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Mona C Toet - One of the best experts on this subject based on the ideXlab platform.

  • additional value of two channel amplitude integrated EEG recording in full term infants with unilateral brain injury
    Archives of Disease in Childhood-fetal and Neonatal Edition, 2010
    Co-Authors: Linda G M Van Rooij, Linda S De Vries, Alexander C Van Huffelen, Mona C Toet
    Abstract:

    Background Amplitude integrated electroencephalography (aEEG) is a valuable tool for evaluating neonatal encephalopathy and identifying electrographic seizures. Objective To compare seizure activity and background pattern (BGP) between one-channel and two-channel aEEG recordings in full-term neonates. Methods The two-channel aEEG recordings (F3-P3; F4-P4) of 34 neonates with seizures were compared with single-channel recordings (P3-P4). Results All 34 infants with unilateral (n=14), diffuse (n=18) or without (n=2) brain injury had seizure patterns on one-channel and two-channel recordings, with 18% more seizure patterns detected with two-channel recording. In 79% of infants with unilateral injury more seizures were noted on the ipsilateral side compared to the contralateral side. In 39% of the infants with diffuse brain damage more seizures were found with two-channel recordings. A sensitivity of 65% was found when using the automatic seizure detection algorithm. In 4/14 (29%) infants with unilateral injury a more severely affected BGP was seen on the ipsilateral side compared to the BGP on one-channel recording. In infants with diffuse injury differences in BGP pattern were seen in 6–17% of the infants depending on the system used for scoring. Conclusion Although there were no major differences found between seizure detection with one-channel or two-channel aEEG, in a subgroup of infants with a predominantly unilateral brain lesion, two-channel recording did provide additional information with identification of more seizure patterns on the affected side, sometimes also associated with a difference in BGP. To improve early diagnosis of unilateral lesions and improve seizure detection in these infants, routine use of two-channel recordings is recommended.

  • detection of subclinical electroencephalographic seizure patterns with multichannel amplitude integrated EEG in full term neonates
    Clinical Neurophysiology, 2009
    Co-Authors: Mireille Bourezswart, Mona C Toet, Linda G M Van Rooij, Cristiano Rizzo, Linda S De Vries, Tineke A Gebbink, Anja G J Ezendam, Alexander C Van Huffelen
    Abstract:

    Abstract Objective To compare the seizure pattern detection rate of single-channel and multichannel Amplitude-Integrated EEG (aEEG), using conventional EEG (cEEG) as a gold standard, in full-term neonates with hypoxic–ischemic encephalopathy. The optimal electrode derivation for seizure detection with single-channel aEEG was also investigated. Methods Twelve infants with cEEG seizure patterns (⩾10 s) were investigated. cEEG signals were transformed into aEEG signals. Seizure patterns and the number of patients identified with ⩾1 seizure patterns were calculated for single- and multichannel aEEG. Results On cEEG, 121 seizure patterns with a mean duration of 58 s were identified, 68% of which occurred over the centrotemporal region. The sensitivity of aEEG for the detection of seizure patterns was 30% (C.I.: 0.22–0.38) for single-channel aEEG and 39% (C.I.: 0.31–0.48) for multichannel aEEG. Multichannel aEEG identified all patients with ⩾1 seizure pattern (C.I.: 0.75–1.00), whereas single-channel aEEG (with C4–C3 as the optimal electrode derivation) identified all but one of the patients (C.I.: 0.66–0.99). Conclusions Seizure pattern detection rate is slightly better with multichannel aEEG compared with single-channel (C4–C3) aEEG. Multichannel aEEG identified correctly all patients with ⩾1 seizure pattern in this small selection of patients. Significance Single-channel aEEG may detect most patients (in a selected group) with severe neonatal seizures patterns; patient identification can be improved using multichannel recordings.

