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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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Weng B, Yan C, Chen Y, Gong X, Cai C. Efficiency Evaluation of Neuroprotection for Therapeutic Hypothermia to Neonatal Hypoxic-Ischemic Encephalopathy. Front Neurosci 2021; 15:668909. [PMID: 34650397 PMCID: PMC8505668 DOI: 10.3389/fnins.2021.668909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 06/21/2021] [Indexed: 11/23/2022] Open
Abstract
Background: To evaluate the safety and neurological outcomes of therapeutic hypothermia to neonatal hypoxic-ischemic encephalopathy (HIE). Materials and Methods: Medical records of 61 neonates with moderate to severe HIE were retrospectively enrolled and divided into a therapeutic hypothermia group (n = 36) and conventional therapy group (n = 25). Results: No significant difference in the incidence of severe adverse events was found between the two groups. Minimum and maximum voltages of amplitude-integrated electroencephalography (aEEG) recording results showed statistically significant differences in therapeutic hypothermia group after 72 h. The neonatal behavioral neurological assessment (NBNA) on the 28th day after birth and Bayley Scales of Infant Development, second edition (BSID II) scores at 18 months old were significant higher in the therapeutic hypothermia group than the conventional therapy group. Conclusion: Therapeutic hypothermia for neonates with moderate to severe HIE improved the development of the nervous system in 0–18-month-old infants and showed a predominant role in reducing death and major neuron development-associated disabilities.
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Affiliation(s)
- Bowen Weng
- Department of Neonatology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Chongbing Yan
- Department of Neonatology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yihuan Chen
- Department of Neonatology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaohui Gong
- Department of Neonatology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Cheng Cai
- Department of Neonatology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
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Consensus protocol for EEG and amplitude-integrated EEG assessment and monitoring in neonates. Clin Neurophysiol 2021; 132:886-903. [PMID: 33684728 DOI: 10.1016/j.clinph.2021.01.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 12/19/2020] [Accepted: 01/06/2021] [Indexed: 12/23/2022]
Abstract
The aim of this work is to establish inclusive guidelines on electroencephalography (EEG) applicable to all neonatal intensive care units (NICUs). Guidelines on ideal EEG monitoring for neonates are available, but there are significant barriers to their implementation in many centres around the world. These include barriers due to limited resources regarding the availability of equipment and technical and interpretive round-the-clock personnel. On the other hand, despite its limitations, amplitude-integrated EEG (aEEG) (previously called Cerebral Function Monitor [CFM]) is a common alternative used in NICUs. The Italian Neonatal Seizure Collaborative Network (INNESCO), working with all national scientific societies interested in the field of neonatal clinical neurophysiology, performed a systematic literature review and promoted interdisciplinary discussions among experts (neonatologists, paediatric neurologists, neurophysiologists, technicians) between 2017 and 2020 with the aim of elaborating shared recommendations. A consensus statement on videoEEG (vEEG) and aEEG for the principal neonatal indications was established. The authors propose a flexible frame of recommendations based on the complementary use of vEEG and aEEG applicable to the various neonatal units with different levels of complexity according to local resources and specific patient features. Suggestions for promoting cooperation between neonatologists, paediatric neurologists, and neurophysiologists, organisational restructuring, and teleneurophysiology implementation are provided.
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Abstract
Immediately after birth through spontaneous breaths, infants' clear lung liquid replacing it with air, and gradually establishing a functional residual capacity to achieve gas exchange. Most infants start breathing independently after birth and ~3% of infants who require positive pressure ventilation. When newborns fail to start breathing the current neonatal resuscitation guidelines recommend initiatingpositive pressure ventilationusing a face mask and a ventilation device. Adequate ventilation is the cornerstone of successful neonatal resuscitation; therefore, it is mandatory that anybody involved in neonatal resuscitation is trained in mask ventilation techniques. One of the main problems with mask ventilation is that it is very subjective with direct feedback lacking and not uncommonly, the resuscitator does not realise that their technique is unsatisfactory. Many studies have shown that monitoring tidal volume and leak around the mask or endotracheal tube enables the resuscitator to identify the problem and adjust their technique to reduce the leak and deliver and appropriate tidal volume. This chapter discusses the currently available monitoring devices used during stabilization/resuscitation in the delivery room.
