The Emergence of Hierarchical Somatosensory Processing in Late Prematurity

Predictive coding and attention in developmental cognitive neuroscience and perspectives for neurodevelopmental disorders

Sensory prediction and repetition suppression are closely related cognitive mechanisms that allow the brain to form predictions about the environment, and guide perception in synergy with attention. Predictive coding is a theory of the fundamental role of predictive mechanisms in brain functions. Authors have proposed a central role of predictive impairments in autism and possibly other neurodevelopmental disorders. However, little is known about predictive mechanisms in typical development, and how they co-develop with attention. Here we review experimental support for predictive coding and its links with attention in healthy adults' brains, the first experimental works performed in typically developing children and infants, and theoretical accounts of neurodevelopmental disorders using a predictive coding framework. We propose future directions for predictive coding research in development. Finally, we describe the first predictive coding experiments in neonates and provide research perspectives for using this framework in searching for early markers of atypical neurodevelopment.

Co-developing sleep-wake and sensory foundations for cognition in the human fetus and newborn

In older children and adults, cognition builds upon waking sensory experience which is consolidated during sleep. In the fetus and newborn, sensory input is instead largely experienced during sleep. The nature of these sensory inputs differs within sleep, between active and quiet sleep, as well as versus wakefulness. Here, sleep-wake organisation in the fetus and newborn is reviewed, and then its interaction with sensory inputs discussed with a focus on somatosensory and auditory modalities. Next, these ideas are applied to how neurological insults affect early development, using fetal growth restriction as a test case. Finally, the argument is made that taking account of sleep-wake state during perinatal functional neuroimaging can better index sensorimotor, language, and cognitive brain activities, potentially improving its diagnostic and prognostic value. To sum up, sensory and sleep-wake functions go hand in hand during early human development. Perturbation of these twinned functions by neurological insults may mediate later neurodevelopmental deficits. Perinatal neuroimaging has the potential to track these trajectories, feasibly identifying opportunities to therapeutically intervene.

Decoding of pain during heel lancing in human neonates with EEG signal and machine learning approach

Currently, pain assessment using electroencephalogram signals and machine learning methods in clinical studies is of great importance, especially for those who cannot express their pain. Since newborns are among the high-risk group and always experience pain at the beginning of birth, in this research, the severity of newborns has been investigated and evaluated. Other studies related to the annoyance of newborns have used the EEG signal of newborns alone; therefore, in this study, the intensity of newborn pain was measured using the electroencephalogram signal of 107 infants who were stimulated by the heel lance in three levels: no pain, low pain and moderate pain were recorded as a single trial and evaluated. The support vector machine (SVM), K-Nearest Neighbors (KNN) and Ensemble bagging classifiers were trained using the K-fold cross-validation method and features of the brain's time-frequency domain. The results were obtained with accuracies of 72.8 ± 2, 84.4 ± 1.3 and 82.9 ± 1.6%, respectively. Also, in examining the problem of distinguishing pain and no pain, the electroencephalogram signal of 74 infants was evaluated, and similar to the three-class mode, with the 10-fold validation method, we reached the highest accuracy of 100% in Bagging classifier and 98.6 ± 0.1 accuracy in KNN and SVM classifiers.

Inter-hemispheric somatosensory coherence and parental stress in hypersensitivity at 8 months old: An electroencephalography study

OBJECTIVE

Infant hypersensitivity affects daily challenges and parental stress. Although the crucial role of tactile sensation in infants' brain function has been highlighted, hypersensitive infants and their families lack support. Electroencephalography may be useful for understanding hypersensitivity traits. We investigated the relationship between infant perceptual hypersensitivity and parental stress, somatosensory-evoked potential (SEP), and magnitude-squared coherence (MSC) in the general population.

METHODS

Infants aged 8 months (n = 63) were evaluated for hypersensitivity and parental stress using a questionnaire and for cortical activity using electroencephalography. Vibration stimuli were applied to the infant's left foot. SEP components that peaked around 150 ms (N2) and at 200 ms (P2) after stimulus onset were evaluated by amplitude and latency at the midline electrode (Cz) and MSC between the midline electrodes (C3-C4).

RESULTS

Parental stress was associated with infant hypersensitivity. The latency of Cz was delayed, and C3-C4 delta MSC was high in infants with hypersensitivity.

