Intrapartum cardiotocography

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Amplitude-integrated EEG assists in detecting cerebral dysfunction in the newborn

Background: Amplitude-integrated encephalography (aEEG) in term-born encephalopathic infants has been shown to be predictive of later neurodevelopmental outcomes, but little is known about the mediating cerebral pathology. In addition, the aEEG is commonly used to monitor electrographic seizures in the newborn, an important manifestation of cerebral pathology, but there is limited data on it’s efficacy for this purpose. It’s clinical application in the preterm infant remains to be explored. Aim: The central aim of this thesis is to prove the hypothesis that the aEEG assists in detecting cerebral dysfunction in the newborn. Methods: 1) In a cohort of term-born infants with encephalopathy and/or seizures digital aEEG background measures of the lower and upper aEEG margins were related to a numeric MRI abnormality score. 2) In at-risk term newborns, the accuracy of two-channel digital aEEG monitoring was compared with continuous concurrent conventional EEG for seizure detection. 3) In preterm infants (gestation at birth < 30 weeks) aEEG measures of lower and upper margin collected in the first week of life were compared in infants with substantial cerebral abnormality to infants without. Results: 1) For all infants in the term cohort, the severity of abnormality of aEEG background was strongly related to severity of abnormality seen on cerebral MRI. 2) Using the aEEG pattern with the raw EEG signal, 76% of electrographic seizures were correctly identified in the term infants. 3) In the preterm cohort, the lower and upper aEEG amplitude margins increased significantly during the first week of life. In the presence of substantial cerebral abnormality, these margins were significantly depressed. Seizures were noted in the smaller and sicker, infants. Conclusion: The central hypothesis of this thesis, that the aEEG assists in detecting cerebral dysfunction in the newborn was proved

Monitoring fetal well-being in labor in late fetal growth restriction

Late-onset fetal growth restriction (FGr) accounts for approximately 70-80% of all cases of FGr secondary to uteroplacental insufficiency. It is associated with an increased incidence of adverse antepartum and perinatal events, which in most instances result from hypoxic insults either present at the onset of labor or supervening during labor as a result of uterine contractions. labor represents a stressful event for the fetoplacental unit being uterine contractions associated with an up-to 60% reduction of the uteroplacental perfusion. intrapartum fetal heart rate monitoring by means of cardiotocography (CTG) currently represents the mainstay for the identification of fetal hypoxia during labor and is recommended for the fetal surveillance during labor in the case of FGr or other conditions associated with an increased risk of intrapartum hypoxia. in this review we discuss the potential implications of an impaired placental function on the intrapartum adaptation to the hypoxic stress and the role of the ctG and alternative techniques for the intrapartum monitoring of the fetal wellbeing in the context of FGR secondary to uteroplacental insufficiency

Lost in transition: a systematic review of neonatal electroencephalography in the delivery room - Are we forgetting an important biomarker for newborn brain health?

Background: Electroencephalography (EEG) monitoring is routine in neonatal intensive care units (NICUs) for detection of seizures, neurological monitoring of infants following perinatal asphyxia, and increasingly, following preterm delivery. EEG monitoring is not routinely commenced in the delivery room (DR). Objectives: To determine the feasibility of recording neonatal EEG in the DR, and to assess its usefulness as a marker of neurological well-being during immediate newborn transition. Methods: We performed a systematic stepwise search of PubMed using the following terms: infant, newborns, neonate, DR, afterbirth, transition, and EEG. Only human studies describing EEG monitoring in the first 15 min following delivery were included. Infants of all gestational ages were included. Results: Two original studies were identified that described EEG monitoring of newborn infants within the DR. Both prospective observational studies used amplitude-integrated EEG (aEEG) monitoring and found it feasible in infants >34 weeks' gestation; however, technical challenges made it difficult to obtain continuous reliable data. Different EEG patterns were identified in uncompromised newborns and those requiring resuscitation. Conclusion: EEG monitoring is possible in the DR and may provide an objective baseline measure of neurological function. Further feasibility studies are required to overcome technical challenges in the DR, but these challenges are not insurmountable with modern technology