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  • 1.
    Akefeldt, Selma O
    et al.
    Karolinska University Hospital Solna, Sweden .
    Finnström, Orvar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Gavhed, Desiree
    Karolinska University Hospital Solna, Sweden .
    Henter, Jan-Inge
    Karolinska University Hospital Solna, Sweden .
    Langerhans cell histiocytosis in children born 1982-2005 after in vitro fertilization2012In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 101, no 11, p. 1151-1155Article in journal (Refereed)
    Abstract [en]

    Aim: In a recent Swedish study, comparing data from the Swedish Cancer Register with the Medical Birth Register including data on IVF, an increased risk of Langerhans cell histiocytosis (LCH) was found in children born 19822005 after IVF. Here, we aimed to verify the LCH diagnoses and examine whether any special forms of the disease were overrepresented in this population. Methods: Medical records for all children with LCH conceived by IVF were acquired and the diagnosis confirmed or discarded. Disease characteristics were compared with data from children diagnosed with LCH 19922001 in the Stockholm County. Results: We verified LCH in seven children born after IVF, all born prior to 2002. These children did not have milder disease forms. The odds ratio (OR) to develop LCH for the whole group born after IVF was 3.2 [95% confidence interval (CI), 1.47.3] and for children born before 2002, 5.2 [95% CI, 2.311.9], compared with children in Stockholm County 19922001. Conclusion: LCH was overrepresented in children born after IVF prior to 2002. Affected children did not have milder disease forms. These findings may be valuable to understand LCH aetiology. Additional studies on a putative correlation between IVF and LCH in the offspring are encouraged.

  • 2.
    Alehagen, Siw
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Finnström, Orvar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Hermansson, Göran
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Somasunduram, Konduri
    Centre for Social Medicine, Pravara Institute of Medical Sciences-Deemed University, Loni, Maharashtra, India.
    Bangal, Vidyadhar
    Pravara Institute of Medical Sciences-Deemed University, Loni, Maharashtra, India.
    Patil, Ashok
    Pravara Institute of Medical Sciences-Deemed University, Loni, Maharashtra, India.
    Chandekar, Pratibha
    Pravara Institute of Medical Sciences-Deemed University, Loni, Maharashtra, India.
    Johansson, AnnaKarin
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Nurse-based antenatal and child health care in rural India, implementation and effects - an Indian-Swedish collaboration2012In: Rural and remote health, ISSN 1445-6354, Vol. 12, no 3Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION:

    Improving maternal and child health care are two of the Millennium Development Goals of the World Health Organization. India is one of the countries worldwide most burdened by maternal and child deaths. The aim of the study was to describe how families participate in nurse-based antenatal and child health care, and the effect of this in relation to referrals to specialist care, institutional deliveries and mortality.

    METHODS:

    The intervention took place in a remote rural area in India and was influenced by Swedish nurse-based health care. A baseline survey was performed before the intervention commenced. The intervention included education program for staff members with a model called Training of Trainers and the establishment of clinics as both primary health centers and mobile clinics. Health records and manuals, and informational and educational materials were produced and the clinics were equipped with easily handled instruments. The study period was between 2006 and 2009. Data were collected from antenatal care and child healthcare records. The Chi-square test was used to analyze mortality differences between years. A focus group discussion and a content analysis were performed.

    RESULTS:

    Families' participation increased which led to more check-ups of pregnant women and small children. Antenatal visits before 16 weeks among pregnant women increased from 32 to 62% during the period. Women having at least three check-ups during pregnancy increased from 30 to 60%. Maternal mortality decreased from 478 to 121 per 100 000 live births. The total numbers of children examined in the project increased from approximately 6000 to 18 500 children. Infant mortality decreased from 80 to 43 per 1000 live births. Women and children referred to specialist care increased considerably and institutional deliveries increased from 47 to 74%.

    CONCLUSION:

    These results suggest that it is possible in a rural and remote area to influence peoples' awareness of the value of preventive health care. The results also indicate that this might decrease maternal and child mortality. The education led to a more patient-friendly encounter between health professionals and patients.

  • 3.
    Bengt Kallen, A. J.
    et al.
    Lund University.
    Finnström, Orvar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Lindam, Anna P.
    National Board for Health and Welfare, Stockholm.
    Nilsson, Emma M. E.
    National Board for Health and Welfare, Stockholm.
    Nygren, Karl-Gosta
    IVF and Fertility Clinic, Stockholm.
    Otterblad Olausson, Petra M.
    National Board for Health and Welfare, Stockholm.
    Cerebral palsy in children born after in vitro fertilization. Is the risk decreasing?2010In: European journal of paediatric neurology, ISSN 1090-3798, E-ISSN 1532-2130, Vol. 14, no 6, p. 526-530Article in journal (Refereed)
    Abstract [en]

    Background: Infants born after in vitro fertilization (IVF) differ from spontaneously conceived infants in a number of aspects which could increase the risk for future cerebral palsy (CP), e.g., multiple births, preterm births, neonatal complications. Aims: To follow up children conceived by IVF with respect to risk for CP. Methods: Infants born after IVF were identified from all IVF clinics in Sweden 1982-2007. Perinatal characteristics were obtained by linkage with the Medical Birth Register. The presence of CP in children born after IVF and in other children was identified from the Patient Register which contains diagnoses given at hospitalizations or specialist outpatient clinics. The risk for CP after IVF was studied after adjustment for year of birth, maternal age, parity, and smoking, all factors which co-vary both with IVF and with CP. Stratification was made for singletons and multiple births and for various neonatal outcomes. Results: The adjusted odds ratio for CP after IVF was 1.81 (95% confidence interval, 95% CI 1.52-2.13), lower and not statistically significant when singletons or when unlike-sexed twins were analyzed. Stratification for various neonatal characteristics also reduced odds ratios to non-significant levels. For the last few years of the study (2004-2007) when the twinning rate after IVF was less than10%, the odds ratio for CP was 0.97 (95% CI 0.57-1.66). Conclusions: The moderately increased risk for CP was most likely a consequence of an increased risk of neonatal morbidity, notably associated with multiple births.

  • 4. Berg, I
    et al.
    Finnström, Orvar
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Barn.
    Nygren, KG
    Barn födda efter in vitro-fertilisering i Sverige 1982-19972001In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 98, p. 4020-4025Article in journal (Other academic)
  • 5.
    Bladh, Marie
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Carstensen, John
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Finnström, Orvar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Hospitalization in Adolescence and Young Adulthood Among Twins and Singletons: A Swedish Cohort Study of Subjects Born Between 1973 and 19832013In: Twin Research and Human Genetics, ISSN 1832-4274, E-ISSN 1839-2628, Vol. 16, no 3, p. 707-715Article in journal (Refereed)
    Abstract [en]

    Children born with non-optimal birth characteristics — that is, are small for gestational age and/or preterm — have an increased risk for several long-term effects such as neurological sequelae and chronic disease. The purpose of this study was to examine whether twins exhibited a different outcome, compared with singletons, in terms of hospitalization during adolescence and early adulthood, and to what extent differences remain when considering the divergence in birth characteristics between singletons and twins. Persons born between 1973 and 1983 in Sweden and surviving until age 13 were included and followed until the end of 2006. Data on birth characteristics, parental socio-demographic factors, and hospitalizations were collected from national registers. Adjusting for parental socio-demographic factors, twins had a higher risk of being hospitalized than singletons (odds ratio, OR = 1.17, 95% confidence interval, CI = 1.10–1.25) and more often due to ‘Congenital anomalies’ (OR = 1.18, 95% CI = 1.06–1.28), ‘Infections’ (OR = 1.14; 95% CI = 1.08–1.20), ‘External causes of illness’ (OR = 1.10, 95% CI = 1.06–1.15), and ‘Diseases of the nervous system’ (OR = 1.18, 95% CI = 1.10–1.26). Stratifying for birth characteristics, this difference diminishes, and for some diagnoses non-optimal twins seem to do slightly better than non-optimal singletons. Thus, twins with non-optimal birth characteristics had a lower risk of hospitalization than non-optimal singletons on, for example, ‘Congenital anomalies’ and ‘Diseases of the nervous system’ (OR = 0.86, 95% CI = 0.77–0.96; OR = 0.88, 95% CI = 0.81–0.97, respectively) and Total (any) hospitalization (OR = 0.87, 95% CI = 0.83–0.92). Among those with optimal birth characteristics, twins had an increased hospitalization due to ‘External causes of illness’ (OR = 1.07, 95% CI = 1.02–1.13) compared with optimal singletons. Twins have higher hospitalization rates than singletons. In stratifying for birth characteristics, this difference diminishes, and for some diagnoses, non-optimal twins seem to do less poorly than non-optimal singletons.

