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Electrographic Seizures in Children and Neonates Undergoing Extracorporeal Membrane Oxygenation

Lin, Jainn-Jim MD; Banwell, Brenda L. MD; Berg, Robert A. MD; Dlugos, Dennis J. MD, MSCE; Ichord, Rebecca N. MD; Kilbaugh, Todd J. MD; Kirsch, Roxanne E. MD; Kirschen, Matthew P. MD, PhD; Licht, Daniel J. MD; Massey, Shavonne L. MD; Naim, Maryam Y. MD; Rintoul, Natalie E. MD; Topjian, Alexis A. MD, MSCE; Abend, Nicholas S. MD, MSCE

Pediatric Critical Care Medicine: March 2017 - Volume 18 - Issue 3 - p 249–257
doi: 10.1097/PCC.0000000000001067
Neurocritical Care

Objective: We aimed to determine the prevalence and risk factors for electrographic seizures in neonates and children requiring extracorporeal membrane oxygenation support.

Design: Prospective quality improvement project.

Setting: Quaternary care pediatric institution.

Patients: Consistent with American Clinical Neurophysiology Society electroencephalographic monitoring recommendations, neonates and children requiring extracorporeal membrane oxygenation support underwent clinically indicated electroencephalographic monitoring.

Interventions: We performed a 2-year quality improvement study from July 2013 to June 2015 evaluating electrographic seizure prevalence and risk factors.

Main Results: Ninety-nine of 112 patients (88%) requiring extracorporeal membrane oxygenation support underwent electroencephalographic monitoring. Electrographic seizures occurred in 18 patients (18%), of whom 11 patients (61%) had electrographic status epilepticus and 15 patients (83%) had exclusively electrographic-only seizures. Electrographic seizures were more common in patients with low cardiac output syndrome (p = 0.03). Patients with electrographic seizures were more likely to die prior to discharge (72% vs 30%; p = 0.01) and have unfavorable outcomes (54% vs 17%; p = 0.004) than those without electrographic seizures.

Conclusions: Electrographic seizures occurred in 18% of neonates and children requiring extracorporeal membrane oxygenation support, often constituted electrographic status epilepticus, and were often electrographic-only thereby requiring electroencephalographic monitoring for identification. Low cardiac output syndrome was associated with an increased risk for electrographic seizures. Electrographic seizures were associated with higher mortality and unfavorable outcomes. Further investigation is needed to determine whether electrographic seizures identification and management improves outcomes.

1Division of Pediatric Critical Care and Pediatric Neurocritical Care, Chang Gung Children’s Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.

2Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.

3Departments of Neurology and Pediatrics, The Children’s Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.

4Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.

5Department of Pediatrics, The Children’s Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.

Dr. Lin disclosed receiving work for higher. Dr. Banwell disclosed that he is Editor for MSARD and received funding from Novartis pharmaceuticals. Dr. Ichord is supported by grants from the National Institutes of Health (NIH) (NHLBI-HV-12-03 and U10NS086474-01) and the Newton Family Charitable Fund for Pediatric Stroke Research and serves as a member of the Clinical Event/Safety Committee of the Berlin Pediatric EXCOR VAD post-marketing study. Dr. Licht was supported by grants from the NIH (1R01NS072338, RO1NS060653, and UO1HD087180) and received support from the Steve and June Wolfson Family foundation. Dr. Topjian is supported by NIH K23NS075363, received funding from Novartis pharmaceuticals for expert witness testimony, received support for article research from the NIH, and her institution also received funding from the NIH. Dr. Abend was supported by NIH (K23NS076550). The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: abend@email.chop.edu

©2017The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies