Outcomes and prognostic factors of infantile acquired hydrocephalus: a single-center experience.

AIM: To assess the etiologies and adverse outcomes of infantile acquired hydrocephalus and predict prognosis. METHODS: A total of 129 infants diagnosed with acquired hydrocephalus were recruited from 2008 to 2021. Adverse outcomes included death and significant neurodevelopmental impairment which was defined as Bayley Scales of Infant and Toddler Development III score < 70, cerebral palsy, visual or hearing impairment, and epilepsy. Chi-squared was used to evaluate the prognostic factors of adverse outcomes. A receiver operating characteristic curve was calculated to determine the cutoff value. RESULTS: Of 113 patients with outcome data, 55 patients (48.7%) had adverse outcomes. Late surgical intervention time (13 days) and severe ventricular dilation were associated with adverse outcomes. The combination of surgical intervention time and cranial ultrasonography (cUS) indices was a better predictive marker compared with any of them (surgical intervention time, P = 0.05; cUS indices, P = 0.002). Post-hemorrhage (54/113, 48%), post-meningitis (28/113, 25%), and hydrocephalus arising from both hemorrhage and meningitis (17/113, 15%) accounted for a large proportion of the etiologies in our study. Hydrocephalus occurs secondary to post-hemorrhage and had a favorable outcome compared with other etiologies in both preterm and term groups. A significant difference in adverse outcomes between the inherited error of metabolism as a cause and other etiologies (P = 0.02). CONCLUSION: Late surgical treatment times and severe ventricular dilation can predict adverse outcomes in infants with acquired hydrocephalus. It is crucial to identify the causes of acquired hydrocephalus to predict the adverse outcomes. Research into measures of improving adverse outcomes following infantile acquired hydrocephalus is urgently necessary.

Near-Infrared Spectroscopy Monitoring of Cerebral Oxygenation and Influencing Factors in Neonates from High-Altitude Areas.

BACKGROUND: Accurate detection of cerebral oxygen saturation (rSO2) may be useful for neonatal brain injury prevention, and the normal range of rSO2 of neonates at high altitude remained unclear. OBJECTIVE: To compare cerebral rSO2 and cerebral fractional tissue oxygen extraction (cFTOE) at high-altitude and low-altitude areas in healthy neonates and neonates with underlying diseases. METHODS: 515 neonates from low-altitude areas and 151 from Tibet were enrolled. These neonates were assigned into the normal group, hypoxic-ischemic encephalopathy (HIE) group, and other diseases group. Near-infrared spectroscopy was used to measure rSO2 in neonates within 24 h after admission. The differences of rSO2, pulse oxygen saturation (SpO2), and cFTOE levels were compared between neonates from low- and high-altitude areas. RESULTS: (1) The mean rSO2 and cFTOE levels in normal neonates from Tibet were 55.0 ± 6.4% and 32.6 ± 8.5%, significantly lower than those from low-altitude areas (p < 0.05). (2) At high altitude, neonates with HIE, pneumonia (p < 0.05), anemia, and congenital heart disease (p < 0.05) have higher cFTOE than healthy neonates. (3) Compared with HIE neonates from plain areas, neonates with HIE at higher altitude had lower cFTOE (p < 0.05), while neonates with heart disease in plateau areas had higher cFTOE than those in plain areas (p < 0.05). CONCLUSIONS: The rSO2 and cFTOE levels in normal neonates from high-altitude areas are lower than neonates from the low-altitude areas. Lower cFTOE is possibly because of an increase in blood flow to the brain, and this may be adversely affected by disease states which may increase the risk of brain injury.

Clinical Manifestations and Amplitude-integrated Encephalogram in Neonates with Early-onset Epileptic Encephalopathy.

