General Movements in preterm infants undergoing craniosacral therapy: a randomised controlled pilot-trial.

BACKGROUND: The objective of this study was to investigate neurological short-term effects of craniosacral therapy as an ideal form of osteopathic manipulative treatment (OMT) due to the soft kinaesthetic stimulation. METHODS: Included were 30 preterm infants, with a gestational age between 25 and 33 weeks, who were admitted to the neonatal intensive care unit of the University Hospital of Graz, Austria. The infants were randomized either into the intervention group (IG) which received standardised craniosacral therapy, or the control group (CG) which received standard care. To guarantee that only preterm infants with subsequent normal neurodevelopment were included, follow up was done regularly at the corrected age (= actual age in weeks minus weeks premature) of 12 and 24 months. After 2 years 5 infants had to be excluded (IG; n = 12; CG: n = 13). General Movements (GMs) are part of the spontaneous movement repertoire and are present from early fetal life onwards until the end of the first half year of life. To evaluate the immediate result of such an intervention, we selected the General Movement Assessment (GMA) as an appropriate tool. Besides the global GMA (primary outcome) we used as detailed GMA, the General Movement Optimality Score (GMOS- secondary outcome), based on Prechtl's optimality concept. To analyse GMOS (secondary outcome) a linear mixed model with fixed effects for session, time point (time point refers to the comparisons of the measurements before vs. after each session) and intervention (IG vs. CG), random effect for individual children and a first order autoregressive covariance structure was used for calculation of significant differences between groups and interactions. Following interaction terms were included in the model: session*time point, session*intervention, time point*intervention and session*time point*intervention. Exploratory post hoc analyses (interaction: session*time point*intervention) were performed to determine group differences for all twelve measurement (before and after all 6 sessions) separately. RESULTS: Between groups no difference in the global GMA (primary outcome) could be observed. The GMOS (secondary outcome) did not change from session to session (main effect session: p = 0.262) in the IG or the CG. Furthermore no differences between IG and CG (main effect group: p = 0.361) and no interaction of time*session could be observed (p = 0.658). Post hoc analysis showed a trend toward higher values before (p = 0.085) and after (p = 0.075) the first session in CG compared to IG. At all other time points GMOS were not significantly different between groups. CONCLUSION: We were able to indicate that a group of "healthy" preterm infants undergoing an intervention with craniosacral therapy (IG) showed no significant changes in GMs compared to preterm infants without intervention (CG). In view of the fact that the global GMA (primary outcome) showed no difference between groups and the GMOS (detailed GMA-secondary outcome) did not deteriorate in the IG, craniosacral therapy seems to be safe in preterm infants. TRIAL REGISTRATION: German Clinical Trials Register DRKS00004258 .

Cerebral and peripheral regional oxygen saturation during postnatal transition in preterm neonates.

OBJECTIVE: To evaluate peripheral regional oxygen saturation (rpSO2) and cerebral regional oxygen saturation (rcSO2) during the immediate postnatal transition in late preterm infants with and without the need for respiratory support. STUDY DESIGN: This was a prospective observational study using near-infrared spectroscopy to evaluate changes in rpSO2 and rcSO2. These variables were measured during the first 15 minutes of life after elective cesarean delivery. Peripheral oxygen saturation (SpO2) and heart rate were measured continuously by pulse oximetry, and cerebral fractional tissue oxygen extraction (cFTOE) was calculated. Two groups were compared based on their need for respiratory support: a respiratory support group and a normal transition group. Positive-pressure ventilation was delivered with a T-piece resuscitator, and oxygen was adjusted based on SpO2 values. A Florian respiratory function monitor was used to record the ventilation variables. RESULTS: There were 21 infants in the normal transition group and 21 infants in the respiratory support group. Changes in heart rate over time were similar in the 2 groups. SpO2, rcSO2, and rpSO2 values were consistently higher in the normal transition group. In the respiratory support group, cFTOE values remained significantly elevated for a longer period. CONCLUSION: This systematic analysis of rpSO2, rcSO2, and cFTOE in late preterm infants found significantly lower oxygen saturation values in infants who received respiratory support compared with a normal transition group. We hypothesize that the elevated cFTOE values in the respiratory support group represent compensation for lower oxygen delivery.

The fetal inflammatory response syndrome is a risk factor for morbidity in preterm neonates.

