Protecting brains and saving futures guidelines: A prospective, multicenter, and observational study on the use of telemedicine for neonatal neurocritical care in Brazil

Variane, Gabriel Fernando Todeschi; Magalhães, Maurício; Pietrobom, Rafaela Fabri Rodrigues; Netto, Alexandre; Rodrigues, Daniela Pereira; Gasperini, Renato; Sant’Anna, Guilherme M.

doi:10.1371/journal.pone.0262581

Cited by 3 publications

(2 citation statements)

References 81 publications

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“…In these hospitals, patients were monitored with a 3-channel video aEEG/EEG, ideally for screening for TH and during the 72 hours of the TH protocol until 12 hours after rewarming. 13 The remaining six NICUs did not have a continuous bedside electrographic monitoring tool, and seizure diagnosis was based on clinical symptoms. This project was approved by the Scientific Committee of all participating centers.…”

Section: Methodsmentioning

confidence: 99%

Therapeutic Hypothermia for Neonatal Hypoxic–Ischemic Encephalopathy: Reducing Variability in Practice through a Collaborative Telemedicine Initiative

Leandro,

Variane,

Dahlen

et al. 2024

Am J Perinatol

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Objective This study aimed to assess the viability of implementing a tele-educational training program in neurocritical care for newborns diagnosed with hypoxic–ischemic encephalopathy (HIE) and treated with therapeutic hypothermia (TH), with the goal of reducing practice variation. Study Design Prospective study including newborns with HIE treated with TH from 12 neonatal intensive care units in Brazil conducted from February 2021 to February 2022. An educational intervention consisting of 12 biweekly, 1-hour, live videoconferences was implemented during a 6-month period in all centers. Half of the centers had the assistance of a remote neuromonitoring team. The primary outcome was the rate of deviations from TH protocol, and it was evaluated during a 3-month period before and after the intervention. Logistic regression via generalized estimating equations was performed to compare the primary and secondary outcomes. Protocol deviations were defined as practices not in compliance with the TH protocol provided. A subanalysis evaluated the differences in protocol deviations and clinical variables between centers with and without neuromonitoring. Results Sixty-six (39.5%) newborns with HIE were treated with TH during the preintervention period, 69 (41.3%) during the intervention period and 32 (19.1%) after intervention. There was not a significant reduction in protocol deviations between the pre- and postintervention periods (37.8 vs. 25%, p = 0.23); however, a decrease in the rates of missing Sarnat examinations within 6 hours after birth was seen between the preintervention (n = 5, 7.6%) and postintervention (n = 2, 6.3%) periods (adjusted odds ratio [aOR]: 0.36 [0.25–0.52], p < 0.001). Centers with remote neuromonitoring support had significantly lower rates of seizures (27.6 vs. 57.5%; aOR: 0.26 [0.12–0.55], p < 0.001) and significant less seizure medication (27.6 vs. 68.7%; aOR: 0.17 [0.07–0.4], p < 0.001). Conclusion This study shows that implementing a tele-educational program in neonatal neurocritical care is feasible and may decrease variability in the delivery of care to patients with HIE treated with TH. Key Points

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Section: Methodsmentioning

confidence: 99%

Therapeutic Hypothermia for Neonatal Hypoxic–Ischemic Encephalopathy: Reducing Variability in Practice through a Collaborative Telemedicine Initiative

Leandro,

Variane,

Dahlen

et al. 2024

Am J Perinatol

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“…A prospective, multicenter, and observational study is currently ongoing in Brazil to evaluate the impact of an advanced telemedicine model of neonatal neurocritical care on clinical outcomes. 55 …”

Section: Electroencephalographic Study Modalitiesmentioning

confidence: 99%

Neonatal Seizures in Low- and Middle-Income Countries: A Review of the Literature and Recommendations for the Management

Spenard,

Salazar Cerda,

Nevzat Çizmeci

2024

Turkish Archives of Pediatrics

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Neonatal seizures are a common cause of neonatal intensive care unit (NICU) admission and a significant source of morbidity and mortality worldwide. Over the recent decades, there have been significant improvements in perinatal and neonatal medicine and electroencephalographic monitoring that have enhanced the diagnosis and treatment of neonatal seizures in high-income countries. However, the management of neonatal seizures remains a major challenge in low- to middle-income countries, where the availabilityof resources is limited. The purpose of this article is to present a comprehensive review of the current evidence on the etiology, pathophysiology, diagnosis, and treatment of neonatal seizures and to offer practical management recommendations that could be implemented in resource-limited settings.

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Use of EEG in neonatal hypoxic-ischemic encephalopathy: A French survey of current practice and perspective for improving health care

Chaton¹,

Bourel-Ponchel

Lamblin³

et al. 2023

Neurophysiologie Clinique

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Protecting brains and saving futures guidelines: A prospective, multicenter, and observational study on the use of telemedicine for neonatal neurocritical care in Brazil

Cited by 3 publications

References 81 publications

Therapeutic Hypothermia for Neonatal Hypoxic–Ischemic Encephalopathy: Reducing Variability in Practice through a Collaborative Telemedicine Initiative

Therapeutic Hypothermia for Neonatal Hypoxic–Ischemic Encephalopathy: Reducing Variability in Practice through a Collaborative Telemedicine Initiative

Neonatal Seizures in Low- and Middle-Income Countries: A Review of the Literature and Recommendations for the Management

Use of EEG in neonatal hypoxic-ischemic encephalopathy: A French survey of current practice and perspective for improving health care

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