Remote brain monitoring in high-risk newborns: a telehealth company six-year experience

*Correspondence: [e-mail].

Abstract

Background: High-risk newborns (NB) are at high risk of developing severe neurological sequels. Amplitude-integrated electroencephalography (aEEG) is a non-invasive, simplified method of continuous bedside brain monitoring that allows assessment of brain activity in real-time. However, the accuracy of aEEG evaluation varies according to the experience of the evaluator. With the advance of telemedicine, the implementation of remote systems with capacity to interact 24 hours/day, 365 days/year, can provide specialized assistance to the bedside physician, allowing more quick and assertive management of high-risk infants.

Objective: To characterize high-risk NBs monitored with video-aEEG/EEG and describe electroencephalographic findings during neuromonitoring.

Methods: Retrospective observational study including the data of all NBs monitored with video-aEEG/EEG between July 2017 to May 2023 by a private company in Brazil. A descriptive analysis was performed and the data were presented according to absolute number and relative frequency.

Results: A total of 8,214 high-risk NBs were monitored with video-aEEG/EEG using the tele-based monitoring system in 68 public, private, and public/private hospitals in Brazil, totaling 519,222 hours of monitoring and 86,537 interactions between the remote monitoring center and the hospital. The most common indications for monitoring were suspected seizures (24%), moderate or severe hypoxic-ischemic encephalopathy (HIE) with criteria for therapeutic hypothermia (17%), mild HIE (14%), extreme prematurity (9%), previous diagnosis of seizures (9%) and hemodynamic/ventilatory instability (9%). 6,242 (76%) newborns had pathological background activity pattern on video-aEEG/EEG and the sleep-wake cycling was absent in 3,778 (46%). Seizures were observed in 1,642 (20%), of which 1,166 (71%) were electrographic only, 312 (19%) electroclinical followed by electrographic only and 164 (10%) were clinical. Seizure control was obtained by only one antiepileptic drug (AED) in 903 (55%) of the cases and phenobarbital was the first drug of choice in 94% of the cases.

Conclusion: Most of the infants had pathological background activity during neuromonitoring and the majority of seizures were electrographic only, emphasizing the importance of neuromonitoring in high-risk NBs, which may significantly increase the accuracy of AED administration.

Publication History

Article published online:
12 May 2025