Perinatal cerebral insults alter auditory event-related potentials

From psychophysiology to brain imaging: forty-five years MMN history of investigating acoustic change sensitivity

Forty-five years have passed since the first publication of the mismatch negativity (MMN) event-related brain potential (ERP) component. The first 10 years of research hardly gained any particular attention of the scientific community interested in acoustic perception. Debates on the nature of sensation versus perception were going on, and the technical possibilities to record ERPs, called in general evoked potentials, were very limited. Subtle changes in pure tone frequency or intensity giving rise to the MMN component were first investigated in humans. The background of the theoretical model developed by Risto Näätänen was the orientation reaction model of E.N. Sokolov published in 1963 so that the MMN was seen first as an electrophysiological correlate of auditory change detection. This fundamental ability of the auditory system seen as crucial for survival led to the development of the first animal model of the MMN (Csépe et al. in Clin Neurophysiol 66: 571-578, 1987). Indeed, it was confirmed that the MMN was the brain correlate of subtle changes detected that might alert to potential threats in the environment and direct the behavioral orientation. The investigations performed after 2000 introduced complex models and more sophisticated methods, both in animal and human studies, so that the MMN method was on the way to become a tool on the first place and not the main goal of research. This approach was further strengthened by the increasing number of studies on different clinical populations aiming at future applications. The aim of our review is to describe and redefine what the MMN may reflect in auditory perception and to show why and how this brain correlate of changes in the auditory scene can be used as a valuable tool in cognitive neuroscience research. We refer to publications selected to underly the argument the MMN cannot be classified anymore as a sign of simple change detection and not all the indicators used to confirm how genuine the MMN elicited by variations of tones are valid for those to  speech contrasts. We provide a fresh view on the broadly used MMN models, provided by some influential publications as well as on the unwritten history of MMN research aiming to give revised picture on what the MMN may truly reflect. We show how the focus and terminology of the MMN research have changed and what kind of misunderstandings and seemingly contradictive results prevent the MMN community to accept a generally usable cognitive model.

Early brain cognitive development in late preterm infants: an event-related potential and resting EEG study

BACKGROUND

Late preterm infants (LPIs) are at risk of neurodevelopmental delay. Research on their cognitive development is helpful for early intervention and follow-up.

METHODS

Event-related potential (ERP) and resting electroencephalography (RS-EEG) were used to study the brain cognitive function of LPIs in the early stage of life. The Gesell Developmental Scale (GDS) was used to track the neurodevelopmental status at the age of 1 year after correction, and to explore the neurophysiological indicators that could predict the outcome of cognitive development in the early stage.

RESULTS

The results showed that mismatch response (MMR) amplitude, RS-EEG power spectrum and functional connectivity all suggested that LPIs were lagging behind. At the age of 1 year after correction, high-risk LPIs showed no significant delay in gross motor function, but lagged behind in fine motor function, language, personal social interaction and adaptability. The ROC curve was used to evaluate the predictive role of MMR amplitude in the brain cognitive development prognosis at 1 year, showing a sensitivity of 80.00% and a specificity of 90.57%. The area under the curve (AUC) was 0.788, with a P-value of 0.007.

CONCLUSIONS

Based on our findings we supposed that the cognitive function of LPI lags behind that of full-term infants in early life. Preterm birth and perinatal diseases or high risk factors affected brain cognitive function in LPIs. MMR amplitude can be used as an early predictor of brain cognitive development in LPIs.

TRIAL REGISTRATION

This clinical trial is registered with the Chinese Clinical Trial Registry (ChiCTR).

TRIAL REGISTRATION NUMBER

ChiCTR2100041929. Date of registration: 2021-01-10. URL of the trial registry record: https://www.chictr.org.cn/ .

Maturation of the mismatch response in pre-school children: Systematic literature review and meta-analysis

Event-related potentials (ERPs), specifically the Mismatch Response (MMR), holds promise for investigating auditory maturation in children. It has the potential to predict language development and distinguish between language-impaired and typically developing groups. However, summarizing the MMR's developmental trajectory in typically developing children remains challenging despite numerous studies. This pioneering meta-analysis outlines changes in MMR amplitude among typically developing children, while offering methodological best-practices. Our search identified 51 articles for methodology analysis and 21 for meta-analysis, involving 0-8-year-old participants from 2000 to 2022. Risk of Bias assessment and methodology analysis revealed shortcomings in control condition usage and reporting of study confounders. The meta-analysis results were inconsistent, indicating large effect sizes in some conditions and no effect sizes in others. Subgroup analysis revealed the main effects of age and brain region, as well as an interaction of age and time-window of the MMR. Future research requires a specific protocol, larger samples, and replication studies to deepen the understanding of the auditory discrimination maturation process in children.

