作者要感谢卡罗琳·哈特利和 Rebeccah 斯莱特 (英国牛津大学儿科系) 对我们的论文和沃尔特 Magerl (生物医学和医学技术中心神经生理学系) 的评论。曼海姆 (CBTM), 德国海德堡大学) 支持我们的技术设备和知识。

这项研究得到了瑞士西北部主管道德委员会 (EKNZ 2015-079) 的批准, 并在测量前获得了有关参与者的书面父母同意。
1. 准备
<ol><li>确保孩子已经安顿好了。它应该是安静和安定的, 不用吮运动在录音期间由于运动文物。婴儿可以睡着9。</li>
	<li>用卷尺测量新生儿头部周长, 确定脑电图帽的大小。</li>
	<li>确定活动电极位置: Cz/顶点位置通过标记中间点之间的 nasion 和 inion 和中间点之间的左, 右 preaurical 点与皮肤标记铅笔。为定位电极也请参见图 1。</li>
	<li>确定地面电极的位置: 右前额 (Fp2) 和参考电极: 左乳突 (A1)。</li>
	<li>用棉签清洗电极部位 (Cz、Fp2 和 A1)。在大量的头发的情况下, 分开的头发, 以可视化头皮。</li>
	<li>用棉签用棉签轻轻擦洗电极部位, 以降低阻抗。</li>
	<li>将脑电图帽与附着在新生儿头上的电极放在一起。</li>
	<li>使用带有短塑料针头的注射器向电极注入导电脑电凝胶, 以优化电极和头皮之间的接触。</li>
	<li>调整电极, 直到阻抗低于50ω, 如制造商的建议和发布的准则12所述。</li>
	<li>放置一个摄像头来记录新生儿的面部表情。</li>
	<li>将平尖探头连接到触点触发装置, 固定在 EEG 记录装置上。当平尖探针到达皮肤的标称力时, 触发信号由触点触发装置产生。这个信号被发送到计算机, 用一个触发标记标记脑电图记录。</li>
</ol>2. 测量
<ol><li>选择一个研究名称来存储数据。</li>
	<li>
添加在线带通滤波器:
	<ol>
<li>显示筛选器: 低截止滤波器: 频率: 1 赫兹 高截止滤波器: 频率:70 赫兹 凹槽过滤器:50 赫兹 采样率: 2000 赫兹</li>
	</ol>
</li>
	<li>启动脑电图和录像</li>
	<li>将新生儿的右手保持在水平位置。刺激也可以应用在不同的站点上,例如脚, 这将导致比手更长的滞后时间, 请参阅详细信息3.7。</li>
	<li>第一记录背景脑电图活动。当新生儿的手举行, 注释的脑电图记录手动记录期间, 没有刺激的应用和婴儿休息。</li>
	<li>根据新生儿右手的研究设计, 进行所需量的平尖探针刺激。在我们的实验设计中, 设置了50平尖端探针刺激的数量。小心地使用平尖端探针垂直地对新生儿的手, 因此提示不弯曲和正确的力量被应用。使用最小2到3秒的 inter-stimulus 间隔 (ISI)6执行平面尖端探头刺激, 以避免求和。</li>
	<li>停止所有的录音。</li>
	<li>记录实验设置细节。</li>
</ol>3. 数据分析
<ol><li>使用高通滤波器在1赫兹和低通滤波器的30赫兹下离线过滤原始脑电图数据。</li>
	<li>片段数据在世纪1500毫秒 (500 毫秒之前到1000毫秒在刺激开始之后)。</li>
	<li>对 pre-stimulus 间隔执行基线校正。</li>
	<li>在目视检查后, 手动拒绝包含人工制品的 EEG 世纪, 如机芯和噪音。请参阅教程大纲: https://sccn.ucsd.edu/wiki/Chapter_01:_Rejecting_Artifacts</li>
	<li>平均 EEG 世纪 (为背景和刺激反应分开)。</li>
	<li>木质过滤器数据以最大抖动±50毫秒在时间窗口 0-1000 毫秒后刺激开始。这使得婴儿之间的潜伏期差异。这样做的背景和刺激反应分开。</li>
	<li>项目一个有害诱发脑活动的模板, 这是定义在一个独立的数据集, 并已详细描述了其他地方11的数据, 以确定在每个单独的试验中的有害诱发反应的程度。该模板描述了有害诱发反应的特征波形, 震级反映了在个体试验中这种有害诱发反应的数量。 注意: 模板投射的时间窗口取决于婴儿的年龄和刺激的位置。如果刺激适用于手然后时间窗口的兴趣是 200-500 毫秒后刺激11。如果刺激被应用到脚然后时间窗口兴趣是 400-700 ms 岗位刺激11。请注意, 该模板目前仅在 34-43 周的妊娠期内进行了验证。有关使用此模板的详细方法以及有关限制的讨论, 请参见哈特利et al. 201711。</li>
	<li>检查使用该模板计算的有害诱发脑活动的幅度在刺激后明显高于背景脑电图。</li>
	<li>使用新生儿面部编码系统2,13, 事后分析行为面部表情 (摄像机与 EEG 记录相关)。</li>
</ol>

