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NEWBORNS UNDERGOING THERAPEUTIC HYPOTHERMIA: A RELATIONSHIP BETWEEN SLEEP-WAKE CYCLE, AMPLITUDE-INTEGRATED ELECTROENCEPHALOGRAPHY BACKGROUND ACTIVITY AND SEIZURES
Hypoxic-ischemic encephalopathy (HIE) affects 3 to 20/1000 live births and is an important cause of neonatal mortality and morbidity. Therapeutic hypothermia (TH) is a standard therapy for newborns with HIE, showing reduction of mortality and major neurodevelopmental disability. Amplitude integrated electroencephalography (aEEG) provides continuous observation of brain activity and allows the assessment of brain injury and adverse outcomes. Sleep-wake cycle (SWC) is considered a marker for neurological wellbeing and the onset on aEEG is important to determine a prognosis.
To identify the SWC and to describe the association with aEEG background activity and presence of seizures in newborns undergoing TH.
We analyzed the database from a private company that works with brain monitoring of newborns with aEEG at 20 hospitals in Brazil. Newborns undergoing TH from July 2017 up to June 2019 were included in this study. SWC was categorized as present or absent, aEEG background activity was categorized as pathological and non-pathological, and seizure activity was categorized as present or absent. We observed the association between the SWC and aEEG background activity, and the association between the SWC and seizures. Data will be presented according to absolute and relative frequency.
274 patients were included in this study, 164(59,8%) were male and 138(50,4%) were born by caesarean section. SWC was present in 129(47%) of monitored infants. Pathological aEEG background activity was shown in 110(40,1%), and 95(34,7%) had the presence of seizures. The majority (76; 80%) of seizures were subclinical, 15(15,8%) were clinical and 4(4,1%) were clinical + subclinical. In newborns with SWC absent, pathological aEEG background activity was identified in 90(62%). In contrast, when the SWC was present, pathological aEEG background activity was shown in only 20(16%) of newborns. Seizures were present in 57(39%) when SWC was absent, but seizures were present in 38(29%) when the SWC was present.
More than half of newborns at high risk for brain injury had SWC absent. The importance of brain monitoring was demonstrated since most diagnosed seizures were subclinical and detected only because of aEEG monitoring. Absence of SWC was more common in newborns with pathological aEEG background activity or seizures. Newborns with abnormal aEEG and seizures have alteration in the SWC.
Newborns, therapeutic hypothermia, amplitude-integrated electroencephalography, sleep-wake cycle, seizures
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