Glucose is the most important fetal nutrient and the production of this substrate increases in the pregnant woman. In the last trimester the increased insulin resistance directs energy substrates to the fetus. Fetal growth is sometimes disturbed, often without an obvious explanation. After birth the newborn infant must produce its own glucose, primarily for the brain. Fatty acids from lipolysis are also important energy substrates. Hypoglycaemia can be a problem, occurring frequently in preterm infants and infants born small for gestational age (SGA). In addition, SGA infants are at risk of developing the metabolic syndrome in adulthood. Neonatal medication can influence energy metabolism. One such medication is theophylline, administered in preterm infants to prevent apnoea. We investigated energy substrate production in women with normal and IUGR pregnancies, in preterm neonates, before and after theophylline treatment and in newborn SGA infants, using stable isotope-labelled compounds and gas chromatography-mass spectrometry. We found that late pregnancy was associated with an almost twofold increase in the rate of lipolysis. This provides substrates for maternal energy metabolism, which may spare glucose for the fetus. Even though glucose production was comparable in the two groups of pregnant women, those with IUGR had a lower rate of lipolysis. A reduced supply of energy substrates could be one factor underlying IUGR. In spite of the insulin resistance of late pregnancy, insulin still had a regulatory role in energy substrate production in the women with normal pregnancies, but not in those with IUGR. Although infants born preterm and/or SGA have limited energy stores, we demonstrated that they are capable of both lipolysis and glucose production. Theophylline had no adverse effects on energy substrate production. Data on insulin and IGFBP-1 in the SGA infants indicate that in such infants insulin sensitivity is increased peripherally but reduced in the liver.

<b>Background. </b>Newborn infants, especially preterm infants, have an increased susceptibility to serious and overwhelming bacterial as well as fungal infections. Symptoms of septicaemia in especially the very preterm neonates are vague and unspecific. No really good biochemical parameter exists today that can confirm or exclude the existence of neonatal septicaemia. The access to such a test in neonates would be most valuable, not only to assure early institution of effective antibiotic therapy when needed, but also to avoid unnecessary use of antibiotics, thereby reducing the risk of further development of antimicrobial resistance. <b>Aim. </b>To investigate the possible use of the expression of the phagocyte receptor CD64 (FcγRI) on neutrophils for early diagnosis of bacterial infections with special reference to neonatal septicaemia. <b>Results. </b>Neutrophils from preterm and term newborn infants, older infants, children, and adults examined during the early phase of a bacterial infection showed a significantly higher expression of CD64 compared with non-infected controls (p&lt;0.001). Neutrophils from even extremely preterm infants expressed CD64 to the same extent as did neutrophils from children and adult patients. The expression of CD64 was not affected by the respiratory distress syndrome (RDS) or by such factors as premature rupture of the membranes, gestational age, steroid treatment before delivery, method of delivery, birth weight or postnatal age. Major surgery in adults (total hip replacement) did not affect the CD64 expression to an extent comparable to that found during bacterial infections. Indirectly CD64 was found to be at least equal to CRP for differentiation between Influenza A infection and bacterial infections in adults. <b>Conclusion.</b> CD64 was found to be a specific and reliable marker for early detection of bacterial infections in preterm and term newborn infants, as well as after surgery. For differentiation between bacterial and viral infections it is probably at least as effective as CRP.

