Impact of amplitude-integrated electroencephalograms on clinical care for neonates with seizures.

Amplitude-integrated electroencephalography (aEEG) was recently introduced into neonatal intensive care in the United States. We evaluated whether aEEG has changed clinical care for neonates with seizures. This study included all 202 neonates treated for seizures at our hospital from 2002-2007. Neonates monitored with aEEG (n = 67) were compared with contemporary control neonates who were not monitored, despite the availability of aEEG (n = 57), and a historic control group of neonates treated for seizures before our neonatal intensive care unit initiated aEEG (n = 78). Eighty-two percent of those receiving phenobarbital (137/167) continued treatment after discharge, with no difference among groups. Adjusted for gestational age and length of stay, no difference among groups was evident in number of neuroimaging studies or number of antiepileptic drugs per patient. Fewer patients undergoing aEEG, compared with contemporary (16/67 vs 29/57, respectively, P = 0.001) or historic (n = 38/78, P = 0.002) controls, were diagnosed clinically with seizures without electrographic confirmation. We conclude that aEEG did not increase neuroimaging tests, and did not alter antiepileptic drug use. However, diagnostic precision regarding neonatal seizures improved with aEEG because fewer neonates were treated for seizures based solely on clinical findings, without electrographic confirmation.