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Prevalence and etiology of false normal aEEG recordings in neonatal hypoxic-ischaemic encephalopathy.

Marics G, Csekő A, Vásárhelyi B, Zakariás D, Schuster G, Szabó M - BMC Pediatr (2013)

Bottom Line: High frequency component (HFC) was found as a cause of normal appearing aEEG in 10 neonates.HFC disappeared while P and MF decreased significantly upon NDMR administration in each observed case.High frequency EEG artifacts suggestive of shivering were found to be the most common cause of false normal aEEG in hypothermic neonates while high voltage ECG artifacts are less common.

View Article: PubMed Central - HTML - PubMed

Affiliation: First Department of Pediatrics, Semmelweis University, Budapest, Bókay u, 53-54, H-1083, Hungary. marics.gabor@gmail.com.

ABSTRACT

Background: Amplitude-integrated electroencephalography (aEEG) is a useful tool to determine the severity of neonatal hypoxic-ischemic encephalopathy (HIE). Our aim was to assess the prevalence and study the origin of false normal aEEG recordings based on 85 aEEG recordings registered before six hours of age.

Methods: Raw EEG recordings were reevaluated retrospectively with Fourier analysis to identify and describe the frequency patterns of the raw EEG signal, in cases with inconsistent aEEG recordings and clinical symptoms. Power spectral density curves, power (P) and median frequency (MF) were determined using the raw EEG. In 7 patients non-depolarizing muscle relaxant (NDMR) exposure was found. The EEG sections were analyzed and compared before and after NDMR administration.

Results: The reevaluation found that the aEEG was truly normal in 4 neonates. In 3 neonates, high voltage electrocardiographic (ECG) artifacts were found with flat trace on raw EEG. High frequency component (HFC) was found as a cause of normal appearing aEEG in 10 neonates. HFC disappeared while P and MF decreased significantly upon NDMR administration in each observed case.

Conclusion: Occurrence of false normal aEEG background pattern is relatively high in neonates with HIE and hypothermia. High frequency EEG artifacts suggestive of shivering were found to be the most common cause of false normal aEEG in hypothermic neonates while high voltage ECG artifacts are less common.

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Patient selection process. Between 2006 and 2010 107 neonates fulfilled the clinical criteria for HIE. Of those, 85 neonates had aEEG recordings available within six hours of age. Seventeen aEEGs were reevaluated. In 4 cases raw EEGs were normal, 3 showed ECG artifacts. HFC were detected in 10 neonates and 7 received NDMR.
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Figure 1: Patient selection process. Between 2006 and 2010 107 neonates fulfilled the clinical criteria for HIE. Of those, 85 neonates had aEEG recordings available within six hours of age. Seventeen aEEGs were reevaluated. In 4 cases raw EEGs were normal, 3 showed ECG artifacts. HFC were detected in 10 neonates and 7 received NDMR.

Mentions: Medical records of 107 term neonates with moderate to severe HIE were reviewed (Figure 1). All neonates were outborn and admitted for hypothermia treatment (HT) to the level III NICU of the First Department of Pediatrics, Semmelweis University, Budapest, between 2006 January and 2010 July. The study was approved by the National Ethical Committee for Medical Research (TUKEB 6008/33/ETT/2002).


Prevalence and etiology of false normal aEEG recordings in neonatal hypoxic-ischaemic encephalopathy.

Marics G, Csekő A, Vásárhelyi B, Zakariás D, Schuster G, Szabó M - BMC Pediatr (2013)

Patient selection process. Between 2006 and 2010 107 neonates fulfilled the clinical criteria for HIE. Of those, 85 neonates had aEEG recordings available within six hours of age. Seventeen aEEGs were reevaluated. In 4 cases raw EEGs were normal, 3 showed ECG artifacts. HFC were detected in 10 neonates and 7 received NDMR.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4222766&req=5

Figure 1: Patient selection process. Between 2006 and 2010 107 neonates fulfilled the clinical criteria for HIE. Of those, 85 neonates had aEEG recordings available within six hours of age. Seventeen aEEGs were reevaluated. In 4 cases raw EEGs were normal, 3 showed ECG artifacts. HFC were detected in 10 neonates and 7 received NDMR.
Mentions: Medical records of 107 term neonates with moderate to severe HIE were reviewed (Figure 1). All neonates were outborn and admitted for hypothermia treatment (HT) to the level III NICU of the First Department of Pediatrics, Semmelweis University, Budapest, between 2006 January and 2010 July. The study was approved by the National Ethical Committee for Medical Research (TUKEB 6008/33/ETT/2002).

Bottom Line: High frequency component (HFC) was found as a cause of normal appearing aEEG in 10 neonates.HFC disappeared while P and MF decreased significantly upon NDMR administration in each observed case.High frequency EEG artifacts suggestive of shivering were found to be the most common cause of false normal aEEG in hypothermic neonates while high voltage ECG artifacts are less common.

View Article: PubMed Central - HTML - PubMed

Affiliation: First Department of Pediatrics, Semmelweis University, Budapest, Bókay u, 53-54, H-1083, Hungary. marics.gabor@gmail.com.

ABSTRACT

Background: Amplitude-integrated electroencephalography (aEEG) is a useful tool to determine the severity of neonatal hypoxic-ischemic encephalopathy (HIE). Our aim was to assess the prevalence and study the origin of false normal aEEG recordings based on 85 aEEG recordings registered before six hours of age.

Methods: Raw EEG recordings were reevaluated retrospectively with Fourier analysis to identify and describe the frequency patterns of the raw EEG signal, in cases with inconsistent aEEG recordings and clinical symptoms. Power spectral density curves, power (P) and median frequency (MF) were determined using the raw EEG. In 7 patients non-depolarizing muscle relaxant (NDMR) exposure was found. The EEG sections were analyzed and compared before and after NDMR administration.

Results: The reevaluation found that the aEEG was truly normal in 4 neonates. In 3 neonates, high voltage electrocardiographic (ECG) artifacts were found with flat trace on raw EEG. High frequency component (HFC) was found as a cause of normal appearing aEEG in 10 neonates. HFC disappeared while P and MF decreased significantly upon NDMR administration in each observed case.

Conclusion: Occurrence of false normal aEEG background pattern is relatively high in neonates with HIE and hypothermia. High frequency EEG artifacts suggestive of shivering were found to be the most common cause of false normal aEEG in hypothermic neonates while high voltage ECG artifacts are less common.

Show MeSH
Related in: MedlinePlus