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  • 1.
    Björkman Hjalmarsson, Louise
    et al.
    Örebro University, School of Medical Sciences. Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Hagberg, Jessika
    Örebro University, School of Science and Technology. Department of Occupational and Environmental Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Schollin, Jens
    Örebro University, School of Medical Sciences.
    Ohlin, Andreas
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Pediatrics.
    Leakage of isopropanol from port protectors used in neonatal intensive careManuscript (preprint) (Other academic)
  • 2.
    Björkman Hjalmarsson, Louise
    et al.
    Örebro University, School of Medical Sciences. Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.
    Ohlin, Andreas
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Paediatrics.
    Schollin, Jens
    Örebro University, School of Medical Sciences.
    Bodin, Lennart
    Örebro University, Örebro University School of Business. Intervention and Implementation Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm; Department of Statistics, Örebro University, Örebro, Sweden.
    Hygiene routines in the EXPRESS study: impact of hygiene routines and antibiotic prophylaxis on neonatal sepsis incidenceManuscript (preprint) (Other academic)
  • 3.
    Björkman Hjalmarsson, Louise
    et al.
    Örebro University, School of Medical Sciences. Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.
    Schollin, Jens
    Örebro University, School of Medical Sciences.
    Bodin, Lennart
    Örebro University, Örebro University School of Business. Intervention and Implementation Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden, Department of Statistics, Örebro University, Örebro, Sweden.
    Ohlin, Andreas
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Paediatrics.
    Hygiene routines in the EXPRESS study: a Swedish national survey of hygiene practices in neonatal intensive careManuscript (preprint) (Other academic)
  • 4.
    Björkman, Louise
    et al.
    Örebro University, School of Medical Sciences. Department of Pediatrics, Örebro University Hospita, Örebro, Sweden.
    Hagberg, J.
    Department of Occupational and Environmental Medicine, Örebro University Hospital, Örebro, Sweden.
    Schollin, Jens
    Örebro University, School of Medical Sciences.
    Ohlin, Andreas
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Pediatrics.
    Can the use of isopropanol impregnated caps cause alcohol leakage into intravenous lines?2017Conference paper (Refereed)
  • 5.
    Björkman, Louise
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Ohlin, Andreas
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Pediatrics.
    Scrubbing the hub of intravenous catheters with an alcohol wipe for 15 sec reduced neonatal sepsis2015In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 104, no 3, p. 232-236Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to investigate whether scrubbing the hub of intravenous catheters with an alcohol wipe for 15 sec could reduce the incidence of neonatal sepsis in a level-three neonatal intensive care unit.

    Methods: We studied the incidence of neonatal sepsis caused by coagulase-negative staphylococci (CoNS) for 16.5 months before the initiative was launched on May 15, 2012 and then for a further 8.5 months after it was introduced. The hub routine was applied to all intravenous catheters.

    Results: During the control period before the initiative was launched, there were nine cases of CoNS sepsis compared with no cases after it was introduced, resulting in a decrease in sepsis incidence from 1.5% to 0% with a risk reduction of 1.5% (0.53-2.58%) (p = 0.06). In the preterm infant population, the incidence of sepsis decreased from 3.6% to 0% (1.1-6.0%) (p = 0.11).

    Conclusion: Scrubbing the hub of intravenous catheters with an alcohol wipe for 15 sec seemed to be an efficient way of preventing sepsis caused by CoNS in newborn infants. However, the evidence for the benefits will remain weak until a large randomised trial has been completed.

  • 6.
    Eriksson, Mats
    et al.
    Örebro University, School of Health Sciences.
    Pettersson, Miriam
    Örebro University, School of Medical Sciences.
    Olsson, Emma
    Örebro University, School of Health Sciences.
    Ohlin, Andreas
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Neurophysiological and behavioural measures of pain during neonatal hip examination2019Conference paper (Refereed)
    Abstract [en]

    Background: In Sweden, all newborns are examined before discharge from the maternity ward to rule out innate abnormalities. Parts of this procedure, such as the hip examination, appear to cause pain and discomfort. Pain in newborns can have both short- and long-term negative consequences and preventing and treating pain is therefore an important part of medical care. There are several ways to recognize and assess pain in newborn infants. Scales such as the Premature Infant Pain Profile-Revised (PIPP-R) are recommended, but recently physiological and neurophysiological measures, e.g. Near-infrared spectroscopy (NIRS) and Galvanic Skin Response (GSR) have been suggested to have pain-assessing properties.

    Aim: The aim of the study was to test the hypothesis that neonatal hip examination causes pain in newborns. 

    Method: The infant was placed on an examination table and a video camera was placed so the face of the newborn was filmed. A pulse oximeter probe, NIRS optodes and GSR electrodes were attached to the infant. Heart auscultation was chosen to be used as a non-painful comparative to hip examination.

    Results: The results showed higher pain scoring for the hip examination than for the heart auscultation. NIRS, showed a significant difference in HbO2 on both sides of cortex. Mean PIPP-R went from 3.0 during the heart auscultation to 8.1 during the hip examination. GSR analyses showed significant increase in area under small peaks during the hip examination. 

    Conclusion: We conclude that neonatal hip examinations are painful and that the pain should be treated, e.g. with oral sweet solution. 

  • 7.
    Jonsson, Maria
    et al.
    Dept Womens & Childrens Hlth, Uppsala Univ, Uppsala, Sweden.
    Ågren, Johan
    Dept Womens & Childrens Hlth, Uppsala Univ, Uppsala, Sweden.
    Norden-Lindeberg, Solveig
    Dept Womens & Childrens Hlth, Uppsala Univ, Uppsala, Sweden.
    Ohlin, Andreas
    Örebro University Hospital. Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Hanson, Ulf
    Dept Womens & Childrens Hlth, Uppsala Univ, Uppsala, Sweden.
    Suboptimal care and metabolic acidemia is associated with neonatal encephalopathy but not with neonatal seizures alone: a population-based clinical audit2014In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 93, no 5, p. 477-482Article in journal (Refereed)
    Abstract [en]

    Objective: To determine the incidence of moderate to severe neonatal encephalopathy (NE) and neonatal seizures without encephalopathy, and the association with metabolic acidemia. Secondly, to investigate the occurrence of suboptimal intrapartum care and its impact on neonatal outcome.

