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To assess the efficacy of a preterm-targeted screening programme against the routine Australian National Health Medical Research Council (NHMRC) universal child health screening programme to detect disability in a general practice setting in children bornor =31 weeks gestation at 12-months of age.Multi-centred trial involving 202 preterm children randomised to receive the preterm-targeted or NHMRC programme. Primary outcome, correct identification of neurosensory disability by general practitioners assessed against gold standard paediatric assessments. Sensitivity analysis estimated interrater agreement and screening accuracy. Secondary outcomes, post natal depression (PND), parental stress, health service use, screening programme helpfulness and correct identification of levels of disability severity.Of the 195 infants with data on the primary outcome in the preterm-targeted group, their general practitioners correctly identified the disability status of 61/93 (65.6%) children, as compared with 69/102 (67.6%) in the NHMRC group (odds ratios (OR) 0.91 95% confidence interval (CI) 0.50, 1.65). Responses where general practitioners were unsure of a child's disability status were coded as incorrect and not paired for sensitivity analysis. Sensitivity analysis for 180 diagnostic pairs showed fair interrater agreement for both groups (preterm-targeted k = 0.30 vs. NHMRC k = 0.29) with screening test results favouring the preterm-targeted group with greater sensitivity (73% vs. 33%) but lower specificity (70% vs. 92%) resulting in more over referrals (30% vs. 8%); however, these had a significantly lower mean Developmental Quotient (DQ) score compared with non-disabled children. PND scores were higher in preterm-targeted group (OR 1.33 95% CI 0.01, 2.66).The preterm-targeted programme used by general practitioners: (i) did not improve overall identification of disability status compared to the NHMRC universal programme (Australian New Zealand Clinical Trails Registry number, ACTRN 12606000472572); however (ii) it did demonstrate greater efficacy as a screening tool in accurately identifying disabled children.

Hypoxic-ischemic (HI) injury in the preterm neonate incurs numerous functional deficits, however little is known about the neurochemically-defined brain nuclei that may underpin them. Key candidates are the brainstem catecholamine neurons. Using an immature animal model, the postnatal day (P)-3 (P3) rat pup, we investigated the effects of HI on brainstem catecholamine neurons in the locus coeruleus, nucleus tractus solitarius (NTS), and ventrolateral medulla (VLM). On P21, we found that prior P3 HI significantly reduced numbers of catecholaminergic neurons in the locus coeruleus, NTS, and VLM. Only locus coeruleus A6, NTS A2, and VLM A1 noradrenergic neurons, but not NTS C2 and VLM C1 adrenergic neurons, were lost. There was also an associated reduction in dopamine-beta-hydroxylase-positive immunolabeling in the forebrain. These findings suggest neonatal HI can affect specific neurochemically-defined neuronal populations in the brainstem and that noradrenergic neurons are particularly vulnerable to HI injury.

Fetal monitoring during labor aims to identify fetal problems which, if uncorrected, may result in morbidity or death. A nonreassuring or abnormal fetal heart rate trace by cardiotocography (CTG) does not necessarily equate with fetal hypoxia and/or acidosis. However, in the absence of more objective data, the use of CTG often results in variable, but inappropriately high, operative delivery rates (forceps, vacuum, or cesarean delivery) for nonreassuring fetal status in many hospitals. The addition of fetal pulse oximetry (FPO) has the potential to improve the assessment of fetal well-being during labor. In this review we consider several aspects of FPO. Several factors, such as sensor to skin contact, uterine contractions, fetal hair, and caput succedaneum, influence the performance and use of FPO. Issues such as clinicians' perspectives of FPO sensor placement, maternal perspectives of FPO during labor, and an economic analysis have all favored FPO. Several randomized controlled trials (RCTs) of FPO reported a reduction in cesarean delivery for nonreassuring fetal status when FPO was added to conventional CTG monitoring, with no difference in overall cesarean delivery rates. One large RCT reported no difference in mode of birth for any indication. Several issues relevant to the future of FPO have been addressed by these RCTs, the major issue being that it makes no difference to cesarean rates. It may be argued that FPO has a valid clinical use in monitoring the fetus with congenital heart block. Additionally, in situations of nonreassuring fetal status and dystocia, FPO may provide the necessary reassurance until adequate resources for cesarean delivery are available.

In normal brain, we previously demonstrated that the exon-9 skipping form of glutamate-aspartate transporter (GLAST; which we refer to as GLAST1b) is expressed by small populations of neurons that appear to be sick or dying and suggested that these cells were subject to inappropriate local glutamate-mediated excitation. To test this hypothesis we examined the expression of GLAST1b in the hypoxic pig brain. In this model glial glutamate transporters such as GLAST and glutamate transporter 1 (GLT-1) are down-regulated in susceptible regions, leading to regional loss of glutamate homeostasis and thus to brain damage. We demonstrate by immunohistochemistry that in those brain regions where astroglial glutamate transporters are lost, GLAST1b expression is induced in populations of neurons and to a lesser extent in some astrocytes. These neurons were also immunolabeled by antibodies against the carboxyl-terminal region of GLAST but did not label with antibodies directed against the amino-terminal region. Our Western blotting data indicate that GLAST1b expressed by neurons lacks the normal GLAST amino-terminal region and may be further cleaved to a smaller approximately 30-kDa fragment. We propose that GLAST1b represents a novel and sensitive marker for the detection of neurons at risk of dying in response to hypoxic and other excitotoxic insults and may have wider applicability in experimental and clinical contexts.

Glial fibrillary acidic protein (GFAP) is an enigmatic protein; it currently has no unambiguously defined role. It is expressed in the cytoskeleton of astrocytes in the mammalian brain. We have used co-immunoprecipitation to identify in vivo binding partners for GFAP in the rat and pig brain. We demonstrate interactions between GFAP, the glutamate transporter GLAST, the PDZ-binding protein NHERF1, and ezrin. These interactions are physiologically relevant; we demonstrate in vitro that transport of D-aspartate (a glutamate analogue) is significantly increased in the presence of GFAP and NHERF1. Moreover, we demonstrate in vivo that expression of GFAP is essential in retaining GLAST in the plasma membranes of astrocytes after an hypoxic insult. These data indicate that the cytoskeleton of the astrocyte plays an important role in protecting the brain against glutamate-mediated excitotoxicity.

