我们感谢我们的护士对视频制作的支持和贡献。

aEEGs 作为临床常规的一部分在我院进行。所提出的协议遵循机构和 #39; 人类研究伦理委员会的指导方针。在影片中出现的所有婴儿的父母都收集了有关拍摄和出版材料的书面知情同意书. 
 1. 收集所需的电源 <ol> <li> 将 eEEG 设备连接到监视所处的位置, 并将模块框插入脑电图设备. #160; #160; </li> <li> 确保有四电极用于单通道脑电图的两路脑电图和两个电极。选择针电极, 金杯, 或水凝胶电极。此外, 有一个水凝胶电极准备作为参考电极. 
	注: 金杯可消毒并可重复使用两年。针和水凝胶电极仅是一次性的。针电极可用于婴儿在23周的妊娠不造成皮肤损害或感染。在这里, 最好的结果是使用针电极在年长的婴儿以及. </li>
	<li> 准备以下用品: 制造商提供的定位条 (帮助正确放置电极)、适合新生儿使用的胶带 ( (如: 、粘胶)、适合新生儿使用的皮肤消毒剂 (。, 酒精或 octenidinhydrocholoride-based), 拭子, 皮肤准备凝胶, 模块盒, 和金杯接触凝胶. 
	注意: 断开电源后, 设备将关闭, 记录将需要重新启动。但是, 有些设备有内部电池, 可以在打开或录制过程中移动. </li>
</ol> 2。应用电极 <ol> <li> 遵守最小处理原则 42 , 43 , 44 , 在常规护理或产房中应用电极照顾.穿戴 (消毒) 手套、长袍、头巾和口罩, 根据机构和 #39 的指导方针以及病人和 #39 的感染状况. </li>
	<li> 为参考电极准备皮肤, 如下所示: <ol> <li> 对皮肤进行消毒。将皮肤准备凝胶放在棉签上直到湿润。用棉签涂抹几下轻柔的笔触, 用很少的压力。在怀孕23和25周的早产儿中, 要非常小心, 避免对未成熟的皮肤造成损害. </li>
		<li> 将参考电极放在婴儿的背部或胸前. </li>
		<li> 将测量装置放在婴儿和 #39 上; s 头, 并在婴儿和 #39 的耳屏和矢状缝合线上的相同的字母/标志; 两个箭头指示放置电极的位置 (C3、P3、C4 和 10-20 系统的 P4). </li>
	</ol> </li> <li> 将电极放在婴儿和 #39 头上, 按照下面的说明, 对应于所选电极的类型. </li>
	<li> 针电极. 
	<ol> <li> 对测量设备指示的区域进行消毒. </li>
		<li> 轻轻伸展皮肤, 将针插入切向, 就在皮肤下方的标记处, 针尖指向尾端方向。使用胶带保持电极到位. </li>
		<li> 对两个/全部四电极重复上述步骤. 
		注意: 使用针电极在非常早产儿, 因为摩擦为皮肤准备不是必要的. </li>
	</ol> </li> <li> 金杯。
	<ol> <li> 对测量设备指示的区域进行消毒. </li>
		<li> 在标记区域中准备皮肤, 如步骤2.2 所述. </li>
		<li> 用接触胶填充每个杯子。把杯子放在适当的位置, 电缆朝头端跑;磁带到位. </li>
	</ol> </li> <li> 水凝胶电极。
	<ol> <li> 对测量设备指示的区域进行消毒. </li>
		<li> 在标记区域中准备皮肤, 如步骤2.2 所述. </li>
		<li> 将电极与电缆连接到头端。用胶带固定电极, 以防它们不留在原地. </li>
	</ol> </li> </ol> 3。将导线连接到显示器 <ol> <li> 将电缆插入模块框中, 如框中的图例所示. </li>
	<li> 默认启动屏幕包括所有电极的阻抗监视. </li>
	<li> 确保所有电极都到位, 并且电极之间没有机械接触。如果一个或多个电极的阻抗不理想, 取出相应的电极, 用棉签进行一两次击球, 但不要施加更多的压力. </li>
	<li> 设置所有内容时开始录制. 
	注意: 强制记录参数是原始的脑电图和阻抗。根据该装置和临床适应症, 其他选择包括突发抑制率、锐瞬态强度和频谱边缘频率等。标准参数的审查包括原始脑电图, 振幅综合脑电图曲线, 和阻抗。根据设备的不同, 还有机会查看更多的功能, 如光谱边缘频率, 或较低、平均和上边框的表示形式。其他功能包括检出检测和突发率分析. </li>
</ol> 4。可选: 放置一个 cpap 帽 <ol> <li> 如果需要, 在脑电图电极上放置一个 cpap 帽或头带. </li> </ol>
 5. 在录制过程中要牢记的方面 <ol> <li> 定期检查阻抗和电极的错位, 以获得高质量的录音。此外, 检查婴儿的皮肤刺激, 以避免损害或感染. </li>
	<li> 标记事件 (例如, 处理, 袋鼠护理 (皮肤护理), 呼吸暂停, 插管, 镇静剂或阿片类药物), 以方便使用大脑屏幕上提供的按钮识别工件功能监视器。在袋鼠护理期间留下脑电图电极以恢复记录. </li>
	<li> 留出脑电图电极用于插管或其他侵入性措施, 以便以后恢复录制。如果电缆不够长, 不能将婴儿放在孵化箱内, 请将它们与模块盒断开, 并在过程之后重新连接. </li>
</ol> 6。查看脑电图跟踪和存储的 <ol> <li> 检查在显示器上重新编码结束时的跟踪, 或将其传输到外部存储设备. </li> </ol>

