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Background: Perinatal asphyxia may be followed by multiple organ dysfunction (MOD) and is often included in prognostication of the individual patient, but evidence of discriminating accuracy is lacking. The aim of this study was to assess whether MOD in asphyxiated neonates during therapeutic hypothermia (TH) predicts mortality or neurodevelopmental impairment (NDI) at 24 months of age and which peripartum variables are associated with the onset of MOD., Methods: A retrospective analysis of a prospective cohort study of asphyxiated newborns undergoing TH was performed. MOD was defined as dysfunction of the brain (encephalopathy) combined with two or more organ systems. Outcome was routinely assessed by standardised developmental testing at the age of 24 months. The predictive accuracy of MOD on the combined outcome and its components (death and NDI) was expressed as areas under the receiver operating characteristic curves (AUROCs). The associations of peripartum variables and development of MOD were expressed as ORs and their CIs., Results: 189 infants (median gestation 40 (range 36-42 weeks) with moderate to severe hypoxic ischaemic encephalopathy were included. 47% developed MOD. The prediction of the combined 24-month outcome or its components showed AUROCs <0.70. Associated with MOD were pH at birth (OR 0.97, CI 0.95 to 0.99), lactate at birth (OR 1.09, CI 1.04 to 1.15), Base Excess (BE) at birth (OR 0.94, CI 0.90 to 0.99) and epinephrine administration during resuscitation (OR 2.09, CI 1.02 to 4.40)., Conclusion: MOD has a low discriminating accuracy in predicting mortality or NDI at 24 months age and might not be useful for prognostication. Signs of acid-base disturbance and adrenalin use at birth are associated with the development of MOD., Competing Interests: Competing interests: TRdH reports grants from The Netherlands Organization for Health Research and Development ZonMW during the conduct of the study., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Posthaemorrhagic ventricular dilatation (PHVD) is a serious complication of prematurity with subsequent disabilities. The diagnostic and therapeutic approaches to PHVD vary among neonatal centres., Aim: To gain more insight into the different diagnostic criteria and treatment policies on PHVD among neonatal intensive care units across Europe. Methods A PHVD questionnaire was designed and sent to neonatologists in 37 European centres., Results: A response was obtained from 32/37 (86%) centres located in 17 European countries. An overall estimated incidence of 7% was reported for severe intraventricular haemorrhages (grades III or IV according to Papile) among premature neonates born below 30 weeks' gestation. Approximately half of these infants developed PHVD, of whom three-quarters required intervention. Ultrasound measurements of ventricular size were most commonly used to diagnose PHVD (94%). No consensus existed on which ventricular parameters needed to be enlarged and when to start treatment of PHVD. Early intervention (ie, initiated after the ventricular index (VI) exceeded the 97th percentile (p97) according to Levene) was provided in 8/32 centres (25%), whereas 23/32 centres (72%) first started therapy once the VI had crossed the p97+4 mm line and/or when neonates presented with a progressive increase in head circumference or with clinical symptoms of raised intracranial pressure. Wide variation was seen with respect to the applied therapy modalities for cerebrospinal fluid drainage., Conclusion: This survey shows that diagnostic and therapeutic approaches to neonates with PHVD vary considerably. Uniform diagnostic criteria would facilitate studies to assess optimal timing and mode of intervention.

Objective: To describe different patterns of associated brain lesions in preterm and full-term infants with cerebral sinovenous thrombosis (CSVT) and to assess whether these different patterns are related to gestational age at onset., Design: Magnetic resonance scans of all neonates (six preterm, 24 full term) with suspected CSVT, collected over a 7-year period in two neonatal intensive care units, were evaluated to assess patterns of associated brain lesions. Comparisons between the two gestational age groups were made., Results: CSVT was confirmed on magnetic resonance venography in 26 of 30 neonates (six preterm, 20≥36 weeks' gestational age). The straight (85%) and superior sagittal (65%) sinus were most often affected. Several sinuses were involved in 81% of infants. White matter damage affecting the entire periventricular white matter was seen in five of six preterm infants. Intraventricular haemorrhage (IVH) was common in both groups (4/6 preterm, 16/20 full term). Frontal punctate white matter lesions with restricted diffusion (15/20) and thalamic haemorrhage associated with IVH (11/20) were the most frequent lesions in full-term infants. Focal arterial infarction was present in four of 20 full-term infants. Six infants died in the neonatal period (four preterm, two full term). Follow-up MRIs at 3 months in all survivors showed evolution of the lesions with frontal atrophy in 13 of 20 (12 full term) and delayed myelination in seven of 20 (six full term)., Conclusions: Preterm and full-term neonates show different patterns of associated brain lesions. Extensive white matter damage is the predominant pattern of injury in the preterm infant, while an IVH associated with a thalamic haemorrhage and punctate white matter lesions are more common in the full-term infant.

