Biomedical subjects

Ann Hellström

Publications and source records attributed to Ann Hellström.

15 recordsLinked to original sources

PubMed2006

Longitudinal postnatal weight and insulin-like growth factor I measurements in the prediction of retinopathy of prematurity.

OBJECTIVE: To investigate whether postnatal growth and development influence retinopathy of prematurity (ROP) and may be included in screening for ROP. DESIGN: We developed an algorithm to predict for individual infants the risk of later ROP development requiring treatment based on the postnatal longitudinal systemic factors of insulin-like growth factor I (IGF-I) level, IGF binding protein 3 level, and postnatal weight gain. We developed the algorithm based on 79 preterm infants considered at risk for ROP by standard criteria (gestational age, 23.6-31.7 weeks) in a longitudinal study measuring weight gain and serum IGF-I and IGF binding protein 3 levels weekly from birth until discharge from the hospital. We monitored deviations from reference models for weight and IGF-I level (preterm children who developed no or minimal ROP) to detect indications for treatable ROP by Early Treatment for Retinopathy of Prematurity study criteria. RESULTS: This monitoring method detected 6 (100%) of 6 infants in this cohort who required treatment for ROP with a warning signal at least 5 weeks before requiring treatment and at least 3 weeks before the onset of stage 3 ROP. The majority of infants (61/73 infants) requiring no treatment were also correctly identified. CONCLUSIONS: Monitoring the postnatal factors of weight, IGF-I level, and IGF binding protein 3 level substantially enhances the clinician's ability to identify patients who will require treatment for ROP.

Algorithms↗

PubMed2006

Periventricular leukomalacia and retinopathy in a term infant born to a mother with asthma.

A male child, born at 37+5 gestational weeks (GWs) (birthweight 2000g) after intrauterine growth retardation (IUG; -3 SD), to a mother treated during pregnancy for asthma, developed periventricular leukomalacia and retinopathy with total retinal detachment in the left eye and partial detachment in the right eye. Apart from basic asthma treatment with terbutalin, budesonid, and fenoterolhydrobromid throughout the pregnancy, she was treated with intravenous or oral cortisone for 6.5 weeks from 28+5 GWs. In addition she developed deep venous thrombosis at 29 GWs and was treated with heparin until delivery. Psychotic symptoms during the 31st GW were treated with diazepam, haloperidol, and levomepromazin. Functional sequelae for the child were visual impairment (visual acuity 5/60), uneven intellectual profile (Wechsler Pre-school and Primary Scale of Intelligence, Verbal IQ 94 and Performance IQ 32 at 8y of age), and autistic-like behaviour. The possibility that pre- and perinatal risk factors (e.g. severe maternal illness, IUGR, and cortisone treatment) in a term infant may create conditions for developing eye and brain pathologies commonly closely related to preterm birth should be considered.

Anti-Asthmatic Agents↗

PubMed2006

Vision in children with hydrocephalus.

Hydrocephalus in children has many aetiologies, and can cause multiple ophthalmic and visual disorders. This study sets out to detect and quantify visual and visuoperceptual dysfunction in children who have received surgical treatment for hydrocephalus with and without myelomeningocele, and to relate the results to the associated diagnoses and results from a comparison group. Seventy-five school-aged children (41 males, 34 females) with surgically-treated hydrocephalus and 140 comparison children (76 males, 64 females) matched for age and sex underwent comprehensive ophthalmologic examination. Median age at examination was 9 years and 4 months (range 7 y 4 mo-12 y 10 mo). Visual function deficits were identified in 83% (62/75) of the children with hydrocephalus. Visual impairment (binocular visual acuity <0.3) was found in 15% (11/73; comparison group 0%) but in none with myelomeningocele. Strabismus was found in 69% (51/74; comparison group 4% [5/140], p < 0.001), and refractive errors were found in 67% (47/70; comparison group 20% [28/140], p < 0.001). Cognitive visual dysfunction was identified in 59% (38/64; comparison group 3% [4/140], p < 0.001). These disorders were identified in various combinations and comprised impaired ability to plan movement through depth (e.g. going down a stair), impaired simultaneous perception, impaired perception of movement, impaired orientation, and (least frequently) impaired recognition. In this study, children with hydrocephalus associated with myelomeningocele were least commonly affected. Visual disorders were most frequent in those with epilepsy, cerebral palsy, and/or cognitive disability.

