Arch Dis Child 2012;97(Suppl 2):A1–A539 A97
after birth and increased to 4.5 (3.16–6.39) at 24h, 6.3 (2.04–19.4) at
48h and 6.19 (1.93–19.8) at 72h. LR+ of BS for mortality was below
1 at any time. LR+ of EA for mortality was 4.95 (2.20–11.1), the
type of EA (e.g. status epilepticus) was not predictive. LR+ of SWC
for survival was 10.7 (1.62–70). RcSO2 increased from 6 to 72h after
birth, but was not different at any time between infants that died
Conclusion aEEG during HT can still be used to predict risk for
mortality of HIE, especially beyond 24 hrs. BS is frequently not
associated with a fatal outcome. RcSO2 has no additional value to
THE RELATIONSHIP BETWEEN RAPID FLUCTUATION IN
SERUM SODIUM AND INTRAVENTRICULAR HEMORRHAGE
(IVH) IN HYPERNATREMIC EXTREMELY LOW BIRTH WEIGHT
S Sarkar, J Dalton, R Dechert. Department of Pediatrics, Division of Neonatal-Perinatal
Medicine, University of Michigan Health System, Ann Arbor, MI, USA
Hypernatremia causes brain shrinkage and resultant vascular rup-
ture with cerebral and IVH. However, it is not known if rapid fluc-
tuation in serum sodium in hypernatremic preterm infants results
in IVH or death.
Objective To determine if the rapid rise in serum sodium or rapid
correction of hypernatremia predict the composite outcome of
severe IVH (grade 3 and 4) or death during the first 10 days of life.
Methods Single center retrospective review of 167 preterm infants
with GA ≤26 weeks who had serum sodium monitored at least
every 12–24 hours and more frequently, if indicated. Logistic regres-
sion analysis identified which of the commonly cited risk factors of
IVH, including rapid (>10 and >15 mmol/l/day) rise or fall in serum
sodium could predict composite outcome in hypernatremic infants.
Results 98 (59%) of 167 infants studied developed hypernatremia
(serum sodium>150 mmol/L), with a maximum median serum
sodium of 154 mmol/l (range 150–181, IQR 152–157), occurring on
median postnatal age of 4 days (IQR 3–5). Grade 4 IVH was more
frequent in hypernatremic compared to normonatremic infants
(p=0.032, OR 3.4, 95% CI 1.1–10.6). Among 98 infants with hyper-
natremia, severe IVH or death occurred in 33 and 21 infants with
rapid (>10 mmol/l/day) rise and drop in serum sodium, respectively.
However, rapid (>10 and >15 mmol/l/day) rise or fall in serum
sodium was not associated with composite outcome on multivari-
Conclusion Correction of hypernatremia not exceeding 10 to 15
mmol/l/day in hypernatremic preterm infants was not associated
with severe IVH or death.
AUTOMATIC IDENTIFICATION OF ACTIVITY BURSTS IN EEG
OF PRETERM INFANTS
K Murphy, R Goulding, N Stevenson, GB Boylan. Paediatrics and Child Health, University
College Cork, Cork, Ireland
Background EEG monitoring provides important information
about the neurological status of the preterm infant but is difficult to
interpret for most. We aim to automatically detect the typical
bursting pattern (trace discontinu) of the preterm EEG and compare
the detections with expert manual annotations.
Methods The method was based on the single channel EEG
method of Palmu et al. but extended to 8-channel recordings for the
first time. The EEG signal was first filtered with a Kaiser-window
filter and the output of a non-linear energy operator (NLEO) was
calculated. The NLEO signal was smoothed and corrected for base-
line artefacts. A burst was identified if the resulting signal remained
Conclusions Severe ROP remains a strong marker of childhood
disabilities in a recent and large international cohort of infants
≤1250 g BW.
THE ASSOCIATION BETWEEN PRETERM BIRTH AND
AUTISM COULD BE EXPLAINED BY MATERNAL AND
S Johansson, S Buchmayer, A Johansson, C Hultman, P Sparen, S Cnattingius.
Karolinska Institutet, Stockholm, Sweden
Background and Aims Children born preterm face an increased
risk of autistic disorders.
We examined whether the association between preterm birth
and risk of autistic disorders could be explained by pregnancy com-
plications or neonatal morbidity.
Methods Swedish, population-based, case-control study including
1216 cases with autistic disorders born between 1987 and 2002, and
6080 controls matched with respect to gender, birth year, and birth
hospital. Associations between gestational age and autistic disor-
ders were assessed and adjusted for maternal, birth and neonatal
Results Compared with infants born at term, the unadjusted odds
ratios (ORs) for autistic disorders among very and moderately pre-
term infants were 2.05 [95% CI: 1.26–3.34] and 1.55 [95% CI: 1.22–
In analyses controlled for maternal, pregnancy, and birth charac-
teristics, ORs were reduced to 1.48 [95% CI: 0.77–2.84] and 1.33
[95% CI: 0.98–1.81], respectively.
Adding also neonatal complications to the analyses, ORs were
0.98 [95% CI: 0.45–2.16] and 1.25 [95% CI: 0.90–1.75], respectively.
Reductions in risks of autistic disorders related to preterm birth
were primarily attributable to preeclampsia, small-for-gestational
age birth, congenital malformations, low Apgar scores at 5 minutes,
and intracranial bleeding, cerebral edema, or seizures in the neonatal
period. Neonatal hypoglycemia, respiratory distress, and neonatal
jaundice were associated with increased risk of autistic disorders for
term but not preterm infants.
Conclusions The increased risk of autistic disorders related to pre-
term birth is mediated primarily by prenatal and neonatal complica-
tions that occur more commonly among preterm infants.
THE PROGNOSTIC VALUE OF AEEG AND NIRS DURING
THERAPEUTIC HYPOTHERMIA IN TERM ASPHYXIATED
1C Niezen, 1A Bos, 2D Sival, 1H ter Horst. 1Pediatrics; 2Child Neurology, University
Medical Center Groningen, Groningen, The Netherlands
Background and objective Infants with hypoxic-ischemic
encephalopathy (HIE) are treated with therapeutic hypothermia
(HT). Following perinatal asphyxia amplitude-integrated EEG
(aEEG) and near-infrared spectroscopy (NIRS) are used to deter-
mine prognosis. We aimed to assess the prognostic value of aEEG
and NIRS during HT.
Methods 40 term infants with HIE and treatment with HT were
retrospectively studied. aEEG and NIRS were started immediately
following admission. aEEGs were assessed by pattern recognition:
background pattern (BP), presence of sleep wake cycling (SWC) and
epileptic activity (EA) were appraised. Recordings during HT (72
hrs) were analysed.
Results 84% of infants had an abnormal BP (discontinuous normal
voltage, burst suppression (BS), continuous low voltage (CLV) or
flat trace (FT)) at admission. The LR+ (95% CI) of an severely
abnormal BP (BS, CLV, FT) for mortality was 1.97 (1.24–3.12) at 6h
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