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Montazeri S, Nevalainen P, Stevenson NJ, Vanhatalo S. Sleep State Trend (SST), a bedside measure of neonatal sleep state fluctuations based on single EEG channels. Clin Neurophysiol 2022; 143:75-83. [PMID: 36155385 DOI: 10.1016/j.clinph.2022.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/27/2022] [Accepted: 08/31/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To develop and validate an automated method for bedside monitoring of sleep state fluctuations in neonatal intensive care units. METHODS A deep learning-based algorithm was designed and trained using 53 EEG recordings from a long-term (a)EEG monitoring in 30 near-term neonates. The results were validated using an independent dataset from 30 polysomnography recordings. In addition, we constructed Sleep State Trend (SST), a bedside-ready means for visualizing classifier outputs. RESULTS The accuracy of quiet sleep detection in the training data was 90%, and the accuracy was comparable (85-86 %) in all bipolar derivations available from the 4-electrode recordings. The algorithm generalized well to a polysomnography dataset, showing 81% overall accuracy despite different signal derivations. SST allowed an intuitive, clear visualization of the classifier output. CONCLUSIONS Fluctuations in sleep states can be detected at high fidelity from a single EEG channel, and the results can be visualized as a transparent and intuitive trend in the bedside monitors. SIGNIFICANCE The Sleep State Trend (SST) may provide caregivers and clinical studies a real-time view of sleep state fluctuations and its cyclicity.
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Affiliation(s)
- Saeed Montazeri
- BABA Center, Department of Clinical Neurophysiology, HUS diagnostic center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Physiology, University of Helsinki, Helsinki, Finland.
| | - Päivi Nevalainen
- BABA Center, Department of Clinical Neurophysiology, HUS diagnostic center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Nathan J Stevenson
- Brain Modeling Group, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Sampsa Vanhatalo
- BABA Center, Department of Clinical Neurophysiology, HUS diagnostic center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Physiology, University of Helsinki, Helsinki, Finland
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Sensory-based interventions in the NICU: systematic review of effects on preterm brain development. Pediatr Res 2022; 92:47-60. [PMID: 34508227 DOI: 10.1038/s41390-021-01718-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 07/12/2021] [Accepted: 08/17/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Infants born preterm are known to be at risk for abnormal brain development and adverse neurobehavioral outcomes. To improve early neurodevelopment, several non-pharmacological interventions have been developed and implemented in the neonatal intensive care unit (NICU). Sensory-based interventions seem to improve short-term neurodevelopmental outcomes in the inherently stressful NICU environment. However, how this type of intervention affects brain development in the preterm population remains unclear. METHODS A systematic review of the literature was conducted for published studies in the past 20 years reporting the effects of early, non-pharmacological, sensory-based interventions on the neonatal brain after preterm birth. RESULTS Twelve randomized controlled trials (RCT) reporting short-term effects of auditory, tactile, and multisensory interventions were included after the screening of 1202 articles. Large heterogeneity was identified among studies in relation to both types of intervention and outcomes. Three areas of focus for sensory interventions were identified: auditory-based, tactile-based, and multisensory interventions. CONCLUSIONS Diversity in interventions and outcome measures challenges the possibility to perform an integrative synthesis of results and to translate these for evidence-based clinical practice. This review identifies gaps in the literature and methodological challenges for the implementation of RCTs of sensory interventions in the NICU. IMPACT This paper represents the first systematic review to investigate the effect of non-pharmacological, sensory-based interventions in the NICU on neonatal brain development. Although reviewed RCTs present evidence on the impact of such interventions on the neonatal brain following preterm birth, it is not yet possible to formulate clear guidelines for clinical practice. This review integrates existing literature on the effect of sensory-based interventions on the brain after preterm birth and identifies methodological challenges for the conduction of high-quality RCTs.
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Shuffrey LC, Pini N, Potter M, Springer P, Lucchini M, Rayport Y, Sania A, Firestein M, Brink L, Isler JR, Odendaal H, Fifer WP. Aperiodic electrophysiological activity in preterm infants is linked to subsequent autism risk. Dev Psychobiol 2022; 64:e22271. [PMID: 35452546 PMCID: PMC9169229 DOI: 10.1002/dev.22271] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 01/31/2022] [Accepted: 03/04/2022] [Indexed: 12/31/2022]
Abstract
Approximately 7% of preterm infants receive an autism spectrum disorder (ASD) diagnosis. Yet, there is a significant gap in the literature in identifying prospective markers of neurodevelopmental risk in preterm infants. The present study examined two electroencephalography (EEG) parameters during infancy, absolute EEG power and aperiodic activity of the power spectral density (PSD) slope, in association with subsequent autism risk and cognitive ability in a diverse cohort of children born preterm in South Africa. Participants were 71 preterm infants born between 25 and 36 weeks gestation (34.60 ± 2.34 weeks). EEG was collected during sleep between 39 and 41 weeks postmenstrual age adjusted (40.00 ± 0.42 weeks). The Bayley Scales of Infant Development and Brief Infant Toddler Social Emotional Assessment (BITSEA) were administered at approximately 3 years of age adjusted (34 ± 2.7 months). Aperiodic activity, but not the rhythmic oscillatory activity, at multiple electrode sites was associated with subsequent increased autism risk on the BITSEA at three years of age. No associations were found between the PSD slope or absolute EEG power and cognitive development. Our findings highlight the need to examine potential markers of subsequent autism risk in high-risk populations other than infants at familial risk.
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Affiliation(s)
- Lauren C Shuffrey
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA.,Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, New York, USA
| | - Nicolò Pini
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA.,Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, New York, USA
| | - Mandy Potter
- Department of Obstetrics and Gynaecology, Stellenbosch University, Tygerberg, Western Cape, South Africa
| | - Priscilla Springer
- Paediatrics and Child Health, Stellenbosch University, Tygerberg, Western Cape, South Africa
| | - Maristella Lucchini
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA.,Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, New York, USA
| | - Yael Rayport
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Ayesha Sania
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA.,Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, New York, USA
| | - Morgan Firestein
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA.,Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, New York, USA
| | - Lucy Brink
- Department of Obstetrics and Gynaecology, Stellenbosch University, Tygerberg, Western Cape, South Africa
| | - Joseph R Isler
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
| | - Hein Odendaal
- Department of Obstetrics and Gynaecology, Stellenbosch University, Tygerberg, Western Cape, South Africa
| | - William P Fifer
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA.,Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, New York, USA.,Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
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Welch MG, Grieve PG, Stark RI, Isler JR, Ludwig RJ, Hane AA, Gong A, Darilek U, Austin J, Myers MM. Family Nurture Intervention increases term age forebrain EEG activity: a multicenter replication trial. Clin Neurophysiol 2022; 138:52-60. [DOI: 10.1016/j.clinph.2022.02.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/26/2022] [Accepted: 02/16/2022] [Indexed: 11/30/2022]
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Hammond J, Kamboj R, Kashyap S, Sahni R. The interaction between diet and neurobehavior in very low birth weight infants. Pediatr Res 2022; 91:646-651. [PMID: 33767376 PMCID: PMC8463624 DOI: 10.1038/s41390-021-01464-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 02/17/2021] [Accepted: 02/22/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Modulation of behavior and physiology by dietary perturbations early in life can provide clues to the pathogenesis of adult diseases. We tested the hypothesis that a period of early protein supplementation modulates sympathetic nervous system activity demonstrated indirectly by an increase in active sleep state distribution in very low birth weight (VLBW) infants. METHODS VLBW infants (n = 71) were randomized to a total parenteral nutritional regimen providing 18% of the energy intake as amino acids (AA) or a conventional regimen providing 12.5% to achieve targeted AA intakes of 4 g/kg/day (0.004 kcal/kg/day) and 3 g/kg/day (0.003 kcal/kg/day), respectively. Both groups were weaned to enteral feeding and advanced to provide similar AA intake of 4 g/kg/day (0.004 kcal/kg/day). Six-hour daytime, behavioral sleep studies were performed when the infants reached full enteral intake (165 ml/kg/day). RESULTS Infants in the high protein group spent more time in active sleep (77.2 ± 10.5% vs. 70.7 ± 11.8%), p < 0.01 and less time in quiet sleep (12.9 ± 3.4% vs. 17.7 ± 7.0%, p < 0.01) as compared to the conventional group. No group differences were observed for indeterminate sleep, awake, or crying states. CONCLUSIONS These results suggest that dietary intake may indirectly influence sympathetic nervous system activity. IMPACT Infants randomized to an early, high protein nutritional regimen spent an increased percentage of time in active sleep, supporting the hypothesis that nutrition and behavior are interactive. Furthermore, sleep states are an indirect measure of sympathetic nervous system activity, suggesting that dietary intake may influence sympathetic nervous system activity. This study highlights the importance of considering the impact of nutrition during critical periods of development in order to further understand and improve the long-term outcomes of very low birth weight infants.
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Affiliation(s)
- Jennifer Hammond
- Division of Neonatology, Department of Pediatrics, Columbia University Irving Medical Center, New York New York
| | - Rajit Kamboj
- Division of Neonatology, Department of Pediatrics, Columbia University Irving Medical Center, New York New York
| | - Sudha Kashyap
- Division of Neonatology, Department of Pediatrics, Columbia University Irving Medical Center, New York New York
| | - Rakesh Sahni
- Division of Neonatology, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA.
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de Groot E, Bik A, Sam C, Wang X, Shellhaas R, Austin T, Tataranno M, Benders M, van den Hoogen A, Dudink J. Creating an optimal observational sleep stage classification system for very and extremely preterm infants. Sleep Med 2022; 90:167-175. [DOI: 10.1016/j.sleep.2022.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 01/18/2022] [Accepted: 01/22/2022] [Indexed: 10/19/2022]
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Hermans T, Thewissen L, Gewillig M, Cools B, Jansen K, Pillay K, De Vos M, Van Huffel S, Naulaers G, Dereymaeker A. Functional brain maturation and sleep organisation in neonates with congenital heart disease. Eur J Paediatr Neurol 2022; 36:115-122. [PMID: 34954621 DOI: 10.1016/j.ejpn.2021.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 11/23/2021] [Accepted: 12/11/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Neonates with Congenital Heart Disease (CHD) have structural delays in brain development. To evaluate whether functional brain maturation and sleep-wake physiology is also disturbed, the Functional Brain Age (FBA) and sleep organisation on EEG during the neonatal period is investigated. METHODS We compared 15 neonates with CHD who underwent multichannel EEG with healthy term newborns of the same postmenstrual age, including subgroup analysis for d-Transposition of the Great Arteries (d-TGA) (n = 8). To estimate FBA, a prediction tool using quantitative EEG features as input, was applied. Second, the EEG was automatically classified into the 4 neonatal sleep stages. Neonates with CHD underwent neurodevelopmental testing using the Bayley Scale of Infant Development-III at 24 months. RESULTS Preoperatively, the FBA was delayed in CHD infants and more so in d-TGA infants. The FBA was positively correlated with motor scores. Sleep organisation was significantly altered in neonates with CHD. The duration of the sleep cycle and the proportion of Active Sleep Stage 1 was decreased, again more marked in the d-TGA infants. Neonates with d-TGA spent less time in High Voltage Slow Wave Sleep and more in Tracé Alternant compared to healthy terms. Both FBA and sleep organisation normalised postoperatively. The duration of High Voltage Slow Wave Sleep remained positively correlated with motor scores in d-TGA infants. INTERPRETATION Altered early brain function and sleep is present in neonates with CHD. These results are intruiging, as inefficient neonatal sleep has been linked with adverse long-term outcome. Identifying how these rapid alterations in brain function are mitigated through improvements in cerebral oxygenation, surgery, drugs and nutrition may have relevance for clinical practice and outcome.
