Neuromonitoring during newborn transition
University College Cork
Background: Newborn infant neurological function can be measured by monitoring electrical activity (electroencephalography) or cerebral oxygenation via NIRS (near infrared spectroscopy). In practice the clinical applications of electroencephalography (EEG) are limited to monitoring infants following moderate to severe hypoxic ischemic injury (HIE), and for the detection of seizures in at risk infants. NIRS monitoring has been the focus of a number of research trials but has no clinical applications in the immediate newborn period to date, and is not routinely performed in neonatal units. Aim: To assess the feasibility of infant neuromonitoring in the immediate period in two important clinical scenarios. Firstly, to assess the feasibility of monitoring brain activity during the first minutes of life in healthy term infants. Secondly, to assess the feasibility and utility of monitoring newborn preterm infants’ brain activity and cerebral oxygenation in the context of an interventional randomized controlled trial. Methods: 1. Healthy term newborn infants had EEG monitoring performed for the first ten minutes of life. EEG was assessed both qualitatively and quantitatively. All infants had respiratory function monitoring performed simultaneously. 2. Forty-five infants (< 32 weeks gestation) were randomly assigned to different methods of newborn infant cord clamping. All infants had EEG and NIRS monitoring for the first 72 hours of life. Quantitative features of EEG and median NIRS values were compared between groups at 6 and 12 hours of life as a primary outcome measure. Results: 1. Forty-nine infants had EEG recordings. Median (IQR) age at time of initial EEG recording was 3.0 (2·5 to 3·8) minutes. End tidal CO2 and tidal volumes increased over the first 3 minutes of life and then stabilized. Good quality EEG, with continuous mixed frequency activity with a range of 25-50μV, was observed in all infants. The majority of EEG spectral power was within the delta band. 2. There were 45 infants included. One infant died in the delivery room. Median time (IQR) from birth until EEG application was 3.05 (1.85 to 5.38) hrs. For primary outcome measures, data was available for 42/44 (95%) at 6 hrs and 44/44 (100%) at 12 hours. There was no significant difference between groups for measures for EEG values or cerebral NIRS. Conclusion: Infant neuromonitoring in the immediate newborn period is feasible in the first minutes of life in healthy term infants and within the first hours of life in preterm infants. Normative quantitative data for electrical activity in healthy newborn term infants during the first minutes of life is described for the first time. Neuromonitoring during the first day of life as an outcome measure for preterm interventional trials is possible and the outcomes from this research is promising for further trials.
Neonatal , Brain function , Newborn transition , EEG , Umbilical cord clamping
Finn, D. 2019. Neuromonitoring during newborn transition. MD Thesis, University College Cork.