Newborns at high risk for brain injury: the role of the amplitude-integrated electroencephalography

ObjectiveAmplitude-integrated electroencephalography (aEEG) is a simplified bedside neurophysiology tool that has been implemented in the neonatal intensive care unit and studied in an extensive range of clinical applications in the past decade. This critical review aimed to evaluate a variety of clinical applications of aEEG monitoring in diagnosis, clinical management, and prognosis assessment in critically ill neonates.SourcesThe databases of Pubmed, SciELO, Lilacs, and Cochrane, books, and other online resources were consulted, as well as sources of professional experiences.Summary of findingsThe clinical use of aEEG to access real-time brain function, background activity, and utility in seizures detection has been described. A critical review was realized considering the authors’ professional experience. Newborns with hypoxic-ischemic encephalopathy and seizures screening represent the most common studied population. However, several studies have shown interesting applications on preterm infants, newborns with congenital heart disease, and other clinical situations of high risk of injury to the developing brain.ConclusionThe aEEG has shown to be a useful non-invasive bedside monitor that aids in evaluating brain function, background activity, and cyclicity. aEEG findings have also demonstrated good prognostic value in a group of critically ill neonates. The aEEG seizure diagnosis capability has limitations, which have been already well established. The use of neonatal brain monitoring such as aEEG was shown to give valuable information in several high-risk clinical situations.     

An international survey of EEG use in the neonatal intensive care unit

Objective: To examine the extent of EEG monitoring in neonatal intensive care units (NICUs), and to survey the level of experience and training of those using it. Study design: A web‐based survey, the link to which was circulated via e‐mail, personal contact, specialist societies and professional groups. Survey data were exported to SPSS for analysis. Results: In total 210 surveys were analysed; 124 from Europe, 54 from the US. Ninety percent of respondents had access to either EEG or aEEG monitoring; 51% had both. EEG was mainly interpreted by neurophysiologists (72%) whereas aEEG was usually interpreted by neonatologists (80%). Only 9% of respondents reported that they felt ‘very confident’ in their ability to interpret aEEG/EEG with 31% reporting that they were ‘not confident’. Half had received no formal training in EEG. Conclusion: Both aEEG and conventional EEG were used extensively in the NICUs surveyed for this study. Most of the survey respondents were not confident in their ability to interpret EEGs despite the fact that they used monitoring routinely. There is an urgent need for a structured and appropriately targeted training programme in EEG methodologies and EEG interpretation for neonatal intensive care unit staff.     

Early abnormal amplitude-integrated electroencephalography (aEEG) is associated with adverse short-term outcome in premature infants

BackgroundIn preterm infants with IVH the electrocortical background activity is affected and there is a correlation between the severity of cerebral injury to the degree of depression, however the usefulness of the early aEEG recordings has hardly been determined.AimTo identify early aEEG features that could be used as prognostic markers for severe brain injury in prematures.MethodsIn 115 infants, 25–32 wk GA, aEEG recordings during the first 72 h of life were correlated with head ultrasound findings. Continuity (Co), sleep–wake cycling (Cy) and amplitude of the lower border (LB) of the aEEG were evaluated by semi-quantitative analysis.ResultsThe infants were divided into four groups based on head ultrasound findings: A (n = 72, normal), B [n = 16, grades 1–2 intraventricular hemorrhage (IVH)], C (n = 21, grades 3–4 IVH) and D (n = 6, periventricular leukomalacia). 18 infants (16 of group C and 2 of group D) died during hospitalization. Significantly lower values of all aEEG features were found in group C infants. The presence of pathological tracings (burst-suppression, continuous low-voltage, flat trace) or discontinuous low-voltage (DLV), the absence of Cy and LB < 3 μV in the initial aEEG displayed a sensitivity of 88.9%, 63% and 51.9% respectively, for severe brain injury. Logistic regression of aEEG features and GA to the presence or absence of severe injury revealed that only Co was significantly correlated to outcome. Using this feature 83.19% of cases were correctly classified.ConclusionPathological tracings or DLV in the initial aEEG is predictive for poor short-term outcome in premature neonates.     

