and several water-soluble vitamins were higher than estimated requirements. High iron intakes were explained by blood transfusions. During the first 70 days of life, taking macronutrient intakes and severity of illness into account, folate intakes were positively correlated with weight (p=0.001) and length gain (p=0.003) and iron intake was negatively associated with length gain (p=0.006).

    Conclusions: Intakes of many micronutrients were insufficient. Even when considering macronutrient intakes and severity of illness, several micronutrients were independent predictors of early growth. Low intakes of folate were associated with poor weight and length growth. Further, high iron intakes were associated with poor length and head circumference growth. Optimized early micronutrient intakes may improve early growth in extremely preterm infants.

  • 470.
    Stoltz Sjöström, Elisabeth
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Öhlund, Inger
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Ahlsson, Fredrik
    Engström, Eva
    Fellman, Vineta
    Hellström, Ann
    Källén, Karin
    Norman, Mikael
    Olhager, Elisabeth
    Serenius, Fredrik
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics. Department of Women's and Children's Health, Uppsala University, Uppsala.
    Domellöf, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Nutrient intakes independently affect growth in extremely preterm infants: results from a population-based study2013In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 102, no 11, p. 1067-1074Article in journal (Refereed)
    Abstract [en]

    Aim To explore associations between energy and macronutrient intakes and early growth in extremely low gestational age (ELGA) infants.

    Methods Retrospective population-based study of all ELGA infants (<27weeks) born in Sweden during 2004-2007. Detailed data on nutrition and anthropometric measurements from birth to 70days of postnatal age were retrieved from hospital records.

    Results Study infants (n=531) had a meanSD gestational age of 25.3 +/- 1.1weeks and a birth weight of 765 +/- 170g. Between 0 and 70 days, average daily energy and protein intakes were 120 +/- 11kcal/kg and 3.2 +/- 0.4g/kg, respectively. During this period, standard deviation scores for weight, length and head circumference decreased by 1.4, 2.3 and 0.7, respectively. Taking gestational age, baseline anthropometrics and severity of illness into account, lower energy intake correlated with lower gain in weight (r=+0.315, p<0.001), length (r=+0.215, p<0.001) and head circumference (r=+0.218, p<0.001). Protein intake predicted growth in all anthropometric outcomes, and fat intake was positively associated with head circumference growth.

    Conclusion Extremely low gestational age infants received considerably less energy and protein than recommended and showed postnatal growth failure. Nutrient intakes were independent predictors of growth even after adjusting for severity of illness. These findings suggest that optimized energy and macronutrient intakes may prevent early growth failure in these infants.

  • 471.
    Stoltz Sjöström, Elisabeth
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Öhlund, Inger
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Tornevi, Andreas
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Domellöf, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Intake and macronutrient content of human milk given to extremely preterm infants2014In: Journal of Human Lactation, ISSN 0890-3344, E-ISSN 1552-5732, Vol. 30, no 4, p. 442-449Article in journal (Refereed)
    Abstract [en]

    Background: Human milk (HM) is the preferred basis of nutrition for infants, including those born prematurely. Information on HM macronutrient content is necessary to optimize nutritional support of preterm infants. Objectives: This study aimed to describe the types and amounts of enteral feeds given to Swedish extremely preterm infants during hospitalization and to investigate the energy and macronutrient contents in HM given to these infants. Methods: A population-based study of Swedish extremely preterm infants (n = 586) born before 27 gestational weeks was conducted. Data on ingested volumes of different milk during hospitalization and analyses of macronutrient content in HM samples were obtained from hospital records. Nutritional content of HM was determined by mid-infrared spectrophotometry analysis. Results: During the first 4 weeks of life, 99% of the infants were exclusively fed HM, and at 4 weeks of life, 70% of the infants received only mother’s own milk (MOM). Nutritional content in 821 MOM samples was analyzed. Protein content in MOM decreased significantly from 2.2 to 1.2 g/100 mL during the first 112 postpartum days, whereas fat and energy content were highly variable within and between MOM samples. In addition, 354 samples of donor milk were analyzed. Content of protein, fat, and energy in pooled donor milk (n = 129) was lower compared to single donor milk. Conclusion: Swedish extremely preterm infants receive MOM to a large extent during hospitalization. Protein, carbohydrates, and energy in MOM changed significantly with time. Weekly analyses of MOM during the first month of lactation would allow more individualized nutritional support for these vulnerable infants.

  • 472. Svanborg, Pär
    et al.
    Thernlund, Gunilla
    Gustafsson, Per A
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Schacht, Alexander
    Kadesjö, Björn
    Atomoxetine improves patient and family coping in attention deficit/hyperactivity disorder: a randomized, double-blind, placebo-controlled study in Swedish children and adolescents2009In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 18, no 12, p. 725-735Article in journal (Refereed)
    Abstract [en]

    This 10-week study assessed the efficacy of atomoxetine in combination with psychoeducation compared to placebo and psychoeducation in the improvement of Quality of Life in Swedish stimulant-naive children and adolescents with attention deficit/hyperactivity disorder. A total of 99 patients were treated with atomoxetine (49 patients) or placebo (50 patients) for 10 weeks and assessed regarding broader areas of functioning using the Quality of Life measures Child Health and Illness Profile-Child Edition (CHIP-CE), Family Strain Index [FSI; equivalent to the Family Burden of Illness Module used in the study], Appraisal of Stress in Child-Rearing (ASCR), Five to fifteen (FTF), "I think I am" ("Jag tycker jag är"), and Children's Depression Rating Scale-Revised (CDRS-R) before and after the active treatment phase. Simultaneously, the patients' parents participated in a 4-session psychoeducation program. A statistically significant difference in favor of atomoxetine was seen in the improvement from baseline to study endpoint for the CHIP-CE domains "Achievement" and "Risk avoidance", for the FSI total score, for the ASCR section (I) domain "Child as a burden", for all FTF domains except for "Language and Speech", and for the CDRS-R total score. No difference between treatment groups was observed in the patient-assessed evaluation of self-esteem using the "I think I am" scale. Atomoxetine combined with psychoeducation had a positive effect on various everyday coping abilities of the patients as well as their families during 10 weeks of treatment, whereas the patients' self-image and the parents' image of the climate in the family were not significantly improved.

