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Neonatal Neurology: New Insights, Diagnosis and Treatment

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Pediatrics".

Deadline for manuscript submissions: closed (30 December 2024) | Viewed by 6157

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Dr. Elena Pavlidis

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Child Neurology and Neurorehabilitation Unit, Department of Pediatrics, Regional Hospital of Bolzano, Bolzano, Italy
Interests: neonatal seizures; neonatal neurology; neonatal epilepsy; neonatal EEG; pediatric neurology
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Special Issue Information

Dear Colleagues,

Neonatal neurology is a rapidly advancing field.

There is an increasing request for neonatal brain monitoring and for earlier diagnoses, in order to provide information regarding prognosis and guidelines for treatment and interventions.

On one side, there is an increasing interest in developing standardized trainings for clinicians and reliable tools for neurological examination of newborns. On the other side, instrumental tools for brain monitoring and brain imaging are developing quickly, with increasing interest in automated analyses (authomated tools for EEG/aEEG analyses) and in possible further tools (i.e. NIRS) to be applied for neurocritical care in the neonatal intensive care units.

In the present Special Issue, we would like to provide an overview on the current advances in the field, both by means of reviews, case reports and case series on new or educational diagnoses, and current studies on EEG/aEEG and other tools appliable in the NICUs for diagnoses and monitoring of the neurologic conditions and brain health of both term and preterm newborns.

Dr. Elena Pavlidis
Guest Editor

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Keywords

brain imaging
neonatal neurology
newborns
neurologic conditions
pediatric brain health

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Published Papers (4 papers)

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11 pages, 1524 KiB

Open AccessArticle

EEG Maturational Age Estimation: A Comparison of Visual and Automated Interpretation of the EEG in Preterm Infants

by Elena Pavlidis, John M. O’Toole, Francesco Pisani, Geraldine B. Boylan and Nathan J. Stevenson

J. Clin. Med. 2025, 14(10), 3528; https://doi.org/10.3390/jcm14103528 - 18 May 2025

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Abstract

Aim: To assess the inter-rater agreement and accuracy of human experts’ estimate of EEG maturational age (EMA) and a computer algorithm’s estimate of EMA over the first days after birth in a cohort of normally developing preterm infants. In addition, we explore the influence of post-natal age (PNA) on EMA estimates. Methods: Analysis was performed on EEG records from newborns determined appropriate for gestational age (GA) with favorable neurodevelopment at 2 years of age and without significant neurological compromise at time of EEG monitoring. Three 1h epochs of EEG were selected from 29 newborns with GA ranging from 23 to <32 weeks, within 72 h of birth. EEG epochs were visually assessed by two pediatric neurologists and a computer algorithm. In addition, the full, long-duration EEG recording of each newborn was assessed by one pediatric neurologist. EMA estimates were compared to GA using Pearson’s correlation coefficient (r) and bias and standard deviation of error (SDE). Intra-newborn agreements for the EMA estimates were assessed using standard deviation. Linear mixed-effects models were used to quantify the effect of PNA on EMA estimates. Results: The algorithm provides a more accurate estimate of GA using 1 h EEG epochs for correlation and bias: algorithm r = 0.83 vs. experts r = 0.60 and 0.66, p < 0.05 for n = 29; algorithm bias = −0.8 days vs. experts’ bias = 3.6 and 7.0 days, p < 0.01 for n = 29. SDE of 8.7 days for the algorithm was not significantly lower compared to the experts’ SDE = 12.4 and 13.2 days, p > 0.05. The algorithm has higher intra-newborn agreement compared to the experts: algorithm SDE = 4.9 days vs. experts SDE = 7.4 and 7.4 days, p = 0.027. For the two experts, increasing PNA is associated with an increase in EMA estimates of 6.6 days/days and 3.7 days/days. The assessment of full, long-duration EEG recordings improved the experts’ estimate of EMA (r = 0.82; SDE = 9.2 days). Conclusions: Automated analysis outperforms visual interpretation of the EEG at estimating EMA for short-duration EEG recordings. PNA is an important factor in EMA estimates. Full article

(This article belongs to the Special Issue Neonatal Neurology: New Insights, Diagnosis and Treatment)

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16 pages, 1696 KiB

Open AccessArticle

The Dammiss EEG Score: A New System to Quantify EEG Abnormalities and Predict the Outcome in Asphyxiated Newborns

by Fabrizio Ferrari, Carolina Bondi, Licia Lugli, Luca Bedetti, Isotta Guidotti, Federico Banchelli, Laura Lucaccioni and Alberto Berardi

