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Hypoxic-ischaemic encephalopathy (HIE) in the newborn baby is a major contributor to neonatal mortality and morbidity across the world. Therapeutic hypothermia (HT) is the current standard treatment for moderate to severe HIE, but not all babies benefit. Potential neuroprotective actions of PROG include anti-apoptotic, anti-inflammatory and anti-oxidative effects and reduction of energy depletion, tissue/cellular oedema and excitotoxicity. In pre-clinical studies of neonatal HIE, progesterone (PROG) has neuroprotective properties, but has not been the subject of systematic review. Here our objective was to evaluate the evidence base for PROG as a potential therapeutic agent in HIE. The PICO framework was used to define the following inclusion criteria; Population: human neonates with HIE/Animal models of HIE, Intervention: PROG +/- other agents, Comparison: V.S. control, Outcome: pathological, neurobehavioural and mechanistic outcome measures. Medline, EMBASE and CINHAL were then searched between August to October 2018 using pre-defined medical subject heading and key words. Study inclusion, data extraction and risk of bias (ROB) analysis using the SYRCLE ROB tool were carried out by two authors. 14 studies were included in the review. They typically displayed a high ROB. This systematic review suggests that PROG had positive effects on neuropathology and reduced neurobehavioural deficits post-hypoxic-ischaemic (HI) injury. However, there was sex dimorphism in the effects of PROG. In addition, there are limitations and biases in these studies and there remains a need for well-designed large pre-clinical studies with greater methodological quality to further inform the efficacy, safety, dose, timing and frequency of PROG administration. With such data, large animal studies could be planned combining PROG administration with and without HT.

Summary Background The WHO VISION 2020 global initiative against blindness, launched in 2000, prioritised childhood visual disability by aiming to end avoidable childhood blindness by 2020. However, progress has been hampered by the global paucity of epidemiological data concerning childhood visual disability. The British Childhood Visual Impairment and Blindness Study 2 (BCVIS2) was done to address this evidence gap. Methods BCVIS2 was a prospective UK-wide, cross-sectional, observational study to establish an inception cohort of children newly diagnosed with visual impairment. Ophthalmologists and paediatricians reported cases from 89 hospitals and community centres across the UK. We included children aged 18 years or younger who were newly diagnosed with any condition causing impaired visual acuity to a level of 0·5 logMAR or worse (worse than 6/18 Snellen) in each eye, or equivalent vision as assessed by standard qualitative measures, between Oct 1, 2015, and Nov 1, 2016. Eligible children were notified simultaneously but independently by their managing ophthalmologists and paediatricians via the two national active surveillance schemes, the British Ophthalmological Surveillance Unit and the British Paediatric Surveillance Unit. Standardised detailed demographic, socioeconomic, and clinical data about detection, management, and treatment were collected at diagnosis and 1 year later. We calculated incidence estimates and relative rates by key sociodemographic factors. We did descriptive analyses of underlying ophthalmic disorders and non-ophthalmic comorbidities. Findings 61 (7%) of 845 eligible children initially notified were ineligible at follow-up because of improved vision after treatment. Thus, the study sample comprised 784 children with permanent newly-diagnosed all-cause visual impairment, severe visual impairment, or blindness. 559 (72%) of 778 children had clinically significant non-ophthalmic impairments or conditions. 28 (4%) of 784 children died within a year after diagnosis of visual disability (all had underlying systemic disorders). Incidence of visual disability in the first year of life was 5·19 per 10 000 children (95% CI 4·71–5·72), almost ten times higher than among 1-to-4-year-olds and between 20 times and 100 times higher than in the older age groups. The overall cumulative incidence (or lifetime risk) of visual impairment, severe visual impairment, or blindness was 10·03 per 10 000 children (9·35–10·76). Incidence rates were higher for those from any ethnic minority group, the lowest quintile of socioeconomic status, and those born preterm or with low birthweight. 345 (44%) of 784 children had a single affected anatomical site. Disorders of the brain and visual pathways affected 378 (48%) of 784 children. Interpretation BCVIS2 provides a contemporary snapshot of the heterogeneity, multi-morbidity, and vulnerability associated with childhood visual disability in a high-income country. These findings could facilitate developing and delivering health care and planning of interventional research. Our findings highlight the importance of including childhood visual disability as a sentinel event and metric in global child health initiatives. Funding Fight for Sight, National Institute for Health Research, and Ulverscroft Foundation.

ObjectiveTo describe temporal changes in inhaled nitric oxide (iNO) use in English neonatal units between 2010 and 2015.DesignRetrospective analysis using data extracted from the National Neonatal Research Database.SettingAll National Health Service neonatal units in England.PatientsInfants of all gestational ages born 2010–2015 admitted to a neonatal unit and received intensive care.Main outcome measuresProportion of infants who received iNO; age at initiation and duration of iNO use.Results4.9% (6346/129 883) of infants received iNO; 31% (1959/6346) were born 34 weeks of gestation. Between epoch 1 (2010–2011) and epoch 3 (2014–2015), there was (1) an increase in the proportion of infants receiving iNO: 34 weeks (4.5% vs 5.0%), (2) increase in postnatal age at iNO initiation: ConclusionsBetween 2010 and 2015, there was an increase in the use of iNO among infants admitted to English neonatal units. This was most notable among the most premature infants with an almost fourfold increase. Given the cost of iNO therapy, limited evidence of efficacy in preterm infants and potential for harm, we suggest that exposure to iNO should be limited, ideally to infants included in research studies (either observational or randomised placebo-controlled trial) or within a protocolised pathway. Development of consensus guidelines may also help standardise practice.

OBJECTIVE: To describe the nature and frequency of posterior fossa (PF) lesions in infants who underwent magnetic resonance (MR) brain imaging in the neonatal period and to correlate with cranial ultrasound (CUS) findings and clinical outcome. STUDY DESIGN: A retrospective review of all neonatal MR brain imaging from 1996 to 2001 (n=558). MR images, CUS and case notes were reviewed in infants with PF abnormality. RESULTS: A total of 20 infants had abnormalities in the PF, which represents 4.7% of abnormalities seen on MR. Out of 10, six term infants had PF extra-axial hemorrhage, three had cerebellar hypoplasia, while one had cerebellar hemorrhage. In the preterm, 8/10 lesions were unilateral; focal cerebellar hemorrhage was seen in 5/10 and extensive hemorrhage with secondary atrophy in 3/10. Out of 20, 17 infants also had supratentorial lesions. Out of 20, 19 had CUS performed, of which 7/19 showed PF abnormality. CONCLUSION: Intracerebellar hemorrhage was more common in preterm infants than in term infants. These hemorrhages tended to be focal, unilateral and were associated with atrophy.

A full-term baby girl weighing 2.9 kg was born by normal delivery. The anomaly scan at 20 weeks (including a 3D facial scan) was normal. She was born in good condition, but was noticed to have bilateral purple-coloured tense mobile, non-pulsatile masses below the medial canthus (figure 1). Figure 1 Bilateral masses below …