我们感谢珀斯儿童医院基金会 （Perth Children's Hospital Foundation） 在购买本项目中使用的脑电图设备方面的慷慨支持。我们感谢 Gardar Thorvardsson （Kvikna） 和 Ieesha Sparks （Temple Medical and Scientific） 在研究项目的技术方面的支持。

该研究获得了儿童和青少年健康服务 （CAHS） 人类研究伦理委员会（HREC，批准号 RGS0000004988）的批准，并遵守了赫尔辛基宣言的原则。
1. 确定纳入研究的患者
<ol><li>在转诊时确定婴儿是否有资格参加研究。任何疑似 HIE 需要运输的婴儿都有资格参加该研究。</li>
	<li>使用标准化诊断标准12 识别疑似 HIE 婴儿：<ol><li>检查胎龄是否为 >35 周。</li>
		<li>检查是否在出生后 <6 小时。</li>
		<li>检查是否存在窒息的证据，如存在以下 4 项标准：<ol><li>检查是否有任何可能导致 HIE 的急性围产期事件（例如，胎盘早剥、脐带脱垂、严重的 FHR 异常）。</li>
			<li>检查 10 分钟时 Apgar 评分是否为 <6，或者在 10 分钟时是否需要继续进行正压通气 +/- 胸外按压复苏。</li>
			<li>出生后 60 分钟内检查脐带 pH 值是否为 <7.0 或 BE 是否为 >12 mmol/L（如果能够进行气体呼吸）。</li>
			<li>如果脐带 pH 值不可用，请在出生后 60 分钟内检查动脉 pH 值是否为 <7.0 或 BE 是否为 >12 mmol/L（如果能够进行气体呼吸）。</li>
		</ol></li>
	</ol></li>
</ol>2. 获得父母的同意
<ol><li>到达后，与父母联系，以获得使用该设备的口头同意，并对其使用的可接受性进行调查。</li>
	<li>提供父母信息表，其中包含知情同意所需的所有信息。</li>
	<li>确保家长理解信息并有机会提出任何问题。</li>
	<li>在口头同意后 72 小时内获得书面同意。</li>
</ol>3. 请求运输医生和护士的同意
<ol><li>请求运输医生和护士同意向他们发送有关他们在运输中使用 aEEG 的经验的调查。</li>
</ol>4. aEEG 应用
<ol><li>按照标准指南13 将 aEEG 电极针插入婴儿的头皮。</li>
	<li>测量并定位解剖标志：矢状缝和耳屏。</li>
	<li>将电极卷尺（图 1）垂直对准头部并平行于面部。</li>
	<li>匹配定位辅助工具上的字母/符号，直到两个位置出现相同的字母/符号（图 1）。</li>
	<li>用手术笔在胶带的每一侧标记位置（图 2）。<ol><li>让头发自然部分，或使用无菌水和棉签棒将其垂直分开，远离标记位置。用纱布擦干。</li>
		<li>用 1% 洗必泰/酒精棉签清洁皮肤并晾干。</li>
		<li>紧紧握住皮肤，以 30° 角插入针头，传感器线朝上。</li>
		<li>使用消毒条和 Chevron 方法14 将皮下针电极固定到位（图 3）。</li>
		<li>对其他针插入重复前面的步骤。</li>
		<li>如果头皮毛茸茸，请在针头插入部位周围使用皮肤准备棉签，并在贴布前晾干。</li>
		<li>将针和电线指向同一方向。</li>
		<li>将参比电极放在胸部（前部或后部）、肩部后部或颈部的后颈区域。</li>
	</ol></li>
	<li>使用 C3/C4 和 P3/P4 配置将电极连接到 aEEG 放大器（参见 图 4）。</li>
</ol>5. 设置脑电图放大器和平板电脑
<ol><li>连接 amplifier 使用以太网电缆连接到平板电脑; 图 5 中显示了连接的概述。</li>
	<li>打开平板电脑并登录。</li>
	<li>进入 Acquire Pro 应用程序。将自动应用默认的新生儿配置。</li>
	<li>将阻抗的默认设置从 5 KΩ 更改为 10 KΩ。</li>
	<li>按 Start Recording（开始记录），将自动创建患者 ID。</li>
	<li>按 EEG 选项卡观察实时轨迹。</li>
	<li>将临床片剂固定在婴儿床上。在 Mansell 新婴儿床或 Voyager 运输培养箱中运输婴儿（图 6 和 图 7）。平板电脑在婴儿床上的位置取决于运输时带走的婴儿床（见 图 8）。</li>
	<li>如果使用飞机，请从婴儿床上取下平板电脑并将其握在手中。</li>
</ol>6. 运输过程中的 aEEG 监测。
<ol><li>在运输过程中，在平板电脑软件上记下任何可能导致伪影、临床变化或癫痫发作的动作。使用平板电脑上可按下的按钮来标记重要事件，包括癫痫发作、患者护理、装载/卸载、起飞和着陆。</li>
	<li>对于癫痫发作等连续临床事件，将为其发生的持续时间添加标签。活动结束后，再次按下按钮。对于非连续事件，只需按一次时间戳按钮。</li>
	<li>到达接收医院后，将婴儿转移到重症监护病床。断开头皮电极与研究放大器的连接，并将其转移到 NICU aEEG 监视器上，在那里可以按单位协议继续记录。 注意：治疗临床医生必须对 aEEG 轨迹不知情，并且不得根据轨迹做出紧急决定。</li>
</ol>7. 数据解释
<ol><li>除了脑电图外，还记录人口统计和交通信息。</li>
	<li>使用 Centrum 应用程序下载 aEEG 跟踪。</li>
	<li>确保 aEEG 轨迹由 CPI 和两名具有 5-20 年新生儿 aEEG 读取经验的独立评估员审查。</li>
	<li>使评估员对临床信息和跟踪不知情。</li>
	<li>将跟踪分成 15 分钟的分段，并查看构件分段的数量。如果三位“专家”中的两位同意，则跟踪的一段被视为伪影。已选择任意值 100 μV，此时表示发生移动伪影。</li>
	<li>以 8 Hz 的速率从 C3-C4 电极下载每条迹线的原始数据。 注意：阻抗 （Z） 是电流的电阻，测量皮肤电极放置和导联运动伪影的质量。低、相等和稳定的阻抗可确保最佳 aEEG。软件系统将阻抗记录为设置为 >10 KΩ 的离散通知。记录每条轨迹的量级和数量。</li>
	<li>在运输后使用电子数据采集平板电脑应用程序完成员工和家长调查。 注意：该研究旨在招募和收集 20 名疑似 HIE 患者的数据。</li>
</ol>8. 分析
<ol><li>使用中位数（四分位距;IQR）。</li>
	<li>将对象显示为总跟踪的百分比。将运动伪影描述为平均值（标准差;SD） 总迹线的百分比。</li>
	<li>将 Z 表示为平均值 （范围），将 Z 幅度表示为中位数 （IQR） 表示千欧姆 （KΩ）。</li>
	<li>将跟踪定义为 80% 的时间内 Z 的总计和无移动伪影。 注：该方法中呈现的代表性结果表示为中位数和四分位数间距以及使用 Mann-Whitney U 检验的中位数比较。</li>
</ol>