  • 473. Szajewska, H.
    et al.
    Shamir, R.
    Chmielewska, A.
    Piescik-Lech, M.
    Auricchio, R.
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Kolacek, S.
    Koletzko, S.
    Korponay-Szabo, I.
    Mearin, M. L.
    Ribes-Koninckx, C.
    Troncone, R.
    Systematic review with meta-analysis: early infant feeding and coeliac disease - update 20152015In: Alimentary Pharmacology and Therapeutics, ISSN 0269-2813, E-ISSN 1365-2036, Vol. 41, no 11, p. 1038-1054Article, review/survey (Refereed)
    Abstract [en]

    BackgroundNew evidence emerged on early feeding practices and the risk of coeliac disease. AimTo systematically update evidence on these practices to find out whether there is a need to revise current recommendations. MethodsMEDLINE, EMBASE and the Cochrane Library were searched from July 2012 (end of last search) to February 2015 for studies of any design that assessed the effect of gluten consumption and breastfeeding on the development of coeliac disease and/or coeliac disease-related autoimmunity. ResultsWe identified 21 publications, including two, new, large, randomised controlled trials performed in high-risk infants. Exclusive or any breastfeeding, as well as breastfeeding at the time of gluten introduction, did not reduce the risk of developing coeliac disease during childhood. For infants at high risk of developing coeliac disease, gluten introduction at 4months of age in very small amounts, or at 6 or 12months of age, resulted in similar rates of coeliac disease diagnosis in early childhood. Later gluten introduction was associated with later development of coeliac specific autoimmunity and coeliac disease during childhood, but not total risk reduction. Observational studies indicate that consumption of a higher amount of gluten at weaning may increase the risk for coeliac disease development. ConclusionsInfant feeding practices (breastfeeding, time of gluten introduction) have no effect on the risk of developing coeliac disease during childhood (at least at specific timeframes evaluated in the included studies), necessitating an update of current European recommendations.

  • 474. Szajewska, Hania
    et al.
    Ruszczynski, Marek
    Szymanski, Henryk
    Sadowska-Krawczenko, Iwona
    Piwowarczyk, Anna
    Rasmussen, Preben Bodstrup
    Kristensen, Mette Bach
    West, Christina E.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hernell, Olle
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Effects of infant formula supplemented with prebiotics compared with synbiotics on growth up to the age of 12 mo: a randomized controlled trial2017In: Pediatric Research, ISSN 0031-3998, E-ISSN 1530-0447, Vol. 81, no 5, p. 752-758Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Growth is an essential outcome measure for evaluating the safety of infant formulas (IF). We investigated the effects of consumption of IF supplemented with prebiotics (fructooligosaccharides, FOS, and galactooligosaccharides, GOS) compared with synbiotics (FOS/GOS and Lactobacillus paracasei ssp. paracasei strain F19) on the growth of healthy infants. METHODS: 182 full-term infants who were weaned completely from breast milk to IF at 28 d of age were randomly assigned to receive prebiotic- or synbiotic-supplemented, otherwise identical, IF until 6 mo of age (intervention period). RESULTS: A total of 146 (80%) infants were included in the intention-to-treat analysis at 6 mo. Anthropometric parameters were similar in the two groups during the intervention and follow-up period until 12 mo of age. Compared with the prebiotic group, a significant reduction in the cumulative incidence of lower respiratory tract infections was found in the synbiotic group; however, the confidence interval of the estimate was wide, resulting in uncertainty. CONCLUSION: The lack of a significant difference between the formula-fed groups in growth, or the occurrence of serious adverse events, supports the safety of using IF supplemented with synbiotics. Further studies are needed to evaluate the effects of such formula on lower-respiratory tract infections.

  • 475. Szajewska, Hania
    et al.
    Shamir, Raanan
    Mearin, Luisa
    Ribes-Koninckx, Carmen
    Catassi, Carlo
    Domellöf, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Fewtrell, Mary S.
    Husby, Steffen
    Papadopoulou, Alexandra
    Vandenplas, Yvan
    Castillejo, Gemma
    Kolacek, Sanja
    Koletzko, Sibylle
    Korponay-Szabo, Ilma R.
    Lionetti, Elena
    Polanco, Isabel
    Troncone, Riccardo
    Gluten Introduction and the Risk of Coeliac Disease: A Position Paper by the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition2016In: Journal of Pediatric Gastroenterology and Nutrition - JPGN, ISSN 0277-2116, E-ISSN 1536-4801, Vol. 62, no 3, p. 507-513Article in journal (Refereed)
    Abstract [en]

    Background:The European Society for Paediatric Gastroenterology, Hepatology and Nutrition recommended in 2008, based on observational data, to avoid both early (<4 months) and late (7 months) introduction of gluten and to introduce gluten while the infant is still being breast-fed. New evidence prompted ESPGHAN to revise these recommendations.Objective:To provide updated recommendations regarding gluten introduction in infants and the risk of developing coeliac disease (CD) during childhood.Summary:The risk of inducing CD through a gluten-containing diet exclusively applies to persons carrying at least one of the CD risk alleles. Because genetic risk alleles are generally not known in an infant at the time of solid food introduction, the following recommendations apply to all infants, although they are derived from studying families with first-degree relatives with CD. Although breast-feeding should be promoted for its other well-established health benefits, neither any breast-feeding nor breast-feeding during gluten introduction has been shown to reduce the risk of CD. Gluten may be introduced into the infant's diet anytime between 4 and 12 completed months of age. In children at high risk for CD, earlier introduction of gluten (4 vs 6 months or 6 vs 12 months) is associated with earlier development of CD autoimmunity (defined as positive serology) and CD, but the cumulative incidence of each in later childhood is similar. Based on observational data pointing to the association between the amount of gluten intake and risk of CD, consumption of large quantities of gluten should be avoided during the first weeks after gluten introduction and during infancy. The optimal amounts of gluten to be introduced at weaning, however, have not been established.

  • 476.
    Szymlek-Gay, Ewa A.
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Domellöf, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hernell, Olle
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hurrell, Richard F.
    Lind, Torbjörn
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Lonnerdal, Bo
    Zeder, Christophe
    Egli, Ines M.
    Mode of oral iron administration and the amount of iron habitually consumed do not affect iron absorption, systemic iron utilisation or zinc absorption in iron-sufficient infants: a randomised trial2016In: British Journal of Nutrition, ISSN 0007-1145, E-ISSN 1475-2662, Vol. 116, no 6, p. 1046-1060Article in journal (Refereed)
    Abstract [en]

    Different metabolic pathways of supplemental and fortification Fe, or inhibition of Zn absorption by Fe, may explain adverse effects of supplemental Fe in Fe-sufficient infants. We determined whether the mode of oral Fe administration or the amount habitually consumed affects Fe absorption and systemic Fe utilisation in infants, and assessed the effects of these interventions on Zn absorption, Fe and Zn status, and growth. Fe-sufficient 6-month-old infants (n 72) were randomly assigned to receive 6<bold></bold>6 mg Fe/d from a high-Fe formula, 1<bold></bold>3 mg Fe/d from a low-Fe formula or 6<bold></bold>6 mg Fe/d from Fe drops and a formula with no added Fe for 45 d. Fractional Fe absorption, Fe utilisation and fractional Zn absorption were measured with oral (Fe-57 and Zn-67) and intravenous (Fe-58 and Zn-70) isotopes. Fe and Zn status, infection and growth were measured. At 45 d, Hb was 6<bold></bold>3 g/l higher in the high-Fe formula group compared with the Fe drops group, whereas serum ferritin was 34 and 35 % higher, respectively, and serum transferrin 0<bold></bold>1 g/l lower in the high-Fe formula and Fe drops groups compared with the low-Fe formula group (all P<0<bold></bold>05). No intervention effects were observed on Fe absorption, Fe utilisation, Zn absorption, other Fe status indices, plasma Zn or growth. We concluded that neither supplemental or fortification Fe nor the amount of Fe habitually consumed altered Fe absorption, Fe utilisation, Zn absorption, Zn status or growth in Fe-sufficient infants. Consumption of low-Fe formula as the only source of Fe was insufficient to maintain Fe stores.

