Cerebral function monitoring in term or near term neonates at MDH : preliminary experience and proposal of a guideline

Abstract

Introduction: Cerebral function monitoring (CFM) is a simplified EEG device that is used to monitor cerebral function at the cot-side. Various studies have shown its value in detecting neonatal encephalopathy and electrographic seizures, prognostication of neonatal cerebral insults, assessment of response to anticonvulsant therapy and in selecting encephalopathic infants for therapeutic hypothermia. This paper describes our preliminary experience with this monitoring device at Mater Dei Hospital, and a draft of a protocol for its clinical application. Methods: Fourteen recordings were performed on neurologically normal and abnormal term neonates. The quality of the records and their correlation with other imaging and standard EEG findings was assessed. A dataset including technical and clinical particulars of these cases was then compiled, analyzed and discussed. Results: Amplitude aEEG traces were recorded from a total of 14 patients, 4 of whom were normal term or near term infants, and 10 were infants with a neurological abnormality. All records were of satisfactory quality, and all showed very high impedance levels. Five out of 11 neurologically-abnormal patients had signs of seizure activity on CFM. A technical fault caused high impedance level in the first 2 traces. Annotations were generally lacking. Five out of 10 infants with CNS problems had clinical seizures of which 4 had electrographic seizures on CFM, 4 had electrographic seizures on formal EEG, and 3 had abnormal MRI findings. Conclusion: Our local experience has confirmed the usefulness of CFM monitoring in the setting of a neonatal intensive care unit. Despite some initial problems with high impedance levels and electrode attachment, the tracings obtained were reproducible and of good quality. Almost half of the neurologically-abnormal neonates showed signs of seizure activity on CFM with good correlation with clinical and standard EEG. The timely diagnosis enabled the clinicians to confirm seizure activity, initiate anticonvulsant therapy and monitor the response. Staff training is vital in order to improve utilisation of CFM in neonatal practice.