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BackgroundEpinephrine treatment is recommended during neonatal resuscitation, if ventilation and chest compressions are ineffective. Endotracheal administration is an option, if the preferred intravenous route is unavailable. We aimed to determine the efficacy of endotracheal epinephrine for achieving return of spontaneous circulation (ROSC), and maintaining physiological stability after ROSC, at standard and higher dose, in severely asphyxiated newborn lambs.MethodsNear-term fetal lambs were instrumented for physiological monitoring, and asphyxiated until asystole. Resuscitation was commenced with ventilation and chest compressions as per ILCOR recommendations. Lambs were randomly allocated to: IV Saline placebo (5 ml/kg, n=6), IV Epinephrine (20 micrograms/kg, n=9), Standard-dose ET Epinephrine (100 micrograms/kg, n=9), and High-dose ET Epinephrine (1 mg/kg, n=9). After three allocated treatment doses, rescue IV Epinephrine was administered if ROSC had not occurred. Lambs achieving ROSC were ventilated and monitored for 60 minutes before euthanasia. Brain histology was assessed for micro-hemorrhage.ResultsROSC in response to allocated treatment (without rescue IV Epinephrine) occurred in 1/6 Saline, 9/9 IV Epinephrine, 0/9 Standard-dose ET Epinephrine, and 7/9 High-dose ET Epinephrine lambs respectively. Three Saline, six Standard-dose ET Epinephrine, and one High-dose ET Epinephrine lambs achieved ROSC after rescue IV Epinephrine. Blood pressure during CPR increased after treatment with IV Epinephrine and High-dose ET Epinephrine, but not Saline or Standard-dose ET Epinephrine.After ROSC, both ET Epinephrine groups had lower pH, higher lactate, and higher blood pressure than the IV Epinephrine group. Cortex micro-hemorrhage was more frequent in the High-dose ET Epinephrine lambs (8/8 lambs examined, versus 3/8 in IV Epinephrine lambs).ConclusionsThe currently recommended dose of ET Epinephrine was ineffective in achieving ROSC. In the absence of convincing clinical or preclinical evidence of efficacy, use of ET Epinephrine at this dose may not be appropriate.High-dose ET Epinephrine requires further evaluation before clinical translation.

Aim: Organisation of care, perinatal and neonatal management of very preterm infants in the Nordic regions were hypothesised to vary significantly. The aim of this observational study was to test this hypothesis.Methods: Information on preterm infants in the 21 greater healthcare regions of Denmark, Finland, Iceland, Norway and Sweden was gathered from national registers in 2021. Preterm birth rates, case-mix, perinatal interventions, neonatal morbidity and survival to hospital discharge in very (Results: Out of 287 642 infants born alive, 16 567 (5.8%) were preterm, 2389 (0.83%) very preterm and 800 (0.28%) were extremely preterm. In very preterm infants, exposure to antenatal corticosteroids varied from 85% to 98%, live births occurring at regional centres from 48% to 100%, surfactant treatment from 28% to 69% and use of mechanical ventilation varied from 13% to 77% (p < 0.05 for all comparisons). Significant regional variations within and between countries were also seen in capacity in neonatal care, case-mix and number of admissions, whereas there were no statistically significant differences in survival or major neonatal morbidities.Conclusion: Management of very preterm infants exhibited significant regional variations in the Nordic countries. Aim: Organisation of care, perinatal and neonatal management of very preterm infants in the Nordic regions were hypothesised to vary significantly. The aim of this observational study was to test this hypothesis. Methods: Information on preterm infants in the 21 greater healthcare regions of Denmark, Finland, Iceland, Norway and Sweden was gathered from national registers in 2021. Preterm birth rates, case-mix, perinatal interventions, neonatal morbidity and survival to hospital discharge in very (