作者没有什么可透露的。

大脑功能监测器是一种易于访问和越来越常见的设备, 用于记录振幅集成脑电图在 NICUs13。在常规护理中, 脑电图的应用需要 3-5 分钟。
本协议中的关键步骤是将电极正确放置在头上, 并将电缆连接到模块盒的相应插头上。电极放置之前需要彻底的皮肤消毒和准备, 特别是对参考电极。根据我们的经验, 当参考电极被放置在婴儿的背部时, 最好记录就会实现。为解决问题, 应检查电极位错在高阻抗的情况下。如果电极位错已被披露, 并重复的皮肤准备失败, 电极可能需要更换。在上边框偏移的情况下, 参考电极需要优化。高频和高振幅的原始脑电图和振幅综合脑电图是由肌肉活动或干扰 (例如,高频振荡通气)。追踪的这一部分不能用于解释。如果在大脑健康的婴儿中发生平迹, 应查看 cross-cerebral 追踪。如果这是正常的, 很可能是像汗液或超声波凝胶的液体导致了两个电极之间的桥接。在持续的问题, 制造商有联系人, 将帮助确定一个解决方案, 甚至会来到新生儿监护病房检查的根本原因。在我们的经验, 针电极是推荐的类型的电极在非常早产婴儿。经过彻底的消毒和温和的皮肤准备的参考电极, 我们没有观察到大量的感染, 严重的皮肤损害, 或出血事件自 large-scale 使用该技术在我们的中心在 2008年 (平均每年 60-80 非常低出生体重婴儿, 1-5 录音每婴儿)。自2014年以来, 我们只使用针电极在所有的新生儿, 因为我们获得最好的结果使用这种类型的电极。
对脑电图的修改通常不进行, 但电极可以放置在任何位置上的头部, 以获得一个理想的跟踪 (从国际 10-20 系统)。在某些情况下, 电极位置可能需要调整 (例如,由于真空萃取或头后的皮肤撕裂)45。对于根据振幅进行分类, 保持标准的极距离很重要, 因为极距离的减少会导致振幅的降低39,45。在极端的头部大小的情况下, 这种极端早产儿 (即, 23-24 周的妊娠) 或足月婴儿由于脑积水, 极距离的重要性, 解释应保持在介意.传统脑电图的另一个修改是连续监视的有限通道脑电图18,46,47。从脑功能监测中获得的原始脑电图曲线可以像传统的脑电图曲线一样进行评估。在我们的中心, 我们使用这种方法来回答有关新生儿 neuropediatric 患者的特殊问题, 与我们的儿科神经学家密切合作。
脑电图的主要限制是, 只有大脑表面的一个小区域被追踪所覆盖。因此, 在大脑表面不同区域的 electrocortical 活动的改变可能仍然被忽视13。由于时间的压缩, short-lasting 脑活动的变化是难以检测不使用原始脑电图曲线。对原始脑电图曲线的进一步解释需要了解常规脑电图或与家或儿科神经学家密切合作。最后, 但并非最不重要的, 有几个外部和内部因素, 导致改变在脑电图波段, 必须牢记在解释跟踪。
尽管如此, 脑电图为新生儿持续脑功能监测提供了可能性。它是容易接近的, 并且解释不是困难的。由于它包含的信息比传统的 EEG 少, 它不能取代这种技术。相反, 它补充了现有的脑诊断方法, 如脑电图, 超声和磁共振成像。有很好的证据来预测足月婴儿出生后窒息的结局, 并建立了脑电图, 作为一种工具, 以确定将受益于冷却8的婴儿。在早产儿, 也有很好的证据表明, 长期神经结果可以预测早期脑电图记录15,16,17,18,19 ,20。然而, 到目前为止, 这一知识并没有导致在这一群体的婴儿的临床决策的后果。对于未来, 大脑功能监测很可能会成为 NICUs 的标准工具, 以及辅助中心和儿科重症监护病房。

