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Kovács V, Remzső G, Tóth-Szűki V, Varga V, Németh J, Domoki F. Inhaled H 2 or CO 2 Do Not Augment the Neuroprotective Effect of Therapeutic Hypothermia in a Severe Neonatal Hypoxic-Ischemic Encephalopathy Piglet Model. Int J Mol Sci 2020; 21:E6801. [PMID: 32948011 PMCID: PMC7555370 DOI: 10.3390/ijms21186801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/09/2020] [Accepted: 09/14/2020] [Indexed: 12/24/2022] Open
Abstract
Hypoxic-ischemic encephalopathy (HIE) is still a major cause of neonatal death and disability as therapeutic hypothermia (TH) alone cannot afford sufficient neuroprotection. The present study investigated whether ventilation with molecular hydrogen (2.1% H2) or graded restoration of normocapnia with CO2 for 4 h after asphyxia would augment the neuroprotective effect of TH in a subacute (48 h) HIE piglet model. Piglets were randomized to untreated naïve, control-normothermia, asphyxia-normothermia (20-min 4%O2-20%CO2 ventilation; Tcore = 38.5 °C), asphyxia-hypothermia (A-HT, Tcore = 33.5 °C, 2-36 h post-asphyxia), A-HT + H2, or A-HT + CO2 treatment groups. Asphyxia elicited severe hypoxia (pO2 = 19 ± 5 mmHg) and mixed acidosis (pH = 6.79 ± 0.10). HIE development was confirmed by altered cerebral electrical activity and neuropathology. TH was significantly neuroprotective in the caudate nucleus but demonstrated virtually no such effect in the hippocampus. The mRNA levels of apoptosis-inducing factor and caspase-3 showed a ~10-fold increase in the A-HT group compared to naïve animals in the hippocampus but not in the caudate nucleus coinciding with the region-specific neuroprotective effect of TH. H2 or CO2 did not augment TH-induced neuroprotection in any brain areas; rather, CO2 even abolished the neuroprotective effect of TH in the caudate nucleus. In conclusion, the present findings do not support the use of these medical gases to supplement TH in HIE management.
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MESH Headings
- Acidosis/blood
- Acidosis/etiology
- Acidosis/prevention & control
- Administration, Inhalation
- Animals
- Animals, Newborn
- Apoptosis Inducing Factor/biosynthesis
- Apoptosis Inducing Factor/genetics
- Asphyxia Neonatorum/complications
- Asphyxia Neonatorum/drug therapy
- Asphyxia Neonatorum/therapy
- Brain Damage, Chronic/etiology
- Brain Damage, Chronic/prevention & control
- Brain-Derived Neurotrophic Factor/biosynthesis
- Brain-Derived Neurotrophic Factor/genetics
- Carbon Dioxide/administration & dosage
- Carbon Dioxide/therapeutic use
- Carbon Dioxide/toxicity
- Caspase 3/biosynthesis
- Caspase 3/genetics
- Caudate Nucleus/pathology
- Cerebral Cortex/metabolism
- Cerebral Cortex/pathology
- Disease Models, Animal
- Drug Evaluation, Preclinical
- Electroencephalography
- Evoked Potentials, Visual/drug effects
- Gene Expression Regulation/drug effects
- Hippocampus/pathology
- Hydrogen/administration & dosage
- Hydrogen/analysis
- Hydrogen/therapeutic use
- Hypothermia, Induced
- Hypoxia-Ischemia, Brain/complications
- Hypoxia-Ischemia, Brain/drug therapy
- Hypoxia-Ischemia, Brain/pathology
- Hypoxia-Ischemia, Brain/therapy
- Nerve Tissue Proteins/biosynthesis
- Nerve Tissue Proteins/genetics
- Neuroprotection/drug effects
- Neuroprotective Agents/administration & dosage
- Neuroprotective Agents/therapeutic use
- Organ Specificity
- Random Allocation
- Swine
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Affiliation(s)
- Viktória Kovács
- Department of Physiology, University of Szeged Faculty of Medicine, H-6720 Szeged, Hungary; (G.R.); (V.T.-S.); (V.V.); (J.N.); (F.D.)
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Pittet-Metrailler MP, Almazrooei AM, Tam EW. Sensory assessment: Neurophysiology in neonates and neurodevelopmental outcome. HANDBOOK OF CLINICAL NEUROLOGY 2020; 174:183-203. [DOI: 10.1016/b978-0-444-64148-9.00014-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Can somatosensory and visual evoked potentials predict neurological outcome during targeted temperature management in post cardiac arrest patients? Resuscitation 2017. [PMID: 28648810 DOI: 10.1016/j.resuscitation.2017.06.022] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSES In cardiac arrest patients treated with targeted temperature management (TTM), it is not certain if somatosensory evoked potentials (SEPs) and visual evoked potentials (VEPs) can predict neurological outcomes during TTM. The aim of this study was to investigate the prognostic value of SEPs and VEPs during TTM and after rewarming. METHODS This retrospective cohort study included comatose patients resuscitated from cardiac arrest and treated with TTM between March 2007 and July 2015. SEPs and VEPs were recorded during TTM and after rewarming in these patients. Neurological outcome was assessed at discharge by the Cerebral Performance Category (CPC) Scale. RESULTS In total, 115 patients were included. A total of 175 SEPs and 150 VEPs were performed. Five SEPs during treated with TTM and nine SEPs after rewarming were excluded from outcome prediction by SEPs due to an indeterminable N20 response because of technical error. Using 80 SEPs and 85 VEPs during treated with TTM, absent SEPs yielded a sensitivity of 58% and a specificity of 100% for poor outcome (CPC 3-5), and absent VEPs predicted poor neurological outcome with a sensitivity of 44% and a specificity of 96%. The AUC of combination of SEPs and VEPs was superior to either test alone (0.788 for absent SEPs and 0.713 for absent VEPs compared with 0.838 for the combination). After rewarming, absent SEPs and absent VEPs predicted poor neurological outcome with a specificity of 100%. When SEPs and VEPs were combined, VEPs slightly increased the prognostic accuracy of SEPs alone. Although one patient with absent VEP during treated with TTM had a good neurological outcome, none of the patients with good neurological outcome had an absent VEP after rewarming. CONCLUSION Absent SEPs could predict poor neurological outcome during TTM as well as after rewarming. Absent VEPs may predict poor neurological outcome in both periods and VEPs may provide additional prognostic value in outcome prediction.
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Nevalainen P, Marchi V, Metsäranta M, Lönnqvist T, Toiviainen-Salo S, Vanhatalo S, Lauronen L. Evoked potentials recorded during routine EEG predict outcome after perinatal asphyxia. Clin Neurophysiol 2017; 128:1337-1343. [PMID: 28570867 DOI: 10.1016/j.clinph.2017.04.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 03/22/2017] [Accepted: 04/26/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the added value of somatosensory (SEPs) and visual evoked potentials (VEPs) recorded simultaneously with routine EEG in early outcome prediction of newborns with hypoxic-ischemic encephalopathy under modern intensive care. METHODS We simultaneously recorded multichannel EEG, median nerve SEPs, and flash VEPs during the first few postnatal days in 50 term newborns with hypoxic-ischemic encephalopathy. EEG background was scored into five grades and the worst two grades were considered to indicate poor cerebral recovery. Evoked potentials were classified as absent or present. Clinical outcome was determined from the medical records at a median age of 21months. Unfavorable outcome included cerebral palsy, severe mental retardation, severe epilepsy, or death. RESULTS The accuracy of outcome prediction was 98% with SEPs compared to 90% with EEG. EEG alone always predicted unfavorable outcome when it was inactive (n=9), and favorable outcome when it was normal or only mildly abnormal (n=17). However, newborns with moderate or severe EEG background abnormality could have either favorable or unfavorable outcome, which was correctly predicted by SEP in all but one newborn (accuracy in this subgroup 96%). Absent VEPs were always associated with an inactive EEG, and an unfavorable outcome. However, presence of VEPs did not guarantee a favorable outcome. CONCLUSIONS SEPs accurately predict clinical outcomes in newborns with hypoxic-ischemic encephalopathy and improve the EEG-based prediction particularly in those newborns with severely or moderately abnormal EEG findings. SIGNIFICANCE SEPs should be added to routine EEG recordings for early bedside assessment of newborns with hypoxic-ischemic encephalopathy.
