Objectives
Seizure is a common sign in neonates hospitalized in the neonatal intensive care units (NICU) that may lead to morbidity and mortality. Most neonatal seizures are subclinical. Conventional EEG (cEEG) is the gold standard for detecting and monitoring seizures but is not widely available. Amplitude-integrated electroencephalography (aEEG) has been used for over a decade to evaluate infants with seizures. In this study, we tried to determine the efficacy of aEEG as
a widely available diagnostic tool in diagnosing seizures.
Materials & Methods
All cases with seizures or suspicious seizures were admitted to the NICU of the Children’s Medical Center for one year. cEEG and aEEG were performed for these infants. aEEG was recorded for at least six hours with a description of the tracing. Clinical information, outcomes, and questionnaires (patient information) were recorded in detail. The obtained data were analyzed with the SPSS version 24 software.
Results
Eleven out of twenty-five aEEG recordings were abnormal; other patients showed normal aEEGs. The most common clinical and neurological manifestations were seizure (68%) and hypotonia (28%); the mortality rate was 12%. No significant correlation was observed between aEEG findings and gender, age, familial relation, outcome, ultrasound result, type of seizure, and underlying disease.

References
1. Volpe JJ. Neurology of the Newborn.6th ed. Philadeplphia: Saunders; 2017. pp. 203–37.
2. Rennie JM, Boylan GB. Neonatal seizures and their treatment. Curr Opin Neurol. 2003;16(2):177–81. www.ncbi.nlm.nih.gov/pubmed/12644746
3. Hill A. Neonatal seizures. Pediatrics in Review. 2000;21(4):117–21. www.ncbi.nlm.nih.gov/pubmed/10756174
4. Tadic BV, Kravljanac R, Sretenovic V, Vukomanovic V. Long-term outcome in children with neonatal seizures: A tertiary center experience in cohort of 168 patients. Epilepsy Behav. 2018;84:107-113. www.ncbi.nlm.nih.gov/pubmed/29775848
5. Glass HC, Kan J, Bonifacio SL, Ferriero DM. Neonatal seizures: treatment practices among term and preterm infants. Pediatric neurology. 2012;46(2):111-5.
6. Rakshasbhuvankar A, Paul S, Nagarajan L, Ghosh S, Rao S. Amplitude-integrated EEG for detection of neonatal seizures: a systematic review. Seizure. 2015;33:90-8. http://dx.doi.org/10.1016/j.seizure.2015.09.014 www.ncbi.nlm.nih.gov/pubmed/26456517
7. Nagarajan L, Palumbo L, Ghosh S. Neurodevelopmental outcomes in neonates with seizures: a numerical score of background encephalography to help prognosticate. J Child Neurol. 2010; 25(8):961-8. http://dx.doi.org/10.1177/0883073809355825 www.ncbi.nlm.nih.gov/pubmed/20223749
8. Sheth RD, Hobbs GR, Mullett M. Neonatal seizures:incidence, onset, and etiology by gestational age. J Perinatol. 1999;19(1):40–3. www.ncbi.nlm.nih.gov/pubmed/10685200
9. Heljic S, Uzicanin S, Catibusic F, Zubcevic S. Predictors of Mortality in Neonates with Seizures; a Prospective Cohort Study. Med Arch. 2016; 70(3): 182-185. www.ncbi.nlm.nih.gov/pubmed/27594742
10. Chang T, N Tsuchida T. Conventional (continuous) EEG monitoring in the NICU. Current pediatric reviews. 2014;10(1):2-10.
11. Pisani F, Spagnoli C. Monitoring of newborns at high risk for brain injury. Italian journal of pediatrics. 2016;42(1):48.
12. Ben-Ari Y, Holmes GL. Effects of seizures on developmental processes in the immature brain. Lancet Neurol.2006;5(12):1055-63. www.ncbi.nlm.nih.gov/pubmed/17110286
13. Murray DM, Boylan GB, Ali I, Ryan CA, Murphy BP, Connolly S. Defining the gap between electrographic seizure burden, clinical expression and staff recognition of neonatal seizures. Arch Dis Child Fetal Neonatal Ed. 2008;93(3):F187-91. http://dx.doi.org/10.1136/adc.2005.086314 www.ncbi.nlm.nih.gov/pubmed/17626147
14. Bok LA, Halbertsma FJ, Houterman S, Wevers RA, Vreeswijk C, Jakobs C, et al. Long‐term outcome in pyridoxine‐dependent epilepsy. Developmental Medicine & Child Neurology. 2012;54(9):849-54.
15. Panayiotopoulos CP. The Epilepsies: Seizues, Syndromes and management. Blandon Medical publishing. Oxfordshire (UK);2005. Chapter 5. www.ncbi.nlm.nih.gov/books/NBK2599
16. Glass HC, Sullivan JE. Neonatal seizures. Current treatment options in neurology. 2009;11(6):405-13.
17. Glass HC, Grinspan ZM, Shellhaas RA, editors. Outcomes after acute symptomatic seizures in neonates. Seminars in Fetal and Neonatal Medicine; 2018: Elsevier.
