Logo of archdischfnArchives of Disease in Childhood - Fetal & NeonatalVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
Arch Dis Child Fetal Neonatal Ed. 2005 May; 90(3): F245–F251.
PMCID: PMC1721875

Recovery of amplitude integrated electroencephalographic background patterns within 24 hours of perinatal asphyxia


Objective: To assess the time course of recovery of severely abnormal initial amplitude integrated electroencephalographic (aEEG) patterns (flat trace (FT), continuous low voltage (CLV), or burst suppression (BS)) in full term asphyxiated neonates, in relation to other neurophysiological and neuroimaging findings and neurodevelopmental outcome.

Methods: A total of 190 aEEGs of full term infants were reviewed. The neonates were admitted within 6 hours of birth to the neonatal intensive care unit because of perinatal asphyxia, and aEEG recording was started immediately. In all, 160 infants were included; 65 of these had an initial FT or CLV pattern and 25 an initial BS pattern. Neurodevelopmental outcome was assessed using a full neurological examination and the Griffiths' mental developmental scale.

Results: In the FT/CLV group, the background pattern recovered to continuous normal voltage within 24 hours in six of the 65 infants (9%). All six infants survived the neonatal period; one had a severe disability, and five were normal at follow up. In the BS group, the background pattern improved to normal voltage in 12 of the 25 infants (48%) within 24 hours. Of these infants, one died, five survived with moderate to severe disability, two with mild disability, and four were normal. The patients who did not recover within 24 hours either died in the neonatal period or survived with a severe disability.

Conclusion: In this study there was a small group of infants who presented with a severely abnormal aEEG background pattern within six hours of birth, but who achieved recovery to a continuous normal background pattern within the first 24 hours. Sixty one percent of these infants survived without, or with a mild, disability.

