Evaluation of brain maturation in pre-term infants using conventional and amplitude-integrated electroencephalograms

Abstract Study Objectives Sleep features in infancy are potential biomarkers for brain maturation but poorly characterised. We describe normative values for sleep macrostructure and sleep spindles at 4-5 months of age. Methods Healthy term infants were recruited at birth and had daytime sleep EEGs at 4-5 months. Sleep staging was performed and 5 features were analysed. Sleep spindles were annotated and 7 quantitative features were extracted. Features were analysed across sex, recording time (am/pm), infant age and from first to second sleep cycles. Results We analysed sleep recordings from 91 infants, 41% girls. Median (IQR) macrostructure results: sleep duration 49.0 (37.8-72.0) minutes (n=77); first sleep cycle duration 42.8 (37.0 – 51.4) minutes; REM percentage 17.4 (9.5 - 27.7)% (n=68); latency to REM 36.0 (30.5-41.1) minutes (n=66). First cycle median (IQR) values for spindle features: number 241.0 (193.0-286.5), density 6.6 (5.7-8.0) spindles.min -1(n=77); mean frequency 13.0 (12.8-13.3) Hz, mean duration 2.9 (2.6-3.6)s, spectral power 7.8 (4.7-11.4)µV 2, brain symmetry index 0.20 (0.16-0.29), synchrony 59.5 (53.2-63.8)% (n=91). In males, spindle spectral power (µV 2) is 24.5% lower (p=0.032) and brain symmetry index 24.2% higher than females (p=0.011) when controlling for gestational and postnatal age and timing of the nap. We found no other significant associations between studied sleep features and sex, recording time (am/pm), or age. Spectral power decreased (p<0.001) on the second cycle. Conclusion This normative data may be useful for comparison with future studies of sleep dysfunction and atypical neurodevelopment in infancy.

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Evaluation of spectrum of MRI findings in children with Hypoxic Ischemic Encephalopathy and its comparison with transcranial sonography

International Journal of Medical Research and Review ◽

10.17511/ijmrr.2021.i02.06 ◽

2021 ◽

Vol 9 (2) ◽

pp. 85-94

Author(s):

Dr. Manoj Mathur ◽

◽

Dr. Ishita Gupta ◽

Dr. Dimple Mittal ◽

◽

...

Keyword(s):

White Matter ◽

Transcranial Sonography ◽

White Matter Injury ◽

Hypoxic Ischemic Encephalopathy ◽

Brain Maturation ◽

Mri Imaging ◽

Mri Findings ◽

Term Infants ◽

Cross Sectional ◽

Ischemic Encephalopathy

Background: Hypoxic ischemic encephalopathy is a serious concern among asphyxiated newbornsdue to the associated long term sequelae like cognitive impairment and cerebral palsy. Though theincidence of hypoxic injury remains higher in preterm babies due to incomplete brain maturation, itcan occur in term babies as well despite institutional deliveries due to an array of unavoidable fetal,maternal and placental causes. Aims: This study was conducted as an attempt to evaluate the riskfactors, to study the correlation between the term of pregnancy with TCUS and MRI imaging findingsin HIE and characterise patterns of CNS involvement. Materials and methods: It was a cross-sectional study carried on 50 neonates with clinically diagnosed HIE presenting to the Department ofRadiodiagnosis, Rajindra Hospital Patiala who were subjected to transcranial sonography and MRI.Results and Conclusion: This study demonstrated term infants have significant involvement ofbasal ganglia thalamus type (central) pattern of involvement and preterm infants haveperiventricular leukomalacia type (white matter injury) of a pattern of involvement. The overallsensitivity and specificity of TCUS in detecting imaging findings in children with clinically diagnosedHIE compared to MRI was found to be 70.45% and 50% respectively, yielding the overall diagnosticaccuracy of TCUS as 68% compared to MRI. TCUS can depict central and white matter abnormalitiesbetter than peripheral lesions. However MRI provides additional diagnostic information in manycases and can detect precisely the extent of brain injury.

