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Updated: Mar 28, 2026
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Published on: February 11, 2013
Neurodevelopmental outcomes after neonatal cardiac surgery: Role of cortical isoelectric activity
Laurie Seltzer1, Michael F Swartz2, Jennifer Kwon1
1Department of Neurology, University of Rochester Medical Center, Rochester, NY.
Insights
Intraoperative electroencephalogram (EEG) monitoring during heart surgery in neonates revealed that prolonged periods of isoelectric states (no brain activity) were linked to poorer neurodevelopmental outcomes in children.
Area of Science:
- Neonatal care
- Neuroscience
- Pediatric cardiology
Background:
- Congenital heart disease (CHD) poses risks for neurodevelopmental impairment in neonates post-cardiac surgery.
- Intraoperative electroencephalogram (EEG) monitoring may offer predictive insights into these outcomes.
Purpose of the Study:
- To investigate the relationship between intraoperative EEG patterns and neurodevelopmental outcomes in neonates undergoing cardiac surgery.
- To determine if EEG activity can predict future neurodevelopmental trajectories.
Main Methods:
- Continuous intraoperative EEG and hemodynamic monitoring were performed on neonates undergoing cardiac surgery.
- EEG suppression levels were categorized (slow continuous, moderate burst, severe burst, isoelectric).
- Neurodevelopmental outcomes were assessed using the Vineland Adaptive Behavior Scale II (Vineland-II).
Main Results:
- Neonates developing an isoelectric EEG state during surgery had significantly longer durations of no brain activity compared to circulatory arrest times.
- At follow-up, neonates with isoelectric states showed lower Vineland-II communication scores.
- Longer durations of isoelectric activity (>90 minutes) correlated with significantly lower overall Vineland-II scores.
Conclusions:
- The duration of intraoperative cortical isoelectric states is associated with neurodevelopmental outcomes in neonates after cardiac surgery.
- Continuous EEG monitoring to minimize isoelectric states could be a valuable strategy during complex congenital heart surgeries.
Objectives:
Neonates with congenital heart disease are at risk for impaired neurodevelopment after cardiac surgery. We hypothesized that intraoperative EEG activity may provide insight into future neurodevelopmental outcomes.
Methods:
Neonates requiring surgery had continuous intraoperative EEG and hemodynamic monitoring. The level of EEG suppression was classified as either: slow and continuous; moderate burst suppression; severe burst suppression; or isoelectric (no brain activity for >3 minutes). Follow-up neurodevelopmental outcomes were assessed using the Vineland Adaptive Behavior Scale II (Vineland-II).
Results:
Twenty-one neonates requiring cardiac surgery developed a slow and continuous EEG pattern after general anesthesia. Ten neonates (48%) maintained continuous brain electrical activity with moderate burst suppression as the maximum level of EEG suppression. Eleven neonates (52%) developed severe burst suppression that progressed into an isoelectric state during the deep hypothermic period required for circulatory arrest. However, the duration of this state was significantly longer than circulatory arrest times (111.1 ± 50 vs 22.3 ± 17 minutes; P < .001). At a mean follow-up at 5.6 ± 1.0 years, compared with neonates with continuous brain electrical activity, neonates who developed an isoelectric state had lower Vineland-II scores in communication. There was an inverse relationship between composite Vineland-II scores and duration of isoelectric activity (R = -0.75, P = .01). Of neonates who experienced an isoelectric state, durations of >90 minutes were associated with the lowest Vineland-II scores (125.0 ± 2.6 vs 81.1 ± 12.7; P < .01).
Conclusions:
The duration of cortical isoelectric states seems related to neurodevelopmental outcomes. Strategies using continuous EEG monitoring to minimize isoelectric states may be useful during complex congenital heart surgery.