  • 6.
    Bladh, Marie
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Carstensen, John
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Finnström, Orvar
    Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping. Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Intergenerational cohort study of preterm and small-for-gestational-age birth in twins and singletons2015In: Twin Research and Human Genetics, ISSN 1832-4274, E-ISSN 1839-2628, Vol. 18, no 5, p. 581-590Article in journal (Refereed)
    Abstract [en]

    To date several studies have investigated the intergenerational effect of preterm and small-for-gestational-age births. However, most studies excluded both twin mothers and twin offspring from the analyses. Thus, the objective of this study was to investigate the intergenerational effect of preterm birth and small for gestational age (SGA) among twins and singletons.

    A prospective population based register study of mother-first-born offspring pairs recorded in the Swedish Medical Birth Register was performed. The study included 4073 twins and 264,794 singletons born in 1973-1983 and their firstborns born in 1986-2009. Preterm birth was defined as birth <37 weeks of gestation and SGA as < 2 standard deviations of the Swedish standard. Logistic regressions were performed to estimate the intergenerational effect of each birth characteristic. Adjustments were made for maternal grandmothers and mother’s socio-demographic factors in addition to maternal birth- characteristics.

    Among mothers born as singletons, being born preterm was associated with an increased risk for delivering a preterm child (adjusted OR 1.39, 95% CI 1.29-1.50) while being born SGA increased the likelihood of a SGA child (adjusted OR 3.04, 95% CI 2.80-3.30) as well as a preterm child (adjusted OR 1.30, 95% CI 1.20-1.40). In twin mothers, the corresponding ORs tended to be lower and the only statistically significant association was between a SGA mother and a SGA child (adjusted OR 2.15, 95% CI 1.40-3.31). A statistically significant interaction between twinning and mother’s size for gestational was identified in a multivariate linear regression analysis indicating that singleton mothers born SGA were associated with a lower birth weight compared to mothers not born SGA.

    Preterm birth and SGA appear to be transferred from one generation to the next, although not always reaching statistical significance. These effects seem to be less evident in mothers born as twins compared with those born as singletons.

  • 7.
    Bladh, Marie
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Carstensen, John
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Finnström, Orvar
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Reproductive pattern among twins and singletons in relation to number of siblings: a Swedish cohort study of individuals born between 1973 and 19932015Manuscript (preprint) (Other academic)
    Abstract [en]

    Background Twinning has been shown to be associated with a reduced reproductive rate compared to singletons. This can partly be explained by the birth-characteristics pertaining to twinning as many twins are born preterm, with low birth weight or small for gestational age. However, the intergenerational reproductive rate may also be due to familial factors such as number of siblings.

    Methods This is a register-based study of all men and women born in Sweden between 1973 and 1993 who were living in Sweden at 13 years of age. Data on the study objects’ own births as well as their offspring, parental socio-demographic factors were collected from Swedish population based registers. Hazard ratios for the likelihood of becoming a parent were estimated using Cox’s proportion hazard models. All models were adjusted for socio-demographic and birth characteristics.

    Results Adjusting for number of siblings, socio-demographic factors and birth characteristics, twinning was associated with a decreased likelihood of becoming a first-time parent, compared with singletons both for females (HR (95% CI)=0.90 (0.88-0.93) and males (HR (95% CI)=0.96 (0.93-0.99). Having 3 or more siblings increased the chance of becoming a first-time parent among both male twins (HR (95% CI)=1.17 (1.08-1.27)) and singletons (HR (95% CI)=1.16 (1.15-1.18)) compared to having fewer than 3 siblings. This increased likelihood of becoming a parent was also present among female twins (HR (95% CI)=1.18 (1.10-1.26)) and singletons (HR (95% CI)=1.22 (1.21-1.24)).

    Conclusions Twins have a decreased likelihood of becoming a parent compared to singletons even when adjusting for number of siblings.

  • 8.
    Bladh, Marie
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Carstensen, John
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
    Finnström, Orvar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Reproductive patterns among twins: a Swedish register study of men and women born 1973-19832013In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 13Article in journal (Refereed)
    Abstract [en]

    Background

    During the last decades there has been a steady increase of twin births. A combination of improved medical treatment of preterm and small-for-gestational age children has contributed to a higher number of surviving twins. Prematurity is known to affect reproduction in a negative way. Few studies have focused on the potential effect twinning may have on future reproduction. Thus, the aim of this study was to investigate the effect of being born a twin compared to being born a singleton have on future reproduction.

    Methods

    In a national population-based register study, all individuals born between 1973–1983 who were alive and living in Sweden at 13 years of age (n = 1 016 908) constituted the sample. Data on each study subject’s own birth as well as the birth of their first offspring, and parental socio-demographic factors were collected from Swedish population based registers. Hazard ratios and corresponding 95% CI was calculated using Cox proportional hazards model.

    Results

    Twins, both men and women, had a reduced likelihood of reproducing compared to singletons (women: HR = 0.89, 95% CI = 0.86-0.93; men: HR = 0.92, 95% CI = 0.87-0.97). This difference in birth rates can only partly be explained by diverging birth characteristics. Amongst men and women born very preterm, twins had an increased likelihood of reproducing compared to singletons (women: HR = 1.25, 95% CI = 1.02-1.62; men: HR = 1.34, 95% CI = 1.01-1.78).

    Conclusions

    Twins have lower reproduction rates compared to singletons, which only to a certain degree can be explained by diverging birth characteristics.

  • 9.
    Bylund, Bengt
    et al.
    Västerviks sjukhus.
    Cervin, Torsten
    Finnström, Orvar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Gäddlin, Per-Olof
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Leijon, Ingemar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Mård, Selina
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Educational Sciences.
    Samuelsson, Stefan
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Educational Sciences.
    Sandstedt, Per
    Wärngård, Olof
    Very low birth weight children at 9 years:  School performance and behaviour in relation to risk factors2000In: Prenatal and Neonatal Medicine, ISSN 1359-8635, E-ISSN 1473-0774, Vol. 5, no 2, p. 124-133Article in journal (Refereed)
    Abstract [en]

    Objectives To investigate the school performance and behavior of very low-birth-weight children in comparison with controls, and relate the findings to risk factors.

    Methods All children with birth weight below 1501 g (VLBW) and normal birth weight (NBW) controls, born in the south-east region of Sweden during a 15-month period in 1987-88, were enrolled in a prospective follow-up study; 81 % (n = 70) and 82% (n = 72), respectively, were re-examined at the age of 9 years regarding growth, neurological status, neurofunctional classification and academic achievement tests (Raven's matrices, mathematics, vocabulary, reading ability). The need for special education at school was assessed and four behavioral problem scores were also assessed (hyperactivity, fine motor skills, gross motor skills, social skills). Children with known handicaps were not re-examined.

    Results VLBW children were shorter and lighter than controls, and differed from them with regard to neurological functional classification. As a group, they produced poorer results in all academic achievement tests except vocabulary, and also in two out of four behavioral subscales (hyperactivity and fine motor skills). When the comparison was restricted to children with normal Raven scores, almost all the differences disappeared. VLBW children had more reading difficulties but were less often than expected defined as dyslexic compared to NEW children.

