Jenny Svedenkrans

Preterm infants have an increased risk of morbidity and mortality, both in the neonatal period and later in life. Good nutrition is essential to improve all outcomes, and mother’s own breast milk is by far the best alternative for this. Mothers with pre-eclampsia are at higher risk of preterm delivery and are often in need of antihypertensive drug treatment, both before and after delivery. It is however not known whether feeding the preterm infant mother’s own milk is more beneficial than harmful when the milk may contain antihypertensive medications. Today the feeding practices differ widely when maternal antihypertensives are involved, but the decision on whether to feed the infant mother’s own milk or not may affect the infant for life. We aim to perform an observational multi-center study including 400 preterm infants, where clinical effects will be related to the level of exposure to antihypertensive drugs through breast milk. We aim to analyze (1) if there are any short-term cardiovascular risks, (2) if there are any correlations to other short-term clinical outcomes, and (3) if there is any correlation to long-term outcomes. Differences between clinical practice at the included units and differences in availability of mother’s own milk (MOM) will create a naturally continuous variable for level of exposure, which will allow for comparisons between high and low exposure as well as with an unexposed group. National quality registers will be used for additional information on maternal and neonatal background characteristics and long-term outcomes. The results from this study may constitute a game changer in the care of preterm infants to mothers with pre-eclampsia. If we can show that the use of MOM is safe and beneficial when the mother is treated with antihypertensive drugs, hundreds of preterm infants every year would be given the opportunity for a better long-term outcome.

The purpose of the SUCCECS study is to improve neonatal health and survival after emergency Cesarean section.  We aim to perform a multicenter study to evaluate a new approach to resuscitation of non-breathing neonates born by Cesarean section. Study design: Multicenter study with stepped wedge cluster randomization.- Population: Singleton term neonates born by emergency Cesarean section.- Intervention: When in need of life support, the neonate will be put on a platform with the cord intact, close to the mother. The neonatal team will give respiratory support with sustained cord circulation, following neonatal CPR guidelines. Cord clamping will be performed after respiration has been established and at the earliest after three minutes.- Control: Management according to standard care, including immediate cord clamping.- Outcome: Composite outcome of admission to neonatal care for predefined criteria (asphyxia at birth, respiratory distress, hypoxic-ischemic encephalopathy, hypoglycemia) and death before admission. Short and long-term neonatal outcomes and adverse maternal and neonatal outcomes will be evaluated.Importance: A reduction in neonatal admissions can benefit both the neonate and their parents, while also yielding positive economic implications for healthcare systems.Time plan: Preparations started in 2022, supported by the SRC planning grant no. 2021-06581. Training of staff will begin in early 2025, while the initial intervention rollout is planned for 2025.