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Biomedical subjects

A Meberg

Publications and source records attributed to A Meberg.

At least 19 recordsLinked to original sources
PubMed2001

[Cerebral palsy as indicator of quality of neonatal care].

BACKGROUND: An investigation of the prevalence of cerebral palsy in relation to neonatal intensive care. MATERIAL AND METHODS: Population based study in live-born children with birthweight > or = 500 g in the Norwegian county of Vestfold over the 25-year period 1970-94 (n = 58,448). Retrospective and prospective control of cases (cases with a postneonatal origin of cerebral palsy excluded) with a minimum follow-up to four years of age. RESULTS: Cerebral palsy was diagnosed in 139 cases (2.4 per 1,000). The prevalence declined from 2.8 per 1,000 in the first five-year cohort born 1970-74, to 2.2 per 1,000 in children born in each of the three five-year cohorts born 1980-84, 1985-89, and 1990-94 (p = 0.24). The neonatal mortality rate declined significantly from 8.7 per 1,000 in the first to 2.8 per 1,000 in the last five-year cohort (p < 0.0001). The low birthweight (500-2,499 g) rate in live-born infants increased significantly in 1990-94 compared to 1985-89 (4.5% vs 3.9% respectively; p < 0.05). After a local ventilator treatment programme (operative from 1989) was established, transports of infants with severe respiratory distress syndrome to the regional hospital declined from 3 per 1,000 live-born infants to 1 per 1,000 (p < 0.0001). INTERPRETATION: A decentralised neonatal intensive care programme can be developed, with substantial decline in neonatal mortality without a corresponding increase in cerebral palsy prevalence.

Cerebral Palsy↗
PubMed2000

Outcome of congenital heart defects--a population-based study.

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

Adolescent↗
PubMed1999

[Drug use in a neonatal unit].

All medication administered to patients admitted to a neonatal intensive care unit was registered during a one-year period (1996). Only two (0.4%) of 469 infants admitted were not given any drug at all. A total of 12,019 single doses were administered, a mean of 33 per day. 7,042 (59%) were given orally, and 3,332 (28%) intravenously. 292 (63%) patients were given vitamin K as the only drug. 113 infants (24%) received systemic antibiotic treatment, 5% of all infants born alive at the hospital. Drugs accounted for 2.7% of the total expenses for running the unit. Surfactant (12 single doses) alone accounted for 47% of the costs of drugs. Drug monitoring by serum concentration measurements showed that 32% of the values were outside the therapeutic range. To a limited extent (44%) this was followed by correction of the dose. One single drug dose (1 per 10,000 doses) was administered to a patient for whom the drug was not prescribed. Quality assurance of medication is an important task in neonatal intensive care units.

Administration, Oral↗
PubMed1999

Early clinical screening of neonates for congenital heart defects: the cases we miss.

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

Cohort Studies↗
PubMed1998

Screening for neonatal hyperbilirubinaemia and ABO alloimmunization at the time of testing for phenylketonuria and congenital hypothyreosis.

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

ABO Blood-Group System↗
PubMed1997

Quality of life in children with congenital heart defects.

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

Abnormalities, Multiple↗
PubMed1997

Does an early neonatal diagnosis of a later spontaneously closed ventricular septal defect impair quality of life?

The hypothesis that early diagnosis of a ventricular septal defect (VSD) with spontaneous closure later on may impair the parental-infant bonding process, with consequences for the child's quality of life in the longer term, was tested in 51 children born in 1986-1991 (gestational age > or = 37-42 weeks) with VSDs diagnosed in the early neonatal period and closing spontaneously during the first 24 months of life. The results were compared to 83 healthy controls matched for gestational age, time and place of birth. A method (questionnaire) taking into consideration the quality of life spheres of external living conditions and the interpersonal and personal conditions of the child was used. Except for a lower satisfaction with family network in the VSD group (p < 0.05), no differences were found between the VSD group and the controls for any of the parameters tested or for overall quality of life (p>0.05).

Heart Murmurs↗
PubMed1996

[A changing panorama of cerebral palsy? A population-based study of children born during the 20-year period 1970-89].

