Compartilhar
Informação da revista
Vol. 90. Núm. 2.
Páginas 143-148 (Março - Abril 2014)
Compartilhar
Compartilhar
Baixar PDF
Mais opções do artigo
Vol. 90. Núm. 2.
Páginas 143-148 (Março - Abril 2014)
ARTIGO ORIGINAL
DOI: 10.1016/j.jpedp.2013.07.005
Open Access
Clinical utility of early amplitude integrated EEG in monitoring term newborns at risk of neurological injury
Utilidade clínica de um monitoramento por EEG de amplitude integrada precoce em recém-nascidos a termo com risco de lesão neurológica
Visitas
...
Paulina A. Tosoa,
Autor para correspondência
ptoso@med.puc.cl

Corresponding author.
, Alvaro J. Gonzáleza, María E. Pérezb, Javier Kattana, Jorge G. Fabresa, José L. Tapiaa, Hernán S. Gonzáleza
a Divisão de Pediatria, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
b Pontificia Universidad Católica de Chile, Santiago, Chile
Conteúdo relacionado
J Pediatr (Rio J). 2014;90:102-410.1016/j.jpedp.2013.12.003
Abbot Laptook
Informação do artigo
Abstract
Objective

to test the clinical utility of an early amplitude-integrated electroencephalography (aEEG) to predict short-term neurological outcome in term newborns at risk of neurology injury.

Methods

this was a prospective, descriptive study. The inclusion criteria were neonatal encephalopathy, neurologic disturbances, and severe respiratory distress syndrome. Sensitivity, specificity, positive and negative predictive values, and likelihood ratio (LR) were calculated. Clinical and demographic data were analyzed. Neurological outcome was defined as the sum of clinical, electroimaging, and neuroimaging findings.

Results

ten of the 21 monitored infants (48%) presented altered short-term neurologic out-come. The aEEG had 90% sensitivity, 82% specificity, 82% positive predictive value, and 90% negative predictive value. The positive LR was 4.95, and the negative LR was 0.12. In three of12 (25%) encephalopathic infants, the aEEG allowed for a better definition of the severity of their condition. Seizures were detected in eight infants (38%), all subclinical at baseline, and none had a normal aEEG background pattern. The status of three infants (43%) evolved and required two or more drugs for treatment.

Conclusions

in infants with encephalopathy or other severe illness, aEEG disturbances occur frequently. aEEG provided a better classification of the severity of encephalopathy, detectedearly subclinical seizures, and allowed for monitoring of the response to treatment. aEEG was a useful tool at the neonatal intensive care unit for predicting poor short-term neurologicaloutcomes for all sick newborn.

Keywords:
Amplitude integrated electroencephalography (aEEG)
Hypoxic ischemic encephalopathy (HIE)
Neonatal intensive care
Seizures
Resumo
Objetivo

testar a utilidade clínica do aEEG precoce em recém-nascidos a termo com risco delesão neurológica, para prever resultados neurológicos de curto prazo.

Métodos

estudo prospectivo e descritivo. Os critérios de inclusão foram encefalopatia neonatal, distúrbios neurológicos e bebês com SARA grave. Sensibilidade, especificidade, valor preditivo positivo e negativo e razão de verossimilhança foram calculados. Dados clínicos edemográficos foram analisados. O resultado neurológico foi definido como a soma de conclusões clínicas, de eletro e de neuroimagem.

Resultados

dentre os 21 neonatos monitorados, dez (48%) apresentaram resultado neu- rológico de curto prazo alterado. O aEEG apresentou sensibilidade de 90%, especificidade de 82%, valor preditivo positivo de 82% e valor preditivo negativo de 90%. A VR positiva foi de 4,95, e a RV negativa de 0,12. Em três dos 12 (25%) neonatos com encefalopatia foi possível definir melhora gravidade de sua condição pelo aEEG. Foram detectadas convul- sões em oito neonatos (38%), todas subclínicas no início do estudo, e nenhum apresentou um padrão histórico normal no aEEG. O estado de três neonatos (43%) evoluiu e exigiu dois ou mais medicamentos para tratamento.

Conclusões

em neonatos com encefalopatia ou outra doença grave, os distúrbios no aEE- Gocorrem com mais frequência. O aEEG forneceu uma classificação melhor da gravidade da encefalopatia, detectou convulsões subclínicas precoces e permitiu que fosse feito o monitoramento da resposta ao tratamento. O aEEG é uma ferramenta útil para prever resultados neurológicos de curto prazo em todos os bebês doentes na UTIN.

