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Ansari A, Pillay K, Arasteh E, Dereymaeker A, Mellado GS, Jansen K, Winkler AM, Naulaers G, Bhatt A, Huffel SV, Hartley C, Vos MD, Slater R, Baxter L. Resting state electroencephalographic brain activity in neonates can predict age and is indicative of neurodevelopmental outcome. Clin Neurophysiol 2024; 163:226-235. [PMID: 38797002 PMCID: PMC11250083 DOI: 10.1016/j.clinph.2024.05.002] [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: 11/10/2023] [Revised: 05/01/2024] [Accepted: 05/04/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVE Electroencephalography (EEG) can be used to estimate neonates' biological brain age. Discrepancies between postmenstrual age and brain age, termed the brain age gap, can potentially quantify maturational deviation. Existing brain age EEG models are not well suited to clinical cot-side use for estimating neonates' brain age gap due to their dependency on relatively large data and pre-processing requirements. METHODS We trained a deep learning model on resting state EEG data from preterm neonates with normal neurodevelopmental Bayley Scale of Infant and Toddler Development (BSID) outcomes, using substantially reduced data requirements. We subsequently tested this model in two independent datasets from two clinical sites. RESULTS In both test datasets, using only 20 min of resting-state EEG activity from a single channel, the model generated accurate age predictions: mean absolute error = 1.03 weeks (p-value = 0.0001) and 0.98 weeks (p-value = 0.0001). In one test dataset, where 9-month follow-up BSID outcomes were available, the average neonatal brain age gap in the severe abnormal outcome group was significantly larger than that of the normal outcome group: difference in mean brain age gap = 0.50 weeks (p-value = 0.04). CONCLUSIONS These findings demonstrate that the deep learning model generalises to independent datasets from two clinical sites, and that the model's brain age gap magnitudes differ between neonates with normal and severe abnormal follow-up neurodevelopmental outcomes. SIGNIFICANCE The magnitude of neonates' brain age gap, estimated using only 20 min of resting state EEG data from a single channel, can encode information of clinical neurodevelopmental value.
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Affiliation(s)
- Amir Ansari
- Department of Electrical Engineering (ESAT), STADIUS Center for Dynamical Systems, Signal Processing and Data Analytics, KU Leuven, Leuven, Belgium
| | - Kirubin Pillay
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - Emad Arasteh
- Department of Electrical Engineering (ESAT), STADIUS Center for Dynamical Systems, Signal Processing and Data Analytics, KU Leuven, Leuven, Belgium; Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Anneleen Dereymaeker
- Department of Development and Regeneration, University Hospitals Leuven, Neonatal Intensive Care Unit, KU Leuven, Leuven, Belgium
| | | | - Katrien Jansen
- Department of Development and Regeneration, University Hospitals Leuven, Neonatal Intensive Care Unit, KU Leuven, Leuven, Belgium; Department of Development and Regeneration, University Hospitals Leuven, Child Neurology, KU Leuven, Leuven, Belgium
| | - Anderson M Winkler
- Department of Human Genetics, University of Texas Rio Grande Valley, Brownsville, TX, USA
| | - Gunnar Naulaers
- Department of Development and Regeneration, University Hospitals Leuven, Neonatal Intensive Care Unit, KU Leuven, Leuven, Belgium
| | - Aomesh Bhatt
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - Sabine Van Huffel
- Department of Electrical Engineering (ESAT), STADIUS Center for Dynamical Systems, Signal Processing and Data Analytics, KU Leuven, Leuven, Belgium
| | | | - Maarten De Vos
- Department of Electrical Engineering (ESAT), STADIUS Center for Dynamical Systems, Signal Processing and Data Analytics, KU Leuven, Leuven, Belgium; Department of Development and Regeneration, University Hospitals Leuven, Child Neurology, KU Leuven, Leuven, Belgium
| | | | - Luke Baxter
- Department of Paediatrics, University of Oxford, Oxford, UK.
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Abbasi SF, Abbas A, Ahmad I, Alshehri MS, Almakdi S, Ghadi YY, Ahmad J. Automatic neonatal sleep stage classification: A comparative study. Heliyon 2023; 9:e22195. [PMID: 38058619 PMCID: PMC10695968 DOI: 10.1016/j.heliyon.2023.e22195] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 09/21/2023] [Accepted: 11/06/2023] [Indexed: 12/08/2023] Open
Abstract
Sleep is an essential feature of living beings. For neonates, it is vital for their mental and physical development. Sleep stage cycling is an important parameter to assess neonatal brain and physical development. Therefore, it is crucial to administer newborn's sleep in the neonatal intensive care unit (NICU). Currently, Polysomnography (PSG) is used as a gold standard method for classifying neonatal sleep patterns, but it is expensive and requires a lot of human involvement. Over the last two decades, multiple researchers are working on automatic sleep stage classification algorithms using electroencephalography (EEG), electrocardiography (ECG), and video. In this study, we present a comprehensive review of existing algorithms for neonatal sleep, their limitations and future recommendations. Additionally, a brief comparison of the extracted features, classification algorithms and evaluation parameters is reported in the proposed study.
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Affiliation(s)
- Saadullah Farooq Abbasi
- Department of Electronic, Electrical and System Engineering, University of Birmingham, Birmingham, United Kingdom
| | - Awais Abbas
- Department of Electronic, Electrical and System Engineering, University of Birmingham, Birmingham, United Kingdom
| | - Iftikhar Ahmad
- James Watt School of Engineering, University of Glasgow, United Kingdom
| | - Mohammed S. Alshehri
- Department of Computer Science, College of Computer Science and Information Systems, Najran University, Najran, Saudi Arabia
| | - Sultan Almakdi
- Department of Computer Science, College of Computer Science and Information Systems, Najran University, Najran, Saudi Arabia
| | - Yazeed Yasin Ghadi
- Department of Computer Science, Al Ain University, Abu Dhabi P.O. Box 112612, United Arab Emirates
| | - Jawad Ahmad
- School of Computing, Engineering and the Built Environment, Edinburgh Napier University, Edinburgh EH10 5DT, UK
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Nilsson S, Tokariev A, Metsäranta M, Norman E, Vanhatalo S. A Bedside Method for Measuring Effects of a Sedative Drug on Cerebral Function in Newborn Infants. SENSORS (BASEL, SWITZERLAND) 2022; 23:444. [PMID: 36617042 PMCID: PMC9823798 DOI: 10.3390/s23010444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/23/2022] [Accepted: 12/29/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Data on the cerebral effects of analgesic and sedative drugs are needed for the development of safe and effective treatments during neonatal intensive care. Electroencephalography (EEG) is an objective, but interpreter-dependent method for monitoring cortical activity. Quantitative computerized analyses might reveal EEG changes otherwise not detectable. METHODS EEG registrations were retrospectively collected from 21 infants (mean 38.7 gestational weeks; range 27-42) who received dexmedetomidine during neonatal care. The registrations were transformed into computational features and analyzed visually, and with two computational measures quantifying relative and absolute changes in power (range EEG; rEEG) and cortico-cortical synchrony (activation synchrony index; ASI), respectively. RESULTS The visual assessment did not reveal any drug effects. In rEEG analyses, a negative correlation was found between the baseline and the referential frontal (rho = 0.612, p = 0.006) and parietal (rho = -0.489, p = 0.035) derivations. The change in ASI was negatively correlated to baseline values in the interhemispheric (rho = -0.753; p = 0.001) and frontal comparisons (rho = -0.496; p = 0.038). CONCLUSION Cerebral effects of dexmedetomidine as determined by EEG in newborn infants are related to cortical activity prior to DEX administration, indicating that higher brain activity levels (higher rEEG) during baseline links to a more pronounced reduction by DEX. The computational measurements indicate drug effects on both overall cortical activity and cortico-cortical communication. These effects were not evident in visual analysis.
