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Lundy C, Boylan GB, Mathieson S, Proietti J, O'Toole JM. Quantitative analysis of high-frequency activity in neonatal EEG. Comput Biol Med 2023; 165:107468. [PMID: 37722158 DOI: 10.1016/j.compbiomed.2023.107468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 08/23/2023] [Accepted: 09/04/2023] [Indexed: 09/20/2023]
Abstract
OBJECTIVE To determine the presence and potential utility of independent high-frequency activity recorded from scalp electrodes in the electroencephalogram (EEG) of newborns. METHODS We compare interburst intervals and continuous activity at different frequencies for EEGs retrospectively recorded at 256 Hz from 4 newborn groups: 1) 36 preterms (<32 weeks' gestational age, GA); 2) 12 preterms (32-37 weeks' GA); 3) 91 healthy full terms; 4) 15 full terms with hypoxic-ischemic encephalopathy (HIE). At 4 standard frequency bands (delta, 0.5-3 Hz; theta, 3-8 Hz; alpha, 8-15 Hz; beta, 15-30 Hz) and 3 higher-frequency bands (gamma1, 30-48 Hz; gamma2, 52-99 Hz; gamma3, 107-127 Hz), we compared power spectral densities (PSDs), quantitative features, and machine learning model performance. Feature selection and further machine learning methods were performed on one cohort. RESULTS We found significant (P < 0.01) differences in PSDs, quantitative analysis, and machine learning modelling at the higher-frequency bands. Machine learning models using only high-frequency features performed best in preterm groups 1 and 2 with a median (95% confidence interval, CI) Matthews correlation coefficient (MCC) of 0.71 (0.12-0.88) and 0.66 (0.36-0.76) respectively. Interburst interval-detector models using both high- and standard-bandwidths produced the highest median MCCs in all four groups. High-frequency features were largely independent of standard-bandwidth features, with only 11/84 (13.1%) of correlations statistically significant. Feature selection methods produced 7 to 9 high-frequency features in the top 20 feature set. CONCLUSIONS This is the first study to identify independent high-frequency activity in newborn EEG using in-depth quantitative analysis. Expanding the EEG bandwidths of analysis has the potential to improve both quantitative and machine-learning analysis, particularly in preterm EEG.
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Affiliation(s)
- Christopher Lundy
- INFANT Research Centre, University College Cork, Cork, Ireland; Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Geraldine B Boylan
- INFANT Research Centre, University College Cork, Cork, Ireland; Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Sean Mathieson
- INFANT Research Centre, University College Cork, Cork, Ireland; Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Jacopo Proietti
- INFANT Research Centre, University College Cork, Cork, Ireland; Department of Neurosciences, Biomedicine and Movement, University of Verona, Italy
| | - John M O'Toole
- INFANT Research Centre, University College Cork, Cork, Ireland; Department of Paediatrics and Child Health, University College Cork, Cork, Ireland.
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Koskela T, Meek J, Huertas-Ceballos A, Kendall GS, Whitehead K. Clinical value of cortical bursting in preterm infants with intraventricular haemorrhage. Early Hum Dev 2023; 184:105840. [PMID: 37556995 DOI: 10.1016/j.earlhumdev.2023.105840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND In healthy preterm infants, cortical burst rate and temporal dynamics predict important measures such as brain growth. We hypothesised that in preterm infants with germinal matrix-intraventricular haemorrhage (GM-IVH), cortical bursting could provide prognostic information. AIMS We determined how cortical bursting was influenced by the injury, and whether this was related to developmental outcome. STUDY DESIGN Single-centre retrospective cohort study at University College London Hospitals, UK. SUBJECTS 33 infants with GM-IVH ≥ grade II (median gestational age: 25 weeks). OUTCOME MEASURES We identified 47 EEGs acquired between 24 and 40 weeks corrected gestational age as part of routine clinical care. In a subset of 33 EEGs from 25 infants with asymmetric injury, we used the least-affected hemisphere as an internal comparison. We tested whether cortical burst rate predicted survival without severe impairment (median 2 years follow-up). RESULTS In asymmetric injury, cortical burst rate was lower over the worst- than least-affected hemisphere, and bursts over the worst-affected hemisphere were less likely to immediately follow bursts over the least-affected hemisphere than vice versa. Overall, burst rate was lower in cases of GM-IVH with parenchymal involvement, relative to milder structural injury grades. Higher burst rate modestly predicted survival without severe language (AUC 0.673) or motor impairment (AUC 0.667), which was partly mediated by structural injury grade. CONCLUSIONS Cortical bursting can index the functional injury after GM-IVH: perturbed burst initiation (rate) and propagation (inter-hemispheric dynamics) likely reflect associated grey matter and white matter damage. Higher cortical burst rate is reassuring for a positive outcome.
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Affiliation(s)
- Tuomas Koskela
- Research IT Services, University College London, London WC1E 7HB, UK.
| | - Judith Meek
- Neonatal Intensive Care Unit, Elizabeth Garrett Anderson Wing, University College London Hospitals, London WC1E 6DB, UK; Academic Neonatology, Institute for Women's Health, University College London, London WC1E 6HU, UK.
| | - Angela Huertas-Ceballos
- Neonatal Intensive Care Unit, Elizabeth Garrett Anderson Wing, University College London Hospitals, London WC1E 6DB, UK.
| | - Giles S Kendall
- Neonatal Intensive Care Unit, Elizabeth Garrett Anderson Wing, University College London Hospitals, London WC1E 6DB, UK; Academic Neonatology, Institute for Women's Health, University College London, London WC1E 6HU, UK.
| | - Kimberley Whitehead
- Neonatal Intensive Care Unit, Elizabeth Garrett Anderson Wing, University College London Hospitals, London WC1E 6DB, UK; Department of Neuroscience, Physiology & Pharmacology, University College London, London WC1E 6BT, UK.
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Abstract
This article describes the changes in normal sleep regulation, structure, and organization and sleep-related changes in respiration from infancy to adolescence. The first 2 years of age are striking, with more time asleep than awake. With development, the electroencephalogram architecture has a marked reduction in rapid eye movement sleep and the acquisition of K-complexes, sleep spindles, and slow-wave sleep. During adolescence there is a reduction in slow-wave sleep and a delay in the circadian phase. Infants have a more collapsible upper airway and lower lung volumes than older children, which predisposes them to obstructive sleep apnea and sleep-related hypoxemia.
