Dados do Trabalho

Título

THE ROLE OF THE CONTINUOUS BRAIN MONITORING WITH VIDEO AEEG/EEG FOR NEONATES WITH SUSPECTED SEIZURES

Introdução

Seizures affect 1.5 - 1.3/1000 live births at term and are associated with worse neurodevelopmental outcomes. 80-90% of neonatal seizures are subclinical. Amplitude integrated electroencephalography associated with raw EEG and video images (video aEEG/EEG) is an alternative for seizure assessment at the bedside.

Objetivo

To assess, among neonates with clinical suspicion of seizures, which had seizures confirmed by video aEEG/EEG and to evaluate the characteristics of these patients, clinical signs most often associated with seizures and early outcomes.

Métodos

Retrospective and descriptive study including neonates monitored with video aEEG/EEG, whose indication was clinical suspicion of seizure between August 2017 and October 2021. Data was collected by medical record review. Categorical variables were described in absolute and relative numbers, and numerical variables were as median, 1st and 3rd interquartile range (IQR), or mean and standard deviation (SD).

Resultados

80 monitoring of 66 newborns were included, 62% males and 53% born by cesarean section, with a median and IQR for birth weight of 2127 (1420-2960) grams. The mean monitoring duration was 38,3 (24-76,8) hours. The median gestational age was 35 (32-38) weeks. Newborns were divided into two groups, 13 (19.7%) with electrographic seizures and 53 (80.3%) without. Autonomic changes frequently led to the suspicion of a seizure in both groups, 10 (66.7%) in the seizures group and 27 (41.5%) in the non-seizure. The seizures group presented more than one sign in 7 (46.7%), while 16 (24.6%) were in the non-seizure group. In the seizure group, 1 (6.7%) had only clinical seizures, 3 (20%) had clinically followed by subclinical, and 11 (73.3%) were only subclinical. Phenobarbital was the most commonly used drug as a first-line treatment. Both groups had similar mortality, with 2 (15.4%) and 6 (11.3%) deaths in the seizure and non-seizure groups, respectively.

Conclusões

Diagnosis of neonatal seizures based on clinical signs is inaccurate. Video aEEG/EEG is an important tool to assess and monitor newborns at risk for brain injury. Brain monitoring makes the diagnosis accurate, avoiding the inadvertent administration of antiepileptic drugs in children with seizures and contributing to better long-term neurodevelopment.

Palavras chave

Neonates, amplitude-integrated electroencephalography, brain monitoring, electroencephalography, neonatal seizures.

Referências (se houver)

Murray DM, Boylan GB, Ali I, Ryan CA, Murphy BP, Connolly S. Defining the gap between electrographic seizure burden, clinical expression and staff recognition of neonatal seizures. Arch Dis Child Fetal Neonatal Ed. 2008 May;93(3):F187-91.
Shellhaas RA, Soaita AI, Clancy RR. Sensitivity of amplitude-integrated electroencephalography for neonatal seizure detection. Pediatrics. 2007 Oct;120(4):770-7.
Rakshasbhuvankar A, Paul S, Nagarajan L, Ghosh S, Rao S. Amplitude-integrated EEG for detection of neonatal seizures: a systematic review. Seizure. 2015 Dec;33:90-8.

Declaração de conflito de interesses de TODOS os autores

Rodrigues, N declara não haver conflito de interesses.
Rodrigues, DP declara não haver conflito de interesses.
Llaguno, NS declara não haver conflito de interesses.
Pietrobom, RFR declara não haver conflito de interesses.
Magalhães, M declara não haver conflito de interesses.
Girotto, PN declara não haver conflito de interesses.
Sampaio LPB declara não haver conflito de interesses.
Variane, GFT declara não haver conflito de interesses.