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Background: Quality assessment of perinatal care can be carried out by classifying perinatal deaths. In the following we have analyzed the geographical contrasts in perinatal deaths according to the Nordic-Baltic perinatal death classification in a sparsely populated Norwegian county.Material and Methods: All stillbirths (> or =28 weeks of gestation) and neonatal deaths (gestational age > or =22 weeks; death < or =28 days) in 1986-96 from Nordland county (240,000 inhabitants) were classified. For comparison the county was geographically divided into six general local hospital areas and one central hospital area.Results: The classification showed a well acceptable inter and intra observer variation. One hundred and seventy-one stillbirths and 155 neonatal deaths were analyzed. The death rate (pr 1,000 births) for single, non-malformed, antenatal stillbirths was higher in the central hospital area than in the local hospital areas (3.22 vs. 2.02). The death rate for extreme preterm infants (22-27 weeks of gestation) was on the other hand higher in the local hospital areas (2.45 vs. 1.05). One of the general local hospital areas was singled out with an especially high neonatal death rate among extreme preterm infants. This was to some extent explained by the death of extreme preterm twins and triplets.Conclusion: The Nordic-Baltic perinatal death classification system is a consistent and reproducible tool also for studying perinatal death in restricted geographical areas. The observed contrasts in perinatal deaths were used as basis for programs aimed at improving perinatal care. The observation of an unexplained increased number of antenatal stillbirths in the central hospital area resulted in a program for prospective recording and better characterization of the placenta and umbilical cord. Proposals for a better antenatal program preventing extreme preterm birth of twins for the whole county has been launched. In utero transfer to a hospital with a neonatal intensive care unit seems crucial in improving the prognosis for these infants. [ABSTRACT FROM AUTHOR]

Among children in the western world, atopic diseases are a major cause of morbidity. However, several prevalence studies have indicated that the frequency of these diseases displays both geographic and ethnic variations. In 1995, we conducted a questionnaire‐based, cross‐sectional survey in northern Norway. Atopic diseases among 8676 schoolchildren, aged 7–13 years, including 491 children with Sami ethnicity, were studied. The role of ethnicity (Sami/white Caucasian) was determined by comparing the reported atopic disease rate in each of the respective groups. In the areas under investigation (the cumulative incidence, the point prevalence of asthma and allergic rhinoconjunctivitis and the cumulative incidence of atopic dermatitis), the Sami children scored higher than the white Caucasian Norwegian children. The relative risks (RR) in Sami children were: current asthma RR = 2.01 [95% confidence interval (CI) 1.48–2.73]; current allergic rhinoconjunctivitis RR = 1.51 (95% CI 1.14–1.99); lifetime atopic dermatitis RR = 1.39 (95% CI 1.18–1.63). We thus conclude that there is an association between Sami ethnicity and asthma and allergy among schoolchildren in northern Norway. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to identify possible risk factors for current asthma revealed by two studies in Northern Norway in 1985 and 2008 and to evaluate these factors contributing to the increased prevalence of asthma over these 23 years., Methods: As part of the 'Asthma and allergy study among schoolchildren in Nordland county' we performed a case-control study (70.0% attendance) comparing 153 children with current asthma (cases) to their non-asthmatic controls. The results from this 2008 study were compared to a similar case-control study (93.2% attendance) performed in 1985 based on 62 current asthmatics., Results: In 1985, the most important risk factors for current asthma were repeated lower respiratory tract infections (LRTIs) with adjusted odds ratio (aOR) 52.11, together with urticaria ever and atopic disease in the family. In 2008, the most important risk factors were food allergy with aOR 7.06, LRTIs during the first three years of life with aOR 5.80 and hospitalisation caused by LRTIs., Conclusion: In both studies, LRTI was the most important risk factor for current asthma. Whether or not LRTIs have contributed to the increased asthma prevalence in this population over 23 years remains unresolved., (©2018 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)

