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(1) Birth asphyxia is the major cause for delivery room resuscitation. Subsequent organ failure and hypoxic-ischemic encephalopathy (HIE) account for 25% of all early postnatal deaths. The neonatal Sequential Organ Failure Assessment (nSOFA) considers platelet count, respiratory and cardiovascular dysfunction in neonates with sepsis. To evaluate whether nSOFA is also a useful predictor for in-hospital mortality in neonates (≥ 36+0 weeks of gestation (GA)) following asphyxia with HIE and therapeutic hypothermia (TH), (2) nSOFA was documented at ≤ 6 hours of life. (3) 65 infants fulfilled inclusion criteria for TH. All but one infant received cardiopulmonary resuscitation and/or respiratory support at birth. nSOFA was lower in survivors (median 0 [IQR 0-2]; n = 56, median GA 39+3, female n = 28 (50%)) than in non-survivors (median 10 [4-12], p < 0.001; n = 9, median GA 38+6, n = 4 (44.4%)). This was also observed for the respiratory (p < 0.001), cardiovascular (p < 0.001), and hematologic sub scores (p = 0.003). The odds ratio for mortality was 1.6 [95% CI = 1.2 – 2.1] per one-point increase in nSOFA. The optimal cut-off value of nSOFA to predict mortality was 3.5 (sensitivity 100.0%, specificity 83.9%). (4) Since early accurate prognosis following asphyxia with HIE and TH is essential to guide end-of-life decisions, nSOFA (≤ 6 hours of life) offers the potential to identify infants at risk of mortality.

Aim To create a magnetic resonance imaging (MRI)-based scoring system specific to neonates born preterm with intraventricular haemorrhage (IVH), which could serve as a reliable prognostic indicator for later development and might allow for improved outcome prediction, individually-tailored parental counselling, and clinical decision-making. Method This retrospective, two-center observational cohort study included 103 infants born preterm with IVH (61 males, 42 females; median gestational age 26wks 6d), born between 2000 and 2016. Term-equivalent MRI was evaluated using a novel scoring system consisting of 11 items. A total MRI score was calculated and correlated with neurodevelopment between 2 years and 3 years of age. Prediction models for outcome were defined. Results The proposed MRI scoring system showed high correlation and strong predictive ability with regard to later cognitive and motor outcome. The prediction models were translated into easy-to-use tables, allowing developmental risk assessment. Interpretation The proposed MRI-based scoring system was created especially for infants born preterm with IVH and enables a comprehensive assessment of important brain areas as well as potential additional abnormalities commonly associated with IVH. Thus, it better represents the severity of brain damage when compared with the conventional IVH classification. Our scoring system should provide clinicians with valuable information, to optimize parental counselling and clinical decision-making.

In the perinatal period the developing brain is extremely vulnerable for a variety of insults. Perinatal conditions, such as extreme prematurity, perinatal asphyxia, and their complications can lead to lifelong sensorimotor, cognitive and behavioral impairment. Prediction of long-term neurodevelopment of preterm and ill term infants at risk for brain injury at an early stage remains a big challenge. Identification of brain lesions and disturbed function is essential for an accurate diagnosis. Currently, the prediction of the outcome is based on a variety of diagnostic tools and clinical assessment of developmental milestones. Several methods for early diagnosis and neuromonitoring of brain injury are available, such as cerebral ultrasound, magnetic resonance imaging (MRI) at term-equivalent age as well as neuromonitoring tools, such as amplitude-integrated electroencephalography (aEEG) and/or conventional EEG and near-infrared spectroscopy (NIRS), general movements assessment (GMA) and clinical assessment by, e.g., the Hammersmith neonatal/infant neurological examination (HNNE/HINE), all of which require substantial personnel and also technical resources. As better biomarkers are urgently needed scientific investigations currently focus on identification of innovative biomarker patterns (omics) and (epi)genetic markers. Furthermore, the individual child's development is determined not only by clinical risk factors, such as associated diseases but also by the socioeconomic environment. Estimation of the most accurate and early prognosis is cost-intensive, but crucial to adequately guide patients and counsel families. The initiation of early interventions is important as the plasticity of the developing brain is highest around birth and in the first few months of life. This review focuses on the characterization of the abovementioned diagnostic tools and the possibilities for combination for outcome prognosis. In addition, an outlook is given on how new technologies can facilitate the prediction of development and follow-up care of these children following perinatal brain injury.

