Neonatal Clinical Care Unit, King Edward Memorial Hospital and Perth Children's Hospital, Perth, Australia; Centre for Neonatal Research and Education, Medical School, University of Western Australia, Australia.
Neonatal Clinical Care Unit, King Edward Memorial Hospital and Perth Children's Hospital, Perth, Australia; Centre for Neonatal Research and Education, Medical School, University of Western Australia, Australia.
Early Hum Dev. 2020 Apr;143:105011. doi: 10.1016/j.earlhumdev.2020.105011. Epub 2020 Mar 4.
Amplitude-integrated electroencephalogram (aEEG) is being used increasingly for seizure detection in neonates. However, data regarding inter-rater reliability among neonatologists for the use of aEEG for the detection of neonatal seizures is lacking.
Term and late-preterm infants at risk of seizures were monitored simultaneously with 24-h video-electroencephalography (vEEG) and aEEG. vEEG was interpreted by an experienced neurologist. Five neonatologists with experience in aEEG interpretation from four different neonatal units interpreted aEEG recordings independently. The Brennan and Prediger kappa coefficient and Intra-class Correlation Coefficients (ICC) were used to assess inter-rater reliability between the neonatologists.
Thirty-five infants at risk of seizure with gestational age at birth 35-42 weeks were recruited for the study after informed parental consent. vEEG detected seizures in seven infants with a total of 169 individual seizure episodes. Neonatologists detected seizures in 10 to 15 infants on aEEG. The sensitivities for the detection of individual seizures by neonatologists ranged from 18% to 38%. The inter-rater reliability for detection of: individual seizure was "fair" (kappa = 0.37; 95% CI: 0.32-0.42), infant with seizure was "moderate" (kappa = 0.60; 95% CI: 0.44-0.75), duration of individual seizure (ICC: 0.22; 95% CI: 0.18-0.28) and total duration of seizures in an infant (ICC: 0.46; 95% CI: 0.30-0.63) was "poor". The neonatologists missed 77-90% of the duration of seizures.
The inter-rater reliability of aEEG for the detection of neonatal seizures was suboptimal. Even when interpreted by experienced and trained clinicians, seizure detection with aEEG has limitations and can miss large number and duration of seizures.
振幅整合脑电图（aEEG）越来越多地用于新生儿的癫痫发作检测。然而，关于新生儿科医生使用 aEEG 检测新生儿癫痫发作的可靠性的研究数据却很少。
有癫痫发作风险的足月和晚期早产儿同时进行 24 小时视频脑电图（vEEG）和 aEEG 监测。vEEG 由一位经验丰富的神经科医生进行解读。来自四个不同新生儿病房的五名具有 aEEG 解读经验的新生儿科医生独立解读 aEEG 记录。使用 Brennan 和 Prediger kappa 系数和组内相关系数（ICC）来评估新生儿科医生之间的评分者间可靠性。
在获得家长知情同意后，共有 35 名胎龄 35-42 周的有癫痫发作风险的婴儿参与了这项研究。vEEG 在 7 名婴儿中检测到了 169 次癫痫发作。新生儿科医生在 aEEG 上检测到 10-15 名婴儿有癫痫发作。新生儿科医生检测到的单个癫痫发作的敏感性为 18%-38%。评分者之间检测单个癫痫发作的可靠性为“一般”（kappa=0.37；95%CI：0.32-0.42），检测有癫痫发作的婴儿为“中度”（kappa=0.60；95%CI：0.44-0.75），单个癫痫发作的持续时间（ICC：0.22；95%CI：0.18-0.28）和婴儿癫痫发作的总持续时间（ICC：0.46；95%CI：0.30-0.63）为“较差”。新生儿科医生漏诊了 77%-90%的癫痫发作持续时间。
aEEG 检测新生儿癫痫发作的评分者间可靠性不理想。即使由经验丰富和训练有素的临床医生进行解读，aEEG 检测也存在局限性，可能会错过大量癫痫发作的次数和持续时间。