    Design: Clinical audit.

    Setting: Two university hospitals in Sweden.

    Population: Neonates 34weeks with moderate or severe NE and neonatal seizures alone, i.e. without encephalopathy, from a population of 71189 births, where umbilical blood gases were routinely analyzed.

    Methods: Neonates were categorized depending on the presence of metabolic acidemia at birth by umbilical artery pH<7.00, base deficit 12mmol/L. Records were audited for suboptimal care and a decision was made on whether management was assessed to have impacted neonatal outcome.

    Main outcome measures: Encephalopathy and seizures alone.

    Results: We identified 80 neonates with NE and 30 with seizures alone, of which 48 (60%) and none, respectively, had metabolic acidemia. Suboptimal care could be assessed in 77 and occurred in 28 (36%) NE cases and in one neonate with seizures alone (p<0.001). In 47 NE cases with metabolic acidemia, suboptimal care occurred in 22 (47%) vs. 6/30 (20%) without metabolic acidemia (p=0.02). Suboptimal care had an impact on outcome in 18/77 (23%) NE cases but in no cases with seizures alone.

    Conclusion: Suboptimal care was commonly seen with NE, particularly in neonates with metabolic acidemia, and also affected neonatal outcome. No such associations were found in neonates with seizures alone.

  • 8.
    Jonsson, Maria
    et al.
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Ågren, Johan
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Nordén-Lindeberg, Solveig
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Ohlin, Andreas
    Örebro University Hospital. Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Hanson, Ulf
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Neonatal encephalopathy and the association to asphyxia in labor2014In: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 211, no 6, p. 667.e1-667.e8, article id S0002-9378(14)00596-1Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: In cases with moderate and severe neonatal encephalopathy, we aimed to determine the proportion that was attributable to asphyxia during labor and to investigate the association between cardiotocographic (CTG) patterns and neonatal outcome.

    STUDY DESIGN: In a study population of 71,189 births from 2 Swedish university hospitals, 80 cases of neonatal encephalopathy were identified. Cases were categorized by admission CTG patterns (normal or abnormal) and by the presence of asphyxia (cord pH, <7.00; base deficit, ≥12 mmol/L). Cases with normal admission CTG patterns and asphyxia at birth were considered to experience asphyxia related to labor. CTG patterns were assessed for the 2 hours preceding delivery.

    RESULTS: Admission CTG patterns were normal in 51 cases (64%) and abnormal in 29 cases (36%). The rate of cases attributable to asphyxia (ie, hypoxic ischemic encephalopathy) was 48 of 80 cases (60%), most of which evolved during labor (43/80 cases; 54%). Both severe neonatal encephalopathy and neonatal death were more frequent with an abnormal, rather than with a normal, admission CTG pattern (13 [45%] vs 11 [22%]; P = .03), and 6 [21%] vs 3 [6%]; P = .04), respectively. Comparison of cases with an abnormal and a normal admission CTG pattern also revealed more frequently observed decreased variability (12 [60%] and 8 [22%], respectively) and more late decelerations (8 [40%] and 1 [3%], respectively).

    CONCLUSION: Moderate and severe encephalopathy is attributable to asphyxia in 60% of cases, most of which evolve during labor. An abnormal admission CTG pattern indicates a poorer neonatal outcome and more often is associated with pathologic CTG patterns preceding delivery.

  • 9.
    Malmqvist, Olle
    et al.
    Department of Pediatrics, Faculty of Medicine and Health, Örebro Universitet, Örebro, Sweden.
    Ohlin, Andreas
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Pediatrics.
    Ågren, Johan
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Jonsson, Maria
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Seizures in newborn infants without hypoxic ischemic encephalopathy - antenatal and labor-related risk factors: a case-control study2020In: The Journal of Maternal-Fetal & Neonatal Medicine, ISSN 1476-7058, E-ISSN 1476-4954, Vol. 33, no 5, p. 799-805Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To identify antepartum and intrapartum risk factors for neonatal seizures in the absence of hypoxic ischemic encephalopathy (HIE).

    METHODS: Population-based case-control study. Of 98 484 births, 40 newborns at 34 gestational weeks or later had seizures within the first 7 days of life. Cases (n = 40) and controls (n = 160) were retrieved from the University hospitals of Örebro for 1994-2013 and Uppsala for 2003-2013. Demographics and characteristics of pregnancy, labor, delivery, and neonatal data were analyzed. Crude odds ratio (OR) and adjusted odds ratios (AOR) with 95% confidence intervals (CIs) for antenatal and intrapartum factors were calculated using logistic regression analysis. Main outcome measure was neonatal seizures within the first 7 days of life.

    RESULTS: The incidence of neonatal seizures without HIE was 0.41/1000 live births. Antenatal risk factors for neonatal seizures were as follows: short maternal stature (AOR: 5.4; 1.8-16.5); previous caesarean section (AOR: 4.8; 1.5-15.0); and assisted fertilization (AOR: 6.8; 1.3-35.2). Intrapartum risk factors were as follows: induction of labor (AOR: 5.7; 1.8-17.7); preterm birth (AOR: 13.5; 3.7-48.9); and head circumference >37 cm (AOR: 6.9; 1.4-34.8).

    CONCLUSIONS: Preterm birth was the strongest risk factor for neonatal seizures in the absence of HIE. The results also indicate that feto-pelvic disproportion is associated with the occurrence of seizures.