  • cerebral oxygen saturation and electrical brain activity before during and up to 36 hours after arterial switch procedure in neonates without pre existing brain damage its relationship to neurodevelopmental outcome
    Experimental Brain Research, 2005
    Co-Authors: Mona C Toet, Annebeth E Flinterman, Ingrid Van De Laar, Jaap W De Vries, G B W E Bennink, Cuno S P M Uiterwaal
    Abstract:

    Objective: To monitor the pattern of cerebral oxygen saturation (rSat), by use of NIRS, in term infants before, during and after the arterial switch operation and to evaluate its relation to neurodevelopmental outcome. Methods: In 20 neonates without pre-existing brain damage hemodynamics and arterial oxygen saturation (AO2-Sat) were monitored simultaneously with rSat and Amplitude-Integrated EEG (aEEG) from 4 h to 12 h before up to 36 h after cardiopulmonary bypass (CPB) and short duration of cardiac arrest during deep hypothermia (DHCA). The Bayleys developmental scale was performed at 30 months. Results: Before surgery rSat was <50% in 16 patients. During CPB rSat increased to normal values, with a sharp decrease during brief CA (median 6.5 min). Post-CPB rSat showed a transient decrease (30–45%) despite normal PaO2 with sustained normalization after 6–26 h. Recovery time of the rSat seemed longer when pre-operative rSat was below 35%, and for lower minimum nasopharyngeal temperature and longer duration of CPB and of DHCA. Recovery time of the aEEG varied and did not correlate with normalization of rSat. Neurodevelopmental outcome was normal in all but two patients. Patients with lower pre-operative rSat (<35%) tended to have lower DQ (developmental quotient) scores at 30–36 months. (median: mental 102 and motor 101 (range 58–125) compared with mental 100 and motor 110 (range 83–125)) Conclusion: Despite prompt normalization of circulation and oxygenation after surgery, recovery of rSat of the brain took 6–26 h, probably because of higher energy demand after CPB. Pre-operative cerebral oxygenation may be underestimated as a possible cause of adverse post-operative outcome.

  • amplitude integrated EEG 3 and 6 hours after birth in full term neonates with hypoxic ischaemic encephalopathy
    Archives of Disease in Childhood-fetal and Neonatal Edition, 1999
    Co-Authors: Mona C Toet, Lena Hellstromwestas, Floris Groenendaal, P Eken, L S De Vries
    Abstract:

    Aim—To assess the prognostic value of amplitude integrated EEG (aEEG) 3 and 6 hours after birth. Methods—Seventy three term, asphyxiated infants were studied (from two diVerent centres), using the Cerebral Function Monitor (CFM Lectromed). The diVerent aEEG tracings were compared using pattern recognition (flat tracing mainly isoelectric (FT); continuous extremely low voltage (CLV); burst‐ suppression (BS); discontinuous normal voltage (DNV); continuous normal voltage (CNV)) with subsequent outcome. Results—Sixty eight infants were followed up for more than 12 months (range 12 months to 6 years).Twenty one out of 68 infants (31%) showed a change in pattern from 3 to 6 hours, but this was only significant in five cases (24%). In three this changed from BS to CNV with a normal outcome. One infant showed a change in pattern from CNV to FT and had a major handicap at follow up. Another infant showed a change in pattern from DNV to BS, and developed a major handicap at follow up. The other 16 infants did not have any significant changes in pattern: 11 infants had CLV, BS, or FT at 3 and 6 hours and died (n = 9) in the neonatal period or developed a major handicap (n = 2). Five infants had a CNV or DNV pattern at 3 and 6 hours, with a normal outcome. The sensitivity and specificity of BS, together with FT and CLV, for poor outcome at 3 hours was 0.85 and 0.77, respectively; at 6 hours 0.91 and 0.86, respectively. The positive predictive value (PPV) was 78% and the negative predictive value (NPV) 84% 3 hours after birth. At 6 hours the PPV was 86% and the NPV was 91%. Conclusion—aEEG could be very useful for selecting those infants who might benefit from intervention after birth asphyxia. (Arch Dis Child Fetal Neonatal Ed 1999;81:F19‐F23)

Ingmar Rosen - One of the best experts on this subject based on the ideXlab platform.