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Fang XY, Tian YL, Chen SY, Shi Q, Zheng D, Wang YJ, Mao J. [A novel method for electroencephalography background analysis in neonates with hypoxic-ischemic encephalopathy]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2023; 25:128-134. [PMID: 36854687 DOI: 10.7499/j.issn.1008-8830.2208102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
OBJECTIVES To explore a new method for electroencephalography (EEG) background analysis in neonates with hypoxic-ischemic encephalopathy (HIE) and its relationship with clinical grading and head magnetic resonance imaging (MRI) grading. METHODS A retrospective analysis was performed for the video electroencephalography (vEEG) and amplitude-integrated electroencephalography (aEEG) monitoring data within 24 hours after birth of neonates diagnosed with HIE from January 2016 to August 2022. All items of EEG background analysis were enrolled into an assessment system and were scored according to severity to obtain the total EEG score. The correlations of total EEG score with total MRI score and total Sarnat score (TSS, used to evaluate clinical gradings) were analyzed by Spearman correlation analysis. The total EEG score was compared among the neonates with different clinical gradings and among the neonates with different head MRI gradings. The receiver operating characteristic (ROC) curve and the area under thecurve (AUC) were used to evaluate the value of total EEG score in diagnosing moderate/severe head MRI abnormalities and clinical moderate/severe HIE, which was then compared with the aEEG grading method. RESULTS A total of 50 neonates with HIE were included. The total EEG score was positively correlated with the total head MRI score and TSS (rs=0.840 and 0.611 respectively, P<0.001). There were significant differences in the total EEG score between different clinical grading groups and different head MRI grading groups (P<0.05). The total EEG score and the aEEG grading method had an AUC of 0.936 and 0.617 respectively in judging moderate/severe head MRI abnormalities (P<0.01) and an AUC of 0.887 and 0.796 respectively in judging clinical moderate/severe HIE (P>0.05). The total EEG scores of ≤6 points, 7-13 points, and ≥14 points were defined as mild, moderate, and severe EEG abnormalities respectively, which had the best consistency with clinical grading and head MRI grading (P<0.05). CONCLUSIONS The new EEG background scoring method can quantitatively reflect the severity of brain injury and can be used for the judgment of brain function in neonates with HIE.
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Affiliation(s)
- Xiu-Ying Fang
- Department of Neonatology, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Yi-Li Tian
- Department of Neonatology, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Shu-Yuan Chen
- Department of Neonatology, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Quan Shi
- Department of Neonatology, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Duo Zheng
- Department of Neonatology, Shengjing Hospital of China Medical University, Shenyang 110004, China
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Bourel-Ponchel E, Querne L, Flamein F, Ghostine-Ramadan G, Wallois F, Lamblin MD. The prognostic value of neonatal conventional-EEG monitoring in hypoxic-ischemic encephalopathy during therapeutic hypothermia. Dev Med Child Neurol 2023; 65:58-66. [PMID: 35711160 PMCID: PMC10084260 DOI: 10.1111/dmcn.15302] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 05/02/2022] [Accepted: 05/04/2022] [Indexed: 01/28/2023]
Abstract
AIM To determine the prognostic value of conventional electroencephalography (EEG) monitoring in neonatal hypoxic-ischemic encephalopathy (HIE). METHOD In this multicentre retrospective study, 95 full-term neonates (mean of 39.3wks gestational age [SD 1.4], 36 [38%] females, 59 [62%] males) with HIE (2013-2016) undergoing therapeutic hypothermia were divided between favourable or adverse outcomes. Background EEG activity (French classification scale: 0-1-2-3-4-5) and epileptic seizure burden (epileptic seizure scale: 0-1-2) were graded for seven 6-hour periods. Conventional EEG monitoring was investigated by principal component analysis (PCA), with clustering methods to extract prognostic biomarkers of development at 2 years and infant death. RESULTS Eighty-one per cent of infants with an adverse outcome had a French classification scale equal to or greater than 3 after H48 (100% at H6-12). The H6-12 epileptic seizure scale was equal to or greater than 1 for 39%, increased to 52% at H30-36 and then remained equal to or greater than 1 for 39% after H48. Forty-five per cent of infants with a favourable outcome had a H6-12 French classification scale equal to or greater than 3, which dropped to 5% after H48; 13% had a H6-12 epileptic seizure scale equal to or greater than 1 but no seizures after H48. Clustering methods based on PCA showed the high efficiency (96%) of conventional EEG monitoring for outcome prediction and allowed the definition of three prognostic EEG biomarkers: H6-78 French classification scale mean, H6-78 French classification scale slope, and H30-78 epileptic seizure scale mean. INTERPRETATION Early lability and recovery of physiological features is prognostic of a favourable outcome. Seizure onset from the second day should also be considered to accurately predict neurodevelopment in HIE and support the importance of conventional EEG monitoring in HIE in infants cooled with therapeutic hypothermia. WHAT THIS PAPER ADDS Comprehensive analysis showed the high prognostic efficiency (96%) of conventional electroencephalography (EEG) monitoring. Prognostic EEG biomarkers consist of the grade of background EEG activity, its evolution, and the mean seizure burden. Persistent seizures (H48) without an improvement in background EEG activity were consistently associated with an adverse outcome.
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Affiliation(s)
- Emilie Bourel-Ponchel
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1105, Research Group on Multimodal Analysis of Brain Function, University of Picardie Jules Verne, Amiens, France.,Pediatric Neurophysiology Unit, Amiens Picardie University Hospital, Amiens, France
| | - Laurent Querne
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1105, Research Group on Multimodal Analysis of Brain Function, University of Picardie Jules Verne, Amiens, France.,Department of Pediatric Neurology, Amiens-Picardie University Hospital, Amiens, France
| | - Florence Flamein
- Department of Neonatology, University Hospital of Lille, Lille, France
| | - Ghida Ghostine-Ramadan
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1105, Research Group on Multimodal Analysis of Brain Function, University of Picardie Jules Verne, Amiens, France.,Neonatal Intensive Care Unit, Amiens-Picardie University Hospital, Amiens, France
| | - Fabrice Wallois
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1105, Research Group on Multimodal Analysis of Brain Function, University of Picardie Jules Verne, Amiens, France.,Pediatric Neurophysiology Unit, Amiens Picardie University Hospital, Amiens, France
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Delval A, Girard B, Lacan L, Chaton L, Flamein F, Storme L, Derambure P, The Tich SN, Lamblin MD, Betrouni N. Neurophysiological recordings improve the accuracy of the evaluation of the outcome in perinatal hypoxic ischemic encephalopathy. Eur J Paediatr Neurol 2022; 36:51-56. [PMID: 34890946 DOI: 10.1016/j.ejpn.2021.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 09/20/2021] [Accepted: 11/16/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Our objective was to evaluate the potential additional value of electroencephalogram (EEG) and evoked potentials in neonates with hypoxic-ischemic encephalopathy to predict their disability at 1 and 2 years old. METHODS 30 full-term infants after perinatal asphyxia who underwent therapeutic hypothermia were evaluated at 1 year and 2 years for disability using International Classification of Functioning, Disability and Health classification. Scores for EEG, sensory evoked potentials and brainstem auditory evoked potentials were evaluated after withdrawal of therapeutic hypothermia that lasted 72 h. A regression approach was investigated to build models allowing to distinguish neonates according to their disability at 1 and 2 years. Two models were built, the first by considering the clinical data and EEG before and after therapeutic hypothermia and the second by incorporating evoked potentials recording. RESULTS Adding EEG and evoked potentials data after rewarming improved dramatically the accuracy of the model considering outcome at 1 and 2 years. INTERPRETATION We propose to record systematically EEG and evoked potentials following rewarming to predict the outcome of neonates with hypoxic ischemic encephalopathy. Combination of altered evoked potentials with no improvement of EEG after rewarming appeared to be a robust criterion for a poor outcome.
