Division of Neurology, Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.; and.
Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.
J Clin Neurophysiol. 2021 Nov 1;38(6):525-529. doi: 10.1097/WNP.0000000000000730.
Neonatal seizures are common and difficult to identify clinically because the majority are subclinical and correct identification of electroclinical seizures based on semiology is unreliable. Therefore, continuous EEG monitoring (CEEG) is critical for seizure identification in neonates and is recommended as the gold standard method in American Clinical Neurophysiology Society guidelines. Despite these recommendations, barriers to implementing widespread CEEG exist.
To expand access to CEEG for at-risk neonates, a framework for providing remote CEEG was established at two network hospital neonatal intensive care units. Utilization and clinical impact were tracked as a quality improvement study.
In a 27-month period from June 2017 through September 2019, 76 neonates underwent CEEG between the two network neonatal intensive care units. Electrographic seizures occurred in about one quarter of records (18/76; 24%), though their incidence varied by CEEG indication. Care notes indicated that CEEG impacted clinical care in three quarters of cases (57/76; 75%). Continuous EEG impacted decisions to treat with anti-seizure medications in approximately one half of patients (impact: 28/57 [49%]; no impact 29/57 [51%]), and CEEG impacted prognostic discussions in approximately two thirds of patients (impact: 39/57 [68%]; no impact 18/57 [32%]).
Establishment of a remote CEEG program for neonates is feasible, effective at identifying seizures, and improves the quality of care provided to neonates hospitalized at these network hospitals.
新生儿癫痫发作很常见，临床上难以识别，因为大多数是亚临床的，并且基于症状学的电临床癫痫发作的正确识别不可靠。因此，连续脑电图监测（CEEG）对于新生儿的癫痫发作识别至关重要，并且被美国临床神经生理学学会指南推荐为金标准方法。尽管有这些建议，但在实施广泛的 CEEG 方面存在障碍。
为了扩大高危新生儿接受 CEEG 的机会，在两个网络医院新生儿重症监护病房建立了提供远程 CEEG 的框架。作为一项质量改进研究，对其使用情况和临床影响进行了跟踪。
在 2017 年 6 月至 2019 年 9 月的 27 个月期间，两个网络新生儿重症监护病房的 76 名新生儿进行了 CEEG。约四分之一的记录（18/76；24%）出现了电癫痫发作，尽管其发生率因 CEEG 指征而异。护理记录表明，CEEG 在四分之三的病例中影响了临床护理（57/76；75%）。持续脑电图大约影响了一半患者（影响：28/57 [49%]；无影响：29/57 [51%]）的抗癫痫药物治疗决策，并且大约三分之二的患者（影响：39/57 [68%]；无影响：18/57 [32%]）的预后讨论受到了 CEEG 的影响。
为新生儿建立远程 CEEG 方案是可行的，能够有效地识别癫痫发作，并提高了这些网络医院住院新生儿的护理质量。
