| 1. |
- Tataranno, M. L., et al.
(författare)
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Morphine affects brain activity and volumes in preterms: An observational multi-center study
- 2020
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Ingår i: Early Human Development. - : Elsevier BV. - 0378-3782 .- 1872-6232. ; 144
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Tidskriftsartikel (refereegranskat)abstract
- Objective: We hypothesized that morphine has a depressing effect on early brain activity, assessed using quantitative aEEG/EEG parameter and depressed activity will be associated with brain volumes at term in extremely preterm infants. Study design: 174 preterm infants were enrolled in 3 European tertiary NICUs (mean GA:26 +/- 1wks) and monitored during the first 72 h after birth with continuous 2 channel aEEG. Six epochs of aEEG recordings were selected and minimum amplitude of aEEG (min aEEG), percentage of time amplitude< 5 mu V (% of time < 5 mu V), spontaneous activity transients (SATrate) and interSAT interval (ISI) were calculated. For infants receiving morphine, the cumulative morphine dosage was calculated. In a subgroup of 58 infants, good quality MRI at term equivalent age (TEA) and the cumulative morphine dose until TEA were available. The effects of morphine administration and cumulative dose on aEEG/EEG measures and on brain volumes were investigated. Results: Morphine administration had a significant effect on all quantitative aEEG/EEG measures, causing depression of early brain activity [longer ISI (beta 2.900), reduced SAT rate (beta -1.386), decreased min aEEG (beta -0.782), and increased % of time < 5 mu V (beta 14.802)] in all epochs. A significant effect of GA and postnatal age on aEEG/EEG measures was observed. Cumulative morphine dose until TEA had a significant negative effect on total brain volume (TBV) (beta -8.066) and cerebellar volume (beta -1.080). Conclusions: Administration of sedative drugs should be considered when interpreting aEEG/EEG together with the negative dose dependent morphine impact on brain development.
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| 8. |
- Hellström, Ann, 1959, et al.
(författare)
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Retrospective evaluation of ophthalmological and neurological outcomes for infants born before 24 weeks gestational age in a Swedish cohort
- 2022
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Ingår i: Bmj Open. - : BMJ. - 2044-6055. ; 12:8
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To retrospectively evaluate ophthalmological and neurological outcomes in a Swedish cohort of infants born before 24 weeks gestational age (GA) and explore risk factors for visual impairment. Setting Eye and paediatric clinics in Sweden. Participants Infants screened for retinopathy of prematurity (ROP) (n=399), born before 24 weeks GA, 2007-2018. Cases were excluded if ophthalmological follow-up records could not be traced. Primary and secondary outcome measures Primary outcomes were ophthalmological, including visual acuity (VA), refractive error, strabismus, nystagmus and cerebral visual impairment (CVI). Secondary outcomes comprised neonatal and neurological morbidities. Data were retrospectively retrieved from medical records. Results The 355 assessed children had a median GA of 23 weeks and 2 days and a median birth weight of 565 g. At the last available ophthalmological examination, the median age was 4.8 years (range 0.5-13.2 years). Nystagmus was recorded in 21.1%, strabismus in 34.8%, and 51.0% wore spectacles. Seventy-three of 333 (21.9%) were visually impaired, defined as being referred to a low vision clinic and/or having a VA less than 20/60 at 3.5 years of age or older. ROP treatment was a significant risk factor for visual impairment (OR 2.244, p=0.003). Visually impaired children, compared with children without visual impairment, more often had neurological deficits such as intellectual disability 63.8% versus 33.3% (p<0.001), epilepsy 21.1% versus 7.5% (p=0.001) and autism spectrum disorders 32.8% versus 20.9% (p=0.043). Nine of the 355 children had been diagnosed with CVI. Conclusions Children born before 24 weeks GA frequently had visual impairment in association with neurological deficits. CVI was rarely diagnosed. A multidisciplinary approach for the evaluation and habilitation of these vulnerable infants is warranted. National follow-up guidelines need to be developed and implemented.
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- Vanhatalo, Sampsa, et al.
(författare)
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Why monitor the neonatal brain-that is the important question
- 2023
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Ingår i: Pediatric Research. - : Springer Nature. - 0031-3998 .- 1530-0447. ; 93:1, s. 19-21
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- A key goal of neonatal neurocritical care is improved outcomes, and brain monitoring plays an essential role. The recent NEST trial(1) reported no outcome benefits using aEEG monitoring compared to clinical seizure identification among neonates treated for seizures. However, the study failed to prove the effects of monitoring on seizure treatment in the first place.
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| 12. |
- Chalak, L., et al.
