Gloria B. McAnulty

A three-center, randomized, controlled trial of individualized developmental care for very low birth weight preterm infants: medical, neurodevelopmental, parenting, and caregiving effects.

ABSTRACT. Medical, neurodevelopmental, and parenting effects of individualized developmental care were investigated in a three-center, randomized, controlled trial. A total of 92 preterm infants, weighing less than 1250 g and aged less than 28 weeks, participated. Outcome measures included medical, neurodevelopmental and family function. Quality of care was also assessed. Multivariate analysis of variance investigated group, site, and interaction effects; correlation analysis identified individual variable contributions to significant effects. The results consistently favored the experimental groups. The following contributed to the group effects: shorter duration of parenteral feeding, transition to full oral feeding, intensive care, and hospialization; lower incidence of necrotizing enterocolitis; reduced discharge ages and hospital charges; improved weight, length, and head circumferences; enhanced autonomic, motor, state, attention, and self-regulatory functioning; reduced need for facilitation; and lowered family stress and enhanced appreciation of the infant. Quality of care was measurably improved. Very low birth weight infants and their parents, across diverse settings, may benefit from individualized developmental care.

Regional brain development in serial magnetic resonance imaging of low-risk preterm infants.

OBJECTIVE. MRI studies have shown that preterm infants with brain injury have altered brain tissue volumes. Investigation of preterm infants without brain injury offers the opportunity to define the influence of early birth on brain development and provide normative data to assess effects of adverse conditions on the preterm brain. In this study, we investigated serial MRI of low-risk preterm infants with the aim to identify regions of altered brain development. METHODS. Twenty-three preterm infants appropriate for gestational age without magnetic resonance–visible brain injury underwent MRI twice at 32 and at 42 weeks’ postmenstrual age. Fifteen term infants were scanned 2 weeks after birth. Brain tissue classification and parcellation were conducted to allow comparison of regional brain tissue volumes. Longitudinal brain growth was assessed from preterm infants’ serial scans. RESULTS. At 42 weeks’ postmenstrual age, gray matter volumes were not different between preterm and term infants. Myelinated white matter was decreased, as were unmyelinated white matter volumes in the region including the central gyri. The gray matter proportion of the brain parenchyma constituted 30% and 37% at 32 and 42 weeks’ postmenstrual age, respectively. CONCLUSIONS. This MRI study of preterm infants appropriate for gestational age and without brain injury establishes the influence of early birth on brain development. No decreased cortical gray matter volumes were found, which is in contrast to findings in preterm infants with brain injury. Moderately decreased white matter volumes suggest an adverse influence of early birth on white matter development. We identified a sharp increase in cortical gray matter volume in preterm infants’ serial data, which may correspond to a critical period for cortical development.

Structure and function: Brain electrical activity mapping and computed tomography in schizophrenia ☆

A computerized topographic technique that maps brain electrical activity is applied to the investigation of neurophysiological abnormalities in medicated and drug-free schizophrenic patients. This topographic approach uses EEG and evoked potentials to provide functional measures of electrophysiological abnormalities. Neurophysiological differences between schizophrenic patients and controls are delineated which add further evidence that frontal lobe dysfunction may be relevant to our understanding of schizophrenia. An initial investigation employs computed tomography to examine the relationship of structural anatomical pathology in schizophrenia with the functional abnormalities that may be defined using brain electrical activity mapping. When schizophrenic patients with and without frontal cortical atrophy were compared, electrophysiological differences were delineated that overlay frontal cortical regions. This preliminary work suggests that in schizophrenia, abnormal electrophysiological function is associated with definable gross morphological abnormalities of the brain.

Prediction of dyslexia in kindergarten boys.

This study followed 163 boys from kindergarten through fourth grade. A battery of neurospychological and preacademic tests and electrophysiological measures (BEAM) were administered in kindergarten, and reading tests at grade 4, in an attempt to delineate precursors of dyslexia. Three of the kindergarten tasks (giving sounds associated with letters, rapid naming of numbers, and finger localization) differentiated dyslexics from normal readers with 98 percent correct classification. The tasks primarily involve grapheme-phoneme associations, storage and retrieval of phonological information in long-term memory, and verbal labeling. Results are interpreted as confirming the role played by phonological processing tasks in the prediction of dyslexia. Preliminary BEAM results for visual evoked potential topography suggest a significant increment in the distribution of this potential in the left parietal and frontal region, and, for auditory evoked potential topography, a significant difference between the two groups in the right posterior hemisphere.

Effectiveness of individualized neurodevelopmental care in the newborn intensive care unit (NICU)

The individual infants neurodevelopmental process provides an integrative framework for the delivery of medical care needed to assure the infants survival and quality of outcome. The infants neurobehavioral functioning and expression provides an opportunity for caregivers to estimate the individual infants current strengths, vulnerabilities and threshold to disorganization, as well as to identify the infants strategies in collaborating in his or her best progression. This perspective supports caregivers in seeing themselves in a relationship with the infant, and in considering opportunities to enhance the infants strengths and reduce apparent stressors in collaboration with the infant and the family. The results of several randomized studies supporting the effectiveness of such a neuro developmental approach to NICU care will be presented, and suggest implications for staff education and nursery‐wide implementation.

