Amplitude-integrated Electroencephalography Research Articles

Association between cerebrospinal fluid levels of neuro-specific enolase after hypothermia alone and in combination with neurodevelopmental outcomes at age six years.

Hypoxic-ischemic encephalopathy (HIE) is still associated with death and sequelae including cerebral palsy and intellectual disability despite induced hypothermia. Biomarkers, as early predictive indicators of adverse outcomes, are lacking. To investigate whether post-rewarming cerebrospinal fluid (CSF)-neuro-specific enolase (NSE) levels after hypothermia are associated with neurodevelopmental outcomes at age six years, alone or when combined with amplitude-integrated electroencephalography (aEEG) and brain magnetic resonance imaging (MRI), as neuroimaging and neurophysiological indicators, respectively. We retrospectively enrolled 157 patients with HIE from 2011 to 2018 with available post-rewarming CSF-NSE levels and developmental tests at age six years. Of these, 148 met the inclusion criteria, and 87 were evaluated in the final analysis. Multivariate receiver operating characteristic analysis determined the predictive ability of post-rewarming CSF-NSE levels for adverse outcomes including death and cerebral palsy, intellectual disability, and borderline disability at age 6years either singly or in combination with aEEG and MRI findings, using logistic regression analysis. The cut-off value for CSF-NSE at a median 5days after birth was 233ng/dL (area under the curve 0.97, 95% confidence intervals of 0.93-1.00, sensitivity 1, specificity 0.94) for death. Regarding cerebral palsy and intellectual disability, the combination of abnormal aEEG at 72h, moderate-severe MRI injury findings, and with or without CSF-NSE (cut-off value: 55ng/mL), odds ratio (95% confidence intervals) improving from 8.6 (2.7-27.8) to 12.4 (3.5-43.9) (p<0.01). In patients with HIE, post-rewarming CSF-NSE levels were associated not only with death independently but with cerebral palsy and intellectual disability in combination with EEG and MRI findings.

Effects of intrathecal administration of sodium nitroprusside and nicardipine on cerebral pial microcirculation, cortical tissue oxygenation, and electrocortical activity in the early post-resuscitation period in a porcine cardiac arrest model.

Recent studies suggested intrathecal vasodilator administration as a therapy to mitigate post-ischemic cerebral hypoperfusion following cardiac arrest. We examined the effects of two commonly used intrathecal vasodilators, sodium nitroprusside (SNP) and nicardipine, on cerebral pial microcirculation, cortical tissue oxygen tension (PctO2), and electrocortical activity in the early post-resuscitation period using a porcine model of cardiac arrest. Thirty pigs were resuscitated after 14 min of untreated cardiac arrest. At 30 min after resuscitation from cardiac arrest, 30 pigs randomly received 4 mg of SNP, 4 mg of nicardipine, or saline placebo via subdural intracranial catheters and were observed for 5 h. Group effect and group-time interaction were assessed using linear mixed-effects models. The mean arterial pressure was lower in the nicardipine group (coefficient [95% confidence interval {CI}], -15.824 [-24.082 to -7.566]) and higher in the SNP group (coefficient [95%CI], 11.232 [2.974-19.490]) compared to the saline group. The percentage of pial arteriole diameter relative to the pre-arrest baseline value (coefficient [95% CI], 48.970 [13.884-84.057]), microvascular flow index (coefficient [95% CI], 0.296 [0.071-0.521]), and PctO2 (coefficient [95% CI], 26.926 [12.404-41.449]) were higher in the SNP group but not in the nicardipine group compared to the saline group. Amplitude-integrated electroencephalography amplitude recovery was faster in the SNP group (coefficient [95% CI], 1.149 [0.468-1.829]) but not in the nicardipine group compared to the saline group. In conclusion, intrathecal SNP but not nicardipine was effective in treating post-ischemic cerebral hypoperfusion after cardiac arrest.

Newborn with Refractory Seizures due to Hemimegalencephaly and Tuberous Sclerosis Complex: Case Report and Literature Review.

