Neonatal seizures during extra corporeal membrane oxygenation support

Maria Chalia; Davinder Singh; Stewart G Boyd; Simon Hannam; Aparna Hoskote; Ronit Pressler

doi:10.1007/s00431-024-05510-w

Neonatal seizures during extra corporeal membrane oxygenation support

Eur J Pediatr. 2024 Jun;183(6):2605-2614. doi: 10.1007/s00431-024-05510-w. Epub 2024 Mar 15.

Authors

Maria Chalia^{1

2}, Davinder Singh³, Stewart G Boyd⁴, Simon Hannam⁵, Aparna Hoskote³, Ronit Pressler^{4

6}

Affiliations

¹ Neonatal Intensive Care Unit, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK. maria.chalia@gosh.nhs.uk.
² Department of Clinical Neurophysiology, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK. maria.chalia@gosh.nhs.uk.
³ Cardiac Intensive Care Unit, Great Ormond Street Hospital for Children, London, UK.
⁴ Department of Clinical Neurophysiology, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK.
⁵ Neonatal Intensive Care Unit, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK.
⁶ Clinical Neuroscience, University College London, UCL, Great Ormond Street Institute of Child Health, London, UK.

PMID: 38488877
DOI: 10.1007/s00431-024-05510-w

Abstract

To evaluate EEG monitoring during neonatal ECMO and to identify any correlations between seizure detection to abnormal neuroimaging. Eight-year, service evaluation of neonates who received at least one continuous EEG (cEEG) whilst on ECMO at Great Ormond Street Hospital. Pearson's chi-square test and multivariate logistic regression analysis were used to assess clinical and EEG variables association with seizures and neuroimaging findings. Fifty-seven neonates were studied; 57 cEEG recordings were reviewed. The incidence of seizures was 33% (19/57); of these 74% (14/19) were electrographic-only. The incidence of status epilepticus was 42%, (8/19 with 6 neonates having electrographic-only status and 2 electro-clinical status. Seizures were detected within an hour of recording in 84%, (16/19). The overall mortality rate was 39% (22/57). Seizure detection was strongly associated with female gender (OR 4.8, 95% CI: 1.1-20.4, p = 0.03), abnormal EEG background activity (OR 2.8, 95% CI: 1.1-7.4, p = 0.03) and abnormal EEG focal features (OR 23.6, 95% CI: 5.4-103.9, p = 0.001). There was a strong association between the presence of seizures and abnormal neuroimaging findings (OR 10.9, 95% CI: 2.8-41.9, p = 0.001). Neonates were highly likely to have abnormal neuroimaging findings in the presence of severely abnormal background EEG (OR 9.5, 95% CI 1.7-52.02, p = 0.01) and focal EEG abnormalities (OR 6.35, 95% CI 1.97-20.5, p = 0.002)Conclusion: The study highlights the importance of cEEG in neonates undergoing ECMO. An association between seizure detection and abnormal neuroimaging findings was described. What is Known: • Patients on ECMO are at a higher risk of seiures. • Continuous EEG monitoring is recommended by the ACNS for high risk and ECMO patients. What is New: • In this cohort, neonates with sezirues were 11 times more likely of having abnromal neuroimaging findings. • Neonates with burst suppressed or suppressed EEG background were 9.5 times more likely to have abnormal neuroimaging findings. What does this study add? • This study reports a 33% incidence of neonatal seizures during ECMO. • Neonates with seizures were 11 times more likely to have an abnormal brain scan. • The study captures the real-time approach of EEG monitoring. • Recommended cEEG monitoring should last at least 24 h for ECMO patients. • This is the first study to assess this in neonates only.

Keywords: ECMO; Electroencephalogram; Intensive care; Neonate; Seizure.

MeSH terms

Electroencephalography* / methods
Extracorporeal Membrane Oxygenation*
Female
Humans
Incidence
Infant, Newborn
Logistic Models
Male
Neuroimaging / methods
Retrospective Studies
Seizures* / diagnosis
Seizures* / etiology
Status Epilepticus / diagnosis
Status Epilepticus / etiology