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The Zika virus (ZIKV) is a newly emerged pathogen in the Western hemisphere. It was declared a global health emergency by the World Health Organization in 2016. There have been 223,477 confirmed cases, including 3720 congenital syndrome cases since 2015. ZIKV infection symptoms range from asymptomatic to Gullain&ndash, Barr&eacute, syndrome and extensive neuropathology in infected fetuses. Passive and active vaccines have been unsuccessful in the protection from or the treatment of flaviviral infections due to antibody-dependent enhancement (ADE). ADE causes an increased viral load due to an increased monocyte opsonization by non-neutralizing, low-avidity antibodies from a previous dengue virus (DENV) infection or from a previous exposure to ZIKV. We have previously demonstrated that polyclonal avian IgY generated against whole-killed DENV-2 ameliorates DENV infection in mice while not inducing ADE. This is likely due to the inability of the Fc portion of IgY to bind to mammalian Fc receptors. We have shown here that ZIKV oligoclonal IgY is able to neutralize the virus in vitro and in IFNAR&minus, /&minus, mice. The concentration of ZIKV-specific IgY yielding 50% neutralization (NT50) was 25 &micro, g/mL. The exposure of the ZIKV, prior to culture with ZIKV-specific IgY or 4G2 flavivirus-enveloped IgG, demonstrated that the ZIKV-specific IgY does not induce ADE. ZIKV IgY was protective in vivo when administered following a lethal ZIKV challenge in 3-week-old IFNAR&minus, mice. We propose polyclonal ZIKV-specific IgY may provide a viable passive immunotherapy for a ZIKV infection without inducing ADE.

Universal pulse oximetry (POX) screening of apparently healthy newborn infants is useful for detection of critical congenital heart defects (CCHDs). First-day-of-life screening shortens time of the diagnostic process at the expense of a higher false positive rate than screening after 24 h of age. A substantial number of false positives, however, represent potentially severe extracardiac disorders. Early detection of such disorders is an added advantage. POX-screening may thus not be looked upon only as a heart screening, however, also a screening for other disorders with true hypoxemia, most hidden pulmonary pathology. Simple postductal screening (probe on foot) may be an alternative to combined pre- and postductal arterial oxygen saturation measurements (SpO2) (probe on right hand and a foot). By combining POX-screening with routine clinical heart examination, a predischarge detection rate for CCHDs of 90 % is obtained. Moderate sensitivity for detecting obstructive lesions from the left heart, especially coarctation of the aorta, emphasizes the need for better screening methods for these conditions.

Aim Pulse oximetry screening of newborn infants increases early detection of critical congenital heart disease and minimises the risk of circulatory collapse before surgery. This study provides an update on the implementation of pulse oximetry screening in the Nordic countries and proposes standardised guidelines. Methods A questionnaire exploring pulse oximetry screening, clinical examination routines and availability of echocardiography was distributed to all 157 delivery units in the Nordic countries in June 2013. Results We received responses from 156 of the 157 delivery units, and 116 (74%) were using pulse oximetry screening by September 2013. Preductal and postductal screening were both used in 59 of 116 units (51%), with just postductal screening in 51 of 116 (44%) and just preductal screening alone in 6 of 116 (5%). Screening was performed before 24 h in 105 of 116 units (91%). The implementation of screening was highest in Finland (29/30, 97%), Sweden (42/46, 91%) and Norway (43/48, 90%) and lowest in Denmark (2/24, 8%) and Iceland (0/8 units). Conclusion In Sweden, Norway and Finland, the implementation of pulse oximetry screening is currently the highest in the world and coverage will be close to 100% in 2014. We propose uniform Nordic guidelines using preductal and postductal screening before 24 h of age.

Aim: To assess basic trends in epidemiology of congenital heart defects (CHDs). Method: Population based prospective observational study. Material: CHDs in infants born alive in a Norwegian county 1982-2011. Results: In 828/71 217 infants (12 per 1000) a CHD was diagnosed. The prevalence increased from 8 to 12 per 1000 after introduction of early echocardiography in newborns with suspected CHD from 1986 (p = 0.0001). Ventricular septal defect (VSD) was the dominating CHD (474; 57%). In 222 (27%) the CHDs were missed and diagnosed after discharge from hospital after birth. Twelve critical CHDs (causing death or requiring invasive procedures before 28 days of life) were missed. Prenatal diagnosis of critical CHDs increased from 4/67 (6%) born 1997-2006 to 4/11 (36%) born 2007-2011 (p = 0.01). In 177 (21%) a syndrome or extracardial defect occurred. The occurrence of CHDs associated with chromosomal disorders (60/73 (82%) trisomies) more than doubled from the cohort born in the first 10-year period 1982-1991 (0.6 per 1000) to the last 2002-2011 (1.4 per 1000) (p < 0.0001) in parallel with increasing births in women ≥ 35 years old in the population. 237 (29%) underwent therapeutic procedures (203 (86%) surgery, of whom 16 after initial catheter intervention, and 34 (14%) catheter intervention alone). 39/237 (16%) died, 101 (43%) were repaired and 97 (41%) had some minor residual defect. The death rate declined significantly from 65/532 (12%) born 1982-2001 to 11/296 (4%) born 2002-2011 (p = 0.0001). 37/76 (49%) deaths occurred within 28 days after birth. Conclusions: The rate of detection of CHDs increased substantially after introduction of echocardiography in newborns with suspected CHD, especially VSDs. Some critical CHDs were overlooked. The prenatal detection rate of such defects increased. The prevalence of CHDs with associated chromosomal disorders increased in parallel with increasing maternal age in the population. Most deaths occurred during the neonatal period. Increasing survival increases the load on long-term follow-up programmes.

Aim: To assess the need for and quality of neonatal transports. Material and methods: Prospective observational study of consecutive transports from a level II neonatal unit. Results: 500 transports were undertaken 1982-2010 in 445 patients, representing 0.7% of liveborn infants (n = 61 450). Indications were congenital malformations in 223 (45%), prematurity/respiratory distress syndrome (RDS) in 87 (17%), and other conditions in 190 (38%). For patients ventilated during transport (n = 121) mean pCO2 was improved at arrival, and for spontaneously breathing patients mean pH, pCO2, and base excess (p < 0.05). After establishing a local respirator programme from 1989, transports for prematurity/RDS declined from 3.4 per 1000 live born infants in 1982-88 to 0.8 per 1 000 in 1989-2010 (p < 0.0001), and night-time transports (departure between 22.00 pm - 06.00 am) declined from 24/119 (20%) to 38/381 (10%) (p = 0.003). Technical mishaps or severe clinical deterioration occurred in 16 (3%) of the transports. Conclusions: Neonatal transport carries risks, but also an opportunity for further stabilization and improvement. A local respirator programme reduced the need for transfer of premature infants with RDS as well as for transports during night-time.

