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Neonates
2
| Question | Answer |
|---|---|
| Delta Brush | Distinctive pattern of premature infants. They appear at 27 weeks, peak around 32-34 weeks and disappear around 44 weeks post-menstrual age (PMA). Delta waves with superimposed 8-20 Hz activity. Seen in Rolandic, Occ or Temp regions during sleep or wake. |
| Conceptional Age | How much time has passed since conception (fertilization), presumed to have occurred on the day of ovulation. |
| Gestational Age | How much time has passed since the first day of the last menstrual period (LMP). |
| What is difference in time between the LMP and ovulation? | Two weeks, which accounts for the two week difference in gestational age and conceptional age. While individual female's menstrual cycles vary by length, timing, etc., a female reliably begins her menstrual period 14 days after ovulation. |
| LFF | Should be 0.3-0.6 Hz or 'Time Constant' (.027-0.53). |
| Sensitivity | 7 uv/mm or higher. 2 uv/mm preferred. |
| In what area of the EEG is pulse artifact sometimes seen? | Fontanelles. |
| Sleep: (24-27 Weeks) - | Remains in atypical sleep with characteristics of both Stage I & Stage II sleep with decreased ocular mvts and no change in hr. |
| Sleep: Typical Sleep - | Emerges around 30 weeks. |
| Sleep: When does sleep begin to take form of nearly organized? | 30-37 weeks of term infants. |
| Sleep: When does Stage II Sleep begin to emerge? | Around 32 weeks. |
| Sleep: When does Stage I begin to emerge? | Near term. |
| Sleep: Quiet Sleep - | Stage I |
| Sleep: Active Sleep - | Stage II |
| Sleep: Quiet Waking Sleep - | Stage III |
| Sleep: What is the best way to determine what stage of sleep a neonate is in? | Physiologic behaviors rather than EEG pattern. |
| Sleep: What two sleep stages combine in newborns? | Stage II and REM sleep. |
| Sleep: When is Stage II sleep fully defined? | 36-37 weeks. REM is now absent in this stage. |
| Sleep: What are two patterns seen in quiet sleep of newborns? | Trace Alternant (TA) and High Voltage Slow Waves (HVS). |
| Sleep: Tracé Alternant (TA) - | Stage I sleep newborns, continuous flat (6-10 s) with bursts of mod amp slow waves, intermixed sharp waves 1-10 s, periods of relative quiescence with extreme low-amplitude. Well defined cycling, resp, EMG. Inactive EOG. Up to 8 weeks post term. |
| Sleep: How long is the newborn sleep cycle? | Very stable at 50-60 minutes, which increase with age. (The adult sleep cycle is 24 hours). |
| Sleep: LVI - | Low Voltage Irregular |
| Sleep: When does the sleep/wake differentiation become clear? | After 37 weeks. |
| Sleep: When is the sleep/wake differentiation challenging? | Before 32 weeks. |
| Sleep: When is Delta Brush commonly seen? | Before 36 weeks but rare after. |
| Sleep: When can you see Occipital Dominance? | Can be seen at 24 weeks conception (6 mo) but not marked until 30 weeks. |
| Sleep: Is Alpha Activity (8-13 Hz) present in infants? | Yes, at 5 months conception and may appear as a delta brush. In 32 weeks +, it is more prominent in Stage I sleep and at 32 weeks -, Stage II Sleep. |
| Sleep: Sharps and Spikes in Newborns: | Regarded as a normal variant, especially during sleep. |
| Sleep: Asymmetry in Newborns: | Normal. |
| Sleep: Temporal Saw-Tooth in Newborns: | Normal. |
| Sleep: What does a startle response do to the neonatal EEG? | Attenuates. |
| Sleep: What age marker will a newborn show a continuous EEG pattern? | 34 weeks. |
| Sleep: HVS | High Voltage Slow. |
| Abnormal: What does the abnormal neonatal reflect? | Severity rather than etiology. |
| Abnormal: How does the moderately abnormal EEG correlate? | Doesn't usually correlate with later psychomotor development. A single EEG is only useful when grossly abnormal. Otherwise a series is best due to rapidly occurring changes. |
