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  • 1.
    Austeng, Dordi
    et al.
    Uppsala University.
    Blennow, Mats
    Karolinska University Hospital .
    Ewald, Uwe
    Uppsala University.
    Fellman, Vineta
    Lund University.
    Fritz, Thomas
    Sahlgrens University Hospital.
    Hellstrom-Westas, Lena
    Uppsala University.
    Hellstrom, Ann
    University Gothenburg.
    Holmgren, Per Åke
    Umea University Hospital.
    Holmstrom, Gerd
    Uppsala University.
    Jakobsson, Peter
    Linköping University, Department of Clinical and Experimental Medicine, Ophthalmology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of Ophthalmology UHL/MH.
    Jeppsson, Annika
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Johansson, Kent
    Umeå University.
    Kallen, Karin
    Lund University.
    Lagercrantz, Hugo
    Astrid Lindgren Childrens Hospital.
    Laurini, Ricardo
    Bodo Central Hospital.
    Lindberg, Eva
    University of Örebro.
    Lundqvist, Anita
    Lund University.
    Marsal, Karel
    Lund University.
    Nilstun, Tore
    Lund University.
    Norden-Lindeberg, Solveig
    Uppsala University.
    Norman, Mikael
    Karolinska Institute.
    Olhager, Elisabeth
    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.
    Oestlund, Ingrid
    University of Örebro.
    Serenius, Fredrik
    Umeå University Hospital.
    Simic, Marija
    Karolinska University Hospital .
    Sjors, Gunnar
    Uppsala University.
    Stigson, Lennart
    Sahlgrens University Hospital.
    Stjernqvist, Karin
    Lund University.
    Stromberg, Bo
    Uppsala University.
    Tornqvist, Kristina
    Lund University.
    Wennergren, Margareta
    Sahlgrens University Hospital.
    Wallin, Agneta
    Karolinska University.
    Westgren, Magnus
    Karolinska University Hospital.
    Incidence of and risk factors for neonatal morbidity after active perinatal care: extremely preterm infants study in Sweden (EXPRESS)2010In: ACTA PAEDIATRICA, ISSN 0803-5253, Vol. 99, no 7, p. 978-992Article in journal (Refereed)
    Abstract [en]

    Aims: The aim of this study was to determine the incidence of neonatal morbidity in extremely preterm infants and to identify associated risk factors. Methods: Population based study of infants born before 27 gestational weeks and admitted for neonatal intensive care in Sweden during 2004-2007. Results: Of 638 admitted infants, 141 died. Among these, life support was withdrawn in 55 infants because of anticipation of poor long-term outcome. Of 497 surviving infants, 10% developed severe intraventricular haemorrhage (IVH), 5.7% cystic periventricular leucomalacia (cPVL), 41% septicaemia and 5.8% necrotizing enterocolitis (NEC); 61% had patent ductus arteriosus (PDA) and 34% developed retinopathy of prematurity (ROP) stage andgt;= 3. Eighty-five per cent needed mechanical ventilation and 25% developed severe bronchopulmonary dysplasia (BPD). Forty-seven per cent survived to one year of age without any severe IVH, cPVL, severe ROP, severe BPD or NEC. Tocolysis increased and prolonged mechanical ventilation decreased the chances of survival without these morbidities. Maternal smoking and higher gestational duration were associated with lower risk of severe ROP, whereas PDA and poor growth increased this risk. Conclusion: Half of the infants surviving extremely preterm birth suffered from severe neonatal morbidities. Studies on how to reduce these morbidities and on the long-term health of survivors are warranted.

  • 2.
    Blennow, M
    et al.
    Karolinska Institute.
    Ewald, U
    Uppsala University.
    Fritz, T
    Sahlgrens University Hospital.
    Fellman, V
    Lund University.
    Hellstrorm-Westas, L
    Uppsala University.
    Holmgren, P A
    Norrland University.
    Holmstrom, G
    Uppsala University.
    Jeppsson, Annika
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Kallen, K
    Lund University.
    Lagercrantz, H
    Karolinska Institute.
    Laurini, R
    Bodo Central Hospital.
    Lindberg, E
    University of Örebro.
    Lundqvist, A
    Lund University.
    Marsal, K
    Lund University.
    Nilstun, T
    Lund University.
    Norden-Lindeberg, S
    Uppsala University.
    Norman, M
    Karolinska Institute.
    Olhager, Elisabeth
    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.
    Otterblad Olausson, P
    Natl Board Hlth & Welf, Epidemiol Centre, Stockholm.
    Ostlund, I
    University of Örebro.
    Serenius, F
    Norrland University.
    Simic, M
    Karolinska University Hospital.
    Sjors, G
    Uppsala University.
    Stigsson, L
    Sahlgrens University Hospital.
    Stjernqvist, K
    Lund University.
    Stromberg, B
    Uppsala University.
    Wennergren, M
    Sahlgrens University Hospital.
    Westgren, M
    Karolinska University Hospital.
    HIGH ONE-YEAR SURVIVAL AFTER ACTIVE PERINATAL CARE: EXTREMELY PRETERM INFANTS IN SWEDEN (EXPRESS)2009In: in ACTA PAEDIATRICA, vol 98, 2009, Vol. 98, p. 8-8Conference paper (Refereed)
    Abstract [en]

    n/a

  • 3.
    Blennow, Mats
    et al.
    Karolinska University Hospital.
    Ewald, Uwe
    Uppsala University.
    Fritz, Tomas
    Sahlgrens University Hospital.
    Ake Holmgren, Per
    Umeå University.
    Jeppsson, Annika
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Lindberg, Eva
    University of Örebro.
    Lundqvist, Anita
    Lund University.
    Norden Lindeberg, Solveig
    Uppsala University.
    Olhager, Elisabeth
    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.
    Ostlund, Ingrid
    Örebro University Hospital.
    Simic, Marija
    Karolinska University Hospital.
    Sjoers, Gunnar
    Uppsala University.
    Stigson, Lennart
    Sahlgrens University Hospital.
    Fellman, Vineta
    Lund University.
    Hellstrom-Westas, Lena
    Uppsala University.
    Norman, Mikael
    Karolinska University Hospital.
    Westgren, Magnus
    Karolinska University Hospital.
    Holmstrom, Gerd
    Uppsala University.
    Laurini, Ricardo
    Nordland Hospital.
    Stjernqvist, Karin
    Lund University.
    Kallen, Karin
    Lund University.
    Lagercrantz, Hugo
    Karolinska Institute.
    Marsal, Karel
    Lund University.
    Serenius, Fredrik
    Umeå University.
    Wennergren, Margareta
    Sahlgrens University Hospital.
    Nilstun, Tore
    Lund University.
    Otterblad Olausson, Petra
    National Board of Health & Welfare.
    Stromberg, Bo
    Uppsala University.
    One-Year Survival of Extremely Preterm Infants After Active Perinatal Care in Sweden2009In: JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, ISSN 0098-7484, Vol. 301, no 21, p. 2225-2233Article in journal (Refereed)
    Abstract [en]