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Affiliation(s)
- Arnaud Delval
- Univ. Lille, Inserm, U1172 - Lille, Neuroscience Cognition, F-59000, Lille, France; Clinical Neurophysiology Department, Lille University Medical Center, F-59000, Lille, France.
| | - Barbara Girard
- Children Department of Physical Medicine and Rehabilitation, Institut Régional de Réadaptation, Flavigny sur Moselle, France
| | - Laure Lacan
- EA4489, Environnement Périnatal et Santé, Faculté de Médecine, Université de Lille, France; Pediatric Neurology Department, Lille University Medical Center, F-59000, Lille, France
| | - Laurence Chaton
- Clinical Neurophysiology Department, Lille University Medical Center, F-59000, Lille, France
| | - Florence Flamein
- EA4489, Environnement Périnatal et Santé, Faculté de Médecine, Université de Lille, France
| | - Laurent Storme
- Pediatric Neurology Department, Lille University Medical Center, F-59000, Lille, France
| | - Philippe Derambure
- Univ. Lille, Inserm, U1172 - Lille, Neuroscience Cognition, F-59000, Lille, France; Clinical Neurophysiology Department, Lille University Medical Center, F-59000, Lille, France
| | - Sylvie Nguyen The Tich
- EA4489, Environnement Périnatal et Santé, Faculté de Médecine, Université de Lille, France; Pediatric Neurology Department, Lille University Medical Center, F-59000, Lille, France
| | - Marie-Dominique Lamblin
- Clinical Neurophysiology Department, Lille University Medical Center, F-59000, Lille, France
| | - Nacim Betrouni
- Univ. Lille, Inserm, U1172 - Lille, Neuroscience Cognition, F-59000, Lille, France
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Basile C, Gigliotti F, Cesario S, Bruni O. The relation between sleep and neurocognitive development in infancy and early childhood: A neuroscience perspective. ADVANCES IN CHILD DEVELOPMENT AND BEHAVIOR 2021; 60:9-27. [PMID: 33641802 DOI: 10.1016/bs.acdb.2020.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Sleep is essential for human life. It has different characteristics in the early stages of life compared to later periods: during development, qualitative and quantitative changes in sleep features occur such as the onset of REM/NREM sleep at 3 months, the progressive increase of night sleep duration, and the reduction of total sleep time. Sleep seems to be essential in the cognitive functions' development, especially in the first period of life. Indeed, higher rates of night sleep at the age of 12 and 18 months are associated with higher executive functions' performance. Furthermore, memory consolidation occurs during sleep and sleep contributes to children's learning not only in retaining information but also in organizing memories most efficiently. Therefore, sleep problems could cause negative effects on some features of cognitive development like memory, executive functions, and learning process. There is also an intimate relationship between sleep and regulation of emotional brain functions, with a link between sleep disturbance and behavioral problems.
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Affiliation(s)
- Consuelo Basile
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Federica Gigliotti
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Serena Cesario
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Oliviero Bruni
- Department of Developmental and Social Psychology, Sapienza University of Rome, Rome, Italy.
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Koch G, Jost K, Schulzke SM, Koch R, Pfister M, Datta AN. The rhythm of a preterm neonate's life: ultradian oscillations of heart rate, body temperature and sleep cycles. J Pharmacokinet Pharmacodyn 2021; 48:401-410. [PMID: 33523331 DOI: 10.1007/s10928-020-09735-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 12/21/2020] [Indexed: 02/07/2023]
Abstract
The objectives are to characterize oscillations of physiological functions such as heart rate and body temperature, as well as the sleep cycle from behavioral states in generally stable preterm neonates during the first 5 days of life. Heart rate, body temperature as well as behavioral states were collected during a daily 3-h observation interval in 65 preterm neonates within the first 5 days of life. Participants were born before 32 weeks of gestational age or had a birth weight below 1500 g; neonates with asphyxia, proven sepsis or malformation were excluded. In total 263 observation intervals were available. Heart rate and body temperature were analyzed with mathematical models in the context of non-linear mixed effects modeling, and the sleep cycles were characterized with signal processing methods. The average period length of an oscillation in this preterm neonate population was 159 min for heart rate, 290 min for body temperature, and the average sleep cycle duration was 19 min. Oscillation of physiological functions as well as sleep cycles can be characterized in very preterm neonates within the first few days of life. The observed parameters heart rate, body temperature and sleep are running in a seemingly uncorrelated pace at that stage of development. Knowledge about such oscillations may help to guide nursing and medical care in these neonates as they do not yet follow a circadian rhythm.
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Affiliation(s)
- Gilbert Koch
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel UKBB, Spitalstrasse 33, 4056, Basel, Switzerland.
| | - Kerstin Jost
- Department of Neonatology, University Children's Hospital Basel UKBB, Basel, Switzerland
| | - Sven M Schulzke
- Department of Neonatology, University Children's Hospital Basel UKBB, Basel, Switzerland
| | | | - Marc Pfister
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel UKBB, Spitalstrasse 33, 4056, Basel, Switzerland
| | - Alexandre N Datta
- Pediatric Neurology and Developmental Medicine Department, University Children's Hospital Basel UKBB, Basel, Switzerland
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Lacan L, Betrouni N, Lamblin MD, Chaton L, Delval A, Bourriez JL, Storme L, Derambure P, NguyenThe Tich S. Quantitative approach to early neonatal EEG visual analysis in hypoxic-ischemic encephalopathy severity: Bridging the gap between eyes and machine. Neurophysiol Clin 2021; 51:121-131. [PMID: 33402313 DOI: 10.1016/j.neucli.2020.12.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/02/2020] [Accepted: 12/02/2020] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To identify relevant quantitative parameters for early classification of neonatal hypoxic-ischemic encephalopathy (HIE) severity from conventional EEGs. METHODS Ninety EEGs, recorded in full-term infants within 6 h of life after perinatal hypoxia, were visually classified according to the French EEG classification into three groups of increasing HIE severity. Physiologically significant EEG features (signal amplitude, continuity and frequency content) were automatically quantified using different parameters. The EEG parameters selection was based on their ability to reproduce the visual EEG classification. Post hoc analysis based on clinical outcome was performed. RESULTS Six EEG parameters were selected, with overall EEG classification performances between 61% and 70%. All parameters differed significantly between group 3 (severe) and groups 1 (normal-mildly abnormal) and 2 (moderate) EEGs (p < 0.001). Amplitude and discontinuity parameters were different between the 3 groups (p < 0.01) and were also the best predictors of clinical outcome. Conversely, pH and lactate did not differ between groups. DISCUSSION This study provides quantitative EEG parameters that are complementary to visual analysis as early markers of neonatal HIE severity. These parameters could be combined in a multiparametric algorithm to improve their classification performance. The absence of relationship between pH lactate and HIE severity reinforces the central role of early neonatal EEG.
