Neonatal/Perinatal Medicine Fellow Children's Hospital of Michigan, Michigan, United States
Background: Neuro NICU care combines expertise of neurology and critical care medicine. Neonates with encephalopathy may benefit from neurocritical care approach through prevention of secondary brain injury by attention to basic physiology, earlier recognition and treatment of neurological complications such as seizures, consistent management using guidelines/protocols. Objective: Primary Objective A. To compare MRI finding in neonatal encephalopathy (NE) before and after implementation of Neuro NICU care by using NICHD MRI grading for comparison.
Secondary Objective A. To evaluate if the routine Video EEG use in Neuro NICU resulted in increased diagnosis of seizure Design/Methods: We did a retrospective chart review of infants with NE from 2014 to 2022 at Children’s Hospital of Michigan. The neuro NICU Care was started in 2018. It includes management using evidence-based guidelines, training of healthcare workers on protocol/guidelines, video EEG monitoring started on admission and continued 12 hours post rewarming or 24 hours post clinical seizure cessation, Near infrared Spectroscopy (NIRS) monitoring, and MRI within first 7 days of life. Infants >35 weeks of gestation with moderate/severe NE, started on therapeutic hypothermia within 6 hours of life were included in the study. Infants with major congenital anomaly or with severe respiratory failure/PPHN requiring ECMO were excluded. MRI finding were compared amongst infant before and after implementation of Neuro NICU using NICHD MRI grading . We will use a parametric paired-samples t-test to examine mean differences between groups on normally distributed continuous variables, whereas non-normally distributed continuous variables will be compared using the non-parametric Wilcoxon rank sum test. Crosstabulation procedures will be conducted on the MRI grading scale scores pre-post intervention. McNemar’s test will be employed by separating responses into 2 X 2 tables. SAS (version 9.4, SAS Institute Inc. Cary, North Carolina) will be used to conduct all statistical procedures. Significance will be set at a value ≤0.05, two-tailed.
