Therapeutic hypothermia is an effective therapy for moderate‐to‐severe hypoxic–ischemic encephalopathy (HIE) in infants born at term or near‐term in high‐resource settings. Yet there remains a substantial proportion of infants who do not benefit or who will have significant disability despite therapeutic hypothermia. Novel investigational therapies that may confer additional neuroprotection by targeting known pathogenic mechanisms of hypoxic–ischemic brain injury are under development. This review focuses on putative neuroprotective agents that have shown promise in animal models of HIE, and that have been translated to clinical studies in neonates with HIE. We include agents that have been studied both with and without concurrent therapeutic hypothermia. Our review therefore addresses not just neonatal HIE in high‐resource countries where therapeutic hypothermia is the standard of care, but also neonatal HIE in low‐ and middle‐income countries where therapeutic hypothermia has been shown to be ineffective, and where the greatest burden of HIE‐related morbidity and mortality exists.

Introduction: Despite standardized neonatal resuscitation program (NRP) training, retention and adherence to the NRP algorithm remain a challenge. Cognitive aids can potentially improve acquisition and application of NRP knowledge and skills. The objective of this study was to determine whether an interactive mobile application providing audiovisual prompts, NRP Prompt, can help novice NRP providers learn the NRP algorithm more effectively and therefore improve their NRP performance. Methods: First- and second-year residents from family medicine and obstetrics and gynecology attending NRP training were randomized into intervention and control groups. Resident pairs used standard visual aids with NRP Prompt (intervention) or visual aids only (control) in two simulated neonatal resuscitation training sessions with each resident taking turns as a team leader. Pairs were then evaluated in a third simulation that was video recorded, where neither group used cognitive aids. The primary outcome was comparing resuscitation performance. Secondary outcomes included the following: times to positive-pressure ventilation, intubation, and chest compressions. Results: Thirty-nine residents participated, of which 18 received the intervention. Neonatal resuscitation program performance scores did not significantly differ (P = 0.69). Wilcoxon rank-sum tests showed no significant differences in secondary outcomes of times to positive-pressure ventilation (P = 0.43), intubation (P = 0.44), or chest compressions (P = 0.35). Conclusions: Training using NRP Prompt did not improve performance scores in simulated neonatal resuscitations immediately after training. Potential reasons include voice prompts in their current format being distracting and lack of customizability to user preferences. Future development of prompting applications should apply a user-centered design approach to optimize the ability to meet end-user needs.

Preterm infants are at risk for adverse neurodevelopmental outcomes, especially language delay. Preterm infants < 29 weeks’ gestational age, cared for in Canadian Neonatal Follow-Up Network affiliated hospitals, were assessed between 18 to 21 months corrected age using the Bayley-III. Bayley-III Language Composite Scores were compared using univariate and multivariate analyses for children in three primary language groups: English, French and other. 6146 children were included. The primary language at home was English, French or another language for 3708 children (60%), 1312 children (21%) and 1126 children (18%), respectively, and overall, 44% were exposed to two or more languages at home. Univariate analysis showed that primary language was associated with lower Bayley-III Language scores; however, multivariate analyses demonstrated that neither primary language nor language of administration were significantly associated with lower language scores when adjusted for gestational age, other developmental delays and sociodemographic factors, but multiple language exposure was. Sociodemographic and other factors are more important in determining language development than primary language at home. Further studies are needed to examine the association between exposure to multiple languages and lower Bayley-III language scores in preterm infants.

Background: Helping Babies Breathe (HBB) is a newborn resuscitation training program designed to reduce neonatal mortality in low- and middle-income countries. However, skills decay after initial training is a significant barrier to sustained impact. Objective: To test whether a mobile app, HBB Prompt, developed with user-centred design, helps improve skills and knowledge retention after HBB training. Methods: HBB Prompt was created during Phase 1 of this study with input from HBB facilitators and providers from Southwestern Uganda recruited from a national HBB provider registry. During Phase 2, healthcare workers (HCWs) in two community hospitals received HBB training. One hospital was randomly assigned as the intervention hospital, where trained HCWs had access to HBB Prompt, and the other served as control without HBB Prompt (NCT03577054). Participants were evaluated using the HBB 2.0 knowledge check and Objective Structured Clinical Exam, version B (OSCE B) immediately before and after training, and 6 months post-training. The primary outcome was difference in OSCE B scores immediately after training and 6 months post-training. Results: Twenty-nine HCWs were trained in HBB (17 in intervention, 12 in control). At 6 months, 10 HCW were evaluated in intervention and 7 in control. In intervention and control respectively, the median OSCE B scores were: 7 vs. 9 immediately before training, 17 vs. 21 immediately after training, and 12 vs. 13 at 6 months after training. Six months after training, the median difference in OSCE B scores was -3 (IQR -5 to -1) in intervention and -8 (IQR -11 to -6) in control (p = 0.02). Conclusion: HBB Prompt, a mobile app created by user-centred design, improved retention of HBB skills at 6 months. However, skills decay remained high 6 months after training. Continued adaptation of HBB Prompt may further improve maintenance of HBB skills.

Digital FM frequency hopping radios closely located together on a platform or on nearby platforms may cause interference to each other. In this paper, the interference effects of cosited radios will be discussed. These effects include transmitter wideband noise, transmitter intermodulation and receiver intermodulation. The performance of the radio will be considered taking into account the interference from intermodulation products and multiple users. Potential solutions to reduce the interference from cosited radios will also be discussed. These solutions include the use of filters, orthogonal hopping, and coupling all cosited radios through a highly linear amplifier. Ways to achieve higher isolation between radios will also be discussed.