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Llamas-Ramos R, Alvarado-Omenat JJ, Llamas-Ramos I. Early EEG and NIRS measurements in preterm babies: a systematic review. Eur J Pediatr 2024; 183:4169-4178. [PMID: 39110215 DOI: 10.1007/s00431-024-05712-2] [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: 06/24/2024] [Revised: 07/23/2024] [Accepted: 07/31/2024] [Indexed: 09/20/2024]
Abstract
Preterm birth represents a public health problem, with prematurity being the leading cause of infant mortality. An objective brain maturation and oxygenation measurement are necessary. The objective has been To test the feasibility of EEG and NIRS combination in the assessment of physiological brain maturation and oxygenation in preterm and non-preterm babies. A systematic review in Pubmed, Web of Science, MEDLINE, Cochrane, Dialnet, CINAHL, Scopus, Lilacs and PEDro databases until December 2022 was developed. 598 registers were found, finally 5 of them reached the inclusion criteria. Two independent reviewers analyzed data and a third reviewer were available for discrepancies. All articles combined EEG and NIRS to assess brain oxygenation and maturation in healthy new-born babies. There is an agreement on the electrode's placement for EEG at P3 and P4; besides, these regions have been shown to be a development predictive area, as well as the frontoparietal region for the NIRS region and comparison between regions. There is little evidence about the physiological brain electrical activity and oxygenation without stimuli.Conclusion: EEG and NIRS have been useful to assess brain electrical activity and oxygenation in preterm and non-preterm. The combined measurement of these instruments could be essential in neurological disorders diagnosis or their sequels. Unfortunately, the heterogeneity of the results found prevents a consensus on which variables are the most appropriate for the assessment of this population. What is Known • Brain assessment could help clinicians to prevent sequels. • There is an agreement for EEG electrodes placement at P3 and P4 region. What is New • EEG and NIRS assessment are effective measurements for preterm babies. • P3 and P4 regions have shown to be a predictive area of development, as well as the frontoparietal region for NIRS assessment.
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Affiliation(s)
- R Llamas-Ramos
- Department of Nursing and Physiotherapy, Universidad de Salamanca, Avd. Donantes de Sangre s/n, 37007, Salamanca, Spain.
- IBSAL) and Primary Care Research Unit of Salamanca (APISAL), Biomedical Research Institute of Salamanca, Salamanca, Spain.
| | | | - I Llamas-Ramos
- Department of Nursing and Physiotherapy, Universidad de Salamanca, Avd. Donantes de Sangre s/n, 37007, Salamanca, Spain
- IBSAL) and Primary Care Research Unit of Salamanca (APISAL), Biomedical Research Institute of Salamanca, Salamanca, Spain
- University Hospital of Salamanca, Salamanca, Spain
- Health Service of Castile and Leon (SACyL), Salamanca, Spain
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Chock VY, Vesoulis ZA, El-Dib M, Austin T, van Bel F. The Future of Neonatal Cerebral Oxygenation Monitoring: Directions After the SafeBoosC-III Trial. J Pediatr 2024; 270:114016. [PMID: 38492916 DOI: 10.1016/j.jpeds.2024.114016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 02/18/2024] [Accepted: 03/12/2024] [Indexed: 03/18/2024]
Affiliation(s)
- Valerie Y Chock
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA.
| | | | - Mohamed El-Dib
- Division of Newborn Medicine, Department of Pediatrics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Topun Austin
- Neonatal Intensive Care Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Frank van Bel
- Department of Neonatology, University Medical Center Utrecht, Utrecht, The Netherlands
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Kolnik SE, Marquard R, Brandon O, Puia-Dumitrescu M, Valentine G, Law JB, Natarajan N, Dighe M, Mourad PD, Wood TR, Mietzsch U. Preterm infants variability in cerebral near-infrared spectroscopy measurements in the first 72-h after birth. Pediatr Res 2023; 94:1408-1415. [PMID: 37138026 DOI: 10.1038/s41390-023-02618-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 03/29/2023] [Accepted: 04/06/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Cerebral near-infrared spectroscopy is a non-invasive tool used to measure regional cerebral tissue oxygenation (rScO2) initially validated in adult and pediatric populations. Preterm neonates, vulnerable to neurologic injury, are attractive candidates for NIRS monitoring; however, normative data and the brain regions measured by the current technology have not yet been established for this population. METHODS This study's aim was to analyze continuous rScO2 readings within the first 6-72 h after birth in 60 neonates without intracerebral hemorrhage born at ≤1250 g and/or ≤30 weeks' gestational age (GA) to better understand the role of head circumference (HC) and brain regions measured. RESULTS Using a standardized brain MRI atlas, we determined that rScO2 in infants with smaller HCs likely measures the ventricular spaces. GA is linearly correlated, and HC is non-linearly correlated, with rScO2 readings. For HC, we infer that rScO2 is lower in infants with smaller HCs due to measuring the ventricular spaces, with values increasing in the smallest HCs as the deep cerebral structures are reached. CONCLUSION Clinicians should be aware that in preterm infants with small HCs, rScO2 displayed may reflect readings from the ventricular spaces and deep cerebral tissue. IMPACT Clinicians should be aware that in preterm infants with small head circumferences, cerebral near-infrared spectroscopy readings of rScO2 displayed may reflect readings from the ventricular spaces and deep cerebral tissue. This highlights the importance of rigorously re-validating technologies before extrapolating them to different populations. Standard rScO2 trajectories should only be established after determining whether the mathematical models used in NIRS equipment are appropriate in premature infants and the brain region(s) NIRS sensors captures in this population, including the influence of both gestational age and head circumference.
