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Biomedical subjects

Gorm Greisen

Publications and source records attributed to Gorm Greisen.

At least 19 recordsLinked to original sources
PubMed2007

Pituitary-gonadal function in adolescent males born appropriate or small for gestational age with or without intrauterine growth restriction.

CONTEXT: Being born small for gestational age (SGA) is suggested to influence female pituitary-gonadal axis, but only a few studies have focused on male pituitary-gonadal function. OBJECTIVE: Our objective was to evaluate the influence of fetal growth rate on male reproductive function. DESIGN: We conducted a follow-up study of a prospective study with data on third trimester fetal growth velocity and birth weight. SETTING: The study was conducted at Copenhagen University Hospital. PARTICIPANTS: Fifty-two healthy adolescent males participated. They were divided into those born appropriate for gestational age (AGA) and SGA, with or without intrauterine growth restriction. MAIN OUTCOME MEASURES: Pubertal stage, testicular size, and reproductive hormones were determined. Overnight 20-min LH and FSH profiles and overnight urine LH and FSH were determined in an additional study (n=30). RESULTS: No significant differences were found in testosterone levels (19.2 vs. 18.9 nmol/liter), inhibin B levels (186.5 vs. 188.0 pg/ml), or LH/testosterone ratio (0.15 vs. 0.18) between AGA and SGA, respectively. No significant differences in overnight secretory patterns of gonadotropins or testicular size and morphology were determined by ultrasonography between AGA and SGA. Fetal growth velocity did not influence any of the reproductive hormone levels. Overnight urinary LH and FSH excretion correlated statistically significantly with overnight LH (r=0.50; P=0.02) and FSH (r=0.44; P=0.04) secretion, respectively. CONCLUSION: Poor third trimester growth and/or low birth weight had no effect on subsequent male reproductive hormones. Contrasting a previous study, we found no difference in testosterone or inhibin B levels between SGA and AGA, suggesting that testicular function was not impaired in adolescent males born after compromised fetal growth.

Adolescent↗
PubMed2007

Agreement between Cochrane Neonatal Group reviews and clinical guidelines for newborns at a Copenhagen University Hospital - a cross-sectional study.

AIM: To assess the agreement between Cochrane Neonatal Group reviews and clinical guidelines of a University Neonatology Department, to evaluate the reasons for potential disagreements and to ascertain whether Cochrane reviews were considered for the guidelines development. METHODS: The recommendations in the reviews and guidelines were compared and classified as being in 'agreement', 'partial agreement' or 'disagreement'. The guideline authors were interviewed for reasons about disagreement and whether Cochrane reviews were considered during the guideline development. RESULTS: Agreement between reviews and guidelines was found for 133 interventions (77%), partial agreement for 31 interventions (18%) and disagreement for nine interventions (5%). Six interventions were recommended in the guidelines, but not in the reviews. Three interventions were recommended in the reviews, but not in the guidelines. Use of consensus statements, evidence on surrogate markers, observational studies, basic immunology and pathophysiological knowledge, expert opinion, economical constraints, reservations about the external validity and unawareness of reviews were reasons for disagreement. Cochrane reviews were rarely (22%) used during the guideline development. CONCLUSION: We found agreement between more than three quarters of Cochrane reviews and neonatal guidelines. However, few important disagreements occurred. Reviews were only used for guideline development in about a fifth of cases.

Consensus↗
PubMed2006

Is near-infrared spectroscopy living up to its promises?

UNLABELLED: The first clinical application of near-infrared spectroscopy (NIRS) was made 20 years ago on the head of newborn infants under intensive care. Since then NIRS has yielded much credible and some important clinical research data. The most important results have been obtained using the cumbersome but quantitative techniques for measuring cerebral blood flow, cerebral blood volume, or venous oxygen saturation with manipulation of FiO(2) or impeding venous outflow from the brain. The continuous nature of NIRS has been combined with monitoring of arterial pressure to obtain measures of cerebrovascular regulation, but this method has not been applied on a larger scale. Second-generation instruments allow a running estimate of vascular haemoglobin oxygen saturation, named the tissue oxygenation index (TOI), in absolute terms. Applied to the head, this is a surrogate measure of cerebro-venous saturation, an important variable in neuro-intensive care. The precision, however, is insufficient to be useful. IN CONCLUSION: clinical application is not in sight.

Brain↗
PubMed2006

[Chronic lung disease in a cohort of children born before the 28th gestational week. Incidence and etiological factors].

