Fragestellung: Die fetale Ausprägung der insulin-ähnlichen Wachstumsfaktoren (IGF) unterscheidet sich von der Regulation der somatotropen Achse im späteren Lebensalter. Ziel der Studie war es, im Längsschnitt Konzentrationen von IGFs und IGF-Bindungsproteinen (IGFBP) von der Geburt bis zum Ende des ersten Lebensjahres zu messen.

Hintergrund: Seit den richtungweisenden Arbeiten von Berger besteht weitgehende Übereinstimmung über die hohe Aussagekraft der alters korrelierten spektralen Veränderungen des EEG über den Reifeprozess des Gehirns.

SummaryStandard EEG risk evaluation works on scoring systems that use different types of questionnaires. Here, an alternative for SIDS (Sudden Infant Death Syndrome) risk detection is presented that is based exclusively on EEG data which possibly could substitute the procedure of questioning the parents and allow a direct qualification of the physiological disposition of the individual neonate: Using EEG-characters an approved SIDS-case could be discriminated as well against the group of “healthy” infants as against the “high-risk-group”. The results of this study may confirm the evidence that the EEG analysis can be a promising approach to predict an increased SIDS risk.

The definition of an electroencephalographic (EEG)-based brain dysmaturity index that could allow automatic detection of neonates who deviate from expected ontogenetic patterns is proposed. The investigation was performed in a group of 94 term and preterm infants (28-112 weeks postconceptional age). For each neonate, one continuous two-channel EEG of 1-6 hours was recorded. The cluster analysis of different age groups was performed with a self-referential neural network. The network performed a nonlinear discriminant analysis; the synaptic strength of input nodes indicates the relevance of an individual EEG feature. The most relevant EEG features are given by the average amplitude in the delta and theta bands and by the relative amplitudes of beta-1/theta and beta-1/delta, respectively. The correlation between the frequency shifts and the postconceptional age agreed with measures of brain dysmaturity in healthy preterm neonates. Thus the presented trend in early EEG development demonstrates that it is possible to establish clinically relevant age dysmaturity scores.

OBJECTIVES:A correlation between sudden infant death syndrome (SIDS) and apnea has been discussed in a variety of studies. We analyzed polysomnographic data in 51 infants and investigated correlations between the manifestation of apneas and changes in EEG pattern.METHODS:Measurements were performed by means of the commercial polysomnographic device 'ALICE III'. Spectral analysis of certain parts of the registered EEG was performed.RESULTS:During apnea a reduction of the EEG amplitude was seen. The extent of the decrease differed slightly between the frequency bands.CONCLUSIONS:According to the widespread agreement that a lower voltage of electrical brain activity is a fundamental sign of waking up, we hypothesize that the observed change might be an immature type of arousal reaction.

We propose the definition of an EEG based brain dysmaturity index that could allow an automatic detection of neonates that deviate from expected ontogenetic patterns. The investigation was carried out in a group of 107 term and preterm born infants of 28-112 weeks of postconceptional age (PCA). For each neonate, one continuous 2-channel EEG of 1-6 hours duration was recorded. The cluster analysis of different age groups was performed with a self-referential neural network. The network performed a nonlinear discriminant analysis; the synaptic strength of input nodes indicates the relevance of an individual EEG feature. The most relevant EEG features are given by the average amplitude in the Delta and in the Theta band and by the quotient of the amplitudes Alpha/Theta and Beta 1/Theta. respectively. The correlation between frequency shifts and postconceptional age agrees with measures of brain dysmaturity in healthy preterm neonates (Scher 1997). Thus, the presented trend in early EEG development shows that it is possible to establish clinically relevant age dysmaturity scores.

Age dependent EEG signatures were detected in the EEG of 71 neonates of 28-100 weeks of conceptional age (CA). Using the new method presented, neonates were automatically classified in three age groups (28-35 weeks CA), (36-40 weeks CA) and (41-100 weeks CA). Analysis was performed employing relative distance functions for the complete frequency spectra of the EEG registered by electrodes in C3 and C4 positions. The analysis was successful in automatic identification of individuals showing EEG anomalies. Polysomnographic analysis demonstrated these to be apnea risk patients. Accordingly, a purely EEG based detection of neonates that are medically at risk becomes feasible.

