Electroencephalography and brain damage in preterm infants

Hellström‐Westas, Lena; Rosén, Ingmar

doi:10.1016/j.earlhumdev.2005.01.006

Cited by 66 publications

(52 citation statements)

References 40 publications

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“…In addition, a correlation between chronic-stage abnormalities and cognitive impairment is suggested (10 -13). Although early postnatal EEG has been used increasingly in preterm infants during the last years, there is no clear evidence to confirm its prognostic value in preterm infants of Ͻ30 wk GA (9).…”

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confidence: 99%

“…These "acute-stage" abnormalities gradually improve with time and are replaced by "chronic-stage" abnormalities such as dysmaturity and disorganization. Several studies suggest that acute changes in the EEG background are powerful but nonspecific markers of brain dysfunction (8,9). In addition, a correlation between chronic-stage abnormalities and cognitive impairment is suggested (10 -13).…”

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confidence: 99%

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Amplitude-Integrated EEG Pattern Predicts Further Outcome in Preterm Infants

et al. 2011

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Changes in EEG background activity are powerful but nonspecific markers of brain dysfunction. Early EEG and amplitudeintegrated EEG (aEEG) pattern predict further neurodevelopmental outcome in term infants; however, sufficient data for prognostic value of aEEG in preterm infants are not available so far. The aim of the study was to evaluate whether aEEG predicts further outcome and to compare it to cerebral ultrasound assessment. In 143 preterm infants, aEEG within the first 2 wk of life and outcome data at 3 y of age (Bayley Scales) could be obtained .aEEG was classified into a graded score according to background activity, appearance of sleep-wake cycling, and occurrence of seizure activity. In preterm infants, aEEG was significantly associated with further outcome. Specificity was 73% for assessment within the first and increased to 95% in the second week of life, whereas sensitivity stayed nearly the same 87% (first week) to 83% (second week). Cerebral ultrasound showed a specificity of 86% within the first and second week, sensitivity also stayed nearly the same (74 and 75%). aEEG has a predictive value for later outcome in preterm infants and can be used as an early prognostic tool. D espite recent advances in perinatal care, the incidence of impaired outcome in preterm infants has not decreased. Rates of CP and overt cerebral lesions [e.g. cystic leukomalacia and intraventricular hemorrhage (IVH)] are decreasing, but the incidence of neurodevelopmental impairment stays high in preterm infants. This is due to different mechanisms in brain injury (e.g. inflammation, oxidative stress, impaired connectivity) and result in mainly cognitive impairment (1-3). Extensive studies have demonstrated the usefulness of cerebral ultrasound (CUS) in detecting cerebral lesions and predicting neurological outcome (4 -7). Also conventional EEG is proven to be useful in evaluating brain function and in predicting further development (8). On the background of an acute brain insult, EEG activity shows various degrees of depression and its severity parallels the magnitude of the brain lesion. These "acute-stage" abnormalities gradually improve with time and are replaced by "chronic-stage" abnormalities such as dysmaturity and disorganization. Several studies suggest that acute changes in the EEG background are powerful but nonspecific markers of brain dysfunction (8,9). In addition, a correlation between chronic-stage abnormalities and cognitive impairment is suggested (10 -13). Although early postnatal EEG has been used increasingly in preterm infants during the last years, there is no clear evidence to confirm its prognostic value in preterm infants of Ͻ30 wk GA (9).The most dominant feature of the extremely preterm infants' EEG is discontinuity, making a "grading" and "severityscoring" in terms of depression in these infants difficult. Furthermore validated reference criteria with regard to maturation and appearance of sleep-wake cycling (SWC) to score "disorganization" and/or "dysmaturity" are still scarce.Recordi...

