Event detection in preterm electroencephalography

Preterm infants may spend months in neonatal intensive care units (NICU). Progress in neurological care of these infants depends on the ability to adequately monitor brain activity during NICU treatment. Brain monitoring is most commonly performed using electroencephalography (EEG). The preterm EEG signals are qualitatively different from EEG signals of older individuals, their distinguishing characteristics are the intermittently occurring spontaneous activity transients (SAT), which are believed to be crucial to early brain development. Automated detection of SATs might offer new tools for a neuroscientifically reasoned monitoring of infant brain in the NICU. In this Thesis, a commercially available algorithm was tested for its applicability in detecting SATs. Because the algorithm was found to be suboptimal, an improved algorithm was developed and its parameters were optimized. Optimization and validation were done systematically, using a gold standard composed of unanimous detections by three human raters. The optimized algorithm was then used to calculate event-based measures in two clinical studies, one studying SAT occurrence in sleep stages, and the other comparing brain activity to structural brain growth. In leave-one-out crossvalidation, the optimized algorithm showed excellent performance (sensitivity 96.6±2.8 %, specificity 95.1±5.6 %). In the clinical studies conducted, the proportion of EEG covered by SATs (SAT%) was shown to differ between sleep states, providing a possibility for developing an EEG-based measure of brain activity cycling in preterm infants. Finally, brain activity indices derived from EEG recordings shortly after birth were shown to correlate with subsequent structural growth of the brain during preterm life. The findings together show that an SAT event detector can be constructed for the brain monitoring in NICU, and that indices based on event detection may offer important insight to brain function in the clinical research.