Predictive Value of Early Amplitude Integrated EEG in Extremely Premature Infants

Abstract

Amplitude integrated EEG (aEEG) is increasingly utilized in preterm infants. The aim of the study was to evaluate whether semiquantitative visual assessment of aEEG background during the first 72 hours of life is associated with long-term outcome in a group of premature infants born less than 28 weeks’ gestation. Infants were prospectively enrolled and monitored in the first 72 hours after birth. aEEG was classified daily according to background activity, appearance of cyclical activity and presence of seizures activity. Log-rank and multivariable cox analysis were used to explore associations of background aEEG activity with short and long-term outcome. Overall, 51 infants were enrolled into the study. Depressed aEEG background on the third day of life was associated with poor outcome ( P = .028). Similarly, absence of cycling on the third day of life was associated with death or poor outcome ( P = .004 and .012, respectively). In different multivariable models adjusted for gestational age, severe intraventricular hemorrhage or use of sedative medication, neither background nor cycling activities were associated with outcome. Depressed aEEG background and absence of aEEG cycling on the third day of life are associated with poor outcome in univariable analysis. Although continuous aEEG monitoring of premature infants can provide real-time assessment of cerebral function, its use as a predictive tool for long-term outcome using visual analysis requires caution as its predictive power is not greater than that of gestational age or intraventricular hemorrhage.

aEEG as a useful tool for neuromonitoring in critically ill children – Current evidence and knowledge gaps

“…Normal background patterns and normalisation are associated with better outcomes than failure to normalise. Preterm infants with normal or normalisation of background patterns within the first 72 h of life achieved better neurodevelopmental outcomes at two years of age than those who displayed a persisting pathological background 22,36,37 …”

“…Preterm infants with normal or normalisation of background patterns within the first 72 h of life achieved better neurodevelopmental outcomes at two years of age than those who displayed a persisting pathological background. 22,36,37 The aEEG background improved postoperatively in a study of young infants undergoing cardiac surgery due to congenital heart disease. 38 A lack of sleep-wake cycling was associated with severe…”

Neuromonitoring in Neonatal-Onset Epileptic Encephalopathies

“…According to the American Clinical Neurophysiology Society Guideline 2011 ( 22 ), EEG is highly sensitive and essential for diagnosing and monitoring neonatal seizures and EOEE. However, age-specific semiology and variability in the EEG maturational pattern and electro-clinical dissociation make interpreting diagnostic and prognostic EEG parameters in very pre-term and critically ill neonates particularly challenging ( 3 , 8 , 23 , 24 ). Moreover, limited data are available on electro-clinical phenotypes of rare genetic neonatal-onset EEs, and specific EEG changes suggestive of a causative variant have not been characterized.…”