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T Markestad

Publications and source records attributed to T Markestad.

At least 19 recordsLinked to original sources
PubMed2003

Circadian variations in sudden infant death syndrome: associations with maternal smoking, sleeping position and infections. The Nordic Epidemiological SIDS Study.

AIM: To study circadian variation in the sudden infant death syndrome (SIDS) and possible associations with risk factors for SIDS. METHODS: A questionnaire-based case-control study matched for place of birth, age and gender was conducted in Denmark, Norway and Sweden: The Nordic Epidemiological SIDS Study. The study comprised 244 SIDS victims and 869 control infants between September 1992 and August 1995. The main outcome was hour found dead. RESULTS: A significant circadian pattern was observed among the 242 SIDS victims with a known hour found dead, with a peak at 08.00-08.59 in the morning (n = 33). Of the SIDS victims, 12% were found dead at 00.00-05.59, 58% at 06.00-11.59, 21% at 12.00-17.59 and 9.0% at 18.00-23.59. When comparing night/morning SIDS and day/evening SIDS (found dead 00.00-11.59 and 12.00-23.59, respectively), the proportion of night/morning SIDS was high among infants of smoking mothers (81% vs 53%, p < 0.001), infants with a reported cold (82% vs 64%, p = 0.007) and infants sleeping side/supine (81% vs 60%, p < 0.001). No associations were observed between hour found dead and other sociodemographic risk factors for SIDS. Risk (odds ratio and 95% confidence interval) of night/morning SIDS and day/evening SIDS was 7.0 (4.5-10.9) and 1.5 (0.8-2.5), respectively, for maternal smoking, 2.2 (1.5-3.1) and 0.6 (0.3-1.3), respectively, if the infant had a reported cold, 3.7 (2.1-6.6) and 3.1 (1.1-8.4), respectively, if the infant was put to sleep in the side position (supine reference), and 11.0 (5.9-20.2) and 21.6 (7.6-60.8), respectively, if the infant was put to sleep in the prone position. CONCLUSION: The observed higher proportion of night/morning cases in SIDS if the mother smoked, if the infant was reported to have a cold and if the infant was sleeping side/supine may contribute to the understanding of some epidemiological characteristics of SIDS.

Causality↗
PubMed2002

Joint association of Apgar scores and early neonatal symptoms with minor disabilities at school age.

OBJECTIVE: To examine whether the combination of a low five minute Apgar score and symptoms of neonatal encephalopathy is associated with minor impairments at school age. DESIGN: Population based cohort study. SETTING: Norway. PARTICIPANTS: All 727 children of the cohort were born between 1983 and 1987, had normal birth weights, no congenital malformations, and no major neurological abnormalities. The cohort comprised three groups with five minute Apgar scores of 0-3, 4-6, and 7-10, and were followed from birth to 8-13 years of age by combining data from The Medical Birth Registry, questionnaires, hospital discharge summaries, and the National Insurance Scheme. MAIN OUTCOME MEASURE: Neurodevelopmental impairments such as learning, behavioural, and minor motor difficulties. RESULTS: Children with a five minute Apgar score of 3 or less and signs consistent with neonatal encephalopathy had a significantly increased risk of developing minor motor impairments (odds ratio (OR) 12.8, 95% confidence interval (CI) 2.6 to 63.2), epilepsy (OR 7.0, 95% CI 1.3 to 39.2), need of extra resources in kindergarten (OR 7.0, 95% CI 1.3 to 39.2) or at school (OR 3.4, 95% CI 1.8 to 6.3), and had reduced performance in reading (OR 4.6, 95% CI 2.3 to 9.5) and mathematics (OR 3.3, 95% CI 1.5 to 7.3), compared with children with normal Apgar scores and no neonatal symptoms. They also more often had problems related to tractability, aggressivity, passivity, anxiety, academic performance, and fine motor development. CONCLUSION: Children with low Apgar scores and subsequent signs of cerebral depression who do not develop cerebral palsy may still have an increased risk of developing a variety of neurodevelopmental impairments and learning difficulties.

Apgar Score↗
PubMed2002

Population based, controlled study of behavioural problems and psychiatric disorders in low birthweight children at 11 years of age.

