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

Objective: 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.Methods: 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.Results: 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; p = .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 (p = .003).Conclusions: Infants exposed to opioids in utero 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.

Effects of Maternal Magnesium Sulfate Treatment on Neonatal Feeding Tolerance.

OBJECTIVE: To determine whether antenatal exposure to magnesium sulfate has an effect on neonatal enteral feeding tolerance. METHODS: In this single-center, retrospective, observational study, charts of pregnant women who received intravenous magnesium sulfate infusions prior to delivery between July 1, 2012, and July 31, 2013, were reviewed. Neonates born at 24 weeks' gestational age or greater admitted to the neonatal intensive care unit (NICU) whose mothers received magnesium sulfate infusions prior to delivery were included. Neonates with independent factors that could lead to feeding intolerance were excluded. The primary outcome was incidence of neonatal enteral feeding intolerance measured by deviations from the NICU feeding protocol. Secondary outcomes included days on parenteral nutrition, incidence of necrotizing enterocolitis, time to first stool, and urine output in the first 72 hours of life. RESULTS: Cumulative maternal magnesium sulfate dose was significantly higher in the enteral feeding intolerance group than those infants who tolerated enteral feeds (70.4 ± 52.3 vs 47.4 ± 40.1 g; p = 0.04). Infants exposed to more than 80 g of maternal magnesium sulfate therapy were more likely to develop enteral feeding intolerance (44% vs 22%; p = 0.04). Multivariate logistic regression indicated that prematurity and cumulative maternal magnesium sulfate dose were the strongest predictors of neonatal enteral feeding intolerance. CONCLUSIONS: Infants of mothers who received more than 80 g of intravenous magnesium sulfate prior to delivery were more likely to develop feeding intolerance. Prematurity also was a significant predictor of intolerance.