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Affiliation(s)
- Sarah E Kolnik
- Department of Pediatrics, Division of Neonatology, University of Washington School of Medicine, Seattle, WA, USA.
| | | | - Olivia Brandon
- Department of Pediatrics, Division of Neonatology, University of Washington School of Medicine, Seattle, WA, USA
| | - Mihai Puia-Dumitrescu
- Department of Pediatrics, Division of Neonatology, University of Washington School of Medicine, Seattle, WA, USA
| | - Gregory Valentine
- Department of Pediatrics, Division of Neonatology, University of Washington School of Medicine, Seattle, WA, USA
| | - Janessa B Law
- Department of Pediatrics, Division of Neonatology, University of Washington School of Medicine, Seattle, WA, USA
| | - Niranjana Natarajan
- Department of Pediatrics, Division of Neonatology, University of Washington School of Medicine, Seattle, WA, USA
- Department of Neurology, Division of Child Neurology, University of Washington School of Medicine, Seattle, WA, USA
| | - Manjiri Dighe
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Pierre D Mourad
- Division of Engineering and Mathematics, School of STEM, University of Washington, Bothell, WA, USA
- Department of Neurological Surgery, School of Medicine, University of Washington, Seattle, WA, USA
| | - Thomas R Wood
- Department of Pediatrics, Division of Neonatology, University of Washington School of Medicine, Seattle, WA, USA
| | - Ulrike Mietzsch
- Department of Pediatrics, Division of Neonatology, University of Washington School of Medicine, Seattle, WA, USA
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Solaz-García Á, Sánchez-Illana Á, Lara-Cantón I, Montejano-Lozoya R, Gimeno-Navarro A, Pinilla-González A, Torrejón-Rodríguez L, Vento M, Sáenz-González P. Analysis of Fractional Cerebral Oxygen Extraction in Preterm Infants during the Kangaroo Care. Neonatology 2023; 120:508-516. [PMID: 37285816 DOI: 10.1159/000530027] [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: 10/13/2022] [Accepted: 02/28/2023] [Indexed: 06/09/2023]
Abstract
INTRODUCTION We aimed to investigate the cerebral fractional tissue oxygen extraction (FtOE) during kangaroo care (KC) in premature infants and compare cardiorespiratory stability and hypoxic or bradycardic events between KC and incubator care. METHODS A single-center prospective observational study was carried out at the NICU of a level 3 perinatal center. Preterm infants <32 weeks gestational age were subjected to KC. Patients were subjected to continuous monitoring of regional cerebral oxygen saturation (rScO2), peripheral oxygen saturation (SpO2), and heart rate (HR) during KC, before KC (pre-KC), and after KC (post-KC). The monitoring data were stored and exported to MATLAB for synchronization and signal analysis including the calculation of the FtOE and events analysis (i.e., desaturations and bradycardias counts and anormal values). Furthermore, the event counts and the mean SpO2, HR, rScO2, and FtOE were compared between studied periods employing the Wilcoxon rank-sum test and the Friedman test, respectively. RESULTS A total of forty-three KC sessions with their corresponding pre-KC and post-KC segments were analyzed. The distributions of the SpO2, HR, rScO2, and FtOE showed different patterns according to the respiratory support, but not differences between the studied periods were detected. Accordingly, no significant differences in monitoring events were evidenced. However, cerebral metabolic demand (FtOE) was significantly lower during KC compared with post-KC (p = 0.019). CONCLUSION Premature infants remain clinically stable during KC. Moreover, cerebral oxygenation is significantly higher and cerebral tissular oxygen extraction is significantly lower during KC compared with incubator care in post-KC. No differences in HR and SpO2 were shown. This novel data analysis methodology could be expanded to other clinical situations.
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Affiliation(s)
- Álvaro Solaz-García
- Neonatal Research Unit, Health Research Institute La Fe, Valencia, Spain,
- Division of Neonatology, University and Polytechnic Hospital La Fe (HUIPLAFE), Valencia, Spain,
| | - Ángel Sánchez-Illana
- Neonatal Research Unit, Health Research Institute La Fe, Valencia, Spain
- Department of Analytical Chemistry, University of Valencia, Burjassot, Spain
| | - Inmaculada Lara-Cantón
- Neonatal Research Unit, Health Research Institute La Fe, Valencia, Spain
- Division of Neonatology, University and Polytechnic Hospital La Fe (HUIPLAFE), Valencia, Spain
| | | | - Ana Gimeno-Navarro
- Neonatal Research Unit, Health Research Institute La Fe, Valencia, Spain
- Division of Neonatology, University and Polytechnic Hospital La Fe (HUIPLAFE), Valencia, Spain
| | - Alejandro Pinilla-González
- Neonatal Research Unit, Health Research Institute La Fe, Valencia, Spain
- Division of Neonatology, University and Polytechnic Hospital La Fe (HUIPLAFE), Valencia, Spain
| | - Laura Torrejón-Rodríguez
- Neonatal Research Unit, Health Research Institute La Fe, Valencia, Spain
- Division of Neonatology, University and Polytechnic Hospital La Fe (HUIPLAFE), Valencia, Spain
| | - Maximo Vento
- Neonatal Research Unit, Health Research Institute La Fe, Valencia, Spain
- Division of Neonatology, University and Polytechnic Hospital La Fe (HUIPLAFE), Valencia, Spain
| | - Pilar Sáenz-González
- Neonatal Research Unit, Health Research Institute La Fe, Valencia, Spain
- Division of Neonatology, University and Polytechnic Hospital La Fe (HUIPLAFE), Valencia, Spain
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Martini S, Thewissen L, Austin T, da Costa CS, de Boode WP, Dempsey E, Kooi E, Pellicer A, Rhee CJ, Riera J, Wolf M, Wong F. Near-infrared spectroscopy monitoring of neonatal cerebrovascular reactivity: where are we now? Pediatr Res 2023:10.1038/s41390-023-02574-6. [PMID: 36997690 DOI: 10.1038/s41390-023-02574-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 02/09/2023] [Accepted: 02/17/2023] [Indexed: 06/19/2023]
Abstract
Cerebrovascular reactivity defines the ability of the cerebral vasculature to regulate its resistance in response to both local and systemic factors to ensure an adequate cerebral blood flow to meet the metabolic demands of the brain. The increasing adoption of near-infrared spectroscopy (NIRS) for non-invasive monitoring of cerebral oxygenation and perfusion allowed investigation of the mechanisms underlying cerebrovascular reactivity in the neonatal population, confirming important associations with pathological conditions including the development of brain injury and adverse neurodevelopmental outcomes. However, the current literature on neonatal cerebrovascular reactivity is mainly still based on small, observational studies and is characterised by methodological heterogeneity; this has hindered the routine application of NIRS-based monitoring of cerebrovascular reactivity to identify infants most at risk of brain injury. This review aims (1) to provide an updated review on neonatal cerebrovascular reactivity, assessed using NIRS; (2) to identify critical points that need to be addressed with targeted research; and (3) to propose feasibility trials in order to fill the current knowledge gaps and to possibly develop a preventive or curative approach for preterm brain injury. IMPACT: NIRS monitoring has been largely applied in neonatal research to assess cerebrovascular reactivity in response to blood pressure, PaCO2 and other biochemical or metabolic factors, providing novel insights into the pathophysiological mechanisms underlying cerebral blood flow regulation. Despite these insights, the current literature shows important pitfalls that would benefit to be addressed in a series of targeted trials, proposed in the present review, in order to translate the assessment of cerebrovascular reactivity into routine monitoring in neonatal clinical practice.
