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Variane GFT, Dahlen A, Pietrobom RFR, Rodrigues DP, Magalhães M, Mimica MJ, Llaguno NS, Leandro DMK, Girotto PN, Sampaio LB, Van Meurs KP. Remote Monitoring for Seizures During Therapeutic Hypothermia in Neonates With Hypoxic-Ischemic Encephalopathy. JAMA Netw Open 2023; 6:e2343429. [PMID: 37966836 PMCID: PMC10652158 DOI: 10.1001/jamanetworkopen.2023.43429] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 10/04/2023] [Indexed: 11/16/2023] Open
Abstract
Importance Neonates with hypoxic-ischemic encephalopathy (HIE) undergoing therapeutic hypothermia (TH) frequently experience seizures, which are associated with adverse outcomes. Efforts to rapidly identify seizures and reduce seizure burden may positively change neurologic and neurodevelopmental outcomes. Objective To describe the onset, treatment, and evolution of seizures in a large cohort of newborns with HIE during TH assisted by a telehealth model and remote neuromonitoring approach. Design, Setting, and Participants This was a prospective, observational, multicenter cohort study performed between July 2017 and December 2021 in 32 hospitals in Brazil. Participants were newborns with HIE meeting eligibility criteria and receiving TH. Data were analyzed from November 2022 to April 2023. Exposure Infants with HIE receiving TH were remotely monitored with 3-channel amplitude-integrated electroencephalography (aEEG) including raw tracing and video imaging, and bedside clinicians received assistance from trained neonatologists and neurologists. Main Outcomes and Measures Data on modified Sarnat examination, presence, timing and seizure type, aEEG background activity, sleep-wake cycling, and antiepileptic drugs used were collected. Descriptive statistical analysis was used with independent t test, χ2, Mann-Whitney test, and post hoc analyses applied for associations. Results A total of 872 cooled newborns were enrolled; the median (IQR) gestational age was 39 (38-40) weeks, 518 (59.4%) were male, and 59 (6.8%) were classified as having mild encephalopathy by modified Sarnat examination, 504 (57.8%) as moderate, and 180 (20.6%) as severe. Electrographic seizures were identified in 296 newborns (33.9%), being only electrographic in 213 (71.9%) and clinical followed by electroclinical uncoupling in 50 (16.9%). Early abnormal background activity had a significant association with seizures. Infants with flat trace had the highest rate of seizures (58 infants [68.2%]) and the greatest association with the incidence of seizures (odds ratio [OR], 12.90; 95% CI, 7.57-22.22) compared with continuous normal voltage. The absence of sleep-wake cycling was also associated with a higher occurrence of seizures (OR, 2.22; 95% CI, 1.67-2.96). Seizure onset was most frequent between 6 and 24 hours of life (181 infants [61.1%]); however, seizure occurred in 34 infants (11.5%) during rewarming. A single antiepileptic drug controlled seizures in 192 infants (64.9%). The first line antiepileptic drug was phenobarbital in 294 (99.3%). Conclusions and Relevance In this cohort study of newborns with HIE treated with TH, electrographic seizure activity occurred in 296 infants (33.9%) and was predominantly electrographic. Seizure control was obtained with a single antiepileptic drug in 192 infants (64.9%). These findings suggest neonatal neurocritical care can be delivered at remote limited resource hospitals due to innovations in technology and telehealth.
