Seizures as a Predictor of Long-Term Neurodevelopmental Outcome in Survivors of Neonatal Extracorporeal Membrane Oxygenation (ECMO)

Abstract

A longitudinal, prospective study was conducted to determine the long-term neurodevelopmental outcome in neonatal extracorporeal membrane oxygenation (ECMO) survivors with and without seizures. One hundred sixty-two ECMO survivors from March 1985 until November 1995 were eligible for follow-up. Sixty-four returned at preschool age (4-6 years). Thirty-nine infants did not experience neonatal seizures (group 1); however, 25 exhibited seizures before or during ECMO (group 2). Twelve infants referred for ECMO, but managed medically, served as a clinical comparison group (group 3). At school age (7-9 years), 32 ECMO children (16 with seizures) returned for neuropsychologic evaluation. The results indicated that the preschool seizure group (group 2) demonstrated a significantly lower mean IQ than group 1 or 3 (P = .002). Furthermore, 56% of group 2 had IQ scores < or =84 (> or =1 SD below the mean). Group 2 also exhibited significantly higher rates of cerebral palsy (P < or = .001) and speech-language disorder than group 1 or 3 (P < .001). At school age, the seizure group continued to perform below average on intelligence testing, with 50% scoring < or =84 and 38% receiving special education. This study extends the previous findings that seizures associated with neonatal ECMO are a primary risk factor for neurodevelopmental sequelae and confirms the need for long-term follow-up to assist with academic programming.

Electrographic Seizures in Children and Neonates Undergoing Extracorporeal Membrane Oxygenation

“…Several studies have found that ES are risk factors for subsequent mortality and neurodevelopmental disorders among survivors. (11–13, 15, 16) In contrast, a recent study of ECMO in 19 children did not find an association between seizures and outcome. (5) Our data adds to this literature by addressing the full spectrum of seizures through the use of cEEG.…”

“…(2, 5, 10–14) Furthermore, seizures during ECMO have been associated with cerebral injury and worse outcomes in some, but not all, studies. (5, 11, 12, 15, 16) However, most of the studies addressing seizure incidence and outcome have included non-consecutive cohorts without standardized use of continuous EEG monitoring (cEEG) to identify ES. (2, 5, 10–14) A recent systematic literature review regarding the use and effectiveness of neuromonitoring methods during ECMO identified only seven studies related to EEG, including two with 1–2 channel amplitude integrated EEG and five with intermittent conventional multi-channel EEG.…”

Nonconvulsive Seizures Are Common in Children Treated With Extracorporeal Cardiac Life Support*

“…Neonates treated with ECLS who experienced seizures were significantly more likely to experience poor outcome, including death or developmental delay (17,18). Follow-up studies in this population revealed that the occurrence of seizures is associated with lower IQ, verbal index, preschool achievement, and higher rate of cerebral palsy and speech/language disorders (19,20). The longterm neurologic outcomes of children who have seizures while receiving ECLS are still not well defined, and it remains to be proven that prolonged EEG monitoring and treatment of seizures improves outcomes in this population.…”

Congenital diaphragmatic hernia

“…The causes of the arrest are variable and the identiication and treatment of the underlying cause will inluence outcome [58]. Of those who survive, at least 60% have a reasonable neurologic outcome.…”