Early Prediction of Outcome with aEEG in Preterm Infants with Large Intraventricular Hemorrhages

Abstract

Background

The electrocortical background contains prognostic information in full-term asphyxiated newborn infants already during the first postnatal hours. In preterm infants with intraventricular hemorrhages (IVH) the background activity in EEG and amplitude-integrated EEG (aEEG) is depressed during the first days of life, and the extent of the depression correlates with the degree of IVH. However, it has not been previously evaluated whether very early aEEG can predict later outcome also in preterm infants.

Objective

To investigate if early prediction of outcome is possible from aEEG in preterm infants with large IVH.

Methods

aEEG recordings from the first postnatal week were investigated in 64 preterm infants with IVH grade III - IV. For every 24-hour period the aEEG background pattern was classified, and the maximum and minimum numbers of bursts/h, respectively, were counted. Outcome was divided into three categories: died (n = 36), survived (n = 28) with “poor” outcome, i.e., severe cerebral palsy and not able to walk and/or mental retardation (n = 8), and survived with “fair” outcome, i.e., healthy or mild cerebral palsy (n = 19). One surviving child was lost in the follow-up.

Results

There were significant differences in maximum bursts/h (MaxB) at 0 - 24 hours (p = 0.033), 24 - 48 hours (p = 0.011), 48 - 72 hours (p = 0.049) and 72 - 96 hours (p = 0.032), respectively, between the infants who died and the surviving infants. At 24 - 48 hours the median (range) MaxB in the surviving infants with “fair” outcome was 156 (103 - 179) versus 102 (73 - 156) in the surviving infants with “poor” outcome (p = 0.002). With the assumption that MaxB < 130 was predictive of death or survival with “poor” outcome, 68 % and 78 % of infants were correctly predicted at 0 - 24 hours and 24 - 48 hours, respectively.

Conclusions

This study shows that outcome may be predicted with aEEG already during the first days of life in preterm infants with large IVH. The findings should be confirmed in prospective studies since they may have clinical implications if specific medical interventions become available.

Preterm infant · Intraventricular hemorrhage · EEG · Amplitude-integrated EEG · Outcome