INTRODUCTION: Advances in perinatal care have increased the survival rate of extremely preterm (ETP) infants during the last decades. A key factor has been the ability to provide respiratory support with mechanical ventilation. Mechanical ventilation, however, is associated with pulmonary disease, such as bronchopulmonary dysplasia (BPD). A national prospective study of all EPT infants born in 1994-95 in Denmark found a low incidence of chronic lung disease (CLD), defined as oxygen dependence at 36 weeks postnatal age. In the cohort of surviving infants (n = 195), the incidence of CLD was 15% (95% CI: 11-19). Only 46% of the surviving children had been mechanically ventilated during the neonatal period, and this factor was proposed as an explanation of the low percentage of infants with CLD. MATERIAL AND METHODS: The present study evaluated CLD in a cohort of EPT infants born in 1998-2001 at Rigshospitalet, the university hospital in Copenhagen. The incidence of CLD was compared to that found in the cohort born in 1994-1995 and the data from the two cohorts were analysed together to investigate changes in CLD. RESULTS: Although only 39% had been treated with mechanical ventilation in the neonatal period, as many as 37% (95% CI: 31-43) of the surviving children in the study (n = 220) had CLD. Analysing the data from the cohort born in 1994-95 and the cohort born in 1998-2001 together, the increase in CLD could be explained by an improved survival rate and a lower gestational age and birth weight in the 1998-2001 cohort. DISCUSSION: Our results support the theory that CLD in EPT infants results from insults other than mechanical ventilation.

Chronic Disease↗
PubMed2006

[Organisation of treatment of newborns].

The total number of births in Denmark in 2004 was 60,670. It is a challenge to organise neonatal care in such a way that the great majority of healthy normal newborns can be born into their families with a minimum of disturbance from the health care system. A need for treatment after birth, however, is not uncommon (10-15%) and can occur unexpectedly. In this context, it is an advantage that 99% of births take place in hospitals, but it is a neonatologic viewpoint that all births should take place in hospitals with a neonatal special care unit. There are presently 17 neonatal special care units and 33 delivery units in Denmark. International experience shows that about 1% of all newborns require intensive care, and the current numbers from the new national database of disease-related groups classification in Denmark are in agreement. The database indicates that 59% (394 of 663) of the newborn intensive care in 2004 was provided by Rigshospitalet (Copenhagen University Hospital) and the university hospitals of Odense and Skejby. The restrictive use of mechanical ventilation in Denmark, the short geographical distances and the short working hours of physicians may all be good reasons for this centralisation.

Denmark↗
PubMed2006

Brain monitoring in the neonate--the Rationale.

Experts argue that no brain monitoring of clinical value is currently available for the very preterm baby. Evidence is lacking about all parts of the therapeutic package: specificity and sensitivity for severe brain compromise, effectiveness of specific intervention, and overall clinical value over and above standard care. However, brain monitoring will probably be most important ultimately for establishing specific causation between modifiable factors and brain dysfunction or damage.

Apnea↗
PubMed2006

Secular change in size at birth from 1973 to 2003: national data from Denmark.

OBJECTIVE: To explore whether birth weight (BW) has been increasing in Denmark at the same level as in other countries and whether this increase is paralleled by an increase in birth length (BL) or whether body proportionality, expressed as ponderal index (PI), has changed. RESEARCH METHODS AND PROCEDURES: This study used data analysis of information from The Danish Medical Birth Registry including all single live births in Denmark from 1973 to 2003 (n = 1,863,456). BW, BL, gestational age, maternal age, and smoking status (only from 1991 on) were measured. RESULTS: Mean BW increased steadily during the period (160 grams; equivalent to approximately 5 g/yr) at a rate higher than that reported from other countries. BL showed only a minor increase (2.4 mm), leading to an increase in PI (0.8 kg/m3) during the period. Controlling for the effect of increasing maternal age and decreasing gestational age and maternal smoking prevalence (only data after 1991), there was still an increase in BW of approximately 4 g/yr. DISCUSSION: During the last 30 years, neonates have become bigger, with a larger relative increase in BW than BL, leading to an increase in PI. The increasing BW and PI, which may be caused by increased maternal weight, could further promote the obesity epidemic.

Adult↗
PubMed2006

Measuring developmental deficit in children born at gestational age less than 26 weeks using a parent-completed developmental questionnaire.

