Lower Intake of Saturated Fatty Acids Is Associated with Improved Lipid Profile in a 6-Year-Old Nationally Representative Population.

To strengthen the organization of new national dietary surveys and interventions in childhood, our aim was to study macronutrient intake and blood lipid profile at 6 years of age by comparing results from two earlier population-based cohorts. Subjects were n = 131 and n = 162 in the years 2001−2002 and 2011−2012, respectively. Three-day weighed food records were used to estimate diet and calculate nutrient intake. Total cholesterol, HDL-cholesterol and triacylglycerol were measured in serum and LDL-cholesterol was calculated. The average intake of saturated fatty acids (SFA) and trans FA was lower in 2011−2012 than 2001−2002 (13.3E% vs. 14.7E%, p < 0.001, and 0.8E% vs. 1.4E%, p < 0.001, respectively), replaced by a higher intake of unsaturated fatty acids. Total cholesterol and LDL-cholesterol were significantly lower in 2011−2012 than 2001−2002 (4.6 vs. 4.4 mmol/L, p = 0.003 and 2.8 vs. 2.5 mmol/L, p < 0.001, respectively). In a multiple linear regression model, one E% increase in SFA intake was related to a 0.03 mmol/L increase in LDL cholesterol (p = 0.04). A lower intake of saturated and trans fatty acids, replaced by unsaturated fatty acids, may have contributed to an improved lipid profile in a healthy 6-year-old population. Biological data for analysis of blood lipids are important in national dietary surveys in healthy children to monitor important health outcomes of interventions.

Larger head circumference in Icelandic children 0-4 years of age compared to the World Health Organization and Swedish growth charts.

AIM: The World Health Organization (WHO) published universal growth standards for children below five year of age in 2006. Traditionally, Swedish growth references have been used to monitor growth of children in Iceland, but it is not yet known how they compare with these reference charts. METHODS: A total of 2128 longitudinal measurements of length or height, 2132 of weight and 2126 of head circumference between birth and four years of age were collected in 1996-2000 from 199 healthy children (53% boys) recruited at Landspitali University Hospital. Measurements were converted to z-scores using the WHO growth standards and Swedish growth references for further analysis with mixed-effects models. RESULTS: Length or height, weight and in particular head circumference largely exceeded the WHO standards, with average z-scores that fluctuated between 0.5 and 1.5. Likewise, the proportion of children with a z-score larger than 2 SD increased about 10-fold. Icelandic children were longer and heavier than their Swedish peers during the first six months of life, but differences were less pronounced thereafter. CONCLUSION: The growth of Icelandic children deviated significantly from the WHO growth standards. Although more comparable to the Swedish references, significant differences were found, suggesting that a national growth reference would be more appropriate.

[Perinatal mortality in Iceland 1988-2017].

Introduction Perinatal mortality refers to stillbirth and neonatal death during the first week of life. Recently perinatal mortality rate in Iceland has been among the lowest in the world. The aim of the study was to evaluate how perinatal mortality rate and its causes have changed in Iceland during the last 30 years, particularly to see if it is possible to lower the perinatal mortality rate even more. Cases and methods The study was retrospective and included all infants that were stillborn or died during the first week of life in 1988-2017. Information was obtained from the Icelandic Medical Birth Registry, the annual reports on births in Iceland. A classification focusing on identifying groups of perinatal death that are potentially avoidable was used. An annual percent change was calculated with Poisson regression. Results The perinatal mortality rate declined on average by 3,3% per year in the period based on ≥28+0 weeks gestation. The number of infants that died because of congenital anomalies decreased on average by 4,8% per year. The number of growth restricted stillborn singletons after ≥28+0 weeks of gestation decreased on average by 3,1% per year. The number of non growth restricted stillborn singletons after ≥28+0 weeks of gestation did not decrease significantly. Conclusion Perinatal mortality rate has declined substantially in Iceland during 30 years. Deaths because of congenital anomalies have decreased considerably due to improvement in prenatal diagnosis. Stillbirths associated with growth restriction have decreased but stillbirths that are not associated with growth restriction have not. Thus it is important to emphasize that women seek medical attention when they experience decreased fetal movements.