Hemimegalencephaly (HME) is a rare congenital disorder that is initiated during embryonic development with abnormal growth of one hemisphere. Tuberous sclerosis complex (TSC), a genetic disorder, is rarely associated with HME.We present a case of a newborn with HME with a confirmed mutation in the TSC-1 gene and describe the clinical course, findings on amplitude-integrated electroencephalography (aEEG), cranial ultrasound (CUS), MRI, and the postmortem evaluation. Furthermore, we conducted a comprehensive literature review of all reported newborns with HME and a genetically confirmed TSC mutation.This infant experienced therapy-resistant seizures after birth despite treatment with multiple antiseizure medications. CUS and MRI revealed HME of the left hemisphere. Early functional hemispherectomy, around the age of 3 months, was considered but dismissed after multidisciplinary evaluation, medical ethical consultation, and multiple discussions with the parents. Care was redirected due to worsening clinical and neurologic conditions, increasing respiratory insufficiency, and ongoing therapy-resistant seizures. Postmortem evaluation of the brain revealed hamartomatous brain changes and irregular gyration of the enlarged hemisphere. in addition, these changes were also present in the previously considered unaffected side, raising thoughts about the potential effectiveness of functional hemispherectomy.This case report illustrates that in cases with TSC abnormalities might not be confined solely to the initially considered affected side. This can have important therapeutic implications.

Developing predictive nomogram models using quantitative electroencephalography for brain function in type a aortic dissection: a prospective observational study.

Type A aortic dissection (TAAD) remains a significant challenge in cardiac surgery, presenting high risks of adverse outcomes such as permanent neurological dysfunction and mortality despite advances in medical technology and surgical techniques. This study investigates the use of quantitative electroencephalography (QEEG) to monitor and predict neurological outcomes during the perioperative period in TAAD patients. This prospective observational study was conducted at the hospital, involving patients undergoing TAAD surgery from February 2022 to January 2023. QEEG parameters, including the dynamic amplitude-integrated electroencephalography (aEEG) grade, which assesses changes in brain function over time, alongside aEEG and relative band power (RBP), were monitored and analyzed to assess brain function preoperatively, intraoperatively, and within 2hours postoperatively. A predictive nomogram model was developed using these QEEG metrics along with other clinical variables to forecast neurological outcomes. In this study, we analyzed the factors contributing to adverse outcomes (AO) and transient neurological dysfunction (TND) following TAAD surgery. For AO, multivariable analysis identified pre-mental status (odds ratio [OR]=4.652, 95% confidence interval [CI]=2.316-10.074, P < 0.001), cardiopulmonary bypass time (OR=1.014, 95% CI=1.006-1.023, P =0.001), and dynamic aEEG grade (OR=9.926, 95% CI=4.493-25.268, P < 0.001) as independent risk factors. The AO model showed high discriminative ability with an area under the curve of 0.888 (95% CI=0.818-0.960) and good calibration (Brier score=0.0728). For TND, significant preoperative differences included dynamic aEEG grade (P < 0.001) and Log(Post-RBP Alpha%) (6.00 vs. 4.00, P < 0.001). Multivariable analysis identified cardiopulmonary bypass time (OR=1.014, 95% CI=1.006-1.023, P =0.001), Post-RBP Alpha% (OR=0.263, 95% CI=0.121-0.532, P < 0.001), and dynamic aEEG grade (OR=12.444, 95% CI=5.337-30.814, P < 0.001) as independent risk factors. The TND model had an area under the curve of 0.893 (95% CI=0.844-0.941) and good calibration (Brier score=0.125). These findings highlight the role of QEEG in predicting postoperative neurological dysfunction in TAAD patients. Through perioperative QEEG monitoring of TAAD patients, combined with clinical indicators such as cardiopulmonary bypass time and preoperative mental status, we developed clinical predictive models for AO and TND after surgery. These models allow for early detection of postoperative brain function impairment, as assessed by QEEG parameters monitored intraoperatively and during the first 2hours after surgery, a period chosen based on clinical definitions of delayed awakening and supported by the findings of this study. This study provides evidence supporting postoperative brain function monitoring in TAAD patients, with potential clinical implications for improved outcomes.

Depression of cortical neuronal activity after a low-dose fentanyl in preterm infants.

Opioids might be harmful to the developing brain and dosing accuracy is important. We aimed at investigating fentanyl effects on cortical activity in infants using computational re-analysis of bedside recorded EEG signals. Fifteen infants born at median 26.4 gestational weeks (range 23.3-34.1), with a birth weight 740 grams (530-1420) and postnatal age 7 days (5-11) received fentanyl 0.5 or 2 μg/kg intravenously before a skin-breaking procedure or tracheal intubation, respectively. Cortical activity was continuously recorded using amplitude-integrated electroencephalography (aEEG). Analyses using three computational EEG features representing cortical synchrony and signal power, were conducted five minutes pre- and 10 minutes post the drug administration. Visual assessment of trends displayed from the EEG metrics did not indicate systematic changes. However, the magnitude of the changes in the parietal and right hemisphere signals after the dose was significantly correlated (ρ < -0.5, p < 0.05) to the EEG amplitude and frequency power level before drug administration. This effect started after 3-4 min. Fentanyl, even in small doses, may affect cortical activity in the preterm brain. The effect is robustly related to the state of cortical activity prior to drug treatment, which must be taken into account when analysing the effects of sedative drugs.