A national survey of the enteral feeding practices in Canadian neonatal intensive care units

AimNutrition affects the growth and neurodevelopmental outcomes of preterm infants, yet controversies exist about the optimal enteral feeding regime. The objective of this study was to compare enteral feeding guidelines in Canadian neonatal intensive care units (NICUs).MethodThe research team identified key enteral feeding practices of interest. Canadian Neonatal Network site investigators at 30 Level 3 NICUs were contacted to obtain a copy of their 2016 to 2017 feeding guidelines for infants who weighed less than 1,500 g at birth. Each guideline was reviewed to compare recommendations around the selected feeding practices.ResultsFive of the 30 NICUs did not have a feeding guideline. The other 25 NICUs used 22 different enteral feeding guidelines. The guidelines in 40% of those NICUs recommend commencing minimal enteral nutrition (MEN) within 24 hours of birth and maintaining that same feeding volume for 24 to 96 hours. In 40% of NICUs, the guideline recommended that MEN be initiated at a volume of 5 to 10 mL/kg/day for infants born at <1,000 g. Guidelines in all 25 NICUs recommend the use of bovine-based human milk fortifier (HMF), and in 56% of NICUs, it is recommended that HMF be initiated at a total fluid intake of 100 mL/kg/day. Guidelines in only 16% of NICUs recommended routine gastric residual checks. Donor milk and probiotics are used in 76% and 72% of the 25 NICUs, respectively.ConclusionThis study revealed substantial variability in recommended feeding practices for very low birth weight infants, underscoring the need to establish a national feeding guideline for this vulnerable group.     

Lack of influence of mild hypothermia on amplitude integrated-electroencephalography in neonates receiving extracorporeal membrane oxygenation

OBJECTIVE: To observe amplitude integrated electroencephalography (aEEG) in neonates receiving ECMO and to determine whether mild hypothermia influenced the aEEG recording. METHODS: Twenty-six consecutive neonates enrolled in a pilot study of mild hypothermia during ECMO were studied. The first group (N=6) was maintained at 37 degrees C throughout the study period. Subsequent groups were cooled to 36 degrees C (N=4), 35 degrees C (N=5), and finally 34 degrees C (N=6) respectively for 24 h and the final group (N=5) to 34 degrees C for 48 h before being rewarmed to 37 degrees C. The aEEG was recorded continuously during the first 5 days of ECMO. The aEEG was classified as normal, moderately or severely suppressed and examined for the occurrence of seizures. To assess the effect of temperature, the aEEG was compared over 12 h during the final 6 h of cooling and during the first 6 h once infants were rewarmed. RESULTS: No change in aEEG amplitude was noted over the temperature range studied. Of the 26 traces obtained, 16 (62%) were normal throughout, 6 (23%) were intermittently moderately abnormal and 1 (14%) was severely abnormal. Three (11%) traces had periods of frequent seizure activity and these were not associated with clinical manifestations in two neonates. In one infant who suffered a cerebral haemorrhage, the aEEG became abnormal before cranial ultrasound abnormalities were apparent. CONCLUSIONS: Continuous cerebral monitoring with aEEG is feasible during ECMO and may add information to clinical examination. Mild hypothermia to 34 degrees C for up to 48 h does not influence the aEEG suggesting that cerebral monitoring with aEEG is possible during mild hypothermia.     

宫内窘迫新生儿生后早期外周血pH值与振幅整合脑电图结果的关系

目的 探讨宫内窘迫新生儿生后早期外周血pH值与振幅整合脑电图（aEEG）结果的关系。方法 收集2017年1月至2018年5月出生的宫内窘迫新生儿的临床资料,按照生后30 min内的外周血pH值分为三组：pH ≤ 7.15组、7.15 < pH ≤ 7.25组、pH > 7.25组,每组30例。生后6 h内进行aEEG监测,各组aEEG异常率及平均脑功能监测（CFM）评分值进行比较。结果 pH ≤ 7.15组的aEEG结果异常率较pH > 7.25组显著增高（P < 0.0167）;pH ≤ 7.15组aEEG CFM评分显著低于7.15 < pH ≤ 7.25组和pH > 7.25组（P < 0.05）。外周血pH值与CFM评分呈显著正相关（r=0.26,P < 0.05）。结论 宫内窘迫新生儿生后早期外周血pH值与aEEG结果有显著关系,应积极防治生后早期外周血pH值严重降低（pH ≤ 7.15）宫内窘迫新生儿的神经系统损伤。     

