Background and Objectives: Hammersmith Neonatal Neurologic Examination (HNNE) is used to identify term and preterm infants at risk of neurodevelopmental disability. The test is recommended at corrected term age in preterm; and around 2 weeks postnatal age in term neonates. As the current trend is to discharge based on physiological stability, it may not be feasible to perform HNNE at recommended age. The authors investigated whether predictive ability of the test for neurodevelopmental disability remained unchanged if performed early (before discharge). Methods: The authors enrolled preterm and at-risk term neonates. HNNE PE was performed before discharge in all infants. The test was repeated in preterm infants at 40 weeks postmenstrual age and in term neonates at 2 weeks of age (HNNE RA). Neurodevelopmental disability was assessed at 1 year of age. Results: HNNE PE was done in 125 neonates (103 preterm, 22 term neonates). HNNE RA was done in 58% infants. Neurodevelopmental disability was assessed in 84 (67%) of infants. Neurodevelopmental disability was noted in 14/84 (16.6%) babies. The receiver operating characteristic curve of raw scores showed that area under the curve for HNNE PE (0.71) and HNNE RA (0.66) were similar. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio for both the tests were similar for a cutoff optimality score of 32.5. HNNE PE could be performed up to 4 weeks earlier than HNNE RA with the same predictive ability for neurodevelopmental disability. Conclusions: HNNE PE was as reliable as HNNE RA in predicting neurodevelopmental disability at 1 year of age. Completion of the test is assured and provides several weeks lead time for early intervention.

Purpose To evaluate change in the severity of hypoxic-ischemic encephalopathy (HIE) and associated morbidities between pre- and during COVID-19 pandemic periods in Canada. Methods We conducted a retrospective cohort study extracting the data from level-3 NICUs participating in Canadian Neonatal Network (CNN). The primary outcome was a composite of death in the first week after birth and/or stage 3 HIE (Sarnat and Sarnat). Secondary outcomes included rate and severity of HIE among admitted neonates, overall mortality, brain injury on magnetic resonance imaging (MRI), neonates requiring resuscitation, organ dysfunction, and therapeutic hypothermia (TH) usage. We included 1591 neonates with gestational age ≥ 36 weeks with HIE during the specified periods: pandemic cohort from April 1st to December 31st of 2020; pre-pandemic cohort between April 1st and December 31st of 2017, 2018, and 2019. We calculated the odds ratio (OR) and confidence intervals (CI). Results We observed no significant difference in the primary outcome (15% vs. 16%; OR 1.08; 95%CI 0.78–1.48), mortality in the first week after birth (6% vs. 6%; OR 1.10, 95%CI 0.69–1.75), neonates requiring resuscitation, organ dysfunction, TH usage, or rate of brain injury. In the ad hoc analysis, per 1000 live births, there was an increase in the rate of infants with HIE and TH use. Conclusions Severity of HIE, associated morbidities, and mortality were not significantly different during the pandemic lockdown compared to a pre-pandemic period in Canada. Anticipated risks and difficulties in accessing healthcare have not increased the mortality and morbidities in neonates with HIE in Canada. Supplementary information The online version contains supplementary material available at 10.1007/s00381-022-05575-8.

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BACKGROUND: Consensus on the defi nition and management of hypotension in preterm neonates is lacking.(1-3) Owing to this, there are wide variations in the reported incidence of hypotension in premature infants, especially in the fi rst week from birth.(1,3,4) Inotropes can often cause vasoconstriction, which may alter brain perfusion especially in the absence of established cerebral autoregulation.(5) The use of these drugs is associated with multiple short and long term morbidities.(2,6-12) Studies that targeted blood pressure alone as the criteria for use of inotropes did not show improvement in mortality and morbidity. (12,13) We evaluated the effect of quality improvement (QI) bundle on rate of inotrope use and associated morbidities. METHODS: Inborn preterm neonates born at <29weeks gestational age (GA) and admitted to level III NICU were