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Štuikienė K, Griesmaier E, Aldakauskienė I, Garčinskienė J, Paškauskė M, Šmigelskas K, Rimdeikienė I, Marmienė V, Tamelienė R. The Predictive Value of Amplitude-Integrated Electroencephalography for the Neurodevelopmental Outcomes of Preterm Newborns at 12 Months Corrected Age. CHILDREN (BASEL, SWITZERLAND) 2024; 11:979. [PMID: 39201913 PMCID: PMC11352888 DOI: 10.3390/children11080979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Revised: 08/09/2024] [Accepted: 08/13/2024] [Indexed: 09/03/2024]
Abstract
BACKGROUND In clinical practice, it is crucial to identify diagnostic methods that can forecast the neurodevelopmental outcomes of very preterm neonates. Our study aimed to assess the predictive significance of amplitude-integrated electroencephalography (aEEG) for the neurodevelopmental outcomes of preterm infants at 12 months corrected age and to establish the cut-off score that could indicate potential neurodevelopmental impairments. METHODS Preterm neonates born before 32 weeks of gestational age between June 2020 and July 2022 were included in a prospective manner. Amplitude-integrated electroencephalography recordings were conducted at five age intervals (days 1-3; first, second, third and fourth weeks). Recordings were analyzed using the Burdjalov scoring system. The neurodevelopment assessment with Bayley Scales of Infant Development-Second Edition was carried out at 12 months corrected age. RESULTS A total of 140 newborns were included in the study. Neurodevelopment was assessed in 108 infants at 12 months corrected age. Higher total aEEG Burdjalov scores were observed in groups with normal cognitive and motor development. The most sensitive and specific score for prediction of cognitive impairment in 12 months corrected age was an aEEG evaluation of 5.5 according to Burdjalov score within the first three days. The most sensitive and specific score for prediction of motor impairment was 8.5 within the first week. CONCLUSIONS According to our research there is currently not enough data to accurately foresee the development of newborns at 12 months corrected age according to early aEEG test results. However, conducting a research with bigger sample size and repeated evaluations at a later age might increase the prognostic value of aEEG. In this study cut-off scores of aEEG performed early in life to predict later neurodevelopment outcomes were determined.
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Affiliation(s)
- Kristina Štuikienė
- Department of Neonatology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Elke Griesmaier
- Department of Pediatrics II, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Ilona Aldakauskienė
- Department of Neonatology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Jurgita Garčinskienė
- Department of Neonatology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Marija Paškauskė
- Department of Neonatology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Kastytis Šmigelskas
- Faculty of Public Health, Health Research Institute, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Inesa Rimdeikienė
- Department of Rehabilitation, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Vitalija Marmienė
- Department of Psychiatry, Lithuanian University of Health Sciences, 50161 Kaunas, Lithuania
| | - Rasa Tamelienė
- Department of Neonatology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
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Pineda R, Vesoulis Z, El Ters N, Mathur A. aEEG in the first 3 days after extremely preterm delivery relates to neurodevelopmental outcomes. J Perinatol 2024; 44:857-864. [PMID: 38553599 PMCID: PMC11161402 DOI: 10.1038/s41372-024-01945-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 03/13/2024] [Accepted: 03/18/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVES Investigate relationships between aEEG in the first 72 h in extremely preterm infants with 1) infant, medical, and environmental factors, and 2) infant feeding and neurobehavioral outcomes at term and school-age. METHODS Sixty-four preterm infants (≤28 weeks gestation) were enrolled within the first 24-hours of life and had two-channel aEEG until 72 h of life. Standardized neurobehavioral and feeding assessments were conducted at term, and parent-reported outcomes were documented at 5-7 years. RESULTS Lower aEEG Burdjalov scores (adjusted for gestational age) were related to vaginal delivery (p = 0.04), cerebral injury (p = 0.01), Black race (p < 0.01) and having unmarried parents (p = 0.02). Lower Burdjalov scores related to less NICU Network Neurobehavioral Scale arousal (p = 0.002) at term and poorer BRIEF global executive function (p = 0.004), inhibition (p = 0.007), working memory (p = 0.02), material organization (p = 0.0008), metacognition (p = 0.01), and behavioral regulation (p = 0.02) at 5-7 years. We did not observe relationships of early aEEG to feeding outcomes or sensory processing measures. CONCLUSION Early aEEG within the first 72 h of life was related to medical and sociodemographic factors as well as cognitive outcome at 5-7 years.
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Affiliation(s)
- Roberta Pineda
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA.
- Keck School of Medicine, Department of Pediatrics, Los Angeles, CA, USA.
- Gehr Family Center for Health Systems Science and Innovation, University of Southern California, Los Angeles, CA, USA.
- Program in Occupational Therapy, Washington University St. Louis, St. Louis, MO, USA.
| | - Zachary Vesoulis
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Nathalie El Ters
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Amit Mathur
- Department of Pediatrics, St. Louis University, St. Louis, MO, USA
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Štuikienė K, Griesmaier E, Aldakauskienė I, Vidmantė R, Šmigelskas K, Tamelienė R. Trends in Amplitude-Integrated Electroencephalography in the Smallest Preterm Neonates. CHILDREN (BASEL, SWITZERLAND) 2024; 11:566. [PMID: 38790561 PMCID: PMC11120065 DOI: 10.3390/children11050566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/06/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Amplitude-integrated electroencephalography is increasingly used for the neuromonitoring of premature infants. However, it is still not clear how bioelectrical activity changes in the smallest gestational age newborns. The aim of our study was to evaluate the bioelectrical activity of amplitude-integrated electroencephalograms in premature newborns of different gestational age to assess how gestational age and postnatal age influence patterns of amplitude-integrated electroencephalograms and to test the hypothesis of whether the bioelectrical activity of the brain matures faster after the birth of premature newborns than in utero. METHODS We prospectively included infants born before 32 weeks of gestational age between June 2020 and July 2022. Serial recordings of amplitude-integrated electroencephalograms were performed at three time points of age (days 1-3, 13-15, and 27-29). Recordings were analyzed for background patterns, the onset and appearance of cyclicity, and lower amplitude border and bandwidth, which were used to derive a composite Burdjalov score. RESULTS In total, 140 premature neonates were included in the study, and 112 of them completed the study. The median gestational age of the newborns enrolled in the study was 29 (27-30) weeks, and the mean weight was 1206 (350) g. Burdjalov scores increased with increasing gestational age. Higher scores were observed in every dimension of the amplitude-integrated electroencephalograms for newborns of lower gestational age when compared to newborns of higher gestational age of the same postmenstrual age. There was a significant correlation between gestational age and parameters of amplitude-integrated electroencephalograms at all time points. CONCLUSIONS A higher gestational age has a positive effect on the bioelectrical activity of amplitude-integrated electroencephalograms. Increasing postnatal age affected amplitude-integrated electroencephalograms more than gestational age. Our hypothesis that the bioelectrical activity of the brain matures faster for premature newborns after birth than in the womb was confirmed.
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Affiliation(s)
- Kristina Štuikienė
- Department of Neonatology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Elke Griesmaier
- Department of Pediatrics II, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Ilona Aldakauskienė
- Department of Neonatology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Regina Vidmantė
- Department of Neonatology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Kastytis Šmigelskas
- Health Research Institute, Faculty of Public Health, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Rasa Tamelienė
- Department of Neonatology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
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Ryan MAJ, Mathieson SR, Livingstone V, O'Sullivan MP, Dempsey EM, Boylan GB. Sleep state organisation of moderate to late preterm infants in the neonatal unit. Pediatr Res 2023; 93:595-603. [PMID: 36474114 PMCID: PMC9988685 DOI: 10.1038/s41390-022-02319-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 09/07/2022] [Accepted: 09/13/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Sleep supports neurodevelopment and sleep architecture reflects brain maturation. This prospective observational study describes the nocturnal sleep architecture of healthy moderate to late preterm (MLP) infants in the neonatal unit at 36 weeks post menstrual age (PMA). METHODS MLP infants, in the neonatal unit of a tertiary hospital in Ireland from 2017 to 2018, had overnight continuous electroencephalography (cEEG) with video for a minimum 12 h at 36 weeks PMA. The total sleep time (TST) including periods of active sleep (AS), quiet sleep (QS), indeterminate sleep (IS), wakefulness and feeding were identified, annotated and quantified. RESULTS A total of 98 infants had cEEG with video monitoring suitable for analysis. The median (IQR) of TST in the 12 h period was 7.09 h (IQR 6.61-7.76 h), 4.58 h (3.69-5.09 h) in AS, 2.02 h (1.76-2.36 h) in QS and 0.65 h (0.48-0.89 h) in IS. The total duration of AS was significantly lower in infants born at lower GA (p = 0.007) whilst the duration of individual QS periods was significantly higher (p = 0.001). CONCLUSION Overnight cEEG with video at 36 weeks PMA showed that sleep state architecture is dependent on birth GA. Infants with a lower birth GA have less AS and more QS that may have implications for later neurodevelopment. IMPACT EEG provides objective information about the sleep organisation of the moderate to late preterm (MLP) infant. Quantitative changes in sleep states occur with each week of advancing gestational age (GA). Active sleep (AS) is the dominant sleep state that was significantly lower in infants born at lower GA. MLP infants who were exclusively fed orally had a shorter total sleep time and less AS compared to infants who were fed via nasogastric tube.
