Department of Neurology, Division of Pediatric and Developmental Neurology, 7548Washington University in St Louis, MO, USA.
Department of Pediatrics, Division of Critical Care Medicine, 7548Washington University in St Louis, MO, USA.
J Child Neurol. 2021 Mar;36(3):230-236. doi: 10.1177/0883073820966917. Epub 2020 Oct 28.
Determine seizure frequency and association with neurologic outcomes in infants undergoing extracorporeal membrane oxygenation. Identify patient or clinical factors associated with seizures or brain injury on imaging.
Retrospective, single-center study including infants less than 1 year of age, who underwent extracorporeal membrane oxygenation between 2012 and 2017.
A total of 104 infants met study criteria including 45 patients with continuous electroencephalographic (EEG) monitoring during their extracorporeal membrane oxygenation run and 59 infants without EEG. Seizures (electrographic-only or electro-clinical) were identified in 18 of the 45 (40%). Among the 18 infants with seizures, 14 (78%) had moderate to severe brain injury, whereas only 44% of those without seizures (12 of 27) on EEG had moderate to severe brain injury ( = .03). Cardiopulmonary resuscitation prior to extracorporeal membrane oxygenation (ECPR), mode of extracorporeal membrane oxygenation, length of stay, survival to discharge, and congenital heart disease were not associated with seizures. One of 10 patients with cyanotic congenital heart disease due to hypoplastic left heart syndrome had seizures compared with 7 of 10 patients with non-hypoplastic left heart syndrome lesions ( = .02). Seizures were associated with moderate to severe brain injury, after adjusting for ECPR and congenital heart disease ( = .04).
Electrographic seizures were common in patients undergoing extracorporeal membrane oxygenation and higher than previously reported. Seizures were associated with moderate to severe abnormalities on imaging, after adjusting for ECPR and congenital heart disease. This study adds to recent literature describing the risk of seizures in patients on extracorporeal membrane oxygenation and highlights the presence of brain injuries that may be identified by routine EEG surveillance.
确定行体外膜肺氧合的婴儿的癫痫发作频率及其与神经结局的关系。确定与癫痫发作或影像学脑损伤相关的患者或临床因素。
回顾性单中心研究，纳入 2012 年至 2017 年间行体外膜肺氧合的年龄小于 1 岁的婴儿。
共 104 例婴儿符合研究标准，其中 45 例在体外膜肺氧合期间进行连续脑电图（EEG）监测，59 例无 EEG。在 45 例中有癫痫发作（仅电或电临床）的 18 例（40%）。在有癫痫发作的 18 例婴儿中，14 例（78%）有中重度脑损伤，而在有 EEG 的无癫痫发作的 27 例婴儿中，只有 12 例（44%）有中重度脑损伤（=.03）。体外膜肺氧合前心肺复苏、体外膜肺氧合模式、住院时间、存活至出院以及先天性心脏病均与癫痫发作无关。10 例因左心发育不全综合征致发绀型先天性心脏病的患者中有 1 例有癫痫发作，而 10 例非左心发育不全综合征病变的患者中有 7 例（=.02）。在调整心肺复苏和先天性心脏病后，癫痫发作与中重度脑损伤相关（=.04）。
行体外膜肺氧合的患者中，电癫痫发作常见，高于既往报道。在调整心肺复苏和先天性心脏病后，癫痫发作与影像学上的中重度异常相关。本研究增加了近期关于体外膜肺氧合患者癫痫发作风险的文献描述，并强调了通过常规 EEG 监测可能发现的脑损伤的存在。
