Abstract
Objective: The aim of our study was to assess the use of aEEG in our pediatric intensive care unit (PICU), indications for neuromonitoring and its findings, utility for seizure detection, and associations with outcome.Design: We retrospectively analyzed non-neonates who were treated in our PICU and received amplitude-integrated EEG (aEEG).Patients: 27 patients aged between 29 days and 10 0/12 years (median 7.3 months) were included, who received a total of 35 aEEGS.Measurements: aEEG tracings were assessed for background (BG) pattern and its evolution, seizures, and side differences using a visual classification (Hellström-Westas). Clinical data were collected from patients' histories and analyzed for correlation with aEEG findings.Main results: While rare in early years, there was an increase in use over time. Most aEEGs were conducted because of (suspected) seizures or for management of antiepileptic treatment. aEEG had low sensitivity but high specificity for recognition of pathological BG pattern with reference to conventional EEG. Worsening of BG pattern or failure to improve was associated with death. Seizure detection rates by aEEG were higher than by clinical observation, especially for identification of non-convulsive epileptic state (ES). Side differences in aEEG were rare, but if present, they were associated with unilateral brain injury.Conclusions: aEEG is useful for the detection of seizures and ES in pediatric intensive care patients. Abnormal BG pattern and poor evolution of BG are negatively associated with survival. aEEG is a potential supplement to conventional EEG, facilitating long-term surveillance of cerebral function when continuous full-channel EEG is not available. Further investigation is needed.
Highlights
A common problem in pediatric intensive care is the neurological assessment of children with altered mental state
All children treated in the pediatric intensive care unit (PICU) of the University Hospital Essen, Germany, who received an amplitude-integrated EEG (aEEG) in our PICU between 07/2009 and 07/2018 were eligible for our retrospective analysis
As our PICU does not have a standardized protocol for the application of aEEG, the indication was set by the physician in charge
Summary
A common problem in pediatric intensive care is the neurological assessment of children with altered mental state. The Evolution of Background Pattern The evolution of background pattern was assessed and categorized according to the suggestion by Sewell et al which was developed for evaluation after perinatal asphyxia [25]. For this purpose, we compared the very first and the very last section that was available for each infant. Pattern and Comparison to EEG Twenty five EEGs were performed within 24 h of aEEG recording. AEEG background pattern was altered in 15 recordings (43%), whereas 21 (84%) conventional EEGs were altered. Sensitivity for recognition of altered EEG pattern by aEEG in these patients was only 62%, but specificity was 100%.
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