Cerebral function monitoring in paediatric intensive care: useful featuresfor predicting outcome

Neurological integrity in sick children is difficult to assess clinically. The aim of this study was to determine the predictive value of EEG activity recorded with a bedside EEG analysing monitor in an intensive care unit. E EG activity was monitored in 108 children (age range a weeks to 16 years, m edian 1.7 years) considered at risk for cerebral abnormalities with a cereb ral function analysing monitor (CFAM). Recordings were evaluated for featur es of background EEG activity including mean amplitude, frequencies, and sy mmetry. Electrical seizure activity was quantified if present. Predictive v alue of the EEG features was evaluated relative to the clinical neurologica l outcome after one year. Asymmetrical recordings were not seen in any chil d with a normal outcome. Suppression of background activity was seen in 75% of the children who died. Seizures were present in 68% of children with a poor outcome. Seventeen of the 32 children (65%) who died had prolonged sei zures. Absence of seizures and the presence of superimposed fast EEG activi ty in response to benzodiazepine infusions correlated with good outcome. A combination of two or more predictive EEG features demonstrated >90% specif icity and positive predictive likelihood of poor outcome. EEG features prov ide information about the functional cerebral integrity of sick children. C hanges in cerebral activity detected by the CFAM aid decision making by pro viding such information readily at the bedside in intensive care.