Amplitude-integrated EEG use in neonatal abstinence syndrome: a pilot study

<b>Objective:</b> Though central nervous system irritability is a well-established consequence of neonatal drug withdrawal, brain function in infants with neonatal abstinence syndrome (NAS) is not well understood. Amplitude-integrated electroencephalography (aEEG) is a bedside tool used for monitoring brain activity and seizures. We describe the prevalence of abnormal aEEG background patterns in infants with NAS. <b>Methods:</b> In this pilot, observational study primary outcomes were aEEG findings, Finnegan scores, and length of hospital stay in NAS patients. Subjects underwent an initial aEEG and a repeat study following pharmacologic treatment. Two independent reviewers analyzed aEEGs post discharge. <b>Results:</b> Six out of nine infants had abnormal aEEGs demonstrating lack of sleep-wake cycling (SWC) (50%), discontinuity (41.7%), and low voltage (8.3%). Seizures were not detected. NAS scores were lower for infants with continuous aEEGs versus those whose aEEGs were not continuous (5.83 versus 9.17; <i>p</i> = .054). Length of stay was 7.8 ± 4.4 days in infants with continuous aEEGs versus 26 ± 10.5 days in infants without continuous aEEGs (<i>p</i> = .003). <b>Conclusions:</b> Infants exposed to opioids <i>in utero</i> are at increased risk for discontinuity and abnormal SWC detectable on aEEG. Infants with abnormal aEEGs are more likely to have higher NAS scores, require pharmacologic treatment and have longer lengths of stay.

**研究目的：** 尽管中枢神经系统激惹是新生儿药物戒断的公认结局，但新生儿戒断综合征（Neonatal Abstinence Syndrome, NAS）患儿的脑功能状态尚未得到充分阐明。振幅整合脑电图（amplitude-integrated electroencephalography, aEEG）是一项用于床旁监测脑活动与痫性发作的检测技术。本研究旨在明确NAS患儿异常aEEG背景模式的患病率。
**研究方法：** 本项观察性预试验的主要结局指标为NAS患儿的aEEG表现、芬尼根评分（Finnegan Score）以及住院时长。所有受试者均接受初始aEEG检测，并在药物治疗后复查aEEG。两名独立评审员在患儿出院后对其aEEG结果进行分析。
**研究结果：** 9例受试患儿中6例aEEG结果异常，具体表现为睡眠-觉醒周期（sleep-wake cycling, SWC）缺失（50%）、背景活动不连续（41.7%）以及低电压（8.3%），未检测到痫性发作。aEEG背景活动连续的患儿其NAS评分低于aEEG背景活动不连续的患儿（5.83 vs 9.17；p=0.054）。aEEG背景活动连续的患儿住院时长为7.8±4.4天，而aEEG背景活动不连续的患儿住院时长为26±10.5天（p=0.003）。
**研究结论：** 宫内暴露于阿片类药物的新生儿，其aEEG检测出背景活动不连续及睡眠-觉醒周期异常的风险显著升高。aEEG结果异常的患儿往往具有更高的NAS评分、更需接受药物治疗且住院时长更长。