Astrid Lindgren Childrens Hospital

Stockholm, Sweden

Astrid Lindgren Childrens Hospital

Stockholm, Sweden
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Fransson P.,Karolinska Institutet | Metsaranta M.,University of Helsinki | Blennow M.,Karolinska Institutet | Aden U.,Astrid Lindgren Childrens Hospital | And 2 more authors.
Cerebral Cortex | Year: 2013

Recent studies have revealed spatial and functional relations in the temporal dynamics of resting-state functional magnetic resonance imaging (rs-fMRI) or electroencephalography (EEG) signals recorded in the adult brain. By modeling the frequency power spectrum of resting-state brain signals with a power-law function O(f)1fα, the power-law exponent α has been shown to relate to the connectivity patterns of spontaneous brain activity that forms so-called rs-fMRI networks in the human adult brain. Here, we present an analysis of the dynamic properties of rs-fMRI and EEG signals acquired both in the newborn and adult brain, and we demonstrate frequency scaling of a power-law kind for orders of magnitude in the hemodynamic (0.01-0.15 Hz) and the electrical (0.2-30 Hz) domain. We show that the spatial segregation of resting-state dynamics of intrinsic fMRI signals in terms of the power-law exponent α is closely related to previously delineated resting-state neuronal architecture that encompasses primary sensory cortices and associate cortex in newborns. Moreover, the spatial profiles of differences in temporal dynamics for rs-fMRI signals could also be observed in EEG measurements in the newborn brain, albeit at a coarser spatial scale, with larger power-law exponents in occipital and parietal cortices compared with signals from the frontal brain. © 2012 The Author.

Falck-Ytter T.,Uppsala University | Falck-Ytter T.,Astrid Lindgren Childrens Hospital | Bakker M.,Uppsala University | Von Hofsten C.,University of Oslo
Neuropsychologia | Year: 2011

Both orienting to audiovisual synchrony and to biological motion are adaptive responses. The ability to integrate correlated information from multiple senses reduces processing load and underlies the perception of a multimodal and unified world. Perceiving biological motion facilitates filial attachment and detection of predators/prey. In the literature, these mechanisms are discussed in isolation. In this eye-tracking study, we tested their relative strengths in young human infants. We showed five-month-old infants point-light animation pairs of human motion, accompanied by a soundtrack. We found that audiovisual synchrony was a strong determinant of attention when it was embedded in biological motion (two upright animations). However, when biological motion was shown together with distorted biological motion (upright animation and inverted animation, respectively), infants looked at the upright animation and disregarded audiovisual synchrony. Thus, infants oriented to biological motion rather than multimodally unified physical events. These findings have important implications for understanding the developmental trajectory of brain specialization in early human infancy. © 2011 Elsevier Ltd.

Dahlin M.,Astrid Lindgren Childrens Hospital | Mansson J.-E.,Molndal Hospital | Amark P.,Astrid Lindgren Childrens Hospital
Epilepsy Research | Year: 2012

The ketogenic diet (KD) is a non-pharmacological treatment of medically refractory epilepsy in children. Its mechanisms of action are still unclear but monoamine neurotransmitters have been proposed to be involved. Norepinephrine, dopamine, and serotonin are known to modulate seizure susceptibility in many animal models. We examined whether the concentrations of norepinephrine, dopamine, and serotonin metabolites were affected by the KD in children with pharmacoresistant epilepsy. The metabolites of norepinephrine, HMPG, of dopamine, HVA, and of serotonin, 5-HIAA, were analyzed in cerebrospinal fluid (CSF) before and 3 months after starting the KD. Twenty-six children (mean age 5.9 years) participated. Twenty-one children had generalized epilepsy and five partial. CSF was sampled by lumbar puncture. Seizure frequency before and during the diet was determined. Highly significant changes were found for HVA (p= 0.0002) and 5-HIAA (p= 0.004), which were both decreased during the KD compared to before diet. The levels of HMPG were unchanged. However, no differences were found between response groups. Valproate medication affected the levels of HMPG during diet with decreased levels in children on valproate and increased in those not on valproate (p= 0.04). Our study indicates that the KD significantly alters the levels of metabolites of dopamine and serotonin but with a stable ratio HVA/5-HIAA in the CSF of children with refractory epilepsy, which finding may be of importance for the mechanism of action. © 2011.

