Background Whereas amplitude EEG (aEEG) recording has gained wide acceptance in intensive care units to identify term infants at risk of neonatal encephalopathy, its use in extremely low birth weight (ELBW; birth weight <1000 g) infants remains less clear.

Objective To assess aEEG background electrical activity trends in ELBW infants during the first 48 h of life and identify any aEEG patterns predictive of severe intracranial haemorrhage.

Design/Methods A prospective cohort of 30 ELBW infants born during 2006 was monitored using the aEEG cerebral function monitor during the first 48 h of life. A severe intracranial haemorrhage was defined as a grade 3 or 4 intraventricular haemorrhage or extensive cerebellar bleed.

Results Mean birth weight was 621 ± 152 g and mean gestational age 25 ± 1.7 weeks. Trends from ELBW infant’s background in the first 48 h showed discontinuous low voltage tracings (73%), with isoelectric burst suppression (17%) and evidence of immature sleep–wake cycling in all infants. Eight infants (27%) had severe intracranial haemorrhage within the first week of life. Five of these eight infants (62%) had isoelectric burst suppression with low burst tracings, whereas none of the remaining 22 infants without haemorrhage showed this pattern (p = 0.01).

Conclusion Most ELBW infants have generalised discontinuous tracings. Low voltage burst suppression had a 100% positive predictive value for the occurrence of severe intracranial haemorrhage.