OBJECTIVE: To evaluate the risk of long term behavioural problems and psychiatric disorders associated with being born with low birth weight. DESIGN/STUDY GROUPS: A population based, controlled follow up study at 11 years of age of 130 low birthweight (LBW) children weighing less than 2000 g at birth who were without major handicaps, and a random sample of 131 normal birthweight (NBW) children born at term weighing over 3000 g. MAIN OUTCOME MEASURES: Validated questionnaires addressing behaviour completed by mothers and teachers and child evaluation by child psychiatrist using a semistructured interview. RESULTS: Behavioural problems, as defined by abnormal scores on more than four of 32 measures, were found in 40% of LBW children compared with 7% of NBW children (odds ratio (OR) 8.2, 95% confidence interval (CI) 3 to 25, p = 0001). A psychiatric disorder was diagnosed in 27% of the LBW children compared with 9% of the NBW children (OR 3.1, 95% CI 1.5 to 6.5, p = 0.001). The LBW children were more often inattentive, had social problems, and low self esteem. None of the pre-, neo-, or peri-natal variables in the LBW group were statistically significant predictors of behavioural outcomes or the presence of psychiatric disorders. Behavioural problems and psychiatric disorders were as common in those with birth weight less than 1500 g as those with birth weight 1500-2000 g. CONCLUSION: An increased risk of behavioural problems and psychiatric disorders persists in LBW adolescents.

Child↗
PubMed2001

[Treatment of extremely premature infants--which limits and what problems?].

In Norway about 300 babies with a birthweight of 500-999 grams and 200 with a gestational age of 24-27 weeks are born annually. This gives a total of 320-330 babies who come under the definition of extreme prematurity. Obstetric care is important in order to avoid premature birth, or, when premature birth is unavoidable, to find the optimal time and place for delivery. There is ongoing discussion of what constitutes reasonable lower limits for offering life support. The survival rate for babies born before 24 gestational weeks is low and the risk of serious neurological damage high. The risk of severe lung disease is reduced with pre- and postnatal treatment with corticosteroids and postnatal treatment with surfactant, but excessive corticosteroid treatment may possibly increase the risk of neurological damage. Despite major recent progress in the treatment of the preterm baby, significant understanding of why disabilities occur is lacking.

Humans↗
PubMed2001

[Approaching the acutely ill child].

The proper evaluation of the acutely ill infant and child requires a systematic approach, and knowledge of normal and pathological clinical findings according to age. In this paper guidelines are suggested on how the child may be evaluated clinically and by judicious use of supplementary investigations which are readily available.

Acute Disease↗
PubMed2001

Behavior in term, small for gestational age preschoolers.

AIMS: To evaluate whether being born small for gestational age (SGA) was associated with an increased frequency of preschool behavioral problems. STUDY DESIGN: Follow-up study at 5 years of age. SUBJECTS: A population based cohort of 318 term infants who were SGA, defined as having a birthweight less than the 15th percentile for gestational age, and without major handicap such as cerebral palsy or mental retardation, and a random control sample of 307 appropriate for gestational age (AGA) infants. OUTCOME MEASURES: The Personality Inventory for Children and the Yale Children's Inventory (completed by the mothers), and child behavior during psychometric testing. RESULTS: Behavior problems was not more common among the SGA children. The results were not confounded by a wide range of parental demographic and child rearing factors, including maternal non-verbal problem solving abilities, child rearing style, and maternal psychological distress. However, the parental factors explained 13% of the variance in a summary score of child behavior compared to 1% explained by SGA vs. AGA status. The SGA children were not more sensitive to the negative impacts of parental risk factors than AGA controls. The study does not address the outcome of severely growth-retarded SGA infants. CONCLUSION: Being born moderately SGA is not a significant risk factor for preschool behavior problems.

Adult↗
PubMed2001

Therapeutic electrical stimulation in cerebral palsy: a randomized, controlled, crossover trial.

The aim of this study was to evaluate the effect of therapeutic electrical stimulation (TES) applied to antagonists of spastic leg muscles on gross motor function in children with spastic diplegic cerebral palsy. Twelve children between 5 and 12 years of age completed a 24-month crossover study in which six were randomly assigned to receive TES for the first 12 months and the remaining six for the last 12 months. Physiotherapy and a home training program were not altered. All were evaluated blindly in terms of tests of motor function and video recordings at the start and at 12 and 24 months. At the end of the study parents/carers gave a subjective assessment of the effect of TES. No significant effect of TES on motor or ambulatory function was found on the blinded evaluation, but parents of 11 of the 12 children stated that TES had a significant effect. We conclude that it is unlikely that TES has a significant effect on motor and ambulatory function in spastic diplegia.

