Sture Andersson, Olli Pitkänen-Argillander ja Outi Mäkitie

Large amounts of data on small premature babies

Sture Andersson
HUS, Lasten ja nuorten sairaudet

There are several ongoing studies at the Children’s Hospital from small premature babies to infants. Professor Sture Andersson’s group studies the treatment results for small premature babies by means of machine learning.

The treatment of small premature babies is complicated and expensive. The Children’s Hospital has already documented data on more than two thousand small premature babies in digital format.

– By using big data technology, events putting small premature babies at risk of complications can be identified. We are developing algorithms based on artificial intelligence to increasingly predict these complications, Sture Andersson explains.

The research results are obtained by combining information on the clinical monitoring of small premature babies, imaging studies (such as central nervous system MRI) and various registers (Small premature babies, Hilmo, Kela). This requires both clinical competencies and knowledge of IT and artificial intelligence technologies.

– The digital data system for the Neonatal Intensive Care Unit at the Children’s Hospital has material on small premature babies which has been documented in detail and is extensive on an international level. In addition, Finland’s comprehensive register activities allow for monitoring patients, Andersson says.

The objective of the research is to develop the quality of treatment and to adopt new diagnostic methods.

The group was launched in 2012 and it cooperates with Aalto University and the HUS IT Department. Between 1999 and 2013, the group examined the predictability of sepsis in premature babies in conjunction with IBM.

How much vitamin D do babies need?

Professor Sture Andersson and Professor Outi Mäkitie’s research group examines the effects of vitamin D, particularly on the bones of infants, on the growth of children, on their immunity and infections as well as their mental development.

– Vitamin D affects most of our cells, and it has significant impacts on bones, on immunity and growth, particularly in childhood. We try to establish the sufficient vitamin D level for resulting in positive health effects in infants, Sture Andersson states.

In a clinical trial (VIDI), 975 healthy children received either 10 micrograms or 30 micrograms of vitamin D per day from the age of two weeks to the age of two years. The study found that 10 micrograms of vitamin D was equally effective for the development of the bones and for restricting the number of infections as a larger daily dose.

In the future, researchers will statistically examine the effect of vitamin D on allergies, vaccine response, virus and bacteria colonies and children’s mental development in the same cohort.

– In Finland, the normal vitamin D supplement of 10 micrograms from the age of two weeks to the age of two years is sufficient, and thus a larger supplement is not beneficial to children.

So far, nine publications have been completed in the project, and a follow-up of the cohort will start in 2019.

The research group, which was launched in 2010, includes competencies in neonatology, pediatric endocrinology, infectious diseases, nutrition and genetics.

Fluid transport in the airways

Olli Pitkänen-Argillander
HUS, Lasten ja nuorten sairaudet

In a unique study, Professor of Neonatology Sture Andersson and Pediatric Cardiologist Olli Pitkänen-Argillander’s research group examines the transport of fluid in neonates’ airways and its contribution to pulmonary edema after heart surgery in actual patients.
Previously, such physiological events have mainly been studied on cell platforms or on animals.

Andersson and Pitkänen-Argillander and a translational research group introduce basic researchers’ findings to the study of patients and healthy people. They began to study fluid transport in the airways of newborns as early as the late 1990s. At that stage, humans are only adapting to breathe air after living in the uterus.

Fetal fluid must be removed from the lungs of newborn babies.

Under Pediatric Cardiologist Pitkänen-Argillander, the group began to examine in the 2010s the contribution of fluid transport in the airways to the onset of pulmonary edema and recovery from it after pediatric heart surgery. Docent Otto Helve has further expanded the study on fluid transport in the airways to pediatric infectious diseases. In addition, there is research cooperation with neonatologists, pulmonary physicians and cardiac anesthesiologists from the Children’s Hospital.

– Fluid transport is mainly based on the transport of osmotic water, brought about by sodium ions, towards the extracellular matrix, and further on to blood and lymph circulation. We examine the respiratory epithelial channel transporting sodium ions by performing ion flow measurements on the mucosa and by means of gene technologies, Pitkänen-Argillander explains.

Significant gene findings

In the early 21st century, the group was at the forefront of finding the gene encoding the ENaC channel in the respiratory epithelium. The research group has also already shown that in prematurely born babies and babies suffering from neonatal respiratory distress syndrome (RDS), fluid transport in the airways is undeveloped, and that a pulmonary ultrasound assessment indicates that the pulmonary fluid is removed more slowly after a cesarean section than after vagina oral delivery.

Babies with congenital cyanotic heart defect have an increased risk of pulmonary edema after heart surgery. After heart surgery, the amount of pulmonary fluid can be assessed not only by means of thoracic imaging but also by means of pulmonary ultrasound.

Fascinating research questions

Among other things, researchers would like to examine whether pulmonary ultrasound could be used to assess pulmonary fluid in clinical work with patients.

The group is also searching for an answer on the role of inflammation mediators in the airways in conditions after heart surgery. How do gender differences manifest themselves in the gene expression of key transportation channels? It is known that boys are more at risk of neonatal breathing difficulties.

A pilot study examines fluid transportation and its abnormalities in the airways of infants with the RS virus infection. And what is the role of Cl ion channels in the removal of pulmonary fluid after birth?

– Since pulmonary ultrasound examinations are rapid and easy, we hope that in the future, they could be part of daily work in the intensive care units for newborns and older children, Pitkänen-Argillander says.

The research group currently includes a dissertation researcher, postdoc researchers and a senior researcher. An experienced laboratory assistant works at the Biomedicum laboratory.

Contact details

Sture Andersson
Children’s Hospital, University of Helsinki

Olli Pitkänen-Argillander
Children’s Hospital, University of Helsinki

Links to studies

Assessment of extravascular lung water by ultrasound after congenital cardiac surgery. Pediatr Pulmonol. 2017 Mar;52(3):345-352. doi: 10.1002/ppul.23531.

Chronic Hypoxemia in Children With Congenital Heart Defect Impairs Airway Epithelial Sodium Transport. Pediatr Crit Care Med. 2016 Jan;17(1):45-52. doi: 10.1097/PCC.0000000000000568.

Lung Ultrasound and Static Lung Compliance during Postnatal Adaptation in Healthy Term Infants. Neonatology. 2015;108(4):287-92. doi: 10.1159/000438453. 

Duration of gestation and mode of delivery affect the genes of transepithelial sodium transport in pulmonary adaptation. Neonatology. 2015;107(1):27-33. doi: 10.1159/000363729.

Delayed lung liquid absorption after cesarean section at term.  Neonatology. 2013;104(2):133-6. doi: 10.1159/000351290. 

Expression of the epithelial sodium channel in airway epithelium of newborn infants de-pends on gestational age. Pediatrics. 2007 Dec;120(6):1311-6.