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Richardson J, Goshen S, Meledin I, Golan A, Goldstein E, Shany E. Predictive Value of Early Amplitude Integrated EEG in Extremely Premature Infants. J Child Neurol 2020; 35:737-743. [PMID: 32516024 PMCID: PMC7488832 DOI: 10.1177/0883073820930505] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Amplitude integrated EEG (aEEG) is increasingly utilized in preterm infants. The aim of the study was to evaluate whether semiquantitative visual assessment of aEEG background during the first 72 hours of life is associated with long-term outcome in a group of premature infants born less than 28 weeks' gestation. Infants were prospectively enrolled and monitored in the first 72 hours after birth. aEEG was classified daily according to background activity, appearance of cyclical activity and presence of seizures activity. Log-rank and multivariable cox analysis were used to explore associations of background aEEG activity with short and long-term outcome. Overall, 51 infants were enrolled into the study. Depressed aEEG background on the third day of life was associated with poor outcome (P = .028). Similarly, absence of cycling on the third day of life was associated with death or poor outcome (P = .004 and .012, respectively). In different multivariable models adjusted for gestational age, severe intraventricular hemorrhage or use of sedative medication, neither background nor cycling activities were associated with outcome. Depressed aEEG background and absence of aEEG cycling on the third day of life are associated with poor outcome in univariable analysis. Although continuous aEEG monitoring of premature infants can provide real-time assessment of cerebral function, its use as a predictive tool for long-term outcome using visual analysis requires caution as its predictive power is not greater than that of gestational age or intraventricular hemorrhage.
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Affiliation(s)
- Justin Richardson
- Neonatology Department, Soroka Medical Center, Beer-Sheva, Israel,Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Sharon Goshen
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Irina Meledin
- Neonatology Department, Soroka Medical Center, Beer-Sheva, Israel,Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Agneta Golan
- Neonatology Department, Soroka Medical Center, Beer-Sheva, Israel,Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Ester Goldstein
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Eilon Shany
- Neonatology Department, Soroka Medical Center, Beer-Sheva, Israel,Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel,Eilon Shany, MD, Neonatal Department, Soroka University Medical Center, Rager Ave 151, Beer Sheva 84101, Israel.
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Castro JSD, Leslie ATFS, Guinsburg R. Perinatal factors associated with amplitude-integrated electroencephalography abnormalities in preterm infants on the first day of life. J Pediatr (Rio J) 2020; 96:644-651. [PMID: 31325413 PMCID: PMC9432229 DOI: 10.1016/j.jped.2019.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/07/2019] [Accepted: 06/18/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Evaluate the association between perinatal factors and amplitude-integrated electroencephalogram abnormalities in preterm infants on the first day of life. METHODS This was a cross-sectional study of 60 infants with gestational age between 23 and 32 weeks, without malformations. Infants were continuously monitored by amplitude-integrated electroencephalogram on the first day of life, for at least 3h. The tracings were recorded and analyzed in each column for the following: burst-suppression pattern, sleep-wake cycle, and amplitude of the lower margin (<3μV or <5μV). The association of maternal complications, mode of delivery, birth weight, gestational age, neonatal sex, resuscitation procedures, hypothermia on admission, and the Score for Neonatal Acute Physiology, Perinatal Extension, Version II [SNAPPE-II]) with amplitude-integrated electroencephalogram alterations was assessed by multiple logistic regression. RESULTS A discontinuous pattern occurred in 65% of infants, and a continuous pattern occurred in 23%. The burst-suppression pattern was associated with vaginal delivery (OR: 7.6; 95% CI: 1.1-53.1) and SNAPPE-II≥40 (OR: 13.1; 95% CI: 1.8-95.1). A lower margin of the amplitude-integrated electroencephalogram of <3μV was also associated with SNAPPE-II≥40 (OR: 10.6, 95% CI: 2.3-49.2), while a value <5μV was associated with lower GA (OR: 0.51, 95% CI: 0.34-0.76). There were no associations between the perinatal variables and the absence of a sleep-wake cycle in amplitude-integrated electroencephalogram recordings on the first day of life. CONCLUSION Biological variables and clinical severity are associated with electroencephalographic characteristics of preterm infants on the first day of life and should be considered in clinical practice when amplitude-integrated electroencephalogram is performed.
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Affiliation(s)
- Junia Sampel de Castro
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Divisão de Medicina Neonatal, São Paulo, SP, Brazil
| | | | - Ruth Guinsburg
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Divisão de Medicina Neonatal, São Paulo, SP, Brazil.
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Castro JSD, Leslie ATFS, Guinsburg R. Perinatal factors associated with amplitude‐integrated electroencephalography abnormalities in preterm infants on the first day of life. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2020. [DOI: 10.1016/j.jpedp.2019.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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54
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Lien R. Neurocritical care of premature infants. Biomed J 2020; 43:259-267. [PMID: 32333994 PMCID: PMC7424083 DOI: 10.1016/j.bj.2020.03.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 03/18/2020] [Accepted: 03/19/2020] [Indexed: 12/17/2022] Open
Abstract
Neurocritical care is an approach of comprehensive care through multidisciplinary coordination and implementation of neuroprotective strategies to reduce the risk of neurologic injury among critically ill patients. Premature infants are at a special risk of sustaining brain injury and having adverse neurodevelopmental outcome. The pathogenesis of "encephalopathy of prematurity" is tightly linked to hemodynamic instability during postnatal transition, immaturity of the cerebral vascular bed and nervous system, and the commonly encountered inflammation in an intensive care setting. Clinical assessment aided by renewed monitoring techniques, together with therapies supported by best available evidence may provide opportunities to salvage these vulnerable brains. Indeed, to promote optimal brain development and to ensure neurodevelopmental intact survival is of imperial priority in the modern care of preterm infants.
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Affiliation(s)
- Reyin Lien
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Han Y, Fu N, Liang J, Cui Y, Zhang Y, Li J, Huang S, Liu J, Qin J. Evaluation of maturity of sleep states in preterm infants using conventional and amplitude-integrated electroencephalography. Sleep Med 2020; 68:154-159. [PMID: 32044551 DOI: 10.1016/j.sleep.2019.09.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 09/01/2019] [Accepted: 09/03/2019] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To determine whether sleep state maturity can be estimated accurately using conventional electroencephalography (cEEG) or amplitude-integrated electroencephalography (aEEG) features concerning sleep in neurologically unimpaired preterm infants. METHODS A total of 51 preterm infants were monitored with cEEG-polygraphy and simultaneous aEEG. Sleep state maturity of EEG corresponded to specific postmenstrual age (PMA). PMA on cEEG was blindly estimated according to cEEG patterns (indicated as background continuity, frequencies, and voltages) as well as developmental markers in specific states. PMA on aEEG was blindly estimated based on the cycling score (cycling representing sleep state transitions) according to a pre-established scoring system. RESULTS A total of 51 EEGs recorded between 32 and 37 weeks PMA were analysed. A significant relationship between estimated PMA (ePMA) and actual chronological PMA (cPMA) was shown by linear regression both on cEEG (r = 0.93, β = 0.98, 95% confidence interval (CI) 0.87-1.09, p < 0.001) and aEEG (r = 0.85, β = 0.83, 95% CI 0.69-0.98, p < 0.001). The estimation gap (defined as ePMA minus cPMA) was between -2 and +2 weeks both on cEEG and aEEG. The percentage of estimation gap between -1 and +1 weeks was 96% for cEEG, which was higher than the estimate of 88% for aEEG. CONCLUSION Estimated maturity of sleep state was well correlated with cPMA both on cEEG and aEEG. PMA corresponding to state maturity could be estimated within two weeks of actual cPMA using either of these two tools. However, cEEG had higher accuracy compared with aEEG in the evaluation of sleep state maturity.
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Affiliation(s)
- Ye Han
- Department of Pediatrics, Peking University People's Hospital, Beijing, China
| | - Na Fu
- Department of Pediatrics, Peking University People's Hospital, Beijing, China
| | - Jingjing Liang
- Department of Pediatrics, Peking University People's Hospital, Beijing, China
| | - Yanan Cui
- Department of Pediatrics, Peking University People's Hospital, Beijing, China
| | - Ying Zhang
- Department of Pediatrics, Peking University People's Hospital, Beijing, China
| | - Jie Li
- Department of Pediatrics, Peking University People's Hospital, Beijing, China
| | - Shanyamei Huang
- Department of Pediatrics, Peking University People's Hospital, Beijing, China
| | - Jie Liu
- Department of Pediatrics, Peking University People's Hospital, Beijing, China.
| | - Jiong Qin
- Department of Pediatrics, Peking University People's Hospital, Beijing, China.
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Early preterm infants with abnormal psychomotor neurodevelopmental outcome at age two show alterations in amplitude-integrated electroencephalography signals. Early Hum Dev 2020; 141:104935. [PMID: 31835163 DOI: 10.1016/j.earlhumdev.2019.104935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 11/26/2019] [Accepted: 12/02/2019] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Recent studies showed that neurodevelopment in preterm infants can be predicted by using amplitude-integrated electroencephalography (aEEG)-derived parameters. In our previous study we demonstrated that aEEG could be useful in predicting neurodevelopmental outcome in very preterm infants at the corrected age of 2 years. AIM The aim of this study was to further evaluate aEEG for predicting neurodevelopmental outcome at the at the corrected age of 2 years in preterm infants. METHODS Between July 2010 and June 2016 440 very preterm infants were eligible for the study at Innsbruck Medical University Hospital. The aEEG was evaluated for the Burdjalov score in 306 preterm infants (mean gestational age 29.5 weeks; range: 24.1-31.9 weeks). At the corrected age of 2 years outcome was assessed by the Bayley Scales of Infant and Toddler Development. RESULTS The cohort was divided into three subgroups: 248 infants with normal outcome, 40 infants with delayed outcome and 18 infants with abnormal outcome. Burdjalov scores were lower in infants with delayed outcome than in infants with normal outcome and even lower in infants with abnormal outcome. Post-hoc analysis showed significant differences between normal and delayed psychomotor outcome at 18-24 h (5 (3;6) versus 3 (3;5), p = .024), 30-36 h (6 (4;8) versus 4 (4;6), p = .033), 42-48 h (7 (5;8.5) versus 4 (4;7), p = .003), 54-60 h (7 (6;9) versus 5 (4;7), p = .003), 66-72 h (8 (6;9) versus 6.5 (4.25;7.75), p = .027) and week one (8 (7;10) versus 6.5 (5;8), p = .021). Additionally, when comparing normal to abnormal outcome, a significant difference was found at week four (12 (9;12) versus 8 (7;10), p = .024). The Burdjalov score was only predictive for a delayed psychomotor outcome, presenting the highest area under the curve (0.690) at week two of life. CONCLUSION We observed differences in aEEG signals and neurodevelopmental outcome at the corrected age of 2 years, especially for psychomotor outcome. The predictive value of the Burdjalov score regarding neurodevelopmental outcome at the corrected age of 2 years in preterm infants was low.