  • 10.
    Dahlquist, G
    et al.
    Univ Uppsala, Childrens Hosp, Dept Women & Chil Hlth, S-75185 Uppsala, Sweden Linkoping Univ Hosp, Dept Paediat, S-58185 Linkoping, Sweden Umea Univ, Dept Paediat, Umea, Sweden Natl Board Hlth & Welf, Ctr Epidemiol, Stockholm, Sweden.
    Finnström, Orvar
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Koster, M
    Univ Uppsala, Childrens Hosp, Dept Women & Chil Hlth, S-75185 Uppsala, Sweden Linkoping Univ Hosp, Dept Paediat, S-58185 Linkoping, Sweden Umea Univ, Dept Paediat, Umea, Sweden Natl Board Hlth & Welf, Ctr Epidemiol, Stockholm, Sweden.
    Stromberg, B
    Univ Uppsala, Childrens Hosp, Dept Women & Chil Hlth, S-75185 Uppsala, Sweden Linkoping Univ Hosp, Dept Paediat, S-58185 Linkoping, Sweden Umea Univ, Dept Paediat, Umea, Sweden Natl Board Hlth & Welf, Ctr Epidemiol, Stockholm, Sweden.
    Neurological sequelae in in-vitro fertilisation babies - Reply2002In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 360, no 9334, p. 719-719Other (Other academic)
  • 11.
    DeKeyser, Nicholas
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Bladh, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Carstensen, John
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Finnström, Orvar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Premature birth and low birthweight are associated with a lower rate of reproduction in adulthood: a Swedish population-based registry study2012In: Human Reproduction, ISSN 0268-1161, E-ISSN 1460-2350, Vol. 27, no 4, p. 1170-1178Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate if individuals born with sub-optimal birth characteristics have reduced probability of reproducing in adulthood. less thanbrgreater than less thanbrgreater thanUsing population-based registries, the authors included 522 216 males and 494 692 females born between 1973 and 1983 and examined their reproductive status as of 2006. Outcome measure was the hazard ratio (HR) of reproducing. Adjustments were made for socio-economic factors. less thanbrgreater than less thanbrgreater thanMales and females born very premature displayed a reduced probability of reproducing [HR 0.78, 95 confidence interval (CI): 0.700.86 for males; HR 0.81, CI: 0.750.88 for females]. Likewise for very low birthweight (HR 0.83, CI: 0.710.95 for males; HR 0.80, 95 CI: 0.720.89 for females). Individuals born large for gestational age (LGA) displayed no significant changes. Males born small for gestational age (SGA) had a 9 lower reproductive rate (CI: 0.890.94) and that reduction increased as the individuals aged. Women born SGA tended to start reproducing at an earlier age. less thanbrgreater than less thanbrgreater thanThe results suggest that being born with low birthweight, premature or SGA (for males) is associated with a reduced probability of reproducing as an adult. LGA shows no statistically significant relationship with future reproduction.

  • 12.
    Ekholm Selling, Katarina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Carstensen, John
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Finnström, Orvar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Hospitalization in adolescence affects the likelihood of giving birth: a Swedish population-based register study.2009In: Acta paediatrica, ISSN 0803-5253, Vol. 98, no 3, p. 561-6Article in journal (Refereed)
    Abstract [en]

    Aim: To examine the effect of hospitalization during adolescence on the likelihood of giving birth.

    Methods: 142 998 women born in 1973-75 were followed with the help of the Swedish Medical Birth Register (MBR) and the Swedish Total Population Register (TPR) up until the end of 2000 with respect to their likelihood of giving birth. All analyses were adjusted for parental socio-economic characteristics and factors related to the studied women's own birth.

    Results: The likelihood of giving birth between 20 and 27 years of age was positively affected by hospitalization at least once during adolescence according to the Swedish Hospital Discharge Register (HDR); adjusted hazard ratio (HR) = 1.32, 95% confidence interval: 1.29-1.35. Women hospitalized due to genitourinary diseases, respiratory diseases, abdominal problems and abuse of alcohol and drugs were more likely to have given birth during the study period, while hospitalizations according to cerebral palsy and congenital malformations tended to decrease childbearing. Women hospitalized due to psychiatric diseases had an increase likelihood of given birth at 20-24 years but a reduced thereafter.

    Conclusion: A majority of the causes of hospitalization during adolescence increased the likelihood of giving birth between ages 20 to 27.

  • 13.
    Ekholm Selling, Katarina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Carstensen, John
    Linköping University, Department of Medicine and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Finnström, Orvar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Hospitalizations in adolescence and early adulthood among Swedish men and women born preterm or small for gestational age2008In: Epidemiology, ISSN 1044-3983, E-ISSN 1531-5487, Vol. 19, no 1, p. 63-70Article in journal (Refereed)
    Abstract [en]

    Background: Preterm birth and reduced intrauterine growth appear to be related to morbidity in childhood and later adulthood. We studied whether the risk of all-cause hospitalization in adolescence and early adulthood differed between individuals who were born preterm or small for gestational age (SGA) compared with those bom at term and appropriate for gestational age.

    Methods: Using Swedish registries, we followed 304,275 men and women born in 1973-1975 for any hospitalizations occurring in 1987-1996. Preterm birth was defined as <37 weeks of gestation and SGA as babies smaller than 2 standard deviations below the mean weight for gestational length, according to Swedish standards. We created 3 mutually exclusive categories: "preterm" (<37 weeks and not SGA), "SGA" (SGA and not preterm), and "both preterm and SGA." The comparison group was all term births not SGA. Childhood socioeconomic characteristics were accounted for in the analyses.

    Results: The overall risk of hospitalization was higher for men and women bom SGA (adjusted odds ratio = 1.16; 95% confidence interval = 1.12-1.21), for those born preterm (1.06; 1.02-1.10), and for those born both preterm and SGA (1.42; 1.26-1.59). In addition to higher risks for previously reported adverse health outcomes, such as neurodevelopment sequelae and congenital anomalies, men and women born SGA or preterm were more likely to be hospitalized due to unspecified symptoms. SGA also appeared to be associated with genitourinary diseases and drug use.

    Conclusions: Men and women born SGA or preterm were at higher risk for hospitalization during adolescence and early adulthood, with men and women born SGA more at risk than those bom preterm.

  • 14.
    Ekholm Selling, Katarina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Carstensen, John
    Linköping University, Department of Medicine and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Finnström, Orvar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Intergenerational effects of preterm birth and reduced intrauterine growth: A population-based study of Swedish mother-offspring pairs2006In: British Journal of Obstetrics and Gynaecology, ISSN 0306-5456, E-ISSN 1365-215X, Vol. 113, no 4, p. 430-440Article in journal (Refereed)
    Abstract [en]

    Objective To estimate the intergenerational effects of preterm birth and reduced intrauterine growth.

    Design Population-based cohort study.

    Settings Mother–first-born offspring pairs recorded in the Swedish Medical Birth Registry.

    Population Children born before 2001 to 38 720 women born in 1973–75.

    Methods The relationships between the mother's and the child's birth characteristics were estimated using logistic regression analysis. Adjustments were made for smoking habits, body mass index (BMI), and current and childhood socio-economic conditions. Analyses were performed on all mother–offspring pairs and on the pairs for which information on neither of the included background variables was missing (n= 24 520).

    Main outcome measures Preterm birth (<37 weeks of gestation) and small for gestational age (SGA) (<−2 SD of the Swedish standard).

    Results Mothers who themselves had been born preterm were not significantly more likely to deliver their own children preterm, compared with those who had been born at term (adjusted OR 1.24, 95% CI 0.95–1.62). Also, preterm birth in the mothers did not influence the occurrence of SGA in the children. However, the odds ratio for giving birth to SGA and preterm children, respectively, was higher among SGA mothers (OR 2.68, 95% CI 2.11–3.41 and OR 1.30, 95% CI 1.05–1.61). Mothers whose intrauterine growth was moderately reduced but who did not meet the criterion of being born SGA were also at higher risk of giving birth to both preterm and SGA children, respectively.

    Conclusions The present study showed evidence of intergenerational effects of reduced intrauterine growth even when socio-economic factors as well as BMI and smoking were adjusted for. There was, however, no consistent intergenerational effect of preterm birth.

  • 15.
    Ekholm (Selling), Katarina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Carstensen, John
    Linköping University, Department of Medicine and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Finnström, Orvar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    The probability of giving birth among women who were born preterm or with impaired fetal growth: A Swedish population-based registry study2005In: American Journal of Epidemiology, ISSN 0002-9262, E-ISSN 1476-6256, Vol. 161, no 8, p. 725-733Article in journal (Refereed)
    Abstract [en]

    The primary aim of this study was to investigate whether women born prematurely or with impaired fetal growth have a reduced probability of giving birth. Using Swedish population-based registries, the authors identified 148,281 women born in 1973–1975 for follow-up until 2001. Of these women, 4.1% were born preterm and 0.32% very preterm, 0.29% were born with a very low birth weight, and 5.4% were small for gestational age. Outcome measures were the hazard ratios for giving birth during the study period. Adjustments were made for socioeconomic factors. Very-low-birth-weight women displayed a reduced probability of giving birth (hazard ratio = 0.74, 95% confidence interval: 0.60, 0.91), most apparent among women aged 25 or more years. There were also tendencies of reduced hazard ratios of giving birth among women born preterm or very preterm in this age interval. Women born small for gestational age (below –2 standard deviations) seemed to be more likely to have given birth (hazard ratio = 1.09, 95% confidence interval: 1.04, 1.14), but when a more extreme group of small-for-gestational-age women (below –3 standard deviations) was defined, the association was less evident (hazard ratio = 1.04, 95% confidence interval: 0.94, 1.16). The results suggest that very-low-birth-weight women and, possibly, women born preterm or very preterm have a reduced probability of giving birth, while the results regarding small for gestational age are less clear.