Aim: A questionnaire has been used repeatedly in cross-sectional studies to determine the prevalence of asthma, allergic rhinoconjunctivitis (AR) and eczema among schoolchildren in Nordland County, Norway. The current study was designed to validate the questionnaire against clinical assessment as the diagnostic gold standard and to investigate the extent of possible misclassification., Methods: A subsample of 801 schoolchildren of 4150, whose parents had answered a questionnaire covering asthma and atopic diseases, underwent a detailed clinical evaluation including a standardized interview, a clinical examination, skin prick tests (SPT), blood samples, spirometry an exercise treadmill test (EIB test) and measurement of exhaled nitrogen oxide (FeNO)., Results: The questionnaire had a sensitivity of 0.96 and a specificity of 0.87 for the diagnosis of asthma ever compared to clinical assessment. The overall agreement (kappa) was 0.80. After clinical assessment the prevalence of asthma ever was adjusted from 17.6 % to 16.9 % (95% CI: 15.8-18.0). The most sensitive and specific questions in identifying asthmatic children by the questionnaire were questions asking about diagnosis ('Has the child ever had asthma?') rather than those covering asthma symptoms such as wheeze, shortness of breath and/or cough. A positive exercise test increased the post-test probability for the asthma diagnosis only to a minimal degree., Conclusion: Based on the good agreement between the questionnaire responses and the clinical assessments, it is concluded that the questionnaire had good validity and served as a useful epidemiological tool. Detailed clinical testing added little additional information.

The article discusses ethical aspects related to isolation of patients with infectious diseases. The empirical basis is a textual analysis of two national guidelines on prevention of spreading of patients with meticillin-resistant Staphylococcus aureus. The analysis shows that even though both documents are founded upon updated scientific evidence on epidemiology and infectious diseases they lack explicit ethical argumentation on several aspects relevant for treatment and care under isolation or other constraints. Presuming that written guidelines make important frames for reflection and learning among practitioners, the authors suggest that such guidelines not just in Scandinavia but internationally should show how ethical considerations can be included into the individual risk assessments concerning patients under isolation., (Copyright © 2010 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.)

Background: The neonatal death rate (death < or = 28 days/1000 live births) has decreased and the level is now so low that it has been questioned whether further improvement is possible. The aim of this study was to categorize nonmalformed infants of 34 weeks' or more gestational age dying in the neonatal period to analyze if these deaths might have been prevented., Material and Methods: We used the audit method to study neonatal deaths during 1986-98 in a county population of approximately 240 000 inhabitants., Results: Twenty-six neonatal deaths from a population of 41 901 live births were analyzed. The neonatal deaths were found to be associated with antepartum hypoxia (six cases); intrapartum catastrophes (seven cases); intrapartum monitoring deficiencies (five cases); resuscitation and stabilization after birth (two cases); infection (one case); sudden infant death syndrome (four cases); and peritonitis (died at home, one case). Suboptimal care was recorded in 16 cases. Neonatal death was unlikely to be associated with suboptimal care in six cases, but in 10 cases suboptimal care might or was likely to have brought about the fatal outcome., Conclusion: Avoiding suboptimal care might or is likely to prevent neonatal death in 10/26 (38.5%) of nonmalformed infants of 34 weeks' or more gestational age. Such improvements may, however, only slightly influence the neonatal death rate, with a reduction from 4.4 to 4.2/1000 live births.

