Background

Single-center studies suggest that up to 30% of children undergoing extracorporeal membrane oxygenation have electrographic seizures. The aim of this study was to characterize seizure prevalence, seizure risk factors, and brain injury prevalence in the pediatric extracorporeal membrane oxygenation population at a tertiary care children’s hospital.

Methods

We performed a retrospective systematic review of medical records for 86 consecutive children (neonates to age 21 years) who received Neurology consults and continuous video electroencephalography while undergoing extracorporeal membrane oxygenation from November 2015 to September 2018.

Results

Continuous video electroencephalography was initiated in 86 of 170 children who required extracorporeal membrane oxygenation (51%); median duration of continuous vodeo electroencephalography was four days. Nineteen of 86 had electroencephalography-confirmed seizures (22%). Sixteen of 19 had seizures within the first 48 hours on continuous video electroencephalography. Interictal epileptiform discharges were a significant risk factor for seizures; 89% of those with seizures versus 46% of those without had interictal epileptiform discharges (P < 0.001, Fisher’s exact test). Children with seizures also had higher pericannulation lactate (median 6.7, interquartile range of 4.3 to 19.0 for those with, and median 4.0, interquartile range of 2.0 to 7.3 for those without; P = 0.02, Mann-Whitney U test). Seizures were associated with hemorrhage on neuroimaging (68% of children with seizures had intracranial hemorrhage versus 34% of those without, P = 0.01, chi-square test).

Conclusion

Approximately half the children undergoing extracorporeal membrane oxygenation received continuous video electroencephalography during the study period, and 22% had seizures. Interictal epileptiform discharges and elevated pre-extracorporeal membrane oxygenation lactate levels were risk factors for seizures; seizures were associated with intracranial hemorrhage.

中文翻译：

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需要体外膜氧合的儿童的电子癫痫发作和脑损伤。

背景

单中心研究表明，接受体外膜充氧的儿童中，多达30％患有电子病发作。这项研究的目的是表征三级儿童医院小儿体外膜氧合人群的癫痫发作率，癫痫发作危险因素和脑损伤患病率。

方法

我们对2015年11月至2018年9月在接受体外膜氧合期间接受神经内科咨询和连续视频脑电图检查的连续86名儿童（新生儿至21岁）的病历进行了回顾性系统回顾。

结果

在需要进行体外膜氧合的170名儿童中，有86名（51％）开始进行连续视频脑电图检查。连续视频脑电图的中位持续时间为四天。86例中有19例经脑电图确诊的癫痫发作（22％）。19例中有16例在连续48个小时的脑电图上癫痫发作。发作间期癫痫样放电是癫痫发作的重要危险因素。有癫痫发作的患者中有89％，没有发作间期癫痫样放电的患者中有46％（P  <0.001，Fisher精确检验）。癫痫发作的儿童的乳酸周环化率也更高（有中位数的儿童，中位数为6.7，四分位数范围为4.3至19.0，而没有中位数的儿童中位数为4.0，四分位数范围为2.0至7.3；P = 0.02，Mann-Whitney U检验）。癫痫发作与神经影像学上的出血有关（癫痫发作的儿童有68％颅内出血，而无癫痫发作的儿童有34％，P  = 0.01，卡方检验）。

结论

在研究期间，约有一半接受体外膜氧合的儿童接受了连续的视频脑电图检查，其中22％患有癫痫发作。发作间期癫痫样放电和体外前膜氧合乳酸水平升高是癫痫发作的危险因素。癫痫发作与颅内出血有关。