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Affiliation(s)
- Sofie Nilsson
- Pediatrics, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, 22185 Lund, Sweden
| | - Anton Tokariev
- BABA Center, Departments of Pediatrics and Clinical Neurophysiology, Children’s Hospital, Helsinki University Hospital Helsinki, 00029 Helsinki, Finland
| | - Marjo Metsäranta
- Department of Pediatrics, Helsinki University Hospital, University of Helsinki, 00029 Helsinki, Finland
| | - Elisabeth Norman
- Pediatrics, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, 22185 Lund, Sweden
| | - Sampsa Vanhatalo
- BABA Center, Departments of Pediatrics and Clinical Neurophysiology, Children’s Hospital, Helsinki University Hospital Helsinki, 00029 Helsinki, Finland
- Department of Physiology, University of Helsinki, 00014 Helsinki, Finland
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4
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Morris EE, Howell MJ, Pickup E, Iber C, Wang SG. Pediatric sleep and pain: etiologies, consequences, and clinical considerations. J Clin Sleep Med 2022; 18:2281-2289. [PMID: 35499282 PMCID: PMC9435332 DOI: 10.5664/jcsm.10008] [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: 11/03/2021] [Revised: 03/31/2022] [Accepted: 03/31/2022] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To examine current evidence of the relationship between sleep and pain from the neonatal period through adolescence. This review serves as a critical review of the literature and of the needs for future research on pediatric sleep and pain. METHODS The PubMed online database was queried from January 1, 1960, to March 1, 2020, producing 149 articles applicable to pain and sleep in the pediatric population. Of those, 97 articles were cited in this review with the key articles including over 3800 participants. RESULTS The pediatric literature supports the relationship between poor sleep (both sleep efficiency and nighttime awakenings) and subsequent risk for pain, especially among children with chronic disease. The reverse effect of pain on sleep is not yet well delineated. The key moderating factors explored in the literature are pharmacologic and nonpharmacologic therapies, psychologic health, and the etiology of pain. There is evidence that both altered sleep and pain early in life impact neurodevelopment, as seen by changes in sleep structure in clinical studies and alterations in brain development in animal models. CONCLUSIONS The complicated relationship between sleep and pain is critically important during pediatric development when alterations to a normal sleep structure can have a lifelong impact. It is becoming clear that sleep deprivation and poor sleep quality exacerbate pain. Further research is needed into the complex alterations of sleep in chronic pain conditions as well as treatments to improve sleep in pediatric care. CITATION Morris EE, Howell MJ, Pickup E, Iber C, Wang SG. Pediatric sleep and pain: etiologies, consequences, and clinical considerations. J Clin Sleep Med. 2022;18(9):2281-2289.
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Affiliation(s)
- Erin E. Morris
- Department of Pediatrics, University of Minnesota–Twin Cities, Minneapolis, Minnesota
| | - Michael J. Howell
- Department of Neurology, University of Minnesota–Twin Cities, Minneapolis, Minnesota
| | - Elizabeth Pickup
- Pediatric Neurology, Children’s National Hospital, Washington, DC
| | - Conrad Iber
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota–Twin Cities, Minneapolis, Minnesota
| | - Sonya G. Wang
- Department of Pediatrics, University of Minnesota–Twin Cities, Minneapolis, Minnesota
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Xue B, Alipio JB, Kao JPY, Kanold PO. Perinatal Opioid Exposure Results in Persistent Hypoconnectivity of Excitatory Circuits and Reduced Activity Correlations in Mouse Primary Auditory Cortex. J Neurosci 2022; 42:3676-3687. [PMID: 35332087 PMCID: PMC9053845 DOI: 10.1523/jneurosci.2542-21.2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/21/2022] [Accepted: 03/14/2022] [Indexed: 11/21/2022] Open
Abstract
Opioid use by pregnant women results in neonatal opioid withdrawal syndrome (NOWS) and lifelong neurobehavioral deficits including language impairments. Animal models of NOWS show impaired performance in a two-tone auditory discrimination task, suggesting abnormalities in sensory processing in the auditory cortex. To investigate the consequences of perinatal opioid exposure on auditory cortex circuits, we administered fentanyl to mouse dams in their drinking water throughout gestation and until litters were weaned at postnatal day (P)21. We then used in vivo two-photon Ca2+ imaging in adult animals of both sexes to investigate how primary auditory cortex (A1) function was altered. Perinatally exposed animals showed fewer sound-responsive neurons in A1, and the remaining sound-responsive cells exhibited lower response amplitudes but normal frequency selectivity and stimulus-specific adaptation (SSA). Populations of nearby layer 2/3 (L2/3) cells in exposed animals showed reduced correlated activity, suggesting a reduction of shared inputs. We then investigated A1 microcircuits to L2/3 cells by performing laser-scanning photostimulation (LSPS) combined with whole-cell patch-clamp recordings from A1 L2/3 cells. L2/3 cells in exposed animals showed functional hypoconnectivity of excitatory circuits of ascending inputs from L4 and L5/6 to L2/3, while inhibitory connections were unchanged, leading to an altered excitatory/inhibitory balance. These results suggest a specific reduction in excitatory ascending interlaminar cortical circuits resulting in decreased activity correlations after fentanyl exposure. We speculate that these changes in cortical circuits contribute to the impaired auditory discrimination ability after perinatal opioid exposure.SIGNIFICANCE STATEMENT This is the first study to investigate the functional effects of perinatal fentanyl exposure on the auditory cortex. Experiments show that perinatal fentanyl exposure results in decreased excitatory functional circuits and altered population activity in primary sensory areas in adult mice. These circuit changes might underlie the observed language and cognitive deficits in infants exposed to opioids.
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Affiliation(s)
- Binghan Xue
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland 20215
- Department of Biology, University of Maryland, College Park, Maryland 20742
| | - Jason B Alipio
- Department of Anatomy and Neurobiology, Program in Neuroscience, University of Maryland School of Medicine, Baltimore, Maryland 21201
| | - Joseph P Y Kao
- Center for Biomedical Engineering and Technology, and Department of Physiology, University of Maryland School of Medicine, Baltimore, Maryland 21201
| | - Patrick O Kanold
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland 20215
- Department of Biology, University of Maryland, College Park, Maryland 20742
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van 't Westende C, Geraedts VJ, van Ramesdonk T, Dudink J, Schoonmade LJ, van der Knaap MS, Stam CJ, van de Pol LA. Neonatal quantitative electroencephalography and long-term outcomes: a systematic review. Dev Med Child Neurol 2022; 64:413-420. [PMID: 34932822 DOI: 10.1111/dmcn.15133] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 10/22/2021] [Accepted: 11/08/2021] [Indexed: 11/29/2022]
Abstract
AIM To evaluate quantitative electroencephalogram (EEG) measures as predictors of long-term neurodevelopmental outcome in infants with a postconceptional age below 46 weeks, including typically developing infants born at term, infants with heterogeneous underlying pathologies, and infants born preterm. METHOD A comprehensive search was performed using PubMed, Embase, and Web of Science from study inception up to 8th January 2021. Studies that examined associations between neonatal quantitative EEG measures, based on conventional and amplitude-integrated EEG, and standardized neurodevelopmental outcomes at 2 years of age or older were reviewed. Significant associations between neonatal quantitative EEG and long-term outcome measures were grouped into one or more of the following categories: cognitive outcome; motor outcome; composite scores; and other standardized outcome assessments. RESULTS Twenty-four out of 1740 studies were included. Multiple studies showed that conventional EEG-based absolute power in the delta, theta, alpha, and beta frequency bands and conventional and amplitude-integrated EEG-related amplitudes were positively associated with favourable long-term outcome across several domains, including cognition and motor performance. Furthermore, a lower presence of discontinuous background pattern was also associated with favourable outcomes. However, interpretation of the results is limited by heterogeneity in study design and populations. INTERPRETATION Neonatal quantitative EEG measures may be used as prognostic biomarkers to identify those infants who will develop long-term difficulties and who might benefit from early interventions.
