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Coviello C, Lori S, Bertini G, Montano S, Gabbanini S, Bastianelli M, Cossu C, Cavaliere S, Lunardi C, Dani C. Morphine exposure and prematurity affect flash visual evoked potentials in preterm infants. Clin Neurophysiol Pract 2024; 9:85-93. [PMID: 38371463 PMCID: PMC10869246 DOI: 10.1016/j.cnp.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 11/14/2023] [Accepted: 12/27/2023] [Indexed: 02/20/2024] Open
Abstract
Objective The present study aimed to explore first the impact of perinatal risk factors on flash-VEP waves and morphology in a group of preterm infants studied at term equivalent age (TEA). Second, to correlate VEP morphology with neurological outcome at 2 years corrected age (CA). Methods Infants with a gestational age (GA) at birth <32 weeks, without major brain injury, were enrolled. Multivariate regression analyses were performed, and the models were run separately for each dependent variable N2, P2, N3 latencies and P2 amplitude. Logistic regression was applied to study N4 component (present/absent) and VEP morphology (regular/irregular). The predictors were GA, bronchopulmonary dysplasia (BPD), postmenstrual age at VEP registration, cumulative morphine and fentanyl dose, and painful procedures. Lastly, linear regression models were performed to assess the relation between the Bayley-III cognitive and motor scores at 2 years CA and VEP morphology, in relation to GA, BPD, painful procedures and cumulative morphine dose. Results Eighty infants were enrolled. Morphine was the predictor of N2 (R2 = 0.09, p = 0.006), P2 (R2 = 0.11, p = 0.002), and N3 (R2 = 0.13, p = 0.003) latencies. Younger GA was associated with lower amplitude (R2 = 0.05, p = 0.029). None of the independent variables predicted the presence of N4 component, nor VEP morphology in the logistic analysis. VEP morphology was not associated with cognitive and motor scores at 2 years. Conclusions Morphine treatment and prematurity were risk factors for altered VEPs parameters at TEA. In our cohort VEP morphology did not predict neurological outcome. Significance Morphine administration should be evaluated according to potential risks and benefits, and dosage individually accustomed, according to pain and comfort scores, considering the possible risk for neurodevelopmental impairment.
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Affiliation(s)
- Caterina Coviello
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Silvia Lori
- Neurophysiology Unit, Neuro-Musculo-Skeletal Department, Careggi University Hospital, Florence, Italy
| | - Giovanna Bertini
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Simona Montano
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Simonetta Gabbanini
- Neurophysiology Unit, Neuro-Musculo-Skeletal Department, Careggi University Hospital, Florence, Italy
| | - Maria Bastianelli
- Neurophysiology Unit, Neuro-Musculo-Skeletal Department, Careggi University Hospital, Florence, Italy
| | - Cesarina Cossu
- Neurophysiology Unit, Neuro-Musculo-Skeletal Department, Careggi University Hospital, Florence, Italy
| | - Sara Cavaliere
- Neurophysiology Unit, Neuro-Musculo-Skeletal Department, Careggi University Hospital, Florence, Italy
| | - Clara Lunardi
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Carlo Dani
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
- Department of Neurosciences, Psychology, Drug Research and Child Health, Careggi University Hospital of Florence, Florence, Italy
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Astasheva IB, Guseva MR, Atamuradov R, Marenkov VV, Kyun YA. [Modern possibilities of diagnosing lesions of the visual analyzer in perinatal lesions of the central nervous system in full-term and premature infants]. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:7-15. [PMID: 36537625 DOI: 10.17116/jnevro20221221217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The article provides an overview of current neuro-ophthalmological diagnostic capabilities in patients with perinatal lesions. The main attention is paid to the diagnosis of patients with periventricular leukomalacia and peri- and intraventricular hemorrhages. The most relevant methods of neuro-ophthalmological diagnosis in hypoxic-ischemic CNS lesions are covered. The functions and peculiarities of blood supply of the germinal matrix are described. The importance of the use of optical coherence tomography and visual evoked potential recording in full-term and premature infants with visual pathway and/or visual cortex lesions in brain lesions is discussed. The conclusion emphasizes the need for an interdisciplinary approach in the examination of children with perinatal CNS lesions.