  • 477. Szymlek-Gay, Ewa A
    et al.
    Lönnerdal, Bo
    Abrams, Steven A
    Kvistgaard, Anne S
    Domellöf, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hernell, Olle
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    alpha-Lactalbumin and Casein-Glycomacropeptide do not affect iron absorption from formula in healthy term infants2012In: Journal of Nutrition, ISSN 0022-3166, E-ISSN 1541-6100, Vol. 142, no 7, p. 1226-1231Article in journal (Refereed)
    Abstract [en]

    Iron absorption from infant formula is relatively low. alpha-Lactalbumin and casein-glycomacropeptide have been suggested to enhance mineral absorption. We therefore assessed the effect of alpha-lactalbumin and casein-glycomacropeptide on iron absorption from infant formula in healthy term infants. Thirty-one infants were randomly assigned to receive 1 of 3 formulas (4 mg iron/L, 13.1 g protein/L) from 4-8 wk to 6 mo of age: commercially available whey-predominant standard infant formula (standard formula), alpha-lactalbumin enriched infant formula (alpha-LAC), or alpha-lactalbumin-enriched/casein-glycomacropeptide-reduced infant formula (alpha-LAC/RGMP). Nine breast-fed infants served as a reference. At 5.5 mo of age, Fe-58 was administered to all infants in a meal. Blood samples were collected 14 d later for iron absorption and iron status indices. Iron deficiency was defined as depleted iron stores, iron-deficient erythropoiesis, or iron deficiency anemia. Iron absorption (mean +/- SD) was 10.3 +/- 7.0% from standard formula, 8.6 +/- 3.8% from alpha-LAC, 9.2 +/- 6.5% from alpha-LAC/RGMP, and 12.9 +/- 6.5% from breast milk, with no difference between the formula groups (P = 0.79) or all groups (P = 0.44). In the formula-fed infants only, iron absorption was negatively correlated with serum ferritin (r = -0.49; P = 0.005) and was higher (P = 0.023) in iron-deficient infants (16.4 +/- 12.4%) compared with those with adequate iron status (8.6 +/- 4.4%). Our findings indicate that alpha-lactalbumin and casein-glycomacropeptide do not affect iron absorption from infant formula in infants. Low serum ferritin concentrations are correlated with increased iron absorption from infant formula. J. Nutr. 142: 1226-1231, 2012.

  • 478. Söderberg, Karin C
    et al.
    Naumburg, Estelle
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics. Department of Medical Epidemiology, Karolinska Institutet, Stockholm; Department of Women’s and Children’s Health, Section for Pediatrics, Uppsala University, Uppsala .
    Anger, Gert
    Cnattingius, Sven
    Ekbom, Anders
    Feychting, Maria
    Childhood leukemia and magnetic fields in infant incubators2002In: Epidemiology, ISSN 1044-3983, E-ISSN 1531-5487, Vol. 13, no 1, p. 45-49Article in journal (Refereed)
    Abstract [en]

    In studies of magnetic field exposure and childhood leukemia, power lines and other electrical installations close to the children's homes constitute the most extensively studied source of exposure. We conducted a study to assess whether exposure to magnetic fields in infant incubators is associated with an increased leukemia risk. We identified all children with leukemia born in Sweden between 1973 and 1989 from the national Cancer Registry and selected at random one control per case, individually matched by sex and time of birth, from the study base. We retrieved information about treatment in infant incubators from medical records. We made measurements of the magnetic fields inside the incubators for each incubator model kept by the hospitals. Exposure assessment was based on measurements of the magnetic field level inside the incubator, as well as on the length of treatment. For acute lymphoblastic leukemia, the risk estimates were close to unity for all exposure definitions. For acute myeloid leukemia, we found a slightly elevated risk, but with wide confidence intervals and with no indication of dose response. Overall, our results give little evidence that exposure to magnetic fields inside infant incubators is associated with an increased risk of childhood leukemia.

  • 479.
    Tanghöj, Gustaf
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Liuba, Petru
    Sjöberg, Gunnar
    Rydberg, Annika
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Naumburg, Estelle
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Adverse events within 1 year after surgical and percutaneous closure of atrial septal defects in preterm children2019In: Cardiology in the Young, ISSN 1047-9511, E-ISSN 1467-1107, Vol. 29, no 5, p. 626-636Article in journal (Refereed)
    Abstract [en]

    Introduction: Atrial septal defect is the third most common CHD. A hemodynamically significant atrial septal defect causes volume overload of the right side of the heart. Preterm children may suffer from both pulmonary and cardiac comorbidities, including altered myocardial function. The aim of this study was to compare the rate of adverse events following atrial septal defect closure in preterm- and term-born children.

    Method: We performed a retrospective cohort study including children born in Sweden, who had a surgical or percutaneous atrial septal defect closure at the children’s hospitals in Lund and Stockholm, between 2000 and 2014, assessing time to the first event within 1 month or 1 year. We analysed differences in the number of and the time to events between the preterm and term cohort using the Kaplan–Meier survival curve, a generalised model applying zero-inflated Poisson distribution and Gary-Anderson’s method.

    Results: Overall, 413 children were included in the study. Of these, 93 (22.5%) were born prematurely. The total number of adverse events was 178 (110 minor and 68 major). There was no difference between the cohorts in the number of events, whether within 1 month or within a year, between major (p = 0.69) and minor (p = 0.84) events or frequencies of multiple events (p = 0.92).

    Conclusion: Despite earlier procedural age, larger atrial septal defects, and higher comorbidity than term children, preterm children appear to have comparable risk for complications during the first year after surgical or percutaneous closure.

  • 480.
    Tanghöj, Gustaf
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics. Unit of Research Education and Development, Östersund Hospital, Östersund, Sweden.
    Odermarsky, Michal
    Naumburg, Estelle
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics. Unit of Research Education and Development, Östersund Hospital, Östersund, Sweden.
    Liuba, Petru
    Early Complications After Percutaneous Closure of Atrial Septal Defect in Infants with Procedural Weight Less than 15 kg2017In: Pediatric Cardiology, ISSN 0172-0643, E-ISSN 1432-1971, Vol. 38, no 2, p. 255-263Article in journal (Refereed)
    Abstract [en]