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Affiliation(s)
- Charlotte van 't Westende
- Department of Child Neurology, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Department of Clinical Neurophysiology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Victor J Geraedts
- Departments of Neurology and Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Tino van Ramesdonk
- Department of Child Neurology, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Jeroen Dudink
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Marjo S van der Knaap
- Department of Child Neurology, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Department of Functional Genomics, Center for Neurogenomics and Cognitive Research, Amsterdam Neuroscience, VU University Amsterdam, Amsterdam, the Netherlands
| | - Cornelis J Stam
- Department of Clinical Neurophysiology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Laura A van de Pol
- Department of Child Neurology, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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Cortes-Ledesma C, Arruza L, Sainz-Villamayor A, Martínez-Orgado J. Dexmedetomidine affects cerebral activity in preterm infants. Arch Dis Child Fetal Neonatal Ed 2022; 108:316-318. [PMID: 35288449 DOI: 10.1136/archdischild-2021-323411] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 02/25/2022] [Indexed: 11/04/2022]
Abstract
The use of dexmedetomidine (DEX) has been extended in preterm newborns, but the effects on cerebral activity and their relationship with haemodynamic changes has not been studied.We retrospectively studied the effects of DEX administered to 10 preterm newborns, assessing amplitude-integrated EEG (aEEG) parameters, brain regional SO2 (brSO2), heart rate, non-invasive mean blood pressure (MBP), transcutaneous oxygen saturation (SpO2), venous pCO2 and haemoglobin (Hb) values, in two 6-hour periods: one starting 6 hours before the beginning of DEX perfusion and the other 6 hours afterwards.DEX infusion led to brSO2 decrease not associated to heart rate, MBP, SpO2, Hb or pCO2 variation, which suggests that brSO2 decrease could be related to local vasoconstriction. DEX infusion led to prolongation of interburst interval and reduction of cycling. Such effects, not been described so far, should be considered in the assessment of aEEG traces after DEX administration to avoid misinterpretations regarding patient's prognosis. More studies are needed to assess the safety of DEX use in the newborn.
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Affiliation(s)
- Cristina Cortes-Ledesma
- Division of Neonatology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
| | - Luis Arruza
- Division of Neonatology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
| | - Angela Sainz-Villamayor
- Division of Neonatology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
| | - José Martínez-Orgado
- Division of Neonatology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
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8
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Martini FJ, Guillamón-Vivancos T, Moreno-Juan V, Valdeolmillos M, López-Bendito G. Spontaneous activity in developing thalamic and cortical sensory networks. Neuron 2021; 109:2519-2534. [PMID: 34293296 DOI: 10.1016/j.neuron.2021.06.026] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 05/05/2021] [Accepted: 06/23/2021] [Indexed: 11/19/2022]
Abstract
Developing sensory circuits exhibit different patterns of spontaneous activity, patterns that are related to the construction and refinement of functional networks. During the development of different sensory modalities, spontaneous activity originates in the immature peripheral sensory structures and in the higher-order central structures, such as the thalamus and cortex. Certainly, the perinatal thalamus exhibits spontaneous calcium waves, a pattern of activity that is fundamental for the formation of sensory maps and for circuit plasticity. Here, we review our current understanding of the maturation of early (including embryonic) patterns of spontaneous activity and their influence on the assembly of thalamic and cortical sensory networks. Overall, the data currently available suggest similarities between the developmental trajectory of brain activity in experimental models and humans, which in the future may help to improve the early diagnosis of developmental disorders.
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Affiliation(s)
- Francisco J Martini
- Instituto de Neurociencias de Alicante, Universidad Miguel Hernández-Consejo Superior de Investigaciones Científicas (UMH-CSIC), Sant Joan d'Alacant, Spain.
| | - Teresa Guillamón-Vivancos
- Instituto de Neurociencias de Alicante, Universidad Miguel Hernández-Consejo Superior de Investigaciones Científicas (UMH-CSIC), Sant Joan d'Alacant, Spain
| | - Verónica Moreno-Juan
- Instituto de Neurociencias de Alicante, Universidad Miguel Hernández-Consejo Superior de Investigaciones Científicas (UMH-CSIC), Sant Joan d'Alacant, Spain
| | - Miguel Valdeolmillos
- Instituto de Neurociencias de Alicante, Universidad Miguel Hernández-Consejo Superior de Investigaciones Científicas (UMH-CSIC), Sant Joan d'Alacant, Spain
| | - Guillermina López-Bendito
- Instituto de Neurociencias de Alicante, Universidad Miguel Hernández-Consejo Superior de Investigaciones Científicas (UMH-CSIC), Sant Joan d'Alacant, Spain.
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Basu SK, Pradhan S, du Plessis AJ, Ben-Ari Y, Limperopoulos C. GABA and glutamate in the preterm neonatal brain: In-vivo measurement by magnetic resonance spectroscopy. Neuroimage 2021; 238:118215. [PMID: 34058332 PMCID: PMC8404144 DOI: 10.1016/j.neuroimage.2021.118215] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/30/2021] [Accepted: 05/25/2021] [Indexed: 12/11/2022] Open
Abstract
Cognitive and behavioral disabilities in preterm infants, even without obvious brain injury on conventional neuroimaging, underscores a critical need to identify the subtle underlying microstructural and biochemical derangements. The gamma-aminobutyric acid (GABA) and glutamatergic neurotransmitter systems undergo rapid maturation during the crucial late gestation and early postnatal life, and are at-risk of disruption after preterm birth. Animal and human autopsy studies provide the bulk of current understanding since non-invasive specialized proton magnetic resonance spectroscopy (1H-MRS) to measure GABA and glutamate are not routinely available for this vulnerable population due to logistical and technical challenges. We review the specialized 1H-MRS techniques including MEscher-GArwood Point Resolved Spectroscopy (MEGA-PRESS), special challenges and considerations needed for interpretation of acquired data from the developing brain of preterm infants. We summarize the limited in-vivo preterm data, highlight the gaps in knowledge, and discuss future directions for optimal integration of available in-vivo approaches to understand the influence of GABA and glutamate on neurodevelopmental outcomes after preterm birth.
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Affiliation(s)
- Sudeepta K Basu
- Neonatology, Children's National Hospital, Washington, D.C., United States; Center for the Developing Brain, Children's National Hospital, Washington, D.C., United States; Division of Neurology, Children's National Hospital, Washington, D.C., United States; The George Washington University School of Medicine, Washington, D.C., United States
| | - Subechhya Pradhan
- Center for the Developing Brain, Children's National Hospital, Washington, D.C., United States; Division of Neurology, Children's National Hospital, Washington, D.C., United States; The George Washington University School of Medicine, Washington, D.C., United States
| | - Adre J du Plessis
- Fetal Medicine institute, Children's National Hospital, Washington, D.C., United States; Division of Neurology, Children's National Hospital, Washington, D.C., United States; The George Washington University School of Medicine, Washington, D.C., United States
| | - Yehezkel Ben-Ari
- Division of Neurology, Children's National Hospital, Washington, D.C., United States; Neurochlore, Marseille, France
| | - Catherine Limperopoulos
- Center for the Developing Brain, Children's National Hospital, Washington, D.C., United States; Division of Diagnostic Imaging and Radiology, Children's National Hospital, Washington, D.C., United States; Division of Neurology, Children's National Hospital, Washington, D.C., United States; The George Washington University School of Medicine, Washington, D.C., United States.
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10
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Sepúlveda PO, Epulef V, Campos G. Why do We Use the Concepts of Adult Anesthesia Pharmacology in Developing Brains? Will It Have an Impact on Outcomes? Challenges in Neuromonitoring and Pharmacology in Pediatric Anesthesia. J Clin Med 2021; 10:2175. [PMID: 34069896 PMCID: PMC8157588 DOI: 10.3390/jcm10102175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/07/2021] [Accepted: 05/07/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Pediatric sedation and anesthesia techniques have plenty of difficulties and challenges. Data on the pharmacologic, electroencephalographic, and neurologic response to anesthesia at different brain development times are only partially known. New data in neuroscience, pharmacology, and intraoperative neuromonitoring will impact changing concepts and clinical practice. In this article, we develop a conversation to guide the debate and search for a view more attuned to the updated knowledge in neurodevelopment, electroencephalography, and clinical pharmacology for the anesthesiologic practice in the pediatric population.
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Affiliation(s)
- Pablo O. Sepúlveda
- Hospital Base San José de Osorno, Service Anesthesiology and Pain, Faculty of Medicine, University Austral, Los Lagos 529000, Chile
| | - Valeria Epulef
- Department of Surgery, Traumatology and Anesthesiology, Medicine Faculty, Universidad de La Frontera, Temuco 4780000, Chile;
- Hospital Hernán Henriquez Aravena, Temuco 4780000, Chile
| | - Gustavo Campos
- Hospital Pediatrico Niño Jesús, Service of Anesthesiology, Córdoba 5500, Argentina;
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11
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Luhmann HJ, Fukuda A. Can we understand human brain development from experimental studies in rodents? Pediatr Int 2020; 62:1139-1144. [PMID: 32531857 DOI: 10.1111/ped.14339] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 05/05/2020] [Accepted: 05/22/2020] [Indexed: 12/12/2022]
Abstract
Animal models are needed to gain an understanding of the genetic, molecular, cellular, and network mechanisms of human brain development. In rodents, a large spectrum of in vitro and in vivo approaches allows detailed analyses and specific experimental manipulations for studying the sequence of developmental steps in corticogenesis. Neurogenesis, neuronal migration, cellular differentiation, programmed cell death, synaptogenesis, and myelination are surprisingly similar in the rodent cortex and the human cortex. Spontaneous EEG activity in the pre- and early postnatal human cortex resembles the activity patterns recorded with intracortical multi-electrode arrays in newborn rodents. This early activity is generated by thalamic activation of a subplate-driven local network coupled via gap junctions, which controls the development of cortical columns and the spatio-temporal pattern of apoptosis. Disturbances of this activity may induce disturbances in cortical structure and function leading to neurological and psychiatric disorders.