In a Manila hospital, 204 mothers were randomized into three groups: two intervention groups receiving home-based counseling visits, one of them (n=68) by counselors trained to use a locally developed, two-tiered program of breastfeeding counseling, and the other by counselors trained in general childcare (n=67), were compared with a control group of mothers (n=69) who did not receive any counseling. All infants were scheduled for seven visits to the hospital for follow-up. During hospital visits, maternal and infant body measurements were made and an independent interviewer asked the mothers individually to recall how the infant had been fed. One study physician, blind to participant groups, was consulted at all scheduled and unscheduled infant visits. At six months, 44% of the breastfeeding-counseled mothers, 7% of the childcare-counseled mothers and none of the mothers in the control group were exclusively breastfeeding. Twenty- four mothers breastfed exclusively during the first six months, of whom 22 received breastfeeding counseling and 2 had no breastfeeding counseling. Among 24 infants who were exclusively breastfed from birth to six months there were no episodes of diarrhea. All infants had gained in weight, length and head circumference. Mean maternal weight loss at six months was similar whether her breastfeeding was exclusive or partial. The reasons why mothers without breastfeeding counseling introduced non-breast milk feeding before six months reflected lack of knowledge and support. Breastfeeding support during the first six months focusing on how to prevent and solve breastfeeding problems, particularly during the first two weeks, will enable mothers to choose to breastfeed exclusively up to six months. This study has provided fundamental evidence of successful intervention by breastfeeding counseling to achieve six months of exclusive breastfeeding among term, low-birthweight infants. The locally developed training program in breastfeeding counseling, which successfully prepared volunteers to counsel mothers at home, could be incorporated into primary health care in the Philippines. Mothers who received breastfeeding counseling appreciated how this helped them to achieve their breastfeeding goals for the first six months. Improved breastfeeding practices as a result of breastfeeding counseling provided infants with protection from diarrhea and respiratory infections, contributing to their health and development.

The overall aim of this thesis was to expand the knowledge and understanding of the processes of breastfeeding and becoming a mother in mothers of preterm infants. For this purpose, in-depth interviews were conducted with 25 mothers, whose very preterm infants had received care in seven neonatal units (NU) in Sweden, 1-12 months after discharge (I-II). In addition, prospective population-based register studies were performed of infants born 1993-2001; among 35 250 term and 2093 preterm infants (III), and a subpopulation of 225 very preterm infants (IV). Data were obtained from the Child Health Service registry of breastfeeding in Uppsala and Örebro, the Medical Birth Registry, and Statistics Sweden. The experiences of mother-infant separation, institutional authority, emotional exhaustion and disregard of breastfeeding as a relational interplay, comprised major hindrances to mothers’ experiences of breastfeeding as reciprocal and of a secure mother-infant relation, during and after the discharge from an NU (I-II). All studied socioeconomic factors, i.e. lower educational level, receiving unemployment benefit or social welfare or having a low equivalent disposable income, were individually adversely associated with breastfeeding up to six months of infants’ postnatal age, but were not found more decisive for weaning in mothers of preterm infants compared to those of term infants (III). Preterm infants were breastfed for a shorter time than term infants (III), but a long breastfeeding duration was evident. In addition, gestational age and neonatal disorders were not associated with breastfeeding duration in very preterm infants (IV). In conclusion, this thesis shows that improvements in the NU environment and the caring paradigm are called for. Furthermore, as socioeconomic status clearly has an impact on breastfeeding duration, increased equity in health care in accordance with the individuals’ needs must be sought, where resources are allocated to ensure fulfilment of needs in more vulnerable mothers and infants.