Vitamin D Intake and Status in 6-Year-Old Icelandic Children Followed up from Infancy.

High serum 25-hydroxyvitamin D (25(OH)D) levels have been observed in infants in Nordic countries, likely due to vitamin D supplement use. Internationally, little is known about tracking vitamin D status from infancy to childhood. Following up 1-year-old infants in our national longitudinal cohort, our aims were to study vitamin D intake and status in healthy 6-year-old Icelandic children (n = 139) and to track vitamin D status from one year of age. At six years, the mean 25(OH)D level was 56.5 nmol/L (SD 17.9) and 64% of children were vitamin D sufficient (25(OH)D ≥ 50 nmol/L). A logistic regression model adjusted for gender and breastfeeding showed that higher total vitamin D intake (Odds ratio (OR) = 1.27, 95% confidence interval (CI) = 1.08-1.49), blood samples collected in summer (OR = 8.88, 95% CI = 1.83-43.23) or autumn (OR = 5.64, 95% CI = 1.16-27.32) compared to winter/spring, and 25(OH)D at age one (OR = 1.02, 95% CI = 1.002-1.04) were independently associated with vitamin D sufficiency at age six. The correlation between 25(OH)D at age one and six was 0.34 (p = 0.003). Our findings suggest that vitamin D status in infancy, current vitamin D intake and season are predictors of vitamin D status in early school age children. Our finding of vitamin D status tracking from infancy to childhood provides motivation for further studies on tracking and its clinical significance.

Vitamin D intake and status in 12-month-old infants at 63-66° N.

The objective was to assess the vitamin D status in healthy 12-month-old infants in relation to quantity and sources of dietary vitamin D, breastfeeding and seasons. Subjects were 76 12-month-old infants. Serum levels of 25-hydroxyvitamin D (25(OH)D) ≥ 50 nmol/L were considered indicative of vitamin D sufficiency and 25(OH)D < 27.5 nmol/L as being indicative of increased risk for rickets. Additionally, 25(OH)D > 125 nmol/L was considered possibly adversely high. Total vitamin D at 9-12 months (eight data collection days) included intake from diet and supplements. The mean ± SD of vitamin D intake was 8.8 ± 5.2 µg/day and serum 25(OH)D 98.1 ± 32.2 nmol/L (range 39.3-165.5). Ninety-two percent of infants were vitamin D sufficient and none at increased risk for rickets. The 26% infants using fortified products and supplements never/irregularly or in small amounts had lower 25(OH)D (76.8 ± 27.1 nmol/L) than the 22% using fortified products (100.0 ± 31.4 nmol/L), 18% using supplements (104.6 ± 37.0 nmol/L) and 33% using both (110.3 ± 26.6 nmol/L). Five of six infants with 25(OH)D < 50 nmol/L had no intake of supplements or fortified products from 0 to 12 months. Supplement use increased the odds of 25(OH)D > 125 nmol/L. Breastfeeding and season did not affect vitamin D status. The majority of infants were vitamin D sufficient. Our findings highlight the need for vitamin D supplements or fortified products all year round, regardless of breastfeeding.

Animal protein intake at 12 months is associated with growth factors at the age of six.