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Feldmann M, Rousson V, Nguyen TD, Bernet V, Hagmann C, Latal B, Natalucci G. Cognitive outcome of early school-aged children born very preterm is not predicted by early short-term amplitude-integrated electroencephalography. Acta Paediatr 2020; 109:78-84. [PMID: 31254357 DOI: 10.1111/apa.14919] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/25/2019] [Accepted: 06/27/2019] [Indexed: 02/06/2023]
Abstract
AIM We investigated the association between early amplitude-integrated electroencephalography (aEEG) and cognitive outcome in very preterm infants at early school-age. METHODS This prospective cohort study, conducted in the Department of Neonatology, University Hospital Zurich, Switzerland, from 2009 to 2012, comprised of infants born at <32 weeks of gestation, who underwent continuous aEEG recording during the first 4 days of life. Cognitive outcome was assessed with the Kaufman-Assessment Battery for Children at 5 years. Univariate and multivariate logistic regressions were calculated between aEEG parameters and normal cognitive outcome, defined as an intelligence quotient (IQ) of at least 85. RESULTS The 118 (52.5% male) infants were born at a mean gestational age of 29.9 weeks and a mean birth weight of 1235 ± 363 g. We followed up 89 children at the age of five, and they had a mean IQ of 97.8 ± 12.7 with 21.3% under 85-and 2.2% had cerebral palsy. Univariate analyses found associations between aEEG measures and normal cognitive outcome, but these were no longer significant after adjustment for confounders. Socioeconomic status and neonatal morbidity were independent predictors of cognitive outcome. CONCLUSION Early short-term aEEG did not predict later cognitive outcome in our cohort of very preterm infants.
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Affiliation(s)
- Maria Feldmann
- Child Development Centre University Children's Hospital Zurich Zurich Switzerland
- Children's Research Centre University Children's Hospital Zurich Zurich Switzerland
| | - Valentin Rousson
- Institute for Social and Preventive Medicine, Statistical Unit Lausanne University Hospital Lausanne Switzerland
| | - Thi Dao Nguyen
- Department of Neonatology University of Zurich and University Hospital Zurich Zurich Switzerland
| | - Vera Bernet
- Department of Neonatology and Paediatric Intensive care University Children's Hospital Zurich Zurich Switzerland
| | - Cornelia Hagmann
- Children's Research Centre University Children's Hospital Zurich Zurich Switzerland
- Department of Neonatology and Paediatric Intensive care University Children's Hospital Zurich Zurich Switzerland
| | - Beatrice Latal
- Child Development Centre University Children's Hospital Zurich Zurich Switzerland
- Children's Research Centre University Children's Hospital Zurich Zurich Switzerland
| | - Giancarlo Natalucci
- Child Development Centre University Children's Hospital Zurich Zurich Switzerland
- Department of Neonatology University of Zurich and University Hospital Zurich Zurich Switzerland
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58
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Bruns N, Felderhoff-Müser U, Dohna-Schwake C, Woelfle J, Müller H. aEEG Use in Pediatric Critical Care-An Online Survey. Front Pediatr 2020; 8:3. [PMID: 32039124 PMCID: PMC6992599 DOI: 10.3389/fped.2020.00003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 01/07/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Evidence supporting continuous EEG monitoring in pediatric intensive care is increasing, but continuous full-channel EEG is a scarce resource. Amplitude-integrated EEG (aEEG) monitors are broadly available in children's hospitals due to their use in neonatology and can easily be applied to older patients. Objective: The aim of this survey was to evaluate the use of amplitude-integrated EEG in German and Swiss pediatric intensive care units (PICUs). Design: An online survey was sent to German and Swiss PICUs that were identified via databases provided by the German Pediatric Association (DGKJ) and the Swiss Society of Intensive Care (SGI). The questionnaire contained 18 multiple choice questions including the PICU size and specialization, indications for aEEG use, perceived benefits from aEEG, and data storage. Main results: Forty-three (26%) PICUs filled out the questionnaire. Two thirds of all interviewed PICUs use aEEG in non-neonates. Main indications were neurological complications or disease and altered mental state. Features assessed were mostly seizures and side differences, less frequently height of amplitude and background pattern. Interpretation of raw EEG also played an important role. All interviewees would appreciate the establishment of reference values for toddlers and children. Conclusions: aEEG is used in a large proportion of the interviewed PICUs. The wide-spread use without validation of data generates the need for further evaluation of this technique and the establishment of reference values for non-neonates.
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Affiliation(s)
- Nora Bruns
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Neurology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Ursula Felderhoff-Müser
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Neurology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Christian Dohna-Schwake
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Neurology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Joachim Woelfle
- Division of Neonatology and Pediatric Intensive Care, Department of Pediatrics, University Hospital Erlangen, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Hanna Müller
- Division of Neonatology and Pediatric Intensive Care, Department of Pediatrics, University Hospital Erlangen, University of Erlangen-Nürnberg, Erlangen, Germany
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Austin T. The development of neonatal neurointensive care. Pediatr Res 2019:10.1038/s41390-019-0729-5. [PMID: 31852010 DOI: 10.1038/s41390-019-0729-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 12/06/2019] [Accepted: 12/09/2019] [Indexed: 01/06/2023]
Abstract
Brain injury remains one of the major unsolved problems in neonatal care, with survivors at high risk of lifelong neurodisability. It is unlikely that a single intervention can ameliorate neonatal brain injury, given the complex interaction between pathological processes, developmental trajectory, genetic susceptibility, and environmental influences. However, a coordinated, interdisciplinary approach to understand the root cause enables early detection, and diagnosis with enhanced clinical care offering the best chance of improving outcomes and facilitate new lines of neuroprotective treatments. Adult neurointensive care has existed as a speciality in its own right for over 20 years; however, it is only recently that large prospective studies have demonstrated the benefit of this model of care. The 'Neuro-intensive Care Nursery' model originated at the University of California San Francisco in 2008, and since then a growing number of units worldwide have adopted this approach. As well as providing consistent coordinated care for infants from a multidisciplinary team, it provides opportunities for specialist education and training in neonatal neurology, neuromonitoring, neuroimaging and nursing. This review outlines the origins of brain-oriented care of the neonate and the development of the Neuro-NICU (neonatal intensive care unit) and discusses some of the challenges and opportunities in expanding this model of care.
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Affiliation(s)
- Topun Austin
- Neonatal Intensive Care Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
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Binder C, Giordano V, Thanhaeuser M, Kreissl A, Huber-Dangl M, Longford N, Haiden N, Berger A, Repa A, Klebermass-Schrehof K. A Mixed Lipid Emulsion Containing Fish Oil and Its Effect on Electrophysiological Brain Maturation in Infants of Extremely Low Birth Weight: A Secondary Analysis of a Randomized Clinical Trial. J Pediatr 2019; 211:46-53.e2. [PMID: 31030946 PMCID: PMC7115932 DOI: 10.1016/j.jpeds.2019.03.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 02/12/2019] [Accepted: 03/26/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To assess whether parenteral nutrition for infants of extremely low birth weight using a mixed lipid emulsion that contains fish oil influences electrophysiological brain maturation. STUDY DESIGN The study is a prespecified secondary outcome analysis of a randomized controlled trial of 230 infants of extremely low birth weight receiving a mixed (soybean oil, medium-chain triglycerides, olive oil, and fish oil; intervention) or a soybean oil-based lipid emulsion (control). The study was conducted at a single-level IV neonatal care unit (Medical University Vienna; June 2012 to October 2015). Electrophysiological brain maturation (background activity, sleep-wake cycling, and brain maturational scores) was assessed biweekly by amplitude-integrated electroencephalography (birth to discharge). RESULTS A total of 317 amplitude-integrated electroencephalography measurements (intervention: n = 165; control: n = 152) from 121 (intervention: n = 63; control: n = 58) of 230 infants of the core study were available for analysis. Demographic characteristics were not significantly different. By 28 weeks of postmenstrual age, infants receiving the intervention displayed significantly greater percentages of continuous background activity. Total maturational scores and individual scores for continuity, cycling, and bandwidth were significantly greater. Maximum maturational scores were reached 2 weeks earlier in the intervention group (36.4 weeks, 35.4-37.5) compared with the control group (38.4 weeks, 37.1-42.4) (median, IQR; P < .001). CONCLUSIONS Using a mixed parenteral lipid emulsion that contains fish oil, we found that electrophysiological brain maturation was accelerated in infants who were preterm. TRIAL REGISTRATION ClinicalTrials.gov: NCT01585935.
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Affiliation(s)
- Christoph Binder
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Medical University of Vienna, Austria
| | - Vito Giordano
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Medical University of Vienna, Austria
| | - Margarita Thanhaeuser
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Medical University of Vienna, Austria
| | - Alexandra Kreissl
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Medical University of Vienna, Austria
| | - Mercedes Huber-Dangl
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Medical University of Vienna, Austria
| | - Nicholas Longford
- Section of Neonatal Medicine, Department of Medicine; Imperial College London, Chelsea and Westminster Campus, London, United Kingdom
| | - Nadja Haiden
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Medical University of Vienna, Austria
| | - Angelika Berger
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Medical University of Vienna, Austria
| | - Andreas Repa
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Medical University of Vienna, Austria.
| | - Katrin Klebermass-Schrehof
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Medical University of Vienna, Austria
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Jiang FY, Liu HP, Chen LT, Song ZR, Xu S, Guo YX, Zhou L, Wang YK, Shu GH. [Clinical value of serum neuroglobin in evaluating hypoglycemic brain injury in neonates]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2019; 21:573-579. [PMID: 31208512 PMCID: PMC7389575 DOI: 10.7499/j.issn.1008-8830.2019.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 04/08/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To study the clinical value of serum neuroglobin in evaluating hypoglycemic brain injury in neonates. METHODS A total of 100 neonates with hypoglycemia were enrolled as subjects. According to amplitude-integrated EEG (aEEG) findings and/or clinical manifestations, they were divided into symptomatic hypoglycemic brain injury group (n=22), asymptomatic hypoglycemic brain injury group (n=37) and hypoglycemic non-brain injury group (n=41). The three groups were compared in terms of blood glucose, duration of hypoglycemia, levels of neuroglobin and neuron-specific enolase (NSE), and modified aEEG score. The correlation of neuroglobin with NSE and modified aEEG score was analyzed. The receiver operating characteristic (ROC) curve was plotted. RESULTS Compared with the asymptomatic hypoglycemic brain injury and hypoglycemic non-brain injury groups, the symptomatic hypoglycemic brain injury group had significantly lower blood glucose and modified aEEG score, significantly higher neuroglobin and NSE levels, and a significantly longer duration of hypoglycemia (P<0.05). Compared with the hypoglycemic non-brain injury group, the asymptomatic hypoglycemic brain injury group had significantly lower blood glucose and modified aEEG score, significantly higher neuroglobin and NSE levels, and a significantly longer duration of hypoglycemia (P<0.05). Neuroglobin was positively correlated with NSE and duration of hypoglycemia (r=0.922 and 0.929 respectively; P<0.05) and negatively correlated with blood glucose and modified aEEG score (r=-0.849 and -0.968 respectively; P<0.05). The areas under the ROC curve of neuroglobin, NSE and modified aEEG score were 0.894, 0.890 and 0.941 respectively, and neuroglobin had a sensitivity of 80.8% and a specificity of 95.8% at the optimal cut-off value of 108 mg/L. CONCLUSIONS Like NSE and modified aEEG score, serum neuroglobin can also be used as a specific indicator for the assessment of brain injury in neonates with hypoglycemia and has a certain value in clinical practice.
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Affiliation(s)
- Feng-Yuan Jiang
- Department of Pediatrics, Yizheng Hospital, Drum Tower Hospital Group of Nanjing, Yizheng, Jiangsu 211900, China.