BACKGROUND: The patients with early-onset epileptic encephalopathy (EOEE) suffer from neurodevelopmental delay. The aim of this study was to analyze the clinical manifestations and amplitude-integrated encephalogram (aEEG) characteristics of infants with EOEE with onset within the neonatal period, to make early diagnosis to improve the prognosis. METHODS: One-hundred and twenty-eight patients with neonatal seizure were enrolled and followed up till 1 year old. Sixty-six neonates evolved into EOEE were as the EOEE group, the other 62 were as the non-EOEE (nEOEE) group. Then we compared the clinical and aEEG characteristics between the two groups to analyze the manifestations in neonates with EOEE. RESULTS: Compared to the nEOEE group, the incidence of daily seizure attacks, more than two types of convulsions, more than two antiepileptic drugs (AEDs) application, severely abnormal aEEG background, absence of cyclicity, and more than two seizures detection were significantly higher in the EOEE group (P < 0.05) (97% vs. 54.8%; 30.3% vs. 14.5%; 97.0% vs. 25.4%; 39.4% vs. 3.2%; 57.6% vs. 9.7%; and 56% vs. 3.2%, respectively). Severely abnormal background pattern (odds ratio [OR] = 0.081, 95% confidence interval [CI]: 0.009-0.729, P = 0.025) and more than two seizures detection by aEEG (OR = 0.158, 95% CI: 0.043-0.576, P = 0.005) were the independent risk factors for the evolvement into EOEE. The upper and lower margins of active sleep (AS) and quiet sleep (QS) were significantly higher in EOEE group than those of the control group (P < 0.05) (34.3 ± 13.6 vs. 21.3 ± 6.4; 9.9 ± 3.7 vs. 6.7 ± 2.2; 41.2 ± 15.1 vs. 30.4 ± 11.4; and 11.9 ± 4.4 vs. 9.4 ± 4.0; unit: µV, respectively). AS upper margin was demonstrated a higher diagnostic specificity and sensitivity for EOEE than another three parameters according to the receiver operating characteristic curves; the area under the curve was 0.827. CONCLUSIONS: The clinical characteristics of the neonatal seizure which will evolve into EOEE were more than two AEDs application, high seizure frequency (daily attack), and more than two types of the seizure. Significant high voltage, severely abnormal background, absence of cyclicity, and more than two seizures detected on aEEG were the meaningful indicators to the prediction of EOEE.

Discrimination of emotional prosodies in human neonates: A pilot fNIRS study.

Very early in development, vocal emotional cues are more critical than facial expressions in guiding infants' behavior. However, the processing of emotional prosody in the very early days of life is still far from clearly understood. To address the issue, this study used functional near-infrared spectroscopy to examine brain response of neonates when they passively listened to fearful, angry, happy and neutral prosodies. It was found that while the right temporal cortex (mainly located in the middle temporal gyrus and superior temporal gyrus) exhibited enhanced response to emotional, relative to neutral, prosody, a right parietal area (approximately located in the supramarginal gyrus) showed a heightened sensitivity to fearful, relative to happy and neutral, prosody. These findings highlight the crucial importance of the right hemisphere in the perception of emotional prosody in neonates. Furthermore, the result is consistent with the notion of a negativity bias, supporting the evolutionary importance of threatening information that could be processed at birth.

[STXBP1 gene mutation in newborns with refractory seizures].

OBJECTIVE: To study the relationship between STXBP1 gene mutations and refractory seizures with unknown causes in newborns. METHODS: The coding region of STXBP1 gene was detected using direct Sanger sequencing in 11 newborns with refractory seizures of unknown causes. RESULTS: STXBP1 gene mutation was found in 1 out of 11 patients. It was a missense mutation: c.1439C>T (p.P480L). CONCLUSIONS: STXBP1 gene mutation can be found in neonatal refractory seizures of unknown causes, suggesting a new approach of further research of this disease.

The prognostic value of amplitude-integrated EEG in full-term neonates with seizures.

Neonatal seizures pose a high risk for adverse outcome in survived infants. While the prognostic value of amplitude-integrated electroencephalogram (aEEG) is well established in neonates with encephalopathy and asphyxia, neonatal seizure studies focusing on the direct correlation between early aEEG measurement and subsequent neurologic outcome are scarce. In this study, the prognostic value of aEEG features was systematically analyzed in 143 full-term neonates to identify prognostic indicators of neurodevelopmental outcome. Neonatal aEEG features of background pattern, cyclicity, and seizure activity, as well as the etiology of neonatal seizures, were significantly associated with neurodevelopmental outcome at one year of age. aEEG background pattern was highly associated with neurologic outcomes (χ²â€Š= 116.9), followed by aEEG cyclicity (χ²â€Š= 87.2) and seizure etiology (χ²â€Š= 79.3). Multiple linear regression showed that the four predictors explained 71.2% of the variation in neurological outcome, with standardized ß coefficients of 0.44, 0.24, 0.22, and 0.14 for the predictors of aEEG background pattern, cyclicity, etiology, and aEEG seizure activity, respectively. This clinically applicable scoring system based on etiology and three aEEG indices would allow pediatricians to assess the risk for neurodevelopmental impairment and facilitate an early intervention in newborns developing seizures.

[Relationship between degree of white matter damage and EEG changes in premature infants early after birth].

OBJECTIVE: To study the relationship between the degree of white matter damage and changes in brain function in premature infants early after birth according to amplitude-integrated electroencephalogram (aEEG) and raw EEG (with burst-suppression patterns). METHODS: Thirty-eight premature infants of less than 32 weeks' gestational age and with white matter damage, including 20 cases of mild white matter damage and 18 cases of severe white matter damage, were included in the study. Forty-two premature infants without white matter damage were selected as a control group. After birth, they were examined using aEEG and brain ultrasound once a week until four weeks after birth or a corrected gestational age of 32 weeks. The white matter damage and control groups were compared in terms of aEEG patterns and amplitudes and burst suppression ratio (BSR) on EEG. RESULTS: The white matter damage and control groups had highly discontinuous patterns and had no complete sleep cycles. The lower amplitude was significantly smaller in the severe white matter damage subgroup than in the mild white matter damage subgroup and control group. There was alternating burst-suppression activity on the raw EEG in the white matter damage and control groups; and the severe white matter damage subgroup had a significantly longer suppression time and a significantly higher BSR on EEG compared with the mild white matter damage subgroup and control group. CONCLUSIONS: Brain function monitoring should be performed in premature infants with white matter damage early after birth so as to detect cases of severe white matter damage in time.

[Combined methylmalonic aciduria and homocysteinemia with hydrocephalus as an early presentation: a case report].

A case of combined methylmalonic aciduria and homocysteinemia presenting with hydrocephalus as an early manifestation was reported for its rarity to see and to discuss the relationship between metabolic diseases and hydrocephalus by literature review. The case was an infant with seizures and hydrocephalus as an early manifestation of the disease, combined with macrocyticanemia, development retardation and visual hearing function lesions. The EEG showed hypsarrhythmia and the MRI showed hydrocephalus. Plasma homocysteinemia level increased (143.06 umol/L) and urine methylmalonic aciduria was 1483 times beyond normal. Based on gene analysis results and increased methylmalonic aciduria and homocysteinemia levels, combined methylmalonic aciduria and homocysteinemia was confirmed, presenting CblC defect (gene mutations homozygous for c.609G>A). After treatment by venous injection of vitamin B12, oral folic acid and betaine, seizures were controlled and development was progressive with ventricle retraction. It was concluded that hydrocephalus can be the early presentation in children with combined methylmalonic aciduria and homocysteinemia. Doctors should carry out metabolic disease screening for patients with hydrocephalus, especially when the cause of hydrocephalus is uncertain.

Incidence of brain injuries in premature infants with gestational age ≤ 34 weeks in ten urban hospitals in China.

