Low-voltage aEEG as predictor of intracranial hemorrhage in preterm infants

Abstract

The objectives of this prospective cohort study were to identify amplitude-integrated electroencephalography (aEEG) background patterns predictive of severe intracranial hemorrhage. Thirty ventilated preterm newborns weighing <1,000 g were assessed by an aEEG cerebral function monitor and ultrasound measurement of cerebral blood flow velocity at time of surfactant administration and tracheal suctioning simultaneously during first 48 hours of life. Birth weight was 624 ± 200 g (mean ± S.D.) and gestational age was 25 ± 2 weeks. Background electrical activity was predominantly discontinuous in 72% of infants. A sharp increase in electrical activity/burst density was observed during surfactant administration and tracheal suctioning in most infants, with a 33.5% increase in mean cerebral blood flow velocity. Burst suppression with low voltage was identified in 57% infants with severe intracranial hemorrhage, whereas no infant without hemorrhage exhibited this pattern (P = 0.014). We conclude that aEEG low-voltage burst suppression might have useful clinical applications with 100% positive predictive value for severe intracranial hemorrhage.

Figure.1. aEEG background sample tracings of 1 hour duration at time of surfactant administration and suctioning

1. A) Continuous activity; 1.B) Discontinuous activity; 1.C) Isoelectric activity with burst suppression. The effect of neonatal procedures is marked in red by the arrows and circle sign. The line below the tracing displayed on the semi logarithmic scaling is indicative of impedance and was kept under 10 Ohm.