Amplitude-Integrated EEG in Infants at Risk of Hypoxic-Ischemic Encephalopathy: A Feasibility Study in Road and Air Transport in Western Australia

We wanted to assess the feasibility of using an Amplitude-Integrated Electroencephalogram during neonatal transport. Using clinical criteria, we determined whether the trace acquired during the transport was readable. This helps the clinician in the diagnosis and prognosis of babies requiring transportation following possible birth asphyxia or hypoxic-ischemic encephalopathy.

Remote monitoring, automated devices, and innovative transport systems to improve outcomes in sick and premature newborns. Performing any research during transport has its difficulties but is essential in improving care. Gaining appropriate consent is challenging in a time of acute stress.

The clinical team is required to perform research as well as clinical tasks, adding to the complexity of the transport process. We have established the necessity of undertaking research in neonatal transport are seeking ways to improve the outcomes in babies who need to be transported after birth. We are working on means of improving thermal regulation in neonatal transport.

We would like to see whether Amplitude-Integrated EEG enables an earlier and more accurate diagnosis of hypoxic-ischemic encephalopathy. We would also like to explore if machine learning can be used to augment diagnostic decisions. Finally, we wish to assess whether this has an impact on important outcomes such as mortality and neurodevelopmental outcome.

To begin assembling the amplitude integrated electroencephalogram or aEEG recording system, first, insert the aEEG electrode pins into the infant's scalp per standard guidelines. Next, measure and locate the two anatomical landmarks, sagittal suture, and ear traga. Align the electrode measuring tape vertically on the head and parallel to the face.

Match the letters or symbols on the positioning aid until the same letter or symbol appears in both locations. Mark the positions with a surgical pen on each side of the tape. Let the hair part naturally or part it vertically away from the marked position, using sterile water and swab sticks.

Dry the area with gauze. Then, clean the skin with swabs containing 1%chlorhexidine and 70%alcohol, and let it dry. Hold the skin tight and insert the needle at a 30-degree angle with the sensor wire upwards.

If the scalp is very hairy, use skin preparation swabs around the needle insertion site. Secure the subdermal needle electrode in place using Steri-Strips and the Chevron method. Use two small pieces of Tegaderm on opposite sides of the needle to sandwich the needle.

Point the needles and wires in the same direction. Place the reference electrode on the chest, anteriorly or posteriorly the back of the shoulder or the nappe area of the neck. Connect the electrodes to the aEEG amplifier using the C3-C4 and P3-P4 configurations.

Connect the amplifier to the Tablet computer using an ethernet cable. Turn on the Tablet and log in. Enter the acquire pro-application, which will automatically apply the default neonatal configuration.

Change the default settings of impedance from five kilohms to 10 kilohms. Press Record Now to automatically create a patient ID.Press the EEG tab to observe the live trace. Finally, secure the clinical Tablet to the cot used to transport the infant, which is either a Mansell Neocot, or a Voyager transport incubator.

The location of the Tablet on the cot depends on which cot is taken on the transport. Proceed to transport the infant after setting up the portable Amplitude-Integrated Electroencephalogram or aEEG recording system. During the transport, note any movements that may contribute to artifact, clinical change, or seizure on the Tablet software.

Use buttons on the Tablet to label important events including seizure, patient care, loading or unloading, takeoff, and landing. For non-continuous events, press the button only once for a timestamp. For continuous clinical events such as seizures, observe the label added for the event duration.

When one continuous event finishes, press the button a second time. On arrival at the receiving hospital, transfer the baby to the intensive care bed. Disconnect scalp electrodes from the study amplifier and transfer them onto the neonatal intensive care unit, aEEG monitor to continue the recording per unit protocol.