OBJECTIVE: The aim of this study was to show and discuss an association between fetal inflammatory response syndrome (FIRS) and an adverse neonatal outcome defined as combined severe neonatal morbidity and mortality in preterm neonates hospitalized in our neonatal intensive care unit. STUDY DESIGN: This was an observational study including all preterm neonates hospitalized in our neonatal intensive care unit over a 21 month period. FIRS was defined as cord blood interleukin (IL)-6 greater than 11 pg/mL. Main outcome parameter was an adverse neonatal outcome defined as hospital mortality and/or the presence of any of 5 prespecified morbidities (bronchopulmonary dysplasia, periventricular leukomalacia, intraventricular hemorrhage, and early- or late-onset sepsis). RESULTS: Fifty-seven of 176 preterm infants hospitalized during the study period (32%) had an adverse neonatal outcome and 62 of these 176 infants (35%) had FIRS with median IL-6 values of 51.8 pg/mL (range, 11.2 to >1000 pg/mL). In a regression analysis, FIRS was significantly associated with adverse neonatal outcome (P < .001) and with the single outcome parameters, intraventricular hemorrhage and early-onset sepsis (P = .006 and P = .018, respectively). In the bivariate analysis, FIRS was associated with death and bronchopulmonary dysplasia (P = .004 and P < .001, respectively). IL-6 correlated with adverse neonatal outcome (r = 0.411, P < .001). When comparing the correlation in neonates less than 32 weeks' gestational age (r = 0.481, P < .001) with neonates 32 weeks or longer (r = 0.233, P = .019), the difference was nearly significant (P = .065). CONCLUSION: FIRS is a risk factor for adverse neonatal outcome in preterm infants. In particular, the combination of IL-6 greater than 11 pg/mL and low gestational age increased the risk for severe neonatal morbidity or death.

Should respiratory care in preterm infants include prophylaxis against respiratory syncytial virus infection? The case in favour.

Respiratory syncytial virus (RSV) is the most significant cause of acute respiratory tract infections (RTI) in infants and young children throughout the world. Preterm infants are at increased risk for severe RSV lower respiratory tract infection due to small lung volumes, a reduced lung surface area, small airways and an increased air space wall thickness. Additionally, the airways of preterm infants have been ventilated mechanically and suctioned and potentially damaged by many microtraumas with disruption of endothelial surfaces enabling pathogens to invade more easily. The immune system of preterm infants is immature resulting in low antibody titers (incomplete transplacental transfer of maternal antibodies) and a reduced cellular immunity with reduced viral clearance. Rehospitalization rates of preterm compared to term infants due to RSV infection are increased as are total morbidity and mortality associated with RSV disease. Palivizumab effectively reduces RSV related rehospitalisation in this high-risk population.

Fecal carriage and intrafamilial spread of extended-spectrum ß-lactamase-producing enterobacteriaceae following colonization at the neonatal ICU.

OBJECTIVE: Fecal carriage of extended-spectrum ß-lactamase-producing enterobacteriaceae may contribute to the spread of extended-spectrum ß-lactamase-producing enterobacteriaceae into the community. The objective of this study was to assess the duration of fecal carriage after discharge and the occurrence of intrafamilial transmission. DESIGN: Case series. SETTING: Quaternary care children's hospital. PATIENTS: Patients colonized with extended-spectrum ß-lactamase-producing enterobacteriaceae at the neonatal ICU and the respective household members. INTERVENTIONS: Screening for intestinal extended-spectrum ß-lactamase-producing enterobacteriaceae colonization was done at 1, 2, 4, 6, 9, and 12 months after discharge. Genetic relatedness of isolated extended-spectrum ß-lactamase-producing enterobacteriaceae strains was determined using automated rep-PCR. RESULTS: Twenty-five neonates (case-patients) colonized with extended-spectrum ß-lactamase-producing enterobacteriaceae (one extended-spectrum ß-lactamase-Escherichia coli; six extended-spectrum ß-lactamase-Klebsiella pneumoniae; 11 extended-spectrum ß-lactamase-Klebsiella oxytoca; and seven extended-spectrum ß-lactamase-Serratia marcescens) were included. Duration of fecal carriage was longer (up to 1 yr) in case-patients colonized with Klebsiella species than in case-patients colonized with Serratia marcescens (<4 months). During follow-up, strains and species of extended-spectrum ß-lactamase-producing enterobacteriaceae different from the primary strain were found in four and three case-patients, respectively. In nine of 49 (18.4%) included household members, extended-spectrum ß-lactamase-producing enterobacteriaceae were found during the follow-up period. In two of nine colonized household members, the isolated extended-spectrum ß-lactamase-producing enterobacteriaceae was identical to the primary strains of the respective case-patients. CONCLUSIONS: After intestinal colonization with extended-spectrum ß-lactamase-producing enterobacteriaceae at the neonatal ICU, infants potentially remain carriers during the first year after discharge. Intrafamilial spread has been proven.

