Cooling and seizure burden in term neonates: an observational study.
OBJECTIVE
To investigate any possible effect of cooling on seizure burden, the authors quantified the recorded electrographic seizure burden based on multichannel video-EEG recordings in term neonates with hypoxic-ischaemic encephalopathy (HIE) who received cooling and in those who did not.


METHODS
Retrospective observational study.


METHODS
Neonates >37 weeks gestation born between 2003 and 2010 in two hospitals.


METHODS
Off-line analysis of prolonged continuous multichannel video-EEG recordings was performed independently by two experienced encephalographers. Comparison between the recorded electrographic seizure burden in non-cooled and cooled neonates was assessed. Data were treated as non-parametric and expressed as medians with interquartile ranges (IQR).


RESULTS
One hundred and seven neonates with HIE underwent prolonged continuous multichannel EEG monitoring. Thirty-seven neonates had electrographic seizures, of whom 31 had EEG recordings that were suitable for the analysis (16 non-cooled and 15 cooled). Compared with non-cooled neonates, multichannel EEG monitoring commenced at an earlier postnatal age in cooled neonates (6 (3-9) vs 15 (5-20) h)and continued for longer (88 (75-101) vs 55 (41-60) h). Despite this increased opportunity to capture seizures in cooled neonates, the recorded electrographic seizure burden in the cooled group was significantly lower than in the non-cooled group (60 (39-224) vs 203 (141-406) min). Further exploratory analysis showed that the recorded electrographic seizure burden was only significantly reduced in cooled neonates with moderate HIE (49 (26-89) vs 162 (97-262) min).


CONCLUSIONS
A decreased seizure burden was seen in neonates with moderate HIE who received cooling. This finding may explain some of the therapeutic benefits of cooling seen in term neonates with moderate HIE.
Neonatal Brain Research Group, Department of Paediatrics and Child Health, University College Cork, Ireland.
Evonne
E
Low
Geraldine B
GB
Boylan
Sean R
SR
Mathieson
Deirdre M
DM
Murray
Irina
I
Korotchikova
Nathan J
NJ
Stevenson
Vicki
V
Livingstone
Janet M
JM
Rennie
D000927:Anticonvulsants / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004569:Electroencephalography / Q000379:methods; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D020925:Hypoxia-Ischemia, Brain / Q000150:complications / Q000628:therapy; D007224:Infant Care / Q000379:methods; D007231:Infant, Newborn; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D012189:Retrospective Studies; D003294:Seizures, Febrile / Q000175:diagnosis / Q000517:prevention & control*; D016896:Treatment Outcome
D000927:Anticonvulsants