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Affiliation(s)
- Gabriel Fernando Todeschi Variane
- Division of Neonatology, Department of Pediatrics, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
- Protecting Brains and Saving Futures Organization, Clinical Research Department, São Paulo, Brazil
| | - Alex Dahlen
- Quantitative Sciences Unit, Stanford University School of Medicine, Palo Alto, California
| | - Rafaela Fabri Rodrigues Pietrobom
- Division of Neonatology, Department of Pediatrics, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
- Protecting Brains and Saving Futures Organization, Clinical Research Department, São Paulo, Brazil
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
| | - Daniela Pereira Rodrigues
- Protecting Brains and Saving Futures Organization, Clinical Research Department, São Paulo, Brazil
- Pediatric Nursing Department, Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Maurício Magalhães
- Division of Neonatology, Department of Pediatrics, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
- Protecting Brains and Saving Futures Organization, Clinical Research Department, São Paulo, Brazil
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
| | - Marcelo Jenné Mimica
- Protecting Brains and Saving Futures Organization, Clinical Research Department, São Paulo, Brazil
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
| | - Nathalie Salles Llaguno
- Protecting Brains and Saving Futures Organization, Clinical Research Department, São Paulo, Brazil
- Pediatric Nursing Department, Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Danieli Mayumi Kimura Leandro
- Division of Neonatology, Department of Pediatrics, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
- Protecting Brains and Saving Futures Organization, Clinical Research Department, São Paulo, Brazil
| | - Paula Natale Girotto
- Protecting Brains and Saving Futures Organization, Clinical Research Department, São Paulo, Brazil
- Division of Neurosurgery, Associação Paulista para o Desenvolvimento da Medicina, Hospital de Transplantes Euryclides de Jesus Zerbini, São Paulo, São Paulo, Brazil
| | - Leticia Brito Sampaio
- Protecting Brains and Saving Futures Organization, Clinical Research Department, São Paulo, Brazil
- Division of Pediatric Neurology, Faculdade de Medicina Hospital das Clínicas, Instituto da Criança, Universidade de São Paulo, São Paulo, Brazil
| | - Krisa Page Van Meurs
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children’s Hospital Stanford, Palo Alto, California
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Variane GFT, Rodrigues DP, Pietrobom RFR, França CN, Netto A, Magalhães M. Newborns at high risk for brain injury: the role of the amplitude-integrated electroencephalography. J Pediatr (Rio J) 2022; 98:565-571. [PMID: 34986412 PMCID: PMC9617284 DOI: 10.1016/j.jped.2021.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 10/04/2021] [Accepted: 10/21/2021] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE Amplitude-integrated electroencephalography (aEEG) is a simplified bedside neurophysiology tool that has been implemented in the neonatal intensive care unit and studied in an extensive range of clinical applications in the past decade. This critical review aimed to evaluate a variety of clinical applications of aEEG monitoring in diagnosis, clinical management, and prognosis assessment in critically ill neonates. SOURCES The databases of Pubmed, SciELO, Lilacs, and Cochrane, books, and other online resources were consulted, as well as sources of professional experiences. SUMMARY OF FINDINGS The clinical use of aEEG to access real-time brain function, background activity, and utility in seizures detection has been described. A critical review was realized considering the authors' professional experience. Newborns with hypoxic-ischemic encephalopathy and seizures screening represent the most common studied population. However, several studies have shown interesting applications on preterm infants, newborns with congenital heart disease, and other clinical situations of high risk of injury to the developing brain. CONCLUSION The aEEG has shown to be a useful non-invasive bedside monitor that aids in evaluating brain function, background activity, and cyclicity. aEEG findings have also demonstrated good prognostic value in a group of critically ill neonates. The aEEG seizure diagnosis capability has limitations, which have been already well established. The use of neonatal brain monitoring such as aEEG was shown to give valuable information in several high-risk clinical situations.
