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Positive rolandic sharp waves in the electroencephalograms of premature neonates with intraventricular hemorrhage
Insights
Positive rolandic sharp waves (PRS) are common in premature infants with severe intraventricular hemorrhage (IVH). These EEG findings, particularly beta-PRS, are linked to poorer outcomes but not significantly worse than those without PRS.
Area of Science:
- Neonatal Neurology
- Neurophysiology
- Pediatric Neurology
Background:
- Intraventricular hemorrhage (IVH) is a significant concern in premature infants.
- Electroencephalograms (EEGs) are crucial for monitoring neurological status in neonates.
Purpose of the Study:
- To investigate the incidence and characteristics of positive rolandic sharp waves (PRS) in premature infants with intraventricular hemorrhage (IVH).
- To correlate PRS findings with IVH severity, EEG background activity, and clinical outcomes.
Main Methods:
- Retrospective review of 78 EEGs from 44 premature infants with documented IVH.
- Analysis of PRS occurrence, associated EEG features (beta activity), and distribution patterns.
- Correlation of PRS findings with IVH grades (3 and 4) and patient outcomes.
Main Results:
- Positive rolandic sharp waves (PRS) were observed in 29.5% of infants with IVH, increasing to 60% in those with grades 3 and 4 IVH.
- Beta activity superimposed on PRS (beta-PRS) was more frequent in severe IVH cases.
- PRS typically appeared early, peaked, and resolved by 3-4 weeks; their distribution was centered on the central parasagittal region.
- Asymmetric PRS involvement may indicate differential hemispheric injury.
- Most infants with PRS experienced poor neurological outcomes, though not significantly worse than those without PRS.
Conclusions:
- PRS are a notable EEG finding in premature infants, particularly those with severe IVH.
- The presence and characteristics of PRS, including beta-PRS, are associated with neurological injury and sequelae.
- While PRS indicate significant neurological insult, their prognostic value compared to infants without PRS requires further investigation.
Abstract:
Seventy-eight electroencephalograms (EEGs) recorded from 44 premature infants with documented intraventricular hemorrhage (IVH) were retrospectively reviewed. Positive rolandic sharp waves (PRS) were observed in 13 of 44 (29.5%) patients. Among infants with grades 3 and 4 IVH, the incidence of PRS was 60% (9 of 15). During the period of study, typical PRS appeared in two EEGs of one premature infant who did not suffer an IVH. PRS were usually associated with moderately abnormal EEG backgrounds and with grades 3 and 4 IVH. Beta activity was superimposed on an average of 21.5% of PRS (beta-PRS). Infants with grades 3 and 4 IVH had a higher incidence of beta-PRS than those with smaller hemorrhages. PRS first appeared in early postnatal life, increased in abundance and then eventually disappeared from the records by 3-4 weeks of age. The field of distribution of PRS was centered at the central parasagittal region (Cz) with generous anteroposterior spread into the frontal and parietal vertices (Fz and Pz) and symmetric lateral spread into the rolandic areas (C3 and C4). Asymmetric involvement of PRS at C3 and C4 may signify differential hemispheric injury. The majority of infants whose EEGs contained PRS died or suffered serious neurologic sequelae. However, their outcomes were not significantly inferior to those without PRS.