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Affiliation(s)
- Päivi Nevalainen
- Department of Clinical Neurophysiology, Children's Hospital, HUS Medical, Imaging Center, University of Helsinki and Helsinki University Hospital (HUH), Helsinki, Finland.
| | - Viviana Marchi
- Department of Developmental Neuroscience, Stella Maris Scientific Institute, IRCCS Stella Maris Foundation Pisa, Italy; Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marjo Metsäranta
- Department of Neonatology, Children's Hospital, University of Helsinki and HUH, Helsinki, Finland
| | - Tuula Lönnqvist
- Department of Child Neurology, Children's Hospital, University of Helsinki and HUH, Helsinki, Finland
| | - Sanna Toiviainen-Salo
- HUS Medical Imaging Center, Radiology, University of Helsinki and HUH, Helsinki, Finland
| | - Sampsa Vanhatalo
- Department of Clinical Neurophysiology, Children's Hospital, HUS Medical, Imaging Center, University of Helsinki and Helsinki University Hospital (HUH), Helsinki, Finland
| | - Leena Lauronen
- Department of Clinical Neurophysiology, Children's Hospital, HUS Medical, Imaging Center, University of Helsinki and Helsinki University Hospital (HUH), Helsinki, Finland
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Carbajal-Valenzuela CC, Santiago-Rodríguez E, Harmony T, Fernández-Bouzas A. Visual Evoked Potentials in Infants With Diffuse Periventricular Leukomalacia. Clin EEG Neurosci 2014; 45:269-273. [PMID: 24615931 DOI: 10.1177/1550059413515655] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Revised: 11/03/2013] [Accepted: 11/10/2013] [Indexed: 11/16/2022]
Abstract
Periventricular leukomalacia (PVL) is characterized by necrosis of the cerebral white matter in the dorsolateral portions of the lateral ventricles. PVL causes motor, sensory, and cognitive deficits. The aim of this study was to analyze the conduction characteristics of the visual pathway in infants with diffuse PVL using visual evoked potentials (VEPs). We studied 11 healthy infants (mean age 3.3 ± 1.3 months) and 17 with diffuse PVL (mean age 2.9 ± 0.8 months and mean gestational age 31.9 ± 3.1 weeks). The N75, P100, and N135 wave latencies; the interwave N75-P100 and P100-N135 latencies; and the N75-P100 and P100-N135 amplitudes were measured in the occipital leads. VEPs were recorded during binocular stimulation at an angle of 120' from the Fz-Oz lead. Healthy children had mean N75, P100, and N135 wave latencies of 84.4 ± 5.8, 143.4 ± 30.6 and 222.9 ± 40.4 ms, respectively. The mean interwave N75-P100 and P100-N135 latencies were 59.0 ± 28.6 and 79.5 ± 13.6 ms, respectively. Compared with the healthy group, infants with PVL had longer N75 and N135 latencies at 92.3 ± 15.3 (P = .05) and 265.0 ms ± 60.3 (P = .05), respectively. The interwave latency P100-N135 (105.5 ± 29.1 ms; P = .017) was longer in children with PVL than in healthy infants. Infants with diffuse PVL had mild alterations in their N75, P100 and, particularly, their N135 latencies. These increases in P100-N135 interwave latencies could be because of damage to the geniculocortical pathways and V2-V3 networks.
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Affiliation(s)
- Cintli Carolina Carbajal-Valenzuela
- Unidad de Investigación en Neurodesarrollo "Dr. Augusto Fernández Guardiola", Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM), Juriquilla, Querétaro, 76230, Mexico
| | - Efraín Santiago-Rodríguez
- Unidad de Investigación en Neurodesarrollo "Dr. Augusto Fernández Guardiola", Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM), Juriquilla, Querétaro, 76230, Mexico
| | - Thalía Harmony
- Unidad de Investigación en Neurodesarrollo "Dr. Augusto Fernández Guardiola", Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM), Juriquilla, Querétaro, 76230, Mexico
| | - Antonio Fernández-Bouzas
- Unidad de Investigación en Neurodesarrollo "Dr. Augusto Fernández Guardiola", Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM), Juriquilla, Querétaro, 76230, Mexico
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Julkunen MK, Himanen SL, Eriksson K, Janas M, Luukkaala T, Tammela O. EEG, evoked potentials and pulsed Doppler in asphyxiated term infants. Clin Neurophysiol 2014; 125:1757-63. [PMID: 24534143 DOI: 10.1016/j.clinph.2014.01.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 01/19/2014] [Accepted: 01/21/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate electroencephalograms (EEG), evoked potentials (EPs) and Doppler findings in the cerebral arteries as predictors of a 1-year outcome in asphyxiated newborn infants. METHODS EEG and EPs (brain stem auditory (BAEP), somatosensory (SEP), visual (VEP) evoked potentials) were assessed in 30 asphyxiated and 30 healthy term infants during the first days (range 1-8). Cerebral blood flow velocities (CBFV) were measured from the cerebral arteries using pulsed Doppler at ∼24h of age. EEG, EPs, Doppler findings, symptoms of hypoxic ischemic encephalopathy (HIE) and their combination were evaluated in predicting a 1-year outcome. RESULTS An abnormal EEG background predicted poor outcome in the asphyxia group with a sensitivity of 67% and 81% specificity, and an abnormal SEP with 75% and 79%, respectively. Combining increased systolic CBFV (mean+3SD) with abnormal EEG or SEP improved the specificity, but not the sensitivity. The predictive values of abnormal BAEP and VEP were poor. Normal EEG and SEP predicted good outcome in the asphyxia group with sensitivities from 79% to 81%. The combination of normal EEG, normal SEP and systolic CBFV<3SD predicted good outcome with a sensitivity of 74% and 100% specificity. CONCLUSIONS Combining abnormal EEG or EPs findings with increased systolic CBFV did not improve prediction of a poor 1-year outcome of asphyxiated infants. Normal EEG and normal SEP combined with systolic CBFV<3SD at about 24 h can be valuable in the prediction of normal 1-year outcome. SIGNIFICANCE Combining systolic CBFV at 24 h with EEG and SEP examinations can be of use in the prediction of normal 1-year outcome among asphyxiated infants.
