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Peri- and intraoperative EEG signatures in newborns and infants
M Markus1, H Nagelsmann1, M Schneider1
1Department of Anaesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany.
Insights
Electroencephalography (EEG) monitoring, developed for adults, shows age-dependent differences in infants under one year. These findings question the current use of these EEG systems in pediatric anesthesia.
Area of Science:
- Anesthesiology and Perioperative Medicine
- Neuroscience
- Pediatric Critical Care
Background:
- Electroencephalography (EEG) derived indices are standard for monitoring adult patients under anesthesia.
- However, these EEG monitoring systems have not been validated for infant populations.
- Significant developmental changes in the infant brain necessitate age-specific validation of neurophysiological monitoring.
Purpose of the Study:
- To investigate age-dependent perioperative electroencephalographic (EEG) signatures in infants younger than one year.
- To assess the differences in EEG power spectra (total, relative β-, α-, θ-, δ-power) across different infant age groups.
- To evaluate perioperative EEG dynamics from baseline to intraoperative conditions and extubation.
Main Methods:
- Frontal EEGs were recorded from 115 infants (<1 year) categorized into four age groups: 0-3, 4-6, 7-9, and 10-12 months.
- Infants received general anesthesia with sevoflurane.
- Analysis included total power and relative power in different frequency bands (β, α, θ, δ), with event markers for perioperative dynamics in a subset of 20 EEGs.
Main Results:
- Newborns exhibited significantly higher intraoperative relative δ-power (80%) compared to 10-12-month-old infants (47.5%).
- Relative β- and α-power were low in newborns (mean 3.2% and 4.6%) but increased markedly in 4-6-month-old infants (10.9% and 14.4%).
- Infants >6 months showed a substantial decrease in relative δ-power from baseline to intraoperative states, correlating with increased faster frequencies.
Conclusions:
- Age-dependent perioperative EEG signatures are evident in infants under one year of age.
- Significant differences in EEG readouts between newborns and infants were demonstrated.
- These findings raise concerns about the current applicability and interpretation of EEG monitoring systems in pediatric anesthesia.
Objective:
The electroencephalographic derived indices have been developed for adult patients, however these monitors have not been validated for infants.
Methods:
Frontal EEGs were recorded in 115 infants aged <1 year [0-3-months (N = 27), 4-6-months (N = 30), 7-9-months (N = 29) and 10-12-months (N = 29)] who received general anaesthesia with sevoflurane. Total power (µV2) and relative β-, α-, θ-, δ-power (%) were analyzed. Additionally, in 20 EEGs event marker were added (baseline, loss of consciousness, intraoperative situation, extubation) to assess perioperative EEG dynamics.
Results:
Newborns show a mean relative δ-power at 80% in intraoperative EEG compared to infants (10-12 months) showing 47.5%. Relative β-power and α-power are low in newborns (mean 3.2% and 4.6%; respectively), with a marked increase in the older infants (4-6 months) (mean 10.9% and 14.4%; respectively). EEG dynamic in newborns from baseline (relative δ-power of 88%) to the intraoperative situation (80.5%) are discrete. In contrast infants >6-months have a strong reduction of relative δ-power from baseline to the intraoperative situation, which corresponds to an increase of faster frequencies.
Conclusions:
Age dependent perioperative EEG signatures can be demonstrated in infants younger than one year.
Significance:
We demonstrate significant differences in EEG readouts between newborns and infants which questions our monitoring systems in paediatric anaesthesia.
