Abstract
ObjectivesTo determine the accuracy of, and agreement among, EEG and aEEG readers’ estimation of maturity and a novel computational measure of functional brain age (FBA) in preterm infants.MethodsSeven experts estimated the postmenstrual ages (PMA) in a cohort of recordings from preterm infants using cloud‐based review software. The FBA was calculated using a machine learning‐based algorithm. Error analysis was used to determine the accuracy of PMA assessments and intraclass correlation (ICC) was used to assess agreement between experts.ResultsEEG recordings from a PMA range 25 to 38 weeks were successfully interpreted. In 179 recordings from 62 infants interpreted by all human readers, there was moderate agreement between experts (aEEG ICC = 0.724; 95%CI:0.658–0.781 and EEG ICC = 0.517; 95%CI:0.311–0.664). In 149 recordings from 61 infants interpreted by all human readers and the FBA algorithm, random and systematic errors in visual interpretation of PMA were significantly higher than the computational FBA estimate. Tracking of maturation in individual infants showed stable FBA trajectories, but the trajectories of the experts’ PMA estimate were more likely to be obscured by random errors. The accuracy of visual interpretation of PMA estimation was compromised by neurodevelopmental outcome for both aEEG and EEG review.InterpretationVisual assessment of infant maturity is possible from the EEG or aEEG, with an average of human experts providing the highest accuracy. Tracking PMA of individual infants was hampered by errors in experts’ estimates. FBA provided the most accurate maturity assessment and has potential as a biomarker of early outcome.
Highlights
Scalp recorded electroencephalography (EEG) is widely used for bedside assessment of newborn brain function
Annals of Clinical and Translational Neurology published by Wiley Periodicals LLC on behalf of American Neurological Association
We showed moderate agreement between expert interpretation of functional brain maturity from the EEG or amplitude integrated EEG (aEEG)
Summary
Scalp recorded electroencephalography (EEG) is widely used for bedside assessment of newborn brain function. It is often used for monitoring epileptic seizures, and to track functional brain recovery after medical adversities such as birth asphyxia or early preterm birth.[1,2,3,4,5,6] Recent advances in neonatal intensive care unit (NICU) treatment protocols have emphasized the need for improved, evidence-based measures of functional brain development. Reliability of EEG Review for Age Estimation developmental delay in neonatal EEG.[4,7,8,9,10,11,12,13] EEG would, be an ideal tool for tracking functional brain maturation in both research trials and clinical routine. The visual interpretation of the EEG is, subjective and its general applicability is necessarily predicated on its reliability
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