AIM: To study the associations between protein intake from different sources with anthropometry and serum insulin-like growth factor 1 (IGF-1) in infancy and childhood. METHODS: Children (n = 199) born in Iceland were followed up to six years of age. Their intake of various animal proteins and vegetable protein was calculated from weighed food records at 12 months and 6 years. Information about their weight and height at birth, 12 and 18 months, and 6 years was gathered. Serum IGF-1 was measured at 12 months and 6 years. RESULTS: At the age of six, children in the highest quartile for animal protein intake at 12 months (≥12.2% of total energy) had 0.8 kg/m(2) (95% CI = 0.1, 1.5) higher body mass index (BMI) than children in the lowest quartile (<7.6% of total energy). They were also heavier and longer in infancy and childhood. At 12 months, dairy protein intake as a percentage of total energy was associated with IGF-1 in six-year-old girls, ß = 5.4 µg/L (95% CI = 2.5, 8.2). CONCLUSION: High animal protein intake in infancy, but not vegetable protein intake, was associated with accelerated growth and higher BMI in childhood. Dairy protein intake in infancy may be positively associated with linear growth and also with IGF-1 in six-year-old girls.

Nutrient intake in infancy and body mass index at six years in two population-based cohorts recruited before and after revision of infant dietary recommendations.

BACKGROUND/AIMS: The dietary intake in infancy can affect growth and the risk of childhood overweight. The aim of this study was to compare the nutrient intake in infancy and the body mass index (BMI) at age 6 years in two population-based cohorts recruited before and after the revision of infant dietary recommendations. METHODS: Two randomly selected population-based cohorts were recruited at birth and studied until 12 months of age and again at 6 years of age. Subjects were 90 and 170 children born in 1995-1996 and 2005, respectively. The dietary intake at 9 and 12 months was assessed via weighed food records. The height and weight from birth to age 12 months and at age 6 years were measured. RESULTS: The contribution of protein to the total energy intake (E%) was significantly lower in the 2005 cohort than in the 1995-1996 cohort [11.9 vs. 14.4 E% (p < 0.001) at 9 months and 14.6 vs. 15.6 E% (p = 0.016) at 12 months]. Relatively fewer children were classified as being overweight (including obese) in the 2005 cohort, i.e. 12 versus 21% (p = 0.045). CONCLUSION: The emphasis placed on the revised infant dietary recommendations resulted in a lower protein intake in the latter half of the first year. Changes in the infants' diets on the population level might have contributed to the lower overweight prevalence seen in the 2005 cohort.

Iron status and developmental scores in 6-year-olds highlights ongoing need to tackle iron deficiency in infants.

AIM: To investigate iron status and developmental scores at 6 years of age in a population with decreased prevalence of iron deficiency in infancy. Iron status at 6 years and tracking from 12 months were also studied. METHODS: Children (n = 143) born in Iceland in 2005 were followed up at the age of six. Motor and verbal development was assessed by a parental questionnaire, and iron status was assessed by Hb, MCV and serum ferritin (SF). Iron depletion was defined as SF <15 µg/L and deficiency as MCV <76 fL and SF <15 µg/L. RESULTS: Iron depletion was observed in 5.6% of 6-year-olds, and 1.4% were iron deficient. Self-help (subset in motor development) differed by -4.14 (95% CI = -7.61, -0.67), between those iron depleted at 12 months (n = 6) and those nondepleted (n = 102), adjusted for maternal education. The combined motor developmental score seemed lower in iron depleted infants, although of borderline significance (p = 0.066). MCV concentration tracked from 12 months to 6 years (r = 0.31, p < 0.002), but Hb and SF did not. CONCLUSION: Improved iron status at 12 months and 6 years has diminished the public health threat associated with iron depletion in the population studied, but iron depletion and development still associate weakly. Action to prevent iron depletion in infancy remains important.

Iron status of one-year-olds and association with breast milk, cow's milk or formula in late infancy.

