An in-depth characterisation of neonatal seizures by early continuous video-EEG analysis

Introduction Seizures are harmful to the neonatal brain; this compels many clinicians and researchers to persevere further in optimizing every aspects of managing neonatal seizures. Aims To delineate the seizure profile between non-cooled versus cooled neonates with hypoxic-ischaemic encephalopathy (HIE), in neonates with stroke, the response of seizure burden to phenobarbitone and to quantify the degree of electroclinical dissociation (ECD) of seizures. Methods The multichannel video-EEG was used in this research study as the gold standard to detect seizures, allowing accurate quantification of seizure burden to be ascertained in term neonates. The entire EEG recording for each neonate was independently reviewed by at least 1 experienced neurophysiologist. Data were expressed in medians and interquartile ranges. Linear mixed models results were presented as mean (95% confidence interval); p values <0.05 were deemed as significant. Results Seizure burden in cooled neonates was lower than in non-cooled neonates [60(39-224) vs 203(141-406) minutes; p=0.027]. Seizure burden was reduced in cooled neonates with moderate HIE [49(26-89) vs 162(97-262) minutes; p=0.020] when compared with severe HIE. In neonates with stroke, the background pattern showed suppression over the infarcted side and seizures demonstrated a characteristic pattern. Compared with 10 mg/kg, phenobarbitone doses at 20 mg/kg reduced seizure burden (p=0.004). Seizure burden was reduced within 1 hour of phenobarbitone administration [mean (95% confidence interval): -14(-20 to -8) minutes/hour; p<0.001], but seizures returned to pre-treatment levels within 4 hours (p=0.064). The ECD index in cooled, non-cooled neonates with HIE, stroke and in neonates with other diagnoses were 88%, 94%, 64% and 75% respectively. Conclusions Further research exploring the treatment effects on seizure burden in the neonatal brain is required. A change to our current treatment strategy is warranted as we continue to strive for more effective seizure control, anchored with use of the multichannel EEG as the surveillance tool.

Evanescent field sensing: optical nanofibres, whispering-gallery-mode microspherical and microbubble resonators

In this thesis, the evanescent field sensing techniques of tapered optical nanofibres and microspherical resonators are investigated. This includes evanescent field spectroscopy of a silica nanofibre in a rubidium vapour; thermo-optical tuning of Er:Yb co-doped phosphate glass microspheres; optomechanical properties of microspherical pendulums; and the fabrication and characterisation of borosilicate microbubble resonators. Doppler-broadened and sub-Doppler absorption spectroscopic techniques are performed around the D2 transition (780.24 nm) of rubidium using the evanescent field produced at the waist of a tapered nanofibre with input probe powers as low as 55 nW. Doppler-broadened Zeeman shifts and a preliminary dichroic atomic vapour laser lock (DAVLL) line shape are also observed via the nanofibre waist with an applied magnetic field of 60 G. This device has the potential for laser frequency stabilisation while also studying the effects of atom-surface interactions. A non-invasive thermo-optical tuning technique of Er:Yb co-doped microspheres to specific arbitrary wavelengths is demonstrated particularly to 1294 nm and the 5S1/2F=3 to 5P3/2Fʹ=4 laser cooling transition of 85Rb. Reversible tuning ranges of up to 474 GHz and on resonance cavity timescales on the order of 100 s are reported. This procedure has prospective applications for sensing a variety of atomic or molecular species in a cavity quantum electrodynamics (QED) experiments. The mechanical characteristics of a silica microsphere pendulum with a relatively low spring constant of 10-4 Nm-1 are explored. A novel method of frequency sweeping the motion of the pendulum to determine its natural resonance frequencies while overriding its sensitivity to environmental noise is proposed. An estimated force of 0.25 N is required to actuate the pendulum by a displacement of (1-2) μm. It is suggested that this is of sufficient magnitude to be experienced between two evanescently coupled microspheres (photonic molecule) and enable spatial trapping of the micropendulum. Finally, single-input borosilicate microbubble resonators with diameters <100 μm are fabricated using a CO2 laser. Optical whispering gallery mode spectra are observed via evanescent coupling with a tapered fibre. A red-shift of (4-22) GHz of the resonance modes is detected when the hollow cavity was filled with nano-filtered water. A polarisation conversion effect, with an efficiency of 10%, is observed when the diameter of the coupling tapered fibre waist is varied. This effect is also achieved by simply varying the polarisation of the input light in the tapered fibre where the efficiency is optimised to 92%. Thus, the microbubble device acts as a reversible band-pass to band-stop optical filter for cavity-QED, integrated solid-state and semiconductor circuit applications.

Vitamin D status and requirements during pregnancy and lactation

Vitamin D deficiency during pregnancy, lactation, and early infancy has been widely reported. Current understanding of vitamin D metabolism during pregnancy and lactation is incomplete, and to date, experimental data to support vitamin D requirements for these life stages are scarce. There is a shortage of nationally representative data and appropriate reference ranges for serum 25-hydroxyvitamin D (25OHD) during pregnancy, lactation and infancy, including in umbilical cord blood. This thesis described concentrations of total 25OHD and individual metabolites including 25OHD3, 25OHD2, and 3-epi-25OHD3 at 15 weeks’ gestation in a large seasonally balanced pregnancy cohort study (n 1768), carried out in Cork, Ireland (52oN). The prevalence of low 25OHD concentrations in pregnant women was higher than published reports in other Caucasian women, and was highest among non-users of vitamin D-containing supplements during winter. A longitudinal pregnancy study was included which suggested gestational stages had an impact on the total serum 25OHD concentration. This thesis incorporated a randomized controlled trial carried out among 100 women across 3 intervention groups using 20 μg/day of vitamin D3 with or without 500 mg calcium, or placebo, over 12-weeks of lactation to investigate the vitamin D requirement for lactating mothers and the vitamin D content of human milk. A daily intake of 25 μg/day was suggested to meet the requirement of lactating women to maintain a 25OHD levels above 50 nmol/L in 97.5% of the population at 52oN all year around. However, vitamin D content in human milk did not increase in response to supplementation. Serum 25OHD concentration has been used as a predictor of a number of health outcomes. This thesis reported large differences in serum 25OHD concentrations using different methods in 86 umbilical cord samples. The need for international standardization of serum 25OHD measurements was re-emphasized in this thesis.