Changes in the Term Neonatal Electroencephalogram with General Anesthesia: A Systematic Review with Narrative...

Area of Science:

• Neonatal Neurology
• Anesthesiology
• Neurophysiology

Background:

• The impact of general anesthesia on neonatal brain activity remains poorly understood.
• Electroencephalography (EEG) offers insights into neuronal function and potential age-dependent variations in neonates.

Approach:

• A systematic literature search was conducted across major databases (MEDLINE, Embase, PubMed, Cochrane Library) up to November 2023.
• Included were English-language studies on term neonates (37-44 weeks postmenstrual age) undergoing general anesthesia for surgery.
• Risk of bias and quality of evidence were assessed using established tools (ROBINS-I, GRADE).

Key Points:

• Nine publications involving 140 neonates met the eligibility criteria; however, data were limited and study quality was very low.
• EEG discontinuity, characterized by alternating amplitude patterns, was observed in 94/119 neonates under general anesthesia and in 23/23 neonates with hypothermia.
• Decreased delta frequency power correlated with increased anesthetic dosage in 22 neonates.

Conclusions:

• Despite identified evidence gaps, findings suggest a correlation between higher sevoflurane concentrations and increased EEG discontinuity.
• Lower body temperature was also associated with increased EEG discontinuity in term neonates.