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Affiliation(s)
- Heiko J Luhmann
- Institute of Physiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Atsuo Fukuda
- Department of Physiology, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
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12
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Kinoshita M, Stempel K, do Nascimento IJB, Vejayaram DN, Norman E, Bruschettini M. Opioids and alpha-2-agonists for analgesia and sedation in newborn infants: protocol of a systematic review. Syst Rev 2020; 9:183. [PMID: 32819417 PMCID: PMC7441710 DOI: 10.1186/s13643-020-01436-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/29/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Hospitalized newborn infants may require analgesia and sedation either for the management of procedural pain, during or after surgery, and other painful conditions. The benefits and harms of opioids administered at different doses and routes of administration have been reported in numerous trials and systematic reviews. The use of alpha-2-agonists such as clonidine and dexmedetomidine in newborn infants is more recent, and they might be prescribed to reduce the total amount of opioids which are thought to have more side effects. Moreover, alpha-2-agonists might play an important role in the management of agitation and discomfort. METHODS We will conduct a systematic review and meta-analysis on the use of opioids, alpha-2-agonists, or the combination of both drugs. We will include randomized controlled trials to assess benefits and harms and observational studies to assess adverse events and pharmacokinetics; preterm and term infants; studies on any opioids or alpha-2-agonists administered for any indication and by any route except spinal, intraosseous, or administration for nerve blocks and wound infusions. The use of opioids or alpha-2-agonists will be compared to no intervention; placebo with normal saline or other non-sedative, non-analgesic drug; control with oral sugar solution or non-pharmacological intervention; same drug of different dose or route; or a different drug (not limiting to opioids and alpha-2-agonists) or combinations of such drugs. The primary outcomes for this review will be all-cause mortality during initial hospitalization and hypotension requiring medical therapy. We will conduct a search in the following databases: The Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), MEDLINE, Embase, and CINAHL. Two review authors will independently screen records for inclusion, undertake data abstraction using a data extraction form and assess the risk of bias of all included trials using the Cochrane "Risk of bias" tool. DISCUSSION This systematic review will summarize and update our knowledge about neonatal analgesia and sedation including pharmacokinetics/pharmacodynamics, and provide a platform for developing evidence-based guidelines that we can immediately apply to our clinical practice. SYSTEMATIC REVIEW REGISTRATION PROSPERO 2020 CRD42020170852.
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Affiliation(s)
- Mari Kinoshita
- Faculty of Medicine, Lund University, Lund, Sweden. .,Keio University School of Medicine, Tokyo, Japan.
| | | | - Israel Junior Borges do Nascimento
- School of Medicine at Universidade Federal de Minas Gerais, Minas Gerais, Belo Horizonte, Brazil.,Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Elisabeth Norman
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Pediatrics, Lund, Sweden
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13
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Stevenson NJ, Oberdorfer L, Tataranno ML, Breakspear M, Colditz PB, de Vries LS, Benders MJNL, Klebermass-Schrehof K, Vanhatalo S, Roberts JA. Automated cot-side tracking of functional brain age in preterm infants. Ann Clin Transl Neurol 2020; 7:891-902. [PMID: 32368863 PMCID: PMC7318094 DOI: 10.1002/acn3.51043] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 03/20/2020] [Indexed: 12/14/2022] Open
Abstract
Objective A major challenge in the care of preterm infants is the early identification of compromised neurological development. While several measures are routinely used to track anatomical growth, there is a striking lack of reliable and objective tools for tracking maturation of early brain function; a cornerstone of lifelong neurological health. We present a cot‐side method for measuring the functional maturity of the newborn brain based on routinely available neurological monitoring with electroencephalography (EEG). Methods We used a dataset of 177 EEG recordings from 65 preterm infants to train a multivariable prediction of functional brain age (FBA) from EEG. The FBA was validated on an independent set of 99 EEG recordings from 42 preterm infants. The difference between FBA and postmenstrual age (PMA) was evaluated as a predictor for neurodevelopmental outcome. Results The FBA correlated strongly with the PMA of an infant, with a median prediction error of less than 1 week. Moreover, individual babies follow well‐defined individual trajectories. The accuracy of the FBA applied to the validation set was statistically equivalent to the training set accuracy. In a subgroup of infants with repeated EEG recordings, a persistently negative predicted age difference was associated with poor neurodevelopmental outcome. Interpretation The FBA enables the tracking of functional neurodevelopment in preterm infants. This establishes proof of principle for growth charts for brain function, a new tool to assist clinical management and identify infants who will benefit most from early intervention.
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Affiliation(s)
- Nathan J Stevenson
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, 4006, Australia
| | - Lisa Oberdorfer
- Department of Pediatrics, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Vienna, Austria
| | - Maria-Luisa Tataranno
- Department of Neonatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michael Breakspear
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, 4006, Australia.,Priority Research Center for Mind and Brain, University of Newcastle, Newcastle, NSW, 2305, Australia
| | - Paul B Colditz
- Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, QLD, 4029, Australia
| | - Linda S de Vries
- Department of Neonatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Manon J N L Benders
- Department of Neonatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Katrin Klebermass-Schrehof
- Department of Pediatrics, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Vienna, Austria
| | - Sampsa Vanhatalo
- Department of Children's Clinical Neurophysiology, BABA Center, Pediatric Research Center, Children's Hospital, HUS Medical Imaging Center, Helsinki University Central Hospital, University of Helsinki, Finland
| | - James A Roberts
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, 4006, Australia
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14
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Tataranno ML, Gui L, Hellström-Westas L, Toet M, Groenendaal F, Claessens NHP, Schuurmans J, Fellman V, Sävman K, de Vries LS, Huppi P, Benders MJNL. Morphine affects brain activity and volumes in preterms: An observational multi-center study. Early Hum Dev 2020; 144:104970. [PMID: 32276190 DOI: 10.1016/j.earlhumdev.2020.104970] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/04/2020] [Accepted: 02/04/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We hypothesized that morphine has a depressing effect on early brain activity, assessed using quantitative aEEG/EEG parameter and depressed activity will be associated with brain volumes at term in extremely preterm infants. STUDY DESIGN 174 preterm infants were enrolled in 3 European tertiary NICUs (mean GA:26 ± 1wks) and monitored during the first 72 h after birth with continuous 2 channel aEEG. Six epochs of aEEG recordings were selected and minimum amplitude of aEEG (min aEEG), percentage of time amplitude <5 μV (% of time < 5 μV), spontaneous activity transients (SATrate) and interSAT interval (ISI) were calculated. For infants receiving morphine, the cumulative morphine dosage was calculated. In a subgroup of 58 infants, good quality MRI at term equivalent age (TEA) and the cumulative morphine dose until TEA were available. The effects of morphine administration and cumulative dose on aEEG/EEG measures and on brain volumes were investigated. RESULTS Morphine administration had a significant effect on all quantitative aEEG/EEG measures, causing depression of early brain activity [longer ISI (β 2.900), reduced SAT rate (β -1.386), decreased min aEEG (β -0.782), and increased % of time < 5 μV (β 14.802)] in all epochs. A significant effect of GA and postnatal age on aEEG/EEG measures was observed. Cumulative morphine dose until TEA had a significant negative effect on total brain volume (TBV) (β -8.066) and cerebellar volume (β -1.080). CONCLUSIONS Administration of sedative drugs should be considered when interpreting aEEG/EEG together with the negative dose dependent morphine impact on brain development.
