The incidence of EEG abnormalities and outcome of infants paralyzed with neuromuscular blocking agents

Abstract

The EEGs of 40 infants paralyzed with D-tubocurarine or pancuronium during the neonatal period were reviewed retrospectively. The 23 infants who survived were re-examined at 1-3 yr of age. Sixteen infants had normal or mildly abnormal EEGs in the neonatal period; 3 died of nonneurologic causes; the remainder were normal at follow-up. Three of 8 infants with moderately abnormal EEGs in the neonatal period died, 2 had neurologic sequelae at follow-up, and 3 were normal at follow-up. Eleven of 16 infants with markedly abnormal EEGs died, and 5 had neurologic deficits at follow-up. Seizures occurred in 16 infants. Ten (63%) of the 16 died, whereas only 7 (29%) of 24 infants without seizures died (p less than .1). Eight infants had seizures only during paralysis. The EEG was statistically the best predictor of neurologic outcome when compared with the following variables recorded before paralysis: estimated gestational age (EGA), birth weight, Apgar score at 1 and 5 min, lowest PO2 and pH and highest PCO2. This study establishes the value of the EEG in the neurologic assessment of iatrogenically paralyzed newborns in the detection of seizures, and confirms previous studies which showed the value of EEG in predicting outcome.