title: Electrographic Seizures in Children and Neonates Undergoing Extracorporeal Membrane Oxygenation.
abstract: OBJECTIVE
  We aimed to determine the prevalence and risk factors for electrographic seizures in neonates and children requiring extracorporeal membrane oxygenation support.
  
  
  METHODS
  Prospective quality improvement project.
  
  
  METHODS
  Quaternary care pediatric institution.
  
  
  METHODS
  Consistent with American Clinical Neurophysiology Society electroencephalographic monitoring recommendations, neonates and children requiring extracorporeal membrane oxygenation support underwent clinically indicated electroencephalographic monitoring.
  
  
  METHODS
  We performed a 2-year quality improvement study from July 2013 to June 2015 evaluating electrographic seizure prevalence and risk factors.
  
  
  RESULTS
  Ninety-nine of 112 patients (88%) requiring extracorporeal membrane oxygenation support underwent electroencephalographic monitoring. Electrographic seizures occurred in 18 patients (18%), of whom 11 patients (61%) had electrographic status epilepticus and 15 patients (83%) had exclusively electrographic-only seizures. Electrographic seizures were more common in patients with low cardiac output syndrome (p = 0.03). Patients with electrographic seizures were more likely to die prior to discharge (72% vs 30%; p = 0.01) and have unfavorable outcomes (54% vs 17%; p = 0.004) than those without electrographic seizures.
  
  
  CONCLUSIONS
  Electrographic seizures occurred in 18% of neonates and children requiring extracorporeal membrane oxygenation support, often constituted electrographic status epilepticus, and were often electrographic-only thereby requiring electroencephalographic monitoring for identification. Low cardiac output syndrome was associated with an increased risk for electrographic seizures. Electrographic seizures were associated with higher mortality and unfavorable outcomes. Further investigation is needed to determine whether electrographic seizures identification and management improves outcomes.
authors.affiliation: 1Division of Pediatric Critical Care and Pediatric Neurocritical Care, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan. 2Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan. 3Departments of Neurology and Pediatrics, The Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. 4Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. 5Department of Pediatrics, The Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
authors.forename: Jainn-Jim
authors.initials: JJ
authors.lastname: Lin
authors.forename: Brenda L
authors.initials: BL
authors.lastname: Banwell
authors.forename: Robert A
authors.initials: RA
authors.lastname: Berg
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Dlugos
authors.forename: Rebecca N
authors.initials: RN
authors.lastname: Ichord
authors.forename: Todd J
authors.initials: TJ
authors.lastname: Kilbaugh
authors.forename: Roxanne E
authors.initials: RE
authors.lastname: Kirsch
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Kirschen
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Licht
authors.forename: Shavonne L
authors.initials: SL
authors.lastname: Massey
authors.forename: Maryam Y
authors.initials: MY
authors.lastname: Naim
authors.forename: Natalie E
authors.initials: NE
authors.lastname: Rintoul
authors.forename: Alexis A
authors.initials: AA
authors.lastname: Topjian
authors.forename: Nicholas S
authors.initials: NS
authors.lastname: Abend
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000379:methods; D004569:Electroencephalography; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D058996:Quality Improvement; D012307:Risk Factors; D012640:Seizures / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology*; D013226:Status Epilepticus / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology