Henriette Astrup

• Ohnstad, Mari Oma; Stensvold, Hans Jørgen; Pripp, Are Hugo; Tvedt, Christine Raaen; Jelsness-Jørgensen, Lars-Petter & Astrup, Henriette [Show all 15 contributors for this article] (2023). Associations between unit workloads and outcomes of first extubation attempts in extremely premature infants below a gestational age of 26 weeks. Frontiers in pediatrics. ISSN 2296-2360. 11, p. 1–9. doi: 10.3389/fped.2023.1090701. Full text in Research Archive Show summary

  Objective: The objective was to explore whether high workloads in neonatal intensive care units were associated with short-term respiratory outcomes of extremely premature (EP) infants born <26 weeks of gestational age. Methods: This was a population-based study using data from the Norwegian Neonatal Network supplemented by data extracted from the medical records of EP infants <26 weeks GA born from 2013 to 2018. To describe the unit workloads, measurements of daily patient volume and unit acuity at each NICU were used. The effect of weekend and summer holiday was also explored. Results: We analyzed 316 first planned extubation attempts. There were no associations between unit workloads and the duration of mechanical ventilation until each infant’s first extubation or the outcomes of these attempts. Additionally, there were no weekend or summer holiday effects on the outcomes explored. Workloads did not affect the causes of reintubation for infants who failed their first extubation attempt. Conclusion: Our finding that there was no association between the organizational factors explored and short-term respiratory outcomes can be interpreted as indicating resilience in Norwegian neonatal intensive care units.

• Ohnstad, Mari Oma; Stensvold, Hans Jørgen; Pripp, Are Hugo; Tvedt, Christine Raaen; Jelsness-Jørgensen, Lars-Petter & Astrup, Henriette [Show all 15 contributors for this article] (2022). Predictors of extubation success: a population-based study of neonates below a gestational age of 26 weeks. BMJ Paediatrics Open. ISSN 2399-9772. 6(1), p. 1–7. doi: 10.1136/bmjpo-2022-001542. Full text in Research Archive Show summary

  The 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 method A 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. Results Among 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. Conclusions The 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.

• Ljungblad, Ulf Wike; Astrup, Henriette; Mørkrid, Lars; Hager, Helle Borgstrøm; Lindberg, Morten & Eklund, Erik A. [Show all 9 contributors for this article] (2022). Breastfed Infants With Spells, Tremor, or Irritability: Rule Out Vitamin B12 Deficiency. Pediatric Neurology. ISSN 0887-8994. 131, p. 4–12. doi: 10.1016/j.pediatrneurol.2022.03.003. Full text in Research Archive Show summary

  Background In Norway, 5-10% of neonates and infants have biomarkers suggesting vitamin B12 deficiency from newborn screening tests and unselected clinical screening, respectively. Aims The aims were to identify risk factors and describe presenting symptoms and biochemical profiles in infants diagnosed with vitamin B12 deficiency. Methods In this case-control study, we searched hospital medical records for infants younger than one year born in 2011-2018, diagnosed with vitamin B12 deficiency. We compared 85 cases with a control group of 252 infants aged 3-7 months. Parents completed questionnaires. Results Of the 85 cases with vitamin B12 deficiency, 80% presented with spells (37%) of apneas, motor seizures, or absences within the first two months of life. Tremor (29%) and irritability (18%) were the most common findings at the first examination. Serum total homocysteine ≥10 μmol/L was found in 77% of cases compared to 28% of controls (P < 0.001). None of the mothers were vegetarians, but 25% reported a previous history of vitamin B12 deficiency and 7% had celiac disease. The dose of nitrous oxide given during labor was significantly associated with infant serum total homocysteine level at diagnosis (r = 0.37, 95% confidence interval = 0.16-0.55, P < 0.001) for cases, but not for controls. Conclusion Spells, tremor, and irritability are common findings in early infant vitamin B12 deficiency. Nitrous oxide given during labor is proposed as a contributing risk factor to the development of early infant vitamin B12 deficiency.

• Ljungblad, Ulf Wike; Paulsen, Henriette; Mørkrid, Lars; Pettersen, Rolf Dagfinn; Hager, Helle Borgstrøm & Lindberg, Morten [Show all 11 contributors for this article] (2021). The prevalence and clinical relevance of hyperhomocysteinemia suggesting vitamin B12 deficiency in presumed healthy infants. European journal of paediatric neurology. ISSN 1090-3798. 35, p. 137–146. doi: 10.1016/j.ejpn.2021.10.008. Full text in Research Archive Show summary

