Seizure detection in the neonatal EEG with synchronization likelihood

OBJECTIVE: To investigate whether epileptic seizure activity can be distinguished from non-epileptic background activity in the neonatal electroenceplalogram (EEG), using synchronization likelihood as a measure of synchronization between EEG channels. METHODS: Forty-two 21s EEG epochs and two complete EEGs from 21 different neonatal patients in a 12-channel bipolar recording were studied (AD-conversion 16bit; sample frequency 200Hz; filter setting 0.5-30Hz). For EEG of each patient, we selected one epoch with epileptic discharges and one without. Synchronization was calculated in all epochs. In two complete EEGs, synchronization was calculated and correlated with a visual scoring of the EEG. RESULTS: Synchronization likelihood was higher in all the epochs with epileptic seizures as compared to the epochs without epileptic activity (P<0.01). When synchronization likelihood exceeded 0.11, the sensitivity for the presence of epileptic activity was 0.85 (95% confidence limits [CL(95)]=0.69-1) and the specificity was 0.75 (CL(95)=0.56-0.94).Analysis of EEG score and synchronization likelihood of two complete EEGs revealed a high correlation between the occurrence of epileptic seizures and elevated synchronization likelihood (Spearman r=0.707, P<0.001). CONCLUSIONS: The results of this study demonstrate that synchronization likelihood is a potential tool in the automatic monitoring of high-risk infants for epileptic activity on neonatal wards

Glutamine-enriched enteral nutrition in very low-birth-weight infants

Objective: To determine the effect of glutamine-enriched enteral nutrition in very low- birth- weight infants on the incidence of allergic and infectious diseases during the first year of life. Design: Follow- up study. Setting: Tertiary care hospital. Participants: All surviving infants who participated in a trial of glutamine- enriched enteral nutrition in very low-birth-weight infants. Intervention: Enteral glutamine supplementation ( L- glutamine, 0.3 g/ kg per day) from 3 through 30 days of life. Main Outcome Measures: The incidence of allergic and infectious diseases during the first year of life, as assessed by means of validated questionnaires. Results: Seventy- seven of 90 infants ( 86%) participated in the follow- up study. Baseline patient, maternal, and environmental characteristics did not differ between the glutamine- supplemented ( n= 37) and control ( n= 40) groups, except for the incidence of serious neonatal infections and child care attendance. After adjustment for confounding factors, the risk for atopic dermatitis was lower in the glutamine- supplemented group ( odds ratio [ OR], 0.13; 95% confidence interval [ CI], 0.020.97). However, the incidence of bronchial hyperreactivity ( OR, 0.34; 95% CI, 0.10- 1.21) and infections of the upper respiratory ( OR, 0.99; 95% CI, 0.35- 2.79), lower respiratory ( OR, 0.39; 95% CI, 0.13- 1.24), and gastrointestinal ( OR 1.25, 95% CI 0.23- 6.86) tracts was not different between the treatment groups. Conclusions: Glutamine- enriched enteral nutrition in very low- birth- weight infants decreased the incidence of atopic dermatitis during the first year of life but had no effect on the incidence of bronchial hyperreactivity and infectious diseases during the first year of lif

Echocardiographic assessment of preload conditions does not help at the neonatal intensive care unit

To determine the value of noninvasive assessment of right ventricular preload in neonates, a prospective unblinded study was performed. Thirty-seven neonates without heart disease (median birth weight 1390 g, range 900 to 4400) were studied at the neonatal intensive care unit, comparing directly measured central venous pressure (CVP) and two-dimensional echocardiographic measurement of the maximum and minimum diameter of the inferior vena cava and calculated vena cava. index (VCI). CVP was higher in conventionally ventilated and high-frequency oscillatory ventilated neonates than in those breathing spontaneously (p <0.0001). VCI in high-frequency oscillatory ventilated patients was lower (5 +/- 4) than in spontaneously breathing (56 +/- 19) and conventionally ventilated (49 +/- 19) (p = 0.002) neonates. CVP and VCI were inversely correlated in spontaneously breathing (r = -0.631), but not in conventionally and high-frequency oscillatory ventilated patients. VCI does not predict CVP in ventilated premature neonates, the correlation is limited only to spontaneously breathing infant

Nutritional factors influencing infections in preterm infants

In contrast with clinical studies in term infants or older children, it is very difficult to investigate possible immunoregulatory effects of a novel infant formula composition in preterm infants. This is mainly because of the multicausal origin of infections in this high-risk population that is usually admitted to the neonatal intensive care unit. Possible effects of nutrition composition on onset and incidence of nosocomial infections in these very small infants have to be compared with infections that may have originated in utero. The development of the gastrointestinal tract may be inhibited after severe intrauterine growth retardation, leading to functional impairment of the gut shortly after birth. This may be related to the onset of necrotizing enterocolitis of the newborn. However, this disease in very small preterm infants is possibly also related to the initiation of oral feeding and/or the amount of feeding. Specific infection risks of neonatal intensive care as a result of invasive techniques such as artificial ventilation or total parenteral nutrition using indwellirg umbilical and/or Silastic lines and so-called "all-in-one'' mixtures may influence the incidence of infections. Widespread use of intravenous antibiotics in the neonatal intensive care unit may create an even larger infection risk. Investigation of possible immunomodulatory effects of factors such as prebiotics and probiotics added to the nutrition of preterm infants should always be considered along with other nutritional factors known to influence the immature immune syste

