Need for quality control for aEEG monitoring of the preterm infant: a 2-year experience

Aim: To establish and apply a questionnaire for the evaluation of amplitude-integrated electroencephalogram (aEEG) with respect to practicability and feasibility in the NICU, to reveal strategies for improvements in daily use and to investigate the level of staff know-how with regard to performance and evaluation of bedside aEEG for the purpose of quality control.

Methods: Amplitude-integrated electroencephalogram was routinely applied in preterm infants below 32 weeks of gestational age for a period of 2 years. Practicability, feasibility and the level of know-how with regard to aEEG were assessed using a multiple-choice questionnaire.

Results: Major problems in the use of aEEG in preterm infants were identified as time needed for placement and frequent readjustment of electrodes. Quality control showed the following problems: seizure activity was correctly diagnosed in 60.0%, discontinuous (DC) background in 45.5% and burst suppression (BS) in 41.8% of patients. Overall, BS and DC were the patterns most frequently interpreted incorrectly.

Conclusion: Amplitude-integrated electroencephalogram is frequently used in neonatology. In preterm infants with several challenges, repeated theoretical and practical trainings as well as quality control are needed in order for aEEG to become a routinely used monitoring instrument in daily preterm care.