NeoCAM: Development and Evaluation of a Neonatal Cerebral Autoregulation Monitor

Cerebral autoregulation is the mechanism that ensures that cerebral blood flow is constant during fluctuations of mean arterial blood pressure. In sick and preterm babies this mechanism is sometimes absent or not functioning properly. Absence of cerebral autoregulation is linked to adverse cerebral outcome and cognitive difficulties later in life. There are currently no commercially available solutions to monitor the state of cerebral autoregulation in patients. This thesis describes the design and evaluation of a monitor for cerebral autoregulation. The main aim was to establish whether the addition of a cerebral autoregulation moni- tor would enhance the situation awareness of physicians. The design of the monitor was based on requirements that followed from a literature study on measures of cerebral au- toregulation and on situation awareness and clinical reasoning. A working prototype of the cerebral autoregulation monitor was implemented and used in an evaluation study. In this study, eight neonatologists participated in a task where they assessed and made a treatment plan for simulated cases. The participants first performed this task on a monitor that was based on the standard monitors the neonatology department uses. Af- terwards, they performed the same task with the standard monitor and the new cerebral autoregulation monitor. After completing the task, the participants were interviewed about their experiences with the cerebral autoregulation monitor and their opinion on using it in clinical practice. It was concluded that the presence of the cerebral autoregulation monitor makes physi- cians more aware of cerebral autoregulation and promotes reasoning about it. However, it also enhances the uncertainty of the physicians while making a treatment plan. This can be explained by the novelty of the monitor. All physicians were positive about the potential use of a cerebral autoergulation monitor in clinical practice in the future. With further research into the use of cerebral autoregulation values in treatment, the cerebral autoregulation monitor could become a valuable clinical tool.