Nathalie H P Claessens1, Lotte Noorlag2, Lauren C Weeke3, Mona C Toet3, Johannes M P J Breur4, Selma O Algra5, Antonius N J Schouten6, Felix Haas7, Floris Groenendaal3, Manon J N L Benders3, Nicolaas J G Jansen8, Linda S de Vries9. 1. Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, The Netherlands; Department of Pediatric Cardiology, Wilhelmina Children's Hospital, Utrecht, The Netherlands; Department of Pediatric Intensive Care, Wilhelmina Children's Hospital, Utrecht, The Netherlands. 2. Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, The Netherlands; Department of Pediatric Neurology, Wilhelmina Children's Hospital, Utrecht, The Netherlands. 3. Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, The Netherlands. 4. Department of Pediatric Cardiology, Wilhelmina Children's Hospital, Utrecht, The Netherlands. 5. Department of Radiology; University Medical Center Utrecht, Utrecht, The Netherlands. 6. Department of Anesthesiology; University Medical Center Utrecht, Utrecht, The Netherlands. 7. Department of Pediatric Cardiothoracic Surgery, Wilhelmina Children's Hospital, Utrecht, The Netherlands. 8. Department of Pediatric Intensive Care, Wilhelmina Children's Hospital, Utrecht, The Netherlands. 9. Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, The Netherlands. Electronic address: l.s.devries@umcutrecht.nl.
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.
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.
Authors: Raymond Stegeman; Maaike Nijman; Nicolaas J G Jansen; Manon J N L Benders; Johannes M P J Breur; Floris Groenendaal; Felix Haas; Jan B Derks; Joppe Nijman; Ingrid M van Beynum; Yannick J H J Taverne; Ad J J C Bogers; Willem A Helbing; Willem P de Boode; Arend F Bos; Rolf M F Berger; Ryan E Accord; Kit C B Roes; G Ardine de Wit Journal: Trials Date: 2022-02-23 Impact factor: 2.279