Background and Purpose: Associations of APOE genotypes with intracerebral hemorrhage (ICH) in preterm infants were previously described. In adults, APOE-ε4 genotype has been proposed as susceptibility factor for impaired recovery after cerebral insult. We here aim to determine APOE genotype-specific neurological consequences of neonatal ICH at school age. Methods: In this multicenter observational cohort study, very low birth weight ( Results: Two thousand two hundred fifteen children participated at follow-up, including 363 children with ultrasound diagnosed neonatal ICH. In univariate analyses of children with a history of ICH, APOE-ε3 carriers had lower frequencies of CP (n=33/250; 13.2 [95% CI, 9.4%–17.8%]), as compared to APOE-ε2 (n=15/63; 23.8 [14.6%–35.3%], P =0.037) and –ε4 carriers (n=31/107; 29.0 [21.0%–38.0%], P P =0.002) after ICH. Notably, at low-grade ICH (grade I) APOE-ε4 expression resulted in an increased rate of CP (n=6/39; 15.4 [6.7–29.0]) in comparison to APOE-ε3 (n=2/105; 1.9 [0.4%–6.0%], P =0.002). Conclusions: APOE-ε4 carriers have an increased risk for long-term motor deficits after ICH. We assume an effect even after low-grade neonatal ICH, but more data are needed to clarify this issue.

Zusammenfassung Hintergrund Fortschritte in der perinatalen Versorgung haben zu einer Senkung der Mortalität sehr unreifer Frühgeborener (FG) geführt bei gleichzeitig unveränderter Langzeit-Morbidität. Die Sozialmedizinische Nachsorge (SMN) ist eine interdisziplinäre Begleitung der Familien zur Sicherstellung des Behandlungserfolges, Verkürzung des stationären Aufenthaltes und Vermeidung von Wiederaufnahmen. Der G-BA fordert in der Qualitätssicherungs-Richtlinie (QFR-RL) u. a. die Sicherstellung der ambulanten Versorgung. Fragestellung Die vorliegende Studie untersuchte, inwieweit Effekte durch die Umsetzung des G-BA Beschlusses bei den Leistungserbringern wahrgenommen wurden. Methodik Es wurde eine explorative Umfrage in 101 Einrichtungen durchgeführt, die SMN nach §43 Abs. 2 SGB V anbieten. Die Fallzahlen wurden mit den Daten aus dem Wirkungsbericht des Bundesverbandes Bunter Kreis e.V. und der Neonatalerhebung des IQTIG verglichen. Ergebnisse Es wurden 53 (52,4%) Datensätze von Teilnehmern aus 9 Bundesländern ausgewertet. 56,6% nehmen Effekte in der Praxis war. Es wurden neue Einrichtungen etabliert (24,5%, n=13), mehr Personal angestellt (17%, n=9) und mehr FG versorgt (18,9%, n=10). Die Fallzahlen zeigen in 2017 eine Versorgungsquote von 24%. Schlussfolgerung Mehr als die Hälfte der Teilnehmer nehmen Effekte durch die Umsetzung der QFR-RL wahr. Im Gegensatz dazu zeigt sich statistisch kein Unterschied auf Bundesebene in den Fallzahlen für 2016/2017. Eine auskömmliche Finanzierung sowie eine Versorgung müssen flächendeckend zur Umsetzung der QFR-RL realisiert werden.