使用便携式振幅积分脑电图进行婴儿运输

<ol>
	<li>Kurinczuk, J. J., White-Koning, M., Badawi, N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Epidemiology+of+neonatal+encephalopathy+and+hypoxic-ischaemic+encephalopathy.">Epidemiology of neonatal encephalopathy and hypoxic-ischaemic encephalopathy.</a> Early Hum Dev. 86 (6), 329-338 (2010).</li><li>. Midwives Notification System, Government of Western Australia, Department of Health Available from: <a target="_blank" href="https://www.health.wa.gov.au/Reports-and-publications/Western-Australias-Mothers-and-Babies-summary-information/data?report=mns_birth_y">https://www.health.wa.gov.au/Reports-and-publications/Western-Australias-Mothers-and-Babies-summary-information/data?report=mns_birth_y</a> (2023)</li><li>Shankaran, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Whole-body+hypothermia+for+neonates+with+hypoxic-ischemic+encephalopathy.">Whole-body hypothermia for neonates with hypoxic-ischemic encephalopathy.</a> N Engl J Med. 353 (15), 1574-1584 (2005).</li><li>Thoresen, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Time+is+brain:+Starting+therapeutic+hypothermia+within+three+hours+after+birth+improves+motor+outcome+in+asphyxiated+newborns.">Time is brain: Starting therapeutic hypothermia within three hours after birth improves motor outcome in asphyxiated newborns.</a> Neonatology. 104 (3), 228-233 (2013).</li><li>Wall&#248;e, L., Hjort, N. L., Thoresen, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Start+cooling+as+soon+as+possible.">Start cooling as soon as possible.</a> Acta Paediatr. 108 (4), 771 (2019).</li><li>Skranes, J. H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Amplitude-integrated+electroencephalography+improves+the+identification+of+infants+with+encephalopathy+for+therapeutic+hypothermia+and+predicts+neurodevelopmental+outcomes+at+2+years+of+age.">Amplitude-integrated electroencephalography improves the identification of infants with encephalopathy for therapeutic hypothermia and predicts neurodevelopmental outcomes at 2 years of age.</a> J Pediatr. 187, 34-42 (2017).</li><li>Shalak, L. F., Laptook, A. R., Velaphi, S. C., Perlman, J. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Amplitude-integrated+electroencephalography+coupled+with+an+early+neurologic+examination+enhances+prediction+of+term+infants+at+risk+for+persistent+encephalopathy.">Amplitude-integrated electroencephalography coupled with an early neurologic examination enhances prediction of term infants at risk for persistent encephalopathy.</a> Pediatrics. 111 (2), 351-357 (2003).</li><li>Hellstrom-Westas, L., Rosen, I., Svenningsen, N. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Predictive+value+of+early+continuous+amplitude+integrated+eeg+recordings+on+outcome+after+severe+birth+asphyxia+in+full+term+infants.">Predictive value of early continuous amplitude integrated eeg recordings on outcome after severe birth asphyxia in full term infants.</a> Arch Dis Child Fetal Neonatal Ed. 72 (1), F34-F38 (1995).</li><li>Davies, A., Wassink, G., Bennet, L., Gunn, A. J., Davidson, J. O. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Can+we+further+optimize+therapeutic+hypothermia+for+hypoxic-ischemic+encephalopathy.">Can we further optimize therapeutic hypothermia for hypoxic-ischemic encephalopathy.</a> Neural Regen Res. 14 (10), 1678 (2019).</li><li>Davis, J. W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Outcomes+to+5+years+of+outborn+versus+inborn+infants+&lt;32+weeks+in+western+australia:+A+cohort+study+of+infants+born+between+2005+and+2018.">Outcomes to 5 years of outborn versus inborn infants &lt;32 weeks in western australia: A cohort study of infants born between 2005 and 2018.</a> Arch Dis Child Fetal Neonatal Ed. 108 (5), 499-504 (2023).</li><li>Schomer, D. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ambulatory+EEG+monitoring,+reviewing,+and+interpreting.">Ambulatory EEG monitoring, reviewing, and interpreting.</a> J Clin Neurophysiol. 38 (2), 77-86 (2021).</li><li>. Neonatology. Hypoxic ischaemic encephalopathy (HIE) Available from: <a target="_blank" href="https://cahs.health.wa.gov.au/~/media/HSPs/CAHS/Documents/Health-Professionals/Neonatology-guidelines/Hypoxic-Ischaemic-Encephalopathy.pdf?thn=0">https://cahs.health.wa.gov.au/~/media/HSPs/CAHS/Documents/Health-Professionals/Neonatology-guidelines/Hypoxic-Ischaemic-Encephalopathy.pdf?thn=0</a> (2018)</li><li>. Neonatology. Monitor: Low impedance needle electrodes Available from: <a target="_blank" href="https://cahs.health.wa.gov.au/-/media/HSPs/CAHS/Documents/Health-Professionals/Neonatology-guidelines/Brainz-Monitor-Low-Impedance-Needle-Electrodes.pdf?thn=0">https://cahs.health.wa.gov.au/-/media/HSPs/CAHS/Documents/Health-Professionals/Neonatology-guidelines/Brainz-Monitor-Low-Impedance-Needle-Electrodes.pdf?thn=0</a> (2021)</li><li>Found, P. W. H., Baines, D. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Efficacy+of+securing+cannulae+with+different+taping+methods.">Efficacy of securing cannulae with different taping methods.</a> Anaesth Intensive Care. 28 (5), 547-551 (2000).</li><li>Stephens, C. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Electroencephalography+quality+and+application+times+in+a+pediatric+emergency+department+setting:+A+feasibility+study.">Electroencephalography quality and application times in a pediatric emergency department setting: A feasibility study.</a> Pediatr Neurol. 148, 82-85 (2023).</li><li>Variane, G. F. T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Remote+monitoring+for+seizures+during+therapeutic+hypothermia+in+neonates+with+hypoxic-ischemic+encephalopathy.">Remote monitoring for seizures during therapeutic hypothermia in neonates with hypoxic-ischemic encephalopathy.</a> JAMA Netw Open. 6 (11), e2343429 (2023).</li><li>Bruns, N., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Application+of+an+amplitude-integrated+EEG+monitor+(cerebral+function+monitor)+to+neonates.">Application of an amplitude-integrated EEG monitor (cerebral function monitor) to neonates.</a> J Vis Exp. 127, 55985 (2017).</li><li>Dilena, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Consensus+protocol+for+eeg+and+amplitude-integrated+eeg+assessment+and+monitoring+in+neonates.">Consensus protocol for eeg and amplitude-integrated eeg assessment and monitoring in neonates.</a> Clin Neurophysiol. 132 (4), 886-903 (2021).</li><li>Moghadam, S. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=An+automated+bedside+measure+for+monitoring+neonatal+cortical+activity:+A+supervised+deep+learning-based+electroencephalogram+classifier+with+external+cohort+validation.">An automated bedside measure for monitoring neonatal cortical activity: A supervised deep learning-based electroencephalogram classifier with external cohort validation.</a> Lancet Digit Health. 4 (12), e884-e892 (2022).</li></ol>