  Background: Previous studies have demonstrated a high prevalence of biochemical vitamin B12 deficiency in infants in Norway. Increased total homocysteine (tHcy) is the most important marker of B12 deficiency in infants. There is a need to evaluate its clinical relevance. Aims: To investigate the prevalence of hyperhomocysteinemia (S-tHcy > 8 μmol/L) suggestive of suboptimal B12 status and the prevalence of clinically relevant hyperhomocysteinemia in presumed healthy infants in Norway. Further, to evaluate risk factors, presence of symptoms and psychomotor development in these children. Methods: In a prospective study we clinically examined 252 infants aged 3-7 months using standardized neurological and psychomotor tests prior to analyzing biochemical B12 deficiency markers in 250 infants. Results: Twenty-five of 250 (10%) infants had hyperhomocysteinemia combined with clinically relevant symptoms suggestive of B12 deficiency. Hyperhomocysteinemia was associated with tremor, excessive sleep, and sub-normal scores in the fine motor section of the Ages and Stages Questionnaire. One-hundred and fourteen of 250 (46%) infants had hyperhomocysteinemia. Multiple regression analysis showed months of infant formula use as the strongest negative predictor for hyperhomocysteinemia. Conclusion: We have demonstrated associations between symptoms suggestive of infant B12 deficiency and increased levels of tHcy in presumed healthy infants The combination of hyperhomocysteinemia and associated relevant symptoms suggestive of B12 deficiency was a common finding, albeit most infants with hyperhomocysteinemia did not show symptoms.

• Wendel, Kristina; Pfeiffer, Helle Cecilie; Fugelseth, Drude; Nestaas, Eirik; Domellöf, Magnus & Skålhegg, Bjørn Steen [Show all 42 contributors for this article] (2021). Effects of nutrition therapy on growth, inflammation and metabolism in immature infants: a study protocol of a double-blind randomized controlled trial (ImNuT). BMC Pediatrics. ISSN 1471-2431. 21. doi: 10.1186/s12887-020-02425-x. Full text in Research Archive Show summary

  Background: Current nutritional management of infants born very preterm results in significant deficiency of the essential fatty acids (FAs) arachidonic acid (ARA) and docosahexaenoic acid (DHA). The impact of this deficit on brain maturation and inflammation mediated neonatal morbidities are unknown. The aim of this study is to determine whether early supply of ARA and DHA improves brain maturation and neonatal outcomes in infants born before 29 weeks of gestation. Methods: Infants born at Oslo University Hospital are eligible to participate in this double-blind randomized controlled trial. Study participants are randomized to receive an enteral FA supplement of either 0.4 ml/kg MCT-oil™ (medium chain triglycerides) or 0.4 ml/kg Formulaid™ (100 mg/kg of ARA and 50 mg/kg of DHA). The FA supplement is given from the second day of life to 36 weeks' postmenstrual age (PMA). The primary outcome is brain maturation assessed by Magnetic Resonance Imaging (MRI) at term equivalent age. Secondary outcomes include quality of growth, incidence of neonatal morbidities, cardiovascular health and neuro-development. Target sample size is 120 infants (60 per group), this will provide 80% power to detect a 0.04 difference in mean diffusivity (MD, mm2/sec) in major white matter tracts on MRI. Discussion: Supplementation of ARA and DHA has the potential to improve brain maturation and reduce inflammation related diseases. This study is expected to provide valuable information for future nutritional guidelines for preterm infants. Trial registration: Clinicaltrials.gov ID: NCT03555019 . Registered 4 October 2018- Retrospectively registered.

• Stensvold, Hans Jørgen; Klingenberg, Claus; Støen, Ragnhild; Moster, Dag; Brække, Kristin & Guthe, Hans Jørgen Timm [Show all 10 contributors for this article] (2017). Neonatal morbidity and 1-year survival of extremely preterm infants. Pediatrics. ISSN 0031-4005. 139(3). doi: 10.1542/peds.2016-1821.
• Burns, Margrete Larsen; Stensvold, Hans Jørgen; Risnes, Kari Ravndal; Guthe, Hans Jørgen Timm; Astrup, Henriette & Nordhov, Solveig Marianne [Show all 9 contributors for this article] (2016). Inotropic Therapy in Newborns, A Population-Based National Registry Study. Pediatric Critical Care Medicine. ISSN 1529-7535. 17(10), p. 948–956. doi: 10.1097/PCC.0000000000000898.

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• Ohnstad, Mari Oma; Stensvold, Hans Jørgen; Pripp, Are Hugo; Tvedt, Christine Raaen; Jelsness-Jørgensen, Lars-Petter & Astrup, Henriette [Show all 15 contributors for this article] (2022). Extubating extremely premature newborns: predictors of success and reasons for failure.
• Hennig, Camilla Bæck; Harket, Marte Smiseth; Astrup, Henriette; Kvammen, Janne Anita; Løkling, Hanne Lund & Ledang, Johanne Kjellevik [Show all 7 contributors for this article] (2019). Vegansk kosthold kan være skadelig for gravide og små barn/ Fem ernæringsfysiologer og to barneleger. Aftenposten (morgenutg. : trykt utg.). ISSN 0804-3116.
• Tangeraas, Trine; Tveten, Kristian; Astrup, Henriette; Rootwelt, Terje; Backe, Paul Hoff & Woldseth, Berit (2016). Cytosolic phosphoenoylpyruvate carboxykinase deficiency (cPEPCK) presenting with gastrointestinal hemorrhage.

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