    RATIONALE: Antepartum and intrapartum risk factors for newborn seizures in the absence of HIE were investigated in a case-control study. Out of 98 484 births at 34 gestational weeks or more, 40 newborns had seizures without HIE. All had a normal Apgar score although they later presented with seizures. Preterm birth was the strongest risk factor (OR: 13.5; 95% CI: 3.7-48.9). Our results also indicate that feto-pelvic disproportion is of importance. Furthermore, a history of prior caesarean was associated with seizures. This is the first study to assess obstetric risk factors for newborn seizures separate from those with seizures and concomitant HIE. The distinction is of importance due to different etiologies, treatments, and preventive strategies.

  • 10.
    Ohlin, Andreas
    Örebro University, School of Health and Medical Sciences.
    Aspects on early diagnosis of neonatal sepsis2010Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    This thesis presents four studies, all designed to improve the problematic diagnostic situation concerning infants with suspected sepsis. Study I included 401 neonates with suspected sepsis. Nine signs of sepsis and C-reactive protein were prospectively recorded and logistic regression was used to assess associations between these signs and a subsequently confirmed diagnosis of sepsis. C-reactive protein and five of the clinical signs were statistically significantly associated with a positive bloodculture. When the material was stratified by gestational age, differences between premature and full term infants were detected.Studies II and III were prospective studies that used samples collected from neonates with suspected sepsis to evaluate a novel real-timepolymerase chain reaction (PCR) method. The results where compared with simultaneously collected blood cultures. Study II used plasma samples and resulted in a sensitivity of 42% and specificity of 95%. In study III, the protocol was improved and adapted to whole blood samples which resulted in a sensitivity of 79% and specificity of 90%. Both protocols included species-specific probes and study III indicated that PCR has the potential to detect bacteria in culture-negative sepsis.Staphylococcus epidermidis is the most common pathogen in neonatal sepsis, but there is still a lack of typing methods suitable for large materials of S. epidermidis. In Study IV we therefore evaluated a new S. epidermidisgenotyping method based on PCR for the repeat regions of four genes thatencode for cell wall anchoring proteins. The method was applied to 49well-defined neonatal blood isolates of S. epidermidis. The combination ofsdrF and aap seemed to be optimal, resulting in a diversity index of 0.92.Conclusions

    • Bradycardia, apnoea, low blood pressure, feeding intolerance and distended abdomen are obvious early signs of neonatal sepsis. Premature and full-term infants differ in terms of the signs they display in neonatal sepsis.

    • Blood is superior to plasma for developing PCR methods for bacterial DNA detection. The PCR method described in study III can detect neonatal bacteraemia, but it can be further improved before it is used in routine care.

    • There has been a lack of useful typing methods for S. epidermidis.We can now present PCR of the genes for the cell wall anchoring proteins sdrF and aap as a novel and feasible approach when there is a need to type a large number of S. epidermidis isolates.

    List of papers
    1. Clinical signs and CRP values associated with blood culture results in neonates evaluated for suspected sepsis
    Open this publication in new window or tab >>Clinical signs and CRP values associated with blood culture results in neonates evaluated for suspected sepsis
    2010 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 99, no 11, p. 1635-1640Article in journal (Refereed) Published
    Abstract [en]

    Aim: To identify which clinical signs at presentation are most predictive of sepsis subsequently confirmed by blood culture and to investigate whether the predictive power of the clinical signs varies by gestational age.

    Methods: Among 401 newborn infants <28 days of age with suspected sepsis, nine signs of sepsis and C-reactive protein (CRP) values were prospectively recorded. Logistic regression assessed the association of these signs and laboratory values with a subsequently confirmed diagnosis of sepsis by positive blood culture. The analysis was stratified by gestational age with mutual simultaneous adjustment for the signs and sex.

    Results: Five of the nine clinical signs (feeding intolerance, distended abdomen, blood pressure, bradycardia and apnoea), along with CRP were statistically significantly associated with a positive blood culture. After simultaneous adjustment for all of the signs, apnoea, hypotension and CRP were independently predictive of positive blood culture. When the material was stratified by gestational age, differences in the association with positive blood culture were found for bradycardia, tachypnea and irritability/seizures.

    Conclusion: In this selected population of infants with suspected sepsis, apnoea and hypotension are independently predictive of a confirmed diagnosis, while bradycardia is more predictive among preterm infants and tachypnea among term infants.

    Place, publisher, year, edition, pages
    Malden, USA: Wiley-Blackwell, 2010
    Keywords
    Diagnosis, logistic regression, neonatal sepsis, neonatology
    National Category
    Medical and Health Sciences
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:oru:diva-12721 (URN)10.1111/j.1651-2227.2010.01913.x (DOI)000282641600008 ()20560896 (PubMedID)2-s2.0-78649728350 (Scopus ID)
    Available from: 2010-12-15 Created: 2010-12-15 Last updated: 2018-07-22Bibliographically approved
    2. Real-time PCR of the 16S-rRNA gene in the diagnosis of neonatal bacteraemia
    Open this publication in new window or tab >>Real-time PCR of the 16S-rRNA gene in the diagnosis of neonatal bacteraemia
    Show others...
    2008 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 97, no 10, p. 1376-1380Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVE: To evaluate a real-time PCR assay for the diagnosis of neonatal bacteraemia. PATIENTS AND METHODS: Two hundred ninety-five plasma samples from 288 newborns with suspected neonatal sepsis were collected prospectively for the purpose of polymerase chain reaction (PCR)-based bacterial detection. A real-time PCR targeting the bacterial gene for 16S-rRNA gene combined with four specific probes designed to detect Gram-negative bacteria, Staphylococcus aureus and coagulase-negative staphylococci (CoNS) was developed. All samples positive in the universal PCR were further sequenced for bacterial identification. RESULTS: When applied to a material from 50 patients with positive blood culture and 245 patients with negative blood culture, the universal PCR showed a sensitivity of 42% (28-57), a specificity of 95% (92-97), a positive predictive value of 64% (45-80), and a negative predictive value of 89% (84-92) (95% confidence intervals in brackets). CONCLUSION: A new real-time PCR technique was for the first time applied to a well-defined prospectively and consecutively enrolled material of newborns with suspected sepsis, combining the benefits of real-time PCR with specific probes and sequencing. The method managed to detect bacteraemia with high specificity even though the sensitivity was low. Factors causing the low sensitivity are identified and further strategies to develop the method are described.