    Context Up-to-date information on infant survival after extremely preterm birth is needed for assessing perinatal care services, clinical guidelines, and parental counseling. Objective To determine the 1-year survival in all infants born before 27 gestational weeks in Sweden during 2004-2007. Design, Setting, and Patients Population-based prospective observational study of extremely preterm infants (707 live-born and 304 stillbirths) born to 887 mothers in 904 deliveries (102 multiple births) in all obstetric and neonatal units in Sweden from April 1, 2004, to March 31, 2007. Main Outcome Measures Infant survival to 365 days and survival without major neonatal morbidity (intraventricular hemorrhage grade andgt; 2, retinopathy of prematurity stage andgt; 2, periventricular leukomalacia, necrotizing enterocolitis, severe bronchopulmonary dysplasia). Associations between perinatal interventions and survival. Results The incidence of extreme prematurity was 3.3 per 1000 infants. Overall perinatal mortality was 45% (from 93% at 22 weeks to 24% at 26 weeks), with 30% stillbirths, including 6.5% intrapartum deaths. Of live-born infants, 91% were admitted to neonatal intensive care and 70% survived to 1 year of age (95% confidence interval [CI], 67%-73%). The Kaplan-Meier survival estimates for 22, 23, 24, 25, and 26 weeks were 9.8% (95% CI, 4%-23%), 53% ( 95% CI, 44%-63%), 67% (95% CI, 59%-75%), 82% (95% CI, 76%-87%), and 85% ( 95% CI, 81%-90%), respectively. Lower risk of infant death was associated with tocolytic treatment (adjusted for gestational age odds ratio [ OR], 0.43; 95% CI, 0.36-0.52), antenatal corticosteroids (OR, 0.44; 95% CI, 0.24-0.81), surfactant treatment within 2 hours after birth ( OR, 0.47; 95% CI, 0.32-0.71), and birth at a level III hospital (OR, 0.49; 95% CI, 0.32-0.75). Among 1-year survivors, 45% had no major neonatal morbidity. Conclusion During 2004 to 2007, 1-year survival of infants born alive at 22 to 26 weeks of gestation in Sweden was 70% and ranged from 9.8% at 22 weeks to 85% at 26 weeks.

  • 4.
    Forsum, Elisabet
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Nutrition. Linköping University, Faculty of Health Sciences.
    Eriksson, Britt
    Linköping University, Department of Clinical and Experimental Medicine, Nutrition. Linköping University, Faculty of Health Sciences.
    Löf, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Nutrition. Linköping University, Faculty of Health Sciences.
    Olausson, Hanna
    Gothenburg University, Gothenburg, Sweden.
    Olhager, Elisabeth
    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.
    Maternal body composition in relation to infant growth and fatness2008In: International Journal of Body Composition Research, ISSN 1479-456X, Vol. 6, p. 131-140Article in journal (Refereed)
  • 5.
    Forsum, Elisabet
    et al.
    Linköping University, Department of Biomedicine and Surgery, Nutrition. Linköping University, Faculty of Health Sciences.
    Löf, Marie
    Linköping University, Department of Biomedicine and Surgery, Nutrition. Linköping University, Faculty of Health Sciences.
    Olausson, Hanna
    Linköping University, Department of Biomedicine and Surgery, Nutrition. Linköping University, Faculty of Health Sciences.
    Olhager, Elisabeth
    Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Maternal body composition in relation to infant birth weight and subcutaneous adipose tissue2006In: British Journal of Nutrition, ISSN 0007-1145, E-ISSN 1475-2662, Vol. 96, no 2, p. 408-414Article in journal (Refereed)
    Abstract [en]

    Infant birth weight has increased recently, representing an obstetric and potentially a public health problem since high birth weight involves a risk of obesity later in life. Maternal nutritional status is important for fetal growth and therefore relationships between maternal body weight and composition v. birth weight and infant subcutaneous adipose tissue were investigated in twenty-three healthy women and their newborn infants using multiple and simple linear regression analysis. Furthermore, using previously published data for nineteen infants, it was demonstrated that an anthropometric method could provide useful estimates of the amount of subcutaneous adipose tissue. Birth weight was correlated with the maternal content of total body fat (TBF) both before pregnancy and in gestational week 32 and, together with gestational age at birth, TBF (%) before pregnancy explained 45% of the variation in birth weight. This figure was not increased when gestational gains in weight or TBF were added to the model. Furthermore, in infants, birth weight correlated with the amount of their subcutaneous adipose tissue. Together maternal TBF (%) and amount of subcutaneous adipose tissue in infants explained 61–63% of the variation in birth weight while the amount of infant subcutaneous adipose tissue alone explained only 55%. The maternal TBF content is likely to be important for the recent increase in birth weight. This factor probably causes a general augmentation in fetal growth rather than a specific stimulation of adipose tissue growth.

  • 6.
    Mernelius, Sara
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Medical Microbiology. Linköping University, Faculty of Health Sciences. Ryhov County Hospital, Sweden .
    Lofgren, Sture
    Ryhov County Hospital, Sweden .
    Lindgren, Per-Eric
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences.
    Blomberg, Marie
    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.
    Olhager, Elisabeth
    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.
    Gunnervik, Christina
    Varnamo Hospital, Sweden .
    Lenrick, Raymond
    Ryhov County Hospital, Sweden .
    Tiefenthal Thrane, Malena
    Hoglands Hospital Eksjo, Sweden .
    Isaksson, Barbro
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Microbiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Clinical Microbiology.
    Matussek, Andreas
    Ryhov County Hospital, Sweden .
    The effect of improved compliance with hygiene guidelines on transmission of Staphylococcus aureus to newborn infants: The Swedish Hygiene Intervention and Transmission of S aureus study2013In: American Journal of Infection Control, ISSN 0196-6553, E-ISSN 1527-3296, Vol. 41, no 7, p. 585-590Article in journal (Refereed)
    Abstract [en]

    Background: Newborn infants are often colonized with Staphylococcus aureus originating from health care workers (HCWs). We therefore use colonization with S aureus of newborn infants to determine the effect of an improved compliance with hygiene guidelines on bacterial transmission. Methods: Compliance with hygiene guidelines was monitored prior to (baseline) and after (follow-up) a multimodal hygiene intervention in 4 departments of obstetrics and gynecology. spa typing was used to elucidate transmission routes of S aureus collected from newborn infants, mothers, fathers, staff members, and environment. Results: The compliance with hygiene guidelines increased significantly from baseline to follow-up. The transmission of S aureus from HCWs to infants was however not affected. Fathers had the highest colonization rates. Persistent carriage was indicated in 18% of the HCWs. The most commonly isolated spa type was t084, which was not detected in a previous study from the same geographic area. Conclusion: It is possible to substantially improve the compliance with hygiene guidelines, by using multimodal hygiene intervention. The improved compliance did not decrease the transmission of S aureus from sources outside the own family to newborn infants. Furthermore, we show the establishment of a new spa type (t084), which now is very common in our region. Copyright (C) 2013 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  • 7.
    Mörelius, Evalotte
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Angelhoff, Charlotte
    Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Eriksson, Jennie
    Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Olhager, Elisabeth
    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.
    Time of initiation of skin-to-skin contact in extremely preterm infants in Sweden2012In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 101, no 1, p. 14-18Article in journal (Refereed)
    Abstract [en]