  • neuron specific enolase correlates with other prognostic markers after cardiac arrest
    Neurology, 2011
    Co-Authors: Tobias Cronberg, Malin Rundgren, Ingmar Rosen, Erik Westhall, Elisabet Englund, Roger Siemund, Hakan Widner, Hans Friberg
    Abstract:

    Objective: Therapeutic hypothermia (TH) is a recommended treatment for survivors of cardiac arrest. Prognostication is complicated since sedation and muscle relaxation are used and established indicators of a poor prognosis are lacking. This prospective, observational study describes the pattern of commonly used prognostic markers in a hypothermia-treated cohort of cardiac arrest patients with prolonged coma. Methods: Among 111 consecutive patients, 19 died, 58 recovered, and 34 were in coma 3 days after normothermia (4.5 days after cardiac arrest), defined as prolonged coma. All patients were monitored with continuous Amplitude-Integrated EEG and repeated samples of neuron-specific enolase (NSE) were collected. In patients with prolonged coma, somatosensory evoked potentials (SSEP) and brain MRI were performed. A postmortem brain investigation was undertaken in patients who died. Results: Six of the 17 patients (35%) with NSE levels 33 failed to recover consciousness. In the >33 NSE group, all 10 studied with MRI had extensive brain injury on diffusion-weighted images, 12/16 lacked cortical responses on SSEP, and all 6 who underwent autopsy had extensive severe histologic damage. NSE levels also correlated with EEG pattern, but less uniformly, since 11/17 with NSE Conclusions: NSE correlates well with other markers of ischemic brain injury. In patients with no other signs of brain injury, postanoxic ESE may explain a poor outcome.

  • continuous brain function monitoring state of the art in clinical practice
    Seminars in Fetal & Neonatal Medicine, 2006
    Co-Authors: Lena Hellstromwestas, Ingmar Rosen
    Abstract:

    Continuous electroencephalographic (EEG) monitoring gives direct information on brain function in newborn infants needing intensive care. To improve the possibilities of long-term monitoring, the EEG is time-compressed and recorded with a reduced number of electrodes. A trend measure of the EEG, the Amplitude-Integrated EEG (aEEG), has proved capable of giving relevant information in newborn infants of differing levels of maturity. The electrocortical background activity gives information on the level of brain activity, which is associated with outcome in both term asphyxiated infants and in preterm infants. However, the background activity is also affected by several medications, and this must be considered when interpreting the aEEG trace. The aEEG also reveals subclinical epileptic seizure activity, and can be used for evaluation of anti-epileptic treatment. The aEEG should be used as a complement to the standard EEG, and close collaboration between neonatologists and clinical neurophysiologists is necessary for optimal performance of EEG monitoring.

  • amplitude integrated EEG aEEG predicts outcome after cardiac arrest and induced hypothermia
    Intensive Care Medicine, 2006
    Co-Authors: Malin Rundgren, Ingmar Rosen, Hans Friberg
    Abstract:

    Objective To evaluate the use of continuous Amplitude-Integrated EEG (aEEG) as a prognostic tool for survival and neurological outcome in cardiac arrest patients treated with hypothermia.

  • early prediction of outcome with aEEG in preterm infants with large intraventricular hemorrhages
    Neuropediatrics, 2001
    Co-Authors: Lena Hellstromwestas, Helena Klette, Kristina Thorngrenjerneck, Ingmar Rosen
    Abstract:

