Lin Jainn-Jim, Banwell Brenda L, Berg Robert A, Dlugos Dennis J, Ichord Rebecca N, Kilbaugh Todd J, Kirsch Roxanne E, Kirschen Matthew P, Licht Daniel J, Massey Shavonne L, Naim Maryam Y, Rintoul Natalie E, Topjian Alexis A, Abend Nicholas S
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.
Pediatr Crit Care Med. 2017 Mar;18(3):249-257. doi: 10.1097/PCC.0000000000001067.
We aimed to determine the prevalence and risk factors for electrographic seizures in neonates and children requiring extracorporeal membrane oxygenation support.
Prospective quality improvement project.
Quaternary care pediatric institution.
Consistent with American Clinical Neurophysiology Society electroencephalographic monitoring recommendations, neonates and children requiring extracorporeal membrane oxygenation support underwent clinically indicated electroencephalographic monitoring.
We performed a 2-year quality improvement study from July 2013 to June 2015 evaluating electrographic seizure prevalence and risk factors.
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.
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.
我们旨在确定需要体外膜肺氧合支持的新生儿和儿童中脑电图癫痫发作的患病率及危险因素。
前瞻性质量改进项目。
四级医疗儿科机构。
根据美国临床神经生理学会脑电图监测建议，需要体外膜肺氧合支持的新生儿和儿童接受了临床指征的脑电图监测。
我们在2013年7月至2015年6月进行了一项为期2年的质量改进研究，评估脑电图癫痫发作的患病率及危险因素。
112例需要体外膜肺氧合支持的患者中有99例（88%）接受了脑电图监测。18例患者（18%）出现脑电图癫痫发作，其中11例患者（61%）出现脑电图癫痫持续状态，15例患者（83%）仅有脑电图癫痫发作。脑电图癫痫发作在低心输出量综合征患者中更为常见（p = 0.03）。与无脑电图癫痫发作的患者相比，有脑电图癫痫发作的患者出院前死亡的可能性更大（72%对30%；p = 0.01），且预后不良的可能性更大（54%对17%；p = 0.004）。
需要体外膜肺氧合支持的新生儿和儿童中，18%出现脑电图癫痫发作，常为脑电图癫痫持续状态，且常仅有脑电图癫痫发作，因此需要进行脑电图监测以识别。低心输出量综合征与脑电图癫痫发作风险增加相关。脑电图癫痫发作与更高的死亡率和不良预后相关。需要进一步研究以确定脑电图癫痫发作的识别和管理是否能改善预后。