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Affiliation(s)
- Gabriel Fernando Todeschi Variane
- Divisão Neonatal, Grupo Santa Joana, São Paulo, SP, Brazil; Divisão Neonatal, Departamento de Pediatria, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil; Organização Protegendo Cérebros e Salvando Futuros, São Paulo, SP, Brazil; Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Daniela Pereira Rodrigues
- Organização Protegendo Cérebros e Salvando Futuros, São Paulo, SP, Brazil; Escola Paulista de Enfermagem, Departamento de Enfermagem Pediátrica, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
| | - Rafaela Fabri Rodrigues Pietrobom
- Divisão Neonatal, Departamento de Pediatria, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil; Organização Protegendo Cérebros e Salvando Futuros, São Paulo, SP, Brazil
| | - Carolina Nunes França
- Organização Protegendo Cérebros e Salvando Futuros, São Paulo, SP, Brazil; Programa de Pós-Graduação em Ciências da Saúde, Universidade de Santo Amaro, São Paulo, SP, Brazil
| | - Alexandre Netto
- Divisão Neonatal, Departamento de Pediatria, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil; Organização Protegendo Cérebros e Salvando Futuros, São Paulo, SP, Brazil
| | - Maurício Magalhães
- Divisão Neonatal, Departamento de Pediatria, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil; Organização Protegendo Cérebros e Salvando Futuros, São Paulo, SP, Brazil; Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
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Beck J, Grosjean C, Bednarek N, Loron G. Amplitude-Integrated EEG Monitoring in Pediatric Intensive Care: Prognostic Value in Meningitis before One Year of Age. CHILDREN 2022; 9:children9050668. [PMID: 35626845 PMCID: PMC9140190 DOI: 10.3390/children9050668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 04/30/2022] [Accepted: 05/01/2022] [Indexed: 11/16/2022]
Abstract
Pediatric morbidity from meningitis remains considerable. Preventing complications is a major challenge to improve neurological outcome. Seizures may reveal the meningitis itself or some complications of this disease. Amplitude-integrated electroencephalography (aEEG) is gaining interest for the management of patients with acute neurological distress, beyond the neonatal age. This study aimed at evaluating the predictive value of aEEG monitoring during the acute phase in meningitis among a population of infants hospitalized in the pediatric intensive care unit (PICU), and at assessing the practicability of the technique. AEEG records of 25 infants younger than one year of age hospitalized for meningitis were retrospectively analyzed and correlated to clinical data and outcome. Recording was initiated, on average, within the first six hours for n = 18 (72%) patients, and overall quality was considered as good. Occurrence of seizure, of status epilepticus, and the background pattern were significantly associated with unfavorable neurological outcomes. AEEG may help in the management and prognostic assessment of pediatric meningitis. It is an easily achievable, reliable technique, and allows detection of subclinical seizures with minimal training. However, it is important to consider the limitations of aEEG, and combinate it with conventional EEG for the best accuracy.
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Affiliation(s)
- Jonathan Beck
- Department of Neonatology, Reims University Hospital Alix de Champagne, 51100 Reims, France; (J.B.); (C.G.); (N.B.)
- CReSTIC EA 3804 UFR Sciences Exactes et Naturelles, Campus Moulin de la Housse, Université de Reims Champagne Ardenne, 51100 Reims, France
| | - Cecile Grosjean
- Department of Neonatology, Reims University Hospital Alix de Champagne, 51100 Reims, France; (J.B.); (C.G.); (N.B.)
| | - Nathalie Bednarek
- Department of Neonatology, Reims University Hospital Alix de Champagne, 51100 Reims, France; (J.B.); (C.G.); (N.B.)
- CReSTIC EA 3804 UFR Sciences Exactes et Naturelles, Campus Moulin de la Housse, Université de Reims Champagne Ardenne, 51100 Reims, France
| | - Gauthier Loron
- Department of Neonatology, Reims University Hospital Alix de Champagne, 51100 Reims, France; (J.B.); (C.G.); (N.B.)