| Abnormal: How does the severely abnormal EEG correlate? | This gives the most accurate prognosis. |
| Abnormal: What information on the EEG provides the most accurate prognosis information? | The background. |
| Abnormal: Severe Burst-Suppression - | Can indicate ECI. If able to get EP, can survive but likely severe neurological impairment will develop. |
| Abnormal: What type of background makes for a poor clinical outcome? | Persistence of slowing (.5-1 Hz) without other frequencies such as theta. |
| Abnormal: What has a grave prognosis? | Superimposed activity, such as rhythmic theta, on a low voltage background (except for Delta Brush). |
| Abnormal: What represents structural/functional problems? | Persistent asymmetry over 50% or more of the record. |
| Abnormal: How much inter-hemispheric asymmetry indicates a poor prognosis? | 25% of the record. |
| Abnormal: Positive Rolandic Sharp Waves (PRSW) | Normal in neonates under 32 weeks but abnormal over that age. |
| Abnormal: Type A PRSW - | Initial steep positives and blends into the background but occur in isolation or intervals of 1 second or more and are clearly separated from the background by morphology and voltage. |
| Abnormal: Type B PRSW - | 3-7 second Rolandic Trains, less than 500 msecs with initial steep positives and then blends into the background. |
| Abnormal: What prognosis does Type A PRSW give? | Poor prognosis. This usually indicates a structural/functional lesion. |
| Abnormal: What prognosis does Type B PRSW give? | Usually has a good outcome. |
| Abnormal: What type of sleep activity gives a poor prognosis in infants over 35 weeks? | The absence of sleep/wake organization. |
| Abnormal: Hypothyroidism - | No Sleep Spindles prior to tx. |
| Abnormal: Down's Syndrome - | Decreased REM, increased Non-REM sleep, poorly defined TA, absence of frontal 1/second activity, vertex sharp waves, increased wakefulness, and decrease of sleep spindle emergence. |
| Abnormal: When might a sz be associated with poor prognosis? | When there is no sleep organization 2-3 days after the sz. |
| Abnormal: Hyperbilirubinemia - | One of the most common problems encountered in term newborns. An excess of bilirubin in the blood. 'Breast Milk Jaundice.' Causes the skin and parts of the eyes to turn a yellow color. |
| Abnormal: Neonates of diabetic mothers: | Increased REM and decreased Stage I Sleep. |
| Abnormal: AEDs - | Increased Stage I Sleep at the expense of Stage II Sleep. |
| Abnormal: Circumcision stress - | A Non-REM onset and increased REM, rather than a REM onset. |
| Abnormal: Severe Hyaline Membrane Disease (HMD) - | Increased quiet sleep and decreased active sleep. Return to normal when dissolves. |
| Abnormal: Unifocal - | Normal background and sleep with high voltage sharp wave discharges or repetitive sharp waves. Can be focal or diffuse to adjacent areas. Most commonly Rolandic. Usually metabolic such as hypo/hyperglycemia. |
| Abnormal: Multifocal - | Abnormal background and immature patterns seen. Evidence of 2+ independent discharge foci, usually fragmented, minimal, or subtle and poorly sustained. Usually caused by infection, congenital abn, birth injury, anoxia, or post maturity. |
| Abnormal: What has a less favorable prognosis in multifocal abnormalities? | Post Maturity. |
| Abnormal: Burst-Suppression (not necessarily severe) - | Non-reactive. Mental status change is apparent. Attenuation is less than 5 uV (to -20 uV) and 1-10 s, poorly formed, asymm or symmetrical, no spikes and slow waves possible, absent sleep cycling. Grave prognosis. |
| Sleep: What can the frequency of Delta Brush measure? | The maturity of the infant (not necessarily age). |
| Abnormal: What type of clinical manifestation do neonatal szs usually produce? | None. |
| Abnormal: Focal or Lateral Lesions - | Will be consistent after 1 week +. |