Brain Data in Pediatric Disorders of Consciousness: Special Considerations

SUMMARY

The diagnosis and management of disorders of consciousness in children continue to present a clinical, research, and ethical challenge. Though the practice guidelines for diagnosis and management of disorders of consciousness in adults are supported by decades of empirical and pragmatic evidence, similar guidelines for infants and children are lacking. The maturing conscious experience and the limited behavioral repertoire to report consciousness in this age group restrict extrapolation from the adult literature. Equally challenging is the process of heightened structural and functional neuroplasticity in the developing brain, which adds a layer of complexity to the investigation of the neural correlates of consciousness in infants and children. This review discusses the clinical assessment of pediatric disorders of consciousness and delineates the diagnostic and prognostic utility of neurophysiological and neuroimaging correlates of consciousness. The potential relevance of these correlates for the developing brain based on existing theoretical models of consciousness in adults is outlined.

Hearing Loss Diagnosis and Early Hearing-Related Interventions in Infants With or at High Risk for Cerebral Palsy: A Systematic Review

AIM

To synthesize published evidence regarding hearing impairment diagnosis and interventions in infants with or at high risk for cerebral palsy in the first year after birth.

METHOD

Nine databases were searched for MeSH terms up to February 2020. Included studies were published in English, enrolled infants with or at high risk for cerebral palsy, and addressed hearing evaluation/rehabilitation within the first year after birth. Quality of evidence was evaluated using RTI Item Bank and QUADAS-2.

RESULTS

Eighteen articles met inclusion criteria. Quality of the evidence ranged from low to high, revealing variability in diagnostic assessment methodologies and adherence to diagnostic schedules. Concerns for bias included lack of recognition of cerebral palsy effects and etiologies on functional hearing assessment methods and results. Two interventions (hearing aid and cochlear implantation) were identified; however, reported use was inconsistent.

INTERPRETATION

Hearing screening in infants with or at high risk for cerebral palsy requires evaluation of the entire auditory pathway preferentially using comprehensive electrophysiological panels of assessments. For infants with perinatal neural insults, pediatric neurologists are uniquely positioned to recommend adherence to systematic surveillance and comprehensive audiology assessments, regardless of comorbidities and motor impairments.

Family-Centered Care Enhanced Neonatal Neurophysiological Function in Preterm Infants: Randomized Controlled Trial

BACKGROUND

Family-centered intervention for preterm infants has shown short- to medium-term developmental benefits; however, the neurological effects of intervention have rarely been explored.

OBJECTIVE

The objectives of this study were to examine the effect of a family-centered intervention program (FCIP) on neurophysiological functions in preterm infants with very low birth weight (VLBW; birth weight of < 1500 g) in Taiwan, to compare the effect of the FCIP with that of a usual-care program (UCP), and to explore the FCIP-induced changes in neurobehavioral and neurophysiological functions.

DESIGN

This was a multicenter, single-blind randomized controlled trial.

SETTING

The study took place in 3 medical centers in northern and southern Taiwan.

PARTICIPANTS

Two hundred fifty-one preterm infants with VLBW were included.

INTERVENTION

The FCIP group received a family-centered intervention and the UCP group received standard care during hospitalization.

MEASUREMENTS

Infants were assessed in terms of neurobehavioral performance using the Neonatal Neurobehavioral Examination-Chinese version, and their neurophysiological function was assessed using electroencephalography/event-related potentials during sleep and during an auditory oddball task during the neonatal period.

RESULTS

The FCIP promoted more mature neurophysiological function than the UCP, including greater negative mean amplitudes of mismatch negativities in the left frontal region in the oddball task in all infants, lower intrahemispheric prefrontal-central coherence during sleep in infants who were small for gestational age, and higher interhemispheric frontal coherence during sleep in those who were appropriate for gestational age. Furthermore, interhemispheric coherence was positively associated with the total neurobehavioral score in preterm infants who were appropriate for gestational age (r = 0.20).

LIMITATIONS

The fact that more parental adherence strategies were used in the FCIP group than in the UCP group might have favored the intervention effect in this study.

CONCLUSIONS

Family-centered intervention facilitates short-term neurophysiological maturation in preterm infants with VLBW in Taiwan.

Short-term effects of single-dose chloral hydrate on neonatal auditory perception: An auditory event-related potential study

Objective

To study the short-term effects of a single-dose chloral hydrate on neonatal auditory perception by measuring auditory event-related potentials (aERPs).

Methods

Thirty-nine full-term neonates, aged 2–28 days and weighing 2980–4350 g, were divided into two groups including a chloral hydrate group (CH group, n = 17) and a non-chloral hydrate control group (non-CH group, n = 22). The CH group was given single-dose chloral hydrate (30 mg/kg) orally before aERPs measurement. An auditory oddball paradigm was used to elicit aERPs. P2 and N2 components of the ERP were recorded from electrodes at the Fz and Cz locations, and the areas under their curves (P2 and N2 areas) were calculated for the comparison between two groups.

