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The use of the EEG to predict outcome in premature infants with positive sharp waves
1Department of Neurology, University of Illinois Medical Center at Chicago 60612.
Insights
Positive sharp waves on EEG in premature infants can predict long-term outcomes. Factors like discharge frequency and other EEG/clinical signs help determine prognosis, guiding clinical care.
Area of Science:
- Neonatal Neurology
- Developmental Neuroscience
- Pediatric Electroencephalography
Background:
- Premature infants are at risk for neurological complications.
- Electroencephalography (EEG) is crucial for monitoring brain activity in neonates.
- Positive sharp waves (PSWs) on neonatal EEG may indicate underlying pathology.
Purpose of the Study:
- To identify predictive factors for long-term prognosis in premature infants with PSWs on EEG.
- To correlate EEG findings with clinical outcomes up to 10 years post-birth.
Main Methods:
- Retrospective analysis of 114 EEGs from 51 premature infants (gestational age 23-36 weeks).
- Correlation of EEG characteristics (PSWs, negative sharp waves, location) with clinical data.
- Longitudinal follow-up assessments up to 10 years to determine outcomes (death, severe, moderate, mild, normal).
Main Results:
- 18% mortality from non-CNS causes (sepsis, cardiac/pulmonary defects).
- Severe outcomes (8%) linked to maternal IVDA and abundant PSWs.
- Moderate outcomes (29%) associated with Grade III-IV ICH/PVL and maternal IVDA.
- Mild (20%) and normal (26%) outcomes related to infrequent PSWs, improving/normalized EEG, vaginal delivery, and absence of seizures.
Conclusions:
- Specific features of PSWs on neonatal EEG, alongside clinical factors, are valuable predictors of long-term outcomes in premature infants.
- Maternal IVDA and specific EEG patterns (e.g., numerous PSWs, central/temporal involvement) are associated with poorer prognoses.
- Infrequent PSWs and EEG normalization suggest a better outlook, especially in the absence of seizures and with normal sonograms.
Abstract:
The goal of this study was to investigate the factors that could predict prognosis in 51 premature infants with positive sharp waves on their EEGs (gestational age 23-36 wks) with 114 tracings. Follow-up clinical examinations were conducted, up to 10 yrs later. Death occurred in 18%, from a non-CNS cause, either sepsis or a congenital cardiac or pulmonary defect. A severe outcome was seen in 8% and was related to maternal i.v. drug abuse (IVDA) and the presence of many positive sharp waves. A moderate outcome, noted in 29%, was associated with a Grade III-IV intracerebral hemorrhage (ICH) or periventricular leukomalacia (PVL) and maternal IVDA. A mild outcome seen in 20% was related to infrequent positive sharp waves, vaginal delivery and an improving EEG over time, while a normal outcome (26%) was also related to infrequent discharges, a normalized EEG over time, a normal sonogram and the absence of clinical seizures. The addition of negative sharp waves to the positive ones and the addition of central to temporal positive sharp waves were associated less often with a normal outcome. The general conclusion of this study was that various aspects of positive sharp waves in premature infants, in addition to other factors, can be used to predict outcome in these neonates.