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Affiliation(s)
- Mia K Julkunen
- Pediatric Research Centre, University of Tampere, Tampere, Finland; Department of Pediatrics, Tampere University Hospital, Tampere, Finland.
| | - Sari-Leena Himanen
- Department of Clinical Neurophysiology, Tampere University Hospital, Tampere, Finland; Faculty of Medicine, University of Tampere, Tampere, Finland
| | - Kai Eriksson
- Pediatric Research Centre, University of Tampere, Tampere, Finland; Pediatric Neurology Unit, Tampere University Hospital, Tampere, Finland
| | - Martti Janas
- Department of Pediatrics, Tampere University Hospital, Tampere, Finland
| | - Tiina Luukkaala
- Science Center, Pirkanmaa Hospital District, Tampere School of Public Health, University of Tampere, Tampere, Finland
| | - Outi Tammela
- Pediatric Research Centre, University of Tampere, Tampere, Finland; Department of Pediatrics, Tampere University Hospital, Tampere, Finland
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Intrapartum-related neonatal encephalopathy incidence and impairment at regional and global levels for 2010 with trends from 1990. Pediatr Res 2013; 74 Suppl 1:50-72. [PMID: 24366463 PMCID: PMC3873711 DOI: 10.1038/pr.2013.206] [Citation(s) in RCA: 389] [Impact Index Per Article: 35.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Intrapartum hypoxic events ("birth asphyxia") may result in stillbirth, neonatal or postneonatal mortality, and impairment. Systematic morbidity estimates for the burden of impairment outcomes are currently limited. Neonatal encephalopathy (NE) following an intrapartum hypoxic event is a strong predictor of long-term impairment. METHODS Linear regression modeling was conducted on data identified through systematic reviews to estimate NE incidence and time trends for 184 countries. Meta-analyses were undertaken to estimate the risk of NE by sex of the newborn, neonatal case fatality rate, and impairment risk. A compartmental model estimated postneonatal survivors of NE, depending on access to care, and then the proportion of survivors with impairment. Separate modeling for the Global Burden of Disease 2010 (GBD2010) study estimated disability adjusted life years (DALYs), years of life with disability (YLDs), and years of life lost (YLLs) attributed to intrapartum-related events. RESULTS In 2010, 1.15 million babies (uncertainty range: 0.89-1.60 million; 8.5 cases per 1,000 live births) were estimated to have developed NE associated with intrapartum events, with 96% born in low- and middle-income countries, as compared with 1.60 million in 1990 (11.7 cases per 1,000 live births). An estimated 287,000 (181,000-440,000) neonates with NE died in 2010; 233,000 (163,000-342,000) survived with moderate or severe neurodevelopmental impairment; and 181,000 (82,000-319,000) had mild impairment. In GBD2010, intrapartum-related conditions comprised 50.2 million DALYs (2.4% of total) and 6.1 million YLDs. CONCLUSION Intrapartum-related conditions are a large global burden, mostly due to high mortality in low-income countries. Universal coverage of obstetric care and neonatal resuscitation would prevent most of these deaths and disabilities. Rates of impairment are highest in middle-income countries where neonatal intensive care was more recently introduced, but quality may be poor. In settings without neonatal intensive care, the impairment rate is low due to high mortality, which is relevant for the scale-up of basic neonatal resuscitation.
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van Laerhoven H, de Haan TR, Offringa M, Post B, van der Lee JH. Prognostic tests in term neonates with hypoxic-ischemic encephalopathy: a systematic review. Pediatrics 2013; 131:88-98. [PMID: 23248219 DOI: 10.1542/peds.2012-1297] [Citation(s) in RCA: 141] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Hypoxic-ischemic encephalopathy (HIE) after perinatal asphyxia in term neonates causes long-term neurologic sequelae or death. A reliable evidence-based prognosis is essential. The study goal was to investigate the prognostic value of currently used clinical tests in neonatal patients with perinatal asphyxia and HIE. METHODS Searches were made on MEDLINE, Embase, Central, and CINAHL for studies occurring between January 1980 and November 2011. Studies were included if they (1) evaluated outcome in term infants with perinatal asphyxia and HIE, (2) evaluated prognostic tests, and (3) reported outcome at a minimal follow-up age of 18 months. Study selection, assessment of methodologic quality, and data extraction were performed by 3 independent reviewers. Pooled sensitivities and specificities of investigated tests were calculated when possible. RESULTS Of the 259 relevant studies, 29 were included describing 13 prognostic tests conducted 1631 times in 1306 term neonates. A considerable heterogeneity was noted in test performance, cut-off values, and outcome measures. The most promising tests were amplitude-integrated electroencephalography (sensitivity 0.93, [95% confidence interval 0.78-0.98]; specificity 0.90 [0.60-0.98]), EEG (sensitivity 0.92 [0.66-0.99]; specificity 0.83 [0.64-0.93]), and visual evoked potentials (sensitivity 0.90 [0.74-0.97]; specificity 0.92 [0.68-0.98]). In imaging, diffusion weighted MRI performed best on specificity (0.89 [0.62-0.98]) and T1/T2-weighted MRI performed best on sensitivity (0.98 [0.80-1.00]). Magnetic resonance spectroscopy demonstrated a sensitivity of 0.75 (0.26-0.96) with poor specificity (0.58 [0.23-0.87]). CONCLUSIONS This evidence suggests an important role for amplitude-integrated electroencephalography, EEG, visual evoked potentials, and diffusion weighted and conventional MRI. Given the heterogeneity in the tests' performance and outcomes studied, well-designed large prospective studies are needed.
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Affiliation(s)
- Henriette van Laerhoven
- Department of aNeonatology, Emma Children’s Hospital, Academic Medical Center Amsterdam, Netherlands
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Nilsson J, Dahlgren J, Karlsson AK, Grönlund MA. Normal visual evoked potentials in preschool children born small for gestational age. Acta Paediatr 2011; 100:1092-6. [PMID: 21352359 DOI: 10.1111/j.1651-2227.2011.02211.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM Previous studies have shown visual evoked potential (VEP) abnormalities in infants and animals born small for gestational age (SGA) compared with controls. The current exploratory study aims to investigate whether VEP abnormalities persist in older ages. METHODS Pattern VEP latencies were obtained in 21 children (11 girls, 10 boys), born SGA and moderately preterm, at an average age of 5 years and 8 months. Fifty-one children (24 girls, 27 boys, mean age of 5 years and 7 months), also born moderately preterm but with normal height and weight at birth, served as controls RESULTS Visual evoked potential results showed no significant differences in latency between children born SGA and controls born appropriate for gestational age (AGA) for either binocular stimulation, right eye or left eye stimulation. CONCLUSIONS Our findings do not indicate any differences in VEP latency at preschool age for children born SGA compared with children born AGA. The results may support previous studies, suggesting that children born SGA show accelerated neurophysiologic maturation during their first year of life and that previously delayed VEP latencies after catch-up stay unchanged compared with controls.
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Affiliation(s)
- Josefin Nilsson
- Department of Clinical Neurophysiology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
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Feng JJ, Wang TX, Yang CH, Wang WP, Xu X. Flash visual evoked potentials at 2-year-old infants with different birth weights. World J Pediatr 2010; 6:163-8. [PMID: 20490772 DOI: 10.1007/s12519-010-0032-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2009] [Accepted: 11/13/2009] [Indexed: 11/26/2022]
Abstract
BACKGROUND Increased prevalence of visual impairments has been reported in preterm populations. However, it remains unclear about the long-term visual electrophysiological outcomes and their association with visual cognitive functions in premature infants. We investigated visual electrophysiological outcome of 2-year-old infants of different birth weights by flash visual evoked potentials (FVEPs) in order to explore the correlation between visual cognitive functions and FVEPs and to assess the application of FVEPs in evaluating the visual capability of an infant. METHODS The FVEPs of 77 infants, including 25 very low birth weight (VLBW) premature infants, 16 low birth weight (LBW) premature infants and 36 full-term infants, were tested with a visual electrophysiological testing device. Neuromotor development was assessed with the Bayley Scales of Infant Development, Second Edition (BSID-II). The visual cognitive functions were evaluated by scoring the proportion passed of 12 items chosen from the BSID-II for infants at 23 to 25 months of age. RESULTS The second prominent positive wave (P2) was the major component presented in all three groups. The mean latency of P2 in the VLBW, LBW and full-term groups was 149.65+/-23.79 ms, 129.39+/-8.70 ms, and 126.14+/-7.73 ms respectively. There was no significant difference in mean latency of P2 wave between the LBW and full-term groups; the mean latency of the P2 wave in the VLBW group was delayed more significantly than those of the other two groups. The difference in amplitude of the P2 peak to the preceding N2 peak (N2P2) between the three groups was not statistically significant. The latency of the P2 main wave was negatively correlated with mental developmental index (MDI) (r'(MDI) = -0.35) and visual cognitive capability (r'(visual capability) = -0.21). CONCLUSIONS The latency of the P2 main wave on FVEPs was delayed more significantly in premature infants than in full-term infants at 2 years of corrected age. The visual functional development was delayed in premature infants, especially in VLBW infants (gestational age <32 weeks). The FVEPs were reported low but there were statistically significant correlations between measures of visual cognition and P2 peak latency. As a noninvasive and convenient method, FVEPs are useful in assessing certain aspects of an infant's visual development and visual function.
