In April 2013, Stanford launched its Neuro-Neonatal Intensive Care Unit (Neuro-NICU), which is housed within the Level III Intensive Care Nursery at Lucile Packard Children’s Hospital Stanford. Preterm and term newborns at risk for brain injury and future developmental problems are cared for by a specially trained team of care providers using advanced neurodiagnostic techniques and treatments. The goal is to provide a developmentally appropriate environment to optimize neurologic and developmental outcomes. The newborns admitted to the Neuro-NICU include infants with hypoxic ischemic encephalopathy, seizures, infants being evaluated for or treated with ECMO, grade III/IV intraventricular hemorrhage, hydrocephalus, extreme prematurity with gestational age ≤ 28 weeks, central nervous system (CNS) infections, CNS anomalies, metabolic disease, and cyanotic congenital heart disease.
We are one of a handful of such units in the nation. Led by medical director Krisa Van Meurs, M.D. and with neurology director Courtney Wusthoff, M.D., the Neuro-NICU was built out of a growing need to help babies not only survive but also thrive. Many babies who are born premature or suffer from encephalopathy immediately after birth are at risk for neurodevelopmental problems, ranging from mild to significant impairments.
Our multidisciplinary team works together not only at the bedside, but in regular meetings to direct the work of the Neuro-NICU and plan for the future. Our Steering Committee includes representation from the Departments of Family Centered Care, Rehabilitation Services, Social Work, Child Neurology, Neurophysiology, Neonatology, Developmental-Behavioral Pediatrics, and our High-Risk Infant Follow Up Clinic, as well as representatives from Nursing Administration, NICU Staff Nurses, Neonatal Nurse Practitioners, Clinical Nurse Specialists and Educators. Preparing for a baby’s transition from the Neuro-NICU to her home is an important component of our care model. We have close relationships with subspecialty services, therapists and follow-up care providers that help to ensure optimal outcomes for our newborns.
Pillars of Care
- NEUROMONITORING: We routinely use non-invasive neuromonitoring such as near-infrared spectroscopy (NIRS), amplitude-integrated electroencephalography (aEEG), and continuous video electroencephalography (cEEG or vEEG) for infants in the Neuro-NICU.
- NEUROASSESSMENT: We train our team on the importance of a focused newborn neuro examination, using standardized assessment tools and tailoring laboratory tests for each patient based on their clinical presentation to guide the plan of care.
- NEUROIMAGING: We use bedside ultrasound technology and sophisticated MRI sequences to aid in diagnosis and to best inform discussions about prognosis when possible.
- NEUROPROTECTION: We implement techniques and treatments that not only prevent brain injury but promote optimal brain development. We offer induced therapeutic hypothermia for infants with HIE both in-unit and on-transport. We foster a protective healing environment by implementing strategies to minimize pain and stress for all infants. We offer positive sensory experiences and parental involvement through kangaroo care, positive touch, positioning and massage therapy.
Research, Training & Outreach
The Neuro-NICU is a translational enterprise that puts our experience in newborn brain research into clinical practice every day. Our ability to care for these infants at the bedside is a direct result of our active participation in clinical trials at a national level. Since 1991 we have been part of the NICHD Neonatal Research Network and have contributed to the evidence that proves the reliability and validity of treatments and technologies to care for the newborn brain. We also conduct specialized, hands-on training programs to prepare our multidisciplinary team to provide quality care for our Neuro-NICU babies.
Wanting to inspire and educate others, we seek out opportunities to share our program and our experience with NICUs around the world. We actively present our work at international conferences and publish the results of our research. In early 2014 we were featured by the Vermont Oxford Network (VON) as part of a webcast and video series showcasing innovative care models. Several times a year, we hold Neuro-NICU training courses and skills days for our staff as well as for outside physicians, nurses and other providers.
Common Tools and Definitions
- cEEG or vEEG: Electrodes are applied to the scalp and record brain activity, which is interpreted by a pediatric neurophysiologist. Video monitoring accompanies the EEG recording to help match the baby’s behavior with brain activity pattern.
- aEEG: As compared to a cEEG, an aEEG requires fewer electrodes to be applied to the scalp. It is a screening tool that records trend patterns, which can be analyzed by doctors and nurses at the bedside, allowing them to screen for seizure activity and assess the overall maturity of brain activity.
- NIRS: A sensor applied to the baby’s forehead allows beside caregivers to assess oxygen saturation and oxygen delivery to the brain. Stanford researchers were early developers of this optical imaging technology using infrared light sensors, and it's now being used at bedsides around the globe.
- Ultrasound: Head ultrasounds can show if there are structural malformations or bleeding. They also provide a visual of blood flow patterns. Ultrasounds are routine screening for premature babies and are also used in babies who require ECMO. Ultrasounds can be performed at the bedside at any time of day.
- MRI: The MRI shows brain structure in great detail using a magnetic field while avoiding ionizing radiation. It can be used to visualize brain structure, vascular malformations, metabolic disease, traumatic brain injury, and CNS infections. Specialized MRI sequences are available to enhance diagnostic capabilities. While it cannot be done at the bedside, the MRI scan often can be performed with feeding and bundling techniques, thus avoiding the need for sedation.
Medical Director: Krisa Van Meurs, MD
Neurology Director: Courtney Wusthoff, MD
Associate Medical Director: Valerie Chock, MD MS Epi
Associate Medical Director: Sonia Bonifacio, MD
Neuro NICU Program Consultant: Kathi Randall, NNP RN CNS
Lead Neuro NICU NNP: Celia Glennon, NNP MSN
Neuro NICU NNP: Rachel Small, NNP
Neuro NICU Nurse Educator: Shannon Tinkler, BSN, RNC-NIC
Social Work Liaison: Emily Perez, MSW
Parent Liaison: Heather Keller
Administrative support: Keithra Ortiz and Caroline Ragadio