A novel method for EEG feature analysis applying neural networks and evolutionary algorithms is proposed. Polysomnographic data of neonate infants are analyzed in order to detect characteristic EEG signatures that correlate with a certain apnea risk group. The method described works without preselected categories, showing the possibility of a purely EEG-based detection of sudden infant death risk patients. Our method employed the registration of relative distance functions and trend analysis of variable EEG features. It is thus shown that an adaptive hyperplane within the multidimensional EEG data room successfully converges towards a unique feature vector that represents the relative EEG characteristics within the patient pool.

The sleep state related EEG was examined in eight newborns with and fifteen newborns without perinatal risk. The coherences within the traditional frequency bands were calculated using the unipolar EEG montages C3, C4, 01 and 02. A significant increase of interhemispheric coherence was found in active sleep compared to quiet sleep, especially for the central montages. The newborns-at-risk showed significant lower interhemispheric coherence in both sleep states. The intrahemispheric coherence was increased during quiet sleep for the 1-8 Hz frequency range. The quantification of the electrical brain interactions via coherence analysis looks promising to support the clinical diagnosis of neonatal brain dysfunction and the physiological description of the neonatal sleep states.

436 out of about 9000 infants who were born between April 1987 and November 1990 in Jena were selected by means of a risk score for a polygraphy monitoring. This score contains anamnestic factors of the mother and the infant which are characteristic of an enhanced risk for the sudden infant death syndrome (SIDS). We performed a day-time polysomnography (ECG, heart rate, respiration, EEG, EOG, EMG) with a sleep duration of at least one hour. 23 of the infants investigated demonstrated abnormal breathing patterns (increased mean apnea duration, apneas longer than 15 s, apneas with bradycardia) and were treated with aminophylline to prevent a possible SIDS event. Now we investigated the statistical relation between 26 anamnestic factors of our risk score and the need for treatment. In univariate statistical comparisons treated infants differed from untreated infants concerning the occurrence of intraventricular haemorrhages (IVH), the gestational age (GA) (preterm of fullterm) and the occurrence of hyperbilirubinemia (HB) in their anamnesis. In a multivariate analysis with all 26 factors the birth weight was the third important factor beside IVH and GA, but only factor IVH was statistically significant. A cluster analysis of the variables with respect to the separation of the two groups of infants indicates that the variables IVH, GA and HB strongly correlate. In the light of these results we can underline that abnormal breathing patterns can be expected especially in infants with IVH, short GA and low birth weight.

436 out of about 9000 infants who were born between April 1987 and November 1990 in Jena were selected by means of a risk score for a polygraphical monitoring. This score contains anamnestical factors of the mother and the infant which are characteristic of an enhanced risk for the sudden infant death syndrome (SIDS). We performed a day-time polysomnography (ECG, heart rate, respiration, EEG, EOG, EMG) with a sleep duration of at least one hour. 23 of the infants investigated demonstrated abnormal breathing patterns (increased mean apnea duration, apneas longer than 15 s, apneas with bradycardia) and were treated with aminophylline to prevent a possible SIDS event. Now we investigated the statistical relation between 26 anamnestical factors of our risk score and the treatment neediness. In univariate statistical comparisons treated infants differed from untreated infants concerning the occurrence of intraventricular haemorrhages (IVH), the gestational age (GA) (preterm or fullterm) and the occurrence of hyperbilirubinemia (HB) in their anamnesis. In a multivariate analysis with all 26 factors the birth weight was the third important factor beside IVH and GA, but only factor IVH was statistically significant. A cluster analysis of the variables with respect to the separation of the two groups of infants indicates that the variables IVH, GA and HB strongly correlate. In the light of these results we can underline that abnormal breathing patterns can be expected especially in infants with IVH, short GA and low birth weight.

Acta PaediatricaVolume 79, Issue 12 p. 1237-1239 Plasma Levels of β-Endorphin and Substance P in the First Year of Life in Full-Term and Preterm Infants S. Scholle, S. Scholle University Clinics of Jena Department of Pediatrics Kochstr. 2, D-6900 Jena, GermanySearch for more papers by this authorS. Closer, S. Closer University Clinics of Jena Department of Pediatrics Kochstr. 2, D-6900 Jena, GermanySearch for more papers by this authorG. Zwacka, G. Zwacka University Clinics of Jena Department of Pediatrics Kochstr. 2, D-6900 Jena, GermanySearch for more papers by this authorB. Scheldt, B. Scheldt University Clinics of Jena Department of Pediatrics Kochstr. 2, D-6900 Jena, GermanySearch for more papers by this author S. Scholle, S. Scholle University Clinics of Jena Department of Pediatrics Kochstr. 2, D-6900 Jena, GermanySearch for more papers by this authorS. Closer, S. Closer University Clinics of Jena Department of Pediatrics Kochstr. 2, D-6900 Jena, GermanySearch for more papers by this authorG. Zwacka, G. Zwacka University Clinics of Jena Department of Pediatrics Kochstr. 2, D-6900 Jena, GermanySearch for more papers by this authorB. Scheldt, B. Scheldt University Clinics of Jena Department of Pediatrics Kochstr. 2, D-6900 Jena, GermanySearch for more papers by this author First published: December 1990 https://doi.org/10.1111/j.1651-2227.1990.tb11416.xCitations: 3AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume79, Issue12December 1990Pages 1237-1239 RelatedInformation

