The prognostic value of amplitude integrated EEG in neonatal sepsis and/or meningitis

Horst, Hendrik J. ter; Olffen, M. van; Remmelts, H. J.; Vries, Herman de; Bos, Arie

doi:10.1111/j.1651-2227.2009.01567.x

Cited by 39 publications

(22 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…15 Neonates at high risk of seizures include 34% to 65% of neonates treated with therapeutic hypothermia for hypoxic ischemic encephalopathy, 21,22 90% of neonates with stroke, 23 10% to 30% of neonates undergoing ECMO, 24–26 and 85% of neonates with meningitis. 27 The incidence of seizures in these at-risk populations is higher than has been reported in the population with CHD, 3,4,9,19 although in many of those populations the impact of seizures on neurodevelopmental outcomes has not been studied. In adult populations, CEEG has not been shown to significantly increase hospital costs, 28,29 but cost-effectiveness analyses have not been performed in neonates with CHD.…”

Section: Discussionmentioning

confidence: 94%

Subclinical seizures identified by postoperative electroencephalographic monitoring are common after neonatal cardiac surgery

Naim

Gaynor

Chen

et al. 2015

The Journal of Thoracic and Cardiovascular Surgery

116

View full text Add to dashboard Cite

Objectives The American Clinical Neurophysiology Society recommends continuous electroencephalographic monitoring after neonatal cardiac surgery because seizures are common, often subclinical, and associated with worse neurocognitive outcomes. We performed a quality improvement project to monitor for postoperative seizures in neonates with congenital heart disease after surgery with cardiopulmonary bypass. Methods We implemented routine continuous electroencephalographic monitoring and reviewed the results for an 18-month period. Clinical data were collected by chart review, and continuous electroencephalographic tracings were interpreted using standardized American Clinical Neurophysiology Society terminology. Electrographic seizures were classified as electroencephalogram-only or electroclinical seizures. Multiple logistic regression was used to assess associations between seizures and potential clinical and electroencephalogram predictors. Results A total of 161 of 172 eligible neonates (94%) underwent continuous electroencephalographic monitoring. Electrographic seizures occurred in 13 neonates (8%) beginning at a median of 20 hours after return to the intensive care unit after surgery. Neonates with all types of congenital heart disease had seizures. Seizures were electroencephalogram only in 11 neonates (85%). Status epilepticus occurred in 8 neonates (62%). In separate multivariate models, delayed sternal closure or longer deep hypothermic circulatory arrest duration was associated with an increased risk for seizures. Mortality was higher among neonates with than without seizures (38% vs 3%, P<.001). Conclusions Continuous electroencephalographic monitoring identified seizures in 8%of neonates after cardiac surgery with cardiopulmonary bypass. The majority of seizures had no clinical correlate and would not have been otherwise identified. Seizure occurrence is a marker of greater illness severity and increased mortality. Further study is needed to determinewhether seizure identification and management lead to improved outcomes.

show abstract

Section: Discussionmentioning

confidence: 94%

Subclinical seizures identified by postoperative electroencephalographic monitoring are common after neonatal cardiac surgery

Naim

Gaynor

Chen

et al. 2015

The Journal of Thoracic and Cardiovascular Surgery

116

View full text Add to dashboard Cite

show abstract

“…Amplitude‐integrated electroencephalography (aEEG) is a safe and generally well‐accepted neurophysiologic monitoring applied in preterm and term infants in neonatal intensive care units (NICUs), and the increasing numbers of newborns with associated risks of neurological disorders and the availability of new therapeutic strategies – such as trials of neuroprotection with hypothermia and antiepileptic drugs – suggest a growing need for aEEG. The interpretation of an aEEG tracing includes three categories – the classification of the background pattern, the identification of sleep–wake cycling (SWC), and the identification of seizures – all of which depend upon the infant's gestational age and different pathophysiological conditions . Previous studies reported that continuous extremely low voltage, flat tracing, or burst suppression of aEEG background patterns is correlated with unfavorable neurological outcomes in asphyxiated neonates, and recurrent seizures and status epilepticus have been shown to be indicators of poor neurodevelopmental outcomes, while fully developed SWC has been shown to be a good prognostic indicator .…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of amplitude‐integrated EEG in neonates with high risk of neurological sequelae

Xiao

Kang

Shi

et al. 2020

Ann Clin Transl Neurol

View full text Add to dashboard Cite

Objective To determine the efficacy and the prognostic value of amplitude‐integrated electroencephalography (aEEG) in term and near‐term neonates with high risk of neurological sequelae. Methods Infants of ≥35 weeks of gestation diagnosed with neonatal encephalopathy or with high risk of brain injury were included. All eligible infants underwent aEEG within 6 h after clinical assessment. The infants were followed up 12 months to evaluate neurological development. Results A total of 250 infants were eligible, of which 85 had normal aEEG, 81 had mildly abnormal aEEG, and 84 had severely abnormal aEEG. Of these infants, 168 were diagnosed with different neonatal encephalopathies, 27 with congenital or metabolic diseases, and 55 with high risk of brain injury. In all, 22 infants died, 19 were lost to follow‐up, and 209 completed the follow‐up at 12 months, of which 62 were diagnosed with a neurological disability. Statistical analysis showed that severely abnormal aEEG predicted adverse neurological outcome with a sensitivity of 70.2%, a specificity of 87.1%, a positive predictive value of 75.6%, and a negative predictive value of 83.7%. Interpretation aEEG can predict adverse outcomes in high‐risk neonates and is a useful method for monitoring neonates with high risk of adverse neurological outcomes.

show abstract

“…In addition to those with neonatal encephalopathy, there are multiple indications for its application, including congenital malformations, stroke, metabolic disorders, meningitis 25 and encephalitis. Although the gold standard for diagnosis and treatment may be standard video-EEG monitoring, this is not feasible or practical in the majority of neonatal units around the world.…”

Section: Introductionmentioning

confidence: 99%

Using amplitude-integrated EEG in neonatal intensive care

Tao

Mathur

2010

J Perinatol

View full text Add to dashboard Cite

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.

show abstract

The prognostic value of amplitude integrated EEG in neonatal sepsis and/or meningitis

Abstract: Low voltage background pattern, SWC and EA on aEEG are helpful to predict neurological outcome in infants with neonatal sepsis or meningitis.

Cited by 39 publications

References 29 publications

Subclinical seizures identified by postoperative electroencephalographic monitoring are common after neonatal cardiac surgery

Subclinical seizures identified by postoperative electroencephalographic monitoring are common after neonatal cardiac surgery

Prognostic value of amplitude‐integrated EEG in neonates with high risk of neurological sequelae

Using amplitude-integrated EEG in neonatal intensive care

Contact Info

Product

Resources

About