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Affiliation(s)
- Silvia Martini
- Neonatal Intensive Care Unit, IRCCS AOU S. Orsola, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
| | | | - Topun Austin
- Neonatal Intensive Care Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Willem P de Boode
- Department of Neonatology, Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Eugene Dempsey
- Department of Paediatrics and Child Health, INFANT Centre, University College Cork, Cork, Ireland
| | - Elisabeth Kooi
- Division of Neonatology, Beatrix Children's Hospital, University Medical Center, University of Groningen, Groningen, The Netherlands
| | - Adelina Pellicer
- Department of Neonatology, La Paz University Hospital, Madrid, Spain
| | - Christopher J Rhee
- Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Joan Riera
- Department of Neonatology, La Paz University Hospital, Madrid, Spain
- Center for Biomedical Technology, Technical University, Madrid, Spain
| | - Martin Wolf
- Biomedical Optics Research Laboratory, Department of Neonatology, University Hospital Zurich, Zurich, Switzerland
| | - Flora Wong
- Monash Newborn, Monash Children's Hospital, Hudson Institute of Medical Research, Department of Paediatrics, Monash University, Melbourne, VIC, Australia
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Hermans T, Carkeek K, Dereymaeker A, Jansen K, Naulaers G, Van Huffel S, De Vos M. Partial wavelet coherence as a robust method for assessment of neurovascular coupling in neonates with hypoxic ischemic encephalopathy. Sci Rep 2023; 13:457. [PMID: 36627381 PMCID: PMC9832127 DOI: 10.1038/s41598-022-27275-8] [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: 04/06/2022] [Accepted: 12/29/2022] [Indexed: 01/12/2023] Open
Abstract
In neonates with hypoxic ischemic encephalopathy, the computation of wavelet coherence between electroencephalogram (EEG) power and regional cerebral oxygen saturation (rSO2) is a promising method for the assessment of neurovascular coupling (NVC), which in turn is a promising marker for brain injury. However, instabilities in arterial oxygen saturation (SpO2) limit the robustness of previously proposed methods. Therefore, we propose the use of partial wavelet coherence, which can eliminate the influence of SpO2. Furthermore, we study the added value of the novel NVC biomarkers for identification of brain injury compared to traditional EEG and NIRS biomarkers. 18 neonates with HIE were monitored for 72 h and classified into three groups based on short-term MRI outcome. Partial wavelet coherence was used to quantify the coupling between C3-C4 EEG bandpower (2-16 Hz) and rSO2, eliminating confounding effects of SpO2. NVC was defined as the amount of significant coherence in a frequency range of 0.25-1 mHz. Partial wavelet coherence successfully removed confounding influences of SpO2 when studying the coupling between EEG and rSO2. Decreased NVC was related to worse MRI outcome. Furthermore, the combination of NVC and EEG spectral edge frequency (SEF) improved the identification of neonates with mild vs moderate and severe MRI outcome compared to using EEG SEF alone. Partial wavelet coherence is an effective method for removing confounding effects of SpO2, improving the robustness of automated assessment of NVC in long-term EEG-NIRS recordings. The obtained NVC biomarkers are more sensitive to MRI outcome than traditional rSO2 biomarkers and provide complementary information to EEG biomarkers.
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Affiliation(s)
- Tim Hermans
- Department of Electrical Engineering (ESAT), STADIUS, KU Leuven, Leuven, Belgium.
| | - Katherine Carkeek
- grid.5596.f0000 0001 0668 7884Department of Development and Regeneration, KU Leuven, Leuven, Belgium ,grid.410569.f0000 0004 0626 3338Neonatal Intensive Care Unit, UZ Leuven, Leuven, Belgium ,grid.48769.340000 0004 0461 6320Neonatal Intensive Care Unit, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - Anneleen Dereymaeker
- grid.5596.f0000 0001 0668 7884Department of Development and Regeneration, KU Leuven, Leuven, Belgium ,grid.410569.f0000 0004 0626 3338Neonatal Intensive Care Unit, UZ Leuven, Leuven, Belgium
| | - Katrien Jansen
- grid.5596.f0000 0001 0668 7884Department of Development and Regeneration, KU Leuven, Leuven, Belgium ,grid.410569.f0000 0004 0626 3338Child Neurology, UZ Leuven, Leuven, Belgium
| | - Gunnar Naulaers
- grid.5596.f0000 0001 0668 7884Department of Development and Regeneration, KU Leuven, Leuven, Belgium ,grid.410569.f0000 0004 0626 3338Neonatal Intensive Care Unit, UZ Leuven, Leuven, Belgium
| | - Sabine Van Huffel
- grid.5596.f0000 0001 0668 7884Department of Electrical Engineering (ESAT), STADIUS, KU Leuven, Leuven, Belgium
| | - Maarten De Vos
- grid.5596.f0000 0001 0668 7884Department of Electrical Engineering (ESAT), STADIUS, KU Leuven, Leuven, Belgium ,grid.5596.f0000 0001 0668 7884Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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Mielgo V, Gastiasoro E, Salomone F, Ricci F, Gomez-Solaetxe MA, Olazar L, Loureiro B, Rey-Santano C. Structural and haemodynamic evaluation of less invasive surfactant administration during nasal intermittent positive pressure ventilation in surfactant-deficient newborn piglets. PLoS One 2023; 18:e0284750. [PMID: 37115799 PMCID: PMC10146512 DOI: 10.1371/journal.pone.0284750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 04/07/2023] [Indexed: 04/29/2023] Open
Abstract
The most recent approaches to the initial treatment of respiratory distress syndrome (RDS)- involve non-invasive ventilation (NIV) and less-invasive surfactant (SF) administration (LISA). Combining these techniques has been proven a useful treatment option for SF-deficient neonates. The objective of this study was to explore the impact on the brain (using cerebral near infrared spectroscopy, NIRS) of different LISA methods during NIV, using nasal intermittent positive pressure ventilation (NIPPV) for treating neonatal RDS. For this, we used five groups of spontaneously breathing newborn piglets (n = 6/group) with bronchoalveolar lavage (BAL)-induced respiratory distress which received NIPPV only (controls), poractant-alfa using the INSURE-like method (bolus delivery) followed by NIPPV, or poractant-alfa using one of three LISA devices, 1) a nasogastric tube (NT), 2) a vascular catheter (VC) or 3) the LISAcath® catheter. We assessed pulmonary, hemodynamic and cerebral effects, and performed histological analysis of lung and brain tissue. Following BALs, the piglets developed severe RDS (pH<7.2, PaCO2>70 mmHg, PaO2<70 mmHg, dynamic compliance<0.5 ml/cmH2O/kg at FiO2 = 1). Poractant-alfa administration using different LISA techniques during NIPPV was well tolerated and efficacious in newborn piglets. In our study, although all groups showed normal physiological ranges of total lung injury score and biochemical lung analysis, VC and LISAcath® catheters were associated with better values of lung compliance and lower values of lung damage than NIPPV, NT or INSURE-like methods. Moreover, neither of the SF administration methods used (LISA or INSURE-like) had a significant impact on the histological neonatal brain injury score. Of note, the LISAcath® has been recently withdrawn from the market.