Amplitude-integrated electroencephalography showed alterations in cerebral activity in monochorionic twins with twin-to-twin transfusion syndrome.

Monochorionic twins are at higher risk of perinatal mortality and morbidity, primarily due to pregnancy-related complications, such as twin-to-twin transfusion syndrome (TTTS). We aimed to investigate whether amplitude-integrated electroencephalography (aEEG) signals are different between monochorionic twins with and without TTTS. This was a retrospective single-centre study conducted at Innsbruck Medical University Hospital, Austria. Preterm infants born before 32 weeks of gestation between 6 November 2010 and 6 December 2022 were eligible. The aEEG was analysed for the total maturation score, its component scores and the number of sleep-wake cycles per hour. We enrolled 79 monochorionic twin infants (48% male) and 157 dichorionic (62% male) twin infants. We found no differences between these two groups of preterm infants regarding the total maturation and component scores, or the number of sleep wake cycles. Monochorionic twins with TTTS showed significantly lower total maturation scores and individual component scores compared to monochorionic twins without TTTS. Preterm infants with TTTS showed differences in neonatal aEEG signals. Whether these differences are caused by prematurity-related or TTTS-related factors, such as hemodynamic and metabolic changes due to placental anastomoses, should be investigated in future prospective studies, to gain more insight into this important topic.

Abstract Su1202: The utility of post cardiac arrest temperature control protocol according to the severity of hypoxic encephalopathy based on amplitude-integrated electroencephalography findings

Introduction: The TTM2 trial showed that active fever prevention below 37.5°C and hypothermia at 33°C had similar outcomes in out-of-hospital post cardiac arrest patients. However, the patients in the trial had mild hypoxic encephalopathy, and the effects of hypothermia may vary with its severity. We previously reported that amplitude-integrated electroencephalography (aEEG) findings after the return of spontaneous circulation can be used to categorize the severity of hypoxic encephalopathy (Crit Care. 2018;22:226). In September 2022, we adopted a new temperature control protocol wherein the target temperature was set based on aEEG findings. This study examined changes in outcomes before and after implementing this new protocol. Methods: We assessed out-of-hospital cardiac arrest patients who received post cardiac arrest care in our emergency intensive care unit between March 2021 and February 2024. We divided the patients into two groups: before (B) and after (A) the introduction of the new protocol. We classified the patients into categories 1 (C1) to 4 (C4) based on the severity of hypoxic encephalopathy (Figure 1). All patients in group B were treated with hypothermia at 34°C. In group A, patients in C1 were treated with active fever prevention, and those in C2–C4 received hypothermia at 34°C (Figure 2). Primary outcome was favorable neurological outcomes (cerebral performance categories of 1 or 2) at hospital discharge. Secondary outcome was the duration of mechanical ventilation. Results: A total of 160 patients were included. The median age was 62 years and 105 (66%) patients had cardiac etiology. Fifty-five (34%) patients underwent extracorporeal cardiopulmonary resuscitation. The median cardiac arrest time was 29 min. Groups B and A comprised 57 and 103 patients, respectively. C1 category comprised 20 and 28 patients in groups B and A, respectively. The rate of favorable neurological outcomes was 35% in both B and A groups (p=1.00). Regarding C1 patients, the rates were 90% and 86% in B and A groups (p=1.00). Median duration of mechanical ventilation was 5 and 3 days in group B and A, respectively (p=0.11). Conclusion: Neurological outcomes before and after introducing the new protocol were similar. Management of patients with mild hypoxic encephalopathy can be simplified with active fever prevention. A temperature control protocol based on the severity of hypoxic encephalopathy using aEEG findings is feasible for emergency physicians.

Altered sleep and inflammation are related to outcomes in neonatal encephalopathy.

