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Updated: Jul 9, 2025
Application of an Amplitude-integrated EEG Monitor Cerebral Function Monitor to Neonates
Published on: September 6, 2017
Amplitude Integrated Electroencephalography: Simulated Assessment of Neonatal Seizure Detection in PICU Patients
Laura J MacDarby1,2, Lauren K Byrne3, Emily T O'Brien3
1Department of Anesthesia and Critical Care, Children's Health Ireland at Crumlin (CHI Crumlin), Dublin, Ireland.
Insights
Amplitude-integrated electroencephalography (aEEG) has moderate accuracy for detecting seizures in older children, with better performance for longer seizures and those occurring during sleep. Neonatal criteria should be used cautiously and supplemented with formal electroencephalography (EEG) for older pediatric patients.
Area of Science:
- Clinical Neurophysiology
- Pediatric Neurology
- Critical Care Medicine
Background:
- Amplitude-integrated electroencephalography (aEEG) is a standard monitoring tool in neonatal intensive care units.
- Existing knowledge gaps hinder the accurate application of neonatal aEEG seizure detection criteria in older children.
Purpose of the Study:
- To evaluate the diagnostic accuracy of established neonatal seizure detection criteria for identifying electrographic seizures (ESzs) in older children admitted to the hospital.
Main Methods:
- A retrospective study analyzed 120 patients (2 months to 16 years) with formal 10-20 system EEG recordings.
- Two-channel aEEG recordings were generated and independently reviewed by a neurophysiologist blinded to the outcome.
- Logistic regression identified factors influencing seizure detection on aEEG.
Main Results:
- aEEG demonstrated a 70% sensitivity and 90% negative predictive value for detecting any ESz using neonatal criteria.
- Detection accuracy decreased for brief seizures or those occurring during wakefulness, improving to 81% sensitivity when seizures <1 minute were excluded.
- Status epilepticus (SE) was identified by aEEG in 70% of cases, though ESzs were present in 80% of these SE cases.
Conclusions:
- Neonatal aEEG seizure detection criteria can be cautiously applied to older children but require supplementation with formal EEG.
- Seizure detection is more reliable for longer seizures and those originating during sleep.
- aEEG may not consistently recognize status epilepticus in the older pediatric population.
Objectives:
Amplitude integrated electroencephalography (aEEG) is a mainstay of care in neonatal ICUs; however, knowledge gaps exist in relation to its accuracy for identifying seizures in older children. We aimed to review the diagnostic accuracy of existing neonatal seizure detection criteria for seizure detection in older children in hospital.
Design:
Retrospective study.
Setting:
PICU/Neurophysiology Department in Dublin.
Patients:
One hundred twenty patients (2 mo to 16 yr old) were chosen from a database of formal 10-20 system, 21-lead electroencephalography recordings (2012-2020), comprising 30 studies with seizures, 90 without.
Interventions:
None.
Measurements And Main Results:
Electroencephalography studies containing electrographic seizures (ESzs) were annotated to describe number, duration, distribution, and spread. Two-channel aEEG (using leads C3-P3, C4-P4) recordings were generated and independently reviewed by a professional specialist in clinical neurophysiology blinded to outcome and without reference to the raw electroencephalography trace. Logistic regression was used to identify factors associated with correct seizure identification on aEEG. Median patient age was 6.1 years. Abnormal recordings featured 123 seizures. Status epilepticus (SE) was evident by electroencephalography in 10 cases. Using neonatal criteria, aEEG had a sensitivity of 70% and negative predictive value of 90% for identifying any ESz. Accurate detection of individual seizures was diminished when seizures were very short or occurred during waking. Sensitivity for individual seizures was 81% when seizures less than 1 minute were excluded. aEEG correctly identified SE in 70% of the 10 cases, although ESz were confirmed to be present in 80% of this subpopulation.
Conclusions:
aEEG criteria for neonatal seizure identification can be applied with caution to older children and should be supplemented by formal electroencephalography. Seizure identification is better for longer seizures and those arising from sleep. SE is not always recognized by aEEG among older children.
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