No neurodevelopmental benefit of cerebral oximetry in the first randomised trial (SafeBoosC II) in preterm infants during the first days of life

Aim: Cerebral hypoxia has been associated with neurodevelopmental impairment. We studied whether reducing cerebral hypoxia in extremely preterm infants during the first 72 hours of life affected neurological outcomes at two years of corrected age. Methods: In 2012‐2013, the phase II randomised Safeguarding the Brains of our smallest Children trial compared visible cerebral near‐infrared spectroscopy (NIRS) monitoring in an intervention group and blinded NIRS monitoring in a control group. Cerebral hy oxia was significantly reduced in the intervention group. We followed up 115 survivors from eight European centres at two years of corrected age, by conducting a medical examination and assessing their neurodevelopment with the Bayley Scales of Infant and Toddler Development, Second or Third Edition, and the parental Ages and Stages Questionnaire (ASQ). Results: There were no differences between the intervention (n = 65) and control (n = 50) groups with regard to the mean mental developmental index (89.6 ± 19.5 versus 88.4 ± 14.7, p = 0.77), ASQ score (215 ± 58 versus 213 ± 58, p = 0.88) and the number of children with moderate‐to‐severe neurodevelopmental impairment (10 versus six, p = 0.58). Conclusions: Cerebral NIRS monitoring was not associated with long‐term benefits or harm with regard to neurodevelopmental outcome at two years of corrected age

Randomized controlled trial of early arachidonic acid and docosahexaenoic acid enteral supplementation in very preterm infants

[Objective]: To evaluate changes in blood long-chain polyunsaturated fatty acid (LCPUFA) and oxylipin concentrations in very preterm infants from birth to 36 weeks’ postmenstrual age (WPA) after providing an emulsified arachidonic acid (ARA):docosahexaenoic acid (DHA) supplement at two different concentrations.[Study design]: This prospective, randomized trial assigned infants to receive a supplement (1) 80:40 group (80 mg/kg/day ARA and 40 mg/kg/day DHA, n = 9) or (2) 120:60 group (120 mg/kg/day ARA and 60 mg/kg/day DHA, n = 9). Infants received supplement daily from birth until 36 WPA. At baseline, 21 days of life and 36 WPA, the LCPUFAs were measured in plasma by gas chromatography/mass spectrophotometry. Additionally, LCPUFAs and oxylipins were analyzed in whole blood by ultra-high-performance liquid chromatography-tandem mass spectrometry. Furthermore, a sample of oral mucosa was obtained to analyze single-nucleotide polymorphism located in the FADS1 gene by PCR.[Results]: Gestational age was similar between groups (80:40 = 28+6 [27+3; 30+3] completed weeks+days; 120:60 = 29+6 [27+3; 30+5] completed weeks+days, p = 0.83). At 36 WPA, the change in plasma ARA was significantly different between groups (80:40 group = 0.15 [−0.67; 0.69] %nmol, 120:60 = 1.68 [1.38; 3.16] %nmol, p = 0.031). In whole blood, the levels of ARA-derived oxylipins (5-, 8-, 9-, 11-, 15-HETE and 8,9-EET) and EPA-derived oxylipins (18-HEPE) significantly increase from baseline to 36 WPA in the 120:60 group than the 80:40 group.[Conclusion]: Supplementation at high doses (120:60 mg/kg/day) increased levels of ARA, and EPA- and ARA-derived oxylipins compared to low doses (80:40 mg/kg/day). Differences were detected in EPA metabolites without a significant increase in plasma DHA.This article was supported by the 20th National Grants for Research in Life Sciences 2021/2021 from Ramón Areces Foundation (Spain), the European Society for Pediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) networking grant 2021, and Spanish Programs for the generation of Knowledge and Scientific and Technological strengthening of the system and oriented to the challenges of Society (PID2020-119084RB-C21 and PID2020-114821RB-I00 funded by MCIN/AEI/10.13039/501100011033) from the Ministry of Science and Innovation (Spain).Peer reviewe

Evaluación de la función cerebral mediante electroencefalografía integrada por amplitud en el niño prematuro ≤ de 28 semanas de edad gestacional: parámetros de normalidad y biomarcadores de lesión cerebral y neurodesarrollo

Tesis Doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Pediatría. Fecha de Lectura: 08-02-2022Esta tesis tiene embargado el acceso al texto completo hasta el 08-08-202

Oceanic lobate ctenophores possess feeding mechanics similar to the impactful coastal species Mnemiopsis leidyi

Lobate ctenophores are often numerically dominant members of oceanic epipelagic and midwater ecosystems. Despite this, little is known about their trophic ecology. Multiple, co-occurring species are often found in these ecosystems and appear to feed similarly via feeding currents that entrain prey. We quantified the hydrodynamics, morphology, and behavior of four co-occurring, cosmopolitan lobate species (Eurhamphaea vexilligera, Ocyropsis crystallina, Bolinopsis vitrea, and Leucothea multicornis) to evaluate whether their feeding mechanics lead to differential feeding rates and prey selection. We compared the feeding characteristics of these four oceanic species to the coastal lobate ctenophore, Mnemiopsis leidyi, which is known as a voracious zooplanktivore. We found that despite their morphological diversity, the five lobate species used the same mechanism to generate their feeding current—the hydrodynamics of their feeding currents were similarly laminar and with very low fluid deformation rates. Despite having similar feeding current traits, the species had different in situ swimming behaviors and feeding postures. We show that these different behaviors and postures lead to different prey encounter rates and that several of the oceanic species have the potential to feed at rates similar to or greater than M. leidyi. As such, the individual and combined trophic impact of oceanic lobate ctenophores is likely to be much greater than previously predicted

Risk factors for EEG seizures in neonates treated with hypothermia: a multicenter cohort study.

