Prevalence and etiology of false normal aEEG recordings in neonatal hypoxic-ischaemic encephalopathy

BMC Pediatrics

Miklós Szabó¹  György Schuster²  Dávid Zakariás¹  Barna Vásárhelyi³  Anna Csekő¹  Gábor Marics¹ 

[1] First Department of Pediatrics, Semmelweis University, Budapest, Bókay u. 53–54. H-1083, Hungary;Department of Measurement and Automation, Kálmán Kandó Faculty of Electrical Engineering, Óbuda University, Budapest Bécsi út 96/B, Hungary;Department of Laboratory Medicine, Semmelweis University, Budapest, Üllői út 26, Hungary

关键词: aEEG;    EEG noise;    Fourier analysis;    Muscular artifact;    Perinatal asphyxia;   

Others  :  1144237
DOI  :  10.1186/1471-2431-13-194

 received in 2013-08-30, accepted in 2013-11-21,  发布年份 2013

【 摘 要 】

Background

Amplitude-integrated electroencephalography (aEEG) is a useful tool to determine the severity of neonatal hypoxic-ischemic encephalopathy (HIE). Our aim was to assess the prevalence and study the origin of false normal aEEG recordings based on 85 aEEG recordings registered before six hours of age.

Methods

Raw EEG recordings were reevaluated retrospectively with Fourier analysis to identify and describe the frequency patterns of the raw EEG signal, in cases with inconsistent aEEG recordings and clinical symptoms. Power spectral density curves, power (P) and median frequency (MF) were determined using the raw EEG. In 7 patients non-depolarizing muscle relaxant (NDMR) exposure was found. The EEG sections were analyzed and compared before and after NDMR administration.

Results

The reevaluation found that the aEEG was truly normal in 4 neonates. In 3 neonates, high voltage electrocardiographic (ECG) artifacts were found with flat trace on raw EEG. High frequency component (HFC) was found as a cause of normal appearing aEEG in 10 neonates. HFC disappeared while P and MF decreased significantly upon NDMR administration in each observed case.

Conclusion

Occurrence of false normal aEEG background pattern is relatively high in neonates with HIE and hypothermia. High frequency EEG artifacts suggestive of shivering were found to be the most common cause of false normal aEEG in hypothermic neonates while high voltage ECG artifacts are less common.

【 授权许可】

   
2013 Marics et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Hallberg B, Grossmann K, Bartocci M, Blennow M: The prognostic value of early aEEG in asphyxiated infants undergoing systemic hypothermia treatment. Acta Paediatr 2010, 99(4):531-536.
• [2]Azzopardi D, Brocklehurst P, Edwards D, Halliday H, Levene M, Thoresen M, Whitelaw A, Group TS: The TOBY study. Whole body hypothermia for the treatment of perinatal asphyxial encephalopathy: a randomised controlled trial. BMC Pediatr 2008, 8:17. BioMed Central Full Text
• [3]Johnston MV, Fatemi A, Wilson MA, Northington F: Treatment advances in neonatal neuroprotection and neurointensive care. Lancet Neurol 2011, 10(4):372-382.
• [4]Ramos G, Brotschi B, Latal B, Bernet V, Wagner B, Hagmann C, Swiss Neonatal N: Therapeutic hypothermia in term infants after perinatal encephalopathy: the last 5 years in Switzerland. Early Hum Dev 2013, 89(3):159-164.
• [5]Shalak LF, Laptook AR, Velaphi SC, Perlman JM: Amplitude-integrated electroencephalography coupled with an early neurologic examination enhances prediction of term infants at risk for persistent encephalopathy. Pediatrics 2003, 111(2):351-357.
• [6]Simbruner G, Mittal RA, Rohlmann F, Muche R: neo.n EnTP: systemic hypothermia after neonatal encephalopathy: outcomes of neo.NEURO.Network RCT. Pediatrics 2010, 126(4):e771-778.
• [7]Griesmaier E, Neubauer V, Ralser E, Trawoger R, Kiechl-Kohlendorfer U, Keller M: Need for quality control for aEEG monitoring of the preterm infant: a 2-year experience. Acta Paediatr 2011, 100(8):1079-1083.
• [8]Hagmann CF, Robertson NJ, Azzopardi D: Artifacts on electroencephalograms may influence the amplitude-integrated EEG classification: a qualitative analysis in neonatal encephalopathy. Pediatrics 2006, 118(6):2552-2554.
• [9]Niemarkt H, Andriessen P, Halbertsma FJ: Artefacts in the amplitude-integrated EEG background pattern of a full-term asphyxiated neonate caused by diaphragm spasms. BMJ case reports 2012, 2012:30.
• [10]Toet MC, Lemmers PMA: Brain monitoring in neonates. Early Hum Dev 2009, 85(2):77-84.
• [11]Hellstrom-Westas L, Rosen I: Continuous brain-function monitoring: state of the art in clinical practice. Semin Fetal Neonatal Med 2006, 11(6):503-511.
• [12]Wong FY, Barfield CP, Walker AM: Power spectral analysis of two-channel EEG in hypoxic-ischaemic encephalopathy. Early Hum Dev 2007, 83(6):379-383.
• [13]Thordstein M, Flisberg A, Lofgren N, Bagenholm R, Lindecrantz K, Wallin BG, Kjellmer I: Spectral analysis of burst periods in EEG from healthy and post-asphyctic full-term neonates. Clin Neurophysiol 2004, 115(11):2461-2466.
• [14]Jansky L: Shivering. In Physiology and Pathophysiology of Temperature Regulation. 2nd edition. Edited by Blatteis CM. Singapore: World Scientific Painter; 2001:52.
• [15]Toet MC, Hellstrom-Westas L, Groenendaal F, Eken P, de Vries LS: Amplitude integrated EEG 3 and 6 hours after birth in full term neonates with hypoxic-ischaemic encephalopathy. Arch Dis Child 1999, 81(1):F19-F23.
• [16]van Rooij LGM, Toet MC, Osredkar D, van Huffelen AC, Groenendaal F, de Vries LS: Recovery of amplitude integrated electroencephalographic background patterns within 24 hours of perinatal asphyxia. Arch Dis Child Fetal Neonatal Ed 2005, 90(3):245-251.
• [17]Goncharova II, McFarland DJ, Vaughan TM, Wolpaw JR: EMG contamination of EEG: spectral and topographical characteristics. Clin Neurophysiol 2003, 114(9):1580-1593.
• [18]Shackman AJ, McMenamin BW, Slagter HA, Maxwell JS, Greischar LL, Davidson RJ: Electromyogenic artifacts and electroencephalographic inferences. Brain Topogr 2009, 22(1):7-12.
• [19]Risbourg B, Vural M, Kremp O, de Broca A, Leke L, Freville M: Neonatal thermoregulation. Turk J Pediatr 1991, 33(2):121-134.
• [20]Young GB, da Silva OP: Effects of morphine on the electroencephalograms of neonates: a prospective, observational study. Clin Neurophysiol 2000, 111(11):1955-1960.