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The Impact of Amplitude-Integrated Electroencephalography on NICU Practice

Published online by Cambridge University Press:  02 December 2014

Juan Pablo Appendino ,
Patrick J. McNamara ,
Matthew Keyzers ,
Derek Stephens  and
Cecil D. Hahn
Juan Pablo Appendino
Affiliation:
Division of Neurology, The Hospital for Sick Children Research Institute and University of Toronto, Toronto, Ontario Division of Neurology, Children's Hospital of Winnipeg and the University of Manitoba, Winnipeg, Manitoba, Canada
Patrick J. McNamara
Affiliation:
Division of Neonatology, The Hospital for Sick Children Research Institute and University of Toronto, Toronto, Ontario
Matthew Keyzers
Affiliation:
Division of Neonatology, The Hospital for Sick Children Research Institute and University of Toronto, Toronto, Ontario
Derek Stephens
Affiliation:
Clinical Research Support Unit, The Hospital for Sick Children Research Institute and University of Toronto, Toronto, Ontario
Cecil D. Hahn*
Affiliation:
Division of Neurology, The Hospital for Sick Children Research Institute and University of Toronto, Toronto, Ontario
*
Division of Neurology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada. Email: cecil.hahn@sickkids.ca
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Abstract

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Objective:

To examine how the introduction of amplitude-integrated electroencephalography (aEEG) to our neonatal intensive care unit (NICU) influenced clinical practice.

Methods:

This was a retrospective study examining clinical practice three years before and three years after the introduction of aEEG monitors to our NICU. A time series analysis was performed to explore whether aEEG introduction was associated with changes in the rates of conventional EEGs performed, neurology consultations and neonates diagnosed with seizures.

Results:

Following aEEG introduction, the total number of conventional EEGs performed remained constant; however, there was significant shift in conventional EEG utilization towards neonates receiving fewer multiple EEGs and more single EEGs. There was no change in the rate of neurology consultations or the number of neonates diagnosed with seizures.

Conclusions:

Introduction of aEEG monitors to our NICU has led to less reliance on conventional EEG as a tool for the serial evaluation of brain function. Since the number of neonates diagnosed with seizures did not increase, aEEG monitoring did not appear to uncover a significant subgroup of patients with subclinical seizures that would previously have gone undetected. Conventional EEG and aEEG are complementary tools for the assessment of newborn cerebral function.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 39 , Issue 3 , May 2012 , pp. 355 - 360
Copyright
Copyright © The Canadian Journal of Neurological 2012

References

1Gluckman, PD, Wyatt, JS, Azzopardi, D, et al.Selective head cooling with mild systemic hypothermia after neonatal encephalopathy: multicentre randomised trial. Lancet. 2005; 365: 663–70.Google Scholar
2al Naqeeb, N, Edwards, AD, Cowan, FM, Azzopardi, D.Assessment of neonatal encephalopathy by amplitude-integrated electroencephalography. Pediatrics. 1999; 103: 1263–71.Google Scholar
3Hellstrom-Westas, L, Rosen, I, Svenningsen, NW.Predictive value of early continuous amplitude integrated EEG recordings on outcome after severe birth asphyxia in full term infants. Arch Dis Child Fetal Neonatal Ed. 1995; 72: F34–8.CrossRefGoogle ScholarPubMed
4ter Horst, HJ, Sommer, C, Bergman, KA, Fock, JM, van Weerden, TW, Bos, AF.Prognostic significance of amplitude-integrated EEG during the first 72 hours after birth in severely asphyxiated neonates. Pediatr Res. 2004; 55: 1026–33.Google Scholar
5Shany, E, Goldstein, E, Khvatskin, S, et al.Predictive value of amplitude-integrated electroencephalography pattern and voltage in asphyxiated term infants. Pediatr Neurol. 2006; 35: 335–42.Google Scholar
6Toet, 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 Fetal Neonatal Ed. 1999; 81: F19–23.CrossRefGoogle ScholarPubMed
7Shellhaas, RA, Soaita, AI, Clancy, RR.Sensitivity of amplitude-integrated electroencephalography for neonatal seizure detection. Pediatrics. 2007; 120: 770–7.CrossRefGoogle ScholarPubMed
8Mathur, AM, Morris, LD, Teteh, F, Inder, TE, Zempel, J.Utility of prolonged bedside amplitude-integrated encephalogram in encephalopathic infants. Am J Perinatol. 2008; 25: 611–15.Google Scholar
9Freeman, JM.The use of amplitude-integrated electroencephalography: beware of its unintended consequences. Pediatrics. 2007; 119: 615–17.Google Scholar
10Shah, DK, de Vries, LS, Hellstrom-Westas, L, Toet, MC, Inder, TE.Amplitude-integrated electroencephalography in the newborn: a valuable tool. Pediatrics. 2008; 122: 863–5.Google Scholar
11Hellström-Westas, L.Comparison between tape-recorded and amplitude-integrated EEG monitoring in sick newborn infants. Acta Paediatr. 1992; 81: 812–19.CrossRefGoogle ScholarPubMed
12Toet, MC, van der Meij, W, de Vries, LS, Uiterwaal, CS, van Huffelen, KC.Comparison between simultaneously recorded amplitude integrated electroencephalogram (cerebral function monitor) and standard electroencephalogram in neonates. Pediatrics. 2002; 109: 772–9.CrossRefGoogle ScholarPubMed
13Richardson, DK, Corcoran, JD, Escobar, GJ, Lee, SK.SNAP-II and SNAPPE-II: simplified newborn illness severity and mortality risk scores. J Pediatr. 2001; 138: 92–100.CrossRefGoogle ScholarPubMed
14Guideline 2: Minimum technical standards for pediatric electoencephalography. J Clin Neurophysiol. 2006; 23: 92–6.Google Scholar
15Clancy, RR, Legido, A, Lewis, D.Occult neonatal seizures. Epilepsia. 1988; 29: 256–61.Google Scholar
16Murray, DM, Boylan, GB, Ali, I, Ryan, CA, Murphy, BP, Connolly, S.Defining the gap between electrographic seizure burden, clinical expression and staff recognition of neonatal seizures. Arch Dis Child Fetal Neonatal Ed. 2008; 93: F187–91.CrossRefGoogle Scholar
17Scher, MS, Alvin, J, Gaus, L, Minnigh, B, Painter, MJ.Uncoupling of EEG-clinical neonatal seizures after antiepileptic drug use. Pediatr Neurol. 2003; 28: 277–80.Google Scholar
18Bourez-Swart, MD, van Rooij, L, Rizzo, C, et al.Detection of subclinical electroencephalographic seizure patterns with multichannel amplitude-integrated EEG in full-term neonates. Clin Neurophysiol. 2009; 120: 1916–22.Google Scholar