Sepsis-associated electroencephalographic changes in extremely low gestational age neonates

Helderman, Jennifer; Welch, Cherrie D.; Leng, Xiaoyan

doi:10.1016/j.earlhumdev.2010.06.006

Cited by 28 publications

(20 citation statements)

References 16 publications

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“…It has been postulated that BS represents a functional thalamo-cortical disconnection in the mature brain (17). However, the significance of BS in VPT infants is not known although transient BS may appear after administration of, for example, morphine or in association with late onset sepsis (18). We found that transient BS, with duration more than two hours, is common in EPT infants and is associated with poor outcome.…”

Section: Discussionmentioning

confidence: 99%

Early single‐channel aEEG/EEG predicts outcome in very preterm infants

et al. 2012

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AimTo characterize early amplitude-integrated electroencephalogram (aEEG) and single-channel EEG (aEEG/EEG) in very preterm (VPT) infants for prediction of long-term outcome.PatientsForty-nine infants with median (range) gestational age of 25 (22–30) weeks.MethodsAmplitude-integrated electroencephalogram/EEG recorded during the first 72 h and analysed over 0–12, 12–24, 24–48 and 48–72 h, for background pattern, sleep–wake cycling, seizures, interburst intervals (IBI) and interburst percentage (IB%). In total, 2614 h of single-channel EEG examined for seizures. Survivors were assessed at 2 years corrected age with a neurological examination and Bayley Scales of Infant Development-II. Poor outcome was defined as death or survival with neurodevelopmental impairment. Good outcome was defined as survival without impairment.ResultsThirty infants had good outcome. Poor outcome (n = 19) was associated with depressed aEEG/EEG already during the first 12 h (p = 0.023), and with prolonged IBI and higher IB% at 24 h. Seizures were present in 43% of the infants and associated with intraventricular haemorrhages but not with outcome. Best predictors of poor outcome were burst-suppression pattern [76% correctly predicted; positive predictive value (PPV) 63%, negative predictive value (NPV) 91%], IBI > 6 sec (74% correctly predicted; PPV 67%, NPV 79%) and IB% > 55% at 24 h age (79% correctly predicted; PPV 72%, NPV 80%). In 35 infants with normal cerebral ultrasound during the first 3 days, outcome was correctly predicted in 82% by IB% (PPV 82%, NPV 83%).ConclusionLong-term outcome can be predicted by aEEG/EEG with 75–80% accuracy already at 24 postnatal hours in VPT infants, also in infants with no early indication of brain injury.

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Section: Discussionmentioning

confidence: 99%

Early single‐channel aEEG/EEG predicts outcome in very preterm infants

et al. 2012

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“…45 Furthermore, late-onset sepsis in preterm infants, both microbiologically proven and clinically diagnosed, is associated with acute alteration of cerebral function, indicated by acute changes in electrographic activity and burst suppression pattern. 46 …”

Section: The Impact Of Infection and Inflammation On Cerebral Injury mentioning

confidence: 99%

“…Systemic inflammation can exert rapid negative impact on cerebral function that precedes peripheral organ dysfunction and can occur without bacterial invasion of the central nervous system. 46,86 This is presumably augmented in part by blood-brain barrier dysfunction during infection, as exposure to bacterial cell wall components directly increases blood-brain barrier permeability. 87 Additional potential mechanisms, such as direct transfer of bacterial components or inflammatory mediators across endothelial cells, remain incompletely characterised (Figure 1).…”

Section: The Impact Of Infection and Inflammation On Cerebral Injury mentioning

confidence: 99%

Infection-induced inflammation and cerebral injury in preterm infants

Strunk

Inder

Wang

et al. 2014

The Lancet Infectious Diseases

233

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Summary Preterm birth and infectious diseases are the most common causes of neonatal and early childhood deaths worldwide. The rates of preterm birth have increased over recent decades and currently account for 11% of all births globally. Preterm infants are at significant risk of severe infection in early life and throughout childhood. Bacteraemia and/or inflammation during the neonatal period in preterm infants is associated with adverse outcomes, including death, chronic lung disease and neurodevelopmental impairment. Recent studies suggest that bacteraemia may trigger cerebral injury even without penetration of viable bacteria into the central nervous system. Here we review available evidence that supports the concept of a strong association between bacteraemia, inflammation and cerebral injury in preterm infants, with an emphasis on the underlying biological mechanisms, clinical correlates and translational opportunities.

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“…The increasing adoption of the aEEG method in the neonatal intensive care unit is reflected by the growing number of studies published during the past decade, although these still do not match the knowledge that was gained in term-born infants over the same period of time (8)(9)(10). Efforts have been made to define normative values and changes in aEEG parameters with respect to gestational age (GA) and postmenstrual age (PMA) (11)(12)(13)(14)(15), and recently, integrative studies correlating aEEG with various clinical parameters have been published (16)(17)(18). These examples demonstrate that the concept of aEEG monitoring can be very useful in preterm infants.…”

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confidence: 99%