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Affiliation(s)
- Mary Anne J Ryan
- INFANT Research Centre, University College Cork, Cork, Ireland.,Department of Paediatrics and Child Health, University College Cork, Cork, Ireland.,Department of Neonatology, Cork University Maternity Hospital, Wilton, Cork, Ireland
| | - Sean R Mathieson
- INFANT Research Centre, University College Cork, Cork, Ireland.,Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Vicki Livingstone
- INFANT Research Centre, University College Cork, Cork, Ireland.,Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Marc Paul O'Sullivan
- INFANT Research Centre, University College Cork, Cork, Ireland.,Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Eugene M Dempsey
- INFANT Research Centre, University College Cork, Cork, Ireland.,Department of Paediatrics and Child Health, University College Cork, Cork, Ireland.,Department of Neonatology, Cork University Maternity Hospital, Wilton, Cork, Ireland
| | - Geraldine B Boylan
- INFANT Research Centre, University College Cork, Cork, Ireland. .,Department of Paediatrics and Child Health, University College Cork, Cork, Ireland.
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Dai HR, Guo HL, Hu YH, Xu J, Ding XS, Cheng R, Chen F. Precision caffeine therapy for apnea of prematurity and circadian rhythms: New possibilities open up. Front Pharmacol 2022; 13:1053210. [PMID: 36532766 PMCID: PMC9753576 DOI: 10.3389/fphar.2022.1053210] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 11/18/2022] [Indexed: 09/10/2024] Open
Abstract
Caffeine is the globally consumed psychoactive substance and the drug of choice for the treatment of apnea of prematurity (AOP), but its therapeutic effects are highly variable among preterm infants. Many of the molecular underpinnings of the marked individual response have remained elusive yet. Interestingly, the significant association between Clock gene polymorphisms and the response to caffeine therapy offers an opportunity to advance our understanding of potential mechanistic pathways. In this review, we delineate the functions and mechanisms of human circadian rhythms. An up-to-date advance of the formation and ontogeny of human circadian rhythms during the perinatal period are concisely discussed. Specially, we summarize and discuss the characteristics of circadian rhythms in preterm infants. Second, we discuss the role of caffeine consumption on the circadian rhythms in animal models and human, especially in neonates and preterm infants. Finally, we postulate how circadian-based therapeutic initiatives could open new possibilities to promote precision caffeine therapy for the AOP management in preterm infants.
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Affiliation(s)
- Hao-Ran Dai
- Pharmaceutical Sciences Research Center, Department of Pharmacy, Children’s Hospital of Nanjing Medical University, Nanjing, China
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Hong-Li Guo
- Pharmaceutical Sciences Research Center, Department of Pharmacy, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Ya-Hui Hu
- Pharmaceutical Sciences Research Center, Department of Pharmacy, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Jing Xu
- Pharmaceutical Sciences Research Center, Department of Pharmacy, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Xuan-Sheng Ding
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Rui Cheng
- Neonatal Intensive Care Unit, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Feng Chen
- Pharmaceutical Sciences Research Center, Department of Pharmacy, Children’s Hospital of Nanjing Medical University, Nanjing, China
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Laptook AR, Chalak L, Pappas A, Davis A, Sanchez PJ, Van Meurs KP, Oh W, Sommers R, Shankaran S, Hensman AM, Rouse DJ, McDonald S, Das A, Goldberg RN, Ambalavanan N, Gyamfi-Bannerman C, Thom EA, Higgins RD. The effects of betamethasone on the amplitude integrated EEG of infants born at 34- or 35-weeks gestation. J Perinatol 2022; 42:1615-1621. [PMID: 35618748 PMCID: PMC9699898 DOI: 10.1038/s41372-022-01415-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 04/21/2022] [Accepted: 05/13/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Assess if maternal betamethasone administration at 34-35 weeks accelerated neonatal amplitude integrated EEG (aEEG) maturation. STUDY DESIGN Nested, observational cohort in 7 centers participating in the Antenatal Late Preterm Steroid randomized trial. Up to 2 aEEGs were obtained in neonates born from 340-356 weeks gestation before 72 h (aEEG 1) and at 5-7 days (aEEG 2) if hospitalized. Personnel and aEEG central readers were masked to the intervention. The primary outcome was maturation reflected by cycle frequency; secondary outcomes were border voltage, span, and discontinuity. RESULTS 58 neonates were enrolled (betamethasone, 28, placebo, 30). On aEEG 1, cycle frequency did not differ, but betamethasone exposed infants had a greater lower border voltage and a broader span. On aEEG 2, both groups displayed increases in lower border voltage. CONCLUSIONS Betamethasone associated changes in lower border voltage support accelerated electrical activity. Further investigation is needed to understand the broader span.
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Affiliation(s)
- Abbot R Laptook
- Department of Pediatrics, Women and Infants Hospital, Brown University, Providence, RI, USA.
| | - Lina Chalak
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Athina Pappas
- Department of Pediatrics, Wayne State University, Detroit, MI, USA
| | - Alexis Davis
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Pablo J Sanchez
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State College of Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Krisa P Van Meurs
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - William Oh
- Department of Pediatrics, Women and Infants Hospital, Brown University, Providence, RI, USA
| | - Ross Sommers
- Neonatology, Wellington Medical Center, Boca Raton, FL, USA
| | - Seetha Shankaran
- Department of Pediatrics, Wayne State University, Detroit, MI, USA
| | - Angelita M Hensman
- Department of Pediatrics, Women and Infants Hospital, Brown University, Providence, RI, USA
| | - Dwight J Rouse
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Women and Infants Hospital, Brown University, Providence, RI, USA
| | - Scott McDonald
- Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle, NC, USA
| | - Abhik Das
- Social, Statistical and Environmental Sciences Unit, RTI International, Rockville, MD, USA
| | | | | | - Cynthia Gyamfi-Bannerman
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, USA
| | - Elizabeth A Thom
- Department of Biostatistics and Bioinformatics, George Washington University, Washington, DC, USA
| | - Rosemary D Higgins
- Department of Global and Community Health, George Mason University, Fairfax, VA, USA
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Greve S, Löffelhardt VT, Della Marina A, Felderhoff-Müser U, Dohna-Schwake C, Bruns N. The impact of age and electrode position on amplitude-integrated EEGs in children from 1 month to 17 years of age. Front Neurol 2022; 13:952193. [PMID: 36090865 PMCID: PMC9452771 DOI: 10.3389/fneur.2022.952193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/03/2022] [Indexed: 11/13/2022] Open
Abstract
AimAmplitude-integrated electroencephalography (aEEG) is used to monitor electrocortical activity in critically ill children but age-specific reference values are lacking. We aimed to assess the impact of age and electrode position on aEEG amplitudes and derive normal values for pediatric aEEGs from neurologically healthy children.MethodsNormal EEGs from awake children aged 1 month to 17 years (213 female, 237 male) without neurological disease or neuroactive medication were retrospectively converted into aEEGs. Two observers manually measured the upper and lower amplitude borders of the C3 – P3, C4 – P4, C3 – C4, P3 – P4, and Fp1 – Fp2 channels of the 10–20 system. Percentiles (10th, 25th, 50th, 75th, 90th) were calculated for each age group (<1 year, 1 year, 2–5 years, 6–9 years, 10–13 years, 14–17 years).ResultsAmplitude heights and curves differed between channels without sex-specific differences. During the first 2 years of life, upper and lower amplitudes of all but the Fp1–Fp2 channel increased and then declined until 17 years. The decline of the upper Fp1–Fp2 amplitude began at 4 years, while the lower amplitude declined from the 1st year of life.ConclusionsaEEG interpretation must account for age and electrode positions but not for sex in infants and children.
