Abstract. Burst suppression (BS) is an electroencephalographic state associated with a profound inactivation of the brain. BS and pathological discontinuous electroencephalography (EEG) are often observed in term-age infants with neurological injury and can be indicative of a poor outcome and lifelong disability. Little is known about the neurophysiological mechanisms of BS or how the condition relates to the functional state of the neonatal brain. We used simultaneous EEG and diffuse optical tomography (DOT) to investigate whether bursts of EEG activity in infants with hypoxic ischemic encephalopathy are associated with an observable cerebral hemodynamic response. We were able to identify significant changes in concentration of both oxy and deoxyhemoglobin that are temporally correlated with EEG bursts and present a relatively consistent morphology across six infants. Furthermore, DOT reveals patient-specific spatial distributions of this hemodynamic response that may be indicative of a complex pattern of cortical activation underlying discontinuous EEG activity that is not readily apparent in scalp EEG.

The spontaneous cerebral activity that gives rise to resting-state networks (RSNs) has been extensively studied in infants in recent years. However, the influence of sleep state on the presence of observable RSNs has yet to be formally investigated in the infant population, despite evidence that sleep modulates resting-state functional connectivity in adults. This effect could be extremely important, as most infant neuroimaging studies rely on the neonate to remain asleep throughout data acquisition. In this study, we combine functional near-infrared spectroscopy with electroencephalography to simultaneously monitor sleep state and investigate RSNs in a cohort of healthy term born neonates. During active sleep (AS) and quiet sleep (QS) our newborn neonates show functional connectivity patterns spatially consistent with previously reported RSN structures. Our three independent functional connectivity analyses revealed stronger interhemispheric connectivity during AS than during QS. In turn, within hemisphere short-range functional connectivity seems to be enhanced during QS. These findings underline the importance of sleep state monitoring in the investigation of RSNs.

BackgroundPerinatal stroke is a potentially debilitating injury, often under-diagnosed in the neonatal period. We conducted a pilot study investigating the role of the portable, non-invasive brain monitoring technique, diffuse optical tomography (DOT), as an early detection tool for infants with perinatal stroke.MethodsFour stroke-affected infants were scanned with a DOT system within the first 3 days of life and compared to four healthy control subjects. Spectral power, correlation, and phase lag between interhemispheric low frequency (0.0055–0.3 Hz) hemoglobin signals were assessed. Optical data analyses were conducted with and without magnetic resonance imaging (MRI)-guided stroke localization to assess the efficacy of DOT when used without stroke anatomical information.ResultsInterhemispheric correlations of both oxyhemoglobin and deoxyhemoglobin concentration were significantly reduced in the stroke-affected group within the very low (0.0055–0.0095 Hz) and resting state (0.01–0.08 Hz) frequencies (p < 0.003). There were no interhemispheric differences for spectral power. These results were observed even without MRI stroke localization.ConclusionThis suggests that DOT and correlation-based analyses in the low-frequency range can potentially aid the early detection of perinatal stroke, prior to MRI acquisition. Additional methodological advances are required to increase the sensitivity and specificity of this technique.

Posters 479prior to the procedure and subsequently throughout the ROP examination, which on average lasted 2 minutes. The results were documented on an Excel spreadsheet and analysed using the paired T-test.Results: A total of 19 infants were studied. The skin conductance peak rate (mean) was 0.017 peaks/s at baseline and was 0.14 peaks/s during the procedure (p< 0.001). Conclusion:The findings indicate that ROP screening causes a degree of stress to preterm infants. The Med-Storm Pain Monitor permits the quantification of the degree of stress encountered by the infant. This technology offers the potential of being able to identify and modify the distress caused by neonatal procedures. Background and aims: Umbilical artery acidbase status is a useful marker of the fetal condition just before birth. The objective of our study was to determine the newborn complications in near term and term infants associated with umbilical artery acidemia of pH ≤ 7.10. COMPLICATIONS IN THE NEAR TERM AND TERM INFANTS WITH SEVERE UMBILICAL ARTERY ACIDEMIA

This paper [Neurophoton 3(3), 031408 (2016)] was originally published with redundant video still images in Figs. 10 and 11. Those videos have been incorporated into the previous Figs. 6 and 8, and Figs. 10 and 11 have been deleted. The article was corrected online on 4 May 2016. It appears correctly in print.

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Background Neonatal septic shock is a devastating condition associated with high morbidity and mortality. Methods A retrospective study was conducted in children's hospital Tunisian PICU between 2005 to 2013. All neonates (<28 days) treated for septic shock with bacterial proof were included. Nosocomial infection was an exclusion critéria. The chart review relieved demographics, length of stay, therapies and outcomes. Results A total of 40 neonates were included. Mean age on admission was 34 h±3.7. Mean SNAPP score was 25 ± 17. Materno-fetal infection was observed in 37 cases, staphylococcal pneumonia in 2 cases and bacterial coinfection with bronchiolitis in the last case. The bacteriological study showed a notable predominance of streptococcus B (40%) and E.coli (35%). All patients required mechanical ventilation (mean duration: 85 ± 556 h) and haemodynamic support (mean duration 49 ± 335 h). Mortality rate was 19% in full term infants, 12.5% in near term infants and 27% in extremely preterm infants. Conclusions Our results would indicate a high mortality rate in neonatal septic shock. A goal -directed therapy for septic shock, implanted in our PICU, could improve outcomes for this vulnerable population. Background and aim In neonatal intensive care coagulase negative Staphylococcus species can be both blood culture contaminant and pathogen. False positive cultures can result in clinical uncertainty and unnecessary antibiotic use. Our aim was to assess the effect of a total sterile blood culture collection bundle on the incidence of false positive blood cultures in a regional surgical neonatal intensive care unit. Method Clinical data of all infants who had blood cultures taken before and after the introduction of the collection bundle (sterile technique and 2% Chlorhexidine) were collected. The rates of false positive blood cultures, defined as the presence of a skin commensal and <3 predefined clinical signs (Modi et al. 2009), were compared. Results In total 367 blood cultures from 294 babies were assessed, 197 pre-intervention (PRE) and 170 following bundle introduction (POST). The median birth weight and gestation were similar in both groups. The rate of false positive cultures in the total PRE group was 9/197 (4.6%) compared to 1/170 (0.6%) in the POST group (p < 0.05). In infants <28 weeks' the rates reduced from 4/29 (13.8%) to 0/30 (0%) (p < 0.05). Unnecessary antibiotic exposure rate was 7.7% in the PRE group versus 0.0% in the POST group (p < 0.05). Conclusion Implementation of this collection bundle reduced the number of false positive blood culture results. This has a potential benefit in reducing unnecessary antibiotic use and associated health care costs. Background Very low birth weight (VLBW) infants with late onset sepsis have increased risk of neurodisability. Care bundles to reduce these infections in NICU are effective. The impact of care bundles on long-term neurodevelopmental outcome has not been described. We aimed to determine if implementation of a sepsis-reduction care bundle was as...

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