Related Experiment Video
Updated: Oct 2, 2026
Application of an Amplitude-integrated EEG Monitor (Cerebral Function Monitor) to Neonates
Published on: September 6, 2017
Early prediction of outcome with aEEG in preterm infants with large intraventricular hemorrhages
L Hellström-Westas1, H Klette, K Thorngren-Jerneck
1Department of Pediatrics, Lund University Hospital, Sweden. lena.westas@skane.se
Insights
Amplitude-integrated electroencephalography (aEEG) can predict outcomes in preterm infants with severe intraventricular hemorrhages (IVH) within the first postnatal week. Early aEEG patterns accurately identified infants at risk of poor outcomes or death.
Area of Science:
- Neonatal neurology
- Clinical neurophysiology
- Pediatric intensive care
Background:
- Electrocortical background activity in neonates contains prognostic information.
- In preterm infants with intra-ventricular hemorrhages (IVH), background activity in EEG and aEEG is depressed, correlating with IVH severity.
- Early aEEG prediction of outcome in preterm infants with IVH has not been previously evaluated.
Purpose of the Study:
- To investigate the potential of early amplitude-integrated electroencephalography (aEEG) for predicting outcomes in preterm infants diagnosed with large intra-ventricular hemorrhages (IVH).
Main Methods:
- Analyzed aEEG recordings from the first postnatal week in 64 preterm infants with IVH grades III-IV.
- Classified aEEG background patterns and counted maximum and minimum bursts per hour for each 24-hour period.
- Categorized outcomes as died, survived with poor outcome (severe CP, unable to walk, mental retardation), or survived with fair outcome (healthy, mild CP).
Main Results:
- Significant differences in maximum bursts/hour (MaxB) were observed between infants who died and those who survived at multiple time points (0-96 hours).
- At 24-48 hours, median MaxB differed significantly between surviving infants with fair (156) and poor (102) outcomes (p=0.002).
- Assuming MaxB < 130 predicted poor outcome or death, 68% and 78% of infants were correctly predicted at 0-24 and 24-48 hours, respectively.
Conclusions:
- Outcome prediction in preterm infants with large IVH is feasible using aEEG during the initial days of life.
- Findings suggest potential clinical implications for early medical interventions.
- Prospective studies are recommended to confirm these predictive capabilities.
Background:
The electrocortical background contains prognostic information in full-term asphyxiated newborn infants already during the first postnatal hours. In preterm infants with intra-ventricular hemorrhages (IVH) the background activity in EEG and amplitude-integrated EEG (aEEG) is depressed during the first days of life, and the extent of the depression correlates with the degree of IVH. However, it has not been previously evaluated whether very early aEEG can predict later outcome also in pre-term infants.
Objective:
To investigate if early prediction of outcome is possible from aEEG in preterm infants with large IVH.
Methods:
aEEG recordings from the first postnatal week were investigated in 64 preterm infants with IVH grade III - IV. For every 24-hour period the aEEG background pattern was classified, and the maximum and minimum numbers of bursts/h, respectively,were counted. Outcome was divided into three categories: died (n = 36), survived (n = 28) with "poor" outcome, i.e., severe cerebral palsy and not able to walk and/or mental retardation (n = 8), and survived with "fair" outcome, i.e., healthy or mild cerebral palsy (n = 19). One surviving child was lost in the follow-up.
Results:
There were significant differences in maximum bursts/h (MaxB) at 0-24 hours (p = 0.033), 24-48 hours (p = 0.011), 48-72 hours (p=0.049) and 72-96 hours (p=0.032), respectively, between the infants who died and the surviving infants. At 24-48 hours the median (range) MaxB in the surviving infants with "fair" outcome was 156 (103-179) versus 102 (73-156) in the surviving infants with "poor" outcome (p = 0.002). With the assumption that MaxB < 130 was predictive of death or survival with "poor" outcome, 68 % and 78% of infants were correctly predicted at 0-24 hours and 24-48 hours, respectively.
Conclusions:
This study shows that outcome may be predicted with aEEG already during the first days of life in preterm infants with large IVH. The findings should be confirmed in prospective studies since they may have clinical implications if specific medical interventions become available.