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Affiliation(s)
- M L Tataranno
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, the Netherlands
| | - L Gui
- Division of Development and Growth, Department of Pediatrics, University of Geneva, Geneva, Switzerland
| | - L Hellström-Westas
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - M Toet
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, the Netherlands
| | - F Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, the Netherlands
| | - N H P Claessens
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, the Netherlands
| | - J Schuurmans
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, the Netherlands
| | - V Fellman
- Lund University, Department of Clinical Sciences, Lund, Pediatrics, Skåne University Hospital, Lund, Sweden
| | - K Sävman
- Department of Pediatrics, Perinatal Center, Institute of Clinical Sciences, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
| | - L S de Vries
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, the Netherlands
| | - P Huppi
- Division of Development and Growth, Department of Pediatrics, University of Geneva, Geneva, Switzerland
| | - M J N L Benders
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, the Netherlands.
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15
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Pillay K, Dereymaeker A, Jansen K, Naulaers G, De Vos M. Applying a data-driven approach to quantify EEG maturational deviations in preterms with normal and abnormal neurodevelopmental outcomes. Sci Rep 2020; 10:7288. [PMID: 32350387 PMCID: PMC7190650 DOI: 10.1038/s41598-020-64211-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 04/11/2020] [Indexed: 12/02/2022] Open
Abstract
Premature babies are subjected to environmental stresses that can affect brain maturation and cause abnormal neurodevelopmental outcome later in life. Better understanding this link is crucial to developing a clinical tool for early outcome estimation. We defined maturational trajectories between the Electroencephalography (EEG)-derived ‘brain-age’ and postmenstrual age (the age since the last menstrual cycle of the mother) from longitudinal recordings during the baby’s stay in the Neonatal Intensive Care Unit. Data consisted of 224 recordings (65 patients) separated for normal and abnormal outcome at 9–24 months follow-up. Trajectory deviations were compared between outcome groups using the root mean squared error (RMSE) and maximum trajectory deviation (δmax). 113 features were extracted (per sleep state) to train a data-driven model that estimates brain-age, with the most prominent features identified as potential maturational and outcome-sensitive biomarkers. RMSE and δmax showed significant differences between outcome groups (cluster-based permutation test, p < 0.05). RMSE had a median (IQR) of 0.75 (0.60–1.35) weeks for normal outcome and 1.35 (1.15–1.55) for abnormal outcome, while δmax had a median of 0.90 (0.70–1.70) and 1.90 (1.20–2.90) weeks, respectively. Abnormal outcome trajectories were associated with clinically defined dysmature and disorganised EEG patterns, cementing the link between early maturational trajectories and neurodevelopmental outcome.
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Affiliation(s)
- Kirubin Pillay
- Institute of Biomedical Engineering (IBME), Department of Engineering Science, University of Oxford, Oxford, United Kingdom. .,Department of Paediatrics, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom.
| | - Anneleen Dereymaeker
- Department of Development and Regeneration, University Hospitals Leuven, Neonatal Intensive Care Unit, KU Leuven (University of Leuven), 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, University of Leuven (KU Leuven), Leuven, Belgium
| | - Gunnar Naulaers
- Department of Development and Regeneration, University Hospitals Leuven, Neonatal Intensive Care Unit, 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
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16
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Kozhemiako N, Nunes A, Vakorin VA, Chau CMY, Moiseev A, Ribary U, Grunau RE, Doesburg SM. Atypical resting state neuromagnetic connectivity and spectral power in very preterm children. J Child Psychol Psychiatry 2019; 60:975-987. [PMID: 30805942 DOI: 10.1111/jcpp.13026] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Children born very preterm often display selective cognitive difficulties at school age even in the absence of major brain injury. Alterations in neurophysiological activity underpinning such difficulties, as well as their relation to specific aspects of adverse neonatal experience, remain poorly understood. In the present study, we examined interregional connectivity and spectral power in very preterm children at school age, and their relationship with clinical neonatal variables and long-term outcomes (IQ, executive functions, externalizing/internalizing behavior, visual-motor integration). METHODS We collected resting state magnetoencephalographic (MEG) and psychometric data from a cohort at the age of 8 years followed prospectively since birth, which included three groups: Extremely Low Gestational Age (ELGA, 24-28 weeks GA n = 24, age 7.7 ± 0.38, 10 girls), Very Low Gestational Age (VLGA, 29-32 weeks GA n = 37, age 7.7 ± 0.39, 24 girls), and full-term children (38-41 weeks GA n = 39, age 7.9 ± 1.02, 24 girls). Interregional phase synchrony and spectral power were tested for group differences, and associations with neonatal and outcome variables were examined using mean-centered and behavioral Partial Least Squares (PLS) analyses, respectively. RESULTS We found greater connectivity in the theta band in the ELGA group compared to VLGA and full-term groups, primarily involving frontal connections. Spectral power analysis demonstrated overall lower power in the ELGA and VLGA compared to full-term group. PLS indicated strong associations between neurophysiological connectivity at school age, adverse neonatal experience and cognitive performance, and behavior. Resting spectral power was associated only with behavioral scores. CONCLUSIONS Our findings indicate significant atypicalities of neuromagnetic brain activity and connectivity in very preterm children at school age, with alterations in connectivity mainly observed only in the ELGA group. We demonstrate a significant relationship between connectivity, adverse neonatal experience, and long-term outcome, indicating that the disruption of developing neurophysiological networks may mediate relationships between neonatal events and cognitive and behavioral difficulties at school age.
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Affiliation(s)
- Nataliia Kozhemiako
- Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Adonay Nunes
- Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Vasily A Vakorin
- Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada.,Behavioral & Cognitive Neuroscience Institute, Simon Fraser University, Burnaby, BC, Canada.,Fraser Health, British Columbia Health Authority, Surrey, BC, Canada
| | - Cecil M Y Chau
- Pediatrics Department, University of British Columbia, Vancouver, BC, Canada.,B.C. Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Alexander Moiseev
- Behavioral & Cognitive Neuroscience Institute, Simon Fraser University, Burnaby, BC, Canada
| | - Urs Ribary
- Behavioral & Cognitive Neuroscience Institute, Simon Fraser University, Burnaby, BC, Canada.,Pediatrics Department, University of British Columbia, Vancouver, BC, Canada.,B.C. Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
| | - Ruth E Grunau
- Pediatrics Department, University of British Columbia, Vancouver, BC, Canada.,B.C. Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Sam M Doesburg
- Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada.,Behavioral & Cognitive Neuroscience Institute, Simon Fraser University, Burnaby, BC, Canada
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17
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O'Toole JM, Pavlidis E, Korotchikova I, Boylan GB, Stevenson NJ. Temporal evolution of quantitative EEG within 3 days of birth in early preterm infants. Sci Rep 2019; 9:4859. [PMID: 30890761 PMCID: PMC6425040 DOI: 10.1038/s41598-019-41227-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 03/01/2019] [Indexed: 01/09/2023] Open
Abstract
For the premature newborn, little is known about changes in brain activity during transition to extra-uterine life. We aim to quantify these changes in relation to the longer-term maturation of the developing brain. We analysed EEG for up to 72 hours after birth from 28 infants born <32 weeks of gestation. These infants had favourable neurodevelopment at 2 years of age and were without significant neurological compromise at time of EEG monitoring. Quantitative EEG was generated using features representing EEG power, discontinuity, spectral distribution, and inter-hemispheric connectivity. We found rapid changes in cortical activity over the 3 days distinct from slower changes associated with gestational age: for many features, evolution over 1 day after birth is equivalent to approximately 1 to 2.5 weeks of maturation. Considerable changes in the EEG immediately after birth implies that postnatal adaption significantly influences cerebral activity for early preterm infants. Postnatal age, in addition to gestational age, should be considered when analysing preterm EEG within the first few days after birth.
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Affiliation(s)
- John M O'Toole
- Neonatal Brain Research Group, Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland.