References

• 1 Armstrong D L, Sauls D, Goddard-Finegold J. Neuropathologic findings in short-term survivors of intraventricular hemorrhage.  AJDC. 1987;  141 617-621
• 2 Aso K, Abdab-Barmada M, Scher M. EEG and neuropathology in premature neonates with intraventricular haemorrhage.  J Clin Neurophysiol. 1993;  10 304-313
• 3 Bell A H, Greisen G, Pryds O. Comparison of the effects of phenobarbitone and morphine administration on EEG activity in preterm babies.  Acta Paediatr. 1993;  82 35-39
• 4 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
• 5 Bjerre I, Hellström-Westas L, Rosén I, Svenningsen N W. Monitoring of cerebral function after severe asphyxia in infancy.  Arch Dis Child. 1983;  58 997-1002
• 6 Borch K, Greisen G. Blood flow distribution in the normal human preterm brain.  Pediatr Res. 1998;  43 28-33
• 7 Clancy R R, Tharp B R, Enzman D. EEG in premature infants with intraventricular hemorrhage.  Neurology. 1984;  34 583-590
• 8 Connell J, Oozeer R, Regev R, deVries L, Dubowitz L MS, Dubowitz V. Continuous four-channel EEG monitoring in the evaluation of echodense ultrasound lesions and cystic leucomalacia.  Arch Dis Child. 1987;  62 1019-1024
• 9 Connell J, deVries L, Oozeer R, Regev R, Dubowitz L MS, Dubowitz V. Predictive value of early continuous electroencephalogram monitoring in ventilated preterm infants with intraventricular hemorrhage.  Pediatrics. 1988;  82 337-343
• 10 de Vries L S, Dubowitz L M, Dubowitz V, Kaiser A, Lary S, Silverman M, Whitelaw A, Wigglesworth J S. Predictive value of cranial ultrasound in the newborn: a reappraisal.  Lancet. 1985;  20 137-114
• 11 Eken P, Toet M C, Groenendaal F, de Vries L S. Predictive value of early neuroimaging, pulsed Doppler and neurophysiology in full term infants with hypoxic-ischaemic encephalopathy.  Arch Dis Child. 1995;  73 F75-80
• 12 Finnstrom O, Otterblad Olausson P, Sedin G. et al . Neurosensory outcome and growth at three years in extremely low birthweight infants: follow-up results from the Swedish national prospective study.  Acta Paediatr. 1998;  87 1055-1060
• 13 Ginsberg M D. The ischemic penumbra, injury thresholds, and therapeutic window for acute stroke.  Ann Neurol. 1994;  36 553-554
• 14 Greisen G, Hellström-Westas L, Lou H, Rosén I, Svenningsen N W. EEG depression and germinal layer haemorrhage in the newborn.  Acta Paediatr Scand. 1987;  76 519-525
• 15 Greisen G, Pryds O. Low CBF, discontinuous EEG activity and periventricular brain injury in ill preterm neonates.  Brain Dev. 1989;  11 164-168
• 16 Guzetta F, Shackelford G D, Volpe S, Perlman J M, Volpe J J. Periventricular intraparenchymal echodensities in the premature newborn: Critical determinant of neurologic outcome.  Pediatrics. 1986;  78 995-1006
• 17 Hellström-Westas L, Rosén I, Svenningsen N W. Silent seizures in sick infants in early life.  Acta Paediatr Scand. 1985;  74 741-748
• 18 Hellström-Westas L, Rosén I, Svenningsen N W. Cerebral function monitoring during the first week of life in extremely small low birthweight (ESLBW) infants.  Neuropediatrics. 1991;  22 27-32
• 19 Hellström-Westas L, Bell A H, Skov L, Greisen G, Svenningsen N W. Cerebroelectrical depression following surfactant treatment in preterm neonates.  Pediatrics. 1992;  89 643-647
• 20 Hellström-Westas L, Rosén I, Svenningsen N W. Predictive value of early continuous amplitude integrated EEG recordings on outcome after severe birth asphyxia in full term infants.  Arch Dis Child. 1995;  72 F34-F38
• 21 McMenamin J B, Shackelford G D, Volpe J J. Outcome of neonatal intraventricular hemorrhage with periventricular echodense lesions.  Ann Neurol. 1984;  15 285-290
• 22 Papile L, Burstein L, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: A study of infants with birthweights less than 1500 g.  J Pediatr. 1978;  92 529-534
• 23 Perlman J M, Risser R. Relationship of uric acid concentrations and severe intraventricular hemorrhage/leukomalacia in the premature infant.  J Pediatr. 1998;  132 436-439
• 24 Robertson N J, Edwards A D. Recent advances in developing neuroprotective strategies for perinatal asphyxia.  Curr Opin Pediatr. 1998;  10 575-580
• 25 Scheffzek A, Stahl M, von Toenges. Die Prognose der sehr kleinen Frühgeburt.  Monatschr Kinderheilkunde. 1989;  137 42-48
• 26 Toet M C, Hellström-Westas L, Groenendaal F, Eken P, de Vries L S. Amplitude integrated EEG at 3 and 6 hours after birth in fullterm neonates with hypoxic ischaemic encephalopathy.  Arch Dis Child. 1999;  81 F19-F23
• 27 Thoresen M, Whitelaw A. Cardiovascular changes during mild therapeutic hypothermia and rewarming in infants with hypoxic-ischemic encephalopathy.  Pediatrics. 2000;  106 92-99
• 28 Volpe J J, Herscovith P, Perlman J M, Raichle M E. Positron emission tomography the newborn: Extensive impairment of regional blood flow with intraventricular hemorrhage and hemorrhagic intracerebral involvement.  Pediatrics. 1983;  72 589-601
• 29 Watanabe K, Hakamada S, Kuroyanagi M, Yamazaki T, Takeuchi T. Electroencephalographical study of intraventricular hemorrhage in the preterm infant.  Neuropediatrics. 1983;  14 225-230
• 30 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