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Early amplitude-integrated EEG correlates with cord TNF-α and brain injury in very preterm infants
Dept. of Pediatrics, Karlstad Central Hospital, Sweden.
Dept. of Pediatrics, Lund University Hospital, Sweden.
Dept. of Pediatrics, Lund University Hospital, Sweden.
Dept. of Clinical Neurophysiology, Lund University Hospital, Lund.
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2008 (English)In: Acta Paediatrica, ISSN 0803-5253, Vol. 97, no 7, 915-919 p.Article in journal (Refereed) Published
Abstract [en]

AIM: To investigate if the early electroencephalogram (EEG) and amplitude-integrated EEG (aEEG) in very preterm infants is affected by perinatal inflammation and brain injury, and correlates with long-term outcome. METHODS: Sixteen infants born at 24-28 gestational weeks (median 25.5) had continuous EEG/aEEG during the first 72 h of life. Minimum and maximum EEG interburst intervals (IBI), and aEEG amplitudes were semi-automatically quantified and averaged over the recording period. Neonatal brain injury was diagnosed with repeated cranial ultrasound investigations. Nine cytokines from four time-points were analyzed during the first 72 h (umbilical cord blood, 6, 24 and 72 h), and outcome was assessed at 2 years of corrected age. RESULTS: Infants with neonatal brain injury (n=9) had prolonged IBI, 11.8 (9.6-23.2) sec versus 8.2 (7.1-11.6) sec in infants (n=7) without brain damage (p=0.005). Handicap at 2 years (n=8, including two infants without neonatally diagnosed brain injury) was associated with prolonged neonatal IBI and lower aEEG amplitudes. Also aEEG amplitudes were decreased in infants with neonatal brain injury. There was a significant positive correlation between the averaged IBI and cord blood TNF-alpha (rs=0.595, p=0.025). CONCLUSION: Early EEG depression is associated with increased cord blood TNF-alpha, neonatal brain damage and handicap at 2 years.

Place, publisher, year, edition, pages
2008. Vol. 97, no 7, 915-919 p.
Keyword [en]
aEEG, brain injury;´, cytokines, preterm, prognosis
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-89266DOI: 10.1111/j.1651-2227.2008.00787.xISI: 000256395300021PubMedID: 18462469OAI: oai:DiVA.org:uu-89266DiVA: diva2:159812
Available from: 2009-02-10 Created: 2009-02-10 Last updated: 2011-05-04Bibliographically approved
In thesis
1. Background aEEG/EEG measures in very preterm infants: Relation to physiology and outcome
Open this publication in new window or tab >>Background aEEG/EEG measures in very preterm infants: Relation to physiology and outcome
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to characterize single-channel aEEG/EEG, recorded during the first postnatal days in preterm infants, in relation to brain function and two-year outcome.

Study I investigated if aEEG/EEG was associated with neonatal brain injury, inflammation and outcome in 16 very preterm (VPT) infants. The interburst interval (IBI) was prolonged, and aEEG amplitudes were lower in infants with brain injury, and in infants developing handicap. Cord blood TNF-α correlated with IBI.

Study II investigated inter-rater agreement of visual burst detection, as compared to automated burst detection based on a non-linear energy operator (NLEO) in an EEG data set from 12 extremely preterm (EPT) and 6 VPT infants. The sensitivity of the NLEO was 64 % and 69 % (EPT and VPT infants, respectively) and the specificity 96 % and 88 %. The algorithm was then modified to further improve the accuracy.

Study III investigated if arterial carbon dioxide and plasma glucose is associated with EEG continuity. In 247 sets of samples (PaCO2, plasma glucose, IBI) from 32 EPT infants there was a positive association between PaCO2 and IBI; higher PaCO2 was associated with longer IBI. Corrected for carbon dioxide, plasma glucose had a U-shaped association with IBI in infants with good outcome.

Study IV investigated the predictive value of aEEG/EEG in 41 EPT and 8 VPT infants. All VPT infants had good outcome. Predictors of outcome in EPT infants included presence or absence of burst-suppression, continuous activity and cyclicity, median IBI and interburst%. Seizures were associated with neonatal brain damage but not with outcome.

Improved preterm brain monitoring may in the future be used for early identification of infants at high risk of brain damage and adverse outcome, which may have implications for direction of care and for early intervention.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2011. 74 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 647
Electroencephalography, brain damage, prediction, interburst interval, Neurodevelopmental impairment
National Category
urn:nbn:se:uu:diva-146737 (URN)978-91-554-8010-3 (ISBN)
Public defence
2011-04-04, Rosensalen, Akademiska sjukhuset, ing. 95, Uppsala, 13:15 (English)
Available from: 2011-03-14 Created: 2011-02-19 Last updated: 2011-05-04Bibliographically approved

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