The predictive value of immature granulocyte count and immature myeloid information in the diagnosis of neonatal sepsis.

BACKGROUND: To determine the predictive value of the immature granulocyte count and the immature myeloid information in neonatal early onset sepsis we examined 133 blood samples of patients admitted to our neonatal intensive care unit. METHODS: Measurements were performed using the Sysmex XE-2100, an automated hematological analyzer. Patients were divided into two groups: 1) symptomatic neonates with diagnosis of early onset sepsis; and 2) controls including asymptomatic neonates who were admitted because of prematurity, low birth weight, or delayed postnatal transition. RESULTS: The number of immature granulocytes and the immature myeloid information were significantly elevated in neonates with early onset sepsis compared to controls (median 280/µL vs. 50/µL, p=0.049 and 639/µL vs. 89/µL, p<0.0001, respectively). CONCLUSIONS: Automated determinations of immature granulocytes and immature myeloid information seem to be useful adjunctive methods in the diagnosis of neonatal early onset sepsis.

Thermographical measuring of the skin temperature using laser needle acupuncture in preterm neonates.

In children, laser acupuncture is used more often than needle acupuncture in Western countries, due to their aversion to needles. When applying laser acupuncture to premature babies and neonates, firstly the degree of the thermal increase to the skin has to be evaluated so as to guarantee safe application. The patients were premature neonates before their discharge from hospital. The measurements were carried out by means of a polygraphy while they were asleep shortly. The large intestine 4 acupoint (LI4, Hegu) was stimulated by a microlaser needle (10 mW, 685 nm) twice (5 and 10 min). Local thermographic pictures were taken with a thermal camera (Flir i5, Flir Systems Inc., Portland, USA), and the warmest point was determined and subsequently compared. The study included 10 premature neonates (7 male, 3 female). The measurements were carried out on the 33rd day of life (weight 2030 g, gestational age 36 + 3 weeks of pregnancy). In comparison to the initial temperature (32.9°C), after 5 minutes of stimulation (33.9°C) (P = 0.025) and also after 10 minutes of stimulation (34.0°C) (P = 0.01), there was found to be a significant increase in the skin temperature. The singular maximum value of 37.9°C bears a potential danger; however, compared to the local temperatures reached in transcutaneous blood gas measurements it appears not to entail any risks.

Cerebral regional oxygen saturation (crSO2): are different sensors comparable?

BACKGROUND: For measurement of cerebral regional oxygen saturation (crSO2) in neonates, one of the frequently used near-infrared spectroscopy devices is the INVOS 5100 with either the neonatal or pediatric sensor. Measurements between adult and pediatric sensors use different algorithms and differ by 10%. There are no published data comparing neonatal and pediatric sensors. OBJECTIVE: Aim of this study was to compare the neonatal sensor with the pediatric sensor of the INVOS 5100 device in a mixed cohort of neonates to recognize possible differences and enable interpretation of data. METHODS: In 40 neonates, crSO2 was measured in identical positions using both the neonatal and the pediatric sensor under identical conditions. Each sensor was reapplied five times to calculate mean values and standard deviations. RESULTS: Cerebral regional oxygen saturation measurements using the neonatal sensor (mean, 76.1 ± 7.9) and crSO2 measurements using the pediatric sensor (mean, 76.4 ± 8.1) were not different. Reproducibility was not significantly different with similar means of standard deviations (neonatal, 3.7 ± 1.6; pediatric, 3.1 ± 1.3). CONCLUSION: In a mixed cohort of neonates, crSO2 measurements were identical when using the INVOS 5100 neonatal sensor and the pediatric sensor. We conclude that studies using the INVOS 5100 neonatal or pediatric sensor are well comparable.

Neonates presenting with temperature symptoms: role in the diagnosis of early onset sepsis.