    Place, publisher, year, edition, pages
    Oslo: Taylor & Francis, 2008
    National Category
    Pediatrics Medical and Health Sciences Clinical Medicine
    Research subject
    Pediatrics; Medicine
    Identifiers
    urn:nbn:se:oru:diva-5149 (URN)10.1111/j.1651-2227.2008.00924.x (DOI)
    Available from: 2009-01-29 Created: 2009-01-29 Last updated: 2017-12-14Bibliographically approved
    3. Diagnosis of neonatal sepsis by broad range 16S real-time PCR
    Open this publication in new window or tab >>Diagnosis of neonatal sepsis by broad range 16S real-time PCR
    Show others...
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Context: The standard diagnostic test (blood culture) for suspected neonatal sepsis has limitations in sensitivity, specificity and 16 S polymerase chain reaction has been suggested as a new diagnostic tool for neonatal sepsis.Objective:To develop and evaluate a new real-time polymerase chain reaction (PCR) method for detection of bacterial DNA in blood samples collected from infants with suspected neonatal sepsis. Primary outcome was the sensitivity, specificity, and positive and negative predictive value of the 16 S real-time PCR assay as compared with blood culture.Design: Prospective study of diagnostic test.Setting: Two Swedish Level III neonatal intensive care units.Patients: 317 infants < 3 months of age subjected to blood culture as decided by the attending neonatologist.Main outcome measures: Sensitivity and specificity of the studied PCR method was the main outcome, with simultaneously collected blood culture acting as the gold standard. Detailed case studies was performed in all cases with conflicting results, to verify if PCR could detect pathogens in culture negative sepsis.Results: The material comprised 368 samples from 317 infants. When compared with blood culture, the assay yielded a sensitivity of 79%, a specificity of 90%, a positive predictive value of 59%, and a negative predictive value of 96%. PCR detected 29/35 (83%) of the Coagulase negative staphylococci samples and 15/21 (71%) of the remaining cultures. In five samples, PCR (but not blood culture) could detect a pathogen that was present in blood culture more than 24 hours earlier.Conclusions: This study presents an evaluation of a new real-time PCR technique that can detect culture-positive sepsis, and suggests that PCR has the potential to detect bacteria in culture-negative samples even if collected after the initiation of intravenous antibiotics.

    National Category
    Medical and Health Sciences Pediatrics
    Research subject
    Pediatrics; Medicine
    Identifiers
    urn:nbn:se:oru:diva-12732 (URN)
    Note

    Andreas Ohlins is also affiliated with Department of Pediatrics, Örebro University Hospital

    Available from: 2010-12-17 Created: 2010-12-17 Last updated: 2017-10-17Bibliographically approved
    4. Rapid typing of neonatal Staphylococcus epidermidis isolates using polymerase chain reaction for repeat regions in surface protein genes
    Open this publication in new window or tab >>Rapid typing of neonatal Staphylococcus epidermidis isolates using polymerase chain reaction for repeat regions in surface protein genes
    Show others...
    2010 (English)In: European Journal of Clinical Microbiology and Infectious Diseases, ISSN 0934-9723, E-ISSN 1435-4373, Vol. 29, no 6, p. 699-704Article in journal (Refereed) Published
    Abstract [en]

    Staphylococcus epidermidis is a significant pathogen in neonatal sepsis and other nosocomial infections. For further investigations of the colonisation patterns and invasive pathways, typing methods that are applicable on large populations of bacterial isolates are warranted. In the present study, a genotyping method based on polymerase chain reaction (PCR) for the repeat regions of four genes (sdrG, sdrF, aap and sesE) that encode for bacterial surface proteins was developed and applied to a sample of well-characterised neonatal blood isolates of S. epidermidis (n = 49). The PCR products were visualised on agarose gel (sdrG, sdrF and sesE) or by fragment analysis (aap). The discriminatory index (D-index) for genotyping of the different genes was compared to genotyping by pulsed-field gel electrophoresis (PFGE). The highest D-index for the PCR-based typing methods was found for the combination of sdrF, sdrG and aap (D-index 0.94), whereas the optimal two-gene combination (sdrF and aap) resulted in a D-index of 0.92. We conclude that the described method can be used for the genotyping of large populations of S. epidermidis isolates with a sufficient discriminatory capacity, and we suggest that the combination of sdrF and aap is the most suitable to use.

    Place, publisher, year, edition, pages
    New York, USA: Springer, 2010
    National Category
    Medical and Health Sciences Infectious Medicine
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:oru:diva-12722 (URN)10.1007/s10096-010-0917-z (DOI)000277711900011 ()20383779 (PubMedID)2-s2.0-77952876158 (Scopus ID)
    Available from: 2010-12-15 Created: 2010-12-15 Last updated: 2017-12-11Bibliographically approved
  • 11.
    Ohlin, Andreas
    Örebro University, School of Health and Medical Sciences.
    What is neonatal sepsis?2010In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 100, no 1, p. 7-8Article in journal (Refereed)
  • 12.
    Ohlin, Andreas
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Pediatrics.
    Björkman, Louise
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Pediatrics.
    Serenius, Fredrik
    Department of Women's and Children's Health, Section for Pediatrics, Uppsala University, Uppsala, Sweden; Department of Pediatrics, Institute of Clinical Sciences, Umeå University, Umeå, Sweden.
    Schollin, Jens
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Pediatrics.
    Källén, Karin
    Department of Obstetrics and Gynecology, Clinical Sciences, Centre of Reproduction Epidemiology, University of Lund, Lund, Sweden.
    Sepsis as a risk factor for neonatal morbidity in extremely preterm infants2015In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 104, no 11, p. 1070-1076Article in journal (Refereed)
    Abstract [en]

    Aim: This study evaluated sepsis as a risk factor for neonatal morbidities and investigated the association between specific pathogens and neonatal morbidities.

