No abstract

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White matter microstructural changes can be detected with diffusion tensor imaging. It was hypothesized that diffusion parameters in the posterior limb of the internal capsule (PLIC) and corpus callosum (CC) bundles in preterm infants at term equivalent age (TEA) were associated with neurodevelopment at 2 y corrected age. In 67 preterm infants, fiber tracking was performed at TEA for the CC and both PLIC bundles. Volume, length, fractional anisotropy (FA), mean diffusivity, axial diffusivity, and radial diffusivity were determined for the three bundles. These parameters were assessed in relation to outcome on the Bayley Scales of Infant and Toddler Development III. In girls, volume and length of the CC bundle and right PLIC bundle volume were associated with cognition. In boys, volume, FA, mean and radial diffusivity, and length of the left PLIC were associated with fine motor scores. Correction for GA, birth weight, intraventricular hemorrhage, white matter injury, and maternal education did not change the results. Fiber tracking parameters in the PLIC and CC bundles in preterm infants at TEA revealed different associations with neurodevelopment between boys and girls. This study suggested that fiber tracking is a useful method to predict neurodevelopment in preterm infants. (Pediatr Res 70: 626-632, 2011)

Our study aimed at automated power spectral analysis of the EEG in preterm infants to identify changes of spectral measures with maturation. Weekly (10 -20 montage) 4-h EEG recordings were performed in 18 preterm infants with GA Ͻ32 wk and normal neurological follow-up at 2 y, resulting in 79 recordings studied from 27 ϩ4 to 36 ϩ3 wk of postmenstrual age (PMA, GA ϩ postnatal age). Automated spectral analysis was performed on 4-h EEG recordings. The frequency spectrum was divided in delta 1 (0.5-1 Hz), delta 2 (1-4 Hz), theta (4 -8 Hz), alpha (8 -13 Hz), and beta (13-30 Hz) band. Absolute and relative power of each frequency band and spectral edge frequency were calculated. Maturational changes in spectral measures were observed most clearly in the centrotemporal channels. With advancing PMA, absolute powers of delta 1 to 2 and theta decreased. With advancing PMA, relative power of delta 1 decreased and relative powers of alpha and beta increased, respectively. In conclusion, with maturation, spectral analysis of the EEG showed a significant shift from the lower to the higher frequencies. Computer analysis of EEG will allow an objective and reproducible analysis for long-term prognosis and/or stratification of clinical treatment. (Pediatr Res 70: 529-534, 2011) A dvances in the care of very preterm infants have led to an increased survival (1). However, a considerable number of these infants experience neurological deficits later in life, even in the absence of neuroimaging abnormalities (2,3). The exact etiology of these developmental deficits remains to be clarified, but it is suggested that medical, environmental, and iatrogenic conditions may interfere with white matter development of the vulnerable preterm brain (4). Therefore, brain function monitoring in preterm infants during their stay in the NICU may be valuable in detecting conditions that interfere with brain development (5). It is a challenge to develop effective monitoring and therapeutic strategies to protect the preterm brain.The EEG is regarded as the gold standard in the assessment of cerebral function. Assessing changes in EEG are useful in the prediction of long-term outcome (6). Although the acute and chronic EEG changes are mainly nonspecific regarding type of damage, they correlate with later neurological and cognitive function (7). In preterm infants developing white matter damage, acute EEG findings include decreased continuity, lower amplitude of background activity, and epileptic seizure activity (8). The chronic EEG changes associated with white matter injury and abnormal neurological development include delayed maturation and disorganized pattern with the presence of abundant positive Rolandic sharp waves (9,10). In addition, EEG patterns of preterm infants change with postmenstrual age (PMA) (11,12). In the very preterm infant, the EEG background activity is characterized by discontinuity, instability, and fragmentation (13). The greater the prematurity, the more marked are these EEG aspects. These characteristics make the ...

The observed increase in absolute spectral estimates in preterm fetuses was probably due to increased sympathetic and parasympathetic modulation and might be a sign of autonomic development. Further improvements in signal processing are needed before this new method of fetal monitoring can be introduced in clinical practice.