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Affiliation(s)
- Jing-Jing Feng
- Department of Child Health Care, Children's Hospital of Fudan University, Shanghai, 201102, China
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Suppiej A, Cappellari A, Franzoi M, Traverso A, Ermani M, Zanardo V. Bilateral loss of cortical somatosensory evoked potential at birth predicts cerebral palsy in term and near-term newborns. Early Hum Dev 2010; 86:93-8. [PMID: 20172665 DOI: 10.1016/j.earlhumdev.2010.01.024] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2009] [Revised: 01/21/2010] [Accepted: 01/29/2010] [Indexed: 11/28/2022]
Abstract
Bilateral loss of cortical somatosensory evoked potential (SEP) is considered the single best indicator of adverse outcome in acute encephalopathy of adult patients and older children. This study determines whether the presence or absence of the neonatal cortical SEP can predict cerebral palsy at two years in survivors of neonatal encephalopathy scored according to Sarnat criteria. We also compare SEPs with visual evoked potentials (VEPs), the EEG and neonatal neurological status. Fifty-nine neonates admitted to the neonatal intensive care unit had SEP, VEP and EEG recordings analysed according to the presence (n=37, 63%) or absence (n=22, 37%) of neonatal encephalopathy (score >or=1). Cortical SEP was always present in the perinatal period in those surviving without major neurological disability, while it was bilaterally absent in all but one patient with a subsequent diagnosis of cerebral palsy. Multivariate analysis using the logistic regression model showed that bilateral loss of cortical SEP and Sarnat Score correctly classified the neurological outcome in all patients. Bilateral absence of cortical SEP indicates early identification of neonates at risk of cerebral palsy indicating that EPs have a clinical role in the workup of neonatal encephalopathy.
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Affiliation(s)
- A Suppiej
- Child Neurology and Clinical Neurophysiology Unit, Department of Paediatrics, University of Padova, Italy. >
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Kułak W, Sobaniec W, Sołowiej E, Boćkowski L. Somatosensory and visual evoked potentials in children with cerebral palsy: Correlations and discrepancies with MRI findings and clinical picture. ACTA ACUST UNITED AC 2009; 9:201-9. [PMID: 17050398 DOI: 10.1080/13638490500343179] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To determine if there is any association between the findings of visual evoked potentials (VEPs), somatosensory evoked potentials (SEPs), and magnetic resonance imaging (MRI) findings with the neurodevelopment and severity in children with cerebral palsy (CP). METHODS The present study included 15 children with spastic diplegic CP and five children with spastic hemiplegic CP and 42 healthy children as controls. The number of the controls was two-times greater than the study group to increase statistical power of this study. VEPs and SEPs were recorded in the CP children and compared with healthy controls. All MR scans were obtained using a 1.5 T MR scanner. RESULTS A significant difference was found in the latencies P100 (VEP) between the CP and controls. No correlations between increased P100 latencies and asphyxia, prematurity, the CP severity, MRI findings and mental retardation were noted. A significant difference in N13-N20 conductions (SEPs) between the subjects with CP and the control group was found. SEPs were positively correlated with mental retardation in CP children. The brain lesions in MRI showed a significant correlation with the CP severity scores and mental retardation. CONCLUSION The differences in VEPs and SEPs were determined between CP children and healthy children. The MRI findings were positively correlated with the CP severity and mental retardation.
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Affiliation(s)
- Wojciech Kułak
- Department of Pediatric Neurology and Rehabilitation, Medical University of Białystok, Poland.
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Racine E, Shevell MI. Ethics in neonatal neurology: when is enough, enough? Pediatr Neurol 2009; 40:147-55. [PMID: 19218027 DOI: 10.1016/j.pediatrneurol.2008.09.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Revised: 08/07/2008] [Accepted: 09/18/2008] [Indexed: 11/16/2022]
Abstract
Decision-making for the severely neurologically compromised newborn is fraught with considerable medical and ethical difficulties. Multiple intrinsic and extrinsic factors challenge our prognostic certainty, which then challenges our ability both to communicate and to make decisions that are rooted in basic principles of fairness and moral integrity. Clinical vignettes illustrate the difficulties and highlight the present status regarding prognostication and consideration of general ethical principles that would permit the consensual withdrawal of care (i.e., end-of-life decisions). Futility in the neonatal setting is examined, as well the mechanisms of the decision-making process and existing relevant professional guidelines.
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Affiliation(s)
- Eric Racine
- Institute of Clinical Research of Montreal-Institut de recherches cliniques de Montreal, Department of Medicine, University of Montreal, Montreal, Quebec, Canada
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14
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Kato T, Watanabe K. Visual evoked potential in the newborn: does it have predictive value? Semin Fetal Neonatal Med 2006; 11:459-63. [PMID: 17070124 DOI: 10.1016/j.siny.2006.08.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We reviewed studies on the predictive value of visual evoked potentials (VEPs) in the newborn. VEPs demonstrated a good correlation with neurodevelopmental outcome in full-term infants with birth asphyxia. However, their prognostic value in preterm infants is controversial. In preterm infants, most studies showed high specificities for neurodevelopmental outcome, but some studies demonstrated lower sensitivities.
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Affiliation(s)
- Toru Kato
- Department of Pediatrics, Okazaki City Hospital, Goshoai 3-1, Okazaki, Aichi 444-8553, Japan.
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15
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Fifer WP, Grieve PG, Grose-Fifer J, Isler JR, Byrd D. High-density electroencephalogram monitoring in the neonate. Clin Perinatol 2006; 33:679-91, vii. [PMID: 16950319 DOI: 10.1016/j.clp.2006.06.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Early diagnosis of neurologic conditions is crucial for successful early intervention; therefore, minimally invasive diagnostic procedures are invaluable during the neonatal period. The clinical usefulness of one such technique, the electroencephalogram (EEG), is well documented. However, the advent of high-density recording systems has extended its application. High-density EEG recording uses a significantly increased number of recordings sites: 128 to 256 electrodes compared with 10 to 30 in standard recording systems. This report describes the benefits of using more electrode sites and highlights the use of related procedures for the assessment of neural integrity across sensory modalities.
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Affiliation(s)
- William P Fifer
- College of Physicians and Surgeons, Columbia University, 630 West 168th Street, New York, NY 10032, USA.