Adolescent↗

PubMed2006

Ophthalmological findings in children born after intracytoplasmic sperm injection.

PURPOSE: To investigate visual function and ocular morphology in children born after intracytoplasmic sperm injection (ICSI) and compare them with visual function and ocular morphology in matched children born after spontaneous conception. METHODS: A total of 137 children born after ICSI and 159 control children were examined at the age of 5 years in a blinded study. The two groups were matched for age, gender and maternal age. The children underwent a detailed ophthalmological investigation by an ophthalmologist and an orthoptist. RESULTS: A total of 90.4% of the ICSI children had a visual acuity (VA) in the better eye of >or= 0.8, compared with 93.7% of the controls (NS). No significant differences were found between ICSI children and controls with regard to hyperopia, myopia, astigmatism, heterotropia, stereoscopic vision and convergence. One child with Goldenhar syndrome and one with Marcus Gunn syndrome were observed in the ICSI group. One child in the ICSI group was treated for retinopathy of prematurity. CONCLUSION: In this limited study group, no significant differences in visual function and/or ocular morphology were found between children born after ICSI and matched control children at the age of 5 years.

Case-Control Studies↗

PubMed2006

Ophthalmological findings in a sample of Swedish children aged 4-15 years.

AIMS: To characterize ophthalmological findings in a sample of Swedish children aged 4-15 years. METHODS: A prospective cross-sectional comprehensive ophthalmological investigation was performed on a sample of 143 children (67 girls, 76 boys) aged 4-15 years. RESULTS: Visual acuity (VA) in the better eye >or=1.0 ( 0.3 logMAR). Amblyopia was found in 0.7% of subjects. A total of 68% of the children had no refractive errors. Hyperopia (>or=2.0 dioptres [D] in spherical equivalent [SE]) was found in 9% and myopia (>or=0.5 D SE) in 6% of children. Astigmatism (>or=0.75 D) was recorded in 22% and anisometropia (>or=1.0 D SE) in 3%. A total of 8% were optically corrected. Strabismus was recorded in 3.5%. Signs of visuoperceptual problems were reported in 3% of the children. CONCLUSION: This sample of Swedish children may serve as a comparison group regarding ophthalmological findings in children aged 4-15 years.

Adolescent↗

PubMed2006

Ophthalmological follow-up at 2 years of age of all children previously screened for retinopathy of prematurity: is it worthwhile?

PURPOSE: To evaluate the extent to which ophthalmological follow-up at 2 years of age of children born before 32 weeks gestation identifies obvious visual problems, strabismus and significant ametropia (target conditions). METHODS: Of 172 children born during a period of 2.5 years from January 2000, 142 underwent an ophthalmological examination at a median age of 2.33 years. This included evaluation of visual behaviour, cover testing and autorefractometry in cycloplegia. For children with the target conditions, we investigated whether the child had been followed in the eye clinic or referred before 2 years of age, or whether the abnormality was detected as a result of the follow-up examination. RESULTS: None of the target conditions were found in 117 children. None of four children with obviously abnormal visual behaviour, two of 10 children with strabismus and four of 11 with large refractive errors were detected in the follow-up examination. Thus the target conditions were detected at the follow-up examination in only six of 142 children (4.2%). CONCLUSIONS: Although ophthalmic abnormalities are common in children born prematurely, most of them are identified because high-risk children are followed regularly in eye clinics and because parents and primary health care personnel detect strabismus. Ophthalmological follow-up of all children born before 32 weeks appears not to be worthwhile and is therefore only recommended for high-risk children.

Child, Preschool↗

PubMed2006

Postnatal head growth deficit among premature infants parallels retinopathy of prematurity and insulin-like growth factor-1 deficit.

