Amplitude integrated electroencephalography – Reference values in children aged 2 months to 16 years

Abstract

Aim: Amplitude integrated electroencephalography (aEEG) is a bedside neuromonitoring tool, standard within neonatal critical care provision. Its application in children is increasing but normative data underpinning such use are lacking. We present a dataset of normative aEEG values for children aged 2 months to 16 years. Methods: This retrospective observational cohort study derives aEEG normative amplitude characteristics from electroencephalograms (EEGs) recorded in Children's Health Ireland at Crumlin. aEEG was derived from 350 normal EEGs, recorded in children aged 2 months to 16 years. Supplementary aEEGs were derived from children with abnormal EEG traces. Median upper and lower margin amplitudes and bandwidth were calculated from 5 min waking and sleeping EEG epochs. Results: aEEG amplitudes vary with age and state, increasing over the first 2 years of life before diminishing. Upper and lower margin amplitudes and bandwidth are greater during sleep for children <6 years. Reference ranges may be cohorted into two groups (upper and lower reference limits; <6 years -38 μV/7 μV awake, 54 μV/10 μV asleep; >6 years -33 μV/5 μV awake, 36 μV/6 μV asleep). Conclusion: aEEG traces evolve with age in childhood and differ from neonatal values. We provide a comprehensive set of aEEG normatives to facilitate clinical interpretation in older children.

Association of bilaterally suppressed EEG amplitudes and outcomes in critically ill children

“…Compared to a lower percentile (e.g., 5th or 1st percentiles) as a threshold or the 10 μV cut-off suggested by the American Clinical Neurophysiology Society (ACNS) for post cardiac arrest EEGs in adults ( Hirsch et al, 2013 ), our approach reduces specificity in favor of sensitivity. Because of the age-dependency of amplitude height ( Greve et al, 2022 ; MacDarby et al, 2022 ) we decided against an absolute threshold like that of the ACNS. Sleep/wakefulness was not accounted for in this study.…”

“…In children, however, the general level of evidence regarding the utility of aEEG is still low ( Bruns et al, 2021 ). While reference values for healthy children were published recently ( Greve et al, 2022 ; MacDarby et al, 2022 ), there is only incipient evidence from small studies that amplitude suppression may be associated with death or unfavorable outcomes as shown in neonates and adults ( Bruns et al, 2019 ; Bourgoin et al, 2020 ; Beck et al, 2022 ). Yet, aEEG devices are broadly available in pediatric departments in Europe due to their indispensable role for the diagnostic and therapeutic decision-making path in neonatal asphyxia ( Bruns et al, 2020 ).…”

Update in Pediatric Neurocritical Care: What a Neurologist Caring for Critically Ill Children Needs to Know

“…Critical care medicine providers can use qEEG to recognize seizures on qEEG with good sensitivity (70-100%). [205][206][207][208][209] Some EEG artifacts can lead to false positives on qEEG, and short or focal seizures can be missed; thus, qEEG abnormalities should be confirmed by cEEG and qEEG should complement rather than replace cEEG. 210 qEEG trends may also allow early detection of rising ICP, impending cerebral herniation, and cerebral ischemia, sometimes hours prior to clinical recognition.…”

Issue highlights

“…Amplitude‐integrated electroencephalography (aEEG) is a standard bedside neuromonitoring tool that is used in neonatal and paediatric intensive care units. MacDarby et al 8 present a dataset of normative aEEG values for children aged 2 months to 16 years. The authors conclude that amplitude is greater during sleep than wakefulness in children under 6 years of age and that the bandwidth gradually decreases with age.…”