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Rhythmic EEG patterns in extremely preterm infants: Classification and association with brain injury and outcome
Lauren C Weeke1, Inge M van Ooijen2, Floris Groenendaal1
1Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands.
Insights
Rhythmic electroencephalogram (EEG) patterns in extremely preterm infants are common but often unrelated to brain injury or neurodevelopmental outcomes. Many waveforms may be artefacts related to infant head position.
Area of Science:
- Neonatal neurology
- Neurophysiology
- Developmental neuroscience
Background:
- Extremely preterm infants exhibit various electroencephalogram (EEG) patterns.
- The clinical significance of these rhythmic EEG patterns, particularly periodic epileptiform discharges (PEDs), in extremely preterm infants remains unclear.
- Distinguishing true epileptiform activity from artefacts is crucial for accurate assessment.
Purpose of the Study:
- To classify rhythmic EEG patterns in extremely preterm infants.
- To investigate the association between these EEG patterns and brain injury.
- To determine the relationship between EEG patterns and neurodevelopmental outcomes.
Main Methods:
- Retrospective analysis of 77 infants born before 28 weeks gestational age.
- EEG data analyzed using the BrainZ seizure detection algorithm for pattern classification.
- Brain injury assessed via cranial ultrasound and MRI; neurodevelopmental outcomes evaluated at 2 and 5 years.
Main Results:
- Rhythmic EEG patterns were observed in 62.3% of infants.
- Periodic epileptiform discharges (PEDs) were common (44%), but their association with brain injury or outcomes was not significant.
- Other rhythmic waveforms were frequently associated with infant head position, suggesting potential artefacts.
Conclusions:
- Clear ictal discharges are rare in this population.
- The clinical significance of PEDs in extremely preterm infants requires further investigation.
- Many observed rhythmic EEG waveforms may represent artefacts rather than true neurological events.
Objective:
Classify rhythmic EEG patterns in extremely preterm infants and relate these to brain injury and outcome.
Methods:
Retrospective analysis of 77 infants born <28 weeks gestational age (GA) who had a 2-channel EEG during the first 72 h after birth. Patterns detected by the BrainZ seizure detection algorithm were categorized: ictal discharges, periodic epileptiform discharges (PEDs) and other waveforms. Brain injury was assessed with sequential cranial ultrasound (cUS) and MRI at term-equivalent age. Neurodevelopmental outcome was assessed with the BSITD-III (2 years) and WPPSI-III-NL (5 years).
Results:
Rhythmic patterns were observed in 62.3% (ictal 1.3%, PEDs 44%, other waveforms 86.3%) with multiple patterns in 36.4%. Ictal discharges were only observed in one and excluded from further analyses. The EEG location of the other waveforms (p<0.05), but not PEDs (p=0.238), was significantly associated with head position. No relation was found between the median total duration of each pattern and injury on cUS and MRI or cognition at 2 and 5 years.
Conclusions:
Clear ictal discharges are rare in extremely preterm infants. PEDs are common but their significance is unclear. Rhythmic waveforms related to head position are likely artefacts.
Significance:
Rhythmic EEG patterns may have a different significance in extremely preterm infants.
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Focal Seizures
Focal seizures originate from specific regions of the brain. These seizures are further sub-classified into two types: