Abstract
Cerebral function monitoring is widely used in neonatal intensive care, but its potential role in assessment of older infants is scarcely reported. We reviewed the use of cerebral function monitoring on a general paediatric ward in a series of young infants admitted with abnormal movements. Review of the amplitude-integrated EEG obtained by cerebral function monitoring revealed electrographic seizures in four of seven infants monitored. We also surveyed general paediatric wards in hospitals in our region of the UK to ask about current use of cerebral function monitoring and local availability of formal electroencephalography services. Cerebral function monitoring was not being used in the 16 other paediatric departments surveyed, and there was very limited provision for obtaining a full-array electroencephalogram out-of-hours.
Conclusion: With adequate training and education, it is feasible to undertake cerebral function monitoring on a general paediatric ward. Continuous cerebral function monitoring is a tool that has potential use for detecting clinical seizures and augmenting clinical neuro-observations of young children admitted to a general paediatric ward.
What is known: • In intensive care settings, cerebral function monitoring (CFM) has long been used for the continuous bedside monitoring of brain function in critically ill neonates, children and adults. • Very few studies have looked at the use of CFM outside of the intensive care setting, and it is presently unclear if CFM is used in the general paediatric ward. |
What is new: • CFM is presently not widely used in the general paediatric setting. • With appropriate training and support, CFM can be successfully introduced to the general paediatric ward with the potential to enhance the clinical monitoring of young infants admitted with abnormal movements. |
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Abbreviations
- aEEG:
-
Amplitude-integrated electroencephalogram
- CFM:
-
Cerebral function monitoring
- cEEG:
-
Conventional electroencephalogram
- EEG:
-
Electroencephalogram
- NICU:
-
Neonatal intensive care unit
References
Al Naqeeb N, Edwards AD, Cowan FM, Azzopardi D (1999) Assessment of neonatal encephalopathy by amplitude-integrated electroencephalography. Pediatrics 103:1263–1271. doi:10.1542/peds.103.6.1263
Maynard D, Prior PF, Scott DF (1969) Device for continuous monitoring of cerebral activity in resuscitated patients. Br Med J 4:545–546. doi:10.1136/bmj.4.5682.545-a
Murdoch-Eaton D, Darowski M, Livingston J (2001) Cerebral function monitoring in paediatric intensive care: useful features for predicting outcome. Dev Med Child Neurol 43:91–96. doi:10.1111/j.1469-8749.2001.tb00722.x
Ponnusamy V, Beach RC, Blake J, Clarke P (2010) A case of near-drowning; a case for routine cerebral monitoring. Acta Paediatr 99:463–466. doi:10.1111/j.1651-2227.2009.01556.x
Ponnusamy V, Nath P, Bissett L, Willis K, Clarke P (2010) Current availability of cerebral function monitoring and hypothermia therapy in UK neonatal units. Arch Dis Child Fetal Neonatal Ed 95:383–384. doi:10.1136/adc.2009.181578
Shah DK, Wusthoff CJ, Clarke P, Wyatt JS, Ramaiah SM, Dias RJ, Becher JC, Kapellou O, Boardman JP (2014) Electrographic seizures are associated with brain injury in newborns undergoing therapeutic hypothermia. Arch Dis Child Fetal Neonatal Ed 99:F219–F224. doi:10.1136/archdischild-2013-305206
Tian G, Qin K, Wu YM, Ji Z, Wang JX, Pan SY (2012) Outcome prediction by amplitude-integrated EEG in adults with hypoxic ischemic encephalopathy. Clin Neurol Neurosurg 114:585–589. doi:10.1016/j.clineuro.2011.12.011
Toet MC, Hellström-Westas L, Groenendaal F, Eken P, de Vries LS (1999) Amplitude integrated EEG 3 and 6 hours after birth in full term neonates with hypoxic-ischaemic encephalopathy. Arch Dis Child Fetal Neonatal Ed 81:F19–F23. doi:10.1136/fn.81.1.F19
Toet MC, van der Meij W, de Vries LS, Uiterwaal CS, van Huffelen KC (2002) Comparison between simultaneously recorded amplitude integrated electroencephalogram (cerebral function monitor) and standard electroencephalogram in neonates. Pediatrics 109:772–779. doi:10.1542/peds.109.5.772
Acknowledgments
We are grateful to the consultant paediatricians, especially Drs Mary-Anne Morris, Bina Mukhtyar and Ruchi Arora for supporting this project, and we thank Kathryn Desira for supporting the training of the paediatric nurses. We also thank Lisa Chalkley, R&D Services Manager, and Vimmi Lutchmeah-Beeharry, Information Governance Manager, for their helpful advice. Finally we thank Dr Adrienne Foran, neonatologist, for her helpful constructive comments on an earlier manuscript version.
Author contributions
PC conceived the idea for this project, assisted with training of medical staff and designed the survey. SS and VK supervised the introduction of CFM on Buxton Children’s Ward. SS conducted the telephone survey. SD provided practical CFM training and support for the paediatric nurses. PC and DS reviewed the aEEG traces. VK and PC wrote the first manuscript draft. All authors contributed to the manuscript revision and approved the final version. PC is the guarantor.
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Conflict of interest
SD gratefully received a generous travel bursary from Natus Inc., which enabled the presentation of this work in abstract form at the JENS Congress, Budapest, September 2015. Natus Inc. had no other involvement with this study. There are no conflicts of interests to declare in relation to this work.
Funding
No specific funding was received for this study.
Ethics approval
This study was reviewed by our NHS Hospital Trust R&D Manager and, as a service evaluation, was judged not to require formal ethics approval under current UK National Research Ethics Service guidance. Our Trust’s Caldicott Approval Group gave permission for external peer review of the anonymised aEEG traces.
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Consent was obtained for publication of the photograph of the infant used in our CFM parent information leaflet (Supporting Information File).
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Communicated by Beat Steinmann
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Kalra, V., Shaw, S.S., Dixon, S. et al. Cerebral function monitoring on a general paediatric ward: feasibility and potential. Eur J Pediatr 175, 1059–1064 (2016). https://doi.org/10.1007/s00431-016-2737-3
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DOI: https://doi.org/10.1007/s00431-016-2737-3