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Affiliation(s)
- Sandra Greve
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care Medicine, and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Verena Tamara Löffelhardt
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care Medicine, and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Adela Della Marina
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care Medicine, and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- C-TNBS, Centre for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ursula Felderhoff-Müser
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care Medicine, and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- C-TNBS, Centre for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Christian Dohna-Schwake
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care Medicine, and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Nora Bruns
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care Medicine, and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- C-TNBS, Centre for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- *Correspondence: Nora Bruns
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A practical approach toward interpretation of amplitude integrated electroencephalography in preterm infants. Eur J Pediatr 2022; 181:2187-2200. [PMID: 35260920 DOI: 10.1007/s00431-022-04428-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/15/2022] [Accepted: 02/19/2022] [Indexed: 11/03/2022]
Abstract
UNLABELLED The developing preterm brain is vulnerable to injury, especially during periods of clinical instability; therefore, monitoring the brain may provide important information on brain health. Over the last 2 decades, a growing body of literature has been reported on preterm amplitude integrated electroencephalography (aEEG) with regards to normative data and associations with adverse outcomes. Despite this, the use of aEEG for preterm infants remains mostly a research tool with limited clinical applicability. In this article, we review the literature on normal and abnormal aEEG patterns in preterm infants and propose a stepwise clinical algorithm for aEEG assessment at the bedside that takes into account assessment of maturation and identification of pathological patterns. CONCLUSION This algorithm may be used by clinicians at the bedside for interpretation to integrate it in clinical practice for neurological surveillance of preterm infants. WHAT IS KNOWN • Studies have reported normative data on aEEG in preterm infants for different gestational ages. • Burst suppression pattern and absent sleep-wake cycling have been described to be associated with brain pathology and adverse outcomes in preterm infants. WHAT IS NEW • We have synthesized aEEG characteristics in preterm infants across the spectrum of prematurity reported in the literature. • We present a stepwise approach for clinically applicable interpretation of aEEG in preterm infants.
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Beck J, Grosjean C, Bednarek N, Loron G. Amplitude-Integrated EEG Monitoring in Pediatric Intensive Care: Prognostic Value in Meningitis before One Year of Age. CHILDREN 2022; 9:children9050668. [PMID: 35626845 PMCID: PMC9140190 DOI: 10.3390/children9050668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 04/30/2022] [Accepted: 05/01/2022] [Indexed: 11/16/2022]
Abstract
Pediatric morbidity from meningitis remains considerable. Preventing complications is a major challenge to improve neurological outcome. Seizures may reveal the meningitis itself or some complications of this disease. Amplitude-integrated electroencephalography (aEEG) is gaining interest for the management of patients with acute neurological distress, beyond the neonatal age. This study aimed at evaluating the predictive value of aEEG monitoring during the acute phase in meningitis among a population of infants hospitalized in the pediatric intensive care unit (PICU), and at assessing the practicability of the technique. AEEG records of 25 infants younger than one year of age hospitalized for meningitis were retrospectively analyzed and correlated to clinical data and outcome. Recording was initiated, on average, within the first six hours for n = 18 (72%) patients, and overall quality was considered as good. Occurrence of seizure, of status epilepticus, and the background pattern were significantly associated with unfavorable neurological outcomes. AEEG may help in the management and prognostic assessment of pediatric meningitis. It is an easily achievable, reliable technique, and allows detection of subclinical seizures with minimal training. However, it is important to consider the limitations of aEEG, and combinate it with conventional EEG for the best accuracy.
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Affiliation(s)
- Jonathan Beck
- Department of Neonatology, Reims University Hospital Alix de Champagne, 51100 Reims, France; (J.B.); (C.G.); (N.B.)
- CReSTIC EA 3804 UFR Sciences Exactes et Naturelles, Campus Moulin de la Housse, Université de Reims Champagne Ardenne, 51100 Reims, France
| | - Cecile Grosjean
- Department of Neonatology, Reims University Hospital Alix de Champagne, 51100 Reims, France; (J.B.); (C.G.); (N.B.)
| | - Nathalie Bednarek
- Department of Neonatology, Reims University Hospital Alix de Champagne, 51100 Reims, France; (J.B.); (C.G.); (N.B.)
- CReSTIC EA 3804 UFR Sciences Exactes et Naturelles, Campus Moulin de la Housse, Université de Reims Champagne Ardenne, 51100 Reims, France
| | - Gauthier Loron
- Department of Neonatology, Reims University Hospital Alix de Champagne, 51100 Reims, France; (J.B.); (C.G.); (N.B.)
- CReSTIC EA 3804 UFR Sciences Exactes et Naturelles, Campus Moulin de la Housse, Université de Reims Champagne Ardenne, 51100 Reims, France
- Correspondence:
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Durrani NUR, Dinan MH. Amplitude-Integrated Electroencephalography: A Primer for Neonatologists and Practitioners in the NICU. Neoreviews 2022; 23:e96-e107. [PMID: 35102390 DOI: 10.1542/neo.23-2-e96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Amplitude-integrated electroencephalography (aEEG) is an essential tool used in the NICU to monitor infants with central nervous system pathology and encephalopathy. This review provides a summary of aEEG, including clinical indications, interpretation of different tracing patterns, and seizure identification, which are essential skills for teams caring for sick newborns. We also discuss the limitations of the clinical application of aEEG in this population.
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Affiliation(s)
- Naveed Ur Rehman Durrani
- Department of Pediatrics, Neonatal Division, Sidra Medicine, Doha, Qatar
- Department of Pediatrics, Weill Cornell Medicine, Doha, Qatar
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Chen S, Xiao X, Lin S, Zhu J, Liang L, Zhu M, Yang Z, Chen S, Lin Z, Liu Y. Early aEEG can predict neurodevelopmental outcomes at 12 to 18 month of age in VLBWI with necrotizing enterocolitis: a cohort study. BMC Pediatr 2021; 21:582. [PMID: 34930183 PMCID: PMC8686651 DOI: 10.1186/s12887-021-03056-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 12/02/2021] [Indexed: 11/21/2022] Open
Abstract
Background Studies have shown that neurological damage is common in necrotizing enterocolitis (NEC) survivors. The purpose of the study was to investigate the predictive value of amplitude-integrated electroencephalogram (aEEG) for neurodevelopmental outcomes in preterm infants with NEC. Methods Infants with NEC were selected, and the control group was selected based on 1:1–2 pairing by gestational age. We performed single-channel (P3–P4) aEEG in the two groups. The Burdjalov scores were compared between the two groups. Cranial magnetic resonance imaging (MRI) was performed several months after birth. The neurological outcomes at 12 to 18 months of age were compared with the Gesell Developmental Schedules (GDS). The predictive value of aEEG scores for neurodevelopmental delay was calculated. Results There was good consistency between the two groups regarding general conditions. In the 1st aEEG examination, the patients in NEC group had lower Co (1.0 (0.0, 2.0) vs. 2.0 (2.0, 2.0), P = 0.001), Cy (1.0 (0.0, 2.0) vs. 3.0 (3.0, 4.0), P < 0.001), LB (1.0 (0.0, 2.0) vs. 2.0 (2.0, 2.0), P < 0.001), B (1.0 (1.0, 2.0) vs. 3.0 (3.0, 3.5), P < 0.001) and T (3.0 (2.0, 8.0) vs. 10.0 (10.0, 11.5), P < 0.001), than the control group. Cranial MRI in NEC group revealed a widened interparenchymal space with decreased myelination. The abnormality rate of cranial MRI in the NEC group was higher than that in the control group (P = 0.001). The GDS assessment indicated that NEC children had inferior performance and lower mean scores than the control group in the subdomains of gross motor (71 (SD = 6.41) vs. 92 (SD = 11.37), P < 0.001), fine motor (67 (SD = 9.34) vs. 96 (SD = 13.69), adaptive behavior (76 (SD = 9.85) vs. 95 (SD = 14.38), P = 0.001), language (68 (SD = 12.65) vs. 95 (SD = 11.41), P < 0.001), personal-social responses (80 (SD = 15.15) vs. 93(SD = 14.75), P = 0.037) and in overall DQ (72 (SD = 8.66) vs. 95 (SD = 11.07), P < 0.001). The logistic binary regression analysis revealed that the NEC patients had a significantly greater risk of neurodevelopmental delay than the control group (aOR = 27.00, 95% CI = 2.561–284.696, P = 0.006). Confirmed by Spearman’s rank correlation analysis, neurodevelopmental outcomes were significantly predicted by the 1st aEEG Burdjalov score (r = 0.603, P = 0.001). An abnormal 1st Burdjalov score has predictive value for neurodevelopmental delay with high specificity (84.62%) and positive predictive value (80.00%). Conclusions Children with NEC are more likely to develop neurodevelopmental delay. There is high specificity and PPV of early aEEG in predicting neurodevelopmental delay.
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Affiliation(s)
- Si Chen
- Department of Neonatology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 West Xueyuan Road, Wenzhou, 325027, Zhejiang, China
| | - Xiuman Xiao
- Department of Neonatology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 West Xueyuan Road, Wenzhou, 325027, Zhejiang, China
| | - Su Lin
- Department of Neonatology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 West Xueyuan Road, Wenzhou, 325027, Zhejiang, China
| | - Jianghu Zhu
- Department of Neonatology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 West Xueyuan Road, Wenzhou, 325027, Zhejiang, China
| | - Lidan Liang
- Children's Rehabilitation Department, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Minli Zhu
- Department of Neonatology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 West Xueyuan Road, Wenzhou, 325027, Zhejiang, China
| | - Zuqin Yang
- Department of Neonatology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 West Xueyuan Road, Wenzhou, 325027, Zhejiang, China
| | - Shangqin Chen
- Department of Neonatology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 West Xueyuan Road, Wenzhou, 325027, Zhejiang, China
| | - Zhenlang Lin
- Department of Neonatology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 West Xueyuan Road, Wenzhou, 325027, Zhejiang, China.
| | - Yanli Liu
- Department of Neonatology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 West Xueyuan Road, Wenzhou, 325027, Zhejiang, China.