    Atrial septal defect (ASD) is the most common congenital cardiac lesion accounting for 10-15% of all cardiac malformations. In the majority of cases, the secundum type of the ASD is closed percutaneously in the catheterization laboratory. Although transcatheter closure of ASD is considered safe and effective in pediatric patients, there are limited data regarding the efficacy and safety of device ASD closure in smaller infants. The aim of this study was to determine risk of complications within 72 h following device closure of ASD in children of body weight < 15 kg compared to larger children. Overall 252 children who underwent transcatheter closure of ASD at Children's Heart Centre in Lund, Sweden, between 1998 and 2015 were included. Data regarding demographics, comorbidity and complications occurring during and after device procedure until discharge were retrieved from the hospital's databases. Echocardiographic data were obtained from the digital and videotape recordings. Nearly half of the study cohort (n = 112; 44%) had a procedural weight < 15 (median 11.3) kg with a median procedural age of 2.02 years. Among this study group, 22 (9%) children had post-procedural in-hospital complications, of which 16 (7%) were considered as major and six (2%) considered as minor. No deaths occurred. There was no significant difference in of the occurrence of major or minor complications between the two groups (p = 0.32). Larger ASD was more often associated with minor complications, OR 1.37 (95% CI 0.99-1.89), which most often consisted of transient arrhythmias during or after the procedure. Percutaneous ASD device closure can be performed safely in low-weight infants with a risk of post-procedural in-hospital complications comparable to larger/older children. Nevertheless, careful considerations of the indications to device closure is needed, particularly in children with larger ASD, as recommended by the current international guidelines for ASD closure.

  • 481. Thunqvist, Per
    et al.
    Tufvesson, Ellen
    Bjermer, Leif
    Winberg, Anna
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Fellman, Vineta
    Domellöf, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Melén, Erik
    Norman, Mikael
    Hallberg, Jenny
    Lung function after extremely preterm birth: A population-based cohort study (EXPRESS)2018In: Pediatric Pulmonology, ISSN 8755-6863, E-ISSN 1099-0496, Vol. 53, no 1, p. 64-72Article in journal (Refereed)
    Abstract [en]

    Background and objectives: Follow-up studies of children and young adults born very-to-moderately preterm show persistent and significant lung function deficits. The aim of the study was to determine lung function and airway mechanics in school-aged children born in 2004 to 2007 and extremely preterm (after 22-26 weeks of gestation).

    Methods: In a population-based cohort of children born extremely preterm and controls born at term (n=350), follow-up at 61/2-years-of-age was performed using spirometry and impulse oscillometry. Associations to gestational age, smallness for gestational age (SGA), and bronchopulmonary dysplasia (BPD) were assessed.

    Results: Children born extremely preterm had lower forced vital capacity (FVC, z-score: -0.7, 95%CI: -1.0;-0.4), forced expiratory volume (FEV1, z-score: -1.1, 95%CI: -1.4; -0.8), higher frequency-dependence of resistance (R5-20, 0.09, 95%CI: 0.05; 0.12 kPaL(-1)s(-1)) and larger area under the reactance curve (AX, 0.78, 95%CI: 0.49; 1.07kPaL(-1)) than controls. In children born at 22-24 weeks of gestation, 24% had FVC and 44% had FEV1 below the lower limit of normal. SGA and severe BPD only marginally contributed to pulmonary outcomes. Asthma-like disease was reported in 40% of extremely preterm children and 15% of controls.

    Conclusion: Many children born extremely preterm have altered airway mechanics and significant obstructive reduction in lung function. This warrants consideration for treatment and continued follow-up.

  • 482.
    Timby, Niklas
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Effects of feeding term infants low energy low protein formula supplemented with bovine milk fat globule membranes2014Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background Observational studies have shown that early nutrition influences short- and long-term health of infants. Formula-fed infants have higher protein and energy intakes and lower intakes of several biologically active components present in human milk. Some of these are present in the milk fat globule membrane (MFGM). The aim of the present study was to examine the effects of feeding term infants an experimental low energy low protein formula supplemented with bovine milk fat globule membranes. Our hypothesis was that infants fed experimental formula (EF), compared to infants fed standard formula (SF), would have outcomes more similar to a breast-fed reference (BFR) group.

    Methods In a double-blinded randomized controlled trial, 160 exclusively formula-fed, healthy, term infants were randomized to receive EF or SF from <2 to 6 months of age. A BFR group consisted of 80 breast-fed infants. Measurements were made at baseline, 4, 6 and 12 months of age. The EF had lower energy (60 vs. 66 kcal/100 mL) and protein (1.20 vs. 1.27 g/100 mL) concentrations, and was supplemented with a bovine MFGM concentrate.

    Results At 12 months of age, the EF group performed better than the SF group in the cognitive domain of Bayley Scales of Infant Development, 3rd Ed. During the intervention, the EF group had a lower incidence of acute otitis media than the SF group, less use of antipyretics and the EF and SF groups differed in concentrations of s-IgG against pneumococci. The formula-fed infants regulated their intakes by increasing meal volumes. Thus, there were no differences between the EF and SF groups in energy or protein intakes, blood urea nitrogen, insulin or growth including body fat percent until 12 months of age. Pressure-to-eat score at 12 months of age was reported lower by parents of formula-fed infants than by parents of breast-fed infants, indicating a low level of parental control of feeding in the formula-fed groups. Neither high pressure-to-eat score nor high restrictive score was associated with formula feeding. During the intervention, the EF group gradually reached higher serum cholesterol concentrations than the SF group, and closer to the BFR group. At 4 months of age, there was no significant difference in the prevalence of lactobacilli in saliva between the EF and SF groups.

    Conclusions Supplementation of infant formula with a bovine MFGM fraction enhanced both cognitive and immunological development in formula-fed infants. Further, the intervention narrowed the gap in serum cholesterol concentrations between formula-fed and breast-fed infants. The lower energy and protein concentrations of the EF were totally compensated for by a high level of self-regulation of intake which might, at least partly, be explained by a low level of parental control of feeding in the study population. The findings are of importance for further development of infant formulas and may contribute to improved short- and long-term health outcomes for formula-fed infants.

  • 483.
    Timby, Niklas
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Domellöf, Erik
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Hernell, Olle
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Lönnerdal, Bo
    Department of Nutrition, University of California, Davis, USA.
    Domellöf, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Neurodevelopment, nutrition, and growth until 12 mo of age in infants fed a low-energy, low-protein formula supplemented with bovine milk fat globule membranes: a randomized controlled trial1,2,32014In: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 99, no 4, p. 860-868Article in journal (Refereed)
    Abstract [en]

    Background: Observational studies have indicated that differences in the composition of human milk and infant formula yield benefits in cognitive development and early growth for breastfed infants

    Objective: The objective was to test the hypothesis that feeding an infant formula with reduced energy and protein densities and supplemented with bovine milk fat globule membrane (MFGM) reduces differences in cognitive development and early growth between formula-fed and breastfed infants.

    Design: In a prospective, double-blind, randomized controlled trial, 160 infants <2 mo of age were randomly assigned to be fed an MFGM-supplemented, low-energy, low-protein experimental formula (EF) or a standard formula (SF) until 6 mo of age. The energy and protein contents of the EF and SF were 60 and 66 kcal/100 mL and 1.20 and 1.27 g/100 mL, respectively. A breastfed reference (BFR) group consisted of 80 infants.

