The Utilization of EEG Monitoring in Premature Infants with High-Grade Intraventricular Hemorrhage
Khaled Al Robaidi1, Monisha Goyal1, Kathryn Lalor1, Vivek Shukla1, Salman Rashid1
1University of Alabama at Birmingham
Objective:
We aimed to study the utility of continuous video electroencephalographic (cvEEG) monitoring as a screening tool for seizures in asymptomatic neonates found to have high-grade IVH.
Background:
High-grade intraventricular hemorrhage (IVH) is one of the possible complications of prematurity, and is considered one of the leading causes of seizures in premature infants. Neonatal seizures can be challenging to detect based on clinical symptoms alone and if left untreated, it can be associated with short- and long-term consequences.
Design/Methods:
We performed a comprehensive retrospective review on all premature infants born at the University of Alabama at Birmingham Regional Neonatal Intensive Care Unit from June 2018 to June 2021. We selected asymptomatic infants found to have high-grade (grade 3 and 4) IVH on head ultrasound who underwent cvEEG monitoring. Patient characteristics and comorbidities were then carefully studied and correlated with the screening EEG findings.
Results:
Among 27 premature infants with IVH enrolled in this study, 7 infants (26%) were found to have seizures detected on EEG. Detected seizures were only subclinical in 5 infants, while 2 infants had clinical in addition to subclinical seizures. Infants with seizures were relatively more premature, had a higher degree IVH, and lower APGAR scores at birth when compared to infants with no seizures.
Conclusions:
Our study suggests that EEG monitoring is vital when resources permit to screen for subclinical seizures in infants born with high-grade IVH. EEG screening should start as soon as IVH is suspected or discovered on imaging as early detection of seizures aid in prompt treatment. Since EEG monitoring is resource intensive, we suggest studying additional variables such as the degree of prematurity and APGAR scores to increase the yield of such screening studies.