Four very low birth weight, very premature infants were monitored during a 12° postural elevation using diffuse correlation spectroscopy (DCS) to measure microvascular cerebral blood flow (CBF) and transcranial Doppler ultrasound (TCD) to measure macrovascular blood flow velocity in the middle cerebral artery. DCS data correlated significantly with peak systolic, end diastolic, and mean velocities measured by TCD (pA =0.036, 0.036, 0.047). Moreover, population averaged TCD and DCS data yielded no significant hemodynamic response to this postural change (p>0.05). We thus demonstrate feasibility of DCS in this population, we show correlation between absolute measures of blood flow from DCS and blood flow velocity from TCD, and we do not detect significant changes in CBF associated with a small postural change (12°) in these patients.

Electrographic seizures are common in neonates with hypoxic-ischemic encephalopathy, but detailed data are not available regarding seizure incidence during therapeutic hypothermia. The objective of this prospective study was to determine the incidence and timing of electrographic seizures in term neonates undergoing whole-body therapeutic hypothermia for hypoxic-ischemic encephalopathy as detected by conventional full-array electroencephalography for 72 hours of therapeutic hypothermia and 24 hours of normothermia. Clinical and electroencephalography data were collected from 26 consecutive neonates. Electroencephalograms were reviewed by 2 pediatric neurophysiologists. Electrographic seizures occurred in 17 of 26 (65%) patients. Seizures were entirely nonconvulsive in 8 of 17 (47%), status epilepticus occurred in 4 of 17 (23%), and seizure onset was in the first 48 hours in 13 of 17 (76%) patients. Electrographic seizures were common, were often nonconvulsive, and had onset over a broad range of times in the first days of life.

Within this large contemporary cohort of newborns with perinatal HIE, the application of therapeutic hypothermia and associated neurodiagnostic studies appear to have expanded relative to reported clinical trials. Although seizure incidence and mortality were lower compared with those reported in the trials, it is unclear whether this represented improved outcomes or therapeutic drift with the treatment of milder disease.

Objective To evaluate the temperature distribution among moderately preterm (MPT, 29–33 weeks) and extremely preterm (EPT, <29 weeks) infants upon neonatal intensive care unit (NICU) admission in 2012–2013, the change in admission temperature distribution for EPT infants between 2002–2003 and 2012–2013, and associations between admission temperature and mortality and morbidity for both MPT and EPT infants. Study design Prospectively collected data from 18 centers in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network were used to examine NICU admission temperature of inborn MPT and EPT infants. Associations between admission temperature and mortality and morbidity were determined by multivariable logistic regression. EPT infants from 2002–2003 and 2012–2013 were compared. Results MPT and EPT cohorts consisted of 5818 and 3213 infants, respectively. The distribution of admission temperatures differed between the MPT vs EPT (P < .01), including the percentage <36.5°C (38.6% vs 40.9%), 36.5°C–37.5°C (57.3% vs 52.9%), and >37.5°C (4.2% vs 6.2%). For EPT infants in 2012–2013 compared with 2002–2003, the percentage of temperatures between 36.5°C and 37.5°C more than doubled and the percentage of temperatures >37.5°C more than tripled. Admission temperature was inversely associated with in-hospital mortality. Conclusions Low and high admission temperatures are more frequent among EPT than MPT infants. Compared with a decade earlier, fewer EPT infants experience low admission temperatures but more have elevated temperatures. In spite of a change in distribution of NICU admission temperature, an inverse association between temperature and mortality risk persists.

BACKGROUND Extremely preterm infants (EPT, <29 weeks’ gestation) represent only 0.9% of births in the U.S., yet these infants are focus of most published research. Moderately preterm neonates (MPT, 29–336/7 weeks), are an understudied group of high-risk infants. METHODS Objective: To determine the neonatal outcomes of MPT across the gestational age spectrum, and to compare these to EPT. A prospective observational cohort was formed in 18 Level 3–4 NICUs in the Eunice Kennedy Shriver NICHD Neonatal Research Network. Participants included all MPT admitted to NICUs, and all EPT born at sites between January 2012 and November 2013. Antenatal characteristics, and neonatal morbidities were abstracted from records using pre-specified definitions by trained neonatal research nurses. RESULTS MPT infants experienced morbidities similar to, although at lower rates, than EPT infants. The main cause of mortality was congenital malformation, accounting for 43% of deaths. CNS injury occurred including intraventricular hemorrhage. Most MPT required respiratory support but sequelae such as bronchopulmonary dysplasia were rare. The primary contributors to hospitalization beyond 36 weeks’ gestation were inability to achieve adequate oral intake and persistent apnea. CONCLUSIONS MPT experience morbidity and prolonged hospitalization. Such morbidity deserves focused research to improve therapeutic and prevention strategies.

Background: Subcutaneous fat necrosis (SCFN) of the newborn is a form of panniculitis that affects full-term neonates who often have suffered either birth asphyxia or hypothermia. The induction of hypothermia in newborns is becoming frequently used to reduce the neurologic sequelae associated with birth asphyxia. The risk of SCFN in neonates undergoing this therapy is unknown.Observation: We describe a neonate who developed an abscesslike presentation of SCFN and subsequent asymp-tomatic hypercalcemia after undergoing whole-body cooling for hypoxic-ischemic encephalopathy.Conclusions: Hypothermia protocols may be placing newborns at increased risk for the development of SCFN. Clinicians should recognize this association, and newborns who undergo therapeutic cooling should have frequent dermatologic assessments.

Characteristics of decisions influence preferences for control over medical decisions among parents of patients in the NICU. These insights may guide improvements in physician-parent communication and consent.

Objective: A bedside method for assessing the effectiveness of strategies to improve cerebral development in very premature infants is desirable. The aim of this study was to compare the growth trajectory of the corpus callosum on cranial ultrasound in very premature infants and compare it with the growth rate seen antenatally. Methods: We recruited 100 very low birth weight infants admitted to a single regional Level III neonatal intensive care unit from November 1998 to November 2000. Sixty-four (32 boys) infants, mean gestational age 28 weeks (range 23-33 weeks), had cranial ultrasound images of the corpus callosum adequate for measurement obtained in the first week of life and at term equivalent. The length of corpus callosum was identified as the most reproducible measurement in a subgroup of 16 infants. The growth rate of the corpus callosum was compared in the 64 study infants to the expected growth rate of 0.20-0.27 mm/day from antenatal data; and correlated with clinical outcome at two years of age in 55 infants using Mental Development Index and Psychomotor Development Index. Results: The average growth rate of the corpus callosum was half the rate expected from antenatal data. Mean growth rates were similar for all age ranges (p = 0.4); 0.12 mm/day (0.07-0.17) for the 9 infants born at 23-25 weeks' gestation; 0.11 mm/day (0.06-0.18) for the 35 infants born at 26-29 weeks; 0.11 mm/day (0.05-0.29) for the 20 born at 30-33 weeks. Growth rate of the corpus callosum was greater in infants who had antenatal steroids (p = 0.02) or who were born IUGR (p = 0.04). There was no correlation with gender, PROM, multiple birth; or BPD or indomethicin postnatally. There was poor correlation with mental and psychomotor outcome. Conclusion: Measurement of the length of the corpus callosum at cranial ultrasound is reproducible. The length of corpus callosum grows at a much lower rate postnatally than in utero among very premature infants.