Artefacts in the amplitude-integrated EEG background pattern of a full-term asphyxiated neonate caused by diaphragm spasms

The amplitude-integrated EEG (aEEG) is used to detect neonatal seizures in neonates with asphyxia, and despite limited data-information compared with standard EEG, aEEG is increasingly used as routine monitoring in neonatal intensive care units due to the logistic advantages. In addition, the aEEG background is of prognostic value in these infants. However, aEEG artefacts can lead to an erroneous interpretation of the background pattern. We report a full-term infant with severe perinatal asphyxia with diaphragm spasms that caused a significant alteration in aEEG background pattern. After administration of a neuromuscular blocker, the aEEG background transformed from discontinuous low-voltage pattern to a flat trace. The aEEG background pattern can be misinterpreted by electrical activity of non-cerebral origin. Administration of neuromuscular blockers is a rapid method to differentiate between cerebral and muscular activity on the aEEG when EEG is not (yet) available.