To Örebro University

OBJECTIVES: It remains unclear whether antenatal SARS-CoV-2 exposure affects subsequent infant neurodevelopment. We aimed to investigate the association between antenatal maternal SARS-CoV-2 infection and neurodevelopment in four-month-old infants.

METHODS: Data was collected within the prospective multicenter COVID-19 during pregnancy and early childhood study, COPE (NCT04433364). Infants exposed to maternal SARS-CoV-2 infection from conception until two days postpartum and unexposed controls were included June 2020-December 2022.

PRIMARY OUTCOME: four-month-old infant neurodevelopment, measured using the Ages and Stages Questionnaire 3rd Edition (ASQ) total mean scores.

SECONDARY OUTCOMES: Scores below cutoff for total ASQ or the ASQ domains. RESULTS: Of 2,453 enrolled infants, 1,446 (555 exposed and 891 unexposed) had available ASQ data. In adjusted regression models, there was no group difference in ASQ total mean scores. Exposed infants had lower risk of fine motor domain scores below cutoff (exposed: 4.0% vs. unexposed: 6.6%; adjusted odds ratio (aOR), 0.55; 95% CI, 0.33-0.92). Infants exposed to severe maternal COVID-19 had increased risk of total ASQ scores below cutoff (exposed: 16.0% vs. unexposed: 6.1%; aOR, 3.57; 95% CI, 1.14-11.24).

CONCLUSIONS: Antenatal maternal SARS-CoV-2 infection was not associated with overall impaired four-month infant neurodevelopmental screening. In exploratory analyses, severe maternal COVID-19 was associated with abnormal screening results.

Home phototherapy is recommended as an alternative to hospital-based therapy for neonatal jaundice in otherwise healthy full-term infants. With a reliable device for transcutaneous bilirubin (TcB) measurement, bilirubin values could be monitored at home during treatment. This study aimed to examine the accuracy of TcB measurement of bilirubin levels before, during, and after home phototherapy. Patients requiring phototherapy were assigned to home (intervention) or hospital-based phototherapy (control). Transcutaneous bilirubin measurement was made at the sternum (uncovered skin) and at sacrum (covered by the diaper during treatment). Simultaneously, total serum bilirubin (TSB) level was collected through a blood sample. The agreement between TcB and TSB before, during, and after phototherapy was assessed using Bland-Altman plots. Altogether 141 patients and 856 paired bilirubin values were included. The results show that TcB measurements underestimate TSB levels. Before phototherapy, the mean difference between TcB and TSB was 75 ± 36 μmol/L at the sternum and 135 ± 39 μmol/L at sacrum, with no difference between study groups. During phototherapy, the mean difference at the sternum was larger in the control group, 105 ± 73 μmol/L, than in the intervention group, 50 ± 41 μmol/L; at sacrum, the mean difference was 125 ± 44 μmol/L, comparable in both study groups. After phototherapy, the TcB–TSB agreement improved, with a mean difference of 29 ± 33 μmol/L (sternum) and 87 ± 35 μmol/L (sacrum), and no difference between study groups. In conclusion this study shows that full-term infants who qualified for phototherapy show poor agreement between TcB measurement and TSB, suggesting that TcB measurements cannot replace measurement of TSB level before, during, or after home phototherapy.

Home phototherapy is recommended as an alternative to hospital-based therapy for neonatal jaundice in otherwise healthy full-term infants. With a reliable device for transcutaneous bilirubin (TcB) measurement, bilirubin values could be monitored at home during treatment. This study aimed to examine the accuracy of TcB measurement of bilirubin levels before, during, and after home phototherapy. Patients requiring phototherapy were assigned to home (intervention) or hospital-based phototherapy (control). Transcutaneous bilirubin measurement was made at the sternum (uncovered skin) and at sacrum (covered by the diaper during treatment). Simultaneously, total serum bilirubin (TSB) level was collected through a blood sample. The agreement between TcB and TSB before, during, and after phototherapy was assessed using Bland-Altman plots. Altogether 141 patients and 856 paired bilirubin values were included. The results show that TcB measurements underestimate TSB levels. Before phototherapy, the mean difference between TcB and TSB was 75 ± 36 μmol/L at the sternum and 135 ± 39 μmol/L at sacrum, with no difference between study groups. During phototherapy, the mean difference at the sternum was larger in the control group, 105 ± 73 μmol/L, than in the intervention group, 50 ± 41 μmol/L; at sacrum, the mean difference was 125 ± 44 μmol/L, comparable in both study groups. After phototherapy, the TcB-TSB agreement improved, with a mean difference of 29 ± 33 μmol/L (sternum) and 87 ± 35 μmol/L (sacrum), and no difference between study groups. In conclusion this study shows that full-term infants who qualified for phototherapy show poor agreement between TcB measurement and TSB, suggesting that TcB measurements cannot replace measurement of TSB level before, during, or after home phototherapy.

