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Objective:The objective of the study was whether temperature management during therapeutic hypothermia correlates with the severity of brain injury assessed on magnetic resonance imaging in term infants with hypoxic-ischemic encephalopathy.Study Design:Prospectively collected register data from the National Asphyxia and Cooling Register of Switzerland were analyzed.Result:Fifty-five newborn infants were cooled for 72 h with a target temperature range of 33 to 34 °C. Individual temperature variability (odds ratio (OR) 40.17 (95% confidence interval (CI) 1.37 to 1037.67)) and percentage of temperatures within the target range (OR 0.95 (95% CI 0.90 to 0.98)) were associated with the severity of brain injury seen on magnetic resonance imaging (MRI). Neither the percentage of measured temperatures above (OR 1.08 (95% CI 0.96 to 1.21)) nor below (OR 0.99 (95% CI 0.92 to 1.07) the target range was associated with the severity of brain injury seen on MRI.Conclusion:In a national perinatal asphyxia cohort, temperature variability and percentage of temperatures within the target temperature range were associated with the severity of brain injury.

Background:Indwelling arterial catheters (IACs) are used for monitoring and blood sampling purposes in intensive care units. Very limited information is available on the incidence and risk factors of IAC‐related thrombosis in children. Objective:To investigate the incidence and predictors of IAC‐related thrombosis in a tertiary care pediatric hospital. Methods:For a period of 12 months, detailed information was prospectively recorded for all consecutive children requiring IACs. Results:Six hundred and fifteen IACs were placed in a total of 473 children at a median age of 0.56 years for a total of 47 440.84 catheter hours. Of the 615 IACs, 418 (68%) were placed in the radial artery, 137 (22%) in the femoral artery, 26 (4%) in the umbilical artery, 11 (2%) in the brachial artery, and 23 (3.7%) in another artery. Thrombosis occurred in 20 cases, reflecting an overall incidence of 3.25%. Eighteen of the 20 IAC‐related thrombi were located in the femoral arteries, reflecting a relative incidence of 13% (18/137). Newborn age, lower body weight, low cardiac output and increased hematocrit were significantly related with an increased risk of femoral artery thrombosis. In logistic regression analysis, younger age (P < 0.001, odds ratio 6.51) was independently associated with an increased thrombotic risk. Conclusions:This study demonstrates that arterial thrombosis occurs with an increased incidence in children requiring IACs in the femoral location. Younger age is independently associated with an increased risk of thrombosis. The radial location is safe, and should be preferred to the femoral location.

Background: It is unclear whether hyperglycemia after infant cardiac surgery adversely affects neurodevelopmental outcome.Methods: Secondary analysis of a prospective cohort study on neurodevelopmental outcome after infant cardiac surgery. Exclusion criteria were: older than one year of age at first surgery, genetic disorders or dysmorphic syndromes and birth weight < 2000 grams and postoperative death. Of 368 children, 172 met inclusion criteria. Ten children did not yet return for the one year follow up examination and two were lost to follow-up. Follow-up examination at four years was available for 56 children, the remaining children were too young. Postoperative highest and lowest glucose levels within 24 hours after bypass surgery were prospectively collected. Neurodevelopmental outcome at one year of age was assessed with the Bayley Scales of Infant Development II (Mental Developmental Index-MDI, Psychomotor Developmental Index-PDI) in 160 children and at four years with the WPPSI.Results: Mean age at surgery was 2.9 months (0.1-10.7 months). Mean highest postoperative glucose values were 12.76 (SD 4.9), mean lowest were 6.82 (SD 1.9). Glucose values normalized in all children within 48 hours, seven children (4%) received insulin infusions. Postoperative highest and lowest glucose levels were not associated with neurodevelopmental outcome at one year or at four years, whereas more abnormal preoperative neurological findings were associated with poorer one-year outcome (MDI p< 0.001, PDI=0.03).Conclusion: In our population glucose values normalized within 48 hours and had no adverse effect on neurodevelopmental outcome.