[This is the truth].
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Biological Products↗
Biomedical subjects
Alf Meberg
Publications and source records attributed to Alf Meberg.
Respiratory syncytial virus infections in congenital heart defects--hospitalizations and costs.
AIMS: To register hospitalizations for respiratory syncytial virus (RSV) infections and estimate costs of prophylaxis with humanized monoclonal antibodies (palivizumab) against RSV, compared to hospital care, in cases with congenital heart defects (CHDs). METHODS: Population based study with prospective registration of CHDs. Costs for hospital treatment of RSV-infections in CHD-patients calculated by means of the Norwegian Diagnosis Related Groups system. RESULTS: In 43 470 infants live born in the population through the 18-year period 1987-2004 a structural CHD was diagnosed in 527 (1.2%). A total of 898 (2.1%) hospitalizations for RSV-infections occurred in the study population 1987-2005. The hospital admittance rate was significantly higher for CHD-cases (4.8%) than for children without CHD (2%) (P = 0.002). Severe CHDs (need for surgery or catheter intervention) had a higher admittance rate (9.2%) compared to the group of remaining CHDs (3.3%) (P = 0.01). Number needed to treat with palivizumab to avoid one hospitalization for RSV-infection in cases of severe CHDs was calculated to 24, at costs of US dollar 195,000. The expenses for palivizuamab prophylaxis in severe CHDs were 31 times that of hospital treatment. CONCLUSION: Prophylaxis with palivizumab in severe CHDs is not cost-effective.
Antibodies, Monoclonal↗
[Quality evaluation of neonatal transports].
BACKGROUND: Neonatal transports carry risk of complications and technical mishaps which may cause deterioration of the patient's condition. MATERIAL AND METHODS: Prospective observational study on all transports from the subregional neonatal unit, Vestfold Hospital, Norway to other hospitals during the 23-year period 1982-2004. RESULTS: 396 transports were undertaken with a total of 359 patients, 0.7% of live born infants (n = 49,250). Indications were prematurity/respiratory distress syndrome (RDS) in 84 (21%), congenital malformations in 188 (47%), and other conditions in 124 (31%). After the establishment a local respirator programme 1989, transports for prematurity/RDS declined significantly from the 7-year period 1982 - 88 to the 16-year period 1989-2004 (3.4 vs. 1.0 per 1000 live born infants ;p < 0.0001). Night-time transports declined by 55 %. Technical mishaps occurred in 4% of the transports. No deaths occurred during transport; however, 10 infants (2.8%) died within 24 hours on arrival. INTERPRETATION: Neonatal transports were associated with risk of deterioration. High local competence and up-to-date technical equipment for neonatal intensive care improve the quality of transport, reduce the incidence of transports of premature infants with RDS, and of transports during night-time.
Air Ambulances↗
Congenital heart defects: the patients who die.
AIMS: To register mortality and causes of death in patients with congenital heart defects (CHDs). METHODS: Prospective population-based observational study. RESULTS: 553 infants with CHD (1.1% of live born) were observed for 1-22 y (median 10 7/12 y). Sixty-four died (11.6%), of whom 32 (50%) died during the first 4 wk, and 51 (79.7%) during the first year of life. Of the total neonatal deaths in the population (3 per 1000), CHDs occurred in 21.5%. Mortality for children with CHDs was not significantly different between the cohorts born in 1982-1991 and 1992-2002, for either neonatal deaths or deaths later on (p>0.05). Out of 170 patients in whom therapeutic procedures (surgery, catheter interventions) were undertaken, 34 (20%) died. Nine cases (1.6%) died with unrecognized CHDs; seven of these on the first day of life with severe extracardiac malformations. In 50 (78.1%) cases, death was judged to be caused directly or indirectly from the CHD, and in 14 (21.9%) from extracardiac malformations or other conditions. CONCLUSION: CHDs occur in a substantial number of neonatal deaths. Most deaths are caused by cardiac insufficiency. The mortality rate remained unchanged.
Adolescent↗
Etiology of cerebral palsy.
AIMS: To register the prevalence of cerebral palsy (CP) and determine etiological factors for the condition. METHODS: Population based study with registration of CP-cases in children born during the 30-year period 1970-99. Cases with postneonatal etiology were excluded. RESULTS: 166 CP-cases were registered among 70 824 children, a prevalence of 2.3 per 1000 live born infants. The prevalence did not change significantly during the period. 66 (40%) were low birthweight infants (LBWIs; <2500 g), and 100 (60%) normal birthweight infants (NBWIs; > or = 2500 g). The origin was classified as prenatal in 37 (22%), perinatal/neonatal in 78 (47%) and unclassifiable in 51 (31 %). In LBWIs 39/66 (59%) had a perinatal/neonatal etiology, most frequently intra- or periventricular hemorrhages (IVH/PVH) and/or periventricular leukomalacia (PVL) or cerebral infarctions (CI) (17; 44%). In NBWIs 39/100 (39%) had a perinatal etiology, most frequently hypoxic-ischemic encephalopathy (HIE) (31; 79%). CONCLUSIONS: In a substantial percentage of CP-cases perinatal/neonatal brain injury was classified as the cause. Among these IVH/PVH/PVL/CI dominated in LBWIs, while HIE dominated in NBWIs. Our data may point to preventability of a larger part of CP than earlier suggested.
Cerebral Palsy↗
[Erythrocyte transfusions in a neonatal intensive care unit].
BACKGROUND: This study present a review of erythrocyte transfusions in a neonatal intensive care unit in a Norwegian county hospital. MATERIAL AND METHODS: Prospective registration 1991-2002. A leucokyte-depleted erythrocyte solution, haematocrit 60%, was used. RESULTS: 28 infants in circulatory collapse received 30 transfusions because of asphyxia (15), twin-twin transfusion (5), septicaemia (3), umbilical cord rupture (3) or other causes (4). Haemoglobin increased 1.8 +/- 1.4 g/dl per 10 ml/kg transfused, compared to 2.6 +/- 1.2 g/dl in 183 transfusions for anaemia in 122 infants (p < 0.05). All transfusions (n = 115) after the first week of life were given because of anaemia, 107 in preterm (< 37 weeks) infants, and at higher haemoglobin levels in preterm infants with anaemia symptoms than in those without (9.7 +/- 1.5 vs. 8.5 +/- .2 g/dl, p < 0.05). INTERPRETATION: The rise in haemoglobin was higher for transfusions for anaemia than for circulatory collapse, probably because of dilution from other fluids given and mobilisation of extravascular fluid in the last group. A substantial percentage of the transfusions were given on indications deviating from the guidelines.
Anemia↗
[Congenital heart defects. Varying degrees of severity; 25 percent of children with heart defects will have persistent cardiac problems in adulthood].
In a population based study including 35,218 infants born alive during the 15-year period 1982-1996, 360 (1%) were diagnosed having a congenital heart defect (CHD). At a follow-up 3-18 years later (median 9.5 years) 154 patients (42.8%) were spontaneously cured, of whom 142 (92.2%) had ventricular septal defects (VSD). 42 patients (11.7%) had died, 22 of whom (52.4%) during the neonatal period (0-28 days after birth). A total of 119 patients (33.1%) underwent therapeutic procedures (surgery, catheter interventions), of whom 24 (20.2%) 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. Of 69 children (19.2%) with persistent untreated defects, 43 (62.3%) had VSD. A chromosomal disorder, various syndromes or extracardiac malformations occurred in 72 children (20%). The study underlines the fact that CHD presents itself in varying degrees of severity, including a high neonatal mortality rate as well as a high rate of spontaneous cure.
Abnormalities, Multiple↗