CONCLUSIONS

Increasing inter-hemispheric MSC synchrony in the stimulated condition in infants with hypersensitivity suggested atypical somatosensory cortical function.

SIGNIFICANCE

These findings contribute to identifying, understanding the mechanisms of, and developing effective coping strategies for early-stage hypersensitivity.

Developmental changes in neonatal hemodynamics during tactile stimulation using whole-head functional near-infrared spectroscopy

Neural-activity-associated hemodynamic changes have been used to noninvasively measure brain function in the early developmental stages. However, the temporal changes in their hemodynamics are not always consistent with adults. Studies have not evaluated developmental changes for a long period using the same stimuli; therefore, this study examined the normalized relative changes in oxygenated hemoglobin (Δ[oxy-Hb]) in full-term infants and compared them with neonates up to 10 months of age during the administration of tactile vibration stimuli to their limbs using whole-head functional near-infrared spectroscopy. The time to peak of normalized Δ[oxy-Hb] was not affected by age. The amplitude of normalized Δ[oxy-Hb] showed an effect of age in broader areas, including sensorimotor-related but excluding supplementary motor area; the amplitude of normalized Δ[oxy-Hb] decreased the most in the 1-2-month-old group and later increased with development. We hypothesized that these results may reflect developmental changes in neural activity, vasculature, and blood oxygenation.

Cortical signatures of visual body representation develop in human infancy

Human infants cannot report their experiences, limiting what we can learn about their bodily awareness. However, visual cortical responses to the body, linked to visual awareness and selective attention in adults, can be easily measured in infants and provide a promising marker of bodily awareness in early life. We presented 4- and 8-month-old infants with a flickering (7.5 Hz) video of a hand being stroked and recorded steady-state visual evoked potentials (SSVEPs). In half of the trials, the infants also received tactile stroking synchronously with visual stroking. The 8-month-old, but not the 4-month-old infants, showed a significant enhancement of SSVEP responses when they received tactile stimulation concurrent with the visually observed stroking. Follow-up experiments showed that this enhancement did not occur when the visual hand was presented in an incompatible posture with the infant's own body or when the visual stimulus was a body-irrelevant video. Our findings provide a novel insight into the development of bodily self-awareness in the first year of life.

Clinical value of cortical bursting in preterm infants with intraventricular haemorrhage

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.

A developmental shift in habituation to pain in human neonates

Habituation to recurrent non-threatening or unavoidable noxious stimuli is an important aspect of adaptation to pain. Neonates, especially if preterm, are exposed to repeated noxious procedures during their clinical care. They can mount strong behavioral, autonomic, spinal, and cortical responses to a single noxious stimulus; however, it is not known whether the developing nervous system can adapt to the recurrence of these inputs. Here, we used electroencephalography to investigate changes in cortical microstates (representing the complex sequential processing of noxious inputs) following two consecutive clinically required heel lances in term and preterm infants. We show that stimulus repetition dampens the engagement of initial microstates and associated behavioral and autonomic responses in term infants, while preterm infants do not show signs of habituation. Nevertheless, both groups engage different longer-latency cortical microstates to each lance, which is likely to reflect changes in higher-level stimulus processing with repeated stimulation. These data suggest that while both age groups are capable of encoding contextual differences in pain, the preterm brain does not regulate the initial cortical, behavioral, and autonomic responses to repeated noxious stimuli. Habituation mechanisms to pain are already in place at term age but mature over the equivalent of the last trimester of gestation and are not fully functional in preterm neonates.

Widespread nociceptive maps in the human neonatal somatosensory cortex

Topographic cortical maps are essential for spatial localisation of sensory stimulation and generation of appropriate task-related motor responses. Somatosensation and nociception are finely mapped and aligned in the adult somatosensory (S1) cortex, but in infancy, when pain behaviour is disorganised and poorly directed, nociceptive maps may be less refined. We compared the topographic pattern of S1 activation following noxious (clinically required heel lance) and innocuous (touch) mechanical stimulation of the same skin region in newborn infants (n = 32) using multioptode functional near-infrared spectroscopy (fNIRS). Within S1 cortex, touch and lance of the heel elicit localised, partially overlapping increases in oxygenated haemoglobin concentration (Δ[HbO]), but while touch activation was restricted to the heel area, lance activation extended into cortical hand regions. The data reveals a widespread cortical nociceptive map in infant S1, consistent with their poorly directed pain behaviour.