  • 16. Eriksson, M
    et al.
    Bodin, L
    Orebro Univ Hosp, Dept Paediat, Orebro, Sweden Orebro Univ Hosp, Unit Stat & Epidemiol, Orebro, Sweden Linkoping Univ Hosp, Dept Paediat, S-58185 Linkoping, Sweden.
    Finnström, Orvar
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Schollin, J
    Orebro Univ Hosp, Dept Paediat, Orebro, Sweden Orebro Univ Hosp, Unit Stat & Epidemiol, Orebro, Sweden Linkoping Univ Hosp, Dept Paediat, S-58185 Linkoping, Sweden.
    Severity-of-illness indices as predictors of 4-year outcome2002In: Pediatric Research, ISSN 0031-3998, E-ISSN 1530-0447, Vol. 51, no 4, p. 2201-Conference paper (Other academic)
  • 17.
    Eriksson, Mats
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics.
    Bodin, L
    Finnström, Orvar
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Barn.
    Schollin, Jens
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics.
    Can severity-of-illness indices for neonatal intensive care predict outcome at 4 years of age?2002In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 91, p. 1093-1100Article in journal (Refereed)
  • 18.
    Eriksson, Mats
    et al.
    Department of Paediatrics, Örebro University Hospital.
    Finnström, Orvar
    Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Can daily repeated doses of orally administered glucose induce tolerance when given for neonatal pain relief?2004In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 93, no 2, p. 246-249Article in journal (Refereed)
    Abstract [en]

    Aim: Orally administered sweet solutions have a pain-relieving effect during painful procedures in newborn infants. The underlying mechanism is not fully understood, but, from the results of animal research, an opioid-like mechanism is often suggested. The aim of this study was to determine whether repeated doses of orally administered glucose would cause tolerance to glucose.

    Methods: Fifty-seven healthy, full-term infants were recruited on the day of birth to receive three daily doses of either 1 ml 30% glucose or sterile water for 3–5 d, after which routine blood samples were collected by heel-lance. All infants received 1 ml 30% glucose before the heel-lance was carried out. Crying time, Premature Infant Pain Profile scores and changes in heart rate were used as pain measures.

    Results: No differences were found between the groups, either in demographic data or in the outcome variables.

    Conclusion: No tolerance was observed under the conditions prevailing in this study. However, we cannot rule out an endogenous opioid mechanism. What is clinically important is that repeated doses of glucose do not decrease the pain-relieving effect.

  • 19.
    Eriksson, Mats
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Pediatrics .
    Finnström, Orvar
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Schollin, J
    Repeated doses of orally given glucose do not cause tolerance when given for neonatal pain relief2003In: Pediatric Research, ISSN 0031-3998, E-ISSN 1530-0447, Vol. 53, no 4, p. 2586-Conference paper (Other academic)
  • 20.
    Finnström, Orvar
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    A genetic reason for male excess in infant respiratory mortality?2004In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 93, no 9, p. 1154-1155Article in journal (Refereed)
    Abstract [en]

    Male infants have a 50% higher risk of death from respiratory diseases and a number of congenital heart diseases that can lead to cerebral hypoxia. The most important of these diseases are infant respiratory distress syndrome and sudden infant death syndrome. Conclusion: The mechanism behind the excess peri-mortality rate in male infants is not known. A genetic factor leading to reduced tolerance to hypoxia is possible.

  • 21.
    Finnström, Orvar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Ethical decision-making in neonatology - a Scandinavian perspective2012In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 101, no 6, p. 555-556Article in journal (Refereed)
    Abstract [en]

    n/a

  • 22.
    Finnström, Orvar
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Barn.
    Mätfel i randomiserade kontrollerade studier i neonatala perioden- Kvalilteten brister rörande det informerade samtycket.2001In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 98, p. 2474-2475Article in journal (Other academic)
  • 23.
    Finnström, Orvar
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Berg, Göran
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Norman, Anna
    Centre for Epidemiology, National Board of Health and Welfare Stockholm.
    Otterblad Olausson, Petra
    Centre for Epidemiology, National Board of Health and Welfare Stockholm.
    Size of delivery unit and neonatal outcome in Sweden. A catchment area analysis2006In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 85, no 1, p. 63-67Article in journal (Refereed)
    Abstract [en]

    Background. Quality of perinatal care was evaluated in relation to size of delivery unit and size of catchment area for deliveries. Methods. Neonatal outcome, measured as neonatal mortality, low Apgar scores at 5 min, and the occurrence of respiratory disorders and cerebral palsy was analyzed during a 15-year period from 1985 to 1999 inclusive. Figures were derived from the Swedish Medical Birth Registry and the Hospital Discharge Registry. Odds ratios were estimated for the different outcomes in relation to size of delivery unit (actual and estimated number of births) and the provision of a pediatric department at the hospital. Seven possible confounders were considered: year of birth, maternal age, parity, smoking during pregnancy, gestational age, parental cohabitation, and maternal body mass index. Results. Neonatal mortality was significantly higher for infants in families living within the catchment area of the smallest units without a pediatric department. Small differences in the occurrence of respiratory disturbances and Apgar scores are probably due to diagnostic differences. There were no differences in the incidence of cerebral palsy. Neonatal mortality continued to decrease during the observation period. Conclusions. Differences were minor, pointing to a fairly homogeneous quality of perinatal care and an efficient referral system for risk pregnancies. Mortality continues to decrease in spite of a reduction in the number of units caring for deliveries. © 2006 Taylor & Francis.

  • 24.
    Finnström, Orvar
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Bylund, Bengt
    Västerviks sjukhus.
    Cervin, Torsten
    Centralsjukhuset i Kalmar.
    Gäddlin, Per-Olof
    Linköping University, Department of Molecular and Clinical Medicine.
    Leijon, Ingemar
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Mård, Selina
    Linköping University, Department of Behavioural Sciences.
    Samuelsson, Stefan
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Behavioural Sciences, Teaching and Learning in School, Teacher Education and other Educational Settings.
    Sandstedt, Per
    hälsouniversitetet i Linköping.
    Wärngård, Olof
    Norrköpings sjukhus.
    Mycket lågviktiga barn vid 9 års ålder. De flesta klarar sig bra men barn med skolsvårigheter är överrepresenterade2000In: Svenska läkartidningen, ISSN 0371-439X, Vol. 97, p. 3492-3498Article in journal (Refereed)
  • 25.
    Finnström, Orvar
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Giordano, Luisa
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Nelson, Nina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Jakobsson, Peter
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Ophthalmology. Östergötlands Läns Landsting, Reconstruction Centre, Department of Ophthalmology UHL.
    Komplikationer i nyföddhetsperioden kan ge synhandikapp senare i livet.2004In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 101, no 34, p. 2560-2562Article in journal (Other academic)
  • 26.
    Finnström, Orvar
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Barn.
    Gäddlin, Per-Olof
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics.
    Leijon, Ingemar
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Barn.
    Samuelsson, S
    Wadsby, Marie
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Child and Adolescent Psychiatry.
    Very-low-birth-weight children at school age: Academic achievement, behavior and self-esteem and relation to risk factors2003In: The Journal of Maternal-Fetal & Neonatal Medicine, ISSN 1476-7058, E-ISSN 1476-4954, Vol. 14, no 2, p. 75-84Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate school performance, behavior and self-esteem of children with very low birth weight (VLBW). Methods: All children with birth weight below 1501 g (VLBW) and normal birth weight controls, born in the south-east region of Sweden during a 15-month period in 1987-88, were enrolled in a prospective follow-up study. At the age of 9 years, 81% and 82%, respectively, were re-examined regarding growth, neurofunctional classification, academic achievement tests, need for special education and behavioral problems. At 12 years, 89% and 76%, respectively, were re-examined regarding growth, neurofunctional classification, visual acuity and self-esteem. Results: VLBW children were shorter and lighter, and differed from the controls with regard to neurological functional classification. They produced poorer results in most academic achievement tests. When the comparison was restricted to children with normal intelligence, almost all the differences in other academic achievements disappeared. VLBW children had more reading difficulties but were less often than expected defined as dyslexics compared to control children. We did not find any major disparity in visual acuity and self-esteem between the groups. Low Apgar scores, intracranial hemorrhage and the need for mechanical ventilation neonatally were associated with poorer results in most outcome measures. Neurofunctional assessments in early childhood were associated with most outcome measures. The mother's education was related to delayed reading skills and need for special education. Conclusions: Although VLBW children performed less well in most academic achievement tests and on some behavioral subscales, those who had a normal intellectual capacity did not differ in any important aspects from the controls.