Objectives: To describe 2-year neurodevelopmental outcome (NDO) in a cohort of extremely low birthweight infants, and compare NDO between two consecutive 5-year periods and between appropriate (AGA, ≥p10) and small for gestational age (SGA, -1 Z score ≤-2) or severely delayed (Z score >-2)., Results: 74.3% of the children had a normal NDO at 2 years corrected age, 20.8% a mildly and 5% a severely delayed outcome. Although survival significantly increased with time (65.8% to 88.1%, p=0.002), significantly fewer children in cohort II (66.1% vs 84.4% in cohort I, p=0.042) as well as fewer SGA children (64.3% vs 86.7% of AGA children, p=0.012) had a normal NDO., Conclusions: Increased survival of infants with a birth weight ≤750 g coincided with more children with an impaired NDO at 2 years corrected age. SGA infants are especially at risk of impaired NDO.

Aim: To assess the prognostic value of amplitude integrated EEG (aEEG) 3 and 6 hours after birth., Methods: Seventy three term, asphyxiated infants were studied (from two different centres), using the Cerebral Function Monitor (CFM Lectromed). The different aEEG tracings were compared using pattern recognition (flat tracing mainly isoelectric (FT); continuous extremely low voltage (CLV); burst-suppression (BS); discontinuous normal voltage (DNV); continuous normal voltage (CNV)) with subsequent outcome., Results: Sixty eight infants were followed up for more than 12 months (range 12 months to 6 years). Twenty one out of 68 infants (31%) showed a change in pattern from 3 to 6 hours, but this was only significant in five cases (24%). In three this changed from BS to CNV with a normal outcome. One infant showed a change in pattern from CNV to FT and had a major handicap at follow up. Another infant showed a change in pattern from DNV to BS, and developed a major handicap at follow up. The other 16 infants did not have any significant changes in pattern: 11 infants had CLV, BS, or FT at 3 and 6 hours and died (n = 9) in the neonatal period or developed a major handicap (n = 2). Five infants had a CNV or DNV pattern at 3 and 6 hours, with a normal outcome. The sensitivity and specificity of BS, together with FT and CLV, for poor outcome at 3 hours was 0.85 and 0.77, respectively; at 6 hours 0.91 and 0.86, respectively. The positive predictive value (PPV) was 78% and the negative predictive value (NPV) 84% 3 hours after birth. At 6 hours the PPV was 86% and the NPV was 91%., Conclusion: aEEG could be very useful for selecting those infants who might benefit from intervention after birth asphyxia.

Aim: To examine the spectrum of neurological dysfunction and perceptual-motor difficulties at school age in a cohort of prematurely born children, and the relation of these measures to neonatal brain lesions, intelligence quotient, and behavioural adjustment., Method: One hundred and eighty three children were tested at the age of 6 years using Touwen's Examination of the Child with Minor Neurological Dysfunction, the Movement Assessment Battery for Children (Movement ABC), the Developmental Test of Visual-Motor Integration (VMI), British Ability Scales, and Rutter Scales., Results: Twenty six children had definite cerebral palsy and one was blind. Of the remaining 156, the proportions falling below the 15th centile point were 31% on Touwen's Examination, 44% on the Movement ABC, and 17% on the VMI. Forty two passed all three tests. No child with a normal ultrasound scan developed cerebral palsy, whereas nearly all those with major lesions did. Minor lesions, however, were not generally predictive of later outcome. Correlations between the tests were generally low., Conclusions: These findings stress the need to assess neurological and perceptual motor functioning separately at school age and to monitor relationships with other aspects of development.