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[Association of peripheral blood pH early after birth with amplitude-integrated electroencephalography findings in neonates with intrauterine distress]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2019. [PMID: 31104662 PMCID: PMC7389430 DOI: 10.7499/j.issn.1008-8830.2019.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To study the association of peripheral blood pH early after birth with amplitude-integrated electroencephalography (aEEG) findings in neonates with intrauterine distress. METHODS The clinical data of the neonates with intrauterine distress who were born from January 2017 to May 2018 were collected. According to peripheral blood pH within 30 minutes after birth, these neonates were divided into 3 groups: pH ≤7.15, 7.15 <pH ≤7.25 and pH >7.25, with 30 neonates in each group. aEEG mornitoring was performed within 6 hours after birth, and the abnormal rate of aEEG findings and average cerebral function monitoring (CFM) score were compared between groups. RESULTS The pH ≤7.15 group had a significantly higher abnormal rate of aEEG findings than the pH >7.25 group (P<0.0167) and a significantly lower aEEG CFM score than the 7.15 <pH ≤7.25 and pH >7.25 groups (P<0.05). Peripheral blood pH was positively correlated with the CFM score (r=0.26, P<0.05). CONCLUSIONS Peripheral blood pH is significantly associated with aEEG findings in neonates with intrauterine distress. Active measures should be adopted for the prevention and treatment of nervous system injury in neonates with intrauterine distress who have a significant reduction in peripheral blood pH early after birth (pH ≤7.15).
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Bruns N, Sanchez-Albisua I, Weiß C, Tschiedel E, Dohna-Schwake C, Felderhoff-Müser U, Müller H. Amplitude-Integrated EEG for Neurological Assessment and Seizure Detection in a German Pediatric Intensive Care Unit. Front Pediatr 2019; 7:358. [PMID: 31555625 PMCID: PMC6722192 DOI: 10.3389/fped.2019.00358] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 08/15/2019] [Indexed: 01/04/2023] Open
Abstract
Objective: The aim of our study was to assess the use of aEEG in our pediatric intensive care unit (PICU), indications for neuromonitoring and its findings, utility for seizure detection, and associations with outcome. Design: We retrospectively analyzed non-neonates who were treated in our PICU and received amplitude-integrated EEG (aEEG). Patients: 27 patients aged between 29 days and 10 0/12 years (median 7.3 months) were included, who received a total of 35 aEEGS. Measurements: aEEG tracings were assessed for background (BG) pattern and its evolution, seizures, and side differences using a visual classification (Hellström-Westas). Clinical data were collected from patients' histories and analyzed for correlation with aEEG findings. Main results: While rare in early years, there was an increase in use over time. Most aEEGs were conducted because of (suspected) seizures or for management of antiepileptic treatment. aEEG had low sensitivity but high specificity for recognition of pathological BG pattern with reference to conventional EEG. Worsening of BG pattern or failure to improve was associated with death. Seizure detection rates by aEEG were higher than by clinical observation, especially for identification of non-convulsive epileptic state (ES). Side differences in aEEG were rare, but if present, they were associated with unilateral brain injury. Conclusions: aEEG is useful for the detection of seizures and ES in pediatric intensive care patients. Abnormal BG pattern and poor evolution of BG are negatively associated with survival. aEEG is a potential supplement to conventional EEG, facilitating long-term surveillance of cerebral function when continuous full-channel EEG is not available. Further investigation is needed.
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Affiliation(s)
- Nora Bruns
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Neurology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Iciar Sanchez-Albisua
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Neurology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Christel Weiß
- Department of Medical Statistics and Biomathematics, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Eva Tschiedel
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Neurology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Christian Dohna-Schwake
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Neurology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Ursula Felderhoff-Müser
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Neurology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Hanna Müller
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Neurology, University Hospital Essen, University Duisburg-Essen, Essen, Germany.,Division of Neonatology and Pediatric Intensive Care, Department of Pediatrics, University Hospital Erlangen, University of Erlangen-Nuremberg, Erlangen, Germany
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Weeke LC, Toet MC, de Vries LS. Amplitude-Integrated EEG and Its Potential Role in Augmenting Management Within the NICU. Neurology 2019. [DOI: 10.1016/b978-0-323-54392-7.00014-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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65
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Giordano V, Deindl P, Goeral K, Czaba C, Weninger M, Berger A, Olischar M, Werther T. The power of N-PASS, aEEG, and BIS in detecting different levels of sedation in neonates: A preliminary study. Paediatr Anaesth 2018; 28:1096-1104. [PMID: 30375123 DOI: 10.1111/pan.13509] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 09/06/2018] [Accepted: 09/17/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Sedatives are essential drugs in every intensive care unit in order to ensure the patient's optimal level of comfort. Avoiding conditions of over- and under-sedation is a challenge in a neonatal intensive care setting. Drug administration could be optimized by the concomitant use of objective methods to assess the level of sedation. AIMS We aimed to look at the ability of different methods (Neonatal Pain, Agitation and Sedation Scale, amplitude-integrated Electroencephalogram, and Bispectral Index), and their combination, in detecting different level of sedation. METHODS Twenty-seven neonates among whom 17 were receiving sedatives with or without opiate analgesics were monitored using the Neonatal Pain, Agitation and Sedation Scale, the amplitude-integrated Electroencephalogram, and the Bispectral Index. According to the expert opinion of two trained neonatologists, patients were categorized into three groups: no, light, and deep sedation. Four hours of simultaneous assessment of the Neonatal Pain, Agitation and Sedation Scale scores, Burdjalov scores (to summarize the amplitude-integrated Electroencephalogram trace), and Bispectral Index values were considered for the comparative analysis across these groups. RESULTS All three methods could differentiate patients who were not sedated from those who were deeply sedated: median score 12 and 9, respectively, (95% CI of difference = 1.99-5.99, P = 0.001) for the amplitude-integrated Electroencephalogram Burdjalov score; median 1 and -5, respectively, (95% CI of difference = 2.99-8.00, P = 0.001) for the Neonatal Pain, Agitation and Sedation Scale; and median 48 and 37, respectively, (CI of difference = 1.77-22.00, P = 0.043) for the Bispectral Index. However none of them, used alone, was able to differentiate light and deep sedation: median score 10 and 9, respectively, for the amplitude-integrated Electroencephalogram Burdjalov score; median -2 and -5, respectively, for the Neonatal Pain, Agitation and Sedation Scale; and median 48 and 37, respectively, for the Bispectral Index. Only the amplitude-integrated Electroencephalogram and the Neonatal Pain, Agitation and Sedation Scale were able to differentiate between the conditions of no sedation and light sedation. Also, according to the area under the curves values, the combination of the Neonatal Pain, Agitation and Sedation Scale with the Burdjalov score derived from the amplitude-integrated Electroencephalogram showed the best accuracy in differentiating light and deep sedation. CONCLUSION While none of the three methods alone was able to precisely differentiate between different levels of sedation, we suggest that using a combination of amplitude-integrated Electroencephalogram and Neonatal Pain, Agitation and Sedation Scale can be useful to distinguish between light and deep sedation in neonatal patients.
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Affiliation(s)
- Vito Giordano
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Vienna, Austria
| | - Philipp Deindl
- Department of Neonatology and Pediatric Intensive Care Medicine, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Katharina Goeral
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Vienna, Austria
| | - Christine Czaba
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Vienna, Austria
| | - Manfred Weninger
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Vienna, Austria
| | - Angelika Berger
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Vienna, Austria
| | - Monika Olischar
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Vienna, Austria
| | - Tobias Werther
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Vienna, Austria
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66
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Kong AHT, Lai MM, Finnigan S, Ware RS, Boyd RN, Colditz PB. Background EEG features and prediction of cognitive outcomes in very preterm infants: A systematic review. Early Hum Dev 2018; 127:74-84. [PMID: 30340071 DOI: 10.1016/j.earlhumdev.2018.09.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/24/2018] [Accepted: 09/26/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVES Very preterm infants are at risk of cognitive impairment, but current capacity to predict at-risk infants is sub-optimal. Electroencephalography (EEG) has been used to assess brain function in development. This review investigates the relationship between EEG and cognitive outcomes in very preterm infants. METHODS Two reviewers independently conducted a literature search in April 2018 using PubMed, CINAHL, PsycINFO, Cochrane Library, Embase and Web of Science. Studies included very preterm infants (born ≤34 weeks gestational age, GA) who were assessed with EEG at ≤43 weeks postmenstrual age (PMA) and had cognitive outcomes assessed ≥3 months of age. Data on the subjects, EEG, cognitive assessment, and main findings were extracted. Meta-analysis was undertaken to calculate pooled sensitivity and specificity. RESULTS 31 studies (n = 4712 very preterm infants) met the inclusion criteria. The age of EEG, length of EEG recording, EEG features analysed, age at follow-up, and follow-up assessments were diverse. The included studies were then divided into categories based on their analysed EEG feature(s) for meta-analysis. Only one category had an adequate number of studies for meta-analysis: four papers (n = 255 very preterm infants) reporting dysmature/disorganised EEG patterns were meta-analysed and the pooled sensitivity and specificity for predicting cognitive outcomes were 0.63 (95% CI: 0.53-0.72) and 0.83 (95% CI: 0.74-0.89) respectively. CONCLUSIONS There is preliminary evidence that background EEG features can predict cognitive outcomes in very preterm infants. Reported findings were however too heterogeneous to determine which EEG features are best at predicting cognitive outcome.
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Affiliation(s)
- Annice H T Kong
- The University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia; The University of Queensland, Perinatal Research Centre, Faculty of Medicine, Brisbane, Australia.
| | - Melissa M Lai
- The University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia; The University of Queensland, Perinatal Research Centre, Faculty of Medicine, Brisbane, Australia
| | - Simon Finnigan
- The University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia; The University of Queensland, Perinatal Research Centre, Faculty of Medicine, Brisbane, Australia
| | - Robert S Ware
- Griffith University, Menzies Health Institute Queensland, Brisbane, Australia
| | - Roslyn N Boyd
- The University of Queensland, Perinatal Research Centre, Faculty of Medicine, Brisbane, Australia; Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Paul B Colditz
- The University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia; The University of Queensland, Perinatal Research Centre, Faculty of Medicine, Brisbane, Australia
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Thewissen L, Caicedo A, Dereymaeker A, Van Huffel S, Naulaers G, Allegaert K, Smits A. Cerebral autoregulation and activity after propofol for endotracheal intubation in preterm neonates. Pediatr Res 2018; 84:719-725. [PMID: 30201953 DOI: 10.1038/s41390-018-0160-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 07/12/2018] [Accepted: 08/10/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Despite increasing use of propofol in neonates, observations on cerebral effects are limited. AIM To investigate cerebral autoregulation (CAR) and activity after propofol for endotracheal intubation in preterm neonates. METHODS Twenty-two neonates received propofol before intubation as part of a published dose-finding study. Mean arterial blood pressure (MABP), near-infrared spectroscopy-derived cerebral oxygenation (rScO2), and amplitude-integrated electroencephalography (aEEG) were analyzed until 180 min after propofol. CAR was expressed as transfer function (TF) gain, indicating % change in rScO2 per 1 mmHg change in MABP. Values exceeding mean TF gain + 2 standard deviations (SD) defined impaired CAR. RESULTS After intubation with a median propofol dose of 1 (0.5-4.5) mg/kg, rScO2 remained stable during decreasing MABP. Mean (±SD) TF gain was 0.8 (±0.3)%/mmHg. Impaired CAR was identified in 1 and 5 patient(s) during drug-related hypotension and normal to raised MABP, respectively. Suppressed aEEG was observed up to 60 min after propofol. CONCLUSIONS Drug-related hypotension and decreased cerebral activity after intubation with low propofol doses in preterm neonates were observed, without evidence of cerebral ischemic hypoxia. CAR remained intact during drug-related hypotension in 95.5% of patients. Cerebral monitoring including CAR clarifies the cerebral impact of MABP fluctuations.
