WP08 - Outcome assessment - EEG

 

Workpackage lead and partners:

WP leader:
Dr Geraldine Boylan, UCC

WP partners:
K.U.Leuven
CUNI

Workpackage objectives: 

  • Development of standards and protocols for EEG recording in very preterm babies at recruitment sites (technical details, EEG recording, helping all centres to obtain needed setups) where EEG will be performed.
  • Validation of EEG recording protocols
  • Validation of a web-based EEG monitoring tool to provide on-line EEG monitoring support where required.
  • Set up of preterm EEG analysis guidelines
  • Correlation of EEG activity with blood pressure and cerebral oxygenation
  • Establish the effect of sedatives, surfactant and inotropes on cerebral activity in the preterm baby

Workpackage description:

In the HIP study, EEG will be used to monitor the effect of blood pressure on cerebral activity. In addition the effect of different treatment strategies will be compared. The effect of prolonged hypotension on cerebral activity in the preterm baby is unknown. In addition, the effect of inotrope administration on cerebral activity remains unknown.  The primary aim of the HIP study is to monitor the efficacy of blood pressure treatment and to relate this to short and long term outcome. Cerebral activity can only be assessed in the preterm baby using EEG monitoring from soon after birth. The HIP consortium is unique as the work package lead and many of the other participants are experienced in Neonatal EEG monitoring.

Task 1:

The aim of this WP will be to ensure that a standard set of recording procedures and protocols are used in all recording centres. This may present some challenges but can only be overcome by arranging a peer-support network between the centres, and in designing physiologically prudent and clinically sensible analysis paradigms for EEG to extend classical visual interpretation.

Task 2:

Definition of practical requirements (protocols, guidelines) for multichannel EEG recordings in preterm babies. Standard operational procedures (SOPs) will be developed. The protocols will define the minimum requirements, such as electrode number and placing, recording bandwidth, sampling frequency, and video parameters for monitoring high risk preterm infants where required. The SOP for supplementary physiological monitoring such as ECG, respiration and blood pressure monitoring will also be developed in this task. 

Task 3:

The HIP Trial participant 1 (UCC) has already developed a web-based real time EEG reporting system in Ireland. All EEG monitoring centres will work with UCC to develop the EEG transmission protocols for extending this service to the HIP Trial consortium in all countries. All EEGs from local monitoring centres can be uploaded to the EEG server in UCC for later analysis by a neonatal neurophysiologist. This is a very important task as it will allow all centres to store data as recorded remotely and securely. The consortium is aware of the fact that babies may be born at any time and that a 24 hour data archiving platform is required. In addition, this platform will mean that an EEG archive can be developed that will serve as a useful educational tool for all participating centres and for the greater scientific community.

Task 4: Development of an electronic data repository for all EEG recordings

A secure web-based, data repository will be developed in the BSRI (http://www.bcri.ucc.ie/) to allow all centres to upload EEG data to a central server for storage and backup. In the HIP Trial, all study investigators will be provided with a large capacity external hard drive for local EEG data backup. Protocols for data upload to the central server will be developed and all study co-ordinators will be trained to use this system.

Task 5: Preterm EEG analysis

A major aim of this WP will be to assess the ability of certain preterm EEG features such as inter-burst interval duration, power, spectral edge frequency and spectral entropy, sleep-wake cycle development to determine long term prognosis in preterm babies with hypotension. This will be analysed by the Neonatal Brain Research Group at UCC. The background EEG is known to be an excellent tool for the prediction of long-term outcome in hypoxic ischaemic encephalopathy. The ability of the EEG to predict long-term outcome in hypotensive and normotensive preterm babies is unknown. In addition, the effect of morphine, surfactant and other commonly used drugs will be assessed. The effect of different background EEG patterns and the implications for early prognosis will be examined and guidelines will be disseminated widely.