Application of an Amplitude-integrated EEG Monitor (Cerebral Function Monitor) to Neonates
September 6th, 2017
Here, we show how to apply amplitude-integrated electroencephalography to monitor cerebral function in neonates.
The overall goal of this clinical examination technique is to monitor infant's cerebral function status during treatment in the neonatal intensive care unit. This method can help to evaluate the cerebral function status and brain maturation in term and preterm infants. The main advantage of this bedside technique is that it is easily accessible and can be used on any infant in the neonatal intensive care unit.
Demonstrating the procedure will be Susanne, a nurse from our own EQ.Begin by connecting the aEEG device to electrical power at the location where the monitoring will take place. Next, collect two electrodes for a single-channel amplitude integrated EEG, or aEEG, and four electrodes for a two-channel aEEG. If not using needle electrodes, choose the type of electrodes you want to use instead.
Prepare a positioning strip, skin disinfectant, tape appropriate for use in neonates, swabs, skin preparation gel, a module box, and contact gel for gold cups. Plug the module box into the aEEG device. Apply the electrodes during routine care by first disinfecting the skin.
Then place skin preparation gel on a cotton swab until it is moist. Apply a few gentle strokes with the cotton swab using very little pressure. Then place the reference electrode on the back or the chest of the infant.
After the reference electrode has been placed, put the measuring device on the infant's head and line up the same signs on the infant's tragus and sagittal suture. Then right before placing the remaining electrodes on the infant's head, disinfect the area indicated by the arrows on the measuring device. When using needle electrodes, stretch the skin slightly and insert the needle tangentially, just underneath the skin of the markings with the tip of the needle pointing in the caudal direction.
Use tape to keep the electrode in place. Next, insert the cables into the module box as indicated by the legend on the box. If the impedance of the reference electrode, gold cups, or hydrogel electrodes is not satisfactory, perform a few strokes with the cotton swab under the corresponding electrode.
Finally, start the recording. If using gold cups, fill each cup with contact gel. Place the cup in the proper position with the cable running towards the head end, tape it into place.
Alternatively, if using hydrogel electrodes, place the electrodes with the cable running towards the head end. Ensure that all electrodes are in place and there is no mechanical contact between electrodes. If required, place a CPAP hat or headband on top of the aEEG electrodes.
During the recording, regularly check for impedance and the dislocation of electrodes to obtain quality recordings. Mark events to facilitate the identification of artefacts using the provided button on the screen of the cerebral function monitor. Check the infant for skin irritation to avoid lesions or infections.
Leave aEEG electrodes in place for intubation, or other invasive measures to resume the recording later. In case the cables are not long enough to move the infant within the incubator, disconnect them from the module box, and reconnect them after the procedure. Finally, review the tracing at the end of the recording on the monitor, or transfer it to an external storage device.
During an aEEG, continuous and discontinuous normal voltage patterns are considered physiological background patterns in term and preterm infants, respectively. A burst suppression pattern, continuous low-voltage pattern, and a flat trace, are pathological background patterns. Seizures in term infants have a characteristic shape with a sudden rise of both the lower and upper border.
In preterm infants however, seizures can be camouflaged by the discontinuous background pattern, and may only be detected by viewing the raw EEG. Once mastered, this technique can be done in a few minutes if it's performed properly. During the recording it's important to check for impedance and electrode dislocation regularly.
After watching this video you should have a good understanding of how to plan an aEEG monitor to a neonate and how to make sure you receive a good quality recording.
Overview
This article demonstrates the application of amplitude-integrated electroencephalography (aEEG) for monitoring cerebral function in neonates. This bedside technique is crucial for evaluating brain maturation in both term and preterm infants in the neonatal intensive care unit.
Key Study Components
Area of Science
- Neonatology
- Clinical monitoring
- Electrophysiology
Background
- Monitoring cerebral function is vital in neonatal care.
- aEEG is a non-invasive method suitable for infants.
- The technique aids in assessing brain health during treatment.
- It is easily accessible in intensive care settings.
Purpose of Study
- To demonstrate the procedure for applying aEEG in neonates.
- To ensure accurate monitoring of cerebral function.
- To provide guidelines for maintaining electrode placement and recording quality.
Methods Used
- Connecting the aEEG device and preparing electrodes.