ObjectiveTo evaluate epidemiology and outcomes among very preterm infants (DesignCohort study using a nationwide, population-based registry.Setting21 neonatal units in Norway.ParticipantsAll very preterm infants born 1 January 2009–31 December 2018 and admitted to a neonatal unit.Main outcome measuresIncidences, pathogen distribution, LOS-attributable mortality and associated morbidity at discharge.ResultsAmong 5296 very preterm infants, we identified 582 culture-positive LOS episodes in 493 infants (incidence 9.3%) and 282 culture-negative LOS episodes in 282 infants (incidence 5.3%). Extremely preterm infants (Staphylococcus aureus(15%), group B streptococci (10%) andEscherichia coli(8%). We observed increased odds of severe bronchopulmonary dysplasia (BPD) associated with both culture-positive (adjusted OR (aOR) 1.7; 95% CI 1.3 to 2.2) and culture-negative (aOR 1.6; 95% CI 1.3 to 2.6) LOS. Only culture-positive LOS was associated with increased odds of cystic periventricular leukomalacia (cPVL) (aOR 2.2; 95% CI 1.4 to 3.4) and severe retinopathy of prematurity (ROP) (aOR 1.8; 95% CI 1.2 to 2.8). Culture-positive LOS-attributable mortality was 6.3%, higher in Gram-negative (15.8%) compared with Gram-positive (4.1%) LOS, p=0.009. Among extremely preterm infants, survival rates increased from 75.2% in 2009–2013 to 81.0% in 2014–2018, p=0.005. In the same period culture-positive LOS rates increased from 17.1% to 25.6%, pConclusionsLOS contributes to a significant burden of disease in very preterm infants and is associated with increased odds of severe BPD, cPVL and severe ROP.

ObjectiveTo compare outcome after less invasive surfactant administration (LISA) and primary endotracheal intubation (non-LISA) in infants born before gestational age (GA) 28 weeks.SettingAll neonatal intensive care units (NICUs) in Norway during 2012–2018.MethodsDefined population-based data were prospectively entered into a national registry. We compared LISA infants with all non-LISA infants and with non-LISA infants who received surfactant following intubation. We used propensity score (PS) matching to identify non-LISA infants who were similar regarding potential confounders.Main outcome variablesRate and duration of mechanical ventilation (MV), survival, neurological and gastrointestinal morbidity, and need of supplemental oxygen or positive pressure respiratory support at postmenstrual age (PMA) 36 and 40 weeks.ResultsWe restricted analyses to GA 25–27 weeks (n=843, 26% LISA) because LISA was rarely used at lower GAs. There was no significant association between NICUs regarding proportions treated with LISA and proportions receiving MV. In the PS-matched datasets, fewer LISA infants received MV (61% vs 78%, pConclusionLISA reduced the rate and duration of MV but had no other clear benefits.

ObjectiveThe aim of the study was to investigate first extubation attempts among extremely premature (EP) infants and to explore factors that may increase the quality of clinical judgement of extubation readiness.Design and methodA population-based study was conducted to explore first extubation attempts for EP infants born before a gestational age (GA) of 26 weeks in Norway between 1 January 2013 and 31 December 2018. Eligible infants were identified via the Norwegian Neonatal Network database. The primary outcome was successful extubation, defined as no reintubation within 72 hours after extubation.ResultsAmong 482 eligible infants, 316 first extubation attempts were identified. Overall, 173 (55%) infants were successfully extubated, whereas the first attempt failed in 143 (45%) infants. A total of 261 (83%) infants were extubated from conventional ventilation (CV), and 55 (17%) infants were extubated from high-frequency oscillatory ventilation (HFOV). In extubation from CV, pre-extubation fraction of inspired oxygen (FiO2) ≤0.35, higher Apgar score, higher GA, female sex and higher postnatal age were important predictors of successful extubation. In extubation from HFOV, a pre-extubation FiO2 level ≤0.35 was a relevant predictor of successful extubation.ConclusionsThe correct timing of extubation in EP infants is important. In this national cohort, 55% of the first extubation attempts were successful. Our results suggest that additional emphasis on oxygen requirement, sex and general condition at birth may further increase extubation success when clinicians are about to extubate EP infants for the first time.

BAKGRUNN - Hud- og bløtvevsinfeksjoner er vanlig hos barn. Vi ønsket å undersøke forekomsten av meticillinresistens blant gule stafylokokker i sårsekret fra barn i Norge. MATERIALE OG METODE - Vi gjennomførte en observasjonsstudie basert på data fra Norsk overvåkingssystem for antibiotikaresistens hos mikrober (NORM) for perioden 2013–21. Resistensdata fra sårsekret med vekst av gule stafylokokker fra barn (0–17 år) og voksne ble inkludert i studien. RESULTATER - Totalt ble 1 416 isolat fra sårsekret fra barn og 7 623 isolat fra voksne med vekst av gule stafylokokker inkludert. Meticillinresistente gule stafylokokker (MRSA, meticillinresistente Staphylococcus aureus) ble påvist i 33 (2,3 %) av isolatene fra barn og 95 (1,2 %) av isolatene fra voksne (p = 0,002). Hos barn var det høyest forekomst av MRSA blant barn i barnehagealder (1–5 år, 4,4 %), sammenlignet med spedbarn (< 1 år, 1,0 %) og barn i skolealder (6–17 år, 1,7 %) (p = 0,011). Barnehagebarn hadde høyest forekomst av erytromycinresistens (9,0 %). FORTOLKNING - Forekomsten av meticillinresistens blant gule stafylokokker i sårsekret fra barn i Norge var generelt lav, men noe høyere i sekret fra barnehagebarn sammenlignet med andre aldersgrupper. En trenger normalt ikke ta høyde for meticillinresistens ved empirisk behandling av hud- og bløtvevsinfeksjoner hos barn i Norge. HOVEDFUNN - Forekomsten av meticillinresistens blant gule stafylokokker i sårsekret fra barn i Norge var på 2,3 %. Høyest forekomst av meticillinresistente gule stafylokokker ble påvist i sårsekret fra barnehagebarn (4,4 %).

