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.

Aim The aim of this study was to determine the acceptance of the midwives regarding the use of newborn pulse oximetry screening (NPOS) over a four-year period in a UK tertiary maternity unit. Methods An electronic survey of 10 questions was emailed to all midwives working in the maternity unit. Feedback was requested on their experience of performing NPOS using a feasibility scale (1=easy to 10=difficult). Other qualitative feedback explored the perceived usefulness and recollection of positive screening outcomes. The collated feedback was analysed using Wilcoxon Signed Rank test. Results Complete responses were received from 99 of 236 (42%) midwives. The average scale rankings of 3.46 (pre-introduction) and 2.38 (post-introduction) indicates that the responding midwives were positive about NPOS (z=-4.5575; p<0.001) and 99% (n=98) felt it was an important screening tool. Of the midwives, 38 (39%) had at least one positive screening result. Conditions identified included cardiac anomalies, sepsis and diaphragmatic hernia. Conclusion Our single-centre survey suggests that the NPOS has been well accepted by the midwifery staff in this maternity unit.

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