Nora Bruns

Bio: Nora Bruns is an academic researcher from University of Duisburg-Essen. The author has contributed to research in topics: Medicine & Intensive care. The author has an hindex of 4, co-authored 20 publications receiving 70 citations.

Comparison of two common aEEG classifications for the prediction of neurodevelopmental outcome in preterm infants

Abstract: Neurodevelopmental outcome after prematurity is crucial. The aim was to compare two amplitude-integrated EEG (aEEG) classifications (Hellstrom-Westas (HW), Burdjalov) for outcome prediction. We recruited 65 infants ≤32 weeks gestational age with aEEG recordings within the first 72 h of life and Bayley testing at 24 months corrected age or death. Statistical analyses were performed for each 24 h section to determine whether very immature/depressed or mature/developed patterns predict survival/neurological outcome and to find predictors for mental development index (MDI) and psychomotor development index (PDI) at 24 months corrected age. On day 2, deceased infants showed no cycling in 80% (HW, p = 0.0140) and 100% (Burdjalov, p = 0.0041). The Burdjalov total score significantly differed between groups on day 2 (p = 0.0284) and the adapted Burdjalov total score on day 2 (p = 0.0183) and day 3 (p = 0.0472). Cycling on day 3 (HW; p = 0.0059) and background on day 3 (HW; p = 0.0212) are independent predictors for MDI (p = 0.0016) whereas no independent predictor for PDI was found (multiple regression analyses). Conclusion: Cycling in both classifications is a valuable tool to assess chance of survival. The classification by HW is also associated with long-term mental outcome.

Relationship between brain function (aEEG) and brain structure (MRI) and their predictive value for neurodevelopmental outcome of preterm infants.

Abstract: To improve the prediction of neurodevelopmental outcome in very preterm infants, this study used the combination of amplitude-integrated electroencephalography (aEEG) within the first 72 h of life and cranial magnetic resonance imaging (MRI) at term equivalent age. A single-center cohort of 38 infants born before 32 weeks of gestation was subjected to both investigations. Structural measurements were performed on MRI. Multiple regression analysis was used to identify independent factors including functional and structural brain measurements associated with outcome at a corrected age of 24 months. aEEG parameters significantly correlated with MRI measurements. Reduced deep gray matter volume was associated with low Burdjalov Score on day 3 (p < 0.0001) and day 1–3 (p = 0.0012). The biparietal width and the transcerebellar diameter were related to Burdjalov Score on day 1 (p = 0.0111; p = 0.0002). The final multiple regression analysis revealed independent predictors of neurodevelopmental outcome: intraventricular hemorrhage (p = 0.0060) and interhemispheric distance (p = 0.0052) for mental developmental index; Burdjalov Score day 1 (p = 0.0201) and interhemispheric distance (p = 0.0142) for psychomotor developmental index. Conclusion: Functional aEEG parameters were associated with altered brain maturation on MRI. The combination of aEEG and MRI contributes to the prediction of outcome at 24 months.

Pediatric Intensive Care Unit Admissions After Adolescent Suicide Attempts During the Pandemic.

Abstract: BACKGROUND AND OBJECTIVES The worldwide SARS-CoV-2 virus pandemic challenges adolescents' mental health. The aim of this study was to compare the number of pediatric intensive care unit (PICU) admissions after suicide attempts during the first German lockdown and one year later during a second, prolonged lockdown with pre-pandemic years. METHODS A retrospective multicenter study was conducted among 27 German PICUs. Cases <18 years admitted to the PICU due to accidents or injuries between March 16th and May 31st of 2017-2021 were identified based on ICD-10 codes (German modification) and patient data entered into a database. This study is a subset analysis on suicide attempts in adolescents aged 12-17.9 years. The Federal Statistics Office was queried for data on fatal suicides, which were available only for 2020 in adolescents aged 10-17.9 years. RESULTS Total admissions and suicide attempts declined during the first lockdown in 2020 (standardized morbidity ratio (SMR) 0.74 (95% CI 0.58-0.92) and 0.69 (0.43-1.04), respectively) and increased in 2021 (2.14 (SMR 1.86-2.45) and 2.84 (2.29-3.49), respectively). Fatal suicide rates remained stable between 2017-2019 and 2020 (1.57 v. 1.48/100,000 adolescent years) with monthly numbers showing no clear trend during the course of 2020. CONCLUSIONS This study shows a strong increase in serious suicide attempts among adolescents during the course of the pandemic in Germany. More research is needed to understand the relation between pandemic prevention measures and suicidal ideation to help implement mental health support for adolescents.

