Seizures in congenital heart disease: risks, outcomes, and birth cohort data from China

Congenital heart disease is the most common birth defect and carries a high risk of seizures; however, specific risk factors and long-term neurodevelopmental outcomes remain poorly defined. We aimed to identify factors associated with seizure occurrence and evaluate neurodevelopmental outcomes in children with congenital heart disease.

This prospective cohort study included 31,734 singleton live births in Lanzhou, China (2018-2023) followed for 18 months. Maternal, demographic, and clinical data were prospectively collected. Congenital heart disease phenotypes were classified as left-to-right shunt, cyanotic, left-sided, or single-ventricle lesions. Univariate logistic regression was conducted to identify factors associated with clinical seizures, and electroclinical and neurodevelopmental profiles were systematically evaluated.

Congenital heart disease was diagnosed in 392 infants (1.2%), of whom 23 (5.9%) experienced clinical seizures. Lower birthweight, prolonged hospitalization, and extracorporeal membrane oxygenation support were significantly associated with seizure occurrence (all P < 0.001). Among congenital heart disease phenotypes, single-ventricle physiology had the highest seizure incidence (5.8%, P < 0.001). Electroencephalography identified focal impaired awareness seizures (n = 13), electrographic-only seizures (n = 2), and diverse interictal abnormalities. At 18 months, children with seizures demonstrated significantly lower motor scores (P = 0.038) and higher rates of global developmental delay/intellectual disability (P < 0.001).

Seizures represent a critical complication in infants with congenital heart disease, particularly those with single-ventricle physiology or requiring prolonged hospitalization or mechanical circulatory support. Seizure development was associated with poorer 18-month neurodevelopmental outcomes, underscoring the need for proactive neurological surveillance and larger multicenter studies to identify independent risk pathways.