    Results: At 12 mo of age, the cognitive score (mean ± SD) on testing with the Bayley Scales of Infant and Toddler Development, Third Edition, was significantly higher in the EF group than in the SF group (105.8 ± 9.2 compared with 101.8 ± 8.0; P = 0.008) but was not significantly different from that in the BFR group (106.4 ± 9.5; P = 0.73). The EF group ingested larger volumes of formula than did the SF group (864 ± 174 compared with 797 ± 165 mL/d; P = 0.022), fully compensating for the lower energy density. No significant differences in linear growth, weight gain, body mass index, percentage body fat, or head circumference were found between the EF and SF groups.

    Conclusions: MFGM supplementation to infant formula narrows the gap in cognitive development between breastfed and formula-fed infants. Between 2 and 6 mo of age, formula-fed term infants have the capacity to upregulate their ingested volumes when the energy density of formula is reduced from 66 to 60 kcal/100 mL. This trial was registered at clinicaltrials.gov as NCT00624689.

  • 484.
    Timby, Niklas
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Domellöf, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Lif Holgerson, Pernilla
    Umeå University, Faculty of Medicine, Department of Odontology.
    West, Christina E.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Lonnerdal, Bo
    Hernell, Olle
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology.
    Oral Microbiota in Infants Fed a Formula Supplemented with Bovine Milk Fat Globule Membranes: A Randomized Controlled Trial2017In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 1, article id e0169831Article in journal (Refereed)
    Abstract [en]

    Background In a recent study, supplementation of infant formula with milk fat globule membranes (MFGM) decreased the incidence of otitis media in infants <6 months of age. Objectives The aim of the present study was to characterize the oral microbiota in infants fed MFGM-supplemented formula and compare it to that of infants fed standard formula or breast milk.

    Methods In a prospective double-blinded randomized controlled trial, exclusively formula-fed infants <2 months of age were randomized to be fed experimental formula (EF, n = 80) with reduced energy and protein and supplemented with a bovine MFGM concentrate, or standard formula (SF, n = 80) until 6 months of age. A breast-fed reference (BFR, n = 80) group was also recruited. The oral microbiota was analyzed at 4 (n = 124) and 12 (n = 166) months of age using Illumina MiSeq multiplex sequencing and taxonomic resolution against the HOMD 16S rDNA database of oral bacteria.

    Results Species richness in the oral samples did not differ between the EF and SF groups, but partial least square modeling identified a few taxa that were significantly associated with being in either group, e.g. lower level of Moraxella catarrhalis in the EF group. Infants in the BFR group had significantly lower species richness at 4 months of age and their microbiota pattern differed markedly from the formula-fed groups.

    Conclusions Supplementation of infant formula with MFGM yielded moderate effects on the oral micro biome. Moraxella catarrhalis was less prevalent in infants fed EF than in those fed SF and may be associated with the decrease in otitis media seen in the same group.

  • 485.
    Timby, Niklas
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Domellöf, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Lonnerdal, Bo
    Hernell, Olle
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Supplementation of Infant Formula with Bovine Milk Fat Globule Membranes2017In: Advances in Nutrition, ISSN 2161-8313, Vol. 8, no 2, p. 351-355Article, review/survey (Refereed)
    Abstract [en]

    Studies have shown that supplementation of infant formula with bovine milk fat globule membranes (MFGMs) may substantially narrow the gap in health outcomes between formula-fed and breastfed infants. In one study, consumption of a formula supplemented with a lipid-rich MFGM concentrate between 2 and 6 mo of age improved cognitive performance at 24 wk of age. In another study, a formula supplemented with a protein rich MFGM concentrate given between 2 and 6 mo of age improved cognitive performance at 12 mo of age, decreased infectious morbidity until 6 mo of age, and yielded serum cholesterol concentrations closer to those of breastfed infants. A third study that assessed the safety of supplementing infant formula with a lipid-rich or a protein-rich MFGM concentrate found a noninferior weight gain for both groups compared with a nonsupplemented formula. In this study, there was an increased risk of eczema in the protein-rich group, but no serious adverse events. Infant formulas with supplemental MFGMs have been launched on the market in several countries. However, the evidence base must still be considered quite limited. Based on 3 randomized controlled trials that are not comparable, the intervention seems safe, but there is not enough evidence for a general recommendation on which MFGM fraction to use and at what concentration as formula supplement for a given outcome.

  • 486.
    Timby, Niklas
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Domellöf, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Lönnerdal, Bo
    Hernell, Olle
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Comment on "Safety and Tolerance Evaluation of Milk Fat Globule Membrane-Enriched Infant Formulas: A Randomized Controlled Multicenter Non-Inferiority Trial in Healthy Term Infants"2015In: Clinical Medicine Insights: Pediatrics, ISSN 1179-5565, Vol. 9, p. 63-64Article in journal (Refereed)
  • 487.
    Timby, Niklas
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hernell, Olle
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Lönnerdal, Bo
    University of California, Davis.
    Domellöf, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Parental feeding control in relation to feeding mode and growth pattern in early infancy2014In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 103, no 10, p. 1072-1077Article in journal (Refereed)
    Abstract [en]

    Aim: A high level of parental control of feeding and disturbed energy self-regulation has previously been suggested as a mechanism for the accelerated growth observed in formula-fed compared with breast-fed infants. This study explored factors associated with parental control of feeding in a population of formula-fed infants with high levels of self-regulation.

    Methods: We included 141 formula-fed and 72 breast-fed infants from a randomised controlled trial, who were prospectively followed from under 2 months of age to 12 months of age. Anthropometry was recorded at baseline, 4, 6 and 12 months of age. Parental feeding control was assessed using a Child Feeding Questionnaire at 4 and 12 months.

    Results: The formula-fed groups fully compensated for different energy and protein densities by regulating their volume intakes. Parents of formula-fed infants had a lower pressure to eat score at 12 months than parents of breast-fed infants. A high parental restrictive score at 12 months was associated with weight at 12 months and high parental pressure to eat score at 12 months with body mass index at 12 months. Neither were associated with feeding mode.

    Conclusion: Formula-fed infants had a high level of energy self-regulation and were subjected to low parental control. Parental control of feeding was mainly influenced by infant growth.

  • 488.
    Timby, Niklas
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hernell, Olle
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Vaarala, Outi
    Department of Vaccination and Immune Protection, National Institute for Health and Welfare, Helsinki, Finland.
    Melin, Merit
    Department of Vaccination and Immune Protection, National Institute for Health and Welfare, Helsinki, Finland.
    Lönnerdal, Bo
    University of California, Davis.
    Domellöf, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Infections in infants fed formula supplemented with bovine milk fat globule membranes2015In: Journal of Pediatric Gastroenterology and Nutrition - JPGN, ISSN 0277-2116, E-ISSN 1536-4801, Vol. 60, no 3, p. 384-389Article in journal (Other academic)
    Abstract [en]

    Objectives: Observational studies have shown that even in high-income countries formula-fed infants have a higher incidence of acute otitis media (AGM), and gastrointestinal and respiratory tract infections during the first year of life compared with breast-fed infants. We hypothesized that components of the milk fat globule membrane (MFGM) may be responsible for some of these differences and that supplementation with bovine MFGM would decrease the infectious morbidity in formula-fed infants.

