Publications by authors named "Jennifer Burnsed"

9 Publications

  • Page 1 of 1

Electroencephalogram Background Predicts Time to Full Oral Feedings in Hypoxic-Ischemic Encephalopathy.

Am J Perinatol 2021 Mar 3. Epub 2021 Mar 3.

Department of Pediatrics, University of Virginia, Charlottesville, Virginia.

Objective:  Infants with a history of neonatal hypoxic-ischemic encephalopathy (HIE) are at risk for oral motor dysfunction. Previous studies have associated the need for gastrostomy tube at neonatal intensive care unit discharge with brainstem injury on magnetic resonance imaging (MRI). However, the factors associated with time to full oral feeds in this population have not been previously described. This study aimed to study factors associated with time to full oral feeds in this population.

Study Design:  This is a single-center, retrospective study that examined these factors using Cox regression.

Results:  A total of 150 infants who received therapeutic hypothermia from 2011 to 2017 were included in this study. The single clinical factor significantly associated with time to full oral feeds was the severity of background abnormality on electroencephalogram in the first 24 hours of age (severe vs. mild 95% confidence interval [CI]: 0.34-0.74; moderate vs. mild 95% CI: 0.19-0.45). Brainstem injury on MRI was the factor most highly associated with need for gastrostomy tube placement ( = 0.028), though the overall incidence of need for gastrostomy tube feeds in this population was low (5%).

Conclusion:  These findings may help clinicians counsel families on what to expect in neonates with HIE and make decisions on the need for and timing to pursue gastrostomy tube in this population.

Key Points: · The overall incidence of the need for assisted feeding at NICU discharge is low in this population.. · MRI brainstem injury was most highly associated with need for gastrostomy tube placement.. · Worsening severity of background abnormality on EEG was associated with longer time to oral feeds..
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http://dx.doi.org/10.1055/s-0041-1725161DOI Listing
March 2021

Continuous Video Electroencephalogram during Hypoxia-Ischemia in Neonatal Mice.

J Vis Exp 2020 06 11(160). Epub 2020 Jun 11.

Department of Pediatrics, University of Virginia; Department of Neurology, University of Virginia;

Hypoxia ischemia is the most common cause of neonatal seizures. Animal models are crucial for understanding the mechanisms and physiology underlying neonatal seizures and hypoxia ischemia. This manuscript describes a method for continuous video electroencephalogram (EEG) monitoring in neonatal mice to detect seizures and analyze EEG background during hypoxia ischemia. Use of video and EEG in conjunction allows description of seizure semiology and confirmation of seizures. This method also allows analysis of power spectrograms and EEG background pattern trends over the experimental time period. In this hypoxia ischemia model, the method allows EEG recording prior to injury to obtain a normative baseline and during injury and recovery. Total monitoring time is limited by the inability to separate pups from the mother for longer than four hours. Although, we have used a model of hypoxic-ischemic seizures in this manuscript, this method for neonatal video EEG monitoring could be applied to diverse disease and seizure models in rodents.
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http://dx.doi.org/10.3791/61346DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7895489PMC
June 2020

Efficacy of Supporting Play Exploration and Early Development Intervention in the First Months of Life for Infants Born Very Preterm: 3-Arm Randomized Clinical Trial Protocol.

Phys Ther 2020 08;100(8):1343-1352

Rehabilitation Movement Sciences Program and Motor Development Lab, Virginia Commonwealth University.

Objective: The aim of this project is to study the effect of a physical therapist intervention provided in the first months of life on developmental outcomes of infants born very preterm. Secondary aims are to investigate the impact of intervention timing on the efficacy and impact of the intervention on infants with and without cerebral palsy.

Methods: This study is a multisite longitudinal controlled trial comparing developmental outcomes from infants in the Supporting Play, Exploration, and Early Development Intervention (SPEEDI)_Late or SPEEDI_Early group to a usual care group.

Settings Are Urban: Urban and rural areas surrounding 2 academic medical centers. There will be 90 preterm infants enrolled in this study born at <29 weeks of gestation. SPEEDI is a developmental intervention provided by collaboration between a physical therapist and parent to support a child's motor and cognitive development. The primary outcome measure is the Bayley Scale of Infant and Toddler Development Cognitive and Gross Motor Scaled Scores. Secondary measures include behavioral coding of early problem solving skills, the Gross Motor Function Measure, and Test of Infant Motor Performance.