Amplitude-integrated EEG pattern predicts further outcome in preterm infants

Changes in EEG background activity are powerful but nonspecific markers of brain dysfunction. Early EEG and amplitude-integrated EEG (aEEG) pattern predict further neurodevelopmental outcome in term infants; however, sufficient data for prognostic value of aEEG in preterm infants are not available so far. The aim of the study was to evaluate whether aEEG predicts further outcome and to compare it to cerebral ultrasound assessment. In 143 preterm infants, aEEG within the first 2 wk of life and outcome data at 3 y of age (Bayley Scales) could be obtained.aEEG was classified into a graded score according to background activity, appearance of sleep-wake cycling, and occurrence of seizure activity. In preterm infants, aEEG was significantly associated with further outcome. Specificity was 73% for assessment within the first and increased to 95% in the second week of life, whereas sensitivity stayed nearly the same 87% (first week) to 83% (second week). Cerebral ultrasound showed a specificity of 86% within the first and second week, sensitivity also stayed nearly the same (74 and 75%). aEEG has a predictive value for later outcome in preterm infants and can be used as an early prognostic tool.     

中国多中心新生儿重症监护室胎龄小于34周早产儿出院前视网膜病变发生率的横断面调查

目的调查中国NICU胎龄34周早产儿视网膜病变(ROP)发生率。方法数据来源于"基于证据的质量改进方法降低我国新生儿重症监护室院内感染发生率的整群随机对照试验"所建立的早产儿临床数据库,收集25家三级NICU 2015年5月1日至2018年4月30日住院期间接受积极治疗、转出NICU或死亡前至少完成1次ROP筛查的胎龄34周早产儿的临床资料,分析不同胎龄及出生体重早产儿的ROP发生率、分期及治疗方式,并比较各单位间的差异。结果14 015例34周的早产儿在出院前或死亡前至少进行了1次ROP筛查,筛查阳性2 304例(16.4%),其中ROP1期1 092例(7.8%),ROP2期1 004例(7.2%),ROP 3～5期208例(1.5%)。胎龄28周早产儿ROP发生率为56.5%(578/1 023),3～5期ROP发生率为9.6%(98/1 023)。出生体重1 000 g和1 000～1 499 g早产儿ROP发生率分别为54.2%(465/858)和22.1%(1 411/6 381),3～5期ROP发生率分别为9.6%(82/858)和1.5%(95/6 381)。2 304例ROP早产儿在出院前188例(8.2%)接受治疗,其中眼内药物注射117例。各单位间ROP发生率存在显著差异。结论胎龄34周的早产儿的ROP发生率为16.4%,8.2%的ROP患儿接受治疗,其中62%采用玻璃体内注药,不同单位间ROP发生率差异显著。     

Risk adjusted and population based studies of the outcome for high risk infants in Scotland and Australia. International Neonatal Network, Scottish Neonatal Consultants, Nurses Collaborative Study Group

OBJECTIVES—To compare outcomes of care in selected neonatal intensive care units (NICUs) for very low birthweight (VLBW) or preterm infants in Scotland and Australia (study 1) and perinatal care for all VLBW infants in both countries (study 2).
DESIGN—Study 1: risk adjusted cohort study; study 2: population based cohort study.
SUBJECTS—Study 1: all 2621 infants of < 1500 g birth weight or < 31 weeks'' gestation admitted to a volunteer sample of hospitals comprising eight of all 17 Scottish NICUs and six of all 12 tertiary NICUs in New South Wales and Queensland in 1993-1994; study 2: all 5986infants of 500-1499 g birth weight registered as live born in Scotland and Australia in 1993-1994.
MAIN OUTCOMES—Study 1: (a) hospital death; (b) death or cerebral damage, each adjusted for gestation and CRIB (clinical risk index for babies); study 2: neonatal (28 day) mortality.
RESULTS—Study 1. Data were obtained for 1628 admissions in six Australian NICUs, 775 in five Scottish tertiary NICUs, and 148 in three Scottish non-tertiary NICUs. Crude hospital death rates were 13%, 22%, and 22% respectively. Risk adjusted hospital mortality was about 50% higher in Scottish than in Australian NICUs (adjusted mortality ratio 1.46, 95% confidence interval (CI) 1.29 to 1.63,p < 0.001). There was no difference in risk adjusted outcomes between Scottish tertiary and non-tertiary NICUs. After risk adjustment, death or cerebral damage was more common in Scottish than Australian NICUs (odds ratio 1.9, 95% CI 1.5 to 2.5). Both these risk adjusted adverse outcomes remained more common in Scottish than Australian NICUs after excluding all infants < 28 weeks'' gestation from the comparison. Study 2. Population based neonatal mortality in infants of 500-1499 g was higher in Scotland (20.3%) than Australia (16.6%) (relative risk 1.22, 95% CI 1.08 to 1.39, p = 0.002). In a post hoc analysis, neonatal mortality was also higher in England and Wales than in Australia.
CONCLUSIONS—Study 1: outcome was better in the Australian NICUs. Study 2: perinatal outcome was better in Australia. Both results may be consistent, at least in part, with differences in the organisation and implementation of neonatal care.

