The effects of betamethasone on the amplitude integrated EEG of infants born at 34- or 35-weeks gestation.

OBJECTIVE: Assess if maternal betamethasone administration at 34-35 weeks accelerated neonatal amplitude integrated EEG (aEEG) maturation. STUDY DESIGN: Nested, observational cohort in 7 centers participating in the Antenatal Late Preterm Steroid randomized trial. Up to 2 aEEGs were obtained in neonates born from 340-356 weeks gestation before 72 h (aEEG 1) and at 5-7 days (aEEG 2) if hospitalized. Personnel and aEEG central readers were masked to the intervention. The primary outcome was maturation reflected by cycle frequency; secondary outcomes were border voltage, span, and discontinuity. RESULTS: 58 neonates were enrolled (betamethasone, 28, placebo, 30). On aEEG 1, cycle frequency did not differ, but betamethasone exposed infants had a greater lower border voltage and a broader span. On aEEG 2, both groups displayed increases in lower border voltage. CONCLUSIONS: Betamethasone associated changes in lower border voltage support accelerated electrical activity. Further investigation is needed to understand the broader span.

Neurological maturation of late preterm infants at 34 wk assessed by amplitude integrated electroencephalogram.

BACKGROUND: This study tested if measures of central nervous system (CNS) immaturity reflected by amplitude integrated electroencephalogram (aEEG) and associated clinical morbidities are determinants of length of hospitalization among late preterm infants born at 34 wk. METHODS: This was a prospective cohort study of infants with a gestational age of 34 wk 0-6 d who had a single aEEG recording acquired over 6 h in a neonatal intensive care unit within 72 h of birth (n = 80). Infants were followed for predefined morbidities (classified as CNS or non-CNS) and length of hospitalization (determined by the clinical care team). aEEG variables were correlated with length of hospitalization. RESULTS: Eighty infants were enrolled and 75 aEEG recordings were analyzed. The average length of hospitalization was 10.4 ± 7.2 d (range 3-46 d). The total number of cycles recorded in the first 72 h following birth were inversely correlated with the length of hospitalization (r(2) = 0.44, P < 0.001). Kaplan-Meier curves indicated that morbidities consistent with neurological immaturity were associated with a longer length of hospitalization (P < 0.001). CONCLUSION: Neurological maturation as indicated by aEEG and specific clinical morbidities is an important determinant of length of hospitalization among late-preterm infants.

Hemodynamic effects of delayed cord clamping in premature infants.

BACKGROUND AND OBJECTIVE: Delayed cord clamping (DCC) has been advocated during preterm delivery to improve hemodynamic stability during the early neonatal period. The hemodynamic effects of DCC in premature infants after birth have not been previously examined. Our objective was to compare the hemodynamic differences between premature infants randomized to either DCC or immediate cord clamping (ICC). METHODS: This prospective study was conducted on a subset of infants who were enrolled in a randomized controlled trial to evaluate the effects of DCC versus ICC. Entry criteria included gestational ages of 24(0) to 31(6) weeks. Twins and infants of mothers with substance abuse were excluded. Serial Doppler studies were performed at 6 ± 2, 24 ± 4, 48 ± 6, and 108 ± 12 hours of life. Measurements included superior vena cava blood flow, right ventricle output, middle cerebral artery blood flow velocity (BFV), superior mesenteric artery BFV, left ventricle shortening fraction, and presence of a persistent ductus arteriosus. RESULTS: Twenty-five infants were enrolled in the DCC group and 26 in the ICC group. Gestational age, birth weight, and male gender were similar. Admission laboratory and clinical events were also similar. DCC resulted in significantly higher superior vena cava blood flow over the study period, as well as greater right ventricle output and right ventricular stroke volumes at 48 hours. No differences were noted in middle cerebral artery BFV, mean superior mesenteric artery BFV, shortening fraction, or the incidence of a persistent ductus arteriosus. CONCLUSIONS: DCC in premature infants is associated with potentially beneficial hemodynamic changes over the first days of life.

Amplitude-integrated EEG differences in premature infants with and without bronchopulmonary dysplasia: a cross-sectional study.

AIM: To evaluate differences in amplitude-integrated electroencephalogram (aEEG) recordings of infants with and without bronchopulmonary dysplasia (BPD). METHODS: This is a cross-sectional study of infants ≤27 weeks at birth who did (n = 17) or did not develop BPD (n = 17). aEEG tracings were recorded at 36(0) -36(6) weeks post-menstrual age for 6 h using the BrainZ BRM3 monitor. A cross-cerebral channel was evaluated using offline software Analyze (BrainZ). RESULTS: Infants with BPD had lower gestational age and higher male predominance (25 ± 1 weeks, 70%) compared with non-BPD infants (26 ± 1 weeks, 30%, all p ≤ 0.03), but similar birth weight (704 ± 195 vs. 796 ± 167 g, p = 0.1). During active sleep, infants with BPD had wider span voltage (p = 0.03), higher lower border voltage (p < 0.03), as well as less periods of quiet sleep per hour (p < 0.01) compared with non-BPD infants. These differences persisted after adjustment for covariates. CONCLUSION: Infants with BPD have small but significant differences in their aEEG tracings compared with infants without BPD at 36 weeks. Further study of infants with BPD using aEEG appears justified to determine whether aEEG variables correlate with neurodevelopmental outcome.