[An extensive study indicates good prognosis for children with extremely low birth weight].
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Cause of Death↗
Biomedical subjects
G Wesström
Publications and source records attributed to G Wesström.
Neurosensory outcome and growth at three years in extremely low birthweight infants: follow-up results from the Swedish national prospective study.
A prospective national investigation comprising 633 extremely low birthweight (ELBW) infants born alive in the 2-y period 1990-1992 with a birthweight of < or = 1000 g and gestational age of > or = 23 completed weeks was conducted regarding neurosensory outcome and growth. Three-hundred and sixty-two (98%) surviving ELBW infants were assessed at a median age of 36 months, using a specially designed protocol. At follow-up, mean height, weight and head circumference in both boys and girls were significantly lower than the reference values. The incidence of cerebral palsy was 7% among all children and 14%, 10% and 3% in children born at 23-24, 25-26 and > or = 27 gestational weeks, respectively. At least one obvious handicap was present in 14%, 9% and 3% of these three groups of children, respectively. After adjustment for gestational age, a significantly increased risk of handicap was found in children with intraventricular haemorrhage grade > or = 3 and/or periventricular leucomalacia and in children with retinopathy of prematurity stage > or = 3. The results show that more than 90% of ELBW children born at > or = 25 completed gestational weeks were without neurosensory handicap at 36 months of corrected age. In infants born at 23-24 weeks of gestation, both survival and long-term outcome were less favourable.
Birth Weight↗
The Swedish national prospective study on extremely low birthweight (ELBW) infants. Incidence, mortality, morbidity and survival in relation to level of care.
In a 2-year (1990-92) prospective national investigation, comprising all stillborn and live-born ELBW infants with a birthweight of < or = 1000 g born at 23 completed weeks of gestation or more, we examined the incidence, neonatal mortality, major morbidity and infant survival in relation to level of care and place of residence. A total of 633 ELBW infants were live-born, i.e. 0.26% of all live-born infants, and 298 were stillborn. The average neonatal mortality was 37% and 91% at 23 weeks, 70% at 24 weeks, and 40% at 25 weeks of gestation. Of neonatal survivors, 8% had intraventricular haemorrhage grade 3, 10% retinopathy of prematurity of stage > or = 3, 2% necrotizing enterocolitis, and 28% were oxygen-dependent at a time corresponding to 36 weeks of gestation. In all, 77% were treated with mechanical ventilation, whereas 19% survived without, almost all of them being CPAP treated. Infant mortality among infants born at level III (tertiary centres) was 30%, at level IIa (with full perinatal service) 46% and at level IIb (with basic neonatal service) 55%. Only 1% was born at hospital level I. Regarding the relation to place of residence, the mortality rates among infants residing in the areas served by levels III, IIa and IIb hospitals were 36%, 45% and 41%, respectively. The referral system thus functioned well, but can be improved, and increased perinatal referral, at borderline perinatal viability, might provide a better quality of care and a better chance of survival.
Cause of Death↗
The prevalence of red cell antibodies in pregnancy correlated to the outcome of the newborn: a 12 year study in central Sweden.
BACKGROUND: All maternal red cell antibodies found during pregnancy in a 12 year period have been compiled. The efficacy of the current antenatal screening and management programme has been ascertained by reviewing the outcome of all newborns to these immunized mothers. METHOD: Patient selection was carried out by computerised searching for all known records of registered antibodies during the study period. Each mother's obstetric record and her baby's hospital file was studied and relevant clinical treatment and laboratory data on both mother and child was recorded and analysed. RESULTS: Eight hundred and twenty-one alloantibodies were detected in 629 immunized pregnant women with 753 fetuses. An overall antibody incidence of 0.57% was observed which included 373 clinically significant antibodies found in 261 mothers (0.24%). Multiple antibodies were present in 8.2% of all samples. Anti-D, by itself or in combination with other Rh-antibodies, caused more severe forms of hemolytic disease of the newborn (HDN) with 46% of all Rh-positive babies having phototherapy and 29% having exchange transfusion. Three of 18 Fya-positive infants required phototherapy and one required exchange transfusion and in the 16 Kell-positive babies, three required phototherapy and one required exchange transfusions. CONCLUSIONS: Few antibodies to blood group antigens other than those in the Rhesus system were found to cause severe HDN. Antibodies that are generally considered non-significant did not cause HDN in this study. All antibodies that induced HDN were detected in time so that adequate measures could be taken to reduce the effects in the newborn. The antenatal screening and management programme currently in use is considered to be reliable.
Diagnosis, Computer-Assisted↗
Severe retinopathy of prematurity in infants from the southern regions of Sweden.
