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Early amplitude-integrated electroencephalography predicts brain injury and neurological outcome in very preterm infants.

Song J, Xu F, Wang L, Gao L, Guo J, Xia L, Zhang Y, Zhou W, Wang X, Zhu C - Sci Rep (2015)

Bottom Line: We found that severe aEEG abnormalities (p=0.000) and aEEG total score<5 (p=0.006) within 72 h after birth were positively correlated with white-matter damage, but aEEG abnormalities were not associated with intracranial hemorrhage (p=0.186).Severe abnormalities in aEEG recordings, head ultrasound, and cranial magnetic resonance imaging (MRI) were all positively correlated with poor outcome at 18 months corrected age.The predictive power of poor outcomes of the aEEG and MRI combination was the same as the aEEG, MRI, and head ultrasound combination with a sensitivity of 52.4%, specificity of 96.2%, positive predictive value of 78.6%, and negative predictive value of 88.4%.

View Article: PubMed Central - PubMed

Affiliation: Department of Neonatology, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.

ABSTRACT
Early amplitude-integrated electroencephalography (aEEG) has been widely used in term infants with brain injury to predict neurodevelopmental outcomes; however, the prognostic value of early aEEG in preterm infants is unclear. We evaluated how well early aEEG could predict brain damage and long-term neurodevelopmental outcomes in very preterm infants compared with brain imaging assessments. We found that severe aEEG abnormalities (p=0.000) and aEEG total score<5 (p=0.006) within 72 h after birth were positively correlated with white-matter damage, but aEEG abnormalities were not associated with intracranial hemorrhage (p=0.186). Severe abnormalities in aEEG recordings, head ultrasound, and cranial magnetic resonance imaging (MRI) were all positively correlated with poor outcome at 18 months corrected age. The predictive power of poor outcomes of the aEEG and MRI combination was the same as the aEEG, MRI, and head ultrasound combination with a sensitivity of 52.4%, specificity of 96.2%, positive predictive value of 78.6%, and negative predictive value of 88.4%. These results indicate that severely abnormal aEEG recordings within 72 h after birth can predict white-matter damage and long-term poor outcomes in very preterm infants. Thus aEEG can be used as an early marker to monitor very preterm infants.

No MeSH data available.


Related in: MedlinePlus

Study flow.A schematic flowchart describing the recruitment and neurodevelopmental follow-up evaluation from birth to 18 months of corrected age for the preterm infants. Lost to follow-up means that contact with the family was lost during the follow-up period. aEEG: amplitude-integrated electroencephalography; HUS: head ultrasonography; MRI: magnetic resonance imaging.
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f1: Study flow.A schematic flowchart describing the recruitment and neurodevelopmental follow-up evaluation from birth to 18 months of corrected age for the preterm infants. Lost to follow-up means that contact with the family was lost during the follow-up period. aEEG: amplitude-integrated electroencephalography; HUS: head ultrasonography; MRI: magnetic resonance imaging.

Mentions: A total of 346 infants were admitted to the NICU during the study period. Four infants were excluded based on the exclusion criteria and 342 were eligible, of which 18 were lost to follow-up and excluded from the analysis. A total of 324 preterm infants with an average GA of 30.0 ± 1.1 weeks (27.1–31.6 weeks) and average birth weight of 1377 ± 288 g (700–2200 g) were included (Table 1). The male to female ratio was 1.8:1. A total of 152 very preterm infants underwent aEEG within 72 h, 337 preterm infants underwent head ultrasonography, 210 preterm infants underwent MRI at 40 weeks of corrected age, 152 preterm infants underwent both aEEG and head ultrasonography, 101 preterm infants underwent both aEEG and MRI, 210 preterm infants underwent both head ultrasonography and MRI, and 101 preterm infants underwent all three examinations. There were 31 preterm infants who died at an average age of 15.2 ± 12.5 days, of which 15 died from brain damage and 16 died from other causes including respiratory failure (n = 7), sepsis (n = 6), perforation of the digestive tract (n = 1), or pulmonary hemorrhage (n = 2), and these were excluded from the analysis of neurodevelopmental outcomes. A total of 308 infants were considered for long-term analysis, but 18 were lost to follow-up. Excluding those lost to follow-up, there were 134 follow-ups for infants who underwent aEEG within 72 h (88.15%), 293 follow-ups for infants who underwent head ultrasonography (86.94%), and 207 follow-ups for infants who underwent brain MRI at 40 weeks of corrected age (98.57%) (Fig. 1).