作者没有要披露的利益冲突示例。Kvikna ehf.冰岛雷克雅未克和澳大利亚新南威尔士州悉尼的 Temple Medical and Scientific 没有参与研究的设计、分析或解释，但资助了出版费。

这项新颖的研究描述了 aEEG 在出生后不久需要转运的疑似 HIE 婴儿中的应用和早期数据采集。以前没有报道过新生儿运输过程中的 aEEG 应用。aEEG 已在新情况下使用，例如巴西远程医疗神经重症监护咨询和儿科 ED15,16 下的远程监测。
aEEG 针应用类似于“静态”新生儿重症监护17 中使用的针头应用，位于头皮上以实现...

出生时向大脑的氧气输送或血流受损会导致脑损伤（缺氧缺血性脑病;HIE）。这是足月婴儿死亡和残疾的主要原因1。据报道，HIE 的全球发病率为每 1000 次分娩 2 次，中低收入国家的发病率可能更高。在西澳大利亚州，每年大约有 50 名临床诊断为 HIE 的婴儿出生（2022 年有 32308 名活产婴儿，发病率约为 1.5/10002）。
HIE 的诊断标准基于出生情况、婴儿血酸平衡的变化（出生后来自脐带或婴儿）以及神经状态的变化3。中度或重度 HIE 的治疗方法是 33-34 °C 的全身低温。 越早开始，对婴儿神经系统结果的益处就越大 3,4,5。振幅整合脑电图 （aEEG） 是评估和监测的重要组成部分，在许多地区仅在三级中心提供。将电极（EEG 安全 DIN 连接器或带有 1.5 毫米直径引脚的 DIN 42802）插入头皮，以测量和记录大脑电活动。然后将电极连接到放大器，放大器又连接到临床平板电脑以显示和记录脑电波活动。aEEG 可以提供有关脑电波活动的信息，并用于协助诊断 HIE6。神经系统检查和 aEEG 的结合可能会增强识别患有中度或重度 HIE 的婴儿的能力 7,8,9。
西澳大利亚新生儿紧急运输服务 （NETS WA） 每年为大约 1100 名患病婴儿提供重症监护运输服务。当地医院的医护人员可以通过免费电话号码联系 NETS WA，并立即通过电话会议与新生儿专科医生和护士联系以请求转移。NETS 团队乘坐专门的公路救护车或带有专门制造的重症监护运输设备床的固定翼飞机旅行。转运团队到达转诊医院后，对婴儿进行评估，并继续或升级治疗。然后，该团队将婴儿转移到该州首府（珀斯）的三级新生儿重症监护室 （NICU）。在西澳大利亚州，由于转诊医院和集中专科服务10 之间的距离通常很远（最大距离为 1381 英里），aEEG 可能在出生后长达数小时内无法应用，从而导致治疗延误。
许多监测系统是为重症监护病房设计的，但由于其尺寸和功率要求，它们不适用于运输环境。基于病房的设备容易出现移动伪影，这可能会在运输环境中记录的质量数据不足。动态脑电图放大器技术主要为患者在家中佩戴而设计，可以连接到带有脑电图检测软件的计算机平板电脑，并在运输过程中应用于新生儿11。这可以由新生儿转运团队携带给疑似 HIE 的婴儿。该软件能够通过便携式互联网上行链路和基于 Web 的查看器进行远程查看。目前，没有关于 aEEG 在运输环境中的适用性或可读性的报告。
以前没有报道过在转运 HIE 婴儿时应用和监测 aEEG，也没有现有的使用方案。没有证据支持运输环境的可行性或实用性。我们提出了一种在新生儿运输中使用 aEEG 的方案。它旨在评估出生后需要转运的 HIE 婴儿的 aEEG 是否可行，并且可以提供可读的临床信息。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Stratus EEG Centrum, Acquire Pro Software for 
			Microsoft Windows</td>
			<td>Stratus Software Solutions LLC 
			Kvikna Medical Lyngh&#225;ls 9 110 Reykjavik Iceland</td>
			<td>Version 4.2</td>
			<td></td>
		</tr>
		<tr>
			<td>Trackit T4PCU24+8</td>
			<td>Lifelines Neuro 
			7 Clarendon Court 
			Over Wallop 
			StockBridge 
			Hants, UK</td>
			<td>SN: T4-170046 
			Issue: 4 C169</td>
			<td></td>
		</tr>
		<tr>
			<td>Ultra Subdermal Needle Electrode</td>
			<td>Natus 
			3150 Pleasant View Road 
			Middleton 
			WI 53562 
			USA</td>
			<td>019-476600</td>
			<td>14 mm x 0.38 mm 
			SST Needle 
			DIN 42802 connector</td>
		</tr>
	</tbody>
</table>