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Affiliation(s)
- Tim Hermans
- Division STADIUS, Department of Electrical Engineering (ESAT), KU Leuven (University of Leuven), Leuven, Belgium
| | - Liesbeth Thewissen
- Department of Development and Regeneration, Neonatal Intensive Care Unit, University Hospitals Leuven, KU Leuven (University of Leuven), Leuven, Belgium
| | - Marc Gewillig
- Department of Cardiovascular Science, Paediatric Cardiology, University Hospitals Leuven, KU Leuven (University of Leuven), Leuven, Belgium
| | - Bjorn Cools
- Department of Cardiovascular Science, Paediatric Cardiology, University Hospitals Leuven, KU Leuven (University of Leuven), Leuven, Belgium
| | - Katrien Jansen
- Department of Development and Regeneration, Child Neurology, University Hospitals Leuven, KU Leuven (University of Leuven), Leuven, Belgium
| | - Kirubin Pillay
- Department of Paediatrics, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Maarten De Vos
- Division STADIUS, Department of Electrical Engineering (ESAT), KU Leuven (University of Leuven), Leuven, Belgium
| | - Sabine Van Huffel
- Division STADIUS, Department of Electrical Engineering (ESAT), KU Leuven (University of Leuven), Leuven, Belgium
| | - Gunnar Naulaers
- Department of Development and Regeneration, Neonatal Intensive Care Unit, University Hospitals Leuven, KU Leuven (University of Leuven), Leuven, Belgium
| | - Anneleen Dereymaeker
- Department of Development and Regeneration, Neonatal Intensive Care Unit, University Hospitals Leuven, KU Leuven (University of Leuven), Leuven, Belgium.
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Shuffrey LC, Rodriguez C, Rodriguez DJ, Mahallati H, Jayaswal M, Barbosa JR, Syme S, Gimenez LA, Pini N, Lucchini M, Fifer WP. Delayed maturation of P2 flash visual evoked potential (VEP) latency in newborns of gestational diabetic mothers. Early Hum Dev 2021; 163:105503. [PMID: 34741833 DOI: 10.1016/j.earlhumdev.2021.105503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 07/22/2021] [Accepted: 10/25/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The prevalence of gestational diabetes mellitus (GDM) has rapidly increased, yet few prior studies have investigated parameters of early brain development in infants born to gestational diabetic mothers. The present study assessed visual evoked potentials (VEPs) in healthy infants born to gestational diabetic mothers and matched controls. METHODS After exclusions, in this prospective study we examined VEPs in 73 neonates between 37 weeks and 41 weeks gestation at birth (n = 37 infants of gestational diabetic mothers). Stroboscopic flashes were presented through closed eyelids during passive electroencephalography (EEG) recording to derive VEP waveforms during natural sleep. RESULTS There was a statistically significant moderate correlation between gestational age at birth and P2 latency of the flash VEP where P2 latency significantly decreased with increasing gestational age (Pearson's R(73) = -0.32, p < .01). There was also a significant moderate correlation between postnatal age (hours of life) and P2 latency of the flash VEP where P2 latency significantly decreased with increasing postnatal age (Pearson's R(73) = -0.23, p < .05). When controlling for gestational age at birth, postnatal age, and sex, there was a significant effect of group (GDM-exposed vs. control) on P2 latency of the flash VEP (p < .05). Infants of gestational diabetic mothers had a significantly longer P2 latency (M: 215.29 ± SD: 2.58 ms) than controls (M: 206.41 ± SD: 2.62 ms). CONCLUSION Our findings suggest P2 flash VEP latency is a potential measure of cortical maturation and marker of immature development in infants of gestational diabetic mothers.
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Affiliation(s)
- Lauren C Shuffrey
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY 10032, United States of America; Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY 10032, United States of America.
| | - Cynthia Rodriguez
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY 10032, United States of America
| | - Daianna J Rodriguez
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY 10032, United States of America
| | - Hana Mahallati
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY 10032, United States of America
| | - Minna Jayaswal
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY 10032, United States of America
| | - Jennifer R Barbosa
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY 10032, United States of America
| | - Samantha Syme
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY 10032, United States of America
| | - Lissete A Gimenez
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY 10032, United States of America
| | - Nicolò Pini
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY 10032, United States of America
| | - Maristella Lucchini
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY 10032, United States of America; Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY 10032, United States of America
| | - William P Fifer
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY 10032, United States of America; Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY 10032, United States of America; Department of Pediatrics, Columbia University Irving Medical Center, New York, NY 10032, United States of America
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Relationship Between Early Functional and Structural Brain Developments and Brain Injury in Preterm Infants. THE CEREBELLUM 2021; 20:556-568. [PMID: 33532923 PMCID: PMC8360868 DOI: 10.1007/s12311-021-01232-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/07/2021] [Indexed: 02/07/2023]
Abstract
Background Recent studies explored the relationship between early brain function and brain morphology, based on the hypothesis that increased brain activity can positively affect structural brain development and that excitatory neuronal activity stimulates myelination. Objective To investigate the relationship between maturational features from early and serial aEEGs after premature birth and MRI metrics characterizing structural brain development and injury, measured around 30weeks postmenstrual age (PMA) and at term. Moreover, we aimed to verify whether previously developed maturational EEG features are related with PMA. Design/Methods One hundred six extremely preterm infants received bedside aEEGs during the first 72h and weekly until week 5. 3T-MRIs were performed at 30weeks PMA and at term. Specific features were extracted to assess EEG maturation: (1) the spectral content, (2) the continuity [percentage of spontaneous activity transients (SAT%) and the interburst interval (IBI)], and (3) the complexity. Automatic MRI segmentation to assess volumes and MRI score was performed. The relationship between the maturational EEG features and MRI measures was investigated. Results Both SAT% and EEG complexity were correlated with PMA. IBI was inversely associated with PMA. Complexity features had a positive correlation with the cerebellar size at 30weeks, while event-based measures were related to the cerebellar size at term. Cerebellar width, cortical grey matter, and total brain volume at term were inversely correlated with the relative power in the higher frequency bands. Conclusions The continuity and complexity of the EEG steadily increase with increasing postnatal age. Increasing complexity and event-based features are associated with cerebellar size, a structure with enormous development during preterm life. Brain activity is important for later structural brain development. Supplementary Information The online version contains supplementary material available at 10.1007/s12311-021-01232-z.
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Bourel-Ponchel E, Hasaerts D, Challamel MJ, Lamblin MD. Behavioral-state development and sleep-state differentiation during early ontogenesis. Neurophysiol Clin 2020; 51:89-98. [PMID: 33148436 DOI: 10.1016/j.neucli.2020.10.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/05/2020] [Accepted: 10/05/2020] [Indexed: 01/11/2023] Open
Abstract
Sleep is a key process in neurodevelopment and essential for the maturation of fundamental brain functions. Premature birth can disturb the initial steps of sleep maturation, which may contribute to the impairment of neurodevelopment. It is thus fundamental to understand the maturation of the various sleep states and the quality of cerebral function in each vigilance state, as well as the development of sleep cyclicity, in at-risk neonatal infants, particularly those born premature. The objective of this review is to provide a precise description of sleep states and cycles and their rhythmic organization in premature and term newborns according to their gestational age. Technical aspects of polysomnography, which requires a high level of expertise in neonates, are also described. Principles of the visual interpretation of polysomnography, including the simultaneous analysis of behavioral (spontaneous motricity and eye movements), polysomnographic parameters (electro-oculogram, electrocardiogram, respiration), and electroencephalography patterns are presented. The neurophysiology of sleep ontogenesis and its interaction with brain maturation are discussed, highlighting the crucial role of sleep states and their duration in premature newborns. In particular, the involvement of myoclonic twitches in functional connectivity in sensorimotor development is discussed. Indeed, sleep quality, determined by combined polysomnographic parameters, reflects either normal or pathological developmental processes during the neonatal period. The fundamental place of neurophysiological explorations in the early detection of sleep disorders is discussed, as well as their potential consequences on neurodevelopmental care to improve the prevention of neurodevelopmental impairment.
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Affiliation(s)
- Emilie Bourel-Ponchel
- INSERM UMR 1105, Research Group on Multimodal Analysis of Brain Function, University of Picardie Jules Verne, 80036 Amiens Cedex, France; INSERM UMR 1105, Pediatric Neurophysiology Unit, Amiens-Picardie University Hospital, 1 rond-point du Pr Christian Chabrol, 80054 Amiens Cedex, France.
| | - Danièle Hasaerts
- Dienst Kinderneurologie UZ Brussel, Laerbeeklaan 101, 1090 Brussels Belgium
| | - Marie-Josèphe Challamel
- Hôpital Femme-Mère-Enfant, Université Claude-Bernard Lyon 1, Centre de Référence Pour la Narcolepsie et les Hypersomnies Rares, Unité de Sommeil de l'Enfant, Unité Inserm U1028, 59, Boulevard Pinel, 69500 Lyon, France
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Shuffrey LC, Myers MM, Isler JR, Lucchini M, Sania A, Pini N, Nugent JD, Condon C, Ochoa T, Brink L, du Plessis C, Odendaal HJ, Nelson ME, Friedrich C, Angal J, Elliott AJ, Groenewald C, Burd L, Fifer WP. Association Between Prenatal Exposure to Alcohol and Tobacco and Neonatal Brain Activity: Results From the Safe Passage Study. JAMA Netw Open 2020; 3:e204714. [PMID: 32396193 PMCID: PMC7218492 DOI: 10.1001/jamanetworkopen.2020.4714] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
IMPORTANCE Research to date has not determined a safe level of alcohol or tobacco use during pregnancy. Electroencephalography (EEG) is a noninvasive measure of cortical function that has previously been used to examine effects of in utero exposures and associations with neurodevelopment. OBJECTIVE To examine the association of prenatal exposure to alcohol (PAE) and tobacco smoking (PTE) with brain activity in newborns. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study enrolled mother-newborn dyads from December 2011 through August 2015, with data analyzed from June 2018 through June 2019. Pregnant women were recruited from clinical sites in Cape Town, South Africa, and the Northern Plains region of the US. Participants were a subset of newborns enrolled in the Safe Passage Study. Exclusions included birth at less than 37 or more than 41 weeks' gestation, multiple birth, or maternal use of psychiatric medication during pregnancy. EXPOSURES PAE and PTE groups were determined by cluster analysis. MAIN OUTCOMES AND MEASURES Analyses of covariance were run on EEG spectral power at 12 scalp locations across the frequency spectrum from 1 to 45 Hz in 3-Hz bins by sleep state. RESULTS The final sample consisted of 1739 newborns (median [interquartile range] gestational age at birth, 39.29 [1.57] weeks; 886 [50.9%] were female; median [interquartile range] newborn age at assessment, 48.53 [44.96] hours). Newborns whose mothers were in the low continuous (95% CI, -0.379 to -0.031; P < .05; 95% CI, -0.379 to -0.045; P < .05), quit (95% CI, -0.419 to -0.127; P < .001; 95% CI, -0.398 to -0.106; P < .005), and moderate or high continuous (95% CI, -0.430 to -0.124; P < .001; 95% CI, -0.420 to -0.119; P < .005) PAE clusters had increased 4- to 6-Hz and 7- to 9-Hz left-temporal EEG power. Newborns with moderate or high continuous PTE had decreased 19- to 21-Hz (95% CI, 0.034 to 0.327; P < .05) and 22- to 24-Hz (95% CI, 0.022 to 0.316; P < .05) right-central EEG compared with newborns with no PTE. Newborns with moderate or high continuous PTE had significantly decreased 22- to 36-Hz right-central EEG power compared with the quit smoking group (22-24 Hz, 95% CI, 0.001 to 0.579; P < .05; 25-27 Hz, 95% CI, 0.008 to 0.586; P < .05; 28-30 Hz, 95% CI, 0.028 to 0.607; P < .05; 31-33 Hz, 95% CI, 0.038 to 0.617; P < .05; 34-36 Hz, 95% CI, 0.057 to 0.636; P < .05). CONCLUSIONS AND RELEVANCE These findings suggest that even low levels of PAE or PTE are associated with changes in offspring brain development.