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Affiliation(s)
- Victoria Mielgo
- Animal Research Unit, Biocruces-Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Elena Gastiasoro
- Primary Health Care, Biocruces-Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
| | | | | | | | - Lara Olazar
- Primary Health Care, Biocruces-Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Begoña Loureiro
- Animal Research Unit, Biocruces-Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Carmen Rey-Santano
- Animal Research Unit, Biocruces-Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
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Oxidative Stress Biomarkers and Early Brain Activity in Extremely Preterm Infants: A Prospective Cohort Study. CHILDREN 2022; 9:children9091376. [PMID: 36138685 PMCID: PMC9497792 DOI: 10.3390/children9091376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/04/2022] [Accepted: 09/07/2022] [Indexed: 11/17/2022]
Abstract
Early brain activity, measured using amplitude-integrated EEG (aEEG), is correlated with neurodevelopmental outcome in preterm newborns. F2-isoprostanes (IPs) are early biomarkers predictive for brain damage. We aimed to investigate the relationship between perinatal IPs concentrations and quantitative aEEG measures in preterm newborns. Thirty-nine infants (gestational age (GA) 24–27 ± 6 weeks) who underwent neuromonitoring using aEEG during the first two days after birth were enrolled. The rate of spontaneous activity transients per minute (SAT rate) and inter-SAT interval (ISI) in seconds were computed. Two postnatal time-points were examined: within 12 h (day 1) and between 24 and 48 h (day 2). IPs were measured in plasma from cord blood (cb-IPs) and between 24 and 48 h (pl-IPs). Multivariable regression analyses were performed to assess the correlation between IPs and brain activity. Cb-IPs were not associated with SAT rate and ISI at day 1. Higher pl-IPs were followed by longer ISI (R = 0.68; p = 0.034) and decreased SAT rate (R = 0.58; p = 0.007) at day 2 after adjusting for GA, FiO2 and IVH. Higher pl-IPs levels are associated with decreased functional brain activity. Thus, pl-IPs may represent a useful biomarker of brain vulnerability in high-risk infants.
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Hanke K, Rausch TK, Sosnowski R, Paul P, Spiegler J, Müller M, König IR, Göpel W, Herting E, Härtel C. Early Skin-to-Skin Contact Does Not Affect Cerebral Tissue Oxygenation in Preterm Infants <32 Weeks of Gestation. CHILDREN 2022; 9:children9020211. [PMID: 35204931 PMCID: PMC8869971 DOI: 10.3390/children9020211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/20/2022] [Accepted: 01/28/2022] [Indexed: 11/16/2022]
Abstract
Aim: It was the aim of our study to determine the regional cerebral tissue oxygenation saturation (rcSO2) as an additional monitoring parameter during early skin-to-skin contact (SSC) in preterm infants with a gestational age of <32 gestational weeks. Methods: We conducted two observational convenience sample studies using additional monitoring with near-infrared spectroscopy (NIRS) in the first 120 h of life: (a) NIRS 1 (gestational age of 26 0/7 to 31 6/7 weeks) and (b) NIRS 2 (gestational age of 24 0/7 to 28 6/7 weeks). The rcSO2 values were compared between resting time in the incubator (period I), SSC (period II) and handling nursing care (period III). For the comparison, we separated the sequential effects by including a “wash-out phase” of 1 h between each period. Results: During the first 120 h of life 38/53 infants in NIRS 1 and 15/23 infants in NIRS 2 received SSC, respectively. We found no remarkable differences for rcSO2 values of NIRS 1 patients between SSC time and period I (95% confidence interval (CI) for the difference in %: SSC vs. period I [1; 3]). In NIRS 2, rcSO2 values during SSC were only 2% lower compared with period I [median [1. quartile; 3. quartile] in %; 78 [73; 82] vs. 80 [74; 85]] but were similar to period III [78 [72; 83]]. In a combined analysis, a small difference in rcSO2 values between SSC and resting times was found using a generalized linear mixed model that included gender and gestational age (OR 95% CI; 1.178 [1.103; 1.253], p < 0.0001). Episodes below the cut-off for “hypoxia”; e.g., <55%, were comparable during SSC and periods I and III (0.3–2.1%). No FiO2 adjustment was required in the vast majority of SSC episodes. Conclusions: Our observational data indicate that rcSO2 values of infants during SSC were comparable to rcSO2 values during incubator care and resting time. This additional monitoring supports a safe implementation of early SSC in extremely preterm infants in NICUs.
