74 results on '"Uwe Ewald"'
Search Results
2. Improved postnatal care is needed to maintain gains in neonatal survival after the implementation of the Helping Babies Breathe initiative
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Johan Wrammert, Uwe Ewald, Mats Målqvist, and Ashish Kc
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Adult ,Postnatal Care ,Pediatrics ,medicine.medical_specialty ,Resuscitation ,Psychological intervention ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Health facility ,Pregnancy ,Cause of Death ,030225 pediatrics ,Infant Mortality ,medicine ,Humans ,Prospective Studies ,030212 general & internal medicine ,Prospective cohort study ,Cause of death ,business.industry ,Neonatal survival ,Infant, Newborn ,Infant ,General Medicine ,Pediatrics, Perinatology and Child Health ,Female ,Neonatal death ,business ,Neonatal resuscitation - Abstract
Aim Helping Babies Breathe (HBB) is a neonatal resuscitation protocol proven to reduce intrapartum-related mortality in low-income settings. The aim of this study was to describe the timing and causes of neonatal in-hospital deaths before and after HBB training at a maternity health facility in Nepal. Methods A prospective cohort study was conducted at the facility between July 2012 and September 2013. All 137 staffs, including medical doctors and midwives, were trained in January 2013. The causes of 299 neonatal deaths and the day of death, up to 27 days, were collected before and after the training course. Results Deaths caused by intrapartum-related complications were reduced from 51% to 33%. Preterm infants survived for more days (p < 0.01) during the neonatal period, but overall in-hospital neonatal mortality was unchanged (p = 0.46) after training. The survival rates linked to complications of infection, congenital anomalies and other causes were unaffected by the intervention. Conclusion The continuum of postnatal care for newborn infants needs to be strengthened after Helping Babies Breathe training, to maintain the gains in neonatal survival on the day of delivery. Additional interventions in the postnatal period are therefore required to increase neonatal survival at facilities in low-income settings.
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- 2017
3. Scaling Up Safer Birth Bundle Through Quality Improvement in Nepal (SUSTAIN)—a stepped wedge cluster randomized controlled trial in public hospitals
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Bijay Kumar Jha, Prajwal Paudel, Johan Wrammert, Uwe Ewald, Jørgen E. Linde, Rejina Gurung, Mats Målqvist, Susheel Pyakurel, Ashish Kc, Honey Malla, Abhishek Gurung, Helena Litorp, Moinuddin, Manish Gautam, Srijana Sharma, Anjani Kumar Jha, Syed Moshfiqur Rahman, and Anna Axelin
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Quality management ,Resuscitation ,Psychological intervention ,Fetal heart rate monitoring ,Health Informatics ,Context (language use) ,Disease cluster ,Stepped wedge cluster randomized control trial ,law.invention ,03 medical and health sciences ,Study Protocol ,0302 clinical medicine ,Health facility ,Randomized controlled trial ,Nepal ,law ,Pregnancy ,Basic neonatal resuscitation ,Infant Mortality ,medicine ,Humans ,030212 general & internal medicine ,Developing Countries ,Monitoring, Physiologic ,lcsh:R5-920 ,business.industry ,Hospitals, Public ,030503 health policy & services ,Health Policy ,Public Health, Environmental and Occupational Health ,Health services research ,Infant, Newborn ,Infant ,Public Health, Global Health, Social Medicine and Epidemiology ,Quality improvement interventions ,General Medicine ,medicine.disease ,Quality Improvement ,Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi ,Perinatal Care ,Maternal Mortality ,Female ,Medical emergency ,lcsh:Medicine (General) ,0305 other medical science ,business ,Neonatal resuscitation ,Patient Care Bundles - Abstract
Background Each year, 2.2 million intrapartum-related deaths (intrapartum stillbirths and first day neonatal deaths) occur worldwide with 99% of them taking place in low- and middle-income countries. Despite the accelerated increase in the proportion of deliveries taking place in health facilities in these settings, the stillborn and neonatal mortality rates have not reduced proportionately. Poor quality of care in health facilities is attributed to two-thirds of these deaths. Improving quality of care during the intrapartum period needs investments in evidence-based interventions. We aim to evaluate the quality improvement package—Scaling Up Safer Bundle Through Quality Improvement in Nepal (SUSTAIN)—on intrapartum care and intrapartum-related mortality in public hospitals of Nepal. Methods We will conduct a stepped wedge cluster randomized controlled trial in eight public hospitals with each having least 3000 deliveries a year. Each hospital will represent a cluster with an intervention transition period of 2 months in each. With a level of significance of 95%, the statistical power of 90% and an intra-cluster correlation of 0.00015, a study period of 19 months should detect at least a 15% change in intrapartum-related mortality. Quality improvement training, mentoring, systematic feedback, and a continuous improvement cycle will be instituted based on bottleneck analyses in each hospital. All concerned health workers will be trained on standard basic neonatal resuscitation and essential newborn care. Portable fetal heart monitors (Moyo®) and neonatal heart rate monitors (Neobeat®) will be introduced in the hospitals to identify fetal distress during labor and to improve neonatal resuscitation. Independent research teams will collect data in each hospital on intervention inputs, processes, and outcomes by reviewing records and carrying out observations and interviews. The dose-response effect will be evaluated through process evaluations. Discussion With the global momentum to improve quality of intrapartum care, better understanding of QI package within a health facility context is important. The proposed package is based on experiences from a similar previous scale-up trial carried out in Nepal. The proposed evaluation will provide evidence on QI package and technology for implementation and scale up in similar settings. Trial registration number ISRCTN16741720. Registered on 2 March 2019.
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- 2019
4. Effectiveness and Acceptability of Bag-and-mask Ventilation with Visual Monitor for Improving Neonatal Resuscitation in Simulated Setting in Six Hospitals of Nepal
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Omkar Basnet, Rejina Gurung, Abhishek Gurung, Ashish Kc, Uwe Ewald, and Priyanka Rajbhandari
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Resuscitation ,medicine.medical_specialty ,Inservice Training ,Manikins ,law.invention ,Nepal ,law ,Medicine ,Humans ,Health worker ,Positive end-expiratory pressure ,Tidal volume ,Asphyxia Neonatorum ,Mask ventilation ,Cross-Over Studies ,business.industry ,Hospitals, Public ,Infant, Newborn ,General Medicine ,Equipment Design ,Quality Improvement ,Cardiopulmonary Resuscitation ,Perinatal Care ,Ventilation (architecture) ,Emergency medicine ,Clinical Competence ,business ,Clinical evaluation ,Neonatal resuscitation - Abstract
Aim: The first minute or the “Golden MinuteSM” is crucial to save 10 million newborns who do not breathe at birth through effective newborn resuscitation. Improving the performance of health workers on neonatal resuscitation will be critical to ensure that the babies are effectively ventilated. We conducted a study to evaluate whether a bag-and-mask ventilation with monitor is effective in improving neonatal resuscitation practice in a simulated setting. Methods: This is a cross-over design conducted in 6 public hospitals with 82 health workers of Nepal nested over the large scale stepped wedged quality improvement project. A standard one-day training on neonatal resuscitation was conducted. At the end of the training, participants were evaluated on the bag-and-mask ventilation performance in a manikin. Neonatal resuscitation performance was evaluated based on the tidal volume, positive end expiratory pressure and air leakage from the mask displayed in the monitor. The evaluation was done in two sessions of neonatal resuscitation performance in the manikin. In one session with the monitor displayed to health workers and other session without the monitor displayed to health worker. The comparison of the neonatal resuscitation performance with and without monitor displayed is calculated. We also conducted assessment of confidence with or without monitor of the health workers. Result: Adequacy of ventilation using bag-and-mask was improved when the health workers were displayed monitor (90%) vs without monitor (76%) (p
- Published
- 2018
5. Parents' presence and parent-infant closeness in 11 neonatal intensive care units in six European countries vary between and within the countries
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Sylvia Caballero, Liisa Lehtonen, Bente Silnes Tandberg, Anna Axelin, Rosario Montirosso, Björn Westrup, Simo Raiskila, Liis Toome, Erik Normann, Boubou Hallberg, and Uwe Ewald
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Parents ,Pediatrics ,medicine.medical_specialty ,health care facilities, manpower, and services ,Closeness ,Skin-to-skin care ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,Intensive care ,Intensive Care Units, Neonatal ,Medicine ,Humans ,030212 general & internal medicine ,ta316 ,Kangaroo care ,Parenting ,business.industry ,Singleton ,Infant, Newborn ,Gestational age ,Pediatrik ,Preterm infants ,Regular Article ,Family-centred care ,General Medicine ,ta3123 ,Skin‐to‐skin care ,Europe ,Family‐centred care ,Single-family room parent-infant closeness ,Single‐family room parent–infant closeness ,Pediatrics, Perinatology and Child Health ,Infant Care ,Neonatology ,business ,Regular Articles ,Demography - Abstract
Aim Little is known about the amount of physical parent-infant closeness in neonatal intensive care units (NICUs) and this study explored that issue in six European countries. Methods The parents of 328 preterm infants were recruited in 11 NICUs in Finland, Estonia, Sweden, Norway, Italy and Spain. They filled in daily diaries about how much time they spent in the NICU, in skin-to-skin contact (SSC) and holding their babies in the first two weeks of their hospitalisation. Results The parents’ NICU presence varied from a median of 3.3 (minimum 0.7- maximum 6.7) to 22.3 (18.7-24.0) hours per day (p
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- 2017
6. First-time events between parents and preterm infants are affected by the designs and routines of neonatal intensive care units
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Maria Gradin, Christine Rubertsson, Uwe Ewald, Kerstin Hedberg Nyqvist, Ylva Thernström Blomqvist, and Rebecca Baylis
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Male ,medicine.medical_specialty ,Neonatal intensive care unit ,Parenting ,business.industry ,Delivery Rooms ,Infant, Newborn ,General Medicine ,Parental bonding ,Kangaroo-Mother Care ,Intensive Care Units, Neonatal ,Intensive care ,Pediatrics, Perinatology and Child Health ,medicine ,Humans ,Female ,Intensive care medicine ,business ,Infant, Premature - Abstract
Early parental bonding with preterm babies is particularly important, and the aim of our study was to explore when parents experienced what they regarded as important events for the first time while their infant was in the neonatal intensive care unit (NICU).The study was part of a longitudinal project on Kangaroo Mother Care at two Swedish university hospitals. The parents of 81 infants completed questionnaires during their infants' hospital stay.Most parents saw and touched their infants immediately after birth, but only a few could hold them skin to skin or swaddle them. Other important events identified by parents included the first time they performed care giving activities and did so independently, interaction and closeness with the infant, signs of the infant's recovery and integration into the family. The timing of the events depended on the physical design of the NICU, whether parents' could stay with their infant round-the-clock and when they were allowed to provide care under supervision and on their own.The design and routines of the NICU dictated when parents first interacted with their infants. Clinical guidelines that facilitate early contact with preterm babies can help parents to make the transition to their parental role.
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- 2014
7. Health consequences of prophylactic exposure to antenatal corticosteroids among children born late preterm or term
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Lena Eriksson, Viveca Odlind, Bengt Haglund, Uwe Ewald, and Helle Kieler
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Pediatrics ,medicine.medical_specialty ,Health consequences ,business.industry ,Late preterm ,Obstetrics and Gynecology ,Medicine ,Observational study ,General Medicine ,Antenatal corticosteroid ,business ,Term (time) ,Cohort study - Abstract
Objective. To investigate the duration of effects and health consequences of earlier antenatal corticosteroid exposure in infants born late preterm or term. Design. Observational cohort study. Sett ...