Cerebral palsy (CP) is still the most common cause of chronic motor disability in hildhood. Until now, there has not been any previous national study of the anorama of subtypes, severity or risk factors among children with CP in Norway. his is a population based study of a cohort of children with CP born 1996 to 1998 in orway. These children are recorded in the Cerebral Palsy Register of Norway. The P definition and classification system agreed on by the Surveillance of Cerebral alsy in Europe (SCPE) are applied. The study showed that the prevalence of CP in orway was 2.1 per 1000 live births, comparable with other similar populations. Most children were classified in the spastic bilateral subtype (49%), about ne third (33%) in the spastic unilateral subtype and less than 10% in the dyskinetic r in the ataxic subtype. Both the distribution of subtypes and gross motor function impairments were comparable with other populations in developed countries. More children in our study had fine motor function impairments, as well as associated impairments. The associated impairments included both impairment of speech and feeding, in addition to impairments of vision, hearing, cognition and presence of active epilepsy. We identified both breech presentation and induction of labour as independent risk factors for CP. There was a significant increased risk of CP in children born in breech presentation compared to vertex presentation, in particular for singletons born at term by vaginal delivery. Breech presentation was however not associated with specific subtypes of CP or with the extent of gross or fine motor impairments. There was also an increased risk for CP in children after induction of labour. Induction of labour was associated with a higher proportion of children with the bilateral spastic subtype as well as in those born at term with four-limb involvement. When we studied multiple risk factors (maternal disease, assisted fertilization, plurality, abnormal placental structure, bleeding in pregnancy, small for gestational age, abnormal presentation, Apgar score at 5 minutes

Summary A 21 months old boy operated for Wilms tumor developed a disseminated Candida infection with septicemia, chorioretinitis, arthritis and osteomyelitis following cytostatic treatment. The chorioretinitis and osteomyelitis healed during systemic treatment with miconazole orally for three months, and the arthritis responded to intraarticular injections with amphotericin B. Zusammenfassung Ein 21 Monate alter Junge, der an einem Wilms Tumor operiert worden war, entwickelte im Anschluβ an die cytostatische Behandlung eine disseminierte Candida-Infektion mit Septicaemia, Chororetinitis, Arthritis und Osteomyelitis. Die Chorioretinitis und Osteomyelitis heilten wahrend der dreimonatigen Behandlung mit Miconazole per os aus. Die Arthritis reagierte auf intraarticulare Injektionen mit Amphotericin B.

Purpose: To report the results of transscleral fixation of posterior chamber intraocular lenses in adults. Methods: We carried out a retrospective analysis of 91 eyes of 81 patients who underwent implantation of posterior chamber lenses with transscleral sutures between 1997 and 2006. The mean age of the patients was 62 years (range 19–94 years). Sixty-eight eyes (74.7%) were aphakic at the time of surgery. In 10 patients (11.0%) an intracapsular cataract extraction and in six patients (6.6%) a pars plana lensectomy was performed prior to the fixation of the posterior chamber intraocular lens. In seven eyes (7.7%) a previously implanted IOL was removed. The mean follow-up was 36 months (range 6–116 months). Results: The mean preoperative best corrected visual acuity (BCVA) was 0.37 (range counting fingers to 1.0), which improved to 0.5 (range light perception to 1.0) postoperatively. At the end of follow-up, BCVA was unchanged or improved in 81 eyes (89.0%), reduced by 2 Snellen lines in four eyes (4.4%), and between finger counting and light perception in four eyes (4.4%). The most serious complication was suprachoroidal haemorrhage, which occurred in two eyes. Retinal detachment occurred in three eyes, all of which successfully reattached after surgery. Suture erosion or spontaneous dislocation caused by suture degradation or breakage was not seen. Conclusions: Secondary implantation of posterior chamber intraocular lenses with transscleral fixation is a reasonably safe procedure in adults, with relatively few serious complications. Even in patients with longterm follow-up, suture breakage was not seen.

Objective To evaluate the efficacy of first day of life pulse oximetry screening to detect congenital heart defects (CHDs). Study design We performed a population-based prospective multicenter study of postductal (foot) arterial oxygen saturation (SpO2) in apparently healthy newborns after transfer from the delivery suite to the nursery. SpO2 Results Of the infants screened, 324 (0.6%) failed the test. Of these, 43 (13%) had CHDs (27 critical), and 134 (41%) had pulmonary diseases or other disorders. The remaining 147 infants (45%) were healthy with transitional circulation. The median age for babies with CHDs at failing the test was 6 hours (range, 1-21 hours). For identifying critical CHDs, the pulse oximetry screening had a sensitivity rate of 77.1% (95% CI, 59.4-89.0), specificity rate of 99.4% (95% CI, 99.3-99.5), and a false-positive rate of 0.6% (95% CI, 0.5-0.7). Conclusions Early pulse oximetry screening promotes early detection of critical CHDs and other potentially severe diseases. The sensitivity rate for detecting critical CHDs is high, and the false-positive rate is low.

In a population-based study in children born alive during the 10-year period from 1982 to 1991 (n = 22,810), ventricular septal defects (VSDs) were diagnosed in 127 cases, an incidence of 5.6 per 1000. The incidence was significantly higher in the cohort of children born during the 6-year period from 1986 to 1991 than among those born in the preceding 4-year period, 1982-1985 (6.5 and 4.0 per 1000 respectively; p0.05). The increase was caused entirely by an increased detection rate of small defects in the muscular part of the interventricular septum after introducing echocardiography as a standard method for investigating suspect congenital heart defects in the neonatal period. This also explained entirely an increase in the total incidence of congenital heart defects to 10.6 per 1000 in the last period from 8.4 per 1000 in the first, although this increase was not significant (p0.05). More children born in 1986-1991 had spontaneous closure of their VSDs (75.5%) than those born in 1982-1985 (51.5%) (p0.05). In 69.3% of patients the VSDs closed during the first year of life. For the cohort born in 1986-1991, 84.6% of the defects located in the muscular part of the septum closed spontaneously. Small defects in the muscular part of the interventricular septum with spontaneous closure in early life may represent the tail of a normal developmental process, and not defects in the sense of malformations.