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作者没有什么可透露的。

这里介绍的方法显示了如何使用脑电图记录和平尖探针刺激对新生儿的有害诱发脑活动进行客观的测量, 以应用实验性的有害刺激。这项技术可用于各种临床设置, 以检测伤害,例如在非语言的人, 如新生儿。完整的研究可以在15分钟内完成, 包括放置婴儿, 识别, 准备和安装电极, 最后应用和记录50有害刺激。这种刺激不会引起婴儿的行为窘迫, 这一方法为评估婴儿的伤害提供了客观的方法。
在这项研究中, 我们使用了一个平尖端探针刺激与温和的力量 32 mN。64 mn 或 128 mn 的更高的力量也可以应用于新生儿, 但可能导致因肢体退缩而增加的运动文物。我们注意到, 在我们的研究中, 新生儿接受了32锰的力量非常好, 并没有撤回他们的四肢, 而刺激与 128 mn 力量导致双边反射撤退6。结果表明, 根据平板探针刺激的力 (32 与 64 mN)6,14, 有害诱发电位更大。Verriotis et al. 显示, 1 岁的儿童在事件相关的顶点电位和较高的疼痛评分上比新生儿的振幅高15。因此, 平尖端探针刺激的力量可以根据患者的年龄16适应。
先前的研究记录了伤害从新生儿护理仰卧或俯卧或甚至在他们的一侧。为了保持实验设置恒定, 我们建议在与几个参与者进行研究时保持一个位置。我们发现在仰卧位执行测量效果良好。我们对新生儿的手进行了扁平探针刺激。对新生儿的定位和操作可能更容易, 如果使用的刺激, 以手比脚。事实上, 在研究中, 脚的使用更加普遍, 但是, 我们发现刺激手的背部比进入脚更容易。反射性戒断是一种有用的额外措施, 它可以被纳入到一个多层面的疼痛评估中, 在这个具有挑战性的非语言人群17。
尽管避免任何不适和运动文物, 总是自发的神经活动。因此, 过滤和平均是重要的, 以减弱背景噪声和可视化事件相关的潜力。此外, 平尖端探针刺激的重复, 例如 50, 强烈地提高了信噪比。为了分析数据, time-locking 所有的测量是至关重要的。
新生儿出生后不久的一个进一步的技术挑战是皮脂-的存在, 包括头部在内的新生儿皮肤, 这就是为什么他们的皮肤需要用一个额外的准备糊剂仔细清洗, 即使有活性电极使用.在我们看来, 活性电极比被动电极更适合这种方法, 因为它们对导线上的外部运动不太敏感。此外, 他们更容易使用, 因为他们接受更高的阻抗, 由于内置前。但是, 也可以使用无源电极。
对于数据分析, 我们使用了哈特利et al.所描述的方法6,11. 另一种方法是由 Hu et al.显示的时频分析18。
在一起, 技术方法, 设置和解释的结果需要一个训练有素的团队, 最好两个人做测量, 一个应用的刺激, 而另一种是检查脑电图。如果新生儿是不稳定的, 脑电图将被污染的运动文物和它是不可能执行的测量。此外, 由于有效性, 它是强制性的, 有一定数量的刺激, 这可能是挑战。
伤害在早期的生活中成熟, 早在34周的妊娠期, 新生儿的大脑就可以区分触摸和伤害17。在34周的怀孕婴儿更可能产生非特异性神经元爆发19 , 而在晚早产儿开始在34周的妊娠, 这里所描述的方法可以使用11。这种方法为各种研究调查打开了大门。例如, 它可以用来测试出生相关压力对伤害20的影响, 或者测试新生儿和婴儿各种镇痛药的具体影响621。例如, 这里介绍的协议最近被使用了在一项研究表明局部麻醉药的功效显著减少有害诱发电位, 当有害刺激被应用到被处理的脚与背景活动或未经处理的脚11。
总之, 脑电记录中的有害诱发电位可以客观地研究非言语患者的疼痛知觉的替代措施。本方法适用于研究调查中的临床应用。通过 time-locking 的平尖端探针刺激的脑电图记录, 可以可靠地评估电生理伤害反应。