- CReSTIC EA 3804 UFR Sciences Exactes et Naturelles, Campus Moulin de la Housse, Université de Reims Champagne Ardenne, 51100 Reims, France
- Correspondence:
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Falsaperla R, Scalia B, Giaccone F, Suppiej A, Pulvirenti A, Mailo J, Ruggieri M. aEEG vs cEEG's sensivity for seizure detection in the setting of neonatal intensive care units: A systematic review and meta-analysis. Acta Paediatr 2022; 111:916-926. [PMID: 35006632 DOI: 10.1111/apa.16251] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/14/2021] [Accepted: 01/05/2022] [Indexed: 11/27/2022]
Abstract
AIM Amplitude-integrated electroencephalography (aEEG)'s accuracy compared to conventional electroencephalography (cEEG) has not been fully established. The aim of our study was to conduct a systematic review on the sensitivity of the aEEG for neonatal seizure detection. METHODS Studies from PubMed and Google Scholar databases comparing recordings of cEEG and aEEG in newborns were included according to the PRISMA method. A quality assessment using the QUADAS-2 tool was provided. A random-effect model was used to account for different sources of variations among studies. Publication biases were represented by a funnel plot, and funnel plot symmetry was assessed. RESULTS Fourteen studies were reported; sensitivity of each diagnostic tool used (single-channel aEEG, two-channel aEEG, two-channel aEEG plus raw trace EEG) was compared to that of the gold-standard cEEG and to those of the other methods used. Overall sensitivity of the aEEG ranged from 31.25% to 90%. CONCLUSION Our study provides evidence that sensitivity of aEEG varies significantly and that seizure detection rate is lower than that of cEEG. The two-channel aEEG with raw trace EEG shows a high sensitivity and might represent a valid alternative to the cEEG in the setting of neonatal intensive care units (NICUs).
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Affiliation(s)
- Raffaele Falsaperla
- Unit of Neonatology University Hospital "Policlinico – San Marco" Catania Italy
| | - Bruna Scalia
- Unit of Neonatology University Hospital "Policlinico – San Marco" Catania Italy
| | - Fabiola Giaccone
- Pediatrics Postgraduate Program Section of Pediatrics and Child Neuropsychiatry Department of Clinical and Experimental Medicine University of Catania Catania Italy
| | - Agnese Suppiej
- Department of Medical Sciences Pediatric Section University of Ferrara Ferrara Italy
| | - Alfredo Pulvirenti
- Bioinformatics Unit Department of Clinical and Experimental Medicine University of Catania Catania Italy
| | - Janette Mailo
- Division of Pediatric Neurology University of Alberta Edmonton Canada
| | - Martino Ruggieri
- Unit of Rare Diseases of the Nervous System Section of Pediatrics and Child Neuropsychiatry A.U.O. Policlinico‐Vittorio Emanuele Catania Catania Italy
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Variane GFT, Magalhães M, Pietrobom RFR, Netto A, Rodrigues DP, Gasperini R, Sant’Anna GM. Protecting brains and saving futures guidelines: A prospective, multicenter, and observational study on the use of telemedicine for neonatal neurocritical care in Brazil. PLoS One 2022; 17:e0262581. [PMID: 35020756 PMCID: PMC8754327 DOI: 10.1371/journal.pone.0262581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 12/29/2021] [Indexed: 11/19/2022] Open
Abstract
Background
Management of high-risk newborns should involve the use of standardized protocols and training, continuous and specialized brain monitoring with electroencephalography (EEG), amplitude integrated EEG, Near Infrared Spectroscopy, and neuroimaging. Brazil is a large country with disparities in health care assessment and some neonatal intensive care units (NICUs) are not well structured with trained personnel able to provide adequate neurocritical care. To reduce this existing gap, an advanced telemedicine model of neurocritical care called Protecting Brains and Saving Futures (PBSF) Guidelines was developed and implemented in a group of Brazilian NICUs.
Methods
A prospective, multicenter, and observational study will be conducted in all 20 Brazilian NICUs using the PBSF Guidelines as standard-of-care. All infants treated accordingly to the guidelines during Dec 2021 to Nov 2024 will be eligible. Ethical approval was obtained from participating centers. The primary objective is to describe adherence to the PBSF Guidelines and clinical outcomes, by center and over a 3-year period. Adherence will be measured by quantification of neuromonitoring, neuroimaging exams, sub-specialties consultation, and clinical case discussions and videoconference meetings. Clinical outcomes of interest are detection of seizures during hospitalization, use of anticonvulsants, inotropes, and fluid resuscitation, death before hospital discharge, length of hospital stay, and referral of patients to specialized follow-up.
