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Perioperative amplitude-integrated EEG and neurodevelopment in infants with congenital heart disease.
MedLine Citation:
PMID:  22653373     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
PURPOSE: Perioperative brain injury is common in young infants undergoing cardiac surgery. We aimed to determine the relationship between perioperative electrical seizures, the background pattern of amplitude-integrated electroencephalography (aEEG) and 2-year neurodevelopmental outcome in young infants undergoing surgery for congenital heart disease. METHODS: A total of 150 newborn infants undergoing cardiac surgery underwent aEEG monitoring prior to and during surgery, and for 72 h postoperatively. Two blinded assessors reviewed the aEEGs for seizure activity and background pattern. Survivors underwent neurodevelopmental outcome assessment using the Bayley Scales of Infant Development (3rd edn.) at 2 years. RESULTS: The median age at surgery was 7 days (IQR 4-11). Cardiopulmonary bypass was used in 83 %. Perioperative electrical seizures occurred in 30 %, of whom 1/4 had a clinical correlate, but were not associated with 2-year outcome. Recovery to a continuous background occurred at a median 6 (3-13) h and sleep-wake cycling recovered at 21 (14-30) h. Prolonged aEEG recovery was associated with increased mortality and worse neurodevelopmental outcome. Failure of the aEEG to recover to a continuous background by 48 postoperative hours was associated with impairment in all outcome domains (p < 0.05). Continued abnormal aEEG at 7 postoperative days was highly associated with mortality (p < 0.001). CONCLUSIONS: Perioperative seizures were common in this cohort of infants but did not impact on 2-year neurodevelopmental outcome. Delayed recovery in aEEG background was associated with increased risk of early mortality and worse neurodevelopment. Ongoing monitoring of the survivors is essential to determine the longer-term significance of these findings.
Authors:
Julia K Gunn; John Beca; Rodney W Hunt; Monika Olischar; Lara S Shekerdemian
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-6-1
Journal Detail:
Title:  Intensive care medicine     Volume:  -     ISSN:  1432-1238     ISO Abbreviation:  -     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-6-1     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Department of Neonatal Medicine, Royal Children's Hospital, Melbourne, Australia, julia.gunn@mcri.edu.au.
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