Neuromonitoring in neonatal critical care part I: neonatal encephalopathy and neonates with possible seizures

Mohamed El-Dib; Nicholas S Abend; Topun Austin; Geraldine Boylan; Valerie Chock; M Roberta Cilio; Gorm Greisen; Lena Hellström-Westas; Petra Lemmers; Adelina Pellicer; Ronit M Pressler; Arnold Sansevere; Tammy Tsuchida; Sampsa Vanhatalo; Courtney J Wusthoff; Newborn Brain Society Guidelines and Publications Committee

doi:10.1038/s41390-022-02393-1

Neuromonitoring in neonatal critical care part I: neonatal encephalopathy and neonates with possible seizures

Pediatr Res. 2023 Jul;94(1):64-73. doi: 10.1038/s41390-022-02393-1. Epub 2022 Dec 7.

Authors

Mohamed El-Dib¹, Nicholas S Abend², Topun Austin³, Geraldine Boylan⁴, Valerie Chock⁵, M Roberta Cilio⁶, Gorm Greisen⁷, Lena Hellström-Westas⁸, Petra Lemmers⁹, Adelina Pellicer¹⁰, Ronit M Pressler¹¹, Arnold Sansevere¹², Tammy Tsuchida¹², Sampsa Vanhatalo¹³, Courtney J Wusthoff¹⁴; Newborn Brain Society Guidelines and Publications Committee

Collaborators

Newborn Brain Society Guidelines and Publications Committee:
Sonia Bonifacio, Pia Wintermark, Hany Aly, Taeun Chang, Vann Chau, Hannah Glass, Monica Lemmon, An Massaro, Courtney Wusthoff, Gabrielle deVeber, Andrea Pardo, Melisa Carrasco McCaul

Affiliations

¹ Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. [email protected].
² Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia and the University of Pennsylvania, Philadelphia, PA, USA.
³ Department of Paediatrics, University of Cambridge, Cambridge, UK.
⁴ INFANT Research Centre & Department of Paediatrics & Child Health, University College Cork, Cork, Ireland.
⁵ Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.
⁶ Department of Pediatrics, Division of Pediatric Neurology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
⁷ Department of Neonatology, Rigshospitalet, Copenhagen University Hospital & Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
⁸ Department of Women's and Children's Health, Uppsala University, and Division of Neonatology, Uppsala University Hospital, Uppsala, Sweden.
⁹ Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
¹⁰ Department of Neonatology, La Paz University Hospital, Madrid, Spain; Neonatology Group, IdiPAZ, Madrid, Spain.
¹¹ Department of Clinical Neurophysiology, Great Ormond Street Hospital for Children NHS Trust, and Clinical Neuroscience, UCL- Great Ormond Street Institute of Child Health, London, UK.
¹² Department of Neurology and Pediatrics, George Washington University School of Medicine and Health Sciences; Children's National Hospital Division of Neurophysiology, Epilepsy and Critical Care, Washington, DC, USA.
¹³ Department of Clinical Neurophysiology, Children's Hospital, BABA Center, Neuroscience Center/HILIFE, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
¹⁴ Division of Child Neurology, Stanford University, Palo Alto, CA, USA.

PMID: 36476747
DOI: 10.1038/s41390-022-02393-1

Abstract

The blooming of neonatal neurocritical care over the last decade reflects substantial advances in neuromonitoring and neuroprotection. The most commonly used brain monitoring tools in the neonatal intensive care unit (NICU) are amplitude integrated EEG (aEEG), full multichannel continuous EEG (cEEG), and near-infrared spectroscopy (NIRS). While some published guidelines address individual tools, there is no consensus on consistent, efficient, and beneficial use of these modalities in common NICU scenarios. This work reviews current evidence to assist decision making for best utilization of neuromonitoring modalities in neonates with encephalopathy or with possible seizures. Neuromonitoring approaches in extremely premature and critically ill neonates are discussed separately in the companion paper. IMPACT: Neuromonitoring techniques hold promise for improving neonatal care. For neonatal encephalopathy, aEEG can assist in screening for eligibility for therapeutic hypothermia, though should not be used to exclude otherwise eligible neonates. Continuous cEEG, aEEG and NIRS through rewarming can assist in prognostication. For neonates with possible seizures, cEEG is the gold standard for detection and diagnosis. If not available, aEEG as a screening tool is superior to clinical assessment alone. The use of seizure detection algorithms can help with timely seizures detection at the bedside.

Publication types

Review
Research Support, Non-U.S. Gov't

MeSH terms

Brain Diseases* / diagnosis
Brain Diseases* / therapy
Critical Care
Electroencephalography / methods
Humans
Infant, Newborn
Infant, Newborn, Diseases* / diagnosis
Infant, Newborn, Diseases* / therapy
Intensive Care Units, Neonatal
Seizures / drug therapy
Seizures / therapy

Grants and funding

DH_/Department of Health/United Kingdom