Objective: The objective of the study was to examine normal variations of umbilical cord arterial pH by gestational age (GA). Study Design: Population-based cohort study of 46 199 infants born from 2008 to 2014 in Stockholm, Sweden, with GA 28 to 42 weeks, Apgar score ⩾7 at 5 min, non-instrumental vaginal delivery, and birth weight for GA⩾3rd and ⩽97th percentile. Quantile regression was used to investigate the associations between GA and infant sex, and pH. Results: The mean umbilical cord arterial pH (s.d.) was 7.29 (0.10), 7.27 (0.07), 7.25 (0.07) and 7.23 (0.07) among infants born at 28 to 31, 32 to 36, 37 to 41 and 42 weeks, respectively. Arterial pH decreased linearly with increasing GA, and female infants had higher pH than male infants ( P <0.001). Conclusion: Umbilical cord arterial pH varied in a linear fashion by GA and was influenced by infant sex. The provided reference curve taking GA into account may yield a more accurate definition of acidosis at birth.

Background and Aim Extremely preterm infants are at increased risk of permanent hearing loss. However, population-based data in infants born with less than 27 weeks gestation are scarce. The aim of this study is to investigate the prevalence of hearing impairments in extremely preterm infants at the age four years. Methods A population based cohort study on infants born before 27 gestational weeks from 1 January 2004 to 31 mars 2007 in Stockholm, Sweden. Perinatal clinical data on all children were collected prospectively. Data on hearing ability were retracted from patient records. Hearing ability was investigated through neonatal hearing screening with otoacoustic emissions (OAE) for children born after 1 November 2005 and for all children at age four years with play audiometry through Child Health Centers. Results Of the 107 children, one infant (0.9%) had a permanent moderate (40–60 dB) bilateral sensorineural hearing impairment. The hearing loss was detected through the neonatal hearing screening and hearing aids were given at age three years. 56 children had neonatal hearing screening of which 46 (82%) had normal hearing. After hearing screening at four years age no additional children were identified with hearing impairment. Several children had neonatal morbidity such as BPD, ROP and IVH. At age 30 months 6 children had CP. Conclusion The prevalence of hearing impairments at the age of four in the studied population is 0.9 %. This prevalence is lower than data published in previous extremely preterm cohorts, and lower than expected in this very high-risk population.

Extrem Frühgeborene zeigen in der Magnetresonanztomografie (MRT) nicht selten Anomalien im Bereich der weißen Gehirnsubstanz. Als Prädiktor für spätere zerebrale Entwicklungsstörungen diskutieren Neonatologen unter anderem diffuse exzessive starke Signale (diffuse excessive high signal intensities, DEHSI). Nach einer aktuellen Arbeit wird deren Bedeutung jedoch überschätzt.

Background and aims Extremely preterm infants are at high risk of brain injury and adverse outcome. This study compares the predictive values of cranial ultrasound (CUS) and conventional magnetic resonance imaging (MRI) at term equivalent age (TEA) for cerebral palsy (CP) and/or severe cognitive delay. Methods Eighty-four infants, born < 27 weeks of gestation, underwent MRI (1.5 T) and CUS (5–8 MHz) at TEA. Images were evaluated by three independent observers. A previously published (Horsch et al. 2010), modified CUS scoring system and a widely used MRI scoring system were applied (Woodward et al. 2006). At age 30 months corrected, 62 infants (74%) underwent neurological examination and assessment with the Bayley Scales of Infant and Toddler Development-III (BSITD-III). Cut off levels for developmental delay (–2 SD) were adjusted to an age and sex matched term born control group (n=85). Results Both CUS and MRI scoring systems predicted CP with a sensitivity of 75%, while specificity was higher for MRI (96%, versus 91%). Predictive values for severe cognitive delay were equal and good, with sensitivities of 100% (specificity 95% for MRI, 90% for CUS). Conclusion We conclude that, using the scoring systems applied in this study, both CUS and MRI at TEA are useful in predicting CP and/or severe cognitive delay at age 30 months. Furthermore, we suggest that these scoring systems, which can be used in clinical routine, are helpful tools in identifying infants who are at high risk of adverse outcome and should undergo MRI.

Aim: To examine associations of structural brain abnormalities, in particular diffuse excessive high signal intensities (DEHSI), assessed by visual inspection of neonatal magnetic resonance images (MRI) with neurodevelopmental outcome at age 30 months corrected in a 3 year cohort of extremely low gestational age (ELGA) infants. Methods: 109 infants born < 27 weeks of gestation underwent conventional MRI at term-equivalent age. Images were analysed using an established scoring system (Inder et al 2003). At age 30 months corrected the infants were assessed using the Bayley Scales of Infant and Toddler Development. Results: No or mild white matter abnormalities (WMA) were seen in 86% of infants. In 14% moderate or severe WMA, and in 5% grey matter abnormalitites (GMA) were detected. DEHSI were seen in 56%. Outcome data were available for 72% of the cohort. Mean composite scores were 95 (SD±10) for cognitive scales, 97 (SD±14) for language scales, and 103 (SD±14) for motor scales. Six percent of the infants had cerebral palsy. Significant associations were seen between moderate-severe WMA and/or GMA and cognitive scores (Mann-Whitney U-test, p< 0.05) as well as language scores (p< 0.05). No significant associations were seen between MRI findings and motor scores. DEHSI were not associated with performance on the Bayley Scales. Conclusion: In our cohort of ELGA infants, moderate-severe brain abnormalitites on neonatal MRI were associated with impaired cognitive and language outcome at age 30 months corrected. The incidence of DEHSI was high, but the presence of DEHSI was not associated with adverse outcome.

