Name: how to obtain reliable visual event-related potentials in newborns
Uploaded: 2019-10-24T14:00:00
Description: Watch this Scientific Journal Video about How to Obtain Reliable Visual Event-related Potentials in Newborns at JoVE.com

Engineer H&#233;ctor Belmont, Dr. M&#243;nica Carlier, Dr. Yuria Cruz and Dr. Mar&#237;a Elena Ju&#225;rez collaborated in data collection. The authors thank Paul Kersey for revising English language use. The project was partially funded by PAPIIT grant IN2009/7 and CONACYT (National Council for Science and Technology, Mexico) grant 4971.

1. Preparation of the Newborns
NOTE: The procedure followed is innocuous and painless, so there are no counter-indications for evaluating full-term and preterm newborns, once they are clinically stable.
<ol>
	<li>Ensure two and half hour fasting and wakefulness before beginning the study, in neonates older than 40 weeks of postconceptional age.</li>
	<li>Make sure that the baby&#39;s head be washed with neutral soap the day before the study. Thus, his/her hair will be clean ...

<ol>
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A case study.</a> Documenta Ophthalmologica. 98, 247-256 (2000).</li><li>Mercuri, E., Siebenthal, K., Tutuncuoglu, S., Guzzetta, E., Casaer, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+Effect+of+Behavioural+States+on+Visual+Evoked+Responses+in+Preterm+and+Full-Term.">The Effect of Behavioural States on Visual Evoked Responses in Preterm and Full-Term.</a> Neuropediatrics. 26, 211-213 (1995).</li><li>Taylor, M. J., Menzies, R., MacMillan, L. J., Whyte, H. 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M., Hirano, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Establishment+of+normal+values+for+flash+visual+evoked+potentials+(VEPs)+in+preterm+infants:+a+longitudinal+study+with+special+reference+to+two+components+of+the+N1+wave.">Establishment of normal values for flash visual evoked potentials (VEPs) in preterm infants: a longitudinal study with special reference to two components of the N1 wave.</a> Electroencephalography and Clinical Neurophysiology. 96, 291-299 (1995).</li><li>Roy, M. S., Gosselin, J., Hanna, N., Orquin, J., Chemtob, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=In&#64258;uence+of+the+state+of+alertness+on+the+pattern+visual+evoked+potentials+(PVEP)+in+very+young+infant.">In&#64258;uence of the state of alertness on the pattern visual evoked potentials (PVEP) in very young infant.</a> Brain &amp; Development. 26, 197-202 (2004).</li><li>Kraemer, M., Abrahamsson, M., Sjostrom, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+neonatal+development+of+the+light+&#64258;ash+visual+evoked+potential.">The neonatal development of the light &#64258;ash visual evoked potential.</a> Documenta Ophthalmologica. 99, 21-39 (1999).</li><li>Apkarian, P., Mirmiran, M., Tijssen, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effects+of+Behavioral+State+on+Visual+Processing+in+Neonates.">Effects of Behavioral State on Visual Processing in Neonates.</a> Neuropediatrics. 22, 85-91 (1991).</li><li>Cubero-Rego, L., Corsi-Cabrera, M., Ricardo-Garcell, J., Cruz-Mart&#237;nez, R., Harmony, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Visual+evoked+potentials+are+similar+in+polysomnographically+de&#64257;ned+quiet+and+active+sleep+in+healthy+newborns.">Visual evoked potentials are similar in polysomnographically de&#64257;ned quiet and active sleep in healthy newborns.</a> International Journal of Developmental Neuroscience. 68, 26-34 (2018).</li><li>Mizrahi, E. M., Mosh&#233;, S. L., Hrachovy, R. A., Niedermeyer, E., Lopes da Silva, F. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Normal+EEG+and+Sleep:+Preterm+and+Term+Neonates.">Normal EEG and Sleep: Preterm and Term Neonates.</a> Niedermeyer's Electroencephalography: Basic Principles, Clinical Applications, and Related. , 154-163 (2011).</li><li>Grigg-Damberger, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+Visual+Scoring+of+Sleep+in+Infants+0+to+2+Months+of+Age.">The Visual Scoring of Sleep in Infants 0 to 2 Months of Age.</a> Journal of Clinical Sleep Medicine. 12 (3), 429-445 (2016).</li><li>Husain, A. M., Niedermeyer, E., Lopes da Silva, F. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Evoked+Potentials+in+Children+and+Infants.">Evoked Potentials in Children and Infants.</a> In Niedermeyer's Electroencephalography: Basic Principles, Clinical Applications, and Related Fields. , 1057-1082 (2011).</li><li>Odom, J. V., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=ISCEV+standard+for+clinical+visual+evoked+potentials:+2016+update.">ISCEV standard for clinical visual evoked potentials: 2016 update.</a> Documenta Ophthalmologica. 133 (1), 1-11 (2016).</li><li>Pojda-Wilczek, D., Maruszczyk, W., Sirek, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Flash+visual+evoked+potentials+(FVEP)+in+various+stimulation+conditions.">Flash visual evoked potentials (FVEP) in various stimulation conditions.</a> Documenta Ophthalmologica. 138, 35-42 (2019).</li><li>Tsuneishi, S., Casaer, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Stepwise+decrease+in+VEP+latencies+and+the+process+of+myelination+in+the+human+visual+pathway.">Stepwise decrease in VEP latencies and the process of myelination in the human visual pathway.</a> Brain &amp; Development. 19, 547-551 (1997).</li></ol>

