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Immature cardiorespiratory control in infants may result in apneas, sudden unexpected postnatal collapse (SUPC), secondary hypoxic brain damage and SIDS. We have shown that prostaglandins are central pathogenic factors in respiratory disorders and the hypoxic response. This has led us to focus on the role of inflammation and brainstem modulation in both clinical and mechanistic studies. These are used to define mechanisms for factors disturbing the physiological and neural pathways that control breathing. main goals are:1) Develop better clinical guidelines and best practices for respiratory failures in newborns e.g. Sudden Unexpected Postnatal Collapse (SUPC).2) To clinically characterize how dysregulation of respiratory control induces life-threatening apneas and if subtle alterations in cardiorespiratory parameters may act as early warning scores for infection, inflammation and a need for increased intervention. Patients recruited at the Pediatric wards and with the help of KTH expertise we use Deep Machine Learning based analysis to develop rapid semiautomatic Novel Early Warning Systems3) To define the pathophysiological mechanism of apneas and involvement of inflammation in the development and activity of brainstem respiration-related neural circuits. In vivo and novel in vitro experimental mouse models and single cell transcriptomics techniques are used.The overall aim is to develop diagnostics and therapeutic approaches against life threatening apneas and collapse.

The primary aim of this research is to determine whether supplementation with probiotics during the first weeks of life reduces the risk of necrotizing enterocolitis (NEC) and neonatal mortality and is safe to use among extremely preterm (EPT) infants born before gestational week 28.P: The study population include EPT infants (n= 1620) born at six tertiary neonatal units in Sweden and four units in Denmark.I: This is a double-blinded multicenter randomized controlled trial where infants in the intervention group will as soon as they tolerate 3 mL breastmilk per feed receive a probiotic combination of Bifidobacterium infantis, Bifidobacterium lactis, and Streptococcus thermophilus diluted in 3 mL breastmilk and given daily until gestational week 34.C: The control group will receive 3 mL breastmilk without probiotic supplementation (blinded) daily.O: Primary outcome variables is a composite endpoint of incidence of NEC and mortality. Secondary outcomes include incidence of sepsis, duration of hospital stay, use of antibiotics, feeding tolerance, growth, and body composition after hospital discharge.Patient benefit: To provide evidence on the usage of probiotics among EPT infants that are not currently covered by clinical recommendations. As EPT infants have the highest risk for NEC and mortality our results have the potential to change current recommendations and improve patient outcomes, decrease mortality, shorten hospitalization, and decrease overall health-care costs.