J. Clin. Med. 2025, 14(6), 1920; https://doi.org/10.3390/jcm14061920 - 12 Mar 2025

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Abstract

Background: The aim of the study was to evaluate a novel EEG scoring system as a diagnostic and prognostic tool for brain injury in infants who had experienced perinatal asphyxia. Methods: The scoring system, based on a semi-quantitative approach, encompassed seven EEG parameters and their aggregate Dammiss score (DS) measured across seven time points (6 h, 12 h, 24 h, 48 h, 72 h, 78 h, and 2 weeks). The EEGs of 61 full-term newborns affected by perinatal asphyxia and treated with therapeutic hypothermia were evaluated. Results: The EEG parameters were correlated with the outcome at 2 years of age: 41 infants showed normal development; 16 presented with mild neurological abnormalities; and 4 developed cerebral palsy. Key EEG features—such as maturational patterns, sleep states, interburst interval, burst morphology and DS at 6 h of life—were highly predictive of outcomes. Correlations were also observed for sleep states, burst morphology, and DS at 12 and 24 h. Notably, burst amplitude and seizure did not correlate with outcome. Additionally, EEG recovery—observed in all patients—was temporarily impaired by seizures in 18% of the cooled infants. Conclusions: The EEG findings within the first 6 h of life were the most predictive of neurodevelopmental outcomes. The DS and EEG maturational features emerged as the most robust indicators of prognosis. Full article

(This article belongs to the Special Issue Neonatal Neurology: New Insights, Diagnosis and Treatment)

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10 pages, 745 KiB

Open AccessArticle

Effects of Resuscitation and Simulation Team Training on the Outcome of Neonates with Hypoxic-Ischemic Encephalopathy in South Tyrol

by Alex Staffler, Marion Bellutti, Arian Zaboli, Julia Bacher and Elisabetta Chiodin

J. Clin. Med. 2025, 14(3), 854; https://doi.org/10.3390/jcm14030854 - 28 Jan 2025

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Abstract

Background/Objectives: Neonatal hypoxic-ischemic encephalopathy (HIE) due to perinatal complications remains an important pathology with a significant burden for neonates, families, and the healthcare system. Resuscitation and simulation team training are key elements in increasing patient safety. In this retrospective cohort study, we evaluated whether regular constant training of all personnel working in delivery rooms in South Tyrol improved the outcome of neonates with HIE. Methods: We retrospectively analyzed three groups of neonates with moderate to severe HIE who required therapeutic hypothermia. The first group included infants born before the systematic introduction of training and was compared to the second group, which included infants born after three years of regular training. A third group, which included infants born after the SARS-CoV-2 pandemic, was compared with the previous two to evaluate retention of skills and the long-term effect of our training program. Results: Over the three study periods, mortality decreased from 41.2% to 0% and 14.3%, respectively. There was also a significant reduction of patients with subclincal seizures detected only through EEG, from 47.1% in the first period to 43.7% and 14.3% in the second and third study periods, respectively. Clinical manifestations of seizures decreased significantly from 47.1% to 37.5% and 10.7%, respectively, as well as severe brain lesions in ultrasound (US) and MRI. Conclusions: In this study, constant and regular simulation training for all birth attendants significantly decreases mortality and improves the outcome in neonates with moderate to severe HIE. This positive effect seems to last even after a one-year period during which training sessions could not be performed due to the COVID-19 pandemic. Full article

(This article belongs to the Special Issue Neonatal Neurology: New Insights, Diagnosis and Treatment)

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18 pages, 381 KiB

Open AccessSystematic Review

Cranial MRI beyond the Neonatal Period and Neurodevelopmental Outcomes in Neonatal Encephalopathy Due to Perinatal Asphyxia: A Systematic Review

by Corline E. J. Parmentier, Tobias Kropman, Floris Groenendaal, Maarten H. Lequin, Linda S. de Vries, Manon J. N. L. Benders and Thomas Alderliesten

J. Clin. Med. 2023, 12(24), 7526; https://doi.org/10.3390/jcm12247526 - 6 Dec 2023

Cited by 3 | Viewed by 3260

Abstract

Background: Magnetic resonance imaging (MRI) including diffusion-weighted imaging within seven days after birth is widely used to obtain prognostic information in neonatal encephalopathy (NE) following perinatal asphyxia. Later MRI could be useful for infants without a neonatal MRI or in the case of clinical concerns during follow-up. Therefore, this review evaluates the association between cranial MRI beyond the neonatal period and neurodevelopmental outcomes following NE. Methods: A systematic literature search was performed using PubMed and Embase on cranial MRI between 2 and 24 months after birth and neurodevelopmental outcomes following NE due to perinatal asphyxia. Two independent researchers performed the study selection and risk of bias analysis. Results were separately described for MRI before and after 18 months. Results: Twelve studies were included (high-quality n = 2, moderate-quality n = 6, low-quality n = 4). All reported on MRI at 2–18 months: seven studies demonstrated a significant association between the pattern and/or severity of injury and overall neurodevelopmental outcomes and three showed a significant association with motor outcome. There were insufficient data on non-motor outcomes and the association between MRI at 18–24 months and neurodevelopmental outcomes. Conclusions: Cranial MRI performed between 2 and 18 months after birth is associated with neurodevelopmental outcomes in NE following perinatal asphyxia. However, more data on the association with non-motor outcomes are needed. Full article

(This article belongs to the Special Issue Neonatal Neurology: New Insights, Diagnosis and Treatment)

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