Related Experiment Video
Updated: Jan 3, 2026
Application of an Amplitude-integrated EEG Monitor Cerebral Function Monitor to Neonates
Published on: September 6, 2017
The probability of seizures during continuous EEG monitoring in high-risk neonates
Lila T Worden1, Dhinakaran M Chinappen2, Sally M Stoyell2
1Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Insights
Neonates undergoing continuous EEG (cEEG) monitoring face significant seizure risks, influenced by the reason for monitoring and early EEG abnormalities. Early epileptiform discharges are key predictors of seizure risk in these infants.
Area of Science:
- Neonatal neurology
- Clinical neurophysiology
Background:
- Neonates undergoing continuous electroencephalography (cEEG) monitoring are at high risk for seizures.
- Understanding factors influencing seizure risk is crucial for optimizing monitoring duration and clinical management.
Purpose of the Study:
- To evaluate the impact of monitoring indication, early electroencephalography (EEG) findings, and clinical features on seizure risk in neonates.
- To determine optimal monitoring durations based on indication and EEG patterns.
Main Methods:
- Analysis of cEEG data from 291 neonates (34-48 weeks postmenstrual age) monitored between 2011-2017.
- Evaluation of monitoring indications (acute neonatal encephalopathy [ANE], suspicious clinical events [SCEs], other high-risk conditions [OHRs]), age, medication, and early EEG abnormalities.
- Application of Kaplan-Meier curves and Cox proportional hazards models to assess time to first seizure and overall seizure risk.
Main Results:
- Seizures occurred in 28% of high-risk neonates; missing seizures could occur if monitoring stopped after 24 hours of seizure freedom.
- Seizure risk was lower for ANE monitoring compared to OHR (P=.004) and trended lower than SCE (P=.097).
- Early epileptiform discharges significantly increased seizure risk across all indications (aHRs ranging from 4.32 to 56.90).
Conclusions:
- Neonatal seizure risk during cEEG monitoring varies significantly by indication and early EEG findings.
- Neonates monitored for OHR and ANE may experience delayed seizures, necessitating longer monitoring.
- Early epileptiform discharges are the strongest EEG predictor of subsequent seizure risk in neonates.
Objective:
We evaluated the impact of monitoring indication, early electroencephalography (EEG), and clinical features on seizure risk in all neonates undergoing continuous EEG (cEEG) monitoring following a standardized monitoring protocol.
Methods:
All cEEGs from unique neonates 34-48 weeks postmenstrual age monitored from 1/2011-10/2017 (n = 291) were included. We evaluated the impact of cEEG monitoring indication (acute neonatal encephalopathy [ANE], suspicious clinical events [SCEs], or other high-risk conditions [OHRs]), age, medication status, and early EEG abnormalities (including the presence of epileptiform discharges and abnormal background continuity, amplitude, asymmetry, asynchrony, excessive sharp transients, and burst suppression) on time to first seizure and overall seizure risk using Kaplan-Meier survival curves and multivariable Cox proportional hazards models.
Results:
Seizures occurred in 28% of high-risk neonates. Discontinuation of monitoring after 24 hours of seizure-freedom would have missed 8.5% of neonates with seizures. Overall seizure risk was lower in neonates monitored for ANE compared to OHR (P = .004) and trended lower compared to SCE (P = .097). The time course of seizure presentation varied by group, where the probability of future seizure was less than 1% after 17 hours of seizure-free monitoring in the SCE group, but required 42 hours in the OHR group, and 73 hours in the ANE group. The presence of early epileptiform discharges increased seizure risk in each group (ANE: adjusted hazard ratio [aHR] 4.32, 95% confidence interval [CI] 1.23-15.13, P = .022; SCE: aHR 10.95, 95% CI 4.77-25.14, P < 1e-07; OHR: aHR 56.90, 95% CI 10.32-313.72, P < 1e-05).
Significance:
Neonates who undergo cEEG are at high risk for seizures, and risk varies by monitoring indication and early EEG findings. Seizures are captured in nearly all neonates undergoing monitoring for SCE within 24 hours of cEEG monitoring. Neonates monitored for OHR and ANE can present with delayed seizures and require longer durations of monitoring. Early epileptiform discharges are the best early EEG feature to predict seizure risk.
Related Concept Videos
01:24Epilepsy and Seizures: Overview
Various factors can trigger epilepsy, including genetic factors, brain damage, metabolic causes, and unknown etiology. Diagnosis of epilepsy involves electroencephalography (EEG), which...
01:13Seizures: Classification
Seizures are typically classified into two main categories: focal and generalized seizures.
Focal Seizures
Focal seizures originate from specific regions of the brain. These seizures are further sub-classified into two types: