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Am J Perinatol 2018; 35(12): 1197-1205
DOI: 10.1055/s-0038-1646954
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Development of a NeuroNICU with a Broader Focus on All Newborns at Risk of Brain Injury: The First 2 Years

Krisa P. Van Meurs
1   Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
,
Elisabeth S. Yan
1   Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
,
Kathi S. Randall
2   Department of Neonatology, Lucile Packard Children's Hospital Stanford, Palo Alto, California
,
Valerie Y. Chock
1   Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
,
Alexis S. Davis
1   Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
,
Cecelia S. Glennon
2   Department of Neonatology, Lucile Packard Children's Hospital Stanford, Palo Alto, California
,
Catherine L. Clark
1   Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
3   Division of Child Neurology, Stanford University School of Medicine, Palo Alto, California
,
Courtney J. Wusthoff
3   Division of Child Neurology, Stanford University School of Medicine, Palo Alto, California
,
Sonia L. Bonifacio
1   Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
› Author Affiliations
Funding This study was supported, in part, by the National Institute of Neurological Disorders and Stroke (NINDS K23 NS082500 05).
Further Information

Publication History

21 September 2017

21 March 2018

Publication Date:
27 April 2018 (online)

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Abstract

Objective Many critically ill neonates have an existing brain injury or are at risk of neurologic injury. We developed a “NeuroNICU” (neurologic neonatal intensive care unit) to better provide neurologically focused intensive care.

Study Design Demographic and clinical variables, services delivered, and patient outcomes were recorded in a prospective database for all neonates admitted to the NeuroNICU between April 23, 2013, and June 25, 2015.

Results In total, 546 neonates were admitted to the NeuroNICU representing 32% of all NICU admissions. The most common admission diagnoses were congenital heart disease (30%), extreme prematurity (18%), seizures (10%), and hypoxic–ischemic encephalopathy (9%). Neuromonitoring was common, with near-infrared spectroscopy used in 69%, amplitude-integrated electroencephalography (EEG) in 45%, and continuous video EEG in 35%. Overall, 43% received neurology or neurosurgery consultation. Death prior to hospital discharge occurred in 11%. Among survivors, 87% were referred for developmental follow-up, and among those with a primary neurologic diagnosis 57% were referred for neurology or neurosurgical follow-up.

Conclusion The NeuroNICU-admitted newborns with or at risk of brain injury comprise a high percentage of NICU volume; 38% had primary neurologic diagnoses, whereas 62% had medical diagnoses. We found many opportunities to provide brain focused intensive care, impacting a substantial proportion of newborns in our NICU.

Keywords

neuroNICU - neuromonitoring - neurocritical care - seizure - cEEG - aEEG