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EEG of preemies demonstrated possible delays later on
Premature babies who had electroencephalogram abnormalities within their first month of life were more likely to have developmental delays and cerebral palsy later on, according to study results published online.
Naoko Hayashi-Kurahashi, MD, of the department of pediatrics at Washington University in St. Louis, and colleagues in Japan looked at the electroencephalography (EEG) records of 333 infants born at less than 34 weeks’ gestation between 2002 and 2008.
The researchers reported that 10% of the infants had a reported developmental delay at 12 to 18 months of age, and 10% had cerebral palsy.
“The grade of EEG abnormalities correlated with the incidence of developmental delay or cerebral palsy in all periods (P<.001),” the researchers wrote, adding that abnormalities were detected at week 2 after birth.
The researchers found some study limitations, including that their follow-up evaluations took place at ages 12 to 18 months, which may have actually underestimated cognitive delays. They suggested future follow-up with these children, including at school age, to better evaluate developmental delays in this population of children.
Disclosure: Hayashi-Kurahashi reports no relevant financial disclosures.
Perspective
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This is a well done blinded, prospective study, utilizing conventional electroencephalogram (EEG) analysis at one center, to determine correlates of electrographic abnormities with later developmental impairments, subsequent to premature birth. The authors emphasize that there has been a shift in neurologic morbidities associated with the modern management of prematurity over the last 2 decades, with diminished severity of brain injuries. However, long-term neurocognitive impairments persist in this population, despite improvements in the care of premature babies. Means of predicting neurodevelopmental outcome have been long sought to help prognosticate for children born prematurely.
EEG has been utilized in the past, and both conventional and amplitude integrated studies have been shown to have prognostic value. However, EEG is often ordered if there are concerns regarding seizures, including subclinical events that may only be evident electrographically. Longer studies, utilizing amplitude integrated EEG (aEEG) have become popular as a means of monitoring brain activity in an ongoing, real-time fashion, but require regular maintenance by technicians and nurses and may interfere with other studies that require access to the scalp. Conventional studies, such as those used here (compared to long-term brain monitoring methods) are typically short, non-invasive and readily completed in a busy intensive care setting, without the need for prolonged maintenance of scalp electrodes.
The short nature of the conventional EEG study helps minimize interference in the busy neonatal care environment, and allows for other studies to be performed, such as head ultrasound or MRI. Serial studies can help demonstrate improvements in background activity or persistent abnormalities.
The study demonstrates that the modern management of premature babies would probably benefit from the regular use of EEG to help flag children most likely to suffer neurodevelopmental challenges. Importantly, many centers have access to EEG, but may not utilize aEEG because of cost constraints/complexity, etc, and so these results might help clinicians prognosticate in such centers without investing in more complex technology. This, therefore, may also be important in the developing world, as improvements in newborn care are improved, and resources for early intervention are minimally available, allowing for limited resources to be directed to the neediest/at risk population.
Cautions in the interpretation/ implementation of the recommendations in the paper include the recognition that centers may not have optimal experience in the interpretation of newborn EEG, and interpretative variability may exist in determining degree of background abnormalities, for instance. Serial analysis as was done in this study should help with demonstration of improvements in background activity, the disappearance/persistence of electrographic abnormalities, thereby further refining the prognostic information.
The authors correctly emphasize also that sedative medications may affect EEG activity and this should be factored into the interpretative process. Additionally, children were followed only through 18 months, and further developmental information should be gathered as they approach school age, to allow for a more refined analysis of developmental/cognitive outcome.
