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Amplitude electroencephalogram characterization in preterm infants undergoing patent ductus arteriosus ligation
Ericalyn Kasdorf1, Murray Engel, Jeffrey M Perlman
1Department of Pediatrics, Division of Newborn Medicine, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York, USA. erk9007@med.cornell.edu
Insights
Amplitude-integrated electroencephalogram (aEEG) voltage did not correlate with vital sign changes during patent ductus arteriosus ligation in preterm infants. Therefore, aEEG is not a reliable pain marker in this surgical context.
Area of Science:
- Neonatal physiology
- Neuroscience
- Surgical outcomes
Background:
- Patent ductus arteriosus (PDA) surgical ligation is linked to neurodevelopmental risks.
- Intraoperative stress and pain are potential contributing factors.
- Understanding pain mechanisms during PDA ligation is crucial.
Purpose of the Study:
- To investigate the relationship between pain indicators (heart rate, blood pressure) and aEEG voltage during PDA ligation.
- To assess the utility of aEEG as a pain biomarker in preterm infants undergoing PDA surgery.
Main Methods:
- Observational pilot study involving preterm infants (22.6-35.1 weeks) with PDA requiring surgical ligation.
- Continuous aEEG monitoring before, during, and after surgery.
- Analysis of mean heart rate, blood pressure, and aEEG voltage across different perioperative periods.
Main Results:
- Seventeen preterm infants were studied.
- aEEG voltage was suppressed post-anesthetic induction and remained low throughout the postoperative period.
- Significant intraoperative increases in heart rate and blood pressure were observed.
- No correlation was found between aEEG voltage and heart rate or blood pressure changes.
Conclusions:
- aEEG voltage does not reliably reflect pain or stress during PDA ligation.
- aEEG is not a suitable tool for intraoperative pain assessment in this population.
- Standardized pain management protocols should be prioritized over aEEG monitoring for pain evaluation.
Background:
Recent studies suggest an increased risk of neurodevelopmental impairment following patent ductus arteriosus surgical ligation. The mechanisms are unclear, but intraoperative stress or pain may contribute. The objectives of this study were to determine if pain, evidenced by an increase in heart rate and blood pressure, during patent ductus arteriosus ligation would be accompanied by an increase in amplitude-integrated electroencephalogram (aEEG) voltage.
Methods:
This was an observational, pilot study of infants born at 22.6-35.1 weeks with patent ductus arteriosus requiring surgical ligation. The aEEG was recorded prior to, during surgery, and for 2 hours following surgery. Mean heart rate, blood pressure, and aEEG voltage were analyzed for each recording period.
Results:
Seventeen preterm infants were studied at a mean postmenstrual age of 26.6 weeks. Following anesthetic induction, aEEG became suppressed and remained suppressed during the postoperative period. Heart rate and blood pressure increased significantly intraoperatively. The aEEG voltage did not increase with an increase in heart rate. Infants received between 3.7-47 μg/kg of fentanyl.
Conclusions:
There was no correlation between aEEG voltage and vital sign changes. aEEG is not a useful tool as a marker of pain during patent ductus arteriosus ligation, rather a more standardized approach to pain management should be considered.
