1. Newnam, Katherine M. PhD, RN, NNP-BC, CPNP, IBCLE

Article Content


Katherine M. Newnam, PhD, RN, NNP-BC, CPNP, IBCLE


Social Media; we are in the midst of a true generational movement. Facebook, Skype, Instagram, FaceTime, Twitter, texting, blogging, vlogs, and many other social contact platforms allow the parents of our tiny patients stay engaged and receive support and information from others. Families who have infants in the neonatal intensive care unit (NICU) use these and other social platforms on their devices daily. It is not surprising that during stressful times, parents reach for methods of communication that allow immediate access to information. Imagine the frustration of being away from your child without reliable means of contact.


Research surrounding the NICU parent experience describes parental feelings of anger and fear.1 Often parents exhibit negative symptoms of stress, depression, anxiety, and even hopelessness following their infants' admission to the NICU.2 These psychological symptoms may create barriers to the process of parent-infant interactions, delay the parental role acquisition, and delay infant bonding.3 These symptoms have been associated with decreased cognitive and emotional development of the infant.4 In addition, maternal psychological functioning has been shown to increase length of stay,5 perform oral feeding behaviors, and difficulty understanding discharge instructions.6


Members of the NICU healthcare team can embrace technology as a means to communicate with parents. Increased understanding of the various platforms may be required to devise creative ways to offer this level of parental support. An exciting publication in the Journal of Pediatrics describes the use of videoconferencing during healthcare team rounds using FaceTime (Apple Inc, Cupertino, California) or Telemedicine technology.7 This allowed the parents who could not travel to the hospital the ability to engage with the healthcare team daily. Real-time participation, and questions to the healthcare team with responses offered, gives parents a sense of belonging, satisfaction, and decreased stress.7


Additional methods of decreasing parental stress include individualized support,3 communication strategies, and enhanced visitation.8 Thinking outside the box, we must consider alternative methods of visitation or communication with families, including virtual.


A review article was published to highlight existing evidence of alternative methods used to support communication with NICU parents.9 These technologies were described as methods to "augment" communication with the healthcare team. They included videoconferencing, videophone, Skype, FaceTime, or webcams (AngelEye Camera Systems or NICVIEW, video streaming devices for NICU patients).9 Although most parents expressed positive feeling of seeing their infants, this was not universal. Parents who expressed positive impressions of seeing their infant described reduced stress and anxiety.10 Parents who expressed negative feelings stated that the experience increased sadness and guilt about not being with their infants. Universally, parents expressed the advantage of sharing real-time videos with grandparents or siblings who could not routinely visit.9


Through the integration of these communication strategies, we can enhance the parental connectedness with the infant and the unit. As we begin to embrace the technologies that exist, we now move toward reasonable methods of integration. One of the biggest future challenges as we embrace these alternative methods of parental contact is protecting our patients personal and health information.


1. Dzbaty DR. Supporting neonatal intensive care unit parents through social media. J Perinat Neonatal Nurs. 2016;30(3):214-217. [Context Link]


2. Roque AT, Lasiuk GC, Radunz V, Hegadoren K. Scoping review of the mental health of parents of infants in the NICU. J Obstet Gynecol Neonatal Nurs. 2017;46:576-587. [Context Link]


3. Gimenez EC, Sanchez-Luna M. Providing parents with individualized support in a neonatal intensive care unit reduced stress, anxiety and depression. Acta Paediatr. 2015;104(7):e300-e305. doi:10.1111/apa.12984. [Context Link]


4. Craig J, Glick C, Phillips R, Hall S, Smith J, Browne J. Recommendations for involving the family in developmental care of the NICU baby. J Perinatol. 2015;35:S5-S8. [Context Link]


5. Cherry AS, Mignogna MR, Roddenberry VA, et al The contribution of maternal psychological functioning to infant length of stay in the neonatal intensive care unit. Int J Womens Health. 2016;27(8):233-242. doi:10.2147/IJWH.S91632. [Context Link]


6. Park J, Thoyre S, Estrem H, Pados BF, Knafl GJ, Brandon D. Mothers' psychological distress and feeding of their preterm infants. MCN Am J Matern Child Nurs. 2016;41(4):221-229. [Context Link]


7. Yager PH, Clark M, Cummings BM, Noviski N. Parent participation in pediatric intensive care unit rounds via telemedicine: feasibility and impact. J Pediatr. 2017;185:181-186. [Context Link]