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- 2012
8. Closeness and separation in neonatal intensive care
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Fiona Dykes, Gill Thomson, Sari Ahlqvist, Renée Flacking, Liisa Lehtonen, Uwe Ewald, Victoria Hall Moran, and Anna Axelin
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Parents ,Pediatrics ,medicine.medical_specialty ,Brain development ,Neonatal intensive care unit ,Hydrocortisone ,media_common.quotation_subject ,Closeness ,Infant behaviour ,Developmental psychology ,Intensive care ,Affection ,Kangaroo-Mother Care Method ,Neonatal ,Intensive Care Units, Neonatal ,Medicine ,Humans ,Family ,Parent-Child Relations ,Object Attachment ,Review Articles ,media_common ,Brain Chemistry ,business.industry ,Infant, Newborn ,Brain ,Preterm birth ,General Medicine ,Feeling ,Touch ,Pediatrics, Perinatology and Child Health ,Health Facility Environment ,Intensive Care, Neonatal ,Power, Psychological ,business ,Infant, Premature - Abstract
In this paper, we highlight the need for acknowledging the importance and impact of both physical and emotional closeness between the preterm infant and parent in the neonatal intensive care unit. Physical closeness refers to being spatially close and emotional closeness to parental feelings of being emotionally connected to the infant (experiencing feelings of love, warmth and affection). Through consideration of the literature in this area, we outline some of the reasons why physical closeness and emotional closeness are crucial to the physical, emotional and social well-being of both the infant and the parent. These include positive effects on infant brain development, parent psychological well-being and on the parent–infant relationship. The influence of the neonatal unit environment and culture on physical and emotional closeness is also discussed. Conclusions: Culturally sensitive care practices, procedures and the physical environment need to be considered to facilitate parent–infant closeness, such as through early and prolonged skin-to-skin contact, family-centred care, increased visiting hours, family rooms and optimization of the space on the units. Further research is required to explore factors that facilitate both physical and emotional closeness to ensure that parent–infant closeness is a priority within neonatal care.
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- 2012
9. Causes of neonatal death: results from NeoKIP community-based trial in Quang Ninh province, Vietnam
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Mats Målqvist, Lars Åke Persson, Nguyen Thu Nga, Dinh Thi Phuong Hoa, and Uwe Ewald
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Community based ,Pediatrics ,medicine.medical_specialty ,Neonatal mortality ,business.industry ,Birth weight ,Age at death ,General Medicine ,Verbal autopsy ,Pediatrics, Perinatology and Child Health ,medicine ,Neonatal death ,business ,Demography - Abstract
Aim: To ascertain the causes of neonatal death in a province in northern Vietnam and analyse their distribution over age at death, birth weight and place of delivery.Methods: Verbal autopsy inter ...
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- 2011
10. Development of smooth pursuit eye movements in very preterm born infants: 3. Association with perinatal risk factors
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Katarina Strand Brodd, Helena Grönqvist, Kerstin Rosander, Gerd Holmström, Uwe Ewald, and Erik Grönqvist
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Very preterm ,medicine.medical_specialty ,business.industry ,Obstetrics ,Pediatrics, Perinatology and Child Health ,Perinatal risk ,Medicine ,General Medicine ,Association (psychology) ,business ,Smooth pursuit - Abstract
Aim: To investigate the association between perinatal risk factors and neonatal complications and early oculo-motor development in very preterm infants. Methods: Perinatal risk factors were ident ...
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- 2011
11. Development of smooth pursuit eye movements in very preterm infants: 1. General aspects
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Claes von Hofsten, Katarina Strand-Brodd, Bo Strömberg, Kerstin Rosander, Uwe Ewald, Gerd Holmström, Erik Grönqvist, and Helena Grönqvist
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Pediatrics ,medicine.medical_specialty ,education.field_of_study ,business.industry ,Population ,Case-control study ,Gestational age ,General Medicine ,Smooth pursuit ,Very preterm ,Sex factors ,Pediatrics, Perinatology and Child Health ,Cohort ,Medicine ,business ,Prospective cohort study ,education - Abstract
Aim: To investigate early oculo-motor development in a population-based cohort of very preterm infants.Methods: Early oculo-motor development was prospectively studied by measuring smooth pursuit ...
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- 2011
12. Perinatal services and outcomes in Quang Ninh province, Vietnam
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Annika Johansson, Lars Åke Persson, Mats Målqvist, Leif A. Eriksson, Dinh Thi Phuong Hoa, Uwe Ewald, Lars Wallin, and Nguyen Thu Nga
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education.field_of_study ,business.industry ,Neonatal mortality ,Neonatal survival ,Population ,Primary health care ,Perinatal care ,General Medicine ,Health services ,Nursing ,Recien nacido ,Pediatrics, Perinatology and Child Health ,Community health workers ,Medicine ,Socioeconomics ,business ,education - Abstract
Aim: We report baseline results of a community-based randomized trial for improved neonatal survival in Quang Ninh province, Vietnam (NeoKIP; ISRCTN44599712). The NeoKIP trial seeks to evaluate a m ...
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- 2010
13. State of the art and recommendationsKangaroo mother care: application in a high-tech environment
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A Cattaneo, Nathalie Charpak, Nils J. Bergman, Kerstin Hedberg Nyqvist, Peláez Jg, Susan M. Ludington-Hoe, Ann-Marie Widström, C. Pallas-Allonso, J. Sizun, Gene Cranston Anderson, Uwe Ewald, Riccardo Davanzo, and Sergio Mendoza
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Pediatrics ,medicine.medical_specialty ,Nursing ,Project commissioning ,business.industry ,Publishing ,Pediatrics, Perinatology and Child Health ,medicine ,MEDLINE ,General Medicine ,business ,Kangaroo-Mother Care - Abstract
Since Kangaroo Mother Care (KMC) was developed in Colombia in the 1970s, two trends in clinical application emerged. In low-income settings, the original KMC modelis implemented. This consists of c ...
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- 2010
14. Incidence of and risk factors for neonatal morbidity after active perinatal care: extremely preterm infants study in Sweden (EXPRESS)
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Ann Hellström, Gerd Holmström, Vineta Fellman, Lena Hellström-Westas, Hugo Lagercrantz, Ricardo Laurini, Karin Källén, Marija Simic, Uwe Ewald, Annika Jeppsson, Ingrid Oestlund, Lennart Stigson, Dordi Austeng, Solveig Nordén-Lindeberg, Gunnar Sjörs, Peter Jakobsson, Thomas Fritz, Elisabeth Olhager, Kristina Tornqvist, Eva Lindberg, Fredrik Serenius, Mikael Norman, Agneta Wallin, Kent Johansson, Bo Strömberg, M Wennergren, Tore Nilstun, Karel Marsal, Anita Lundqvist, Mats Blennow, Karin Stjernqvist, Magnus Westgren, and Per Holmgren
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Mechanical ventilation ,congenital, hereditary, and neonatal diseases and abnormalities ,Pediatrics ,medicine.medical_specialty ,Obstetrics ,business.industry ,medicine.medical_treatment ,CPVL ,Gestational age ,Retinopathy of prematurity ,General Medicine ,medicine.disease ,Lower risk ,Bronchopulmonary dysplasia ,Intensive care ,Pediatrics, Perinatology and Child Health ,Necrotizing enterocolitis ,medicine ,business - Abstract
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 >= 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.
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- 2010
15. The influence of fathers’ socioeconomic status and paternity leave on breastfeeding duration: A population-based cohort study
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Fiona Dykes, Uwe Ewald, and Renée Flacking
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Male ,Pediatrics ,medicine.medical_specialty ,Time Factors ,Population ,Breastfeeding ,Cohort Studies ,Fathers ,Humans ,Medicine ,Prospective Studies ,Prospective cohort study ,education ,Socioeconomic status ,Sweden ,education.field_of_study ,business.industry ,Infant, Newborn ,Public Health, Environmental and Occupational Health ,Infant ,General Medicine ,Parental Leave ,Breast Feeding ,Socioeconomic Factors ,Educational Status ,Household income ,Female ,Parental leave ,business ,Breast feeding ,Demography ,Cohort study - Abstract
Aim: The propensity to breastfeed is a matter of public concern because of the favourable effects for infants. However, very few studies have described the influence of paternal variables upon duration of breastfeeding. The aim of this study was to describe the effects of fathers’ socioeconomic status and their use of paternity leave on breastfeeding duration for infants up to 1 year of age. Methods: A prospective population-based cohort study was undertaken. Data on breastfeeding, registered in databases in two Swedish counties for 1993—2001, were matched with data on socioeconomic status and paternity leave obtained from Statistics Sweden. Fathers of 51,671 infants were identified and included. Results: Infants whose fathers had a lower level of education, were receiving unemployment benefit and/or had a lower equivalent disposable household income were significantly less likely to be breastfed at 2, 4, 6, 9, and 12 months of age. Infants whose fathers did not take paternity leave during the infant’s first year were significantly less likely to be breastfed at 2 (p < 0.001), 4 (p < 0.001), and 6 months (p < 0.001). Conclusions: This paper shows that an enabling of an increased involvement from fathers during the infants’ first year of life, such as by paid paternity leave, may have beneficial effects on breastfeeding up to 6 months of age. A more systematic approach to supporting fathers’ involvement may be particularly valuable to those infants whose fathers have a lower socioeconomic status.
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- 2010
16. Neurodevelopmental Outcome in Extremely Preterm Infants at 2.5 Years After Active Perinatal Care in Sweden
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Mats Blennow, Pia Lundqvist, Fredrik Serenius, Eva Lindberg, Karel Marsal, Mikael Norman, Karin Källén, Lennart Stigson, Elisabeth Olhager, Vineta Fellman, Gerd Holmström, Bo Strömberg, Brigitte Vollmer, Uwe Ewald, and Karin Stjernqvist
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Pediatrics ,medicine.medical_specialty ,Obstetrics ,business.industry ,Extremely preterm ,education ,Perinatal care ,medicine ,Obstetrics and Gynecology ,General Medicine ,business - Abstract
Neurodevelopmental Outcome in Extremely Preterm Infants at 2.5 Years After Active Perinatal Care in Sweden EDITORIAL COMMENT
- Published
- 2013
17. Postnatal peer counselling on exclusive breastfeeding of low-birthweight infants: A randomized, controlled trial
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Grace V. Agrasada, Uwe Ewald, Jan Gustafsson, and Elisabeth Kylberg
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Pediatrics ,medicine.medical_specialty ,Pregnancy ,business.industry ,Birth weight ,education ,Breastfeeding ,Peer group ,General Medicine ,medicine.disease ,law.invention ,Clinical trial ,Low birth weight ,Randomized controlled trial ,law ,Pediatrics, Perinatology and Child Health ,medicine ,medicine.symptom ,business ,Breast feeding ,reproductive and urinary physiology - Abstract
Postnatal peer counselling on exclusive breastfeeding of low-birthweight infants : a randomized, controlled trial.
