P–784 Neonatal follow-up of babies born derived from mono-pronuclear zygotes

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
H Tsuji ◽  
H Kitasaka ◽  
N Fukunaga ◽  
Y Asada
Keyword(s):  
Birth Weight ◽  
Embryo Transfer ◽  
Live Birth ◽  
Birth Defects ◽  
Congenital Anomalies ◽  
Clinical Utility ◽  
Average Height ◽  
Average Birth Weight ◽  
Significant Difference

Abstract Study question Are the neonatal outcomes normal of babies derived from the transfer of blastocysts derived from mono-pronuclear(1PN) zygotes? Summary answer There was no effect on growth or increase in congenital anomalies up to 18-months in babies of 1PN-derived births. What is known already 1PN zygotes are observed in ART, albeit at a low rate. We have previously reported that 80.7% of 1PN zygotes derived from IVF or ICSI had a biparental chromosome using Live Cell imaging techniques, and some of these developed to the blastocyst stage (Tokoro et al. ASRM 2013). Furthermore, we have reported that these blastocysts can result in a viable pregnancy and healthy live birth (Tsuji et al. ASRM2020). However, there is some uncertainty about the developmental mechanism of 1PN zygotes, and there is no clear consensus on their clinical utility. Study design, size, duration This was a retrospective study which included 55 cases where there was a live birth after single embryo transfer of a blastocyst derived from 1PN zygote. The incidence of birth defects, birth weight was recorded as well as a physical development survey of 25 children who responded to the 18-months follow-up survey. The time period was 72 months (January 2013 to December 2018). Participants/materials, setting, methods Patients seeking fertility treatment at an established private IVF clinic. We compared the birth weight, birth after18-months height and weight of children born to 1PN zygotes with data from a control, 2PN group. Statistical significance was determined using the t-test (level of P < 0.05). Main results and the role of chance The incidence of birth defects in 1PN embryo-derived infants was 1.8% (1/55). The average birth weight of boys in the 1PN group was 3105.6+/–360.3g, which was not significantly different from 3041.0+/–443.3 g in the 2PN group. In girls, the average birth weight was 3085.7+/–454.9 g in the 1PN group, which was not significantly different from the 2PN group (2938.9+/–311.5 g). The average height at 18-months, was 81.6+/–2.5 cm vs 80.5+/–3.4 cm for boys; 79.0+/–1.8 cm vs 79.0+/–3.4 cm for girls in the 1PN and 2PN groups, respectively. The average body weights of the 1PN and 2PN groups were 11.1+/–1.1 kg vs 10.7+/–1.1 kg for boys; 9.7+/–0.9 kg vs 10.1+/–1.0 kg for girls, respectively. There was no significant difference in average height and weight up-to the 18-months follow-up survey. Limitations, reasons for caution The incidence of 1PN derived births is low and the study was limited to cases of single blastocyst embryo transfer. Wider implications of the findings: The incidence of congenital anomalies in Japan was around 1.7 to 2%, and the incidence was similar in the 1PN. There was no difference in the birth weight and 18-months follow-up survey of the 1PN compared with the 2PN. We have demonstrated that there is clinical utility of 1PN embryo. Trial registration number Not applicable

scholarly journals Oocytes With Smooth Endoplasmic Reticulum Aggregates Are Not Associated With Impaired Reproductive Outcomes: A Matched Retrospective Cohort Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Jian Xu ◽  
Li Yang ◽  
Zhi-Heng Chen ◽  
Min-Na Yin ◽  
Juan Chen ◽  
...  
Keyword(s):  
Endoplasmic Reticulum ◽  
Embryo Transfer ◽  
Live Birth ◽  
Birth Defects ◽  
Birth Rate ◽  
Smooth Endoplasmic Reticulum ◽  
Live Birth Rate ◽  
Clinical Pregnancy ◽  
Reproductive Outcomes ◽  
Significant Difference