Background: Preterm infants are at increased risk of neurodevelopmental impairment due to the vulnerability of the immature brain. Early risk stratification is necessary for predicting outcome in the period of highest neuroplasticity. Several biomarkers in magnetic resonance imaging (MRI) at term equivalent age (TEA) have therefore been suggested. Objective: To assess the predictive value of simple brain metrics and the total abnormality score (TAS) – a modified score for brain injury and growth – in relation to neurodevelopmental outcome of very preterm infants in MRI at TEA. Methods: Single-centre cohort study including preterm infants with gestational age (GA) ≤32 weeks and birth weight ≤1,500 g. Biparietal width (BPW), interhemispheric distance, transcerebellar diameter (TCD) and TAS were assessed. To detect subtle haemorrhages, additional susceptibility-weighted imaging (SWI) was used in addition to conventional MRI to evaluate its clinical relevance. Neurodevelopment was tested by the Mental and Psychomotor Developmental Index (MDI/PDI) of the Bayley Scales of Infant Development II at a corrected age of 24 months. Results: One hundred twenty-nine children with median GA of 28.1 weeks and median birth weight of 980 g were included. BPW significantly correlated with PDI (p= 0.01, R2 = 0.06) and TCD with MDI (p < 0.01, R2 = 0.05) and PDI (p < 0.01, R2 = 0.06) but explained variances were low. TAS was not predictive of neurodevelopmental outcome. By using SWI, additional 4 cases of low grade haemorrhages were identified compared to conventional sequences. In one case this additional information was clinically relevant (MDI/PDI below average). Conclusion: Simple brain metrics and TAS did not reliably predict neurodevelopmental outcome in a cohort with low prevalence of high grade brain injury. The additional value of SWI is yet to be determined in larger cohorts. The combination of imaging and functional biomarkers may be advisable for the prediction of neurodevelopmental outcome.

Very preterm infants more likely exhibit deficient executive functions than term born controls. Delay of gratification, as part of the executive functions, allows for rejecting an immediate in favor of a greater future reward. Time comprehension might help to delay gratification.We hypothesized that delay of gratification and time comprehension is less developed in preterm children and that time comprehension is associated with the ability to wait for a greater reward.Very preterm children (32weeks' gestation) and term born controls were tested for receptive language skills, time comprehension and delay of gratification at the (corrected) age of 4years.25 preterm subjects (12 female; median: gestational age (GA) 28.3weeks, corrected age 4years, 22days) and 26 controls (16 female, median GA: 40.0weeks, age 4years, 25days) participated.Correct answers in the time comprehension and receptive language task, waiting time in the delay-of-gratification task were measured.Preterm subjects had less time comprehension than controls (43% vs. 53%, p=0.017, one-tailed) but receptive language skills were similar. Waiting time in the delay-of-gratification task was 3:42min in preterm subjects, versus 10:09min in controls (p=0.043, one-tailed). Even after controlling for language skills, waiting time correlated positively with time comprehension in both groups (r=0.399, p=0.004, two-tailed).Preterm children's time comprehension and delay of gratification ability is impaired. Future research is warranted to investigate whether training in time comprehension increases the ability to delay gratification.

The Prechtl General Movement Assessment (GMA) has become a cornerstone assessment in early identification of cerebral palsy (CP), particularly during the fidgety movement period at 3&ndash, 5 months of age. Additionally, assessment of motor repertoire, such as antigravity movements and postural patterns, which form the Motor Optimality Score (MOS), may provide insight into an infant&rsquo, s later motor function. This study aimed to identify early specific markers for ambulation, gross motor function (using the Gross Motor Function Classification System, GMFCS), topography (unilateral, bilateral), and type (spastic, dyskinetic, ataxic, and hypotonic) of CP in a large worldwide cohort of 468 infants. We found that 95% of children with CP did not have fidgety movements, with 100% having non-optimal MOS. GMFCS level was strongly correlated to MOS. An MOS &gt, 14 was most likely associated with GMFCS outcomes I or II, whereas GMFCS outcomes IV or V were hardly ever associated with an MOS &gt, 8. A number of different movement patterns were associated with more severe functional impairment (GMFCS III&ndash, V), including atypical arching and persistent cramped-synchronized movements. Asymmetrical segmental movements were strongly associated with unilateral CP. Circular arm movements were associated with dyskinetic CP. This study demonstrated that use of the MOS contributes to understanding later CP prognosis, including early markers for type and severity.

