Despite substantial advances in neonatal care over recent decades, approximately 20% of extremely preterm infants—defined as those born before 28+0 weeks of gestation—still die in Sweden. Mortality in this population is primarily attributable to severe complications, including sepsis, necrotizing enterocolitis (NEC), and adverse neurodevelopmental outcomes. There is robust evidence demonstrating associations between early nutritional exposures and the risk of NEC, severe infections, and long-term neurological impairment. In addition, extremely preterm infants are at increased risk of impaired pulmonary function later in childhood.
Our research group investigates whether targeted nutritional interventions can mitigate these complications. This work includes randomized controlled trials (e.g. the N-forte study) as well as observational studies examining associations between specific components of human breast milk and infant growth, morbidity, and clinical outcomes.
The pathogenesis of NEC remains incompletely understood; however, nutrition-related factors are believed to play a central role. These include gastrointestinal dysmotility, impaired intestinal barrier function, and immaturity of the mucosal immune system. Importantly, these factors both influence and are influenced by the intestinal microbiota. Accordingly, we have conducted extensive analyses of the gut microbiome in extremely preterm infants, alongside randomized intervention studies evaluating probiotic supplementation (e.g., the PROPEL study), and we participate in several national collaborative probiotic trials.
The biobanked samples and laboratory components of the PROPEL and N-forte studies provide a platform for continued investigation into the mechanisms underlying impaired growth, immune-mediated complications such as NEC, and long-term outcomes including pulmonary dysfunction and neurodevelopmental impairment. Through comprehensive multi-omics approaches and data-driven analytical methods, we aim to identify predictive biomarkers for these adverse outcomes.
Our research program also includes longitudinal follow-up studies assessing neurodevelopmental outcomes and pulmonary function up to 14 years of age, as well as evaluations of health-related quality of life extending into late adolescence.
In addition, we conduct research in perinatology in close collaboration with obstetric specialists, focusing on optimizing perinatal care for both mother and infant. For example, in the PreDECESS study, we evaluate delayed umbilical cord clamping combined with immediate skin-to-skin contact in preterm deliveries. In the SUCCECS study, we investigate delayed umbilical cord clamping in the context of emergency cesarean sections performed due to suspected fetal asphyxia.