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Affiliation(s)
- Laure Lacan
- EA4489, Environnement périnatal et santé, Faculté de médecine, Université de Lille, 2 Avenue Eugène Avinée, 59120 Loos, France; Service de Neurologie pédiatrique, Hôpital Roger Salengro, CHRU de Lille, Avenue du Professeur Emile Laine, 59037, France.
| | - Nacim Betrouni
- Inserm U 1172, Faculté de médecine, Université de Lille, 2 Avenue Eugène Avinée, 59120 Loos, France; Service de Neurophysiologie Clinique, Hôpital Roger Salengro, CHRU de Lille, Avenue du Professeur Emile Laine, 59037, France
| | - Marie-Dominique Lamblin
- Service de Neurophysiologie Clinique, Hôpital Roger Salengro, CHRU de Lille, Avenue du Professeur Emile Laine, 59037, France
| | - Laurence Chaton
- Inserm U 1172, Faculté de médecine, Université de Lille, 2 Avenue Eugène Avinée, 59120 Loos, France; Service de Neurophysiologie Clinique, Hôpital Roger Salengro, CHRU de Lille, Avenue du Professeur Emile Laine, 59037, France
| | - Arnaud Delval
- Inserm U 1172, Faculté de médecine, Université de Lille, 2 Avenue Eugène Avinée, 59120 Loos, France; Service de Neurophysiologie Clinique, Hôpital Roger Salengro, CHRU de Lille, Avenue du Professeur Emile Laine, 59037, France
| | - Jean-Louis Bourriez
- Inserm U 1172, Faculté de médecine, Université de Lille, 2 Avenue Eugène Avinée, 59120 Loos, France; Service de Neurophysiologie Clinique, Hôpital Roger Salengro, CHRU de Lille, Avenue du Professeur Emile Laine, 59037, France
| | - Laurent Storme
- EA4489, Environnement périnatal et santé, Faculté de médecine, Université de Lille, 2 Avenue Eugène Avinée, 59120 Loos, France
| | - Philippe Derambure
- Inserm U 1172, Faculté de médecine, Université de Lille, 2 Avenue Eugène Avinée, 59120 Loos, France; Service de Neurophysiologie Clinique, Hôpital Roger Salengro, CHRU de Lille, Avenue du Professeur Emile Laine, 59037, France
| | - Sylvie NguyenThe Tich
- EA4489, Environnement périnatal et santé, Faculté de médecine, Université de Lille, 2 Avenue Eugène Avinée, 59120 Loos, France; Service de Neurologie pédiatrique, Hôpital Roger Salengro, CHRU de Lille, Avenue du Professeur Emile Laine, 59037, France
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Garvey AA, Pavel AM, O’Toole JM, Walsh BH, Korotchikova I, Livingstone V, Dempsey EM, Murray DM, Boylan GB. Multichannel EEG abnormalities during the first 6 hours in infants with mild hypoxic-ischaemic encephalopathy. Pediatr Res 2021; 90:117-124. [PMID: 33879847 PMCID: PMC8370873 DOI: 10.1038/s41390-021-01412-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Infants with mild HIE are at risk of significant disability at follow-up. In the pre-therapeutic hypothermia (TH) era, electroencephalography (EEG) within 6 hours of birth was most predictive of outcome. This study aims to identify and describe features of early EEG and heart rate variability (HRV) (<6 hours of age) in infants with mild HIE compared to healthy term infants. METHODS Infants >36 weeks with mild HIE, not undergoing TH, with EEG before 6 hours of age were identified from 4 prospective cohort studies conducted in the Cork University Maternity Services, Ireland (2003-2019). Control infants were taken from a contemporaneous study examining brain activity in healthy term infants. EEGs were qualitatively analysed by two neonatal neurophysiologists and quantitatively assessed using multiple features of amplitude, spectral shape and inter-hemispheric connectivity. Quantitative features of HRV were assessed in both the groups. RESULTS Fifty-eight infants with mild HIE and sixteen healthy term infants were included. Seventy-two percent of infants with mild HIE had at least one abnormal EEG feature on qualitative analysis and quantitative EEG analysis revealed significant differences in spectral features between the two groups. HRV analysis did not differentiate between the groups. CONCLUSIONS Qualitative and quantitative analysis of the EEG before 6 hours of age identified abnormal EEG features in mild HIE, which could aid in the objective identification of cases for future TH trials in mild HIE. IMPACT Infants with mild HIE currently do not meet selection criteria for TH yet may be at risk of significant disability at follow-up. In the pre-TH era, EEG within 6 hours of birth was most predictive of outcome; however, TH has delayed this predictive value. 72% of infants with mild HIE had at least one abnormal EEG feature in the first 6 hours on qualitative assessment. Quantitative EEG analysis revealed significant differences in spectral features between infants with mild HIE and healthy term infants. Quantitative EEG features may aid in the objective identification of cases for future TH trials in mild HIE.
