{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T12:47:25Z","timestamp":1791982045321,"version":"4.4.0"},"reference-count":22,"publisher":"American Academy of Pediatrics (AAP)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[1999,6,1]]},"abstract":"<jats:sec><jats:title>Objective.<\/jats:title><jats:p>To define normal and abnormal patterns, test interobserver variability, and the prognostic accuracy of amplitude-integrated electroencephalography (aEEG) soon after the onset of neonatal encephalopathy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods.<\/jats:title><jats:p>Consecutive cases of neonatal encephalopathy (n = 56; gestation median, 40; range, 35\u201342 weeks) and healthy infants (n = 14; gestation median, 40; range, 39\u201340 weeks) were studied. aEEG was recorded using a cerebral function monitor, at median, 0, range, 0\u201321 days of age. Of the infants, 24 of the 56 with encephalopathy and all of the normal infants were studied within 12 hours of birth (median, 5; range, 3\u201312 hours). Forty infants were suspected of having suffered birth asphyxia. Criteria for normal and abnormal patterns were defined and the interobserver variability of these classifications determined. Results were compared with neurodevelopmental outcome assessed at 18 to 24 months of age. aEEG also was compared with a standard EEG and with magnetic resonance imaging.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results.<\/jats:title><jats:p>The median upper margin of the widest band of aEEG activity in the control infants was 37.5 \u03bcV (range, 30\u201348 \u03bcV), and median lower margin was 8 \u03bcV (range, 6.5\u201311 \u03bcV). We classified the aEEG background activity as normal amplitude, the upper margin of band of aEEG activity &amp;gt;10 \u03bcV and the lower margin &amp;gt;5 \u03bcV; moderately abnormal amplitude, the upper margin of band of aEEG activity &amp;gt;10 \u03bcV and the lower margin \u22645 \u03bcV; and suppressed amplitude, the upper margin of the band of aEEG activity &amp;lt;10 \u03bcV and lower margin &amp;lt;5 \u03bcV. Recordings were analyzed further for the presence of seizures, defined as periods of sudden increase in voltage accompanied by a narrowing of the band of aEEG activity.<\/jats:p><jats:p>Tests of interobserver variability showed excellent agreement both for assessment of amplitude (\u03ba statistic = 0.85) and for identification of seizures (\u03ba statistic = 0.76)<\/jats:p><jats:p>There was a close relationship between the aEEG and subsequent outcome: 19 of 21 infants with a normal aEEG finding were normal on follow-up at 18 to 24 months of age, whereas 27 of 35 infants with a moderately abnormal or suppressed aEEG and\/or seizures died or developed neurologic abnormalities. Thus, aEEG predicted outcome with a sensitivity of 0.93, a specificity of 0.70, positive predictive value of 0.77, negative predictive value of 0.90, and the likelihood ratio of a positive result of 3.1 and a negative result of 0.06. For the 24 infants studied within 12 hours of birth, the corresponding results were sensitivity, 1.0; specificity, 0.82; positive predictive value, 0.85; negative predictive value, 1; likelihood ratio of a positive result, 5.5; and likelihood ratio of a negative result, 0.18.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion.<\/jats:title><jats:p>The aEEG is a simple but accurate and reproducible clinical tool that could be useful in the assessment of infants with encephalopathy.