Discussion
The study will provide evaluation of PBSF Guidelines adherence and its impact on clinical outcomes. Thus, data from this large prospective, multicenter, and observational study will help determine whether neonatal neurocritical care via telemedicine can be effective. Ultimately, it may offer the necessary framework for larger scale implementation and development of research projects using remote neuromonitoring.
Trial registration
NCT03786497, Registered 26 December 2018, https://www.clinicaltrials.gov/ct2/show/NCT03786497?term=protecting+brains+and+saving+futures&draw=2&rank=1.
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Affiliation(s)
- Gabriel Fernando Todeschi Variane
- Neonatal Division, Department of Pediatrics, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
- Neonatal Division, Grupo Santa Joana, São Paulo, Brazil
- Protecting Brains and Saving Futures Organization, São Paulo, Brazil
- * E-mail:
| | - Maurício Magalhães
- Neonatal Division, Department of Pediatrics, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
- Protecting Brains and Saving Futures Organization, São Paulo, Brazil
- Neonatal Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
| | - Rafaela Fabri Rodrigues Pietrobom
- Neonatal Division, Department of Pediatrics, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
- Protecting Brains and Saving Futures Organization, São Paulo, Brazil
| | - Alexandre Netto
- Neonatal Division, Department of Pediatrics, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
- Protecting Brains and Saving Futures Organization, São Paulo, Brazil
| | - Daniela Pereira Rodrigues
- Protecting Brains and Saving Futures Organization, São Paulo, Brazil
- Pediatric Nursing Department, Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Renato Gasperini
- Neonatal Division, Department of Pediatrics, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
- Protecting Brains and Saving Futures Organization, São Paulo, Brazil
- Neonatal Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
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Yuan X, Kang W, Song J, Guo J, Guo L, Zhang R, Liu S, Zhang Y, Liu D, Wang Y, Ding X, Dong H, Chen X, Cheng Y, Zhang X, Xu F, Zhu C. Prognostic value of amplitude-integrated EEG in neonates with high risk of neurological sequelae. Ann Clin Transl Neurol 2020; 7:210-218. [PMID: 32031755 PMCID: PMC7034499 DOI: 10.1002/acn3.50989] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 01/13/2020] [Accepted: 01/14/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To determine the efficacy and the prognostic value of amplitude-integrated electroencephalography (aEEG) in term and near-term neonates with high risk of neurological sequelae. METHODS Infants of ≥35 weeks of gestation diagnosed with neonatal encephalopathy or with high risk of brain injury were included. All eligible infants underwent aEEG within 6 h after clinical assessment. The infants were followed up 12 months to evaluate neurological development. RESULTS A total of 250 infants were eligible, of which 85 had normal aEEG, 81 had mildly abnormal aEEG, and 84 had severely abnormal aEEG. Of these infants, 168 were diagnosed with different neonatal encephalopathies, 27 with congenital or metabolic diseases, and 55 with high risk of brain injury. In all, 22 infants died, 19 were lost to follow-up, and 209 completed the follow-up at 12 months, of which 62 were diagnosed with a neurological disability. Statistical analysis showed that severely abnormal aEEG predicted adverse neurological outcome with a sensitivity of 70.2%, a specificity of 87.1%, a positive predictive value of 75.6%, and a negative predictive value of 83.7%. INTERPRETATION aEEG can predict adverse outcomes in high-risk neonates and is a useful method for monitoring neonates with high risk of adverse neurological outcomes.
