Th value of amplitude-integrated electroencephalography (aEEG) in the newborn is explored by researchers at Washington University, St Louis; Wilhelmina Children’s Hospital, Utrecht, Netherlands; and Uppsala University Hospital, Sweden. The system was originally designed to monitor lower amplitude signals of 1 to 10 mcV and depressed cerebral activity in adults undergoing bypass surgery, as well as seizure activity. Meta-analysis has confirmed that the aEEG pattern in the first 6 hours of life of term newborns with hypoxic-ischemic encephalopathy is strongly predictive of outcome. Pattern-recognition may be more reliable than amplitude in the evaluation of aEEG. The electrode placement over parietal areas, coinciding with vulnerable watershed areas of cortex, yields a high sensitivity (81%) for electrical seizure activity. Bedside aEEG monitoring “on-line” and around the clock is underway in the NICU to explore feasibility and impact on management of electrographic seizures. In contrast to a low sensitivity and high false-positive rate using electronic fetal heart monitoring, the early use of aEEG has a sensitivity of 85% to 91% for predicting neurodevelopmental outcome in term newborn infants with neonatal encephalopathy. aEEG is used to recruit patients for study of therapeutic hypothermia, and clinically to evaluate the newborn by complementing the neurologic examination, conventional EEG, and neuroimaging, not in isolation. [1]
COMMENT. Analsis of clinical data at 18 months in a study of head cooling for neonatal encephalopathy found that infants with greater amplitude-integrated EEG, lower birth weight, absence of seizures, and higher Apgar score had significantly better outcomes. Gender and gestational age were not significantly associated with outcome (Ped Neur Briefs June 2007;21:48). [2]