AIM: To assess developmental deficit in children born at gestational age (GA) < 26 wk using a parental questionnaire and to use regression analysis to study a cohort born in 1999-2003. PATIENTS AND METHODS: Three groups were studied: group 1, GA < 26 wk; group 2, GA 26-27 wk; group 3, children born at term. The Ages & Stages Questionnaire (ASQ) was used. The parents of each child were mailed an age-specific questionnaire between November 2004 and April 2005. The term children were used as a reference to calculate a standard deviation score (ASQ-SDS) for each child in the two preterm groups. RESULTS: Seventy-five per cent of the questionnaires were returned (group 1: n=61; group 2: n=57; group 3: n=72). The age at scoring ranged from 12 to 60 mo (mean 32.8 mo). After correction for parental education, 22% of the children born at GA < 26 wk and 13% of those at GA 26-27 wk had an ASQ-SDS below -2. Chronic lung disease of prematurity was associated with developmental deficit (mean difference -1.1 ASQ-SDS, p=0.004). CONCLUSION: The ASQ identified a significant developmental deficit in the children born extremely preterm. The rate of 22%, however, in children born at GA < 26 wk is reassuring.

Age Factors↗
PubMed2006

Intellectual development in a Danish cohort of prematurely born preschool children: specific or general difficulties?

A national cohort of extremely low birth weight (ELBW) and/or extremely preterm (EPT) children and a term control group was followed up at the age of 5 years. The primary objective was to investigate whether premature birth had a global impact on cognitive functions or affected specific functions only. Assessment tools were Wechsler Preschool and Primary Scale of Intelligence-Revised (WPPSI-R), Movement Assessment Battery for Children (M-ABC), and subtests from the Neuropsychological Assessment 4-7 years (NEPSY). The mean Full Scale IQ (FSIQ) and M-ABC score of the index children were 1.1 and 1.2 SDs lower than that of the control children (p <.001). Most WPPSI-R subtests showed medium to large differences between index and control children, suggesting a global impact of premature birth on cognitive functions. For both unadjusted and FSIQ adjusted means, no significant group differences on tests of memory or executive function were observed (p >.1), suggesting little impact of premature birth on these specific functions. In this sample, cognitive difficulties in 5-year-old ELBW and/or EPT children tended to be associated with general intellectual difficulties rather than with specific dysfunctions; however, the implications of this finding are ambiguous due to substantial attrition on the NEPSY subtests.

Child, Preschool↗
PubMed2005

Diffuse reflectance spectrophotometry with visible light: comparison of four different methods in a tissue phantom.

The purpose of the study was to compare algorithms of four methods (plus two modifications) for spectrophotometric haemoglobin saturation measurements. Comparison was made in tissue phantoms basically consisting of a phosphate buffer, Intralipid and blood, allowing samples to be taken for reference measurements. Three experimental series were made. In experiment A (eight phantoms) we used the Knoefel method and measured specific extinction coefficients with a reflection spectrophotometer. In experiment B (six phantoms) the fully oxygenated phantoms were gradually deoxygenated with baker's yeast, and simultaneous measurements were made with our spectrophotometer and with a reference oxymeter (ABL-605) in 3 min intervals. For each spectrophotometric measurement haemoglobin saturation was calculated with all algorithms and modifications, and compared with reference. In experiment C (11 phantoms) we evaluated the ability of a modification of the Knoefel method to measure haemoglobin concentration in absolute quantities using extinction coefficients from experiment A.Results. Experiment A: with the Knoefel method extinction coefficients (+/-SD) for oxyhaemoglobin at 553.04 and 573.75 nm were 1.117 (+/-0.0396) ODmM(-1) and 1.680 (+/- 0.0815) ODmM(-1), respectively, and for deoxyhaemoglobin 1.205 (+/- 0.0514) ODmM(-1) and 0.953 (+/-0.0487) ODmM(-1), respectively. Experiment B: high correlation with the reference was found in all methods (r = 0.94-0.97). However, agreement varied from evidently wrong in method 3 and the original method 4 (e.g. saturation above 160%) to high agreement in method 2 as well as the modifications of methods 1 and 4, where oxygen dissociation curves were close to the reference method. Experiment C: with the modified Knoefel method the mean haemoglobin concentration difference from reference was 8.3% and the correlation was high (r = 0.91). We conclude that method 2 and the modifications of 1 and 4 were superior to the others, but depended on known values in the same or similar phantoms. The original method 1 was independent of results from the tissue phantoms, but agreement was slightly poorer. Method 3 and the original method 4 could not be recommended. The ability of the modified method 1 to measure haemoglobin concentration is promising, but needs further development.