Aim: To register chromosomal anomalies, syndromes and extracardiac malformations in patients with Congenital heart defects (CHDs). Method: Population-based prospective observational study. Results: Of 57 027 live births during 1982–2005, CHDs were detected in 662 (11.6 per 1000), of whom 146 (22%) had associated anomalies. Of these 52 (36%) had chromosomal anomalies (exclusive microdeletions), 26 (18%) genetic syndromes/microdeletions, 1 (0.7%) a teratogenous syndrome and 67 (46%) extracardiac malformations. In perimembraneous ventricular septal defects (VSDs), associated anomalies occurred in 22 of 70 (31%) compared to 27 of 298 (9%) in VSDs located in the muscular part of the septum (p < 0.0001). The prevalence of CHDs with associated disorders increased significantly from the cohort born during 1982–1993 to those born during 1994–2005 (2.0 vs. 3.1 per 1000, respectively; p < 0.0001), mainly caused by an increase of chromosomal trisomies (0.5 vs. 1.1 per 1000; p = 0.026). The percentage of women giving live birth at 35 years of age or more was 7.6% for the period 1982–1993 compared to 13.4% for 1994–2005 (p = 0.001). Conclusions: Chromosomal anomalies, syndromes and extracardiac malformations occurred in nearly one-fourth of CHD cases. Muscular VSDs had a low prevalence of such conditions. The prevalence of CHDs with chromosomal trisomies increased, and was probably related to an increasing age of women giving birth.

In a population-based study including 2463 infants, serum bilirubin measurements were added to the neonatal screening programme for phenylketonuria and congenital hypothyreosis. This screening programme detected 11/17 (65%) of infants with serum bilirubin levels >350 micromol 1(-1), of whom 7 (3 per 1000) were readmitted from home (6 treated with phototherapy). A total of 139 infants (5.6%) received phototherapy. Maternal blood type O occurred significantly more often in term infants treated (30/54; 55.6%) compared with preterm infants treated (32/85; 37.6%) and with blood type O occurrence in the total population of mothers (906/2426; 37.3%) (p < 0.05). The blood type constellations mother O/infant A or B showed a sensitivity of 64%, specificity 65%, positive predictive value 12% and a negative predictive value of 96% for the requirement of phototherapy for the whole material. Exchange transfusion was not required in any of the infants. No infant developed bilirubin encephalopathy (kemicterus). Adding bilirubin to a neonatal screening programme detects some cases with unexpectedly high bilirubin levels in need of intervention. Routine ABO blood typing of pregnant women, ABO cord blood typing and Coombs' test in infants of mothers with blood type O cannot be recommended because of low positive predictive value for the requirement of intervention (phototherapy) by these tests.

Aims: To register mortality and causes of death in patients with congenital heart defects (CHDs). Methods: Prospective population-based observational study. Results: 553 infants with CHD (1.1% of live born) were observed for 1–22 y (median 10 7/12 y). Sixty-four died (11.6%), of whom 32 (50%) died during the first 4 wk, and 51 (79.7%) during the first year of life. Of the total neonatal deaths in the population (3 per 1000), CHDs occurred in 21.5%. Mortality for children with CHDs was not significantly different between the cohorts born in 1982–1991 and 1992–2002, for either neonatal deaths or deaths later on (p>0.05). Out of 170 patients in whom therapeutic procedures (surgery, catheter interventions) were undertaken, 34 (20%) died. Nine cases (1.6%) died with unrecognized CHDs; seven of these on the first day of life with severe extracardiac malformations. In 50 (78.1%) cases, death was judged to be caused directly or indirectly from the CHD, and in 14 (21.9%) from extracardiac malformations or other conditions. Conclusion: CHDs occur in a substantial number of neonatal deaths. Most deaths are caused by cardiac insufficiency. The mortality rate remained unchanged.

BACKGROUND The guidelines for diagnosis and treatment of neonatal hyperbilirubinaemia were changed at Vestfold Hospital, Norway in 1994 and 2007. Universal screening for ABO-immunization was implemented in 2006. This article describes effects of these changes. MATERIAL AND METHODS Blood-type immunization, phototherapy and exchange transfusions were prospectively recorded in the 21-year period 1988-2008. Three cohorts comprised the basis for the analyses: infants born in the time-periods 1988-93, 1994-2006 or 2007-2008. RESULTS 6.2 % of the infants born 1988-93 and 6.7 % born 1994-2006 received phototherapy. Physiological hyperbilirubinaemia in term infants was the main reason for phototherapy in the first cohort, while it was hyperbilirubinemia in preterm infants in the second cohort. 4.8 % of the infants born 2007-8 received phototherapy. Exchange transfusion was performed in 0.02 % born 1994-2008 and 0.2 % born 1988-93. Such transfusions were undertaken more frequently in cases with RhD-immunization (7.8 %) than in those with ABO-immunization (2.0 %). Universal screening for ABO-immunization increased the percentage of diagnosed cases in the population from 2.1 % to 3.6 %. No case of kernicterus was diagnosed. INTERPRETATION Fewer term infants were treated with phototherapy for hyperbilirubinaemia after the changes of therapeutic guidelines in 1994, while more preterm infants were treated after this change. Far less exchange transfusions are performed nowadays than before 1994. ABO-immunization has been diagnosed more often after implementation of universal screening.

UNLABELLED In a population-based study including 35,218 infants born alive during the 15-y period 1982-96, 360 (1%) were diagnosed as having a congenital heart defect (CHD). At a follow-up 3-18 y after birth (median 9.5 y) 154 patients (42.8%) were spontaneously cured; of these, 142 (92.2%) had ventricular septal defects (VSDs). Forty-two patients (11.7%) died, 22 of these (52.4%) during the neonatal period (0-28 d after birth). A total of 119 patients (33.1%) underwent therapeutic procedures (surgery, catheter interventions), 24 (20.2%) of whom died. Of the 95 children surviving therapeutic procedures, 54 (56.8%) had their defects completely repaired, while 41 (43.2%) had residual defects or cardiac sequelae, often of minor importance. In 69 children (19.2%) with persistent non-operated defects, 43 (62.3%) had VSDs. A chromosomal disorder, syndrome or associated extracardiac malformation occurred in 72 children (20%). CONCLUSIONS The study underlines the broad variety in severity of CHDs, with a high neonatal mortality rate as well as a high rate of spontaneous cure. It is estimated that 25% of infants born with a CHD will grow into adult age with persistent non-operated defects, residual defects or cardiac sequelae after therapeutic procedures.

