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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Pediatr. | doi: 10.3389/fped.2019.00358

Amplitude-integrated EEG for neurological assessment and seizure detection in a German pediatric intensive care unit

 Nora Bruns1*, Iciar Sanchez-Albisua1, Christel Weiss2,  Eva Tschiedel1, Christian Dohna-Schwake1,  Ursula Felderhoff-Müser1 and Hanna Müller3
  • 1Department of Paediatrics I, University Hospital Essen, Germany
  • 2Department of Medical Statistics, Biomathematics and Information Processing, Medical Faculty Mannheim, University of Heidelberg, Germany
  • 3Department of Neonatology and Pediatric Intensive Care, Children and Youth Clinic, University Hospital Erlangen, Germany

Objective: The aim of our study was to assess the use of aEEG in our pediatric intensive care unit (PICU), indications for neuromonitoring and its findings, utility for seizure detection, and associations with outcome.
Design: We retrospectively analyzed non-neonates who were treated in our PICU and received amplitude-integrated EEG (aEEG).
Patients: 27 patients aged between 29 days and 10 0/12 years (median 7.3 months) were included, who received a total of 35 aEEGS.
Measurements: aEEG tracings were assessed for background (BG) pattern and its evolution, seizures, and side differences using a visual classification (Hellström-Westas). Clinical data were collected from patients’ histories and analyzed for correlation with aEEG findings.
Main results: While rare in early years, there was an increase in use over time. Most aEEGs were conducted because of (suspected) seizures or for management of antiepileptic treatment. aEEG had low sensitivity but high specificity for recognition of pathological BG pattern with reference to conventional EEG. Worsening of BG pattern or failure to improve was associated with death. Seizure detection rates by aEEG were higher than by clinical observation, especially for identification of non-convulsive epileptic state (ES). Side differences in aEEG were rare, but if present, they were associated with unilateral brain injury.
Conclusions: aEEG is useful for the detection of seizures and ES in pediatric intensive care patients. Abnormal BG pattern and poor evolution of BG are negatively associated with survival. aEEG is a potential supplement to conventional EEG, facilitating long-term surveillance of cerebral function when continuous full-channel EEG is not available. Further investigation is needed.

Keywords: Amplitude integrated EEG, pediatric critical care, Neuromonitoring, aEEG, Outcome, seizure, Continuous EEG, cEEG = continuous EEG

Received: 07 May 2019; Accepted: 15 Aug 2019.

Copyright: © 2019 Bruns, Sanchez-Albisua, Weiss, Tschiedel, Dohna-Schwake, Felderhoff-Müser and Müller. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Nora Bruns, Department of Paediatrics I, University Hospital Essen, Essen, Germany, nora.bruns@uk-essen.de