Infant Journal
for neonatal and paediatric healthcare professionals

Improving the effectiveness of aEEG monitoring: a novel CFM observation chart and a care bundle approach

Cerebral function monitoring (CFM) has become standard practice in monitoring infants with suspected encephalopathy in the UK, yet there are no standard recommendations of practice to ensure that continuous amplitude-integrated electroencephalography (aEEG) is as regularly monitored as other parameters in the neonatal intensive care setting. In this article, we present a simple intervention combining human factor principles and quality improvement (QI) methods to ensure regular timely review and documentation to improve the effectiveness of aEEG monitoring with a clear process of escalating concerns.

Helen Doyle
Advanced Neonatal Nurse Practitioner

Bharat Vakharia
Neonatal Consultant

Claudia Chetcuti Ganado
Neonatal Consultant
claudia.chetcutiganado@ldh.nhs.uk

Neonatal Unit, Luton and Dunstable Hospital, Bedfordshire Hospitals NHS Foundation Trust

Doyle H., Vakharia B., Chetcuti Ganado C. Improving the effectiveness of aEEG monitoring: a novel CFM observation chart and a care bundle approach. Infant 2023; 19(4): 127-32.

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Keywords
aEEG; hypoxic-ischaemic encephalopathy; cerebral function monitoring; neonatal encephalopathy; aEEG observation chart
Key points
  1. Despite widespread use, there are no standardised guidelines to monitor and record aEEG at the bedside, leading to potential for delayed recognition of neonatal seizures.
  2. We propose a novel aEEG observation chart and a care bundle approach to the monitoring of infants on aEEG.
  3. Using simple QI and human factor methodologies, we ensure that aEEG is reviewed and recorded hourly.

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Congenital factor xiii deficiency is an extremely rare bleeding disorder, which is inherited in an autosomal recessive pattern.1,5 Factor xiii is the key element in the terminal end of the coagulation cascade that ensures the stability of blood clot formation.1 Delayed bleeding (12 to 36 hours) after trauma or surgery is the pathognomonic feature of factor xiii deficiency.2 Here, we report on a term neonate with congenital factor xiii deficiency, who was diagnosed following significant delayed bleeding tendencies in the form of subgaleal haemorrhage and subcutaneous bleeding on the dorsum of the left hand, severe enough to drop the haemoglobin drastically to 62g/L, requiring urgent blood transfusion.

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