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Epidemiology and pathogenesis of stroke in preterm infants: A systematic review

Journal of Neonatal-Perinatal Medicine ◽

10.3233/npm-200597 ◽

2021 ◽

pp. 1-8

Author(s):

B. Roy ◽

K. Walker ◽

C. Morgan ◽

M. Finch-Edmondson ◽

C. Galea ◽

...

Keyword(s):

Systematic Review ◽

Preterm Infants ◽

Meta Analysis ◽

Transverse Sinus ◽

Brain Maturation ◽

Left Middle Cerebral Artery ◽

Arterial Ischemic Stroke ◽

Term Infants ◽

Cerebral Sinovenous Thrombosis ◽

Causal Pathway

BACKGROUND: Perinatal stroke is one of the principal causes of cerebral palsy (CP) in preterm infants. Stroke in preterm infants is different from stroke in term infants, given the differences in brain maturation and the mechanisms of injury exclusive to the immature brain. We conducted a systematic review to explore the epidemiology and pathogenesis of periventricular hemorrhagic infarction (PVHI), perinatal arterial ischemic stroke (PAIS) and cerebral sinovenous thrombosis (CSVT) in preterm infants. METHODS: Studies were identified based on predefined study criteria from MEDLINE, EMBASE, SCOPUS and WEB OF SCIENCE electronic databases from 2000 –2019. Results were combined using descriptive statistics. RESULTS: Fourteen studies encompassed 546 stroke cases in preterm infants between 23 –36 weeks gestational ages and birth weights between 450 –3500 grams. Eighty percent (436/546) of the stroke cases were PVHI, 17%(93/546) were PAIS and 3%(17/546) were CSVT. Parietal PVHI was more common than temporal and frontal lobe PVHI. For PAIS, left middle cerebral artery (MCA) was more common than right MCA or cerebellar stroke. For CSVT partial or complete thrombosis in the transverse sinus was universal. All cases included multiple possible risk factors, but the data were discordant precluding aggregation within a meta-analysis. CONCLUSION: This systematic review confirms paucity of data regarding the etiology and the precise causal pathway of stroke in preterm infants. Moreover, the preterm infants unlike the term infants do not typically present with seizures. Hence high index of clinical suspicion and routine cUS will assist in the timely diagnosis and understanding of stroke in this population.

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Sleep–wake regulation in preterm and term infants

SLEEP ◽

10.1093/sleep/zsaa148 ◽

2020 ◽

Author(s):

Anastasis Georgoulas ◽

Laura Jones ◽

Maria Pureza Laudiano-Dray ◽

Judith Meek ◽

Lorenzo Fabrizi ◽

...

Keyword(s):

Brain Maturation ◽

Survival Models ◽

Relative Importance ◽

Active Sleep ◽

Term Infants ◽

Environmental Interventions ◽

Heavy Tailed Distribution ◽

Postmenstrual Age ◽

Heavy Tailed ◽

And Behavior

Abstract Study Objectives In adults, wakefulness can be markedly prolonged at the expense of sleep, e.g. to stay vigilant in the presence of a stressor. These extra-long wake bouts result in a heavy-tailed distribution (highly right-skewed) of wake but not sleep durations. In infants, the relative importance of wakefulness and sleep are reversed, as sleep is necessary for brain maturation. Here, we tested whether these developmental pressures are associated with the unique regulation of sleep–wake states. Methods In 175 infants of 28–40 weeks postmenstrual age (PMA), we monitored sleep–wake states using electroencephalography and behavior. We constructed survival models of sleep–wake bout durations and the effect of PMA and other factors, including stress (salivary cortisol), and examined whether sleep is resilient to nociceptive perturbations (a clinically necessary heel lance). Results Wake durations followed a heavy-tailed distribution as in adults and lengthened with PMA and stress. However, differently from adults, active sleep durations also had a heavy-tailed distribution, and with PMA, these shortened and became vulnerable to nociception-associated awakenings. Conclusions Sleep bouts are differently regulated in infants, with especially long active sleep durations that could consolidate this state’s maturational functions. Curtailment of sleep by stress and nociception may be disadvantageous, especially for preterm infants given the limited value of wakefulness at this age. This could be addressed by environmental interventions in the future.