    BACKGROUND: The electrocortical background contains prognostic information in full-term asphyxiated newborn infants already during the first postnatal hours. In preterm infants with intra-ventricular hemorrhages (IVH) the background activity in EEG and Amplitude-Integrated EEG (aEEG) is depressed during the first days of life, and the extent of the depression correlates with the degree of IVH. However, it has not been previously evaluated whether very early aEEG can predict later outcome also in pre-term infants. OBJECTIVE: To investigate if early prediction of outcome is possible from aEEG in preterm infants with large IVH. METHODS: aEEG recordings from the first postnatal week were investigated in 64 preterm infants with IVH grade III - IV. For every 24-hour period the aEEG background pattern was classified, and the maximum and minimum numbers of bursts/h, respectively,were counted. Outcome was divided into three categories: died (n = 36), survived (n = 28) with "poor" outcome, i.e., severe cerebral palsy and not able to walk and/or mental retardation (n = 8), and survived with "fair" outcome, i.e., healthy or mild cerebral palsy (n = 19). One surviving child was lost in the follow-up. RESULTS: There were significant differences in maximum bursts/h (MaxB) at 0-24 hours (p = 0.033), 24-48 hours (p = 0.011), 48-72 hours (p=0.049) and 72-96 hours (p=0.032), respectively, between the infants who died and the surviving infants. At 24-48 hours the median (range) MaxB in the surviving infants with "fair" outcome was 156 (103-179) versus 102 (73-156) in the surviving infants with "poor" outcome (p = 0.002). With the assumption that MaxB < 130 was predictive of death or survival with "poor" outcome, 68 % and 78% of infants were correctly predicted at 0-24 hours and 24-48 hours, respectively. CONCLUSIONS: This study shows that outcome may be predicted with aEEG already during the first days of life in preterm infants with large IVH. The findings should be confirmed in prospective studies since they may have clinical implications if specific medical interventions become available.

  • predictive value of early continuous amplitude integrated EEG recordings on outcome after severe birth asphyxia in full term infants
    Archives of Disease in Childhood-fetal and Neonatal Edition, 1995
    Co-Authors: Lena Hellstromwestas, Ingmar Rosen, N W Svenningsen
    Abstract:

    The background pattern in single channel amplitude integrated EEG recordings (aEEG) was recorded in 47 infants within the first six hours after birth to see if this could predict outcome after birth asphyxia. The aEEG background pattern during the first six hours of life was continuous and of normal voltage in 26 infants. All these infants survived; 25 were healthy, one had delayed psychomotor development. A continuous but extremely low voltage pattern was present in two infants, both of whom survived with severe handicap. Five infants had flat (mainly isoelectric) tracings during the first six hours of life; four died in the neonatal period, and one survived with severe neurological handicap. Burst-suppression pattern was identified in 14 infants, of whom five died, six survived with severe handicap, and three were healthy at follow up. The type of background pattern recorded within the first six postnatal hours in the aEEG tracings predicted outcome correctly in 43 of 47 (91.5%) infants. Use of aEEG monitoring can predict outcome, with a high degree of accuracy, after birth asphyxia, within the first six hours after birth. The predictive value of a suppression-burst pattern was, however, somewhat lower than the other background patterns. The aEEG seems to be a feasible technique for identifying infants at high risk of subsequent brain damage who might benefit from interventionist treatment after asphyxia.

Lena Hellstromwestas - One of the best experts on this subject based on the ideXlab platform.

  • continuous brain function monitoring state of the art in clinical practice
    Seminars in Fetal & Neonatal Medicine, 2006
    Co-Authors: Lena Hellstromwestas, Ingmar Rosen
    Abstract:

    Continuous electroencephalographic (EEG) monitoring gives direct information on brain function in newborn infants needing intensive care. To improve the possibilities of long-term monitoring, the EEG is time-compressed and recorded with a reduced number of electrodes. A trend measure of the EEG, the Amplitude-Integrated EEG (aEEG), has proved capable of giving relevant information in newborn infants of differing levels of maturity. The electrocortical background activity gives information on the level of brain activity, which is associated with outcome in both term asphyxiated infants and in preterm infants. However, the background activity is also affected by several medications, and this must be considered when interpreting the aEEG trace. The aEEG also reveals subclinical epileptic seizure activity, and can be used for evaluation of anti-epileptic treatment. The aEEG should be used as a complement to the standard EEG, and close collaboration between neonatologists and clinical neurophysiologists is necessary for optimal performance of EEG monitoring.