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Affiliation(s)
- Liesbeth Thewissen
- Department of Neonatology, University Hospitals Leuven, Leuven, Belgium.
| | - Alexander Caicedo
- Department of Electrical Engineering, ESAT-Stadius, KU Leuven, Leuven, Belgium
| | | | - Sabine Van Huffel
- Department of Electrical Engineering, ESAT-Stadius, KU Leuven, Leuven, Belgium
| | - Gunnar Naulaers
- Department of Neonatology, University Hospitals Leuven, Leuven, Belgium
| | - Karel Allegaert
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Anne Smits
- Department of Neonatology, University Hospitals Leuven, Leuven, Belgium
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68
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Postnatal Maturation of Amplitude Integrated Electroencephalography (aEEG) in Preterm Small for Gestational Age Neonates. Indian Pediatr 2018. [DOI: 10.1007/s13312-018-1396-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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69
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Backman S, Rosén I, Blennow M, Andersson T, Englund M, Flink R, Hallberg B, Liedholm LJ, Norman E, Sailer A, Thordstein M. Swedish consensus reached on recording, interpretation and reporting of neonatal continuous simplified electroencephalography that is supported by amplitude-integrated trend analysis. Acta Paediatr 2018; 107:1702-1709. [PMID: 29897141 DOI: 10.1111/apa.14460] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 05/07/2018] [Accepted: 06/11/2018] [Indexed: 11/27/2022]
Abstract
Continuous monitoring of electroencephalography (EEG), with a focus on amplitude-integrated EEG (aEEG), has been used in neonatal intensive care for decades. A number of systems have been suggested for describing and quantifying aEEG patterns. Extensive full-montage EEG monitoring is used in specialised intensive care units. The American Clinical Neurophysiology Society published recommendations for defining and reporting EEG findings in critically ill adults and infants. Swedish neonatologists and clinical neurophysiologists collaborated to optimise simplified neonatal continuous aEEG and EEG recordings based on these American documents. CONCLUSION This paper describes the Swedish consensus document produced by those meetings.
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Affiliation(s)
- Sofia Backman
- Department of Clin Sciences; Division of Clin Neurophysiology; Skåne University Hospital; Lund Sweden
| | - Ingmar Rosén
- Department of Clin Sciences; Division of Clin Neurophysiology; Skåne University Hospital; Lund Sweden
| | - Mats Blennow
- Department of New Born medicine; CLINTEC; Karolinska Institutet and Karolinska University Hospital; Stockholm Sweden
| | - Thomas Andersson
- Department of Clin Neurophysiology; Karolinska University Hospital; Stockholm Sweden
| | - Marita Englund
- Department of Clin Neurophysiology; Karolinska University Hospital; Stockholm Sweden
| | - Roland Flink
- Department of Neurosciences, Clin Neurophysiology; Uppsala University Hospital; Uppsala Sweden
| | - Boubou Hallberg
- Department of New Born medicine; CLINTEC; Karolinska Institutet and Karolinska University Hospital; Stockholm Sweden
| | | | - Elisabeth Norman
- Department of Pediatrics; Lund University; The Neonatal Intensive Care Unit; Skåne University Hospital; Lund Sweden
| | - Alexandra Sailer
- Department of Clin Neurophysiology; Umeå University Hospital; Umeå Sweden
| | - Magnus Thordstein
- Department of Clin Neurophysiology; Institute of Clin and Experimental Medicine; Linköping University; Linköping Sweden
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70
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Amplitude-Integrated EEG and Brain Sparing in Preterm Small-for-Gestational-Age Infants. J Clin Neurophysiol 2018; 34:456-460. [PMID: 28873072 DOI: 10.1097/wnp.0000000000000399] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Preterm small-for-gestational-age (SGA) infants are at risk for a high mortality rate and impaired cognitive development. Only a few studies have focused on amplitude-integrated EEG (aEEG) in preterm SGA infants. They have been shown to have a slower rate of brain maturation, but these findings have not consistently been related to neurodevelopmental outcomes. The aim of our study was to evaluate early aEEG monitoring in SGA compared with adequate-for-gestational-age preterms. METHODS This prospective cohort study enrolled infants with very low birth weight who were admitted to the neonatal intensive care unit at Hospital Puerta del Mar, Cádiz, Spain, from June 2009 to September 2012. This study was a subanalysis of SGA from the global cohort previously described by our group. Adverse outcome included severe intraventricular hemorrhage and/or death. Cerebral function was monitored using aEEG recordings during the first 72 hours of life. RESULTS Preterm SGA infants (18 SGA in the global cohort of 92 patients) had lower 1- and 5-minute Apgar scores, higher score for neonatal acute physiology perinatal extension II scores, and higher proportion of adverse outcomes. When comparing preterm adequate-for-gestational-age infants with SGA infants with good prognosis, those with SGA had more mature and continuous aEEG patterns. Low margin amplitude depression was not as severe in these patients, and a higher proportion of these patients developed sleep-wake cycles. CONCLUSIONS The results of our study suggest that SGA infants with a good prognosis have a more mature aEEG pattern than preterm adequate-for-gestational-age patients with the same outcome. These findings support the brain sparing theory in SGA infants.
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71
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Amplitude-integrated electroencephalography for seizure detection in newborn infants. Semin Fetal Neonatal Med 2018; 23:175-182. [PMID: 29472139 DOI: 10.1016/j.siny.2018.02.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The amplitude-integrated electroencephalogram (aEEG) is a filtered and compressed EEG trend that can be used for long-term monitoring of brain function in patients of all ages. aEEG is increasingly used in neonatal intensive care units since several studies have shown its utility in high-risk newborn infants. Main indications for aEEG monitoring include early evaluation of brain function after perinatal asphyxia and seizure detection. The aEEG is usually recorded from one or two channels derived from parietal, central, or frontal leads. Although the aEEG is very useful for identifying high-risk infants and infants with seizures, the compressed trend has limitations with regards to detection of individual seizures. However, modern monitors also display the corresponding EEG (aEEG/EEG), which increases the probability of detecting single brief seizures. For improved evaluation of electrocortical brain activity the aEEG/EEG should be assessed together with repeated conventional EEGs or multi-channel EEG monitoring in a multi-disciplinary team.
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72
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Qiu J, Zhao L, Yang Y, Zhang JH, Feng Y, Cheng R. Effects of fentanyl for pain control and neuroprotection in very preterm newborns on mechanical ventilation. J Matern Fetal Neonatal Med 2018; 32:3734-3740. [PMID: 29712500 DOI: 10.1080/14767058.2018.1471593] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Objective: This study aimed to evaluate the cerebral protection effect of fentanyl infusion in very preterm infants in the first 72 h of mechanical ventilation. Methods: In this double-blind, randomized, controlled trial, mechanically ventilated newborns (<32 weeks' gestational age) were randomized to fentanyl (continuous infusion of fentanyl) or placebo (continuous infusion of glucose, controls) in the first 72 h of the mechanical ventilation period. The premature infant pain profile (PIPP), cerebral blood flow velocity, neuron-specific enolase (NSE) concentrations in plasma samples, and cerebral function monitoring (CFM) recordings were evaluated. Results: Twenty-seven infants were allocated to the fentanyl group and 26 to the control group. The fentanyl group had significantly lower PIPP scores than did the control group at 12, 24, 48, and 72 h after the start of infusion (all p < .05). No significant changes in hemodynamic parameters were observed during the observation period using transcranial Doppler flow measurements (p > .05). The fentanyl group had lower NSE levels and higher total CFM scores compared with the control group (both p < .05). Conclusion: In very preterm infants on mechanical ventilation, continuous fentanyl infusion might protect the developing brain by relieving pain during the first 72 h of mechanical ventilation.
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Affiliation(s)
- Jie Qiu
- a Department of Newborn Infants , Children's Hospital of Nanjing Medical University , Nanjing , China
| | - Li Zhao
- a Department of Newborn Infants , Children's Hospital of Nanjing Medical University , Nanjing , China
| | - Yang Yang
- a Department of Newborn Infants , Children's Hospital of Nanjing Medical University , Nanjing , China
| | - Jing-Han Zhang
- a Department of Newborn Infants , Children's Hospital of Nanjing Medical University , Nanjing , China
| | - Yun Feng
- a Department of Newborn Infants , Children's Hospital of Nanjing Medical University , Nanjing , China
| | - Rui Cheng
- a Department of Newborn Infants , Children's Hospital of Nanjing Medical University , Nanjing , China
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Stokes A, Agthe AG, El Metwally D. Music exposure and maturation of late preterm sleep-wake cycles: a randomised crossover trial. Acta Paediatr 2018; 107:582-586. [PMID: 28929527 DOI: 10.1111/apa.14079] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 08/01/2017] [Accepted: 09/08/2017] [Indexed: 12/19/2022]
Abstract
AIM To determine the effect of music on sleep-wake cycle (SWC) patterns in late preterm neonates. METHODS In a masked crossover study, infants between 32 and 36 6/7 weeks gestation were randomised to music exposure either during the first six or last six hours of a 12-hour observation period. SWC characteristics were determined by continuous amplitude-integrated electroencephalography (aEEG) read by two coders masked to exposure sequence. Analysis was performed in paired comparisons. ANOVA was used to assess the effects of music exposure, period and crossover on SWC outcomes: (i) Burdjalov Scores (BS) during active sleep (AS) (ii) per cent and duration of quiet sleep (QS). RESULTS Thirty infants were studied. A total of 222 QS cycles (median seven per patient; range five to 12) were analysed. Music exposure was associated with higher BS (F = 10.60, p = 0.0019) in AS and decreased interruptions during QS. The advanced postconceptual age (PCA) SWC pattern during AS was equivalent to a one-week mean. Number, duration and ratio of QS cycles did not change with music exposure. CONCLUSION Music exposure elicits an increasing PCA pattern in AS and fewer interruptions in QS. Music may benefit sleep in late preterm infants.