BACKGROUND: Congenital malformations of the kidneys and urinary tract may have changed over time. MATERIAL AND METHODS: Data for diagnosis, treatment and results were retrospectively recorded in children born in one of three Norwegian counties 1987-2006; their age at time of recording was from 1 to 21 years. RESULTS: 389 of 142 986 (2.7 per 1000) live born children had malformations of the kidneys and/or urinary tract. The prevalence was higher for children born in the period 1997-2006 (241/70 217; 3.4 per 1000) than in 1987-1996 (148/72 769; 2.0 per 1000), p< 0.0011. The percentage of children with anomalies diagnosed prenatally increased significantly from the first born 10-year cohort (35/148; 24 %) to the last (125/241; 52 %), p < 0.0011. Urosepsis occurred in 8 (1.1 per 1000) patients in the first 10-year cohort and in 9 (1.3 per 1000) patients in the last cohort (p = 0.75). 137 (35 %) patients had undergone surgery, of whom 68 (0.9 per 1000) were born 1987-96 and 69 (1 per 1000) were born 1997-2006. Chronic renal failure developed in 6 patients (0.1 per 1000) in each 10-year cohort; 4 (0.05 per 1000) and 11 (0.16 per 1000) patients died in the two cohorts (p = 0.07) respectively. INTERPRETATION: More frequent use of prenatal ultrasound screening has caused a 69 % increase in the prevalence of malformations in kidneys and the urinary tract. The number of patients treated by surgery, deaths and the prevalence of urosepsis and chronic renal failure has remained unchanged. This may indicate increased detection of less severe malformations.

Plantar verrucae, caused by human papillomavirus (HPV), are commonly found in patients who have tested positive for the antibodies to human immunodeficiency virus (HIV). A better understanding of the characteristics of plantar verrucae in HIV+ patients in needed. A pilot study was conducted concentrating on three characteristics--the size, the number, and the clinical type--of verrucae present in this population. These parameters were studied in HIV+ and HIV- populations, and they were evaluated in relation to the CD4 levels of HIV+ individuals. The HIV+ individuals presented with plantar verrucae that were larger and more numerous than those found in HIV- individuals. The HIV+ population presented with all three clinical types of plantar verrucae and had significantly more mosaic-type warts than did HIV- individuals. The three characteristics did not correlate with CD4 cell counts, suggesting that the severity and extent of HPV infection do not depend on the level of immunosuppression of the HIV+ patient.

Aims: To register hospitalizations for respiratory syncytial virus (RSV) infections and estimate costs of prophylaxis with humanized monoclonal antibodies (palivizumab) against RSV, compared to hospital care, in cases with congenital heart defects (CHDs). Methods: Population based study with prospective registration of CHDs. Costs for hospital treatment of RSV-infections in CHD-patients calculated by means of the Norwegian Diagnosis Related Groups system. Results: In 43 470 infants live born in the population through the 18-year period 1987–2004 a structural CHD was diagnosed in 527 (1.2%). A total of 898 (2.1%) hospitalizations for RSV-infections occurred in the study population 1987–2005. The hospital admittance rate was significantly higher for CHD-cases (4.8%) than for children without CHD (2%) (P=0.002). Severe CHDs (need for surgery or catheter intervention) had a higher admittance rate (9.2%) compared to the group of remaining CHDs (3.3%) (P=0.01). Number needed to treat with palivizumab to avoid one hospitalization for RSV-infection in cases of severe CHDs was calculated to 24, at costs of US$ 195 000. The expenses for palivizuamab prophylaxis in severe CHDs were 31 times that of hospital treatment. Conclusion: Prophylaxis with palivizumab in severe CHDs is not cost-effective.

In a population-based study cerebral palsy (CP) was diagnosed in 110 cases (2.4 per 1000) among children live born with birth weight > or = 500 g (n = 45,976) during the 20-year-period 1970-89 (CP cases with a postneonatal etiology excluded). The CP-incidence showed a linear trend of decline from 2.8 per 1,000 in the first 5-year-cohort born 1970-74, to 2.0 per 1,000 in children born 1985-89 (p = 0.17). Birth weight specific CP-incidence showed a trend of decline in very low birth weight infants (500-1,499 g) and in infants > or = 2,500 g from the first 10-year-cohort born 1970-79 to the second born 1980-89. The same trend occurred for the incidence of spastic diplegia in total and in children born preterm. These trends of decline did not achieve statistical significance (p > 0.05). The CP-incidence was 36.7 and 11.3 times higher among infants with birth weight 500-1,499 g and 1,500-2,499 g respectively compared to infants > or = 2,500 g (p < 0.01). 15.9% of the decline in CP-incidence from the first to the second 10-year-cohort could be explained by a decreased low birth weight rate (500-2,499 g) in the population, from 4.2% 1970-79 to 3.8% 1980-89 (p < 0.05). The origin of CP was considered prenatal in 22 (20%), perinatal in 47 (42.7%), and undifferentiated in 41 (37.3%) of the cases. More CP-children born in the 10-year-period 1980-89 were treated with mechanical ventilation in the neonatal period (13/46; 28.3%) than those born in the 10-year-period 1970-79 (4/64; 6.3%) (p < 0.01). The neonatal mortality rate declined significantly from 7.2 per 1,000 in the first to 3.9 per 1,000 in the last 10-year-cohort respectively (p < 0.01). Birth weight-specific neonatal mortality rates declined more than 50% in all weight groups (p < 0.01). The results are contradictive to other investigations showing increased CP-incidence following improved survival rates in low birth weight infants, and may reflect a different pattern for development of perinatal care (organization, intensive care). The overall effect of mechanical ventilation may be improved survival and prevention of brain damage, though the percentage of ventilated CP-children increased. Preventing low birth weight should be a main strategy for preventing CP.

