Implementing a Digital Neurocritical Care Unit for Neonates in Brazil: A 4-Year Experience

Area of Science:

• Neonatal Neurology
• Digital Health Implementation
• Neurocritical Care

Background:

• Neonatal seizures are challenging to diagnose and manage, particularly in resource-limited settings.
• Digital health strategies offer potential solutions for continuous neuromonitoring.
• The feasibility and impact of tele-based video-aEEG/EEG in publicly funded NICUs remain underexplored.

Purpose of the Study:

• To describe neuromonitoring findings using continuous, real-time, tele-based video-aEEG/EEG in a Brazilian NICU.
• To correlate these findings with short-term clinical and imaging outcomes in high-risk newborns.
• To evaluate the impact of this digital health strategy on seizure diagnosis and treatment.

Main Methods:

• Prospective, observational cohort study of 116 high-risk newborns over 8,000+ monitoring hours.
• Utilized continuous, tele-based video-aEEG/EEG monitoring.
• Correlated neuromonitoring data (background activity, seizures, sleep-wake cycle) with clinical data and cranial ultrasound (cUS) findings.

Main Results:

• 43% of neonates had pathological background activity; 58.6% lacked a sleep-wake cycle.
• Seizures were detected in 31% of neonates, often electrographic-only and early in life.
• Pathological aEEG/EEG findings were significantly associated with abnormal cUS and increased mortality risk.

Conclusions:

• Tele-based video-aEEG/EEG monitoring is feasible and valuable in low-resource NICUs.
• This digital health strategy enhances diagnostic accuracy for neonatal seizures.
• It optimizes antiseizure medication use and aids in early neuroprotective interventions.