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Subtle changes in body temperature affect the outcomes of ill newborns. However, the temperature profile of neonatal brains remains largely unknown. In open-cot care, increased cerebral perfusion is correlated with higher superficial brain temperatures. This study investigated the dependence of brain temperature (relative to rectal temperature) on ambient temperature, body size, cerebral perfusion, and metabolism in infants receiving incubator care. Rectal, scalp, and brain temperatures, superior vena cava flow, and brain oxygenation were assessed using echocardiography, thermo-compensatory temperature monitoring, and near-infrared spectroscopy in 60 newborns. These infants had a mean postconceptional age of 36.9 (2.2) weeks and weighed 2348 (609) g at the time of evaluation. The ambient temperature was maintained at 30.0 (1.0) °C. A higher rectal temperature was associated with greater postconceptional age (p = 0.002), body weight (p < 0.001), and head circumference (p < 0.001). Relative scalp, superficial brain, and deep brain temperatures were associated with smaller head circumference (p < 0.001, p = 0.030, and p = 0.015, respectively) and superior vena cava flow (p = 0.002, p = 0.003, and p = 0.003, respectively). In infants receiving incubator care, larger head sizes and increased brain perfusion were associated with lower relative scalp and brain temperatures. When considered alongside previous reports, cerebral perfusion may contribute to maintaining stable cerebral tissue temperature against ambient temperature changes. [ABSTRACT FROM AUTHOR]

Introduction: Respiratory morbidities in neonates are often progressive and life-threatening, and its early prediction is crucial. Intrauterine inflammation is one of the key control variables of respiratory morbidities in both very preterm and term neonates; however, little is known about its effects in the remaining group of moderate-to-late preterm neonates born between 32+0 and 36+6 weeks of gestation. This study aimed to confirm whether intrauterine inflammation is associated with respiratory morbidities in moderate-to-late preterm neonates. Methods: A single-center retrospective observational study was conducted in neonates born between 32+0 and 34+6 weeks of gestation between April 2013 and March 2018. The correlation between respiratory morbidities (defined as a requirement for invasive mechanical ventilation longer than the median duration of 3 days) and intrauterine inflammation was assessed using multivariable logistic regression analysis. Results: The study population comprised 242 neonates born at 33.7 ± 0.8 weeks of gestation and weighing 1,936 ± 381 g. The multivariable model to predict the outcome comprised respiratory distress syndrome (odds ratio [OR]: 9.1; 95% confidence interval [CI]: 3.7–22.5; p < 0.001), lower gestational age (per week; OR: 0.5; 95% CI: 0.3–0.8; p < 0.005), higher birth-weight z-score (OR: 1.6; 95% CI: 1.2–2.2; p < 0.005), lower cord blood pH (per 0.10; OR: 0.5; 95% CI: 0.3–0.7; p < 0.005), and chorioamnionitis (OR: 2.8; 95% CI: 1.1–7.2; p < 0.05). Conclusion: Together with the incidence of respiratory distress syndrome and gestational age, chorioamnionitis and high birth-weight z-scores were associated with an increased incidence of respiratory morbidities in moderate-to-late preterm neonates. The deleterious impact of intrauterine inflammation on the lungs may be common in neonates of virtually all gestational ages. Traditional admission policy of neonatal intensive care units based on a threshold birth-weight, may leave a group of neonates without close observation despite their increased risks for respiratory morbidities. [ABSTRACT FROM AUTHOR]

Following hypoxia-ischaemia (HI), an early biomarker of insult severity is desirable to target neuroprotective therapies to patients most likely to benefit; currently there are no biomarkers within the "latent phase" period before the establishment of secondary energy failure. Brief transient phosphocreatine (PCr) recovery overshoot (measured absolutely or relative to nucleotide triphosphate, NTP) following HI has been observed in cardiac and skeletal muscle; its significance however is unclear. To investigate cerebral PCr recovery levels after HI in relation to (i) baseline metabolism, (ii) insult severity, (iii) energy metabolism at recovery and (iv) subsequent metabolic derangement, cerebral NTP, PCr and inorganic phosphate (relative to the exchangeable high-energy phosphate pool) were measured serially in an "in vivo" model of perinatal asphyxial encephalopathy using phosphorus-31 magnetic resonance spectroscopy. Measures were compared either in all piglets or between 3 subgroups with no (n = 5, favourable outcome), moderate (n = 8, intermediate outcome) or severe (n = 5, unfavourable outcome) secondary energy failure at 24 h after HI. Maximum NTP, PCr and inorganic phosphate recoveries were observed 2-8 h after HI. Following resuscitation, in subjects with favourable outcome PCr recovered to higher than its baseline level (overshoot); in subjects with unfavourable outcome maximum PCr recovery was lower than baseline and lower than in subjects with favourable and intermediate outcomes. Recovery PCr correlated linearly and negatively with both acute insult severity and baseline PCr/NTP. These results suggest that recovery metabolism 2-8 h after HI may provide an early biomarker of injury severity. PCr recovery overshoot in the developing brain may indicate a protective response to HI leading to cell recovery, survival and protection against subsequent stress. In addition, baseline cerebral metabolism (PCr/NTP) may identify vulnerable infants prior to invasive surgery.

Aim: We evaluated the predictive ability of prolonged requirements for mechanical ventilation or tube feeding support for 18‐month composite outcomes in infants with hypoxic‐ischaemic encephalopathy treated with hypothermia. Methods: This retrospective, nationwide, observational study focused on newborn infants registered in Japan's Baby Cooling Registry between 1 January 2012 and 31 December 2016. The adverse outcomes were defined as death or survival with cerebral palsy, visual or auditory impairment or the requirement for mechanical ventilation or tube feeding at 18 months of age. Results: Adverse outcomes occurred in 165 (28%) of the 591 children in the final cohort. These were predicted by prolonged dependence on mechanical ventilation or tube feeding for more than seven and more than 14 days. The respective values were positive predictive value 0.34 (95% CI 0.33–0.34) and 0.60 (95% CI 0.56–0.62), negative predictive value 0.97 (95% CI 0.91–0.99) and 0.93 (95% CI 0.90–0.95) and area under the curve 0.59 (95% CI 0.54–0.64) and 0.81 (95% CI 0.77–0.85). Conclusion: Prolonged dependence on mechanical ventilation or tube feeding for more than 14 days may be useful in predicting 18‐month outcomes in newborn infants who have received therapeutic hypothermia. [ABSTRACT FROM AUTHOR]

Problem On 11 March 2011, the Great East Japan Earthquake produced a catastrophic tsunami that devastated the city of Rikuzen-Takata and left it without an effective health infrastructure and at increased risk of outbreaks of disease. Approach On 2 May 2011, a disease-surveillance team was formed of volunteers who were clinicians or members of Rikuzen-Takata's municipal government. The team's main goal was to detect the early signs of disease outbreaks. Local setting Seven weeks after the tsunami, 16 support teams were providing primary health care in Rikuzen-Takata but the chain of command between them was poor and 70% of the city's surviving citizens remained in evacuation centres. The communication tools that were available were generally inadequate. Relevant changes The surveillance team collected data from the city's clinics by using a simple reporting form that could be completed without adding greatly to the workloads of clinicians. The summary findings were reported daily to clinics. The team also collaborated with public health nurses in rebuilding communication networks. Public health nurses alerted evacuation centres to epidemics of communicable disease. Lessons learnt Modern health-care systems are highly vulnerable to the loss of advanced technological tools. The initiation--or reestablishment--of disease surveillance following a natural disaster can therefore prove challenging even in a developed country. Surveillance should be promptly initiated after a disaster by (i) developing a surveillance system that is tailored to the local setting, (ii) establishing a support team network, and (iii) integrating the resources that remain--or soon become--locally available. Probleme Le 11 mars 2011, le tsunami catastrophique provoque par le grand seisme dans l'est du Japon devastait la ville de Rikuzen-Takata en la laissant sans infrastructure de sante efficaces et avec un risque accru de flambees d'epidemies. Approche Le 2 mai 2011 s'est constituee une equipe de surveillance des maladies, formee de volontaires cliniciens ou membres du gouvernement municipal de Rikuzen-Takata. L'objectif principal de l'equipe etait la detection des signes precoces d'epidemies Environnement local Sept semaines apres le tsunami, 16 equipes de soutien fournissaient