BACKGROUND: There is a large number (1.5 million per year) of premature births in China. It is necessary to obtain the authentic incidences of intraventricular hemorrhage (IVH) and periventricular leukomalacia (PVL), the common brain injuries, in Chinese premature infants. The present multicenter study aimed to investigate the incidence of brain injuries in premature infants in ten urban hospitals in China. METHODS: The research proposal was designed by the Subspecialty Group of Neonatology of Pediatric Society of the Chinese Medical Association. Ten large-scale urban hospitals voluntarily joined the multicenter investigation. All premature infants with a gestational age ≤ 34 weeks in the ten hospitals were subjected to routine cranial ultrasound within three days after birth, and then to repeated ultrasound every 3-7 days till their discharge from the hospital from January 2005 to August 2006. A uniform data collection sheet was designed to record cases of brain injuries. RESULTS: The incidences of overall IVH and severe IVH were 19.7% (305/1551) and 4.6% (72/1551), respectively with 18.4% (56/305) for grade 1, 58.0% (177/305) for grade 2, 17.7% (54/305) for grade 3 and 5.9% (18/305) for grade 4 in nine hospitals. The incidences of overall PVL and cystic PVL were 5.0% (89/1792) and 0.8% (14/1792) respectively, with 84.3% (75/89) for grade 1, 13.5% (12/89) for grade 2, and 2.2% (2/89) for grade 3 in the ten hospitals. The statistically significant risk factors that might aggravate the severity of IVH were vaginal delivery (OR=1.883, 95% CI: 1.099-3.228, P=0.020) and mechanical ventilation (OR=4.150, 95% CI: 2.384-7.223, P=0.000). The risk factors that might result in the development of cystic PVL was vaginal delivery (OR=21.094, 95% CI: 2.650-167.895, P=0.000). CONCLUSIONS: The investigative report can basically reflect the incidence of brain injuries in premature infants in major big cities of China. Since more than 60% of the Chinese population live in the rural areas of China, it is expected to undertake a further multicenter investigation covering the rural areas in the future.

The utility of amplitude-integrated EEG and NIRS measurements as indices of hypoxic ischaemia in the newborn pig.

OBJECTIVE: The early detection and stratification of potential hypoxic ischaemia (HI) injury in neonates are crucial for reducing the risk of neural disability. This study investigates early changes in brain function caused by acute HI of varying severities in the neonatal pig. METHODS: Two non-invasive techniques, amplitude-integrated electroencephalogram (aEEG) and near-infrared spectroscopy (NIRS), were used to monitor electrocortical and cerebral haemodynamic function, respectively. The fraction of inspired oxygen (FiO(2)) was varied to produce different HI severities. The sensitivity and HI correlation of these methods were systematically analysed to assess their abilities to both detect injury early and assess HI severity accurately. RESULTS: The tissue oxygen index measured via NIRS detected acute changes in cerebral oxygenation and was highly sensitive to HI (sensitivity=0.97), whereas aEEG was comparatively insensitive to HI. On the other hand, aEEG measurements correlated well with FiO(2) during the entire HI event as well as the 3-h recovery period (R=0.43-0.61). NIRS measurements did not correlate well with FiO(2). CONCLUSIONS: Parameters measured via aEEG and NIRS displayed different time profiles during and following the HI event. SIGNIFICANCE: These results highlight the potential advantage of using aEEG and NIRS in conjunction to monitor neonatal brain function, and provide an objective and rigorous method for the characterisation of cerebral function both during and following HI insults.

Reference values for amplitude-integrated EEGs in infants from preterm to 3.5 months of age.