  • 27.
    Finnström, Orvar
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Kallen, Bengt
    Lund University, Sweden .
    Letter: The term asthma" should be avoided in describing the chronic pulmonary disease of prematurity2013In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 42, no 5, p. 1431-1431Article in journal (Other academic)
    Abstract [en]

    n/a

  • 28.
    Finnström, Orvar
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Källén, Bengt
    Tornblad Institute, University of Lund, Lund.
    Lindam, Anna
    Department of Statistics, Monitoring and Analyses, National Board of Health and Welfare, Stockholm.
    Nilsson, Emma
    Department of Statistics, Monitoring and Analyses, National Board of Health and Welfare, Stockholm.
    Nygren, Karl-Gösta
    IVF and Fertility Clinic, Sophiahemmet Hospital, Stockholm.
    Otterblad Olausson, Petra
    Department of Statistics, Monitoring and Analyses, National Board of Health and Welfare, Stockholm.
    Maternal and child outcome after in vitro fertilization - a review of 25 years of population-based data from Sweden2011In: ACTA OBSTETRICIA ET GYNECOLOGICA SCANDINAVICA, ISSN 0001-6349, Vol. 90, no 5, p. 494-500Article in journal (Refereed)
    Abstract [en]

    Objective. To summarize data on deliveries after in vitro fertilization (IVF) performed in Sweden up to 2006. Design. Cohort study of women and children, conceived after IVF, with comparisons of deliveries after IVF before and after 1 April 2001. Setting. Study based on Swedish health registers. Population. Births registered in the Swedish Medical Birth Register with information on IVF from all IVF clinics in Sweden. Methods. Results from the second study period are summarized, and outcomes between the two periods are compared. Long-term follow-up is based on data from both periods. Main outcome measures. Maternal and perinatal outcomes, long-term sequels. Results. Some maternal pregnancy complications decreased in rate, notably pre-eclampsia and premature rupture of membranes. The rate of multiple births and preterm births decreased dramatically, with a better neonatal outcome, including reduced neonatal mortality. No difference in outcome existed between IVF and intracytoplasmic sperm injection or between the use of fresh and cryopreserved embryos, but children born after blastocyst transfer had a slightly higher risk for preterm birth and congenital malformations than children born after cleavage stage transfer. An increased risk for cerebral palsy, possibly for attention deficit and hyperactivity disorder, for impaired visual acuity and for childhood cancer was noted, but these outcomes were rare also after IVF. An increased risk for asthma was demonstrated. No effect on maternal cancer risk was seen. Conclusion. A marked decrease in multiple births was the main reason for better pregnancy and neonatal outcome and may also have a beneficial effect on long-term results, notably cerebral palsy.

  • 29.
    Finnström, Orvar
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Barn.
    Leijon, Ingemar
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Barn.
    Samuelsson, S
    Bylund, B
    Cervin, T
    Gäddlin, PO
    Mård, S
    Wärngård, O
    Skolsvårigheter vanliga hos barn med mycket låg födelsevikt. Extra uppmärksamhet och stöd behövs vid skolstart.2000In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 97, p. 3492-3498Article in journal (Other academic)
  • 30.
    Finnström, Orvar
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Nygren, KG
    IVF Clinic Sophiahemmet, Stockholm.
    Otterblad Olausson, P
    Centre for Epidemiology Stockholm.
    Strömberg, B
    Wennerholm, Ulla-Britt
    Kvinnokliniken Göteborg.
    Cerebral palsy in children born after IVF in Sweden 1982-1995: type of CP and maternal/obsterical characteristics are similar to those in non-IVF children with CP2005In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 84, no 12, p. 1215-1215Article in journal (Refereed)
  • 31.
    Finnström, Orvar
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Nygren, K-G
    IVF och Fertilitetskliniken, Sophiahemmet, Stockholm.
    Otterblad Olausson, Petra
    Epidemiologiskt Centrum, Socialstyrelsen, Stockholm.
    IVF i Sverige - Fortsatt uppföljning av barn och mödrar2006In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 103, no 32-33, p. 2301-2305Article in journal (Refereed)
    Abstract [sv]

    This paper summarises six recently published studies which evaluate Swedish in vitro fertilization from 1982 to 2003 and is a register study, based on national registers linked through personal identification numbers. Data were available for all 12186 mothers and their 16280 children. Comparisons were made with the total delivering population. The number of children born after IVF increases steadily and amounts to 3% presently. The number of twins has decreased considerably. Some increased risks persist after IVF, a slightly higher perinatal death rate and an increased risk for congenital malformations. There were no differences between conventional IVF and ICSI. The risk for cancer was not increased with one possible exception, histiocytosis. Morbidity during childhood measured as hospital admissions, was increased due to more preterm births and multiple births in the IVF group. IVF mothers were older and smoked less than other mothers. Their medical drug use differed from that of other pregnant women. In general they had a decreased cancer risk, but probably an increased risk for ovarian cancer. Maternal mortality was not increased. Several obstetric complications were more common in IVF mothers: ovarial torsion, preeclampsia, premature rupture of membranes, bleeding at delivery and placental abruption. The deliveries were more often induced, and the frequency of caesarean section was increased.

  • 32.
    Finnström, Orvar
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Barn.
    Otterblad-Olausson, P
    Sedin, G
    Serenius, F
    Svenningsen, N
    Thiringer, K
    Tunell, R
    Wennergren, M
    Wesström, G
    Stor studie indikerar god prognos för barn med extremt låg födelsevikt. 1999In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 96, p. 1560-1567Article in journal (Other (popular science, discussion, etc.))
  • 33.
    Finnström, Orvar
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Barn.
    Persson, J
    Ethical aspects of decision-making at the limit of viability.1999In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 88, p. 708-709Article in journal (Other (popular science, discussion, etc.))
  • 34.
    Finnström, Orvar
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Persson, J.
    Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Withdrawing treatment--difficult decisions in neonatal care [Avsluta behandling--svåra beslut i neonatalvården.]2009In: Läkartidningen, ISSN 0023-7205, Vol. 106, no 13, p. 909-910Article in journal (Refereed)
    Abstract [sv]

    Hur långt ska man driva behandling inom neonatalvården? Ska man ta hänsyn till de konsekvenser en behandling kan få på sikt, vilket är den allmänna uppfattningen, eller gäller överlevnad till varje pris? En konsekvensetisk uppfattning ställs mot en pliktetisk, menar författarna, som refererar praxis och rekommendationer.

  • 35. Gaddlin, P-O
    et al.
    Finnström, Orvar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Leijon, Ingemar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Most very low birth weight subjects do well as adults2009In: ACTA PAEDIATRICA, ISSN 0803-5253, Vol. 98, no 9, p. 1513-1520Article in journal (Refereed)
    Abstract [en]

    Aim: To study health, quality of life, educational level and occupation in very low birth weight (VLBW) children in early adulthood and the relationship of the findings to neonatal risk factors and later handicap. Methods: This is a prospective long-term follow-up study of a regional cohort of 20-year-old VLBW subjects (n = 77) of all surviving VLBW children (n = 86) and 69/86 term controls born in 1987-1988 in the south-east of Sweden. Postal questionnaires were used: 1. A study-specific form, 2. Medical Outcomes Study, Short Form (SF-36), 3. Sense of Coherence. Results: VLBW subjects did not differ significantly from their controls in self-perceived health, use of tobacco, education, occupation and way of living, or scoring on SF-36 and Sense of Coherence. Sixteen had cerebral palsy, attention deficit hyperactivity disorder or isolated mental retardation, and these subjects differed significantly from controls on SF-36 in physical functioning and physical health score, but not on Sense of Coherence. VLBW subjects were significantly lighter and shorter than their controls. Extremely low birth weight (ELBW), bronchopulmonary dysplasia and intraventricular haemorrhage were significantly associated with poorer scores on physical function. Conclusion: The 20-year old VLBW subjects reported perceived health and managed transition to adulthood similar to controls. Handicapped subjects had poorer self-perceived physical function. ELBW and severe neonatal complications were associated with poorer self-perceived physical health.

