CHOP study finds remote monitoring effectively detects seizures in at-risk newborns

June 22, 2020

Philadelphia, June 22, 2020 - A team of researchers from Children's Hospital of Philadelphia (CHOP) has demonstrated how to easily and effectively monitor for seizures in newborn infants, catching more instances than typical methods and improving the quality of care for infants in hospitals that lack the on-site resources to detect these seizures. The findings were published today in the Journal of Clinical Neurophysiology.

"This study allowed us to test a framework for expanding remote continuous monitoring of at-risk neonates, beginning at two regional affiliate hospital NICUs within our network," said Mark P. Fitzgerald, MD, PhD, a pediatric neurologist in the Division of Neurology at CHOP and lead author of the study. "Not only did we show that such monitoring was technically feasible and effective, allowing neonates to receive care locally, but we also demonstrated that the approach positively impacted clinical care."

A variety of underlying conditions, including an acquired structural injury to the brain, ischemic stroke, and intracranial hemorrhage, are responsible for neonatal seizures, which occur in as many as 4 of every 1,000 live births. Continuous electroencephalogram (CEEG) monitoring is important for identifying seizures, since more than 80% of these seizures do not have any identifiable symptoms. Even skilled clinicians must rely on this technology to identify these seizures when they occur, and an accurate diagnosis is critical in making sure that these newborns receive the appropriate amount of anti-seizure medication.

Although the American Clinical Neurophysiology Society and World Health Organization have recommended CEEG as the gold standard for seizure identification, there are barriers to implementing its use in neonatal intensive care units, including lack of equipment and experienced personnel. Many centers have used amplitude-integrated EEG (aEEG) monitoring instead, but its sensitivity for seizure detection is lower than CEEG.

In order to overcome some of the barriers preventing widespread adoption of CEEG, the researchers developed a framework to use the technology remotely to monitor for seizures. Under this framework, a network hospital identifies a newborn who should undergo CEEG based on clinical concerns, such as therapeutic hypothermia or unexplained encephalopathy, or concern for seizures that may not otherwise be detected. Once these newborns have been identified, an EEG technologist at the network hospital places the EEG leads and gathers a set of standardized clinical data, notifying an EEG technologist at the main hospital (in this instance, CHOP).

The study team reviewed the EEG results and clinical care notes of the newborns monitored during the first 27 months of the pilot program. Between June 2017 and September 2019, 76 newborns underwent CEEG between the two network hospital NICUs. Seizures occurred in about one-quarter of the records. According to the care notes, CEEG impacted clinical care in three-quarters of the cases, decisions to treat with anti-seizure medications in approximately half of the patients, and discussions about the future course of care in approximately two-thirds of patients.

"In the first two years of this pilot program, we demonstrated that neonatal seizures are common in at-risk neonates and that CEEG often impacted outcomes," Fitzgerald said. "By providing remote CEEG to network hospitals, we allow these neonates to remain in centers that could meet their overall medical needs and alleviate the safety risks associated with transferring critically ill newborns between hospitals."
Fitzgerald et al. "Expanding access to continuous-EEG monitoring in neonatal intensive care units." J Clin Neurophysio. Online 9 June 2020. DOI: 10.1097/WNP.0000000000000730.

About Children's Hospital of Philadelphia: Children's Hospital of Philadelphia was founded in 1855 as the nation's first pediatric hospital. Through its long-standing commitment to providing exceptional patient care, training new generations of pediatric healthcare professionals, and pioneering major research initiatives, Children's Hospital has fostered many discoveries that have benefited children worldwide. Its pediatric research program is among the largest in the country. In addition, its unique family-centered care and public service programs have brought the 564-bed hospital recognition as a leading advocate for children and adolescents. For more information, visit

Children's Hospital of Philadelphia

Related Seizures Articles from Brightsurf:

Hallucinations in people with seizures may point to suicide risk
A study from scientists at Trinity College Dublin and Royal College of Surgeons in Ireland shows that 8% of individuals with a history of seizures report hallucinations, including experiences of hearing or seeing things that are not based in reality.

Epilepsy: Seizures not forecastable as expected
Epileptic seizures can probably not be predicted by changes in brain wave patterns that were previously assumed to be characteristic precursors.

Predicting epileptic seizures might be more difficult than previously thought
By studying the brain dynamics of 28 subjects with epilepsy, scientists demonstrated there is no evidence for a previously suspected warning sign for seizures known as 'critical slowing down,' which refers to characteristic changes in the behavior of a complex system that approaches a theoretical tipping point; when this point is exceeded, there can be impactful and devastating changes.

Gene protective against fruit fly heat-induced seizures may explain some human seizures
Researchers identified a gene in fruit flies that helps prevent the hyperexcitability of specific neurons that trigger seizures.

Rethinking seizures associated with cardiac disease
Research from Washington University in St. Louis finds that mutations of a gene implicated in long QT syndrome in humans may trigger seizures because of their direct effects on certain classes of neurons in the brain -- independent from what the genetic mutations do to heart function.

UTSA reduces seizures by removing newborn neurons
Epileptic seizures happen in one of every 10 people who have experienced a traumatic brain injury (TBI).

Reducing seizures by removing newborn neurons
Removing new neurons born after a brain injury reduces seizures in mice, according to new research in JNeurosci.

Inducing seizures to stop seizures
Surgery is the only way to stop seizures in 30 per cent of patients with focal drug-resistant epilepsy.

New research could help predict seizures before they happen
A new study has found a pattern of molecules that appear in the blood before a seizure happens.

New drug could help treat neonatal seizures
A new drug that inhibits neonatal seizures in rodent models could open up new avenues for the treatment of epilepsy in human newborns.

Read More: Seizures News and Seizures Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to