BACKGROUND: In this study, we aimed to evaluate the role of fever, hypothermia, and temperature instability in term and preterm newborns during the first 3 days of life and to identify risk factors for early onset sepsis (EOS) among newborns presenting with these temperature symptoms. METHODS: In this retrospective cohort study set in our level III neonatal intensive care unit, we included all newborns hospitalized within the first 24 h of life from 2004 to 2007. RESULTS: Of 851 newborns, 127 presented with temperature symptoms during the first 3 days of life (15%): 69 had fever, 69 had hypothermia, and 55 had temperature instability (8%, 8%, and 6%, respectively). Of 127 newborns presenting with temperature symptoms, 14 had culture-proven EOS/pneumonia (33% of all 42 newborns with culture-proven EOS/pneumonia), 67 had clinical EOS (30% of all 209 newborns with clinical EOS) and 46 were EOS-negative (8% of all 600 EOS-negatives). Factors associated with culture-proven EOS/pneumonia in newborns presenting with temperature symptoms were maternal fever (P = 0.009), chorioamnionitis (P < 0.001), antibiotic therapy of the mother (P = 0.04), poor skin color (P = 0.001) and syndrome of persistent fetal circulation (P = 0.01). CONCLUSIONS: Every seventh newborn hospitalized at our neonatal intensive care unit developed fever, hypothermia and/or temperature instability during the first 3 days of life. Two-thirds of them had culture-proven or clinical sepsis. Temperature symptoms were rarely observed in EOS-negative newborns (8%) but despite low sensitivity, were highly specific for bacterial infection in preterm and term newborns.

Performance of the definitions of the systemic inflammatory response syndrome and sepsis in neonates.

AIMS: The aim of this study was to examine the applicability of the definitions of the systemic inflammatory response syndrome (SIRS) and sepsis to neonates during the first 3 days of life. METHODS: This is a retrospective study of all term neonates hospitalized within the first 24 h of life from 2004 to 2010 at our neonatal intensive care unit. RESULTS: Of 476 neonates, 30 (6 %) had a diagnosis of culture-proven early-onset sepsis (EOS) and 81 (17 %) had culture-negative clinical EOS or suspected EOS. SIRS and sepsis criteria were applied to 116 (24 %) and 61 (13 %) neonates, respectively. Of 30 neonates with culture proven, EOS 14 (53 %) fulfilled SIRS and sepsis criteria. The single diagnostic criterion of SIRS applied to 20 % (hypothermia or fever), 43 % (white blood cell count/immature-to-total neutrophil ratio), 87 % (respiratory symptoms), and 33 % (cardiocirculatory symptoms) of all neonates with culture-proven EOS. CONCLUSIONS: The definitions of SIRS and sepsis did not apply to about half of all cases of culture-proven EOS. An evidence-based approach to find the appropriate criteria for defining EOS in the neonate is needed.

Open government data: A systematic literature review of empirical research.

Open government data (OGD) holds great potential for firms and the digital economy as a whole and has attracted increasing interest in research and practice in recent years. Governments and organizations worldwide are struggling in exploiting the full potential of OGD and require a comprehensive understanding of this phenomenon. Although scientific debates in OGD research are intense and heterogeneous, the field lacks theoretical integration of OGD topics and their systematic consideration in the context of the digital economy. In addition, OGD has been widely neglected by information systems (IS) research, which promises great potential for advancing our knowledge of the OGD concept and its role in the digital economy. To fill in this gap, this study conducts a systematic literature review of 169 empirical OGD studies. In doing so, we develop a theoretical review framework of Antecedents, Decisions, Outcomes (ADO) to unify and grasp the accumulating isolated evidence on OGD in context of the digital economy and provide a theory-informed research agenda to tap the potential of IS research for OGD. Our findings reveal six related key topic clusters of OGD research and substantial gaps, opening up prospective research avenues and particularly outlining how IS research can inform and advance OGD research. Supplementary information: The online version contains supplementary material available at 10.1007/s12525-022-00582-8.

Regional oxygen saturation of the brain during birth transition of term infants: comparison between elective cesarean and vaginal deliveries.