PURPOSE: Studies on iron status in infancy and early childhood have shown contradicting results concerning prolonged breast-feeding and cow's milk intake. The aim of the present study was to investigate associations between iron status among one-year-olds and feeding, with focus on the type of milk. METHODS: Randomly selected healthy infants were prospectively investigated until 1 year of age in two cohorts born 1995-1996 (n = 114) and 2005 (n = 140). Information on birth data, feeding and growth until 12 months and iron status at 12 months was collected. Data from the two cohorts were pooled and the infants categorized into three groups according to their predominant milk consumption at 9 months of age, that is, breast milk, cow's milk or follow-on formula. RESULTS: The prevalence of iron deficiency was highest in the cow's milk group and lowest in the follow-on formula group. According to a linear model, adjusted for gender, birth weight and exclusive breast-feeding duration, cow's milk consumption was negatively associated with serum ferritin (SF) and formula positively, but breast milk not. Predicted SF (µg/l) = 11.652(intercept) - 5.362(boy) + 0.005 × birth weight (g) + 2.826(exclusively breastfed ≥ 4 months) + 0.027 × formula (ml) - 0.022 × cow's milk (ml) + 0.005 × breast milk (ml). Correction for other dietary factors did not change these results. CONCLUSION: In this pooled analysis, cow's milk intake in late infancy associated negatively, and follow-on formula positively, with iron status. Prolonged partial breast-feeding does not seem to be of importance for iron status. Fortified food seems to improve iron status in late infancy.

Timing of the introduction of complementary foods in infancy: a randomized controlled trial.

OBJECTIVE: To increase knowledge on iron status and growth during the first 6 months of life. We hypothesized that iron status would be better in infants who received complementary foods in addition to breast milk compared with those exclusively breastfed. METHODS: One hundred nineteen healthy term (≥37 weeks) singleton infants were randomly assigned to receive either complementary foods in addition to breast milk from age 4 months (CF) or to exclusive breastfeeding for 6 months (EBF). Dietary data were collected by 3-day weighed food records, and data on iron status and growth were also collected. RESULTS: One hundred infants (84%) completed the trial. Infants in the CF group had higher mean serum ferritin levels at 6 months (P = .02), which remained significant when adjusted for baseline characteristics. No difference was seen between groups in iron deficiency anemia, iron deficiency, or iron depletion. The average daily energy intake from complementary foods of 5-month-olds in the CF group was 36.8 kJ per kg body weight. Infants in both groups grew at the same rate between 4 and 6 months of age. CONCLUSIONS: In a high-income country, adding a small amount of complementary food in addition to breast milk to infants' diets from 4 months of age does not affect growth rate between 4 and 6 months, but has a small and positive effect on iron status at 6 months. The biological importance of this finding remains to be determined.

Increasing incidence of late-onset neonatal invasive group B streptococcal infections in Iceland.

BACKGROUND: Group B streptococci (GBS) may cause life-threatening invasive infections in infants. The incidence of these infections has been increasing during the last decades. The aim of the study was to determine the epidemiology of neonatal GBS infections to be able to implement therapeutic and preventive measures more effectively. METHODS: A retrospective case study was conducted in Iceland that included all neonates with positive GBS cultures from blood or cerebrospinal fluid during the period 1975 to 2006. Serotyping of all available GBS isolates was performed. RESULTS: A total of 87 children with 89 infections were included in the study. In all, 53 infants had early-onset (EO) GBS infections (occurring <7 days after birth) and 34 had late-onset (LO) infections (occurring on days 7-90). EO infections increased during the first 3 quartiles of the study period but decreased during the last quartile. LO infections increased throughout the entire study period. GBS was cultured from cerebrospinal fluid in 21 patients; 9 with EO and 12 with LO infections. Premature infants comprised 15 with EO and 14 with LO infections. Eight children died of GBS infection, 7 with EO and 1 with LO infections; no correlation with serotypes was found. Serotype III was most common for both EO (34%) and LO infections (62%). CONCLUSION: The number of GBS infections increased during the study period. The decrease in EO infections in recent years could be attributed to intrapartum antibiotic treatment. The increasing number of LO infections is a concern.

Nutrition and Iron Status of 1-Year Olds following a Revision in Infant Dietary Recommendations.

