Intraoperative movement despite low SedLine Patient State Index in a preterm neonate: evidence of algorithm limitation in neonatal EEG monitoring - A Case Report

Mostafa Nagy; Ahmed Haroun M. Mahmoud; Abdullah Aldhuwaihy; Mohammed E. Alessa; Mohammad Alshammeri; Abdullah Saud Alosaimi; Ahmed Mahmoud

doi:10.24911/IJMDC.51-1763975946

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Case Report
Online Published: 21 Dec 2025

IJMDC. 2025; 9(12): 3428-3431

doi: 10.24911/IJMDC.51-1763975946

Intraoperative movement despite low SedLine Patient State Index in a preterm neonate: evidence of algorithm limitation in neonatal EEG monitoring - A Case Report

Mostafa Nagy, Ahmed Haroun M. Mahmoud, Abdullah Aldhuwaihy, Mohammed E. Alessa, Mohammad Alshammeri, Abdullah Saud Alosaimi, Mohammad Alshammeri, Ahmed Mahmoud.

Abstract
Background: Processed electroencephalographic (EEG) indices, such as the SedLine Patient State Index (PSI), are increasingly used to guide anesthetic depth in pediatric anesthesia. However, their reliability in neonates and ex-preterm infants remains uncertain because current algorithms are derived from adult EEG data, which differ significantly from immature neonatal patterns.
Case Presentation: We report a 3-month-old ex-preterm infant (former 29-week gestation) undergoing bilateral laser photocoagulation for retinopathy of prematurity under general anesthesia. Despite persistently low PSI values (3-10) with a high suppression ratio suggestive of deep anesthesia, the infant exhibited spontaneous limb movement and tachycardia during surgical stimulation, indicating inadequate anesthetic depth. Increasing the sevoflurane concentration and administering fentanyl eliminated movement, but PSI values remained unchanged. The remainder of the procedure was uneventful, and the infant recovered smoothly without postoperative complications.
Conclusion: This case highlights a physiologic-algorithmic mismatch between neonatal EEG patterns and processed EEG indices such as PSI. In neonates and ex-preterm infants, low PSI values may not accurately reflect anesthetic depth. Clinicians should interpret processed EEG indices cautiously in this population and rely on multimodal assessment and clinical judgment until neonatal-specific algorithms become available.

Key words: Neonatal anesthesia; Processed EEG monitoring; Patient State Index (PSI); Algorithm limitation; Premature infant.

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Pubmed Style

Nagy M, Mahmoud AHM, Aldhuwaihy A, Alessa ME, Alshammeri M, Alosaimi AS, Alshammeri M, Mahmoud A. Intraoperative movement despite low SedLine Patient State Index in a preterm neonate: evidence of algorithm limitation in neonatal EEG monitoring - A Case Report. IJMDC. 2025; 9(12): 3428-3431. doi:10.24911/IJMDC.51-1763975946

Web Style

Nagy M, Mahmoud AHM, Aldhuwaihy A, Alessa ME, Alshammeri M, Alosaimi AS, Alshammeri M, Mahmoud A. Intraoperative movement despite low SedLine Patient State Index in a preterm neonate: evidence of algorithm limitation in neonatal EEG monitoring - A Case Report. https://www.ijmdc.com/?mno=298981 [Access: January 17, 2026]. doi:10.24911/IJMDC.51-1763975946

AMA (American Medical Association) Style

Nagy M, Mahmoud AHM, Aldhuwaihy A, Alessa ME, Alshammeri M, Alosaimi AS, Alshammeri M, Mahmoud A. Intraoperative movement despite low SedLine Patient State Index in a preterm neonate: evidence of algorithm limitation in neonatal EEG monitoring - A Case Report. IJMDC. 2025; 9(12): 3428-3431. doi:10.24911/IJMDC.51-1763975946

Vancouver/ICMJE Style

Nagy M, Mahmoud AHM, Aldhuwaihy A, Alessa ME, Alshammeri M, Alosaimi AS, Alshammeri M, Mahmoud A. Intraoperative movement despite low SedLine Patient State Index in a preterm neonate: evidence of algorithm limitation in neonatal EEG monitoring - A Case Report. IJMDC. (2025), [cited January 17, 2026]; 9(12): 3428-3431. doi:10.24911/IJMDC.51-1763975946

Harvard Style

Nagy, M., Mahmoud, . A. H. M., Aldhuwaihy, . A., Alessa, . M. E., Alshammeri, . M., Alosaimi, . A. S., Alshammeri, . M. & Mahmoud, . A. (2025) Intraoperative movement despite low SedLine Patient State Index in a preterm neonate: evidence of algorithm limitation in neonatal EEG monitoring - A Case Report. IJMDC, 9 (12), 3428-3431. doi:10.24911/IJMDC.51-1763975946

Turabian Style

Nagy, Mostafa, Ahmed Haroun M. Mahmoud, Abdullah Aldhuwaihy, Mohammed E. Alessa, Mohammad Alshammeri, Abdullah Saud Alosaimi, Mohammad Alshammeri, and Ahmed Mahmoud. 2025. Intraoperative movement despite low SedLine Patient State Index in a preterm neonate: evidence of algorithm limitation in neonatal EEG monitoring - A Case Report. International Journal of Medicine in Developing Countries, 9 (12), 3428-3431. doi:10.24911/IJMDC.51-1763975946

Chicago Style

Nagy, Mostafa, Ahmed Haroun M. Mahmoud, Abdullah Aldhuwaihy, Mohammed E. Alessa, Mohammad Alshammeri, Abdullah Saud Alosaimi, Mohammad Alshammeri, and Ahmed Mahmoud. "Intraoperative movement despite low SedLine Patient State Index in a preterm neonate: evidence of algorithm limitation in neonatal EEG monitoring - A Case Report." International Journal of Medicine in Developing Countries 9 (2025), 3428-3431. doi:10.24911/IJMDC.51-1763975946

MLA (The Modern Language Association) Style

Nagy, Mostafa, Ahmed Haroun M. Mahmoud, Abdullah Aldhuwaihy, Mohammed E. Alessa, Mohammad Alshammeri, Abdullah Saud Alosaimi, Mohammad Alshammeri, and Ahmed Mahmoud. "Intraoperative movement despite low SedLine Patient State Index in a preterm neonate: evidence of algorithm limitation in neonatal EEG monitoring - A Case Report." International Journal of Medicine in Developing Countries 9.12 (2025), 3428-3431. Print. doi:10.24911/IJMDC.51-1763975946

APA (American Psychological Association) Style

Nagy, M., Mahmoud, . A. H. M., Aldhuwaihy, . A., Alessa, . M. E., Alshammeri, . M., Alosaimi, . A. S., Alshammeri, . M. & Mahmoud, . A. (2025) Intraoperative movement despite low SedLine Patient State Index in a preterm neonate: evidence of algorithm limitation in neonatal EEG monitoring - A Case Report. International Journal of Medicine in Developing Countries, 9 (12), 3428-3431. doi:10.24911/IJMDC.51-1763975946

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