Abstracts

Rationale: Continuous electroencephalogram (cEEG) in the Neonatal Intensive Care Unit (NICU) is the gold standard for detection of seizures and abnormal electrical activity in the brain.¹ It has been noted that skin breakdown can occur as a result of prolonged electrode placement in contact with the newborn scalp. Our institution has implemented a monitoring protocol to allow technicians to document the condition of the skin of patients who are undergoing cEEG in an attempt to identify those at risk of developing skin breakdown and prevent serious complications. Findings are recorded on a skin monitoring sheet. There has been no literature reporting the incidence of skin breakdown or complications arising as a result of cEEG monitoring. Methods: Patients admitted to the NICU that underwent cEEG from 12/2013 to 5/2014 were identified from patient logs. Chronological and gestational age and sex, indication and length of monitoring, anti-epileptic medication treatment and EEG results were tabulated. The types of EEG electrodes and affixing method were reported. The degree of skin breakdown and any resultant associated complications noted. Results: 16 cEEGs were performed on 10 patients in the NICU from 12/2013 to 5/2014. Prior to applying the electrodes, the skin was prepped by using Weaver and Company NuPrep gel for skin abrasion. Grass gold 10mm cup electrodes with Ten20 conductive paste was used. Hydrodot EEG SkinSaver pads were used when the electrodes were applied to bare skin in 25% of patients. The FP1, FP2, A1 and A2 electrodes were Natus disposable silver/silver chloride pre-gelled 20mm diameter electrode disks. The most common monitoring indication was suspicion of seizure in 9 of the 16 studies (56%). The gestational age ranged from 32 to 40 weeks, with a median age of 34 weeks. The age at the time of monitoring ranged from 1 day to 15 days old, with the mean age of 7.8 days. The monitoring length ranged from 1 to 24 hours, with a modal length of 24 hours. The most common comorbid condition was hypoxic-ischemic encephalopathy present in 4 of 10 patients (40%); 2 of which underwent induced hypothermia. The EEGs were normal in 5 of 16 studies (31%). The most common abnormality was background attenuation. Seizures were captured on two different studies performed on the same patient. The most common antiepileptic was phenobarbital, used in 5 patients (50%). Skin breakdown was noted in 1 of 16 studies in the location of C3 electrode and there was no SkinSaver pad used. No adverse event or extended length of stay was noted. Conclusions: cEEG monitoring in the NICU has been demonstrated to be a safe and effective way of detecting seizures and abnormal brain activity in infants. Pasting and wrapping electrodes with the use of flat leads over the bony prominences and utilizing skin savers, is an efficient method to prevent serious complications which can potentially lead to longer length of hospital stay. Implementation of a skin monitoring program to document skin abnormalities is an important tool to successfully identify any potential adverse events that may occur as a result of cEEG monitoring.