Infants born at extremely low gestational ages are at high risk for developmental impairments. Early predictors of these impairments are useful for both clinicians and researchers. Our objective was to assess the correlation between the rate of brain wave maturation as measured by serial amplitude-integrated electroencephalograms (aEEGs) and scores on standardized measures of infant development in extremely low gestational age neonates.
This was a prospective observational study of 65 infants born before 28 weeks' gestational age who were assessed with an aEEG monthly between 28 and 36 weeks' postmenstrual age and with the Bayley Scales of Infant and Toddler Development-III at 18 to 22 months adjusted age. We analyzed the correlation between the rate of brain wave maturation on aEEG and Bayley Scales of Infant and Toddler Development-III Cognitive and Motor Scales.
The mean rate of brain wave maturation was 0.83 (±0.36) points per week. Brain wave maturation was not correlated with either the Cognitive or Motor Scale (adjusted regression coefficients for Cognitive and Motor Scales were 1.61 (s.e.: 4.20; P=0.70) and 2.39 (s.e.: 4.62; P=0.61), respectively.
Among extremely preterm infants, the rate of maturational changes in brain wave characteristics between 28 and 36 weeks' postmenstrual age is not predictive of developmental abilities at 18 to 22 months adjusted age.
[Show abstract][Hide abstract] ABSTRACT: A systems approach to the study of brain damage in very preterm newborns has been lacking.
In this perspective piece, we offer encephalopathy of prematurity as an example of the complexity and interrelatedness of brain-damaging molecular processes that can be initiated inflammatory phenomena.
Using three transcription factors, nuclear factor-kappa B (NF-κB), Notch-1, and nuclear factor erythroid 2 related factor 2 (NRF2), we show the inter-connectedness of signaling pathways activated by some antecedents of encephalopathy of prematurity.
We hope that as biomarkers of exposures and processes leading to brain damage in the most immature newborns become more readily available, those who apply a systems approach to the study of neuroscience can be persuaded to study the pathogenesis of brain disorders in the very preterm newborn.
Frontiers in Systems Neuroscience 04/2015; 9. DOI:10.3389/fnsys.2015.00058
[Show abstract][Hide abstract] ABSTRACT: Early amplitude-integrated electroencephalography (aEEG) has been widely used in term infants with brain injury to predict neurodevelopmental outcomes; however, the prognostic value of early aEEG in preterm infants is unclear. We evaluated how well early aEEG could predict brain damage and long-term neurodevelopmental outcomes in very preterm infants compared with brain imaging assessments. We found that severe aEEG abnormalities (p = 0.000) and aEEG total score < 5 (p = 0.006) within 72 h after birth were positively correlated with white-matter damage, but aEEG abnormalities were not associated with intracranial hemorrhage (p = 0.186). Severe abnormalities in aEEG recordings, head ultrasound, and cranial magnetic resonance imaging (MRI) were all positively correlated with poor outcome at 18 months corrected age. The predictive power of poor outcomes of the aEEG and MRI combination was the same as the aEEG, MRI, and head ultrasound combination with a sensitivity of 52.4%, specificity of 96.2%, positive predictive value of 78.6%, and negative predictive value of 88.4%. These results indicate that severely abnormal aEEG recordings within 72 h after birth can predict white-matter damage and long-term poor outcomes in very preterm infants. Thus aEEG can be used as an early marker to monitor very preterm infants.
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