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A new neurological focus in neonatal intensive care

Abstract

Advances in the care of high-risk newborn babies have contributed to reduced mortality rates for premature and term births, but the surviving neonates often have increased neurological morbidity. Therapies aimed at reducing the neurological sequelae of birth asphyxia at term have brought hypothermia treatment into the realm of standard care. However, this therapy does not provide complete protection from neurological complications and a need to develop adjunctive therapies for improved neurological outcomes remains. In addition, the care of neurologically impaired neonates, regardless of their gestational age, clearly requires a focused approach to avoid further injury to the brain and to optimize the neurodevelopmental status of the newborn baby at discharge from hospital. This focused approach includes, but is not limited to, monitoring of the patient's brain with amplitude-integrated and continuous video EEG, prevention of infection, developmentally appropriate care, and family support. Provision of dedicated neurocritical care to newborn babies requires a collaborative effort between neonatologists and neurologists, training in neonatal neurology for nurses and future generations of care providers, and the recognition that common neonatal medical problems and intensive care have an effect on the developing brain.

Key Points

  • Clinical trials in brain development and the pathophysiology of brain injury in premature and term neonates promote the development of new therapies for neurological conditions in neonates

  • Amplitude-integrated EEG and near-infrared spectroscopy enable monitoring of brain function during critical illness and improved ability to detect and treat neonatal seizures, and might provide early prognostic information

  • Hypothermia therapy is the only approach proven to decrease morbidity and mortality from neonatal hypoxic–ischemic encephalopathy in term infants; this treatment is being implemented in hospitals around the world

  • In the neonatal neurocritical care model, neonatologists and neurologists work together to care for newborn babies with primary and secondary neurological conditions

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Figure 1: Patterns of electrocortical background activity observed using aEEG.
Figure 2: MRI scans showing normal findings and examples of brain injuries in term newborn babies.
Figure 3: MRI scans of the brain in preterm newborn babies.

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D. M. Ferriero, H. C. Glass, S. Peloquin and S. L. Bonifacio contributed equally to researching data for the article, writing the article, and review and/or editing of the manuscript before submission.

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Correspondence to Sonia L. Bonifacio.

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Bonifacio, S., Glass, H., Peloquin, S. et al. A new neurological focus in neonatal intensive care. Nat Rev Neurol 7, 485–494 (2011). https://doi.org/10.1038/nrneurol.2011.119

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