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland.
| | - Elena Pavlidis
- Neonatal Brain Research Group, Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
| | - Irina Korotchikova
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Geraldine B Boylan
- Neonatal Brain Research Group, Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Nathan J Stevenson
- BABA Center, Department of Children's Clinical Neurophysiology, Children's Hospital, HUS Medical Imaging Center, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
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18
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Boylan GB, Kharoshankaya L, Mathieson SR. Diagnosis of seizures and encephalopathy using conventional EEG and amplitude integrated EEG. HANDBOOK OF CLINICAL NEUROLOGY 2019; 162:363-400. [PMID: 31324321 DOI: 10.1016/b978-0-444-64029-1.00018-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Seizures are more common in the neonatal period than at any other time of life, partly due to the relative hyperexcitability of the neonatal brain. Brain monitoring of sick neonates in the NICU using either conventional electroencephalography or amplitude integrated EEG is essential to accurately detect seizures. Treatment of seizures is important, as evidence increasingly indicates that seizures damage the brain in addition to that caused by the underlying etiology. Prompt treatment has been shown to reduce seizure burden with the potential to ameliorate seizure-mediated damage. Neonatal encephalopathy most commonly caused by a hypoxia-ischemia results in an alteration of mental status and problems such as seizures, hypotonia, apnea, and feeding difficulties. Confirmation of encephalopathy with EEG monitoring can act as an important adjunct to other investigations and the clinical examination, particularly when considering treatment strategies such as therapeutic hypothermia. Brain monitoring also provides useful early prognostic indicators to clinicians. Recent use of machine learning in algorithms to continuously monitor the neonatal EEG, detect seizures, and grade encephalopathy offers the exciting prospect of real-time decision support in the NICU in the very near future.
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Affiliation(s)
- Geraldine B Boylan
- Department of Paediatrics and Child Health, Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland.
| | - Liudmila Kharoshankaya
- Department of Paediatrics and Child Health, Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
| | - Sean R Mathieson
- Department of Paediatrics and Child Health, Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
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19
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Khazipov R, Milh M. Early patterns of activity in the developing cortex: Focus on the sensorimotor system. Semin Cell Dev Biol 2018; 76:120-129. [DOI: 10.1016/j.semcdb.2017.09.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 09/07/2017] [Accepted: 09/08/2017] [Indexed: 02/08/2023]
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20
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de Camp NV, Hense F, Lecher B, Scheu H, Bergeler J. Models for Preterm Cortical Development Using Non Invasive Clinical EEG. Transl Neurosci 2018; 8:211-224. [PMID: 29445543 PMCID: PMC5811640 DOI: 10.1515/tnsci-2017-0029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 09/20/2017] [Indexed: 01/14/2023] Open
Abstract
The objective of this study was to evaluate the piglet and the mouse as model systems for preterm cortical development. According to the clinical context, we used non invasive EEG recordings. As a prerequisite, we developed miniaturized Ag/AgCl electrodes for full band EEG recordings in mice and verified that Urethane had no effect on EEG band power. Since mice are born with a “preterm” brain, we evaluated three age groups: P0/P1, P3/P4 and P13/P14. Our aim was to identify EEG patterns in the somatosensory cortex which are distinguishable between developmental stages and represent a physiologic brain development. In mice, we were able to find clear differences between age groups with a simple power analysis of EEG bands and also for phase locking and power spectral density. Interhemispheric coherence between corresponding regions can only be seen in two week old mice. The canolty maps for piglets as well as for mice show a clear PAC (phase amplitude coupling) pattern during development. From our data it can be concluded that analytic tools relying on network activity, as for example PAC (phase amplitude coupling) are best suited to extract basic EEG patterns of cortical development across species.
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Affiliation(s)
- Nora Vanessa de Camp
- Medical Center of the Johannes Gutenberg, University Mainz, Mainz, Germany.,Free University Berlin, Berlin, Germany.,Humboldt University Berlin, Berlin, Germany
| | - Florian Hense
- Medical Center of the Johannes Gutenberg, University Mainz, Mainz, Germany
| | | | - Helmut Scheu
- Lehr- und Versuchstieranstalt Hofgut Neumühle, Neumühle, Germany
| | - Jürgen Bergeler
- Medical Center of the Johannes Gutenberg, University Mainz, Mainz, Germany.,Free University Berlin, Berlin, Germany
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21
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M Toye J, Mirea L, Yang J, Sankaran K. Trends in narcotics and sedative use during mechanical ventilation of preterm infants in Canadian neonatal intensive care units. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2018; 20:5-11. [PMID: 29335074 PMCID: PMC7390316 DOI: 10.7499/j.issn.1008-8830.2018.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 09/12/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Mechanical ventilation (MV) in preterm infants (PTI) causes discomfort. Whether it causes pain is controversial. Meta analysis reviews of published work on PTI during MV have shown no clinically significant impact of opioids on pain scales, and hence not recommended for routine use in neonatal intensive care units (NICUs). Similarly regular use of sedative midazolam is also not recommended. Therefore we hypothesized a downward trend in narcotics and sedatives used in MV of PTI in NICUs. This study aimed to assess trends of sedatives and narcotics use during MV of PTI in Canadian NICUs during 2004-2009. METHODS PTI born at gestational age (GA) of <35 weeks requiring invasive MV for >24 hours were identified retrospectively from the Canadian Neonatal Network database for 2004-2009. PTI were excluded if moribund on admission, had major congenital anomalies, surgery (except laser eye surgery), necrotizing enterocolitis, chest tube or history of maternal narcotic abuse. PTI were classified according to whether they received any narcotics (morphine, fentanyl, methadone, sufentanyl, meperidine, alfentynl and codiene) or sedatives (chloral hydrate, midazolam, lorazepam, phenobarbital, pentobarbital, ketamine and propofol) for >24 consecutive hours during MV. Trends of narcotics and sedatives were assessed using the Cochrane-Armitage Trend test separately for PTI born at <29 and 29-34 weeks of GA. RESULTS Among 5 638 study subjects, 2 169 (38.5%) received narcotics and 897 (15.9%) received sedatives. The most common narcotics were morphine (62.2%) and fentanyl (63.8%) and sedatives were phenobarbital (44.9%) and chloral hydrate (44.2%). A significant decreasing trend (P<0.01) in the use of any sedatives during MV was observed in PTI <29 and 29-34 weeks of GA. However, the use of any narcotics during MV increased significantly (P=0.03) among PTI <29 weeks of GA, and no change in trend was detected for PTI born at 29-34 weeks of GA. CONCLUSIONS The use of sedatives during MV in PTI born at <35 weeks of GA was positively affected, however the narcotics use during MV remained constant for PTI born at 29-34 weeks, and increased in extremely low GA group (less than 29 weeks) suggesting evidence based practice change was not observed during the study period.
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Affiliation(s)
- Jennifer M Toye
- Division of Neonatology, Department of Pediatrics, University of Alberta, EdmontonDivision of Neonatology, Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Lucia Mirea
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto
| | - Junmin Yang
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto
| | - Koravangattu Sankaran
- Division of Neonatology, Department of Pediatrics, University of Saskatchewan, Saskatoon)
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22
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Kirischuk S, Sinning A, Blanquie O, Yang JW, Luhmann HJ, Kilb W. Modulation of Neocortical Development by Early Neuronal Activity: Physiology and Pathophysiology. Front Cell Neurosci 2017; 11:379. [PMID: 29238291 PMCID: PMC5712676 DOI: 10.3389/fncel.2017.00379] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 11/13/2017] [Indexed: 12/23/2022] Open
Abstract
Animal and human studies revealed that patterned neuronal activity is an inherent feature of developing nervous systems. This review summarizes our current knowledge about the mechanisms generating early electrical activity patterns and their impact on structural and functional development of the cerebral cortex. All neocortical areas display distinct spontaneous and sensory-driven neuronal activity patterns already at early phases of development. At embryonic stages, intermittent spontaneous activity is synchronized within small neuronal networks, becoming more complex with further development. This transition is accompanied by a gradual shift from electrical to chemical synaptic transmission, with a particular role of non-synaptic tonic currents before the onset of phasic synaptic activity. In this review article we first describe functional impacts of classical neurotransmitters (GABA, glutamate) and modulatory systems (e.g., acetylcholine, ACh) on early neuronal activities in the neocortex with special emphasis on electrical synapses, nonsynaptic and synaptic currents. Early neuronal activity influences probably all developmental processes and is crucial for the proper formation of neuronal circuits. In the second part of our review, we illustrate how specific activity patterns might interfere with distinct neurodevelopmental processes like proliferation, migration, axonal and dendritic sprouting, synapse formation and neurotransmitter specification. Finally, we present evidence that transient alterations in neuronal activity during restricted perinatal periods can lead to persistent changes in functional connectivity and therefore might underlie the manifestation of neurological and neuropsychiatric diseases.
