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Early amplitude-integrated EEG monitoring 6 h after birth predicts long-term neurodevelopment of asphyxiated late preterm infants

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Abstract

The present study aimed to assess the prognostic value of early amplitude-integrated electroencephalogram (aEEG) in late preterm infants who were born at a gestational age between 34 0/7 and 36 6/7 weeks for the prediction of neurobehavioral development. Late preterm infants (n = 170) with normal, mild, and severe asphyxia underwent continuous recording of aEEG for 4–6 h starting 6–8 h after delivery. The recordings were analyzed for background pattern, sleep-wake cycle (SWC), and seizures. Survivors were assessed at 18 months by neurological examination and Bayley Scales of Infant Development II. The incidence of adverse neurological outcome in the asphyxia group was significantly higher than in the normal group. For late preterm infants in the asphyxia group, abnormal aEEG pattern had a predictive potential of neurological outcomes with sensitivity of 78.57 % (specificity, 87.80 %; positive predictive value [PPV], 68.75 %; negative predictive value [NPV], 92.31 %; power, 85.45 %). Non-SWC and intermediate SWC significantly were increased (25.45 and 52.73 %, respectively) in the asphyxia group vs. the normal group. SWC pattern had neurological prognosis value in the asphyxia group with sensitivity of 64.29 % (specificity, 87.80 %; PPV, 64.29 %; NPV, 87.80 %; power, 81.82 %).

Conclusion: Early aEEG patterns are important determinants of long-term prognosis of neurodevelopmental outcome in asphyxiated late preterm infants.

What is Known:

• Perinatal asphyxia has been reported to lead to adverse long-term neurological outcome of late preterm infants. Early amplitude-integrated EEG (aEEG) is a valuable method in predicting the long-term prognosis within the first 6 h of birth in the neonatal intensive care units.

What is New:

• The results suggest that the aEEG pattern is an important determinant of long-term prognosis of neurodevelopmental outcome in asphyxiated late preterm infants.

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Abbreviations

aEEG:

Amplitude-integrated electroencephalogram

BSID-II:

Bayley Scales of Infant Development II

BS:

Burst suppression

CLV:

Continuous extremely low voltage

CNV:

Continuous normal voltage

DNV:

Discontinuous normal voltage

FT:

Flat tracing

FPz:

Forehead central zone

GA:

Gestational age

NPV:

Negative predictive value

NICU:

Neonatal intensive care units

PA:

Postnatal age

PDI:

Psychomotor Development Index

PPV:

Positive predictive value

SWC:

Sleep-wake cycle

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Acknowledgments

The investigators thank the patients and their parents, Dr. Lang Ya-qin (MD), pediatric graduate students and residents, and the staffs at the NICU of the Hangzhou Hospital of Nanjing Medical University for their help with patient recruitment and data collection. We thank Dr. Shen Fang from Mental Health Division of Tongde Hospital of Zhejiang Province for the help in neurobehavioral developmental assessment rating scale and statistical processing of data. The study was supported by the Zhejiang Science and Technology Project (no. 2010KYB085), the Medical and Health Technology Projects of Hangzhou (no. 2010A002), and Hangzhou Key Disciplines Fund.

Conflict of interest

We clarified that the authors have no conflict of interest for this study.

Authors Contribution

X.M.H. conceived the idea and designed the research with C.M.J, C.M.J and Y.H.Y analyzed the data and wrote the manuscript. Y.H.Y. and L.Q.C supplied theoretical background for the explanation,the others contributed to deta collected and recorded. All the authors contributed to discussion of the results.

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Authors and Affiliations

  1. Department of Pediatrics, Nanjing Medical University Affiliated Hospital of Hangzhou, Hangzhou First People’s Hospital Hangzhou, Hangzhou, 310003, China

    Chun-Ming Jiang, Yi-Hua Yang, Li-Qiong Chen, Xiang-Hua Shuai, Hui Lu, Jun-Hua Xiang, Zhan-Li Liu, Yun-Xia Zhu, Ren-Yan Xu, Da-Rong Zhu & Xian-Mei Huang

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  1. Chun-Ming Jiang
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Correspondence to Xian-Mei Huang.

Additional information

Communicated by Peter de Winter

Chun-Ming Jiang and Yi-Hua Yang contributed equally to this work.

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Jiang, CM., Yang, YH., Chen, LQ. et al. Early amplitude-integrated EEG monitoring 6 h after birth predicts long-term neurodevelopment of asphyxiated late preterm infants. Eur J Pediatr 174, 1043–1052 (2015). https://doi.org/10.1007/s00431-015-2490-z

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