Syfte: Att studera föräldrars uppfattning om den preoperativa information de får inför sitt barns planerade operation, samt undersöka om och på vilket sätt föräldrarna anser att informationen behöver förbättras. Metod: Kvantitativ, deskreptiv enkätstudie. Enkäten innehöll främst standardiserade frågor men även några öppna frågor. Föräldrar till barn i åldrarna 0-3 år inneliggande på en barnkirurgisk vårdavdelning ombads delta i studien. Antalet insamlade enkäter var 22 stycken. Resultat: Föräldrarna var som helhet nöjda med den preoperativa informationen, majoriteten ansåg att mängden information varit lagom omfattande och att informationen från personalen oftast gavs på ett sätt så att de förstod. Några föräldrar ansåg att informationen gällande det postoperativa vårdförloppet delvis varit bristfällig. De flesta ansåg att informationen de fått stämde med vårdförloppet som följde. Dock framkom att föräldrarna önskat få mer förberedande information, såväl praktisk som medicinsk tillsammans med kallelsen. Slutsats: Resultatet visar att de flesta föräldrar som helhet var nöjda med informationen de fått inför sitt barns operation med visst undantag för innehållet i kallelsen och den properativa informationen gällande det postoperativa förloppet. / Aim: To study the parent’s perception of the preoperative information they receive for their child's scheduled surgery, and examine whether and how parents believe that the information needs to be improved. Method: Quantitative Descriptive survey study. The questionnaire contained mainly standardized questions and some open questions. Parents of children aged 0-3 years hospitalized at a children's surgical ward were asked to participate in the study. The number of collected questionnaires was 22 pieces. Results: Parents were overall satisfied with the preoperative information, the majority felt that the amount of information was extensive enough and that the information from the staff is usually given in a way that they understood. Some parents felt that the information regarding the postoperative care process had partly been inadequate. Most parents felt that the information they received matched the care process that followed. However, it was found that parents wanted more preparatory information, both practical and medical, with the invitation. Conclusion: The results show that most parents as a whole were satisfied with the information they received before their child's surgery with certain exceptions for the content of the notice and the properativa information regarding the postoperative course.

Det finns inga exakta siffror i Sverige på hur många barn som erhåller akut avancerad vård, men sjukhusvistelserna för barn omfattar en hög del akut, ofta kritisk vård. Det finns heller inga klart uttryckta riktlinjer för föräldrars närvaro i samband med akut avancerad vård av deras barn på sjukhusen i Sverige. Syftet med studien var att öka kunskapen om föräldrars upplevelser av att vara närvarande vid akut avancerad vård av deras barn som vårdas på sjukhus, med målet att få systematisk kunskap om huruvida närvaro bör uppmuntras. En litteraturstudie genomfördes och fem vetenskapliga artiklar och en uppsats på nivån 61-80 poäng granskades. Föräldrar mellan 20-44 år ingick i studien och barnen som genomgått akut avancerad vård var mellan 0-18 år. Resultatet visar att föräldrarna upplever att närvaron till största del är positiv. De upplever att deras närvaro lindrar både deras eget och barnets lidande. Det förekommer dock upplevelser som leder till ett ökat lidande, som t.ex. brister i vården. Resultatet beskriver också att föräldrarna har en moralisk plikt att närvara, att det är deras rättighet och skyldighet som förälder. Som allmänsjuksköterska är det vanligt att stöta på situationer där föräldrarna vill närvara vid deras barns akuta avancerade vård. Det är då viktigt att kunna stödja både patienten och föräldrarna och denna studie bidrar med kunskap om vad föräldrarna upplever som viktiga faktorer för att detta ska kunna ske.

På pediatriska akutvårdsavdelningar vårdas barn mellan 0-18 år med skilda behov. Dödsfall är ovanliga men när de sker ställs vårdare inför utmaningar. Det döende barnets specifika behov tillgodoses oftast av både de naturliga och de professionella vårdarna där vårdandet blir en balansgång mellan att lindra och att bota. Syftet med denna deskriptiva, induktiva studie var att beskriva professionella vårdares upplevelse och erfarenhet av att vårda döende barn på en pediatrisk akutvårdsavdelning. Metoden var kvalitativ, där djupintervjuer analyserades med vägledning av Giorgis beskrivning av det fenomenologiska förhållningssättet. I resultatet visar sig fenomenet att vårda vara avhängigt förtroendefulla och ärliga relationer där närvaron präglas av medkänsla, lyhördhet, mod och respekt. Vårdares självkännedom är avgörande för vårdandet och inverkar på närvaron. Barnets döende beskrivs som orättvist och svårt att tala om. När närvaron i vårdandet upplevs hotad och när vårdare känner sig otillräckliga eller ibland även tvingas avstå, enligt dem, väsentliga vårdhandlingar, uppstår ett vårdarlidande. Vårdares behov av stöd från kollegor och föräldrar klargörs, där detta stöd upplevs stärka vårdandet samt ge de professionella vårdarna personlig och yrkesmässig växt. I framtida forskning behöver innebörden i begreppet närvaro ytterligare utredas samt de nära anhörigas upplevelser och erfarenheter av barnets sista levnadstid på en pediatrisk akutvårdsavdelning.