    Aim:  To describe the time of first skin-to-skin contact in extremely preterm infants in a national perspective and to investigate possible factors affecting the time of first skin-to-skin contact. Methods:  A population-based prospective descriptive study of extremely preterm infants (n = 520) in seven regional hospitals in Sweden. Results:  Extremely preterm infants in Sweden experience first skin-to-skin contact with the parent at a median of six postnatal days (range 0-44). Low gestational age, a high score on the clinical risk index for babies, and the number of days on a ventilator tended to delay first skin-to-skin contact. A statistically significant difference was also found between regional hospitals. Conclusion:  There is a difference in the time of first skin-to-skin contact based on the infant's medical condition and the tradition in the neonatal intensive care unit at the regional hospital where the infant is born.

  • 8.
    Olhager, Elisabeth
    Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Studies on adipose tissue, body fat, body water and energy expenditure during the first four months of infancy using magnetic resonance imaging, skinfold measurements and the doubly labelled water method2003Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    During recent years much interest has been focused on the relationship between early nutrition and the future health of humans. Poor growth during early life has been associated with impaired glucose tolerance and coronary heart disease later in life, while rapid weight gain in infancy has been associated with an increased risk of obesity during childhood. Access to appropriate methods that can provide information about adipose tissue (AT), total body fat (TBF), and total energy expenditure (TEE) during infancy is important in order to conduct successful research in this area. The magnetic resonance imaging (MRI) technique based on the combination of a magnetic field and radiowaves can provide images of the body by which total adipose tissue volume (ATV) as well as its distribution between subcutaneous and non-subcutaneous ATV can be assessed. The doubly labelled water (DLW) method can assess total body water (TBW) and TEE. Estimates ofTBW can be used to calculate TBF. Measurements ofskinfold thickness (SFT) represent a traditional technique for assessing body fatness in humans, but even though it is simple in concept and easily applied, it has so far not been evaluated in infants under four months of age. The combination of the MRI and DLW methods represents a new possibility-to evaluate estimates of TBF based on measurements of SFT and to study various aspects of body composition during infancy. A method based on MRI which can assess total, subcutaneous and non-subcutaneous ATV was therefore developed, evaluated and applied in studies of infants.

    Total, subcutaneous and non-subcutaneous ATV was assessed in 46 fullterm infants between four and 131 days old (25 boys and 21 girls), and in eight moderately preterm infants (six boys and two girls) with a postnatal age of 44-75 days. The infants were also studied by means of the DLW method to assess TBW and TEE, while TBF and the degree of hydration in fat free weight (FFW) and AT fat content were calculated. TBF based on SFT measurements was also assessed in 43 of these infants.

    The MRI method can assess total ATV with good precision and with relative validity. During the first four months of life a considerable gain in ATV was found in both boys and girls. About 90% of the adipose tissue was located subcutaneously. Based on estimates of ATV and TBW, changes in body fat, FFW and in the degree of hydration in FFW were found to be similar to classical reference data for early infancy. During the first four months of life a significant increase in TEE (kJ/kg/24h) with age was found, probably an effect of a gradual increase in physical activity. In preterm infants at term postconceptional age and in fullterm newboms, the ATV (ml/kg body weight), TBW (%), the fat content in AT as well as the proportion of total ATV present as subcutaneous ATV were similar, while TEE (kJ/kg/24h) was 20% higher in the preterm infants than in the fullterm newboms. This difference could be explained by more rapid growth and also by higher physical activity in the preterm infants. Estimates of TBF based on SFT produces biased estimates of body fat in fullterm infants under four months of age. This bias can to a large extent be explained by a considerable variation in the fat content of AT. However, estimates of TBF obtained by means of the SFT method can be used to estimate body fatness in groups of infants with similar AT fat content.

    In conclusion, estimates of ATV obtained by means of MRI contributed to new knowledge regarding various aspects of body composition during infancy.

    List of papers
    1. Description and evaluation of a method based on magnetic resonance imaging to estimate adipose tissue volume and total body fat in infants
    Open this publication in new window or tab >>Description and evaluation of a method based on magnetic resonance imaging to estimate adipose tissue volume and total body fat in infants
    1998 (English)In: Pediatric Research, ISSN 0031-3998, E-ISSN 1530-0447, Vol. 44, no 4, p. 572-577Article in journal (Refereed) Published
    Abstract [en]

    Information about body fatness is important during nutritional assessment of infants, but current methods to estimate body composition in vivo are often not applicable in infants. Therefore, a new method based on magnetic resonance imaging (MRI) was developed. This method, which can assess the volume and distribution of adipose tissue (AT) as well as total body fat, was applied in 11 healthy full-term infants. Their total body water was also estimated using the isotope dilution technique. Adipose tissue volume (ATV) was calculated from AT area in 16 images of the body taken by an MRI scanner (1.5 tesla). AT area was assessed using a computer program in which AT criteria was defined by the observer. ATV of the infants was therefore evaluated once by three observers and twice by a fourth observer. The different observers estimated total, s.c., and non-s.c. ATV with a precision that varied between 1.9 and 7.2%, 2.0 and 4.8%, and 4.2 and 40.7%, respectively. Variations during AT area calculations accounted for a large part of the imprecision when assessing total and s.c. ATV. The linear relationship between percent total body water and total ATV in relation to body weight was significant in all evaluations. Although average total ATV varied when estimated by the four observers, there was, within each evaluation, a fairly constant order between infants with respect to their ATV. It is concluded that the MRI procedure represents a useful possibility to assess body fatness in infants.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-84497 (URN)10.1203/00006450-199810000-00017 (DOI)
    Available from: 2012-10-10 Created: 2012-10-10 Last updated: 2017-12-07Bibliographically approved
    2. Studies on human body composition during the first 4 months of life using magnetic resonance imaging and isotope dilution
    Open this publication in new window or tab >>Studies on human body composition during the first 4 months of life using magnetic resonance imaging and isotope dilution
    2003 (English)In: Pediatric Research, ISSN 0031-3998, E-ISSN 1530-0447, Vol. 54, no 6, p. 906-912Article in journal (Refereed) Published
    Abstract [en]