ObjectiveTo investigate whether the reproductive outcomes of oocytes with smooth endoplasmic reticulum aggregates (SERa) are impaired.MethodsA total of 2893 intracytoplasmic sperm injection (ICSI) cycles were performed between January 2010 and December 2019 in our center. In 43 transfer cycles, transferred embryos were totally derived from SERa+ oocytes. Each of the 43 cycles was matched with a separate control subject from SERa- patient of the same age ( ± 1 year), embryo condition, main causes of infertility, type of protocols used for fresh or frozen embryo transfer cycles. The clinical pregnancy, implantation, ectopic pregnancy and live birth rate were compared between the two groups.Results43 embryo transfer cycles from SERa- patient were matched to the 43 transferred cycles with pure SERa+ oocytes derived embryos. No significant difference was observed in clinical pregnancy rate (55.81% vs. 65.11%, p=0.5081), implantation rate (47.89% vs. 50.70%, p=0.8667) and live birth rate (48.84% vs. 55.81%, p=0.6659) between the SERa+ oocyte group and the matched group. No congenital birth defects were found in the two groups.ConclusionOur results suggest that the implantation, clinical pregnancy, live birth and birth defects rate of embryos derived from oocytes with SERa are not impaired.

The effects of the day of trophectoderm biopsy and blastocyst grade on the clinical and neonatal outcomes of preimplantation genetic testing–frozen embryo transfer cycles

Zygote ◽  
2021 ◽  
pp. 1-6
Author(s):  
Linjun Chen ◽  
Zhenyu Diao ◽  
Jie Wang ◽  
Zhipeng Xu ◽  
Ningyuan Zhang ◽  
...  
Keyword(s):  
Birth Weight ◽  
Genetic Testing ◽  
Embryo Transfer ◽  
Live Birth ◽  
Frozen Embryo Transfer ◽  
Neonatal Outcomes ◽  
Miscarriage Rate ◽  
Birth Rates ◽  
Preimplantation Genetic Testing ◽  
Live Birth Rates

Summary This study analyzed the effects of the day of trophectoderm (TE) biopsy and blastocyst grade on clinical and neonatal outcomes. The results showed that the implantation and live birth rates of day 5 (D5) TE biopsy were significantly higher compared with those of D6 TE biopsy. The miscarriage rate of the former was lower than that of the latter, but there was no statistically significant difference. Higher quality blastocysts can achieve better implantation and live birth rates. Among good quality blastocysts, the implantation and live birth rates of D5 and D6 TE biopsy were not significantly different. Among fair quality and poor quality blastocysts, the implantation and live birth rates of D5 TE biopsy were significantly higher compared with those of D6 TE biopsy. Neither blastocyst grade nor the day of TE biopsy significantly affected the miscarriage rate. Neonatal outcomes, including newborn sex, gestational age, preterm birth, birth weight and low birth weight in the D5 and D6 TE biopsies were not significantly different. Both blastocyst grade and the day of TE biopsy must be considered at the same time when performing preimplantation genetic testing–frozen embryo transfer.

RELATIONSHIP OF ELEVATED BLOOD TYROSINE TO THE ULTIMATE INTELLECTUAL PERFORMANCE OF PREMATURE INFANTS

PEDIATRICS ◽  
1972 ◽  
Vol 49 (2) ◽  
pp. 218-224 ◽  
Author(s):  
John H. Menkes ◽  
Doris W. Welcher ◽  
Helene S. Levi ◽  
Joseph Dallas ◽  
Neil E. Gretsky
Keyword(s):  
Birth Weight ◽  
Premature Infants ◽  
Maximum Level ◽  
Intellectual Performance ◽  
Wide Range Achievement Test ◽  
Follow Up Study ◽  
Wide Range ◽  
Significant Difference ◽  
Picture Completion

Blood tyrosine concentrations were followed from birth to nursery discharge in 71 premature infants fed a high protein formula supplemented by 60 mg/day of ascorbic acid. In 89% of infants blood tyrosine concentrations were abnormal, and in 38% of infants the maximum level observed was 15.0 mg/100 ml or higher. Maximum blood tyrosine levels correlated significantly with gestational age (p = < 0.05) but not with birth weight. In a follow-up study performed at 15 months of age, infants with high tyrosine levels had no increase in the incidence of neurological abnormalities. Between 7 and 8 years of age a second follow-up study was performed on 62 children. This included a WISC, a Wide-Range Achievement Test (WRAT), and tests for psychomotor and language maturity. Two children had died in the interval, and five of the 62 were retarded for full testing. The full scale WISC I.Q. of all children correlated with birth weight at the 10% confidence level (p = < 0.1). The mean WISC I.Q. of high and low tyrosine subjects was 82.9 and 81.6 respectively. When infants were grouped by birth weight, a significant difference was detected in subjects weighing 2,000 gm or more. High tyrosine infants had a significantly lower performance I.Q. than low tyrosine infants (82.4 and 97.8 respectively; p = < 0.02). Significant differences were recorded in the scores on Object Assembly, Picture Assembly, and Picture Completion of the WISC. Significant differences were also seen on the Spelling subtest of the WRAT (p = < 0.02). We observed no adverse effect of high tyrosine levels on the intellectual performance of smaller premature infants, who on the whole have a greater risk for other complications of prematurity.

