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Long-Term Video Electroencephalographic Monitoring in <30-Week Gestational Age Infants With High-Grade
Salman Rashid1, Monisha Goyal2, Kathryn Lalor2
1Division of Pediatric Neurology, University of Alabama, Birmingham, Alabama.
Insights
Seizures occur in about 16% of high-risk preterm infants with intraventricular hemorrhage. These subclinical seizures are often detected by electroencephalographic monitoring in younger infants.
Area of Science:
- Neonatal neurology
- Pediatric epilepsy
- Neurocritical care
Background:
- Current guidelines for neonatal seizures lack robust data.
- Preterm neonates (<30 weeks gestation) with high-grade intraventricular hemorrhage (IVH) are at high risk for seizures.
- Evaluating asymptomatic preterm infants requires further investigation.
Purpose of the Study:
- To determine the seizure risk in high-risk preterm infants (<30 weeks gestation) with high-grade IVH.
- To investigate seizure occurrence in asymptomatic infants using long-term video electroencephalographic (EEG) monitoring.
- To identify factors associated with seizure detection in this population.
Main Methods:
- Retrospective review of infants <30 weeks gestation admitted between June 2018 and October 2022.
- Inclusion criteria: underwent EEG monitoring without prior clinical seizure concern.
- Data collected: gestational age, IVH grade, EEG timing and duration.
Main Results:
- Six out of 37 (approximately 16%) infants had subclinical seizures detected by EEG.
- Seizure occurrence was significantly associated with younger chronological age at EEG initiation (median 6.5 days vs 9 days).
- Infants with seizures were more likely to undergo repeat EEG monitoring (P=0.0418).
Conclusions:
- Long-term video EEG monitoring identified seizures in approximately 16% of asymptomatic preterm neonates (<30 weeks gestation) with high-grade IVH.
- Younger chronological age at EEG initiation and increased likelihood of remonitoring were associated with seizure detection.
- These findings highlight the utility of EEG in identifying subclinical seizures in high-risk preterm infants.
Background:
Despite recognizing high seizure risk, the current consensus guidelines on evaluating seizures in preterm neonates are based on limited data. We chose to investigate the seizure risk in high-risk preterm (<30 weeks gestation) asymptomatic (without a clinical concern for seizures) infants with high-grade intraventricular hemorrhage who underwent long-term video electroencephalographic monitoring.
Methods:
We performed a comprehensive retrospective review on all infants of <30-week gestational age admitted to the University of Alabama at Birmingham Regional Neonatal Intensive Care Unit from June 2018 to October 2022. We selected those patients who underwent electroencephalographic monitoring without a prior clinical concern for seizures. We recorded gender, gestational age, APGAR scores (one and five minutes), intraventricular hemorrhage (grade, age at diagnosis), and electroencephalographic monitoring (timing and duration) data.
Results:
Among 37 premature infants, six had seizures detected on electroencephalographic monitoring. All six infants had subclinical seizures. Only two of six patients had a clinical correlation (although not identified by the providers) with some of their seizures. Patients with seizures were significantly younger in chronological age (median age 6.5 days vs 9 days, P value 0.009) at the time of the electroencephalographic monitoring initiation and were more likely to have subsequent monitoring studies (P value 0.0418).
Conclusions:
Long-term video electroencephalographic monitoring performed after the diagnosis of high-grade intraventricular hemorrhage captured seizures in ∼16% of asymptomatic premature neonates of <30 weeks' gestation. Patients identified to have seizures were significantly younger (chronological age) at the time of the electroencephalographic monitoring initiation and were more likely to be remonitored.
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