Case 3.3

A full-term infant born at 37 weeks and 4 days, delivered via failed vacuum vaginal delivery that progressed to an urgent caesarean section. The infant had poor tone for gestational age. The arterial umbilical pH was 6.95, with a base deficit of -13.5 mmol/L. Apgar scores were 5 and 8 at 1 and 5 minutes, respectively. The examination was suggestive of moderate encephalopathy, and head examination showed boggy swelling at the back of the head concerning for a subgaleal collection. Hypothermia was initiated based on these findings.

The aEEG was placed, showing the following pattern:

How would you classify the background activity? Please note upper panel is left and lower panel is right.

At the time of rewarming this was the aEEG:

What does this aEEG show?