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Tian Q, Pan Y, Zhang Z, Li M, Xu LX, Gong M, Miao P, Jiang X, Yang X, Feng CX, Pan J, Yu Y, Sun B, Ding X. Predictive value of early amplitude integrated electroencephalogram (aEEG) in sleep related problems in children with perinatal hypoxic-ischemia (HIE). BMC Pediatr 2021; 21:410. [PMID: 34537048 PMCID: PMC8449491 DOI: 10.1186/s12887-021-02796-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 07/13/2021] [Indexed: 11/10/2022] Open
Abstract
Background While great attention has been paid to motor and cognitive impairments in children with neonatal Hypoxic-Ischemic Encephalopathy (HIE), sleep related circadian rhythm problems, although commonly present, are often neglected. Subsequently, no early clinical indicators have been reported to correlate with sleep-related circadian dysfunction during development. Methods In this study, we first analyzed patterns of the amplitude integrated electroencephalogram (aEEG) in a cohort of newborns with various degrees of HIE. Next, during follow-ups, we collected information of sleep and circadian related problems in these patients and performed correlation analysis between aEEG parameters and different sleep/circadian disorders. Results A total of 101 neonates were included. Our results demonstrated that abnormal aEEG background pattern is significantly correlated with circadian rhythmic (r = 0.289, P = 0.01) and breathing issues during sleep (r = 0.237, P = 0.037). In contrast, the establishment of sleep–wake cycle (SWC) showed no correlation with sleep/circadian problems. Detailed analysis showed that summation of aEEG score, along with low base voltage (r = 0.272, P = 0.017 and r = -0.228, P = 0.048, respectively), correlates with sleep circadian problems. In contrast, background pattern (BP) score highly correlates with sleep breathing problem (r = 0.319, P = 0.004). Conclusion Abnormal neonatal aEEG pattern is correlated with circadian related sleep problems. Our study thus provides novel insights into predictive values of aEEG in sleep-related circadian problems in children with HIE. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-021-02796-9.
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Affiliation(s)
- Qiuyan Tian
- Soochow Key Laboratory of Prevention and Treatment of Child Brain Injury, Children's Hospital of Soochow University, No.92 Zhongnanjie Road, Suzhou, 215025, P.R. China
| | - Yizhi Pan
- Soochow Key Laboratory of Prevention and Treatment of Child Brain Injury, Children's Hospital of Soochow University, No.92 Zhongnanjie Road, Suzhou, 215025, P.R. China
| | - Zheng Zhang
- Pediatrics Research Institute, Children's Hospital of Soochow University, Suzhou, 215025, P.R. China
| | - Mei Li
- Pediatrics Research Institute, Children's Hospital of Soochow University, Suzhou, 215025, P.R. China
| | - Li-Xiao Xu
- Pediatrics Research Institute, Children's Hospital of Soochow University, Suzhou, 215025, P.R. China
| | - Min Gong
- Soochow Key Laboratory of Prevention and Treatment of Child Brain Injury, Children's Hospital of Soochow University, No.92 Zhongnanjie Road, Suzhou, 215025, P.R. China
| | - Po Miao
- Department of Neonatology, Children's Hospital of Soochow University, Suzhou, 215025, P.R. China
| | - Xiaolu Jiang
- Pediatrics Research Institute, Children's Hospital of Soochow University, Suzhou, 215025, P.R. China
| | - Xiaofeng Yang
- Department of Neonatology, Children's Hospital of Soochow University, Suzhou, 215025, P.R. China
| | - Chen-Xi Feng
- Pediatrics Research Institute, Children's Hospital of Soochow University, Suzhou, 215025, P.R. China
| | - Jian Pan
- Pediatrics Research Institute, Children's Hospital of Soochow University, Suzhou, 215025, P.R. China
| | - Yun Yu
- Soochow Key Laboratory of Prevention and Treatment of Child Brain Injury, Children's Hospital of Soochow University, No.92 Zhongnanjie Road, Suzhou, 215025, P.R. China.
| | - Bin Sun
- Soochow Key Laboratory of Prevention and Treatment of Child Brain Injury, Children's Hospital of Soochow University, No.92 Zhongnanjie Road, Suzhou, 215025, P.R. China.
| | - Xin Ding
- Soochow Key Laboratory of Prevention and Treatment of Child Brain Injury, Children's Hospital of Soochow University, No.92 Zhongnanjie Road, Suzhou, 215025, P.R. China.
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Effect of prenatal marijuana exposure on sleep wake cycles and amplitude-integrated electroencephalogram (aEEG). J Perinatol 2021; 41:1355-1363. [PMID: 33462338 DOI: 10.1038/s41372-020-00911-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 11/21/2020] [Accepted: 12/04/2020] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To assess whether prenatal exposure to marijuana (THC) results in abnormal amplitude integrated encephalograms (aEEG). DESIGN This was a (2018-2020) prospective cohort study of prenatally THC-exposed newborns. Maternal and Infant demographics, urine (UDS) and umbilical cord drug screening (UCDS) were recorded. A limited channel continuous aEEG was obtained within 48 h of birth. Statistical analysis included univariate, multivariate, and logistical regression. RESULTS A total of 30 mother/infant dyads were enrolled. 60% (18/30) of neonates had abnormal aEEGs with sleep wake cycle (SWC) disturbances (p < 0.001). UCDS Carboxy-THC pg/g levels were similar in infants with abnormal [1758 (296,2838)] and normal aEEG [1589 (332,2794)], p = 0.82. CONCLUSIONS Absence of SWCs on aEEG is associated with prenatal THC exposure. While THC UCDS levels did not correlate to aEEG results future longitudinal studies are necessary to obtain detailed history of THC use and to evaluate its association with abnormal aEEG and the neurodevelopmental outcomes.
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Chen C, Xu Y, Wang Z, Sun C, Zhao X, Fan J, Niemarkt H, Andriessen P, Wang L, Chen W. A digitized approach for amplitude-integrated electroencephalogram transformation towards a standardized procedure. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2021.102433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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15
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The value of cardiorespiratory parameters for sleep state classification in preterm infants: A systematic review. Sleep Med Rev 2021; 58:101462. [PMID: 33826975 DOI: 10.1016/j.smrv.2021.101462] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 02/24/2021] [Accepted: 03/03/2021] [Indexed: 11/23/2022]
Abstract
Cardiorespiratory activity is highly associated with infants' sleep duration and quality. We performed a systematic literature search of PubMed and EMBASE databases to investigate if and how cardiorespiratory parameters can be used for sleep state classification in preterm infants and in what way maturation influences this relation. All retrieved citations were screened against predetermined inclusion and exclusion criteria. Only studies of preterm infants (<37 wk postmenstrual age during sleep state classification) admitted to a neonatal ward and of whom at least one sleep state and one cardiorespiratory parameter was measured, were included. Two researchers independently reviewed the included studies on methodological quality. Of the 1097 initially retrieved studies, 23 were included for analysis. Heart rate and respiration frequency are strongly correlated with active sleep and quiet sleep. In quiet sleep, as compared to active sleep, respiratory frequency is more stable, and the heart rate is lower and less variable. This association, however, differed across preterm birth subtypes (i.e., extremely, very or late preterm), indicating that maturation - in the form of both gestational and postnatal age - influences the cardiorespiratory characteristics of preterm sleep states. The knowledge gained from this review can help improve behavioral sleep classification and automated sleep classification algorithms for preterm infants.
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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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18
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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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Kadivar M, Moghadam EM, Shervin Badv R, Sangsari R, Saeedy M. A Comparison Of Conventional Electroencephalography With Amplitude-Integrated EEG In Detection Of Neonatal Seizures. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2019; 12:489-496. [PMID: 31849541 PMCID: PMC6911316 DOI: 10.2147/mder.s214662] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 10/10/2019] [Indexed: 01/08/2023] Open
Abstract
Introduction Amplitude-integrated electroencephalogram (aEEG) is widely used in Neonatal Intensive Care Units (NICUs) to monitor neonatal seizures. This method is still not well established compared to conventional electroencephalogram (cEEG), the diagnostic gold standard. However, aEEG can be a good screening tool for the diagnosis of seizures in infants. Our aim in this review study is to evaluate aEEG diagnostic accuracy in comparison with cEEG, for detection of neonatal seizures. Methods In this work, we studied the published articles which used EEG and aEEG in the evaluation process of seizures in neonates and compared these techniques to obtain an approach for the detection of neonatal seizures. Results Seventeen articles were included. Using aEEG with raw trace to detect individual seizures showed median sensitivity of 78% (range: 68-85) and median specificity of 78% (range: 71-84). The median sensitivity and specificity were 54% (range: 25-95) and 81% (range: 50-100), respectively, in case of using aEEG without raw traces. Brief duration seizures and those occurring away from aEEG leads were less detected. Conclusion Studies showed that aEEG has variable sensitivity and specificity. Based on the evidences, aEEG cannot be recommended as the only way for diagnosis and management of seizures in neonates; however, it could complete the diagnosis of seizures in the infant and could be a very good tool for screening seizures.
