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Published on: June 21, 2024
An Amplitude-Integrated EEG Evaluation of Neonatal Opioid Withdrawal Syndrome
Christopher Lust1, Zachary Vesoulis2, John Zempel3
1Department of Neonatology, Children's Minnesota NICU, St. Louis, Missouri.
Insights
Amplitude-integrated electroencephalography (aEEG) shows frequent abnormalities, including absent sleep-wake cyclicity, in infants with neonatal opioid withdrawal syndrome (NOWS) that persist after treatment. Brief seizures are also common in these infants.
Area of Science:
- Neonatal neurology
- Neurophysiology
- Developmental pediatrics
Background:
- Neonatal opioid withdrawal syndrome (NOWS) is characterized by neurobehavioral disruption requiring hospitalization and treatment.
- Electroencephalography (EEG) is a valuable tool for assessing brain function in neonates.
Purpose of the Study:
- To evaluate electroencephalography (EEG) abnormalities using amplitude-integrated EEG (aEEG) in infants diagnosed with NOWS.
- To correlate aEEG findings with the severity of opioid withdrawal.
Main Methods:
- A prospective observational pilot study involving 18 term-born infants with NOWS.
- aEEG monitoring was initiated within 24 hours of recruitment and continued twice weekly until discharge.
- aEEG data were analyzed for background patterns and seizure activity, with withdrawal severity assessed using the modified Finnegan scoring (MFS) system.
Main Results:
- Complete aEEG datasets were obtained from 15 neonates.
- Continuous aEEG background activity was observed in 87% of infants, but none exhibited sleep-wake cyclicity (SWC) initially.
- Sixty percent of infants experienced brief electrographic seizures, and a lack of SWC correlated with higher MFS scores. At discharge, 53% showed absent or emerging SWC.
Conclusions:
- aEEG abnormalities, particularly absent SWC, are prevalent in NOWS infants and often persist post-treatment.
- Brief electrographic seizures are a common finding in this population.
- Neonates with persistent aEEG abnormalities at discharge require close follow-up due to potential long-term neurodevelopmental implications.
Objective:
Infants with neonatal opioid withdrawal syndrome (NOWS) have disrupted neurobehavior that requires hospitalization and treatment. This article aimed to evaluate electroencephalography (EEG) abnormalities using amplitude-integrated EEG (aEEG) in NOWS.
Study Design:
Eighteen term born infants with NOWS were recruited prospectively for an observational pilot study. aEEG monitoring was started within 24 hours of recruitment and twice weekly through discharge. aEEG data were analyzed for background and seizures. Severity of withdrawal was monitored using the modified Finnegan scoring (MFS) system.
Results:
Fifteen neonates had complete datasets. Thirteen (87%) had continuous aEEG background in all recordings. None had sleep-wake cyclicity (SWC) at initial recording. Brief seizures were noted in 9 of 15 (60%) infants. Lack of SWC was associated with higher MFS scores. At discharge, 8 of 15 (53%) had absent or emerging SWC.
Conclusion:
aEEG abnormalities (absent SWC) are frequent and persist despite treatment at the time of discharge in the majority of patients with NOWS. Brief electrographic seizures are common. Neonates with persistent aEEG abnormalities at discharge warrant close follow-up.
Key Points:
· EEG abnormalities are common and persist after clinical signs resolve in patients with NOWS.. · Short subclinical seizures may be seen.. · aEEG may identify neonates who need follow-up..
