Abstract
Background:
In preterm infants, the amplitude-integrated electroencephalogram (aEEG) is not established in clinical routine. The aim of this study was to derive normative data on aEEG parameters by means of longitudinal characterization and to evaluate the impact of gestational age (GA), postnatal age (PNA), postmenstrual age, sedation, and patent ductus arteriosus (PDA).
Methods:
Recordings from 61 infants with GA 28–31 weeks were obtained during the first 72 h, then weekly until the age of 4 wk. Infants were divided into three groups: (i) no sedation, no PDA, (ii) sedation, no PDA, and (iii) sedation, PDA. Assessed parameters included background activity, cycling, amplitude, and log ratio of the maximum/minimum amplitude.
Results:
GA and PNA had a significant impact within 72 h. Sedation modified aEEG, and presence of PDA was associated with reduced aEEG scores within 72 h. The log ratio of the amplitude correlated with GA but was unaffected by sedation and PDA.
Conclusion:
Evaluation of electrocortical background activity within the first postnatal hours and longitudinally over days and weeks is important to better understand the postnatal factors impacting cerebral function in preterm infants. There is a need to agree on definitions and a standardized reporting system in order to permit comparisons between studies and establish aEEG as a method for routine monitoring of preterm infants.
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References
Bowen JR, Paradisis M, Shah D . 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. Pediatr Res 2010;67:538–44.
El-Dib M, Massaro AN, Glass P, et al. Early amplitude integrated electroencephalography and outcome of very low birth weight infants. Pediatr Int 2011;53:315–21.
Hellström-Westas L, Rosén I . Electroencephalography and brain damage in preterm infants. Early Hum Dev 2005;81:255–61.
Kato T, Okumura A, Hayakawa F, Tsuji T, Natsume J, Hayakawa M . Amplitude-integrated electroencephalography in preterm infants with cystic periventricular leukomalacia. Early Hum Dev 2011;87:217–21.
Klebermass K, Olischar M, Waldhoer T, Fuiko R, Pollak A, Weninger M . Amplitude-integrated EEG pattern predicts further outcome in preterm infants. Pediatr Res 2011;70:102–8.
Niemarkt HJ, Andriessen P, Peters CH, et al. Quantitative analysis of amplitude-integrated electroencephalogram patterns in stable preterm infants, with normal neurological development at one year. Neonatology 2010;97:175–82.
Olischar M, Klebermass K, Kuhle S, et al. Reference values for amplitude-integrated electroencephalographic activity in preterm infants younger than 30 weeks’ gestational age. Pediatrics 2004;113(1 Pt 1):e61–6.
Thoresen M, Hellström-Westas L, Liu X, de Vries LS . Effect of hypothermia on amplitude-integrated electroencephalogram in infants with asphyxia. Pediatrics 2010;126:e131–9.
Toet MC, van Rooij LG, de Vries LS . The use of amplitude integrated electroencephalography for assessing neonatal neurologic injury. Clin Perinatol 2008;35:665–78, v.
Shankaran S, Pappas A, McDonald SA, et al.; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Predictive value of an early amplitude integrated electroencephalogram and neurologic examination. Pediatrics 2011;128:e112–20.
Burdjalov VF, Baumgart S, Spitzer AR . Cerebral function monitoring: a new scoring system for the evaluation of brain maturation in neonates. Pediatrics 2003;112:855–61.
Hellström-Westas L, Rosén I, de Vries LS, et al. Amplitude-integrated EEG classification and interpretation in preterm and term infants. NeoReviews 2006;7:76–87.
Kato T, Okumura A, Hayakawa F, Tsuji T, Natsume J, Watanabe K . Evaluation of brain maturation in pre-term infants using conventional and amplitude-integrated electroencephalograms. Clin Neurophysiol 2011;122:1967–72.
Klebermass K, Kuhle S, Olischar M, Rücklinger E, Pollak A, Weninger M . Intra- and extrauterine maturation of amplitude-integrated electroencephalographic activity in preterm infants younger than 30 weeks of gestation. Biol Neonate 2006;89:120–5.