The impact of premature extrauterine exposure on infants' stimulus-evoked brain activity across multiple sensory systems

Prematurity can result in widespread neurodevelopmental impairment, with the impact of premature extrauterine exposure on brain function detectable in infancy. A range of neurodynamic and haemodynamic functional brain measures have previously been employed to study the neurodevelopmental impact of prematurity, with methodological and analytical heterogeneity across studies obscuring how multiple sensory systems are affected. Here, we outline a standardised template analysis approach to measure evoked response magnitudes for visual, tactile, and noxious stimulation in individual infants (n = 15) using EEG. By applying these templates longitudinally to an independent cohort of very preterm infants (n = 10), we observe that the evoked response template magnitudes are significantly associated with age-related maturation. Finally, in a cross-sectional study we show that the visual and tactile response template magnitudes differ between a cohort of infants who are age-matched at the time of study but who differ according to whether they are born during the very preterm or late preterm period (n = 10 and 8 respectively). These findings demonstrate the significant impact of premature extrauterine exposure on brain function and suggest that prematurity can accelerate maturation of the visual and tactile sensory system in infants born very prematurely. This study highlights the value of using a standardised multi-modal evoked-activity analysis approach to assess premature neurodevelopment, and will likely complement resting-state EEG and behavioural assessments in the study of the functional impact of developmental care interventions.

Hierarchical Organization of Corticothalamic Projections to the Pulvinar

Signals from lower cortical visual areas travel to higher-order areas for further processing through cortico-cortical projections, organized in a hierarchical manner. These signals can also be transferred between cortical areas via alternative cortical transthalamic routes involving higher-order thalamic nuclei like the pulvinar. It is unknown whether the organization of transthalamic pathways may reflect the cortical hierarchy. Two axon terminal types have been identified in corticothalamic (CT) pathways: the types I (modulators) and II (drivers) characterized by thin axons with small terminals and by thick axons and large terminals, respectively. In cats, projections from V1 to the pulvinar complex comprise mainly type II terminals, whereas those from extrastriate areas include a combination of both terminals suggesting that the nature of CT terminals varies with the hierarchical order of visual areas. To test this hypothesis, distribution of CT terminals from area 21a was charted and compared with 3 other visual areas located at different hierarchical levels. Results demonstrate that the proportion of modulatory CT inputs increases along the hierarchical level of cortical areas. This organization of transthalamic pathways reflecting cortical hierarchy provides new and fundamental insights for the establishment of more accurate models of cortical signal processing along transthalamic cortical pathways.

A touch of hierarchy: population receptive fields reveal fingertip integration in Brodmann areas in human primary somatosensory cortex

Several neuroimaging studies have shown the somatotopy of body part representations in primary somatosensory cortex (S1), but the functional hierarchy of distinct subregions in human S1 has not been adequately addressed. The current study investigates the functional hierarchy of cyto-architectonically distinct regions, Brodmann areas BA3, BA1, and BA2, in human S1. During functional MRI experiments, we presented participants with vibrotactile stimulation of the fingertips at three different vibration frequencies. Using population Receptive Field (pRF) modeling of the fMRI BOLD activity, we identified the hand region in S1 and the somatotopy of the fingertips. For each voxel, the pRF center indicates the finger that most effectively drives the BOLD signal, and the pRF size measures the spatial somatic pooling of fingertips. We find a systematic relationship of pRF sizes from lower-order areas to higher-order areas. Specifically, we found that pRF sizes are smallest in BA3, increase slightly towards BA1, and are largest in BA2, paralleling the increase in visual receptive field size as one ascends the visual hierarchy. Additionally, we find that the time-to-peak of the hemodynamic response in BA3 is roughly 0.5 s earlier compared to BA1 and BA2, further supporting the notion of a functional hierarchy of subregions in S1. These results were obtained during stimulation of different mechanoreceptors, suggesting that different afferent fibers leading up to S1 feed into the same cortical hierarchy.

Sleep-wake regulation in preterm and term infants

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.

Vibration Alert to the Brain: Evoked and Induced MEG Responses to High-Frequency Vibrotactile Stimuli on the Index Finger of Dominant and Non-dominant Hand

Background: In recent years, vibrotactile haptic feedback technology has been widely used for user interfaces in the mobile devices. Although functional neuroimaging studies have investigated human brain responses to different types of tactile inputs, the neural mechanisms underlying high-frequency vibrotactile perception are still relatively unknown. Our aim was to investigate neuromagnetic brain responses to high-frequency vibrotactile stimulation, using magnetoencephalography (MEG).

