BACKGROUND
Our understanding of cardiovascular adaptation at birth is limited and mostly based on animal models. Several echocardiographic indices of loading condition and myocardial performance have been validated in the neonatal population.

OBJECTIVE
To describe perinatal circulatory changes through echocardiographic assessments over the first 24 hours of transition.

METHODS
Prospective observational study in Cork University Maternity Hospital, Ireland. Echocardiograms were performed at 5 minutes (T1) and 24 hours (T2) of life in 56 vigorous term infants. Measurements were obtained with pulsed-wave (PW) doppler and PW-tissue doppler imaging (TDI). Variables were compared using Paired-Samples T-Test or Wilcoxon Signed-Rank Test.

RESULTS
Left and right ventricular output (LVO-RVO) were significantly lower at T2 along with a lower heart rate, while right and left stroke volume (SV) significantly increased. Pulmonary acceleration time/ejection time (PAATi) was higher at T2 (0.35[0.30-0.41] vs 0.29[0.25-0.32], p<.001), while RV isovolumic times and MPI were lower (p<.001). Septal and lateral wall TDI-derived velocities were significantly higher at T1 vs T2.

CONCLUSIONS
In the immediate perinatal period, we observed notably higher left myocardial tissue velocities. This may reflect a hyperdynamic status sustained by catecholamines release at birth and increased cardiac output (CO) following cord clamping. Perinatal changes in CO are more dependent on heart rate than SV. Shorter RV-relaxation time and increasing PAATi, a proxy of falling pulmonary vascular resistance, reflect the lowering trend of right afterload after birth. Changes in loading conditions have a larger impact on right heart function, as demonstrated by improved right ventricular performance at 24 hrs.

BACKGROUND
Despite ongoing advances in perinatal care, preterm infants remain at significant risk of Bronchopulmonary Dysplasia (BPD). Chronic pulmonary hypertension (PH) can complicate the clinical course of these patients (BPD-PH).

OBJECTIVES
To assess echocardiographic features in infants born <32 weeks over a 6-month period in a tertiary NICU, after establishing a screening protocol for PH-BPD at 32 (T1) and 36 weeks (T2) cGA.

METHODS
Retrospective single-centre study. PH severity was graded using tricuspid regurgitation jet (TRJ) and systolic eccentricity index (sEI). Pulmonary vascular resistances, shunt direction (PFO/ASD, PDA, VSD), biventricular function were analyzed. Severity of lung disease was assessed with modified respiratory score (mRSS), OSI, SpO2/FiO2, while BPD was classified according to Jensen criteria.

RESULTS
To date, 36 infants were admitted to NICU, of whom 9 excluded. At T1, none had significant sPAP (≥40 mmHg estimated from TRJ), 3(12.5%) had sEI ≥1.3. At T2, 1(4.7%) patient had bidirectional shunt through PDA, 3(14%) developed increased sPAP and 4(19%) increased sEI.
Moderate-severe BPD was diagnosed in 5(23.8%) infants, of whom 3(60%) had either TRJ≥40 mmHg or sEI ≥1.3 at T2. None in the moderate-severe BPD group had TRJ≥40 mmHg or sEI ≥1.3 at T1. LV myocardial performance index (LV-MPI) at T2 was significantly higher in the moderate-severe group (0.41±0.087 vs 0.33 ±0.027, p<0.05).

CONCLUSIONS
Early PAPs did not reflect later diagnosis of PH. Patients with moderate-severe BPD should have echocardiographic screening at 36/40 weeks to determine the presence of BPD-PH. Left global myocardial performance was impaired in the moderate-severe group.

Background:
Neonatal Encephalopathy (NE) continues to be one of the leading causes of seizures in term neonates and, if present, implies a moderate-severe grade of NE.
The aim of this study is to describe MRI outcomes in infants initially classified as having mild NE who later developed seizures.

Methods:
Retrospective study of infants receiving therapeutic hypothermia(TH) for NE at the Brigham and Women’s Hospital, Boston (2016-2021). From this cohort, infants with mild NE with seizures were identified. EEGs and MRIs were independently graded according to previously published grading systems by 2 Neonatologists with Neurology subspecialisation.

