Sharpe Cynthia, Davis Suzanne L, Reiner Gail E, Lee Lilly I, Gold Jeff J, Nespeca Mark, Wang Sonya G, Joe Priscilla, Kuperman Rachel, Gardner Marissa, Honold Jose, Lane Brian, Knodel Ellen, Rowe Deborah, Battin Malcolm R, Bridge Renee, Goodmar Jim, Castro Ben, Rasmussen Maynard, Arnell Kathy, Harbert MaryJane, Haas Richard
Paediatric Neurology, Auckland District Health Board, Auckland, New Zealand.
Department of Neurosciences, Rady Children's Hospital San Diego, University of California, San Diego, California.
J Clin Neurophysiol. 2019 Jan;36(1):9-13. doi: 10.1097/WNP.0000000000000525.
Continuous video electroencephalography (cEEG) monitoring is the recommended gold standard of care for at-risk neonates but is not available in many Neonatal Intensive Care Units (NICUs). To conduct a randomized treatment trial of levetiracetam for the first-line treatment of neonatal seizures (the NEOLEV2 trial), we developed a monitoring infrastructure at five NICUs, implementing recent technological advancements to provide continuous video EEG monitoring and real-time response to seizure detection. Here, we report on the feasibility of providing this level of care.
Twenty-five key informant interviews were conducted with study neurologists, neonatologists, coordinators, and EEG technicians from the commercial EEG monitoring company Corticare. A general inductive approach was used to analyze these qualitative data.
A robust infrastructure for continuous video EEG monitoring, remote review, and real-time seizure detection was established at all sites. At the time of this survey, 260 babies had been recruited and monitored for 2 to 6 days. The EEG technician review by the commercial EEG monitoring company was reassuring to families and neonatologists and led to earlier detection of seizures but did not reduce work load for neurologists. Neurologists found the automated neonatal seizure detector algorithm provided by the EEG software company Persyst useful, but the accuracy of the algorithm was not such that it could be used without review by human expert. Placement of EEG electrodes to initiate monitoring, especially after hours, remains problematic.
Technological advancements have made it possible to provide at-risk neonates with continuous video EEG monitoring, real-time detection of and response to seizures. However, this standard of care remains unfeasible in usual clinical practice. Chief obstacles remain starting a recording and resourcing the real-time specialist review of suspect seizures.
连续视频脑电图（cEEG）监测是高危新生儿推荐的护理金标准，但许多新生儿重症监护病房（NICU）无法提供。为开展左乙拉西坦一线治疗新生儿惊厥的随机治疗试验（NEOLEV2试验），我们在5个新生儿重症监护病房建立了监测基础设施，采用最新技术进步以提供连续视频脑电图监测和对癫痫发作检测的实时响应。在此，我们报告提供这种护理水平的可行性。
对来自商业脑电图监测公司Corticare的研究神经科医生、新生儿科医生、协调员和脑电图技术人员进行了25次关键 informant访谈。采用一般归纳法分析这些定性数据。
在所有站点都建立了强大的连续视频脑电图监测、远程审查和实时癫痫发作检测基础设施。在本次调查时，已招募260名婴儿并进行了2至6天的监测。商业脑电图监测公司的脑电图技术人员审查让家庭和新生儿科医生放心，并导致癫痫发作的更早检测，但并未减轻神经科医生的工作量。神经科医生发现脑电图软件公司Persyst提供的自动新生儿癫痫发作检测算法很有用，但该算法的准确性不足以使其在无需专家审查的情况下使用。脑电图电极的放置以启动监测，尤其是在工作时间之后，仍然存在问题。
技术进步使为高危新生儿提供连续视频脑电图监测、癫痫发作的实时检测和响应成为可能。然而，这种护理标准在常规临床实践中仍然不可行。主要障碍仍然是开始记录以及为可疑癫痫发作的实时专家审查提供资源。
