Use of Multimodal Brain Monitoring in the NICU to Guide Treatment and Predict Outcomes

Multimodality neuromonitoring facilitates the diagnosis and prevention of neurological injury in critically ill neonates. Multimodal monitoring may encompass physiologic bedside parameters including heart rate, blood pressure, respiratory rate, and peripheral oxygen saturation (SpO2). In addition to these continuous vital signs, the addition of simultaneous neuromonitoring data such as near-infrared spectroscopy (NIRS) and amplitude-integrated electroencephalography (aEEG) using a time-synchronized approach may aid in the identification of hemodynamic and functional activity changes in the brain. Early detection of impaired cerebral oxygenation (rScO2) or electrographic abnormalities may also allow clinicians to intervene to prevent or reduce the risk of cerebral injury. In this chapter, several clinical scenarios from the neonatal intensive care unit (NICU) illustrate the combined use of comprehensive multimodal monitoring to provide rapid recognition of hemodynamic and neurologic status and inform treatment decisions.