Neonatal EEG/ Terms Flashcards
Information that must be included in the study information available to the electroencephalographer
The baby’s gestational age at birth, chronologic age, and postmenstrual age on the day of recording, stated in weeks
Postmenstrual age (PMA) is
gestational age (GA) plus chronological age (CA)
Gestational age (GA) is
the time elapsed between the first day of the last menstrual period and the day of delivery
Chronological age (CA) is
the time elapsed since birth
aka Legal Age
Aside from the baby’s age, document…
- the patient’s temperature - especially in cases of hypothermia
- if there is a modified/ double-distance lead placement
*Head Circumference
What to expect of Neonatal EEG
weeks 24-31
- Monomorphic Occipital Delta
- Rhythmic Temporal Theta
- IBI (Interburst Interval) up to 30 sec, as baby matures IBI shortens and bursts lengthen
- Trace Discontinue in Quiet Sleep
- No reactivity until 30 wks
- Amplitude <2uV
- Synchronous but asymmetry between the hemispheres
*Delta Brush
What to expect of Neonatal EEG
weeks 32-35
- Delta brushes peak
- Trace Discontinue becoming Trace Alternant
- Anterior Dysrhythmia starts
- Encoches Frontales starts
- Activite moyenne starts
- Awake & Active sleep increases in continuity
What to expect of Neonatal EEG
weeks 37-40
- Continuous wake & active sleep
- Increasing in synchrony
- Trace Discontinue becomes Trace Alternant
*Decreasing occurrence of Delta brushes - Attenuation with reactivity
What to expect of Neonatal EEG
weeks 40-44
- Trace Alternant replaced by Cont. Slow Wave Sleep in Quiet Sleep
continuous, reactive, synchronous
What to expect of Neonatal EEG
weeks 44-46
develops V-Waves and spindles, delta brushes & trace alternant are gone
PDR by 48 weeks
Parameters most frequently monitored along with EEG in infants are:
heart rate (ECG), respirations, and eye movements.
In neonates with invariant patterns, it may be necessary to obtain at least:
60 minutes of recording to demonstrate that the tracings are not likely to change.
An adequate neonatal sleep tracing must include:
a full epoch of quiet sleep.
The yield of EEG monitoring to confirm the epileptic basis of isolated, paroxysmal autonomic signs (e.g., isolated paroxysmal increases in the heart rate or blood pressure) is:
low
when episodes of autonomic dysfunction are the result of seizures, they can only be accurately identified by:
EEG monitoring
most neonatal seizures are:
subclinical (i.e., they have no outwardly visible clinical signs and may only be identified by EEG monitoring).
Clinical settings in which to suspect neonatal seizures:
- Infants who are at a high risk for acute brain injury
- those with demonstrated acute brain injury
- those with clinically suspected seizures or neonatal epilepsy syndromes
Examples of Sudden, Stereotyped Clinical Events
That May Raise the Suspicion for Neonatal Seizures
- Focal clonic or tonic movements
- Intermittent forced, conjugate, horizontal gaze deviation
- Myoclonus
- Generalized tonic posturing
- “Brainstem release phenomena” such as oral–motor stereotypes, reciprocal swimming movements of the upper extremities or bicycling movements of the legs
- Autonomic paroxysms such as unexplained apnea, pallor, flushing, tearing, and cyclic periods of tachycardia or elevated blood pressures
the recommended electrode locations for single-channel aEEG recordings obtained in isolation are
P3 and P4
because they overlie the apices of the cerebrovascular
watershed zones
artifacts that may mimic neonatal electrographic seizures
- chest physical therapy
- patting
- sucking on a pacifier or endotracheal tube
- high frequency or conventional ventilation artifacts
- extra corporeal membrane oxygenator pump artifacts
- electrocardiogram
- pulsatile fontanelle
- or other environmental or electrical interference
For high-risk infants, a _____ long EEG is considered inadequate to screen for seizures.
1-hour
Ideally, the EEG technologist should remain at bedside for the _______ of recording to ____________________________.
- first hour
- ensure a high quality recording and to make note of relevant clinical signs.
activité moyenne
roughly meaning “average or medium”
EEG background has continuous, low to medium voltage [25-50 mV peak-to-peak (pp)] mixed frequency activity with a predominance of theta and delta and overriding beta activity
Active Sleep
healthy term neonate in active sleep has eyes closed, intermittent periods of rapid eye movements, and irregular respirations with small and large body movements. The EEG background shows activité moyenne, indistinguishable from that of normal wakefulness.