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Brain Maturation in Children With Cochlear Implants

ASHA Leader ◽

10.1044/leader.ftr3.14052009.14 ◽

2009 ◽

Vol 14 (5) ◽

pp. 14-17 ◽

Cited By ~ 2

Author(s):

Anu Sharma ◽

Amy Nash

Keyword(s):

Cochlear Implants ◽

Brain Maturation

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Neural activation in mothers of preterm and full-term infants: Preliminary findings from a 3T fMRI study

PsycEXTRA Dataset ◽

10.1037/e579192013-354 ◽

2012 ◽

Author(s):

R. Montirosso ◽

S. Moriconi ◽

B. Riccardi ◽

G. Reni ◽

F. Arrigoni ◽

...

Keyword(s):

Full Term ◽

Neural Activation ◽

Term Infants ◽

Fmri Study

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The Platelet of the Newborn Infant – Adenine Nucleotide Metabolism and Release

Thrombosis and Haemostasis ◽

10.1055/s-0038-1650026 ◽

1980 ◽

Vol 43 (02) ◽

pp. 099-103 ◽

Cited By ~ 9

Author(s):

J M Whaun ◽

P Lievaart ◽

Keyword(s):

Newborn Infant ◽

Adenine Nucleotide ◽

Platelet Rich Plasma ◽

Adenine Nucleotides ◽

Newborn Infants ◽

Specific Radioactivity ◽

Nucleotide Metabolism ◽

Breakdown Product ◽

Term Infants ◽

Adenine Nucleotide Metabolism

SummaryBlood from normal full term infants, mothers and normal adults was collected in citrate. Citrated platelet-rich plasma was prelabelled with 3H-adenine and reacted with release inducers, collagen and adrenaline. Adenine nucleotide metabolism, total adenine nucleotide levels and changes in sizes of these pools were determined in platelets from these three groups of subjects.At rest, the platelet of the newborn infant, compared to that of the mother and normal adult, possessed similar amounts of adenosine triphosphate (ATP), 4.6 ± 0.2 (SD), 5.0 ± 1.1, 4.9 ± 0.6 µmoles ATP/1011 platelets respectively, and adenosine diphosphate (ADP), 2.4 ± 0.7, 2.8 ± 0.6, 3.0 ± 0.3 umoles ADP/1011 platelets respectively. However the marked elevation of specific radioactivity of ADP and ATP in these resting platelets indicated the platelet of the neonate has decreased adenine nucleotide stores.In addition to these decreased stores of adenine nucleotides, infant platelets showed significantly impaired release of ADP and ATP on exposure to collagen. The release of ADP in infants, mothers, and other adults was 0.9 ± 0.5 (SD), 1.5 ± 0.5, 1.5 ± 0.1 umoles/1011 platelets respectively; that of ATP was 0.6 ± 0.3, 1.0 ± 0.1,1.3 ± 0.2 µmoles/1011 platelets respectively. With collagen-induced release, platelets of newborn infants compared to those of other subjects showed only slight increased specific radioactivities of adenine nucleotides over basal levels. The content of metabolic hypoxanthine, a breakdown product of adenine nucleotides, increased in both platelets and plasma in all subjects studied.In contrast, with adrenaline as release inducer, the platelets of the newborn infant showed no adenine nucleotide release, no change in total ATP and level of radioactive hypoxanthine, and minimal change in total ADP. The reason for this decreased adrenaline reactivity of infant platelets compared to reactivity of adult platelets is unknown.Infant platelets may have different membranes, with resulting differences in regulation of cellular processes, or alternatively, may be refractory to catecholamines because of elevated levels of circulating catecholamines in the newborn period.

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