     

Continuous brain-function monitoring: state of the art in clinical practice

Continuous electroencephalographic (EEG) monitoring gives direct information on brain function in newborn infants needing intensive care. To improve the possibilities of long-term monitoring, the EEG is time-compressed and recorded with a reduced number of electrodes. A trend measure of the EEG, the amplitude-integrated EEG (aEEG), has proved capable of giving relevant information in newborn infants of differing levels of maturity. The electrocortical background activity gives information on the level of brain activity, which is associated with outcome in both term asphyxiated infants and in preterm infants. However, the background activity is also affected by several medications, and this must be considered when interpreting the aEEG trace. The aEEG also reveals subclinical epileptic seizure activity, and can be used for evaluation of anti-epileptic treatment. The aEEG should be used as a complement to the standard EEG, and close collaboration between neonatologists and clinical neurophysiologists is necessary for optimal performance of EEG monitoring.     

振幅整合脑电图监测不同胎龄早产儿宫外环境下脑发育的多中心观察性研究

目的 了解宫外生活对28~36周早产儿振幅整合脑电图（aEEG）的影响。方法 以出生时无窒息抢救史早产儿为早产儿组,以胎龄37周出生后正常的新生儿为对照组;早产儿组采用振幅整合脑电图仪分别于生后3 d内,然后每周监测1次直至出院（或最长监测至纠正胎龄37周）,对照组于生后第3 d 行aEEG监测。每次连续监测4 h。分析胎龄和纠正胎龄对aEEG成熟过程影响,包括aEEG背景连续性、睡眠-觉醒周期、下边界振幅和带宽。5家参研医院均采用相同品牌和型号的aEEG,研究开始前统一进行操作技术培训,样本的临床和图像数据发送至复旦大学附属儿科医院整理。结果 2008年5月1日至2009年8 月31日5家参研医院符合本文纳入和排除标准的早产儿组135例,对照组20例。早产儿aEEG的成熟度受胎龄和纠正胎龄的影响,随胎龄和纠正胎龄增加,aEEG背景连续性和睡眠-觉醒周期出现的百分比均增加,逐步出现连续性电压（χ2=26.865,P<0.01）,≥34周出生的早产儿成熟的睡眠-觉醒周期的出现的百分比均为100％（χ2=192.4,P<0.01）;下边界振幅升高（F＝11.4,P<0.01）,带宽变窄（F＝8.731,P<0.01）。纠正胎龄和同出生胎龄的新生儿比较,连续性电压百分比、睡眠-觉醒周期的出现率均显著增加,胎龄＞34周的早产儿出生时aEEG均可见明显的睡眠-觉醒周期,而纠正胎龄32周时,睡眠-觉醒周期出现的百分比已达到100%;窄带下界也显著增高;窄带带宽变窄,至34周龄后,纠正胎龄和同出生胎龄新生儿均变化不明显。结论 早产儿aEEG的成熟度与出生胎龄和纠正胎龄相关,宫外生活加速了早产儿脑发育成熟。     

Background patterns and sleep-wake cycles on amplitude-integrated electroencephalography in preterms younger than 30 weeks gestational age with peri-/intraventricular haemorrhage