Background More than 50 percent of all infants born very preterm will experience significant motor and cognitive impairment. Provision of early intervention is dependent upon accurate, early identification of infants at risk of adverse outcomes. Magnetic resonance imaging at term equivalent age combined with General Movements assessment at 12 weeks corrected age is currently the most accurate method for early prediction of cerebral palsy at 12 months corrected age. To date no studies have compared the use of earlier magnetic resonance imaging combined with neuromotor and neurobehavioural assessments (at 30 weeks postmenstrual age) to predict later motor and neurodevelopmental outcomes including cerebral palsy (at 12–24 months corrected age). This study aims to investigate i) the relationship between earlier brain imaging and neuromotor/neurobehavioural assessments at 30 and 40 weeks postmenstrual age, and ii) their ability to predict motor and neurodevelopmental outcomes at 3 and 12 months corrected age. Methods/design This prospective cohort study will recruit 80 preterm infants born ≤30 week’s gestation and a reference group of 20 healthy term born infants from the Royal Brisbane & Women’s Hospital in Brisbane, Australia. Infants will undergo brain magnetic resonance imaging at approximately 30 and 40 weeks postmenstrual age to develop our understanding of very early brain structure at 30 weeks and maturation that occurs between 30 and 40 weeks postmenstrual age. A combination of neurological (Hammersmith Neonatal Neurologic Examination), neuromotor (General Movements, Test of Infant Motor Performance), neurobehavioural (NICU Network Neurobehavioural Scale, Premie-Neuro) and visual assessments will be performed at 30 and 40 weeks postmenstrual age to improve our understanding of the relationship between brain structure and function. These data will be compared to motor assessments at 12 weeks corrected age and motor and neurodevelopmental outcomes at 12 months corrected age (neurological assessment by paediatrician, Bayley scales of Infant and Toddler Development, Alberta Infant Motor Scale, Neurosensory Motor Developmental Assessment) to differentiate atypical development (including cerebral palsy and/or motor delay). Discussion Earlier identification of those very preterm infants at risk of adverse neurodevelopmental and motor outcomes provides an additional period for intervention to optimise outcomes. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12613000280707. Registered 8 March 2013. Electronic supplementary material The online version of this article (doi:10.1186/s12887-015-0439-z) contains supplementary material, which is available to authorized users.

Uteroplacental vascular insufficiency in humans is a common cause of intrauterine growth restriction (IUGR) and is associated with an increased incidence of perinatal asphyxia and neurodevelopmental disorders compared to normal weight newborns. Experimental models that provide an opportunity to analyze the pathogenesis of these relationships are limited. Here, we used neonatal pigs from large litters in which there were piglets of normal birth weight (for controls) and of low birth weight (for uteroplacental vascular insufficiency). Hypoxia was induced in paired littermates by reducing the fraction of inspired oxygen to 4% for 25 min. Brain tissue was collected 4 h post-hypoxia. Cerebral levels of apoptosis were quantified morphologically and verified with caspase-3 activity and TUNEL. Expression of Bcl-2, Bcl-XL and Bax proteins was investigated using immunohistochemistry. Cellular positivity for Bcl-2 was consistently higher in the non-apoptotic white matter of the hypoxic IUGR animals compared with their littermates and reached significance at P < 0.05 in several pairs of littermates. Alterations in Bax showed a trend towards higher expression in the hypoxic IUGR littermates but rarely reached significance. The IUGR piglets showed a significantly greater amount of apoptosis in response to the hypoxia than the normal weight piglets, suggesting an increased vulnerability to apoptosis in the IUGR piglets.

Background: Fetal pulse oximetry improves the assessment of fetal well-being during labor. The objective of this study was to evaluate women's satisfaction with their experience with this additional technology. Methods: We surveyed women participating in the FOREMOST trial, a randomized controlled trial comparing the addition of fetal pulse oximetry (FPO) to conventional cardiotocograph (CTG) monitoring (intervention group), versus CTG-only (control group), in the presence of nonreassuring fetal status during labor. Our survey evaluated 3 aspects of women's experience: labor, fetal monitoring, and participation in the research. The survey was administered within a few days of giving birth and repeated 3 months later. Results: No differences were found between the intervention and control groups for women's evaluations of their labor, fetal monitoring, research, or overall experiences when surveyed on both occasions. Within each study group, a small but statistically significant decline occurred in women's scores for their experience of labor and overall experience from the initial survey close to the time of giving birth, to 3 months later. The magnitude of differences in responses over time was similar for the both groups. Women were more satisfied after a spontaneous or assisted vaginal birth than after cesarean section. Length of time the research midwife was present had a significant positive effect on women's ratings of their experience several days after giving birth (p = 0.006), but no effect at 3 months. Conclusions: The addition of fetal pulse oximetry for the assessment of fetal well-being during labor did not affect childbearing women's perceptions of fetal monitoring or their labor. Women evaluated their experience in the research process positively overall. Small changes occurred in women's perception of their satisfaction over time.

Background: Fetal pulse oximetry (FPO) may improve the assessment of the fetal well-being in labour. Reports of health-care provider's evaluations of new technology are important in the overall evaluation of that technology. Aims: To determine doctors' and midwives' perceptions of their experience placing FPO sensors. Methods: We surveyed clinicians (midwives and doctors) following placement of a FPO sensor during the FOREMOST trial (multicentre randomised trial of fetal pulse oximetry). Clinicians rated ease of sensor placement (poor, fair, good and excellent). Potential influences on ease of sensor placement (staff category, prior experience in Birth Suite, prior experience in placing sensors, epidural analgesia, cervical dilatation and fetal station) were examined by ordinal regression. Results: There were 281 surveys returned for the 294 sensor placement attempts (response rate 96%). Sensors were placed by midwives (29%), research midwives (48%), registrars (22%) and obstetricians (1%). The majority of clinicians had 1 or more years' Birth Suite experience, had placed six or more sensors previously, and rated ease of sensor placement as good. Advancing fetal station (P < 0.001) and the presence of epidural analgesia prior to sensor placement (P = 0.029) predicted improved ease of sensor placement. Having a clinician placing a sensor for the first time predicted a lower rating for ease of sensor placement (P = 0.001), compared to having placed one or more sensors previously. Conclusions: Clinicians with varying levels of Birth Suite experience successfully placed fetal oxygen saturation sensors, with the majority rating ease of sensor placement as good.

We compared the whole body (WB) and segmental bioelectrical impedance analysis (BIA) methodologies in a group of healthy adults (n= 25). It has been suggested that the segmental methodology may overcome the difficulty in generating a single algorithm to predict total body water (TBW) in all groups whether healthy or not. We measured TBW, using D2O dilution, and WB and segmental BIA parameters. Cole-Cole analysis was used to determine the impedance at the characteristic frequency (Zc). The correlation between TBW (by D2O dilution) and segmental BIA measures (multiple regression, r= 0.90, p < 0.001, SEE = 3.1 L) was not significantly higher than the correlation between TBW (D2O dilution) and WB BIA measures (simple regression, r= 0.85, p < 0.001, SEE = 3.6 L). Others have observed this “lack of improvement” in a group of healthy subjects. The true value of the segmental BIA methodology may lie in applications involving groups with altered distributions of segmental and compartmental fluid.