des soins de sante primaires a Rikuzen-Takata mais la hierarchie entre elles restait faible et 70% des citoyens survivants se trouvaient encore dans des centres d'evacuation. Les outils de communication disponibles etaient generalement inappropries. Changements significatifs L'equipe de surveillance a collecte des donnees dans les cliniques de la ville en utilisant un simple formulaire de rapport pouvant etre complete sans trop ajouter au travail des cliniciens. Les resultats etaient communiques quotidiennement aux cliniques. L'equipe a egalement collabore avec des infirmiers de la sante publique pour retablir les reseaux de communication. Les infirmiers de la sante publique alertaient les centres d'evacuation des epidemies de maladies transmissibles. Lecons tirees Les systemes de sante modernes sont fortement vulnerables a la perte des outils technologiques de pointe. Finitiation --ou le retablissement--de la surveillance des maladies a la suite d'une catastrophe naturelle peut donc se reveler diflicile meme dans un pays developpe. La surveillance devrait pouvoir etre initiee rapidement apres la catastrophe en (i) developpant un systeme de surveillance a la mesure des installations locales, en (il) etablissant un reseau d'equipes de soutien et en (iii) integrant les ressources qui demeurent--ou peuvent rapidement etre--disponibles localement. Situacion El 11 de marzo de 2011, el Gran Terremoto del Este de Japon ocasiono un tsunami catastrofico que devasto la ciudad de RikuzenTakata y la dejo sin una infraestructura sanitaria eficaz y con un riesgo mayor de sufrir brotes de enfermedades. Enfoque El 2 de mayo de 2011, se formo un equipo de control de enfermedades constituido por voluntarios medicos o miembros del gobierno municipal de Rikuzen-Takata. El objetivo principal del equipo era detectar los primeros signos de brotes de enfermedades. Marco regional Siete semanas tras el tsunami, habia 16 equipos de asistencia encargados de proporcionar atencion primaria sanitaria en Rikuzen-Takata, pero con una cadena de mando debil entre ellos, por lo que el 70% de los ciudadanos que sobrevivieron permanecieron en centros de evacuacion. Las herramientas de comunicacion disponibles fueron, en general, insuficientes. Cambios importantes El equipo de control recibio los datos de las clinicas de la ciudad a traves de un formulario de informe sencillo que se podia completar sin que la carga de trabajo de los medicos aumentara demasiado. Se informaba diariamente a las clinicas sobre el resumen de los resultados. Asimismo, el equipo colaboro con los enfermeros de salud publica en la reconstruccion de las redes de comunicacion. Los enfermeros de salud publica alertaron a los centros de evacuacion acerca de las epidemias de enfermedades transmisibles. Lecciones aprendidas Los sistemas de salud modernos son muy vulnerables a la perdida de herramientas tecnologicas avanzadas. Por tanto, la iniciacion (o el restablecimiento) del control de enfermedades tras un desastre natural puede resultar un reto, incluso en paises desarrollados. El control debe iniciarse inmediatamente tras un desastre mediante (i) el desarrollo de un sistema de control adaptado al contexto local, (ii) el establecimiento de una red de equipo de asistencia, y (iii) la integracion de los recursos restantes o que vayan a estar disponibles pronto a nivel local., Introduction On 11 March 2011, north-eastern Japan experienced one of the most catastrophic natural disasters ever recorded--the huge tsunami that resulted from the Great East Japan Earthquake) In Rikuzen-Takata, in [...]

