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Published on: July 1, 2015
Postoperative EEG abnormalities in relation to neurodevelopmental outcomes after pediatric cardiac surgery
Jinqing Feng1,2, Rouyi Lin1,2, Yani Zhang3
1Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Medical University, Guangzhou, Guangdong Province, China.
Insights
Postoperative EEG abnormalities in children after cardiac surgery, including background and discharge issues, are linked to neurodevelopmental impairment. Early EEG evaluation can help understand brain injury and guide clinical management.
Area of Science:
- Pediatric Neurology
- Cardiac Surgery Outcomes
- Neurodevelopmental Pediatrics
Background:
- Previous research linked early postoperative EEG abnormalities to adverse outcomes in pediatric cardiac surgery patients.
- Sleep-wake cycle (SWC) and discharge abnormalities (seizures, spikes/sharp waves) were previously correlated with early adverse outcomes.
- The relationship between these specific EEG findings and long-term neurodevelopmental outcomes remained to be fully elucidated.
Purpose of the Study:
- To investigate the association between early postoperative electroencephalogram (EEG) abnormalities and neurodevelopmental outcomes at approximately two years of age in children following cardiac surgery.
- To analyze the impact of EEG background abnormalities, sleep-wake cycle disturbances, seizures, and spikes/sharp waves on cognitive and motor development.
Main Methods:
- A cohort of 121 infants undergoing cardiac surgery (median age 3.3 months) was studied.
- Postoperative EEG abnormalities were assessed within the first 48 hours after surgery.
- Neurodevelopmental assessment using the Griffiths Mental Development Scales-Chinese was performed at 16-31 months of age.
Main Results:
- Over 48% of patients exhibited EEG background abnormalities, with a significant portion not recovering within 48 hours.
- Abnormalities in sleep-wake cycle, seizures (including frontal lobe seizures), and spikes/sharp waves were observed in a notable percentage of patients.
- EEG background abnormalities, the number of spikes/sharp waves, and frontal lobe seizures were significantly associated with neurodevelopmental impairment at 1-2 years post-surgery.
Conclusions:
- Early postoperative EEG abnormalities, encompassing background and discharge patterns, are significantly associated with neurodevelopmental impairment in children after cardiac surgery.
- Comprehensive early EEG evaluation is crucial for understanding postoperative brain injury and its long-term neurodevelopmental consequences.
- These findings underscore the importance of EEG monitoring for guiding clinical management and improving outcomes in pediatric cardiac surgery patients.
Background:
We had reported that postoperative EEG background including sleep-wake cycle (SWC) and discharge (seizures, spikes/sharp waves) abnormalities were significantly correlated with adverse early outcomes in children after cardiac surgery. We aimed to analyze the relations between these EEG abnormalities and neurodevelopmental outcomes at about 2 years after cardiac surgery.
Methods:
We enrolled 121 patients undergoing cardiac surgery at 3.3 months (0.03 ~ 28 months). EEG abnormalities described above during the first postoperative 48 h were evaluated. Griffiths Mental Development Scales-Chinese was used to evaluate the quotients of overall development and 5 subscales of the child's locomotor, language, personal-social, eye-hand coordination and performance skills at 16 ~ 31 months of age.
Results:
EEG background abnormalities occurred in 59/121 (48.8%) patients and 33 (55.9%) unrecovered to normal by 48 h. Abnormal SWC occurred in 15 (12.4%) patients and 7 (5.8%) unrecovered to normal by 48 h. EEG seizures occurred in 11 (9.1%) patients with frontal lobe seizures in 4. Spikes/sharp waves occurred in 100 (82.6%). EEG background abnormalities, number of spikes/sharp waves and frontal lobe seizures were significantly associated with neurodevelopmental impairment at about 1 ~ 2 year after surgery (Ps ≤ 0.05).
Conclusions:
Most parameters of EEG abnormalities were significantly associated with neurodevelopmental impairment after cardiac surgery.
Impact:
Neurodevelopmental impairment in children with congenital heart disease remain poorly understood. Previous studies had reported that either EEG seizures or background abnormalities were associated with worse neurodevelopmental outcomes. Our present study showed that all the EEG background and discharge abnormalities including EEG background, seizures and spikes/sharp waves in the early postoperative period were significantly associated with neurodevelopmental impairment at about 1 ~ 2 years after cardiac surgery. Comprehensive evaluation of early postoperative EEG may provide further insights about postoperative brain injury, its relation with neurodevelopmental impairment, and guide to improve clinical management.
