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Neuropediatrics 2017; 48(06): 413-419
DOI: 10.1055/s-0037-1604403
Review Article
Georg Thieme Verlag KG Stuttgart · New York

The Role of Amplitude Integrated Electroencephalogram in Very Low-Birth-Weight Preterm Infants: A Literature Review

Luiza Vieira da Silva Magalhães
1   Postgraduate Program in Child and Adolescent Health, Department of Pediatrics, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
,
Maria Isabel Bragatti Winckler
2   Section of Neuropediatrics, Hospital de Clinicas de Porto Alegre, Rio Grande do Sul, Brazil
,
José Augusto Bragatti
3   Section of Neurology, Hospital de Clinicas de Porto Alegre, Rio Grande do Sul, Brazil
,
Renato Procianoy
1   Postgraduate Program in Child and Adolescent Health, Department of Pediatrics, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
4   Section of Neonatology, Hospital de Clinicas de Porto Alegre, Rio Grande do Sul, Brazil
,
Rita de Cássia Santos Silveira
1   Postgraduate Program in Child and Adolescent Health, Department of Pediatrics, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
4   Section of Neonatology, Hospital de Clinicas de Porto Alegre, Rio Grande do Sul, Brazil
› Author Affiliations
Further Information

Publication History

15 March 2017

09 June 2017

Publication Date:
09 August 2017 (online)

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Abstract

Neurological sequelae are common in very low-birth-weight preterm infants. The prevention of brain injury and development of neuroprotective strategies have been the main objectives of modern neonatal neurology. Amplitude integrated electroencephalogram (aEEG) is a continuous brain monitoring method that can aid in early diagnosis and detect patients who are at risk. While its role in the assessment of full-term newborn infants is already well established, there are still doubts about its use in preterm infants. The objective of this review was to describe the main recommendations for the use of aEEG in very low-birth-weight preterm infants and its accuracy in assessing the prognosis and detecting epileptic seizures in this population.

Keywords

preterm newborn - outcome - monitoring - periventricular hemorrhage - leukomalacia
 

