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In general, the definition of these states in the newborn is based on a combination of EEG and several physiological parameters including electrooculograms, body movements, respiration and chin electromyograms. IS is a sleep state which does not fulfil AS and QS criteria.
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Thus, this article will discuss the usefulness of treating cyclical aEEG patterns as representative of SWC versus treating it as variation in background EEG activity.Īt term equivalent postmenstrual age, it is possible to differentiate between five conscious states of the newborn infant: wakefulness, drowsiness, active sleep (AS), quiet sleep (QS) and indeterminate sleep (IS). 4, 5, 6 Evidence from conventional EEGs, however, suggests that the absence of cyclicity on an aEEG in asphyxiated infants constitutes a continuum consisting of a suppressed aEEG background pattern. 4 Additionally, the importance of cyclicity has been underscored by aEEG users because its presence or absence in term asphyxiated infants has a prognostic value that is independent of that of the background classification. Term-born infants sleep for ∼16 h each day, 3 and their patterns of wakefulness do not appear to be as frequent as the 20- to 30-min cycling observed on the aEEG. However, SWC is a biological term that refers to a pattern of alternating sleeping and waking states. 2 During evaluation of compressed aEEG tracings, clinicians and researchers often use the term ‘sleep–wake cycling’ (SWC) to describe the periodical change in the pattern of aEEG neonatal recording ( Figure 1). 1 aEEG can evaluate background cerebral activity, detect electroencephalographic seizure activity, assist in predicting outcomes and aid in the selection of infants for neuroprotective strategies. Amplitude-integrated electroencephalography (aEEG) monitoring is increasingly utilized in monitoring the brains of newborns.