Palavras-chave:
Eletroencefalo- gramade amplitude integrada (aEEG)
Encefalopatia hipóxico-isquêmica (EHI)
Terapia intensiva neonatal
Convulsões
O texto completo está disponível em PDF
Referências
[1]
S. Victor, A.G. Marson, R.E. Appleton, M. Beirne, A.M. Weindling.
Relationship between blood pressure, cerebral electrical activity, cerebral fractional oxygen extraction, and peripheral bloodflow in very low birth weight newborn infants.
Pediatr Res., 59 (2006), pp. 314-319
[2]
G. Greisen, O. Pryds, I. Rosén, H. Lou.
Poor reversibility of EEG abnormality in hypotensive, preterm neonates.
Acta Paediatr Scand., 77 (1988), pp. 785-790
[3]
M.J. Benders, J.H. Meinesz, F. van Bel, M. van de Bor.
Changes in electrocortical brain activity during exchange transfusions in newborn infants.
Biol Neonate., 78 (2000), pp. 17-21
[4]
C.R. West, A.M. Groves, C.E. Williams, J.E. Harding, J.R. Skinner, C.A. Kuschel, et al.
Early low cardiac output is associated with compromised electroencephalographic activity in very preterminfants.
Pediatr Res., 59 (2006), pp. 610-615
[5]
E. Thornberg, B. Ekström-Jodal.
Cerebral function monitoring: amethod of predicting outcome in term neonates after severe perinatal asphyxia.
Acta Paediatr., 83 (1994), pp. 596-601
[6]
Hellström-Westas L, Rosén I, Svenningsen NW. Predictive value of early continuous amplitude integrated EEG recordings on out- come after severe birth asphyxia in full term infants. Arch Dis Child Fetal Neonatal Ed. 1995; 72:F34-8.
[7]
van Rooij LG, Toet MC, Osredkar D, van Huffelen AC, Groenendaal F, de Vries LS. Recovery of amplitude integrated electro- encephalographic background patterns within 24hours of perinatal asphyxia. Arch Dis Child Fetal Neonatal Ed. 2005; 90: F245-51.
[8]
H.J. ter Horst, C. Sommer, K.A. Bergman, J.M. Fock, T.W. van Weerden, A.F. Bos.
Prognostic significance of amplitude-integrated EEG during the first 72hours after birth in severely asphyxiated neonates.
Pediatr Res., 55 (2004), pp. 1026-1033
[9]
H.B. Sarnat, M.S. Sarnat.
Neonatal encephalopathy following fetal distress. A clinical and electroencephalographic study.
Arch Neurol., 33 (1976), pp. 696-705
[10]
R.E. Spitzmiller, T. Phillips, J. Meinzen-Derr, S.B. Hoath.
Amplitude- integrated EEG is useful in predicting neurodevelopmental outcome in full-term infants with hypoxic-ischemic encephalopathy: a meta- analysis.
J Child Neurol., 22 (2007), pp. 1069-1078
[11]
L. Hellström-Westas, U. Westgren, I. Rosén, N.W. Svenningsen.
Lidocaine for treatment of severe seizures in newborn infants Clinical effects and cerebral electrical activity monitoring.
Acta Paediatr Scand., 77 (1988), pp. 79-84
[12]
R.A. Shellhaas, A.I. Soaita, R.R. Clancy.
Sensitivity of amplitude- integrated electroencephalography for neonatal seizure detection.
Pediatrics., 120 (2007), pp. 770-777
[13]
C.F. Hagmann, N.J. Robertson, D. Azzopardi.
Artifacts on electroencephalograms may influence the amplitude-integrated EEG classification: a qualitative analysis in neonatal encephalopathy.
Pediatrics., 118 (2006), pp. 2552-2554
[14]
L. Hellström-Westas, I. Rosén, L.S. de Vries, G. Greisen.
Amplitude- integrated EEG classification and interpretation in preterm andterm infants.
NeoReviews., 7 (2006), pp. e76-e87
[15]
A.H. Bell, G. Greisen, O. Pryds.
Comparison of the effects of phenobarbitone and morphine administration on EEG activity inpreterm babies.
Acta Paediatr., 82 (1993), pp. 35-39
[16]
K. van Leuven, F. Groenendaal, M.C. Toet, A.F. Schobben, S.A. Bos, L.S. de Vries, et al.
Midazolam and amplitude-integrated EEG inasphyxiated full-term neonates.
Acta Paediatr., 93 (2004), pp. 1221-1227
[17]
S. Nguyen The Tich, M.F. Vecchierini, T. Debillon, Y. Péréon.
Effects of sufentanil on electroencephalogram in very and extremely preterm neonates.
Pediatrics., 111 (2003), pp. 123-128
[18]
G.B. Young, O.P. da Silva.
Effects of morphine on the electroencephalograms of neonates: a prospective, observational study.
Clin Neurophysiol., 111 (2000), pp. 1955-1960
[19]
D. Maynard, P.F. Prior, D.F. Scott.
Device for continuous monitoring of cerebral activity in resuscitated patients.
Br Med J., 4 (1969), pp. 545-546
[20]
U.L. Verma, F. Archbald, N.A. Tejani, S.M. Handwerker.
Cerebral function monitor in the neonate I: Normal patterns.
Dev Med Child Neurol., 26 (1984), pp. 154-161
[21]
L. Hellström-Westas, I. Rosén.
Amplitude-integrated electroen- cephalogram in newborn infants for clinical and research purposes.
Acta Paediatr., 91 (2002), pp. 1028-1030
[22]
M.C. Toet, W. van der Meij, L.S. de Vries, C.S. Uiterwaal, K.C. van Huffelen.
Comparison between simultaneously recorded amplitude integrated electroencephalogram (cerebral function monitor) and standard electroencephalogram in neonates.
Pediatrics., 109 (2002), pp. 772-779
[23]
L. Hellström-Westas.
Comparison between tape-recorded and amplitude-integrated EEG monitoring in sick newborn infants.
Acta Paediatr., 81 (1992), pp. 812-819
[24]
L.F. Shalak, A.R. Laptook, S.C. Velaphi, J.M. Perlman.
Amplitude- integrated electroencephalography coupled with an early neurologic examination enhances prediction of term infants at risk for persistent encephalopathy.
Pediatrics., 111 (2003), pp. 351-357
[25]
P.D. Gluckman, J.S. Wyatt, D. Azzopardi, R. Ballard, A.D. Edwards, D.M. Ferriero, et al.
Selective head cooling with mild systemic hypothermia after neonatal encephalopathy: multicentre randomised trial.
Lancet., 365 (2005), pp. 663-670
[26]
H. Tekgul, B.F. Bourgeois, K. Gauvreau, A.M. Bergin.
Electroencepha-lography in neonatal seizures: comparison of a reduced and a full 10/20 montage.
Pediatr Neurol., 32 (2005), pp. 155-161
[27]
M. Thoresen.
Hypothermia after perinatal asphyxia: selection for treatment and cooling protocol.
J Pediatr., 158 (2011), pp. e45-e49
[28]
D.V. Azzopardi, B. Strohm, A.D. Edwards, L. Dyet, H.L. Halliday, E. Juszczak, et al.
Moderate hypothermia to treat perinatal asphyxial encephalopathy.
N Engl J Med., 361 (2009), pp. 1349-1358
[29]
S. Shankaran, A. Pappas, S.A. McDonald, A.R. Laptook, R. Bara, R.A. Ehrenkranz, et al.
Predictive value of an early amplitude integrated electroencephalogram and neurologic examination.
Pediatrics., 128 (2011), pp. e112-e120
[30]
M.C. Toet, F. Groenendaal, D. Osredkar, A.C. van Huffelen, VriesL.S. de.
Postneonatal epilepsy following amplitude-integrated EEG-detected neonatal seizures.
Pediatr Neurol., 32 (2005), pp. 241-247