Algorithms↗
PubMed2005

[Neurological late sequelae in twins born after in vitro fertilisation--secondary publication. A national cohort study].

Currently 4% of the Danish national birth cohort is born after in vitro fertilisation techniques and almost 40% of these children are twins. In this register-based national cohort study, twins from assisted conception (n = 3393) had a similar risk of neurological sequelae and cerebral palsy as their naturally conceived peers (n = 10.239) and assisted conceived singletons (n = 5130). Further children born after intracytoplasmic sperm injection (ICSI) had the same risk of neurological sequelae as children born after conventional IVF.

Adult↗
PubMed2005

Autoregulation of cerebral blood flow in newborn babies.

Autoregulation is the result of a basic property of vascular smooth muscle cells where transmural pressure modifies muscle tone. As a result, flow is kept more or less constant over a range of blood pressures. In foetal lambs autoregulation develops from 0.6 gestation, whereas in extremely preterm babies the evidence is conflicting. Static autoregulation, measuring at steady state, is developed with a lower threshold at or below 30 mm Hg. The upper limit has not been determined. Dynamic autoregulation, measuring before steady state, appears not to be operating in preterm babies. The reason for this discrepancy is unknown and the clinical relevance is uncertain. In term and preterm babies with hypoxic-ischaemic brain injury, or with arterial hypotension treated with dopamine static autoregulation has been found absent. For clinical practice the relation between pressure and blood flow is less important than the relation between arterial pCO(2) and blood flow.

Blood Pressure↗
PubMed2005

Doxapram and developmental delay at 12 months in children born extremely preterm.

AIM: To examine the relation of doxapram to a developmental score achieved by a structured telephone interview in a group of extremely-preterm-born children. METHODS: Parents of 88 children born extremely preterm were contacted by telephone and interviewed by a structured questionnaire (R-PDQ) when the corrected age of their child was 9-15 mo. RESULTS: We found that doxapram treatment was associated with a deficit in age-adjusted R-PDQ score. CONCLUSION: Doxapram may have a negative effect on neurodevelopmental outcome.

Case-Control Studies↗
PubMed2005

Developmental delay at 12 months in children born extremely preterm.

AIM: To evaluate the feasibility and validity of a structured telephone interview to assess the development of children born extremely preterm. METHODS: The parents of 88 children born with a gestational age below 28 wk admitted to the neonatal intensive care unit (NICU) at Rigshospitalet, Copenhagen, were interviewed by telephone when their child was 1 y of age, corrected for preterm birth. A fully structured questionnaire on psychomotor function was used (Revised Prescreening Developmental Questionnaire (R-PDQ)). The parents of 30 children born at term without complications were interviewed for comparison. The interview was conducted by NICU staff. To validate the R-PDQ, parents of 22 children in the preterm group and parents of 19 children in the reference group conducted an Ages and Stages Questionnaire (ASQ) when their children had reached the age of 3-3(1/2) y. RESULTS: The R-PDQ was easy to use by staff and well accepted by parents. The mean score in the preterm group was 14.9+/-3.9 vs 17.7+/-2.7 in the term group (p<0.001). Three children had developmental scores below-2 SD. The R-PDQ score was associated with the ASQ score 2 y later. CONCLUSION: A structured questionnaire administrated by telephone is an alternative and usable tool for assessing neurodevelopmental deficit in children born extremely preterm. The mean developmental delay in the preterm group compared to the term group (about-1 SD) was close to expectations.

Child, Preschool↗
PubMed2005

Ages and Stages Questionnaire used to measure cognitive deficit in children born extremely preterm.

AIM: To validate the Ages and Stages Questionnaire (ASQ) and to measure average cognitive deficit in children born extremely preterm. METHODS: Parents of 30 term children aged 36-42 mo completed the ASQ and the children underwent the Wechsler Preschool and Primary Scales of Intelligence--Revised. In a second study, the ASQ was obtained in 22 children born extremely preterm and 19 term children at the age of 35-44 mo. RESULTS: The overall ASQ score correlated significantly with IQ (p=0.007). The children born extremely preterm had an ASQ score of -1.06 SD below the score of the term children (p=0.048). CONCLUSION: The ASQ identified a developmental deficit of the expected magnitude.

Age Factors↗