BACKGROUND: We hypothesized that in premature infants, retinal vascular growth retardation between birth and postmenstrual age of approximately 30 to 32 weeks that initiates retinopathy of prematurity is paralleled by brain growth retardation. METHODS: In a prospective longitudinal study, we measured postnatal head growth, retinopathy of prematurity stage, protein and energy intake, severity of illness and serum insulin-like growth factor-1 levels in 58 preterm infants (mean gestational age at birth: 27.6 weeks) from birth until postmenstrual age of approximately 40 weeks. RESULTS: Premature infant head growth decelerates dramatically after birth until postmenstrual age of approximately 30 weeks. Head growth retardation coincides with retinal vascular growth suppression. Accelerated growth follows between post menstrual ages of approximately 30 to 32 weeks and approximately 40 weeks. The degree of head growth retardation up to postmenstrual age of 31 weeks corresponds to the degree of retinopathy of prematurity and to the degree of suppression of serum levels of insulin-like growth factor-1. At postmenstrual age of 31 weeks, if a child's head circumference SD is below -2.5, then the probability of also developing at least stage 3 retinopathy of prematurity increases fivefold compared with head circumference above -2.5 SD (32% vs 6%) suggesting parallel processes in brain and retina. Serum insulin-like growth factor-1 levels correlate positively with head circumference SD score and with the degree of retinopathy of prematurity. CONCLUSIONS: The correlation between head and retinal growth is consistent with insulin growth factor-1 being one of the postnatal growth factors involved in this multifactorial process and also suggests that factors that contribute to retinopathy of prematurity during this critical period may also affect neurological dysfunction. Additional studies are required to establish this connection.

Female↗

PubMed2005

The role of maternal factors, postnatal nutrition, weight gain, and gender in regulation of serum IGF-I among preterm infants.

IGF-I is important for somatic growth and development of the human fetus and neonate. IGF-I also plays an important role in normal vascularization of human retina, as it has been suggested that insufficient IGF-I may be a factor in the development of retinopathy of prematurity. The principal regulator of the bioavailability of IGF-I in the circulation is IGF binding protein 3 (IGFBP-3). The aim of this study was to study factors associated with postnatal serum concentrations of IGF-I and of IGFBP-3 in preterm infants from birth to an age corresponding to 40 wk postmenstruation. We conducted a prospective, longitudinal study in which we measured serum IGF-I and IGFBP-3 concentrations in 76 preterm infants from birth (postmenstrual ages 23-32 wk) until discharge from hospital around 40 wk. Information regarding nutrition, weight gain, maternal factors, and treatment with corticosteroids were collected weekly. Variables found to be associated with postnatal change over time of serum IGF-I and IGFBP-3 were postmenstrual age (p<0.001), weight gain (standard deviation score) (p<0.001), and enteral intake of protein (p<0.001). Male gender was associated with lower IGF-I levels (p<0.001). The relationship between protein intake and IGF-I (and also between protein intake and IGFBP-3) was positive, as was the relationship between weight gain and IGF-I (and between weight gain and IGFBP-3). These results indicate that the degree of prematurity, low enteral protein intake, male gender, and slow weight gain are associated with a slower postnatal increase of IGF-I in preterm infants.

Birth Weight↗

PubMed2005

Strabismus and binocular functions in a sample of Swedish children aged 4-15 years.

