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Objective: Prolonged continuous video-electroencephalography (cEEG) is recommended for neonates at risk of seizures. The cost and expertise required to provide a real-time response to detected seizures often limits its utility. We hypothesised that the first hour of cEEG could predict subsequent seizures.Design and Setting: Retrospective multicentre diagnostic accuracy study.Patients: 266 term neonates at risk of seizure or with suspected seizures.Intervention: The first hour of cEEG was graded by expert and novice interpreters as normal, mildly, moderately or severely abnormal; seizures were identified.Main Outcome Measures: Association between abnormalities in the first hour of cEEG and the presence of seizures during total cEEG monitoring.Results: 50/98 (51%) of neonates who developed seizures had their first seizure in the first hour of cEEG monitoring. The 'time-to-event' risk of seizure from 0 to 96 hours was 0.38 (95% CI 0.32 to 0.44) while the risk in the first hour was 0.19 (95% CI 0.15 to 0.24). cEEG background was normal in 48% of neonates, mildly abnormal in 30%, moderately abnormal in 13% and severely abnormal in 9%. Inter-rater agreement for determination of background was very good (weighted kappa=0.81, 95% CI 0.72 to 0.91). When neonates with seizures during the first hour were excluded, an abnormal background resulted in 2.4 times increased risk of seizures during the subsequent monitoring period (95% CI 1.3 to 4.4, p<0.003) while a severely abnormal background resulted in a sevenfold increased risk (95% CI 3.4 to 14.3, p<0.0001).Conclusions: The first hour of cEEG in at-risk neonates is useful in identifying and predicting whether seizures occur during cEEG monitoring up to 96 hours. This finding enables identification of high-risk neonates who require closer observation. [ABSTRACT FROM AUTHOR]

Objective: To assess the value of neonatal EEG for predicting non-optimal neurodevelopmental outcomes in very preterm infants, using a multimodal strategy of evaluation comprising brain imaging and clinical assessment.Design and Setting: Between 2003 and 2009, we performed an observational, population-based study. Out of 2040 eligible preterm infants born before 32 weeks, 1954 were enrolled in the French regional Loire Infant Follow-Up Team (LIFT) cohort. 1744 (89%) of these completed the follow-up. Neonatal EEGs were recorded prospectively as two EEGs during the first 2 weeks of life and then one every 2 weeks up to 33 weeks.Main Outcome Measures: The neurodevelopmental outcome was assessed by physical examination, the Brunet-Lézine Test and/or the Age and Stages Questionnaire at 2 years of corrected age.Results: Of the 1744 infants assessed at 2 years, 422 had a non-optimal outcome. A total of 4804 EEGs were performed, and 1345 infants had at least one EEG. EEG abnormalities were predictive of non-optimal outcomes after controlling for confounding factors such as severe intracranial lesions detected by brain imaging. Transient moderate and severe abnormalities were independent predictors of non-optimal outcomes with an OR and 95% CI of 1.49 (1.08 to 2.04) and 2.38 (1.49 to 3.81), respectively. In the validation group, the predictive risk stratification tree identified severe abnormalities as a factor contributing to the prognosis of two subgroups: infants with severe cranial lesions and infants with a normal examination at discharge and without severe cranial lesions. [ABSTRACT FROM AUTHOR]

