Combined Conventional and Amplitude-Integrated EEG Monitoring in Neonates: A Prospective Study

2019 ◽  
Vol 34 (6) ◽  
pp. 313-320 ◽  
Author(s):  
Sarah Grace Buttle ◽  
Brigitte Lemyre ◽  
Erick Sell ◽  
Stephanie Redpath ◽  
Srinivas Bulusu ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Neonatal Intensive Care ◽  
Diagnostic Yield ◽  
Standard Of Care ◽  
Seizure Detection ◽  
Neonatal Intensive Care Units ◽  
Eeg Monitoring ◽  
Clinical Events ◽  
A Prospective Study ◽  
Post Hoc

Background/Objective: Seizure monitoring via amplitude-integrated EEG is standard of care in many neonatal intensive care units; however, conventional EEG is the gold standard for seizure detection. We compared the diagnostic yield of amplitude-integrated EEG interpreted at the bedside, amplitude-integrated EEG interpreted by an expert, and conventional EEG. Methods: Neonates requiring seizure monitoring received amplitude-integrated EEG and conventional EEG in parallel. Clinical events and amplitude-integrated EEG were interpreted at bedside. Subsequently, amplitude-integrated EEG and conventional EEG were independently analyzed by experienced neonatology and neurology readers. Sensitivity and specificity of bedside amplitude-integrated EEG as compared to expert amplitude-integrated EEG interpretation and conventional EEG were evaluated. Results: Thirteen neonates were monitored for an average duration of 33 hours (range 15-94, SD 25). Fourteen seizure-like events were detected by clinical observation, and 12 others by bedside amplitude-integrated EEG analysis. One of the clinical, and none of the bedside amplitude-integrated EEG events were confirmed as seizures on conventional EEG. Post hoc expert amplitude-integrated EEG interpretation revealed eight suspected seizures, all different from the ones detected by the bedside amplitude-integrated EEG team, of which one was confirmed via conventional EEG. Eight seizures were recorded on conventional EEG. Expert amplitude-integrated EEG interpretation had a sensitivity of 13% with 46% specificity for individual seizure detection, and a sensitivity of 50% with 46% specificity for detecting patients with seizures. Conclusion: Real-world bedside amplitude-integrated EEG monitoring failed to detect all seizures evidenced via conventional EEG, while misclassifying other events as seizures. Even post hoc expert amplitude-integrated EEG interpretation provided limited sensitivity and specificity. Considering the poor sensitivity and specificity of bedside amplitude-integrated EEG interpretation, combined monitoring may provide limited clinical benefit.

scholarly journals P.056 Combined conventional and amplitude-integrated EEG monitoring in neonates: a prospective study

2019 ◽  
Vol 46 (s1) ◽  
pp. S29
Author(s):  
SG Buttle ◽  
B Lemyre ◽  
E Sell ◽  
S Redpath ◽  
S Bulusu ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Clinical Observation ◽  
Average Duration ◽  
Diagnostic Yield ◽  
Standard Of Care ◽  
Seizure Detection ◽  
Clinical Events ◽  
A Prospective Study ◽  
Post Hoc ◽  
Limited Sensitivity

Background: Seizure monitoring via amplitude-integrated EEG (aEEG) is standard of care in many NICUs; however, conventional EEG (cEEG) is the gold standard for seizure detection. We compared the diagnostic yield of aEEG interpreted at the bedside, aEEG interpreted by an expert, and cEEG. Methods: Neonates received aEEG and cEEG in parallel. Clinical events and aEEG were interpreted at bedside and subsequently independently analyzed by experienced neonatology and neurology readers. Sensitivity and specificity of bedside aEEG as compared to expert aEEG interpretation and cEEG were evaluated. Results: Thirteen neonates were monitored for an average duration of 33 hours (range 15-94). Fourteen seizure-like events were detected by clinical observation, and 12 others by bedside aEEG analysis. None of the bedside aEEG events were confirmed as seizures on cEEG. Expert aEEG interpretation had a sensitivity of 13% with 46% specificity for individual seizure detection (not adjusting for patient differences), and a sensitivity of 50% with 46% specificity for detecting patients with seizures. Conclusions: Real-world bedside aEEG monitoring failed to detect seizures evidenced via cEEG, while misclassifying other events as seizures. Even post-hoc expert aEEG interpretation provided limited sensitivity and specificity. Considering the poor sensitivity and specificity of bedside aEEG interpretation, combined monitoring may provide limited clinical benefit.