Preoperative templating is an important part of a THA. The ability to accurately determine magnification of the hip on the radiograph and apply identical magnification to the radiograph and template will improve accuracy of preoperative templating of THA. We designed a templating method using a new way of determining the hip magnification with a linear relationship between magnification of the hip and the reference object on top of the pubis symphysis; the relationship was determined on 50 radiographs. We then compared our method with two other templating methods: an analog method assuming an average hip magnification of 15% and a digital method determining the hip magnification with a one-to-one relationship between the reference object and the hip. All methods were reproducible. Uniform undersizing occurred when templating with the digital method based on the oneto-one relationship; the analog method best predicted the implanted prosthesis size, closely followed by our new digital templating method; the new method will be particularly applicable for preoperative THA when analog methods are replaced by digital methods.

AimAlarm fatigue is a well-recognized patient safety concern in intensive care settings. Decreased nurse responsiveness and slow response times to alarms are the potentially dangerous consequences of alarm fatigue. The aim of this study was to determine the factors that modulate nurse responsiveness to critical patient monitor and ventilator alarms in the context of a private room neonatal intensive care setting.MethodsThe study design comprised of both a questionnaire and video monitoring of nurse-responsiveness to critical alarms. The Likert scale questionnaire, comprising of 50 questions across thematic clusters (critical alarms, yellow alarms, perception, design, nursing action, and context) was administered to 56 nurses (90% response rate). Nearly 6000 critical alarms were recorded from 10 infants in approximately 2400 hours of video monitoring. Logistic regression was used to identify patient and alarm-level factors that modulate nurse-responsiveness to critical alarms, with a response being defined as a nurse entering the patient’s room within the 90s of the alarm being generated.ResultsBased on the questionnaire, the majority of nurses found critical alarms to be clinically relevant even though the alarms did not always mandate clinical action. Based on video observations, for a median of 34% (IQR, 20–52) of critical alarms, the nurse was already present in the room. For the remaining alarms, the response rate within 90s was 26%. The median response time was 55s (IQR, 37-70s). Desaturation alarms were the most prevalent and accounted for more than 50% of all alarms. The odds of responding to bradycardia alarms, compared to desaturation alarms, were 1.47 (95% CI = 1.21–1.78; <0.001) while that of responding to a ventilator alarm was lower at 0.35 (95% CI = 0.27–0.46; p <0.001). For every 20s increase in the duration of an alarm, the odds of responding to the alarm (within 90s) increased to 1.15 (95% CI = 1.1–1.2; p <0.001). The random effect per infant improved the fit of the model to the data with the response times being slower for infants suffering from chronic illnesses while being faster for infants who were clinically unstable.DiscussionEven though nurses respond to only a fraction of all critical alarms, they consider the vast majority of critical and yellow alarms as useful and relevant. When notified of a critical alarm, they seek waveform information and employ heuristics in determining whether or not to respond to the alarm.ConclusionAmongst other factors, the category and duration of critical alarms along with the clinical status of the patient determine nurse-responsiveness to alarms.

Background Advances in neonatal intensive care have not yet reduced the high incidence of neurodevelopmental disability among very-low-birth-weight (VLBW) infants. As neurological deficits are related to white-matter injury, early detection is important. Diffusion tensor imaging (DTI) could be an excellent tool for assessment of white-matter injury. Objective To provide DTI fractional anisotropy (FA) reference values for white-matter tracts of VLBW infants for clinical use. Materials and methods We retrospectively analysed DTI images of 28 VLBW infants (26-32 weeks gestational age) without evidence of white-matter abnormalities on conventional MRI sequences, and normal developmental outcome (assessed at age 1-3 years). For DTI an echoplanar sequence with diffusion gradient (b=1,000 s/mm 2 ) applied in 25 non-collinear directions was used. We measured FA and apparent diffusion coefficient (ADC) of different whitematter tracts in the first 4 days of life. Results A statistically significant correlation was found between gestational age and FA of the posterior limb of the internal capsule in VLBW infants (r=0.495, P<0.01). Conclusion Values of FA and ADC were measured in white-matter tracts of VLBW infants. FA of the pyramidal tracts measured in the first few days after birth is related to gestational age.