In a population-based study cerebral palsy was diagnosed in 110 cases (2.4 per 1,000) among live born children with birth weight > or = 500 g (N = 45,976) during the 20-year period 1970-89 (cerebral palsy cases with a postneonatal etiology excluded). The incidence of cerebral palsy showed a linear declining trend from 2.8 per 1,000 in the first five-year cohort born 1970-74 to 2.0 per 1,000 in children born 1985-89 (p = 0.17). 15.9% of the decline in incidence of cerebral palsy from the first to the second ten-year cohort could be explained by a decreasing rate of low birth weight (500-2,499 g) in the population, from 4.2% 1970-79 to 3.8% 1980-89 (p < 0.05). The neonatal mortality rate declined significantly from 7.2 per 1,000 in the first to 3.9 per 1,000 in the last ten-year cohort respectively (p < 0.01). More children with cerebral palsy born in the ten-year period 1980-89 were treated with mechanical ventilation in the neonatal period (13/46; 28.3%) than such children born in the ten-year period 1970-79 (4/64; 6.3%) (p < 0.01). The results contrast with the traditional findings of a higher incidence of cerebral palsy incidence following improved survival of infants with low birth weight. Our results may reflect a more integrated development of perinatal care. Research on ways of preventing low birth weight may allow us to lower the incidence of cerebral palsy still further.

Cerebral Palsy↗
PubMed1995

[Ventilator treatment at a subregional neonatal unit. Experiences form the Vestfold central hospital 1989-1994].

During the six-year period 1989-94, 106 infants were treated with mechanical ventilation at the neonatal unit, Vestfold Central Hospital, Tønsberg, Norway (0.8% of live born infants). A total of 114 treatments were started. Indications were respiratory distress syndrome (RDS) in 63 (55%) of the treatments, asphyxia in 21 (18%), septicaemia/pneumonia in 12 (11%), congenital malformations in 8 (7%) and other indications in 10 (9%). 56 (49%) of the treatments lasted less than 24 hours until extubation or transportation to a regional hospital. The mean duration of treatment was 42.2 hours (range 0.7-183 hours). Pneumothorax occurred in seven infants (7%), in six of these during resuscitation and stabilizing treatment before mechanical ventilation. 16 infants (15%) died (cumulated mortality). Of the 90 surviving infants, nine (10%) acquired brain damage. The local ventilator treatment programme reduced the need of postnatal transports in infants with RDS by 65% during the period 1989-94 (1.2 per 1000 live born infants) compared with the period 1982-88 (3.4 per 1000) (p < 0.01). Ventilator treatment programmes for newborn infants can be undertaken safely at a subregional neonatal unit. The incidence of postnatal transports to a regional hospital is reduced.

Evaluation Studies as Topic↗
PubMed1995

A changing pattern of cerebral palsy. Declining trend for incidence of cerebral palsy in the 20-year period 1970-89.

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

Cerebral Palsy↗
PubMed1994

Increasing incidence of ventricular septal defects caused by improved detection rate.

In a population-based study in children born alive during the 10-year period from 1982 to 1991 (n = 22,810), ventricular septal defects (VSDs) were diagnosed in 127 cases, an incidence of 5.6 per 1000. The incidence was significantly higher in the cohort of children born during the 6-year period from 1986 to 1991 than among those born in the preceding 4-year period, 1982-1985 (6.5 and 4.0 per 1000 respectively; p < 0.05). The increase was caused entirely by an increased detection rate of small defects in the muscular part of the interventricular septum after introducing echocardiography as a standard method for investigating suspect congenital heart defects in the neonatal period. This also explained entirely an increase in the total incidence of congenital heart defects to 10.6 per 1000 in the last period from 8.4 per 1000 in the first, although this increase was not significant (p > 0.05). More children born in 1986-1991 had spontaneous closure of their VSDs (75.5%) than those born in 1982-1985 (51.5%) (p < 0.05). In 69.3% of patients the VSDs closed during the first year of life. For the cohort born in 1986-1991, 84.6% of the defects located in the muscular part of the septum closed spontaneously. Small defects in the muscular part of the interventricular septum with spontaneous closure in early life may represent the tail of a normal developmental process, and not defects in the sense of malformations.

