Amplitude Integrated Electroencephalography and Continuous Electroencephalography Monitoring Is Crucial in High-Risk Infants and Their Findings Correlate With Neurodevelopmental Outcomes.

Inn-Chi Lee,Yi-Ting Chen,Syuan-Yu Hong,Yi-Ho Weng

doi:10.3389/fped.2021.691764

Abstract

Background: To evaluate seizure diagnosis in sick infants in the neonatal intensive care unit (NICU) based on electroencephalography (EEG) monitoring combined with amplitude integrated electroencephalography (aEEG).Methods: We retrospectively reviewed EEG and aEEG findings and determined their correlations with neurodevelopmental outcomes at the age of >1 year in 65 patients with diagnosed seizures, encephalopathy, or both.Results: Seizure identification rate was 43.1%. The rate in nonstructural groups (hypocalcemic, hypoglycemic, and genetic seizures) was 71.4%, which was higher (p < 0.05) than the rate of 35.3% of structural brain lesion group [hypoxic–ischemic encephalopathy (HIE) and congenital brain structural malformation]. The aEEG background correlating with neurodevelopmental outcomes had 70.0% positive prediction value (PPV), 65.5%% negative prediction value (NPV), 67.7% specificity, and 67.9% sensitivity (p < 0.005). The aEEG background strongly (PPV, 93.8%; p < 0.005) correlated with the outcomes in HIE. For genetic seizures, the detected rate was high. The ictal recordings for the nonstructural seizures revealed downflected on the aEEG background initially, which differed from the structural lesion.Conclusions: EEG monitoring combined with aEEG can detect seizures, facilitating early treatment. EEG changes during seizures could exhibit delta-theta waves with or without clinical seizures in patients with brain lesions. In non-structural etiologies (hypocalcemic and KCNQ2 seizures), aEEG initially exhibited lower background during seizures that could aid in differentiating these EEG changes from those of other etiologies. The aEEG background was correlated with neurodevelopmental outcome and exhibited high PPV but not NPV in neonatal HIE.

Highlights

Infants who require admission to the neonatal intensive care unit (NICU) are at a high risk of brain disorders, encephalopathy, and seizure
We retrospectively reviewed cases recorded during 2017–2019 of children with various etiologies who were admitted to an NICU at the age of 0 days to 4 months
The number of antiepileptic medications prescribed for groups with genetic seizures were significantly higher (p < 0.005) than it was for other groups, which indicated that seizures because of those etiologies were more refractory, genetic seizures, and required more antiepileptic drugs for seizure control

Summary

Introduction

Infants who require admission to the neonatal intensive care unit (NICU) are at a high risk of brain disorders, encephalopathy, and seizure. The diagnosis of seizures in sick infants based only on clinical presentations is often inaccurate and not timely [1]. Non-convulsive seizures and non-convulsive status epilepticus are common in infants with encephalopathy, and the sick infants have a high non-convulsive seizure risk [1]. Diagnosis and rapid treatment are critical for the longterm prognosis of neonatal seizures [2]. Neonatal seizures and encephalopathy are typically detected on the basis of the patient’s clinical history; neurological examination, in unconsciousness newborns; and sudden clinical events suspected of seizures. To evaluate seizure diagnosis in sick infants in the neonatal intensive care unit (NICU) based on electroencephalography (EEG) monitoring combined with amplitude integrated electroencephalography (aEEG).

Results

Discussion

Conclusion