Karoline Aker

• Francke, Karen Haugvik; Støen, Ragnhild; Thomas, Niranjan & Aker, Karoline (2024). Biochemical profiles and organ dysfunction in neonates with hypoxic-ischemic encephalopathy post-hoc analysis of the THIN trial. BMC Pediatrics. ISSN 1471-2431. 24(1). doi: 10.1186/s12887-024-04523-6.
• Kristoffersen, Laila Marie; Bergseng, Håkon; Engesland, Helene; Bagstevold, Anne; Aker, Karoline & Støen, Ragnhild (2023). Skin-to-skin contact in the delivery room for very preterm infants: a randomised clinical trial. BMJ Paediatrics Open. ISSN 2399-9772. 7(1). doi: 10.1136/bmjpo-2022-001831. Full text in Research Archive
• Aker, Karoline; Thomas, Niranjan; Adde, Lars; Koshy, Beena; Martinez-Biarge, Miriam & Nakken, Ingeborg Elise [Show all 8 contributors for this article] (2021). Prediction of outcome from MRI and general movements assessment after hypoxic-ischaemic encephalopathy in low-income and middle-income countries: data from a randomised controlled trial. Archives of Disease in Childhood: Fetal and Neonatal Edition. ISSN 1359-2998. doi: 10.1136/archdischild-2020-321309. Full text in Research Archive Show summary

  Objective To evaluate the accuracy of neonatal MRI and general movements assessment (GMA) in predicting neurodevelopmental outcomes in infants with hypoxic-ischaemic encephalopathy (HIE). Design Secondary analyses of a randomised controlled trial (RCT). Setting Tertiary neonatal intensive care unit in India. Methods Fifty infants with HIE were included in an RCT of therapeutic hypothermia (25 cooled and 25 non-cooled). All infants underwent brain MRI at day 5, GMA at 10–15 weeks and outcome assessments including Bayley Scales of Infant and Toddler Development, third edition, at 18 months. Associations between patterns of brain injury, presence/absence of fidgety movements (FMs) and outcomes were assessed. Results Seventeen of 47 (36%) had adverse outcome (5 (21%) cooled vs 12 (52%) non-cooled, p=0.025). Eight infants died (four before an MRI, another three before GMA). Two developed severe cerebral palsy and seven had Bayley-III motor/cognitive composite score <85. Twelve (26%) had moderately/severely abnormal MRI and nine (23%) had absent FMs. The positive predictive value (95% CI) of an adverse outcome was 89% (53% to 98%) for moderate/severe basal ganglia and thalami (BGT) injury, 83% (56% to 95%) for absent/equivocal signal in the posterior limb of the internal capsule (PLIC) and 67% (38% to 87%) for absent FMs. Negative predictive values (95% CI) were 85% (74% to 92%) for normal/mild BGT injury, 90% (78% to 96%) for normal PLIC and 86% (74% to 93%) for present FMs. Conclusion(s) Neonatal MRI and GMA predicted outcomes with high accuracy in infants with HIE. The GMA is a feasible low-cost method which can be used alone or complementary to MRI in low-resource settings to prognosticate and direct follow-up. Trial registration number CTRI/2013/05/003693.

• Aker, Karoline; Støen, Ragnhild; Eikenes, Live; Martinez-Biarge, Miriam; Nakken, Ingeborg Elise & Håberg, Asta [Show all 8 contributors for this article] (2019). Therapeutic hypothermia for neonatal hypoxic-ischaemic encephalopathy in India (THIN study): a randomised controlled trial. Archives of Disease in Childhood: Fetal and Neonatal Edition. ISSN 1359-2998. doi: 10.1136/archdischild-2019-317311. Full text in Research Archive Show summary