The prevalence of asthma and allergy in children is increasing. In order to investigate time trends, follow-up studies conducted several years apart and with identical study designs are essential. We compared two identical, cross-sectional and questionnaire-based studies of asthma and allergy in north-Norwegian schoolchildren (7-13 years of age). The first study was conducted in 1985 (n = 10,093) and the second in 1995 (n = 8,676). The cumulative incidence was as follows: diagnosed asthma, 8.6% in 1995 vs. 5.1% in 1985, relative risk (RR) = 1.71 (95% CI: 1.53-1.90); allergic rhinoconjunctivitis, 22.1% in 1995 vs. 16.4% in 1985, RR = 1.39 (95% CI: 1.31-1.47); and atopic dermatitis, 19.7% in 1995 vs. 13.2% in 1985, RR = 1.48 (95% CI: 1.39-1.58). The cumulative incidence of allergic rhinoconjunctivitis and atopic dermatitis was higher in children of Sami ethnicity than Norse ethnicity in the 1985 study. Furthermore, although not statistically significant, there was a trend towards a greater increase in the cumulative incidence of diagnosed asthma, symptoms of asthma, allergic rhinoconjunctivitis, and atopic dermatitis from 1985 to 1995 in children of Sami ethnicity than Norse ethnicity. We conclude that there has been a marked increase in the cumulative incidence of asthma and allergy prevalence among schoolchildren in northern Norway from 1985 to 1995.

Background: Previous studies have shown that the prevalence of asthma and allergy in children is lower in Eastern than Western Europe., Methods: We have compared the prevalence of asthma, respiratory symptoms, allergic rhinoconjunctivitis, and atopic dermatitis in schoolchildren aged 7-13 years in a questionnaire-based study conducted in the city of Nikel on the Kola Peninsula, Russia, in 1994 (n = 1143) and another conducted in northern Norway in 1995 (n = 8676)., Results: The prevalence of diagnosed asthma was 5.1% in Russian children and 8.6% in Norwegian children; RR =0.58 (95% CI: 0.44-0.76). The prevalence of all respiratory symptoms was higher in Russian children. The prevalence of allergic rhinoconjunctivitis was 16.9%, in Russian children and 22.1%, in Norwegian children: RR =0.74 (95% CI: 0.65-0.85). The prevalence of atopic dermatitis was 7.4% in Russian children and 19.7% in Norwegian children; RR=0.38 (95% CI: 0.31-0.46)., Conclusions: We conclude that the prevalence of diagnosed asthma, allergic rhinoconjunctivitis, and atopic dermatitis was higher in Norwegian than Russian schoolchildren. The higher prevalence of respiratory symptoms in Russian children probably reflects a higher prevalence of undiagnosed, nonallergic asthma.

Background: The Norwegian Board of Health has proposed to divide the delivery units into three categories. For several of today's smaller consultant managed units this could lead to a reclassification into midwife managed units., Material and Methods: During 1997 and 1998 the community hospital in Lofoten has tried out a modified type of midwife managed unit. By a continuous selection process a high risk and a low risk group of gravidas were identified. The high risk group was referred to the central hospital in Bodø, while the low risk group was offered to deliver locally., Results: Previously more than 90% delivered at the community hospital in Lofoten, while approximately 70% still delivered locally during the trial period. There were no deliveries during transport and no serious complications for mother or child caused by the new system. The community hospital had facilities for performing emergency caesarean sections. In 1997 nine caesarean sections out of 211 deliveries and in 1998 four out of 224 were performed. The caesarean section rate for the total population was lower during the trial period than over the previous five years., Interpretation: A modified midwife managed unit could be a good alternative for small consultant managed units if the Norwegian Board of Health's proposal is carried through.

Background: As small obstetrical departments may not be able to give second-level perinatal care, the delivery unit at Lofoten hospital was for the years 1997-98 reorganized to a modified midwife managed unit. Women at low obstetrical risk were delivered at this unit and women at high risk were referred to the central hospital. We assessed the effectiveness of the risk selection., Material and Methods: The study was a prospective, pragmatic, population-based trial. Desired outcome was defined as a non-operative delivery at 35-42 weeks gestational age giving an infant not needing resuscitation. Intermediate outcomes: Operative deliveries, infants transferred to neonatal intensive care unit and infants diverging from normal. The intended place of delivery was ultimately decided at admittance to the midwife managed unit., Results: Of the 628 women in study 435 (69.3%) gave birth at the midwife managed unit, 152 (24.2%) were selected to be delivered at the central hospital and 41 (6.5%) were transferred to the central hospital after admittance to the midwife managed unit. Desired outcome was recorded in 94% of the deliveries at the midwife managed unit as compared to 50.3% at the central hospital. Women who intended to be delivered at the midwife managed unit, needed fewer operative deliveries and relatively few infants were transferred to the neonatal intensive care unit or diverged from normal., Conclusions: As nearly 70% of the births occurred at the midwife managed unit and 94% of these deliveries had a desired outcome, this indicates an effective selection process. This model might be an alternative to centralization of births in sparsely population areas.