Impact: More than 270,000 infants are born very preterm in the United States each year, 50% of whom will have neurological dysfunction that limits their ability to keep pace with peers who are typically developing. This study is a step toward understanding the impact that intensive developmental intervention could have in this population in the first months of life.
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http://dx.doi.org/10.1093/ptj/pzaa077DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7439229PMC
August 2020

Neuronal Circuit Activity during Neonatal Hypoxic-Ischemic Seizures in Mice.

Ann Neurol 2019 12 18;86(6):927-938. Epub 2019 Oct 18.

Department of Neurology, University of Virginia, Charlottesville, VA.

Objective: To identify circuits active during neonatal hypoxic-ischemic (HI) seizures and seizure propagation using electroencephalography (EEG), behavior, and whole-brain neuronal activity mapping.

Methods: Mice were exposed to HI on postnatal day 10 using unilateral carotid ligation and global hypoxia. EEG and video were recorded for the duration of the experiment. Using immediate early gene reporter mice, active cells expressing cfos were permanently tagged with reporter protein tdTomato during a 90-minute window. After 1 week, allowing maximal expression of the reporter protein, whole brains were processed, lipid cleared, and imaged with confocal microscopy. Whole-brain reconstruction and analysis of active neurons (colocalized tdTomato/NeuN) were performed.

Results: HI resulted in seizure behaviors that were bilateral or unilateral tonic-clonic and nonconvulsive in this model. Mice exhibited characteristic EEG background patterns such as burst suppression and suppression. Neuronal activity mapping revealed bilateral motor cortex and unilateral, ischemic somatosensory cortex, lateral thalamus, and hippocampal circuit activation. Immunohistochemical analysis revealed regional differences in myelination, which coincide with these activity patterns. Astrocytes and blood vessel endothelial cells also expressed cfos during HI.

Interpretation: Using a combination of EEG, seizure semiology analysis, and whole-brain neuronal activity mapping, we suggest that this rodent model of neonatal HI results in EEG patterns similar to those observed in human neonates. Activation patterns revealed in this study help explain complex seizure behaviors and EEG patterns observed in neonatal HI injury. This pattern may be, in part, secondary to regional differences in development in the neonatal brain. ANN NEUROL 2019;86:927-938.
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http://dx.doi.org/10.1002/ana.25601DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7025736PMC
December 2019

Gabapentin for pain, movement disorders, and irritability in neonates and infants.

Dev Med Child Neurol 2020 03 25;62(3):386-389. Epub 2019 Jul 25.

Division of Neonatology, Department of Pediatrics, University of Virginia, Charlottesville, VA, USA.

We aimed to report our institution's experience with gabapentin therapy to manage agitation and pain in the neonatal intensive care unit (NICU) setting. This was a retrospective, single-center study of NICU patients admitted between January 2015 and December 2017, who received gabapentin. Data on neonatal agitation, pain, Neonatal Pain, Agitation and Sedation Scale (N-PASS) scores, neurosedative medications, and adverse events were collected. Gabapentin was initiated in 16 patients at a corrected gestational age of 44 weeks (range 36.2-75wks) for agitation (n=9), pain (n=6), and movement disorders (n=1). A neurological diagnosis was present in 13 patients. Neonatal agitation, pain, and N-PASS scores and the need for other neurosedatives were significantly decreased 14 days after treatment initiation. Gabapentin is well tolerated in neonates and infants; it is associated with decreased pain scores and decreased need for multiple neurosedative medications 2 weeks after initiation. WHAT THIS PAPER ADDS: Gabapentin is well tolerated in neonates and infants. Gabapentin decreases pain scores and the need for other neurosedative medications in neonates and infants.
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http://dx.doi.org/10.1111/dmcn.14324DOI Listing
March 2020

Neonatal therapeutic hypothermia outside of standard guidelines: a survey of U.S. neonatologists.

Acta Paediatr 2017 Nov 9;106(11):1772-1779. Epub 2017 Aug 9.

Department of Pediatrics, University of Virginia, Charlottesville, VA, USA.

Aim: Therapeutic hypothermia is standard of care in term infants with moderate-to-severe hypoxic-ischaemic encephalopathy (HIE). The goal of this survey was to explore the attitudes of U.S. neonatologists caring for infants with HIE who fall outside of current guidelines.

