Elsevier

Pediatric Neurology

Volume 44, Issue 5, May 2011, Pages 364-369
Pediatric Neurology

Original Article
Low-Voltage aEEG as Predictor of Intracranial Hemorrhage in Preterm Infants

https://doi.org/10.1016/j.pediatrneurol.2010.11.018Get rights and content

The objectives of this prospective cohort study were to identify amplitude-integrated electroencephalography (aEEG) background patterns predictive of severe intracranial hemorrhage. Thirty ventilated preterm newborns weighing <1,000 g were assessed by an aEEG cerebral function monitor and ultrasound measurement of cerebral blood flow velocity at time of surfactant administration and tracheal suctioning simultaneously during first 48 hours of life. Birth weight was 624 ± 200 g (mean ± S.D.) and gestational age was 25 ± 2 weeks. Background electrical activity was predominantly discontinuous in 72% of infants. A sharp increase in electrical activity/burst density was observed during surfactant administration and tracheal suctioning in most infants, with a 33.5% increase in mean cerebral blood flow velocity. Burst suppression with low voltage was identified in 57% infants with severe intracranial hemorrhage, whereas no infant without hemorrhage exhibited this pattern (P = 0.014). We conclude that aEEG low-voltage burst suppression might have useful clinical applications with 100% positive predictive value for severe intracranial hemorrhage.

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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