Cerebral Palsy↗
PubMed2001

The association of Apgar score with subsequent death and cerebral palsy: A population-based study in term infants.

OBJECTIVE: To estimate the risk of adverse outcomes for newborns with a low Apgar score. STUDY DESIGN: Population-based cohort study. All 235,165 children born between 1983 and 1987 in Norway with a birth weight of at least 2500 g and no registered birth defects were followed up from birth to age 8 to 12 years by linkage of 3 national registries. Outcomes were death and cerebral palsy (CP). RESULTS: Five-minute Apgar scores of 0 to 3 were recorded for 0.1%, and scores of 4 to 6 were recorded for 0.6% of the children. Compared with children who had 5-minute Apgar scores of 7 to 10, children who had scores of 0 to 3 had a 386-fold increased risk for neonatal death (95% CI: 270-552) and an 81-fold (48-138) increased risk for CP. If Apgar scores at both 1 and 5 minutes were 0 to 3, the risks for neonatal death and CP were increased 642-fold (442-934) and 145-fold (85-248), respectively, compared with scores of 7 to 10. CONCLUSION: The strong association of low Apgar scores with death and CP in this population with a low occurrence of low scores shows that the Apgar score remains important for the early identification of infants at increased risk for serious and fatal conditions.

Apgar Score↗
PubMed2001

Neonatal mortality rates in communities with small maternity units compared with those having larger maternity units.

OBJECTIVE: To compare neonatal mortality in geographical areas where most deliveries occur in large hospitals with areas where a larger proportion of deliveries occur in small maternity units. DESIGN: Population-based study using data from The Norwegian Medical Birth Registry. SETTING: Records on all deliveries in Norway from 1967 to 1996, a total of 1.7 million births, were equipped with data on the size of the maternity units used by delivering women in that particular area. MAIN OUTCOME MEASURE: Risk of neonatal death. RESULTS: Women living in areas where the most frequently used delivery unit had less than 2000 annual deliveries had 1.2 fold the risk of experiencing neonatal death of their newborn (95% CI 1.1-1.3). The relative risk of neonatal death in geographical areas where more than 75% of deliveries occurred in units with more than 3000 annual births was 0.8 (95% CI 0.7-0.9) compared with areas where none delivered in such large units. The relative risk of neonatal death in areas where the most frequently used delivery units had less than 100 annual births was 1.4 (95% CI 1.1-1.7) compared with areas where units of more than 3000 annual births were the most frequently used. Differences in outcome could not be explained by differences in travelling distance to an urban centre where most referral delivery units are located, differences between rural and urban municipalities, or by differences in biological or socio-economic risk factors between municipalities. CONCLUSIONS: We observed a small but significantly decreased neonatal mortality in areas where the great majority of births occurred in large hospitals.

Birth Weight↗
PubMed2001

Randomised controlled trial of infantile colic treated with chiropractic spinal manipulation.

AIMS: To investigate the efficacy of chiropractic spinal manipulation in the management of infantile colic. METHODS: One hundred infants with typical colicky pain were recruited to a randomised, blinded, placebo controlled clinical trial. RESULTS: Nine infants were excluded because inclusion criteria were not met, and five dropped out, leaving 86 who completed the study. There was no significant effect of chiropractic spinal manipulation. Thirty two of 46 infants in the treatment group (69.9%), and 24 of 40 in the control group (60.0%), showed some degree of improvement. CONCLUSION: Chiropractic spinal manipulation is no more effective than placebo in the treatment of infantile colic. This study emphasises the need for placebo controlled and blinded studies when investigating alternative methods to treat unpredictable conditions such as infantile colic.

Colic↗
PubMed2001

Determinants of cobalamin status in newborns.

OBJECTIVE: Cobalamin deficiency accompanied by bone marrow dysfunction and impaired central nervous system development has been reported in infants who were born to mothers with low cobalamin intake. We investigated the relation between cobalamin status in newborns and in their healthy mothers who consumed an omnivorous diet. METHODS: Serum cobalamin and the functional markers plasma methylmalonic acid (MMA) and total homocysteine (tHcy) were determined in 173 newborns and their mothers. Forty-five children and mothers were reinvestigated after 6 weeks. RESULTS: At birth, median (interquartile range) serum cobalamin levels were 245 (175-323) pmol/L in the mothers and 314 (238-468) pmol/L in the newborns. In the neonates, serum cobalamin, but not folate, was inversely associated with MMA and tHcy. Among maternal factors, low serum cobalamin was the strongest predictor of impaired cobalamin function (defined as low cobalamin, high tHcy, or high MMA levels) in the newborns. After 6 weeks, the maternal cobalamin levels had increased (to 421 [271-502] pmol/L), whereas the newborn levels had declined (to 230 [158-287] pmol/L). In the same interval, the infants had a marked increase in plasma MMA (from 0.29 [0.24-0.38] to 0.81 [0.37-1.68] micromol/L). At 6 weeks, parity was a strong predictor of cobalamin status in the infant. CONCLUSION: The cobalamin status in the neonatal period is strongly associated with maternal cobalamin status and parity. A reduction in serum cobalamin and an increase in metabolite levels are consistent with impaired cobalamin function in a significant portion of the infants who were born to healthy, nonvegetarian mothers.