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

Abstract: 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.

Amplitude-Integrated EEG for Neurological Assessment and Seizure Detection in a German Pediatric Intensive Care Unit.

Abstract: Objective: The aim of our study was to assess the use of aEEG in our pediatric intensive care unit (PICU), indications for neuromonitoring and its findings, utility for seizure detection, and associations with outcome. Design: We retrospectively analyzed non-neonates who were treated in our PICU and received amplitude-integrated EEG (aEEG). Patients: 27 patients aged between 29 days and 10 0/12 years (median 7.3 months) were included, who received a total of 35 aEEGS. Measurements: aEEG tracings were assessed for background (BG) pattern and its evolution, seizures, and side differences using a visual classification (Hellstrom-Westas). Clinical data were collected from patients’ histories and analyzed for correlation with aEEG findings. Main results: While rare in early years, there was an increase in use over time. Most aEEGs were conducted because of (suspected) seizures or for management of antiepileptic treatment. aEEG had low sensitivity but high specificity for recognition of pathological BG pattern with reference to conventional EEG. Worsening of BG pattern or failure to improve was associated with death. Seizure detection rates by aEEG were higher than by clinical observation, especially for identification of non-convulsive epileptic state (ES). Side differences in aEEG were rare, but if present, they were associated with unilateral brain injury. Conclusions: aEEG is useful for the detection of seizures and ES in pediatric intensive care patients. Abnormal BG pattern and poor evolution of BG are negatively associated with survival. aEEG is a potential supplement to conventional EEG, facilitating long-term surveillance of cerebral function when continuous full-channel EEG is not available. Further investigation is needed.

Neonatal Intensive Care at Borderline Viability???Is It Worth It?

Abstract: Reported survival rates for very preterm infants of borderline viability, particularly those less than 25 weeks of gestational age, have increased through the 1990s, but most of the figures come from single hospital studies. Survival rates from geographically defined regions are always lower because infants who later die are not usually excluded. This cohort study of consecutive live births was an attempt to detect incremental changes in long-term outcomes and use of resources for very preterm infants. Participants had been born at gestational age 23-27 weeks in Victoria, Australia, in the years 1991-1992 and 1997. The groups included 401 and 208 infants, respectively. They were compared with randomly chosen normal-birth-weight (NBW) infants numbering 265 in the earlier period and 198 in 1977. Survivors were evaluated at age 2 years (corrected for prematurity) by pediatricians and psychologists knowing nothing of the infants' perinatal status. Impairments included cerebral palsy (CP), blindness (defined as visual acuity less than 20/200 in the better eye), deafness. requiring amplification, and developmental delay as demonstrated by the Mental Developmental Index (MDI) of the Bayley Scales of Infant Development. Intensive care was offered significantly more often in 1997 than in the earlier period. Survival to age 2 years exceeded 90% for each cohort in each time period. Rates of CP, blindness, and deafness in preterm infants were similar in both periods, as was the distribution of developmental quotient scores. The mean MDI for preterm children born in 1991-1992, based on the original Bayley Scales, was significantly lower than for NBW children from that era. The mean MDI on the revised Bayley Scales was significantly lower for preterm children born in 1997 than for their NBW peers. Rates of neurosensory disability were similar in the 2 periods. In each era, disability rates declined and the use of hospital resources (including assisted ventilation) increased with increasing gestational age. Approximately 1 in 2 very preterm survivors and 1 in 5 NBW controls had a disability. The incremental cost of improving survival and quality-adjusted survival was similar for infants born at gestational ages of 23-24 weeks and 25-27 weeks. This study shows improved outcome for very preterm infants related to increased intensive care. The incremental cost of improved outcomes is not excessive compared with infants who are slightly more mature at birth.

A review of important electroencephalogram features for the assessment of brain maturation in premature infants

Abstract: This review describes the maturational features of the baseline electroencephalogram (EEG) in the neurologically healthy preterm infant. Features such as continuity, sleep state, synchrony and transient waveforms are described, even from extremely preterm infants and includes abundant illustrated examples. The physiological significance of these EEG features and their relationship to neurodevelopment is highlighted where known. This review also demonstrates the importance of multichannel conventional EEG monitoring for preterm infants as many of the features described are not apparent if limited channel EEG monitors are used. Conclusion This review aims to provide healthcare professionals in the neonatal intensive care unit with guidance on the more common normal maturational features seen in the EEG of preterm infants. This article is protected by copyright. All rights reserved.