Immune dysregulation and delayed onset of sleep wake cycling (SWC) are associated with worse outcome in neonatal encephalopathy (NE), however the association between sleep and immune dysfunction in NE remains unclear. Aimed to evaluate association of sleep and systemic inflammation with outcomes in NE. Amplitude-integrated electroencephalography (aEEG) recordings were collected on infants undergoing therapeutic hypothermia (TH). Duration to onset of (SWC) and sleep quality (SQ) were examined. Blood samples collected during the first 2 days of life. Thirteen pro- and anti-inflammatory serum cytokines were quantified. Adverse outcome defined as death or abnormal MRI brain. Earlier onset of SWC and better SQ had less adverse outcomes. SQ provided better prognostic value and showed better interobserver agreement compared to duration to SWC. Better SQ associated with lower cytokines EPO and interleukin (IL)-1β. In infants with unfavourable outcome, shorter duration to SWC was associated with higher EPO and better SQ was associated with lower TNF-α. Earlier onset of SWC or better SQ showed less systemic inflammation and fewer adverse outcomes. SQ during TH provided better prognostic information than time of onset of SWC. Modulation of circadian rhythm in infants with NE may have an immunomodulatory role, leading to improved outcomes.

Role of early postnatal aEEG and brain MRI in predicting neurodevelopmental outcome in preterm infants at the age of 1 year

BackgroundPreterm birth is a principal reason for perinatal morbidity and mortality increasing the incidence of severe neurodevelopmental deficits. There is growing proof that early postnatal amplitude-integrated electroencephalography (aEEG) has a prognostic value for neurodevelopmental consequence in preterm born neonates. Furthermore, MRI has been widely utilized to enhance comprehension of the brain substrate responsible for neurodevelopmental abnormalities. Thus, this study aims at evaluating the role of early postnatal aEEG and brain MRI in forecasting neurodevelopmental consequence in preterm infants at the age of 1 year.MethodsA cohort study performed in the neonatal intensive care unit of a tertiary hospital during the duration from October 2021 to June 2023 including 60 preterm neonates < 32 weeks of gestation. All cases were monitored by aEEG within the 1st 72 h of life for at least 4 h, and then brain MRI and aEEG were done at term equivalent age (TEA) of 40 weeks. Regarding the neurodevelopmental outcome, our cases were assessed by Bayley scale III screening test at the age of 1 year.ResultsOf the study participants, 41.7% were males, and 58.3% were females with a mean gestational age of 30.40 ± 0.94 weeks and mean weight of 1.36 ± 0.17 kg. aEEG showed that 83.3% of the cases had continuous normal background activity at TEA, and MRI showed that 75% of the cases were normal. Comparing between non-affected and affected groups as categorized by Bayley scale regarding aEEG and MRI findings, there was greatly statistically significant difference between the two groups (P < 0.001). Brain MRI showed higher sensitivity and accuracy than aEEG.ConclusionBrain MRI at TEA is more sensitive and accurate than aEEG to predict the neurodevelopmental outcome. aEEG at TEA is more predictor for neurodevelopmental outcome than at birth. The combination of both aEEG and brain MRI at TEA gives more prediction about the degree of affection in neurodevelopmental outcome in preterm infants.

Analysis of electrode performance on amplitude integrated electroencephalography in neonates: evaluation of a new electrode aCUP-E vs. liquid gel electrodes.

Neonatologists and clinical neurophysiologists face challenges with the current electrodes used for long-duration amplitude-integrated electroencephalography (aEEG) in neonatal intensive care units (NICU), limiting the capacity to diagnose brain damage. The objectives of this study were to develop methods for comparing the performance of different electrodes to be used in aEEG. The comparison was done between a newly designed neonate-specific electrode, aCUP-E, with commercial liquid gel electrodes used in amplitude-integrated electroencephalography (aEEG). The comparison included impedance stability, electrode survival, recording quality, usability, and satisfaction of NICU staff. aEEG recordings with bipolar montage was used, with one hemisphere fitted with commercial electrodes and the other with aCUP-E electrodes, alternated among subjects. Continuous impedance and raw EEG data were collected over a minimum of 24 h, and signal processing was performed using Python and MATLAB. aCUP-E electrodes demonstrated superior performance, including: Increased impedance stability and electrode survival, enhanced recording quality with fewer artifacts, high correlation in signal capture between electrodes during optimal brain activity segments, higher signal-to-noise ratio (SNR) across varying impedance levels, greater staff satisfaction and ease of use. Moreover, Kaplan-Meier curves indicated a higher survival rate for aCUP-E electrodes over 24 h compared to commercial electrodes. Impedance variability analysis showed statistically significant stability improvements for aCUP-E. aCUP-E electrodes outperform commercial liquid gel electrodes in impedance stability, electrode survival, and recording quality. These results suggest that aCUP-E electrodes could significantly enhance aEEG utilization in diagnosing and treating neonatal brain conditions in NICUs. Future improvements to the aCUP-E electrode may further reduce artifacts and increase electrode longevity, potentially leading to a significant improvement in neonatal brain monitoring by means of aEEG.

