Cordeiro Malaika, Peinado Helena, Montes María Teresa, Valverde Eva
Servicio de Neonatología, Hospital Universitario La Paz, Madrid, España; Fundación NeNe, Madrid, España.
Servicio de Neonatología, Hospital Universitario La Paz, Madrid, España.
An Pediatr (Engl Ed). 2020 Oct 27. doi: 10.1016/j.anpedi.2020.09.009.
Monitoring of brain function using continuous electroencephalography (aEEG/cEEG) is an essential tool in the standard care of the term infant, and its use is growing in the premature infant as a biomarker of lesion and brain maturity. However, the placing of the electrodes is a great challenge, particularly in the extremely premature infant, which often discourages neuromonitoring. The aim of this study is to assess the different electrodes available, to select the one that best suits the peculiarities of the extremely premature infant, and evaluate its applicability in clinical practice.
With the aim of designing a neuromonitoring study protocol using aEEG/cEEG in<28 weeks premature infants, an analysis was made of our experience with the type of electrodes available. The electrode that was considered most suitable for this population was chosen by assessing: the need of preparing the scalp, speed in positioning the electrodes, if the application was invasive or not, the possibility of repositioning, risk of skin injuries, sterility of the technique, and durability. The electrode chosen was used for continuous electroencephalographic monitoring started in the first 24h of life, and maintained until at least 72h of life.
The electrodes evaluated were: subdermal needles, silver cups, and 2 types of self-adhesive electrodes (solid hydrogel and wet gel). The wet gel electrodes were chosen. They were used on 41 neonates with a mean gestational age of 25.8±1.1 weeks. Good stable impedance was rapidly obtained, without the need of excessive manipulations, and no skin injuries were observed. The satisfaction of the staff involved in positioning them was very high.
The self-adhesive disposable electrodes with wet gel and integrated cable enabled the electrodes to be positioned rapidly and provided continuous non-invasive and good quality aEEG/cEEG monitoring in the extremely premature infant.
使用连续脑电图（振幅整合脑电图/连续脑电图，aEEG/cEEG）监测脑功能是足月儿标准护理中的一项重要工具，并且作为病变和脑成熟的生物标志物，其在早产儿中的应用也日益增多。然而，电极的放置是一项巨大挑战，尤其是在极早产儿中，这常常阻碍神经监测的开展。本研究的目的是评估现有的不同电极，选择最适合极早产儿特点的电极，并评估其在临床实践中的适用性。
为了设计一项在孕周小于28周的早产儿中使用aEEG/cEEG进行神经监测的研究方案，我们对现有的电极类型的使用经验进行了分析。通过评估以下方面来选择被认为最适合该人群的电极：头皮准备的必要性、电极放置速度、是否为侵入性操作、重新放置的可能性、皮肤损伤风险、技术的无菌性以及耐用性。所选电极用于在出生后的头24小时内开始的连续脑电图监测，并持续至至少出生后72小时。
评估的电极包括：皮下针电极、银杯电极和两种自粘电极（固体水凝胶电极和湿凝胶电极）。选择了湿凝胶电极。它们被用于41例平均胎龄为25.8±1.1周的新生儿。迅速获得了良好稳定的阻抗，无需过多操作，且未观察到皮肤损伤。参与放置电极的工作人员满意度很高。
带有湿凝胶和集成电缆的一次性自粘电极能够快速放置电极，并为极早产儿提供连续的非侵入性且高质量的aEEG/cEEG监测。
