TOP 19 - Improving Neurologic Monitoring through aEEG Implementation in a Level IV NICU

Publication Number: 3747.TOP 19

Samantha T. Kay-Green, Women & Infants Hospital of Rhode Island, Providence, RI, United States; Avery Zierk, Women & Infants Hospital of Rhode Island, Providence, RI, United States; Leah Fox, Women & Infants Hospital of Rhode Island, Providence, RI, United States

Background: Conventional full-montage EEG (cEEG) is the gold standard for neurologic monitoring and seizure identification in neonates. Placing an infant on cEEG is reliant on the availability of specialized technicians and result interpretation requires subspecialist consultation. Lack of availability of specialized personnel can lead to delays in initiation of neurologic monitoring for high-risk patients. Amplitude-integrated EEG (aEEG) is a limited-channel EEG that has proven to be an effective and reliable tool to assess neurologic function and screen for seizures when cEEG is not available. We conducted a quality improvement project to reduce delays in neurologic monitoring for high-risk neonates through implementation of aEEG within the Women & Infants Hospital (WIH) of Rhode Island Level IV NICU.

Objective: We aim to decrease the average time to initiation of neurologic monitoring to under 6 hours after the EEG order is placed for patients at risk for seizure within 6 months of implementing aEEG within the WIH NICU.

Design/Methods: A multidisciplinary team was assembled and included neonatology attendings and fellows, pediatric neurologist, and neonatal nurses. Through baseline data collection, literature review, and team discussions, members of the multidisciplinary team determined the barriers to initiating neurologic monitoring and key drivers for aEEG implementation (Figures 1 & 2). Through a series of plan-do-study-act (PDSA) cycles, aEEG was implemented within the WIH NICU on September 18, 2025 and data is currently being collected to assess the impact of this intervention. The primary outcome measure is time to neurologic monitoring for high-risk neonates. Secondary outcome measures include frequency of anti-epileptic medication doses given without EEG-confirmed seizures, and percentage of patients with mild encephalopathy who receive cooling therapy based on aEEG findings. Process Measures include determining the percentage of patients for whom aEEG was ordered that were successfully placed on aEEG. Balancing measures include frequency of adverse events related to scalp injury from aEEG placement.

Figure 1
Fishbone diagram detailing challenges within the existing cEEG process that contribute to delays to neurologic monitoring in the WIH NICU

Figure 2
Key Driver Diagram of current barriers to prompt neurologic monitoring in the WIH NICU

Figure 3
Run Chart of Average Time from EEG order to EEG Placement/Initiation of Neurologic Monitoring in the WIH NICU