Methods: We measured 152-channel whole-head MEG in 30 healthy, right-handed volunteers (aged 20–28 years, 15 females). A total of 300 vibrotactile stimuli were presented at the tip of either the left index finger or the right index finger in two separate sessions. Sinusoidal vibrations at 150 Hz for 200 ms were generated with random inter-stimulus intervals between 1.6 and 2.4 s. Both time-locked analysis and time-frequency analysis were performed to identify peak responses and oscillatory modulations elicited by high-frequency vibrations. The significance of the evoked and induced responses for dominant and non-dominant hand stimulation conditions was statistically tested, respectively. The difference in responses between stimulation conditions was also statistically evaluated.

Results: Prominent peak responses were observed at 56 ms (M50) and at 100 ms (M100) for both stimulation conditions. The M50 response revealed clear dipolar field patterns in the contralateral side with significant cortical activations in the contralateral primary sensorimotor area, whereas the M100 response was not as prominent as the M50. Vibrotactile stimulation induced significant suppression of both alpha (8–12 Hz) and beta (20–30 Hz) band activity during the mid-latency period (0.2–0.4 s), primarily in sensorimotor areas contralateral to the stimulation side. In addition, a significant alpha enhancement effect in posterior regions was accompanied with alpha suppressions in sensorimotor regions. The alpha suppression was observed in a broader distribution of cortical areas for the non-dominant hand stimulation.

Conclusion: Our data demonstrate that high-frequency tactile vibrations, which is known to primarily activate Pacinian corpuscles, elicit somatosensory M50 and M100 responses in the evoked fields and induce modulations of alpha and beta band oscillations during mid-latency periods. Our study is also consistent with that the primary sensorimotor area is significantly involved in the processing of high-frequency vibrotactile information with contralateral dominance.

The impact of parental contact upon cortical noxious-related activity in human neonates

BACKGROUND

Neonates display strong behavioural, physiological and cortical responses to tissue-damaging procedures. Parental contact can successfully regulate general behavioural and physiological reactivity of the infant, but it is not known whether it can influence noxious-related activity in the brain. Brain activity is highly dependent upon maternal presence in animal models, and therefore this could be an important contextual factor in human infant pain-related brain activity.

METHODS

Global topographic analysis was used to identify the presence and inter-group differences in noxious-related activity in three separate parental contexts. EEG was recorded during a clinically required heel lance in three age and sex-matched groups of neonates (a) while held by a parent in skin-to-skin (n = 9), (b) while held by a parent with clothing (n = 9) or (c) not held at all, but in individualized care (n = 9).

RESULTS

The lance elicited a sequence of 4-5 event-related potentials (ERPs), including the noxious ERP (nERP), which was smallest for infants held skin-to-skin and largest for infants held with clothing (p=0.016). The nERP was then followed by additional and divergent long-latency ERPs (> 750 ms post-lance), not previously described, in each of the groups, suggesting the engagement of different higher level cortical processes depending on parental contact.

CONCLUSIONS

These results show the importance of considering contextual factors in determining infant brain activity and reveal the powerful influence of parental contact upon noxious-related activity across the developing human brain.

SIGNIFICANCE

This observational study found that the way in which the neonatal brain processes a noxious stimulus is altered by the type of contact the infant has with their mother. Specifically, being held in skin-to-skin reduces the magnitude of noxious-related cortical activity. This work has also shown that different neural mechanisms are engaged depending on the mother/infant context, suggesting maternal contact can change how a baby's brain processes a noxious stimulus.

Long-range temporal organisation of limb movement kinematics in human neonates

OBJECTIVE

Movement provides crucial sensorimotor information to the developing brain, evoking somatotopic cortical EEG activity. Indeed, temporal-spatial organisation of these movements, including a diverse repertoire of accelerations and limb combinations (e.g. unilateral progressing to bilateral), predicts positive sensorimotor outcomes. However, in current clinical practice, movements in human neonates are qualitatively characterised only during brief periods (a few minutes) of wakefulness, meaning that the vast majority of sensorimotor experience remains unsampled. Here our objective was to quantitatively characterise the long-range temporal organisation of the full repertoire of newborn movements, over multi-hour recordings.