(författare)
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Bedside and laboratory neuromonitoring in neonatal encephalopathy
- 2021
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Ingår i: Seminars in Fetal & Neonatal Medicine. - : Elsevier. - 1744-165X .- 1878-0946. ; 26:5
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Forskningsöversikt (refereegranskat)abstract
- Several bedside and laboratory neuromonitoring tools are currently used in neonatal encephalopathy (NE) to assess 1) brain function [amplitude-integrated electroencephalogram (aEEG) and EEG], 2) cerebral oxygenation delivery and consumption [near-infrared spectroscopy (NIRS)] and 3) blood and cerebrospinal fluid biomarkers. The aim of the review is to provide the role of neuromonitoring in understanding the development of brain injury in these newborns and better predict their long-term outcome. Simultaneous use of these monitoring modalities may improve our ability to provide meaningful prognostic information regarding ongoing treatments. Evidence will be summarized in this review for each of these modalities, by describing (1) the methods, (2) the clinical evidence in context of NE both before and with hypothermia, and (3) the research and future directions.
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- Hellström-Westas, Lena, et al.
(författare)
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Cerebroelectrical depression following surfactant treatment in preterm neonates
- 1992
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Ingår i: Pediatrics. - 1098-4275. ; 89:4 Pt 1, s. 643-647
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Tidskriftsartikel (refereegranskat)abstract
- During surfactant treatment of respiratory distress syndrome, 23 premature newborns were investigated with continuous amplitude-integrated electroencephalography (cerebral function monitors). Simultaneously, arterial blood pressure and transcutaneous blood gas values were recorded. A short (less than 10 minutes) but significant decrease in cerebral activity was seen in almost all neonates immediately after the surfactant instillation, in spite of an improved pulmonary function. In 21 of 23 neonates, a transient fall in mean arterial blood pressure of 9.3 mm Hg (mean) occurred coincidently with the cerebral reaction. Neonates in whom intraventricular hemorrhage developed tended to have lower presurfactant mean arterial blood pressure (P greater than .05), but they had a significantly lower mean arterial blood pressure after surfactant instillation (P less than .05). No other differences were found between neonates in whom intraventricular hemorrhage developed and those without intraventricular hemorrhage. The present findings demonstrate that an acute cerebral dysfunction may occur after surfactant instillation. In some vulnerable neonates with arterial hypotension and severe pulmonary immaturity, the fall in mean arterial blood pressure may increase the risk of cerebral complications and could be related to an unchanged rate of intraventricular hemorrhage after surfactant treatment.
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- Kontio, T., et al.
(författare)
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Early neurophysiology and MRI in predicting neurological outcome at 9-10 years after birth asphyxia
- 2013
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Ingår i: Clinical Neurophysiology. - : Elsevier BV. - 1388-2457 .- 1872-8952. ; 124:6, s. 1089-1094
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To assess whether early somatosensory evoked potentials (SEP) predict long-term neurodevelopmental outcome in normothermic, full-term infants with mild to moderate neonatal encephalopathy (NE), and to compare their predictive value to already available amplitude integrated EEG (aEEG) and magnetic resonance imaging (MRI). Methods: Fifty-six infants with post-asphyxia NE were prospectively recruited, and their SEP, aEEG and MRI data were acquired during the first five days. Follow-up continued to 9-10 years for assessment of neuromotor and neurocognitive development. We analysed SEP latency (N1 component), normality of aEEG background pattern, as well as patterns of injury on the neonatal MRI. Neurological outcome measures at 9-10 years included conventional MRI, Movement-ABC and the WISC-III NL. Results: A SEP latency <50 ms during the first five days was associated with a normal neuromotor outcome (p < 0.03), and a prolonged day 3 latency was associated with lower childhood IQ (p = 0.02). The presence of multiple seizures in aEEG, as well as a moderate or severe injury on the neonatal MRI was associated with a poor neuromotor score (p = 0.03 and p < 0.01, respectively). Combination of multiple techniques improved prediction of long-term outcome compared to single modality. Conclusion: Early SEPs provide information that is comparable to the already available aEEG and MRI paradigms in the prediction of long-term outcome of full-term infants with mild to moderate neonatal encephalopathy. Significance: The present results call for further studies using early SEP to aid early assessment of infants treated with hypothermia.
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| 19. |
- Lundgren, Pia, 1967, et al.
(författare)
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National cohort of infants born before 24 gestational weeks showed increased survival rates but no improvement in neonatal morbidity
- 2022
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Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 111:8, s. 1515-1525
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Tidskriftsartikel (refereegranskat)abstract
- Aim To describe survival and neonatal morbidities in infants born before 24 weeks of gestation during a 12-year period. Methods Data were retrieved from national registries and validated in medical files of infants born before 24 weeks of gestation 2007-2018 in Sweden. Temporal changes were evaluated. Results In 2007-2018, 282 live births were recorded at 22 weeks and 460 at 23 weeks of gestation. Survival to discharge from hospital of infants born alive at 22 and 23 weeks increased from 20% to 38% (p = 0.006) and from 45% to 67% (p < 0.001) respectively. Caesarean section increased from 12% to 22% (p = 0.038) for infants born at 22 weeks. Neonatal morbidity rates in infants alive at 40 weeks of postmenstrual age (n = 399) were unchanged except for an increase in necrotising enterocolitis from 0 to 33% (p = 0.017) in infants born at 22 weeks of gestation. Bronchopulmonary dysplasia was more common in boys than girls, 90% versus 82% (p = 0.044). The number of infants surviving to 40 weeks doubled over time. Conclusion Increased survival of infants born before 24 weeks of gestation resulted in increasing numbers of very immature infants with severe neonatal morbidities likely to have a negative impact on long-term outcome.