脑电图最初被开发为成人监护病房的床边监测器1。第一份详述其在新生儿中使用的出版物可追溯到二十世纪八十年代代末的2,3。早期临床应用主要用于检测脑检出活动, 监测抗癫痫药物治疗4, 并预测新生儿窒息后的脑结局5,6,7 ,8,9。婴儿与出生窒息没有显示严重抑制的背景活动和癫痫活动有一个更有利的结果, 如果他们被冷却8, 但本主题的研究仍在进行中10,11, 12。在过去的30年中, 新生儿脑功能监测在 NICUs13中变得更为普遍。现在, 它越来越多地被用于早产儿的人口。脑电图已被证明是一种安全的方法, 大脑功能监测, 即使在极端早产儿, 并一般接受的新生儿监护病房工作人员14。几项研究显示早产儿早期脑电图记录与神经发育结局的相关性15,16,17,18,19, 20。
脑电图是基于传统的脑电图, 这是记录与两个或四头皮电极, 描绘的振幅的原始脑电图在一个 time-compressed 半规模1。在国际10-20 系统的 C3、P3、C4 和 P4 位置放置的两个或四电极的信号通过带通滤波器传递, 它增强了2到15赫兹之间的频率. 频率在2赫兹和高于15赫兹之下被减弱为了消除人工制品, 如出汗, 运动, 肌肉活动, 和电气干扰, 尽可能多的1,4。进一步的处理包括滤波、整流、平滑、半振幅压缩和时间压缩。振幅和 #60; 10 µV 显示在线性尺度和振幅和 #62; 10 µV 在对数刻度上21。最低检测的振幅显示为下边框, 最高的振幅显示为上边框21。通过这种方法, 即使在较低振幅的微小变化仍然可见, 而在高振幅显示的重载是避免21 (图 1)。由于时间压缩, 5-6 cm 在时间刻度代表 1 h, 因而做回顾脑子活动在小时和甚而几天可能1,4,13。
脑电图跟踪中的可见信息仅限于振幅的变化。现代设备提供了观察原始脑电图的可能性, 所以原始脑电图曲线的频率和形态也可以考虑解释。这有助于区分在脑电图带4的可疑部分期间的人工制品和实际扣押活动。一些脑电图设备可以记录患者的同步视频, 以便更好地识别癫痫和伪影。在整个记录21期间监视电极阻抗。在使用四电极的双通道脑电图设备中, 调查人员可以在两个内曲线或一个 transcerebral 曲线之间切换 (图 2)。根据制造商, 软件提供了额外的功能, 如癫痫检测, 突发率分析, 肌电图,等。也可以从 full-channel EEG 设备中获得脑电图, 该装置提供视频记录、肌电图、electrooculography、心电图、等。
减少的电生理信息和时间压缩, 使连续监测和床边解释可能不需要特定的知识有关 EEG。由于记录时间长, 甚至可以检测到亚临床检出活动, 否则将保持不被注意4,22 , 因为常规的脑电图监测在很长的时间段内是不可用的NICUs然而, 必须考虑的是, 并非所有的病理改变, 如癫痫发作, 是由于大脑表面的小面积记录13。因此, 脑电图并不意味着取代传统的脑电图, 而是补充它13。
Electrocortical 活动, 如脑电图背景模式所反映, 根据婴儿的孕龄变化4,23,24,25。足月婴儿和晚早产儿的背景模式主要是连续的, 其振幅低于5µV4。在安静睡眠期间, 背景图案变得更加不连续26。在非常早产儿, 支配的背景模式是不连续的: 高活动期 (即,高爆发) 交替与低活动的事件27。这种生理模式必须与爆裂抑制模式区别开来, 这是病态的27。随着孕龄的增加, 脑电图和背景模式变得更加连续, 连续活动的持续时间增加27,28,29。发展和现有的病理条件也可以显示的脑电图跟踪 (例如,发展的脑室出血和脑室白质与急性干扰的背景活动)30,31. 严重的脑膜炎可以引起平坦的痕迹。
脑电图的定性解释一般包括三类: 背景模式的分类、睡眠唤醒循环和癫痫的存在。几位作者对描述大脑成熟的分类和评分提出了建议16,21<s></s>向上,24,25。脑电图的定量分析虽然在现代设备中是可能的, 但很少有研究小组利用这种方法32,33,34。我们想简单地介绍3种不同的方法对脑电图脉象的定性和半定量评估:
Hellström-Westas:21
对追踪的评估纯粹是定性的, 结果没有转化成一个分数。分类允许描述病理条件。已发表了孕龄的标准值, 以帮助解释模式是否适合年龄21: (1) 背景模式: 连续正常电压 (生理), 间断正常电压 (生理早产婴儿), 爆裂抑制模式 (病理), 连续低电压 (病理), 扁平迹 (病理);(2) 睡眠唤醒循环: 无, 迫在眉睫, 成熟 (生理/病理, 视婴儿年龄而定);和 (3) 癫痫发作: 无, 单发作, 反复发作, 癫痫状态。
Burdjalov:25
这种分类的方法是对跟踪的定性评估及其转化为分数。分数随着孕龄而上升, 每个相应胎龄的标准评分值已公布: (1) 0-2 点为连续性, (2) 0-5 点为睡眠-苏醒循环, (3) 0-2 点为下边界的振幅, (4) 0-4 点为 的带宽, (5) 0-13 点的总分。
Olischar/Klebermass:16,24
分有关的背景模式 (即,不连续的正常电压, 不连续的低电压和连续的正常电压) 的百分比持续时间和爆发率被开发为孕龄。脉象被评估为一个年龄充足的背景模式, 存在睡眠唤醒循环, 和存在的癫痫活动 (即, 重复发作或持续癫痫状态)。然后, 将脉象分为分级评分如下: (1) 正常脑电图 (所有类别正常), (2) 中等异常 (1 出3类别归类为异常), 和 (3) 严重异常 (2 或3出的3类别归类为异常)。这一评分已被证明有一个预测价值的神经发育结果在3年的修正年龄。
脑电图追踪的变化是由许多 extracortical 因素引起的, 如脑血流量的变化, 药物 (如:阿片、镇静剂、咖啡因)、酸中毒、二氧化碳张力的变化、临床情况 (如:hypogylcemia, 脓毒症, 脑膜炎, 动脉导管未闭),等21,32,35,36,37,38。脑电图带本身对阻抗的变化相当敏感, 但在电极距离和定位39方面观察到了显著的变化。工件可能会造成解释上的问题: 由于头皮水肿或极距离的影响, 振幅变化的绝对值39,40。由心电图、高频振荡通气、肌肉活动、婴儿运动或处理引起的干扰可能导致更低的边框增加40。在现代设备中, 可以通过同时记录原始脑电图和脑电图, 并通过标记处理的开始和结束部分来避免这种情况。液体 (例如,汗或超声波凝胶) 可以导致电极之间的连接, 假装平坦的痕迹模式。大约12% 录音时间在长期 aEEGs 被改变由于文物, 55% 由电子干涉导致和45% 是运动工件41。