The Deferred Embryo Transfer Strategy Seems Not to be a Good Option After Repeated IVF/ICSI Cycle Failures

2018 ◽  
Vol 26 (9) ◽  
pp. 1210-1217 ◽  
Author(s):  
Mathilde Bourdon ◽  
Pietro Santulli ◽  
Yulian Chen ◽  
Catherine Patrat ◽  
Khaled Pocate-Cheriet ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Embryo Transfer ◽  
Live Birth ◽  
Birth Rate ◽  
Previous History ◽  
Multivariate Logistic Regression Analysis ◽  
Live Birth Rate ◽  
Multivariate Logistic Regression ◽  
Icsi Cycle ◽  
Significant Difference

Objective: The aim of this study was to assess whether a deferred frozen–thawed embryo transfer (Def-ET) offers any benefits compared to a fresh ET strategy in women who have had 2 or more consecutive in vitro fertilization (IVF)/intracytoplasmic injection (ICSI) cycle failures. Design: An observational cohort study in a tertiary referral care center including 416 cycles from women with a previous history of 2 or more consecutive IVF/ICSI failures cycles. Both Def-ET and fresh ET strategies were compared using univariate and multivariate logistic regression models. The main outcome measured was the cumulative live birth rate (CLBR). Results: A total of 416 cycles were included in the analysis: 197 in the fresh ET group and 219 in the Def-ET group. The CLBR was not significantly different between the fresh and Def-ET groups (58/197 [29.4%] and 57/219 [26.0%], respectively, P = .437). In addition, after the first ET, there was no significant difference in the live birth rate between the fresh ET and Def-ET groups (50/197 [25.4%] vs 44/219 [20.1%], respectively). Multivariate logistic regression analysis indicated that compared to the fresh strategy, the Def-ET strategy was not associated with a higher probability of live birth. Conclusions: In cases with 2 or more consecutive prior IVF/ICSI cycle failures, a Def-ET strategy did not result in better ART outcomes than a fresh ET strategy.

scholarly journals Influence of surgical evacuation on pregnancy outcomes of subsequent embryo transfer cycle following miscarriage in an initial IVF cycle: a retrospective cohort study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Junan Meng ◽  
Mengchen Zhu ◽  
Wenjuan Shen ◽  
Xiaomin Huang ◽  
Haixiang Sun ◽  
...  
Keyword(s):  
Embryo Transfer ◽  
Live Birth ◽  
Pregnancy Outcomes ◽  
Birth Rate ◽  
Endometrial Thickness ◽  
Live Birth Rate ◽  
First Trimester ◽  
Miscarriage Rate ◽  
Significant Difference ◽  
Surgical Evacuation

Abstract Background It is still uncertain whether surgical evacuation adversely affects subsequent embryo transfer. The present study aims to assess the influence of surgical evacuation on the pregnancy outcomes of subsequent embryo transfer cycle following first trimester miscarriage in an initial in vitro fertilization and embryo transfer (IVF-ET) cycle. Methods A total of 645 patients who underwent their first trimester miscarriage in an initial IVF cycle between January 2013 and May 2016 in Nanjing Drum Tower Hospital were enrolled. Surgical evacuation was performed when the products of conception were retained more than 8 h after medical evacuation. Characteristics and pregnancy outcomes were compared between surgical evacuation patients and no surgical evacuation patients. The pregnancy outcomes following surgical evacuation were further compared between patients with ≥ 8 mm or < 8 mm endometrial thickness (EMT), and with the different EMT changes. Results The EMT in the subsequent embryo transfer cycle of surgical evacuation group was much thinner when compared with that in the no surgical evacuation group (9.0 ± 1.6 mm vs. 9.4 ± 1.9 mm, P = 0.01). There was no significant difference in implantation rate, clinical pregnancy rate, live birth rate or miscarriage rate between surgical evacuation group and no surgical evacuation group (P > 0.05). The live birth rate was higher in EMT ≥ 8 mm group when compared to < 8 mm group in surgical evacuation patients (43.0% vs. 17.4%, P < 0.05). Conclusions There was no significant difference in the pregnancy outcomes of subsequent embryo transfer cycle between surgical evacuation patients and no surgical evacuation patients. Surgical evacuation led to the decrease of EMT, especially when the EMT < 8 mm was association with a lower live birth rate.