    Methods: This was a nationwide Swedish prospective cohort study, consisting of the 497 extremely premature children, who were born before 27weeks of gestation between 2004 and 2007 and survived their first year of life. Neonatal sepsis was evaluated as a risk factor for neonatal morbidity using multiple logistic linear regression analyses.

    Results: We found that 326 (66%) of the infants had at least one sepsis episode and coagulase-negative staphylococci was the most common pathogen. Definite sepsis, with an odds ratio (OR) of 1.6, was associated with severe bronchopulmonary dysplasia, but not clinical sepsis (OR 1.1). Definite sepsis was also associated with a prolonged hospital stay (OR 1.6). Sepsis was not significantly associated with a higher risk of retinopathy of prematurity or intraventricular haemorrhage.

    Conclusion: Extremely preterm infants face a great risk of acquiring neonatal sepsis, with coagulase-negative staphylococci being the most common pathogen in this population. Definite sepsis seemed to be a risk factor for severe bronchopulmonary dysplasia and prolonged hospital stay, but the associations were weaker than in previous studies.

  • 13.
    Ohlin, Andreas
    et al.
    Örebro University, School of Health and Medical Sciences. Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.
    Björkqvist, Maria
    Örebro University, School of Health and Medical Sciences. Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.
    Montgomery, Scott M.
    Örebro University, School of Health and Medical Sciences.
    Schollin, Jens
    Örebro University, School of Health and Medical Sciences. Department of Paediatrics, Örebro University Hospital, Örebro, Sweden;.
    Clinical signs and CRP values associated with blood culture results in neonates evaluated for suspected sepsis2010In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 99, no 11, p. 1635-1640Article in journal (Refereed)
    Abstract [en]

    Aim: To identify which clinical signs at presentation are most predictive of sepsis subsequently confirmed by blood culture and to investigate whether the predictive power of the clinical signs varies by gestational age.

    Methods: Among 401 newborn infants <28 days of age with suspected sepsis, nine signs of sepsis and C-reactive protein (CRP) values were prospectively recorded. Logistic regression assessed the association of these signs and laboratory values with a subsequently confirmed diagnosis of sepsis by positive blood culture. The analysis was stratified by gestational age with mutual simultaneous adjustment for the signs and sex.

    Results: Five of the nine clinical signs (feeding intolerance, distended abdomen, blood pressure, bradycardia and apnoea), along with CRP were statistically significantly associated with a positive blood culture. After simultaneous adjustment for all of the signs, apnoea, hypotension and CRP were independently predictive of positive blood culture. When the material was stratified by gestational age, differences in the association with positive blood culture were found for bradycardia, tachypnea and irritability/seizures.

    Conclusion: In this selected population of infants with suspected sepsis, apnoea and hypotension are independently predictive of a confirmed diagnosis, while bradycardia is more predictive among preterm infants and tachypnea among term infants.

  • 14.
    Ohlin, Andreas
    et al.
    Örebro University, School of Health and Medical Sciences.
    Bäckman, Anders
    Clinical Research Centre, Örebro University Hospital.
    Ewald, Uwe
    Women’s and Children’s Health, Uppsala University, Uppsala.
    Schollin, Jens
    Örebro University, School of Health and Medical Sciences.
    Björkqvist, Maria
    Women’s and Children’s Health, Uppsala University, Uppsala.
    Diagnosis of neonatal sepsis by broad range 16S real-time PCRManuscript (preprint) (Other academic)
    Abstract [en]

    Context: The standard diagnostic test (blood culture) for suspected neonatal sepsis has limitations in sensitivity, specificity and 16 S polymerase chain reaction has been suggested as a new diagnostic tool for neonatal sepsis.Objective:To develop and evaluate a new real-time polymerase chain reaction (PCR) method for detection of bacterial DNA in blood samples collected from infants with suspected neonatal sepsis. Primary outcome was the sensitivity, specificity, and positive and negative predictive value of the 16 S real-time PCR assay as compared with blood culture.Design: Prospective study of diagnostic test.Setting: Two Swedish Level III neonatal intensive care units.Patients: 317 infants < 3 months of age subjected to blood culture as decided by the attending neonatologist.Main outcome measures: Sensitivity and specificity of the studied PCR method was the main outcome, with simultaneously collected blood culture acting as the gold standard. Detailed case studies was performed in all cases with conflicting results, to verify if PCR could detect pathogens in culture negative sepsis.Results: The material comprised 368 samples from 317 infants. When compared with blood culture, the assay yielded a sensitivity of 79%, a specificity of 90%, a positive predictive value of 59%, and a negative predictive value of 96%. PCR detected 29/35 (83%) of the Coagulase negative staphylococci samples and 15/21 (71%) of the remaining cultures. In five samples, PCR (but not blood culture) could detect a pathogen that was present in blood culture more than 24 hours earlier.Conclusions: This study presents an evaluation of a new real-time PCR technique that can detect culture-positive sepsis, and suggests that PCR has the potential to detect bacteria in culture-negative samples even if collected after the initiation of intravenous antibiotics.