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Affiliation(s)
- Lauren C. Shuffrey
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, New York
| | - Michael M. Myers
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, New York
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Joseph R. Isler
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Maristella Lucchini
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, New York
| | - Ayesha Sania
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Nicolò Pini
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, New York
| | - J. David Nugent
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, New York
| | - Carmen Condon
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, New York
| | - Timothy Ochoa
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, New York
| | - Lucy Brink
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Science, Stellenbosch University, Cape Town, Western Cape, South Africa
| | - Carlie du Plessis
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Science, Stellenbosch University, Cape Town, Western Cape, South Africa
| | - Hein J. Odendaal
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Science, Stellenbosch University, Cape Town, Western Cape, South Africa
| | - Morgan E. Nelson
- Center for Pediatric & Community Research, Avera Research Institute, Sioux Falls, South Dakota
- Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls
| | - Christa Friedrich
- Center for Pediatric & Community Research, Avera Research Institute, Sioux Falls, South Dakota
- Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls
| | - Jyoti Angal
- Center for Pediatric & Community Research, Avera Research Institute, Sioux Falls, South Dakota
- Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls
| | - Amy J. Elliott
- Center for Pediatric & Community Research, Avera Research Institute, Sioux Falls, South Dakota
- Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls
| | - Coen Groenewald
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Science, Stellenbosch University, Cape Town, Western Cape, South Africa
| | - Larry Burd
- Department of Pediatrics, University of North Dakota Medical School, Grand Forks
| | - William P. Fifer
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, New York
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
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12
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Electroencephalographic functional connectivity in extreme prematurity: a pilot study based on graph theory. Pediatr Res 2020; 87:753-759. [PMID: 31726463 DOI: 10.1038/s41390-019-0621-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 09/06/2019] [Accepted: 10/08/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND Connectivity studies based on functional magnetic resonance imaging (MRI) provided new insights in neonatal brain development but cannot be performed at bedside in the clinical setting. The electroencephalogram (EEG) connectivity has been less studied, particularly using the new approach based on graph theory. This study aimed to explore the functional EEG connectivity using graph theory analysis at an early post-conception age in extremely premature and late-preterm babies free of medical complications and overt brain damage. METHODS Sixteen neonates (8 extremely low gestational age (ELGA) and 8 late-preterm infants), both groups having performed multichannel EEG recordings at 35 weeks' post-conception, were recruited in a single tertiary-level neonatal intensive care unit and well-baby nursery, respectively. Global (i.e., small-worldness) and local (i.e., clustering and strength) connectivity measures were calculated on a single-subject connectivity matrix of EEG data. RESULTS Both ELGA and late-preterm infants showed small-worldness organization at 35 weeks' post-conception. The ELGA group had the strength parameter of the theta frequency band lower in the right than in the left hemisphere. This asymmetry did not emerge in the late-preterm group. Moreover, the mean strength parameter was significantly greater in the right hemisphere in the late preterms than in the ELGA group. CONCLUSION EEG connectivity measures could represent an index of left-to-right maturation and developmental disadvantage in extremely preterm infants.
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13
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Appearance of sleep cycling after birth in term neonates: an electro-physiologic study. Pediatr Res 2020; 87:711-715. [PMID: 31493770 DOI: 10.1038/s41390-019-0560-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 07/13/2019] [Accepted: 08/07/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Appearance of sleep cycling has been associated with good outcome in term and preterm infants, but the normal time of its appearance has not been determined. The objectives of this study were, to correlate the time of sleep cycling appearance and the length of quiet sleep in neonates with different degrees of mild perinatal stress. METHODS Three groups of term infants recorded with aEEG after birth were studied: infants delivered by planned cesarean section (group 1), infants with mild perinatal stress (group 2) and infants with mild neonatal encephalopathy (group 3). Groups were correlated with the appearance and length of quiet sleep. RESULTS In all, 132 infants were assessed. Quiet sleep appearance differed significantly between groups (p < 0.001). All infants in group 1 developed quiet sleep before the age of 6 h compared to 81% in group 2 and 52% in group 3 (p < 0.001). No differences in the quiet sleep length was found between groups. Belonging to group 3 (p < 0.001) and 1-min Apgar score (p = 0.002) significantly predicted a delay in appearance of the first quiet sleep period. Cesarean delivery significantly predicted an earlier appearance of quiet sleep (p < 0.001). CONCLUSIONS Appearance of quiet sleep after birth but not its length may be delayed in case of mild perinatal stress.
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Wallois F, Routier L, Bourel-Ponchel E. Impact of prematurity on neurodevelopment. HANDBOOK OF CLINICAL NEUROLOGY 2020; 173:341-375. [PMID: 32958184 DOI: 10.1016/b978-0-444-64150-2.00026-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The consequences of prematurity on brain functional development are numerous and diverse, and impact all brain functions at different levels. Prematurity occurs between 22 and 36 weeks of gestation. This period is marked by extreme dynamics in the physiologic maturation, structural, and functional processes. These different processes appear sequentially or simultaneously. They are dependent on genetic and/or environmental factors. Disturbance of these processes or of the fine-tuning between them, when caring for premature children, is likely to induce disturbances in the structural and functional development of the immature neural networks. These will appear as impairments in learning skills progress and are likely to have a lasting impact on the development of children born prematurely. The level of severity depends on the initial alteration, whether structural or functional. In this chapter, after having briefly reviewed the neurodevelopmental, structural, and functional processes, we describe, in a nonexhaustive manner, the impact of prematurity on the different brain, motor, sensory, and cognitive functions.
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Affiliation(s)
- Fabrice Wallois
- Research Group on Multimodal Analysis of Brain Function, Jules Verne Picardie University, Amiens, France; Department of Pediatric Functional Exploration of the Nervous System, University Hospital, Picardie, Amiens, France.
| | - Laura Routier
- Research Group on Multimodal Analysis of Brain Function, Jules Verne Picardie University, Amiens, France; Department of Pediatric Functional Exploration of the Nervous System, University Hospital, Picardie, Amiens, France
| | - Emilie Bourel-Ponchel
- Research Group on Multimodal Analysis of Brain Function, Jules Verne Picardie University, Amiens, France; Department of Pediatric Functional Exploration of the Nervous System, University Hospital, Picardie, Amiens, France
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15
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Scarpelli S, Bartolacci C, D'Atri A, Gorgoni M, De Gennaro L. Mental Sleep Activity and Disturbing Dreams in the Lifespan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3658. [PMID: 31569467 PMCID: PMC6801786 DOI: 10.3390/ijerph16193658] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 09/11/2019] [Accepted: 09/27/2019] [Indexed: 02/05/2023]
Abstract
Sleep significantly changes across the lifespan, and several studies underline its crucial role in cognitive functioning. Similarly, mental activity during sleep tends to covary with age. This review aims to analyze the characteristics of dreaming and disturbing dreams at different age brackets. On the one hand, dreams may be considered an expression of brain maturation and cognitive development, showing relations with memory and visuo-spatial abilities. Some investigations reveal that specific electrophysiological patterns, such as frontal theta oscillations, underlie dreams during sleep, as well as episodic memories in the waking state, both in young and older adults. On the other hand, considering the role of dreaming in emotional processing and regulation, the available literature suggests that mental sleep activity could have a beneficial role when stressful events occur at different age ranges. We highlight that nightmares and bad dreams might represent an attempt to cope the adverse events, and the degrees of cognitive-brain maturation could impact on these mechanisms across the lifespan. Future investigations are necessary to clarify these relations. Clinical protocols could be designed to improve cognitive functioning and emotional regulation by modifying the dream contents or the ability to recall/non-recall them.
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Affiliation(s)
- Serena Scarpelli
- Department of Psychology, "Sapienza" University of Rome, Via dei Marsi, 78, 00185 Rome, Italy.
| | - Chiara Bartolacci
- Department of Psychology, "Sapienza" University of Rome, Via dei Marsi, 78, 00185 Rome, Italy.
| | - Aurora D'Atri
- Department of Psychology, "Sapienza" University of Rome, Via dei Marsi, 78, 00185 Rome, Italy.
| | - Maurizio Gorgoni
- Department of Psychology, "Sapienza" University of Rome, Via dei Marsi, 78, 00185 Rome, Italy.
| | - Luigi De Gennaro
- Department of Psychology, "Sapienza" University of Rome, Via dei Marsi, 78, 00185 Rome, Italy.
- IRCCS Santa Lucia Foundation, 00142 Rome, Italy.
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16
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Nghiem GT, Nishijo M, Pham TN, Ito M, Pham TT, Tran AH, Nishimaru H, Nishino Y, Nishijo H. Adverse effects of maternal dioxin exposure on fetal brain development before birth assessed by neonatal electroencephalography (EEG) leading to poor neurodevelopment; a 2-year follow-up study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 667:718-729. [PMID: 30849612 DOI: 10.1016/j.scitotenv.2019.02.395] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 02/13/2019] [Accepted: 02/25/2019] [Indexed: 06/09/2023]
Abstract
We previously reported the adverse effects of perinatal dioxin exposure on child neurodevelopment around a former US military airbase in Vietnam. In the present study, we investigated the effects of maternal dioxin exposure on fetal brain development, which may predict neurodevelopmental outcomes in early childhood. A total of 55 newborns with mothers from dioxin-contaminated areas were recruited in the prefecture hospital in Bien Hoa, Vietnam. Dioxins in maternal breast milk collected 1 month after birth were used as a maternal exposure marker. Relative powers and coherence were computed from neonatal electroencephalogram (EEG) records during active sleep stages. Relationships between the EEG parameters and dioxin exposure markers were analyzed using linear regression and a general linear model after adjusting for gestational age, body length, and head circumference of infants at birth. Using data from 47 infants whose neurodevelopment was examined in a 2-year follow-up study, associations between EEG parameters and neurodevelopment were analyzed after adjusting for confounding factors. On the right frontal and parietal regions, relative delta powers were significantly decreased, and relative alpha and beta powers were significantly increased with increasing dioxin exposure. Increases in delta power and decreases in alpha power on the right frontal and parietal regions were associated with an increase in language scores at 2 years of age. Furthermore, intra- and inter-hemispheric coherence in theta and alpha bands were positively and inversely correlated with dioxin exposure, respectively, and increased intra-coherence in the right hemisphere was associated with lower language scores. These findings suggest that prenatal dioxin exposure affects neuronal activity and functional connectivity between brain regions, and may lead to poor language development.
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Affiliation(s)
- GiangThi Thuy Nghiem
- System Emotional Science, Graduate School of Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Muneko Nishijo
- Department of Public Health, Kanazawa Medical University, Ishikawa 920-0293, Japan.
| | - Thao Ngoc Pham
- Department of Public Health, Kanazawa Medical University, Ishikawa 920-0293, Japan
| | - Mika Ito
- Department of Obstetrics and Gynecology, University of Toyama, Toyama 930-0194, Japan
| | - Tai The Pham
- Biomedical and Pharmaceutical Research Center, Vietnamese Military Medical University, Hanoi, Viet Nam
| | - Anh Hai Tran
- Biomedical and Pharmaceutical Research Center, Vietnamese Military Medical University, Hanoi, Viet Nam
| | - Hiroshi Nishimaru
- System Emotional Science, Graduate School of Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Yoshikazu Nishino
- Department of Public Health, Kanazawa Medical University, Ishikawa 920-0293, Japan
| | - Hisao Nishijo
- System Emotional Science, Graduate School of Medicine, University of Toyama, Toyama 930-0194, Japan
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17
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Sleep and prematurity: sleep outcomes in preterm children and influencing factors. World J Pediatr 2019; 15:209-218. [PMID: 30830664 DOI: 10.1007/s12519-019-00240-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 02/19/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Sleep undergoes changes from birth to adulthood, while sleep disorders are associated with various cognitive deficiencies in childhood. In parallel, prematurity is known to predispose to poor neurodevelopmental outcomes. Our aim is to provide literature data about factors influencing sleep in the premature infants and sleep outcomes in this population. METHODS A systematic review was conducted using a variety of health-related databases. Original research papers were considered and no year-of-publication restriction was placed. RESULTS In total, 22 articles fulfilled our selection criteria. Available studies present remarkable heterogeneity in terms of methodological design. Compared to full term, premature infants exhibit significant differences in sleep structure, which mainly include differences in electroencephalographic spectral values, in total sleep time and in arousal threshold. Furthermore, prematurity seems to be a risk factor of sleep breathing disorders in childhood and adolescence. Data about the effect of methylxanthines and the environment of neonatal intensive care unit is controversial. With regard to the impact of prematurity-related sleep disorders on future neurodevelopment, available research papers are generally few. CONCLUSIONS The alterations in sleep patterns are an outcome of prematurity (immaturity of nervous system) as well as of postnatal factors and comorbidities. Sleep problems in this population of infants seems to be a missing piece of the puzzle of impaired neurodevelopment. Future studies should focus on interventions to improve sleep hygiene and limit neurodevelopmental problems.
