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...

Early commencement of octreotide is recommended although further reports to evaluate the safety and efficacy would add to the profile of this medication in the treatment of CC.

There was insufficient evidence to recommend a particular antibiotic regimen for the treatment of NEC. There were concerns about adverse effects following the usage of clindamycin, related to the development of strictures. To address this issue a large randomised controlled trial needs to be performed.

Premature infants with PPROM and presumed severe hypoxemic respiratory failure because of hypoplastic lungs often have significant PPHN and may show improvement in oxygenation after treatment with HFV and iNO. Early fECHO results in earlier identification and treatment of infants with PPHN in this high-risk group.