• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of archdischfnLink to Publisher's site
Arch Dis Child Fetal Neonatal Ed. Jul 1999; 81(1): F19–F23.
PMCID: PMC1720950

Amplitude integrated EEG 3 and 6 hours after birth in full term neonates with hypoxic-ischaemic encephalopathy

Abstract

AIM—To assess the prognostic value of amplitude integrated EEG (aEEG) 3 and 6 hours after birth.
METHODS—Seventy three term, asphyxiated infants were studied (from two different centres), using the Cerebral Function Monitor (CFM Lectromed). The different aEEG tracings were compared using pattern recognition (flat tracing mainly isoelectric (FT); continuous extremely low voltage (CLV); burst-suppression (BS); discontinuous normal voltage (DNV); continuous normal voltage (CNV)) with subsequent outcome.
RESULTS—Sixty eight infants were followed up for more than 12 months (range 12 months to 6 years).Twenty one out of 68 infants (31%) showed a change in pattern from 3 to 6 hours, but this was only significant in five cases (24%). In three this changed from BS to CNV with a normal outcome. One infant showed a change in pattern from CNV to FT and had a major handicap at follow up. Another infant showed a change in pattern from DNV to BS, and developed a major handicap at follow up. The other 16 infants did not have any significant changes in pattern: 11 infants had CLV, BS, or FT at 3 and 6 hours and died (n = 9) in the neonatal period or developed a major handicap (n = 2). Five infants had a CNV or DNV pattern at 3 and 6 hours, with a normal outcome. The sensitivity and specificity of BS, together with FT and CLV, for poor outcome at 3 hours was 0.85 and 0.77, respectively; at 6 hours 0.91 and 0.86, respectively. The positive predictive value (PPV) was 78% and the negative predictive value (NPV) 84% 3 hours after birth. At 6 hours the PPV was 86% and the NPV was 91%.
CONCLUSION—aEEG could be very useful for selecting those infants who might benefit from intervention after birth asphyxia.