All 271 liveborn infants with birthweight < or = 1,500 g born of mothers residing in Nordland county during 1978-89 were studied retrospectively. Mean birthweight was 1,083 g, mean gestational age 29 weeks and 21% of the children were growth retarded. 18% of the newborns were transported from local hospitals to a neonatal intensive care unit, most of them (82%) by the unit's transport team. The number of infants delivered by caesarean section increased during the study period. 103 children (38%) died before the age of four. 15 children (6%) died after the newborn period, mostly due to bronchopulmonary dysplasia (n = 8) and sudden infant death syndrome (n = 4). Mortality rate corrected for birthweight < or = 500 g, lethal malformations and sudden infant death syndrome was 32%. The proportion of liveborn children suffering from cerebral palsy was 4.8%. Although the mortality rate remained unchanged during the study period, the proportion of disabilities decreased.

The aim of this study was to describe principal problems and to analyse transport times, stabilizing procedures, adverse events during transfer, outcome, effectiveness and the care of infants transferred by air from district general hospitals and maternity homes to a central hospital. Transfer times, equipment adverse events and clinical deterioration were recorded as they occurred. Data regarding clinical problems, diagnoses and outcome were collected retrospectively from hospital records. During the study period (1984-95) 275 infants (267 transports) were transferred by fixed-wing aircraft (233) or helicopter (34). Median time from request of transfer to arrival of the transport team (usually a neonatal nurse and a paediatrician) was 120 min, median stabilizing time 60 min. Ninety-six infants (35%) were intubated, 62 (22.5%) by the transport team. During 34 transports (12.7%), equipment-related adverse events occurred making six infants worse. Ten more infants deteriorated during transit. A significant correlation between birthweight and after-transfer temperature was recorded. After-transfer temperature for very low birthweight (<1500 g, VLBW) infants was significantly higher when the transport team attended the delivery than when they did not (35.9 degrees C vs 34.7 degrees C). All nine infants (3.2%) with after-transfer temperature <34.0 degrees C died, 15 infants (5.5%) died within 24 h after transfer and 20 (7.3%) died later. Adjusted OR for death among transported versus in utero transferred VLBW infants was 3.8 (1.4-10.4). Every effort should be taken to transfer VLBW infants in utero. If preterm deliveries at 26-28 weeks of gestation at district general hospitals is unavoidable, an early request for the neonatal transport team to be there at delivery is advisable. Transport of very immature infants <26 weeks gestational age is not recommended. An outreach educational program ("Team Pink Newborn") has been created. Staff training to combat hypothermia and regular inspection and control of the transport equipment by three neonatal intensive care nurses has now been implemented.

Objective: To evaluate the outcome for very low birthweight (VLBW) infants in northern Norway., Subjects and Methods: All live born infants (n = 536) with birthweight < or = 1500 g born during 1978-89 to women residing in the northern health region of Norway were studied retrospectively. Data were from the Medical Birth Registry (MBR), hospital records and from follow-up recordings to 4 y of age at maternal and child health centres. Stillborn infants (n = 269) with birthweight < or = 1500 g during the same period were also registered., Results: The annual incidence of live born VLBW infants (7.1/1000 live births) did not change, but the proportion of infants born alive before 26 weeks' gestation increased and the stillborn part decreased significantly. The Caesarean section (CS) rate, antenatal transfer and the use of a neonatal transport team increased significantly. Four hundred and seventy-five infants (89%) were considered viable at birth, 347 (65%) survived to 1 y and 343 (64%) to 4 y. The likelihood of survival was independently related to female gender. The trend for survival to 4 y of age did not increase significantly. Thirty children suffered from cerebral palsy (8.7% of survivors, 5.6% of live births) and the cerebral palsy rate for infants with birthweight 751-1000 g decreased. The proportion of survivors considered to be normal or mild disabled increased and the part suffering from moderate or severe disability decreased significantly., Conclusions: In spite of long distances and unfavourable climatic conditions VLBW infants can be adequately cared for in this sparsely populated region of Norway.