scholarly journals The Impact of Blastocyst Grade on Singleton Birthweight in Fresh Transplanted Cycles

2021 ◽  
Author(s):  
Qiongyao Shi ◽  
Senlin Shi ◽  
Wenyan Song ◽  
Feifei Zhao ◽  
Haixia Jin ◽  
...  
Keyword(s):  
Birth Weight ◽  
Live Birth ◽  
Cell Mass ◽  
The Other ◽  
Low Grade ◽  
High Grade ◽  
Significant Difference ◽  
Group A ◽  
Grade 3 ◽  
The Impact

Abstract Background: A retrospectively cohort study was performed to compare the birth weight of different blastocyst grades in fresh transplantation cycle and explore the related factors affecting the birth weight. Methods: The 1301 fresh cycles of single blastocyst transplantation and single live birth profile were analyzed,four groups were divided according to the grade of transplanted blastocyst. There are 170 cycles in group A with AA blastocyst grade, 312 cycles in group B with AB/BA blastocyst grade, 559 cycles in group C with BB/CA/AC blastocyst grade and 260 cycles in group D with BC/CB blastocyst grade. Comparison were made among four groups of birth weight, general conditions, fertilization rate, embryo rate, cleavage rate and D5,D6 blastocyst formation rate and other laboratory indicators. And then comparison were performed among the birth weight of different groups which were divided by the degree of blastocyst expansion, and the classification of inner cell mass(ICM) and the trophectoderm(TE). Results: The study shows that the birth weight of group A is significantly higher than that of the other three groups (P < 0.05). And the high quality embryo rate and blastocyst rate of group A are significantly higher than those of the other three groups (P < 0.05). What’s more, the clinical pregnancy rate, implantation rate and live birth rate of high grade blastocyst are higher, but there are no significant difference in abortion rate. The birth weight of the degree of blastocyst expansion in grade 3 and below is significantly lower than that of those with grade 3 and above (P < 0.05). The birth weight of grade A of ICM is significantly higher than that of grade B (P < 0.05). The birth weight of grade B of TE is significantly heavier than that of grade C (P < 0.05). Conclusions: Our results indicate that high grade blastocyst transplantation can achieve better pregnancy outcome. Different blastocyst grades affect birth weight, and low grade blastocyst transplantation is associated with a single birth weight loss.

scholarly journals Prevalence and Analysis of Inborn Birth Defects in A Tertiary Level Hospital in Bangladesh

2019 ◽  
Vol 3 (5) ◽  
Keyword(s):  
Risk Factors ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Congenital Malformation ◽  
Live Birth ◽  
Birth Defects ◽  
Gestational Age ◽  
Still Birth ◽  
New Born ◽  
Icd 10

