Risk Factors for Seizures Among Young Children Monitored With Continuous Electroencephalography in Intensive Care Unit: A Retrospective Study

Objective: cEEG is an emerging technology for which there are no clear guidelines for patient selection or length of monitoring. The purpose of this study was to identify subgroups of pediatric patients with high incidence of seizures.Study Design: We conducted a retrospective study on 517 children monitored by cEEG in the intensive care unit (ICU) of a children's hospital. The children were stratified using an age threshold selection method. Using regression modeling, we analyzed significant risk factors for increased seizure risk in younger and older children. Using two alternative correction procedures, we also considered a relevant comparison group to mitigate selection bias and to provide a perspective for our findings.Results: We discovered an approximate risk threshold of 14 months: below this threshold, the seizure risk increases dramatically. The older children had an overall seizure rate of 18%, and previous seizures were the only significant risk factor. In contrast, the younger children had an overall seizure rate of 45%, and the seizures were significantly associated with hypoxic-ischemic encephalopathy (HIE; p = 0.007), intracranial hemorrhage (ICH; p = 0.005), and central nervous system (CNS) infection (p = 0.02). Children with HIE, ICH, or CNS infection accounted for 61% of all seizure patients diagnosed through cEEG under 14 months.Conclusions: An extremely high incidence of seizures prevails among critically ill children under 14 months, particularly those with HIE, ICH, or CNS infection

Intracranial Pressure Forecasting in Children Using Dynamic Averaging of Time Series Data

Increased Intracranial Pressure (ICP) is a serious and often life-threatening condition. If the increased pressure pushes on critical brain structures and blood vessels, it can lead to serious permanent problems or even death. In this study, we propose a novel regression model to forecast ICP episodes in children, 30 min in advance, by using the dynamic characteristics of continuous intracranial pressure, vitals and medications during the last two hours. The correlation between physiological parameters, including blood pressure, respiratory rate, heart rate and the ICP, is analyzed. Linear regression, Lasso regression, support vector machine and random forest algorithms are used to forecast the next 30 min of the recorded ICP. Finally, dynamic features are created based on vitals, medications and the ICP. The weak correlation between blood pressure and the ICP (0.2) is reported. The Root-Mean-Square Error (RMSE) of the random forest model decreased from 1.6 to 0.89% by using the given medication variables in the last two hours. The random forest regression gave an accurate model for the ICP forecast with 0.99 correlation between the forecast and experimental values