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Affiliation(s)
- Maliheh Kadivar
- Department of Neonatology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Elahe Movahedi Moghadam
- Department of Neonatology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Shervin Badv
- Department of Neonatology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Raziye Sangsari
- Department of Neonatology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Saeedy
- Department of Neonatology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
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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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Kadivar M, Mosayebi Z, Badoo RS, Sangesari R, Attari SJ, Saeedi M, Moghadam EM. Evaluation of the efficacy of amplitude-integrated electroencephalography in the screening of newborns with metabolic disorder admitted to the NICU. BMC Med Imaging 2018; 18:33. [PMID: 30236069 PMCID: PMC6148992 DOI: 10.1186/s12880-018-0274-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 08/31/2018] [Indexed: 11/11/2022] Open
Abstract
Background Neonate patients with metabolic disorder show encephalopathy and seizures that may lead to morbidity and mortality. Thus rapid detection and treatment of these patients is necessary. Although Amplitude-integrated electroencephalography (aEEG) has been used for more than a decade in the evaluation of infants with encephalopathy but has not been used in the assessment of neonates suffering from metabolic disorders. In this study, we tried to determine the efficacy of aEEG as an easily available diagnostic tool in the diagnosis of neonates with metabolic diseases. Methods All cases which admitted to the Neonatal Intensive Care Unit (NICU) of the Children’s Medical Center during a one-year period were enrolled. aEEG recordings were obtained by installing 4 electrodes on the infant’s head by a trained nurse and aEEG was recorded for at least 24 h with a description of the whole tracing. Clinical information, final outcome and questionnaires, including patient information: symptoms of the disease, gender, age, duration of hospitalization and the type of the metabolic disease were recorded in details. The obtained data was analyzed with the Spss24 software. Results Only 3 (two girl and one boy) out of 29 aEEGs recordings were abnormal; other patients showed normal aEEGs. The most common clinical and neurological manifestations were seizure (34.5%), hypotonia (31%), and mortality rate was 10.3%. There was no significant correlation between aEEG findings and gender, age, type of disease, laboratory tests findings and positive family history. Conclusions Although it has been shown that EEG has a diagnostic value in metabolic diseases, there has been no study on the efficacy of aEEG to evaluate neonates with metabolic diseases. But good accessibility and easy of working with aEEG, promote a tendency to use this procedure as screening tool for metabolic diseases. The current study about aEEG monitoring in these patients, while limited, can be used as a pilot study for further research on this topic. Therefore, a correct judgment in this field requires administration of aEEG on a larger population of neonates with metabolic diseases.
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Affiliation(s)
- Maliheh Kadivar
- Neonatal Health Research Center, Research Institute for Children Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ziba Mosayebi
- Neonatal Health Research Center, Research Institute for Children Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Shervin Badoo
- Neonatal Health Research Center, Research Institute for Children Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Raziyeh Sangesari
- Neonatal Health Research Center, Research Institute for Children Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeed Jedari Attari
- Neonatal Health Research Center, Research Institute for Children Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Saeedi
- Neonatal Health Research Center, Research Institute for Children Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elahe Movahedi Moghadam
- Neonatal Health Research Center, Research Institute for Children Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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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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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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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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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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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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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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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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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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Iyer KK, Roberts JA, Hellström-Westas L, Wikström S, Hansen Pupp I, Ley D, Vanhatalo S, Breakspear M. Cortical burst dynamics predict clinical outcome early in extremely preterm infants. Brain 2015; 138:2206-18. [PMID: 26001723 DOI: 10.1093/brain/awv129] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 03/19/2015] [Indexed: 01/15/2023] Open
Abstract
Intermittent bursts of electrical activity are a ubiquitous signature of very early brain activity. Previous studies have largely focused on assessing the amplitudes of these transient cortical bursts or the intervals between them. Recent advances in basic neuroscience have identified the presence of scale-free 'avalanche' processes in bursting patterns of cortical activity in other clinical contexts. Here, we hypothesize that cortical bursts in human preterm infants also exhibit scale-free properties, providing new insights into the nature, temporal evolution, and prognostic value of spontaneous brain activity in the days immediately following preterm birth. We examined electroencephalographic recordings from 43 extremely preterm infants (gestational age 22-28 weeks) and demonstrated that their cortical bursts exhibit scale-free properties as early as 12 h after birth. The scaling relationships of cortical bursts correlate significantly with later mental development-particularly within the first 12 h of life. These findings show that early preterm brain activity is characterized by scale-free dynamics which carry developmental significance, hence offering novel means for rapid and early clinical prediction of neurodevelopmental outcomes.
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Affiliation(s)
- Kartik K Iyer
- 1 Systems Neuroscience Group, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia 2 School of Medicine, Faculty of Medicine and Biomedical Sciences, University of Queensland, Australia
| | - James A Roberts
- 1 Systems Neuroscience Group, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | | | - Sverre Wikström
- 4 Department of Paediatrics, Karlstad Central Hospital, Sweden
| | - Ingrid Hansen Pupp
- 5 Department of Paediatrics, Institute for Clinical Sciences, Lund University, Lund, Sweden
| | - David Ley
- 5 Department of Paediatrics, Institute for Clinical Sciences, Lund University, Lund, Sweden
| | - Sampsa Vanhatalo
- 6 Department of Children's Clinical Neurophysiology, HUS Medical Imaging Centre, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland 7 Department of Paediatrics, Children's Hospital, University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Michael Breakspear
- 1 Systems Neuroscience Group, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia 8 The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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Tataranno ML, Alderliesten T, de Vries LS, Groenendaal F, Toet MC, Lemmers PMA, Vosse van de RE, van Bel F, Benders MJNL. Early oxygen-utilization and brain activity in preterm infants. PLoS One 2015; 10:e0124623. [PMID: 25965343 PMCID: PMC4429123 DOI: 10.1371/journal.pone.0124623] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 03/17/2015] [Indexed: 12/24/2022] Open
Abstract
The combined monitoring of oxygen supply and delivery using Near-InfraRed spectroscopy (NIRS) and cerebral activity using amplitude-integrated EEG (aEEG) could yield new insights into brain metabolism and detect potentially vulnerable conditions soon after birth. The relationship between NIRS and quantitative aEEG/EEG parameters has not yet been investigated. Our aim was to study the association between oxygen utilization during the first 6 h after birth and simultaneously continuously monitored brain activity measured by aEEG/EEG. Forty-four hemodynamically stable babies with a GA < 28 weeks, with good quality NIRS and aEEG/EEG data available and who did not receive morphine were included in the study. aEEG and NIRS monitoring started at NICU admission. The relation between regional cerebral oxygen saturation (rScO2) and cerebral fractional tissue oxygen extraction (cFTOE), and quantitative measurements of brain activity such as number of spontaneous activity transients (SAT) per minute (SAT rate), the interval in seconds (i.e. time) between SATs (ISI) and the minimum amplitude of the EEG in μV (min aEEG) were evaluated. rScO2 was negatively associated with SAT rate (β=-3.45 [CI=-5.76- -1.15], p=0.004) and positively associated with ISI (β=1.45 [CI=0.44-2.45], p=0.006). cFTOE was positively associated with SAT rate (β=0.034 [CI=0.009-0.059], p=0.008) and negatively associated with ISI (β=-0.015 [CI=-0.026- -0.004], p=0.007). Oxygen delivery and utilization, as indicated by rScO2 and cFTOE, are directly related to functional brain activity, expressed by SAT rate and ISI during the first hours after birth, showing an increase in oxygen extraction in preterm infants with increased early electro-cerebral activity. NIRS monitored oxygenation may be a useful biomarker of brain vulnerability in high-risk infants.
