Prognostic value of abnormal EEG transients in preterm and full-term neonates

doi:10.1016/0921-884X(96)95649-0

Electroencephalography and Clinical Neurophysiology

Volume 99, Issue 1, July 1996, Pages 1-9

https://doi.org/10.1016/0921-884X(96)95649-0 Get rights and content

Abstract

The prognostic value of abnormal EEG transients was investigated in 362 subjects submitted to EEG recording during the neonatal age and followed-up at least until the 12th month of corrected age. The incidence of negative and positive spikes and sharp waves, of rhythmic sharp θ and σ activities and of α discharges were evaluated by means of a quantitative score. These abnormal EEG transients appeared to be generally rare and even absent in a large number of subjects. In infants with normal outcome their incidence tends to increase from low postmenstrual ages towards term period. Full-term newborns with abnormal neurological outcome presented a significantly higher incidence of these transients. Preterm infants with unfavourable evolution showed a higher incidence only when submitted to EEG recording at around term age. However, no difference between subjects with normal and abnormal outcome was detected in preterm infants when evaluated at low postmenstrual ages. The hypothesis that at low postmenstrual ages brain damage might, on the one hand, give rise to abnormal transients and, on the other, alter the ‘capability’ of manifesting them (together with other EEG maturational aspects), might explain these results.

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Citation Excerpt :
However, to do this they amalgamated several different types of transients together (negative or positive sharp waves or spikes, rhythmic sharp theta or delta activity, and alpha discharges). The incidence of these transients in a high risk population (of mixed pathology and gestation) was quantified and 78% of recordings had no abnormal transient detected, or less than 1 per 5 min (Biagioni et al., 1996). They did find a significant correlation between the incidence of abnormal transients and the long term outcome among those >36 weeks gestation at birth, however the difference was an incidence per 5 min epoch of, 0.63 ± 1.05 for a normal outcome, 1.6 ± 1.36 for a severely abnormal outcome, and 2 ± 2 among those that died.
Neonatal hypoxic ischaemic encephalopathy continues to be one of the leading causes of morbidity and mortality among neonates around the globe. With the advent of therapeutic hypothermia, the need to accurately classify the severity of injury in the early neonatal period is of great importance. As clinical measures cannot always accurately estimate the severity early enough for treatment to be initiated, clinicians have become more dependent on conventional and amplitude integrated EEG. Despite this, there is currently no single agreed classification scheme for the neonatal EEG in hypoxic ischaemic encephalopathy. In this review we discuss classification schemes of neonatal background EEG, published over the past 35 years, highlighting the urgent need for a universal visual analysis scheme.
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In the bursts, the delta waves are too high and slow for the conceptional age in the occipital and temporal areas (Hayakawa et al., 1997a,b; Watanabe et al., 1999) and the theta rhythms are too high in the occipital areas. The other immature elements are the persistence of temporal saw tooth after 32 weeks CA (Biagioni et al., 1994, 1996a,b) (Fig. 1), the persistence of delta-brushes after 36 weeks CA (Watanabe and Iwase, 1972), and the asynchrony of occipital and/or temporal and/or rolandic high-amplitude slow waves. We included interhemispheric asynchrony in this definition because synchrony of high-amplitude EEG bursts has been described during maturation of the normal premature infant from 28 to 29 weeks GA (Vecchierini et al., 2003).
To analyze EEG findings, especially chronic-stage EEG abnormalities, i.e., dysmature and disorganized patterns, during the late neonatal period in very premature infants without severe early cranial ultrasound and/or EEG abnormalities.
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Fifty-eight infants were studied. Abnormal EEGs were observed in 28 infants: 7 infants with dysmature EEGs, 13 infants with disorganized EEGs, and 8 infants with dysmature-disorganized EEGs. At 12-month corrected age, 15 of 28 infants had various neurological abnormalities. Normal EEGs were observed in 30 infants. None of these infants showed any marked motor or cognitive impairment. The neurological abnormality difference between these two groups of infants was highly significant (p < 0.0001).
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Les aspects pathologiques de l’EEG du grand prématuré portent sur les anomalies de l’organisation du tracé de fond et sur la présence de figures pathologiques. Parmi celles-ci, les pointes positives rolandiques (PPR) tiennent une place importante par leur valeur diagnostique et pronostique bien reconnue dans la leucomalacie périventriculaire du prématuré. Les anomalies du tracé de fond apportent des renseignements complémentaires essentiels. Les graphoéléments inhabituels par leur morphologie, leur amplitude ou leur localisation sont des marqueurs potentiels précoces de lésions cérébrales. L’analyse de ces aspects pathologiques doit tenir compte des médicaments administrés à l’enfant et qui peuvent modifier l’EEG. Plusieurs cas cliniques illustrent l’intérêt d’une surveillance systématique et régulière de l’EEG.

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Main articlePrognostic value of abnormal EEG transients in preterm and full-term neonates

Abstract

Electroenceph. clin. Neurophysiol.

Rev. EEG Neurophysiol.

Electroenceph. clin. Neurophysiol.

Electroenceph. clin. Neurophysiol.

Rev. EEG Neurophysiol. Clin.

Behav. Brain Res.

Electroenceph. clin. Neurophysiol.

Electroenceph. clin. Neurophysiol.

Electroenceph. clin. Neurophysiol.

Electroenceph. clin. Neurophysiol.

Electroenceph. clin. Neurophysiol.

EEG and the neuropathology in premature neonates intraventricular haemorrhage

J. Clin. Neurophysiol.

Registrazioni in video-EEG dinamico nelle convulsioni neonatali

Neonatologica

Les pointes au vertex chez le nouveau-né en anoxie cerebrale aigue. Interêt prognostique

Arch. Fr. Pediatr.

Main article
Prognostic value of abnormal EEG transients in preterm and full-term neonates