Therapeutic hypothermia: A descriptive, cohort study conducted over 10 years at a tertiary care public hospital.

Introduction. Therapeutic hypothermia (TH) reduces the risk of death or disability in children with moderate to severe hypoxic ischemic encephalopathy (HIE). Objective. To describe a population of patients with HIE that required TH and their course until discharge. Population and methods. Retrospective, descriptive, cohort study. All patients admitted to TH between 2013 and 2022 were studied. Epidemiological, clinical, monitoring, and treatment data were assessed, together with supplementary tests and condition at discharge. Risk factors were compared between deceased patients and survivors; and, among the latter, those requiring special healthcare needs (SHCN) at discharge. Results. A total of 247 patients were included. Mortality: 11%. Most common sentinel event: prolonged second stage of labor (39%). Treatment initiation: median of 5 hours of life. Seizures: 57%. Intravenous erythropoietin: 66.7%. Abnormal pattern in brain function monitoring: 52%. Normalization of monitoring: median of 24 hours. Pathological magnetic resonance imaging: 42%. Predictor variables of mortality: severe Sarnat and Sarnat staging and pathological ultrasound upon admission. Conclusion. The overall mortality rate was 11%. Referrals increased more markedly since 2018. The time of TH initiation was later than in previous reports. Severe neurological signs as per the Sarnat and Sarnat staging and a pathological baseline cranial ultrasound were independent predictors of mortality at discharge. Patients with SHCN at discharge showed a normalized tracing in the amplitude-integrated electroencephalography performed later. The most common finding in the magnetic resonance imaging was basal ganglia involvement. No statistically significant differences were observed in terms of clinical characteristics or complications among patients who received erythropoietin.

Postnatal cytomegalovirus infections did not alter amplitude-integrated electroencephalography signals or general movements in preterm infants.

Controversy prevails about whether postnatal cytomegalovirus (CMV) infections are associated with adverse neurodevelopmental outcomes. We aimed to investigate whether amplitude-integrated electroencephalography (aEEG) signals and General Movement Assessment (GMA) scores differed in very preterm infants with postnatal CMV infections. This was a retrospective single-centre study, conducted at Innsbruck Medical University Hospital, Austria, between February 2011 and November 2018. We screened 461 infants born before 32 weeks of gestation for CMV infections. Their aEEG signals were analysed for the distribution of background activity patterns and their total maturation scores and component scores. The GMA was performed at 36 weeks of postmenstrual age, term-equivalent age and 3 months of corrected age. We studied 20 infants (55% male) with postnatal CMV infections, born at a mean gestational age of 28.1 (25.3-30.7) weeks and a mean birth weight of 1064 (640-1600) grams. No differences were found in the aEEG signals or GMA scores between these infants and 441 uninfected controls. Preterm infants with postnatal CMV infections showed no alterations in neonatal aEEG signals or GMA scores, compared with the uninfected controls. Longer follow-up studies are needed to evaluate the effect of postnatal cytomegalovirus infections on later neurodevelopmental outcomes.

Quantitative Electroencephalography for Predication of Neurological Dysfunction in Type A Aortic Dissection: A Prospective Observational Study.