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Amplitude-Integrated EEG Pattern Predicts Further Outcome in Preterm Infants

et al. 2011

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“…Monitoring of brain function is more difficult. Electroencephalography (EEG) monitoring is a sensitive method for detection of brain injury in preterm infants (3)(4)(5)(6); however, the fragile nature of the extremely premature neonate makes it difficult to perform long-term monitoring using multichannel EEG recordings and is particularly difficult during the first few days of life when the neonate is often critically unwell.…”

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Decreased aEEG Continuity and Baseline Variability in the First 48 Hours of Life Associated With Poor Short-Term Outcome in Neonates Born Before 29 Weeks Gestation

2010

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Amplitude-integrated electroencephalography (aEEG) provides us with a method of assessing brain activity in critically ill neonates. In extremely premature neonates, the aEEG trace is predominantly discontinuous, making it difficult to distinguish between a "normal" and "abnormal" trace. We measured aEEG activity in the first 48 h of life in neonates born before 29-wk gestation and used both visual and quantitative analysis of the aEEG data to assess differences in neonates with poor short-term outcome [death or peri/intraventricular hemorrhage (P/IVH)] compared with those who survived without P/IVH to identify features of an abnormal aEEG. On quantitative analysis, EEG continuity Ͻ80% at 10-V level was a sensitive and specific marker of poor short-term outcome. By using this marker, we identified 83% of neonates who died or developed grade 3 or 4 IVH and 60% of neonates who developed grades 1 or 2 IVH, with a positive predictive value for death or any IVH of 73% and a negative predictive value of 86%. Absence of sleep-wake cycling with baseline variability Ͻ2 V was the strongest predictor of outcome using visual analysis alone. (Pediatr Res 67: 538-544, 2010) E xtremely premature neonates have been provided with life-saving intensive care support in neonatal intensive care units (NICUs) for more than three decades. As survival rates for these infants have improved, an increasing emphasis is being placed on the quality of survival and long-term neurologic outcome in these vulnerable children (1,2).Cardiorespiratory monitoring is performed as standard care in neonatal units. Monitoring of brain function is more difficult. Electroencephalography (EEG) monitoring is a sensitive method for detection of brain injury in preterm infants (3-6); however, the fragile nature of the extremely premature neonate makes it difficult to perform long-term monitoring using multichannel EEG recordings and is particularly difficult during the first few days of life when the neonate is often critically unwell.Limited channel amplitude-integrated EEG (aEEG) monitoring provides a simplified form of EEG monitoring that can be performed over prolonged periods of time in the NICU. In full-term neonates, aEEG monitoring is used in the first few days of life for neonates with encephalopathy or risk of seizures to help guide treatment and to assist with prognosis (7-15).The role of aEEG monitoring in the premature neonate is less clear. The EEG in the premature neonate is predominantly discontinuous, with bursts of activity alternating with periods of relative attenuation (6,16,17). The sleep-wake pattern seen in the aEEG recording of the mature full-term neonate is poorly developed in the preterm neonate. The general immaturity of the EEG trace in the extremely premature neonate results in difficulty distinguishing between a "normal" and "abnormal" aEEG trace in these neonates. A number of studies have assessed aEEG recordings of premature neonates during the first few weeks of life (18 -23); however, few studies have assessed ext...

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“…По статистическим данным, в России 6 из 1000 новорожденных имеют дефекты слуха, но ранняя диагностика этих дефектов осуществляется лишь у 1-2 детей [1]. По мнению некоторых зарубеж-ных авторов, частота нарушений слуха у новорож-денных может достигать 2-15,5%, а средний возраст ребенка, когда выявляется врожденная тугоухость, при недейственности скрининговых программ, состав-ляет 18-30 мес, и это только при наличии глубоких, двусторонних потерь слуха, без учета слабых и сред-них потерь [2]. В связи с этим в настоящее время перед неонатологами и педиатрами поставлена зада-ча раннего выявления снижения слуха у детей с целью профилактики вторичных речевых нарушений (ранняя аппаратная коррекция и ставшее возможным эндо-протезирование позволяют предупредить речевые дисфункции, нарушения формирования интеллекта и личности в целом).…”

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“…Роль недоношенности в развитии врожденной пато-логии слуха обусловлена значительной насыщенностью онтогенеза недоношенных детей вышеперечисленными факторами перинатального риска и большей ранимо-стью сенсорных систем у незрелых детей. Наиболее высок риск снижения слуха у маловесных недоношен-ных детей [2,4].…”

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