METHODS

We monitored motor activity across 2-4 h in 11 healthy newborn infants (median 1 day old), who wore limb sensors containing synchronised tri-axial accelerometers and gyroscopes. Movements were identified using acceleration and angular velocity, and their organisation across the recording was characterised using cluster analysis and spectral estimation.

RESULTS

Movement occurrence was periodic, with a 1-hour cycle. Peaks in movement occurrence were associated with higher acceleration, and a higher proportion of movements being bilateral.

CONCLUSIONS

Neonatal movement occurrence is cyclical, with periods consistent with sleep-wake behavioural architecture. Movement kinematics are organised by these fluctuations in movement occurrence. Recordings that exceed 1-hour are necessary to capture the long-range temporal organisation of the full repertoire of newborn limb movements.

SIGNIFICANCE

Future work should investigate the prognostic value of combining these movement recordings with synchronised EEG, in at-risk infants.

Body maps in the infant brain: implications for neurodevelopmental disabilities

This review and synthesis discusses recent work that has utilized brain imaging methods, such as the electroencephalogram (EEG) and magnetoencephalogram, to provide insights into the ways that the body is represented in the infant brain. One aspect of body representation concerns somatotopic maps of the body surface in somatosensory cortex. A good deal is known about the properties of these maps in adults, but there has been relatively little developmental work. Recent studies have provided new insights into the organization of infant neural body maps and have laid the foundations for examining their plasticity in relation to behavioral development. Other work has suggested that neural body maps may be involved in the registration of correspondences between self and other, with implications for early social development. Here, body representations are discussed in the context of preterm birth and autism spectrum disorder, providing novel perspectives relevant to developmental medicine and child neurology. WHAT THIS PAPER ADDS: ●Somatotopic body maps develop prenatally through intrinsic and activity-dependent mechanisms. ●There is increasing interest in understanding postnatal plasticity in body maps. ●Body representations may be involved in the registration of preverbal, interpersonal relationships.

Is Low-Grade Intraventricular Hemorrhage in Very Preterm Infants an Innocent Condition? Structural and Functional Evaluation of the Brain Reveals Regional Neurodevelopmental Abnormalities

BACKGROUND AND PURPOSE

There is increasing evidence of abnormal neurodevelopmental outcomes in very preterm infants with low-grade intraventricular hemorrhage grades I and II. Our purpose was to evaluate the effects of low-grade intraventricular hemorrhage on gray and white matter integrity.

MATERIALS AND METHODS

MR imaging at around term-equivalent age was performed in 16 very preterm infants (mean gestational age, 28.8 ± 5.3 weeks) with mild intraventricular hemorrhage on brain sonography and 13 control subjects (mean gestational age, 29.6 ± 4.1 weeks) without intraventricular hemorrhage. Structural and functional evaluation of the cortex was performed using regional measurements of surface area, thickness and volume, and resting-state fMRI, respectively, and of WM microstructural integrity, applying Tract-Based Spatial Statistics to diffusion tensor imaging data.

RESULTS

Compared with the control infants, the infants with low-grade intraventricular hemorrhage had decreases in the following: 1) GM surface area in Brodmann areas 19 left and 9 and 45 right, and GM volume in Brodmann areas 9 and 10 right; 2) fractional anisotropy bilaterally in major WM tracts; and 3) brain activity in the left lower lateral and in the right higher medial somatosensory cortex.

CONCLUSIONS

Very premature infants with low-grade intraventricular hemorrhage at around term-equivalent age may present with regional abnormalities, appearing on imaging studies as cortical underdevelopment, functional impairment, and microstructural immaturity of major WM tracts.

Altered cortical processing of somatosensory input in pre-term infants who had high-grade germinal matrix-intraventricular haemorrhage

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Infants who had GM-IVH recruit different cortical sources following foot stimulation.

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Results indicate restructuring of somatosensory processing during the weeks after GM-IVH.

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GM-IVH is more detrimental for lower than upper limb somatosensory processing.

