Images in Neuropediatrics Cerebral Oxygenation Patterns during Electroclinical Neonatal Seizures Silvia Martini1,2 Vittoria Paoletti1 Giacomo Faldella1,2 1 Intensive Care Unit, Division of Neonatology, St. Orsola-Malpighi University Hospital, Bologna, Italy 2 Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy Luigi Corvaglia1,2 Address for correspondence Silvia Martini, MD, Intensive Care Unit, Division of Neonatology, St. Orsola-Malpighi University Hospital, Via Massarenti 11—40138 Bologna, Italy (e-mail: silvia.martini4@gmail.com). A 2,950-g-weighted infant was born at 35 weeks’ gestation by emergency C-section due to abnormal cardiotocography. Full neonatal resuscitation was required; Apgar’s scores were 1–4–4, cord gas pH 6.87, base deficit 18.4 mmol/L. The infant was admitted to the neonatal intensive care unit immediately after birth and started on therapeutic hypothermia due to clinical signs of hypoxic-ischemic encephalopathy (HIE) and suppressed activity of the amplitude-integrated EEG (aEEG). A continuous monitoring of cerebral oxygen saturation (cSO2) by near-infrared spectroscopy (NIRS), which used to provide useful information on brain oxygenation and, indirectly, the underlying haemodynamics fluctuations, was associated for the whole cooling period. At 45 hours of life, the infant developed serial clinical seizures (prolonged hypertonic spasms of upper and lower limbs) with electrographic correlate, requiring treatment with midazolam, phenobarbital, and phenytoin. During this period, rhythmic cSO2 fluctuations (range: 62–94%) were seen at NIRS monitoring (►Fig. 1). These cSO2 patterns showed an evident temporal relationship with ictal aEEG activity and were no longer evident after seizures ceased. This finding suggests the occurrence of possible neurovascular coupling mechanisms during neonatal seizures; Fig. 1 Cerebral oxygenation (cSO2) patterns and cerebral function monitoring (CFM) trace during seizures (highlighted by blue bars). Drops in peripheral oxygen saturation < 80% are marked as desat. Ongoing medications are shown as blue triangles (boluses) and blue lines (continuous infusions). Ventilation modality and changes in inspired oxygen fraction (FiO2 ) are also provided. SIPPVþVG, synchronized intermittent positive pressure ventilation þ volume guarantee. Silvia Martini's ORCID is https://orcid.org/0000-0003-2078-7114. received February 20, 2019 accepted after revision May 30, 2019 © Georg Thieme Verlag KG Stuttgart · New York DOI https://doi.org/ 10.1055/s-0039-1693058. ISSN 0174-304X. Downloaded by: Universitätsbibliothek. Copyrighted material. Neuropediatrics Seizure-Related Brain Oxygen Changes Martini et al. in this context, NIRS might play role as a complementary monitoring tool in infants at high ictal risk. Conflict of Interest None declared References 1 Silas R, Sehgal A, Walker AM, Wong FY. Cerebral oxygenation namics during neonatal seizures using diffuse optical tomography: a case study. Neuroimage Clin 2014;5:256–265 3 Wintermark P, Hansen A, Warfield SK, Dukhovny D, Soul JS. Near-infrared spectroscopy versus magnetic resonance imaging to study brain perfusion in newborns with hypoxic-ischemic encephalopathy treated with hypothermia. Neuroimage 2014; 85(Pt. 1):287–293 4 da Costa CS, Greisen G, Austin T. Is near-infrared spectroscopy clinically useful in the preterm infant? Arch Dis Child Fetal Neonatal Ed 2015;100(06):F558–F561 Downloaded by: Universitätsbibliothek. Copyrighted material. during subclinical seizures in neonatal hypoxic-ischaemic encephalopathy. Eur J Paediatr Neurol 2012;16(03):304–307 2 Singh H, Cooper RJ, Wai Lee C, et al. Mapping cortical haemody- Neuropediatrics