Servicio de Neonatología, Hospital Universitario La Paz, Madrid, Spain; Fundación NeNe, Madrid, Spain.
Servicio de Neonatología, Hospital Universitario La Paz, Madrid, Spain.
An Pediatr (Engl Ed). 2021 Dec;95(6):423-430. doi: 10.1016/j.anpede.2020.09.010. Epub 2021 Oct 20.
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 24 h of life, and maintained until at least 72 h 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（aEEG/cEEG）监测脑功能是足月婴儿标准护理的重要工具，在早产儿中，其作为病变和脑成熟的生物标志物的作用正在不断增强。然而，电极的放置是一个巨大的挑战，尤其是在极早产儿中，这常常会阻碍神经监测的进行。本研究旨在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。
为了设计一项使用 aEEG/cEEG 监测<28 周早产儿的神经监测研究方案，我们对现有电极类型的使用经验进行了分析。通过评估以下因素，选择了被认为最适合该人群的电极：头皮准备的需求、电极定位的速度、应用是否具有侵入性、是否可重新定位、皮肤损伤的风险、技术的无菌性和耐用性。选择的电极用于在生命的头 24 小时内开始进行连续脑电图监测，并至少持续到生命的第 72 小时。
评估的电极包括：皮下针、银杯和 2 种自粘电极（固体水凝胶和湿凝胶）。最终选择了湿凝胶电极。在 41 名胎龄平均为 25.8±1.1 周的新生儿中使用了这些电极。迅速获得了良好的稳定阻抗，无需过度操作，且未观察到皮肤损伤。参与定位电极的工作人员非常满意。
带有湿凝胶和集成电缆的一次性自粘电极可快速定位电极，并为极早产儿提供连续的非侵入性和高质量的 aEEG/cEEG 监测。