scholarly journals Simplification of the Finnegan Neonatal Abstinence Scoring System: retrospective study of two institutions in the USA

BMJ Open ◽  
2017 ◽  
Vol 7 (9) ◽  
pp. e016176 ◽  
Author(s):  
Enrique Gomez Pomar ◽  
Loretta P Finnegan ◽  
Lori Devlin ◽  
Henrietta Bada ◽  
Vanessa A Concina ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Gestational Age ◽  
Scoring System ◽  
Neonatal Intensive Care ◽  
Statistical Correlation ◽  
Neonatal Intensive Care Units ◽  
Pearson’S Correlation ◽  
Backward Elimination ◽  
The Usa ◽  
Pearson's Correlation

ObjectiveTo develop a simplified Finnegan Neonatal Abstinence Scoring System (sFNAS) that will highly correlate with scores ≥8 and ≥12 in infants being assessed with the FNAS.Design, setting and participantsThis is a retrospective analysis involving 367 patients admitted to two level IV neonatal intensive care units with a total of 40 294 observations. Inclusion criteria included neonates with gestational age ≥37 0/7 weeks, who are being assessed for neonatal abstinence syndrome (NAS) using the FNAS. Infants with a gestational age <37 weeks were excluded.MethodsA linear regression model based on the original FNAS data from one institution was developed to determine optimal values for each item in the sFNAS. A backward elimination approach was used, removing the items that contributed least to the Pearson’s correlation. The sFNAS was then cross-validated with data from a second institution.ResultsPearson’s correlation between the proposed sFNAS and the FNAS was 0.914. The optimal treatment cut-off values for the sFNAS were 6 and 10 to predict FNAS scores ≥8 and ≥12, respectively. The sensitivity and specificity of these cut-off values to detect FNAS scores ≥8 and ≥12 were 0.888 and 0.883 for a cut-off of 6, and 0.637 and 0.992 for a cut-off of 10, respectively. The sFNAS cross-validation resulted in a Pearson’s correlation of 0.908, sensitivity and specificity of 0.860 and 0.873 for a cut-off of 6, and 0.525 and 0.986 for a cut-off of 10, respectively.ConclusionThe sFNAS has a high statistical correlation with the FNAS, and it is cross-validated for the assessment of infants with NAS. It has excellent specificity and negative predictive value for identifying infants with FNAS scores ≥8 and ≥12.

Digital Scrapbooking as a Standard of Care in Neonatal Intensive Care Units: Initial Experience

2012 ◽  
Vol 31 (3) ◽  
pp. 162-168 ◽  
Author(s):  
Muhammad T. Subhani ◽  
Ifrah Kanwal
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Intensive Care Units ◽  
Neonatal Intensive Care ◽  
Standard Of Care ◽  
Neonatal Intensive Care Units ◽  
Initial Experience ◽  
Digital Photo ◽  
Ancillary Staff

In this article, we describe a digital photo scrapbooking project as a standard of care for the parents of infants admitted in a neonatal intensive care unit (NICU). Photographs were taken from birth until discharge or expiry at special moments during the infant’s hospitalization and used to create a digital scrapbook with daily notes by the parents. The scrapbook and original photos were provided on a CD at discharge or at expiry. Parents and their families unanimously appreciated the photos and the opportunity to record their thoughts, and considered the CDs as a lifetime treasure. Digital photo journaling could be implemented as a standard of care at other institutions with a commitment from the nursing and ancillary staff of the NICU and labor and delivery department, with possible support from volunteers.

scholarly journals Extremely Preterm Infant Admissions Within the SafeBoosC-III Consortium During the COVID-19 Lockdown

2021 ◽  
Vol 9 ◽  
Author(s):  
Marie Isabel Rasmussen ◽  
Mathias Lühr Hansen ◽  
Gerhard Pichler ◽  
Eugene Dempsey ◽  
Adelina Pellicer ◽  
...  
Keyword(s):  
Neonatal Intensive Care ◽  
Ad Hoc ◽  
Neonatal Intensive Care Units ◽  
Clinical Trial Registration ◽  
Time Period ◽  
Extremely Preterm ◽  
The Everyday ◽  
Local Impact ◽  
Post Hoc ◽  
Major Reduction

