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Perioperative amplitude-integrated EEG and neurodevelopment in infants with congenital heart disease
Julia K Gunn1, John Beca, Rodney W Hunt
1Department of Neonatal Medicine, Royal Children's Hospital, Melbourne, Australia. julia.gunn@mcri.edu.au
Insights
Perioperative seizures in infants undergoing heart surgery did not affect 2-year outcomes. However, delayed recovery of amplitude-integrated electroencephalography (aEEG) patterns indicated higher mortality and poorer neurodevelopmental results.
Area of Science:
- Neonatal neurology
- Pediatric cardiology
- Neurodevelopmental outcomes
Background:
- Perioperative brain injury is a significant concern in infants undergoing cardiac surgery.
- Amplitude-integrated electroencephalography (aEEG) is used to monitor brain activity in this vulnerable population.
Purpose of the Study:
- To investigate the relationship between perioperative electrical seizures, aEEG background patterns, and 2-year neurodevelopmental outcomes in infants undergoing cardiac surgery.
- To assess the prognostic value of aEEG in predicting outcomes after congenital heart surgery.
Main Methods:
- 150 newborn infants undergoing cardiac surgery were monitored using aEEG before, during, and for 72 hours after surgery.
- Two blinded assessors analyzed aEEG for seizures and background patterns.
- Survivors underwent neurodevelopmental assessment at 2 years using the Bayley Scales of Infant Development (3rd edn.).
Main Results:
- Perioperative electrical seizures occurred in 30% of infants and were not associated with 2-year outcomes.
- Delayed recovery of a continuous aEEG background pattern (beyond 48 hours) was linked to impaired neurodevelopment across all domains.
- Failure of aEEG to normalize by 7 days postoperatively strongly correlated with increased mortality.
Conclusions:
- While perioperative seizures did not impact 2-year neurodevelopmental outcomes, delayed aEEG recovery is a critical indicator of increased mortality risk and worse neurodevelopment.
- Continued aEEG monitoring is essential for assessing long-term outcomes in infants post-cardiac surgery.
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.