Type A aortic dissection presents challenges with postoperative cerebral complications, and this study evaluates the predictive value of quantitative electroencephalography for perioperative brain function prognosis. Amplitude-integrated electroencephalography (aEEG) processes raw signals through filtering, amplitude integration, and time compression, displaying the data in a semilogarithmic format. Using this method, postoperative relative band power (post-RBP) α% and dynamic aEEG (ΔaEEG) grade were significantly associated with neurological dysfunction in univariate and multivariable analyses, with area under the receiver operating characteristic curve of 0.876 (95% CI, 0.825-0.926) for the combined model. Postoperative relative band power α% and ΔaEEG were significantly associated with adverse outcomes, with area under the receiver operating characteristic curve of 0.903 (95% CI, 0.835-0.971) for the combined model. Postoperative relative band power α% and ΔaEEG were significantly associated with transient neurological dysfunction and stroke, with areas under the receiver operating characteristic curve of 0.818 (95% CI, 0.760-0.876) and 0.868 (95% CI, 0.810-0.926) for transient neurological dysfunction, and 0.815 (95% CI, 0.743-0.886) and 0.831 (95% CI, 0.746-0.916) for stroke. Among 56 patients, the Alberta Stroke Program Early Computed Tomography score was superior to ΔaEEG in predicting neurological outcomes (area under the receiver operating characteristic curve of 0.872 versus 0.708 [95% CI, 0.633-0.783]; P<0.05). Perioperative quantitative electroencephalography monitoring offers valuable insights into brain function changes in patients with type A aortic dissection. ∆aEEG grades can aid in early detection of adverse outcomes, while postoperative relative band power and ∆aEEG grades predict transient neurological dysfunction. Quantitative electroencephalography can assist cardiac surgeons in assessing brain function and improving outcomes in patients with type A aortic dissection. URL: https://www.chictr.org.cn; Unique identifier: ChiCTR2200055980.

Using cerebral regional oxygen saturation and amplitude-integrated electroencephalography in neonates on extracorporeal membrane oxygenation: preliminary experience from a single center

ObjectiveThis study aims to evaluate the application value in neurological outcome of cerebral regional oxygen saturation (CrSO2) and amplitude-integrated electroencephalography (aEEG) monitoring during neonatal extracorporeal membrane oxygenation (ECMO) courses.Methods We retrospectively analyzed 18 neonates receiving veno-arterial ECMO (V-A ECMO) support at our hospital from July 2021 to December 2022. Continuous monitoring of CrSO2 and brain electrical activity was conducted using near-infrared spectroscopy (NIRS) and aEEG throughout the ECMO treatment. We collected and analyzed related clinical data.ResultsAmong the 11 survivors, 5 were categorized as the normal group (N group) and 6 as the abnormal group (AN group) based on post-ECMO brain MRI outcomes. The N group exhibited shorter time percentage of significant CrSO2 reduction (> 25% from baseline or absolute value < 40%), better fractional tissue oxygen extraction (FTOE) rates, and more stable mean percentage changes in CrSO2 compared to the AN group. Neonates in the N group predominantly showed mildly abnormal aEEG readings, with one patient displaying disrupted sleep-wake cycles. This particular patient also had more significant CrSO2 reduction and poorer FTOE compared to others in the N group. Additionally, the Test of Infant Motor Performance (TIMP) scores indicated hypoevolutism in this patient before discharge, while others in the N group had normal TIMP scores. In the AN group, 4 exhibited moderate and 2 severe aEEG abnormalities; 5 had hypoevolutism TIMP scores, and 1 with moderate aEEG abnormalities maintained a normal TIMP score, exhibiting lesser CrSO2 reduction and improved FTOE.ConclusionCrSO2 and aEEG monitoring show potential as routine assessments for neurological outcomes during neonatal ECMO. In our cohort, a tendency was observed where neonates with greater reductions in CrSO2 and more severe aEEG abnormalities experienced poorer neurological outcomes.

Neuromonitoring practices for neonates with congenital heart disease: a scoping review.

Neonates with congenital heart disease (CHD) are at risk for adverse neurodevelopmental outcomes. This scoping review summarizes neuromonitoring methods in neonates with CHD. We identified 84 studies investigating the use of near-infrared spectroscopy (NIRS) (n = 37), electroencephalography (EEG) (n = 20), amplitude-integrated electroencephalography (aEEG) (n = 10), transcranial Doppler sonography (TCD) (n = 6), and multimodal monitoring (n = 11). NIRS was used to evaluate cerebral oxygenation, identify risk thresholds and adverse events in the intensive care unit (ICU), and outcomes. EEG was utilized to screen for seizures and to predict adverse outcomes. Studies of aEEG have focused on characterizing background patterns, detecting seizures, and outcomes. Studies of TCD have focused on correlation with short-term clinical outcomes. Multimodal monitoring studies characterized cerebral physiologic dynamics. Most of the studies were performed in single centers, had a limited number of neonates (range 3-183), demonstrated variability in neuromonitoring practices, and lacked standardized approaches to neurodevelopmental testing. We identified areas of improvement for future research: (1) large multicenter studies to evaluate developmental correlates of neuromonitoring practices; (2) guidelines to standardize neurodevelopmental testing methodologies; (3) research to address geographic variation in resource utilization; (4) integration and synchronization of multimodal monitoring; and (5) research to establish a standardized framework for neuromonitoring techniques across diverse settings. IMPACT: This scoping review summarizes the literature regarding neuromonitoring practices in neonates with congenital heart disease (CHD). The identification of low cerebral oxygenation thresholds with NIRS may be used to identify neonates at risk for adverse events in the ICU or adverse neurodevelopmental outcomes. Postoperative neuromonitoring with continuous EEG screening for subclinical seizures and status epilepticus, allow for early and appropriate therapy. Future studies should focus on enrolling larger multicenter cohorts of neonates with CHD with a standardized framework of neuromonitoring practices in this population. Postoperative neurodevelopmental testing should utilize standard assessments and testing intervals.

