Bedside EEG Monitoring in the Neonatal Intensive Care Unit

Purpose of review: The use of electroencephalogram (EEG) monitoring in the neonatal intensive care unit (NICU) is crucial for the diagnosis and treatment of neonatal seizures. This review highlights the special features of EEG monitoring in the NICU for clinicians. Recent findings: In neonates, EEG is the best and sometimes the only way for seizure detection. Neonates in the NICU are at high risk for seizures, which are associated with increased risk of mortality and poor long-term neuro-developmental outcome. Therefore, there is a need to develop updated guidelines that will characterize which neonates are at higher risk for seizures and who should be connected to EEG and when, in order to improve the efficiency of EEG monitoring strategies in the NICU. In spite of the increased recognition of high seizure risk, the time course of seizure presentation in neonates and the exact use of EEG are not well characterized. In many NICUs, the decision when and how to monitor high-risk neonates and the duration of EEG monitoring are usually dependent on individual practice and resources, instead of being guided by evidence-based data. Summary: Neonatal seizures are a common medical emergency, usually a reflection of an underlying neurologic condition. Neonatal seizures have an influence on the outcome, but a clinical evaluation of neonatal seizures is unreliable. Therefore, using EEG monitoring in the NICU is crucial. The American Clinical Neurophysiology Society recommended that neonates with known or suspected acute brain injury, combined with encephalopathy, be monitored with 24 h of EEG. Indications for EEG monitoring in the NICU include characterization of abnormal paroxysmal events, and screening neonates in high-risk clinical scenarios. An EEG confirmation of suspected seizures in neonates is mandatory in order to avoid misdiagnosis, especially among preterm neonates. Continuous EEG monitoring is considered currently as the gold standard for detection of neonatal seizures, in order to initiate treatment, and monitor treatment success. However, since this method has limitations, amplitude-integrated EEG has gained ground providing excellent complementary data.