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Affiliation(s)
- Georg M Schmölzer
- Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada; Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
| | - Colin J Morley
- Department of Obstetrics and Gynaecology, University of Cambridge, United Kingdom
| | - Omar C O F Kamlin
- Neonatal Services, The Royal Women's Hospital, Melbourne, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
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Zhu X, Guo Y, Liu Y, Liu K. Amplitude-Integrated Electroencephalography for Early Diagnosis and Prognostic Prediction of Hypoxic Encephalopathy in Preterm Infants. Med Sci Monit 2018; 24:8795-8802. [PMID: 30514829 PMCID: PMC6290585 DOI: 10.12659/msm.909330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The aim of this study was to analyze amplitude-integrated electroencephalography (aEEG) in early diagnosis and prognosis of hypoxic encephalopathy (HE) in premature infants. MATERIAL AND METHODS Thirty-six premature infants with HE who were treated in Linyi Central Hospital were enrolled into the study group, while 40 premature infants without HE were assigned into the control group. aEEG was conducted within 6 h after delivery to compare aEEG continuity, mature sleep-wake cycle, and maximum and minimum voltage in the 2 groups. Correlations between aEEG abnormalities and clinical grading, neurological prognosis, Apgar score, and blood gas were also analyzed among the premature infants with HE. RESULTS Compared with the control group, there were reductions in the continuous rate of aEEG, mature sleep-wake cycle, and the minimum voltage, and an increase in the maximum voltage in the study group (all P<0.05). The study group had a higher abnormal rate of aEEG and a lower normal rate of aEEG than in the control group (both P<0.05). Spearman's rank correlation coefficients for abnormal aEEG and clinical grade and poor neurological prognosis were 0.758 and 0.799, respectively. The sensitivity of abnormal aEEG in predicting severity of clinical grading was 100% with a specificity of 82.5%. The sensitivity of abnormal aEEG in predicting neurological prognosis was 100% with a specificity of 90.3%. The Apgar scores and blood glass pH of the infants with various abnormal rates of aEEG were significantly different at 1 min, 5 min, and 10 min after delivery (all P<0.05). CONCLUSIONS HE in premature infants has specific aEEG characteristics, which can be used to predict the severity and prognosis of HE.
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Affiliation(s)
- Xia Zhu
- Department of Child Health, Linyi Central Hospital, Linyi, Shandong, China (mainland)
| | - Yingmeng Guo
- Department of Neonatology, Linyi Central Hospital, Linyi, Shandong, China (mainland)
| | - Yuanjuan Liu
- Department of Child Health, Linyi Central Hospital, Linyi, Shandong, China (mainland)
| | - Kemiao Liu
- Department of Child Health, Linyi Central Hospital, Linyi, Shandong, China (mainland)
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The Neu-Prem Trial: Neuromonitoring of Brains of Infants Born Preterm During Resuscitation-A Prospective Observational Cohort Study. J Pediatr 2018; 198:209-213.e3. [PMID: 29680471 DOI: 10.1016/j.jpeds.2018.02.065] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 02/07/2018] [Accepted: 02/28/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine whether monitoring cerebral oxygen tissue saturation (StO2) with near-infrared spectroscopy (NIRS) and brain activity with amplitude-integrated electroencephalography (aEEG) can predict infants at risk for intraventricular hemorrhage (IVH) and death in the first 72 hours of life. STUDY DESIGN A NIRS sensor and electroencephalography leads were placed on 127 newborns <32 weeks of gestational age at birth. Ten minutes of continuous NIRS and aEEG along with heart rate, peripheral arterial oxygen saturation, fraction of inspired oxygen, and mean airway pressure measurements were obtained in the delivery room. Once the infant was transferred to the neonatal intensive care unit, NIRS, aEEG, and vital signs were recorded until 72 hours of life. An ultrasound scan of the head was performed within the first 12 hours of life and again at 72 hours of life. RESULTS Thirteen of the infants developed any IVH or died; of these, 4 developed severe IVH (grade 3-4) within 72 hours. There were no differences in either cerebral StO2 or aEEG in the infants with low-grade IVH. Infants who developed severe IVH or death had significantly lower cerebral StO2 from 8 to 10 minutes of life. CONCLUSIONS aEEG was not predictive of IVH or death in the delivery room or in the neonatal intensive care unit. It may be possible to use NIRS in the delivery room to predict severe IVH and early death. TRIAL REGISTRATION ClinicalTrials.gov: NCT02605733.
