1
|
Wang Z, Zhang P, Zhou W, Zhou X, Shi Y, Cheng X, Lin Z, Xia S, Zhou W, Cheng G. Electroencephalography monitoring in the neonatal intensive care unit: a Chinese perspective. Transl Pediatr 2021; 10:552-559. [PMID: 33850813 PMCID: PMC8039787 DOI: 10.21037/tp-20-340] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Electroencephalography (EEG) is an accessible technique for bedside monitoring of the cerebral function in the neonatal intensive care unit (NICU). The popularization of EEG in the field of newborns in China is relatively late compared with western countries. To learn more about current practices and improvement of EEG monitoring, we conducted a survey to describe current utilization of EEG in NICU in China. METHODS A cross-sectional electronic survey with 21-items about EEG using in NICU was administered for pediatricians in China on the official website of "Questionnaire Star". RESULTS A total of 251 participants were involved, in which 64% of them reported using EEG. EEG was employed in NICUs of Children's hospitals (97%), and grade III, class A hospitals (69%). Besides, neonatal encephalopathy and suspected seizures were the most common indications for use. In clinical practice, the vast majority of physicians managed their patients on the basis of EEG (93%). Pediatricians prefer to use conventional video-EEG (cEEG) to detect seizures and make the diagnosis of encephalopathy. Both amplitude integrated EEG (aEEG) (78%) and cEEG (56%) were mainly interpreted by neonatologists. However, only 56% of respondents had ever taken a formal EEG training course. Overall, 96% of the respondents reported that they would be interested in attending an education session on EEG in the NICU. aEEG interpretation was the most interesting part to learn (81%). For those who were not using EEG, cost (43%) and difficulty interpretation (30%) were reported as barriers to use. CONCLUSIONS The utilization rate of EEG in NICU in China is significantly lower than the international level. There is an urgent need for standardized training and financial support for neonatologists in the use of EEG and interpretation of aEEG results.
Collapse
Affiliation(s)
- Zheng Wang
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Peng Zhang
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Wenhao Zhou
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Xiaoyu Zhou
- Department of Neonatology, Children's Hospital of Nanjing Medical University, Nanjing China
| | - Yuan Shi
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xiuyong Cheng
- Department of Neonatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhenlang Lin
- Department of Neonatology, Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Shiwen Xia
- Department of Neonatology, Maternal and Child Hospital of Hubei Province, Wuhan, China
| | - Wei Zhou
- Department of Neonatology, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Guoqiang Cheng
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| |
Collapse
|
2
|
Mescall S, Dhamodaran M, Clarke P, Ponnusamy V. Current availability of cerebral function monitoring and therapeutic hypothermia equipment in UK neonatal units and networks. Arch Dis Child Fetal Neonatal Ed 2021; 106:225-227. [PMID: 33122247 DOI: 10.1136/archdischild-2020-320493] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/08/2020] [Indexed: 01/02/2023]
Affiliation(s)
- Sarah Mescall
- Neonatal Intensive Care Unit, Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, UK
| | - Madhuvanthi Dhamodaran
- Neonatal Intensive Care Unit, Norfolk & Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Paul Clarke
- Neonatal Intensive Care Unit, Norfolk & Norwich University Hospitals NHS Foundation Trust, Norwich, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
| | - Vennila Ponnusamy
- Neonatal Intensive Care Unit, Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, UK
| |
Collapse
|
3
|
Consensus protocol for EEG and amplitude-integrated EEG assessment and monitoring in neonates. Clin Neurophysiol 2021; 132:886-903. [PMID: 33684728 DOI: 10.1016/j.clinph.2021.01.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 12/19/2020] [Accepted: 01/06/2021] [Indexed: 12/23/2022]
Abstract
The aim of this work is to establish inclusive guidelines on electroencephalography (EEG) applicable to all neonatal intensive care units (NICUs). Guidelines on ideal EEG monitoring for neonates are available, but there are significant barriers to their implementation in many centres around the world. These include barriers due to limited resources regarding the availability of equipment and technical and interpretive round-the-clock personnel. On the other hand, despite its limitations, amplitude-integrated EEG (aEEG) (previously called Cerebral Function Monitor [CFM]) is a common alternative used in NICUs. The Italian Neonatal Seizure Collaborative Network (INNESCO), working with all national scientific societies interested in the field of neonatal clinical neurophysiology, performed a systematic literature review and promoted interdisciplinary discussions among experts (neonatologists, paediatric neurologists, neurophysiologists, technicians) between 2017 and 2020 with the aim of elaborating shared recommendations. A consensus statement on videoEEG (vEEG) and aEEG for the principal neonatal indications was established. The authors propose a flexible frame of recommendations based on the complementary use of vEEG and aEEG applicable to the various neonatal units with different levels of complexity according to local resources and specific patient features. Suggestions for promoting cooperation between neonatologists, paediatric neurologists, and neurophysiologists, organisational restructuring, and teleneurophysiology implementation are provided.
