Risk Factors for Seizures Among Young Children Monitored With Continuous Electroencephalography in Intensive Care...

Area of Science:

• Pediatric Neurology
• Critical Care Medicine
• Neurophysiology

Background:

• Continuous electroencephalography (cEEG) is increasingly used in pediatric intensive care units (ICUs).
• Clear guidelines for patient selection and monitoring duration for cEEG are lacking.
• Identifying pediatric subgroups with high seizure incidence is essential for optimizing cEEG use.

Purpose of the Study:

• To identify pediatric patient subgroups with a high incidence of seizures using cEEG.
• To determine age-related seizure risk thresholds.
• To analyze risk factors associated with seizures in different pediatric age groups.

Main Methods:

• Retrospective study of 517 children monitored with cEEG in a pediatric ICU.
• Stratification of patients based on an age threshold (14 months).
• Regression modeling to identify significant risk factors for seizures in younger and older children, with bias mitigation techniques.

Main Results:

• An approximate seizure risk threshold was identified at 14 months of age.
• Older children (>14 months) had an 18% seizure rate, with previous seizures as the sole significant risk factor.
• Younger children (<14 months) had a 45% seizure rate, significantly associated with hypoxic-ischemic encephalopathy (HIE), intracranial hemorrhage (ICH), and central nervous system (CNS) infection.

Conclusions:

• Critically ill children under 14 months exhibit an extremely high incidence of seizures.
• HIE, ICH, and CNS infections are significant risk factors for seizures in this young population.
• These conditions accounted for 61% of all cEEG-diagnosed seizures in infants under 14 months.