Bispectral index and lower margin amplitude of the amplitude-integrated electroencephalogram in neonates

Neonatology. 2015;107(1):34-41. doi: 10.1159/000365277. Epub 2014 Oct 10.


Background: The lower margin amplitude (LMA) of the amplitude-integrated electroencephalogram (aEEG) is suppressed in neonates during deep sedation, a feature that is attributed to the bispectral index (BIS) in adults.

Objective: We compare the BIS and the LMA of the aEEG in neonates.

Methods: Thirty neurologically healthy neonates between 37 and 44 weeks postmenstrual age were included in this study. Twenty patients received sedoanalgesic therapy for various reasons. BIS and aEEG recordings were performed simultaneously. The digital data were imported in the numerical software environment Matlab®. The LMA of the aEEG was computed on a 1-min time scale and synchronized with the BIS data. The correlation between the time-dependent variables BIS and LMA was estimated using the Spearman rank correlation index.

Results: The median correlation between BIS and LMA was 0.3. Inclusion of recordings of high signal quality only into analysis improved the median correlation index to 0.6.

Conclusions: We found a light-to-moderate correlation between BIS and LMA in our study cohort and a good correlation in the subgroup with high signal quality.

MeSH terms

  • Analgesics, Opioid / pharmacology
  • Brain Waves / drug effects*
  • Deep Sedation / methods
  • Electroencephalography* / drug effects
  • Electroencephalography* / methods
  • Female
  • Fentanyl / pharmacology*
  • Humans
  • Hypnotics and Sedatives / pharmacology
  • Infant, Newborn
  • Infant, Newborn, Diseases / therapy
  • Male
  • Midazolam / pharmacology*
  • Morphine / pharmacology*
  • Neuromuscular Blocking Agents / pharmacology
  • Neurophysiological Monitoring / methods
  • Vecuronium Bromide / pharmacology*


  • Analgesics, Opioid
  • Hypnotics and Sedatives
  • Neuromuscular Blocking Agents
  • Morphine
  • Vecuronium Bromide
  • Midazolam
  • Fentanyl