It is generally assumed that rodent brains can be used as representative models of neurochemical function in other species, such as humans. We have compared the distributions of the predominant glial glutamate transporters in rodents, rabbits, cats, pigs, monkeys, and humans. We identify similarities but also significant differences between species. GLT-1v, which is abundantly expressed by rodent astrocytes, is expressed only in a rare subset of astrocytes of cats and humans, and appears to be absent from brains of rabbits and monkeys. Conversely, in the pig brain GLT-1v is expressed only by oligodendrocytes. GLAST and GLT-1 expression differed significantly between species; while rodents and rabbits exhibited uniform expression patterns in cortex, higher species, including cats, pigs, monkeys, and humans, exhibited heterogeneities in cortical and hippocampal expression. Patches devoid of labeling intermingling with patches of strong labeling were evident in areas such as temporal cortex and frontal cortex. In addition, we noted that in human motor cortex, there were inconsistencies in labeling for the C-terminal of GLT-1 and common domains of GLT-1, suggesting that the C-terminal region may be missing or that an unidentified splicing is present in many human astrocytes. Collectively our data suggest that assumptions as to the roles of glutamate transporters in any species may need to be tested empirically. © 2004 Wiley-Liss, Inc.

Background and Purpose— To determine the optimal dose of 2-iminobiotin (2-IB) for the treatment of moderate to severe asphyxia in a neonatal piglet model of hypoxia-ischemia. Methods— Newborn piglets were subjected to a 30-minute hypoxia-ischemia insult and randomly treated with vehicle or 2-IB (0.1 mg/kg, 0.2 mg/kg, or 1.0 mg/kg). aEEG background and seizure activity were scored after hypoxia-ischemia every 4 h until 24 h and at 48 h and neurobehavioral scores were obtained. Brain tissue was collected and processed for analysis of caspase-3 activity, histology, and tyrosine nitration. Results— A dose range of 0.1 to 1.0 mg/kg/dose of 2-IB improved short-term outcome as demonstrated by an increased survival with a normal aEEG and decreased nitrotyrosine staining in the 2-IB–treated animals, indicating decreased cellular damage. Neurobehavior, caspase-3 activity in thalamus, and histology scores were not significantly different. Conclusions— Based on survival with a normal aEEG, 0.2 mg/kg 2-IB is likely to be the most appropriate dose for use in future clinical trials in neonates with perinatal hypoxia-ischemia.

Although the rate of sudden infant death syndrome (SIDS) has been reduced with the 'Back to Sleep' campaign, SIDS is still a common cause of death in infancy. A range of environmental factors may interact to contribute to the adverse health conditions conducive to SIDS. Nine studies have evaluated the association between exposure to air pollution and the incidence of SIDS. The available evidence is inadequate to come to any conclusion about a relationship between air pollution and SIDS, although the body of evidence appears to suggest that air pollution (especially particles and some gaseous pollutants) may play a certain role in the occurrence of SIDS. We suggest that future studies should focus on the research design, role of indoor air quality and the effect of smaller particles, particularly those in the ultrafine range.

BACKGROUND Fortification of flour with folic acid is a safe, sustainable, and cost-effective approach for preventing spina bifida and anencephaly, and it is likely to confer multiple health benefits to the adult population. Scientists and advocates are bringing this intervention to the attention of policymakers in countries around the world, and consequently the demand for sound, science-backed policy rationale is increasing. METHODS We recently prepared this scientific review for scientists, physicians, and advocates who were promoting mandatory folic acid fortification of flour in Australia and New Zealand. This short document references the most relevant published scientific data and national and international recommendations from other countries and presents an argument for fortification based on demonstrated need, proven effectiveness, safety, and multiple health benefits. CONCLUSIONS With some modifications, this document could be utilized in other countries considering fortification of flour or other staple products with folic acid. Other useful tools can be found at The Micronutrient Initiative website at www.micronutrient.org. Birth Defects Research (Part A) 2004. © 2004 Wiley-Liss, Inc.

This paper presents the estimation of a nonstationary nonlinear model of seizures in infants based on parallel Wiener structures. The model comprises two parts and is partly derived from the Roessgen et al. seizure model. The first part consists of a nonlinear Wiener model of the pure background activity, and the second part in a nonlinear Wiener model of the pure seizure activity with a time-varying deterministic input signal. The two parts are then combined in a parallel structure. The Wiener model consists of an autoregressive moving average filter followed by a nonlinear shaping function to take into account the non-Gaussian statistical behavior of the data. Model estimation was performed on 64 infants of whom four showed signs of clinical and electrical seizures. Model validation is performed using time-frequency-based entropy distance and shows an averaged improvement of 50% in modeling performance compared with the Roessgen model.

BACKGROUND AND PURPOSE: The diagnostic and prognostic potential of brain MR imaging before term-equivalent age is limited until valid MR imaging scoring systems are available. This study aimed to validate an MR imaging scoring system of brain injury and impaired growth for use at 29 to 35 weeks postmenstrual age in infants born at

In newborn EEG, the presence of burst suppression carries with it a high probability of poor neurodevelopmental outcome. This paper presents a novel method to detect neonatal bust suppression from multichannel EEG using a time-frequency (T-F) based approach. In this approach, features are extracted from T-F representations of EEG signals obtained using quadratic time-frequency distributions (QTFDs). Such features take into account the non-stationarity of EEG signals and are shown to be able to discriminate between burst and suppression patterns. The features are based on the energy concentration of the signals in the T-F domain, instantaneous frequency of the signals, and Renyi entropy and singular-value decomposition (SVD) of the TFDs of EEG. For each feature, the receiver operating characteristic (ROC) is found and the area under the ROC curve (AUC) is calculated as the performance criterion. Experimental results using EEG signals with burst suppression acquired from 3 term neonates show that the features extracted from the singular values of TFDs and energy concentration outperform others. Amongst different QTFDs, features extracted from the optimized extended modified B distribution exhibit the best performance. Also, a classifier which uses these features achieves a total accuracy of 99.6%. Qatar National Research Fund under its National Priorities Research Program award number NPRP 6-885-2-364. Scopus

