Ritesh Korumilli, MD, MPH
Pediatric Intensivist
Nicklaus Childrens Hospital, United States
Disclosure information not submitted.
Anuj Jayakar, MD
Director of Neuro Critical Care
Nicklaus Children's Hospital
Miami, Florida, United States
Disclosure information not submitted.
Hugh Ladd, MD, FAAP
Assistant Medical Director, ECLS/ECMO Services
Nicklaus Childrens Hospital, United States
Disclosure information not submitted.
Keith Meyer, MD, FAAP
Medical Director, ECLS/ECMO and Apheresis Services
Nicklaus Childrens Hospital, United States
Disclosure information not submitted.
Balagangadhar Totapally, MBBS, MD, DCH, MRCP, FAAP, FCCP, FCCM
Chief, Division of Critical Care Medicine. Program Director, Critical Care Fellowship Program
Nicklaus Children's Hospital, United States
Disclosure information not submitted.
Title: Video EEG Abnormalities Among Neonates During Extracorporeal Life Support
Introduction: Neurologic complications such as seizures are common in neonates receiving extracorporeal life support (ECLS). The aims of the study were to determine the frequency of abnormal video EEG (vEEG) findings and determine the characteristics of patients with an abnormal vEEG among neonates requiring ECLS.
Methods: This is a single center retrospective cohort study of neonatal patients requiring ECLS from 2016-2020. All neonates requiring ECLS were screened and those who had vEEG monitoring were included in the study. An abnormal vEEG was defined as having seizures, burst suppression, or periodic pattern as reported by a neurologist. Demographic, clinical and ECMO run data were compared between patients that had abnormal vEEG’s and patients that did not have abnormal vEEG’s. PaO2/FiO2 (P/F) ratio, oxygenation index (OI) and mean airway pressure (MAP) just prior to initiation of ECMO were used in the analysis. The prevalence of CNS hemorrhage/infarction in the 2 groups was compared using Fisher’s exact test.
Results: A total of 46 neonates required ECLS during the study period, of which 33 patients (72%) had vEEG monitoring and were included in the study. Of the 33 neonates, 51.5% were male, 45.5% were white, 12.1% were African American, and 39.4% were Hispanic. The underlying diagnoses that required ECMO were Meconium aspiration syndrome (45.5%), sepsis (24.2%), persistent pulmonary hypertension (PPHN) (21.2) and congenital diaphragmatic hernia (CDH) (9.1%). The median duration of ECLS was 166 (IQR: 90.5 – 420) hours. The mortality rate in our cohort was 33.3%. Six (18.2%) patients developed CNS hemorrhage/infarction. An abnormal vEEG pattern was present in 6 (18.2%) neonates. There was no association between CNS hemorrhage/infarction and an abnormal vEEG(p = 0.295). There was a significant difference in the median PF ratio (24 vs 36; p=0.024), OI (79.2 vs 42.4; p=0.006), and MAP (22 vs 17; p=0.012) in patients that had an abnormal vEEG.
Conclusions: In neonates requiring ECLS, 18.2% have abnormal vEEG findings. An abnormal vEEG finding is associated with a lower PF ratio, a higher OI, and a higher mean airway pressure before ECLS initiation. The presence of CNS hemorrhage/infarction is not significantly associated with abnormal vEEG in our study.