Glutamine-enriched enteral nutrition in very-low-birth-weight infants and effects on feeding tolerance and infectious morbidity: a randomized controlled trial

Background: Glutamine depletion has negative effects on the functional integrity of the gut and leads to immunosuppression. Very-low-birth-weight (VLBW) infants are susceptible to glutamine depletion because nutrition is limited in the first weeks of life. Objective: The objective was to determine the effect of glutamine-enriched enteral nutrition on feeding tolerance, infectious morbidity, and short-term outcome in VLBW infants. Design: In a double-blind randomized controlled trial, VLBW infants (gestational age = 1 serious infection compared with 38 of 50 (76%) in the control group (odds ratio: 0.32; 95% CI: 0.14, 0.74; P = 0.008). Other variables of feeding tolerance and short-term outcome were not significantly different between groups. Conclusions: Glutamine-enriched enteral nutrition did not improve feeding tolerance or short-term outcome in VLBW infants. However, infectious morbidity was significantly lowered in infants who received glutamine-enriched enteral nutritio

The intestinal bacterial colonisation in preterm infants: A review of the literature

The aim of this study is to review the normal development of the intestinal microflora of preterm infants and the factors influencing its development. Preterm infants have an increased intestinal permeability, which may lead to bacterial. translocation to systemic organs and tissues. In combination with immaturity of the immune system the risk to systemic infections might be increased. Especially potential pathogenic bacteria are able to translocate. The intestinal microflora of breast-fed term infants, dominated by bifidobacteria and lactobacilli, is thought to suppress the growth of potentially pathogenic bacteria. Many attempts have been made to stimulate the presence of bifidobacteria and lactobacilli with changes in the diet and ingredients-like prebiotics and probiotics. After selection, six studies were included reviewing the intestinal bacterial colonisation of preterm infants. In general, these studies show that the intestinal bacterial colonisation with beneficial bacteria is delayed in preterm infants. The number of potentially pathogenic bacteria is high. Antibiotics influence the intestinal colonisation. Many preterm infants receive prophylactic antibiotics at birth. As antibiotics delay the normal intestinal colonisation, caution should be given to the treatment with broadspectrum antibiotics in preterm infants at birth and every attempt has to be made to restrict the period of treatment. (C) 2006 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserve

The effect of enteral supplementation of a prebiotic mixture of non-human milk galacto-, fructo- and acidic oligosaccharides on intestinal permeability in preterm infants

Preterm infants have an impaired gut barrier function. We aimed to determine the effects of enteral supplementation of a prebiotic mixture consisting of neutral oligosaccharides (short-chain galacto-oligosaccharides ((SC)GOS)/long-chain fructo-oligosaccharides (LCFOS)) and acidic oligosaccharides (AOS) on intestinal permeability of preterm infants as measured by the sugar absorption test in the first week of life. Furthermore, we determined host-and treatment-related factors associated with intestinal permeability. In a randomised controlled trial, preterm infants with a gestational ag

Mannose-binding lectin in term newborns and their mothers: genotypic and phenotypic relationship

Functional mannose-binding lectin (f-MBL) plays an important role in the innate neonatal immune system. We studied the origin of f-MBL in umbilical cord blood (UCB) by measuring maternal MBL (n=47), collected before elective cesarean section, and neonatal MBL (n=43) in arterial umbilical cord blood. In a subgroup, arterial and venous UCB MBL levels were measured. In addition, MBL expression was correlated with genetic mutations. The f-MBL levels in term infants were lower than in their mothers (0.70 microg/ml vs 1.11 microg/ml, p <0.01) and maternal and neonatal MBL levels were only weakly correlated (R=0.32, p <0.001), which suggests a fetal origin of f-MBL. Arterial and venous UCB median MBL levels did not differ (0.98 microg/ml vs. 1.40 microg/ml, p=0.20). No homozygous mutations were found. MBL was lower in mothers and infants with a (compound) heterozygous mutation than in those with a wild type. One new (HYPB) and two rare haplotypes (HXPA, LYPD) were reported in our population. Levels of MBL differed depending on the genotype of the mother or the infant. Because the role of MBL in host defense is still unclear, both f-MBL and haplotype should be measured to determine the clinical implications of MBL deficiency in infant