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Affiliation(s)
- Adia Stokes
- Department of Pediatrics; Division of Neonatology; University of Maryland School of Medicine; Baltimore MD USA
- Neonatology Associates Ltd; Pediatrix Medical Group; Phoenix Children's Hospital; St Joseph Hospital and Medical Center; Phoenix AZ USA
| | - Alexander G. Agthe
- Department of Pediatrics; Division of Neonatology; University of Maryland School of Medicine; Baltimore MD USA
- Department of Pediatrics; Division of Neonatology; Vanderbilt University School of Medicine; Nashville TN USA
| | - Dina El Metwally
- Department of Pediatrics; Division of Neonatology; University of Maryland School of Medicine; Baltimore MD USA
- Department of Pediatrics; Faculty of Medicine; Suez Canal University; Ismailia Egypt
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El Ters NM, Vesoulis ZA, Liao SM, Smyser CD, Mathur AM. Term-equivalent functional brain maturational measures predict neurodevelopmental outcomes in premature infants. Early Hum Dev 2018; 119:68-72. [PMID: 29579560 PMCID: PMC6190680 DOI: 10.1016/j.earlhumdev.2018.02.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 02/06/2018] [Accepted: 02/13/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Term equivalent age (TEA) brain MRI identifies preterm infants at risk for adverse neurodevelopmental outcomes. But some infants may experience neurodevelopmental impairments even in the absence of neuroimaging abnormalities. OBJECTIVE Evaluate the association of TEA amplitude-integrated EEG (aEEG) measures with neurodevelopmental outcomes at 24-36 months corrected age. METHODS We performed aEEG recordings and brain MRI at TEA (mean post-menstrual age of 39 (±2) weeks in a cohort of 60 preterm infants born at a mean gestational age of 26 (±2) weeks. Forty-four infants underwent Bayley Scales of Infant Development, 3rd Edition (BSID-III) testing at 24-36 months corrected age. Developmental delay was defined by a score greater than one standard deviation below the mean (<85) in any domain. An ROC curve was constructed and a value of SEF90 < 9.2, yielded the highest sensitivity and specificity for moderate/severe brain injury on MRI. The association between aEEG measures and neurodevelopmental outcomes was assessed using odds ratio, then adjusted for confounding variables using logistic regression. RESULTS Infants with developmental delay in any domain had significantly lower values of SEF90. Absent cyclicity was more prevalent in infants with cognitive and motor delay. Both left and right SEF90 < 9.2 were associated with motor delay (OR left: 4.7(1.2-18.3), p = 0.02, OR right: 7.9 (1.8-34.5), p < 0.01). Left SEF90 and right SEF90 were associated with cognitive delay and language delay respectively. Absent cyclicity was associated with motor and cognitive delay (OR for motor delay: 5.8 (1.3-25.1), p = 0.01; OR for cognitive delay: 16.8 (3.1-91.8), p < 0.01). These associations remained significant after correcting for social risk index score and confounding variables. CONCLUSIONS aEEG may be used at TEA as a new tool for risk stratification of infants at higher risk of poor neurodevelopmental outcomes. Therefore, a larger study is needed to validate these results in premature infants at low and high risk of brain injury.
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Affiliation(s)
- Nathalie M El Ters
- Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.
| | - Zachary A Vesoulis
- Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Steve M Liao
- Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Christopher D Smyser
- Division of Pediatric Neurology, Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Amit M Mathur
- Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
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Shellhaas RA, Burns JW, Hassan F, Carlson MD, Barks JDE, Chervin RD. Neonatal Sleep-Wake Analyses Predict 18-month Neurodevelopmental Outcomes. Sleep 2018; 40:4096871. [PMID: 28958087 DOI: 10.1093/sleep/zsx144] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Objectives The neurological examination of critically ill neonates is largely limited to reflexive behavior. The exam often ignores sleep-wake physiology that may reflect brain integrity and influence long-term outcomes. We assessed whether polysomnography and concurrent cerebral near-infrared spectroscopy (NIRS) might improve prediction of 18-month neurodevelopmental outcomes. Methods Term newborns with suspected seizures underwent standardized neurologic examinations to generate Thompson scores and had 12-hour bedside polysomnography with concurrent cerebral NIRS. For each infant, the distribution of sleep-wake stages and electroencephalogram delta power were computed. NIRS-derived fractional tissue oxygen extraction (FTOE) was calculated across sleep-wake stages. At age 18-22 months, surviving participants were evaluated with Bayley Scales of Infant Development (Bayley-III), 3rd edition. Results Twenty-nine participants completed Bayley-III. Increased newborn time in quiet sleep predicted worse 18-month cognitive and motor scores (robust regression models, adjusted r2 = 0.22, p = .007, and 0.27, .004, respectively). Decreased 0.5-2 Hz electroencephalograph (EEG) power during quiet sleep predicted worse 18-month language and motor scores (adjusted r2 = 0.25, p = .0005, and 0.33, .001, respectively). Predictive values remained significant after adjustment for neonatal Thompson scores or exposure to phenobarbital. Similarly, an attenuated difference in FTOE, between neonatal wakefulness and quiet sleep, predicted worse 18-month cognitive, language, and motor scores in adjusted analyses (each p < .05). Conclusions These prospective, longitudinal data suggest that inefficient neonatal sleep-as quantified by increased time in quiet sleep, lower electroencephalogram delta power during that stage, and muted differences in FTOE between quiet sleep and wakefulness-may improve prediction of adverse long-term outcomes for newborns with neurological dysfunction.
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Affiliation(s)
- Renée A Shellhaas
- Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI.,Sleep Disorders Center, University of Michigan, Ann Arbor, MI
| | - Joseph W Burns
- Michigan Tech Research Institute, Michigan Technological University, Ann Arbor, MI
| | - Fauziya Hassan
- Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI.,Sleep Disorders Center, University of Michigan, Ann Arbor, MI
| | - Martha D Carlson
- Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI
| | - John D E Barks
- Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI
| | - Ronald D Chervin
- Sleep Disorders Center, University of Michigan, Ann Arbor, MI.,Department of Neurology, University of Michigan, Ann Arbor, MI
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Jia W, Lei X, Dong W, Li Q. Benefits of starting hypothermia treatment within 6 h vs. 6-12 h in newborns with moderate neonatal hypoxic-ischemic encephalopathy. BMC Pediatr 2018; 18:50. [PMID: 29433475 PMCID: PMC5809807 DOI: 10.1186/s12887-018-1013-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 01/28/2018] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND It has been suggested that mild hypothermia treatment of hypoxia-ischemic encephalopathy (HIE) should start within 6 h after HIE, but many children are admitted to the hospital > 6 h, particularly in developing areas. We aimed to determine whether hypothermia treatment could remain effective within 12 h after birth. METHODS According to their admission, 152 newborns were enrolled in the < 6 h and 6-12 h after HIE groups. All newborns received conventional treatment combined with mild head hypothermia therapy, according to our routine clinical practice. Some newborns only received conventional treatment (lacking informed consent). All newborns received amplitude-integrated electroencephalography (aEEG) monitoring for 4 h and neuron-specific enolase (NSE) measurement before and after 3 days of therapy. RESULTS Compared to the conventional treatment, hypothermia significantly improved the aEEG scores and NSE values in all newborns of the < 6-h group. In the 6-12-h group, the aEEG scores (F = 5.67, P < 0.05) and NSE values (F = 4.98, P < 0.05) were only improved in newborns with moderate HIE. Hypothermia treatment seems to have no effect in newborns with severe HIE after 6 h (P > 0.05). Hypothermia improved the rates of neonatal death and 18-month disability (all P < 0.01). CONCLUSIONS In newborns with moderate HIE, starting hypothermia therapy < 6 h and 6-12 h after HIE showed curative effects. In those with severe HIE, only starting hypothermia therapy within 6 h showed curative effects.
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Affiliation(s)
- Wen Jia
- Department of Neonatology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000 China
| | - Xiaoping Lei
- Department of Neonatology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000 China
| | - Wenbin Dong
- Department of Neonatology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000 China
| | - Qingping Li
- Department of Neonatology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000 China
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Hüning B, Storbeck T, Bruns N, Dransfeld F, Hobrecht J, Karpienski J, Sirin S, Schweiger B, Weiss C, Felderhoff-Müser U, Müller H. Relationship between brain function (aEEG) and brain structure (MRI) and their predictive value for neurodevelopmental outcome of preterm infants. Eur J Pediatr 2018; 177:1181-1189. [PMID: 29789947 PMCID: PMC6061051 DOI: 10.1007/s00431-018-3166-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 04/30/2018] [Accepted: 05/02/2018] [Indexed: 11/26/2022]
Abstract
UNLABELLED To improve the prediction of neurodevelopmental outcome in very preterm infants, this study used the combination of amplitude-integrated electroencephalography (aEEG) within the first 72 h of life and cranial magnetic resonance imaging (MRI) at term equivalent age. A single-center cohort of 38 infants born before 32 weeks of gestation was subjected to both investigations. Structural measurements were performed on MRI. Multiple regression analysis was used to identify independent factors including functional and structural brain measurements associated with outcome at a corrected age of 24 months. aEEG parameters significantly correlated with MRI measurements. Reduced deep gray matter volume was associated with low Burdjalov Score on day 3 (p < 0.0001) and day 1-3 (p = 0.0012). The biparietal width and the transcerebellar diameter were related to Burdjalov Score on day 1 (p = 0.0111; p = 0.0002). The final multiple regression analysis revealed independent predictors of neurodevelopmental outcome: intraventricular hemorrhage (p = 0.0060) and interhemispheric distance (p = 0.0052) for mental developmental index; Burdjalov Score day 1 (p = 0.0201) and interhemispheric distance (p = 0.0142) for psychomotor developmental index. CONCLUSION Functional aEEG parameters were associated with altered brain maturation on MRI. The combination of aEEG and MRI contributes to the prediction of outcome at 24 months. What is Known: • Prematurity remains a risk factor for impaired neurodevelopment. • aEEG is used to measure brain activity in preterm infants and cranial MRI is performed to identify structural gray and white matter abnormalities with impact on neurodevelopmental outcome. What is New: • aEEG parameters observed within the first 72 h of life were associated with altered deep gray matter volumes, biparietal width, and transcerebellar diameter at term equivalent age. • The combination of aEEG and MRI contributes to the prediction of neurodevelopmental outcome at 2 years of corrected age in very preterm infants.
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Affiliation(s)
- Britta Hüning
- 0000 0001 2187 5445grid.5718.bDepartment of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Neurology, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Tobias Storbeck
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Neurology, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.
| | - Nora Bruns
- 0000 0001 2187 5445grid.5718.bDepartment of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Neurology, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Frauke Dransfeld
- 0000 0001 2187 5445grid.5718.bDepartment of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Neurology, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Julia Hobrecht
- 0000 0001 2187 5445grid.5718.bDepartment of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Neurology, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Julia Karpienski
- 0000 0001 2187 5445grid.5718.bDepartment of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Neurology, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Selma Sirin
- 0000 0001 2187 5445grid.5718.bInstitute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Bernd Schweiger
- 0000 0001 2187 5445grid.5718.bInstitute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Christel Weiss
- 0000 0001 2190 4373grid.7700.0Department of Medical Statistics and Biomathematics, University Hospital Mannheim, University of Heidelberg, Ludolf-Krehl-Straße 13-17, 68167 Mannheim, Germany
| | - Ursula Felderhoff-Müser
- 0000 0001 2187 5445grid.5718.bDepartment of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Neurology, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Hanna Müller
- 0000 0001 2187 5445grid.5718.bDepartment of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Neurology, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany ,0000 0001 2107 3311grid.5330.5Division of Neonatology and Pediatric Intensive Care, Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University of Erlangen-Nürnberg, Loschgestr. 15, 91054 Erlangen, Germany
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Bruns N, Blumenthal S, Meyer I, Klose-Verschuur S, Felderhoff-Müser U, Müller H. Application of an Amplitude-integrated EEG Monitor (Cerebral Function Monitor) to Neonates. J Vis Exp 2017. [PMID: 28930990 PMCID: PMC5752191 DOI: 10.3791/55985] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Amplitude-integrated EEG (aEEG) is an easily accessible technique to monitor the electrocortical activity in preterm and term infants in neonatal intensive care units (NICUs). This method was first used to monitor newborns after asphyxia, providing information about future neurological outcomes. The aEEG is also helpful to select newborns who benefit from cooling. The aEEG monitoring of preterm infants is becoming more widespread, as various studies have shown that neurodevelopmental outcome is related to early aEEG tracings. Here, we demonstrate the application of the aEEG monitoring system and present typical patterns that depend upon gestational age and pathophysiological conditions. Furthermore, we mention pitfalls in the interpretation of the aEEG, as this method requires accurate fixation and localization of the electrodes. Additionally, the raw EEG can be used to detect neonatal seizures or to identify aEEG application problems. In conclusion, aEEG is a safe and generally well-tolerated method for the bedside monitoring of neonatal cerebral function; it can even provide information about long-term outcome.
