EEG in premature infants with intraventricular hemorrhage

Seventy-eight EEGs from 44 premature infants with CT- or autopsy-verified intraventricular hemorrhage (IVH) were reviewed retrospectively. The patient's most abnormal EEG was a reliable predictor of outcome, independent of the estimated gestational age, 1- and 5-minute Apgar scores, and IVH grade. Nine of 12 infants who had all normal or mildly abnormal EEGs had favorable outcomes. The nine infants whose worst EEGs were moderately abnormal experienced mixed outcomes, ranging from normal survival to death. All 23 infants with one or more markedly abnormal EEGs suffered unfavorable outcomes. Positive rolandic sharp waves, a highly specific EEG pattern for IVH in premature infants, occurred in only 29.5% of the patients. The degree of EEG abnormality correlated significantly with the patient's mental status, but not with the IVH grade. Subarachnoid hemorrhage, hypoxia-ischemia, and focal parenchymal lesions caused electrographic seizures in 14 patients, 12 of whom died (85.7%). This study suggests that EEG has limited value in the diagnosis of IVH. However, it may play an important role in the neurologic assessment of the premature infant with established IVH by confirming clinically suspected seizures and providing reliable prognostic information.