N°32 – Negative Central Activity in extremely preterm newborns: EEG characterization, relationships with brain injuries and 2 years outcome
Résumé
Objectives
The objectives were to characterize the negative central Activity (NCA), a pathological overlooked electroencephalographic figure of the preterm newborn, to investigate its relationship with brain injuries, and with neurodevelopmental outcome.
Content
109 preterm infants (23–28 weeks of gestational age) were included retrospectively. NCAs were selected at negative peak on conventional EEG (cEEG). Durations, amplitudes and slopes of individual averaged NCAs were automatically determined. Brain structural data were collected from cranial ultrasounds (cUS). Neurodevelopmental outcome at 2 years-old was assessed by Denver Developmental Screening Test-II. Thirty-six (33%) children had NCAs on their early cEEG. 6721 NCAs were selected, 134.8 ± 176.4 NCAs per hour. NCAs had a triphasic morphology with an amplitude and a negative part duration of 24.6–40.0 µV and 222.7–256.3 ms. The presence of NCA on cEEG was associated (i) with higher intraventricular hemorrhage (IVH) grade on both first and worst neonatal cUS (P = 0.016 and P < 0.001, respectively) and (ii) with poorer neurodevelopmental outcome (P < 0.001). In the NCA group (18 newborns), the NCA load did not differ significantly between high-grade IVH and no-high-grade IVH. NCA was first objectively characterized in cEEG. NCA relationships with adverse outcome at 2 years-old and with the presence/severity of IVH dictate to consider NCA in the assessment of pathological processes on the developing brain network and in the outcome prediction. The NCA appearance in sequence in some children raises the question of equivalent of neonatal seizures or Brief potentially Ictal Rhythmic Discharges.