title: Acute neonatal encephalopathy and seizures recurrence: a combined aEEG/EEG study.
abstract: OBJECTIVE
  To evaluate amplitude-integrated EEG (aEEG) in comparison with conventional (cEEG) for the identification of electrographic seizures in neonates with acute neonatal encephalopathies.
  
  
  METHODS
  Thirty-one conventional cEEG/aEEG long-term recordings from twenty-eight newborns were reviewed in order to assess the electrographic seizure detection rate and recurrence in newborns. Two paediatric neurologists and one neonatologist, blinded to the raw full array cEEG, were asked to mark any events suspected to be an electrographic seizures on aEEG. They were asked to decide if the displayed aEEG trace showed the pattern of a single seizure (SS), repetitive seizures (RS) or status epilepticus (SE). Their ability to recognize electrographic seizures on aEEG was compared to seizures identified on full array cEEG.
  
  
  RESULTS
  25 of the 31 long-term cEEGs recordings showed electrographic seizures. The two paediatric neurologists and the neonatologist identified SE in 100% of the reviewed traces using aEEG alone while they identified 49.4% and 37.5% of electrographic seizures using aEEG alone. Overall, the correct identification ranged from 23.5% to 30.7% for SS and 66% for RS. The inter-observer agreement (k) for the identification of SE for the two paediatric neurologists and the neonatologist was 1.0. Overall the inter-observer agreement (k) for the detection of SS, RS and SE of the two paediatric neurologists was 0.91.
  
  
  CONCLUSIONS
  In our study the observers identified SE in 100% of the reviewed traces using raw aEEG alone, thus aEEG might represent a useful tool to detect SE in the setting of NICU. SS may not be reliably identified using aEEG alone. Simultaneous recording of the raw cEEG/aEEG provides a good level of sensitivity for the detection of neonatal electrographic seizures.
authors.affiliation: U.O. Neurologia Pediatrica, V. Buzzi Hospital, Milan, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Mastrangelo
authors.forename: Isabella
authors.initials: I
authors.lastname: Fiocchi
authors.forename: Paola
authors.initials: P
authors.lastname: Fontana
authors.forename: Gaetano
authors.initials: G
authors.lastname: Gorgone
authors.forename: Gianluca
authors.initials: G
authors.lastname: Lista
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Belcastro
mesh_terms: D000927:Anticonvulsants / Q000627:therapeutic use; D001927:Brain Diseases / Q000175:diagnosis*; D058256:Brain Waves / Q000187:drug effects / Q000502:physiology*; D004569:Electroencephalography; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D012640:Seizures / Q000175:diagnosis* / Q000188:drug therapy; D018709:Statistics, Nonparametric
chemical_list: D000927:Anticonvulsants
keywords: Acute neonatal encephalopathy; Amplitude-integrated EEG; Neonatal intensive care unit; Neonatal status epilepticus; Seizures recurrence