Continuous Electroencephalography (cEEG) in Infants with Congenital Heart Disease (CHD)

Overview

Journal Pediatr Res

Specialties Biology
Pediatrics

Date 2023 Feb 15

PMID 36792651

Authors

Swetha Padiyar

Neil Friedman

Elia Pestana-Knight

Ahsan Mossa-Naduvil

Linda Franic

Sarah Worley

Hany Aly

Affiliations

Soon will be listed here.

Abstract

Background: Neonates with congenital heart disease (CHD) undergoing cardiopulmonary bypass (CPB) surgery have increased risk of impaired neurodevelopmental outcomes secondary to brain injury. This study aims to characterize pre- and post-operative continuous EEG (cEEG) patterns to detect abnormal cerebral activity in infants with CHD and investigate whether an association exists between the degree of encephalopathy in pre- and post-operative cEEG.

Methods: This retrospective cohort study conducted between 2010 and 2018 at a tertiary hospital in Cleveland, OH included infants with CHD with cEEG monitoring, who underwent CPB surgery within first 6 months of life.

Results: Study included 77 patients, of which 61% were males who were operated at median age 6 days. Pre-operatively, 69% and 87% had normal cEEG and sleep-wake cycles, respectively. Post-operatively, 80% had abnormal cEEG. Longer circulatory arrest time and CPB were associated with lack of continuity (p 0.011), excessive discontinuity (p 0.007) and prolonged inter-burst interval (IBI) duration (p value < 0.001). A significant association existed between severity of encephalopathy in immediate and 24-h post-operative period (p value < 0.001).

Conclusions: More than 80% of neonates with CHD have abnormal post-operative EEG. Longer circulatory arrest time and CPB were associated with lack of continuity, excessive discontinuity, and prolonged IBI duration on post-operative EEG.

Impact: This study shows that majority of neonates with congenital heart disease (CHD) have normal pre-operative EEG with a continuous background and normal sleep-wake cycles. Also, 80% of neonates had abnormal post-operative EEG. Longer duration of arrest time and bypass time was associated with lack of continuity, excessive discontinuity, and prolonged IBI duration during post-operative EEG monitoring. These findings will help clinicians when counseling parents in the intensive care unit, risk stratification, and long-term neurodevelopmental monitoring in these high-risk patients.

Citing Articles

Neuromonitoring practices for neonates with congenital heart disease: a scoping review.

Pardo A, Carrasco M, Wintermark P, Nunes D, Chock V, Sen S Pediatr Res. 2024; .

PMID: 39183308 DOI: 10.1038/s41390-024-03484-x.

Perioperative Neuromonitoring in Children with Congenital Heart Disease.

Massey S, Weinerman B, Naim M Neurocrit Care. 2023; 40(1):116-129.

PMID: 37188884 DOI: 10.1007/s12028-023-01737-x.

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