Brain monitoring in neonates

Continuous EEG monitoring with amplitude-integrated electroencephalography (aEEG) has become a part of the routine neurological care in the neonatal unit, especially in full-term infants with hypoxia-ischemia and in infants suspected of seizures. Its prognostic value after birth asphyxia is well established and seizure detection has improved with the new digital aEEG devices with access to the "real" EEG, and even with seizure detection in some devices. Recent experience shows that aEEG monitoring also appears to be very helpful in premature infants. One has to be aware of possible artefacts, like ECG or movement artefacts, which can lead to misinterpretation of the background pattern. Cerebral oximetry records regional saturation of the brain using Near Infrared Spectroscopy (NIRS) and provides a non-invasive method to continuously monitor brain oxygen imbalance. Cerebral oximetry is increasingly being used as a trend monitor in critically ill neonates. Its usefulness has been assessed in cardiac surgery, patent ductus arteriosus, hypoxia-ischemia and ventilation with high mean airway pressures. A combination of both monitoring modalities will probably become the future for neonatal neuromonitoring.