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Affiliation(s)
- Maria Luisa Tataranno
- Dept. of Perinatology and Brain Center Rudolph Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
- Dept. of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Thomas Alderliesten
- Dept. of Perinatology and Brain Center Rudolph Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Linda S. de Vries
- Dept. of Perinatology and Brain Center Rudolph Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Floris Groenendaal
- Dept. of Perinatology and Brain Center Rudolph Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mona C. Toet
- Dept. of Perinatology and Brain Center Rudolph Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Petra M. A. Lemmers
- Dept. of Perinatology and Brain Center Rudolph Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Renè E. Vosse van de
- Dept. of Medical Technology and Clinical Physics, University Services, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frank van Bel
- Dept. of Perinatology and Brain Center Rudolph Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Manon J. N. L. Benders
- Dept. of Perinatology and Brain Center Rudolph Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
- Centre for the Developing Brain, King's College London, London, United Kingdom
- * E-mail:
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Serial aEEG recordings in a cohort of extremely preterm infants: feasibility and safety. J Perinatol 2015; 35:373-8. [PMID: 25474559 PMCID: PMC4414657 DOI: 10.1038/jp.2014.217] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 09/15/2014] [Accepted: 09/30/2014] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Amplitude-integrated electroencephalography (aEEG) monitoring is increasing in the neonatal population, but the safety and feasibility of performing aEEG in extremely preterm infants have not been systematically evaluated. STUDY DESIGN Inborn infants 23(0/7) to 28(6/7) weeks gestation or birth weight 401 to 1000 g were eligible. Serial, 6-h aEEG recordings were obtained from first week of life until 36 weeks postmenstrual age. Adverse events were documented, and surveys evaluated the impact of the aEEGs on routine care. Success of performing aEEGs according to protocol and aEEG quality were assessed. RESULT A total of 102 infants were enrolled, with 755 recordings performed. 83% of recordings were performed according to schedule, and 96% were without adverse event. Bedside nurses reported no interference with routine care for 89% of recordings. 92% of recordings had acceptable signal quality. CONCLUSION Serial aEEG monitoring is safe in preterm infants, with few adverse events and general acceptance by nursing staff.
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Affiliation(s)
- Nicholas R. Anderson
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri
| | - Kimberly J. Wisneski
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri
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Benavente-Fernández I, Lubián-López SP, Jiménez-Gómez G, Lechuga-Sancho AM, Garcia-Alloza M. Low-voltage pattern and absence of sleep-wake cycles are associated with severe hemorrhage and death in very preterm infants. Eur J Pediatr 2015; 174:85-90. [PMID: 24997846 DOI: 10.1007/s00431-014-2360-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 06/03/2014] [Accepted: 06/04/2014] [Indexed: 10/25/2022]
Abstract
UNLABELLED Amplitude integrated electroencephalogaphy (aEEG) is becoming an important tool for the assessment of cerebral activity in preterm newborns. Describing the relationship between early aEEG patterns and intraventricular hemorrhage (IVH) can improve our knowledge of neurological injury in the preterm newborn. The aim of this prospective study was to identify early changes in the aEEG in premature newborns that could be associated to severe neurological lesion/death. Preterm newborns with a birth weight ≤1,500 g and/or 32 weeks of gestation were included. aEEG monitoring was performed during the first 72 h of life. A qualitative analysis of the aEEG recordings was performed, based on continuity, sleep-wake cycles (SWCs), inferior lower margin amplitude (LMA), and bandwidth (BW). Key outcomes were severe IVH and/or death. Ninety-two subjects were included (mean gestational age 28 weeks). In 28.6 % of subjects with HIV III/IHP, a low-voltage pattern was observed. A statistically significant relationship was found between low-voltage tracings and death and neurological lesion/death. Absent SWCs during the first 72 h were also related to death. CONCLUSION Early aEEG patterns can be predictive of neurological outcome in the preterm newborn. Low-voltage tracing and absence of SWCs are associated with severe neurological lesions/death.
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Affiliation(s)
- Isabel Benavente-Fernández
- Department of Neonatology, Hospital Universitario Puerta del Mar, Av. Ana de Viya 21, 11009, Cádiz, Spain,
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Schwindt E, Thaller C, Czaba-Hnizdo C, Giordano V, Olischar M, Waldhoer T, Fuiko R, Berger A, Weninger M, Klebermass-Schrehof K. Being Born Small for Gestational Age Influences Amplitude-Integrated Electroencephalography and Later Outcome in Preterm Infants. Neonatology 2015; 108:81-7. [PMID: 26044362 DOI: 10.1159/000382013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 03/31/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND The impact of growth restriction on perinatal morbidity is well known, but electroencephalographic (EEG) data on its influence are still scarce. OBJECTIVES We aimed to analyze the influence of being born small for gestational age (SGA; defined as a birth weight <10th percentile) on the amplitude-integrated EEG (aEEG) score in the first 2 weeks of life in preterm infants born before 30 weeks of gestation, and its impact on later outcome. METHODS aEEG data obtained within the first 2 weeks of life on preterm infants born SGA and before 30 weeks of gestational age (GA) were analyzed retrospectively using a combined score [including background activity, occurrence of sleep-wake cycles (SWC) and suspected seizure activity]. Neurodevelopmental outcome was evaluated at 24 months by means of the Bayley Scales of Infant Development II and a standardized neurological examination. RESULTS One hundred and thirty-six patients were included (47 SGA and 89 controls). Infants with SGA had abnormal aEEG scores significantly more often (57 vs. 24%, p = 0.002) than infants born appropriate for gestational age (AGA). They also displayed SWC less frequently (65 vs. 96%, p = 0.001), were more likely to develop seizure activity (15 vs. 4%, p = 0.013) and had a normal neurodevelopmental outcome at the age of 2 years less frequently (36.2 vs. 59.6%, p = 0.02). CONCLUSION Preterm infants born SGA and before 30 weeks of GA had less optimal scores on early aEEG and a poorer neurodevelopmental outcome at 24 months than the AGA controls.
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Affiliation(s)
- Eva Schwindt
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Medical University of Vienna, Vienna, Austria
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Saji R, Hirasawa K, Ito M, Kusuda S, Konishi Y, Taga G. Probability distributions of the electroencephalogram envelope of preterm infants. Clin Neurophysiol 2014; 126:1132-1140. [PMID: 25441153 DOI: 10.1016/j.clinph.2014.08.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 08/26/2014] [Accepted: 08/30/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To determine the stationary characteristics of electroencephalogram (EEG) envelopes for prematurely born (preterm) infants and investigate the intrinsic characteristics of early brain development in preterm infants. METHODS Twenty neurologically normal sets of EEGs recorded in infants with a post-conceptional age (PCA) range of 26-44 weeks (mean 37.5 ± 5.0 weeks) were analyzed. Hilbert transform was applied to extract the envelope. We determined the suitable probability distribution of the envelope and performed a statistical analysis. RESULTS It was found that (i) the probability distributions for preterm EEG envelopes were best fitted by lognormal distributions at 38 weeks PCA or less, and by gamma distributions at 44 weeks PCA; (ii) the scale parameter of the lognormal distribution had positive correlations with PCA as well as a strong negative correlation with the percentage of low-voltage activity; (iii) the shape parameter of the lognormal distribution had significant positive correlations with PCA; (iv) the statistics of mode showed significant linear relationships with PCA, and, therefore, it was considered a useful index in PCA prediction. CONCLUSION These statistics, including the scale parameter of the lognormal distribution and the skewness and mode derived from a suitable probability distribution, may be good indexes for estimating stationary nature in developing brain activity in preterm infants. SIGNIFICANCE The stationary characteristics, such as discontinuity, asymmetry, and unimodality, of preterm EEGs are well indicated by the statistics estimated from the probability distribution of the preterm EEG envelopes.
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Affiliation(s)
- Ryoya Saji
- Brain Science Institute, Tamagawa University, Tokyo, Japan.
| | | | - Masako Ito
- Tokyo Women's Medical University Hospital, Tokyo, Japan
| | | | - Yukuo Konishi
- Center for Baby Science, Doshisha University, Kyoto, Japan
| | - Gentaro Taga
- Graduate School of Education, The University of Tokyo, Tokyo, Japan
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Amplitudenintegriertes Elektroenzephalogramm. Monatsschr Kinderheilkd 2014. [DOI: 10.1007/s00112-014-3106-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Impact of perinatal factors on continuous early monitoring of brain electrocortical activity in very preterm newborns by amplitude-integrated EEG. Pediatr Res 2014; 75:774-80. [PMID: 24608568 DOI: 10.1038/pr.2014.32] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 12/04/2013] [Indexed: 11/08/2022]
Abstract
BACKGROUND Amplitude-integrated electroencephalogram (aEEG) is increasingly used for neuromonitoring in preterms. We aimed to quantify the effects of gestational age (GA), postnatal age (PNA), and other perinatal factors on the development of aEEG early after birth in very preterm newborns with normal cerebral ultrasounds. METHODS Continuous aEEG was prospectively performed in 96 newborns (mean GA: 29.5 (range: 24.4-31.9) wk, birth weight 1,260 (580-2,120) g) during the first 96 h of life. aEEG tracings were qualitatively (maturity scores) and quantitatively (amplitudes) evaluated using preestablished criteria. RESULTS A significant increase in all aEEG measures was observed between day 1 and day 4 and for increasing GA (P < 0.001). The effect of PNA on aEEG development was 6.4- to 11.3-fold higher than that of GA. In multivariate regression, GA and PNA were associated with increased qualitative and quantitative aEEG measures, whereas small-for-GA status was independently associated with increased maximum aEEG amplitude (P = 0.003). Morphine administration negatively affected all aEEG measures (P < .05), and caffeine administration negatively affected qualitative aEEG measures (P = 0.02). CONCLUSION During the first few days after birth, aEEG activity in very preterm infants significantly develops and is strongly subjected to the effect of PNA. Perinatal factors may alter the early aEEG tracing and interfere with its interpretation.
