Association between electroencephalographic findings and neurologic status in infants with congenital heart defects
C Limperopoulos1, A Majnemer, B Rosenblatt
1School of Physical and Occupational Therapy and the Department of Neurology, Montreal Children's Hospital-McGill University, QC.
Insights
Perioperative electroencephalography (EEG) in infants undergoing heart surgery is crucial. Abnormal EEG findings correlate with poor neurologic status and outcomes, while normal postoperative EEGs suggest a favorable neurologic outcome.
Area of Science:
- Pediatric Neurology
- Cardiovascular Surgery
- Neurophysiology
Background:
- Neurologic status is a significant concern for infants with congenital heart defects (CHDs) undergoing open-heart surgery.
- Assessing perioperative electroencephalography (EEG) provides insights into acute neurologic status and long-term outcomes in this vulnerable population.
Purpose of the Study:
- To examine the association between perioperative EEG findings and acute neurologic status in infants with CHDs.
- To determine the predictive value of EEG abnormalities for neurologic outcomes following open-heart surgery.
Main Methods:
- A cohort of 60 infants with CHDs undergoing open-heart surgery was studied.
- Preoperative and postoperative EEG recordings and neurologic examinations were performed.
- Statistical analysis was used to correlate EEG findings with neurologic status and outcomes.
Main Results:
- Preoperative EEG abnormalities were observed in 14/27 infants, with epileptiform activity in 5 and background disturbances in 9.
- Postoperatively, only 17/47 infants had normal EEGs; newborns (<1 month) showed higher rates of abnormalities.
- Severe background abnormalities on postoperative EEG predicted death or severe disability (100%), while normal EEGs were associated with positive neurologic outcomes (P = .04).
Conclusions:
- Perioperative EEG abnormalities are linked to increased likelihood of acute neurologic deficits in infants undergoing heart surgery.
- Postoperative EEG findings are valuable for predicting neurologic outcomes, with normal EEGs being reassuring.
- EEG monitoring is essential for managing neurologic status and predicting outcomes in infants with CHDs undergoing cardiac surgery.
Abstract:
Neurologic status is of concern in infants with congenital heart defects undergoing open heart surgery. The association between perioperative electroencephalography (EEG) with acute neurologic status and subsequent outcome was examined in a cohort of 60 infants. Preoperative EEG and neurologic examinations were performed within 1 to 2 days prior to surgery (n = 27) and postoperatively (n = 47). Prior to surgery, 15 of 27 infants had normal EEG, whereas 5 had epileptiform activity and 9 had disturbances in background activity that were primarily moderate (8/9) and diffuse (7/9). Postoperatively, only 17 of 47 infants had normal recordings. Newborns (<1 month) were more likely (P< .001) to demonstrate EEG abnormalities than infants. Epileptiform activity was documented in 15, whereas 28 had background abnormalities that were moderate-severe (22/28) and diffuse (20/28) in most. Epileptiform activity prior to surgery was always associated with an abnormal neurologic examination, and this association persisted postoperatively (86%). Moderate to severe background abnormalities in the postoperative EEG was also strongly associated with acute neurologic abnormalities (93%). Severe background abnormalities (n = 5) were 100% predictive of death or severe disability. Long-term follow-up revealed that all children with normal postoperative EEGs had positive neurologic outcomes (P = .04); however, there were many false positives. Perioperative EEG abnormalities increased the likelihood for acute neurologic findings, whereas normal recordings following surgery were reassuring with regard to a favorable outcome.
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