Five examples of how brain monitoring helps to improve patient outcomes and prognosticate the future for neonates

We are monitoring everything else.  Why not the brain?

Monitoring infants has, for years, been one of the most important tasks for clinicians in the NICU. Monitoring heart rate, respiratory rate, blood pressure, temperature, etc., is standard, but yet, monitoring the brain is not a common practice.

This is despite the fact that monitoring the brain follows the same pathway, as for example, as monitoring the heart:

• When monitoring the heart with a bedside heart rate monitor, a 3-lead ECG configuration is used, which yields an easy-to-interpret pattern.
• When monitoring the brain with a bedside brain monitor, a 3/5-lead aEEG configuration is used, which yields an easy-to-interpret pattern.

Another factor to consider is:

• In the case that something abnormal is detected on an ECG trace, a cardiologist is consulted to perform a 12-lead ECG.
• In the case that something abnormal is detected on an aEEG trace, a neurologist is consulted to perform a multi-channel EEG for diagnosis purposes.
  Based on either finding, appropriate diagnosis and treatment options are determined.

Why monitor the infant’s brain?

Although increases in perinatal survival rates drive clinical focus on improving long-term outcomes, many NICUs are lacking a bedside tool to help monitor neurological status. Poor neurological outcomes are associated with poor background brain activity and lack of sleep/wake cycling.

For pre-term infants, changes in aEEG patterns, such as the emergence of sleep/wake cycling, is evidence of increasing brain organization and brain health. In contrast, the absence of sleep/wake cycling or the presence of abnormal background activity is a predictor of poor long-term neurological outcomes.

In addition to background brain function, aEEG can help the clinician identify if an infant is having seizures. Eighty percent of seizures in neonates are subclinical¹, making seizure detection without aEEG monitoring difficult through clinical assessment alone. Recognizing and recording frequency and intensity of seizures is important for assisting with anticonvulsive therapy management.

aEEG helps the clinician:

• Establish a benchmark for improvement or decline
• Monitor valuable background trends and changes
• Identify the need for full EEG and pediatric neurology consultation
• Identify subclinical seizures
• Monitor the impact of treatment

aEEG beyond HIE

aEEG was first used in the neonate population in the early 1970s for infants with hypoxic ischaemic encephalopathy (HIE). Since then, aEEG has been proven to be beneficial for additional clinical applications, such as monitoring during therapeutic hypothermia, premature infants, infants with known or suspected seizures, cardiac/surgical patients, neonatal abstinence syndrome, metabolic disease and hyperbilirubinemia.

Thus, Natus has put together a compilation of case studies to widen the perspective on the use of aEEG through the following five clinician-led cases for aEEG monitoring in neonates with the Olympic Brainz Monitor (OBM):

• Seizures – Case study: aEEG Monitoring on an infant with recurring apnea
• Cardiac/surgical infants – Case study: aEEG monitoring on an infant with critical congenital heart disease
• Hyperbilirubinemia – Case study: aEEG Monitoring in a newborn with Hyperbilirubinemia
• Metabolic diseases – Case study: aEEG in metabolic disease
• Preterm infants – Case study: aEEG monitoring in Periventricular Leukomalacia