Groups of children with a statistically enhanced risk for SIDS: siblings of SIDS-victims and other full-term and preterm infants with anamnestic signs for an enhanced risk of SIDS and a control group of healthy infants without anamnestical sign of risk were polysomnographically investigated in the first year of life. The mean apnoea duration (MA-value estimated by frequency and length of apnoeas ≥3s) in the sleep states active and quiet sleep was calculated. During active sleep there is a significant inverse correlation between MA and postnatal age in the full-term and preterm SIDS-risk infants but not in the controls and siblings of SIDS-victims. In all age groups there are some children in the full-term and preterm infants with extremely enhanced MA-values. For 6 age groups of the first year of life the 90% percentil of the MA-value was calculated separately in the sleep states active and quiet sleep to select infants with an abnormal breathing pattern. This limit could be a help for the decision on therapy.

Groups of children with a statistically enhanced risk for SIDS: siblings of SIDS-victims and other full-term and preterm infants with anamnestic signs for an enhanced risk of SIDS and a control group of healthy infants without anamnestic signs of risk were polysomnographically investigated in the first year of life. The mean apnoea duration (MA-value estimated by frequency and length of apnoeas greater than or equal to 3s) in the sleep states active and quiet sleep was calculated. During active sleep there is a significant inverse correlation between MA and postnatal age in the full-term and preterm SIDS-risk infants but not in the controls and siblings of SIDS-victims. In all age groups there are some children in the full-term and preterm infants with extremely enhanced MA-values. For 6 age groups of the first year of life the 90% percentile of the MA-value was calculated separately in the sleep states active and quiet sleep to select infants with an abnormal breathing pattern. This limit could be a help for the decision on therapy.

In order to evaluate disturbances of the respiratory control in the first year of life in children with a statistically enhanced risk of SIDS, substance P-like immunoreactivity (SPLI) in plasma and mean apnoea duration (MA) were examined. 4 groups of infants were investigated: Controls, full-term infants with anamnestic SIDS-risk factors, preterm infants with additional risk factors and preterm infants without such factors. Infants aged from -4(corrected age) to 63 weeks. SPLI in plasma was determined by a specific, homologous radioimmunoassay. The SPLI-level was significantly higher in controls (n = 41; means +/- SE = 36.37 +/- 4.86 pg/ml) than in preterm infants without (n = 21; 25.41 +/- 5.54 pg/ml) or with additional anamnestic risk factors (n = 111; 25.89 +/- 3.09 pg/ml). SPLI was higher in full-term SIDS-risk infants (n = 150; 30.73 +/- 2.35 pg/ml) than in the preterm groups. There is a significant age dependence in the groups full-term SIDS-risk infants and preterm infants with additional risk factors. During maturation the SPLI-level in plasma rises in these groups from lower values. The MA-values were determined by means of a daytime polygraphy. There is an age dependence of the MA-values during active sleep in full-term SIDS-risk infants and in preterm infants with additional anamnestic risk factors. In the age group 4-17 weeks (peak of SIDS frequency) in active sleep the MA-values were significantly higher in all 3 risk groups than in the controls.(ABSTRACT TRUNCATED AT 250 WORDS)

SIDS is a topical problem in pediatrics. The cause of SIDS is still unknown. The paper considers different possible pathomechanisms and on the basis of different observations a variety of hypotheses: There is the apnoe hypothesis, the sleep hypothesis, the QT-hypothesis, the arousal hypothesis and the functional deficit primarily concerning the reticular formation of the brainstem. Therefore there is an urgent need for screening programms to find out children at risk of SIDS. Finally, aspects of prophylaxis and treatment in case of recognized risk are discussed.