Original ArticleLow-Voltage aEEG as Predictor of Intracranial Hemorrhage in Preterm Infants
Introduction
Amplitude-integrated electroencephalography (aEEG) provided by a cerebral function monitor is being introduced in neonatal intensive care units as a quick and easy bedside alternative for monitoring sick infants. Specifically, we and others have reported good aEEG predictive value in the diagnosis of severity of hypoxic-ischemic encephalopathy and in the selection of term infants most likely to benefit from hypothermia treatment [1], [2], [3], [4].
In contrast to the use of aEEG in term infants, the interpretation of aEEG tracings in very preterm infants is more problematic. First, aEEG background activity changes from a discontinuous to continuous pattern as preterm infants mature. Additionally, preterm infants require more medications and procedures that may affect the background electrical activity. Despite these limitations, the rationale for continuous brain monitoring in preterm infants, who may be sedated or may be unable to manifest clinical signs of neurologic compromise, is appealing [5]. With future development of targeted neuroprotective interventions for preterm infants, the aEEG may help define the population most likely to benefit from treatment. There is a definite need to evaluate real-time aEEG parameters that could be easily detected at the bedside by simple pattern recognition that might aid clinicians in the early detection of intracranial hemorrhage (ICH).
The objectives for this prospective pilot study of aEEG recordings in extremely low birth weight (ELBW, birth weight ≤1,000 g) newborns during the first 48 hours of life were to assess background electrical activity, to assess the effect of procedures on background electrical activity, and to determine patterns predictive of severe ICH.
Section snippets
Study Design
This was a prospective pilot study conducted at a regional perinatal center in a rural state. Participants were consecutively enrolled from January to July 2007. The University of Arkansas for Medical Sciences institutional review board approved the study protocol. Informed consent was obtained from parents before study participation.
Participants
Inborn infants with birth weight of 401 to 1,000 g, 23 to 28 weeks completed gestation, and those who were mechanically ventilated and administered surfactant for
Results
The birth weight was 624 ± 200 g, and the gestational age was 25 ± 2 weeks. The other clinical characteristics of the 30 infants are listed in Table 1. Additionally, all these infants received fentanyl as needed for sedation while mechanically ventilated, 4 infants received dopamine infusions for hypotension, 1 infant required insulin for hyperglycemia, and 2 infants underwent cardiopulmonary resuscitation during newborn resuscitation. None of the infants had any clinical seizures. Two infants
Discussion
This prospective pilot study of intubated and mechanically ventilated ELBW infants revealed that most infants displayed a discontinuous tracing that was briefly disrupted during surfactant and suctioning procedures. Most importantly, we observed that the aEEG low-voltage burst suppression pattern was an ominous predictor, with 100% positive predictive value for developing severe ICH.
This study focused on the description of the aEEG electrical background activity in newborn ELBW infants.
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Clinical value of cortical bursting in preterm infants with intraventricular haemorrhage
2023, Early Human DevelopmentPerinatal factors associated with amplitude-integrated electroencephalography abnormalities in preterm infants on the first day of life
2020, Jornal de PediatriaCitation Excerpt :This study showed that discontinuous tracings were the predominant electroencephalographic tracings in the evaluated preterm infants, and that patients’ biological variables and their clinical severity were associated with electroencephalographic characteristics on the first day of life. Burst suppression occurred in 12% of the preterm infants included in this study, and this rate was similar to that found by Chalak et al.18 (16%) in infants with GA < 28 weeks monitored on the first day of life. Wikström et al.19 analyzed aEEG tracings during the first 72 h of life and observed burst suppression in 25% of patients with GA between 28 and 30 weeks and 5 in 8% of those with GA < 28 weeks.
Altered cortical processing of somatosensory input in pre-term infants who had high-grade germinal matrix-intraventricular haemorrhage
2020, NeuroImage: ClinicalCitation Excerpt :High-grade GM-IVH comprised: GM-IVH with ventricular dilatation (grade III) or GM-IVH with secondary intraparenchymal lesion (IPL) (de Vries, 2018)) (Table 1). It is typical to combine these two subcategories in a single group as high-grade GM-IVH (e.g. (Ancel et al., 2015; Chalak et al., 2011; Nevalainen et al., 2015; Olischar et al., 2007)). Control infants were defined as having either normal cranial ultrasound imaging or a small (grade I) germinal matrix haemorrhage which had not bled into the ventricles (one infant).
Pathogenesis of Germinal Matrix Hemorrhage
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