  • 36.
    Gradin, Maria
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Pediatrics .
    Finnström, Orvar
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Schollin, J
    Comparison of oral glucose and breast-feeding on neonatal pain response to venipuncture2003In: Pediatric Research, ISSN 0031-3998, E-ISSN 1530-0447, Vol. 53, no 4, p. 2583-Conference paper (Other academic)
  • 37.
    Gradin, Maria
    et al.
    Department of Paediatrics, Örebro University Hospital, Örebro Sweden.
    Finnström, Orvar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Schollin, Jens
    Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.
    Feeding and oral glucose: additive effects on pain reduction in newborns2004In: Early Human Development, ISSN 0378-3782, E-ISSN 1872-6232, Vol. 77, no 1-2, p. 57-65Article in journal (Refereed)
    Abstract [en]

    Aims: The aims of this study were to compare the pain reducing effect of oral glucose with that of being breast-fed shortly before venipuncture in newborns, and also the pain score and crying time with parents' assessment.

    Design: Randomised, controlled trial.

    Subjects: 120 full term newborns undergoing venipuncture randomly assigned to on of four groups: I, Breast-fed and 1-ml placebo; II, Breast-fed and 1-ml 30% glucose; III, Fasting and 1-ml placebo; and IV, Fasting and 1-ml 30% glucose.

    Outcome measures: Pain during venipuncture was measured with the Premature Infant Pain Profile (PIPP). Crying time was recorded. The parents assessed their babies' pain on a Visual Analogue Scale (VAS).

    Results: The PIPP score was significantly lower in the infants receiving glucose, than in those not given glucose (p=0.004). There was no significant difference in PIPP score between the infants who were fed and the fasting infants. The PIPP score was lower in group II (median 7) than in group I (md 10). There was a similar difference between group IV (md 9) and group III (md 11). The median crying times during the first 3 min in groups I, II, III, and IV were 63, 18, 142 and 93 s, respectively. There was low agreement between the parents' assessment of pain and the PIPP score and crying time.

    Conclusion: Breast-feeding shortly before venipuncture has no major impact on the pain score but on crying time. The combination of oral glucose and breast-feeding shows the lowest pain score and significantly shorter duration of crying.

  • 38.
    Gäddlin, Per-Olof
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Finnström, Orvar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Hellgren, Kerstin
    Department of Ophthalmology, University Hospital, Uppsala, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Leijon, Ingemar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Hospital readmissions and morbidity in a fifteen-year follow-up of very low birthweight children in Southeast Sweden2007In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 96, no 4, p. 499-505Article in journal (Refereed)
    Abstract [en]

    Aim: To study the effect of very low birthweight on hospital care and morbidity, and their relationship to gender, birthweight, and neonatal complications.

    Methods: 85 very low birthweight (VLBW; ≤1500 g) children and term controls born in 1987-1988 in south-east region of Sweden were checked in registers regarding readmissions and diagnoses, need for habilitation and child psychiatric care up to 15 years of age. Ophthalmological examinations were made at age 4 in 64 of VLBW and 61 of control children, and at age 15 in 59 of VLBW and 55 of control children.

    Results: VLBW boys had three times more readmissions compared with normal weight control boys (p=0.003). Neonatal risk factors for readmissions were gestational age under 30 weeks (OR 3.1), birthweight less than 1000 g (OR 4.6), mechanical ventilation (OR 9.5), and more than 60 days’ stay in neonatal ward (OR 5.0). A minority of VLBW children had an impairment/handicap such as cerebral palsy (CP) in five (5.9 %) children, attention deficit hyperactivity disorders (ADHD) in five children, and blindness due to retinopathy of prematurity in one child. One child in the control group had ADHD. At the 15-year examination median visual acuity in the best eye was better in the control group (1.6) than in the VLBW group (1.3) (p=0.009). 32% of VLBW children and 11% of controls had latent or manifest strabismus (p=0.007).

    Conclusion: Risk factors for readmissions were gender, low gestational age, birthweight <1000 g or mechanical ventilation. A minority of VLBW children had a handicap that influenced their daily life activities at 15 years of age.

  • 39.
    Gäddlin, Per-Olof
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Finnström, Orvar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Samuelsson, Stefan
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Wadsby, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry . Linköping University, Faculty of Health Sciences.
    Wang, Chen
    Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden.
    Leijon, Ingemar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Academic achievement, behavioural outcomes and MRI findings at 15 years of age in very low birthweight children2008In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 97, no 10, p. 1426-1432Article in journal (Refereed)
    Abstract [en]

    Aim: To assess cognitive, academic, and behavioural functions in 15-year-old very low birthweight (VLBW) children and relate results to gender, neonatal risk factors, growth, and Magnetic Resonance Imaging (MRI) findings.

    Methods: 61/86 VLBW children and 57/86 term controls born in the south-east region of Sweden were assessed regarding cognition (WISC III), school outcome, behaviour, and growth. VLBW children were examined using cerebral MRI.

    Results: VLBW children performed significantly lower than their term controls on WISC III and 49% had IQ lower than 85. Ten VLBW children with IQ <70 had not been clinically identified earlier and a majority of these children attended mainstream school. VLBW girls had significantly lower total problems scores. Using MRI, white matter damage (WMD) was detected in 16 (27%) children. VLBW boys with WMD had significantly lower IQ than those without. Small occipito-frontal circumference correlated with low IQ. Mechanical ventilation and intraventricular haemorrhage (IVH) showed significant correlations with lower IQ and reading skills.

    Conclusion: VLBW children achieved poorer results compared with their controls in cognitive tests. Mechanical ventilation and IVH were related to poorer academic outcome. Many of the children with low IQ had not been identified earlier. Therefore, we recommend that VLBW children undergo an IQ test before beginning school in order to receive adequate support.

  • 40.
    Gäddlin, Per-Olof
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Finnström, Orvar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Leijon, Ingemar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Health, quality of life, educational level, and occupation in early adulthood in very low birthweight subjects in south-east SwedenManuscript (Other academic)
    Abstract [en]

    Objectives: To study health, quality of life, educational level and occupation in very low birthweight children (VLBW; ≤1500 g) in early adulthood and relationship to neonatal risk factors and handicap.

    Design: Prospective long-term follow-up study.

    Setting: Regional cohort.

    Participants: Twenty-year-old VLBW subjects (n=77) of all surviving VLBW children (n=86) and 69/86 term controls born in 1987-1988 in the south-east of Sweden.

    Outcome Measures: Postal questionnaires: 1. A study-specific form with questions about health, tobacco and alcohol use, weight and height, education, occupation and socio-economic situation. 2. Medical Outcomes Study, Short Form (SF-36). 3. Sense of Coherence (SOC).

    Results: VLBW subjects did not differ significantly from the controls in self-perceived health, use of tobacco, education, occupation and way of living, or scoring on SF-36 and SOC. Sixteen had cerebral palsy, attention deficit hyperactivity disorder, or isolated mental retardation, and those differed significantly from controls on SF-36 in physical functioning and physical health score, but not on SOC. VLBW subjects were significantly lighter and shorter than their controls. Extremely low birthweight (ELBW), bronchopulmonary dysplasia and intraventricular haemorrhage were significantly associated with poorer scores on physical functioning and physical health score.

    Conclusions: A majority of VLBW subjects were healthy at 20 years of age and managed transition to adulthood similar to controls. A minority had handicaps that influenced their physical function. ELBW and severe neonatal complications were associated with poorer self-perceived physical health in early adulthood.

  • 41.
    Gäddlin, Per-Olof
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Finnström, Orvar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Wang, Chen
    Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden.
    Leijon, Ingemar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    A fifteen-year follow-up of neurological conditions in VLBW children without overt disability: Relation to gender, neonatal risk factors, and end stage MRI findings2008In: Early Human Development, ISSN 0378-3782, E-ISSN 1872-6232, Vol. 84, no 5, p. 343-349Article in journal (Refereed)
    Abstract [en]

    Background: Very low birthweight (VLBW; birth weight ≤ 1500 g) children run a greater risk than controls of developing neurosensory disabilities, but also minor neurological disturbances.