<\/jats:p><\/jats:sec>","DOI":"10.1542\/peds.103.6.1263","type":"journal-article","created":{"date-parts":[[2004,8,13]],"date-time":"2004-08-13T23:45:45Z","timestamp":1092440745000},"page":"1263-1271","source":"Crossref","is-referenced-by-count":388,"title":["Assessment of Neonatal Encephalopathy by Amplitude-integrated Electroencephalography"],"prefix":"10.1542","volume":"103","author":[{"given":"Niran","family":"al Naqeeb","sequence":"first","affiliation":[{"name":"1 From the Department of Paediatrics, Imperial College School of Medicine, Hammersmith Hospital, London, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. David","family":"Edwards","sequence":"additional","affiliation":[{"name":"1 From the Department of Paediatrics, Imperial College School of Medicine, Hammersmith Hospital, London, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frances M.","family":"Cowan","sequence":"additional","affiliation":[{"name":"1 From the Department of Paediatrics, Imperial College School of Medicine, Hammersmith Hospital, London, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denis","family":"Azzopardi","sequence":"additional","affiliation":[{"name":"1 From the Department of Paediatrics, Imperial College School of Medicine, Hammersmith Hospital, London, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[1999,6,1]]},"reference":[{"key":"2021121002534263100_B1","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/0013-4694(82)90106-7","article-title":"Prognostic value of the electroencephalogram in neonatal asphyxia.","volume":"53","author":"Holmes","year":"1982","journal-title":"Electroencephalogr Clin Neurophysiol."},{"key":"2021121002534263100_B2","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1177\/155005948201300106","article-title":"Prediction of outcome in neonates using EEG.","volume":"13","author":"Obrecht","year":"1982","journal-title":"Clin Electroencephalogr."},{"key":"2021121002534263100_B3","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/0013-4694(85)90030-6","article-title":"Prognostic value of the electroencephalogram in term and preterm infants following neonatal seizures.","volume":"60","author":"Rowe","year":"1985","journal-title":"Electroencephalogr Clin Neurophysiol."},{"key":"2021121002534263100_B4","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1111\/j.1600-0404.1995.tb00435.x","article-title":"The prognostic value of the EEG in asphyxiated newborns.","volume":"91","author":"van Lieshout","year":"1995","journal-title":"Acta Neurol Scand."},{"key":"2021121002534263100_B5","doi-asserted-by":"crossref","first-page":"1080","DOI":"10.1111\/j.1469-8749.1991.tb14830.x","article-title":"A new system for cotside display and analysis of the preterm neonatal electroencephalogram.","volume":"33","author":"Wertheim","year":"1991","journal-title":"Dev Med Child Neurol."},{"key":"2021121002534263100_B6","doi-asserted-by":"crossref","first-page":"F97","DOI":"10.1136\/fn.71.2.F97","article-title":"Prognostic value of continuous electroencephalographic recording in full term infants with hypoxic ischaemic encephalopathy.","volume":"71","author":"Wertheim","year":"1994","journal-title":"Arch Dis Child."},{"key":"2021121002534263100_B7","first-page":"599","article-title":"Cerebral function monitoring: a method of predicting outcome in term neonates after severe perinatal asphyxia.","volume":"83","author":"Thorenberg","year":"1983","journal-title":"Acta Paediatr."},{"key":"2021121002534263100_B8","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1136\/adc.58.12.997","article-title":"Monitoring cerebral function after severe asphyxia in infancy.","volume":"58","author":"Bjerre","year":"1983","journal-title":"Arch Dis Child."},{"key":"2021121002534263100_B9","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1111\/j.1651-2227.1990.tb11324.x","article-title":"Normal pattern of the cerebral function monitor trace in term and preterm neonates.","volume":"79","author":"Thorenberg","year":"1990","journal-title":"Acta Paediatr Scand."},{"key":"2021121002534263100_B10","doi-asserted-by":"crossref","first-page":"812","DOI":"10.1111\/j.1651-2227.1992.tb12109.x","article-title":"Comparison between tape-recorded and amplitude integrated EEG monitoring in sick newborn infants.","volume":"81","author":"Hellstrom Westas L","year":"1992","journal-title":"Acta Paediatr."},{"key":"2021121002534263100_B11","first-page":"541","article-title":"Tape recorded EEG and the cerebral function monitor: amplitude integrated, time compressed EEG.","volume":"22","author":"Greisen","year":"1994","journal-title":"J Perinat Med."