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  1. Goswami, Ipsita MD
  2. Bello-Espinosa, Luis MD
  3. Buchhalter, Jeffrey MD, PhD
  4. Amin, Harish MD
  5. Howlett, Alexandra MD
  6. Esser, Michael MD, PhD
  7. Thomas, Sumesh MD
  8. Metcalfe, Cathy CNE
  9. Lind, Jan CSN
  10. Oliver, Norma CSN
  11. Kozlik, Silvia RET
  12. Mohammad, Khorshid MD


Background: Continuous video electroencephalographic (EEG) (cvEEG) monitoring is emerging as the standard of care for diagnosis and management of neonatal seizures. However, cvEEG is labor-intensive and the need to initiate and interpret studies on a 24-hour basis is a major limitation.


Purpose: This study aims at establishing consistency in monitoring of newborns admitted to 2 different neonatal intensive care units (NICUs) managed by the same neurocritical care team.


Methods: Neonatal nurses were trained to apply scalp electrodes, troubleshoot technical issues, and identify amplitude-integrated EEG abnormalities. Guidelines, checklists, and visual training modules were developed. A central network system allowed remote access to the cvEEGs by the epileptologist for timely interpretation and feedback. A cohort of 100 infants with moderate to severe hypoxic-ischemic encephalopathy before and after the training program was compared.


Results: During the study period, 192 cvEEGs were obtained. The time to initiate brain monitoring decreased by 31.5 hours posttraining; this, in turn, led to an increase in electrographic seizure detection (20% before vs 34% after), decrease in seizure clinical misdiagnosis (65% before and 36% after), and reduction in antiseizure medication burden.


Implications for Practice: Training experienced NICU nurses to set up, start, and monitor cvEEGs can decrease the time to initiate cvEEGs, which may lead to better seizure diagnosis and management.


Implications for Research: Further understanding of practice bundles for best supporting infants at risk and being treated for seizures needs to be evaluated for integration into practice.


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