    Assessing body composition during infancy requires data for the so-called reference infant. Currently available data for this purpose need to be updated and extended using methods based on principles different from those used previously to define the reference infant. Thus, magnetic resonance imaging was applied to full-term healthy boys (n = 25) and girls (n = 21), 4-131 d old, to estimate adipose tissue volume (ATV) and the amounts of s.c. and non-s.c. adipose tissue (AT). Total body water was estimated using isotope dilution. Total body fat (TBF), fat free weight (FFW) and the degree of hydration in FFW were calculated. Increases in weight, TBF, and FFW with age agreed with current reference data, although when compared with the reference, a slightly more rapid increase in % TBF was observed for boys. The degree of hydration in FFW was 78.9 ± 4.5% (n = 45). Both sexes showed significant increases with age in s.c. ATV (14.7 and 13.0 mL/d for boys and girls, respectively) and in non-s.c. ATV (1.58 and 1.26 mL/d, respectively). Subcutaneous ATV was 90.5 ± 1.8% (boys) and 91.1 ± 1,9% (girls) of total ATV. In conclusion, a pronounced increase with age in the amount of AT was demonstrated involving a considerable gain in s.c. fat during early life. Except for % TBF in boys, changes in body composition with age agreed with current reference data.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-46416 (URN)10.1203/01.PDR.0000088064.63106.5E (DOI)
    Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2017-12-13Bibliographically approved
    3. Total energy expenditure, body composition and weight gain in moderately preterm and full-term infants at term postconceptional age
    Open this publication in new window or tab >>Total energy expenditure, body composition and weight gain in moderately preterm and full-term infants at term postconceptional age
    2003 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 92, no 11, p. 1327-1334Article in journal (Refereed) Published
    Abstract [en]

    Aim: To assess total energy expenditure (TEE) and body composition, i.e. total body water (TBW) and adipose tissue volume (ATV), at term age in 8 healthy preterm infants, born between gestational weeks 30 and 33, and in 9 healthy full-term newborns.

    Methods: Total and subcutaneous ATVs were assessed using magnetic resonance imaging, while TEE and TBW were estimated using doubly labelled water.

    Results: Total ATV was 272 ±21 and 261 ± 56 ml/kg body weight, while subcutaneous ATV was 88.9 ± 1.6 and 89.7 ± 2.0% of total ATV for preterm and full-term infants, respectively. The corresponding figures for TBW (as percentage of body weight) were 67.4 ± 2.5 and 68.1 ± 4.1, respectively. A significant correlation between ATV/kg body weight and body weight was found for full-term (p < 0.0001) but not for preterm infants. TEE for preterm infants was 315 ± 20 kJ/kg body weight/24 h, which was significantly higher (p < 0.05) than TEE for full-term infants (254 ± 45 kJ/kg body weight/24 h). At the time of investigation preterm infants weighed significantly (p < 0.05) less (540 g) than full-term infants. After the time of investigation, weight gains of preterm and full-term infants were 38 ± 12 and 24 ± 14 g/24 h, respectively.

    Conclusion: When compared to full-term newborns, predominantly breastfed healthy preterm infants at term postconceptional age were significantly smaller, had a similar average proportion of body fat and showed catch-up growth. Their higher TEE/kg body weight can be explained by a higher growth rate and possibly also by higher physical activity.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-25018 (URN)10.1080/08035250310005396 (DOI)9439 (Local ID)9439 (Archive number)9439 (OAI)
    Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13Bibliographically approved
    4. Assessment of total body fat using the skinfold technique and body water dilution in fullterm and preterm infants under four months of age
    Open this publication in new window or tab >>Assessment of total body fat using the skinfold technique and body water dilution in fullterm and preterm infants under four months of age
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Aim: To evaluate a method based on measurements of skinfold thickness (SFT) in infants under four months of age.

    Methods: Adipose tissue volume was assessed by means of magnetic resonance imaging and total body fat (TBF) by means of a method based on skinfold measurements previously developed for children under two years of age (TBF-SFT). Estimates of TBF obtained by means of body water dilution (TBF-BWD) represented reference values. The subjects were 45 fullterm infants, 4-131 days old, and eight premature infants born in gestational weeks 30-33 and studied at a postnatal age of 63 ± 10 days.

    Results: In fullterm infants TBF-SFT and TBF-BWD were 23.3 ± 3.4 and 21.8 ± 7.0 %, respectively, and the difference between the two methods was non-significant. However TBF-SFT minus TBF-BWD (%, y) was significantly con-elated (p<0.0001) with the average TBF-SFT and TBF-BWD (%, x), showing that the skinfold method overstimated TBF in lean infants while it underestimated TBF in infants with a high body fat content. In fullterm infants adipose tissue (AT) contained 0.68 ± 0.14 g fat/ml. Significant correlations were found between the AT fat content (g/ml, y) and TBF-BWD (%, x) (p<0.0001 ), as well as between the AT fat content (g/ml, x) and TBF-SFT minus TBF-BWD (%, y) (p<0.0001). In premature infants TBF-SFT (%), TBF-BWD (%) and the AT fat content were similar to the corresponding figures for nine fullterm newborns.

    Conclusion: In fullterm infants the skinfold method produced biased estimates of TBF, which to a large extent can be explained by a variation in the AT fat content. However, the method has the potential to provide meaningful results in groups of infants with similar AT fat content.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-84498 (URN)
    Available from: 2012-10-10 Created: 2012-10-10 Last updated: 2012-10-10Bibliographically approved
  • 9.
    Olhager, Elisabeth
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Flinke, Eva
    Linköping University, Department of Medicine and Care, Medical Radiology. Linköping University, Faculty of Health Sciences.
    Hannerstad, Ulf
    Linköping University, Department of Biomedicine and Surgery, Division of clinical chemistry. Linköping University, Faculty of Health Sciences.
    Forsum, Elisabet
    Linköping University, Department of Clinical and Experimental Medicine, Nutrition. Linköping University, Faculty of Health Sciences.
    Studies on human body composition during the first 4 months of life using magnetic resonance imaging and isotope dilution2003In: Pediatric Research, ISSN 0031-3998, E-ISSN 1530-0447, Vol. 54, no 6, p. 906-912Article in journal (Refereed)
    Abstract [en]

    Assessing body composition during infancy requires data for the so-called reference infant. Currently available data for this purpose need to be updated and extended using methods based on principles different from those used previously to define the reference infant. Thus, magnetic resonance imaging was applied to full-term healthy boys (n = 25) and girls (n = 21), 4-131 d old, to estimate adipose tissue volume (ATV) and the amounts of s.c. and non-s.c. adipose tissue (AT). Total body water was estimated using isotope dilution. Total body fat (TBF), fat free weight (FFW) and the degree of hydration in FFW were calculated. Increases in weight, TBF, and FFW with age agreed with current reference data, although when compared with the reference, a slightly more rapid increase in % TBF was observed for boys. The degree of hydration in FFW was 78.9 ± 4.5% (n = 45). Both sexes showed significant increases with age in s.c. ATV (14.7 and 13.0 mL/d for boys and girls, respectively) and in non-s.c. ATV (1.58 and 1.26 mL/d, respectively). Subcutaneous ATV was 90.5 ± 1.8% (boys) and 91.1 ± 1,9% (girls) of total ATV. In conclusion, a pronounced increase with age in the amount of AT was demonstrated involving a considerable gain in s.c. fat during early life. Except for % TBF in boys, changes in body composition with age agreed with current reference data.

