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PEDIATRICS Vol. 111 No. 1 January 2003, pp. 27-33

Lowered Electroencephalographic Spectral Edge Frequency Predicts the Presence of Cerebral White Matter Injury in Premature Infants

Terrie E. Inder, MD, FRACP, MBChB^*,, Liz Buckland, Christopher E. Williams, PhD^||, Carole Spencer, Mark I. Gunning, MSc^||, Brian A. Darlow, MD, FRACP, Joseph J. Volpe, MD, PhD and Peter D. Gluckman, PhD, FRACP, MBChB^||

^* Murdoch Children’s Research Institute and Howard Florey Institute and Royal Women’s and Royal Children’s Hospital, Melbourne, Australia
Department of Pediatrics, Christchurch Hospital and School of Medicine, University of Otago, Christchurch, New Zealand
Department of Neurology, Children’s Hospital and Harvard Medical School, Boston, Massachusetts
^|| Liggins Institute, University of Auckland, Auckland, New Zealand

--> Objective. Current methods for early identification of cerebral white matter injury in the premature infant at the bedside are inadequate. This study investigated the utility of advanced spectral analysis of the neonatal electroencephalogram (EEG) in the early diagnosis of white matter injury in the premature infant. The critical measurement used, suggested largely by previous studies in animal models, was the spectral edge frequency (SEF), calculated here as the frequency below which 90% of the power in the EEG exists.

Methods. Fifty-nine very low birth weight infants (87% of eligible infants) had electrodes placed over the central and parietal regions (C3, P3, C4, and P4 sites according to the 10-20 international system) for the collection of EEG amplitude, intensity, and SEF. All averaged signals were analyzed off-line using software (Chart Analyzer; BrainZ Instruments, Auckland, NZ). All infants had a magnetic resonance imaging scan at term to identify the presence and severity of white matter injury.

Results. There was no significant difference between conventional EEG amplitude and intensity for infants with or without evidence of white matter injury. However, premature infants with increasingly severe white matter injury had progressively lower SEFs compared with infants who did not exhibit white matter injury.

Conclusions. These data suggest that SEF-based measures are useful for defining the presence and severity of white matter injury at the bedside.

Key Words: white matter injury • prematurity • very low birth weight infant • electroencephalography • spectral analysis

Abbreviations: EEG, electroencephalogram • a-EEG, amplitude-integrated electroencephalogram • CFM, cerebral function monitor • SEF, spectral edge frequency • GA, gestational age • MRI, magnetic resonance imaging • ANOVA, analysis of variance

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Received for publication Feb 6, 2002; Accepted May 17, 2002.

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eLetters:

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The importance of evaluation of the original signal

Magnus Thordstein

Pediatrics Online, 6 Mar 2003 [Full text]

Response to Thordstein & Kjellmer letter March 6th:

Terrie Inder

Pediatrics Online, 11 Mar 2003 [Full text]