Amplitude-Integrated Electroencephalography for Early Recognition of Brain Injury in Neonates with Critical Congenital Heart Disease - 23/10/18
Abstract |
Objective |
To study perioperative amplitude-integrated electroencephalography (aEEG) as an early marker for new brain injury in neonates requiring cardiac surgery for critical congenital heart disease (CHD).
Study design |
This retrospective observational cohort study investigated 76 neonates with critical CHD who underwent neonatal surgery. Perioperative aEEG recordings were evaluated for background pattern (BGP), sleep-wake cycling (SWC), and ictal discharges. Spontaneous activity transient (SAT) rate, inter-SAT interval (ISI), and percentage of time with an amplitude <5 µV were calculated. Routinely obtained preoperative and postoperative magnetic resonance imaging of the brain were reviewed for brain injury (moderate-severe white matter injury, stroke, intraparenchymal hemorrhage, or cerebral sinovenous thrombosis).
Results |
Preoperatively, none of the neonates showed an abnormal BGP (burst suppression or worse) or ictal discharges. Postoperatively, abnormal BGP was seen in 18 neonates (24%; 95% CI, 14%-33%) and ictal discharges was seen in 13 neonates (17%; 95% CI, 8%-26%). Abnormal BGP and ictal discharges were more frequent in neonates with new postoperative brain injury (P = .08 and .01, respectively). Abnormal brain activity (ie, abnormal BGP or ictal discharges) was the single risk factor associated with new postoperative brain injury in multivariable logistic regression analysis (OR, 4.0; 95% CI, 1.3-12.3; P = .02). Postoperative SAT rate, ISI, or time <5 µV were not associated with new brain injury.
Conclusion |
Abnormal brain activity is an early, bedside marker of new brain injury in neonates undergoing cardiac surgery. Not only ictal discharges, but also abnormal BGP, should be considered a clear sign of underlying brain pathology.
Le texte complet de cet article est disponible en PDF.Keywords : brain function, brain activity, cardiac surgery, heart defect, newborns, MRI, brain abnormalities
Abbreviations : aEEG, BGP, BS−, BS+, BVP, BVP-AO, CHD, CNV, CPB, DNV, EEG, FT, ISI, SAT, SVP, SWC
Plan
| The authors declare no conflicts of interest. |
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| Portions of this study were presented at the Joint European Neonatal Societies (JENS) Meeting in Venice, October 31-November 4, 2017, Venice, Italy and the European Society of Paediatric and Neonatal Intensive Care (ESPNIC) Meeting, June 6-9, 2017, Lisbon, Portugal. |
Vol 202
P. 199 - novembre 2018 Retour au numéro
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