We investigated the effect of morphine, midazolam and their active met
abolites on background electroencephalogram (EEG) in 6 neonates underg
oing extracorporeal membrane oxygenation (ECMO) by conducting simultan
eous EEGs and serum drug levels. Despite serum levels that were suffic
ient to produce adequate sedation, no patients had burst-suppressed or
flat EEG backgrounds. We did, however, note that scalp oedema caused
by prolonged immobility led to artefactual attenuation of EEG backgrou
nd. We conclude that an EEG prior to sedation will provide important b
aseline information that allows subsequent comparison and an awareness
that scalp oedema after prolonged sedation and immobility will reduce
misinterpretation of artefactual EEG attenuation.