Amplitude-integrated electroencephalography in neonates.

Conventional electroencephalography (EEG) has been used for decades in the neonatal intensive care unit for formulating neurologic prognoses, demonstrating brain functional state and degree of maturation, revealing cerebral lesions, and identifying the presence and number of electrographic seizures. However, both the immediate availability of conventional EEG and the expertise with which it is interpreted are variable. Amplitude-integrated EEG provides simplified monitoring of cerebral function, and is rapidly gaining popularity among neonatologists, with growing use in bedside decision making and inclusion criteria for randomized clinical studies. Nonetheless, child neurologists and neurophysiologists remain cautious about relying solely on this tool and prefer interpreting conventional EEG. The present review examines the technical aspects of generating, recording, and interpreting amplitude-integrated EEG and contrasts this approach with conventional EEG. Finally, several proposed amplitude-integrated EEG classification schemes are reviewed. A clear understanding of this emerging technology of measuring brain health in the premature or sick neonate is critical in modern care of the newborn infant.

[1]  R. Shellhaas,et al.  Assessment of neonatal electroencephalography (EEG) background by conventional and two amplitude-integrated EEG classification systems. , 2008, The Journal of pediatrics.

[2]  J. F. Peters,et al.  Development of EEG and daytime sleep patterns in low risk premature infants during the first year of life: longitudinal observations. , 1980, Electroencephalography and clinical neurophysiology.

[3]  Robert D. White,et al.  Training neonatal staff in recording and reporting continuous electroencephalography. , 2006, Clinics in perinatology.

[4]  Kimberlee Gauvreau,et al.  Electroencephalography in neonatal seizures: comparison of a reduced and a full 10/20 montage. , 2005, Pediatric neurology.

[5]  G. Holmes,et al.  Prognostic value of the electroencephalogram in neonatal asphyxia. , 1982, Electroencephalography and clinical neurophysiology.

[6]  L. Brion,et al.  Amplitude-Integrated EEG in Preterm Infants: Maturation of Background Pattern and Amplitude Voltage with Postmenstrual Age and Gestational Age , 2005, Journal of Perinatology.

[7]  C T Lombroso,et al.  Neonatal Polygraphy in Full‐Term and Premature Infants: A Review of Normal and Abnormal Findings , 1985, Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society.

[8]  A. Aarabi,et al.  A multistage knowledge-based system for EEG seizure detection in newborn infants , 2007, Clinical Neurophysiology.

[9]  D. Metcalf The Effect of Extrauterine Experience on the Ontogenesis of EEG Sleep Spindles , 1969, Psychosomatic medicine.

[10]  I Rosén,et al.  Silent Seizures in Sick Infants in Early Life , 1985, Acta paediatrica Scandinavica.

[11]  A. Bos,et al.  Prognostic Significance of Amplitude-Integrated EEG during the First 72 Hours after Birth in Severely Asphyxiated Neonates , 2004, Pediatric Research.

[12]  J. Meinzen-Derr,et al.  Amplitude-Integrated EEG Is Useful in Predicting Neurodevelopmental Outcome in Full-Term Infants With Hypoxic-Ischemic Encephalopathy: A Meta-Analysis , 2007, Journal of child neurology.

[13]  P. Prior EEG monitoring and evoked potentials in brain ischaemia. , 1985, British journal of anaesthesia.

[14]  K. Hara,et al.  Behavioral state cycles, background EEGs and prognosis of newborns with perinatal hypoxia. , 1980, Electroencephalography and clinical neurophysiology.

[15]  Robert R. Clancy,et al.  Characterization of neonatal seizures by conventional EEG and single-channel EEG , 2007, Clinical Neurophysiology.

[16]  G B Boylan,et al.  Non-expert use of the cerebral function monitor for neonatal seizure detection , 2004, Archives of disease in childhood. Fetal and neonatal edition.

[17]  I. Rosén,et al.  Monitoring of cerebral function after severe asphyxia in infancy. , 1983, Archives of disease in childhood.

[18]  L Strunin,et al.  Monitoring Cerebral Function: Clinical Experience with New Device for Continuous Recording of Electrical Activity of Brain , 1971, British medical journal.