AIM: The objective of this prospective study was to evaluate the influence of peri-/intraventricular haemorrhage (PIVH) grades I-IV on amplitude-integrated electroencephalographic (aEEG) activity in preterm infants<30 weeks gestational age (GA). METHODS: The aEEG tracings of the first 2 weeks of life of 56 preterm infants younger than 30 weeks GA (2 groups: group A=23-26 weeks GA, group B=27-29 weeks GA) born during a 4-year period with PIVH grades I-IV were assessed for the relative duration of four background aEEG activity patterns (continuous pattern, discontinuous high-voltage pattern, discontinuous low-voltage pattern and nearly isoelectric pattern), the presence of seizure activity and the appearance of sleep-wake cycles and compared to the tracings of 75 neurologically healthy preterms without PIVH. RESULTS: Analysis of aEEG background activity showed a decrease of continuous activity whereas discontinuous activity increased in both groups with larger haemorrhages (grades III and IV) and when compared to controls. Suspected seizure activity was more common with increasing degree of bleeding in group A (50% with PIVH I or II, 75% with PIVH III or IV) and when compared to controls and was the same with increasing degree of bleeding in group B (47% with PIVH I or II, 45% with PIVH III or IV). Sleep-wake cycles were less common with larger haemorrhages in both groups (group A: 41% with PIVH I or II, 25% with PIVH III or IV; group B: 52% with PIVH I or II, 9% with PIVH III or IV) and when compared to controls. CONCLUSIONS: The aEEG characteristics of severe PIVH consist in a combination of a more discontinuous background pattern, a lack of sleep-wake cycles and a higher likelihood of seizure activity when compared to age-matched controls.     

振幅整合脑电图对早产儿脑损伤的诊断价值及其影响因素

目的　探讨振幅整合脑电图(aEEG)对早产儿脑损伤(BIPI)的诊断价值及其影响因素。方法　将116例胎龄27~36+6周早产儿纳入研究, 对所有早产儿生后 6 h 内aEEG进行评分; 依据BIPI诊断结果将116例早产儿分为BIPI组(n=63)和非BIPI组(n=53), 采用logistic回归分析对导致BIPI发生的危险因素进行评估; 依据aEEG检测结果再将116例早产儿分为aEEG正常组(n=58)和aEEG异常组(n=58), 对影响早产儿aEEG结果的因素行单因素分析。结果　BIPI组中aEEG异常52 例(83%); 非BIPI组中aEEG 异常6例(11%), 两组aEEG异常率比较差异有统计学意义(P<0.05)。将早产儿依据胎龄27~33+6周和34~36+6周进行划分, BIPI组aEEG评分明显低于同胎龄非BIPI组(P<0.01)。Logistic回归分析显示：小胎龄(<32周)、低出生体重(<1 500 g)、胎盘胎膜及脐带异常和母孕期高血压是导致BIPI发生的高危因素(P<0.05)。aEEG异常组与aEEG正常组在胎龄、出生体重、胎盘胎膜及脐带异常和母孕期高血压4方面比较差异有统计学意义(P<0.05)。结论 导致BIPI发生的危险因素与影响早产儿aEEG结果的因素相一致, 提示aEEG有助于BIPI的早期诊断。     

Investigating the European perspective of neonatal point-of-care echocardiography in the neonatal intensive care unit—a pilot study

Point-of-care functional neonatal echocardiography (fnECHO) is increasingly used to assess haemodynamic status or patency of the ductus arteriosus (PDA). In Australasia, 90 % of neonatal intensive care units (NICUs) practice point-of-care fnECHO. The Australian Society of Ultrasound Medicine offers a training certificate for fnECHO. In Europe, the use and indications of fnECHO and the extent of point-of-care fnECHO training and accreditation are unknown. We aimed to assess utilisation and training of fnECHO in Europe. For this, we conducted an email survey of 45 randomly chosen tertiary NICUs in 17 European countries. The recall rate was 89 % (n?=?40). Neonatologists with skills in fnECHO worked in 29 NICUs (74 %), but paediatric cardiologists would routinely perform most fnECHOs. Twenty-four-hour echocardiography service was available in 31 NICUs (78 %). Indications for fnECHO included assessment of haemodynamic volume status (53 %), presence or absence of pulmonary hypertension of the neonate (55 %), indication for and effect of volume replacement therapy (58 %), PDA assessment and monitoring of PDA treatment (80 %). Teaching of fnECHO was offered to trainees in 22 NICUs (55 %). Teaching of fnECHO was provided by paediatric cardiologists (55 %) or by neonatologists (45 %). Only six (15 %) national colleges accredited fnECHO teaching courses. Conclusion: fnECHO is widely practiced by neonatologists across Europe for a broad range of clinical questions. However, there is a lack of formal training and accreditation of fnECHO skills. This could be addressed by designing a dedicated European fnECHO training programme and by agreeing on a common European certificate of fnECHO.     

