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Neonates

2

QuestionAnswer
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