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Affiliation(s)
- Sergei Kirischuk
- Institute of Physiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Anne Sinning
- Institute of Physiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Oriane Blanquie
- Institute of Physiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Jenq-Wei Yang
- Institute of Physiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Heiko J Luhmann
- Institute of Physiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Werner Kilb
- Institute of Physiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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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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Luhmann HJ, Khazipov R. Neuronal activity patterns in the developing barrel cortex. Neuroscience 2017; 368:256-267. [PMID: 28528963 DOI: 10.1016/j.neuroscience.2017.05.025] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 05/12/2017] [Accepted: 05/12/2017] [Indexed: 11/26/2022]
Abstract
The developing barrel cortex reveals a rich repertoire of neuronal activity patterns, which have been also found in other sensory neocortical areas and in other species including the somatosensory cortex of preterm human infants. The earliest stage is characterized by asynchronous, sparse single-cell firing at low frequencies. During the second stage neurons show correlated firing, which is initially mediated by electrical synapses and subsequently transforms into network bursts depending on chemical synapses. Activity patterns during this second stage are synchronous plateau assemblies, delta waves, spindle bursts and early gamma oscillations (EGOs). In newborn rodents spindle bursts and EGOs occur spontaneously or can be elicited by sensory stimulation and synchronize the activity in a barrel-related columnar network with topographic organization at the day of birth. Interfering with this early activity causes a disturbance in the development of the cortical architecture, indicating that spindle bursts and EGOs influence the formation of cortical columns. Early neuronal activity also controls the rate of programed cell death in the developing barrel cortex, suggesting that spindle bursts and EGOs are physiological activity patterns particularly suited to suppress apoptosis. It remains to be studied in more detail how these different neocortical activity patterns control early developmental processes such as formation of synapses, microcircuits, topographic maps and large-scale networks.
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Affiliation(s)
- Heiko J Luhmann
- Institute of Physiology, University Medical Center of the Johannes Gutenberg University Mainz, Duesbergweg 6, D-55128 Mainz, Germany.
| | - Rustem Khazipov
- INMED - INSERM, Aix-Marseille University, Marseille 13273, France; Laboratory of Neurobiology, Kazan Federal University, Kazan 420008, Russia
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25
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Abstract
Conventional EEG and amplitude-integrated electroencephalography are used in neonates to assess prognosis and significant changes in brain activity. Neuroactive medications and hypothermia can influence brain activity and therefore alter EEG interpretation. There are limited studies on the effect of these therapies on neonatal EEG background activity. Medication effects on the EEG or amplitude-integrated electroencephalography include increased interburst interval duration, voltage suppression, and sleep disruption. The effect is transient in term newborns but can be persistent in premature newborns. Although therapeutic hypothermia does not produce significant changes in EEG activity, it does change the time point at which EEG can accurately predict neurodevelopmental outcome. It is important to account for these effects on the EEG to avoid inaccurate interpretation that may affect prognostication.
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26
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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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27
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Govindan RB, Kota S, Al-Shargabi T, Massaro AN, Chang T, du Plessis A. Effect of electrocardiogram interference on cortico-cortical connectivity analysis and a possible solution. J Neurosci Methods 2016; 270:76-84. [PMID: 27291356 DOI: 10.1016/j.jneumeth.2016.06.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 06/07/2016] [Accepted: 06/08/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Electroencephalogram (EEG) signals are often contaminated by the electrocardiogram (ECG) interference, which affects quantitative characterization of EEG. NEW METHOD We propose null-coherence, a frequency-based approach, to attenuate the ECG interference in EEG using simultaneously recorded ECG as a reference signal. After validating the proposed approach using numerically simulated data, we apply this approach to EEG recorded from six newborns receiving therapeutic hypothermia for neonatal encephalopathy. We compare our approach with an independent component analysis (ICA), a previously proposed approach to attenuate ECG artifacts in the EEG signal. The power spectrum and the cortico-cortical connectivity of the ECG attenuated EEG was compared against the power spectrum and the cortico-cortical connectivity of the raw EEG. RESULTS The null-coherence approach attenuated the ECG contamination without leaving any residual of the ECG in the EEG. COMPARISON WITH EXISTING METHOD We show that the null-coherence approach performs better than ICA in attenuating the ECG contamination without enhancing cortico-cortical connectivity. CONCLUSION Our analysis suggests that using ICA to remove ECG contamination from the EEG suffers from redistribution problems, whereas the null-coherence approach does not. We show that both the null-coherence and ICA approaches attenuate the ECG contamination. However, the EEG obtained after ICA cleaning displayed higher cortico-cortical connectivity compared with that obtained using the null-coherence approach. This suggests that null-coherence is superior to ICA in attenuating the ECG interference in EEG for cortico-cortical connectivity analysis.
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Affiliation(s)
- R B Govindan
- Division of Fetal and Transitional Medicine, Fetal Medicine Institute, Children's National Health System, 111 Michigan Ave., NW, Washington, DC 20010, USA.
| | - Srinivas Kota
- Division of Fetal and Transitional Medicine, Fetal Medicine Institute, Children's National Health System, 111 Michigan Ave., NW, Washington, DC 20010, USA
| | - Tareq Al-Shargabi
- Division of Fetal and Transitional Medicine, Fetal Medicine Institute, Children's National Health System, 111 Michigan Ave., NW, Washington, DC 20010, USA
| | - An N Massaro
- Division of Neonatology, Children's National - 111 Michigan Ave., NW, Washington, DC 20010, USA
| | - Taeun Chang
- Division of Neurology, Children's National - 111 Michigan Ave., NW, Washington, DC 20010, USA
| | - Adre du Plessis
- Division of Fetal and Transitional Medicine, Fetal Medicine Institute, Children's National Health System, 111 Michigan Ave., NW, Washington, DC 20010, USA
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28
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Dereymaeker A, Koolen N, Jansen K, Vervisch J, Ortibus E, De Vos M, Van Huffel S, Naulaers G. The suppression curve as a quantitative approach for measuring brain maturation in preterm infants. Clin Neurophysiol 2016; 127:2760-2765. [PMID: 27417049 DOI: 10.1016/j.clinph.2016.05.362] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 05/27/2016] [Accepted: 05/31/2016] [Indexed: 02/08/2023]
Abstract
OBJECTIVES We apply the suppression curve (SC) as an automated approach to describe the maturational change in EEG discontinuity in preterm infants. This method allows to define normative values of interburst intervals (IBIs) at different postmenstrual ages (PMA). METHODS Ninety-two multichannel EEG recordings from 25 preterm infants (born ⩽32weeks) with normal developmental outcome at 9months, were first analysed using the Line Length method, an established method for burst detection. Subsequently, the SC was defined as the 'level of EEG discontinuity'. The mean and the standard deviation of the SC, as well as the IBIs from each recording were calculated and correlated with PMA. RESULTS Over the course of development, there is a decrease in EEG discontinuity with a strong linear correlation between the mean SC and PMA till 34weeks. From 30weeks PMA, differences between discontinuous and continuous EEG become smaller, which is reflected by the decrease of the standard deviation of the SC. IBIs are found to have a significant correlation with PMA. CONCLUSIONS Automated detection of individual maturational changes in EEG discontinuity is possible with the SC. These changes include more continuous tracing, less amplitude differences and shorter suppression periods, reflecting development of the vigilance states. SIGNIFICANCE The suppression curve facilitates automated assessment of EEG maturation. Clinical applicability is straight forward since values for IBIs according to PMA are generated automatically.
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Affiliation(s)
- A Dereymaeker
- Department of Development and Regeneration, University Hospitals Leuven, Neonatal Intensive Care Unit, University of Leuven (KU Leuven), Leuven, Belgium.
| | - N Koolen
- Division STADIUS, Department of Electrical Engineering (ESAT), University of Leuven (KU Leuven), Leuven, Belgium; iMinds-KU Leuven Medical IT Department, Leuven, Belgium.
| | - K Jansen
- Department of Development and Regeneration, University Hospitals Leuven, Neonatal Intensive Care Unit, University of Leuven (KU Leuven), Leuven, Belgium; Department of Development and Regeneration, University Hospitals Leuven, Child Neurology, University of Leuven (KU Leuven), Belgium.
| | - J Vervisch
- Department of Development and Regeneration, University Hospitals Leuven, Neonatal Intensive Care Unit, University of Leuven (KU Leuven), Leuven, Belgium; Department of Development and Regeneration, University Hospitals Leuven, Child Neurology, University of Leuven (KU Leuven), Belgium.
| | - E Ortibus
- Department of Development and Regeneration, University Hospitals Leuven, Child Neurology, University of Leuven (KU Leuven), Belgium.
| | - M De Vos
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK.
| | - S Van Huffel
- Division STADIUS, Department of Electrical Engineering (ESAT), University of Leuven (KU Leuven), Leuven, Belgium; iMinds-KU Leuven Medical IT Department, Leuven, Belgium.
| | - G Naulaers
- Department of Development and Regeneration, University Hospitals Leuven, Neonatal Intensive Care Unit, University of Leuven (KU Leuven), Leuven, Belgium.
