Usefulness of Parent-Completed ASQ for Neurodevelopmental Screening of Preterm Children at Five Years of Age.

International audienceINTRODUCTION: Preterm children are at greater risk of developmental impairment and require close follow-up for early and optimal medical care. Our goal was to examine use of the parent-completed Ages and Stages Questionnaire (ASQ) as a screening tool for neurodevelopmental disabilities in preterm infants at five years of age.PATIENTS AND METHODS: A total of 648 preterm children (285 were not distinctive for mild delay or normal development. In children with developmental delay, no difference was found when ASQ scores according to maternal education levels were analyzed.CONCLUSIONS: ASQ at five years is a simple and cost-effective tool that can detect severe developmental delay in preterm children regardless of maternal education level, while its capacity to identify children with mild delay appears to be more limited

Parent-Completed Developmental Screening in Premature Children: A Valid Tool for Follow-Up Programs

Our goals were to (1) validate the parental Ages and Stages Questionnaires (ASQ) as a screening tool for psychomotor development among a cohort of ex-premature infants reaching 2 years, and (2) analyse the influence of parental socio-economic status and maternal education on the efficacy of the questionnaire. A regional population of 703 very preterm infants (<35 weeks gestational age) born between 2003 and 2006 were evaluated at 2 years by their parents who completed the ASQ, by a pediatric clinical examination, and by the revised Brunet Lezine psychometric test with establishment of a DQ score. Detailed information regarding parental socio-economic status was available for 419 infants. At 2 years corrected age, 630 infants (89.6%) had an optimal neuromotor examination. Overall ASQ scores for predicting a DQ score ≤85 produced an area under the receiver operator curve value of 0.85 (95% Confidence Interval:0.82–0.87). An ASQ cut-off score of ≤220 had optimal discriminatory power for identifying a DQ score ≤85 with a sensitivity of 0.85 (95%CI:0.75–0.91), a specificity of 0.72 (95%CI:0.69–0.75), a positive likelihood ratio of 3, and a negative likelihood ratio of 0.21. The median value for ASQ was not significantly associated with socio-economic level or maternal education. ASQ is an easy and reliable tool regardless of the socio-economic status of the family to predict normal neurologic outcome in ex-premature infants at 2 years of age. ASQ may be beneficial with a low-cost impact to some follow-up programs, and helps to establish a genuine sense of parental involvement

Continuous EEG monitoring in children in the intensive care unit (ICU)

International audiencePediatric EEG in the intensive care unit (ICU) requires specific technical requirements in order to yield relevant data depending upon clinical scenario: diagnosis of electroclinical or subclinical seizures, their quantification before and after therapeutic changes and sometimes evaluation of severity of cortical dysfunction. The urgent nature of these indications implies the rapid set-up of the EEG system by qualified staff and possibility of maintaining the electrodes in place during long periods of time. Various techniques are available today for EEG monitoring, the interpretation of which depends on the contribution of an experienced physician. Among recent techniques, those most commonly used are trend curves obtained via signal analysis such as amplitude EEG (a-EEG) and density spectral array (DSA) or compressed spectral array (CSA). Trend curves enable the digital creation of a display graph containing several hours of transformed and compressed EEG recorded data. Visualized on one sole display graph, these trend curves can facilitate the identification of very slow changes in EEG background activity and their variation (alertness cycles, changes linked to treatment administrations) as well as seizure patterns and their quantification. In this chapter, we propose a brief overview of monitoring techniques, followed by a review of the various data yielded by EEG monitoring as well as the relevance of this type of management; finally, detailed clinical indications will be discussed after thorough analysis of the literature.Copyright © 2015. Published by Elsevier SAS