OBJECTIVE. We sought to compare the prognostic utilities of early MRI spin-spin relaxometry and proton magnetic resonance spectroscopy in neonatal encephalopathy. METHODS. Twenty-one term infants with neonatal encephalopathy were studied at a mean age of 3.1 days (range: 1-5). Basal ganglia, thalamic and frontal, parietal, and occipital white matter spin-spin relaxation times were determined from images with echo times of 25 and 200 milliseconds. Metabolite ratios were determined from an 8-mL thalamic-region magnetic resonance spectroscopy voxel ([sup.1]H point-resolved spectroscopy; echo time 270 milliseconds). Outcomes were assigned at age 1 year as follows: (1) normal, (2) moderate (neuromotor signs or Griffiths developmental quotient of 75-84), (3) severe (functional neuromotor deficit or developmental quotient RESULTS. Thalamic and basal ganglia spin-spin relaxation times correlated positively with outcome and predicted adversity. Although thalamic and basal ganglia spin-spin relaxation times were prognostic of adversity, magnetic resonance spectroscopy metabolite ratios were better predictors, and, of these, lactate/N-acetylaspartate was most accurate. CONCLUSIONS. Deep gray matter spin-spin relaxation time was increased in the first few days after birth in infants with an adverse outcome. Proton magnetic resonance spectroscopy was more prognostic than spin-spin relaxation time, with lactate/N-acetylaspartate the best measure. Nevertheless, both techniques were useful for early prognosis, and the potential superior spatial resolution of spin-spin relaxometry may define better the precise anatomic pattern of injury in the early days after birth. Key Words neonatal, encephalopathy, MRI, T2 relaxometry, magnetic resonance spectroscopy Abbreviations NE--neonatal encephalopathy HI--hypoxia-ischemia T2--spin-spin relaxation time DWI--diffusion-weighted imaging [sup.1]H MRS--proton magnetic resonance spectroscopy Cr--creatine plus phosphocreatine NAA--N-acetylaspartate TE--echo time TR--recovery time ROI--region of interest DQ--developmental quotient, TWENTY-THREE PERCENT OF the 4 million annual worldwide neonatal deaths are caused by perinatal asphyxia. (1) In the United Kingdom, hypoxic-ischemic injury leads to death or severe neurologic disability in [...]

OBJECTIVES. Fundamental questions remain about the precise temperature providing optimal neuroprotection after perinatal hypoxia-ischemia (HI). Furthermore, if hypothermia delays the onset of the neurotoxic cascade and the secondary impairment in cerebral energy generation, the "latent phase" may be prolonged, thus extending the period when additional treatments may be effective. The aims of this study were to investigate the effects of delayed systemic cooling at either 33[degrees]C or 35[degrees]C on the following: (1) latent-phase duration, and (2) cerebral metabolism during secondary energy failure itself, in the 48-hour period after transient HI. METHODS. Piglets were randomly assigned to the following: (1) HI-normothermic (HI-n) rectal temperature ([T.sub.rectal]; n = 12), (2) HI-[T.sub.rectal] 35[degrees]C (HI-35; n = 7), and (3) HI-[T.sub.rectal] 33[degrees]C (HI-33; n = 10). Groups were cooled to the target [T.sub.rectal] between 2 and 26 hours after HI. Serial magnetic resonance spectroscopy was performed over 48 hours. The effect of cooling on secondary energy failure severity (indexed by the nucleotide triphosphate/exchangeable phosphate pool [NTP/EPP] and phosphocreatine/inorganic phosphate [PCr/Pi] ratios) was assessed. RESULTS. Compared with HI-n, HI-35 and HI-33 had a longer NTP/EPP latent phase and during the entire study duration had higher mean NTP/EPP and PCr/Pi. The latent phase (both PCr/Pi and NTP/EPP) and the whole-brain cerebral energetics were similar for HI-35 and HI-33. During the hypothermic period, compared with HI-n, PCr/Pi was preserved in the cooled groups, but this advantage was not maintained after rewarming. Compared with HI-n, HI-35 and HI-33 had higher NTP/EPP after rewarming. CONCLUSIONS. Whole-body hypothermia for 24 hours at either 35 or 33[degrees]C, commenced 2 hours after resuscitation, prolonged the NTP/EPP latent phase and reduced the overall secondary falls in mean PCr/Pi and NTP/EPP during 48 hours after HI. Reducing the temperature from 35 to 33[degrees]C neither increased mean PCr/Pi and NTP/EPP nor further lengthened the latent phase. Key Words phosphorus magnetic resonance spectroscopy, hypoxic-ischemic encephalopathy, perinatal asphyxia, whole-body cooling, neuroprotection, hypothermia, Abbreviations HI--hypoxia-ischemia NE--neonatal encephalopathy [sup.31]P--phosphorus MRS--magnetic resonance spectroscopy PCr--phosphocreatine ATP--adenosine triphosphate Pi--inorganic phosphate FID--free induction decay NTP--nucleotide triphosphate EPP--exchangeable phosphate pool [T.sub.rectal]--rectal temperature F[IO.sub.2]--inspired oxygen fraction AED--acute energy depletion CI--confidence [...]