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16
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Benavente I, Tamargo P, Tajada N, Yuste V, Oliván MJ. Flash visually evoked potentials in the newborn and their maturation during the first six months of life. Doc Ophthalmol 2006; 110:255-63. [PMID: 16328934 DOI: 10.1007/s10633-005-0818-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2005] [Indexed: 10/25/2022]
Abstract
The aim of this paper has been to obtain normative data for the major components of the visually evoked potentials obtained by flash stimulus (F-PEV) in the newborn, and to analyse the evolution of these responses during the first 24 weeks of life. In order to do so, F-VEP were recorded in 109 normal full-term newborn infants. Fifty-five of these infants were also studied longitudinally at 4, 8, 12 and 24 weeks. We recorded responses in all newborns. A great morphological variability was observed. P2 was the only component present in all of these infants. Early components, which were always present from the fourth week of life on, were recorded in 34% of the newborns. There were significant differences according to waking/sleep state. At 24 weeks the most characteristic response was a triphasic waveform with clear negative-positive-negative components at 67.9, 110 and 158.3 ms. The morphological variability observed in the F-PEV of the newborn and the presence of early components in some cases, suggest differences in the maturation of the specific and unspecific visual system at birth. The study of these responses provides us with information about certain aspects of visual maturation. The relative stability of P2 response of the newborn and of the early negative components later on, made them the most useful components to be used in paediatric clinical work . The latency of P2 in the newborn is the parameter that showed lower variability, and therefore the most suitable one to establish normative data.
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Affiliation(s)
- Isabel Benavente
- Department of Clinical Neurophysiology, San Jorge Hospital, Huesca, Spain.
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17
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Azra Haider B, Bhutta ZA. Birth asphyxia in developing countries: current status and public health implications. Curr Probl Pediatr Adolesc Health Care 2006; 36:178-88. [PMID: 16631096 DOI: 10.1016/j.cppeds.2005.11.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Batool Azra Haider
- Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
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18
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van Rooij LGM, Toet MC, Osredkar D, van Huffelen AC, Groenendaal F, de Vries LS. Recovery of amplitude integrated electroencephalographic background patterns within 24 hours of perinatal asphyxia. Arch Dis Child Fetal Neonatal Ed 2005; 90:F245-51. [PMID: 15846017 PMCID: PMC1721875 DOI: 10.1136/adc.2004.064964] [Citation(s) in RCA: 115] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess the time course of recovery of severely abnormal initial amplitude integrated electroencephalographic (aEEG) patterns (flat trace (FT), continuous low voltage (CLV), or burst suppression (BS)) in full term asphyxiated neonates, in relation to other neurophysiological and neuroimaging findings and neurodevelopmental outcome. METHODS A total of 190 aEEGs of full term infants were reviewed. The neonates were admitted within 6 hours of birth to the neonatal intensive care unit because of perinatal asphyxia, and aEEG recording was started immediately. In all, 160 infants were included; 65 of these had an initial FT or CLV pattern and 25 an initial BS pattern. Neurodevelopmental outcome was assessed using a full neurological examination and the Griffiths' mental developmental scale. RESULTS In the FT/CLV group, the background pattern recovered to continuous normal voltage within 24 hours in six of the 65 infants (9%). All six infants survived the neonatal period; one had a severe disability, and five were normal at follow up. In the BS group, the background pattern improved to normal voltage in 12 of the 25 infants (48%) within 24 hours. Of these infants, one died, five survived with moderate to severe disability, two with mild disability, and four were normal. The patients who did not recover within 24 hours either died in the neonatal period or survived with a severe disability. CONCLUSION In this study there was a small group of infants who presented with a severely abnormal aEEG background pattern within six hours of birth, but who achieved recovery to a continuous normal background pattern within the first 24 hours. Sixty one percent of these infants survived without, or with a mild, disability.
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Affiliation(s)
- L G M van Rooij
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, KE 04.123.1, PO Box 85090, 3508 AB Utrecht, The Netherlands
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19
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Chapter 11 Assessment of vision in infants and young children. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/s1567-4231(09)70208-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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20
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Thordstein CM, Sultan BL, Wennergren MM, Törnqvist E, Lindecrantz KG, Kjellmer I. Visual evoked potentials in disproportionately growth-retarded human neonates. Pediatr Neurol 2004; 30:262-70. [PMID: 15087105 DOI: 10.1016/j.pediatrneurol.2003.10.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2003] [Accepted: 10/06/2003] [Indexed: 11/25/2022]
Abstract
To study brain function in the neonatal period, disproportionately growth-retarded (n = 33) and appropriately grown (n = 21) infants were examined using Doppler flow velocities prenatally and visual evoked potentials postnatally. Visual evoked potentials recordings were made at gestation of 40 and 46 weeks. The group of growth-retarded infants had significantly prolonged latencies to both of the two major peaks (designated P and N), most pronounced for the P peak. This result was observed at both ages investigated and corresponds to a developmental delay of 3 weeks. For individuals, the increase in P latency correlated to prenatal flow indices and to neonatal anthropometric parameters indicative of growth retardation. We conclude that in utero growth retardation affects brain development as assessed by visual evoked potentials in the neonatal period. This developmental delay may be produced by intracerebral factors during the process of growth retardation, and these alterations may have a prognostic value.
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21
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Hallioglu O, Topaloglu AK, Zenciroglu A, Duzovali O, Yilgor E, Saribas S. Denver developmental screening test II for early identification of the infants who will develop major neurological deficit as a sequalea of hypoxic-ischemic encephalopathy. Pediatr Int 2001; 43:400-4. [PMID: 11472587 DOI: 10.1046/j.1442-200x.2001.01418.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The primary aim of this study was to find widely available, inexpensive, and non-invasive parameters for early identification or prediction of the infants with hypoxic-ischemic encephalopathy (HIE) who will have a severe adverse outcome (classified as death or a major neurological deficit). METHODS Fifty-seven full-term or near-term newborn infants with a diagnosis of HIE were consecutively admitted to the neonatal intensive care unit and studied. Occurrence of seizures during the first 24 h, cranial ultrasonography (US) findings within the first 5 days of life, and Denver developmental screening test II (DDST II) at 6 months of age, were analyzed in relation to mortality and neurological status at 2 years of age. RESULTS Of the 57 infants, 10 were lost to follow-up. Twenty of the remaining 47 infants had a severe adverse outcome. Among the predictors of severe adverse outcome, occurrence of seizures was found to have a poor predictive accuracy. Cranial US had 100% sensitivity, however with a rather low specificity (55%). However, DDST II at 6 months of age, yielded a very high predictive accuracy (sensitivity=100%, specificity=95%). CONCLUSION We conclude that DDST II at 6 months of age could be used in predicting severe neurological outcome in infants with HIE.
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Affiliation(s)
- O Hallioglu
- Mersin University, Faculty of Medicine, Department of Pediatrics, Mersin, Turkey.
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22
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Majnemer A, Rosenblatt B. Prediction of outcome at school age in neonatal intensive care unit graduates using neonatal neurologic tools. J Child Neurol 2000; 15:645-51. [PMID: 11063077 DOI: 10.1177/088307380001501002] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Prediction of outcome for neonatal intensive care unit graduates is clinically useful to counsel families effectively and target those who may benefit from early interventions. Evoked potentials have proven prognostic value of neurologic outcomes in early childhood; however, their long-term predictive validity remains to be determined. The objective of this prospective study was to determine the long-term predictive value of three neonatal neurologic assessments: brainstem auditory evoked potentials, somatosensory evoked potentials, and the Einstein Neonatal Neurobehavioral Assessment Scale. Seventy-eight high-risk newborns and 28 healthy controls were recruited and were assessed in the newborn period using these tests. At 8 to 9 years of age, 42 subjects and 13 controls were re-evaluated for developmental progress using a range of psychologic, sensorimotor, and neurologic measures. Findings indicated that the somatosensory evoked potential was most accurate at predicting outcome at school age, with high specificity (83-100%) across all domains tested and good sensitivity (80-100%) for intellectual performance and sensorimotor abilities. The brainstem auditory evoked potential was limited by false-negatives, whereas the neonatal neurobehavioral assessment yielded many false-positives. This study provides new evidence that associations between neonatal somatosensory evoked potentials and developmental sequelae continue to be significant at school age.
