The impact of age and electrode position on amplitude-integrated EEGs in children from 1 month to 17 years of age

Abstract

AimAmplitude-integrated electroencephalography (aEEG) is used to monitor electrocortical activity in critically ill children but age-specific reference values are lacking. We aimed to assess the impact of age and electrode position on aEEG amplitudes and derive normal values for pediatric aEEGs from neurologically healthy children.MethodsNormal EEGs from awake children aged 1 month to 17 years (213 female, 237 male) without neurological disease or neuroactive medication were retrospectively converted into aEEGs. Two observers manually measured the upper and lower amplitude borders of the C3 – P3, C4 – P4, C3 – C4, P3 – P4, and Fp1 – Fp2 channels of the 10–20 system. Percentiles (10th, 25th, 50th, 75th, 90th) were calculated for each age group (<1 year, 1 year, 2–5 years, 6–9 years, 10–13 years, 14–17 years).ResultsAmplitude heights and curves differed between channels without sex-specific differences. During the first 2 years of life, upper and lower amplitudes of all but the Fp1–Fp2 channel increased and then declined until 17 years. The decline of the upper Fp1–Fp2 amplitude began at 4 years, while the lower amplitude declined from the 1st year of life.ConclusionsaEEG interpretation must account for age and electrode positions but not for sex in infants and children.

Bilaterally suppressed EEG amplitudes predict death and poor functional outcomes in critically ill children

“…The C3-P3 and C4-P4 channels were analyzed channels semi-automatically by two independent researchers (LP and NB) as previously described in detail [14, 23]. Briefly, amplitudes were measured by aligning the integrated measurement tool with the upper and lower amplitude.…”

“…Based on previously specified age-specific percentiles [14], the upper and lower amplitudes were classified as suppressed (<10 th percentile) or normal (≥ 10 th percentile) for each hemisphere. Suppression patterns were then classified into normal (no amplitude suppressed), one amplitude suppressed, or both amplitudes suppressed for the upper and lower amplitudes, respectively.…”

“…Based on previously specified age-specific percentiles [14], the upper and lower amplitudes were classified as suppressed (<10 Interrater agreement was assessed by Bland-Altmann plots [24] and intraclass correlation coefficients (two-way mixed model for individual ratings (ICC 3,1)) [25] for the upper and lower amplitudes as previously described [14,23].…”

“…In children, however, the general level of evidence regarding aEEG use is still low [13]. Only recently, reference values for healthy children have been published [14,15] and there is no more but incipient evidence from small studies that amplitude suppression may be associated with death or adverse outcomes as shown in neonates and adults [16][17][18]. Yet, aEEG devices are ubiquitous available in pediatric departments due to their indispensable role for the diagnostic and therapeutic decision-making path in neonatal asphyxia.…”

Niedrige aEEG Amplitude in Korrelation mit schlechtem neurologischen Outcome anhand des PCPC-Scores

“…Deskriptive Statistiken und eine binäre logistische Regression zum Zusammenhang einer Amplitude unterhalb der 10. Perzentile in der C3-P3-Ableitung und dem PCPC vor der akuten kritischen Erkrankung (baseline PCPC), schlechtes neurologisches Outcome (PCPC > 3 bei Entlassung) und Versterben während des stationären Aufenthalts wurden durchgeführt 1 2 3 .…”