Enhancing postoperative analgesia in carotid endarterectomy patients: The potential of ultrasound-guided carotid sheath block combined with superficial cervical plexus block: A randomised trial.

Carotid endarterectomy (CEA) is a common procedure conducted under regional anaesthesia, providing real-time cerebral function monitoring. Many different combinations of regional cervical blocks exist, and most offer adequate analgesia in intraoperative and postoperative recovery. This research compares a superficial cervical plexus block (SCB) alone and combined with an ultrasound (US)-guided carotid sheath block (CSB). The primary objective was to explore the length of the sensory block after combining SCB and CSB. Patients scheduled for nonemergency CEA surgery were randomised into two cohorts. The Subject group (28 participants) received US-guided CSB and SCB. The Control group (31 participants) received only an SCB. Both groups received 0.5% levobupivacaine (2 mg/kg) along with 2% lidocaine (2 mg/kg). The sensory block time and its initiation, analgesia and neutrophil-to-lymphocyte ratio (NLR) were recorded before and after the block. The numeric pain rating scale (NPRS) was used to evaluate analgesia every 2 h for 12 h post block. Analysis of variance, Mann-Whitney U or log-rank test was used to analyse the distinction of selected variables. The demographic characteristics were comparable across the cohorts. The Subject group demonstrated a significantly accelerated onset of sensory block (P = 0.029) and an extended time to first analgesia (P = 0.003). The sensory block was also substantially extended in the Subject group (P = 0.040). Postoperative pain (NPRS ≥1) within the first 12 h was more recurrent in the Control group (P = 0.048). NLR showed minimal disparity between the groups (P = 0.125). Combining SCB and US-guided CSB effectively and safely extends postoperative analgesia for CEA surgery.

Amplitude-integrated electroencephalography monitoring results of hospitalized neonates in plateau areas

To investigate the amplitude-integrated electroencephalography (aEEG) monitoring results of hospitalized neonates in plateau areas. A retrospective analysis was conducted on 5 945 neonates who were admitted to the Department of Neonatology, Kunming Children's Hospital, and received aEEG monitoring from January 2020 to December 2022. According to the aEEG monitoring results, they were divided into a normal aEEG group and an abnormal aEEG group. The incidence rate of aEEG abnormalities was analyzed in neonates with various systemic diseases, as well as the manifestations of aEEG abnormalities and the consistency between aEEG abnormalities and clinical abnormalities. Among the 5 945 neonates, the aEEG abnormality rate was 19.28% (1 146/5 945), with an abnormality rate of 29.58% (906/3 063) in critically ill neonates and 8.33% (240/2 882) in non-critically ill neonates (P<0.05). The children with inherited metabolic diseases showed the highest aEEG abnormality rate of 60.77% (79/130), followed by those with central nervous system disorders [42.22% (76/180)] and preterm infants [35.53% (108/304)]. Compared with the normal aEEG group, the abnormal aEEG group had significantly lower age and gestational age, as well as a significantly lower birth weight of preterm infants (P<0.05). Among the 1 146 neonates with aEEG abnormalities, the main types of aEEG abnormalities were sleep cycle disorders in 597 neonates (52.09%), background activity abnormalities in 294 neonates (25.65%), and epileptiform activity in 255 neonates (22.25%), and there were 902 neonates (78.71%) with abnormal clinical manifestations. The sensitivity and specificity of aEEG monitoring for brain function abnormalities were 33.51% and 92.50%, respectively. In plateau areas, there is a relatively high rate of aEEG abnormalities among hospitalized neonates, particularly in critically ill neonates and those with smaller gestational ages and younger ages, suggesting a high risk of brain injury. Therefore, routine aEEG monitoring for the hospitalized neonates can help with the early detection of brain function abnormalities, the decision-making in treatment, and the formulation of brain protection strategies.