8. Greene MM, Rossman B, Patra K, Kratovil A, Khan S, Meier PP. Maternal psychological distress and visitation to the neonatal intensive care unit. Acta Paediatr. 2015;104(7):e306-e313. doi:10.1111/apa.12975. [Context Link]


9. Epstein EG, Arechiga J, Dancy M, Simon J, Wilson D, Alhusen JL. Integrative review of technology to support communication with parents of infants in the NICU. J Obstet Gynecol Neonatal Nurs. 2017;46(3):357-366. [Context Link]


10. Rhodes SJ, Green A, Gauss CH, Mitchell A, Pate B. Web camera use of mothers and fathers when viewing their hospitalized neonate. Adv Neonatal Care. 2015;15(6):440-446. [Context Link]



Can you imagine an extremely low birth-weight infant resting within the incubator with physiological parameters monitored by wireless technology? A world where there would be no "spaghetti wires" when repositioned or when we move the infant to the parent's chest for kangaroo care. Well, as we speak, this technology is being worked on by bioengineers and researchers across the world. One of the first breakthroughs in this technology is a multichannel electroencephalographic (EEG) that is showing promise in the NICU patient.


According to the consensus statement by the American Clinical Neurophysiology Society, long-term, conventional EEG monitoring is recommended for some high-risk neonates with the goal to predict and improve neurodevelopmental outcome. Specific clinical conditions that confer this classification of high risk include acute neonatal encephalopathy, pulmonary risk for acute brain injury, central nervous system (CNS) infection or trauma, suspected or confirmed inborn errors of metabolism, perinatal stroke, sinovenous thrombosis, high-grade intraventricular hemorrhage, and/or genetic syndrome involving the CNS.1 EEG procedures and timing are also discussed within this consensus statement.


Conventional EEG is considered the gold standard for diagnosing seizure activity and/or monitoring cerebral electrical activity in the neonate.1 This test can be expensive, and the correct electrode placement/connection may be difficult to maintain on our tiny patients. Lack of experienced personnel that are necessary to set up testing during evening and/or night shifts may also create delays for the NICU patient. Amplitude-integrated EEG (aEEG) has been shown to be more practical in this setting, yet this method does not provide localized abnormalities and may deliver a high rate of artifact affecting the accuracy of results.2


This new device is called a microEEG and was developed by Bio-Signal Group. It is Food and Drug Administration approved for use in neonates.3 The wireless EEG device is connected by adaptor to a specialized electrode cap (ANT-Neuro). The EEG signals are digitized by the device and transmitted via Bluetooth technology to a laptop housed at the bedside.


A prospective, observational study was conducted to assess feasibility and problem areas during the use of a compact wireless device to obtain multichannel EEG recordings in the NICU.4 The study enrolled 28 infants between 2013 and 2014, and the subjects underwent 61 EEG recordings.4 Notable findings were 6 (10%) of the EEG recordings were uninterpretable secondary to artifact, 1 could not be downloaded, and the remaining 54 (89%) were acceptable for interpretation by the pediatric neurophysiologist.


The bottom line is this ultra-compact wireless microEEG has the potential to provide long-term multichannel EEG recording to NICU patients. It is uniquely portable, reportedly easy to set up, and has clear application to the NICU setting. Correlation between existing wired continuous EEGs and/or video EEG testing would be valuable.


1. Shellhaas RA, Chang T, Tsuchida T, et al The American Clinical Neurophysiology Society's guideline on continuous EEG monitoring in neonates. J Clin Neurophysiol. 2011;28(6):611-617. [Context Link]


2. Boylan GB. EEG monitoring in the neonatal intensive care unit: a critical juncture. Clin Neurophysiol. 2011;122(10):1905-1907. [Context Link]


3. Omurtag A, Baki SG, Chari G, et al Technical and clinical analysis of micro EEG: a miniature wireless EEG device designed to record high-quality EEG in the emergency department. Int J Emerg Med. 2012;5(1):35. [Context Link]


4. Ibrahim ZH, Chari G, Baki SA, Bronshtein V, Kim MR, Weedon J, et al Wireless multichannel electroencephalography in the newborn. J Neonatal Perinat Med. 2016;9(4):341-348. doi:10.3233/NPM-161643. [Context Link]