Fransson P.,Karolinska Institutet | Aden U.,Astrid Lindgren Childrens Hospital | Blennow M.,Karolinska Institutet | Lagercrantz H.,Astrid Lindgren Childrens Hospital
Cerebral Cortex | Year: 2011

The functional network topology of the adult human brain has recently begun to be noninvasively mapped using resting-state functional connectivity magnetic resonance imaging and described using mathematical tools originating from graph theory. Previous studies have revealed the existence of disproportionally connected brain regions, so called cortical hubs, which act as information convergence zones and supposedly capture key aspects of how the brain's architecture supports human behavior and how it is affected by disease. In this study, we present results showing that cortical hubs and their associated cortical networks are largely confined to primary sensory and motor brain regions in the infant brain. Our findings in infants stand in stark contrast to the situation found in adults where the majority of cortical hubs and hub-related networks are located in heteromodal association cortex. Our findings suggest that the functional network architecture in infants is linked to support tasks that are of a perception-action nature. © The Author 2010. Published by Oxford University Press.

Van'T Hooft I.,Astrid Lindgren Childrens Hospital | Norberg A.L.,Karolinska Institutet
NeuroRehabilitation | Year: 2010

In a pilot study we examined the feasibility of a condensed version of the Swedish Memory and Attention Re-Training on children treated for medulloblastoma combined with a structured coaching programme for their parents. Parental coaching contained the translation of the child's new skills into daily life, and education regarding their own stress mechanisms. Before and after intervention we assessed the children's cognitive performance, social relations and self image as well as their parents stress. All three families continued the programme without interruption. Observations revealed that this condensed version of the programme was more stressful to participants. However, several aspects of the children's attention and memory performance improved from pre to post-training assessment. In addition, all of the children reported enhancement of their social relations and self image. Initially, symptoms of parental stress were pronounced for the three mothers, but fairly low for the fathers. After training and coaching, the stress level of both mothers and fathers was low. Our findings encourage full scale studies examining whether this combination of condensed cognitive training and specific coaching programme for parents may influence not only the children's cognitive performance but also their social relations, self image and their parents stress. © 2010-IOS Press and the authors. All rights reserved.

Sonesson S.-E.,Astrid Lindgren Childrens Hospital | Eliasson H.,Astrid Lindgren Childrens Hospital | Conner P.,Astrid Lindgren Childrens Hospital | Wahren-Herlenius M.,Karolinska Institutet
Ultrasound in Obstetrics and Gynecology | Year: 2014

Objective To distinguish between blocked atrial bigeminy (BB) and incomplete atrioventricular block with 2:1 conduction (2:1 AVB) can be very difficult, especially in the mid-term fetus. Making a correct diagnosis has important clinical implications, as their prognosis and management differ markedly. Our objective was to investigate whether analysis of isovolumetric time intervals could improve Doppler echocardiography in differentiating these conditions. Methods Sixteen fetuses with sustained BB or isolated 2:1 AVB, diagnosed at our tertiary center from 2002 to 2012, were reviewed retrospectively. Doppler recordings of left ventricular in- and outflow, including mitral and aortic valve movements, were used to measure isovolumetric contraction (ICT) and relaxation (IRT) time intervals. ICT reference values obtained from 104 normal pregnancies were used for comparison. Results Ten fetuses had BB and six 2:1 AVB. Five of the AVB cases were anti-Ro antibody positive and one had long QT syndrome (LQTS). ICT was systematically shorter in BB than in antibody-mediated 2:1 AVB. Nine of 10 cases with BB had an ICT below -2 SD and the five with antibody-mediated 2:1 AVB had values at or above +2 SD. All 15 fetuses with either BB or antibody-mediated AVB had an IRT of < 70 ms, as opposed to a markedly prolonged IRT (105 ms) in the LQTS case. Conclusion Measurement of ICT can improve the differential diagnosis between BB and antibody-mediated 2:1 AVB. Fetuses with BB or antibody-mediated AVB are unlikely to have IRT measurements exceeding 70 ms and, when this is observed, LQTS should be considered a more likely diagnosis Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.

