8. Multiparametric neurophysiological assessment in neonatal-ICU: Preliminary normative data and application in hypoxic-ischemic encephalopathy

Abstract

ElectroEncephaloGraphy and Somatosensory Evoked Potentials play an important role in diagnosis/prognosis of brain damage validated by international consensus to Adult-ICU monitoring. Video-EEG and Cerebral-Function-Monitoring are widely used in Neonatal-ICU while SEPs are still underused to early hypoxic brain damage evaluation. We propose an Integrated Multiparametric Neurophysiological Assessment (IMNA) simultaneously recording VEEG, CFM, Density-Spectral-Analysis and SEPs, to evaluate neonatal brain functions. Twelve healthy fullterm-neonates and 32 hypoxic newborns (2 severe, 30 moderate) were studied, within 48 h after birth, with IMNA short monitoring (1 h): VEEG (8 channels), CFM–DSA (4 channels) and cascade-SEPs (Cc-Fz; Cc-Ci; Cv7-Fz) with alternate stimulus (1 Hz) from median nerve. 1 h-IMNA-monitoring was globally alterate in severe-hypoxic neonates, in moderate-hypoxia the VEEG–CFM–DSA were fundamentally normal while cascade-SEPs showed a morphological variability. IMNA was normal and in particular cascade-SEPs was present with behavioral-states related modulation in all healthy fullterm-neonates. 1 h-IMNA-monitoring was able to evaluate a sleep-cycle (VEEG), cortical amplitude and frequency spectral activity (CFM–DSA); the cascade-SEPs were early reliable parameters, suggestive in brain neonatal damage, also moderate. 1 h-IMNA monitoring, especially cascade-SEPs, is a useful tool to early evaluation of various severity neonatal hypoxic brain damage and could be able to identify different outcomes.