Electrocortical Activity at 7 Days of Life is Affected in Extremely Premature Infants with Patent Ductus Arteriosus

Abstract

Background: The aim of this study was to determine whether the aEEG at 7 days of life is influenced by the presence of a PDA in non-sedated extremely low gestational age preterm infants.

Patients: We prospectively recruited infants born at less than 28 weeks of gestation between 11/2007 and 12/2009.

Method: aEEGs were recorded at seven days of life and assessed by using the Burdjalov score and the electronically assessed lower border (eLBA). Kruskal-Wallis-Test and linear regression analysis were performed to determine how GA and a PDA affect the aEEG score and the eLBA. Using linear regression analysis we tested which components of the score are affected by a PDA.

Results: We recruited 44 infants with a GA of 26.5/7 (23.4/7–27.6/7) weeks and a birth weight of 837 (461–1230) g. The total sum of score points increased from 4 (1–6) to 8 (5–9) points in infants born at 23/24 weeks and 27 weeks of gestation, respectively. In infants with relevant PDA the aEEG scored lower with 8 (3–10) points compared to those with PDA: 5 (1–8) points. Linear regression analysis showed a positive influence of GA and a negative influence of a PDA on the total score. GA had a positive influence on SWC and the visually assessed LBA. A PDA had a negative influence on continuity. The eLBA increased from 4.61 (3.18–5.53) µV to 5.27 (3.38–6.51) µV in infants of 23/24 vs. 27 gestational weeks, but was not significantly influenced by a PDA.

Conclusion: A PDA has a negative influence on the total Burdjalov score and continuity at 7 days of age in infants born at less than 28 weeks of gestation. The electrocortical disturbances may be the consequence of a diminished cerebral perfusion in the presence of a PDA.

Zusammenfassung

Hintergrund: Ziel der Studie war zu untersuchen, ob das aEEG bei stabilen nicht-sedierten extrem unreifen Frühgeborenen am 7. LT durch einen PDA beeinflusst wird.

Patienten: Prospektiver Einschluss von Frühgeborenen mit einem GA<28 SSW.

Methode: Am 7. LT wurden aEEGs aufgezeichnet. Die Bewertung erfolgte durch den Burdjalov score sowie durch die elektronisch ermittelte untere Amplitude (eLBA). Mittels Kruskal-Wallis-Test und linearer Regressionsanalyse ermittelten wir, wie das GA und ein PDA den Score und die eLBA beeinflussen. Nun überprüften wir mittels linearer Regressionsanalyse, welche Komponenten des Burdjalov score durch einen PDA beeinflusst werden.

Ergebnisse: 44 Frühgeborene mit einem medianen GA von 26,5/7 (23,4/7–27,6/7), medianes Geburtsgewicht 837 (461–1 230) g wurden untersucht. Der Gesamtscore stieg von 4 (1–6) Punkten bei 23/24 SSW auf 8 (5–9) Punkte bei 27 SSW an. Kinder mit einem relevanten PDA hatten eine reduzierte Punktzahl von 5 (1–8) im Vergleich zu 8 (3–10) Punkten bei Kindern ohne PDA. Die lineare Regressionsanalyse zeigte einen Anstieg des Scores mit dem GA und eine Reduktion der Punktzahl durch einen PDA. Das GA hat einen positiven Einfluss auf den Schlaf-Wach-Rhythmus und die untere Amplitude, ein PDA hat einen negativen Einfluss auf die Kontinuität. Die eLBA stieg von 4,61 (3,18–5,53) µV bei 23/24 SSW auf 5,27 (3,38–6,51) µV bei 27 SSW ohne signifikante Beeinflussung durch einen PDA.

Schlussfolgerung: Ein persistierender Ductus arteriosus reduziert die Gesamtpunktzahl und die Kontinuität im Burdjalov score bei extrem unreifen Frühgeborenen im Alter von 7 Tagen. Diese elektrokorticalen Veränderungen könnten die Folge einer PDA-bedingten reduzierten zerebralen Perfusion darstellen.

