EEG and spectral edge frequency: analysis in posthypoxic newborn piglets.

OBJECTIVE: To evaluate the frequency content of the electroencephalogram (EEG) during recovery after a severe hypoxic insult in newborn piglets. METHODS: EEG was continuously monitored in nine newborn piglets exposed to a severe hypoxic period. Power spectra in five frequency bands were calculated using Fourier transformation. Spectral edge frequency 90 (SEF90) was defined as the frequency below which 90% of the power in the EEG was located. The piglets were divided into two groups; Group 1 represented piglets with some EEG recovery and Group 2 represented piglets without any EEG recovery. RESULTS: The recovery of the EEG in Group 1 had the same time course in all frequency bands. SEF90 indicates recovery earlier than the value of total power. But SEF90 also signals activity in the EEGs that were almost completely suppressed. When SEF90 was calculated during periods of periodic EEG activity during the very early phase of recovery, the values fell within the same range as during the control period. CONCLUSION: Spectral analysis of continuous EEG in newborn piglets exposed to very severe hypoxia showed that no specific frequency band of the EEG preceded the other ones during recovery. The results of the SEF90 measure, demonstrates the need for critical analysis of the raw EEG before any reliable estimation of cerebral function can be made.

[Intoxication with prilocaine/lidocaine can cause serious methemoglobinemia]. / Överdos av prilokain/lidokain kan ge svår methemoglobinemi - Tre fall där krämen gett toxiska effekter hos spädbarn.

Prilocaine/lidocaine is widely used as local anesthetic in children for cannulation and minor surgical procedures. Usually it is unproblematic but it is important to adhere to recommended dose to avoid serious complications. Excessive amount of prilocaine/lidocaine, large application area, prolonged application time or repeated application can, especially in infants, cause methemoglobinemia with clinical symptoms. In severe cases intensive care and antidote treatment with Methylene blue may be required. We report three infants who were overdosed with prilocaine/lidocaine, two of them due to incorrect use after circumcision and one premature baby where prilocaine/lidocaine was not removed in time. Two of the babies had MetHb levels > 33% and were seriously affected with hypoxia, tachycardia and fatigue. After Methylene blue was given the infants recovered within 15 minutes and MetHb levels returned to normal.

Sex differences in electrocortical activity in human neonates.

Cerebral cortical activity in healthy, full-term human neonates (10 boys and 10 girls) was evaluated using spectral estimation of electroencephalogram frequency content with new equipment and analysis technique allowing the assessment of the lowest frequencies (i.e. infraslow waves). The activity was analysed under quiet sleep and active wakefulness taking sex into consideration. During sleep, the mean amount of infraslow activity was 27% larger in boys, whereas during wakefulness the average amount of higher frequencies was 17% larger in girls. Both these differences indicate an earlier maturation of cortical function in girls than in boys.

STAN in clinical practice--the outcome of 2 years of regular use in the city of Gothenburg.

OBJECTIVE: The purpose of this study was to monitor the introduction of the STAN-methodology (Noventa Medical, Moelndal, Sweden). STUDY DESIGN: This was a prospective observational study covering the total population of deliveries at term during 2 years. Four thousand eight hundred and thirty out of 14,687 term pregnancies were monitored using the STAN S 21 fetal heart monitor and the associated clinical guidelines. Cord artery metabolic acidosis, neonatal outcome, and rates of operative deliveries for fetal distress were assessed. RESULTS: The annual rate of STAN usage increased from 28.1% to 37.7% and was associated with a significant reduction in metabolic acidosis rate in the total population from 0.76% to 0.44% (P < .05). The compliance with the clinical guidelines increased in cases requiring intervention. The rates for moderate/severe hypoxic neonatal encephalopathy were consistently low, 0.55 and 0.68 per 1000 deliveries, respectively, and corresponding to previous findings. The rate of operative delivery did not change during the 2 years in the total population. CONCLUSION: Increasing STAN usage provided consistent improvements in fetal outcome equalling those noted in the Swedish randomized controlled trial (RCT) without increasing operative interventions for fetal distress.

3D limb movement tracking and analysis for neurological dysfunctions of neonates using multi-camera videos.

Central nervous system dysfunction in infants may be manifested through inconsistent, rigid and abnormal limb movements. Detection of limb movement anomalies associated with such neurological dysfunctions in infants is the first step towards early treatment for improving infant development. This paper addresses the issue of detecting and quantifying limb movement anomalies in infants through non-invasive 3D image analysis methods using videos from multiple camera views. We propose a novel scheme for tracking 3D time trajectories of markers on infant's limbs by video analysis techniques. The proposed scheme employ videos captured from three camera views. This enables us to detect a set of enhanced 3D markers through cross-view matching and to effectively handle marker self-occlusions by other body parts. We track a set of 3D trajectories of limb movements by a set of particle filters in parallel, enabling more robust 3D tracking of markers, and use the 3D model errors for quantifying abrupt limb movements. The proposed work makes a significant advancement to the previous work in [1] through employing tracking in 3D space, and hence overcome several main barriers that hinder real applications by using single camera-based techniques. To the best of our knowledge, applying such a multi-view video analysis approach for assessing neurological dysfunctions of infants through 3D time trajectories of markers on limbs is novel, and could lead to computer-aided tools for diagnosis of dysfunctions where early treatment may improve infant development. Experiments were conducted on multi-view neonate videos recorded in a clinical setting and results have provided further support to the proposed method.

A novel splicing mutation causes an undescribed type of analbuminemia.

