Amplitude-Integrated Electroencephalography and Brain Injury in Infants Undergoing Norwood-Type Operations

Gunn, Julia; Beca, John; Penny, Daniel J.; Horton, Stephen; d’Udekem, Yves; Finucane, Kirsten; Olischar, Monika; Hunt, Rod W.; Shekerdemian, Lara

doi:10.1016/j.athoracsur.2011.08.014

Cited by 47 publications

(45 citation statements)

References 34 publications

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“…These studies suggest that identifying and treating seizures may reduce secondary brain injury and improve outcomes. Gunn and colleagues 8,19 did not find neurodevelopmental impairment at 2-year follow-up in neonates who had perioperative seizures, but testing at this age is limited and does not test higher functions such as memory and executive function. Further, there may have been some misclassification of patients with and without seizures because the study used amplitude-integrated EEG and not conventional full-array EEG.…”

Section: Discussionmentioning

confidence: 97%

“…In the Boston Circulatory Arrest Study, 2% (n = 3) of infants died within 1 month of surgery, but no association with postoperative seizures was reported. 9 Gunn and colleagues 8 reported a 44% early mortality in neonates with hypoplastic left heart syndrome and variants who had seizures after Norwood type operations compared with 13% without postoperative seizures.…”

Section: Discussionmentioning

confidence: 99%

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Subclinical seizures identified by postoperative electroencephalographic monitoring are common after neonatal cardiac surgery

Naim

Gaynor

Chen

et al. 2015

The Journal of Thoracic and Cardiovascular Surgery

118

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Objectives The American Clinical Neurophysiology Society recommends continuous electroencephalographic monitoring after neonatal cardiac surgery because seizures are common, often subclinical, and associated with worse neurocognitive outcomes. We performed a quality improvement project to monitor for postoperative seizures in neonates with congenital heart disease after surgery with cardiopulmonary bypass. Methods We implemented routine continuous electroencephalographic monitoring and reviewed the results for an 18-month period. Clinical data were collected by chart review, and continuous electroencephalographic tracings were interpreted using standardized American Clinical Neurophysiology Society terminology. Electrographic seizures were classified as electroencephalogram-only or electroclinical seizures. Multiple logistic regression was used to assess associations between seizures and potential clinical and electroencephalogram predictors. Results A total of 161 of 172 eligible neonates (94%) underwent continuous electroencephalographic monitoring. Electrographic seizures occurred in 13 neonates (8%) beginning at a median of 20 hours after return to the intensive care unit after surgery. Neonates with all types of congenital heart disease had seizures. Seizures were electroencephalogram only in 11 neonates (85%). Status epilepticus occurred in 8 neonates (62%). In separate multivariate models, delayed sternal closure or longer deep hypothermic circulatory arrest duration was associated with an increased risk for seizures. Mortality was higher among neonates with than without seizures (38% vs 3%, P<.001). Conclusions Continuous electroencephalographic monitoring identified seizures in 8%of neonates after cardiac surgery with cardiopulmonary bypass. The majority of seizures had no clinical correlate and would not have been otherwise identified. Seizure occurrence is a marker of greater illness severity and increased mortality. Further study is needed to determinewhether seizure identification and management lead to improved outcomes.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Subclinical seizures identified by postoperative electroencephalographic monitoring are common after neonatal cardiac surgery

Naim

Gaynor

Chen

et al. 2015

The Journal of Thoracic and Cardiovascular Surgery

118

View full text Add to dashboard Cite

show abstract

“…11 A study of aEEG postoperatively showed that a delayed recovery of the cerebral background pattern was associated with impaired motor outcomes at two years of age. 13 Therefore, evaluation of an infant’s EEG can provide valuable neurodevelopmental prognostic information.…”

Section: Introductionmentioning

confidence: 99%

Amplitude-Integrated EEG in Newborns With Critical Congenital Heart Disease Predicts Preoperative Brain Magnetic Resonance Imaging Findings

