Amplitude-integrated EEG for detection of neonatal seizures: a systematic review.

PURPOSE: Amplitude-integrated electroencephalogram (aEEG) is being used increasingly for monitoring seizures in neonatal units. Its accuracy, compared with "the gold-standard" conventional elecroencephalogram (cEEG) is still not well established. We aimed to conduct a systematic review to evaluate the diagnostic accuracy of aEEG when compared with cEEG, for detection of neonatal seizures. METHOD: A systematic review was conducted using the Cochrane methodology. EMBASE, CINAHL and PubMed databases were searched in September 2014. Studies comparing simultaneous recordings of cEEG and aEEG for detection of seizures in neonatal population were included. QUADAS 2 tool was used to examine "risk of bias" and "applicability". RESULTS: Ten studies (patient sample 433) were included. Risk of bias was high in five studies, unclear in one and low in four. For the detection of individual seizures, when "aEEG with raw trace" was used, median sensitivity was 76% (range: 71-85), and specificity 85% (range: 39-96). When "aEEG without raw trace" was used, median sensitivity was 39% (range: 25-80) and specificity 95% (range: 50-100). Detailed meta-analysis could not be done because of significant clinical/methodological heterogeneity. Seizure detection was better when interpreted by experienced clinicians. Seizures with low amplitude/brief duration and those occurring away from aEEG leads were less likely to be detected. CONCLUSION: Studies included in the systematic review showed aEEG to have relatively low and variable sensitivity and specificity. Based on the available evidence, aEEG cannot be recommended as the mainstay for diagnosis and management of neonatal seizures. There is an urgent need of well-designed studies to address this issue definitively.

Long-distance transport of neonates with transposition of the great arteries for the arterial switch operation: A 26-year Western Australian experience.

AIM: There is evidence that outcomes of complex paediatric cardiac procedures including the arterial switch operation (ASO) for transposition of the great arteries (TGA) are improved when performed at higher volume centres. While in utero transport for surgery is considered ideal, antenatal detection rates of TGA are low. Long-distance transport of post-natally diagnosed neonates has the potential to destabilise the patient's clinical condition. Since 1986, many neonates with TGA have been transported interstate from Perth to Melbourne or Brisbane for ASO surgery. The aim of this study was to review the Western Australian experience of interstate transport of newborns with TGA for ASO, noting transport complications and comparing the early mortality of these patients with published outcomes of the ASO from Royal Children's Hospital (RCH), Melbourne. METHOD: In this retrospective cohort study, we reviewed the neonatal and cardiology databases and medical records to identify infants with TGA born between 1986 and 2011 and requiring ASO surgery during the neonatal period. RESULTS: Over 26 years, 80 neonates were transferred interstate for ASO surgery. Twelve infants required ventilation, 36 needed prostaglandin (prostaglandin E1) infusion and 3 inotropic support. There was no mortality during transport and there was a single early post-operative death. This early mortality of 1.2% compares favourably with the RCH mortality of 2.8% from a recently published review of early outcomes for ASO. CONCLUSIONS: When in utero transport is not possible, long-distance transport of neonates with TGA can be safely undertaken, with no evidence of increased transport mortality/ major morbidity or higher early surgical mortality.

Poractant alfa versus beractant for respiratory distress syndrome in preterm infants: a retrospective cohort study.

AIM: Poractant alfa and beractant are the commonly used animal derived surfactants in preterm infants with respiratory distress syndrome. Between 2005 and 2007, poractant alfa and beractant were alternated every month in our neonatal intensive care unit for 27 months. The aim of this study was to compare the outcomes of preterm infants who received poractant alfa versus beractant. METHOD: Single-centre, retrospective cohort study of inborn preterm infants <32 weeks gestation (23-31(+6) ). RESULTS: Six hundred sixty-four preterm infants (<32 weeks) were born during the study period, of which 415 received surfactant (poractant alfa: 214; beractant: 201). Infants in the poractant alfa group were 2.8 days younger than beractant (27.0 ± 2.3 vs. 27.4 ± 2.3 weeks; P = 0.03). All other baseline characters including Clinical Risk Index for Babies II scores were similar for both groups. No significant differences were found for the following outcomes: death or chronic lung disease (78/212 vs. 59/200; P = 0.28); death (24/214 vs. 15/201, P = 0.24); moderate to severe chronic lung disease (63/212 vs. 46/200; P = 0.45) and moderate to severe disability (20/163 vs. 19/151, P = 0.98) between poractant alfa and beractant, respectively. CONCLUSIONS: The results of our study do not support the need for preferential use of poractant alfa or beractant.