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18
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Kong AHT, Lai MM, Finnigan S, Ware RS, Boyd RN, Colditz PB. Background EEG features and prediction of cognitive outcomes in very preterm infants: A systematic review. Early Hum Dev 2018; 127:74-84. [PMID: 30340071 DOI: 10.1016/j.earlhumdev.2018.09.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/24/2018] [Accepted: 09/26/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVES Very preterm infants are at risk of cognitive impairment, but current capacity to predict at-risk infants is sub-optimal. Electroencephalography (EEG) has been used to assess brain function in development. This review investigates the relationship between EEG and cognitive outcomes in very preterm infants. METHODS Two reviewers independently conducted a literature search in April 2018 using PubMed, CINAHL, PsycINFO, Cochrane Library, Embase and Web of Science. Studies included very preterm infants (born ≤34 weeks gestational age, GA) who were assessed with EEG at ≤43 weeks postmenstrual age (PMA) and had cognitive outcomes assessed ≥3 months of age. Data on the subjects, EEG, cognitive assessment, and main findings were extracted. Meta-analysis was undertaken to calculate pooled sensitivity and specificity. RESULTS 31 studies (n = 4712 very preterm infants) met the inclusion criteria. The age of EEG, length of EEG recording, EEG features analysed, age at follow-up, and follow-up assessments were diverse. The included studies were then divided into categories based on their analysed EEG feature(s) for meta-analysis. Only one category had an adequate number of studies for meta-analysis: four papers (n = 255 very preterm infants) reporting dysmature/disorganised EEG patterns were meta-analysed and the pooled sensitivity and specificity for predicting cognitive outcomes were 0.63 (95% CI: 0.53-0.72) and 0.83 (95% CI: 0.74-0.89) respectively. CONCLUSIONS There is preliminary evidence that background EEG features can predict cognitive outcomes in very preterm infants. Reported findings were however too heterogeneous to determine which EEG features are best at predicting cognitive outcome.
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Affiliation(s)
- Annice H T Kong
- The University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia; The University of Queensland, Perinatal Research Centre, Faculty of Medicine, Brisbane, Australia.
| | - Melissa M Lai
- The University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia; The University of Queensland, Perinatal Research Centre, Faculty of Medicine, Brisbane, Australia
| | - Simon Finnigan
- The University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia; The University of Queensland, Perinatal Research Centre, Faculty of Medicine, Brisbane, Australia
| | - Robert S Ware
- Griffith University, Menzies Health Institute Queensland, Brisbane, Australia
| | - Roslyn N Boyd
- The University of Queensland, Perinatal Research Centre, Faculty of Medicine, Brisbane, Australia; Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Paul B Colditz
- The University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia; The University of Queensland, Perinatal Research Centre, Faculty of Medicine, Brisbane, Australia
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19
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Sun W, Li SX, Jiang Y, Xu X, Spruyt K, Zhu Q, Tseng CH, Jiang F. A Community-Based Study of Sleep and Cognitive Development in Infants and Toddlers. J Clin Sleep Med 2018; 14:977-984. [PMID: 29852903 DOI: 10.5664/jcsm.7164] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 03/06/2018] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To examine the prevalence and correlates of nighttime awakenings and to explore the association between sleep and cognitive development in a community sample of infants and toddlers. METHODS A total of 590 healthy infants (aged 2-11 months) and 512 toddlers (aged 12-30 months) from 8 provinces of China were assessed for their sleep and cognitive development. Data on sleep duration and nighttime awakenings were collected through the Brief Infant Sleep Questionnaire. Cognitive development was assessed by trained pediatricians using the Bayley Scales of Infant Development. RESULTS Prevalence of no nighttime awakening, and nighttime awakening(s) for 1×/night, 2×/night, and ≥ 3×/night was 6.8%, 20.2%, 33.2%, and 39.3% in infants, and was 25.8%, 34.6%, 23.8%, and 15.8% in toddlers, respectively. Nighttime awakenings were generally associated with younger age, lower maternal education level, and being currently breastfed. In addition, nighttime awakenings were associated with being boys in toddlers. After controlling for potential confounders, infants with nighttime awakenings for 2×/night were found to have significantly higher Mental Development Index (MDI) score, as compared to those without and those with more frequent nighttime awakenings. However, toddlers with nighttime awakenings for ≥ 3×/night had significantly lower MDI, as compared to those with fewer nighttime awakenings. Total sleep duration was not associated with any developmental indices in both infants and toddlers. CONCLUSIONS Frequent nighttime awakenings are associated with poor cognitive functions in toddlers. Meanwhile, a nonlinear association between nighttime awakenings and cognitive performance was found among infants. The findings provide a developmental context for the effect of sleep on cognitive abilities in young children. Further longitudinal studies and interventional studies on the effects of parent-based sleep-focused intervention on cognitive abilities among young children are warranted.
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Affiliation(s)
- Wanqi Sun
- Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, MOE-Shanghai Key Laboratory of Children's Environmental Health, Shanghai, China.,Sleep Research Clinic and Laboratory, Department of Psychology, The University of Hong Kong, Hong Kong
| | - Shirley Xin Li
- Sleep Research Clinic and Laboratory, Department of Psychology, The University of Hong Kong, Hong Kong.,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
| | - Yanrui Jiang
- Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, MOE-Shanghai Key Laboratory of Children's Environmental Health, Shanghai, China
| | - Xiaojuan Xu
- Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, MOE-Shanghai Key Laboratory of Children's Environmental Health, Shanghai, China
| | - Karen Spruyt
- Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, MOE-Shanghai Key Laboratory of Children's Environmental Health, Shanghai, China.,Laboratory of Integrative Physiology of Brain Arousal Systems, Center of Research in Neuroscience of Lyon, School of Medicine, Claude Bernard University, France
| | - Qi Zhu
- Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, MOE-Shanghai Key Laboratory of Children's Environmental Health, Shanghai, China
| | - Chia-Huei Tseng
- Research Institute of Electrical Communication, Tohoku University, Sendai, Japan
| | - Fan Jiang
- Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, MOE-Shanghai Key Laboratory of Children's Environmental Health, Shanghai, China
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20
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Inkelis SM, Thomas JD. Sleep in Infants and Children with Prenatal Alcohol Exposure. Alcohol Clin Exp Res 2018; 42:10.1111/acer.13803. [PMID: 29852534 PMCID: PMC6274610 DOI: 10.1111/acer.13803] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 05/22/2018] [Indexed: 01/12/2023]
Abstract
Prenatal exposure to alcohol can result in a range of neurobehavioral impairments and physical abnormalities. The term "fetal alcohol spectrum disorders (FASD)" encompasses the outcomes of prenatal alcohol exposure (PAE), the most severe of which is fetal alcohol syndrome. These effects have lifelong consequences, placing a significant burden on affected individuals, caregivers, and communities. Caregivers of affected children often report that their child has sleep problems, and many symptoms of sleep deprivation overlap with the cognitive and behavioral deficits characteristic of FASD. Alcohol-exposed infants and children demonstrate poor sleep quality based on measures of electroencephalography, actigraphy, and questionnaires. These sleep studies indicate a common theme of disrupted sleep pattern, more frequent awakenings, and reduced total sleep time. However, relatively little is known about circadian rhythm disruption and the neurobehavioral correlates of sleep disturbance in individuals with PAE. Furthermore, there is limited information available to healthcare providers about identification and treatment of sleep disorders in patients with FASD. This review consolidates the findings from studies of infant and pediatric sleep in this population, providing an overview of typical sleep characteristics, neurobehavioral correlates of sleep disruption, and potential avenues for intervention in the context of PAE.
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Affiliation(s)
- Sarah M Inkelis
- Center for Behavioral Teratology (SMI, JDT), San Diego State University, San Diego, California
| | - Jennifer D Thomas
- Center for Behavioral Teratology (SMI, JDT), San Diego State University, San Diego, California
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21
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Shellhaas RA, Burns JW, Hassan F, Carlson MD, Barks JDE, Chervin RD. Neonatal Sleep-Wake Analyses Predict 18-month Neurodevelopmental Outcomes. Sleep 2018; 40:4096871. [PMID: 28958087 DOI: 10.1093/sleep/zsx144] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Objectives The neurological examination of critically ill neonates is largely limited to reflexive behavior. The exam often ignores sleep-wake physiology that may reflect brain integrity and influence long-term outcomes. We assessed whether polysomnography and concurrent cerebral near-infrared spectroscopy (NIRS) might improve prediction of 18-month neurodevelopmental outcomes. Methods Term newborns with suspected seizures underwent standardized neurologic examinations to generate Thompson scores and had 12-hour bedside polysomnography with concurrent cerebral NIRS. For each infant, the distribution of sleep-wake stages and electroencephalogram delta power were computed. NIRS-derived fractional tissue oxygen extraction (FTOE) was calculated across sleep-wake stages. At age 18-22 months, surviving participants were evaluated with Bayley Scales of Infant Development (Bayley-III), 3rd edition. Results Twenty-nine participants completed Bayley-III. Increased newborn time in quiet sleep predicted worse 18-month cognitive and motor scores (robust regression models, adjusted r2 = 0.22, p = .007, and 0.27, .004, respectively). Decreased 0.5-2 Hz electroencephalograph (EEG) power during quiet sleep predicted worse 18-month language and motor scores (adjusted r2 = 0.25, p = .0005, and 0.33, .001, respectively). Predictive values remained significant after adjustment for neonatal Thompson scores or exposure to phenobarbital. Similarly, an attenuated difference in FTOE, between neonatal wakefulness and quiet sleep, predicted worse 18-month cognitive, language, and motor scores in adjusted analyses (each p < .05). Conclusions These prospective, longitudinal data suggest that inefficient neonatal sleep-as quantified by increased time in quiet sleep, lower electroencephalogram delta power during that stage, and muted differences in FTOE between quiet sleep and wakefulness-may improve prediction of adverse long-term outcomes for newborns with neurological dysfunction.
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Affiliation(s)
- Renée A Shellhaas
- Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI.,Sleep Disorders Center, University of Michigan, Ann Arbor, MI
| | - Joseph W Burns
- Michigan Tech Research Institute, Michigan Technological University, Ann Arbor, MI
| | - Fauziya Hassan
- Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI.,Sleep Disorders Center, University of Michigan, Ann Arbor, MI
| | - Martha D Carlson
- Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI
| | - John D E Barks
- Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI
| | - Ronald D Chervin
- Sleep Disorders Center, University of Michigan, Ann Arbor, MI.,Department of Neurology, University of Michigan, Ann Arbor, MI
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22
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Cohen E, Wong FY, Wallace EM, Mockler JC, Odoi A, Hollis S, Horne RSC, Yiallourou SR. EEG power spectrum maturation in preterm fetal growth restricted infants. Brain Res 2017; 1678:180-186. [PMID: 29050860 DOI: 10.1016/j.brainres.2017.10.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 09/03/2017] [Accepted: 10/08/2017] [Indexed: 01/23/2023]
Abstract
Power spectral analysis of the electroencephalogram (EEG) is a non-invasive method to examine infant brain maturation. Preterm fetal growth restricted (p-FGR) neonates display an altered EEG power spectrum compared to appropriate-for-gestational-age (AGA) peers, suggesting delayed brain maturation. Longitudinal studies investigating EEG power spectrum maturation in p-FGR infants are lacking, however. We thus aimed to investigate brain maturation using sleep EEG power spectral analysis in p-FGR infants compared to preterm and term AGA controls (p-AGA and t-AGA, respectively). EEG was recorded during spontaneous sleep in 13 p-FGR, 17 p-AGA and 19 t-AGA infants at 1 and 6 months post-term age. Infant sleep states (active and quiet sleep) were scored using standard criteria. Power spectral analysis of a single-channel EEG (C3-M2/C4-M1) was performed using Fast Fourier Transform. The EEG power spectrum was divided into delta (0.5-4 Hz), theta (4-8 Hz), alpha (8-12 Hz), sigma (12-14 Hz) and beta (14-30 Hz) frequency bands. Relative (%) powers and the spectral edge frequency were calculated. The spectral edge frequency was significantly higher in p-FGR infants compared to p-AGA controls in quiet sleep at 1 month post-term age (p < .01). This was due to significantly reduced %-delta and significantly increased %-theta, %-alpha and %-beta power (p < .01 for all) compared to p-AGA infants. p-FGR infants also showed significantly increased %-beta power compared to t-AGA infants (p < .05). No group differences were observed in active sleep or at 6 months post-term age. In conclusion, p-FGR infants show altered sleep EEG power spectrum maturation compared to AGA peers. However, changes resolved by 6 months post-term age.
