Neuromonitoring in neonatal critical care part I: neonatal encephalopathy and neonates with possible seizures

El‐Dib, Mohamed; Abend, Nicholas S.; Austin, Topun; Boylan, Geraldine B.; Chock, Valerie Y.; Cilio, Maria Roberta; Greisen, Gorm; Hellström‐Westas, Lena; Lemmers, Petra; Pellicer, Adelina; Pressler, Ronit; Sansevere, Arnold J.; Tsuchida, Tammy N.; Vanhatalo, Sampsa; Wusthoff, Courtney J.

doi:10.1038/s41390-022-02393-1

Cited by 14 publications

(7 citation statements)

References 130 publications

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“…Electroencephalography also provides valuable prognostic information to complement other data to give the best estimate of early childhood outcome. 52 Magnetic resonance imaging is the optimal imaging technique for HIE and typically is performed after completion of hypothermia between days 4 and 7 after birth. Brain MRI provides the greatest discrimination to differentiate presence or absence of injury and is critical for providing prognostic information for families.…”

Section: What Type Of Neonatal Unit Should Provide Hypothermia Treatm...mentioning

confidence: 99%

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Neonatal Hypoxic-Ischemic Encephalopathy and Hypothermia Treatment

Arnautovic,

Sinha,

Laptook

2023

Obstetrics &Amp; Gynecology

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Neonatal hypoxic-ischemic encephalopathy (HIE) is an important clinical entity because it is associated with death and long-term disability, including cognitive impairment, cerebral palsy, seizures, and neurosensory deficits. Over the past 40 years, there has been an intensive search to identify therapies to improve the prognosis of neonates with HIE. Hypothermia treatment represents the culmination of laboratory investigations including small and large animal studies, followed by pilot human studies, and, finally, randomized controlled trials to establish efficacy and safety. Clinical trials have demonstrated that hypothermia treatment reduces mortality and improves early childhood outcome among survivors. Hypoxic-ischemic encephalopathy is a multi-system disease process that requires intensive medical support for brain monitoring and monitoring of non–central nervous system organ dysfunction. Treatment must be conducted in a level III or IV neonatal intensive care unit with infrastructure for an integrated approach to care for critically ill neonates. Hypothermia treatment is the first and currently the only therapy to improve outcomes for neonates with HIE and indicates that HIE is modifiable. However, outcomes likely can be improved further. Hypothermia treatment has accelerated investigation of other therapies to combine with hypothermia. It has also stimulated a more intensive approach to brain monitoring, which allows earlier intervention for complications. Finally, HIE and hypothermia treatment negatively influences the psychological state of affected families, and there is growing recognition of the importance of trauma-informed principles to guide medical professionals.

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Section: What Type Of Neonatal Unit Should Provide Hypothermia Treatm...mentioning

confidence: 99%

“…Electroencephalography also provides valuable prognostic information to complement other data to give the best estimate of early childhood outcome. 52…”

Section: What Type Of Neonatal Unit Should Provide Hypothermia Treatm...mentioning

confidence: 99%

Neonatal Hypoxic-Ischemic Encephalopathy and Hypothermia Treatment

Arnautovic,

Sinha,

Laptook

2023

Obstetrics &Amp; Gynecology

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“…Amplitude‐integrated electroencephalography (aEEG) presents a non‐invasive, valuable tool to continuously monitor brain function at the bedside. Several reports have shown that aEEG is an important part of neuromonitoring, especially in high‐risk newborn infants 6,7 . However, the application of aEEG in preterm infants is still controversially discussed 8 .…”

Section: Introductionmentioning

confidence: 99%

“…Several reports have shown that aEEG is an important part of neuromonitoring, especially in high-risk newborn infants. 6,7 However, the application of aEEG in preterm infants is still controversially discussed. 8 Pathological traces are related to brain injury and correlate with neurological impairment in preterm infants.…”

mentioning

confidence: 99%

Association of aEEG and brain injury severity on MRI at term‐equivalent age in preterm infants

Griesmaier,

Schreiner,

Winkler

et al. 2023

Acta Paediatrica

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AimMeasures to detect and monitor brain injury in preterm infants are amplitude‐integrated electroencephalography (aEEG) and magnetic resonance imaging (MRI). To investigate the association between aEEG and MRI in a large cohort of preterm infants. Five hundred and twenty‐three preterm infants were included in the study.MethodsAEEG was interpreted for the total maturation score (TMS) according to Burdjalov. Cerebral MRI was evaluated using a validated scoring system by Kidokoro.ResultsOne hundred and forty‐six infants (27.9%) showed some form of brain injury, with 111 infants (21.2%) showing mild injury and 35 (6.7%) showing severe injury. TMS were significantly higher in infants without injury compared to severe injury. When comparing infants with isolated intraventricular haemorrhage to infants without brain injury, TMS were significantly lower.ConclusionPrediction of adverse outcome is an important aspect of neonatal care. The combination of diagnostic measures evaluating brain injury might enhance our abilities in neonatal care to provide accurate information about later outcome. Early aEEG is predictive for the severity of brain injury detected by MRI at term‐equivalent age. Whether aEEG is also predictive for neurodevelopmental outcome needs to be further investigated in relation to the various patterns of preterm brain injury.

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“…Real-time manual identification and assessments of EEG data is challenging and requires expert clinical knowledge [18][19][20][21][22]. This is even more challenging when subtle waveforms, often with complex morphological patterns, need to be quantified [23,24].…”

Section: Introductionmentioning

confidence: 99%

Early Signatures of Brain Injury in the Preterm Neonatal EEG

Abbasi,

Battin,

Butler

et al. 2023

Signals

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Reliable prognostic biomarkers are needed to support the early diagnosis of brain injury in extremely preterm infants, and to develop effective neuroprotective protocols that are tailored to the progressing phases of injury. Experimental and clinical research shows that severity of neuronal damage is correlated with changes in the electroencephalogram (EEG) after hypoxic-ischemia (HI). We have previously reported that micro-scale sharp-wave EEG waveforms have prognostic utility within the early hours of post-HI recordings in preterm fetal sheep, before injury develops. This article aims to investigate whether these subtle EEG patterns are translational in the early hours of life in clinical recordings from extremely preterm newborns. This work evaluates the existence and morphological similarity of the sharp-waves automatically identified throughout the entire duration of EEG data from a cohort of fetal sheep 6 h after HI (n = 7, at 103 ± 1 day gestation) and in recordings commencing before 6 h of life in extremely preterm neonates (n = 7, 27 ± 2.0 weeks gestation). We report that micro-scale EEG waveforms with similar morphology and characteristics (r = 0.94) to those seen in fetal sheep after HI are also present after birth in recordings started before 6 h of life in extremely preterm neonates. This work further indicates that the post-HI sharp-waves show rapid morphological evolution, influenced by age and/or severity of neuronal loss, and thus that automated algorithms should be validated against such signal variations. Finally, this article discusses the need for more focused research on the early assessment of EEG changes in preterm infants to help determine the timing of brain injury to identify biomarkers that could assist in targeting novel therapies for particular phases of injury.

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Neuromonitoring in neonatal critical care part I: neonatal encephalopathy and neonates with possible seizures

Cited by 14 publications

References 130 publications

Neonatal Hypoxic-Ischemic Encephalopathy and Hypothermia Treatment

Neonatal Hypoxic-Ischemic Encephalopathy and Hypothermia Treatment

Association of aEEG and brain injury severity on MRI at term‐equivalent age in preterm infants

Early Signatures of Brain Injury in the Preterm Neonatal EEG

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