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Affiliation(s)
- I B Astasheva
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - M R Guseva
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - R Atamuradov
- Pirogov Russian National Research Medical University, Moscow, Russia
| | | | - Yu A Kyun
- Morozov Children's City Clinical Hospital, Moscow, Russia
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Kovács V, Remzső G, Tóth-Szűki V, Varga V, Németh J, Domoki F. Inhaled H 2 or CO 2 Do Not Augment the Neuroprotective Effect of Therapeutic Hypothermia in a Severe Neonatal Hypoxic-Ischemic Encephalopathy Piglet Model. Int J Mol Sci 2020; 21:E6801. [PMID: 32948011 PMCID: PMC7555370 DOI: 10.3390/ijms21186801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/09/2020] [Accepted: 09/14/2020] [Indexed: 12/24/2022] Open
Abstract
Hypoxic-ischemic encephalopathy (HIE) is still a major cause of neonatal death and disability as therapeutic hypothermia (TH) alone cannot afford sufficient neuroprotection. The present study investigated whether ventilation with molecular hydrogen (2.1% H2) or graded restoration of normocapnia with CO2 for 4 h after asphyxia would augment the neuroprotective effect of TH in a subacute (48 h) HIE piglet model. Piglets were randomized to untreated naïve, control-normothermia, asphyxia-normothermia (20-min 4%O2-20%CO2 ventilation; Tcore = 38.5 °C), asphyxia-hypothermia (A-HT, Tcore = 33.5 °C, 2-36 h post-asphyxia), A-HT + H2, or A-HT + CO2 treatment groups. Asphyxia elicited severe hypoxia (pO2 = 19 ± 5 mmHg) and mixed acidosis (pH = 6.79 ± 0.10). HIE development was confirmed by altered cerebral electrical activity and neuropathology. TH was significantly neuroprotective in the caudate nucleus but demonstrated virtually no such effect in the hippocampus. The mRNA levels of apoptosis-inducing factor and caspase-3 showed a ~10-fold increase in the A-HT group compared to naïve animals in the hippocampus but not in the caudate nucleus coinciding with the region-specific neuroprotective effect of TH. H2 or CO2 did not augment TH-induced neuroprotection in any brain areas; rather, CO2 even abolished the neuroprotective effect of TH in the caudate nucleus. In conclusion, the present findings do not support the use of these medical gases to supplement TH in HIE management.
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MESH Headings
- Acidosis/blood
- Acidosis/etiology
- Acidosis/prevention & control
- Administration, Inhalation
- Animals
- Animals, Newborn
- Apoptosis Inducing Factor/biosynthesis
- Apoptosis Inducing Factor/genetics
- Asphyxia Neonatorum/complications
- Asphyxia Neonatorum/drug therapy
- Asphyxia Neonatorum/therapy
- Brain Damage, Chronic/etiology
- Brain Damage, Chronic/prevention & control
- Brain-Derived Neurotrophic Factor/biosynthesis
- Brain-Derived Neurotrophic Factor/genetics
- Carbon Dioxide/administration & dosage
- Carbon Dioxide/therapeutic use
- Carbon Dioxide/toxicity
- Caspase 3/biosynthesis
- Caspase 3/genetics
- Caudate Nucleus/pathology
- Cerebral Cortex/metabolism
- Cerebral Cortex/pathology
- Disease Models, Animal
- Drug Evaluation, Preclinical
- Electroencephalography
- Evoked Potentials, Visual/drug effects
- Gene Expression Regulation/drug effects
- Hippocampus/pathology
- Hydrogen/administration & dosage
- Hydrogen/analysis
- Hydrogen/therapeutic use
- Hypothermia, Induced
- Hypoxia-Ischemia, Brain/complications
- Hypoxia-Ischemia, Brain/drug therapy
- Hypoxia-Ischemia, Brain/pathology
- Hypoxia-Ischemia, Brain/therapy
- Nerve Tissue Proteins/biosynthesis
- Nerve Tissue Proteins/genetics
- Neuroprotection/drug effects
- Neuroprotective Agents/administration & dosage
- Neuroprotective Agents/therapeutic use
- Organ Specificity
- Random Allocation
- Swine
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Affiliation(s)
- Viktória Kovács
- Department of Physiology, University of Szeged Faculty of Medicine, H-6720 Szeged, Hungary; (G.R.); (V.T.-S.); (V.V.); (J.N.); (F.D.)
