Objective: To evaluate cerebrovascular autoregulation as a function of arterial blood pressure (ABP) in the critically ill, premature infant.Study Design: A prospective observational pilot study was conducted in two tertiary care Neonatal Intensive-Care Units. Premature infants (n ¼ 23, p30 weeks estimated gestational age with invasive ABP monitoring) were enrolled and received routine care while undergoing continuous autoregulation monitoring, using the cerebral oximetry index (COx). The COx is a moving, linear correlation coefficient between cortical reflectance oximetry and ABP. COx values were stratified as a function of ABP for individual subject recordings and for the cohort.Result: The mean duration of autoregulation monitoring was 3.2 days (median: 2.97, range: 0.61-3.99). A total of 10 of 23 (43%) developed intraventricular hemorrhage and 1 of 23 (4%) developed periventricular leukomalacia by head ultrasound. No association was found between neurologic injury and percentage of the monitoring periods with autoregulation impairment (defined as COx>0.5). Lower ABP was associated with dysautoregulation (higher COx values, P<0.01). The percentage of time with impaired autoregulation was greater with lower ABP (P ¼ 0.013, Spearman r ¼ 0.51).Conclusion: All infants studied had periods with intact and periods with impaired cerebrovascular autoregulation, measured with the COx. Low ABP was associated with impaired autoregulation.

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Purpose Compare infant and retinopathy of prematurity (ROP) characteristics from three clinical studies conducted over a 27-year period in the United States. Design secondary analysis of results of three clinical studies Subjects Infants with birth weights <1251g Methods analysis of data from the Cryotherapy for ROP (CRYO-ROP) and Early Treatment for ROP (ETROP) trials (Ophthalmology 1991;98:1628–40, Pediatrics 2005;116:15–23) and the primary data from “Telemedicine approaches for the evaluation of acute-phase ROP - e-ROP” study (JAMA Ophthalmology 2014;132:1178). Main outcome measures infant characteristics and onset, severity, and time course of ROP Results Across the three studies, mean (standard deviation) birth weight (BW) and mean gestational age (GA) decreased over time from CRYO-ROP [954g (185), 27.9 weeks (2.2)] to ETROP [907g (205), 27.4 weeks (2.2)] to e-ROP [864g (212), 27.0 weeks (2.2) with an increase in % infants enrolled <750g (15.8% CRYO, 24.9% ETROP, 33.4% e-ROP, p<0.0001). The percentage of infants who developed ROP varied only minimally (65.8% CRYO, 68.0% ETROP, 63.7% e-ROP, p=0.003). Moderately severe ROP (defined as prethreshold or referral-warranted) varied (17.8% CRYO, 12.3% ETROP, 19.4% e-ROP, p<0.0001), while the time of onset of any ROP did not vary (34.3wks CRYO, 34.1wks ETROP, 34.8wks e-ROP). Conclusions BW and GA of infants enrolled in ROP studies in the US have decreased over the last 27 years, while ROP prevalence and onset of disease are stable.