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Electroencephalographic Patterns on Follow-Up Visits in Extremely Premature Infants With Periventricular
Sammie Lai1, Jacob Keeley2, Danielle Nolan3
1Division of Child and Adolescent Neurology, Mayo Clinic College of Medicine and Science, Jacksonville, Florida; Department of Pediatrics, University of Florida College of Medicine, Jacksonville, Florida.
Insights
Severe Periventricular Leukomalacia (PVL) in premature infants is linked to abnormal EEG patterns, including DEE-SWAS. Early EEG monitoring can identify risks and improve outcomes for these vulnerable infants.
Area of Science:
- Neonatal neurology
- Neurodevelopmental disorders
- Pediatric epilepsy
Background:
- Periventricular leukomalacia (PVL) is a common brain injury in premature infants.
- Epilepsy and specific EEG patterns like DEE-SWAS are significant complications.
- These patterns correlate with long-term deficits, even without diagnosed epilepsy.
Purpose of the Study:
- To investigate the relationship between PVL severity and EEG patterns in premature infants.
- To identify the occurrence of DEE-SWAS in relation to PVL grades.
Main Methods:
- Retrospective study of infants born <36 weeks gestational age (2020-2022).
- Review of patient demographics, prematurity complications, head ultrasounds (HUS), and EEG studies.
- EEG grading and correlation with HUS-determined PVL grades.
Main Results:
- 155 infants included; 26 had PVL, 9 with grade 2-3 PVL.
- More severe PVL grades significantly correlated with worse EEG patterns (P=0.005).
- Five infants with grade 2-3 PVL exhibited the DEE-SWAS pattern; 3 were diagnosed with epilepsy.
Conclusions:
- EEG effectively identifies abnormal electrographic patterns in premature infants with PVL.
- Early detection of these patterns may allow for timely intervention.
- Intervention can potentially improve long-term neurodevelopmental outcomes in this high-risk population.
Background:
Periventricular leukomalacia (PVL) is a common brain injury in premature infants, and epilepsy remains a significant complication. One concerning electroencephalographic (EEG) pattern found is developmental and/or epileptic encephalopathy with spike-and-wave activation in sleep (DEE-SWAS). This pattern is associated with persistent neuropsychological and motor deficits, even without a diagnosis of epilepsy. The purpose of this study is to identify the relationships between various PVL grades and EEG patterns in this population on follow-up visits, especially the occurrence of DEE-SWAS pattern on EEG.
Methods:
This is a retrospective study of <36 weeks gestational age newborns who were followed in the neurodevelopmental clinic at Corewell Health East/Corewell Health Children's Hospital in Royal Oak, Michigan, between 2020 and 2022. Patients' demographics along with prematurity complications, diagnostic head ultrasound (HUS), and EEG studies were reviewed and graded. EEG studies are usually ordered when seizures were suspected.
Results:
A total of 155 newborns met the inclusion criteria. Twenty-six patients had PVL. Nine patients had grade 2 to 3 PVL based on HUS review. EEG was performed on 15 patients with PVL at a mean age of 22 months. More severe PVL grades were significantly associated with worse EEG patterns (P = 0.005). Five patients had DEE-SWAS pattern on EEG, all of whom had grade 2 or 3 PVL. Epilepsy was eventually diagnosed in three infants with PVL.
Conclusions:
EEG can help identify important abnormal electrographic patterns in premature infants with PVL early in life; this might give a window of opportunity to intervene early and improve long-term developmental outcomes in this population.