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Affiliation(s)
- Kathrin Hanke
- Department of Pediatrics, University of Lübeck, D-23538 Lüebeck, Germany; (T.K.R.); (R.S.); (W.G.); (E.H.)
- Correspondence: ; Tel.: +49-451-500-42800; Fax: +49-451-500-42804
| | - Tanja K. Rausch
- Department of Pediatrics, University of Lübeck, D-23538 Lüebeck, Germany; (T.K.R.); (R.S.); (W.G.); (E.H.)
- Institut für Medizinische Biometrie und Statistik, University of Lübeck, D-23538 Lübeck, Germany;
| | - Runa Sosnowski
- Department of Pediatrics, University of Lübeck, D-23538 Lüebeck, Germany; (T.K.R.); (R.S.); (W.G.); (E.H.)
| | - Pia Paul
- Department of Pediatrics, University of Würzburg, D-97080 Würzburg, Germany; (P.P.); (J.S.); (M.M.); (C.H.)
| | - Juliane Spiegler
- Department of Pediatrics, University of Würzburg, D-97080 Würzburg, Germany; (P.P.); (J.S.); (M.M.); (C.H.)
| | - Mirja Müller
- Department of Pediatrics, University of Würzburg, D-97080 Würzburg, Germany; (P.P.); (J.S.); (M.M.); (C.H.)
| | - Inke R. König
- Institut für Medizinische Biometrie und Statistik, University of Lübeck, D-23538 Lübeck, Germany;
| | - Wolfgang Göpel
- Department of Pediatrics, University of Lübeck, D-23538 Lüebeck, Germany; (T.K.R.); (R.S.); (W.G.); (E.H.)
| | - Egbert Herting
- Department of Pediatrics, University of Lübeck, D-23538 Lüebeck, Germany; (T.K.R.); (R.S.); (W.G.); (E.H.)
| | - Christoph Härtel
- Department of Pediatrics, University of Würzburg, D-97080 Würzburg, Germany; (P.P.); (J.S.); (M.M.); (C.H.)
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Tataranno ML, Vijlbrief DC, Dudink J, Benders MJNL. Precision Medicine in Neonates: A Tailored Approach to Neonatal Brain Injury. Front Pediatr 2021; 9:634092. [PMID: 34095022 PMCID: PMC8171663 DOI: 10.3389/fped.2021.634092] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 04/14/2021] [Indexed: 11/27/2022] Open
Abstract
Despite advances in neonatal care to prevent neonatal brain injury and neurodevelopmental impairment, predicting long-term outcome in neonates at risk for brain injury remains difficult. Early prognosis is currently based on cranial ultrasound (CUS), MRI, EEG, NIRS, and/or general movements assessed at specific ages, and predicting outcome in an individual (precision medicine) is not yet possible. New algorithms based on large databases and machine learning applied to clinical, neuromonitoring, and neuroimaging data and genetic analysis and assays measuring multiple biomarkers (omics) can fulfill the needs of modern neonatology. A synergy of all these techniques and the use of automatic quantitative analysis might give clinicians the possibility to provide patient-targeted decision-making for individualized diagnosis, therapy, and outcome prediction. This review will first focus on common neonatal neurological diseases, associated risk factors, and most common treatments. After that, we will discuss how precision medicine and machine learning (ML) approaches could change the future of prediction and prognosis in this field.
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Affiliation(s)
| | | | | | - Manon J. N. L. Benders
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
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Rugytė DČ, Strumylaitė L. Potential Relationship between Cerebral Fractional Tissue Oxygen Extraction (FTOE) and the Use of Sedative Agents during the Perioperative Period in Neonates and Infants. CHILDREN-BASEL 2020; 7:children7110209. [PMID: 33153002 PMCID: PMC7692108 DOI: 10.3390/children7110209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 12/27/2022]
Abstract
Fractional tissue oxygen extraction (FTOE) by means of cerebral near-infrared spectroscopy (NIRS) provides information about oxygen uptake in the brain. Experimental animal data suggest that sedative agents decrease cerebral oxygen demand. The aim of the present study was to investigate the association between the cerebral FTOE and the use of pre and intraoperative sedative agents in infants aged 1-90 days. Cerebral NIRS was continuously applied during open major non-cardiac surgery in 46 infants. The main outcomes were the mean intraoperative FTOE and the percentage (%) of time of intraoperative hyperoxiaFTOE relative to the total duration of anesthesia. HyperoxiaFTOE was defined as FTOE ≤ 0.1. Cumulative doses of sedative agents (benzodiazepines and morphine), given up to 24 h preoperatively, correlated with the mean intraoperative FTOE (Spearman's rho = -0.298, p = 0.0440) and were predictive for the % of time of intraoperative hyperoxiaFTOE (β (95% CI) 47.12 (7.32; 86.92)) when adjusted for the patients' age, type of surgery, preoperative hemoglobin, intraoperative sevoflurane and fentanyl dose, mean intraoperative arterial blood pressure, and end-tidal CO2 by multivariate 0.75 quantile regression. There was no association with 0.5 quantile regression. We observed the suggestive positive association of decreased fractional cerebral tissue oxygen extraction and the use of sedative agents in neonates and infants undergoing surgery.
