Pathological features of neonatal EEG in preterm babies born before 30 weeks of gestationnal age

Tich, Sylvie Nguyen The; Am, D'Allest; Villepin, A. Touzery de; Belliscize, J. de; Walls-Esquivel, E.; Salefranque, F.; Lamblin, Marie‐Dominique

doi:10.1016/j.neucli.2007.10.001

Cited by 31 publications

(26 citation statements)

References 63 publications

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“…2010). The implications of these findings are unclear for preterm babies whose sleep architecture is discontinuous, without defined sleep states (Tich et al . 2007).…”

Section: Introductionmentioning

confidence: 99%

“…2011). Thus, it is critical to understand whether and how common clinical interventions such as antenatal glucocorticoids affect preterm brain activity (Tich et al . 2007; Scher & Loparo, 2009).…”

Section: Introductionmentioning

confidence: 99%

“…In the fetus, exposure to exogenous glucocorticoids alters behaviour (Bennet et al 1999;Quaedackers et al 2005;Mulder et al 2009), and in near-term fetal sheep they are associated with marked non-linear EEG changes during REM but not non-REM sleep (Schwab et al 2001), and increased Na + -K + -ATPase activity and tight junction expression (Mehter et al 2009;Sadowska et al 2010). The implications of these findings are unclear for preterm babies whose sleep architecture is discontinuous, without defined sleep states (Tich et al 2007).…”

Section: Introductionmentioning

confidence: 99%

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Maternal dexamethasone and EEG hyperactivity in preterm fetal sheep

Davidson

Quaedackers

George

et al. 2011

The Journal of Physiology

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Non-technical summary Long-acting glucocorticoids such as dexamethasone are commonly given to women at risk of preterm labour. While they significantly improve survival of the prematurely born infant, their effects on preterm brain activity is surprisingly unclear. We found that, in sheep, a conventional clinical course of maternal dexamethasone treatment was associated with dramatic, evolving low-frequency hyperactivity of the fetal EEG. This activity reflected a striking shift to less-frequent but higher amplitude EEG waveforms, and unexpectedly, EEG waveforms whose duration and pattern were highly consistent with seizure activity. After resolution of hyperactivity, the EEG showed changes consistent with maturation of sleep architecture, and reassuringly there was no histological evidence of brain injury 5 days after first exposure. The long-term implications are uncertain, but these effects may contribute to improved neonatal outcomes.Abstract Maternal treatment with synthetic corticosteroids such as dexamethasone (DEX) significantly reduces neonatal morbidity and mortality, but its effects on the fetal brain remain unclear. In this study we evaluated the effects of DEX on EEG activity in preterm fetal sheep. Ewes at 103 days gestation received two intramuscular injections of DEX (12 mg, n = 8) or saline vehicle (n = 7) 24 h apart. Fetal EEG activity was recorded from 6 h before until 120 h after the first injection (DEX-1). DEX-1 was associated with a marked transient rise in total EEG power, maximal at 12 h (P < 0.001), with a relative increase in delta and reduced theta, alpha and beta activity, resolving by 24 h. Continuous EEG records showed a shift to larger but less frequent transient waveforms (P < 0.001). Unexpectedly, evolving epileptiform activity, consistent with electrographic and clinical seizures, developed from 178 ± 44 min after DEX-1. Similar but smaller changes were seen after the second injection. Following the injections, total power returned to control values, but the proportion of alpha activity progressively increased vs. controls (P < 0.001), with reduced interburst interval duration and number (P < 0.001). No histological neural injury or microglial activation was seen. In summary, exposure to maternal dexamethasone was associated with dramatic, evolving low-frequency hyperactivity on fetal cortical EEG recordings, followed by sustained changes consistent with maturation of fetal sleep architecture. We postulate that these effects may contribute to improved neonatal outcomes. Abbreviations DEX-1 and -2, first and second dexamethasone injections; IBI, interburst interval; HPA, hypothalamic-pituitary-adrenal; REM, rapid-eye movement.

