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Cot-side electroencephalography for outcome prediction in preterm infants: observational study
  1. Claire R West1,
  2. Jane E Harding2,
  3. Chris E Williams3,
  4. Melinda Nolan4,
  5. Malcolm R Battin5
  1. 1Neonatal Intensive Care Unit, Middlemore Hospital, Auckland, New Zealand
  2. 2Liggins Institute, University of Auckland, Auckland, New Zealand
  3. 3Department of Surgery, University of Melbourne, Victoria, Australia
  4. 4Neurology Department, Starship Children's Health, Auckland, New Zealand
  5. 5Newborn Service, National Women's Health, Auckland, New Zealand
  1. Correspondence to Dr Claire R West, Neonatal Intensive Care Unit, Middlemore Hospital, Private Bag 93311, Otahuhu, Manukau 1640, Auckland, New Zealand; westc{at}


Objective To assess the use of two-channel electroencephalographical (EEG) recordings for predicting adverse neurodevelopmental outcome (death or Bayley II mental developmental index/psychomotor developmental index < 70) in extremely preterm infants and to determine the relationship between quantitative continuity measures and a specialist neurophysiologist assessment of the same EEG segment for predicting outcome.

Design Observational study.

Setting The study was conducted in a neonatal intensive care unit.

Patients Preterm infants born <29 weeks' gestation.

Interventions Two-channel EEGs using the reBRM2 monitor (BrainZ Instruments, Auckland, New Zealand) within 48 h of delivery. One-hour segments were analysed, blinded to the clinical outcome, by off-line quantitative analysis of continuity and a review of the raw EEG by a neurophysiologist.

Main outcome measures Developmental assessment at a median of 15 months' corrected age.

Results 76 infants had an EEG within 48 h of delivery and a developmental assessment. The analysed segment of the EEG was obtained at 24 (3–48) h of age (median (range)). The neurophysiologist's assessment was a better predictor of adverse outcome than the continuity measures (positive predictive value 95% CI 75 (54% to 96%) vs 41 (22% to 60) at 25-µV threshold, negative predictive value 88 (80% to 96%) vs 84 (74% to 94%) and positive likelihood ratio 9.0 (3.2 to 24.6) vs 2.0 (1.2 to 3.6)). All the infants with definite seizures identified by the neurophysiologist had poor outcomes.

Conclusions Modified cot-side EEG has potential to assist with identification of extremely preterm infants at risk for adverse neurodevelopmental outcomes. However, analysis by a neurophysiologist performed better than the currently available continuity analyses.

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  • Funding CRW received a University of Auckland Senior Health Research Scholarship during the period of data collection. The reBRM EEG machines were leased from BrainZ Instruments using a University of Auckland Staff Research Grant awarded to MRB.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Auckland Ethics Committee X and The University of Auckland ethics committee, and the Auckland District Health Board granted ethical approval.

  • Provenance and peer review Not commissioned; externally peer reviewed.