amplitude-integrated eeg in infants at risk of hypoxic-ischemic encephalopathy: a feasibility study in road and air transport in western australia

有 HIE 风险的婴儿需要早期识别并开始治疗性低温 （TH）。早期 TH 治疗与更好的结果相关。在决定是否开始 TH 时经常使用 aEEG。由于这通常仅限于三级中心，如果婴儿需要转运到提供 TH 的中心，TH 可能会延迟。我们旨在提供一种振幅集成脑电图 （aEEG） 的应用方法，并确定在运输过程中获取具有临床意义的信息的可行性。所有 ≥35 周，转诊时有 HIE 风险的婴儿均符合纳入标准。头皮电极置于 C3-C4 中;P3-P4 位置位于婴儿的头皮上，并连接到 aEEG 放大器。反过来，aEEG 放大器连接到带有 EEG 软件的临床平板电脑，以收集和分析 aEEG 信息。首席研究员和两名独立审查员 （盲法） 审查了背景痕迹和伪影的录音。预定义的数据质量标准被设置为移动伪影和软件阻抗通知。医护人员和家长完成了调查，以确保可接受性和易用性。

Impaired oxygen delivery or blood flow to the brain around the time of birth can cause brain injury (hypoxic ischemic encephalopathy; HIE). This is a leading cause of death and disability in full-term babies1. HIE is reported to have a worldwide incidence of 2 per 1000 deliveries, which is likely to be higher in low to middle-income countries. In Western Australia, approximately 50 babies are born each year who have a clinical diagnosis of HIE (32308 live births in 2022, an incidence of approximately 1.5 per 10002).
HIE is diagnosed with criteria based on the circumstances of birth, changes in the infant&#39;s blood acid balance (from umbilical cord or baby after birth), and changes in neurological status3. The treatment for moderate or severe HIE is whole-body hypothermia of 33-34 &#176;C. The earlier this is commenced, the likely greater the benefit to the baby&#39;s neurological outcome3,4,5. Amplitude-integrated EEG (aEEG) is an essential part of assessment and monitoring, which in many regions is only available in tertiary centers. Electrodes (EEG safety DIN connector or DIN 42802 with 1.5 mm diameter pin) are inserted into the scalp to measure and record brain electrical activity. Electrodes are then connected to an amplifier, which is in turn connected to a clinical tablet computer to display and record brainwave activity. aEEG can provide information on brain wave activity and be used to assist with the diagnosis of HIE6. The combination of neurological examination and aEEG may enhance the ability to identify infants with moderate or severe HIE7,8,9.
The Newborn Emergency Transport Service of Western Australia (NETS WA) provides intensive care transport to approximately 1100 sick babies per year. Healthcare staff in local hospitals can contact NETS WA through a free phone number and are immediately connected via a conference call with a neonatal specialist doctor and nurse to request a transfer. The NETS team travels either by specialized road ambulance or fixed-wing aircraft with a purpose-built intensive care transport equipment cot. On arrival of the transport team to the referring hospital, the baby is assessed, and treatment is continued or escalated. The team then transfers the infant to a tertiary neonatal intensive care unit (NICU) in the state capital (Perth). In Western Australia, owing to the often-large distances between referring hospitals and centralized specialist services10 (a maximum distance of 1381 miles), aEEG may not applied for up to many hours after birth, leading to a delay in treatment.
Many monitoring systems have been designed for the intensive care unit but owing to their size and power requirement, they are impractical for the transport environment. Ward-based equipment is prone to movement artifacts, which may record insufficient quality data in the transport environment. Ambulatory EEG amplifier technology, designed primarily to be worn by patients at home, can connect to a computer tablet with EEG detection software and be applied to a newborn during transport11. This can be carried by the neonatal transport team to a baby with suspected HIE. The software is capable of being viewed remotely via a portable internet uplink and web-based viewer. Currently, there are no reports on the suitability or readability of aEEG in the transport environment.
Applying and monitoring aEEG in the transport of infants with HIE has not been previously reported, and there are no existing protocols for its use. There is no evidence to support feasibility or utility in the transport environment. We present a protocol for aEEG use in neonatal transport. It aims to assess whether aEEG in babies with HIE who require transport after birth is feasible and can provide readable clinical information.

