APPLICATION OF AMPLITUDE-INTEGRATED ELECTROENCEPHALOGRAPHY IN PATIENTS OF NEONATAL INTENSIVE CARE UNITS

Abstract

Intriduction. Amplitude-integrated electroencephalography is a technique for monitoring continuous cerebral function, when electroencephalographic signal is filtered, scaled and compressed in time.
 Objective of the study is to elucidate peculiarities of interpreting findings of the amplitude-integrated electroencephalography in patients of neonatal intensive care units, and represent a clinical case of establishing diagnosis by using the amplitude-integrated electroencephalography for a critically sick neonate.
 Materials and methods. A comprehensive literature review was conducted across international and national databases, including Elsevier, PubMed, Medline, Web of Science, Scopus, Cochrane Central Register of Controlled Trials, and Google Scholar, covering the period from 2019 to 2023. The search focused on the keywords "amplitude-integrated electroencephalography" and/or "aEEG" and "neonates" and/or "term infants" and/or "preterm infants." The clinical case presented took place at the neonatal intensive care unit of the Maternity Home "Central Municipal Clinical Hospital", Chernivtsi, Ukraine. Permission for publication was obtained from both parents of the child.
 Results. The main indications for conducting the amplitude-integrated electroencephalography in neonates include the assessment of the cerebral function and the degree of cerebral damage with hypoxic-ischemic encephalopathy or asphyxia at birth (often combined with therapeutic hypothermia); assessment of sleep-wake cycle; identification of seizures; assessment of cerebral function maturity in preterm neonates.
 The underlying cerebral activity is estimated according to the amplitude-integrated electroencephalography findings by means of a simple recognition of visual images corresponding to the five main patterns: Continuous Normal Voltage, Discontinuous Normal Voltage, Burst Suppression, Low Voltage, and Flat Trace. A typical neonatal single seizure fit on the amplitude-integrated electroencephalography looks like a “hump” or lower edge elevation interrupting the background recording. Repeated fits (epileptic status) look like a “saw” of repeated “humps”, one of each represents one attack. The article presents a clinical case of the diagnostic search in the neonate with congenital pneumonia and development of multiple organ failure syndrome including seizure syndrome. Clinical tonic-clonic seizures of the infant were associated with electroencephalographic criteria of status epilepticus both on the amplitude-integrated electroencephalography (repeated symmetrical elevations of the lower edge in the left and right) and on the standard electroencephalography (different variations of seizure graphic elements in the right and left). Considering the results of the clinical and instrumental examination, an adequate anticonvulsant therapy was administered.
 Conclusions. Continuous recording of the video-amplitude-integrated electroencephalography and standard electroencephalography in infants from the risk group is a good strategy of the neurological status effective monitoring. It enables to assess the underlying cerebral electric activity and it maturity, diagnose seizures and manage anticonvulsant therapy correctly. An adequate training of the staff who are at the patient’s bedside 24/7 is an important part of the interdisciplinary collaboration which is essential for a safe and effective management of patients in the neonatal intensive care units, prevention of early complications and disability in the future.