Kari Risnes

Background: Preterm-born children are vulnerable to respiratory tract infections (RTIs), but we know little about how these were affected by COVID-19 pandemic control measures. Methods: We studied Norwegian population-wide registry data on 1–5-year olds born 2012–2021. RTI hospitalisations were identified from primary hospitalisation diagnosis codes. We modelled prepandemic hospitalisation rates, January 2017 to March 2020, using quasi-Poisson regression with harmonic seasonal terms. These were compared with monthly hospitalisation rates, March 2020 to December 2022. The calculations were performed separately for gestational age groups: 23–33, 34–36, 37–41 completed weeks. Results: We identified 9734 RTI hospitalisations among 449 105 children aged 1–5 years, with higher rates in the most preterm groups. Across gestational ages, we observed lower hospitalisation rates during control measures in 2020, followed by a surge after measures were lifted in 2021. For children born in weeks 23–33, the rate reduction with 95% CI during the first year of the pandemic compared with the prepandemic years was −21 per 1000 person-years (95% CI −30 to −13), whereas in April–December 2022, there was an increase of 22 (95% CI 12 to 31). For term born (week 37–41), the corresponding changes were −4.9 (95% CI −5.5 to −4.3) and 3.6 (95% CI 2.9 to 4.2). Conclusions: Compared with term born, preterm-born children of all gestational age groups were more distinctly protected by pandemic control measures. They were also more affected by the resurgence of infections when measures were lifted. These findings call for policies to protect preterm-born children better from RTIs, especially when viral spread is high.

Aims: The Norwegian national recommendations for the evaluation and treatment of bronchiolitis were updated in 2018. Two Choosing Wisely recommendations were launched to reduce unwarranted chest X‐ray, repeated blood tests and routine inhalations. The aim of this study was to evaluate adherence to the recommendations, temporal changes and differences between hospitals. Methods: In this multicentre retrospective study, we compared routine data from 1186 infants < 12 months of age hospitalised for bronchiolitis at five Norwegian hospitals during the winter seasons 2017–2018, 2018–2019 and 2021–2022. Results: Overall, 29% of the included infants had a chest x‐ray taken with non‐significant change over seasons. A decreasing proportion had more than one blood test taken over the years (60.4%, 56.6%, 43.5%; p < 0.001). The use of antibiotics (overall 4.5%), systemic steroids (2.7%) and inhalations with beta‐2 agonists or adrenaline (15.4%) was generally low. The use of adrenaline decreased over the three seasons (18.1%, 10.5%, 5.2%; p < 0.001). There was a large variation in diagnostic and treatment procedures between hospitals. Conclusion: Some diagnostic procedures and treatments for bronchiolitis were reduced in accordance with guidelines, but substantial variation remained between hospitals. There is a potential to further reduce the overuse of chest X‐rays and repeated blood testing.

Objective: To assess relative age effects (how the youngest children in a school class are at increased risk compared with their older classmates) on healthcare use with psychiatric diagnoses in childhood and adolescence within preterm and term-born boys and girls. Design/setting/patients: Registry-based cohort study including individuals born in Norway from 1991 to 2012 with follow-up data from the National Patient Registry from 2008 to 2017 when they were aged between 4 and 18 years. Exposures: Relative age was defined according to birth month and grouped in four 3-month periods. Gestational age at birth (GA week+days) was categorised into preterm (GA 23+0–36+6) and term (GA 37+0–41+6). Main outcome measures: The presence of psychiatric diagnoses (any diagnosis and specific diagnosis groups according to ICD-10) in data from specialist healthcare contacts at different ages during follow-up was compared between relative age groups in preterm and term born using generalised estimating equation logistic regression analyses. Results: Of 1 109 411 individuals, 7% were born preterm. Relative age effects for psychiatric diagnosis and specific diagnosis groups were seen for both preterm and term-born boys and girls, with the strongest estimates for any psychiatric diagnosis in the relatively younger preterm girls born in October–December, compared with the relatively older preterm girls born in January–March (OR 1.43 (95% CI 1.25 to 1.63) at ages 4–10 years). Conclusions: Relative age effects were widely demonstrated for healthcare use with psychiatric diagnoses within term and preterm born, for both girls and boys. The excess risk for those born late in the year added to already existing adversity in children born preterm, emphasising the need for additional consideration related to school and societal structures.

Background: Hospital regionalization involves balancing hospital volume and travel time. We investigated how hospital volume and travel time affect perinatal mortality and the risk of delivery in transit using three different study designs. Methods: This nationwide cohort study used data from the Medical Birth Registry of Norway (1999-2016) and Statistics Norway. We compared estimates across three designs: (1) Observed confounder adjustment: Comparing women giving birth at hospitals of different sizes and travel times (1,066,332 births), (2) Sibling comparison: Comparing women who moved between hospital catchment areas between births (203,464 births), (3) Neighbor comparison: comparing women living in neighboring municipalities, but in different hospital catchment areas (460,776 births). Results: The study population included 5080 (0.48%) perinatal deaths and 7063 deliveries in transit (0.66%). For hospitals with 2000 compared with 500 births/year, observed confounder adjustment showed 1.81 times higher perinatal mortality (95% confidence interval [CI] 1.21-2.73). However, sibling and neighbor comparisons showed a factor 0.64 (95% CI 0.43-0.97) and 0.61% (95% CI 0.43-0.88) lower perinatal mortality, respectively. Increased travel time was strongly associated with higher perinatal mortality using observed confounder adjustment, but this was not supported by the other designs. Longer travel time was consistently linked to an increased risk of delivery in transit. Conclusions: Perinatal mortality was higher in high-volume hospitals when adjusting for observed confounders. However, triangulating inferences from the other designs suggested the opposite, estimating that observed confounder control was insufficient. This supports the idea that access to higher-volume hospitals could improve perinatal outcomes at the population level.