Background The use of conventional cardiotocographic (CTG) monitoring of fetal well-being during labour is associated with an increased caesarean section rate, compared with intermittent auscultation of the fetal heart rate, resulting in a reduction in neonatal seizures, although no differences in other neonatal outcomes. To improve the sensitivity of this test and therefore reduce the number of caesarean sections performed for nonreassuring fetal status, several additional measures of evaluating fetal well-being have been considered. These have demonstrated some effect on reducing caesarean section rates, for example, fetal scalp blood sampling for pH estimation/lactate measurement. The adaptation of pulse oximetry for use in the unborn fetus could potentially contribute to improved evaluation during labour and therefore lead to a reduction in caesarean sections for nonreassuring fetal status, without any change in neonatal outcomes. Objectives To compare the effectiveness and safety of fetal intrapartum pulse oximetry with other surveillance techniques. Search methods We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 May 2014), contacted experts in the field and searched reference lists of retrieved studies. In previous versions of this review, we performed additional searches of MEDLINE, Embase and Current Contents. These searches were discontinued for this review update, as they consistently failed to identify any trials that were not shown in the Cochrane Pregnancy and Childbirth Group's Trials Register. Selection criteria All published and unpublished randomised controlled trials that compared maternal and fetal outcomes when fetal pulse oximetry was used in labour, (i) with or without concurrent use of conventional fetal surveillance, that is, cardiotocography (CTG), compared with using CTG alone or (ii) with or without concurrent use of both CTG and other method(s) of fetal surveillance, such as fetal electrocardiography (ECG) plus CTG. Data collection and analysis At least two independent review authors performed data extraction. We sought additional information from the investigators of three of the reported trials. Main results We included seven published trials: six comparing fetal pulse oximetry and CTG with CTG alone (or when fetal pulse oximetry values were blinded) and one comparing fetal pulse oximetry plus CTG with fetal ECG plus CTG. The published trials, with some unpublished data, were at high risk of bias in terms of the impractical nature of blinding participants and clinicians, as well as high risk or unclear risk of bias for outcome assessor for all but one report. Selection bias, attrition bias, reporting bias and other sources of bias were of low or unclear risk. The trials reported on a total of 8013 pregnancies. Differing entry criteria necessitated separate analyses, rather than meta-analysis of all trials. Systematic review of four trials from 34 weeks not requiring fetal blood sampling (FBS) prior to study entry showed no evidence of differences in the overall caesarean section rate between those monitored with fetal oximetry and those not monitored with fetal pulse oximetry or for whom the fetal pulse oximetry results were masked (average risk ratio (RR) 0.99 using random-effects, 95% confidence intervals (CI) 0.86 to 1.13, n = 4008, I² = 45%). There was evidence of a higher risk of caesarean section in the group with fetal oximetry plus CTG than in the group with fetal ECG plus CTG (one study, n = 180, RR 1.56, 95% CI 1.06 to 2.29). Neonatal seizures and neonatal encephalopathy were rare in both groups. No studies reported details of long-term disability. There was evidence of a decrease in caesarean section for nonreassuring fetal status in the fetal pulse oximetry plus CTG group compared to the CTG group, gestation from 34 weeks (average RR (random-effects) 0.65, 95% CI 0.46 to 0.90, n = 4008, I² = 63%). There was no evidence of differences between groups in caesarean section for dystocia, although the overall incidence rates varied between the trials. Authors' conclusions The addition of fetal pulse oximetry does not reduce overall caesarean section rates. One study found a higher caesarean section rate in the group monitored with fetal pulse oximetry plus CTG, compared with fetal ECG plus CTG. The data provide limited support for the use of fetal pulse oximetry when used in the presence of a nonreassuring CTG, to reduce caesarean section for nonreassuring fetal status. A better method than pulse oximetry is required to enhance the overall evaluation of fetal well-being in labour.

This paper presents a time-frequency approach for fetal movement monitoring which is based on the instantaneous amplitude (IA) and instantaneous frequency (IF) of signals collected using 3axial accelerometers placed over the maternal abdomen. Results of a feature selection method based on receiver operating characteristic analysis shows that the mean of the IAs and deviation of the Ifs outperform other features. A support vector machine based classifier which uses these 2 features exhibits a total accuracy of 96.6% with reasonably high sensitivity and specificity.

This paper presents a proof-of-concept that shows that the use of accelerometers can be used for the detection of Fetal Movements. (Additional details can be found in the comprehensive book on Time-Frequency Signal Analysis and Processing (see http://www.elsevier.com/locate/isbn/0080443354). In addition, the most recent upgrade of the original software package that calculates Time-Frequency Distributions and Instantaneous Frequency estimators can be downloaded from the web site: www.time-frequency.net. This was the first software developed in the field, and it was first released publicly in 1987 at the 1st ISSPA conference held in Brisbane, Australia, and then continuously updated). This paper describes a multi-sensor fetal movement (FetMov) detection system based on a time–frequency (TF) signal processing approach. Fetal motor activity is clinically useful as a core aspect of fetal screening for well-being to reduce the current high incidence of fetal deaths in the world. FetMov are present in early gestation but become more complex and sustained as the fetus progresses through gestation. A decrease in FetMov is an important element to consider for the detection of fetal compromise. Current methods of FetMov detection include maternal perception, which is known to be inaccurate, and ultrasound imaging which is intrusive and costly. An alternative passive method for the detection of FetMov uses solid-state accelerometers, which are safe and inexpensive. This paper describes a digital signal processing (DSP) based experimental approach to the detection of FetMov from recorded accelerometer signals. The paper provides an overview of the significant measurement and signal processing challenges, followed by an approach that uses quadratic time–frequency distributions (TFDs) to appropriately deal with the non-stationary nature of the signals. The paper then describes a proof-of-concept with a solution consisting of a detection method that includes (1) a new experimental set-up, (2) an improved data acquisition procedure, and (3) a TF approach for the detection of FetMov including TF matching pursuit (TFMP) decomposition and TF matched filter (TFMF) based on high-resolution quadratic TFDs. Detailed suggestions for further refinement are provided with preliminary results to establish feasibility, and considerations for application to clinical practice are reviewed.

The purpose of this study was to develop a newborn piglet model of hypoxia/ischaemia which would better emulate the clinical situation in the asphyxiated human neonate and produce a consistent degree of histopathological injury following the insult. One-day-old piglets (n=18) were anaesthetised with a mixture of propofol (10 mg/kg/h) and alfentinal (55.5 microg/kg/h) i.v. The piglets were intubated and ventilated. Physiological variables were monitored continuously. Hypoxia was induced by decreasing the inspired oxygen (FiO(2)) to 3-4% and adjusting FiO(2) to maintain the cerebral function monitor peak amplitude at < or =5 microV. The duration of the mild insult was 20 min while the severe insult was 30 min which included 10 min where the blood pressure was allowed to fall below 70% of baseline. Control piglets (n=4 of 18) were subjected to the same protocol except for the hypoxic/ischaemic insult. The piglets were allowed to recover from anaesthesia then euthanased 72 h after the insult. The brains were perfusion-fixed, removed and embedded in paraffin. Coronal sections were stained by haematoxylin/eosin. A blinded observer examined the frontal and parietal cortex, hippocampus, basal ganglia, thalamus and cerebellum for the degree of damage. The total mean histology score for the five areas of the brain for the severe insult was 15.6+/-4.4 (mean +/-S.D., n=7), whereas no damage was seen in either the mild insult (n=4) or control groups. This 'severe damage' model produces a consistent level of damage and will prove useful for examining potential neuroprotective therapies in the neonatal brain.