In family care (FC) program for neonatal intensive care units (NICUs), parents are encouraged to reside together with their infant for 24 hours a day to actively be involved in the care. The aim of this study was to assess the impact of FC on maternal confidence and breast-feeding. Maternal confidence and rate of breast-feeding were assessed in 31 mothers offered FC that included special family rooms in the NICU, and in 30 mothers from a comparable NICU providing traditional care without such facilities. One week prior to hospital discharge, mothers in the FC group felt better informed regarding nursing issues and had more confidence in interpretation of the infants regarding feeding issues and in caregiving without staff attendance (P < .05). They also reported a higher level of empowerment (P < .05). Three months after discharge, the mothers in the FC group had a higher self-reported skill level for interpretation of the infant's signals and knowledge about breast-feeding (P < .05). Despite similar rate of breast-feeding at discharge, more infants in the FC group were breastfed 3 months after discharge (P < .05). An FC program in the NICU promoted better maternal confidence during the hospital stay and 3 months after discharge compared with traditional care.

SAMMENDRAGNye indikasjoner for behandling av hyperbilirubinemi hos nyfødte (bilirubinskjema fra Hillingdon sykehus,England) ble innført ved Vestfold sentralsykehus primo 1994. Endringene i panoramaet av behandlingstiltak(lysbehandling, utskiftningstransfusjon) ble registrert i kohortene av levende fødte ved sykehuset i toårsperioden1994-95 og sammenlignet med foregående treårsperiode 1991-93. Total lysbehandlingsprevalens falt signifikantfra 6,9% av levende fødte i perioden 1991-93 til 5,5% i perioden 1994-95 (p < 0,005). Dette skyldtes helt etbetydelig fall i prevalensen av fullbårne barn som ble lysbehandlet for fysiologisk ikterus, fra 4,3% til 1,6% ihenholdsvis første og siste periode (p < 0,0005). Prevalensen av barn som ble behandlet for prematuritetshyperbilirubinemisteg signifikant fra 2,0% av levende fødte til 3,2% (p < 0,0005). Dette var delvis forårsaket av enøkning i prematuritetsinsidensen, som steg fra 4,5% i perioden 1991-93 til 5,9% i perioden 1994-95 (p < 0,0005).Andelen premature som ble lysbehandlet steg fra 45,2% i første til 53,1% i siste periode (p < 0,05). Prevalensenav blodgruppeimmuniserte barn som ble lysbehandlet var uforandret i de to periodene (henholdsvis 0,6% og0,7%) (p > 0,05). Det var en markert reduksjon i prevalensen av barn som gjennomgikk utskiftningstransfusjon(fra 0,2 til 0,06% henholdsvis i de to periodene) (p < 0,05). Mulighetene for uheldige psykologiske og biologiskeeffekter av lysbehandling til friske fullbårne barn med ikterus, reduseres relativt betydelig med de moderatejusteringer av indikasjonene som er foretatt. Rutineskiftet har også betydd ressurssparing. På landsbasis vil en slikrutineendring medføre at 1000-2000 fullbårne barn hvert år kan unngå lysbehandling. Indikasjonene for fototerapiog utskiftningstransfusjon for hyperbilirubinemi hos nyfødte i Norge må diskuteres på nytt i lys av ny forskningmed tanke på nasjonal konsensus. Kortere liggetider for nyfødte i sykehus etter fødselen gjør det nødvendig medgode rutiner for oppfølging av hyperbilirubinemi utenfor sykehus.Meberg A. Hyperbilirubinemia – a controversial topic. Experiences with new guidelines for phototherapyand exchange transfusion . Nor J Epidemiol 1997; 7 (1): 85-91.ENGLISH SUMMARYNew guidelines for treatment of hyperbilirubinemia in newborn infants (according to a bilirubin chart used atHillingdon Hospital, England) were introduced at Vestfold Central Hospital primo 1994. Changes in the panoramaof interventions (phototherapy, exchange transfusion) were recorded for the two-year period 1994-95 and comparedto the preceding three-year period 1991-93. Total prevalence of infants treated by phototherapy declinedfrom 6.9% among those born 1991-93 to 5.5% in those born 1994-95 (p < 0.005). This was entirely caused by adecline in the prevalence of term infants treated for physiological hyperbilirubinemia, from 4.3% in the cohortborn 1991-93 to 1.6% in the cohort born 1995-95 (p < 0.0001). The prevalence of preterm infants (gestational age< 37 weeks) treated by phototherapy increased from 2.0% to 3.2% respectively in the two periods (p < 0.0005).This was partly caused by an increase in the preterm incidence from 4.5% of live born 1991-93 to 5.9% amongthose born 1994-95 (p < 0.0005). The percentage of preterm infants treated by phototherapy increased from 45.2%to 53.1% respectively in the two periods (p < 0.05). No significant change in the incidence of infants treated byphototherapy for blood group immunization occurred (0.6% and 0.7% respectively for the two periods; p > 0.05).The prevalence of infants treated by exchange transfusion decreased from 0.2% 1991-93 to 0.06% 1994-95 (p <0.05). Psychological and biological side-effects from phototherapy in healthy term infants may have been reducedby the changes in guidelines undertaken. The change in therapeutic guidelines has also resulted in a save ofresources. Applying these routines on a national base will avoid phototherapy in 1000-2000 term infants annually.Successively shorter stay of newborns in hospital after birth necessitates good routines for follow-up ofhyperbilirubinemia after discharge. The guidelines for phototherapy and exchange transfusion for neonatalhyperbilirubinemia should be rediscussed to obtain a national consensus.

Objective: To compare strategies with and without first-day of life pulse oximetry screening to detect critical congenital heart defects (CCHDs). Study design: Population based study including all live born infants in Norway in 2005 and 2006 (n = 116 057). Postductal (foot) arterial oxygen saturation (SpO2) was measured in apparently healthy newborns after transferral to the nursery, with SpO2 < 95% as cut-off point. Out of 57 959 live births in the hospitals performing pulse oximetry screening, 50 008 (86%) were screened. Results: A total of 136 CCHDs (1.2 per 1000) were diagnosed, 38 (28%) of these prenatally. Of the CCHDs detected after birth, 44/50 (88%) were detected before discharge in the population offered pulse oximetry screening (25 by pulse oximetry), compared to 37/48 (77%) in the non-screened population (p = 0.15). Median times for diagnosing CCHDs in-hospital before discharge were 6 and 16 h after birth respectively (p < 0.0001). In the screened population 6/50 (12%) CCHDs were missed and recognized after discharge because of symptoms. Two of the six missed cases failed the pulse oximetry screening, but were overlooked (echocardiography not performed before discharge). If these cases had been recognized, 4/50 (8%) would have been missed compared to 11/48 (23%) in the non-screened population (p = 0.05). Of the cases missed, 14/17 (82%) had left-sided obstructive lesions. Conclusion: First-day of life pulse oximetry screening provides early in-hospital detection of CCHDs and may reduce the number missed and diagnosed after discharge.