A previous study showed low iron status in 12-month-old Icelandic infants associated most strongly with cow's milk intake and growth. Infant dietary recommendations were revised in 2003. This study investigated nutrition and iron status in a new infant cohort. Subjects/Methods. Randomly selected infants were prospectively investigated for diet, anthropometry, and iron status (n = 110-141). Results. Breastfeeding initiation rate was 98%; 38% of 5-month olds were exclusively and 20% of 12-month olds partially breastfed. Formula was given to 21% of 6-month olds and 64% of 12-month olds, but cow's milk to 2.5% and 54.4% of 6- and 12-month olds, respectively. Iron depletion (serum ferritin < 12 µg/L) affected 5.8%, 1.4% were also iron deficient (MCV < 74 fl), and none were anemic (Hb < 105 g/l). Iron status associated negatively with growth and breastfeeding duration and positively with meat and formula intake at 9-12 months, but not with cow's milk. Conclusion. Improved iron status might be explained by a shift from cow's milk to formula in the diet of Icelandic 6-12-month olds. Dietary changes altered associations between foods and iron status.

[Hyponatremia in very low birth weight infants]. / Lág théttni natríums í sermi fyrirbura.

AIM: Hyponatremia can potentially have serious effects in the premature infant, Therefore, it is important to recognize its causes and prevent it if possible. The aim of this study was to evaluate the causes of hyponatremia in very low birth weight (VLBW) infants cared for at the Neonatal Intensive Care Unit (NICU) of Children's Hospital Iceland. SUBJECTS AND METHODS: Retrospective descriptive study of 20 VLBW infants at the NICU of Children's Hospital Iceland, born after <30 weeks gestation with birth weight of < or =1250 g. Information was obtained on fluid administration, weight loss, sodium administration and serum sodium concentrations during their first ten days of life. RESULTS: The median gestational age was 27 weeks (24-29 weeks) and the median birth weight was 905 g (620-1250 g). A negative correlation was found between birth weight and the amount of fluids given (R2=-0.42; p=0.002). The median weight loss was 10.6% (3.1-29.5%). A positive correlation was found between weight loss and the amount of fluids the infants received (R2=0.76; p<0.001). The amount of sodium given was on the average 5.7+3.1 mmól/kg/24 hours. The median serum sodium concentration was 137 mmól/L (127-150 mmól/L). A negative correlation was found between the amount of sodium given and serum sodium concentrations (R2=-0.42; p<0.001). There was no correlation between the amount of fluids given and serum sodium concentrations (R2=0.006; p=0.7). A negative correlation was found between birth weight and serum sodium concentrations (R2=-0.24; p=0.027). CONCLUSION: High sodium requirements in VLBW infants at our hospital suggests that their hyponatremia is mainly due to the immaturity of their kidneys, which is known to result in excessive loss of sodium in the urine.

The relation of fatness to insulin is independent of fitness in 9- but not 15-yr-olds.

PURPOSE: To explore the relationship between varying aerobic fitness (fitness), fatness, and fasting insulin levels in healthy children. METHODS: A population-based sample of 9-yr-old (9YO, 47 boys, 56 girls) and 15-yr-old (15YO, 53 boys, 51 girls) Icelandic children. Body fatness was evaluated via body mass index, waist circumference adjusted for height (waist adj), and sum of four skinfolds. Fitness was assessed with a graded maximal cycle ergometer test. Fasting insulin was measured using an ECLIA. RESULTS: Fasting insulin correlated to all fatness measures (9YO, r = 0.43-0.46, P < 0.001; 15YO, r = 0.30-0.37, P < 0.003) and fitness (9YO, r = -0.29, P = 0.003; 15YO, r = -0.32, P = 0.001). Adjustment for fitness did not affect the relations between fatness and fasting insulin in 9YO (r = 0.33-0.37, P < 0.001); however, only waist adj remained significantly related to fasting insulin (r = 0.24, P = 0.016) in 15YO. Children in the upper half of fitness and fatness split on the median did not differ in fasting insulin from children in the upper half of fitness but lower half of fatness. Fatness was related to fasting insulin in 9YO (r = 0.51-0.54, P = 0.001) and 15YO (r = 0.31-0.35, P = 0.011-0.028) in the lower half of fitness, but no association was observed in the upper half of fitness in either group. CONCLUSION: Fatness has a greater association with fasting insulin than fitness, especially among 9YO; however, fitness attenuates the adverse relation of fatness to fasting insulin in 15YO but does not change it in 9YO. In both age groups, being fitter and fatter does not result in greater fasting insulin than being fitter and leaner, and fatness is primarily associated with fasting insulin in lower-fit children.

