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Perioperative amplitude-integrated EEG and neurodevelopment in infants with congenital heart disease

  • Pediatric Original
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Abstract

Purpose

Perioperative brain injury is common in young infants undergoing cardiac surgery. We aimed to determine the relationship between perioperative electrical seizures, the background pattern of amplitude-integrated electroencephalography (aEEG) and 2-year neurodevelopmental outcome in young infants undergoing surgery for congenital heart disease.

Methods

A total of 150 newborn infants undergoing cardiac surgery underwent aEEG monitoring prior to and during surgery, and for 72 h postoperatively. Two blinded assessors reviewed the aEEGs for seizure activity and background pattern. Survivors underwent neurodevelopmental outcome assessment using the Bayley Scales of Infant Development (3rd edn.) at 2 years.

Results

The median age at surgery was 7 days (IQR 4–11). Cardiopulmonary bypass was used in 83 %. Perioperative electrical seizures occurred in 30 %, of whom 1/4 had a clinical correlate, but were not associated with 2-year outcome. Recovery to a continuous background occurred at a median 6 (3–13) h and sleep–wake cycling recovered at 21 (14–30) h. Prolonged aEEG recovery was associated with increased mortality and worse neurodevelopmental outcome. Failure of the aEEG to recover to a continuous background by 48 postoperative hours was associated with impairment in all outcome domains (p < 0.05). Continued abnormal aEEG at 7 postoperative days was highly associated with mortality (p < 0.001).

Conclusions

Perioperative seizures were common in this cohort of infants but did not impact on 2-year neurodevelopmental outcome. Delayed recovery in aEEG background was associated with increased risk of early mortality and worse neurodevelopment. Ongoing monitoring of the survivors is essential to determine the longer-term significance of these findings.

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Abbreviations

aEEG:

Amplitude-integrated electroencephalography

CHD:

Congenital heart disease

CPB:

Cardiopulmonary bypass

ECMO:

Extracorporeal membrane oxygenation

EEG:

Electroencephalography

HLHS:

Hypoplastic left heart syndrome

SWC:

Sleep–wake cycling

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Acknowledgments

Thank you to the following people for their assistance with data collection (the Hearts and Minds Study research nurses in Melbourne and Auckland, particularly Michelle Goldsworthy, Laura-Clare Whelan, Stephen McKeever and Carmel Delzoppo) and for their support of our study (the cardiac surgeons, anaesthetists, perfusionists and paediatric intensive care staff of both hospitals). We are also appreciative of Prof Terrie Inder for her involvement in the original study design. Funding support was received from the National Heart Foundation (Australia), Heart Foundation of New Zealand, Auckland Medical Research Fund, Green Lane Research and Education Fund, Australian and New Zealand Intensive Care Foundation, Murdoch Childrens Research Institute (MCRI) and the Victorian Government’s Operational Infrastructure Support Program. Dr Gunn received a postgraduate health research scholarship from National Health and Medical Research Council (NHMRC) and MCRI.

Conflicts of interest

The authors have no financial disclosures or conflicts of interest to declare.

Author information

Authors and Affiliations

  1. Department of Neonatal Medicine, Royal Children’s Hospital, Melbourne, Australia

    Julia K. Gunn, Rodney W. Hunt & Monika Olischar

  2. Neonatal Research Group, Murdoch Children’s Research Institute, Melbourne, Australia

    Julia K. Gunn & Rodney W. Hunt

  3. Paediatric Intensive Care Unit, Starship Children’s Hospital, Auckland, New Zealand

    John Beca

  4. Department of Paediatrics, The University of Melbourne, Melbourne, Australia

    Rodney W. Hunt

  5. The Medical University of Vienna, Vienna, Austria

    Monika Olischar

  6. Intensive Care Services, Texas Children’s Hospital, Houston, USA

    Lara S. Shekerdemian

  7. Baylor College of Medicine, 6621 Fannin Street, WT6-006, Houston, TX, 77030, USA

    Lara S. Shekerdemian

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  1. Julia K. Gunn
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  2. John Beca
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  5. Lara S. Shekerdemian
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Correspondence to Lara S. Shekerdemian.

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Gunn, J.K., Beca, J., Hunt, R.W. et al. Perioperative amplitude-integrated EEG and neurodevelopment in infants with congenital heart disease. Intensive Care Med 38, 1539–1547 (2012). https://doi.org/10.1007/s00134-012-2608-y

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  • DOI: https://doi.org/10.1007/s00134-012-2608-y

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