Use of 2-Channel Bedside Electroencephalogram Monitoring in Term-Born Encephalopathic Infants Related to Cerebral Injury Defined by Magnetic Resonance Imaging

Shah, Divyen K.; Lavery, Shelly; Doyle, Lex W.; Wong, Connie; McDougall, Peter; Inder, Terrie E.

doi:10.1542/peds.2005-1294

Cited by 52 publications

(37 citation statements)

References 22 publications

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“…The two machines read similar levels for both the lower and upper borders, with machine B obtaining 3.37 V lower values for the upper margin of aEEG. In comparison to the original Lectromed paper trace, slightly lower borders have also been reported using machine B in humans (39).…”

Section: Discussionmentioning

confidence: 80%

Development of Amplitude-Integrated Electroencephalography and Interburst Interval in the Rat

et al. 2009

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Continuous monitoring of electrocortical brain activity with amplitude-integrated electroencephalography (aEEG) is important in neonatology. aEEG is affected by, for example, maturity, encephalopathy, and drugs. Neonatal research uses rat pups of different ages. Postnatal day (P) 7 rats are suggested to be equivalent neurodevelopmentally to near-term infants. We hypothesized that electroencephalography (EEG) and aEEG in P1-P21 rats follow the same developmental pattern with respect to background activity and the longest interburst interval (IBI) as that seen in infants from 23-wk gestational age (GA) to post-term. We examined aEEG and EEG on 49, unsedated rat pups with two clinical monitors. aEEG traces were analyzed for lower and upper margin amplitude, bandwidth and the five longest IBI in each trace were measured from the raw EEG. The median longest IBI decreased linearly with age by 5.24 s/d on average. The lower border of the aEEG trace was Ͻ5 V until P7 and rose exponentially reaching 10 V by P12. This correlated strongly with the decrease in IBI; both reflect increased continuity of brain activity with postnatal age. Based on aEEG trace analysis, the rat aEEG pattern at P1 corresponds to human aEEG at 23-wk gestation; P7 corresponds to 30 -32 wk and P10 to 40 -42 wk. (Pediatr Res 65: 62-66, 2009) A mplitude-integrated electroencephalography (aEEG) is increasingly used in neonatology for continuous monitoring of cerebral electrical activity (1) in relation to brain injury, seizures, and assessment of brain maturation. aEEG has gained widespread popularity as an adjunct to conventional EEG because of its simplicity of application and interpretation and feasibility for long-term recording alongside clinical care. Although multi-channel, raw electroencephalography (EEG) is still the "gold standard" in assessing the brain's functional state, its usefulness in the newborn is limited for several practical reasons (2,3). The assessment of background activity, presence of sleep wake cycling (SWC), and seizure identification, of particular importance in neonatology, require a longer recording period than the standard 30-min EEG. As global brain activity is the focus of interest in the newborn, one or two EEG channels are generally sufficient; thus reducing the number of electrodes attached to a small head.Translational research, the use of animals to model human disease, is essential in developing effective treatments for human disorders. The newborn rat has proven invaluable in increasing our understanding of mechanisms of brain injury and repair processes (4 -8). The Vanucci model, in which 7-d-old rats undergo unilateral ligation of the common carotid artery and exposure to 8% oxygen, is the most widely used animal model in the study of neonatal hypoxic-ischemic encephalopathy (HIE) (8); however, many models from postnatal day (P) 1 until P14 have been developed (5,8 -10). The usefulness of animal models is contingent on their validity. Previous research has correlated the maturation of the rat to the ...

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Section: Discussionmentioning

confidence: 80%

Development of Amplitude-Integrated Electroencephalography and Interburst Interval in the Rat

et al. 2009

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“…This agrees with the low FTOE we observed during this period in HIϩVEH. None of HIϩVEH piglets did recover EEG amplitude over 4 V and all of them showed seizure activity, both effects that signal an unfavourable outcome in human newborns (26,27). In contrast, CBD administration led to a significant recovery of amplitude, with six of eight piglets regaining EEG amplitude by more than 4 V at the end of the experiment.…”

Section: Discussionmentioning

confidence: 88%

“…In contrast, CBD administration led to a significant recovery of amplitude, with six of eight piglets regaining EEG amplitude by more than 4 V at the end of the experiment. Improvement in aEEG pattern is considered a good predictor of favorable outcome in newborns (26). In addition, only half of HIϩCBD piglets had significant seizures; a similar reduction of seizures occurs in HI piglets in response to high doses of the anticonvulsant topiramate (18).…”

Section: Discussionmentioning

confidence: 95%

Neuroprotective Effects of the Nonpsychoactive Cannabinoid Cannabidiol in Hypoxic-Ischemic Newborn Piglets

Álvarez¹,

Lafuente²,

Rey-Santano³

et al. 2008

Pediatr Res

132

113

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ABSTRACT:To test the neuroprotective effects of the nonpsychoactive cannabinoid cannabidiol (CBD), piglets received i.v. CBD or vehicle after hypoxia-ischemia (HI: temporary occlusion of both carotid arteries plus hypoxia). Nonhypoxic-ischemic sham-operated piglets remained as controls. Brain damage was studied by near-infrared spectroscopy (NIRS) and amplitudeintegrated electroencephalography (aEEG) and by histologic assessment (Nissl and FluoroJadeB staining). In HIϩvehicle, HI led to severe cerebral hemodynamic and metabolic impairment, as reflected in NIRS by an increase in total Hb index (THI) and a decrease in the fractional tissue oxygenation extraction (FTOE); in HIϩCBD the increase of THI was blunted and FTOE remained similar to SHAM. HI profoundly decreased EEG amplitude, which was not recovered in HIϩvehicle, indicating cerebral hypofunction; seizures were observed in all HIϩvehicle. In HIϩCBD, however, EEG amplitude recovered to 46.4 Ϯ 7.8% baseline and seizures appeared only in 4/8 piglets (both p Ͻ 0.05). The number of viable neurons decreased and that of degenerating neurons increased in HIϩvehicle; CBD reduced both effects by more than 50%. CBD administration was free from side effects; moreover, CBD administration was associated with cardiac, hemodynamic, and ventilatory beneficial effects. In conclusion, administration of CBD after HI reduced short-term brain damage and was associated with extracerebral benefits. (Pediatr Res 64: 653-658, 2008)

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“…16 Several studies have shown that 6 to 12 h of life is the time period during which the aEEG background is most valuable. 12,17,18 Sensitivities in these studies range from 91 to 100%, with positive predictive values of B85%.…”

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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Use of 2-Channel Bedside Electroencephalogram Monitoring in Term-Born Encephalopathic Infants Related to Cerebral Injury Defined by Magnetic Resonance Imaging

Abstract: Bedside EEG measures in term-born encephalopathic infants are related to the severity of cerebral injury as defined by qualitative MRI. A minimum amplitude of <4 microV appears useful in predicting outcome.

Cited by 52 publications

References 22 publications

Development of Amplitude-Integrated Electroencephalography and Interburst Interval in the Rat

Development of Amplitude-Integrated Electroencephalography and Interburst Interval in the Rat

Neuroprotective Effects of the Nonpsychoactive Cannabinoid Cannabidiol in Hypoxic-Ischemic Newborn Piglets

Using amplitude-integrated EEG in neonatal intensive care

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