OBJECTIVE: To evaluate differences in regional oxygen saturation of the brains of term infants of vaginal or cesarean deliveries. STUDY DESIGN: Vaginal delivery (n = 63) and elective cesarean delivery infants were prospectively evaluated for the first 10 minutes after delivery. Peripheral arterial oxygen saturation (SpO(2)) and heart rate were measured on the right hand using pulsoximetry with near infrared spectroscopy. Regional oxygen saturation of the brain (rSO(2)brain) was measured. Fractional tissue oxygen extraction was calculated for each minute. RESULTS: From 4 to 8 minutes, SpO(2) values for cesarean delivery infants were significantly lower than for vaginally delivered infants. Heart rate of the cesarean delivery infants was significantly lower throughout the whole observation period. There was no difference between groups in rSO(2)brain. Fractional tissue oxygen extraction only differed at minute 10. CONCLUSIONS: Although SpO(2) and heart rate were significantly lower in cesarean-delivered infants, there were no differences in rSO(2)brain with respect to mode of delivery.

Non-infectious conditions and gestational age influence C-reactive protein values in newborns during the first 3 days of life.

BACKGROUND: Our aim was to analyze C-reactive protein (CRP) values in term and preterm infants and correlate non-infection-associated increases with various neonatal disorders. METHODS: Retrospective cohort study that included all newborns hospitalized at a tertiary care center between 2004 and 2007 with documented CRP values in the first 3 days of life. Analysis of differences in CRP values between term and preterm newborns and cases with CRP increases in sepsis negative newborns. RESULTS: For diagnosis of blood culture proven sepsis (19 and 14 cases, respectively) in 353 preterm and 179 term newborns, CRP at a cut-off of 8 mg/L had sensitivities of 53% and 86% and specificities of 91% and 88%, respectively. The area under the receiver operating characteristics curves were 0.799 and 0.890, respectively. Preterm newborns had lower median values compared to term newborns in sepsis positive (9 vs. 18.5 mg/L, p < 0.001) and negative newborns (0.5 vs. 2 mg/L, p < 0.001). Increases in individuals without infection were correlated significantly with meconium aspiration syndrome and surfactant application in term newborns (p = 0.009 and 0.025, respectively) and with surfactant application and higher birth weight in preterm newborns (p < 0.001 and 0.031, respectively). CONCLUSIONS: CRP values were significantly lower in preterm compared to term newborns, and its application in the diagnosis of sepsis in preterm newborns was not as reliable as in term newborns. Meconium aspiration syndrome, surfactant application, and high birth weight were associated significantly with increased CRP values.

Regional oxygen saturation of the brain and peripheral tissue during birth transition of term infants.

OBJECTIVE: To evaluate regional tissue oxygenation of the brain and preductal and postductal peripheral (muscle) tissue during immediate transition after birth, and to correlate with peripheral preductal and postductal arterial oxygen saturation. STUDY DESIGN: We conducted a prospective observational study. With near-infrared spectroscopy (NIRS), changes in regional oxygen saturation of the brain (rSO2brain), peripheral preductal tissue (rSO2pre), and peripheral postductal tissue (rSO2post) were measured during the first 10 minutes of life in 59 healthy term infants after elective caesarean delivery. Fractional tissue oxygen extraction was calculated for all 3 regions. RESULTS: Mean rSO2brain increased rapidly from 44% (3 minutes) to 76% (7 minutes); thereafter no significant change occurred. Mean rSO2pre and rSO2post increased constantly from minute 3 to minute 10, from 36%(pre)/27%(post) to 66%(pre)/58%(post). Fractional tissue oxygen extraction decreased in all 3 regions during the first minutes of life. Fractional tissue oxygen extraction of the brain did not change significantly after 5 minutes, and preductal and postductal fractional tissue oxygen extraction did not change significantly after 8 minutes. CONCLUSIONS: During transition, the brain had the highest saturation levels, indicating a preference of oxygen delivery to the brain. Fractional tissue oxygen extraction of the brain reached a plateau earlier compared with peripheral tissue.

Pacifier use does not alter the frequency or duration of spontaneous arousals in sleeping infants.

