From Neonatal Intensive Care to Neurocritical Care: Is It Still a Mirage? The Sicilian Multicenter Project

Overview

Journal Crit Care Res Pract

Publisher Wiley

Specialty Critical Care

Date 2021 Aug 24

PMID 34426771

Citations 1

Authors

Raffaele Falsaperla

Laura Mauceri

Milena Motta

Ettore Piro

Gabriella DAngelo

Eloisa Gitto

Giovanni Corsello

Martino Ruggieri

Affiliations

Soon will be listed here.

Abstract

Background: Neonatal brain injury (NBI) can lead to a significant neurological disability or even death. After decades of intense efforts to improve neonatal intensive care and survival of critically ill newborns, the focus today is an improved long-term neurological outcome through brain-focused care. The goal of neuroprotection in the neonatal intensive care unit (NICU) is the prevention of new or worsening NBI in premature and term newborns. As a result, the neonatal neurocritical care unit (NNCU) has been emerging as a model of care to decrease NBI and improve the long-term neurodevelopment in critically ill neonates.

Purpose: Neurocritical care (NCC) Sicilian project includes three academic sites with NICU in Sicily (Catania, Messina, and Palermo), and its primary goal is to develop neurocritical neonatal care unit (NNCU).

Methods: In 2018, the three NICUs created a dedicated space for neonates with primary neurological diagnosis or at risk for neurological injuries-NNCU. Admission criteria for eligible patients and treatment protocols were created. Contact with parents, environmental protection, basic monitoring, brain monitoring, pharmacological therapy, and organization of the staff were protocolized.

Results: Evaluation of the efforts to establish NNCU within existing NICU, current protocols, and encountered problems are shown. Implications for Practice. Our outcome confirmed the need for dedicated NNCU for neuroprotection of critically ill neonates at risk for a neurological injury. Although the literature on neonatal neurocritical care is still scarce, we see the value of such targeted approach to newborn brain protection and therefore we will continue developing our NNCU, even though there have been problems encountered. The project of building NNCU will continue to be closely monitored.

Conclusions: The development of our neonatal neurocritical model of care is far from being completed. Although it is currently limited to the Sicilian area only, the goal of this paper is to share the development of this multicenter interdisciplinary project focused on a newborn brain protection. After evaluating our outcome, we strongly believe that a combined expertise in neonatal neurology and neonatal critical care can lead to an improved neurodevelopmental outcome for critically ill neonates, from the extremely preterm to those with brain injuries.

Citing Articles

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PMID: 35209975 PMC: 8884055. DOI: 10.7499/j.issn.1008-8830.2112129.

References

Flacking R, Lehtonen L, Thomson G, Axelin A, Ahlqvist S, Moran V . Closeness and separation in neonatal intensive care. Acta Paediatr. 2012; 101(10):1032-7. PMC: 3468719. DOI: 10.1111/j.1651-2227.2012.02787.x. View

Natarajan G, Laptook A, Shankaran S . Therapeutic Hypothermia: How Can We Optimize This Therapy to Further Improve Outcomes?. Clin Perinatol. 2018; 45(2):241-255. PMC: 5953210. DOI: 10.1016/j.clp.2018.01.010. View

Glass H, Numis A, Gano D, Bali V, Rogers E . Outcomes After Acute Symptomatic Seizures in Children Admitted to a Neonatal Neurocritical Care Service. Pediatr Neurol. 2018; 84:39-45. DOI: 10.1016/j.pediatrneurol.2018.03.016. View

Singhi S, Johnston M . Recent advances in perinatal neuroprotection. F1000Res. 2020; 8. PMC: 6979470. DOI: 10.12688/f1000research.20722.1. View

Martinello K, Hart A, Yap S, Mitra S, Robertson N . Management and investigation of neonatal encephalopathy: 2017 update. Arch Dis Child Fetal Neonatal Ed. 2017; 102(4):F346-F358. PMC: 5537522. DOI: 10.1136/archdischild-2015-309639. View

