The Added Value of Simultaneous EEG and Amplitude-Integrated EEG Recordings in Three Newborn Infants

Invasive ventilation is often necessary for the treatment of newborn infants with respiratory insufficiency. The neonatal patient has unique physiological characteristics such as small airway caliber, few collateral airways, compliant chest wall, poor airway stability, and low functional residual capacity. Pathologies affecting the newborn’s lung are also different from many others observed later in life. Several different ventilation modes and strategies are available to optimize mechanical ventilation and to prevent ventilator-induced lung injury. Important aspects to be considered in ventilating neonates include the use of correct sized endotracheal tube to minimize airway resistance and work of breathing, positioning of the patient, the nursing care, respiratory kinesiotherapy, sedation and analgesia, and infection prevention, namely, the ventilator-associated pneumonia and nosocomial infection, as well as prevention and treatment of complications such as air leaks and pulmonary hemorrhage. Aspects of ventilation in patients under ECMO (extracorporeal membrane oxygenation) and in palliative care are of increasing interest nowadays. Online pulmonary mechanics and function testing as well as capnography are becoming more commonly used. Echocardiography is now a routine in most neonatal units. Near infrared spectroscopy (NIRS) is an attractive tool potentially helping in preventing intraventricular hemorrhage and periventricular leukomalacia. Lung ultrasound is an emerging tool of diagnosis and can be of added value in helping monitoring the ventilated neonate. The aim of this scientific literature review is to address relevant aspects concerning the respiratory care and monitoring of the invasively ventilated newborn in order to help physicians to optimize the efficacy of care.

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Contribution of ictal source imaging for localizing seizure onset zone in patients with focal epilepsy patients

Neurology ◽

10.1212/wnl.0000000000011109 ◽

2020 ◽

pp. 10.1212/WNL.0000000000011109

Author(s):

Shuai Ye ◽

Lin Yang ◽

Yunfeng Lu ◽

Michal T. Kucewicz ◽

Benjamin Brinkmann ◽

...

Keyword(s):

Surgical Resection ◽

Focal Epilepsy ◽

High Density ◽

Concordance Rate ◽

Added Value ◽

Seizure Onset ◽

Source Imaging ◽

Intracranial Eeg ◽

Seizure Onset Zone ◽

Eeg Recordings

ObjectiveTo determine whether seizure onset zone can be accurately localized prior to surgical planning in focal epilepsy patients, we performed non-invasive EEG recordings and source localization analyses on 39 patients.MethodsIn a total of 39 focal epilepsy patients, we recorded and extracted 138 seizures and 1,325 interictal epileptic discharges using high-density EEG. We have investigated a novel approach for directly imaging sources of seizures and interictal spikes from high density EEG recordings, and rigorously validated it for noninvasive localization of seizure onset zone (SOZ) determined from intracranial EEG findings and surgical resection volume. Conventional source imaging analyses were also performed for comparison.ResultsIctal source imaging showed a concordance rate of 95% when compared to intracranial EEG or resection results. The average distance from estimation to seizure onset (intracranial) electrodes is 1.35 cm in patients with concordant results, and 0.74 cm to surgical resection boundary in patients with successful surgery. About 41% of the patients were found to have multiple types of interictal activities; coincidentally, a lower concordance rate and a significantly worse performance in localizing SOZ were observed in these patients.ConclusionNoninvasive ictal source imaging with high-density EEG recording can provide highly concordant results with clinical decisions obtained by invasive monitoring or confirmed by resective surgery. By means of direct seizure imaging using high-density scalp EEG recordings, the added value of ictal source imaging is particularly high in patients with complex interictal activity patterns, who may represent the most challenging cases with poor prognosis.

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EEG for the assessment of neurological function in newborn infants immediately after birth

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2018-315231 ◽

2018 ◽

Vol 104 (5) ◽

pp. F510-F514

Author(s):

Daragh Finn ◽

John M O’Toole ◽

Eugene M Dempsey ◽

Geraldine B Boylan

Keyword(s):

Spectral Power ◽

Elective Caesarean Section ◽

Newborn Infants ◽

Maternity Hospital ◽

Neurological Function ◽

Transitional Period ◽

Term Infants ◽

Movement Artefact ◽

Central Regions ◽

Eeg Recordings

ObjectiveTo assess the neurological function of newborn infants in the first minutes after birth using EEG.Design and patientsWe obtained electroencephalography (EEG) recordings in term infants following elective caesarean section. After delivery, disposable EEG electrodes were attached to the infants’ scalp over the frontal and central regions bilaterally and EEG was recorded for 10 min. Both visual and quantitative measures were used to analyse the EEGs.SettingThe operative delivery theatre of Cork University Maternity Hospital, Ireland.ResultsForty-nine infants had EEG recordings over the frontal and central regions. The median (IQR) age at time of initial EEG recording was 3.0 (2.5–3.8) min. While movement artefact contaminated parts of many recordings, good-quality EEG, with mixed-frequency activity with a range of 25–50 μV, was observed in all infants. The majority of EEG spectral power was within the delta band: the median (IQR) relative delta power was 87.8% (83.7%–90%). Almost all (95%) spectral power was below a median (IQR) of 7.56 Hz (6.17–9.76 Hz).ConclusionsEEG recording is very feasible in the immediate newborn period. This study provides valuable objective information about neurological function during this transitional period.