Objective: To evaluate if the number of admitted extremely preterm (EP) infants (born before 28 weeks of gestational age) differed in the neonatal intensive care units (NICUs) of the SafeBoosC-III consortium during the global lockdown when compared to the corresponding time period in 2019.Design: This is a retrospective, observational study. Forty-six out of 79 NICUs (58%) from 17 countries participated. Principal investigators were asked to report the following information: (1) Total number of EP infant admissions to their NICU in the 3 months where the lockdown restrictions were most rigorous during the first phase of the COVID-19 pandemic, (2) Similar EP infant admissions in the corresponding 3 months of 2019, (3) the level of local restrictions during the lockdown period, and (4) the local impact of the COVID-19 lockdown on the everyday life of a pregnant woman.Results: The number of EP infant admissions during the first wave of the COVID-19 pandemic was 428 compared to 457 in the corresponding 3 months in 2019 (−6.6%, 95% CI −18.2 to +7.1%, p = 0.33). There were no statistically significant differences within individual geographic regions and no significant association between the level of lockdown restrictions and difference in the number of EP infant admissions. A post-hoc analysis based on data from the 46 NICUs found a decrease of 10.3%in the total number of NICU admissions (n = 7,499 in 2020 vs. n = 8,362 in 2019).Conclusion: This ad hoc study did not confirm previous reports of a major reduction in the number of extremely pretermbirths during the first phase of the COVID-19 pandemic.Clinical Trial Registration:ClinicalTrial.gov, identifier: NCT04527601 (registered August 26, 2020), https://clinicaltrials.gov/ct2/show/NCT04527601.

Why Are We Trimming Peripherally Inserted Central Venous Catheters?

2004 ◽  
Vol 23 (3) ◽  
pp. 82-83 ◽  
Author(s):  
Carol Trotter
Keyword(s):  
Neonatal Intensive Care ◽  
Very Low Birth Weight ◽  
Insertion Site ◽  
Standard Of Care ◽  
Central Venous Catheters ◽  
Neonatal Intensive Care Units ◽  
Central Venous ◽  
Intravenous Access ◽  
Catheter Insertion Site ◽  
Catheter Tip

PERIPHERALLY INSERTED CENTRAL venous catheters (PICCs) are used as the standard of care for longterm intravenous access in neonates treated in neonatal intensive care units. Little evidence supports many of the practices associated with PICC lines, however. Some practices needing more evidence include catheter tip placement in very low birth weight neonates, the catheter insertion site, the catheter material, insertion site dressings, and mechanisms to prevent catheter-related sepsis. Of particular concern is the practice of trimming the excess length off the distal end of the catheter prior to insertion.

Current and Potentially New Management Strategies for Perinatal Hypoxic-Ischemic Encephalopathy

PEDIATRICS ◽  
1990 ◽  
Vol 85 (6) ◽  
pp. 961-968 ◽  
Author(s):  
Robert C. Vannucci
Keyword(s):  
Neonatal Intensive Care ◽  
Management Strategies ◽  
Newborn Infants ◽  
Standard Of Care ◽  
Neonatal Intensive Care Units ◽  
Future Research ◽  
Optimal Management ◽  
Ischemic Brain ◽  
The Brain ◽  
Ischemic Encephalopathy

Given the current dilemma in the brain-oriented therapy of newborn infants sustaining cerebral hypoxia-ischemia, it is not surprising that management strategies vary widely among neonatal intensive care units.9 Thus, there is no uniform standard of care, and it remains for future research to uncover new and effective modes of therapy for the neurologically compromised infant. Prevention, or at least optimal management, of prepartum and intrapartum asphyxia remains the best available means of reducing the incidence and severity of peninatal hypoxic-ischemic brain damage.

Electrographic Seizure Detection by Neuro ICU Nurses via Bedside Real-Time Quantitative EEG

2021 ◽  
pp. 10.1212/CPJ.0000000000001107
Author(s):  
Safa Kaleem ◽  
Jennifer H. Kang ◽  
Alok Sahgal ◽  
Christian E. Hernandez ◽  
Saurabh R. Sinha ◽  
...  
Keyword(s):  
Real Time ◽  
Sensitivity And Specificity ◽  
Standard Of Care ◽  
Seizure Detection ◽  
Quantitative Eeg ◽  
Primary Objective ◽  
Clinical Trial Registration ◽  
Icu Patients ◽  
Registration Number ◽  
Nurse Time

