We have reported feasibility, safety and ranges for rsSO₂ for a small number of preterm infants in the first 2 weeks of life.

Objective: To compare the admission temperatures, incidence of hypothermia and discharge outcomes of preterm neonates managed with Trans-warmer mattress (TWM) initiated in the delivery room (DR) and controls.Study Design: A prospective quasi-randomized controlled trial was performed between January and November 2009 on preterm neonates <32 weeks gestation. Infants in the intervention group were resuscitated and transported to neonatal intensive care unit (NICU) on a TWM, in addition to other measures recommended by the Neonatal Resuscitation Program.Result: The mean (s.d.) gestational age 28.7 (3) vs 28.7 (2.4) weeks and birth weight 1151 (407) vs 1175 (413) g) were comparable in the intervention (n ¼ 53) and control (n ¼ 49) groups. Temperature of the DR, maternal temperature, 5 min Apgar score, mode of delivery, cord pH and need for resuscitation were similar in both groups. Temperature of neonates in the DR (36.3 vs 36.0 1C) was also similar. Admission temperature in the NICU was significantly higher 36.2 1C (0.8) vs 35.7 1C (0.8) and incidence of hypothermia (temperatures <36 1C) lower in the intervention group (34 vs 57%, P<0.05). TWM use was not associated with any adverse effects. On logistic regression, low birth weight, lack of use of TWM and low DR temperature were independently associated with admission hypothermia. Conclusion:In this quasi-randomized controlled trial, the admission temperatures of preterm neonates on whom TWM was used were significantly higher compared to controls with a reduction in the incidence of hypothermia. A TWM initiated in the DR may be a simple efficacious method of reducing hypothermia in preterm neonates.

Red blood cell transfusions (RBCTs) have been associated with necrotising enterocolitis (NEC) in preterm infants (PTIs). The objective of this report is to evaluate the use of regional cerebral (cRSO 2) and splanchnic (sRSO 2) tissue oximetry measured using near infrared (NIR) spectroscopy as biomarkers to evaluate the association between RBCT and NEC in a secondary analysis of a hypothesis-generating Phase I exploratory study of biomarker development. cRSO 2 and sRSO 2 were monitored in PTIs receiving RBCTs. Three time periods were defined: pre-RBCT (12 h prior to RBCT), during RBCT and post-RBCT (24 h after RBCT). Three groups were defined: absence of NEC within ±7 days of index RBCT (Group 1); NEC within 7 days prior (Group 2) and within 7 days after RBCT (Group 3). Mean hourly sRSO 2 and cRSO 2 were compared between groups across RBCT periods using the mixed effect method. Neonatal postnatal morbidities and treatments were included as covariates. Fifty-seven infants (median gestational age 27 weeks) received 147 RBCTs (Group 1 = 120, Group 2 = 19, and Group 3 = 8) during NIR spectroscopy monitoring. In the adjusted analysis, there was a significant change in sRSO 2 during the course of RBCT (p = 0.0405) with significant interaction with group (p < 0.0001) such that in Groups 1 and 2, sRSO 2 increased over RBCT periods, whereas in Group 3, sRSO 2 declined over RBCT periods. cRSO 2 increased during the course of the RBCT (p < 0.0001) with significant interaction with group (p = 0.0258). cRSO 2 and sRSO 2 increased significantly following RBCT in infants without NEC or NEC diagnosed prior to RBCT. Post-RBCT sRSO 2 decreased in infants who were subsequently diagnosed with NEC in this exploratory secondary analysis of a Phase I Biomarker study. sRSO 2 response may potentially be a biomarker to identify infants who are likely to develop NEC post-RBCT that needs to be validated in larger prospective "hypothesis-testing" randomised controlled trials.