Aims/hypothesis: Children and adults born preterm have an increased risk of type 1 diabetes. However, there is limited information on risk patterns across the full range of gestational ages, especially after extremely preterm birth (23–27 weeks of gestation). We investigated the risk of type 1 diabetes in childhood and young adulthood across the full range of length of gestation at birth. Methods: Data were obtained from national registers in Finland, Norway and Sweden. In each country, information on study participants and gestational age was collected from the Medical Birth Registers, information on type 1 diabetes diagnoses was collected from the National Patient Registers, and information on education, emigration and death was collected from the respective national register sources. Individual-level data were linked using unique personal identity codes. The study population included all individuals born alive between 1987 and 2016 to mothers whose country of birth was the respective Nordic country. Individuals were followed until diagnosis of type 1 diabetes, death, emigration or end of follow-up (31 December 2016 in Finland, 31 December 2017 in Norway and Sweden). Gestational age was categorised as extremely preterm (23–27 completed weeks), very preterm (28–31 weeks), moderately preterm (32–33 weeks), late preterm (34–36 weeks), early term (37–38 weeks), full term (39–41 weeks; reference) and post term (42–45 weeks). HRs and 95% CIs from country-specific covariate-adjusted Cox regression models were combined in a meta-analysis using a common-effect inverse-variance model. Results: Among 5,501,276 individuals, 0.2% were born extremely preterm, 0.5% very preterm, 0.7% moderately preterm, 4.2% late preterm, 17.7% early term, 69.9% full term, and 6.7% post term. A type 1 diabetes diagnosis was recorded in 12,326 (0.8%), 6364 (0.5%) and 16,856 (0.7%) individuals at a median age of 8.2, 13.0 and 10.5 years in Finland, Norway and Sweden, respectively. Individuals born late preterm or early term had an increased risk of type 1 diabetes compared with their full-term-born peers (pooled, multiple confounder-adjusted HR 1.12, 95% CI 1.07, 1.18; and 1.15, 95% CI 1.11, 1.18, respectively). However, those born extremely preterm or very preterm had a decreased risk of type 1 diabetes (adjusted HR 0.63, 95% CI 0.45, 0.88; and 0.78, 95% CI 0.67, 0.92, respectively). These associations were similar across all three countries. Conclusions/interpretation: Individuals born late preterm and early term have an increased risk of type 1 diabetes while individuals born extremely preterm or very preterm have a decreased risk of type 1 diabetes compared with those born full term. Graphical

Background: Preterm birth affects lungs in several ways but few studies have follow-up until adulthood. We investigated the association of the entire spectrum of gestational ages with specialist care episodes for obstructive airway disease (asthma and chronic obstructive pulmonary disease (COPD)) at age 18–50 years.Methods: We used nationwide registry data on 706 717 people born 1987–1998 in Finland (4.8% preterm) and 1 669 528 born 1967–1999 in Norway (5.0% preterm). Care episodes of asthma and COPD were obtained from specialised healthcare registers, available in Finland for 2005–2016 and in Norway for 2008–2017. We used logistic regression to estimate odds ratios (ORs) for having a care episode with either disease outcome.Results: Odds of any obstructive airway disease in adulthood for those born at <28 or 28–31 completed weeks were 2–3-fold of those born full term (39–41 completed weeks), persisting after adjustments. For individuals born at 32–33, 34–36 or 37–38 weeks, the odds were 1.1- to 1.5-fold. Associations were similar in the Finnish and the Norwegian data and among people aged 18–29 and 30–50 years. For COPD at age 30–50 years, the OR was 7.44 (95% CI 3.49–15.85) for those born at <28 weeks, 3.18 (95% CI 2.23–4.54) for those born at 28–31 weeks and 2.32 (95% CI 1.72–3.12) for those born at 32–33 weeks. Bronchopulmonary dysplasia in infancy increased the odds further for those born at <28 and 28–31 weeks.Conclusion: Preterm birth is a risk factor for asthma and COPD in adulthood. The high odds of COPD call for diagnostic vigilance when adults born very preterm present with respiratory symptoms.

The present study aims to explore the relative effectiveness of two group-based cognitive rehabilitation programs for reducing fatigue in pediatric acquired brain injury (pABI). This is an exploratory study of secondary endpoints in a blinded, parallel-randomized controlled trial with children and adolescents (ages 10-17 years) with pABI and reported executive dysfunction. It investigates the effectiveness of a metacognitive program (pediatric goal management training, n = 36) compared to a psychoeducational program (pediatric brain health workshop, n = 37) for reducing fatigue (Pediatric Quality of Life Inventory, Multidimensional Fatigue Scale), 8 weeks and 6 months postintervention. Seventy-three participants completed the allocated interventions, and 71 attended the 6-month follow-up. The results showed a significant decrease in parent-reported fatigue for both interventions from baseline to the 6-month follow-up. Forty percent of the total sample had a reliable change. There was no significant difference between the intervention groups, but a tendency in favor of the psychoeducational approach. Only subscales cognitive and sleep/rest fatigue showed significant reductions. In regression analyses, several factors predicted fatigue at 6 months follow-up, but only better global outcome and executive attention predicted a decrease in fatigue symptoms after 6 months. Group-based cognitive rehabilitation in the chronic phase of pABI, including education of parents and teachers, may be helpful in reducing fatigue. Global outcome and executive attention at baseline predicted fatigue improvement. Developmental factors are important to consider when tailoring pediatric interventions, as well as modifiable factors associated with fatigue. (PsycInfo Database Record (c) 2022 APA, all rights reserved).