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Affiliation(s)
- Nora Bruns
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Neurology, University Hospital Essen, University Duisburg-Essen;
| | - Susanne Blumenthal
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Neurology, University Hospital Essen, University Duisburg-Essen
| | - Irmgard Meyer
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Neurology, University Hospital Essen, University Duisburg-Essen
| | - Susanne Klose-Verschuur
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Neurology, University Hospital Essen, University Duisburg-Essen
| | - Ursula Felderhoff-Müser
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Neurology, University Hospital Essen, University Duisburg-Essen
| | - Hanna Müller
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Neurology, University Hospital Essen, University Duisburg-Essen; Division of Neonatology, Department of Pediatrics, University of Heidelberg
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Van Meurs KP, Bonifacio SL. Brain‐focused care in the neonatal intensive care unit: the time has come. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2017. [DOI: 10.1016/j.jpedp.2017.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Van Meurs KP, Bonifacio SL. Brain-focused care in the neonatal intensive care unit: the time has come. J Pediatr (Rio J) 2017; 93:439-441. [PMID: 28359015 DOI: 10.1016/j.jped.2017.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Krisa Page Van Meurs
- Stanford University School of Medicine, Department of Pediatrics, Division of Neonatal and Developmental Medicine, Palo Alto, California, United States.
| | - Sonia Lomeli Bonifacio
- Stanford University School of Medicine, Department of Pediatrics, Division of Neonatal and Developmental Medicine, Palo Alto, California, United States
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Impact of brain injury on functional measures of amplitude-integrated EEG at term equivalent age in premature infants. J Perinatol 2017; 37:947-952. [PMID: 28492522 PMCID: PMC5578901 DOI: 10.1038/jp.2017.62] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 03/22/2017] [Accepted: 04/03/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate the association between qualitative and quantitative amplitude-integrated EEG (aEEG) measures at term equivalent age (TEA) and brain injury on magnetic resonance imaging (MRI) in preterm infants. STUDY DESIGN A cohort of premature infants born at <30 weeks of gestation and with moderate-to-severe MRI injury on a TEA MRI scan was identified. A contemporaneous group of gestational age-matched control infants also born at <30 weeks of gestation with none/mild injury on MRI was also recruited. Quantitative aEEG measures, including maximum and minimum amplitudes, bandwidth span and spectral edge frequency (SEF90), were calculated using an offline software package. The aEEG recordings were qualitatively scored using the Burdjalov system. MRI scans, performed on the same day as aEEG, occurred at a mean postmenstrual age of 38.0 (range 37 to 42) weeks and were scored for abnormality in a blinded manner using an established MRI scoring system. RESULTS Twenty-eight (46.7%) infants had a normal MRI or mild brain abnormality, while 32 (53.3%) infants had moderate-to-severe brain abnormality. Univariate regression analysis demonstrated an association between severity of brain abnormality and quantitative measures of left and right SEF90 and bandwidth span (β=-0.38, -0.40 and 0.30, respectively) and qualitative measures of cyclicity, continuity and total Burdjalov score (β=-0.10, -0.14 and -0.12, respectively). After correcting for confounding variables, the relationship between MRI abnormality score and aEEG measures of SEF90, bandwidth span and Burdjalov score remained significant. CONCLUSION Brain abnormalities on MRI at TEA in premature infants are associated with abnormalities on term aEEG measures, suggesting that anatomical brain injury may contribute to delay in functional brain maturation as assessed using aEEG.
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Koolen N, Oberdorfer L, Rona Z, Giordano V, Werther T, Klebermass-Schrehof K, Stevenson N, Vanhatalo S. Automated classification of neonatal sleep states using EEG. Clin Neurophysiol 2017; 128:1100-1108. [DOI: 10.1016/j.clinph.2017.02.025] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 02/02/2017] [Accepted: 02/23/2017] [Indexed: 02/06/2023]
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Ralser E, Neubauer V, Pupp-Peglow U, Kiechl-Kohlendorfer U, Griesmaier E. Amplitude-integrated electroencephalography can predict neurodevelopmental outcome at 12 months of corrected age in very preterm infants. Acta Paediatr 2017; 106:594-600. [PMID: 28109027 DOI: 10.1111/apa.13748] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 10/24/2016] [Accepted: 01/17/2017] [Indexed: 11/30/2022]
Abstract
AIM It is difficult to find diagnostic tools than can reliably predict neurodevelopmental outcomes in very preterm infants in clinical practice. This study evaluated whether amplitude-integrated electroencephalography predicted neurodevelopmental outcome in preterm infants when they reached 12 months of corrected age. METHODS Between October 2007 and December 2013, we studied 232 preterm infants (51% male) at Innsbruck Medical University Hospital, Austria. Their mean birthweight was 1264 g, and their mean gestational age was 29.5 weeks. Amplitude-integrated electroencephalography was evaluated using the Burdjalov score, and outcomes were assessed using the Bayley Scales of Infant Development - Second Edition. RESULTS The cohort was divided into three subgroups: 154 infants with normal outcomes, 53 infants with moderate delays and 25 infants with severe delays. The amplitude-integrated electroencephalography Burdjalov scores were lower in infants with moderate delays than in infants with normal outcomes and even lower in infants with severe delays. The highest area under the curve (0.776) for the Burdjalov score was at 18-24 hours of life. CONCLUSION Our study confirmed the predictive value of amplitude-integrated electroencephalography and showed that this needed to be carried out early in life to provide reliable information on neurodevelopmental outcomes in very preterm infants.
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Affiliation(s)
- Elisabeth Ralser
- Department of Paediatrics II, Neonatology; Innsbruck Medical University; Innsbruck Austria
| | - Vera Neubauer
- Department of Paediatrics II, Neonatology; Innsbruck Medical University; Innsbruck Austria
| | - Ulrike Pupp-Peglow
- Department of Paediatrics II, Neonatology; Innsbruck Medical University; Innsbruck Austria
| | | | - Elke Griesmaier
- Department of Paediatrics II, Neonatology; Innsbruck Medical University; Innsbruck Austria
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Meledin I, Abu Tailakh M, Gilat S, Yogev H, Golan A, Novack V, Shany E. Comparison of Amplitude-Integrated EEG and Conventional EEG in a Cohort of Premature Infants. Clin EEG Neurosci 2017; 48:146-154. [PMID: 27230038 DOI: 10.1177/1550059416648044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare amplitude-integrated EEG (aEEG) and conventional EEG (EEG) activity in premature neonates. METHODS Biweekly aEEG and EEG were simultaneously recorded in a cohort of infants born less than 34 weeks gestation. aEEG recordings were visually assessed for lower and upper border amplitude and bandwidth. EEG recordings were compressed for visual evaluation of continuity and assessed using a signal processing software for interburst intervals (IBI) and frequencies' amplitude. Ten-minute segments of aEEG and EEG indices were compared using regression analysis. RESULTS A total of 189 recordings from 67 infants were made, from which 1697 aEEG/EEG pairs of 10-minute segments were assessed. Good concordance was found for visual assessment of continuity between the 2 methods. EEG IBI, alpha and theta frequencies' amplitudes were negatively correlated to the aEEG lower border while conceptional age (CA) was positively correlated to aEEG lower border ( P < .001). IBI and all frequencies' amplitude were positively correlated to the upper aEEG border ( P ≤ .001). CA was negatively correlated to aEEG span while IBI, alpha, beta, and theta frequencies' amplitude were positively correlated to the aEEG span. CONCLUSIONS Important information is retained and integrated in the transformation of premature neonatal EEG to aEEG. SIGNIFICANCE aEEG recordings in high-risk premature neonates reflect reliably EEG background information related to continuity and amplitude.
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Affiliation(s)
- Irina Meledin
- 1 Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.,2 Neonatal Department, Soroka Medical Center, Beer Sheva, Israel
| | - Muhammad Abu Tailakh
- 1 Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.,3 Clinical Research Center, Soroka Medical Center, Beer Sheva, Israel
| | - Shlomo Gilat
- 4 S. Gilat Medical Research & Equipment Ltd, Karkur, Israel
| | - Hagai Yogev
- 5 Academic College of Tel-Aviv Yaffo, Tel Aviv, Israel
| | - Agneta Golan
- 1 Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.,2 Neonatal Department, Soroka Medical Center, Beer Sheva, Israel
| | - Victor Novack
- 1 Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.,3 Clinical Research Center, Soroka Medical Center, Beer Sheva, Israel
| | - Eilon Shany
- 1 Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.,2 Neonatal Department, Soroka Medical Center, Beer Sheva, Israel
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Bruns N, Dransfeld F, Hüning B, Hobrecht J, Storbeck T, Weiss C, Felderhoff-Müser U, Müller H. Comparison of two common aEEG classifications for the prediction of neurodevelopmental outcome in preterm infants. Eur J Pediatr 2017; 176:163-171. [PMID: 27924356 PMCID: PMC5243906 DOI: 10.1007/s00431-016-2816-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 11/15/2016] [Accepted: 11/17/2016] [Indexed: 12/04/2022]
Abstract
UNLABELLED Neurodevelopmental outcome after prematurity is crucial. The aim was to compare two amplitude-integrated EEG (aEEG) classifications (Hellström-Westas (HW), Burdjalov) for outcome prediction. We recruited 65 infants ≤32 weeks gestational age with aEEG recordings within the first 72 h of life and Bayley testing at 24 months corrected age or death. Statistical analyses were performed for each 24 h section to determine whether very immature/depressed or mature/developed patterns predict survival/neurological outcome and to find predictors for mental development index (MDI) and psychomotor development index (PDI) at 24 months corrected age. On day 2, deceased infants showed no cycling in 80% (HW, p = 0.0140) and 100% (Burdjalov, p = 0.0041). The Burdjalov total score significantly differed between groups on day 2 (p = 0.0284) and the adapted Burdjalov total score on day 2 (p = 0.0183) and day 3 (p = 0.0472). Cycling on day 3 (HW; p = 0.0059) and background on day 3 (HW; p = 0.0212) are independent predictors for MDI (p = 0.0016) whereas no independent predictor for PDI was found (multiple regression analyses). CONCLUSION Cycling in both classifications is a valuable tool to assess chance of survival. The classification by HW is also associated with long-term mental outcome. What is Known: •Neurodevelopmental outcome after preterm birth remains one of the major concerns in neonatology. •aEEG is used to measure brain activity and brain maturation in preterm infants. What is New: •The two common aEEG classifications and scoring systems described by Hellström-Westas and Burdjalov are valuable tools to predict neurodevelopmental outcome when performed within the first 72 h of life. •Both aEEG classifications are useful to predict chance of survival. The classification by Hellström-Westas can also predict long-term outcome at corrected age of 2 years.
