A Comparison Of Conventional Electroencephalography With Amplitude-Integrated EEG In Detection Of Neonatal Seizures

Figures & data

Table 1 Important Characteristics Of The Included Studies

Author & Year Of Publication	Sample Size	Subject, Conceptional Age	Results	Conclusions
Hellstrom-Westas 1995^Citation29	47	Term neonates with HIE 37–42w	Normal pattern: Sensitivity: 89% Specificity: 94.7% PPV: 96.2% Abnormal pattern: Sensitivity: 94.7% Specificity: 89.3% PPV: 85.7%	aEEG monitoring at 6 hrs after birth predicts the outcome, with a high degree of accuracy, after birth asphyxia
Eken 1995^Citation30	31	Term neonates with HIE	Seizure detection: Sensitivity: 94.1% Specificity: 78.6% PPV: 84.2% NPV: 91.7%	aEEG provided the most useful data about encephalopathy and subsequent neurodevelopmental outcome
Toet 2002^Citation39	36	Neonate ≥ 36w	PWS detection: Sensitivity: 76% Specificity: 100% PPV: 100% NPV: 80%	aEEG is a reliable tool to detect seizures as a monitoring method
Rennie 2004^Citation24	40	At-risk neonate, 24–42 w	Seizure detection: Sensitivity: 38, 54, 55% Specificity: 92, 75, 61%	About half of the seizures are not detected by aEEG
Van Rooij 2005^Citation31	160	Term neonates with perinatal asphyxia	Seizure detection: Sensitivity: 93% Specificity: 85% PPV: 88% NPV: 91%	aEEG is not enough to accurate prediction of neurodevelopmental outcomes.
Sisman 2005^Citation40	31	Preterm, GA < 33 w, Without neurologic anomaly	frequency of mature SWC increased with PMA independent of GA, while the frequency of continuity increased with PMA and was higher	aEEG in preterm infants may need to be analyzed by comparing results with standards of similar PMA and GA
Osredkar 2006^Citation42	15	Term neonates without severe HIE, but suspicious	Seizure detection: Sensitivity: 50% Specificity: 100% PPV: 100% NPV: 75%	aEEG could evaluate the presence or absence of epileptiform activity in term without severe HIE
Shelhaas 2007^Citation41	121	Mixed group of the near-term neonate (35–50 w)	Seizure detection: Sensitivity: 25.5% Patient with seizure: Sensitivity:40.3%	aEEG is a useful supplemental tool to detect seizure and predict of outcome in neonates
Shah 2008^Citation26	21	Term neonate with seizure	Seizure detection: Sensitivity: 76% Specificity: 78% PPV: 78% NPV: 78% PWS detection: Sensitivity:85%	aEEG with raw trace detected the majority of seizures by an experienced neonatologist
Lawrence 2009^Citation27	40	Neonate with HIE, ≥36 w	Seizure detection: Sensitivity 79% False-positive rate:26%, PPV:73%, NPV: 99%	aEEG with raw trace can be interpreted accurately and compares favorably with cEEG
Bourez Swart 2009^Citation46	12	Term infant with HIE	Single-channel aEEG: Seizure detection: Sensitivity: 30% (95% CI: 0.22–0.38) PWS detection: Sensitivity: 92% (95% CI:0.65–0.99) Multichannel aEEG: Seizure detection: Sensitivity: 39% (95% CI:0.31–0.48) PWS detection: Sensitivity: 100% (95% CI:0.31–1)	aEEG is a reliable tool for long-term monitoring in NICUs
Evans 2010^Citation48 {Evans, 2010^Citation48}	44	At-risk neonate, >31w	Seizure detection: Sensitivity: 80% Specificity: 50%	aEEG overdiagnosed seizures. Seizures noted on aEEG require sEEG confirmation
Frenkel 2011^Citation28	38	At-risk neonate, 24-43w	PWS detection: Sensitivity: 68%–84% Specificity: 71%–84%	aEEG with raw trace has very high sensitivity and specificity when used by experienced users
Zhang 2011^Citation54	62	At-risk neonates, term	aEEG: Seizure detection: Sensitivity: 44% PWS detection: Sensitivity: 17% aEEG with raw trace: Seizure detection: Sensitivity: 85% PWS detection: Sensitivity: 70%oro	aEEG and clinical observation were not reliable in diagnosing neonatal seizures
Mastrangelo 2013^Citation51	28	High-risk neurological insult term	Seizure detection: Sensitivity by neurologist: 49% Sensitivity by neonatologist: 37.5%	aEEG is used as a monitoring tool and cEEG complemented to detect seizures in newborns with acute encephalopathy.
Toso 2014^Citation52	21	At-risk term infants	Seizure detection: Sensitivity: 90% Specificity: 82% PPV: 82% NPV: 90%	In NICUs, aEEG is a useful device in all sick infants for predicting short-term neurological outcomes.
Meledin 2016^Citation20	67	Preterm neonate, GA<34w	EEG IBI, alpha, and theta frequencies’ amplitudes were negatively correlated to the aEEG lower border, while conceptional age (CA) was positively correlated to aEEG lower border (P < 0.001). IBI and all frequencies’ amplitude were positively correlated to the upper aEEG border (P ≤ 0.001)	aEEG recordings in high-risk premature neonates reflect reliably EEG background information related to continuity and amplitude

Abbreviations: HIE, hypoxic ischemic encephalopathy; aEEG, amplitude-integrated electroencephalogram; FSIQ, Fullscale Intelligence Quotient; cEEG, conventional electroencephalogram; SWC, sleep-wake cycling; C.I., confidence interval; sEEG, standard EEG; CFM, cerebral function monitor; EEG, electroencephalogram; GA, gestational age; h, hours; cm-centimeter; NPV, negative predictive value; PPV, positive predictive value; PWS, patients with seizures.

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