Cellular immune responses in amniotic fluid of women with preterm prelabor rupture of membranes

Abstract: Background Preterm birth is the leading cause of perinatal morbidity and mortality. Preterm prelabor rupture of membranes (pPROM) occurs in 30% of preterm births; thus, this complication is a major contributor to maternal and neonatal morbidity. However, the cellular immune responses in amniotic fluid of women with pPROM have not been investigated. Methods Amniotic fluid samples were obtained from women with pPROM and a positive (n = 7) or negative (n = 10) microbiological culture. Flow cytometry was performed to evaluate the phenotype and number of amniotic fluid leukocytes. The correlation between amniotic fluid immune cells and an interleukin-6 (IL-6) concentration or a white blood cell (WBC) count in amniotic fluid was calculated. Results Women with pPROM and a positive amniotic fluid culture had (1) a greater number of total leukocytes in amniotic fluid, including neutrophils and monocytes/macrophages and (2) an increased number of total T cells in amniotic fluid, namely CD4+ T cells and CD8+ T cells, but not B cells. The numbers of neutrophils and monocytes/macrophages were positively correlated with IL-6 concentrations and WBC counts in amniotic fluid of women with pPROM. Conclusion Women with pPROM and a positive amniotic fluid culture exhibit a more severe cellular immune response than those with a negative culture, which is associated with well-known markers of intra-amniotic inflammation.

Simultaneous Near-Infrared Spectroscopy (NIRS) and Amplitude-Integrated Electroencephalography (aEEG): Dual Use of Brain Monitoring Techniques Improves Our Understanding of Physiology.

Abstract: Continuous brain monitoring tools are increasingly being used in the neonatal intensive care unit (NICU) to assess brain function and cerebral oxygenation in neonates at high risk for brain injury. Near infrared spectroscopy (NIRS) is useful in critically ill neonates as a trend monitor to evaluate the balance between tissue oxygen delivery and consumption, providing cerebral and somatic oximetry values, and allowing earlier identification of abnormalities in hemodynamics and cerebral perfusion. Amplitude-integrated electroencephalography (aEEG) is a method for continuous monitoring of cerebral function at the bedside. Simultaneous use of both monitoring modalities may improve the understanding of alterations in hemodynamics and risk of cerebral injury. Several studies have described correlations between aEEG and NIRS monitoring, especially in infants with hypoxic-ischemic encephalopathy (HIE), but few describe the combined use of both monitoring techniques in a wider range of clinical scenarios. We review the use of NIRS and aEEG in neonates and describe four cases where abnormal NIRS values were immediately followed by changes in brain activity as seen on aEEG allowing the impact of a hemodynamic disturbance on the brain to be correlated with the changes in the aEEG background pattern. These four clinical scenarios demonstrate how simultaneous neuromonitoring with aEEG and NIRS provides important clinical information. We speculate that routine use of these combined monitoring modalities may become the future standard for neonatal neuromonitoring.

Comparison of two common aEEG classifications for the prediction of neurodevelopmental outcome in preterm infants

Abstract: Neurodevelopmental outcome after prematurity is crucial. The aim was to compare two amplitude-integrated EEG (aEEG) classifications (Hellstrom-Westas (HW), Burdjalov) for outcome prediction. We recruited 65 infants ≤32 weeks gestational age with aEEG recordings within the first 72 h of life and Bayley testing at 24 months corrected age or death. Statistical analyses were performed for each 24 h section to determine whether very immature/depressed or mature/developed patterns predict survival/neurological outcome and to find predictors for mental development index (MDI) and psychomotor development index (PDI) at 24 months corrected age. On day 2, deceased infants showed no cycling in 80% (HW, p = 0.0140) and 100% (Burdjalov, p = 0.0041). The Burdjalov total score significantly differed between groups on day 2 (p = 0.0284) and the adapted Burdjalov total score on day 2 (p = 0.0183) and day 3 (p = 0.0472). Cycling on day 3 (HW; p = 0.0059) and background on day 3 (HW; p = 0.0212) are independent predictors for MDI (p = 0.0016) whereas no independent predictor for PDI was found (multiple regression analyses). Conclusion: Cycling in both classifications is a valuable tool to assess chance of survival. The classification by HW is also associated with long-term mental outcome.