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Biomedical subjects

G Greisen

Publications and source records attributed to G Greisen.

At least 19 recordsLinked to original sources
PubMed2006

The impact of maternal smoking on fetal and infant growth.

BACKGROUND: Low birth weight is associated with accelerated postnatal growth and adverse adult health outcomes. Maternal smoking is a major risk factor for low birth weight. This study aims to assess: Pre- and postnatal growth associated with maternal smoking compared to other risk factors for low birth weight. The effect of reduction of maternal smoking on growth. SUBJECTS: A cohort (n=269) followed with ultrasound measurements in the third trimester and postnatal anthropometric measurements until 6 months of age. Mothers were interviewed about their smoking habits at 18 and 28 weeks of pregnancy. RESULTS: Maternal smoking was associated with a greater reduction in birth length SDS than other causes of equally reduced birth weight (mean difference: -0.25 SDS, P=0.013). The adjustment of gestational age, based on bi-parietal diameter at an early dating scan, indicated that mothers who reduced smoking carried smaller fetuses than mothers who continued to smoke heavily (mean difference=2.6 days, P=0.012). Birth weights in these two groups were similar (P=0.87). However at 3 months of age, reduced smoking was associated with lower weight (mean difference=-0.38 SDS, P=0.045). CONCLUSIONS: Maternal smoking was associated with a reduction of linear growth, which was more marked than that of other risk factors, and which seemed to occur before the 3rd trimester. The results indicated a beneficial effect of reduction of smoking upon third trimester growth, and that the decision to reduce smoking in mid-pregnancy may be influenced by early fetal size.

Female↗
PubMed2004

Perinatal risk factors of adverse outcome in very preterm children: a role of initial treatment of respiratory insufficiency?

AIM: To investigate risk factors of adverse outcome in a cohort of very preterm children treated mainly with nasal continuous positive airway pressure (CPAP) during the neonatal course. METHODS: In Denmark, preterm children are treated with nasal CPAP as a first approach to respiratory support. A national prospective study of all infants with a birthweight below 1000 g or a gestational age below 28 wk born in 1994-1995 was initiated to evaluate this approach. Of the 269 surviving children 164 (61%) were not treated with mechanical ventilation in the neonatal period. A follow-up of the children at 5 y of age was conducted. Data from the neonatal period and the 5-y follow-up were analysed. RESULTS: In multivariate analyses including 250 children, a severely abnormal neonatal brain ultrasound scan was predictive of cerebral palsy (OR = 19.9, CI 95%: 6.1-64.8) and intellectual disability (OR = 6.2, CI 95%: 2.3-16.5). A high Clinical Risk Index for Babies (CRIB) score (OR = 2.4, CI 95%: 1.1-5.5) and chronic lung disease (OR = 2.8, CI 95%: 1.2-6.9) were predictive of intellectual disability. In univariate analyses mechanical ventilation was associated with cerebral palsy (OR=4.3, CI 95%: 1.7-10.8) and intellectual disability (OR = 2.2, CI 95%: 1.2-4.2), but the associations became insignificant in multivariate analyses including chronic lung disease and a severely abnormal ultrasound scan. CONCLUSION: The associations between neonatal risk factors and adverse outcome in our cohort were very similar to those found in other cohorts with another initial treatment of respiratory insufficiency. We found no significant adverse effects of mechanical ventilation beyond what could be explained by associations with chronic lung disease and IVH 3-4/PVL.

Cerebral Palsy↗
PubMed2004

Meaningful care for babies born after 22, 23 or 24 weeks.

UNLABELLED: The dilemma of proper treatment of very low-birthweight infants is discussed. CONCLUSION: Professionals should be aware of the data in order to consider the chances of every baby and to engage in the relationship with the family, care team and society.

Denmark↗
PubMed2004

Early nasal continuous positive airway pressure in a cohort of the smallest infants in Denmark: neurodevelopmental outcome at five years of age.

