Arch Dis Child Fetal Neonatal Ed 1999;81:F19-F23 ( July )

Amplitude integrated EEG 3 and 6 hours after birth in full term neonates with hypoxic-ischaemic encephalopathy

M C Toet^a, L Hellström-Westas^b, F Groenendaal^a, P Eken^a, L S de Vries^a

^a Department of Neonatology Wilhelmina Children's Hospital Utrecht The Netherlands, ^b Department of Neonatology University Hospital Lund Sweden

Correspondence to: Dr L S de Vries Department of Neonatology KE 04.1231 POB 85090 AB Utrecht The Netherlands. Email:l.devries{at}WKZ.AZU.nl

Accepted 30 December 1998

AIMTo assess the prognostic value of amplitude integrated EEG (aEEG) 3 and 6 hours after birth.
METHODSSeventy three term, asphyxiated infants were studied (from two different centres), using the Cerebral Function Monitor (CFM Lectromed). The different aEEG tracings were compared using pattern recognition (flat tracing mainly isoelectric (FT); continuous extremely low voltage (CLV); burst-suppression (BS); discontinuous normal voltage (DNV); continuous normal voltage (CNV)) with subsequent outcome.
RESULTSSixty eight infants were followed up for more than 12 months (range 12 months to 6 years).Twenty one out of 68 infants (31%) showed a change in pattern from 3 to 6 hours, but this was only significant in five cases (24%). In three this changed from BS to CNV with a normal outcome. One infant showed a change in pattern from CNV to FT and had a major handicap at follow up. Another infant showed a change in pattern from DNV to BS, and developed a major handicap at follow up. The other 16 infants did not have any significant changes in pattern: 11 infants had CLV, BS, or FT at 3 and 6 hours and died (n = 9) in the neonatal period or developed a major handicap (n = 2). Five infants had a CNV or DNV pattern at 3 and 6 hours, with a normal outcome. The sensitivity and specificity of BS, together with FT and CLV, for poor outcome at 3 hours was 0.85 and 0.77, respectively; at 6 hours 0.91 and 0.86, respectively. The positive predictive value (PPV) was 78% and the negative predictive value (NPV) 84% 3 hours after birth. At 6 hours the PPV was 86% and the NPV was 91%.
CONCLUSIONaEEG could be very useful for selecting those infants who might benefit from intervention after birth asphyxia.


Keywords: cerebral function; amplitude integrated EEG; hypoxic-ischaemic encephalopathy; birth asphyxia

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© 1999 by Archives of Disease in Childhood
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