Neonatal seizures during extra corporeal membrane oxygenation support

Area of Science:

• Neonatal Neurology
• Neurocritical Care
• Medical Technology

Background:

• Patients on extracorporeal membrane oxygenation (ECMO) face increased seizure risk.
• Continuous electroencephalogram (cEEG) monitoring is recommended for high-risk neonates, including those on ECMO.
• Understanding seizure activity and its neurological correlates in neonates on ECMO is crucial for patient management.

Purpose of the Study:

• To evaluate the utility of continuous EEG (cEEG) monitoring in neonates receiving ECMO.
• To determine the incidence of seizures in neonates on ECMO.
• To identify correlations between seizure detection and abnormal neuroimaging findings.

Main Methods:

• A service evaluation of 57 neonates who underwent at least one cEEG during ECMO.
• Analysis of cEEG recordings for seizure detection, including electrographic-only seizures and status epilepticus.
• Statistical analysis using Pearson's chi-square test and multivariate logistic regression to assess associations between clinical/EEG variables and neuroimaging findings.

Main Results:

• A 33% incidence of seizures was observed in neonates on ECMO, with 74% being electrographic-only.
• Seizures were strongly associated with female gender, abnormal EEG background, and focal EEG abnormalities.
• A significant association was found between the presence of seizures and abnormal neuroimaging findings (OR 10.9).
• Abnormal EEG background and focal abnormalities were also linked to higher likelihood of abnormal neuroimaging.

Conclusions:

• Continuous EEG monitoring is vital for neonates undergoing ECMO, aiding in seizure detection.
• The study confirms a strong association between seizure detection and abnormal neuroimaging in this population.
• Findings underscore the importance of EEG in identifying neurological injury in neonates on ECMO.
• The study suggests cEEG monitoring should ideally last at least 24 hours for ECMO patients.