    Methods: In a double-blind randomized controlled trial, 160 formula-fed infants received experimental formula (EF) supplemented with bovine MFGM (EF) or unsupplemented standard formula (SF) from <2 months until 6 months of age. A breast-fed reference group consisted of 80 infants. Disease symptoms, health care contacts, and medication were recorded by the parents until 12 months of age. Serum immunoglobulin G for 10 pneumococcal serotypes was analyzed at 6 months of age.

    Results: The cumulative incidence of AOM during the intervention was lower in the EF group than in the SF group (1% vs 9%, P = 0.034), and did not differ from the breast-fed reference group (0%, P = 1.0). The incidence (25% vs 43%, P = 0.021) and longitudinal prevalence (P = 0.012) of antipyretic use were significantly lower in the EF group than in the SF group. Serum immunoglobulin G concentrations against pneumococcal serotypes 1, 5, and 14 were lower in the EF group than in the SF group.

    Conclusions: Supplementation of formula with bovine MFGM reduces the risk of AOM, decreases antipyretics use in formula-fed infants, and has immunomodulatory effects on humoral response against pneumococcus vaccine.

  • 489.
    Timby, Niklas
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Lönnerdal, Bo
    Department of Nutrition, University of California, Davis, California.
    Hernell, Olle
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Domellöf, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Cardiovascular risk markers until 12 mo of age in infants fed a formula supplemented with bovine milk fat globule membranes2014In: Pediatric Research, ISSN 0031-3998, E-ISSN 1530-0447, Vol. 76, no 4, p. 394-400Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Some of the health advantages of breast-fed as compared to formula-fed infants have been suggested to be due to metabolic programming effects resulting from early nutrition. METHODS: In a prospective double-blinded randomized trial, 160 infants <2 mo of age were randomized to experimental formula (EF) with added milk fat globule membrane (MFGM) or standard formula (SF) until 6 mo of age. A breast-fed reference (BFR) group consisted of 80 infants. Measurements were made at inclusion and at 4, 6, and 12 mo of age. RESULTS: During the intervention, the EF group had higher total serum cholesterol concentration than the SF group, reaching the level of the BFR group. The EF group had a low-density lipoprotein to high-density lipoprotein ratio not significantly different from the SF group but lower than the BFR group. CONCLUSION: Supplementation of infant formula with MFGM modified the fat composition of the formula and narrowed the gap between breast-fed and formula-fed infants with regard to serum lipid status at 12 mo.

  • 490.
    Timby, Niklas
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Lönnerdal, Bo
    University of California, Davis.
    Hernell, Olle
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Domellöf, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Cardiovascular risk markers until 12 months of age in infants fed a formula supplemented with bovine milk fat globule membranesManuscript (preprint) (Other academic)
    Abstract [en]

    Background Some of the health advantages of breast-fed as compared to formula-fed infants have been suggested to be due to metabolic programming effects resulting from early nutrition.

    Methods In a prospective double-blinded randomized trial, 160 infants <2 months of age were randomized to experimental formula (EF) with added milk fat globule membrane or standard formula (SF) until 6 months of age. A breast-fed reference (BFR) group consisted of 80 infants. Measurements were made at inclusion, 4, 6 and 12 months of age.

    Results During the intervention, the EF group had higher total serum cholesterol concentration than the SF group, reaching the level of the BFR group. The EF group had a low density lipoprotein to high density lipoprotein ratio not significantly different from the SF group but lower than the BFR group.

    Conclusion Supplementation of infant formula with MFGM modified the fat composition of the formula and narrowed the gap between breast-fed and formula-fed infants with regard to serum lipid status at 12 months.

  • 491. Tomaz, S. A.
    et al.
    Jones, R. A.
    Hinkley, T.
    Bernstein, S. L.
    Twine, R.
    Kahn, Kathleen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, South Africa.
    Norris, S. A.
    Draper, C. E.
    Gross motor skills of South African preschool-aged children across different income settings2019In: Journal of Science and Medicine in Sport, ISSN 1440-2440, E-ISSN 1878-1861, Vol. 22, no 6, p. 689-694Article in journal (Refereed)
    Abstract [en]

    Objectives: No studies have investigated gross motor skill (GMS) proficiency of preschool-aged children across different income settings in South Africa. Research from high-income countries suggests that children from low-income settings display poorer GMS proficiency compared to higher-income peers. This study aimed to (1) describe GMS proficiency of preschool-aged children in urban high-income (UH), urban low-income (UL) and rural low-income (RL) settings; and (2) explore differences in proficiency between income settings and sex.

    Design: Descriptive cross-sectional study.

    Methods: The Test of Gross Motor Development-Edition 2 (TGMD-2) was used to assess GMS. The TGMD-2 gross motor quotient, standardised scores and raw scores were used to describe proficiency.

    Results: GMS proficiency was assessed in n = 259 3-6-year-old children (n = 46 UH, n = 91 UL, n =122 RL). Overall, 93% of the children were classified as having 'average' or better GMS. According to TGMD-2 standardised scores, the RL children performed significantly better than UH and UL children (p = 0.028 and p= 0.009, respectively). RL children were significantly more proficient than UH and UL children in the strike and horizontal jump when comparing raw scores. Overall, boys performed significantly better than girls in the strike, stationary dribble, kick and leap when comparing raw scores (all p <0.001).

    Conclusions: This study reports high GMS proficiency in preschool-aged children across income settings in South Africa. The factors associated with higher GMS in low-income settings are not immediately obvious. Thus, future research should explore potential factors and identify opportunities to ensure that GMS proficiency is capitalised on as preschool-aged children enter formal schooling. (C) 2018 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  • 492.
    Toppe, Cecilia
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    End stage renal disease in type 1 diabetes: time trends and risk factors2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background and aims: Sweden has a high incidence of type 1 diabetes (T1D) and the incidence is increasing worldwide. The incidence is now twice as high as when the registration of childhood onset T1D in Sweden started in 1977. One of the major risk factors for developing late complications such as renal failure (ESRD) is duration of T1D. With a disease onset early in life this could lead to young patients with serious complications. It is therefore of interest to follow these patients to see how the risk for complications develops over time. In the first study, time trends in onset of ESRD due to diabetes (type 1 and 2) and other causes of kidney failure were studied as well as the age at onset of ESRD. To follow up on this, the aim of the second study was to look at cumulative incidence in ESRD and analyse possible time trends and gender differences in a younger diabetes population with known T1D duration. An earlier study had shown a low incidence of ESRD and now 8 more years of follow up could be added. Besides genetics, metabolic control is a factor with strong impact on the future risk of complications. The social environment of the child and adolescent with diabetes influence the understanding and management of the disease and hence the blood glucose control. Social vulnerability and/or low education imposes even more stress on the individual which could negatively influence disease management. The aim of the third study was therefore to study the impact of socio-economic status (SES) on the risk of developing ESRD in the young diabetes population. The aim of the fourth study was to analyse time trends in the treatment choices once the patients develop ESRD, the survival and cause of death in treatment and how it has developed over time.