<p>På pediatriska akutvårdsavdelningar vårdas barn mellan 0-18 år med skilda behov. Dödsfall är ovanliga men när de sker ställs vårdare inför utmaningar. Det döende barnets specifika behov tillgodoses oftast av både de naturliga och de professionella vårdarna där vårdandet blir en balansgång mellan att lindra och att bota. Syftet med denna deskriptiva, induktiva studie var att beskriva professionella vårdares upplevelse och erfarenhet av att vårda döende barn på en pediatrisk akutvårdsavdelning. Metoden var kvalitativ, där djupintervjuer analyserades med vägledning av Giorgis beskrivning av det fenomenologiska förhållningssättet. I resultatet visar sig fenomenet att vårda vara avhängigt förtroendefulla och ärliga relationer där närvaron präglas av medkänsla, lyhördhet, mod och respekt. Vårdares självkännedom är avgörande för vårdandet och inverkar på närvaron. Barnets döende beskrivs som orättvist och svårt att tala om. När närvaron i vårdandet upplevs hotad och när vårdare känner sig otillräckliga eller ibland även tvingas avstå, enligt dem, väsentliga vårdhandlingar, uppstår ett vårdarlidande. Vårdares behov av stöd från kollegor och föräldrar klargörs, där detta stöd upplevs stärka vårdandet samt ge de professionella vårdarna personlig och yrkesmässig växt. I framtida forskning behöver innebörden i begreppet närvaro ytterligare utredas samt de nära anhörigas upplevelser och erfarenheter av barnets sista levnadstid på en pediatrisk akutvårdsavdelning.</p>

The objectives of this thesis were 1) to describe the occurrence and co-occurrence of recurrent pain (headache, stomach-ache, and backache) in young school children; 2) to describe Health Related Quality of Life (HRQoL) in these children, from the perspective of the child, 3) to examine the psychometric properties of the PedsQL, a pediatric HRQoL instrument. Three data collections were performed, two in Umeå, Sweden, and one in a nearby smaller municipality, Lycksele. In Umeå, the first survey included schoolchildren from grades 0-6 and three years later all schoolchildren attending grade three and six were approached. In Lycksele all school children attending grades three through six and grade nine were invited to participate. Pain and quality of life were measured by questionnaires. The main findings of the thesis were that 2/3 of the children experienced pain from the head, stomach or back recurrently (at least monthly) and 1/3 experienced weekly pain. Weekly headache was reported by 23% of the children, 19 % reported weekly stomach-ache and 7% weekly backache. Half of the children with recurrent pain conditions reported pain from several body sites, and, in children with weekly pain, 2/3 reported multi-site pain. HRQoL in children with recurrent pain problems was markedly impaired, especially in children with multi-site pain and in children with weekly pain. Finally, The Swedish PedsQL self-report forms showed acceptable psychometric properties. In conclusion, in young schoolchildren, headache, stomach-ache and backache are common conditions associated with a clearly reduced HRQoL. The results show an urgent need for early preventive and curative programs targeting HRQoL domains such as physical, emotional, social and school areas. The results also indicate that recurrent pain should be regarded a potential general pain disorder rather than merely a local disorder. The PedsQL was found to be a reliable and valid measure of HRQoL in young Swedish school-aged children.

Diss. (sammanfattning) Stockholm : Karol. inst., 2002. / Härtill 7 uppsatser.