Analbuminemia is a rare autosomal recessive disorder manifested by the absence or severe reduction of circulating serum albumin in homozygous subjects. In this report we describe a new molecular defect that caused the analbuminemic trait in a newborn of Iraqi origin. When the parents' DNA was analyzed, both subjects were found to be heterozygous for the same mutation found in the infant. All the 14 exon and flanking intron sequences of the albumin gene were amplified via PCR and screened for mutations by SSCP and heteroduplex analysis. A mutation in the DNA region encoding exon 1 and its flanking intron was revealed by the presence of a heteroduplex. The fragment, which was directly DNA sequenced, contains a previously unreported single nucleotide change, consisting in a G to A substitution at nucleotide 118 in the structural gene of the human protein. This mutation, involving the first base of intron 1, destroys the GT dinucleotide consensus sequence found at the 5' end of most intervening sequences and causes the defective pre-mRNA splicing responsible for the analbuminemic trait.

Spectroscopy study of the dynamics of the transencephalic electrical impedance in the perinatal brain during hypoxia.

Hypoxia/ischaemia is the most common cause of brain damage in neonates. Thousands of newborn children suffer from perinatal asphyxia every year. The cells go through a response mechanism during hypoxia/ischaemia, to maintain the cellular viability and, as a response to the hypoxic/ischaemic insult, the composition and the structure of the cellular environment are altered. The alterations in the ionic concentration of the intra- and extracellular and the consequent cytotoxic oedema, cell swelling, modify the electrical properties of the constituted tissue. The changes produced can be easily measured using electrical impedance instrumentation. In this paper, we report the results from an impedance spectroscopy study on the effects of the hypoxia on the perinatal brain. The transencephalic impedance, both resistance and reactance, was measured in newborn piglets using the four-electrode method in the frequency range from 20 kHz to 750 kHz and the experimental results were compared with numerical results from a simulation of a suspension of cells during cell swelling. The experimental results make clear the frequency dependence of the bioelectrical impedance, confirm that the variation of resistance is more sensitive at low than at high frequencies and show that the reactance changes substantially during hypoxia. The resemblance between the experimental and numerical results proves the validity of modelling tissue as a suspension of cells and confirms the importance of the cellular oedema process in the alterations of the electrical properties of biological tissue. The study of the effects of hypoxia/ischaemia in the bioelectrical properties of tissue may lead to the development of useful clinical tools based on the application of bioelectrical impedance technology.

Remote sessions and frequency analysis for improved insight into cerebral function during pediatric and neonatal intensive care.

A project involving recording and analysing EEG together with cardiovascular signals and temperature has been initiated. The aim of this project is to establish difficulties and possibilities involved with implementing a system for remote sessions and analysing EEG in correlation with other physiological signals. One objective is to find indicators of cerebral function during postasphyxia neonatal intensive care and pediatric cardiopulmonary bypass surgery with hypothermia. Remote sessions for joint interpretation have been carried out between pediatricians and clinical neurophysiologists, and EEG has been analyzed using frequency analyzing tools. One result is the discovery of reversible spectral changes coinciding with blood pressure falls, which may indicate loss of autoregulation function. This finding is one outcome from initial use of a system, developed during the project to facilitate communication about, and analysis of the recorded signals. Thus, already from a limited number of remote sessions and the use of basic signal processing techniques, important results have been achieved and better insight has been gained of how cerebral function is affected by cardiopulmonary bypass surgery. In this paper, we present our experiences from introducing a system for remote consultations, and evaluate the use for such a system in the current applications.

Leiomodin-3 dysfunction results in thin filament disorganization and nemaline myopathy.

Nemaline myopathy (NM) is a genetic muscle disorder characterized by muscle dysfunction and electron-dense protein accumulations (nemaline bodies) in myofibers. Pathogenic mutations have been described in 9 genes to date, but the genetic basis remains unknown in many cases. Here, using an approach that combined whole-exome sequencing (WES) and Sanger sequencing, we identified homozygous or compound heterozygous variants in LMOD3 in 21 patients from 14 families with severe, usually lethal, NM. LMOD3 encodes leiomodin-3 (LMOD3), a 65-kDa protein expressed in skeletal and cardiac muscle. LMOD3 was expressed from early stages of muscle differentiation; localized to actin thin filaments, with enrichment near the pointed ends; and had strong actin filament-nucleating activity. Loss of LMOD3 in patient muscle resulted in shortening and disorganization of thin filaments. Knockdown of lmod3 in zebrafish replicated NM-associated functional and pathological phenotypes. Together, these findings indicate that mutations in the gene encoding LMOD3 underlie congenital myopathy and demonstrate that LMOD3 is essential for the organization of sarcomeric thin filaments in skeletal muscle.

Automatic classification of background EEG activity in healthy and sick neonates.

The overall aim of our research is to develop methods for a monitoring system to be used at neonatal intensive care units. When monitoring a baby, a range of different types of background activity needs to be considered. In this work, we have developed a scheme for automatic classification of background EEG activity in newborn babies. EEG from six full-term babies who were displaying a burst suppression pattern while suffering from the after-effects of asphyxia during birth was included along with EEG from 20 full-term healthy newborn babies. The signals from the healthy babies were divided into four behavioural states: active awake, quiet awake, active sleep and quiet sleep. By using a number of features extracted from the EEG together with Fisher's linear discriminant classifier we have managed to achieve 100% correct classification when separating burst suppression EEG from all four healthy EEG types and 93% true positive classification when separating quiet sleep from the other types. The other three sleep stages could not be classified. When the pathological burst suppression pattern was detected, the analysis was taken one step further and the signal was segmented into burst and suppression, allowing clinically relevant parameters such as suppression length and burst suppression ratio to be calculated. The segmentation of the burst suppression EEG works well, with a probability of error around 4%.