Rhythmic EEG patterns in extremely preterm infants: classification and association with brain injury and outcome

Publication date: Available online 3 October 2017
Source:Clinical Neurophysiology
Author(s): Lauren C. Weeke, Inge M. van Ooijen, Floris Groenendaal, Alexander C. van Huffelen, Ingrid C. van Haastert, Carolien van Stam, Manon J. Benders, Mona C. Toet, Lena Hellström-Westas, Linda S. de Vries
ObjectiveClassify rhythmic EEG patterns in extremely preterm infants and relate these to brain injury and outcome.MethodsRetrospective analysis of 77 infants born <28 weeks gestational age (GA) who had a 2-channel EEG during the first 72h after birth. Patterns detected by the BrainZ seizure detection algorithm were categorized: ictal discharges, periodic epileptiform discharges (PEDs) and other waveforms. Brain injury was assessed with sequential cranial ultrasound (cUS) and MRI at term-equivalent age. Neurodevelopmental outcome was assessed with the BSITD-III (2 years) and WPPSI-III-NL (5 years).ResultsRhythmic patterns were observed in 62.3% (ictal 1.3%, PEDs 44%, other waveforms 86.3%) with multiple patterns in 36.4%. Ictal discharges were only observed in one and excluded from further analyses. The EEG location of the other waveforms (p<0.05), but not PEDs (p=0.238), was significantly associated with head position. No relation was found between the median total duration of each pattern and injury on cUS and MRI or cognition at 2 and 5 years.ConclusionsClear ictal discharges are rare in extremely preterm infants. PEDs are common but their significance is unclear. Rhythmic waveforms related to head position are likely artefacts.SignificanceRhythmic EEG patterns may have a different significance in extremely preterm infants.



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