[19]  L. D. de Vries,et al.  Amplitude integrated EEG 3 and 6 hours after birth in full term neonates with hypoxic–ischaemic encephalopathy , 1999, Archives of disease in childhood. Fetal and neonatal edition.

[20]  Cerebral Glucose Metabolism and Early EEG/aEEG in Term Newborn Infants with Hypoxic-Ischemic Encephalopathy , 2003, Pediatric Research.

[21]  D. Azzopardi,et al.  Artifacts on Electroencephalograms May Influence the Amplitude-Integrated EEG Classification: A Qualitative Analysis in Neonatal Encephalopathy , 2006, Pediatrics.

[22]  C. Wusthoff,et al.  Limitations of single-channel EEG on the forehead for neonatal seizure detection , 2009, Journal of Perinatology.

[23]  S. Kuhle,et al.  Intra- and Extrauterine Maturation of Amplitude-Integrated Electroencephalographic Activity in Preterm Infants Younger than 30 Weeks of Gestation , 2006, Neonatology.

[24]  A. Bos,et al.  The Added Value of Simultaneous EEG and Amplitude-Integrated EEG Recordings in Three Newborn Infants , 2006, Neonatology.

[25]  Gordon Lightbody,et al.  An evaluation of automated neonatal seizure detection methods , 2005, Clinical Neurophysiology.

[26]  A. Fanaroff,et al.  Improved Survival Rates With Increased Neurodevelopmental Disability for Extremely Low Birth Weight Infants in the 1990s , 2005, Pediatrics.

[27]  A. David Edwards,et al.  Assessment of Neonatal Encephalopathy by Amplitude-integrated Electroencephalography , 1999, Pediatrics.

[28]  L. Doyle,et al.  Use of 2-Channel Bedside Electroencephalogram Monitoring in Term-Born Encephalopathic Infants Related to Cerebral Injury Defined by Magnetic Resonance Imaging , 2006, Pediatrics.

[29]  D. Maynard,et al.  Device for continuous monitoring of cerebral activity in resuscitated patients. , 1969, British medical journal.

[30]  T. Inder,et al.  Seizure detection algorithm for neonates based on wave-sequence analysis , 2006, Clinical Neurophysiology.

[31]  G. Holmes,et al.  Prognostic value of background patterns in the neonatal EEG. , 1993, Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society.

[32]  Seyed M. Mirsattari,et al.  A comparison of subdermal wire electrodes with collodion-applied disk electrodes in long-term EEG recordings in ICU , 2006, Clinical Neurophysiology.

[33]  D. Maynard,et al.  Cerebral Function Monitor Studies in Neonates , 1984, Clinical EEG.

[34]  Ingmar Rosén,et al.  Amplitude-integrated EEG Classification and Interpretation in Preterm and Term Infants , 2006 .

[35]  Anthony G Marson,et al.  Spectral Analysis of Electroencephalography in Premature Newborn Infants: Normal Ranges , 2005, Pediatric Research.

[36]  Ingmar Rosén,et al.  An Atlas of Amplitude-Integrated EEGs in the Newborn , 2002 .

[37]  M. Levene,et al.  Evaluation of the Cerebro Trac 2500 for monitoring of cerebral function in the neonatal intensive care. , 1994, Neuropediatrics.

[38]  L. Hellström-Westas Comparison between tape‐recorded and amplitude‐integrated EEG monitoring in sick newborn infants , 1992, Acta paediatrica.

[39]  M. Vecchierini,et al.  Normal EEG of premature infants born between 24 and 30 weeks gestational age: Terminology, definitions and maturation aspects , 2007, Neurophysiologie Clinique/Clinical Neurophysiology.

[40]  P. Kellaway,et al.  Neurological and electroencephalographic correlative studies in infancy , 1965 .

[41]  T. Pedley Current Practice of Clinical Electroenceph‐alography , 1980, Neurology.

[42]  Arnold Pollak,et al.  Reference values for amplitude-integrated electroencephalographic activity in preterm infants younger than 30 weeks' gestational age. , 2004, Pediatrics.

[43]  Andrew Whitelaw,et al.  Selective head cooling with mild systemic hypothermia after neonatal encephalopathy: multicentre randomised trial , 2005, The Lancet.

[44]  P. Andriessen,et al.  An algorithm for the automatic detection of seizures in neonatal amplitude‐integrated EEG , 2007, Acta paediatrica.