Neurodevelopmental outcome after prematurity is crucial. The aim was to compare two amplitude-integrated EEG (aEEG) classifications (Hellström-Westas (HW), Burdjalov) for outcome prediction. We recruited 65 infants ≤32 weeks gestational age with aEEG recordings within the first 72 h of life and Bayley testing at 24 months corrected age or death. Statistical analyses were performed for each 24 h section to determine whether very immature/depressed or mature/developed patterns predict survival/neurological outcome and to find predictors for mental development index (MDI) and psychomotor development index (PDI) at 24 months corrected age. On day 2, deceased infants showed no cycling in 80% (HW, p = 0.0140) and 100% (Burdjalov, p = 0.0041). The Burdjalov total score significantly differed between groups on day 2 (p = 0.0284) and the adapted Burdjalov total score on day 2 (p = 0.0183) and day 3 (p = 0.0472). Cycling on day 3 (HW; p = 0.0059) and background on day 3 (HW; p = 0.0212) are independent predictors for MDI (p = 0.0016) whereas no independent predictor for PDI was found (multiple regression analyses). Conclusion: Cycling in both classifications is a valuable tool to assess chance of survival. The classification by HW is also associated with long-term mental outcome.What is Known:•Neurodevelopmental outcome after preterm birth remains one of the major concerns in neonatology.•aEEG is used to measure brain activity and brain maturation in preterm infants.What is New:•The two common aEEG classifications and scoring systems described by Hellström-Westas and Burdjalov are valuable tools to predict neurodevelopmental outcome when performed within the first 72 h of life.•Both aEEG classifications are useful to predict chance of survival. The classification by Hellström-Westas can also predict long-term outcome at corrected age of 2 years. OA hybrid

Hintergrund: Die Versorgung Fruhgeborener (FG) hat sich in den letzten Jahrzehnten durch einschneidende medizinische Fortschritte, aber auch auf dem Sektor psychosozialer Betreuung stark gewandelt. Mit dem G-BA-Beschluss erkennt die Politik die Notwendigkeit familienzentrierter Betreuung an. Ziel der Untersuchung: Notwendige zeitliche und personelle Ressourcen an einem Zentrum mit etablierter sektorubergreifender Betreuung zu evaluieren. Methodik: Die Elternberatung/Bunter Kreis betreut FG und kranke Neugeborene (NG) von der Risikoschwangerschaft bis nach Hause mit demselben interdisziplinaren Team. Konzeptanalyse (2011–2014): 1.) Entwicklung der Fallzahlen/ Inanspruchnahme des Betreuungsangebotes 2.) zeitliche Ressourcen, 3.) personelle Ressourcen, 4.) Finanzierung, 5.) okonomische Auswirkungen. Ergebnisse: Vom 1.1.2011–31.12.2014 wurden 441 Falle (2212 vollstationare Falle) beraten. Die Inanspruchnahme durch Familien sehr kleiner FG lag im Mittel (MW) bei 92% (86,4–97,2%). Der zeitliche Aufwand ist bei Kindern mit angeborenen Fehlbildungen am hochsten: Median 13,8 Stunden (h), sehr kleine FG: 11,2 h. Entlassung und ambulante Betreuung beanspruchen die meiste Zeit: Median 7,3 (0–42,5) h. Mit MW 3,1 Vollzeitpflegekraften (mehrere Teilzeitkrafte), konnen MW 48 Familien/Quartal betreut werden. Komplexe Falle wurden durch Krankenkassen teilfinanziert (erfolgreiche Antrage sozialmedizinische Nachsorge: MW 92,7 (79,6–97,7)%). Schlussfolgerung: Die psychosoziale Betreuung sehr kleiner Fruhgeborener wird gut von den Eltern angenommen und liegt zeitlich in einem uberschaubaren Rahmen.

