Neonatal Seizure/Status Epilepticus — Guidance on EEG Monitoring — Clinical Pathway: N/IICU

Neonatal Seizure/Status Epilepticus Clinical Pathway — N/IICU

Guidance on EEG Monitoring

Seizure Diagnosis

  • Continuous EEG (cEEG) is the gold standard screening approach. Amplitude integrated EEG (aEEG) may be reasonable in some situations but has limitations.
  • Only focal clonic and focal tonic-clonic seizures can be reliably diagnosed by clinical observation alone.
  • All other paroxysmal events suspected to be seizures or aEEG events require assessment with cEEG.
  • Consider transfer to N/IICU with cEEG capability.

EEG Types

Continuous EEG
(cEEG)
  • Gold standard for background assessment and trajectory
  • Gold standard for seizure screening and management
  • Should include time-locked video
Routine EEG
(Spot EEG)
  • Rarely indicated for neonates
  • Background assessment
  • Not effective for seizure screening or management
Amplitude Integrated EEG (aEEG)
  • Interpreted by neonatologist at bedside
  • May assess background
  • May over-call seizures (false positives) or under-call seizures (false negatives)
  • Confirm suspected seizures with cEEG