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Affiliation(s)
- Xiao Yuan
- Henan Key Laboratory of Child Brain Injury, Third Affiliated Hospital and Institute of Neuroscience, Zhengzhou University, Zhengzhou, 450052, China
| | - Wenqing Kang
- Neonatal Intensive Care Unit, Zhengzhou Key Laboratory of Newborn Disease Research, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, 450018, China
| | - Juan Song
- Henan Key Laboratory of Child Brain Injury, Third Affiliated Hospital and Institute of Neuroscience, Zhengzhou University, Zhengzhou, 450052, China
| | - Jing Guo
- Neonatal Intensive Care Unit, Zhengzhou Key Laboratory of Newborn Disease Research, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, 450018, China
| | - Lanlan Guo
- Henan Key Laboratory of Child Brain Injury, Third Affiliated Hospital and Institute of Neuroscience, Zhengzhou University, Zhengzhou, 450052, China
| | - Ruili Zhang
- Henan Key Laboratory of Child Brain Injury, Third Affiliated Hospital and Institute of Neuroscience, Zhengzhou University, Zhengzhou, 450052, China
| | - Shasha Liu
- Henan Key Laboratory of Child Brain Injury, Third Affiliated Hospital and Institute of Neuroscience, Zhengzhou University, Zhengzhou, 450052, China
| | - Yaodong Zhang
- Neonatal Intensive Care Unit, Zhengzhou Key Laboratory of Newborn Disease Research, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, 450018, China
| | - Dapeng Liu
- Neonatal Intensive Care Unit, Zhengzhou Key Laboratory of Newborn Disease Research, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, 450018, China
| | - Yong Wang
- Henan Key Laboratory of Child Brain Injury, Third Affiliated Hospital and Institute of Neuroscience, Zhengzhou University, Zhengzhou, 450052, China
| | - Xue Ding
- Henan Key Laboratory of Child Brain Injury, Third Affiliated Hospital and Institute of Neuroscience, Zhengzhou University, Zhengzhou, 450052, China
| | - Huimin Dong
- Henan Key Laboratory of Child Brain Injury, Third Affiliated Hospital and Institute of Neuroscience, Zhengzhou University, Zhengzhou, 450052, China
| | - Xi Chen
- Henan Key Laboratory of Child Brain Injury, Third Affiliated Hospital and Institute of Neuroscience, Zhengzhou University, Zhengzhou, 450052, China
| | - Yanchao Cheng
- Henan Key Laboratory of Child Brain Injury, Third Affiliated Hospital and Institute of Neuroscience, Zhengzhou University, Zhengzhou, 450052, China
| | - Xiaoli Zhang
- Henan Key Laboratory of Child Brain Injury, Third Affiliated Hospital and Institute of Neuroscience, Zhengzhou University, Zhengzhou, 450052, China
| | - Falin Xu
- Henan Key Laboratory of Child Brain Injury, Third Affiliated Hospital and Institute of Neuroscience, Zhengzhou University, Zhengzhou, 450052, China
| | - Changlian Zhu
- Henan Key Laboratory of Child Brain Injury, Third Affiliated Hospital and Institute of Neuroscience, Zhengzhou University, Zhengzhou, 450052, China.,Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, 40530, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, 2995, Sweden
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Kadivar M, Moghadam EM, Shervin Badv R, Sangsari R, Saeedy M. A Comparison Of Conventional Electroencephalography With Amplitude-Integrated EEG In Detection Of Neonatal Seizures. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2019; 12:489-496. [PMID: 31849541 PMCID: PMC6911316 DOI: 10.2147/mder.s214662] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 10/10/2019] [Indexed: 01/08/2023] Open
Abstract
Introduction Amplitude-integrated electroencephalogram (aEEG) is widely used in Neonatal Intensive Care Units (NICUs) to monitor neonatal seizures. This method is still not well established compared to conventional electroencephalogram (cEEG), the diagnostic gold standard. However, aEEG can be a good screening tool for the diagnosis of seizures in infants. Our aim in this review study is to evaluate aEEG diagnostic accuracy in comparison with cEEG, for detection of neonatal seizures. Methods In this work, we studied the published articles which used EEG and aEEG in the evaluation process of seizures in neonates and compared these techniques to obtain an approach for the detection of neonatal seizures. Results Seventeen articles were included. Using aEEG with raw trace to detect individual seizures showed median sensitivity of 78% (range: 68-85) and median specificity of 78% (range: 71-84). The median sensitivity and specificity were 54% (range: 25-95) and 81% (range: 50-100), respectively, in case of using aEEG without raw traces. Brief duration seizures and those occurring away from aEEG leads were less detected. Conclusion Studies showed that aEEG has variable sensitivity and specificity. Based on the evidences, aEEG cannot be recommended as the only way for diagnosis and management of seizures in neonates; however, it could complete the diagnosis of seizures in the infant and could be a very good tool for screening seizures.