Schon die Pflege eines Sauglings, der regular nach neun Monaten geboren wurde, stellt seine Eltern vor grose Herausforderungen. Diese sind noch um einiges groser, wenn das Baby als Fruhchen zur Welt kommt. Um Muttern und Vatern ihre Aufgabe zu erleichtern, haben die Klinik fur Kinderheilkunde I des UK Essen und die Elternberatung Fruhstart/Bunter Kreis zusammen mit der Westfalischen Hochschule Gelsenkirchen eine „Fruhstart-App“ entwickelt, die Eltern und Pflegende entlastet. Die Eltern von Fruhchen stehen vor besonderen Herausforderungen. Fur ihre Unterstutzung wurde am Universitatsklinikum Essen eine leicht bedienbare App mit den vier Bereichen „Meine Termine“, „Meine Medikamente“, „Meine Entwicklung“ sowie „Mein Tagebuch“ entwickelt. Die App soll den Eltern zum einen dabei helfen, ihren Teil zu einer medizinisch optimalen Versorgung des Kindes zu leisten. Zum anderen soll sie die Eltern psychisch entlasten, indem sie — mit Hilfe der Plattform „Vitabook“ — Familienangehorigen und Freunden die Moglichkeit gibt, auf digitalem Wege an der Entwicklung des Kindes teilzunehmen. Dies geschieht unter strenger Beachtung des Datenschutzes. Die App tragt auch zur Entlastung von Pflegenden und Arzten bei.

BACKGROUND:Experimental studies suggest that platelet-triggered ductal sealing is critically involved in definite ductus arteriosus closure. Whether thrombocytopenia contributes to persistently patent ductus arteriosus (PDA) in humans is controversial. This was a retrospective study of 1350 very low birth weight (VLBW; METHODS:All infants who had a platelet count in the first 24 hours after birth and an echocardiogram performed on day of life 4 to 5 were included. The incidence of thrombocytopenia was analyzed in infants with and without PDA, and in those who did or did not undergo PDA intervention. The impact of thrombocytopenia, gestational age, birth weight, gender, and sepsis on PDA was determined by receiver operating characteristic curve, odds ratio, and regression analyses.RESULTS:Platelet numbers within the first 24 hours after birth did not differ between VLBW/ELBW infants with and without spontaneous ductal closure. Platelet numbers were not associated with subsequent PDA treatment. Low platelet counts were not related to failure of pharma-cologic PDA treatment and the need for subsequent surgical ligation. Lower gestational age or birth weight, male gender, and sepsis were linked to the presence of PDA in VLBW infants on day of life 4 to 5.CONCLUSIONS:Thrombocytopenia in the first 24 hours after birth was not associated with PDA in this largest VLBW/ELBW infant cohort studied to date. Impaired platelet function, due to immaturity and critical illness, rather than platelet number, might play a role in ductus arteriosus patency.

