Neonatal Intensive Care Unit
Conditions
Keywords
Quantitative neuromonitoring, Pediatric and neonatal critical care, Neonatal encephalopathy
Brief summary
The detection and appropriate treatment of seizures significantly impact the neurological prognosis of patients in intensive care. Indeed, altered brain function including seizures is described in critically ill children, regardless of the reason for admission. Most seizures are subclinical and therefore impossible to diagnose without neuromonitoring tools. Despite being concidered ad Gold Standard, continuous EEG (cEEG) with video recording shows difficulty of implementation and interpretation at all hours of the day and night explaining that less than 10% of centers in France use cEEG routinely. Most departments prefer simplified techniques, including amplitude traces (aEEG) which can be used continuously at the bedside. However, the positive predictive value of aEEG in the detection of seizures does not exceed 78% and 64% in newborns and children respectively making necessary an optimization of the information provided by these techniques. This project is a pragmatic diagnostic study that aims at developing and evaluating a neuromonitoring interface adapted to the needs of pediatric and neonatal intensive care units and meeting the requirements of neurophysiologists in terms of EEG trace quality.
Detailed description
This research will take place in three phases : 1. Parameterization of the interface, which will display an 8-channel aEEG trace associated with reading aids (CDSA and automated seizure detection) available to the clinician. 2. Teams' training regarding the placement of additional electrodes and the use of reading aid tools. 3. Patient's inclusion. The obtained traces will be accessible at any time for direct interpretation and can be read on demand by a neurophysiologist during office hours. Post-hoc review of the entire EEG trace by an expert in pediatric EEG, blinded to the interpretation made at the bedside (gold standard). Research hypothesis is that continuous neuromonitoring combining optimized quantitative EEG techniques and targeted advice from a neurophysiologist would allow the detection of a majority of seizure events requiring treatment and background trace abnormalities associated with critical encephalopathy.
Interventions
OTHERNeuromonitoring with 10 electrodes
In case of no parental objection, the clinician may begin neuromonitoring according to standard indications. The number of electrodes applied to the child's skull will be 10 electrodes (8 recording electrodes, 1 reference electrode, and 1 ground electrode) instead of the current 5. The intensivist will analyze the quantitative EEG trace as they currently do but will also have access to additional tools for seizure detection support (CDSA and seizure detection software) and targeted review of part of the recording by a neurophysiologist in case of doubt. Access to the neurophysiologist will be available during current working hours on weekdays. Data will be collected in 12-hour periods.
Sponsors
Nantes University Hospital
Study design
Observational model
CASE_ONLY
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
No minimum to 24 Months
Healthy volunteers
No
Inclusion criteria
: * Patients younger than 2 years old hospitalized in the intensive care unit with an indication for neuromonitoring. The same patient may be included multiple times. * Written non-opposition from legal representatives. * Patients affiliated with or beneficiaries of a social security or similar scheme (CMU).
Exclusion criteria
: * Parents who do not understand French. * Inability to set up monitoring equipment (neurosurgery preventing access to electrode placement sites). * Corrected age \< 37 weeks of gestation (GA) for preterm infants.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Evaluate the diagnostic performance of neuromonitoring combining quantitative EEG and possible interpretation by a neurophysiologist in detecting neurological impairment. | 48 hours |
Secondary
| Measure | Time frame |
|---|---|
| Evaluation of the detection of convulsive seizures | 48 hours |
| Evaluation of the classification of the background tracing in critical encephalopathy grade | 48 hours |
| Impact of tracing aids on intensivists' confidence level during decision-making | 48 hours |
| Number of suitable anticonvulsant treatments | 48 hours |
| Prescription period for anticonvulsant treatments | 48 hours |
| Hypothermia treatment rates indicated after subsequent rereading of the tracing by the expert | 48 hours |
Countries
France
Contacts
CONTACTNoura ZAYAT, PH
CONTACTPierre BOURGOIN, PH
Outcome results
None listed