Abstract
Objective:
Assessing qualitative patterns of amplitude-integrated electroencephalography (aEEG) maturation of preterm infants requires personnel with training in interpretation and an investment of time. Quantitative algorithms provide a method for rapidly and reproducibly assessing an aEEG recording independent of provider skill level. Although there are several qualitative and quantitative normative data sets in the literature, this study provides the broadest array of quantitative aEEG measures in a carefully selected and followed cohort of preterm infants with mild or no visible injury on term-equivalent magnetic resonance imaging (MRI) and subsequently normal neurodevelopment at 2 and 7 years of age.
Study Design:
A two-channel aEEG recording was obtained on days 4, 7, 14 and 28 of life for infants born ⩽30 weeks estimated gestational age. Measures of amplitude and continuity, spectral edge frequency, percentage of trace in interburst interval (IBI), IBI length and frequency counts of smooth delta waves, delta brushes and theta bursts were obtained. MRI was obtained at term-equivalent age and neurodevelopmental testing was conducted at 2 and 7 years of corrected age.
Result:
Correlations were found between increasing postmenstrual age (PMA) and decreasing maximum amplitude (R= −0.23, P=0.05), increasing minimum amplitude (R=0.46, P=0.002) and increasing spectral edge frequency (R=0.78, P=4.17 × 10−14). Negative correlations were noted between increasing PMA and counts of smooth delta waves (R= −0.39, P=0.001), delta brushes (R= −0.37, P=0.003) and theta bursts (R= −0.61, P=5.66 × 10−8). Increasing PMA was also associated with a decreased amount of time spent in the IBI (R= −0.38, P=0.001) and a shorter length of the maximum IBI (R= −0.27, P=0.03).
Conclusion:
This analysis supports a strong correlation between quantitatively determined aEEG measures and PMA, in a cohort of preterm infants with normal term-equivalent age neuroimaging and neurodevelopmental outcomes at 7 years of age, which is both predictable and reproducible. These ‘normative’ quantitative values support the pattern of maturation previously identified by qualitative analysis.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Burdjalov VF, Baumgart S, Spitzer AR . Cerebral function monitoring: a new scoring system for the evaluation of brain maturation in neonates. Pediatrics 2003; 112 (4): 855–861.
Hellström-Westas L, De Vries LS, Rosén I . Atlas of Amplitude-Integrated EEGs in the newborn. Informa Healthcare; Distributed in North and South America by Taylor & Francis: London; Boca Raton, FL, 2008.
Vecchierini M-F, André M, d’ Allest AM . Normal EEG of premature infants born between 24 and 30 weeks gestational age: terminology, definitions and maturation aspects. Neurophysiol Clin Clin Neurophysiol 2007; 37 (5): 311–323.
West CR, Harding JE, Williams CE, Nolan M, Battin MR . Cot-side electroencephalography for outcome prediction in preterm infants: observational study. Arch Dis Child Fetal Neonatal Ed 2011; 96 (2): F108–F113.
Niemarkt HJ, Andriessen P, Peters CHL, Pasman JW, Blanco CE, Zimmermann LJ, et al. Quantitative analysis of amplitude-integrated electroencephalogram patterns in stable preterm infants, with normal neurological development at one year. Neonatology 2010; 97 (2): 175–182.
Palmu K, Wikström S, Hippeläinen E, Boylan G, Hellström-Westas L, Vanhatalo S . Detection of ‘EEG bursts’ in the early preterm EEG: visual vs automated detection. Clin Neurophysiol 2010; 121 (7): 1015–1022.
Wilson SB . A neural network method for automatic and incremental learning applied to patient-dependent seizure detection. Clin Neurophysiol 2005; 116 (8): 1785–1795.
Roessgen M, Zoubir AM, Boashash B . Seizure detection of newborn EEG using a model-based approach. IEEE Trans Biomed Eng 1998; 45 (6): 673–685.
Liu A, Hahn JS, Heldt GP, Coen RW . Detection of neonatal seizures through computerized EEG analysis. Electroencephalogr Clin Neurophysiol 1992; 82 (1): 30–37.
Gotman J, Flanagan D, Zhang J, Rosenblatt B . Automatic seizure detection in the newborn: methods and initial evaluation. Electroencephalogr Clin Neurophysiol 1997; 103 (3): 356–362.
Navakatikyan MA, Colditz PB, Burke CJ, Inder TE, Richmond J, Williams CE . Seizure detection algorithm for neonates based on wave-sequence analysis. Clin Neurophysiol 2006; 117 (6): 1190–1203.
Thornberg E, Thiringer K . Normal pattern of the cerebral function monitor trace in term and preterm neonates. Acta Paediatr Scand 1990; 79 (1): 20–25.
Natalucci G, Hagmann C, Bernet V, Bucher H-U, Rousson V, Latal B . Impact of perinatal factors on continuous early monitoring of brain electrocortical activity in very preterm newborns by amplitude-integrated EEG. Pediatr Res 2014; 75 (6): 774–780.
Niemarkt HJ, Jennekens W, Pasman JW, Katgert T, Van Pul C, Gavilanes AWD, et al. Maturational changes in automated EEG spectral power analysis in preterm infants. Pediatr Res 2011; 70 (5): 529–534.