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Affiliation(s)
- Aisling A. Garvey
- INFANT Research Centre, Cork, Ireland ,grid.7872.a0000000123318773Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Andreea M. Pavel
- INFANT Research Centre, Cork, Ireland ,grid.7872.a0000000123318773Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - John M. O’Toole
- INFANT Research Centre, Cork, Ireland ,grid.7872.a0000000123318773Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Brian H. Walsh
- INFANT Research Centre, Cork, Ireland ,grid.7872.a0000000123318773Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Irina Korotchikova
- INFANT Research Centre, Cork, Ireland ,grid.7872.a0000000123318773Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Vicki Livingstone
- INFANT Research Centre, Cork, Ireland ,grid.7872.a0000000123318773Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Eugene M. Dempsey
- INFANT Research Centre, Cork, Ireland ,grid.7872.a0000000123318773Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Deirdre M. Murray
- INFANT Research Centre, Cork, Ireland ,grid.7872.a0000000123318773Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Geraldine B. Boylan
- INFANT Research Centre, Cork, Ireland ,grid.7872.a0000000123318773Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
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11
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Li D, Huang W, Yang F, Li B, Cai S. Study of the modulatory mechanism of the miR-182-Clock axis in circadian rhythm disturbance after hypoxic–ischemic brain damage. EUR J INFLAMM 2020. [DOI: 10.1177/2058739220929159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Hypoxic–ischemic encephalopathy (HIE) in neonates can lead to severe chronic neurological deficit, including mental retardation, epilepsy, and sleep–wake cycle (SWC) disorder. Among these defects, little is known about the molecular mechanism of circadian rhythm disorder after HIE. Therefore, further study of sleep problems and its mechanism in HIE children will provide new ideas for clinical treatment of HIE children. For pediatric patients with cerebral ischemia, somnipathy often occurs due to visual and airway abnormalities. From May 2010 to August 2013, 128 newborns with history of HIE were followed up. Meanwhile, 88 normal full-term newborns in the same period were taken as the control group. The clinical data of the patients were collected and the sleep status was assessed by questionnaire. To establish the hypoxic–ischemic brain injury model of neonatal rats and analyze the mechanism of mir-182 in the circadian rhythm disorder caused by pineal function injury. The core clock genes during the regulation of the circadian clock were explored by bioinformatics methods. Patients’ sleep quality was affected by the circadian rhythm and respiratory problems; the pineal gland can regulate the core clock genes in the circadian clock during regulation. miR-182 was highly expressed in the pineal gland after hypoxic–ischemic brain damage (HIBD). Children with mild and moderate HIE showed significant sleep disorders in varying degrees, which provided a clinical basis for improving the long-term prognosis of children with HIE through targeted treatment of sleep disorders. MiR-182 is highly expressed in the pineal gland and is related to the expression of CLOCK protein. CLOCK gene is the target gene of miR-182, which provides a new target for the treatment of rhythm disorder related to the damage of pineal function caused by HIBD.
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Affiliation(s)
- Dezhan Li
- Department of Anesthesiology, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University, Jingzhou, P.R. China
| | - Wei Huang
- Department of Neurology, Taihe Hospital, Hubei University of Medicine, Shiyan, P.R. China
| | - Fang Yang
- Department of Clinical Oncology, Taihe Hospital, Hubei University of Medicine, Shiyan, P.R. China
| | - Bin Li
- Department of Pediatric Surgery, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University, Jingzhou, P.R. China
| | - Shanshan Cai
- Department of Cardiovascular, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, P.R. China
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12
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Interrater and Intrarater Agreement in Neonatal Electroencephalogram Background Scoring. J Clin Neurophysiol 2019; 36:1-8. [PMID: 30383719 DOI: 10.1097/wnp.0000000000000534] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Many neonates undergo electroencephalogram (EEG) monitoring to identify and manage acute symptomatic seizures. Information about brain function contained in the EEG background data may also help predict neurobehavioral outcomes. For EEG background features to be useful as prognostic indicators, the interpretation of these features must be standardized across electroencephalographers. We aimed at determining the interrater and intrarater agreement among electroencephalographers interpreting neonatal EEG background patterns. METHODS Five neonatal electroencephalographers reviewed 5-to-7.5-minute epochs of EEG from full-term neonates who underwent continuous conventional EEG monitoring. The EEG assessment tool used to classify background patterns was based on the American Clinical Neurophysiology Society's guideline for neonatal EEG terminology. Interrater and intrarater agreement were measured using Kappa coefficients. RESULTS Interrater agreement was consistently highest for voltage (binary: substantial, kappa = 0.783; categorical: moderate, kappa = 0.562), seizure presence (fair-substantial; kappa = 0.375-0.697), continuity (moderate; kappa = 0.481), burst voltage (moderate; kappa = 0.574), suppressed background presence (moderate-substantial; kappa = 0.493-0.643), delta activity presence (fair-moderate; kappa = 0.369-0.432), theta activity presence (fair-moderate; kappa = 0.347-0.600), presence of graphoelements (fair; kappa = 0.381), and overall impression (binary: moderate, kappa = 0.495; categorical: fair-moderate, kappa = 0.347, 0.465). Agreement was poor or inconsistent for all other patterns. Intrarater agreement was variable, with highest average agreement for voltage (binary: substantial, kappa = 0.75; categorical: substantial, kappa = 0.714) and highest consistent agreement for continuity (moderate-substantial; kappa = 0.43-0.67) and overall impression (moderate-substantial; kappa = 0.42-0.68). CONCLUSIONS This study demonstrates substantial variability in neonatal EEG background interpretation across electroencephalographers, indicating a need for educational and technological strategies aimed at improving performance.
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13
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Zhu L, Qi B, Hou D. Roles of HIF1α- and HIF2α-regulated BNIP3 in hypoxia-induced injury of neurons. Pathol Res Pract 2019; 215:822-827. [DOI: 10.1016/j.prp.2019.01.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 01/03/2019] [Accepted: 01/17/2019] [Indexed: 12/19/2022]
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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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15
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Dempsey EM, Kooi EMW, Boylan G. It's All About the Brain-Neuromonitoring During Newborn Transition. Semin Pediatr Neurol 2018; 28:48-59. [PMID: 30522728 DOI: 10.1016/j.spen.2018.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- E M Dempsey
- Department of Paediatrics and Child Health, Neonatal Intensive Care Unit, University College Cork, Cork, Ireland; INFANT, Irish Centre for Fetal and Neonatal Translational Research, University College Cork, Cork, Ireland
| | - E M W Kooi
- Department of Paediatrics and Child Health, Neonatal Intensive Care Unit, University College Cork, Cork, Ireland; Division of Neonatology, University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Groningen, The Netherlands
| | - Geraldine Boylan
- Department of Paediatrics and Child Health, Neonatal Intensive Care Unit, University College Cork, Cork, Ireland; INFANT, Irish Centre for Fetal and Neonatal Translational Research, University College Cork, Cork, Ireland.
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16
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Rensing N, Moy B, Friedman JL, Galindo R, Wong M. Longitudinal analysis of developmental changes in electroencephalography patterns and sleep-wake states of the neonatal mouse. PLoS One 2018; 13:e0207031. [PMID: 30399187 PMCID: PMC6219806 DOI: 10.1371/journal.pone.0207031] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 10/23/2018] [Indexed: 11/19/2022] Open
Abstract
The neonatal brain undergoes rapid maturational changes that facilitate the normal development of the nervous system and also affect the pathological response to brain injury. Electroencephalography (EEG) and analysis of sleep-wake vigilance states provide important insights into the function of the normal and diseased immature brain. While developmental changes in EEG and vigilance states are well-described in people, less is known about the normal maturational properties of rodent EEG, including the emergence and evolution of sleep-awake vigilance states. In particular, a number of developmental EEG studies have been performed in rats, but there is limited comparable research in neonatal mice, especially as it pertains to longitudinal EEG studies performed within the same mouse. In this study, we have attempted to provide a relatively comprehensive assessment of developmental changes in EEG background activity and vigilance states in wild-type mice from postnatal days 9-21. A novel EEG and EMG method allowed serial recording from the same mouse pups. EEG continuity and power and vigilance states were analyzed by quantitative assessment and fast Fourier transforms. During this developmental period, we demonstrate the timing of maturational changes in EEG background continuity, frequencies, and power and the emergence of identifiable wake, NREM, and REM sleep states. These results should serve as important control data for physiological studies of mouse models of normal brain development and neurological disease.
