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Updated: Oct 1, 2025
Application of an Amplitude-integrated EEG Monitor Cerebral Function Monitor to Neonates
Published on: September 6, 2017
A practical approach toward interpretation of amplitude integrated electroencephalography in preterm infants
Poorva Deshpande1,2, Patrick J McNamara3,4, Cecil Hahn3,4
1Department of Paediatrics, Mount Sinai Hospital, 600 University Ave, Toronto, ON, M5G 1X5, Canada. poorva.deshpande@sinaihealth.ca.
Insights
Amplitude-integrated electroencephalography (aEEG) monitoring helps assess preterm infant brain health. This review proposes a bedside algorithm for interpreting aEEG patterns, enhancing clinical practice for neurological surveillance.
Area of Science:
- Neonatal neurology
- Neurophysiology
- Pediatric brain monitoring
Background:
- The preterm brain is susceptible to injury, necessitating effective monitoring strategies.
- Amplitude-integrated electroencephalography (aEEG) has been studied for normative data and adverse outcome associations in preterm infants.
- Current clinical application of aEEG in preterm infants is limited, primarily existing as a research tool.
Purpose of the Study:
- To review normal and abnormal aEEG patterns in preterm infants.
- To propose a stepwise clinical algorithm for bedside aEEG assessment.
- To facilitate the integration of aEEG into routine clinical practice for neurological surveillance.
Main Methods:
- Literature review of aEEG characteristics in preterm infants.
- Synthesis of reported normative data across various gestational ages.
- Development of a stepwise interpretation algorithm for bedside use.
Main Results:
- Established understanding of normal and abnormal aEEG patterns in preterm infants.
- Identification of burst suppression and absent sleep-wake cycling as indicators of brain pathology.
- A proposed algorithm for assessing maturation and pathological patterns.
Conclusions:
- The developed algorithm offers a practical tool for clinicians.
- It enables bedside interpretation and integration into clinical practice.
- This approach supports enhanced neurological surveillance of preterm infants.
Abstract:
The developing preterm brain is vulnerable to injury, especially during periods of clinical instability; therefore, monitoring the brain may provide important information on brain health. Over the last 2 decades, a growing body of literature has been reported on preterm amplitude integrated electroencephalography (aEEG) with regards to normative data and associations with adverse outcomes. Despite this, the use of aEEG for preterm infants remains mostly a research tool with limited clinical applicability. In this article, we review the literature on normal and abnormal aEEG patterns in preterm infants and propose a stepwise clinical algorithm for aEEG assessment at the bedside that takes into account assessment of maturation and identification of pathological patterns.
Conclusion:
This algorithm may be used by clinicians at the bedside for interpretation to integrate it in clinical practice for neurological surveillance of preterm infants.
What Is Known:
• Studies have reported normative data on aEEG in preterm infants for different gestational ages. • Burst suppression pattern and absent sleep-wake cycling have been described to be associated with brain pathology and adverse outcomes in preterm infants.
What Is New:
• We have synthesized aEEG characteristics in preterm infants across the spectrum of prematurity reported in the literature. • We present a stepwise approach for clinically applicable interpretation of aEEG in preterm infants.
