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Updated: May 24, 2026
Application of an Amplitude-integrated EEG Monitor (Cerebral Function Monitor) to Neonates
Published on: September 6, 2017
Early abnormal amplitude-integrated electroencephalography (aEEG) is associated with adverse short-term outcome in
Vassiliki Soubasi1, Konstantinos Mitsakis, Kosmas Sarafidis
1Dept of Neonatology, Aristotle University of Thessaloniki, 1st Neonatal Clinic of Aristotle University of Thessaloniki, Hippokration Hospital, Konstantinoupoleos 49, Thessaloniki 54642, Greece. soubasi@med.auth.gr
Insights
Early electroencephalography (aEEG) patterns can predict severe brain injury in premature infants. Pathological tracings or discontinuous low-voltage patterns on initial aEEG indicate a poor short-term outcome for neonates.
Area of Science:
- Neonatal neurology
- Neurophysiology
- Pediatric critical care
Background:
- Electrocortical background activity is affected in preterm infants with intraventricular hemorrhage (IVH).
- Correlation exists between cerebral injury severity and electrocortical activity depression.
- The prognostic value of early amplitude-integrated electroencephalography (aEEG) recordings for brain injury in neonates remains largely undetermined.
Purpose of the Study:
- To identify early aEEG features as prognostic markers for severe brain injury in premature infants.
- To correlate aEEG findings with head ultrasound in preterm neonates.
- To assess the predictive value of aEEG for short-term outcomes.
Main Methods:
- 115 preterm infants (25-32 weeks gestational age) underwent aEEG recordings within the first 72 hours of life.
- aEEG recordings were analyzed for continuity (Co), sleep-wake cycling (Cy), and lower border amplitude (LB) using semi-quantitative methods.
- aEEG data were correlated with head ultrasound findings to assess brain injury severity.
Main Results:
- Infants were grouped by head ultrasound findings: normal (n=72), mild IVH (n=16), severe IVH (n=21), and periventricular leukomalacia (n=6).
- Significantly lower aEEG feature values were observed in infants with severe IVH.
- Pathological tracings (e.g., burst-suppression) or discontinuous low-voltage (DLV) patterns, absence of Cy, and LB < 3 μV showed high sensitivity for predicting severe brain injury.
- Continuity (Co) was the only aEEG feature significantly correlated with outcome in logistic regression analysis, correctly classifying 83.19% of cases.
Conclusions:
- Initial aEEG findings of pathological tracings or DLV are predictive of poor short-term outcomes in premature neonates.
- Continuity of electrocortical activity on early aEEG is a significant predictor of neurological outcome in preterm infants.
- aEEG serves as a valuable non-invasive tool for assessing brain injury risk in high-risk neonates.
Background:
In preterm infants with IVH the electrocortical background activity is affected and there is a correlation between the severity of cerebral injury to the degree of depression, however the usefulness of the early aEEG recordings has hardly been determined.
Aim:
To identify early aEEG features that could be used as prognostic markers for severe brain injury in prematures.
Methods:
In 115 infants, 25-32 wk GA, aEEG recordings during the first 72 h of life were correlated with head ultrasound findings. Continuity (Co), sleep-wake cycling (Cy) and amplitude of the lower border (LB) of the aEEG were evaluated by semi-quantitative analysis.
Results:
The infants were divided into four groups based on head ultrasound findings: A (n=72, normal), B [n=16, grades 1-2 intraventricular hemorrhage (IVH)], C (n=21, grades 3-4 IVH) and D (n=6, periventricular leukomalacia). 18 infants (16 of group C and 2 of group D) died during hospitalization. Significantly lower values of all aEEG features were found in group C infants. The presence of pathological tracings (burst-suppression, continuous low-voltage, flat trace) or discontinuous low-voltage (DLV), the absence of Cy and LB<3 μV in the initial aEEG displayed a sensitivity of 88.9%, 63% and 51.9% respectively, for severe brain injury. Logistic regression of aEEG features and GA to the presence or absence of severe injury revealed that only Co was significantly correlated to outcome. Using this feature 83.19% of cases were correctly classified.
Conclusion:
Pathological tracings or DLV in the initial aEEG is predictive for poor short-term outcome in premature neonates.
