Background: Retrospective studies have reported the occurrence of nonconvulsive seizures in

Background: Hypoxic ischemic brain injury secondary to pediatric cardiac arrest (CA) may result in

Electrographic seizures are common in neonates with hypoxic-ischemic encephalopathy, but detailed data are not available regarding seizure incidence during therapeutic hypothermia. The objective of this prospective study was to determine the incidence and timing of electrographic seizures in term neonates undergoing whole-body therapeutic hypothermia for hypoxic-ischemic encephalopathy as detected by conventional full-array electroencephalography for 72 hours of therapeutic hypothermia and 24 hours of normothermia. Clinical and electroencephalography data were collected from 26 consecutive neonates. Electroencephalograms were reviewed by 2 pediatric neurophysiologists. Electrographic seizures occurred in 17 of 26 (65%) patients. Seizures were entirely nonconvulsive in 8 of 17 (47%), status epilepticus occurred in 4 of 17 (23%), and seizure onset was in the first 48 hours in 13 of 17 (76%) patients. Electrographic seizures were common, were often nonconvulsive, and had onset over a broad range of times in the first days of life.

Objective Electroencephalographic seizures (ESs) are common in encephalopathic critically ill children, but ES identification with continuous electroencephalography (EEG) monitoring (CEEG) is resource‐intense. We aimed to develop an ES prediction model that would enable clinicians to stratify patients by ES risk and optimally target limited CEEG resources. We aimed to determine whether incorporating data from a screening EEG yielded better performance characteristics than models using clinical variables alone. Methods We performed a prospective observational study of 719 consecutive critically ill children with acute encephalopathy undergoing CEEG in the pediatric intensive care unit of a quaternary care institution between April 2017 and February 2019. We identified clinical and EEG risk factors for ES. We evaluated model performance with area under the receiver‐operating characteristic (ROC) curve (AUC), validated the optimal model with the highest AUC using a fivefold cross‐validation, and calculated test characteristics emphasizing high sensitivity. We applied the optimal operating slope strategy to identify the optimal cutoff to define whether a patient should undergo CEEG. Results The incidence of ES was 26%. Variables associated with increased ES risk included age, acute encephalopathy category, clinical seizures prior to CEEG initiation, EEG background, and epileptiform discharges. Combining clinical and EEG variables yielded better model performance (AUC 0.80) than clinical variables alone (AUC 0.69; P < .01). At a 0.10 cutoff selected to emphasize sensitivity, the optimal model had a sensitivity of 92%, specificity of 37%, positive predictive value of 34%, and negative predictive value of 93%. If applied, the model would limit 29% of patients from undergoing CEEG while failing to identify 8% of patients with ES. Significance A model employing readily available clinical and EEG variables could target limited CEEG resources to critically ill children at highest risk for ES, making CEEG‐guided management a more viable neuroprotective strategy.

Summary Objectives We aimed to determine whether implementation of a structured multi-disciplinary EEG monitoring pathway improved the timeliness of anti-seizure medication administration in response to electrographic seizures in encephalopathic critically ill children. Methods A multidisciplinary team developed a pathway to standardize EEG monitoring and seizure management in encephalopathic critically ill children, aiming to decrease the time from electrographic seizure onset to anti-seizure medication administration. Data was collected to inform the team of improvement opportunities which were then provided by an institutional pathway, staff education, and streamlined communication. Measurements were obtained prior to and after pathway implementation to assess for improvement. Results We collected data on 41 patients before and 21 after pathway implementation. There were no differences between the baseline and pathway groups in demographic characteristics, acute encephalopathy etiologies, or anti-seizure medications utilized. The median duration from seizure onset to anti-seizure medication administration was shorter for patients treated with the pathway (64 minutes [50, 101]) compared to patients treated prior to pathway implementation (139 minutes [71, 189]) (p=0.0006). The interval from seizure onset to anti-seizure medication order was shorter for the pathway group (31 minutes [20, 49]) than the baseline group (71 minutes [33, 131]) (p=0.003). The interval from anti-seizure medication order to administration was shorter for the pathway group (30 minutes [19, 40]) than the baseline group (40 minutes [17, 68]) (p=0.047). Seizure termination was more likely to occur following initial anti-seizure medication administration in the pathway than baseline group (67% vs. 27%, p=0.002). Significance Implementation of the pathway resulted in a significant reduction in the duration between electrographic seizure onset and anti-seizure medication administration, and a significant increase in the rate of electrographic seizure termination following an initial anti-seizure medication. Further study is needed to determine whether these changes are associated with improved outcomes.