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Updated: Aug 9, 2025
Application of an Amplitude-integrated EEG Monitor Cerebral Function Monitor to Neonates
Published on: September 6, 2017
Continuous electroencephalography (cEEG) in infants with congenital heart disease (CHD)
Swetha Padiyar1, Neil Friedman2, Elia Pestana-Knight3
1Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, OH, USA. swetha.padiyar@gmail.com.
Insights
Neonates with congenital heart disease (CHD) often have normal pre-operative EEGs, but over 80% show abnormalities post-surgery. Longer cardiopulmonary bypass (CPB) times correlate with increased EEG discontinuity, indicating potential brain injury.
Area of Science:
- Neuroscience
- Pediatric Cardiology
- Medical Technology
Background:
- Neonates with congenital heart disease (CHD) face heightened risks of neurodevelopmental impairment following cardiopulmonary bypass (CPB) surgery.
- Brain injury is a significant concern in these vulnerable infants.
Purpose of the Study:
- To characterize pre- and post-operative continuous electroencephalogram (cEEG) patterns in infants with CHD.
- To investigate the association between encephalopathy severity and cEEG findings before and after surgery.
Main Methods:
- A retrospective cohort study of 77 infants with CHD who underwent CPB surgery.
- Continuous EEG monitoring was performed pre- and post-operatively.
- Data collected included CPB duration and circulatory arrest time.
Main Results:
- Most neonates (69%) had normal pre-operative cEEG and sleep-wake cycles (87%).
- Post-operatively, 80% of infants exhibited abnormal cEEG patterns.
- Extended CPB and circulatory arrest times were significantly associated with EEG discontinuity and prolonged inter-burst intervals (IBI).
Conclusions:
- The majority of neonates with CHD experience abnormal post-operative EEGs.
- Prolonged CPB and circulatory arrest times are linked to specific EEG abnormalities.
- Findings aid in parental counseling, risk stratification, and neurodevelopmental monitoring for high-risk infants.
Background:
Neonates with congenital heart disease (CHD) undergoing cardiopulmonary bypass (CPB) surgery have increased risk of impaired neurodevelopmental outcomes secondary to brain injury. This study aims to characterize pre- and post-operative continuous EEG (cEEG) patterns to detect abnormal cerebral activity in infants with CHD and investigate whether an association exists between the degree of encephalopathy in pre- and post-operative cEEG.
Methods:
This retrospective cohort study conducted between 2010 and 2018 at a tertiary hospital in Cleveland, OH included infants with CHD with cEEG monitoring, who underwent CPB surgery within first 6 months of life.
Results:
Study included 77 patients, of which 61% were males who were operated at median age 6 days. Pre-operatively, 69% and 87% had normal cEEG and sleep-wake cycles, respectively. Post-operatively, 80% had abnormal cEEG. Longer circulatory arrest time and CPB were associated with lack of continuity (p 0.011), excessive discontinuity (p 0.007) and prolonged inter-burst interval (IBI) duration (p value < 0.001). A significant association existed between severity of encephalopathy in immediate and 24-h post-operative period (p value < 0.001).
Conclusions:
More than 80% of neonates with CHD have abnormal post-operative EEG. Longer circulatory arrest time and CPB were associated with lack of continuity, excessive discontinuity, and prolonged IBI duration on post-operative EEG.
Impact:
This study shows that majority of neonates with congenital heart disease (CHD) have normal pre-operative EEG with a continuous background and normal sleep-wake cycles. Also, 80% of neonates had abnormal post-operative EEG. Longer duration of arrest time and bypass time was associated with lack of continuity, excessive discontinuity, and prolonged IBI duration during post-operative EEG monitoring. These findings will help clinicians when counseling parents in the intensive care unit, risk stratification, and long-term neurodevelopmental monitoring in these high-risk patients.
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