- Applying electrodes to the infant's scalp following skin preparation.
- Monitoring impedance and electrode placement during recording.
- Reviewing recordings for quality and identifying artefacts.
Main Results
- Successful placement of electrodes leads to quality aEEG recordings.
- Regular checks for impedance ensure reliable data.
- Identifying physiological and pathological patterns in recordings.
- Understanding the significance of monitoring in neonatal care.
Conclusions
- aEEG is an effective tool for monitoring neonatal cerebral function.
- Proper technique and maintenance are crucial for quality recordings.
- Mastering this technique can enhance neonatal care outcomes.
Frequently Asked Questions
Executive Industry Relevance
Amplitude-integrated EEG (aEEG) provides a non-invasive, bedside method for monitoring cerebral function in neonates, supporting early assessment of brain maturation and neurological risk. This technique enables real-time evaluation of physiological and pathological brain activity patterns, aiding in clinical decision-making for therapeutic interventions such as hypothermia cooling. Its accessibility in neonatal intensive care units facilitates continuous monitoring, contributing to predictive confidence in neurodevelopmental outcome stratification.
Strategic Applications in Biopharma R&D
Early Discovery & Target Validation
- Scientific Value: Enables interrogation of cerebral function status to support therapeutic hypothesis testing in neonatal neuroprotection.
- Operational Value: Provides quantitative, real-time electrocortical readouts for pathway clarification and target engagement assessment.
- Predictive Value: Supports mechanistic de-risking by correlating early aEEG tracings with long-term neurodevelopmental outcomes.
Screening & Assay Development
- Scientific Value: Delivers standardized, reproducible background pattern classifications (continuous, discontinuous, burst suppression, flat trace) for assay readiness.
- Operational Value: Ensures signal quality through regular impedance and electrode dislocation checks, enabling reliable longitudinal monitoring.
- Translational Value: Facilitates preparation of validated neonatal models for downstream screening of neuroprotective compounds.
Translational & Preclinical Research
- Scientific Value: Offers disease-relevant system insights by linking aEEG patterns to pathophysiological conditions such as asphyxia and preterm brain injury.
- Operational Value: Enables raw EEG review to detect seizures or technical artefacts, enhancing data integrity in preclinical validation.
- Predictive Value: Supports risk-adjusted advancement decisions by identifying infants who may benefit from cooling therapy based on aEEG criteria.
Pipeline & Workflow Integration
aEEG monitoring fits within the early discovery continuum, supporting hypothesis testing in neonatal neurology and enabling quantitative assessment of cerebral function prior to lead identification in neuroprotective screening campaigns.
- Discovery Biology: Supports cerebral function status evaluation and brain maturation tracking in term and preterm infants.
- Screening: Delivers reproducible, quantitative voltage pattern outputs essential for compound effect comparison.
- Analytics: Provides measurable electrocortical readouts (e.g., upper/lower border shifts, seizure morphology) for condition comparison and artefact identification.
- Translational Research: Connects early aEEG patterns to long-term neurodevelopmental outcomes, supporting biomarker alignment.
- Enterprise Reuse: Represents a scalable, bedside-capable monitoring platform applicable across neonatal cohorts and study designs.
Operational & Enterprise Impact
- Scientific Value: Predictive confidence in neurodevelopmental risk, reduction of mechanistic ambiguity in neonatal brain injury models.
- Operational Value: Standardization, reproducibility, and scalability of cerebral function monitoring at the bedside.
- Strategic Value: Improved go/no-go decisions in neuroprotective programs, reduced late-stage biological risk through early outcome prediction.
- Portfolio Impact: Enables risk-adjusted prioritization of neonates for intervention based on aEEG-derived prognostic indicators.
Implementation Considerations
- Requires expertise in neonatal skin preparation, electrode placement, and impedance monitoring.
- Dependent on appropriate instrumentation (aEEG device, electrodes, gels, tapes) and infrastructure for signal acquisition.
- Necessitates cross-team standardization of electrode application and artefact marking protocols.
- Involves adaptation considerations for varying gestational ages and clinical conditions (e.g., preterm vs. term, asphyxia).
- Limited by the need for accurate fixation and localization of electrodes to avoid signal distortion or misinterpretation.