Cohort Studies↗
PubMed1993

[Transport from a subregional neonatal unit. Experiences from Vestfold Central Hospital during an 11-year period 1982-92].

A key element of neonatal regionalization is the establishment of transport links between centres of tertiary care and subregional centres. During the 11-year period 1982-92, 186 transports were undertaken from the neonatal unit, Vestfold Central Hospital, for a total of 180 patients, or 0.8% of all live born infants (n = 23,652). 64 patients (36%) were referred for prematurity/respiratory distress syndrome (IRDS), 81 (45%) for congenital malformations, and 35 (19%) for other conditions. Transports for prematurity/IRDS declined significantly from the the first 6-year period 1982-87 to the last 5-year period 1988-92 (3.6 vs. 1.8 per 1,000 live born infants; p < 0.01), owing to the establishment of a local respirator treatment programme for severe IRDS. In 71 (38%) transports the infants were mechanically ventilated. Seven (10%) suffered in-transport complications related to the endotracheal tube. At arrival, significantly more patients were anaemic (Hb < 14 g%; transports before 48 hours after birth), alcalotic (pH > 7.50), hypocapnic (PCO2 < 4 kPa) or had a base excess < -10 mmol/l than before transportation (p < 0.05). There was a tendency towards more patients with hypothermia (tp < 36 degrees C), acidosis (pH (< 7.20) and hypercapnia (PCO2 > 10 kPa) at arrival than before transportation (p > 0.05). No deaths occurred during transport. However, two infants died within two hours after arrival, giving a transport-related mortality rate of 1%. Transporting critically ill neonates implies discontinuity of treatment and monitoring of these infants. Optimal stabilization before transportation, and scrupulous work on technical details are of utmost importance.

Humans↗
PubMed1993

[Neonatal respiratory distress syndrome treated with a natural surfactant. The Norwegian Curosurf study].

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.

Biological Products↗
PubMed1991

[Neonatal conjunctivitis in a nursery and a neonatal unit].

After Credé prophylaxis was abandoned at our hospital in 1984 scrupulous clinical surveillance of all neonates for conjunctivitis, and bacterial cultures from purulent eye discharge, have become routine. During the two-year period 1 March 1987 to 28 February 1989, testing for Chlamydia trachomatis (EIA-technique) was added in all infants with clinical conjunctivitis. During the period concerned there were 332 cases of conjunctivitis among 4,520 live born infants, an incidence of 7.3%. The incidence was higher for infants staying in the nursery (8.2%) than for those admitted to the neonatal unit (3.5%) (p less than 0.01). 90% of the infections were diagnosed during the first week of life. 468 isolates were identified by routine bacteriological investigation, 452 gram-positives (96.6%), and 16 gram-negatives (3.4%). The following strains were found: Staphylococcus aureus 171 (51.5% of the patients), Staphylococcus epidermidis 153 (46.1%), Streptococcus viridans 106 (31.9%), diphteroids 11 (3.3%), beta-hemolytic streptococci seven (2.1%), Streptococcus pneumoniae two (0.6%), enterococci two (0.6%), Hemophilus influenzae six (1.8%), Escherichia coli five (1.5%), Proteus two (0.6%) and Branhamella catarrhalis one (0.3%). Not a single case of gonococcal ophthalmia was diagnosed. Positive tests for Chlamydia were found in 13 infants (3.9% of all infants with conjunctivitis), an incidence of 0.3% for the whole population of live born infants. Six of the chlamydia infections (46%) occurred within the first week of life. Expenses for chlamydia testing were estimated to be NOK 1,020 per positive test. Preventing conjunctivitis in our nursery and neonatal unit calls for strategies to protect newborn infants from colonization with pathogenic bacteria, especially S. aureus.(ABSTRACT TRUNCATED AT 250 WORDS)

Conjunctivitis, Bacterial↗