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Neonatal Neurocritical Care Series

Neuromonitoring in neonatal critical care part II: extremely premature infants and critically ill neonates

Pediatric Research volume 94, pages 55–63 (2023)Cite this article

Abstract

Neonatal intensive care has expanded from cardiorespiratory care to a holistic approach emphasizing brain health. To best understand and monitor brain function and physiology in the neonatal intensive care unit (NICU), the most commonly used tools are amplitude-integrated EEG, full multichannel continuous EEG, and near-infrared spectroscopy. Each of these modalities has unique characteristics and functions. While some of these tools have been the subject of expert consensus statements or guidelines, there is no overarching agreement on the optimal approach to neuromonitoring in the NICU. This work reviews current evidence to assist decision making for the best utilization of these neuromonitoring tools to promote neuroprotective care in extremely premature infants and in critically ill neonates. Neuromonitoring approaches in neonatal encephalopathy and neonates with possible seizures are discussed separately in the companion paper.

Impact

  • For extremely premature infants, NIRS monitoring has a potential role in individualized brain-oriented care, and selective use of aEEG and cEEG can assist in seizure detection and prognostication.

  • For critically ill neonates, NIRS can monitor cerebral perfusion, oxygen delivery, and extraction associated with disease processes as well as respiratory and hypodynamic management. Selective use of aEEG and cEEG is important in those with a high risk of seizures and brain injury.

  • Continuous multimodal monitoring as well as monitoring of sleep, sleep–wake cycling, and autonomic nervous system have a promising role in neonatal neurocritical care.

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Fig. 1: Maturation of EEG and aEEG with postmenstrual age.
Fig. 2: Demonstration of the value of multimodal monitoring in a term neonate with severe HIE.

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Author information

Authors and Affiliations

  1. Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Mohamed El-Dib

  2. Departments of Neurology and Pediatrics, Children’s Hospital of Philadelphia and the University of Pennsylvania, Philadelphia, PA, USA

    Nicholas S. Abend

  3. Department of Paediatrics, University of Cambridge, Cambridge, UK

    Topun Austin

  4. INFANT Research Centre & Department of Paediatrics & Child Health, University College Cork, Cork, Ireland

    Geraldine Boylan

  5. Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, CA, USA

    Valerie Chock

  6. Department of Pediatrics, Division of Pediatric Neurology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium

    M. Roberta Cilio

  7. Department of Neonatology, Rigshospitalet, Copenhagen University Hospital & Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark

    Gorm Greisen

  8. Department of Women’s and Children’s Health, Uppsala University and Division of Neonatology, Uppsala University Hospital, Uppsala, Sweden

    Lena Hellström-Westas

  9. Department of Neonatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands

    Petra Lemmers

  10. Department of Neonatology, La Paz University Hospital, Madrid, Spain; Neonatology Group, IdiPAZ, Madrid, Spain

    Adelina Pellicer

  11. Department of Clinical Neurophysiology, Great Ormond Street Hospital for Children NHS Trust, and Clinical Neuroscience, UCL- Great Ormond Street Institute of Child Health, London, UK

    Ronit M. Pressler

  12. Department of Neurology and Pediatrics, George Washington University School of Medicine and Health Sciences; Children’s National Hospital Division of Neurophysiology, Epilepsy and Critical Care, Washington, DC, USA

    Arnold Sansevere & Tammy Tsuchida

  13. Division of Neonatology, 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary

    Eniko Szakmar

  14. Department of Clinical Neurophysiology, Children’s Hospital, BABA Center, Neuroscience Center/HILIFE, Helsinki University Hospital and University of Helsinki, Helsinki, Finland

    Sampsa Vanhatalo

  15. Division of Child Neurology, Stanford University, Palo Alto, CA, USA

    Courtney J. Wusthoff

  16. Neonatology, Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA

    Sonia Bonifacio

  17. Neonatology, Pediatrics/Newborn Medicine, Montreal Children’s Hospital, McGill University, Montreal, QC, Canada

    Pia Wintermark

  18. Neonatology, Cleveland Clinic Children’s Hospital, Bratenahl, OH, USA

    Hany Aly

  19. Neurology, Children’s National Hospital, Washington, DC, USA

    Taeun Chang

  20. Neurology, Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada

    Vann Chau

  21. Neurology, Pediatrics, Epidemiology & Biostatistics, University of California, San Francisco, CA, USA

    Hannah Glass

  22. Neurology, Pediatrics, Population Health Sciences, Duke University School of Medicine, Durham, NC, USA

    Monica Lemmon

  23. Neonatology, Children’s National Hospital and The George Washington University School of Medicine, Washington, DC, USA

    An Massaro

  24. Neurology, Child Neurology, Stanford, Stanford, CA, USA

    Courtney Wusthoff

  25. Neurology, Hospital for Sick Children, Toronto, ON, Canada

    Gabrielle deVeber

  26. Neurology, Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA

    Andrea Pardo

  27. Neurology, University of Wisconsin, Madison, WI, USA

    Melisa Carrasco McCaul

Authors
  1. Mohamed El-Dib
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  2. Nicholas S. Abend
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  3. Topun Austin
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  4. Geraldine Boylan
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  5. Valerie Chock
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  6. M. Roberta Cilio
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  7. Gorm Greisen
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  8. Lena Hellström-Westas
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  9. Petra Lemmers
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  10. Adelina Pellicer
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  11. Ronit M. Pressler
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  12. Arnold Sansevere
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  13. Eniko Szakmar
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  14. Tammy Tsuchida
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  15. Sampsa Vanhatalo
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  16. Courtney J. Wusthoff
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Consortia

On behalf of the Newborn Brain Society Guidelines and Publications Committee

  • Sonia Bonifacio
  • , Pia Wintermark
  • , Hany Aly
  • , Taeun Chang
  • , Vann Chau
  • , Hannah Glass
  • , Monica Lemmon
  • , An Massaro
  • , Courtney Wusthoff
  • , Gabrielle deVeber
  • , Andrea Pardo
  •  & Melisa Carrasco McCaul

Contributions

Substantial contributions to conception and design: all authors. Drafting the article or revising it critically for important intellectual content: all authors. Final approval of the version to be published: all authors.

Corresponding author

Correspondence to Mohamed El-Dib.

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Competing interests

The authors declare no competing interests.

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El-Dib, M., Abend, N.S., Austin, T. et al. Neuromonitoring in neonatal critical care part II: extremely premature infants and critically ill neonates. Pediatr Res 94, 55–63 (2023). https://doi.org/10.1038/s41390-022-02392-2

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  • DOI: https://doi.org/10.1038/s41390-022-02392-2

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