<table><tbody><tr><td>disposable subdermal needle electrodes</td><td>Technomed</td><td>TE/S43-438</td><td></td></tr><tr><td>Genuine Grass Gold Disk Electrodes</td><td>Natus</td><td>FE5GH-03</td><td></td></tr><tr><td>neonatal hydrogel sensors</td><td>Natus</td><td>CZA00037</td><td></td></tr><tr><td>positioning strips</td><td>Natus</td><td>OBM00047</td><td></td></tr><tr><td>skin markers</td><td>Natus</td><td>CZN00011</td><td></td></tr><tr><td>Nu Prep skin prepping gel</td><td>Weaver and Company</td><td>10-30</td><td></td></tr><tr><td>contact gel Ten 20</td><td>Weaver and Company</td><td>10-20-4T</td><td></td></tr><tr><td>skin disinfectant</td><td></td><td></td><td></td></tr><tr><td>tape</td><td></td><td></td><td></td></tr><tr><td>cotton swab</td><td></td><td></td><td></td></tr><tr><td>Braintrend&lt;sup&gt;&amp;#174;&lt;/sup&gt; aEEG Monitor</td><td>aEEG Monitor</td><td></td><td></td></tr></tbody></table>

application of an amplitude-integrated eeg monitor (cerebral function monitor) to neonates

振幅综合脑电图 (脑电图) 是一种易于获取的技术, 以监测早产儿和足月婴儿在新生儿重症监护病房 (NICUs) electrocortical 活动。该方法首次用于新生儿窒息后的监测, 提供有关未来神经系统结局的信息。脑电图也有助于选择从降温中受益的新生儿。对早产儿的脑电图监测越来越普遍, 因为各种研究表明神经发育结局与早期脑电图脉象有关。在这里, 我们展示了脑电图监测系统的应用和目前的典型模式, 依赖于孕龄和病理生理条件。此外, 我们提到的脑电图解释的陷阱, 因为这种方法需要精确的固定和定位的电极。此外, 原始脑电图可用于检测新生儿癫痫发作或识别脑电图的应用问题。结论脑电图是一种安全、一般耐受的新生儿脑功能监护方法;它甚至可以提供有关长期结果的信息。

图 2显示了脑电图监视器的典型视图。连续和间断的正常电压模式分别被认为是足月和早产儿的生理背景模式 (图 3和图 4)。一个突发抑制模式, 连续的低压模式, 和平坦的痕迹是病理背景模式 (图 5, 图 6, 图 7)。
足月婴儿的癫痫发作有一个典型的形状, 下边界和上边框都突然上升 (图 8)。然而, 在早产儿中, 癫痫发作可以用不连续的模式伪装, 只能通过观察原始脑电图来检测 (图 9)。
液体桥接可以导致明显的平面跟踪 (图 10)。通常, 这发生在双通道脑电图 (内曲线)。如果 cross-cerebral 脑电图是生理的, 而内曲线显示一个平坦的痕迹, 电极应检查液体。电干扰, 运动和处理可能导致明显的癫痫发作, 甚至明显的癫痫持续状态。如果发生这种情况, 应检查阻抗和参考电极, 并应查看原始脑电图 (图 11)。下边界和上边框高程的另一个原因是参考电极的位移。