Etude de la discontinuité de l électroencéphalogramme du nouveau-né prématuré

L EEG fait partie des examens complémentaires utilisés pour le dépistage des lésions cérébrales des nouveau-nés prématurés. La naissance avant terme expose à un risque de séquelles neurosensorielles. Les lésions cérébrales sont souvent asymptomatiques en période néonatale. L EEG du nouveau-né prématuré est physiologiquement discontinu, constitué de bouffées d activité séparées par des intervalles interbouffées. Une augmentation de la durée des intervalles interbouffées est un marqueur d atteinte cérébrale sévère indiquant un risque élevé de séquelles neurologiques. Nous avons étudié le nombre et la durée des bouffées et des intervalles interbouffées chez des nouveau-nés prématurés nés avant 33 semaines d aménorrhée et recherché des facteurs de variation. Nous avons montré que l administration d un morphinomométique de synthèse comme le sufentanil faisait varier de façon significative la discontinuité et pouvait interférer avec l interprétation des tracés. Nous avons ensuite développé un logiciel spécifiquement dédié à l analyse automatique de ces paramètres et démontré la validité de cette analyse par rapport à l analyse visuelle. L application de cette technique à des tracés considérés comme normaux après analyse visuelle a montré que la durée des intervalles interbouffées diminue avec l âge post menstruel, quelque soit l'âge gestationnel, et de façon indépendante de l'augmentation des bouffées d activité. Les bouffées et les intervalles interbouffées semblent générés par des mécanismes physiologiques différents. Les périodes de discontinuité devraient donc être considérées comme une forme immature d activité cérébrale dont l origine électrophysiologique reste à explorer.The EEG is currently used in neonatal care units to assess brain maturation. Premature birth exposes to an increased risk of neurological impairments. However, cerebral injuries remain clinically silent in the neonatal period. The use of EEG and ultrasound scan is mandatory to early diagnosis of brain lesion. The preterm EEG has the unique characteristic to be discontinuous, constituted of bursts alternating with interburst intervals. Increased discontinuity is a strong marker of cerebral injury and is well-correlated with further impairments. We studied factors that can influence the degree of discontinuity and the effect of a sedative drug (sufentanil) on number and duration of bursts and interburst intervals in preterm EEG. We showed that administration of Sufentanil significantly increased the discontinuity and could interfere with clinical analysis. Considering that these quantitative values were valuable parameters to assess brain maturation, we designed a specific tool for automatic analysis of discontinuity, meant to be a user-friendly help for neurophysiologist. Comparison of automatic and visual results showed a strong correlation. Automatic analysis of normal EEGs of preterm infants born before 33 weeks of gestation showed that the degree of discontinuity decreased as post menstrual age increased, without influence of gestational age at birth. Burst and interburst intervals varied following different pattern suggesting that they reflect independent mechanisms. Interburst intervals could be considered as an immature form of cerebral activity and not as periods of inactivity. Further studies are needed to elucidate electrophysiological basis of this activity.NANTES-BU Médecine pharmacie (441092101) / SudocPARIS-BIUP (751062107) / SudocSudocFranceF

Feasibility and validity of monitoring subarachnoid hemorrhage by a noninvasive MRI imaging perfusion technique: Pulsed Arterial Spin Labeling (PASL)

International audienceBACKGROUND AND PURPOSE: To evaluate the validity of pulsed arterial spin labeling (PASL) imaging with cerebral blood flow (CBF) quantification for monitoring subarachnoid hemorrhage (SAH); to describe changes in the perfusion signal in the absence of or following several classic complications.MATERIALS AND METHODS: Fifteen patients and 14 healthy volunteers were assigned to SAH and control populations, respectively. ASL imaging was performed three times: between Day 0 (D0, i.e., day of onset of SAH symptoms) and D3, between D7 and D9 and between D12 and D14. ASL points were classified as complicated (symptomatic vasospasm, intraparenchymal hematoma or severe intracranial hypertension) or uncomplicated. Perfusion and CBF maps were generated after automated processing. The inversion time (TI) was fixed at 1800 ms.RESULTS: CBF mean value of Day0-3 uncomplicated SAH patients (47 ± 11.7 mL/min/100g) was significantly higher than that of the volunteers (36.5 ± 7.6 mL/min/100g; P=0.014). In a case-by-case analysis, we observed a global or regional hypoperfusion pattern when SAH was complicated by vasospasm or severe intracranial hypertension, particularly at the junctional areas. Furthermore, we have faced major vascular artefacts, visible as serpiginous high signals and related to the retention of labeled protons in arteries concerning by angiographic vasospasm.CONCLUSION: PASL is an interesting perfusion technique to non-invasively highlight perfusion changes in complicated SAH and can provide a new element in the decision to perform urgent endovascular treatment. However, the increase in arterial transit time makes the Buxton quantification model inapplicable and leads to false high CBF values in the single-TI PASL technique.Copyright © 2015 Elsevier Masson SAS. All rights reserved

Automatic Detector of Abnormal EEG for Preterm Infants

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Fetal brain response to worsening acidosis: an experimental study in a fetal sheep model of umbilical cord occlusions

Abstract Perinatal anoxia remains an important public health problem as it can lead to hypoxic–ischaemic encephalopathy (HIE) and cause significant neonatal mortality and morbidity. The mechanisms of the fetal brain’s response to hypoxia are still unclear and current methods of in utero HIE prediction are not reliable. In this study, we directly analysed the brain response to hypoxia in fetal sheep using in utero EEG. Near-term fetal sheep were subjected to progressive hypoxia induced by repeated umbilical cord occlusions (UCO) at increasing frequency. EEG changes during and between UCO were analysed visually and quantitatively, and related with gasometric and haemodynamic data. EEG signal was suppressed during occlusions and progressively slowed between occlusions with the increasing severity of the occlusions. Per-occlusion EEG suppression correlated with per-occlusion bradycardia and increased blood pressure, whereas EEG slowing and amplitude decreases correlated with arterial hypotension and respiratory acidosis. The suppression of the EEG signal during cord occlusion, in parallel with cardiovascular adaptation could correspond to a rapid cerebral adaptation mechanism that may have a neuroprotective role. The progressive alteration of the signal with the severity of the occlusions would rather reflect the cerebral hypoperfusion due to the failure of the cardiovascular adaptation mechanisms

Is there an excess of left-handedness after neonatal stroke?

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