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Am J Perinatol 2024; 41(S 01): e290-e297
DOI: 10.1055/a-1877-9291
Original Article

An Amplitude-Integrated EEG Evaluation of Neonatal Opioid Withdrawal Syndrome

Christopher Lust
1   Department of Neonatology, Children's Minnesota NICU, St. Louis, Missouri
,
Zachary Vesoulis
2   Division of Newborn Medicine, Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri
,
John Zempel
3   Department of Neurology, Washington University in St Louis School of Medicine, St Louis, Missouri
,
Hongjie Gu
4   Division of Biostatistics, Washington University School of Medicine, St. Louis, Missouri
,
Stephanie Lee
2   Division of Newborn Medicine, Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri
,
Rakesh Rao
2   Division of Newborn Medicine, Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri
,
Amit M. Mathur
5   Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Saint Louis University, St. Louis, Missouri
› Author Affiliations Funding The Barnes-Jewish Hospital Foundation and the Washington University Institute of Clinical and Translational Sciences provided funding for this study (NIH/NCATS UL1 TR000448).
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Abstract

Objective Infants with neonatal opioid withdrawal syndrome (NOWS) have disrupted neurobehavior that requires hospitalization and treatment. This article aimed to evaluate electroencephalography (EEG) abnormalities using amplitude-integrated EEG (aEEG) in NOWS.

Study Design Eighteen term born infants with NOWS were recruited prospectively for an observational pilot study. aEEG monitoring was started within 24 hours of recruitment and twice weekly through discharge. aEEG data were analyzed for background and seizures. Severity of withdrawal was monitored using the modified Finnegan scoring (MFS) system.

Results Fifteen neonates had complete datasets. Thirteen (87%) had continuous aEEG background in all recordings. None had sleep–wake cyclicity (SWC) at initial recording. Brief seizures were noted in 9 of 15 (60%) infants. Lack of SWC was associated with higher MFS scores. At discharge, 8 of 15 (53%) had absent or emerging SWC.

Conclusion aEEG abnormalities (absent SWC) are frequent and persist despite treatment at the time of discharge in the majority of patients with NOWS. Brief electrographic seizures are common. Neonates with persistent aEEG abnormalities at discharge warrant close follow-up.

Key Points

  • EEG abnormalities are common and persist after clinical signs resolve in patients with NOWS.

  • Short subclinical seizures may be seen.

  • aEEG may identify neonates who need follow-up.

Keywords

amplitude-integrated EEG - neonatal opioid withdrawal syndrome - neonatal sleep–wake cyclicity - neonatal seizures - modified Finnegan score

Authors' Contributions

C.L. conceptualized and designed the study, organized data collection, enrolled patients and collected data, conducted statistical analysis, drafted the initial manuscript, and reviewed and revised the manuscript.


Z.V. assisted with data analysis, reviewed, and revised the final manuscript.


J.Z. assisted with analyzing aEEG data and reviewed/edited the final manuscript.


H.G. conducted statistical analysis and reviewed the manuscript.


S.L. was the second independent blinded reviewer of the aEEG traces.


R.R. assisted with study design, reviewed, and revised the final manuscript.


A.M.M. conceptualized design of the study and data collection process, and critically reviewed and revised the final manuscript for important intellectual content.


All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.




Publication History

Received: 21 October 2021

Accepted: 01 June 2022

Accepted Manuscript online:
16 June 2022

Article published online:
12 September 2022

© 2022. Thieme. All rights reserved.

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333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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