CARFS⁷: A guide and proforma for reading a preterm neonate's EEG

Area of Science:

• Neonatal neurology
• Neurophysiology
• Pediatric electroencephalography

Background:

• Electroencephalography (EEG) is crucial for assessing brain function in preterm infants, but interpretation can be challenging.
• Rapid brain development in the third trimester leads to dynamic EEG patterns.
• Accurate EEG interpretation is vital for predicting outcomes and guiding treatment.

Purpose of the Study:

• To develop a standardized proforma, CARFS7 (Continuity, Amplitude, Reactivity, Frequency, Synchrony, Symmetry, Sleep, Sharps, Shapes, Size, and Seizures), for interpreting preterm infant EEGs.
• To enhance confidence, ease, and accuracy for neurologists reading EEGs of premature babies.
• To create a more repeatable and homogenous reporting system among operators.

Main Methods:

• The CARFS7 proforma was developed using literature review and expert clinical experience.
• It systematically evaluates key EEG parameters: Continuity, Amplitude, Reactivity/Variability, Frequency, Synchrony, Symmetry, Sleep, Sharps, Shapes/Patterns, Size, and Seizures.
• Interrater reliability of the CARFS7 scoring system was assessed.

Main Results:

• The CARFS7 proforma provides a structured approach to evaluating preterm EEGs.
• High interrater reliability was demonstrated for the CARFS7 scoring system.
• Independent ratings by two child neurologists showed high agreement using the CARFS7 proforma.

Conclusions:

• CARFS7 is a user-friendly proforma for interpreting EEGs in preterm infants.
• The proforma facilitates accurate and reproducible assessment of brain function.
• CARFS7 has the potential to significantly improve clinical practice for preterm infant neurodiagnostics.