[Viral hepatitis B and C among immigrants in Iceland]. / Lifrarbólga af vökdum lifrarbólguveira B og C hjá innflytjendum á Islandi.

BACKGROUND: Viral hepatitis B and C are a major health problem worldwide. The prevalence of these diseases varies throughout the world. In Iceland, the incidence of hepatitis B and C has increased in recent years. At the same time, the number of immigrants from countries where viral hepatitis is endemic, has also increased. The aim of this study was to investigate the epidemiology of hepatitis B and C among immigrants in Iceland. MATERIAL AND METHODS: Immigrants from outside the European Economic Area (EEA) were screened for hepatitis B and C. Medical records for the years 2000-2002 were reviewed for country of origin, viral serology and liver transaminases. Information was gathered from the State Epidemiologist's central registry of notifiable diseases and from the Icelandic Directorate of Immigration on the number of residence permits issued. RESULTS: 70% of all immigrants from countries outside the EEA during the study period were included in the study. Blood samples were obtained from 2946 immigrants. 83 (2.8%) had hepatitis B and 24 (0.8%) had hepatitis C. Prevalence of hepatitis B was highest among immigrants from Africa,11/171 (6.4%; 95% CI: 3.3-11.2%) and hepatitis C among immigrants from Eastern Europe, 16/1502 (1.1%; 95% CI: 0.6-1.7%). 482 (16%) had serological markers of previous hepatitis B infection. Of all registered cases of hepatitis B, immigrants were 56% and of hepatitis C 10%. CONCLUSIONS: 1. Majority of those diagnosed with hepatitis B during the study period were immigrants. 2. Among immigrants, hepatitis B was more prevalent than hepatitis C. 3) The high prevalence of hepatitis B justifies screening for the disease in this population.

Anthropometric predictors of serum fasting insulin in 9- and 15-year-old children and adolescents.

BACKGROUND AND AIM: As the prevalence of overweight and obesity increases, the risk of insulin resistance rises. The aim was to study the association between anthropometric measurements and fasting insulin concentration in a population-based sample of 9- and 15-year-old children and adolescents. METHODS AND RESULTS: Subjects were randomly selected 9- and 15-year-old pupils (n=262) in a cross-sectional, population-based study. Weight and height, waist, hip and mid-arm-circumference and subcutaneous skinfolds were measured using standard procedures. Fasting insulin was measured. In general the mean anthropometric measurements increased across insulin quartiles. Higher fasting insulin concentration was seen in overweight children and adolescents than in those of normal weight (8.3+/-4.4 vs. 4.9+/-3.6 mmol/L and 11.0+/-4.4 vs. 9.0+/-4.2 mmol/L in 9- and 15 year-olds, respectively). The odds ratio for having insulin in the highest quartile (age and gender-specific) was, when compared with the lowest quartile, 7.2 (95% CI 3.0-17.2) for body mass index and 6.9 (2.8-16.7) for waist circumference. Other measurements of body fatness were less predictive. About 14-20% of children defined as being of normal weight had high fasting insulin values, i.e., were in the highest quartile of fasting insulin. CONCLUSIONS: Body fatness is positively related to fasting insulin concentration in 9- and 15-year-old children. A large number of normal-weight individuals with high fasting insulin concentration was observed, and these children could be at increased risk of weight gain, compared with normal-weight individuals with normal fasting insulin concentration.

[The efficacy of high frequency ventilation in severe neonatal respiratory failure]. / Arangur meoferoar meo hátíoniöndunarvél hjá nýburum meo alvarlega öndunarbilun.

