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Introduction of Continuous Video EEG Monitoring into 2 Different NICU Models by Training Neonatal Nurses

Goswami, Ipsita, MD; Bello-Espinosa, Luis, MD; Buchhalter, Jeffrey, MD, PhD; Amin, Harish, MD; Howlett, Alexandra, MD; Esser, Michael, MD, PhD; Thomas, Sumesh, MD; Metcalfe, Cathy, CNE; Lind, Jan, CSN; Oliver, Norma, CSN; Kozlik, Silvia, RET; Mohammad, Khorshid, MD

Section Editor(s): Harris-Haman, Pamela A. DNP, CRNP, NNP-BC; ; Zukowsky, Ksenia PhD, APRN, NNP-BC;

doi: 10.1097/ANC.0000000000000523
Clinical Issues in Neonatal Care

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.

Sections of Neurology (Drs Bello-Espinosa and Esser) and Neonatology (Drs Goswami, Amin and Howlett), Department of Pediatrics, and Departments of Pediatrics and Clinical Neurosciences (Dr Buchhalter), Alberta Children's Hospital (Messrs Lind and Oliver), Calgary, Alberta, Canada; Section of Neonatology, Department of Pediatrics, Foothills Medical Centre Calgary, Alberta, Canada (Dr Thomas); NICU, Foothills Hospital Calgary, Alberta, Canada (Ms Metcalfe); Department of Neurosciences (Ms Kozlik), and Section of Neonatology, Department of Pediatrics (Dr Mohammad), Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.

Correspondence: Khorshid Mohammad, MD, Section of Neonatology, Department of Pediatrics, University of Calgary, 2888 Shaganappi Trail NW, Calgary, AB T3B 6A8, Canada (khorshid.mohammad@ahs.ca).

Establishment of the Neonatal Neurocritical Care program has been supported by funds from the Alberta Children's Hospital Foundation and the Alberta Children's Hospital Research Institute. The authors acknowledge Cindy Germain, one of their nursing leads, for her contribution in the program establishment and development of the video abstract.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (www.advancesinneonatalcare.org).

The authors have no conflicts of interest to disclose.

© 2018 by The National Association of Neonatal Nurses