Neurodiagnostic technologists play a “fundamental role” in the care of premature newborns, according to a new paper published in the journal Clinical Neurophysiology.

Premature birth itself is considered a neurological risk factor and requires close monitoring. This often includes electroencephalography (EEG) in neonates, especially those below 28 weeks gestational age and up to 33 weeks when other risk factors are present.

“EEG is an essential tool for assessing brain function during the neonatal period,” write the authors, and “the procedures for recording and interpreting EEGs require well-trained technicians.”

Along with outlining the work done by these specially trained technologists, the authors offer new guidelines and technical recommendations.

The key takeaway? These newborns are not simply miniature adults. Their EEG readings require special set-up, scheduling, and hyper-focused observation on the part of the tech throughout their readings.

Special Set up

Aseptic rules, in particular, must be “rigorous” when caring for newborns in the NICU. This includes universal precautions and sterile equipment as well as removing all jewelry, keeping nails clean and short, wearing short-sleeved uniforms and a patient-specific over-blouse.

Because of the infection risk and the fragility of the newborn scalp, it needs to be cleaned entirely using a neutral soap. Abrasives should be used sparingly and with extreme caution.

Traditional solutions including acetone, ether, and collodion are now prohibited due to their toxicity and flammability, the authors write. Instead, pastes based on sweet almond oil, oleo-limestone liniment, or pumice stone are used.

Maintaining consistency of the newborn’s environment is important. Electrodes are placed on the infant inside the incubator under their same sound and light conditions. They are to be handled gently and moved as little as possible. The authors recommend placing the newborn in a supine or lateral position.

Hyper-Focused Observation

Techs need to work around the patient’s usual care routine. This means scheduling around feedings — before meals is best — as well as sleep. All of this needs to be carefully coordinated with the nursing staff.

Capturing EEG data alone isn’t enough — the tech to needs simultaneously observe the behavior of the newborn and the EEG activity. The newborn’s movement and reactivity can be subtle and not well captured on video. For this reason, even with live recordings, the tech needs to maintain close observation, and thorough documentation, of the child.

That means being familiar with the different stages of alertness in premature newborns, taking note of eye movements, facial expressions, suction movements, as well fine movements of the extremities.

Abnormal neurological events can also be subtle in these patients, requiring careful observation of things sch as changes in facial expression, vocalizations, pallor, and tone.

Under stressful conditions, these techs work at the very top of their game. It’s nice to see that in this new set of guidelines they are getting the recognition they deserve.