Impact of a neuro-intensive care service for newborns

Harbert, Mary J.; Sey, Rachelle; Arnell, Kathy; Salinda, L; Brown, Melissa K; Lazarus, Danielle; Poeltler, Debra; Wozniak, Phillip; Rasmussen, Maynard

doi:10.3233/npm-181751

Cited by 6 publications

(2 citation statements)

References 11 publications

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“…Third, we speculate that implementation of therapeutic hypothermia as a neuroprotective strategy for neonates with hypoxic‐ischemic encephalopthy 33 may have reduced the risk of epilepsy in our study participants. Finally, comprehensive neurocritical care 34–38 including conventional EEG monitoring 19 for all neonates with seizures in our patient cohort, may have facilitated prompt seizure detection and treatment which might also have contributed to lower rates of post‐neonatal epilepsy.…”

Section: Discussionmentioning

confidence: 99%

Early‐life epilepsy after acute symptomatic neonatal seizures: A prospective multicenter study

et al. 2021

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Objective We aimed to evaluate early‐life epilepsy incidence, seizure types, severity, risk factors, and treatments among survivors of acute neonatal seizures. Methods Neonates with acute symptomatic seizures born 7/2015‐3/2018 were prospectively enrolled at nine Neonatal Seizure Registry sites. One‐hour EEG was recorded at age three months. Post‐neonatal epilepsy and functional development (Warner Initial Developmental Evaluation of Adaptive and Functional Skills – WIDEA‐FS) were assessed. Cox regression was used to assess epilepsy‐free survival. Results Among 282 infants, 37 (13%) had post‐neonatal epilepsy by 24‐months [median age of onset 7‐months (IQR 3–14)]. Among those with post‐neonatal epilepsy, 13/37 (35%) had infantile spasms and 12/37 (32%) had drug‐resistant epilepsy. Most children with post‐neonatal epilepsy had abnormal neurodevelopment at 24‐months (WIDEA‐FS >2SD below normal population mean for 81% of children with epilepsy vs 27% without epilepsy, RR 7.9, 95% CI 3.6–17.3). Infants with severely abnormal neonatal EEG background patterns were more likely to develop epilepsy than those with mild/moderate abnormalities (HR 3.7, 95% CI 1.9–5.9). Neonatal EEG with ≥3 days of seizures also predicted hazard of epilepsy (HR 2.9, 95% CI 1.4–5.9). In an adjusted model, days of neonatal EEG‐confirmed seizures (HR 1.4 per day, 95% CI 1.2–1.6) and abnormal discharge examination (HR 3.9, 95% CI 1.9–7.8) were independently associated with time to epilepsy onset. Abnormal (vs. normal) three‐month EEG was not associated with epilepsy. Significance In this multicenter study, only 13% of infants with acute symptomatic neonatal seizures developed post‐neonatal epilepsy by age 24‐months. However, there was a high risk of severe neurodevelopmental impairment and drug‐resistant seizures among children with post‐neonatal epilepsy. Days of EEG‐confirmed neonatal seizures was a potentially modifiable epilepsy risk factor. An EEG at three months was not clinically useful for predicting epilepsy. These practice changing findings have implications for family counseling, clinical follow‐up planning, and future research to prevent post‐neonatal epilepsy.

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Section: Discussionmentioning

confidence: 99%

Early‐life epilepsy after acute symptomatic neonatal seizures: A prospective multicenter study

et al. 2021

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“…The University of California, San Francisco (UCSF) was the first unit in the United States to establish a neonatal neurointensive care nursery ( 4 ). This strategy has acquired significant popularity globally during the last decade, with several teams describing their experience establishing similar models of care ( 20 – 22 ).…”

Section: Strategies For Neuroprotection and The Neuro-nicu Conceptmentioning

confidence: 99%

Current Status and Future Directions of Neuromonitoring With Emerging Technologies in Neonatal Care

Variane

Camargo²,

Rodrigues

et al. 2022

Front. Pediatr.

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Neonatology has experienced a significant reduction in mortality rates of the preterm population and critically ill infants over the last few decades. Now, the emphasis is directed toward improving long-term neurodevelopmental outcomes and quality of life. Brain-focused care has emerged as a necessity. The creation of neonatal neurocritical care units, or Neuro-NICUs, provides strategies to reduce brain injury using standardized clinical protocols, methodologies, and provider education and training. Bedside neuromonitoring has dramatically improved our ability to provide assessment of newborns at high risk. Non-invasive tools, such as continuous electroencephalography (cEEG), amplitude-integrated electroencephalography (aEEG), and near-infrared spectroscopy (NIRS), allow screening for seizures and continuous evaluation of brain function and cerebral oxygenation at the bedside. Extended and combined uses of these techniques, also described as multimodal monitoring, may allow practitioners to better understand the physiology of critically ill neonates. Furthermore, the rapid growth of technology in the Neuro-NICU, along with the increasing use of telemedicine and artificial intelligence with improved data mining techniques and machine learning (ML), has the potential to vastly improve decision-making processes and positively impact outcomes. This article will cover the current applications of neuromonitoring in the Neuro-NICU, recent advances, potential pitfalls, and future perspectives in this field.

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