Development of a NeuroNICU with a Broader Focus on All Newborns at Risk of Brain Injury: The First 2 Years

Meurs, Krisa P. Van; Yan, Elisabeth S.; Randall, Kathi Salley; Chock, Valerie Y.; Davis, Alexis S.; Glennon, Cecelia; Clark, Catherine L.; Wusthoff, Courtney J.; Bonifacio, Sonia L.

doi:10.1055/s-0038-1646954

Cited by 19 publications

(10 citation statements)

References 44 publications

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“…Compared to other modalities highlighted in this review, clinical NIRS devices are typically more portable and rapidly applied and do not require a clinical specialist. Ease of use has promoted increasing application in emergent and critical care settings [ 28 , 162 – 180 ]. However, consensus on utility and standardized guidance for interpretation remains lacking [ 175 , 178 , 181 – 184 ].…”

Section: Advances In Neuromonitoringmentioning

confidence: 99%

Advanced Neuromonitoring Modalities on the Horizon: Detection and Management of Acute Brain Injury in Children

Catennacio

Shin

et al. 2023

Neurocrit Care

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Timely detection and monitoring of acute brain injury in children is essential to mitigate causes of injury and prevent secondary insults. Increasing survival in critically ill children has emphasized the importance of neuroprotective management strategies for long-term quality of life. In emergent and critical care settings, traditional neuroimaging modalities, such as computed tomography and magnetic resonance imaging (MRI), remain frontline diagnostic techniques to detect acute brain injury. Although detection of structural and anatomical abnormalities remains crucial, advanced MRI sequences assessing functional alterations in cerebral physiology provide unique diagnostic utility. Head ultrasound has emerged as a portable neuroimaging modality for point-of-care diagnosis via assessments of anatomical and perfusion abnormalities. Application of electroencephalography and near-infrared spectroscopy provides the opportunity for real-time detection and goal-directed management of neurological abnormalities at the bedside. In this review, we describe recent technological advancements in these neurodiagnostic modalities and elaborate on their current and potential utility in the detection and management of acute brain injury.

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Section: Advances In Neuromonitoringmentioning

confidence: 99%

Advanced Neuromonitoring Modalities on the Horizon: Detection and Management of Acute Brain Injury in Children

Catennacio

Shin

et al. 2023

Neurocrit Care

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“…Current NNCCP protocols have focused on peripartum, parturition, and neonatal time-periods when fetal/neonatal neurologic phenotypes are more readily identified based on current diagnostic skills and testing tools. Peripartum fetal surveillance results, neonatal clinical assessment scores, multi-systemic disease monitoring, neuroimaging/EEG protocols, and developmental care strategies applicable to these time-periods comprise the datasets that presently guide clinical care pathways into early childhood ( 10 ).…”

Section: Current Programs Emphasize Neonatal Neurocritical Carementioning

confidence: 99%

“The First Thousand Days” Define a Fetal/Neonatal Neurology Program

Scher

2021

Front. Pediatr.

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Gene–environment interactions begin at conception to influence maternal/placental/fetal triads, neonates, and children with short- and long-term effects on brain development. Life-long developmental neuroplasticity more likely results during critical/sensitive periods of brain maturation over these first 1,000 days. A fetal/neonatal program (FNNP) applying this perspective better identifies trimester-specific mechanisms affecting the maternal/placental/fetal (MPF) triad, expressed as brain malformations and destructive lesions. Maladaptive MPF triad interactions impair progenitor neuronal/glial populations within transient embryonic/fetal brain structures by processes such as maternal immune activation. Destructive fetal brain lesions later in pregnancy result from ischemic placental syndromes associated with the great obstetrical syndromes. Trimester-specific MPF triad diseases may negatively impact labor and delivery outcomes. Neonatal neurocritical care addresses the symptomatic minority who express the great neonatal neurological syndromes: encephalopathy, seizures, stroke, and encephalopathy of prematurity. The asymptomatic majority present with neurologic disorders before 2 years of age without prior detection. The developmental principle of ontogenetic adaptation helps guide the diagnostic process during the first 1,000 days to identify more phenotypes using systems-biology analyses. This strategy will foster innovative interdisciplinary diagnostic/therapeutic pathways, educational curricula, and research agenda among multiple FNNP. Effective early-life diagnostic/therapeutic programs will help reduce neurologic disease burden across the lifespan and successive generations.

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“…Unlike adults, the majority of neonates that are evaluated by a neurocritical care service have a primary medical diagnosis as the reason for admission, including complications of prematurity and congenital heard malformation. 6,7 The most common conditions treated within a neonatal neurocritical care service are encephalopathy and seizures, usually due to global hypoxic-ischemic injury, focal arterial and venous infarcts, intracranial hemorrhage and infection. 6,8…”

Section: Origins and Principles Of Neonatal Neurocritical Carementioning

confidence: 99%

“…But unlike adult and pediatric neurocritical care patient populations, half of NICN patients are admitted for medical issues other than a primary neurological disorder, placing greater emphasis on the care of the baby as a whole. 6,7 Co-morbidities may include hemodynamic collapse, electrolytes and metabolic derangements, coagulopathy, systemic and CNS infection, and cardiorespiratory failure requiring extracorporeal life support (ECLS/ECMO). 9 Thus, many Neonatal Neurocritical Care Programs are in highacuity NICU settings at larger tertiary care hospitals with pediatric surgical and subspecialty support; and often Centers of Excellence in pediatric neurologic care.…”

Section: Development Of a Neurointensive Care Nursery (Nicn)mentioning

confidence: 99%

The neurointensive nursery: concept, development, and insights gained

Glass

Ferriero

Rowitch

et al. 2019

Current Opinion in Pediatrics

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Purpose of review With the advent of therapeutic hypothermia for treatment of hypoxic ischemic encephalopathy, and improvements in neuroimaging and bedside neuromonitoring, a new era of neonatal brain-focused care has emerged in recent years. We describe the development of the first neurointensive care nursery (NICN) as a model for comanagement of neonates with identified neurologic risk factors by a multidisciplinary team constituted of neurologists, neonatologists, specialized nurses, and others with the goal of optimizing management, preventing secondary injury and maximizing long-term outcomes. Recent findings Optimizing brain metabolic environment and perfusion and preventing secondary brain injury are key to neurocritical care. This includes close management of temperature, blood pressure, oxygenation, carbon dioxide, and glucose levels. Early developmental interventions and involvement of physical and occupational therapy provide additional assessment information. Finally, long-term follow-up is essential for any neurocritical care program. Summary The NICN model aims to optimize evidence-based care of infants at risk for neurologic injury. Results from ongoing hypothermia and neuroprotective trials are likely to yield additional treatments. New technologies, such as functional MRI, continuous neurophysiological assessment, and whole genomic approaches to rapid diagnosis may further enhance clinical protocols and neonatal precision medicine. Importantly, advances in neurocritical care improve our ability to provide comprehensive information when counseling families. Long-term follow-up data will determine if the NICN/Neuro-NICU provides enduring benefit to infants at risk for neurologic injury.

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Development of a NeuroNICU with a Broader Focus on All Newborns at Risk of Brain Injury: The First 2 Years

Cited by 19 publications

References 44 publications

Advanced Neuromonitoring Modalities on the Horizon: Detection and Management of Acute Brain Injury in Children

Advanced Neuromonitoring Modalities on the Horizon: Detection and Management of Acute Brain Injury in Children

“The First Thousand Days” Define a Fetal/Neonatal Neurology Program

The neurointensive nursery: concept, development, and insights gained

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