Neonatal EEG/ Terms

Question 1

Information that must be included in the study information available to the electroencephalographer

Answer 1

The baby’s gestational age at birth, chronologic age, and postmenstrual age on the day of recording, stated in weeks

Question 1

Postmenstrual age (PMA) is

Answer 1

gestational age plus chronological age

Question 2

Gestational age (GA) is

Answer 2

the time elapsed between the first day of the last menstrual period and the day of delivery

Question 3

Chronological age is

Answer 3

the time elapsed since birth

Question 4

Aside from the baby’s age, document…

Answer 4

• the patient’s temperature - especially in cases of hypothermia
• if there is a modified/ double-distance lead placement

Question 5

What to expect of Neonatal EEG
weeks 24-34

Answer 5

• Monomorphic Occipital Delta
• Rhythmic Temporal Theta
• IBI (Interburst Interval) of 6-12 sec
• Trace Discontinue in Quiet Sleep
• No reactivity until 30 wks
• Amplitude <2uV
• Synchronous

Question 6

What to expect of Neonatal EEG
weeks 34-35

Answer 6

• Delta brushes peak
• Trace Discontinue becomes Trace Alternant
• Anterior Dysrhythmia starts
• Encoches Frontales starts
• Activite moyenne starts
• Awake & Active sleep increases in continuity

Question 7

What to expect of Neonatal EEG
weeks 37-40

Answer 7

• Continuous wake & active sleep
• Increasing in synchrony
• Trace Alternant replaced by Cont. Slow Wave Sleep in Quiet Sleep
• Attenuation with reactivity

Question 8

What to expect of Neonatal EEG
weeks 40-44

Answer 8

continuous, reactive, synchronous

Question 9

What to expect of Neonatal EEG
weeks 44-46

Answer 9

develops V-Waves and spindles
PDR by 48 weeks

Question 10

Parameters most frequently monitored along with EEG in infants are:

Answer 10

heart rate, respirations, and eye movements.

Question 11

In neonates with invariant patterns, it may be necessary to obtain at least:

Answer 11

60 minutes of recording to demonstrate that the tracings are not likely to change.

Question 12

An adequate neonatal sleep tracing must include:

Answer 12

a full epoch of quiet sleep.

Question 13

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:

Answer 13

low

Question 14

when episodes of autonomic dysfunction are the result of seizures, they can only be accurately identified by:

Answer 14

EEG monitoring

Question 15

most neonatal seizures are:

Answer 15

subclinical (i.e., they have no outwardly visible clinical signs and may only be identified by EEG monitoring).

Question 16

Clinical settings in which to suspect neonatal seizures:

Answer 16

• 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

Question 17

Examples of Sudden, Stereotyped Clinical Events
That May Raise the Suspicion for Neonatal Seizures

Answer 17

• 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

Question 18

the recommended electrode locations for single-channel aEEG recordings obtained in isolation are

Answer 18

P3 and P4
because they overlie the apices of the cerebrovascular
watershed zones

Question 19

artifacts that may mimic neonatal electrographic seizures

Answer 19

• 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

Question 20

For high-risk infants, a _____ long EEG is considered inadequate to screen for seizures.

Answer 20

1-hour

Question 21

Ideally, the EEG technologist should remain at bedside for the _______ of recording to ____________________________.

Answer 21

• first hour
• ensure a high quality recording and to make note of relevant clinical signs.

Question 22

activité moyenne
roughly meaning “average or medium”

Answer 22

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

Question 23

Active Sleep

Answer 23

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.

Question 24

Tracé discontinu

Answer 24

describes the normal discontinuous tracing encountered in healthy preterm babies. This EEG pattern is characterized by bursts of high voltage (50–300 mVpp) activity that are regularly interrupted by low voltage interburst periods (<25 mV pp).

Question 25

Quiet Sleep

Answer 25

Quiet sleep is clinically characterized by eye closure, absence of rapid eye movements, and scant body movements, except for occasional sucking activity or generalized myoclonic “startles.”

*Near term, the quiet sleep EEG background tracé alternant, evolves from the less mature tracé discontinu in the preterm *

Question 26

PDR by age:

Answer 26

4-5Hz by 6 months
6Hz by 1 year
7Hz by 2 years
8Hz by 3 years
9Hz by 8 years
10Hz by 10 years

Question 27

Neonate terms SGA and LGA mean what?

Answer 27

SGA= Small for Gestational Age - Infants who weighs < the 10th percentile
LGA= Large for Gestational Age - Infants who weighs > 90th percentile