Prognostic Accuracy of Electroencephalograms in Preterm Infants: A Systematic Review

CONTEXT: Brain injury is common in preterm infants, and predictors of neurodevelopmental outcome are relevant. OBJECTIVE: To assess the prognostic test accuracy of the background activity of the EEG recorded as amplitude-integrated EEG (aEEG) or conventional EEG early in life in preterm infants for predicting neurodevelopmental outcome. DATA SOURCES: The Cochrane Library, PubMed, Embase, and the Cumulative Index to Nursing and Allied Health Literature. STUDY SELECTION: We included observational studies that had obtained an aEEG or EEG within 7 days of life in preterm infants and reported neurodevelopmental outcomes 1 to 10 years later. DATA EXTRACTION: Two reviewers independently performed data extraction with regard to participants, prognostic testing, and outcomes. RESULTS: Thirteen observational studies with a total of 1181 infants were included. A meta-analysis was performed based on 3 studies (267 infants). Any aEEG background abnormality was a predictor of abnormal outcome. For prediction of a developmental quotient < 70 points, cerebral palsy, or death, the pooled sensitivity was 0.83 (95% confidence interval, 0.69-0.92) and specificity 0.83 (95% confidence interval, 0.77-0.87). LIMITATIONS: All studies were at high risk of bias. Heterogeneity was evident among the studies with regard to the investigated aEEG and EEG variables, neurodevelopmental outcomes, and cutoff values. CONCLUSIONS: aEEG or EEG recorded within the first 7 days of life in preterm infants may have potential as a predictor for later neurodevelopmental outcome. We need high-quality studies to confirm these findings. Meanwhile, the prognostic value of aEEG and EEG should be used only as a scientific tool.