Optimizing neurocritical care for the neonatal unit [Workshop Session]

Hi everyone, checking in from the neonatal neurology sessions at CEPAS here in Lyon! We just wrapped up a fantastic morning diving deep into neurocritical care and early intervention. For those who couldn't be here, I wanted to share a quick summary of the core take-home messages from our first two speakers, along with some points to chew on.

What is Neurocritical Care and who are the babies at risk? (Lina Chalak, USA)

• NIRS as a CO2 Proxy: Dr. Chalak highlighted using near-infrared spectroscopy (NIRS) practically to monitor CO2 levels. Keeping CO2 strictly between 40–45 during the first five days is vital; outside this window, autoregulation fails and blood pressure fluctuations directly impact the developing brain.

• Unsedated MRIs for Micro-preemies: Her unit routinely does term-equivalent MRIs for all infants under 1000g before discharge. By bundling the scan with feeding and swaddling, they avoid sedation and frequently catch subtle diffuse white matter injuries and cerebellar bleeds that standard serial sonography misses.

• Placental Pathology: They integrate placental pathology into neuro-assessments. Fetal inflammatory response (seen in 42% of her cohort) directly correlated with lower MRI scores and 2-year cognitive deficits, even in the complete absence of clinical chorioamnionitis.

• Telemedicine for the "Golden Hour": To reduce care variability across regional hospitals, her team uses iPad-based remote assessments by a central examiner to standardize the decision to initiate therapeutic hypothermia, allowing cooling to start immediately on transport.

EI-SMART (Betty Hutchon, UK)

• Rethinking Therapy: Citing recent evidence, Hutchon pointed out that traditional early intervention often struggles because it isolates motor skills and relies on passive, sometimes stressful therapies (like forced tummy time) rather than fostering holistic, active exploration.

• The Power of Everyday Routines: EI-SMART weaves four threads of development (Sensory, Motor, Attention & Regulation, and Relationships) into the things we already do. Rather than doing a once-a-week therapy session, the framework focuses on adapting the 50+ times a day a baby is naturally handled—like optimizing supportive holds during nappy changes or feeding—to provide a constant, low-stress sensory-motor environment.

• Parent Co-Production: Clinicians are encouraged to drop medicalized "goals" and deficit-focused questions (e.g., "Can your baby sit?"). Instead, the approach utilizes a "Developmental Care Profile," collaborating with parents by starting with what positions or toys the baby likes, framing parents as the equal experts on their infant.

Do NOT miss the excellent resources provided by the EI-SMART team ➡️ https://eismart.co.uk/r

I'd love to hear your thoughts on these topics:

1. Using NIRS as a practical proxy for CO2 and autoregulation during the first five days was a major point in Dr. Chalak's talk. How widely adopted is continuous NIRS monitoring in your units, and what hurdles have you faced in training bedside staff to actively use these trends for respiratory management?

2. How does your NICU manage the logistics of routine term-equivalent MRIs for extremely low birth weight infants, and have you successfully adopted unsedated "feed and wrap" scanning protocols?

3. The EI-SMART framework emphasizes turning routine bedside moments (like nappy changes) into early intervention. What practical challenges do you face in aligning therapists, bedside nurses, and parents to consistently execute this before discharge?

Disclosure: This is an AI-assisted summary of the session, generated from a recording made by our team in attendance. We believe it is as accurate as our own notes would be, but please refer to the speakers’ original work before applying anything in clinical practice.