TY - JOUR T1 - Does the first hour of continuous electroencephalography predict neonatal seizures? JF - Archives of Disease in Childhood - Fetal and Neonatal Edition JO - Arch Dis Child Fetal Neonatal Ed SP - 162 LP - 167 DO - 10.1136/archdischild-2020-318985 VL - 106 IS - 2 AU - Emma Macdonald-Laurs AU - Cynthia Sharpe AU - Mark Nespeca AU - Neggy Rismanchi AU - Jeffrey J Gold AU - Rachel Kuperman AU - Sonya Wang AU - Ngoc Minh D Lee AU - David J Michelson AU - Richard Haas AU - Peter Reed AU - Suzanne L Davis Y1 - 2021/03/01 UR - http://fn.bmj.com/content/106/2/162.abstract N2 - Objective Prolonged continuous video-electroencephalography (cEEG) is recommended for neonates at risk of seizures. The cost and expertise required to provide a real-time response to detected seizures often limits its utility. We hypothesised that the first hour of cEEG could predict subsequent seizures.Design and setting Retrospective multicentre diagnostic accuracy study.Patients 266 term neonates at risk of seizure or with suspected seizures.Intervention The first hour of cEEG was graded by expert and novice interpreters as normal, mildly, moderately or severely abnormal; seizures were identified.Main outcome measures Association between abnormalities in the first hour of cEEG and the presence of seizures during total cEEG monitoring.Results 50/98 (51%) of neonates who developed seizures had their first seizure in the first hour of cEEG monitoring. The ‘time-to-event’ risk of seizure from 0 to 96 hours was 0.38 (95% CI 0.32 to 0.44) while the risk in the first hour was 0.19 (95% CI 0.15 to 0.24). cEEG background was normal in 48% of neonates, mildly abnormal in 30%, moderately abnormal in 13% and severely abnormal in 9%. Inter-rater agreement for determination of background was very good (weighted kappa=0.81, 95% CI 0.72 to 0.91). When neonates with seizures during the first hour were excluded, an abnormal background resulted in 2.4 times increased risk of seizures during the subsequent monitoring period (95% CI 1.3 to 4.4, p<0.003) while a severely abnormal background resulted in a sevenfold increased risk (95% CI 3.4 to 14.3, p<0.0001).Conclusions The first hour of cEEG in at-risk neonates is useful in identifying and predicting whether seizures occur during cEEG monitoring up to 96 hours. This finding enables identification of high-risk neonates who require closer observation. ER -