PURPOSE: To investigate strabismus, head posture, nystagmus, stereoacuity, ocular motility, near point of convergence (NPC) and accommodative convergence to accommodation ratio (AC/A) in a sample of Swedish children. METHODS: A prospective cross-sectional study was carried out on 143 children, 4-15 years of age. RESULTS: Heterotropia was found in five children (3.5%), four with esotropia and one with exotropia. One child with esotropia had a slight overaction of both inferior oblique muscles. Heterophoria was found in 37 children (26%) at near and/or distance fixation and it was four times more common at near than at distance. In 29 children, heterophoria was found at one distance only and orthophoria at the other. Orthophoria at both near and distance fixation was noted in 101 children (70.5%). The near point of convergence was < or =6 cm in 97% of the children and 97% had stereoacuity of 60" or better. In the whole group, the median AC/A ratio calculated with the heterophoria method was 5.6/1 prism diopters/diopters (PD/D) and with the gradient method, 1.3/1 PD/D. No anomalous head postures or nystagmus were observed and all children had normal versions. CONCLUSION: In this study, 143 well-defined children were investigated with a battery of accurately described tests, commonly used in clinical practice. These results are in agreement with those of other studies examining one or few variables in larger populations and the authors therefore conclude that their results may be used for comparisons with different patient groups.

Adolescent↗

PubMed2005

Fixation stability in normal children.

Fixation stability was found to increase with increasing age (4-15 years) in normal children, but there was no directional preponderance in fixation location.

Adolescent↗

PubMed2004

Abnormal retinal vascular morphology in young adults following intrauterine growth restriction.

OBJECTIVE: Intrauterine growth restriction (IUGR) resulting in low birth weight for gestational age may predispose one to development of cardiovascular disease later in life. Abnormal fetal blood flow in the presence of fetal growth restriction helps to distinguish infants with true fetal growth impairment from small but normal infants. Our goal was to investigate associations between IUGR with abnormal fetal blood flow and abnormal retinal vascular morphology at 18 years of age. METHODS: A prospective study was performed with 21 subjects with IUGR (abnormal fetal aortic blood flow velocity; birth weight small for gestational age; median birth weight deviation from the population mean of -31% [range: -22% to -42%] and in 23 subjects with birth weight appropriate for gestational age [normal fetal aortic blood flow velocity; median birth weight deviation of -2% (range: -10% to 22%)]). The retinal vessel morphology was evaluated by digital image analysis. RESULT: Subjects with IUGR (n = 21) had significantly less retinal vascularization as evidenced by a lower number of vascular branching points (median: 26; range: 20-31) as compared with the subjects who were born appropriate for gestational age (median: 28; range: 26-32). Within the entire group (N = 44), increasing negative birth weight deviation was associated with a reduced number of vascular branching points (r = 0.36. CONCLUSION: Our findings show that IUGR with abnormal fetal blood flow is associated with abnormal retinal vascular morphology in young adult life.

Adolescent↗

PubMed2003

Visually impaired children with posterior ocular malformations: pre- and neonatal data and visual functions.

AIM: To analyse pre- and neonatal data and ocular findings in children with visual impairment caused by posterior ocular malformations. METHODS: Medical records were scrutinized, dried blood spot cards were analysed for virus DNA and ophthalmological assessments were performed in 28 children with optic nerve hypoplasia (ONH) and 10 with optic/chorio-retinal coloboma. RESULTS: Prenatal exposure to possible teratogens was documented in 5/28, herpes simplex virus type 1 DNA was identified in the dried blood spot cards of 1/26 children and neonatal hypoglycaemia in 12/28 children with ONH. The time delay from ocular to endocrinological diagnosis and treatment was 3 years. Children with ONH and severe visual impairment had endocrinopathy more often (11/13) than ONH children with better visual functions (5/15). Prenatal exposure to teratogens or neonatal hypoglycaemia was not identified in any of the children with coloboma. CONCLUSION: Neonatal hypoglycaemia was common in children with ONH. Severe visual impairment predicted endocrinopathy. Analysis of dried blood spot cards could serve as an additional diagnostic tool in children with ocular malformations.

Child↗

PubMed2003

Postnatal serum insulin-like growth factor I deficiency is associated with retinopathy of prematurity and other complications of premature birth.