Background and objective: Nutrition in the neonatal unit may impact the neurological outcome of very preterm infants, and male preterms are more likely to suffer neonatal morbidity and adverse neurological outcomes. We hypothesised that growth during hospitalisation would impact neurological outcome differently, depending on infant gender. Methods: Surviving infants born between 1 January 2003 and 31 December 2009 with a gestational age <33 weeks, and enrolled in Loire Infant Follow-up Team, a regional cohort in western France, qualified for the study. Growth during neonatal hospitalisation was assessed by the change in weight z-score between birth and discharge, and infants where ranked into 5 classes, depending on their change in z-score ( < - 2, - 2 to - 1 . 0 1, - 1 to - 0 . 5 1, - 0 . 5 0 to 0.01 and _0), the last class being the reference. The main outcome criterion was neurodevelopmental outcome at 2 years of corrected age. For each class of changes in weight z-score, crude or adjusted OR for non-optimal outcome was calculated for each gender, and compared between genders. Results: 1221 boys and 1056 girls were included. Gender and early growth interact, (p=0.02). Moreover when change in weight z-score varied from < - 2 to ( - 0 . 5 0 to -0.01), adjusted OR for non-optimal outcome varied from 3.2 (1.5-6.8) to 2.2 (1.2-4.1) in boys versus 1.8 (0.7-4.2) to 0.95 (0.4-1.9) in girls. For each class, the OR was significantly higher in boys. Conclusions: In very preterm infants, male neurodevelopment appears to be much more sensitive than female to poor postnatal growth. [ABSTRACT FROM AUTHOR]

Objectives To identify infant, obstetrical and maternal characteristics associated with arterial ischaemic stroke (AIS) and venous thromboembolism (VTE) in infancy (<1 year). Design Nationwide, population-based nested casecontrol study. All infants with a verifi ed first-time diagnosis of AIS, VTE or both in Denmark through the years 1994-2006 were included, and 10 population controls were selected for each case. Results Case-infants presented with AIS (n=71) or VTE (n=38). AIS in infancy was associated with primiparity (adjusted OR 5.9 CI 95% 3.0 to 11.6)), delivery by an emergency caesarean section (adjusted OR 1.9 (CI 95% 1.0 to 3.3)), and post-term birth (adjusted OR 2.2 (CI 95% 1.1 to 4.8)). Male sex was associated with an increased risk of AIS among neonates (crude OR 1.8 (CI 95% 1.0 to 3.4)) but not among later born (crude OR 0.6 (CI 95% 0.2 to 1.4)). Risk factors for VTE in infancy included preterm birth (adjusted OR 5.5 (CI 95% 1.8 to 16.9)), low Apgar score (adjusted OR 9.2 (CI 95% 1.9 to 45.2)), and multiple births (adjusted OR 7.1 (CI 95% 1.1 to 48.1)). Previous maternal thromboembolism and pregnancyrelated disorders were not associated with the risk of thromboembolism in the children. Conclusion Several apparently independent infant, obstetrical and maternal characteristics were associated with thromboembolism in early life. INSETS: What is already known on this topic:;What this study adds:. [ABSTRACT FROM AUTHOR]

Objective The incidence of perinatal arterial ischaemic stroke (PAIS) is about 1 in 2300 live births. Evidence about the aetiology is still lacking. The aim of this study was to identify maternal, perinatal and neonatal risk factors for symptomatic PAIS in full-term infants. Methods Each full-term infant with PAIS was matched to three healthy controls for gestational age, date of birth and hospital of birth. Antenatal and perinatal risk factors were studied using univariate and multivariate conditional logistic regression analysis. Results Fifty-two infants were diagnosed with PAIS. Signifi cant risk factors in the univariate analysis (p<0.05) were nulliparity (64% vs 47%), maternal fever (>38°C) during delivery (10% vs 1%), fetal heart rate decelerations (63% vs 16%), meconium-stained amniotic fl uid (44% vs 17%), emergency caesarean section (35 vs 2%), Apgar score (1 min) ≤3 (29% vs 1%), Apgar score (5 min) <7 (25% vs 1%), umbilical artery pH <7.10 (56% vs 10%), hypoglycaemia <2.0 mmol/l (29% vs 3%) and early-onset sepsis/meningitis (14% vs 2%). In the multivariate analysis, maternal fever (OR 10.2; 95% CI 1.3 to 78.5), Apgar score (5 min) <7 (OR 18.1; 95% CI 3.4 to 96.8), hypoglycaemia <2.0 mmol/l (OR 13.0; 95% CI 3.2 to 52.6) and early-onset sepsis/meningitis (OR 5.8; 95% CI 1.1 to 31.9) were signifi cantly associated with PAIS. Conclusions Maternal fever during delivery and earlyonset sepsis/meningitis were found to be involved with PAIS as was previously noted. Apgar score (5 min) <7 and hypoglycaemia were found to be important risk factors in term PAIS. INSETS: What is already known on this topic;What this study adds. [ABSTRACT FROM AUTHOR]