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Affiliation(s)
- Danguolė Č Rugytė
- Department of Anesthesiology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
- Correspondence:
| | - Loreta Strumylaitė
- Neuroscience Institute, Lithuanian University of Health Sciences, 50161 Kaunas, Lithuania;
- Department of Preventive Medicine, Faculty of Public Health, Lithuanian University of Health Sciences, 47181 Kaunas, Lithuania
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12
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Hanke K, Rausch TK, Paul P, Hellwig I, Krämer C, Stichtenoth G, Herz A, Wieg C, König IR, Göpel W, Herting E, Härtel C. The effect of less invasive surfactant administration on cerebral oxygenation in preterm infants. Acta Paediatr 2020; 109:291-299. [PMID: 31310677 DOI: 10.1111/apa.14939] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 06/13/2019] [Accepted: 07/11/2019] [Indexed: 11/29/2022]
Abstract
AIM To determine the regional cerebral tissue oxygenation saturation (rcSO2 ) in a group of infants requiring less invasive surfactant administration (LISA) as compared to infants with continuous positive airway pressure (CPAP) only. METHODS In preterm infants with a gestational age 26 0/7-31 6/7 weeks, we conducted an observational study using near-infrared spectroscopy (NIRS) in the first 120 hours of life. RESULTS We analysed the data of 22 infants who never received surfactant (CPAP), 22 infants had LISA and CPAP (LISA) and 6 infants received surfactant via endotracheal tube (ETT). Four infants had both surfactant application modes including six LISA applications. In total, there were 32 successful LISA applications but 44 attempts; 13/44 (30%) of LISA attempts resulted in a 20% decrease of rcSO2 . During the first 120 hours of life, rcSO2 values of CPAP were similar to those of infants in the LISA group, that is median rcSO2 values 90% vs 85%, respectively (P = .126). Episodes with rcSO2 values <65% were 0.4% in the CPAP group as compared to 4.8% in the LISA group (P < .001). CONCLUSION Our observational data indicate that rcSO2 values of infants in the LISA group were similar to the CPAP group.
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Affiliation(s)
- Kathrin Hanke
- Department of Pediatrics University of Lübeck Lübeck Germany
| | - Tanja K. Rausch
- Department of Pediatrics University of Lübeck Lübeck Germany
- Institute for Medical Biometry and Statistics University of Lübeck Lübeck Germany
| | - Pia Paul
- Department of Pediatrics University of Lübeck Lübeck Germany
| | - Isabel Hellwig
- Department of Pediatrics University of Lübeck Lübeck Germany
| | | | | | - Alexander Herz
- Department of Pediatrics University of Lübeck Lübeck Germany
| | - Christian Wieg
- Department of Neonatology Klinikum Aschaffenburg‐Alzenau Aschaffenburg Germany
| | - Inke R. König
- Institute for Medical Biometry and Statistics University of Lübeck Lübeck Germany
| | - Wolfgang Göpel
- Department of Pediatrics University of Lübeck Lübeck Germany
| | - Egbert Herting
- Department of Pediatrics University of Lübeck Lübeck Germany
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13
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Terstappen F, Richter AE, Lely AT, Hoebeek FE, Elvan-Taspinar A, Bos AF, Ganzevoort W, Pels A, Lemmers PM, Kooi EMW. Prenatal Use of Sildenafil in Fetal Growth Restriction and Its Effect on Neonatal Tissue Oxygenation-A Retrospective Analysis of Hemodynamic Data From Participants of the Dutch STRIDER Trial. Front Pediatr 2020; 8:595693. [PMID: 33344386 PMCID: PMC7744464 DOI: 10.3389/fped.2020.595693] [Citation(s) in RCA: 4] [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: 08/17/2020] [Accepted: 11/16/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: Sildenafil is under investigation as a potential agent to improve uteroplacental perfusion in fetal growth restriction (FGR). However, the STRIDER RCT was halted after interim analysis due to futility and higher rates of persistent pulmonary hypertension and mortality in sildenafil-exposed neonates. This hypothesis-generating study within the Dutch STRIDER trial sought to understand what happened to these neonates by studying their regional tissue oxygen saturation (rSO2) within the first 72 h after birth. Methods: Pregnant women with FGR received 25 mg placebo or sildenafil thrice daily within the Dutch STRIDER trial. We retrospectively analyzed the cerebral and renal rSO2 monitored with near-infrared spectroscopy (NIRS) in a subset of neonates admitted to two participating neonatal intensive care units, in which NIRS is part of standard care. Secondarily, blood pressure and heart rate were analyzed to aid interpretation. Differences in oxygenation levels and interaction with time (slope) between placebo- and sildenafil-exposed groups were tested using mixed effects analyses with multiple comparisons tests. Results: Cerebral rSO2 levels were not different between treatment groups (79 vs. 77%; both n = 14) with comparable slopes. Sildenafil-exposed infants (n = 5) showed lower renal rSO2 than placebo-exposed infants (n = 6) during several time intervals on day one and two. At 69-72 h, however, the sildenafil group showed higher renal rSO2 than the placebo group. Initially, diastolic blood pressure was higher and heart rate lower in the sildenafil than the placebo group, which changed during day two. Conclusions: Although limited by sample size, our data suggest that prenatal sildenafil alters renal but not cerebral oxygenation in FGR neonates during the first 72 post-natal hours. The observed changes in renal oxygenation could reflect a vasoconstrictive rebound from sildenafil. Similar changes observed in accompanying vital parameters support this hypothesis.
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Affiliation(s)
- Fieke Terstappen
- University Medical Center Utrecht, Wilhelmina Children's Hospital, Department of Obstetrics, Utrecht University, Utrecht, Netherlands.,University Medical Center Utrecht, Wilhelmina Children's Hospital and Brain Center, Department for Developmental Origins of Disease, Utrecht University, Utrecht, Netherlands
| | - Anne E Richter
- University Medical Center Groningen, Beatrix Children's Hospital, Division of Neonatology, University of Groningen, Groningen, Netherlands
| | - A Titia Lely
- University Medical Center Utrecht, Wilhelmina Children's Hospital, Department of Obstetrics, Utrecht University, Utrecht, Netherlands
| | - Freek E Hoebeek
- University Medical Center Utrecht, Wilhelmina Children's Hospital and Brain Center, Department for Developmental Origins of Disease, Utrecht University, Utrecht, Netherlands
| | - Ayten Elvan-Taspinar
- University Medical Center Groningen, Department of Obstetrics, University of Groningen, Groningen, Netherlands
| | - Arend F Bos
- University Medical Center Groningen, Beatrix Children's Hospital, Division of Neonatology, University of Groningen, Groningen, Netherlands
| | - Wessel Ganzevoort
- Amsterdam University Medical Centers, Department of Obstetrics, University of Amsterdam, Amsterdam, Netherlands
| | - Anouk Pels
- Amsterdam University Medical Centers, Department of Obstetrics, University of Amsterdam, Amsterdam, Netherlands
| | - Petra M Lemmers
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Elisabeth M W Kooi
- University Medical Center Groningen, Beatrix Children's Hospital, Division of Neonatology, University of Groningen, Groningen, Netherlands
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14
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McDonald FB, Dempsey EM, O'Halloran KD. The impact of preterm adversity on cardiorespiratory function. Exp Physiol 2019; 105:17-43. [PMID: 31626357 DOI: 10.1113/ep087490] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 10/15/2019] [Indexed: 12/16/2022]
Abstract
NEW FINDINGS What is the topic of this review? We review the influence of prematurity on the cardiorespiratory system and examine the common sequel of alterations in oxygen tension, and immune activation in preterm infants. What advances does it highlight? The review highlights neonatal animal models of intermittent hypoxia, hyperoxia and infection that contribute to our understanding of the effect of stress on neurodevelopment and cardiorespiratory homeostasis. We also focus on some of the important physiological pathways that have a modulatory role on the cardiorespiratory system in early life. ABSTRACT Preterm birth is one of the leading causes of neonatal mortality. Babies that survive early-life stress associated with immaturity have significant prevailing short- and long-term morbidities. Oxygen dysregulation in the first few days and weeks after birth is a primary concern as the cardiorespiratory system slowly adjusts to extrauterine life. Infants exposed to rapid alterations in oxygen tension, including exposures to hypoxia and hyperoxia, have altered redox balance and active immune signalling, leading to altered stress responses that impinge on neurodevelopment and cardiorespiratory homeostasis. In this review, we explore the clinical challenges posed by preterm birth, followed by an examination of the literature on animal models of oxygen dysregulation and immune activation in the context of early-life stress.