The Predictive Value of Amplitude-Integrated Electroencephalography for the Neurodevelopmental Outcomes of Preterm Newborns at 12 Months Corrected Age.

In clinical practice, it is crucial to identify diagnostic methods that can forecast the neurodevelopmental outcomes of very preterm neonates. Our study aimed to assess the predictive significance of amplitude-integrated electroencephalography (aEEG) for the neurodevelopmental outcomes of preterm infants at 12 months corrected age and to establish the cut-off score that could indicate potential neurodevelopmental impairments. Preterm neonates born before 32 weeks of gestational age between June 2020 and July 2022 were included in a prospective manner. Amplitude-integrated electroencephalography recordings were conducted at five age intervals (days 1-3; first, second, third and fourth weeks). Recordings were analyzed using the Burdjalov scoring system. The neurodevelopment assessment with Bayley Scales of Infant Development-Second Edition was carried out at 12 months corrected age. A total of 140 newborns were included in the study. Neurodevelopment was assessed in 108 infants at 12 months corrected age. Higher total aEEG Burdjalov scores were observed in groups with normal cognitive and motor development. The most sensitive and specific score for prediction of cognitive impairment in 12 months corrected age was an aEEG evaluation of 5.5 according to Burdjalov score within the first three days. The most sensitive and specific score for prediction of motor impairment was 8.5 within the first week. According to our research there is currently not enough data to accurately foresee the development of newborns at 12 months corrected age according to early aEEG test results. However, conducting a research with bigger sample size and repeated evaluations at a later age might increase the prognostic value of aEEG. In this study cut-off scores of aEEG performed early in life to predict later neurodevelopment outcomes were determined.

The clinical value of amplitude-integrated electroencephalography in a historical cohort with neonatal encephalopathy: A comparison of short-term versus prolonged-period monitoring

To compare the amplitude-integrated electroencephalography (aEEG) monitoring (short-term versus prolonged-period) for neonatal seizure detection and outcome. The aEEG monitoring in a historical cohort (n=88, preterm:42, and term:46) with neonatal encephalopathy between 2010-2022 was re-evaluated for neonatal seizures (electrographic, electro-clinical, and clinical seizures) and EEG background scoring. The cohort was dichotomized: group I (short-period with 6-12h, n=36) and group II (prolonged-period with 24-48h, n=52). Both monitoring types were evaluated for the diagnostic accuracy of the "patients with seizures" and for outcome characteristics (early death as well as adverse outcomes at 12months of age). A total of 67 (76%) neonates of the cohort were diagnosed as "patients with seizures": electrographic-only seizures in 10 (15%), electro-clinical seizures in 22 (33%), and clinical-only seizures in 35 (52%). The aEEG provides the "patients with seizures" in neonates with a 36.5% rate with both types of monitoring: 17/36 (47.2%) with short-term and 15/52 (28.8%) with prolonged-period monitoring. The prolonged period aEEG had higher diagnostic values for seizure detection (sensitivity=0.73 and negative predictivity value=0.81). However, the aEEG background scores were similar for both types of aEEG monitoring, respectively (the mean±SD: 4.73±2.9 versus 4.4±4. p=0.837). The aEEG scoring was correlated with the magnitude of brain injury documented with MRI, the early death, and the adverse outcome at 12months of age. Both aEEG types are valuable for monitoring the "patients with seizures" and outcome characteristics.

Mnemonics for the use and interpretation of amplitude-integrated electroencephalography in newborn infants.

An electroencephalography (EEG) has always been considered a specialized field, whose use and interpretation requires training. For this reason, access to these monitoring studies has been restricted to neurologists and neurophysiologists. Newborn infants admitted to the neonatal intensive care unit (NICU) require neurophysiological monitoring to establish their diagnosis and prognosis, so a simple and accessible tool is required for NICU staff. Such features have been covered by amplitude-integrated electroencephalography (aEEG), which, through simple visual patterns of brain activity, allows to approach neurological conditions. The objective of this study is to help with the management of mnemonics that facilitate the identification of normal and pathological visual patterns in an aEEG. Although simple in appearance, this nomenclature is intended to create an easy-to-understand idea of basic concepts for the use and interpretation of neurophysiological monitoring with aEEG.