Published online January 19, 2009
PEDIATRICS Vol. 123 No. 2 February 2009, pp. e328-e332 (doi:10.1542/peds.2008-2850)
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Suk, D.
Right arrow Articles by Perlman, J. M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Suk, D.
Right arrow Articles by Perlman, J. M.
Related Collections
Right arrow Neurology & Psychiatry
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Facebook   Add to Reddit   Add to Technorati   Add to Twitter  
What's this?

ARTICLE

Amplitude-Integrated Electroencephalography in the NICU: Frequent Artifacts in Premature Infants May Limit Its Utility as a Monitoring Device

Debbie Suk, MD, Alfred N. Krauss, MD, Murray Engel, MD and Jeffrey M. Perlman, MB, ChB

Departments of Pediatrics and Neurology, Weill Cornell Medical College of Cornell University, New York, New York

BACKGROUND. Amplitude-integrated electroencephalography has become an important tool for assessing cortical status noninvasively. Newer units have the additional feature of visualizing the raw electroencephalogram, which has resulted in the identification of frequent artifacts.

OBJECTIVE. To highlight the problem of artifacts and to introduce caution when using the amplitude-integrated electroencephalography technique to assess cortical function in the premature population.

METHODS. Ten premature infants were evaluated. Compressed amplitude-integrated electroencephalography recordings were made by using a pair of standard electroencephalogram electrodes attached to the scalp frontotemporal areas. Impedance was maintained at <10 k{Omega}. Continuous amplitude-integrated electroencephalography recordings were performed for at least 60 minutes on several occasions in the first month. Artifacts were identified as follows: large amplitude difference between the wave peaks and troughs, a jagged appearance to wave peaks and troughs, and large deflections of the overall tracing in either a positive or negative direction from baseline.

RESULTS. Forty-eight amplitude-integrated electroencephalography recordings were reviewed. Of 1683 total segments analyzed, 529 (31.4%) were categorized as normal brain waves, 1013 (60.2%) as artifacts, and 142 (8.4%) as indeterminate. Generally, when the amplitude-integrated electroencephalography tracing is of modest amplitude, normal brain waves predominated, whereas with upward spikes in amplitude the accompanying raw electroencephalogram was classified as artifact.

CONCLUSIONS. Artifacts contribute substantially to the amplitude-integrated electroencephalography tracing, rendering it problematic as an assessment tool in premature infants. Artifacts may be influenced by muscle activity, electrode positioning, and application techniques. Caution is recommended when using amplitude-integrated electroencephalography as an assessment tool in this population.

Key Words: premature infant • cerebral function monitor • amplitude-integrated electroencephalography • raw electroencephalogram, artifact

Abbreviations: EEG—electroencephalography • aEEG—amplitude-integrated electroencephalography • CFM—cerebral function monitor

Accepted Oct 21, 2008.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Facebook Facebook   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter    What's this?