疼痛是一种不愉快的感觉和情感体验, 与实际或潜在的组织损害有关, 或在这种损害方面描述为1。无法口头交流并不能否定个人正在经历痛苦的可能性, 但却使评估减轻疼痛的治疗具有挑战性, 例如新生儿2。一些行为和生理指标被用来评估非语言患者的疼痛。不同的尺度已经发展了多年, 选择取决于类型的刺激, 孕龄和环境中的新生儿是嵌入式3,4,5。这些疼痛评估工具要么依赖于评分员的解释, 要么需要二级生理指标。
在这个视频中, 我们提出了一种方法来评估伤害的电生理记录优化用于新生儿。伤害被定义为有害刺激编码的神经过程。因此, 量化伤害是一个优雅和客观的方法来确定神经输入的非语言的人。此外, 脑电图 (eeg) 检测到的皮层活动与有害事件强度相关,5,6。
这里提出的方法结合脑电图记录与机械刺激产生的有害刺激与扁平尖端探针, 也称为针刺7, 这不是皮肤破损, 并没有造成行为困扰6。它已经表明, 伤害以下的加标点刺激主要是介导的 Aδ纤维, 不需要皮肤破裂病变8和伤害性特定电位的大小不依赖于睡眠状态9。在与新生儿的研究环境中应用这种方法时, 家长也很好地接受了这一探针。探针是电子连接到 eeg 记录系统, 使脑电图记录准确标签时, 探针接触皮肤。这大大简化了时间锁定的过程, 是所有后续脑电图分析的前提。为了最大限度地减少婴儿脑电图记录的准备时间, 我们使用了一个改进的国际10/20 电极放置系统, 我们减少了电极的数量, 以最低要求的三电极 (图 1)。中心顶点 Cz 电极, 其中有害诱发脑活动是最大的9,10,11, 与一个参考和一个接地电极一起使用。

<table><tbody><tr><td>Easycap</td><td>EASYCAP GmbH</td><td>AC-32-C</td><td>EEG caps for infants sizes 34 and 36</td></tr><tr><td>actiCAP</td><td>Brain Products GmbH</td><td>BP-04243-SIG</td><td>active electrodes</td></tr><tr><td>ImpBox</td><td>Brain Products GmbH</td><td></td><td>impedance measurement</td></tr><tr><td>V-Amp</td><td>Brain Products GmbH</td><td></td><td>EEG recording device</td></tr><tr><td>Contact trigger for pinprick stimulation</td><td>MRC Systems GmbH</td><td></td><td></td></tr><tr><td>PinPrick stimulator set</td><td>MRC Systems GmbH</td><td></td><td></td></tr><tr><td>EEG prepping paste</td><td>USB Pharmacy</td><td></td><td>contains sodium chloride, pumice stone, propylene glycol</td></tr><tr><td>SuperVisc</td><td>EASYCAP GmbH</td><td></td><td>Electrolyte-Gel for active electrodes</td></tr><tr><td>Brain Vision Recorder</td><td>Brain Products GmbH</td><td></td><td></td></tr><tr><td>Brain Vision Analyzer</td><td>Brain Products GmbH</td><td></td><td></td></tr><tr><td>MATLAB using EEGLAB &lt;p&gt;&lt;/p&gt; &lt;p&gt;&lt;/p&gt; &lt;p&gt;&lt;/p&gt; &lt;p&gt;&lt;/p&gt; &lt;p&gt;&lt;/p&gt; </td><td>Swartz Center for Computational Neuroscience, University of California San Diego</td><td></td><td>For EEG processing, including averaging of all EEG epochs &lt;p&gt;&lt;/p&gt; &lt;p&gt;&lt;/p&gt; &lt;p&gt;&lt;/p&gt; </td></tr></tbody></table>