Mulkey

Yap

Bai

et al. 2015

Pediatric Neurology

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OBJECTIVE The study aims are to evaluate cerebral background patterns using amplitude-integrated electroencephalography (aEEG) in newborns with critical congenital heart disease (CHD), determine if aEEG is predictive of preoperative brain injury and assess the incidence of preoperative seizures. We hypothesize that aEEG will show abnormal background patterns in the early preoperative period in infants with CHD that have preoperative brain injury on magnetic resonance imaging (MRI). METHODS Twenty-four newborns with CHD requiring surgery at less than 30 days of age were prospectively enrolled within the first three days of age at a tertiary care pediatric hospital. Infants had aEEG for 24 hours beginning close to birth and preoperative brain MRI. The aEEGs were read to determine if the background pattern was normal, mildly abnormal, or severely abnormal. The presence of seizures and sleep-wake cycling were noted. The preoperative brain MRIs were used for brain injury and brain atrophy assessment. RESULTS Fifteen of 24 infants had an abnormal aEEG at 0.71 [0–2] (mean [range]) days of age. In five infants the background pattern was severely abnormal (burst suppression and/or continuous low voltage). Of the 15 infants with an abnormal aEEG, 9 (60%) had brain injury. One infant, with brain injury, had a seizure on aEEG. A severely abnormal background pattern on aEEG was associated with brain atrophy (P = 0.03) and absent sleep-wake cycling (P = 0.022). CONCLUSION Background cerebral activity is abnormal on aEEG following birth in newborns with CHD that have findings of brain injury and/or brain atrophy on preoperative brain MRI.

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“…Gunn and colleagues 22 evaluated 39 full-term infants undergoing the Norwood procedure with amplitude-integrated EEG monitoring both intraoperatively and for 72 hours postoperatively. However, this technique is less accurate in detecting EEG seizures compared with conventional EEG monitoring.…”

Section: Discussionmentioning

confidence: 99%

Postoperative electroencephalographic seizures are associated with deficits in executive function and social behaviors at 4 years of age following cardiac surgery in infancy

Gaynor

Jarvik

Gerdes

et al. 2013

The Journal of Thoracic and Cardiovascular Surgery

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Objective The occurrence of an electroencephalographic (EEG) seizure after surgery for complex congenital heart defects has been associated with worse neurodevelopmental (ND) outcomes. We previously identified post-operative seizures documented by 48-hour EEG monitoring in 11% of 178 neonates and infants. Evaluation at 1 year of age did not identify an adverse effect of an EEG seizure on ND outcomes. The current study was undertaken to determine if testing in the preschool period would identify deficits that become apparent as children develop. Methods The ND outcomes assessed at 4 years of age included cognition, language, attention, impulsivity, executive function, behavior problems, academic achievement, and visual and fine motor skills. Results Developmental evaluations were performed in 132 (87%) of 151 survivors. For the entire cohort, the Full-Scale IQ was 95.0 ± 18.5. IQ was 95.1 ± 18.7 for patients without a history of seizure and 93.6 ± 16.7 for those with a history of seizure. After covariate adjustment, occurrence of an EEG seizure was associated with worse executive function (P = .037) and impaired social interactions/restricted behavior (P = .05). Seizures were not significantly associated with worse performance for cognition, language, attention, impulsivity, academic achievement, or motor skills (all P > .1). Conclusions The occurrence of a postoperative seizure is a biomarker of brain injury. This study confirms that postoperative EEG seizures are associated with worse ND outcomes, characterized by impairments of executive function and a higher prevalence of deficits in social interactions and repetitive/restricted behaviors in preschool survivors of cardiac surgery in infancy. However, EEG seizures were not associated with worse cognitive, language, or motor skills.

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Amplitude-Integrated Electroencephalography and Brain Injury in Infants Undergoing Norwood-Type Operations

Cited by 47 publications

References 34 publications

Subclinical seizures identified by postoperative electroencephalographic monitoring are common after neonatal cardiac surgery

Subclinical seizures identified by postoperative electroencephalographic monitoring are common after neonatal cardiac surgery

Amplitude-Integrated EEG in Newborns With Critical Congenital Heart Disease Predicts Preoperative Brain Magnetic Resonance Imaging Findings

Postoperative electroencephalographic seizures are associated with deficits in executive function and social behaviors at 4 years of age following cardiac surgery in infancy

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