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Affiliation(s)
- A Majnemer
- School of Physical and Occupational Therapy, Department of Neurology, McGill University-Montreal Children's Hospital, PQ, Canada.
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23
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Abstract
To explore the role of posterior tibial somatosensory evoked potentials (SSEP) and flash visual evoked potentials (VEP) in the early prediction of functional brain injury, 93 infants of less than 32 weeks gestation at birth were studied. Neuromotor outcome was defined by clinical examination at the age of 2 years. SSEP, VEP and cerebral ultrasound were compared as predictors of neuromotor outcome. Posterior tibial SSEP were the most accurate single method of predicting neuromotor abnormalities with a 83% positive predictive power for cerebral palsy and a 100% predictive power for abnormal neurology, compared to 17% and 40% for cerebral ultrasound and 38% and 85% for VEP respectively. When SSEP and VEP results were concordant, the positive predictive power for cerebral palsy and abnormal neurology was 100%. Our results suggest that posterior tibial SSEP and VEP are accurate tools in the prediction of outcome in very preterm infants.
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Affiliation(s)
- A A Pike
- Department of Child Health, St. Michael 's Hospital, Bristol, UK
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24
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Groenendaal F, de Vries LS. Selection of babies for intervention after birth asphyxia. SEMINARS IN NEONATOLOGY : SN 2000; 5:17-32. [PMID: 10802747 DOI: 10.1053/siny.1999.0119] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Based on animal experiments, the therapeutic window for neonates with signs of perinatal hypoxia-ischaemia is probably less than 6 h, and early selection of patients is of utmost importance. In term neonates, fetal heart rate and blood flow patterns, the Apgar score, and other clinical scoring systems are insufficient to select patients for intervention, whereas umbilical artery pH<7.0 combined with umbilical arteriovenous differences in PCO(2), lactate/pyruvate ratios in cord blood, and CSF interleukin-1beta have a better predictive value. At present, neurophysiological methods such as (amplitude-integrated) EEG and evoked potentials have the best predictive value. In preterm neonates, lactate/pyruvate and uric acid measurements in cord blood, as well as neurophysiology appear to be helpful to predict brain injury, and might be used to select patients for intervention.
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Affiliation(s)
- F Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre, Utrecht, the Netherlands.
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25
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Abstract
The pediatric neurologist is often requested to predict the neurologic outcome in an uncertain situation. A common and problematic clinical setting in which this occurs is the asphyxiated term newborn. This report reviews the predictive tools available for prognostication in this situation and formulates a practical paradigm that the authors hope will improve predictive accuracy and lessen uncertainty in this setting.
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Affiliation(s)
- M I Shevell
- Department of Neurology/Neurosurgery, McGill University Faculty of Medicine, Montreal, Quebec, Canada
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26
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Meek JH, Elwell CE, McCormick DC, Edwards AD, Townsend JP, Stewart AL, Wyatt JS. Abnormal cerebral haemodynamics in perinatally asphyxiated neonates related to outcome. Arch Dis Child Fetal Neonatal Ed 1999; 81:F110-5. [PMID: 10448178 PMCID: PMC1720987 DOI: 10.1136/fn.81.2.f110] [Citation(s) in RCA: 103] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM To measure changes in cerebral haemodynamics during the first 24 hours of life following perinatal asphyxia, and relate them to outcome. METHODS Cerebral blood volume (CBV), its response (CBVR) to changes in arterial carbon dioxide tension (PaCO(2)), and cerebral blood flow (CBF) were measured using near infrared spectroscopy (NIRS) in 27 term newborn infants with clinical and/or biochemical evidence consistent with perinatal asphyxia. RESULTS Both CBF and CBV were higher on the first day of life in the infants with adverse outcomes, and a CBV outside the normal range had a sensitivity of 86% for predicting death or disability. The mean (SD) CBVR on the first day of life was 0.13 (0.12) ml/100 g/1/kPa, which, in 71% of infants, was below the lower 95% confidence limit for normal subjects. CONCLUSION An increase in CBV on the first day of life is a sensitive predictor of adverse outcome. A reduction in CBVR is almost universally seen following asphyxia, but is not significantly correlated with severity of adverse outcome.
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Affiliation(s)
- J H Meek
- Department of Paediatrics The Rayne Institute University College London Medical School London WC1E 6JJ.
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27
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van de Riet JE, Vandenbussche FP, Le Cessie S, Keirse MJ. Newborn assessment and long-term adverse outcome: a systematic review. Am J Obstet Gynecol 1999; 180:1024-9. [PMID: 10203673 DOI: 10.1016/s0002-9378(99)70676-9] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The medical literature was searched for publications between 1966 and September 1997 for data on the association of Apgar score, umbilical blood pH, or Sarnat grading of encephalopathy with long-term adverse outcome. Odds ratios for these associations were combined to calculate common odds ratios with 95% confidence intervals. Our search identified abstracts of 1312 studies and 81 articles with sufficient numeric data to formulate contingency tables. Forty-two of these qualified for inclusion in our meta-analysis. The strongest associations in the prediction of neonatal death were found by comparing umbilical artery pH <7 with pH >/=7 (common odds ratio 43; 95% confidence interval 15-124) and by comparing Sarnat grade III with grade II (common odds ratio 24; 95% confidence interval 13-45). In the prediction of cerebral palsy, the strongest associations were found for Sarnat grade III versus grade II (common odds ratio 20; 95% confidence interval 6-70) and for 20-minute Apgar score 0 to 3 versus 4 to 6 (common odds ratio 15; 95% confidence interval 5-50).
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Affiliation(s)
- J E van de Riet
- Department of Obstetrics and Gynaecology and the Department of Medical Statistics, Leiden University Medical Centre, Leiden, The Netherlands
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28
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Scalais E, François-Adant A, Nuttin C, Bachy A, Guérit JM. Multimodality evoked potentials as a prognostic tool in term asphyxiated newborns. ELECTROENCEPHALOGRAPHY AND CLINICAL NEUROPHYSIOLOGY 1998; 108:199-207. [PMID: 9566633 DOI: 10.1016/s0168-5597(97)00076-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Hypoxic-ischemic (HI) events may cause permanent brain damage, and it is difficult to predict the long-term neurological outcome of survivors. Multimodality evoked potentials (MEPs), using flash visual (fVEPs), somatosensory (SEPs), and brain-stem auditory evoked potentials (BAEPs) may assess the cerebral function in term neonates. MEPs were recorded in 40 hypoxic-ischemic term or near-term neonates during the first week of life in order to predict the neurological outcome. A 3 point grading system registered either mild, moderate, or severe abnormalities. At 24 months of corrected age, the infants were assessed with a blind protocol to determine neurological development. Grade 0 fVEPs and SEPs were associated with a normal neurological status with 100% (P < 0.001) of the infants. Abnormal SEPs or total grade (VEPs + SEPs) > I were not associated with normal outcomes (P < 0.0001). Normal BAEPs did not predict a normal outcome, but severely abnormal BAEPs did predict an abnormal outcome. A significant correlation was found between EP (VEPs + SEPs) grade (r = 0.9, P < 0.0001), Sarnat stage (r = 0.6, P < 0.001), and clinical outcome. This study confirmed that both fVEPs and SEPs are more accurate as prognostic indicators for term neonates. EPs (VEPs + SEPs) also are more accurate in predicting the ultimate neurological outcome compared with the Sarnat scoring.
