RT Journal Article
SR Electronic
T1 Non-expert use of the cerebral function monitor for neonatal seizure detection
JF Archives of Disease in Childhood - Fetal and Neonatal Edition
JO Arch Dis Child Fetal Neonatal Ed
FD BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health
SP F37
OP F40
DO 10.1136/fn.89.1.F37
VO 89
IS 1
A1 J M Rennie
A1 G Chorley
A1 G B Boylan
A1 R Pressler
A1 Y Nguyen
A1 R Hooper
YR 2004
UL http://fn.bmj.com/content/89/1/F37.abstract
AB Background: The cerebral function monitor (CFM) is widely used to detect neonatal seizures, but there are very few studies comparing it with simultaneous electroencephalography (EEG). Objective: To determine the accuracy of non-expert use of the CFM and to assess interobserver agreement of CFM seizure detection. Patients: Babies admitted to the neonatal intensive care unit at King’s College Hospital who were at high risk of seizure and had video-EEG monitoring. Methods: Video-EEG was used to detect seizures. Each baby had CFM recordings at speeds of 6, 15, and 30 cm/h during the EEG. Four neonatologists, trained in CFM seizure recognition, independently rated one hour CFM samples at three speeds from each baby. Interobserver agreement was quantified using Cohen’s κ. Results: CFM traces from 19 babies with EEG seizures and 21 babies without EEG seizures were analysed. Overall non-expert interpretation of the CFM performed poorly as a seizure detector compared with simultaneous EEG (sensitivities 38% at 6 cm/h; 54% at 15 cm/h; 55% at 30 cm/h). Although babies with seizures were more likely to be correctly classified at higher speeds (p = 0.02), babies without seizures were also more likely to be misclassified (p < 0.001). Agreement between observers was not good at any speed (κ values from 0.01 to 0.39). The observers usually detected generalised seizures but often missed seizures that were focal, low amplitude, or lasted less than one minute. Conclusion: Approximately half of all neonatal seizures may be missed using CFM alone. Neonatal seizures need to be diagnosed, characterised, and quantified first using EEG. The CFM may then be useful for long term monitoring.