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Kharal A, Khanal S, Shrestha JB, Shrestha GS, Paudel N. Flash VEP in clinically stable pre-term and full-term infants. Doc Ophthalmol 2020; 141:259-267. [PMID: 32506270 DOI: 10.1007/s10633-020-09773-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 05/20/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Pre-term infants are at risk of abnormal visual development that can range from subtle to severe. The aim of this study was to compare flash VEPs in clinically stable pre-term and full-term infants at 6 months of age. METHODS Twenty-five pre-term and 25 full-term infants underwent flash VEP testing at the age of 6 months. Monocular VEPs were recorded using flash goggles on a RETIscan system under normal sleeping conditions. Amplitude and peak time responses of the P2 component in the two eyes were averaged and compared between the two groups. Multiple regression analyses were performed to assess the relationship of the P2 responses with birth weight (BW) and gestational age (GA). RESULTS At 6 months corrected age, pre-term infants had significantly delayed P2 peak times than full-term infants (mean difference: 10.88 [95% CI 4.00-17.76] ms, p = 0.005). Pre-term infants also showed significantly reduced P2 amplitudes as compared to full-term infants (mean difference: 2.36 [0.83-3.89] µV, p = 0.003). Although the regression model with GA and BW as fixed factors explained 20% of the variance in the P2 peak time (F2,47 = 5.98, p = .0045), only GA showed a significant negative relationship (β = -2.66, p = .003). Neither GA (β = 0.21, p = .28) nor BW (β = 0.001, p = .32) showed any relationship with P2 amplitude. CONCLUSIONS Our results demonstrate that, compared with full-term infants, clinically stable pre-term infants exhibit abnormal flash VEPs, with a delay in P2 peak time and a reduction in P2 amplitude. These findings support a potential dysfunction of the visual pathway in clinically stable pre-term infants as compared to full-term infants.
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Affiliation(s)
- Anish Kharal
- B.P. Koirala Lions Centre for Ophthalmic Studies, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Safal Khanal
- School of Optometry, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jyoti Baba Shrestha
- B.P. Koirala Lions Centre for Ophthalmic Studies, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Gauri Shankar Shrestha
- B.P. Koirala Lions Centre for Ophthalmic Studies, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Nabin Paudel
- Centre for Eye Research Ireland, Technological University Dublin, Dublin, Ireland.
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Pojda-Wilczek D, Maruszczyk W, Sirek S. Flash visual evoked potentials (FVEP) in various stimulation conditions. Doc Ophthalmol 2018; 138:35-42. [PMID: 30470955 PMCID: PMC6349809 DOI: 10.1007/s10633-018-9663-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 11/06/2018] [Indexed: 11/28/2022]
Abstract
Aim To compare flash visual evoked potentials (FVEP) elicited using a Ganzfeld bowl (G), Mini Ganzfeld (MG) and Flash Goggles (GG) with eyes open and closed. Patients and method The study group comprised 17 volunteers with mean age of 30 years; all of them were examined with the Roland Consult electrophysiological diagnostic system. Active electrodes were placed at O1 and O2. With the G and MG stimulators, the flash generated by white-light-emitting diodes (LEDs) presented standard flash of 3 cd s m−2. The GG used red LED flash of 3 cd s m−2. Stimulus frequency of 1.0 Hz, low-pass filter of 1.0 Hz and high-pass filters of 100 Hz (G); 50 Hz (MG); 30 Hz (GG) were used. P2 amplitude and latency were compared by the means of the Wilcoxon matched-pairs signed-rank test. Results After right eye stimulation (from O1; n = 17), the mean amplitudes of P2, elicited with the G, MG and GG, were 13, 7 and 10 µV, respectively. The respective latencies were 129, 114 and 110 ms. Hence, the difference between the results obtained with these stimulators was statistically significant (p < 0.05). The mean P2 amplitudes, acquired by the means of the G, MG and GG, were 13 µV, 7 µV and 10 µV for open eyes, and 11 µV, 8 µV and 8 µV for closed eyes. The respective latencies were 129, 114 and 110 ms for eyes open, and 127, 125 and 121 ms for eyes closed. These results of the MG (latency only) and GG (latency and amplitude) stimulation differed significantly (p < 0.05). Conclusion The amplitudes and latencies of the FVEP P2 elicited with different stimulators are not suitable for comparison. Closing the eye during the examination had a significant effect on the components of FVEP waveform elicited with the Flash Goggle and on the latency of P2 elicited with the MG.