UNLABELLED Infants with potentially life threatening congenital heart defects (CHDs) are discharged from hospital after birth with the condition unrecognized. Improved prenatal ultrasound imaging and universal pulse oximetry screening of babies in nurseries are strategies that probably most would contribute to avoid such defects to be missed. CONCLUSION In general combining first day of life pulse oximetry, clinical examination and echocardiography before discharge in suspect cases is a rational strategy for early postnatal detection of heart defects. Universal echocardiography screening of newborns may be too resource consuming to be cost-effective.

The present study was undertaken to separate the impacts of a declining incidence of low birth weight from the effects of an improved perinatal care on perinatal mortality and incidence of cerebral palsy (CP) in an unselected population of infants and children. In the total population of infants with birth weight 500 g or more born in a Norwegian county (Vestfold) 1970-84 (n = 34,756), the incidence of low birth weight (500-2499 g) declined significantly, from 5% during the 10-year period 1970-79, to 4.1% during the 5-year period 1980-84 (p less than 0.01). The decline was stronger for very low birth weight infants (500-1499 g) than for moderately low birth weight infants (1500-2499 g) (31% vs. 13%; p less than 0.01). Perinatal mortality decreased from 17 to 10.3% (p less than 0.01), and the incidence of CP from 2.6 to 2.1% (p = 0.4). Because low birth weight infants were at increased risk for perinatal death and CP, the declining incidence of low birth weight was attributable 41.4% of the decline in perinatal mortality, and 40% of the reduction of CP from the period 1970-79 to 1980-84. Strategies for prevention of low birth weight may be important for further reduction of perinatal mortality and handicaps related to low birth weight.

Background/aim To describe prevalence, subtypes and severity of cerebral palsy (CP) in Norway using criteria proposed by the Surveillance of Cerebral Palsy in Europe (SCPE) network. Material All children in Norway with CP born in January 1996–December 1998 were registered in the Cerebral Palsy Registry of Norway. The Medical Birth Registry of Norway provided the perinatal data. Results A total of 374 children with CP were identified with a prevalence of 2.1 per 1000 live births. Detailed information was obtained from 294 (79%) children. Median age at clinical assessment was 6.9 years (range: 1.9–10.2 years). Thirty-three percent of the children had spastic unilateral CP, 49% spastic bilateral, 6% dyskinetic, 5% ataxic CP and 7% were not classified. Severely impaired vision and hearing were present in 5% and 4% of the children, respectively. Active epilepsy was present in 28%, mental retardation in 31% and severely impaired or no speech in 28% children. The most severe impairments in gross motor function were observed in children with low Apgar scores, and the most severe impairments in fine motor function in children born at term, with normal birth weight and low Apgar scores. Conclusion Compared with other populations, the prevalence of CP as well as the proportions of subtypes and gross motor impairments were similar, whereas fine motor impairments and associated impairments were more common. The classification of children with mixed forms of CP is still a challenge. Children were more severely affected if Apgar scores were low, and if they were born at term.

An 80m long retrievable "one-run" straddle assembly was successfully installed in order to shut off a gas breakthrough in the 130 degrees deviated reservoir section of a "U shape/Fish hook" sub sea oil producer in the Njord field. Coiled tubing with an internal electric line in combination with a tandem fluid driven tractor was used to convey the straddle assembly.

To register the prevalence of cerebral palsy (CP) and determine etiological factors for the condition.Population based study with registration of CP-cases in children born during the 30-year period 1970-99. Cases with postneonatal etiology were excluded.166 CP-cases were registered among 70 824 children, a prevalence of 2.3 per 1000 live born infants. The prevalence did not change significantly during the period. 66 (40%) were low birthweight infants (LBWIs;2500 g), and 100 (60%) normal birthweight infants (NBWIs;or = 2500 g). The origin was classified as prenatal in 37 (22%), perinatal/neonatal in 78 (47%) and unclassifiable in 51 (31 %). In LBWIs 39/66 (59%) had a perinatal/neonatal etiology, most frequently intra- or periventricular hemorrhages (IVH/PVH) and/or periventricular leukomalacia (PVL) or cerebral infarctions (CI) (17; 44%). In NBWIs 39/100 (39%) had a perinatal etiology, most frequently hypoxic-ischemic encephalopathy (HIE) (31; 79%).In a substantial percentage of CP-cases perinatal/neonatal brain injury was classified as the cause. Among these IVH/PVH/PVL/CI dominated in LBWIs, while HIE dominated in NBWIs. Our data may point to preventability of a larger part of CP than earlier suggested.

were born at term. In our opinion, the major problem with the paper is in the conclusion section where Andersen et al. state that the most noteworthy finding is a fourfold-increased risk for CP among singletons born at term and delivered vaginally. In the results section, however, they write that the risk for CP among singleton term infants is not significantly influenced by mode of delivery (odds ratio 1.7 for vaginal delivery compared with Caesarean section with confidence interval 0.5–6.4). Also, it should be pointed out that this comparison was based on 4 cases versus 5 cases only (Table II). Thus, the authors misinterpret their own data. After having established breech presentation as an independent risk factor for CP, it is misleading to compare infants born in breech presentation delivered vaginally with those born in vertex presentation. This misinterpretation is underlined in the last paragraph where the authors write, ‘It is possible that a few cases of CP could have been prevented had Caesarean section been performed in all cases of term breech delivery...’. This conclusion is not supported by the data presented in the paper. The appropriate conclusion from this study is that vaginal breech delivery of singleton infants at term in Norway is a safe procedure with good results, and the results do not provide any indications that routine Caesarean section in term breech presentation would prevent any cases of CP.

