Can EEG accurately predict 2-year neurodevelopmental outcome for preterm infants?
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Published on: September 6, 2017
Rhodri O Lloyd1,2, John M O'Toole1,2, Vicki Livingstone1,2
1INFANT Research Centre, University College Cork, Ireland.
Insights
Serial multichannel electroencephalography (EEG) in preterm infants accurately predicts 2-year neurodevelopmental outcomes. A 35-week postmenstrual age EEG is the strongest predictor, offering valuable prognostication for high-risk infants.
Area of Science:
- Neonatal Neurology
- Neurodevelopmental Pediatrics
- Clinical Neurophysiology
Background:
- Preterm infants face significant risks of adverse neurodevelopmental outcomes.
- Accurate prognostication is crucial for timely intervention and management.
- Current predictive methods like clinical assessments and cranial ultrasounds have limitations.
Purpose of the Study:
- To determine the predictive accuracy of serial multichannel video electroencephalography (EEG) for 2-year neurodevelopmental outcomes in preterm infants.
- To compare the predictive performance of EEG with clinical risk scores and cranial ultrasound findings.
Main Methods:
- Prospective enrollment of infants born <32 weeks gestational age (GA).
- Serial EEGs recorded at three time points: early neonatal period, ~32 weeks, and ~35 weeks postmenstrual age (PMA).
- EEG scoring used an age-specific grading scheme; neurodevelopmental outcome assessed using Bayley Scales of Infant Development III at 2 years corrected age.
Main Results:
- Fifty-seven infants completed follow-up; 17 had abnormal outcomes or died.
- All EEG time points individually predicted abnormal outcomes, with the 35-week PMA EEG showing the highest predictive accuracy (AUC=0.91).
- EEG prediction significantly outperformed clinical course (AUC=0.68) and cranial ultrasound (AUC=0.58).
Conclusions:
- Multichannel EEG, particularly around 35 weeks PMA, is a robust predictor of 2-year neurodevelopmental outcomes in preterm infants.
- Early postnatal EEG can be reassuring if normal, while later EEG aids in prognostication, especially considering postnatal clinical complications.
- EEG offers a valuable tool for identifying preterm infants at high risk for brain injury and guiding clinical management.
Objective:
Establish if serial, multichannel video electroencephalography (EEG) in preterm infants can accurately predict 2-year neurodevelopmental outcome.
Design And Patients:
EEGs were recorded at three time points over the neonatal course for infants <32 weeks' gestational age (GA). Monitoring commenced soon after birth and continued over the first 3 days. EEGs were repeated at approximately 32 and 35 weeks' postmenstrual age (PMA). EEG scores were based on an age-specific grading scheme. Clinical score of neonatal morbidity risk and cranial ultrasound imaging were completed.
Setting:
Neonatal intensive care unit at Cork University Maternity Hospital, Ireland.
Main Outcome Measures:
Bayley Scales of Infant Development III at 2 years' corrected age.
Results:
Sixty-seven infants were prospectively enrolled in the study and 57 had follow-up available (median GA 28.9 weeks (IQR 26.5-30.4)). Forty had normal outcome, 17 had abnormal outcome/died. All EEG time points were individually predictive of abnormal outcome; however, the 35-week EEG performed best. The area under the receiver operating characteristic curve (AUC) for this time point was 0.91 (95% CI 0.83 to 1), p<0.001. Comparatively, the clinical course AUC was 0.68 (95% CI 0.54 to 0.80, p=0.015), while abnormal cranial ultrasound was 0.58 (95% CI 0.41 to 0.75, p=0.342).
Conclusion:
Multichannel EEG is a strong predictor of 2-year outcome in preterm infants particularly when recorded around 35 weeks' PMA. Infants at high risk of brain injury may benefit from early postnatal EEG recording which, if normal, is reassuring. Postnatal clinical complications can contribute to poor outcome; therefore, we state that a later EEG around 35 weeks has a role to play in prognostication.
