Nuevas técnicas de monitorización cerebral en el recién nacido

Introduction. Continuous display four-channels EEG monitoring and near-infrared spectroscopy (NIRS) are relatively new and valuable techniques used for continuous brain monitoring in the neonatal period. Supporting the value of continuous display four-channels EEG monitoring in the evaluation of neonates with paroxysmal motor events is a study recently conducted at Miami Children's Hospital. Development. In this study 30 events were captures in 88 hours of simultaneous continuous display four-channels EEG monitoring and continuous video-EEG telemetry recording in five patients. Fourteen of the events were consider epileptic and 16 were considered non epileptic after evaluation of the continuous display four-channels EEG monitoring printed epochs. Results. The continuous video-EEG telemetry confirmed the diagnosis for all the events. Several studies attest to the usefulness of NIRS in neonates and in older children with pathologies similar to those seeing in neonates. Conclusions. 1. NIRS is the best method to monitor regional cerebral oxygen saturation; 2. Regional cerebral oxygen saturation values are primarily those of the venous circulation in the subcortical white matter below the sensor; 3. Values of regional oxygen saturation should be considered not independently but only relative as a changeover time; 4. Decreased regional cerebral oxygen saturation may be a sign of impending or established hypoxemia or hypo tension, increased cerebral metabolic demands, or a cerebral oxygenation or perfusion problem that involve only brain, and 5. NIRS should be used in conjunction with arterial oxygen saturation and pressure monitoring (to detect hypoxemia and hypotension), with EEG to detect increased cerebral metabolic demands (electroencephalographic seizures) and with anterior cerebral artery Doppler ultrasound to detect perfusion (decreased flow velocity) and oxygenation (constant flow velocity) problems that involve only the brain.