The American Clinical Neurophysiology Society Guideline on Indications for Continuous Electroencephalography Monitoring in Neonates

Courtney J. Wusthoff, Department of Neurology, University of California, Davis, Sacramento, CA.
Adam L. Numis, Department of Neurology and Weill Institute for Neuroscience, University of California San Francisco, San Francisco, CA.
Ronit M. Pressler, Clinical Neuroscience, UCL-Great Ormond Street Institute of Child Health and Great Ormond Street Hospital, London, Great Britain.
Catherine J. Chu, Divisions of Child Neurology and Neurophysiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Shavonne Massey, Departments of Neurology and Pediatrics, University of Pennsylvania, and the Children's Hospital of Philadelphia, Philadelphia, PA.
Robert R. Clancy, Departments of Neurology and Pediatrics, University of Pennsylvania, and the Children's Hospital of Philadelphia, Philadelphia, PA.
Sylvie Nguyen, CHU Lille, Child Neurology Unit, Lille, France.
Cecil D. Hahn, Division of Neurology, The Hospital for Sick Children and Department of Paediatrics, University of Toronto, Toronto, Canada.
Mark S. Scher, Case Western Reserve University School of Medicine, Cleveland, OH.
Betsy Pilon, Hope for HIE, West Bloomfield, MI.
Donald T. King, Children's Hospital of Alabama, Birmingham, AL.
Hong-Nei Wong, Lane Medical Library, Stanford University School of Medicine, Palo Alto, CA.
Tammy N. Tsuchida, Departments of Neurology and Pediatrics, George Washington University School of Medicine and Health Sciences, Children's National Hospital, Washington, DC.
James J. Riviello, Division of Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospita, Houston, TX; and.
Renée A. Shellhaas, Department of Neurology, Washington University in St Louis, St. Louis, MO.

Document Type

Journal Article

Publication Date

1-1-2025

Journal

Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society

Volume

42

Issue

1

DOI

10.1097/WNP.0000000000001120

Abstract

PURPOSE: Continuous EEG (cEEG) monitoring is increasingly used in the management of neonates with seizures. There remains debate on what clinically relevant information can be gained from cEEG in neonates with suspected seizures, at high risk for seizures, or with definite seizures, as well as the use of cEEG for prognosis in a variety of conditions. In this guideline, we address these questions using American Clinical Neurophysiology Society structured methodology for clinical guideline development. METHODS: A working group was formed from American Clinical Neurophysiology Society membership with expertise in neonatal cEEG and a set of priority questions developed. We performed literature searches in PubMed and EMBASE to identify relevant studies. Evidence tables were compiled from extracted data and quality assessments performed. A modification of the GRADE process was used to evaluate the body of evidence and draft recommendations. RESULTS: Our working group identified six priority questions to evaluate the accuracy of cEEG for neonatal seizure diagnosis and the formulation of prognosis. An initial literature search yielded 18,167 results, which were distilled to a set of 217 articles. Overall, the quality of evidence for most priority questions was rated as very low and we provided conditional recommendations based on published literature and expert consensus. For each priority question, we also considered the benefits and harms of cEEG, with relative harms considered to be far less than the potential benefits across recommendations. CONCLUSIONS: We present evidence-based clinical guidelines regarding indications for cEEG monitoring in neonates. Considering resource utilization and feasibility, when cEEG monitoring results have a likelihood of altering clinical decision making, the authors felt the resource investment was justifiable.

Department

Neurology

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