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Neonatal Neurocritical Care Series

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

Pediatric Research volume 94, pages 64–73 (2023)Cite this article

Abstract

The blooming of neonatal neurocritical care over the last decade reflects substantial advances in neuromonitoring and neuroprotection. The most commonly used brain monitoring tools in the neonatal intensive care unit (NICU) are amplitude integrated EEG (aEEG), full multichannel continuous EEG (cEEG), and near-infrared spectroscopy (NIRS). While some published guidelines address individual tools, there is no consensus on consistent, efficient, and beneficial use of these modalities in common NICU scenarios. This work reviews current evidence to assist decision making for best utilization of neuromonitoring modalities in neonates with encephalopathy or with possible seizures. Neuromonitoring approaches in extremely premature and critically ill neonates are discussed separately in the companion paper.

Impact

  • Neuromonitoring techniques hold promise for improving neonatal care.

  • For neonatal encephalopathy, aEEG can assist in screening for eligibility for therapeutic hypothermia, though should not be used to exclude otherwise eligible neonates. Continuous cEEG, aEEG and NIRS through rewarming can assist in prognostication.

  • For neonates with possible seizures, cEEG is the gold standard for detection and diagnosis. If not available, aEEG as a screening tool is superior to clinical assessment alone. The use of seizure detection algorithms can help with timely seizures detection at the bedside.

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Fig. 1: Common classification used to describe aEEG tracing, especially in term infants: Continuous (C), Discontinuous (DC), Burst Suppression (BS), Low Voltage (LV) and Inactive, flat trace (FT).
Fig. 2: Progression of cEEG in a term infant with HIE.
Fig. 3: Illustration of the value of NIRS in monitoring neonates receiving therapeutic hypothermia for neonatal encephalopathy.
Fig. 4: Examples of seizures and seizures-like artifacts on aEEG and the corresponding cEEG.

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Funding

M.E.-D. discloses he is the PI of an investigator-initiated research funded by Medtronic and served once on an advisory board for Radiometer. R.M.P. is an investigator for studies with UCB Biosciences, Inc and Johnson & Johnson and has served as a speaker, consultant and/or on advisory boards for Kephala, GW, Natus and UCB Biosciences, Inc. Her research is supported by the National Institute of Health Research (NIHR) Biomedical Research Centre at Great Ormand Street Hospital (GOSH), Cambridge Biomedical Research Centre NIHR and the Evelina Trust. Other authors are disclosing no financial interest.

Author information

Authors and Affiliations

  1. Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Mohamed El-Dib

  2. Departments of Neurology and Pediatrics, Children’s Hospital of Philadelphia and the University of Pennsylvania, Philadelphia, PA, USA

    Nicholas S. Abend

  3. Department of Paediatrics, University of Cambridge, Cambridge, UK

    Topun Austin

  4. INFANT Research Centre & Department of Paediatrics & Child Health, University College Cork, Cork, Ireland

    Geraldine Boylan

  5. Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, CA, USA

    Valerie Chock

  6. Department of Pediatrics, Division of Pediatric Neurology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium

    M. Roberta Cilio

  7. Department of Neonatology, Rigshospitalet, Copenhagen University Hospital & Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark

    Gorm Greisen

  8. Department of Women’s and Children’s Health, Uppsala University, and Division of Neonatology, Uppsala University Hospital, Uppsala, Sweden

    Lena Hellström-Westas

  9. Department of Neonatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands

    Petra Lemmers

  10. Department of Neonatology, La Paz University Hospital, Madrid, Spain; Neonatology Group, IdiPAZ, Madrid, Spain

    Adelina Pellicer

  11. Department of Clinical Neurophysiology, Great Ormond Street Hospital for Children NHS Trust, and Clinical Neuroscience, UCL- Great Ormond Street Institute of Child Health, London, UK

    Ronit M. Pressler

  12. Department of Neurology and Pediatrics, George Washington University School of Medicine and Health Sciences; Children’s National Hospital Division of Neurophysiology, Epilepsy and Critical Care, Washington, DC, USA

    Arnold Sansevere & Tammy Tsuchida

  13. Department of Clinical Neurophysiology, Children’s Hospital, BABA Center, Neuroscience Center/HILIFE, Helsinki University Hospital and University of Helsinki, Helsinki, Finland

    Sampsa Vanhatalo

  14. Division of Child Neurology, Stanford University, Palo Alto, CA, USA

    Courtney J. Wusthoff

  15. Neonatology, Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA

    Sonia Bonifacio

  16. Neonatology, Pediatrics/Newborn Medicine, Montreal Children’s Hospital, McGill University, Montreal, QC, Canada

    Pia Wintermark

  17. Neonatology, Cleveland Clinic Children’s Hospital, Bratenahl, OH, USA

    Hany Aly

  18. Neurology, Children’s National Hospital, Washington, DC, USA

    Taeun Chang

  19. Neurology, Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada

    Vann Chau

  20. Neurology, Pediatrics, Epidemiology & Biostatistics, University of California, San Francisco, CA, USA

    Hannah Glass

  21. Neurology, Pediatrics, Population Health Sciences, Duke University School of Medicine, Durham, NC, USA

    Monica Lemmon

  22. Neonatology, Children’s National Hospital and The George Washington University School of Medicine, Washington, DC, USA

    An Massaro

  23. Neurology, Child Neurology, Stanford, Stanford, CA, USA

    Courtney Wusthoff

  24. Neurology, Hospital for sick children, Toronto, ON, Canada

    Gabrielle deVeber

  25. Neurology, Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA

    Andrea Pardo

  26. Neurology, University of Wisconsin, Madison, WI, USA

    Melisa Carrasco McCaul

Authors
  1. Mohamed El-Dib
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  2. Nicholas S. Abend
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  3. Topun Austin
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  4. Geraldine Boylan
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  15. Courtney J. Wusthoff
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Consortia

on behalf of the Newborn Brain Society Guidelines and Publications Committee

  • Sonia Bonifacio
  • , Pia Wintermark
  • , Hany Aly
  • , Taeun Chang
  • , Vann Chau
  • , Hannah Glass
  • , Monica Lemmon
  • , An Massaro
  • , Courtney Wusthoff
  • , Gabrielle deVeber
  • , Andrea Pardo
  •  & Melisa Carrasco McCaul

Contributions

Substantial contributions to conception and design: All Authors. Drafting the article or revising it critically for important intellectual content: All authors. Final approval of the version to be published: All authors.

Corresponding author

Correspondence to Mohamed El-Dib.

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El-Dib, M., Abend, N.S., Austin, T. et al. Neuromonitoring in neonatal critical care part I: neonatal encephalopathy and neonates with possible seizures. Pediatr Res 94, 64–73 (2023). https://doi.org/10.1038/s41390-022-02393-1

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  • DOI: https://doi.org/10.1038/s41390-022-02393-1

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