In a population-based study of 35,218 infants born alive during the 15 years from 1982 to 1996, 353(1%) were diagnosed as having a congenital heart defect, of whom 84 (24%) were diagnosed subsequent to discharge from hospital after birth (2.4/1000). Of these, 40 (48%) had a ventricular septal defect, 14 (17%) an atrial septal defect, 9 (11%) a patent arterial duct, 8 (10%) an aortic stenosis and 13 (15%) other defects. Compared with those in whom diagnosis was made before discharge, the group of patients with defects detected late had an increased prevalence of atrial septal defects, patent arterial duct and aortic stenosis, but less decreased prevalence of ventricular septal defects (p< 0.05). Median age at detection of the defects subsequent to discharge was 6 months (range 2 weeks–11 years). Seven patients (8%) presented with clinical symptoms of cardiac decompensation. The mortality rate was significantly lower in those in whom defects were detected late (1/84; 1%) as compared with those detected immediately after birth (37/269; 14%) (p< 0.05). The total rate for early detection was the same after using one clinical examination (8.2/1000) of newborns as our basic routine instead of two (7.1/1000) (p> 0.05). A substantial proportion of congenital cardiac malformations are detected after discharge from hospital after birth. Some patients with these lesions present with cardiac decompensation and are in need of medication and surgery. One clinical examination of newborns detects congenital malformations of the heart as efficient as two.

Quality of life was measured in children with congenital heart defects (CHDs) registered in a total population of infants born live in the period 1982-91 (n = 22,810), using essential life spheres: external living conditions, interpersonal and personal conditions. In 200 children with CHD alive at the time the investigation was performed, 164 (82%) of the families answered a questionnaire addressing different dimensions of these quality of life spheres. Three subgroups of CHDs were investigated: CHDs spontaneously cured (n = 80), CHDs treated by surgery (n = 56), and CHDs with associated syndromes/malformations (n = 29). 301 (75%) out of 400 controls, matched for age and habitat (county), answered the same questionnaire. The children's ages at investigation were 2 y 2 months-12 y 2 months (median 6 y 1 month). There were no statistically significant differences between the CHD groups and the controls for overall quality of life for any of the three life spheres (p > 0.05). In children with operated CHDs and CHDs associated with syndromes/malformations, quality of life was influenced at some aspects of the external as well as at the interpersonal and personal levels. A trend existed for a higher subjective experience of quality of life in the total CHD group as well as in all the subgroups. It is speculated that this may represent development of coping mechanisms and recalibration of values of life.

The hypothesis that early diagnosis of a ventricular septal defect (VSD) with spontaneous closure later on may impair the parental-infant bonding process, with consequences for the child's quality of life in the longer term, was tested in 51 children born in 1986-1991 (gestational ageor = 37-42 weeks) with VSDs diagnosed in the early neonatal period and closing spontaneously during the first 24 months of life. The results were compared to 83 healthy controls matched for gestational age, time and place of birth. A method (questionnaire) taking into consideration the quality of life spheres of external living conditions and the interpersonal and personal conditions of the child was used. Except for a lower satisfaction with family network in the VSD group (p0.05), no differences were found between the VSD group and the controls for any of the parameters tested or for overall quality of life (p0.05).

The interesting article by Hodgman et al 1 published in the September 1993 issue of AfDC documents transient episodes of bradycardia of 60 to 70 beats per minute as a common finding in preterm and term infants during the first weeks of life. The exact mechanisms responsible for these episodes are not completely understood; however, the authors consider them to be normal reflex responses. In our neonatal unit, continuous monitoring of heart rhythms and breathing movements is routine in sick infants as well as in preterm infants in stable condition during the first weeks of life. The equipment used (Diascope 2, S&W Medico Teknik A/S, Albertslund, Denmark) includes automatic recording on paper of the electrocardiographic pattern with a 4-second memory function for episodes when the heart rate moves outside preset limits. Transient episodes of bradycardia lasting 5 to 20 seconds are frequently registered, in accordance with the observations of Hodgman et

250 Health Promoting Effects of a Family Focused Care Programme in a Norwegian Neonatal Intensive Care Unit

In a prospective randomized study 2 different regimens for umbilical disinfection in newborn infants were tested: (i) a bandage of hydrophobic material (Sorbact; n = 1,213), and (ii) daily cleansing with 0.5% chlorhexidine in 70% ethanol (n = 1,228). Infections were registered in the nursery as well as after discharge until 6 weeks of age, and bacterial cultures taken from infected areas. A total of 410 infections were registered in 377 (15.4%) of the 2,441 infants. Total infection rates of 16.3 and 14.6% were found in the hydrophobic material group and the chlorhexidine-ethanol group respectively (p greater than 0.05). No differences were found between the groups in infection rates in the nursery (8.9 vs. 8.7%), after discharge (7.4 vs. 5.9%), or in rates of different types of infections (conjunctivitis, pyoderma, paronychia, omphalitis) (p greater than 0.05). 536 strains were isolated. 498 (92.9%) were gram-positive, 45 (8.4%) gram-negative, and 7 (1.3%) candida strains. 229 (55.9%) were Staphylococcus aureus strains. No differences were found between the two groups concerning distribution of the different strains isolated. Separation of the umbilical cord occurred significantly later in the hydrophobic material group than in the chlorhexidine-ethanol group (6.2 +/- 2.2 vs. 5.8 +/- 2.1 days; p less than 0.05). Hydrophobic material does not prevent infections more effectively compared to 0.5% chlorhexidine in 70% alcohol.

In forty-five children the hypoxanthine concentration in cerebrospinal fluid (CSF) was measured (fifty-two samples). In newborn infants (nineteen patients) the hypoxanthine levels were higher in patients with clinical conditions associated with hypoxia (idiopathic respiratory distress syndrome, asphyxia, apneic attacks) than in patients without clinical hypoxia (P less than 0.01). In hypoxic patients the hypoxanthine concentration varied between 5 and 28 mu mol/l. In children outside the neonatal period the hypoxanthine concentration in CSF varied considerably in different diseases. High levels were registered in meningitis prior to treatment, febrile convulsions and in lymphoblastic leukaemia, probably reflecting tissue hypoxia and an increased tissue catabolism.

