Impact of perinatal factors on continuous early monitoring of brain electrocortical activity in very preterm newborns by amplitude-integrated EEG

Abstract

Background: Amplitude-integrated electroencephalogram (aEEG) is increasingly used for neuromonitoring in preterms. We aimed to quantify the effects of gestational age (GA), postnatal age (PNA), and other perinatal factors on the development of aEEG early after birth in very preterm newborns with normal cerebral ultrasounds. Methods: Continuous aEEG was prospectively performed in 96 newborns (mean GA: 29.5 (range: 24.4-31.9) wk, birth weight 1,260 (580-2,120) g) during the first 96 h of life. aEEG tracings were qualitatively (maturity scores) and quantitatively (amplitudes) evaluated using preestablished criteria. results: A significant increase in all aEEG measures was observed between day 1 and day 4 and for increasing GA (P < 0.001). The effect of PNA on aEEG development was 6.4-to 11.3-fold higher than that of GA. In multivariate regression, GA and PNA were associated with increased qualitative and quantitative aEEG measures, whereas small-for-GA status was independently associated with increased maximum aEEG amplitude (P = 0.003). Morphine administration negatively affected all aEEG measures (P < .05), and caffeine administration negatively affected qualitative aEEG measures (P = 0.02). conclusion: During the first few days after birth, aEEG activity in very preterm infants significantly develops and is strongly subjected to the effect of PNA. Perinatal factors may alter the early aEEG tracing and interfere with its interpretation.

Association between development of early cortical activity on amplitude-integrated EEG and 5-years neurodevelopmental outcome in the preterm infant

“…Furthermore, in our cohort morphine sedation during aEEG monitoring was found to be associated with a decrease in the odds of having an IQ in the normal range. These results are in line with previous studies reporting that morphine administration in preterm born infants may affect aEEG tracings (31) and may be associated with adverse neurodevelopmental outcome as well as reduced regional cerebral growth (32). However, post hoc analyses of baseline characteristics among neonates who received morphine sedation during aEEG recording in our cohort compared to non-sedated neonates revealed some collinearity of ‘morphine sedation’ and other variables indicating high clinical instability of the sedated subjects (e.g.…”

Cognitive outcome of early school‐aged children born very preterm is not predicted by early short‐term amplitude‐integrated electroencephalography

“…Furthermore, in this cohort morphine sedation during aEEG monitoring was found to be associated with a decrease in the odds of having an IQ within the normal range. These results are in line with previous studies reporting that morphine administration in preterm born infants may affect aEEG tracings17 and may be associated with adverse neurodevelopmental outcome and reduced regional cerebral growth 27. However, post hoc analyses of baseline characteristics among neonates who received morphine sedation during aEEG recording in this cohort, compared with nonsedated neonates revealed some collinearity of morphine sedation and other variables, such as lower gestational age, higher Score for Neonatal Acute Physiology with Perinatal Extension-II.…”

“…Cranial ultrasound was performed at day one, three and seven of life and repeated weekly until hospital discharge. Mild brain lesions were defined as intraventricular haemorrhage grade I‐II and, or periventricular leukomalacia grade I, whereas severe brain lesions were defined as grade III intraventricular haemorrhage and periventricular haemorrhagic infarction, cerebellar haemorrhage, cerebral atrophy and cystic periventricular leukomalacia as described previously . Socioeconomic status was assessed based on maternal education and paternal occupation and was scored according to Largo et al Scores were transformed so that higher scores indicate higher socioeconomic status, ranging from 2 to 12.…”

Automated cot-side tracking of functional brain age in preterm infants

“…There is evidence to suggest that several of these challenges, interventions (many which are designed to accelerate maturation), and other relevant clinical variables can influence EEG activity and, therefore, contribute to variability in the FBA and, therefore, PAD. These variables include the difference between GA and PMA (intra-uterine vs extra-uterine maturation), post-natal adaption, medications, ventilation, birthweight, kangaroo care/infant massage, and gender (47)(48)(49)(50)(51)(52)(53)(54)(55)(56). We aim to investigate these effects in future work to differentiate them from other potential causes of inter-subject variability such as natural variability in the course of in-utero growth (57).…”