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Affiliation(s)
- Maliheh Kadivar
- Department of Neonatology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Elahe Movahedi Moghadam
- Department of Neonatology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Shervin Badv
- Department of Neonatology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Raziye Sangsari
- Department of Neonatology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Saeedy
- Department of Neonatology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
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Variane GFT, Magalhães M, Gasperine R, Alves HCBR, Scoppetta TLPD, Figueredo RDJG, Rodrigues FPM, Netto A, Mimica MJ, Gallacci CB. Early amplitude-integrated electroencephalography for monitoring neonates at high risk for brain injury. J Pediatr (Rio J) 2017; 93:460-466. [PMID: 28238681 DOI: 10.1016/j.jped.2016.12.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 11/13/2016] [Accepted: 11/18/2016] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE This study aimed to correlate amplitude-integrated electroencephalography findings with early outcomes, measured by mortality and neuroimaging findings, in a prospective cohort of infants at high risk for brain injury in this center in Brazil. METHODS This blinded prospective cohort study evaluated 23 preterm infants below 31 weeks of gestational age and 17 infants diagnosed with hypoxic-ischemic encephalopathy secondary to perinatal asphyxia, with gestational age greater than 36 weeks, monitored with amplitude-integrated electroencephalography in a public tertiary center from February 2014 to January 2015. Background activity (classified as continuous, discontinuous high-voltage, discontinuous low-voltage, burst-suppression, continuous low-voltage, or flat trace), presence of sleep-wake cycling, and presence of seizures were evaluated. Cranial ultrasonography in preterm infants and cranial magnetic resonance imaging in infants with hypoxic-ischemic encephalopathy were performed. RESULTS In the preterm group, pathological trace or discontinuous low-voltage pattern (p=0.03) and absence of sleep-wake cycling (p=0.019) were associated with mortality and brain injury assessed by cranial ultrasonography. In patients with hypoxic-ischemic encephalopathy, seizure patterns on amplitude-integrated electroencephalography traces were associated with mortality or brain lesion in cranial magnetic resonance imaging (p=0.005). CONCLUSION This study supports previous results and demonstrates the utility of amplitude-integrated electroencephalography for monitoring brain function and predicting early outcome in the studied groups of infants at high risk for brain injury.