We studied children born in 1986-1989 with severe retinopathy of prematurity (ROP) defined as stage 3 "plus" or more. Sixteen children from the southern and central areas of Sweden were identified and 15 of these were referred to Orebro Medical Center Hospital for surgical treatment of ROP. The incidence of severe ROP was estimated as 0.8 per 10,000 newborns per year. All children were born before 29 weeks' gestation and weighed less than 1310 g; they also needed ventilatory support for a long time. The overall neonatal morbidity was high. A model for eye examination in premature newborns is suggested.
Female↗
[An inquiry among pediatric clinics. Kawasaki disease--common even in Sweden].
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Child, Preschool↗
Follow-up study on children with infective endocarditis.
A follow-up study on 36 children having had infective endocarditis during the time period 1971-80 was performed. All answered a questionnaire and 33 underwent a complete non-invasive cardiac examination including exercise test. The study comprised 406 patient years. During this time there were four late deaths and three recurrent attacks of endocarditis. Seventeen (47%) took prophylactic antibiotics. Two patients had been operated on because of the initial infection and another five had developed intracardiac sequelae. An ability index given to each patient before the infection and at the follow-up showed that as a group these patients were doing well.
Adolescent↗
Epidural versus combined spinal epidural block for cesarean section.
In a controlled study a single segment combined spinal epidural (CSE) block was compared with epidural block for cesarean section. Thirty healthy parturients were randomly divided into two groups. In both groups a T4 block was aimed at. Bupivacaine was used to provide analgesia in both groups. All patients receiving CSE block had good to excellent analgesia, while 11 patients (74%) receiving epidural block had similar pain relief. This was reflected in the requirement for additional analgesics, sedatives or N2O anesthesia. The muscular relaxation was also better following CSE block. The total dose of bupivacaine for a T4 block was three times larger in patients receiving only epidural block. The maternal and fetal blood bupivacaine levels were correspondingly about three times higher in the epidural group. Additionally, the incidence of maternal hypotension was higher in patients receiving epidural block. Apgar scores, blood gases and neurobehavioural evaluation did not show any differences between the two groups of neonates. No postspinal headache was noted. CSE block appears to combine the reliability of spinal block and the flexibility of epidural block while minimizing their drawbacks.
Adult↗
The evaluation of maternal anti-D concentrations during pregnancy.
Anti-D quantitation by the AutoAnalyzer technique has been shown to be a helpful aid in assessing the severity of D alloimmunization during pregnancy. In this study, the technique has been used both to detect antibody boosting after amniocentesis and to differentiate active D immunization from the presence of passive antibodies. The AutoAnalyzer technique and the more generally used indirect antiglobulin test titration method showed good agreement at titre levels of 32 or lower. A titre of 32 was found to be a good discriminative level to separate the mildly affected from the more severely affected newborns suffering from Rh haemolytic disease. At higher titre levels, however, the AutoAnalyzer technique was the method of choice for correct clinical assessment of the severity of D alloimmunization.
Amniocentesis↗
A management programme for Rh alloimmunization during pregnancy.
A management programme for the control and treatment of Rh0 (D) immunized during pregnancy is presented. A total of 34,650 births were registered during a 4.5 year period and included 63 D positive newborns to D-immunized mothers. The outcome of all infants has been evaluated according to the severity of the haemolytic disease. Exchange transfusion was unnecessary in 43 mild cases (68.3%). Fourteen infants (22.2%) required exchange transfusion, and in 6 severe cases (9.5%) maternal plasma exchange and exchange transfusion was performed. No detrimental effects or deaths occurred among the infants suffering from Rh haemolytic disease. We recommend that the frequency and volume of plasma exchange therapy should be individually adjusted to suit each patient and the effect monitored regularly through maternal anti-D levels using a sensitive quantitative technique.
Amniotic Fluid↗
Intercrural differences of arterial blood-pressure and blood-flow in new-born infants.
Intercrural systolic blood-pressure differences did not exceed 10 mmHg in 22 healthy infants who were term, pre-term or small for their gestational age (three); as measured simultaneously in both legs with 3-cm wide thigh cuffs and mercury-in-silastic strain gauges around the calves. In 13 infants with indwelling umbilical artery catheter and normal angiographic findings in both legs, blood-pressure differences were similarly low in a majority of the infants, but in three of these intercrural differences of 15-20 mmHg were found. Resting and submaximal arterial leg blood-flow, measured with venous occlusion plethysmography, showed larger intercrural differences than blood-pressure, and did not add further information. The results indicate that simultaneous systolic blood-pressure measurements in the legs, with strain gauge plethysmography, is a simple and risk-free noninvasive method, suitable, for example, for diagnosing thromboembolism in infants. An indwelling umbilical artery catheter seems to interfere very little with the arterial circulation in the catheterized leg.
Birth Weight↗
Congenital myotonic dystrophy. Incidence, clinical aspects and early prognosis.