The pattern of age-related differences in electrophysiological activity of healthy males and females

Age-related differences in quantified electrophysiological measures were examined in 202 subjects (109 females; 93 males) ages 30-80 all of whom were judged to be optimally healthy on a wide variety of criteria. The study utilized both absolute and relative measures from EEG spectral analysis as well as additional measures from long latency-evoked potentials. The same findings were noted for the 109 newly studied females as were reported for 63 previously studied male subjects. Results indicate that there is a broad trend for decreased EEG slow and increased fast activity with age, however, some of the measures change linearly and others are best represented by nonlinear functions. There is no decade where activities remain stable. Overall the pattern of change for males and females is similar, however, gender differences in both the EEG and EP data were present. The females had higher magnitudes for almost all absolute spectral and fast relative spectral measures. However, females demonstrated lower absolute alpha amplitude, lower relative slow activity, and lower late-latency EP data. Moreover, the absolute slow activity measure showed a gender X age interaction, indicating that the females had a different change in pattern of activity with increasing age than the males. Thus, gender-related findings were complex and could not be expressed as simple differences in overall amplitude. Age-related change is not a simple linear process but differs for differing EEG spectral bands, relative, and absolute spectral measures and for males and females. The overall findings contradict the common wisdom that EEG and alpha slow with age and that age related EEG change is on a continuum with findings in Alzheimers disease where increased slowing predominates.

Effects of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) at Age 8 Years: Preliminary Data

The current study reports the effects of NIDCAP (Newborn Individualized Developmental Care and Assessment Program) at 8 years of age for a randomized controlled trial of 38 very early born (≤29 weeks postmenstrual age), high-risk preterm infants. It was hypothesized that the experimental group at school age in comparison with the control group would perform significantly better neuropsychologically and neuroelectrophysiologically. Twenty-two (11 control, 11 experimental) children of the original 38 (18 control, 20 experimental) participants were studied at school age with a detailed neuropsychological battery and with EEG spectral coherence measures. Results indicated significantly better right hemisphere and frontal lobe function in the experimental group than the control group, both neuropsychologically and neurophysiologically. Neurobehavioral and physiological results in the newborn period successfully predicted the beneficial brain function effects at age 8 years. Results support the conclusion that the NIDCAP intervention has lasting effects into school age.

Effects of age upon interhemispheric EEG coherence in normal adults

Age-related differences in quantified electrophysiological measures of interhemispheric EEG coherence were studied in 371 subjects (171 males and 200 females), ages 20-80, all of whom were judged to be optimally healthy. Principal components analysis (PCA) was performed on interhemispheric coherence of Laplacian referenced data from eight homologous left-right electrode pairs, from 0.5 to 32 Hz. Regression procedures, using signals from artifact monitoring channels, were used to minimize effects of eye movement and muscle artifact. Forty-six factors described 80% of the total variance, with electrode location the primary source of communality in factor formation. Within 350 right-handed subjects, results indicated a broad trend for decreased interhemispheric coherence with advancing age. Using canonical correlation, the coherence-based factors also successfully predicted spectral variables, previously found to maximally illustrate age-related EEG desynchronization. We speculate that age-related reduction of interhemispheric coherence may in part explain age-related EEG desynchrony and stems from age-related reduction of cortical connectivity. Gender differences of interhemispheric coherence were also evident. Females demonstrated higher interhemispheric coherence than males. Within a smaller subpopulation of 63 subjects (21 left and 42 right handed), there was a gender-by-handedness interaction, with higher interhemispheric coherence in right-handed females than right-handed males and the reverse in left-handed male and female subjects.

Linguistic profiles of dyslexic and good readers

Linguistic profiles of 60 boys with average intelligence were examined at kindergarten, grade 2, and grade 4. The subjects were 7 dyslexic, 7 mildly dyslexic, 30 average, and 16 good readers, defined in terms of the discrepancy between standardized reading and intelligence scores. Across the three ages, reader groups did not differ in language comprehension, but did differ in confrontation and rapid automatized naming (RAN), three syntactic measures, and verbal memory. Group strengths and weaknesses were, with few exceptions apparent in kindergarten and maintained throughout. The kindergarten tasks which most effectively predicted reading group membership at grade 4 were giving letter sounds, and rapid naming; these predicted 4th grade reading group at close to 100 percent accuracy. The study, together with a further comparison of average and high IQ good readers, provides an interesting contrast between the role of RAN and Confrontation naming in reading.

Unrestricted principal components analysis of brain electrical activity: Issues of data dimensionality, artifact, and utility

SummaryPrincipal components analysis (PCA) was performed on the 1536 spectral and 2944 evoked potential (EP) variables generated by neurophysiologic paradigms including flash VER, click AER, and eyes open and closed spectral EEG from 202 healthy subjects aged 30 to 80. In each case data dimensionality of 1500 to 3000 was substantially reduced using PCA by magnitudes of 20 to over 200. Just 20 PCA factors accounted for 70% to 85% of the variance. Visual inspection of the topographic distribution of factor loading scores revealed complex loadings across multiple data dimensions (time-space and frequency-space). Forty-two non-artifactual factors were successful in classifying age, gender, and a separate group of 60 demented patients by linear discriminant analysis. Discrimination of age and gender primarily involved EP derived factors, whereas dementia primarily involved EEG derived factors. Thirty-eight artifactual factors were identified which, alone, could not discriminate age but were relatively successful in discriminating gender and dementia. The need to parsimoniously develop real neurophysiologic measures and to objectively exclude artifact are discussed. Unrestricted PCA is suggested as a step in this direction.