Objectives Conventional MRI at term age has been reported to be superior to cranial ultrasound (cUS) in detecting white matter (WM) abnormalities and predicting outcome in preterm infants. However, in a previous study cUS was performed during the first 6 weeks only and not in parallel to MRI at term age. Therefore, the aim of the present work was to study brain injuries in preterm infants performing concomitant cUS and MRI at full-term age. Methods In a population-based cohort of 72 extremely low gestational age infants paired cUS and conventional MRI were performed at term age. Abnormalities on MRI were graded according to a previously published scoring system. On cUS images the lateral ventricles, the corpus callosum, the interhemispheric fissure and the subarachnoidal spaces were measured and the presence of cysts, grey matter abnormalities and gyral folding were scored. Results Moderate or severe WM abnormalities were detected on MRI in 17% of infants and abnormalities of the grey matter in 11% of infants. Among infants with normal ultrasound (n=28, 39%) none had moderate or severe WM abnormalities or abnormal grey matter on MRI. All infants with severe abnormalities (n=3, 4%) were identified as severe on MRI and cUS. Conclusions All severe WM abnormalities identified on MRI at term age were also detected by cUS at term, providing the examinations were performed on the same day. Infants with normal cUS at term age were found to have a normal MRI or only mild WM abnormalities on MRI at term age.

Hintergrund: Woodward et al konnten zeigen, dass eine MRT des Schädels am errechneten Geburtstermin (ET) bei extrem unreifen Frügeborenen hinsichtlich der Diagnose von diffusen Veränderungen der weißen Substanz und prognostischem Wert für späteres Outcome der Schädelsonographie überlegen ist (Woodward et al, N Engl J Med 2006). Jedoch wurde die Schädelsonographie in dieser – wie auch in anderen Studien – lediglich in den ersten 6 Lebenswochen und nicht parallel zur MRT am ET durchgeführt. Fragestellung: Ziel der Studie war es, bei extrem unreifen Frühgeborenen (<27 SSW, ELGA) zerebrale Schädigungen mit MRT und Sonographie am ET zu evaluieren und beide Methoden zu vergleichen. Methoden: In einer populationsbasierten Kohorte von 73 ELGA Frühgeborenen, geboren zwischen 8/2004 und 11/2006 in der Region Stockholm, mittleres Geburtsgewicht 819g (494–1161g), mittleres Gestationsalter 25+4 Wochen (23+3–26+6w), wurden Schädelsonographie und MRT am ET durchgeführt. Alle Untersuchungen wurden von drei unabhängigen Untersuchern beurteilt. Veränderungen der grauen und weißen Substanz auf MRT Bildern wurden anhand eines etablierten Scoringssystems (Inder et al, J Pediatr 2003) klassifiziert. Schädelsonographisch wurde die Größe der Seitenventrikeln, C. callosum, Interhemisphärenspalt und Subarachnoidealraum gemessen, Zysten beschrieben und Komplexität der Gyrierung subjektiv beurteilt. Ergebnisse: Mittels MRT wurden moderate-schwere Veränderungen der weißen Substanz bei 18% und Veränderungen der grauen Substanz bei 11% der Kinder diagnostiziert. Schädelsonographisch wurden zystische Läsionen und/oder schwere Ventrikulomegalie bei 8 Kindern (11%) und die Kombination aus reduzierter Komplexität der Gyrierung, verbreitertem Interhemisphärenspalt und Subarchnoidealraum (indirekte Zeichen zerebaler Atrophie) bei 13 Kindern (18%) diagnostiziert. Bei keinem der Kinder mit komplett unauffälliger Schädelsonographie (n=27) wurde mittels MRT moderate oder schwere Veränderungen der weißen oder grauen Substanz nachgewiesen. Alle Kinder mit schweren Schädigungen (n=3) wurden sowohl mittels MRT als auch Schädelsonographie gleichermaßen erfasst. Schlussfolgerung: Schädelsonographie sowie MRT am ET erfassen Kinder mit schwerwiegenden Schädigungen der weißen Substanz. Kinder mit unauffälliger Schädelsonographie am ET hatten entweder einen unauffälligen MRT-Befund oder nur milde Veränderungen der weißen und grauen Substanz. Ob diese milden Veränderungen in der MRT von klinischer Relevanz sind und wie der individuelle prognostische Wert von Sonographie und MRT am ET ist, wird zur Zeit anhand der entwicklungsneurologischen Nachuntersuchungen im korrigierten Alter von 30 Monaten evaluiert.