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Biomedical subjects

N Svenningsen

Publications and source records attributed to N Svenningsen.

At least 19 recordsLinked to original sources
PubMed1998

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↗
PubMed1997

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↗
PubMed1997

Respiratory distress syndrome in infants with impaired intrauterine growth.

The recently introduced intrauterine growth curve, based on ultrasonically estimated foetal weights, was retrospectively applied to an inborn population of 883 infants born before 33 gestational weeks at the University Hospital of Lund, during 1985-94. The estimation of birthweight deviation resulted in 630 (71.3%) infants with a birthweight appropriate for gestational age (AGA), 244 (27.6%) infants with a birthweight small for gestational age (SGA) and 9 (1.1%) infants with a birthweight large for gestational age. Birthweight deviation was associated with an increased mortality [odds ratio (OR) adjusted for gestational age 1.29 per SD (12%) change in birthweight for gestational age, 95% CI: 1.10-1.50; p = 0.002]. At gestational age 25-28 weeks, SGA-infants had an increased incidence of respiratory distress syndrome (RDS) as compared to AGA-infants (OR adjusted for gestational age: 1.98, 95% CI: 1.12-3.52; p = 0.019). At gestational age 29-32 weeks, SGA-infants had a lower incidence of RDS as compared to AGA-infants (OR adjusted for gestational age: OR 0.52, 95% CI: 0.34-0.80; p = 0.003). After adjustment for confounding variables, infants born at gestational age 25-28 weeks from mothers with pre-eclampsia, appeared to be a high-risk group for RDS, whereas at the age of 29-32 gestational weeks, negative birthweight deviation had a protective effect against RDS. Antenatal corticosteroid administration appeared to have a less beneficial effect on mortality, RDS and cerebral haemorrhage in infants born SGA vs in those born AGA.

Fetal Growth Retardation↗
PubMed1992

Protease inhibitors in bronchoalveolar lavage fluid from neonates with special reference to secretory leukocyte protease inhibitor.

An imbalance of proteolytic enzymes and protease inhibitors may contribute to the development of bronchopulmonary dysplasia. We studied secretory leukocyte protease inhibitor (not previously addressed), and alpha 1-antitrypsin, alpha 1-antichymotrypsin, alpha 2-macroglobulin and elastase. Albumin was used as an internal reference. Infants with pneumonia had higher concentrations of secretory leukocyte protease inhibitor (p = 0.02) and elastase (p = 0.04) in bronchoalveolar lavage fluid than those with respiratory distress syndrome; those who also developed bronchopulmonary dysplasia had intermediate values. A decreased concentration of alpha 1-antitrypsin was found in the second and third postnatal weeks (p = 0.002). Further detailed studies of the balance between proteases and protease inhibitors and of the importance of pulmonary infections in the pathogenesis of bronchopulmonary dysplasia are suggested. Secretory leukocyte protease inhibitor is important both as an elastase inhibitor of bronchial mucus and as a marker of infection in the bronchi.

Bronchoalveolar Lavage Fluid↗
PubMed1989

Potential of early chest roentgen examination in ventilator treated newborn infants to predict future lung function and disease.

The potentially of early chest X-ray to predict the risk of lung function abnormalities was studied prospectively in 40 preterm ventilator treated infants in a 8-10-year follow-up investigation. According to the findings at chest X-ray 3 to 10 days after completed ventilator treatment the infants were divided into 3 groups considered to represent increasing risk and severity of lung damage: 1) normal findings, 2) interstitial parenchymal abnormalities exclusively or 3) in combination with local or general hyperinflation. Lung function tests and chest x-ray were performed at the age of 8 to 10 years. A correlation was found between the findings at the early chest roentgen examination and the risk of abnormal lung function at the follow-up. Occurrence of focal or general hyperinflation or both were associated with a greater risk of airway obstruction. Infants with only interstitial abnormalities were, however, at a higher risk than those with normal chest examination to develop general hyperinflation and increased air way obstruction.

Bronchopulmonary Dysplasia↗
PubMed1987

Endotracheal administration of surfactant in very low birth weight infants with respiratory distress syndrome.

