Prolonged Background Suppression Induced by Anticonvulsants Misleading Amplitude-Integrated Electroencephalography's...

Prognostic role of the amplitude-integrated electroencephalography (aEEG) is undeniable, but few works focused on the contribution of medications in misleading its interpretation. We report the case of an asphyxiated newborn enrolled for therapeutic hypothermia (TH) that required the simultaneous use of three anticonvulsants, whose administration resulted in a comatose state and in a switch to a flat trace on the aEEG. The prolonged flat trace on the aEEG, pointing toward a state of irreversible brain damage, led to early stop of TH to prevent therapeutic obstinacy; unexpectedly, once Midazolam was weaned off, the aEEG recovered to a discontinuous pattern. The case emphasizes the aEEG's noninfallibility and advises clinicians to consider the potential misleading effects of depressant medications on its interpretation in asphyxiated newborns undergoing TH.