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Affiliation(s)
- Emily Cohen
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics, Monash University, Level 5 Monash Children's Hospital, 246 Clayton Road, Clayton, Victoria 3168, Australia; Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center Utrecht and Utrecht University, PO Box 85090, 3508 AB Utrecht, The Netherlands
| | - Flora Y Wong
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics, Monash University, Level 5 Monash Children's Hospital, 246 Clayton Road, Clayton, Victoria 3168, Australia; Monash Newborn, Monash Health, Level 5 Monash Children's Hospital, 246 Clayton Road, Clayton, Victoria 3168, Australia
| | - Euan M Wallace
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Level 5 Monash Medical Centre, 246 Clayton Road, Clayton, Victoria 3168, Australia
| | - Joanne C Mockler
- Department of Obstetrics and Gynaecology, Monash University and Monash Women's, Monash Health, Level 5 Monash Medical Centre, 246 Clayton Road, Clayton, Victoria 3168, Australia
| | - Alexsandria Odoi
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics, Monash University, Level 5 Monash Children's Hospital, 246 Clayton Road, Clayton, Victoria 3168, Australia
| | - Samantha Hollis
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics, Monash University, Level 5 Monash Children's Hospital, 246 Clayton Road, Clayton, Victoria 3168, Australia
| | - Rosemary S C Horne
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics, Monash University, Level 5 Monash Children's Hospital, 246 Clayton Road, Clayton, Victoria 3168, Australia.
| | - Stephanie R Yiallourou
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics, Monash University, Level 5 Monash Children's Hospital, 246 Clayton Road, Clayton, Victoria 3168, Australia
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Dereymaeker A, Pillay K, Vervisch J, De Vos M, Van Huffel S, Jansen K, Naulaers G. Review of sleep-EEG in preterm and term neonates. Early Hum Dev 2017; 113:87-103. [PMID: 28711233 PMCID: PMC6342258 DOI: 10.1016/j.earlhumdev.2017.07.003] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Neonatal sleep is a crucial state that involves endogenous driven brain activity, important for neuronal survival and guidance of brain networks. Sequential EEG-sleep analysis in preterm infants provides insights into functional brain integrity and can document deviations of the biologically pre-programmed process of sleep ontogenesis during the neonatal period. Visual assessment of neonatal sleep-EEG, with integration of both cerebral and non-cerebral measures to better define neonatal state, is still considered the gold standard. Electrographic patterns evolve over time and are gradually time locked with behavioural characteristics which allow classification of quiet sleep and active sleep periods during the last 10weeks of gestation. Near term age, the neonate expresses a short ultradian sleep cycle, with two distinct active and quiet sleep, as well as brief periods of transitional or indeterminate sleep. Qualitative assessment of neonatal sleep is however challenged by biological and environmental variables that influence the expression of EEG-sleep patterns and sleep organization. Developing normative EEG-sleep data with the aid of automated analytic methods, can further improve our understanding of extra-uterine brain development and state organization under stressful or pathological conditions. Based on those developmental biomarkers of normal and abnormal brain function, research can be conducted to support and optimise sleep in the NICU, with the ultimate goal to improve therapeutic interventions and neurodevelopmental outcome.
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Affiliation(s)
- Anneleen Dereymaeker
- Department of Development and Regeneration, University Hospitals Leuven, Neonatal Intensive Care Unit, KU Leuven (University of Leuven), Leuven, Belgium.
| | - Kirubin Pillay
- Institute of Biomedical Engineering (IBME), Department of Engineering Science, University of Oxford, Oxford, United Kingdom..
| | - Jan Vervisch
- Department of Development and Regeneration, University Hospitals Leuven, Neonatal Intensive Care Unit, KU Leuven (University of Leuven), Leuven, Belgium; Department of Development and Regeneration, University Hospitals Leuven, Child Neurology, KU Leuven (University of Leuven), Leuven, Belgium.
| | - Maarten De Vos
- Institute of Biomedical Engineering (IBME), Department of Engineering Science, University of Oxford, Oxford, United Kingdom..
| | - Sabine Van Huffel
- KU Leuven (University of Leuven), Department of Electrical Engineering-ESAT, Division Stadius, Leuven, Belgium; Imec, Leuven, Belgium.
| | - Katrien Jansen
- Department of Development and Regeneration, University Hospitals Leuven, Neonatal Intensive Care Unit, KU Leuven (University of Leuven), Leuven, Belgium; Department of Development and Regeneration, University Hospitals Leuven, Child Neurology, KU Leuven (University of Leuven), Leuven, Belgium.
| | - Gunnar Naulaers
- Department of Development and Regeneration, University Hospitals Leuven, Neonatal Intensive Care Unit, KU Leuven (University of Leuven), Leuven, Belgium.
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24
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Dereymaeker A, Pillay K, Vervisch J, Van Huffel S, Naulaers G, Jansen K, De Vos M. An Automated Quiet Sleep Detection Approach in Preterm Infants as a Gateway to Assess Brain Maturation. Int J Neural Syst 2017; 27:1750023. [PMID: 28460602 PMCID: PMC6342251 DOI: 10.1142/s012906571750023x] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Sleep state development in preterm neonates can provide crucial information regarding functional brain maturation and give insight into neurological well being. However, visual labeling of sleep stages from EEG requires expertise and is very time consuming, prompting the need for an automated procedure. We present a robust method for automated detection of preterm sleep from EEG, over a wide postmenstrual age (PMA = gestational age + postnatal age) range, focusing first on Quiet Sleep (QS) as an initial marker for sleep assessment. Our algorithm, CLuster-based Adaptive Sleep Staging (CLASS), detects QS if it remains relatively more discontinuous than non-QS over PMA. CLASS was optimized on a training set of 34 recordings aged 27–42 weeks PMA, and performance then assessed on a distinct test set of 55 recordings of the same age range. Results were compared to visual QS labeling from two independent raters (with inter-rater agreement Kappa = 0. 93), using Sensitivity, Specificity, Detection Factor (DF = proportion of visual QS periods correctly detected by CLASS) and Misclassification Factor (MF = proportion of CLASS-detected QS periods that are misclassified). CLASS performance proved optimal across recordings at 31–38 weeks (median DF = 1.0, median MF 0–0.25, median Sensitivity 0.93–1.0, and median Specificity 0.80–0.91 across this age range), with minimal misclassifications at 35–36 weeks (median MF = 0). To illustrate the potential of CLASS in facilitating clinical research, normal maturational trends over PMA were derived from CLASS-estimated QS periods, visual QS estimates, and nonstate specific periods (containing QS and non-QS) in the EEG recording. CLASS QS trends agreed with those from visual QS, with both showing stronger correlations than nonstate specific trends. This highlights the benefit of automated QS detection for exploring brain maturation.
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Affiliation(s)
- Anneleen Dereymaeker
- 1 Department of Development and Regeneration, University Hospitals Leuven, Neonatal Intensive Care Unit, KU Leuven (University of Leuven), Leuven, Belgium
| | - Kirubin Pillay
- 2 Institute of Biomedical Engineering (IBME), Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Jan Vervisch
- 3 Department of Development and Regeneration, University Hospitals Leuven, Neonatal Intensive Care, Unit & Child Neurology, KU Leuven, (University of Leuven), Leuven, Belgium
| | - Sabine Van Huffel
- 4 Department of Electrical Engineering-ESAT, Division Stadius, KU Leuven (University of Leuven), Leuven, Belgium.,5 imec, Leuven, Belgium
| | - Gunnar Naulaers
- 1 Department of Development and Regeneration, University Hospitals Leuven, Neonatal Intensive Care Unit, KU Leuven (University of Leuven), Leuven, Belgium
| | - Katrien Jansen
- 3 Department of Development and Regeneration, University Hospitals Leuven, Neonatal Intensive Care, Unit & Child Neurology, KU Leuven, (University of Leuven), Leuven, Belgium
| | - Maarten De Vos
- 6 Institute of Biomedical Engineering (IBME), Department of Engineering Science, University of Oxford, Old Road Campus Research Building, OX3 7DG, Oxford, United Kingdom
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25
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Zhang L, Zhou Y, Li X, Cheng T. Hyperbilirubinemia Influences Sleep-Wake Cycles of Term Newborns in a Non-Linear Manner. PLoS One 2017; 12:e0169783. [PMID: 28072860 PMCID: PMC5224785 DOI: 10.1371/journal.pone.0169783] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 12/21/2016] [Indexed: 12/04/2022] Open
Abstract
Hyperbilirubinemia is a common cause for irreversible neuronal influence in the brain of term newborns, while the feature of neurological symptoms associated with hyperbilirubinemia has not been well characterized yet. In the present study, we examined a total of 203 neonates suffering from hyperbilirubinemia with a bedside amplitude-integrated Electroencephalography (aEEG) device, in order to determine whether there is any special change in sleep-wake cycles (SWCs). Among these patients, 14 cases showed no recognizable SWCs with the total serum bilirubin (TSB) level at 483.9–996.2 μmol/L; 75 cases exhibited reduced SWCs with the TSB level at 311.2–688.5 μmol/L; and the rest cases had the normal SWCs. The number of the normal SWCs occurrence had a significant negative correlation with the increased TSB level in a non-linear manner (r = -0.689, p <0.001). In addition, the increased TSB reshaped the structure of SWC by narrowing down the broadband and broadening the narrowband. Spearman’s correlation analysis indicated a significant negative correlation between the TSB level and the ratio of broadband (r = -0.618, p < 0.001), a significant positive correlation between the TSB level and the narrowband ratio (r = 0.618, p < 0.001), respectively. Furthermore, the change of SWC seemed like a continuous phenomenon, and the hyperbilirubinemia caused SWC changes was fit into a loess model in this paper. In summary, the hyperbilirubinemia influenced SWC of term newborns significantly at a non-linear manner, and these results revealed the feature of the neurological sequela that is associated with TSB.
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Affiliation(s)
- Lian Zhang
- Department of Neonatology, Guangzhou Women and Children’s Medical Center, Guangzhou, P. R. China
- * E-mail:
| | - Yanxia Zhou
- Department of Neurology, Guangzhou Women and Children’s Medical Center, Guangzhou, P. R. China
| | - Xufang Li
- Department of Neonatology, Guangzhou Women and Children’s Medical Center, Guangzhou, P. R. China
| | - Tingting Cheng
- Department of Neonatology, Guangzhou Women and Children’s Medical Center, Guangzhou, P. R. China
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Bennet L, Fyfe KL, Yiallourou SR, Merk H, Wong FY, Horne RSC. Discrimination of sleep states using continuous cerebral bedside monitoring (amplitude-integrated electroencephalography) compared to polysomnography in infants. Acta Paediatr 2016; 105:e582-e587. [PMID: 27659907 DOI: 10.1111/apa.13602] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 08/15/2016] [Accepted: 09/20/2016] [Indexed: 01/22/2023]
Abstract
AIM Limited two-channel electroencephalography (EEG) and amplitude-integrated EEG (aEEG) monitorings are being increasingly used; however, these measurements have not been compared with polysomnographic monitoring, the gold standard for determining infant sleep states. We aimed to determine the accuracy of two-channel EEG and aEEG recordings in defining sleep states and wakefulness in term infants compared to polysomnographic monitoring. METHODS Sleep was assessed in eight healthy term born infants (mean: 34 ± 3 days), using simultaneous polysomnography (Compumedics S-Series) and a two-channel EEG monitor (Brainz BRM2). EEG intensity, 90% spectral edge frequency (SEF), aEEG amplitude frequency bands were analysed in 30-second epochs during quiet sleep, active sleep and awake as determined by polysomnography. RESULTS BRM2-recorded EEG accurately identified quiet sleep from active sleep for EEG intensity (p = 0.003), SEF (p = 0.001) and aEEG amplitude (p = 0.003) and quiet sleep from awake, but not active sleep from awake. Frequency band analysis showed that wake could be identified by changes in absolute power (p = 0.015) and frequency as a percentage of total power (p = 0.03). CONCLUSION We demonstrate that limited two-channel EEG monitoring can distinguish quiet sleep from active sleep and may be suitable for investigating the development of sleep in infants in the neonatal intensive care setting.
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Affiliation(s)
- Laura Bennet
- Department of Physiology; Faculty of Medical and Health Sciences; The University of Auckland; Auckland New Zealand
| | - Karinna L. Fyfe
- The Ritchie Centre; Hudson Institute of Medical Research; Melbourne Victoria Australia
- The Department of Paediatrics; Monash University; Melbourne Victoria Australia
| | - Stephanie R. Yiallourou
- The Ritchie Centre; Hudson Institute of Medical Research; Melbourne Victoria Australia
- The Department of Paediatrics; Monash University; Melbourne Victoria Australia
| | - Henriette Merk
- The Ritchie Centre; Hudson Institute of Medical Research; Melbourne Victoria Australia
| | - Flora Y. Wong
- The Ritchie Centre; Hudson Institute of Medical Research; Melbourne Victoria Australia
- The Department of Paediatrics; Monash University; Melbourne Victoria Australia
| | - Rosemary S. C. Horne
- The Ritchie Centre; Hudson Institute of Medical Research; Melbourne Victoria Australia
- The Department of Paediatrics; Monash University; Melbourne Victoria Australia
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27
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Tomalski P, Moore DG, Ballieux H, Kushnerenko EV, Johnson MH, Karmiloff-Smith A. Separating the effects of ethnicity and socio-economic status on sleep practices of 6- to 7-month-old infants. LEARNING AND INDIVIDUAL DIFFERENCES 2016. [DOI: 10.1016/j.lindif.2015.12.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mitchell AW, Moore EM, Roberts EJ, Hachtel KW, Brown MS. Sensory processing disorder in children ages birth-3 years born prematurely: a systematic review. Am J Occup Ther 2015; 69:6901220030. [PMID: 25553748 DOI: 10.5014/ajot.2015.013755] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This systematic review of multidisciplinary literature synthesizes evidence of the prevalence and patterns of sensory processing disorder (SPD) in children ages birth-3 yr born preterm. Forty-five articles including physiological, behavioral, temperament, and SPD research met the inclusion criteria and provided 295 findings related to SPD-130 (44%) positive (evidence of SPD) and 165 (56%) negative (no evidence of SPD). The majority of findings related to sensory modulation disorder (SMD; 43% positive). The most prevalent subcategory of SMD was sensory overresponsivity (82% of findings positive). Evidence of sensory underresponsivity and sensory-seeking SMD, sensory discrimination disorder, and sensory-based motor disorder was limited. This study supports the education of neonatologists, pediatricians, and caregivers about the symptoms and potential consequences of SPD and helps justify the need for follow-up screening for SPD in children ages birth-3 yr born preterm. Research using measures based on sensory processing theory is needed.
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Affiliation(s)
- Anita Witt Mitchell
- Anita Witt Mitchell, PhD, OTR, is Associate Professor, Occupational Therapy Department, University of Tennessee Health Science Center, Memphis;
| | - Elizabeth M Moore
- Elizabeth M. Moore, MOT, OTR/L, is Occupational Therapist, Signature Healthcare at St. Francis, Memphis, TN; At the time of the study, Elizabeth Moore, Emily Roberts, Kristen Hachtel, and Melissa Brown were Students, Department of Occupational Therapy, University of Tennessee Health Science Center, Memphis, TN
| | - Emily J Roberts
- Emily J. Roberts, MOT, OTR/L, is Occupational Therapist, Regional One Health, Memphis, TN
| | - Kristen W Hachtel
- Kristen W. Hachtel, MOT, OTR/L, is Occupational Therapist, First Choice Speech and Occupational Therapy, Hernando, MS
| | - Melissa S Brown
- Melissa S. Brown, MOT, OTR/L, is Occupational Therapist, Methodist Healthcare South Hospital, Memphis, TN
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29
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Rioualen S, Roué JM, Lefranc J, Gouillou M, Nowak E, Alavi Z, Dubourg M, Sizun J. Actigraphy is not a reliable method for measuring sleep patterns in neonates. Acta Paediatr 2015; 104:e478-82. [PMID: 26081297 DOI: 10.1111/apa.13088] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 02/18/2015] [Accepted: 06/12/2015] [Indexed: 11/29/2022]
Abstract
AIM Polysomnography is the gold standard for studying sleep, but it is complex to use, and this can be problematic in clinically unstable preterm infants. We evaluated the reliability of actigraphy and polysomnography in detecting sleep-wake patterns in newborn infants. METHODS A prospective, monocentric study was conducted that measured the sleep patterns of 48 infants: 24 late preterm neonates born at 34-36 weeks of gestational age and 24 term neonates. We used both polysomnography and the Actiwatch Mini during a three-hour period and then compared the results from the two methods. RESULTS The baseline measurements for the preterm and terms groups were as follows: gestational age (34.5 weeks and 39.2 weeks), birthweight (2368 g and 3393 g) and age (6.4 days and 0.72 days). With the Actiwatch Mini, sensitivity for the late preterm and full-term infants was 78% and 87% for the leg actigraph and 78% and 93% for the arm actigraph. For specificity, the respective figures were 42% and 31% for the leg and 34% and 20% for the arm. CONCLUSION Actigraphy using the Actiwatch Mini was not a reliable method for measuring sleep patterns in healthy late preterm and term neonates a few days after birth.
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Affiliation(s)
- Stéphane Rioualen
- Pôle de la Femme de la Mère et de l'Enfant; CHRU Brest; Brest France
- Faculté de Médecine et des Sciences de la Santé; Université de Bretagne Occidentale; Brest France
| | - Jean-Michel Roué
- Pôle de la Femme de la Mère et de l'Enfant; CHRU Brest; Brest France
- Faculté de Médecine et des Sciences de la Santé; Université de Bretagne Occidentale; Brest France
| | - Jérémie Lefranc
- Pôle de la Femme de la Mère et de l'Enfant; CHRU Brest; Brest France
| | | | | | | | - Morgane Dubourg
- Pôle de la Femme de la Mère et de l'Enfant; CHRU Brest; Brest France
| | - Jacques Sizun
- Pôle de la Femme de la Mère et de l'Enfant; CHRU Brest; Brest France
- Faculté de Médecine et des Sciences de la Santé; Université de Bretagne Occidentale; Brest France
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Visscher MO, Lacina L, Casper T, Dixon M, Harmeyer J, Haberman B, Alberts J, Simakajornboon N. Conformational positioning improves sleep in premature infants with feeding difficulties. J Pediatr 2015; 166:44-8. [PMID: 25311708 DOI: 10.1016/j.jpeds.2014.09.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 08/27/2014] [Accepted: 09/08/2014] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To determine whether premature infants' sleep organization, total sleep time, and arousals may be modulated while on a conformational positioner that provides boundaries, customized positioning, and containment compared with standard positioning (standard crib mattress). STUDY DESIGN A proof of concept trial using a within subject crossover design was conducted among 25 premature infants with feeding difficulties. Infants of 31.5 weeks gestational age served as their own control during overnight polysomnography at postconceptual age 38.4 weeks. Each baby received both interventions (order randomized), 1 for each one-half of the 10.5-hour study. RESULTS Use of the conformational positioner resulted in higher sleep efficiency of 61% vs 54% for the standard mattress (P < .05). The interventions did not differ for percent active sleep, percent quiet sleep, percent indeterminate sleep, or spontaneous arousals. Sleep efficiency was higher on the conformational positioner than standard positioning for surgical subjects and for subjects with necrotizing enterocolitis or gastroschisis (n = 10). The surgical subjects (n = 9) had lower sleep efficiency, lower percentage of active sleep, and more spontaneous arousals compared with the nonsurgical group. CONCLUSIONS The use of the conformational positioner improved sleep efficiency vs the standard mattress in premature infants with feeding difficulties. Infants requiring surgery or with gastrointestinal diagnoses may be more susceptible to environmental stress.
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Affiliation(s)
- Marty O Visscher
- Newborn Intensive Care Unit, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Plastic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
| | - Linda Lacina
- Newborn Intensive Care Unit, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Tammy Casper
- Newborn Intensive Care Unit, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Melodie Dixon
- Newborn Intensive Care Unit, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Joann Harmeyer
- Newborn Intensive Care Unit, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Beth Haberman
- Newborn Intensive Care Unit, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Jeffrey Alberts
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN
| | - Narong Simakajornboon
- Newborn Intensive Care Unit, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Drury PP, Davidson JO, Mathai S, van den Heuij LG, Ji H, Bennet L, Tan S, Silverman RB, Gunn AJ. nNOS inhibition during profound asphyxia reduces seizure burden and improves survival of striatal phenotypic neurons in preterm fetal sheep. Neuropharmacology 2014; 83:62-70. [PMID: 24726307 DOI: 10.1016/j.neuropharm.2014.03.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 03/17/2014] [Accepted: 03/31/2014] [Indexed: 12/01/2022]
Abstract
Basal ganglia injury after hypoxia-ischemia remains common in preterm infants, and is closely associated with later cerebral palsy. In the present study we tested the hypothesis that a highly selective neuronal nitric oxide synthase (nNOS) inhibitor, JI-10, would improve survival of striatal phenotypic neurons after profound asphyxia, and that the subsequent seizure burden and recovery of EEG are associated with neural outcome. 24 chronically instrumented preterm fetal sheep were randomized to either JI-10 (3 ml of 0.022 mg/ml, n = 8) or saline (n = 8) infusion 15 min before 25 min complete umbilical cord occlusion, or saline plus sham-occlusion (n = 8). Umbilical cord occlusion was associated with reduced numbers of calbindin-28k-, GAD-, NPY-, PV-, Calretinin- and nNOS-positive striatal neurons (p < 0.05 vs. sham occlusion) but not ChAT-positive neurons. JI-10 was associated with increased numbers of calbindin-28k-, GAD-, nNOS-, NPY-, PV-, Calretinin- and ChAT-positive striatal neurons (p < 0.05 vs. saline + occlusion). Seizure burden was strongly associated with loss of calbindin-positive cells (p < 0.05), greater seizure amplitude was associated with loss of GAD-positive cells (p < 0.05), and with more activated microglia in the white matter tracts (p < 0.05). There was no relationship between EEG power after 7 days recovery and total striatal cell loss, but better survival of NPY-positive neurons was associated with lower EEG power. In summary, these findings suggest that selective nNOS inhibition during asphyxia is associated with protection of phenotypic striatal projection neurons and has potential to help reduce basal ganglia injury in some premature babies.
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Affiliation(s)
- Paul P Drury
- Department of Physiology, University of Auckland, Auckland, New Zealand
| | - Joanne O Davidson
- Department of Physiology, University of Auckland, Auckland, New Zealand
| | - Sam Mathai
- Department of Physiology, University of Auckland, Auckland, New Zealand
| | | | - Haitao Ji
- Department of Chemistry, Department of Molecular Biosciences, Chemistry of Life Processes Institute, Center for Molecular Innovation and Drug Discovery, Northwestern University, Evanston, IL 60208-3113, USA; Department of Chemistry, University of Utah, Salt Lake City, UT, USA
| | - Laura Bennet
- Department of Physiology, University of Auckland, Auckland, New Zealand
| | - Sidhartha Tan
- Department of Pediatrics, NorthShore University HealthSystem, Evanston, IL, USA
| | - Richard B Silverman
- Department of Chemistry, Department of Molecular Biosciences, Chemistry of Life Processes Institute, Center for Molecular Innovation and Drug Discovery, Northwestern University, Evanston, IL 60208-3113, USA
| | - Alistair J Gunn
- Department of Physiology, University of Auckland, Auckland, New Zealand.