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Affiliation(s)
- Nicholas Rensing
- Department of Neurology and the Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Brianna Moy
- Department of Neurology and the Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Joseph L. Friedman
- Department of Neurology and the Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Rafael Galindo
- Department of Neurology and the Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Michael Wong
- Department of Neurology and the Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, Missouri, United States of America
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Demianenko LE, Poddubnaya EP, Makedonsky IA, Kulagina IB, Korogod SM. Hypothermic Suppression of Epileptiform Bursting Activity of a Hyppocampal Granule Neuron Possessing Thermosensitive TRP Channels (a Model Study: Biophysical and Clinical Aspects). NEUROPHYSIOLOGY+ 2017. [DOI: 10.1007/s11062-017-9624-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Wu H, Li Z, Liu J, Liu G, Yang X. Clinical study on amplitude integrated electroencephalogram in cerebral injury caused by severe neonatal hyperbilirubinemia. Minerva Pediatr 2017; 70:539-544. [PMID: 28206723 DOI: 10.23736/s0026-4946.17.04792-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND This study was designed in order to assess the validity of the use of amplitude-integrated electroencephalogram (aEEG) in cerebral injury caused by severe neonatal hyperbilirubinemia. METHODS A total of 56 full-term neonates diagnosed with severe neonatal hyperbilirubinemia and admitted to the NICU of our hospital from July 2013 to December 2014 were continuously selected for the study. The total serum bilirubin (TSB) was higher than 342 μmol/L and was dominated by a higher amount of unconjugated bilirubin. Each patient underwent aEEG monitoring upon admission. And according to the results of the test, they were assigned into an aEEG normal group (N.=38) or an aEEG abnormal group (N.=18). Dynamic monitoring of bilirubin and blood biochemistry was also conducted for all the children after admission. Patients were treated with blue light, anti-infection agents, acidosis correction measures, transfusion exchanges, intravenous drips of albumin or globulin and other specific treatments as needed in each particular case. Brainstem auditory evoked potential (BAEP), MRI examination and a behavioral neurological assessment (NBNA) with 20-item examinations were provided within 4-17 days after admission. Follow-up observations were conducted on growth level (physical development and Gesell scores) at 3, 6, 12 and 18 months. RESULTS The results of all the diagnostic tests performed in the patients of both groups all yielded a significantly higher abnormality rate in the aEEG abnormal group compared to the results in the aEEG normal group. Furthermore, the results of follow-up tests showing growth and child development also showed higher abnormality rates in the aEEG abnormal group than in the aEEG normal group. CONCLUSIONS Since the results of our aEEG monitoring were consistent with the findings of other diagnostic tests, we proved the convenience and effectivity of aEEG for guiding the treatment and prognosis of severe hyperbilirubinemia in neonates.
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Affiliation(s)
- Hongwei Wu
- Department of Neonatology, Xuzhou Children's Hospital, Xuzhou, China
| | - Zhenguang Li
- Department of Neonatology, Xuzhou Children's Hospital, Xuzhou, China -
| | - Jinfeng Liu
- Department of Neonatology, Xuzhou Children's Hospital, Xuzhou, China
| | - Gang Liu
- Department of Neonatology, Xuzhou Children's Hospital, Xuzhou, China
| | - Xia Yang
- Department of Neonatology, Xuzhou Children's Hospital, Xuzhou, China
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Grigg-Damberger MM. The Visual Scoring of Sleep in Infants 0 to 2 Months of Age. J Clin Sleep Med 2017; 12:429-45. [PMID: 26951412 DOI: 10.5664/jcsm.5600] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 12/13/2015] [Indexed: 11/13/2022]
Abstract
UNLABELLED In March 2014, the American Academy of Sleep Medicine (AASM) Board of Directors requested the Scoring Manual Editorial Board develop rules, terminology, and technical specifications for scoring sleep/wake states in full-term infants from birth to 2 mo of age, cognizant of the 1971 Anders, Emde, and Parmelee Manual for Scoring Sleep in Newborns. On July 1, 2015, the AASM published rules for scoring sleep in infants, ages 0-2 mo. This evidence-based review summarizes the background information provided to the Scoring Manual Editorial Board to write these rules. The Anders Manual only provided criteria for coding physiological and behavioral state characteristics in polysomnograms (PSG) of infants, leaving specific sleep scoring criteria to the individual investigator. Other infant scoring criteria have been published, none widely accepted or used. The AASM Scoring Manual infant scoring criteria incorporate modern concepts, digital PSG recording techniques, practicalities, and compromises. Important tenets are: (1) sleep/wake should be scored in 30-sec epochs as either wakefulness (W), rapid eye movement, REM (R), nonrapid eye movement, NREM (N) and transitional (T) sleep; (2) an electroencephalographic (EEG) montage that permits adequate display of young infant EEG is: F3-M2, F4-M1, C3-M2, C4-M1, O1-M2, O2-M1; additionally, recording C3-Cz, Cz-C4 help detect early and asynchronous sleep spindles; (3) sleep onsets are more often R sleep until 2-3 mo postterm; (4) drowsiness is best characterized by visual observation (supplemented by later video review); (5) wide open eyes is the most crucial determinant of W; (6) regularity (or irregularity) of respiration is the single most useful PSG characteristic for scoring sleep stages at this age; (7) trace alternant (TA) is the only relatively distinctive EEG pattern, characteristic of N sleep, and usually disappears by 1 mo postterm replaced by high voltage slow (HVS); (8) sleep spindles first appear 44-48 w conceptional age (CA) and when present prompt scoring N; (9) score EEG activity in an epoch as "continuous" or "discontinuous" for inter-scorer reliability; (10) score R if four or more of the following conditions are present, including irregular respiration and rapid eye movement(s): (a) low chin EMG (for the majority of the epoch); (b) eyes closed with at least one rapid eye movement (concurrent with low chin tone); (c) irregular respiration; (d) mouthing, sucking, twitches, or brief head movements; and (e) EEG exhibits a continuous pattern without sleep spindles; (11) because rapid eye movements may not be seen on every page, epochs following an epoch of definite R in the absence of rapid eye movements may be scored if the EEG is continuous without TA or sleep spindles, chin muscle tone low for the majority of the epoch; and there is no intervening arousal; (12) Score N if four or more of the following conditions are present, including regular respiration, for the majority of the epoch: (a) eyes are closed with no eye movements; (b) chin EMG tone present; (c) regular respiration; and (d) EEG patterns of either TA, HVS, or sleep spindles are present; and (13) score T sleep if an epoch contains two or more discordant PSG state characteristics (either three NREM and two REM characteristics or two NREM and three REM characteristics). These criteria for ages 0-2 mo represent far more than baby steps. Like all the other AASM Manual rules and specifications none are fixed in stone, all open for debate, discussion and revision with the fundamental goal to provide standards for comparison of methods and results. COMMENTARY A commentary on this article appears in this issue on page 291.