AIM: To evaluate neurodevelopmental outcome at age 5 y of age in a cohort of preterm children treated mainly with nasal continuous positive airway pressure (CPAP) in the neonatal period. METHODS: A national prospective observational study was conducted in Denmark which included all 269 surviving children with a birthweight below 1000 g or a gestational age below 28 wk born in Denmark in between 1994 and 1995. A total of 164 children (61%) had been treated with nasal CPAP only in the neonatal period. A reference group (n = 76) of term children was studied in parallel. RESULTS: Of the 269 surviving children, 252 (94%) were examined. Twenty-four children (10%) had cerebral palsy, and three children were blind. No case of hearing impairment was detected. Nineteen percent of the index children had an IQ score <-- 2 SD and 42% had an IQ score <-- 1 SD of the mean score of the reference group. CONCLUSIONS: The intellectual development of children in this cohort treated with early nasal CPAP did not suggest a higher proportion of adverse effects on the brain compared to the published follow-up studies of preterm children treated with mechanical ventilation. In our population-based cohort, however, the survival rate for infants below 25 wk of gestation was relatively low and this may indicate a limit for the use of early nasal CPAP.

Age Factors↗
PubMed2003

Treatment of extremely preterm infants: parents' attitudes.

AIM: To conduct a survey of the attitude towards treatment of extremely preterm infants by comparing the attitude towards life-saving treatment between a group of parents of extremely preterm children and parents in the general population. The importance the two groups of respondents assigned to parental preferences was also investigated. METHODS: A Danish national cohort of children born from 1994 to 1995 with a birthweight below 1000 g or a gestational age below 28 wk were assessed in a 5-y follow-up study including a reference group of children born at term. The parents of the children were given a sequence of case vignettes presenting different clinical situations, which formed part of a questionnaire. RESULTS: More than 80% of 222 possible index respondents and 76 possible reference respondents fulfilled the vignettes. Both groups of respondents were positive towards life-saving treatment of extremely preterm infants. The recommendations given by both groups were significantly influenced by the hypothetical child's risk of having a serious handicap and the parents' preferences. The results suggest that parents of extremely preterm children do not have a more conservative attitude towards life-saving treatment of extremely preterm infants than parents in the general population, and also support the view that parents' preferences should influence treatment decisions; although many believe that these should not be decisive. CONCLUSION: Compared to the general population, parents of children born extremely preterm did not express a more conservative attitude towards life-saving treatment of extremely preterm infants.

Adult↗
PubMed2003

Preterm delivery and calculation of survival rate below 28 weeks of gestation.

AIM: To estimate the number of still- and live-births below 28 wk of gestation in a 2-y period in Denmark, and to determine how the calculated survival rates vary using three different denominators: 1) the number of infants actively treated in the Neonatal Care Units, NNUs, 2) the number of all live-born infants, and 3) the number of all births, including stillbirths. METHODS: The number of stillbirths and live-born infants at 20 to 27 wk of gestation was estimated over a 2-y period in Denmark. Data on live-born infants and survival rates were obtained from a national prospective study and the National Births Register. The number of women hospitalized owing to spontaneous abortion was obtained from The Danish National Health Register; the number of stillbirths was calculated from these data. RESULTS: The estimated number of both still- and live-births was similar in every week from 20 to 27 wk of gestation; approximately 1 per 1000 live-births at each gestational week. At from 23 to 25 wk of gestation the overall chances of survival varied significantly depending on the denominator: actively treated infants 46% (CI 95%; 37%-54%), all live-born infants 34% (CI 95%; 27%-41%), all births including stillbirths 14% (CI 95%: 11-17%). CONCLUSION: The chances of survival for the intrauterine fetus below 26 wk of gestation are significantly lower than the reported survival rates from the NNUs. The low percentage of fetuses delivered before 26 wk of gestation classified as live-born renders the reported birth-rates sensitive to differences in the way "live-born" is interpreted.

Denmark↗
PubMed2001

[Early selective surfactant treatment--also to very premature infants treated with CPAP?].