Background There is scarce information on biopsy-verified kidney disease in childhood and its progression to chronic kidney disease stage 5 (CKD 5). This study aims to review biopsy findings in children, and to investigate risk of kidney replacement therapy (KRT). Methods We conducted a retrospective long-term follow-up study of children included in the Norwegian Kidney Biopsy Registry (NKBR) and in the Norwegian Renal Registry (NRR) from 1988 to 2021. Results In total, 575 children with a median (interquartile range, IQR) age of 10.7 (6.1 to 14.1) years were included, and median follow-up time (IQR) after kidney biopsy was 14.3 (range 8.9 to 21.6) years. The most common biopsy diagnoses were minimal change disease (MCD; n = 92), IgA vasculitis nephritis (IgAVN; n = 76), IgA nephropathy (n = 63), and focal and segmental glomerulosclerosis (FSGS; n = 47). In total, 118 (20.5%) of the biopsied children reached CKD 5, median (IQR) time to KRT 2.3 years (7 months to 8.4 years). Most frequently, nephronophthisis (NPHP; n = 16), FSGS (n = 30), IgA nephropathy (n = 9), and membranoproliferative glomerulonephritis (MPGN; n = 9) led to KRT. Conclusions The risk of KRT after a kidney biopsy diagnosis is highly dependent on the diagnosis. None of the children with MCD commenced KRT, while 63.8% with FSGS and 100% with NPHP reached KRT. Combining data from kidney biopsy registries with registries on KRT allows for detailed information concerning the risk for later CKD 5 after biopsy-verified kidney disease in childhood. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information

På verdensbasis fødes det hvert år omkring 600 000 barn før uke 28, definert som ekstremt premature barn (EPB) (2). EPB har en høy dødelighet og sykelighet, og har et betydelig behandlingsbehov. Som følge av teknologiske fremskritt og økt kunnskap kan nå EPB født i uke 22 overleve, men dessverre kan de overlevende affiseres av flere ulike komplikasjoner som kan gi varige handikapp. Det gjør at ikke alle barn tilbys intensivbehandling, men at noen får palliasjon som vil føre til død. Disse behandlingsvalgene er etisk utfordrende, derfor finnes det ulike tilnærminger til behandling av EPB i høyinntektsland (6).Formålet med oppgaven var å belyse etiske problemstillinger og klinisk praksis i utvalgte europeiske land gjeldende behandling av EPB. En nettbasert spørreundersøkelse med 16 nyfødtmedisinere fra ulike europeiske land ble gjennomført. Deretter ble etiske problemstillinger ved praksisen identifisert med utgangspunkt i de fire medisinsk-etiske grunnprinsippene: å respektere selvbestemmelse (autonomi), å ikke skade, å gjøre godt og å være rettferdig. I spørreundersøkelsen varierte nedre anbefalte grense for resuscitering mellom uke 22-24. Gestasjonsalder, foreldrenes ønsker, risiko for alvorlige handikapp og fremtidig livskvalitet var de fire viktigste faktorene ved vurdering av behandlingsvalg. Spørreundersøkelsen viste også at foreldre er involvert i behandlingsavgjørelser, men at leger har hovedansvaret. Flere etiske problemstillinger ble identifisert. Blant annet gjeldende ønskeligheten og muligheten for foreldrenes selvbestemmelse, vanskeligheter med å gjennomføre smertefulle prosedyrer på EPB som ikke kan samtykke, utfordringer med å vite hva som er til barnets beste og spørsmål om urettferdig forskjellsbehandling både innad i gruppen EPB og av gruppen EPB som helhet i forhold til andre pasientgrupper. Løsningen på de etiske problemstillingene avhenger blant annet av hvilke verdier og etiske prinsipper som skal vektes sterkest. Av den grunn kan det være nyttig at retningslinjer og klinikere tydeliggjør hvilke verdier og prinsipper anbefalinger bygger på.