  • References

  • 1 Davis AS, Berger VK, Chock VY. Perinatal neuroprotection for extremely preterm infants. Am J Perinatol 2016; 33 (03) 290-296
    Article in Thieme ConnectPubMedGoogle Scholar
  • 2 Johnston MV, Fatemi A, Wilson MA, Northington F. Treatment advances in neonatal neuroprotection and neurointensive care. Lancet Neurol 2011; 10 (04) 372-382
    CrossrefPubMedGoogle Scholar
  • 3 Volpe JJ. Brain injury in premature infants: a complex amalgam of destructive and developmental disturbances. Lancet Neurol 2009; 8 (01) 110-124
    CrossrefPubMedGoogle Scholar
  • 4 Chalak LF, Sikes NC, Mason MJ, Kaiser JR. Low-voltage aEEG as predictor of intracranial hemorrhage in preterm infants. Pediatr Neurol 2011; 44 (05) 364-369
    CrossrefPubMedGoogle Scholar
  • 5 Hayashi-Kurahashi N, Kidokoro H, Kubota T. , et al. EEG for predicting early neurodevelopment in preterm infants: an observational cohort study. Pediatrics 2012; 130 (04) e891-e897
    CrossrefPubMedGoogle Scholar
  • 6 Shellhaas RA. Continuous long-term electroencephalography: the gold standard for neonatal seizure diagnosis. Semin Fetal Neonatal Med 2015; 20 (03) 149-153
    CrossrefPubMedGoogle Scholar
  • 7 El-Dib M, Chang T, Tsuchida TN, Clancy RR. Amplitude-integrated electroencephalography in neonates. Pediatr Neurol 2009; 41 (05) 315-326
    CrossrefPubMedGoogle Scholar
  • 8 Maynard D, Prior PF, Scott DF. Device for continuous monitoring of cerebral activity in resuscitated patients. Br Med J. 1969; 4 (5682): 545-546
    PubMedGoogle Scholar
  • 9 Prior PF, Maynard DE, Sheaff PC. , et al. Monitoring cerebral function: clinical experience with new device for continuous recording of electrical activity of brain. Br Med J. 1971; 2 (5764): 736-738
    CrossrefPubMedGoogle Scholar
  • 10 Azzopardi D. Clinical applications of cerebral function monitoring in neonates. Semin Fetal Neonatal Med 2015; 20 (03) 154-163
    CrossrefPubMedGoogle Scholar
  • 11 Cui H, Ding Y, Yu Y, Yang L. Changes of amplitude integration electroencephalogram (aEEG) in different maturity preterm infant. Childs Nerv Syst 2013; 29 (07) 1169-1176
    CrossrefPubMedGoogle Scholar
  • 12 Shah NA, Wusthoff CJ. How to use: amplitude-integrated EEG (aEEG). Arch Dis Child Educ Pract Ed 2015; 100 (02) 75-81
    CrossrefPubMedGoogle Scholar
  • 13 Spitzmiller RE, Phillips T, Meinzen-Derr J, Hoath SB. Amplitude-integrated EEG is useful in predicting neurodevelopmental outcome in full-term infants with hypoxic-ischemic encephalopathy: a meta-analysis. J Child Neurol 2007; 22 (09) 1069-1078
    CrossrefPubMedGoogle Scholar
  • 14 al Naqeeb N, Edwards AD, Cowan FM, Azzopardi D. Assessment of neonatal encephalopathy by amplitude-integrated electroencephalography. Pediatrics 1999; 103 (6, Pt 1): 1263-1271
    CrossrefPubMedGoogle Scholar
  • 15 Hellström-Westas L, Rosén 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 (01) F34-F38
    CrossrefPubMedGoogle Scholar
  • 16 Bjerre I, Hellström-Westas L, Rosén I, Svenningsen N. Monitoring of cerebral function after severe asphyxia in infancy. Arch Dis Child 1983; 58 (12) 997-1002
    CrossrefPubMedGoogle Scholar
  • 17 Osredkar D, Toet MC, van Rooij LGM, van Huffelen AC, Groenendaal F, de Vries LS. Sleep-wake cycling on amplitude-integrated electroencephalography in term newborns with hypoxic-ischemic encephalopathy. Pediatrics 2005; 115 (02) 327-332
    CrossrefPubMedGoogle Scholar
  • 18 ter Horst HJ, Sommer C, Bergman KA, Fock JM, van Weerden TW, Bos AF. Prognostic significance of amplitude-integrated EEG during the first 72 hours after birth in severely asphyxiated neonates. Pediatr Res 2004; 55 (06) 1026-1033
    CrossrefPubMedGoogle Scholar
  • 19 Toet MC, Hellström-Westas L, Groenendaal F, Eken P, de Vries LS. Amplitude integrated EEG 3 and 6 hours after birth in full term neonates with hypoxic-ischaemic encephalopathy. Arch Dis Child Fetal Neonatal Ed 1999; 81 (01) F19-F23
