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Neonatal burst suppression: its developmental significance
M M Grigg-Damberger1, S B Coker, C L Halsey
1Department of Neurology, Loyola University of Chicago Stritch School of Medicine, Maywood, Illinois.
Insights
Neonatal burst suppression on electroencephalograms indicates a poor prognosis. Most infants with this EEG pattern experienced severe neurodevelopmental deficits or death, highlighting its significance.
Area of Science:
- Neonatal neurology
- Clinical electroencephalography
- Developmental pediatrics
Background:
- Burst suppression is an electroencephalogram (EEG) pattern observed in term infants.
- The prognostic significance of neonatal burst suppression requires further elucidation.
Purpose of the Study:
- To investigate the neurodevelopmental outcomes and prognostic implications of burst suppression detected via EEG in term infants.
Main Methods:
- Retrospective review of 274 term infants over 5 years.
- Analysis of EEG recordings for burst suppression.
- Clinical examination, perinatal history review, and neurodevelopmental testing of affected infants.
Main Results:
- Burst suppression was identified in 15 (5.4%) infants.
- 93% of infants with burst suppression had poor outcomes, including death (26%) or severe neurodevelopmental deficits.
- Survivors exhibited significant motor deficits, intellectual disability (mean Gesell DQ 28), intractable epilepsy, and blindness.
Conclusions:
- Neonatal burst suppression is a strong predictor of severe neurodevelopmental disability or mortality.
- Early identification and intervention may be crucial, although outcomes remain dire.
Abstract:
Burst suppression was recorded on electroencephalograms of 15 of 274 term infants (5.4%) in our hospital within a 5 year period. These 15 infants were examined, their perinatal histories reviewed, and detailed neurodevelopmental testing performed to examine the prognostic significance of burst suppression. Fourteen children (93%) had poor outcomes. Four (26%) died in infancy. Ten survivors were followed for a mean of 30 months (range: 18-61 months). Nine have severe motor deficits, 6 require total custodial care, 5 have intractable epilepsy, and 3 are blind. Their mean Gesell Developmental Quotient was 28; a score of less than 68 suggests severe retardation. A single patient, the only 1 with a perinatal history complicated by an easily-treated bacterial meningitis, achieved normal growth and development. This study documents the dire prognosis of neonatal burst suppression. The appearance of burst suppression, though transient, portended death or severe neurodevelopmental disability in 93% of our patients.