Results:
During this time, 291 infants received TH for NE. Twenty-six infants (9%) had seizures confirmed electrographically, of which 6 had a clinical diagnosis of mild NE. Table 1 outlines the relevant EEG and clinical findings. Four of the six infants had a normal MRI Brain prior to discharge. Two infants had moderate-severe injury on their MRI, both of whom had moderate abnormalities noted on their EEG in the first day. One of these infants had profound hypoglycaemia suggestive of an underlying metabolic condition and died on day 11.

Conclusion:
In our cohort, 67% (4/6) infants with mild NE who later had seizures had a normal MRI Brain. Infants with injury noted on their MRI (2/6) had abnormal features on their early EEG. Presence of seizures does not, by default, imply a poor outcome however further research and long-term follow up is required. EEG may be helpful in identifying infants at risk.

Background:
Breastfeeding rates in Ireland are amongst the lowest in Europe. Currently, rates of exclusive breastfeeding on discharge from Cork University Maternity Hospital are 25-35%. Neonatal unit admission can interfere with the establishment of breastfeeding.

Objective
This study aimed to describe the impact of admissions to the neonatal unit on breastfeeding practices in babies >37 weeks gestation.

Methods
A retrospective chart review was performed analysing all babies partially breastfed, exclusively breastfed or with the intention to breastfeed if feeding had not yet been commenced at time of admission. All babies born after 37 weeks gestation (37+0 and above) who were admitted to the neonatal unit from February 1 2023 to March 31 2023 were included. Babies who were exclusively formula-fed prior to admission were excluded.

Results
There were 72 babies included in the study. The median age at admission was 9.25 hours. The median length of admission was 2 days.
55 had already initiated breastfeeding, 36 of whom were exclusively breastfeeding. 17 had the intention to breastfeed.
During admission 83% of babies received artificial supplementation. On discharge 25 were exclusively breastfed, 43 were breastfeeding and supplemented with artificial formula and 4 were exclusively formula fed.
The three most common reasons for admission were hypoglycaemia (24% n=17), jaundice (21% n=15) and respiratory distress (17% n=12).

Conclusions
Supplemetation of babies admitted to the unit is common and exclusive breastfeeding rates are lower than the wider neonatal numbers throughout the hospital. Additional education and support of breastfeeding could be beneficial within our unit.

BACKGROUND:
To date, brain functional connectivity (FC) fMRI analysis has been used in some asleep infant studies. Although considered practically challenging, this study aimed to investigate whether awake infant fMRI might yield richer data possibly containing stronger features allowing classification using supervised (labelled) machine learning.
METHODS:
The first 100 infants (aged 2months corrected) recruited as part of the FOUNDCOG Project watched videos while in the MRI. Region-of-interest(ROI) extraction of fMRI data was achieved using a 400 parcel 7 network atlas. Group average functional connectivity was calculated asleep and awake using Pearson partial correlation (motion covariant). The video/stimulus evoked component of FC was determined using Pearson correlation across subjects watching the same video.
RESULTS:
Of 100 infants scanned 76 infants (17 born preterm <34 weeks gestation, 59 born term) contributed both awake and asleep runs in the same session. Group average FC showed significantly increased limbic network connectivity when asleep, versus increased visual, somatomotor and salience/ventral-attention networks when awake. The visual, control and dorsal-attention networks contributed significantly towards the evoked component. To classify ‘preterm versus term’ a Support-Vector-Machine (linear) classifier achieved a balanced-accuracy score of 0.67 (SD 0.05) p=0.001 versus 0.61 (SD 0.04) p=0.004 using awake and asleep data respectively. Classification was equivocal(non-significant) using the evoked component alone.
CONCLUSION:
Aged 2-months corrected seems an opportune time to acquire awake infant fMRI. A machine learning classifier can better classify preterm vs term gestation using awake compared to asleep data. It does not appear that stimulus evoked connectivity alone is driving this difference.

Background: Cerebrovascular autoregulation (CAR) is often impaired in preterm infants but requires invasive mean arterial blood pressure (MABP) measurements for continuous assessment.

Objective: We aimed to assess whether using heart rate (HR) as alternative surrogate for cerebral perfusion pressure results in different CAR assessment compared with using MABP.

