Hospital Sepaco advances in brain monitoring in neonatal ICU

One of the greatest challenges in a Neonatal ICU, detecting the "silent" risks to a baby's health, has an important ally in the continuous monitoring of the newborn's brain function. In partnership with Protecting Brains Saving Futures (PBSF), the Hospital e Maternidade Sepaco – ranked among the best hospitals in the world in Pediatrics for three consecutive years, according to the World’s Best Specialized Hospitals ranking – has, as of January this year, treated 665 babies with the resource that allows for the early detection of brain abnormalities or dysfunctions, preventing injuries that could compromise the child's entire life.​

Hospital Sepaco, located in São Paulo, has been offering this service since 2017, totaling 45,944 hours of brain electrical activity monitoring in neonates and young infants with a wide range of diagnoses, including, among others, perinatal asphyxia, seizures, prematurity, congenital heart disease, and children undergoing extracorporeal membrane oxygenation (ECMO) therapy. Over these seven years, 29% of the analyzed cases involved epileptic seizures without clinical manifestation, diagnosed exclusively thanks to this type of monitoring. Another relevant statistic is the diagnostic exclusion of seizures, safely avoiding the use of medication in 74% of children monitored for suspected seizures, and the positive psychological impact this has on the family.​

But the function of aEEG goes far beyond seizure detection. Monitoring brain electrical activity allows for the prediction of the outcome a child will have after suffering acute brain damage (cardiac surgery, severe infections, traumatic brain injury, cardiopulmonary arrest, etc.). The psychological impact this information can have on the family is highly significant.​

"The faster we detect a neurological dysfunction, the greater the chance of early intervention and achieving good clinical outcomes, allowing not only the child's survival but also their discharge with quality of life and preservation of their neurological potential."

Seizures are very frequent in the ICU, for example, after cardiac surgeries or after a cardiopulmonary arrest. Approximately one-third of them have no motor manifestation. In these cases, the only way to know that the child is seizing is through electroencephalographic monitoring," explains the Coordinator of the Neonatal and Pediatric ICU at Hospital e Maternidade Sepaco, Lúcio Peixoto de Lima.

A reference in Neonatology, Pediatric Intensive Care, and Pediatric Cardiac Surgeries of high complexity, the hospital uses a multimodal neurological monitoring model, which includes non-invasive exams such as electroencephalogram, NIRS, and transcranial Doppler flowmetry, in addition to invasive monitoring measures (e.g., intracranial pressure monitoring). According to neonatologist pediatrician Gabriel Variane, founder of PBSF, Sepaco is a center with vast experience in the use of this solution, which still faces challenges for adoption worldwide.​

"Despite its growing use in various states and countries, there is still a very significant challenge in bringing highly specialized care to multiple centers around the world, and this is even described in first-world countries like the United States. In recent years, neonatology has made very important advances; we have managed to reduce child mortality, and the great challenge at this exact moment is to maintain their quality of life, that is, to prevent permanent neurological sequelae in this population," says Variane.​

Among the neurological injuries that can be prevented with the resource are cerebral palsy, cognitive impairment, and blindness.