System identifies epileptic seizures in babies – 01/05/2024 – Health

It was at the Itanhaém Regional Hospital, where she works, located in the city of Itanhaém, in Baixada Santista, that nurse Ailda dos Santos Nascimento, 40, understood the importance of the hypothermia protocol and brain monitoring for high-risk newborns. First, as a healthcare professional and, in August 2020, as Nicolas’ mother.

The birth was difficult, the baby was born pale and did not cry. He was intubated and taken to the neonatal ICU. There, he had his body cooled to 33.5°C and had electrodes applied to his head. Monitoring brain activity made it possible to identify epileptic seizures that were imperceptible to the naked eye and Nicolas received the appropriate medication.

“As a mother, I’m grateful because, if there wasn’t monitoring, we wouldn’t realize that my son was having a crisis. And, as a nurse, I think it’s important because it prevents neurological damage in children,” she says. Nicolas had no consequences and is a talkative and smart boy, his mother highlights.

Cases like Nicolas’s were reported in a scientific article published in the Jama Network Open magazine. The text points out that in a set of 872 babies subjected to hypothermia with monitoring of brain activity, 296 (33.9%) had epileptic seizures. Of these, 213 (71.9%) did not manifest any clinical signs, such as seizures, and were diagnosed exclusively by brain wave variation.

“The greater the burden of epileptic seizures, the greater the risk of permanent brain damage. If we can detect it, we treat it appropriately and we will have a better prognosis”, says Gabriel Variane, medical director of the Neurological Neonatal ICU at Santa Casa de São Paulo and first study author.

Santa Casa was a pioneer in providing neuroprotective hypothermia for children with perinatal asphyxia. According to the WHO (World Health Organization), lack of oxygenation before, during or after birth is the third leading cause of neonatal death, representing 23% of newborn deaths, and is among the main reasons for permanent brain injuries. . In Brazil, the estimate is 20 thousand cases of perinatal asphyxia per year.

Brain damage caused by asphyxiation has two phases, explains Maurício Magalhães, head of neonatology at Santa Casa and co-author of the study. The first is the lack of oxygenation itself. The second usually occurs between 6 and 72 hours after resuscitation. At this stage, substances are released that kill neurons, causing permanent damage and affecting the child’s development. The reduction in body temperature for 72 hours, followed by slow rewarming, reduces the dispersion of neurotoxic free radicals and, thus, the risk of death and serious neurological sequelae.

Asphyxia is also the main cause of epileptic seizures in the neonatal period, points out Variane. But it is not the only situation in which monitoring brain activity is indicated. Monitoring is also adopted in case of atypical movements, central nervous system infection, malformations and for premature babies.

“We published the experience of 872 babies undergoing hypothermia protocol, but we are very close to reaching the mark of 10 thousand babies monitored, considering all indications. Today, we have the largest experience in monitoring newborns in the world”, says Variane.

The number is possible because, unlike that carried out by institutions such as Stanford University, a partner in the research, the system operated by the Brazilian team brings together information from several hospitals. There are currently 47, with simultaneous monitoring of dozens of newborns.

The data is presented in real time on panels at the headquarters of PBSF (Protecting Brains and Saving Futures), a company created by Variane to expand the offer of brain monitoring. Thanks to a partnership with Microsoft, they are also available in the cloud, which allows the 22 doctors on the team to monitor babies from anywhere.

When they observe a possibly pathological pattern in brain activity, they contact the hospital where the child is admitted and alert them to the change. In addition to epileptic seizures, experts analyze the sleep-wake cycle, associated with the baby’s prognosis, and symmetry, which allows bleeding in the brain to be identified.

If necessary, the child receives anticonvulsants and the situation is discussed between the teams, in real-time consultation. “It’s a strategy that enables homogeneity of care between hospitals that have different amounts of resources”, highlights Variane.

For Magalhães, who was Variane’s teacher and almost the entire PBSF team, where he serves as scientific director, it is a life project. “It started inside the Santa Casa de São Paulo, treating hypothermia with an ice pack, looking for partnerships. It’s exciting.”