Perinatal distress in the preterm neonate, and the consequent loss of cerebrovascular autoregulation, has been implicated in the pathogenesis of neonatal cerebral lesions. A component of this distress is thought to be hypotension. We examined the autoregulatory capacity of hypotensive and normotensive infants using the 133 Xe technique to measure cerebral blood flow. Global CBF was measured during only normotension in 5 infants, and during both hypotension and normotension in 11 infants. All the infants were ventilated and blood pressure was measured using an intra-arterial catheter. Fourteen CBF measurements were made on the normotensive infants. Forty-seven CBF measurements were made on the hypotensive infants, 34 measurements during hypotension and 13 during normotension. The global CBF of the normotensive and hypotensive infants were 13.3 and 13.6 mL/ 100 g/min, respectively. The mean arterial blood pressure (MABP)-CBF reactivity (95% CI) of the normotensive and hypotensive infants were 1.9% (Ϫ0.8% to 4.7%)/mm Hg and 1.9% (0.8% to 3.0%)/mm Hg, respectively. The CO 2 -CBF reactivity (95%CI) of the normotensive and hypotensive infants was 11.1% (6.8% to 15.5%)/KPa ⌬PaCO 2 and 4.1% (Ϫ5.0% to 14.1%)/KPa ⌬PaCO 2 . The implications of these calculated CBF reactivities is that normotensive infants may have intact autoregulation but with a diminished response to fluctuations in PaCO 2 . Hypotension in the sick preterm infant has been implicated as one causative factor in the pathogenesis of a number of serious conditions including intraventricular hemorrhage (IVH) (1), periventricular leukomalacia (PVL) (2), necrotizing enterocolitis (3), and developmental delay in preterm infants (4).It is thought that perinatal asphyxia combined with hypotension leads to a loss of cerebrovascular autoregulation, which may lead to a pressure passive cerebral circulation (5). In this state, abrupt elevations in systemic blood pressure may be transmitted to the fragile vessels of the germinal matrix, possibly resulting in intraventricular hemorrhage. Historically, systemic hypotension was thought to lead to under perfusion of watershed areas, which then underwent infarction and cystic necrosis, resulting in PVL (6). Thus, absent autoregulation may be central to many causes of perinatal CNS pathology.The work of Tyszczuk et al. among others, has led to the re-evaluation of the absent autoregulation hypothesis (7). They found no significant difference between the cerebral blood flow (CBF) of normotensive infants and that of hypotensive infants. Furthermore, a number of studies have found no association between hypotension and PVL (2, 8, 9). More recently, it was found that 53% of ventilated preterm infants had evidence of impaired autoregulation (10) and Boylan et al. have identified abnormalities in the autoregulatory capacity of preterm infants (11). Only in the work of Tyszczuk was the influence of hypotension analyzed in the etiology of impaired autoregulation.Changes in arterial carbon dioxide are a major mediator of CBF variatio...

The focus of this review is to collate the literature on the phenomenon of impaired thermal adaptation after hypoxic ischaemic (HI) delivery often culminating in hypothermia. This phenomenon appears different in severity and duration to a spontaneous postnatal fall in temperature observed after normal delivery. The original observation and contemporary descriptions of the temperature response to HI are described and a mechanism of action is proposed that may be utilised as a novel biomarker for HI.

AimTo determine congenital and developmental outcomes of children with Unilateral Hearing Loss (UHL) who were admitted to the Neonatal Intensive Care Unit (NICU).MethodRetrospective, single-site study that followed 25 children with permanent congenital UHL and a NICU admission to a NICU of Nottingham University Hospital. Birth and two-year developmental follow-up data were collected. They were compared to matched control group who had a NICU admission but no hearing loss (matched on gestational age, weight and sex).ResultsThe median birthweights, gestational ages and number of days spent on the NICU for the UHL population were 2510 g, 36 weeks, and 12 days respectively. Most children (20/25; 80%) with UHL and a NICU admission were diagnosed with a congenital anomaly within the first two years of life. Only half (13/25) of these children were diagnosed with a congenital anomaly at discharge. Children with UHL and a NICU admission were more likely than the matched group (NICU admission only; p < .001) to have multiple congenital anomalies. We found a positive association between multiple congenital anomalies and developmental impairment for the NICU graduates with UHL (p = .019). This UHL-NICU group were also more likely than the matched NICU children to have developmental impairment (7/25 vs. 0/25; p = .01), speech and language therapy (13/25 vs. 1/25; p < .001), inner ear malformations (14/25 vs. 0/25, p < .001) or craniofacial anomalies (12/25 vs. 2/25; p = .004).InterpretationChildren with UHL and a NICU admission were at high risk of congenital anomalies and certain adverse developmental outcomes. Improved congenital anomaly screening is needed at birth for this population. Having multiple congenital anomalies suggests closer developmental monitoring is needed. This study contributes towards producing clinical screening and management guidelines to ensure consistent high-quality care for this unique population.

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Aims To identify and ensure that neonates with high gentamicin levels were referred for hearing assessment at 8 months. To compare practice in two tertiary level neonatal units against national guidelines. Background There is good evidence that aminoglycosides are associated with cochlear ototoxicity. Gentamicin used in conjunction with furosemide is dangerous. National Guidelines (Newborn Hearing Screening Programme) recommend babies with high levels of ototoxic drugs (outside the therapeutic range) should be referred for audiological assessment around 8 months or sooner irrespective of newborn hearing screen outcome. Methodology We retrospectively reviewed all gentamicin levels done between 7 April to 7 May and 8 July to 8 Dec across two tertiary neonatal units (Unit 1 and Unit 2). Gentamicin levels done were identified by microbiology database and high levels were defined as Trough (pre dose) >2 mg/l and Post dose >10 mg/l. Results We found 33 high gentamicin levels from both the units (17 levels from Unit 1 and 16 levels from Unit 2). There were 11 Trough and 6 post dose high levels in Unit 1, 11 Trough and 5 post dose high levels in Unit 2. Unit 1 had no referrals out of 17 (0%) and Unit 2 referred only 6 (37.5%). Conclusion As a result of this audit, both units have changed practice and there is a system in place to identify and refer neonates with high gentamicin levels for audiology assessment. Paediatricians should be aware that all neonates with high gentamicin levels should be identified and promptly referred for audiology assessment at 8 months to pick up sensorineural deafness.