METHODS A large database of neonatal EEG recorded from term neonates was

Methods a large database of neonatal eeg recorded

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METHODS: A large database of neonatal EEG recorded from term neonates was annotated for the presence or absence of seizures by three international experts. Experts were given no additional clinical information on each neonate but were permitted the use of any montage for analysis. The database contained EEG recordings from neonates both with and without EEG evidence of seizure and with a variety of aetiologies. The annotations were converted into a binary time series sampled every second where one denoted the presence of seizure and zero denoted the absence of seizure. The annotation time series of all neonates were then concatenated together to form the basis for comparison. Inter-observer agreement was measured using Fleiss’ Kappa Statistic and a seizure event based analysis. The 95% confidence interval was estimated using bootstrap resampling of the cohort. RESULTS: A total of 4066 hours of multi-channel EEG recorded from 70 neonates was annotated by each expert. An average of 2555 seizures was annotated. The number of neonates who were determined to have had seizures was 37, 35 and 38 for the three experts. The kappa value for agreement in determining the presence of seizure in a neonate was 0.828 (95% CI: 0.694-0.923). The kappa value for the concatenated time series of the annotation was 0.827 (95% CI: 0.769-0.865). This corresponds to a seizure agreement rate of 77.9% (95% CI: 66.9-84.7) and 0.142 (95% CI: 0.083-0.215) disagreements per hour. CONCLUSION: Inter-observer agreement in neonatal seizure detection based on the visual interpretation of multi-channel EEG is high. The visual interpretation of the EEG by the expert is a reliable method for the detection of seizures. 52
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14.50-14.55 – Saturday 27 th September Neonatal REDUCING NEONATAL MORTALITY IN CENTRAL KENYA C Duncan 1 Paediatric Department, Altnagelvin Area Hospital, Derry, UK 2 Global Links Prgramme, Royal College of Paediatrics & Child Health, London, UK 3 Nanyuki Teaching & Referral Hospital, Ministry of Health, Nanyuki, Kenya Aims Forty percent of mortality of children under the age of of five in Kenya occurs in the neonatal period. The two most common causes are perinatal asphyxia & sepsis. During a six-month volunteer placement at a government hospital in Nanyuki, Kenya, two interventions were introduced. A triage system provided universal screening & examination of all babies delivered in hospital, with a resultant 25% reduction in mortality & 40% reduction in re-admission rates due to late onset neonatal sepsis. Scenario-based training sessions to all maternity ward staff reduced the rate of admissions of perinatal asphyxia to the Newborn Baby Unit (NBU) from 33% to 10%. Methods A newborn triage checklist was written, based on a similar system used in a larger hospital in neighbouring Tanzania, comprising two examinations of the newborn. The first, shortly after birth, identified risk factors for sepsis & suggested subsequent action, based on classification into green, amber or red categories. The second, performed just before discharge, identified
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