作者聚焦：评估在新生儿转运过程中使用振幅集成脑电图的可行性

有缺氧缺血性脑病风险婴儿的振幅整合脑电图：西澳大利亚公路和航空运输的可行性研究

We wanted to assess the feasibility of using an amplitude-integrated electroencephalogram during neonatal transport. Using clinical criteria, we determined whether the trace acquired during the transport was readable. This helps the clinician in the diagnosis and prognosis of babies requiring transportation following possible birth asphyxia or hypoxic ischemic encephalopathy.Remote monitoring automated devices and innovative transport systems to improve outcomes in sick and premature newborns. Performing any research during transport has its difficulties but is essential in improving care. Getting appropriate consent is challenging in a time of acute stress.The clinical team is required to perform research as well as clinical tasks, adding to the complexity of the transport process. We have established the necessity of undertaking research in neonatal transport and are seeking ways to improve the outcomes in babies who need to be transported after birth. We are working on means of improving thermal regulation in neonatal transport.We would like to see whether amplitude-integrated EEG enables an earlier and more accurate diagnosis of hypoxic ischemic encephalopathy. We would also like to explore if machine learning can be used to augment diagnostic decisions. Finally, we wish to assess whether this has an impact on important outcomes such as mortality and neurodevelopmental outcomes.

在 2022年 9 月 1 日至 2023年 6 月 5 日期间，25 名婴儿在西澳大利亚被运送，可能患有 HIE，并符合纳入资格。其中，20 名婴儿获得同意、招募并在运输过程中成功应用 aEEG。共有 5 名患者未招募，3 名患者因同意而错过。在一个案例中，该设备已启动自动软件更新并且无法使用;在一个案例中，婴儿没有 HIE 的风险，被认为没有资格招募。在这 20 名婴儿中，12 名 （12/20;60%） 为男性，8 ?...

在这里，我们提出了一项可行性研究，以评估便携式振幅集成脑电图 （aEEG） 记录系统在转运疑似缺氧缺血性脑病 （HIE） 婴儿过程中的作用。

Infants at risk of HIE require early identification and initiation of therapeutic hypothermia (TH). Earlier treatment with TH is associated with better ...

amplitude-integrated-eeg-infants-at-risk-hypoxic-ischemic

Research

JoVE Journal

Medicine

Amplitude-Integrated EEG in Infants at Risk of Hypoxic-Ischemic Encephalopathy: A Feasibility Study in Road and Air Transport in Western Australia

309 次观看.  Government of Western Australia, Child and Adolescent Health Service. 我们想评估在新生儿转运过程中使用振幅积分脑电图的可行性。使用临床标准，我们确定了在运输过程中获得的痕迹是否可读。这有助于临床医生诊断和预后可能患有出生窒息或缺氧缺血性脑病后需要转运的婴儿。远程监控自动化设备和创新的运输系统，以改善生病和早产儿的预后。在运输过程中进行任何研究都有其困难，但对于改善护理至关...