  • early prediction of outcome with aEEG in preterm infants with large intraventricular hemorrhages
    Neuropediatrics, 2001
    Co-Authors: Lena Hellstromwestas, Helena Klette, Kristina Thorngrenjerneck, Ingmar Rosen
    Abstract:

    BACKGROUND: The electrocortical background contains prognostic information in full-term asphyxiated newborn infants already during the first postnatal hours. In preterm infants with intra-ventricular hemorrhages (IVH) the background activity in EEG and Amplitude-Integrated EEG (aEEG) is depressed during the first days of life, and the extent of the depression correlates with the degree of IVH. However, it has not been previously evaluated whether very early aEEG can predict later outcome also in pre-term infants. OBJECTIVE: To investigate if early prediction of outcome is possible from aEEG in preterm infants with large IVH. METHODS: aEEG recordings from the first postnatal week were investigated in 64 preterm infants with IVH grade III - IV. For every 24-hour period the aEEG background pattern was classified, and the maximum and minimum numbers of bursts/h, respectively,were counted. Outcome was divided into three categories: died (n = 36), survived (n = 28) with "poor" outcome, i.e., severe cerebral palsy and not able to walk and/or mental retardation (n = 8), and survived with "fair" outcome, i.e., healthy or mild cerebral palsy (n = 19). One surviving child was lost in the follow-up. RESULTS: There were significant differences in maximum bursts/h (MaxB) at 0-24 hours (p = 0.033), 24-48 hours (p = 0.011), 48-72 hours (p=0.049) and 72-96 hours (p=0.032), respectively, between the infants who died and the surviving infants. At 24-48 hours the median (range) MaxB in the surviving infants with "fair" outcome was 156 (103-179) versus 102 (73-156) in the surviving infants with "poor" outcome (p = 0.002). With the assumption that MaxB < 130 was predictive of death or survival with "poor" outcome, 68 % and 78% of infants were correctly predicted at 0-24 hours and 24-48 hours, respectively. CONCLUSIONS: This study shows that outcome may be predicted with aEEG already during the first days of life in preterm infants with large IVH. The findings should be confirmed in prospective studies since they may have clinical implications if specific medical interventions become available.

  • amplitude integrated EEG 3 and 6 hours after birth in full term neonates with hypoxic ischaemic encephalopathy
    Archives of Disease in Childhood-fetal and Neonatal Edition, 1999
    Co-Authors: Mona C Toet, Lena Hellstromwestas, Floris Groenendaal, P Eken, L S De Vries
    Abstract:

    Aim—To assess the prognostic value of amplitude integrated EEG (aEEG) 3 and 6 hours after birth. Methods—Seventy three term, asphyxiated infants were studied (from two diVerent centres), using the Cerebral Function Monitor (CFM Lectromed). The diVerent aEEG tracings were compared using pattern recognition (flat tracing mainly isoelectric (FT); continuous extremely low voltage (CLV); burst‐ suppression (BS); discontinuous normal voltage (DNV); continuous normal voltage (CNV)) with subsequent outcome. Results—Sixty eight infants were followed up for more than 12 months (range 12 months to 6 years).Twenty one out of 68 infants (31%) showed a change in pattern from 3 to 6 hours, but this was only significant in five cases (24%). In three this changed from BS to CNV with a normal outcome. One infant showed a change in pattern from CNV to FT and had a major handicap at follow up. Another infant showed a change in pattern from DNV to BS, and developed a major handicap at follow up. The other 16 infants did not have any significant changes in pattern: 11 infants had CLV, BS, or FT at 3 and 6 hours and died (n = 9) in the neonatal period or developed a major handicap (n = 2). Five infants had a CNV or DNV pattern at 3 and 6 hours, with a normal outcome. The sensitivity and specificity of BS, together with FT and CLV, for poor outcome at 3 hours was 0.85 and 0.77, respectively; at 6 hours 0.91 and 0.86, respectively. The positive predictive value (PPV) was 78% and the negative predictive value (NPV) 84% 3 hours after birth. At 6 hours the PPV was 86% and the NPV was 91%. Conclusion—aEEG could be very useful for selecting those infants who might benefit from intervention after birth asphyxia. (Arch Dis Child Fetal Neonatal Ed 1999;81:F19‐F23)