Adult↗
PubMed2000

Early motor development of premature infants with birthweight less than 2000 grams.

UNLABELLED: The aim was to assess motor function during infancy in order to predict later function, mainly cerebral palsy. The neuromotor development of a population-based cohort of 209 of 236 (89%) survivors with a birthweight less than 2000 g was assessed using the Infant Neurological International Battery (INFANIB) and detailed neurological assessment. The infants were classified as being normal, dystonic, hypotonic or having suspected cerebral palsy (CP) at 4, 7, 13 and 18 mo corrected age if birthweight was less than 1500 g (n = 119) and at 7 and 13 mo if birthweight was 1500-1999 g (n = 90). Those with dystonia or suspected CP were followed until diagnosed as normal or as having CP after at least 36 mo of age. Fourteen (7%) finally developed CP. Motor function at 4 mo was inaccurate in predicting function at 7 mo and later. All who were normal at 7 mo remained normal in the follow-up period. Eight of 65 who were dystonic at 7 mo developed suspected CP, and three judged as suspected CP were eventually normal. The 14 who developed CP were judged as suspected CP (n = 5) or dystonic (n = 8) and one as hypotonic at 7 mo of age. CONCLUSIONS: The specificity of motor evaluation at 7 mo corrected age regarding CP is unsatisfactory, since dystonia at this age is most often transient. A normal neuromotor assessment at 7 mo is highly predictive of subsequent normal motor function.

Cerebral Palsy↗
PubMed2000

Cognitive development of term small for gestational age children at five years of age.

AIM: To assess the relative significance for cognitive development of small for gestational age, parental demographic factors, and factors related to the child rearing environment. METHODS: IQ of a population based cohort of 338 term infants who were small for gestational age (SGA) and without major handicap, and a random control sample of 335 appropriate for gestational age (AGA) infants were compared at 5 years of age. RESULTS: The mean non-verbal IQ was four points lower, while the mean verbal IQ was three points lower for the children in the SGA group. The results were not confounded by parental demographic or child rearing factors. However, parental factors, including maternal non-verbal problem solving abilities, and child rearing style, accounted for 20% of the variance in non-verbal IQ, while SGA versus AGA status accounted for only 2%. The comparable numbers for verbal IQ were 30 and 1%. Furthermore, we found no evidence that the cognitive development of SGA children was more sensitive to a non-optimal child rearing environment than that of AGA children. Maternal smoking at conception was associated with a reduction in mean IQ comparable to that found for SGA status, and this effect was the same for SGA and AGA children. The cognitive function of asymmetric SGA was comparable to that of symmetric SGA children. CONCLUSIONS: Our findings indicate that child cognitive development is strongly associated with parental factors, but only marginally associated with intrauterine growth retardation.

Case-Control Studies↗
PubMed2000

Assessing quality of obstetric care for low-risk deliveries; methodological problems in the use of population based mortality data.

BACKGROUND: Studies evaluating safety of different birth settings for low-risk deliveries are often difficult to interpret because of great methodological problems. OBJECTIVE: To assess potential bias in comparisons of mortality between maternity institutions with different size and level of care, particularly when using various definitions of low-risk delivery and when studying stillbirth rates. DESIGN: Population-based study. POPULATION: The population of 1.74 million births in Norway from 1967 to 1996 recorded in The Medical Birth Registry of Norway. METHODS: First we explored the problems of properly identifying low-risk deliveries from population-based data and calculated adjusted perinatal mortality rates in sub-populations by excluding different risk factors. Then we measured the difference in apparent low-risk deliveries between institutions of different size and level of care. Finally we explored bias by using stillbirths and discuss the loss of statistical power by studying only livebirths. RESULTS: The occurrence of a whole spectrum of risk factors differed between small and large institutions, even after adjustment for birthweight. Although the majority of births were from low-risk deliveries, only 1/10th of all perinatal deaths occurred in this group after admission to a maternity unit. There was a systematic difference in the reporting of time of death for stillbirths between types of institutions; the rate of stillbirths occurring during delivery was higher among small institutions, while large institutions were more often uncertain in classifying time of death for stillbirths. CONCLUSIONS: Adjustments for a large number of different risk factors, large sample-sizes and caution in including stillbirth as outcome measure are needed when comparisons of safety between different sizes of delivery units are made for low-risk pregnancies.