  • 10.
    Olhager, Elisabeth
    et al.
    Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Forsum, Elisabet
    Linköping University, Department of Biomedicine and Surgery, Nutrition. Linköping University, Faculty of Health Sciences.
    Assessment of total body fat using the skinfold technique and body water dilution in fullterm and preterm infants under four months of ageManuscript (preprint) (Other academic)
    Abstract [en]

    Aim: To evaluate a method based on measurements of skinfold thickness (SFT) in infants under four months of age.

    Methods: Adipose tissue volume was assessed by means of magnetic resonance imaging and total body fat (TBF) by means of a method based on skinfold measurements previously developed for children under two years of age (TBF-SFT). Estimates of TBF obtained by means of body water dilution (TBF-BWD) represented reference values. The subjects were 45 fullterm infants, 4-131 days old, and eight premature infants born in gestational weeks 30-33 and studied at a postnatal age of 63 ± 10 days.

    Results: In fullterm infants TBF-SFT and TBF-BWD were 23.3 ± 3.4 and 21.8 ± 7.0 %, respectively, and the difference between the two methods was non-significant. However TBF-SFT minus TBF-BWD (%, y) was significantly con-elated (p<0.0001) with the average TBF-SFT and TBF-BWD (%, x), showing that the skinfold method overstimated TBF in lean infants while it underestimated TBF in infants with a high body fat content. In fullterm infants adipose tissue (AT) contained 0.68 ± 0.14 g fat/ml. Significant correlations were found between the AT fat content (g/ml, y) and TBF-BWD (%, x) (p<0.0001 ), as well as between the AT fat content (g/ml, x) and TBF-SFT minus TBF-BWD (%, y) (p<0.0001). In premature infants TBF-SFT (%), TBF-BWD (%) and the AT fat content were similar to the corresponding figures for nine fullterm newborns.

    Conclusion: In fullterm infants the skinfold method produced biased estimates of TBF, which to a large extent can be explained by a variation in the AT fat content. However, the method has the potential to provide meaningful results in groups of infants with similar AT fat content.

  • 11.
    Olhager, Elisabeth
    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.
    Forsum, Elisabet
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery.
    Assessment of total body fat using the skinfold technique in full-term and preterm infants2006In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 95, no 1, p. 21-28Article in journal (Refereed)
    Abstract [en]

    Background: Assessment of body composition may be of interest when the nutritional status of infants is evaluated but is often difficult since simple and valid methods are lacking. With appropriate validation, measurements based on skinfold thickness (SFT) may be useful for this purpose. Aims: To evaluate the potential of a published method, based on measurements of SFT, to assess total body fat (TBF) of infants, and to calculate the fat content of adipose tissue (AT) in infants using previously published information regarding AT volume and total body water. Subjects and methods: Forty-five full-term infants and eight infants born in gestational weeks 31-33 were studied at a postnatal age of 4-131 and 44-75 d, respectively. The body water dilution method was used to obtain reference estimates of TBF (TBF-BWD). Results: In full-term infants, TBF assessed using the skinfold method (TBF-SFT) minus TBF-BWD was 1.5±10.8% (mean±2 SD). Furthermore, TBF-SFT minus TBF-BWD (%, y) was correlated (p <0.0001) with the average of TBF-SFT and TBF-BWD (%, x), showing that TBF-SFT was too high in lean infants and too low in infants with more TBF. In the full-term infants, AT contained 0.68±0.14 g fat/ml. In the premature infants, TBF-SFT (%), TBF-BWD (%) and the AT fat content were similar to the corresponding figures in nine full-term newborns. Conclusion: The results indicate that the SFT method produced inaccurate and biased estimates of TBF in infants. A considerable variation between infants regarding their AT fat content may be an important reason for these findings. © 2006 Taylor & Francis.

  • 12.
    Olhager, Elisabeth
    et al.
    Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Forsum, Elisabet
    Linköping University, Department of Biomedicine and Surgery, Nutrition. Linköping University, Faculty of Health Sciences.
    Total energy expenditure, body composition and weight gain in moderately preterm and full-term infants at term postconceptional age2003In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 92, no 11, p. 1327-1334Article in journal (Refereed)
    Abstract [en]

    Aim: To assess total energy expenditure (TEE) and body composition, i.e. total body water (TBW) and adipose tissue volume (ATV), at term age in 8 healthy preterm infants, born between gestational weeks 30 and 33, and in 9 healthy full-term newborns.

    Methods: Total and subcutaneous ATVs were assessed using magnetic resonance imaging, while TEE and TBW were estimated using doubly labelled water.

    Results: Total ATV was 272 ±21 and 261 ± 56 ml/kg body weight, while subcutaneous ATV was 88.9 ± 1.6 and 89.7 ± 2.0% of total ATV for preterm and full-term infants, respectively. The corresponding figures for TBW (as percentage of body weight) were 67.4 ± 2.5 and 68.1 ± 4.1, respectively. A significant correlation between ATV/kg body weight and body weight was found for full-term (p < 0.0001) but not for preterm infants. TEE for preterm infants was 315 ± 20 kJ/kg body weight/24 h, which was significantly higher (p < 0.05) than TEE for full-term infants (254 ± 45 kJ/kg body weight/24 h). At the time of investigation preterm infants weighed significantly (p < 0.05) less (540 g) than full-term infants. After the time of investigation, weight gains of preterm and full-term infants were 38 ± 12 and 24 ± 14 g/24 h, respectively.

    Conclusion: When compared to full-term newborns, predominantly breastfed healthy preterm infants at term postconceptional age were significantly smaller, had a similar average proportion of body fat and showed catch-up growth. Their higher TEE/kg body weight can be explained by a higher growth rate and possibly also by higher physical activity.