  • predictive value of early continuous amplitude integrated EEG recordings on outcome after severe birth asphyxia in full term infants
    Archives of Disease in Childhood-fetal and Neonatal Edition, 1995
    Co-Authors: Lena Hellstromwestas, Ingmar Rosen, N W Svenningsen
    Abstract:

    The background pattern in single channel amplitude integrated EEG recordings (aEEG) was recorded in 47 infants within the first six hours after birth to see if this could predict outcome after birth asphyxia. The aEEG background pattern during the first six hours of life was continuous and of normal voltage in 26 infants. All these infants survived; 25 were healthy, one had delayed psychomotor development. A continuous but extremely low voltage pattern was present in two infants, both of whom survived with severe handicap. Five infants had flat (mainly isoelectric) tracings during the first six hours of life; four died in the neonatal period, and one survived with severe neurological handicap. Burst-suppression pattern was identified in 14 infants, of whom five died, six survived with severe handicap, and three were healthy at follow up. The type of background pattern recorded within the first six postnatal hours in the aEEG tracings predicted outcome correctly in 43 of 47 (91.5%) infants. Use of aEEG monitoring can predict outcome, with a high degree of accuracy, after birth asphyxia, within the first six hours after birth. The predictive value of a suppression-burst pattern was, however, somewhat lower than the other background patterns. The aEEG seems to be a feasible technique for identifying infants at high risk of subsequent brain damage who might benefit from interventionist treatment after asphyxia.

Arend F. Bos - One of the best experts on this subject based on the ideXlab platform.

  • the relationship between electrocerebral activity and cerebral fractional tissue oxygen extraction in preterm infants
    Pediatric Research, 2011
    Co-Authors: Hendrik J Ter Horst, Elise A. Verhagen, Paul Keating, Arend F. Bos
    Abstract:

    Impaired cerebral oxygen delivery may cause cerebral damage in preterm infants. At lower levels of cerebral perfusion and oxygen concentration, electrocerebral activity is disturbed. The balance between cerebral oxygen delivery and oxygen use can be measured by near-infrared spectroscopy (NIRS), and electrocerebral activity can be measured by Amplitude-Integrated EEG (aEEG). Our aim was to determine the relationship between regional cerebral tissue oxygen saturation (rcSO2), fractional tissue oxygen extraction (FTOE), and aEEG. We recorded longitudinal digital aEEG and rcSO2 prospectively in 46 preterm infants (mean GA 29.5 wk, SD 1.7) for 2 hr on the 1st to 5th, 8th, and 15th d after birth. We excluded infants with germinal matrix hemorrhage exceeding grade I and recordings of infants receiving inotropes. FTOE was calculated using transcutaneous arterial oxygen saturation (tcSaO2) and rcSO2 values: (tcSaO2 - rcSO2)/tcSaO2. aEEG was assessed by calculating the mean values of the 5th, 50th, and 95th centiles of the aEEG amplitudes. The aEEG amplitude centiles changed with increasing GA. FTOE and aEEG amplitude centiles increased significantly with postnatal age. More mature electrocerebral activity was accompanied by increased FTOE. FTOE also increased with increasing postnatal age and decreasing Hb levels.

Amit M Mathur - One of the best experts on this subject based on the ideXlab platform.

  • term equivalent functional brain maturational measures predict neurodevelopmental outcomes in premature infants
    Early Human Development, 2018
    Co-Authors: N El M Ters, Zachary A Vesoulis, Steve M Liao, Christopher D Smyser, Amit M Mathur
    Abstract:

