This study aimed to describe neuromonitoring findings and short-term outcomes after the implementation of a digital health strategy comprising continuous, real-time, tele-based video-aEEG/EEG monitoring in a publicly funded NICU in Brazil.

Prospective, observational cohort study conducted between July 2017 and June 2021, analyzing neuromonitoring data of high-risk newborns and correlating it with clinical and imaging outcomes.

A total of 116 newborns, with a median gestational age of 37 weeks (interquartile range [IQR]: 322/7–392/7) and a median birth weight of 2,800 g (IQR: 1,472–3,305), were enrolled with more than 8,000 hours of monitoring. The main indication was suspected seizure (n = 49, 42.2%). A total of 43 (37.1%) neonates presented pathological background activity, and sleep–wake cycle (SWC) was absent in 68 (58.6%). Seizures were identified in 36 (31.0%) neonates, predominantly within the first 12 hours of life (n = 14, 38.9%), electrographic-only (n = 29, 80.6%), and repetitive (n = 24, 66.7%). A total of 47 (40.5%) neonates received antiseizure medications, with phenobarbital being the most frequently used (46; 97.9%). Only one patient (2.1%) was discharged receiving antiseizure medication. Cranial ultrasound (cUS) was performed in 94 (81.0%) infants, with abnormal findings in 34 (36.2%) infants. Pathological background activity, absence of SWC, and seizures were significantly associated with severe abnormalities on cUS, and increased risk of death before discharge.

The implementation of a digital health strategy incorporating real-time and continuous video-aEEG/EEG monitoring demonstrated potential to improve diagnostic accuracy for electrographic seizures, optimize antiseizure medication stewardship, and inform early neuroprotective interventions.

Brain monitoring improves seizure diagnosis.

aEEG/EEG supported antiseizure medication discontinuation.

Abnormal aEEG/EEG findings are associated with poor outcomes.

Remote aEEG/EEG monitoring is feasible in LMIC.

S.S.A., D.M.K.L., T.S.S., P.G.R., J.Q.T., T.M.L.d.O.U.B., C.G.M., A.C.P.B.F., F.B.P.S., M.M., G.F.T.V., and M.J.M.: concept and design; S.S.A., D.M.K.L., P.G.R., J.Q.T., T.M.L.d.O.U.B., C.G.M., A.C.P.B.F., and F.B.P.S.: data collection and analysis; G.F.T.V., and M.J.M.: study supervision. All the authors drafted and revised the manuscript.

Received: 20 August 2025

Accepted: 23 November 2025

Article published online:
04 December 2025

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