Adult↗
PubMed2000

Maternal smoking and birthweight: effect modification of period, maternal age and paternal smoking.

OBJECTIVE: To study the effect on birthweight of maternal smoking, and its modification by study period, maternal age and paternal smoking. DESIGN: A retrospective questionnaire based national survey comprising a random sample (n=34,799) of all mothers giving birth in Norway 1970-91. Variables studied were parental smoking during pregnancy, birthweight, maternal age and infant's year of birth. RESULTS: The overall difference in mean birthweight between non-smoking and smoking mothers was 197 g. The difference in birthweight between non-smoking and smoking mothers increased with maternal age from 182 g (<20 years of age) to 232 g (35+ years of age). There was no significant effect of paternal smoking on birthweight when the mother was a non-smoker. When the mother was a smoker and the father was a non-smoker, the birthweight, adjusted for maternal age, was reduced by 153 g (p<0.005). However, when both parents smoked, the birthweight, adjusted for maternal age, was reduced by 201 g (p<0.0005). Even though the prevalence of paternal smoking decreased by 38% during the study period, there was no significant increase in overall mean birthweight. IMPLICATION AND RELEVANCE OF RESULTS: The negative effect of maternal smoking on birthweight appears to increase with maternal age. For a non-smoking pregnant woman to live with a smoking partner has little, if any, effect on birthweight. The negative effect of paternal smoking was only observed when the mother was smoking and might reflect two possible mechanisms: (1) that a smoking mother has a greater cigarette consumption when the partner also smokes, and (2) that a smoking mother is less concerned about passive smoking than a non-smoking mother.

Adult↗
PubMed1999

Interactions of infectious symptoms and modifiable risk factors in sudden infant death syndrome. The Nordic Epidemiological SIDS study.

The aim of the study was to investigate the effect of infection on sudden infant death syndrome (SIDS) and to analyse whether modifiable risk factors of SIDS, prone sleeping, covered head and smoking act as effect modifiers. In a consecutive multicentre case-control study of SIDS in Denmark, Norway and Sweden, questionnaires on potential risk factors for SIDS were completed by parents of SIDS victims, and for at least two controls matched for gender, age and place of birth. All SIDS cases were verified by an autopsy. The study comprised 244 SIDS cases and 869 controls, analysed by conditional logistic regression. Significantly more cases than controls presenting symptoms of infectious diseases during the last week and/or last day were treated with antibiotics and had been seen by a physician. The finding is consistent with the hypothesis of an infectious mechanism in SIDS induced by local microorganism growth and toxin or cytokine production, and also adds further support to a possible association between infection and SIDS by loss of protective mechanisms, such as arousal. The risk of SIDS among infants with the combined presence of infectious symptoms and either of the other modifiable risk factors, prone sleeping, head covered or parental smoking, was far greater than the sum of each individual factor. These risk factors thus modify the dangerousness of infection in infancy.

Case-Control Studies↗
PubMed1999

Relation between size of delivery unit and neonatal death in low risk deliveries: population based study.

AIM: To examine risk of neonatal death after low risk pregnancies in relation to size of delivery units. METHODS: A population based study of live born singleton infants in Norway with birthweights of at least 2500 g was carried out. Antenatal risk factors were adjusted for. RESULTS: From 1972 to 1995, 1.25 million births fulfilled the criteria. The neonatal death rate was lowest for maternity units with 2001-3000 annual births and steadily increased with decreasing size of the maternity unit to around twice that for units with less than 100 births a year (odds ratio 2.1; 95 % confidence interval 1.6 to 2.8). Institutions with more than 3000 deliveries a year also had a higher rate (odds ratio 1.7; 95% CI 1.4 to 2.0), but analyses suggest that this rate is overestimated. CONCLUSION: Around 2000 to 3000 annual births are needed to reduce the risk of neonatal deaths after low risk deliveries.

Birth Rate↗