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32
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Welch MG, Myers MM, Grieve PG, Isler JR, Fifer WP, Sahni R, Hofer MA, Austin J, Ludwig RJ, Stark RI. Electroencephalographic activity of preterm infants is increased by Family Nurture Intervention: a randomized controlled trial in the NICU. Clin Neurophysiol 2013; 125:675-684. [PMID: 24140072 DOI: 10.1016/j.clinph.2013.08.021] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 07/23/2013] [Accepted: 08/17/2013] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To assess the impact of Family Nurture Intervention (FNI) on electroencephalogram (EEG) activity in preterm infants (26-34 weeks gestation). METHODS Two groups were tested in a single, level IV neonatal intensive care unit (NICU; standard care or standard care plus FNI) using a randomized controlled trial design. The intervention consists of sessions designed to achieve mutual calm and promote communication of affect between infants and their mothers throughout the NICU stay. EEG recordings were obtained from 134 infants during sleep at ∼35 and ∼40 weeks postmenstrual age (PMA). Regional brain activity (power) was computed for 10 frequency bands between 1 and 48 Hz in each of 125 electrodes. RESULTS Near to term age, compared to standard care infants, FNI infants showed robust increases in EEG power in the frontal polar region at frequencies 10 to 48 Hz (20% to 36% with p-values <0.0004). Effects were significant in both quiet and active sleep, regardless of gender, singleton-twin status, gestational age (26-30 or 30-35 weeks) or birth weight (<1500 or >1500 g). CONCLUSION FNI leads to increased frontal brain activity during sleep, which other investigators find predictive of better neurobehavioral outcomes. SIGNIFICANCE FNI may be a practicable means of improving outcomes in preterm infants.
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Affiliation(s)
- Martha G Welch
- Department of Psychiatry, Columbia University College of Physicians & Surgeons, New York, NY 10032, USA; Department of Pediatrics, Columbia University College of Physicians & Surgeons, New York, NY 10032, USA; Department of Pathology & Cell Biology, Columbia University College of Physicians & Surgeons, New York, NY 10032, USA; Department of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY 10032, USA.
| | - Michael M Myers
- Department of Psychiatry, Columbia University College of Physicians & Surgeons, New York, NY 10032, USA; Department of Pediatrics, Columbia University College of Physicians & Surgeons, New York, NY 10032, USA; Department of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY 10032, USA
| | - Philip G Grieve
- Department of Pediatrics, Columbia University College of Physicians & Surgeons, New York, NY 10032, USA; Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA
| | - Joseph R Isler
- Department of Pediatrics, Columbia University College of Physicians & Surgeons, New York, NY 10032, USA
| | - William P Fifer
- Department of Psychiatry, Columbia University College of Physicians & Surgeons, New York, NY 10032, USA; Department of Pediatrics, Columbia University College of Physicians & Surgeons, New York, NY 10032, USA; Department of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY 10032, USA
| | - Rakesh Sahni
- Department of Pediatrics, Columbia University College of Physicians & Surgeons, New York, NY 10032, USA
| | - Myron A Hofer
- Department of Psychiatry, Columbia University College of Physicians & Surgeons, New York, NY 10032, USA; Department of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY 10032, USA
| | - Judy Austin
- Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Robert J Ludwig
- Department of Psychiatry, Columbia University College of Physicians & Surgeons, New York, NY 10032, USA
| | - Raymond I Stark
- Department of Pediatrics, Columbia University College of Physicians & Surgeons, New York, NY 10032, USA
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33
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Sajedi F, Ahmadlou M, Vameghi R, Gharib M, Hemmati S. Linear and nonlinear analysis of brain dynamics in children with cerebral palsy. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:1388-1396. [PMID: 23474991 DOI: 10.1016/j.ridd.2013.01.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Revised: 01/20/2013] [Accepted: 01/21/2013] [Indexed: 06/01/2023]
Abstract
This study was carried out to determine linear and nonlinear changes of brain dynamics and their relationships with the motor dysfunctions in CP children. For this purpose power of EEG frequency bands (as a linear analysis) and EEG fractality (as a nonlinear analysis) were computed in eyes-closed resting state and statistically compared between 26 CP and 26 normal children. Based on these characteristics accuracy of the classification between the two groups was obtained by enhanced probabilistic neural network (EPNN). Severity of gross motor and manual disabilities was determined by standard systems and the relation between the deficient brain dynamics and severity of the motor dysfunctions was obtained by Pearson's correlation coefficient. A definitely higher delta and lower theta and alpha powers, and higher EEG complexity in CP patients. As such a high accuracy of 94.8% in distinguishing the two groups was obtained. Moreover significant positive correlations were found between beta power and severity of manual disabilities and gross motor dysfunctions in the boys with CP. It is concluded that the obtained brain dynamics' characteristics are useful in diagnosis of CP. Furthermore severity of the motor dysfunctions in boys with CP could be evaluated by the beta activity.
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Affiliation(s)
- Firoozeh Sajedi
- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Williams IA, Tarullo AR, Grieve PG, Wilpers A, Vignola EF, Myers MM, Fifer WP. Fetal cerebrovascular resistance and neonatal EEG predict 18-month neurodevelopmental outcome in infants with congenital heart disease. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 40:304-9. [PMID: 22351034 PMCID: PMC3612978 DOI: 10.1002/uog.11144] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/08/2012] [Indexed: 05/21/2023]
Abstract
OBJECTIVES The purpose of this study was to investigate early markers of risk for neurobehavioral compromise in survivors with congenital heart disease (CHD). METHODS Pregnant women in whom a fetal CHD had been diagnosed before 24 weeks' gestational age (GA) were enrolled in this prospective pilot study for serial Doppler ultrasound assessment of the fetal middle cerebral artery (MCA) and umbilical arteries. The cerebral-to-placental resistance ratio (CPR) and MCA pulsatility index (PI) Z-scores for GA were calculated. After birth, subjects underwent high-density (128-lead) electroencephalography (EEG), and beta frequency (12-24 Hz) band EEG power, a measure of local neural synchrony, was analyzed. Neurodevelopment was assessed at 18 months with the Bayley Scales of Infant Development (BSID)-III. RESULTS Thirteen subjects were enrolled: four with hypoplastic left heart syndrome (HLHS), four with transposition of the great arteries (TGA) and five with tetralogy of Fallot (TOF). Compared with subjects with normal CPR, those with CPR < 1 (n = 7) had lower mean BSID cognitive scores (91.4 ± 4.8 vs. 99.2 ± 3.8, P = 0.008). Fetal MCA-PI Z-score also correlated with BSID cognitive score (r = 0.589, P = 0.03) as did neonatal EEG left frontal polar (r = 0.58, P = 0.037) and left frontal (r = 0.77, P = 0.002) beta power. Furthermore, fetal Doppler measures were associated with EEG power: fetuses with CPR < 1 had lower left frontal polar (t = 2.36, P = 0.038) and left frontal (t = 2.85, P = 0.016) beta power as newborns than did fetuses with normal CPR, and fetal MCA-PI Z-score correlated with neonatal EEG left frontal polar (r = 0.596, P = 0.04) and left frontal (r = 0.598, P = 0.04) beta power. CONCLUSION In fetuses with HLHS, TGA and TOF, abnormal cerebrovascular resistance predicts decreased neonatal EEG left frontal beta power and lower 18-month cognitive development scores.
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Affiliation(s)
- I A Williams
- Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, Department of Pediatrics, New York, NY 10032, USA.
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THIRIEZ GÉRARD, TOURNOUD MAUD, WERMENBOL VANESSA, VERMEYLEN DANIÈLE, ECOCHARD RENÉ, IWAZ JEAN, LIN JIANSHENG, FRANCO PATRICIA. Decreased spontaneous arousability in preterm newborns with impaired neurological outcome. J Sleep Res 2012. [DOI: 10.1111/j.1365-2869.2012.01004.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bayesian assessment of newborn brain maturity from two-channel sleep electroencephalograms. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2012; 2012:629654. [PMID: 22474536 PMCID: PMC3310217 DOI: 10.1155/2012/629654] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Accepted: 12/22/2011] [Indexed: 11/17/2022]
Abstract
Newborn brain maturity can be assessed by expert analysis of maturity-related patterns recognizable in polysomnograms. Since 36 weeks most of these patterns become recognizable in EEG exclusively, particularly, in EEG recorded via the two central-temporal channels. The use of such EEG recordings enables experts to minimize the disturbance of sleep, preparation time as well as the movement artifacts. We assume that the brain maturity of newborns aged 36 weeks and older can be automatically assessed from the 2-channel sleep EEG as accurately as by expert analysis of the full polysomnographic information. We use Bayesian inference to test this assumption and assist experts to obtain the full probabilistic information on the EEG assessments. The Bayesian methodology is feasibly implemented with Monte Carlo integration over areas of high posterior probability density, however the existing techniques tend to provide biased assessments in the absence of prior information required to explore a model space in detail within a reasonable time. In this paper we aim to use the posterior information about EEG features to reduce possible bias in the assessments. The performance of the proposed method is tested on a set of EEG recordings.
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Van den Bergh BR, Mulder EJ. Fetal sleep organization: A biological precursor of self-regulation in childhood and adolescence? Biol Psychol 2012; 89:584-90. [DOI: 10.1016/j.biopsycho.2012.01.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Revised: 11/19/2011] [Accepted: 01/05/2012] [Indexed: 10/14/2022]
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Olischar M, Davidson AJ, Lee KJ, Hunt RW. Effects of morphine and midazolam on sleep-wake cycling in amplitude-integrated electroencephalography in post-surgical neonates ≥ 32 weeks of gestational age. Neonatology 2012; 101:293-300. [PMID: 22286323 DOI: 10.1159/000334636] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Accepted: 10/08/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND Studies of children who undergo major non-cardiac surgery in the neonatal period are needed so that subsequent abnormal neurodevelopment can be better understood. OBJECTIVE It was the aim of our study to describe the influence of analgesic and sedative medication on the predominant background pattern and the development of sleep-wake cycling (SWC), as measured on amplitude-integrated electroencephalography (aEEG), in newborn infants born ≥ 32 weeks' gestation after major non-cardiac surgery. METHODS This prospective study included infants ≥ 32(+0) weeks' gestation admitted to the Neonatal Intensive Care Unit at The Royal Children's Hospital in Melbourne who were undergoing major non-cardiac surgery. Data on morphine and midazolam given after surgery were recorded and the BrainZ Monitor was applied post-operatively. The maximum levels of morphine and midazolam were assessed as predictors of time to aEEG outcomes using linear regression. RESULTS Forty-seven eligible infants were included. Emergence of SWC was observed at a mean of 13 h after surgery. The maximum dose of morphine or midazolam was not predictive of time to either any or developed SWC. CONCLUSIONS Despite high doses of morphine and midazolam, SWC was observed on aEEG in neonates ≥ 32 weeks' gestational age soon after major non-cardiac surgery. The aEEG background pattern was not affected by the maximum dose of either morphine or midazolam.
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Affiliation(s)
- Monika Olischar
- Department of Neonatology, University Children's Hospital, Vienna, Austria
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Guzzetta A, D'Acunto MG, Carotenuto M, Berardi N, Bancale A, Biagioni E, Boldrini A, Ghirri P, Maffei L, Cioni G. The effects of preterm infant massage on brain electrical activity. Dev Med Child Neurol 2011; 53 Suppl 4:46-51. [PMID: 21950394 DOI: 10.1111/j.1469-8749.2011.04065.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM Early intervention programmes based on the manipulation of the extra-uterine environment have been used in preterm infants with the aim of improving development and functional outcome. Infant massage, among them, has proved effective for weight gain and reduced length of stay in the neonatal intensive care unit. We have recently shown that infant massage accelerates brain maturation of low-risk preterm infants without brain abnormalities as measured by global parameters of electroencephalography (EEG) activity. In the present study we further analyse the same cohort of preterm infants, testing the hypothesis that massage determines changes in EEG spectral activity, a highly sensitive index of brain maturation. METHOD Infants were randomly allocated to a massage or comparison group. Intervention consisted of standard care only (comparison group) or standard care plus infant massage (massage group). Massage was started at around 10 days after birth and was provided for 12 days during a 2-week period. EEG was performed at around 1 and 4 weeks, i.e. before and after intervention. Spectral EEG analysis was performed on 80 seconds of active sleep, applying the fast Fourier transform on the signal obtained from eight monopolar derivations. RESULTS The modification in global EEG spectral power between the two assessments was significantly different for the two groups, especially for the delta band activity; the spectral power did not change in massaged infants although, not surprisingly, it decreased significantly in the comparison group, as shown by previous studies. INTERPRETATION We propose that massage intervention affects the maturation of brain electrical activity and favours a process more similar to that observed in utero in term infants.
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Affiliation(s)
- Andrea Guzzetta
- Department of Developmental Neuroscience, Stella Maris Scientific Institute, Pisa, Italy.