Early amplitude-integrated electroencephalography predicts brain injury and neurological outcome in very preterm infants.

Song J, Xu F, Wang L, Gao L, Guo J, Xia L, Zhang Y, Zhou W, Wang X, Zhu C - Sci Rep (2015)

Study flow.A schematic flowchart describing the recruitment and neurodevelopmental follow-up evaluation from birth to 18 months of corrected age for the preterm infants. Lost to follow-up means that contact with the family was lost during the follow-up period. aEEG: amplitude-integrated electroencephalography; HUS: head ultrasonography; MRI: magnetic resonance imaging.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4562298&req=5

f1: Study flow.A schematic flowchart describing the recruitment and neurodevelopmental follow-up evaluation from birth to 18 months of corrected age for the preterm infants. Lost to follow-up means that contact with the family was lost during the follow-up period. aEEG: amplitude-integrated electroencephalography; HUS: head ultrasonography; MRI: magnetic resonance imaging.
Mentions: A total of 346 infants were admitted to the NICU during the study period. Four infants were excluded based on the exclusion criteria and 342 were eligible, of which 18 were lost to follow-up and excluded from the analysis. A total of 324 preterm infants with an average GA of 30.0 ± 1.1 weeks (27.1–31.6 weeks) and average birth weight of 1377 ± 288 g (700–2200 g) were included (Table 1). The male to female ratio was 1.8:1. A total of 152 very preterm infants underwent aEEG within 72 h, 337 preterm infants underwent head ultrasonography, 210 preterm infants underwent MRI at 40 weeks of corrected age, 152 preterm infants underwent both aEEG and head ultrasonography, 101 preterm infants underwent both aEEG and MRI, 210 preterm infants underwent both head ultrasonography and MRI, and 101 preterm infants underwent all three examinations. There were 31 preterm infants who died at an average age of 15.2 ± 12.5 days, of which 15 died from brain damage and 16 died from other causes including respiratory failure (n = 7), sepsis (n = 6), perforation of the digestive tract (n = 1), or pulmonary hemorrhage (n = 2), and these were excluded from the analysis of neurodevelopmental outcomes. A total of 308 infants were considered for long-term analysis, but 18 were lost to follow-up. Excluding those lost to follow-up, there were 134 follow-ups for infants who underwent aEEG within 72 h (88.15%), 293 follow-ups for infants who underwent head ultrasonography (86.94%), and 207 follow-ups for infants who underwent brain MRI at 40 weeks of corrected age (98.57%) (Fig. 1).

Bottom Line: We found that severe aEEG abnormalities (p=0.000) and aEEG total score<5 (p=0.006) within 72 h after birth were positively correlated with white-matter damage, but aEEG abnormalities were not associated with intracranial hemorrhage (p=0.186).Severe abnormalities in aEEG recordings, head ultrasound, and cranial magnetic resonance imaging (MRI) were all positively correlated with poor outcome at 18 months corrected age.The predictive power of poor outcomes of the aEEG and MRI combination was the same as the aEEG, MRI, and head ultrasound combination with a sensitivity of 52.4%, specificity of 96.2%, positive predictive value of 78.6%, and negative predictive value of 88.4%.

View Article: PubMed Central - PubMed

Affiliation: Department of Neonatology, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.

ABSTRACT
Early amplitude-integrated electroencephalography (aEEG) has been widely used in term infants with brain injury to predict neurodevelopmental outcomes; however, the prognostic value of early aEEG in preterm infants is unclear. We evaluated how well early aEEG could predict brain damage and long-term neurodevelopmental outcomes in very preterm infants compared with brain imaging assessments. We found that severe aEEG abnormalities (p=0.000) and aEEG total score<5 (p=0.006) within 72 h after birth were positively correlated with white-matter damage, but aEEG abnormalities were not associated with intracranial hemorrhage (p=0.186). Severe abnormalities in aEEG recordings, head ultrasound, and cranial magnetic resonance imaging (MRI) were all positively correlated with poor outcome at 18 months corrected age. The predictive power of poor outcomes of the aEEG and MRI combination was the same as the aEEG, MRI, and head ultrasound combination with a sensitivity of 52.4%, specificity of 96.2%, positive predictive value of 78.6%, and negative predictive value of 88.4%. These results indicate that severely abnormal aEEG recordings within 72 h after birth can predict white-matter damage and long-term poor outcomes in very preterm infants. Thus aEEG can be used as an early marker to monitor very preterm infants.

No MeSH data available.


Related in: MedlinePlus