<img alt="Figure 1" class="xfigimg" src="/files/ftp_upload/55985/55985fig1.jpg"> 
图1。脑电图追踪的形成。 信号从原始的 eeg (上部曲线) 被处理, 导致振幅综合 eeg 带 (下曲线)。高振幅形成上边界, 而低振幅形成较低的边界。当振幅高度的强变化导致一个宽的脑电图带时, 如果振幅高度的变化不大, 脑电图带就会变窄。y-axis 的规模是线性的10µV 和对数以上的10µV.<a href="http://ecsource.jove.com/files/ftp_upload/55985/55985fig1large.jpg" target="_blank">请单击此处查看此图的较大版本.</a>
<img alt="Figure 2" class="xfigimg" src="/files/ftp_upload/55985/55985fig2.jpg"> 
图2。脑电图显示器的典型显示。 显示器的上半部分显示原始 EEG 曲线 (显示的区域等于十年代)。在左显示, 下半显示单边脑电图跟踪 (显示的部分等于约3小时)。在右侧显示中, 显示相应的 cross-cerebral 跟踪。游标表示从原始 EEG 中进行振幅积分跟踪的部分。<a href="http://ecsource.jove.com/files/ftp_upload/55985/55985fig2large.jpg" target="_blank">请单击此处查看此图的较大版本.</a>
<img alt="Figure 3" class="xfigimg" src="/files/ftp_upload/55985/55985fig3v2.jpg"> 
图3。连续的正常电压模式。 连续的背景模式与睡眠唤醒循环。x 轴等于时间 (一平方 = 10 分钟)。<a href="http://ecsource.jove.com/files/ftp_upload/55985/55985fig3v2large.jpg" target="_blank">请单击此处查看此图的较大版本.</a>
<img alt="Figure 4" class="xfigimg" src="/files/ftp_upload/55985/55985fig4.jpg"> 
图4。不连续的正常电压模式。 不连续的背景模式与迫在眉睫的睡眠唤醒循环。x 轴等于时间 (一平方 = 10 分钟)。<a href="http://ecsource.jove.com/files/ftp_upload/55985/55985fig4large.jpg" target="_blank">请单击此处查看此图的较大版本.</a>
<img alt="Figure 5" class="xfigimg" src="/files/ftp_upload/55985/55985fig5.jpg"> 
图5。突发抑制模式。 冲击抑制模式, 低振幅持续低, 无变化。x 轴等于时间 (一平方 = 10 分钟)。 从布伦斯, n Amplituden-integriertes 脑电图北极端 unreifen Frühgeborenen 在洞穴 ersten 4 Lebenswochen。http://www.diss.fu-berlin.de/diss/receive/FUDISS_thesis_000000036576 (2012)。<a href="http://ecsource.jove.com/files/ftp_upload/55985/55985fig5large.jpg" target="_blank">请单击此处查看此图的较大版本.</a>
<img alt="Figure 6" class="xfigimg" src="/files/ftp_upload/55985/55985fig6.jpg"> 
图6。平坦的痕迹。 在一个足月婴儿与严重脑炎的两侧平坦的痕迹。x 轴等于时间 (一平方 = 10 分钟)。 从布伦斯, n Amplituden-integriertes 脑电图北极端 unreifen Frühgeborenen 在洞穴 ersten 4 Lebenswochen。http://www.diss.fu-berlin.de/diss/receive/FUDISS_thesis_000000036576 (2012)。<a href="http://ecsource.jove.com/files/ftp_upload/55985/55985fig6large.jpg" target="_blank">请单击此处查看此图的较大版本.</a>
<img alt="Figure 7" class="xfigimg" src="/files/ftp_upload/55985/55985fig7.jpg"> 
