Objective To assess and contrast the incidence and severity of abnormalities on cerebral magnetic resonance imaging (MRI) between infants with mild, moderate, and severe neonatal encephalopathy who received therapeutic hypothermia. Study design This is a retrospective cohort study of infants with mild, moderate, and severe NE who received TH at a single tertiary neonatal intensive care unit (NICU) between 2013 and 2015. Two neuro-radiologists masked to the clinical condition evaluated brain MRIs for cerebral injury following TH using the Barkovich classification system. Additional abnormalities not included in this classification system were also noted. The rate, pattern, and severity of abnormalities/injury were compared across the grades of NE. Results Eighty-nine infants received TH and met study criteria – 48 with mild NE, 35 with moderate NE, and six with severe NE. Forty-eight infants (54%) had an abnormality on MRI. There was no difference in the rate of overall MRI abnormalities by grade of NE (mild NE 54%, moderate NE 54%, and severe NE 50%, p=0.89). Basal ganglia/thalamic injury was more common in those with severe NE (mild NE 4%; moderate NE 9%; severe NE 34%, p=0.03). In contrast, watershed injury did not differ between NE grades (mild NE 36%; moderate NE 32%; severe NE 50%, p=0.3) Conclusion Mild NE is commonly associated with MRI abnormalities after TH. The grade of NE during the first hours of life may not adequately discriminate between infants with and without cerebral injury noted by MRI after TH.

Background: Organ-specific vascular endothelial growth factor (VEGF) expression is decreased during the pathogenesis of bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP) several weeks before either disease can be diagnosed. Early measurement of organ-specific tissue VEGF levels might allow identification of infants at high risk for these diseases, but is not clinically feasible. Urine VEGF is easily measured and useful in early diagnosis of several diseases. Objectives: Our aims were to assess the correlation of urine VEGF levels measured in the first postnatal month with subsequent BPD or ROP diagnosis and to determine whether various infant characteristics influence urine VEGF levels. Methods: 106 subjects born at <29 weeks' gestation and surviving to 36 weeks' postmenstrual age were selected from an existing database and biorepository. Urine VEGF and total protein were measured in 2-3 samples per subject. Results: Urine VEGF/protein levels increased by 72% per week (p < 0.0001) during the first postnatal month. In multivariable analysis controlling for postnatal age, lower VEGF/protein was associated with higher levels of mechanical respiratory support (p = 0.006), male gender (p = 0.001) and early sepsis (p = 0.003) but not with fraction of inspired oxygen. Lower urine VEGF/protein and mechanical ventilation were each associated with BPD and ROP. In analyses adjusted for respiratory support, lower urine VEGF/protein and ROP remained associated but urine VEGF/protein and BPD did not. Conclusions: Low urine VEGF/protein levels in the first postnatal month are associated with mechanical ventilation, BPD, and ROP.

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