| Background and objectiveThe emergence of amplitude-integrated electroencephalogram(aEEG)opened up a new era of electroencephalography in neonates.aEEG has gradually become a common examination method for neonatal brain injury due to its advantages of long-term bedside monitoring and more intuitive and easy analysis after compression and integration.At present,one-channel and two-channel are recommended for aEEG mode.However,there is a study found that average reference montage is more advantageous in EEG,while average reference montage in aEEG is rarely reported in literature.Therefore,this study compared the amplitude and sleep-wake cycle of single-channel C3-C4 and average reference montage,and investigated the feasibility of the application of the average reference montage in aEEG.MethodsFrom August 2018 to September 2019,a total of 90 cases of full-term newborns admitted to the department of neonatology of Nanfang Hospital with EEG results as normal were selected,excluding those who failed to complete the monitoring or found intracranial hemorrhage or hypoxic-ischemic encephalopathy during the monitoring.The general information of each newborn was recorded,and quantitative indexes such as the upper and lower amplitude of aEEG in single-channel C3-C4 and the average reference montage were collected.SPSS 24.0 statistical software was used for data analysis,non-normal distribution data was expressed as M(P25,P75),Friedman test was used for multi-group comparison,and rank-transformed variance analysis or adjusted test level to Wilcoxon method was used for multiple comparison of inter-group differences.Results1.The amplitude and bandwidth of the upper and lower margins of the single-channel C3-C4 are higher than the average reference montage,and the multi-group comparison is statistically significant.There are also statistically significant differences between single-channel C3-C4 and 9 channels in average reference montage.2.In the average reference montage,the Cz-AV channel has the highest amplitude.The lowest amplitude of broad-band is Fpl-AV channel,and the narrow-band’s lowest amplitude is in Ol-AV channel.By pairwise comparison of 9 channels,the amplitude of Cz-AV channel is statistically different from that of other channels.3.According to post-menstrual age(PMA),the amplitudes of the upper and lower margins of the broadband increase with the growth of PMA.The amplitudes and bandwidths of the upper and lower margins of the narrow-band show no significant trend change in the average reference montage,while the single-channel C3-C4 shows a slight downward trend.4.In terms of graphical analysis,judging from the single-channel C3-C4,90 newborns have a mature sleep-wake cycle,while the sensitivity of Ol-AV channel in average reference montage to the judgment of sleep-wake cycle is only 60.0%(54/90),and the sensitivity of O2-AV channel is only 53.3%(48/90).Besides,90 newborns aEEGs are interpreted as normal by single channel C3-C4 while in the average reference montage,at least 6 newborns’ partial lower amplitudes of broad-band are less than 5μV,and the misjudgment rate can reach 6.7%.Conclusions1.During the graphical interpretation of neonatal aEEG,the results of single-channel C3-C4 and the average reference montage of 9 channels are not completely consistent,and the average reference montage is not sensitive to the recognition of the sleep-wake cycle of neonatal aEEG,especially the Ol-AV channel and 02-AV channel,which would result in misdiagnosis.2.Average reference montage are not recommended for neonatal aEEG interpretation based on the existing diagnostic criteria,and new standards need to be developed.3.As the post-menstrual age increases,the amplitude of the upper and lower margins of the broadband also increases.Then,the amplitude of the central electrode is the highest,and the voltage decreases from occipital to frontal pole. |
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