Early amplitude-integrated electroencephalography for monitoring neonates at high risk for brain injury☆

Variane, Gabriel Fernando Todeschi; Magalhães, Maurício; Gasperine, Renato; Alves, Heitor Castelo Branco Rodrigues; Scoppetta, Thiago Luiz Pereira Donoso; Figueredo, Rodrigo de Jesus Gonçalves; Rodrigues, Francisco Paulo Martins; Netto, Alexandre; Mimica, Marcelo Jenne; Gallacci, Clery Bernardi

doi:10.1016/j.jped.2016.12.003

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Original articles • J. Pediatr. (Rio J.) 93 (5) • Sep-Oct 2017 • https://doi.org/10.1016/j.jped.2016.12.003 copy

Early amplitude-integrated electroencephalography for monitoring neonates at high risk for brain injury^☆ ☆ Please cite this article as: Variane GF, Magalhães M, Gasperine R, Alves HC, Scoppetta TL, Figueredo RJ, et al. Early amplitude-integrated electroencephalography for monitoring neonates at high risk for brain injury. J Pediatr (Rio J). 2017;93:460–6.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

This study aimed to correlate amplitude-integrated electroencephalography findings with early outcomes, measured by mortality and neuroimaging findings, in a prospective cohort of infants at high risk for brain injury in this center in Brazil.

Methods:

This blinded prospective cohort study evaluated 23 preterm infants below 31 weeks of gestational age and 17 infants diagnosed with hypoxic-ischemic encephalopathy secondary to perinatal asphyxia, with gestational age greater than 36 weeks, monitored with amplitude-integrated electroencephalography in a public tertiary center from February 2014 to January 2015. Background activity (classified as continuous, discontinuous high-voltage, discontinuous low-voltage, burst-suppression, continuous low-voltage, or flat trace), presence of sleep-wake cycling, and presence of seizures were evaluated. Cranial ultrasonography in preterm infants and cranial magnetic resonance imaging in infants with hypoxic-ischemic encephalopathy were performed.

Results:

In the preterm group, pathological trace or discontinuous low-voltage pattern (p = 0.03) and absence of sleep-wake cycling (p = 0.019) were associated with mortality and brain injury assessed by cranial ultrasonography. In patients with hypoxic-ischemic encephalopathy, seizure patterns on amplitude-integrated electroencephalography traces were associated with mortality or brain lesion in cranial magnetic resonance imaging (p = 0.005).

Conclusion:

This study supports previous results and demonstrates the utility of amplitude-integrated electroencephalography for monitoring brain function and predicting early outcome in the studied groups of infants at high risk for brain injury.

KEYWORDS
Newborn; Brain injury; Amplitude-integrated EEG; Early outcome

	Total n (%)	Poor early outcome n (%)	Good early outcome n (%)
Lesion in PLIC
Present	14 (87.5%)	2 (12.5%)	12 (75%)
Absent	2 (12.5%)	2 (12.5%)	0 (0%)

Lesion in BGT
Absent	6 (37.5%)	0 (0%)	6 (37.5%)
Mild	6 (37.5%)	1 (6.25%)	5 (31.25%)
Moderate	2 (12.5%)	2 (12.5%)	0 (0%)
Severe	2 (12.5%)	2 (12.5%)	0 (0%)

Lesion in white matter
Absent	6 (37.5%)	0 (0%)	6 (37.5%)
Mild	7 (43.75%)	2 (12.5%)	5 (31.25%)
Moderate	1 (6.25%)	1 (6.25%)	0 (0%)
Severe	2 (12.5%)	2 (12.5%)	0 (0%)

Lesion in cortical gray matter
Absent	2 (12.5%)	0 (0%)	2 (12.5%)
Mild	11 (68.75%)	2 (12.5%)	9 (56.25%)
Moderate	1 (6.25%)	1 (6.25%)	0 (0%)
Severe	2 (12.5%)	2 (12.5%)	0 (0%)

Sociedade Brasileira de Pediatria Av. Carlos Gomes, 328 cj. 304, 90480-000 Porto Alegre RS Brazil, Tel.: +55 51 3328-9520 - Porto Alegre - RS - Brazil
E-mail: jped@jped.com.br

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[1] * Corresponding author. E-mail:gftvariane@hotmail.com (G.F. Variane).

Extremely preterm group	Total (n = 23)	Good early outcome (n = 10)	Poor early outcome (n = 13)	p value
Gestational age (wk) (mean ± SD)	28 ± 1.7	28.3 ± 1.3	27.6 ± 1.6	NS
Weight (g) (mean ± SD)	917 ± 243	965 ± 261	880 ± 185	NS
Male (n)	12	6	6	NS
Apgar 1 (mean ± SD)	5.2 ± 2.5	5.9 ± 2.8	4.7 ± 2.1	NS
Apgar 5 (mean ± SD)	7.9 ± 2.6	8.9 ± 1.2	7.1 ± 3.2	NS
HIE group	Total (n = 17)	Good early outcome (n = 11)	Poor early outcome (n = 6)	p value
Gestational age (wk) (mean ± SD)	39 ± 1.5	39.3 ± 1	38.6 ± 2.2	NS
Weight (g) (mean ± SD)	3100 ± 422	3139 ± 217	3029 ± 680	NS
Male (n)	14	8	6	NS
Apgar 1 (mean ± SD)	2.2 ± 1	2.2 ± 0.9	2.3 ± 1.3	NS
Apgar 5 (mean ± SD)	4.7 ± 1.3	4.8 ± 1	4.7 ± 1.8	NS

Sarnat score (n)
Mild encephalopathy	0	0	0	NS
Moderate encephalopathy	10	6	4	NS
Severe encephalopathy	7	5	2	NS

Therapeutic hypothermia (n)	17	11	6	NS

Extremely preterm group	Total (n = 23)	Good early outcome (n = 10)	Poor early outcome (n = 13)	p value
Background activity
Pathological trace	9	0	9	0.002
DLVP	9	1	8	0.029
Pathological trace or DLVP	11	1	10	0.003
DHVP or continuous	12	9	3	NS

SWC				0.019
Developed	0	0	0
Immature	7	6	1
Absent	16	4	12
HIE group	Total (n = 17)	Good early outcome (n = 11)	Poor early outcome (n = 6)	p value
aEEG background activity, 3-6 h of life				NS
Continuous	11	9	2	NS
Not continuous	6	2	4	NS

TTNT (mean)	12.17	5.36	24.7	0.015
Presence of SWC	11	9	2	NS

Seizures (n)	6	1	5	0.005
Single seizures	0	0	0	NS
Repetitive seizures	3	1	2	NS
Status epilepticus	3	0	3	0.029
Repetitive or status epilepticus	6	1	5	0.005
Clinical seizures	4	1	3	NS