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Postoperative Amplitude-Integrated Electroencephalography Predicts Four-Year Neurodevelopmental Outcome in Children
Beatrice Latal1, Gabriele Wohlrab2, Barbara Brotschi3
1Child Development Center, University Children's Hospital, Zurich, Switzerland; Children's Research Center, University Children's Hospital, Zurich, Switzerland.
Insights
Amplitude-integrated electroencephalography (aEEG) can predict neurodevelopmental outcomes in infants with congenital heart disease (CHD) after surgery. Abnormal postoperative aEEG patterns and lack of sleep-wake cycles indicate poorer cognitive development.
Area of Science:
- Pediatric Cardiology
- Neurodevelopmental Pediatrics
- Clinical Neurophysiology
Background:
- Congenital heart disease (CHD) affects numerous infants globally.
- Cardiac surgery in early infancy can pose risks to neurodevelopmental outcomes.
- Predictive tools are needed to identify infants at risk for adverse neurodevelopmental trajectories post-cardiac surgery.
Purpose of the Study:
- To assess the predictive capability of pre- and postoperative amplitude-integrated electroencephalography (aEEG) for neurodevelopmental outcomes in infants undergoing surgery for CHD.
- To identify specific aEEG parameters that correlate with cognitive and motor development in this population.
Main Methods:
- A prospective cohort of 60 infants with CHD, aged within the first 3 months of life, were enrolled.
- aEEG monitoring was conducted for 12 hours preoperatively and 48 hours postoperatively.
- Neurodevelopmental outcomes were evaluated at 1 and 4 years using standardized tests, with aEEG background patterns, seizures, and sleep-wake cycles (SWCs) analyzed.
Main Results:
- Postoperatively, 12% of infants exhibited abnormal aEEG background patterns (flat trace, burst suppression, or continuous low voltage).
- 32% of infants did not achieve normal sleep-wake cycles (SWCs) within the postoperative recording period.
- Abnormal postoperative aEEG background patterns and lack of SWCs independently predicted lower intelligence quotients at 4 years, but not motor outcomes.
Conclusions:
- Amplitude-integrated electroencephalography (aEEG) serves as a valuable bedside tool for predicting outcomes in infants undergoing open-heart surgery for CHD.
- Postoperative abnormal aEEG background patterns and delayed return to SWCs are significant markers of subsequent impaired cognitive development.
Objectives:
To evaluate the predictive value of pre- and postoperative amplitude-integrated electroencephalography (aEEG) on neurodevelopmental outcomes in children operated for congenital heart disease (CHD).
Study Design:
Prospectively enrolled cohort of 60 infants with CHD who underwent cardiac surgery with cardiopulmonary bypass in the first 3 months of life. Infants with a genetic comorbidity were excluded. aEEG was assessed for 12 hours pre- and 48 hours postoperatively. Background pattern was classified by the use of standard categories, and the presence of seizures and sleep-wake cycles (SWCs) was noted. Outcome at 1 and 4 years of age was assessed with standardized developmental tests.
Results:
Preoperatively, infants either showed continuous normal voltage (n = 56) or discontinuous normal voltage (n = 4). Postoperatively, abnormal background pattern (flat trace, burst suppression, or continuous low voltage) was detected in 7 (12%), discontinuous normal voltage in 37 (61%), and continuous normal voltage in 16 (27%) infants. Nineteen infants (32%) did not return to normal SWCs within the recording period. Seizures were detected in 4 infants preoperatively and in another 4 postoperatively. After we controlled for surgical and postoperative risk factors, abnormal postoperative background pattern and lack of return to SWCs independently predicted poorer intelligence quotient at 4 years (P = .03 and P = .04 respectively) but was not related to motor outcome.
Conclusion:
aEEG is a useful bedside tool that helps to predict outcome in infants undergoing open-heart surgery for CHD. Abnormal postoperative background pattern and lack of return to SWCs are markers for subsequent impaired cognitive development.
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