Monday, November 9, 2015

Why is continuous EEG in the Neonatal Intensive Care Unit so unique?

I worked in clinical EEG from 1978 to 2004, when I became a member of the ASET staff.  For fourteen of those years, I worked at Children’s Hospital in Boston, and I have always loved working with pediatric patients the most!  And of all the pediatric patients, my very favorites are the newborns!  I find it so fascinating to observe the maturation of the brain! 

Back in the 1980’s I worked at Memorial Hospital in Worcester, MA, where there was a very busy neonatal intensive care unit that provided care for almost all of the critically ill infants from miles around.  I was working in a one-person lab so I recorded every EEG requested in that unit, which averaged about 15 neonatal EEGs per month.  I was always happy to spend hours in the NICU, observing the medical staff, new parents, and many tiny patients.  I often did serial EEGs on premature infants and I was able to observe the remarkable changes in EEG patterns as the brain develops.  You can actually estimate the conceptional age of an infant pretty accurately by using EEG, since new patterns appear about every two weeks in the pre-term infant.  For example: the Delta Brush pattern is very distinctive and generally peaks at 31-33 weeks conceptional age.  I took great pride in understanding neonatal EEG patterns and became very familiar with them, since I observed so many over the years.
While all EEGs are an important component of the diagnostic process, continuous EEG for the critically ill newborn is vital and of the utmost importance!  Neurological complications can occur rapidly and can be difficult to recognize without EEG monitoring.  Urgent intervention can have such a huge impact on the future of a child:  not surviving a crisis, or incurring significant anoxia and brain damage can be a real possibility.  Our youngest and most fragile patients benefit the most from a high quality EEG recording: including lead placement that does not break the skin, artifact-free recording, systematic review of data being recorded, and prompt notification of significant changes in EEG patterns.
I think that recording EEG in the neonate requires a high level of skill, great care and patience, a delicate touch and strong communication skills as we need to work closely with so many others in this setting to apply leads, set-up a recording and maintain a continuous recording when you can’t be present to monitor the record all of the time. 
So, I am inviting you to participate in the extended webinar that ASET is offering this week, on Nov. 11 & 12, on the topic of “Continuous EEG in the Neonatal Intensive Care Unit”.  If you cannot spend 3 hours each day listening to the live presentations and discussion, then perhaps consider purchasing the recorded version which will soon be available.  For the full schedule of webinar presentations, and to sign-up for the webinar, please use this link:Webinar info
If you are new to the field and work in an institution where you will be recording neonatal EEG, this webinar will be essential to helping you work in this special environment.  If you don’t work with neonates but are planning to take the ABRET EEG Registry exam or their CLTM exam, you will need to know all about neonatal EEG to cover questions on the exam that have to deal with all aspects of EEG in this age group:  both normal and abnormal patterns, clinical correlations and the ACNS guidelines for recording neonatal EEG.  There is also a fairly new ACNS guideline for terminology used to report on neonatal EEG.  So, you see, this really is a world of its own and one that is worth exploring!

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