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A Bedside, Single Burr Hole Approach to Multimodality Monitoring in Severe Brain Injury
Published on: March 26, 2019
Single versus bihemispheric amplitude-integrated electroencephalography in relation to cerebral injury and outcome in
Shelly Lavery1, Divyen K Shah, Rodney W Hunt
1Victorian Infant Brain Study Group, and Murdoch Childrens Research Institute, The Royal Children's Hospital Melbourne, Victoria, AUstralia. shelly.lavery@rch.org.au
Insights
Two-channel amplitude-integrated electroencephalogram (B-aEEG) shows higher sensitivity than single-channel (S-aEEG) for detecting cerebral injury in encephalopathic infants. This improved detection correlates with more accurate prognostication of neurodevelopmental outcomes.
Area of Science:
- Neonatal Neurology
- Neurophysiology
- Pediatric Neuroimaging
Background:
- Increasing demand for early diagnosis of cerebral injury in term encephalopathic infants.
- Single-channel amplitude-integrated electroencephalogram (S-aEEG) shows predictive utility for severe encephalopathy.
- Limited data compare new multi-channel aEEG devices with S-aEEG.
Purpose of the Study:
- To compare the diagnostic utility of S-aEEG and two-channel B-aEEG.
- To assess prediction of cerebral injury via MRI and neurodevelopmental outcomes.
- To evaluate advanced aEEG monitoring in neonatal encephalopathy.
Main Methods:
- Simultaneous S-aEEG and B-aEEG recordings in term encephalopathic infants.
- Magnetic resonance imaging (MRI) to classify cerebral injury extent.
- Neurodevelopmental outcome assessment at 2 years of age.
Main Results:
- High agreement between S-aEEG and B-aEEG (Kappa = 0.68).
- Discrepancies in four cases: S-aEEG normal, B-aEEG abnormal.
- These four cases showed severe MRI abnormalities and poor neurodevelopmental outcomes.
Conclusions:
- B-aEEG amplitude measurements demonstrate greater sensitivity for detecting cerebral injury.
- B-aEEG is particularly effective in identifying unilateral brain injury.
- Enhanced detection by B-aEEG may improve prognostication in neonatal encephalopathy.
Background:
The demand for early diagnosis and prognostication of cerebral injury in the encephalopathic term infant is increasing to facilitate appropriate management. The single-channel amplitude-integrated electroencephalogram (S-aEEG) has been shown to have predictive utility for the severely encephalopathic infant. New bedside aEEG devices with more channels are entering the neonatal environment. Little data are available to compare the utility of two channels (B-aEEG) with that of an S-aEEG recording.
Aim:
To compare the utility of the S-aEEG and the B-aEEG in the prediction of cerebral injury, as determined by magnetic resonance imaging (MRI), and neurodevelopmental outcome in the term encephalopathic infant.
Methods:
Term encephalopathic infants, with or without seizures, admitted to a level III NICU were included in this study. These infants had simultaneous S-aEEG and B-aEEG recordings. MRI was undertaken during the clinical course and classified as to the extent of cerebral injury. Neurological outcome was assessed at 2 years of age.
Results:
Twenty-eight encephalopathic term infants were included in the study. There was high level of agreement between both brain monitors (Kappa = 0.68, P < 0.001), but there was disagreement in the classification in four cases where the S-aEEG was normal when the B-aEEG was severely abnormal (McNemar's test P = 0.046). Of note in these four cases, all had a severely abnormal MRI and poor neurodevelopmental outcome at 2 years.
Conclusion:
Amplitude measurements by the B-aEEG appear more sensitive in detecting cerebral injury in comparison with the S-aEEG, particularly in the setting of unilateral injury.
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