Congenital myotonic dystrophy (CMD) is characterized by hypotonia, facies myopathica, feeding and respiratory problems, skeletal deformities and polyhydramniosis. It is an autosomal-dominant disorder transmitted via the mother. The diagnosis can as a role be confirmed by examining the mother, but can fail as she might be asymptomatic. During a nine year period, eight children were diagnosed as CMD which means an incidence of one case per approximately 3,500 live births. The diagnosis was confirmed in six of the mothers. The two floppy infants, where positive inheritance could not be proven, showed most of the signs and symptoms described in CMD. Four children died, two from respiratory insufficiency and two suddenly and unexpectedly. CMD may be one less common cause of sudden infant death syndrome (SIDS). The four children who survived displayed delayed psychomotor development.
Female↗
Infective endocarditis in Swedish children. I. Incidence, etiology, underlying factors and port of entry of infection.
A retrospective study of Swedish children with infective endocarditis (IE) during the period 1971-80 was made. Sixty-six instances were identified in 64 children (0.39 cases per 100,000 children per year). Fifty (78%) had a previously known heart disease. Most commonly this was a ventricular septal defect and tetralogy of Fallot. Seventy-one percent had positive blood cultures. Streptococcus viridans and Staphylococcus aureus were most commonly isolated. Twenty-two percent of the children had undergone previous cardiac surgery. One case closely followed cardiac surgery and in only nine children could a definite port of entry of infection be demonstrated.
Adolescent↗
Infective endocarditis in Swedish children. II. Location, major complications, laboratory findings, delay of treatment, treatment and outcome.
66 cases of infective endocarditis (IE) during 1971-1980 were studied. The infection was in most cases located to the mitral or aortic valve. Major complications were found in 43 children. In 17 children there was a long history of infection for which medical consultation had previously been sought prior to correct diagnosis. Antibiotics were administered to 60 children, in 58 intravenously while 2 received oral therapy only. Acute surgical intervention was necessary in six children and three of these children died. In all, 15 (23%) children died as a consequence of the infection.
Adolescent↗
Acute rheumatic fever in Swedish children 1971-80.
Hospital records from all Swedish children 0-15 years old diagnosed as having acute rheumatic fever (ARF) during 1971-80 were studied. Thirty-one children fully met with Jones' modified criterias which gives an incidence of 0.2 cases per 100 000 children and year. Carditis was the most common major manifestation of ARF. In most children the carditis was mild but in three cases there was a persistent cardial affection. 16 of the children received prophylactic antibiotic treatment. No recurrent attacks of ARF were found during the study period.
Acute Disease↗
Early infant death in nemaline (rod) myopathy.
Congenital 'floppy infant' syndrome with very early death is uncommon. It is here described in a girl. Histopathological examination of a muscle biopsy at the age of 10 days showed rods and infiltration of inflammatory cells. Death occurred at 5 weeks of age. Electron microscopy of the necropsy material showed widened Z disks and rods of Z disk density with a typical transverse periodicity of 18-20 nm. The differential diagnosis between nemaline (rod) myopathy and infantile polymyositis is discussed. Nemaline (rod) myopathy should always be considered in cases of the congenital 'floppy infant' syndrome.
Female↗
Umbilical artery catheterization in newborns. IV. Strain-gauge plethysmography for the diagnosis of catheter-related thrombo-embolism in the legs.
Strain-gauge plethysmography was performed shortly after withdrawal of the catheter in 48 of 49 newborn ifnats who had undergone umbilical artery catheterization. Plethysmorgraphy was used to find a noninvasive method for diagnosing catheter-related thrombo-embolism in neonates. The results were compared with the findings at aniography. The method permits simultaneous measurements of the systolic blood pressure and of the resting and submaximal blood flow in both legs. Nine infants howed angiographic signs of total or partial occlusion in one leg, and 8 of them were investigated with plethysmorgraphy. The systolic blood pressure was signifcantly reduced in ifants with total and/or partial occlusion, but the blood flow was reduced only in infants with total occlusion. The peak flow after sugrasystolic occlusion was significantly otener delayed in infants with thrombo-embolism in the leg.
Catheterization↗
Umbilical artery catheterization in newborns. V. A clinical follow-up study.
The long-term effects of umbilical artery catheterization were studied in forty-nine children. At the age of about 18 months their gross motor and neurological development, peripheral circulation, and growth of the legs were investigated. The infants with catheter-related thrombo-embolism in the legs diagnosed in the neonatal period with the aid of angiography and investigated by plethysmography were re-examined once or more during the first year of life by strain-guage plethysmography. One child who showed total occlusion of the iliac artery as newborn, had a difference in calf circumference at the 18-month examination of 1.5 cm, the only finding in this study related to catheter-associated thrombosis. In infants with neonatal thrombo-embolism in the legs the initial crural difference in systolic blood pressure diminished slowly, and at 12 months a blood-pressure difference of more than 10 mmHg remained in only one infant.
Catheterization↗