Early Prediction of Outcome with aEEG in Preterm Infants with Large Intraventricular Hemorrhages

Hellström‐Westas, Lena; Klette, Hans; Thorngren-Jerneck, Kristina; Rosén, Ingmar

doi:10.1055/s-2001-20408

Cited by 137 publications

(90 citation statements)

References 24 publications

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“…The sensitivity for prediction of outcome from EEG was significantly lower already after 3 days 29 . In a study of infants with large IVH's (grade 3-4) the maximum burst rate per hour during the first 24-48 postnatal hours was predictive of gross neurological outcome 30 . However, neurodevelopmental outcome in extremely preterm infants may be affected by several other factors including e.g.…”

Section: Prediction Of Outcomementioning

confidence: 97%

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Electroencephalography and brain damage in preterm infants

Hellström‐Westas

Rosén

2005

Early Human Development

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Electroencephalography (EEG) is a sensitive method for detection of brain injury in preterm infants. Although the acute and chronic EEG changes are mainly non-specific regarding type of injury, they correlate with later neurological and cognitive function. In infants developing periventricular hemorrhagic or ischemic brain injury, acute EEG findings include depression of background activity and presence of epileptic seizure activity. The chronic EEG changes associated with white matter injury and abnormal neurological development include delayed maturation, and presence of abundant rolandic sharp waves. Suboptimal cognitive development in preterm infants has been associated with changes in various sleep measures in EEG's recorded at full term. Continuous EEG-monitoring during neonatal intensive careshows that cerebral electrical activity during this vulnerable period can be affected by several extracerebral factors, e.g. cerebral blood flow, acidosis and some commonly used medications. For diagnosis of brain injury in preterm infants with neurophysiological methods, a combination of early continuous EEG monitoring during the initial intensive care period and full EEG, performed at later stages, is probably optimal.Key words: EEG, aEEG, Cerebral Function Monitor, preterm, brain injuryThe normal EEG of the very preterm infantOur knowledge about what can be considered as a normal early postnatal EEG in an extremely preterm infant has increased considerably during the last few years. Such studies of extremely preterm infants are methodologically difficult to perform, not least due to the vulnerability of these infants during the first days of life, and the study populations are consequently relatively small. Nevertheless, a few studies have managed to include very immature infants with no intracranial pathology on cranial ultrasound or magnetic resonance imaging and with normal long-term follow up. Postconceptional age (PCA) is a commonly used term in EEG studies for describing the infant's degree of maturation. It is often defined as gestational age (GA) in weeks at delivery plus postnatal age in weeks. However, some authors use other terms, e.g. conceptional age and postmenstrual age. In this review we have chosen to use the authors' own terminology regarding the infant's maturity. Extrauterine life is not a normal condition in preterm infants, and therefore data on "normal" postnatal development of EEG in extremely preterm infants is lacking. Serial EEG's of preterm infants without brain lesions and who developed normally give the closest approximation of normal EEG development. However, some studies from healthy preterm infants indicate that some features of the EEG, especially regarding sleep-state variables, at full-term may differ from the EEG's of newborns born at normal gestations 1,2 . Magnetoencephalography (MEG) is an advanced non-invasive method that can be performed on normal intrauterine fetuses. It is likely that MEG-data in the future can add knowledge on the normal neurophysiological develo...

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Section: Prediction Of Outcomementioning

confidence: 97%

“…Presence of early, during the first week of life, sleep wake cycling in aEEG recordings in preterm infants with large IVH's (grade 3-4) is associated with better outcome 30 . Sleep measures in EEG's performed at full term in prematurely born infants seem to be sensitive predictors of developmental performance.…”

Section: Prediction Of Outcomementioning

confidence: 99%

Electroencephalography and brain damage in preterm infants

Hellström‐Westas

Rosén

2005

Early Human Development

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“…Increased burst rate and an earlier onset of cycling are associated with better outcomes, and burst rates <130 h -1 are associated with poorer outcomes. 54 The use of these tools on early aEEG examination may help in providing useful counseling information. Interburst interval, the quiescent period of isoelectric activity measured on the raw unprocessed signal, is increased in infants with brain injury and may predict handicap at 2 years of age.…”

Section: Introductionmentioning

confidence: 99%

Using amplitude-integrated EEG in neonatal intensive care

Tao

Mathur

2010

J Perinatol

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The implementation of amplitude-integrated electroencephalography (aEEG) has enhanced the neurological monitoring of critically ill infants. Limited channel leads are applied to the patient and data are displayed in a semilogarithmic, time-compressed scale. Several classifications are currently in use to describe patient tracings, incorporating voltage criteria, pattern recognition, cyclicity, and the presence or absence of seizures. In term neonates, aEEG has been used to determine the prognosis and treatment for those affected by hypoxic-ischemic encephalopathy, seizures, meningitis and even congenital heart disease. Its application as inclusion criteria for therapeutic hypothermia remains controversial. In preterm infants, normative values and patterns corresponding to gestational age are being established. As these standards emerge, the predictive value of aEEG increases, especially in the setting of preterm brain injury and intraventricular hemorrhage. The sensitivity and specificity of aEEG are enhanced by the display of a simultaneous raw EEG, which aids interpretation. Caution must be taken when using and interpreting this tool in conjunction with certain medications and in the setting of less experienced staff. Continuing efforts at developing software that can aid seizure detection and background classification will enhance the bedside utility of this tool.

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“…The mechanism of this rapid recovery is unclear. Moreover, there is relatively limited information on neurophysiological recovery after asphyxia in preterm infants (9), when important visual prognostic markers such as sleep-wake cycling have not yet developed (10).…”

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confidence: 99%