In May 2024 with a subsequent update in June 2025, the Swedish Medical Products Agency's expert group revised guidelines on the management and treatment of respiratory syncytial virus (RSV) infection. This is an abridged version and commentary on the full recommendation including specific recommendations for the RSV-season 2025/2026. Key points are: (i) RSV is a seasonal, highly contagious infection. Almost all children are infected by age two, usually with mild illness; (ii) Some infants, children with underlying conditions, and frail elderly are at risk for developing severe disease requiring hospital care; (iii) Preventive measures-such as hand hygiene and avoiding contact with people with colds-are essential to protect infants and the elderly; (iv) Prophylactic treatment with monoclonal antibodies reduces the risk of infants developing severe RSV disease and requiring hospital care. The long-acting drug nirsevimab is preferred over the shorter-acting palivizumab; (v) Universal prophylaxis in infants reduce disease burden for both families and society; (vi) If supply is limited, children at highest risk should be prioritised for prophylaxis; (vii) Maternal vaccination during pregnancy lowers the risk of severe RSV in newborns, decreasing hospital admissions. The protective effect is considered to be equivalent to that of monoclonal antibodies. Recommendations and funding decision for maternal vaccination is under investigation during the autumn of 2025; (viii) In the elderly, vaccination is the most effective pharmacological prevention; (ix) There is no effective antiviral treatment for established RSV disease; management is symptomatic and supportive. Hospitalised children should not be subjected to measures with no proven effect, preferable minimal interventions, with treatment focused on ensuring adequate nutrition; (x) The Swedish recommendations state that during the RSV season 2025/2026, nirsevimab should be administered to prevent RSV infection in all infants aged 0-3 months during the RSV season and to infants under 12 months with increased risk of severe RSV and certain high risk children under 24 months.

PURPOSE: The Extremely Preterm Infants in Sweden Study (EXPRESS) followed a national cohort of extremely preterm born (EPT, i.e. <27 weeks) children until 12 years of age. This study aimed to investigate the longitudinal development of visual acuity (VA) in children born EPT, explore the predictive value of early visual assessments, and evaluate risk factors for visual impairment at the age of 12 years.

METHODS: All 462 children born EPT in Sweden during April 2004-March 2007, and surviving to age 6.5 years, and full-term born matched controls were invited to participate in the 12-year follow-up. VA was assessed at 12 years and the results were compared with values at 2.5 and 6.5 years.

RESULTS: At age 12, 332 (72%) EPT survivors and 189 controls were examined. The mean VA in the EPT group was lower than in the control group (1.15, 95%CI [1.12-1.19] vs. 1.33, 95% CI [1.29-1.37]). Fifteen (4.5%) EPT had visual impairment. The examination at age 2.5 failed to identify most of them, while the examination at 6.5 could predict the final visual outcome at 12. Risk factors for visual impairment were low gestational age, moderate and severe intraventricular haemorrhage, treatment-requiring retinopathy of prematurity, cerebral palsy, and cognitive disability.

CONCLUSION: In this national cohort, the VA outcome at age 12 was lower in children born EPT than full-term controls. As eye examination at 2.5 years did not reliably identify visual impairment, clinical risk factors should be considered in the screening of children born EPT to early identify the visually impaired.

AIM: Swedish guidelines for therapeutic hypothermia (TH) after perinatal asphyxia were established in 2007, following several randomised studies that demonstrated improved outcomes. We assessed the implementation of hypothermia treatment in a mid-Swedish region with a sizeable proportion of outborn infants.

METHOD: A population-based TH cohort from 2007 to 2015 was scrutinised for adherence to national guidelines, interhospital transport, including the use of a cooling mattress made of phase change material for thermal management, and outcomes.

RESULTS: Of 136 admitted infants, 99 (73 %) were born outside the hospital. Ninety-eight percent fulfilled the criteria for postnatal depression/acidosis, and all patients had moderate-to-severe encephalopathy. Treatment was initiated within 6 h in 85 % of patients; amplitude-integrated electroencephalography/electroencephalography was recorded in 98 %, cranial ultrasound in 78 %, brain magnetic resonance imaging in 79 %, hearing tests in all, and follow-up was performed in 93 %. Although target body temperature was attained later (p < 0.01) in outborn than in inborn infants, at a mean (standard deviations) age of 6.2 (3.2) h vs 4.4 (2.6) h, 40 % of those transported using the cooling mattress were already within the therapeutic temperature range on arrival, and few were excessively cooled. The mortality rate was 23 %, and 38 % of the survivors had neurodevelopmental impairment at a median of 2.5 years.

