| Autor: |
Goswami, Ipsita, Bello-Espinosa, Luis, Buchhalter, Jeffrey, Amin, Harish, Howlett, Alexandra, Esser, Michael, Thomas, Sumesh, Metcalfe, Cathy, Lind, Jan, Oliver, Norma, Kozlik, Silvia, Mohammad, Khorshid |
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| Zdroj: |
Advances in Neonatal Care (Lippincott Williams & Wilkins); Aug2018, Vol. 18 Issue 4, p250-259, 10p |
| Abstrakt: |
Background: Continuous video electroencephalographic (EEG) (cvEEG) monitoring is emerging as the standard of care for diagnosis and management of neonatal seizures. However, cvEEG is labor-intensive and the need to initiate and interpret studies on a 24-hour basis is a major limitation.Purpose: This study aims at establishing consistency in monitoring of newborns admitted to 2 different neonatal intensive care units (NICUs) managed by the same neurocritical care team.Methods: Neonatal nurses were trained to apply scalp electrodes, troubleshoot technical issues, and identify amplitude-integrated EEG abnormalities. Guidelines, checklists, and visual training modules were developed. A central network system allowed remote access to the cvEEGs by the epileptologist for timely interpretation and feedback. A cohort of 100 infants with moderate to severe hypoxic-ischemic encephalopathy before and after the training program was compared.Results: During the study period, 192 cvEEGs were obtained. The time to initiate brain monitoring decreased by 31.5 hours posttraining; this, in turn, led to an increase in electrographic seizure detection (20% before vs 34% after), decrease in seizure clinical misdiagnosis (65% before and 36% after), and reduction in antiseizure medication burden.Implications For Practice: Training experienced NICU nurses to set up, start, and monitor cvEEGs can decrease the time to initiate cvEEGs, which may lead to better seizure diagnosis and management.Implications For Research: Further understanding of practice bundles for best supporting infants at risk and being treated for seizures needs to be evaluated for integration into practice.Video Abstract Available at https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx. [ABSTRACT FROM AUTHOR] |
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