Hack M, Taylor HG, Drotar D, Schluchter M, Cartar L, Wilson-Costello D, et al. Poor predictive validity of the Bayley Scales of Infant Development for cognitive function of extremely low birth weight children at school age. Pediatrics 2005; 116 (2): 333–341.
Spittle AJ, Cheong J, Doyle LW, Roberts G, Lee KJ, Lim J, et al. Neonatal white matter abnormality predicts childhood motor impairment in very preterm children. Dev Med Child Neurol 2011; 53 (11): 1000–1006.
Filan PM, Hunt RW, Anderson PJ, Doyle LW, Inder TE . Neurologic outcomes in very preterm infants undergoing surgery. J Pediatr 2012; 160 (3): 409–414.
Shah DK, Doyle LW, Anderson PJ, Bear M, Daley AJ, Hunt RW, et al. Adverse neurodevelopment in preterm infants with postnatal sepsis or necrotizing enterocolitis is mediated by white matter abnormalities on magnetic resonance imaging at term. J Pediatr 2008; 153 (2): 170–175.
West CR, Harding JE, Williams CE, Gunning MI, Battin MR . Quantitative electroencephalographic patterns in normal preterm infants over the first week after birth. Early Hum Dev 2006; 82 (1): 43–51.
Bell AH, McClure BG, McCullagh PJ, McClelland RJ . Spectral edge frequency of the EEG in healthy neonates and variation with behavioural state. Biol Neonate 1991; 60 (2): 69–74.
Sisman J, Campbell DE, Brion LP . Amplitude-integrated EEG in preterm infants: maturation of background pattern and amplitude voltage with postmenstrual age and gestational age. J Perinatol 2005; 25 (6): 391–396.
Inder TE, Buckland L, Williams CE, Spencer C, Gunning MI, Darlow BA, et al. Lowered electroencephalographic spectral edge frequency predicts the presence of cerebral white matter injury in premature infants. Pediatrics 2003; 111 (1): 27–33.
Mitchell TJ, Neil JJ, Zempel JM, Thio LL, Inder TE, Bretthorst GL . Automating the analysis of EEG recordings from prematurely-born infants: a Bayesian approach. Clin Neurophysiol Off J Int Fed Clin Neurophysiol 2013; 124 (3): 452–461.
Hellstrom-Westas L, Rosen I, de Vries LS, Greisen G . Amplitude-integrated EEG classification and interpretation in preterm and term infants. NeoReviews 2006; 7 (2): e76–e87.
Benders MJ, Palmu K, Menache C, Borradori-Tolsa C, Lazeyras F, Sizonenko S, et al. Early brain activity relates to subsequent brain growth in premature infants. Cereb Cortex [Internet] 27 May 2014. Available at: http://www.cercor.oxfordjournals.org/cgi/doi/10.1093/cercor/bhu097 (7 November 2014).
Hayakawa F, Okumura A, Kato T, Kuno K, Watanabe K . Dysmature EEG pattern in EEGs of preterm infants with cognitive impairment: maturation arrest caused by prolonged mild CNS depression. Brain Dev 1997; 19 (2): 122–125.
Kidokoro H, Anderson PJ, Doyle LW, Woodward LJ, Neil JJ, Inder TE . Brain injury and altered brain growth in preterm infants: predictors and prognosis. Pediatrics 2014; 134 (2): e444–e453.
Eaton DG, Wertheim D, Oozeer R, Dubowitz LM, Dubowitz V . Reversible changes in cerebral activity associated with acidosis in preterm neonates. Acta Paediatr 1994; 83 (5): 486–492.
Bell AH, Greisen G, Pryds O . Comparison of the effects of phenobarbitone and morphine administration on EEG activity in preterm babies. Acta Paediatr 1993; 82 (1): 35–39.
Wikström S, Ley D, Hansen-Pupp I, Rosén I, Hellström-Westas L . Early amplitude-integrated EEG correlates with cord TNF-alpha and brain injury in very preterm infants. Acta Paediatr 2008; 97 (7): 915–919.
Stoll BJ, Hansen NI, Bell EF, Shankaran S, Laptook AR, Walsh MC, et al. Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network. Pediatrics 2010; 126 (3): 443–456.
Acknowledgements
We thank Peter Anderson, PhD, and the Victorian Infants Brain Study research group for their assistance in collection and analysis of the presented data. This work was supported by National Institutes of Health, NICHD (P30 HD062171 and R01 HD057098) and Doris Duke Distinguished Clinical Scientist Award.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
Vesoulis, Z., Paul, R., Mitchell, T. et al. Normative amplitude-integrated EEG measures in preterm infants. J Perinatol 35, 428–433 (2015). https://doi.org/10.1038/jp.2014.225
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/jp.2014.225
This article is cited by
-
The effects of betamethasone on the amplitude integrated EEG of infants born at 34- or 35-weeks gestation
Journal of Perinatology (2022)
-
A practical approach toward interpretation of amplitude integrated electroencephalography in preterm infants
European Journal of Pediatrics (2022)
-
Neurovascular coupling (NVC) in newborns using processed EEG versus amplitude-EEG
Scientific Reports (2021)
-
Functional maturation in preterm infants measured by serial recording of cortical activity
Scientific Reports (2017)