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Critical congenital heart disease screening with a pulse oximetry in neonates

Journal of Perinatal Medicine ◽

10.1515/jpm-2017-0006 ◽

2018 ◽

Vol 46 (2) ◽

pp. 203-207 ◽

Cited By ~ 1

Author(s):

Şahin Hamilçıkan ◽

Emrah Can

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Pulse Oximetry ◽

Congenital Heart ◽

Septal Defect ◽

Ductus Arteriosus ◽

Newborn Infants ◽

Added Value ◽

Critical Congenital Heart Disease ◽

Pulse Oximetry Screening

AbstractObjective:To compare the results of pulse oximetry screening for critical congenital heart disease (CCHD) in newborn infants performed at <24 h and >24 h following.Method:Measurements were taken for each group at <24 h and >24 h following birth. Echocardiography was performed if the SpO2 readings remained abnormal results.Results:A total of 4518 newborns were included in this prospective descriptive study. Of these, 2484 (60.3%) were delivered vaginally and 1685 (39.7%) by cesarean section. Median time points of the screening were 25.4 (25.3–25.5) vs. 17.3 (12.2–22.4) hours after birth. In 4109 infants screened 24 h after birth, the mean pre- and postductal oxygen saturations (SpO2) were 96.5±1.99 and 97.7±1.98, while 127 infants screened within 24 h of mean preductal and postductal SpO2 were 91.33±2.64 and 94.0±4.44. No CCHD was detected during the study period. Pulse oximetry screening was false positive for CCHD in 9 of 4109 infants (0.02%); of these, six infants were referred to pediatric cardiology and three cases were diagnosed as other significant, non-cardiac pathology. There were two cases with AVSD (atrioventricular septal defect, three cases with ventricular septal defect (VSD), and one case with patent ductus arteriosus (PDA).Conclusions:Saturation values are different between <24-h and >24-h neonates in pulse oximetry screening. The screening in this study identified infants with other important pathologies, this forms an added value as an assessment tool for newborn infants.

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The Added Value of Graphical Input and Display for Electron Lens Design

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100179701 ◽

1990 ◽

Vol 48 (1) ◽

pp. 190-191

Author(s):

B. Lencova ◽

G. Wisselink

Keyword(s):

Flux Density ◽

Numerical Data ◽

Added Value ◽

Lens Design ◽

Step Size ◽

Magnetic Lens ◽

Flux Lines ◽

Fine Mesh ◽

Electron Lens ◽

User Friendly

Recent progress in computer technology enables the calculation of lens fields and focal properties on commonly available computers such as IBM ATs. If we add to this the use of graphics, we greatly increase the applicability of design programs for electron lenses. Most programs for field computation are based on the finite element method (FEM). They are written in Fortran 77, so that they are easily transferred from PCs to larger machines.The design process has recently been made significantly more user friendly by adding input programs written in Turbo Pascal, which allows a flexible implementation of computer graphics. The input programs have not only menu driven input and modification of numerical data, but also graphics editing of the data. The input programs create files which are subsequently read by the Fortran programs. From the main menu of our magnetic lens design program, further options are chosen by using function keys or numbers. Some options (lens initialization and setting, fine mesh, current densities, etc.) open other menus where computation parameters can be set or numerical data can be entered with the help of a simple line editor. The "draw lens" option enables graphical editing of the mesh - see fig. I. The geometry of the electron lens is specified in terms of coordinates and indices of a coarse quadrilateral mesh. In this mesh, the fine mesh with smoothly changing step size is calculated by an automeshing procedure. The options shown in fig. 1 allow modification of the number of coarse mesh lines, change of coordinates of mesh points or lines, and specification of lens parts. Interactive and graphical modification of the fine mesh can be called from the fine mesh menu. Finally, the lens computation can be called. Our FEM program allows up to 8000 mesh points on an AT computer. Another menu allows the display of computed results stored in output files and graphical display of axial flux density, flux density in magnetic parts, and the flux lines in magnetic lenses - see fig. 2. A series of several lens excitations with user specified or default magnetization curves can be calculated and displayed in one session.

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Preliminary Findings on the Use of Session Questionnaires to Improve Clinician-Client Alliance With Special Consideration to Clinical Education

Perspectives on Administration and Supervision ◽

10.1044/aas25.1.50 ◽

2015 ◽

Vol 25 (1) ◽

pp. 50-60

Author(s):

Anu Subramanian

Keyword(s):

Graduate Students ◽

Clinical Education ◽

Clinical Decision Making ◽

Rating Scale ◽

Treatment Effectiveness ◽

Clinical Decision ◽

Added Value ◽

Therapeutic Outcomes ◽

Specific Feedback ◽

Stakeholder Perspective

ASHA's focus on evidence-based practice (EBP) includes the family/stakeholder perspective as an important tenet in clinical decision making. The common factors model for treatment effectiveness postulates that clinician-client alliance positively impacts therapeutic outcomes and may be the most important factor for success. One strategy to improve alliance between a client and clinician is the use of outcome questionnaires. In the current study, eight parents of toddlers who attended therapy sessions at a university clinic responded to a session outcome questionnaire that included both rating scale and descriptive questions. Six graduate students completed a survey that included a question about the utility of the questionnaire. Results indicated that the descriptive questions added value and information compared to using only the rating scale. The students were varied in their responses regarding the effectiveness of the questionnaire to increase their comfort with parents. Information gathered from the questionnaire allowed for specific feedback to graduate students to change behaviors and created opportunities for general discussions regarding effective therapy techniques. In addition, the responses generated conversations between the client and clinician focused on clients' concerns. Involving the stakeholder in identifying both effective and ineffective aspects of therapy has advantages for clinical practice and education.

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