Methods: Case-based survey administered to members of the Section on Neonatal-Perinatal Medicine of the American Academy of Pediatrics.

Results: A total of 447 responses were analysed, a response rate of 19%. We found significant variability amongst U.S. neonatologists with regard to the use of therapeutic hypothermia for infants with HIE who fall outside standard inclusion criteria. Scenarios with the most variability included HIE in a late preterm infant and HIE following a postnatal code. Provision of therapeutic hypothermia outside of standard guidelines was not influenced by number of years in practice, neonatal intensive care type (NICU) or NICU size.

Conclusion: Significant variability in practice exists when caring for infants with HIE who do not meet standard inclusion criteria, emphasizing the need for continued and rigorous research in this area.
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http://dx.doi.org/10.1111/apa.13983DOI Listing
November 2017

Hypoxia-ischemia and therapeutic hypothermia in the neonatal mouse brain--a longitudinal study.

PLoS One 2015 16;10(3):e0118889. Epub 2015 Mar 16.

Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.

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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0118889PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4361713PMC
March 2016

Imaging neurodegeneration in the mouse hippocampus after neonatal hypoxia-ischemia using oscillating gradient diffusion MRI.

Magn Reson Med 2014 Sep 4;72(3):829-40. Epub 2013 Oct 4.

Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

Purpose: To investigate if frequency-dependent contrasts using oscillating gradient diffusion MRI (dMRI) can detect hypoxia-ischemia (HI) -induced neurodegeneration in the neonatal mouse hippocampus.

Methods: Pulsed- and oscillating-gradient dMR images (at 50, 100, and 150 Hz) were acquired from postmortem fixed brains of mice exposed to neonatal HI using the Rice-Vanucci model. MRI data were acquired at 1, 4, and 8 days following HI, and compared with histological data from the same mice for in situ histological validation of the MRI findings.

Results: The rate of change of apparent diffusion coefficient with gradient frequency (Δf ADC) revealed unique layer-specific contrasts in the neonatal mouse hippocampus. Δf ADC measurements were found to show a significant decrease in response to neonatal HI injury, in the pyramidal (Py) and granule (GrDG) cell layers compared with contralateral regions. The areas of reduced intensity in the Δf ADC maps corresponded to regional neurodegeneration seen with H&E and Fluoro-Jade C stainings, indicating that alterations in Δf ADC contrasts are sensitive to early microstructural changes due to HI-induced neurodegeneration in the studied regions.

Conclusion: The findings show that the frequency-dependence of ADC measurements with oscillating-gradient dMRI can provide a sensitive contrast to detect HI-induced neurodegeneration in neuronal layers of the neonatal mouse hippocampus.
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http://dx.doi.org/10.1002/mrm.24956DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3976472PMC
September 2014

Clinical severity, rather than body temperature, during the rewarming phase of therapeutic hypothermia affect quantitative EEG in neonates with hypoxic ischemic encephalopathy.

J Clin Neurophysiol 2011 Feb;28(1):10-4

Department of Pediatrics, University of Virginia, Charlottesville, Virginia 22902, USA.

EEG is important in monitoring neonates with hypoxic-ischemic encephalopathy (HIE) during hypothermia therapy (HT). Although EEG is used to evaluate the severity of HIE and predict outcome, HT itself may affect EEG parameters. The goal of this study is to evaluate whether core body temperature (CBT) during the rewarming phase of HT in neonates with HIE changes quantified EEG parameters. Quantified EEG parameters were reviewed in 10 neonates with HIE treated with HT. Total power, 90% spectral edge frequency, the mean and lower border of amplitude-integrated EEG (aEEG), and approximate entropy of the aEEG were calculated from 10-minute samples centered on CBT measurements. Patients were classified by clinical HIE severity and length of stay. Two-way analysis of variance was used to test interactions among CBT and EEG data. CBT had no significant effects on the quantified EEG parameters. The aEEG-average and lower border amplitudes were significantly lower in severe HIE. The aEEG-average was significantly more orderly in patients with longer length of stay, regardless of CBT. HIE severity and length of stay but not CBT affect quantified EEG. Findings suggest quantified EEG is reliable during HT. In addition, EEG may aid in predicting short-term outcome of neonates with HIE.
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http://dx.doi.org/10.1097/WNP.0b013e318205134bDOI Listing
February 2011