Zhang D, Liu Y, Hou X, et al. Reference values for amplitude-integrated EEGs in infants from preterm to 3.5 months of age. Pediatrics 2011;127:e1280–7.
Helderman JB, Welch CD, Leng X, O’Shea TM . Sepsis-associated electroencephalographic changes in extremely low gestational age neonates. Early Hum Dev 2010;86:509–13.
ter Horst HJ, Jongbloed-Pereboom M, van Eykern LA, Bos AF . Amplitude-integrated electroencephalographic activity is suppressed in preterm infants with high scores on illness severity. Early Hum Dev 2011;87:385–90.
Wikström S, Lundin F, Ley D, et al. Carbon dioxide and glucose affect electrocortical background in extremely preterm infants. Pediatrics 2011;127:e1028–34.
Kuint J, Turgeman A, Torjman A, Maayan-Metzger A . Characteristics of amplitude-integrated electroencephalogram in premature infants. J Child Neurol 2007;22:277–81.
Sisman J, Campbell DE, Brion LP . Amplitude-integrated EEG in preterm infants: maturation of background pattern and amplitude voltage with postmenstrual age and gestational age. J Perinatol 2005;25:391–6.
Soubasi V, Mitsakis K, Nakas CT, et al. The influence of extrauterine life on the aEEG maturation in normal preterm infants. Early Hum Dev 2009;85:761–5.
Hagmann CF, Robertson NJ, Azzopardi D . Artifacts on electroencephalograms may influence the amplitude-integrated EEG classification: a qualitative analysis in neonatal encephalopathy. Pediatrics 2006;118:2552–4.
Shany E . The influence of phenobarbital overdose on aEEG recording. Eur J Paediatr Neurol 2004;8:323–5.
Suk D, Krauss AN, Engel M, Perlman JM . Amplitude-integrated electroencephalography in the NICU: frequent artifacts in premature infants may limit its utility as a monitoring device. Pediatrics 2009;123:e328–32.
Supcun S, Kutz P, Pielemeier W, Roll C . Caffeine increases cerebral cortical activity in preterm infants. J Pediatr 2010;156:490–1.
van den Berg E, Lemmers PM, Toet MC, Klaessens JH, van Bel F . Effect of the “InSurE” procedure on cerebral oxygenation and electrical brain activity of the preterm infant. Arch Dis Child Fetal Neonatal Ed 2010;95:F53–8.
Kurtis PS, Rosenkrantz TS, Zalneraitis EL . Cerebral blood flow and EEG changes in preterm infants with patent ductus arteriosus. Pediatr Neurol 1995;12:114–9.
Lemmers PM, Molenschot MC, Evens J, Toet MC, van Bel F . Is cerebral oxygen supply compromised in preterm infants undergoing surgical closure for patent ductus arteriosus? Arch Dis Child Fetal Neonatal Ed 2010;95:F429–34.
Limperopoulos C, Bassan H, Kalish LA, et al. Current definitions of hypotension do not predict abnormal cranial ultrasound findings in preterm infants. Pediatrics 2007;120:966–77.
R Development Core Team (2010). R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing. ISBN 3-900051-07-0, (http://www.R-project.org).
Barnard GA . Significance tests for 2 X 2 tables. Biometrika 1947;34:123–38.
Zuur AF, Ieno EN, Walker N, et al. Mixed Effects Models and Extensions in Ecology With R, 1st edn. New York, USA: Springer Science+Business Media, 2009:574.
Heinze G . A comparative investigation of methods for logistic regression with separated or nearly separated data. Stat Med 2006;25:4216–26.
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Griesmaier, E., Enot, D., Bachmann, M. et al. Systematic characterization of amplitude-integrated EEG signals for monitoring the preterm brain. Pediatr Res 73, 226–235 (2013). https://doi.org/10.1038/pr.2012.171
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DOI: https://doi.org/10.1038/pr.2012.171
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