Background: Therapeutic hypothermia is the standard treatment for neonates with hypoxic–ischemic encephalopathy. Preclinical evidence indicates that the time to initiate therapeutic hypothermia correlates with its therapeutic success. This study aims to explore whether there is a correlation between the early initiation of therapeutic hypothermia and improved short-term neurological outcomes in cooled asphyxiated newborns. Methods: A retrospective analysis was conducted, involving 68 neonates from two different neonatal intensive care units. The impact of time to initiate treatment, time to reach the target temperature, and time between initiation and target temperature was correlated with short-term outcomes on MRI. Results: We did not find a significant difference between outcomes regarding the time to start treatment and the time to achieve the target temperature. Interestingly, neonates with a poor outcome were treated on average earlier than neonates with a favorable outcome but required more time to reach the target temperature. Additionally, the study results did not support the hypothesis that a shorter time to initiate treatment would lead to shorter times to achieve the target temperature. Conclusion: Based on our findings, it is recommended to prioritize a thorough evaluation of neonatal encephalopathy before initiating therapeutic hypothermia. Early initiation of treatment should be balanced with the time required for precise assessment to ensure better outcomes.

Introduction: Advances in neonatology, neonatal surgery, and extracorporeal membrane oxygenation have improved the prognosis of congenital diaphragmatic hernia (CDH). However, CDH survivors are at considerable risk of long-term neurological morbidity. Magnetic resonance imaging (MRI) abnormalities are reported in up to 84% of CDH survivors but have only been rarely compared with neurodevelopmental outcomes. This study aims to investigate whether assessment of postnatal MRI in CDH survivors allowed association with and prediction of long-term outcome. Methods: Brain MRI was performed in 36 neonates with CDH using the Weeke score, assessing the mammillary bodies, the corpus callosum, cortical folding, and cerebrospinal fluid space (CSF). Outcomes were measured using Bayley-III-examinations at 12 months. Results: In total, 91.6% of the neonates exhibited MRI abnormalities. Among them, 83.3% showed white matter (WM), 16.6% gray matter abnormalities, 8.3% cerebellar abnormalities, and 20% had an intracranial hemorrhage. A total of 30.5% showed abnormal mammillary bodies, 44.4% enlarged CSF, 5.5% reduced cortical folding, and 8.3% reduced corpus callosum thickness. While the use of the Weeke score was not helpful for outcome prediction, specific MRI abnormalities were associated with adverse long-term outcomes. Based on these findings, a novel MRI-scoring system was developed. This easy-to-perform score effectively predicted adverse outcomes at 12 months. Conclusion: Interpretation of MRI in neonates with CDH should focus on WM pathologies, CSF enlargement, internal capsule involvement, mammillary body abnormalities, and intraventricular hemorrhage. Our novel simple scoring system helps identify neonates at risk for adverse neurological outcomes at discharge and aids to implement therapeutic strategies at an early point.

Besides its limitations, cranial ultrasound is the standard imaging method in neonates. Early postnatal magnetic resonance imaging (MRI) offers more objective measurements, but access to MRI is often limited. Portable ultralow-field (ULF) MRI could expand MRI access. To date, no comparison is available between cranial ultrasound and ULF MRI measuring neonatal brain metrics. We performed paired ULF MRI and cranial ultrasound in 28 term newborns. Dimensions of ten routinely measured anatomic structures were measured and compared between the modalities. Correlations between ULF MRI and ultrasound biometrics was significant for most anatomic brain structures (median correlation coefficient 0,73). ULF MRI reliably displays ultrasound biometry of the neonatal brain. We found that ULF imaging can be performed as point-of-care MRI at the neonatal bedside during natural sleep, which may widen the access to MRI. This work is supported by the Bill and Melinda Gates Foundation (Ultralow field Neuroimaging in The Young: INV-005798).

