Background: Few data have been published on the combined use of amplitude-integrated electroencephalography (aEEG) and near-infrared spectroscopy (NIRS) for outcome prediction in neonates cooled for hypoxic-ischemic encephalopathy (HIE). Objective: Our aimwas to evaluate the predictive values and the most powerful predictive combinations of single aEEG and NIRS parameters and the respective cut-off values with regard to short-term outcomes in HIE II. Methods: aEEG and NIRS were prospectively studied at the Medical University of Vienna in the first 102 h of life with regard to magnetic resonance imaging (MRI). Thirty-two neonates diagnosed with HIE II treated with hypothermia were investigated. The measurement period was divided into 6-h epochs. According to MRI, 2 outcome groups were defined and predictive values of aEEG parameters, regional cerebral oxygen saturation (rScO₂), and the additional value of both methods combined were studied. Receiver operating curves (ROC) were obtained and area under the curve (AUC) values were calculated. ROC were then used to detect the optimal cut-off points, sensitivity, specificity, positive predictive values, and negative predictive values. Results: At all time epochs, combined parameter scores were more predictive than single parameter scores. The highest AUC were observed between 18 and 60 h of cooling for the aEEG summation score (0.72-0.84) and for (background pattern + seizures) × rScO₂ (0.79-0.85). At 42-60 h sensitivity was similar between those 2 scores (87.5-90.0%), but the addition of NIRS to aEEG led to an increase in specificity (from 52.4-59.1% to 72.7-90.5%). Conclusions: In HIE II, aEEG and NIRS are important predictors of short-term outcome. The combination of both methods improves prognostication. The highest predictive abilities were observed between 18 and 60 h of cooling.

There is considerable variation in assigning Apgar scores. Definitions are required to apply the Apgar score to infants under clinical conditions such as preterm delivery, resuscitation or artificial ventilation.

BACKGROUND AND PURPOSE: Former preterm born males are at higher risk for neurodevelopmental disabilities compared with female infants born at the same gestational age. This retrospective study investigated sex-related differences in the maturity of early myelinating brain regions in infants born ,28 weeks' gestational age using diffusion tensor-and relaxometry-based MR imaging. MATERIALS AND METHODS:Quantitative MR imaging sequence acquisitions were analyzed in a sample of 35 extremely preterm neonates imaged at term-equivalent ages. Quantitative MR imaging metrics (fractional anisotropy; ADC [10 À3 mm 2 /s]; and T1-/T2relaxation times [ms]) of the medulla oblongata, pontine tegmentum, midbrain, and the right/left posterior limbs of the internal capsule were determined on diffusion tensor-and multidynamic, multiecho sequence-based imaging data. ANCOVA and a paired t test were used to compare female and male infants and to detect hemispheric developmental asymmetries. RESULTS:Seventeen female (mean gestational age at birth: 26 1 0 [SD, 1 1 4] weeks1days) and 18 male (mean gestational age at birth: 26 1 1 [SD, 1 1 3] weeks1days) infants were enrolled in this study. Significant differences were observed in the T2-relaxation time (P ¼ .014) of the pontine tegmentum, T1-relaxation time (P ¼ .011)/T2-relaxation time (P ¼ .024) of the midbrain, and T1-relaxation time (P ¼ .032) of the left posterior limb of the internal capsule. In both sexes, fractional anisotropy (P [$] , .001/P [#] , .001) and ADC (P [$] ¼ .017/P [#] ¼ .028) differed significantly between the right and left posterior limbs of the internal capsule. CONCLUSIONS:The combined use of various quantitative MR imaging metrics detects sex-related and interhemispheric differences of WM maturity. The brainstem and the left posterior limb of the internal capsule of male preterm neonates are more immature compared with those of female infants at term-equivalent ages. Sex differences in WM maturation need further attention for the personalization of neonatal brain imaging.

Near-infrared spectroscopy may be of additional clinical value in progressive PHVD to determine the optimal time point for ventricular decompression.

Kinder-und Jugendheilkunde (ÖGKJ) 2 Arbeitsgruppe für Ethik in der Kinder-und Jugendheilkunde der Österreichischen Gesellschaft für Kinder-und Jugendheilkunde (ÖGKJ)