Results

Significant differences was found in the P2 area between the two groups at Fz and Cz (Fz: F (1,37) = 487.75, P < 0.05; Cz: F (1,37) = 1465.94, P < 0.05). Similarly, significant difference was also in the N2 area between the two groups at both locations (Fz: F(1,37) = 153.38, P < 0.05; Cz: F(1,37) = 798.42, P < 0.05).

Conclusion

A single-dose of chloral hydrate impacts neonatal auditory perception in the short-term. Long-term effects will also be studied in future.

Impact of Brain Injury on Processing of Emotional Prosodies in Neonates

Being able to appropriately process different emotional prosodies is an important cognitive ability normally present at birth. In this study, we used event-related potential (ERP) to assess whether brain injury impacts the ability to process different emotional prosodies (happy, fear, and neutral) in neonates; whether the ERP measure has potential value for the evaluation of neurodevelopmental outcome in later childhood. A total of 42 full-term neonates were recruited from the neonatology department of Peking University First Hospital from June 2014 to January 2015. They were assigned to the brain injury group (n = 20) or control group (n = 22) according to their clinical manifestations, physical examinations, cranial images and routine EEG outcomes. Using an oddball paradigm, ERP data were recorded while subjects listened to happy (20%, deviation stimulus), fearful (20%, deviation stimulus) and neutral (80%, standard stimulus) prosodies to evaluate the potential prognostic value of ERP indexes for neurodevelopment at 30 months of age. Results showed that while the mismatch responses (MMRs) at the frontal lobe were larger for fearful than happy prosody in control neonates, this difference was not observed in neonates with brain injuries. This finding suggests that perinatal brain injury may influence the cognitive ability to process different emotional prosodies in neonatal brain; this deficit could be reflected by decreased MMR amplitudes in response to fearful prosody. Moreover, the decreased MMRs at the frontal lobe was associated with impaired neurodevelopment at 30 months old.

Enhanced Neonatal Brain Responses To Sung Streams Predict Vocabulary Outcomes By Age 18 Months

Words and melodies are some of the basic elements infants are able to extract early in life from the auditory input. Whether melodic cues contained in songs can facilitate word-form extraction immediately after birth remained unexplored. Here, we provided converging neural and computational evidence of the early benefit of melodies for language acquisition. Twenty-eight neonates were tested on their ability to extract word-forms from continuous flows of sung and spoken syllabic sequences. We found different brain dynamics for sung and spoken streams and observed successful detection of word-form violations in the sung condition only. Furthermore, neonatal brain responses for sung streams predicted expressive vocabulary at 18 months as demonstrated by multiple regression and cross-validation analyses. These findings suggest that early neural individual differences in prosodic speech processing might be a good indicator of later language outcomes and could be considered as a relevant factor in the development of infants' language skills.

Evaluation of auditory perception development in neonates by quantitative electroencephalography and auditory event-related potentials

Objective

The present study was performed to investigate neonatal auditory perception function by quantitative electroencephalography (QEEG) and auditory event-related potentials (aERPs) and identify the characteristics of auditory perception development in newborns.

Methods

Fifty-three normal full-term neonates were divided into three groups according their age in days. An auditory oddball paradigm was used. QEEG (resting state and task state) and aERPs were performed. EEG δ power in the resting and task states and at different ages was respectively analyzed. The N2 area and latency of aERPs at different ages were also compared.

Results

The four main findings of this study are as follows. First, the increase in the EEG δ power was significantly greater in the task than resting state in Group 3 at the Fz lead (t = −3.371, P = 0.004) and in Groups 2 and 3 at the Cz lead (Group 2: t = −3.149, P = 0.005; Group 3: t = −3.609, P = 0.002). Second, the δ power gradually increased from 1 to 10 days of age (Group 1), peaked at 11 to 20 days (Group 2), and gradually decreased from 21 to 28 days (Group 3). The data in the Fz lead during the task state and in the Cz lead during the resting and task states were statistically significant (F = 5.875, P = 0.005; F = 5.523, P = 0.007; and F = 5.402, P = 0.008, respectively). Third, the N2 area significantly increased with age by presentation of target stimuli (F = 5.26, P = 0.01). The N2 area increased most significantly from 21 to 28 days (Group 3). Finally, the N2 latency significantly decreased with age (Fz lead: F = 4.66, P = 0.023; Cz lead: F = 7.18, P = 0.005). The N2 latency decreased most significantly from 11 to 20 days of age (Group 2).