  • 15.
    Ohlin, Andreas
    et al.
    Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Bäckman, Anders
    Clinical Research Centre, Örebro University Hospital, Örebro, Sweden.
    Ewald, Uwe
    Women’s and Children’s Health, Uppsala University, Uppsala, Sweden .
    Schollin, Jens
    Örebro University, School of Health and Medical Sciences.
    Björkqvist, Maria
    Örebro University, School of Health and Medical Sciences. Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Diagnosis of neonatal sepsis by broad-range 16S real-time polymerase chain reaction2012In: Neonatology, ISSN 1661-7800, E-ISSN 1661-7819, Vol. 101, no 4, p. 241-246Article in journal (Refereed)
    Abstract [en]

    Background: The standard diagnostic test (blood culture) for suspected neonatal sepsis has limitations in sensitivity and specificity, and 16S polymerase chain reaction (PCR) has been suggested as a new diagnostic tool for neonatal sepsis. Objectives: To develop and evaluate a new real-time PCR method for detection of bacterial DNA in blood samples collected from infants with suspected neonatal sepsis. Methods: Immediately after blood culture, a study sample of 0.5–1.0 ml whole blood was collected and used for a novel 16S real-time PCR assay. All positive samples were sequenced. Detailed case studies were performed in all cases with conflicting results, to verify if PCR could detect pathogens in culture negative sepsis. Results: 368 samples from 317 infants were included. When compared with blood culture, the assay yielded a sensitivity of 79%, a specificity of 90%, a positive predictive value of 59%, and a negative predictive value of 96%. Seven of the 31 samples with a positive PCR result and a negative blood culture had definite or suspected bacterial sepsis. In five samples, PCR (but not blood culture) could detect a pathogen that was present in a blood culture collected more than 24 h prior to the PCR sample. Conclusions: This study presents an evaluation of a new real-time PCR technique that can detect culture-positive sepsis, and suggests that PCR has the potential to detect bacteria in culture-negative samples even after the initiation of intravenous antibiotics.

  • 16.
    Ohlin, Andreas
    et al.
    Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.
    Bäckman, Anders
    Clinical Research Centre, Örebro University Hospital, Örebro, Sweden.
    Söderquist, Bo
    Department of Clinical Microbiology, Örebro University Hospital, Örebro, Sweden.
    Wingren, Sten
    Örebro University, School of Health and Medical Sciences.
    Björkqvist, Maria
    Örebro University, School of Health and Medical Sciences. Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.
    Rapid typing of neonatal Staphylococcus epidermidis isolates using polymerase chain reaction for repeat regions in surface protein genes2010In: European Journal of Clinical Microbiology and Infectious Diseases, ISSN 0934-9723, E-ISSN 1435-4373, Vol. 29, no 6, p. 699-704Article in journal (Refereed)
    Abstract [en]

    Staphylococcus epidermidis is a significant pathogen in neonatal sepsis and other nosocomial infections. For further investigations of the colonisation patterns and invasive pathways, typing methods that are applicable on large populations of bacterial isolates are warranted. In the present study, a genotyping method based on polymerase chain reaction (PCR) for the repeat regions of four genes (sdrG, sdrF, aap and sesE) that encode for bacterial surface proteins was developed and applied to a sample of well-characterised neonatal blood isolates of S. epidermidis (n = 49). The PCR products were visualised on agarose gel (sdrG, sdrF and sesE) or by fragment analysis (aap). The discriminatory index (D-index) for genotyping of the different genes was compared to genotyping by pulsed-field gel electrophoresis (PFGE). The highest D-index for the PCR-based typing methods was found for the combination of sdrF, sdrG and aap (D-index 0.94), whereas the optimal two-gene combination (sdrF and aap) resulted in a D-index of 0.92. We conclude that the described method can be used for the genotyping of large populations of S. epidermidis isolates with a sufficient discriminatory capacity, and we suggest that the combination of sdrF and aap is the most suitable to use.

  • 17.
    Olsson, Emma
    et al.
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Pettersson, Miriam
    Örebro University, School of Medical Sciences.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    Ohlin, Andreas
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Glukos som smärtlindring vid neonatal höftledsundersökning: En randomiserad kontrollerad studie2018Conference paper (Refereed)
  • 18.
    Olsson, Emma
    et al.
    Örebro University, School of Health Sciences. Örebro University Hospital. Department of Pediatrics.
    Pettersson, Miriam
    Örebro University, School of Medical Sciences. Department of Pediatrics.
    Eriksson, Mats
    Örebro University, School of Health Sciences. Department of Pediatrics.
    Ohlin, Andreas
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Pediatrics.
    Oral sweet solution to prevent pain during neonatal hip examination: a randomized controlled trial2019In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 108, no 4, p. 626-629Article in journal (Refereed)
    Abstract [en]

    Aim: To determine if oral glucose can have a pain relieving effect during routine hip exams in newborn infants.

    Methods: In this randomized controlled study 100 newborn infants undergoing the routine physical examination including the potentially painful hip exam were included between March 2016 and April 2017. 50 infants were randomized to water (control) and 50 to oral glucose (intervention) before their examination. Pain was assessed using crying time, Astrid Lindgren and Lund Children's Hospital Pain and Stress Assessment Scale (ALPS‐Neo) and Visual analogue scale (VAS).

    Results:  Total crying time (p=0.06), crying time during the hip examination (p=0.028), ALPS‐Neo (p=0.004) and VAS (p=0.006) (when assessed by the physician) were all significantly decreased in the group of infants receiving glucose. VAS assessment made by the parents did not reach statistical significance (p=0.127).

    Conclusion:  Oral glucose given before the examination has a pain relieving effect during the hip exam in healthy newborn infants.

  • 19.
    Pettersson, Miriam
    et al.
    Örebro University, School of Medical Sciences. Department of Paediatrics.
    Olsson, Emma
    Örebro University, School of Health Sciences. Department of Paediatrics.
    Ohlin, Andreas
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Paediatrics.
    Eriksson, Mats
    Örebro University, School of Health Sciences. Department of Paediatrics.
    Neurophysiological and behavioral measures of pain during neonatal hip examination2019In: Paediatric and Neonatal Pain, ISSN 2637-3807, Vol. 1, no 1, p. 15-20Article in journal (Refereed)
    Abstract [en]

    Introduction: The aim of this study was to test the hypothesis that neonatal hip ex ‐amination causes pain in newborns. Pain assessment using instruments such as the Premature Infant Pain Profile‐Revised (PIPP‐R) scale is recommended, but recently physiological and neurophysiological measures, for example, near‐infrared spectros‐copy (NIRS) and galvanic skin response (GSR), have been used as well.