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Affiliation(s)
- Nora Bruns
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Neurology, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.
| | - Frauke Dransfeld
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Neurology, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Britta Hüning
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Neurology, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Julia Hobrecht
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Neurology, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Tobias Storbeck
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Neurology, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Christel Weiss
- Institute of Medical Statistics and Biomathematics, University Hospital Mannheim,, University of Heidelberg, Ludolf-Krehl-Straße 13-17D, 68167 Mannheim, Germany
| | - Ursula Felderhoff-Müser
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Neurology, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Hanna Müller
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Neurology, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany ,Division of Neonatology, Department of Pediatrics, University of Heidelberg, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany
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Werther T, Olischar M, Naulaers G, Deindl P, Klebermass-Schrehof K, Stevenson N. Are All Amplitude-Integrated Electroencephalogram Systems Equal? Neonatology 2017; 112:394-401. [PMID: 28926828 DOI: 10.1159/000480008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 08/03/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Filter and peak detection algorithms implemented in amplitude-integrated electroencephalogram (aEEG) systems are not standardized. New aEEG systems are continuously enriching the market and clinicians are faced with different aEEG devices whose tracings may vary. OBJECTIVES The aim of this work was to determine the role of different aEEG systems on quantitative measurements of the aEEG. METHODS In this observational study, a single-channel aEEG recording (Olympic CFM 6000) with corresponding EEG signal was obtained from 32 infants at a gestational age of 36-44 weeks. The signals were split into 334 episodes of 4 h. New aEEG tracings were generated using the NicoletOne Reader Software and aEEG emulations with varying filter profiles and peak detection settings. The aEEG amplitude margins and automated annotation of continuous normal voltage (CNV) were compared. RESULTS The output of the Olympic and the NicoletOne systems are very similar but not identical; the Spearman rank correlations of the aEEG amplitude margins exceeded 0.9 and the differences in the lower and upper amplitude margins were 1.55 μV (SD 1.47) and -2.12 μV (SD 1.44) on average (n = 309), respectively. The aEEG emulation showed that the differences between the output of the Olympic and the NicoletOne system could be primarily ascribed to the peak detection algorithm. The differences in output can affect automated analyses with agreement rates in CNV detection of 76% (n = 32, positive) and 92% (n = 32, negative) when comparing the Olympic to the NicoletOne outputs. CONCLUSIONS Commercial aEEG systems have similar but not identical outputs. Care is advised when interpreting automated aEEG classifications across different devices.
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Affiliation(s)
- Tobias Werther
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Vienna, Austria
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[Background patterns and sleep-wake cycles on amplitude-integrated electroencephalography in preterm infants with periventricular-intraventricular hemorrhage]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2016. [PMID: 27751212 PMCID: PMC7389548 DOI: 10.7499/j.issn.1008-8830.2016.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To study the background patterns and sleep-wake cycles (SWC) on amplitude-integrated electroencephalography (aEEG) in preterm infants with different grades of periventricular-intraventricular hemorrhage (PIVH). METHODS Fifty-six preterm infants with a gestational age between 25 and 33 weeks who were diagnosed with PIVH and 31 gestational age-matched normal preterm without ICH were enrolled. According to Papile staging criteria, the infants with PIVH were subdivided into mild group (grades I and II) and moderate-severe group (grades III and IV). The results of the aEEG were compared between groups. RESULTS The moderate-severe PIVH group showed a decreased continuity of the voltage, an increased loss rate of SWC, and a lower aEEG score than the mild PIVH and control groups (P<0.017). There were no significant differences in these parameters between the mild PIVH and control groups. CONCLUSIONS The changes of background patterns and SWCs may be associated with the severity of PIVH in preterm infants.
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Shibasaki J, Toyoshima K, Kishigami M. Blood pressure and aEEG in the 96h after birth and correlations with neurodevelopmental outcome in extremely preterm infants. Early Hum Dev 2016; 101:79-84. [PMID: 27614328 DOI: 10.1016/j.earlhumdev.2016.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 08/22/2016] [Accepted: 08/24/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The management of hypotension immediately after the birth of preterm infants is controversial. AIM To investigate the relationship between blood pressure (BP), amplitude-integrated electroencephalography (aEEG), and neurodevelopmental outcome in extremely preterm infants. METHODS BP and aEEG were monitored for 96h after birth in 36 infants born at <27weeks gestation. aEEG data were analyzed with Burdjalov scores. Correlations of aEEG findings with BP and several clinical characteristics, including the Score for Neonatal Acute Physiology, Perinatal Extension-II (SNAPPE-II) were explored. A subgroup analysis of BP, aEEG activity, and neurodevelopmental outcome at 18-22months corrected age was also performed. Poor outcome was defined as death or a developmental quotient <70. RESULTS Multiple regression analyses revealed no association between BP during the first 48h after birth and aEEG activity. However, BP 48-96h after birth was significantly associated with simultaneous aEEG activity (p<0.001). Within 48h after birth, SNAPPE-II was significantly associated with aEEG activity. Outcome was assessed in 32 infants; 24 and 8 of whom had good and poor outcomes, respectively. aEEG activity was significantly lower in neonates with a poor outcome than those with a good outcome (<0.001). No significant differences in outcome were observed for BP. CONCLUSION The activity of aEEG was associated with illness severity during the first 48h after birth. After 48h, there was no effect of illness severity but there was an association with BP. We do not know if hypotension results in a poor outcome. However, aEEG activity was associated with neurodevelopmental outcome.
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Affiliation(s)
- Jun Shibasaki
- Department of Neonatology, Kanagawa Children's Medical Center, 2-138-4 Mutsukawa, Minami-ku, Yokohama, 232-8555, Japan.
| | - Katsuaki Toyoshima
- Department of Neonatology, Kanagawa Children's Medical Center, 2-138-4 Mutsukawa, Minami-ku, Yokohama, 232-8555, Japan.
| | - Makoto Kishigami
- Department of Neonatology, Kanagawa Children's Medical Center, 2-138-4 Mutsukawa, Minami-ku, Yokohama, 232-8555, Japan.
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90
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Rhie S, Chae KY, Jo HS, Lee KH. Sleep-wake cycle on amplitude-integrated EEG and neuroimage outcomes in newborns. Ital J Pediatr 2016; 42:85. [PMID: 27633892 PMCID: PMC5025544 DOI: 10.1186/s13052-016-0294-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 09/08/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the results of sleep-wake cycle monitoring using amplitude-integrated EEG (aEEG) and neuroimaging in newborn infants with a possible perinatal hypoxic insult, investigate the correlation between the findings, and determine the relevance of the findings to reasonably predict neurological outcome. METHODS aEEG was recorded among newborn infants suspected of perinatal asphyxia between November, 2014 and June, 2015 in one neonatal intensive care unit facility. Brain imaging with serial ultrasonography and MRI when available were performed, and the infants were divided into two groups according to findings and potential neurological outcome: Group I (favorable findings) and Group II (severe findings such as high grade intraventricular hemorrhage, cerebral infarction or white matter injury). Established sleep-wake cycle times after birth was compared between the two groups. RESULTS Among 107 newborn infants, 85 subjects were classified as Group I and the remaining 22 subjects as Group II. The total number of aEEG sessions was 207 and recording time was 2,796 h with a mean of 14.43 ± 13.40 h per study. Estimated times of cyclicity were earlier in Group I (113.34 h, 95 % CI 82.31-144.37) as compared to Group II (504.39 h, 95 % CI 319.91-688.88; p < 0.001). CONCLUSIONS Delayed cyclicity on aEEG has a strong correlation with unfavorable brain neuroimages in newborns with possible perinatal asphyxia. If sleep-wake cycles do not appear during initial period after birth, follow-up aEEG studies are recommended. TRIAL REGISTRATION Retrospectively registered Registration number: BD 2015-148 Name of registry: amplitude integrated EEG in neonate Date of registration: September 9, 2015.
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Affiliation(s)
- Seonkyeong Rhie
- Department of Pediatrics, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-712, South Korea
| | - Kyu Young Chae
- Department of Pediatrics, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-712, South Korea
| | - Heui Seung Jo
- Department of Pediatrics, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-712, South Korea.
| | - Kyu Hyung Lee
- Department of Pediatrics, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-712, South Korea
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91
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92
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Topcuoglu S, Kolsuz LD, Gursoy T, Ovali F, Karatekin G. Effects of preeclampsia on the amplitude integrated electroencephalography activity in preterm infants. J Perinat Med 2016; 44:345-9. [PMID: 26352066 DOI: 10.1515/jpm-2015-0096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 06/17/2015] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Preeclampsia leads to chronic intrauterine hypoxia by interfering with placental blood supply. The aim of this study was to investigate whether preeclampsia exposure has an influence on the central nervous system of infants, as monitored by amplitude integrated electroencephalography (aEEG). METHODS We recruited 52 infants with gestational age between 30 and 34 weeks. Twenty-seven infants were born to preeclamptic mothers, and 25 gestational age-matched infants whose mothers were healthy were enrolled as a control group. aEEG recordings were performed between 24 and 48 h of life using a cerebral function monitor (CFM) (Olympic Brainz monitor). Along with aEEG, middle cerebral artery (MCA) blood flow velocities (BFV) were measured using Doppler ultrasound. RESULTS The duration of quiet sleep was significantly shorter (P=0.001), and Burdjalov score was lower (P=0.04) in the preeclampsia group. However, there was no change in MCA BFV in this group. CONCLUSIONS Preeclampsia altered cerebral electrical activity of premature infants born to preeclamptic mothers.
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93
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Navakatikyan MA, O'Reilly D, Van Marter LJ. Automatic measurement of interburst interval in premature neonates using range EEG. Clin Neurophysiol 2016; 127:1233-1246. [PMID: 26690783 DOI: 10.1016/j.clinph.2015.11.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 11/11/2015] [Accepted: 11/13/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To explore the direct measure of EEG amplitude (range EEG, rEEG) for detection of interburst intervals (IBIs) and bursts in neonates. METHODS Previously described 177 two-channel EEG recordings 3-6h long from 26 preterm infants (median gestational age of 26 weeks) at 23-38 weeks post-menstrual age (PMA) without major abnormalities were used to test four definitions of IBI detection algorithms with various settings of the parameters. RESULTS As the basis for all four algorithms we developed the aggregation of rEEG signal over the channels by taking its maximum, and method of EEG trace selection at different phases of sleep-wake cycle (with different degree of discontinuity). The two less restrictive algorithms - with one and two amplitude thresholds - turned to be the most promising definitions. There were enough IBI detections for analysis, with no substantial difference in mean and maximum values of intervals. The longest IBI were measured at the location of greater discontinuity. Values of bursts and IBI indices as well as association with PMA were close to the published normative values derived manually. CONCLUSIONS rEEG as a direct measure of EEG amplitude can be used for detection of bursts and IBI. SIGNIFICANCE The automatic measurement of IBI based on rEEG provides a basis for improvements in neonatal brain monitoring.