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20
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Finn D, Dempsey EM, Boylan GB. Lost in Transition: A Systematic Review of Neonatal Electroencephalography in the Delivery Room-Are We Forgetting an Important Biomarker for Newborn Brain Health? Front Pediatr 2017; 5:173. [PMID: 28848727 PMCID: PMC5554119 DOI: 10.3389/fped.2017.00173] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 07/24/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Electroencephalography (EEG) monitoring is routine in neonatal intensive care units (NICUs) for detection of seizures, neurological monitoring of infants following perinatal asphyxia, and increasingly, following preterm delivery. EEG monitoring is not routinely commenced in the delivery room (DR). OBJECTIVES To determine the feasibility of recording neonatal EEG in the DR, and to assess its usefulness as a marker of neurological well-being during immediate newborn transition. METHODS We performed a systematic stepwise search of PubMed using the following terms: infant, newborns, neonate, DR, afterbirth, transition, and EEG. Only human studies describing EEG monitoring in the first 15 min following delivery were included. Infants of all gestational ages were included. RESULTS Two original studies were identified that described EEG monitoring of newborn infants within the DR. Both prospective observational studies used amplitude-integrated EEG (aEEG) monitoring and found it feasible in infants >34 weeks' gestation; however, technical challenges made it difficult to obtain continuous reliable data. Different EEG patterns were identified in uncompromised newborns and those requiring resuscitation. CONCLUSION EEG monitoring is possible in the DR and may provide an objective baseline measure of neurological function. Further feasibility studies are required to overcome technical challenges in the DR, but these challenges are not insurmountable with modern technology.
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Affiliation(s)
- Daragh Finn
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland.,Irish Centre for Fetal and Neonatal Translational Research, University College Cork, Cork, Ireland
| | - Eugene M Dempsey
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland.,Irish Centre for Fetal and Neonatal Translational Research, University College Cork, Cork, Ireland
| | - Geraldine B Boylan
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland.,Irish Centre for Fetal and Neonatal Translational Research, University College Cork, Cork, Ireland
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21
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Pisani F, Spagnoli C. Monitoring of newborns at high risk for brain injury. Ital J Pediatr 2016; 42:48. [PMID: 27180227 PMCID: PMC4867092 DOI: 10.1186/s13052-016-0261-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 05/06/2016] [Indexed: 01/06/2023] Open
Abstract
Due to the increasing number of surviving preterm newborns and to the recognition of therapeutic hypothermia as the current gold standard in newborns with hypoxic-ischaemic encephalopathy, there has been a growing interest in the implementation of brain monitoring tools in newborns at high risk for neurological disorders.Among the most frequent neurological conditions and presentations in the neonatal period, neonatal seizures and neonatal status epilepticus, paroxysmal non-epileptic motor phenomena, hypoxic-ischaemic encephalopathy, white matter injury of prematurity and stroke require specific approaches to diagnosis. In this review we will describe the characteristics, aims, indications and limitations of routinely available diagnostic techniques such as conventional and amplitude-integrated EEG, evoked potentials, cranial ultrasound and brain MRI. We will conclude by briefly outlining potential future perspectives from research studies.
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Affiliation(s)
- Francesco Pisani
- Child Neuropsychiatry Unit, Neuroscience Department, University of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Carlotta Spagnoli
- Child Neuropsychiatry Unit, Neuroscience Department, University of Parma, Via Gramsci 14, 43126, Parma, Italy.
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Saliba E, Fakhri N, Debillon T. Establishing a hypothermia service for infants with suspected hypoxic-ischemic encephalopathy. Semin Fetal Neonatal Med 2015; 20:80-6. [PMID: 25683599 DOI: 10.1016/j.siny.2015.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The translation of new treatments based upon established evidence into clinical practice is often difficult. The establishment of a therapeutic hypothermia (TH) service and a related cooling register would provide the opportunity to examine how a new therapy becomes implemented in a country or region. The objectives of a TH program should be: to provide guidance to clinicians who are considering the introduction of this new therapy; to ensure standardized clinical practices; to audit the implementation and conduct of TH; to provide surveillance for cooling-related adverse effects; and to evaluate the subsequent neurodevelopmental outcome. Prior to the use of TH, the most important practices to prioritize during its implementation should be identified and include the following: ensure timely identification of infants with neonatal encephalopathy; develop a coordinated system with the local or regional referral cooling center; develop a transport team capable of performing cooling during transport; ensure that each participating unit has access to a national encephalopathy register, and have developmental follow-up arrangements in place that are appropriate and uniform for the region/country.
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Affiliation(s)
- Elie Saliba
- Neonatology and Pediatric Intensive Care Unit, Clocheville Hospital, University François Rabelais, Tours, France; INSERM Research Unit 930, University François Rabelais, Tours, France.
| | - Nadine Fakhri
- Neonatology and Pediatric Intensive Care Unit, Clocheville Hospital, University François Rabelais, Tours, France
| | - Thierry Debillon
- Neonatology and Pediatric Intensive Care Unit, Grenoble University Hospital, France
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Bojak I, Stoyanov ZV, Liley DTJ. Emergence of spatially heterogeneous burst suppression in a neural field model of electrocortical activity. Front Syst Neurosci 2015; 9:18. [PMID: 25767438 PMCID: PMC4341547 DOI: 10.3389/fnsys.2015.00018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 02/02/2015] [Indexed: 11/17/2022] Open
Abstract
Burst suppression in the electroencephalogram (EEG) is a well-described phenomenon that occurs during deep anesthesia, as well as in a variety of congenital and acquired brain insults. Classically it is thought of as spatially synchronous, quasi-periodic bursts of high amplitude EEG separated by low amplitude activity. However, its characterization as a “global brain state” has been challenged by recent results obtained with intracranial electrocortigraphy. Not only does it appear that burst suppression activity is highly asynchronous across cortex, but also that it may occur in isolated regions of circumscribed spatial extent. Here we outline a realistic neural field model for burst suppression by adding a slow process of synaptic resource depletion and recovery, which is able to reproduce qualitatively the empirically observed features during general anesthesia at the whole cortex level. Simulations reveal heterogeneous bursting over the model cortex and complex spatiotemporal dynamics during simulated anesthetic action, and provide forward predictions of neuroimaging signals for subsequent empirical comparisons and more detailed characterization. Because burst suppression corresponds to a dynamical end-point of brain activity, theoretically accounting for its spatiotemporal emergence will vitally contribute to efforts aimed at clarifying whether a common physiological trajectory is induced by the actions of general anesthetic agents. We have taken a first step in this direction by showing that a neural field model can qualitatively match recent experimental data that indicate spatial differentiation of burst suppression activity across cortex.
