Prognostic Significance of Amplitude-Integrated EEG during the First 72 Hours after Birth in Severely Asphyxiated Neonates

Horst, Hendrik J. ter; Sommer, CM; Bergman, Klasien A.; Fock, Johanna M.; Weerden, T. W. van; Bos, Arend F.

doi:10.1203/01.pdr.0000127019.52562.8c

Cited by 151 publications

(86 citation statements)

References 36 publications

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“…These findings are consistent with studies in term infants that have highlighted that initially abnormal amplitude-integrated EEG patterns shortly after birth sometimes recover to normal within 24 h (7,8). The specific mechanisms of this early transient suppression are unclear.…”

Section: Articlessupporting

confidence: 90%

“…Amplitude-integrated EEG is an easily applied bedside technology that at term can be used to identify high-risk infants after neonatal hypoxia-ischemia (4). However, there is increasing evidence that abnormal patterns may be associated with rather variable outcomes (5,6) and that initially abnormal amplitude-integrated EEG patterns shortly after birth can recover to normal within 24 h (7,8). The mechanism of this rapid recovery is unclear.…”

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confidence: 99%

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Limited predictive value of early changes in EEG spectral power for neural injury after asphyxia in preterm fetal sheep

et al. 2012

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Section: Articlessupporting

confidence: 90%

mentioning

confidence: 99%

Limited predictive value of early changes in EEG spectral power for neural injury after asphyxia in preterm fetal sheep

et al. 2012

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“…Spontaneous recovery of severely abnormal EEG patterns within 24 h in asphyxiated term infants is not uncommon. 10,11 Both positive and negative predictive values of an abnormal aEEG background pattern for subsequent poor neurodevelopmental outcome change significantly, even when assessed at different times (3 and 6 h) during the first 6 h of life. 12 Since the period from birth to the initial aEEG varied little in the study infants, the stage of evolution of damage would mainly be influenced by the timing of intrauterine hypoxia.…”

Section: Discussionmentioning

confidence: 99%

Should amplitude-integrated electroencephalography be used to identify infants suitable for hypothermic neuroprotection?

2007

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Objective: Amplitude-integrated electroencephalography (aEEG) has been used adjunctively to identify infants suitable for hypothermic neuroprotection following severe intrapartum asphyxia. To determine whether an early aEEG predicts short-term adverse outcome in infants with significant hypoxic-ischemic encephalopathy (HIE) evaluated for hypothermic neuroprotection.Study Design: The aEEG recordings were obtained within 6 h of birth in infants X36 weeks' gestational age during evaluation for possible selective head or whole-body cooling. Recordings were subsequently re-evaluated for both background pattern and voltage abnormalities by a certified reader masked to clinical history and brain-oriented interventions. All infants with moderate or severe HIE evaluated for hypothermic neuroprotection also underwent magnetic resonance imaging (MRI) of the brain at a median postnatal age of 7 days. The predictive value using the aEEG for determining short-term dichotomous outcomes, defined as early death related to HIE, or a characteristic pattern of abnormalities consistent with hypoxic-ischemic injury on the MRI brain scans was assessed.Result: Fifty-four infants with moderate or severe HIE were evaluated with aEEG for hypothermic neuroprotection; 34 infants received selective head cooling, 12 infants underwent total body cooling and 8 infants were not cooled. Outcome data, available for 46 of the 54 infants, revealed a poor correlation between the early aEEG and short-term adverse outcomes, with a sensitivity of 54.8% and negative predictive value (NPV) of only 44%. Conclusion:Because of the poor NPV of an early aEEG for a short-term adverse outcome, its use as an 'additional selection criterion' for hypothermic neuroprotection may not be appropriate.

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“…19 The duration of monitoring may be important as well, as several studies advocate longer monitoring beyond 24 h. A retrospective study in 2004 indicated that recovery of the background pattern to normal is not uncommon, and that the sooner the background pattern normalized, the better the prognosis. 20 Similarly, van Rooij et al 21 showed that in infants with severely abnormal patterns at 6 h, recovery to normal by 24 h resulted in mild or no disability in 61% of infants. Sleep-wake cycling (SWC) can also be used to determine prognosis in term infants with HIE, and is characterized as regular variations in aEEG bandwidth (Figure 2).…”

Section: Introductionmentioning

confidence: 96%

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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Prognostic Significance of Amplitude-Integrated EEG during the First 72 Hours after Birth in Severely Asphyxiated Neonates

Cited by 151 publications

References 36 publications

Limited predictive value of early changes in EEG spectral power for neural injury after asphyxia in preterm fetal sheep

Limited predictive value of early changes in EEG spectral power for neural injury after asphyxia in preterm fetal sheep

Should amplitude-integrated electroencephalography be used to identify infants suitable for hypothermic neuroprotection?

Using amplitude-integrated EEG in neonatal intensive care

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