    Aims: To assess neurological status from the neonatal period up to fifteen years of age in VLBW children without overt neurological disability in relation to gender, neonatal risk factors, and Magnetic Resonance Imaging (MRI) findings of the brain.

    Study design: A population based follow-up study of VLBW children and their controls.

    Subjects: Eighty VLBW children without overt disability, in a cohort of 86 surviving VLBW children, were enrolled in a follow-up study at 40 weeks gestational age and at 4, 9, and 15 years of age. 56 VLBW children were examined with cerebral MRI at 15 years of age.

    Outcome measures: Neurological test scores. MRI findings, principally white matter damage (WMD).

    Results: VLBW children were inferior in neurological assessments in comparison with controls at 40 weeks gestational age and 4 and 15 years of age. VLBW girls did not differ from their controls at 9 and 15 years. Fourteen of 56 (25%) VLBW children had abnormal MRI findings and 13 were evaluated as mild WMD. Children with WMD did not differ in neurological outcome from those without WMD at any examination. Mechanical ventilation and/or intraventricular haemorrhage (IVH) during the neonatal period were significantly related to less a favourable outcome at follow-up examinations.

    Conclusion: A cohort of VLBW children without overt neurological disability had a poorer neurological condition up to adolescence in comparison with controls. A quarter of the VLBW children had mild WMD but without relation to the neurological functions. Mechanical ventilation and IVH were related to poorer neurological outcome.

  • 42. Holm Sjögren, L
    et al.
    Finnström, Orvar
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Barn.
    Fohlin, L
    Uppföljning av barnsjukvården bra kunskapskälla som kan bli bättre. 1999In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 96, p. 1201-1205Article in journal (Other (popular science, discussion, etc.))
  • 43.
    Ivars, Katrin
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Nelson, Nina
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Finnström, Orvar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Mörelius, Evalotte
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Nasopharyngeal suctioning does not produce a salivary cortisol reaction in preterm infants2012In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 101, no 12, p. 1206-1210Article in journal (Refereed)
    Abstract [en]

    Aim: To investigate whether nasopharyngeal suctioning produces a physiological and behavioural stress reaction in preterm infants and if a possible reaction can be dampened by sweet solution. Methods: Eleven preterm infants were randomly assigned to receive either 30% oral glucose or nothing prior to morning nasopharyngeal suctioning; the procedure was reversed in the afternoon. The study included a total of 44 samples from preterm infants evaluated with salivary cortisol, pain score (Visual Analogue Scale), heart rate, oxygen saturation and recovery time through the Newborn Individualized Developmental Care and Assessment Program. For reference, 44 samples from eleven full-term infants were evaluated for salivary cortisol. Results: Regardless of whether or not preterm infants received glucose before nasopharyngeal suctioning, no statistically significant difference was found in salivary cortisol reactivity, pain score, heart rate, oxygen saturation or recovery time. Nor were any statistically significant differences between salivary cortisol baseline and response values found in full-term infants after nasopharyngeal suctioning. Conclusion: In the present setting, nasopharyngeal suctioning was not stressful enough to increase salivary cortisol or pain score. Oral glucose did not alter salivary cortisol levels.

  • 44.
    Kallen, A J Bengt
    et al.
    Tornblad Institute, University of Lund.
    Finnström, Orvar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Lindam, Anna P
    Department of Statistics, Monitoring and Analyses, National Board of Health and Welfare, Stockholm.
    Nilsson, Emma M E
    Department of Statistics, Monitoring and Analyses, National Board of Health and Welfare, Stockholm.
    Nygren, Karl-Gösta
    IVF and Fertility Clinic, Sophiahemmet, Stockholm.
    Otterblad Olausson, Petra M
    Department of Statistics, Monitoring and Analyses, National Board of Health and Welfare, Stockholm.
    Is there an increased risk for drug treated attention deficit/hyperactivity disorder in children born after in vitro fertilization?2011In: EUROPEAN JOURNAL OF PAEDIATRIC NEUROLOGY, ISSN 1090-3798, Vol. 15, no 3, p. 247-253Article in journal (Refereed)
    Abstract [en]

    Background: There is mounting evidence that children born after in vitro fertilization (IVF) run an increased risk of neurological complications and notably cerebral palsy. Whether developmental disturbances occur more often than expected is debated. Aim: To investigate the risk for ADHD in children conceived after IVF. Methods: Children conceived after IVF and born between 1982 and 2005 were identified from all IVF clinics in Sweden. Children who developed attention deficit/hyperactivity disorder (ADHD) were identified with the use of a register over all prescribed drugs in Sweden, using prescriptions for methylphenidate or atomixetine as indicators of ADHD. Maternal and neonatal characteristics were obtained by linkage with the Medical Birth Register and relevant confounders were adjusted for using Mantel-Haenszel procedures. We studied 28158 children born after IVF and compared them with 2417886 children in the population. Results: After adjustment for year of birth, maternal age, parity, smoking, BMI, and maternal education and after exclusion of women who did not cohabit, a weak but statistically significant association was found with an odds ratio = 1.18, 95% confidence interval 1.03-1.36. The effect was stronger in girls (OR = 1.40) than boys (OR = 1.11) but this difference could be random. After adjustment for length of involuntary childlessness, the OR decreased slightly and lost statistical significance. Conclusions: The study suggests a weak association between IVF and drug treated ADHD.

  • 45.
    Kallen, B
    et al.
    Lund University.
    Finnström, Orvar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Lindam, A
    Board of Health and Welfare, Stockholm, Sweden .
    Nilsson, E
    Board of Health and Welfare, Stockholm, Sweden .
    Nygren, K-G
    IVF and Fertil Clin, Stockholm, Sweden .
    Otterblad Olausson, P
    Board of Health and Welfare, Stockholm, Sweden .
    Malignancies among women who gave birth after in vitro fertilization2011In: HUMAN REPRODUCTION, ISSN 0268-1161, Vol. 26, no 1, p. 253-258Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Relatively few studies published to date have investigated IVF and cancer risk. In this study we compared the occurrence of cancer in women who gave birth after IVF with all other women who gave birth in the study period. METHODS: All women who were treated with IVF and gave birth during the years 1982-2006 in Sweden were identified from all IVF clinics, and the occurrence of cancer in these women was identified by linkage with the nationwide Swedish cancer register. Comparison was made with Mantel-Haenszel odds ratios (ORs), adjusting for year of delivery and maternal age, parity and smoking. Cancer before IVF was only studied in first parity women. Specific cancer forms were also studied. RESULTS: Among 24 058 women who had been treated with IVF, 1279 appeared in the cancer register. The total number of women studied in the population was 1 394 061, and 95 775 of these were registered in the cancer register. The risk for cancer before IVF was increased [OR 1.37, 95% confidence interval (CI) 1.27-1.48] and was especially high for ovarian cancer (3.93). The risk for cancer after IVF was significantly lower (OR 0.74, 95% CI 0.67-0.82), mainly due to a lower than expected risk for breast and cervical cancer. The risk for ovarian cancer was increased but lower than the risk before IVF (2.13). CONCLUSIONS: Cancer or cancer treatment may increase the risk for infertility leading to IVF. After IVF, in most cases with treatment with fertility hormones, a significantly low cancer risk was found. Ovarian cancer showed an increased risk, although lower than before IVF. One possible reason is ovarian pathology causing both infertility and an increased cancer risk.

  • 46.
    Kallen, B
    et al.
    Lund University.
    Finnström, Orvar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Lindam, A
    National Board for Health and Welfare, Stockholm.
    Nilsson, E
    National Board for Health and Welfare, Stockholm.
    Nygren, K-G
    IVF and Fertil Clin, Stockholm.
    Otterblad Olausson, P
    National Board for Health and Welfare, Stockholm.
    Selected neonatal outcomes in dizygotic twins after IVF versus non-IVF pregnancies2010In: BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, ISSN 1470-0328, Vol. 117, no 6, p. 676-682Article in journal (Refereed)
    Abstract [en]

    Objective To compare neonatal outcome among twins conceived after in vitro fertilisation (IVF) with that of spontaneously conceived twins. Design Comparison of different-sex (dizygotic) twins born after IVF with non-IVF dizygotic twins. Setting National health registers in Sweden. Population All births in Sweden during the period 1982-2007. Methods We studied gestational duration, lowest birthweight and birthweight difference in the twin pair, presence of one or two twins with a respiratory complication, and with jaundice in one or both twins. Risk estimates were calculated as odds ratios with adjustments for year of birth, maternal age, parity and smoking in pregnancy. Main outcome measures Gestational duration, birth weight, respiratory complications, jaundice. Results We studied 1545 pairs of dizygotic twins born after IVF, and 8675 pairs of dizygotic twins where IVF was not known to have occurred. The risk for preterm delivery before 32 weeks of gestation was significantly increased among dizygotic twin pairs born after IVF compared with non-IVF dizygotic twin pairs. No significant difference in low birthweight or birthweight difference within twin pairs was seen. There was an increased occurrence of twin pairs with respiratory problems or jaundice, but only the latter diagnosis occurred in a statistically significant excess. Conclusions The study confirms recent findings that IVF is associated with an increased risk for some neonatal complications, not only among singletons but also among twins.