OBJECTIVE To examine the feasibility of an individualized exercise program to prevent gestational diabetes mellitus (GDM) in obese pregnant women. RESEARCH DESIGN AND METHODS The study was a pilot randomized controlled trial with obese pregnant women (intervention group, individualized exercise program [n = 25]; control group, usual care [n = 25]). Average weekly energy expenditure (MET hours per week and kilocalories per week) of exercise-specific activity was assessed during pregnancy using the Pregnancy Physical Activity Questionnaire. Fasting glucose and insulin and homeostasis model assessment of insulin resistance (HOMA-IR) were assessed at baseline and 20, 28, and 36 weeks' gestation. RESULTS Of the women in the intervention group, 16 of 22 (73%) achieved more than 900 kcal/week of exercise-based activity at 28 weeks compared with 8 of 19 women in the control group (42%), P = 0.047. However, insulin resistance (HOMA-IR) did not differ between the groups. CONCLUSION This intervention was feasible and prompted a modest increase in physical activity. However, we are not confident that this intervention would be sufficient to prevent GDM.

Despite the pressing clinical need to improve fetal intrapartum surveillance, fetal oximetry has lagged well behind its application in the neonate because of the difficulty of developing a suitable method to record data from the fetus and testing its accuracy and reproducibility. Acceptable values of oxygen saturation that indicate fetal well-being are much lower than in neonates. The development of fetal pulse oximetry instrumentation is discussed. Recent clinical data acquired using the latest instrumentation are summarized and exciting new clinical applications proposed.

This study was designed to determine in rats whether morphine-3-glucuronide (M3G) produces its neuro-excitatory effects most potently in the ventral hippocampus (as has been reported previously for subanalgesic doses of opioid peptides). Guide cannulae were implanted into one of seven regions of the rat brain: lateral ventricle; ventral, CA1 and CA2-CA3 regions of the hippocampus; amygdala; striatum or cortex. After a 7 day recovery period, rats received intracerebral injections of (i) M3G (1.1 or 11 nmol) (ii) DADLE ([D-Ala2,D-Leu5]enkephalin), (45 nmol, positive controls) or (iii) vehicle (deionised water), and behavioral excitation was quantified over 80 min. High-dose M3G (11 nmol) evoked behavioral excitation in all brain regions but the onset, severity and duration of these effects varied considerably among brain regions. By contrast, low-dose M3G (1.1 nmol) evoked excitatory behaviors only when administered into the ventral hippocampus and the amygdala, with the most potent effects being observed in the ventral hippocampus. Prior administration of the nonselective opioid antagonists, naloxone and beta-funaltrexamine into the ventral hippocampus, markedly attenuated low-dose M3G's excitatory effects but did not significantly alter levels of excitation evoked by high-dose M3G. Naloxone given 10 min after M3G (1.1 or 11 nmol) did not significantly attenuate behavioral excitation. Thus, M3G's excitatory behavioral effects occur most potently in the ventral hippocampus as reported previously for subanalgesic doses of opioid peptides, and appear to be mediated through at least two mechanisms, one possibly involving excitatory opioid receptors and the other, non-opioid receptors.

Objective: To determine safe and appropriate alarm limits for the Marquette 8000 pulse oximeter to prevent hyperoxic and hypoxic episodes in neonates. It is necessary to define these limits for each brand of oximeter because of the variance in nonuser adjustable calibration algorithms used in pulse oximeters. Methodology: Oxygen saturation values obtained from a Marquette 8000 pulse oximeter (SpO(2)) were compared with simultaneous arterial brood gas PaO2 values obtained from blood gas analysis, for 322 samples in 24 consecutive neonates (median 30 weeks' gestation). Results: In order to prevent 95% of hyperoxic episodes (PaO2 > 90 mmHg), the upper alarm limit was 95% SpO(2) Similarly, to prevent 95% of hypoxic episodes (PaO2 < 40 mmHg), the lower alarm limit was 95% SpO(2). A sensitivity lower than 95% had to be accepted to develop an alarm range which prevented both hyperoxic and hypoxic episodes. To maintain PaO2 values between 40 and 90 mmHg, an appropriate alarm range of 94-97% SpO(2) (90% sensitivity, 28% specificity) was established. Conclusions: The relative merits of high sensitivity versus high specificity should be considered when determining appropriate alarm limits. Alarm limits which represent a balance between sensitivity and specificity will minimise false alarms and provide a clinically practical range. It would be useful for this type of information to be available for each brand of oximeter, to assist the user in determining appropriate alarm settings.

Oxygen availability to the fetus during uterine contractions has not been widely reported. We examined whether fetal oxygen saturation (FSpO(2)) values and signal quality (SQ) were affected by uterine contractions. An intrauterine pressure catheter and a Nellcor FS14 fetal oxygen saturation sensor (Nellcor Puritan Bennett Inc., Pleasanton, CA) were placed transvaginally during the first stage of 17 labors. Fetal SpO(2) and SQ units were recorded on a beat-to-beat basis and 10 sec averages of the data calculated over 25 contractions per patient. Five epochs were determined: (1) 30 sec prior to a contraction; (2) during a contraction; (3)50 sec following completion of a contraction; (4) noncontraction periods, excluding epochs 1 or 3; and (5) equivocal, that is, overlap of epochs 1-3. Mean FSpO(2) was lowest during epoch 3 (45.0) and highest during epoch 2 (47.3%) (p < 0.001). This small difference is unlikely to be of any clinical significance, however. Mean signal quality was lowest in epoch 1 (42.8 units) and highest in epoch 4 (48.0 units) (p < 0.05), that is, in noncontraction periods. We conclude that FSpO(2) and SQ were unaffected by uterine contractions.

