Even if your NICU does not call itself a NeuroNICU, you can implement many aspect of the 4 Pillars in to your NICU and create a more neuro-nurturing experience for your babies (and their families).
In a previous blog article, I outlined the basic about the 4 Pillars of the NeuroNICU and invited you to consider each area as a score card where you might be able to identify areas that your NICU might be able to focus on and improve.  So for the next few weeks, we will break down each pillar individually.

Pillar One: Neuro Assessment

Assessment is one of the most challenging and complicated aspects of our job, since we care for such a diversity of patient diagnoses, sizes and ages. Despite all the sophisticated tools at our disposal our clinical exam of babies is still one of the strongest and most reliable tools in our toolbox.
Using validated tools for specific populations is common in the NICU and are there to guide us and standardize our observations.  Some examples of the most common assessment tools that we use to evaluate infant’s neuro state are:
  1. Dubowitz – for gestational and neurological assessment
  2. Sarnat – for determining the level of encephalopathy and eligibility for therapeutic hypothermia
  3. NPASS – for assessing pain and sedation levels
  4. Finnegan – for trending infants signs/symptoms of Neonatal Abstinence Syndrome (NAS)
Other common exams that you might not consider “neuro-exams” but certainly tell you about the health of the nervous system include:
  1. Mandatory newborn screening – to identify metabolic disorders that could injure the brain
  2. Mandatory hearing screening before discharge records evoked responses from the auditory center of the brain
  3. Lumbar Puncture to assess for infection/inflammation in the CNS
A final area of assessment is the use of neuro-imaging with simple bedside ultrasound, or more complex assessments using MRI, MRA, and MRS studies which both provide tremendous amounts of information about the function, structure, and activity of the developing brain.  Imaging capabilities continue to expand, and now additional sequences such as ADC mapping and function anisotropy (FA) are now providing even more detailed exams of neuronal connectivity at levels never known before.
There are a variety of quality improvement and practice improvement projects that could stem from this first Pillar if you just took a look.
For example:
  1. What is your inter-rater reliability on one of the standardized assessment tools I mentioned?
  2. Is everyone using both the pain and the sedation score on the NPASS?
  3. Does everyone follow the same treatment plan based on Finnegan scores?
  4. Does every infant with HIE get an MRI before discharge?
  5. What percentage of infants require sedation for MRI?
  6. What is your temperature ranges for infants who go to the MRI suite?
If you need a little inspiration for your next quality improvement project, download our Quickstart Guide, which covers all four pillars of NeuroNICU programs.

 

References:

  1. FA – http://www.ajnr.org/content/28/2/226