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- 2007
18. Serum amyloid A (SAA) protein and high-sensitivity C-reactive protein (hsCRP) in healthy newborn infants and healthy young through elderly adults
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Anders Lannergård, Uwe Ewald, Göran Friman, Anders Larsson, and Lars Lind
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medicine.medical_specialty ,biology ,business.industry ,C-reactive protein ,SAA protein ,Acute-phase protein ,General Medicine ,Serum samples ,Endocrinology ,Internal medicine ,Pediatrics, Perinatology and Child Health ,biology.protein ,Medicine ,Elderly adults ,Serum amyloid A ,Young adult ,business ,Serum Amyloid A Protein - Abstract
AIM:To determine the levels of serum amyloid A (SAA) protein and high-sensitivity C-reactive protein (hsCRP) in different age groups.METHODS:Serum samples from 70 healthy newborn infants, 80 blood ...
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- 2007
19. Appropriate prophylaxis with restrictive palivizumab regimen in preterm children in Sweden
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Lars Navér, Uwe Ewald, Magnus Lindroth, A. Linde, Jens Schollin, and Margareta Eriksson
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Palivizumab ,Pediatrics ,medicine.medical_specialty ,medicine.medical_treatment ,Infant, Premature, Diseases ,Respiratory Syncytial Virus Infections ,Antibodies, Monoclonal, Humanized ,Antiviral Agents ,Pneumovirinae ,medicine ,Humans ,Prospective Studies ,Prospective cohort study ,Sweden ,Mechanical ventilation ,Pregnancy ,business.industry ,Infant, Newborn ,Antibodies, Monoclonal ,General Medicine ,medicine.disease ,Hospitalization ,Regimen ,El Niño ,Practice Guidelines as Topic ,Pediatrics, Perinatology and Child Health ,Gestation ,business ,Infant, Premature ,medicine.drug - Abstract
AIM: Palivizumab (Synagis) was registered in Sweden in 1999 for prophylaxis against respiratory syncytial virus (RSV) in premature infants. The high costs and the limited knowledge of the efficacy of this substance have led to debate about how and when it should be used. National guidelines for the use of palivizumab in Sweden were constructed in the year 2000. The aim of this study was to evaluate the guidelines. METHODS: A nation-wide prospective study was conducted during the two RSV seasons of the years 2000-2002. The paediatric departments in Sweden reported the use of palivizumab, the indication for its use, and the number of infants born preterm before 36 wk of gestation and less than 2 y old who were admitted to hospital for RSV infection. RESULTS: During the two seasons, 218 (3.8%) children who were born before 36 wk of gestation, and 97 (5.4%) who were born before 33 wk, were hospitalized because of RSV infection. Five children were treated with mechanical ventilation. No death caused by RSV was reported. A total of 390 children were treated with palivizumab, and 16 (4.1%) of those who received prophylactic treatment were admitted to hospital with RSV infection. CONCLUSION: We consider the comparatively restrictive Swedish recommendations to be safe and recommend that palivizumab should also be used very restrictively in the future. In our opinion, palivizumab in preterm children could be recommended only for those with chronic lung disease younger than 1 y of age, and with active treatment for their disease.
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- 2007
20. Early oral behaviour in preterm infants during breastfeeding: an electromyographic study
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K Hedberg Nyqvist, C Farnstrand, K. Edebol Eeg-Olofsson, and Uwe Ewald
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,High intensity ,Breastfeeding ,Orbicularis oris muscle ,Direct observation ,General Medicine ,Electromyography ,Audiology ,Surgery ,body regions ,Breastfeeding behaviour ,fluids and secretions ,stomatognathic system ,Pediatrics, Perinatology and Child Health ,Medicine ,business ,Mouthing ,Breast feeding - Abstract
UNLABELLED The objectives were to increase the understanding of the characteristics of oral behaviour during breastfeeding in preterm infants and to validate direct observations of infant sucking. Twenty-six infants were investigated once by simultaneous observation and surface electromyography (EMG) at 32.1-37.1 postmenstrual weeks. The orbicularis oris muscle was used for data analysis, as it provided the most distinct registrations. High correlation coefficients were observed with respect to classifications of EMG data by two raters on the number of sucks per burst (r = 0.97) and duration of sucking bursts (r = 0.99). The agreement between direct observations of sucking and EMG data was high. The median for mean number of sucks per burst was 8 (range 2-33) and for longest burst 28 (5-96) sucks. Sucks with low and very high intensity constituted a median of 14 (1-94)% and 25 (0-87)% of all sucks. The range in mean sucking frequency was 1.0-1.8 sucks s(-1). Suck duration ranged from 0.6 to 1.1 s. There was a considerable variation between infants in the extent of mouthing. No association with maturational level appeared for any of the components in oral behaviour. CONCLUSION EMG data provided evidence of early sucking competence in preterm infants during breastfeeding, with wide individual variations. Surface EMG and direct observation are recommended as valid methods in the evaluation of breastfeeding behaviour in preterm infants.
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- 2007
21. Energy substrate production in infants born small for gestational age
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Barbro Diderholm, Jan Gustafsson, Uwe Ewald, and Fredrik Ahlsson
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Blood Glucose ,Glycerol ,Male ,medicine.medical_specialty ,Lipolysis ,Radioimmunoassay ,Glucose production ,Internal medicine ,Humans ,Insulin ,Medicine ,Insulin-Like Growth Factor I ,Radioactive Tracers ,business.industry ,Obstetrics ,Gluconeogenesis ,Infant, Newborn ,General Medicine ,Glucagon ,medicine.disease ,Infant newborn ,Insulin-Like Growth Factor Binding Protein 1 ,Endocrinology ,Recien nacido ,Infant, Small for Gestational Age ,Pediatrics, Perinatology and Child Health ,Small for gestational age ,Female ,business - Abstract
To investigate energy substrate production and its hormonal regulation in infants born small for gestational age.Eleven infants, aged 24.4 +/- 5.3 hour, were studied following a fast of 4.0 +/- 0.6 hour. Gestational age was 35.4 +/- 2.8 weeks and birth weight 1804 +/- 472 g (-2 SD). Rates of glucose production and lipolysis were analyzed using [6,6-(2)H(2)]-glucose and [2-(13)C]-glycerol.Plasma levels of glucose and glycerol were 4.1 +/- 1.1 mmol x L(-1) and 224 +/- 79 micromol x L(-1), respectively. Glucose appearance averaged 30.3 +/- 8.2 and glucose production rate 21.1 +/- 6.1 micromol x kg(-1) x minutes(-1). Glycerol production rate was 5.6 +/- 1.6 micromol x kg(-1) x minutes(-1), correlating strongly to birth weight (r = 0.904, p0.001). Of the glycerol produced, 55 +/- 22% was converted to glucose, corresponding to 8 +/- 3% of the glucose production.Even though the infants could produce energy substrates, lipolysis was reduced and the glucose production was in the low end of the normal range compared with infants born appropriate for gestational age. The correlation between glycerol production and birth weight indicates that lipolysis depends on the amount of stored fat. Data on insulin and insulin-like growth factor binding protein 1 support the view that insulin sensitivity in these infants is reduced in the liver but increased peripherally.
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- 2007
22. Litmus tests for verification of feeding tube location in infants: evaluation of their clinical use
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Annette Sorell, Kerstin Hedberg Nyqvist, and Uwe Ewald
- Subjects
Parents ,Validation study ,Pediatrics ,medicine.medical_specialty ,medicine.medical_treatment ,Gestational Age ,Suction ,Sensitivity and Specificity ,Enteral Nutrition ,Clinical Protocols ,Predictive Value of Tests ,Neonatal Nursing ,medicine ,Humans ,Intubation ,Intubation, Gastrointestinal ,Feeding tube ,Nursing Assessment ,General Nursing ,Reagent Strips ,Evidence-Based Medicine ,Reagent strip ,business.industry ,Age Factors ,Infant ,Gastric Acidity Determination ,General Medicine ,Hydrogen-Ion Concentration ,Community Health Nursing ,Home Care Services ,Litmus ,Nursing Evaluation Research ,Auscultation ,Predictive value of tests ,business - Abstract
To examine the clinical use of litmus paper tests for the assessment of aspirates in infants.In connection with establishing a programme for home care of infants with requirement of tube feeding with parents as the infants' carers, the need for a research-based method for verification of feeding tube position was identified by nurses as a complement to other methods. In adult care the litmus paper test is commonly used when visual inspection is not sufficient for assessment of aspirates obtained from feeding tubes.Observational study.Nurses performed litmus tests for verification of feeding tube location in a convenience sample of 60 infants born at a gestational age (GA) of 24-42 weeks. Presence/absence and volumes of aspirates were recorded as well as positive/negative litmus test reactions. Analyses on the association between test results and the infants' GA and postmenstrual and postnatal age at the time of the tests were conducted.Data were obtained from 2970 tube feeds. Aspirates were present on 1840 occasions (62%). A higher proportion of infants with absence of aspirates were born at a GA below 32 weeks. A positive reaction occurred in 97% of the tests in volumes between 0.01 and 22 ml. Birth at a GA below 32 weeks and respiratory problems were associated with negative tests.The high ratio of positive litmus reactions at all maturational levels supports the bedside use of analysis of pH in gastric aspirates for verification of feeding tube location.Application of pH indicator paper is recommended as a complementary method for assessment of aspirates from feeding tubes.
- Published
- 2005
23. Short-term outcome after active perinatal management at 23-25 weeks of gestation. A study from two Swedish perinatal centres. Part 3: neonatal morbidity
- Author
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Fredrik Serenius, Aijaz Farooqi, Gunnar Sedin, P A Holmgren, Stellan Håkansson, and Uwe Ewald
- Subjects
medicine.medical_specialty ,Pediatrics ,Developmental stage ,business.industry ,Medical record ,Gestational age ,General Medicine ,Neonatal morbidity ,Intensive care ,Recien nacido ,mental disorders ,Pediatrics, Perinatology and Child Health ,Epidemiology ,medicine ,Gestation ,business - Abstract
AIM: To determine major neonatal morbidity in surviving infants born at 23-25 weeks, and to identify maternal and infant factors associated with major morbidity. METHODS: The medical records of 224 ...
- Published
- 2004
24. Short-term outcome after active perinatal management at 23-25 weeks of gestation. A study from two Swedish tertiary care centres. Part 2: infant survival
- Author
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Aijaz Farooqi, Gunnar Sedin, P A Holmgren, Stellan Håkansson, Fredrik Serenius, and Uwe Ewald
- Subjects
Pediatrics ,medicine.medical_specialty ,Pregnancy ,business.industry ,Neonatal survival ,Gestational age ,General Medicine ,medicine.disease ,Extremely Preterm Infant ,Tertiary care ,female genital diseases and pregnancy complications ,Intensive care ,Pediatrics, Perinatology and Child Health ,medicine ,Gestation ,Neonatal death ,business ,reproductive and urinary physiology - Abstract
AIM: To determine neonatal survival rates based on both foetal (stillborn) and neonatal deaths among infants delivered at 23-25 wk, and to identify maternal and neonatal factors associated with sur ...
- Published
- 2004
25. The rate of candidaemia in preterm infants born at a gestational age of 23-28 weeks is inversely correlated to gestational age
- Author
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H Johnsson and Uwe Ewald
- Subjects
Developmental stage ,Pediatrics ,medicine.medical_specialty ,biology ,business.industry ,Gestational age ,General Medicine ,medicine.disease ,biology.organism_classification ,Infant newborn ,Tasa ,Pediatrics, Perinatology and Child Health ,Medicine ,business ,Fungemia ,Mycosis - Abstract
The rate of candidaemia in preterm infants born at a gestational age of 23-28 weeks is inversely correlated to gestational age.
