Background: Neuromuscular disorders encountered in neonatal and paediatric intensive care units (ICUs) include a broad spectrum of both acute and chronic pathologies, alongside neuromuscular complications of prolonged ICU stay.1 Bedside neurological evaluation of critically ill children can be limited. Electroneuromyography (ENMG) plays an important role in facilitating a timely diagnosis and management of these children. This study aims to explore that role and describe the type of pathologies encountered in this setting through the experience in a tertiary paediatric centre over a decade.
Methods: We reviewed the EMG studies performed for evaluation of neuromuscular conditions in children staying in one of the three intensive care units (neonatal, paediatric, cardiac) at Great Ormond Street Hospital in London, UK from 2010 to 2019. Electrodiagnostic data was extracted from departmental database. Patients’ medical records were reviewed, and clinical diagnoses were identified based on clinical profile, laboratory, genetic, imaging and pathology test results.
Results: A total of 431 EMG tests were performed in 351 patients (mean age 42.2 months), 57% of which were infants. Isolated respiratory distress was the most frequent reason for referral. Most patients underwent routine nerve conduction and electromyography, while some (~20%) required specialized tests like repetitive nerve stimulation, stimulation single-fibre EMG and blink reflex. We classified the electrodiagnostic findings into motor neuronopathy (n=92), myopathy (n=49), neuropathy (n=45), neuromuscular junction disorder (n=31), critical illness (neuro)myopathy(CINM) (n=28), other (n=4) and normal (n=102). A positive electrophysiological-clinical correlation was found in almost all cases within the CINM and neuropathy group; correlation ranged between 50% and 70% within the remaining groups. A wide range of pathologies were identified in each group.
Conclusions: This study confirms the valuable role of EMG as an adjunctive tool in the management of complex neuromuscular conditions in the paediatric intensive care unit and highlights the most commonly encountered diseases in this setting.