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| 26. |
- Skov, L, et al.
(författare)
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Acute changes in cerebral oxygenation and cerebral blood volume in preterm infants during surfactant treatment
- 1992
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Ingår i: Neuropediatrics. - 0174-304X. ; 23:3, s. 126-130
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Tidskriftsartikel (refereegranskat)abstract
- Following administration of surfactant a marked depression in aEEG activity occurs for about 10 minutes; the mechanism of this depression is unknown. In view of this, twenty-nine preterm infants were investigated with near infrared spectroscopy (NIRS) to evaluate rapid changes in total cerebral haemoglobin concentration and cerebral oxyhaemoglobin concentration during rescue treatment with natural surfactant. During surfactant instillation there was a short-lasting hypoxaemia as demonstrated by pulseoximetry as well as a considerable fall in arterial blood pressure. With NIRS, tissue hypoxia was demonstrated by a drop in cerebral oxyhaemoglobin concentration. The marked drop in arterial blood pressure occurring immediately following surfactant was not matched by a drop in total cerebral haemoglobin concentration. This suggests that cerebral blood volume and hence cerebral blood flow was maintained. In the following minutes there was an improvement in cerebral oxygenation as indicated by the rise in cerebral oxyhaemoglobin concentration in nearly all the infants.
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| 27. |
- Toet, M C, et al.
(författare)
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Amplitude integrated EEG 3 and 6 hours after birth in full term neonates with hypoxic-ischaemic encephalopathy
- 1999
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Ingår i: Archives of disease in childhood. Fetal and neonatal edition. - 1359-2998. ; 81:1, s. 19-23
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To assess the prognostic value of amplitude integrated EEG (aEEG) 3 and 6 hours after birth. METHODS: Seventy three term, asphyxiated infants were studied (from two different centres), using the Cerebral Function Monitor (CFM Lectromed). The different aEEG tracings were compared using pattern recognition (flat tracing mainly isoelectric (FT); continuous extremely low voltage (CLV); burst-suppression (BS); discontinuous normal voltage (DNV); continuous normal voltage (CNV)) with subsequent outcome. RESULTS: Sixty eight infants were followed up for more than 12 months (range 12 months to 6 years).Twenty one out of 68 infants (31%) showed a change in pattern from 3 to 6 hours, but this was only significant in five cases (24%). In three this changed from BS to CNV with a normal outcome. One infant showed a change in pattern from CNV to FT and had a major handicap at follow up. Another infant showed a change in pattern from DNV to BS, and developed a major handicap at follow up. The other 16 infants did not have any significant changes in pattern: 11 infants had CLV, BS, or FT at 3 and 6 hours and died (n = 9) in the neonatal period or developed a major handicap (n = 2). Five infants had a CNV or DNV pattern at 3 and 6 hours, with a normal outcome. The sensitivity and specificity of BS, together with FT and CLV, for poor outcome at 3 hours was 0.85 and 0.77, respectively; at 6 hours 0.91 and 0.86, respectively. The positive predictive value (PPV) was 78% and the negative predictive value (NPV) 84% 3 hours after birth. At 6 hours the PPV was 86% and the NPV was 91%. CONCLUSION: aEEG could be very useful for selecting those infants who might benefit from intervention after birth asphyxia.
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| 29. |
- Westas, Emma, 1982, et al.
(författare)
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Using QCM-D to study the adhesion of human gingival fibroblasts on implant surfaces
- 2015
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Ingår i: Journal of Biomedical Materials Research. Part A. - : Wiley. - 1549-3296 .- 1552-4965. ; 103:10, s. 3139-3147
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Tidskriftsartikel (refereegranskat)abstract
- Sealing the soft tissue-implant interface is one of the key issues in preventing transcutaneous implant-associated infections. A promising surface modification for improving osseointegration and possibly soft tissue integration is to coat the implant surface with hydroxyapatite (HA) nanoparticles. When new implant materials are developed, their ability to facilitate cell attachment and spreading are commonly investigated in vitro to establish their potential for good in vivo performance. However, commonly used techniques, such as microscopy methods, are time consuming, invasive, and subjective. This is the first study using quartz crystal microbalance with dissipation monitoring, where the real-time adhesion of biopsy-derived human gingival fibroblasts onto titanium and nanostructured HA was investigated. Experiments were performed for at least 16 h, and we found that cellular attachment and spreading kinetics can be followed in situ by observing the change in dissipation and frequency with time. Interestingly, a correlation between cell coverage and the magnitude of dissipation shift reached at the end of the experiment was found, but no such trend was observed for the frequency. Furthermore, the level of cell coverage was found to influence the cellular attachment and spreading behavior. No difference in cell response to the two surface types, Ti and nanostructured HA, was found.
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