- Published
- 2004
26. Short-term outcome after active perinatal management at 23-25 weeks of gestation. A study from two Swedish tertiary care centres. Part 1: maternal and obstetric factors
- Author
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Gunnar Sedin, P A Holmgren, Aijaz Farooqi, Fredrik Serenius, Uwe Ewald, and Stellan Håkansson
- Subjects
Adult ,Pediatrics ,medicine.medical_specialty ,Time Factors ,Multivariate analysis ,Gestational Age ,Tertiary care ,Pregnancy ,Intensive care ,Humans ,Medicine ,Retrospective Studies ,Sweden ,business.industry ,Infant, Newborn ,Pregnancy Outcome ,Gestational age ,Retrospective cohort study ,General Medicine ,Delivery, Obstetric ,medicine.disease ,Extremely Preterm Infant ,Parity ,Logistic Models ,Pregnancy Trimester, Second ,Multivariate Analysis ,Pediatrics, Perinatology and Child Health ,Gestation ,Female ,business ,Infant, Premature ,Maternal Age - Abstract
To provide descriptive data on women who delivered at 23-25 wk of gestation, and to relate foetal and neonatal outcomes to maternal factors, obstetric management and the principal reasons for preterm birth.Medical records of all women who had delivered in two tertiary care centres in 1992-1998 were reviewed. At the two centres, policies of active perinatal and neonatal management were universally applied. Logistic regression models were used to identify prenatal factors associated with survival.Of 197 women who delivered at 23-25 wk, 65% had experienced a previous miscarriage, 15% a previous stillbirth and 12% a neonatal death. The current pregnancy was the result of artificial reproduction in 13% of the women. In 71%, the pregnancy was complicated either by pre-eclampsia, chorioamnionitis, placental abruption or premature rupture of membranes. Antenatal steroids were given in 63%. Delivery was by caesarean section in 47%. The reasons for preterm birth were idiopathic preterm labour in 36%, premature rupture of membranes in 41% and physician-indicated deliveries in 23% of the mothers. Demographic details, use of antenatal steroids, caesarean section delivery and birthweight differed between mothers depending on the reason for preterm delivery. Of 224 infants, 5% were stillbirths and 63% survived to discharge. On multivariate logistic regression analysis comprising prenatally known variables, reasons for preterm birth were not associated with survival. Advanced gestational duration (OR: 2.43 per wk; 95% CI: 1.59-3.74), administration of any antenatal steroids (OR: 2.21; 95% Cl: 1.14-4.28) and intrauterine referral from a peripheral hospital (OR: 2.93; 95% CI: 1.5-5.73) were associated with survival.Women who deliver at 23-25 wk comprise a risk group characterized by a high risk of reproductive failure and pregnancy complications. Survival rates were similar regardless of the reason for preterm birth. Policies of active perinatal management virtually eliminated intrapartum stillbirths.
- Published
- 2004
27. Perinatal conditions related to growth restriction and inflammation are associated with an increased risk of bronchopulmonary dysplasia
- Author
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Maria Altman, Viveca Odlind, Bengt Haglund, Lena Eriksson, Helle Kieler, and Uwe Ewald
- Subjects
Male ,Pediatrics ,medicine.medical_specialty ,Inflammation ,Growth restriction ,Risk Factors ,mental disorders ,medicine ,Odds Ratio ,Humans ,Registries ,book ,Bronchopulmonary Dysplasia ,Respiratory Distress Syndrome, Newborn ,Fetal Growth Retardation ,Respiratory distress ,business.industry ,Infant, Newborn ,General Medicine ,medicine.disease ,Perinatal conditions ,Increased risk ,Bronchopulmonary dysplasia ,Lung disease ,Case-Control Studies ,Pediatrics, Perinatology and Child Health ,Pediatric Infectious Disease ,book.journal ,Female ,medicine.symptom ,business ,Infant, Premature - Abstract
Bronchopulmonary dysplasia (BPD) is a frequent chronic lung disease in preterm infants, and we aimed to identify factors associated with this condition in infants with respiratory distress syndrome (RDS).This case-control study, using national Swedish data, included 2255 preterm infants, born before 33 gestational weeks. The 667 BPD cases were oxygen dependent at 36 weeks' postmenstrual age, and the 1558 controls only had RDS. Comparisons included perinatal conditions and pharmacological treatments. Adjusted odds ratios with 95% confidence intervals were calculated in a conditional logistic regression model, with gestational age as the conditioning term.An increased risk of BPD was associated with prelabour preterm rupture of membranes of more than 1 week (3.35, 2.16-5.19), small for gestational age (2.73, 2.11-3.55), low Apgar score (1.37, 1.05-1.81), patent ductus arteriosus (1.70, 1.33-2.18), persistent pulmonary hypertension (5.80, 3.21-10.50), pulmonary interstitial emphysema (2.78, 1.37-5.64), pneumothorax (2.95, 1.85-4.72), late onset infections (2.69, 1.82-3.98), intubation (1.56, 1.20-2.03), chest compressions (2.05, 1.15-3.66) and mechanical ventilation (2.16, 1.69-2.77), but not antenatal corticosteroids.Growth restriction and inflammation increased the risk of BPD in preterm infants and prelabour preterm rupture of membranes, small for gestational age, low Apgar score or need for resuscitation should raise clinical suspicions.
- Published
- 2014
28. Errors in estimating neonatal production of glucose with stable isotopes during 'approximate steady state'
- Author
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Jan Gustafsson, Torgny Groth, and Uwe Ewald
- Subjects
Isotope ,Chemistry ,Stable isotope ratio ,Quantitative Biology::Tissues and Organs ,Clinical Biochemistry ,Infant, Newborn ,Thermodynamics ,General Medicine ,Deuterium ,Models, Biological ,Sensitivity and Specificity ,Constant rate infusion ,Quantitative Biology::Cell Behavior ,Glucose ,Neonatal Screening ,Biochemistry ,Recien nacido ,Homeostasis ,Humans ,Steady state (chemistry) ,Infant, Premature - Abstract
In studies of glucose metabolism in neonates, a commonly used approach is based on constant rate infusion of glucose labelled with a stable isotope in order to reach an approximate steady state with regard to isotopic enrichment in plasma. Under presumed conditions of a glucose steady state, the rates of appearance and disappearance of glucose can, in principle, be calculated with use of a simple steady-state formula. However, in the neonate, steady-state conditions do not generally prevail and results derived on such assumptions are questionable. In the present study, we have taken a pragmatic approach and compared estimates obtained from the conventional formula with values calculated with Steele's non-steady-state method. The results show that the estimated glucose appearance and disappearance rates change more or less over the observed time period in all the typical cases studied, and that "steady-state estimates" may differ from the corresponding non-steady-state values by up to 37%. In a sensitivity analysis, the value of the distribution volume factor was found to be non-critical, a circumstance that supports the use of Steele's method. Thus, even though the classical Steele pool-fraction method for computation of rates of appearance and disappearance under non-steady-state conditions has been criticized, it is still the most realistic alternative to the frequently used simple steady-state formula in applications to newborns.
- Published
- 2001
29. Pre- and Postnatal Transplantation of Fetal Mesenchymal Stem Cells in Osteogenesis Imperfecta: A Two-Center Experience
- Author
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Mahesh Choolani, Jahan Taslimi, Uwe Ewald, Allen Eng Juh Yeoh, Arijit Biswas, Magnus Westgren, Gail E. Graham, Nicholas M. Fisk, Citra Nurfarah Zaini Mattar, Eva Åström, Jerry Kok Yen Chan, S. W. Steven Shaw, Katarina Le Blanc, Peter H. Byers, Cecilia Götherström, Po-Jen Cheng, and Ju Li Lin
- Subjects
Male ,medicine.medical_specialty ,Genotype ,Mesenchymal Stem Cell Transplantation ,In utero transplantation ,Cell therapy ,Fetus ,Pregnancy ,Tissue Engineering and Regenerative Medicine ,medicine ,Humans ,Embryonic Stem Cells ,Bone Development ,business.industry ,Mesenchymal stem cell ,Mesenchymal Stem Cells ,Cell Biology ,General Medicine ,Osteogenesis Imperfecta ,medicine.disease ,Surgery ,Pedigree ,Transplantation ,Radiography ,Fetal Diseases ,Osteogenesis imperfecta ,Gestation ,Female ,business ,Developmental Biology - Abstract
Osteogenesis imperfecta (OI) can be recognized prenatally with ultrasound. Transplantation of mesenchymal stem cells (MSCs) has the potential to ameliorate skeletal damage. We report the clinical course of two patients with OI who received prenatal human fetal MSC (hfMSC) transplantation and postnatal boosting with same-donor MSCs. We have previously reported on prenatal transplantation for OI type III. This patient was retransplanted with 2.8 × 106 same-donor MSCs per kilogram at 8 years of age, resulting in low-level engraftment in bone and improved linear growth, mobility, and fracture incidence. An infant with an identical mutation who did not receive MSC therapy succumbed at 5 months despite postnatal bisphosphonate therapy. A second fetus with OI type IV was also transplanted with 30 × 106 hfMSCs per kilogram at 31 weeks of gestation and did not suffer any new fractures for the remainder of the pregnancy or during infancy. The patient followed her normal growth velocity until 13 months of age, at which time longitudinal length plateaued. A postnatal infusion of 10 × 106 MSCs per kilogram from the same donor was performed at 19 months of age, resulting in resumption of her growth trajectory. Neither patient demonstrated alloreactivity toward the donor hfMSCs or manifested any evidence of toxicities after transplantation. Our findings suggest that prenatal transplantation of allogeneic hfMSCs in OI appears safe and is of likely clinical benefit and that retransplantation with same-donor cells is feasible. However, the limited experience to date means that it is not possible to be conclusive and that further studies are required.
- Published
- 2013
30. National guidelines for Swedish neonatal nursing care: evaluation of clinical application
- Author
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Lars Wallin, Karin Wikblad, Anne-Marie Boström, Uwe Ewald, and Gill Harvey
- Subjects
medicine.medical_specialty ,Evidence-based practice ,Quality management ,Attitude of Health Personnel ,Nursing care ,Nursing ,Intensive Care Units, Neonatal ,Neonatal Nursing ,Surveys and Questionnaires ,medicine ,Humans ,Nurse Administrators ,Obstetrical nursing ,Information Services ,Sweden ,Evidence-Based Medicine ,business.industry ,Health Policy ,Nursing research ,Infant, Newborn ,Public Health, Environmental and Occupational Health ,General Medicine ,Logistic Models ,Family medicine ,Practice Guidelines as Topic ,Neonatal nursing ,Guideline Adherence ,business ,Total Quality Management - Abstract
To evaluate the clinical application of national guidelines for neonatal nursing.Questionnaire survey.Thirty-nine neonatal care units in Sweden.Thirty-five of 39 nurse managers at all Swedish neonatal care units.Thirteen clinical guidelines for neonatal nursing care were presented in 1997. Recommendations on evidence-based nursing care and auditing measures were given. Most neonatal units in Sweden participated in the guideline development.Extent of guideline application, ways in which the guidelines were used and perceived usefulness.The guidelines were applied to different extents in 30 of the 35 units. Almost all the guidelines were applied, especially those covering general nursing care. In total, 72 Quality Improvement (QI) projects were reported, of which 51 concerned specific topics covered in the guidelines. Twenty units applied the guidelines as a starting point for QI. Four units evaluated nursing practice against the guidelines. Four factors [Dynamic Standard Setting System (DySSSy) as the QI method,or = 4 years of practice as nurse manager, experience of nursing research, and good staff resources] were closely related to a more extensive application of the guidelines. Units with both a nurse manager and an assistant nurse manager were more likely to have used the guidelines as the basis for changing clinical practice.The guidelines were successfully disseminated and diffused, but practitioner involvement in guideline development did not guarantee implementation. Downsizing, leadership and facilitation seemed to be crucial factors when getting evidence into practice. Limited occurrence of evaluations of clinical practice against guideline recommendations suggests a need for valid and user-friendly measures.
