H. J. ter Horst

The prognostic value of amplitude integrated EEG in neonatal sepsis and/or meningitis

Aim:  To investigate the longitudinal course and prognostic value of amplitude integrated EEG (aEEG) in infants with neonatal sepsis or meningitis.

Amplitude integrated electroencephalographic activity in infants with congenital heart disease before surgery

BACKGROUND Infants with congenital heart disease (CHD) are at risk for brain injury. An accurate tool to monitor brain function is amplitude integrated EEG (aEEG). It records both background patterns and electrographic seizure activity (EA). AIMS Our aim was to determine aEEG patterns in infants with CHD and to determine the differences between infants with a cyanotic or an acyanotic CHD. STUDY DESIGN AND SUBJECTS Sixty-two full term newborns had either a cyanotic CHD (transposition of the great arteries (n=24)) or an acyanotic CHD (hypoplastic left heart syndrome (n=26), critical aortic valve stenosis (n=1) or aortic coarctation (n=11)). The background patterns, sleep-wake cycling (SWC), and EA were assessed. The first 72h after starting prostaglandin E(1)-therapy were used for analysis. RESULTS The background patterns were mildly abnormal in 45% of the infants and severely abnormal at some point during the recording in 14% of the infants. We found no differences in background patterns between the two groups. EA was present in 12 (19%) infants. EA was more frequent in infants with acyanotic CHD (OR 9.4, 95% CI 1.1-78, p=0.039). SWC was equally frequent in infants with cyanotic and infants with acyanotic CHD. A severely abnormal aEEG and EA were associated with more profound acidosis. CONCLUSIONS Before surgery the majority of infants with a CHD had an abnormal aEEG. aEEG helped to identify EA and it was a useful tool to evaluate brain function prior to surgery in CHD.

The prevalence of feeding problems in children formerly treated in a neonatal intensive care unit.

Objective:To determine the prevalence of oral feeding problems in neonatal intensive care unit (NICU) graduates at 1 to 2 years, and to identify clinical risk factors during NICU admission.Study Design:Observational cohort study of 378 children, who received level III/IV NICU care for 4 days or more in 2011 to 2012, chromosomal abnormalities excluded. We detected feeding problems in four gestational age (GA) groups (<28, 28 to 31, 32 to 36 weeks, and term-borns) using the Dutch standardized Screeningslijst Eetgedrag Peuters, and collected clinical factors for logistic regression analyses.Results:The prevalence of feeding problems was higher in NICU (20.4%) than in reference (15.0%) population (P=0.024), but similar for all GA groups (P=0.468). Prolonged tube feeding, that is, >30 days (odds ratio (OR) 2.50, confidence interval (CI) 1.13 to 5.56) and being born small for GA (OR 4.79, CI 1.64 to 14.03) were the most prevalent risk factors in children with GA ⩾32 and GA <32 weeks, respectively.Conclusion:Feeding problems are more prevalent in NICU graduates, with prolonged tube feeding as most important risk factor.

Amplitude-Integrated EEG and Cerebral Near-Infrared Spectroscopy in Cooled, Asphyxiated Infants

Objective To assess the predictive value of amplitude‐integrated electroencephalography EEG (aEEG) and near‐infrared spectroscopy (NIRS) during therapeutic hypothermia. Patients and Methods We studied 39 cooled, asphyxiated infants. We assessed aEEG and calculated mean regional cerebral oxygen saturation (rcSO2 ) during and after treatment. At 30 months, we performed a neurological examination and administered the Bayley Scales of Infant and Toddler Development, 3rd edition. We calculated the odds ratios (ORs) of abnormal aEEG and rcSO2 for severely abnormal outcome. Results At 6 and 12 hours, severely abnormal aEEGs predicted severely abnormal outcomes (OR, 7.7 [95% confidence interval, CI, 1.39‐42.6] and 24.4 [95% CI 4.2‐143] respectively), as did epileptic activity (OR 28.9, 4.6‐183). During the first 48 hours, rcSO2 was not associated with outcome, but at 72 hours after birth and after rewarming it was, with ORs for severely abnormal outcomes of 12.8 (1.31‐124) and 21.6 (1.05‐189), respectively. In multivariate analyses, aEEG and rcSO2 remained independently predictive in the model at 48 hours and significantly from 72 hours after birth onward. Conclusion aEEG was a strong predictor of adverse outcome. After 48 hours of cooling, a higher rcSO2 was associated with a severely abnormal outcome, adding to the predictive value of aEEG in cooled, asphyxiated infants.