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“…2010). The implications of these findings are unclear for preterm babies whose sleep architecture is discontinuous, without defined sleep states (Tich et al . 2007).…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Maternal dexamethasone and EEG hyperactivity in preterm fetal sheep

Davidson

Quaedackers

George

et al. 2011

The Journal of Physiology

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“…They are sometimes difficult to distinguish from normal temporal transients such as premature temporal theta [58,80] . They have a more uncertain prognostic significance in comparison to the PRSWs [40] but are associated with a poor outcome when very frequent [81] .…”

Section: Positive Temporal Sharp Wavesmentioning

confidence: 99%

“…EEG abnormalities in the neonatal period are traditionally divided into acute and chronic stage [32] . A study by Tich et al [58] described pathological features of the EEG in infants born before 30 weeks' GA, a population that has increased dramatically in recent years. We believe that further work is needed in order to standardize the normative values of both normal and pathological features, for specific GAs, particularly the growing population of extremely preterm infants.…”

Section: Introductionmentioning

confidence: 99%

EEG - A Valuable Biomarker of Brain Injury in Preterm Infants

Pavlidis¹,

Lloyd²,

Boylan³

2017

Dev Neurosci

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This review focuses on the role of electroencephalography (EEG) in monitoring abnormalities of preterm brain function. EEG features of the most common developmental brain injuries in preterm infants, including intraventricular haemorrhage, periventricular leukomalacia, and perinatal asphyxia, are described. We outline the most common EEG biomarkers associated with these injuries, namely seizures, positive rolandic sharp waves, EEG suppression/increased interburst intervals, mechanical delta brush activity, and other deformed EEG waveforms, asymmetries, and asynchronies. The increasing survival rate of preterm infants, in particular those that are very and extremely preterm, has led to a growing demand for a specific and shared characterization of the patterns related to adverse outcome in this unique population. This review includes abundant high-quality images of the EEG patterns seen in premature infants and will provide a valuable resource for everyone working in developmental neuroscience.

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Predicting the Neurodevelopmental Outcome in Extremely Preterm Newborns Using a Multimodal Prognostic Model Including Brain Function Information

et al. 2023

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ImportanceEarly assessment of the prognosis of preterm newborns is crucial for accurately informing parents and making treatment decisions. The currently available prognostic models rarely incorporate functional brain information from conventional electroencephalography (cEEG).ObjectiveTo examine the performance of a multimodal model combining (1) brain function information with (2) brain structure information (cranial ultrasonography), and (3) perinatal and (4) postnatal risk factors for the prediction of death or neurodevelopmental impairment (NDI) in extremely preterm infants.Design, Setting, and ParticipantsPreterm newborns (23-28 weeks’ gestational age) admitted to the neonatal intensive care unit at Amiens-Picardie University Hospital were retrospectively included (January 1, 2013, to January 1, 2018). Risk factors from the 4 categories were collected during the first 2 weeks post delivery. Neurodevelopmental impairment was assessed at age 2 years with the Denver Developmental Screening Test II. No or moderate NDI was considered a favorable outcome. Death or severe NDI was considered an adverse outcome. Data analysis was performed from August 26, 2021, to March 31, 2022.Main Outcomes and MeasuresAfter the selection of variables significantly associated with outcome, 4 unimodal prognostic models (considering each category of variable independently) and 1 multimodal model (considering all variables simultaneously) were developed. After a multivariate analysis for models built with several variables, decision-tree algorithms were run on each model. The areas under the curve for decision-tree classifications of adverse vs favorable outcomes were determined for each model, compared using bootstrap tests, and corrected for type I errors.ResultsA total of 109 newborns (58 [53.2% male]) born at a mean (SD) gestational age of 26.3 (1.1) weeks were included. Among them, 52 (47.7%) had a favorable outcome at age 2 years. The multimodal model area under the curve (91.7%; 95% CI, 86.4%-97.0%) was significantly higher than those of the unimodal models (P &lt; .003): perinatal model (80.6%; 95% CI, 72.5%-88.7%), postnatal model (81.0%; 95% CI, 72.6%-89.4%), brain structure model (cranial ultrasonography) (76.6%; 95% CI, 67.8%-85.3%), and brain function model (cEEG) (78.8%; 95% CI, 69.9%-87.7%).Conclusions and RelevanceIn this prognostic study of preterm newborns, the inclusion of brain information in a multimodal model was associated with significant improvement in the outcome prediction, which may have resulted from the complementarity of the risk factors and reflected the complexity of the mechanisms that interfered with brain maturation and led to death or NDI.

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Pathological features of neonatal EEG in preterm babies born before 30 weeks of gestationnal age

Cited by 31 publications

References 63 publications

Maternal dexamethasone and EEG hyperactivity in preterm fetal sheep

Maternal dexamethasone and EEG hyperactivity in preterm fetal sheep

EEG - A Valuable Biomarker of Brain Injury in Preterm Infants

Predicting the Neurodevelopmental Outcome in Extremely Preterm Newborns Using a Multimodal Prognostic Model Including Brain Function Information

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