OBJECTIVE: It has been reported that pacifiers might reduce the risk of SIDS by favouring infants' arousability from sleep. We evaluated the influence of a pacifier on the frequency and duration of spontaneous arousals in healthy infants. METHODS: Polygraphic recordings were performed in 14 infants with an age of 51.7+/-19.9 days (means+/-SD) who regularly used a pacifier during sleep. Cortical and subcortical arousals were scored according to the recommendations of the "International Paediatric Work Group on Arousals." The number of arousals per 10-min-period and the duration of arousals were determined for periods of pacifier use as well as for periods after pacifier dislodgement and were compared with the data of 10 control infants (age 49.8+/-16.5 days) who never used a pacifier. RESULTS: Altogether, 211 arousals in pacifier users and 225 arousals in non-users were scored. In pacifier users, 2.0+/-1.6 arousals per 10-min-period with a duration of 12.2+/-3.0 s occurred during pacifier use, and 1.7+/-1.6 arousals per 10-min-period with a duration of 12.2+/-3.1s occurred during periods without pacifier. In pacifier non-users, 2.3+/-1.2 arousals per 10-min-period (duration 13.9+/-2.9s) were scored. The results did not show a significant difference concerning frequency and duration of spontaneous arousals between pacifier users and non-users. CONCLUSIONS: Our findings suggest that factors other than arousal mechanisms might be responsible for the efficacy of pacifiers in SIDS prophylaxis.

Combination of different noninvasive measuring techniques: a new approach to increase accuracy of peripheral near infrared spectroscopy.

One of the problems of near-infrared-spectroscopy (NIRS) measurements is low reproducibility. The aim of the present study was to introduce quality criteria to increase reproducibility of peripheral NIRS measurements. In a prospective cohort study in 40 neonates, repeated NIRS measurements were performed on the calf. During five "reapplication" periods (of NIRS optodes), five "measurements" (venous occlusions) were performed. Tissue oxygenation index (TOI), mixed venous oxygenation (SvO2), fractional oxygen extraction (FOE), hemoglobin flow (Hbflow), oxygen delivery (DO2), and oxygen consumption (VO2) were assessed. Measurements with linear changes during venous occlusions were included for further analysis (first quality criterion: R(2)>0.95). The second quality criterion was the equation 0 < or = TOI-SvO2 < or = (SaO2-SvO2)x0.2. Variance components and mean standard deviations were analyzed after introduction of the quality criteria. Variance components of reapplication and measurement decreased after introduction of the second quality criterion (TOI: 46.6-35.0%, SvO2: 76.8-38.2%, FOE: 73.1-37.5%, Hbflow: 70.3-51.9%, DO2: 71.5-52.7%, and VO2: 70.9-63.8%). Mean standard deviations of TOI (6.6+/-3.0 to 4.7+/-3.2%), SvO2 (11.1+/-4.8 to 5.7+/-3.9%), FOE (11.3+/-4.8 to 5.9+/-4.0%), Hbflow (4.3+/-2.0 to 2.9+/-1.6 micromol100 mLmin), and DO2 (17.8+/-7.6 to 11.4+/-6.2 micromol100 mLmin) decreased significantly, too. Only 12% of measurements fulfilled both quality criteria. With the introduction of two quality criteria, test-retest variability of peripheral NIRS measurements decreased significantly and reproducibility increased significantly.

Correlation between EEG burst-to-burst intervals and HR acceleration in preterm infants.

One objective of this paper is to confirm the coupling between heart rate (HR) changes and electroencephalographic (EEG) bursts (as reported for the first time in Pfurtscheller et al. [K. Pfurtscheller, G.R. Müller-Putz, B. Urlesberger, W. Müller, G. Pfurtscheller, Relationship between slow-wave EEG bursts and heart rate changes in preterm infants, Neurosci. Lett. 385 (2) (2005) 126-130]) in a larger group of preterm infants. Other objectives are to report on semi-automatic detection of burst-to-burst intervals (BBI, time period between the onsets of 2 consecutive EEG bursts) and on correlations between BBI and HR changes. A group of 34 preterm infants with a conceptional age (CA) of 35.9+/-0.6 weeks (mean+/-S.D.) was studied. Periods with a length of about 10 min with low HR variability and discontinuous EEG were selected from long-term EEG and ECG registrations and analyzed. From the automated detection of EEG bursts, an estimate for the mean burst-to-burst interval was obtained. EEG trials with a duration of 16s and a single EEG burst in the middle, were selected and averaged together with the corresponding instantaneous HR trials. It was found that preterm infants without evidence of neurological deficit and with normal development revealed a mean BBI of 13.4+/-2.6s (mean+/-S.D.) and a HR increase of 1.7+/-0.9 bpm (mean+/-S.D.) during the occurrence of EEG bursts. This HR increase is comparable with the earlier reported increase of 1.9+/-0.8 bpm. A significant negative correlation of r=0.453 (p<0.01) was found between BBI and HR increase and a positive correlation between CA and HRV (r=0.438, p<0.01) and between CA and HRI (r=0.452, p<0.01).