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The incidence of impaired outcomes in neonates at high risk for brain injury is high and represents a challenge in neonatal care. Amplitude-integrated electroencephalography (aEEG) consists in a non-invasive, bedside and simplified method of continuous brain monitoring, which is used to access brain function in NICU. Sleep-wake cycle (SWC) is a marker for neurological development and the onset helps to determine a prognostic factor in newborn. Precise evaluation and early diagnosis of brain injury plays is important to prevent neurological impairment, and the brain monitoring with aEEG can give information about neurological status and prognosis. Data from SWC in wide groups of infants is still scarce.


To describe the indication of brain monitoring using aEEG and to identify SWC in newborns at high risk for brain injury.


We analyzed the database from a private company that works with remote and centralized brain monitoring using aEEG in 20 hospitals in Brazil. Monitored infants from July 2017 up to June 2019 were included in this study. We identified SWC and classified it into present or absent. The indications for brain monitoring with aEEG were identified and SWC was analyzed in each group of indication. Statistical analysis was descriptive, and data was presented according to absolute and relative frequency.


A total of 1639 patients were analyzed, 59% were male and 67% were caesarean section. According to the indication for brain monitoring, was found 335 (20%) of suspected seizure, 274(17%) of asphyxia + therapeutic hypothermia(TH), 166(10%) of previous seizure, 142(9%) of neonatal anoxia, 127(8%) extreme prematurity, 115(7%) asphyxia >35weeks, 91(6%) congenital heart disease(CHD), and 389(24%) of other 28 different indications. The SWC was present in 774(47,2%) of the total of newborns, being 160(47,8%) of newborns with suspected seizure, 129(47,1%) asphyxia + TH, 69(41,6%) previous seizure, 90(63,4%) neonatal anoxia, 36(28,3%) extreme prematurity, 67(58,3%) asphyxia >35weeks, 16(17,6%) CHD, and 207(53,2%) other indications.


Absence of SWC was common in the population, as we found presence of SWC in less than 50% of newborns, and this varied according to the clinical condition. The group of extreme prematurity and CHD showed the major absence of SWC. Brain monitoring allows real time access to the brain function and SWC, which may be related with neurodevelopmental outcomes.


Neonates, amplitude-integrated electroencephalography, sleep-wake cycle


Área Clínica


Division of Neonatology, Department of Pediatrics, Irmandade da Santa Casa de Misericórdia de São Paulo - Sao Paulo - Brasil, Division of Neonatology, Grupo Santa Joana - Sao Paulo - Brasil, Neonatal Unit, Sociedade Beneficente Israelita Brasileira Hospital Albert Einstein - Sao Paulo - Brasil, Nutrition Department, Centro de Pesquisas Clínicas – CPClin - Sao Paulo - Brasil, Pediatric Nursing Department, Escola Paulista de Enfermagem, Universidade Federal de São Paulo - Sao Paulo - Brasil, Protecting Brains and Saving Futures Organization - Sao Paulo - Brasil


Daniela Pereira Rodrigues, Ariane Ferreira Machado Avelar, Gabriel Fernando Todeschi Variane, Rafaela Fabri Rodrigues Pietrobom, Alexandre Netto, Laura Tafner, Maurício Magalhães