Uromucoid (Tamm-Horsfall's mucoprotein) was not detected in amniotic fluid from pregnancies with gestational are 12-18 weeks, but was detected in 5 of 9 samples of amniotic fluid from full-term pregnancies, and in urine from all full-term infants investigated 1st day of life. This suggests that uromucoid excretion under normal conditions established near term. Change from intrauterine to extrauterine life may rapidly induce uromucoid excretion, as this protein was found in premature infants (32-34 weeks of gestation) at the 2nd day of life. Healthy newborn infants had a lower uromucoid concentration in urine than children 7--13 years old. In newborns with uncomplicated prematurity, idiopathic respiratory distress syndrome and full-term asphyxiated newborns, the uromucoid concentration in urine during the 1st week of life was not different from healthy newborn infants. Though uromucoid is found to be the major constituent of hyaline casts, the excretion of casts did not correlate to the uromucoid concentration.

In a prospective randomized study different regimens for skin and umbilical disinfection in newborn infants were tested: daily whole body soap wash (control group), daily whole body soap wash and umbilical cleansing with (i) benzine solution, or (ii) 0.05% chlorhexidine, and daily whole body wash and umbilical cleansing with a 4% chlorhexidine detergent solution (Hibiscrub). Bacterial cultures were taken from the nose and umbilical area at discharge. Clinical infections were registered in the nursery, and after discharge until 6 weeks of age. Cultures were taken from infected areas. In the control group a high colonization rate was found for S. aureus (91%), E. coli (39%), and group B streptococci (GBS) (20%). The colonization rates were influenced by the Hibiscrub regimen (colonization rate for S. aureus 59%, E. coli 23%, and GBS 10%), but not by the other regimens. Infections (pemphigus, paronychia, conjunctivitis, umbilical infection) occurred in 12.9% of the infants, of whom 65% got infection after discharge from the nursery. 96% of the infections were caused by S. aureus, and 87% caused by strains colonizing the infants in the nursery. None of the tested regimens reduced the rate of infections during the first 6 weeks of life.

Meberg, A., Haga, P., Sande, H. and Foss, O. P. (Departments of Paediatrics, Obstetrics and Gynaecology, Clinical Chemistry and Pathology, Ulleval Hospital, Oslo, Norway). Smoking during pregnancy—hematological observations in the newborn. Acta Paediatr Scand, 68: 731, 1979.—Hematological values were measured in 28 newborn infants of mothers smoking 10–20 cigarettes daily during pregnancy, and in 25 infants of non-smokers. Higher hematocrit levels were found on the 1st day of life in infants of smoking mothers (60.8±5.0%, mean ±S.D.) compared to controls (57.5±4.8%) (p

Fourteen infants with birth weight appropriate for gestational age (AGA) and 16 small for gestational age (SGA) infants were investigated for haemoglobin concentration, haematocrit level and thrombocyte count on the first day of life. Cord serum was tested for erythropoietin (ESF) and thrombopoietin (TSF) activity. The same investigations were performed on venous blood and serum from 18 healthy adult individuals. SGA infants had higher haemoglobin concentration and haematocrit level (p less than 0.05), and lower platelet count (p less than 0.001) than AGA infants. Significant ESF activity was present in cord serum, but was not detectable in serum from adults. Significant TSF activity was present in cord serum as well as in serum from adults, with higher levels in the newborn infants (p less than 0.05). An inverse relationship was found between serum TSF activity and the number of platelets in adults, which was not demonstrable in newborn infants. Long-term intrauterine hypoxia because of placental dysfunction may be the reason for polycythemia and thrombocytopenia in SGA infants. Thrombocytopenia may be caused by competitive mechanisms on common stem cells for erythropoiesis and thrombopoiesis, shunting stem cells in direction of erythropoiesis during hypoxic exposure. Normal serum TSF activity in SGA infants indicates that lack of the humoral factor for platelet production is not the reason for the thrombocytopenia in these infants. A negative feed-back mechanism may exist between platelet number and TSF production.

Summary: Pregnant mice were exposed to hypobaric hypoxia (0.7 atmospheres) continuously during days 13 to 20 of pregnancy. In the newborn offspring, the body weights were decreased, and liver weight/body weight ratios were increased compared to nonhypoxic control animals (P < 0.001). After intrauterine hypoxia, the newborn animals were polycythemic, and a postnatal transitory thrombocytopenia lasting 7 days occurred. A rebound thrombocytosis appeared on days 13 to 15 after birth. Bone marrow megacaryocyte concentrations were increased in the hypoxic animals on days 5 to 15 after birth compared to the nonhypoxic controls. These findings may be explained by a competitive mechanism on common stem cells. Increased demand for erythropoiesis during hypoxia may shunt hematopoietic cells in direction of erythropoiesis at expense of thrombopoiesis. Speculation: Common stem cells for crythopoiesis and megacaryopoicsis may exist. Increased demand for ervthropoiesis during long-term hypoxia may shunt hematopoietic cells in direction of ervthropoiesis at expense of thrombopoiesis. Placental dysfunction may impair oxygenation of the fetus, explaining the frequent occurring polycythemia and transitory postnatal thrombocytopenia in growth-retarded newborn human infants.

Infants delivered at term by mothers smoking at least 10 cigarettes daily during pregnancy (n = 46) were found to be growth retarded compared to infants of non-smoking mothers (n = 49), birthweights 3,445 +/- 385 (SD) g and 3,667 +/- 392 g respectively (p less than 0.05) in the two groups. Cord serum thyrotropin (TSH) was significantly decreased (8.2 +/- 4.0 U/l vs. 10.3 +/- 4.9 U/l) and free thyroxine index (FT4I)/TSH ratio significantly increased (18.8 +/- 9.0 vs. 14.4 +/- 7.6) (p less than 0.05) in the smoking group compared to infants of non-smokers. Cord serum thyroxine (T4) and FT4I were higher in the smoking group (149.0 +/- 22.4 nmol/l and 125.5 +/- 14.9 respectively) compared to infants of non-smoking mothers (140.6 +/- 21.6 nmol/l and 120.0 +/- 16.5 respectively), with borderline statistical significance (0.05 less than p less than 0.10). The results indicate that infants of smoking mothers may have a hyperfunction of the thyroid gland at birth compared to infants of non-smokers, with a negative feed-back on TSH production from the pituitary gland. Increased metabolic rate and oxygen consumption caused by fetal thyroid hyperfunction may be pathogenetic factors for the fetal growth retardation caused by maternal smoking.