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Updated: Jun 16, 2026
Application of an Amplitude-integrated EEG Monitor (Cerebral Function Monitor) to Neonates
Published on: September 6, 2017
Effect of treatment of subclinical neonatal seizures detected with aEEG: randomized, controlled trial
Linda G M van Rooij1, Mona C Toet, Alexander C van Huffelen
1Wilhelmina Children's Hospital, Department of Neonatology, KE 04.123.1, PO Box 85090, 3508 AB Utrecht, Netherlands.
Insights
Treating both clinical and subclinical seizures in neonates with hypoxic-ischemic encephalopathy (HIE) showed a trend toward reduced seizure duration. Longer seizure patterns correlated with increased brain injury severity on MRI scans.
Area of Science:
- Neonatal neurology
- Pediatric epilepsy
- Neurocritical care
Background:
- Hypoxic-ischemic encephalopathy (HIE) is a major cause of neonatal brain injury.
- Subclinical seizures are common in neonates with HIE and may contribute to brain damage.
- Continuous electroencephalography (EEG) monitoring, such as amplitude-integrated EEG (aEEG), is crucial for detecting seizures.
Purpose of the Study:
- To determine the rate of missed subclinical seizures in neonates with HIE without continuous aEEG.
- To evaluate if immediate treatment of both clinical and subclinical seizures reduces seizure duration and brain injury.
- To assess the correlation between seizure duration and brain injury severity on MRI.
Main Methods:
- A multicenter, randomized, controlled trial involving term infants with moderate to severe HIE and seizures.
- Infants were randomly assigned to either immediate treatment of all seizures (Group A) or treatment of clinical seizures only with aEEG blinding (Group B).
- Seizure duration, antiepileptic drug (AED) use, and MRI-scored brain injury severity were analyzed.
Main Results:
- Median seizure duration was 196 minutes in Group A versus 503 minutes in Group B (not significant).
- No significant differences in AED use were observed between groups.
- A significant correlation was found between longer seizure duration and increased brain injury severity on MRI scans.
Conclusions:
- There was a trend towards reduced seizure duration when both clinical and subclinical seizures were treated in neonates with HIE.
- The duration of seizure patterns was associated with the severity of brain injury observed on MRI scans.
- Continuous aEEG monitoring is valuable for detecting and managing subclinical seizures in neonatal HIE.
Objectives:
The goals were to investigate how many subclinical seizures in full-term neonates with hypoxic-ischemic encephalopathy (HIE) would be missed without continuous amplitude-integrated electroencephalography (aEEG) and whether immediate treatment of both clinical and subclinical seizures would result in a reduction in the total duration of seizures and a decrease in brain injury, as seen on MRI scans.
Methods:
In this multicenter, randomized, controlled trial, term infants with moderate to severe HIE and subclinical seizures were assigned randomly to either treatment of both clinical seizures and subclinical seizure patterns (group A) or blinding of the aEEG registration and treatment of clinical seizures only (group B). All recordings were reviewed with respect to the duration of seizure patterns and the use of antiepileptic drugs (AEDs). MRI scans were scored for the severity of brain injury.
Results:
Nineteen infants in group A and 14 infants in group B were available for comparison. The median duration of seizure patterns in group A was 196 minutes, compared with 503 minutes in group B (not statistically significant). No significant differences in the number of AEDs were seen. Five infants in group B received AEDs when no seizure discharges were seen on aEEG traces. Six of 19 infants in group A and 7 of 14 infants in group B died during the neonatal period. A significant correlation between the duration of seizure patterns and the severity of brain injury in the blinded group, as well as in the whole group, was found.
Conclusions:
In this small group of infants with neonatal HIE and seizures, there was a trend for a reduction in seizure duration when clinical and subclinical seizures were treated. The severity of brain injury seen on MRI scans was associated with a longer duration of seizure patterns.
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