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Affiliation(s)
- Michael A Navakatikyan
- National Centre for Classification in Health, Faculty of Health Sciences, The University of Sydney, Australia.
| | - Deirdre O'Reilly
- Boston Children's Hospital, Newborn Medicine and Harvard Medical School, Boston, MA, United States
| | - Linda J Van Marter
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
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Kazanci E, Gucuyener K, Ergenekon E, Aktas S. Functional brain maturation of prematurely born, growth discordant monochorionic twins assessed by aEEG. Brain Dev 2016; 38:100-2. [PMID: 26170018 DOI: 10.1016/j.braindev.2015.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 06/01/2015] [Accepted: 06/30/2015] [Indexed: 11/17/2022]
Abstract
The amplitude-integrated electroencephalogram (aEEG) is a simple and convenient tool for brain function monitoring. It is being more widely used in monitoring high risk neonates in neonatal intensive care units. Normal values and patterns for aEEG activity in preterm infants are still being developing. Here we report the functional brain maturation of preterm twin siblings with aEEG who were severely affected by fetal growth discordance. The aEEG records of growth retarded twin was compared with her appropriate for gestational age sibling in order to see if there is also a developmental discordance in the functional brain maturation of these twins.
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Affiliation(s)
- Ebru Kazanci
- Division of Newborn Medicine, Gazi University Hospital, Ankara, Turkey.
| | - Kivilcim Gucuyener
- Division of Pediatric Neurology, Gazi University Hospital, Ankara, Turkey
| | - Ebru Ergenekon
- Division of Newborn Medicine, Gazi University Hospital, Ankara, Turkey
| | - Selma Aktas
- Division of Newborn Medicine, Gazi University Hospital, Ankara, Turkey
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95
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De Luca D, Romain O, Yousef N, Andriamanamirija D, Shankar-Aguilera S, Walls E, Sgaggero B, Aube N, Tissières P. Monitorages physiopathologiques en réanimation néonatale. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.jpp.2015.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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96
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Early amplitude-integrated electroencephalography predicts brain injury and neurological outcome in very preterm infants. Sci Rep 2015; 5:13810. [PMID: 26348553 PMCID: PMC4562298 DOI: 10.1038/srep13810] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 08/06/2015] [Indexed: 12/20/2022] Open
Abstract
Early amplitude-integrated electroencephalography (aEEG) has been widely used in term infants with brain injury to predict neurodevelopmental outcomes; however, the prognostic value of early aEEG in preterm infants is unclear. We evaluated how well early aEEG could predict brain damage and long-term neurodevelopmental outcomes in very preterm infants compared with brain imaging assessments. We found that severe aEEG abnormalities (p=0.000) and aEEG total score<5 (p=0.006) within 72 h after birth were positively correlated with white-matter damage, but aEEG abnormalities were not associated with intracranial hemorrhage (p=0.186). Severe abnormalities in aEEG recordings, head ultrasound, and cranial magnetic resonance imaging (MRI) were all positively correlated with poor outcome at 18 months corrected age. The predictive power of poor outcomes of the aEEG and MRI combination was the same as the aEEG, MRI, and head ultrasound combination with a sensitivity of 52.4%, specificity of 96.2%, positive predictive value of 78.6%, and negative predictive value of 88.4%. These results indicate that severely abnormal aEEG recordings within 72 h after birth can predict white-matter damage and long-term poor outcomes in very preterm infants. Thus aEEG can be used as an early marker to monitor very preterm infants.
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97
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Jiang CM, Yang YH, Chen LQ, Shuai XH, Lu H, Xiang JH, Liu ZL, Zhu YX, Xu RY, Zhu DR, Huang XM. Early amplitude-integrated EEG monitoring 6 h after birth predicts long-term neurodevelopment of asphyxiated late preterm infants. Eur J Pediatr 2015; 174:1043-52. [PMID: 25727101 DOI: 10.1007/s00431-015-2490-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Revised: 01/07/2015] [Accepted: 01/13/2015] [Indexed: 12/15/2022]
Abstract
UNLABELLED The present study aimed to assess the prognostic value of early amplitude-integrated electroencephalogram (aEEG) in late preterm infants who were born at a gestational age between 34 0/7 and 36 6/7 weeks for the prediction of neurobehavioral development. Late preterm infants (n = 170) with normal, mild, and severe asphyxia underwent continuous recording of aEEG for 4-6 h starting 6-8 h after delivery. The recordings were analyzed for background pattern, sleep-wake cycle (SWC), and seizures. Survivors were assessed at 18 months by neurological examination and Bayley Scales of Infant Development II. The incidence of adverse neurological outcome in the asphyxia group was significantly higher than in the normal group. For late preterm infants in the asphyxia group, abnormal aEEG pattern had a predictive potential of neurological outcomes with sensitivity of 78.57% (specificity, 87.80%; positive predictive value [PPV], 68.75%; negative predictive value [NPV], 92.31%; power, 85.45%). Non-SWC and intermediate SWC significantly were increased (25.45 and 52.73%, respectively) in the asphyxia group vs. the normal group. SWC pattern had neurological prognosis value in the asphyxia group with sensitivity of 64.29% (specificity, 87.80%; PPV, 64.29%; NPV, 87.80%; power, 81.82%). CONCLUSION Early aEEG patterns are important determinants of long-term prognosis of neurodevelopmental outcome in asphyxiated late preterm infants.
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Affiliation(s)
- Chun-Ming Jiang
- Department of Pediatrics, Nanjing Medical University Affiliated Hospital of Hangzhou, Hangzhou First People's Hospital Hangzhou, Hangzhou, 310003, China,
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98
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Griesmaier E, Burger C, Ralser E, Neubauer V, Kiechl-Kohlendorfer U. Amplitude-integrated electroencephalography shows mild delays in electrocortical activity in preterm infants born small for gestational age. Acta Paediatr 2015; 104:e283-8. [PMID: 25656306 DOI: 10.1111/apa.12967] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 12/22/2014] [Accepted: 02/02/2015] [Indexed: 11/26/2022]
Abstract
AIM Being born small for gestational age (SGA) seems to be a relevant risk factor for long-term neurologic deficits. We compared the differences between amplitude-integrated electroencephalography (aEEG) signals in very preterm infants born small for gestational age (SGA) and those in age-matched infants born appropriate size for gestational age (AGA). METHODS We performed serial aEEG recording on 305 infants: 255 (83.6%) were AGA, and 50 (16.3%) were SGA. RESULTS The number of bursts per hour decreased over time in both groups, but was higher in the SGA group at every time point. On day one, it was significantly higher in the SGA group (17.4) than in the AGA group (10.1) (p = 0.016). The total Burdjalov score increased with post-natal age and tended to be lower in SGA infants, but did not reach statistical significance at any time point. The percentage of continuous background patterns increased with post-natal age in both groups, with no significant difference between the groups. CONCLUSION Very preterm infants born SGA showed normal maturation of aEEG signals during post-natal life, but they also showed mild delays in electrocortical activity compared to age-matched AGA infants. The predictive value of these findings on neurodevelopmental outcome needs to be further evaluated.
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Affiliation(s)
- E Griesmaier
- Department of Pediatrics II; Neonatology; Innsbruck Medical University; Innsbruck Austria
| | - C Burger
- Department of Pediatrics II; Neonatology; Innsbruck Medical University; Innsbruck Austria
| | - E Ralser
- Department of Pediatrics II; Neonatology; Innsbruck Medical University; Innsbruck Austria
| | - V Neubauer
- Department of Pediatrics II; Neonatology; Innsbruck Medical University; Innsbruck Austria
| | - U Kiechl-Kohlendorfer
- Department of Pediatrics II; Neonatology; Innsbruck Medical University; Innsbruck Austria
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Abstract
The cerebral function monitor is a device for trend monitoring of changes in the amplitude of the electroencephalogram, typically recorded from one or two pairs of electrodes. Initially developed and introduced to monitor cerebral activity in encephalopathic adult patients or during anaesthesia, it is now most widely used in newborns to assess the severity of encephalopathy and for determining prognosis. The duration and severity of abnormalities of the amplitude-integrated electroencephalogram tracing is highly predictive of subsequent neurologic outcome following neonatal hypoxic-ischemic encephalopathy, including in newborns receiving neuroprotective treatment with prolonged moderate hypothermia. The cerebral function monitor is also used for seizure detection and to monitor response to anticonvulsant therapies. Amplitude-integrated electroencephalography compares well with standard electroencephalography when used to assess the severity of neonatal encephalopathy, but a standard electroencephalogram is still required to provide important information about changes in frequency, and in the synchrony and distribution and other characteristics of cerebral cortical activity. The role of the amplitude-integrated electroencephalogram to identify brain injury in preterm infants remains to be determined.
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Affiliation(s)
- Denis Azzopardi
- Centre for the Developing Brain, Perinatal Imaging, King's College London, St Thomas' Hospital, London, UK.
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100
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Vesoulis ZA, Paul RA, Mitchell TJ, Wong C, Inder TE, Mathur AM. Normative amplitude-integrated EEG measures in preterm infants. J Perinatol 2015; 35:428-33. [PMID: 25521561 PMCID: PMC4447544 DOI: 10.1038/jp.2014.225] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 11/17/2014] [Accepted: 11/18/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Assessing qualitative patterns of amplitude-integrated electroencephalography (aEEG) maturation of preterm infants requires personnel with training in interpretation and an investment of time. Quantitative algorithms provide a method for rapidly and reproducibly assessing an aEEG recording independent of provider skill level. Although there are several qualitative and quantitative normative data sets in the literature, this study provides the broadest array of quantitative aEEG measures in a carefully selected and followed cohort of preterm infants with mild or no visible injury on term-equivalent magnetic resonance imaging (MRI) and subsequently normal neurodevelopment at 2 and 7 years of age. STUDY DESIGN A two-channel aEEG recording was obtained on days 4, 7, 14 and 28 of life for infants born ⩽30 weeks estimated gestational age. Measures of amplitude and continuity, spectral edge frequency, percentage of trace in interburst interval (IBI), IBI length and frequency counts of smooth delta waves, delta brushes and theta bursts were obtained. MRI was obtained at term-equivalent age and neurodevelopmental testing was conducted at 2 and 7 years of corrected age. RESULT Correlations were found between increasing postmenstrual age (PMA) and decreasing maximum amplitude (R= -0.23, P=0.05), increasing minimum amplitude (R=0.46, P=0.002) and increasing spectral edge frequency (R=0.78, P=4.17 × 10(-14)). Negative correlations were noted between increasing PMA and counts of smooth delta waves (R= -0.39, P=0.001), delta brushes (R= -0.37, P=0.003) and theta bursts (R= -0.61, P=5.66 × 10(-8)). Increasing PMA was also associated with a decreased amount of time spent in the IBI (R= -0.38, P=0.001) and a shorter length of the maximum IBI (R= -0.27, P=0.03). CONCLUSION This analysis supports a strong correlation between quantitatively determined aEEG measures and PMA, in a cohort of preterm infants with normal term-equivalent age neuroimaging and neurodevelopmental outcomes at 7 years of age, which is both predictable and reproducible. These 'normative' quantitative values support the pattern of maturation previously identified by qualitative analysis.
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Affiliation(s)
- Zachary A. Vesoulis
- Department of Pediatrics– Washington University School of Medicine, St. Louis, MO, USA
| | - Rachel A. Paul
- Department of Psychiatry– Washington University School of Medicine, St. Louis, MO, USA
| | - Timothy J. Mitchell
- Department of Physics – Washington University in St. Louis, St. Louis, MO, USA
| | - Connie Wong
- Newborn Research Centre – The Royal Women’s Hospital, Melbourne, Victoria, Australia
| | - Terrie E. Inder
- Department of Pediatric Newborn Medicine – Brigham and Women’s Hospital, Boston, MA, USA
| | - Amit M. Mathur
- Department of Pediatrics– Washington University School of Medicine, St. Louis, MO, USA
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