UNLABELLED The aim of this study was to assess whether blood sampling from umbilical artery catheters reduces cerebral blood volume and cerebral oxygenation in very low birthweight infants. A total of 20 infants, median birthweight 890 g (530-1,500 g), median gestation age 26 +4 wk (range: 22 +5 to 30 +6 wk) were studied from 10 min before until 10 min after routine blood sampling from umbilical artery catheters placed in the high position. Using near infrared spectroscopy, changes in concentrations of cerebral oxygenated and deoxygenated haemoglobin were measured, and changes in cerebral blood volume and cerebral oxygenation index were calculated. Heart rate, oxygen saturation, transcutaneous PO2 and PCO2 were registered continuously. Mean arterial blood pressure was measured before and after sampling. Oxygenated haemoglobin decreased significantly from baseline during blood sampling, whereas deoxygenated haemoglobin did not change significantly. This resulted in a decrease in cerebral blood volume and cerebral oxygenation index. Heart rate increased slightly, but significantly, from baseline. Oxygen saturation, blood pressure, transcutaneous PO2 and PCO2 did not change significantly. CONCLUSION Blood sampling from umbilical artery catheters induces a significant decrease in cerebral blood volume and cerebral oxygenation.

Elternberatung Frühstart is a family-centred care programme for very preterm infants and seriously ill neonates and their parents. The uniqueness of this programme is in its consistency and continuity in parental counselling from pregnancy at risk to follow-up home visits.Family-centred care is provided by specialised nurses, a social education worker, a case manager, a psychologist and neonatologists. They give support and information to parents and facilitate transition to home including co-ordination of health care services and support networks. The programme starts with information for parents at risk of preterm delivery to lessen their anxieties and worries. After birth, parental bonding is encouraged and parents are involved in daily care procedures. The following weeks focus on communication, information and education in order to enhance parental competence. Discharge planning and coordinated follow-up visits involve the family doctor and several members of the welfare and health care system. One of the key objectives is to prevent re-hospitalisation. Over a 4 year period 330 families participated. Funding is provided by: 1) the hospital, from admission to discharge equivalent to one full-time nursing staff, 2) charity donations for follow-up visits and 3) health care insurance for social medical aftercare (Bunter Kreis) following §43, 2 SGB V in severe cases.As a result of this programme, the median length of stay was reduced by 24 days; the number of patients that stayed longer than average were reduced by 64% in the group of patients born 1 500 g. At the same time the patient throughput increased from 243 to 413.To conclude, a family-centred care programme with coordinated follow-up increases parental satisfaction, reduces the length of the hospital stay and is therefore profitable.

Background: Surgical closure of a patent ductus arteriosus (PDA) in very low birth weight (VLBW) infants has been associated with impaired neurodevelopmental outcome. Surgical PDA closure may result in abrupt changes of cerebral haemodynamics. Objective: To examine the cerebral blood volume changes occurring after surgical closure of PDA. Design: Continuous cerebral near-infrared spectroscopy (NIRS) recording throughout PDA surgery. Setting: Tertiary neonatal intensive care unit, with PDA surgery performed on the ward. Patients: Ten VLBW infants, median birth weight 748 g (range 590–1070), gestational age 24 (23–27) weeks, chronological age 14 (12–22) days. Intervention: Surgical closure of PDA. Main outcome measures: Changes in cerebral oxygenated haemoglobin, cerebral deoxygenated haemoglobin, and tissue oxygenation index (measured), changes in cerebral blood volume (CBV) and cerebral haemoglobin difference (calculated) as measured by NIRS. Results: During the first 2 minutes after closure of the PDA, CBV increased significantly (mean (SD) 0.14 (0.12) ml/100 g tissue; p = 0.01) and returned to baseline within 2–5 minutes. Cerebral oxygenation did not change. Conclusions: There is a short-lasting increase in CBV immediately after surgical closure of PDA, but no change in cerebral oxygenation. These transient changes are unlikely to cause harm.