  • 13.
    Olhager, Elisabeth
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Nold-Petry, Claudia A.
    Monash University, Australia .
    Joshi, Mandar S.
    Monash University, Australia .
    Doery, James C. G.
    Monash Medical Centre, Australia Monash University, Australia .
    Samarasinghe, Thilini
    Monash University, Australia .
    Walker, Adrian M.
    Monash University, Australia .
    Wong, Flora Y.
    Monash University, Australia Monash Medical Centre, Australia Monash University, Australia .
    Preterm lambs given intravenous dopamine show increased dopamine in their cerebrospinal fluid2014In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 103, no 3, p. 337-342Article in journal (Refereed)
    Abstract [en]

    AimDopamine is used as an inotropic medication in preterm infants. The preterm human blood brain barrier (BBB) is permeable to intravascular dopamine, and the impact of exogenous dopamine on the preterm brain remains unknown. The preterm lamb model may be suitable for studying the cerebral impact of dopamine therapy whether its BBB permeability is similar to preterm human infants. We aimed to examine BBB permeability to exogenous dopamine in the preterm lamb, by measuring dopamine levels in the cerebrospinal fluid (CSF). MethodsNine preterm foetal lambs (125-130days, term=147days) were given either dopamine at 10g/kg/min (dopamine, n=4) or saline (control, n=5). CSF, and plasma samples were taken for dopamine assay. ResultsThe median (range) baseline CSF dopamine level for the combined control and dopamine groups (n=9) was 0.10(0.03-0.16)ng/mL, and baseline plasma dopamine was 0.30(0.13-0.84) ng/mL. The dopamine lambs showed increase in CSF dopamine to 3.91(1.87-11.35)ng/mL with plasma dopamine increased to 14.2 (9.1-57.9)ng/mL. No change was found in the control lambs. ConclusionIn the preterm lamb, the BBB permeability and pharmacokinetics to dopamine infusion are similar to findings in the preterm human infant, supporting applicability of the preterm lamb model for studying effects of dopamine infusion in the preterm human brain.

  • 14.
    Olhager, Elisabeth
    et al.
    Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Linköping University, Department of health and environment. Linköping University, Faculty of Health Sciences.
    Thuomas, Karl-Åke
    Linköping University, Department of Medicine and Care, Radiology. Linköping University, Faculty of Health Sciences.
    Wigström, Lars
    Linköping University, Department of Medicine and Care, Clinical Physiology. Linköping University, Faculty of Health Sciences.
    Forsum, Elisabet
    Linköping University, Department of Biomedicine and Surgery, Nutrition. Linköping University, Faculty of Health Sciences.
    Description and evaluation of a method based on magnetic resonance imaging to estimate adipose tissue volume and total body fat in infants1998In: Pediatric Research, ISSN 0031-3998, E-ISSN 1530-0447, Vol. 44, no 4, p. 572-577Article in journal (Refereed)
    Abstract [en]

    Information about body fatness is important during nutritional assessment of infants, but current methods to estimate body composition in vivo are often not applicable in infants. Therefore, a new method based on magnetic resonance imaging (MRI) was developed. This method, which can assess the volume and distribution of adipose tissue (AT) as well as total body fat, was applied in 11 healthy full-term infants. Their total body water was also estimated using the isotope dilution technique. Adipose tissue volume (ATV) was calculated from AT area in 16 images of the body taken by an MRI scanner (1.5 tesla). AT area was assessed using a computer program in which AT criteria was defined by the observer. ATV of the infants was therefore evaluated once by three observers and twice by a fourth observer. The different observers estimated total, s.c., and non-s.c. ATV with a precision that varied between 1.9 and 7.2%, 2.0 and 4.8%, and 4.2 and 40.7%, respectively. Variations during AT area calculations accounted for a large part of the imprecision when assessing total and s.c. ATV. The linear relationship between percent total body water and total ATV in relation to body weight was significant in all evaluations. Although average total ATV varied when estimated by the four observers, there was, within each evaluation, a fairly constant order between infants with respect to their ATV. It is concluded that the MRI procedure represents a useful possibility to assess body fatness in infants.

  • 15.
    Olhager, Elisabeth
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Törnqvist, Caroline
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Body composition in late preterm infants in the first 10 days of life and at full term2014In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 103, no 7, p. 737-743Article in journal (Refereed)
    Abstract [en]

    AIM:

    To investigate changes in body weight, fat-free mass, fat mass and percentage of body fat during early life and at full-term postconceptional age (PCA) in preterm infants born after 32 gestational weeks and before 37.

    METHODS:

    Twenty-nine late preterm infants underwent growth and body composition assessment by air displacement plethysmography (ADP) at the age of 4 days and at full-term PCA. In 25 of these infants, body composition was assessed three times between days four and nine of life. The preterm infants were compared with 29 full-term infants, matched for gestational age, sex and body weight.

    RESULTS:

    There was a significant increase in birth weight and fat-free mass between days four and nine of life. Preterm infants had significantly more body fat 382 ± 180 g vs 287 ± 160 g than full-term infants at full-term PCA. Preterm infants showed poor linear growth between birth and full-term PCA.

    CONCLUSION:

    Weight gain after the initial postnatal weight loss consists of gain in fat-free mass. At full-term PCA, preterm infants were stunted. When compared with full-term new born infants matched for body weight and gestational age, preterm infants had more body fat and a higher percentage of body fat.

  • 16.
    Samuelsson, Annika
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Clinical Microbiology. Östergötlands Läns Landsting, Center for Health and Developmental Care, Department of Infection Control.
    Isaksson, Barbro
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Clinical Microbiology. Östergötlands Läns Landsting, Center for Health and Developmental Care, Department of Infection Control.
    Hanberger, Håkan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Infectious Diseases.
    Olhager, Elisabeth
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Late onset neonatal sepsis, risk factors and interventions: an analysis of recurrent outbreaks of Serratia marcescens 2006-20112014In: Journal of Hospital Infection, ISSN 0195-6701, E-ISSN 1532-2939, Vol. 86, no 1, p. 57-63Article in journal (Refereed)
    Abstract [en]

    Background: during the period 2006 to 2011 we observed 11 patients with Serratia marcescens sepsis, a total of 47 patients were colonised due to spread of different clones. These recurrent clusters brought about interventions to reduce spread between patients.

    Aim: to evaluate the effect of stepwise introduced interventions to prevent S marcescens colonisation/sepsis and to analyse risk factors for late onset sepsis (LOS).

    Methods: to evaluate the interventions an open retrospective observational study was performed. A retrospective case-control study was performed to analyse risk factors for LOS.

    Findings: main findings of this study were the decrease in S marcescens sepsis and colonisation after the stepwise adoption of hygiene interventions, as well as identifying low gestational age, low birth weight, indwelling central venous or umbilical catheter and ventilator treatment as risk factors for LOS. Compliance to basic hygiene guidelines was the only intervention continuously monitored from late 2007. Compliance increased gradually to a steady high level early 2009. There was a decrease in LOS with S marcescens (LOS-Ser) clustering after the second quarter of 2008. After the first quarter of 2009 we saw a decrease in S marcescens colonisation.

    Conclusion: We were not able to isolate specific effects of each intervention, but an update of our antibiotic policy probably had effect on the occurrence of LOS-ser. The delayed effect of interventions on S marcescens colonisation was probably due to the time it takes for new routines to have impact, illustrated by the gradual increase in compliance to basic hygiene guidelines.

