Abstracts

Rationale: Access to conventional EEG monitoring in the Neonatal Intensive Care Unit (NICU) may be limited due to a variety of factors. Few NICUs are equipped with EEG machines or staffed with specialized technologists who can properly apply EEG electrodes and provide a technically adequate study. The microEEG is a small (88gm, 9.4x4.4x3.8cm), portable, wireless FDA-approved device developed by the BioSignal Group. The microEEG device digitizes EEG signals close to the electrodes and transmits the digital data wirelessly to a personal computer, which then uploads the EEG to a remote secure server. The microEEG can be used with electrode caps applied by the bedside staff. The microEEG has the potential to overcome many of the obstacles to obtaining EEG recordings in the NICU setting. The goal of this study was to assess the ease and technical quality of the microEEG device to obtain continuous EEG recording in preterm infants.Methods: Continuous microEEG monitoring was performed in the NICUs of two academic centers. Eight preterm babies underwent continuous EEG monitoring over a period of 9 hours, using the microEEG device (BioSignal Group) with an electrode cap (waveguard ANT Neuro) of appropriate head size. The electrode cap consisted of 20 scalp electrodes using the 10-20 international system. Additionally, two eye channels and EKG were also recorded. The corrected gestational age of these preterm infants ranged from 27 34 weeks at the first recording. Continuous EEG recording was repeated at 2-4 week intervals; each neonate received at least 3 recordings before discharge. This is a part of an ongoing NIH-funded study of preterm babies with apnea / bradycardia / desaturation events.Results: A total of 21 continuous EEG studies were obtained from the 8 preterm babies. A neonatologist with no specialized training in neurology or EEG was able to place the cap and begin recording in less than 30 minutes. The EEGs were transmitted to a remote server at the end of the recording. An electroencephalographer reviewed and interpreted the studies remotely using a web-based case manager with secure log-in credentials. Three of the 21 studies were technically limited due to abundant artifacts. The remaining 18 studies were acceptable for clinical review and interpretation. Five of the eighteen studies showed EEG alterations (27%). Immaturity of background (> 2 weeks below corrected gestational age) was found in 4 of the 18 EEGs. Sharp transients were present in one of the EEGs with immature background. Clinical and electrographic seizures were recorded in one EEG. One bradycardia event (heart rate < 60) was recorded, with no change on simultaneous EEG.Conclusions: Use of the microEEG system can potentially provide a practical, accessible, high quality continuous EEG recording in the neonatal ICU. Clinically acceptable EEG recordings can be obtained in preterm babies using the microEEG device and electrode cap. These can be remotely reviewed and interpreted. This approach has the potential to improve access to EEG in the neonatal ICU.