INTRODUCTION: Early selective surfactant treatment of premature infants on mechanical ventilation, defined as treatment of selected children within the first two hours of life, reduces the incidence of complications to neonatal respiratory distress syndrome (RDS) as compared with delayed selective surfactant treatment. Treatment of children judged to be solely at risk of RDS, however, eventually leads to overtreatment in some. MATERIALS AND METHODS: A population of premature neonates born at a gestational age of 24 + 0 to 29 + 6 weeks at Rigshospitalet, were studied retrospectively. RESULTS: Of the 171 children supported by nasal continuous positive airway pressure (CPAP) at the age of two hours, 99 were eventually treated with a natural surfactant (Curosurf) at a median age of nine hours. A statistically significant association was found between later surfactant treatment and an oxygen supplement of more than 30% at the age of two hours (chi 2: p < 0.001). Furthermore, there was a statistically significant association between later surfactant treatment and birth as the second twin or second or third triplet (chi 2: p < 0.001). Surprisingly, a gestational age of between 24 + 0 and 27 + 6 weeks, a birth weight less than 1.000 g, and a birth weight less than 80% of that expected was not correlated with later surfactant treatment. Forty-nine per cent of the children treated with surfactant received mechanical ventilation at some time before discharge. DISCUSSION: Earlier selective surfactant treatment of premature neonates supported by nasal CPAP with an oxygen supplement of more than 30% at the age of two hours would have been possible in 71 of 99 children needing the surfactant. As a consequence, 13 of 72 children would have been overtreated.

Biological Products↗
PubMed2001

[Cooling as treatment of birth asphyxia].

In about 10 per cent of children with cerebral palsy, the most probable cause is birth asphyxia. The brain injury following birth asphyxia evolves in part over hours or days--as a secondary process. This opens a 'window of opportunity' for intervention. Decreasing the temperature by as little as 3 degrees C appears to be effective. It is possible to identify babies with a 50 per cent risk of death or survival with cerebral palsy within 3 to 6 hours after birth. Pilot trials of cooling suggest that the side-effects of cooling can be managed. Randomized controlled trials are underway. Obtaining informed consent from the parents for these trials represents a particular challenge.

Asphyxia Neonatorum↗
PubMed2001

[Emergency transport of newborn infants--fetch or bring?].

INTRODUCTION: Neonatal transport is difficult and often associated with problems. In 1998, the Neonatal Intensive Care Unit, University Hospital of Copenhagen, H:S Rigshospitalet, set up a neonatal transport team. The aim of this study was to assess whether a better quality of high risk transport could justify the increased consumption of time. METHOD: The schedules for observation and assessment filled in by the transport team were collected and compared with records of the transport of high-risk neonates by local transport. The comparison consisted in the number of infants, severity of the problems, interventions carried out either locally or after arrival at the Neonatal Intensive Care Unit, and the condition of the infants judged on the pH, blood sugar level, blood pressure, and body temperature. RESULTS: The neonatal transport team fetched 68 high-risk infants, whereas 140 high-risk infants were brought by local transport. Infants fetched by the transport team were more sick, both before and during transport, than those brought to us. On arrival at the Neonatal Intensive Care Unit, more infants brought by local transport had problems (31% vs 16%): 12 (9%) transports had more than one critical problem, in contrast to none of the infants fetched by the transport team. The transport team carried out 71 interventions on 44 of the 68 infants (65%). These interventions explain the better condition of the infants on arrival. Acute interventions soon after arrival at the Neonatal Intensive Care Unit were carried out on 91 of the 140 infants brought by local transport (65%). DISCUSSION: Neonatal transport of extremely ill infants is difficult. A specialised (transport) team with local stabilisation and transport reduces the frequency of complications. The number of high-risk neonates transported is so small that it is improbable that adequate expertise can be built up and maintained locally.

Ambulances↗
PubMed2001

Cerebral palsy births in eastern Denmark, 1987--90: implications for neonatal care.

