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Seizures Are Associated With Brain Injury in Infants Undergoing Extracorporeal Membrane Oxygenation
Sarah L Bauer Huang1, Ahmed S Said2, Christopher D Smyser1,3
1Department of Neurology, Division of Pediatric and Developmental Neurology, 7548Washington University in St Louis, MO, USA.
Insights
Seizures are common in infants on extracorporeal membrane oxygenation (ECMO) and linked to brain injury. Continuous EEG monitoring can help identify these seizures and associated brain damage in critically ill infants.
Area of Science:
- Neonatal neurology
- Pediatric critical care
- Neurophysiology
Background:
- Infants undergoing extracorporeal membrane oxygenation (ECMO) are at risk for neurologic complications.
- Seizure detection and their association with brain injury in this population require further investigation.
Purpose of the Study:
- To determine seizure frequency in infants during ECMO.
- To identify factors associated with seizures and neurologic outcomes, including brain injury on imaging.
Main Methods:
- Retrospective, single-center study of infants (<1 year) who underwent ECMO (2012-2017).
- Analysis included 104 infants, with 45 undergoing continuous electroencephalographic (EEG) monitoring.
- Seizures and brain injury on imaging were assessed.
Main Results:
- Seizures occurred in 40% of infants with continuous EEG monitoring.
- Seizures were significantly associated with moderate to severe brain injury (78% vs. 44%, P = .03).
- Seizures were also linked to moderate to severe brain injury after adjusting for extracorporeal cardiopulmonary resuscitation (ECPR) and congenital heart disease (P = .04).
Conclusions:
- Electrographic seizures are more frequent in infants on ECMO than previously reported.
- Seizures are a significant risk factor for moderate to severe brain injury in this vulnerable population.
- Routine EEG surveillance is crucial for identifying brain injuries in infants receiving ECMO.
Objective:
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.
Methods:
Retrospective, single-center study including infants less than 1 year of age, who underwent extracorporeal membrane oxygenation between 2012 and 2017.
Results:
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 (P = .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 (P = .02). Seizures were associated with moderate to severe brain injury, after adjusting for ECPR and congenital heart disease (P = .04).
Conclusions:
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.
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