Lundeberg S.,Astrid Lindgren Childrens Hospital | Lundeberg S.,Karolinska Institutet
Paediatric Anaesthesia | Year: 2015

Morphine, paracetamol and local anesthetics have for a long time been the foremost used analgesics in the pediatric patient by tradition but not always enough effective and associated with side effects. The purpose with this article is to propose alternative approaches in pain management, not always supported up by substantial scientific work but from a combination of science and clinical experience in the field. The scientific literature has been reviewed in parts regarding different aspects of pain assessment and analgesics used for treatment of diverse pain conditions with focus on procedural and acute pain. Clinical experience has been added to form the suggested improvements in accomplishing an improved pain management in pediatric patients. The aim with pain management in children should be a tailored analgesic medication with an individual acceptable pain level and optimal degree of mobilization with as little side effects as possible. Simple techniques of pain control are as effective as and complex techniques in pediatrics but the technique used is not of the highest importance in achieving a good pain management. Increased interest and improved education of the doctors prescribing analgesics is important in accomplishing a better pain management. The optimal treatment with analgesics is depending on the analysis of pain origin and analgesics used should be adjusted thereafter. A multimodal treatment regime is advocated for optimal analgesic effect. © 2014 John Wiley & Sons Ltd.

Lagercrantz H.,Astrid Lindgren Childrens Hospital | Changeux J.-P.,Institute Pasteur Paris
Seminars in Perinatology | Year: 2010

The newborn shows several signs of consciousness, such as being awake and aware of him/herself and mother. The infant processes olfactory and painful inputs in the cortex, where consciousness is believed to be localized. Furthermore, the newborn expresses primary emotions such as joy, disgust, and surprise and remember rhymes and vowels to which he or she has been exposed during fetal life. Thus, the newborn infant fulfills the criteria of displaying a basic level of consciousness, being aware of its body and him/her-self and somewhat about the external world. Preterm infants may be conscious to a limited degree from about 25 weeks, when the thalamocortical connections are established. © 2010 Elsevier Inc.

Lundeberg S.,Astrid Lindgren Childrens Hospital | Roelofse J.A.,University of the Western Cape | Roelofse J.A.,University College London
Paediatric Anaesthesia | Year: 2011

Sufentanil is a potent synthetic opioid. Like other opioids, sufentanil creates a stable hemodynamic environment in cardiovascularly compromised pediatric patients. Clearance, expressed as per kilogram, is increased in children compared to adults. The P450 CYP3A4 enzyme is responsible for the major metabolic N-dealkylation pathway. Enzyme activity is reduced in neonates but the maturation of sufentanil clearance is not described. The free active fraction is affected by age because of the reduced α1-acid glycoprotein plasma concentrations in neonates. Intranasal administration of sufentanil is a possible option for premedication, procedural sedation and analgesia in children, as this option has been found to be safe and effective. Studies concerning the pharmacokinetics and dynamics of sufentanil administered as a bolus or continuous infusion in children are few. © 2010 Blackwell Publishing Ltd.

Hertting O.,Astrid Lindgren Childrens Hospital | Shingadia D.,Great Ormond Street Hospital
Journal of Infection | Year: 2013

Although childhood tuberculosis has declined dramatically in the UK over the last century, it is now increasing again and globally childhood tuberculosis still accounts for a significant proportion of the tuberculosis disease burden. Children may present with non-specific symptoms, and because of the paucibacillary nature of disease and the difficulty of producing sputum samples, tuberculosis in children is often difficult to diagnose. Apart from the traditional diagnostic methods, like chest X-ray, tuberculin skin testing and mycobacterial staining or culture, new diagnostic strategies have been developed. In particular, immune-based diagnostics, such as interferon-gamma release assays, have now been introduced for clinical use. However these tests do not offer substantial improvements in sensitivity over tuberculin skin testing for the diagnosis of active disease. Further research is needed to develop better diagnostic tests for tuberculosis in children. © 2013 The British Infection Association.

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