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An electroencephalogram (EEG) of a newborn shows unique features compared to that of older children and adults. This technique is the only clinically available one that can address the premature neonate's normal and abnormal functional development week after week. The abnormalities usually seen include background rhythm abnormalities, states and maturation, and neonatal seizures. The principles employed in identifying abnormalities emphasize the polyphasic sleep activity of newborns and the maturation of the brain. In adjunct to EEGs, the clinical context and neuroimaging results also play a crucial role in diagnosing and managing neonatal seizures. Many neonatal units employ simplified electroencephalographic techniques and amplitude-integrated EEG (aEEG) for rapid screening and monitoring. This activity covers essential features of abnormal EEGs in newborns and highlights the role of the interprofessional team in treating patients with this condition. Objectives: Evaluate abnormal EEG patterns in the newborn. Differentiate normal neonatal EEGs from abnormal or concerning neonatal EEG abnormalities. Determine the possible differential diagnosis of a patient with an abnormal neonatal EEG. Communicate interprofessional team strategies for improving care coordination and communication for patients diagnosed with an abnormal neonatal EEG. Access free multiple choice questions on this topic.

An electroencephalogram of a newborn shows unique features compared to those of older children and adults. This technique is the only clinically available study that addresses the premature neonate's normal and abnormal functional development week after week. EEG changes result from gradual structural and functional modifications during the last trimester of pregnancy. EEG features are classified according to whether they manifest endogenous generators, such as theta activities that coalesce with a slow wave or delta brushes or originate from a broader network.[1] Neonatal patterns evolve weekly based on the gestational age.[2] Moreover, delta brush, a common characteristic waveform of the human preterm electroencephalogram, represents spontaneous electrical activity. Recent studies suggested that delta brushes are also evoked by external sensory stimulation or spontaneous movement and reflect the activity of subplate neurons, which plays a significant role in early brain development and network organization.[3]

Neonates with abnormal EEGs require special attention. Early identification can help risk stratify them for more aggressive treatment. A dedicated team of neonatal nurses, pharmacists, neurologists, and neurophysiologists with state-of-the-art technology is essential in diagnosing and managing neonatal seizures. Recent studies showed that EEG background is highly associated with neurodevelopmental impairment at 2 years old. These findings are helpful to healthcare providers in planning for follow-up care and counseling families for decision-making related to goals of care.[28] A strategic approach is equally crucial, involving evidence-based strategies to optimize treatment plans and minimize adverse effects. Ethical considerations must guide decision-making, ensuring informed consent and respecting patient autonomy in treatment choices. Effective interprofessional communication is paramount, allowing seamless information exchange and collaborative decision-making among the team members. Care coordination plays a pivotal role in ensuring that the patient's journey from diagnosis to treatment and follow-up is well-managed, minimizing errors and enhancing patient safety. By embracing these principles of skill, strategy, ethics, responsibilities, interprofessional communication, and care coordination, healthcare professionals can deliver patient-centered care, ultimately improving patient outcomes and enhancing team performance in the management of abnormal neonatal EEGs.