Neurodevelopmental outcomes after neonatal cardiac surgery: Role of cortical isoelectric activity

Laurie Seltzer; Michael F Swartz; Jennifer Kwon; James Burchfiel; Jill M Cholette; Hongyue Wang; Dawn Sweeney; Heather R Adams; Cecilia Meagher; Ron Angona; Ronnie Guillet; George M Alfieris

doi:10.1016/j.jtcvs.2015.10.065

Neurodevelopmental outcomes after neonatal cardiac surgery: Role of cortical isoelectric activity

J Thorac Cardiovasc Surg. 2016 Apr;151(4):1137-42. doi: 10.1016/j.jtcvs.2015.10.065. Epub 2015 Oct 27.

Authors

Affiliations

¹ Department of Neurology, University of Rochester Medical Center, Rochester, NY.
² Department of Surgery, University of Rochester Medical Center, Rochester, NY. Electronic address: Michael_Swartz@urmc.rochester.edu.
³ Department of Pediatrics, University of Rochester Medical Center, Rochester, NY.
⁴ Department of Statistics, University of Rochester Medical Center, Rochester, NY.
⁵ Department of Surgery, University of Rochester Medical Center, Rochester, NY; Department of Anesthesia, University of Rochester Medical Center, Rochester, NY.
⁶ Department of Surgery, University of Rochester Medical Center, Rochester, NY.
⁷ Department of Neonatology, University of Rochester Medical Center, Rochester, NY.

PMID: 26707762
DOI: 10.1016/j.jtcvs.2015.10.065

Abstract

Objectives: Neonates with congenital heart disease are at risk for impaired neurodevelopment after cardiac surgery. We hypothesized that intraoperative EEG activity may provide insight into future neurodevelopmental outcomes.

Methods: Neonates requiring surgery had continuous intraoperative EEG and hemodynamic monitoring. The level of EEG suppression was classified as either: slow and continuous; moderate burst suppression; severe burst suppression; or isoelectric (no brain activity for >3 minutes). Follow-up neurodevelopmental outcomes were assessed using the Vineland Adaptive Behavior Scale II (Vineland-II).

Results: Twenty-one neonates requiring cardiac surgery developed a slow and continuous EEG pattern after general anesthesia. Ten neonates (48%) maintained continuous brain electrical activity with moderate burst suppression as the maximum level of EEG suppression. Eleven neonates (52%) developed severe burst suppression that progressed into an isoelectric state during the deep hypothermic period required for circulatory arrest. However, the duration of this state was significantly longer than circulatory arrest times (111.1 ± 50 vs 22.3 ± 17 minutes; P < .001). At a mean follow-up at 5.6 ± 1.0 years, compared with neonates with continuous brain electrical activity, neonates who developed an isoelectric state had lower Vineland-II scores in communication. There was an inverse relationship between composite Vineland-II scores and duration of isoelectric activity (R = -0.75, P = .01). Of neonates who experienced an isoelectric state, durations of >90 minutes were associated with the lowest Vineland-II scores (125.0 ± 2.6 vs 81.1 ± 12.7; P < .01).

Conclusions: The duration of cortical isoelectric states seems related to neurodevelopmental outcomes. Strategies using continuous EEG monitoring to minimize isoelectric states may be useful during complex congenital heart surgery.

Keywords: EEG; deep hypothermic circulatory arrest; neurodevelopmental outcomes.

Publication types

Observational Study
Research Support, N.I.H., Extramural

MeSH terms

Age Factors
Cardiac Surgical Procedures / adverse effects*
Cerebral Cortex / growth & development*
Child
Child Development*
Child, Preschool
Electroencephalography*
Female
Heart Defects, Congenital / diagnosis
Heart Defects, Congenital / physiopathology
Heart Defects, Congenital / surgery*
Humans
Infant Behavior
Infant, Newborn
Intraoperative Neurophysiological Monitoring / methods*
Male
Postoperative Complications / physiopathology
Prospective Studies
Time Factors
Treatment Outcome

Grants and funding

K-12NS 066098/NS/NINDS NIH HHS/United States