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Affiliation(s)
- Fiona B McDonald
- Department of Physiology, School of Medicine, College of Medicine & Health, University College Cork, Cork, Ireland.,Irish Centre for Fetal and Neonatal Translational Research (INFANT) Research Centre, University College Cork, Cork, Ireland
| | - Eugene M Dempsey
- Irish Centre for Fetal and Neonatal Translational Research (INFANT) Research Centre, University College Cork, Cork, Ireland.,Department of Paediatrics & Child Health, School of Medicine, College of Medicine & Health, Cork University Hospital, Wilton, Cork, Ireland
| | - Ken D O'Halloran
- Department of Physiology, School of Medicine, College of Medicine & Health, University College Cork, Cork, Ireland.,Irish Centre for Fetal and Neonatal Translational Research (INFANT) Research Centre, University College Cork, Cork, Ireland
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15
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Regional tissue oxygenation monitoring in the neonatal intensive care unit: evidence for clinical strategies and future directions. Pediatr Res 2019; 86:296-304. [PMID: 31247635 DOI: 10.1038/s41390-019-0466-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 05/24/2019] [Accepted: 06/08/2019] [Indexed: 12/19/2022]
Abstract
Near-infrared spectroscopy (NIRS)-based monitoring of regional tissue oxygenation (rSO2) is becoming more commonplace in the neonatal intensive care unit (NICU). While increasing evidence supports rSO2 monitoring, actual standards for applying this noninvasive bedside technique continue to evolve. This review highlights the current strengths and pitfalls surrounding practical NIRS-based monitoring in the neonatal population. The physiologic background of rSO2 monitoring is discussed, with attention to understanding oxygen delivery/consumption mismatch and its effects on tissue oxygen extraction. The bedside utility of both cerebral and peripheral rSO2 monitoring in the NICU is then explored from two perspectives: (1) disease/event-specific "responsive" monitoring and (2) "routine," continuous monitoring. Recent evidence incorporating both monitoring approaches is summarized with emphasis on practical applicability in the NICU. Finally, a future paradigm for a broad-based NIRS monitoring strategy is presented, with attention towards improving personalization of neonatal care and ultimately enhancing long-term outcomes.
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16
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Hendrikx D, Smits A, Lavanga M, De Wel O, Thewissen L, Jansen K, Caicedo A, Van Huffel S, Naulaers G. Measurement of Neurovascular Coupling in Neonates. Front Physiol 2019; 10:65. [PMID: 30833901 PMCID: PMC6387909 DOI: 10.3389/fphys.2019.00065] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 01/21/2019] [Indexed: 01/01/2023] Open
Abstract
Neurovascular coupling refers to the mechanism that links the transient neural activity to the subsequent change in cerebral blood flow, which is regulated by both chemical signals and mechanical effects. Recent studies suggest that neurovascular coupling in neonates and preterm born infants is different compared to adults. The hemodynamic response after a stimulus is later and less pronounced and the stimulus might even result in a negative (hypoxic) signal. In addition, studies both in animals and neonates confirm the presence of a short hypoxic period after a stimulus in preterm infants. In clinical practice, different methodologies exist to study neurovascular coupling. The combination of functional magnetic resonance imaging or functional near-infrared spectroscopy (brain hemodynamics) with EEG (brain function) is most commonly used in neonates. Especially near-infrared spectroscopy is of interest, since it is a non-invasive method that can be integrated easily in clinical care and is able to provide results concerning longer periods of time. Therefore, near-infrared spectroscopy can be used to develop a continuous non-invasive measurement system, that could be used to study neonates in different clinical settings, or neonates with different pathologies. The main challenge for the development of a continuous marker for neurovascular coupling is how the coupling between the signals can be described. In practice, a wide range of signal interaction measures exist. Moreover, biomedical signals often operate on different time scales. In a more general setting, other variables also have to be taken into account, such as oxygen saturation, carbon dioxide and blood pressure in order to describe neurovascular coupling in a concise manner. Recently, new mathematical techniques were developed to give an answer to these questions. This review discusses these recent developments.
