A Pilot Study of Continuous Limited-Channel aEEG in Term Infants with Encephalopathy

Lawrence, Russell; Mathur, Amit M.; Tich, Sylvie Nguyen The; Zempel, John; Inder, Terrie E.

doi:10.1016/j.jpeds.2009.01.002

Cited by 82 publications

(61 citation statements)

References 18 publications

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“…[2][3][4][5] Because the clinical recognition of NSs is unreliable, NSs are often over or underestimated, resulting in inappropriate use of AEDs. 6,7 Standard treatment of NSs includes phenobarbital and fosphenytoin with or without benzodiazepines. 8,9 Animal data reveal that commonly used anticonvulsants may have deleterious effects on the developing brain.…”

Section: What This Study Addsmentioning

confidence: 99%

Treating EEG Seizures in Hypoxic Ischemic Encephalopathy: A Randomized Controlled Trial

Srinivasakumar¹,

Zempel²,

et al. 2015

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BACKGROUND: The impact of treating electrographic seizures in hypoxic ischemic encephalopathy (HIE) is unknown. METHODS:Neonates $36 weeks with moderate or severe HIE were randomly assigned to either treatment of electrographic seizures alone (ESG) or treatment of clinical seizures (CSG). Conventional EEG video was monitored in both groups for up to 96 hours. Cumulative electrographic seizure burden (SB) was calculated in seconds and converted to log units for analysis. MRI scans were scored for severity of brain injury. Infants underwent neurodevelopmental evaluation at 18 to 24 months. Statistical analyses were performed by using SAS 9.3 version (SAS Institute, Inc, Cary, NC).RESULTS: Thirty-five of 69 neonates (51%) who were randomly assigned and included in the study developed seizures (15 in ESG and 20 in CSG). Excluding infants with status epilepticus, median SB (interquartile range) in seconds in ESG (n = 10) was lower than in CSG (n = 16) (449 [113-2070] vs 2226 [760-7654]; P = .02). ESG had fewer seizures with shorter time to treatment (P = .04). Twenty-four of 30 (80%) surviving infants with seizures underwent neurodevelopmental evaluation at 18 to 24 months. Increasing SB in the combined cohort was significantly associated with higher brain injury scores (P , .03) and lower performance scores across all 3 domains on BSID III (P = .03). CONCLUSIONS:In neonates with HIE, EEG monitoring and treatment of electrographic seizures results in significant reduction in SB. SB is associated with more severe brain injury and significantly lower performance scores across all domains on BSID III. WHAT'S KNOWN ON THIS SUBJECT:Continuous conventional EEG video is currently gold standard for identifying neonatal seizures and a substantial proportion of neonatal seizures are electrographic. Currently there is no direct evidence that EEG monitoring, seizure identification, or treatment impacts long-term outcomes. WHAT THIS STUDY ADDS:In neonates with hypoxic ischemic encephalopathy, EEG monitoring and treatment of electrographic seizures results in significant reduction in seizure burden. Increasing seizure burden is associated with more severe brain injury and significantly lower performance scores on Bayley Scales of Infant Development III.

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Section: What This Study Addsmentioning

confidence: 99%

Treating EEG Seizures in Hypoxic Ischemic Encephalopathy: A Randomized Controlled Trial

Srinivasakumar¹,

Zempel²,

et al. 2015

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“…14,26 A recent pilot study on the feasibility of aEEG in our tertiary-care NICU showed that 73% of seizures >30 s and 87% >60 s were detected by the aEEG seizure algorithm. 27 Furthermore, when compared with a blinded study group, patients whose tracings were visible to bedside physicians showed a trend toward reduced seizure burden without evidence of overtreatment.…”

Section: Introductionmentioning

confidence: 98%

“…In the study by Lawrence et al, 27 neonatologists had access to the limited-channel unprocessed EEG signal. However, physicians without access to this raw signal may have more difficulty.…”

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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“…Even numbers (2,4,6,8) refer to the right hemisphere and odd numbers (1,3,5,7) refer to the left hemisphere. The z refers to an electrode placed on the midline.…”

Section: Definition Of Clinical Termsmentioning

confidence: 99%

“…'Hypoxic' means a decreased amount of oxygen, 'ischaemic' a decrease in blood flow and 'encephalopathy' the injury to the brain; together, 'Hypoxic Ischaemic Encephalopathy' means a decreased amount of oxygen caused by a decrease in blood flow resulting in injury to the brain. HIE can be defined as the presence of any two of three features in the presence of a known perinatal event [3] (cord prolapse or rupture, pathological fetal heart rate tracing, placental abruption, placenta praevia, uterine rupture and shoulder dystocia etc. )-need for respiratory support shortly after birth, an Apgar score at 5 min of…”

Section: Chapter 1 Introductionmentioning

confidence: 99%

Design and optimisation of time-frequency analysis for multichannel neonatal EEG background features in term neonates with hypoxic ischaemic encephalopathy: characterisation, classification and neurodevelopmental outcome prediction

Awal¹

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Neonatal Hypoxic Ischaemic Encephalopathy (HIE) is a major cause of morbidity and mortality in newborns throughout the world with an incidence of 1-8/1000 newborns in developed countries and up to 26/1000 newborns in developing countries. It causes one million neonatal deaths globally per year. Electroencephalography (EEG) is a useful method for assessment of brain activity in newborns with HIE. EEG performs well in the early diagnosis and classification of HIE severity and in predicting neurodevelopmental outcome. A normal EEG is highly predictive of a normal outcome and various abnormal EEG features are associated with neurological abnormalities or death.A systematic review and meta-analysis of the literature was undertaken to determine which specific background features of the EEG best predict outcome (Aim 1). Automatic detection and classification

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A Pilot Study of Continuous Limited-Channel aEEG in Term Infants with Encephalopathy

Cited by 82 publications

References 18 publications

Treating EEG Seizures in Hypoxic Ischemic Encephalopathy: A Randomized Controlled Trial

Treating EEG Seizures in Hypoxic Ischemic Encephalopathy: A Randomized Controlled Trial

Using amplitude-integrated EEG in neonatal intensive care

Design and optimisation of time-frequency analysis for multichannel neonatal EEG background features in term neonates with hypoxic ischaemic encephalopathy: characterisation, classification and neurodevelopmental outcome prediction

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