High-grade (large) germinal matrix-intraventricular haemorrhage (GM-IVH) is one of the most common causes of somatomotor neurodisability in pre-term infants. GM-IVH presents during the first postnatal week and can impinge on somatosensory circuits resulting in aberrant somatosensory cortical events straight after injury. Subsequently, somatosensory circuits undergo significant plastic changes, sometimes allowing the reinstatement of a somatosensory cortical response. However, it is not known whether this restructuring results in a full recovery of somatosensory functions. To investigate this, we compared somatosensory responses to mechanical stimulation measured with 18-channels EEG between infants who had high-grade GM-IVH (with ventricular dilatation and/or intraparenchymal lesion; n = 7 studies from 6 infants; mean corrected gestational age = 33 weeks; mean postnatal age = 56 days) and age-matched controls (n = 9 studies from 8 infants; mean corrected gestational age = 32 weeks; mean postnatal age = 36 days). We showed that infants who had high-grade GM-IVH did not recruit the same cortical source configuration following stimulation of the foot, but their response to stimulation of the hand resembled that of controls. These results show that somatosensory cortical circuits are reinstated in infants who had GM-IVH, during the several weeks after injury, but remain different from those of infants without brain injury. An important next step will be to investigate whether these evidences of neural reorganisation predict neurodevelopmental outcome.

Cortical responses to tactile stimuli in preterm infants

The conventional assessment of preterm somatosensory functions using averaged cortical responses to electrical stimulation ignores the characteristic components of preterm somatosensory evoked responses (SERs). Our study aimed to systematically evaluate the occurrence and development of SERs after tactile stimulus in preterm infants. We analysed SERs performed during 45 electroencephalograms (EEGs) from 29 infants at the mean post-menstrual age of 30.7 weeks. Altogether 2,087 SERs were identified visually at single-trial level from unfiltered signals capturing also their slowest components. We observed salient SERs with a high-amplitude slow component at a high success rate after hand (95%) and foot (83%) stimuli. There was a clear developmental change in both the slow wave and the higher-frequency components of the SERs. Infants with intraventricular haemorrhage (IVH; eleven infants) had initially normal SERs, but those with bilateral IVH later showed a developmental decrease in the ipsilateral SER occurrence after 30 weeks of post-menstrual age. Our study shows that tactile stimulus applied at bedside elicits salient SERs with a large slow component and an overriding fast oscillation, which are specific to the preterm period. Prior experimental research indicates that such SERs allow studying both subplate and cortical functions. Our present findings further suggest that they might offer a window to the emergence of neurodevelopmental sequelae after major structural brain lesions and, hence, an additional tool for both research and clinical neurophysiological evaluation of infants before term age.

THE DEVELOPING BRAIN REVEALED DURING SLEEP

Given the prevalence of sleep in early development, any satisfactory account of infant brain activity must consider what happens during sleep. Only recently, however, has it become possible to record sleep-related brain activity in newborn rodents. Using such methods in rat pups, it is now clear that sleep, more so than wake, provides a critical context for the processing of sensory input and the expression of functional connectivity throughout the sensorimotor system. In addition, sleep uniquely reveals functional activity in the developing primary motor cortex, which establishes a somatosensory map long before its role in motor control emerges. These findings will inform our understanding of the developmental processes that contribute to the nascent sense of embodiment in human infants.

Event-related potentials following contraction of respiratory muscles in pre-term and full-term infants

OBJECTIVE

Involuntary isolated body movements are prominent in pre-term and full-term infants. Proprioceptive and tactile afferent feedback following limb muscle contractions is associated with somatotopic EEG responses. Involuntary contractions of respiratory muscles, primarily the diaphragm - hiccups - are also frequent throughout the human perinatal period during active behavioural states. Here we tested whether diaphragm contraction provides afferent input to the developing brain, as following limb muscle contraction.

METHODS

In 13 infants on the neonatal ward (30-42 weeks corrected gestational age), we analysed EEG activity (18-electrode recordings in six subjects; 17-electrode recordings in five subjects; 16-electrode recordings in two subjects), time-locked to diaphragm contractions (n = 1316) recorded with a movement transducer affixed to the trunk.

RESULTS

All bouts of hiccups occurred during wakefulness or active sleep. Each diaphragm contraction evoked two initial event-related potentials with negativity predominantly across the central region, and a third event-related potential with positivity maximal across the central region.

CONCLUSIONS

Involuntary contraction of the diaphragm can be encoded by the brain from as early as ten weeks prior to the average time of birth.

SIGNIFICANCE

Hiccups - frequently observed in neonates - can provide afferent input to developing sensory cortices in pre-term and full-term infants.