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Gomez RL, Newman-Smith KC, Breslin JH, Bootzin RR. Learning, Memory, and Sleep in Children. Sleep Med Clin 2011. [DOI: 10.1016/j.jsmc.2010.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Geiger A, Achermann P, Jenni OG. Sleep, intelligence and cognition in a developmental context: differentiation between traits and state-dependent aspects. PROGRESS IN BRAIN RESEARCH 2011; 185:167-79. [PMID: 21075239 DOI: 10.1016/b978-0-444-53702-7.00010-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This article addresses associations between sleep, cognition and intelligence in a developmental context and clarifies the terminology. Research must differentiate between aspects related to general underlying traits and those aspects that are characterized by state-dependent fluctuations.
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Affiliation(s)
- Anja Geiger
- Child Development Center, University Children's Hospital Zürich, Zürich, Switzerland
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Tsai SW, Chen CH, Lin MC. Prediction for developmental delay on Neonatal Oral Motor Assessment Scale in preterm infants without brain lesion. Pediatr Int 2010; 52:65-8. [PMID: 19400913 DOI: 10.1111/j.1442-200x.2009.02882.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Preterm infants often have difficulty in achieving a coordinated sucking pattern. To analyze the correlation between preterm infants with disorganized sucking and future development, weekly studies were performed of 27 preterm infants from initiation of bottle feeding until a normal sucking pattern was recognized. METHODS A total of 27 preterm infants without brain lesion participated in the present study. Neonatal Oral Motor Assessment Scale (NOMAS) was utilized to evaluate the sucking pattern. Infants who were initially assessed as having disorganized sucking on NOMAS and regained a normal sucking pattern by 37 weeks old were assigned to group I; infants with a persistent disorganized sucking pattern after 37 weeks were assigned to group II. The mental (MDI) and psychomotor (PDI) developmental indices of Bayley Scales of Infant Development, second edition were used for follow-up tests to demonstrate neurodevelopment at 6 months and 12 months of corrected age. RESULTS At 6 months follow up, subjects in group I had a significantly higher PDI score than group II infants (P= 0.04). At 12 months follow up, group I subjects had a significantly higher score on MDI (P= 0.03) and PDI (P= 0.04). There was also a higher rate for development delay in group II at 6 months (P= 0.05). CONCLUSION NOMAS-based assessment for neonatal feeding performance could be a helpful tool to predict neurodevelopmental outcome at 6 and 12 months. Close follow up and early intervention may be necessary for infants who present with a disorganized sucking pattern after 37 weeks post-conceptional age.
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Affiliation(s)
- Sen-Wei Tsai
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung, Taiwan
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Ednick M, Cohen AP, McPhail GL, Beebe D, Simakajornboon N, Amin RS. A review of the effects of sleep during the first year of life on cognitive, psychomotor, and temperament development. Sleep 2009; 32:1449-58. [PMID: 19928384 PMCID: PMC2768951 DOI: 10.1093/sleep/32.11.1449] [Citation(s) in RCA: 156] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
During the first year of life, infants spend most of their time in the sleeping state. Assessment of sleep during infancy presents an opportunity to study the impact of sleep on the maturation of the central nervous system (CNS), overall functioning, and future cognitive, psychomotor, and temperament development. To assess what is currently known regarding sleep during infancy and its effects on cognitive, psychomotor, and temperament development, we assessed the relevant literature published over the last several decades. To provide a foundation for a more in-depth understanding of this literature, we preface this with an overview of brain maturation, sleep development, and various assessment tools of both sleep and development during this unique period. At present, we do not have sufficient data to conclude that a causal relationship exists between infant sleep and cognitive, psychomotor, and temperament development. Caution should be used in predicting outcomes, as the timing and subjectivity of evaluations may obviate accurate assessment. Collectively, studies assess a wide array of sleep measures, and findings from one developmental period cannot be generalized readily to other developmental periods. Future studies should follow patients longitudinally. Additionally, refinements of existing assessment tools would be useful. In view of the relatively high reported pediatric prevalence of cognitive and behavioral deficits that carry significant long-term costs to individuals and society, early screening of sleep-related issues may be a useful tool to guide targeted prevention and early intervention.
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Affiliation(s)
- Mathew Ednick
- Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
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Lee SJ, Hatran DP, Tomimatsu T, Peña JP, McAuley G, Longo LD. Fetal cerebral blood flow, electrocorticographic activity, and oxygenation: responses to acute hypoxia. J Physiol 2009; 587:2033-47. [PMID: 19406885 DOI: 10.1113/jphysiol.2009.166983] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Arterial blood gases are critical in regulation of cerebral blood flow (CBF) and cerebral metabolic rate for O(2) (CMRO(2)). However, the relation of these variables to cortical tissue (t ), and electrocorticographic (ECoG) activity (high voltage low frequency, HVLF, versus low voltage high frequency, LVHF), are not well defined. In the fetus, we tested the hypothesis that ECoG pattern is associated closely with cerebral oxygenation. In fetal sheep (n = 8) with laser Doppler flowmeter, fluorescent O(2) probe and ECoG electrodes, we measured laser Doppler CBF (LD-CBF), tP(O2), ECoG and spectral edge frequency-90 (SEF(90)) in response to 40 min isocapnic hypoxia. In the normoxic fetus, LD-CBF and CMRO(2) correlated highly with ECoG state. With a shift from HVLF to LVHF, tP(O2) decreased followed by increased LD-CBF (18%) and CMRO(2) (13%). With acute hypoxia (P(aO2)= 12 +/- 1 Torr), tp(O2) decreased toapproximately 3 Torr, LD-CBF increased 48 +/- 10%, ECoG shifted to chiefly the HVLF state, SEF(90) decreased approximately 15%, and CMRO(2) decreased approximately 20% (P < 0.05 for each). For the normoxic fetus, CBF was closely related to ECoG state, but this association was less evident during acute hypoxia. We speculate that, in the otherwise stressed fetus, acute hypoxia may further compromise cerebral oxygenation.
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Affiliation(s)
- Stephen J Lee
- Center for Perinatal Biology, Department of Physiology, Loma Linda University, School of Medicine, Loma Linda, CA 92350, USA
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Piryatinska A, Terdik G, Woyczynski WA, Loparo KA, Scher MS, Zlotnik A. Automated detection of neonate EEG sleep stages. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2009; 95:31-46. [PMID: 19233504 DOI: 10.1016/j.cmpb.2009.01.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Revised: 12/17/2008] [Accepted: 01/08/2009] [Indexed: 05/27/2023]
Abstract
The paper integrates and adapts a range of advanced computational, mathematical and statistical tools for the purpose of analysis of neonate sleep stages based on extensive electroencephalogram (EEG) recordings. The level of brain dysmaturity of a neonate is difficult to assess by direct physical or cognitive examination, but dysmaturity is known to be directly related to the structure of neonatal sleep as reflected in the nonstationary time series produced by EEG signals which, importantly, can be collected trough a noninvasive procedure. In the past, the assessment of sleep EEG structure has often been done manually by experienced clinicians. The goal of this paper is to develop rigorous algorithmic tools for the same purpose by providing a formal scheme to separate different sleep stages corresponding to different stationary segments of the EEG signal based on statistical analysis of the spectral and nonlinear characteristics of the sleep EEG recordings. The methods developed in this paper can, potentially, be translated to other areas of biomedical research.
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Affiliation(s)
- Alexandra Piryatinska
- Department of Mathematics, San Francisco State University, San Francisco, CA 94132, United States.
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Grieve PG, Isler JR, Izraelit A, Peterson BS, Fifer WP, Myers MM, Stark RI. EEG functional connectivity in term age extremely low birth weight infants. Clin Neurophysiol 2008; 119:2712-20. [PMID: 18986834 DOI: 10.1016/j.clinph.2008.09.020] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2007] [Revised: 09/11/2008] [Accepted: 09/21/2008] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The hypothesis is tested that electrocortical functional connectivity (quantified by coherence) of extremely low birth weight (ELBW) infants, measured at term post-menstrual age, has regional differences from that of full term infants. METHODS 128 lead EEG data were collected during sleep from 8 ELBW infants with normal head ultrasound exams and 8 typically developing full term infants. Regional spectral power and coherence were calculated. RESULTS No significant regional differences in EEG power were found between infant groups. However, compared to term infants, ELBW infants had significantly reduced interhemispheric coherence (in frontal polar and parietal regions) and intrahemispheric coherence (between frontal polar and parieto-occipital regions) in the 1-12Hz band but increased interhemispheric coherence between occipital regions in the 24-50Hz band. CONCLUSIONS ELBW infants at term post-menstrual age manifest regional differences in EEG functional connectivity as compared to term infants. SIGNIFICANCE Distinctive spatial patterns of electrocortical synchrony are found in ELBW infants. These regional patterns may presage regional alterations in the structure of the cortex.
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The development of potentially better practices to support the neurodevelopment of infants in the NICU. J Perinatol 2007; 27 Suppl 2:S48-74. [PMID: 18034182 DOI: 10.1038/sj.jp.7211844] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To review the existing evidence used to identify potentially better care practices that support newborn brain development. STUDY DESIGN Literature review. RESULT Sixteen potentially better practices are identified and grouped into two operational clinical bundles based upon timing for recommended implementation. CONCLUSION Existing evidence supports the implementation of selected care practices that potentially may support newborn brain development.
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Scher MS. Ontogeny of EEG-sleep from neonatal through infancy periods. Sleep Med 2007; 9:615-36. [PMID: 18024172 DOI: 10.1016/j.sleep.2007.08.014] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2007] [Revised: 08/10/2007] [Accepted: 08/14/2007] [Indexed: 10/22/2022]
Abstract
Serial neonatal and infant electroencephalographic (EEG)-polysomnographic studies document the ontogeny of cerebral and noncerebral physiologic behaviors based on visual inspection or computer analyses. EEG patterns and their relationship to other physiologic signals serve as templates for normal brain organization and maturation, subserving multiple interconnected neuronal networks. Interpretation of serial EEG-sleep patterns also helps track the continuity of brain functions from intrauterine to extrauterine time periods. Recognition of the ontogeny of behavioral and electrographic patterns provides insight into the developmental neurophysiological expression of neural plasticity. Sleep ontogenesis from neonatal and infancy periods documents expected patterns of postnatal brain maturation, which allows for alterations from genetically programmed neuronal processes under stressful and/or pathological conditions. Automated analyses of cerebral and noncerebral signals provide time- and frequency-dependent computational phenotypes of brain organization and maturation in healthy or diseased states. Research pertaining to the developmental origins of health and disease can use these computational phenotypes to design longitudinal studies for the assessment of gene-environment interactions. Computational strategies may ultimately improve our diagnostic skills to identify special-needs children and to track the neurorehabilitative care of the high-risk fetus, neonate, and infant.
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Affiliation(s)
- Mark S Scher
- Division of Pediatric Neurology, Laboratory for Computational Neuroscience, Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH 44106-6090, USA.
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Milh M, Kaminska A, Huon C, Lapillonne A, Ben-Ari Y, Khazipov R. Rapid Cortical Oscillations and Early Motor Activity in Premature Human Neonate. Cereb Cortex 2006; 17:1582-94. [PMID: 16950867 DOI: 10.1093/cercor/bhl069] [Citation(s) in RCA: 191] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Delta-brush is the dominant pattern of rapid oscillatory activity (8-25 Hz) in the human cortex during the third trimester of gestation. Here, we studied the relationship between delta-brushes in the somatosensory cortex and spontaneous movements of premature human neonates of 29-31 weeks postconceptional age using a combination of scalp electroencephalography and monitoring of motor activity. We found that sporadic hand and foot movements heralded the appearance of delta-brushes in the corresponding areas of the cortex (lateral and medial regions of the contralateral central cortex, respectively). Direct hand and foot stimulation also reliably evoked delta-brushes in the same areas. These results suggest that sensory feedback from spontaneous fetal movements triggers delta-brush oscillations in the central cortex in a somatotopic manner. We propose that in the human fetus in utero, before the brain starts to receive elaborated sensory input from the external world, spontaneous fetal movements provide sensory stimulation and drive delta-brush oscillations in the developing somatosensory cortex contributing to the formation of cortical body maps.
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Affiliation(s)
- Mathieu Milh
- INMED/INSERM U29, Université de la Méditerranée, Marseille, France
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