Conclusion

Rapid cognitive development occurs during the neonatal period. In the first several days after birth, the EEG δ power and N2 area manifested the characteristic performance of identifying task information. QEEG and aERP measurement can be used as objective indices with which to evaluate auditory perception development in neonates.

Evaluation of auditory perception development in neonates by event-related potential technique

OBJECTIVE

To investigate auditory perception development in neonates and correlate it with days after birth, left and right hemisphere development and sex using event-related potential (ERP) technique.

METHODS

Sixty full-term neonates, consisting of 32 males and 28 females, aged 2-28days were included in this study. An auditory oddball paradigm was used to elicit ERPs. N2 wave latencies and areas were recorded at different days after birth, to study on relationship between auditory perception and age, and comparison of left and right hemispheres, and males and females.

RESULTS

Average wave forms of ERPs in neonates started from relatively irregular flat-bottomed troughs to relatively regular steep-sided ripples. A good linear relationship between ERPs and days after birth in neonates was observed. As days after birth increased, N2 latencies gradually and significantly shortened, and N2 areas gradually and significantly increased (both P<0.01). N2 areas in the central part of the brain were significantly greater, and N2 latencies in the central part were significantly shorter in the left hemisphere compared with the right, indicative of left hemisphere dominance (both P<0.05). N2 areas were greater and N2 latencies shorter in female neonates compared with males.

CONCLUSION

The neonatal period is one of rapid auditory perception development. In the days following birth, the auditory perception ability of neonates gradually increases. This occurs predominantly in the left hemisphere, with auditory perception ability appearing to develop earlier in female neonates than in males. ERP can be used as an objective index used to evaluate auditory perception development in neonates.

Auditory event-related potentials are related to cognition at preschool age after very preterm birth

BACKGROUND

Auditory event-related potentials (AERP) are neurophysiological correlates of sound perception and cognitive processes. Our aim was to study in very preterm born children at preschool age if AERP correlate with cognitive outcome.

METHODS

Seventy children (mean ± SD gestational age 27.4 ± 1.9 wk, birth weight 996 ± 288 g) were investigated at age 4.3-5.3 y with psychological testing (WPPSI-R, four subtests of NEPSY). Electroencephalogram was recorded while they listened to a repeated standard tone, randomly replaced by one of three deviants. Latencies and amplitudes for AERP components and mean amplitudes in successive 50-ms AERP time windows were measured.

RESULTS

Better cognitive test results and higher gestational age correlated with shorter P1 latencies and more positive mean amplitudes 150-500 ms after stimulus change onset. Neonatal brain damage was associated with a negative displacement of AERP curves. Neonatal morbidity had an impact on earlier time windows while gestational age and brain damage on both early and later time windows.

CONCLUSION

AERP measures were associated with cognitive outcome. Neonatal morbidity mainly affects early cortical auditory encoding, while immaturity and brain damage additionally influence higher cortical functions of auditory perception and distraction. Perinatal auditory environment might play a role in development of auditory processing.

Brain development in infants born preterm: looking beyond injury

Infants born very preterm are high risk for acquired brain injury and disturbances in brain maturation. Although survival rates for preterm infants have increased in the last decades owing to improved neonatal intensive care, motor disabilities including cerebral palsy persist, and impairments in cognitive, language, social, and executive functions have not decreased. Evidence from neuroimaging studies exploring brain structure, function, and metabolism has indicated abnormalities in the brain development trajectory of very preterm-born infants that persist through to adulthood. In this chapter, we review neuroimaging approaches for the identification of brain injury in the preterm neonate. Advances in medical imaging and availability of specialized equipment necessary to scan infants have facilitated the feasibility of conducting longitudinal studies to provide greater understanding of early brain injury and atypical brain development and their effects on neurodevelopmental outcome. Improved understanding of the risk factors for acquired brain injury and associated factors that affect brain development in this population is setting the stage for improving the brain health of children born preterm.

The mismatch negativity (MMN)--a unique window to disturbed central auditory processing in ageing and different clinical conditions

In this article, we review clinical research using the mismatch negativity (MMN), a change-detection response of the brain elicited even in the absence of attention or behavioural task. In these studies, the MMN was usually elicited by employing occasional frequency, duration or speech-sound changes in repetitive background stimulation while the patient was reading or watching videos. It was found that in a large number of different neuropsychiatric, neurological and neurodevelopmental disorders, as well as in normal ageing, the MMN amplitude was attenuated and peak latency prolonged. Besides indexing decreased discrimination accuracy, these effects may also reflect, depending on the specific stimulus paradigm used, decreased sensory-memory duration, abnormal perception or attention control or, most importantly, cognitive decline. In fact, MMN deficiency appears to index cognitive decline irrespective of the specific symptomatologies and aetiologies of the different disorders involved.