Van Meurs K, Yan E, Randall K, Chock V, Davis A, Glennon C . Development of a NeuroNICU with a Broader Focus on All Newborns at Risk of Brain Injury: The First 2 Years. Am J Perinatol. 2018; 35(12):1197-1205. DOI: 10.1055/s-0038-1646954. View

Adams Jr H, Del Zoppo G, Alberts M, Bhatt D, Brass L, Furlan A . Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the.... Stroke. 2007; 38(5):1655-711. DOI: 10.1161/STROKEAHA.107.181486. View

Ballabh P . Pathogenesis and prevention of intraventricular hemorrhage. Clin Perinatol. 2014; 41(1):47-67. PMC: 3925310. DOI: 10.1016/j.clp.2013.09.007. View

Maller V, Choudhri A, Cohen H . Neonatal Head Ultrasound: A Review and Update-Part 2: The Term Neonate and Analysis of Brain Anomalies. Ultrasound Q. 2019; 35(3):212-223. DOI: 10.1097/RUQ.0000000000000446. View

10.

Dhar R, Rajajee V, Finley Caulfield A, Maas M, James M, Kumar A . The State of Neurocritical Care Fellowship Training and Attitudes toward Accreditation and Certification: A Survey of Neurocritical Care Fellowship Program Directors. Front Neurol. 2017; 8:548. PMC: 5668669. DOI: 10.3389/fneur.2017.00548. View

11.

Darcy A, Hancock L, Ware E . A descriptive study of noise in the neonatal intensive care unit: ambient levels and perceptions of contributing factors. Adv Neonatal Care. 2008; 8(5 Suppl):S16-26. DOI: 10.1097/01.ANC.0000337268.85717.7c. View

12.

Lodha A, Entz R, Synnes A, Creighton D, Yusuf K, Lapointe A . Early Caffeine Administration and Neurodevelopmental Outcomes in Preterm Infants. Pediatrics. 2018; 143(1). DOI: 10.1542/peds.2018-1348. View

13.

Glass H . Neonatal neurocritical care: overlooked neurologic syndromes. Pediatr Neurol. 2012; 47(6):466-7. DOI: 10.1016/j.pediatrneurol.2012.08.018. View

14.

Meaney M, Szyf M . Maternal care as a model for experience-dependent chromatin plasticity?. Trends Neurosci. 2005; 28(9):456-63. DOI: 10.1016/j.tins.2005.07.006. View

15.

Bonifacio S, Van Meurs K . Neonatal Neurocritical Care: Providing Brain-Focused Care for All at Risk Neonates. Semin Pediatr Neurol. 2019; 32:100774. DOI: 10.1016/j.spen.2019.08.010. View

16.

Glass H, Ferriero D, Rowitch D, Shimotake T . The neurointensive nursery: concept, development, and insights gained. Curr Opin Pediatr. 2019; 31(2):202-209. DOI: 10.1097/MOP.0000000000000733. View

17.

Bashir R, Espinoza L, Vayalthrikkovil S, Buchhalter J, Irvine L, Bello-Espinosa L . Implementation of a Neurocritical Care Program: Improved Seizure Detection and Decreased Antiseizure Medication at Discharge in Neonates With Hypoxic-Ischemic Encephalopathy. Pediatr Neurol. 2016; 64:38-43. DOI: 10.1016/j.pediatrneurol.2016.07.007. View

18.

Mann P, Gospe S, Steinman K, Wilfond B . Integrating neurocritical care approaches into neonatology: should all infants be treated equitably?. J Perinatol. 2015; 35(12):977-81. DOI: 10.1038/jp.2015.95. View

19.

Shellhaas R, Chang T, Tsuchida T, Scher M, Riviello J, Abend N . The American Clinical Neurophysiology Society's Guideline on Continuous Electroencephalography Monitoring in Neonates. J Clin Neurophysiol. 2011; 28(6):611-7. DOI: 10.1097/WNP.0b013e31823e96d7. View

20.

Calciolari G, Montirosso R . The sleep protection in the preterm infants. J Matern Fetal Neonatal Med. 2011; 24 Suppl 1:12-4. DOI: 10.3109/14767058.2011.607563. View