  OBJECTIVE: To evaluate the neuroprotective effect of therapeutic hypothermia (TH) induced by phase changing material (PCM) on MRI biomarkers in infants with hypoxic-ischaemic encephalopathy (HIE) in a low-resource setting. DESIGN: Open-label randomised controlled trial. SETTING: One neonatal intensive care unit in a tertiary care centre in India. PATIENTS: 50 term/near-term infants admitted within 5 hours after birth with predefined physiological criteria and signs of moderate/severe HIE. INTERVENTIONS: Standard care (n=25) or standard care plus 72 hours of hypothermia (33.5°C±0.5°C, n=25) induced by PCM. MAIN OUTCOME MEASURES: Primary outcome was fractional anisotropy (FA) in the posterior limb of the internal capsule (PLIC) on neonatal diffusion tensor imaging analysed according to intention to treat. RESULTS: Primary outcome was available for 22 infants (44%, 11 in each group). Diffusion tensor imaging showed significantly higher FA in the cooled than the non-cooled infants in left PLIC and several white matter tracts. After adjusting for sex, birth weight and gestational age, the mean difference in PLIC FA between groups was 0.026 (95% CI 0.004 to 0.048, p=0.023). Conventional MRI was available for 46 infants and demonstrated significantly less moderate/severe abnormalities in the cooled (n=2, 9%) than in the non-cooled (n=10, 43%) infants. There was no difference in adverse events between groups. CONCLUSIONS: This study confirmed that TH induced by PCM reduced brain injury detected on MRI in infants with moderate HIE in a neonatal intensive care unit in India. Future research should focus on optimal supportive treatment during hypothermia rather than looking at efficacy of TH in low-resource settings. TRIAL REGISTRATION NUMBER: CTRI/2013/05/003693.

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• Aker, Karoline; Støen, Ragnhild & Thomas, Niranjan (2024). Letter in response to the article: “Therapeutic hypothermia for neonatal encephalopathy in developing countries: Current evidence”. Clinical Epidemiology and Global Health. ISSN 2452-0918. 27. doi: 10.1016/j.cegh.2024.101593.
• Aker, Karoline & Støen, Ragnhild (2021). Incidence of perinatal asphyxia and hypoxic-ischemic encephalopathy before and after implementation of therapeutic hypothermia – a population-based study.
• Thomas, Niranjan; Støen, Ragnhild; Aker, Karoline; Martinez-Biarge, Miriam; Nakken, Ingeborg Elise & Håberg, Asta [Show all 7 contributors for this article] (2021). Rise and Fall of Therapeutic Hypothermia in Low‑Resource Settings: Lessons from the HELIX Trial: Correspondence. Indian Journal of Pediatrics (IJP). ISSN 0019-5456. doi: 10.1007/s12098-021-03967-3.
• Aker, Karoline; Støen, Ragnhild; Martinez-Biarge, Miriam & Thomas, Niranjan (2021). Questions about the HELIX trial. The Lancet Global Health. ISSN 2572-116X. 9(12). doi: 10.1016/S2214-109X(21)00496-4.
• Aker, Karoline; Støen, Ragnhild; Martinez-Biarge, Miriam; Fjørtoft, Toril Larsson; Adde, Lars & Thomas, Niranjan (2018). General Movement Assessment and early MRI in a randomized trial of therapeutic hypothermia for infants with hypoxic-ischemic encephalopathy in India (THIN-study).
• Aker, Karoline; Støen, Ragnhild; Martinez-Biarge, Miriam & Thomas, Niranjan (2018). A randomized controlled trial of therapeutic hypothermia for neonatal hypoxic-ischemic encephalopathy in India (THIN-study) .
• Aker, Karoline; Brantberg, Anne & Nyrnes, Siri Ann (2015). Prenatal constriction of the ductus arteriosus following maternal diclofenac medication in the third trimester. BMJ Case Reports. ISSN 1757-790X. 205:210473. doi: 10.1136/bcr-2015-210473. Show summary

  We describe a case of a 21-year-old primigravida at 36 weeks’ gestation who was admitted to a local hospital because of abdominal pain. She was prescribed a total of six doses of diclofenac 50 mg over 2 days. One day later, there was difficulty registering the fetal heartbeats on cardiotocography. Ultrasound examination revealed a fetus with ascites and pathological flow over the tricuspid valve. The patient was referred to a tertiary centre for fetal medicine. Fetal echocardiography revealed, in addition to ascites and tricuspid regurgitation, a constricted ductus arteriosus, dilated right ventricle and reduced flow in the pulmonary artery. Immediate caesarean section resulted in an excellent neonatal outcome.

• Aker, Karoline (2022). Perinatal asphyxia in a global perspective: How can we improve outcomes? NTNU. ISSN 978-82-326-6303-3. 2022(137).

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