Equipped for Success – Brain Monitoring in the Neuro-Nurturing NICU

What’s the first thing you do when you admit a baby in your NICU? 

…You get that baby on a monitor, right? 

In most units that means a cardiopulmonary monitor, so that we can continuously monitor the baby’s vital signs – heart rate, respiratory rate, pulse oximetry.  

 

 

But doesn’t that leave out the most important organ? 

Standard monitoring equipment in the NICU usually does not include brain monitoring, a curious practice considering that continuous brain monitoring is the standard of care in the neuro-compromised pediatric and adult patient. 

Thankfully, continuous neonatal brain monitoring has grown in popularity and is now utilized in many NICUs, but we still have more ground to cover before it is considered standard practice. 

 

What types of brain monitoring equipment are used in the NICU?

There are two main types, or categories, of brain monitoring equipment in the NICU: brain perfusion and brain function monitoring. 

Near Infrared Spectroscopy or NIRS is utilized to monitor brain oxygen and perfusion. 

Tools such as video-EEG and amplitude-integrated EEG (aEEG) are used for continuous monitoring of brain function.

 

What are the key points to consider when integrating brain monitoring tools in your NICU? 

Maybe you already have brain monitoring tools, or maybe you are just beginning to research options.  Wherever you are with your brain monitoring practices, there are key points to consider for success in building and maintaining lasting practices:

  1. Choose the right device for your NICU – Consider what type of monitoring you want to do, and how that monitoring will be assessed? Does it need remote viewing, network archiving?

 

  1. Divide up the roles and responsibility – Brain monitoring is a team sport. Consider how your team will work together to use your brain monitoring devices. Who will apply the electrodes, who will review and interpret the recordings (and how often), who, what and where will you document the monitoring data?

 

  1. Establish your protocols – Ensure that your use of brain monitoring equipment aligns with evidence based practice. Which babies will you monitor and for how long and which devices will be used? 

 

*If you are looking for a national guideline to support your desire for more continuous EEG or aEEG monitoring in your NICU, check out this guideline by the American Clinical Neurophysiology Society (ACNS).

 

 

  1. Use your device often –  Practice makes perfect.  This goes along with #3 — It seems to me that confidence with brain monitoring is a bit of a perishable skill.  If you only use aEEG or NIRS every once in a while, your team’s competence and confidence will likely be shaky and this will add to everyone’s stress.

 

  1. Training, training, training and more training – Initial training is usually provided by a manufacturer’s rep or educator, but the ongoing competency and training will fall to you and your team.   Case studies are great ways to keep up interest and offer training in between use and can be sent by email, or presented at monthly meetings or annual review.

 

In the end, to take bedside brain monitors from the box to bedside takes team-work, training, and tenacity!

I always love hearing from you….  Are you using aEEG or NIRS in your NICU? What are your greatest challenges when using them?

Want to dive deeper in to brain monitoring? Check out these awesome resources below.

 

Blog written by Sarah Bakke

Sarah Bakke, BSN, RNC-NIC

Consultant

Sarah started her career in a level III NICU in Indiana, and has worked in both level III and IV NICUs over the course of her career.  She is currently a staff nurse in the NICU at the Nemours Alfred I. duPont Hospital for Children in Wilmington, DE, and is working towards her MSN as a Pediatric Nurse Practitioner at Drexel University.

 

She has led a number of neuroprotective initiatives during her time at Nemours including launching a language nutrition program, founding a multidisciplinary NeuroNICU committee, and organizing quality improvement projects.  Sarah is passionate about all things NeuroNICU.

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