The Cerebral Palsy Register in eastern Denmark has collected cases using a uniform data sampling procedure since birth year 1979. We have investigated changes in the rate of cerebral palsy, related to gestational age, mortality and perinatal risk factors in children born 1983--90. The total cerebral palsy birth prevalence decreased from 3.0 in the birth year period 1983--86 to 2.4 per 1000 live births (P < 0.01) in 1987--90, owing to a decrease among all preterm infants (29--19 per 1000, P < 0.001). The perinatal and early neonatal mortality in preterm infants was unchanged from 1983--86 to 1987--90. The rate of cerebral palsy in term infants was 1.5 per 1000 in all birth-year periods from 1979--90. Among the cerebral palsy infants, the proportion of very preterm babies treated with mechanical ventilation in the neonatal period decreased from 95% in 1983--86 to 61% in 1987--90 (P < 0.001), while the group treated with CPAP among the moderately preterm babies increased from 61% to 78% (P < 0.05). The significant decline in cerebral palsy rate in preterm infants born 1987--90 may be due to a change in treatment at the neonatal intensive care units using less mechanical ventilation, a hypothesis which needs further investigation.

Cerebral Palsy↗
PubMed2001

Quality of life in young adults with very low birth weight.

OBJECTIVES: To assess quality of life (QoL) in a group of young adults born in 1980-1982 with very low birth weight (VLBW) and to compare this with a reference group and a similar cohort born eight years earlier. DESIGN: Telephone interview using a fully structured questionnaire. SETTING: Level 3 neonatal intensive care unit. PATIENTS: VLBW group (n = 92, 90% participation rate), LBW group (n = 119, 86%), normal birth weight/reference group (n = 69, 75%). MAIN OUTCOME MEASURES: Objective and subjective QoL. RESULTS: Objective QoL in the VLBW subgroup who did not report a handicap or chronic health problem was lower than in the reference group (median 0.79 v 0.84, p = 0.02). Objective QoL was 0.81 in the similar LBW subgroup whereas it was only 0.72 in the group of 13 VLBW and nine LBW subjects who reported a handicap or chronic health problem. Interestingly, subjective QoL did not differ between the VLBW subgroup and the reference group (median 0.87 v 0.88, p = 0.5). On comparing the VLBW subgroup in the 1980-1982 cohort with the similar VLBW subgroup in the 1971-1974 cohort, objective QoL had apparently increased. CONCLUSION: The VLBW young adults had a lower objective QoL than the reference group, whereas the subjective QoL was similar. Objective QoL in Danish youngsters has apparently increased over the past eight years.

Adolescent↗
PubMed2001

White matter injury in the preterm neonate: the role of perfusion.

The preterm infant is at special risk of white matter injury. It was hypothesized long ago that ischemia is the principal etiology. The commonly used experimental animals for perinatal brain injury research may differ importantly from humans as regards the white matter. Therefore, evidence from human neonates that the white matter is selectively exposed to ischemia is relevant. Blood flow to the white matter appears to be particularly low in the premature human infant, with only 17% of flow to the gray matter. Furthermore, the blood flow to the white matter appears to be selectively reduced when blood pressure is low. There are important methodological limitations to all the studies reviewed; whereas the hypothesis has not had strong support, it has not been refuted. It appears wise to consider ischemia to the white matter a real threat in sick preterm infants.

Brain Ischemia↗
PubMed2001

Is periventricular leucomalacia a result of hypoxic-ischaemic injury? Hypocapnia and the preterm brain.

Decrease in the arterial partial pressure of carbon dioxide (PaCO(2)) causes a reduction in cerebral blood flow in humans and in most animal species; in adults as well as in newborns and even in fetal life. Severely decreased PaCO(2) increases cerebral lactate production, modifies spontaneous electric brain activity, and may decrease the metabolic rate of oxygen. A relation between very low PaCO(2) and brain injury, however, has not been shown in adult humans or full-term newborn infants, nor in perinatal animals. In contrast, an association between low PaCO(2) and cerebral palsy and white matter injury in preterm infants has been reported repeatedly. A cause-and-effect relation is suggested by data from the immature rat: brain damage induced by ligation of a carotid artery can be reduced by adding CO(2) to the inspired gas and hence avoiding the consequences of spontaneous hyperventilation. This may be relevant for the clinical care of preterm infants, since PaCO(2) to a large extent is a function of respiratory management. The questions to be addressed are whether hypocapnia sensitizes the brain to hypoxaemia, and also whether the escape mechanisms are less effective in the preterm human brain.

Animals↗