- Published
- 2000
31. Short-term Outcome of Perinatal Care in a Swedish County
- Author
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K. Hammarlund, Kristina Persson, Gunnar Sedin, Uwe Ewald, T Riesenfeld, T. Norsted, Bo Strömberg, S Kjartansson, and Anders Jonzon
- Subjects
Pediatrics ,medicine.medical_specialty ,Time Factors ,Perinatal care ,Corrected Age ,Intensive care ,Epidemiology ,medicine ,Humans ,Prospective Studies ,Fetal Death ,Survival rate ,Bronchopulmonary Dysplasia ,Ultrasonography ,Sweden ,business.industry ,Skull ,Infant, Newborn ,Pneumothorax ,General Medicine ,Infant mortality ,Very preterm ,Perinatal Care ,Outcome and Process Assessment, Health Care ,Intensive Care, Neonatal ,Population study ,Morbidity ,Pulmonary Ventilation ,business ,Follow-Up Studies - Abstract
Improvements in obstetrical and neonatal care during the last decades have led to a marked increase in survival rate of preterm and term infants. In order to study the short- and long-term outcome in infants who survived neonatal intensive care (NIC) and were born in the county of Uppsala between January 1st 1986 and April 30th 1989, a prospective long-term follow-up study was conducted. Epidemiological data on all infants born in the county during the study period and the short-term outcome, measured as overall neuromotor function at term and at 2, 4, 6 and 10 months of corrected age in 245 infants surviving NIC and 72 healthy control infants are presented. The infants' neuromotor function was evaluated with different clinical neurological methods. In the study population of NIC infants 85.9% survived the neonatal period. The early infant mortality was high in this group 11.6% compared to that of all infants born in the county of Uppsala (0.30%). Only a minority of the infants showed abnormal neuromotor function. A comparison of the results of the overall evaluation of neuromotor function at 10 months of age with those of the examinations made at an earlier age showed poor correspondence in individual infants, especially in preterm and very preterm infants.
- Published
- 1999
32. Serum magnesium and protein concentrations during the first five years of insulin-dependent diabetes in children
- Author
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Torsten Tuvemo, Uwe Ewald, LA Proos, and M. Kobbah
- Subjects
Male ,medicine.medical_specialty ,Adolescent ,Serum albumin ,chemistry.chemical_element ,Orosomucoid ,Sex Factors ,Diabetes mellitus ,Internal medicine ,Magnesium deficiency (medicine) ,medicine ,Humans ,Magnesium ,Prospective Studies ,Child ,Sweden ,biology ,business.industry ,Age Factors ,Albumin ,Blood Proteins ,General Medicine ,medicine.disease ,Blood proteins ,Zinc ,Transthyretin ,Diabetes Mellitus, Type 1 ,Endocrinology ,chemistry ,Case-Control Studies ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Disease Progression ,biology.protein ,Female ,business ,Follow-Up Studies - Abstract
Thirty-four children were followed up prospectively for 5 years from the onset of diabetes regarding serum magnesium, zinc and some proteins. Serum magnesium decreased to significantly lower values (0.76 +/- 0.05 mmol l-1) than those in matched controls after 2 and 5 years, with the lowest mean values in diabetic girls. Serum zinc concentration was higher in the diabetic group than in the control children, and again the diabetic girls differed most from the controls. Serum prealbumin was significantly lower in the diabetic patients after 2 and 5 years than in the controls. Serum albumin was also slightly reduced in the diabetic patients, while orosomucoid was normal. These data indicate chronic magnesium deficiency and insufficient liver synthesis of certain serum proteins in diabetic children.
- Published
- 1997
33. Ophthalmological outcome and visuospatial ability in very preterm children measured at 2.5 years corrected age
- Author
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Helena Örnkloo, Gerd Holmström, J. Hreinsdottir, Uwe Ewald, C. von Hofsten, and K Strand Brodd
- Subjects
Male ,Pediatrics ,medicine.medical_specialty ,Vision Disorders ,Outcome (game theory) ,Corrected Age ,Cognition ,Spatial Processing ,Medicine ,Humans ,Prospective Studies ,Vision, Ocular ,Sweden ,business.industry ,General Medicine ,Visual cognition ,Visuospatial ability ,Test (assessment) ,Very preterm ,Case-Control Studies ,Child, Preschool ,Space Perception ,Pediatrics, Perinatology and Child Health ,Female ,business ,Infant, Premature - Abstract
To investigate the ophthalmological outcome of very preterm children at 2.5 years corrected age (CA) and perform a test of visuospatial and cognitive abilities.A population-based, prospective study (LOVIS study) in Uppsala County, Sweden, comprised 111 very preterm children (32 w gestational age [GA]) born between 1 January 2004 and 31 December 2007. Ophthalmic evaluations were undertaken in 98/109 children (89.9%) alive at 2.5 years. Spatial cognition was investigated with a test of five alternative blocks in 48 preterm and 25 term-born children.Visual impairment, strabismus or refractive errors, were found in 12% of the children. None of the children were blind in both eyes. Logistic regression analyses revealed significant associations between strabismus and periventricular leucomalacia/intraventricular haemorrhage (OR 9.6, p = 0.025) and between refractive errors and severe retinopathy of prematurity (OR 9.8, p = 0.011) and GA (OR 0.763, p = 0.034). Oval and rectangular blocks were significantly more difficult to insert into a box for preterm than full-term children (p = 0.048 and 0.013, respectively). There was a significant correlation between total scores for the five blocks and GA at birth (p = 0.035).Eye and visual problems were found in 12% of the preterm children at 30 months CA. Preterm children had difficulties with blocks of complex shapes.
- Published
- 2013
34. Ten years follow up after prenatal transplantation of fetal mesenchymal stem cell in a patient with severe osteogenesis imperfecta
- Author
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Gail E. Graham, Eva Åström, Magnus Westgren, Jahan Taslimi, Uwe Ewald, Cecilia Götherström, and Katarina Le Blanc
- Subjects
Pathology ,medicine.medical_specialty ,Fetus ,Prenatal transplantation ,Osteogenesis imperfecta ,business.industry ,Mesenchymal stem cell ,medicine ,General Medicine ,medicine.disease ,business - Published
- 2013
35. Effect of facilitation of local maternal-and-newborn stakeholder groups on neonatal mortality : cluster-randomized controlled trial
- Author
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Katarina Ekholm Selling, Leif A. Eriksson, Duong M. Duc, Vu Thi Thu Thuy, Dinh Thi Phuong Hoa, Tran Viet Tiep, Lars Wallin, Nguyen Thu Nga, Mats Målqvist, Uwe Ewald, Lars Åke Persson, and Tran Q. Huy
- Subjects
Medicin och hälsovetenskap ,Pediatrics ,Health Knowledge, Attitudes, Practice ,Time Factors ,Child Health Services ,Social and Behavioral Sciences ,Medical and Health Sciences ,law.invention ,Randomized controlled trial ,law ,Pregnancy ,Health care ,Infant Mortality ,Odds Ratio ,Medicine ,Cooperative Behavior ,Problem Solving ,education.field_of_study ,Mortality rate ,food and beverages ,General Medicine ,Community-Institutional Relations ,Vietnam ,Facilitation ,Female ,Live Birth ,Research Article ,Adult ,medicine.medical_specialty ,Health Personnel ,Population ,Nursing ,Social Facilitation ,Young Adult ,Humans ,Maternal Health Services ,education ,Social facilitation ,business.industry ,Omvårdnad ,Administrative Personnel ,Infant, Newborn ,Patient Acceptance of Health Care ,Infant mortality ,Socioeconomic Factors ,Interdisciplinary Communication ,business ,Breast feeding - Abstract
Lars Åke Persson and colleagues conduct a cluster randomised control in northern Vietnam to analyze the effect of the activity of local community-based maternal-and-newborn stakeholder groups on neonatal mortality. Please see later in the article for the Editors' Summary, Background Facilitation of local women's groups may reportedly reduce neonatal mortality. It is not known whether facilitation of groups composed of local health care staff and politicians can improve perinatal outcomes. We hypothesised that facilitation of local stakeholder groups would reduce neonatal mortality (primary outcome) and improve maternal, delivery, and newborn care indicators (secondary outcomes) in Quang Ninh province, Vietnam. Methods and Findings In a cluster-randomized design 44 communes were allocated to intervention and 46 to control. Laywomen facilitated monthly meetings during 3 years in groups composed of health care staff and key persons in the communes. A problem-solving approach was employed. Births and neonatal deaths were monitored, and interviews were performed in households of neonatal deaths and of randomly selected surviving infants. A latent period before effect is expected in this type of intervention, but this timeframe was not pre-specified. Neonatal mortality rate (NMR) from July 2008 to June 2011 was 16.5/1,000 (195 deaths per 11,818 live births) in the intervention communes and 18.4/1,000 (194 per 10,559 live births) in control communes (adjusted odds ratio [OR] 0.96 [95% CI 0.73–1.25]). There was a significant downward time trend of NMR in intervention communes (p = 0.003) but not in control communes (p = 0.184). No significant difference in NMR was observed during the first two years (July 2008 to June 2010) while the third year (July 2010 to June 2011) had significantly lower NMR in intervention arm: adjusted OR 0.51 (95% CI 0.30–0.89). Women in intervention communes more frequently attended antenatal care (adjusted OR 2.27 [95% CI 1.07–4.8]). Conclusions A randomized facilitation intervention with local stakeholder groups composed of primary care staff and local politicians working for three years with a perinatal problem-solving approach resulted in increased attendance to antenatal care and reduced neonatal mortality after a latent period. Trial registration Current Controlled Trials ISRCTN44599712 Please see later in the article for the Editors' Summary, Editors' Summary Background Over the past few years, there has been enormous international effort to meet the target set by Millennium Development Goal 4 to reduce the under-five child mortality rate by two-thirds and to reduce the number of maternal deaths by three-quarters, respectively, from the 1990 level by 2015. There has been some encouraging progress and according to the latest figures from the World Health Organization, in 2011, just under 7 million children aged under 5 years died, a fall of almost 3 million from a decade ago. However, currently, 41% of all deaths among children under the age of 5 years occur around birth and the first 28 days of life (perinatal and neonatal mortality). Simple interventions can substantially reduce neonatal deaths and there have been several international, national, and local efforts to implement effective care packages to help reduce the number of neonatal deaths. Why Was This Study Done? In order for these interventions to be most effective, it is important that the local community becomes involved. Community mobilization, especially through local women's groups, can empower women to prioritize specific interventions to help improve their own health and that of their baby. An alternative strategy might be to mobilize people who already have responsibility to promote health and welfare in society, such as primary care staff, village health workers, and elected political representatives. However, it is unclear if the activities of such stakeholder groups result in improved neonatal survival. So in this study from northern Vietnam, the researchers analyzed the effect of the