Single versus bihemispheric amplitude-integrated electroencephalography in relation to cerebral injury and outcome in the term encephalopathic infant

Background: The demand for early diagnosis and prognostication of cerebral injury in the encephalopathic term infant is increasing to facilitate appropriate management. The single-channel amplitude-integrated electroencephalogram (S-aEEG) has been shown to have predictive utility for the severely encephalopathic infant. New bedside aEEG devices with more channels are entering the neonatal environment. Little data are available to compare the utility of two channels (B-aEEG) with that of an S-aEEG recording. Aim: To compare the utility of the S-aEEG and the B-aEEG in the prediction of cerebral injury, as determined by magnetic resonance imaging (MRI), and neurodevelopmental outcome in the term encephalopathic infant. Methods: Term encephalopathic infants, with or without seizures, admitted to a level III NICU were included in this study. These infants had simultaneous S-aEEG and B-aEEG recordings. MRI was undertaken during the clinical course and classified as to the extent of cerebral injury. Neurological outcome was assessed at 2 years of age. Results: Twenty-eight encephalopathic term infants were included in the study. There was high level of agreement between both brain monitors (Kappa = 0.68, P < 0.001), but there was disagreement in the classification in four cases where the S-aEEG was normal when the B-aEEG was severely abnormal (McNemar's test P = 0.046). Of note in these four cases, all had a severely abnormal MRI and poor neurodevelopmental outcome at 2 years. Conclusion: Amplitude measurements by the B-aEEG appear more sensitive in detecting cerebral injury in comparison with the S-aEEG, particularly in the setting of unilateral injury.