Shifting to a “Brain-Focused Culture”

As more research points to the benefits of hypothermia induction in neonates to protect brain function, never has there been more need to have the entire NICU team focused on working together to create a “brain-focused culture.” This includes nursing, neonatology, neurology, and the transport team working together aggressively to identify HIE (hypoxic ischemic encephalopathy) and begin brain cooling early.

HIE was the topic of much discussion at the recent Brain Monitoring and Neuroprotection in the Newborn Meeting in Killarney, Ireland in October. The Lifelines team exhibited at the show, featuring the Incereb neon as well as our NICU Clinical System and iEEG Cloud Services.

HIE is a type of brain damage that occurs when an infant’s brain doesn’t receive enough oxygen and blood. It is a dangerous condition that requires immediate medical intervention. According to the Florida Neonatal Neurologic Network, HIE affects 20 out of every 1000 full term births; the incidence rate in premature babies is 60 percent of all live births.

One of the keynote speakers and true thought leaders in the field is Dr. Geraldine Boylan, Co-Director of the Irish Center for Fetal and Neonatal Translational Research (INFANT) at University College Cork in Ireland. During her keynote, Dr. Boylan said several times, “Even though EEG is hard, we still need to do it.”

Dr. Boylan highlighted the following needs during her presentation:

  • Establishing EEG monitoring first before giving meds, when possible
  • Training more people to read EEGs
  • Cloud-based reading is needed to speed up read-time
  • Newly developed algorithms that detect possible seizures and alert the bedside staff to evaluate if the patient is having a subclinical seizure.

Other awareness needed related to NICU EEG included:

  • Expanded monitoring of NICU babies
  • Need for multi-channel recordings
  • Use of both raw EEG and aEEG
  • Start cooling early; time is brain
  • Video is very helpful during EEG and aEEG; also have record of events/seizures to review later
  • Newborns CAN HAVE GTCs (Generalized Tonic-Clonic Seizures)
  • Currently developing standards in Neonatal Seizure Protocol
  • Neonatal electrode caps, first introduced in 1999, cause the deep brain temperature to rise higher than usual, thus making it difficult to follow protocols on babies monitored with caps
  • Recognize HIE early and start cooling within six hours. 
  • ACNS guidelines recognized that EEG monitoring leads to better seizure detection.
  • Research points to early EEG monitoring improving outcomes
  • EEG monitoring is valuable for babies treated for HIE, with its low cost and good outcome
  • NBHS (newborn heart surgery) babies benefit from EEG monitoring

It was an excellent meeting and showed the hard work this group is putting in to improve NICU EEG monitoring. 

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