In order to explore the possibility of converting a delivery unit at a small hospital to a maternity home, we examined the medical records of those women who delivered by Caesarean section, forceps or vacuum extraction at Lofoten hospital during 1995. How many of these women might it have been necessary to transfer to an obstetrical department if Lofoten hospital had been a maternity home caring for low risk deliveries (primipara and multipara)? Out of a total of 271 deliveries (primiparas 98), 49 women delivered by Caesarean section (n = 35), forceps (n = 5) or vacuum extraction (n = 9). Using risk assessment, 22 women (45%) would have been selected for antenatal transfer, and 20 (41%) for intrapartum transport. For seven women no transfer would have been possible. These women would have delivered locally by vacuum extraction. Primipara versus multipara had a relative risk of 2.8 for Caesarean section or assisted vaginal delivery. It is estimated that 8-9% of the women would be selected prenatally for planned delivery at a hospital unit and that 7-8% would be transferred in labour if primiparas delivered at the maternity home. If primiparas were excluded, the proportions would be 41% and 1-2% respectively. In 1997 the delivery unit at Lofoten hospital was temporarily converted to a maternity home for a period of two years.

For estimation of the prevalence, degree of severity, and association with outdoor pollution, a questionnaire on asthma and other atopic diseases was distributed to the parents of 4666 7-13-year-olds, comprising all the children in 36 schools in Telemark County, Norway, including 37% of the schoolchildren in the county. The response rate was 94%. In a validity study employing clinical evaluations, the questionnaire-based diagnosis of asthma was found to have a sensitivity of 0.96 and a specificity of 0.88. The lifetime prevalence of asthma in Telemark was 9% (boys 11.3%, girls 6.6%; p < 0.001). There was no significant difference in the lifetime prevalence of asthma by pollution zone; 8.3% in heavily, 9.3% in moderately, and 9.2% in minimally polluted zones. The asthma prevalence was significantly higher (14.2%; p < 0.05) among boys in the coastal area of the county than in the mountainous area (8.9%). Both of these areas were in the minimal pollution zone. Of asthma cases, 67% were categorized as mild, 29% as moderate, and 4% as severe. The lifetime prevalence was 17.8% (boys 21.3%, girls 14.2%; p < 0.001) for allergic rhinitis, 13.2% (boys 11.4%, girls 15.2%; p < 0.001) for atopic eczema, and 29.6% (boys 31.7%, girls 27.4%; p < 0.01) for overall atopic disease (asthma, allergic rhinitis, eczema). These findings are not compatible with the hypothesis that outdoor pollution is associated with the lifetime prevalence of asthma in school-age children. The results also show that less than 0.5% of schoolchildren suffer from severe asthma.

43 Norwegian premature infants with respiratory distress syndrome were randomized to receive either a high dose (initial dose 200 mg/kg) or a low dose (initial dose 100 mg/kg) of natural porcine surfactant (Curosurf). In the high dose group, up to five doses of surfactant could be given compared with three in the low dose group. In the high dose group, oxygen requirement was significantly lower during the first 36 hours after surfactant was administered than the requirement in the low dose group. There was no difference in outcome between the high and low dose groups. Outcome was poor for babies with birthweight < 750 gram or gestational age < 26 weeks, in spite of an initial favourable surfactant response in several of them. We conclude that the initial dose of Curosurf should be 100 mg/kg and two more doses can be given if necessary.