Dados do Trabalho

Título

REMOTE BRAIN MONITORING IN HIGH-RISK NEWBORNS: A TELEHEALTH COMPANY SIX-YEAR EXPERIENCE

Introdução

High-risk newborns (NB) are at high risk of developing severe neurological sequels. Amplitude-integrated electroencephalography (aEEG) is a non-invasive, simplified method of continuous bedside brain monitoring that allows assessment of brain activity in real-time. However, the accuracy of aEEG evaluation varies according to the experience of the evaluator. With the advance of telemedicine, the implementation of remote systems with capacity to interact 24 hours/day, 365 days/year, can provide specialized assistance to the bedside physician, allowing more quick and assertive management of high-risk infants.

Objetivo

The primary objective of the study was to characterize high-risk NBs monitored with video-aEEG/EEG and describe electroencephalographic findings during neuromonitoring.

Método

Retrospective observational study including the data of all NBs monitored with video-aEEG/EEG between July 2017 to May 2023 by a private company in Brazil. A descriptive analysis was performed and the data were presented according to absolute number and relative frequency.

Resultados e Conclusões

A total of 8,214 high-risk NBs were monitored with video-aEEG/EEG using the tele-based monitoring system in 68 public, private, and public/private hospitals in Brazil, totaling 519,222 hours of monitoring and 86,537 interactions between the remote monitoring center and the hospital. The most common indications for monitoring were: suspected seizures (24%), moderate or severe hypoxic-ischemic encephalopathy (HIE) with criteria for therapeutic hypothermia (17%), mild HIE (14%), extreme prematurity (9%), previous diagnosis of seizures (9%) and hemodynamic/ventilatory instability (9%). 6,242 (76%) newborns had pathological background activity pattern on video-aEEG/EEG and the sleep-wake cycling was absent in 3,778 (46%). Seizures were observed in 1,642 (20%), of which 1,166 (71%) were electrographic only, 312 (19%) electroclinical followed by electrographic only and 164 (10%) were clinical. Seizure control was obtained by only one antiepileptic drug (AED) in 903 (55%) of the cases and phenobarbital was the first drug of choice in 94% of the cases.
In conclusion, most of the infants had pathological background activity during neuromonitoring and the majority of seizures were electrographic only, emphasizing the importance of neuromonitoring in high-risk NBs, which may significantly increase the accuracy of AED administration.

Palavras Chave

High-risk newborns; amplitude-integrated electroencephalography; remote brain monitoring

Declaração de conflito de interesses de TODOS os autores

Variane, GFT is the president of Protecting Brains & Saving Futures (PBSF), a private company that provides remote neuromonitoring to high-risk newborns. Netto, A is the vice president of PBSF. The other authors are employees at PBSF.

Referências (se houver)

1. Abend NS, Wusthoff CJ, Goldberg EM, Dlugos DJ. Electrographic seizures and status epilepticus in critically ill children and neonates with encephalopathy. Lancet Neurol (2013) 12:1170–9.10.1016/S1474-4422(13)70246-1
2. Shah DK, Zempel J, Barton T, Lukas K, Inder TE. Electrographic seizures in preterm infants during the first week of life are associated with cerebral injury. Pediatr Res. 2010;67:102–6. doi: 10.1203/PDR.0b013e3181bf5914
3. 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. doi: 10.1136/adc.2005.086314. Epub 2007 Jul 11. PMID: 17626147.