CHAPTER 2

Techniques of Recording

GENERAL PRINCIPLES

The general principles of recording the electroencephalogram (EEG) in older children and adults apply to the recording of the EEG in neonates with some important additions and exceptions. Guidelines for the recording of the neonatal EEG have been established and recently updated by the American Clinical Neurophysiology Society (ACNS, 1986, 2006b) and the International Federation of Clinical Neurophysiology (De Weerd et al., 1999). In addition ACNS guidelines have been proposed for continuous EEG monitoring in neonates and standardized terminology for these studies (Tsuchida et al., 2013).

Personnel

Critical to the recording of neonatal EEG is a well-trained staff of electroneurodiagnostic technologists (ENDTs) with expertise in the recording of newborn and young infants. Such technologists provide the expert interface between the patient, the direct care givers, and the interpreting clinical neurophysiologist by ensuring technical excellence; a clinical understanding of neonatal care; detailed observation of normal and abnormal infant behaviors; a good working relationship with nursing staff; and a compassionate and caring relationship with parents who may be at the bedside during recording. Technologists require specialized training to produce clinically relevant records.

Clinical neurophysiologists with expertise in the interpretation of neonatal EEG are also essential. The neurophysiologist should be familiar with the clinical problems that neonates may encounter to provide individualized and relevant interpretations and clinical correlations.

It is most helpful for neonatal EEG services to be available 24 hours per day, 7 days per week since the most frequent reasons for referral are for suspicion of onset or ongoing clinical seizures and acute alteration of mental status. In order for the EEG to be most valuable in the assessment of these infants, it best be available around-the-clock with specialized instrumentation, ENDTs and clinical neurophysiologists.

Biomedical engineering, information technology, and other technical support staff familiar with recording software, hardware, and network applications are essential members of the neonatal EEG team.

DATA COLLECTION

The findings of the neonatal EEG are most valuable when considered in relationship to an individual patient’s history and clinical findings. Initially, the ENDT obtains basic information about each neonate to be recorded. This information typically collected in the Texas Children’s Hospital (TCH) neurophysiology laboratory is listed in Table 2.1 and includes standard demographic data, description of the recording environment, documentation of reason for referral, details of the medical history, a list and timing of medications, and the specifics of the infant’s general medical and neurological condition. This information may be obtained from the infant’s referring physician, parents, and medical record. Thus, the technologist must be trained to be familiar with the medical issues of neonates. To aid in data collection, a well-designed data collection form, which can be tailored for use in each neurophysiology laboratory, is helpful and eventually becomes part of the infant’s laboratory and hospital medical record.

Table 2.1 Data Collection for Recording of the Neonatal EEG

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