Neuromonitoring in neonatal critical care part II: extremely premature infants and critically ill neonates

Mohamed El-Dib, Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. mel-dib@bwh.harvard.edu.
Nicholas S. Abend, Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia and the University of Pennsylvania, Philadelphia, PA, USA.
Topun Austin, Department of Paediatrics, University of Cambridge, Cambridge, UK.
Geraldine Boylan, INFANT Research Centre & Department of Paediatrics & Child Health, University College Cork, Cork, Ireland.
Valerie Chock, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.
M Roberta Cilio, Department of Pediatrics, Division of Pediatric Neurology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
Gorm Greisen, Department of Neonatology, Rigshospitalet, Copenhagen University Hospital & Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Lena Hellström-Westas, Department of Women's and Children's Health, Uppsala University and Division of Neonatology, Uppsala University Hospital, Uppsala, Sweden.
Petra Lemmers, Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
Adelina Pellicer, Department of Neonatology, La Paz University Hospital, Madrid, Spain; Neonatology Group, IdiPAZ, Madrid, Spain.
Ronit M. Pressler, Department of Clinical Neurophysiology, Great Ormond Street Hospital for Children NHS Trust, and Clinical Neuroscience, UCL- Great Ormond Street Institute of Child Health, London, UK.
Arnold Sansevere, Department of Neurology and Pediatrics, George Washington University School of Medicine and Health Sciences; Children's National Hospital Division of Neurophysiology, Epilepsy and Critical Care, Washington, DC, USA.
Eniko Szakmar, Division of Neonatology, 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary.
Tammy Tsuchida, Department of Neurology and Pediatrics, George Washington University School of Medicine and Health Sciences; Children's National Hospital Division of Neurophysiology, Epilepsy and Critical Care, Washington, DC, USA.
Sampsa Vanhatalo, Department of Clinical Neurophysiology, Children's Hospital, BABA Center, Neuroscience Center/HILIFE, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Courtney J. Wusthoff, Division of Child Neurology, Stanford University, Palo Alto, CA, USA.

Document Type

Journal Article

Publication Date

11-25-2022

Journal

Pediatric research

DOI

10.1038/s41390-022-02392-2

Abstract

Neonatal intensive care has expanded from cardiorespiratory care to a holistic approach emphasizing brain health. To best understand and monitor brain function and physiology in the neonatal intensive care unit (NICU), the most commonly used tools are amplitude-integrated EEG, full multichannel continuous EEG, and near-infrared spectroscopy. Each of these modalities has unique characteristics and functions. While some of these tools have been the subject of expert consensus statements or guidelines, there is no overarching agreement on the optimal approach to neuromonitoring in the NICU. This work reviews current evidence to assist decision making for the best utilization of these neuromonitoring tools to promote neuroprotective care in extremely premature infants and in critically ill neonates. Neuromonitoring approaches in neonatal encephalopathy and neonates with possible seizures are discussed separately in the companion paper. IMPACT: For extremely premature infants, NIRS monitoring has a potential role in individualized brain-oriented care, and selective use of aEEG and cEEG can assist in seizure detection and prognostication. For critically ill neonates, NIRS can monitor cerebral perfusion, oxygen delivery, and extraction associated with disease processes as well as respiratory and hypodynamic management. Selective use of aEEG and cEEG is important in those with a high risk of seizures and brain injury. Continuous multimodal monitoring as well as monitoring of sleep, sleep-wake cycling, and autonomic nervous system have a promising role in neonatal neurocritical care.

Department

Neurology

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