Fall 2010

Neurointensive Care Nursery Forges New Care Model for At-Risk Infants

UCSF Neurointensive Care Nursery"Despite advances in saving patients' lives, neonatologists have struggled to improve neurological outcomes for newborns at risk due to seizures, intracranial bleeding or hypoxic-ischemic encephalopathy (HIE)," says David Rowitch, M.D., Ph.D., chief of Neonatology at UCSF Benioff Children's Hospital.

Many such patients — especially premature infants — wind up with neurological complications, which are the leading cause of mental retardation and cerebral palsy in the United States.

"The UCSF Neurointensive Care Nursery (NICN) seeks to improve outcomes," says Yao Sun, M.D., Ph.D., director of neonatal clinical programs. "Our clinical research will uncover new ways to mitigate brain injury and promote repair."

A Pioneering Concept

Championed by Rowitch and Neonatal Neurologist Donna Ferriero, M.D., the NICN at UCSF Benioff Children's Hospital opened in 2008 as the first of its kind in the country. Of the approximately 800 patients treated each year in UCSF's Intensive Care Nursery (ICN), the NICN team sees about 200.

The NICN incorporates a specially trained, multidisciplinary team 24/7 — including neonatal neurologists, neonatologists, neuroradiologists, nurse practitioners and registered nurses — into the intensive care nursery. Advanced monitoring equipment and new protocols enable early diagnoses, improved counseling of families and faster, more informed decisions about treatment options.

Early Successes

Among the advances forging a new care model for newborns at risk for brain injury:

  • Rapid diagnosis of seizures. Seizure identification and management involve the use of electroencephalograms (EEGs) and cerebral function monitors (CFMs) to identify clinically silent seizures. Medication may lessen the long-term impact of these seizures.
  • Optimized use of hypothermia for infants with HIE. "Treating or evaluating over 100 patients at risk for hypoxic-ischemic encephalopathy, some with other life-threatening complications such as pulmonary hypertension, teaches us that while simple in concept, therapeutic hypothermia is complex in practice, requiring a multidisciplinary team and the support of a regional center," says Thomas Shimotake, M.D., co-director of the NICN, along with Sonia Bonifacio, M.D., and Hannah Glass, M.D.
  • Advanced neuroimaging. Experience with magnetic resonance imaging (MRI) of infants enables further identification of potential brain problems. The use of an MRI-compatible incubator, pioneered at UCSF, makes this procedure rapid, safe and sensitive.

Once infants are released from the hospital, NICN teams work closely with referring physicians to help coordinate what can be complex follow-up care, and track patients through the ICN Follow-Up Program.

Eligibility Criteria for Therapeutic Cooling

For newborns to be considered, they must fulfill all three of the following within six hours of birth:

  1. ≥ 36 weeks gestational age
  2. One or more of the following:
    • Low Apgar scores, < 5 at 10 minutes.
    • Prolonged resuscitation at birth, e.g., chest compressions and intubation or mask ventilation at 10 minutes.
    • Severe acidosis, pH < 7.00 from cord or patient blood gas within 60 minutes of birth.
    • Abnormal base excess, < –12 mmol/L in cord gas or blood gas within 60 minutes of birth.
  3. Moderate to severe encephalopathy

For help identifying eligible infants or to receive a protocol and consultation to begin the process prior to transfer, contact the UCSF Access Center at (877) 822–4453.

For more information, contact the Neurointensive Care Nursery at (415) 353–1565.

 

Fall 2010 Table of Contents

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