Key words

preterm - PDA - aEEG - brain maturation

Schlüsselwörter

Frühgeborene - PDA - aEEG - Hirnreifung

• Literatur

• 1 Benders MJ, Meinesz JH, van Bel F et al. Changes in electrocortical brain activity during exchange transfusions in newborn infants. Biol Neonate 2000; 78: 17-21
• 2 Bowen JR, Paradisis M, Shah D. Decreased aEEG continuity and baseline variability in the first 48 h of life associated with poor short-term outcome in neonates born before 29 weeks gestation. Pediatr Res 2010; 67: 538-544
• 3 Burdjalov VF, Baumgart S, Spitzer AR. Cerebral function monitoring: a new scoring system for the evaluation of brain maturation in neonates. Pediatrics 2003; 112: 855-861
• 4 Deeg KH, Gerstner R, Brandl U et al. Doppler sonographic flow parameter of the anterior cerebral artery in patent ductus arteriosus of the newborn infant compared to a healthy control sample. Klinische Padiatrie 1986; 198: 463-470
• 5 Greisen G, Pryds O, Rosen I et al. Poor reversibility of EEG abnormality in hypotensive, preterm neonates. Acta Paediatr Scand 1988; 77: 785-790
• 6 Griesmaier E, Enot DP, Bachmann M et al. Systematic characterization of amplitude-integrated EEG signals for monitoring the preterm brain. Pediatr Res 73: 226-235
• 7 Hamrick SE, Hansmann G. Patent ductus arteriosus of the preterm infant. Pediatrics 2010; 125: 1020-1030
• 8 Hellstrom-Westas L, Rosen I. Continuous brain-function monitoring: state of the art in clinical practice. Semin Fetal Neonatal Med 2006; 11: 503-511
• 9 Hellstrom-Westas L, Rosen I, Svenningsen NW. Predictive value of early continuous amplitude integrated EEG recordings on outcome after severe birth asphyxia in full term infants. Arch Dis Child Fetal Neonatal Ed 1995; 72: F34-F38
• 10 Huning BM, Asfour B, Konig S et al. Cerebral blood volume changes during closure by surgery of patent ductus arteriosus. Arch Dis Child Fetal Neonatal Ed 2008; 93: F261-F264
• 11 Kato T, Okumura A, Hayakawa F et al. Amplitude-integrated electroencephalography in preterm infants with cystic periventricular leukomalacia. Early Hum Dev 2011; 87: 217-221
• 12 Klebermass K, Kuhle S, Olischar M et al. Intra- and extrauterine maturation of amplitude-integrated electroencephalographic activity in preterm infants younger than 30 weeks of gestation. Biol Neonate 2006; 89: 120-125
• 13 Lemmers PM, Toet MC, van Bel F. Impact of patent ductus arteriosus and subsequent therapy with indomethacin on cerebral oxygenation in preterm infants. Pediatrics 2008; 121: 142-147
• 14 Leslie AT, Jain A, El-Khuffash A et al. Evaluation of cerebral electrical activity and cardiac output after patent ductus arteriosus ligation in preterm infants. J Perinatol 33: 861-866
• 15 Maynard D, Prior PF, Scott DF. Device for continuous monitoring of cerebral activity in resuscitated patients. Br Med J 1969; 4: 545-546
• 16 Niemarkt HJ, Andriessen P, Peters CH et al. Quantitative analysis of amplitude-integrated electroencephalogram patterns in stable preterm infants, with normal neurological development at one year. Neonatology 2010; 97: 175-182
• 17 Olischar M, Klebermass K, Kuhle S et al. Reference values for amplitude-integrated electroencephalographic activity in preterm infants younger than 30 weeks' gestational age. Pediatrics 2004; 113: e61-e66
• 18 Pees C, Walch E, Obladen M et al. Echocardiography predicts closure of patent ductus arteriosus in response to ibuprofen in infants less than 28 week gestational age. Early Hum Dev 2010; 86: 503-508
• 19 Rheinlaender C, Helfenstein D, Pees C et al. Neurodevelopmental outcome after COX inhibitor treatment for patent ductus arteriosus. Early Hum Dev 2010; 86: 87-92
• 20 Rosen I. The physiological basis for continuous electroencephalogram monitoring in the neonate. Clin Perinatol 2006; 33: 593-611
• 21 Sisman J, Campbell DE, Brion LP. Amplitude-integrated EEG in preterm infants: maturation of background pattern and amplitude voltage with postmenstrual age and gestational age. J Perinatol 2005; 25: 391-396
• 22 Soubasi V, Mitsakis K, Nakas CT et al. The influence of extrauterine life on the aEEG maturation in normal preterm infants. Early Hum Dev 2009; 85: 761-765
• 23 Supcun S, Kutz P, Pielemeier W et al. Caffeine increases cerebral cortical activity in preterm infants. J Pediatr 2010; 156: 490-491
• 24 ter Horst HJ, Verhagen EA, Keating P et al. The relationship between electrocerebral activity and cerebral fractional tissue oxygen extraction in preterm infants. Pediatr Res 2011; 70: 384-388
• 25 van den Berg E, Lemmers PM, Toet MC et al. Effect of the "InSurE" procedure on cerebral oxygenation and electrical brain activity of the preterm infant. Arch Dis Child Fetal Neonatal Ed 2010; 95: F53-58
• 26 West CR, Groves AM, Williams CE et al. Early low cardiac output is associated with compromised electroencephalographic activity in very preterm infants. Pediatr Res 2006; 59: 610-615
• 27 West CR, Harding JE, Williams CE et al. Quantitative electroencephalographic patterns in normal preterm infants over the first week after birth. Early Hum Dev 2006; 82: 43-51
• 28 Wikstrom S, Ley D, Hansen-Pupp I et al. Early amplitude-integrated EEG correlates with cord TNF-alpha and brain injury in very preterm infants. Acta Paediatr 2008; 97: 915-919
• 29 Zhang D, Liu Y, Hou X et al. Reference values for amplitude-integrated EEGs in infants from preterm to 3.5 months of age. Pediatrics 2011; 127: e1280-e1287