We observed a significant association between the clinical grade of HIE and biomarkers of liver metabolism and function. Therapeutic hypothermia was associated with delayed CRP responses and with lower ALT concentrations and so may have the potential to modulate hepatic injury. What is Known: • Ischemic hepatic injury occurs frequently as a part of multiorgan dysfunction in infants with hypoxic ischemic encephalopathy (HIE). • The neuroprotective role of therapeutic hypothermia in management of infants with HIE is well recognized, but the potential hepato-protective effects of hypothermia are unclear. What is New/What this study adds: • Therapeutic hypothermia was associated with lower alanine aminotransferase and albumin concentrations and a delayed C-reactive protein (CRP) response and so may have the potential to modulate hepatic injury. • An elevated CRP concentration during the first postnatal week may be regarded as an expected finding in moderate and severe HIE and, in the overwhelming majority of cases, occurs secondary to hepatic hypoxia-ischemia in the absence of blood culture-positive sepsis.

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Background: Children who undergo bi-fronto-orbital advancement (BFOA) frequently develop a contour deformity on the temporal and supra-orbital region, with an incidence reported as high as 55% and 75%, respectively. Up to 20% of patients may require correction. Hydroxyapatite cement (HAC) is a good alternative to autogenous tissue. The available literature on its use focusses on the reconstruction of bone defects, but little has been published on its efficacy and safety as an onlay graft over intact cranium. Objectives: To describe our institution's experience with HAC in the pediatric population. Methods: Retrospective chart review from 1998 to 2018 on all patients from the Craniofacial Unit at the Sydney Children's Hospital who had either coronal or metopic craniosynostosis and underwent BFOA and later in life required cranioplasty with HAC for contour repair. Findings: We have performed 166 BFOA and nineteen secondary cranioplasties for contour repair using onlay HAC. The mean age at the time of operation was 14 years. Bi-coronal craniosynostosis was most frequently associated with secondary cranioplasty and 37% had an associated syndrome. The mean volume of HAC used was 37 mL. There was only 1 patient who had a complication (5.3%) and required partial removal of allograft. The mean length of admission was 2 days. Mean follow up time of 22.4 months. Conclusions: HAC represents a safe option when used correctly, with low rates of complication and satisfactory cosmetic outcomes.

Abstracts labour ≤37°C, gestational age ≥37 weeks and birthweight centile ≥10%. Analysis was performed on plasma EDTA, using ELISA Quantikine® (R&D Systems, Europe). Results The study consisted of samples from 48 infants with two different modes of delivery; unassisted vaginal delivery (n=12 male, n=12 female) and pre-labour elective caesarean section (n=12 male, n=12 female). The range of all samples was normally distributed between 87.0 and 114.6 pg/ml. Mean (SD) for IL-16 was 103.1 (± 21.9) pg/ml. Levels were not affected by gender or mode of delivery. Conclusion For the first time we have described the expected range of cord plasma IL-16 levels in healthy term infants. Background and Aims Production of C-reactive protein (CRP), an acute phase reactant of hepatic origin, may be affected by perinatal asphyxia. This study tested hypotheses that circulatory CRP concentrations correlate with clinical severity of hypoxic-ischaemic encephalopathy (HIE) and that total body hypothermia modulates CRP response. Methods Clinical records in three centres were reviewed for neonates ≥36 weeks' gestation admitted between 01/07/06 and 30/06/11 with HIE of any severity (grades 1-3 Sarnat-Sarnat). Participating centres adopted routine cooling at different dates. Data extracted included CRP concentrations in the first postnatal week measured during routine clinical practice, clinical HIE grading, and reception of therapeutic hypothermia. Proportions with raised CRP (>10 mg/L), and maximum CRP concentrations were assessed according to HIE grade and whether cooled. Conclusion A raised CRP is a common finding in the first postnatal week in neonates admitted with HIE and is found in most infants with moderate-severe HIE. Peak CRP concentrations did not differ with clinical HIE grade and whole body hypothermia did not significantly affect peak CRP concentrations. C-REACTIVE PROTEIN CONCENTRATIONS IN NEONATES

Background After an aeroplane crash, recovery of the ‘black box’ is a high priority for investigators; analysis of recorded parameters frequently identifies cause or contributing factors. The placenta likewise provides an invaluable record of the pre-‘crash’ period in hypoxic ischaemic encephalopathy (HIE); its examination often identifies significant factors such as inflammation or vasculopathy. Objective To determine the frequency of histopathologic placental examination and chorioamnionitis in a high-risk population of encephalopathic newborns. Methods We studied neonates ≥36 weeks’ gestation admitted with HIE to three tertiary-level UK centres between 01/07/06 and 30/06/11. We assessed if placental histopathological examination was carried out and if there was evidence of chorioamnionitis and/or funisitis. Results 305 infants were admitted with HIE in the 5-year study period. Placental data were unavailable for 140 outborn infants. Only 50/165 (30%) inborn babies had placentas submitted to pathology. Histopathological examination confirmed chorioamnionitis and/or funisitis in 16/50 (32%) cases. Conclusion Placental examination serves several vital roles in babies born with suspected HIE: it defines pathophysiology, provides important prognostic information regarding future neurodevelopmental outcome, and shows mitigating factors of medicolegal relevance to causation of brain injury. Intrapartum infection and chorioamnionitis are associated with poor neonatal outcomes including cerebral palsy. Only 30% placentas were examined in our tertiary centres, yet those examinations showed a high incidence of chorioamnionitis. The low rate of placentas being submitted for examination in neonates born depressed, coupled with the high incidence of proven chorioamnionitis in those submitted, is of great concern.