OBJECTIVES: Amplitude-integrated electroencephalogram (aEEG) is a valuable tool for the continuous evaluation of functional brain maturation in infants. The amplitudes of the upper and lower margins of aEEGs are postulated to change with maturation and correlate with postmenstrual age (PMA). In this study we aimed to establish reliable reference values of aEEG amplitudes, which provide quantitative guidelines for assessing brain maturation as indicated by aEEG results in neonates and young infants. METHODS: aEEGs from healthy infants (n = 274) with PMAs that ranged from 30 to 55 weeks were divided into 10 groups according to their PMAs. Two 5-minute segments were selected from each aEEG and were used to automatically calculate the upper and lower margins and bandwidths of the aEEG tracings. RESULTS: Interobserver agreement was achieved with an overall correlation of 0.99. The upper and lower margins of the aEEGs in both active and quiet sleep clearly rose in infants after the neonatal period. The bandwidth defined as the graphic distance decreased almost monotonically throughout the PMA range from 30 to 55 weeks. The lower margin of the aEEG was positively correlated with PMA, with a larger rank correlation coefficient during quiet sleep (r = 0.89) than during active sleep (r = 0.49). CONCLUSIONS: Reference values of aEEG amplitudes were obtained for infants with a wide range of PMAs and constituted the basis for the quantitative assessment of aEEG changes with maturation in neonates and young infants. The normative amplitudes of aEEG margins, especially of the lower margin in quiet sleep, are recommended as a source of reference data for the identification of potentially abnormal aEEG results.

NIRS study of cerebral oxygenation and hemodynamics in neonate at birth.

To study the changes of cerebral oxygenation and hemodynamics in normal neonates at 2-5 min post-birth and understand the effects of pregnancy-induced hypertension (PIH) upon cerebral oxygenation and hemodynamics in newborn neonates. The near infrared spectroscopy (NIRS) was employed to measure the absolute quantity of brain tissue oxygen saturation (rSO2) in newborn neonates and the changes of concentrations of deoxyhemoglobin (Hb) and oxygenation hemoglobin (HbO2) with time relative to initial values to further obtain the changes of total hemoglobin (tHb) and cerebral perfusion (denoted by HbD). In normal neonates at 2-5 min post-birth, rSO2 increased while tHb remained relatively stable and HbD increased. In neonates born of PIH mothers at 3-5 min post-birth, the changes of tHb were markedly higher than those in the normal infants, p<0.05; at 2-5 min post-birth, the changes were markedly lower than the normal term infants. We concluded that NIRS can detect the changes of cerebral oxygenation and blood flow in a non-invasive and effective way.

Selective head cooling with mild systemic hypothermia after neonatal hypoxic-ischemic encephalopathy: a multicenter randomized controlled trial in China.

OBJECTIVE: To investigate the efficacy and safety of selective head cooling with mild systemic hypothermia in hypoxic-ischemic encephalopathy (HIE) in newborn infants. STUDY DESIGN: Infants with HIE were randomly assigned to the selective head cooling or control group. Selective head cooling was initiated within 6 hours after birth to a nasopharyngeal temperature of 34 degrees+/-0.2 degrees C and rectal temperature of 34.5 degrees to 35.0 degrees C for 72 hours. Rectal temperature was maintained at 36.0 degrees to 37.5 degrees C in the control group. Neurodevelopmental outcome was assessed at 18 months of age. The primary outcome was a combined end point of death and severe disability. RESULTS: One hundred ninety-four infants were available for analysis (100 and 94 infants in the selective head cooling and control group, respectively). For the selective head cooling and control groups, respectively, the combined outcome of death and severe disability was 31% and 49% (OR: 0.47; 95% CI: 0.26-0.84; P=.01), the mortality rate was 20% and 29% (OR:0.62; 95% CI: 0.32-1.20; P=.16), and the severe disability rate was 14% (11/80) and 28% (19/67) (OR: 0.40; 95% CI: 0.17-0.92; P=.01). CONCLUSIONS: Selective head cooling combined with mild systemic hypothermia for 72 hours may significantly decrease the combined outcome of severe disability and death, as well as severe disability.

[Measurement of brain regional oxygen saturation in neonates in China: a multicenter randomized clinical trial].