Objective: To assess the prevalence of congenital defects and to investigate the maternal and perinatal aspects in relation to the detailed ICD-10 coding of each individual case using The New Born Data base NBBD data collection system under Global surveillance in collaboration with Center for Disease Control CDC, Atlanta and All India Institute of Medical Science AIMS, New Delhi and Bangabandhu Sheikh Mujib Medical University BSMMU as the Focal point of investigation. Methods: All births and terminations of pregnancy beyond 24 weeks with structural and sonographically detectable birth defects from October,2014 to October, 2018 in the Department of Obstetrics and Gynaecology of Bangladesh Medical College and Hospital were carefully scrutinized and detailed information regarding the maternal and associated clinical risk factors were compiled using the NBBD (New Born Birth Defects) surveillance system. Among that period all births (Live birth and still birth) were counted to have a prevalence data of birth defects using the total number of births as the denominator and the number of birth defects as the numerator. Results: The prevalence of detectable birth defects among the 2002 total births (which includes 110 still births) was found to be 4.34% (87/2002 x 100). According to birth defect category using the ICD-10 coding system, 11 broad categories were found. Musculoskeletal deformities Q65-Q79 were the highest (25/87), followed by congenital malformation of the nervous system Q00-Q07(15/87) and congenital malformation of eye, ear, face and neck Q10-Q18(14/87). The birth defects were categorized as isolated, syndrome and sequence; among the 87 cases, 44 were isolated defects, 40 were syndromic / multiple birth defects and 3 were result of Potter sequence. Regarding maternal variables, maternal age<18 years was 23.4%, 18-25 years was 48.93% ,26-33 years was 23.4% and ≥ 34 years was 6.4%; father’s age < 35 yearswas 74.5% and ≥ 35 years 25.5%%, parental consanguinity was present in 4.3% of case. Analyzing the variables relating to labour conditions, majority of pregnancies were singletons 95.7% leaving only 4.3% of pregnancies being Twin pregnancies. Reviewing babies according to gestational age, 69 (73.4%%) of babies were less than 34 weeks and 26.6% remaining were equal to/more than 34 weeks of gestation reflecting a higher frequency of prematurity or pre-term delivery either induced or spontaneous onset. Regarding the mode of delivery, vaginal birth was conducted in approximately 74% of cases and C-Section was performed in remaining cases, the indication of C-section was guided by obstetric causes such as previous C-section and maternal desire for an elective abdominal delivery. Results of the foetal variables by sex distribution showed a significant male predominance (51/87) 51 male, 26 female and 10 ambiguous. Reviewing babies according to gestational age, 64 (73.4%%) of babies were less than 34 weeks and 26.6% remaining were more than 34 weeks of gestation reflecting a higher frequency of prematurity. The studied foetal variable as categorized by weight, as ≤1500gm (extreme low birth weight ELBW) was 23.4%, 1501-2499gm (Low birth weight LBW) was 50% and ≥2500g (Average birth weight) was 26.6 %. The studied foetal variable as categorized by percentage of babies that were born live birth was 87%, 17 % were stillbirth: a significant portion of those terminated late were found macerated. Data was also compiled regarding the following risk factors: Previous history of birth defects/ previous still birth/ previous spontaneous abortions/ terminations for birth defects which did not reveal significant differences. Conclusion: The study notified only the most visible defects in most cases. However, the study is part of an ongoing surveillance program which has incited much alertness among the participants regarding documentation. The prevalence records and the type of defects may help in the expansion of these programs for the development of future preventive strategies.

scholarly journals GROWTH, NEURODEVELOPMENT IN EXTREMELY LOWBIRTH BABIES AT TWO YEAR OF CORRECTED AGE

2019 ◽  
Vol 3 (5) ◽  
Author(s):  
Dr. Ashok Kumar ◽  
Dr. Kanya Mukhopadhyay ◽  
Dr. Prabhjot Malhi ◽  
Dr. Anil Kumar Bhalla
Keyword(s):  
Birth Weight ◽  
Neurological Examination ◽  
Gestational Age ◽  
Head Circumference ◽  
Control Group ◽  
Case Group ◽  
Significant Difference ◽  
Catch Up