Collapse
|
4
|
Grass B, Crosdale B, Keyzers M, Deshpande P, Hahn C, Ly LG, McNamara PJ. Implementation of amplitude-integrated electroencephalography in tertiary Canadian Neonatal Intensive Care Units-a longitudinal study. Paediatr Child Health 2019; 25:511-517. [PMID: 33354260 DOI: 10.1093/pch/pxz091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 05/16/2019] [Indexed: 11/14/2022] Open
Abstract
Aim To investigate the implementation of amplitude-integrated electroencephalography (aEEG) as bedside monitoring tool of cerebral function in tertiary Canadian Neonatal Intensive Care Units (NICU) over the past decade. Methods Longitudinal study consisting of online surveys of neonatologists on the use of aEEG in 2009 and 2018. Results The response rate to the survey was 72 of 149 (49%) in 2009 and 18 of 30 (60%) in 2018, respectively. aEEG has been implemented in almost all (2009: 62.5%; 2018: 94%) tertiary Canadian NICUs. Two-thirds (2009: 67%; 2018: 71%) of the respondents considered information from aEEG tracing helpful in clinical practice. The main indications for aEEG were term neonates with hypoxic ischemic encephalopathy (2009 and 2018: 76%) and seizure detection/surveillance (2009: 88%; 2018: 94%). Teaching on aEEG has been implemented for neonatologists (2018: 100%) and health care providers (2018: 50%) in tertiary Canadian NICUs but there is a lack of standardization of training. Use of aEEG in preterm neonates (2009: 37%, 2018: 33%) and application of aEEG in research (18% reported occasional use) is less common. Conclusion aEEG is well established in tertiary Canadian NICUs to monitor cerebral function and detect seizure activity. There is a need to develop formalized aEEG training programs and methods to assess competence. Further implementation of aEEG in preterm neonates and research is desirable.
Collapse
Affiliation(s)
- Beate Grass
- Division of Neonatology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario
| | - Blondel Crosdale
- Division of Neonatology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario
| | - Matthew Keyzers
- Division of Neonatology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario
| | - Poorva Deshpande
- Department of Pediatrics, University of Toronto, Toronto, Ontario.,Division of Neonatology, Mount Sinai Hospital, Toronto, Ontario
| | - Cecil Hahn
- Department of Pediatrics, University of Toronto, Toronto, Ontario.,Neonatal Neuroscience Team, The Hospital for Sick Children, Toronto, Ontario
| | - Linh G Ly
- Division of Neonatology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario.,Department of Pediatrics, University of Toronto, Toronto, Ontario
| | - Patrick J McNamara
- Division of Neonatology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario.,Department of Pediatrics, University of Toronto, Toronto, Ontario.,Division of Neonatology, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| |
Collapse
|
5
|
Ibrahim ZH, Chari G, Abdel Baki S, Bronshtein V, Kim MR, Weedon J, Cracco J, Aranda JV. Wireless multichannel electroencephalography in the newborn. J Neonatal Perinatal Med 2017; 9:341-348. [PMID: 28009337 PMCID: PMC5181680 DOI: 10.3233/npm-161643] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES: First, to determine the feasibility of an ultra-compact wireless device (microEEG) to obtain multichannel electroencephalographic (EEG) recording in the Neonatal Intensive Care Unit (NICU). Second, to identify problem areas in order to improve wireless EEG performance. STUDY DESIGN: 28 subjects (gestational age 24–30 weeks, postnatal age <30 days) were recruited at 2 sites as part of an ongoing study of neonatal apnea and wireless EEG. Infants underwent 8-9 hour EEG recordings every 2–4 weeks using an electrode cap (ANT-Neuro) connected to the wireless EEG device (Bio-Signal Group). A 23 electrode configuration was used incorporating the International 10–20 System. The device transmitted recordings wirelessly to a laptop computer for bedside assessment. The recordings were assessed by a pediatric neurophysiologist for interpretability. RESULTS: A total of 84 EEGs were recorded from 28 neonates. 61 EEG studies were obtained in infants prior to 35 weeks corrected gestational age (CGA). NICU staff placed all electrode caps and initiated all recordings. Of these recordings 6 (10%) were uninterpretable due to artifacts and one study could not be accessed. The remaining 54 (89%) EEG recordings were acceptable for clinical review and interpretation by a pediatric neurophysiologist. Of the recordings obtained at 35 weeks corrected gestational age or later only 11 out of 23 (48%) were interpretable. CONCLUSIONS: Wireless EEG devices can provide practical, continuous, multichannel EEG monitoring in preterm neonates. Their small size and ease of use could overcome obstacles associated with EEG recording and interpretation in the NICU.