OBJECTIVES: To understand the value of measuring neonatal cerebral regional oxygen saturation (rSO2) using near infrared spectroscopy (NIRS) in assessing cerebral oxygenation, to establish the normal range of neonatal cerebral rSO2 and to collect data of the changes of cerebral rSO2 under certain disease status. METHODS: Nine large hospitals participated in the multicenter randomized clinical trial from Jan 2007 to Apr 2008. Using the NIRS human tissue oximeter (TSAH-100) independently developed in China, the cerebral rSO2 of 223 normal full-term and 95 otherwise healthy preterm neonates without any special disease, was detected at 1, 2 and 3 days after birth, respectively. The cerebral rSO2 of 102 neonates with diseases which may affect the cerebral oxygenation, was also detected during the severe phases. The pulse oxygen saturation (SpO2) measured at the finger tip, and also the arterial oxygen saturation (SaO2) measured by blood gas analysis, which could indicate the oxygen supply of the whole body, were obtained simultaneously. The correlations among cerebral rSO2, pulse SpO2 and arterial SaO2 were analyzed. RESULTS: (1) The cerebral rSO2 of the normal full-term neonates was (62+/-2)%. Cerebral hypoxia was defined as rSO2 lower than 58%. The cerebral rSO2 of the normal full-terms was steady at 1, 2 and 3 days after birth respectively, without any significant differences among them (F=0.610, P>0.05). The cerebral rSO2 of the neonates with diseases was (55+/-7)%, which was significantly lower than that of the normal full-term neonates (t=15.492, P<0.05). (2) The cerebral rSO2 was positively correlated with the SpO2 (r=0.74, P<0.01) and the SaO2 (r=0.71, P<0.01). (3) Under some special diseases, the changes of cerebral rSO2 was asynchronous with those of the SpO2: (1) For 18 cases under severe cerebral damages or under relatively low hemoglobin concentration, the cerebral rSO2 was significantly low (50%-58%), but the SpO2 was still normal (above 90%). (2) During the recovery of some critically ill neonates, the increase of cerebral rSO2 was lagged as compared with that of pulse SpO2. Especially, during the severe phases of 6 cases with multi-organ failure, the SpO2 and the cerebral rSO2 were both significantly low (55%-80% for SpO2, and 44%-50% for cerebral rSO2); when the diseases were alleviated, although the SpO2 recovered to above 85%, the cerebral rSO2 was still significantly low (around 50%). (3) In 3 cases, during the severe phases of serious hypoxic-ischemic encephalopathy (HIE), the cerebral rSO2 significantly increased to 70%-72%, which was significantly higher than the normal value (62%). CONCLUSIONS: The range of cerebral rSO2 of the normal full-term neonates was (62+/-2)%. Cerebral oxygenation can be externally indicated by the rSO2 noninvasively and continuously measured by NIRS, which was positively correlated with traditional pulse SpO2 and arterial SaO2. In some special diseases, the rSO2 measured by NIRS can be helpful for clinical diagnoses and treatments.

3D ultrasound in assessment of growth and development of frontal lobes in children with perinatal brain injury.

To investigate the functions of cranial 3D ultrasound in the assessment of growth and development of the volume of frontal lobes in children with perinatal brain injury, 226 neonates of different gestational ages and 86 full term with perinatal brain injury were selected as subjects. The volume of frontal lobe of neonate increased with gestational age within 7 days after birth (r=0.676, P<0.05). The volume of frontal lobe in the 33 children with serious brain injury was lower than that in the control group at 1 month and the difference was significant at 3 and 6 months (P<0.01). There was a correlation between the long-term nervous system dysplasia and the slow increase of frontal lobe volume. The volume of frontal lobe increases with gestational age. The brain injury during the perinatal period affects the development of frontal lobe and is related with neural dysplasia. 3D ultrasound is useful for evaluating the normal and abnormal brain development.

[Comparison of the models of acute hypoxia and hypoxic-ischemia in newborn piglets].

