Since the beginning of preterm EEG practise half a century ago, the interpretation of EEG has remained phenomenological, and based on observing clinical correlates of otherwise unexplained waveforms. Recent developments in basic neurobiology, as well as in the EEG recording and analysis techniques, have offered pathways to paradigm shifts at multiple levels.
Experimental studies have shown that early brain activity consists of events that are crucial for the activity-dependent, experience-independent network growth that takes place during last trimester and/or early prematurity. New recording techniques have made it possible to characterise these events from the human preterm babies, hence opening a window to translational studies where brain activity in a live preterm baby is studied with understanding the cellular level mechanisms, and basic science findings can be directly linked to clinical studies in a bidirectional manner.
Most importantly, new data has shown that focusing EEG analysis on the early network events will allow objective, quantitative means to follow brain wealth and its reactions to interventions: These events will show specific reactions to drugs, they will allow automated assessment of vigilance states, and the events may even allow very early prediction of short term risks as well as long term outcomes. Taken together, it seems that appreciating the events as the main constituent of early brain activity brings neonatal neurophysiology back to be part of genuine neuroscience, and it likely opens unprecedented vistas to the early clinical brain monitoring of newborn babies.