Amplitude integrated electroencephalographic activity in infants with congenital heart disease before surgery

Infants with congenital heart disease (CHD) are at risk for brain injury. An accurate tool to monitor brain function is amplitude integrated EEG (aEEG). It records both background patterns and electrographic seizure activity (EA).

Our aim was to determine aEEG patterns in infants with CHD and to determine the differences between infants with a cyanotic or an acyanotic CHD.

Sixty-two full term newborns had either a cyanotic CHD (transposition of the great arteries (n=24)) or an acyanotic CHD (hypoplastic left heart syndrome (n=26), critical aortic valve stenosis (n=1) or aortic coarctation (n=11)). The background patterns, sleep-wake cycling (SWC), and EA were assessed. The first 72h after starting prostaglandin E(1)-therapy were used for analysis.

The background patterns were mildly abnormal in 45% of the infants and severely abnormal at some point during the recording in 14% of the infants. We found no differences in background patterns between the two groups. EA was present in 12 (19%) infants. EA was more frequent in infants with acyanotic CHD (OR 9.4, 95% CI 1.1-78, p=0.039). SWC was equally frequent in infants with cyanotic and infants with acyanotic CHD. A severely abnormal aEEG and EA were associated with more profound acidosis.

Before surgery the majority of infants with a CHD had an abnormal aEEG. aEEG helped to identify EA and it was a useful tool to evaluate brain function prior to surgery in CHD.