Collapse
Affiliation(s)
- Z H Ibrahim
- Pediatrics, Division of Neonatology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - G Chari
- Child Neurology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | | | - V Bronshtein
- Pediatrics, Division of Neonatology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - M R Kim
- Pediatrics, Brookdale University Medical Center, Brooklyn, NY, USA
| | - J Weedon
- Research Division, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - J Cracco
- Child Neurology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - J V Aranda
- Pediatrics, Division of Neonatology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| |
Collapse
|
6
|
Kalra V, Shaw SS, Dixon S, Shah DK, Clarke P. Cerebral function monitoring on a general paediatric ward: feasibility and potential. Eur J Pediatr 2016; 175:1059-64. [PMID: 27271341 DOI: 10.1007/s00431-016-2737-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 05/16/2016] [Accepted: 05/19/2016] [Indexed: 11/29/2022]
Abstract
UNLABELLED Cerebral function monitoring is widely used in neonatal intensive care, but its potential role in assessment of older infants is scarcely reported. We reviewed the use of cerebral function monitoring on a general paediatric ward in a series of young infants admitted with abnormal movements. Review of the amplitude-integrated EEG obtained by cerebral function monitoring revealed electrographic seizures in four of seven infants monitored. We also surveyed general paediatric wards in hospitals in our region of the UK to ask about current use of cerebral function monitoring and local availability of formal electroencephalography services. Cerebral function monitoring was not being used in the 16 other paediatric departments surveyed, and there was very limited provision for obtaining a full-array electroencephalogram out-of-hours. CONCLUSION With adequate training and education, it is feasible to undertake cerebral function monitoring on a general paediatric ward. Continuous cerebral function monitoring is a tool that has potential use for detecting clinical seizures and augmenting clinical neuro-observations of young children admitted to a general paediatric ward. WHAT IS KNOWN • In intensive care settings, cerebral function monitoring (CFM) has long been used for the continuous bedside monitoring of brain function in critically ill neonates, children and adults. • Very few studies have looked at the use of CFM outside of the intensive care setting, and it is presently unclear if CFM is used in the general paediatric ward. What is new: • CFM is presently not widely used in the general paediatric setting. • With appropriate training and support, CFM can be successfully introduced to the general paediatric ward with the potential to enhance the clinical monitoring of young infants admitted with abnormal movements.
Collapse
Affiliation(s)
- Vivek Kalra
- Department of Paediatrics, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, NR4 7UY, UK
| | - Shahul Sikkander Shaw
- Department of Paediatrics, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, NR4 7UY, UK
| | - Stacey Dixon
- Neonatal Intensive Care Unit, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, NR4 7UY, UK
| | - Divyen K Shah
- Neonatal Intensive Care Unit, Royal London Hospital, London, E1 1BB, UK.,Barts and the London Medical School, London, UK
| | - Paul Clarke
- Neonatal Intensive Care Unit, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, NR4 7UY, UK.
| |
Collapse
|
7
|
Hellström‐Westas L, Boylan G, Ågren J. Systematic review of neonatal seizure management strategies provides guidance on anti-epileptic treatment. Acta Paediatr 2015; 104:123-9. [PMID: 25251733 DOI: 10.1111/apa.12812] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 07/11/2014] [Accepted: 09/19/2014] [Indexed: 11/28/2022]
Abstract
UNLABELLED There is a lack of scientific evidence to support the best management of neonatal seizures. Current strategies for neonatal seizure management were investigated by analysis of all surveys published during the time period 2000-2012. Methods for seizure diagnosis and availability of electroencephalogram (EEG), including monitoring, varied. Phenobarbital was the drug of first choice, and the use of off-label drugs and treatment times varied. CONCLUSION We conclude that there is an urgent need for more evidence-based studies to guide neonatal seizure management.
