Developing a Consultation Model for Neonatal Neurocritical Care: A 2-Year Experience

Abstract BACKGROUND: Developing brain has unique pattern of injury and responds to injury differently. Management of neonatal seizures, perinatal asphyxia as well as ischemic-hemorrhagic preterm brain injury requires specific skill sets of neonatology, neurology, neurophysiology and neuroradiology. The impact of neurological conditions extends beyond neonatal intensive care unit stay warranting continuity of care in order to improve outcomes. OBJECTIVES: Establishing a special interest group to run within the existing intensive care facility based on separate subspeciality model of neurocritical care in adults and study the impact of the change on short term outcome of neurological conditions in neonates. DESIGN/METHODS: A multidisciplinary team was formulated including faculties from Neonatology, Pediatric Neurology, Diagnostic Imaging and Neonatal Follow up to form a neonatal neurocritical care (NNCC) core team. Roles to each team members was defined and oncall schedule for round the clock coverage developed. Hypoxic Ischemic Encephalopathy (HIE) was targeted first by standardized policies and procedures to be followed after admission, introduction of continuous video EEG monitoring and series of training sessions for nurses and fellows on bedside application of diagnostic tools. The core team was involved in care of the infant from admission to discharge with a well defined follow up plan and had 24 hour remote access to EEG recorded in any of the 2 Level 3 NICU involved. RESULTS: On comparing management and outcomes prior to and following the start of NNCC we found that the use of anti-epileptic drugs (AED) reduced from 60 to 46%, the use of maintenance dose was halved. Considerable reduction in death or MRI documented brain injury was noted. CONCLUSION: Consultation model of NNCC resulted in improved communication and collaboration between disciplines, better HIE care pathway and short term outcomes, creation of database that will allow assessment of long term outcome. The group is currently targeting Intra-Ventricular hemorrhage and post-hemorrhagic hydrocephalus management. In future the team will focus on real time multimodal brain monitoring.