},{"key":"2021121002534263100_B12","doi-asserted-by":"crossref","first-page":"F34","DOI":"10.1136\/fn.72.1.F34","article-title":"Predictive value of early continuous amplitude integrated EEG recordings on outcome after severe birth asphyxia in full term infants.","volume":"72","author":"Hellstrom Westas L, Rosen I, Svenningsen NW","year":"1995","journal-title":"Arch Dis Child Fetal Neonatal Educ."},{"key":"2021121002534263100_B13","doi-asserted-by":"crossref","first-page":"F75","DOI":"10.1136\/fn.73.2.F75","article-title":"Predictive value of early neuroimaging, pulsed Doppler and neurophysiology in full term infants with hypoxic\u2013ischaemic encephalopathy.","volume":"73","author":"Eken","year":"1995","journal-title":"Arch Dis Child Fetal Neonatal Educ."},{"key":"2021121002534263100_B14","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1001\/archneur.1976.00500100030012","article-title":"Neonatal encephalopathy following fetal distress. A clinical and electroencephalographic study.","volume":"33","author":"Sarnat","year":"1976","journal-title":"Arch Neurol"},{"key":"2021121002534263100_B15","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1111\/j.1469-8749.1984.tb04426.x","article-title":"Cerebral function monitor in the neonate. I. Normal patterns.","volume":"26","author":"Verma","year":"1984","journal-title":"Dev Med Child Neurol."},{"key":"2021121002534263100_B16","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1097\/00004691-199307000-00008","article-title":"Prognostic value of background patterns in the neonatal EEG.","volume":"10","author":"Holmes","year":"1993","journal-title":"J Clin Neurophysiol."},{"key":"2021121002534263100_B17","doi-asserted-by":"crossref","first-page":"F145","DOI":"10.1136\/fn.75.3.F145","article-title":"Hypoxic ischaemic encephalopathy: early and late magnetic resonance imaging findings in relation to outcome.","volume":"73","author":"Rutherford","year":"1996","journal-title":"Arch Dis Child Fetal Neonatal Educ."},{"key":"2021121002534263100_B18"},{"key":"2021121002534263100_B19","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1055\/s-2008-1073021","article-title":"Prognostic value of early MR imaging in term infants with severe perinatal asphyxia.","volume":"25","author":"Keunzle","year":"1994","journal-title":"Neuropediatrics."},{"key":"2021121002534263100_B20","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1136\/adc.58.10.785","article-title":"Diagnosis of neonatal seizure by continuous recording and rapid analysis of the electroencephalogram.","volume":"58","author":"Eyre","year":"1983","journal-title":"Arch Dis Child."},{"key":"2021121002534263100_B21","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1542\/peds.82.3.337","article-title":"Predictive value of early continuous electroencephalogram monitoring in ventilated preterm infants with intraventricular hemorrhage.","volume":"82","author":"Connell","year":"1988","journal-title":"Pediatrics."},{"key":"2021121002534263100_B22","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1055\/s-2008-1071411","article-title":"Cerebral function monitoring during the first week of life in extremely small low birthweight (ESLBW) infants.","volume":"22","author":"Hellstrom Westas L, Rosen I, Svenningsen NW","year":"1991","journal-title":"Neuropediatrics."}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/103\/6\/1263\/844647\/1263.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/103\/6\/1263\/844647\/1263.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,29]],"date-time":"2023-04-29T05:32:08Z","timestamp":1682746328000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/103\/6\/1263\/62339\/Assessment-of-Neonatal-Encephalopathy-by-Amplitude"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1999,6,1]]},"references-count":22,"journal-issue":{"issue":"6","published-online":{"date-parts":[[1999,6,1]]},"published-print":{"date-parts":[[1999,6,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.103.6.1263","relation":{},"ISSN":["1098-4275","0031-4005"],"issn-type":[{"value":"1098-4275","type":"electronic"},{"value":"0031-4005","type":"print"}],"subject":[],"published":{"date-parts":[[1999,6,1]]}}}