Abstract
Due to the increasing number of surviving preterm newborns and to the recognition of therapeutic hypothermia as the current gold standard in newborns with hypoxic-ischaemic encephalopathy, there has been a growing interest in the implementation of brain monitoring tools in newborns at high risk for neurological disorders.Among the most frequent neurological conditions and presentations in the neonatal period, neonatal seizures and neonatal status epilepticus, paroxysmal non-epileptic motor phenomena, hypoxic-ischaemic encephalopathy, white matter injury of prematurity and stroke require specific approaches to diagnosis. In this review we will describe the characteristics, aims, indications and limitations of routinely available diagnostic techniques such as conventional and amplitude-integrated EEG, evoked potentials, cranial ultrasound and brain MRI. We will conclude by briefly outlining potential future perspectives from research studies.
Highlights
We will describe methods, timing, indications and aims of brain monitoring in newborns at risk for brain injury with the conventional techniques of monitoring currently used in newborns with neonatal seizures, hypoxic-ischaemic encephalopathy (HIE), intraventricular haemorrhage (IVH), periventricular leukomalacia and stroke
For the purporses of this article, first of all we identified topics which, in our own experience, constitute the main aspects of brain monitoring in neonatal neurology, we identified the most relevant and widely available techniques in clinical practice and we selected papers dealing with arbitrarily selected clinical issues, chosen for their epidemiological relevance in clinical practice
Continuous monitoring has been recommended for at least the first 24 h of life, as the majority of seizures would be identified within this time frame [45,46,47], some researchers have proven an increased risk in the first 24–36 h period [45,46,47] and additional studies reported seizures in preterm newborns to occur later than in fullterm ones, secondary to the timing of IVH [20]
Summary
The increasing number of preterm births with the associated risk of long term neurological sequelae [1] and, at the same time, the availability of new therapeutic strategies [2] determine a growing need for cerebral function monitoring in newborns who are at high risk of brain injury. We will describe methods, timing, indications and aims of brain monitoring in newborns at risk for brain injury with the conventional techniques of monitoring currently used in newborns with neonatal seizures, hypoxic-ischaemic encephalopathy (HIE), intraventricular haemorrhage (IVH), periventricular leukomalacia and stroke. For the purporses of this article, first of all we identified topics which, in our own experience, constitute the main aspects of brain monitoring in neonatal neurology, we identified the most relevant and widely available techniques in clinical practice and we selected papers dealing with arbitrarily selected clinical issues (neonatal seizures, hypoxic-ischemic encephalopathy, stroke, prematurity), chosen for their epidemiological relevance in clinical practice.
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