Welcome to the first edition of Neonatal Neuromonitoring News. Our goal is to provide a periodic update of news in neonatal neuromonitoring and related areas. We plan to keep the newsletter fun and informative. We will also use the newsletter to provide updates on our products and users. We encourage you to contribute and we hope you like it.

Dr. Linda deVries Dick Moberg of Day One Medical recently had the pleasure of sharing a glass of wine and some conversation in Napa, California with Dr. Linda deVries of Utrecht, The Netherlands. Dr. deVries is an internationally known neonatologist with considerable expertise in neonatal neuromonitoring. How did you get into monitoring baby brains?

When I heard the first presentation by Nils Svenningsen in 1989 about the aEEG, I really felt that this technique could be very useful and I was keen to learn the technique. Of course we were doing intermittent standard EEGs in our infants during those days, but when I was working in London (the Hammersmith Hospital), John Connell had introduced continuous 2 channel EEG monitoring and it was shown by him and also by Janet Eyre in Oxford that there was a lot of gain from continuous monitoring. Our neurophysiology was initially not very keen, the aEEG technique was old, and maybe a newer technique would be better than this one designed in the sixties. However, in 1992 I decided to ask Nils Svenningsen whether I could visit and then spent a week in Lund and was taught the essentials by him and especially Lena Hellstrom-Westas. When I came back, I initially faxed quite a number of query cases, but together with Mona Toet, who had spent a few months in Leeds with Debbie Murdoch-Eaton, we started to learn the ins and outs of the aEEG.

We started off with a single analog Lectromed machine but soon had 4 of them and then gradually changed to the digital machine once they became available.

Tell me some details about how monitoring is done in Utrecht.

We now have seven digital machines (three BrainZ BRM3 monitors, two Olympic CFM-6000 monitors, one Day One Medical CNS Monitor, one NicoletOne monitor) and it is not uncommon to have five or six running simultaneously. We have nurses apply either needle-electrodes or hydrogel electrodes.

All full-term infants with neonatal encephalopathy and/or seizures are monitored for at least 72 hours after admission. We also monitor all infants who are getting hypothermia and infants with infections of the central nervous system. Suspected metabolic disorders are monitored as well, and also all infants who need muscle relaxants. (about 60-80 per year). We are also involved in a European study, and for this study we monitor all ELGAN babies, another 40 per year. We always try to use a 2-channel machine when there are hemi-convulsions or when we suspect a unilateral lesion on the basis of neuro-imaging.

What about the future? What would you like to see happen? What are the major problems?

For the future, we hope that the seizure detection algorithms will become more reliable and that we will be able to see on-line the degree of interburst interval and percentage of continuity within the EEG, which will be especially helpful in the preterm infant where visual analysis of the aEEG is not sufficient and more difficult than in the full term infant. We now also have a project together with the intensive care unit for children and they have now use the BRM3 more and find it especially useful in the young cardiac patients who undergo surgery.

Problems? I'm not sure, although maybe I am a bit anxious that people want to re-invent the wheel and want something far superior to a simple aEEG. However, we should not forget that the aEEG was originally meant to monitor adults during cardiac bypass surgery. But since the introduction of this technique in our NICU, the number of full EEGs has increased rather than decreased.

2009

December 6-8, 2009
Hot Topics in Neonatology
Omni Shoreham Hotel, Washington, DC
Contact: www.hottopics.org

2010

January 21-23, 2010
The Fifth International Conference on Brain Monitoring and Neuroprotection in the Newborn
Sand Key Resort, Clearwater, Florida
Contact: www.cme.hsc.usf.edu/brain10

February 10-14, 2010
neo: The Conference for Neonatology
Hilton-Waldorf Astoria Bonnet Creek Resort, Orlando, Florida
Contact: www.neoconference.com

Controversies in neonatal seizure management.
Glass HC, Wirrell E.
J Child Neurol. 2009 May;24(5):591-9.
A review of the current controversies facing child neurologists and neonatologists, including how to define, monitor, and treat neonatal seizures.