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Affiliation(s)
- Ingo Bojak
- Systems Neuroscience Research Group, School of Systems Engineering, University of Reading Reading, UK
| | - Zhivko V Stoyanov
- Systems Neuroscience Research Group, School of Systems Engineering, University of Reading Reading, UK
| | - David T J Liley
- Brain and Psychological Sciences Research Centre, School of Health Sciences, Swinburne University of Technology Hawthorn, VIC, Australia
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Lloyd RO, Goulding RM, Filan PM, Boylan GB. Overcoming the practical challenges of electroencephalography for very preterm infants in the neonatal intensive care unit. Acta Paediatr 2015; 104:152-7. [PMID: 25495482 PMCID: PMC5024034 DOI: 10.1111/apa.12869] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 09/13/2014] [Accepted: 11/17/2014] [Indexed: 11/27/2022]
Abstract
Aim Long‐term electroencephalogram (EEG) recording is increasingly being used in the neonatal period, but application and maintenance of the EEG electrodes is challenging, especially in preterm infants. This study proposes a practical method of electrode application that can be used in the neonatal intensive care unit (NICU). Methods EEG recording in preterm infants of <32 weeks of gestational age is often challenging and requires careful preparation and strict adherence to NICU protocols. An effective technique for EEG application in preterm infants is to use prepackaged, sterile, disposable, flat‐surfaced EEG electrodes. The use of these electrodes in combination with a continuous positive airway pressure hat provides good security for electrodes and good quality EEG recordings. It also limits the handling of the infant, while strictly adhering to infection control policies. Results Long‐term monitoring for >72 h has been achieved using this technique. Important steps to consider are efficient preparation of the recording machine and materials, careful electrode application and infection control. Conclusion A fast and effective method of EEG electrode placement is required for neonatal EEG monitoring. The practical techniques described in this article outline a reliable method of EEG electrode placement, suitable for even extremely preterm infants.
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Affiliation(s)
- RO Lloyd
- Neonatal Brain Research Group Irish Centre for Fetal and Neonatal Translational Research (INFANT) University College Cork Ireland
- Neonatal Intensive Care Unit Cork University Maternity Hospital Wilton Cork Ireland
| | - RM Goulding
- Neonatal Brain Research Group Irish Centre for Fetal and Neonatal Translational Research (INFANT) University College Cork Ireland
- Neonatal Intensive Care Unit Cork University Maternity Hospital Wilton Cork Ireland
| | - PM Filan
- Neonatal Brain Research Group Irish Centre for Fetal and Neonatal Translational Research (INFANT) University College Cork Ireland
- Neonatal Intensive Care Unit Cork University Maternity Hospital Wilton Cork Ireland
| | - GB Boylan
- Neonatal Brain Research Group Irish Centre for Fetal and Neonatal Translational Research (INFANT) University College Cork Ireland
- Neonatal Intensive Care Unit Cork University Maternity Hospital Wilton Cork Ireland
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Low E, Mathieson SR, Stevenson NJ, Livingstone V, Ryan CA, Bogue CO, Rennie JM, Boylan GB. Early postnatal EEG features of perinatal arterial ischaemic stroke with seizures. PLoS One 2014; 9:e100973. [PMID: 25051161 PMCID: PMC4106759 DOI: 10.1371/journal.pone.0100973] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Accepted: 06/01/2014] [Indexed: 11/18/2022] Open
Abstract
Background Stroke is the second most common cause of seizures in term neonates and is associated with abnormal long-term neurodevelopmental outcome in some cases. Objective To aid diagnosis earlier in the postnatal period, our aim was to describe the characteristic EEG patterns in term neonates with perinatal arterial ischaemic stroke (PAIS) seizures. Design Retrospective observational study. Patients Neonates >37 weeks born between 2003 and 2011 in two hospitals. Method Continuous multichannel video-EEG was used to analyze the background patterns and characteristics of seizures. Each EEG was assessed for continuity, symmetry, characteristic features and sleep cycling; morphology of electrographic seizures was also examined. Each seizure was categorized as electrographic-only or electroclinical; the percentage of seizure events for each seizure type was also summarized. Results Nine neonates with PAIS seizures and EEG monitoring were identified. While EEG continuity was present in all cases, the background pattern showed suppression over the infarcted side; this was quite marked (>50% amplitude reduction) when the lesion was large. Characteristic unilateral bursts of theta activity with sharp or spike waves intermixed were seen in all cases. Sleep cycling was generally present but was more disturbed over the infarcted side. Seizures demonstrated a characteristic pattern; focal sharp waves/spike-polyspikes were seen at frequency of 1–2 Hz and phase reversal over the central region was common. Electrographic-only seizure events were more frequent compared to electroclinical seizure events (78 vs 22%). Conclusions Focal electrographic and electroclinical seizures with ipsilateral suppression of the background activity and focal sharp waves are strong indicators of PAIS. Approximately 80% of seizure events were the result of clinically unsuspected seizures in neonates with PAIS. Prolonged and continuous multichannel video-EEG monitoring is advocated for adequate seizure surveillance.
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Affiliation(s)
- Evonne Low
- Neonatal Brain Research Group, Irish Centre for Fetal and Neonatal Translational Research, Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Sean R. Mathieson
- Elizabeth Garrett Anderson Institute for Women's Health, University College London Hospital, London, United Kingdom
| | - Nathan J. Stevenson
- Neonatal Brain Research Group, Irish Centre for Fetal and Neonatal Translational Research, Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Vicki Livingstone
- Neonatal Brain Research Group, Irish Centre for Fetal and Neonatal Translational Research, Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - C. Anthony Ryan
- Neonatal Brain Research Group, Irish Centre for Fetal and Neonatal Translational Research, Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Conor O. Bogue
- Neonatal Brain Research Group, Irish Centre for Fetal and Neonatal Translational Research, Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Janet M. Rennie
- Elizabeth Garrett Anderson Institute for Women's Health, University College London Hospital, London, United Kingdom
| | - Geraldine B. Boylan
- Neonatal Brain Research Group, Irish Centre for Fetal and Neonatal Translational Research, Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
- * E-mail:
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Guerit JM. Clinical neurophysiology in neonatology. Neurophysiol Clin 2013; 43:265-6. [DOI: 10.1016/j.neucli.2013.10.132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Accepted: 10/14/2013] [Indexed: 11/26/2022] Open
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