Background EEG activity in preterm infants: correlation of outcome with selected maturational features

Biagioni, Enrico; Bartalena, Laura; Boldrini, Antonio; Cioni, Giovanni; Giancola, Stephanie E.; Ipata, A.E.

doi:10.1016/0013-4694(94)90065-5

Cited by 80 publications

(53 citation statements)

References 23 publications

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“…The interburst interval was calculated manually. It was defined as a period between electrical bursts during which activities were Ͻ30 V in all leads (18). Voltage was confirmed using the manufacturer's software (Micromed) when in doubt.…”

Section: Methodsmentioning

confidence: 99%

Spectral Analysis of Electroencephalography in Premature Newborn Infants: Normal Ranges

et al. 2005

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Continuous EEG monitoring has not been used widely in neonatal intensive care, especially in the care of extremely premature infants, probably in part because of a lack of a reliable quantitative method. The purpose of this study was to quantify the EEG of the very premature infants just after birth by using spectral analysis and to describe the characteristics of the spectral signal when infants were clinically stable. Digital EEG recordings were performed on 53 infants who were Յ30 wk gestation for 75 min each day during the first 4 d after birth. Artefact was rejected manually after visual inspection of trace. The EEG was analyzed by manual measurement of interburst interval and automatically by spectral analysis using Fast Fourier Transformation. Spectral analysis generated the normal ranges of the relative power of the ␦ (0.5-3.5 Hz), (4 -7.5 Hz), ␣ (8 -12.5 Hz), and ␤ (13-30 Hz) frequency bands, spectral edge frequency, and symmetry. The median (range) relative power of the ␦ band increased significantly from 68% (62-76%) on day 1 to 81% (72-89%) on day 4 (p ϭ 0.001). The interburst intervals became progressively shorter between days 1 [14s (10 -25)] and 3 [8s (6 -12)]; there were no significant differences between days 3 and 4. The relative power of the ␦ band seemed to be the most useful and repeatable spectral measurement for continuous long-term monitoring. However, automatic artefact rejection software needs to be developed before continuous quantitative EEG monitoring can be used in the neonatal intensive care environment. The hemodynamic status of extremely premature infants is particularly labile during the first days after birth. Intensive interventions for such infants are intended to maintain an adequate tissue oxygen supply, particularly to the brain. Because clinical management is aimed at preserving cerebral integrity in these infants, it would be helpful to have some form of continuous neuromonitoring to guide clinical interventions. EEG provides a useful, noninvasive technique for monitoring cerebral electrical activity, and advances in digital technology have made it possible to record high-quality EEG even in an electrically noisy intensive care environment and have done away with the necessity of using large amounts of recording paper. However, interpretation of the EEG is generally considered to be highly specialized, and this is at least one reason that continuous EEG monitoring is not used widely in neonatal intensive care.There are three major issues to be considered for the automatic and reliable analysis of the EEG signal of premature infants and for data to be presented in a manner that is useful to clinicians. First, the EEG of these infants consists predominantly of high-amplitude slow waves (1,2). Bell et al. (3) showed that the relative power of slow waves with frequency Ͻ1 Hz might be as high as 90% in infants at 28 wk gestation. A recent study using DC EEG on infants between 34 and 37 wk gestation found that the spontaneous EEG activity of sleeping preterm infants consiste...

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Section: Methodsmentioning

confidence: 99%

Spectral Analysis of Electroencephalography in Premature Newborn Infants: Normal Ranges

et al. 2005

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“…Hayakawa et al, 6 using 8-channel conventional EEG, also found brief episodes of continuous activity as early as 23 weeks' GA. Connell et al 25 found brief periods of continuous activity at 26 weeks' GA. Other authors did not find continuous activity at these early GAs. 5,26 However, this discrepancy may be explained by differences in the study population. Further, most of the infants in our study received caffeine citrate for treatment of apnea.…”

Section: E64mentioning

confidence: 98%

“…This finding is in agreement with conventional EEG studies, in which amplitudes up to 500 V may still be physiologic. 26 The present study aimed to establish normal values and patterns for aEEG activity in healthy preterm infants Ͻ30 weeks of gestation. However, the criteria of what constitutes a healthy, normal preterm infant are not easy to define, because prematurity itself is a pathology.…”

Section: E64mentioning

confidence: 99%

Reference Values for Amplitude-Integrated Electroencephalographic Activity in Preterm Infants Younger Than 30 Weeks’ Gestational Age

et al. 2004

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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...

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“…The EEG recordings were obtained from eight active electrodes (Fp1-Fp2, C3-C4, O1-O2, T3-T4 of the International 10 -20 System) applied to the scalp using adhesive paste. From each tracing, 30 min of artifact-free recording was analyzed and the following parameters were evaluated (Biagioni et al, 1994(Biagioni et al, , 1996: (1) for maximum interval duration (seconds), an interval was taken as a period of low activity (Ͻ30 V) in all leads; (2) for minimum burst duration (seconds), a burst was defined as waves emerging from the low activity of the interval in at least half of the leads (waves Ͼ30 V observed in less than half of the leads were considered to interrupt the interval but were not taken to be bursts), and the beginning of the first wave and the end of the last one were taken as the onset and the offset of the burst; (3) for incidence of 8 -20 Hz, activities superimposed on ␦ waves (the ␦ brush pattern): they were only considered present on a burst when reaching at least one-half of their maximum amplitude; and (4) incidence of temporal sawtooth (i.e., a rhythmic regular 4 -7 Hz activity, detectable on temporal regions).…”

Section: Electrophysiological Measuresmentioning

confidence: 99%

Massage Accelerates Brain Development and the Maturation of Visual Function

Guzzetta¹,

Baldini²,

Bancale³

et al. 2009

J. Neurosci.

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207

162

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Environmental enrichment (EE) was shown recently to accelerate brain development in rodents. Increased levels of maternal care, and particularly tactile stimulation through licking and grooming, may represent a key component in the early phases of EE. We hypothesized that enriching the environment in terms of body massage may thus accelerate brain development in infants. We explored the effects of body massage in preterm infants and found that massage accelerates the maturation of electroencephalographic activity and of visual function, in particular visual acuity. In massaged infants, we found higher levels of blood IGF-1. Massage accelerated the maturation of visual function also in rat pups and increased the level of IGF-1 in the cortex. Antagonizing IGF-1 action by means of systemic injections of the IGF-1 antagonist JB1 blocked the effects of massage in rat pups. These results demonstrate that massage has an influence on brain development and in particular on visual development and suggest that its effects are mediated by specific endogenous factors such as IGF-1.

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Background EEG activity in preterm infants: correlation of outcome with selected maturational features

Cited by 80 publications

References 23 publications

Spectral Analysis of Electroencephalography in Premature Newborn Infants: Normal Ranges

Spectral Analysis of Electroencephalography in Premature Newborn Infants: Normal Ranges

Reference Values for Amplitude-Integrated Electroencephalographic Activity in Preterm Infants Younger Than 30 Weeks’ Gestational Age

Massage Accelerates Brain Development and the Maturation of Visual Function

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