ABSTRACTObjective:Our primary objective was to determine the performance of real-time Neuroscience ICU (Neuro ICU) nurse interpretation of quantitative EEG (qEEG) at the bedside for seizure detection. Secondary objectives included determining nurse time to seizure detection and assessing factors that influenced nurse accuracy.Methods:Nurses caring for Neuro ICU patients undergoing cEEG were trained using a 1-hour qEEG panel (rhythmicity spectrogram and amplitude-integrated EEG) bedside display. Nurses’ hourly interpretations were compared to post-hoc cEEG review by two neurophysiologists as the gold standard. Diagnostic performance, time to seizure detection as compared to standard of care (SOC), and effects of other factors on nurse accuracy were calculated.Results:109 patients and 65 nurses were studied. Eight patients had seizures during the study period (7%). Nurse sensitivity and specificity for the detection of seizures were 74% and 92%, respectively. Mean nurse time to seizure detection was significantly shorter than SOC by 132 minutes (Cox proportional hazard ratio 6.96). Inaccurate nurse interpretation was associated with increased hours monitored and presence of brief rhythmic discharges.Conclusions:This prospective study of real-time nurse interpretation of qEEG for seizure detection in Neuro ICU patients showed clinically adequate sensitivity and specificity. Time to seizure detection was less than that of SOC.Classification of Evidence:This study provides Class I evidence that Neuro ICU nurse interpretation of qEEG detects seizures in adults with a sensitivity of 74% and specificity of 92% as compared to traditional cEEG review.Clinical Trial Registration Number: NCT02082873

Expanding Access to Continuous EEG Monitoring in Neonatal Intensive Care Units

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Mark P. Fitzgerald ◽  
Shavonne L. Massey ◽  
France W. Fung ◽  
Karen M. Puopolo ◽  
Michael Posencheg ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Neonatal Intensive Care ◽  
Neonatal Intensive Care Units ◽  
Eeg Monitoring ◽  
Continuous Eeg ◽  
Continuous Eeg Monitoring

scholarly journals Congenital anomalies and genetic disorders in neonates and infants: a single-center observational cohort study

2021 ◽  
Author(s):  
A. Marouane ◽  
R. A. C. M. Olde Keizer ◽  
G. W. J. Frederix ◽  
L. E. L. M. Vissers ◽  
W. P. de Boode ◽  
...  
Keyword(s):  
Congenital Anomalies ◽  
Neonatal Intensive Care ◽  
Diagnostic Yield ◽  
Genetic Disorders ◽  
Genetic Disorder ◽  
Genetic Diagnosis ◽  
Neonatal Intensive Care Units ◽  
Academic Level ◽  
Observational Cohort ◽  
Neonates And Infants

AbstractNeonates with genetic disorders or congenital anomalies (CA) contribute considerably to morbidity and mortality in neonatal intensive care units (NICUs). The objective of this study is to study the prevalence of genetic disorders in an academic level IV NICU. We retrospective collected and analyzed both clinical and genetic data of all 1444 infants admitted to the NICU of the Radboudumc (October 2013 to October 2015). Data were collected until infants reached at least 2 years of age. A total of 13% (194/1444) of the patients were genetically tested, and 32% (461/1444) had a CA. A total of 37% (72/194) had a laboratory-confirmed genetic diagnosis. In 53%, the diagnosis was made post-neonatally (median age = 209 days) using assays including exome sequencing. Exactly 63% (291/461) of the patients with CA, however, never received genetic testing, despite being clinically similar those who did.Conclusions: Genetic disorders were suspected in 13% of the cohort, but only confirmed in 5%. Most received their genetic diagnosis in the post-neonatal period. Extrapolation of the diagnostic yield suggests that up to 6% of our cohort may have remained genetically undiagnosed. Our data show the need to improve genetic care in the NICU for more inclusive, earlier, and faster genetic diagnosis to enable tailored management. What is Known:• Genetic disorders are suspected in many neonates but only genetically confirmed in a minority.• The presence of a genetic disorder can be easily missed and will often lead to a diagnostic odyssey requiring extensive evaluations, both clinically and genetically. What is New:• Different aspects of the clinical features and uptake of genetic test in a NICU cohort.• The need to improve genetic care in the NICU for more inclusive, earlier, and faster genetic diagnosis to enable tailored management.

Sign in / Sign up

Export Citation Format

Share Document