Bispectral Index and Lower Margin Amplitude of the Amplitude-Integrated Electroencephalogram in Neonates

Werther, Tobias; Olischar, Monika; Giordano, Vito; Czaba, C; Waldhoer, Thomas; Berger, Angelika; Pollak, Arnold; Deindl, Philipp

doi:10.1159/000365277

Cited by 6 publications

(5 citation statements)

References 25 publications

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“…aEEG can sensitively reflect the change of brain physiology at the early stage of brain ischemic hypoxia. This is the only way to detect subclinical seizures and reversible changes of brain function [ 23 , 24 ]. Some authors [ 25 ] indicated that aEEG can confirm encephalopathy within 6 h after HIE.…”

Section: Discussionmentioning

confidence: 99%

Benefits of starting hypothermia treatment within 6 h vs. 6–12 h in newborns with moderate neonatal hypoxic-ischemic encephalopathy

et al. 2018

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BackgroundIt has been suggested that mild hypothermia treatment of hypoxia-ischemic encephalopathy (HIE) should start within 6 h after HIE, but many children are admitted to the hospital > 6 h, particularly in developing areas. We aimed to determine whether hypothermia treatment could remain effective within 12 h after birth.MethodsAccording to their admission, 152 newborns were enrolled in the < 6 h and 6–12 h after HIE groups. All newborns received conventional treatment combined with mild head hypothermia therapy, according to our routine clinical practice. Some newborns only received conventional treatment (lacking informed consent). All newborns received amplitude-integrated electroencephalography (aEEG) monitoring for 4 h and neuron-specific enolase (NSE) measurement before and after 3 days of therapy.ResultsCompared to the conventional treatment, hypothermia significantly improved the aEEG scores and NSE values in all newborns of the < 6-h group. In the 6–12-h group, the aEEG scores (F = 5.67, P < 0.05) and NSE values (F = 4.98, P < 0.05) were only improved in newborns with moderate HIE. Hypothermia treatment seems to have no effect in newborns with severe HIE after 6 h (P > 0.05). Hypothermia improved the rates of neonatal death and 18-month disability (all P < 0.01).ConclusionsIn newborns with moderate HIE, starting hypothermia therapy < 6 h and 6–12 h after HIE showed curative effects. In those with severe HIE, only starting hypothermia therapy within 6 h showed curative effects.

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Section: Discussionmentioning

confidence: 99%

Benefits of starting hypothermia treatment within 6 h vs. 6–12 h in newborns with moderate neonatal hypoxic-ischemic encephalopathy

et al. 2018

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“…42 The mean BIS values considering all three groups were considerably lower than the more appropriate cutoff values proposed by Lamas et al 30 Even if the BIS is prone to change when higher doses of sedative and analgesic drugs are administered, this method does not add more information than the aEEG already does (Figure 1). 43 As already concluded by Kissin,44 when the BIS is used for a new drug or a new population it must revalidated because changes in the basic algorithm of this method could occur.…”

Section: P-value (95% Ci) Light Vs Deep Sedationmentioning

confidence: 99%

The power of N‐PASS, aEEG, and BIS in detecting different levels of sedation in neonates: A preliminary study

Giordano

Deindl

Goeral

et al. 2018

Pediatric Anesthesia

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Summary Background Sedatives are essential drugs in every intensive care unit in order to ensure the patient's optimal level of comfort. Avoiding conditions of over‐ and under‐sedation is a challenge in a neonatal intensive care setting. Drug administration could be optimized by the concomitant use of objective methods to assess the level of sedation. Aims We aimed to look at the ability of different methods (Neonatal Pain, Agitation and Sedation Scale, amplitude‐integrated Electroencephalogram, and Bispectral Index), and their combination, in detecting different level of sedation. Methods Twenty‐seven neonates among whom 17 were receiving sedatives with or without opiate analgesics were monitored using the Neonatal Pain, Agitation and Sedation Scale, the amplitude‐integrated Electroencephalogram, and the Bispectral Index. According to the expert opinion of two trained neonatologists, patients were categorized into three groups: no, light, and deep sedation. Four hours of simultaneous assessment of the Neonatal Pain, Agitation and Sedation Scale scores, Burdjalov scores (to summarize the amplitude‐integrated Electroencephalogram trace), and Bispectral Index values were considered for the comparative analysis across these groups. Results All three methods could differentiate patients who were not sedated from those who were deeply sedated: median score 12 and 9, respectively, (95% CI of difference = 1.99‐5.99, P = 0.001) for the amplitude‐integrated Electroencephalogram Burdjalov score; median 1 and −5, respectively, (95% CI of difference = 2.99‐8.00, P = 0.001) for the Neonatal Pain, Agitation and Sedation Scale; and median 48 and 37, respectively, (CI of difference = 1.77‐22.00, P = 0.043) for the Bispectral Index. However none of them, used alone, was able to differentiate light and deep sedation: median score 10 and 9, respectively, for the amplitude‐integrated Electroencephalogram Burdjalov score; median −2 and −5, respectively, for the Neonatal Pain, Agitation and Sedation Scale; and median 48 and 37, respectively, for the Bispectral Index. Only the amplitude‐integrated Electroencephalogram and the Neonatal Pain, Agitation and Sedation Scale were able to differentiate between the conditions of no sedation and light sedation. Also, according to the area under the curves values, the combination of the Neonatal Pain, Agitation and Sedation Scale with the Burdjalov score derived from the amplitude‐integrated Electroencephalogram showed the best accuracy in differentiating light and deep sedation. Conclusion While none of the three methods alone was able to precisely differentiate between different levels of sedation, we suggest that using a combination of amplitude‐integrated Electroencephalogram and Neonatal Pain, Agitation and Sedation Scale can be useful to distinguish between light and deep sedation in neonatal patients.

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“…[1] Most of the drugs that are frequently used in the paediatric population affect the characteristics of the electroencephalogram (EEG), and several calculated EEG parameters have been used to monitor the depth of anaesthesia in both children [2][3][4] and neonates. [5] The amplitudeintegrated EEG (aEEG) is a bedside monitoring tool widely used in newborns to continuously monitor brain activity and detect seizures. [6,7] Following neonatal encephalopathy, the degree and timing of aEEG voltage depression and aEEG recovery also predicts outcome after perinatal asphyxia in both cooled and non-cooled newborns.…”

Section: Introductionmentioning

confidence: 99%

Xenon depresses aEEG background voltage activity whilst maintaining cardiovascular stability in sedated healthy newborn pigs

Sabir

Wood

Gill

et al. 2016

Journal of the Neurological Sciences

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Bispectral Index and Lower Margin Amplitude of the Amplitude-Integrated Electroencephalogram in Neonates

Cited by 6 publications

References 25 publications

Benefits of starting hypothermia treatment within 6 h vs. 6–12 h in newborns with moderate neonatal hypoxic-ischemic encephalopathy

Benefits of starting hypothermia treatment within 6 h vs. 6–12 h in newborns with moderate neonatal hypoxic-ischemic encephalopathy

The power of N‐PASS, aEEG, and BIS in detecting different levels of sedation in neonates: A preliminary study

Xenon depresses aEEG background voltage activity whilst maintaining cardiovascular stability in sedated healthy newborn pigs

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