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Léveillé- P, Hamel M, Ardilouze JL, Pasquier JC, Deacon C, Whittingstall K, Plourde M. Pilot study of EEG in neonates born to mothers with gestational diabetes mellitus. Int J Dev Neurosci 2018; 66:37-44. [PMID: 29360555 DOI: 10.1016/j.ijdevneu.2018.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 01/15/2018] [Accepted: 01/15/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The goal was to evaluate whether there was neurodevelopmental deficits in newborns born to mothers with gestational diabetes mellitus (GDM) compared to control newborns born to healthy mothers. METHODS Forty-six pregnant women (21 controls and 25 GDM) were recruited. Electroencephalogram (EEG) was recorded in the newborns within 48 h after birth. The EEG signal was quantitatively analyzed using power spectral density (PSD); coherence between hemispheres was calculated in paired channels of frontal, temporal, central and occipital regions. RESULTS The left centro-occipital PSD in control newborns was 12% higher than in GDM newborns (p = 0.036) but was not significant after adjustment for gestational age. While coherence was higher in the frontal regions compared to the occipital regions (p < 0.001), there was no difference between the groups for the fronto-temporal, frontal-central, centro-occipital and tempo-occipital regions. CONCLUSION Our results support that EEG differences between groups were mainly modified by gestational age and less by GDM status of the mothers. However, there is a need to confirm this result with a higher number of mother-newborns. Quantitative EEG in GDM newborns within 48 h after birth is feasible. This study emphasizes the importance of controlling blood glucose during GDM to protect infant brain development.
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Affiliation(s)
- Pauline Léveillé-
- Research Center on Aging, Centre intégré de santé et services sociaux de l'Estrie-Centre hospitalier de l'Université de Sherbrooke, 1036 Belvédère Sud, Sherbrooke, Quebec, J1H 4C4, Canada; Department of Physiology, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, Quebec, J1H 5N4, Canada; Institute of Nutrition and Functional Foods, Laval University, Quebec, QC, Canada
| | - Mathieu Hamel
- Research Center on Aging, Centre intégré de santé et services sociaux de l'Estrie-Centre hospitalier de l'Université de Sherbrooke, 1036 Belvédère Sud, Sherbrooke, Quebec, J1H 4C4, Canada
| | - Jean-Luc Ardilouze
- Department of Physiology, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, Quebec, J1H 5N4, Canada; Department of Medicine, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, Quebec, J1H 5N4, Canada; Centre de recherche du CHUS, 3001, 12e Avenue Nord, Sherbrooke, Quebec, J1H 5N4, Canada
| | - Jean-Charles Pasquier
- Department of Medicine, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, Quebec, J1H 5N4, Canada; Centre de recherche du CHUS, 3001, 12e Avenue Nord, Sherbrooke, Quebec, J1H 5N4, Canada
| | - Charles Deacon
- Department of Medicine, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, Quebec, J1H 5N4, Canada
| | - Kevin Whittingstall
- Department of Medicine, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, Quebec, J1H 5N4, Canada; Centre de recherche du CHUS, 3001, 12e Avenue Nord, Sherbrooke, Quebec, J1H 5N4, Canada.
| | - Mélanie Plourde
- Research Center on Aging, Centre intégré de santé et services sociaux de l'Estrie-Centre hospitalier de l'Université de Sherbrooke, 1036 Belvédère Sud, Sherbrooke, Quebec, J1H 4C4, Canada; Institute of Nutrition and Functional Foods, Laval University, Quebec, QC, Canada; Department of Medicine, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, Quebec, J1H 5N4, Canada.
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Frasch MG, Boylan GB, Wu HT, Devane D. Commentary: Computerised interpretation of fetal heart rate during labour (INFANT): a randomised controlled trial. Front Physiol 2017; 8:721. [PMID: 29033845 PMCID: PMC5625115 DOI: 10.3389/fphys.2017.00721] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 09/06/2017] [Indexed: 12/31/2022] Open
Affiliation(s)
- Martin G. Frasch
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States
| | - Geraldine B. Boylan
- Irish Centre for Fetal and Neonatal Translational Research, Cork, Ireland
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Hau-tieng Wu
- Department of Mathematics and Department of Statistical Science, Duke University, Durham, NC, United States
| | - Declan Devane
- Irish Centre for Fetal and Neonatal Translational Research, Cork, Ireland
- School of Nursing and Midwifery, NUI Galway, Galway, Ireland
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