Could preterm infants benefit from neuromonitoring with video AEEG/EEG?

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Background: More than 80% of neonatal seizures are completely subclinical and represent a risk factor for neurodevelopmental delays in preterm infants. Amplitude integrated electroencephalography combined with raw electroencephalography and video images (video aEEG/EEG) provides real-time monitoring for seizure detection. Objective: To analyze the incidence, pattern and treatment of seizures verified on video aEEG/EEG in preterm infants. Methods: Retrospective cohort study carried out from June 2017 to June 2021, including preterm infants with gestational age <32 weeks monitored with video aEEG/EEG for at least 24 hours in the first seven days of life. Data was collected by medical records and database review of monitored infants in 39 hospitals in Brazil. Demographic and clinical data were correlated with video aEEG/EEG findings. Descriptive analysis was performed using absolute and relative frequencies, and nonparametric variables were presented as median and interquartile ranges (IQR). Results: 392 preterm infants were included, 55.8% male and 68,9% born by C-section. The median birth weight was 1060 (815-1325) grams, and for gestational age, 29 (27-30) weeks. The median of the monitoring time was 68.9 (47.7-91.0) hours. 102 (26.0%) newborns presented seizures, 67 (65.7%) repetitive. 89 (87.2%) seizures were subclinical, and 59 (57.8%) were identified in the first 24 hours of monitoring. Pathological background activity pattern was present in 82 (80.4%) newborns that had seizures and 94 (32.4%) of those without seizures (p<0.0001). Newborns <28 weeks had a higher percentage of 60.3% pathological background activity pattern and 30.5% presence of seizures. Very low-weight preterm newborns had a higher percentage of pathological patterns, 59.3%, and the presence of seizures, 32.9%. 96 (94.1%) newborns that presented seizures received antiepileptic drugs. Phenobarbital was the first line treatment in 100% of the cases, and in 59 (60.8%) cases was sufficient for total seizure control. Conclusions: Given the high incidence of subclinical seizures in preterm infants, monitoring with video aEEG/EEG is essential for seizure diagnosis and management, as well as for the feasibility of the intervention in real-time. Publication History Article published online: 18 September 2023 © 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/) Thieme Revinter Publicações Ltda. Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

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