electrophysiological measurement of noxious-evoked brain activity in neonates using a flat-tip probe coupled to electroencephalography

疼痛是一种不愉快的感官和情感体验。在非语言患者中, 即使用疼痛评估工具也很难测量疼痛。这些工具是主观的或确定的次要生理指标, 也有一定的限制, 特别是在探索的有效性镇痛。由于皮质加工对疼痛知觉至关重要, 脑活动措施可为评估婴儿疼痛提供一种有用的方法。在这里, 我们提出了一种方法来评估伤害与电生理脑活动录音优化用于新生儿。为了产生高度标准化和可重复性的有害刺激, 我们应用了机械刺激与平尖端探针,例如, 针刺, 这不是皮肤破损, 不会造成行为困扰。有害诱发电位可客观测量非言语患者的伤害。这种方法可用于新生儿早在34周的孕龄。此外, 它可以应用在不同的情况下, 如测量镇痛或麻醉药物的功效。

图 1是使用修改过的国际10/20 电极放置系统的电极定位的图解表示。图 2显示了在使用带有 32 mN 力的平头探针进行一项单一有害刺激的应用之前和之后的脑电图活动, 这种刺激发生在新生儿的右手协议 (图 2A) 中。在大约 300 ms 后刺激开始 (时间 0), 毒性诱发反应是可见的。图 2B显示了50种刺激对同一患者的平均反应, 其应用 32 mN 的力。请注意, 如果施加更多的刺激, 有害诱发电位就会更加明显。如图 2C所示, 木质过滤可用于调整响应滞后时间的细微变化。以红色显示的预定义模板11被投射到 EEG 上, 以计算有害诱发反应的大小。
<img alt="Figure 1" class="xfigimg" src="/files/ftp_upload/56531/56531fig1.jpg"> 图 1: 使用修改后的国际10/20 电极放置系统的电极定位的图解表示法。
<img alt="Figure 2" class="xfigimg" src="/files/ftp_upload/56531/56531fig2.jpg"> 图 2: 对实验性有害刺激的反应记录的脑电图活动.一个平尖端探针刺激 (32 mN) 被应用在一个病人的右手, 时间窗口的兴趣 200-500 毫秒后刺激是阴影。小组 A: EEG 活动在一次刺激之后, 主要峰顶在250毫秒用箭头标记。B 组:50 刺激后的平均反应。面板 C: 带有投影模板 (红色) 的木质过滤数据。<a href="//cloudflare-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/56531/56531fig2large.jpg" target="_blank">请单击此处查看此图的较大版本.</a>

Watch this Scientific Journal Video about Electrophysiological Measurement of Noxious-evoked Brain Activity in Neonates Using a Flat-tip Probe Coupled to Electroencephalography at JoVE.com

Electrophysiological Measurement of Noxious-evoked Brain Activity in Neonates Using a Flat-tip Probe Coupled to Electroencephalography

应用平板探针结合脑电图对新生儿有害诱发脑活动的电生理测量

测量非语言患者的疼痛是一个挑战。在本研究中, 我们结合脑电记录与刺激使用平尖端探针检测有害诱发脑活动的客观方式。

Pain is an unpleasant sensory and emotional experience. In non-verbal patients, it is very difficult to measure pain, even with pain assessment tools. ...