    Study population: In all studies, data from the Swedish Renal Register (SRR) were used. The data on the T1D patients with onset before the age of 15, used in studies II-IV, came from the Swedish Childhood Diabetes Register (SCDR).  In study II we also retrieved data from the Swedish National Diabetes Register (NDR) and the Diabetes Incidence Study in Sweden (DISS). All registers have national coverage. The diabetes registers were linked to the SRR to find the patients who had developed ESRD. In study III we used the linkage between the SCDR, the SRR and Longitudinal integration database for health insurance and labour market studies (LISA).

    Results: Even though the incidence of ESRD in Sweden remained stable, the incidence of ESRD due to T1D decreased over the studied years, 1991-2010. We did not see a concurrent change for T2D. The age when the T1D patients developed ESRD had increased by 3 years and this was not seen in patients with other causes of ESRD. For patients in the SCDR the increase in age was almost 6 years. The cumulative incidence of ERSD in Sweden due to T1D is still low, 5.6% at a maximum follow up of 38 years (median 23). The incidence of ESRD is decreasing when comparing onset of T1D in the 1970´s and 80´s to onset in the 90´s, even when adjusting for T1D duration. Once they had developed ESRD, the survival in renal replacement therapy (RRT) had also improved over the years. The longest survival was seen after receiving a kidney transplant which about 50% of the patients do.

    When analysing social risk factors for development of ESRD we found that the educational level of both parents, but especially the mothers, affected the child’s risk of developing ESRD. The strongest association of education however was seen in the T1D patients own education. There was also an increased risk of developing ESRD if any or both of the parents had received income support.

    Conclusion: The incidence of ESRD due to T1D is decreasing in Sweden and the age at onset of ESRD has increased by at least 3 years. There was a significant decrease in development of ESRD over time. The patients have a longer survival once in RRT today and many of them are transplanted, further improving their survival. Growing up in families with a lower SES increases the risk of later developing ESRD, a finding worthy of recognition in the clinical setting.

  • 493.
    Toppe, Cecilia
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics. Ryhov City Hospital, Department of Internal Medicin, Jönköping, Sweden.
    Möllsten, Anna
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Schon, S.
    Dahlquist, Gisela
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Socio-economic factors influencing the development of end-stage renal disease in people with Type 1 diabetes: a longitudinal population study2017In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 34, no 5, p. 676-682Article in journal (Refereed)
    Abstract [en]

    Aims: The development of end-stage renal disease (ESRD) in Type 1 diabetes is multifactorial. Familial socio-economic factors may influence adherence to and understanding of diabetes treatment, and also general health behaviour. We investigate how parental and personal education level and exposure to low economic status, indicated by the need for income support, influence the development of ERSD caused by Type 1 diabetes.

    Methods: Participants were retrieved from the nationwide Swedish Childhood Diabetes Registry, which was linked to the Swedish Renal Registry, to find people with ESRD caused by Type 1 diabetes, and to Statistic Sweden to retrieve longitudinal socio-economic data on participants and their parents. Data were analysed using Cox regression modelling.

    Results: Of 9287 people with diabetes of duration longer than 14 years, 154 had developed ESRD due to diabetes. Median diabetes duration (range) for all participants was 24.2 years (14.0-36.7 years). Low maternal education ( 12 years) more than doubled the risk of developing ESRD, hazard ration (HR) = 2.9 [95% confidence interval (95% CI): 1.7-4.8]. For people with a low personal level of education HR was 5.7 (3.4-9.5). In an adjusted model, the person's own education level had the highest impact on the risk of ESRD. If at least one of the parents had ever received income support the HR was 2.6 (1.9-3.6).

    Conclusions: Socio-economic factors, both for the parents and the person with diabetes, have a strong influence on the development of ESRD in Type 1 diabetes. It is important for caregivers to give enough support to more vulnerable people and their families.

  • 494.
    Toppe, Cecilia
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Möllsten, Anna
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Schön, Staffan
    Dahlquist, Gisela
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Improved survival in Renal Replacement Therapy for type 1 diabetes patients in Sweden: a national register studyManuscript (preprint) (Other academic)
  • 495.
    Toppe, Cecilia
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics. Department of Internal Medicine, Ryhov County Hospital, Jönköping, Sweden.
    Möllsten, Anna
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Waernbaum, Ingeborg
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Schön, Staffan
    Swedish Renal Registry, Jönköping, Sweden.
    Gudbjörnsdottir, Soffia
    Swedish National Diabetes Register, Gothenburg, Sweden.
    Landin-Olsson, Mona
    Diabetes Incidence Study in Sweden Department of Clinical Sciences, Lund University, Lund, Sweden.
    Dahlquist, Gisela
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Decreasing Cumulative Incidence of End-Stage Renal Disease in Young Patients With Type 1 Diabetes in Sweden: a 38-Year Prospective Nationwide Study2019In: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 42, no 1, p. 27-31Article in journal (Refereed)
    Abstract [en]

    Objective: Diabetic nephropathy is a serious complication of type 1 diabetes. Recent studies indicate that end-stage renal disease (ESRD) incidence has decreased or that the onset of ESRD has been postponed; therefore, we wanted to analyze the incidence and time trends of ESRD in Sweden.

    Research design and methods: In this study, patients with duration of type 1 diabetes >14 years and age at onset of diabetes 0–34 years were included. Three national diabetes registers were used: the Swedish Childhood Diabetes Register, the Diabetes Incidence Study in Sweden, and the National Diabetes Register. The Swedish Renal Registry, a national register on renal replacement therapy, was used to identify patients who developed ESRD.

    Results: We found that the cumulative incidence of ESRD in Sweden was low after up to 38 years of diabetes duration (5.6%). The incidence of ESRD was lower in patients with type 1 diabetes onset in 1991–2001 compared to onset in 1977–1984 and 1985–1990, independently of diabetes duration.

    Conclusion: The risk of developing ESRD in Sweden in this population is still low and also seems to decrease with time.

