The neurointensive nursery: concept, development, and insights gained

Abstract

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.

Centre-specific differences in short-term outcomes in neonates with hypoxic-ischaemic encephalopathy

“…Furthermore, seizure detection is not straightforward and requires specific expertise in neonates with HIE receiving therapeutic hypothermia [21]. Overand underdetection of neonatal seizures has been reported to be a common problem in neonates with HIE [22]. For this reason, neonatal neuro-critical care teams have been established in high volume centres for HIE [21,22], providing advice on tailored seizure management.…”

“…Overand underdetection of neonatal seizures has been reported to be a common problem in neonates with HIE [22]. For this reason, neonatal neuro-critical care teams have been established in high volume centres for HIE [21,22], providing advice on tailored seizure management. To improve seizure management, it is mandatory to foster education in aEEG seizure recognition by bedside staff and clarify responsibilities regarding aEEG interpretation.…”

Precision Medicine in Neonates: A Tailored Approach to Neonatal Brain Injury

“…Intraventricular hemorrhage (IVH) and its severe complications: PVHI and PVHD, are common conditions after premature birth and are frequently associated with mortality and adverse longterm neurodevelopmental outcome (25). Regarding treatment, IVH prevention bundles such as delayed cord clamping, minimal handling, midline head position, limiting the number of infusions, and frequent multidisciplinary assessments have emerged as essential tools for reducing IVH morbidity (26)(27)(28)(29).…”

“…Advances in neonatal care, specifically “brain oriented care,” particularly the use of therapeutic hypothermia for the treatment of hypoxic-ischemic encephalopathy, paved the way for neuroprotection in newborns at risk for brain injury. A multidisciplinary team for “brain-oriented care” is warranted in the NICU to optimally implement such treatments ( 26 ) and provide tailored care. This team should include pediatric neurologists, neonatologists, and “brain-oriented” specialized nurses ( 26 ).…”

“…A multidisciplinary team for “brain-oriented care” is warranted in the NICU to optimally implement such treatments ( 26 ) and provide tailored care. This team should include pediatric neurologists, neonatologists, and “brain-oriented” specialized nurses ( 26 ). Furthermore, specific protocols should be combined with neuroimaging (MRI) and neuromonitoring [video multi-channel EEG and amplitude-integrated EEG, near infrared spectroscopy (NIRS)] ( Figure 1 ).…”