activity of local maternal-and-newborn stakeholder groups on neonatal mortality. What Did the Researchers Do and Find? Between 2008 and 2011, the researchers conducted a cluster-randomized controlled trial in 90 communes within the Quang Ninh province of northeast of Vietnam: 44 communes were allocated to intervention and 46 to the control. The local women's union facilitated recruitment to the intervention, local stakeholder groups (Maternal and Newborn Health Groups), which comprised primary care staff, village health workers, women's union representatives, and the person with responsibility for health in the commune. The groups' role was to identify and prioritize local perinatal health problems and implement actions to help overcome these problems. Over the three-year period, the Maternal and Newborn Health Groups in the 44 intervention communes had 1,508 meetings. Every year 15–27 unique problems were identified and addressed 94–151 times. The problem-solving processes resulted in an annual number of 19–27 unique actions that were applied 297–649 times per year. The top priority problems and actions identified by these groups dealt with antenatal care attendance, post-natal visits, nutrition and rest during pregnancy, home deliveries, and breast feeding. Neonatal mortality in the intervention group did not change over the first two years but showed a significant improvement in the third year. The three leading causes of death were prematurity/low birth-weight (36%), intrapartum-related neonatal deaths (30%), and infections (15%). Stillbirth rates were 7.4 per 1,000 births in the intervention arm and 9.0 per 1,000 births in the control arm. There was one maternal death in the intervention communes and four in the control communes and there was a significant improvement in antenatal care attendance in the intervention arm. However, there were no significant differences between the intervention and control groups of other outcomes, including tetanus immunization, delivery preparedness, institutional delivery, temperature control at delivery, early initiation of breastfeeding, or home visit of a midwife during the first week after delivery. What Do These Findings Mean? These findings suggest that local stakeholder groups comprised of primary care staff and local politicians using a problem-solving approach may help to reduce the neonatal mortality rate after three years of implementation (although the time period for an expected reduction in neonatal mortality was not specified before the trial started) and may also increase the rate of antenatal care attendance. However, the intervention had no effect on other important outcomes such as the rate of institutional delivery and breast feeding. This study used a novel approach of community-based activity that was implemented into the public sector system at low cost. A further reduction in neonatal deaths around delivery might be achieved by neonatal resuscitation training and home visits to the mother and her baby. Additional Information Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001445. The World Health Organization provides comprehensive statistics on neonatal mortality The Healthy Newborn Network has information on community interventions to help reduce neonatal mortality from around the world
- Published
- 2013
36. Initiation and extent of skin-to-skin care at two Swedish neonatal intensive care units
- Author
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Christine Rubertsson, Uwe Ewald, Kerstin Hedberg Nyqvist, Maria Gradin, and Ylva Thernström Blomqvist
- Subjects
Male ,Parents ,Pediatrics ,medicine.medical_specialty ,Time Factors ,Hospital setting ,Skin to skin ,Early initiation ,Intensive care ,Intensive Care Units, Neonatal ,Medicine ,Humans ,skin and connective tissue diseases ,Skin ,Sweden ,integumentary system ,Parenting ,business.industry ,Infant, Newborn ,General Medicine ,Kangaroo-Mother Care ,Object Attachment ,Multicenter study ,Pediatrics, Perinatology and Child Health ,Female ,business ,Hospital stay ,Infant, Premature - Abstract
Aim To describe initiation and extent of parents’ application of skin-to-skin care (SSC) with their preterm infants at two Swedish neonatal intensive care units. Methods The duration of SSC was recorded in 104 infants’ medical charts during their hospital stay, and the parents answered a questionnaire. Results Both parents were involved in the practice of SSC. Three infants experienced SSC directly after birth, 34 within 1 h, 85 within 24 h and the remaining 19 at 24–78 h postbirth. SSC commenced earlier (median age of 50 min) in infants whose first SSC was with their father instead of with their mother (median age of 649 min: p
- Published
- 2012
37. Cytomegalovirus-specific CD4 and CD8 T cell responses in infants and children
- Author
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Gunilla Malm, Eva Karltorp, Fredrik Sund, Thomas H. Tötterman, Olle Korsgren, Ilona Lewensohn-Fuchs, Uwe Ewald, Anna Karin Lidehäll, Mona-Lisa Engman, and Britt-Marie Eriksson
- Subjects
Adult ,CD4-Positive T-Lymphocytes ,Male ,Adolescent ,T cell ,Immunology ,Congenital cytomegalovirus infection ,Twins ,Cytomegalovirus ,Epitopes, T-Lymphocyte ,Viremia ,CD8-Positive T-Lymphocytes ,Virus ,Interferon-gamma ,Young Adult ,Immune system ,Antigen ,medicine ,Cytotoxic T cell ,Humans ,Lymphocyte Count ,Interferon-gamma production ,business.industry ,Infant, Newborn ,virus diseases ,Infant ,General Medicine ,medicine.disease ,medicine.anatomical_structure ,Child, Preschool ,Cytomegalovirus Infections ,Female ,business - Abstract
Congenital cytomegalovirus (CMV) infection is the most common congenital infection causing childhood morbidity. The pathogenetic mechanisms behind long-term sequelae are unclear, but long-standing viremia as a consequence of the inability to convert the virus to a latent state has been suggested to be involved. Whereas primary CMV infection in adults is typically rapidly controlled by the immune system, children have been shown to excrete virus for years. Here, we compare T cell responses in children with congenital CMV infection, children with postnatal CMV infection and adults with symptomatic primary CMV infection. The study groups included 24 children with congenital CMV infection, 19 children with postnatal CMV infection and eight adults with primary CMV infection. Among the infants with congenital CMV infection, 13 were symptomatic. T cell responses were determined by analysis of interferon gamma production after stimulation with CMV antigen. Our results show that whereas adults display high CMV-specific CD4 T cell responses in the initial phase of the infection, children younger than 2 years have low or undetectable responses that appear to increase with time. There were no differences between groups with regard to CD8 T cell function. In conclusion, inadequate CD 4 T cell function seems to be involved in the failure to get immune control of the CMV infection in children younger than 2 years of age with congenital as well as postnatal CMV infection.
- Published
- 2012
38. Time to consider a new treatment protocol for aggressive posterior retinopathy of prematurity?
- Author
-
Ulrich Spandau, Eva Larsson, Zoran Tomic, Gerd Holmström, Uwe Ewald, and Hanna Åkerblom
- Subjects
Male ,Vascular Endothelial Growth Factor A ,medicine.medical_specialty ,Treatment protocol ,genetic structures ,Bevacizumab ,Birth weight ,Salvage therapy ,Angiogenesis Inhibitors ,Gestational Age ,Retinal Neovascularization ,Antibodies, Monoclonal, Humanized ,Cryosurgery ,Ophthalmology ,Photography ,Medicine ,Humans ,Retinopathy of Prematurity ,Retrospective Studies ,Laser Coagulation ,business.industry ,Postmenstrual Age ,Infant, Newborn ,Gestational age ,Retinopathy of prematurity ,General Medicine ,University hospital ,medicine.disease ,Combined Modality Therapy ,eye diseases ,Surgery ,Treatment Outcome ,Infant, Extremely Low Birth Weight ,Female ,sense organs ,business ,medicine.drug - Abstract
Purpose: To discuss treatment modalities for aggressive posterior retinopathy of prematurity (AP-ROP). Methods: The medical charts of all infants with AP-ROP at Uppsala University Hospital, Sweden, during a 2-year period (2009 and 2010) were reviewed. Eight infants (16 eyes) with a mean gestational age of 23.8 weeks and a mean birth weight of 592 g were treated with laser and/or intravitreal injections of bevacizumab (0.4 and 0.625 mg). RetCam photography was used to document the retinal appearance before and after treatment. Results: All infants (16 eyes) had AP-ROP in zone I. Mean time at initial treatment was 34 weeks postmenstrual age. Two eyes (one infant) were only treated with laser, and six eyes (three infants) were treated with laser therapy or cryopexy and, because of lack of regression, with bevacizumab as salvage therapy. Eight eyes (four infants) were treated with a first-line bevacizumab injection and four of these eyes (two infants) with additional laser ablation for continued disease progression in zone II. Macular dragging occurred in one eye of one infant primarily treated with laser. Conclusions: Given the high complication rate of the extensive laser treatment for zone I ROP, it is worth considering anti-vascular endothelial growth factor treatment as an alternative therapy. Further knowledge concerning side effects and long-term ocular and systemic outcome is warranted before this drug becomes general clinical practice.
- Published
- 2012
39. Short and long-term effects of antenatal corticosteroids assessed in a cohort of 7,827 children born preterm
- Author
-
Viveca Odlind, Helle Kieler, Lena Eriksson, Bengt Haglund, and Uwe Ewald
- Subjects
Adult ,Male ,Pediatrics ,medicine.medical_specialty ,Population ,Prenatal care ,Infant, Premature, Diseases ,Betamethasone ,Dexamethasone ,Cohort Studies ,Young Adult ,Sex Factors ,medicine ,Humans ,education ,Glucocorticoids ,education.field_of_study ,Epilepsy ,business.industry ,Cerebral Palsy ,Infant, Newborn ,Obstetrics and Gynecology ,Retinopathy of prematurity ,Prenatal Care ,General Medicine ,medicine.disease ,Intraventricular hemorrhage ,Treatment Outcome ,Bronchopulmonary dysplasia ,Cohort ,Apgar score ,Female ,business ,Infant, Premature ,Cohort study - Abstract
To study the benefits of antenatal corticosteroids (ACS) in clinical settings and to evaluate the occurrence of long-term neuro-sensory effects such as epilepsy and cerebral palsy (CP).Observational population-based study including all births between gestational weeks 24 and 34 during 1976-1997 in Sweden. Exposure to ACS was evaluated at hospital level. Children were followed up to their ninth birthday.Seven thousand eight hundred twenty-seven infants of which 5,632 were exposed to ACS. Data on hospital ACS routines was based on questionnaires and interviews with physicians and pharmacy sales. Outcomes were obtained from the national health registers and assessed according to gender of the child. Logistic regression was used to assess associations.Neonatal death, low Apgar score, respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), retinopathy of prematurity (ROP), CP, and epilepsy.After adjustment, exposed infants had reduced risks of RDS (OR 0.80, 95% CI 0.70-0.92), late neonatal death (OR 0.86, 95% CI 0.57-1.29), BPD (OR 0.87, 95% CI 0.62-1.22), ROP (OR 0.80, 95% CI 0.48-1.32), IVH (OR 0.93, 95% CI 0.67-1.3), and CP (OR 0.82, 95% CI 0.58-1.15). Males had a higher risk of epilepsy (OR 1.74, 95% CI 0.85-3.55) than females (OR 0.50, 95% CI 0.25-1.03).The results confirm the beneficial effect of ACS regarding RDS in clinical settings. Except for a tendency to increased risk of epilepsy among male infants there were no increased risks of neuro-sensory outcomes.
