The impact of a telemedicine neuromonitoring protocol for perinatal asphyxia in neonatal intensive care units

Background: Brain monitoring of high-risk neonates with integrated video amplitude electroencephalography associated with raw electroencephalography (video aEEG/EEG) is promoted by the Protecting Brains and Saving Futures (PBSF) Protocol which works within an advanced model of telemedicine for specialized neonatal neurological care in neonatal ICUs.

Objective: To compare the incidence of clinical and electrographic seizures, and drug treatment of newborns assisted by the PBSF Protocol with those who did not, to assess the impact of implementing this protocol on the immediate outcome of neonates.

Methods: Prospective multicenter clinical study carried out in 12 NICUs between Feb/2021 and Feb/2022, six with the PBSF protocol implemented and six not. All newborns submitted to therapeutic hypothermia (TH) due to perinatal asphyxia with gestational age ≥ 35 weeks and birth weight ≥ 1800g were included.

Results: 167 newborns were included and divided into PBSF group (n= 87) and non-PBSF group (n= 80). Video aEEG/EEG) was performed in the PBSF group. PBSF group: Presence of more moderate or severe results on the modified Sarnat score (p= 0.002) compared to non-PBSF. TH was provided by active cooling in 67 (77.0%) and passive cooling in 20 (23.0%). All newborns were monitored with video aEEG/EEG, and 24 (27.6%) newborns presented electrographic seizures. Seizures were completely subclinical in 7 (29,2%) and clinical followed by subclinical in 6 (25%) newborns. Antiepileptic drugs were used in all newborns that presented electrographic seizures, and a single drug was able to achieve seizure control in 9 (37.5%) infants. Non-PBSF group: TH was provided by active cooling in 39 (48.7%) and passive cooling in 41 (51.3%). 46 (57.5%) newborns presented clinical suspicion of seizures and received antiepileptic drugs, with a significant difference (p<0.0001) compared to the PBSF group. A single drug achieved seizure control in 20 (43.5%). In both groups, seizure onset was most frequent between 1 to 12 hours of life and the first line treatment was phenobarbital. In the cranium MRI, 25 (62.5%) newborns in the PBSF and 10 (50%) in the non-PBSF group presented favorable results. Early outcomes were similar in both groups.

Conclusions: Non-PBSF group, without electrographic assessment, diagnosed seizures and used antiepileptic drugs twice times more than the PBSF group. It demonstrates the importance of implementing continuous neuromonitoring in high-risk newborns in the NICU.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
18 September 2023