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THE RELATION OF THE SLEEP-WAKE CYCLE WITH AMPLITUDE-INTEGRATED ELECTROENCEPHALOGRAPHY BACKGROUND ACTIVITY AND SEIZURES IN NEWBORNS
The incidence of impaired outcomes in newborns at high risk for brain injury is high. Amplitude-integrated electroencephalography (aEEG) is a non-invasive, bedside and simplified method for brain monitoring to access brain function, presence of seizures and sleep-wake cycle (SWC). The presence of SWC is associated with a better prognosis for babies, this involves endogenous brain activity and has impact on cognitive, psychomotor and behavioral development.
To describe SWC with aEEG background activity and presence of seizures in newborns.
Retrospective and descriptive analysis of the database of a private company that works with brain monitoring of newborns with aEEG at 20 hospitals in Brazil. All monitored newborns from July 2017 up to June 2019 were included in this study. SWC was categorized as present or absent, aEEG background activity was classified as pathological and non-pathological, and the seizure was categorized as present or absent. We described the concomitant occurrence of SWC and aEEG background activity, and concomitant occurrence of SWC and seizures. The data was presented according to absolute and relative frequency.
In this study were included 1,639 newborns. SWC was present in 774(47.2%) newborns. The pathological aEEG background activity was shown in 442(27%), and 376(23%) had the presence of seizures. Almost the totality (276; 73.4%) of seizures were subclinical, 74(19.7%) clinical and 29(7.7%) clinical + subclinical. In newborns with SWC absent (865; 52.8%) aEEG pathological background activity was shown in 378(43.7%). However, in the pathological aEEG background activity was shown only in 64(8.3%) when the SWC was present. At the absence of SWC, 244(28.2%) of the newborns had the presence of seizures, but when the SWC was present, 641(82.8%) did not have seizures. There was a difference of the aEEG background activity between newborns with and without SWC. Seizures were more common when SWC was absent. Newborns with brain dysfunction had alteration in SWC.
More than half of newborns at high risk for brain injury had absence of SWC. The importance of brain monitoring was pointed when more than 70% of diagnosed seizures were subclinical and detected only because of aEEG monitoring, this helped to guide the treatment and, possibly, improved the prognosis. Brain monitoring detects brain dysfunction, to screen for seizures and to assess the presence of SWC.
Newborns, sleep-wake cycle, amplitude-integrated electroencephalography, seizures
Division of Neonatology, Department of Pediatrics, Irmandade da Santa Casa de Misericórdia de São Paulo - Sao Paulo - Brasil, Neonatal Unit, Sociedade Beneficente Israelita Albert Einstein, 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
Ariane Ferreira Machado Avelar, Daniela Pereira Rodrigues, Rafaela Fabri Rodrigues Pietrobom, Alexandre Netto, Laura Tafner, Maurício Magalhães, Gabriel Fernando Todeschi Variane