OBJECTIVE: To assess the risk factors for electrographic seizures among neonates treated with therapeutic hypothermia for hypoxic-ischemic encephalopathy (HIE). METHODS: Three-center observational cohort study of 90 term neonates treated with hypothermia, monitored with continuous video-EEG (cEEG) within the first day of life (median age at onset of recording 9.5 hours, interquartile range 6.3-14.5), and continued for >24 hours (total recording 93.3 hours, interquartile range 80.1-112.8 among survivors). A pediatric electroencephalographer at each site reviewed cEEGs for electrographic seizures and initial EEG background category. RESULTS: A total of 43 (48%) had electrographic seizures, including 9 (10%) with electrographic status epilepticus. Abnormal initial EEG background classification (excessively discontinuous, depressed and undifferentiated, burst suppression, or extremely low voltage), but not clinical variables (including pH <6.8, base excess ≤-20, or 10-minute Apgar ≤ 3), was strongly associated with seizures. CONCLUSIONS: Electrographic seizures are common among neonates with HIE undergoing hypothermia and are difficult to predict based on clinical features. These results justify the recommendation for cEEG monitoring in neonates treated with hypothermia

Risk factors for EEG seizures in neonates treated with hypothermia: a multicenter cohort study.

To assess the risk factors for electrographic seizures among neonates treated with therapeutic hypothermia for hypoxic-ischemic encephalopathy (HIE).Three-center observational cohort study of 90 term neonates treated with hypothermia, monitored with continuous video-EEG (cEEG) within the first day of life (median age at onset of recording 9.5 hours, interquartile range 6.3-14.5), and continued for >24 hours (total recording 93.3 hours, interquartile range 80.1-112.8 among survivors). A pediatric electroencephalographer at each site reviewed cEEGs for electrographic seizures and initial EEG background category.A total of 43 (48%) had electrographic seizures, including 9 (10%) with electrographic status epilepticus. Abnormal initial EEG background classification (excessively discontinuous, depressed and undifferentiated, burst suppression, or extremely low voltage), but not clinical variables (including pH <6.8, base excess ≤-20, or 10-minute Apgar ≤ 3), was strongly associated with seizures.Electrographic seizures are common among neonates with HIE undergoing hypothermia and are difficult to predict based on clinical features. These results justify the recommendation for cEEG monitoring in neonates treated with hypothermia

Risk factors for EEG seizures in neonates treated with hypothermia: a multicenter cohort study.

ObjectiveTo assess the risk factors for electrographic seizures among neonates treated with therapeutic hypothermia for hypoxic-ischemic encephalopathy (HIE).MethodsThree-center observational cohort study of 90 term neonates treated with hypothermia, monitored with continuous video-EEG (cEEG) within the first day of life (median age at onset of recording 9.5 hours, interquartile range 6.3-14.5), and continued for >24 hours (total recording 93.3 hours, interquartile range 80.1-112.8 among survivors). A pediatric electroencephalographer at each site reviewed cEEGs for electrographic seizures and initial EEG background category.ResultsA total of 43 (48%) had electrographic seizures, including 9 (10%) with electrographic status epilepticus. Abnormal initial EEG background classification (excessively discontinuous, depressed and undifferentiated, burst suppression, or extremely low voltage), but not clinical variables (including pH <6.8, base excess ≤-20, or 10-minute Apgar ≤ 3), was strongly associated with seizures.ConclusionsElectrographic seizures are common among neonates with HIE undergoing hypothermia and are difficult to predict based on clinical features. These results justify the recommendation for cEEG monitoring in neonates treated with hypothermia

Evaluation of Dry Sensors for Neonatal EEG Recordings.

INTRODUCTION: Neonatal seizures are a common neurologic diagnosis in Neonatal Intensive Care Units (NICUs), occurring in approximately 14,000 newborns annually in the US. While the only reliable means of detecting and treating neonatal seizures is with an EEG recording, many neonates do not get an EEG or experience delays in getting them. Barriers to obtaining neonatal EEGs include: 1) lack of skilled EEG technologists to apply conventional wet electrodes to delicate neonatal skin, 2) poor signal quality due to improper skin preparation and artifact, 3) extensive time needed to apply electrodes. Dry sensors have the potential to overcome these obstacles but have not been previously evaluated on neonates. METHODS: Sequential and simultaneous recordings with wet and dry sensors were performed for one hour on 27 neonates from 35-42.5 weeks postmenstrual age. Recordings were analyzed for correlation and amplitude, and were reviewed by neurophysiologists. Performance of dry sensors on simulated vernix was examined. RESULTS: Analysis of dry and wet signals showed good time-domain correlation (reaching >0.8) given the non-superimposed sensor positions, and similar power spectral density curves. Neurophysiologist reviews showed no statistically significant difference between dry and wet data on most clinically-relevant EEG background and seizure patterns. There was no skin injury after 1 hr of dry sensor recordings. In contrast to wet electrodes, impedance and electrical artifact of dry sensors were largely unaffected by simulated vernix. CONCLUSIONS: Dry sensors evaluated in this study have the potential to provide high-quality, timely EEG recordings on neonates with less risk of skin injury