title: Cortical burst dynamics predict clinical outcome early in extremely preterm infants.
abstract: Intermittent bursts of electrical activity are a ubiquitous signature of very early brain activity. Previous studies have largely focused on assessing the amplitudes of these transient cortical bursts or the intervals between them. Recent advances in basic neuroscience have identified the presence of scale-free 'avalanche' processes in bursting patterns of cortical activity in other clinical contexts. Here, we hypothesize that cortical bursts in human preterm infants also exhibit scale-free properties, providing new insights into the nature, temporal evolution, and prognostic value of spontaneous brain activity in the days immediately following preterm birth. We examined electroencephalographic recordings from 43 extremely preterm infants (gestational age 22-28 weeks) and demonstrated that their cortical bursts exhibit scale-free properties as early as 12 h after birth. The scaling relationships of cortical bursts correlate significantly with later mental development-particularly within the first 12 h of life. These findings show that early preterm brain activity is characterized by scale-free dynamics which carry developmental significance, hence offering novel means for rapid and early clinical prediction of neurodevelopmental outcomes.
authors.affiliation: 1 Systems Neuroscience Group, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia 2 School of Medicine, Faculty of Medicine and Biomedical Sciences, University of Queensland, Australia kartik.iyer@uqconnect.edu.au.
authors.forename: Kartik K
authors.initials: KK
authors.lastname: Iyer
authors.affiliation: 1 Systems Neuroscience Group, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.
authors.forename: James A
authors.initials: JA
authors.lastname: Roberts
authors.affiliation: 3 Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
authors.forename: Lena
authors.initials: L
authors.lastname: Hellström-Westas
authors.affiliation: 4 Department of Paediatrics, Karlstad Central Hospital, Sweden.
authors.forename: Sverre
authors.initials: S
authors.lastname: Wikström
authors.affiliation: 5 Department of Paediatrics, Institute for Clinical Sciences, Lund University, Lund, Sweden.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Hansen Pupp
authors.affiliation: 5 Department of Paediatrics, Institute for Clinical Sciences, Lund University, Lund, Sweden.
authors.forename: David
authors.initials: D
authors.lastname: Ley
authors.affiliation: 6 Department of Children's Clinical Neurophysiology, HUS Medical Imaging Centre, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland 7 Department of Paediatrics, Children's Hospital, University Central Hospital and University of Helsinki, Helsinki, Finland.
authors.forename: Sampsa
authors.initials: S
authors.lastname: Vanhatalo
authors.affiliation: 1 Systems Neuroscience Group, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia 8 The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Breakspear
mesh_terms: D001921:Brain / Q000502:physiology* / Q000503:physiopathology; D002657:Child Development / Q000502:physiology*; D002675:Child, Preschool; D004569:Electroencephalography; D005260:Female; D005865:Gestational Age; D006801:Humans; D007223:Infant; D062071:Infant, Extremely Premature / Q000502:physiology*; D007234:Infant, Premature / Q000502:physiology*; D008297:Male
keywords: brain monitoring; bursts; long-term outcome; preterm; scale-free; spontaneous activity transient