Clinical Validation of the New EEG Trend, Brain State of the Newborn, Against aEEG Interpretation

AIM: Previous studies have shown that the novel EEG trend, Brain State of the Newborn (BSN), is useful for monitoring recovery of electrocortical activity in high-risk newborns. Here, we validate the automatically computed BSN trend against visual amplitude-integrated EEG (aEEG) interpretation in asphyxiated hypothermia-treated infants. METHODS: A total of 731 3-h aEEG epochs from 85 hypothermia-treated infants were randomized in order and scored independently by two clinical experts blinded for clinical data. First, we compared the BSN values to the aEEG scores at epoch level. Second, we assessed how the BSN trends align with aEEG scores in depicting electrocortical recovery. RESULTS: The BSN values showed robust differentiation between the experts' aEEG background scores (p ≤ 0.001 for all pairwise comparisons; effect size 1.0-6.5). Recovery of the BSN trend was also strongly correlated to the expert-defined aEEG recovery to continuous normal voltage (Spearman's ρ = 0.72, p < 0.001). CONCLUSION: The objective and fully automated BSN trend provides an effective, real-time complement to the visual aEEG interpretation. High BSN levels are reliable indicators of electrocortical recovery in hypothermia-treated infants. Future prospective studies are needed to establish evidence-based and context-sensitive clinical guidelines for the use of BSN in routine clinical care.