NONINVASIVE MONITORING OF CRITICALLY ILL CHILD

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ELECTROENCEPHALOGRAPHY MONITORING IN CRITICALLY ILL CHILD

Ahmet Ziya Birbilen1 Burcu Akbaba2 Özlem Tekşam3

1Hacettepe University, Faculty of Medicine, Department of Pediatrics, Ankara, Türkiye
2Hacettepe University, Faculty of Medicine, Department of Pediatrics, Ankara, Türkiye
3Hacettepe University, Faculty of Medicine, Department of Pediatrics, Ankara, Türkiye

Birbilen AZ, Akbaba B, Tekşam Ö. Electroencephalography Monitoring in Critically Ill Child. In: Bal A, editor. Noninvasive Monitoring of Critically Ill Child. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.51-59.

ABSTRACT

Over the last decade, electroencephalography (EEG) has been used more and more as an important tool of neurological monitoring in pediatric emergencies. Seizures, ischemia, cerebral edema, and high IC pressure are the etiological diagnoses often presented as critical illnesses in children. These diseases demand instantaneous recognition and intermediate steps. Given the limitations imposed by clinical conditions such as sedation and neuromuscular blockade, conventional neurological examinations may be inadequate. Therefore, EEG is emerging as a vital, noninvasive method that allows detailed assess- ment of cerebral activity under challenging conditions.

In this article, we discuss the technical and clinical aspects of EEG in pediatric emergencies. In routine EEG, scalp electrodes (usually 19 in a standard array) are placed to record electrical discharges created by neuronal firing. The signal recorded reflects the total postsynaptic potentials (excitators-inhibitors) of brain activity. These data are then handled by methods such as differential conversion, which splits it into different forms like delta, theta, alpha, beta, and gamma. In the end, standard EEG is still the gold standard. However, rapid alternatives in emergent situations have been introduced as a few mon- tage EEGs. Clinically acceptable diagnostic sensitivity and specificity It, therefore, aids in the rapid decision-making of clinicians.

Moreover, related EEG modalities in the acute care setting (continuous EEG cEEG, quantitative EEG qEEG/amplitude-integrated qEEG (aEEG)) will also be encountered in emergencies. Every EEEG helps make rapid identification of both convulsive and nonconvulsive seizures. They influence treat- ment and predict outcomes. It has been demonstrated to reduce needless patient transfers for EEG at reference hospitals, decrease length of stay, and reduce total cost savings.

Among these tools, the incorporation of machine learning and artificial intelligence can offer instanta- neous analysis/predictive capabilities. Hence, it helps with reading the EEG. These breakthroughs open pathways for future closed-loop systems to substantially enhance patient management. To summarize, progress in traditional and more advanced EEG paradigms is a significant step towards implementing pediatric neuros critical care. New diagnostic and therapeutic trial protocols are needed for clinical improvement. EEG reading education may be required for emergency staff in the near future.

Keywords: Electroencephalography; Pediatric emergency medicine; Status epilepticus; Critical care;

Artificial intelligence

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