Cot-side electroencephalography for outcome prediction in preterm infants: observational study.
OBJECTIVE
To assess the use of two-channel electroencephalographical (EEG) recordings for predicting adverse neurodevelopmental outcome (death or Bayley II mental developmental index/psychomotor developmental index < 70) in extremely preterm infants and to determine the relationship between quantitative continuity measures and a specialist neurophysiologist assessment of the same EEG segment for predicting outcome.


METHODS
Observational study.


METHODS
The study was conducted in a neonatal intensive care unit.


METHODS
Preterm infants born <29 weeks' gestation.


METHODS
Two-channel EEGs using the reBRM2 monitor (BrainZ Instruments, Auckland, New Zealand) within 48 h of delivery. One-hour segments were analysed, blinded to the clinical outcome, by off-line quantitative analysis of continuity and a review of the raw EEG by a neurophysiologist.


METHODS
Developmental assessment at a median of 15 months' corrected age.


RESULTS
76 infants had an EEG within 48 h of delivery and a developmental assessment. The analysed segment of the EEG was obtained at 24 (3-48) h of age (median (range)). The neurophysiologist's assessment was a better predictor of adverse outcome than the continuity measures (positive predictive value 95% CI 75 (54% to 96%) vs 41 (22% to 60) at 25-µV threshold, negative predictive value 88 (80% to 96%) vs 84 (74% to 94%) and positive likelihood ratio 9.0 (3.2 to 24.6) vs 2.0 (1.2 to 3.6)). All the infants with definite seizures identified by the neurophysiologist had poor outcomes.


CONCLUSIONS
Modified cot-side EEG has potential to assist with identification of extremely preterm infants at risk for adverse neurodevelopmental outcomes. However, analysis by a neurophysiologist performed better than the currently available continuity analyses.
West
Claire R
CR
Neonatal Intensive Care Unit, Middlemore Hospital, Otahuhu, Manukau 1640, Auckland, New Zealand. westc@middlemore.co.nz
Harding
Jane E
JE
Williams
Chris E
CE
Nolan
Melinda
M
Battin
Malcolm R
MR
D002657:Child Development; D002658:Developmental Disabilities / Q000175:diagnosis; D004569:Electroencephalography / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology*; D015931:Intensive Care, Neonatal / Q000379:methods*; D008991:Monitoring, Physiologic / Q000379:methods; D019095:Point-of-Care Systems; D011237:Predictive Value of Tests; D011379:Prognosis; D012640:Seizures / Q000175:diagnosis; D012815:Signal Processing, Computer-Assisted