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29
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Luhmann HJ, Sinning A, Yang JW, Reyes-Puerta V, Stüttgen MC, Kirischuk S, Kilb W. Spontaneous Neuronal Activity in Developing Neocortical Networks: From Single Cells to Large-Scale Interactions. Front Neural Circuits 2016; 10:40. [PMID: 27252626 PMCID: PMC4877528 DOI: 10.3389/fncir.2016.00040] [Citation(s) in RCA: 155] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 05/06/2016] [Indexed: 11/13/2022] Open
Abstract
Neuronal activity has been shown to be essential for the proper formation of neuronal circuits, affecting developmental processes like neurogenesis, migration, programmed cell death, cellular differentiation, formation of local and long-range axonal connections, synaptic plasticity or myelination. Accordingly, neocortical areas reveal distinct spontaneous and sensory-driven neuronal activity patterns already at early phases of development. At embryonic stages, when immature neurons start to develop voltage-dependent channels, spontaneous activity is highly synchronized within small neuronal networks and governed by electrical synaptic transmission. Subsequently, spontaneous activity patterns become more complex, involve larger networks and propagate over several neocortical areas. The developmental shift from local to large-scale network activity is accompanied by a gradual shift from electrical to chemical synaptic transmission with an initial excitatory action of chloride-gated channels activated by GABA, glycine and taurine. Transient neuronal populations in the subplate (SP) support temporary circuits that play an important role in tuning early neocortical activity and the formation of mature neuronal networks. Thus, early spontaneous activity patterns control the formation of developing networks in sensory cortices, and disturbances of these activity patterns may lead to long-lasting neuronal deficits.
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Affiliation(s)
- Heiko J Luhmann
- Institute of Physiology, University Medical Center of the Johannes Gutenberg University Mainz Mainz, Germany
| | - Anne Sinning
- Institute of Physiology, University Medical Center of the Johannes Gutenberg University Mainz Mainz, Germany
| | - Jenq-Wei Yang
- Institute of Physiology, University Medical Center of the Johannes Gutenberg University Mainz Mainz, Germany
| | - Vicente Reyes-Puerta
- Institute of Physiology, University Medical Center of the Johannes Gutenberg University Mainz Mainz, Germany
| | - Maik C Stüttgen
- Institute of Pathophysiology, University Medical Center of the Johannes Gutenberg University Mainz Mainz, Germany
| | - Sergei Kirischuk
- Institute of Physiology, University Medical Center of the Johannes Gutenberg University Mainz Mainz, Germany
| | - Werner Kilb
- Institute of Physiology, University Medical Center of the Johannes Gutenberg University Mainz Mainz, Germany
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30
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Iyer KK, Roberts JA, Hellström-Westas L, Wikström S, Hansen Pupp I, Ley D, Vanhatalo S, Breakspear M. Cortical burst dynamics predict clinical outcome early in extremely preterm infants. Brain 2015; 138:2206-18. [PMID: 26001723 DOI: 10.1093/brain/awv129] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 03/19/2015] [Indexed: 01/15/2023] Open
Abstract
Intermittent bursts of electrical activity are a ubiquitous signature of very early brain activity. Previous studies have largely focused on assessing the amplitudes of these transient cortical bursts or the intervals between them. Recent advances in basic neuroscience have identified the presence of scale-free 'avalanche' processes in bursting patterns of cortical activity in other clinical contexts. Here, we hypothesize that cortical bursts in human preterm infants also exhibit scale-free properties, providing new insights into the nature, temporal evolution, and prognostic value of spontaneous brain activity in the days immediately following preterm birth. We examined electroencephalographic recordings from 43 extremely preterm infants (gestational age 22-28 weeks) and demonstrated that their cortical bursts exhibit scale-free properties as early as 12 h after birth. The scaling relationships of cortical bursts correlate significantly with later mental development-particularly within the first 12 h of life. These findings show that early preterm brain activity is characterized by scale-free dynamics which carry developmental significance, hence offering novel means for rapid and early clinical prediction of neurodevelopmental outcomes.
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Affiliation(s)
- Kartik K Iyer
- 1 Systems Neuroscience Group, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia 2 School of Medicine, Faculty of Medicine and Biomedical Sciences, University of Queensland, Australia
| | - James A Roberts
- 1 Systems Neuroscience Group, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | | | - Sverre Wikström
- 4 Department of Paediatrics, Karlstad Central Hospital, Sweden
| | - Ingrid Hansen Pupp
- 5 Department of Paediatrics, Institute for Clinical Sciences, Lund University, Lund, Sweden
| | - David Ley
- 5 Department of Paediatrics, Institute for Clinical Sciences, Lund University, Lund, Sweden
| | - Sampsa Vanhatalo
- 6 Department of Children's Clinical Neurophysiology, HUS Medical Imaging Centre, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland 7 Department of Paediatrics, Children's Hospital, University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Michael Breakspear
- 1 Systems Neuroscience Group, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia 8 The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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31
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Benders MJ, Palmu K, Menache C, Borradori-Tolsa C, Lazeyras F, Sizonenko S, Dubois J, Vanhatalo S, Hüppi PS. Early Brain Activity Relates to Subsequent Brain Growth in Premature Infants. Cereb Cortex 2014; 25:3014-24. [PMID: 24867393 DOI: 10.1093/cercor/bhu097] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Recent experimental studies have shown that early brain activity is crucial for neuronal survival and the development of brain networks; however, it has been challenging to assess its role in the developing human brain. We employed serial quantitative magnetic resonance imaging to measure the rate of growth in circumscribed brain tissues from preterm to term age, and compared it with measures of electroencephalographic (EEG) activity during the first postnatal days by 2 different methods. EEG metrics of functional activity were computed: EEG signal peak-to-peak amplitude and the occurrence of developmentally important spontaneous activity transients (SATs). We found that an increased brain activity in the first postnatal days correlates with a faster growth of brain structures during subsequent months until term age. Total brain volume, and in particular subcortical gray matter volume, grew faster in babies with less cortical electrical quiescence and with more SAT events. The present findings are compatible with the idea that (1) early cortical network activity is important for brain growth, and that (2) objective measures may be devised to follow early human brain activity in a biologically reasoned way in future research as well as during intensive care treatment.
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Affiliation(s)
- Manon J Benders
- Division of Development and Growth, Department of Pediatrics, Children's Hospital, University of Geneva, Geneva, Switzerland Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kirsi Palmu
- Department of Biomedical Engineering and Computational Science, School of Science, Aalto University, Helsinki FIN-00076, Finland Department of Children's Clinical Neurophysiology, Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Caroline Menache
- Division of Development and Growth, Department of Pediatrics, Children's Hospital, University of Geneva, Geneva, Switzerland
| | - Cristina Borradori-Tolsa
- Division of Development and Growth, Department of Pediatrics, Children's Hospital, University of Geneva, Geneva, Switzerland
| | - Francois Lazeyras
- Center for Biomedical Imaging (CIBM), Department of Radiology, University Hospital of Geneva, Geneva, Switzerland
| | - Stephane Sizonenko
- Division of Development and Growth, Department of Pediatrics, Children's Hospital, University of Geneva, Geneva, Switzerland
| | - Jessica Dubois
- Division of Development and Growth, Department of Pediatrics, Children's Hospital, University of Geneva, Geneva, Switzerland Cognitive Neuroimaging Unit U992, NeuroSpin, INSERM-CEA, Gif-sur-Yvette, France
| | - Sampsa Vanhatalo
- Department of Children's Clinical Neurophysiology, Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Petra S Hüppi
- Division of Development and Growth, Department of Pediatrics, Children's Hospital, University of Geneva, Geneva, Switzerland
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