Early abnormal amplitude-integrated electroencephalography (aEEG) is associated with adverse short-term outcome in premature infants

Background: In preterm infants with IVH the electrocortical background activity is affected and there is a correlation between the severity of cerebral injury to the degree of depression, however the usefulness of the early aEEG recordings has hardly been determined. Aim: To identify early aEEG features that could be used as prognostic markers for severe brain injury in prematures. Methods: In 115 infants, 25-32 wk GA, aEEG recordings during the first 72 h of life were correlated with head ultrasound findings. Continuity (Co), sleep-wake cycling (Cy) and amplitude of the lower border (LB) of the aEEG were evaluated by semi-quantitative analysis. Results: The infants were divided into four groups based on head ultrasound findings: A (n = 72, normal), B [n = 16, grades 1-2 intraventricular hemorrhage (IVH)], C (n = 21, grades 3-4 IVH) and D (n = 6, periventricular leukomalacia). 18 infants (16 of group C and 2 of group D) died during hospitalization. Significantly lower values of all aEEG features were found in group C infants. The presence of pathological tracings (burst-suppression, continuous low-voltage, flat trace) or discontinuous low-voltage (DLV), the absence of Cy and LB < 3 mu V in the initial aEEG displayed a sensitivity of 88.9%, 63% and 51.9% respectively, for severe brain injury. Logistic regression of aEEG features and GA to the presence or absence of severe injury revealed that only Co was significantly correlated to outcome. Using this feature 83.19% of cases were correctly classified. Conclusion: Pathological tracings or DLV in the initial aEEG is predictive for poor short-term outcome in premature neonates. (C) 2012 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved

Association of increased maternal ferritin levels with gestational diabetes and intra-uterine growth retardation.

AIM: The objectives of the present study were to determine whether or not increased serum ferritin in women with premature labour is associated with gestational diabetes mellitus (GDM) and intra-uterine growth retardation (IUGR) and, if so, whether or not such increased levels reflect excess maternal iron stores, and have an effect on neonatal iron status and outcome. METHODS: This prospective, single-hospital, observational study involved 63 mothers and their 90 preterm neonates. Full blood counts as well as serum ferritin, soluble transferrin receptor (sTfR) and erythropoietin concentrations were compared across the three study groups based on maternal ferritin levels at the time of delivery. Perinatal history, neonatal morbidity and early outcomes were also assessed. RESULTS: High maternal ferritin levels were significantly associated with higher rates of GDM and IUGR. However, there was no correlation between maternal ferritin and sTfR levels or between maternal and neonatal iron status. CONCLUSION: Elevated maternal ferritin is not a reflection of excess iron stores, but is related to an increased risk of GDM or IUGR. Also, maternal ferritin levels are not associated with either neonatal iron status or neonatal outcomes. Copyright (c) 2009 Elsevier Masson SAS. All rights reserved

Bayley-III scales at 12 months of corrected age in preterm infants: Patterns of developmental performance and correlations to environmental and biological influences

Background and aims: Premature infants are at high risk for neurodevelopmental impairment (NDI) even in the absence of known brain complications of prematurity. Evaluation of the effectiveness of therapeutic interventions in association to neurodevelopmental outcome is required to improve or prevent the neurodevelopmental consequences of prematurity. The Bayley-III is currently the most commonly applied measurement tool for assessing early development both in clinical practice and research settings. Objective: To evaluate the relationship between known risk factors and early performance on the Bayley Scales of Infant Development-Third Edition at 12 months adjusted age in premature infants. Methods. Prospective study in a cohort of premature infants with gestational age ≤32 weeks, who underwent comprehensive developmental assessment using the five domains of Bayley Scales, cognitive, language, motor, social emotional and adaptive behavior at 12 months corrected age. Developmental scores were evaluated in relation to environmental influences, therapeutic interventions or practices and complications of prematurity. Results: Composite and Subscale scores for the cognitive, language and motor scales were below the 50th percentile, with no significant differences among them. Scores for the social-emotional and adaptive behavior, which are derived from the parent-report questionnaires, were near the average and significantly higher than the scores derived by the examiners. Multiple regression analyses showed that blood transfusions, apart from severely abnormal head ultrasound, gender, being small for gestational age and duration of invasive mechanical ventilation and oxygen administration were consistently related to neurodevelopmental outcome. Conclusions: Bayley-III assessments are important for getting early information about development following premature birth. Parents may overestimate children's performance. Neurodevelopmental outcome is related to several environmental, biological or medical conditions associated with prematurity. Adoption of therapeutic strategies targeting known neonatal risk factors could positively affect neurodevelopmental outcome. © 2015 Elsevier Ltd

The influence of extrauterine life on the aEEG maturation in normal preterm infants

Objective: To study, the maturational changes of the amplitude-integrated electroencephalogram (aEEG) in preterm infants without neurological disorders and especially the influence of the duration of extrauterine life, over this process. Methods: 96 preterm infants, 25-34 weeks' gestational age (CA) at birth, clinically stable and without ultrasonographic evidence of neurological abnormalities, were studied. The aEEG recordings were obtained within 72 h of life and then weekly until discharge. Four aspects of each tracing (continuity. sleep-wake cycling, bandwidth, and lower border), were evaluated by visual analysis, applying pre-established criteria. Results: We analysed 624 aEEG recordings at postmenstrual age (PMA) of 25-42 weeks. With advanced CA the aEEG becomes more continuous (p: 0.022), it displays definite sleep-wake cycles (p: 0.011), and its bandwidth acquires the mature pattern (p: 0.012). A positive significant interaction of CA and PMA in the evolution of aEEG was found regarding continuity (p: 0.002), sleep-wake cycling (p: 0.002), and bandwidth (p: 0.02). Conclusion: The evolution of the aEEG tracing depends on both CA and PMA. The older the infants at birth the more mature the aEEG pattern. At the same PMA, preterm infants of lower CA display an advanced maturation of the aEEG comparing with others of higher GA. (c) 2009 Elsevier Ireland Ltd. All rights reserved

Impact of perinatal factors on continuous early monitoring of brain electrocortical activity in very preterm newborns by amplitude-integrated EEG.

Background:Amplitude-integrated electroencephalogram (aEEG) is increasingly used for neuromonitoring in preterms. We aimed to quantify the effects of gestational age (GA), postnatal age (PNA), and other perinatal factors on the development of aEEG early after birth in very preterm newborns with normal cerebral ultrasounds.Methods:Continuous aEEG was prospectively performed in 96 newborns (mean GA: 29.5 (range: 24.4-31.9) wk, birth weight 1,260 (580-2,120) g) during the first 96 h of life. aEEG tracings were qualitatively (maturity scores) and quantitatively (amplitudes) evaluated using preestablished criteria.Results:A significant increase in all aEEG measures was observed between day 1 and day 4 and for increasing GA (P &lt; 0.001). The effect of PNA on aEEG development was 6.4- to 11.3-fold higher than that of GA. In multivariate regression, GA and PNA were associated with increased qualitative and quantitative aEEG measures, whereas small-for-GA status was independently associated with increased maximum aEEG amplitude (P = 0.003). Morphine administration negatively affected all aEEG measures (P &lt; .05), and caffeine administration negatively affected qualitative aEEG measures (P = 0.02).Conclusion:During the first few days after birth, aEEG activity in very preterm infants significantly develops and is strongly subjected to the effect of PNA. Perinatal factors may alter the early aEEG tracing and interfere with its interpretation