Background: Multiple neonatal disorders are associated with risks of neurological injury. Thus, management of these infants should involve a coordinated approach to permit early diagnosis with improved clinical care. Such initiative involves the use of standardized protocols, continuous and specialized brain monitoring with electroencephalography (EEG), amplitude integrated EEG (aEEG) and Near Infrared Spectroscopy (NIRS), neuroimaging and training. Brazil is a very large country with disparities in health care assessment; some neonatal intensive care units (NICUs) are not well structured and trained to provide adequate neurocritical care. However, the development and implementation of these neurocritical care units requires high expertise and significant investment of time, manpower and equipment. In order to reduce the existing gap, a unique advanced telemedicine model of neurocritical care called Protecting Brains and Saving Futures (PBSF) protocol was developed and implemented in some Brazilian NICUs. Methods: A prospective observational cohort study will be conducted in 20 Brazilian NICUs that have adopted the PBSF protocol. All infants receiving the protocol during January 2021 to December 2023 will be eligible. Ethical approval will be obtained from the participating institutions. The primary objective is to describe the use of the PBSF protocol and clinical outcomes, by center and over a 3 years period. The use of the PBSF protocol will be measured by quantification of neuromonitoring, neuroimaging exams and sub-specialties consultation. Clinical outcomes of interest after the protocol implementation are length of hospital stay, detection of EEG seizures during hospitalization, use of anticonvulsants, inotropes, and fluid resuscitation, death before hospital discharge, and referral of patients to high-risk infant follow-up. These data will be also compared between infants with primarily neurologic and primarily clinical diagnosis. Discussion: The implementation of the PBSF protocol may provide adequate remote neurocritical care in high-risk infants with optimization of clinical management and improved outcomes. Data from this large, prospective, multicenter study are essential to determine whether neonatal neurocritical units can improve outcomes. Finally, it may offer the necessary framework for larger scale implementation and help in the development of studies of remote neuromonitoring.
Age range
3 Months
Sex
ALL
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Applicability of telemedicine model for monitored infants
Timeframe: 3 years period
Applicability of telemedicine model for recorded remote monitoring
Timeframe: 3 years period
Use of aEEG/EEG monitoring
Timeframe: 3 years period
Duration of aEEG/EEG monitoring
Timeframe: 3 years period
Number primary neurologic or medical patients with aEEG or EEG monitoring and the duration of the monitoring (hours)
Timeframe: 3 years period
Number of primary neurologic or medical patients with NIRS monitoring and the duration of the NIRS monitoring (hours)
Timeframe: 3 years period
Number of primary neurologic or medical patients with brain MRI, neurology consult, and neurosurgery consult.
Timeframe: 3 years period
Number of clinical case discussions and videoconference meetings
Timeframe: 3 years period
Length of hospital stay
Timeframe: 3 years period
Number of electroencephalographic seizures during hospitalization
Timeframe: 3 years period
Use and types of anticonvulsants administered
Timeframe: 3 years period
Number and types of anticonvulsants prescribed at discharge
Timeframe: 3 years period
Use and types of inotropes administered during NICU stay
Timeframe: 3 years period
Use and types of fluid resuscitation administered during NICU stay
Timeframe: 3 years period
Death before hospital discharge
Timeframe: 3 years period
Number of patients referred to neurology or neurosurgery
Timeframe: 3 years period
Number of patients referred to high-risk infant follow-up
Timeframe: 3 years period