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Affiliation(s)
- E Scalais
- Department of Pediatrics, Pediatric Neurology, Entité Hospitalière, Centre Hospitalier Espérance St-Joseph, Liège, Belgium
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29
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du plessis A, Volpe JJ. Prognosis for Development in the Newborn Requiring Neurosurgical Intervention. Neurosurg Clin N Am 1998. [DOI: 10.1016/s1042-3680(18)30289-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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30
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Clarke MP, Mitchell KW, Gibson M. The prognostic value of flash visual evoked potentials in the assessment of non-ocular visual impairment in infancy. Eye (Lond) 1997; 11 ( Pt 3):398-402. [PMID: 9373485 DOI: 10.1038/eye.1997.84] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The results of flash visual evoked potentials (VEPs) in 44 infants blind or severely visually impaired from non-ocular causes are presented, and related to the subsequent visual outcome. Ocular causes of visual impairment were excluded by clinical examination and electroretinography. Using a 2 x 2 contingency table, a significant association between VEP and outcome was demonstrated (chi 2 = 3.51, 1 d.f., p = 0.05). Of 13 infants with normal VEPs, 11 demonstrated substantial visual improvement (negative predictive value = 84.6%). However, of the 31 with abnormal VEPs, only 14 remained severely impaired/blind; the other 17 demonstrating visual improvement (positive predictive value = 45.1%). The sensitivity of the method was high in that 14 of 16 (87.5%) infants who remained impaired/blind had abnormal VEPs, but specificity was low as only 11 of 28 (39.3%) who showed visual improvement had normal VEPs. The accuracy of the technique was therefore low, 25 of 44 (56.8%) being true positive/ negative. With regard to visual outcome when faced with an apparently blind infant, it is important not to be too pessimistic for, as is shown in this study, 28 of 44 demonstrated substantial improvement. There are no absolute indicators of prognosis, but the presence of structural cerebral lesions and a history of either neonatal meningitis or encephalopathy are relatively bad prognostic signs. The flash VEP, despite its limitations, is a useful prognostic tool, particularly in those apparently blind infants whose normal ocular examination/electroretinogram is accompanied by normal VEPs. Those with abnormal VEPs, however, do not necessarily have a poor prognosis, but should be followed-up as maturational changes and/or improvements in function of the sensory pathway will be reflected in the evoked potentials.
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Affiliation(s)
- M P Clarke
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
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31
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Hadders-Algra M. The assessment of general movements is a valuable technique for the detection of brain dysfunction in young infants. A review. ACTA PAEDIATRICA (OSLO, NORWAY : 1992). SUPPLEMENT 1996; 416:39-43. [PMID: 8997446 DOI: 10.1111/j.1651-2227.1996.tb14275.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Recently, a new assessment technique by which to evaluate brain function in the fetus and newborn infant has been developed. The method is based on the assessment of the quality of General Movements (GMs). GMs are complex movements involving all parts of the body. They are present throughout fetal life and postnatally until about 3-4 months post-term. The persistent presence of abnormal GMs during the neonatal period and the absence of age-specific characteristics ("fidgety" movements) around 3 months-post term are both powerful predictors of the development of handicap.
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Affiliation(s)
- M Hadders-Algra
- Department of Medical Physiology, University of Groningen, The Netherlands
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32
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Majnemer A, Rosenblatt B. Evoked potentials as predictors of outcome in neonatal intensive care unit survivors: review of the literature. Pediatr Neurol 1996; 14:189-95. [PMID: 8736401 DOI: 10.1016/0887-8994(96)00049-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Neonatal intensive care unit survivors are at substantial risk for a range of neurodevelopmental sequelae, and therefore a variety of clinical diagnostic techniques have been evaluated as predictors of outcome. We summarize the prognostic value of evoked potentials in newborns at risk. A review of the literature reveals that brainstem conduction abnormalities in auditory brainstem evoked potentials are associated with neuromotor impairment; however, there are many false negative studies. Visual evoked potentials are highly accurate in predicting neurologic deficits in early childhood in asphyxiated term neonates. Sensitivity and specificity are consistently high for somatosensory evoked potentials in term newborns; however, correlations with outcome in premature infants is controversial. Several studies have compared neonatal findings on neuroimaging studies and evoked potentials, and concordant results between these two tests are highly predictive. However, neurologic sequelae often can most accurately be predicted by visual or somatosensory evoked potentials. Evoked potentials may therefore be a useful adjunct to the clinical investigation and prognostication of outcome in the high risk newborn.
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Affiliation(s)
- A Majnemer
- School of Physical and Occupational Therapy, Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
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33
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Abstract
This paper has reviewed the techniques used for recording evoked potentials in the premature infant and the early developmental changes. The maturational changes in the evoked potentials, including morphological changes, and the very rapid latency changes within the first months of life, provide an invaluable means for assessing and monitoring development within the central nervous system. The maturational changes are such that normative values are requisite, and the norms must take into account both the infant's gestational age at birth as well as the postnatal age. These norms can then be used to aid in the assessment of gestational age, and whether there has or has not been normal maturational development, either in utero or during the postnatal preterm period. Evoked potentials are of increasing value clinically in preterm neonates, primarily because of the difficulty in obtaining reliable neurological evaluation of these infants. Median nerve SEPs may provide reliable information in preterm infants at risk of PVL, and when recorded in the second week of life, predict cerebral palsy. PTN SEPs seem to be even more reliable indicators of outcome, but the difficulty in obtaining them in preterm infants needs to be taken into consideration. Further study is needed in some areas, such as in apnoeic preterm babies clearly to establish the role that evoked potentials (in this case BAEPs) may have in understanding both the aetiology and the clinical course of this dysfunction. In other conditions, such as delayed intrauterine growth, that may lead to neurological sequelae, evoked potentials can provide objective CNS assessment. Evoked potentials may also prove useful in the monitoring of treatment modalities for preterm infants. The evoked potentials are a valuable adjunct in the assessment of preterm neonates and, as their value is recognised, we expect their use to increase.