Purpose: This study aims to assess the applicability of ultralow-field (ULF) magnetic resonance imaging (MRI) in the neonatal intensive care unit (NICU), its impact on both the neonate being scanned and neighboring patients, and its effects on medical procedures and early parent-child interaction. Background: Neonatal MRI is crucial for diagnosis and treatment in the NICU, but access is limited, both in high-income countries and low- and middle-income countries. Portable ULF MRI presents an opportunity to expand access, but its applicability and potential impacts on neonates and nearby patients have not been studied, including its effects on medical care and early parent-child interaction. Methods: We assessed applicability, safety and stress levels of neonates during ULF MRI at a NICU by measuring heart rate, oxygen saturation and blood pressure of the neonate scanned and neighboring patients and by measuring subjective stress levels assessed by attending physicians, nurses and parents. Using questionnaires, we assessed whether medical care and early parent-child interaction was affected. Results: No significant differences were found in the physiological measures of the scanned and neighboring neonates. Medical care and parent-child interaction were not affected by ULF MRI. Conclusions: ULF MRI can be safely performed in the NICU without causing stress to neonates or affecting medical care or parent-child interaction. It can be performed at the bedside during natural sleep, requiring fewer resources compared to high-field MRI, making it a viable point-of-care option in both the NICU and low-resource settings. This could significantly increase MRI accessibility.

Aim: There is a wide treatment heterogeneity for asphyxiated newborn infants between hospitals in Germany. This study aimed to identify the leading entry criteria initiating therapeutic hypothermia (TH) using data from the German Hypothermia Registry. Methods: We retrospectively analyzed 262 asphyxiated newborn infants treated with TH across 74 neonatal units in Germany. Clinical and metabolic parameters and neurological assessments were recorded before the initiation of TH using a standardised electronic form in REDCap, a secure web‐based platform for clinical research. Correlations between metabolic indicators (pH, base deficit, lactate) and neurological assessments, including Sarnat score, Thompson score and initial amplitude‐integrated electroencephalography (aEEG) were examined. Results: Mean gestational age was 39.4 ± 1.7 weeks. Acidosis and abnormal aEEG patterns were the most frequent criteria initiating treatment. Lower pH was strongly associated with abnormal aEEG (odds ratio 0.02, 95% confidence interval 0.002–0.19, p < 0.01). Base deficit and lactate showed weaker, non‐significant associations. Lower 10‐min Apgar scores predicted abnormal aEEG (odds ratio 0.77, 95% confidence interval 0.69–0.87, p < 0.001). Conclusion: Severe acidosis (pH < 7.0) was significantly associated with abnormal aEEG patterns, the main determinant initiating TH. Identifying abnormal aEEG patterns is essential for confirming moderate to severe encephalopathy and guiding treatment.

Zusammenfassung: Hintergrund: Die neonatale Enzephalopathie (NE) nach perinataler Asphyxie ist eine der Hauptursachen für Neugeborenensterblichkeit und für neurologische Langzeitschäden. Die therapeutische Hypothermie (TH) stellt die einzige etablierte Therapie für Neugeborene mit moderater bis schwerer NE dar. Trotz dieser Therapie besteht ein hohes Risiko für bleibende neurologische Beeinträchtigungen. Frühzeitige Aussagen über das Langzeit-Outcome sind hilfreich, um therapeutische Entscheidungen zu treffen, frühzeitig neuroprotektive und -rehabilitative Maßnahmen einzuleiten und die betroffene Familie zu beraten. Ziel: In diesem Übersichtsartikel möchten wir einen Überblick über mögliche Prognoseparameter des Langzeit-Outcome asphyktischer Neugeborener nach TH geben. Methoden: Wir bewerten mögliche Prognoseparameter systematisch, um abschließend eine klinisch anwendbare Vorgehensweise zu entwickeln und das Langzeit-Outcome nach TH möglichst zuverlässig einschätzen zu können. Ergebnisse: Zuverlässige Prognoseparameter nach TH sind eine ausbleibende Normalisierung des (a) EEG nach 48 h, ein dauerhaftes Ausbleiben eines Schlaf-Wach-Rhythmus im (a) EEG, das Vorliegen eines Status epilepticus im (a) EEG sowie spezifische Auffälligkeiten in bildgebenden Untersuchungen (Schädelsonographie und MRT). Standardisierte klinisch-neurologische Untersuchungen besitzen insbesondere für das motorische Outcome eine hohe Aussagekraft. Parameter der ersten Lebensstunden wie 1‑min-, 5‑min- und 10-min-Apgar-Index, pH-Wert und Sarnat‑/Thompson-Score erlauben keine Aussage über das Langzeit-Outcome, helfen aber jene Neugeborenen zu identifizieren, die mittels TH behandelt werden sollten. Diskussion: Die Langzeitprognose nach TH sollte in der Zusammenschau verschiedener klinischer und apparativer Untersuchungen erfolgen.