OBJECTIVE: Insulin-like growth factor I (IGF-I) is necessary for normal development of retinal blood vessels in mice and humans. Because retinopathy of prematurity (ROP) is initiated by abnormal postnatal retinal development, we hypothesized that prolonged low IGF-I in premature infants might be a risk factor for ROP. DESIGN: We conducted a prospective, longitudinal study measuring serum IGF-I concentrations weekly in 84 premature infants from birth (postmenstrual ages: 24-32 weeks) until discharge from the hospital. Infants were evaluated for ROP and other morbidity of prematurity: bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), and necrotizing enterocolitis (NEC). RESULTS: Low serum IGF-I values correlated with later development of ROP. The mean IGF-I +/- SEM level during postmenstrual ages 30-33 weeks was lowest with severe ROP (25 +/- 2.41 micro g/L), 29 +/- 1.76 micro g/L with moderate ROP, and 33 +/- 1.72 micro g/L with no ROP. The duration of low IGF-I also correlated strongly with the severity of ROP. The interval from birth until serum IGF-I levels reached >33 micro g/L was 23 +/- 2.6 days for no ROP, 44 +/- 4.8 days for moderate ROP, and 52 +/- 7.5 days for severe ROP. Each adjusted stepwise increase of 5 micro g/L in mean IGF-I during postmenstrual ages 30 to 33 weeks decreased the risk of proliferative ROP by 45%. Other complications (NEC, BPD, IVH) were correlated with ROP and with low IGF-I levels. The relative risk for any morbidity (ROP, BPD, IVH, or NEC) was increased 2.2-fold (95% confidence interval: 1.41-3.43) if IGF-I was <or=33 micro g/L at 33 weeks' postmenstrual age. CONCLUSIONS: These results indicate that persistent low serum concentrations of IGF-I after premature birth are associated with later development of ROP and other complications of prematurity. IGF-I is at least as strong a determinant of risk for ROP as postmenstrual age at birth and birth weight.

Birth Weight↗

PubMed2002

IGF-I is critical for normal vascularization of the human retina.

Experimental and clinical studies suggest that GH and IGF-I may be involved in neovascularization of the retina in diabetes and retinopathy of prematurity. However, the role of GH and IGF-I has not been well established in normal retinal vessel development in humans. Therefore, we examined retinal vessel morphology by digital image analysis of ocular fundus photographs in 13 patients with genetic defects of the GH/IGF-I axis and low levels of IGF-I during and after normal retinal vessel growth. Eleven patients (four females and seven males aged 10-49 yr) had defects of the GH receptor (Laron syndrome). One male (20 yr) had a partial deletion of the IGF-I gene, and one female (14 yr) had a single allele deletion of the IGF-I receptor gene. Patients with defects in the GH/IGF-I axis had significantly less retinal vascularization as evidenced by lower number of vascular branching points (median 23, range 16-25), compared with the reference group of 100 normal controls (median 28, range 19-40, P < 0.001). All 13 individuals had vascular branching points below the median of the reference group. This is the first study to provide genetic evidence for a role of the GH and IGF-I system in retinal vascularization in humans.

Adolescent↗

PubMedDate not supplied

Visual function in young adults following intrauterine growth retardation.

BACKGROUND: Intrauterine growth retardation (IUGR) resulting in infants born small for gestational age is a known risk factor for neurologic deficits and may predispose to poor cognitive development later in life. We recently found an association between IUGR and a reduced neuroretinal rim area at 18 years of age. We evaluated the possible association between IUGR and visual function. SUBJECTS AND METHODS: We studied 26 subjects who had been born small for gestational age and 20 subjects whose birth weights were appropriate for gestational age (controls) using letter acuity thresholds, color vision testing, full-threshold frequency doubling technology perimetry, and rarebit perimetry at 18 years of age. gestational age had a rarebit hit rate below the normal range as compared with none of the controls (P = .006). These 8 subjects had a significantly smaller rim-disc ratio compared with the subjects who were small for gestational age who had a normal rarebit hit rate (P = .047). The frequency doubling technology indices did not differ significantly between the control group and the group that was small for gestational age, nor did the visual acuity, refraction, and color vision test results. CONCLUSION: These data indicate that IUGR is associated with an increased rate of impaired visual function, which can be detected by using rarebit perimetry but not frequency doubling technology perimetry, visual acuity, or color vision tests.

Adolescent↗