Methods: We compared daily mean moving window correlation-coefficients between rcSO₂ and MABP (COx) and rcSO₂ and HR (TOHRx), and %time with impaired CAR calculated using either COx (>0.3), or TOHRx (<-0.3), during the first 72h after very preterm birth. We assessed the association between %time impaired CAR of both methods with short-term cerebral injury on ultrasound.

Results: Thirty-two infants with a median gestational age of 25.0 weeks (range 24.3-27.0) and a mean birth weight of 901 ± 244 grams were included in the analysis. Mean COx and TOHRx differed during the initial two days after birth (day 1 p= 0.003, day 2 p= 0.004). %Time impaired CAR using MABP, appeared higher on day 1 (p=0.003), and day 3 (p=0.019) compared to using HR. Both methods simultaneously indicated impaired CAR during 65.7%-69.6% of the monitoring period. Both measurements were not associated with early cerebral injury. Data shown in Table 1.

Conclusion: The findings suggest that HR and MABP are not interchangeable when assessing CAR in preterm infants. Further investigation is warranted to explore the utility of HR as an alternative measure for identifying impaired CAR and its relationship with short-term cerebral injury.

Background
An audit of admission temperatures in our tertiary unit showed that 14.5% of babies were hypothermic, the majority of which were preterm. Hypothermia has been shown to increase morbidity and mortality in preterm infants. To combat this, we introduced humidified gases during resuscitation in the delivery suite for babies between 23 and 24 weeks gestation.

Objective
To introduce humidified gases during resuscitation in the delivery suite to improve our hypothermia rate in preterm infants between 23 and 34 weeks.

Methods
Humidification chamber incorporated into pre-existing portable resuscitation device. Chamber pre-heated for 15 minutes. Gases delivered through face/nasal mask or ET tube. Infant's temperature measured with axillary probe on admission. Temperature values gathered from patient notes/Badgernet.

Results
Data collected on 54 babies born between September and December 2022.
All infants received standard thermal care. One infant recieved humidified gas via ET tube, the rest via mask ventilation.
22 infants recieved humidified gas during resuscitation. Gestational age 25 to 34 weeks. Temperature range 36.4>37.5. Lowest birth weight 402g.
32 infants did not recieve humidified gas during resuscitation. Gestational age 23 to 32 weeks. Temperature range 32.1>38.7. Lowest birthweight 470g.

On re-audit, hypothermia rate reduced to 7.8%.

Conclusion
There were no cases of significant hypothermia in the infants receiving humidified gas even at extremes of gestation and extremely low birthweight. Challenges facing us included quick deliveries meaning limited time to warm the gases and a reduction in the use of humidified gas when the infant was intubated in the delivery suite.

Background and Objective:
Hyperbilirubinemia is a common cause of neonatal disease. Severe hyperbilirubinemia is a risk factor for auditory system injury. To determine the usefulness of auditory brainstem responses (ABR), in early diagnosis of hearing impairments in healthy term infants with elevated bilirubin levels requiring exchange transfusions or treated with exchange transfusions.

Material & Methods:
During a two year period, in a prospective descriptive analytic study, 64 (32 female, 32 male), healthy term (> 37 weeks) infants, who required treatment or were treated with phototherapy or exchange transfusions for elevated bilirubin levels or jaundice, were studied. After obtaining consent from parents post treatment, infants were tested with auditory brainstem responses (ABR), then results were analyzed using SPSS 16 software.

Results:
No significant correlation was seen between ABR and age, weight, bilirubin level and ABO group. 19 of 64 infants were treated with exchange transfusion, 3 of 19 infants (16%) showed abnormal ABR and 16 of 19 infants (84%) had normal ABR, which showed no significant correlation between exchange transfusion and ABR (p<0.05).

Conclusions:
These results showed that 14% of infants with elevated bilirubin who required exchange transfusion had abnormal ABR, which indicate that elevated bilirubin levels requiring exchange transfusion without kernicterus is an important risk factor for hearing impairments and may lead to abnormalities in hearing tests. Because it is yet unclear how long these tests remain abnormal, this requires further research.