This study was designed to evaluate whether the ventilatory maneuvers associated with surfactant replacement would, per se, influence oxygenation in newborn infants with severe respiratory distress syndrome. Eight patients (700 to 1400 g), all requiring mechanical ventilation with fraction of inspired oxygen greater than 0.6, were included in the trial; four were randomized to receive surfactant, and the others served as controls. Porcine surfactant (2 ml/kg; phospholipid concentration, 100 mg/ml) was instilled via a naso-endotracheal tube at end-expiration and dispersed into the lungs during a period of standardized "sighing" mediated by the ventilator: two prolonged ventilatory cycles (10 sec each) with an inspiration/expiration ratio of 4:1, followed by a 6-min ventilation with a frequency of 60 breath/min and an inspiration/expiration ratio of 4:1. Control babies received no surfactant but were otherwise subjected to the same ventilatory maneuvers. Surfactant-treated infants showed a rapid increase in transcutaneous oxygen associated with improved lung aeration in chest x-rays; the response was transient in three babies and persistent in one. No improvement was observed in control babies. We conclude that the beneficial effect of surfactant replacement cannot be attributed to the ventilatory maneuvers associated with the instillation procedure.

Critical Care↗
PubMed1986

Reactivity of non-stress tests and its relationship to outcome in infants born prior to the 33rd week of gestation.

In order to evaluate the significance of the non-stress test (NST) in the immature fetus, 60 patients who gave birth between the 26th and 33rd week of gestation were studied. They were grouped according to reactivity of the last non-stress test performed 24 hours prior to delivery. Twenty-eight (47%) of the patients were reactive, 10 (17%) non-reactive, and 22 (37%) non-reactive with decelerations on the last NST. The one-year mortality rates were significantly higher in those non-reactive with decelerations (41%) and in those non-reactive (30%), than in the reactive group (7%) (p less than 0.001, p less than 0.05). The results suggest that reactive non-stress tests and those that are non-reactive with decelerations predicted the fetal outcome similarly to the same findings in term pregnancies. Non-reactive non-stress tests without decelerations were associated with poor outcome in fetuses with a gestational age of more than 29 weeks. Conversely, in more immature fetuses, nonreactive patterns occurred in patients with favorable outcome. The clinical implications of these findings are discussed.

Female↗
PubMed1985

Sleep-waking shifts and cerebral blood flow in stable preterm infants.

Cerebral blood flow was estimated on 60 occasions in 15 well infants, 29-34 wk of gestational age, 5-17 days after birth, using 133-Xenon clearance after intravenous injection. The sleep state of the infants was determined by biparietal electroencephalography, clinical observation, and tracings of heart rate and respiration. Blood flow was 22% higher in the 11 estimations made during wakefulness, when compared to the 17 estimations made during quiet sleep. There was no difference between blood flow in active and quiet sleep. Also there was no difference between blood flow during periods of trace alternant and blood flow during periods of continuous electroencephalographic activity. It is suggested that flow-metabolism coupling is present in stable, preterm infants. The absence of an increase in cerebral blood flow during active sleep as compared with quiet sleep suggests that the neurophysiologic and neurometabolic mechanisms of rapid eye movement sleep are not yet fully developed in preterm infants.

Brain↗
PubMed1984

Transient increase of early-onset group B streptococcal septicemia.

Since 1976, all cases of neonatal group B streptococcal (GBS) septicemia/meningitis have been registered at two Swedish University Hospitals. A significant increase in the number of infants contracting early-onset GBS-septicemia was noticed at one clinic in 1981, from 1-3 cases per yr to 8 cases. Six months prior to this increase the number of deliveries increased from about 1500 per yr to nearly 3000 per yr. It is suggested that external factors, e.g., subtle changes in the nursing combined with an extended disadvantage at the ward might influence the development of early-onset GBS septicemia.

Humans↗
PubMed1984

Intrauterine lung infection with Chlamydia trachomatis in a premature infant.

The present study shows the probable intrauterine infection with Chlamydia trachomatis in a premature infant born in the 29th week of gestation. Chlamydiae were isolated from lung tissue collected at sterile autopsy and also demonstrated in sections of such tissue by immunofluorescence tests using monoclonal antibodies.

Adult↗
PubMed1984

Intrapartum fetal acidosis in preterm infants: fetal monitoring and long-term morbidity.

Fetal heart rate (FHR) and fetal acid-base status were studied prospectively in 61 patients in preterm labor of unknown etiology. Neonatal data were analyzed, and all surviving infants participated in a follow-up study for at least two years. Ominous FHR patterns correlated well with fetal acidosis. Infants with fetal acidosis (pH less than 7.25 in scalp blood) had more neurologic abnormalities in the neonatal period and a higher rate of neurodevelopmental disabilities at the follow-up than nonacidotic infants of the same gestational weeks. In the surveillance of patients in preterm labor electronic fetal monitoring is mandatory. At late or pronounced variable decelerations, pH analysis of fetal scalp blood should be performed immediately. If not available, prompt abdominal delivery is recommended.

Acidosis↗