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Affiliation(s)
- Dorota Pojda-Wilczek
- Ophthalmology Clinic and Department of Ophthalmology, University Clinical Centre, School of Medicine in Katowice, Medical University of Silesia in Katowice, Ceglana 35, 40-514, Katowice, Poland.
| | - Wojciech Maruszczyk
- Ophthalmology Clinic and Department of Ophthalmology, University Clinical Centre, School of Medicine in Katowice, Medical University of Silesia in Katowice, Ceglana 35, 40-514, Katowice, Poland
| | - Sebastian Sirek
- Ophthalmology Clinic and Department of Ophthalmology, University Clinical Centre, School of Medicine in Katowice, Medical University of Silesia in Katowice, Ceglana 35, 40-514, Katowice, Poland
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The impact of extrauterine life on visual maturation in extremely preterm born infants. Pediatr Res 2018; 84:403-410. [PMID: 29967524 DOI: 10.1038/s41390-018-0084-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 05/22/2018] [Accepted: 05/25/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Extrauterine life is an important factor when considering brain maturation. Few studies have investigated the development of visual evoked potentials (VEP) in extremely preterm infants, and only a minority have taken into consideration the impact of extrauterine life. The aim of this study was to assess the normal maturation of VEP in infants born prior to 29 weeks gestational age (GA) and to explore the potential influence of extrauterine life. METHODS VEP were prospectively recorded in extremely preterm infants, and principal peaks (N0, N1, P1, N2, P2, N3) were identified. The mean of peak-time and percentages of peak appearances were assessed for three GA groups (23/24, 25/26, 27/28 weeks) and four subgroups of increasing postnatal age (PNA), up to 8 weeks after birth. RESULTS A total of 163 VEP recordings in 38 preterm infants were analyzed. With increasing GA at birth, peak-times decreased. When comparing infants with equal GA but longer extrauterine life, those with the highest PNA demonstrated the shortest VEP peak-times. However, this effect was less present in infants born prior to 25 weeks GA. CONCLUSION Provided that a certain maturational threshold is reached, extrauterine life appears to accelerate maturation of the visual system in preterm infants.
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Kwinta P, Lesniak A, Herman-Sucharska I, Klimek M, Karcz P, Kubatko-Zielińska A, Nitecka M, Dutkowska G, Romanowska-Dixon B. Microstructure changes of occipital white matter are responsible for visual problems in the 3–4-year-old very low birth weight children. Indian J Ophthalmol 2017. [PMID: 28643715 PMCID: PMC5508461 DOI: 10.4103/ijo.ijo_679_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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An Influence of Birth Weight, Gestational Age, and Apgar Score on Pattern Visual Evoked Potentials in Children with History of Prematurity. Neural Plast 2015; 2015:754864. [PMID: 26417461 PMCID: PMC4568372 DOI: 10.1155/2015/754864] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 05/19/2015] [Indexed: 01/20/2023] Open
Abstract
Purpose. The objective of our study was to examine a possible influence of gestational age, birth weight, and Apgar score on amplitudes and latencies of P100 wave in preterm born school-age children. Materials and Methods. We examined the following group of school-age children: 28 with history of prematurity (mean age 10.56 ± 1.66 years) and 25 born at term (mean age 11.2 ± 1.94 years). The monocular PVEP was performed in all children. Results. The P100 wave amplitudes and latencies significantly differ between preterm born school-age children and those born at term. There was an essential positive linear correlation of the P100 wave amplitudes with birth weight, gestational age, and Apgar score. There were the negative linear correlations of P100 latencies in 15-minute stimulation from O1 and Oz electrode with Apgar score and O1 and O2 electrode with gestational age. Conclusions. PVEP responses vary in preterm born children in comparison to term. Low birth weight, early gestational age, and poor baseline output seem to be the predicting factors for the developmental rate of a brain function in children with history of prematurity. Further investigations are necessary to determine perinatal factors that can affect the modified visual system function in preterm born children.
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