Full Text

The Full Text of this article is available as a PDF (130K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Hagberg B, Hagberg G, Olow I. The changing panorama of cerebral palsy in Sweden. VI. Prevalence and origin during the birth year period 1983-1986. Acta Paediatr. 1993 Apr;82(4):387–393. [PubMed]
  • Levene M, Blennow M, Whitelaw A, Hankø E, Fellman V, Hartley R. Acute effects of two different doses of magnesium sulphate in infants with birth asphyxia. Arch Dis Child Fetal Neonatal Ed. 1995 Nov;73(3):F174–F177. [PMC free article] [PubMed]
  • Van Bel F, Shadid M, Moison RM, Dorrepaal CA, Fontijn J, Monteiro L, Van De Bor M, Berger HM. Effect of allopurinol on postasphyxial free radical formation, cerebral hemodynamics, and electrical brain activity. Pediatrics. 1998 Feb;101(2):185–193. [PubMed]
  • Haaland K, Løberg EM, Steen PA, Thoresen M. Posthypoxic hypothermia in newborn piglets. Pediatr Res. 1997 Apr;41(4 Pt 1):505–512. [PubMed]
  • Amess PN, Penrice J, Cady EB, Lorek A, Wylezinska M, Cooper CE, D'Souza P, Tyszczuk L, Thoresen M, Edwards AD, et al. Mild hypothermia after severe transient hypoxia-ischemia reduces the delayed rise in cerebral lactate in the newborn piglet. Pediatr Res. 1997 Jun;41(6):803–808. [PubMed]
  • Thoresen M, Penrice J, Lorek A, Cady EB, Wylezinska M, Kirkbride V, Cooper CE, Brown GC, Edwards AD, Wyatt JS, et al. Mild hypothermia after severe transient hypoxia-ischemia ameliorates delayed cerebral energy failure in the newborn piglet. Pediatr Res. 1995 May;37(5):667–670. [PubMed]
  • Edwards AD, Azzopardi D. Hypothermic neural rescue treatment: from laboratory to cotside? Arch Dis Child Fetal Neonatal Ed. 1998 Mar;78(2):F88–F91. [PMC free article] [PubMed]
  • Edwards AD, Wyatt JS, Thoresen M. Treatment of hypoxic-ischaemic brain damage by moderate hypothermia. Arch Dis Child Fetal Neonatal Ed. 1998 Mar;78(2):F85–F88. [PMC free article] [PubMed]
  • Vannucci RC, Perlman JM. Interventions for perinatal hypoxic-ischemic encephalopathy. Pediatrics. 1997 Dec;100(6):1004–1014. [PubMed]
  • Carter BS, McNabb F, Merenstein GB. Prospective validation of a scoring system for predicting neonatal morbidity after acute perinatal asphyxia. J Pediatr. 1998 Apr;132(4):619–623. [PubMed]
  • King TA, Jackson GL, Josey AS, Vedro DA, Hawkins H, Burton KM, Burks MN, Yellin WM, Laptook AR. The effect of profound umbilical artery acidemia in term neonates admitted to a newborn nursery. J Pediatr. 1998 Apr;132(4):624–629. [PubMed]
  • Shankaran S. Identification of term infants at risk for neonatal morbidity. J Pediatr. 1998 Apr;132(4):571–572. [PubMed]
  • Dijxhoorn MJ, Visser GH, Huisjes HJ, Fidler V, Touwen BC. The relation between umbilical pH values and neonatal neurological morbidity in full term appropriate-for-dates infants. Early Hum Dev. 1985 May;11(1):33–42. [PubMed]
  • Ekert P, Perlman M, Steinlin M, Hao Y. Predicting the outcome of postasphyxial hypoxic-ischemic encephalopathy within 4 hours of birth. J Pediatr. 1997 Oct;131(4):613–617. [PubMed]
  • Wayenberg JL, Vermeylen D, Bormans J, Magrez P, Müller MF, Pardou A. Diagnosis of severe birth asphyxia and early prediction of neonatal neurological outcome in term asphyxiated newborns. J Perinat Med. 1994;22(2):129–136. [PubMed]
  • Eken P, Jansen GH, Groenendaal F, Rademaker KJ, de Vries LS. Intracranial lesions in the fullterm infant with hypoxic ischaemic encephalopathy: ultrasound and autopsy correlation. Neuropediatrics. 1994 Dec;25(6):301–307. [PubMed]
  • Rutherford MA, Pennock JM, Dubowitz LM. Cranial ultrasound and magnetic resonance imaging in hypoxic-ischaemic encephalopathy: a comparison with outcome. Dev Med Child Neurol. 1994 Sep;36(9):813–825. [PubMed]
  • Martin E, Barkovich AJ. Magnetic resonance imaging in perinatal asphyxia. Arch Dis Child Fetal Neonatal Ed. 1995 Jan;72(1):F62–F70. [PMC free article] [PubMed]
  • de Vries LS. Somatosensory-evoked potentials in term neonates with postasphyxial encephalopathy. Clin Perinatol. 1993 Jun;20(2):463–482. [PubMed]
  • Gibson NA, Graham M, Levene MI. Somatosensory evoked potentials and outcome in perinatal asphyxia. Arch Dis Child. 1992 Apr;67(4 Spec No):393–398. [PMC free article] [PubMed]
  • Holmes G, Rowe J, Hafford J, Schmidt R, Testa M, Zimmerman A. Prognostic value of the electroencephalogram in neonatal asphyxia. Electroencephalogr Clin Neurophysiol. 1982 Jan;53(1):60–72. [PubMed]
  • Pezzani C, Radvanyi-Bouvet MF, Relier JP, Monod N. Neonatal electroencephalography during the first twenty-four hours of life in full-term newborn infants. Neuropediatrics. 1986 Feb;17(1):11–18. [PubMed]
  • Monod N, Pajot N, Guidasci S. The neonatal EEG: statistical studies and prognostic value in full-term and pre-term babies. Electroencephalogr Clin Neurophysiol. 1972 May;32(5):529–544. [PubMed]
  • Watanabe K, Miyazaki S, Hara K, Hakamada S. Behavioral state cycles, background EEGs and prognosis of newborns with perinatal hypoxia. Electroencephalogr Clin Neurophysiol. 1980 Sep;49(5-6):618–625. [PubMed]
  • Svenningsen NW, Blennow G, Lindroth M, Gäddlin PO, Ahlström H. Brain-orientated intensive care treatment in severe neonatal asphyxia. Effects of phenobarbitone protection. Arch Dis Child. 1982 Mar;57(3):176–183. [PMC free article] [PubMed]
  • Archbald F, Verma UL, Tejani NA, Handwerker SM. Cerebral function monitor in the neonate. II: Birth asphyxia. Dev Med Child Neurol. 1984 Apr;26(2):162–168. [PubMed]
  • Bjerre I, Hellström-Westas L, Rosén I, Svenningsen N. Monitoring of cerebral function after severe asphyxia in infancy. Arch Dis Child. 1983 Dec;58(12):997–1002. [PMC free article] [PubMed]
  • Thornberg E, Thiringer K. Normal pattern of the cerebral function monitor trace in term and preterm neonates. Acta Paediatr Scand. 1990 Jan;79(1):20–25. [PubMed]
  • Hellström-Westas L. Comparison between tape-recorded and amplitude-integrated EEG monitoring in sick newborn infants. Acta Paediatr. 1992 Oct;81(10):812–819. [PubMed]
  • 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 Jan;72(1):F34–F38. [PMC free article] [PubMed]
  • Eken P, Toet MC, Groenendaal F, de Vries LS. Predictive value of early neuroimaging, pulsed Doppler and neurophysiology in full term infants with hypoxic-ischaemic encephalopathy. Arch Dis Child Fetal Neonatal Ed. 1995 Sep;73(2):F75–F80. [PMC free article] [PubMed]
  • Hall RT, Hall FK, Daily DK. High-dose phenobarbital therapy in term newborn infants with severe perinatal asphyxia: a randomized, prospective study with three-year follow-up. J Pediatr. 1998 Feb;132(2):345–348. [PubMed]
  • Hagberg B, Hagberg G, Olow I. The changing panorama of cerebral palsy in Sweden 1954-1970. I. Analysis of the general changes. Acta Paediatr Scand. 1975 Mar;64(2):187–192. [PubMed]
  • Sarnat HB, Sarnat MS. Neonatal encephalopathy following fetal distress. A clinical and electroencephalographic study. Arch Neurol. 1976 Oct;33(10):696–705. [PubMed]

Articles from Archives of Disease in Childhood. Fetal and Neonatal Edition are provided here courtesy of BMJ Group

Formats:

Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...

Links

  • MedGen
    MedGen
    Related information in MedGen
  • PubMed
    PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...