According to national neonatal perinatal data (NNPD) the survival of ELBW babies has improved from 37% in 2000 to 45% in 2002-3 reports. In our neonatal unit in PGIMER the survival of ELBW babies has been 54-56% in last 5 years, however unfortunately there is very scanty reports of long term outcome of ELBW babies from India. There is very scanty report of long term growth outcome of VLBW and ELBW Babies in our country, we reported VLBW and ELBW babies in our follow up had poor catch up growth, though some catch-up was observed at 6 month but subsequent lag in growth probably reflects poor weaning at 1 year.  Infants with extremely low birth weights (ELBWs) are more susceptible to all of the possible complications of premature birth, both in the immediate neonatal period and after discharge from the nursery. These babies are at risk of poor growth and developmental. in the present study a total of 39 cases of ELBW Babies were enrolled during one year study period from July 2011- June2012 attending the neonatal follow up clinic attained 2year±3month of corrected age. Their detail birth data and postnatal illnesses retrieved from their initial hospital files and unit discharge record. A similar number of babies enrolled at 2yrs±3months of age in the control group. In the presence study, we assessed the growth, and neurological out come in extremely low birth baby attained 2yrs±3 months of corrected age. The study population consisted of 39 children of ELBW baby born during 2009 -10 at PGIMER & same number of normal birth weight children at 2yr±3 months of corrected age who satisfied the inclusion and exclusion criteria. These children were enrolled from neonatal follow up clinic who were already undergoing long term follow up. For growth outcome, we used weight, height & head circumference measurement of child, for neurological and developmental outcome used clinical neurological examination and DP-III .Base line demographic characteristics of our ELBW babies (Cases) where as follows.   Mean (S.D) gestational age of  ELBW babies was 29.87±2.3 week. Mean (S.D) birth weight 867±71.1 grams, Mean (S.D) lenght35±2.1cm & head circumference was 25.76±1.9 cm. Mean hospital stay in the ELBW babies was 48.6±19.9 days. Mean birth weight and gestational age of control group where 2684±166.2grm and 39.03±0.9 weeks. At 2year of corrected age we found  - Weight was similar in both in case group & control group. (10.04±1.4 Vs 10.75±1.1). Height and head circumference were smaller in cases than control group. (81.4±4.3 Vs 84.4±3.3 and 45.9±1.6 Vs 46.8±1.5. 5% Babies had cerebral palsy in case group (N=2/39) and none in control group. Gross development score(GDS) in Development profile-III in both study group (cases & controls) was  similar  (72.49±8.08 Vs 73.54±9.3,p=0.596). Significant difference in domains physical (84.5±7.8 Vs.90±3.5, p=0.000) and domains adaptive (81±6.7 Vs. 85.3±5.4,p= 0.003) in cases as compared to controls. There was no difference between SGA and AGA among cases in growth and neurological development. There was no difference between male and female in case group in any parameter .There is very scanty data from our country on longterm follow up of ELBW babies. Our data shows that our ELBW cohort remained small in height and had smaller head circumference though weight was similar as compared to normal control babies.  Key words: ELBW, VLBW, birth weight, neurological examination.

scholarly journals The effect of ladder approach on development of preterm low birth weight infants with HIE-2

2020 ◽  
Vol 7 (3) ◽  
pp. 520
Author(s):  
Tushar R. Jadhav ◽  
Shailaja S. Jaywant
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Premature Infants ◽  
Tertiary Care ◽  
Control Group ◽  
Care Hospital ◽  
Post Intervention ◽  
Low Birth Weight Infants ◽  
Significant Difference

Background: Premature infants with Peri-natal asphyxia leading to a hypoxic-ischemic encephalopathy (HIE) are at greater risk for cerebral palsy. HIE grade II infants have long term neurological complications due to maladaptive brain wiring during NICU stay. Ladder approach, with graded stimulation program is administered by Occupational therapist, plays a vital role to minimize the maladaptive responses to environment. Objective of this study was to effect of Ladder Approach on preterm low birth weight Infants with HIE-2 as compared to conventional treatment. Design of this study was to Prospective Block Randomized Convenient Sampling Control Trial, Experimental design study. The study was carried out in the NICU and PU ward of Tertiary care hospital in metropolitan city from April 2015 to October 2016. The study subjects included a convenient sample of 30 preterm Low birth weight HIE-2 infants randomly selected into study or control groups. Neonatal behavioural Assessment scale (NBAS), Infant Neurological International Battery (INFANIB).Methods: The preterm infants from study group who received Ladder Approach and control group who received routine conventional care only. Outcome measures NBAS was at baseline and first follow up. INFANIB was administered at second follow up to assess neurodevelopment.Results: Showed that the premature infants of the study had significant difference in neuro behavioral status with mean for all subcomponents from to post intervention mean 39.6 in experimental group and from baseline mean of 24.3 to post intervention mean score of 33.2 in control group on neurobehavioral scale. Further neurodevelopmental status showed similar results on INFANIB in experimental group.Conclusions: The premature Infants with HIE grade 2, receiving ladder approach have shown more mature responses resulting into well-organized Neurobehavioral status, and resulted in improved brain wiring as evident in INFANIB.

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