Abstract
The clinical use of therapeutic hypothermia (TH) is established as a standard of care for neonates with perinatal asphyxia, for whom TH leads to improved neurologic outcome at 18-month recovery. TH has not proven effective in randomized trials of children with severe traumatic brain injury (TBI) or out-of-hospital cardiac arrest (CA). Despite a promising initial randomized-controlled study of TH in severe pediatric TBI [1], two further studies demonstrated decreased intracranial pressure during hypothermia but no difference in neurological outcome in children at 3 and 6 months of recovery and a possible increase in mortality in children treated with TH versus normothermia [2, 3]. The most recent study was stopped early for futility as safety concerns prompted for an interim analysis [3]. A study of TH for out-of-hospital CA in 260 children also showed no benefit at 1-year recovery [4]. In this chapter, we will discuss EEG monitoring in neonates after perinatal hypoxic ischemic encephalopathy (HIE) and in children in the context of CA, extracorporeal membrane oxygenation (ECMO), status epilepticus (SE), and acute liver failure. A summary of the effects of TH in neonates and children with respect to EEG changes during cooling and rewarming, the clinical applications of EEG in pediatrics, and its use for prognostication in pediatric brain insults is shown in Table 21.1.
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References
Adelson PD, Ragheb J, Kanev P, et al. Phase II clinical trial of moderate hypothermia after severe traumatic brain injury in children. Neurosurgery. 2005;56(4):740–54.
Hutchison JS, Ward RE, Lacroix J, et al. Hypothermia therapy after traumatic brain injury in children. N Engl J Med. 2008;358(23):2447–56.
Adelson PD, Wisniewski SR, Beca J, et al. Comparison of hypothermia and normothermia after severe traumatic brain injury in children (Cool Kids): a phase 3, randomised controlled trial. Lancet Neurol. 2013;12(6):546–53.
Moler FW, Silverstein FS, Holubkov R, et al. Therapeutic hypothermia after out-of-hospital cardiac arrest in children. N Engl J Med. 2015;372(20):1898–908.
Karnatovskaia LV, Wartenberg KE, Freeman WD. Therapeutic hypothermia for neuroprotection. Neurohospitalist. 2014;4(3):153–63.
Zanelli S, Buck M, Fairchild K. Physiologic and pharmacologic considerations for hypothermia therapy in neonates. J Perinatol Off J Calif Perinat Assoc. 2011;31(6):377–86.
Stecker MM, Cheung AT, Pochettino A, et al. Deep hypothermic circulatory arrest: I. Effects of cooling on electroencephalogram and evoked potentials. Ann Thorac Surg. 2001;71(1):14–21.
Banoczi W. How some drugs affect the electroencephalogram (EEG). Am J Electroneurodiagnostic Technol. 2005;45(2):118–29.
Bennet L, Roelfsema V, George S, Dean JM, Emerald BS, Gunn AJ. The effect of cerebral hypothermia on white and grey matter injury induced by severe hypoxia in preterm fetal sheep. J Physiol. 2007;578(Pt 2):491–506.
Jacobs SE, Berg M, Hunt R, Tarnow-Mordi WO, Inder TE, Davis PG. Cooling for newborns with hypoxic ischaemic encephalopathy. Cochrane Database Syst Rev. 2013;1, CD003311.
Shellhaas RA, Chang T, Tsuchida T, et al. The American Clinical Neurophysiology Society’s guideline on continuous electroencephalography monitoring in neonates. J Clin Neurophysiol Off Publ Am Electroencephalogr Soc. 2011;28(6):611–7.
Srinivasakumar P, Zempel J, Wallendorf M, Lawrence R, Inder T, Mathur A. Therapeutic hypothermia in neonatal hypoxic ischemic encephalopathy: electrographic seizures and magnetic resonance imaging evidence of injury. J Pediatr. 2013;163(2):465–70.
Low E, Boylan GB, Mathieson SR, et al. Cooling and seizure burden in term neonates: an observational study. Arch Dis Child Fetal Neonatal Ed. 2012;97(4):F267–72.
Glass HC, Wusthoff CJ, Shellhaas RA, et al. Risk factors for EEG seizures in neonates treated with hypothermia: a multicenter cohort study. Neurology. 2014;82(14):1239–44.
Shah DK, Mackay MT, Lavery S, et al. Accuracy of bedside electroencephalographic monitoring in comparison with simultaneous continuous conventional electroencephalography for seizure detection in term infants. Pediatrics. 2008;121(6):1146–54.
Shankaran S, Pappas A, McDonald SA, et al. Predictive value of an early amplitude integrated electroencephalogram and neurologic examination. Pediatrics. 2011;128(1):e112–20.
Shah DK, Wusthoff CJ, Clarke P, et al. Electrographic seizures are associated with brain injury in newborns undergoing therapeutic hypothermia. Arch Dis Child Fetal Neonatal Ed. 2014;99(3):F219–24.
Wyatt JS, Gluckman PD, Liu PY, et al. Determinants of outcomes after head cooling for neonatal encephalopathy. Pediatrics. 2007;119(5):912–21.
Thoresen M, Hellström-Westas L, Liu X, de Vries LS. Effect of hypothermia on amplitude-integrated electroencephalogram in infants with asphyxia. Pediatrics. 2010;126(1):e131–9.
Abend NS, Topjian A, Ichord R, et al. Electroencephalographic monitoring during hypothermia after pediatric cardiac arrest. Neurology. 2009;72(22):1931–40.
Kessler SK, Topjian AA, Gutierrez-Colina AM, et al. Short-term outcome prediction by electroencephalographic features in children treated with therapeutic hypothermia after cardiac arrest. Neurocrit Care. 2011;14(1):37–43.
Horan M, Azzopardi D, Edwards AD, Firmin RK, Field D. Lack of influence of mild hypothermia on amplitude integrated-electroencephalography in neonates receiving extracorporeal membrane oxygenation. Early Hum Dev. 2007;83(2):69–75.
Guilliams K, Rosen M, Buttram S, et al. Hypothermia for pediatric refractory status epilepticus. Epilepsia. 2013;54(9):1586–94.
Hansen G, Grimason M, Collins JW, Wainwright MS. Selective head cooling for the treatment of neurologic complications of acute liver failure in a newborn with disseminated herpes infection. SpringerPlus. 2013;2:572.
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Ducharme-Crevier, L., Wainwright, M.S. (2017). Therapeutic Hypothermia in Children. In: Husain, A., Sinha, S. (eds) Continuous EEG Monitoring. Springer, Cham. https://doi.org/10.1007/978-3-319-31230-9_21
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DOI: https://doi.org/10.1007/978-3-319-31230-9_21
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