Aim: We have shown previously that blood sampling via umbilical artery catheters decreases cerebral oxygenation and cerebral blood volume in preterm infants. To evaluate alternative methods, we assessed the effects of blood sampling via umbilical vein catheters in a cohort of preterm infants. Methods: Twenty neonates (median birth weight 900 g [range 410–1900 g], median gestational age 27 weeks [24–31 weeks]) were studied during routine blood sampling via umbilical vein catheters by near-infrared spectroscopy. Tissue oxygenation index and changes in concentrations of cerebral oxygenated and deoxygenated haemoglobin were measured and changes in cerebral oxygenation and cerebral blood volume were calculated. Oxygen saturation and heart rate were recorded simultaneously. Results: There was a significant drop of cerebral oxygenation (−2.135 ± 0.532 μmol/L) and cerebral blood volume (−0.037 ± 0.019 mL/100 g tissue) during umbilical vein blood sampling. Although peripheral arterial oxygen saturation remained unchanged, cerebral tissue oxygenation index decreased from 64.8 ± 2.5% to 62.4 ± 2.6% (p < 0.01), accompanied by a slight increase in heart rate (from 140 ± 2.9 to 144 ± 2.9 beats/min, p < 0.01). Conclusions: Umbilical vein blood sampling reduces cerebral oxygenation and cerebral blood volume. The magnitude of the effects is similar to those during umbilical artery blood sampling.

Aim: Blood sampling from umbilical artery catheters decreases cerebral blood volume and cerebral oxygenation. The aim of this study was to assess the impact of sampling volume and velocity. Methods: Forty-eight infants, median birthweight 965 g (480–1500 g), median gestational age 27 wk (23–34 wk), were studied during routine blood sampling from umbilical artery catheters. The sampling procedure was performed following a strict protocol for draw-up volume (1.6 ml), sampling volume (1.7 ml or 0.2 ml), re-injection volume (1.6 ml) and flushing volume (0.6 ml), time of aspiration (40 s or 80 s), re-injection (30 s) and flushing (6 s). In each infant, sampling volume and aspiration time were subject to sequential variation in a randomized fashion (1.7 ml/40 s, 1.7 ml/80 s, 0.2 ml/30 s). Using near-infrared spectroscopy, changes in concentrations of cerebral oxygenated and deoxygenated haemoglobin were measured, and changes in cerebral blood volume and cerebral oxygenation were calculated. Results: During all three sampling procedures, oxygenated haemoglobin decreased significantly from baseline, whereas deoxygenated haemoglobin did not change. Correspondingly, a decrease in cerebral blood volume and cerebral oxygenation occurred. This decrease was not affected significantly by extending the sampling time from 40 s to 80 s, whereas it was blunted by reducing the amount of blood withdrawn. Conclusion: Blood sampling from umbilical artery catheters induces a decrease in cerebral blood volume and cerebral oxygenation. The magnitude of the decrease depends on the blood volume withdrawn but not on sampling velocity.

Background and aims: In term neonates venepuncture is considered less painful than heel lance for blood sampling. Here, we compared the effects of venepuncture and heel lance blood sampling in preterm infants < 1500 g birth weight. Methods: Twenty infants (median [range] birth weight 855 [355 - 1470] g, gestational age 28 [24 - 32] weeks) were studied during sequentially performed venepuncture and heel lance blood sampling. Heart rate and arterial oxygen saturation were registered continuously. Cerebral tissue oxygenation index (TOI) was measured by near infrared spectroscopy. Cerebral fractional oxygen extraction (FOE) was calculated. Results: During both procedures, heart rate increased and TOI decreased significantly. The decrease in TOI was significantly larger during venepuncture (from 64 [45-99]% to 57 [47-95%]) than during heel lance blood sampling (from 68 [51-99]% to 63 [47-99] %, p=0.05). Arterial oxygen saturation decreased and FOE increased during venepuncture only. Conclusions: Our results indicate that - in contrast to term neonates - for preterm infants venepuncture is more stressful than heel lance blood sampling.

UMBILICAL ARTERY CATHETER (UAC) BLOOD SAMPLING DECREASES CONCENTRATIONS OF CEREBRAL TOTAL (tHb) AND OXYGENATED HEMOGLOBIN (O 2 Hb) IN VERY LOW BIRTH WEIGHT INFANTS