1. Neonatal Cerebral Function Monitoring (CFM): A survey of its provision and usage in practice throughout the East of England Neonatal Network D Marikar 1, O’Mara C 2, S Shanmugalingam 3 1) Luton and Dunstable NHS Foundation Trust, UK 2) Rosie Hospital, Cambridge, UK 3) Royal Free NHS Foundation Trust, UK Introduction Cerebral Function Monitoring (CFM) provides useful information to assess seizure activity in neonates and monitor severity of encephalopathy. CFM can also help guide management of babies in whom there is evidence of perinatal distress, but where a diagnosis of Hypoxic Ischaemic Encephalopathy (HIE) is uncertain. A regional guideline exists for the use of CFM in the East of England Neonatal Network. The aims of our study were to 1) survey the provision and practical use of CFM in neonatal units in the region, 2) audit usage of the regional guideline 3) Identify variations in practice and barriers to CFM use. Patients and Methods Nursing and Consultant leads in all neonatal units in the region (n=17) were sent an online survey. The key questions included: a) whether their unit had CFM, b) whether CFM was used in clinical practice c) whether regional guidelines were used, d) indications for CFM use, e) the availability of staff competent in setting-up and interpreting CFM and f) barriers impeding the use of CFM. Results All 17 neonatal units in the region provided at least one completed survey, 59% (n=10) contributing both consultant and nurse responses. 35% (n=6) of units did not have a CFM(fig1). A commonly cited reason (table 1) was insufficient patient numbers to justify clinical need - 67% (n=4). Of the 65%(n=11) units that possess a CFM, 90% (10/11) report using it regularly. One unit used CFM rarely - citing lack of trained medical and nursing staff. Of the 10 units that use CFM, 60% (6/10) use the regional guideline, 10%(1/10) use a local CFM guideline and 30% (3/10) did not use any guidelines. Only 20% (2/10) of units using CFM regularly reported no difficulties. 40%(4/10) of units using CFM reported that they do not have 24 hour availability of staff at any level who are able to either set up or interpret CFM. 40% of units reported nursing and clinical staff were not confident with CFM. Conclusions The majority of neonatal units in the region either do not use CFM or cannot provide a 24 hour service. Staff confidence in setting up and intepreting CFM was cited as a barrier to its use. We propose a regional education programme to raise awareness of the utility of CFM in the neurological assessment of neonates, to increase awareness of regional guidelines and provide training of the practicalities of setting up and interpreting CFM. fig 1: Neonatal units in the East of England that possess a CFM % No of units Insufficient funds/awaiting funds 50%3 Lack of trained medical staff 17%1 Lack of trained nursing staff 17%1 Insufficient patient numbers to justify need 67%4 Clinicians not convinced of clinical need - babies transferred out for cooling 17%1 Table 1: Neonatal units without CFM - reasons cited by nursing and consultant leaders