- Published
- 2009
40. Gestational Diabetes-perinatal Outcome with a Policy of Liberal and Intensive Insulin Therapy
- Author
-
G. Lindmark, C. Berne, Uwe Ewald, and A. Sunehag
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Birth weight ,Overweight ,Fetal Macrosomia ,Pregnancy ,Risk Factors ,Diabetes mellitus ,Humans ,Insulin ,Medicine ,Caesarean section ,Retrospective Studies ,Sweden ,business.industry ,Obstetrics ,Infant, Newborn ,Pregnancy Outcome ,General Medicine ,medicine.disease ,Hypoglycemia ,Gestational diabetes ,Diabetes, Gestational ,Female ,medicine.symptom ,business ,Weight gain ,Body mass index - Abstract
During 3 years of continuous screening for gestational diabetes mellitus in the county of Uppsala, 133 pregnant women (1.2%) were given this diagnosis. Maternal characteristics and the perinatal outcome of the pregnancies were examined retrospectively. Maternal overweight [body mass index greater than 23.9 kg/(m)2] was noted in 54.9% of the 133 women. Insulin therapy, with a mean daily dose of 42 U, was given to 62.4% of the patients, whereas the others were given dietary instructions alone. The frequency of infants with a birth weight greater than 2 SD was 24.1% and was significantly (p less than 0.025) related to pre-pregnancy overweight and also to pregnancy weight gain 18kg (p less than 0.01). Caesarean section was performed in 27% of the pregnancies complicated by diabetes, compared with the overall figure of 11% in Uppsala during the study period. Neonatal hypoglycaemia (blood glucose greater than or equal to 1.6 mM) was noted in 17.3% of the infants and was significantly (p less than 0.01) related to maternal sympathomimetic therapy. Despite liberal and intensive insulin therapy, there was a considerable rate of perinatal complications. Although not severe, they indicate a need for further improvement in the care of women with gestational diabetes.
- Published
- 1991
41. Human serum amyloid A (SAA) and high sensitive C-reactive protein (hsCRP) in preterm newborn infants with nosocomial infections
- Author
-
Anders Larsson, Göran Friman, Uwe Ewald, and Anders Lannergård
- Subjects
Male ,medicine.medical_specialty ,Gestational Age ,Pilot Projects ,High sensitive ,Gastroenterology ,Internal medicine ,medicine ,Retrospective analysis ,Humans ,Serum amyloid A ,Serum Amyloid A Protein ,Retrospective Studies ,Cross Infection ,biology ,business.industry ,C-reactive protein ,Acute-phase protein ,Infant, Newborn ,General Medicine ,Bacterial Infections ,Serum samples ,Very preterm ,C-Reactive Protein ,Pediatrics, Perinatology and Child Health ,Immunology ,biology.protein ,Female ,business ,Infant, Premature - Abstract
Human serum amyloid A (SAA) and high sensitive C-reactive protein (hsCRP) and their relation to suggestive nosocomial infections (NIs) were investigated in very preterm (VPT) newborn infants. In a retrospective analysis, information of suggestive NI was matched to levels of SAA and hsCRP in 224 serum samples from 72 VPT newborn infants. As a control group, 35 healthy-term newborn infants were chosen. Of the 224 serum samples, 145 samples were not associated with nosocomial infections. However, 79 were associated with NI: of these 79, 42 were found to be culture-proven NI. Trimmed mean (α= 0.05) levels for SAA and hsCRP in VPT newborn infants were higher than in control term newborn infants (1.74, 2.67 mg/L vs. 0.78, 0.16 mg/L; p = 0.01 and
- Published
- 2008
42. Perinatal and socioeconomic determinants of breastfeeding duration in very preterm infants
- Author
-
Renée Flacking, Lars Wallin, and Uwe Ewald
- Subjects
medicine.medical_specialty ,Pediatrics ,Time Factors ,Breastfeeding ,Mothers ,Gestational Age ,Infant, Premature, Diseases ,Weaning ,Cohort Studies ,medicine ,Birth Weight ,Humans ,Infant, Very Low Birth Weight ,Prospective Studies ,Registries ,Duration (project management) ,Socioeconomic status ,Neonatal Disorder ,Sweden ,business.industry ,Public health ,Infant, Newborn ,Infant ,General Medicine ,Very preterm ,Breast Feeding ,Socioeconomic Factors ,Pediatrics, Perinatology and Child Health ,business ,Breast feeding ,Infant, Premature ,Biomedical sciences - Abstract
To describe the impact of prematurity, size at birth, neonatal disorders and the families' socioeconomic status (SES) on breastfeeding duration in mothers of very preterm infants.Prospective population-based cohort study. Data on breastfeeding, registered in databases in two Swedish counties in 1993-2001, were matched with data from two national registries: the Medical Birth Registry and Statistics Sweden. Mothers of 225 very preterm singleton infants were identified and included.Seventy-nine percent of the mothers breastfed at 2 months, 62% at 4 months, 45% at 6 months, 22% at 9 months and 12% at 12 months. Prematurity, size at birth and neonatal disorders did not show an effect on breastfeeding duration. Being adversely exposed to any of the SES factors (maternal education, unemployment benefit, social welfare and equivalent disposable income in the household) was significantly associated with earlier weaning up to 6 months of infants' postnatal age.This study shows new and noteworthy results concerning breastfeeding duration in mothers of very preterm infants, which was not influenced by degree of prematurity, size at birth or neonatal disorders but was affected by SES. This highlights the need for improved support of socioeconomically disadvantaged mothers, during and after the hospital stay.
- Published
- 2007
43. Understanding work contextual factors: a short-cut to evidence-based practice?
- Author
-
Uwe Ewald, Karin Wikblad, Shannon Scott-Findlay, Bengt B. Arnetz, and Lars Wallin
- Subjects
Adult ,Male ,Health Knowledge, Attitudes, Practice ,Evidence-based practice ,Attitude of Health Personnel ,Feedback, Psychological ,Interprofessional Relations ,Applied psychology ,Organizational culture ,Nursing Methodology Research ,Burnout ,Nursing Staff, Hospital ,Social support ,Nursing ,Organization development ,Intensive Care Units, Neonatal ,Neonatal Nursing ,Surveys and Questionnaires ,Health care ,Medicine ,Humans ,Workplace ,Burnout, Professional ,General Nursing ,Decision Making, Organizational ,Self-efficacy ,Sweden ,Motivation ,Evidence-Based Medicine ,business.industry ,Professional development ,Social Support ,General Medicine ,Middle Aged ,Organizational Culture ,Organizational Innovation ,Self Efficacy ,Linear Models ,Female ,Clinical Competence ,business - Abstract
It has become increasingly clear that workplace contextual factors make an important contribution to provider and patient outcomes. The potential for health care professionals of using research in practice is also linked to such factors, although the exact factors or mechanisms for enhancing this potential are not understood. From a perspective of implementing evidence-based nursing practice, the authors of this article report on a study examining contextual factors.The objective of this study was to identify predictors of organizational improvement by measuring staff perceptions of work contextual factors.The Quality Work Competence questionnaire was used in a repeated measurement survey with a 1-year break between the two periods of data collection. The sample consisted of 134 employees from four neonatal units in Sweden.Over the study period significant changes occurred among staff perceptions, both within and between units, on various factors. Changes in staff perceptions on skills development and participatory management were the major predictors of enhanced potential of overall organizational improvement. Perceived improvement in skills development and performance feedback predicted improvement in leadership. Change in commitment was predicted by perceived decreases in work tempo and work-related exhaustion.These findings indicate the potential for organizational improvement by developing a learning and supportive professional environment as well as by involving staff in decision-making at the unit level. Such initiatives are also likely to be of importance for enhanced use of research in practice and evidence-based nursing. On the other hand, high levels of work tempo and burnout appear to have negative consequences on staff commitment for improving care and the work environment. A better understanding of workplace contextual factors is necessary for improving the organizational potential of getting research into practice and should be considered in future implementation projects.
- Published
- 2006
44. CD64 (Fcgamma receptor I) cell surface expression on maturing neutrophils from preterm and term newborn infants
- Author
-
Per Venge, Lena Håkansson, Gustav Fjaertoft, Tony Foucard, and Uwe Ewald
- Subjects
Adult ,CD32 ,Fetal Membranes, Premature Rupture ,Neutrophils ,Neutrophile ,Cell ,CD16 ,Granulocyte ,Pregnancy ,Gene expression ,medicine ,Humans ,Receptor ,CD64 ,CD11b Antigen ,biology ,business.industry ,Receptors, IgG ,Age Factors ,Infant, Newborn ,General Medicine ,Flow Cytometry ,medicine.anatomical_structure ,Pediatrics, Perinatology and Child Health ,Immunology ,biology.protein ,Female ,business ,Infant, Premature - Abstract
The expression of CD64 (FcgammaRI) is increased from an almost negligible to a marked level on neutrophils in patients with bacterial infections. CD64 expression on neutrophils might therefore be a potential candidate for the diagnosis of bacterial infections in infants.This study was performed to monitor changes of neutrophil expression of CD64 during the postpartum period to further evaluate the usefulness of this analysis. The possible influence on the expression of this receptor by other factors was also investigated, including respiratory distress syndrome (RDS) and preterm rupture of the membranes (PROM).Cell surface expression of CD64 on neutrophils from preterm and term newborn infants and healthy adults was analysed by flow cytometry. The expression of the other Fcgamma receptors, CD32 and CD16, and the complement receptors CD11b/CD18 and CD35 was also analysed for comparison.Neutrophils from preterm newborn infants showed a moderately increased level of CD64 expression that, during their first month of life, was reduced to the level observed on neutrophils from term newborn infants and adults. In contrast, the level of neutrophil expression of CD32 and CD16 was significantly lower in preterm than term newborn infants and adults. Neutrophils from all groups indicated similar levels of CD11b expression, but the expression on neutrophils from newborn infants increased after birth.Our results showed that neutrophil expression of CD64 is moderately increased in preterm newborn infants at birth. It seems not to be influenced by RDS, PROM or other factors related to preterm birth but by bacterial infection.
- Published
- 2005
45. Vascular reactivity and platelet aggregability during the first five years of insulin-dependent diabetes in children
- Author
-
Torsten Tuvemo, Uwe Ewald, and M. Kobbah
- Subjects
Male ,medicine.medical_specialty ,Adolescent ,Platelet Aggregation ,Population ,Vasodilation ,Diabetic angiopathy ,Sex Factors ,Internal medicine ,Diabetes mellitus ,Medicine ,Humans ,Platelet ,Prospective Studies ,education ,Child ,Skin ,Sweden ,Type 1 diabetes ,education.field_of_study ,business.industry ,Vascular disease ,Microcirculation ,Microangiopathy ,Puberty ,Age Factors ,General Medicine ,medicine.disease ,Endocrinology ,Diabetes Mellitus, Type 1 ,Case-Control Studies ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Cardiology ,Disease Progression ,Female ,business ,Diabetic Angiopathies ,Follow-Up Studies - Abstract
Skin microvascular reactivity and platelet aggregation in response to collagen and adenosine diphosphate (ADP) was studied prospectively in a population-based cohort of children with newly acquired type 1 diabetes mellitus (IDDM), who have now been followed up longitudinally for 5 years. The skin microvascular vasodilation in response to ischaemia was recorded by means of transcutaneous oximetry at 37 degrees C and compared with that in a control group of 58 healthy children. Platelet aggregation was compared with 42 healthy control children. Sixty months after diagnosis, the same degree of impairment of vasodilatory capacity was noted as previously recorded at 24 months and on admission, on all these occasions being significantly lower than the control value and the results from the 12-month follow-up. A sex difference was noted, diabetic girls both during and after puberty exhibiting a greater impairment of vasodilator capacity as compared with diabetic boys. The same degree of platelet aggregation in response to collagen was noted 60 months after diagnosis as had been recorded previously at 24 and 12 months, all significantly increased as compared with the results from admission, but not different from those in controls. By contrast, the aggregation in response to ADP was now lower than that observed on admission. No statistically significant gender difference was noted. The implication of the impaired skin microvascular vasodilation and of the changing pattern of platelet aggregation for later diabetic angiopathy needs to be evaluated in the coming decade.
