Role of cerebral function monitoring in the newborn

Vries, LS de; Hellström‐Westas, Lena

doi:10.1136/adc.2004.062745

Cited by 104 publications

(67 citation statements)

References 48 publications

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“…The aEEG signal scoring method employed in this study was based on the techniques of de Vries et al (10). In other studies, the weights of 1 and 2, given to continuous low-voltage and burst suppression activity, respectively, are switched, since seizure activity is particularly destructive and is of the upmost importance for treatment.…”

Section: Discussionmentioning

confidence: 99%

“…The background pattern was classified as either continuous or discontinuous, and the presence of seizure activity or burst-suppression pattern was noted. A summary of the scoring method is presented in Table 1 based on the analysis of de Vries et al (10). The aEEG data from each experiment were scored in 10-min intervals by an analyst blinded to the duration of hypoxia-ischemia.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Cerebral metabolic rate of oxygen and amplitude-integrated electroencephalography during early reperfusion after hypoxia-ischemia in piglets

Tichauer¹,

Elliott²,

Hadway³

et al. 2009

Journal of Applied Physiology

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Tichauer KM, Elliott JT, Hadway JA, Lee T, St. Lawrence KS. Cerebral metabolic rate of oxygen and amplitude-integrated electroencephalography during early reperfusion after hypoxia-ischemia in piglets. J Appl Physiol 106: 1506 -1512. First published March 19, 2009 doi:10.1152/japplphysiol.91156.2008.-The therapeutic window following perinatal hypoxia-ischemia is brief, and early clinical signs of injury can be subtle. Electroencephalography (EEG) represents the most promising early diagnostic of hypoxia-ischemia; however, some studies have questioned the sensitivity and specificity of EEG. The present study investigated the use of both near-infrared spectroscopy (NIRS) measurements of the cerebral metabolic rate of oxygen (CMRO 2) and amplitude-integrated EEG (aEEG) to detect the severity of hypoxia-ischemia after 1 h of reperfusion in newborn piglets (10 insult, 3 control). The CMRO2 was measured before and after 1 h of reperfusion from hypoxia-ischemia, the duration of which was varied from piglet to piglet with a range of 3-24 min, under fentanyl/nitrous oxide anesthesia to mimic awake-like levels of cerebral metabolism. EEG data were collected throughout the study. On average, the CMRO2 and mean aEEG background signals were significantly depressed following the insult (P Ͻ 0.05). Mean CMRO 2 and mean aEEG background were 2.61 Ϯ 0.11 ml O2 ⅐ min Ϫ1 ⅐ 100 g Ϫ1 and 20.4 Ϯ 2.7 V before the insult and 1.58 Ϯ 0.09 ml O2⅐min Ϫ1 ⅐100 g Ϫ1 and 11.8 Ϯ 2.9 V after 1 h of reperfusion, respectively. Both CMRO2 and aEEG displayed statistically significant correlations with duration of ischemia (P Ͻ 0.05; r ϭ 0.71 and r ϭ 0.89, respectively); however, only CMRO2 was sensitive to milder injuries (Ͻ5 min). This study highlights the potential for combining NIRS measures of CMRO2 with EEG in the neonatal intensive care unit to improve early detection of perinatal hypoxia-ischemia. near-infrared spectroscopy; piglet; hypoxia-ischemia; electroencephalography PERINATAL HYPOXIC-ISCHEMIC encephalopathy is a substantial cause of infant mortality and morbidity. It remains a detrimental factor in roughly 1 of every 500 live term births in developed nations, leading to long-term neurological and developmental disabilities (20). Recent clinical trials have demonstrated that the incidence of death and disability from hypoxia-ischemia in newborns can be significantly reduced by initiating treatment strategies, hypothermia, for example, after birth and within a 6-h therapeutic window (9,11,14,32). Due to the brevity of the therapeutic window, early detection of injury and early determination of those infants who are likely candidates for treatment are crucial (15). In this regard, traditional early indicators of brain injury, including Apgar scores, umbilical artery acidosis, and fetal heart rate monitoring, suffer from poor specificity (7, 31), and more specific indicators of injury, such as magnetic resonance imaging and spectroscopy, are insensitive or difficult to implement within the therapeutic window (6, 21).To this point, the most...

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Cerebral metabolic rate of oxygen and amplitude-integrated electroencephalography during early reperfusion after hypoxia-ischemia in piglets

Tichauer¹,

Elliott²,

Hadway³

et al. 2009

Journal of Applied Physiology

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show abstract

“…Both the background pattern and voltage criteria were evaluated, and care was taken to recognize interference, which can cause significant upward drift of the baseline. 8 The aEEG traces were classified as having moderately abnormal amplitude, with the lower margin of the trace <5 mV and upper margin >10 mV, or severely depressed amplitude, with the upper margin of the trace <10 mV. In addition, each aEEG was classified according to the presence or absence of seizures.…”

Section: Methodsmentioning

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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“…Dianjurkan kejang neonatus pertama kali dikonfirmasi dengan pemeriksaan EEG konvensional, selanjutnya CFM dipakai untuk monitor jangka panjang. 15,16 Pemeriksaan EEG dan CFM juga dipakai untuk melihat respon terapi antikonvulsan dengan berkurangnya aktifitas epileptiform, serta menentukan lama terapi dan prognosis.…”

Section: Evaluasi Diagnostikunclassified

Kejang pada Neonatus, Permasalahan dalam Diagnosis dan Tata laksana

Handryastuti

2016

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Kejang pada neonatus sulit didiagnosis karena ada beberapa gejala yang tidak khas sehingga terjadi keterlambatan atau diagnosis yang berlebihan. Demikian juga dalam hal tata laksana seringkali kita hanya terpaku pada pemberantasan kejang sehingga upaya untuk mencari dan mengobati etiologi terlambat dan kurang tepat. Selain itu masih terdapat kontroversi dalam hal tata laksana kejang terutama pemilihan obat antikonvulsan yang tepat. Deteksi kejang secara dini, penelusuran etiologi serta tata laksana yang mencakup pemberantasan kejang dan terapi spesifik terhadap etiologi sangat menentukan mortalitas dan morbiditas neonatus. (Sari Pediatri 2007; 9(2):112-120).Kata kunci: kejang neonatus, diagnosis, tata laksana K ejang pada neonatus sering ditemukan dan merupakan satu-satunya gejala disfungsi susunan saraf pusat pada neonatus, 1 sulit dideteksi, sukar diberantas serta berkaitan erat dengan mortalitas dan morbiditas seperti epilepsi, palsi serebral dan keterlambatan perkembangan di kemudian hari.2 Deteksi dini, mencari etiologi dan memberikan tata laksana yang adekuat sangat penting pada kejang neonatus. (1) Kejang umumnya berkaitan dengan penyakit berat yang memerlukan terapi spesifik, (2) Kejang mempengaruhi tindakan suportif seperti alat bantu nafas dan alimentasi yang sering diberikan pada neonatus dengan penyakit tertentu, (3) Kejang dapat menyebabkan kerusakan otak.

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Role of cerebral function monitoring in the newborn

Cited by 104 publications

References 48 publications

Cerebral metabolic rate of oxygen and amplitude-integrated electroencephalography during early reperfusion after hypoxia-ischemia in piglets

Cerebral metabolic rate of oxygen and amplitude-integrated electroencephalography during early reperfusion after hypoxia-ischemia in piglets

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

Kejang pada Neonatus, Permasalahan dalam Diagnosis dan Tata laksana

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