With the advent of therapeutic hypothermia for treatment of hypoxic ischemic encephalopathy, and improvements in neuroimaging and bedside neuromonitoring, a new era of neonatal brain-focused care has emerged in recent years. We describe the development of the first neurointensive care nursery (NICN) as a model for comanagement of neonates with identified neurologic risk factors by a multidisciplinary team constituted of neurologists, neonatologists, specialized nurses, and others with the goal of optimizing management, preventing secondary injury and maximizing long-term outcomes.
Optimizing brain metabolic environment and perfusion and preventing secondary brain injury are key to neurocritical care. This includes close management of temperature, blood pressure, oxygenation, carbon dioxide, and glucose levels. Early developmental interventions and involvement of physical and occupational therapy provide additional assessment information. Finally, long-term follow-up is essential for any neurocritical care program.
The NICN model aims to optimize evidence-based care of infants at risk for neurologic injury. Results from ongoing hypothermia and neuroprotective trials are likely to yield additional treatments. New technologies, such as functional MRI, continuous neurophysiological assessment, and whole genomic approaches to rapid diagnosis may further enhance clinical protocols and neonatal precision medicine. Importantly, advances in neurocritical care improve our ability to provide comprehensive information when counseling families. Long-term follow-up data will determine if the NICN/Neuro-NICU provides enduring benefit to infants at risk for neurologic injury.
aDepartment of Neurology
bDepartment Pediatrics, UCSF Benioff Children's Hospital
cDepartment of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California, USA
dDepartment of Paediatrics, Wellcome-MRC Stem Cell Institute, Cambridge University, Cambridge, UK
Correspondence to Hannah C. Glass, MDCM, MAS, Departments of Neurology & Pediatrics, University of California San Francisco, 675 Nelson Rising Lane, Room 494, Box 0663, San Francisco, CA 94158, USA. Tel: +1 415 502 7327; fax: +1 415 476 3428; e-mail: Hannah.Glass@ucsf.edu