    CrossrefPubMedGoogle Scholar
  • 20 Rakshasbhuvankar A, Paul S, Nagarajan L, Ghosh S, Rao S. Amplitude-integrated EEG for detection of neonatal seizures: a systematic review. Seizure 2015; 33: 90-98
    CrossrefPubMedGoogle Scholar
  • 21 Boylan GB, Stevenson NJ, Vanhatalo S. Monitoring neonatal seizures. Semin Fetal Neonatal Med 2013; 18 (04) 202-208
    CrossrefPubMedGoogle Scholar
  • 22 Shellhaas RA, Clancy RR. Characterization of neonatal seizures by conventional EEG and single-channel EEG. Clin Neurophysiol 2007; 118 (10) 2156-2161
    CrossrefPubMedGoogle Scholar
  • 23 Davis AS, Gantz MG, Do B. , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Serial aEEG recordings in a cohort of extremely preterm infants: feasibility and safety. J Perinatol 2015; 35 (05) 373-378
    CrossrefPubMedGoogle Scholar
  • 24 Hellström-Westas L. Continuous electroencephalography monitoring of the preterm infant. Clin Perinatol 2006; 33 (03) 633-647 , vi
    CrossrefPubMedGoogle Scholar
  • 25 Klebermass K, Olischar M, Waldhoer T, Fuiko R, Pollak A, Weninger M. Amplitude-integrated EEG pattern predicts further outcome in preterm infants. Pediatr Res 2011; 70 (01) 102-108
    PubMedGoogle Scholar
  • 26 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 (06) 391-396
    CrossrefPubMedGoogle Scholar
  • 27 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 (12) 761-765
    CrossrefPubMedGoogle Scholar
  • 28 Hassanein SMA, Gad GI, Ismail RIH, Diab M. Effect of caffeine on preterm infants' cerebral cortical activity: an observational study. J Matern Fetal Neonatal Med 2015; 28 (17) 2090-2095
    CrossrefPubMedGoogle Scholar
  • 29 Supcun S, Kutz P, Pielemeier W, Roll C. Caffeine increases cerebral cortical activity in preterm infants. J Pediatr 2010; 156 (03) 490-491
    CrossrefPubMedGoogle Scholar
  • 30 Song J, Xu F, Wang L. , et al. Early amplitude-integrated electroencephalography predicts brain injury and neurological outcome in very preterm infants. Sci Rep 2015; 5: 13810
    CrossrefPubMedGoogle Scholar
  • 31 Soubasi V, Mitsakis K, Sarafidis K, Griva M, Nakas CT, Drossou V. Early abnormal amplitude-integrated electroencephalography (aEEG) is associated with adverse short-term outcome in premature infants. Eur J Paediatr Neurol 2012; 16 (06) 625-630
    CrossrefPubMedGoogle Scholar
  • 32 Rennie JM, Chorley G, Boylan GB, Pressler R, Nguyen Y, Hooper R. Non-expert use of the cerebral function monitor for neonatal seizure detection. Arch Dis Child Fetal Neonatal Ed 2004; 89 (01) F37-F40
    CrossrefPubMedGoogle Scholar
  • 33 Frenkel N, Friger M, Meledin I. , et al. Neonatal seizure recognition--comparative study of continuous-amplitude integrated EEG versus short conventional EEG recordings. Clin Neurophysiol 2011; 122 (06) 1091-1097
    CrossrefPubMedGoogle Scholar
  • 34 Burdjalov VF, Baumgart S, Spitzer AR. Cerebral function monitoring: a new scoring system for the evaluation of brain maturation in neonates. Pediatrics 2003; 112 (04) 855-861
    CrossrefPubMedGoogle Scholar
  • 35 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 (1, Pt 1): e61-e66
    CrossrefPubMedGoogle Scholar
  • 36 Hellstrom-Westas L, Rosen I, de Vries LS, Greisen G. Amplitude-integrated EEG classification and interpretation in preterm and term infants. NeoReviews 2006; 7: e76-e87
    CrossrefPubMedGoogle Scholar
  • 37 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 (05) e1280-e1287
    CrossrefPubMedGoogle Scholar
  • 38 Vesoulis ZA, Paul RA, Mitchell TJ, Wong C, Inder TE, Mathur AM. Normative amplitude-integrated EEG measures in preterm infants. J Perinatol 2015; 35 (06) 428-433
    CrossrefPubMedGoogle Scholar
  • 39 Ment LR, Bada HS, Barnes P. , et al. Practice parameter: neuroimaging of the neonate: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology 2002; 58 (12) 1726-1738
    CrossrefPubMedGoogle Scholar