This paper presents a time-frequency approach for fetal movement monitoring which is based on classification of accelerometry signals collected from pregnant women's abdomen. Features extracted from time-frequency distribution of these signals were supplied into statistical analysis to generate feature-measure mixtures. Four various classes subjectively are recognized in accelerometry data by means of objective tools such as ultrasound sonography. These include strong and weak fetal movement, artefact, and background. Receiver operating characteristic analysis utilized to compute the performance of feature-measures for the comparison between various classes. Next, a feature selection applied to reduce the feature space dimension by means of principal component analysis. The selected feature-measures then employed in support vector machine classifiers to classify artefact and fetal movement in different subsets of available classes. The results indicate the fetal movement events are identified with an accuracy of 92.19%. Qatar National Research Fund under its National Priorities Research Program award number NPRP 09-626-2-243. Scopus

Fetal oxygen saturation (FSpO2) was recorded during labour to determine the relationship between FSpO2 and indicators of fetal well-being, including umbilical blood gases, xanthine (X), hypoxanthine (Hx) and Apgar scores. This is one of the largest reported series of fetal pulse oximetry, with 118 fetuses monitored for over 329 hours. Mean FSpO2 for all cases was 46.9% (SD = 9.1%). There was no correlation between FSpO2 during the last 10 minutes of monitoring and arterial pH, Hx or X. A mean FSpO2or = 30% was associated with a 5 minute Apgar score ofor = 7 in the majority of cases. One fetus had a mean FSpO230% during the final 10 minutes of monitoring and an umbilical arterial pH7.20, while there were 10 fetuses with an umbilical arterial pH7.20, and mean FSpO2or = 30%. As these numbers are small, a larger series is necessary to further characterize the small number of fetuses who are significantly hypoxic.

Aim Preterm birth is associated with an increased risk of adverse neurodevelopmental outcomes. Diffusion magnetic resonance imaging (dMRI) combined with tractography can be used to assess non-invasively white matter microstructure and brain development in preterm infants. Our aim was to conduct a systematic review of the current evidence obtained from tractography studies of preterm infants in whom MRI was performed up to term-equivalent age. Method Databases were searched for dMRI tractography studies of preterm infants. Results Twenty-two studies were assessed. The most frequently assessed tracts included the corticospinal tract, the corpus callosum, and the optic radiations. The superior longitudinal fasciculus, and the anterior and superior thalamic radiations were investigated less frequently. A clear relationship exists between diffusion metrics and postmenstrual age at the time of scanning, although the evidence of an effect of gestational age at birth and white matter injury is conflicting. Sex and laterality may play an important role in the relationship between diffusion metrics, early clinical assessment, and outcomes. Interpretation Studies involving infants of all gestational ages are required to elucidate the relationship between gestational age and diffusion metrics, and to establish the utility of tractography as a predictive tool. There is a need for more robust acquisition and analysis methods to improve the accuracy of assessing development of white matter pathways.

Background Large animal models are an essential tool in the development of rationally-based new clinical therapies for preterm infants. We provide a description of the newborn pig as a model of the preterm neonate in terms of growth parameters, physiology and the requirement for intensive care over a range of gestational ages. Methods Twenty-nine litters of piglets (n = 298) were delivered by caesarean section at six timepoints during gestation from 91d to 113d (term = 115d). Two groups, at 91 and 97d gestation, also received maternal glucocorticoid treatment. At four of these timepoints, piglets (n = 79) were ventilated, sedated and monitored using standard neonatal intensive care techniques for up to 8 h in various experimental protocols. Results Body weight increased from mean 697 g (SD 193) at 91d gestation to 1331 g (SD 368) at 113d gestation. Piglets delivered at 97d gestation were able to be resuscitated and kept alive for at least 8 h on respiratory support after surfactant administration. Maternal glucocorticoid treatment 48 h and 24 h hours prior to delivery reduced the requirement for ventilator support and improved cardiovascular stability. Conclusion The pig provides a relevant model for the study of human preterm physiology and for investigation of novel therapies to improve outcomes.

Perinatal hypoxia is a cause of cerebral injury in foetuses and neonates. Detection of foetal hypoxia during labour based on the pattern recognition of heart rate signals suffers from high observer variability and low specificity. We describe a new automated hypoxia detection method using time-frequency analysis of heart rate variability (HRV) signals. This approach uses features extracted from the instantaneous frequency and instantaneous amplitude of HRV signal components as well as features based on matrix decomposition of the signals' time-frequency distributions using singular value decomposition and non-negative matrix factorization. The classification between hypoxia and non-hypoxia data is performed using a support vector machine classifier. The proposed method is tested on a dataset obtained from a newborn piglet model with a controlled hypoxic insult. The chosen HRV features show strong performance compared to conventional spectral features and other existing methods of hypoxia detection with a sensitivity 93.3 %, specificity 98.3 % and accuracy 95.8 %. The high predictive value of this approach to detecting hypoxia is a substantial step towards developing a more accurate and reliable hypoxia detection method for use in human foetal monitoring. QNRF, a member of Qatar foundation, under NPRP Grant No: 09-626-2-243 Scopus

This paper presents a time-frequency approach to detect perinatal hypoxia by characterizing the nonstationary nature of heart rate variability (HRV) signals. Quadratic time-frequency distributions (TFDs) are used to represent the HRV signals. Six features based on the instantaneous frequency (IF) of the lower frequency components of HRV signals are selected to establish a classifier using support vector machine. The classifier is trained and tested using the signals recorded from a neonatal piglet model under a controlled hypoxic condition, which provides reliable annotations on the data. The method shows superior performance in the detection of hypoxic epochs with sensitivity (89.8%), specificity (100%) and total accuracy (94.9%) compared with that based on frequency domain features, indicating that nonstationarity should be taken into account for a more accurate assessment of the newborn status with possible hypoxia when analyzing HRV signals.

Perfluorocarbon administration increases cerebral blood flow. This can be mitigated by preventing a rise in carbon dioxide by adjusting pressure-controlled ventilation. Volume-controlled ventilation should prevent increases in arterial carbon dioxide and cerebral blood flow. This study aims to determine if cerebral blood flow is increased during administration of 10 mL/kg of perfluorocarbon while using volume-controlled ventilation.Two New Zealand white rabbits, ventilated with volume-control, were each allocated to six dosing events where each dosing event was randomly allocated to one of two dosing strategies: a control group - given a sham dose of air (10 mL/kg) over 20 min; or a partial liquid ventilation group - given 10 mL/kg FC-77 slowly over 20 min. Data were recorded for 1 min before and 30 min after the start of each dosing event. No adjustment of ventilation (except fraction of inspired oxygen) was allowed during each dosing event.There were no significant changes over time and no differences between groups for carotid blood flow (P = 0.48 at the end of the dose). There were slight increases in cortical cerebral blood flow in both groups; there was no statistically significant difference between groups (P = 0.56 at end dose and P = 0.49 at time of maximum difference). There was no difference between groups for the variability in carotid blood flow or cortical cerebral blood flow.Cerebral blood flow was not significantly increased during administration of a dose of 10 mL/kg of perfluorocarbon during commencement of partial liquid ventilation when using volume-controlled ventilation.

