Prognostic Value of EEG Depression in Preterm Infants for Later Development of Cerebral Palsy

 

 Buy Article Permissions and Reprints

Abstract

The aim of this study is to examine the most appropriate timing for EEG recordings in order to predict the risk of cerebral palsy (CP) on the basis of the degree of acute stage abnormalities (ASA) in preterm infants. We retrospectively investigated the correlation between the degree of ASA and psychomotor outcome of 295 infants born between 27 and 32 weeks of gestational age whose initial EEG recording was performed within 7 days of life. Forty-six infants were diagnosed as having CP at 18 months of corrected age, and most of them suffered from diplegia due to periventricular leukomalacia (PVL). The maximum degree of ASA correlated with a later development of CP and its severity. Correlation between the degree of ASA and the severity of CP was highest on day 1 - 2, but this tendency was less clear after day 3. Specificity and negative predictive value were generally high within the first 7 days of life. But sensitivity was markedly decreased after day 3, and positive predictive value was highest on day 2. An EEG on day 1 or 2 will be useful in order to predict developmental outcome of preterm infants on the basis of the grade of ASA.

References

• 1 Baud O, d'Allest A M, Lacaze-Masmonteil T, Zupan V, Nedelcoux H, Boithias C. et al . The early diagnosis of periventricular leukomalacia in premature infants with positive rolandic sharp waves on serial electroencephalography.  J Pediatr. 1998;  132 813-817
  PubMedGoogle Scholar
• 2 Bejar R, Coen R W, Merritt T A, Vaucher Y, Trice J, Centeno R. et al . Focal necrosis of the white matter (periventricular leukomalacia): sonographic, pathologic, and electroencephalographic features.  AJNR Am J Neuroradiol. 1986;  7 1073-1079
  PubMedGoogle Scholar
• 3 Biagioni E, Bartalena L, Biver P, Pieri R, Cioni G. Electroencephalographic dysmaturity in preterm infants: a prognostic tool in the early postnatal period.  Neuropediatrics. 1996;  27 311-316
  PubMedGoogle Scholar
• 4 Biagioni E, Bartalena L, Boldrini A, Pieri R, Cioni G. Electroencephalography in infants with periventricular leukomalacia: prognostic features at preterm and term age.  J Child Neurol. 2000;  15 1-6
  CrossrefPubMedGoogle Scholar
• 5 Connell J, de Vries L, Oozeer R, Regev R, Dubowitz L M, Dubowitz V. Predictive value of early continuous electroencephalogram monitoring in ventilated preterm infants with intraventricular hemorrhage.  Pediatrics. 1988;  82 337-343
  PubMedGoogle Scholar
• 6 Hagberg B, Hagberg G, Olow I, von Wendt L. The changing panorama of cerebral palsy in Sweden. VII. Prevalence and origin in the birth year period, 1987 - 1990.  Acta Paediatr. 1996;  85 954-960
  CrossrefPubMedGoogle Scholar
• 7 Hayakawa F, Okumura A, Kato T, Kuno K, Watanabe K. Disorganized patterns: chronic-stage EEG abnormality of the late neonatal period following severely depressed EEG activities in early preterm infants.  Neuropediatrics. 1997;  28 272-275
  Article in Thieme ConnectPubMedGoogle Scholar
• 8 Hayakawa F, Okumura A, Kato T, Kuno K, Watanabe K. Determination of timing of brain injury in preterm infants with periventricular leukomalacia with serial neonatal electroencephalography.  Pediatrics. 1999;  104 1077-1081
  CrossrefPubMedGoogle Scholar
• 9 Holmes G L, Lombroso C T. Prognostic value of background patterns in the neonatal EEG.  J Clin Neurophysiol. 1993;  10 323-352
  CrossrefPubMedGoogle Scholar
• 10 Hughes J R, Guerra R. The use of the EEG to predict outcome in premature infants with positive sharp waves.  Clin Electroencephalogr. 1994;  25 127-135
  PubMedGoogle Scholar
• 11 Marret S, Parain D, Jeannot E, Eurin D, Fessard C. Positive rolandic sharp waves in the EEG of the premature newborn: a five year prospective study.  Arch Dis Child. 1992;  67 948-951
  CrossrefPubMedGoogle Scholar
• 12 Marret S, Parain D, Menard J F, Blanc T, Devaux A M, Ensel P. et al . Prognostic value of neonatal electroencephalography in premature newborns less than 33 weeks of gestational age.  Electroencephalogr Clin Neurophysiol. 1997;  102 178-185
  PubMedGoogle Scholar
• 13 Okumura A, Hayakawa F, Kato T, Kuno K, Watanabe K. MRI findings in patients with spastic cerebral palsy I: Correlation with gestational age at birth.  Dev Med Child Neurol. 1997;  39 363-368
  PubMedGoogle Scholar
• 14 Okumura A, Hayakawa F, Kato T, Kuno K, Watanabe K. Positive rolandic sharp waves in preterm infants with periventricular leukomalacia: their relation to background electroencephalographic abnormalities.  Neuropediatrics. 1999;  30 278-282
  Article in Thieme ConnectPubMedGoogle Scholar
• 15 Pharoah P O, Platt M J, Cooke T. The changing epidemiology of cerebral palsy.  Arch Dis Child Fetal Neonatal Ed. 1996;  75 F169-F173
  PubMedGoogle Scholar
• 16 Radvanyi-Bouvet M F, de Bethmann O, Monset-Couchard M, Fazzi E. Cerebral lesions in early prematurity: EEG prognostic value in the neonatal period.  Brain Dev. 1987;  9 399-405
  PubMedGoogle Scholar
• 17 Tharp B R, Scher M S, Clancy R R. Serial EEGs in normal and abnormal infants with birth weights less than 1200 grams - a prospective study with long term follow-up.  Neuropediatrics. 1989;  20 64-72
  PubMedGoogle Scholar
• 18 Watanabe K, Hayakawa F, Okumura A. Neonatal EEG: a powerful tool in the assessment of brain damage in preterm infants.  Brain Dev. 1999;  21 361-372
  CrossrefPubMedGoogle Scholar

M. D. Koichi Maruyama

Department of Pediatrics
Nagoya University Graduate School of Medicine

65 Tsurumai-cho

Showa-ku, Nagoya, Aichi 466 - 8550

Japan

Email: kmaruyam@med.nagoya-u.ac.jp