electrophysiological-measurement-noxious-evoked-brain-activity

Nanyang Technological University

Research

JoVE Journal

Medicine

6.5K 次观看.  University of Basel Children's Hospital. 测量非语言患者的疼痛是一个挑战。在本研究中, 我们结合脑电记录与刺激使用平尖端探针检测有害诱发脑活动的客观方式。

视频: Electrophysiological Measurement of Noxious-evoked Brain Activity in Neonates Using a Flat-tip Probe Coupled to Electroencephalography

Infant Auditory Processing and Event-related Brain Oscillations

Rapid auditory processing and acoustic change detection abilities play a critical role in allowing human infants to efficiently process the fine spectral and temporal changes that are characteristic of human language. These abilities lay the foundation for effective language acquisition; allowing infants to hone in on the sounds of their native language. Invasive procedures in animals and scalp-recorded potentials from human adults suggest that simultaneous, rhythmic activity (oscillations) between and within brain regions are fundamental to sensory development; determining the resolution with which incoming stimuli are parsed. At this time, little is known about oscillatory dynamics in human infant development. However, animal neurophysiology and adult EEG data provide the basis for a strong hypothesis that rapid auditory processing in infants is mediated by oscillatory synchrony in discrete frequency bands. In order to investigate this, 128-channel, high-density EEG responses of 4-month old infants to frequency change in tone pairs, presented in two rate conditions (Rapid: 70 msec ISI and Control: 300 msec ISI) were examined. To determine the frequency band and magnitude of activity, auditory evoked response averages were first co-registered with age-appropriate brain templates. Next, the principal components of the response were identified and localized using a two-dipole model of brain activity. Single-trial analysis of oscillatory power showed a robust index of frequency change processing in bursts of Theta band (3 - 8 Hz) activity in both right and left auditory cortices, with left activation more prominent in the Rapid condition. These methods have produced data that are not only some of the first reported evoked oscillations analyses in infants, but are also, importantly, the product of a well-established method of recording and analyzing clean, meticulously collected, infant EEG and ERPs. In this article, we describe our method for infant EEG net application, recording, dynamic brain response analysis, and representative results.

High-density electroencephalography (dEEG) is being used increasingly to study brain development and plasticity in the early years of life. Here we present an application of sophisticated analysis techniques that builds on traditional EEG recording to understand the oscillatory dynamics of rapid auditory processing in the infant brain.

婴儿听觉处理和事件相关的脑振荡

Rapid auditory processing and acoustic change detection abilities play a critical role in allowing human infants to efficiently process the fine spectral ...

科研

行为学

Electrophysiological Measurements and Analysis of Nociception in Human Infants

Pain is an unpleasant sensory and emotional experience. Since infants cannot verbally report their experiences, current methods of pain assessment are based on behavioural and physiological body reactions, such as crying, body movements or changes in facial expression. While these measures demonstrate that infants mount a response following noxious stimulation, they are limited: they are based on activation of subcortical somatic and autonomic motor pathways that may not be reliably linked to central sensory processing in the brain. Knowledge of how the central nervous system responds to noxious events could provide an insight to how nociceptive information and pain is processed in newborns.
The heel lancing procedure used to extract blood from hospitalised infants offers a unique opportunity to study pain in infancy. In this video we describe how electroencephalography (EEG) and electromyography (EMG) time-locked to this procedure can be used to investigate nociceptive activity in the brain and spinal cord.
This integrative approach to the measurement of infant pain has the potential to pave the way for an effective and sensitive clinical measurement tool.

The assessment and treatment of pain in infants is difficult because infants cannot verbally report their experience. In this video we describe quantitative electrophysiological methods and analysis techniques that can be used to measure the response to noxious events from the infant nervous system.

在人类婴儿的伤害性电生理测量和分析

Pain is an unpleasant sensory and emotional experience. Since infants cannot verbally report their experiences, current methods of pain assessment are ...