  • 47.
    Kallen, B
    et al.
    Lund University.
    Finnström, Orvar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Lindam, A
    National Board for Health and Welfare, Sweden .
    Nilsson, E
    National Board for Health and Welfare, Sweden .
    Nygren, K-G
    IVF and Fertility Clinic, Sweden .
    Otterblad Olausson, P
    National Board for Health and Welfare, Sweden .
    Trends in delivery and neonatal outcome after in vitro fertilization in Sweden: data for 25 years2010In: HUMAN REPRODUCTION, ISSN 0268-1161, Vol. 25, no 4, p. 1026-1034Article in journal (Refereed)
    Abstract [en]

    Marked changes have occurred in in vitro fertilization (IVF) methodology during the past 25 years but also in characteristics of couples undergoing treatment. This study was based on 27 386 women undergoing IVF treatment from 1982 to 2006 and giving birth to 31 850 infants. Outcomes of deliveries were studied using Swedish health registers. Comparisons were made with all deliveries in the population (n = 2 603 601). Adjusted odds ratios were calculated when important changes in background rates had occurred. There was a substantial increase in the use of intracytoplasmatic sperm injection (ICSI) and the transfer of cryopreserved embryos. Among all ICSI cases, the proportion using epididymal or testicular sperm varied between 5 and 10%. Maternal characteristics changed during the observation period but the median age remained relatively constant in spite of the increasing maternal age in the population. There was a decline in the rate of some maternal pregnancy diagnoses (notably pre-eclampsia, premature rupture of membranes) and some neonatal diagnoses (notably preterm births, low birthweight, cerebral hemorrhage, respiratory diagnoses, use of continuous positive airway pressure and mechanical ventilation, sepsis/pneumonia). Up till 1992, the twinning rate increased to a maximum of about 30% and then declined to 5% towards the end of the period whereas higher order multiples nearly disappeared. The total rate of infants with congenital malformations changed only little. The decrease in unwanted outcomes can, to a large extent, be explained by the reduced rate of multiple births but was seen also among singletons. Other explanations can be sought in changes in the characteristics of patients undergoing IVF.

  • 48.
    Kallen, Bengt
    et al.
    Lund University.
    Finnström, Orvar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Lindam, Anna
    National Board for Health and Welfare, Stockholm.
    Nilsson, Emma
    National Board for Health and Welfare, Stockholm.
    Nygren, Karl-Gosta
    IVF and Fertil Clinic, Stockholm.
    Olausson Otterblad, Petra
    National Board for Health and Welfare, Stockholm.
    Congenital Malformations in Infants Born after In Vitro Fertilization in Sweden2010In: BIRTH DEFECTS RESEARCH PART A-CLINICAL AND MOLECULAR TERATOLOGY, ISSN 1542-0752, Vol. 88, no 3, p. 137-143Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The risk for congenital malformations is increased in infants born after in vitro fertilization (IVF). Some specific malformations appear to be more affected than others. METHODS: The presence of congenital malformations in 15,570 infants born after IVF with an embryo transfer between April 1, 2001, and the end of 2006 were compared with all infants born in Sweden during 2001 to 2007 (n = 689,157). Risk estimates were made after adjusting for year of birth, maternal age, parity, smoking, and body mass index. The risks of specific malformations were compared with data from a previous study (1982 to March 31, 2001) of 16,280 infants born after IVF. Different IVF methods were compared to respect to malformation risk. RESULTS: Increased risks of a similar magnitude were found for most cardiovascular malformations and limb reduction defects for both study periods. For neural tube defects, cardiac septal defects, and esophageal atresia, there was still an increased risk, but it was lower during the second than during the first period. For small bowel atresia, anal atresia, and hypospadias, the risk increase observed during the first study period had disappeared during the second period. An increased risk was seen for some syndromes that have been associated with imprinting errors. No difference in malformation risk according to IVF method was apparent. CONCLUSIONS: A slightly increased risk for congenital malformations after IVF persists. A decreasing risk is seen for some specific malformations, either true or the result of multiple testing.

  • 49.
    Kallen, Bengt
    et al.
    Lund University.
    Finnström, Orvar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Lindam, Anna
    National Board for Health and Welfare, Stockholm, Sweden .
    Nilsson, Emma
    National Board for Health and Welfare, Stockholm, Sweden .
    Nygren, Karl-Gosta
    Sophiahemmet.
    Otterblad Olausson, Petra
    National Board for Health and Welfare, Stockholm, Sweden .
    Blastocyst versus cleavage stage transfer in in vitro fertilization: differences in neonatal outcome?2010In: FERTILITY AND STERILITY, ISSN 0015-0282, Vol. 94, no 5, p. 1680-1683Article in journal (Refereed)
    Abstract [en]

    Objective: To compare neonatal outcome of blastocyst and cleavage stage embryo transfers after IVF. Design: Register study. Setting: Births recorded in the Swedish Medical Birth Register after IVF performed, 2002-2006. Patient(s): Treatments reported from all Swedish IVF clinics. Intervention(s): None. Main Outcome Measure(s): Some neonatal characteristics were compared in 1,311 infants born after blastocyst-stage transfer and 12,562 infants born after cleavage-stage transfer. Comparisons were also made with all births, 2002-2007 (n = 598,687). Result(s): After adjusting for year of birth, maternal age, parity, smoking habits, and body mass index, the risk of preterm birth among singletons was significantly greater after blastocyst-stage transfer than after cleavage-stage transfer. The risk of congenital malformations was also significantly higher. When the analysis was restricted to clinics where blastocyst transfers were made, the risk estimates increased for preterm birth, low birth weight, low APGAR score, and respiratory diagnoses, but did not change for congenital malformations. Conclusion(s): The results indicate a small increase in risk associated with blastocyst transfer, perhaps owing to the longer period of in vitro culture. There is a possibility that this effect is due, at least in part, to a selection of women for blastocyst transfers. Further studies are needed either to verify or to refute the found associations.

  • 50.
    Kallen, Bengt
    et al.
    Lund University.
    Finnström, Orvar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Lindam, Anna
    National Board of Health and Welfare, Stockholm, Sweden .
    Nilsson, Emma
    National Board of Health and Welfare, Stockholm, Sweden .
    Nygren, Karl-Gosta
    IVF and Fertil Clin, Stockholm, Sweden .
    Otterblad Olausson, Petra
    National Board of Health and Welfare, Stockholm, Sweden .
    Cancer Risk in Children and Young Adults Conceived by In Vitro Fertilization2010In: PEDIATRICS, ISSN 0031-4005, Vol. 126, no 2, p. E270-E276Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Studies conducted so far have found no statistically significant increased risk for cancer among children who are born after in vitro fertilization (IVF). METHODS: We followed 26 692 children who were born after IVF during the years 1982-2005 by using the Swedish Cancer Register and compared the number of children who had cancer and were born after IVF with children who were not conceived by IVF. Adjustment was made for year of birth. RESULTS: Maternal age, parity, smoking, subfertility, previous miscarriages, BMI, and multiple births did not significantly affect cancer risk in offspring. High birth weight, premature delivery, and the presence of respiratory diagnoses and low Apgar score were risk factors for cancer. We identified 53 cases of cancer in children who were born after IVF against 38 expected cases: 18 of them with hematologic cancer (15 of them acute lymphoblastic leukemia), 17 with eye or central nervous system tumors, and 12 with other solid cancers. There were 6 cases of Langerhans histiocytosis against 1.0 expected. The total cancer risk estimate was 1.42 (95% confidence interval: 1.09-1.87). CONCLUSIONS: We found a moderately increased risk for cancer in children who were conceived by IVF. Putative intermediary factors could be preterm birth and neonatal asphyxia.

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