Como citar este artigo: Toso PA, González AJ, Pérez ME, Kattan J, Fabres JG, Tapia JL, et al. Clinical utility of early amplitude inte- grated EEG in monitoring term newborns at risk of neurological injury. J Pediatr (Rio J). 2014;90:143-8.

Unidade de Terapia Intensiva Neonatal, Hospital Clínico, Pontificia Universidad Católica de Chile, Santiago, Chile.

Copyright © 2013. Brasileira de Pediatria
Idiomas
Jornal de Pediatria

Receba a nossa Newsletter

Opções de artigo
Ferramentas
en pt
Taxa de publicaçao Publication fee
Os artigos submetidos a partir de 1º de setembro de 2018, que forem aceitos para publicação no Jornal de Pediatria, estarão sujeitos a uma taxa para que tenham sua publicação garantida. O artigo aceito somente será publicado após a comprovação do pagamento da taxa de publicação. Ao submeterem o manuscrito a este jornal, os autores concordam com esses termos. A submissão dos manuscritos continua gratuita. Para mais informações, contate assessoria@jped.com.br. Articles submitted as of September 1, 2018, which are accepted for publication in the Jornal de Pediatria, will be subject to a fee to have their publication guaranteed. The accepted article will only be published after proof of the publication fee payment. By submitting the manuscript to this journal, the authors agree to these terms. Manuscript submission remains free of charge. For more information, contact assessoria@jped.com.br.
Cookies policy Política de cookies
To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here. Utilizamos cookies próprios e de terceiros para melhorar nossos serviços e mostrar publicidade relacionada às suas preferências, analisando seus hábitos de navegação. Se continuar a navegar, consideramos que aceita o seu uso. Você pode alterar a configuração ou obter mais informações aqui.