Objective We aimed to study EEG electrode temperatures during MRI recordings using a neonatal-size phantom to establish the safety of neonatal EEG–MRI. Methods We constructed a phantom set-up for co-registration of EEG and MRI measurements with newborn size configurations. The set-up consisted of a spherical glass phantom fitted with a customised MRI-compatible 64-channel EEG cap and EEG amplifier. Temperatures were recorded during and after five different scanning sequences (two T2∗ sensitised BOLD fMRI, one T1-weighted and two T2-weighted spin echo) in five electrode locations using a thermistor that was integrated into the electrode housing. A temperature increase >4°C was defined a priori as the safety limit. Results During fMRI and T1 sequences, none of the electrodes showed meaningful temperature changes. Only one MRI sequence (T2 with Max turbo factor 25; SAR 89%) caused temperature increase in one electrode (Fpz; +4.1°C) that slightly exceeded our predefined safety limit, while the conventional T2 sequence was within safety limits (up to +1.7°C). Conclusions Co-registration of EEG and fMRI can be considered safe in babies with respect to electrode heating, which is the primary safety concern. Significance The present findings open up a possibility to commence studies where EEG and MRI/fMRI are co-registered in human babies. Such studies hold significant promise of a better understanding of the early development of brain function and neurovascular coupling.

Preterm birth is associated with a high prevalence of adverse neurodevelopmental outcome. Non-invasive techniques which can probe the neural correlates underpinning these deficits are required. This can be achieved by measuring the structural network of connections within the preterm infant's brain using diffusion MRI and tractography. We used diffusion MRI and T2 relaxometry to identify connections with altered white matter properties in preterm infants compared to term infants. Diffusion and T2 data were obtained from 9 term neonates and 18 preterm-born infants (born

Flow continuity of two brands of syringe pumps and four brands of syringes was studied as a possible cause of hemodynamic fluctuations observed in neonates. Cyclical fluctuations were observed in the blood pressure of 14 neonates receiving dopamine infusions by syringe pump at flow rates from 0.2 to 1 mL/hr. Atom 235 and IVAC 770 pumps and various sizes of Terumo, Becton Dickinson, Omnifix, and IVAC syringes were evaluated. Flow continuity was assessed by using a gravimetric technique. The force needed to initiate and maintain syringe plunger motion was also measured. Noncontinuous flow was encountered most commonly with Terumo syringes, which delivered boluses at regular intervals at flow rates up to 5 mL/hr. The interval was dependent on flow rate and was similar to the time between the blood pressure fluctuations observed clinically. The syringe plunger force exhibited regular fluctuations indicative of the plunger sticking, and simultaneous measurement of flow established a direct temporal relationship with boluses. The other syringes tested did not exhibit such fluctuations. No differences were found between the two syringe pumps. Syringe plunger sticking, resulting in intermittent boluses and potential blood pressure fluctuations, may occur at low flow rates and with certain syringe brands. This appeared to be the cause of hemodynamic fluctuations in neonates receiving dopamine infusions.

Fetal pulse oximetry allows direct non-invasive measurement of fetal oxygen saturation to assess the ability of a fetus to cope with the stress of labor. Sensor design has evolved to overcome the relative inaccessibility of the fetus during labor and the low saturation values that are a feature of fetal circulation. Clinical studies have demonstrated that fetal oxygen saturation alters with maternal position and maternal oxygen administration, but not with epidural analgesia. Although the value of fetal pulse oximetry in determining urgency of delivery has been established, clinical use has declined due to the lack of influence on overall cesarean section rates.

Accurate instantaneous frequency (IF) estimation of the non-stationary heart rate signal is important in quantifying the heart rate variability (HRV) measures. This study compares the effectiveness of four IF estimation methods in analyzing HRV signals. Specifically, they are the direct localization of the maximal peaks in the signal time-frequency distribution (TFD), IF estimation based on component linking technique in the TFD, IF estimation using the TFD with optimal windows based on intersection of confidence intervals rule and complex demodulation. Results of applying the IF estimation methods to synthesized and real piglet HRV signals reveal that, the approach using component linking technique outperform the other techniques with respect to the accuracy and implementation. It provides new insights in studying the evolution of the autonomic nervous regulation of the cardiovascular function over time.

Fetal movement can help clinicians understand fetal functional development. Active methods for fetal monitoring such as ultrasound are expensive and there are objections to their long term usage. This paper presents a passive approach for fetal monitoring which uses solid state accelerometers placed on the mother's abdomen for the collection of fetal movements.

Inter-hemispheric asynchrony within the multichannel recordings of newborn EEG is associated with abnormal functionality of the newborn brain. Mean Phase Coherence (MPC) as a bivariate phase synchrony measure is widely used for pair-wise comparisons of scalp EEG phase information. A bivariate measure, however, is unlikely to capture the key feature of asynchrony seen in the sick neonatal brain, which is characterized by a global disruption of synchrony. In this study, the concept of cointegration is employed to generalize the bivariate MPC to deal with the multivariate case. The performance of the generalized MPC (GMPC) is evaluated using two simulated signals. It is also tested on a multichannel newborn EEG dataset with asynchronous inter-hemispheric bursts. The proposed method can be used to detect and quantify the degree of inter-hemispheric asynchrony from EEG signals.

There is an increased need to better understand the relation between brain structures and functions in newborns by using EEG source localization techniques. This requires a realistic head model that would take into account the different macroscopic and microscopic structures of neonatal skull, which likely have an effect on tissue conductivities. The analysis of spatial decay of both amplitude of focal transients and linear correlation between EEG channels is presented for six neonatal and one adult datasets. This allows to i) study whether skull openings (fontanels) in the neonatal head have an impact on volume conduction, and ii) compare the volume conduction observed in adult and neonatal scalp EEG. The initial results indicate that there is no statistically significant difference in conductivity between 'Fontanel' region and the other parts of the newborn skull, but the scalp amplitudes show a much steeper decline in neonates as compared to adults. These findings set the basis for building a realistic head model, a key step towards source localization of neonatal EEG activity.

This paper introduces the notion of the instantaneous frequency (IF) based generalized phase synchrony in time-frequency analysis based on the concept of cointegration. This phase synchrony is then quantified by investigating the linear relationships between IF laws of nonstationary multivariate signals. The proposed approach is applied to a multichannel newborn EEG signal and the results are compared with that of a bivariate phase synchrony measure.

