title: Early Detection of Preterm Intraventricular Hemorrhage From Clinical Electroencephalography.
abstract: OBJECTIVE
  Intraventricular hemorrhage is a common neurologic complication of extremely preterm birth and leads to lifelong neurodevelopmental disabilities. Early bedside detection of intraventricular hemorrhage is crucial to enabling timely interventions. We sought to detect early markers of brain activity that preempt the occurrence of intraventricular hemorrhage in extremely preterm infants during the first postnatal days.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Level III neonatal ICU.
  
  
  METHODS
  Twenty-five extremely preterm infants (22-28 wk gestational age).
  
  
  RESULTS
  We quantitatively assessed electroencephalography in the first 72 hours of postnatal life, focusing on the electrical burst activity of the preterm. Cranial ultrasound was performed on day 1 (0-24 hr) and day 3 (48-72 hr). Outcomes were categorized into three classes: 1) no intraventricular hemorrhage (grade 0); 2) mild-moderate intraventricular hemorrhage (grades 1-2, i.e., germinal matrix hemorrhages or intraventricular hemorrhage without ventricular dilatation, respectively); and 3) severe intraventricular hemorrhage (grades 3-4, i.e., intraventricular hemorrhage with ventricular dilatation or intraparenchymal involvement). Quantitative assessment of electroencephalography burst shapes was used to preempt the occurrence and severity of intraventricular hemorrhage as detected by ultrasound. The shapes of electroencephalography bursts found in the intraventricular hemorrhage infants were significantly sharper (F = 13.78; p < 0.0001) and less symmetric (F = 6.91; p < 0.015) than in preterm infants without intraventricular hemorrhage. Diagnostic discrimination of intraventricular hemorrhage infants using measures of burst symmetry and sharpness yielded high true-positive rates (82% and 88%, respectively) and low false-positive rates (19% and 8%). Conventional electroencephalography measures of interburst intervals and burst counts were not significantly associated with intraventricular hemorrhage.
  
  
  CONCLUSIONS
  Detection of intraventricular hemorrhage during the first postnatal days is possible from bedside measures of brain activity prior to ultrasound confirmation of intraventricular hemorrhage. Significantly, our novel automated assessment of electroencephalography preempts the occurrence of intraventricular hemorrhage in the extremely preterm. Early bedside detection of intraventricular hemorrhage holds promise for advancing individual care, targeted therapeutic trials, and understanding mechanisms of brain injury in neonates.
authors.affiliation: 1Systems Neuroscience Group, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia. 2School of Medicine, Faculty of Medicine and Biomedical Sciences, University of Queensland, QLD, Australia. 3Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. 4Department of Pediatrics, Karlstad Central Hospital, Karlstad, Sweden. 5Department of Pediatrics, Institute for Clinical Sciences, Lund University, Lund, Sweden. 6Metro North Mental Health Service, Brisbane, QLD, Australia. 7Department of Children's Clinical Neurophysiology, HUS Medical Imaging Center, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland. 8Department of Pediatrics, Children's Hospital, University Central Hospital and University of Helsinki, Helsinki, Finland.
authors.forename: Kartik K
authors.initials: KK
authors.lastname: Iyer
authors.forename: James A
authors.initials: JA
authors.lastname: Roberts
authors.forename: Lena
authors.initials: L
authors.lastname: Hellström-Westas
authors.forename: Sverre
authors.initials: S
authors.lastname: Wikström
authors.forename: Ingrid
authors.initials: I
authors.lastname: Hansen Pupp
authors.forename: David
authors.initials: D
authors.lastname: Ley
authors.forename: Michael
authors.initials: M
authors.lastname: Breakspear
authors.forename: Sampsa
authors.initials: S
authors.lastname: Vanhatalo
mesh_terms: D002543:Cerebral Hemorrhage / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D042241:Early Diagnosis; D004569:Electroencephalography; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000175:diagnosis*