Collapse
Affiliation(s)
| | - Geraldine Boylan
- Department of Paediatrics & Child Health University College Cork Cork Ireland
| | - Johan Ågren
- Department of Women's and Children's Health Uppsala University Uppsala Sweden
| |
Collapse
|
8
|
Abend NS, Wusthoff CJ, Goldberg EM, Dlugos DJ. Electrographic seizures and status epilepticus in critically ill children and neonates with encephalopathy. Lancet Neurol 2014; 12:1170-9. [PMID: 24229615 DOI: 10.1016/s1474-4422(13)70246-1] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Electrographic seizures are seizures that are evident on EEG monitoring. They are common in critically ill children and neonates with acute encephalopathy. Most electrographic seizures have no associated clinical changes, and continuous EEG monitoring is necessary for identification. The effect of electrographic seizures on outcome is the focus of active investigation. Studies have shown that a high burden of electrographic seizures is associated with worsened clinical outcome after adjustment for cause and severity of brain injury, suggesting that a high burden of such seizures might independently contribute to secondary brain injury. Further research is needed to determine whether identification and management of electrographic seizures reduces secondary brain injury and improves outcome in critically ill children and neonates.
Collapse
Affiliation(s)
- Nicholas S Abend
- Departments of Neurology and Pediatrics, The Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | | | | | | |
Collapse
|
9
|
Glass HC, Wusthoff CJ, Shellhaas RA. Amplitude-integrated electro-encephalography: the child neurologist's perspective. J Child Neurol 2013; 28:1342-50. [PMID: 23690296 PMCID: PMC4091988 DOI: 10.1177/0883073813488663] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Neurologists increasingly recognize that critically ill patients are at high risk for seizures, particularly nonconvulsive seizures, and that neuromonitoring is a useful tool for diagnosing seizures and assessing brain function in these patients. Amplitude-integrated electroencephalography (EEG) is a simplified bedside neurophysiology tool that has become widely used in neonates over the past decade. Despite widespread interest by both neurologists and neonatologists in continuous brain monitoring, amplitude-integrated EEG has been largely ignored by neurologists, forcing neonatologists to "go it alone" when interpreting data from this bedside tool. Although amplitude-integrated EEG cannot replace conventional EEG for background monitoring and detection of seizures, it remains a useful instrument that complements conventional EEG, is being widely adopted by neonatologists, and should be supported by neonatal neurologists.
Collapse
Affiliation(s)
- Hannah C. Glass
- Departments of Neurology & Pediatrics, University of California, San Francisco
| | | | - Renée A. Shellhaas
- Department of Pediatrics & Communicable Diseases (Division of Pediatric Neurology), University of Michigan
| |
Collapse
|
10
|
Abstract
Continuous electroencephalographic (CEEG) monitoring is used with increasing frequency in critically ill children to provide insight into brain function and to identify electrographic seizures. CEEG monitoring use often impacts clinical management, most often by identifying electrographic seizures and status epilepticus. Most electrographic seizures have no clinical correlate, and thus would not be identified without CEEG monitoring. There are increasing data showing that electrographic seizures and electrographic status epilepticus are associated with worse outcome. Seizure identification efficiency may be improved by further development of quantitative electroencephalography trends. This review describes the clinical impact of CEEG data, the epidemiology of electrographic seizures and status epilepticus, the impact of electrographic seizures on outcome, the utility of quantitative electroencephalographic trends for seizure identification, and practical considerations regarding CEEG monitoring.
Collapse
|
11
|
Abstract
Neonatal seizures are common, often require EEG monitoring for diagnosis and management, may be associated with worse neurodevelopmental outcome, and can often be treated with existing anticonvulsants. A neonatal electrographic seizure is defined as a sudden, repetitive, evolving, and stereotyped event of abnormal electrographic pattern with amplitude of at least 2 μV and a minimum duration of 10 seconds. The diagnosis of neonatal seizures relies heavily on the neurophysiologist's interpretation of EEG. Consideration of specific criteria for the definition of a neonatal seizure, including seizure duration, location, morphology, evolution, semiology, and overall seizure burden, has utility for both the clinician and the researcher. The importance of EEG in the diagnosis and management of neonatal seizures, the electrographic characteristics of neonatal seizures, the impact of neonatal seizures on outcome, and tools to aid in the identification of neonatal seizures are reviewed.
Collapse
|