Engineering aspects of the quantified amplitude-integrated electroencephalogram in neonatal cerebral monitoring.
Quigg M, Leiner D.
J Clin Neurophysiol. 2009 Jun;26(3):145-9.
An investigation of the aEEG related to differences in machines, inter-electrode distances, and electrode locations.

EEG in the healthy term newborn within 12 hours of birth.
Korotchikova I, Connolly S, Ryan CA, Murray DM, Temko A, Greene BR, Boylan GB.
Clin Neurophysiol. 2009 Jun;120(6):1046-53.
A investigation of normal newborn EEG using quantitative analysis methods that include Spectral Edge Frequency, Spectral Entropy, and relative Delta Power.

Electroencephalographic monitoring during hypothermia after pediatric cardiac arrest.
Abend NS, Topjian A, Ichord R, Herman ST, Helfaer M, Donnelly M, Nadkarni V, Dlugos DJ, Clancy RR.
Neurology. 2009 Jun 2;72(22):1931-40.
An evaluation of the safety and feasibility of long-term EEG monitoring for assessing electroencephalographic background and seizure characteristics in children undergoing therapeutic hypothermia after cardiac arrest.

Predictive value of clinical and EEG features in the diagnosis of stroke and hypoxic ischemic encephalopathy in neonates with seizures.
Rafay MF, Cortez MA, de Veber GA, Tan-Dy C, Al-Futaisi A, Yoon W, Fallah S, Moore AM.
Stroke. 2009 Jul;40(7):2402-7.
An investigation of neonates with seizures for clinical and EEG features that may differentiate between diagnoses of stroke and HIE.

Elevated cerebral pressure passivity is associated with prematurity-related intracranial hemorrhage.
O'Leary H, Gregas MC, Limperopoulos C, Zaretskaya I, Bassan H, Soul JS, Di Salvo DN, du Plessis AJ.
Pediatrics. 2009 Jul;124(1):302-9.
An investigation of continuous monitoring of MAP and cerebral near-infrared spectroscopy hemoglobin difference (HbD) for the quantification of cerebral pressure passivity and its association to germinal matrix/intraventricular hemorrhage.

Noninvasive optical measures of CBV, StO(2), CBF index, and rCMRO(2) in human premature neonates' brains in the first six weeks of life.
Roche-Labarbe N, Carp SA, Surova A, Patel M, Boas DA, Grant PE, Franceschini MA.
Hum Brain Mapp. 2009 Jul 31.
An investigation of the cerebral blood flow (CBF) and cerebral blood volume (CBV) relationship in premature newborns using frequency domain near infrared spectroscopy (FD-NIRS) and diffuse correlation spectroscopy (DCS).

Day One Medical and Cincinnati Sub-Zero connect! Day One Medical's CNS Monitor can now connect to the CSZ Blanketrol® III Hyper-Hypothermia System and continuously record and display the patient temperature, water temperature, and set point. The Blanketrol® system is widely used for whole body cooling of neonates undergoing therapeutic hypothermia. It is one of the few cooling systems that provides data for external recording. For more information about this interface, read our press release.

Research Partners Program

We are pleased to announce our Research Partners program. As many of you know, the parent company of Day One Medical (Moberg Research, Inc.) and its predecessors have been actively involved in neuromonitoring research for three decades. We have been the recipient of numerous NIH and DoD grants related to neuromonitoring which are leading to new monitoring technologies including neonatal seizure detection and a neonatal brain wellness index. Over the years we have developed some excellent research partnerships which have been beneficial to our company as well as to our academic or clinical partners. We are interested in forming new collaborative partnerships to share data and resources for research in neurological monitoring. If you would like more information, please email dayone-research@moberg.com.

In this section, we want to showcase recent recordings that are "of interest" from a clinical perspective or that highlight current research. We encourage you to submit descriptions (including screen shots or images) of recent recordings involving neonatal or pediatric neurological monitoring.

To submit your case, please email it to nnn-cases@moberg.com. Case descriptions should be 250 words or less, and the total size of included images should be less than 3MB. Please ensure that no patient-identifiable information is included within the description or images.

Look here in the next issue for our first cases!

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Day One Medical, LLC is an affiliate of Moberg Research, Inc.

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