Evolution of Cortical Functional Networks in Healthy Infants.

During normal childhood development, functional brain networks evolve over time in parallel with changes in neuronal oscillations. Previous studies have demonstrated differences in network topology with age, particularly in neonates and in cohorts spanning from birth to early adulthood. Here, we evaluate the developmental changes in EEG functional connectivity with a specific focus on the first 2 years of life. Functional connectivity networks (FCNs) were calculated from the EEGs of 240 healthy infants aged 0-2 years during wakefulness and sleep using a cross-correlation-based measure and the weighted phase lag index. Topological features were assessed via network strength, global clustering coefficient, characteristic path length, and small world measures. We found that cross-correlation FCNs maintained a consistent small-world structure, and the connection strengths increased after the first 3 months of infancy. The strongest connections in these networks were consistently located in the frontal and occipital regions across age groups. In the delta and theta bands, weighted phase lag index networks decreased in strength after the first 3 months in both wakefulness and sleep, and a similar result was found in the alpha and beta bands during wakefulness. However, in the alpha band during sleep, FCNs exhibited a significant increase in strength with age, particularly in the 21-24 months age group. During this period, a majority of the strongest connections in the networks were located in frontocentral regions, and a qualitatively similar distribution was seen in the beta band during sleep for subjects older than 3 months. Graph theory analysis suggested a small world structure for weighted phase lag index networks, but to a lesser degree than those calculated using cross-correlation. In general, graph theory metrics showed little change over time, with no significant differences between age groups for the clustering coefficient (wakefulness and sleep), characteristics path length (sleep), and small world measure (sleep). These results suggest that infant FCNs evolve during the first 2 years with more significant changes to network strength than features of the network structure. This study quantifies normal brain networks during infant development and can serve as a baseline for future investigations in health and neurological disease.

Scalp EEG markers of normal infant development using visual and computational approaches.

The infant brain is rapidly developing, and these changes are reflected in scalp electroencephalography (EEG) features, including power spectrum and sleep spindle characteristics. These biomarkers not only mirror infant development, but they are also altered by conditions such as epilepsy, autism, developmental delay, and trisomy 21. Prior studies of early development were generally limited by small cohort sizes, lack of a specific focus on infancy (0-2 years), and exclusive use of visual marking for sleep spindles. Therefore, we measured the EEG power spectrum and sleep spindles in 240 infants ranging from 0-24 months. To rigorously assess these metrics, we used both clinical visual assessment and computational techniques, including automated sleep spindle detection. We found that the peak frequency and power of the posterior dominant rhythm (PDR) increased with age, and a corresponding peak occurred in the EEG power spectra. Based on both clinical and computational measures, spindle duration decreased with age, and spindle synchrony increased with age. Our novel metric of spindle asymmetry suggested that peak spindle asymmetry occurs at 6-9 months of age.Clinical Relevance- Here we provide a robust characterization of the development of EEG brain rhythms during infancy. This can be used as a basis of comparison for studies of infant neurological disease, including epilepsy, autism, developmental delay, and trisomy 21.

Comprehensive Migraine Initiative in the Pediatric Emergency Department Improves Treatment Outcomes.

OBJECTIVE: To compare pediatric migraine treatment efficacy in the emergency department before and after the implementation of a comprehensive migraine initiative, consisting of a standardized treatment protocol, provider educational series and standardized physician documentation template. BACKGROUND: Pediatric migraine is common, accounting for 1% of pediatric emergency department visits. Yet there is large variability in treatment practices, with few studies looking into measures of both clinical effectiveness and timeliness of treatment following implementation of standardized protocols. METHODS: A single-center retrospective chart review of pediatric patients presenting to the emergency department with migraine before and after implementation of an institutional headache initiative designed to more effectively and efficiently deliver care to pediatric migraine patients. RESULTS: The study yielded 110 patients each in the intervention and preintervention groups. There were no significant differences in patient characteristics with respect to age, gender, or initial pain score. Compared with the preintervention group, the intervention group demonstrated a significant reduction in headache pain score prior to discharge (decrease of 5.9 vs 4.8 in preintervention group, P value .006) with a greater percentage of patients achieving ≥50% reduction in pain (82% vs 67% in preintervention group, P value .039). Additionally, we found a significantly decreased time to treatment in the intervention group compared with the preintervention group (1.8 vs 2.1 hours, P value .046). CONCLUSION: Through the use of a standardized treatment protocol, improved provider education, and ease of documentation, this comprehensive migraine initiative improved efficacy and efficiency of migraine treatment in the pediatric emergency department.