Full Text

The Full Text of this article is available as a PDF (153K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • al Naqeeb N, Edwards AD, Cowan FM, Azzopardi D. Assessment of neonatal encephalopathy by amplitude-integrated electroencephalography. Pediatrics. 1999 Jun;103(6 Pt 1):1263–1271. [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]
  • 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]
  • Toet MC, Hellström-Westas L, Groenendaal F, Eken P, de Vries LS. Amplitude integrated EEG 3 and 6 hours after birth in full term neonates with hypoxic-ischaemic encephalopathy. Arch Dis Child Fetal Neonatal Ed. 1999 Jul;81(1):F19–F23. [PMC free article] [PubMed]
  • Toet Mona C, van der Meij Wil, de Vries Linda S, Uiterwaal Cuno S P M, van Huffelen Kees C. Comparison between simultaneously recorded amplitude integrated electroencephalogram (cerebral function monitor) and standard electroencephalogram in neonates. Pediatrics. 2002 May;109(5):772–779. [PubMed]
  • ter Horst Hendrik J, Sommer Constanze, Bergman Klasien A, Fock Johanna M, van Weerden Tiemen W, Bos Arend F. Prognostic significance of amplitude-integrated EEG during the first 72 hours after birth in severely asphyxiated neonates. Pediatr Res. 2004 Jun;55(6):1026–1033. [PubMed]
  • Azzopardi D, Robertson NJ, Cowan FM, Rutherford MA, Rampling M, Edwards AD. Pilot study of treatment with whole body hypothermia for neonatal encephalopathy. Pediatrics. 2000 Oct;106(4):684–694. [PubMed]
  • Thoresen M, Whitelaw A. Cardiovascular changes during mild therapeutic hypothermia and rewarming in infants with hypoxic-ischemic encephalopathy. Pediatrics. 2000 Jul;106(1 Pt 1):92–99. [PubMed]
  • Groenendaal F, de Vries LS. Selection of babies for intervention after birth asphyxia. Semin Neonatol. 2000 Feb;5(1):17–32. [PubMed]
  • Thornberg E, Ekström-Jodal B. Cerebral function monitoring: a method of predicting outcome in term neonates after severe perinatal asphyxia. Acta Paediatr. 1994 Jun;83(6):596–601. [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]
  • Sarnat HB, Sarnat MS. Neonatal encephalopathy following fetal distress. A clinical and electroencephalographic study. Arch Neurol. 1976 Oct;33(10):696–705. [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]
  • Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol. 1997 Apr;39(4):214–223. [PubMed]
  • Barkovich AJ, Westmark K, Partridge C, Sola A, Ferriero DM. Perinatal asphyxia: MR findings in the first 10 days. AJNR Am J Neuroradiol. 1995 Mar;16(3):427–438. [PubMed]
  • Cowan F. Outcome after intrapartum asphyxia in term infants. Semin Neonatol. 2000 May;5(2):127–140. [PubMed]
  • Rutherford MA, Pennock JM, Schwieso JE, Cowan FM, Dubowitz LM. Hypoxic ischaemic encephalopathy: early magnetic resonance imaging findings and their evolution. Neuropediatrics. 1995 Aug;26(4):183–191. [PubMed]
  • Rutherford M, Pennock J, Schwieso J, Cowan F, Dubowitz L. Hypoxic-ischaemic encephalopathy: early and late magnetic resonance imaging findings in relation to outcome. Arch Dis Child Fetal Neonatal Ed. 1996 Nov;75(3):F145–F151. [PMC free article] [PubMed]
  • Soul JS, Robertson RL, Tzika AA, du Plessis AJ, Volpe JJ. Time course of changes in diffusion-weighted magnetic resonance imaging in a case of neonatal encephalopathy with defined onset and duration of hypoxic-ischemic insult. Pediatrics. 2001 Nov;108(5):1211–1214. [PubMed]
  • Robertson RL, Ben-Sira L, Barnes PD, Mulkern RV, Robson CD, Maier SE, Rivkin MJ, du Plessis A. MR line-scan diffusion-weighted imaging of term neonates with perinatal brain ischemia. AJNR Am J Neuroradiol. 1999 Oct;20(9):1658–1670. [PubMed]
  • Rutherford Mary, Counsell Serena, Allsop Joanna, Boardman James, Kapellou Olga, Larkman David, Hajnal Jo, Edwards David, Cowan Frances. Diffusion-weighted magnetic resonance imaging in term perinatal brain injury: a comparison with site of lesion and time from birth. Pediatrics. 2004 Oct;114(4):1004–1014. [PubMed]
  • de Vries LS. Somatosensory-evoked potentials in term neonates with postasphyxial encephalopathy. Clin Perinatol. 1993 Jun;20(2):463–482. [PubMed]
  • Muttitt SC, Taylor MJ, Kobayashi JS, MacMillan L, Whyte HE. Serial visual evoked potentials and outcome in term birth asphyxia. Pediatr Neurol. 1991 Mar-Apr;7(2):86–90. [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]
  • Selton D, André M. Prognosis of hypoxic-ischaemic encephalopathy in full-term newborns--value of neonatal electroencephalography. Neuropediatrics. 1997 Oct;28(5):276–280. [PubMed]
  • Pressler RM, Boylan GB, Morton M, Binnie CD, Rennie JM. Early serial EEG in hypoxic ischaemic encephalopathy. Clin Neurophysiol. 2001 Jan;112(1):31–37. [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]
  • van Leuven K, Groenendaal F, Toet MC, Schobben AFAM, Bos SAJ, de Vries LS, Rademaker CMA. Midazolam and amplitude-integrated EEG in asphyxiated full-term neonates. Acta Paediatr. 2004 Sep;93(9):1221–1227. [PubMed]
  • ter Horst HJ, Brouwer OF, Bos AF. Burst suppression on amplitude-integrated electroencephalogram may be induced by midazolam: a report on three cases. Acta Paediatr. 2004 Apr;93(4):559–563. [PubMed]
  • Boylan GB, Pressler RM, Rennie JM, Morton M, Leow PL, Hughes R, Binnie CD. Outcome of electroclinical, electrographic, and clinical seizures in the newborn infant. Dev Med Child Neurol. 1999 Dec;41(12):819–825. [PubMed]
  • McBride MC, Laroia N, Guillet R. Electrographic seizures in neonates correlate with poor neurodevelopmental outcome. Neurology. 2000 Aug 22;55(4):506–513. [PubMed]
  • Barnett AL, Guzzetta A, Mercuri E, Henderson SE, Haataja L, Cowan F, Dubowitz L. Can the Griffiths scales predict neuromotor and perceptual-motor impairment in term infants with neonatal encephalopathy? Arch Dis Child. 2004 Jul;89(7):637–643. [PMC free article] [PubMed]

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


Save items

Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...


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

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...