图7。连续低电压模式。 连续低压模式, 无睡眠唤醒循环。x 轴等于时间 (一平方 = 10 分钟)。 从布伦斯, n Amplituden-integriertes 脑电图北极端 unreifen Frühgeborenen 在洞穴 ersten 4 Lebenswochen。http://www.diss.fu-berlin.de/diss/receive/FUDISS_thesis_000000036576 (2012)。<a href="http://ecsource.jove.com/files/ftp_upload/55985/55985fig7large.jpg" target="_blank">请单击此处查看此图的较大版本.</a>
<img alt="Figure 8" class="xfigimg" src="/files/ftp_upload/55985/55985fig8.jpg"> 
图8。足月婴儿的癫痫发作。 脑电图的典型描述: 在低和上缘突然上升之后, 活动的时间就会减少。重复发作约3.5 小时。x 轴等于时间 (一平方 = 10 分钟)。 从布伦斯, n Amplituden-integriertes 脑电图北极端 unreifen Frühgeborenen 在洞穴 ersten 4 Lebenswochen。http://www.diss.fu-berlin.de/diss/receive/FUDISS_thesis_000000036576 (2012)。<a href="http://ecsource.jove.com/files/ftp_upload/55985/55985fig8large.jpg" target="_blank">请单击此处查看此图的较大版本.</a>
r. 内页 = "1" ><img alt="Figure 9" class="xfigimg" src="/files/ftp_upload/55985/55985fig9.jpg"> 
图9。早产婴儿的癫痫发作。 如果没有原始的脑电图, 两个半球的 hypersynchronous 活动将保持不被察觉。x 轴等于时间 (一平方 = 10 分钟)。 从布伦斯, n Amplituden-integriertes 脑电图北极端 unreifen Frühgeborenen 在洞穴 ersten 4 Lebenswochen。http://www.diss.fu-berlin.de/diss/receive/FUDISS_thesis_000000036576 (2012)。<a href="http://ecsource.jove.com/files/ftp_upload/55985/55985fig9large.jpg" target="_blank">请单击此处查看此图的较大版本.</a>
<img alt="Figure 10" class="xfigimg" src="/files/ftp_upload/55985/55985fig10.jpg"> 
图10。明显平坦的痕迹。 在单侧脉象, 在没有脑损伤的婴儿中, 似乎有一种病理性扁平的痕迹。cross-cerebral 追踪显示了一种具有连续活动短段的生理不连续背景模式。在这种情况下, 平迹是由电极之间的液体架桥 (特别是水凝胶电极) 造成的伪迹。x 轴等于时间 (一平方 = 10 分钟)。 从布伦斯, n Amplituden-integriertes 脑电图北极端 unreifen Frühgeborenen 在洞穴 ersten 4 Lebenswochen。http://www.diss.fu-berlin.de/diss/receive/FUDISS_thesis_000000036576 (2012)。<a href="http://ecsource.jove.com/files/ftp_upload/55985/55985fig10large.jpg" target="_blank">请单击此处查看此图的较大版本.</a>
<img alt="Figure 11" class="xfigimg" src="/files/ftp_upload/55985/55985fig11.jpg"> 
图11。明显的癫痫发作 此图像显示在很长一段时间内的高频活动。未见原始脑电图曲线, 显示癫痫持续状态。这个工件是由肌肉活动引起的。x 轴等于时间 (一平方 = 10 分钟)。 从布伦斯, n Amplituden-integriertes 脑电图北极端 unreifen Frühgeborenen 在洞穴 ersten 4 Lebenswochen。http://www.diss.fu-berlin.de/diss/receive/FUDISS_thesis_000000036576 (2012)。<a href="http://ecsource.jove.com/files/ftp_upload/55985/55985fig11large.jpg" target="_blank">请单击此处查看此图的较大版本.</a>