[45]  R. Oozeer,et al.  Continuous 4-channel EEG monitoring: a guide to interpretation, with normal values, in preterm infants. , 1987, Neuropediatrics.

[46]  S. Donn,et al.  Should amplitude-integrated electroencephalography be used to identify infants suitable for hypothermic neuroprotection? , 2008, Journal of Perinatology.

[47]  G. Benda,et al.  Prolonged inactive phases during the discontinuous pattern of prematurity in the electroencephalogram of very-low-birthweight infants. , 1989, Electroencephalography and clinical neurophysiology.

[48]  Robert R. Clancy,et al.  Sensitivity of Amplitude-Integrated Electroencephalography for Neonatal Seizure Detection , 2007, Pediatrics.

[49]  I. Rosén,et al.  Predictive value of early continuous amplitude integrated EEG recordings on outcome after severe birth asphyxia in full term infants. , 1995, Archives of disease in childhood. Fetal and neonatal edition.

[50]  Terrie E. Inder,et al.  Accuracy of Bedside Electroencephalographic Monitoring in Comparison With Simultaneous Continuous Conventional Electroencephalography for Seizure Detection in Term Infants , 2008, Pediatrics.

[51]  A. Spitzer,et al.  Cerebral function monitoring: a new scoring system for the evaluation of brain maturation in neonates. , 2003, Pediatrics.

[52]  A. Okumura,et al.  Background electroencephalographic (EEG) activities of very preterm infants born at less than 27 weeks gestation: a study on the degree of continuity , 2001, Archives of disease in childhood. Fetal and neonatal edition.

[53]  E. Thornberg,et al.  Normal Pattern of the Cerebral Function Monitor Trace in Term and Preterm Neonates , 1990, Acta paediatrica Scandinavica.

[54]  M. Vecchierini,et al.  Effects of sufentanil on electroencephalogram in very and extremely preterm neonates. , 2003, Pediatrics.

[55]  A. Legido,et al.  Occult Neonatal Seizures , 1988, Epilepsia.

[56]  Eli M. Mizrahi,et al.  Atlas of Neonatal Electroencephalography , 2003 .

[57]  A. Prusa,et al.  Sleep-wake cycles in preterm infants below 30 weeks of gestational age. Preliminary results of a prospective amplitude-integrated EEG study. , 2001, Wiener klinische Wochenschrift.

[58]  C T Lombroso,et al.  Stability in waking-sleep states in neonates as a predictor of long-term neurologic outcome. , 1985, Pediatrics.

[59]  I Rosén,et al.  Cerebral function monitoring during the first week of life in extremely small low birthweight (ESLBW) infants. , 1991, Neuropediatrics.

[60]  John R Ives,et al.  New Chronic EEG Electrode for Critical/Intensive Care Unit Monitoring , 2005, Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society.

[61]  Floris Groenendaal,et al.  Sleep-Wake Cycling on Amplitude-Integrated Electroencephalography in Term Newborns With Hypoxic-Ischemic Encephalopathy , 2005, Pediatrics.

[62]  M. André,et al.  Normal EEG in very premature infants: reference criteria , 2000, Clinical Neurophysiology.

[63]  M. Scher,et al.  Cyclicity of Neonatal Sleep Behaviors at 25 to 30 Weeks' Postconceptional Age , 2005, Pediatric Research.

[64]  D. Samson-Dollfus,et al.  Électroencéphalographie du nouveau-né prématuré et à terme. Aspects maturatifs et glossaire , 1999, Neurophysiologie Clinique/Clinical Neurophysiology.

[65]  N. Tejani,et al.  CEREBRAL FUNCTION MONITOR IN THE NEONATE, I: NORMAL PATTERNS , 1984, Developmental medicine and child neurology.

[66]  Linda S de Vries,et al.  Comparison between simultaneously recorded amplitude integrated electroencephalogram (cerebral function monitor) and standard electroencephalogram in neonates. , 2002, Pediatrics.

[67]  H. Monyer,et al.  Interburst interval measurements in the EEGs of premature infants with normal neurological outcome. , 1989, Electroencephalography and clinical neurophysiology.

[68]  D. Maynard,et al.  Monitoring Cerebral Function: Long-Term Monitoring of Eeg and Evoked Potentials , 1987 .