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Development and Validation of a Seizure Prediction Model in Neonates After Cardiac Surgery
Maryam Y Naim1, Mary Putt2, Nicholas S Abend3
1Division of Cardiac Critical Care Medicine, Department of Anesthesiology, Critical Care Medicine, and Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
A prediction model for electroencephalographic seizures (ESs) after neonatal cardiac surgery showed initial promise but ultimately failed validation. Continuous electroencephalographic monitoring (CEEG) is recommended for all neonates post-cardiopulmonary bypass.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Neurocritical Care
Background:
- Electroencephalographic seizures (ESs) are common and often subclinical after neonatal cardiac surgery.
- ESs are linked to adverse neurodevelopmental outcomes in neonates.
- Accurate prediction models could enable targeted continuous electroencephalographic monitoring (CEEG).
Purpose of the Study:
- To develop and validate a prediction model for ESs in neonates following cardiac surgery.
- To assess the clinical utility of the ES prediction model using decision curve analysis (DCA).
Main Methods:
- A multicenter prospective cohort study was conducted.
- All neonates undergoing cardiopulmonary bypass (CPB) received CEEG postoperatively.
- A prediction model was developed and validated using clinical and surgical variables.
Main Results:
- ESs occurred in 7.4% of neonates.
- The model performed well in the derivation cohort but poorly in the validation cohort (c-statistic 0.61).
- Decision curve analysis showed no net benefit for the prediction model in the validation cohort.
Conclusions:
- The developed ES prediction model demonstrated weak performance in the validation cohort.
- Poor discrimination and calibration limit the model's clinical utility.
- Continuous electroencephalographic monitoring (CEEG) is recommended for all neonates after cardiopulmonary bypass.