OBJECTIVE: To evaluate the efficacy of high frequency ventilation (HFV) in infants failing conventional ventilator therapy at our institution. STUDY GROUP AND METHODS: Medical records of all infants managed on HFV after having failed conventional ventilator management from 1994-2004 were reviewed. Ventilatory settings, blood gases and pH just prior to starting HFV, and two and four hours after starting HFV were recorded. RESULTS: Sixty one infants met the study criteria. At two hours of HFV there was a significant improvement in oxygenation (Alveolar to arterial oxygen tension difference), ventilation and acid-base balance. These values were not significantly different between two and four hours of HFV. There was no significant difference in oxygenation between survivors (n=41) and non-survivors (n=20) prior to HFV, but after two hours of HFV the survivors had significant improvement in oxygenation. Thirty one of the survivors had improved oxygenation at two and four hours of HFV, but only eight of the nonsurvivors (p=0.03). CONCLUSIONS: HFV results in significant improvements in oxygenation, ventilation and acid-base balance in most infants failing conventional ventilatory management. The immediate response to HFV may be a predictor of survival in infants with severe hypoxic respiratory failure.

[Uniparental disomy of chromosome 11 in a patient with Beckwith-Wiedemann syndrome. First reported case in Iceland]. / Tvístaeoa litnings nr. 11 frá föour hjá sjúklingi meo Beckwith-Wiedemann heilkenni. Fyrsta greining á Islandi--Sjúkratilfelli.

Beckwith-Wiedemann syndrome (BWS) is a generalized overgrowth condition as well as regional and organ overgrowth in newborn children. It includes an increased risk of certain embryonal tumours. The aetiology of BWS is complex as different genetic and epigenetic alterations at chromosome region 11p15.5 may occur. We report the first case of paternal uniparental disomy in Beckwith-Wiedemann syndrome in Iceland. The diagnosis of Beckwith-Wiedemann syndrome is important as the risk of malignant tumors makes it mandatory that the children are followed for several years with regular investigations to detect the tumors as early as possible.

[Carriage of group B beta-haemolytic streptococci among pregnant women in Iceland and colonisation of their newborn infants.].

OBJECTIVE: To determine the carrier rate of group B beta-haemolytic streptococci (GBS) of pregnant women in Iceland and the colonisation of their newborns. MATERIAL AND METHODS: A prospective study was conducted from October 1994 until October 1997, where culture specimens for GBS were taken from vagina and rectum of pregnant women attending the prenatal clinics at the Department of Obstetrics and Gynecology, Landspitali University Hospital and the Reykjavik Health Centre. The samples were taken at 23 and 36 weeks gestation and at delivery. Culture samples were also taken from axilla, umbilical area and pharynx of their newborn infants immediately after birth. Included in the study were pregnant women born on every fourth day of each month. Carrier state was not treated during pregnancy, but Penicillin G was given i.v. at delivery if the last culture before delivery was positive and gestational age was <37 weeks, rupture of membranes was >12 hours before delivery or the mother had a fever >38 degrees C. RESULTS: Cultures were taken from 280 women and their children. GBS carrier rate of pregnant women in Iceland was 24.3%. Twelve newborns had GBS positive cultures. No newborn had a confirmed septicemia. Cultures from 25% of newborns, who s mothers were still GBS carriers at birth, were positive for GBS. Positive predictive value of cultures taken at 23 weeks gestation was 64% and 78% at 36 weeks. Negative predictive value was 95% and 99% respectively. CONCLUSION: One out of every four pregnant women in Iceland is a GBS carrier. Twentyfive percent of newborns become colonised with GBS if the mother is a GBS carrier at delivery. When screening for GBS carrier state is done cultures from both vagina and rectum is more sensitive than cultures from vagina only. At least five percent of all newborns in Iceland are therefore expected to have positive skin cultures at birth. If the mother does not have positive GBS cultures during pregnancy, the likelihood that she will give birth to a GBS colonised child is almost none.