However, in their discussion the authors argue that their findings support routine electroencephalogram (EEG) monitoring of newborn infants with hypoxic ischaemic encephalopathy (HIE), and infer that because of “ethical concerns” large multi-centre trials of EEG monitoring should not occur. It confirms findings from previous studies that greater seizure burden is associated with more severe brain injury, and that pharmacological treatment reduces electrical seizures.
EEG FOR SEIZURES TRIAL
The paper by Sreenivasakumar et al(1) is a valuable addition to the small existing randomized trial literature on monitoring and treatment of seizures in newborn infants. Short-term outcomes after perinatal hypoxic ischemic encephalopathy: a report from the Children's Hospitals Neonatal Consortium HIE focus group. The American Clinical Neurophysiology Society's Guideline on Continuous Electroencephalography Monitoring in Neonates.
Wilkinson and Stenson on the importance of answering the question of the long-term benefits of EEG monitoring in neonatal HIE with a large, appropriately powered, randomized clinical trial, but such a trial would only be feasible in a country/region where equipoise still exists in clinical practice on the benefits of EEG monitoring in neonatal HIE.ġ. At least in the USA, there is no longer equipoise in the neonatal intensive care and pediatric neurology community on the benefits of EEG monitoring in neonatal hypoxic-ischemic encephalopathy (HIE). In a recent review published from the Children’s Hospital Neonatal Consortium (CHNC) Database, a collaborative neonatal database of 27 regional NICUs from Children’s Hospitals across the USA, 78% of infants admitted for neonatal encephalopathy and therapeutic hypothermia underwent conventional EEG and/or amplitude integrated EEG monitoring in the first 24 hours of life2. These guidelines, while acknowledging lack of data on the long term benefit of this practice, nevertheless recommend EEG monitoring for at least 24 hours in all infants admitted with neonatal encephalopathy. The reason we discuss the ethical dilemma around such a potential trial is based on clinical practice recommendations from the American Clinical Neurophysiology Society (ACNS)1. This will need a larger multicenter effort. As they point out, and as we state in our article, our study was not powered, a priori, to address the impact of treating EEG seizures on neurodevelopmental outcomes. Wilkinson and Stenson for their comments on our clinical trial.