OBJECTIVE: To compare the newborn piglet models of hypoxic ischemic brain damage in hypoxia and hypoxia combined with occlusion of both carotid arteries. METHODS: Twenty four 7-day-old piglets were divided into two groups. Group H: mechanical ventilation with low concentration of oxygen, Group HI: mechanical ventilation with low concentration of oxygen combined with occlusion of both carotid arteries. The piglets were inhaled with 10%, 8%, and 6% low-concentration oxygen for 30 min, and grouped into mild, moderate, and severe hypoxia ones. The changes of physiological parameter, cerebral blood flow and cerebral oxygen perfusion were detected. RESULTS: There were no significant differences in blood gas analysis of oxygen saturation, blood lactic acid and pH between the two groups(P>0.05).The mean arterial pressure of severe hypoxia in HI was significantly lower than in H (P<0.05). The cerebral blood flow in H and HI was relatively stable after different degrees of hypoxia. As compared with the cerebral blood flow perfusion in group H and HI, there were no significant differences between them(P>0.05). The cerebral oxygen perfusion in H and HI was significantly descent after different degrees of hypoxia(P<0.05). As compared with the cerebral oxygen perfusion in groups H and HI, there were no significant differences between them. CONCLUSION: H and HI have the same effect on physiological parameter, cerebral volume and cerebral oxygen perfusion of newborn piglets. The mechanical ventilation with low concentration of oxygen to newborn piglets can develop the HIBD model, it is not necessary to occlude carotid arteries.

Neurodevelopment in newborns: a sample entropy analysis of electroencephalogram.

The present paper investigates the neural ontogeny of newborns in view of electroencephalogram (EEG) complexity during active sleep (AS) and quiet sleep (QS). Sample entropy (SampEn) is applied to EEG recordings from 168 newborns with postmenstrual age (PMA) ranging from 25 to 60 weeks. The relationship between neurodevelopment and PMA is then explored according to the statistical analysis of the median and interquartile range of SampEn curves. It is found that SampEn of EEG during AS is higher than that during QS. SampEn increases during both AS and QS before about 42 weeks in PMA while it ceases its increase in QS and even decreases in AS after newborns reaching term age. A distinct decrease in the interquartile range of SampEn is found with increasing PMA (from 25 to about 50 weeks), followed by maintenance of low fluctuation in SampEn curves. The study in this paper sets the stage for exhaustive investigation of the SampEn of EEG during brain maturation in newborns. And it could be hoped that SampEn in sleep EEG might be a useful parameter against which delays and aberrations in brain maturation might be tested. The SampEn changes during brain maturation also offer functional clues about neurodevelopment, based on which further explorations could be done. The significance of this paper is the discovery of the decrease in EEG complexity after newborns reaching term. Although some potential neurophysiologic reasons are given, this new discovery might require more study to investigate. In addition, the fluctuation of EEG complexity is analyzed for the first time, which helps to understand the EEG maturation in neurodevelopment.

[Multicenter follow-up report of 147 premature infants with brain injuries from 6 hospitals in China].

OBJECTIVE: Sponsored by the Subspecialty Group of Neonatology of Pediatric Society, China Medical Association, more than 10 large-scale hospitals participated in the near two-year multicenter investigation for Brain Injuries in Premature Infants in China. The present study presents the follow-up results of 147 premature infants with brain injuries from 6 Third Class A Level hospitals. METHODS: All premature infants with intraventricular hemorrhage (IVH) or periventricular leukomalacia (PVL) diagnosed in the early neonatal period in the 6 hospitals were followed-up between January 2005 and August 2006. Based on the synthetic results of physical development, examination of nervous system, intelligence tests and cranial ultrasound, the premature infants with brain injuries were classified as normal development, marginal development and retarded development. RESULTS: One hundred and forty-seven premature infants with brain injuries from the 6 hospitals consisted of 141 cases of IVH and 36 cases of PVL (30 cases having IVH and PVL). Based on the synthetic follow-up results, 51.4% of premature infants with brain injuries were generally assessed as normal development, 38.4% as marginal development and 10.7% as retarded development. Among them, delayed growth in head circumference, height and weight was 13.4%; the occurrence frequency of cerebral paralysis (CP) was 7.1% in PVL grade I, 28.6% in PVL grade II and 100% in PVL grade III; 12.7% showed retarded development of intelligence; and 30% presented post-injurious changes on cranial sonography. CONCLUSIONS: The data of the multicenter follow-up can basically reflect the short-term prognosis of premature infants with brain injuries in major big cities of China. About 10% of them have retarded physical, motor-and mental developments. The long-term regular follow-up study is expected for more premature infants with brain injuries, and behavioral sequelae of brain injuries which may occur in peri-school age and adolescence should be paid particularly close attention.

