Abstract

BACKGROUNDThe developing neonatal brain displays different electroencephalographic (EEG) responses to GABAergic anaesthetics than adults. Evidence suggests the importance of isoelectric-like activity patterns. However, markers of hypnotic depth are currently lacking for this population.OBJECTIVETo explore potential EEG markers of propofol-induced hypnosis in sedated critically ill term neonates.DESIGNObservational exploratory cohort study.PATIENTSTwenty critically ill term neonates (postmenstrual age 37 to 44weeks) undergoing intensive care and requiring anaesthesia for noncardiac surgery. Patients with perinatal asphyxia, neurological pathology, brain malformations and metabolic or haemodynamic instability were excluded.INTERVENTION(S)Frontal EEG (Sedline) was recorded before induction and during a 20-min continuous rate propofol infusion.MAIN OUTCOME MEASURESDepending on peak amplitude, segmented EEG signals (1s epochs) were classified as either isoelectric (<10?V), low-voltage 10 to 25?V), or high-voltage (>25?V). Propofol effects were evaluated in terms of time occupancy and spectral properties within these EEG states. Correlations between clinical variables and EEG states were explored.RESULTSThe EEGs of 17 neonates were analysed. Most showed periods of low-voltage (16/17, 94%) and isoelectric states (2/17, 70.5%) before anaesthesia. The time spent in these EEG states increased significantly during propofol infusion; 17/17 (100%), P<0.001 and 16/17 (94.1%), P=0.016, respectively. Propofol increased the mean [95% confidence interval (CI)] time spent in the isoelectric state per patient: 12.4 (3.3 to 21.5)% versus 28.6 (14.4 to 42.8)%, P<0.002. A reduced spectral power was observed across all frequency bands during low-voltage states (all P<0.026). Gestational age was negatively correlated with time in the isoelectric state; rho, 95% CI, -0.539 (-0.11 to -0.87), P=0.031.CONCLUSIONOur results show that isoelectric periods are common before anaesthesia in our studied population and more frequent in patients born at earlier gestational ages. The data suggest that propofol anaesthesia increases isoelectric EEG states while also reducing the spectral power, specifically during low-voltage EEG states. Potentially, both of these EEG changes could be biomarkers of neonatal hypnosis depth in this particular critically ill subpopulation.TRIAL REGISTRATIONClinicalTrials.gov identifier: NCT04904965. © 2025 Lippincott Williams and Wilkins. All rights reserved.