The effect of maturation and sedation on amplitude-integrated electroencephalogram of the preterm neonate: results of a prospective study

Background and aim: Amplitude-integrated electroencephalogram (aEEG) is becoming more common in NICUs for monitoring infants after perinatal asphyxia. We used aEEGs for preterm infants, and analysed the influence of sedation and maturation on their aEEG, focusing on continuous activity. Methods: Weekly or biweekly aEEGs were performed in preterm infants and evaluated by visual analysis. Results: We analysed 92 aEEGs of 56 preterm infants (gestational age (GA) 24 + 6 to 34 + 0 wk, median 30 + 0 wk). In their first week of life, children with higher GA had a higher percentage of continuous activity: with a GA ≤ 28 + 0 wk it was 8.1%, 33.5% with a GA from 28 + 1 to 30 + 0 wk (p=0.02), 85.9% with a GA from 30 + 1 to 32 + 0 wk (p=0.005), and 89.1% with a GA from 32 + 1 to 34 + 0 wk. Continuous activity increased with growing postnatal age. With a GA ≤ 28 + 0 wk, it rose from 8.1% (first week) to 55.3% (second week) and reached 96.8% (week 6/7) (p=0.017). With GA from 28 + 1 to 30 + 0 wk, continuous activity was 33.5% (first week) and 86.6% (second week) (p=0.03).

Conclusion: The aEEG of preterm infants appears to be a good tool for monitoring cerebral activity. Continuous activity seems to indicate maturation in the neonatal brain. Further investigations of aEEGs in preterm infants should be performed.     

Postnatal Maturation of Amplitude Integrated Electroencephalography (aEEG) in Preterm Small for Gestational Age Neonates

Objective

The primary objective was to evaluate the postnatal maturation pattern on aEEG during first two weeks of life in clinically stable and neurologically normal preterm small for gestational age (PSGA) and gestation matched (1 week) preterm appropriate for gestational age (PAGA) neonates born between 30^0/7 and 34^6/7 weeks of gestation.

Methods

Serial aEEG tracings were recorded on 3rd, 7th and 14th day of life. The primary outcome was total aEEG maturation score. Three blinded assessors assigned the scores.

Results

We analyzed a total of 117 aEEG recordings in 40 (19 PSGA and 21 PAGA) neonates. The baseline characteristics were comparable except for birthweight [1186 (263) vs 1666 (230) g]. There was no difference in the mean (SD) total scores on day 3 (9.0 (1.8) vs. 9.5 (1.1), P=0.32) and day 14 of life, but was lower in PSGA infants on day 7 (8.6 (2.4) vs. 10.1 (1.1), P=0.02). On multivariate analysis, maturation of PSGA neonates was found to be significantly delayed at any point of life from day 3 to day 14 (mean difference, -0.8, 95 % CI: -1.6 to -0.02, P=0.04).

Conclusion

Lower aEEG maturation score on day 7 possibly indicates delayed maturation in PSGA neonates in the first week of life.

     

Need for quality control for aEEG monitoring of the preterm infant: a 2-year experience

Aim: To establish and apply a questionnaire for the evaluation of amplitude‐integrated electroencephalogram (aEEG) with respect to practicability and feasibility in the NICU, to reveal strategies for improvements in daily use and to investigate the level of staff know‐how with regard to performance and evaluation of bedside aEEG for the purpose of quality control. Methods: Amplitude‐integrated electroencephalogram was routinely applied in preterm infants below 32 weeks of gestational age for a period of 2 years. Practicability, feasibility and the level of know‐how with regard to aEEG were assessed using a multiple‐choice questionnaire. Results: Major problems in the use of aEEG in preterm infants were identified as time needed for placement and frequent readjustment of electrodes. Quality control showed the following problems: seizure activity was correctly diagnosed in 60.0%, discontinuous (DC) background in 45.5% and burst suppression (BS) in 41.8% of patients. Overall, BS and DC were the patterns most frequently interpreted incorrectly. Conclusion: Amplitude‐integrated electroencephalogram is frequently used in neonatology. In preterm infants with several challenges, repeated theoretical and practical trainings as well as quality control are needed in order for aEEG to become a routinely used monitoring instrument in daily preterm care.     