18. Rakshasbhuvankar A, Paul S, Nagarajan L, Ghosh S, Rao S. Amplitude-integrated EEG for detection of neonatal seizures: a systematic review. Seizure. 2015;33:90-8. http://dx.doi.org/10.1016/j.seizure.2015.09.014 www.ncbi.nlm.nih.gov/pubmed/26456517
19. Nagarajan L, Palumbo L, Ghosh S. Neurodevelopmental outcomes in neonates with seizures: a numerical score of background encephalography to help prognosticate. J Child Neurol. 2010; 25(8):961-8. http://dx.doi.org/10.1177/0883073809355825 www.ncbi.nlm.nih.gov/pubmed/20223749
20. Boylan G, Burgoyne L, Moore C, O'Flaherty B, Rennie J. An international survey of EEG use in the neonatal intensive care unit. Acta Paediatr. 2010;99(8):1150-5. http://dx.doi.org/10.1111/j.1651-2227.2010.01809.x www.ncbi.nlm.nih.gov/pubmed/20353503
21. Malone A, Ryan CA, Fitzgerald A, Burgoyne L, Connolly S, Boylan GB. Interobserver agreement in neonatal seizure identification. Epilepsia 2009;50:2097–101. www.ncbi.nlm.nih.gov/pubmed/19490044
22. Martin RJ, Fanaroff AA, Walsh MC. Fanaroff and Martin's Neonatal-Perinatal Medicine E-Book: Diseases of the Fetus and Infant: Elsevier Health Sciences; 2010.
23. Abend NS, Wusthoff CJ. Neonatal Seizures and Status Epilepticus. J Clin Neurophysiol. 2012;29(5):441-8. www.ncbi.nlm.nih.gov/pubmed/23027101
24. Thorngate L, Foreman SW, Thomas KA. Quantification of neonatal amplitude-integrated EEG patterns. Early Hum Dev. 2013;89(12):931-7. http://dx.doi.org/10.1016/j.earlhumdev.2013.09.018 www.ncbi.nlm.nih.gov/pubmed/24120246
25. Toet MC, Lemmers PM. Brain monitoring in neonates. Early Hum Dev. 2009;85(2):77-84. http://dx.doi.org/10.1016/j.earlhumdev.2008.11.007 www.ncbi.nlm.nih.gov/pubmed/19150756
26. Meledin I, Abu Tailakh M, Gilat S, Yogev H, Golan A, Novack V, et al. Comparison of Amplitude-Integrated EEG and Conventional EEG in a Cohort of Premature Infants. Clin EEG Neurosci. 2017;48(2):146-54. http://dx.doi.org/10.1177/1550059416648044 www.ncbi.nlm.nih.gov/pubmed/27230038
27. Kadivar M, Mosayebi Z, Badv RS, Sangesari R, et al. Evaluation of the efficacy of amplitude-integrated electroencephalography in the screening of newborns with metabolic disorder admitted to the NICU. BMC Med Imaging. 2018 Sep 20;18(1):33. doi: 10.1186/s12880-018-0274-4. PMID: 30236069; PMCID: PMC6148992.
28. Gucuyener K. Use of Amplitude-integrated electroencephalography in neonates with special emphasis on Hypoxic-ischemic encephalopathy and therapeutic hypothermia. J Clinl Neonat. 2016;5(1):18-30. http://dx.doi.org/10.4103/2249-4847.173272
29. Shah NA, Wusthoff CJ. How to use: amplitude-integrated EEG (aEEG). Arch Dis Child Educ Pract Ed. 2015;100(2):75-81. http://dx.doi.org/10.1136/archdischild-2013-305676 www.ncbi.nlm.nih.gov/pubmed/25035312
30. Neubauer, Osredkar D, Paro-Panjan, Skofljanec A, Derganc M. Recording conventional and amplitude-integrated EEG in neonatal intensive care unit. Eur J Paediatr Neurol. 2011;15(5): 405-16. www.ncbi.nlm.nih.gov/pubmed/21802965
31. Karpiński Ł, Mazela J. Amplitude-Integrated Electroencephalography Use in Preterm Infants: Current Knowledge and Applications. NeoReviews. 2015;16(9):e526-e34. http://dx.doi.org/10.1542/neo.16-9-e526
32. Tao JD, Mathur AM. Using amplitude-integrated EEG in neonatal intensive care. J Perinatol. 2010;30 Suppl:S73-81. http://dx.doi.org/10.1038/jp.2010.93 www.ncbi.nlm.nih.gov/pubmed/20877412
33. Hagmann CF, Robertson NJ, Azzopardi D. Artifacts on electroencephalograms may influence the amplitude-integrated EEG classification: a qualitative analysis in neonatal encephalopathy. Pediatrics. 2006;118(6):2552-4. http://dx.doi.org/10.1542/peds.2006-2519 www.ncbi.nlm.nih.gov/pubmed/17142543
34. Sanchez Fernandez I, Loddenkemper T. aEEG and cEEG: Two complementary techniques to assess seizures and encephalopathy in neonates: Editorial on "Amplitude-integrated EEG for detection of neonatal seizures: A systematic review" by Rakshasbhuvankar et al. Seizure. 2015;33:88-9. http://dx.doi.org/10.1016/j.seizure.2015.10.010 www.ncbi.nlm.nih.gov/pubmed/26560180
35. Spitzmiller RE, Phillips T, Meinzen-Derr J, Hoath SB. Amplitude-integrated EEG is useful in predicting neurodevelopmental outcome in full-term infants with hypoxic-ischemic encephalopathy: a meta-analysis. J Child Neurol. 2007;22:1069-78. http://dx.doi.org/10.1177/0883073807306258 www.ncbi.nlm.nih.gov/pubmed/17890403
36. Theda C. Use of amplitude integrated electroencephalography (aEEG) in patients with inborn errors of metabolism - a new tool for the metabolic geneticist. Mol Genet Metab. 2010;100 Suppl 1:S42-8. http://dx.doi.org/10.1016/j.ymgme.2010.02.013 www.ncbi.nlm.nih.gov/pubmed/20303809
37. Osredkar D, Deganc M, Paro-panjan D, Neubauer D. Amplitude-integrated encephalography in full-term newborns without sever hypoxic-ischemic encephalopathy: Case Series. Croat med J. 2006;47:285-91. www.ncbi.nlm.nih.gov/pubmed/16625694