神经科学

Preterm EEG: A Multimodal Neurophysiological Protocol

Since its introduction in early 1950s, electroencephalography (EEG) has been widely used in the neonatal intensive care units (NICU) for assessment and monitoring of brain function in preterm and term babies. Most common indications are the diagnosis of epileptic seizures, assessment of brain maturity, and recovery from hypoxic-ischemic events. EEG recording techniques and the understanding of neonatal EEG signals have dramatically improved, but these advances have been slow to penetrate through the clinical traditions. The aim of this presentation is to bring theory and practice of advanced EEG recording available for neonatal units. 
In the theoretical part, we will present animations to illustrate how a preterm brain gives rise to spontaneous and evoked EEG activities, both of which are unique to this developmental phase, as well as crucial for a proper brain maturation. Recent animal work has shown that the structural brain development is clearly reflected in early EEG activity. Most important structures in this regard are the growing long range connections and the transient cortical structure, subplate. Sensory stimuli in a preterm baby will generate responses that are seen at a single trial level, and they have underpinnings in the subplate-cortex interaction. This brings neonatal EEG readily into a multimodal study, where EEG is not only recording cortical function, but it also tests subplate function via different sensory modalities. Finally, introduction of clinically suitable dense array EEG caps, as well as amplifiers capable of recording low frequencies, have disclosed multitude of brain activities that have as yet been overlooked.
In the practical part of this video, we show how a multimodal, dense array EEG study is performed in neonatal intensive care unit from a preterm baby in the incubator. The video demonstrates preparation of the baby and incubator, application of the EEG cap, and performance of the sensory stimulations.

This video explains the background theory of the neonatal EEG activity and the sensory responses, followed by a live demonstration of their recording in neonatal intensive care unit.

早产儿的脑电图：多式联运神经生理学议定书

Since its introduction in early 1950s, electroencephalography (EEG) has been widely used in the neonatal intensive care units (NICU) for assessment and ...

Neonatal Pial Surface Electroporation

Over the past several years the pial surface has been identified as a germinal niche of importance during embryonic, perinatal and adult neuro- and gliogenesis, including after injury. However, methods for genetically interrogating these progenitor populations and tracking their lineages had been limited owing to a lack of specificity or time consuming production of viruses. Thus, progress in this region has been relatively slow with only a handful of investigations of this location. Electroporation has been used for over a decade to study neural stem cell properties in the embryo, and more recently in the postnatal brain. Here we describe an efficient, rapid, and simple technique for the genetic manipulation of pial surface progenitors based on an adapted electroporation approach. Pial surface electroporation allows for facile genetic labeling and manipulation of these progenitors, thus representing a time-saving and economical approach for studying these cells.

The pial surface is a unique progenitor zone in the CNS that is receiving increasing attention. Herein, we detail a method for rapid genetic manipulation of this progenitor zone using a modified electroporation method. This procedure can be used for cellular and molecular investigations of cell lineages and signaling pathways involved in cell differentiation and to elucidate the fate and properties of daughter cells.

新生儿软脑膜表面电穿孔

Over the past several years the pial surface has been identified as a germinal niche of importance during embryonic, perinatal and adult neuro- and ...

Recording EEG in Freely Moving Neonatal Rats Using a Novel Method

EEG is a useful method to detect electrical activity in the brain. Moreover, it is a widely used diagnostic tool for various neurological conditions, such as epilepsy and neurodegenerative disorders. However, it is technically difficult to obtain EEG recordings in neonates as it requires specialized handling and great care. Here, we present a novel method to record EEG in neonatal rat pups (P8-P15). We designed a simple and reliable electrode using computer pin loci; it can be easily implanted into the skull of a rat pup to record high-quality EEG signals in the normal and epileptic brain. Pups were given an intraperitoneal (i.p.) injection of the neurotoxin kainic acid (KA) to induce epileptic seizures. The surgical implantation performed in this procedure is less expensive than other EEG procedures for neonates. This method allows one to record high-quality and stable EEG signals for more than 1 week. Furthermore, this procedure can also be applied to adult rats and mice to study epilepsy or other neurological disorders.

