Seizures are common in term infants undergoing head cooling

Area of Science:

• Neonatal neurology
• Pediatric critical care

Background:

• Hypoxic-ischemic encephalopathy (HIE) is a serious condition in newborns.
• Selective head cooling is a therapeutic intervention for infants at risk of HIE.
• Early detection and management of seizures are critical in neonatal care.

Purpose of the Study:

• To delineate the occurrence and timing of clinical and electrographic seizures during selective head cooling in at-risk infants.
• To evaluate the utility of continuous electroencephalography (EEG) monitoring during therapeutic hypothermia.

Main Methods:

• Selective head cooling was applied to 20 term infants within 6 hours of birth.
• Continuous amplitude-integrated electroencephalography (aEEG) and single-channel EEG were performed during cooling.
• Routine EEG and video EEG were used for intermittent and post-cooling monitoring.
• Magnetic resonance imaging (MRI) was performed at week 1.

Main Results:

• Clinical seizures were most prominent on day 1 (n=18).
• Amplitude-integrated electroencephalography (aEEG) detected seizures upon admission and day 1 (n=19), with continuous seizures between 24-36 hours (n=9).
• Electrographic seizures were frequent and often lacked clinical correlation; MRI revealed basal ganglia abnormalities in 8/9 infants.

Conclusions:

• Continuous EEG monitoring during selective head cooling is essential for detecting subclinical seizures.
• The high frequency of electrographic seizures highlights the need for vigilant neurophysiological assessment.
• Findings support the integration of EEG monitoring into HIE treatment protocols.