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Published on: September 6, 2017
Trends in cyclicity and amplitudes on amplitude-integrated electroencephalography during transition in extremely low
Poorva Deshpande1,2, Julia Dirks3, Amish Jain1,2
1Mount Sinai Hospital, Toronto, Ontario, Canada.
Insights
Amplitude integrated electroencephalography (aEEG) shows increased cyclicity in extremely low gestational age neonates (ELGANs) without neurological injury. Maturation scores and voltage margins also increase over time in these infants.
Area of Science:
- Neonatal neurology
- Clinical neurophysiology
- Pediatric electroencephalography
Background:
- Extremely low gestational age neonates (ELGANs) are vulnerable to neurological complications.
- Amplitude integrated electroencephalography (aEEG) is a valuable tool for monitoring brain activity in neonates.
- Understanding aEEG patterns in ELGANs is crucial for early detection of neurological issues.
Purpose of the Study:
- To describe aEEG cyclicity, background pattern, voltage margins, and maturation scores in ELGANs within the first 72 hours of life.
- To compare aEEG findings between uncomplicated and complicated cases in ELGANs.
- To assess the temporal evolution of aEEG parameters in ELGANs.
Main Methods:
- Prospective study of 50 infants with gestational age 23+0-27+6 weeks.
- Classification of infants into 'Uncomplicated' and 'Complicated' groups based on intraventricular hemorrhage and disorders of transition.
- Analysis of aEEG parameters including cyclicity, background pattern, voltage, and maturation scores within the first 72 hours.
Main Results:
- Increased cyclicity was observed in the 'Uncomplicated' group (87%) compared to the 'Complicated' group (54%).
- The 'Uncomplicated' group showed more cycles per hour.
- Maturation scores, high, and low base voltage increased over time in the 'Uncomplicated' group.
Conclusions:
- Clinically stable ELGANs without neurological injury exhibit increased aEEG cyclicity within the first 72 hours.
- aEEG maturation scores and voltage margins show a temporal increase in uncomplicated ELGANs.
- aEEG is a sensitive indicator for neurological status and maturation in ELGANs.
Aim:
The aim of the study was to describe amplitude integrated electroencephalography (aEEG) cyclicity, background pattern, voltage margins and maturation scores in extremely low gestational age neonates (ELGANs) in the first 72 h.
Methods:
Fifty infants with gestational age (GA) 23+0-27+6 weeks were prospectively studied. Infants with intraventricular haemorrhage ≦ Grade I and no disorders of transition (persistent pulmonary hypertension, hypotension, pulmonary haemorrhage) belonged to the 'Uncomplicated' group and those with intraventricular haemorrhage > Grade I and/or disorders of transition, to the 'Complicated' group.
Results:
Thirty-six infants without opioid exposure were included: 23 with GA 25.9 (23.1-27.7) weeks in the 'Uncomplicated' group and 13 with GA 24.6 (23.3-27.4) weeks in the 'Complicated' group. Cyclicity was more common in the 'Uncomplicated' group [20/23 (87%) vs. 7/13 (54%), p = 0.045] with more cycles/hour [0.2 (0-0.78) vs. 0.03 (0-67), p = 0.036]. Age at appearance of cyclicity was similar [20 (7.7-40.7) hours in 'Uncomplicated' vs. 23.7 (5.4-60) hours in 'Complicated' group, p = 0.8]. In the 'Uncomplicated' group, maturation scores (p = 0.02), high (p < 0.0001) and low (p = 0.03) base voltage increased over time.
Conclusion:
During the first 72 h, clinically stable ELGANs without neurological injury demonstrate increased cyclicity compared to those with a complicated course. Maturation score, high and low base voltage increase over time.