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Benders MJ, Palmu K, Menache C, Borradori-Tolsa C, Lazeyras F, Sizonenko S, Dubois J, Vanhatalo S, Hüppi PS. Early Brain Activity Relates to Subsequent Brain Growth in Premature Infants. Cereb Cortex 2014; 25:3014-24. [PMID: 24867393 DOI: 10.1093/cercor/bhu097] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Recent experimental studies have shown that early brain activity is crucial for neuronal survival and the development of brain networks; however, it has been challenging to assess its role in the developing human brain. We employed serial quantitative magnetic resonance imaging to measure the rate of growth in circumscribed brain tissues from preterm to term age, and compared it with measures of electroencephalographic (EEG) activity during the first postnatal days by 2 different methods. EEG metrics of functional activity were computed: EEG signal peak-to-peak amplitude and the occurrence of developmentally important spontaneous activity transients (SATs). We found that an increased brain activity in the first postnatal days correlates with a faster growth of brain structures during subsequent months until term age. Total brain volume, and in particular subcortical gray matter volume, grew faster in babies with less cortical electrical quiescence and with more SAT events. The present findings are compatible with the idea that (1) early cortical network activity is important for brain growth, and that (2) objective measures may be devised to follow early human brain activity in a biologically reasoned way in future research as well as during intensive care treatment.
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Affiliation(s)
- Manon J Benders
- Division of Development and Growth, Department of Pediatrics, Children's Hospital, University of Geneva, Geneva, Switzerland Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kirsi Palmu
- Department of Biomedical Engineering and Computational Science, School of Science, Aalto University, Helsinki FIN-00076, Finland Department of Children's Clinical Neurophysiology, Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Caroline Menache
- Division of Development and Growth, Department of Pediatrics, Children's Hospital, University of Geneva, Geneva, Switzerland
| | - Cristina Borradori-Tolsa
- Division of Development and Growth, Department of Pediatrics, Children's Hospital, University of Geneva, Geneva, Switzerland
| | - Francois Lazeyras
- Center for Biomedical Imaging (CIBM), Department of Radiology, University Hospital of Geneva, Geneva, Switzerland
| | - Stephane Sizonenko
- Division of Development and Growth, Department of Pediatrics, Children's Hospital, University of Geneva, Geneva, Switzerland
| | - Jessica Dubois
- Division of Development and Growth, Department of Pediatrics, Children's Hospital, University of Geneva, Geneva, Switzerland Cognitive Neuroimaging Unit U992, NeuroSpin, INSERM-CEA, Gif-sur-Yvette, France
| | - Sampsa Vanhatalo
- Department of Children's Clinical Neurophysiology, Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Petra S Hüppi
- Division of Development and Growth, Department of Pediatrics, Children's Hospital, University of Geneva, Geneva, Switzerland
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Reynolds LC, Pineda RG, Mathur A, Vavasseur C, Shah DK, Liao S, Inder T. Cerebral maturation on amplitude-integrated electroencephalography and perinatal exposures in preterm infants. Acta Paediatr 2014; 103:e96-e100. [PMID: 24354724 PMCID: PMC3945948 DOI: 10.1111/apa.12485] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 10/03/2013] [Accepted: 10/22/2013] [Indexed: 11/30/2022]
Abstract
AIM To determine the associations between perinatal exposures, cerebral maturation on amplitude-integrated encephalography (aEEG) and outcome. METHODS During this prospective cohort study, 136 infants ≤30 weeks estimated gestational age received 4 h of aEEG at four time points (between the first 2 weeks of life and term-equivalent age) during hospitalisation. Perinatal factors were documented. Associations between perinatal exposures and Burdjalov-scores were investigated. Neurodevelopmental outcome was assessed at the age of two. RESULTS Immature cyclicity on the initial aEEG recording was associated with higher CRIB score (p = 0.01), vaginal delivery (p = 0.02), male gender (p < 0.01) and death (p = 0.01). Perinatal factors associated with lower Burdjalov-scores included cerebral injury (p < 0.01), sepsis (p < 0.01), lower caffeine dose (p = 0.006), prolonged mechanical ventilation (p = 0.002) and death (p < 0.01). Burdjalov-scores at 30 (β = 2.62, p < 0.01) and 34 weeks postmenstrual age (β = 2.89, p = 0.05) predicted motor scores. CONCLUSION aEEG measures of cyclicity and Burdjalov-scores in the first 6 weeks of life, with an emphasis on 30 and 34 weeks postmenstrual age, demonstrated associations with perinatal factors known to predict adverse neurodevelopmental outcome.
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Affiliation(s)
- Lauren C. Reynolds
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, United States
| | - Roberta G. Pineda
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri, United States
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, United States
| | - Amit Mathur
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, United States
| | - Claudine Vavasseur
- Department of Newborn Medicine, National Maternity Hospital, Dublin, Ireland
| | - Divyen K. Shah
- Department of Neonatology, Barts and the London Childrens Hospital, Whitechapel, London, United Kingdom
| | - Steve Liao
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, United States
| | - Terrie Inder
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, United States
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, United States
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri, United States
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Amplitude-integrated EEG and range-EEG modulation associated with pneumatic orocutaneous stimulation in preterm infants. J Perinatol 2014; 34:213-9. [PMID: 24310443 PMCID: PMC3943746 DOI: 10.1038/jp.2013.150] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 10/14/2013] [Accepted: 10/23/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Controlled somatosensory stimulation strategies have demonstrated merit in developing oral feeding skills in premature infants who lack a functional suck, however, the effects of orosensory entrainment stimulation on electrocortical dynamics is unknown. The objective of the study was to determine the effects of servo-controlled pneumatic orocutaneous stimulation presented during gavage feedings on the modulation of amplitude-integrated electroencephalogram (aEEG) and range electroencephalogram (rEEG) activity. STUDY DESIGN Two-channel EEG recordings were collected during 180 sessions that included orocutaneous stimulation and non-stimulation epochs among 22 preterm infants (mean gestational age=28.56 weeks) who were randomized to treatment and control 'sham' conditions. The study was initiated at around 32 weeks post-menstrual age. The raw EEG was transformed into aEEG margins, and rEEG amplitude bands measured at 1-min intervals and subjected to a mixed models statistical analysis. RESULT Multiple significant effects were observed in the processed EEG during and immediately following 3-min periods of orocutaneous stimulation, including modulation of the upper and lower margins of the aEEG, and a reorganization of rEEG with an apparent shift from amplitude bands D and E to band C throughout the 23-min recording period that followed the first stimulus block when compared with the sham condition. Cortical asymmetry also was apparent in both EEG measures. CONCLUSION Orocutaneous stimulation represents a salient trigeminal input, which has both short- and long-term effects in modulating electrocortical activity, and thus is hypothesized to represent a form of neural adaptation or plasticity that may benefit the preterm infant during this critical period of brain maturation.
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Modulation of EEG spectral edge frequency during patterned pneumatic oral stimulation in preterm infants. Pediatr Res 2014; 75:85-92. [PMID: 24129553 PMCID: PMC4005474 DOI: 10.1038/pr.2013.179] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Accepted: 06/16/2013] [Indexed: 12/18/2022]
Abstract
BACKGROUND Stimulation of the nervous system plays a central role in brain development and neurodevelopmental outcomes. Thalamocortical and corticocortical development is diminished in premature infants and correlated to electroencephalography (EEG) progression. The purpose of this study was to determine the effects of orocutaneous stimulation on the modulation of spectral edge frequency fc = 90% (SEF-90), which is derived from EEG recordings in preterm infants. METHODS A total of 22 preterm infants were randomized to experimental and control conditions. Pulsed orocutaneous stimulation was presented during gavage feedings begun at ~32 wk postmenstrual age. The SEF-90 was derived from two-channel EEG recordings. RESULTS Compared with the control condition, the pulsed orocutaneous stimulation produced a significant reorganization of SEF-90 in the left (P = 0.005) and right (P < 0.0001) hemispheres. Notably, the left and right hemispheres showed a reversal in the polarity of frequency shift, demonstrating hemispheric asymmetry in the frequency domain. Pulsed orocutaneous stimulation also produced a significant pattern of short-term cortical adaptation and a long-term neural adaptation manifested as a 0.5 Hz elevation in SEF-90 after repeated stimulation sessions. CONCLUSION This is the first study to demonstrate the modulating effects of a servo-controlled oral somatosensory input on the spectral features of EEG activity in preterm infants.
