Combined Conventional and Amplitude-Integrated EEG Monitoring in Neonates: A Prospective Study

Sarah Grace Buttle; Brigitte Lemyre; Erick Sell; Stephanie Redpath; Srinivas Bulusu; Richard J Webster; Daniela Pohl

doi:10.1177/0883073819829256

Combined Conventional and Amplitude-Integrated EEG Monitoring in Neonates: A Prospective Study

J Child Neurol. 2019 May;34(6):313-320. doi: 10.1177/0883073819829256. Epub 2019 Feb 14.

Authors

Sarah Grace Buttle¹, Brigitte Lemyre^{2

3}, Erick Sell^{1

3}, Stephanie Redpath^{2

3}, Srinivas Bulusu⁴, Richard J Webster⁵, Daniela Pohl^{1

3}

Affiliations

¹ 1 Division of Neurology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada.
² 2 Division of Neonatology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
³ 3 Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada.
⁴ 4 Neurophysiology Laboratory, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
⁵ 5 Clinical Research Unit, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.

PMID: 30761936
DOI: 10.1177/0883073819829256

Abstract

Background/objective: Seizure monitoring via amplitude-integrated EEG is standard of care in many neonatal intensive care units; however, conventional EEG is the gold standard for seizure detection. We compared the diagnostic yield of amplitude-integrated EEG interpreted at the bedside, amplitude-integrated EEG interpreted by an expert, and conventional EEG.

Methods: Neonates requiring seizure monitoring received amplitude-integrated EEG and conventional EEG in parallel. Clinical events and amplitude-integrated EEG were interpreted at bedside. Subsequently, amplitude-integrated EEG and conventional EEG were independently analyzed by experienced neonatology and neurology readers. Sensitivity and specificity of bedside amplitude-integrated EEG as compared to expert amplitude-integrated EEG interpretation and conventional EEG were evaluated.

Results: Thirteen neonates were monitored for an average duration of 33 hours (range 15-94, SD 25). Fourteen seizure-like events were detected by clinical observation, and 12 others by bedside amplitude-integrated EEG analysis. One of the clinical, and none of the bedside amplitude-integrated EEG events were confirmed as seizures on conventional EEG. Post hoc expert amplitude-integrated EEG interpretation revealed eight suspected seizures, all different from the ones detected by the bedside amplitude-integrated EEG team, of which one was confirmed via conventional EEG. Eight seizures were recorded on conventional EEG. Expert amplitude-integrated EEG interpretation had a sensitivity of 13% with 46% specificity for individual seizure detection, and a sensitivity of 50% with 46% specificity for detecting patients with seizures.

Conclusion: Real-world bedside amplitude-integrated EEG monitoring failed to detect all seizures evidenced via conventional EEG, while misclassifying other events as seizures. Even post hoc expert amplitude-integrated EEG interpretation provided limited sensitivity and specificity. Considering the poor sensitivity and specificity of bedside amplitude-integrated EEG interpretation, combined monitoring may provide limited clinical benefit.

Keywords: diagnostic accuracy; electroencephalography (EEG); neonatal neurology; neurocritical care; newborn.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Electroencephalography / methods*
Female
Humans
Infant, Newborn
Intensive Care Units, Neonatal
Male
Monitoring, Physiologic / methods*
Prospective Studies
Seizures / diagnosis*
Sensitivity and Specificity