    Methods: Heart auscultation and hip examination were performed, and the response of the newborn was registered by NIRS optodes, GSR electrodes, and a pulse oxime‐ter probe attached to the infant. The face of the newborn was filmed. Heart ausculta‐tion was used as a nonpainful reference.

    Results: The pain scores for hip examination were higher than for the heart ausculta‐tion. Near‐infrared spectroscopy showed a significant higher increase from baseline in oxygenated hemoglobin (HbO2) on both sides of the cortex at hip examination compared with at heart auscultation (P = .011 and P= .017). Mean PIPP‐R scores for the hip examination compared with heart auscultation increased from 3.0 to 8.1 (P = .000). The GSR analyses of hip examination compared with heart auscultation showed a significant increase in area under small peaks during the hip examination (P = .016), however, not when measured in peaks per second (P = .104). Interrater reliability was calculated for the NIRS interpretations, with an intraclass correlation coefficient (ICC) range of 0.93‐1.0 (P = .000).

    Discussion: Pain in newborns can have negative consequences, and pain prevention and treatment are therefore important. We conclude that neonatal hip examinations are painful and that the pain should be treated, for example, with oral sweet solution. This is a change from present routines during neonatal hip examination and is hoped to lead to a change in national guidelines.

  • 20.
    Pettersson, Miriam
    et al.
    Örebro University, School of Medical Sciences.
    Olsson, Emma
    Örebro University, School of Health Sciences.
    Ohlin, Andreas
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    Neurophysiological and behavioural measures of pain during neonatal hip examination2019Conference paper (Refereed)
    Abstract [en]

    Background

    In Sweden, all newborns are examined before discharge from the maternity ward to rule out innate abnormalities. Parts of this procedure, such as the hip examination, appear to cause pain and discomfort. Pain in newborns can have both short- and long-term negative consequences and preventing and treating this pain is therefore an important part of medical care. There are several ways to recognize and assess pain in newborn infants. Scales such as the Premature Infant Pain Profile-Revised (PIPP-R) are recommended, but recently physiological and neurophysiological measures, e.g. Near-infrared spectroscopy (NIRS) and Galvanic Skin Response (GSR) have been suggested to have pain-assessing properties.

    The aim of the study was to test the hypothesis that neonatal hip examination causes pain in newborns.

    Methods

    The infant was placed on an examination table and a video camera was placed so the face of the newborn was filmed. A pulse oximeter probe, NIRS optodes and GSR electrodes were attached to the infant. Heart auscultation was chosen to be used as a non-painful comparative to hip examination.

    Results

    The results showed higher pain scoring for the hip examination than for the heart auscultation. NIRS, showed a significant difference in HbO2 on both sides of cortex (p=0,011 and p=0,017). Mean PIPP-R went from 3.0 during the heart auscultation to 8.1 during the hip examination (p=0.000). GSR analyses showed significant increase in area under small peaks during the hip examination (p=0.016), however not when measured in peaks per second (p=0.104). Interrater reliability was calculated for the NIRS interpretations, with an ICC-range of 0.93-1.0 (p=0.000).

    Conclusion

    We conclude that neonatal hip examinations are painful and that the pain should be treated, e.g. with oral sweet solution. 

  • 21.
    Pettersson, Miriam
    et al.
    Örebro University, School of Medical Sciences.
    Olsson, Emma
    Örebro University, School of Health Sciences.
    Ohlin, Andreas
    Örebro University Hospital. Örebro University, School of Medical Sciences.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    Neurophysiological and behavioural measures of pain during neonatal hip examination2019Conference paper (Refereed)
    Abstract [en]

    Introduction and Purpose: In Sweden, all newborns are examined before discharge from the maternity ward to rule out innate abnormalities. Parts of this procedure, such as the hip examination, appear to cause pain and discomfort. Pain in newborns can have both short- and long-term negative consequences and preventing and treating this pain is therefore an important part of medical care. There are several ways to recognize and assess pain in newborn infants. Scales such as the Premature Infant Pain Profile-Revised (PIPP-R) are recommended, but recently physiological and neurophysiological measures, e.g. Near-in-frared spectroscopy (NIRS) and Galvanic Skin Response (GSR) have been suggested as superior pain measuring methods. The aim of the study was to test the hypothesis that neonatal hip examination causes pain in newborns.

    Methods: The infant was placed on an examination table and a video camera was placed so the face of the newborn was filmed. A pulse oximeter probe, NIRS optodes and GSR electrodes were attached to the infant. Heart auscultation was chosen to be used as a non-painful comparative to hip examination.

    Results: The results showed higher pain scoring for the hip examination than for the heart auscultation. NIRS, showed a significant difference in HbO2 on both sides of cortex (p=0,011 and p=0,017). Mean PIPP-R went from 3.0 during the heart auscultation to 8.1 during the hip examination (p=0.000). GSR analyses showed significant increase in area under small peaks during the hip examination (p=0.016), however not when measured in peaks per second (p=0.104). The interrater reliability for NIRS interpretations had an ICC-range of 0,93-1,0 (p<0,001). 

    Conclusion: We conclude that neonatal hip examinations are painful and that the pain should be treated, e.g. with oral sweet solution.

  • 22.
    Pettersson, Miriam
    et al.
    Örebro University, School of Medical Sciences.
    Olsson, Emma
    Örebro University, School of Health Sciences.
    Ohlin, Andreas
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    Neurophysiological and behavioural measures of pain during neonatal hip examination2019Conference paper (Refereed)
    Abstract [en]

    Background: In Sweden, all newborns are examined before discharge from the maternity ward to rule out innate abnormalities. Parts of this procedure, such as the hip examination, appear to cause pain and discomfort. Pain in newborns can have both short- and long-term negative consequences and preventing and treating this pain is therefore an important part of medical care. There are several ways to recognize and assess pain in newborn infants. Scales such as the Premature Infant Pain Profile-Revised (PIPP-R) are recommended, but recently physiological and neurophysiological measures, e.g. Near-infrared spectroscopy (NIRS) and Galvanic Skin Response (GSR) have been suggested to have pain-assessing properties.

