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Interpreting cerebral function monitor traces: survey of skills in Paediatric registrars in the Oxford deanery

Presented at the Neonatal Society 2010 Spring Meeting.

Marinova J, Gupta A

Neonatal Intensive Care Unit, John Radcliffe Hospital, Oxford, OX3 9DU, UK

Background and Aims: Bedside cerebral function monitoring (CFM) is being increasingly used as a routine tool for assessment and therapeutic decision making in infants who have suffered a hypoxic ischemic insult (1,2). Trainees’ exposure to the use of CFM is varied and proficiency in the interpretation of CFM traces may not be uniform or accurate. This is a survey conducted to assess the abilities of trainees on HST programme in interpreting CFM traces.

Methods: 23 trainees at the ST4/SpR were asked to respond to 10 questions. Each question comprised of a CFM trace along with a short medical history. Two of the traces were normal, two showed seizure activity, two were moderately abnormal and four were severely abnormal. Additional data relating to the trainees’ previous neonatal experience, training in the use of CFM were also collected.

Results: 87% of trainees had either been exposed to use of or used a Cerebral Function Monitor. 87% of trainees had at least 6 month of level III experience as a registrar. 30% of trainees had previous level III neonatal experience as a senior house officer and SpR. 13% of trainees had never used/exposed to the use of a CFM before.

On average 46% (range 13% to 72%) of the questions were answered correctly. Approximately half the candidates correctly identified a normal trace. The trace showing frequent seizure was correctly identified by 72% of candidates. The rest of the moderately and severely abnormal traces were correctly identified in less than 60% of cases. The mean (SD) number of questions scored rightly was 4(2). The duration of previous level III experience correlated with higher scores.

Conclusion: The survey reflects the current state of knowledge in interpretation of CFM amongst middle grade training. Both normal and abnormal traces were incorrectly identified in approximately half the cases suggesting a need for further training.

References
1. Hellstorm-Westas L, Rosen I, Svenningsen NW. Predictive value of early continuous amplitude integrated EEg recording on outcome after severe birth asphyxia in full term infants. Arch Dis Child Fetal Neonatal Ed 1995; 72(1): F34-F38
2. Eicher D, Wagner C, Katikaneni L, Hulsey T, Bass W, Kaufman D, Horgan M, Languani S, Bhatia J, Givelichian L. Moderate hypothermia in neonatal encephalopathy. Efficacy outcome. Paediatric Neurology 2005, Volume32, Issue1. Pages 11-24
3. Azzopardi DV, Strohm B, Edwards AD, et al for the TOBY trial Group. Moderate Hypothermia to Treat Perinatal Asphyxial Encephalopathy. N Engl J Med (Oct 1, 2009); 361:1349-1358

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