A Review of Long-term EEG Monitoring in Critically Ill Children With Hypoxic–Ischemic Encephalopathy, Congenital Heart Disease, ECMO, and Stroke

Abend, Nicholas S.; Dlugos, Dennis J.; Clancy, Robert R.

doi:10.1097/wnp.0b013e3182872af9

Cited by 62 publications

(52 citation statements)

References 120 publications

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“…Acute abnormalities were described in 50% (41 of 82) of patients. The most common acute abnormality was intracranial hemorrhage which occurred in 37% (30) of patients and included intraventricular hemorrhage in 22% (18) of patients, subdural hemorrhage in 7% (6) of patients, and parenchymal hemorrhage in 11% (9) patients. Other acute abnormalities included hypoxic-ischemic brain injury in 13% (11) of patients, thrombotic stroke in 12% (10) of patients, and cerebral edema in 5% (4) of patients.…”

Section: Resultsmentioning

confidence: 99%

“…Patients requiring ECMO support are at risk for neurological injury due to pre-ECMO medical conditions, management during ECMO support, or combined effects,(1–7) which may result in acute symptomatic seizures. (8) As recently reviewed,(9) clinical and electrographic seizures (ES) have been reported in 5–30% of neonates and children undergoing ECMO. (2, 5, 10–14) Furthermore, seizures during ECMO have been associated with cerebral injury and worse outcomes in some, but not all, studies.…”

Section: Introductionmentioning

confidence: 99%

“…There were no studies which had consistently assessed seizures using cEEG. (17) The resulting epidemiologic knowledge gaps (9, 17) lead to uncertainty regarding the appropriate role for cEEG which is resource-intense and not available at all institutions. (18, 19) Despite these limited data, a neonatal guideline (20) and a pediatric consensus statement (21) from the American Clinical Neurophysiology Society both recommend cEEG in neonates and children at risk for ES, including those undergoing ECMO support.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Electrographic Seizures in Children and Neonates Undergoing Extracorporeal Membrane Oxygenation

Lin

Banwell

Berg

et al. 2017

Pediatric Critical Care Medicine

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Objective We aimed to determine the incidence and risk factors for electrographic seizures (ES) in neonates and children requiring extracorporeal membrane oxygenation (ECMO) support. Design Prospective quality improvement project. Setting Quaternary care pediatric institution. Patients Consistent with American Clinical Neurophysiology Society EEG monitoring recommendations, neonates and children requiring ECMO support underwent clinically indicated EEG monitoring. Interventions We performed a two-year quality improvement study from July 2013 – June 2015 evaluating ES incidence and risk factors. Main Results 99 of 112 patients (88%) requiring ECMO support underwent EEG monitoring. ES occurred in 18 patients (18%), of which 11 patients (61%) had electrographic status epilepticus and 15 patients (83%) had exclusively EEG-only seizures. ES were more common in patients with low cardiac output syndrome (p=0.03). Patients with ES 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 ES. Conclusions ES occurred in 18% of neonates and children requiring ECMO support, often constituted electrographic status epilepticus, and were often EEG-only thereby requiring EEG monitoring for identification. Low cardiac output syndrome was associated with an increased risk for ES. ES were associated with higher mortality and unfavorable outcomes. Further investigation is needed to determine whether ES identification and management improves outcomes.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Electrographic Seizures in Children and Neonates Undergoing Extracorporeal Membrane Oxygenation

Lin

Banwell

Berg

et al. 2017

Pediatric Critical Care Medicine

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“…1 Clinically evident seizures have been reported in 5% to 20% of neonates during the postoperative period. 2,3 Studies using continuous electroencephalographic (CEEG) monitoring have reported that electroencephalogram (EEG)-only seizures (also termed “nonconvulsive seizures”) may be more common, occurring in 5% to 26% of neonates.…”

mentioning

confidence: 99%

Subclinical seizures identified by postoperative electroencephalographic monitoring are common after neonatal cardiac surgery

Naim

Gaynor

Chen

et al. 2015

The Journal of Thoracic and Cardiovascular Surgery

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125

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Objectives The American Clinical Neurophysiology Society recommends continuous electroencephalographic monitoring after neonatal cardiac surgery because seizures are common, often subclinical, and associated with worse neurocognitive outcomes. We performed a quality improvement project to monitor for postoperative seizures in neonates with congenital heart disease after surgery with cardiopulmonary bypass. Methods We implemented routine continuous electroencephalographic monitoring and reviewed the results for an 18-month period. Clinical data were collected by chart review, and continuous electroencephalographic tracings were interpreted using standardized American Clinical Neurophysiology Society terminology. Electrographic seizures were classified as electroencephalogram-only or electroclinical seizures. Multiple logistic regression was used to assess associations between seizures and potential clinical and electroencephalogram predictors. Results A total of 161 of 172 eligible neonates (94%) underwent continuous electroencephalographic monitoring. Electrographic seizures occurred in 13 neonates (8%) beginning at a median of 20 hours after return to the intensive care unit after surgery. Neonates with all types of congenital heart disease had seizures. Seizures were electroencephalogram only in 11 neonates (85%). Status epilepticus occurred in 8 neonates (62%). In separate multivariate models, delayed sternal closure or longer deep hypothermic circulatory arrest duration was associated with an increased risk for seizures. Mortality was higher among neonates with than without seizures (38% vs 3%, P<.001). Conclusions Continuous electroencephalographic monitoring identified seizures in 8%of neonates after cardiac surgery with cardiopulmonary bypass. The majority of seizures had no clinical correlate and would not have been otherwise identified. Seizure occurrence is a marker of greater illness severity and increased mortality. Further study is needed to determinewhether seizure identification and management lead to improved outcomes.

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“…Continuous electroencephalographic (EEG) monitoring is common in pediatric ECMO patients [46]. Specifically, it can be used to detect nonconvulsive seizures and nonconvulsive status epilepticus.…”

Section: Monitoringmentioning

confidence: 99%

Neurocognitive outcomes after extracorporeal membrane oxygenation

Graber

Quillinan

Marrotte

et al. 2015

Best Practice & Research Clinical Anaesthesiology

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A Review of Long-term EEG Monitoring in Critically Ill Children With Hypoxic–Ischemic Encephalopathy, Congenital Heart Disease, ECMO, and Stroke

Cited by 62 publications

References 120 publications

Electrographic Seizures in Children and Neonates Undergoing Extracorporeal Membrane Oxygenation

Electrographic Seizures in Children and Neonates Undergoing Extracorporeal Membrane Oxygenation

Subclinical seizures identified by postoperative electroencephalographic monitoring are common after neonatal cardiac surgery

Neurocognitive outcomes after extracorporeal membrane oxygenation

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