Three components of visual-evoked responses (NII, PII and NIII) were characterized in healthy, full-term newborns while doing stimulation with LED googles, and recorded during polygraphically-identified sleep states. The VEP morphology observed is consistent with previous results reported for fewer neonates11,15. The characterization of VEP responses was achieved by recording 20 healthy, full-term newborns at similar post-conceptional age16</sup...

Early detection of abnormal development of the central nervous system in at-risk newborns is crucial for successful early interventions1,2. Visual event-related potentials (VEPs) provide a useful means of evaluating visual cortical status because they do not require patient cooperation, which is not possible in the first month of life, are objective, and are sensitive to structural and functional brain damage3,4.
Though, some studies of newborns have shown that normal visual-evoked responses indicate adequate neural maturation of the cerebral cortex4,5, and that this has often been studied in newborns to assess neurodevelopment and identify abnormal development of the visual pathways4,5, the clinical use of VEPs has been limited by the variability observed in their morphology4,5,6,7. Therefore, it is important to obtain better, more reliable characterizations of VEPs in newborns.
One cause of the variability in VEP morphology is that earlier studies have mixed preterm and older babies (over one month)8,9,10. However, the most important source is the lack of attention paid to the infants&#39; behavioral state while recording VEPs; namely, awake, quiet (QS), active (AS), or transitional sleep. QS and AS have either not been analyzed separately5,11,12, or studies have relied exclusively on behavioral observation without using polysomnography to identify states7,8. Trac&#233; alternant, which consists in bursts of high amplitude slow activity alternating with inter-burst intervals of minimal amplitudes is present in QS, but has not been taken into account when averaging VEPs. Some studies with newborns have measured VEPs by recording during wakefulness13,14, but at this stage of development waking periods are brief and newborns are usually crying or moving, which makes it difficult to obtain high quality, reliable recordings.
Few studies have used light-emitting diodes (LEDs) googles6,9 to elicit VEPs, though this light source generates more consistent recordings than the usual strobe flashes of white light11,14,15, which are less reliable. Obtaining replicable VEPs in the same newborn is indispensable for clinical use4, but another cause of variability is the low reproducibility of VEP morphology, likely due to the lack of control of physiological states and of the stimuli used to elicit VEPs. Given these conditions, the high variability of VEP morphology is hardly surprising.
A previous study conducted with 20 healthy full-term newborns that considered several sources of variability: post-conceptional age, polysomnographically-identified sleep states, LED googles to elicit VEPs, and measures of reproducibility between two VEP averages found that a clearer, more reliable VEP morphology can be obtained during active sleep. During this sleep stage all infants generated clear VEPs with higher correlations between two averages than in QS. Also, fewer VEP averages were required to obtain reproducibility16.
Given the clinical usefulness of VEP studies to assess, as early as possible, the integrity of visual pathways, this study proposes a series of methodological steps designed to obtain reliable VEPs in preterm and older newborns, using LED goggles during AS unambiguously defined by simultaneous polysomnography.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Digital Electroencephalograph</td>
			<td>Neuronic Mexicana, SA</td>
			<td>Medicid 3E</td>
			<td>Sleep electroencephalogram record</td>
		</tr>
		<tr>
			<td>Evoked Potentials equipment</td>
			<td>Neuronic Mexicana, SA</td>
			<td>Neuronic PE (N_N-SW-2.0)</td>
			<td>Visual evoked potentials record</td>
		</tr>
		<tr>
			<td>Nuprep Gel</td>
			<td colspan="2">WEAVER and Company</td>
			<td>Skin preparing abrasive gel (114 g)</td>
		</tr>
		<tr>
			<td>Ten20 Conductive Paste</td>
			<td colspan="2">WEAVER and Company</td>
			<td>Neurodiagnostic electrode paste (228 g)</td>
		</tr>
		<tr>
			<td>Tubular elastic mesh bandage</td>
			<td>Le Roy</td>
			<td></td>
			<td>Fixation of cranial surface electrodes, Size 4 or Small</td>
		</tr>
	</tbody>
</table>

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.

To detect adequate maturation in the function of the visual pathway it is essential to obtain the PII component of the VEP, which can be seen in both term and preterm infants. The simultaneous recording of VEPs with polysomnography during AS makes it possible to obtain typical VEPs.
Reliable VEP studies require obtaining reproducible average waveforms that will be indispensable for clinical use. Figure 2</st...

Watch this Scientific Journal Video about How to Obtain Reliable Visual Event-related Potentials in Newborns at JoVE.com

How to Obtain Reliable Visual Event-related Potentials in Newborns

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.

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

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