ABSTRACT. Objective. To prospectively investigate the development of amplitude-integrated electroencephalographic (aEEG) activity during the first 2 weeks of life in neurologically normal and clinically stable preterm infants <30 weeks' gestational age (GA).Patients and Methods. Infants with a GA of <30 weeks admitted to the neonatal intensive care unit of the Vienna University Children's Hospital (Vienna, Austria) were studied prospectively by using aEEG and cranial ultrasound. Clinically stable infants without clinical or sonographic evidence of neurologic abnormalities were eligible for inclusion in the reference group. The distribution of 3 background aEEG activity patterns (discontinuous low-voltage, discontinuous high-voltage, and continuous), presence of sleep-wake cycles, and number of bursts per hour in the reference group were determined by visual analysis.Results. Seventy-five infants (median GA: 27 weeks; range: 23-29 weeks) were eligible for inclusion in the reference group and had aEEG recordings during the first 2 weeks of life available. Analysis of aEEG background activity showed that with higher GA the relative amount of continuous activity increased while discontinuous patterns decreased. The number of bursts per hour decreased with increasing GA. Cyclical changes in aEEG background activity resembling early sleep-wake cycles were observed in all infants.Conclusions. Normal values for aEEG background activity were determined in preterm infants <30 weeks' GA. Clinically stable and neurologically normal preterm infants exhibit at least 2 different patterns of aEEG activity. There is a correlation between the GA and the relative duration of continuous aEEG activity. A dvances in neonatal intensive care during the last decades have led to an increased survival rate of extremely low birth weight infants. However, neurologic and developmental disability is still common among survivors. 1 Prevention of brain injury in these patients has become one of the main goals of modern neonatology. Continuous monitoring of neonatal brain function may aid in the identification of risk factors and patients at increased risk for neurologic morbidity. Early recognition and modification of potentially harmful environmental factors may prevent secondary brain injury.Conventional electroencephalography (EEG) is one of the most useful tools for intermittent and continuous assessment of brain function and prediction of neurologic outcome in term infants and children. 2-4 However, conventional EEG has limitations in its application for extremely low birth weight infants. Registration and interpretation of conventional EEG in this age group are difficult because of the electrical interferences on the neonatal intensive care unit, the large volume of data generated during a longer recording, and the need for 24-hour availability of a skilled examiner experienced in EEG of preterm infants. Further, data on normal EEG patterns in extremely premature infants are still limited. 5,6 Recently, amplitude-integrated EEG (aEEG) pro...

Changes in EEG background activity are powerful but nonspecific markers of brain dysfunction. Early EEG and amplitudeintegrated EEG (aEEG) pattern predict further neurodevelopmental outcome in term infants; however, sufficient data for prognostic value of aEEG in preterm infants are not available so far. The aim of the study was to evaluate whether aEEG predicts further outcome and to compare it to cerebral ultrasound assessment. In 143 preterm infants, aEEG within the first 2 wk of life and outcome data at 3 y of age (Bayley Scales) could be obtained .aEEG was classified into a graded score according to background activity, appearance of sleep-wake cycling, and occurrence of seizure activity. In preterm infants, aEEG was significantly associated with further outcome. Specificity was 73% for assessment within the first and increased to 95% in the second week of life, whereas sensitivity stayed nearly the same 87% (first week) to 83% (second week). Cerebral ultrasound showed a specificity of 86% within the first and second week, sensitivity also stayed nearly the same (74 and 75%). aEEG has a predictive value for later outcome in preterm infants and can be used as an early prognostic tool. D espite recent advances in perinatal care, the incidence of impaired outcome in preterm infants has not decreased. Rates of CP and overt cerebral lesions [e.g. cystic leukomalacia and intraventricular hemorrhage (IVH)] are decreasing, but the incidence of neurodevelopmental impairment stays high in preterm infants. This is due to different mechanisms in brain injury (e.g. inflammation, oxidative stress, impaired connectivity) and result in mainly cognitive impairment (1-3). Extensive studies have demonstrated the usefulness of cerebral ultrasound (CUS) in detecting cerebral lesions and predicting neurological outcome (4 -7). Also conventional EEG is proven to be useful in evaluating brain function and in predicting further development (8). On the background of an acute brain insult, EEG activity shows various degrees of depression and its severity parallels the magnitude of the brain lesion. These "acute-stage" abnormalities gradually improve with time and are replaced by "chronic-stage" abnormalities such as dysmaturity and disorganization. Several studies suggest that acute changes in the EEG background are powerful but nonspecific markers of brain dysfunction (8,9). In addition, a correlation between chronic-stage abnormalities and cognitive impairment is suggested (10 -13). Although early postnatal EEG has been used increasingly in preterm infants during the last years, there is no clear evidence to confirm its prognostic value in preterm infants of Ͻ30 wk GA (9).The most dominant feature of the extremely preterm infants' EEG is discontinuity, making a "grading" and "severityscoring" in terms of depression in these infants difficult. Furthermore validated reference criteria with regard to maturation and appearance of sleep-wake cycling (SWC) to score "disorganization" and/or "dysmaturity" are still scarce.Recordi...

The aEEG characteristics of severe PIVH consist in a combination of a more discontinuous background pattern, a lack of sleep-wake cycles and a higher likelihood of seizure activity when compared to age-matched controls.

We hypothesized that small volume enemas accelerate meconium evacuation in very low birth weight (VLBW) infants. In a randomized controlled trial, VLBW infants (n = 81) received either repeated daily small volume enemas if complete spontaneous meconium passage failed within 24 h or no intervention. Small volume enemas did not accelerate complete meconium evacuation, which occurred after 6.0 to 9.6 (95% CI) d in the intervention group and after 7.7 to 11.0 (95% CI) d in the control group. No adverse events were observed. Daily administration of small volume enemas had no effect on total meconium evacuation defined by the time of last meconium passage.

With the limitation of a slight imbalance in baseline data between the study groups, combined therapy with vitamin B12, folate, erythropoietin, and orally and intravenously administered iron seemed more effective in stimulating erythropoiesis among premature infants, compared with erythropoietin, iron, and low-dose folate alone. Additional trials are necessary to confirm these data.

The results of this national study are in accordance with the international literature: mortality and morbidity increased with decreasing gestational age.

Objective: To prospectively investigate the longitudinal changes of amplitude-integrated electroencephalographic (aEEG) activity in preterm infants <30 weeks gestational age (GA). Methods: Infants (GA <30 weeks) without evidence of neurological abnormalities had weekly aEEG recordings performed. The relative duration of the three aEEG patterns (discontinuous low voltage, discontinuous high voltage and continuous) was determined and the influence of GA and postnatal age (PNA) on the occurrence of each pattern was assessed. Results: Ninety-eight infants (median GA 26 weeks; range 23–29 weeks) were studied. With higher GA (OR 1.68, 95% CI 1.33–2.13) and PNA (OR 1.91, 95% CI 1.53–2.38), the likelihood for the occurrence of continuous activity increased. The discontinuous low-voltage pattern was less likely to occur with increasing GA (OR 0.68, 95% CI 0.55–0.83) and PNA (OR 0.70, 95% CI 0.61–0.81). Conclusion: Maturation of aEEG activity in preterm infants is influenced by both GA and PNA.

Continuous neurophysiological monitoring by aEEG may be of value in the diagnostic and therapeutic management of preterm infants with progressive PHH.