    The aim of the study was to test the hypothesis that neonatal hip examination causes pain in newborns. 

    Methods: The infant was placed on an examination table and a video camera was placed so the face of the newborn was filmed. A pulse oximeter probe, NIRS optodes and GSR electrodes were attached to the infant. Heart auscultation was chosen to be used as a non-painful comparative to hip examination. 

    Results: The results showed higher pain scoring for the hip examination than for the heart auscultation. NIRS, showed a significant difference in HbO2 on both sides of cortex (p=0,011 and p=0,017). Mean PIPP-R went from 3.0 during the heart auscultation to 8.1 during the hip examination (p=0.000). GSR analyses showed significant increase in area under small peaks during the hip examination (p=0.016), however not when measured in peaks per second (p=0.104). Interrater reliability was calculated for the NIRS interpretations, with an ICC-range of 0.93-1.0 (p=0.000).

    Conclusion: We conclude that neonatal hip examinations are painful and that the pain should be treated, e.g. with oral sweet solution. 

  • 23.
    Serenius, Fredrik
    et al.
    Section for Pediatrics, Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden; Department of Pediatrics, Institute of Clinical Sciences, Umeå University, Umeå, Sweden.
    Ewald, Uwe
    Section for Pediatrics, Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Farooqi, Aijaz
    Department of Pediatrics, Institute of Clinical Sciences, Umeå University, Umeå, Sweden.
    Fellman, Vineta
    Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden.
    Hafström, Maria
    Department of Pediatrics, Institute of Clinical Sciences, The Queen Silvia Children’s Hospital, University of Gothenburg, Göteborg, Sweden; Department of Paediatrics, St Olavs Hospital Trondheim, Trondheim, Norway; Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway.
    Hellgren, Kerstin
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Marsál, Karel
    Department of Obstetrics and Gynecology, Clinical Sciences Lund, Lund University, Lund, Sweden.
    Ohlin, Andreas
    Örebro University, School of Medical Sciences. Department of Pediatrics, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Olhager, Elisabeth
    Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Stjernqvist, Karin
    Department of Psychology, Lund University, Lund, Sweden.
    Strömberg, Bo
    Section for Pediatrics, Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Ådén, Ulrika
    Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden.
    Källén, Karin
    Centre of Reproductive Epidemiology, Lund University, Lund, Sweden.
    Neurodevelopmental Outcomes Among Extremely Preterm Infants 6.5 Years After Active Perinatal Care in Sweden2016In: JAMA pediatrics, ISSN 2168-6203, E-ISSN 2168-6211, Vol. 170, no 10, p. 954-963Article in journal (Refereed)
    Abstract [en]

    IMPORTANCE: Active perinatal care increases the rate of survival of extremely preterm infants, but there are concerns that improved survival might increase the rate of disabled survivors.

    OBJECTIVE: To determine the neurodevelopmental outcomes of a national cohort of children 6.5 years of age who had been born extremely preterm (<27 weeks' gestational age) in Sweden.

    DESIGN, SETTING, AND PARTICIPANTS: Population-based prospective cohort study of consecutively born extremely preterm infants. All of these infants were born in Sweden during the period from April 1, 2004, to March 31, 2007. Of 707 live-born extremely preterm infants, 486 (68.7%) survived to 6.5 years of age. These children were assessed and compared with matched controls who had been born at term. Comparison estimates were adjusted for demographic differences. Assessments ended in February 2014, and analysis started thereafter.

    MAIN OUTCOMES AND MEASURES: Cognitive ability was measured with the fourth edition of the Wechsler Intelligence Scale for Children (WISC-IV), and the mean (SD) scores of the children who had been born extremely preterm were compared with those of the controls. Clinical examinations and parental questionnaires were used for diagnosis of cerebral palsy, hearing and vision impairments, and cognition for the children who were not assessed with the WISC-IV.

    RESULTS: Of 486 eligible infants who were born extremely preterm, 441 (90.7%) were assessed at 6.5 years of age (59 by medical record review only) alongside 371 controls. The adjusted mean (SD) full-scale WISC-IV score was 14.2 (95% CI, 12.1-16.3) points lower for children who had been born extremely preterm than for controls. Cognitive disability was moderate for 18.8% of extremely preterm children and 2.2% of controls (P < .001), and it was severe for 11.1% of extremely preterm children and 0.3% of controls (P < .001). Cerebral palsy was observed in 9.5% of extremely preterm children and 0.0% of controls (P < .001), blindness was observed in 2.0% of extremely preterm children and 0.0% of controls (P < .001), and hearing impairment was observed in 2.1% of extremely preterm children and 0.5% of controls (P = .07). Overall, 36.1%(95% CI, 31.7%-40.6%) of extremely preterm children had no disability, 30.4%(95% CI 26.3%-34.8%) had mild disability, 20.2%(95% CI, 16.6%-24.2%) had moderate disability, and 13.4%(95% CI, 10.5%-16.9%) had severe disability. For extremely preterm children, moderate or severe overall disability decreased with gestational age at birth (adjusted odds ratio per week, 0.65 [95% CI, 0.54-0.79]; P < .001) and increased from 26.6% to 33.5%(P = .01) for children assessed both at 2.5 and 6.5 years.

    CONCLUSIONS AND RELEVANCE: Of the 441 extremely preterm infants who had received active perinatal care, 293 (66.4%) had no or mild disability at 6.5 years; of the 371 controls, 11 (3.0%) had moderate or severe disability. Disability rates at 6.5 years increased relative to the rates at 2.5 years. Results are relevant for health care professionals and planners, and for clinicians counseling families facing extremely preterm births.

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