Objectives: The objective of this study was to define the association between the burden of severe hypoxemia (SpO 2 ≤70%) in the first week of life and development of severe ICH (grade III/IV) in preterm infants. Study Design: Infants born <32 weeks or weighing <1500g underwent prospective SpO 2 recording from birth through 7d. Severe hypoxemia burden was calculated as the percentage of the error-corrected recording where SpO 2 ≤70%. Binary logistic regression was used to model the relationship between hypoxemia burden and severe ICH. Results: A total of 163.3 million valid SpO 2 data points were collected from 645 infants with mean EGA=27.7±2.6 weeks, BW=1005±291g; 38/645 (6%) developed severe ICH. There was a greater mean hypoxemia burden for infants with severe ICH (3%) compared to those without (0.1%) and remained significant when controlling for multiple confounding factors. Conclusion: The severe hypoxemia burden in the first week of life is strongly associated with severe ICH.

Background: Gram-negative late-onset neonatal sepsis has high mortality, but initial antibiotic regimens may not cover these most virulent pathogens. While heart rate characteristics (HRC) monitoring can lead to early sepsis diagnosis, other non-infective conditions elevate the HRC index, or HeRO score. Since a recent randomized trial showed reduced mortality with HeRO monitoring, we expect its use to increase. Cytokine levels rise in response to systemic inflammation and sepsis, and patterns of expression might differ depending on the infective organism.

Objective Infants in the neonatal intensive care unit (NICU) are at high risk of adverse neuromotor outcomes. Atypical patterns of heart rate (HR) and pulse oximetry (SpO2) may serve as biomarkers for risk assessment for cerebral palsy (CP). The purpose of this study was to determine whether atypical HR and SpO2 patterns in NICU patients add to clinical variables predicting later diagnosis of CP. Study Design This was a retrospective study including patients admitted to a level IV NICU from 2009 to 2017 with archived cardiorespiratory data in the first 7 days from birth to follow-up at >2 years of age. The mean, standard deviation (SD), skewness, kurtosis and cross-correlation of HR and SpO2 were calculated. Three predictive models were developed using least absolute shrinkage and selection operator regression (clinical, cardiorespiratory and combined model), and their performance for predicting CP was evaluated. Results Seventy infants with CP and 1,733 controls met inclusion criteria for a 3.8% population prevalence. Area under the receiver operating characteristic curve for CP prediction was 0.7524 for the clinical model, 0.7419 for the vital sign model, and 0.7725 for the combined model. Variables included in the combined model were lower maternal age, outborn delivery, lower 5-minute Apgar's score, lower SD of HR, and more negative skewness of HR. Conclusion In this study including NICU patients of all gestational ages, HR but not SpO2 patterns added to clinical variables to predict the eventual diagnosis of CP. Identification of risk of CP within the first few days of life could result in improved therapy resource allocation and risk stratification in clinical trials of new therapeutics. Key Points

BACKGROUND: There are limited evidence-based published blood pressure ranges for premature neonates. The aim of the study was to determine blood pressure ranges in a large cohort of premature neonates based on gestational and post-menstrual age. METHODS: Retrospective observational study of premature neonates admitted to the neonatal intensive care unit at our institution between January 2009 and October 2015. We stratified data by gestational and post-menstrual age groups as well as by method of blood pressure measurement (non-invasive vs. invasive). RESULTS: Over two billion blood pressure values in 1708 neonates were analyzed to generate heat maps and establish percentile-based reference ranges. The median gestational age of the cohort was 31 weeks (IQR 28–33 weeks). We found moderate correlation (r = 0.57) between simultaneously obtained non-invasive and invasive blood pressure measurements. CONCLUSIONS: Our results can serve as a reference during the bedside assessment of the critically-ill neonate.