1230 The Predictive Value of Early aEEG Patterns for Functional Outcome at School Age in Preterm Infants

Introduction Brain activity of preterm infants can be assessed by amplitude integrated electroencephalography (aEEG). Objective To determine whether early aEEGs of preterm infants are associated with functional outcome at 7 years. Methods Eighteen infants participating in a prospective observational study in 2004 were seen for follow-up at median age of 7 years, 5 months. Median GA was 28.9wks (26.7–32.9). aEEGs of 2h duration were recorded within 48h and one and two weeks after birth. aEEGs were assessed by pattern recognition and by calculating the mean of aEEG amplitude centiles. Functional outcome was determined by assessing intelligence, attention, verbal memory, visuospatial processing, executive functioning and motor skills. Results In case of burst suppression < 48h Total IQ was 13 points lower (P=0.018), Performance IQ was 18 points lower (P=0.016) and visuospatial processing scores were 0.68 SD lower (P=0.027). Mean p5 and p50 centiles recorded < 48h after birth correlated positively with Total IQ (r=0.507, r=0.495, repectively; P<0.05), Performance IQ (r=0.578, r=0.514, respectively; P<0.05), selective attention (r=0.586, r=0.577, respectively; P<0.05), visuospatial processing (r=0.488, r=0.534, respectively; P<0.05) and fine motor skills (r=0.558, r=0.556, respectively; P<0.05). All correlations remained significant at one week and after adjustment for GA, except for visuospatial processing and fine motor skills. Conclusion Burst suppression and lower aEEG amplitude centiles within 48hrs and at one week after birth were associated with poorer cognition at 7 years. This indicates that early aEEGs may be useful in predicting functional outcome of preterm children at school age.

1071 Aeeg During the First 72 Hours After Birth in Infants With Prenatally Diagnosed Congenital Heart Defect

Background and objective Survival in infants with congenital heart defects (CHD) is associated with neurologic morbidity. Hypoxic-ischemia after closure of the ductus arteriosus is probably one of the factors resulting in brain damage. Prenatal diagnosis makes it possible to prevent closure of the ductus arteriosus and therefore cerebral perfusion can be preserved. Amplitude integrated EEG (aEEG) is a method to evaluate brain injury. Abnormal (a)EEG patterns and epileptic activity (EA) are frequently observed in infants with CHD. Our aim was to determine the course of aEEG patterns in infants with prenatally diagnosed CHD. Methods Retrospective cohort study of infants prenatally diagnosed with CHD. aEEGs were assessed by pattern recognition: background pattern (BP), presence of sleep wake cycling (SWC) and EA were appraised. Results Twenty infants (mean GA 39 wks; birth weight 3416 g) were included. Eleven infants had transposition of the great arteries, 7 infants had hypoplastic left heart syndrome, and 2 had aortic valve stenosis. At 6h after birth 80% of infants had normal BPs (continuous normal voltage (CNV)). Only 2 infants had severely abnormal BPs (continuous low voltage). At 24h, 94% had CNV. None of the infants showed EA. SWC was present in 85% and emerged at a median postnatal age of 10.4 hrs. Conclusions aEEGs of infants with a prenatally diagnosed CHD are normal in the majority of infants, with normal emergence of SWC and absence of EA. This indicates that prenatal diagnosis can prevent brain damage in infants with CHD.

331 The Prognostic Value of aEEG and NIRS during Therapeutic Hypothermia in Term Asphyxiated Newborns

Background and objective Infants with hypoxic-ischemic encephalopathy (HIE) are treated with therapeutic hypothermia (HT). Following perinatal asphyxia amplitude-integrated EEG (aEEG) and near-infrared spectroscopy (NIRS) are used to determine prognosis. We aimed to assess the prognostic value of aEEG and NIRS during HT. Methods 40 term infants with HIE and treatment with HT were retrospectively studied. aEEG and NIRS were started immediately following admission. aEEGs were assessed by pattern recognition: background pattern (BP), presence of sleep wake cycling (SWC) and epileptic activity (EA) were appraised. Recordings during HT (72 hrs) were analysed. Results 84% of infants had an abnormal BP (discontinuous normal voltage, burst suppression (BS), continuous low voltage (CLV) or flat trace (FT)) at admission. The LR+ (95% CI) of an severely abnormal BP (BS, CLV, FT) for mortality was 1.97 (1.24–3.12) at 6h after birth and increased to 4.5 (3.16–6.39) at 24h, 6.3 (2.04–19.4) at 48h and 6.19 (1.93–19.8) at 72h. LR+ of BS for mortality was below 1 at any time. LR+ of EA for mortality was 4.95 (2.20–11.1), the type of EA (e.g. status epilepticus) was not predictive. LR+ of SWC for survival was 10.7 (1.62–70). RcSO2 increased from 6 to 72h after birth, but was not different at any time between infants that died or survived. Conclusion aEEG during HT can still be used to predict risk for mortality of HIE, especially beyond 24 hrs. BS is frequently not associated with a fatal outcome. RcSO2 has no additional value to predict mortality.