Watch this Scientific Journal Video about Application of an Amplitude-integrated EEG Monitor Cerebral Function Monitor to Neonates at JoVE.com

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

在这里, 我们展示了如何应用振幅综合脑电图监测新生儿脑功能。

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 ...

application-an-amplitude-integrated-eeg-monitor-cerebral-function

Research

JoVE Journal

Medicine

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

38.3K 次观看.  University Duisburg-Essen. 在这里, 我们展示了如何应用振幅综合脑电图监测新生儿脑功能。

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

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

The Application Of Permanent Middle Cerebral Artery Ligation in the Mouse

Focal cerebral ischemia is among the most common type of stroke seen in patients. Due to the clinical significance there has been a prolonged effort to develop suitable animal models to study the events that unfold during ischemic insult. These techniques include transient or permanent, focal or global ischemia models using many different animal models, with the most common being rodents.
The permanent MCA ligation method which is also referred as pMCAo in the literature is used extensively as a focal ischemia model in rodents 1-6. This method was originally described for rats by Tamura et al. in 1981 7. In this protocol a craniotomy was used to access the MCA and the proximal regions were occluded by electrocoagulation. The infarcts involve mostly cortical and sometimes striatal regions depending on the location of the occlusion. This technique is now well established and used in many laboratories 8-13. Early use of this technique led to the definition and description of &#x201C;infarct core&#x201D; and &#x201C;penumbra&#x201D; 14-16, and it is often used to evaluate potential neuroprotective compounds 10, 12, 13, 17. Although the initial studies were performed in rats, permanent MCA ligation has been used successfully in mice with slight modifications 18-20 .
This model yields reproducible infarcts and increased post-survival rates. Approximately 80% of the ischemic strokes in humans happen in the MCA area 21 and thus this is a very relevant model for stroke studies. Currently, there is a paucity of effective treatments available to stroke patients, and thus there is a need for good models to test potential pharmacological compounds and evaluate physiological outcomes. This method can also be used for studying intracellular hypoxia response mechanisms in vivo. 
Here, we present the MCA ligation surgery in a C57/BL6 mouse. We describe the pre-surgical preparation, MCA ligation surgery and 2,3,5 Triphenyltetrazolium chloride (TTC) staining for quantification of infarct volumes.

