Cortical burst dynamics predict clinical outcome early in extremely preterm infants

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.

Translational Perspectives for Computational Neuroimaging

“…Critically, predictive validity of this sort cannot be established in cross-sectional comparisons but requires prospective designs with a focus on individual predictability. In contrast to neuropsychological studies (Barch et al, 2003), so far, prospective computational neuroimaging studies are extremely rare (but see Anticevic et al, 2015;Iyer et al, 2015).…”

Review of sleep-EEG in preterm and term neonates

“…Intensive monitoring of the vulnerable preterm and critically ill term neonate, has been increasingly complemented with bed-side neuromonitoring to achieve optimal insight into neurological well-being [1–3]. Serial electro-encephalography (EEG) monitoring over time can document actual normal or altered brain function and provides insight into the progress of brain maturation during this period of intensive neonatal care [1,4,5], with the ultimate goal to improve therapeutic interventions and long-term neurodevelopmental outcome.…”

“…Serial electro-encephalography (EEG) monitoring over time can document actual normal or altered brain function and provides insight into the progress of brain maturation during this period of intensive neonatal care [1,4,5], with the ultimate goal to improve therapeutic interventions and long-term neurodevelopmental outcome.…”

Quick and accurate quantification of the premature brain

“…Furthermore, the clinical utility of this automated estimator relies on its ability to perform on clinically ill children and remains to be tested on a representative clinical population including premature neonates with abnormal EEGs. Nonetheless, this study provides an important step to reliably categorize the dynamic cortical physiology present during early cortical maturation and contributes to an exciting growing literature that careful quantification of clinically recognized EEG features can provide reliable and improved EEG classification in this age group (Iyer et al, 2015). Successful characterization of the complex age-specific baseline present in early development paves the road for future work to unmask the subtle abnormalities that may present on top of this background and further accelerate our discovery of novel physiological biomarkers of cortical development and disease.…”