CONCLUSION: The regionalisation of TH, including interhospital transport, was feasible and resulted in outcomes comparable to those of randomised controlled studies.

Background

There are a few previous studies on home phototherapy but there is a lack of randomised controlled trials. The aim of this study was therefore to assess whether home phototherapy is a safe and effective alternative to hospital treatment and whether it has an impact on bonding and stress. 

Methods

This was a randomised controlled, multicentre, trial in which newborns with a total serum bilirubin of 18-24 mg/dl (300-400 µmol/) were randomized to either home phototherapy or conventional in-hospital phototherapy. The inclusion criteria were a chronological age of more than 48 hours, a gestational age above 36 +0 weeks and a bilirubin above 20.5 mg/dl (350 µmol/L) after 72 hours of age. After inclusion, the patients were randomised, to either home phototherapy or hospital treatment.

Results

147 patients were recruited from 6 hospitals, 69 patients were randomized to conventional phototherapy and 78 to home phototherapy

Safety/feasability

The duration of phototherapy, length of stay, amount of blood tests and weight change showed no statistically significant differences between hospital and home phototherapy (table 2). However, home treatment failed in three patients and the total readmission rate was 4 %. It is recommended to provide daily check-ups and 24/7 telephone support to the parents.

Bonding and stress

Parents in the intervention group had better bonding both at discharge (p = 0.034) and at 4 months (p = 0.008; effect size r = 0.2) and lower levels of stress at 4 months (p = 0.024) compared with controls.

Cost

The cost was €337 per patient for home phototherapy compared with €1156 for the hospital alternative indicating average cost savings of €819 (95% confidence interval €613–1025) or 71% per  patient.

Descriptive qualitative study

A total of 15 interviews were performed (8 mothers, 7 fathers).The interviews showed that parents felt secure at home. The overall experience of home phototherapy was positive, and five categories were identified describing their experiences: continuing life at home, adjusting to having a newborn, feeling secure, experiencing parenthood, and accessing information.

Background/Objective: The aim of this study was to assess whether home phototherapy is a safe alternative to hospital treatment.

Method: This was a randomised controlled, multicentre, trial in which term newborns with a total serum bilirubin of 300-400 μmol/ were randomized to either home phototherapy or conventional in-hospital phototherapy.The outcome measurements were parent-infant bonding, stress and measurements of safety and feasibility. A descriptive qualitative study based on interviews was performed as well as a health economic analysis.

Result: 147 patients were recruited from 6 hospitals, Results showed no difference between groups in the safety and feasibility outcomes. Parents in the intervention group had better scores on bonding and lower levels of stress. The interviews showed that parents felt secure at home. The cost per patient was €337 for home phototherapy compared with €1156 for the hospital alternative indicating average cost savings of €819 or 71% per patient.

Conclusion: Home phototherapy can be considered a safe and feasible alternative to hospital care for well selected patients. It improves bonding and stress for parents and reduces health care costs. Since the first publication from this study was published home phototherapy is now recommended by the American Academy of Pediatrics as an alternative to hospital care for patients with uncomplicated hyperbilirubinemia.

This study aimed to establish the cost‑effectiveness of home phototherapy versus hospitalphototherapy treating hyperbilirubinemia in neonates more than 36 weeks. Based on clinical resultsfrom a randomised controlled trial showing that home phototherapy for hyperbilirubinemia in termneonates is as effective as hospital phototherapy, we performed a cost‑minimisation analysis toidentify the most cost‑effective alternative. We included costs for health care resource use as wellas costs for transportation in connection with re‑visits. The cost per patient was €337 for homephototherapy compared with €1156 for the hospital alternative indicating average cost savingsof €819 (95% confidence interval €613–1025) or 71% per patient. Transportation and outpatientcosts were higher in the home treatment group and hospital care costs were higher in the hospitalgroup. Sensitivity analysis shows that results are robust also when allowing for uncertainty. Homephototherapy for neonates more than 36 weeks costs less than in‑hospital phototherapy whilebeing equally effective, meaning that home phototherapy is a cost‑effective alternative to hospitaltreatment for infants with neonatal hyperbilirubinemia.