Digital neonatal neurocritical care in Brazil: a retrospective multicentre cohort study of over 11,000 remotely monitored infants.

Abstract

Neonatal brain injury is a major global health challenge, disproportionately affecting low- and middle-income countries (LMIC), where access to specialized care remains limited. Technology-driven neuroprotective strategies may allow the dissemination of specialized care to resource-constrained settings. This study describes the implementation of a digital health strategy to deliver specialized neurocritical care to multiple neonatal intensive care units (NICUs) in Brazil. Retrospective observational multicenter cohort study analyzing data from July 2017 to June 2024, from 79 NICUs across Brazil. A digital health strategy was implemented, incorporating real-time video amplitude-integrated and raw electroencephalography (video-aEEG/EEG), near-infrared spectroscopy (NIRS), and vital signs monitoring, supported by neonatology and pediatric neurology experts available 24/7. Education and training of bedside providers were accomplished by initial in-person sessions, followed by online training. An immersive reality tool was piloted to conduct consultations between the central monitoring and bedside teams. 11,333 neonates received neurocritical care with 727,858 h of remotely recorded brain monitoring and 124,967 interactions between monitoring centers and bedside teams. Most neonates were male (57.7%), the median gestational age was 37 weeks (IQR 32-39), and the mean birth weight was 2667 g (SD ± 635 g). The most common neuromonitoring indications were suspected seizures (23.3%), moderate or severe hypoxic-ischemic encephalopathy (15.9%), and mild hypoxic-ischemic encephalopathy (13.3%). In the study population, electrographic seizures were identified in 18.4%, and a single antiseizure medication achieved seizure control in 56.1%. The first line antiseizure medication was phenobarbital (97%). Pathologic aEEG/EEG background pattern was seen in 24.9%, and sleep-wake cycling was absent in 41.2%. Simultaneous video-aEEG/EEG and NIRS monitoring data were acquired from 1688 infants. Immersive reality was successfully piloted in 2023 in a single center, enhancing consultations between central monitoring and bedside teams and standardizing the training of healthcare professionals performing the modified Sarnat exam. Applying digital solutions for specialized neurocritical care and training across distant and resource-limited centers is feasible and has the potential to promote equity and increase quality of care for high-risk infants. None.