Middle cerebral artery (MCA) ligation is a technique to study focal cerebral ischemia in animal models. In this method, the middle cerebral artery is exposed by craniotomy and ligated by cauterization. This method gives highly reproducible infarct volumes and increased post-operative survival rates compared to other methods available.

在小鼠永久性大脑中动脉结扎术中的应用

Focal cerebral ischemia is among the most common type of stroke seen in patients. Due to the clinical significance there has been a prolonged effort to ...

医学

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 ...

Using Quantitative Real-time PCR to Determine Donor Cell Engraftment in a Competitive Murine Bone Marrow Transplantation Model

Murine bone marrow transplantation models provide an important tool in measuring hematopoietic stem cell (HSC) functions and determining genes/molecules that regulate HSCs. In these transplant model systems, the function of HSCs is determined by the ability of these cells to engraft and reconstitute lethally irradiated recipient mice. Commonly, the donor cell contribution/engraftment is measured by antibodies to donor- specific cell surface proteins using flow cytometry. However, this method heavily depends on the specificity and the ability of the cell surface marker to differentiate donor-derived cells from recipient-originated cells, which may not be available for all mouse strains. Considering the various backgrounds of genetically modified mouse strains in the market, this cell surface/ flow cytometry-based method has significant limitations especially in mouse strains that lack well-defined surface markers to separate donor cells from congenic recipient cells. Here, we reported a PCR-based technique to determine donor cell engraftment/contribution in transplant recipient mice. We transplanted male donor bone marrow HSCs to lethally irradiated congenic female mice. Peripheral blood samples were collected at different time points post transplantation. Bone marrow samples were obtained at the end of the experiments. Genomic DNA was isolated and the Y chromosome specific gene, Zfy1, was amplified using quantitative Real time PCR. The engraftment of male donor-derived cells in the female recipient mice was calculated against standard curve with known percentage of male vs. female DNAs. Bcl2 was used as a reference gene to normalize the total DNA amount. Our data suggested that this approach reliably determines donor cell engraftment and provides a useful, yet simple method in measuring hematopoietic cell reconstitution in murine bone marrow transplantation models. Our method can be routinely performed in most laboratories because no costly equipment such as flow cytometry is required.

Determining donor cell engraftment presents a challenge in mouse bone marrow transplant models that lack well-defined phenotypical markers. We described a methodology to quantify male donor cell engraftment in female transplant recipient mice. This method can be used in all mouse strains for the study of HSC functions.

采用实时定量PCR检测供体细胞植入一个具有竞争力的小鼠骨髓移植模型

Murine bone marrow transplantation models provide an important tool in measuring hematopoietic stem cell (HSC) functions and determining genes/molecules ...

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 ...

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

Pain is an unpleasant sensory and emotional experience. In non-verbal patients, it is very difficult to measure pain, even with pain assessment tools. Those tools are subjective or determine secondary physiological indicators which also have certain limitations particularly when exploring the effectiveness of analgesia. As cortical processing is essential for pain perception, brain activity measures may provide a useful approach to assess pain in infants. Here we present a method to assess nociception with electrophysiological brain activity recordings optimized for the use in newborn infants. To produce highly standardized and reproducible noxious stimuli we applied mechanical stimulation with a flat-tip probe, e.g., PinPrick, which is not skin-breaking and does not cause behavioral distress. The noxious-evoked potential allows the objective measurement of nociception in non-verbal patients. This method can be used in newborn infants as early as 34 weeks of gestational age. Moreover, it could be applied in different situations such as measuring the efficacy of analgesic or anesthetic drugs.

Measuring pain in non-verbal patients is a challenge. In this study we combine EEG recording with stimulation using a flat-tip probe to detect noxious-evoked brain activity in an objective manner.

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

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

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 ...

振幅综合脑电图监测仪 (脑功能监护仪) 在新生儿中的应用

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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

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