  • 40 Hintz SR, Barnes PD, Bulas D. , et al; SUPPORT Study Group of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Neuroimaging and neurodevelopmental outcome in extremely preterm infants. Pediatrics 2015; 135 (01) e32-e42
    CrossrefPubMedGoogle Scholar
  • 41 Bowen JR, Paradisis M, Shah D. Decreased aEEG continuity and baseline variability in the first 48 hours of life associated with poor short-term outcome in neonates born before 29 weeks gestation. Pediatr Res 2010; 67 (05) 538-544
    CrossrefPubMedGoogle Scholar
  • 42 Natalucci G, Rousson V, Bucher HU, Bernet V, Hagmann C, Latal B. Delayed cyclic activity development on early amplitude-integrated EEG in the preterm infant with brain lesions. Neonatology 2013; 103 (02) 134-140
    CrossrefPubMedGoogle Scholar
  • 43 Song J, Zhu C, Xu F, Guo J, Zhang Y. Predictive value of early amplitude-integrated electroencephalography for later diagnosed cerebral white matter damage in preterm infants. Neuropediatrics 2014; 45 (05) 314-320
    Article in Thieme ConnectPubMedGoogle Scholar
  • 44 Benavente-Fernández I, Lubián-López SP, Jiménez-Gómez G, Lechuga-Sancho AM, Garcia-Alloza M. Low-voltage pattern and absence of sleep-wake cycles are associated with severe hemorrhage and death in very preterm infants. Eur J Pediatr 2015; 174 (01) 85-90
    CrossrefPubMedGoogle Scholar
  • 45 Volpe JJ. Neurology of the newborn. 5th ed. London: Elsevier Health Sciences; 2008
    Google Scholar
  • 46 Inder TE, Volpe JJ. Mechanisms of perinatal brain injury. Semin Neonatol 2000; 5 (01) 3-16
    CrossrefPubMedGoogle Scholar
  • 47 Connell J, Oozeer R, Regev R, De Vries LS, Dubowitz LM, Dubowitz V. Continuous four-channel EEG monitoring in the evaluation of echodense ultrasound lesions and cystic leucomalacia. Arch Dis Child 1987; 62 (10) 1019-1024
    CrossrefPubMedGoogle Scholar
  • 48 Olischar M, Klebermass K, Waldhoer T, Pollak A, Weninger M. Background patterns and sleep-wake cycles on amplitude-integrated electroencephalography in preterms younger than 30 weeks gestational age with peri-/intraventricular haemorrhage. Acta Paediatr 2007; 96 (12) 1743-1750
    CrossrefPubMedGoogle Scholar
  • 49 Shah DK, Zempel J, Barton T, Lukas K, Inder TE. Electrographic seizures in preterm infants during the first week of life are associated with cerebral injury. Pediatr Res 2010; 67 (01) 102-106
    CrossrefPubMedGoogle Scholar
  • 50 Schlapbach LJ, Aebischer M, Adams M. , et al; Swiss Neonatal Network and Follow-Up Group. Impact of sepsis on neurodevelopmental outcome in a Swiss National Cohort of extremely premature infants. Pediatrics 2011; 128 (02) e348-e357
    CrossrefPubMedGoogle Scholar
  • 51 Hellström-Westas L, Klette H, Thorngren-Jerneck K, Rosén I. Early prediction of outcome with aEEG in preterm infants with large intraventricular hemorrhages. Neuropediatrics 2001; 32 (06) 319-324
    Article in Thieme ConnectPubMedGoogle Scholar
  • 52 Wikström S, Ley D, Hansen-Pupp I, Rosén I, Hellström-Westas L. Early amplitude-integrated EEG correlates with cord TNF-α and brain injury in very preterm infants. Acta Paediatr 2008; 97 (07) 915-919
    CrossrefPubMedGoogle Scholar
  • 53 Kidokoro H, Kubota T, Hayashi N. , et al. Absent cyclicity on aEEG within the first 24 h is associated with brain damage in preterm infants. Neuropediatrics 2010; 41 (06) 241-245
    Article in Thieme ConnectPubMedGoogle Scholar
  • 54 Wikström S, Pupp IH, Rosén I. , et al. Early single-channel aEEG/EEG predicts outcome in very preterm infants. Acta Paediatr 2012; 101 (07) 719-726
    CrossrefPubMedGoogle Scholar
  • 55 Hellström-Westas L, Rosén I. Continuous brain-function monitoring: state of the art in clinical practice. Semin Fetal Neonatal Med 2006; 11 (06) 503-511
    CrossrefPubMedGoogle Scholar
  • 56 Jacobs J, Spelbrink EM. Seizures in Preterm Infants. J Clin Neurophysiol 2016; 33 (05) 382-393
    CrossrefPubMedGoogle Scholar