- Published
- 1997
46. Neurodevelopmental Outcome in Extremely Preterm Infants at 2.5 Years After Active Perinatal Care in Sweden
- Author
-
Fredrik Serenius, Karin Källén, Mats Blennow, Uwe Ewald, Vineta Fellman, Gerd Holmström, Eva Lindberg, Pia Lundqvist, Karel Maršál, Mikael Norman, Elisabeth Olhager, Lennart Stigson, Karin Stjernqvist, Brigitte Vollmer, Bo Strömberg, and for the EXPRESS Group
- Subjects
Male ,Pediatrics ,medicine.medical_specialty ,Developmental Disabilities ,Population ,Gestational Age ,Blindness ,Language Development ,Severity of Illness Index ,Bayley Scales of Infant Development ,Cerebral palsy ,Child Development ,Cognition ,Severity of illness ,medicine ,Humans ,Prospective Studies ,Survivors ,Statistics & numerical data ,education ,Prospective cohort study ,Sweden ,education.field_of_study ,business.industry ,Cerebral Palsy ,Infant, Newborn ,Infant ,Gestational age ,General Medicine ,Prognosis ,medicine.disease ,Disabled Children ,Perinatal Care ,Treatment Outcome ,Premature birth ,Case-Control Studies ,Child, Preschool ,Infant, Extremely Premature ,Premature Birth ,Female ,business ,Infant, Premature - Abstract
Importance Active perinatal care increases survival of extremely preterm infants; however, improved survival might be associated with increased disability among survivors. Objective To determine neurodevelopmental outcome in extremely preterm children at 2.5 years (corrected age). Design, Setting, and Participants Population-based prospective cohort of consecutive extremely preterm infants born before 27 weeks of gestation in Sweden between 2004 and 2007. Of 707 live-born infants, 491 (69%) survived to 2.5 years. Survivors were assessed and compared with singleton control infants who were born at term and matched by sex, ethnicity, and municipality. Assessments ended in February 2010 and comparison estimates were adjusted for demographic differences. Main Outcomes and Measures Cognitive, language, and motor development was assessed with Bayley Scales of Infant and Toddler Development (3rd edition; Bayley-III), which are standardized to mean (SD) scores of 100 (15). Clinical examination and parental questionnaires were used for diagnosis of cerebral palsy and visual and hearing impairments. Assessments were made by week of gestational age. Results At a median age of 30.5 months (corrected), 456 of 491 (94%) extremely preterm children were evaluated (41 by chart review only). For controls, 701 had information on health status and 366 had Bayley-III assessments. Mean (SD) composite Bayley-III scores (cognition, 94 [12.3]; language, 98 [16.5]; motor, 94 [15.9]) were lower than the corresponding mean scores for controls (cognition, 104 [10.6]; P < .001; adjusted difference in mean scores, 9.2 [99% CI, 6.9-11.5]; language, 109 [12.3]; P < .001; adjusted difference in mean scores, 9.3 [99% Cl, 6.4-12.3]; and motor, 107 [13.7]; P < .001; adjusted difference in mean scores, 12.6 [99% Cl, 9.5-15.6]). Cognitive disability was moderate in 5% of the extremely preterm group vs 0.3% in controls (P < .001) and it was severe in 6.3% of the extremely preterm group vs 0.3% in controls (P < .001). Language disability was moderate in 9.4% of the extremely preterm group vs 2.5% in controls (P < .001) and severe in 6.6% of the extremely preterm group vs 0% in controls (P < .001). Other comparisons between the extremely preterm group vs controls were for cerebral palsy (7.0% vs 0.1%; P < .001), for blindness (0.9% vs 0%; P = .02), and for hearing impairment (moderate and severe, 0.9% vs 0%; P = .02, respectively). Overall, 42% (99% CI, 36%-48%) of extremely preterm children had no disability, 31% (99% CI, 25%-36%) had mild disability, 16% (99% CI, 12%-21%) had moderate disability, and 11% (99% CI, 7.2%-15%) had severe disability. Moderate or severe overall disability decreased with gestational age at birth (22 weeks, 60%; 23 weeks, 51%; 24 weeks, 34%; 25 weeks, 27%; and 26 weeks, 17%; P for trend < .001). Conclusions and Relevance Of children born extremely preterm and receiving active perinatal care, 73% had mild or no disability and neurodevelopmental outcome improved with each week of gestational age. These results are relevant for clinicians counseling families facing extremely preterm birth. JAMA. 2013;309(17):1810-1820
- Published
- 2013
47. Glycerol carbon contributes to hepatic glucose production during the first eight hours in healthy term infants
- Author
-
Jan Gustafsson, Agneta Sunehag, and Uwe Ewald
- Subjects
Blood Glucose ,Glycerol ,medicine.medical_specialty ,Hepatic glucose ,medicine.medical_treatment ,Lipolysis ,Endogeny ,Biology ,chemistry.chemical_compound ,Internal medicine ,medicine ,Humans ,Insulin ,Gluconeogenesis ,Infant, Newborn ,Substrate (chemistry) ,General Medicine ,Respiratory quotient ,Endocrinology ,Glucose ,chemistry ,Liver ,Pediatrics, Perinatology and Child Health - Abstract
The newborn infant must mobilize endogenous substrate stores to meet the requirements of glucose-dependent organs. High concentrations of free fatty acids and glycerol, and a rapid decrease in the respiratory quotient, indicate that lipids are an important fuel soon after birth. The purpose of the present study was to determine the onset of lipolysis and gluconeogenesis from glycerol in healthy, term, unfed infants. Eight infants were studied from a postnatal age of 3.5 +/- 0.5 h to 7.4 +/- 0.2 h using [6,6-2H2] glucose and [2-13C]glycerol analysed by gas chromatography/mass spectrometry. Plasma concentrations of glucose, glycerol and insulin averaged 2.9 +/- 0.4 mM, 369 +/- 89 microM and 9.4 +/- 9.4 +/- 3.7 microU.ml-1, respectively. The hepatic glucose production rate averaged 25.0 +/- 3.5 mumol.kg-1 min-1 (4.5 +/- 0.6 mg.kg-1.min-1) and the endogenous plasma appearance rate of glycerol 8.7 +/- 1.2 mumol.kg-1.min. On average, 57.9 +/- 8.4% of the glycerol was converted to glucose, representing 11.1 +/- 2.3% of hepatic glucose output. Thus, lipolysis and gluconeogenesis from glycerol are established within the first 8 h of life in term infants.
- Published
- 1996
48. Congenital chloride diarrhoea: a prenatal differential diagnosis of small bowel atresia
- Author
-
K Lundkvist, P.G. Lindgren, and Uwe Ewald
- Subjects
Diarrhea ,Polyhydramnios ,medicine.medical_specialty ,Intestinal Atresia ,Prenatal diagnosis ,Gastroenterology ,Ultrasonography, Prenatal ,Chlorides ,Pregnancy ,Internal medicine ,medicine ,Humans ,Peristalsis ,Fetus ,business.industry ,General Medicine ,medicine.disease ,Fetal Diseases ,Atresia ,Pediatrics, Perinatology and Child Health ,Gestation ,Female ,Differential diagnosis ,business - Abstract
We compared ultrasound findings and pre- and postnatal clinical signs in 8 patients with congenital chloride diarrhoea and 14 with small bowel atresia diagnosed in 1977-1991 in order to evaluate the possibility of a prenatal distinguishing diagnostic sign. In the patients with congenital chloride diarrhoea the pregnancy was complicated by marked polyhydramnios, the symphysis-fundus distance exceeded + 2 SD before gestational week 31 and the fetus displayed normal peristalsis in extensively dilated intestines and the "frog position". In the patients with small bowel atresia the symphysis-fundus distance was normal before gestational week 31 and the fetus displayed increased peristalsis in a few dilated intestinal loops.
- Published
- 1996
49. Cutaneous blood flow during a hypoglycaemic clamp in insulin-dependent diabetic patients and healthy subjects
- Author
-
J Aman, Christian Berne, Torsten Tuvemo, and Uwe Ewald
- Subjects
Adult ,Blood Glucose ,Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Vasodilation ,Hypoglycemia ,Forearm ,Internal medicine ,medicine ,Humans ,Insulin ,Skin ,business.industry ,General Medicine ,Blood flow ,Laser Doppler velocimetry ,medicine.disease ,medicine.anatomical_structure ,Endocrinology ,Clamp ,Diabetes Mellitus, Type 1 ,Regional Blood Flow ,Anesthesia ,Forehead ,Female ,business - Abstract
1. A marked cutaneous vasodilatation has been shown to occur in healthy subjects, but not in insulin-dependent diabetic patients, in response to hypoglycaemia induced by a rapid intravenous bolus injection of insulin. 2. In the present study cutaneous blood flow in response to a gradual decline in blood glucose concentration was investigated in eight young adult diabetic patients and in eight age- and sex-matched control subjects. After a hyperinsulinaemic euglycaemic clamp for 40 min, hypoglycaemia was induced (plasma glucose concentration 2 mmol/l) by a standardized stepwise reduction in the intravenous glucose infusion 3. Blood flow was measured by using a laser Doppler sensor and a cutaneous O2 electrode placed on the medial aspect of the forearm, and a laser Doppler sensor placed on the forehead. 4. No significant change in cutaneous blood flow occurred during euglycaemic hyperinsulinaemia. 5. In control subjects a marked increase in blood flow during hypoglycaemia was observed in the forearm by both methods. No corresponding change was observed in the forehead. 6. In the diabetic patients the increase in cutaneous blood flow was absent in both the forearm and forehead. 7. It is concluded that hypoglycaemia, but not hyperinsulinaemia, is associated with a regional cutaneous vasodilatation in healthy control subjects. This cutaneous vasodilatation is absent in diabetic patients.
- Published
- 1992
50. Two cases of neonatal pneumococcal septicemia
- Author
-
Anna Schwan, Hans Johnsson, Staffan Bergström, and Uwe Ewald
- Subjects
Adult ,Pediatrics ,medicine.medical_specialty ,business.industry ,Relative incidence ,Infant, Newborn ,Obstetrics and Gynecology ,General Medicine ,Infant, Premature, Diseases ,bacterial infections and mycoses ,medicine.disease_cause ,Group B ,Pneumococcal Infections ,Pneumococcal septicemia ,Sepsis ,Immunology ,Streptococcus pneumoniae ,Medicine ,Humans ,Female ,Neonatal septicemia ,business ,Early onset - Abstract
Pneumococci (Streptococcus pneumoniae) infrequently cause neonatal septicemia. An increased number of cases have been reported in recent years, but no increase in the relative incidence among neonatal infections has been noted. Two recent cases that occurred within a short period of time are described. They were found to exhibit most clinical characteristics, previously described, of Group B Streptococci (GBS) septicemia with an early onset, but appear to have a graver prognosis.
- Published
- 1992
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