Here, we introduce a novel technique designed to record electroencephalography (EEG) in freely moving neonatal epileptic pups and describe its procedures, features, and applications. This method allows one to record EEG for more than 1 week.

使用新颖的方法在自由移动的新生大鼠中记录脑电图

EEG is a useful method to detect electrical activity in the brain. Moreover, it is a widely used diagnostic tool for various neurological conditions, such ...

Application of an Amplitude-integrated EEG Monitor (Cerebral Function Monitor) to Neonates

Amplitude-integrated EEG (aEEG) is an easily accessible technique to monitor the electrocortical activity in preterm and term infants in neonatal intensive care units (NICUs). This method was first used to monitor newborns after asphyxia, providing information about future neurological outcomes. The aEEG is also helpful to select newborns who benefit from cooling. The aEEG monitoring of preterm infants is becoming more widespread, as various studies have shown that neurodevelopmental outcome is related to early aEEG tracings. Here, we demonstrate the application of the aEEG monitoring system and present typical patterns that depend upon gestational age and pathophysiological conditions. Furthermore, we mention pitfalls in the interpretation of the aEEG, as this method requires accurate fixation and localization of the electrodes. Additionally, the raw EEG can be used to detect neonatal seizures or to identify aEEG application problems. In conclusion, aEEG is a safe and generally well-tolerated method for the bedside monitoring of neonatal cerebral function; it can even provide information about long-term outcome.

Application of an Amplitude-integrated EEG Monitor Cerebral Function Monitor to Neonates

Here, we show how to apply amplitude-integrated electroencephalography to monitor cerebral function in neonates.

振幅综合脑电图监测仪 (脑功能监护仪) 在新生儿中的应用

Amplitude-integrated EEG (aEEG) is an easily accessible technique to monitor the electrocortical activity in preterm and term infants in neonatal ...

医学

Objective Nociceptive Assessment in Ventilated ICU Patients: A Feasibility Study Using Pupillometry and the Nociceptive Flexion Reflex

The concept of objective nociceptive assessment and optimal pain management have gained increasing attention. Despite the known negative short- and long-term consequences of unresolved pain or excessive analgosedation, adequate nociceptive monitoring remains challenging in non-communicative, critically ill adults. In the intensive care unit (ICU), routine nociceptive evaluation is carried out by the attending nurse using the Behavior Pain Scale (BPS) in mechanically ventilated patients. This assessment is limited by medication use (e.g., neuromuscular blocking agents) and the inherent subjective character of nociceptive evaluation by third parties.
Here, we describe the use of two nociceptive reflex testing devices as tools for objective pain evaluation: the pupillary dilation reflex (PDR) and nociception flexion reflex (NFR). These measurement tools are non-invasive and well tolerated, providing clinicians and researchers with objective information regarding two different nociceptive processing pathways: (1)&#160;the pain-related autonomic reactivity&#160;and (2) the ascending component of the somatosensory system. The use of PDR and NFR measurements are currently limited to specialized pain clinics and research institutions because of impressions that these are technically demanding or time-consuming procedures, or even because of a lack of knowledge regarding their existence.
By focusing on the two abovementioned nociceptive reflex assessments, this study evaluated their feasibility as a physiological pain measurement method in daily practice. Pursuing novel technologies for evaluating the analgesia level in unconscious patients may further improve individual pharmacological treatment and patient related outcome measures. Therefore, future research must include large well-designed clinical trials in a real-life environment.

Pain assessment in anesthetized patients who cannot communicate with the outside world in any way remains challenging despite the development of innovative objective pain evaluation tools. In this project, the pupillary dilation reflex and the nociception flexion reflex are assessed in critically ill, mechanically ventilated adult patients.

应用 Pupillometry 和伤害性屈曲反射的可行性研究--通气 ICU 患者的客观伤害评估

The concept of objective nociceptive assessment and optimal pain management have gained increasing attention. Despite the known negative short- and ...

