Commentary: Mediation and moderation analyses: a novel approach to exploring the complex pathways between maternal medical conditions, preterm birth and associated newborn morbidity risk

International Journal of Epidemiology (Impact Factor: 9.18). 01/2014; 43(3). DOI: 10.1093/ije/dyt285
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    • "It is also compatible with the interpretation that prenatal disturbances, such as placental infections or brain haemorrhages , predispose the child to adverse outcomes (Brown et al., 2013; Shapiro-Mendoza, 2014), and that our present EEG metrics capture the immediate consequences of these system-level disturbances coupled with the gestational age of the infant. In the absence of acute complications, the preterm infant is considered to be metabolically stable by the third day of life (Klein, 2002). "
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    ABSTRACT: Intermittent bursts of electrical activity are a ubiquitous signature of very early brain activity. Previous studies have largely focused on assessing the amplitudes of these transient cortical bursts or the intervals between them. Recent advances in basic neuroscience have identified the presence of scale-free 'avalanche' processes in bursting patterns of cortical activity in other clinical contexts. Here, we hypothesize that cortical bursts in human preterm infants also exhibit scale-free properties, providing new insights into the nature, temporal evolution, and prognostic value of spontaneous brain activity in the days immediately following preterm birth. We examined electroencephalographic recordings from 43 extremely preterm infants (gestational age 22-28 weeks) and demonstrated that their cortical bursts exhibit scale-free properties as early as 12 h after birth. The scaling relationships of cortical bursts correlate significantly with later mental development-particularly within the first 12 h of life. These findings show that early preterm brain activity is characterized by scale-free dynamics which carry developmental significance, hence offering novel means for rapid and early clinical prediction of neurodevelopmental outcomes. © The Author (2015). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email:
    Brain 05/2015; 138(Pt 8). DOI:10.1093/brain/awv129 · 9.20 Impact Factor