226 Evaluation of Developmental Centered Care in Spanish Neonatal Units

Abstract

Background: From clinical point of view it is important to detect all seizure activity in neonates. The cerebral function monitor (CFM) processes the electro encephalogram (EEG) into an amplitudeintegrated EEG (aEEG) signal that is relatively easy to read and interpret compared to the classical EEG. So far seizures were defined based on the visual interpretation of a typical pattern.Objective: The objective of this study is to create a program for automatic detection of seizures in neonatal aEEG signals, based on a quantitative analysis. Seizures of a length of more than 60 seconds are included.Method: Since high cerebral activity corresponds with high amplitude in the aEEG signal, the program detects rises in amplitude of the lower margin, compared to the background signal. The lower margin is defined as a threshold value, where 95% of the aEEG samples are above this threshold. If this lower margin for a segment is significantly higher than the mean lower margin of the 6 minutes prior to the segment, and if this difference in height continues for at least 60 seconds, this pattern is marked as a seizure. Muscle artefacts are detected based on the frequency content of the EEG signal. Other artefacts are detected using the amplitudes of aEEG, EEG and impedance of the electrodes. Three signals were used to train the program.Results: Three CFM recordings of 9 hours from full-term newborns with different background patterns were used to evaluate the program. The signals were annotated by an expert in neonatal neurophysiology, who found in total 95 seizures. The program detected 101 patterns as seizures, with a sensitivity of 98% (93 true positives) and a positive predictive value of 92% (8 false positives).Conclusion: This study indicates that it is possible to automatically detect seizures of more than 60 seconds, using CFM recordings. Objective: Evaluation of DC in Spanish neonatal units through consideration of some aspects of the care provided to very low birth weight infants and their families. EVALUATION OF DEVELOPMENTAL CENTERED CARE IN SPANISH NEONATAL UNITSMethods: The study centers on Spanish hospitals caring for children under 1500g. In a telephone questionnaire, we performed a transversal study by asking 25 questions releated to DC.Results: Of the 100 hospitals taking care of children under 1500g, 83 of them, representative of all the regions, responded to the questionnaire. Of these, 31% had noise pollution controls, 72% controlled light intensity, 75% bound the infants and 29% used sacarose as an analgesic, 10% allowed unrestricted parental visits. In 22% Kangaroo care is openly used. 63% of the centers admitted difficulties with regards to introducing changes in the DC. There are not differences in the implementation of the DC between big and small hospitals.Conclusions: In practically all centers some type of DC activity occurs although in certain areas such as unrestricted parental visits, the rate of implementation is low. Clinical protocols based on available evidence and supported by wide staff co...

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