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Relation of seizures after cardiac surgery in early infancy to neurodevelopmental outcome. Boston Circulatory Arrest
L A Rappaport1, D Wypij, D C Bellinger
1Department of Medicine, Children's Hospital, Boston, MA 02115, USA. Rappaport@A1.tch.harvard.edu
Insights
Infants experiencing seizures after heart surgery may face developmental delays and neurological issues. Early detection of these seizures can signal potential brain injury and long-term consequences.
Area of Science:
- Pediatric Neurology
- Cardiovascular Surgery
- Developmental Neuroscience
Background:
- The neurodevelopmental outcomes of infants experiencing transient seizures post-open heart surgery remain understudied.
- This study utilizes data from the Boston Circulatory Arrest Study, focusing on 171 children with D-transposition of the great arteries.
Purpose of the Study:
- To investigate the association between early postoperative clinical and electroencephalogram (EEG) seizures and neurodevelopmental outcomes at 1 and 2.5 years of age.
- To identify potential early indicators of brain injury following cardiac surgery in infants.
Main Methods:
- Prospective evaluation of 171 infants undergoing arterial switch operation for D-transposition of the great arteries.
- Assessment of clinical and EEG seizures in the early postoperative period.
- Neurodevelopmental evaluations, neurological examinations, and MRI scans at 1 year, with developmental questionnaires at 2.5 years.
Main Results:
- Infants with early postoperative seizures exhibited significantly lower Psychomotor Development Index scores at 1 year.
- Seizure occurrence was linked to a higher likelihood of abnormal neurological examinations and MRI findings at 1 year.
- Children with EEG seizures showed poorer functional scores at 2.5 years of age.
Conclusions:
- Transient postoperative seizures in infants undergoing arterial switch operation for D-transposition of the great arteries are associated with adverse neurodevelopmental outcomes.
- These seizures may serve as an early marker for brain injury, predicting neurological and developmental sequelae.
- Findings underscore the importance of monitoring for seizures post-cardiac surgery to identify infants at risk for long-term complications.
Background:
The outcome of infants who have transient seizures after open heart surgery has not been studied. Using the database of the Boston Circulatory Arrest Study involving 171 children with D-transposition of the great arteries, we explored the relationship between early postoperative clinical and EEG seizures and neurodevelopmental outcomes at ages 1 and 2 1/2 years.
Methods And Results:
At 1 year, children returned for developmental and neurological evaluations and MRI. Parent-completed developmental questionnaires were collected at 2 1/2 years of age. At 1 year, children with early postoperative seizures had lower Psychomotor Development Index (motor function) scores (clinical seizures: 12.9 mean difference [MD]; 95% confidence interval [CI], 2.2 to 23.6; P=.02; EEG seizures: 13.3 MD; 95% CI, 6.8 to 19.7; P<.001). Mental Developmental Index scores of children with clinical or EEG seizures were also lower, but the differences were not statistically significant. Infants with seizures were more likely to have an abnormal neurological examination (clinical seizures: 78% versus 31%; P=.008; EEG seizures: 58% versus 34%; P=.04). Children with EEG seizures were more likely to have MRI abnormalities (43% versus 13%, P=.002). At age 2 1/2, children with EEG seizures had lower scores in several areas of function.
Conclusions:
In infants undergoing the arterial switch operation for correction of D-transposition of the great arteries, transient postoperative clinical and EEG seizures were associated with worse neurodevelopmental outcomes at ages 1 and 2 1/2 years as well as neurological and MRI abnormalities at 1 year of age. The occurrence of such seizures may provide an early sign of brain injury with neurological and developmental sequelae.