    BACKGROUND Term equivalent age (TEA) brain MRI identifies preterm infants at risk for adverse neurodevelopmental outcomes. But some infants may experience neurodevelopmental impairments even in the absence of neuroimaging abnormalities. OBJECTIVE Evaluate the association of TEA Amplitude-Integrated EEG (aEEG) measures with neurodevelopmental outcomes at 24-36 months corrected age. METHODS We performed aEEG recordings and brain MRI at TEA (mean post-menstrual age of 39 (±2) weeks in a cohort of 60 preterm infants born at a mean gestational age of 26 (±2) weeks. Forty-four infants underwent Bayley Scales of Infant Development, 3rd Edition (BSID-III) testing at 24-36 months corrected age. Developmental delay was defined by a score greater than one standard deviation below the mean (<85) in any domain. An ROC curve was constructed and a value of SEF90 < 9.2, yielded the highest sensitivity and specificity for moderate/severe brain injury on MRI. The association between aEEG measures and neurodevelopmental outcomes was assessed using odds ratio, then adjusted for confounding variables using logistic regression. RESULTS Infants with developmental delay in any domain had significantly lower values of SEF90. Absent cyclicity was more prevalent in infants with cognitive and motor delay. Both left and right SEF90 < 9.2 were associated with motor delay (OR left: 4.7(1.2-18.3), p = 0.02, OR right: 7.9 (1.8-34.5), p < 0.01). Left SEF90 and right SEF90 were associated with cognitive delay and language delay respectively. Absent cyclicity was associated with motor and cognitive delay (OR for motor delay: 5.8 (1.3-25.1), p = 0.01; OR for cognitive delay: 16.8 (3.1-91.8), p < 0.01). These associations remained significant after correcting for social risk index score and confounding variables. CONCLUSIONS aEEG may be used at TEA as a new tool for risk stratification of infants at higher risk of poor neurodevelopmental outcomes. Therefore, a larger study is needed to validate these results in premature infants at low and high risk of brain injury.

  • impact of brain injury on functional measures of amplitude integrated EEG at term equivalent age in premature infants
    Journal of Perinatology, 2017
    Co-Authors: N El M Ters, Zachary A Vesoulis, Steve M Liao, Christopher D Smyser, Amit M Mathur
    Abstract:

    Impact of brain injury on functional measures of Amplitude-Integrated EEG at term equivalent age in premature infants

  • prediction of neonatal seizures in hypoxic ischemic encephalopathy using electroencephalograph power analyses
    Pediatric Neurology, 2017
    Co-Authors: Siddharth V Jain, Amit M Mathur, Preethi Srinivasakumar, Michael Wallendorf, Joseph P Culver, John M Zempel
    Abstract:

    Abstract Background The severity of the initial encephalopathy in neonatal hypoxic-ischemic encephalopathy correlates with seizure burden. Early electroencephalograph (EEG) background activity reflects the severity of encephalopathy. Thus, we hypothesized that early EEG background would be predictive of subsequent seizures in neonatal hypoxic-ischemic encephalopathy. Methods This study included infants undergoing therapeutic hypothermia at St. Louis Children's Hospital between January 2009 and April 2013. Two pediatric epilepsy specialists independently characterized EEG background qualitatively using Amplitude-Integrated EEG trends. Total EEG power in the 1-20 Hz frequency band was calculated for quantitative EEG background assessment. Seizures were identified on conventional full montage EEG. Statistical analysis was performed using logistic regression. Results Seventy-eight of the 93 eligible infants had artifact-free EEG data; 23 of 78 infants (29%) developed seizures, and of these, 11 developed status epilepticus. The best predictors of subsequent seizures during the first hour of EEG recording were a flat tracing pattern on Amplitude-Integrated EEG (sensitivity 26%, specificity 98%, likelihood ratio 13, positive predictive value 85%) and the total EEG power less than 10 μV 2 (sensitivity 52%, specificity 98%, likelihood ratio 30, positive predictive value 92%). Conclusions Early EEG biomarkers predict subsequent seizures in infants with hypoxic-ischemic encephalopathy. Compared with the qualitative Amplitude-Integrated EEG background, total EEG power improves our ability to identify high-risk infants from the first hour of EEG recording. Infants with a total EEG power of less than 10 μV 2 have a 90% risk of subsequent seizures. Quantitative EEG measures could stratify cohorts while evaluating novel neuroprotective strategies in neonatal hypoxic-ischemic encephalopathy.