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Clinical Electroencephalography pp 177–202Cite as

Normal Neonatal EEG

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Abstract

In this chapter, the peculiar aspects of the normal neonatal EEG are discussed, alongside with the recording modalities and the characteristic and age-specific electroencephalographic physiological patterns of the newborn, from preterm birth to the end of the neonatal period. In the iconographic material the physiological markers of electrogenesis maturation have been highlighted; in the Appendix, the terms utilized to describe the neonatal EEG will be defined. The knowledge of normal EEG patterns is a prerequisite for the interpretation of the abnormal neonatal EEG.

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Acknowledgments

  • To the EEG technicians of the Pediatric Neurology Unit: Francesca Tabarelli, Deborah Meroni, and Gaetano Turi for their competence and sensitivity, constantly expressed in the management of newborns and in the acquisition of EEG recordings.

  • To the colleagues of the Pediatric Neurology Unit and Neonatology and Neonatal Intensive Therapy Unit of the Buzzi Children’s Hospital, for the daily fruitful collaboration.

  • To Dr. Alfredo Radaelli and Davide Radaelli, for their essential advices in preparing the figures and the manuscript.

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Authors and Affiliations

  1. Pediatrics Department, V.Buzzi Children Hospital, ASST Fatebenefratelli Sacco, Milan, Italy

    Massimo Mastrangelo & Barbara Scelsa

  2. Medicine and Surgery Department, Parma University, Parma, Italy

    Francesco Pisani

Authors
  1. Massimo Mastrangelo
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  2. Barbara Scelsa
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  3. Francesco Pisani
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Corresponding author

Correspondence to Massimo Mastrangelo .

Editor information

Editors and Affiliations

  1. Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy

    Oriano Mecarelli

Appendix

Appendix

Glossary

Activité moyenne: EEG pattern of the full-term newborn corresponding to wakefulness or to active sleep after quiet sleep state. Continuous electric activity with prevalent frequencies between 4 and 7 Hz (1–10 Hz), with an amplitude between 25 and 50 μV, with intermixed low-voltage delta activity.

  • Activity at 0–3 Hz: slow waves at 0.3–3 Hz, of amplitude up to 300 μV, in the preterm newborn of less than 26 weeks GA.

  • Activity at 3–7 Hz activity: occipital and isolated or in short runs of 1–2 s, of amplitude between 50 and 200 μV, in the preterm newborn of less than 27 weeks GA.

  • Activity at 8–13 Hz: in short runs of 1–2 s, of amplitude between 25 and 30 μV, prevalent on Rolandic and occipital regions, in the preterm newborn of less than 28 weeks GA.

Anterior slow dysrhythmia (ASD): physiological pattern of the term newborn. In the neonatal period, the word dysrhythmia is still accepted—the ASD is characterized by a short sequence of 1–2 s of anterior slow waves at 2–3 Hz and of amplitude between 50 and 150 μV, synchronous (and asynchronous), sometimes associated with the frontal sharp transients.

Background activity: it includes the predominant frequencies and amplitudes with their variability, in relation to the spatial and temporal parameters, during the EEG recording. The background activity can be continuous or discontinuous depending on the presence, or not, in a given recording period, significant changes in the frequency, and/or amplitude of the electrical activity. However, the term “discontinuous” is used to define the recordings in which there are sections of significant voltage attenuation up to the absence of electrical activity. In relation to the clinical meanings of the “discontinuous tracing,” the reader might refer to the iconography of this chapter and of the following chapter concerning the pathologic neonatal EEG recordings.

Conceptional age (CA): GA plus the weeks since birth; gestational age, measured from the time of the last menstrual period + chronological age.

Concordance and discordance: the presence or absence of regularly structured electrical and behavioral parameters, in relation to the specific state in the different GA.