Neonatal seizures are a distinct and not uncommon sign of neurological disease in the newborn, most often occurring in association with hypoxic-ischaemic encephalopathy at term. The diagnosis and monitoring of seizures in the newborn is a considerable challenge, with many suspected clinical seizures having no electrographic correlates, while many electrographic seizures have no clinical correlate. Continuous video- EEG is the gold standard for seizure monitoring, but few centres have the resources or expertise required. Amplitude-integrated EEG can be a helpful monitoring tool in experienced hands, but has potential for error when used by inexperienced staff. Automated seizure detection algorithms show much promise and some cotside systems are already available. The efficiency and accuracy of these systems is likely to improve. [ABSTRACT FROM AUTHOR]

Background Amplitude integrated electroencephalography (aEEG) is a valuable tool for evaluating neonatal encephalopathy and identifying electrographic seizures. Objective To compare seizure activity and background pattern (BGP) between one-channel and two-channel aEEG recordings in full-term neonates. Methods The two-channel aEEG recordings (F3-P3; F4-P4) of 34 neonates with seizures were compared with single-channel recordings (P3-P4). Results All 34 infants with unilateral (n=14), diffuse (n=18) or without (n=2) brain injury had seizure patterns on one-channel and two-channel recordings, with 18% more seizure patterns detected with two-channel recording. In 79% of infants with unilateral injury more seizures were noted on the ipsilateral side compared to the contralateral side. In 39% of the infants with diffuse brain damage more seizures were found with two-channel recordings. A sensitivity of 65% was found when using the automatic seizure detection algorithm. In 4/14 (29%) infants with unilateral injury a more severely affected BGP was seen on the ipsilateral side compared to the BGP on one-channel recording. In infants with diffuse injury differences in BGP pattern were seen in 6-17% of the infants depending on the system used for scoring. Conclusion Although there were no major differences found between seizure detection with one-channel or two-channel aEEG, in a subgroup of infants with a predominantly unilateral brain lesion, two-channel recording did provide additional information with identification of more seizure patterns on the affected side, sometimes also associated with a difference in BGP. To improve early diagnosis of unilateral lesions and improve seizure detection in these infants, routine use of two-channel recordings is recommended. [ABSTRACT FROM AUTHOR]

Background Amplitude integrated electroencephalography (aEEG) is a valuable tool for evaluating neonatal encephalopathy and identifying electrographic seizures. Objective To compare seizure activity and background pattern (BGP) between one-channel and two-channel aEEG recordings in full-term neonates. Methods The two-channel aEEG recordings (F3-P3; F4-P4) of 34 neonates with seizures were compared with single-channel recordings (P3-P4). Results All 34 infants with unilateral (n=14), diffuse (n=18) or without (n=2) brain injury had seizure patterns on one-channel and two-channel recordings, with 18% more seizure patterns detected with two-channel recording. In 79% of infants with unilateral injury more seizures were noted on the ipsilateral side compared to the contralateral side. In 39% of the infants with diffuse brain damage more seizures were found with two-channel recordings. A sensitivity of 65% was found when using the automatic seizure detection algorithm. In 4/14 (29%) infants with unilateral injury a more severely affected BGP was seen on the ipsilateral side compared to the BGP on one-channel recording. In infants with diffuse injury differences in BGP pattern were seen in 6⋅17% of the infants depending on the system used for scoring. Conclusion Although there were no major differences found between seizure detection with one-channel or two-channel aEEG, in a subgroup of infants with a predominantly unilateral brain lesion, two-channel recording did provide additional information with identification of more seizure patterns on the affected side, sometimes also associated with a difference in BGP. To improve early diagnosis of unilateral lesions and improve seizure detection in these infants, routine use of two-channel recordings is recommended. [ABSTRACT FROM AUTHOR]