[Effect of hyperbaric oxygenation on the differentiation of implanted human neural stem cells into neurons in vivo].

OBJECTIVE: To study the effect of hyperbaric oxygenation (HBO) on the differentiation of the implanted human neural stem cells (hNSCs) into neurons in neonatal rats following hypoxic-ischemic brain damage (HIBD). METHODS: HIBD model was prepared by ligation of the left common carotid artery, followed by 8% hypoxia exposure in 7-day-old Sprague-Dawley rat pups. Three days later, the rats received implantation of hNSCs into the left cerebral ventricles. Then the survived rats were randomly divided into two groups: transplantation alone and transplantation+HBO (n=8 each). HBO treatment was administered (1.8 ATA, 1 hr once daily for 10 days) in the transplantation+HBO group 1 hr after hNSCs transplantation. Brains were removed 10 days after transplantation. Frozen coronal sections were prepared for immunofluorescence analysis to detect the neural differentiation of the transplanted cells in the cerebral cortex and hippocampus. RESULTS: Differentiated neurons of implanted cells distributed mainly in the cortex and the hippocampus of the injured side. There was no difference in the number of neurons in the cortex between the two groups, while the number of neurons in the hippocampus significantly increased in the transplantation+HBO group compared with that in the transplantation alone group (231.4+15.1 vs 162.6+5.6; P<0.05). CONCLUSIONS: HBO treatment may promote the differentiation of implanted hNSCs into neurons in the hippocampus of neonatal rats following HIBD.

[Detecting cerebral hypoxia-ischemia of newborn piglets using spatially-resolved near-infrared spectroscopy].

As a non-invasive technique for measuring tissue oxygenation, near-infrared spectroscopy (NIRS) has increasing applications in detecting cerebral hypoxia-ischemia. The authors, introduced the basic principle of the NIRS oximeter developed independently by our group (TSAH-100). The authors achieved the optimal coupling between the probe and the detected cerebral tissue. The present study investigated different regional oxygen saturations of brain (rSO2) measured non-invasively by NIRS, arterial blood oxygen saturation (SaO2) measured invasively by blood gas analysis and physiological parameters in newborn pigs with different hypoxia, in order to prove if the non-invasively cerebral rSO2 can indicate cerebral oxygenation status in clinical practice. Using this oximeter, cerebral rSO2 of 28 newborn piglets under different oxygenation status was detected. After mechanical ventilation and inhalation of 8%-17% oxygen for 30 min in the newborn pigs, the pigs were grouped according to the inhalation of oxygen. With the inhalation of 13%-17% oxygen was mild hypoxia group, with 10%-13% was moderate hypoxia group, and with 8%-10% was severe hypoxia group. There were 4 animals in mild hypoxia group, 8 animals in moderate hypoxia group, 12 animals in severe hypoxia group and 4 animals were in the normal control group. The physiological parameters were monitored during the experiment. The SaO2 were invasively measured by blood gas analysis after the experiment. The results indicate that both rSO2 and SaO2 decreased after different degree of hypoxia and there was a good correlation between cerebral rSO2 non-invasively measured by NIRS and SaO2 invasively measured by blood gas analysis (p<0.001). Cerebral rSO2 was also consistent with the degree of hypoxia and the changes in physiological parameters after hypoxia. The arterial pH and the mean arterial pressure (MAP) in the severe hypoxia group was lower than that in the control group (p<0.05). The blood lactic acid in the severe hypoxia group was higher than that in the control group (p<0.05). Thus, the rSO2 can accurately and directly indicate cerebral oxygenation status and can also replace the SaO2 invasively measured by blood gas analysis. Cerebral hypoxia-ischemia can be non-invasively and conveniently diagnosed using NIRS.