How to Obtain Reliable Visual Event-related Potentials in Newborns

The present study discusses the characteristics of visual event-related potentials (VEPs) and outlines methodological steps for obtaining reliable measurements in newborns. Obtaining high-quality, reliable VEPs is crucial for the early detection of abnormal development of the central nervous system in at-risk newborns, and for implementing successful early interventions. Recommendations are based on a previous study which showed that when post-conceptional age, polysomnography-identified sleep stages, and light-emitting diodes (LEDs) googles as the luminous source are controlled, no more than 4 repetitions of VEP averages are required to obtain replicable recordings, variability decreases, and reliable VEPs can be obtained. By controlling for these sources of variability and using statistical analyses, we were able to clearly and reliably identify the amplitude and latency of three main components (NII, PII and NIII) present in 100% of newborns (n = 20) during active sleep. Recording VEPs during awake states, quiet sleep and transitional sleep is not recommended because VEP morphology may differ significantly from one average to the next, leading to the risk of misleading clinical prognoses. Moreover, it is easier to obtain VEPs during active sleep because this state can be clearly and reliably identified at this stage of development, sleep cycles are short enough to allow measurements to be taken in a reasonable time, and the method does not require new o expensive equipment.

Several important points for obtaining high-quality reliable visual evoked potentials (VEPs) in newborns while minimizing variability and the risk of misleading prognoses are presented.

如何获得新生儿中可靠的视觉事件相关潜力

The present study discusses the characteristics of visual event-related potentials (VEPs) and outlines methodological steps for obtaining reliable ...

使用便携式振幅积分脑电图进行婴儿运输

Amplitude-Integrated EEG in Infants at Risk of Hypoxic-Ischemic Encephalopathy: A Feasibility Study in Road and Air Transport in Western Australia

Infants at risk of HIE require early identification and initiation of therapeutic hypothermia (TH). Earlier treatment with TH is associated with better outcomes. aEEG is frequently used when making the decision whether to commence TH. As this is often limited to tertiary centers, TH may be delayed if the infant requires transport to a center that provides it. We aimed to provide a method for the application of amplitude-integrated electroencephalogram (aEEG) and to determine the feasibility of acquiring clinically meaningful information during transport. All infants &#8805;35 weeks, at risk of HIE at referral, were eligible for inclusion. Scalp electrodes were placed in the C3-C4; P3-P4 position on the infant&#39;s scalp and connected to the aEEG amplifier. The aEEG amplifier was, in turn, connected to a clinical tablet computer with EEG software to collect and analyze aEEG information. Recordings were reviewed by the chief principal investigator and two independent reviewers (blinded) for background trace and artifact. Predefined criteria for data quality were set to movement artifacts and software impedance notifications. Surveys were completed by healthcare staff and parents for acceptability and ease of use.

作者聚焦:评估在新生儿转运过程中使用振幅集成脑电图的可行性

Here, we present a feasibility study to assess a portable amplitude-integrated electroencephalogram (aEEG) recording system during the transport of infants with suspected hypoxic ischemic encephalopathy (HIE).

有缺氧缺血性脑病风险婴儿的振幅整合脑电图:西澳大利亚公路和航空运输的可行性研究

Infants at risk of HIE require early identification and initiation of therapeutic hypothermia (TH). Earlier treatment with TH is associated with better ...

应用平板探针结合脑电图对新生儿有害诱发脑活动的电生理测量

摘要

探索更多视频

此视频中的章节

婴儿听觉处理和事件相关的脑振荡

在人类婴儿的伤害性电生理测量和分析

早产儿的脑电图：多式联运神经生理学议定书

新生儿软脑膜表面电穿孔

使用新颖的方法在自由移动的新生大鼠中记录脑电图

振幅综合脑电图监测仪 (脑功能监护仪) 在新生儿中的应用

应用 Pupillometry 和伤害性屈曲反射的可行性研究--通气 ICU 患者的客观伤害评估

如何获得新生儿中可靠的视觉事件相关潜力

有缺氧缺血性脑病风险婴儿的振幅整合脑电图:西澳大利亚公路和航空运输的可行性研究

有缺氧缺血性脑病风险婴儿的振幅整合脑电图:西澳大利亚公路和航空运输的可行性研究