Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may result in the multisystem inflammatory syndrome in children (MIS-C). The clinical presentation of MIS-C includes fever, severe illness, and the involvement of two or more organ systems, in combination with laboratory evidence of inflammation and laboratory or epidemiologic evidence of SARS-CoV-2 infection. Some features of MIS-C resemble Kawasaki Disease, toxic shock syndrome, and secondary hemophagocytic lymphohistiocytosis/macrophage activation syndrome. The relationship of MIS-C to SARS-CoV-2 infection suggests that the pathogenesis involves post-infectious immune dysregulation. Patients with MIS-C should ideally be managed in a pediatric intensive care environment since rapid clinical deterioration may occur. Specific immunomodulatory therapy depends on the clinical presentation. The relationship between the immune response to SARS-CoV-2 vaccines in development and MIS-C requires further study.

Hypoxic ischemic encephalopathy due to acute perinatal asphyxia is an important cause of childhood neurodevelopmental deficits among infants who were born at full-term. Five randomized clinical trials of induced hypothermia at 33.0°C to 34.0°C for 72 hours have demonstrated a decrease in death or disability up to 24 months of age.^1-7 This neuroprotection continues to childhood^8-10; however, the rate of death or disability in the cooled group remains high (range, 44%-55%).^1-7

Congenital Diaphragmatic hernia (CDH) is a condition characterized by a defect in the diaphragm leading to protrusion of abdominal contents into the thoracic cavity interfering with normal development of the lungs. The defect may range from a small aperture in the posterior muscle rim to complete absence of diaphragm. The pathophysiology of CDH is a combination of lung hypoplasia and immaturity associated with persistent pulmonary hypertension of newborn (PPHN) and cardiac dysfunction. Prenatal assessment of lung to head ratio (LHR) and position of the liver by ultrasound are used to diagnose and predict outcomes. Delivery of infants with CDH is recommended close to term gestation. Immediate management at birth includes bowel decompression, avoidance of mask ventilation and endotracheal tube placement if required. The main focus of management includes gentle ventilation, hemodynamic monitoring and treatment of pulmonary hypertension followed by surgery. Although inhaled nitric oxide is not approved by FDA for the treatment of PPHN induced by CDH, it is commonly used. Extracorporeal membrane oxygenation (ECMO) is typically considered after failure of conventional medical management for infants ≥ 34 weeks’ gestation or with weight >2 kg with CDH and no associated major lethal anomalies. Multiple factors such as prematurity, associated abnormalities, severity of PPHN, type of repair and need for ECMO can affect the survival of an infant with CDH. With advances in the management of CDH, the overall survival has improved and has been reported to be 70-90% in non-ECMO infants and up to 50% in infants who undergo ECMO.

OBJECTIVES: Evaluate the spectrum of neurodevelopmental outcome in a contemporary cohort of extremely preterm infants. We hypothesize that the rate of severe neurodevelopmental impairment (NDI) decreases over time. METHODS: Retrospective analysis of neurodevelopmental outcome of preterm infants ≤27 weeks’ gestational age (GA) from a Neonatal Research Network center that completed neurodevelopmental follow-up assessments between April 1, 2011, and January 1, 2015. The Bayley Scales of Infant Development-III (BSID III) and a standardized neurosensory examination were performed between 18 and 26 months’ adjusted age. Outcome measures were neurologic examination diagnoses, BSID III cognitive and motor scores, sensory impairment, and the composite outcome of NDI, based on the BSID III cognitive score (analyzed by using a cutoff of <85 or <70), BSID III motor score of <70, moderate or severe cerebral palsy (CP), bilateral blindness, and hearing impairment. RESULTS: Two thousand one hundred and thirteen infants with a mean GA of 25.0 ± 1.0 weeks and mean birth weight of 760 ± 154 g were evaluated. The 11% lost to follow-up were less likely to have private insurance, late-onset sepsis, or severe intraventricular hemorrhage. Neurologic examination results were normal in 59%, suspect abnormal in 19%, and definitely abnormal in 22%. Severe CP decreased 43% whereas mild CP increased 13% during the study. The rate of moderate to severe NDI decreased from 21% to 16% when using the BSID III cognitive cutoff of <70 (P = .07) or from 34% to 31% when using the BSID III cognitive cutoff of <85 (P = .67). CONCLUSIONS: Extremely preterm children are at risk for NDI. Over time, the rate of moderate to severe NDI did not differ, but the rates of severe CP decreased, and mild CP increased.

Term pregnancy has been defined as one in which 37 to 41^6/7 weeks have elapsed since the first day of the last menstrual period, referred to as postmenstrual age (PMA).¹ Neonates born during this 5-week period have traditionally been considered a homogeneous low-risk group. Categorizing groups of newborns is of value to focus attention on negative outcomes and to develop strategies to address the causes.² For example, the late-preterm neonate emerged as a newly described group in the last decade, defined in part to draw attention to the significantly higher than perceived risk for morbidity and mortality. This resulted in efforts such as the 2005 workshop of the Eunice Kennedy Shriver National Institute of Child Health and Human Development on late-preterm infants (34-36^6/7 weeks’ PMA), which served as a platform for raising awareness and effecting prevention.^3,4 The designation of early-term infants (37-38^6/7 weeks’ PMA) was more recently coined to focus attention on the risk for morbidity and mortality in such infants compared with other term infants born at 39 to 41^6/7 weeks’ gestational age.^1,2,5 Morbidity among early-term infants is considerably less than that among late-preterm infants.⁶ However, early-term infants outnumber late-preterm infants by 3 to 1 in the United States (27.6% vs 8.7% of all births in 2009).⁷ Studies linking gestational age to outcomes among term neonates have focused on the presence of labor and mode of delivery and have provided limited description of neonatal outcomes^8,9 or are based on admissions to a tertiary care center and not a specific geographic area.¹⁰