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Affiliation(s)
- M J Taylor
- INSERM Unité 316, et Centre de Pédiatrie Gatien de Clocheville, Tours, France
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34
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Scalais E, François A, Nuttin C. [Diagnostic and prognostic value of evoked potentials facing cerebral hypoxia in newborn infants]. Arch Pediatr 1996; 3 Suppl 1:251s-253s. [PMID: 8796033 DOI: 10.1016/0929-693x(96)86058-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- E Scalais
- Départment de neurologie pédiatrique, hôpital Saint-Joseph-Espérance, Rocourt, Belgique
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Majnemer A, Rosenblatt B. Prediction of outcome at school entry in neonatal intensive care unit survivors, with use of clinical and electrophysiologic techniques. J Pediatr 1995; 127:823-30. [PMID: 7472846 DOI: 10.1016/s0022-3476(95)70183-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To determine the predictive value of multimodality evoked potentials as well as the neonatal neurobehavioral assessment in neonatal intensive care unit survivors at school entry. STUDY DESIGN In this prospective study, healthy (n = 24) and high-risk newborn infants (n = 78) were assessed in the newborn period with auditory brain-stem responses (ABRs) and somatosensory evoked potentials (SEPs), as well as the Einstein Neonatal Neurobehavioral Assessment Scale (ENNAS). Healthy and high-risk newborn infants were assessed in a blind fashion at 1, 3, and 5 years of age by a psychologist and a pediatric neurologist. Of those healthy (all 24) and high-risk newborn infants (72/78) with a neonatal ABR, SEP, or both, 62.5% were assessed at 5 years of age with the Wechsler Preschool and Primary Scale of intelligence, the Beery-Buktenica Test of Visual-Motor Integration, the Griffiths Locomotor Subscale, and neurologic examination. Chi-square analyses were carried out on neonatal and outcome measures, and sensitivity, specificity, and predictive values for each of the neonatal tests were ascertained. RESULTS The ENNAS and the ABR had good negative predictive value for cognitive (85.7% to 93.3%), locomotor (83.3%), and visual-motor (91.4% to 100%) performance. The ABR had good specificity, whereas the ENNAS was more sensitive. The SEP was an excellent prognostic tool, with high sensitivity (100%) and specificity (80% to 81.3%) for motor as well as cognitive domains. All infants with normal SEPs had favorable outcomes, whereas those with absent potentials did poorly. The SEP abnormalities were associated with findings on neurologic examination in all cases. CONCLUSIONS Normal neonatal evoked potentials and ENNAS are associated with favorable outcomes. The SEP most accurately predicts neurodevelopmental status at school entry.
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Affiliation(s)
- A Majnemer
- School of Physical and Occupational Therapy, Montreal Children's Hospital, McGill University, Quebec, Canada
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Eken P, Toet MC, Groenendaal F, de Vries LS. Predictive value of early neuroimaging, pulsed Doppler and neurophysiology in full term infants with hypoxic-ischaemic encephalopathy. Arch Dis Child Fetal Neonatal Ed 1995; 73:F75-80. [PMID: 7583610 PMCID: PMC2528491 DOI: 10.1136/fn.73.2.f75] [Citation(s) in RCA: 156] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
To evaluate their prognostic value, five different non-invasive techniques were used on 34 full term infants with hypoxic-ischaemic encephalopathy (HIE) within six hours of delivery. Cranial ultrasonography, the resistance index (RI) of the middle cerebral artery obtained with Doppler ultrasonography, somatosensory evoked potentials (SEPs), visual evoked potentials (VEPs) and the cerebral function monitor (CFM) were used. According to the criteria of Sarnat, 11 infants developed mild, seven moderate, and 16 severe encephalopathy. The CFM had the highest positive (PPV 84.2%) and negative predictive value (NPV 91.7%). All but one of the infants with a continuous pattern had a good outcome. The CFM of 11 cases with a suppression-burst pattern changed to a continuous pattern over 24 to 48 hours in four infants, and was associated with a normal outcome in three. All five cases with an isoelectric CFM died. The SEPs also provided useful information (PPV 81.8%; NPV 91.7%). VEPs were often delayed during the first hours or life and did not carry a poor prognosis in five of 14 cases (PPV 77.3%). Both ultrasonography and Doppler RI were of little value, as they were almost always normal at this early stage. In 34 full term infants with HIE, studied within 6 hours of life, the CFM and SEPs provided the most useful information about the expected course of encephalopathy and subsequent neurodevelopmental outcome.
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Affiliation(s)
- P Eken
- Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
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Thakran P, Nelson RM, Leuschen MP. Loop diuretic derivative L-644,711 inhibits K(+)-stimulated cellular injury in neonatal guinea pig cortical astrocytes. MOLECULAR AND CHEMICAL NEUROPATHOLOGY 1994; 21:23-39. [PMID: 8179770 DOI: 10.1007/bf03160082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
An early pathological rise in extracellular K+ following acute hypoxia results in Cl- uptake into astrocytes through the Cl/HCO3- exchanger with an osmotic equivalent of water. This study addressed effects of the anion transport inhibitor, L-644,711, (5,6,-dichloro-2,3, 9,9a-tetrahydro-3-oxo-9a-propyl-1H-fluroen-7-yl)oxyacetic acid. Confluent primary cultures from neonatal guinea pigs, characterized as > 95% astrocytes with antiserum to glial fibrillary acidic protein, were manipulated by incubation in either basal buffer (BB) with the ionic composition of Dulbecco's minimum essential media (DMEM) or one with high extracellular K+ (HiK). Incubation in 27 or 60 mM Hik significantly reduced cell viability and precipitated a time-dose dependent increase in lactate dehydrogenase (LDH) efflux (30 min to 4 h). L-644,711 was not cytotoxic, and significantly inhibited HiK-stimulated LDH efflux. The optimal effective dose of L-644,711 for preventing injury in guinea pig astrocytes was 10(-11)M when administered simultaneously with the HiK paradigm or in reversing injury when administered 30 min after exposing cells to HiK. These findings indicate the potential usefulness of agents which modify ion transport processes in hypoxic-ischemic cerebral injury.
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Affiliation(s)
- P Thakran
- Joint Division of Newborn Medicine, Creighton University, University of Nebraska Medical Center, Omaha 68131
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Leinonen L, Sams M, Heiskala H, Klippi A, Korhonen AM, Hakapää M. Cortical sensory evoked potentials and communicative forebrain functions. Brain Dev 1994; 16:32-9. [PMID: 8059926 DOI: 10.1016/0387-7604(94)90110-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Cortical evoked potentials were measured to visual, auditory and somatosensory stimuli in 20 subjects with serious neurodevelopmental impairments due to various etiologies. The results were compared with behavioral observations to find out whether the absence/presence of the responses corresponded to the level of social functioning. No cortical evoked potentials were elicited in two subjects, responses to the stimulation of one modality were missing in three subjects (retinal b-waves and brainstem auditory and somatosensory evoked potentials were, however, preserved in them). No communicative behavior was observed in subjects with absent responses. Ten subjects had marked deviations in the evoked potentials, the behavioral observations in them, ranging from no communication to sentenced speech. Five subjects had normal response patterns and they showed a great variety of communicative skills, including speech. The results support the view that bilateral loss of cortical somatosensory, visual, and auditory evoked potentials is a sign of loss of neural substrates of communication.
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Affiliation(s)
- L Leinonen
- Department of Physiology, University of Helsinki, Finland
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Taylor MJ, Murphy WJ, Whyte HE. Prognostic reliability of somatosensory and visual evoked potentials of asphyxiated term infants. Dev Med Child Neurol 1992; 34:507-15. [PMID: 1612209 DOI: 10.1111/j.1469-8749.1992.tb11471.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The purpose of this study was to determine whether SEPs would improve the predictive power of VEPs for the prognosis of asphyxiated infants. 57 term infants had SEPs and VEPs recorded during the first three days of life, during the first week and at follow-up visits. All survivors have been followed for 18 to 24 months. 34 had a normal outcome, 12 had severe neurological sequelae and 11 died. The SEPs had both high sensitivity (96 per cent) and negative predictive power (97 per cent); normal SEPs virtually guaranteed normal outcome. The VEPs had both a specificity and positive predictive power of 100 per cent; abnormal VEPs guaranteed abnormal outcome. Both together had a higher predictive power than either alone. The combination of VEPs and SEPs yields a powerful means of prognostication for term asphyxiated infants; the results suggest that both be included in the assessment of this population.
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Affiliation(s)
- M J Taylor
- Division of Neonatology, Hospital for Sick Children, Toronto, Ontario, Canada
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Coker SB. VEP and predicting outcome in birth asphyxia. Pediatr Neurol 1991; 7:310-1. [PMID: 1930428 DOI: 10.1016/0887-8994(91)90056-q] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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