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Neuropediatrics
DOI: 10.1055/a-2436-8767
Original Article

Amplitude-Integrated Electroencephalogram in Premature Infants: A Prospective Cohort Study

Gayathri G. Vinnakota 
1   Department of Paediatrics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
,
Leslie E. Lewis 
1   Department of Paediatrics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
,
Shruthi K. Bharadwaj 
2   Department of Neonatology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
,
Jayashree Purkayastha 
1   Department of Paediatrics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
,
Anand K. Patil 
1   Department of Paediatrics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
› Author Affiliations Funding None.

Trial Registration Number CTRI/2021/05/033540
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Abstract

Objective The study aimed to interpret and establish patterns of amplitude-integrated electroencephalogram (aEEG) in stable preterm neonates and compare the aEEG among different gestational age groups using three standard classifications.

Methods This prospective cohort study included stable preterm neonates between 240/7 and 366/7 weeks of gestation. aEEG was recorded in the first and second week of life and interpreted using the L. Hellström–Westas, Burdjalov, and Magalhães classification for background pattern, continuity, upper and lower margin amplitude, sleep–wake cycle, bandwidth, and presence of seizures. Subgroup analysis was performed based on ≤30 and >30 weeks' gestation.

Results A total of 76 aEEG recordings were analyzed from 45 preterm neonates. In the first week, 60% of the neonates had normal voltage patterns, which increased to 80% in the second week. All infants ≤30 weeks displayed discontinuous wave patterns during the first week, and half transitioned to continuous waves in the second week. The lower margin amplitude increased, and the upper margin amplitude decreased with increased gestational age. Additionally, 65% of neonates had a mature sleep–wake cycle in the second week compared with 22% in the first week. The median (interquartile range) CFM score in the second week was 12 (4.5) compared with 8 (4) in the first week, and the CFM score positively correlated with gestation (Spearman correlation coefficient, 0.8; 95% confidence interval, 0.7–0.86). Magalhães grading in both groups was predominantly normal.

Conclusion aEEG is predominantly a continuous normal voltage pattern in >30 weeks' gestation and discontinuous in ≤30 weeks' gestation. CFM score correlates positively with advancing gestation gestational age.

Keywords

amplitude-integrated EEG - aEEG - background activity - preterm - sleep–wake cycle - upper margin amplitude - lower margin amplitude - bandwidth

Institutional Ethics Committee

IEC 929/2020.


Future Directions

Further research is needed to describe abnormal patterns in preterm aEEG and their associations with adverse outcomes. There is a need for studies on using aEEG to predict long-term outcomes in preterm infants. There is also a need for a simplified algorithm to interpret bedside aEEG in preterm infants, which can be easily applied in clinical settings for neurological surveillance of preterm infants.


Authors' Contributions

G.G.V.: conceptualization of study design, patient recruitment, conduction of the studies, analysis and interpretation of the records, preparation of manuscript. L.E.L.: conceptualization of study design, analysis and interpretation of the records, final revision, and approval of the manuscript. S.K.B.: conceptualization of study design, analysis and interpretation of the records, preparation, final revision, and approval of the manuscript. J.P.: conceptualization of study design, final revision, and approval of the manuscript. A.K.P.: data collection and study conduct. All authors reviewed the results and approved the final version of the manuscript.


Supplementary Material



Publication History

Received: 23 April 2024

Accepted: 08 October 2024

Accepted Manuscript online:
09 October 2024

Article published online:
04 November 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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