  • 17.
    Serenius, Fredrik
    et al.
    Uppsala University, Sweden and Umeå University, Sweden .
    Kallen, Karin
    Lund University, Sweden .
    Blennow, Mats
    Karolinska Institute, Sweden .
    Ewald, Uwe
    Uppsala University, Sweden .
    Fellman, Vineta
    Lund University, Sweden .
    Holmström, Gerd
    Uppsala University, Sweden .
    Lindberg, Eva
    Örebro University, Sweden .
    Lundqvist, Pia
    Lund University, Sweden .
    Marsal, Karel
    Lund University, Sweden .
    Norman, Mikael
    Karolinska Institute, Sweden .
    Olhager, Elisabeth
    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.
    Stigson, Lennart
    Gothenburg University, Sweden .
    Stjernqvist, Karin
    Lund University, Sweden .
    Vollmer, Brigitte
    Karolinska Institute, Sweden .
    Strömberg, Bo
    Uppsala University, Sweden .
    Neurodevelopmental Outcome in Extremely Preterm Infants at 2.5 Years After Active Perinatal Care in Sweden2013In: Obstetrical and Gynecological Survey, ISSN 0029-7828, E-ISSN 1533-9866, Vol. 68, no 12, p. 781-783Article in journal (Other academic)
    Abstract [en]

     A proactive approach to the care of extremely preterm infants has increased survival and lowered the gestational age of viability, but these improvements may be associated with later neurodevelopmental disability. EXPRESS is a national population-based prospective study of all infants born alive or stillborn at less than 27 weeks’ gestation between 2004 and 2007 in Sweden. This prospective follow-up study was undertaken to assess neurologic and developmental outcome of the EXPRESS cohort at 2.5 years corrected age compared with a matched control group born at term.

    Of 707 live-born infants, 497 (70%) survived to corrected age 2.5 years; the final cohort included 491 children. Each preterm child was matched with 2 control subjects at 2.5 years chronological age. Cognitive, language, and motor development were assessed with the Bayley Scales of Infant and Toddler Development (Bayley III). Cerebral palsy (CP), visual and hearing disability, and a composite outcome of overall disabilities were assessed. The overall outcome was characterized as no, mild, moderate, and severe disability.

    Of 415 infants assessed with clinical examinations, 399, 393, and 382, respectively, completed the Bayley III cognitive, language, and motor scales; 366 control children were assessed with Bayley III. The mean composite cognitive, language, and motor scores for children in the preterm and control groups were 94 ± 12 and 104 ± 11, respectively (P < 0.001), 98 ± 17 and 109 ± 12 (P < 0.001), respectively, and 94 ± 16 and 107 ± 14 (P < 0.001), respectively. Normal cognitive development or mild cognitive disability was found in 354 preterm children (88.8%) and 364 control children (99.5%). Moderate or severe cognitive disability was present in 20 preterm children (5.0%) and 1 control child (0.3%) (P < 0.001) and in 25 (6.3%) and 1 (0.3%), respectively (P < 0.001). Normal language development or mild language disability was found in 330 children (83.9%) in the preterm group and with 351 (97.5%) in the control group (all group comparisons, P < 0.001). Normal motor development or mild motor disability occurred in 324 (84.8%) and 348 (98.6%) of children in the preterm and control groups, respectively. Moderate or severe mental developmental delay was seen in 88 and 10 children (20% and 2.8%), respectively (P < 0.001).

    In the preterm group, Bayley III cognitive, language, and motor scores increased with advancing gestational age at birth by 2.5 points (99% confidence interval [CI], 1.0–4.0) per week (P < 0.001), by 3.6 points (99% CI, 1.6–5.6) per week (P < 0.001), and by 2.5 points (99% CI, 0.5–4.5) per week scores (P = 0.001), respectively. Cerebral palsy was present in 32 preterm children (7.0%; 99% CI, 3.9–10.1%). Of 456 preterm children, 42.1% were classified as normal, 30.7% as having mild disabilities, and 27.2% as having moderate or severe disabilities (vs 78.1%, 18.6%, 3.3% of control subjects, respectively; P < 0.001 for all comparisons). The proportion of children with mild or no disabilities increased from 40% at 22 weeks to 83% at 26 weeks (P < 0.001 for trend). Moderate or severe disabilities decreased from 60% at 22 weeks to 17% at 26 weeks (P < 0.001 for trend).

    The impact of prematurity on neurodevelopmental outcome indicates that further improvements in neonatal care are necessary. Although preterm children had poorer neurodevelopmental outcomes than those born at term, 73% had no or mild disability, and neurodevelopmental outcome improved with each week of gestational age. These results are relevant for clinicians counseling couples facing extremely preterm birth of their infant

  • 18.
    Serenius, Fredrik
    et al.
    Uppsala University, Sweden Umeå University, Sweden .
    Källén, Karin
    Lund University, Sweden .
    Blennow, Mats
    Karolinska Institute, Stockholm, Sweden.
    Ewald, Uwe
    Uppsala University, Sweden .
    Fellman, Vineta
    Lund University, Sweden .
    Holmström, Gerd
    Uppsala University, Sweden .
    Lindberg, Eva
    Örebro University, Sweden .
    Lundqvist, Pia
    Lund University, Sweden .
    Marsal, Karel
    Lund University, Sweden .
    Norman, Mikael
    Karolinska Institute, Stockholm, Sweden.
    Olhager, Elisabeth
    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.
    Stigson, Lennart
    University of Gothenburg, Sweden .
    Stjernqvist, Karin
    Lund University, Sweden .
    Vollmer, Brigitte
    Karolinska Institute, Stockholm, Sweden .
    Strömberg, Bo
    Uppsala University, Sweden .
    Neurodevelopmental Outcome in Extremely Preterm Infants at 2.5 Years After Active Perinatal Care in Sweden2013In: Journal of the American Medical Association (JAMA), ISSN 0098-7484, E-ISSN 1538-3598, Vol. 309, no 17, p. 1810-1820Article in journal (Refereed)
    Abstract [en]

    IMPORTANCE:

    Active perinatal care increases survival of extremely preterm infants; however, improved survival might be associated with increased disability among survivors.

    OBJECTIVE:

    To determine neurodevelopmental outcome in extremely preterm children at 2.5 years (corrected age).

    DESIGN, SETTING, AND PARTICIPANTS:

    Population-based prospective cohort of consecutive extremely preterm infants born before 27 weeks of gestation in Sweden between 2004 and 2007. Of 707 live-born infants, 491 (69%) survived to 2.5 years. Survivors were assessed and compared with singleton control infants who were born at term and matched by sex, ethnicity, and municipality. Assessments ended in February 2010 and comparison estimates were adjusted for demographic differences.