Glial fibrillary acidic protein (GFAP) is an intermediate filament protein expressed in the astrocyte cytoskeleton that plays an important role in the structure and function of the cell. GFAP can be phosphorylated at six serine (Ser) or threonine (Thr) residues but little is known about the role of GFAP phosphorylation in physiological and pathophysiological states. We have generated antibodies against two phosphorylated GFAP (pGFAP) proteins: p8GFAP, where GFAP is phosphorylated at Ser-8 and p13GFAP, where GFAP is phosphorylated at Ser-13. We examined p8GFAP and p13GFAP expression in the control neonatal pig brain and at 24 and 72 h after an hypoxic-ischemic (HI) insult. Immunohistochemistry demonstrated pGFAP expression in astrocytes with an atypical cytoskeletal morphology, even in control brains. Semi-quantitative western blotting revealed that p8GFAP expression was significantly increased at 24 h post-insult in HI animals with seizures in frontal, parietal, temporal and occipital cortices. At 72 h post-insult, p8GFAP and p13GFAP expression were significantly increased in HI animals with seizures in brain regions that are vulnerable to cellular damage (cortex and basal ganglia), but no changes were observed in brain regions that are relatively spared following an HI insult (brain stem and cerebellum). Increased pGFAP expression was associated with poor neurological outcomes such as abnormal encephalography and neurobehaviour, and increased histological brain damage. Phosphorylation of GFAP may play an important role in astrocyte remodelling during development and disease and could potentially contribute to the plasticity of the central nervous system.

Diffusion MRI (dMRI) is a popular noninvasive imaging modality for the investigation of the neonate brain. It enables the assessment of white matter integrity, and is particularly suited for studying white matter maturation in the preterm and term neonate brain. Diffusion tractography allows the delineation of white matter pathways and assessment of connectivity in vivo. In this review, we address the challenges of performing and analysing neonate dMRI. Of particular importance in dMRI analysis is adequate data preprocessing to reduce image distortions inherent to the acquisition technique, as well as artefacts caused by head movement. We present a summary of techniques that should be used in the preprocessing of neonate dMRI data, and demonstrate the effect of these important correction steps. Furthermore, we give an overview of available analysis techniques, ranging from voxel-based analysis of anisotropy metrics including tract-based spatial statistics (TBSS) to recently developed methods of statistical analysis addressing issues of resolving complex white matter architecture. We highlight the importance of resolving crossing fibres for tractography and outline several tractography-based techniques, including connectivity-based segmentation, the connectome and tractography mapping. These techniques provide powerful tools for the investigation of brain development and maturation.

This paper presents a TF matched filter for detection of neonatal seizure based on cross-correlation betweenthe TFD of EEG signals. (Additional details can be found in the comprehensive book on Time-Frequency Signal Analysis and Processing (see http://www.elsevier.com/locate/isbn/0080443354). In addition, the most recent upgrade of the original software package that calculates Time-Frequency Distributions and Instantaneous Frequency estimators can be downloaded from the web site: www.time-frequency.net. This was the first software developed in the field, and it was first released publicly in 1987 at the 1st ISSPA conference held in Brisbane, Australia, and then continuously updated). Neonatal EEG seizures often manifest as nonstationary and multicomponent signals, necessitating analysis in the time–frequency (TF) domain. This paper presents a novel neonatal seizure detector based on effective implementation of the TF matched filter. In the detection process, the TF signatures of EEG seizure are extracted to construct the TF templates used by the matched filter. Matching pursuit (MP) decomposition and narrowband filtering are proposed for the reduction of artifacts prior to seizure detection. Geometrical correlation is used to consolidate the multichannel detections and to reduce the number of false detections due to remnant artifacts. A data-dependent threshold is defined for the classification of EEG. Using 30 newborn EEG records with seizures, the classification process yielded an overall detection accuracy of 92.4% with good detection rate (GDR) of 84.8% and false detection rate of 0.36 FD/h. Better detection performance (accuracy >95%) was recorded for relatively long EEG records with short seizure events.

OBJECTIVE Neonatal adiposity is a well-recognized complication of gestational diabetes mellitus (GDM). This study aimed to identify factors influencing adiposity in male and female infants of women treated for GDM. RESEARCH DESIGN AND METHODS This was a prospective study of 84 women with GDM. Daily blood glucose levels (BGLs) were retrieved from glucose meters, and overall mean fasting and mean 2-h postprandial BGLs were calculated for each woman. Infant body composition was measured at birth, and regression analysis was used to identify significant predictors of infant body fat separately in male and female infants. RESULTS Maternal fasting BGL was the major predictor of adiposity in male infants but had little relationship to adiposity in female infants. In male infants, percent fat was increased by 0.44% for each 0.1 mmol/L increase in mean maternal fasting BGL. Maternal BMI was the primary predictor in female infants but had little effect in males. In female infants, percent fat was increased by 0.11% for each 1 kg/m2 increase in maternal prepregnancy BMI. CONCLUSIONS Fetal sex may influence the impact that treatment strategies for GDM have on infant adiposity.

This paper presents a time-varying cortical connectivity analysis for to a source localization approach within the inner layers of the newborn brain. (Additional details can be found in the comprehensive book on Time-Frequency Signal Analysis and Processing (see http://www.elsevier.com/locate/isbn/0080443354). In addition, the most recent upgrade of the original software package that calculates Time-Frequency Distributions and Instantaneous Frequency estimators can be downloaded from the web site: www.time-frequency.net. This was the first software developed in the field, and it was first released publicly in 1987 at the 1st ISSPA conference held in Brisbane, Australia, and then continuously updated). Multivariate Granger causality in the timefrequency domain as a representation of time-varying cortical connectivity in the brain has been investigated for the adult case. This is, however, not the case in newborns as the nature of the transient changes in the newborn EEG is different from that of adults. This paper aims to evaluate the performance of the time-varying versions of the two popular Granger causality measures, namely Partial Directed Coherence (PDC) and direct Directed Transfer Function (dDTF). The parameters of the time-varying AR, that models the inter-channel interactions, are estimated using Dual Extended Kalman Filter (DEKF) as it accounts for both non-stationarity and non-linearity behaviors of the EEG. Using simulated data, we show that fast changing cortical connectivity between channels can be measured more accurately using the time-varying PDC. The performance of the time-varying PDC is also tested on a neonatal EEG exhibiting seizure.

This paper aims to assess and compare the performance of two brain connectivity measures based on time-varying multivariate AR modelling for newborn EEG analysis. Relationships between cortical neural recordings as a representation of functional connectivity between cortical brain regions were quantified using different time-frequency criteria. Among these, Partial Directed Coherence (PDC) and Directed Transfer Function (DTF) and their extensions have found wide acceptance. This paper aims to assess and compare the performance of these two connectivity measures that are based on time-varying multivariate AR modeling. The time-varying parameters of the AR model are estimated using an Adaptive AR modeling (AAR) approach and a short-time based stationary approach. The performance of these two approaches is compared using both simulated signal and a multichannel newborn EEG recording. The results show that the time-varying PDC outperforms the time-varying DTF measure. The results also point to the limitation of the AAR algorithm in tracking rapid parameter changes and the drawback of the short-time approach in providing high resolution time-frequency coherence functions. However, it can be demonstrated that time-varying MVAR representations of the cortical connectivity will potentially lead to better understanding of non-symmetric relations between EEG channels.