The Role of Rehabilitation Specialists in Canadian NICUs: A 21st Century Perspective

Rehabilitation specialists are an integral part of the team in the neonatal intensive care unit (NICU). New approaches to rehabilitation practice in the NICU have evolved over the past decade that aim to promote child health and development. Aims: The aim of this study was to describe the current roles of the occupational therapist (OT), physical therapist (PT) and speech-language pathologist (SLP) in Canadian NICUs as compared to the roles documented in an earlier national survey conducted 15 years ago. Methods: A telephone survey was conducted across Canadian NICUs and each telephone interview was recorded by a research assistant. In total, 42 questionnaires were completed across 25 health care institutions. Results: Eighty percent of the PT, 93.7% of OT and 50% of SLP provided direct services to neonates in the NICU. The results demonstrated that the therapists were involved with case discussion (85.7%), decision-making (97.6%), referrals to other services (97.6%) and discharge planning (97.6%). Splinting (87.5%) and feeding (100%) were most often carried out by OT, whereas chest physiotherapy (65%) and range of motion (100%) were predominantly provided by PT. Changes in the role of rehabilitation specialists over the last decade predominantly included enhanced collaboration with the NICU team, more frequent use of standardized outcome measures and use of interventions supported by evidence. Conclusion: In comparison with results of the previous survey of rehabilitation practices in Canadian NICUs, rehabilitation specialists now have more dedicated time in the NICU and more frequently use standardized measures and apply interventions that are supported by recent scientific studies.     

The Evidence-based Practice for Improving Quality method has greater impact on improvement of outcomes than dissemination of practice change guidelines and quality improvement training in neonatal intensive care units

OBJECTIVES:To determine whether outcome improvements achieved by neonatal intensive care units (NICUs) in the Evidence-based Practice for Improving Quality (EPIQ) trial could be reproduced in other NICUs by providing quality improvement (QI) training and practice change guidelines developed during the EPIQ trial; and to examine whether the results of the EPIQ trial were sustained.METHODS:The present prospective before-after study included 5812 infants born at ≤32 weeks’ gestation and admitted to 19 level 3 NICUs in the Canadian Neonatal Network between October 1, 2005 and December 31, 2007. During a three-month baseline period, multi-disciplinary teams received general training in QI techniques at a two-day workshop, and practice change guidelines targeting nosocomial infection (NI) and bronchopulmonary dysplasia (BPD) developed during the EPIQ trial were provided to all participants. Outcome data collected during the intervention period were compared with data from the baseline period and reported quarterly.RESULTS:In NICUs that had not previously participated in the EPIQ trial (non-EPIQ NICUs), there were no significant changes in the incidence trends of NI or BPD. However, within NICUs that had previously participated in the EPIQ trial (EPIQ NICUs) there was a continued reduction in the incidence trend of NI and BPD among EPIQ NICUs randomized during the trial to reduce NI and BPD, respectively.CONCLUSIONS:Providing NICUs with QI training and practice change guidelines developed during a successful QI initiative in other units is not effective. The authors speculate that successful practice change involves organizational culture and behaviour change, and should be driven by context-specific evidence.     

振幅整合脑电图检查在早产儿脑成熟度评价中的应用

目的 研究振幅整合脑电图检查在早产儿脑成熟度评价中的应用.方法2008年9月至2009年8月在我院NICU住院的早产儿共91例,完成振幅整合脑电图检查112例次,对图形连续性、睡眠觉醒周期及振幅的最低电压和最高电压进行分析.结果随早产儿校正胎龄的增加,图形逐渐从不连续到连续,睡眠觉醒周期逐渐规律出现,振幅最低及最高电压与校正胎龄明显相关(r =0.982,P＜0.01;r=-0.964,P＜0.01).结论振幅整合脑电图可以作为一项简便易行的监测手段来评价早产儿脑成熟度.