    MAIN OUTCOMES AND MEASURES:

    Cognitive, language, and motor development was assessed with Bayley Scales of Infant and Toddler Development (3rd edition; Bayley-lll), which are standardized to mean (SD) scores of 100 (15). Clinical examination and parental questionnaires were used for diagnosis of cerebral palsy and visual and hearing impairments. Assessments were made by week of gestational age.

    RESULTS:

    At a median age of 30.5 months (corrected), 456 of 491 (94%) extremely preterm children were evaluated (41 by chart review only). For controls, 701 had information on health status and 366 had Bayley-lll assessments. Mean (SD) composite Bayley-III scores (cognition, 94 [12.3]; language, 98 [16.5]; motor, 94 [15.9]) were lower than the corresponding mean scores for controls (cognition, 104 [10.6]; P < .001; adjusted difference in mean scores, 9.2 [99% CI, 6.9-11.5]; language, 109 [12.3]; P < .001; adjusted difference in mean scores, 9.3 [99% Cl, 6.4-12.3]; and motor, 107 [13.7]; P < .001; adjusted difference in mean scores, 12.6 [99% Cl, 9.5-15.6]). Cognitive disability was moderate in 5% of the extremely preterm group vs 0.3% in controls (P < .001) and it was severe in 6.3% of the extremely preterm group vs 0.3% in controls (P < .001). Language disability was moderate in 9.4% of the extremely preterm group vs 2.5% in controls (P < .001) and severe in 6.6% of the extremely preterm group vs 0% in controls (P < .001). Other comparisons between the extremely preterm group vs controls were for cerebral palsy (7.0% vs 0.1%; P < .001), for blindness (0.9% vs 0%; P = .02), and for hearing impairment (moderate and severe, 0.9% vs 0%; P = .02, respectively). Overall, 42% (99% CI, 36%-48%) of extremely preterm children had no disability, 31% (99% CI, 25%-36%) had mild disability, 16% (99% CI, 12%-21%) had moderate disability, and 11% (99% CI, 7.2%-15%) had severe disability. Moderate or severe overall disability decreased with gestational age at birth (22 weeks, 60%; 23 weeks, 51%; 24 weeks, 34%; 25 weeks, 27%; and 26 weeks, 17%; P for trend < .001).

    CONCLUSIONS AND RELEVANCE:

    Of children born extremely preterm and receiving active perinatal care, 73% had mild or no disability and neurodevelopmental outcome improved with each week of gestational age. These results are relevant for clinicians counseling families facing extremely preterm birth.

  • 19.
    Serenius, Fredrik
    et al.
    Uppsala University, Sweden Umeå University, Sweden .
    Sjors, Gunnar
    Uppsala University, Sweden .
    Blennow, Mats
    Karolinska University Hospital, Sweden .
    Fellman, Vineta
    Lund University, Sweden .
    Holmstrom, Gerd
    Uppsala University, Sweden .
    Marsal, Karel
    Lund University, Sweden .
    Lindberg, Eva
    University of Örebro, Sweden .
    Olhager, Elisabeth
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Stigson, Lennart
    Sahlgrens University Hospital, Sweden .
    Westgren, Magnus
    Karolinska University Hospital, Sweden .
    Kallen, Karin
    Lund University, Sweden .
    EXPRESS study shows significant regional differences in 1-year outcome of extremely preterm infants in Sweden2014In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 103, no 1, p. 27-37Article in journal (Refereed)
    Abstract [en]

    AimThe aim of this study was to investigate differences in mortality up to 1year of age in extremely preterm infants (before 27weeks) born in seven Swedish healthcare regions. MethodsNational prospective observational study of consecutively born, extremely preterm infants in Sweden 2004-2007. Mortality was compared between regions. Crude and adjusted odds ratios and 95% CI were calculated. ResultsAmong 844 foetuses alive at mothers admission for delivery, regional differences were identified in perinatal mortality for the total group (22-26weeks) and in the stillbirth and perinatal and 365-day mortality rates for the subgroup born at 22-24weeks. Among 707 infants born alive, regional differences were found both in mortality before 12h and in the 365-day mortality rate for the subgroup (22-24weeks) and for the total group (22-26weeks). The mortality rates were consistently lower in two healthcare regions. There were no differences in the 365-day mortality rate for infants alive at 12h or for infants born at 25weeks. Neonatal morbidity rates among survivors were not higher in regions with better survival rates. Perinatal practices varied between regions. ConclusionMortality rates in extremely preterm infants varied considerably between Swedish healthcare regions in the first year after birth, particularly between the most immature infants.

  • 20.
    Stoltz Sjostrom, Elisabeth
    et al.
    Umeå University, Sweden .
    Ohlund, Inger
    Umeå University, Sweden .
    Ahlsson, Fredrik
    Uppsala University, Sweden .
    Engstrom, Eva
    University of Gothenburg, Sweden .
    Fellman, Vineta
    Lund University, Sweden .
    Hellstrom, Ann
    University of Gothenburg, Sweden .
    Kallen, Karin
    Lund University, Sweden .
    Norman, Mikael
    Karolinska Institute, Sweden .
    Olhager, Elisabeth
    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.
    Serenius, Fredrik
    Umeå University, Sweden .
    Domellof, Magnus
    Umeå University, Sweden .
    Nutrient intakes independently affect growth in extremely preterm infants: results from a population-based study2013In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 102, no 11, p. 1067-1074Article in journal (Refereed)
    Abstract [en]

    AimTo explore associations between energy and macronutrient intakes and early growth in extremely low gestational age (ELGA) infants. less thanbrgreater than less thanbrgreater thanMethodsRetrospective population-based study of all ELGA infants (andlt;27weeks) born in Sweden during 2004-2007. Detailed data on nutrition and anthropometric measurements from birth to 70days of postnatal age were retrieved from hospital records. less thanbrgreater than less thanbrgreater thanResultsStudy infants (n=531) had a meanSD gestational age of 25.3 +/- 1.1weeks and a birth weight of 765 +/- 170g. Between 0 and 70days, average daily energy and protein intakes were 120 +/- 11kcal/kg and 3.2 +/- 0.4g/kg, respectively. During this period, standard deviation scores for weight, length and head circumference decreased by 1.4, 2.3 and 0.7, respectively. Taking gestational age, baseline anthropometrics and severity of illness into account, lower energy intake correlated with lower gain in weight (r=+0.315, pandlt;0.001), length (r=+0.215, pandlt;0.001) and head circumference (r=+0.218, pandlt;0.001). Protein intake predicted growth in all anthropometric outcomes, and fat intake was positively associated with head circumference growth. less thanbrgreater than less thanbrgreater thanConclusionExtremely low gestational age infants received considerably less energy and protein than recommended and showed postnatal growth failure. Nutrient intakes were independent predictors of growth even after adjusting for severity of illness. These findings suggest that optimized energy and macronutrient intakes may prevent early growth failure in these infants.

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