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Affiliation(s)
| | - Maurício Magalhães
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Departamento de Pediatria, São Paulo, SP, Brazil
| | - Renato Gasperine
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Departamento de Pediatria, São Paulo, SP, Brazil
| | | | | | | | | | - Alexandre Netto
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Departamento de Pediatria, São Paulo, SP, Brazil
| | - Marcelo Jenne Mimica
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Departamento de Pediatria, São Paulo, SP, Brazil; Faculdade de Ciências Médicas da Santa Casa de São Paulo, Departamento de Patologia, São Paulo, SP, Brazil
| | - Clery Bernardi Gallacci
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Departamento de Pediatria, São Paulo, SP, Brazil
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Early amplitude‐integrated electroencephalography for monitoring neonates at high risk for brain injury. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2017. [DOI: 10.1016/j.jpedp.2017.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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10
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Silveira RC, Procianoy RS. Hypothermia therapy for newborns with hypoxic ischemic encephalopathy. J Pediatr (Rio J) 2015; 91:S78-83. [PMID: 26354871 DOI: 10.1016/j.jped.2015.07.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 08/03/2015] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Therapeutic hypothermia reduces cerebral injury and improves the neurological outcome secondary to hypoxic ischemic encephalopathy in newborns. It has been indicated for asphyxiated full-term or near-term newborn infants with clinical signs of hypoxic-ischemic encephalopathy (HIE). SOURCES A search was performed for articles on therapeutic hypothermia in newborns with perinatal asphyxia in PubMed; the authors chose those considered most significant. SUMMARY OF THE FINDINGS There are two therapeutic hypothermia methods: selective head cooling and total body cooling. The target body temperature is 34.5 °C for selective head cooling and 33.5 °C for total body cooling. Temperatures lower than 32 °C are less neuroprotective, and temperatures below 30 °C are very dangerous, with severe complications. Therapeutic hypothermia must start within the first 6h after birth, as studies have shown that this represents the therapeutic window for the hypoxic-ischemic event. Therapy must be maintained for 72 h, with very strict control of the newborn's body temperature. It has been shown that therapeutic hypothermia is effective in reducing neurologic impairment, especially in full-term or near-term newborns with moderate hypoxic-ischemic encephalopathy. CONCLUSION Therapeutic hypothermia is a neuroprotective technique indicated for newborn infants with perinatal asphyxia and hypoxic-ischemic encephalopathy.
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Affiliation(s)
- Rita C Silveira
- Department of Pediatrics, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Neonatology Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Renato S Procianoy
- Department of Pediatrics, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Neonatology Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.
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Hypothermia therapy for newborns with hypoxic ischemic encephalopathy. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2015. [DOI: 10.1016/j.jpedp.2015.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Oliveira SRD, Machado ACCDP, Miranda DMD, Campos FDS, Ribeiro CO, Magalhães LDC, Bouzada MCF. [Near-infrared spectroscopy as an auxiliary tool in the study of child development]. REVISTA PAULISTA DE PEDIATRIA 2015; 33:230-40. [PMID: 25862295 PMCID: PMC4516378 DOI: 10.1016/j.rpped.2015.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 08/07/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE: To investigate the applicability of Near-Infrared Spectroscopy (NIRS) for
cortical hemodynamic assessment tool as an aid in the study of child development.
DATA SOURCE: Search was conducted in the PubMed and Lilacs databases using the following
keywords: ''psychomotor performance/child development/growth and
development/neurodevelopment/spectroscopy/near-infrared'' and their equivalents in
Portuguese and Spanish. The review was performed according to criteria established
by Cochrane and search was limited to 2003 to 2013. English, Portuguese and
Spanish were included in the search. DATA SYNTHESIS: Of the 484 articles, 19 were selected: 17 cross-sectional and two longitudinal
studies, published in non-Brazilian journals. The analyzed articles were grouped
in functional and non-functional studies of child development. Functional studies
addressed the object processing, social skills development, language and cognitive
development. Non-functional studies discussed the relationship between cerebral
oxygen saturation and neurological outcomes, and the comparison between the
cortical hemodynamic response of preterm and term newborns. CONCLUSIONS: NIRS has become an increasingly feasible alternative and a potentially useful
technique for studying functional activity of the infant brain.
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Laptook A. Amplitude integrated electroencephalogram (aEEG): has it found its niche in neonatal intensive care unit? JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2014. [DOI: 10.1016/j.jpedp.2013.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Laptook A. Amplitude integrated electroencephalogram (aEEG): has it found its niche in neonatal intensive care unit? J Pediatr (Rio J) 2014; 90:102-4. [PMID: 24361509 DOI: 10.1016/j.jped.2013.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 12/10/2013] [Indexed: 12/01/2022] Open
Affiliation(s)
- Abbot Laptook
- Pediatrics, Alpert Medical School of Brown University, Neonatal Intensive Care Unit, Women and Infants Hospital of Rhode Island, Providence, USA.
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