  • 496. Torres-Espinola, Francisco J
    et al.
    Berglund, Staffan K
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    García-Valdés, Luz M
    Segura, M Teresa
    Jerez, Antonio
    Campos, Daniel
    Moreno-Torres, Rosario
    Rueda, Ricardo
    Catena, Andrés
    Peréz-García, Miguel
    Campoy, Cristina
    Maternal Obesity, Overweight and Gestational Diabetes Affect the Offspring Neurodevelopment at 6 and 18 Months of Age: A Follow Up from the PREOBE Cohort2015In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 7, article id e0133010Article in journal (Refereed)
    Abstract [en]

    Background: Brain development in fetal life and early infancy is critical to determine lifelong performance in various neuropsychological domains. Metabolic pathologies such as overweight, obesity, and gestational diabetes in pregnant women are prevalent and increasing risk factors that may adversely affect long-term brain development in their offspring. Objective: The objective of this research was to investigate the influence of maternal metabolic pathologies on the neurodevelopment of the offspring at 6 and 18 months of life. Design This was a prospective case-control study of 331 mother- and child pairs from Granada, Spain. The mothers were included during pregnancy into four groups according to their pre-gestational body mass index and their gestational diabetes status; overweight (n:56), obese (n:64), gestational diabetic (n:79), and healthy normal weight controls (n:132). At 6 months and 18 months we assessed the children with the Bayley III scales of neurodevelopment. Results: At 6 months (n=215), we found significant group differences in cognition composite language, and expressive language. Post hoc test revealed unexpectedly higher scores in the obese group compared to the normal weight group and a similar trend in overweight and diabetic group. The effects on language remained significant after adjusting for confounders with an adjusted odds ratio for a value above median in composite language score of 3.3 (95% CI: 1.1, 10.0; p=0.035) for children of obese mothers. At 18 month (n=197), the off-spring born to obese mothers had lost five points in language composite scores and the previous differences in language and cognition was replaced by a suggestive trend of lower gross motor scores in the overweight, obese, and diabetic groups. Conclusions: Infants of obese mothers had a temporary accelerated development of cognition and language, followed by a rapid deceleration until 18 months of age, particularly of language scores. This novel observation prompts further confirmative studies to explore possible placental and neurodevelopmental mechanisms involved.

  • 497. Turck, Dominique
    et al.
    Michaelsen, Kim F.
    Shamir, Raanan
    Braegger, Christian
    Campoy, Cristina
    Colomb, Virginie
    Decsi, Tamas
    Domellöf, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Fewtrell, Mary
    Kolacek, Sanja
    Mihatsch, Walter
    Moreno, Luis A.
    van Goudoever, Johannes
    World Health Organization 2006 Child Growth Standards and 2007 Growth Reference Charts: A Discussion Paper by the Committee on Nutrition of the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition2013In: Journal of Pediatric Gastroenterology and Nutrition - JPGN, ISSN 0277-2116, E-ISSN 1536-4801, Vol. 57, no 2, p. 258-264Article in journal (Refereed)
    Abstract [en]

    Growth charts are essential for evaluating children's health including their nutrition; however, the evaluation of child growth trajectories and consequently the decision to intervene are highly dependent on the growth charts used. The aim of this discussion paper of the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition Committee on Nutrition is to provide information on the background and rationale of the World Health Organization (WHO) 2006 child growth standards and WHO 2007 growth reference charts, describe their development, outline their main innovative aspects, discuss potential limitations, and make recommendations. WHO 2006 child growth standards (0-5 years) are based on prospectively collected data describing the growth of healthy infants who were breast-fed according to WHO recommendations, showing a pattern of linear growth, which is remarkably consistent between different countries and ethnic groups. WHO 2007 growth reference charts (5-19 years) are based mainly on a re-analysis of National Centre for Health Statistics data from 1977, without information on feeding. European Society for Paediatric Gastroenterology, Hepatology, and Nutrition Committee on Nutrition recommends that WHO child growth standards should be used to monitor growth in all children in the age range 0 to 2 years in Europe, whether breast- or formula-fed, and that they should be considered to be used in the age range 2 to 5 years. Implementation of the WHO child growth standards should be preceded by evaluation of the implication of their use on national healthcare policies. Health professionals should be guided on their use and interpretation and an adequate communication strategy should be available locally to ensure that parents receive clear and consistent advice. The decision on whether to implement the WHO growth references (5-19 years) should be made by national bodies because the growth pattern during the 5- to 19-year period differs between populations.

  • 498.
    Tärnvik, Arne
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Clinical Bacteriology.
    Sundqvist, G
    Gothefors, Leif
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Gustafsson, H
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Meningitis caused by Fusobacterium necrophorum.1986In: European Journal of Clinical Microbiology and Infectious Diseases, ISSN 0934-9723, E-ISSN 1435-4373, Vol. 5, no 3, p. 353-355Article in journal (Refereed)
  • 499.
    Törnell, Siv
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Ekeus, C.
    Hultin, Magnus
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Håkansson, Stellan
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Thunberg, Johan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Högberg, U.
    Low Apgar score, neonatal encephalopathy and epidural analgesia during labour: a Swedish registry-based study2015In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 59, no 4, p. 486-495Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Maternal intrapartum fever (MF) is associated with neonatal sequelae, and women in labour who receive epidural analgesia (EA) are more likely to develop hyperthermia. The aims of this study were to investigate if EA and/or a diagnosis of MF were associated to adverse neonatal outcomes at a population level. METHODS: Population-based register study with data from the Swedish Birth Register and the Swedish National Patient Register, including all nulliparae (n = 294,329) with singleton pregnancies who gave birth at term in Sweden 1999-2008. Neonatal outcomes analysed were Apgar score (AS) < 7 at 5 min and ICD-10 diagnosis of neonatal encephalopathy (e.g. convulsions or neonatal cerebral ischaemia). Multivariate logistic regression was used to calculate adjusted odds ratios (AOR) with 95% confidence intervals (CI). RESULTS: EA was used in 44% of the deliveries. Low AS or encephalopathy was found in 1.26% and 0.39% of the children in the EA group compared with 0.80% and 0.29% in the control group. In multivariate analysis, EA was associated with increased risk with low AS, AOR 1.27 (95% CI 1.16-1.39), but not with diagnosis of encephalopathy, 1.11 (0.96-1.29). A diagnosis of MF was associated with increased risk for both low AS, 2.27 (1.71-3.02), and of neonatal encephalopathy, 1.97 (1.19-3.26). CONCLUSION: Diagnosis of MF was associated with low AS and neonatal encephalopathy, whereas EA was only associated with low AS and not with neonatal encephalopathy. The found associations might be a result of confounding by indication, which is difficult to assess in a registry-based population study.

  • 500. Udo, Camilla
    et al.
    Kreicbergs, Ulrika
    Axelsson, Bertil
    Umeå University, Faculty of Medicine, Department of Radiation Sciences. Unit of Clinical Research Centre‐Östersund.
    Björk, Olle
    Lövgren, Malin
    Physicians working in oncology identified challenges and factors that facilitated communication with families when children could not be cured2019In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 108, no 12, p. 2285-2291Article in journal (Refereed)
    Abstract [en]

    Aim: We explored physicians' experiences of communicating with families when their child had cancer and a cure was no longer an option, by focusing on barriers and facilitating factors.

    Methods: Physicians from the six cancer centres in Sweden took part in focus group discussions between December 2017 and May 2018, and the data were analysed using qualitative content analysis. Focus groups enabled us to gather individual and shared perspectives.

    Results: The 35 physicians (20 male) had a mean age of 47 (range 31-74) and a mean of 11 years' experience in oncology, ranging from under one year to 43 years. They reported communication challenges when a cure was not possible, namely: emotional and mental drain, lack of mutual understanding and uncertainty about communication skills. They also reported facilitating factors: flexibility in complex conversations, the child's position in the conversations, continuity and trusting relationships, support from colleagues and having discussed the potentially life-threatening nature of cancer from the very start of treatment.

    Conclusion: Training to overcome communication issues could support the early integration of palliative care.

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