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Affiliation(s)
- Dries Hendrikx
- Department of Electrical Engineering, KU Leuven, Leuven, Belgium
- imec, Leuven, Belgium
| | - Anne Smits
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Neonatal Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
| | - Mario Lavanga
- Department of Electrical Engineering, KU Leuven, Leuven, Belgium
- imec, Leuven, Belgium
| | - Ofelie De Wel
- Department of Electrical Engineering, KU Leuven, Leuven, Belgium
- imec, Leuven, Belgium
| | - Liesbeth Thewissen
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Neonatal Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
| | - Katrien Jansen
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Neonatal Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
- Child Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Alexander Caicedo
- Facultad de Ciencias Naturales y Matemáticas, Universidad del Rosario, Bogotá, Colombia
| | - Sabine Van Huffel
- Department of Electrical Engineering, KU Leuven, Leuven, Belgium
- imec, Leuven, Belgium
| | - Gunnar Naulaers
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Neonatal Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
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17
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Semenova O, Lightbody G, O'Toole JM, Boylan G, Dempsey E, Temko A. Modelling interactions between blood pressure and brain activity in preterm neonates. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2017:3969-3972. [PMID: 29060766 DOI: 10.1109/embc.2017.8037725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Hypotension or low blood pressure (BP) is a common problem in preterm neonates and has been associated with adverse short and long-term outcomes. Deciding when and whether to treat hypotension relies on an understanding of the relations between blood pressure and brain function. This study aims to investigate the interaction between BP and multichannel EEG in preterm infants less than 32 weeks gestational age. The mutual information is chosen to model interaction. This measure is independent of absolute values of BP and electroencephalography (EEG) power and quantifies the level of coupling between the short-term dynamics in both signals. It is shown that while adverse health conditions as measured by higher clinical risk indices for babies (CRIB II) are accompanied by consistently lower blood pressure (r=0.43), no significant correlation was observed between CRIB scores and EEG spectral power. More importantly, the chosen measure of interaction between dynamics of EEG and BP was found to be more closely related to CRIB scores (r=0.49, p-value=0.012), with higher CRIB score associated with lower levels of interaction.
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18
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Coupling between mean blood pressure and EEG in preterm neonates is associated with reduced illness severity scores. PLoS One 2018; 13:e0199587. [PMID: 29933403 PMCID: PMC6014641 DOI: 10.1371/journal.pone.0199587] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 06/11/2018] [Indexed: 11/19/2022] Open
Abstract
Hypotension or low blood pressure (BP) is a common problem in preterm neonates and has been associated with adverse short and long-term neurological outcomes. Deciding when and whether to treat hypotension relies on an understanding of the relationship between BP and brain functioning. This study aims to investigate the interaction (coupling) between BP and continuous multichannel unedited EEG recordings in preterm infants less than 32 weeks of gestational age. The EEG was represented by spectral power in four frequency sub-bands: 0.3-3 Hz, 3-8 Hz, 8-15 Hz and 15-30 Hz. BP was represented as mean arterial pressure (MAP). The level of coupling between the two physiological systems was estimated using linear and nonlinear methods such as correlation, coherence and mutual information. Causality of interaction was measured using transfer entropy. The illness severity was represented by the clinical risk index for babies (CRIB II score) and contrasted to the computed level of interaction. It is shown here that correlation and coherence, which are linear measures of the coupling between EEG and MAP, do not correlate with CRIB values, whereas adjusted mutual information, a nonlinear measure, is associated with CRIB scores (r = -0.57, p = 0.003). Mutual information is independent of the absolute values of MAP and EEG powers and quantifies the level of coupling between the short-term dynamics in both signals. The analysis indicated that the dominant causality is from changes in EEG producing changes in MAP. Transfer entropy (EEG to MAP) is associated with the CRIB score (0.3-3 Hz: r = 0.428, p = 0.033, 3-8 Hz: r = 0.44, p = 0.028, 8-15 Hz: r = 0.416, p = 0.038) and indicates that a higher level of directed coupling from brain activity to blood pressure is associated with increased illness in preterm infants. This is the first study to present the nonlinear measure of interaction between brain activity and blood pressure and to demonstrate its relation to the initial illness severity in the preterm infant. The obtained results allow us to hypothesise that the normal wellbeing of a preterm neonate can be characterised by a nonlinear coupling between brain activity and MAP, whereas the presence of weak coupling with distinctive directionality of information flow is associated with an increased mortality rate in preterms.
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Chiarelli AM, Zappasodi F, Di Pompeo F, Merla A. Simultaneous functional near-infrared spectroscopy and electroencephalography for monitoring of human brain activity and oxygenation: a review. NEUROPHOTONICS 2017; 4:041411. [PMID: 28840162 PMCID: PMC5566595 DOI: 10.1117/1.nph.4.4.041411] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 07/24/2017] [Indexed: 05/24/2023]
Abstract
Multimodal monitoring has become particularly common in the study of human brain function. In this context, combined, synchronous measurements of functional near-infrared spectroscopy (fNIRS) and electroencephalography (EEG) are getting increased interest. Because of the absence of electro-optical interference, it is quite simple to integrate these two noninvasive recording procedures of brain activity. fNIRS and EEG are both scalp-located procedures. fNIRS estimates brain hemodynamic fluctuations relying on spectroscopic measurements, whereas EEG captures the macroscopic temporal dynamics of brain electrical activity through passive voltages evaluations. The "orthogonal" neurophysiological information provided by the two technologies and the increasing interest in the neurovascular coupling phenomenon further encourage their integration. This review provides, together with an introduction regarding the principles and future directions of the two technologies, an evaluation of major clinical and nonclinical applications of this flexible, low-cost combination of neuroimaging modalities. fNIRS-EEG systems exploit the ability of the two technologies to be conducted in an environment or experimental setting and/or on subjects that are generally not suited for other neuroimaging modalities, such as functional magnetic resonance imaging, positron emission tomography, and magnetoencephalography. fNIRS-EEG brain monitoring settles itself as a useful multimodal tool for brain electrical and hemodynamic activity investigation.
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Affiliation(s)
- Antonio M. Chiarelli
- University of Illinois at Urbana Champaign, Beckman Institute, Urbana, Illinois, United States
| | - Filippo Zappasodi
- Università G. d’Annunzio, Department of Neuroscience, Imaging and Clinical Science, Chieti, Italy
- Università G. d’Annunzio, Institute for Advanced Biomedical Technologies, Chieti, Italy
| | - Francesco Di Pompeo
- Università G. d’Annunzio, Department of Neuroscience, Imaging and Clinical Science, Chieti, Italy
- Università G. d’Annunzio, Institute for Advanced Biomedical Technologies, Chieti, Italy
| | - Arcangelo Merla
- Università G. d’Annunzio, Department of Neuroscience, Imaging and Clinical Science, Chieti, Italy
- Università G. d’Annunzio, Institute for Advanced Biomedical Technologies, Chieti, Italy
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