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Seizures in Infants With Congenital Heart Disease: A National Cohort Study
Safwat Aly1,2, Ibrahim Qattea3, Nao Sasaki1,2
1Department of Cardiology Boston Children's Hospital Boston MA.
Insights
Infants with congenital heart disease (CHD) have a significantly higher risk of seizures, with single ventricle defects posing the greatest threat. Seizures in these infants are linked to increased mortality and longer hospital stays.
Area of Science:
- Pediatric Neurology
- Cardiology
- Neonatology
Background:
- Infants with congenital heart disease (CHD) present a unique population with potential for neurological complications.
- Seizures are a significant concern in this vulnerable group, impacting outcomes.
Purpose of the Study:
- To investigate the incidence and risk factors of seizures in infants diagnosed with congenital heart disease.
- To compare seizure occurrence and outcomes between infants with CHD and those without.
- To identify specific types of CHD associated with higher seizure risk.
Main Methods:
- Analysis of the US National Inpatient Sample Database from 2016-2020.
- Inclusion of infants with CHD and seizures, excluding premature infants and those with CNS/genetic disorders.
- Classification of CHD into shunt, cyanotic, left-sided, or single ventricle lesions for comparative analysis.
Main Results:
- Infants with CHD had a 5.7 times higher odds of experiencing seizures compared to those without (1.8% vs 0.21%).
- Single ventricle physiology showed the highest seizure incidence (3.2%), while cyanotic CHDs had the lowest (1.2%).
- Seizures in CHD infants were associated with increased mortality (8.5% vs 1.1%) and longer hospitalizations.
Conclusions:
- Congenital heart disease significantly elevates the risk of seizures in infants.
- Specific CHD types, particularly single ventricle defects, are associated with higher seizure incidence.
- Seizures in infants with CHD are a marker for poorer outcomes, including higher mortality rates.
Background:
Infants with congenital heart disease (CHD) may have an increased risk of seizures.
Methods:
We analyzed the US National Inpatient Sample Database (2016-2020). We included infants with CHD who developed seizures. We excluded premature infants <34 weeks and infants with central nervous system or genetic disorders. CHD was classified into shunt, cyanotic, left-sided, or single ventricle lesions. We compared demographics, clinical characteristics, and outcomes between CHD infants with versus without seizures.
Results:
Infants in the weighted sample (19 089 414) met our inclusion criteria. Of that group, 42.4% of patients were female and 45.8% were White. There were 417 053 (2.2%) patients identified with CHD, and 47 501 (0.25%) patients had at least 1 episode of seizure. Seizures occurred in 1.8% of infants with any CHD versus 0.21% of infants with no CHD (adjusted odds ratio, 5.7 [95% CI, 5.5-5.8]; P <0.001). Cyanotic CHDs were associated with the lowest incidence of seizure (1.2%) compared with shunt lesions (1.8%), left-sided CHD (1.9%), or single ventricle physiology (3.2%). Factors associated with seizure in patients with CHD included male sex, maternal hypertension, sepsis, acute kidney injury, stroke, and extracorporeal membrane oxygenation support. Mortality was higher in infants with CHD who developed seizures (8.5% versus 1.1%, adjusted odds ratio 3.6 [95% CI, 3.3-4.0], P <0.001).
Conclusions:
Infants with CHD have higher odds of experiencing seizure. Cyanotic CHD had the lowest incidence of seizure, while patients with single ventricle experienced the highest risk. Having seizures was associated with longer hospital stay and higher odds of mortality. This information may help in counseling families about the neurologic outcomes of infants with CHD.
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