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Thorngate L, Foreman SW, Thomas KA. Quantification of neonatal amplitude-integrated EEG patterns. Early Hum Dev 2013; 89:931-7. [PMID: 24120246 PMCID: PMC3858205 DOI: 10.1016/j.earlhumdev.2013.09.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 09/14/2013] [Accepted: 09/24/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND Amplitude-integrated EEG (aEEG) is increasingly used in research with premature infants; however, comprehensive interpretation is limited by the lack of simple approaches for reliably quantifying and summarizing the data. AIM Explore operational measures for quantifying continuity and discontinuity, measured by aEEG as components of infant brain function. STUDY DESIGN An exploratory naturalistic study of neonates while in the Neonatal Intensive Care Unit (NICU). One single channel aEEG recording per infant was obtained without disruption of nursing care practices. SUBJECTS 24 infants with mean postmenstrual age (PMA) of 33.11 weeks (SD 3.49), average age of 2.62 weeks (SD 1.35) and mean birth weights of 1.39 kg (SD 0.73). OUTCOME MEASURES Quantification of continuity and discontinuity included bandwidth and lower border of aEEG, calculated proportion of time with signal amplitude below 10 μV, and peak counts. Variance of bandwidth and lower border denoted cycling. RESULTS Group mean bandwidth was 52.98 μV (SD 27.62). Median peak count in 60 second epochs averaged 3.63 (SD 1.74), while median proportion < 10 μV was 22% (SD 0.20). The group mean of lower border within-subject aggregated medians was 6.20 μV (SD 2.13). Group mean lower border standard deviation was 3.96 μV. Proportion < 10 μV showed a strong negative correlation with the natural log of the lower border median (r = -0.906, p < .0001) after controlling for PMA. CONCLUSIONS This study introduces a novel quantification process by counting peaks and proportion of time < 10 μV. Expanded definitions and analytic techniques will serve to strengthen the application of existing scoring systems for use in naturalistic research settings and clinical practice.
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Affiliation(s)
- Lauren Thorngate
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, USA.
| | - Shuyuann Wang Foreman
- Clinical Assistant Professor, Department of Family and Child Nursing, University of Washington, Seattle, WA
| | - Karen A. Thomas
- Ellery and Kirby Cramer Endowed Professor in Nursing, Department of Family and Child Nursing, University of Washington, Seattle, WA
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El-Dib M, Massaro AN, Glass P, Aly H. Sleep wake cycling and neurodevelopmental outcome in very low birth weight infants. J Matern Fetal Neonatal Med 2013; 27:892-7. [DOI: 10.3109/14767058.2013.845160] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Changes of amplitude integration electroencephalogram (aEEG) in different maturity preterm infant. Childs Nerv Syst 2013; 29:1169-76. [PMID: 23463128 DOI: 10.1007/s00381-013-2060-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2012] [Accepted: 02/21/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND With the improvement of perinatal care and neonatal intensive care technology in recent years, a preterm infant, especially with small gestational age and very low birth weight, survives more and more. At the same time, adverse neurodevelopmental prognosis caused by brain damage in preterm infant also increased significantly. Preterm infant brain injury has become the most important factor for early death and neurodevelopment of preterm infant. METHODS Amplitude integration electroencephalogram (aEEG) has an important clinical value in the assessment of brain development in the maturity of preterm infant. With the application of a neonatal brain function monitor, we value the aEEG graphic continuity, periodicity, narrowband lower margin amplitude, and bandwidth score and analyze wide- and narrowband on the lower bounds of voltage and bandwidth. RESULTS The graphics of preterm infant aEEG become mature with the growth of the gestational age (1). With the growth of corrected gestational age, the aEEG graphics of preterm infant has the following feature: lower bound voltage of narrowband rising and width narrowing of narrowband (2). Extrauterine life can speed up the maturation of aEEG graphics (3). CONCLUSIONS The aEEG technology is a noninvasive, operable, and simple analysis and suitable for application in the newborn intensive care unit.
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Natalucci G, Leuchter RHV, Bucher HU, Latal B, Koller B, Hüppi PS, Hagmann C. Functional brain maturation assessed during early life correlates with anatomical brain maturation at term-equivalent age in preterm infants. Pediatr Res 2013; 74:68-74. [PMID: 23563193 DOI: 10.1038/pr.2013.57] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 12/03/2012] [Indexed: 11/09/2022]
Abstract
BACKGROUND Amplitude-integrated electroencephalogram (aEEG) is a reliable monitoring tool for electrocortical activity with good predictive value in preterm infants. Magnetic resonance imaging (MRI) is a good neuroimaging tool to detect brain lesions and to evaluate brain maturation. We hypothesized that early aEEG measures, recorded over the first 3 d of life in very preterm infants, correlate with brain maturation and injury score assessed by conventional MRI at term-equivalent age. METHODS Thirty-nine infants born at a mean (range) gestational age (GA) of 29.5 (27.0-31.9) wk and birth weight 1,230 (680-2,020) g had continuous aEEG during the first postnatal 72-84 h. aEEG maturity scores and average maximum and minimum amplitudes were evaluated. Conventional brain MRI was performed at 41.2 (37.1-44.1) wk postmenstrual age (PMA) on a 3T GE system and scored qualitatively for injury and maturation. RESULTS The average aEEG total maturity score and its cycling subscore were positively and significantly associated with the total MRI maturation score after adjustment for GA, morphine sedation, and PMA at MRI examination. No association was found between the aEEG measures and the MRI injury scores. CONCLUSION Early aEEG maturity seems to relate to structural MRI brain maturation at term-equivalent age in preterm infants.
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Abstract
BACKGROUND In preterm infants, the amplitude-integrated electroencephalogram (aEEG) is not established in clinical routine. The aim of this study was to derive normative data on aEEG parameters by means of longitudinal characterization and to evaluate the impact of gestational age (GA), postnatal age (PNA), postmenstrual age, sedation, and patent ductus arteriosus (PDA). METHODS Recordings from 61 infants with GA 28-31 weeks were obtained during the first 72 h, then weekly until the age of 4 wk. Infants were divided into three groups: (i) no sedation, no PDA, (ii) sedation, no PDA, and (iii) sedation, PDA. Assessed parameters included background activity, cycling, amplitude, and log ratio of the maximum/minimum amplitude. RESULTS GA and PNA had a significant impact within 72 h. Sedation modified aEEG, and presence of PDA was associated with reduced aEEG scores within 72 h. The log ratio of the amplitude correlated with GA but was unaffected by sedation and PDA. CONCLUSION Evaluation of electrocortical background activity within the first postnatal hours and longitudinally over days and weeks is important to better understand the postnatal factors impacting cerebral function in preterm infants. There is a need to agree on definitions and a standardized reporting system in order to permit comparisons between studies and establish aEEG as a method for routine monitoring of preterm infants.
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Zhang D, Ding H. Calculation of compact amplitude-integrated EEG tracing and upper and lower margins using raw EEG data. Health (London) 2013. [DOI: 10.4236/health.2013.55116] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Natalucci G, Rousson V, Bucher HU, Bernet V, Hagmann C, Latal B. Delayed cyclic activity development on early amplitude-integrated EEG in the preterm infant with brain lesions. Neonatology 2013. [PMID: 23207184 DOI: 10.1159/000345202] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Maturation of amplitude-integrated electroencephalogram (aEEG) activity is influenced by both gestational age (GA) and postmenstrual age. It is not fully known how this process is influenced by cerebral lesions. OBJECTIVE To compare early aEEG developmental changes between preterm newborns with different degrees of cerebral lesions on cranial ultrasound (cUS). METHODS Prospective cohort study on preterm newborns with GA <32.0 weeks, undergoing continuous aEEG recording during the first 84 h after birth. aEEG characteristics were qualitatively and quantitatively evaluated using pre-established criteria. Based on cUS findings three groups were formed: normal (n = 78), mild (n = 20), and severe cerebral lesions (n = 6). Linear mixed models for repeated measures were used to analyze aEEG maturational trajectories. RESULTS 104 newborns with a mean GA (range) 29.5 (24.4-31.7) weeks, and birth weight 1,220 (580-2,020) g were recruited. Newborns with severe brain lesions started with similar aEEG scores and tendentially lower aEEG amplitudes than newborns without brain lesions, and showed a slower development of the cyclic activity (p < 0.001), but a more rapid increase of the maximum and minimum aEEG amplitudes (p = 0.002 and p = 0.04). CONCLUSIONS Preterm infants with severe cerebral lesions manifest a maturational delay in the aEEG cyclic activity already early after birth, but show a catch-up of aEEG amplitudes to that of newborns without cerebral lesions. Changes in the maturational aEEG pattern may be a marker of severe neurological lesions in the preterm infant.
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Affiliation(s)
- Giancarlo Natalucci
- Department of Neonatology, University Hospital, University Children's Hospital Zurich, Zurich, Switzerland.
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Kuhnke N, Jacobs J. Monitoring brain maturation in extremely premature infants. Clin Neurophysiol 2012; 123:2109-10. [PMID: 22608484 DOI: 10.1016/j.clinph.2012.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Revised: 04/05/2012] [Accepted: 04/07/2012] [Indexed: 11/17/2022]
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