| Abnormal: Hydroencephaly - | Severe diffuse voltage decrease or focal activity. |
| Abnormal: Herpes Simplex Encephalitis - | Multifocal period discharges in neonates. |
| Neonatal EEG is complicated by certain background patterns being associated with excellent prognosis while representing abnormal function in others. What is main determining factor in dx? | Context (age, state, etc.). |
| Normal: Inactive flats (5 uV or lower), longer than 9.3 seconds is normal in what age? | 29 weeks. |
| Normal: Inactive flats (5 uV or lower), longer than 4.4 seconds is normal in what age? | Term. |
| Abnormal: A large number of inactive flats (5 uV or lower), longer than 25-30 seconds is significantly abnormal in what age? | Early neonates. |
| Normal: Is decreased amplitude activity persistence abnormal in infants? | No. |
| Normal: Mild anterior sharps and slow waves, synchronous or asynchronous, are normal at what age? | The first month of life when born at 36-41 weeks gestation and should disappear by 48 weeks gestation. |
| Abnormal: Excessive slow waves (.5 Hz) with abrupt high amplitude sharp bursts or persistent frontal sharp or slow waves is abnormal and associated with what? | Corgen (generalized, forceful) infections and anoxia. |
| Normal: What abnormal pattern can be normal in a newborn EEG? | Sharp transients. |
| Abnormal: Rapid spikes are abnormal after what age? | 1 week of term infant. |
| Abnormal: When are sharp transients in wake or active sleep (Stage II) abnormal? | In a 2 week old infant that was 36-38 weeks gestation. |
| At what age should all sharp transients disappear? | 49 weeks conceptional age. |
| Is it a normal variant to see very slow transients on a depressed background? | No. |
| Abnormal: Positive Rolandic spikes are abnormal after what age? | 32 weeks conception. |
| Which frequency ranges are normal to see prolonged? | All are abnormal. |
| Rhythmic Alpha is most commonly associated with a hx of what? | Anoxia. |
| What is Rhythmic Alpha less commonly associated with a hx of? | Congenital malformation or encephalitis. |
| Normal: What age is prolonged theta or rhythmic discharges of theta activity normal? | After 6 months conception. |
| Abnormal: When abnormal prolonged theta or rhythmic discharges of theta activity is seen, what is it usually associated with? | Clinical sz. |
| Abnormal: Prolonged Rhythmic Delta Activity often occur in what group? | Newborns with szs. |
| Abnormal: When is Delta Brush abnormal? | In term infants because it indicates maturation age. If seen unilaterally, it is pathologic in that hemisphere. |
| What frequency ranges do neonatal szs occur in? | Theta and alpha. |
| Benign Neonatal Familial Convulsions/Epilepsy/Szs (BFNC)(BFNE)(BFNS): | Rare autosomal dominant inherited epilepsy in newborns, seen in the first 7d of life as TC szs. Otherwise normal b/t attacks and develop normally. Normally spontaneously ceases w/in the first 15 weeks of life. Lifetime szs is increased (16%). |
| What 'must be' criteria is needed for dx of Benign Neonatal Familial Convulsions? | Normal neuro exam, negative eval for another etiology of sz, Normal development and intellect, Positive family hx of IS with benign outcome, Onset of szs during early infantile period. |
| What 'must be' criteria is needed for dx of Benign Neonatal Convulsions? | Birth after 39 weeks gestation, APGAR score of 9 about 5 minutes after birth, Presence of sz free interval b/t birth and onset of szs, Clonic or apneic szs, Negative evaluations for etiology, Favorable neuro development outcome. |
| What is the guideline for utilizing a Neonatal Montage? | Neonates and young infants up to 8 weeks post-term when the head circumference is less than 36 centimeters (cm). (2010-2011) |
Created by:
kmburg5840
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