Delta brush: physiological transient of the preterm and healthy newborn, with variable localization depending on the GA. It is a complex transient in which fast activity at 8–22 Hz, generally of low voltage (10–70 μV), immediately precedes; it is superimposed or immediately follows a high-amplitude slow wave at 0.3–1.5 Hz, between 75 and 250 μV of amplitude. The characteristics of both fast activity and slow wave vary according to the degree of prematurity.

Dysmaturity: EEG characteristic due to the presence of an electric pattern corresponding to a lower GA than expected for that specific GA.

Encoches frontales (frontal sharp transients): typical physiological features since 35 weeks’ GA, characterized by a biphasic wave (negative-positive) of amplitude variable between 50 and 200 μV, anteriorly localized, bilaterally synchronous and asynchronous; observable until the end of the neonatal period in quiet sleep state.

Gestational age (GA): the number of weeks since the beginning of the last menstrual.

High-voltage slow (HVS): slow pattern of high voltage—electric pattern of the full-term newborn during the quiet sleep state: frequencies between 0.5 and 4 Hz, of amplitude between 50 and 150 μV, irregularly rhythmic.

Liability: poorly definable or unstable behavioral state.

Low-voltage irregular (LVI): low-voltage irregular pattern—electric pattern of the full-term newborn, corresponding to the active sleep that appears after a quiet sleep phase: frequencies between 1 and 8 Hz with amplitude lower than 40–60 μV.

Mixed activity: electric pattern of the full-term infant corresponding to the active sleep that generally appears at the beginning of a sleep cycle. It is constituted by the moyenne activité pattern over which theta-delta activity at 2–4 Hz is superimposed, with an amplitude of less than 100 μV.

Neonatal period: the first 4 weeks of life for the full-term newborn (40 weeks’ GA) and in any case up to the 44 weeks of GA for the preterm newborn:

  • Preterm newborn: born before 37 weeks of GA.

  • Term newborn: born between 38 and 42 weeks of GA.

  • Post-term newborn: born over 42 weeks of GA.

Paroxysmal: mode of appearance of an electrical event that begins and ends abruptly, clearly distinguishing itself from the background activity, generally of higher but sometimes of lower amplitude.

Positive and negative (temporal/Rolandic sharp waves): phase reversal in a bipolar derivation with variable localization, generally isolated and with voltage lower than 100 μV. Otherwise, they have a connotation of focal pathological transients and/or white matter involvement (positive Rolandic sharp waves).

Reactivity: modification of the background activity after external stimulation.

Sharp transients: spike or sharp wave transients that maintain the same morphological definition usually used in electroencephalography at any age but in the neonatal period are frequently typical physiological features of specific GA.

State: well-defined behavioral modality characterized by physiological events that occur in specific epochs of postnatal life both in the full-term and in the preterm newborn, with a predictable and cyclical trend.

Temporal spike and sharp waves: physiological elements, of variable amplitude, peculiar to an age between 29 and 32 weeks’ and at 37 weeks’ GA (multifocal interburst sharp waves).

Temporal theta burst or temporal sawtooth: peculiar physiological elements of the preterm newborn <33 weeks’ GA—short sequences of 3–5 s of diffuse rhythmic activity at 4–7 Hz, of amplitude between 50 and 250 μV, synchronous on the same hemisphere or more evident in the temporal region, bilaterally synchronous and asynchronous.

Tracé alternant (TA, alternating tracing): electric pattern of the full-term newborn observable in the quiet sleep—epochs of 3–8 s with delta activity at 0.5–3 Hz of amplitude between 50 and 200 μV, with superimposed fast activity of lower voltage, interspersed with sections of 3–8 s with theta activity at 4–6 Hz of amplitude between 25 and 40 μV.

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Mastrangelo, M., Scelsa, B., Pisani, F. (2019). Normal Neonatal EEG. In: Mecarelli, O. (eds) Clinical Electroencephalography. Springer, Cham. https://doi.org/10.1007/978-3-030-04573-9_11

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  • DOI: https://doi.org/10.1007/978-3-030-04573-9_11

  • Publisher Name: Springer, Cham

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