Specialized Neurological Studies

Volpe, Joseph J.

doi:10.1016/b978-0-323-42876-7.00010-7

Cited by 5 publications

(12 citation statements)

References 395 publications

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“…This is an important distinction, because while burst suppression has been associated with poor neurologic outcomes such as hypoxemic injury, discontinuous EEG activity can be routinely seen in the premature infant and in the newborn during quiet sleep (up to 4 weeks postterm). [13][14][15] To our knowledge, burst suppression with neuraxial anesthesia has not been observed in adults, suggesting that the EEG discontinuity observed in our study is perhaps more reflective of the EEG discontinuity seen during normal development of premature and term infants (Supplemental Digital Content 1, Table 1, http://links.lww.com/AA/E223). [13][14][15] One distinguishing feature of burst suppression, in contrast to EEG discontinuity or tracé alternant, is the absence of reactivity to external stimuli.…”

Section: Eeg Discontinuitymentioning

confidence: 91%

“…4,12 Postmenstrual age is the chronological age added to the gestational age, and infants with postmenstrual age <36 weeks can have some unique EEG features including discontinuous EEG activity and burst suppression (Supplemental Digital Content 1, Table 1, http://links.lww.com/AA/E223), while infants tend to develop sleep spindles at chronological age 4 to 9 weeks postterm or postmenstrual age 44 to 49 weeks. 13–15 As such, the presence of spindle activity or EEG discontinuity may correlate with gestational age, postmenstrual age, or chronological age.…”

Section: Methodsmentioning

confidence: 99%

“…Given clinical observations that infants under spinal anesthesia appear to be sedated, we hypothesized that we would observe sleep-like characteristics on the EEG in infants under spinal anesthesia, and that these features would vary with age, corresponding to developmental changes in the brain known to occur during infancy. Specifically, we hypothesized that we would see the appearance of spindles (12)(13)(14)(15)(16) in infants under spinal anesthesia, and that we would observe an increased incidence of EEG discontinuity in younger infants, particularly preterm infants who may have a predisposition to EEG discontinuity even without spinal anesthesia.…”

mentioning

confidence: 99%

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Age-Dependent Electroencephalogram Features in Infants Under Spinal Anesthesia Appear to Mirror Physiologic Sleep in the Developing Brain: A Prospective Observational Study

Mercado

Lee

Liu

et al. 2023

Anesthesia &Amp; Analgesia

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BACKGROUND: Infants under spinal anesthesia appear to be sedated despite the absence of systemic sedative medications. In this prospective observational study, we investigated the electroencephalogram (EEG) of infants under spinal anesthesia and hypothesized that we would observe EEG features similar to those seen during sleep. METHODS: We computed the EEG power spectra and spectrograms of 34 infants undergoing infraumbilical surgeries under spinal anesthesia (median age 11.5 weeks postmenstrual age, range 38–65 weeks postmenstrual age). Spectrograms were visually scored for episodes of EEG discontinuity or spindle activity. We characterized the relationship between EEG discontinuity or spindles and gestational age, postmenstrual age, or chronological age using logistic regression analyses. RESULTS: The predominant EEG patterns observed in infants under spinal anesthesia were slow oscillations, spindles, and EEG discontinuities. The presence of spindles, observed starting at about 49 weeks postmenstrual age, was best described by postmenstrual age (P=.002) and was more likely with increasing postmenstrual age. The presence of EEG discontinuities, best described by gestational age (P = .015), was more likely with decreasing gestational age. These age-related changes in the presence of spindles and EEG discontinuities in infants under spinal anesthesia generally corresponded to developmental changes in the sleep EEG. CONCLUSIONS: This work illustrates 2 separate key age-dependent transitions in EEG dynamics during infant spinal anesthesia that may reflect the maturation of underlying brain circuits: (1) diminishing discontinuities with increasing gestational age and (2) the appearance of spindles with increasing postmenstrual age. The similarity of these age-dependent transitions under spinal anesthesia with transitions in the developing brain during physiological sleep supports a sleep-related mechanism for the apparent sedation observed during infant spinal anesthesia.

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Section: Eeg Discontinuitymentioning

confidence: 91%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Age-Dependent Electroencephalogram Features in Infants Under Spinal Anesthesia Appear to Mirror Physiologic Sleep in the Developing Brain: A Prospective Observational Study

Mercado

Lee

Liu

et al. 2023

Anesthesia &Amp; Analgesia

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“…Supportive of an effect on myelin development in iron-deficient infants is the finding on studies of auditory and visual evoked potentials of prolonged latencies, without impairment of amplitudes [23][24][25][26]. (The normal maturational decline in latencies relates to acquisition of myelin, whereas changes in amplitude relate more to neuronal development [27]). A recent study of delayed umbilical cord clamping (DCC) in full-term infants suggests a beneficial effect of iron on MRI-quantitated myelin at four months of age [28].…”

Section: Iron and Pre-ol Maturation/myelinationmentioning

confidence: 99%

Iron and zinc: Nutrients with potential for neurorestoration in premature infants with cerebral white matter injury

Volpe

2020

NPM

Self Cite

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“…11 Reactivity EEG reactivity to external stimuli usually consists of a generalized attenuation of the amount and voltage of delta activity, especially evident in response to sound. 21 If a low voltage background is present, reactivity may consist of a train of slow waves. 19…”

Section: Interhemispheric Synchronymentioning

confidence: 99%

Normal Neonatal Electroencephalogram at a Glance

Cappellari

2020

Journal of Neonatology

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Interpreting neonatal electroencephalogram (EEG) presents a challenge owing to rapid evolution of EEG patterns occurring during brain maturation in the neonatal period and rich variety of normal patterns of EEG activity, which is difficult to categorize completely. Furthermore, the description of some aspects during maturation varies in different studies. Neonatal EEG is unfamiliar to most neurologists, and its interpretation requires knowledge of the physiological markers of electrogenesis maturation. The purpose of this review was to provide health-care professionals in the neonatal intensive care unit with guidance on the more common normal maturational features of the neonatal EEG. A simplified layout with the essential elements of normal neonatal EEG is included.

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Specialized Neurological Studies

Cited by 5 publications

References 395 publications

Age-Dependent Electroencephalogram Features in Infants Under Spinal Anesthesia Appear to Mirror Physiologic Sleep in the Developing Brain: A Prospective Observational Study

Age-Dependent Electroencephalogram Features in Infants Under Spinal Anesthesia Appear to Mirror Physiologic Sleep in the Developing Brain: A Prospective Observational Study

Iron and zinc: Nutrients with potential for neurorestoration in premature infants with cerebral white matter injury

Normal Neonatal Electroencephalogram at a Glance

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