Neuro-Intensive Care Nursery
In the past three decades, the survival rate for premature babies has increased significantly. But, extremely premature infants are prone to neurological complications that doctors currently cannot prevent. Premature infants develop cerebral palsy in 5-15 percent of cases and 25-50 percent develop cognitive disorders or learning dysfunction.
Neonatologists, neurologists and radiologists at UCSF Benioff Children’s Hospital are working to change these statistics. With the April 2008 opening of a new Neuro-Intensive Care Nursery, this team inaugurated a program to improve neurodevelopmental outcomes in very premature infants and in full-term babies who are at high risk of neurological injury or have clinical evidence of encephalopathy, seizures or stroke.
The program has been championed by Donna Ferriero, MD, chief of Pediatric Neurology, and David Rowitch, MD, PhD, who is chief of Neonatology and a Howard Hughes Medical Institute investigator. Dr. Rowitch was drawn from Harvard Medical School to UCSF by the opportunity to work with internationally known UCSF experts to provide this much-needed care.
“Birth-related neurological injury is the leading cause of mental retardation and cerebral palsy in the United States. The UCSF Neuro-Intensive Care Nursery will offer a new standard of care for patients and address concerns of families confronted with the possibility of neurological injury in their newborn. Our goal is to create the most comprehensive possible assessment and treatment program in the United States.”
Newborns in the nursery will also be routinely evaluated with magnetic resonance imaging (MRI), using techniques pioneered by A. James Barkovich, MD, chief of Pediatric Neuroradiology. Working with a team that included clinical nurse specialists, Barkovich developed the first MRI-compatible incubator, which has allowed this imaging study to be performed on extremely premature babies who require a carefully controlled environment. Magnetic resonance imaging studies will be integrated with information from cerebral function monitoring and magnetic resonance spectroscopy to provide valuable insights into brain anatomy and metabolic activity.
Cerebral function monitoring (CFM) can provide a window into the brain activity of newborns. Under the direction of Yao Sun, MD, PhD, director of Neonatal Clinical Programs at UCSF, the new nursery will routinely use the same intensive monitoring that adult stroke patients receive. It is provided through 8-12 lead electroencephalography (EEG) that can quickly switch from a simplified (amplitude integrated) reading to a full EEG. CFM is used in other nurseries, but typically only when an infant may be having seizures, according to Dr. Sun. In the Neuro-Intensive Care Nursery, this monitoring will be a routine part of clinical care. Dr. Sun, who has an extensive background in computer science, will oversee the integration of the large amount of data gathered on these babies into a clinically useful form.
Our approach to neuro-monitoring meets all recommendations of the The American Clinical Neurophysiology Society's Guideline on Continuous Electroencephalography Monitoring in Neonates. For more information, download the ACNS Guideline on Continuous Electroencephalography Monitoring in neonates.pdf
Under a clinical research protocol, the nursery will be treating infants who have moderate hypoxic encephalopathy with hypothermia – lowering the baby’s temperature with a cooling cap or blanket. Research has shown that cooling the brain and body by a few degrees immediately after birth can help reduce neurological damage in babies who have sustained certain types of brain injury
More info on Hypothermia Treatment
- Giving At-Risk Newborns the “Deep Chill” to Prevent Brain Injury [PDF]
- Hypothermia Treatment for Hypoxic Ischemic Encephalopathy [PDF]
- Acute Severe Birth Asphyxia [PDF]
Dedicated Newborn Neurology
Dr. Ferriero, one of the foremost neonatal neurologists in the United States, oversees a dedicated team that assesses neurological function in critically ill newborns. Working with her is neonatal neurologist Hannah Glass, MD, who will coordinate the clinical aspects of neurological care provided in the nursery. The neurology team will also oversee the training of a new cadre of specialists seeking to understand the role of complications of early birth and intensive care in the newborn brain injury.
Individualized Developmental Care
New staff member Kathleen VandenBerg, PhD, will oversee implementation of a Newborn Individualized Developmental Care and Assessment Program (NIDCAP) training center at UCSF. In the NIDCAP model of care, infants are carefully observed within the newborn ICU setting to determine if their behaviors suggest that they are under any stress of discomfort. This information is then used to provide an environment that is as comfortable as possible and developmentally appropriate for each baby.
New Directions in Research
Efforts to advance diagnosis and treatment will be coordinated by Drs. Rowitch and Ferriero, co-directors of the UCSF Newborn Brain Research Institute (NBRI). As more is learned about the structure and function of the newborn brain, a “translational” approach will streamline the development and testing of new neuroprotective therapies. Researchers hope to quickly determine if a therapy may be effective by analyzing data from imaging studies, monitoring and clinical observation. “Our goal is to offer patients and their families real therapeutic options when faced with neurological injuries,” says Dr. Rowitch.
Last updated 12-04-2012